Specific Mortality Research Articles

The impact of metformin on survival in diabetic endometrial cancer patients: a retrospective population-based analysis

PurposeThe aim of our study was to assess overall survival and cancer-specific survival in endometrial cancer patients with type 2 diabetes mellitus (T2DM) using metformin.MethodsPatients with endometrial cancer and T2DM during 2000–2012 period were identified from the Lithuanian Cancer Registry and the National Health Insurance Fund database. Cancer-specific and overall survival were primary outcomes.ResultsIn our study we included 6287 women with endometrial cancer out of whom 664 were diagnosed with T2DM (598 metformin users and 66 never users). During follow-up (mean follow-up time was 8.97 years), no differences in risk of endometrial cancer specific mortality was observed in diabetic patients treated with metformin (Hazard Ratio (HR) 0.87, 95% Confidence Interval (CI) 0.70–1.07). Overall mortality in the diabetic metformin ever users’ group was significantly higher compared with the non-diabetic endometrial cancer women (HR 1.17, 95% CI 1.03–1.32) and in the group of metformin never users with T2DM (HR 1.42, 95% CI 1.07–1.87).ConclusionOur study results suggest no beneficial impact on overall and cancer-specific survival in endometrial cancer patients who were treated with metformin as part of their diabetes treatment.

Mortality from Breast Cancer in Women under 50 Years of Age in Colombia.

To calculate and analyze the mortality rates from breast cancer in women under 50 years of age in Colombia and to compare them with those of other countries in the region. Based on data from the registry of deaths in 2018 and the results of the National Population and Housing Census of Colombia for the same year, specific mortality rates in women with breast cancer, specific mortality according to age group, standardized by age, proportional mortality, potential years of life lost, and years of life expectancy lost in women under 50 years of age who died from breast cancer were calculated. The mortality rate of regional countries was consulted on the Global Cancer Observatory webpage. In the group from 20 to 49 years, the specific mortality rate was higher in the age range from 45 to 49 years, with a rate of 23.42 × 100,000, a value that was above the specific mortality rate due to breast cancer in women in Colombia, 15.17 × 100.000. In the age range of 45 to 49 years, the potential years of life lost were 42.16. Of the 0.275 years of life expectancy lost by the population due to this neoplasia, women under 50 years of age represented 0.091 (33%). Colombia is the fifth in the rank of mortality in Latin American countries in this age group. Breast cancer in patients from 30 to 59 years is the number one cause for the decrease in life expectancy of women in Colombia. Women under 50 years of age represent one third of this decrease. This neoplasm is also the leading cause of mortality in women younger than 50 years in South America.

Prostate-Specific Antigen Response to Androgen Deprivation Therapy in the Neoadjuvant Setting for High-Risk Prostate Adenocarcinoma (PIRANHA): Pooled Analysis of Two Randomized Clinical Trials

A suboptimal prostate-specific antigen (PSA) response to neoadjuvant androgen deprivation therapy (ADT) among men who go on to receive definitive radiation therapy for prostate cancer might suggest the existence of castration-resistant disease or altered androgen receptor signaling. This in turn may portend worse long-term clinical outcomes, especially in men with high-risk disease. We set out to evaluate the prognostic impact of poor PSA response to neoadjuvant ADT in men with high-risk prostate cancer. This was a post hoc analysis of the multicenter TROG 03.04 RADAR and PCS IV randomized clinical trials. Inclusion criteria for this analysis were patients with high-risk prostate cancer (defined as Gleason score ≥8, initial PSA ≥20 ng/mL, or cT3a disease or higher) who received definitive radiation therapy, at least 18 months of ADT, and had a preradiation therapy PSA level drawn after at least 3 months of neoadjuvant ADT. Poor PSA response was defined as PSA >0.5 ng/mL. Cox regression and Fine-Gray models were used to test whether poor PSA response was associated with metastasis-free survival, biochemical recurrence, prostate-cancer specific mortality, and overall survival. Nine hundred thirty men met inclusion criteria for this analysis. Median follow-up was 130 months (interquartile range [IQR], 89-154 months). After a median of 3 months (IQR, 3-4.2 months) of neoadjuvant ADT, the median PSA was 0.60 ng/mL (IQR, 0.29-1.59). Overall, 535 men (57%) had a PSA >0.5 ng/mL. Poor PSA response was associated with significantly worse metastasis-free survival (hazard ratio [HR], 3.93; P = .02), worse biochemical recurrence (subdistribution HR, 2.39; P = .003), worse prostate-cancer specific mortality (subdistribution HR, 1.50; P = .005), and worse overall survival (HR, 4.51; P = .05). Patients with PSA >0.5 mg/mL after at least 3 months of neoadjuvant ADT had worse long-term clinical outcomes and should be considered for treatment intensification.

Abstract C113: Geographic variation in low-dose computed tomography scanning for lung cancer screening in the United States

Abstract Background: Early detection using low-dose computed tomography scanning reduces lung cancer specific mortality by 20%. Despite its efficacy and its recommendation by the United States Preventive Services Task Force, the uptake of lung cancer screening (LCS) among high-risk individuals (aged 55–80 years with a >30-pack-year smoking history and who currently smoke or have quit within the previous 15 years) remains low. The purpose of this study was to assess whether LCS uptake varies by geographic location. Methods: Data for this study were obtained from the 2019 Behavioral Risk Factor Surveillance System. After excluding ineligible subjects, 10,242 subjects were included in the final analysis. Multivariable logistic regression models were used to model the associations between the predictor and the outcome variable, adjusting for potential confounders. Results: In metropolitan statistical areas, individuals who reside outside the center city are less likely to receive LCS than those who reside in the center city (OR: 0.65; 95% CI: 0.43 – 0.98). Stratifying the data by race/ethnicity, we found a non-significant difference between Whites who reside in the center city and those outside the center city in LCS uptake (OR: 0.69; 95% CI: 0.45 – 1.06). Among Blacks (OR:0.10; 95% CI: 0.02 – 0.59) and other minorities (OR:0.10; 95% CI: 0.02 – 0.63), individuals who reside outside the center city are less likely to receive LCS than their respective counterparts residing in the center city. Nevertheless, we found a non-significant difference in LCS uptake between urban and rural counties (OR: 1.06; 95% CI: 0.76-1.48).Conclusions: LCS uptake is related to metropolitan statistical area (residents in the center city vs. outside the center city), but it is modified by race/ethnicity. This finding has important implications for policy makers and program planners in helping them design more effective interventions to promote LCS targeting racial/ethnic minorities residing outside the center city. Citation Format: Abdi T. Gudina, Lee A. Kehoe, Sara Hardy, Charles S. Kamen, Paula Cupertino. Geographic variation in low-dose computed tomography scanning for lung cancer screening in the United States [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C113.

Mortalidad de pacientes hospitalizados por COVID 19 en México, Revisión sistemática

Introduction Since the start of the pandemic, Mexico was one of the countries with the highest mortality rates from COVID 19. Objective To determine if type 2 diabetes mellitus, arterial hypertension, and obesity increase mortality in patients diagnosed with COVID-19 who required hospitalization in Mexico. Method Systematic review in Pubmed MeSH, Web of Science, Lilas, Scielo, and Google Scholar with the terms MeSH COVID-19, SARS-COV2, Coronavirus, and Mexico for the years 2020 and 2021, in English or Spanish. Two reviewers selected the studies, two additional reviewers participated in the analysis of the studies. Results Seventy three studies carried out in Mexico from 2020 to 2021 were included with information obtained from the databases of the National Epidemiological Surveillance System of Mexico. With an average age of 52.9 ± 13.27 years, 64% of the included patients were women, in general, a mortality rate of 16.76% (Min-Max 0.77-73.73%) was reported. 71% of the studies (52) did not report specific mortality related to comorbidities the most prevalent pathology was obesity with 24.23% (Min-Max 11.50-71.00%), followed by arterial hypertension 22.23% (Min-Max 2.0-53.96%) and finally Diabetes mellitus with 18.10% (Min-Max 1.83-40.00%). Conclusions The most common comorbidity among patients hospitalized for COVID in Mexico was obesity, followed by type 2 diabetes mellitus and hypertension.

Air pollution deaths attributable to fossil fuels: observational and modelling study

ObjectivesTo estimate all cause and cause specific deaths that are attributable to fossil fuel related air pollution and to assess potential health benefits from policies that replace fossil fuels with...

A Surgical Audit of Tracheostomy.

To study the magnitude of tracheostomy, its various indications and complications. Prospective Observational Study. A Prospective Observational study was carried out on 640 patients with various indications of tracheostomy admitted in ENT or referred from other departments for tracheostomy from July 2015 to March 2022. The epidemiological data regarding their age, sex, symptoms, indication and complications of tracheostomy were recorded. Necessary interventions were done as and when required. Patients ranged from 6months to 86 yrs. Assisted ventilation was the most common indications for tracheostomy (68.125%, n = 436). The most common complication was subcutaneous emphysema (10.625%, n = 68) followed by tube displacement (5.625%, n = 36. The complication rate was 21.25% and the mortality rate 4.375% (n = 28) with specific mortality rate 0.625% (n = 4). Tracheostomy is one of the commonest surgeries. Data was collected from this study on the various indications of tracheostomy, the epidemiological factors and various complications associated with tracheostomy. Such a data is useful to learn from the mistakes and carry forward the virtouosity.

Cardiovascular Disease Burden, Mortality, and Sudden Death Risk in Epilepsy: A UK Biobank Study

BackgroundSudden death is the leading cause of mortality in medically refractory epilepsy. Middle-aged persons with epilepsy (PWE) are under investigated regarding their mortality risk and burden of cardiovascular disease (CVD). MethodsUsing UK Biobank, we identified 7786 (1.6%) participants with diagnoses of epilepsy and 6,171,803 person-years of follow-up (mean 12.30 years, standard deviation 1.74); 566 patients with previous histories of stroke were excluded. The 7220 PWE comprised the study cohort with the remaining 494,676 without epilepsy as the comparator group. Prevalence of CVD was determined using validated diagnostic codes. Cox proportional hazards regression was used to assess all-cause mortality and sudden death risk. ResultsHypertension, coronary artery disease, heart failure, valvular heart disease, and congenital heart disease were more prevalent in PWE. Arrhythmias including atrial fibrillation/flutter (12.2% vs 6.9%; P < 0.01), bradyarrhythmias (7.7% vs 3.5%; P < 0.01), conduction defects (6.1% vs 2.6%; P < 0.01), and ventricular arrhythmias (2.3% vs 1.0%; P < 0.01), as well as cardiac implantable electric devices (4.6% vs 2.0%; P < 0.01) were more prevalent in PWE. PWE had higher adjusted all-cause mortality (hazard ratio [HR], 3.9; 95% confidence interval [CI], 3.01-3.39), and sudden death-specific mortality (HR, 6.65; 95% CI, 4.53-9.77); and were almost 2 years younger at death (68.1 vs 69.8; P < 0.001). ConclusionsMiddle-aged PWE have increased all-cause and sudden death-specific mortality and higher burden of CVD including arrhythmias and heart failure. Further work is required to elucidate mechanisms underlying all-cause mortality and sudden death risk in PWE of middle age, to identify prognostic biomarkers and develop preventative therapies in PWE.

Results from Lung Cancer Screening Outreach Utilizing a Mobile CT Scanner in an Urban Area

IntroductionLung cancer screening using low-dose (LD) CT reduces lung cancer–specific and all-cause mortality in high-risk individuals, although significant barriers to screening remain. We assessed the outreach of a mobile lung cancer screening program to increase screening accessibility and early detection of lung cancer. MethodsWe placed a mobile CT unit in a high-traffic area in New York City and offered free screening to all eligible patients. Characteristics of the mobile screening cohort were compared with those of our hospital-based screening cohort. ResultsBetween December 9, 2019, and January 30, 2020, a total of 216 patients underwent mobile LDCT screening. Compared with the hospital-based screening cohort, mobile screening participants were significantly more likely to be younger, be uninsured, and have lower smoking intensity and were less likely to meet 2013 US Preventive Services Task Force guidelines (but would meet their 2021 guidelines) and self-identify as White race and Hispanic ethnicity. Asian New Yorkers were substantially underrepresented in both hospital and mobile screening cohorts, compared with their level of representation in New York City. Two patients were diagnosed with lung cancer and were treated. Potentially clinically significant non–lung cancer findings were identified in 28.2%, most commonly moderate-severe coronary artery calcification and emphysema. ConclusionsMobile LDCT screening is useful and effective in detecting lung cancer and other significant findings and may engage a distinct high-risk patient demographic. Disproportionately low screening rates among certain high-risk populations highlight the imperative of implementing strategies aimed at understanding health behaviors and access barriers for diverse populations. Effective care-navigation services, facilitating high-quality care for all patients, are critical.

NCOG-26. CORE OUTCOME SETS FOR USE IN FUTURE MENINGIOMA CLINICAL STUDIES: RESULTS OF THE COSMIC PROJECT

Abstract OBJECTIVE Core Outcome Sets (COS) define the minimum outcomes that should be measured and reported in all clinical trials for a specific health condition or health area. The aim was to develop two COS for intracranial meningioma; one for clinical trials (COSMIC: Intervention) and one for observational studies (COSMIC: Observation). METHODS A study advisory group was formed with representation from international stakeholders of charities (IBTA, TBTC, brainstust), neurosurgery societies (SBNS, BIMS) and neuro-oncology societies (BNOS, EANO, EORTC, ICOM, RANO-PRO, SNO). Two systematic literature reviews and trial registry searches were performed to identify outcomes reported in published and ongoing 1) meningioma clinical trials, and 2) studies of incidental/untreated meningioma. Outcomes were deduplicated and categorised. Individuals were recruited from stakeholder groups (including meningioma patients and carers, healthcare professionals, researchers) to participate in 2-round, international, modified eDelphi surveys. The final core outcome sets were ratified through online consensus meetings. RESULTS The COSMIC: Intervention systematic review identified 660 verbatim outcomes, rationalized into 24 Delphi survey items. Following the consensus meeting, 15 outcomes were included in the final set. For COSMIC: Observation, 267 verbatim outcomes were identified and rationalized into 17 Delphi survey items. 16 outcomes were included in the final set. There were eight core outcomes common to both COSMIC: Intervention and COSMIC: Observation COS, namely tumour growth, physical, emotional, and neurocognitive functioning, overall quality of life, progression-free survival, meningioma specific mortality and overall survival. Role and social functioning were core outcomes in COSMIC Observation but not COSMIC intervention. CONCLUSIONS The COSMIC study has defined the core outcome sets for use in future meningioma clinical trials and studies. Role and social functioning were important to incidental meningioma patients and likely reflects the anxiety and uncertainty around clinical treatment. International stakeholder agreement should ensure widespread use and adoption.

Worse outcomes in young women compared to men presenting with ST-elevation myocardial infarction: a 15-year statewide population-linkage cohort study

Abstract Background Gender disparity in outcomes among patients presenting with acute ST-elevation myocardial infarction (STEMI) is well recognised. It is unclear whether the gap has improved with contemporary management and therapies over time. This study compared the 30-day mortality between women and men admitted with STEMI from 2003-2017. Purpose To examine whether the gender disparity in 30-day mortality following STEMI is consistent across patient age groups and whether it has changed over time with contemporary management. Methods We used the NSW Admission-Patient-Data-Collection (APDC) database which maintains the admission records of more than 97% of the state’s healthcare facilities to identify consecutive STEMI patients admitted from 1-Jan-2003 to 31-Dec-2017. Cause-specific mortality (classified as cardiac, non-cardiac) was identified from death certificates. Multivariable logistic regression analysis was performed to examine the impact of gender on mortality adjusted for comorbidities, admission year-groups, PCI during STEMI, and stratified by age groups of ≤60, 61-70 and &amp;gt;70yo. Results The study cohort comprised 65033 STEMI patients: 32% women (n=20825; median age 76.1yrs); 68% men (n=44208; median age 63.8yrs). The overall 30-day all-cause and cardiac mortality was 11.5% and 8.3% respectively, with women having worse outcomes compared to men (all-cause: 17.0% vs 8.9%; cardiac: 12.2% vs 6.5% respectively, both p&amp;lt;0.0001). Following adjustment, higher mortality among women persisted: adjusted odds ratio [aOR]=1.65 (95% confidence interval [CI]=1.40-1.94) and 1.55 (95%CI=1.28-1.87) for total and cardiac mortality respectively. The gender disparity in mortality did not change during the study period. There was an interaction between age and gender so that differences in gender specific mortality were greater in younger than in older patients: total mortality women vs men ≤60yrs aOR=1.65 (95%CI=1.40-1.94), &amp;gt;70yrs aOR=1.19 (95%CI=1.12-1.27), p(interaction)=0.0011; cardiac mortality women vs men ≤60yrs aOR=1.55 (95%CI=1.28-1.87), &amp;gt;70yrs aOR=1.17 (95%CI=1.09-1.25), p(interaction)=0.026. Unexpectedly, a similar age-gender interaction was observed for non-cardiac mortality: women vs men ≤60yrs aOR=1.88 (95%CI=1.41-2.51), &amp;gt;70yrs aOR=1.15 (95%CI=1.03-1.28), p(interaction)=0.0063. Conclusion Women admitted with STEMI have significantly higher 30-day mortality than their male counterparts, with no improvement in gender disparity during the study period. The gender-bias is most pronounced in the younger age-group across and is observed for both cardiac and non-cardiac mortality. Further efforts are needed to identify the drivers of worse outcomes following STEMI in younger women.

Abstract 16139: Rising Cardiovascular Mortality in Prostate Cancer Patients: Results From Surveillance, Epidemiology and End Results (SEER) Database

Introduction: Prostate cancer is the second most common cancer in men and the fifth leading cause of cancer related mortality. Advancement in therapy has led to improved survival among patients, however, there has been increased incidence of cardiovascular events among cancer survivors. Objective To observe the trend of cardiovascular specific death rate among patient with prostate cancer as compared to death due to cancer Methods: Patients with prostate cancer registered in SEER database from 2005 to 2020 were included. Prostate cancer specific mortality rate, cardiovascular (CV) specific mortality rate and all-cause mortality rate were analyzed using SEER*Stat version 8.4.1 software in the rate session. Joinpoint version 5.0.2 was used to create annual log-linear time trends. Results: The study included 857,410 patients diagnosed with prostate cancer from 2005 to 2020. The average annual percentage change (AAPC) of prostate cancer showed decreased incidence by 2.8 % (95% CI 1.8% to 4.1%, p&lt;0.05) from 2005 to 2020 with significant decrease in annual percent change (APC) from 2005 to 2014 by 4.9% (95% CI 2.9 % to 12.5, p&lt;0.05). AAPC of prostate cancer specific mortality rate increased by 1.8% ( 95% CI 1.3% to 2.9%, p&lt;0.05) from 2005 to 2020 with significant increase in APC by 2.4% (95% CI 1.3% to 9.2%, p&lt;0.05) from 2005 to 2018. AAPC of CV specific mortality rate increased by 4.4% (95% CI 4.1% to 4.9%, p&lt;0.05) from 2005 to 2020 with significant increase in APC by 7.1% (95% CI 6% to 9.2%, p&lt;0.05) from 2005 to 2011 and 2.6% (95% CI 2% to 3.1%, p&lt;0.05) from 2011 to 2020 (Figure 1). Conclusions: Around 2009, the cardiovascular specific mortality rate became higher than cancer specific mortality rate among prostate cancer patients and this trend has been consistent since then. It highlights advancement in treatment which has increased survival from prostate cancer, however it has increased cardiovascular mortality in patients due to advancing age as well as direct toxicity of treatment.

Abstract 16756: Trends of Cardiovascular Deaths in Patients With Melanoma From 2005 to 2019: An Analysis Based on SEER Program Database

Introduction: Melanoma is the fifth most common cancer diagnosis in the United States. With recent advances in treatment modalities, including immune checkpoint inhibitors (ICIs), targeted therapies, there has been improvement in survival among melanoma patients. However, increasing resistance and treatment related adverse effects (TrAEs) are being reported including cardiovascular side effects. Objectives: To evaluate the trend of cardiovascular specific death rate among patients with melanoma. Methods: We used Surveillance, Epidemiology, and End Results (SEER) Program database 17 registries from 2000 to 2019 and SEER*Stat Version 8.4.1 software to analyze the data using the rate session. Joinpoint software, version 4.7.1.0 was used to create log-linear time trends annually. Results: Our study included 301,632 patients with melanoma from 2005 to 2019. The annual percentage change (APC) of melanoma was 0.46% (95% CI -1.45 to 1.07, p&gt;0.05) annually from 2005 to 2011 and 3.33% (95% CI 1.79 to 4.27, p&lt;0.05) annually from 2011 to 2014 and the incidence rate decreased by 0.06% (95% CI -1.44 to 0.5, p&gt;0.05) annually from 2014 to 2019. Melanoma specific mortality rate increased annually by 2.03 % (95% CI 0.78 to 3.94, P &lt;0.05) from 2005 to 2013 and decreased by 5.49% annually (95% CI -8.65 to -3.65, P &lt;0.05) from 2013 to 2019. Cardiovascular disease specific mortality rate increased by 7.08% annually (95% CI 4.66 to 9.64, P &lt;0.05) from 2005 to 2019. (Figure 1) Conclusion: Our study shows that there has been an annual increase in cardiovascular specific mortality rate from 2005 to 2019, while there was annual decrease in melanoma specific mortality rate from 2013 to 2019. Increase in cardiovascular specific death rates could be due to the direct toxicity of newer therapies and prolonged survival, which further could be due to advancement in diagnostics and newer therapies.

Abstract 13362: Proteomic Architecture of Frailty Across the Spectrum of Cardiovascular Disease

Introduction: With an aging population, understanding how frailty affects treatment response is paramount to improve patient-centered outcomes. Hypothesis: We hypothesized that circulating proteomic correlates of frailty will identify novel pathways for therapeutic investigation and provide prognostic information. Methods: From a multicenter, prospective cohort of 809 participants (median age 83 years; 44% women) with symptomatic, severe aortic stenosis (AS) and systematic assessments of frailty, we measured &gt;900 circulating proteins (Olink). We used principal component analysis (PCA) to define composite “axes” of 12 measures of frailty (Figure). Using ordinary and penalized regression (LASSO), we related proteins to both individual measures of frailty and the composite axes. Prioritized proteins were then examined for their relation with age and morbidity in external, published datasets. LASSO model coefficients were used to calculate protein “scores” of frailty, which were tested for their relation with all-cause mortality in the AS cohort and cause specific mortality in &gt;1,800 participants from the Framingham Heart Study (FHS; mean age 55 years, 54% women). Results: PCA identified 3 axes of frailty (“patient reported outcomes”, “body composition” and “physical function”) that explained ≈49% of variance. Proteins related to axes of frailty were (1) related to inflammatory and metabolic phenotypes and (2) weakly related to age, in &gt;35,000 community dwelling Icelanders (mean age 55±17 years). The protein score of physical function was associated with all-cause post-transcatheter aortic valve implantation (TAVI) mortality in the AS cohort (HR 0.68 [0.59-0.79]) and non-cardiovascular mortality in FHS (0.83 [0.75-0.91]). Conclusions: Circulating proteins capture frailty phenotypes that are weakly related to age, and provide prognostic information in both older adults undergoing TAVI and younger community dwelling adults.

Abstract 15264: Impact of 2018 Change in UNOS Heart Transplant Policy on Wait List Outcomes

Introduction: In October 2018, the updated Heart transplant (HT) policy by United network of Organ Sharing (UNOS) gave priority to critically ill heart failure patients. It has made significant improvement in long term survival of ECMO bridged HT recipients. However, there are limited reports on wait list mortality following change in this policy. Hypothesis: Review of waitlist mortality following 2018 change in guideline Methods: This is a retrospective cohort study including all adult heart failure patients listed for HT alone between 2015 and 2022 in the UNOS data. Cohort was stratified on the basis of year of listing, those who listed between 2015 &amp; 2018 and those who listed between 2019 &amp; 2022. The categorical and continuous variables were compared using chi2 and Kruskal Wallis test, respectively. Time to death analysis between both the group was evaluated using Kaplan Meier curve and log rank test. Results: Total 33,908 patients were included, of them 16,281 were listed between 2015 &amp; 2018 and remaining 17,627 were listed between 2019 &amp; 2022. The rate of HT did not change between both the time period (10,660 (65.5%) &amp; 11,660 (66.1%), p=0.19)), respectively. There was no difference in age, gender and BMI between both the groups. The use of Intra-aortic balloon pump, ventilator, Inotropes and other parameters indicating severity of illness were frequently noted among patients listed between 2019 &amp; 2022. The overall wait list mortality has reduced from 1250/16,281(7.7%) to 764/17,627 (4.0%) during later time period, p&lt;0.001 (Figure 1). Similarly, patients’ dropouts due to illness severity has reduced from 1321/16821 (8.1%) to 764/17,627 (4.3%), p&lt;0.001, respectively. There is significant reduction in disease etiology specific mortality following 2018 change. Conclusions: The change in HT policy in 2018 has significantly reduced the wait list mortality and dropouts during study periods. In addition, sicker patients were listed for transplant following 2018 change.

Fibromyalgia and risk of all-cause, specific mortality: A meta-analysis of observational studies.

To evaluate the risk of all-cause, specific mortality among patients with fibromyalgia, which is a controversial topic. We conducted a thorough search for cohort studies across the PubMed, Cochrane Library, and Embase databases, from their inception to 1 March 2023, using medical subject headings and relevant keywords. All data were meticulously analyzed using Stata statistical software version 16.0. The protocol was registered on PROSPERO (CRD42023402337). After analyzing seven cohort studies involving 152 933 individuals published between 2001 and 2020, we found no clear evidence linking fibromyalgia or widespread pain to all-cause mortality risk (odds ratio [OR] 1.11, 95% confidence interval [CI] 0.81-1.53; I2 = 82.6%, p = .505). However, our subgroup analysis revealed that the risk of suicide was significantly higher in fibromyalgia patients compared with non-fibromyalgia patients (OR 5.39, 95% CI 2.16-13.43; I2 = 69.9%, p < .05). Our research did not discover any proof indicating a link between fibromyalgia or widespread pain and all-cause mortality. However, it is worth noting that there may be a potential correlation between individuals with fibromyalgia or widespread pain and a higher likelihood of suicide. As we had a limited number of participants in our study, further research is necessary to thoroughly investigate the relationship between these factors.

Partial versus radical nephrectomy for T1b renal cell carcinoma: A comparison of efficacy and prognostic factors based on the Surveillance, Epidemiology, and End Results database

Abstract Objectives This study compared the long-term efficacy and prognostic factors of partial nephrectomy (PN) and radical nephrectomy (RN) for T1bN0M0 renal cell carcinoma (RCC) using data from the Surveillance, Epidemiology, and End Results database. Materials and methods We retrospectively analyzed the clinical data of 12,471 patients diagnosed with T1bN0M0 RCC from the Surveillance, Epidemiology, and End Results database between 2010 and 2019. Patients were divided into the PN and RN groups, and propensity score matching was conducted to balance the differences between the groups. We compared overall survival (OS), RCC cancer–specific mortality (CSM), and noncancer-specific mortality (NCSM) between the 2 groups. The risk factors for all-cause and RCC-related mortality were analyzed. Results After propensity score matching, there were 3817 patients in each group. After matching, OS and NCSM were significantly longer in the PN group (p &lt; 0.001); however, there was no significant between-group difference in the RCC-CSM. The hazard ratio (HR) for all-cause mortality was significantly lower in the PN group (HR, 0.671; 95% confidence interval [CI], 0.579–0.778, p &lt; 0.001), but PN was not associated with lower RCC-related mortality. Subgroup analysis showed that PN reduced the HR of all-cause mortality by 35% (HR, 0.647; 95% CI, 0.536–0.781; p &lt; 0.001) in patients with 4.0- to 5.5-cm tumors compared with RN and by 29% (HR, 0.709; 95% CI, 0.559–0.899; p = 0.004) in those with larger tumors (5.6–7.0 cm). Multifactorial analysis showed that PN was an independent predictor of OS (HR, 0.671; 95% CI, 0.579–0.778; p &lt; 0.001). In addition, multivariate analysis validated that age at diagnosis, sex, pathological grade, and tumor size were associated with outcomes. Conclusions In patients with T1b RCC, PN resulted in better OS and NCSM outcomes than RN. The benefit of PN in all-cause mortality was pronounced in patients with 4.0–5.5 cm tumor loads. Therefore, individualized treatment schemes should prioritize PN, when technically feasible.

Mortality Risk for Docetaxel-Treated, High-Grade Prostate Cancer With Low PSA Levels

Patients with high-grade prostate cancer with low levels of prostate-specific antigen (PSA; <4 ng/mL) are at high risk of mortality, necessitating an improved treatment paradigm. To assess for these patients whether adding docetaxel to standard of care (SOC) treatment is associated with decreased prostate cancer-specific mortality (PCSM) and all-cause mortality (ACM). PubMed search from 2000 to 2022. Five prospective randomized clinical trials (RCTs) performed in the US, France, and the United Kingdom evaluating SOC treatment with radiotherapy and androgen deprivation therapy (ADT) or with radical prostatectomy vs SOC plus docetaxel. Individual data were included from patients with nonmetastatic prostate cancer, a PSA level of less than 4 ng/mL, and a Gleason score of 8 to 10. Patients initiated treatment between February 21, 2006, and December 31, 2015 (median follow-up, 7.1 [IQR, 5.4-9.9] years). Data were analyzed on December 16, 2022. Hazard ratio (HR) of ACM and subdistribution HR (sHR) of PCSM adjusted for performance status (1 vs 0 or good health), Gleason score (9 or 10 vs 8), tumor category (T3-T4 vs T1-T2 or TX), and duration of ADT (2 years vs 4-6 months). From a cohort of 2184 patients, 145 patients (6.6%) in 4 RCTs were eligible (median age, 63 [IQR, 46-67] years). Thirty-one patients died, and of these deaths, 22 were due to prostate cancer. Performance status was 0 for 139 patients (95.9%) and 1 for 6 patients (4.1%). A reduced but nonsignificant risk of ACM (HR, 0.51 [95% CI, 0.24-1.09]) and PCSM (sHR, 0.42 [95% CI, 0.17-1.02]) was associated with patients randomized to SOC plus docetaxel compared with SOC. The risk reduction in ACM (HR, 0.46 [95% CI, 0.21-1.02]) was more pronounced among patients with a performance status of 0 and was significant for PCSM (sHR, 0.30 [95% CI, 0.11-0.86]). Adding docetaxel to SOC treatment for patients who are in otherwise good health with a PSA level of less than 4 ng/mL and a Gleason score of 8 to 10 was associated with a significant reduction in PCSM and therefore has the potential to improve prognosis.

Prostate Cancer Mortality Among Elderly Men After Discontinuing Organised Screening: Long-term Results from the European Randomized Study of Screening for Prostate Cancer Rotterdam

BackgroundThe optimal timing for discontinuing screening of prostate cancer (PCa) in elderly men is currently not known and remains debated. ObjectiveTo assess prostate cancer–specific mortality (PCSM) in elderly men who previously underwent prostate-specific antigen (PSA)-based screening and to identify those who may benefit from continued screening. Design, setting, and participantsA total of 7052 men, who participated in the screening arm of the Rotterdam section of the European Randomized Study of Screening for Prostate Cancer and were aged 70–74 yr at their last screening visit after undergoing a maximum of three screening rounds without being diagnosed with PCa, were included. Outcome measurements and statistical analysisThe cumulative incidence of PCSM by the age of 85 yr was assessed. Additionally, a competing risk regression was performed to assess the potential predictors of PCSM. Results and limitationsThe median follow-up was 16 yr. The cumulative incidence of PCSM by the age of 85 yr was 0.54% (95% confidence interval [CI]: 0.40–0.70) in all men, 0.11% (95% CI: 0.05–0.27) in men with PSA <2 ng/ml, 0.85% (95% CI: 0.47–1.5) in men with PSA 2–3 ng/ml, and 6.8% (95% CI: 3.1–15) in men with PSA ≥6.5 ng/ml and no previous benign biopsy. PSA (subdistribution hazard ratio [sHR]: 2.0; 95% CI: 1.7–2.3), previous benign prostate biopsy (sHR: 0.41; 95% CI: 0.23–0.72), and hypertension (sHR: 0.48; 95% CI: 0.25–0.91) were significantly associated with PCSM. ConclusionsMen aged 70–74 yr who have previously undergone PSA-based screening without receiving a PCa diagnosis have a very low risk of dying from PCa by the age of 85 yr. These data suggest that screening may be discontinued in men with PSA <3.0 ng/ml or previous benign prostate biopsies. Those with higher PSA levels and no prior biopsies may consider continued screening if life expectancy exceeds 10 yr. Patient summaryThis study shows that men who participated in a prostate cancer screening trial have a very low risk of dying from prostate cancer if they have not been diagnosed with prostate cancer by the age of 74 yr.

Outcomes of Biopsy Grade Group 1 Prostate Cancer Diagnosis in the Danish Population

BackgroundDebate regarding a nomenclature change for grade group 1 (GG 1) prostate cancer to noncancer has been revived, as this could be a powerful tool in reducing the overtreatment of indolent disease. ObjectiveTo describe outcomes for all men diagnosed with GG 1 prostate cancer in the Danish population, with a focus on men followed conservatively. Design, setting, and participantsThis was a population-based observational study using data from the Danish Prostate Registry. Outcome measurements and statistical analysisWe measured the cumulative incidence of curative treatment, endocrine treatment, and cause-specific mortality. Results and limitationsThe cumulative incidence of endocrine therapy at 10 yr was 5.3% (95% confidence interval [CI] 4.3–6.3%) for men with initial active surveillance and 21% (95% CI 19–23%) for men with initial watchful waiting for localized GG 1. In the GG1 cohort, the prostate cancer–specific mortality rate at 15 yr was 14% (95 CI% 11–16%) for men on watchful waiting, 10% (95 CI% 6.7–14%) for men with prostate-specific antigen <10 ng/ml on watchful waiting, and 16% (95 CI% 13–19%) for men who did not receive curative-intent treatment or histological assessment. The study is limited by the historic nature of the observations over a period during which diagnostic procedures and treatments have evolved. ConclusionsGG 1 cancer can lead to disease-specific mortality in men with localized prostate cancer, and changing the nomenclature for all men may lead to undertreatment. Patient summaryKey opinion leaders have suggested that prostate cancers of Gleason grade group 1 (GG 1) should be renamed as noncancer to reduce overtreatment. The argument is that low-grade cancer does not metastasize. However, our nationwide population-based study showed that death from prostate cancer can occur in some men diagnosed with GG 1 disease. These men should be considered in discussions on changing the name for GG 1 prostate cancer.