Significant Difference In Survival Research Articles

Comorbidities, long-term outcome and poststroke epilepsy associated with ischemic stroke - A multicenter observational study of 125 dogs.

Little is known regarding the comorbidities and prognostic factors associated with the long-term outcome of ischemic stroke in dogs. Although poststroke epilepsy is a well-recognized syndrome in people, it is unclear if this phenomenon also occurs in dogs. Document comorbidities, long-term outcome (survival and stroke recurrence), and occurrence of epileptic seizures associated with ischemic stroke. One hundred and twenty-five client-owned dogs. Multicenter observational study including dogs diagnosed with ischemic stroke between 2000 and 2021. Associations between comorbidities, stroke location and extent, poststroke epileptic seizures, and long-term outcome were investigated. Referring veterinarians and owners were contacted to obtain follow-up information. Fifty-two dogs (41.6%) had a comorbidity. The most common comorbidities were hypertension (20%) and proteinuria (8%). Eight dogs (6.4%) that did not survive to discharge had a territorial ischemic stroke. Overall median survival time for dogs with a comorbidity was 482 days (range, 1-3013) and 907 days (range, 1-3027) in dogs without comorbidities (Kaplan-Meier survival analysis P = .602). Twenty-four dogs (19.2%) had a suspected stroke recurrence and a total of 8/109 dogs (7.3%) developed poststroke epilepsy. No association was found between suspected stroke recurrence or development of poststroke epilepsy and survival (P = .812, P = .487). Despite no significant difference in survival of dogs diagnosed with ischemic stroke, with or without comorbidities, investigations for underlying causes are recommended to provide appropriate treatment. Poststroke epilepsy is uncommon.

What is the optimal treatment strategy of salvage line treatment after progression on anti-epidermal growth factor receptor monoclonal antibody in patients with tissue RAS/BRAF wild-type metastatic colorectal cancer?

138 Background: Trifluridine/tipiracil (FTD/TPI) plus bevacizumab (BEV) and anti-epidermal growth factor receptor (EGFR) monoclonal antibody (mAb) re-challenge are treatment options for tissue RAS/BRAF wild-type (WT) metastatic colorectal cancer (mCRC) in salvage line, although the optimal treatment sequence of salvage line remains unclear. Methods: RAS/BRAF WT mCRC patients refractory to anti-EGFR mAb were retrospectively enrolled at a single cancer institute from November 2017 to April 2024. We compared responses, progression-free survival (PFS), and overall survival (OS) between Group A (anti-EGFR mAb re-challenge given first) and B (FTD/TPI plus BEV given first). We compared responses between Group C (treated with anti-EGFR mAb re-challenge at any line) and D (treated with FTD/TPI plus BEV at any line). We explored the clinical factors related to the treatment efficacy using multivariate analysis. Results: A total of 89 patients (median age, 63 years) were included. The cohort included 74 patients with a primary lesion in the left-sided colon, while 15 patients had a primary lesion in the right-sided colon. The response rate (RR) was 3.4%. The disease control rate (DCR) was 52.8%. The median PFS (mPFS) and OS (mOS) were 3.5 months (95% confidence interval [CI], 2.8-4.2) and 12.8 months (95% CI, 8.8-15.7) respectively. Two of 18 patients (11.1%) in Group A and 1 of 71 patients (1.4%) in Group B achieved partial response (PR). The RR of Group C was significantly higher than Group D (9.6% vs 1.2%; p = 0.031). Both PFS and OS showed no significant difference between Group A and B (mPFS: 3.3 vs 3.9 months; hazard ratio [HR], 1.08; 95% CI, 0.63-1.84; p = 0.79) (mOS: 12.8 vs 15.0 months; HR, 0.90; 95% CI, 0.49-1.65; p = 0.72). Multivariate analysis identified that primary tumor resection was associated with PFS (HR, 0.44; 95% CI, 0.25–0.80; p = 0.0068) and primary tumor resection (HR, 0.34; 95% CI, 0.18–0.65; p = 0.0010) and serum CA19-9 level (HR, 1.75; 95% CI, 1.02-3.00; p = 0.043) were associated with OS. Conclusions: No significant survival difference was observed between patients administered anti-EGFR mAb re-challenge first and those administered FTD/TPI plus BEV first, whereas the RR of anti-EGFR mAb re-challenge is significantly higher than that of FTD/TPI plus BEV.

Radiomics-based prediction of HCC response to atezolizumab/bevacizumab.

636 Background: Advanced hepatocellular carcinoma (HCC) treatment has evolved with the introduction of atezolizumab/bevacizumab, showing improved outcomes over sorafenib. However, the response varies among patients, particularly between viral and non-viral etiologies. This study aimed to develop and evaluate multimodal prediction models combining quantitative imaging and clinical markers to predict treatment response in HCC patients. Methods: From March 2020 to May 2023, patients with advanced HCC treated with atezolizumab/bevacizumab were retrospectively identified from six centers in Germany and Austria. Patients underwent baseline contrast-enhanced liver MRI and follow-up imaging to assess therapy response. Machine learning models, including RandomForestClassifier, were developed for radiomics, clinical, and combined datasets. Hyperparameter tuning was performed using RandomizedSearchCV, followed by cross-validation to evaluate model performance. Results: The study included 103 patients, with 70 achieving disease control (DC) and 33 experiencing disease progression (PD). Key findings included significant differences in treatment response and progression-free survival between DC and PD groups. The radiomics model, using 14 selected features, achieved 73.1% accuracy and a ROC AUC of 0.635 on the test set. The clinical model, with 4 selected features, achieved 73% accuracy and a ROC AUC of 0.649 on the test set. The combined model showed improved performance with 69% accuracy and a ROC AUC of 0.753 on the test set. Hyperparameter tuning further enhanced the combined model's accuracy to 80.1% and ROC AUC to 0.771 on the test set. Conclusions: The hybrid model combining clinical and radiological data outperformed individual models, providing better predictions of response to atezolizumab/bevacizumab in HCC patients.

Efficacy of Second-line Nivolumab Versus Tyrosine Kinase Inhibitors for Renal Cell Carcinoma With Bone Metastases.

Combination therapy with immune checkpoint inhibitors has become the standard first-line treatment for metastatic renal cell carcinoma (mRCC), leading to changes in second-line treatment options, such as nivolumab or tyrosine kinase inhibitors (TKIs). However, very few studies have compared the efficacy of these drugs in patients with mRCC, particularly those with bone metastases (BM), which are associated with a poor prognosis. This study compared the efficacy of nivolumab and TKIs as second-line treatments for mRCC patients with BM and examined the microenvironments of primary tumors and BM lesions. This multi-institutional retrospective study included 87 mRCC patients with BM who received either nivolumab or TKIs as second-line treatments. We analyzed tumor-infiltrating immune cells expressing CD8 and CD20, along with PD-L1, HIF2α, c-MET, VEGFR2, and AXL, in primary tumors and BM sites using immunohistochemistry. This analysis indicated that poor-risk classification, as per the International Metastatic RCC Database Consortium criteria (p<0.01), and elevated serum alkaline phosphatase levels (p=0.031) were significantly associated with poor prognosis. No significant difference in overall survival was observed between patients receiving nivolumab and those receiving TKIs. However, the objective response rate of patients with BM lesions was significantly higher when receiving TKIs than when receiving nivolumab (p=0.014). Immunohistochemistry revealed significantly higher VEGFR2 expression in BM lesions than primary tumors. TKIs could be a promising second-line treatment option for mRCC patients with bone-limited metastases.

Efficacy and safety of reduced-port laparoscopic surgery versus conventional laparoscopic surgery for colorectal cancer

BackgroundLaparoscopic radical resection has become the most important treatment for resectable colorectal cancer (CRC). However, there is still a lack of researches on the efficacy and safety of reduced-port laparoscopic surgery (RPLS) versus conventional laparoscopic surgery (CLS) in the treatment of CRC.Patients and methodsFrom January 2019 to July 2022, 698 patients with CRC received surgical treatment in the Sixth Affiliated Hospital of Sun Yat-sen University were enrolled in this retrospective cohort study. Patients were divided into RPLS group (n = 220) and CLS group (n = 478) according to their surgical procedures. Propensity score matching (PSM) was used to adjust the differences in baseline characteristics. The incidence of perioperative outcomes and survival rates related results were analyzed after PSM.ResultsFour hundred twenty-two patients were equally divided into RPLS group (n = 211) and CLS group (n = 211) after PSM. There were no statistically significant differences in overall survival (OS) and progression-free survival (PFS) between the two groups (P value was 0.773 and 0.579 respectively). The perioperative outcomes of patients between the two groups were comparable, except that patients in the RPLS group had a shorter postoperative hospital stay (P value < 0.001).ConclusionFor patients with CRC, both RPLS and CLS might be acceptable surgical options. No significant differences in perioperative outcomes, PFS rates and OS rates were observed between the two groups. For certain cases, RPLS was superior to CLS in terms of postoperative recovery.

Effect of marital status and race on survival of patients with well differentiated neuroendocrine tumors (NETs).

654 Background: Socioeconomic status factors (SES) such as marital status, income, and race can influence and enhance disparities in cancer incidence and outcomes. Marriage has documented positive impacts on overall survival of numerous cancer types. Consequences of divorce have been less explored. The unique indolent, secretory nature of NETs may be differentially affected by SES factors. This study identifies implications of marital status and sex on 5-year survival rates of different racial groups diagnosed with NETs within the Surveillance, Epidemiology, and End Results (SEER) database between 2000-2020 while controlling broadly for the type of treatment received. Methods: Within the SEER data base patients with reported sex, race, marital status and treatment who were diagnosed with well differentiated NETs were selected excluding carcinomas. Relative and disease specific 5-year survival analyses were calculated with 95% confidence intervals and age standardized. Three groupings were analyzed single, separated/divorced/widowed and domestic-partner/married. Results: For all races and sexes, relative survival for individuals in a union was higher than those who were single, or separated, divorced/widowed [86.9% (CI 86.1% - 87.7%); 79.3% (77% to 81.3%); and 79.2% (78% to 80.3%) respectively]. When individuals of each marital status group were compared by matching sex and race, there were no significant differences in relative survival. But males of any race who left a union had lower chances of survival than corresponding females [72.4% (69.7% to 74.9%) vs 81.6% (80.3% to 82.8%)]. As expected, all groupings who received surgical treatment had a higher relative survival than those who did not. Those who received surgical treatment while in a partnership had a higher relative survival then those who were separated [94.5% (93.6% to 95.3%) vs 88.7% (87.3% to 89.9%)]. All marital groupings who underwent surgery or did not, had comparable relative survival between races; except, black individuals in a partnership had improved outcomes compared to the white population. More specifically, when accounting for race, sex, marital status and treatment received, black men who did not undergo surgery had a higher relative survival compared to white men [69.9% (62.2% to 76.3%) vs 59.4% (56.6% to 62.1%)]. All the same conclusions were statistically significant for disease specific survival. Conclusions: Due to NETs slow growing nature SES factors play a major role in the care of patients living with them. Our findings demonstrate generally, irrespective of race, sex, or surgical treatment, being involved in a union is advantageous, showing a protective effect on patient survival, while parting from a union could be deleterious as it is tied to less favorable outcomes. These findings underscore the importance of considering these factors in treatment and care strategies.

Successful of autologous hematopoietic stem cell mobilization with plerixafor combined with G-CSF in pediatric neuroblastoma patients, a single center experience.

Neuroblastoma (NB) is the most common extracranial solid tumor in pediatric. In highrisk NB patients, the 5-year overall survival rate (OS) remains a stark < 50 % with conventional therapies. Autologous hematopoietic stem cell transplantation with high dose chemotherapies was used in poor prognosis and high-risk patients.Today, Plerixafor is used to increase stem cells mobilization in patients who are candidates for autologous transplantation. This study examined safety and efficacy Plerixafor is administered as a subcutaneous injection in pediatric NB patients for stem cell mobilization STUDY DESIGN: A cohort of 19 pediatric neuroblastoma (NB) patients underwent autologous hematopoietic stem cell transplantation (HSCT) between February 2017 and April 2019, receiving G-CSF mobilization only. Subsequently, 37 NB patients underwent HSCT between December 2019 and October 2023, receiving both G-CSF and plerixafor for mobilization (auto-HSCT). The final product CD34 cell dose /kg was evidently higher in combination group at 5.363 ± 4.243 vs. G-CSF group at 2.827 ± 3.586 × 106(P value= 0.001). Neutrophils and platelet engraftment were occurred sooner in combination group compared with G-CSF group. The 1-year overall survival (OS) rate for the G-CSF and G-CSF-and-plerixafor combination group was 70.8 % and 63.3 %, respectively (P = 0.874). No statistically significant difference in OS or disease-free survival (DFS) was observed between the two treatment groups. The results show that plerixafor may be safe and effective in NB pediatric patients in routine clinical practice. It was well tolerated in NB patients and no specific side effects were observed. It was not associated with improved survival.

Impact of unplanned readmission to the same facility within 30 days following robot-assisted and laparoscopic hemicolectomy for early-onset non-metastatic colon cancer.

111 Background: Colon cancer in younger populations has risen in recent years, prompting changes in screening guidelines. Hemicolectomy remains integral for standard treatment for non-metastatic early-onset colon cancer, and many institutions have adopted robot-assisted approaches for this procedure. However, high costs associated with this technology along with mixed data regarding survival benefits and post-surgical complications warrant further investigations on the specific advantages of robot-assisted surgery. This study aims to examine the impact of unplanned readmission to the same facility within 30 days following surgery for patients receiving robot-assisted and laparoscopic hemicolectomy on long-term survival for early-onset non-metastatic colon cancer to see how current paradigms of colon cancer treatment extend to early-onset patients. Methods: The National Cancer Database was used to identify patients under the age of 50 receiving a minimally invasive hemicolectomy for primary non-metastatic colon cancer diagnosed between 2016-2020. Patients were stratified based on surgical approach and whether they underwent an unplanned readmission to the same facility within 30 days following surgery, and survival differences were calculated log-rank test and Cox regression analysis that included co-variates related to tumor characteristics, patient demographics, and facility characteristics. Results: 5,076 patients were identified, with 577 receiving a robot-assisted approach and 4,499 receiving a laparoscopic approach. Multivariate analysis found no significant difference in long-term survival between patients receiving a laparoscopic versus robot-assisted approach (HR: 0.893, 95% CI: 0.687-1.161, p=0.398). Additionally, multivariate analysis found that unplanned readmission within 30 days did not have a significant impact on long-term survival outcomes for patients receiving a robot-assisted approach (HR: 0.856, 95% CI: 0.257-2.848, p=0.800), but it did find worsened survival outcomes for the laparoscopic approach (HR: 1.535, 95% CI: 1.070-2.203, p=0.020). Conclusions: Patients receiving laparoscopic hemicolectomy for early-onset non-metastatic colon cancer appear to have worsened overall long-term survival outcomes when undergoing an unplanned readmission to the same facility within 30 days of surgery when compared to patients receiving a robot-assisted surgical approach. However, it also appears that overall, both surgical approaches have similar overall long-term survival. Further research on how robot-assisted surgery impacts survival and post-surgical complications in patients with early-onset non-metastatic colon cancer is warranted to examine how this advancing technology could improve cancer care.

The State of Combined Thoracoabdominal Triple Organ Transplantation in the United States

BackgroundAs triple organ transplants (TOT) have become more common, we evaluate patient characteristics, risk factors, and clinical outcomes of patients undergoing thoracoabdominal TOT. MethodsThis retrospective study utilized data from heart-lung-liver (HLL), heart-lung-kidney (HLK), heart-kidney-liver (HKL), and heart-kidney-pancreas (HKP) recipients from the UNOS registry between 1989 and 2023. Recipient and donor characteristics and risk factors for mortality were analyzed using Cox regression hazard models. Recipient survival up to 10-years were analyzed using the Kaplan-Meier method. ResultsDuring the study period, 81 TOTs were performed (13 HLLs, 13 HLKs, 46 HKLs, 9 HKPs). There were no statistically significant differences in long-term survival between TOTs (p=0.13). However, HLL and HLK recipients had significantly worse (p<0.0001) and improved (p<0.0001) survival, respectively, when compared to heart-lung, isolated heart, and lung transplant recipients. HLK was associated with improved survival (HR:0.22, p=0.033). We found no differences in survival among HKL (p=0.24) and HKP (p=0.19) recipients compared to their dual- and single-organ counterparts. TOTs after 2007 (HR: 0.29, p=0.003) were associated with improved survival, whereas increased recipient age (HR:1.06, p=0.037), eGFR (HR:1.02, p=0.005), and donor age (HR:1.05, p=0.031) were associated with higher mortality. ConclusionsThe prevalence of TOTs has dramatically increased over the past decade. While overall survival between TOTs appears similar, adding a liver to a heart-lung transplant may be associated with a poorer prognosis compared to adding a kidney. A careful, multidisciplinary approach to patient selection and management remains paramount in optimizing outcomes for high-risk patients undergoing TOTs.

A novel 2-2 5-5 model for stratifying liver metastasis burden in patients with pancreatic cancer.

711 Background: In metastatic pancreatic cancer (MPC), hepatic metastasis is uniformly counted as just ‘one organ metastasis’ regardless of its metastatic tumor burden. This study aims to develop a novel stratification system for liver metastasis based on tumor burden, and to evaluate its prognostic significance in MPC patients. Methods: Patients with MPC treated at Seoul National University Bundang Hospital from 2011 to 2021 were included as the training cohort. Patients with liver-only metastasis were selected for analysis. Liver metastasis burden was categorized by the number and maximum diameter of metastases as measured from diagnostic CT images. Optimal cutoffs for metastasis number and size were determined using Cox proportional hazards regression, adjusted for chemotherapy regimen. An independent cohort from Seoul St. Mary’s Hospital and Hallym University Sacred Heart Hospital served as the validation group. The ‘H category classification’ suggested by the Japanese Society for Cancer of the Colon and Rectum (JSCCR) was also referenced. Results: A total of 1,257 patients were included, with 1,084 in the training cohort and 173 in the validation cohort. In the training cohort, data from 311 patients with liver-only metastasis were analyzed to derive the Two-two five-five (‘2-2 5-5’) criteria, classifying metastasis into Oligo-metastasis (≤2 metastases and ≤2 cm), Meso-metastasis (non-oligo and non-mega), and Mega-metastasis (≥5 metastases or ≥5 cm). Median overall survival (OS) significantly differed between the groups: Oligo (11.4 months), Meso (9.2 months, HR 1.66, 95% CI 1.14–2.43), Mega (5.6 months, HR 2.63, 95% CI 1.94–3.58) in the training cohort; Oligo (5.8 months) vs Mega (1.81 months, HR 1.94, 95% CI 1.16–3.22) in the validation cohort. Conclusions: This 2-2 5-5 model effectively stratifies MPC patients with hepatic metastasis into three prognostic groups, demonstrating significant survival differences in both training and validation cohorts. This could rationalize the independent therapeutic strategies by extent of hepatic metastasis. Demographic characteristics of patients classified according to “two-two five-five” criteria. Oligo-metastasis(n = 88) Meso-metastasis(n = 59) Mega-metastasis(n = 164) Total(n = 311) P-value* Age, median (range) 66.0 (33.2-91.0) 67.1(37.2-86.9) 68.7 (40.1-94.6) 67.9 (33.2-94.6) 0.587 Male, n (%) 43 (48) 36 (61) 91 (55) 170 (54) 0.330 Tumor location(Head), n(%) 47 (53) 27 (45) 60 (36) 134 (43) &lt;0.05 Number of liver metastasis, median (range) 1 (1-2) 3 (1-4) 12 (2-14) 5 (1-14) &lt;0.05 Maximal size of liver metastasis, cm (IQR)Average size of liver metastasis, cm (IQR) 10.6 (8.1-13.1)10.3 (8.0-12.1) 15.9 (10.1-24.2)13.5 (7.8-19.1) 21.6 (16.8-33.7)13.2 (10.5-19.2) 17.2 (10.9-25.2)11.9 (9.2-17.1) &lt;0.05&lt;0.05 CA19-9 (U/mL) 462 (103-1,334) 560 (89-1,480) 1,170 (100-9,500) 745 (100-3,700) &lt;0.05

Evaluation of CSF1R as a potential prognostic biomarker in colorectal cancer (Alliance).

285 Background: Immune checkpoint inhibitors (ICIs) have shown limited efficacy in colorectal cancer (CRC) outside of mismatch repair (MMR) deficient/microsatellite instability-high (MSI-H) tumors. Most CRC cases are MMR proficient /microsatellite stable and demonstrate resistance to ICIs, attributed to the tumor microenvironment. Colony Stimulating Factor 1 Receptor (CSF1R), a regulator of tumor-associated macrophages, has emerged as a potential target due to its association with poor prognosis in CRC. Methods: Data from 433 metastatic CRC (mCRC) patients in the CALGB/SWOG 80405 trial were analyzed. CSF1R RNA was extracted from formalin-fixed, paraffin-embedded tumor samples and sequenced. Patients were divided into tertiles of CSF1R expression (high, medium, low). Progression-free survival (PFS) and overall survival (OS) were compared using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards models. Subgroup analyses were conducted based on liver metastases, treatment type (Bevacizumab, Cetuximab, FOLFOX, FOLFIRI), and MSI status. Results: Low CSF1R expression (CSF1R-L) was associated with significantly better survival outcomes. Median PFS was 12.9 months for CSF1R-L, compared to 11.2 and 9.2 months for CSF1R-M and CSF1R-H (p = 0.003). Median OS was 35.8 months for CSF1R-L versus 32.5 and 24.4 months for CSF1R-M and CSF1R-H (p = 0.00086). Stratification by liver metastases showed that CSF1R-L remained a strong prognostic factor only in patients with liver metastases. There were no significant survival differences based on CSF1R expression in bevacizumab-treated patients. However, in cetuximab-treated patients, CSF1R-L tumors had significantly longer PFS (12.9 vs 8.8 months, p = 0.037) and OS (35.8 vs 21.4 months, p = 0.002) than CSF1R-H tumors. Similarly, in FOLFOX-treated patients, CSF1R-L tumors showed longer PFS and OS (p = 0.018 and p = 0.013, respectively), and in FOLFIRI-treated patients, OS was significantly longer for CSF1R-L tumors (42.2 vs 24.7 months, p = 0.022) than CSF1R-H tumors. Conclusions: Our data suggests that CSF1R expression may serve as a prognostic biomarker in CRC, with lower expression potentially linked to improved survival, particularly in patients with liver metastases. These findings warrant further investigation of CSF1R as a possible prognostic and predictive biomarker, as well as a potential therapeutic target in CRC. Clinical trial information: NCT00265850 .

Laryngeal Squamous Cell Carcinoma Incidence and Survival Trends in the United States: A Population-Based Analysis of Two Decades.

Laryngeal cancer has undergone a complex evolution in incidence, management, and standards of care over the past 20 years. Disease-wide demographic and survival risk factors have yet to be elucidated. Examine incidence, management, and survival trends in laryngeal cancer from 2000 to 2019. The Surveillance, Epidemiology, and End Results database was utilized to identify age-adjusted incidence rates (AAIRs) of laryngeal squamous cell carcinoma (LSCCa) from 2000 to 2019. Joinpoint regression was conducted to identify annual percentage changes (APCs). Chi-squared analysis was used to find changes in demographic, clinicopathologic, and treatment changes over the study period. Finally, univariate Kaplan-Meier and COX multivariate regressions were conducted to identify survival differences. There were 46 266 cases of LSCCa identified between 2000 and 2019 with AAIR of 2.7 per 100 000 person-years with APC of -2.6% [95% CI: -2.8% to 2.4%]. These rates have largely been down-trending among demographic substratifications. Age at initial diagnosis has been increasing (64.6 → 66.0, p < 0.001). Higher median household income was associated with lower AAIR (35 000 5.3; > $75 000 2.2) and increased annual percentage decrease (< $35 000, -1.1%*; > $75 000, -3.2%*). There were no other clinically significant differences in demographic and clinicopathologic trends although persistent demographic differences were noted. Late T-stage at diagnosis has increased over the study period (T3, 18% → 23%, p < 0.001). Treatment with primary chemoradiotherapy has increased significantly (20.0% → 27.0%, p < 0.001). On univariate analysis, there were no significant differences in survival; however, on multivariate analysis, there has been a progressive improvement in disease-specific and overall survival over 5-year bins. Late-stage disease had a progressive improvement in survival with each treatment period on both univariate and multivariate analysis. There has been a progressively significant decrease in age-adjusted incidence of LSCCa with increased utilization of primary chemoradiotherapy. When adjusted for associated characteristics, there has been a continuing improvement in survival over the study period, primarily in late-stage disease.

Epidemiology of Colpocephaly in the Texas Birth Defects Registry, 1999 to 2020.

Colpocephaly is a congenital brain defect characterized by enlargement of the occipital horns of the lateral ventricles. Few population-based studies have focused on this central nervous system (CNS) defect. This study aimed to evaluate the birth prevalence and survival of Texas infants with colpocephaly delivered between 1999 and 2020. Cases from the Texas Birth Defects Registry (TBDR) with a diagnosis of colpocephaly were identified. Unadjusted birth prevalence, 1-year survival estimates, and crude hazard ratios with 95% confidence intervals (CIs) were calculated from data collected from the medical record abstraction and linked vital records. Select maternal and infant variables were assessed overall and across four medical classification groups (presence of isolated, chromosomal, syndromic, or multiple major defects). From 1999 to 2020, 1,146 cases with colpocephaly were identified. The overall birth prevalence of colpocephaly was 1.36/10,000 live births (95% CI: 1.28-1.44). Significantly higher prevalence was noted for male infants, infants with low birth weight (<2,500 g), and very preterm (<32 weeks) infants. Overall, 1-year survival was 89.5%, with statistically significant differences observed in each medical classification group (e.g., isolated) across levels of maternal education, Texas/Mexico border maternal residence at delivery, infant birth weight, and gestational age. These findings have important implications for pediatric neurology and future research, such as counseling on the prevalence and prognosis of colpocephaly. Additionally, these findings highlight that the population burden of CNS defects may be higher than previously believed, supporting the expansion of research of rare brain defects. · The overall birth prevalence of colpocephaly for Texas infants delivered between 1999 and 2020 was 1.36/10,000 live births.. · Statistically significant differences in 1-year survival were observed across select maternal and infant variables.. · Longitudinal studies are necessary to fully ascertain the prevalence of colpocephaly beyond the first year of life..

Wolbachia does not give an advantage to the ectoparasitoid Habrobracon hebetor (Say, 1836) when it develops on an infected host.

The effect of Wolbachia on the viability and antimicrobial activity of the ectoparasitoid Habrobracon hebetor was evaluated in laboratory experiments. Two lines of the parasitoid, Wolbachia-infected (W+) and Wolbachia-free (W-), were used. Parasitoid larvae were fed with a host orally infected with a sublethal dose of Bacillus thuringiensis (Bt) and on the host uninfected with Bt. Parasitoid survival was assessed at developmental stages from second-instar larvae to adults. At all developmental stages, there were no statistically significant differences in survival between lines W+ and W-, regardless of host Bt infection. In both W+ and W- lines, the expression of lysozyme-like proteins, antimicrobial peptides (AMPs), and Hsp70 genes was analysed in fourth-instar larvae fed with an infected and uninfected host. In addition, lysozyme-like activity and antibacterial activity were evaluated. The expression of AMPs was significantly higher in W- larvae and did not get induced during the feeding on the Bt-infected host. mRNA expression of lysozyme-like proteins and lysozyme activity were significantly higher in W+ larvae than in W- larvae and did not get induced when the larvae were fed with the infected host. In whole-body homogenates of H. hebetor larvae fed with the uninfected host, antibacterial activity against gram-positive bacteria (Bacillus cereus and Bacillus subtilis) was significantly higher in the W+ line and did not get induced during the feeding with the Bt-infected host. Therefore, there is no obvious immunostimulatory effect of Wolbachia in H. hebetor larvae when they feed on a host infected with an entomopathogenic bacterium.

P-1446. Impact of Social Determinants of Health on Infectious Outcomes in Patients Undergoing Amputation

Abstract Background Studies have demonstrated the impact of SDOH on outcomes following vascular surgery, but few have focused on risk factors for infectious complications following major amputation. Odds Ratios (Confidence Intervals) for Infectious Outcomes Based on Social Determinants of Health Methods Local data for the Society Vascular Surgery Vascular Quality Initiative, a multicenter registry of quality improvement, were queried for demographics, clinical, procedure, and outcomes of 371 patients with amputation as index procedure 6/1/2015 to 7/31/2023. Zip codes were used to derive CDC/ATSDR Social Vulnerability Index (SVI). The impact of SDOH and SVI on surgical outcomes with a focus on infection was evaluated by logistical regression with R v4.3.2. Primary outcomes for univariate analysis included surgical site infection (SSI), readmission for infection, composite infection-related outcome, organ system complications during index admission, mortality at 30 days, 1 year, 2 years, and 5 years, and composite surgical adverse outcome inclusive of infectious and non-infectious complications. Significant variables were selected for multivariate regression. Odds Ratios (Confidence Intervals) Additional Factors and Surgical Outcomes Based on Social Determinants of Health Results SDOH correlated with multiple parameters in univariate analysis (Fig 1, 2). Male patients had higher ASA score and uncontrolled infection as indication for amputation but were less likely to incur an SSI, or require above trans-metatarsal amputation. Publicly insured patients were more likely to be wheelchair bound or bedridden, or residing in a facility preoperatively, and had the highest risk of readmission for infection (OR=8.09), along with a higher risk of 2 year mortality. Patients with ongoing tobacco use had increased mortality at 1 (OR=1.9) and 2 years (OR=1.7). In multivariate analysis, male gender was associated with SSI (OR 0.25 CI 0.06-0.96). Composite infectious complication was associated with emergent procedure status (OR 2.96 CI 1.22-6.97). There was no significant difference in survival for SDOH derived subgroups (Fig 1) or composite surgical adverse outcome. Kaplan-Meier Survival Analysis for subgroups based on SDOH parameters Conclusion Association between demographic, clinical, and peri-operative complications, with focus on infection, provides opportunity to identify high-risk patients, and serves as a framework for additional interventions, such as close post-operative follow up, and robust involvement of social work and care management teams. Disclosures All Authors: No reported disclosures

Prognostic value of right ventricular ejection fraction using three-dimensional echocardiography in patients with ischemic cardiomyopathy and dilated cardiomyopathy

Abstract Background Prognostic value of right ventricular (RV) ejection fraction (EF) using three-dimensional echocardiography (3DE) in a diverse group of patients has been demonstrated in several studies [1-3]. However, little is known about its potential utility in patients with ischaemic cardiomyopathy (ICM) and dilated cardiomyopathy (DCM). Purpose To investigate the prognostic value of 3DE-RVEF in ICM and DCM. Methods We retrospectively selected ICM and DCM patients who had undergone 3DE from December 2007 to December 2018. 3DE analysis was performed using 3DE speckle tracking software. The primary end point was a composite of cardiac events, including cardiac death, heart failure hospitalization, myocardial infarction, or ventricular tachyarrhythmia. Results 268 ICM and 127 DCM patients were included in this analysis. During a median of 33 and 51 months of follow-up, 84 and 43 patients reached a primary end point in ICM and DCM, respectively. Univariable analysis showed RVEF was significantly associated with cardiac events in both groups [ICM, hazard ratio (HR): 0.92, 95% confidence interval (CI): 0.90 – 0.94; DCM, HR: 0.91, 95% CI: 0.88 – 0.94, respectively]. In multivariable analysis, RVEF (HR: 0.91, both for p&amp;lt;0.001) was significantly associated with cardiac events, after adjustment for age, chronic kidney disease, New York Heart Association function class (NYHA), Charlson comorbidity index (CCI), E/e', left ventricular (LV) EF or LV global longitudinal strain (GLS) in ICM. In DCM, RVEF (HR: 0.91 – 0.94, all for p&amp;lt;0.001) was significantly associated with outcome, after adjusting clinical factors (age and CCI or NYHA) and echocardiographic parameters (E/e' or LVEF or LVGLS). Kaplan-Meier survival curves, divided into four groups by RVEF ≥ 45% and &amp;lt; 45% and E/e' 14 ≥ and &amp;lt; 14, showed significant risk stratification for both ICM and DCM (Log-rank: p&amp;lt;0.0001, Fig 1). Crude Kaplan-Meyer survival analysis revealed there were no significant survival differences between ICM and DCM (p=0.36). However, ICM had a worse outcome than DCM after adjustment for age, NYHA, CCI, E/e', RVEF, LVEF or LVGLS (p=0.049 and p=0.028, respectively, Fig 2). Conclusions Our study confirmed the independent prognostic value of RVEF in patients with ICM and DCM and provided detailed risk stratification of cardiac events by E/e' and RVEF. In addition, ICM was associated with worse outcome than DCM after adjusting multiple covariates.

P-912. A 10-Year Retrospective, Single-Center Analysis of Nocardiosis in Immunocompetent and Immunocompromised Hosts: Clinical and Microbiological Features, Treatment Outcomes, and Determinants of Central Nervous System Involvement

Abstract Background Nocardia species are organisms with the potential to affect numerous organ systems, including the brain. However, it is unknown whether specific host or microbe factors are associated with central nervous system (CNS) nocardiosis and whether outcomes for CNS nocardiosis differ according to host immune status. Demographics and clinical characteristics by immune status. SOTr: solid organ transplant recipient. SCTr: stem cell transplant recipient. MSK: musculoskeletal structure, such as bone or joint. COPD: chronic obstructive pulmonary disease. WBC: white blood cell count. *The isolation of Nocardia in 2 or more non-contiguous body sites constituted disseminated disease Methods We performed a retrospective review of all adults admitted to Yale New Haven Hospital with laboratory-confirmed nocardiosis from 2013 to 2023. CNS involvement was defined as the identification of Nocardia spp on brain tissue or new radiological brain lesions in a patient with extra-neural nocardiosis. We performed multivariate logistic regression analyses of clinical and microbiological variables related to CNS involvement. Nocardia species distribution by CNS involvement Results 94 patients were included, of which 63 (67%) were immunocompromised (Table 1). The most common immunocompromising conditions were recipients of solid organ transplants (32%) and stem cell transplants (22%). Sixteen (17%) patients had CNS involvement of their nocardiosis; this included 22% of immunocompromised and 6% of immunocompetent patients (p=.056). The most common species isolated was the Nocardia nova complex (Table 2). Table 3 summarizes the univariate analysis of factors associated with CNS involvement. Black race [OR 3.7 (1.2-11.7), p=.03] and N. farcinica infection [OR 5.9 (1.8-19.3), p=.005] were associated with increased risk of CNS involvement. In a multivariate analysis, infection by N. farcinica was an independent risk factor for CNS involvement [OR 5.3 (1.5-18.7), p=.009]. There were no significant survival differences in immunocompromised hosts, with or without CNS disease, compared to immunocompetent hosts. Univariate analysis of demographic, host immune status and organism features associated with CNS involvement. Conclusion N. farcinica infection was identified as an independent risk factor of CNS involvement in patients with nocardiosis. Other factors related to the net state of immunosuppression were not associated with an increased risk for CNS involvement. Disclosures All Authors: No reported disclosures

Comparison of the efficacy of neoadjuvant chemotherapy and neoadjuvant chemoradiotherapy in locally advanced rectal cancer patients: meta-analysis of randomized controlled trials.

Preoperative neoadjuvant chemoradiotherapy (nCRT) is considered to be the standard treatment strategy for locally advanced rectal cancer (LARC); however, the risk of adverse events and postoperative recurrence remains significant. This study aimed to evaluate the non-inferiority of neoadjuvant chemotherapy (nCT) compared with nCRT in patients with LARC and to assess the possibility of eliminating radiotherapy on the basis of guaranteed efficacy. We searched the PubMed, Embase, and Cochrane Library databases to identify randomized controlled trials (RCTs) comparing the efficacy of nCRT and nCT for LARC. The study protocol was registered with the Prospective Register of Systematic Reviews (PROSPERO). A total of 2706 patients from 7 studies were included in the meta-analysis. There was no significant difference in overall survival (OS) or disease-free survival (DFS) between the nCT and nCRT groups. This study demonstrated a lower rate of infection (OR=0.53, 95% CI=0.34-0.82; P=0.005), anastomotic leak (OR=0.55, 95% CI=0.34-0.87; P=0.01), tumor regression grade (TRG) 0-1 (OR=0.50, 95% CI=0.36-0.69; P < 0.0001), preventive diverting ileostomy (OR=0.41, 95% CI=0.17-1.02; P=0.05) and leukopenia (OR=0.50, 95% CI=0.25-1.01; P=0.05) in the nCT group. However, there was no significant difference in the other toxic events, such as intestinal obstruction, urinary complications, diarrhoea, and surgical or pathological outcomes, such as clinical fistula, sphincter preservation, postoperative mortality (≤ 60 d), R0 resection, ypStage 0-I, positive circumferential resection margin (CRM+) or pathological complete response (pCR) between the two groups. This study indicated that OS and DFS were not lower in the nCT group than in the nCRT group. In addition, the nCT group had fewer complications. Preoperative nCT is expected to become a standard treatment option for most patients with stage II-III LARC. It is worth noting that radiotherapy can not be ignored for some patients who need to ensure the conversion effect of neoadjuvant therapy and strongly request to preserve organ function.

Segmental Resection with Ureteral Reimplantation vs Radical Nephroureterectomy with Bladder Cuff Removal for Urothelial Carcinoma of Distal Ureter: A Propensity Score Matching Study in a Large Chinese Center.

Purpose: We aim to compare the clinical outcomes of radical nephroureterectomy with bladder cuff removal (RNU) and segmental resection with ureteral reimplantation (RR) in Chinese patients with distal ureteral urothelial carcinoma. Materials and Methods: A retrospective analysis of medical records was performed for 922 patients found to have distal ureteral cancer, defined as below the level of the iliac vessels, with 747 patients who underwent RNU and 175 who underwent RR included in the final analysis. The primary endpoints included clinical outcomes and changes in the estimated glomerular filtration rate (eGFR). Survival analysis was conducted using the Kaplan-Meier method, and propensity score matching (PSM) was utilized to mitigate selection bias between the two surgical approaches. Results: After PSM, the Kaplan-Meier survival curves demonstrated significant associations between surgical approach and both local recurrence-free survival (LRFS) and bladder recurrence-free survival (BRFS), but no significant differences were found in cancer-specific survival (CSS) and overall survival (OS). There were no significant differences in metastasis-free survival and contralateral recurrence-free survival between the two groups. Multivariate Cox regression analysis identified RR as an independent predictor of poorer outcomes for LRFS and BRFS. In addition, a significant increase in eGFR was observed following RR, whereas a significant decrease was noted after RNU. Conclusion: RR is associated with equivalent CSS and OS compared with RNU, even in the context of high-risk distal ureteral cancer, and results in improved postoperative eGFR, whereas the potential of RR to increase the risk of local tumor recurrence and intravesical recurrence requires clinical consideration.

Percutaneous edge-to-edge mitral valve repair in patients with complex mitral valve anatomy: mid- to long-term results in a tertiary referral university hospital.

Abstract Introduction Transcatheter edge-to-edge repair (TEER) has proven to be an effective therapeutic alternative for certain cases of mitral regurgitation (MR) in patients who are not surgical candidates. Accumulated experience and technological advances allow TEER in selected patients with complex mitral valve anatomy who might initially be considered non-candidates for percutaneous treatment. Our main objective was to analyse the mid-to long-term characteristics and prognosis in patients with complex mitral valve anatomy treated with this technique compared to those with non-complex mitral anatomy. Methods An observational study was conducted on a prospective cohort of patients from a tertiary referral hospital, which included all cases of severe MR treated using TEER from November 2011 to January 2024. Two groups of patients were compared: those with complex valve anatomy (CVA) versus those who did not present it (NCVA). Mitral valve complexity was defined as the presence of mitral cleft, calcification in the grasping zone, mitral valve area (MVA) ≤3cm2 , mobile posterior leaflet length &amp;lt;7mm, rheumatic leaflet thickening or presence of Barlow syndrome. Clinical, analytical and echocardiographic variables were analysed at baseline and during follow-up. Baseline characteristics and event-free survival, defined as death or hospitalisation for heart failure (HF) during follow-up, were compared between the CVA and NCVA groups using Kaplan-Meier curves. Results A total of 191 patients were analysed (67% male, median age 74 (64-80) years), of whom 53 cases had complex valve anatomy. Among these, 7 cases presented with a mitral cleft, 2 cases had calcification in grasping zone, 3 cases had MVA≤3cm2, 35 cases with a mobile posterior leaflet length &amp;lt;7mm, 3 cases with rheumatic leaflet thickening and 8 cases had Barlow syndrome. Baseline clinical characteristics of both groups showed no significant differences, though there was a higher prevalence of hypertension in the CVA group, as shown in table 1. Most patients were in NYHA III-IV (62.3% CVA vs 72.4% NCVA, p=0.40) with a high percentage of prior hospitalization for HF in both groups without significant differences. The most common etiology of MR was functional with no differences between groups (CVA 77.4% vs NCVA 78.2%, p=0.43). With a median follow-up of 24 [9-50] months, event-free survival for readmission due to HF or all-cause mortality was 67% in CVA group, versus 64% in NCVA group, with no significant differences in median survival between them (p=0.41) (Figure 1). Conclusions In patients with MR and complex mitral valve anatomy who were initially not candidates for surgical or percutaneous treatment, a high event-free survival from death or readmission due to HF was achieved in the medium to long term. In centres with accumulated experience, TEER represents an effective therapeutic tool even in cases with complex anatomy, with no differences compared to those with more favourable anatomy. Baseline clinical characteristics. Kaplan-Meier curves