Survival Outcomes Research Articles

Retrospective Cohort Study of Additional Procedures and Transplant-Free Survival for Patients With Functionally Single Ventricle Disease Undergoing Staged Palliation in England and Wales.

Reinterventions may influence the outcomes of children with functionally single-ventricle (f-SV) congenital heart disease. We undertook a retrospective cohort study of children starting treatment for f-SV between 2000 and 2018 in England, using the national procedure registry. Patients were categorized based on whether they survived free of transplant beyond 1 year of age. Among patients who had transplant-free survival beyond 1 year of age, we explored the relationship between reinterventions in infancy and the outcomes of survival and Fontan completion, adjusting for complexity. Of 3307 patients with f-SV, 909 (27.5%), had no follow-up beyond 1 year of age, among whom 323 (35.3%) had ≥1 reinterventions in infancy. A total of 2398 (72.5%) patients with f-SV had transplant-free survival beyond 1 year of age, among whom 756 (31.5%) had ≥1 reinterventions in infancy. The 5-year transplant-free survival and cumulative incidence of Fontan, among those who survived infancy, were 93.4% (95% CI, 92.4%-94.4%) and 79.3% (95% CI, 77.4%-81.2%), respectively. Both survival and Fontan completion were similar for those with a single reintervention and those who had no reinterventions. Patients who had >1 additional surgery (adjusted hazard ratio, 3.93 [95% CI, 1.87-8.27] P<0.001) had higher adjusted risk of mortality. Patients who had >1 additional interventional catheter (adjusted subdistribution hazard ratio, 0.71 [95% CI, 0.52-0.96] P=0.03) had a lower likelihood of achieving Fontan. Among children with f-SV, the occurrence of >1 reintervention in the first year of life, especially surgical reinterventions, was associated with poorer prognosis later in childhood.

P-364 Impact on fertility outcomes in survivors after hematopoietic stem cell transplantation for benign and malignant hematologic disorders: a systematic review and meta-analysis

Abstract Study question What is the prevalence of infertility after hematopoietic stem cell transplantation (HSCT) in females and males up to the age of 1 year? Summary answer The overall prevalence of infertility (95% CI) in women treated with HSTC is 64% (0.58-0.70) and in men 39% (0.31-0.47). What is known already HSCT is a well-established treatment that has significantly increased survival in haematological malignancies and also benign diseases since its introduction in the 1980s. The use of high-dose chemotherapy and radiotherapy, myeloablative conditioning, combined with HSCT exposes serious long-term complications, including gonadal dysfunction and infertility. The risk of ovarian and testicular damage seems to be very high. Therefore, the European Society for Blood and Marrow Transplantation (EBMT) had recommended in 2015 to consider fertility preservation measures in children and adolescents requiring HSCT. However, the data on which this recommendation was based was limited and heterogeneous. Study design, size, duration The systematic review and meta-analysis is part of the FertiTOX project (www.fertitox.com) which aims to close the gap of data regarding gonadotoxicity of cancer therapies to enable more accurate counselling regarding fertility preservation. A systematic literature search was conducted in Medline, Embase and Cochrane in November 2023, considering papers published since 2000. Participants/materials, setting, methods A total of 1632 records were identified for abstract screening. Only females and males without recurrent disease and follow up of more than one year were considered. For the systematic review, 68 studies fulfilled the criteria. For the meta-analysis, studies with &amp;lt; 10 patients were excluded. Infertility was defined in females as very low AMH, hypergonadotropic hypogonadism, amenorrhoea and/or need for hormone replacement therapy and in males as low inhibin B and/or azoospermia. Main results and the role of chance In total, 68 out of 1632 studies were included in the final analysis. Malignant diseases were mainly acute myeloid / lymphoblastic leukemia, chronic myeloid leukemia/ lymphocytic leukemia and non-hodgkin’s and hodgkin’s lymphoma. Benign diseases were sickle cell disease, Fanconi anaemia, and β-thalassemia major. In the meta-analysis, 56 studies were included, comprising 1853 female malignant cases, 241 female benign cases, 1871 male malignant cases, and 226 male benign cases. The analysis, employing a random-effects model for estimating prevalence and its 95% confidence interval, revealed that the overall pooled prevalence of infertility exceeded 30% in all groups. The prevalence of infertility was highest in female malignant cases (65%, 95% CI: 0.58-0.71). In women with benign diseases it was 61% (95% CI: 0.48-0.73). In males with malignant diseases it reached 41% (95% CI: 0.32 to 0.51) and with benign diseases 31% (95% CI: 0.19 to 0.46). Heterogeneity of data was high as shown by female as shown by the malignant cases of 83% and benign cases of 65% in women and the malignant cases of 91% and benign cases of 74% in males. Limitations, reasons for caution The heterogeneity of the included studies due to treatment variations and diverse characteristics of the study populations with large age ranges, did not allow further subgroup analyses. Thus, an individual and reliable fertility prognosis is still difficult to give. Wider implications of the findings The results of this meta-analysis support the clinical necessity of fertility preservation counselling in females and males undergoing HSCT treatment. Further prospective studies addressing the individual impact of the HSCT treatment on gonadal function are needed Trial registration number The study protocol was registered at the international Prospective Register of Systematic Reviews, PROSPERO (Registry number CRD42023486928).

Prospective Study to Assess the Clinicopathological and Prognostic Value of BRAF V600E Mutation in Metastatic Colorectal Cancer

Abstract Background BRAF is a protein kinase downstream of RAS in the RAS-RAF-MEK- ERK kinase pathway. The majority (&amp;gt;95%) of BRAF mutations in metastatic colorectal cancer (mCRC) is the BRAFV600E mutation, which is considered an important negative prognostic marker and is associated with resistance to standard chemotherapies in mCRC patients. Objectives This study aimed to investigate the BRAF mutation in patients with mCRC and its association with clinicopathological factors and survival outcomes. Patients and Methods The included specimens were analysed for BRAFV600E mutation by immunohistochemistry (IHC) from confirmed CRC patients with radiological or pathological evidence of metastasis. Results The BRAF mutation was positive in 9.1% of patients. Synchronous metastasis was observed in patients with BRAF mutation with statistical significance (P = 0.033). With regard to treatment, there was no statistically significant difference in patients with BRAF mutations who received targeted chemotherapy as first-line therapy also there was no statistically significant difference in median PFS of patients with BRAF mutation (p = 0.789) and also in median OS (p = 0.343). Conclusion Although the BRAF mutation is a relatively rare finding in mCRC, it is characterized by a critical negative impact on treatment outcome. Given this poor outcome, optimization of therapy is an important goal.

Precursor Epithelial Subtypes of Adenocarcinoma Arising from Intraductal Papillary Mucinous Neoplasms (A-IPMN): Clinicopathological Features, Recurrence and Response to Adjuvant Chemotherapy.

The clinico-oncological outcomes of precursor epithelial subtypes of adenocarcinoma arising from intraductal papillary mucinous neoplasms (A-IPMN) are limited to small cohort studies. Differences in recurrence patterns and response to adjuvant chemotherapy between A-IPMN subtypes are unknown. Clincopathological features, recurrence patterns and long-term outcomes of patients undergoing pancreatic resection (2010-2020) for A-IPMN were reported from 18 academic pancreatic centres worldwide. Precursor epithelial subtype groups were compared using uni- and multivariate analysis. In total, 297 patients were included (median age, 70 years; male, 78.9%), including 54 (18.2%) gastric, 111 (37.3%) pancreatobiliary, 80 (26.9%) intestinal and 52 (17.5%) mixed subtypes. Gastric, pancreaticobiliary and mixed subtypes had comparable clinicopathological features, yetthe outcomes were significantly less favourable than the intestinal subtype. The median time to recurrence in gastric, pancreatobiliary, intestinal and mixed subtypes were 32, 30, 61 and 33 months. Gastric and pancreatobiliary subtypes had worse overall recurrence (p=0.048 and p=0.049, respectively) compared with the intestinal subtype but gastric and pancreatobiliary subtypes had comparable outcomes. Adjuvant chemotherapy was associated with improved survival in the pancreatobiliary subtype (p=0.049) but not gastric (p=0.992), intestinal (p=0.852) or mixed subtypes (p=0.723). In multivariate survival analysis, adjuvant chemotherapy was associated with a lower likelihood of death in pancreatobiliarysubtype, albeit with borderline significance [hazard ratio (HR) 0.56; 95% confidence interval (CI) 0.31-1.01; p=0.058]. Gastric, pancreatobiliary and mixed subtypes have comparable recurrence and survival outcomes, which are inferior to the more indolent intestinal subtype. Pancreatobiliary subtype may respond to adjuvant chemotherapy and further research is warranted to determine the most appropriate adjuvant chemotherapy regimens for each subtype.

Overexpression of Estrogen Receptor Beta and Its Prognostic Significance among Malignant Pleural Mesothelioma Patients

Abstract Background The expression of estrogen receptor beta (ER beta) and its correlation with the prognosis of malignant mesothelioma remains controversial. This study aimed at studying ER beta expression in tumour cells in patients with mesothelioma and its association with clinicopathological factors and survival outcomes. Material and Methods A prospective study to evaluate prognostic significance of ER beta overexpression by immunohistochemistry (IHC) on paraffin blocks among malignant mesothelioma patients at Ain Shams university hospital and correlate their overexpression with the patients' follow up clinical data, OS, and PFS. Results Forty-two mesothelioma cases were enrolled and followed up, High ER beta expression (modified Allred score 7-9) was reported in 9.5% of the patients (4 cases), moderate expression (modified Allred score 4-6) was reported in 28.6% of the patients(12 cases), weak and negative expression ( modified Allred score 0-3) was reported in 61% of the patients(26 cases), percent of ER beta positive cases was 69% of the total patients, there was no statistical difference as regard age (p value:0.8), sex(p value:0.4), stage (p-value: 0.71), ECOG (p-value :0.84), histological subtype(p value:0.17) and response to first-line treatment (p value:0.5) across the 3 groups of patients (high, moderate, weak and negative ER beta on tumour cells).there was no statistically significant difference in OS and PFS for ER beta overexpression. Conclusion ER beta overexpression was not associated with improved OS or PFS in mesothelioma patients, larger sample size would be recommended for more solid conclusions.

Proximal Gastrectomy is Associated with Lower Incidence of Anemia and Vitamin B12 Deficiency Compared to Total Gastrectomy in Patients with Upper Gastric Cancer.

Proximal gastrectomy is an alternative to total gastrectomy (TG) for early gastric cancer (EGC) treatment in the upper stomach. However, its benefits in terms of perioperative and long-term outcomes remain controversial. The aim of this study was to compare the perioperative, body compositional, nutritional, and survival outcomes of patients undergoing proximal gastrectomy with double-tract reconstruction (PG-DTR) and TG for pathological stage I gastric cancer in upper stomach. The study included 506 patients who underwent gastrectomy for pathological stage I gastric cancer in the upper stomach between 2015 and 2019. Clinicopathological, perioperative, body compositional, nutritional, and survival outcomes were compared between the PG-DTR and TG groups. The PG-DTR and TG groups included 197 (38.9%) and 309 (61.1%) patients, respectively. The PG-DTR group had a lower rate of early complications (p=0.041), lower diagnosis rate of anemia and vitamin B12 deficiency (all p<0.001), and lower replacement rate of iron and vitamin B12 compared to TG group (all p<0.001). The PG-DTR group showed reduced incidence of sarcopenia at 6-months postoperatively, preserved higher amount of visceral fat after surgery (p=0.032 and p=0.040, respectively), and showed a higher hemoglobin level (p=0.007). Oncologic outcomes were comparable between the groups. The PG-DTR for EGC located in the upper stomach offered advantages of fewer complications, lower incidence of anemia and vitamin B12 deficiency, less decrease in visceral fat volume, and similar survival compared to TG. Consequently, PG-DTR may be considered a superior alternative treatment option to TG.

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...

P-582 Analysis of assisted reproductive outcomes for gynecologic cancer survivors: a retrospective study

Abstract Study question Do women diagnosed with gynecologic cancer have worse pregnancy and neonatal outcomes of assisted reproductive technology (ART) ? Summary answer Decreased live birth rate was observed in female gynecologic cancer patients undergoing ART, particularly in endometrial cancers and cervical cancers. What is known already Gynecologic malignancies comprise approximately 13% of female cancer diagnoses, and oncological treatments such as surgery, chemotherapy, abdominal or pelvic radiotherapy, and hormonotherapy may induce infertility, premature ovarian failure, or early menopause, resulting in a loss of reproductive potential. ART has emerged as an important option for cancer patients undergoing treatment, but the reproductive outcomes of ART among cancer survivors remain poorly understood. Limited research exists regarding the impact of a history of gynecologic cancer on reproductive outcomes of ART. Study design, size, duration 136 women diagnosed with gynecologic cancer who underwent their first IVF/ICSI treatment between 2013 and 2021 were retrospectively enrolled in this study. 241 infertile women without any history of cancer were matched to the cancer group. Participants/materials, setting, methods Women diagnosed with gynecologic cancer who underwent their first IVF/ICSI treatment between 2013 and 2021 were included. Infertile women without any history of cancer were matched to the cancer group. The primary outcome was the cumulative live birth rate. A propensity score-based patient-matching approach was adopted to ensure comparability between individuals with and without specific cancer type. Main results and the role of chance A total of 136 patients with a history of gynecologic cancer and 241 healthy infertile controls were included in this study. Endometrial cancer constituted 50.70% of the cases and cervical cancer constituted 34.60% of the cases. The cancer group exhibited significant shorter duration of stimulation, lower levels of estradiol, lower number of retrieved oocytes, day-3 embryos, and blastocysts compared to the control group (P &amp;lt; 0.05). The cumulative live birth rate of the gynecologic cancer group was significantly lower than that of the control group (36.10% vs. 60.50%, P &amp;lt; 0.001). Maternal and neonatal complications did not significantly differ between the groups (P &amp;gt; 0.05). The endometrial cancer and cervical cancer groups showed significantly lower cumulative live birth rates than their matched controls (38.60% vs. 64.50%, P = 0.011 and 24.20% vs. 68.60%, P &amp;lt; 0.001, respectively). Limitations, reasons for caution Our study was limited by the retrospective design in nature and small sample size of its patient cohort. In addition, the effect of cancer treatments was not evaluated specifically in the current study due to the limited number of patients and possible inconsistency in surgical operations. Wider implications of the findings Our study provides data support for further exploration of the effects of endometrial cancer, cervical cancer, and other gynecologic cancers on fertility. Comprehensive ovarian function assessment, detailed counseling, individualized fertility guidance, and close follow-up after ART therapy are recommended for patients with gynecologic malignancy history. Trial registration number Not applicable

P-116 Relationship between exposure in equilibration solution pre-vitrification for human collapsed blastocysts and miscarriage rate in ART treatments

Abstract Study question To explore the relationship between equilibration time pre-vitrification of human collapse blastocyst and clinical pregnancy and miscarriage rate in patients undergoing ART treatments Summary answer The miscarriage rate was significantly lower in the group with a short equilibration time of 7-8 minutes compared to the group of 9-10 minutes What is known already The introduction of vitrification represents one of the most important advancement in ART. However, protocols currently applied to cryopreserve human embryos still have some weak points that might be improved. A critical aspect is represented by the high concentration of cryoprotectants (CPAs) used during the vitrification and some of this CPAs might impact negatively cellular metabolism and function. Thus, this study investigated whether a shorter time in the equilibration solution before vitrification of artificially collapsed blastocysts might have an impact on survival and pregnancy outcomes, as well as live birth rate and risk of miscarriage in patients undergoing ART. Study design, size, duration This prospective study was performed at the Centre for Reproductive Medicine, Haikou Mary Hospital, China from March 2018 to May 2022. Informed consent for experimentation with human subjects was obtained before the patients start the ovarian stimulation. Female age &amp;lt;35 years, and causes of infertility included male factors, female infertility, and unexplained infertility. Following the fresh embryo transfer, supernumerary good quality blastocysts ≥ 2, according to Gardner’s score were vitrified and allocated as discussed below Participants/materials, setting, methods The study included a total of 831 expanded blastocysts, which were divided into two groups according to the equilibration time before vitrification: group (A) 7-8 minutes (413); and group (B) 9-10 minutes (418). Expanded blastocysts (grade 3 or more) were artificially shrunk by applying one or two laser pulses. Patients were included in the study only when at least two blastocysts were available for vitrification, in order to be allocated one in each group Main results and the role of chance Results: A total of 831 vitrified-warmed blastocysts were analysed in this study, of which 825 survived at the warming step (99.3%: 825/831). All surviving blastocysts were transferred in 585 embryo transfers. Overall, the clinical pregnancy rate per transfer was CPR: 68.5% (401/585), and live birth and miscarriage rates: 61.0% (357/585) and 11.0% (44/401). No significant differences were observed between the two groups regarding the mean age of patients, the average number of blastocysts transferred, the basal FSH, BMI, and infertility duration. Results show the same survival rate after warming for group A (99.3%) and group B (99.3%), as well as similar CPR (A: 69.1% versus B: 68.0%).The live birth (A: 63.8% versus B: 58.3%) and multiple gestation rates (A: 20.8% versus B: 23.5%) were comparable in the two groups. When analysing the overall miscarriage rate, data displayed a statistically significant difference (P &amp;lt; 0.05) in favour of group A (7.6%) compared to group B (14.2%). There were no differences between the two groups concerning the prevalence of male babies (A: 57.1% and B: 55.4%), average gestational length (A: 38.67±1.37 versus B: 38.33±1.21), preterm birth rate (A: 19.2% versus B: 20.6%), and birth weight (A: 2.95±0.58 versus B: 3.05±0.63 kg). Limitations, reasons for caution This is not a randomized controlled trial, it is a prospective observational cohort study aiming to calculate the effect of a shorted ES time on the risk of miscarriage. Also, potential confounding factors due to the heterogeneous nature of the sample investigated may impair the validity of our conclusions. Wider implications of the findings Results demonstrate that a shorter equilibration time resulted in optimal survival, clinical pregnancy, and live birth rates compared to exposure to ES for 9-10. Thus, suggesting that a longer exposure to the ES is not needed, and might negatively effect cellular metabolism and function, increasing the risk of miscarriage. Trial registration number Not applicatione

P-391 Association between meteorological season at the time of embryo transfer and pregnancy outcomes in freeze-all cycles: lessons from seasonal reproductive mammals

Abstract Study question Is there any effect of meteorological season at the time of embryo transfer on clinical outcomes of freeze-all cycles? Summary answer Optimal conditions for implantation appear to be associated with spring and summer. Embryo transfers performed in autumn or winter are associated with reduced ongoing pregnancy. What is known already Extensive research has consistently shown that most mammals are seasonal breeders, and as day length increases, gonadotropin secretion increases, to anticipate reproduction in the spring and summer months. There is intriguing evidence that there is a seasonal variance in human reproduction, but the data are inconclusive. Therefore, the goal for the present study was to evaluate the effect the meteorological season at the time of embryo transfer on clinical outcomes of freeze-all cycles. Study design, size, duration This historical cohort study was performed in a private university-affiliated IVF center between February 2018 and December 2022. A total of 4952 frozen-thawed embryos transferred to 3725 cycles in a single clinic were analyzed. Participants/materials, setting, methods Both vitrification and the warming procedures were performed using the Cryotop method. Embryos survival and clinical outcomes were analyzed by the season, at the time of embryo transfer, using generalized linear models adjusted for potential confounders. Main results and the role of chance The mean maternal age was 37.0 ± 4.7 years. Embryos were cryopreserved for a mean of 8.1 ± 17.3 months. Autumn was designated as the reference season for all analyses. No significant differences were observed in embryo survival rates when the seasons were compared, however, lowest implantation and pregnancy rates were observed when embryo transfers occurred in autumn (44.6%), followed by winter (45.8%, OR: 1.049, CI: 0.876 – 1.257, p = 0.603) and summer (49.0%, OR: 1.196, CI: 1.010 – 1.415, p = 0.038), while spring embryo transfers had a 30% increased odds of pregnancy (51.2%, OR: 1.302, CI: 1.100 – 1.541, p = 0.002). An increased miscarriage rate was observed when embryo transfers occurred in autumn (13.9%), followed by winter (11.4%, OR: 0.510, CI: 0.323 – 0.805, p = 0.004) and summer (10.4%, OR: 0.461, CI: 0.292 – 0.727, p = 0.001), while spring embryo transfers had a 63% decreased odds of miscarriage (5.6%, OR: 0.369, CI: 0.230 – 0.592, p &amp;lt; 0.001). Limitations, reasons for caution The use of historical cohort groups is a drawback. Despite the eligibility criteria for inclusion in the analysis, potential differences in the baseline characteristics cannot be ruled out. Wider implications of the findings In seasonal breeding mammals, melatonin increases the gonadotropins’ release during the transition period. Melatonin rise favors embryo implantation and protects offspring by increasing progesterone levels. Our evidence suggests that human reproductive potential may be influenced by climatic variations. Trial registration number N/A

Treatment Outcomes for Maple Syrup Urine Disease Detected by Newborn Screening.

Maple syrup urine disease (MSUD), a life-threatening metabolic disorder, is included in newborn screening (NBS) programs worldwide. The study aims to evaluate the impact of NBS on the long-term outcome of MSUD patients. We performed a prospective, national, multicenter, observational study. In the studied NBS cohort (N = 33; 22 classic MSUD [cMSUD], 11 variant MSUD [vMSUD]; median age at last visit 10.4 years), 32 (97%) patients survived, 58% of them had normal cognitive functions (median IQ 87). Initial peak leucine increased linearly with age in cMSUD (median: 1712 µmol/L), but not in vMSUD. Global IQ correlated inversely with the initial peak leucine concentration (P = .04; β = -0.0081) and the frequency of decompensations (P = .02; β = -9.133). A cluster analysis identified 2 subgroups differing in their long-term metabolic control (median leucine concentration: 162 vs 278 µmol/L; P < .001). In cMSUD, lower leucine concentrations were associated with a higher IQ (95.5 vs 80; P = .008). Liver transplantation (median age 5.8 years) was not associated with better cognitive outcome. NBS is highly sensitive for cMSUD, but vMSUD might be missed (N = 2 missed by NBS). NBS and the early start of treatment improve survival and long-term outcome in individuals with cMSUD. Disease severity is an important modifier of outcome; however, the time to NBS report and the quality of long-term metabolic control had an independent impact on cognitive outcome, highlighting the importance of an early diagnosis and the quality of treatment.

P-248 Egg vitrification related to female age: survival and laboratory outcome of 1233 vitrified-thawed oocytes in non-medical autologous use

Abstract Study question Is the female age at retrieval a determinant factor for the viability and potential of the thawed eggs? Summary answer In patients over 40, thawed oocytes display more abnormal fertilization, develop less in extended culture and yield less top quality blastocyst. What is known already Oocyte cryopreservation is a well-established procedure especially since the advent of the vitrification technique. The successful outcomes achieved with vitrification encourage its application in fertility preservation (FP) for medical and non-medical reasons. Besides, the age-related decline in women’s fertility and the oocyte quality negatively affect the outcome of assisted reproduction. Some studies have reported that age at oocyte retrieval strongly influences reproductive prognosis after FP. However, the appropriate age for non-medical FP is still debated. Although oocyte freezing at a younger age is recommended, there should be a balance between a favourable outcome and the cost-effectiveness of the strategy. Study design, size, duration Retrospective study on 166 patients with frozen-thawed oocytes who underwent ICSI during 2021-2023 in a single hospital. Oocyte vitrification had different purposes: banking for poor responders, to limit the number of embryos, and to solve unexpected situations where partner’s semen sample was unavailable. Patients were divided into three groups according to their age at retrieval (Group A ≤ 37 n = 77, Group B 37-40 n = 44, Group C ≥ 40 n = 45). Post-warming survival, fertilization, and embryological data were studied. Participants/materials, setting, methods 1233 oocytes were thawed. The intact oocytes were microinjected 1-2 hours after warming. Embryos were cultured in Sage 1-StepTM to blastocyst stage, and rated on daily basis. Embryo transfer was performed on day 3 or day 5 and remaining blastocysts were frozen on Day 5 or Day 6. Post warming survival, lysis after ICSI, fertilization, embryo development, blastulation rate (BR) and top blastulation rate (TBR), and morphokinetic features were studied in the 3 groups. Main results and the role of chance 84.6% of the 1233 oocytes (vitrified in a high-security closed system) survived the warming process. 1043 eggs were injected and the post-ICSI lysis rate was 11.2%. No significant differences were seen in thawing survival rate in groups A, B and C (85.6% vs. 83.5% vs. 83.8%, p=0.635) nor in the post-ICSI lysis rate (13.1% vs. 7.4% vs. 11.2%, p=0.072). 2PN fertilization rate was similar between the groups (67.8% vs. 61.3% vs. 67.7%, p=0.178) as well as the total number of embryos (303 vs 146 vs 188 p=0.605). However, triploid fertilization rate (3PN) statistically grew with age (2.8% vs. 5.8% vs. 6.5%, p=0.034). Significant differences were also reported in the global abnormal fertilisation rate (1PN+3PN) (6.4% vs 10.3% vs. 13.3%, p= 0.005). BR and TBR were statistically lower after the age of 40 (BR: 61.5% vs. 62.7% vs 40% p&amp;lt;0.001, TBR: 43.3% vs. 47.9% vs. 24.3% p&amp;lt;0.001). Morphokinetic features in the 3 groups were studied (abnormal cleavage pattern, tSB and tB). Overall results were similar between group A and group B but oocyte potential decreases drastically from the age of 40. Limitations, reasons for caution The major limitation of the study is its retrospective nature and the relative small size of each group. As most of patients were transferred during 2023, the pregnancies have not delivered yet so the live birth rate is not mentioned. Wider implications of the findings Studies have reported the impact of age at oocyte retrieval in case of medical FP in cancer and endometriosis. Here we report a negative effect on outcome after the age of 40 in non-medical FP. Patients should be informed that FP is not a certification of a successful outcome. Trial registration number not applicable

Retrospective Study of Survival Outcome of Primary Debulking Surgery vs Neoadjuvant Chemotherapy for Advanced Epithelial Ovarian Cancer in Ain Shams University Hospitals Patients

Abstract Background Role of Neoadjuvant chemotherapy in advanced Epithelial Ovarian cancer is evolving, but primary debulking surgery is still the main treatment approach. Aim and Objectives to investigate weather neoadjuvant chemotherapy followed by interval debulking surgery is equal or superior to primary debulking surgery in terms of progression free survival and overall survival in patients with advanced epithelial ovarian cancer. Subjects and Methods we conducted a retrospective study of 50 patients identified with epithelial ovarian cancer stages III &amp;IV in Ain Shams University Hospital from January 2017 to December 2018, and stratified into two treatment groups 1st group was for patients who underwent primary debulking surgery followed by adjuvant chemotherapy, 2nd group was for patients who received neoadjuvant chemotherapy followed by interval debulking surgery, And followed them up to 3 years. Results out of 50 patients included in the study 36 patients (72%) underwent PDS followed by adjuvant chemotherapy, while 14 patients (28%) received neoadjuvant chemotherapy followed by IDS, among the PDS group, the median PFS time in months was 18 month, 95% CI(13.2-22.7) and for neoadjuvant chemotherapy group was 25 month 95% CI (16-52), this difference was not statistically significant, Log Rank test. P value = 0.373, the three year progression free survival was 32% among the studied population, and rates were, respectively, 27.8% and 42.9% in primary debulking and neoadjuvant group. Among primary debulking group the mean survival time in months was 32.6 month, 95% CI(30.2-34.7) and for neoadjuvant chemotherapy group was 30.26 month 95% CI (25.28-35.25), this difference was not statistically significant, Log Rank test. P value = 0.0.768. The three year overall survival rate among the studied group was 74.4%, and rates were, respectively, 75% and 73.3% in PDS and NAC group. Out of all sociodemographic and clinical characteristics of the patients included, Our study demonstrated 2 independent prognostic factors which are optimal debulking surgery and surprisingly positive family history. Conclusion our study demonstrated that neoadjuvant chemotherapy followed by interval debulking surgery provides equal survival compared with primary debulking surgery followed by adjuvant chemotherapy, NAC is a very considerable option to treat advanced EOC for selected cases in which surgery is infeasible or has very high risk morbidity and mortality.

946 Soft Tissue Sarcoma Survival Analysis and Evaluation of Management Options in Wales: A 3-Year Retrospective Single-Centre Analysis

Abstract Aim Soft tissue sarcomas (STS) are a rare group of mesenchymal neoplasm with great heterogeneity in their histologic subtype, anatomy, natural biological behaviour, and prognosis. The aim of this project is to evaluate the need of early detection and review the prognostic factors contributing to the overall STS survival outcome among patients who were under the care of the Welsh Sarcoma Service over a three-year period. Method Patients are selected from the Morriston Hospital sarcoma database from March 2019 to March 2022. Demographic data, tumour grade, histological subtype, performance status, treatment type, operative details and outcomes were recorded. Results 159 patients with a diagnosis of STS were selected from the database. The median overall survival was 2.19 years; with a 23.9% of mortality rate in the first-year post diagnosis and 10.8% in the third-year post diagnosis. Of all factors evaluated, grading (p = 0.008), performance status (p &amp;lt;0.001), treatment types (p= &amp;lt;0.001) and site of cancer recurrence (p = 0.024) resulted statistically significant. Metastatic development has a significant increased risk of death by 2.5-fold compared to those without recurrence. Conclusions This study evaluates the management of STS at a single centre over three years and summarises the significant prognostic factors contributing to the overall survival rate. Analysis further highlights development of metastasis carry a poorer prognosis. Hence, the importance of early detection and treatment within the first year of diagnosis should not be overlooked.

1195 The Outcomes of Liver Resection for Metastatic Liver Disease from Melanoma: A Systematic Review and Meta-Analysis

Abstract Aim There remains controversy in the literature regarding the choice of treatment of melanoma metastases to the liver. This systematic review aims to compare the survival and morbidity rates of patients undergoing liver metastasectomy with patients undergoing medical treatment. Method A literature search was conducted from inception until June 2022 using Ovid, Medline, Embase and the Cochrane library. Snowball and hand searches were also carried out. Included studies compared survival outcomes between patients undergoing metastasectomy to those undergoing medical management. Meta-analyses were performed comparing the survival at 6 months, 1, 3 and 5 years as well as overall survival. A sub-analysis was performed comparing the overall survival between surgically and medically treated patients which exclusively uveal melanoma hepatic metastases. Results 25 studies with a total of 2990 participants were included in our study. All studies were found to have some degree of risk of bias. Mean Overall survival was 44.31 (SD 46.25) and 21.59 (SD 24.31) in surgically and medically treated patients respectively. Meta-analysis showed a statistically significant benefit overall in favour of surgically treated patients (OR = 1.33, 95% CI 0.29 to 2.3, p =0.01, I²=0). This was also the case at 6 months, 1, 3 and 5 years. Meta-analysis showed no significant differences in survival between surgically and medically treated patients which exclusively uveal melanoma metastases. Conclusions This review demonstrates improved survival in patients undergoing hepatic metastatectomy for melanoma metastases compared to those undergoing medical treatment, but this may not be the case for those with uveal metastases.

Impact of long-term exposure to ambient particulate matter and nitrogen dioxide on chronic obstructive pulmonary disease: results from the Women’s Health Initiative cohort

Abstract Rationale:&amp;#xD;Although COPD prevalence and exacerbations have been linked to ambient pollutants, evidence on the impact of ambient pollutants on COPD incidence is relatively sparse.&amp;#xD;Objectives:&amp;#xD;To evaluate the associations of long-term ambient particulate matter (PM2.5; PM10), nitrogen dioxide (NO2), and incident self-reported COPD in the Women’s Health Initiative (WHI), a large prospective cohort study of post-menopausal women across the United States.&amp;#xD;Methods:&amp;#xD;We estimated annual average residential pollutant concentrations using validated spatiotemporal models and monitored data. We estimated pollutant-COPD associations as hazard ratios (HRs) and 95% confidence intervals (CI) per inter-quartile range (IQR) increase in pollutant using time-varying Cox proportional hazards models adjusted for potential confounders including sociodemographic characteristics, lifestyle and health factors, and WHI Clinical Center at baseline. Finally, we assessed the joint impact of exposure to multiple pollutants using quantile-based G-computation for survival outcomes.&amp;#xD;

Acute aortic dissection during scuba diving

ABSTRACT Yanagawa Y, Ohsaka H, Yatsu S, Suwa, S. Acute aortic dissection during scuba diving. Undersea Hyperb Med. 2024 Second Quarter; 51(2):185-187. A 60-year-old man with hypertension and dyslipidemia complained of chest pain upon ascending from a maximum depth of 27 meters while diving. After reaching the shore, his chest pain persisted, and he called an ambulance. When a physician checked him on the doctor’s helicopter, his electrocardiogram (ECG) was normal, and there were no bubbles in his inferior vena cava or heart on a portable ultrasound examination. The physician still suspected that he had acute coronary syndrome instead of decompression illness; therefore, he was transported to our hospital. After arrival at the hospital, standard cardiac echography showed a flap in the ascending aorta. Immediate enhanced computed tomography revealed Stanford type A aortic dissection. The patient obtained a survival outcome after emergency surgery. To our knowledge, this is the first reported case of aortic dissection potentially associated with scuba diving. It highlights the importance of considering aortic dissection in patients with sudden-onset chest pain during physical activity. In addition, this serves as a reminder that symptoms during scuba diving are not always related to decompression. This report also suggests the usefulness of on-site ultrasound for the differential diagnosis of decompression sickness from endogenous diseases that induce chest pain. Further clinical studies of this management approach are warranted.

Surgical treatment of atrial fibrillation in elderly patients undergoing high risk cardiac surgery

BackgroundEvaluating outcomes of concurrent Cox-Maze procedures in elderly patients undergoing high-risk cardiac surgery.MehodsWe retrospectively identified patients aged over 70 years with Atrial Fibrillation (AF) from 2011 to 2017 who had two or more other cardiac procedures. They were subdivided into two groups: 1. Cox-Maze IV AF ablation. 2. No-Surgical AF treatment. A propensity match score was used to generate a homogeneous cohort and to eliminate confounding variables. Heart rhythm was assessed from Holter reports or 12-lead ECG. Follow-up data was collected through telephone consultations and medical records.ResultsThere were 239 patients. Median follow up was 61 months. 70 patients had Cox-Maze IV procedures (29.3%). Demographic, intra- and post-operative outcomes were similar between groups although duration of pre-operative AF was shorter in Cox-Maze group (p = 0.001). There was no significant 30-day mortality difference in propensity matched cohorts (n = 84. P = 0.078). Sinus rhythm at annual and latest follow-up was 84.9% and 80.0% respectively in Maze group – 160 patients (66.9%) were alive at long-term follow-up with good survival outcomes in Cox Maze group. There was a high proportion of patients in NYHA 1 status in Cox-Maze group. No differences observed in freedom from stroke (p = 0.80) or permanent pacemaker (p = 0.33) between the groups.ConclusionsSurgical ablation is beneficial in elderly patients undergoing high-risk surgery - promoting excellent long-term freedom from AF and symptomatic / prognostic benefits, without added risk. Therefore, surgical risk should not be reason to deny benefits of concomitant AF-ablation.Clinical trial registrationNot required.

217 Outcomes of Reoperation for Residual or Recurrent Obstruction After Previous Myectomy in Patients with Hypertrophic Cardiomyopathy

Abstract Aim Describe the mechanism(s) of residual or recurrent obstruction in patients who have previously undergone septal myectomy for hypertrophic cardiomyopathy and assess early outcomes of reoperation. Method From January 1989 to March 2022, we performed 73 repeat myectomies at our institution. Patients’ demographics, operative details, echocardiographic parameters, and postoperative complications were retrieved from a prospectively maintained surgical database and electronic healthrecords. Results Median age at reoperation was 48.3 years (IQR 38.6-58.6); 51 patients were women (69.9%). 90.4% presented with NYHA class III/IV symptoms. Median interval between previous myectomy and reoperation was 2.7 years (IQR 1.2-4.5). Mechanism of obstruction was an inadequate length of previous septectomy in 41 patients (56.2%), a combination of inadequate length and midventricular obstruction in 30 (41.1%), and isolated midventricular obstruction in 2 patients (2.7%). There were no instances of recurrent LVOT obstruction due to muscle regrowth at the site of previous resection. All patients had an extended transaortic septal myectomy; 14 patients (19.2%) had concomitant transapical myectomy. Preoperatively, the median LVOT gradient was 83 mmHg (IQR 60-122), which reduced to 2 mmHg (IQR 0-7) following repeat myectomy. There were no perioperative deaths. Postoperatively, 4 patients (5.5%) developed a new CHB, necessitating PPM implantation. The 5-,10-, and 20-year survival after reoperation were 100%, 91%, and 76%, respectively. Conclusions Inadequate resection at the time of primary septal myectomy is the commonest cause of residual or recurrent obstruction in oHCM patients. However, repeat myectomy, including a combined transaortic and transapical approach has minimal risk with excellent hemodynamic and long-term survival outcomes.

VRAM Versus ALT Flap Reconstruction for Large Head and Neck Defects: Does Weight Influence Complication Rate?

Background: Obesity remains a high-level risk factor for various cancers. Yet, some research has shown that higher BMIs may improve survival outcomes, particularly for head and neck squamous cell carcinoma (HNSCC). While this is a clear deviation from the norm, it raises the question of what other effects obesity may have on head and neck cancer patients, including surgical outcomes. Choosing the most appropriate flap for patients can be difficult for even experienced surgeons. Head and neck reconstructive surgeries are no exception to this rule and can be especially challenging. To produce the most favorable outcomes, a physician must be able to combine all flap attributes including donor and recipient site location, flap thickness, as well as each patient’s individual risk factors such as prior radiation. Purpose: The purpose of this study was to compare the outcomes of vertical rectus femoris myocutaneous (VRAM) and anterolateral thigh (ALT) flaps in overweight and obese individuals with varying head and neck cancers leaving large-sized defects to the outcomes in normal and underweight patients. Methods: A retrospective chart review was conducted of VRAM and ALT flaps performed over a period of 12 months at our university hospital for large head and neck reconstruction. Results: Of the 17 ALT patients, 80% (4/5) of the underweight patients, 57% (4/7) of the normal weight patients, 50% (1/2) of the overweight patients, and 33% (1/3) of the obese patients experienced complications. Of the 15 VRAM patients, 40% (2/5) of the underweight patients, 83% (5/6) of the overweight patients, and 50% (1/2) of the obese patients experienced complications. Conclusions: In our small sample size, a smaller percentage of obese patients with head and neck cancer who underwent flap reconstruction surgery had complications when undergoing ALT flaps than VRAM flaps, which contrasts with the normal and underweight patients, who had less complications with VRAM flaps than ALT flaps.