Multicenter Retrospective Cohort Study Research Articles

Reduced functional independence and multimorbidity increases the risk of severe infection among older patients with Omicron: a multicenter retrospective cohort study

Reduced functional independence and multimorbidity increases the risk of severe infection among older patients with Omicron: a multicenter retrospective cohort study

Outcomes of type A aortic dissection in Australia.

Without surgical intervention, type A aortic dissection (TAAD) carries a high risk of life-threatening complications and mortality. Due to the low incidence of aortic dissection, case numbers vary significantly between institutions. This study reports outcomes for patients undergoing surgical TAAD repair in Australia between 2001 and 2021, and the impact of institution case numbers on mortality. Retrospective multicentre cohort study using the Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) data, including consecutive adult patients undergoing surgery for TAAD. Patients were divided into groups based on 30-day mortality. Secondary morbidity outcomes are reported. Between 2001 and 2021, 2604 patients (median age 65; 67% male) underwent operative intervention for TAAD. Over this period, the number of aortic dissections recorded in the database annually increased (from <50 to >200 cases per year), consistent with the increasing number of contributing institutions. Thirty-day mortality rates varied by unit from 0% to 100%, with an average over the period of 18%. Despite unit case numbers ranging from 1 or 2 to over 200 cases, funnel plot analysis demonstrated no units fell outside the accepted 99.7% control level for 30-day mortality. Individual surgeons showed decreased mortality with increased caseload. Non-survivors were more likely to have prior respiratory or cerebrovascular disease, previous myocardial infarction, or severe left ventricular dysfunction. Post-operative stroke, return to theatre for bleeding, renal failure and atrial fibrillation were more common in the non-survivors (P < 0.05). Mortality outcomes for TAAD in Australia have improved over time, stabilizing at 18% over the last 5 years. Units performing fewer operations for TAAD showed equivalent mortality outcomes to high volume units, while surgeons performing fewer procedures displayed a higher mortality.

Predicting futile outcomes following deceased donor liver transplantation in non-Hcc patients with MELD-Na score above 30: a retrospective international multicenter cohort study.

In the current "sickest first" allocation policy for limited deceased liver grafts, identifying patients "too sick to transplant" before transplantation is crucial to optimize outcomes. This study aimed to predict futile outcomes following deceased donor liver transplantation (DDLT) in patients with Model for End-Stage Liver Disease-Sodium (MELD-Na) scores ≥30. This international multicenter study was conducted as part of the International Society of Liver Surgeons. We collected data from patients with a MELD-Na score ≥30 who underwent DDLT. A total of 994 patients were enrolled between 2010-2021, including 654 from the Republic of Korea, 224 from the US, and 116 from other regions. Futility was defined as death within three months or during the hospital stay following a DDLT. After exclusion, 160 (16.6%) patients were classified into a futile group and 803 (83.4%) into a non-futile group. The MELD-Na scores collected at three time points (listing, matching, and transplantation) were comparable between the groups (P=0.442, P=0.180, and P=0.554, respectively). Regarding concomitant organ failure factors, the futile group showed a higher incidence of organ dysfunction across all measured parameters, including the use of mechanical ventilators, continuous renal replacement therapy (CRRT), pneumonia, bacteremia, and vasopressor use (all P<0.01). Independent risk factors for futile outcome were recipient age (≥65years), body mass index (<18.5kg/m2), mechanical ventilator use, CRRT (≥1week), and prolonged ICU stay before transplantation (≥2weeks). The futility rate was 53.3% in patients with ≥3 risk factors (P<0.001). We developed a nomogram to predict futility after DDLT based on multivariate regression analysis, which showed a better predictive power than previous models. The risk factors and new nomogram, which adequately reflect concomitant organ failure before liver transplantation, could effectively predict the risk of futile outcomes after DDLT and contribute to decision-making regarding transplantation eligibility in clinical practice.

Epidemiological Investigation of Unplanned Intensive Care Unit Admissions From the Operating Room After Elective Surgery: A Nationwide Observational Study in Japan.

Over 75% of surgeries worldwide are elective and unplanned ICU admissions after these surgeries pose a major-albeit rare-challenge. However, few epidemiological studies have focused on patients requiring unplanned ICU admission directly from the operating room after elective surgeries are lacking. This study uses the Japanese Intensive Care Patient Database (JIPAD) to describe unplanned ICU admissions after elective surgeries. We conducted a multicenter retrospective cohort study using data from the JIPAD from April 2015 to March 2022, focusing on patients with unplanned ICU admissions after elective surgery. Collected variables included patient characteristics, treatments, outcomes, reasons for ICU admission, and type of surgery. We categorized the reasons for ICU admission into 9 types: anaphylaxis, hemorrhage, anesthesia-related complications, respiratory-related complications, cardiovascular-related complications, neurological-related complications, surgical-related complications, electrolyte/acid-base abnormalities, and unknown causes. The type of surgery was classified using JIPAD definitions. Among 141,969 patients in the JIPAD who underwent elective surgery, 2666 patients (1.9%) required an unplanned ICU admission. Cardiac arrest before ICU admission occurred in 52 patients (2.0%), the median APACHE III score was 51, and 1218 patients (45.7%) required postoperative mechanical ventilation. The median hospital stay for patients with unplanned ICU admission was 21 days and in-hospital mortality was 3.3% (88/2666). The most common reason for ICU admission was respiratory complications (n = 440, 16.5%), followed by hemorrhage (n = 377, 14.1%). Cardiovascular-related complications had the highest in-hospital mortality at 6.8% (20/294). Hospital mortality exceeded ICU mortality, suggesting that patients expected to derive limited benefit from intensive care may have been transitioned out of the ICU to accommodate other patients with greater need. The most frequent surgeries requiring unplanned ICU admission were for gastrointestinal neoplasms (n = 464, 17.4%), followed by orthopedic surgeries (n = 303, 11.4%). Anaphylaxis occurred across a broad spectrum of surgeries. Respiratory-related complications were common in patients with other respiratory diseases and accounted for over half of the total number of cases according to surgery type. Neurological-related complications were most frequent in craniotomies for neoplasms. In our review of a nationwide ICU database from 2015 to 2022 we identified a 1.9% rate of unplanned ICU admission and found that mortality varied according to the reasons for ICU admission. Respiratory-related complications were most common, and cardiovascular complications were most associated with in-hospital mortality. Further research may help us to better understand the epidemiology of unplanned ICU admission after surgery.

Lenvatinib and tislelizumab versus atezolizumab and bevacizumab in combination with TAE-HAIC for unresectable hepatocellular carcinoma with high tumor burden: a multicenter retrospective cohort study

BackgroundSystemic and locoregional combination therapy has demonstrated promising outcomes for unresectable hepatocellular carcinoma (HCC); However, the best combination option remains unknown. This study compared the efficacy and safety of lenvatinib and tislelizumab versus atezolizumab and bevacizumab in combination with transarterial embolization (TAE) plus hepatic artery infusion chemotherapy (HAIC) for unresectable HCC with high tumor burden.MethodsThis multicenter retrospective cohort study enrolled treatment-naive patients with unresectable HCC treated with TAE-HAIC plus lenvatinib and tislelizumab (THLP group) or TAE-HAIC plus atezolizumab and bevacizumab (THTA group). The primary endpoint was overall survival (OS). Secondary endpoints included progression-free survival (PFS), tumor response, and adverse events (AEs). Propensity score matching (PSM) was performed to reduce bias.ResultsOf the 240 patients enrolled, 153 and 51 patients were assigned to the THLP and THTA groups, respectively after PSM (3:1). The THLP group showed a longer median OS (22 months vs. 18.2 months; P = 0.412), whereas the median PFS was longer in the THTA group (8.1 months vs. 7 months; P = 0.723), with statistically insignificant intergroup differences. No statistical differences were observed in objective response rate (RECIST 1.1: 33.9 vs. 31.4%; mRECIST: 77.1% vs. 74.5%; P = 0.635), disease control rate (RECIST 1.1: 88.9% vs. 92.2; mRECIST: 92.2% vs. 94.1%; P = 0.716), and in grade 3/4 AEs. Gastrointestinal hemorrhage rate was significantly higher in the THTA group (9.1% vs. 1.6%; P = 0.007). All AEs were controllable and no treatment-related grade 5 AEs occurred.ConclusionsTAE-HAIC plus lenvatinib and tislelizumab or TAE-HAIC plus atezolizumab and bevacizumab showed similar outcomes for unresectable HCC with high tumor burden, and manageable safety. The results need further validation.

The impact of quantitative platform on candidacy for bronchoscopic lung volume reduction: a multi-center retrospective cohort study.

Bronchoscopic lung volume reduction (BLVR) can be an effective treatment for highly selected patients with severe emphysema but only half of carefully selected patients derive clinical benefit. Two commercially available platforms exist to help determine candidacy for BLVR via quantitative analysis of computed tomography (CT) scans. To determine if the two commercially available quantitative platforms identified the same patient population that may benefit from BLVR. A multicenter, retrospective cohort study. Consecutive patients referred for BLVR between January 1, 2022 and March 31, 2023 at three medical centers in the United States with the same CT scan submitted for quantitative analysis to two commercially available platforms to determine BLVR candidacy were analyzed. The primary outcome of interest was whether quantitative analysis provided different recommendations for individual patients. The recommendation to proceed with BLVR was based on a prespecified algorithm using criteria established in clinical trials for each quantitative platform, respectively. A total of 83 patients referred for BLVR across three centers were included; patients were a median 67 years old, had a median post bronchodilator FEV1 of 30% predicted (IQR: 25, 38), a median residual volume of 220% predicted (IQR: 185, 268), and 29 (34.9%) received endobronchial valves. A total of 26 patients (31.3%) received different recommendations from the two quantitative platforms. In this cohort of patients evaluated for BLVR across multiple medical centers, nearly a third of patients received different recommendations based on the platform utilized for valve assessment. This suggests that the selection process for BLVR may warrant refinement.

Short- and long-term outcomes of conversion surgery for initially unresectable advanced gastric cancer: A Japanese multicenter retrospective cohort study.

402 Background: The efficacy of conversion surgery in patients with unresectable advanced gastric cancer at the initial diagnosis who converted to be resectable due to remarkable response to chemotherapy is unclear. To evaluate short- and long-term outcomes of conversion surgery for initially unresectable cStage IVB/pStage IV gastric cancer as the basic data for the JCOG2301 trial, which is a randomized controlled trial comparing conversion surgery with continuation of chemotherapy, a multicenter retrospective cohort study was conducted in the Stomach Cancer Study Group of the Japan Clinical Oncology Group. Methods: Inclusion criteria were as follows; (1)gastric cancer with at least one of following distant metastasis at the initial diagnosis; (i) peritoneal metastasis (PER) diagnosed by imaging examination or P1b or P1c disease diagnosed by laparoscopy or laparotomy, (ii) multiple liver metastasis (HEP) more than three lesions, and (iii) distant lymph node metastasis (LYM) beyond paraaortic lymph node station 16a2/b1, (2) conversion to be resectable after systemic chemotherapy, (3) surgery aiming at an R0 resection of the primary and remaining lesions between April 2010 and September 2017. Clinical data were retrospectively obtained from electronic patient records of 58 institutions. Results: Atotal of 241 patients were included to the study. Initial unresectable factors were PER, HEP, and LYM in 132(55%), 37(15%), and 63(26%) patients, respectively, and 9(4%) patients had two or more factors. Conversion to be resectable obtained during the first and second/later line chemotherapy was in 209 (87%) patients and 32 (13%), respectively. 182(76%), 29(12%), and 30(12%) patients underwent R0, R1, and R2 resection, respectively. The incidence of postoperative complication of Clavien-Dindo Grade II or higher was 24% and no surgery-related death was observed. The median overall survival (mOS) from surgery was 45.4 (95%CI 30.9-61.4) months in R0 resection, 16.6 (11.5-18.5) months in R1, and 20.9 (11.3-35.6) months in R2. In case of R0 resection, the mOS from surgery was 34.4 (95%CI 26.5-59.2) months in PER, 55.9 (21.8-96.7) months in HEP, 54.6 (30.9-98.3) months in LYM, and not reached (19.7-NA) in two or more factors. Conclusions: Conversion surgery appears to be safe and a promising treatment strategy for patients who have initially unresectable advanced gastric cancer and presented remarkable response to systemic chemotherapy.

Female Sex is associated with reduced thrombolytic administration in an Australian Stroke Cohort: A multicentre retrospective cohort study

Female Sex is associated with reduced thrombolytic administration in an Australian Stroke Cohort: A multicentre retrospective cohort study

Psychological health status after major trauma across different levels of trauma care: A multicentre secondary analysis.

Concentration of trauma care in trauma network has resulted in different trauma populations across designated levels of trauma care. Describing psychological health status, by means of the impact event scale (IES) and the hospital anxiety and depression scale (HADS), of major trauma patients one and two years post-trauma across different levels of trauma care in trauma networks. A multicentre retrospective cohort study was conducted. aged ≥ 18 and an Injury Severity Score (ISS) > 15, surviving their injuries one year after trauma. Psychological health status was self-reported with HADS and IES. Subgroup analysis, univariate, and multivariable analysis were done on level of trauma care and trauma region for HADS and IES as outcome measures. Psychological health issues were frequently reported (likely depressed n = 31, 14.7 %); likely anxious n = 32, 15.2 %; indication of a post-traumatic stress disorder n = 46, 18.0 %). Respondents admitted to a level I trauma centre reported more symptoms of anxiety (3, P25-P75 1-6 vs. 5, P25-P75 2-9, p = 0.002), depression (2, P25-P75 1-5 vs. 5, P25-P75 2-9, p < 0.001), and post-traumatic stress (6, P25-P75 0-15 vs. 13, P25-P75 3-33, p = 0.001), than patients admitted to a non-level I trauma centre. Differences across trauma regions were reported for depression (3, P25-P75 1-6 vs. 4, P25-P75 2-10, p = 0.030) and post-traumatic stress (7, P25-P75 0-18 vs. 15, P25-P75 4-34, p < 0.001). Major trauma patients admitted to a level I trauma centre have more depressive, anxious, and post-traumatic stress symptoms than when admitted to a non-level I trauma centre. These symptoms differed across trauma regions, indicating populations differences. Level of trauma care and trauma region are important when analysing psychological health status.

Development and validation of a deep learning–based pathomics signature for prognosis and chemotherapy benefits in colorectal cancer: A retrospective multicenter cohort study.

298 Background: The current TNM staging system fails to provide adequate information for prognosis and adjuvant chemotherapy benefits in colorectal cancer (CRC). Pathomics, an emerging field, shows promise in improving prognosis estimation and decision-making. In this study, we developed and validated a pathomics signature (PS CRC ) that directly analyzes hematoxylin and eosin–stained slides using deep learning to predict outcomes. Methods: A total of 883 whole slide images from two cohorts, Harbin Medical University Cancer Hospital and The Cancer Genome Atlas (TCGA), were retrospectively analyzed. An interpretable, multi-instance deep learning model was proposed to establish the PS CRC . Shapley additive explanations were employed to interpret the model's decisions, and gradient-weighted class activation mapping was applied to visualise the pathological phenotypes of the PS CRC . The transcriptomics data from TCGA cohort was used to explore the potential pathogenesis underlying the PS CRC . Results: The PS CRC was identified as an independent prognostic factor associated with both overall survival and disease-free survival. Incorporating the PS CRC into the TNM stage model resulted in a significant improvement in prognosis estimation, as evidenced by a notable increase in net reclassification improvement and integrated discrimination improvement. Moreover, among stage II and III CRC patients with low levels of PS CRC , satisfactory benefits from chemotherapy were observed. Notably, the main underlying features of PS CRC include tumor cell infiltration, adipocyte accumulation, fibrous tissue deposition, and stromal infiltration. Transcriptome analysis further support the relevance of PS CRC to tumor progression and immune suppression. Conclusions: Our finds highlight the significant potential of histopathology images-based deep learning in predicting prognosis and assess therapeutic response of CRC. The PS CRC could serve as an effective tool in clinical decision for CRC management, providing insights into the underlying pathogenic mechanisms. However, prospective studies are still necessary for further validation.

Clinical outcomes and management following progressive disease with anti-PD-(L)1 therapy in patients with advanced Merkel Cell Carcinoma.

Merkel Cell Carcinoma (MCC) is a rare skin cancer with a rising incidence worldwide. Anti-programmed death-1/ligand-1 (anti-PD-(L)1) therapies are effective for the treatment of advanced MCC. This study examines patterns of response / progression of advanced MCC to anti-PD-(L)1 therapies and describes subsequent management. This is a multi-centre international retrospective cohort study with data collected up to May 2023 from 17 centres across 6 countries. Outcomes included objective response rate (ORR), duration of response (DOR), progression-free survival (PFS), and overall survival (OS) for anti-PD-(L)1 and subsequent therapy. One-hundred and eighty-five advanced MCC patients received anti-PD-(L)1 therapy. At median follow-up of 28.7 months (95 % CI: 21.4-38.3), ORR was 57.3 %, median DOR was 42.8 months (95 % CI, 25.8 - not reached (NR)), median PFS was 14 months (95 % CI, 8.1- 19.8), and median OS was 42.8 months (95 % CI, 30.3 - NR). One-hundred and eight patients (59 %) experienced progressive disease; 50 % (n = 54/108) with primary resistance and 26 % (n = 28/108) with secondary resistance. Fifty patients (27 %; n = 50/185) received subsequent systemic therapies (+/- local therapy) with response data; 18 (36 %; n = 18/50) received doublet platinum chemotherapy (ORR 67 %, DOR 5.0 months [95 % CI; 3.7 - NR]) and 16 (32 %; n = 16/50) were rechallenged with anti-PD-(L)1 (ORR 56 %, DOR 20.2 months [95 % CI; 8.3 - NR]). The most common subsequent treatment for patients with primary resistance was chemotherapy, while those with secondary resistance most frequently underwent further anti-PD-(L)1 therapy in combination with other therapies. Despite both therapies demonstrating promising ORR, doublet platinum chemotherapy had a poorer DOR compared to anti-PD-(L)1 rechallenge.

Abstract WP91: Which patients with acute ischaemic strokes requiring reperfusion therapy present without ambulance transport?

Introduction: Education campaigns have previously successfully informed the public regarding stroke symptoms and the need for urgent evaluation of suspected stroke. However, not all patients with strokes requiring intervention present to the hospital by ambulance, which would usually be the fastest means by which to reach a hospital. The aims of this study were to characterize the cohort of patients with an acute ischemic stroke that require reperfusion therapy who present to an emergency department without engaging ambulance services. Methods: A multicentre statewide retrospective cohort study was conducted involving all acute ischemic stroke admissions in South Australia from January 1, 2018, to January 1, 2024. Data were analyzed for all patients who received reperfusion therapy (either thrombolysis or endovascular thrombectomy) and presented directly to hospital (interhospital transfers and remote retrievals were excluded) via either ambulance or a non-ambulance (walk-in or driven by other) method. Results: Of the 1,497 individuals who presented directly to hospital and 66.1% received thrombolysis and 53.6% received endovascular thrombectomy, 60/1,497 (4.0%) presented without an ambulance (10 cases per year in a state with a population of 1.8 million). Those who received reperfusion therapy after presenting without an ambulance were more likely to be male (75.0% vs 56.0%, P &lt; 0.001) and younger (median 65.4 vs 75.5 years, P &lt; 0.001) than other patients who received reperfusion. Those who presented without an ambulance had longer door-to-scan (median 24 vs 34 minutes, P &lt; 0.001) and door-to-needle times (median 63 minutes vs 70 minutes, P = 0.18). Conclusion: Reperfusion-eligible stroke patients not utilising ambulance services are more likely to be young and male. Patients receiving reperfusion therapy after presenting without an ambulance are uncommon, but such cases demonstrate the ongoing need for educating specific patient populations about the importance of identifying new stroke symptoms and seeking urgent evaluation and hospital transport. Further research is needed to elucidate the underlying causes, and design education strategies to reinforce the need to urgent emergency service contact.

Major Pathologic Response as a Prognostic Surrogate in Esophageal Squamous Cell Carcinoma Patients Receiving Neoadjuvant Chemotherapy/Chemoimmunotherapy: a Multi-center Cohort Study

To determine the prognostic and survival surrogate value of major pathologic response (MPR) in esophageal squamous cell carcinoma (ESCC) patients undergoing neoadjuvant chemotherapy/chemoimmunotherapy(nCT/nICT) and surgery. A retrospective multi-center study cohort study enrolled 305 ESCC patients who underwent neoadjuvant chemotherapy/chemoimmunotherapy followed by esophagectomy. Endpoints included recurrence-free survival (RFS), locoregional recurrence-free survival(L-RFS), distant metastasis-free survival(D-MFS), and recurrence patterns. The Cox regression analysis and Harrell's C-index were used to analyze survival differences and surrogate endpoints. The Kaplan-Meier method was used for the subgroup analysis in two subgroups(the patients receiving nICT and patients receiving nCT) and the prognostic value analysis of adjuvant therapy in non-MPR and MPR patients. Of the 305 patients, 105 achieved MPR, demonstrating a significantly improved RFS (P value<0.001), L-RFS (P value<0.001), and D-MFS (P value=0.003). MPR was identified as an independent risk factor for RFS(HR:0.415, 95%CI:[0.227, 0.759], P value=0.004) and demonstrated equal predictive capacity to be a surrogate of survival endpoints with T stage and N stage(Harrell's C-index: 0.613). In subgroup analysis, patients with MPR showed better survival outcomes in subgroups that received neoadjuvant chemoimmunotherapy (P value=0.012) and neoadjuvant chemotherapy(P value<0.001). Additionally, adjuvant therapy did not confer additional survival benefits to both MPR and non-MPR patients. Compared with patients who achieved MPR, non-MPR patients exhibited a higher recurrence rate, although the recurrence sites were similar between the two groups. MPR can serve as an independent prognostic factor and a surrogate of survival endpoints in ESCC patients undergoing nCT/nICT. Besides, as a potential indicator for postoperative management, MPR can provide reference basis and evidence support in clinical practice.

Results of a multicenter retrospective cohort study evaluating the safety and efficacy of FTD/TPI plus ramucirumab in advanced gastric cancer (HGCSG2302).

351 Background: In advanced gastric cancer, trifluridine/tipiracil (FTD/TPI) is one of the standard treatments for later-line chemotherapy. Ramucirumab (RAM), an anti-VEGFR-2 monoclonal antibody, has shown promising efficacy in combination with FTD/TPI in phase II studies conducted in Japan, suggesting that this combination could improve treatment outcomes. However, there remains a paucity of real-world clinical data comparing the efficacy and safety of FTD/TPI monotherapy and FTD/TPI plus RAM combination therapy in general clinical practice. Methods: This retrospective analysis to evaluate safety and efficacy included patients with gastric cancer who were received FTD/TPI plus RAM combination therapy or FTD/TPI monotherapy between August 2019 and March 2023 at 21 institutions. Results: 164 patients were analyzed, 38 patients in the RAM combination group and 126 in the FTD/TPI monotherapy group. The distribution of treatment lines (third/fourth/fifth) was 10/13/15 in the RAM group and 26/54/46 in the monotherapy group, respectively. RAM had been previously administered to 34 patients (89.5%) in the RAM group. Objective response rate and disease control rate were 11.1% / 55.6% (OR 2.0, 95% C.I. 0.84-4.77, p=0.126) in the RAM group and 5.5% /38.5% (OR 2.0, 95% C.I. 0.84-4.77, p=0.126) in the monotherapy group, respectively. Median progression-free survival (PFS) was 3.5 months in the RAM group and 2.1 months in the monotherapy group (HR 0.69, 95% C.I. 0.49-1.02, p=0.06), respectively. Median overall survival (OS) was 8.4 months in the RAM group and 5.8 months in the monotherapy group (HR 0.82, 95% C.I. 0.54-1.25, p=0.350), respectively. Grade 3 neutropenia was reported in 48.6%/52.4% (p=0.707), and there were no significant differences in other adverse event profiles between the two groups. Additionally, in the RAM group, a comparison between patients receiving standard dosing (2 weeks on/2 weeks off; n=7) and those on biweekly dosing (1 week on/1 week off; n=24) showed no notable differences in efficacy or safety. Conclusions: FTD/TPI plus RAM combination therapy showed a trend toward prolonged PFS compared to FTD/TPI monotherapy, but no significant difference in OS.

Comparative analysis of first-line treatment in NSCLC including unresectable stage III (IIIB/IIIC) and stage IV with low PD-L1 expression: Clinical trial eligible versus ineligible patients.

Clinical trial eligible patients with advanced non-small cell lung cancer (aNSCLC) and low programmed cell death ligand 1 (PD-L1) expression achieve greater benefit from immune checkpoint inhibitor (ICI) combination chemotherapy (ICI-Chemo) compared with Chemo alone. We examined whether patients ineligible for clinical trials may benefit from ICI-Chemo. This multicenter retrospective cohort study enrolled patients with aNSCLC, including unresectable Stage III (IIIB/IIIC) and IV disease with a PD-L1 tumor proportion score of 1-49% treated with ICI-Chemo or Chemo as first-line therapy from 2018 to 2023 in Japan. Treatment outcome and safety of ICI-Chemo versus Chemo groups in trial-eligible and trial-ineligible patients was compared based on criteria from previous phase III clinical trials. Overall, 728 patients were analyzed: 333 trial-eligible and 395 ineligible patients. The median overall survival was 25.1months in the ICI-Chemo group and 18.5months in the Chemo group for eligible patients (HR 0.73, 95%CI: 0.54-0.97) and was 18.2months in the ICI-Chemo group and 14.9months in the Chemo group for ineligible patients (HR 0.75, 95%CI: 0.59-0.95). Median progression-free survival was longer with ICI-Chemo in both groups. For ineligible patients, performance status (PS)≥2 and squamous cell carcinoma (SqCC) were clinical factors associated with worse survival prognosis, and survival outcomes with ICI-Chemo and Chemo were comparable. The ineligible group had no increase in severe adverse events compared to the eligible group. This study suggests a possible clinical benefit of receiving ICI-Chemo for trial-ineligible patients with low PD-L1 expression, excluding those with PS ≥2 or SqCC.

Similar patient-reported outcomes, but lower re-dislocation and higher revision rates following primary Latarjet vs primary Arthroscopic Bankart Repair in patients with 10-20% glenoid bone loss at minimum 2 years follow-up.

The amount of glenoid bone loss is closely related to the success rate of surgical treatment following anterior shoulder dislocations. There is an ongoing debate on the most successful treatment in patients with a subcritical amount (10-20%) of glenoid bone loss (GBL). This study aimed to compare patient-reported outcome measures (PROMs) following primary open Latarjet procedure and primary arthroscopic Bankart repair (ABR) in patients with 10-20% GBL at minimum 2 years follow-up. This multicenter retrospective cohort study included 53 patients with traumatic anterior shoulder dislocations treated with Latarjet or ABR between 2011 and 2019. PROMs included the Western Ontario Shoulder Instability Index (WOSI) and Oxford Shoulder Instability Score (OSIS). Secondary outcomes included recurrence, complications, revision surgery, patient satisfaction, and return to sport (RTS). The mean follow-up was 77±31.7 months. Baseline characteristics were similar between ABR and Latarjet, except for time to follow-up (91±30 vs 61±26 months, p<0.001) and percentage GBL (15±3 vs 17±3, p=0.024). WOSI scores were higher in Latarjet patient compared to ABR, however this difference was not statistically significant (220 vs 457, p = 0.10). OSIS scores were similar following ABR and Latarjet (42 vs 45, p = 0.33). Recurrence rates were higher in ABR patients (7 (24%) vs 0 (0%) recurrences, p=0.01), whereas revision rates were higher in Latarjet patients (4 vs 0 revisions, p=0.04). Patient satisfaction and complications were not different between the two procedures and neither were RTS and RTS to pre-injury level. The null hypothesis in which Latarjet and ABR show similar patient-reported outcomes could not be rejected based on the underpowered analysis. Patients treated with Latarjet did not have any recurrences versus 7 in the ABR group (p=0.01). However, revision rates were higher in Latarjet patients (4 vs 0 revisions, p=0.04).

Abstract TP165: Computed-Tomography (CT) Based Imaging Scores in Basilar Artery Occlusions – A Comparison of Predictive Abilities for Functional Outcomes

Background: Posterior circulation (PC) large-vessel occlusion (LVO) strokes have significant morbidity and mortality, but patient selection for acute interventions remains understudied. Multiple computed tomography (CT)-based scores exist, including the CT-perfusion-based CAPS score, CT-angiogram(CTA)-based BATMAN and PC-CTA scores, and CTA source image or non-contrast-CT-based PC-ASPECTS score, but their predictive values for long-term outcomes after thrombectomy have not been directly compared. Methods: We conducted a retrospective multicenter cohort study of patients with basilar artery occlusions treated with endovascular thrombectomy. Four CT-based scores were assessed: PC-ASPECTS, BATMAN, PC-CTA, and CAPS. The primary outcome of interest for the study was favourable functional outcome at 3 months (mRS of 0-3). We generated receiver operating characteristic curves measuring area under the curve (AUC) for poor functional outcomes and compared AUCs with non-parametric methods. Results: 98 patients were included for analysis, with an average age of 64.9±15.6 years. The median National Institute of Health Stroke Severity Score (NIHSS) was 13.5 (IQR 7.0 – 23.0). AUC values were highest for the CAPS score (AUC 0.72 (95%CI 0.63 – 82)), and lowest for the pc-CTA score (AUC 0.57 (95%CI 0.45 – 0.68)), p=0.019. There was a trend towards the CAPS score outperforming the BATMAN (AUC 0.66 (95%CI 0.55 – 0.77) and PC-ASPECTS scores (AUC 0.63 (95%CI 0.52 – 0.75)), though this difference was not statistically significant (p=0.29 and p=0.23, respectively). However, the CAPS score was the only score with 100% specificity for predicting inability to achieve good functional outcome after thrombectomy: 0/12 patients with CAPS score of 4-6 went on to have a good functional outcome at 3 months after thrombectomy. Conclusion: Our analysis demonstrated that the CT-perfusion-based CAPS score outperformed three other imaging-based scores for predicting outcomes after 3 months. The CAPS score could be implemented to inform patient selection for endovascular thrombectomy in basilar artery occlusions.

Prophylactic clip closure in preventing delayed bleeding after colorectal endoscopic submucosal dissection in patients on anticoagulants: a multicenter retrospective cohort study in Japan.

The effectiveness of prophylactic clip closure in reducing the risk of delayed bleeding after colorectal endoscopic submucosal dissection (ESD) is uncertain among patients on anticoagulants. We therefore aimed to assess this effectiveness using data from a large multicenter study. We used the ABCD-J study database to analyze delayed bleeding among 34 455 colorectal ESD cases from 47 Japanese institutions. Delayed bleeding rates among the no/partial and complete closure groups were compared in patients on direct oral anticoagulants (DOACs) or warfarin. Propensity score matching was used for baseline characteristics to reduce the effects of selection bias. Overall, data from 1478 patients on anticoagulants who underwent colorectal ESD were examined. After propensity score matching, the complete and no/partial closure groups were compared in 212 patients on DOACs and 82 on warfarin. The complete closure group showed a significantly lower delayed bleeding rate in patients receiving DOACs (10.8 % vs. 5.2 %, absolute risk reduction [ARR] 5.7 %, P = 0.048) and warfarin (17.1 % vs. 6.1 %, ARR 11.0 %, P = 0.049). Additionally, complete closure significantly reduced the risk of delayed bleeding among patients taking DOACs for right-sided lesions (ARR 6.7 %, P = 0.04), whereas no risk reduction was observed for left-sided (P > 0.99) or rectal (P = 0.50) lesions. A similar trend was observed among patients on warfarin. Prophylactic complete clip closure after colorectal ESD significantly reduced the delayed bleeding rate in patients receiving DOACs or warfarin. It should be performed after ESD, particularly for right-sided lesions.

Brief communication: virological outcomes and dolutegravir resistance mutations in HIV-infected patients: a multicenter retrospective cohort study in Mozambique.

The global HIV epidemic remains a major public health challenge, with DTG playing a key role in ART regimens due to its efficacy and tolerability. This study evaluated virological outcomes and resistance mutations in patients on DTG in Mozambique through a retrospective cohort study in seven DREAM centers. Data from 29,601 patients (98.1% on DTG) revealed a virological suppression rate of 95% (27,622/29,051). Factors positively associated with suppression included age > 50, longer ART duration, and being female. Of 17 resistance tests, 8 showed major mutations, including G118R and E138K. Results highlight DTG's effectiveness and the need for resistance surveillance.

Risk Factors for Gastrointestinal Bleeding in Patients With Acute Myocardial Infarction: Multicenter Retrospective Cohort Study.

Gastrointestinal bleeding (GIB) is a severe and potentially life-threatening complication in patients with acute myocardial infarction (AMI), significantly affecting prognosis during hospitalization. Early identification of high-risk patients is essential to reduce complications, improve outcomes, and guide clinical decision-making. This study aimed to develop and validate a machine learning (ML)-based model for predicting in-hospital GIB in patients with AMI, identify key risk factors, and evaluate the clinical applicability of the model for risk stratification and decision support. A multicenter retrospective cohort study was conducted, including 1910 patients with AMI from the Affiliated Hospital of Guangdong Medical University (2005-2024). Patients were divided into training (n=1575) and testing (n=335) cohorts based on admission dates. For external validation, 1746 patients with AMI were included in the publicly available MIMIC-IV (Medical Information Mart for Intensive Care IV) database. Propensity score matching was adjusted for demographics, and the Boruta algorithm identified key predictors. A total of 7 ML algorithms-logistic regression, k-nearest neighbors, support vector machine, decision tree, random forest (RF), extreme gradient boosting, and neural networks-were trained using 10-fold cross-validation. The models were evaluated for the area under the receiver operating characteristic curve, accuracy, sensitivity, specificity, recall, F1-score, and decision curve analysis. Shapley additive explanations analysis ranked variable importance. Kaplan-Meier survival analysis evaluated the impact of GIB on short-term survival. Multivariate logistic regression assessed the relationship between coronary heart disease (CHD) and in-hospital GIB after adjusting for clinical variables. The RF model outperformed other ML models, achieving an area under the receiver operating characteristic curve of 0.77 in the training cohort, 0.77 in the testing cohort, and 0.75 in the validation cohort. Key predictors included red blood cell count, hemoglobin, maximal myoglobin, hematocrit, CHD, and other variables, all of which were strongly associated with GIB risk. Decision curve analysis demonstrated the clinical use of the RF model for early risk stratification. Kaplan-Meier survival analysis showed no significant differences in 7- and 15-day survival rates between patients with AMI with and without GIB (P=.83 for 7-day survival and P=.87 for 15-day survival). Multivariate logistic regression showed that CHD was an independent risk factor for in-hospital GIB (odds ratio 2.79, 95% CI 2.09-3.74). Stratified analyses by sex, age, occupation, marital status, and other subgroups consistently showed that the association between CHD and GIB remained robust across all subgroups. The ML-based RF model provides a robust and clinically applicable tool for predicting in-hospital GIB in patients with AMI. By leveraging routinely available clinical and laboratory data, the model supports early risk stratification and personalized preventive strategies.