Estimated Survival Rates Research Articles

Surgical outcomes of complete atrioventricular septal defect repair in children at the Cardiovascular Center, E Hospital

Objective: To evaluate the outcomes of complete atrioventricular septal defect repair in children at the Cardiovascular Center, E Hospital Methods: An observation study was conducted on 45 patients ≤15 years old diagnosed and surgically treated for complete atrioventricular septal defect at E Hospital from January 2017 to May 2024. Results: Among a total of 45 participants, the mortality and rate of terminal discharge was 6,7% (3 patients), with one patient (2,2%) requiring a second surgery to repair the mitral valve. The most common complications were infections (62.2%) and low cardiac output syndrome (22.2%), with pacemaker implantation in 1 patient (2,2%). Postoperative echocardiography showed residual ventricular septal defect in 45.2% of patients. After 3-6 months of follow-up, 36 patients were evaluated. Among them, 2 patients required a second surgery for mitral valve repair and 4 patients died or were terminal discharged due to severe respiratory failure or pneumonia. The residual ventricular septal defect rate decreased to 8.3%. Analysis showed that patients who died or terminal discharged had significantly longer mechanical ventilation post-surgery time, intensive care time, higher VIS in the first 24 hours, presence of low cardiac output syndrome, acute kidney failure and use of peritoneal dialysis during post-operative care compared to the control group (p < 0.05). The estimated survival rates at 6, 12, and 36 months were 88.9%, 86.7%, and 84.4% respectively, with a mortality rate of 0.51/100 patient-years, showing no significant difference in outcomes between patients aged ≤6 months and those older than 6 months (p=0.09). Conclusion: Complete atrioventricular septal defect repair at E Hospital shows promising results with low mortality rate. However, the rates of complications and residual lesions remain high, requiring active post-operative monitoring and management.

Current Knowledge on Breast Implant-Associated Anaplastic Large Cell Lymphoma: Evidence from Italian Ministry of Health Registry Data.

Accurate estimation of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) incidence is crucial for assessing breast-implant-associated risk. However, the size of the implanted population worldwide is unknown, making it challenging to appropriately estimate this figure. This study aims to provide a new reliable and reproducible method to estimate the breast-implanted-population (BIP), reporting a reliable annual BIA-ALCL incidence estimate. Moreover, we discuss all activities performed over the past decade in collecting complete histories, managing, and monitoring outcomes of each Italian case. Data from the National Breast Implant Registry and from manufacturers have been used to define a new formula to estimate the BIP at risk of developing a breast-implant-related event. From the BIA-ALCL registry, complete information on Italian cases has been collected and analysed. Overall survival is estimated by the Kaplan-Meier curve. From 2010 to June 2024, 111 BIA-ALCL cases were recorded in Italy. The estimated incidence rate showed an upward trend, ranging from 2.68 to 6.35 cases per 100,000 patient-years. Thanks to newly promoted disease awareness, most patients had a complete response to treatment, resulting in a three-year overall survival rate estimate of 98.2%. The BIP formula showed to be an innovative, effective and reproducible tool to make a reliable estimation of the implanted population, confirming that BIA-ALCL is a rare disease with an incidence rate estimate varying from 2.7 to 6.3 cases/100.000 patient-years in the last five years. Eleven-year experience in this field also confirmed that this disease has a favorable prognosis if properly treated. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Estimation of demographics of self-sustaining groups of pied flycatcher <i>Ficedula hypoleuca</i> (Passeriformes: Muscipapidae) taking into account the long-term dynamics of the population breeding in the Tomsk oblast (Western Siberia)

We present the main demographic parameters of the Western Siberian pied flycatcher population, nesting in natural habitats, at different stages of population dynamics. The average values, range, boundaries, and direction of changes in the survival of sexually mature individuals, fecundity, and the encounter probability at different ages were analyzed. Using matrix models of population structure and population dynamics, an estimate of the true survival rate of fledglings is given. The range of values of demographic parameters that characterize viable groups of the studied bird species is indicated.

Updated overall survival and ctDNA analysis in patients with EGFR T790M-positive advanced non-small cell lung cancer treated with lazertinib in the phase 1/2 LASER201 study.

Lazertinib is a potent, irreversible, third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) with significant efficacy in patients with EGFR T790M-mutated non-small cell lung cancer (NSCLC). This is the final overall survival (OS) report from the phase 1/2 LASER201 study in patients with advanced NSCLC with disease progression on or after prior EGFR TKI therapy. Eligible patients were aged ≥ 20years, with advanced EGFR-mutated NSCLC and previous therapy with EGFR TKI. Patients in this integrated analysis received oral lazertinib 240mg/day. Endpoints included efficacy and safety; exploratory analyses included associations between circulating EGFR-mutant tumor DNA (ctDNA) and efficacy parameters. This integrated analysis included 78 patients in Korea who received second- or later-line lazertinib. The median OS was 38.9months; estimated survival rates at 12, 24, and 36months were 89.5%, 73.9%, and 52.8%, respectively. The cumulative 12-month incidence of central nervous system progression was 9.4%. EGFR-mutant ctDNA was detected in 46 patients (62.2%) at baseline. The presence of ctDNA at baseline significantly predicted progression-free survival (PFS), disease control rate (DCR), and OS. PFS, response rate, and DCR were significantly associated with EGFR-mutant ctDNA clearance at cycle 3; PFS and OS were significantly associated with ctDNA clearance at cycle 5. The safety profile of lazertinib 240mg/day was consistent with previous findings. Lazertinib is a promising treatment option for patients with EGFR T790M-positive NSCLC following disease progression on prior EGFR-directed TKIs. Patients in LASER201 experienced prolonged OS, regardless of their EGFR mutation, brain metastases, or prior brain radiation status. Clearance of plasma EGFR mutations after lazertinib was associated with patient outcomes. ClinicalTrials.gov identifier NCT03046992.

Outcomes of partial pulpotomy in permanent molars of children with irreversible pulpitis: A prospective cohort study.

Vital pulp therapy is gaining traction in dental practice, especially for young patients. To evaluate the outcomes of partial pulpotomy in permanent molars of children diagnosed with irreversible pulpitis (IP) using iRoot BP Plus. A total of 94 permanent molars in 88 patients, aged 6-15 years, with symptoms of IP, were treated with partial pulpotomy, using iRoot BP Plus as the pulp capping agent. The treated teeth underwent clinical and radiographic assessments at 1, 6, 12, 18, and 24 months postoperative. The outcomes were determined based on clinical and radiographic criteria by calibrated examiners. The success rates were 98.4% (63/64), 93.2% (41/44), and 89.7% (26/29) at the 6-month, 12-month, and 24-month follow-up. By the end of this study, the median follow-up period was 15.1 months, and the estimated survival rate was 95.2% at 24 months. Gender, root maturity, and number of missing walls had no significant effect on success rates. Six molars were failed, and root canal therapy (RCT) was applied. Partial pulpotomy for permanent molars with IP in young patients using iRoot BP Plus as pulp capping material achieved high success. This method presents a viable alternative to apexification and RCT for treating vital, inflamed molars with IP in children.

Use of capture–recapture models to evaluate abundance and dynamics of a stocked Muskellunge population

AbstractTo evaluate the success of a stocking program in Fox Lake, Minnesota, adult (≥76 cm total length) Muskellunge were captured with large nearshore trap nets and individually marked with passive integrated transponder tags during the 2011–2013 and 2015–2017 spawning seasons; then, capture–recapture data were analyzed at two different time scales. Despite substantial sampling effort, daily capture histories within a single season only supported closed‐population abundance estimates for both sexes in half the years; estimates were imprecise, and there was evidence of trap shyness or violation of the short‐term closure assumption in some years. Jolly–Seber models over all years supported relatively precise abundance estimates for both sexes every year, as well as estimates of annual survival, recruitment, and population growth rate. Link–Barker Jolly–Seber models provided estimates of population growth rate λ ≈ 1 indicating that per‐capita annual recruitment rates of only about 0.15–0.20 were adequate to maintain the adult population given the high annual apparent survival rates of 0.80 for adult females and 0.89 for adult males. POPAN Jolly–Seber models revealed that about 80 adult females and 90–126 adult males were vulnerable to capture each year in the 385 ha lake, and about 16–18 fish of each sex recruited to the adult population annually. This study illustrates the importance of open‐population models with multiple years of data to evaluate the abundance and population dynamics of a low‐density, long‐lived species.

Outcomes of thoracic endovascular aortic repair with fenestrated surgeon-modified stent-grafts for type B aortic dissection involving the aortic arch: a multicenter retrospective study.

Thoracic endovascular aortic repair (TEVAR) with fenestrated surgeon-modified stent-grafts (f-SMSGs) is becoming an option for treating type B aortic dissection (TBAD) involving the aortic arch. This study aimed to evaluate the outcomes of this technique. A retrospective multicenter study was conducted, involving consecutive patients from three medical centers in China who underwent TEVAR with f-SMSG for TBAD. A new technique called "Lu's direction-turnover technique" was employed to align the fenestrations with supra-aortic vessels. From March 2016 to January 2020, 117 patients diagnosed with TBAD were deemed eligible for inclusion. The technical success rate was 94% (n=110). The estimated 30-day survival rate was 97.4% [95% confidence interval (CI): 94.5% to 100.0%], with freedom from re-intervention estimated at 95.7% (95% CI: 92.0% to 99.4%). The median follow-up period was 27 months (interquartile range, 19 to 35 months). The estimated survival rate at 27 months was 94.9% (95% CI: 90.8% to 98.9%) and the rate of freedom from re-intervention was 91.5% (95% CI: 86.3% to 96.6%). Cases of retrograde type A aortic dissection, stroke and endoleaks were documented. Five cases of retrograde type A aortic dissection were documented, with three occurring within 30 days and one during the follow-up. Four cases of stroke were recorded, with one occurring within 30 days and three during the follow-up. Furthermore, eleven cases of endoleaks were recorded, with one occurring within 30 days and ten during the follow-up. Clinically acceptable technical success and prognosis were observed in a cohort with TEVAR with f-SMSG for the treatment of TBAD involving the aortic arch, which necessitated revascularization of the supra-aortic vessels. Further comparative studies are required to validate the benefits of this approach.

Survival and complication rates of tooth- and implant-supported restorations after an observation period up to 36 years.

Tooth- and implant-supported fixed dental prostheses are well-documented and aesthetic treatment alternatives, and after a comprehensive periodontal treatment, a protocol with a good long-term prognosis if the maintenance program is strictly followed. To reexamine a pre-existing patient cohort in order to obtain estimated long-term survival and complication outcomes of fixed dental prostheses. For this study, patients treated with fixed dental prostheses between 1978 and 2002 were reexamined between 2019 and 2020. The restorations were divided in single crowns and fixed dental prostheses supported by teeth (TSC, FPTDP) and implants (ISC, FPIDP). Survival and complication rates were obtained. Kaplan-Meier functions were used to model complication probabilities, and average hazard ratios of different strata were compared using weighted Cox regression. The mean observation time of 40 patients and 223 reconstructions was 20.3 (±9.7, 1.2-36.2) years. The estimated survival rates were 84% (CI: 77%-92%) for TSC, 63% (CI: 51%-79%) for FPTDP, 87% (CI: 71%-100%) for ISC, and 64% (CI: 34%-100%) for FPIDP after 25 years. Biological complications included carious lesions (10.6%), periodontitis (7.9%), and peri-implantitis (6.8%). Technical complications included chipping (20.2%) and loss of retention (10.8%). Biological complications lead to abutment loss in more than two-thirds of cases, regardless of the type of abutment (tooth or implant). Technical complications are less associated with abutment loss than biological complications.

Anterior cruciate ligament repair using dynamic intraligamentary stabilization grants 88.5% survival at minimum follow-up of 5 years.

The aim of this study was to report on the revision rates and clinical outcomes following dynamic intraligamentary stabilization (DIS) at a minimum follow-up of 5 years and to investigate which preoperative or intraoperative characteristics could influence revision rates or clinical scores. The authors retrospectively assessed all 609 knees that underwent ACL repair using DIS at a single centre. At a minimum follow-up of 5 years, patients were assessed using the Lysholm, International Knee Documentation Committee (IKDC) and Tegner scores, as well as passive flexion and extension. At a follow-up of 5.1 ± 0.3 years (range, 5-10), of the 609 patients, 428 patients were available for clinical assessment. Anterior tibial translation decreased from 9.7 ± 2.1 to 7.8 ± 1.9 mm, and side-to-side difference decreased from 4.3 ± 2.3 to 1.5 ± 1.8 mm. The postoperative Lysholm score was 96.9 ± 5.6, subjective IKDC was 95.6 ± 6.1 and Tegner scores ranged from 4 to 11, of which 51% of patients had a score of 7 or more. The estimated survival rate was 86% for the first half of the cohort and increased to 91% for the second half of the cohort. At a minimum follow-up of 5 years following ACL repair using DIS, it was found that it grants satisfactory clinical outcomes and that surgeons should inform patients who have predispositions about the higher risk of revision. Level IV retrospective study.

Paraneoplastic Syndrome Prevalence and Survival in Racially-Diverse Cohort With Renal Cell Carcinoma

IntroductionThe prevalence of preoperative paraneoplastic syndromes (PNS) in renal cell carcinoma (RCC) is poorly understood. Many laboratory abnormalities representative of PNS have demonstrated prognostic value when incorporated into predictive survival models in RCC. We sought to characterize the relationship between baseline prevalence of PNS with overall survival (OS) and cancer-specific survival (CSS) in RCC patients following nephrectomy. MethodsOur prospectively maintained nephrectomy database was retrospectively reviewed for any stage, major histology RCC patients that underwent surgery from 2000 to 2022. Baseline laboratory values within 90 days (closest used) were required. Presence of PNS was defined according to established laboratory cutoffs. Kaplan-Meier curves estimated survival rates, and multivariable Cox proportional hazards models examined the association between PNS with OS and CSS following nephrectomy. Results2599 patients were included with listed staging: 1494 Stage I; 180 Stage II; 616 Stage III; 306 Stage IV. Proportion of patients presenting with >1 PNS significantly increased from stage I (31.3%) to stage IV (74.2%) RCC (P < .001). Elevated C-reactive protein was the most prevalent PNS (45.4%). On multivariable analysis, the presence of >1 PNS was associated with higher risk of all-cause (HR 2.09; P < .001) and cancer-specific mortality (HR 2.55; P < .001). The 10-year OS estimates as reported: 65.2% (no PNS), 52.3% (1 PNS), 36.6% (>1 PNS); and 10-year CSS estimates: 88.3% (no PNS), 79.3% (1 PNS), 61.6% (>1 PNS). DiscussionIncreased prevalence of PNS in major histology RCC was associated with a significant increase in the risk of all-cause and cancer-specific mortality even when accounting for patient and disease characteristics.

Analysis of the causes of neonatal death and genetic variations in congenital anomalies: a multi-center study.

Neonatal deaths often result from preventable conditions that can be addressed with appropriate interventions. This study aims to analyze the distribution of the causes of neonatal death and explore genetic variations that lead to congenital anomalies in Northwest China. This multi-center observational study was conducted across six medical centers in Shaanxi province, Northwest China. Clinical data were retrospectively collected from neonates admitted between 2016 and 2020. Kaplan-Meier analysis was utilized to estimate survival rates, while high-throughput sequencing platforms were employed to detect mutations causing congenital anomalies. Among 73,967 neonates requiring hospital care, 424 neonatal deaths were recorded, leading to a neonatal mortality rate of 0.57%. The primary causes of death included neonatal respiratory distress syndrome (23.8%), birth asphyxia (19.8%), neonatal septicemia (19.3%), and congenital anomalies (13.6%). The leading causes of neonatal deaths due to congenital anomalies were congenital heart defects (38.6%), bronchopulmonary dysplasia (14.0%), and inherited metabolic disorders (10.5%). Genetic analysis identified 83 pathogenic or likely pathogenic variants in 23 genes among the neonates with congenital anomalies, including four novel mutations (c.4198+1G>T, c.1075delG, c.610-1G>A, c.7769C>T) in the ABCC8, CDKL5, PLA2G6, and NIPBL genes. Congenital anomalies represent a significant and preventable cause of neonatal deaths in Northwest China. Early detection of congenital anomalies through genetic testing and comprehensive prenatal care are crucial for reducing neonatal mortality rates and improving pregnancy outcomes.

Harvest of transboundary grey wolves from Yellowstone National Park is largely additive

Abstract Large carnivores are globally threatened due to habitat fragmentation and loss, prey depletion and human exploitation. Human exploitation includes both legal and illegal hunting and trapping. Protected areas can create refugia from hunting and trapping; however, hunting can still threaten wide‐ranging large carnivores when they leave these areas. Large carnivore reintroductions to protected areas are often motivated to restore ecological processes, including wolf reintroduction to Yellowstone National Park (YNP). Determining if harvest is compensatory or additive is essential for informed conservation strategies, as it influences the overall impact on wolf populations and their ecosystems. If harvest was compensatory, then increasing harvest pressure outside YNP should not decrease overall survival for transboundary wolves. Alternatively, if increasing harvest was additive, then increasing harvest pressure outside YNP should decrease overall survival for transboundary wolves. We tested the effects of variable harvest pressure following delisting on the survival of YNP grey wolves (Canis lupus) from 1995 to 2022. We defined three harvest levels: no harvest, harvest with limited quotas and unlimited harvest. We used Cox‐proportional hazards models and cumulative incidence functions to estimate survival rates, factors affecting survival and cause‐specific mortality between these three harvest periods to test predictions of the additive mortality hypothesis. Most harvested wolves that primarily lived in YNP were killed adjacent to the park border. Cox‐proportional hazards models revealed that mortality was highest during years of unlimited harvest during winter outside YNP. Cause‐specific mortality analyses showed that natural mortality from other wolves and harvest were the two leading causes of death, but that harvest mortality had additive effects on wolf mortality. Wolf survival decreased with increased harvest mortality, while natural mortality remained relatively unchanged. Synthesis and applications. High rates of additive harvest mortality of wolves could negatively impact wolf survival in YNP. Harvest mortality of transboundary wolves is additive possibly due to source‐sink dynamics of uneven spatial susceptibility of wolves to harvest mortality across protected area borders, as well as effects of harvest on complex social dynamics of wolves in YNP. Transboundary management of large carnivores is challenging, yet cooperation between agencies is vital for wolf management in and around YNP. Our results support the use of small quota zones surrounding protected areas, that minimize transboundary mortality impacts on large carnivores living primarily inside protected areas.

Performance of Bonded Lithium Disilicate Partial-coverage Crowns in the Restoration of Endodontically Treated Posterior Teeth: An Up to Seven-Year Retrospective Study.

To evaluate the clinical performance of adhesively bonded lithium disilicate glass-ceramic (LDG) partial-coverage crowns in restoring posterior endodontically treated teeth (ETT). A total of 121 morphologically compromised posterior ETT were restored with LDG partial-coverage crowns between October 2015 and January 2018. The restorations were fabricated in the laboratory or at the chairside. Two adhesive systems and resin cements were used to cement the restorations. Tooth and restoration survival rates were calculated. The restorations were evaluated clinically using the modified United States Public Health Service (USPHS) criteria for an observation period of 5-7 years. The Cox proportional hazards model was used to estimate relative failure risks such as tooth type, resin cements, gender, and sleep bruxism. The standard chi-squared test was used to compare the survival of different tooth types for significant differences (α=0.05). In addition, survival probability was calculated using the Kaplan-Meier algorithm. Among seven failed cases, one was a tooth fracture, and six were restoration fractures. According to the Kaplan-Meier analysis, the estimated survival rate of the teeth was 99% for seven years, while the estimated survival rate of the restorations was 94.8% for 5 years and 92.8% for 7 years. Tooth type and resin cements did not influence restoration survival rates (p>0.05), while sleep bruxism and male patients might increase the risk of failure (p<0.05). The indirect adhesively bonded LDG partial-coverage crowns of posterior ETT exhibited favorable clinical outcomes. Ceramic fracture was the most common failure pattern.

Endograft Thrombosis as an Indication for Open Conversion after Endovascular Aneurysm Repair in a Multicenter Experience over 25 Years

To describe the outcomes of aortic endograft thrombosis (AET) as an indication for open conversion (OC) after endovascular aortic aneurysm repair (EVAR) in a multicenter experience. This study retrospectively analyzed cases of OC for AET following EVAR across 12 Italian Vascular Surgery centers from 1997 to September 2022. The end points were as follows: 30-day mortality and major postoperative complications. Follow-up data included survival and aortic-related complications. Sixteen patients (mean age: 68.6±8.5years) were included. The median elapsed time between EVAR and OC was 26.46months (interquartile range: 13.8-45.9). Proximal aortic cross-clamping site was supraceliac in 8 out of 16 (50%) patients, and complete removal of the stentgraft was achieved in 75% of cases (12/16 patients). Reconstructions were aorto-bi-iliac grafts in 8 cases (50%), 7 aortobifemoral bypass grafts (43.8%), and 1 aortoaortic tube graft (6.3%). All patients were symptomatic at presentation (68.7% unilateral acute limb ischemia, 25% bilateral acute limb ischemia, 1 patient had chronic severe claudication). Thirty-day mortality was 12.5% (2/16 patients). The overall morbidity rate was 43.8% (7 of 16 patients). No specific risk factors for early mortality were found. The overall estimated survival rate was 80.4% at 1year, 62.5% at 2years, and 41.7% at 3years. OC for AET is typically reserved for complex cases that are not amenable to endovascular solutions. The frequent need for suprarenal clamping and complete endograft removal seems to be associated with high short-term mortality.

Impact of High-Voltage Device Implantation in Elderly Japanese Patients With Heart Failure as Primary Prevention - Post Hoc Analysis of HINODE.

Despite an increased incidence of chronic heart failure (HF) and sudden cardiac death (SCD), the use of implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy (CRT) is much lower in Japan than in Western countries. The HF Indication and SCD Prevention Trial Japan (HINODE) prospectively assessed the mortality rate, appropriately treated ventricular arrhythmias (VA), and HF in Japanese patients with a higher risk of HF.Methods and Results: HINODE consisted of ICD, CRT-defibrillator (CRT-D), pacing, and non-device treatment cohorts. This subanalysis evaluated the impact of the implantation of high-voltage devices (HVD; ICD and CRT-D) in 171 Japanese patients. We compared all-cause mortality, VA, and HF events between elderly (age >70 years at study enrollment) and non-elderly HVD recipients. The estimated survival rate through 24 months in the HVD cohort was 85.8% (97.5% lower control limit 77.6%). The risk of all-cause mortality was increased for the elderly vs. non-elderly (hazard ratio [HR] 2.82; 95% confidence interval [CI] 1.01-7.91; P=0.039), but did not differ after excluding ICD patients with CRT-D indication (HR 2.32; 95% CI 0.79-6.78; P=0.11). There were no differences in VA and HF event-free rates between elderly and non-elderly HVD recipients (P=0.73 and P=0.55, respectively). Although elderly patients may have a higher risk of mortality in general, the benefit of HVD therapy in this group is comparable to that in non-elderly patients.

Socioeconomic and demographic factors in multifocal superficial basal cell carcinoma: An NCDB analysis.

e21576 Background: Multifocal superficial basal cell carcinoma (SBCC) is an uncommon clinical type of basal cell carcinoma (BCC). Usually located in the papillary dermis, it is characterized by superficial basaloid cell lobules infiltrating the dermis. This carcinoma has historically been reported to have a preference for the chest and shoulders, however, this NCDB analysis shows that the cancers reported under this code (8091) primarily appear on the vulva or scrotum. Though without significant morbidity, this lesion must be correctly identified and treated either surgically or non-invasively to achieve the best outcomes. By exploring the demographic factors of SBCC on the National Cancer Database (NCDB), important insight can be gained into its epidemiology and diagnostics, and ensure more uniform reporting of this cancer. Methods: Using retrospective cohort analysis on histologically-confirmed cases of SBCC (ICD-O-3 Code 8091) in the 2004-2020 National Cancer Database (NCDB), demographic factors such as age, sex, race, Hispanic status, insurance status, facility type, and Charlson-Deyo score were descriptively analyzed. Regression analysis was used to explore diagnostic trends of multifocal SBCC. Results: A total of 51 patients were identified in the NCDB with a diagnosis of multifocal superficial basal cell carcinoma between 2004 and 2020, and the frequency of diagnosis remained relatively constant with a rate of -0.14 (R2 = 0.11). The average age of diagnosis is 73.4 years (SD = 12.1, range = 32 - 90 years). Of the 51 patients diagnosed with multifocal superficial basal cell carcinoma, the majority were female (96%) and white (94%). The primary site of the neoplasm was the vulva in 100% of females and the scrotum in 100% of males. 50 patients underwent surgical excision at the primary site of the neoplasm, with a majority (86%) having successful excision with no residual tumor. From the data collected, 100% of patients survived after 30 and 90 days of surgery. The 2, 5, and 10-year estimated survival rates were 94%, 87%, and 57% respectively. The average survival was 11.17 years (95% CI of 9.51 - 12.84). 88% of patients had a Charles-Deyo score of 0. The patient’s primary payor at diagnosis was Medicare (73%). For valid patients, the most common treatment facilities were comprehensive community cancer programs (45%). Conclusions: This NCDB analysis helps to address the knowledge gap for multifocal SBCC with information about survival and socioeconomic data that further differentiate this diagnosis from classical BCC, and previous descriptions of multifocal SBCC. Most patients diagnosed with multifocal SBCC are white females with neoplasm of the vulva, which differs from previous reporting of the chest and shoulders as the most common site of multifocal SBCC. In light of this NCDB analysis, further research is needed to help elucidate the impact of socioeconomic factors on diagnosis in this patient population.

Pulmonary vascular resistance predicts the mortality in patients with bronchiectasis-associated pulmonary hypertension.

Pulmonary hypertension is a severe complication of bronchiectasis, characterized by elevated pulmonary vascular resistance (PVR) and subsequent right heart failure. The association between PVR and mortality in bronchiectasis-associated pulmonary hypertension has not been investigated previously. In the present study, a retrospective analysis was conducted on 139 consecutive patients diagnosed with bronchiectasis-associated pulmonary hypertension based on right heart catheterization, enrolled between January 2010 and June 2023. Baseline clinical characteristics and hemodynamic assessment were analyzed. The survival time for each patient was calculated in months from the date of diagnosis until the date of death or, if the patient was still alive, until their last visit. Patients with bronchiectasis-associated pulmonary hypertension exhibited estimated survival rates of 89.5, 70, and 52.9 at 1-year, 3-year, and 5-year intervals respectively, with a median survival time of 67 months. Multivariable Cox regression analysis revealed that increased age [(adjusted hazard ratio per year 1.042, 95% confidence interval (CI) 1.008-1.076, P = 0.015] and elevated PVR (adjusted HR per 1 Wood Units 1.115, 95% CI 1.015-1.224, P = 0.023) were associated with an increased risk of all-cause mortality. In contrast, higher BMI was associated with a decreased risk of all-cause death (adjusted hazard ratio per 1 kg/m 2 0.915, 95% CI 0.856-0.979, P = 0.009). Receiver-operating characteristic analyses identified a cutoff value for PVR at 4 Wood Units as predictive for all-cause death within 3 years [area under the curve (AUC) = 0.624; specificity= 87.5%; sensitivity= 35.8%; P < 0.05]. Patients with a PVR greater than 4 Wood Units had a significantly higher risk of all-cause death compared with those with 4 Wood Units or less (adjusted hazard ratio 2.392; 95% CI 1.316-4.349; P = 0.019). Notably, there were no significant differences in age, sex, BMI, WHO functional class, 6-min walk distance, and NT-proBNP levels at baseline between patients categorized as having 4 Wood Units or less or greater than 4 Wood Units for PVR. Based on these data, PVR could serve as a discriminative marker for distinguishing between nonsevere pulmonary hypertension (PVR ≤ 4 Wood Units) and severe pulmonary hypertension (PVR > 4 Wood Units). The utilization of a PVR cutoff value of 4.0 Wood Units provides enhanced prognostic capabilities for predicting mortality.

The Real-World Data on Patients With Cardiac Stage IIIb AL Amyloidosis

BackgroundMorbidity and mortality of patients with immunoglobulin light chain (AL) amyloidosis are strongly associated with the severity of cardiac involvement, especial in patients with cardiac stage IIIb, but the real-world data on these patients is still limited. Patients and MethodsA retrospective analysis was conducted on 77 patients diagnosed with cardiac stage IIIb AL amyloidosis at our center. We analyzed the clinical characteristics, treatment and outcome of the patients. ResultsThe median age of patients was 57 years and 49.4% were male. Median serum N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac troponin T (cTnT) were 13,384 ng/L and 0.166 ug/L, and 42 (54.5%) patients had heart failure at diagnosis. Fifty-seven (74.0%) patients received antiplasma cell treatment, and the main treatment options include bortezomib or thalidomide combined with dexamethasone. The hematologic overall response rate was 70% (28/40), and at 6-month landmark analysis, patients with hematologic responses had a higher survival rate. Cardiac and renal responses were achieved in 14 (37.8%) and 13 (32.5%) patients, respectively. After a median follow-up of 10 months (range 1-115 months), median overall survival (OS) was 18 months, and the estimated survival rates at 3, 6, and 12 months were 79.9%, 75.6%, and 54.5%, respectively. In Cox regression models, age, hypotension and cTnT were independently predictive of mortality after adjusting for heart failure. ConclusionThe hematologic, cardiac and renal responses were relative lower in patients with cardiac stage IIIb AL amyloidosis. The overall prognosis of patients was poor, and age, hypotension, and cTnT can be used to predict mortality.

Abstract PO2-17-09: Overall survival differences between HER2 Low and other breast cancer subtypes in a reference center in Brazil

Abstract Background: Breast cancer (BC) is a heterogeneous disease, and its subtypes have different prognosis and diverse responses to endocrine therapy and chemotherapy. In clinical practice, immunohistochemical markers are often used to classify BC into subtypes according to the presence of hormone receptors, human epidermal growth factor receptor 2 (HER2) and evaluation of proliferation measured by Ki67. Recently, there has been a suggestion for a possible alternative terminology for situations involving IHC 1+ or 2+ with negative ISH, this proposed term is referred to as HER2-low and represents about 50 to 55% of all primary BC. There are relevant gaps regarding the outcomes of HER2-low BC. Considering the new emerging therapies for HER2-low, a better description of the epidemiology, response to treatment and results of this population is extremely relevant. Objective: The purpose of this study was to use real-world data in order to investigate the Brazilian patients with BC treated in a Reference Center and evaluate the survival outcomes in different subtypes identified by molecular immunohistochemistry including HER2-Low and evaluate the survival in subtypes by stage. Methods: This retrospective cohort study included women, age &amp;gt; 18 years with breast cancer treated between 2010 and 2019 at Perola Byington Hospital in the city of São Paulo, Brazil. After the diagnose, the included patients were submitted to an immunohistochemical analysis to identify the subtype of the BC. Institutional Review Board of Pérola Byington Hospital approved the use of patients' data before the beginning of the study, under the reference number CAAE 7238317.6.0000.0069). An informed consent was dismissed, and this study was carried out according to the Declaration of Helsinki, including protection of patients' confidentiality. The primary outcome measure was overall survival (OS), which was defined as the length of time (in months) from the date of diagnosis to the date of death (from any cause). The secondary outcome measure was disease-free survival (DFS), which was defined as the length of time after the end of the primary cancer treatment in which the patient survives without any signs or symptoms of cancer. Continuous variables were summarized using their mean. Qualitative variables were summarized for the general population and by HCI subgroups using counts, percentages, and absolute numbers. The Kaplan-Meier method was used to estimate survival rates and mean survival times in the general population and by groups. All statistical tests were bilateral and p&amp;lt; 0.05 was considered significant. Statistical analyses were performed using the Python programming language version 3.8. Results: Between January 2010 and December 2019, 1,826 women were diagnosed with breast cancer and classified as a HER2-low subtype, among the 9,278 participants included in the study (19,68%). Regarding the OS analysis, patients with the "Luminal A" subtype had better survival (106 months) results when compared with the other subtypes and women with triple negative disease had the worse prognosis with OS of 96 months. The median survival in HER2-low with hormonal receptor positive was 101 months and statistically significant when compared with 90 months in HER2-low hormonal receptor negative (p &amp;lt; 0,01). When looking for stage IV HER2-low and HER2+ have better overall survival rates compared to other subtypes. Conclusion: This real-world data study shows difference in the prevalence of the HER2-low subtype. In addition, there is a difference in OS between tumor subtypes and when evaluating the HER2-low subtype with or without the presence of receptors, this difference is marked. Citation Format: Andre Mattar, Andressa Amorim, Marina Diogenes, Marcelo Antonini, Francisco Pimentel Cavalcante, Luiz Henrique Gebrim. Overall survival differences between HER2 Low and other breast cancer subtypes in a reference center in Brazil [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-17-09.

Abstract PO5-18-12: Can we cure de novo oligometastatic stage IV HER2+ breast cancer with multimodality therapy? (CHLOE)

Abstract Background: The current standard of care is to treat all patients with metastatic breast cancer with palliative intent, regardless of extent of disease. However, in real world practice patients with oligometastatic disease are sometimes treated with surgery and/or radiation/ablation in combination with systemic therapy to render them as having no evidence of disease. Previous randomized clinical trials have not shown a benefit to adding surgery or radiation in metastatic breast cancer, however, these trials had a small number of HER2+ patients. HER2+ patients are uniquely responsive to combination of chemotherapy and targeted HER2 therapy and therefore may have different outcomes with a multimodality approach. The goal of this project is to use a novel, user friendly, on-line clinical study platform that registers patients and enables follow-up data collection to test the hypothesis that de novo stage IV oligometastatic HER2+ patients treated with multimodality therapy may result in improved long-term distant metastasis free survival and overall survival. Trial design: This is a prospective, nationwide registry study that will enroll newly diagnosed (de novo) oligometastatic (operationally defined by local tumor boards as disease where all metastatic lesions can be ablated) HER2+ breast cancer. A secure online portal has been created by the Yale IT team in accordance with HIPPA and cybersecurity guidelines. Data will be directly entered into the online portal by participating investigators and information regarding what treatment the patient received, if they completed treatment, and survival data will be collected. All treatment decisions will be at the discretion of the treating provider. Eligibility criteria: Patients with de novo oligometastatic HER2+ breast cancer in whom local treatment of all metastatic sites by either surgery, radiation, or ablative techniques is feasible as determined by multidisciplinary discussion or local tumor board. Specific aims: Primary: To estimate the 3 year distant metastasis free survival in patients with de novo oligometastatic HER2+ breast cancer treated with a multi-modality treatment plan. Secondary: To estimate 3 year overall survival and to monitor QOL. Statistical methods: The major analysis will occur after at least 3 years following the last subject’s enrollment in a cohort, to ensure that the objective of distant metastasis free survival at 3 years will be analyzed. It will include: tabulation of all cases entered, number and location of metastases, if treatment plan was implemented, compliance rate of treatment delivery, observed results with respect to the primary endpoint. Kaplan-Meier estimates will be presented for the analysis of survival endpoints together with a summary of associated statistics (median survival time if reached, landmark survival rate estimates and estimates for every 6 months thereafter if applicable), including the corresponding two-sided 95% confidence intervals. The 95% exact Clopper Pearson confidence intervals will be presented for binary endpoints. Paired t-test or Wilcoxon signed rank test will be used to assess the difference of continuous variables measured at different time points. The secondary clinical outcome is overall survival at 3 years, defined as the percentage of patients without an event at the 3-year follow-up time point measured from the study registration date. An event is considered death from any cause. OS time will be measured from the date of randomization to the date of first OS failure or last follow-up. OS will be estimated by the Kaplan-Meier method with OS failure defined as: death from any cause. Present accrual and target accrual: 4/42 patients Contact information for people with a specific interest in the trial: Mariya.Rozenblit@yale.edu https://chloe.yalepathaws.org Citation Format: Mariya Rozenblit, Nathalie Wiesendanger, Kelly Shanahan, Christine Hodgdon, Peter Gershkovich, Mehra Golshan, Meena Moran, Maryam Lustberg, Lajos Pusztai. Can we cure de novo oligometastatic stage IV HER2+ breast cancer with multimodality therapy? (CHLOE) [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-18-12.