Survival Estimates Research Articles

Braden score predicts 30-day mortality risk in patients with ischaemic stroke in the ICU: A retrospective analysis based on the MIMIC-IV database.

Ischaemic stroke remains a significant global health challenge, associated with high mortality rates. While the Braden Scale is traditionally employed to assess pressure ulcer risk, its potential to predict mortality among the intensive care unit (ICU) patients with ischaemic stroke has not been thoroughly investigated. This study evaluates the predictive value of the Braden Scale for 30-day mortality among patients with ischaemic stroke admitted to ICU. We conducted a retrospective analysis of 4710 adult patients with ischaemic stroke from the Medical Information Mart for Intensive Care (MIMIC)-IV database. The association between the Braden Scale scores and 30-day mortality was assessed using receiver operating characteristic (ROC) curve analysis, Cox regression models and Kaplan-Meier survival estimates. Patients with Braden Scale scores ≤ 15.5 showed significantly higher 30-day mortality rates (p-value < 0.001; hazard ratio (HR): 2.08, 95% confidence interval (CI): 1.71-2.53). The area under the ROC curve (AUC) was 0.71, demonstrating good predictive performance. Multivariate analysis confirmed the Braden Scale as an independent predictor of mortality, after adjusting for age, gender and comorbidities. The Braden Scale effectively identifies high-risk ischaemic stroke patients in ICU settings, endorsing its integration into routine assessments to facilitate early intervention strategies. Integrating the Braden Scale into routine ICU evaluations can enhance mortality risk stratification and improve patient care tailoring.

Pediatric intramedullary spinal cord tumors: A national cancer database analysis of demographics, patterns of care, and survival

ObjectiveQuery the National Cancer Database (NCDB) to delineate epidemiologic frequency, care patterns, and survival outcomes of pediatric intramedullary spinal cord tumors (IMSCTs). MethodsIMSCTs included ependymoma, astrocytoma, and hemangioblastoma. We examined data from the NCDB spanning 2004–2018, focusing on IMSCT in children aged 0–21 years. Our analysis included logistic and Poisson regression, Kaplan-Meier survival estimates, and Cox proportional hazards models. ResultsThis study included 1066 patients aged 0–21 years. 59.4 % of patients were male, while 83.1 % were white. The most common tumor histology was ependymoma (57.5 %), followed by astrocytoma (36.1 %) and hemangioblastoma (6.4 %). 24.9 % of patients received radiotherapy, with radiotherapy utilization being highest among patients aged 6–10 years. Chemotherapy utilization was highest in patients aged 0–5 years. 87.2 % of patients underwent surgical resection, with higher rates in patients aged 16–21 years. Overall survival did not differ significantly between resected and non-resected patients (p = 0.315). Patients in rural areas had worse OS than those in metro areas (HR = 4.42, p = 0.048). Patients with astrocytoma had worse OS compared to other histologies (HR = 2.21, p = 0.003). Astrocytoma patients were over twice as likely to have prolonged LOS compared to ependymoma patients (OR = 2.204, p < 0.001). ConclusionsIn summary, our analysis utilizing the NCDB database provides a comprehensive overview of demographics, care patterns, and outcomes for the largest cohort of pediatric IMSCTs to date. These insights underscore the complexity of managing IMSCTs and emphasize the need for tailored approaches to improve patient outcomes.

Effect of a correlated competing risk on marginal survival estimation in an accelerated failure time model

In problems with a time to event outcome, subjects may experience competing events, which censor the outcome of interest. Cox’s partial likelihood estimator treating competing events as independent censoring is commonly used to examine group differences in clinical trials but fails to adjust for omitted covariates and can bias the assessment of marginal benefit. A bivariate normal linear model generating latent data with dependent censoring is used to assess this bias. Our R-package bnc provides maximum penalized likelihood (MPL) parameter estimation using a novel EM algorithm. Using bnc, we study the properties of such MPL estimation. Simulation results for two-sample survival comparisons of time to an event of interest, with independent censoring accompanied by censoring from a correlated competing risk, are presented. Key parameters—means, hazard ratios, and correlation—are estimated. These results demonstrated that, despite ill-conditioning in models generating correlated competing risks, estimates of marginal effects are reliable. Bivariate normal models were fitted in a trial of head and neck cancer. Model fits help with clinical interpretation while also supplementing other standard methods for follow-up that are terminated by intervening risks.

The influence of gender on outcomes following transcatheter aortic valve implantation.

This study aimed to compare gender-related differences in short- and long-term outcomes after transcatheter aortic valve implantation. Patients who underwent transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) from September 2017 to December 2022 were enrolled. The primary endpoint was 5-year all-cause mortality. The secondary endpoints were 30-day mortality and the incidence of post-procedural complication. Patients were separated according to gender before statistical analysis. To compare patients with similar baseline characteristics, we performed a propensity matching. A total of 704 patients [females, 361 (51.3%); males, 343 (48.7%)] were enrolled. Compared to women, men had a higher incidence of smoking (40.5% vs. 14.7%, p < 0.001), diabetes (32.9% vs. 25.1%, p < 0.025), peripheral artery disease (35.8% vs. 18.3%, p < 0.001), and previous cardiac surgery (13.7% vs. 7.2%, p = 0.006) and a lower ejection fraction [56.6 (9.3) vs. 59.8 (7.5), p = 0.046]. Female patients were frailer at the time of the procedure [poor mobility rate, 26% vs. 11.7%, p < 0.001; CCI (Charlson comorbidity index) 2.4 (0.67) vs. 2.32 (0.63), p = 0.04]. Despite these different risk profiles, no significant differences were reported in terms of post-procedural outcomes and long-term survival. Propensity score matching resulted in a good match of 204 patients in each group (57.9% of the entire study population). In the matched cohort, men had a significantly higher incidence of new pacemaker implantation compared to women [33 (16.2%) vs. 18 (8.8%)]. The Kaplan-Meier 5-year survival estimate was 82.4% for women and 72.1% for men, p = 0.038. Female gender could be considered as a predictor of better outcomes after TAVI.

Initial surgery for spontaneous intestinal perforation in extremely low birth weight infants is not associated with mortality or in-hospital morbidities.

Determine short-term outcomes following peritoneal drain (PD), laparotomy (LAP) after PD (PD-LAP), and LAP in extremely low birth weight (ELBW) infants with spontaneous intestinal perforation (SIP). ELBW infants with SIP were identified using the Children's Hospitals Neonatal Database. Mortality and length of stay (LOS) were compared among groups. Of 729 SIP infants from 6/2010-12/2016, 383(53%) received PD, 61(8%) PD-LAP, and 285(39%) LAP. PD infants had lower GA at birth, at SIP diagnosis and upon admission than PD-LAP or LAP; and higher sepsis rates than LAP. Bivariate analysis and Kaplan-Meier survival estimates suggested PD had increased mortality vs. PD-LAP and LAP (27%, 11.5%, and 15.8% respectively, p < 0.001). However, surgical approach was not significantly associated with mortality in multivariable analysis accounting for GA and illness severity. LOS did not differ by surgical approach. In ELBW infants with SIP, mortality, and LOS are independent of the initial surgical approach.

Clinical Outcomes, Predictors, and Surgical Management of Infracardiac Total Anomalous Pulmonary Venous Connection.

This study sought to find the risk factors of postoperative pulmonary venous obstruction (PVO), PVO-related reintervention, and postoperative mortality, determine the relationship between pulmonary venous confluence (PVC) morphology and the clinical outcomes, and provide the basis for the selection of the optimal surgical strategy for infracardiac total anomalous pulmonary venous connection (TAPVC). From December 2009 to December 2023, 101 patients with infracardiac TAPVC undergoing surgical repair in our institution were included [Conventional surgery (CS) group, n = 73; Sutureless technique (ST) group, n = 28]. The Kaplan-Meier curve was used to demonstrate the survival estimates. The Cox proportional hazard model was used to identify risk factors for primary endpoints. There were 8 in-hospital deaths and 4 late deaths. The survival rates at 1, 5, and 10years were 88.8%, 87.6%, and 87.6%, respectively, in the whole cohort. Multivariable analysis showed that prolonged cardiopulmonary bypass (CBP) time was associated with overall mortality and Y-shaped PVC has a trend for a higher mortality rate. Postoperative PVO occurred in 27 patients. Freedom from postoperative PVO at 1, 5, and 10years were 81.8%, 69.9%, and 69.9%, respectively. Y-shaped PVC and preoperative PVO were incremental risk factors for PVO, but ST repair was a protective factor. Sixteen patients underwent PVO-related reintervention. Y-shaped PVC was the only independent risk factors for PVO-related reintervention while ST repair was a protective factor. Sutureless technique can achieve satisfactory outcomes for infracardiac TAPVC repair. Compared with CS repair, ST repair is significantly associated with decreased postoperative PVO and PVO-related reintervention. Y-shaped PVC is associated with a higher risk of PVO, PVO-related reintervention, and mortality, respectively. Patients with preoperative PVO are more likely to develop postoperative PVO.

Factors Affecting the Outcome of Spine Metastases: A Single-Center Evaluation in Surgically Treated Patients

BACKGROUNDThe estimation of survival is extremely important for metastatic disease in the spine. The aim of this study was to determine the factors affecting the outcome of patients with spinal metastasis, primarily the character of neurological deficit and the histopathology of the tumor. METHODA retrospective examination was made of 158 patients with spinal metastasis who were followed up in our clinic between 2010 and 2020 and were underwent surgical intervention. The patients were examined in respect of demographic characteristics, the primary tumor, comorbidities, preoperative-postoperative Visual Analogue Scale scores, preoperative-postoperative neurological examinations and neurological deficit if present and ambulation status, postoperative survival duration, tumor localization, characteristics of the surgeries, complications, the Karnofsky Performance Scale, revised Tokuhashi, and Tomita scores. RESULTSSpinal metastasis was seen more frequently in males (72,8% male, 27,8% female). Male gender, multiple level involvement, intradural localization, and Karnofsky Performance Scale <70 were seen to cause a shorter survival time. Patients with a primary focus of hematological malignancy, breast cancer, and lymphoma had a longer survival. The revised Tokuhashi, and Tomita scores were observed to be successful in the prediction of survival. A decrease in postoperative Visual Analogue Scale score had a positive effect on functional survival. The absence of preoperative neurological deficit and the patient’s ability for preoperative and postoperative ambulation affected survival positively. The overall survival period decreased in patients who were mobilized in the early postoperative period but became non-mobile in the late period, and in those who were non-mobile in both the early and late postoperative periods. CONCLUSIONThe neurological and ambulatory status, the Tomita and Tokuhashi scores, intradural localization, and gender are the factors with a significant effect on prognosis.

Local tumour control and patient survival after ruthenium-106 brachytherapy for small choroidal melanoma

AimTo report local tumour control, metastasis and survival rates of patients with small choroidal melanoma (CM) after treatment with ruthenium-106 (Ru-106) plaque brachytherapy.MethodsRetrospective case series of 353 consecutive eyes with...

Survival outcomes after breast cancer surgery among older women with early invasive breast cancer in England: population-based cohort study.

This study assessed the influence of age, co-morbidity and frailty on 5-year survival outcomes after breast conservation surgery (BCS) with radiotherapy (RT) versus mastectomy (with or without RT) in women with early invasive breast cancer. Women aged over 50 years with early invasive breast cancer diagnosed in England (2014-2019) who had breast surgery were identified from Cancer Registry data. Survival estimates were calculated from a flexible parametric survival model. A competing risk approach was used for breast cancer-specific survival (BCSS). Standardized survival probabilities and cumulative incidence functions for breast cancer death were calculated for each treatment by age. Among 101 654 women, 72.2% received BCS + RT and 27.8% received mastectomy. Age, co-morbidity and frailty were associated with overall survival (OS), but only age and co-morbidity were associated with BCSS. Survival probabilities for OS were greater for BCS + RT (90.3%) versus mastectomy (87.0%), and the difference between treatments varied by age (50 years: 1.9% versus 80 years: 6.5%). Cumulative incidence functions for breast cancer death were higher after mastectomy (5.1%) versus BCS + RT (3.9%), but there was little change in the difference by age (50 years: 0.9% versus 80 years: 1.2%). The results highlight the change in baseline mortality risk by age for OS compared to the stable baseline for BCSS. For OS, the difference in survival probabilities for BCS + RT and mastectomy increased slightly with age. The difference in cumulative incidence functions for breast cancer death by surgery type was small regardless of age. Evidence on real-world survival outcomes among older populations with breast cancer is informative for treatment decision-making.

A scenario based approach to optimizing cost-effectiveness of physician-staffed Helicopter Emergency Medical Services compared to ground-based Emergency Medical Services in Finland

ObjectivesSince Helicopter Emergency Medical Services (HEMS) is an expensive resource in terms of unit price compared to ground-based Emergency Medical Service (EMS), it is important to further investigate which methods would allow for the optimization of these services. The aim of this study was to evaluate the cost-effectiveness of physician-staffed HEMS compared to ground-based EMS in developed scenarios with improvements in triage, aviation performance, and the inclusion of ischemic stroke patients.MethodsIncremental cost-effectiveness ratio (ICER) was assessed by comparing health outcomes and costs of HEMS versus ground-based EMS across six different scenarios. Estimated 30-day mortality and quality-adjusted life years (QALYs) were used to measure health benefits. Quality-of-Life (QoL) was assessed with EuroQoL instrument, and a one-way sensitivity analysis was carried out across different patient groups. Survival estimates were evaluated from the national FinnHEMS database, with cost analysis based on the most recent financial reports.ResultsThe best outcome was achieved in Scenario 3.1 which included a reduction in over-alerts, aviation performance enhancement, and assessment of ischemic stroke patients. This scenario yielded 1077.07–1436.09 additional QALYs with an ICER of 33,703-44,937 €/QALY. This represented a 27.72% increase in the additional QALYs and a 21.05% reduction in the ICER compared to the current practice.ConclusionsThe cost-effectiveness of HEMS can be highly improved by adding stroke patients into the dispatch criteria, as the overall costs are fixed, and the cost-effectiveness is determined based on the utilization rate of capacity.

Associations between COVID-19 therapies and outcomes in rural and urban America: A multisite, temporal analysis from the Alpha to Omicron SARS-CoV-2 variants.

To investigate the enduring disparities in adverse COVID-19 events between urban and rural communities in the United States, focusing on the effects of SARS-CoV-2 vaccination and therapeutic advances on patient outcomes. Using National COVID Cohort Collaborative (N3C) data from 2021 to 2023, this retrospective cohort study examined COVID-19 hospitalization, inpatient death, and other adverse events. Populations were categorized into urban, urban-adjacent rural (UAR), and nonurban-adjacent rural (NAR). Adjustments included demographics, variant-dominant waves, comorbidities, region, and SARS-CoV-2 treatment and vaccination. Statistical methods included Kaplan-Meier survival estimates, multivariable logistic, and Cox regression. The study included 3,018,646 patients, with rural residents constituting 506,204. These rural dwellers were older, had more comorbidities, and were less vaccinated than their urban counterparts. Adjusted analyses revealed higher hospitalization odds in UAR and NAR (aOR 1.07 [1.05-1.08] and 1.06 [1.03-1.08]), greater inpatient death hazard (aHR 1.30 [1.26-1.35] UAR and 1.37 [1.30-1.45] NAR), and greater risk of other adverse events compared to urban dwellers. Delta increased, while Omicron decreased, inpatient adverse events relative to pre-Delta, with rural disparities persisting throughout. Treatment effectiveness and vaccination were similarly protective across all cohorts, but dexamethasone post-ventilation was effective only in urban areas. Nirmatrelvir/ritonavir and molnupiravir better protected rural residents against hospitalization. Despite advancements in treatment and vaccinations, disparities in adverse COVID-19 outcomes persist between urban and rural communities. The effectiveness of some therapeutic agents appears to vary based on rurality, suggesting a nuanced relationship between treatment and geographic location while highlighting the need for targeted rural health care strategies.

Age at natural menopause and its associated characteristics among Brazilian women: cross-sectional results from ELSI-Brazil.

This study aimed to determine the median age at natural menopause and analyze lifestyle, anthropometric, and dietary characteristics associated with the age at natural menopause among Brazilian women. This cross-sectional study involved 2,731 women 50 years and over, drawn from the baseline of the Brazilian Longitudinal Study of Aging (ELSI-Brazil, 2015/16). Nonparametric Kaplan-Meier cumulative survivorship estimates were used to assess the median timing of natural menopause. Cox proportional hazards regression models were employed to estimate the associations between age at natural menopause and exposure variables. The overall median age at natural menopause was 50 years. In the adjusted Cox model, current smoking (hazard ratio [HR], 1.11; 95% CI, 1.01-1.23) and underweight (HR, 1.34; 95% CI, 1.12-1.61) were associated with earlier natural menopause. Conversely, performing recommended levels of physical activity in the last week (HR, 0.88; 95% CI, 0.80-0.97), being overweight (HR 0.86; 95% CI, 0.74-0.99), and adhering to two or three healthy eating markers (HR, 0.80; 95% CI, 0.66-0.97; HR, 0.76; 95% CI, 0.61-0.94, respectively) were associated with later age at natural menopause. Binge drinking and waist circumference were not associated with age at natural menopause. Lifestyle, anthropometric, and dietary characteristics are significant factors that affect the age at natural menopause. Our findings can contribute to public policies targeted at Brazilian women's health.

Bendamustine is a safe and effective lymphodepletion agent for axicabtagene ciloleucel in patients with refractory or relapsed large B-cell lymphoma

BackgroundFludarabine in combination with cyclophosphamide (FC) is the standard lymphodepletion regimen for CAR T-cell therapy (CAR T). A national fludarabine shortage in 2022 necessitated the exploration of alternative regimens with...

Theoretical framework and inference for fitting extreme data through the modified Weibull distribution in a first-failure censored progressive approach

The importance of biomedical physical data is underscored by its crucial role in advancing our comprehension of human health, unraveling the mechanisms underlying diseases, and facilitating the development of innovative medical treatments and interventions. This data serves as a fundamental resource, empowering researchers, healthcare professionals, and scientists to make informed decisions, pioneer research, and ultimately enhance global healthcare quality and individual well-being. It forms a cornerstone in the ongoing pursuit of medical progress and improved healthcare outcomes. This article aims to tackle challenges in estimating unknown parameters and reliability measures related to the modified Weibull distribution when applied to censored progressive biomedical data from the initial failure occurrence. In this context, the article proposes both classical and Bayesian techniques to derive estimates for unknown parameters, survival, and failure rate functions. Bayesian estimates are computed considering both asymmetric and symmetric loss functions. The Markov chain Monte Carlo method is employed to obtain these Bayesian estimates and their corresponding highest posterior density credible intervals. Due to the inherent complexity of these estimators, which cannot be theoretically compared, a simulation study is conducted to evaluate the performance of various estimation procedures. Additionally, a range of optimization criteria is utilized to identify the most effective progressive control strategies. Lastly, the article presents a medical application to illustrate the effectiveness of the proposed estimators. Numerical findings indicate that Bayesian estimates outperform other estimation methods by achieving minimal root mean square errors and narrower interval lengths.

Long-term outcome after the Ross procedure in 173 adults with up to 25 years of follow-up.

The potential risk of autograft dilatation and homograft stenosis after the Ross procedure mandates lifelong follow-up. This retrospective cohort study aimed to determine long-term outcome of the Ross procedure, investigating autograft and homograft failure patterns leading to reintervention. All adults who underwent the Ross procedure between 1991 and 2018 at the University Hospitals Leuven were included, with follow-up data collected retrospectively. Autograft implantation was performed using the full root replacement technique. The primary end-point was long-term survival. Secondary end-points were survival free from any reintervention, autograft or homograft reintervention-free survival, and evolution of autograft diameter, homograft gradient and aortic regurgitation grade over time. A total of 173 adult patients (66% male) with a median age of 32 years (range 18-58 years) were included. External support at both the annulus and sinotubular junction was used in 38.7% (67/173). Median follow-up duration was 11.1 years (IQR, 6.4-15.9; 2065 patient-years) with 95% follow-up completeness. There was one (0.6%) perioperative death. Kaplan-Meier estimate for 15-year survival was 91.1% and Ross-related reintervention-free survival was 75.7% (autograft: 83.5%, homograft: 85%). Regression analyses demonstrated progressive neoaortic root dilatation (0.56 mm/year) and increase in homograft gradient (0.72 mmHg/year). The Ross procedure has the potential to offer excellent long-term survival and reintervention-free survival. These long-term data further confirm that the Ross procedure is a suitable option in young adults with aortic valve disease which should be considered on an individual basis.

Vitelliform Lesions Associated with Leptochoroid and Pseudodrusen

ObjectiveTo characterize clinical and prognostic implications of leptovitelliform maculopathy (LVM), a distinctive phenotype of vitelliform lesion characterized by the coexistence of subretinal drusenoid deposits (SDD) and leptochoroid. DesignRetrospective, cohort study. SubjectsThe study compares patients affected by leptovitelliform maculopathy with cohorts displaying a similar phenotypic spectrum. This includes patients with acquired vitelliform lesions (AVL) and those with SDD alone. MethodsA total of 60 eyes of 60 patients were included, of whom 20 eyes had LVM, 20 eyes had AVL, and the remaining had SDD. Patients older than 50 years with complete medical records and multimodal imaging for at least 6 months of follow-up, including color fundus photograph (CFP) or MultiColor, optical coherence tomography (OCT), fundus autofluorescence (FAF), and OCT angiography (OCTA) were included. Main Outcome MeasuresChoroidal vascularity index (CVI); proportion of late-stage complications (macular neovascularization, atrophy). ResultsThe AVL subgroup exhibited a significantly higher CVI compared to both LVM (p<0.001) and SDD subgroups (p<0.001). The proportion of late-stage complications significantly differed among subgroups (χ2=7.5, p=0.02). Eyes with LVM presented the greatest proportion of complications (55%) after a mean of 29.3 months, while the remaining eyes presented a similar proportion of complications, including 20% in AVL after 27.6 months and 20% in SDD after 36.9 months. Kaplan-Meier estimates of survival demonstrated a significant difference in atrophy development between groups (p<0.001), with a median survival of 3.9 years for LVM and 7.1 years for controls. The presence of LVM correlated with a fourfold increase in the likelihood of developing complications. Conclusions: Leptovitelliform maculopathy, characterized by the association of vitelliform lesions with SDD and leptochoroid, represents a distinct clinical phenotype in the broader spectrum of vitelliform lesions. The importance of a clinical distinction for these lesions is crucial due to a higher propensity for faster progression and an elevated rate of complications, particularly toward atrophic conversion.

Modeling highly crosslinked polyethylene vs. non–highly crosslinked polyethylene glenoid revision rates for anatomic shoulder arthroplasty in osteoarthritis including differing polyethylene glenoid fixation designs

BackgroundWe compared anatomic total shoulder arthroplasty (aTSA) for osteoarthritis to both highly crosslinked polyethylene (XLPE) and non–highly crosslinked polyethylene (non-XLPE) to determine the rate of revision for multiple patient and implant characteristics, modeling the effect of variation in glenoid fixation design (glenoid component type). MethodsData from a large national arthroplasty registry were analyzed for the period April 16, 2004, to December 31, 2022. The study population included all primary aTSA (stemmed and stemless shoulder arthroplasty) procedures with a primary diagnosis of osteoarthritis and performed using prostheses in current use. These procedures were grouped into 2 cohorts: all polyethylene-bearing glenoid components with either XLPE or non-XLPE. The cumulative percent revision was determined using Kaplan–Meier estimates of survivorship and hazard ratios from Cox proportional hazard models adjusted for age, sex, humeral head size, humeral fixation, type of primary (total stemmed or stemless anatomic), glenoid component type (modular and nonmodular metal-backed glenoid, cemented polyethylene glenoid, and polyethylene glenoid with modified central peg), and surgeon volume (after 2008). Possible interactions were examined. A subanalysis from January 1, 2017, captured the additional patient demographics of American Society of Anesthesiologists score, body mass index, and glenoid morphology. ResultsOf 11,003 aTSA procedures, the cumulative percent revision at 14 years for all XLPE glenoids (n = 3865) was 5.8% (95% confidence interval [CI] 3.9, 8.7), and 18.7% (95% CI 16.6, 21.0) for non-XLPE (n = 7138). XLPE had a lower rate of revision from 2 years (non-XLPE vs. XLPE 2 years + hazard ratio = 1.66, (95% CI 1.09, 2.53), P = .018) adjusting for age, sex, humeral head size, type of primary, humeral stem fixation, and glenoid component type. Overall, glenoid component type and polyethylene type were strongly associated (P < .001 and P = .021, respectively) with all-cause aTSA revision rates. The difference between non-XLPE and XLPE is observed across all polyethylene glenoid types. When considering procedures performed between 2017 and 2022, XLPE vs. non-XLPE rates of revision were not significantly different with extended adjustment at subanalysis, but loosening did not predominate for non-XLPE until year 6 of follow-up. ConclusionBoth the glenoid design and the type of polyethylene predict the revision rate for aTSA. However, the relative rates of revision between glenoid designs did not differ with polyethylene type. While the polyethylene type was not associated with aTSA revision rates in a more contemporary analysis, the incidence of loosening in non-XLPE prostheses combinations was higher from 6 years may explain this.

Effect of Radical Prostatectomy on Survival for Men with High-risk Nonmetastatic Prostate Cancer Features Selected According to STAMPEDE Criteria: An EMPaCT Study

Background and objectiveA meta-analysis of two randomized STAMPEDE platform trials revealed that 3 yr of abiraterone acetate in addition to androgen deprivation therapy and radiation therapy significantly improved metastasis-free and overall survival (OS) in high-risk nonmetastatic prostate cancer (PCa) and should be considered a new standard of care. The aim of our study was to assess long-term cancer-specific survival (CSS) and OS for surgically treated patients with newly diagnosed nonmetastatic node-negative PCa meeting the STAMPEDE criteria for high risk. MethodsThis was a retrospective, multicenter cohort study of patients with European Association of Urology (EAU) high-risk PCa who underwent radical prostatectomy and extended pelvic lymph node dissection. CSS was assessed using cumulative incidence curves and the Kaplan-Meier method was used to evaluate OS. We used a Fine and Gray model to evaluate the prognostic value of STAMPEDE high-risk factors (SHRFs) for CSS, and a Cox proportional-hazards model to assess the association of SHRFs with OS. Key findings and limitationsA total of 2994 patients with EAU high-risk PCa were divided into groups with 0, 1, 2, or 3 SHRFs. The 10-yr survival estimates for patients with 0–1 versus 2–3 SHRFs were 95% versus 82% for CSS and 81% versus 64% for OS (both p < 0.0001). In comparison to patients with 0 SHRFs, hazard ratios were 1.2 (p = 0.5), 3.9 (p < 0.0001), and 5.5 (p < 0.0001) for CSS, and 1.1 (p = 0.4), 2.2 (p < 0.0001), and 2.5 (p = 0.0004) for OS for patients with 1, 2, and 3 SHRFs, respectively. Conclusions and clinical implicationsOur results confirm that the STAMPEDE high-risk criteria identify a subgroup of patients with highly aggressive PCa features and adverse long-term oncological outcomes. This population is likely to benefit most from aggressive multimodal treatment. Nevertheless, we have shown for the first time that surgery remains a viable treatment option for patients with STAMPEDE high-risk PCa. Patient summaryProstate cancer that meets the high-risk definitions from the STAMPEDE trial is an aggressive type of cancer. Our results for long-term cancer control outcomes indicate that surgery is a viable option for the subgroup of patients with this type of prostate cancer.

Anatomic total shoulder arthroplasty using hybrid glenoid fixation with a porous-coated titanium post. Two- to ten-year follow-up of 256 cases with primary glenohumeral osteoarthritis

BackgroundAnatomic total shoulder arthroplasty is one of the recommended surgical treatments for severe glenohumeral osteoarthritis, providing good pain relief and function. Aseptic loosening of the glenoid component, however, is a major cause for revision. Hybrid components have been introduced, combining traditional cemented fixation with porous titanium bone ingrowth to improve fixation. The purpose of this study was to report our midterm to longterm experience using such a component, including clinical outcomes and implant survival. MethodsWe reviewed all patients who were operated for primary osteoarthritis during the period 2011-19, leaving a minimum of 2-year follow-up. The severity of the osteoarthritis was graded using Samilson-Prieto score, while glenoid morphology was graded using the modified Walch classification. Clinical outcomes included Western Ontario Osteoarthritis of the Shoulder (WOOS) index, EQ-5D-5L, and Constant-Murley score. Postoperative radiographs were analyzed for radiolucent lines. Patient records were studied for complications including revisions. Supplementary data for revision and outcome were obtained from the Danish Shoulder Arthroplasty Registry. Kaplan-Meier estimates for implant survival were calculated. ResultsA total of 256 arthroplasties in 224 patients were included (mean age: 69 years ± 9 years, 149 females). 81% of cases were graded radiographically as severe osteoarthritis, according to Samilson-Prieto. Walch type B1 was most commonly followed by B2 (29% and 28% respectively). The mean follow-up time was 49 months (range 24-127). The response rate for patient reported outcomes was 91%. The median WOOS index was 94% (81%-99%), the median EQ-5D-5L was 0.87 (0.69-0.95), and the mean Constant-Murley score was 75 (SD 17.7). 13 cases (6%) had a WOOS index below 50%. 8.2% had complications related to surgery. A radiolucent line had developed around the central post in six cases and at the bone-cement interface in three cases at follow-up. Six cases had been revised (2.3%); three due to aseptic loosening of the glenoid. The 10-year survival estimate was 95.6 % (95% CI: 87.9%-98.5%). ConclusionAnatomic total shoulder arthroplasty with hybrid glenoid fixation provides excellent clinical outcome with a low complication rate in patients, with primary glenohumeral osteoarthritis. The 10-year survival rate is high and comparable to that reported for the best- performing all-polyethylene components. Longer observation is needed to see if hybrid fixation will outperform standard all-cemented components.

The Impact of Fibroblast Growth Factor Receptor Alterations in Clinical Outcomes of Patients With Advanced Urothelial Carcinoma: Real-World Data From a Latin American Population

IntroductionFibroblast growth factor receptor (FGFR) mutations and fusions are relevant biomarkers in metastatic urothelial carcinoma (mUC). However, the prevalence of genomic alterations and their impact on clinical outcomes in a Latin American population remains unknown. This study aimed to explore the prevalence of FGFR mutations and/or fusions in patients with mUC in Latin America (LATAM) and its association with clinicopathological characteristics, Bellmunt's prognostic model, and survival outcomes. Patients and methodsA multicenter retrospective cohort study from 2016 to 2019 of patients with mUC from several LACOG LATAM institutions. FGFR alterations were analyzed by real-time PCR and/or next-generation sequencing in tumor samples and clinicopathologic characteristics and survival outcomes data were collected. The prevalence of FGFR, patient characteristics, and treatment in real-world settings were summarized. Kaplan-Meier survival estimates and Cox regression analyses were used to evaluate the associations of FGFR mutation and/or fusion status with median overall survival (mOS), median time to treatment failure (mTTF), and clinicopathological characteristics. ResultsIn total, 222 patients were screened. Of these, 196 patients were considered eligible and were included in the analysis. FGFR mutations and/or fusions were found in 35 (17.9%) patients. There was no statistical difference in mOS and mTTF in FGFR-altered and non-altered patients (13.1 vs. 16.8 months, P = .20 and 3.9 vs. 4.1 months, P = .96, respectively). Bellmunt's prognostic model correctly predicted overall survival (P = .049). ConclusionsThis is the largest study evaluating the prevalence of FGFR alterations in patients with mUC in the LATAM population. FGFR alterations in mUC were found in 17.9% of the patients, and the presence of this biomarker was not associated with OS. We validated Bellmunt's prognostic model in this cohort.