Prognostic Factors For Outcome Research Articles

Acute perioperative hyperlactatemia in oncoplastic reconstructive surgeries: What is the significance?

Background and Aims:We aim to study the significance of intraoperative hyperlactatemia in reconstructive oncoplastic surgery.Material and Methods:A retrospective observational study was conducted on a cohort of patients who underwent reconstructive oncoplastic surgery with free flap for oral cancer over a 6-month period. The study population was divided into two groups based on peak lactate levels. Group N with peak lactate level less than 2 mmol/L and Group H peak lactate level more than 2 mmol/L. The various parameter studied were patient's comorbidities; intraoperative events (vasopressor requirement, blood transfusion, and duration of surgery); postoperative parameters including the need for re- exploration and duration of stay in hospital and intensive care unit.Results:The study demonstrates that intraoperative rise of lactate was not influenced by comorbidities. None of the intraoperative parameters studied influenced the lactate levels. Baseline lactate level was found to correlate with peak lactate level intraoperatively. But it was observed that there was normalization of lactate level within 24 hours postoperatively in both the groups. There was no difference in outcome parameters in the two groups.Conclusion:Intraoperative hyperlactatemia is not a significant prognostic factor for outcome in oncoplastic reconstructive surgery.

Red Cell Distribution Width (RDW) As Prognostic Factor in Acute Leukemia Patients Undergoing Allogeneic Hematopoietic Transplantation

Background:Red cell distribution width (RDW) is an erythrocyte index influenced by anisocytosis and useful in approaching patient with various types of anemia or suspected myelodysplasia. RDW can predict mortality in sepsis, chronic kidney diseases and cardiovascular disease, RDW has a prognostic value also in patients with breast cancer, lung cancer, glioblastoma, myeloma and chronic lymphocytic leukemia. No data, however, are available on the prognostic value of RDW in patients affected by acute leukemia. We studied prognostic value of RDW-SD assessed at pre-transplant evaluation, in acute leukemia patients who underwent allogeneic transplantation.Methods:We retrospectively studied the prognostic value of RDW-SD in a group of 94 adult acute leukemia patients affected by AML (70) ALL (19) or advanced MDS (5). RDW-SD was measured after patients had received induction and consolidation chemotherapy to achieve maximal anti-leukemic response. A MINDRAY BC6800 automatic cell counter was used. Patients, subsequently, underwent allogeneic transplantation from a sibling or from an alternative donors (MUD or Haplo-identical donors). Median age was 46 years (18-70). Ninths-five percent of patients received a fully myeloablative conditioning. Cytogenetic classification of leukemic cells was available in 95% of AML/MDS patients (72/75). Fifty-four percent of all patients were in an early phase of disease (1st complete remission) while 46% in the advanced phase (2nd CR or active disease). RDW-SD upper normal limit was 55 fL and patients were grouped according to this threshold. Data were analyzed by R software.Results:At baseline, before the transplant, an RDW-SD higher than normal (=/> 56 fL) was observed in 44% of all acute leukemia patients. RDW-SD correlates with MCV (r=0.611, p=0.0001) but not with other hematological parameters present at the time of RDW assessment. A high co-morbidity score (HTC-CI score 2-5) at the pre-transplant screening was a factor significantly associated to high RDW-SD, in fact, 27% of patients having an “RDW-SD over normal” had a comorbidity score of 2-5, while in the group of patients having an “RDW-SD within normal” a comorbidity score 2-5 was observed only in 9% (Chi-square-test p:0.02). The group of patients having an “RDW-SD over normal” had in respect to group “RDW-SD within normal” a higher serum LHD (p: 0.02). An unfavourable cytogenetics was observed in 26% of patients in the group “RDW-SD over normal” versus 8% in the group “RDW within normal” (p=0.10). The two groups of patients were not significantly different in age, gender, diagnosis, phase of the disease, level of WT-1 before transplant, previous transplantation, C-reactive protein, ferritin, creatinine and arterial diastolic pressure. In the whole set of patients, the Overall Survival at 3 y was 45% with a median follow up, for uncensored patients, of 99 weeks. OS at 3 years in the group “RDW within normal” was 61% versus 25% in the group “RDW-SD over normal” (log-rank, p=0-01). Differences in OS between these two groups was present also when patients were stratified according to cytogenetics or phase of disease (Fig 1). In univariate analysis other factors important for OS were phase of disease (p=0.004), graft from an alternative donor (p=0.03) and age (p=0.005). The comorbidity score was not an important factor for OS. In multivariate analysis, using Cox proportional hazard, factors important for OS remained age (HR: 1.040; CI: 1010-1070; P=0.008) and a pre-transplant “RDW-SD over normal ” (HR, 3.274; CI: 1.694-6.328; p=0.0004). The group of patients having an “RDW over normal” had a Relapse Rate (RR) higher than the group having “RDW-SD within normal” (RR: 60% versus 30%, Gray test p= 0.05). Treatment related mortality (TRM) was 14% in the group “RDW within normal” versus 22% in the group “RDW over normal” (Gray test not significant).Conclusions:Abnormal RDW-SD is frequently found in acute leukemia patients treated by chemotherapy and in complete or partial response before allogeneic transplantation, “RDW-SD over normal” at time of pre-transplant screening is an independent negative prognostic factor for outcome after transplantation. The poor OS of the group of patients showing “RDW-SD over normal” is, at least in part, due to a higher relapse rate. The association of “RDW-SD over normal” and adverse cytogenetics deserves further studies. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

The 10-year Survival Analysis of Radiofrequency Ablation for Solitary Hepatocellular Carcinoma 5 cm or Smaller: Primary versus Recurrent HCC.

Background Although favorable outcomes have been reported with radiofrequency ablation (RFA) for limited hepatocellular carcinoma (HCC), the efficacy of this treatment for recurrent HCC has not been thoroughly investigated. Purpose To compare the long-term outcomes and analyze the prognostic factors for outcomes after RFA for initial HCC versus as a second-line treatment for recurrent HCC. Materials and Methods This retrospective study included 560 patients with solitary tumors 5 cm or smaller (263 initial HCCs, 297 -recurrent HCCs) who underwent percutaneous US-guided RFA from January 2005 to December 2016. Of 297 patients with -recurrent HCC, 134 had previously undergone hepatectomy, 128 had undergone transarterial chemoembolization (TACE), and 35 had undergone local ablation therapy. Overall survival (OS) between initial HCC and recurrent HCC was compared before and after propensity score matching. Prognostic factors for all patients were analyzed with the log-rank test and Cox proportional hazards model. Results A total of 560 patients (mean age, 60 years ± 12 [standard deviation]; 441 men) were evaluated. Before matching, the OS rates at 1, 3, 5, and 10 years were 92.6%, 73.9%, 59.3%, and 39.6%, respectively, in patients with recurrent HCC and 92.8%, 75.4%, 63.3%, and 44.7% in patients with initial HCC (P = .27). After matching, the OS rates at 1, 3, 5, and 10 years were 94.8%, 75.7%, 61.6%, and 47.3% in the initial HCC group and 91.9%, 71.2%, 58.7%, and 45.2% in the recurrent HCC group (P = .32). Among patients with recurrent HCC, no significant difference in mean OS was noted for local recurrence versus distant recurrence (81.6 months ± 5.1 vs 83.8 months ± 6.6, P = .82) or previous treatment modality (82.0 months ± 7.3 in the resection group, 82.7 months ± 5.3 in the TACE group, and 79.3 months ± 10.8 in the local ablation group; P = .83). Local tumor progression after previous local ablation (10 of 35 [28.6%]) was higher than that after previous hepatectomy (15 of 134 [11.2%], P = .04). Multivariable analysis demonstrated that tumor size (hazard ratio, 1.58; 95% CI: 1.06, 2.36; P = .02), portal hypertension (hazard ratio, 1.52; 95% CI: 1.03, 2.26; P = .04), Child-Pugh class (hazard ratio, 2.01; 95% CI: 1.02, 3.96; P = .045), and serum α-fetoprotein level (hazard ratio, 1.62; 95% CI: 1.10, 2.39; P = .01) were independent predictive factors for recurrent HCC outcomes. Conclusion Radiofrequency ablation provides similar long-term survival for solitary hepatocellular carcinoma of 5 cm or less, regardless of whether treatment is initial or salvage therapy. © RSNA, 2021 Online supplemental material is available for this article.

MR-proADM as prognostic factor of outcome in COVID-19 patients

Mid Regional pro-ADM (MR-proADM) is a promising novel biomarker in the evaluation of deteriorating patients and an emergent prognosis factor in patients with sepsis, septic shock and organ failure. It can be induced by bacteria, fungi or viruses. We hypothesized that the assessment of MR-proADM, with or without other inflammatory cytokines, as part of a clinical assessment of COVID-19 patients at hospital admission, may assist in identifying those likely to develop severe disease. A pragmatic retrospective analysis was performed on a complete data set from 111 patients admitted to Udine University Hospital, in northern Italy, from 25th March to 15th May 2020, affected by SARS-CoV-2 pneumonia. Clinical scoring systems (SOFA score, WHO disease severity class, SIMEU clinical phenotype), cytokines (IL-6, IL-1b, IL-8, TNF-α), and MR-proADM were measured. Demographic, clinical and outcome data were collected for analysis. At multivariate analysis, high MR-proADM levels were significantly associated with negative outcome (death or orotracheal intubation, IOT), with an odds ratio of 4.284 [1.893–11.413], together with increased neutrophil count (OR = 1.029 [1.011–1.049]) and WHO disease severity class (OR = 7.632 [5.871–19.496]). AUROC analysis showed a good discriminative performance of MR-proADM (AUROC: 0.849 [95% Cl 0.771–0.730]; p < 0.0001). The optimal value of MR-proADM to discriminate combined event of death or IOT is 0.895 nmol/l, with a sensitivity of 0.857 [95% Cl 0.728–0.987] and a specificity of 0.687 [95% Cl 0.587–0.787]. This study shows an association between MR-proADM levels and the severity of COVID-19. The assessment of MR-proADM combined with clinical scoring systems could be of great value in triaging, evaluating possible escalation of therapies, and admission avoidance or inclusion into trials. Larger prospective and controlled studies are needed to confirm these findings.

Reappraisal of the Prognostic Factors of Outcome and Recovery Time in Patients with Idiopathic Bell's Palsy: A Retrospective Single-Center Analysis.

Study Objectives: This retrospective study investigated prognostic factors and recovery time in patients with Bell’s palsy after different doses and durations of oral glucocorticoid treatments. Subjects and Methods: A total of 396 patients initially diagnosed with Bell’s palsy that had visited the Department of Neurology of Chang Gung Memorial Hospital, Taoyuan, a tertiary referral medical center in Taiwan, between January 2014 and December 2018 were included. Medical records, facial electroneurography (fENoG), and blink reflex (BR) tests were reviewed and analyzed. A favorable outcome was defined as patients who improved to grade ≤ II, and an unfavorable outcome was defined as patients who improved to grade ≥ III in 6 months according to the House–Brackmann (HB) grading system. Results: The rate of favorable outcomes was 89.4% (354 of 396 patients) at the 6-month follow-up. A favorable outcome (HB less than grade II) was associated with a delayed BR (odds ratio, OR, 5.38; 95% CI, 1.82 to 15.90) and fENoG values (the lesion side/the healthy side) over 33% (OR, 6.67; 95% CI, 3.02 to 14.71). The recovery time was significantly shorter for those with a delayed BR than for those with an absent BR and shorter for those with good fENoG values (>33%) than for those with poor values (≤33%). However, treatment without or with different doses and durations of oral glucocorticoid did not influence the final outcome or recovery time in this study. Conclusions: The fENoG and BR tests were significant and highly valuable examinations for predicting the final outcome. Moreover, age younger than 60 years, a delayed BR, and fENoG values > 33% were associated with shorter recovery times.

Quantitative Whole-Body Diffusion-weighted MRI after One Treatment Cycle for Aggressive Non-Hodgkin Lymphoma Is an Independent Prognostic Factor of Outcome.

To evaluate the prognostic utility of apparent diffusion coefficient (ADC) changes at whole-body diffusion-weighted (WB-DW) MRI after one treatment cycle for aggressive non-Hodgkin lymphoma (NHL) compared with response assessment at interim and end-of-treatment fluorine 18 (18F) fluorodeoxyglucose (FDG) PET/CT. This was a secondary analysis of a prospective study (ClinicalTrials.gov identifier: NCT01231269) in which participants with aggressive NHL were recruited between March 2011 and April 2015 and underwent WB-DW MRI before and after one cycle of immunochemotherapy. Volunteers were recruited for test-retest WB-DW MRI (ClinicalTrials.gov identifier: NCT01231282) to assess ADC measurement repeatability. Response assessment was based on ADC change after one treatment cycle at WB-DW MRI and Deauville criteria at 18F-FDG PET/CT. To evaluate prognostic factors of disease-free survival (DFS), Kaplan-Meier survival analysis and univariable and multivariable Cox regression were performed; intraclass correlation coefficient (ICC) and mean difference with limits of agreement were calculated to determine inter- and intraobserver repeatability of ADC measurements. Forty-five patients (mean age, 58 years ± 17 [standard deviation]; 31 men) and nine volunteers (mean age, 22 years ± 3; seven men) were enrolled. Median DFS was 48 months (range, 2-48 months). Outcome prediction accuracy was 86.7% (39 of 45), 71.4% (30 of 42), and 73.8% (31 of 42) for WB-DW MRI and interim and end-of-treatment 18F-FDG PET/CT, respectively. WB-DW MRI (hazard ratio [HR], 17.8; P < .001) and interim (HR, 5; P = .008) and end-of-treatment (HR, 4.3; P = .017) 18F-FDG PET/CT were prognostic of DFS. After multivariable analysis, WB-DW MRI remained an independent predictor of outcome (HR, 26.8; P = .002). Intra- and interobserver agreement for ADC measurements were excellent (ICC = 0.85-0.99). Quantitative WB-DW MRI after only one cycle of immunochemotherapy predicts DFS in aggressive NHL and is noninferior to routinely performed interim and end-of-treatment 18F-FDG PET/CT.Keywords: MR-Diffusion Weighted Imaging, Lymphoma, Oncology, Tumor Response, Whole-Body ImagingSupplemental material is available for this article.© RSNA, 2021.

Prognostic role of the duration of response to androgen deprivation therapy in patients with metastatic castration resistant prostate cancer treated with enzalutamide or abiraterone acetate.

Our retrospective study aims to evaluate the prognostic role of duration of response to androgen deprivation therapy (ADT) in metastatic castration resistant prostate cancer (mCRPC) patients treated with enzalutamide (E) or abiraterone acetate (AA). Data about ADT start and duration were available in 255 (82%) of 311 patients treated with AA or E. Patients were divided in three groups according to ADT response (group 1 [G1]: <12 months; group 2 [G2]: 12-36 months; group 3 [G3]: >36 months). Outcome measures were progression-free survival (PFS) and overall survival (OS). Patients with longer ADT response had better OS (median 17.3 months G1, 19.9 months G2, 31.6 months G3; HR G3 vs G1 0.41, 95% CI 0.25-0.64; p = 0.001) and better PFS (median 5.9 months G1, 8.8 months G2, 11.7 months G3; HR G3 vs G1 0.41, 95% CI 0.41-0.27; p < 0001). In docetaxel-naive patients, median OS was 18.8 in G1, 35.2 in G2, and not reached in G3 (HR G3 vs G1 0.33, 95% CI 0.14-0.78; p = 0.038), median PFS was 7 months G1, 9.3 months G2, and 20 months G3 (HR G3 vs G1 0.31, 95% CI 0.15-0.62; p = 0.003). In postdocetaxel patients, median OS was 13.1 months in G1, 17.2 months in G2, and 21.4 months in G3 (HR G3 vs G1 0.52, 95% CI 0.29-0.94; p = 0.082), while median PFS was 5.2 months in G1, 6.8 months in G2, and 8.3 months in G3 (HR G3 vs G1 0.54, 95% CI 0.32-0.91; p = 0.067). Duration of ADT response is an independent prognostic factor of outcome with AA or E.

Abstract PS6-43: The prognostic impact of breast cancer subtype based on hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) statuses for end-stage disease

Abstract Background: Most patients with metastatic cancer request information regarding their prognosis, most notably when death is clearly approaching. Several clinical indices are used to predict the prognosis of end-stage cancer based on performance status and clinical factors. For example, the Palliative Prognostic Index (PPI) includes a range of scores from 0-15 based on factors that include performance status, oral intake, presence of edema, dyspnea at rest, and delirium. For scores greater than six, survival for an additional three weeks was predicted with a sensitivity of 80% and a specificity of 85%. However, the predictive power of these indices is currently insufficient; the quality of life of end-stage breast cancer patients would be markedly improved with a more accurate prediction model. Breast cancer subtypes based on the hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) statuses are important prognostic factors with respect to the outcome of initial breast cancer therapy; the subtype defined by these parameters was also identified as an independent prognostic factor for outcomes in cases of metastatic breast cancer. However, the prognostic impact of breast cancer subtype with respect to end-stage disease remains unclear. In this retrospective observational study, we evaluated the relationship between survival time and associated clinicopathological factors, including breast cancer subtype, in order to develop a more accurate prognostic model for end-stage breast cancer patients. Methods: Seventy-three patients with end-stage breast cancer who were admitted to our hospice care unit from January 2014 to December 2018 were enrolled in the study. Patients in this unit were not provided with anticancer therapy but did receive highest-quality supportive care. The primary endpoint was survival time from the admission. Patient information, including age, PPI, disease-free interval (DFI), the number of treatments for the metastatic disease, metastatic site, and breast cancer subtypes were collected from medical records. Breast cancer subtypes included Luminal (Lum), Lum-HER2, HER2, and triple negative (TN) with respect to those that were HR+HER2−, HR+HER2−, HR−HER2+, and HR−HER2−, respectively. The study was approved by the ethical committee of the Oikawa Hospital (OHCT022). Results: The median survival time was 23 days (1-359 days). From the univariate analysis, PPI scores of less than six were associated with significantly shorter survival (14 days vs. 36.5 days, P = 0.001). Patients diagnosed with Lum-HER2 subtype, those who were older and were without liver metastasis, those with a shorter DFI, and those who underwent fewer treatments for metastatic disease showed a tendency toward a favorable prognosis, although these findings did not reach statistical significance. Multivariate logistic regression analysis revealed that a PPI score less than six (P = 0.001), Lum-HER2 subtype (P = 0.003), absence of liver metastasis (P = 0.001), and DFI lower than the median (33 months; P = 0.028) all contributed to longer survival time. Discussion &amp; Conclusion: In addition to the PPI, breast cancer subtype can be used to provide more precise prognoses for end-stage breast cancer patients. Survival of patients diagnosed with the Lum-HER2 subtype was longer than that observed among those with any of the other subtypes who had not undergone any anticancer treatment for metastatic disease; these results suggest that anti-HER2 therapy may be associated with critical immunological modifications. Taken together, our results indicate that breast cancer subtype should be included to provide a more accurate prognostic model for end-stage breast cancer patients. Citation Format: Masahiro Oikawa, Yumika Setoguchi, Yasuko Enomoto, Kazuhumi Hisamatsu, Tetsuaki Inamitsu, Tatsuji Oikawa. The prognostic impact of breast cancer subtype based on hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) statuses for end-stage disease [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-43.

Prognostic Factors for Functional Outcome of Patients with Optic Nerve Sheath Meningiomas Treated with Stereotactic Radiotherapy-Evaluation of Own and Meta-Analysis of Published Data.

Simple SummaryThis article highlights the fractionated stereotactic radiotherapy in the treatment of optic nerve sheath meningioma (ONSM). ONSM, a slow-growing tumor next to the optic nerve, causes over a long period partial or complete blindness. As visual impairments appear and progress slowly in the disease history, the need for treatment and treatment starting time are controversial. We restate in our article that fractionated stereotactic radiotherapy improves visual function. We further search for prognostic factors which might provide valuable additional and independent information on when to start treatment. We reveal that the visual acuity is a prognostic factor for the outcome of stereotactic therapy for ONSM and promote it as a biomarker for the decision for treatment initiation.Objective: To evaluate prognostic factors for a favorable outcome (improvement of the visual acuity or visual fields) after fractionated stereotactic radiotherapy (fSRT) of optic nerve sheath meningioma (ONSM). Methods: We performed a database search for ONSM treatments during the period from April 2008 to September 2019 in the prospective database for stereotactic radiosurgery/radiotherapy (SRS/SRT) of the Robert Janker Clinic Bonn (Department of Radiotherapy) and performed a literature review and meta-analysis of published data on ONSM between 2010 and 2019. Ophthalmic status before and after treatment was evaluated and the collective was dichotomized into two groups: functional improvement (FI; improvement of either visual acuity or visual fields) and non functional improvement (NFI; with stable or deteriorating visual acuity or visual fields). The two groups were compared regarding different variables: pretreatment visual acuity, age, gender, gross tumor volume (GTV), follow up (FU) time, tumor localization, and maximal retina dose. Results: Overall, 13 stereotactic radiotherapies were performed for ONSM (12 × fSRT, 1 × SRS). Mean follow up was 3 years (range: 1–5 years). The total dose was 50.4 Gy (5 × 1.8 Gy/week) in 12 patients treated with fSRT and 1 × 14 Gy in one SRS case. Mean GTV was 1.13 ccm (range: 0.44–2.20 ccm). During follow up, all tumors were stable or showed shrinkage of tumor volume (100% tumor control), no adverse events were observed, 53% of the patients achieved either better visual acuity or visual fields. Pretreatment visual acuity was significantly different between the FI and the NFI group (0.17 vs. 0.63, p = 0.03) in our series and in the meta analysis (p < 0.01). Moreover, shorter FU time and lower retinal dose were significantly linked (p < 0.05 and p < 0.01, respectively) with a better outcome in the meta-analysis but not in our patient cohort. Intracranial tumor localization, gender, and age were not significantly different between the two outcome groups. Conclusion: FSRT for ONSM achieves in over 50% of cases an improvement of the ophthalmic status with low morbidity and excellent tumor control in our series and the meta analysis. Patients with a favorable outcome had in all analysis a significantly higher visual acuity before treatment start. Therefore, we advocate using fSRT as early as possible before vision deterioration occurs.

The role of 18F-FDG PET/CT metabolic parameters in pediatric lymphoblastic lymphoma

ObjectiveThis retrospective study aimed to evaluate the role of metabolic parameters of 18F-FDG PET/CT in pediatric lymphoblastic lymphoma (LBL). MethodsThirty patients with LBL underwent 42 scans. Metabolic parameters including maximum standardized uptake value (SUVmax), total metabolic tumor volume (TMTV), and total lesion glycolysis (TLG) were measured at baseline PET/CT. Univariate and multivariate analysis for survival were performed to assess their prognostic value. Twelve patients underwent PET/CT after reinduction regime, and the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET/CT for predicting relapse were calculated. ResultsPatients with stage Ⅳ had a higher TMTV than those with stage III (p = 0.031). Besides, patients with T-LBL or mediastinal involvement had a high TMTV and TLG (p < 0.05). There was no significant difference in PET/CT metabolic parameters between patients with different outcomes (p > 0.05). Children with a low TMTV (<242.91 cm³) had a better 3-year EFS compared with those with a high TMTV (88.9% vs. 56.3%; p = 0.036). SUVmax and TLG were not predictive of EFS (p = 0.874; p = 0.152). However, none of the metabolic parameters of baseline PET/CT were independent prognostic factors for outcomes of pediatric LBL. PET/CT underwent after reinduction regime present with higher sensitivity (50% vs. 0%) and NPV (90% vs. 83.3%) for predicting relapse than CT alone. ConclusionsMetabolic parameters of baseline PET/CT were not predictive of outcomes in children with LBL. PET/CT done after the reinduction regime had better sensitivity and NPV than CT alone, and a negative scan could be a reliable indicator for sustained remission.

Risk factors of regional lymph node (RLN) metastasis among patients with bone sarcoma and survival of patients with RLN-positive bone sarcoma.

BackgroundRegional lymph node metastasis (RLNM) has been reported to be a prognostic factor for poor survival outcomes of bone sarcoma. However, studies about risk factors for RLNM of bone sarcoma are extremely rare, and the outcome of such patients remains to be explored. We aimed to identify risk factors for RLNM of bone sarcoma and conduct survival analysis for patients with bone sarcoma with RLNM.MethodsA total of 10,641 patients confirmed of malignant bone sarcomas from 1983 to 2014 were identified from the Surveillance, Epidemiology, and End Results (SEER) database, with 311 being regional lymph node positive. Logistic regression analysis was used to identify risk factors for RLNM, while the Cox proportional hazards model and the Fine and Gray’s regression model were used for survival analysis.ResultsThe proportion of RLNM was 6.0% in Ewing sarcoma, 2.5% in osteosarcoma and 1.1% in chondrosarcoma. Other bone tumors together had a RLNM rate of 4.2%. Risk factors identified by the logistic regression analysis for RLNM were male patients, primary tumor site, tumor type and size. The multivariate Cox regression analysis suggested age, race, distant metastasis, tumor type and surgical treatment to be prognostic factors for the overall survival of patients with RLNM. Taking non-cancer-specific death as a competing risk, however, we found only age between 30–60 years [sub-distribution hazard ratio (SHR), 1.528, 95% CI, 1.028–2.271; P=0.02], distant metastasis (SHR, 2.418, 95% CI, 1.682–3.474; P<0.001) and surgery treatment (SHR, 0.493, 95% CI, 0.339–0.718; P<0.001) remained significant for the cancer-specific survival in the Fine and Gray’s regression model.ConclusionsPredictive factors for RLNM of bone sarcoma are sex, tumor site, type and size. In the presence of RKNM, only age, distant metastasis and surgery treatment are prognostic factors for the outcome of patients with bone sarcoma.

Mortality rate and prognostic factors for poor outcome in HIV-infected Bulgarian patients with Pneumocystis pneumonia over a 3-year period

Background: In spite of the use of combination antiretroviral therapy and specific prophylaxis, Pneumocystis pneumonia remains one of the most common AIDS-defining disease with high mortality rate. The aim of this study is to analyze the cases of pneumocystis pneumonia over a three-year period by means of assessing the mortality rate and the prognostic factors for the outcome of the disease. Material and methods: Epidemiological, clinical, laboratory and demographic data were analyzed for 13 HIV-infected patients with proved pneumocystis pneumonia, hospitalized at the AIDS Department over the period January 2017–December 2019. For data processing we used different methods of descriptive statistics. Results: All presented patients have extremely severe immune deficiency and other opportunistic infections or AIDS-related diseases. The diagnosis of pneumocystis pneumonia was confirmed with PCR in 76.9% of the patients and with Giemsa staining for cysts and trophozoites in 23,1% of the patients. Most of our patients are male (84,6%) and the leading mechanism of HIV infection is unprotected homosexual contact. The mean age of the patients presented is 37.4 ± 10.27. Our results showed high PJP mortality (46.3 %), despite the applied etiological therapy. Conclusions: Pneumocystis jirovecii pneumonia (PJP) continues to be a life-threatening infection in HIV-infected patients with severe immune suppression. PJP mortality continues to be high, and there is a statistically significant dependence on age, male sex, low CD 4 T+ cell count, high viral load of HIV, low blood albumin, and the number and severity of comorbidities.

Prognostic factors for survival in children who relapsed after allogeneic hematopoietic stem cell transplantation for acute leukemia.

Post-transplant relapse has a dismal prognosis in children with acute leukemia undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). Data on risk factors, treatment options, and outcomes are limited. In this retrospective multicenter study in which a questionnaire was sent to all pediatric transplant centers reporting relapse after allo-HSCT for a cohort of 938 children with acute leukemia, we analyzed 255 children with relapse of acute leukemia after their first allo-HSCT. The median interval from transplantation to relapse was 180days, and the median follow-up from relapse to the last follow-up was 1844days. The 3-year overall survival (OS) rate was 12.0%. The main cause of death was disease progression or subsequent relapse (82.6%). The majority of children received salvage treatment with curative intent without a second HSCT (67.8%), 22.0% of children underwent a second allo-HSCT, and 10.2% received palliative therapy. Isolated extramedullary relapse (hazard ratio (HR): 0.607, P=.011) and relapse earlier than 365days post-transplantation (HR: 2.101, P<.001 for 0-180days; HR: 1.522, P=.041 for 181-365days) were found in multivariate analysis to be significant prognostic factors for outcome. The type of salvage therapy in chemosensitive relapse was identified as a significant prognostic factor for OS. A salvage approach with curative intent may be considered for patients with post-transplant relapse, even if they relapse in the first year post-transplantation. For sustainable remission, a second allo-HSCT may be recommended for patients who achieve complete remission after reinduction treatment.

In Epilepsy Surgery, Pathology Matters, and Lesions Need to Go.

Seizure Outcome and Use of Antiepileptic Drugs After Epilepsy Surgery According to Histopathological Diagnosis: A Retrospective Multicenter Cohort Study Lamberink HJ, Otte WM, Blümcke I, et al; European Epilepsy Brain Bank writing group; study group; European Reference Network EpiCARE. Lancet Neurol. 2020;19(9):748-757. doi:10.1016/s1474-4422(20)30220-9Background:Surgery is a widely accepted treatment option for drug-resistant focal epilepsy. A detailed analysis of longitudinal postoperative seizure outcomes and use of antiepileptic drugs for different brain lesions causing epilepsy is not available. We aimed to analyze the association between histopathology and seizure outcome and drug freedom up to 5 years after epilepsy surgery, to improve presurgical decision-making and counselling.Methods:In this retrospective, multicenter, longitudinal, cohort study, patients who had epilepsy surgery between January 1, 2000, and December 31, 2012, at 37 collaborating tertiary referral centers across 18 European countries of the European Epilepsy Brain Bank consortium were assessed. We included patients of all ages with histopathology available after epilepsy surgery. Histopathological diagnoses and a minimal data set of clinical variables were collected from existing local databases and patient records. The primary outcomes were freedom from disabling seizures (Engel class 1) and drug freedom at 1, 2, and 5 years after surgery. Proportions of individuals who were Engel class 1 and drug-free were reported for the 11 main categories of histopathological diagnosis. We analyzed the association between histopathology, duration of epilepsy, and age at surgery, and the primary outcomes using random effects multivariable logistic regression to control for confounding.Findings:A total of 9147 patients were included, of whom seizure outcomes were available for 8191 (89.5%) participants at 2 years, and for 5577 (61.0%) at 5 years. The diagnoses of low-grade epilepsy-associated neuroepithelial tumor (LEAT), vascular malformation, and hippocampal sclerosis had the best seizure outcome at 2 years after surgery, with 77.5% (1027 of 1325) of patients free from disabling seizures for LEAT, 74.0% (328 of 443) for vascular malformation, and 71.5% (2108 of 2948) for hippocampal sclerosis. The worst seizure outcomes at 2 years were seen for patients with focal cortical dysplasia type I or mild malformation of cortical development (50.0%, 213 of 426 free from disabling seizures), those with malformation of cortical development-other (52.3%, 212 of 405 free from disabling seizures), and for those with no histopathological lesion (53.5%, 396 of 740 free from disabling seizures). The proportion of patients being both Engel class 1 and drug-free was 0% to 14% at 1 year and increased to 14% to 51% at 5 years. Children were more often drug-free; temporal lobe surgeries had the best seizure outcomes; and a longer duration of epilepsy was associated with reduced chance of favorable seizure outcomes and drug freedom. This effect of duration was evident for all lesions, except for hippocampal sclerosis.Interpretation:Histopathological diagnosis, age at surgery, and duration of epilepsy are important prognostic factors for outcomes of epilepsy surgery. In every patient with refractory focal epilepsy presumed to be lesional, evaluation for surgery should be considered.

Comparison between dispatcher-assisted bystander CPR and self-led bystander CPR in out-of-hospital cardiac arrest (OHCA)

IntroductionBystander cardiopulmonary resuscitation (CPR) is an important prognostic factor for outcome in out-of-hospital cardiac arrest (OHCA). The dispatcher-assisted (DA) bystander CPR program has increased the rate of bystander CPR by targeting bystanders with a lower level of CPR training. We evaluated the effects of dispatcher-assisted bystander CPR and self-led bystander CPR. MethodsA retrospective analysis was performed using a nationwide OHCA database from 2014 to 2018. Adult EMS-treated OHCA patients with presumed cardiac origin were enrolled. OHCAs were classified into 3 groups according to the type of bystander CPR (DA bystander CPR vs. self-led bystander CPR vs. no bystander CPR) provided. The primary outcome was good neurologic recovery at hospital discharge. A multivariable logistic regression model was used to estimate the association between the type of bystander CPR and outcomes. ResultsA total of 91,557 eligible OHCA patients was enrolled in the final analysis. The proportion of patients with favorable neurologic outcomes was highest with self-led bystander CPR (9.0% for self-led bystander CPR, 5.2% for DA bystander CPR and 3.2% for no bystander CPR, p < 0.01). Self-led bystander CPR was associated with better neurological recovery than DA bystander CPR (aOR with 95% CI (DA-CPR as reference): 0.63 (0.58−0.69) for no bystander CPR, 1.28 (1.17–1.40) for self-led bystander CPR). ConclusionAlthough DA CPR was associated with better neurologic outcomes than no bystander CPR, good neurologic outcomes were most strongly associated with self-led bystander CPR.

Prognostic Factors For Outcome, For A Phase I Prospective Trial Evaluating A Novel Alpha-Emitting Radionuclide For The Treatment Of Locally Advanced Recurrent Squamous Cell Carcinomas Of The Skin And Head And Neck

Prognostic Factors For Outcome, For A Phase I Prospective Trial Evaluating A Novel Alpha-Emitting Radionuclide For The Treatment Of Locally Advanced Recurrent Squamous Cell Carcinomas Of The Skin And Head And Neck

Non-idiopathic peripheral facial palsy: prognostic factors for outcome

ObjectivesThere is a lack of data on patients’ and diagnostic factors for prognostication of complete recovery in patients with non-idiopathic peripheral facial palsy (FP).MethodsCohort register-based study of 264 patients with non-idiopathic peripheral FP and uniform diagnostics and standardized treatment in a university hospital from 2007 to 2017 (47% female, median age: 57 years). Clinical data, facial grading, electrodiagnostics, motor function tests, non-motor function tests, and onset of prednisolone therapy were assessed for their impact on the probability of complete recovery using univariable and multivariable statistics.ResultsThe most frequent reason for a non-idiopathic peripheral FP was a reactivation of Varicella Zoster Virus (VZV; 36.4%). Traumatic origin had a higher proportion of complete FP (52.9%). Furthermore, in traumatic FP, the mean interval between onset and start of prednisolone therapy was longer than in other cases (5.6 ± 6.2 days). Patients with reactivation of VZV, Lyme disease or otogenic FP had a significant higher recovery rate (p = 0.002, p < 0.0001, p = 0.018, respectively), whereas patients with post-surgery FP and other reasons had a significant lower recovery rate (p < 0.0001). After multivariate analyses voluntary activity in first EMG, Lyme disease and post-surgery cause were identified as independent diagnostic and prognostic factors on the probability of complete recovery (all p < 0.05).ConclusionInfectious causes for non-idiopathic FP like VZV reactivation and Lyme disease had best probability for complete recovery. Post-surgery FP had a worse prognosis.Level of evidence2

Prognosis of Intravascular Large B Cell Lymphoma (IVLBCL): Analysis of 182 Patients from Global Case Series.

PurposeThis study provides an overview of the prognosis of intravascular large B cell lymphoma (IVLBCL) over the past 10 years and analyzes the possible relevant factors.Patients and MethodsWe conducted a literature search of case reports, case series, and retrospective studies of IVLBCL published from January 2008 to July 2018. After excluding inappropriate data, 103 publications were selected for the analysis. Statistical analyses of different treatment modalities, the effect of blood–brain barrier (BBB)-penetrating drugs, and prognostic factors for outcomes were performed.ResultsIn total, 182 pathologically confirmed cases of IVLBCL were included in our study. The results revealed that the 1- and 3-year overall survival rates were 42.3 and 11.5%, respectively, whereas the median overall survival was 340 days. Overall survival (450 days vs 180 days) and progression-free survival (420 days vs 150 days) were significantly longer in patients who received rituximab-containing regimens than in those treated with other regimens. For IVLBCL involving the CNS, regimens containing BBB-penetrating drugs failed to provide an additional survival benefit. In addition, lactic dehydrogenase levels ≥700 U/L, CNS involvement, and hemophagocytic syndrome were identified as unfavorable risk factors in patients with IVLBCL, whereas skin involvement appeared to be a protective factor.ConclusionRituximab-containing chemotherapy can improve the outcomes of patients with IVLBCL, but the prognosis remains unsatisfactory. Treatment regimens containing BBB-penetrating drugs failed to improve outcomes in patients with CNS-involved IVLBCL. Several factors affect the prognosis of patients with IVLBCL, and further research on the underlying mechanisms is needed.

Variability in multimodality treatment influences survival in non-metastatic gastric cancer patients.

While gastric cancer is a leading cause of cancer-related mortality in Eastern Europe and Asia, it is less common in the USA. Recommendations regarding optimal treatment of non-metastatic gastric cancer (nmGC) with regard to type and extent of surgery, choice and sequence of chemotherapeutic agents, and use of radiation therapy vary across geographic locations. To determine how variability in treatment practices affects patient outcomes, we conducted a retrospective study to evaluate clinical outcomes in nmGC patients treated at four high-volume academic institutions. California Cancer Registry data were collected for nmGC patients who underwent gastrectomy with curative intent from 2010 to 2018. We conducted chart reviews of the patients' electronic health records to validate clinical factors and outcomes. We performed multivariable Cox regressions to determine prognostic factors for outcomes. Demographics of study cohort (n=326): mean age 66 years; 64% male; 44% Caucasian, 35% Asian, 16% Latino. Tumor stage: 48% loco-regional (pT4 or pN1+) vs. 52% localized (pT1-3, pN0). Histology: 47% intestinal, 30% diffuse, 8% mixed, 15% unknown. Surgery: 34% open gastrectomy, 48% laparoscopic, 18% unknown; number of recovered lymph nodes varied from 0 to 60 in any tumor stage. Chemotherapy: 20% neoadjuvant alone, 25% adjuvant alone, 16% perioperative, 39% none. Multimodality therapy: 44% surgery only, 31% chemotherapy, 25% chemotherapy and radiation. With a median post-surgical follow-up of 6 years, 24% of patients developed recurrence and 40% had died. Compared to open surgery, laparoscopic surgeries were associated with fewer recovered lymph nodes (mean =18 vs. 25, P=0.0042). Fewer recovered lymph nodes were associated with a significant decrease in 5-year overall survival [hazard ratio (HR) =1.9, 95% confidence interval (CI): 1.3-2.8]. Timing of chemotherapy and addition of radiation therapy to chemotherapy did not confer further improvements in survival; in contrast, greater lymph node recovery plus chemotherapy were associated with a significant increase in survival (HR =0.3, 95% CI: 0.1-0.6). This study highlights major practice differences in the management of nmGC patients across providers and institutions. Further efforts should be made to standardize the use of chemotherapy and adequate recovery and assessment of lymph nodes in this patient population.

Prognostic Factors of Outcome in Methanol Poisoning; an 8-year Retrospective Cross-sectional Study.

Identification of high-risk patients with poor prognosis is essential for quick diagnosis and treatment of methanol poisoning to prevent death and improve the outcome. The aim of this study was to evaluate the clinical and laboratory factors in patients with methanol poisoning to determine the prognosis and outcome. In this retrospective cross-sectional study, all patients with methanol poisoning, who had presented to the emergency department of Tohid Hospital, Sanandaj, Iran from 2011 to 2019 (8 years) were enrolled using census method. Multivariate logistic regression analysis was performed to find the independent predictive factors of poor outcome in the mentioned patients. Methanol poisoning was diagnosed in 52 (11.55%) of the 450 cases admitted to hospital for alcohol intoxication. In multivariate analysis, time interval from methanol intake to hospital admission (OR=1.06; 95% CI= 1.00-1.11; p=0.04), respiratory arrest (OR=25.59; 95% CI= 1.37-478.13; p=0.03), and higher concentration of blood glucose (OR=1.03; 95% CI= 1.00-1.09; p=0.03) had a significant correlation with Poor outcomes. Based on the findings of this study, delayed admission to hospital, respiratory arrest and hyperglycemia were identified as independent risk factors of poor outcome in methanol poisoning.