Retrospective Propensity Score-matched Analysis Research Articles

Mortality risk among individuals who smoke opioids compared with those who inject: A propensity score-matched cohort analysis of United States national treatment data.

Opioid smoking is becoming more common in the United States. The aim of this analysis was to estimate relative mortality risk among those who primarily smoke opioids compared with those who inject. Retrospective propensity score-matched cohort analysis. 2006-2021 US treatment episode data from SAMHSA TEDS-D. We matched 287 481 individuals in a substance use treatment program reporting smoking opioids as their primary substance use to an equal weighted number of individuals in a substance use treatment program reporting injecting opioids as their primary substance use. The majority of individuals reporting smoking were male (62.6%), 21-29 years old (47.9%), white (65.7%), independently housed (54.3%) and in the West Census Region (70.3%). Cohort characteristics were closely balanced after matching. The outcome of interest was death during a treatment episode. Variables used for matching were year, opioid category, gender, race/ethnicity, age category, census region, housing status, employment status, number of prior treatment admissions, variables associated with opioid use severity (opioid use frequency, treatment setting intensity, age at first opioid use, use of medication-assisted treatment) and other reported substance use (methamphetamine, alcohol, benzodiazepines, cocaine). The mortality rate was 6.5 [95% confidence interval (CI) =5.9-7.1] per 1000 person-years in the smoking cohort and 9.7 (95% CI = 8.8-10.8) per 1000 person-years in the injection cohort, with a mortality rate ratio of 0.67 (95% CI = 0.58-0.77). Among individuals in substance use treatment in the United States, those who usually smoke opioids appear to have a lower all-cause mortality risk than those who usually inject.

Efficacy of prophylactic laxatives against opioid-induced constipation: retrospective propensity score matching analysis

PurposeOpioid-induced constipation (OIC) is problematic for patients with cancer receiving opioid therapy. Some guidelines recommend initiating regular laxatives at the same time as opioid analgesics. However, the effectiveness of prophylactic laxatives on OIC has not been widely demonstrated. We therefore examined the incidence of OIC among patients with and without prophylactic laxatives within one week after initiating strong opioid analgesics and the factors associated with the incidence of OIC.MethodsEligible patients were adults with cancer for whom strong opioid analgesics were initiated after admission and who remained hospitalized for over a week. Propensity score matching analysis was used to compare outcomes after adjusting for patient background.ResultsIn total, 928 patients were enrolled, from which 536 were selected after propensity score matching analysis. The incidence of OIC in patients with prophylactic laxatives was not significantly different from that without prophylactic laxatives (48.1% vs 48.9%, odds ratio (OR) = 0.97, 95% confidence interval (CI): 0.69–1.36). In multivariable logistic analysis, age ≥ 65 years (OR = 1.53, 95% CI: 1.07–2.19) and Eastern Cooperative Oncology Group Performance Status (ECOG PS) ≥ 3 (OR = 1.69, 95% CI: 1.04–2.77) were associated with a higher incidence of OIC.ConclusionProphylactic laxatives did not affect the incidence of OIC in our study. Our results suggest that prophylactic laxatives are not necessarily required when initiating opioid therapy. In addition, we found that age ≥ 65 years and ECOG PS ≥ 3 were associated in our study with a higher incidence of OIC.

Impact of concomitant aortic valve replacement in patients with mild-to-moderate aortic valve regurgitation undergoing left ventricular assist device implantation: EUROMACS analysis.

Left ventricular assist device (LVAD) therapy may lead to an aortic regurgitation, limiting left ventricular unloading and causing adverse events. Whether concomitant aortic valve replacement may improve outcomes in patients with preoperative mild-to-moderate aortic regurgitation remains unclear. A retrospective propensity score-matched analysis of adult patients with preoperative mild-to-moderate aortic regurgitation undergoing durable LVAD implantation between 01/01/2011 and 30/11/2021 was performed. Patients undergoing concomitant valve surgery other than biological aortic valve replacement were excluded, resulting in 77 with concomitant biological aortic valve replacement and 385 without. Following 1:1 propensity score matching, two groups of 55 patients with and without biological aortic valve replacement were obtained, (mean age 59 ± 11 years, 92% male, 59.1% HeartWare). Aortic regurgitation was mild in 72.7% and 76.4% and moderate in 27.3% and 23.6% in non-replacement and replacement cohorts respectively. The 30-day survival was 89.1% vs. 85.5% (p = 0.59), 1-year survival 69.1% vs. 56.4% (p = 0.19), and 2-year survival 61.8% vs. 47.3% (p = 0.10) in the non-replacement and replacement groups, respectively. After a mean follow-up of 1.2 years, non-replacement patients had a higher incidence of pump thrombosis (11 [20%] vs. 3 [5.5%], p = 0.022) and fewer major bleedings (2 [3.6%] vs. 11 [20%], p = 0.008). Compared with those treated conservatively, patients with mild-to-moderate aortic regurgitation undergoing concomitant aortic valve replacement during LVAD implantation have a similar survival up to 2 years on support. Patients with concomitant valve replacement had a higher risk of bleeding complications but fewer pump thromboses.

Wound Healing in External Rhinoplasty-The Effect of Fibrin Glue on Dead Space Closure: A Retrospective Propensity Score-Matched Study.

The presence of "dead space" in external rhinoplasty creates a welcoming environment for erratic soft tissue contraction. Poor redraping of the skin over the underlying osseocartilaginous framework at the end of the surgery may result in its creation. If surgeons can control and reliably predict skin contraction and wound healing, septorhinoplasty results would undoubtedly improve. Fibrin glue application has previously demonstrated a reduction in adverse events in plastic surgery. Several potential advantages have been attributed to the application of fibrin glue, such as reducing downtime, improving patient satisfaction and reducing complication rates. To evaluate the effectiveness of homologous fibrin glue on the long-term healing process in external rhinoplasty. We performed a retrospective propensity score-matched analysis in 154 patients enrolled for external septorhinoplasty. An aesthetic evaluation was performed with the FACE-Q nose and nostrils, the Utrecht Questionnaire including VAS score and the NOSE. Assessments were conducted prior to surgery and post-operatively at 3, 6 and 12months. After propensity score matching, two equal groups of 66 patients were retained. The first cohort of 66 patients underwent a rhinoplasty without the application of fibrin glue; in the second cohort of 66 patients, human fibrin glue was used to achieve better adherence of the skin to the underlying skeletal framework. All patients had a statistically highly significant improvement on all PROMs post-operatively. The post-operative results remained stable over the different time points. However, no statistically significant difference in the aesthetic outcome was discovered whether fibrin glue was used or not during surgery. Obliteration of dead space is a key component in septorhinoplasty as it minimizes soft tissue contraction, resulting in a more predictable outcome. Although fibrin glue has been used successfully in different medical fields, no long-term positive effects on patient satisfaction could be detected in the present study. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract 4144520: Glucagon-like Peptide-1 Receptor Agonists for the Primary Prevention of Major Adverse Cardiac Events in Drug-naïve Type 2 Diabetes: A Propensity-score Analysis

Background: The effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1 RA) as a first-line agent for the primary prevention of major adverse cardiac events (MACE) in obese patients with diabetes mellitus (DM) is unknown. Research Question: Does initial treatment with GLP-1 RA in obese drug-naïve patients with type 2 DM prevent future MACE? Aims: To examine the association between GLP-1 RA treatment and the primary prevention of MACE in drug-naïve type 2 DM patients with obesity. Methods: A retrospective propensity score-matched (PSM) analysis was conducted using the TriNetX Global database. We implemented a new-user design, including adult overweight/obese patients with drug-naive type 2 DM between January 1 st , 2019 and May 1 st , 2023. Patients with prior heart failure (HF), myocardial infarction (MI), coronary revascularization, stroke, or cardiac arrest were excluded. We compared those starting GLP-1 RA versus starting non GLP-1 RA. Medication starting window spans from the first diagnosis to 3 months afterwards. Patients with insulin were excluded if they had any emergency or inpatient encounters during this window. The primary outcome was incident MACE, defined as any death, decompensated HF, MI, cardiac arrest, or ventricular tachycardia/fibrillation, within 5 years of initial drug dispense. Secondary outcomes were individual MACE. Gastrointestinal bleeding was set as a falsification endpoint. Results: Of 1,245,340 patients with A1c <10% and 293,072 patients with A1c ≥10%, 7,483 and 1,563 patients started on GLP-1 RA as a single agent and part of a combined approach, respectively. After PSM, baseline covariates were balanced between the two treatment groups and no significant differences were observed in the falsification endpoint by treatment arm (Figure) . Compared with non-GLP-1 RA, with the exception of sodium-glucose cotransporter-2 (SGLT2i), starting a GLP-1 RA first was associated with a significant reduction in MACCE, primarily driven by reductions in decompensated HF (Figure) . Conclusions: Initiation of a GLP-1 RA as the first agent for obese patients with drug-naïve type 2 DM was associated with a significant reduction in MACE compared to all other diabetes medications, with the exception of SGLT2i.

History of Preoperative Use of Gabapentin Before Lower Extremity Bypass Predisposes Patients to a High Risk of Opioid Use and Dependence in a Dose-Dependent Manner

IntroductionThis study assesses the association of preoperative use of gabapentinoids (GBPs) with postoperative risk of opioid-related disorders in peripheral artery disease patients undergoing lower extremity bypass operation. MethodsThis is a retrospective propensity score-matched analysis of patients undergoing peripheral artery bypass in TriNetX, a multicenter national database. Two study groups were constituted based on the preoperative history of prescribed GBPs. Primary outcomes were opioid-related disorders and mortality. The outcomes were reported at two-time endpoints that is, at 1 and 5 y. ResultsThis study population included a total of 23,706 patients. After propensity score-matched analysis, each group contained 5130 patients. The primary outcomes showed a significant increase in postoperative opioid-related disorders at the 1 and 5-y time points between GBPs and no GBPs groups: 1-y outcome (2.0% versus 1.1%; adj. P = 0.007) and 5-y outcome (4.5% versus 3.5%; adj. P = 0.035). Logistic regression analysis revealed an increase in the 1-y (adjusted odds ratio= 1.664; 95% CI [1.217, 2.273], P = 0.001) and 5-y (OR = 1.353; 95% CI [1.107, 1.653], P = 0.003) odds of opioid-related disorders in patients on GBPs. A secondary analysis showed a significant dose-dependent increase in the associated risk of 5-y opioid-related disorders in patients with a history of prescribed gabapentin. ConclusionsIn patients undergoing lower extremity bypass with a history of gabapentin use, there is an associated increased long-term risk of opioid-related disorders in a dose-dependent fashion. Overall, this study highlights weighing risks and benefits of prescribing GBPs for pain control versus their long-term associated risk of opioid-related disorders among other adverse outcomes.

Does Dialysis Therapy Cause Cognitive Impairment in Older Adults? A Propensity Score Matching Retrospective Study From a Japanese Long-Term Care Insurance Certification Survey.

This study explored the longitudinal connection between dialysis therapy in older adults and the incidence of cognitive impairment, and trends of general abilities. We conducted a retrospective propensity score matching (PSM) analysis of data from the care-needs certification survey in City A, Japan, spanning 2017 to 2021. Our sample comprised 11 443 initially cognitively intact older adults from the baseline year 2017. Among them, individuals had received dialysis therapy at baseline, and 216 individuals were included after PSM. The dialysis group had a significantly lower incidence of cognitive impairment during follow-up than the control group (P = 0.02). The competing risk of death was significantly higher in the dialysis group than in the control group (P < .001). Both groups showed a decline in their comprehensive ability over the time. There have been several reports of a negative association between dialysis and cognitive impairment, but more detailed investigation of the longitudinal relationship may be needed. Comprehensive support remains critical for both dialysis and non-dialysis older adults.

The trends and outcomes of inflammatory bowel disease surgery during the COVID-19 pandemic: A retrospective propensity score-matched analysis from a multi-institutional research network.

The coronavirus disease 2019 (COVID-19) pandemic has affected the management of inflammatory bowel disease (IBD) patients. Elective operations and surveillance endoscopies were postponed for IBD patients to preserve healthcare resources and to prevent the spread of COVID-19. This study aimed to describe the trends and outcomes of IBD surgery during the pandemic. This was a retrospective propensity score-matched analysis using data extracted from TriNetX, a multi-institutional research database. IBD patients admitted for surgery were identified between March 2019 to February 2020 (prepandemic) and March 2020 to February 2023 (pandemic). The monthly volume of IBD surgical procedures was compared during the pandemic to the prepandemic period. After matching, the risk of adverse outcomes following IBD surgery was compared between the 3 years of the pandemic compared to the prepandemic cohort. There was a reduction in both elective and emergency IBD operations during the pandemic. These trends were not significant. After matching, the risks of returning to theaters and hospital readmission were comparable across the 3 years of the pandemic. In the first and second years of the pandemic, elective patients were at a greater risk of mortality (risk ratio [RR], 2; 95% confidence interval [CI], 1.160-3.448 and RR, 1.778; 95% CI, 1.003-3.150, respectively) and the emergency cohort had a higher risk of critical care admission (RR, 1.759; 95% CI, 1.126-2.747 and RR, 1.742; 95% CI, 1.131-2.682, respectively). Our study highlights the impact of the COVID-19 pandemic on the management of IBD patients undergoing surgery. These results provide insights into the management of IBD surgery during times of crisis and can help guide decision-making and resource allocation for IBD patients requiring surgical intervention.

The effect of brace treatment history on bone density in preoperative patients with adolescent idiopathic scoliosis (AIS) assessed by vertebral bone quality (VBQ) score: a retrospective propensity score-matched analysis

IntroductionAdolescent idiopathic scoliosis (AIS), a prevalent condition among teenagers, is often accompanied by osteopenia. However, the impact of brace treatment on bone density in AIS patients remains a matter of debate. The Vertebral bone quality (VBQ) score, derived from MRI signal intensity, has been shown to correlate with bone mineral density (BMD). Yet, no studies to date have drawn comparisons between VBQ scores in preoperative AIS patients who had brace treatment history and those who have not received brace treatment.ObjectiveThis study aims to elucidate the influence of brace treatment on bone density in AIS patients using VBQ score.MethodsA retrospective analysis was conducted on 243 AIS patients, each with Cobb angles ranging from 50–70°, who had undergone preoperative MRI scans. The patients were segregated into two cohorts: those who received brace treatment (n = 174) and those who did not (n = 69). Through propensity score matching, a total of 53 matched pairs were selected for further analysis. VBQ scores were extracted from T1-weighted MRI scans.ResultsPost-matching, no significant baseline discrepancies were observed between the two groups. Interestingly, brace-treated patients exhibited lower average VBQ scores than their non-brace-treated counterparts (2.43 ± 0.11 vs. 2.55 ± 0.12, p < 0.01), suggesting a higher bone density. Furthermore, a negative correlation was observed between VBQ scores and the duration of brace usage (R2 = 0.3853, p < 0.01).ConclusionBrace treatment may potentially enhance bone density in AIS patients by mitigating vertebral fat infiltration. The utilization of VBQ scores presents an alternative, potentially robust approach to assessing bone quality.

Costs of Robotic and Laparoscopic Bariatric Surgery: A Retrospective Propensity Score-matched Analysis.

Robotic bariatric surgery has not shown significant advantages compared to laparoscopy, yet costs remain a major concern. The aim of our study was to assess costs of robotic and laparoscopic bariatric surgery. We retrospectively collected data of all patients who underwent either robotic or laparoscopic bariatric surgery at our institution. We retrieved demographics, clinical characteristics, postoperative data, and costs using a bottom-up approach. The primary endpoint was hospital costs in the robotic and laparoscopic groups. Data was analyzed using a propensity score matching. Out of the total 122 patients enrolled in the study, 42 were subsequently chosen based on propensity scores, with 21 patients allocated to each group. No difference in clinical characteristics and postoperative outcomes were noted. Length of hospital stay was 2.4 ± 0.7days vs. 2.6 ± 1.1days (p = 0.520). In the robotic and laparoscopic groups, total costs were USD 16,275 ± 4018 vs. 12,690 ± 2834 (absolute difference USD 3585, 95%CI 1416-5753, p = 0.002), direct costs were USD 5037 ± 1282 vs. 3720 ± 1308 (absolute difference USD 1316, 95% CI 509-2214, p = 0.002), and indirect costs were USD 11,238 ± 3234 vs. 8970 ± 3021 (absolute difference USD 2,268, 95% CI 317-4220, p = 0.024). Subgroup analyses revealed a decreasing trend in the cost difference in patients undergoing primary gastric bypass and revisional surgery. Overall hospital costs were higher in patients operated on with the robotic system than with laparoscopy, yet a clinical advantage has not been demonstrated so far. Subgroup analyses showed lesser disparity in costs among patients undergoing revisional bariatric surgery, where robotics are likely to be more worthwhile.

Impact of pulmonary rehabilitation on exercise capacity, health-related quality of life, and cardiopulmonary function in lung surgery patients: a retrospective propensity score-matched analysis.

Pulmonary rehabilitation is considered beneficial for patients undergoing lung surgery, yet its specific impacts on exercise capacity, health-related quality of life (HRQL), and cardiopulmonary function require further elucidation. This study aimed to evaluate the effect of PR on these outcomes in patients undergoing lung surgery using a retrospective propensity score-matched analysis. We retrospectively analyzed 420 patients with non-small cell lung cancer (NSCLC) who underwent lung surgery from January 2022 to May 2024. Among these, 84 patients received PR while 336 did not (control group). Propensity score matching (PSM) at a 1:1 ratio yielded 46 patients in each group. Baseline characteristics, spirometry, cardiopulmonary exercise testing, respiratory muscle strength, HRQL, and muscle measurements were assessed pre-and post-surgery. Before PSM, significant differences existed between groups, with the PR group being older and having different pulmonary function baselines. After PSM, groups were well-balanced. Postoperatively, the PR group showed significant improvements in FEV1/FVC (64.17% vs. 50.87%, p < 0.001), FEV1 (2.31 L/min vs. 1.75 L/min, p < 0.001), and predicted FVC percentage (88.75% vs. 68.30%, p < 0.001). Cardiovascular responses showed a lower CI during exercise in the PR group post-PSM (6.24 L/min/m2 vs. 7.87 L/min/m2, p < 0.001). In terms of exercise capacity, the PR group had higher maximal WR percentage (104.76% vs. 90.00%, p = 0.017) and peak VO2 (1150.70 mL/min vs. 1004.74 mL/min, p = 0.009). PR also resulted in less leg soreness and lower total CAT scores postoperatively. Muscle measurements indicated significantly smaller reductions in ΔHUESMCSA and percentage change in the PR group. Pulmonary rehabilitation significantly enhances exercise capacity, HRQL, and cardiopulmonary function in patients undergoing lung surgery. It also mitigates postoperative muscle loss, underscoring its importance in the postoperative management of lung surgery patients.

Programmed cell death ligand 1 (PD-L1) inhibitors versus programmed cell death 1 (PD-1) inhibitors for the first-line therapy of extensive-stage small cell lung cancer: A propensity score-matched study.

206 Background: Addition of programmed cell death ligand 1 (PD-L1) inhibitors or programmed cell death 1 (PD-1) inhibitors to etoposide‐platinum (EP) chemotherapy has become the standard first-line regimen for ES-SCLC. The clinical efficacy and safety between the two types of immune checkpoint inhibitors (ICIs) remain controversial. We conduct the retrospective study and propensity score-matched analysis to explore the potential differences between them. Methods: Patients diagnosed with ES-SCLC and treated by EP plus PD-L1 or PD-1 inhibitors at Shandong Cancer Hospital between March 2019 and November 2022 were reviewed retrospectively. According to PD-L1 or PD-1 inhibitors, they were divided into two groups. Propensity score matching (1:1) was performed to balance the baseline characteristics of the two groups. The baseline characteristics and adverse events between the two groups were compared using the chi-squared test. The survival curves of overall survival (OS) and progression-free survival (PFS) were plotted by the Kaplan-Meier method and differences were analyzed by the log-rank test.The primary endpoints were OS and PFS. Results: As a result, 448 patients were analyzed in this study. 264 patients received PD-L1 inhibitors plus EP and 184 received PD-1 inhibitors plus EP. The median follow-up was 17.6 months. The median OS and PFS was 20.4 months and 7.8 months in the overall population. Before propensity score matching, the median OS was 20.1 months in PD-L1 inhibitor plus EP group and 20.7 months in PD-1 inhibitor plus EP group, respectively (HR 1.043, 95%CI 0.776-1.401; p= 0.781). The median PFS was 7.6 months in the PD-L1 inhibitor plus EP group and 8.5 months in PD-1 inhibitor plus EP group (HR 1.099, 95%CI 0.886-1.364; p= 0.390). After propensity score matching, the median OS and PFS were 20.4 months and 7.8months in PD-L1 inhibitor plus EP group, and those were 20.1 months and 8.6 months in PD-1 inhibitor plus EP group. There was no significant difference in OS and PFS between PD-L1 inhibitors plus EP and PD-1 inhibitors plus EP in the matched population (HR 1.104; p= 0.578 and HR 1.072; p= 0.602, respectively). The overall adverse events were comparable in the two groups. Only ≥3 grade neutropenia was more frequent in the PD-L1 inhibitors plus EP group (77.7% vs 69.0%, p= 0.040). Conclusions: In conclusion, the overall efficacy and safety profile was similar between PD-L1 inhibitors and PD-1 inhibitors for the first-line treatment of ES-SCLC.

Prophylactic Dose of Rivaroxaban Versus Warfarin for the Treatment of Isolated Calf Muscle Vein Thrombosis: A Retrospective Propensity Score-Matched Analysis

BackgroundProphylactic dose of rivaroxaban is often used in treatment of isolated calf muscle vein thrombosis (ICMVT), nevertheless, its effect is less reported. This study aims to evaluate short-term outcomes in patients with ICMVT who received prophylactic dose of rivaroxaban or warfarin therapy. MethodsA retrospective analysis of 472 ICMVT patients who received two different treatment regimens was undertaken. Propensity score matching method was used to balance the confounding effect of baseline clinical data. Chi-squared test and logistic regression analysis were used to compare outcomes (venous thromboembolism events, bleeding events, complete clot resolution) according to the type of treatment regimens before and after propensity score matching. Univariate and multivariable analysis were used to investigate risk factors for incomplete clot resolution of ICMVT after propensity score matching. Results242 ICMVT patients received prophylactic dose of rivaroxaban (rivaroxaban group, RG), and 230 received warfarin (warfarin group, WG). After propensity score matching, 156 patients were included in each group; Venous thromboembolism (VTE) events occurred in 14 (9.0%) patients in the RG and 10 (6.4%) in the WG (P = 0.395); No major bleeding events occurred in each group, and clinically relevant non-major bleeding events occurred in 5 (3.2%) patients in the RG and 10 (6.4%) in the WG (P = 0.186); Complete clot resolution at 3 months occurred in 80 (51.3%) patients in the RG and 100 (64.1%) in the WG (P = 0.022). Logistic regression analysis showed that there were no significant differences between RG and WG in VTE events (odds ratio 1.439, 95% confidence interval 0.619 to 3.347, P = 0.397) and clinically relevant non-major bleeding events (odds ratio 0.483, 95% confidence interval 0.161 to 1.449, P = 0.194); it revealed that complete clot resolution rate at 3 months was different in the two groups (odds ratio 0.589, 95% confidence interval 0.375 to 0.928, P = 0.022). Treatment regimens (prophylactic dose of rivaroxaban), thrombosis (maximum diameter >7 mm) and risk factors for VTE (non-surgery risk factors, mainly referring to active malignancy) were risk factors for incomplete clot resolution of ICMVT (P < 0.05). ConclusionsIn this retrospective study with a short-term follow-up, ICMVT patients who received prophylactic dose of rivaroxaban had no significant differences in VTE and bleeding events compared to those who received warfarin therapy (the overall INR > 2.0 for >50% of the time); but it was not conducive to complete clot resolution.

Impact of immunotherapy combined with neoadjuvant chemotherapy or chemoradiotherapy on perioperative safety in locally advanced esophageal squamous cell carcinoma (LA-ESCC): A retrospective propensity score-matched analysis.

e16105 Background: Immunotherapy combined with chemotherapy (nICT) or chemoradiotherapy (nICRT) has become the latest option for patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC). The safety of this treatment remains uncertain. This study aims to evaluate the perioperative safety profile of nICT or nICRT among patients diagnosed with LA-ESCC. Methods: LA-ESCCpatients who underwent esophagectomy with or without neoadjuvant immunotherapy combining treatments (nIComT) at Jiangsu Cancer Hospital from January 2020 to January 2022 were included. A 1:1 propensity score matching (PSM) was used to balance demographic and oncologic characteristics between the two groups. The primary endpoint was postoperative complications, which were assessed by the Esophageal Cancer Complications Consensus Group (ECCG) criteria and the Clavien-Dindo criteria. Results: 1477 patients were screened, and a total of 873 patients were eligible for this study.Through PSM based on age, gender, body mass index, and clinical TNM stage, 118 pairs of patients were evenly allocated to the surgery-alone and nIComT groups. Compared to the surgery-alone group, the nIComT group showed slightly higher complication rates (66.1% vs 77.1%, P= 0.061). Grade Ⅰ or Ⅱ cardiovascular system complications appeared to be more common in the nIComT group than the surgery-alone group (57.6% vs 37.3%, P= 0.002). The cardiovascular system complications mainly included hypotension with sinus tachycardia (53.4% vs 34.7%, P= 0.004) which requires continuous pumping of vasopressor medications including dopamine, ephedrine, and norepinephrine during the perioperative period. It is noteworthy that patients in the nIComT group exhibited a higher incidence of perioperative diuretic and cardiotonic therapy due to congestive heart failure compared to the surgery-alone group (11.0% vs 5.1%, P= 0.094), although this disparity did not attain statistical significance. The nIComT group exhibited a notable increase in the percentage of patients requiring perioperative blood transfusion (35.6% vs 16.9%, P= 0.001), as well as an extended operation duration (277 ± 66 vs 246 ± 62 mins, P&lt; 0.001), when compared to the surgery-alone group. Additionally, there was also a trend towards a higher proportion of patients in the nIComT group requiring intraoperative blood transfusion due to excessive blood loss (7.6% vs 2.5%, P= 0.075). The surgery-alone group ( n= 1) and the nIComT group ( n= 3) showed no significant differences in 30-day mortality rates ( P= 0.614). Conclusions: Our findings revealed a heightened incidence of cardiovascular complications among patients received nIComT, underscoring the significance of perioperative circulatory interventions. Further prospective studies are needed for validation.

Programmed cell death ligand 1 (PD-L1) inhibitors versus programmed cell death 1 (PD-1) inhibitors for the first-line therapy of extensive-stage small cell lung cancer: A propensity score-matched study.

8086 Background: Addition of programmed cell death ligand 1 (PD-L1) inhibitors or programmed cell death 1 (PD-1) inhibitors to etoposide‐platinum (EP) chemotherapy has become the standard first-line regimen for ES-SCLC. The clinical efficacy and safety between the two types of immune checkpoint inhibitors (ICIs) remain controversial. We conduct the retrospective study and propensity score-matched analysis to explore the potential differences between them. Methods: Patients diagnosed with ES-SCLC and treated by EP plus PD-L1 or PD-1 inhibitors at Shandong Cancer Hospital between March 2019 and November 2022 were reviewed retrospectively. According to PD-L1 or PD-1 inhibitors, they were divided into two groups. Propensity score matching (1:1) was performed to balance the baseline characteristics of the two groups. The baseline characteristics and adverse events between the two groups were compared using the chi-squared test. The survival curves of overall survival (OS) and progression-free survival (PFS) were plotted by the Kaplan-Meier method and differences were analyzed by the log-rank test.The primary endpoints were OS and PFS. Results: As a result, 448 patients were analyzed in this study. 264 patients received PD-L1 inhibitors plus EP and 184 received PD-1 inhibitors plus EP. The median follow-up was 17.6 months. The median OS and PFS was 20.4 months and 7.8 months in the overall population. Before propensity score matching, the median OS was 20.1 months in PD-L1 inhibitor plus EP group and 20.7 months in PD-1 inhibitor plus EP group, respectively (HR 1.043, 95%CI 0.776-1.401; p= 0.781). The median PFS was 7.6 months in the PD-L1 inhibitor plus EP group and 8.5 months in PD-1 inhibitor plus EP group (HR 1.099, 95%CI 0.886-1.364; p= 0.390). After propensity score matching, the median OS and PFS were 20.4 months and 7.8months in PD-L1 inhibitor plus EP group, and those were 20.1 months and 8.6 months in PD-1 inhibitor plus EP group. There was no significant difference in OS and PFS between PD-L1 inhibitors plus EP and PD-1 inhibitors plus EP in the matched population (HR 1.104; p= 0.578 and HR 1.072; p= 0.602, respectively). The overall adverse events were comparable in the two groups. Only ≥3 grade neutropenia was more frequent in the PD-L1 inhibitors plus EP group (77.7% vs 69.0%, p= 0.040). Conclusions: In conclusion, the overall efficacy and safety profile was similar between PD-L1 inhibitors and PD-1 inhibitors for the first-line treatment of ES-SCLC.

Comparison of Survival Outcomes between Radical Antegrade Modular Pancreatosplenectomy and Conventional Distal Pancreatosplenectomy for Pancreatic Body and Tail Cancer: Korean Multicenter Propensity Score Match Analysis.

(1) Background: The aim of this study was to compare the survival benefit of radical antegrade modular pancreatosplenectomy (RAMPS) with conventional distal pancreatosplenectomy (cDPS) in left-sided pancreatic cancer. (2) Methods: A retrospective propensity score matching (PSM) analysis was conducted on 333 patients who underwent RAMPS or cDPS for left-sided pancreatic cancer at four tertiary cancer centers. The study assessed prognostic factors and compared survival and operative outcomes. (3) Results: After PSM, 99 patients were matched in each group. RAMPS resulted in a higher retrieved lymph node count than cDPS (15.0 vs. 10.0, p < 0.001). No significant differences were observed between the two groups in terms of R0 resection rate, blood loss, hospital stay, or morbidity. The 5-year overall survival rate was similar in both groups (cDPS vs. RAMPS, 44.4% vs. 45.2%, p = 0.853), and disease-free survival was also comparable. Multivariate analysis revealed that ASA score, preoperative CA19-9, histologic differentiation, R1 resection, adjuvant treatment, and lymphovascular invasion were significant prognostic factors for overall survival. Preoperative CA19-9, histologic differentiation, T-stage, adjuvant treatment, and lymphovascular invasion were independent significant prognostic factors for disease-free survival. (4) Conclusions: Although RAMPS resulted in a higher retrieved lymph node count, survival outcomes were not different between the two groups. RAMPS was a surgical option to achieve R0 resection rather than a standard procedure.

Survival outcomes and toxicity profiles among patients with nonmetastatic nasopharyngeal carcinoma treated with intensity-modulated radiotherapy (IMRT) versus IMRT + carbon-ion radiotherapy: A propensity score-matched analysis.

To compare survival outcomes and toxic effects among patients with newly diagnosed nonmetastatic nasopharyngeal carcinoma (NPC) when treated with intensity-modulated radiotherapy (IMRT) versus IMRT + carbon-ion radiotherapy (CIRT). We performed a retrospective propensity score matching analysis (1:1) of patients treated with IMRT and IMRT + CIRT. Descriptive statistics were used to examine the baseline characteristics of the patients. Survival was estimated using the Kaplan-Meier method. Univariate and multivariable logistic regression analysis were used to identify the independent predictors of survival. We examined the association between risk factors and adverse events (AEs) using chi-square tests. Cox model and logistic regression were used to analyze AEs. Hundred and nine patients who received IMRT + CIRT were included and the median follow-up time was 20.6 months (range: 4.6-82 months). There were no statistically significant differences in locoregional failure-free survival, distant metastasis-free survival, disease-free survival, or overall survival between the two groups, but potentially better in IMRT + CIRT group (p > 0.05, respectively). Nodal boost was the only significant factor associated with LRFS and DFS on multivariable analysis. Thirty-seven patients (34.0%) developed grade 3 acute OMs and no grade 4 acute OMs were observed in IMRT + CIRT group. All patients in IMRT + CIRT group developed grade 1 dermatitis; while in the match group, 76 patients developed grade 1 dermatitis, 27 patients developed grade 2 dermatitis, 5 patients developed grade 3 dermatitis, 1 patient developed grade 4 dermatitis. IMRT + CIRT treatment was associated with a significant trend of lower grades of OM and dermatitis (p < 0.05, respectively). Any severe (i.e., grade 3) chronic AEs, such as xerostomia, skin fibrosis, temporal lobe necrosis, osteoradionecrosis, or radiation-induced optic neuropathy, was not observed. In this study, IMRT + CIRT was associated with significantly reduced acute toxicity burden compared with full course of IMRT, with excellent survival outcomes. Patients with persistent disease after treatment and treated with nodal boost had a worse outcome. More accurate assessments of IMRT + CIRT to primary nonmetastatic NPC patients will be imperative.

Therapeutic plasma exchange decreases serum triglyceride level rapidly and reduces early recurrence rate but no advantages in improving outcomes for patients with hyperlipidemic acute pancreatitis: a retrospective propensity score matching analysis based on twenty year’s experience

BackgroundHyperlipidaemic acute pancreatitis (HLAP) has become the most common cause of acute pancreatitis (AP) not due to gallstones or alcohol (Mosztbacher et al, Pancreatology 20:608-616, 2020; Yin et al, Pancreas 46:504-509, 2017). Therapeutic plasma exchange (TPE) has been reported to be effective in reducing serum TG levels which is important in management of HLAP (World J Clin Cases 9:5794-803, 2021). However, studies on TPE are mostly focusing on cases reports, TPE remains poorly evaluated till date and need to be compared with conservative therapy with a well-designed study.MethodsA retrospectively cohort study on HLAP patients between January 2003 and July 2023 was conducted. Factors correlated with efficacy of TPE were included in a propensity model to balance the confounding factors and minimize selection bias. Patients with and without TPE were matched 1:2 based on the propensity score to generate the compared groups. Lipid profiles were detected on admission and consecutive 7 days. The triglyceride (TG) level decline rates, percentage of patients to reach the target TG levels, early recurrence rate, local complications and mortality were compared between groups.ResultsA total of 504 HLAP patients were identified. Since TPE was scarcely performed on patients with TG < 11.3 mmol/L, 152 patients with TG level 5.65 to 11.3 mmol/L were excluded while 352 with TG ≧11.3 mmol/L were enrolled. After excluding 25 cases with incomplete data or pregnancy, 327 patients, of whom 109 treated without TPE while 218 treated with TPE, were included in data analysis. One-to-two propensity-score matching generated 78 pairs, 194 patients with well-balanced baseline characteristics. Of 194 patients enrolled after matching done, 78 were treated without while 116 with TPE. In the matched cohort (n = 194), patients treated with TPE had a higher TG decline rate in 48 h than those without TPE (70.00% vs 54.00%, P = 0.001); the early recurrence rates were 8.96% vs 1.83%, p = 0.055. If only SAP patients were analyzed, the early recurrence rates were 14.81% vs 0.00% (p = 0.026) respectively. For patients with CT severity index (CTSI) rechecked within 14 days, early CTSI improment rate were 40.90% vs 31.91%. Local complications checked 6 months after discharge were 44.12% vs 38.30%. Mortality was 1.28% vs 1.72%. No differences were found in early stage CTSI improment rate (P = .589), local complications (P = .451) or motality between two groups.ConclusionsTPE reduces TG levels more quickly in 48 h compared with those with conservative treatment, but no difference in the consecutive days. TPE tends to reduce the early recurrence rate comparing with conventional therapy, but TPE has no advantages in improving CTSI in early stage, and no improvement for outcomes including local complications and mortalty.

A retrospective propensity score-matched analysis of oncological and functional outcomes of submental island flap versus radial forearm free flap for oral cavity cancer reconstruction

BackgroundThis retrospective study aims to compare the oncological and functional outcomes of the submental island flap versus the radial forearm free flap used for oral cavity cancer reconstruction after minimizing differences in baseline characteristics.MethodsPropensity scores for each oral cavity cancer patient who underwent surgical resection and immediate reconstruction with a submental island flap or a radial forearm free flap with a flap size ≤ 60 cm2 between October 2008 and December 2021 were generated based on the likelihood of being selected given their baseline characteristics. Patients were matched using a 1:1 nearest-neighbor approach.ResultsThe final matched-pair analysis included 51 patients in each group. The 5-year overall survival, disease-specific survival, and locoregional control rates were 70.1% and 64.8% (p = 0.612), 77.3% and 83.7% (p = 0.857), and 76.1% and 73.3% (p = 0.664), respectively, for the submental island flap group and the radial forearm free flap group. Speech and swallowing functions were comparable between groups. However, there were significantly lower rates of complication associated with both donor and recipient sites in the submental island flap group, and also the duration of hospital stays and hospital costs were significantly lower in these patients. A subgroup analysis of patients in which the reconstruction was carried out using the submental island flap procedure revealed that in selected cases, the presence of clinically and pathologically positive level I lymph nodes did not affect survival or locoregional control rates.ConclusionsAlthough this study was not randomized, the matched-pair analysis of surgically treated oral cavity cancer patients showed that submental island flap reconstruction is as effective as radial forearm free flap reconstruction with regard to oncological and functional outcomes with lower complication rates, hospital stay, and hospital costs. This flap can be safely and effectively performed in selected cases with a clinical level I lymph node smaller than 1.5 cm and no signs of extranodal extension.

Effect of intraoperative magnesium sulphate on acute kidney injury following robot-assisted radical prostatectomy: a retrospective propensity score-matched analysis.

Although intraoperative magnesium sulphate administration has various advantages, its influence on the occurrence of postoperative acute kidney injury (AKI) remains unclear, particularly in patients undergoing robot-assisted radical prostatectomy (RARP). The steep Trendelenburg position and a high intra-abdominal pressure can render patients susceptible to AKI after surgery. This study aimed to evaluate the effects of intraoperative magnesium sulphate administration on postoperative AKI in patients who underwent RARP. This retrospective study used a propensity score-matched analysis to evaluate the medical records of patients who underwent RARP between May 2013 and December 2021 in a single institution. In total, 3,239 cases were reviewed. After propensity score matching, 456 patients were each included in the magnesium and control groups. Univariate and multivariate logistic regression analyses were conducted to identify risk factors for postoperative AKI, as defined by the Kidney Disease Improving Global Outcomes criteria, within seven days after surgery. The incidence of postoperative AKI did not differ significantly between the magnesium and control groups (30.7% versus 31.4%). The univariate logistic regression analysis revealed that intraoperative magnesium sulphate administration was not associated with AKI after RARP (p=0.83). In the multivariate analysis, body mass index (odds ratio [OR], 1.069; p=0.018) and duration of surgery (OR, 1.005; p=0.027) were independent risk factors, while total intravenous anaesthesia (OR, 0.448; p=0.005) and intraoperative fluid replacement (OR, 0.856; p=0.012) were protective factors for postoperative AKI. Intraoperative magnesium sulphate administration had no significant effect on the occurrence of postoperative AKI in patients undergoing RARP.