Risk Factors For Long-term Survival Research Articles

Lymphangiosis carcinomatosa independently affects long-term survival of Non-Small Cell Lung Cancer patients

ObjectiveThe significance of postoperatively diagnosed Lymphangiosis Carcinomatosa (L1) as an independent risk factor for long-term survival in Non-Small Cell Lung Cancer (NSCLC) remains controversial. We analyzed the effect of L1 on postoperative survival in stage I, II and III NSCLC-patients. MethodsWe investigated all consecutive patients with NSCLC between January 2012 and December 2019 who underwent an anatomical resection and radical lymphadenectomy at our institute. L1-were compared to L0-patients. All patients received adjuvant chemotherapy in accordance with European guidelines. 3- and 5- year survival rates and median-survival were assessed. To investigate whether L1 is an independent risk factor, we carried out a multivariate cox regression and a pair-match analysis looking at different properties such as TNM. ResultsA total of 641 patients (L0: 74%; L1: 26%) were analyzed. Baseline characteristics were comparable between groups. The mean age was 65.3 ± 10.2 years and 64.9 ± 9.4 years in the L0 and L1-groups respectively (p-value = 0.703). 58.5% of L0-patients were male (L1: 62.7%; p-value = 0.351). Overall survival in the L1-group was significantly shorter compared to the L0-group (L1: 42.3 ± 2.8; L0: 67.6 ± 2.1 months; p-value<0.0001). We confirmed this finding in a pair-matched analysis (L0: 73.9 ± 4.7 months; L1: 42.2 ± 4.2; p-value = 0.009). 3- and 5-year survival were significantly shorter for L1-patients (3-year: L0: 65.9%; L1: 35.9%; p-value<0.0001) (5-year: L0: 34.9%; L1: 7.5%; p-value<0.0001). ConclusionL1 is an independent risk factor for long-term survival of patients with NSCLC. This cohort supports that the L0/L1 status should be included in pathological reports. We suggest to further include L0/L1-status in guideline recommendations for NSCLC patients.

Retrograde cerebral perfusion for surgery of type A aortic dissection

BackgroundFor type A aortic dissection (TAAD), antegrade cerebral perfusion (ACP) was proposed as a more physiological method than retrograde cerebral perfusion (RCP) for intra-operative brain protection, but it is still debatable whether antegrade cerebral perfusion (ACP) or retrograde cerebral perfusion (RCP) is related to the better clinical outcome. The present study was undertaken to compare the results in our patients receiving surgery for TAAD with ACP or RCP. The primary aim of this study was focused on the incidence of and the factors associated with surgical mortality, post-operative neurological outcomes and long-term survival. MethodsFrom February 2001 to March 2019, there were 223 consecutive patients with TAAD treated surgically at our hospital. The median age at presentation was 56 years (range 29–88 years) and 70 patients (31.4%) over 65 years of age. There were 168 patients treated with RCP and 55 patients treated with ACP. The primary endpoints were surgical mortality and neurological outcome. Propensity score matching was used to compare the treatment results of surgeries with RCP or ACP. The long-term survival was also analyzed. ResultsThe overall in-hospital mortality rate and the overall 30-day mortality rate were 15.6% and 14.3% respectively. For the patients without pre-operative shock (n = 184), the in-hospital mortality rate was 10.3% and the 30-day mortality rate was 8.7% and higher long-term survival rates (88.3% for 5 years, 86.5% for 10 years, 86.5% for 15 years) were documented for this patient group. There was no significant difference on the surgical mortality between the ACP group and the RCP group. In the entire cohort, there were 23 patients (10.3%) who suffered from post-operative neurological deficits (PND) and there were less PND for the patients with RCP than the patients with ACP (7.7% vs 18.1%, p = 0.027). After propensity score matching, there was still higher incidence of PND in the ACP group than in the RCP group but without statistical significance (18.5% vs 11.1%, p = 0.279). ConclusionsAortic surgery carries high risk for the patients with TAAD and PND is not an unusual post-operative morbidity. In our series, pre-operative shock, pre-operative CPR, CRI, past history with CAD are related to higher surgical mortality. The younger patients (<65 years old) without pre-operative shock got better surgical outcome and long-term survival. RCP could provide acceptable cerebral protection during aortic surgery for the TAAD patients. Old age, pre-operative shock, CRI and past history of CAD are independent risk factors for long-term survival.

Liver Resection for Patients with Hepatocellular Carcinoma and Child B Liver Function: A Single-center Experience

Objectives: Liver resection is the first-line treatment option for patients with hepatocellular carcinoma (HCC). Whether patient with HCC and Child B liver function can performed liver resection is still controversial. Methods: From January 2012 to June 2018, Child B patients with HCC who underwent liver resection were enrolled in this study. Perioperative complications and risk factors for long-term survival were analyzed. Results: During the study period, 186 Child B patients perform liver resection. Of these, 140 patients (75.3%) were presented with cirrhosis, 154 (82.8%) with ascites, 98 (52.7%) with portal hypertension, and the median tumor size was 7.2 cm. Forty-one patients performed laparoscopic liver resection, and 40 patients received additional splenectomy. Most patients (77.4%) only underwent minor resection and non-anatomical hepatectomy. The minor and major surgical complication was 31.2% and 24.7%, respectively. The 1-, 3-, and 5-year disease-free and overall survival were 49.8% and 69.5%, 33.8% and 47.5%, 24.5% and 30.4%, respectively. The laparoscopic procedure achieved similar long-term survival but better perioperative outcomes. Among those with portal hypertension, patients received additional splenectomy achieved better oncological outcomes. Multivariate analysis showed that portal hypertension (HR 1.490, 95% CI 0.979-2.269, P=0.043), tumor size >5 cm (HR 1.928, 95% CI 1.276-2.914, P=0.002), macrovascular invasion (HR 1.746, 95% CI 1.116-2.733, P=0.015). Conclusions: Liver resection achieved long-term survival in some selective patients with HCC and Child B liver function, especially for those with small tumor size, and without portal hypertension and macrovascular invasion. A laparoscopic procedure could decrease surgical complications and splenectomy could prolong long-term survival.

Impact of hypertension on short- and long-term survival of patients who underwent emergency surgery for type A acute aortic dissection.

BackgroundTo explore the clinical characteristics and prognosis of patients with hypertension underwent emergency surgery for type A acute aortic dissection (TA-AAD).MethodsThe present study enrolled 712 consecutive patients diagnosed with TA-AAD and received aortic repair surgery at our hospital between January 2014 to December 2018. Clinical characteristics of enrolled patients were retrospectively reviewed. Patients were grouped by preexisting hypertension history and matched with propensity scores matching method. Patients’ clinical characteristics were compared and analyzed before and after propensity scoring. To identify predictors for long-term mortality rate, Kaplan-Meier survival estimation and Cox proportional hazard analysis were performed.ResultsA total of 492 patients (69.1% of all patients in the cohort) were included in the hypertensive group and they had increased age and weight compared to patients in the non-hypertensive group. Between two groups, preoperative leukocyte count and serum creatinine level were found significant different (P<0.05). After propensity scoring, 128 pairs (256 patients) were successfully matched. Our analysis showed that there was no significant difference of ventilation duration, 30-day mortality rate, intensive care unit stay and hospitalization time between two groups. However, our data suggested that hypertensive patients presented with less intra-operative aortic valve involvement. There was a significant difference in long-term survival rate (P=0.037) between two groups. Cox regression analysis demonstrated that hypertension was an independent risk factor [hazard ratio (HR), 3.040; 95% confidence interval (CI), 1.124–8.227; P=0.029].ConclusionsOur data suggested that TA-AAD patients complicated with hypertension had increased age and weight compared to non-hypertensive patients. Concomitant hypertension identified upon hospital administration was an independent risk factor for long-term survival in TA-AAD patients while did not influence the 30-day mortality rate.

Reassessment of kidney function equations in predicting long-term survival in cardiac surgery.

Chronic kidney disease (CKD) is a risk factor for long-term survival in cardiac surgery. The Cockcroft-Gault, Modification of Diet in Renal Disease (MDRD) study, CKD Epidemiology Collaboration (CKD-EPI), revised Lund-Malmö (LM), and full age spectrum equations are used to estimate glomerular filtration rates (eGFR), but each have advantages and disadvantages. Our objective was to determine which equation better predicts long-term survival. Data on 1492 consecutive patients who underwent isolated off-pump coronary artery bypass surgery between September 1996 and December 2008 were prospectively collected. Preoperative and postoperative eGFR were calculated using the five equations and compared using Cox regression analyses and time-dependent receiver operating characteristic (ROC) curves at 10 years. In a Cox regression model after correction for significant predictors of long-term mortality, adjusted hazard ratios (HR) for one standard deviation increase in preoperative eGFR were 0.661 (P < .0001), 0.844 (P = .0166), 0.787 (P = .0002), 0.746 (P < .0001), and 0.717 (P < .0001) for the CG, MDRD, CKD-EPI, LM, and FAS equations, respectively. The areas under the time-dependent ROC curve at 10 years also showed that the CG formula has a better predictive value. Postoperative eGFR at discharge were also significant predictors of long-term mortality (HR = 0.603, P < .0001; HR = 0.725, P < .0001; HR = 0.688, P < .0001; HR = 0.673, P < .0001; HR = 0.632, P < .0001 for the CG, MDRD, CKD-EPI, LM, and FAS equations, respectively). The CG formula was shown to better predict survival in cardiac surgery, though the FAS equation has a comparable prognostic value. Additionally, postoperative eGFR at discharge also predicted long-term survival.

Evaluation of \u03b2-blocker therapy for long-term outcomes in patients with low ejection fraction after cardiac surgery

BackgroundPreoperative low left ventricular ejection fraction (LVEF) has been reported as an independent risk factor for in-hospital mortality. However, there were few studies evaluating the long-term mortality in these patients. We, therefore, conducted this study to investigate long-term outcomes of surgery on patients with LVEF≤35% undergoing a broad range of cardiac procedures.MethodsWe performed a retrospective cohort study in 510 patients from January 1, 2007 to September 1, 2019. These patients were divided into survival group (n = 386) and non-survival group (n = 124). The multivariate Cox analysis was used to estimate the risk factors for survival. In Cox analysis, β-blockers were indicated to be associated with long-term mortality. To further address bias, we derived a propensity score predicting the function of β-blockers on survival, and matched 52 cases to 52 controls with similar risk profiles.ResultsPatients were followed for a median period of 24 months (interquartile range: 11–44 months). Multivariate Cox regression analysis indicated that the non-survival group had higher weight, higher EuroSCORE, more smoking patients, longer time of cardiopulmonary bypass (CPB), more intra-aortic balloon pump (IABP) use, and more patients who always used β-blocker (HR: 2.056, 95%CI:1.236–3.420, P = 0.005) compared with survival group. After propensity matching, the group which always used β-blocker showed higher rate of all-cause death compare with the control group (61.54% vs 80.77%, P = 0.030).ConclusionsThe risk factors for long-term survival were weight, EuroSCORE, smoking, CPB, IABP, always used β-blockers in patients with LVEF≤35%. The discharge prescription of β-blocker should be cautiously administrated in those patients.

The impact of severe acute kidney injury requiring renal replacement therapy on survival and renal function of heart transplant recipients - a UK cohort study.

Severe acute kidney injury (AKI), defined as requiring renal replacement therapy (RRT), is associated with higher mortality postheart transplantation, but its long-term renal consequences are not known. Anonymized data of 3365 patients, who underwent heart transplantation between 1995 and 2017, were retrieved from the UK Transplant Registry. Multivariable binary logistic regression was performed to identify risk factors for severe AKI requiring RRT, Kaplan-Meier analysis to compare survival and renal function deterioration of the RRT and non-RRT groups, and multivariable Cox regression model to identify predicting factors of mortality and end-stage renal disease (ESRD). 26.0% of heart recipients received RRT post-transplant. The RRT group has lower survival rates at all time points, especially in the immediate post-transplant period. However, conditional on 3months survival, older age, diabetes and coronary heart disease, but not post-transplant RRT, were the risk factors for long-term survival. The predicting factors for ESRD were insulin-dependent diabetes, renal function at transplantation, eGFR decline in the first 3months post-transplant, post-transplant severe AKI and transplantation era. Severe AKI requiring RRT post-transplant is associated with worse short-term survival, but has no impact on long-term mortality. It also accelerates recipients' renal function deterioration in the long term.

P0840RENAL FUNCTION AND RISK FACTORS IN LIVER TRANSPLANT PATIENTS

Abstract Background and Aims Advanced surgical techniques and medical managements play major roles in improving patient survival after liver transplantation (LT). At the same time, identifying the causes and risk factors for long-term survival after LT are also important. Renal dysfunction following malignancy and infection is known as an important cause of mortality after LT. Various causes such as pre/post transplantation factors are known to affect renal function. The purpose of this study is to investigate the changes of renal function in patients undergoing LT and to identify factors that can predict long-term renal dysfunction. Method A retrospective study was performed on 113 patients aged 15 years or older who had undergone LT at Daegu Catholic University Hospital form January 2012 to December 2013. 97 patients survived and were followed up. Changes of renal function after LT were identified using serum creatinine every year up to 4 years. And all patients were divided into groups with increased creatinine (70 patients) and non-increased creatinine (27 patients) at 4 years after LT. pre-transplantation factors were blood urea nitrogen (BUN), creatinine, protein, albumin, hemoglobin, total bilirubin, international normalized ratio. Subsequent BUN and creatinine were compared by independent t test. Statistical analysis was performed with IBM SPSS Statistics for Window, Version 19.0. Results 58 were male (59.7%) and the mean age was 49.5 years old. 83 patients (85.6%) received liver transplantations from living donors. There were no significant differences in the donor types and recipient’s sex between the two groups with the increased and non-increased creatinine at 4 years after LT. However, the age of recipients was a significant difference between the two groups (51.3 and 45.4 years old) (p=0.018). Annual mean creatinine levels from pre-transplantation to 4 years after LT were 0.88 ± 0.39 (before transplant), 1.19 ± 0.54 (1 year after LT), 1.07 ± 0.44 (2 years), 1.12 ± 0.68 (3 years), and 1.19 ± 0.99 (4 years). Renal function decreased in 1 year after LT and improved in 2 years, then decreased again. In univariate analysis, the increased creatinine group was older than the non-increased group, and BUN and creatinine at 1 year after LT were significant differences in the two groups (p = 0.018, p = 0.031, p = 0.013). Multivariate analysis identified the creatinine at 1 year was an independent risk factor for long-term renal function after LT (OR 14.31, 95% CI: 1.5-133.3, p = 0.019). Conclusion This study explored that renal function was continuously decreased after LT and renal function at 1 year after LT had a significant effect on long-term renal function. Therefore, management of renal function during one year after LT is important for long-term renal function and may reduce mortality.

Surgical Outcomes of Hepatocellular Carcinoma With Bile Duct Tumor Thrombus

To identify optimal surgical methods and the risk factors for long-term survival in patients with hepatocellular carcinoma accompanied by macroscopic bile duct tumor thrombus (BDTT). Prognoses of patients with hepatocellular carcinoma accompanied by BDTT have been known to be poor. There have been significant controversies regarding optimal surgical approaches and risk factors because of the low incidence and small number of cases in previous reports. Records of 257 patients from 32 centers in Korea and Japan (1992-2014) were analyzed for overall survival and recurrence rate using the Cox proportional hazard model. Curative surgery was performed in 244 (94.9%) patients with an operative mortality of 5.1%. Overall survival and recurrence rate at 5 years was 43.6% and 74.2%, respectively. TNM Stage (P < 0.001) and the presence of fibrosis/cirrhosis (P = 0.002) were independent predictors of long-term survival in the Cox proportional hazards regression model. Both performing liver resection equal to or greater than hemihepatectomy and combined bile duct resection significantly increased overall survival [hazard ratio, HR = 0.61 (0.38-0.99); P = 0.044 and HR = 0.51 (0.31-0.84); P = 0.008, respectively] and decreased recurrence rate [HR = 0.59 (0.38-0.91); P = 0.018 and HR = 0.61 (0.42-0.89); P = 0.009, respectively]. Clinical outcomes were mostly influenced by tumor stage and underlying liver function, and the impact of BDTT to survival seemed less prominent than vascular invasion. Therefore, an aggressive surgical approach, including major liver resection combined with bile duct resection, to increase the chance of R0 resection is strongly recommended.

What are the Particularities of Gastric and Bariatric Surgery in the Cirrhotic Patient.

The objective of this work was to review the entire literature on gastric and bariatric surgery in order to best define the surgical indications and the specifics of their management. A literature review from 1995 to August 2015 was conducted in Pubmed and Google Scholar, using French and English as publication languages. 21 studies were included (level 3 and 4) over 128 identified. In total, if the cirrhotic patients, candidates for gastric surgery, are appropriately selected, long-term survival seems relatively good. No risk factors for long-term survival have been reported. The literature data are insufficient to be able to make recommendations concerning bariatric surgery in the cirrhotic patient.

What are the Particularities of Pancreatic Surgery in the Cirrhotic Patient?

The objective of this work was to review the entire literature on pancreatic surgery in order to best define the surgical indications and the specifics of their management. The bibliographic research was done on Pubmed over the period from January 1995 to June 2015, using French and English as the languages of publication. The two main indications discussed here are the management of cancer and chronic pancreatitis. Surgery in the cirrhotic patient exposes the patient to a higher risk of complications than in the non-cirrhotic patient. Child-Pugh and MELD scores should be used to assess risk and guide operative decision. Child-Pugh classes B and a MELD score value greater than 15 are associated with higher morbidity and mortality. However, if suitable selection is made of cirrhotic patients who are candidates for pancreatic surgery, long-term survival seems to be equivalent to the non-cirrhotic group. No risk factors for long-term survival have been reported. In conclusion, cirrhotic patients, candidates for pancreatic surgery must be correctly selected, cirrhosis exposes to a higher risk of postoperative morbidity and mortality.

Dynamic prediction of long-term survival in patients with primary gastric diffuse large B-cell lymphoma: a SEER population-based study

BackgroundThis study investigated a large number of patients to develop a predictive nomogram for survival and a web-based survival rate calculator that can dynamically predict the long-term survival of patients with primary gastric diffuse large B-cell lymphoma.MethodsA total of 2647 patients diagnosed with primary gastric diffuse large B-cell lymphoma from 1998 to 2014 were extracted from the SEER database. We used the Lasso Cox regression model to identify independent risk factors for long-term survival and to develop a predictive nomogram for survival and a web-based survival rate calculator.ResultsThe median (mean) follow-up time was 30 months (52.8 months). Cancer-specific survival rates decreased with time, while the 5-year conditional survival increased with time. Cancer-specific deaths were not constant. Cancer-specific deaths of patients within the first 2 years were high, while the risk remained relatively constant after 2 years. The independent risk factors included surgery, chemotherapy, tumor stage and age, according to the Lasso Cox regression analysis. We developed a predictive nomogram and a web-based survival rate calculator (https://linjuli1991.shinyapps.io/dynnomapp/). The calibration plot suggested that the actual value exhibited good agreement with the predicted value.ConclusionsWe found that patients with primary gastric diffuse large B-cell lymphoma had a high risk of death during the first 2 years. Additional active follow-up strategies should be provided during this period. This is the first study to develop a predictive nomogram and a web-based survival rate calculator that can provide evidence for individual treatment and follow-up.

Surgical Resection and Prognosis of Bronchopulmonary Carcinoid

背景与目的肺类癌是一种少见的神经内分泌肿瘤，有关其预后因素的研究较少。本研究旨在探讨外科手术治疗肺类癌的疗效，并分析其预后影响因素。方法回顾2000年1月-2017年12月解放军总医院收治的肺类癌患者的临床资料。以Kaplan-Meier方法计算患者的生存率，比较不同因素对预后的影响，进行单因素分析，并采用Log-rank检验; 通过Cox比例风险模型进行多因素分析。结果98例肺类癌患者行外科手术治疗，其中典型类癌和不典型类癌者分别41例、57例。肺类癌患者的5年及10年总体生存率分别为80.0%、73.6%。单因素分析显示，年龄(P=0.000, 1)、吸烟(P=0.005)、病理亚型(P < 0.000, 1)、肿瘤分期(P < 0.000, 1)、T分期(P=0.000, 2)是影响预后的因素。多因素分析显示，年龄(P=0.005)、肿瘤分期(P=0.017)是预后的独立影响因素。结论行外科手术治疗的肺类癌患者总体预后较好。年龄、肿瘤分期是影响肺类癌术后远期生存的独立危险因素。

Significance of Interstitial Lung Disease on Outcomes Following Cardiac Surgery

Interstitial lung disease (ILD) is a known risk factor for noncardiac surgery due to acute pulmonary exacerbations but its impact after cardiac surgery is not known. We examined perioperative outcomes and risk factors for long-term survival in ILD patients who underwent cardiac surgery. From January 2002 to June 2017, 294 cardiac surgery patients with a previous ILD diagnosis, including 75 patients with idiopathic pulmonary fibrosis (IPF), were identified. A comparison cohort of 1,481 non-ILD patients was selected based on a priori variables. Long-term survival was evaluated using Cox proportional hazard modeling. Median follow-up was 6.4 years. ILD patients had higher postoperative mortality, reintubation rates, longer intensive care unit stay, and higher 30-day readmission rates (all p <0.05). Kaplan-Meier estimates of survival at 1, 5, and 10 years were 89%, 62%, and 37% for the non-IPF ILD cohort, 89%, 50%, and 13% for the IPF cohort, and 95%, 82%, and 67% for the comparison cohort, respectively (overall p <0.001). These significant differences in survival persisted in our risk-adjusted survival analysis. Adjusted survival analysis identified IPF (hazard ratio 3.04) and ILD (non-IPF; hazard ratio 1.78) as significant contributors to all-cause mortality. However, there were no changes in pulmonary function tests after 48 months postprocedure. In conclusion, ILD patients who underwent cardiac surgery have increased operative mortality, reintubation rates, longer intensive care unit, and higher 30-day readmissions compared with non-ILD patients. Moreover, severity of ILD, especially in IPF, appears to be associated with shorter long-term survival. In these patients, pulmonary risk stratification and multidisciplinary team approach are crucial.

Decision analysis on treatment strategies for patients aged 75 years and over with severe valvular heart diseases

Objective To summarize the treatment decision-making strategy and its long-term efficacy for advanced elderly patients with severe valvular heart disease and clear indications for surgery. Methods Clinical data of 196 patients aged 75 years and older firmly diagnosed as severe valvular heart diseases were retrospectively analyzed.The patients were divided into the surgical group(a mean age of 77.4±2.0 years, n=126)and the conservative group(a mean age of 80.5±5.0 years, n=70). Factors affecting therapeutic decision-making were analyzed, and the differences in a long-term survival were compared between the two groups. Results The most common reason for choosing conservative treatment was the recommendation of the doctor giving a preliminary diagnosis and worrying about the high-risk surgery for the patients(62.9%, 44/70). Only 26(37.1%)patients in the conservative group were evaluated by cardiac surgeons, among whom 12(17.1%)patients were considered to have surgical contraindications, and 14(20.0%)patients themselves or their family members chose conservative treatment for the fear of surgical risks.Patients in the operation group were mainly from the outpatient department of cardiac surgery, and only 8(6.3%)cases were referred from department of internal medicine.Logistic regression analysis showed that female, chronic renal insufficiency, advanced age, pneumonia and emergency hospital admissions were independent predictors for the conservative option(P<0.01), while patients with isolated aortic valve disease tended to receive surgical treatment.Overall 5-year survival was higher in the surgical group than in the conservative group(76.4% vs.39.9%, P<0.01). Cox regression analysis disclosed that the conservative treatment option was the single risk factor for long-term survival in all series. Conclusions Many factors affect the process of therapeutic decision-making for patients with severe valvular heart diseases, and a multidisciplinary collaboration is the best way for the optimal treatment strategy for those patients. Key words: Heart valve diseases; Clinical protocols

Antiviral therapy improves post-operative survival outcomes in patients with HBV-related hepatocellular carcinoma of less than 3 cm – A retrospective cohort study

BackgroundThe impact of antiviral therapy on long-term survival outcomes in patients with small HBV-related hepatocellular carcinoma (HBV-related HCC) after liver resection is still controversial, as the impact can be overshadowed by tumor-related factors. This study investigated this impact on recurrence and survival in patients with HCC of less than 3 cm. ObjectiveThis study was designed to further determine the impact of antiviral treatment on prognosis of patients with HCC after liver resection, to verify whether patients with cirrhosis still benefited from antiviral treatment, to study the impact of antiviral treatment on post-operative HCC recurrence, and to determine whether patients with a low preoperative HBV-DNA viral load should receive antiviral therapy. MethodsThe clinical data on patients who underwent curative liver resection for histopathologically confirmed small HCC (≤3 cm in diameter) were analyzed to determine factors which were related with HCC recurrence and survival. The disease-free and overall survival outcomes were estimated by the Kaplan-Meier method. Univariate and multivariate analyses were performed to identify the risk factors of long-term survival. ResultsOf the 795 patients in this study, patients with high preoperative HBV-DNA levels had significantly worse DFS and OS outcomes at 1-, 3- and 5- year after liver resection when compared with those with low HBV-DNA levels (86.1%, 60.8%, 46.6% vs 90.5%, 71.3%, 51.4%; and 98.5%, 89.3%, 75.2% vs 98.8%, 91.5%, 84%, respectively). Patients who received antiviral therapy had significantly better DFS and OS outcomes at 1-, 3- and 5- year after liver resection when compared with those without (91.6%, 69.5%, 55% vs 80.2%, 56%, 44.2%; and 99.6%, 93.5%, 87% vs 96.1%, 80.5%, 61.3%, respectively). Antiviral therapy significantly improved the OS but not DFS outcomes in patients with low HBV-DNA levels. The corresponding 1-, 3- and 5- year DFS and OS outcomes were 92.6%, 73%, 59.1% vs 87.1%, 68.5%, 57.9%; and 99.5%, 95.1%, 91.1% vs 97.6%, 85.5%, 72.4%, respectively. Antiviral treatment significantly prolonged DFS and OS in patients with cirrhosis. The corresponding 1-, 3- and 5- year DFS and OS were 90.2%, 66%, 49% vs 73.9%, 46.6%, 32.8%; and 100%, 93.6%, 85% vs 93.8%, 73.3%, 52.6%, respectively. ConclusionAntiviral therapy improved the prognosis of small HBV-related HCC of less than 3 cm. The survival benefit was also detected in patients with cirrhosis. Antiviral therapy should be considered a routine post-operative therapy for patients with HBV-related HCC.

Initiation Condition of Hemodialysis Is Independently Associated with All-Cause Mortality in Maintenance Hemodialysis Patients: A Retrospective Study

Background: Despite the progression of dialysis techniques, the mortality of hemodialysis (HD) patients is still high in China. Here, a retrospective study was performed to investigate the neglected risk factors of all-cause mortality during maintenance HD (MHD). Methods: We investigated 117 MHD patients who died between 2011 and 2016 in the Second Xiangya Hospital of Central South University HD center. In order to analyze the risk factors of 48 months all-cause death, the methods of Kaplan-Meier and Cox regression were used. Results: Multivariate analyses of adjusted age and gender showed that MHD patients with estimated glomerular filtration rate <7 or >10 mL/min/1.73 m² and anemia (hemoglobin <100 g/L) at the initiation of dialysis are independently associated with the higher death risk. Using central venous catheter vascular access, cerebrovascular comorbidities, diabetes, low-flux dialyzer, and dialysis frequency ≤2 times weekly were also the independent risk factors of death within 48 months. Conclusions: This study indicated that the status of HD initiation is a risk factor of long-term survival in MHD patients, which were usually ignored for lacking of nephrology care prior and could potentially be identified and modified to improve the survival prognosis. Video Journal Club “Cappuccino with Claudio Ronco” at https://www.karger.com/Journal/ArticleNews/223997?sponsor=52

The Impact of Surgery on Long-Term Survival of Patients with Primary Gastric Diffuse Large B-Cell Lymphoma: A SEER Population-Based Study.

Background The aim of this retrospective study was to compare the long-term survival of patients receiving conservative with surgical treatment to analyze the prognostic factors and the impact of surgery on oncological outcomes of patients with primary gastric diffuse large B-cell lymphoma. Methods A total of 2647 patients diagnosed with primary gastric diffuse large B-cell lymphoma from 1998 to 2014 were extracted from SEER database. Propensity matching was performed to compare the clinicopathological characteristics of the two groups. Based on the recursive partitioning analysis, the patients were divided into three risk subgroups: low risk, intermediate risk, and high risk. Results After propensity score matching, patient characteristics did not differ significantly between the two groups. The 5-year cancer-specific survival rates of the surgical group and the conservative treatment group were, respectively, 60% and 59.2% (P = 0.952) before propensity matching and 64.2% and 58.6% (P = 0.046) after propensity matching. According to the multivariate analysis, age, tumor stage, and chemotherapy and surgery were independent risk factors for long-term survival. The 5-year cancer-specific survival rates differed significantly between the low-risk, intermediate-risk, and high-risk patients (76.2% vs. 57.4% vs. 25.5%, respectively, P < 0.001). The 5-year cancer-specific survival rate of the surgical group was significantly higher than that of the conservative treatment group in the low-risk patients. However, it did not differ significantly in the intermediate-risk and high-risk patients (P > 0.05). Conclusions A prognostic model was constructed based on the independent risk factors of age, tumor stage, and chemotherapy. The prognostic model indicated that low-risk patients (age < 75 years, stage I/II, with/without chemotherapy) undergoing surgical treatment may benefit from long-term survival, while intermediate- and high-risk patients (age ≥ 75 years, stage I/II, with/without chemotherapy or III/IV patients, with/without chemotherapy) gain no significant benefit from surgery.

Sex as an independent risk factor for long-term survival after endovascular aneurysm repair

BackgroundSeveral vascular surgical procedures, including repair of abdominal aortic aneurysms (AAAs), show poorer outcomes for women than for men. We evaluated the impact of sex-based demographic differences on survival after endovascular aneurysm repair (EVAR). MethodsWe reviewed EVARs performed at our institution between 2003 and 2009 and assessed aortic neck variables (length, diameter, angulation, and calcification), iliac artery variables (length, tortuosity, angulation, and calcification), and AAA diameter. Cox proportional hazards models were used to examine the association between sex and 5-year mortality while adjusting for patients' demographics, comorbidities, anatomic variables, and AAA parameters. The final model adjusted for sex, age, body mass index, hypertension, iliac artery length, and aortic neck length. ResultsOf 336 patients, 278 were male (mean age, 73 years) and 58 were female (mean age, 77 years; P = .0005). Men had more coronary artery bypass grafts (79 vs 8; P = .02) and percutaneous coronary interventions (52 vs 4; P = .03) than women did. Significant differences between the sexes was seen for aortic neck angle, diameter, and length and for iliac artery diameter and length. Men (44%) were more likely than women (22%; P = .0002) to have EVAR performed within the device guidelines. Five-year survival was 73% in men and 49% in women. Multivariable analysis showed that female sex, increase in age, low body mass index (<25 kg/m2), and aortic neck length were significantly associated with risk of 5-year mortality. ConclusionsWomen presented at an older age and with a more hostile anatomy. They had reduced survival compared with men after EVAR. After controlling for comorbidities and aortic neck and iliac artery anatomy, sex remained an independent predictor for survival.

Radiation to the Immune System May be an Important Risk Factor for Long-term Survival after SBRT in Early Stage Non-small Cell Lung Cancer: A Role of RT Plan Optimization

Stereotactic body radiation therapy (SBRT) is the treatment of choice in patients with early stage inoperable non-small cell lung cancer (NSCLC). Local tumor control after SBRT is outstanding; however, 5-year overall survival rates remain suboptimal at less than 50%, which cannot be fully explained by known etiologies such as comorbidity, distant cancer progression or conventional toxicity. We hypothesize that radiation to normal tissue, particularly the sensitive lymphocytes in the immune system, contribute to the poor survival in these patients. Patients with T1-T2 N0 M0 NSCLC who received SBRT without previous RT and had retrievable radiotherapy (RT) plans in our modern treatment planning system were eligible. The primary endpoint was overall survival, calculated from the start of SBRT. Clinical factors included age, gender, race, tobacco history, respiratory and cardiovascular comorbidity, tumor lobar location, histology, T stage, gross tumor volume (GTV), planning target volume (PTV), and prescription dose BED10. Heart and lung were contoured consistently by one radiation oncologist according to the RTOG atlas. Effective dose to lymphocytes were computed by an in-house model. A total of 280 patients met criteria. The median follow-up was 6.7 years. The median survival time was 33 months (95% CI: 25-42 months). The 2-year, 3-year and 5-year survival rates were 63%, 53% and 45%, respectively. Univariate analysis demonstrated that age (HR=1.02, p=0.04), gender (HR=0.75 for female, p=0.07), tumor T stage (HR=1.3 for T2, 2.5 for T3, using T1 as the reference, p=0.10), KPS(HR=0.97, p<0.001), GTV (HR=1.01, p<0.001), PTV (HR=1.01, p<0.001), mean lung dose (HR=1.2, p<0.001), mean heart dose (HR=1.001, p=0.029) and EDIC were all significantly associated with overall survival. Multivariate analysis demonstrated KPS, GTV, mean lung dose, mean heart dose and EDIC were all significant as continuous variables, but only KPS, GTV, EDIC remained. A 1 Gy increase in EDIC was associated with a 46 % increase in the risk of death, or 20% reduction in 5-year survival. This study is the first to demonstrate that radiation dose to lung, heart and lymphocytes are independent factors predicting long-term overall survival after SBRT. These findings suggests that the poor survival after SBRT is likely at least in part from damage to radiation-sensitive lymphocytes and may suggest an area of further plan optimization during SBRT practice.