Multicenter Retrospective Analysis Research Articles

Cutaneous Collagenous Vasculopathy: A Retrospective Clinical and Histopathologic Analysis of 34 Cases.

Cutaneous collagenous vasculopathy (CCV) is a rare acquired microangiopathy that commonly affects middle-aged, fair-skinned individuals. It presents with telangiectatic lesions involving the lower extremities. Histologic analysis is mandatory for diagnosis. To describe and characterize the patients diagnosed with CCV at the Mayo Clinic. A multicenter retrospective observational analysis was performed on patients with a clinical and histological diagnosis of CCV at the Mayo Clinic in Florida, Arizona, and Rochester from January 2000 to October 2023. The study included 34 patients, 22 (64.7%) females. The median age at diagnosis was 52 years (range, 12-80 years). CCV lesions were found to affect the lower extremities in 29 (85.3%) patients, followed by the trunk in 14 (41.2%). Nineteen (55.9%) patients presented 1 concomitant medical condition, 8 (23.5%) 2 conditions, and 5 (14.7%) 3 or more medical conditions, such as arterial hypertension 10 (29.4%), type 2 diabetes mellitus 3 (8.8%), hyperlipidemia 3 (8.8%), cardiac disease 3 (8.8%), and hematologic malignancy 3 (8.8%). Thirty-one patients (91.2%) were taking medications, with 19 (55.9%) taking 3 or more. Pathology staining revealed periodic acid-Schiff positivity in 23 of 34 cases (67.6%), and collagen IV in 26 of 34 cases (47.1%). Treatments included pulsed dye laser 3 (8.8%) and topical sirolimus 1 (2.9%). CCV is an uncommon microangiopathy that affects pediatric, middle-aged, and elderly patients. It involves the lower extremities, trunk, and upper extremities. Patients often present with associated metabolic and cardiovascular conditions and are usually taking at least 1 medication. Treatment options are limited.

Endovascular intervention for carotid blowout syndrome and predictors of recurrence: A retrospective and multicenter cohort study

IntroductionCarotid blowout syndrome (CBS) is a potentially life-threatening complication of head and neck cancer and associated treatment. In this study, we assess the safety and efficacy of deconstructive and reconstructive procedures with a focus on CBS recurrence. MethodsWe conducted a multicenter retrospective analysis of a prospectively maintained database and identified 80 consecutive neurointerventions for CBS from 2016 to 2020. Patients were divided into 2 groups: deconstructive embolization (68 patients) and reconstructive stenting (12 patients). A comparative analysis was performed between the two groups. ResultsThe CBS recurrence rate was 23.8 % with 84.2 % of recurrences occurring within 90 days of the primary event. The median time to rebleeding was 8.0 days (IQR: 2.0 – 28.5) with a mortality rate of 26.3 %. There was no significant difference in rates of peri-operative ischemic stroke (1.5 % vs. 0 %, p=0.672) or peri-operative mortality (1.5 % vs. 0 %, p=0.670). CBS recurrence was significantly higher in the reconstructive group (58.3 % vs. 17.6 %, p=0.002). On multivariate analysis, reconstructive stenting independently predicted rebleeding (adjusted hazard ratio 8.31, 95 % CI: 2.34–29.59, p=0.001). There was no significant association between CBS recurrence and pre-operative (p=0.600) or post-operative (p=0.275) anticoagulant/antiplatelet use. ConclusionCBS remains a challenging and potentially catastrophic complication of head and neck cancers. Reconstructive procedures, including stenting, predicted CBS recurrence independent of bleeding site or tumor invasion. Postoperative surveillance based on time intervals to CBS recurrence and engineering advancements including improved vessel reconstruction devices have the potential to reduce rehemorrhage rates and improve patient outcomes. Further clinical investigations amongst larger cohorts are needed.

Pegylated interferon-α2a in cutaneous T-cell lymphoma - a multicenter retrospective data analysis with 70 patients.

Interferon-alpha is an important therapeutic option for the treatment of the cutaneous T-cell lymphomas (CTCL). Since the approved recombinant interferon-α-2a(IFN-α2a) has no longer been produced sinceJanuary 2020, pegylated interferon-α2a (pegIFN-α2a) can be used as an alternative treatment, even though it is not approved for the treatment of CTCL. The aim of this multicentre study was to generate comprehensive data on the efficacy and tolerability of pegIFN-α2a in the treatment of CTCL. A multicenter retrospective study was conducted with 70 patients with CTCL from twelve German skin centers. In total, 70 patients were included in the study, with 57.2% male and a mean age of 58.8 ±14.9 years. Mycosis fungoides was present in 71.4% of cases and Sézary Syndrome in 28.6%. An overall response rate of 55.2% was observed with pegIFNα-2a therapy. In 50% of cases, therapy was discontinued after 63.6 ±33.5 weeks. The most common reason for discontinuation was adverse events, which occurred in 68.6% of cases and which were classified as severe in 29.2%. Blood count changes, fatigue and liver toxicity occurred most frequently. Our analysis provides comprehensive data on the efficacy and tolerability of pegIFNα-2a therapy in patients with CTCL. In terms of response rates and side effect profile, pegIFNα-2a appears to be comparable to IFN-α2a therapy.

ID: 323169 Clinical Outcomes of Peripheral Nerve Stimulation: A Multi-Center Retrospective Analysis

ID: 323169 Clinical Outcomes of Peripheral Nerve Stimulation: A Multi-Center Retrospective Analysis

Observational study of immunosuppressive treatment patterns and outcomes in primary membranous nephropathy: a multicenter retrospective analysis

BackgroundWe evaluated the efficacy of different immunosuppressive regimens in patients with primary membranous nephropathy in a large national cohort.MethodsIn this registry study, 558 patients from 47 centers who were treated with at least one immunosuppressive agent and had adequate follow-up data were included. Primary outcome was defined as complete (CR) or partial remission (PR). Secondary composite outcome was at least a 50% reduction in estimated glomerular filtration (eGFR), initiation of kidney replacement therapies, development of stage 5 chronic kidney disease, or death.ResultsMedian age at diagnosis was 48 (IQR: 37–57) years, and 358 (64.2%) were male. Patients were followed for a median of 24 (IQR: 12–60) months. Calcineurin inhibitors (CNIs) with or without glucocorticoids were the most commonly used regimen (43.4%), followed by glucocorticoids and cyclophosphamide (GC-CYC) (39.6%), glucocorticoid monotherapy (25.8%), and rituximab (RTX) (9.1%). Overall remission rate was 66.1% (CR 26.7%, PR 39.4%), and 59 (10.6%) patients reached secondary composite outcome. Multivariate logistic regression showed that baseline eGFR (OR 1.011, 95% CI: 1.003–1.019, p = 0.007), serum albumin (OR 1.682, 95% CI: 1.269–2.231, p < 0.001), and use of RTX (OR 0.296, 95% CI: 0.157–0.557, p < 0.001) were associated with remission rates; whereas only lower baseline hemoglobin was significantly associated with secondary composite outcome (OR: 0.843, 95% CI: 0.715–0.993, p = 0.041). CYC use was significantly associated with higher remission (OR 1.534, 95% CI: 1.027–2.290, p = 0.036).ConclusionsHigher baseline eGFR and serum albumin levels correlated with increased remission rates. Remission rates were lower in patients treated with RTX, while those on GC-CYC showed higher rates of remission. Due to the study’s retrospective nature and multiple treatments used, caution is warranted in interpreting these findings.

The Clinical Outcomes of Cervical Spine Chordoma: A Nationwide Multicenter Retrospective Study.

Chordoma, a rare malignant tumor originating from embryonal notochord remnants, exhibits high resistance to conventional treatments, making surgical resection imperative. However, the factors influencing prognosis specifically for cervical spine chordoma have not been clearly identified. We investigate the prognosis of cervical spine chordoma with factors influential in a nationwide multicenter retrospective study. This study included all patients diagnosed with cervical spine chordoma at 7 tertiary referral centers from January 1998 to March 2023, excluding those with clivus and thoracic spine chordomas extending into the cervical spine. Local recurrence (LR) was identified through follow-up magnetic resonance imaging, either as reappearance in completely resected tumors or regrowth in residual tumors. The study assessed LR and overall survival, analyzing factors influencing LR and death. Forty-five patients with cervical spine chordoma had a mean age of 46.4 years. Over a median follow-up of 52 months, LR and distant metastasis were observed in 21 (46.7%) and 4 patients (8.9%), respectively, and 16 patients (36%) were confirmed dead. The 5-year and 10-year cumulative LR rates were 51.3% and 60%, respectively, while the 5-year and 10-year survival rates were 82% and 53%. Age was the only significant factor affecting mortality (hazard ratio, 1.04; 95% confidence interval, 1.04-1.07; p=0.015). Notably, the degree of resection and adjuvant therapy did not statistically significantly impact local tumor control and mortality. This study, the largest multicenter retrospective analysis of cervical spine chordoma in Korea, identified age as the only factor significantly affecting patient survival.

The efficacy of second-line tyrosine kinase inhibitor for patients with metastatic non-clear cell renal cell carcinoma following first-line immune-oncology combination therapy.

Metastatic non-clear cell renal cell carcinoma (nccRCC) is a heterogeneous disease with a poor prognosis and is treated with immunotherapy (IO)-based combinations according to the clear cell renal cell carcinoma. Tyrosine-kinase inhibitors (TKIs), such as cabozantinib and axitinib, are commonly used as the 2nd line therapy after 1st line IO combination therapy, but their efficacy as 2nd line TKI therapy for nccRCC is unknown. In this study, we performed a retrospective multicenter analysis of nccRCC patients who were previously treated with IO combination therapy and received 2nd line TKIs. Among 254 patients enrolled in the Japanese multicenter retrospective study, 52 patients with nccRCC histology who received second-line TKIs were included in this study. Progression-free survival and overall survival (OS) from 2nd line TKIs were analyzed by log-rank test and Cox-proportional hazard model. Objective response rate (ORR) of 2nd line TKIs were analyzed. The 1-year PFS and OS rates were 25.0% (95% CI = 13.1-36.8) and 63.8% (95% CI, 48.0-75.9), respectively. No patients had a complete response, 11 had a partial response, and 18 had stable disease. ORR was 21.1%. IMDC poor risk and sunitinib as the 2nd line therapy were significantly associated with poor PFS. The 2nd-line TKI was effective for a small group of nccRCC patients previously treated with IO combination therapy, although this study was retrospectively analyzed with a small number of cases.

Middle Meningeal Artery Embolization for Chronic Subdural Hematoma Using N-Butyl Cyanoacrylate With a D5W Push Technique: A Multicentric North American Study of 269 Patients

BACKGROUND AND OBJECTIVES: As the aging population increases, the incidence of chronic subdural hematomas (cSDHs) is expected to rise. Surgical evacuation, though effective, sees up to 30% recurrence. Middle meningeal artery (MMA) embolization, particularly with n-butyl cyanoacrylate (n-BCA) glue diluted in D5W for distal penetration, has shown promise in reducing recurrences. Limited reports have investigated the safety and technical feasibility of n-BCA as a primary liquid embolic agent using the D5W push technique in cSDH. This series is the largest in the literature investigating the outcomes of this technique in cSDH. METHODS: A multicenter retrospective database analysis was conducted on consecutive patients who underwent MMA embolization using n-BCA embolisate. Data collected included patient demographics, procedural information, angiographic data, and periprocedural complications. RESULTS: The study included 269 patients with a median age of 76 years. Nearly half of the patients had previous surgeries, and 93 underwent contralateral embolization for bilateral cSDH. Successful MMA embolization with effective distal penetration was achieved in all cases. The complication rate was 2.2%. Significant improvements were noted at a 60-day follow-up, with a median reduction in cSDH diameter of 40.6% (P &lt; .001) and 53% of patients showing neurological improvement. No recurrent cSDH or need for retreatment was observed in patients who underwent follow-up. CONCLUSION: MMA embolization using n-BCA with the D5W push technique is safe and technically feasible. It can be used adjunctively or as an alternative to surgery in patients with cSDH, resulting in decreased recurrence, high technical success, improved distal penetration, and low complication rates.

Characterization of Disparities, Diagnoses and Treatment Outcomes with Pemphigus Vulgaris

Pemphigus vulgaris (PV) and foliaceus (PF) are classified as rare autoimmune blistering disorders in which IgG antibodies destroy desmosome proteins desmoglein 1 and desmoglein 3 within the stratum spinosum of the epithelial layer of the skin. These disorders once used to be a fatal condition, but the advent of steroids and immunosuppressants has made these diseases manageable. Such treatments, however, only alleviate symptoms and have not been viable in allowing patients to achieve prolonged steroid-free remission. In 2018, the US Food and Drug Administration (FDA) approved the anti-CD20 monoclonal antibody rituximab as the first-line treatment for moderate to severe cases of pemphigus. While rituximab has been generally successful in treating this disease and has led to prolonged steroid-free remission in many patients, treatment disparities and differences in patient outcomes due to social determinants of health have not yet been studied in the context of PV and PF. Such studies have already been conducted with more common dermatological disorders such as hidradenitis suppurativa (HS), which show significant evidence of outcome disparities due to social factors such as race, ethnicity and socioeconomic status. However, such studies have yet to be conducted with pemphigus likely because of how rare the disease is and because the current first-line treatment was FDA approved recently in 2018. The aim of this study is to conduct a retrospective multivariable analysis of 100 patients with pemphigus from UT Southwestern Medical Center and Parkland County Hopital to determine which social factors are the most responsible for any discovered pemphigus treatment outcome disparities. The impacts of this study are far-reaching as any discovered disparities can alert dermatologists to place a special emphasis to address any social factors that may play a role in leading to treatment outcome differences for patients with pemphigus.

Treatment outcomes and their predictors in children hospitalized with varicella complicated by bacterial superinfections after pandemic of COVID-19 – a retrospective multicenter analysis of real-life data in Poland

Treatment outcomes and their predictors in children hospitalized with varicella complicated by bacterial superinfections after pandemic of COVID-19 – a retrospective multicenter analysis of real-life data in Poland

Which dose of calcium dobesilate is more effective and safe in chronic venous insufficiency? Multicenter retrospective clinical trial

Objectives This study aimed to evaluate the effectiveness and safety of different dosages of calcium dobesilate in the management of Chronic Venous Insufficiency (CVI) among patients in CEAP classes C3–C4. Methods A comprehensive multicenter retrospective analysis was conducted, including patients aged 18-70 with CEAP class C3–C4 CVI. Participants were divided into two groups: one receiving 500 mg of calcium dobesilate twice daily and the other 1000 mg twice daily. Patient progress was monitored using the Global Index Score, CIVIC-20 Score, and precise measurements of ankle and calf circumferences over a 12-month period. Results The higher dosage group (1000 mg twice daily) showed significant improvements in both symptom relief and edema reduction. Ankle circumference reduced notably at 6 months, while calf circumference and overall quality of life, measured by the Global Index Score, showed significant improvement by 12 months compared to the lower dosage group. Conclusions Higher doses of calcium dobesilate markedly enhance the management of CVI symptoms and reduce edema more effectively than lower doses, particularly in patients with advanced CVI. These findings support the use of higher dosages for optimal treatment, though further research is needed to fully evaluate long-term safety.

Comparison of two surgical approaches in treating children with thoracolumbar junction tuberculosis: a multicenter study

ObjectivesWe conducted a multicenter retrospective analysis to compare the clinical outcomes and complications associated with the posterior-anterior and posterior-only approaches in treating Thoracolumbar Junction (TLJ) Tuberculosis (TB) in children aged 3–10 years.MethodsHerein, 52 TLJ TB patients (age range = 3–10 years; mean age = 6.8 ± 2.2 years; females = 22; males = 30) treated with debridement, fusion, and instrumentation were recruited from two hospitals in China between May 2008 and February 2022, and their clinical data were reviewed retrospectively. Among them, 24 group A patients and 28 group B patients underwent the posterior-anterior and posterior-only approaches, respectively. The two groups were assessed for surgical time, blood loss, hospitalization duration, operative complications, inflammatory indicators, Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) scores, kyphosis angles, and neurologic functions. Results or differences with P < 0.05 were considered statistically significant.ResultsThe average follow-up period was 37.5 ± 23.3 months. Compared to group A patients, group B patients exhibited significantly lower surgical time, blood loss amount, time it took to stand, and hospitalization duration, as well as fewer complications. Notably, the Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) values of patients in both groups returned to normal one year post-surgery. Furthermore, compared to the preoperative values, patients’ VAS and ODI scores, as well as neurological functions and kyphosis angles, were significantly improved postoperatively and at the final follow-up, but with no statistically significant differences between the two groups. Moreover, there was no internal fixation failure or TB recurrence, and all patients exhibited solid bone fusion at the last follow-up.ConclusionFor pediatric TLJ TB involving no or at most two segments, both posterior-anterior and posterior-only approaches could effectively remove lesions and decompress the spinal cord, restore spinal stability, correct kyphosis, and prevent deformity deterioration. Nonetheless, the posterior-only approach can more effectively shorten the surgical time, reduce related trauma and complications, and promote rapid recovery, making it a safer and highly preferable minimally invasive approach.

Short-term effectiveness and side effects of ketogenic diet for drug-resistant epilepsy in children with genetic epilepsy syndromes.

Drug-resistant epilepsy (DRE) impacts a significant portion, one-third, of individuals diagnosed with epilepsy. In such cases, exploring non-pharmacological interventions are crucial, with the ketogenic diet (KD) standing out as a valuable option. KD, a high-fat and low-carb dietary approach with roots dating back to the 1920s for managing DRE, triggers the formation of ketone bodies and modifies biochemistry to aid in seizure control. Recent studies have increasingly supported the efficacy of KD in addressing DRE, showcasing positive outcomes. Furthermore, while more research is needed, limited data suggests that KD May also be beneficial for specific genetic epilepsy syndromes (GESs). This study aimed to assess the short-term efficacy of KD among pediatric patients diagnosed with GESs. This is a multi-center retrospective analysis of pediatric patients with GESs diagnosed using next-generation sequencing. The enrolled patients followed the keto-clinic protocol, and the KD efficacy was evaluated at 3, 6, and 12-month intervals based on seizure control and compliance. The collection instrument included demographic, baseline, and prognostic data. The collected data was coded and analyzed promptly. We enrolled a cohort of 77 patients with a mean current age of 7.94 ± 3.83 years. The mean age of seizure onset was 15.5 months. Notably, patients experienced seizures at a younger age tended to have less positive response to diet. Overall, 55 patients responded favorably to the diet (71.4%) while 22 patients (28.6%) showed no improvement. Patients with genetic etiology showed a significantly more favorable responses to the dietary intervention. Patients with Lennox-Gastaut syndrome showed the most significant improvement (14/15) followed by patients with Dravet syndrome (6/8), and West syndrome (3/4). The number of used anti-seizure medications also played a significant role in determining their response to the diet. While some patients experienced mild adverse events, the most common being constipation, these occurrences were not serious enough to necessitate discontinuation of the diet. The study revealed a high improvement rate in seizure control, especially among younger patients and those with later seizure onset. The success of dietary treatment hinges greatly on early intervention and the patient's age. Certain genetic mutations responded favorably to the KD, while efficacy varied among various genetic profiles.

Clinical and pathological renal outcomes of COVID-19 patients: an Egyptian retrospective multi-center pooled analysis

BackgroundKidneys have been one of the different organs affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) since its discovery, Acute kidney injury was the most common presentation. A pooled data from different kidney centers or hospitals in Egypt who sent their renal biopsy specimens from patients with renal trouble, up to 4 months after catching SARS-CoV-2, to PATH LAB for diagnosis, were analyzed.ResultsBeside acute kidney injury, a variety of different presentations was found, such as accidentally discovered impaired kidney function, varying degrees of proteinuria, and nephrotic syndrome. Not only acute tubular injury, acute tubulointerstitial nephritis, or thrombotic microangiopathy, but the extent of observation for 4 months revealed, unexpected pathologies, such as podocytopathies, membranous glomerulonephritis, proliferative and necrotizing glomerulonephritis, and lupus nephritis.ConclusionThis virus has been incriminated in a chain of different kidney disease presentations and pathologies, although, a causal relationship is difficult to prove.

Histopathological Growth Patterns Determine the Outcomes of Colorectal Cancer Liver Metastasis Following Liver Resection.

Colorectal cancer liver metastasis (CRCLM) remains a lethal diagnosis, with an overall 5-year survival rate of 5-10%. Two distinct histopathological growth patterns (HGPs) of CRCLM are known to have significantly differing rates of patient survival and response to treatment. We set out to review the results of 275 patients who underwent liver resection for CRCLM at the McGill University Health Center (MUHC) and analyze their clinical outcome, mutational burden, and pattern of cancer progression in light of their HGPs, and to consider their potential effect on surgical decision making. We performed a retrospective multivariate analysis on clinical data from patients with CRCLM (n = 275) who underwent liver resection at the McGill University Health Center (MUHC). All tumors were scored using international consensus guidelines by pathologists trained in HGP scoring. A total of 109 patients (42.2%) were classified as desmoplastic and angiogenic, whereas 149 patients (57.7%) were non-desmoplastic and vessel co-opting. The 5-year survival rates for angiogenic patients compared with vessel co-opting patients were 47.1% and 13%, respectively (p < 0.0001). Multivariate analysis showed patients with vessel co-opting CRCLM had a higher incidence of extrahepatic metastatic disease (p = 0.0215) compared with angiogenic CRCLM. Additionally, KRAS mutation status was a marker of increased likelihood of disease recurrence (p = 0.0434), as was increased number of liver tumors (p = 0.0071) and multiple sites of extrahepatic metastatic disease (p < 0.0001). Multivariate analysis identified key clinical prognostic and molecular features correlating with the two HGPs. Determining liver tumor HGPs is essential for patient prognostication and treatment optimization.

ASO Author Reflections: Are Common Risk Calculators Able to Predict Morbidity and Mortality Outcomes for Patients with Primary Retroperitoneal Sarcoma? A Multicentric Retrospective Analysis.

ASO Author Reflections: Are Common Risk Calculators Able to Predict Morbidity and Mortality Outcomes for Patients with Primary Retroperitoneal Sarcoma? A Multicentric Retrospective Analysis.

727P Real-world efficacy and safety of cadonilimab in recurrent or metastatic cervical cancer: A multicenter retrospective analysis in China

727P Real-world efficacy and safety of cadonilimab in recurrent or metastatic cervical cancer: A multicenter retrospective analysis in China

Obesity Paradox in Transcatheter Aortic Valve Replacement.

Obesity paradox in cardiovascular risk prediction has gained increasing attention in recent years. We aimed to investigate the impact of BMI on mortality following transcatheter aortic valve replacement (TAVR). We performed a multi-center retrospective analysis of patients with severe aortic stenosis undergoing TAVR. Patients were categorized into: Underweight (BMI < 18.5), normal weight (18.5 ≤ BMI < 25), overweight (25 ≤ BMI < 30) and obese (BMI ≥ 30). Multivariate cox-proportional hazard model was used to compare all-cause mortality. Total of 6688 patients included (175 underweight, 2252 normal weight, 2368 overweight and 1893 with obesity). Mean age of patients was 81 ± 8 years with 55% males. Patients with obesity had higher prevalence of comorbidities but a lower overall STS score. Mortality at 30-days post-TAVR was lower in the obese population compared to underweight, normal weight, and overweight patients (1.6% vs. 6.9%, 3.6%, and 2.8%, respectively, p < 0.001). Similarly, 3-year mortality was lowest in patients with obesity (17.1% vs. 28.9%, 24.5% and 18.6%, respectively, p < 0.001). On multivariate analysis, long term all-cause mortality at 3-years remained significantly lower in patients with obesity compared to underweight (HR 1.74, 95% CI: 1.30-2.40, p < 0.001) and normal weight (HR: 1.41, 95% CI:1.21-1.63, p < 0.001) but not in overweight patients (HR: 1.10, 95% CI:0.94-1.28, p = 0.240). In conclusion, patients with obesity have improved short and long term mortality following TAVR with an observed progressive increase in mortality with lower BMI ranges.

Comparison of Various Low Density Lipoprotein Cholesterol Calculators: Is It Time for the Friedewald Equation to Go in India?

Low-density lipoprotein cholesterol (LDL-c) is the main target in the management of dyslipidemia in primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD). Our study aims to compare the conventional and most popular Friedewald equation, and the more recent Sampson equation (literally unknown in India but more accurate), to the directly estimated LDL-c by the homogenous method. No such comparative study has been done in India. A multicenter retrospective analysis of the lipid profiles of patients whose LDL-c was derived directly by the homogenous method was included. Indirect LDL-c was estimated using the Friedewald and Sampson equations. The accuracy, error, and level of correlation between direct LDL-c and the two equations were assessed for concordance and discordance based on LDL-c categories (≤50, 51-70, 71-100, 101-130, ≥131 mg/dL). Upward discordance is when the calculated LDL-c was at least one category higher and downward discordance is when the calculated LDL-c was at least one category lower than the corresponding direct LDL-c (DLDL-c). Subgroup analyses were also done for triglycerides (TGLs) <150, 151-199, ≥200 mg/dL. TGL >400 were assessed separately. A total of 30,810 samples from four centers were studied. The overall mean DLDL-c was 107.86 mg/dL. The mean estimated LDL-c by Friedewald's equation (FLDL-c) and Sampson's equation (SLDL-c) were 101.37 and 104.37 mg/dL, respectively. There was statistical significance (p-value < 0.0005) in the mean difference when DLDL-c was compared with combined SLDL-c and FLDL-c as per the Games-Howell multiple comparison study, in which the mean difference was greater with the Friedewald equation (6.495) than with the Sampson equation (3.491). The overall concordance between FLDL-c vs DLDL-c and SLDL-c vs DLDL-c was nearly similar (74 vs 77%, respectively). The overall discordance upward was 5% with FLDL-c and 7% with SLDL-c (p-value < 0.0005). The overall discordance downward for FLDL-c and SLDL-c was 22 and 15% (p-value < 0.0005). When subgroup analysis was done for LDL-c ≤ 70, the downward discordance was 41% (FLDL-c) and 32% (SLDL-c), giving a false sense of goal LDL-c being achieved more often with FLDL-c. For LDL-c > 70, the corresponding downward discordance was 16 and 11%, respectively. Starting from TGL ≥ 200 mg/dL, there was consistent underestimation of LDL-c by the Friedewald equation. When TGL was > 400, the mean DLDL-c was 109 mg/dL, while for FLDL-c, it was 82 mg/dL and for SLDL-c, it was 98 mg/dL. Sampson's equation improves the accuracy of the indirectly calculated LDL-c compared to Friedewald's equation. The FLDL-c is estimated falsely low at LDL-c ≤ 70 mg/dL, giving a lower sense of LDL-c goal being achieved, and these patients will be undertreated. By switching to Sampson's equation, 9% in the LDL-c ≤ 70 mg/dL and 5% in the LDL-c > 70 mg/dL can be correctly classified. The shift to Sampson's equation requires a simple formula change and can be easily embraced in India-a small change but in the right direction.

637. UPFRONT SURGERY IN ESOPHAGEAL CANCER: ACCURACY OF PREOPERATIVE CLINICAL STAGING

Abstract Background Treatment of locally limited esophageal cancer is still a frequently discussed topic. Especially, the inaccuracy of clinical staging in lymph node-negative T2-carcinomas has to be considered further in the treatment pathway. Aim of this study was to evaluate the accuracy of clinical staging in patients treated with esophagectomy without neoadjuvant treatment. Methods We conducted a retrospective multicenter analysis at the departments of surgery from two university clinics. All patients between January 2016 and December 2023, who underwent an esophagectomy because of an esophageal adenocarcinoma or squamous cell carcinoma without neoadjuvant treatment were included. Advanced tumor stage, T staging greater than T2, was defined as exclusion criteria. Results Fifty-three patients after upfront esophagectomy were included in the analysis. In 40 (75%) patients a gastroesophageal junction adenocarcinoma was diagnosed, and 13 (25%) patients were treated because of a squamous cell carcinoma of the esophagus. Clinical T staging was T1 or T2 and all lymph node stages were included. The endosonographic preoperative staging of invasion depth was accurate in 32 (60%) patients in comparison to the histopathological staging. In 7 (13%) cases the T-values were upstaged one level and in 5 (9%) cases one level downstaged after resection. The endosonographic preoperative staging of nodal spread was accurate in 32 (60%) patients. Furthermore, in 7 (13%) cases node status was upstaged and in 5 (9%) patients downstaged. Nine (17%) patients did not undergo a sufficient endosonographic staging, mainly due to prior endoscopic submucosal dissection or stenosis. In these patients, clinical lymph node staging was accurate in 4 patients. Conclusion Preoperative staging using endoscopic ultrasound and computed tomography is not accurate enough in a high number of patients, therefore we are seeking to identify other predictive factors underlying advanced stage esophageal cancer.