Overall Risk Of Death Research Articles

Trends in overall mortality among US veterans with primary myelofibrosis

BackgroundPrimary myelofibrosis [PMF] is a myeloproliferative neoplasm associated with reduced overall survival (OS). Management strategies for PMF have evolved over the last two decades, including approval of ruxolitinib as the first Janus kinase 1 (JAK1)/JAK2 inhibitor for patients with intermediate or high-risk myelofibrosis. This study assessed changes in mortality before and after ruxolitinib approval, independent of ruxolitinib treatment.MethodsThis retrospective study investigated mortality trends among US veterans with PMF in 2 time periods, pre-ruxolitinib approval (01/01/2007–12/31/2010) and post-ruxolitinib approval (01/01/2015–09/30/2018). Deidentified patient-level data were extracted from US Veterans Health Administration (VHA) databases using PMF diagnosis codes; index was the first PMF diagnosis date. The analysis included adults with ≥2 PMF claims during the analysis periods who were continuously enrolled in the VHA plan 1 calendar year prior to and 6 months post-index and had ≥1 available International Prognostic Scoring System (IPSS) risk factor (available factors were age > 65, hemoglobin < 10 g/dL, and white blood cell count > 25 × 109/L; each counted as one point). Patients with ≥1 MF diagnosis for 12 months before the index period were excluded. Ruxolitinib treatment was not a requirement to be included in the post-ruxolitinib approval cohort. Mortality rates and OS were estimated using the Kaplan-Meier approach; all-cause mortality hazard ratio was estimated using univariate Cox regression.ResultsThe pre- and post-ruxolitinib approval cohorts included 193 and 974 patients, respectively, of which 80 and 197 had ≥2 IPSS risk factors. Ruxolitinib use in the post-ruxolitinib cohort was 8.5% (83/974). At end of follow-up, median (95% CI) OS was significantly shorter in the pre-ruxolitinib cohort (1.7 [1.2–2.6] years vs not reached [3.4–not reached]; P < 0.001). Overall mortality rates for the pre- versus post-ruxolitinib approval cohorts were 79.8% versus 47.3%, respectively, and overall risk of death was 53% lower in the post-ruxolitinib period (hazard ratio, 0.47; 95% CI, 0.37–0.58; P < 0.001). Mortality rates were lower among patients with < 2 vs ≥2 IPSS risk factors.ConclusionsAlthough veterans with PMF have high overall mortality rates, and results in this population might not be generalizable to the overall population, there was a significant lowering of mortality rate in the post-ruxolitinib period.

Prognostic Value of Preoperative Controlling Nutritional Status in Hypopharyngeal Cancer Patients Undergoing Surgery-Oriented Comprehensive Treatment.

The preoperative controlling nutritional status (pCONUT) score has been shown correlated with the prognosis of some cancerous diseases; however, little is known about the effect of pCONUT score on hypopharyngeal cancer (HPC). Therefore, the objective of our study was to demonstrate the relationship between the pCONUT score and the clinical outcome of patients with HPC. Ninety-four patients with HPC who underwent surgery between May 2012 and Dec 2020 were enrolled in this study. We evaluated retrospectively their pCONUT scores and calculated the cutoff value regarding the patients' overall survival using the X-tile software. Kaplan-Meier and Cox proportional hazard regression model were used to determine how the pCONUT score affected overall survival. A cutoff level of 4 was determined to be optimal for the pCONUT score, by which the patients were grouped into high pCONUT score (≥4, n = 22, 23.4%) or low pCONUT score (<4, n = 72, 76.6%) groups. The univariate analysis showed that high pCONUT scores correlated with reduced overall survival (hazard ratio: 2.925, 95% confidence interval: 1.526-5.607, P = .001). Furthermore, the multivariate analysis also showed that high pCONUT scores increased the risk of overall death (hazard ratio: 2.639, 95% confidence interval: 1.365-5.101, P = .004). The pCONUT score is considered a useful prognostic factor in patients with HPC.

Overall Survival Differences in Young Black Colorectal Cancer Patients: a Report from the National Cancer Database.

Objectives: Black patients have the highest overall incidence rate of early onset colorectal cancer, with many of these patients presenting with more aggressive disease at diagnosis, ultimately leading to decreased overall survival. We aimed to (1) evaluate how race and age affected overall survival in colorectal cancer patients, and (2) determine the different demographic and clinical covariables that may influence survival in younger individuals. Methods: The 2017 National Cancer Database (NCDB) was used to identify all patients that had colorectal cancer between 2004-2017. These patients were then divided into groups according to age (<45 and ≥45 years old) and race (white and black). Overall survival (OS) between white and black groups according to age was compared. Initial testing of survivor functions between groups revealed violations of the proportional hazards assumption. Accordingly, we used parametric maximum likelihood analyses fitting the survivor functions to Weibull distributions. Logistic regression analysis was used to determine univariate and multivariate relationships between the covariates and race for younger subjects. Propensity score matching analysis was also used to control for differences in the demographic or clinical variables between the young black versus white subgroups. Results: Out of 1.4 million potential cases initially identified, 207,823 unique cases were deemed eligible for evaluation based on study criteria. Black patients in the study population were more likely to be female, have medical comorbidities, and come from areas with lower average income and baseline education. OS was lower in older patients of both race categories when compared to the younger cohorts. Among patients older than 45 years, there were no significant differences in proportional hazard of death between black and white patients. However, among those younger than 45 years, younger black patients had significantly increased hazard of death. Regarding disease burden at diagnosis, pathologic characteristics and overall risk of death, there were no significant differences between black and white patients. Conclusions: Overall survival in young black patients with colorectal cancer is significantly reduced when compared to young white patients, even when controlling for demographic and pathologic factors. This suggests that the outcome disparities between black and white patients are complex, and the underlying factors are not well understood.

Effects of Autoimmune Disease on Non-High Risk MDS Outcomes: A Population Analysis

Introduction: Myelodysplastic syndromes (MDS) frequently occur in patients (pts) with autoimmune diseases (AD). Concomitant inflammatory or AD are found in 10-30% of MDS cases. Studies exploring the impact of AD on MDS outcomes show discordant results and small samples in these studies hinder definitive conclusions. We conducted a large epidemiological analysis aimed at defining the impact of concomitant AD on outcomes of non-high-risk MDS pts. Methods: Pts ≥66 years with MDS were identified from 2007 - 2017 in the Surveillance, Epidemiology, and End Results (SEER) - Medicare database. Cases were excluded if they lacked continuous Medicare A and B, were enrolled in HMOs, had MDS diagnosed solely from death certificate or autopsy, or had MDS with excess blasts. Using claims from 12 months before MDS diagnosis, pre-existing AD was identified. MDS cohorts with and without concomitant AD were compared. Covariates included age, sex, race, and MDS risk, classified into low and intermediate using the International Classification of Diseases for Oncology (ICD-O-3) codes, rurality (using Rural-Urban Continuum Codes), and Charlson Comorbidity Index (CCI). Outcomes included transformation to acute myeloid leukemia (AML) during follow-up and overall survival, calculated from MDS diagnosis to date of death or end of follow-up. Logistic regression tested the association between AD and AML transformation. Cox proportional hazards regression estimated the association of AD with survival. Risk estimates are reported as odds ratio (OR) and hazard ratios (HR), with a corresponding 95% confidence interval (CI). Results: A total of 13,344 pts diagnosed with MDS between 2007 - 2017 were analyzed, including 1,978 (14.8%) with baseline AD. Pts with concomitant AD were younger, proportion >80 years accounted for 60% vs. 65.2% in MDS cases without AD (p<0.001). They were also predominantly female (55.4% vs. 45.3%, p<0.001), non-Hispanic whites (NHW) (88.8% vs. 86.2%, p=0.045), and had a higher comorbidity burden, with CCI ≥2 accounting for 68.5% in the AD cohort compared to 51.2% (p<0.001). MDS risk distribution based on ICD-O-3 histology codes is similar between groups. In a multivariate logistic regression model adjusting for age, sex, race, MDS risk/histology, rurality, and CCI, baseline AD at MDS diagnosis was associated with 18% increased odds of AML transformation; OR = 1.18 (95% CI 1.01-1.39). Table 1 shows other covariates significantly associated with AML transformation. Increasing age, female sex, and higher CCI score were factors associated with decreased odds for AML transformation. As expected, MDS risk had the largest effect, the intermediate risk was associated with 2.3-fold increased odds of AML transformation (95% CI 1.8-2.8) compared to low risk. In a multivariate Cox-proportional hazard model adjusting for age, sex, race, MDS risk/histology, rurality, and CCI, baseline AD at MDS diagnosis was associated with a 6% decreased risk of overall death (HR 0.94, 95% CI 0.89 - 0.99). Table 2 shows other covariates significantly associated with overall survival. Non-Hispanic Black race and female sex were factors associated with decreased risk of death while rising age, rurality, and higher CCI were associated with increased hazard for death. MDS risk had the largest effect on overall survival, with the intermediate risk associated with a 52% increased risk of death (95% CI, 1.44-1.60) compared to low risk. Conclusions: In a large population-based analysis, pts with AD and non-high risk MDS were predominantly female, and Non-Hispanic Whites had a higher comorbidity burden. Concomitant AD at MDS diagnosis was associated with increased risk of AML transformation but decreased risk of mortality. These seemingly contradicting results suggest that the pathophysiologic mechanisms linking systemic inflammation with MDS and their clinical consequences remain to be fully elucidated. Inflammatory bone marrow microenvironment in AD may promote clonal evolution while neoplastic clones driven by auto-inflammation could have a less aggressive phenotype. Future studies should assess molecular mutations and clonal dynamics involved in autoimmunity and MDS to build on these epidemiologic findings. Despite the limitations of a claim-based analysis, AD prevalence among MDS pts and factors associated with MDS outcomes in our cohort were consistent with previous reports. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Incorporation of Machine Learning Tools to Predict Global Outcomes for Patients with Relapsed and Refractory Peripheral T and NK/T-Cell Lymphomas in the Contemporary Era

There has been a progressive increase in therapies for patients with relapsed and refractory (R/R) peripheral T-cell lymphomas (PTCLs) in the last decade, including antibody-drug conjugates, epigenetic modifiers, small molecule inhibitors, and monoclonal antibodies (novel single agents, SA). Their comparative efficacy to conventional chemotherapy (CC) globally remains unknown. Here, we present preliminary results of an international collaborative study spanning multiple centers across 6 continents with diverse histological epidemiology, demographics, treatment patterns, and drug access. We analyzed data from 324 patients with R/R PTCL enrolled between Jan 2010 and Dec 2020 [Brazil (n=120), Australia (AUS, n=69), COMPLETE registry USA (n=61), South Korea (SK, n=37), South Africa (SAF, n=24), and Saudi Arabia (SAU, n=13)], with ongoing participation from investigators in Italy, Chile, India, and Japan. Of 321 patients, 197 (61%) were refractory to 1st line therapy and 39% had relapsed. As expected, there was demographic heterogeneity globally. Median age at diagnosis was 54, with patients from AUS being significantly older (63). Majority were males except in SK (60% vs 25%). Overall, the most common histological subtypes were PTCL-NOS (40%), ALK- ALCL (16%), AITL (14%) and ENKTCL (12%). Exceptions included ENKTCL as the dominant subtype in SK (46%), ALCL in SAU (46%), and ATLL as the second most common subtype in Brazil (21%). Majority of patients had Ann Arbor stage III-IV disease (75%) and intermediate risk IPI (67%) and PIT scores (72%). SK and SAF had higher proportions of patients with early-stage disease and low risk IPI. Overall, only 17% of patients underwent autoSCT consolidation in first remission with higher rates in SAU (50%) and SK (41%). Patients received either SA (25%) or CC (73%) for first retreatment. Brazilian patients received significantly less SA relative to CC (6% vs. 92%) in contrast with USA (49% vs. 51%), AUS (35% vs. 64%), SK (30% vs. 68%), SAF (29% vs. 71%) and SAU (15% vs. 85%). Globally, 38% and 22% achieved a second complete (CR) and partial remission respectively upon first retreatment. 25% of patients proceeded to alloSCT, with a significantly higher number in USA (71%) and SAF (43%). Second retreatment with SA vs. CC was received by 71% vs. 26% patients in AUS and 58% vs. 42% in USA as opposed to 35% vs. 65% in SK and 33% vs. 67% in SAF. Of interest, up to 48% of patients achieved a third CR to second retreatment. No patients in Brazil received second retreatment or further salvage therapy. At median follow-up of 1.4 years (0.79-3.09), 32% of patients were alive, 61% had died, and 7% were lost to follow up. The median overall survival (OS) for patients with refractory disease (1.25 y) was inferior to those with relapsed disease (3.24 y; p<0.0001). When stratifying OS in each histological subtype by country, no statistically significant difference was found among patients with PTCL-NOS and ALCL entities. However, within the AITL subset, patients in Brazil exhibited a shorter survival compared to their counterparts in USA (p=0.045) and SK (p=0.045). In contrast, amid ENKTCL, patients in SK and Brazil had superior OS in comparison with USA (p=0.02 and 0.036) despite comparable age, stage, and IPI score. No statistically significant difference in OS was identified with respect to first retreatment with SA or CC overall and within individual histologies (Figure. 1). When stratified by calendar period of diagnosis (2010-2015 vs. 2016-2020), patients with ENKTCL (p=0.028) and ALCL (p=0.049) demonstrated an improved OS. In separate models, overall risk of death was associated with histological subtype, PIT score, and lack of CR to 1st line treatment (Table 1). We then derived a final model by comparing AICs and concordance index across several models with combinations of these three measures. We verified the risk prediction of our final model with a second machine learning strategy using random survival forest. In conclusion, this global study represents the first analysis of this type in R/R PTCL contrasting SA to CC and demonstrates that both strategies are comparable. Results confirm dismal prognosis for patients with primary refractory disease but also highlight improvements in OS in ALCL and ENKTCL in the last 5 years. We continue to enroll patients in our study and build better prediction models using state of the art synthetic intervention approaches to inform future clinical trials. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Severity of emergency department presentations due to acute drug toxicity in Europe: a longitudinal analysis over a 6-year period (2014-2019) stratified by sex.

To investigate whether the severity of acute recreation drug toxicity presentations to emergency departments (EDs) in Europe has changed in recent years and to uncover potential sex differences. We analysed presentations to 36 EDs in 24 European countries relating to acute recreational drug toxicity, with separate analysis for presentations involving lone use of cannabis, cocaine, and heroin. As severity markers, we calculated rates of hospitalization, admission to ICU, intubation, and death by annual quarters between 2014 and 2019. Trends on severity over time were estimated by logistic regression. Differences between men and women were assessed by interaction. Sensitivity analysis was performed including only EDs that provided data for all 24 quarters. Analyses of intoxications taken altogether were adjusted by age and sex, while of lone intoxications being also adjusted by ethanol co-ingestion. There were 43 633 presentations (median age = 31 years, interquartile range = 25-40 years, men = 76.5%) resulting in 10 344 hospitalizations (23.9%), 2568 ICU admissions (5.9%), 1391 intubations (3.2%), and 171 deaths (0.39%). Hospitalization, ICU admission and death did not differ by sex, but intubation was more frequent in men (3.4% vs. 2.3%, P < 0.001). No significant changes in the severity of drug intoxications over time were found when considered altogether, neither for lone cannabis (n = 4264) nor cocaine (n = 3562). Conversely, significant increases in hospitalization [odds ratios (OR) = 1.023, 95% confidence interval (CI) = 1.004-1.041], ICU admission (OR = 1.080, 95% CI = 1.042-1.118) and in intubation (OR = 1.049, 95% CI = 1.001-1.099) were detected for lone heroin presentations (n = 1997). Sensitivity analysis (32 245 presentations, 14 EDs, 9 countries) confirmed the overall absence of changes in severity markers (except for death rate, which significantly decreased by quarter: OR = 0.968, 95% CI = 0.943-0.994). Additionally, it suggested an increased risk over time of intubation for cocaine (OR = 1.068, 95% CI = 1.009-1.130) and confirmed the increased risk of ICU admission for heroin (OR = 1.058, 95% CI = 1.013-1.105). Changes in severity over time did not differ according to sex in the main analysis of the whole cohort, while a significantly higher decrease in risk of death in men was found in the sensitivity analysis (OR = 0.894, 95% CI = 0.825-969 vs. OR = 0.949, 95% CI = 0.860-1.048; P interaction = 0.042). The severity of presentations to European EDs remained mainly unchanged during 2014-2019, but the risk of death may have decreased. Conversely, intubation in lone cocaine and ICU admission in lone heroin intoxications have increased. Although men and women exhibited a similar pattern over the period for the majority of comparisons, our data suggest that women exhibited a smaller decrease of the overall risk of death.

Abstract 9772: Paroxysmal Atrial Fibrillation Among Pulmonary Embolism Patients; Insight From the 2019 National Inpatient Sample

Introduction: Various factors can trigger events of Pulmonary Embolism(PE). Several studies have linked cardiac arrhythmias such as Paroxysmal Atrial Fibrillation (PAF) with a higher risk of multiple cardiovascular and pulmonary complications. As there is a paucity of data on the risk factors for an event of PAF among PE patients and the factors contributing to death, we conducted a retrospective analysis using the 2019 National Inpatient Sample(NIS). Methods: Our study focused on finding patients with a principal diagnosis of Pulmonary Embolism and a diagnosis of Paroxysmal Atrial Fibrillation. A multivariable regression model evaluated several risk factors for PAF incidence among PE patients and their possible mortality risks. Results: A total of 188,850 cases of PE were observed in our study, including 9,960 (5.3%) cases of PAF. Hyperlipidemia (aOR 1.348, 95% CI 1.290-1.409, p&lt;0.01), hypertension (aOR 1.988, 95% CI 1.887-2.095, p&lt;0.01), and old myocardial infarct (aOR 1.574, 95% CI 1.463-1.693, p&lt;0.01) predisposed to PAF among PE, while females (aOR: 0.873, 95% CI 0.837-0.910, p&lt;0.01), patients with obesity (aOR 0.858, 95% CI 0.818-0.900, p&lt;0.01), and those classified as racially Black (aOR 0.603, 95% CI 0.534-0.681, p&lt;0.01), and Hispanic (aOR 0.653, 95% CI 0.562-0.758, p&lt;0.01) (compared to group excluding Whites, Blacks and Hispanics) reduced their risk. An in-hospital mortality rate of 4.0% was also estimated as 395 patients with PAF died. PAF patients with PE had a higher chance of dying if they also had a diagnosis of diabetes (aOR 1.347, 95% CI 1.070-1.695, p=0.011), whereas those who were obese (aOR 0.421, 95% CI 0.311-0.570, p&lt;0.01), with hyperlipidemia (aOR 0.732, 95% CI 0.590-0.909, p&lt;0.01), and smokers (aOR 0.751, 95% CI 0.606-0.931, p&lt;0.01) expressed a lower risk of mortality. PAF patients with PE reported a higher overall risk of death during hospitalization (aOR 1.322, 95% CI 1.190-1.469, p&lt;0.01). Conclusions: Patients with a diagnosis of PAF while admitted with PE showed a higher risk of mortality. Several factors influenced the presence of PAF among PE patients. It is thus essential for physicians to monitor various cardiovascular complications and arrhythmias in patients admitted with PE.

Appendicular dedifferentiated chondrosarcoma: A management and survival study from the SEER database

IntroductionDedifferentiated chondrosarcoma (DDC) is an aggressive osseous neoplasm with a dismal prognosis. Treatment commonly involves limb-salvage surgery or amputation. In patients with appendicular DDC, we sought to describe demographic, clinical and treatment characteristics (1), analyze risk factors for metastasis (2) and overall death (3), and assess survival rates by treatment (4). Materials and methodsTwo-hundred-and-five patients from the SEER Database were included in our analysis. Demographic, clinical and treatment variables were analyzed. Multivariate regression was performed to identify risk factors. Survival analysis was performed using the Kaplan-Meier method. ResultsFifty-one (24.9 %) of the patients included presented metastasis at diagnosis. The most common locations were the lungs, other sites, and bone. Surgery to the primary site was more common in patients without metastasis (94.2 %) than those with (78.2 %); limb-salvage procedures were more common than amputations. Tumors >8 cm (T2) and those discontinuous (T3) were more likely to present metastasis at diagnosis (OR = 2.54, p = 0.043 and OR = 7.4, p = 0.008, respectively). Female gender was found to be a protective factor for overall death on crude analysis (OR = 0.33, p = 0.019). Metastases to sites other than the lungs (M1b) had the highest risk of overall death (OR = 49, p = 0.01). Combination of surgery and chemotherapy showed a trend towards higher overall survival in non-metastatic patients (p = 0.1069 and p = 0.1703). ConclusionsAppendicular DDC displays a high metastatic rate and low survival rates. The most common procedure is a limb-salvage surgery. Tumor size increases the risk of presenting metastases at diagnosis and female gender is a protective factor against death.

Diabetes Is a Risk Factor for the Prognosis of Patients with Bladder Cancer: A Meta-Analysis.

Objective To systematically evaluate the impact of diabetes on the prognosis of bladder cancer patients after radical cystectomy (RC). Methods PubMed, Embase, and Cochrane Library databases were selected from inception to October 2021. The studies on the effects of diabetes on bladder cancer patients after RC were included for analysis. The inclusion and exclusion criteria were independently selected for literature screening, the quality of the included studies was evaluated, and data were extracted. Results A total of 5 cohort studies were included, with a total of 2 661 subjects, including 391 cases in the diabetic group, non-diabetes. Meta-analysis results show that diabetes increases the overall risk of death in patients after RC (HR = 1.36, 95% CI: 1.30 ∼ 1.43, P < 0.001) and the risk of tumor-specific death (HR = 1.59, 95% CI: 1.29 ∼ 1.95, P < 0.001). Sensitivity analysis shows that the stability of this study is well. Conclusion Diabetes was an independent risk factor in terms of overall and cancer-specific survival in patients who underwent RC.

Long-term risk of death in patients with hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is associated with substantial morbidity. Few studies have addressed the natural history and mortality rates associated with HS. A higher risk of cardiovascular death in patients with HS has been reported. We investigated whether patients with HS have an increased overall risk of death compared with age- and gender-matched referents. We performed a retrospective cohort study of residents of Olmsted County, Minnesota, with incident HS between January 1, 1980, and December 31, 2008, and age- and gender-matched referents. The main outcomes and measures were the overall and cause-specific risks of death. We identified 226 incident cases of HS and 678 age- and gender-matched referents among Olmsted County residents during the study period. Compared to referents, patients with HS had a significantly higher risk of all-cause death (hazard ratio [HR, 2.48; 95% CI, 1.53-4.03, P < 0.001) and cardiovascular- or cerebrovascular-related death (HR, 2.85; 95% CI, 1.10-7.40, P = 0.03). However, these risks were attenuated by adjusting for smoking history: all-cause HR, 1.65 (95% CI, 0.97-2.82, P = 0.07) and cardiovascular- or cerebrovascular-related HR, 2.03 (95% CI, 0.71-5.81, P = 0.18). The 71% of patients were former or current smokers at the time of HS diagnosis. Hidradenitis suppurativa patients have a substantially increased risk of death from any cause, including cardiovascular or cerebrovascular causes; the risk is especially dependent on smoking history.

Neutrophil-lymphocyte-ratios and lymphocyte-monocyte-ratios as prognostic biomarkers for vulvar cancer (160)

Objectives: Neutrophil to lymphocyte ratios (NLR) and lymphocyte to monocyte ratios (LMR) have been identified as potential biomarkers for prognosis in multiple solid tumors and may be indicative of systemic inflammation and tumor-promoting immune responses, with high NLR and low LMR indicating poorer prognostic outlook. We sought to examine whether the relationships between NLR and LMR near diagnosis and overall survival identified in other solid tumors extend to those diagnosed with vulvar cancer. Methods: This retrospective study included 109 patients treated for vulvar cancer at the University of Minnesota Gynecologic Oncology clinics between 2009 and 2020 with available laboratory measurements within 60 days of diagnosis. Clinical data were abstracted from electronic health records. Laboratory measurements of interest included absolute neutrophils, lymphocytes, and monocytes. NLR and LMR were defined as absolute neutrophils or absolute lymphocytes divided by absolute lymphocytes and monocytes, respectively. Multivariable Cox proportional hazard models were used to examine the associations between NLR and LMR with overall risk of death, computing hazard ratios (HR) with 95% confidence intervals (CI), adjusting for age, histology, and FIGO stage. Results: Patients included in this analysis were 66.5 (±12.7) years old on average and primarily non-Hispanic Whites (95.1%). The majority of patients were diagnosed with squamous cell carcinoma (89.9%), with 35.6% being diagnosed at an advanced stage (III/IV). Most patients underwent surgical resection (76.2%), and less than half received chemotherapy (33.0%) and/or radiation (43.1%). The median NLR and LMR values observed in our cohort were 2.78 (0.21-41.0) and 2.86 (0.78-66.4), respectively. In multivariable analysis, each unit increase in NLR was associated with a 16% increased risk of dying (HR: 1.16; 95% CI: 1.08-1.26, p=0.0001). Additionally, each unit increase in LMR was associated with a 21% decreased risk of dying, though this association was not statistically significant (HR: 0.79; 95% CI: 0.60-1.04, p=0.09). Conclusions: Our study demonstrates the potential prognostic association between NLR and overall survival among patients diagnosed with cancer of the vulva. Future research is necessary to reproduce these findings. Identification of subgroups at high risk for poor outcomes at diagnosis could inform treatment decisions and surveillance. Objectives: Neutrophil to lymphocyte ratios (NLR) and lymphocyte to monocyte ratios (LMR) have been identified as potential biomarkers for prognosis in multiple solid tumors and may be indicative of systemic inflammation and tumor-promoting immune responses, with high NLR and low LMR indicating poorer prognostic outlook. We sought to examine whether the relationships between NLR and LMR near diagnosis and overall survival identified in other solid tumors extend to those diagnosed with vulvar cancer. Methods: This retrospective study included 109 patients treated for vulvar cancer at the University of Minnesota Gynecologic Oncology clinics between 2009 and 2020 with available laboratory measurements within 60 days of diagnosis. Clinical data were abstracted from electronic health records. Laboratory measurements of interest included absolute neutrophils, lymphocytes, and monocytes. NLR and LMR were defined as absolute neutrophils or absolute lymphocytes divided by absolute lymphocytes and monocytes, respectively. Multivariable Cox proportional hazard models were used to examine the associations between NLR and LMR with overall risk of death, computing hazard ratios (HR) with 95% confidence intervals (CI), adjusting for age, histology, and FIGO stage. Results: Patients included in this analysis were 66.5 (±12.7) years old on average and primarily non-Hispanic Whites (95.1%). The majority of patients were diagnosed with squamous cell carcinoma (89.9%), with 35.6% being diagnosed at an advanced stage (III/IV). Most patients underwent surgical resection (76.2%), and less than half received chemotherapy (33.0%) and/or radiation (43.1%). The median NLR and LMR values observed in our cohort were 2.78 (0.21-41.0) and 2.86 (0.78-66.4), respectively. In multivariable analysis, each unit increase in NLR was associated with a 16% increased risk of dying (HR: 1.16; 95% CI: 1.08-1.26, p=0.0001). Additionally, each unit increase in LMR was associated with a 21% decreased risk of dying, though this association was not statistically significant (HR: 0.79; 95% CI: 0.60-1.04, p=0.09). Conclusions: Our study demonstrates the potential prognostic association between NLR and overall survival among patients diagnosed with cancer of the vulva. Future research is necessary to reproduce these findings. Identification of subgroups at high risk for poor outcomes at diagnosis could inform treatment decisions and surveillance.

Nationwide mortality associated with perioperative acute dialysis requirement in major surgeries

BackgroundChronic kidney disease is associated with perioperative mortality. However, outcomes of patients who perioperatively received acute dialysis have not been clarified. We aimed to determine risks for in-hospital death and functional decline following various surgeries with an acute dialysis requirement versus maintenance dialysis and non-dialysis. Materials and methodsWe analyzed 22,857 patients who underwent major surgeries during hospitalization in Japan from 2018 until 2019 using an inpatient administrative claims database. Risks of overall death and functional decline assessed by Barthel index scores were determined with logistic regression models. ResultsAmong the propensity score-matched groups, mortality rates were 8.54% [95% confidence interval (CI) 7.92–9.17], 5.97% (95% CI 5.44–6.50), and 1.12% (95% CI 0.88–1.35) with an acute dialysis requirement, maintenance dialysis, and non-dialysis, respectively. The survivor rates with ≥20%-decline in Barthel index scores were 7.67% (95% CI 7.07–8.26), 8.56% (95% CI 7.93–9.19), and 3.48% (95% CI 3.07–3.89), respectively. Lower preoperative Barthel index scores were strongly associated with mortality independent of surgeries. Cardiac surgery, colorectal resection, esophagectomy, and gastrectomy led to higher mortality, while cardiac surgery, and orthopedic surgery were associated with higher risk of functional decline. In addition, mortality rates after hepatic lobectomy/cholecystectomy/pancreatectomy [odds ratio (OR) 3.09, 95% CI 1.61–5.91] and esophagectomy/gastrectomy (OR 2.65, 95% CI 1.68–4.38) were markedly higher with an acute dialysis requirement when compared with maintenance dialysis. ConclusionPerioperative acute dialysis requirements were associated with substantial risks for mortality and functional decline. Several types of surgeries led to even higher mortality rates for acute dialysis than maintenance dialysis.

Long term survival after a first transient ischaemic attack in England: A retrospective matched cohort study

ObjectiveTransient ischaemic attacks (TIA) serve as warning signs for future stroke, and the impact of TIA on long term survival is uncertain. We assessed the long-term hazards of all-cause mortality following a first episode of a transient ischaemic attack (TIA). DesignRetrospective matched cohort study. MethodsCohort study using electronic primary health care records from The Health Improvement Network (THIN) database in the United Kingdom. Cases born in or before 1960, resident in England, with a first diagnosis of TIA between January 1986 and January 2017 were matched to three controls on age, sex and general practice. The primary outcome was all-cause mortality. The hazards of all-cause mortality were estimated using a time-varying Double-Cox Weibull survival model with a random frailty effect of general practice, while adjusting for different socio-demographic factors, medical therapies, and comorbidities. Results20,633 cases and 58,634 controls were included. During the study period, 24,176 participants died comprising of 7,745 (37.5%) cases and 16,431(28.0%) controls. In terms of hazards of mortality, cases aged 39 to 60 years at the first TIA event had the highest hazard ratio (HR) of mortality compared to their 39-60 years matched controls (HR = 3.04 (2.91 - 3.18)). The HR for cases aged 61-70 years, 71-76 years and 77+ years were 1.98 (1.55 - 2.30), 1.79 (1.20 - 2.07) and 1.52 (1.15 - 1.97) compared to their same-aged matched controls. Cases aged 39-60 at TIA onset who were prescribed aspirin were associated with reduced HR of 0.93 (0.84 - 1.01), 0.90 (0.82 - 0.98) and 0.88 (0.80 - 0.96) at 5, 10 and 15 years respectively, compared to the same aged cases who were not prescribed any antiplatelet. Statistically significant reductions in hazard ratios were observed with aspirin at 10 and 15 years in all age groups. Hazard ratio point estimates for other antiplatelets (dipyridamole or clopidogrel) and dual antiplatelet therapy were very similar to aspirin at 5, 10 and 15 years but with wider confidence intervals that included 1. There was no survival benefit associated with antiplatelet prescription in controls. ConclusionsThe overall risk of death was considerably elevated in all age groups after a first-ever TIA event. Aspirin prescription was associated with a reduced risk. These findings support the use of aspirin in secondary prevention for people with a TIA. The results do not support the use of antiplatelet medication in people without TIA.

Matched-pair analysis of survival in patients with poorly differentiated versus well and moderately differentiated hypopharyngeal squamous cell carcinoma.

Hypopharyngeal squamous cell carcinoma (HPSCC) is among the most common malignances of the head and neck and is associated with a poor prognosis. Although both differentiation and tumor-node-metastasis stage affect tumor aggressiveness, the effect of differentiation on the prognosis of HPSCC at different stages is unclear. The aim of this study was to compare survival outcomes between patients with poorly differentiated versus well-differentiated and moderately differentiated HPSCC.Patients with well/moderately differentiated and poorly differentiated HPSCC were matched based on age, sex, smoking status, alcohol use, comorbidity score, tumor stage, and therapeutic strategies. The Kaplan-Meier curve and Cox proportional hazards model were used to analyze survival. A total of 204 patients with newly diagnosed HPSCC were included after matching 102 well/moderately differentiated cases and 102 poorly differentiated cases from Peking Union Medical College Hospital.Patients with well/moderately differentiated HPSCC had significantly better disease-specific survival (P = .003) and overall survival (P = .006) than patients with poorly differentiated HPSCC. Additionally, multivariable analysis indicated that increased differentiation was associated with a significantly reduced risk of overall death (adjusted hazard ratio, 0.51; 95% confidence interval, 0.34–0.78, P = .002), and death due to disease (adjusted hazard ratio, 0.44; 95% confidence interval, 0.28–0.69, P < .001).Survival outcomes differed significantly between the well/moderately differentiated and poorly differentiated HPSCC patients. Treatment strategies based on the level of pathological differentiation might be necessary to improve survival outcomes in patients with HPSCC.

Motoric Cognitive Risk Syndrome, Subtypes and 8-Year All-Cause Mortality in Aging Phenotypes: The Salus in Apulia Study.

Background: This study aims to establish the key clinical features of different motoric cognitive risk (MCR) subtypes based on individual quantitative measures of cognitive impairment and to compare their predictive power on survival over an 8-year observation time. Methods: We analyzed data from a population-based study of 1138 subjects aged 65 years and older in south Italy. These individuals were targeted and allocated to subtypes of the MCR phenotype according to the slowness criterion plus one other different cognitive domain for each characterized phenotype (Subjective Cognitive Complaint [SCC]; Global Function [Mini Mental State Examination (MMSE) < 24]; or a combination of both). Clinical evaluation and laboratory assays, along with a comprehensive battery of neuropsychological and physical tests, completed the sample investigation. Results: MCR prevalence was found to be 9.8% (n = 112), 3.6% (n = 41), 3.4% (n = 39) and 1.8% (n = 21) for the MCR, MCR-GlobalFunction, MCR-StructuredSCC and MCR-SCC and GlobalFunction, respectively. Univariate Cox survival analysis showed an association only of the MCR-GlobalFunction subtype with an almost three-fold increased risk of overall death as compared to the other counterparts (HR 2.53, 95%CI 1.28 to 4.99) over an 8-year observation period. Using Generalized Estimating Equations (GEE) for clustered survival data, we found that MCR males had an increased and significant mortality risk with respect to MCR female subjects. Conclusions: MCR phenotypes assigned to the MMSE cognitive domain are more likely to have an increased risk of overall mortality, and gender showed a huge effect on the risk of death for MCR subjects over the 8-year observation.

Temporal and geographical variations in survival of children born with congenital anomalies in Europe: A multi-registry cohort study.

Congenital anomalies are a major cause of perinatal, neonatal and infant mortality. The aim was to investigate temporal changes and geographical variation in survival of children with major congenital anomalies (CA) in different European areas. In this population-based linkage cohort study, 17 CA registries members of EUROCAT, the European network for the surveillance of CAs, successfully linked data on 115,219 live births with CAs to mortality records. Registries estimated Kaplan-Meier survival at 28 days and 5 years of age and fitted Cox's proportional hazards models comparing mortality at 1 year and 1-9 years of age for children born during 2005-2014 with those born during 1995-2004. The hazard ratios (HR) from each registry were combined centrally using a random-effects model. The 5-year survival conditional on having survived to 28 days of age was calculated. The overall risk of death by 1 year of age for children born with any major CA in 2005-2014 decreased compared to 1995-2004 (HR 0.68, 95% confidence interval [CI] 0.53, 0.89). Survival at 5 years of age ranged between registries from 97.6% to 87.0%. The lowest survival was observed for the registry of OMNI-Net (Ukraine) (87.0%, 95% CI 86.1, 87.9). Survival of children with CAs improved for births in 2005-2014 compared with 1995-2004. The use of CA registry data linked to mortality data enables investigation of survival of children with CAs. Factors such as defining major CAs, proportion of terminations of pregnancy for foetal anomaly, source of mortality data and linkage methods are important to consider in the design of future studies and in the interpretation of the results on survival of children with CAs.

MO515: Mortality Differences Between Men and Women With Chronic Kidney Disease in the Irish Health System: The National Kidney Disease Surveillance Programme

Abstract BACKGROUND AND AIMS Chronic kidney disease is associated with higher mortality compared with the general population, but mortality differences between men and women with CKD are poorly understood. Although the prevalence of CKD is consistently higher in women than in men, emerging studies suggest that men experience poorer survival. The primary goal of this study was to compare mortality rates between men and women in the Irish health system and determine whether kidney function influenced these sex-specific risks. METHOD We created a cohort of 125 890 patients from the National Kidney Disease Surveillance System (NKDSS) to compare mortality rates between men and women. Patients were recruited from 1 January 2005 to 31 December 2010 and followed until 31 December 2013. Kidney function was determined using the CKD-EPI equation, generating estimated glomerular filtration rate (mL/min/1.73 m2) (eGFR). The primary outcome was all-cause mortality from national records provided by the Central Statistics Office (CSO). The principal exposure was participant sex, classified as men or women. Patients were censored at the date of initiation of dialysis or kidney transplantation, death, loss to follow-up or end of follow-up 31 December 2013. Mortality risks were compared using the Fine-Gray approach, which accounted for the competing risks of renal replacement therapy. Adjustments were made for baseline age, kidney function and blood biomarkers, which indicated the presence and severity of clinical disease. RESULTS Of the 125 890 participants, 55.1% were women, with a mean age of 54.1 (SD: 17.7) years. The median follow-up was 7.75 years (IQR: 6.33–8.55), 243 patients (0.19%) patients progressed to RRT and 14 179 patients (11.26%) died. Overall, mortality rates were significantly higher in men than in women (18.4 versus 16.6 deaths/1000 pyrs, respectively). Compared with women, men with CKD experienced significantly higher rates of death and RRT, P &amp;lt; .001 (Figure 1a). With each worsening GFR category, crude mortality rates increased by 18-fold in women compared with 9-fold in men. The P-value for the interaction of sex and GFR with mortality was &amp;lt;0.001. In stratified analyses, the magnitude of the sHR for men versus women decreased with each descending eGFR category from a peak of 2.17 (1.88–2.49) for eGFR &amp;gt;90 mL/min down to 1.21 (0.98–1.49) for eGFR &amp;lt;29 mL/min/1.72 m2 (Table 1) and was no longer significant in the eGFR &amp;lt;29 mL/min/1.72 m² category. CONCLUSION Although women have a higher burden of CKD than men in the Irish health system, the overall risks of death and RRT were far greater in men than in women. However, the excess risk in men diminished with increasing severity of kidney disease such that mortality risks for women approached those of men with advanced kidney disease. While these findings may have a biologic basis, fundamental disparities in care delivery, quality or accessibility between men and women is a far more likely explanation.

MP47-17 IMPACT OF PATIENT AND LIFESTYLE FACTORS IN PATIENTS WITH STAGE III &amp; IV RENAL CANCER: A DANISH NATIONWIDE STUDY

You have accessJournal of UrologyCME1 May 2022MP47-17 IMPACT OF PATIENT AND LIFESTYLE FACTORS IN PATIENTS WITH STAGE III & IV RENAL CANCER: A DANISH NATIONWIDE STUDY Freja Ebbestad, Louise Geertsen, Naomi Nadler, Sofie Axelsen, Trine Horsbøll, Susanne Dalton, Jane Christensen, Frede Donskov, Lars Lund, and Nessn Azawi Freja EbbestadFreja Ebbestad More articles by this author , Louise GeertsenLouise Geertsen More articles by this author , Naomi NadlerNaomi Nadler More articles by this author , Sofie AxelsenSofie Axelsen More articles by this author , Trine HorsbøllTrine Horsbøll More articles by this author , Susanne DaltonSusanne Dalton More articles by this author , Jane ChristensenJane Christensen More articles by this author , Frede DonskovFrede Donskov More articles by this author , Lars LundLars Lund More articles by this author , and Nessn AzawiNessn Azawi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002618.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In this nationwide study, we investigated the effect of patient-related and lifestyle factors, and the use of multidisciplinary team meetings (MDT) in patient decision making, with overall and cancer-specific death, risk of recurrence and risk of death after recurrence as endpoints. METHODS: The study population included 949 patients with stage III and IV renal cancer, registered in the Danish Renal Cancer Database between 2014 and 2016 and followed until January 2021. Data sources were national registries supplemented with manual extraction of information from patient medical records. The hazard ratio (HR) with corresponding 95 % confidence intervals (CI) over overall death, cancer-specific death and recurrence were estimated using Cox proportional hazards regression with multivariate adjustment. RESULTS: Of 949 patients included, 502 (53 %) had localized disease only and 447 (47%) had stage IV at diagnosis; 625 (73%) had nephrectomy, 464 (49%) had treatment decisions made in MDT, and 526 (55%) had hypertension at diagnosis. Hypertension, poor performance status and primary metastasis increased the HR of both overall and cancer-specific death, while smoking was associated with a borderline increased HR of overall death (Table 1). 167 of 500 patients (33%) had recurrence after nephrectomy; only positive surgical margin (HR: 2.32, CI: 1.41;3.80) was statistically significant for risk of recurrence. HR of overall death after recurrence was 0.63 (CI: 0.47;0.84) per year from primary diagnosis to the diagnosis of recurrence. When treatment of recurrence was solely oncological (HR: 4.02, CI: 1.52;10.59), or no treatment was given (HR: 3.57, CI: 1.11;11.44), patients had a higher risk of overall death compared to patients treated with surgery. CONCLUSIONS: Patient-related factors such as hypertension and performance status were associated with survival and warrant attention in patient risk stratification. A longer time to recurrence reduced the risk of death after recurrence. Patients whose recurrence was treated without surgery had worse survival, confirming the role of surgery in treating advanced renal cancer. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e817 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Freja Ebbestad More articles by this author Louise Geertsen More articles by this author Naomi Nadler More articles by this author Sofie Axelsen More articles by this author Trine Horsbøll More articles by this author Susanne Dalton More articles by this author Jane Christensen More articles by this author Frede Donskov More articles by this author Lars Lund More articles by this author Nessn Azawi More articles by this author Expand All Advertisement PDF DownloadLoading ...

Risk of heart failure with preserved versus reduced ejection fraction in women with breast cancer.

While clinical heart failure (HF) is recognized as an adverse effect from breast cancer (BC) treatment, sparse data exist on specific HF phenotypes in affected BC survivors. We examined risk of HF by left ventricular ejection fraction (LVEF) status in women with a history of BC. 14,804 women diagnosed with all stages of invasive BC from 2005 to 2013 and with no history of HF were matched 1:5 to 74,034 women without BC on birth year, race, and ethnicity. LVEF values were extracted from echocardiography studies within 30days before through 90days after the HF clinical encounter. HF was stratified into HF with preserved ejection fraction (HFpEF, LVEF ≥ 45%) and HF with reduced ejection fraction (HFrEF, LVEF < 45%). Cumulative incidence rates (CIRs) were estimated with competing risk of overall death. Hazard ratios (HR) were calculated by multivariable Cox proportional hazards regression. Mean time to HF diagnosis was 5.31years (range 0.03-13.03) in cases and 5.25years (range 0.01-12.94) in controls. 10-year CIRs were 1.2% and 0.9% for overall HF, 0.8% and 0.7% for HFpEF, and 0.4% and 0.2% for HFrEF in cases and controls, respectively. In fully adjusted models, an overall significant increased risk of HF in cases versus controls was observed (HR: 1.31, 95% CI 1.14, 1.51). The increased risk was seen for both HFrEF (HR: 1.59, 95% CI 1.22, 2.08) and HFpEF (HR: 1.22; 95% CI 1.03, 1.45). BC survivors experienced higher risk of HF compared with women without BC, and the risk persisted across LVEF phenotypes. Systematic cardio-oncology surveillance should be considered to mitigate this risk in BC patients.

Comparison of treatment strategies and survival of early-onset gastric cancer: a population-based study

Treatments for early-onset gastric cancer (EOGC) patients are rarely included in clinical trials, resulting in an unclear impact on survival. This study aimed to investigate the treatment patterns of EOGC patients and their impact on survival. Based on the Surveillance, Epidemiology, and End Results database, we conducted a retrospective analysis of 1639 EOGC patients (< 50 years) diagnosed between 2010 and 2018. Patients with larger tumours, distant metastasis, and AJCC TNM stage in IV were prone to receive nonsurgical treatment. Patients treated with surgery alone had a better prognosis than those receiving SROC or SCRT or nonsurgical treatment. However, analyses stratified by histological type, tumour size and TNM stage showed that patients did not benefit more from SROC and SCRT than from surgery alone. Similar results were observed in the stratified Cox regression risk analysis. Patients who received nonsurgical treatment had the highest risk of overall death [hazard ratio (HR) = 2.443, 95% confidence interval (CI) 1.865–3.200, P < 0.001]. This study indicated that additional radiotherapy, chemotherapy or chemoradiotherapy did not provide a coordinated survival benefit to EOGC patients.