Survival Rate Of Elderly Patients Research Articles

Obesity paradox on the survival of elderly patients with diabetes: an AHAP-based study.

Background and objectivesOverweight and obesity are among the important challenges in health issues and survival of elderly people. The current study aimed to evaluate the survival rate of elderly patients with diabetes, and its influencing factors, on the basis of body mass index (BMI).Methods and materialsThe design of the current study was based on the Amirkola Health and Aging Project (AHAP) cohort. The 5–year survival rate of elderly people with diabetes and the factors that influence the mortality rate by Cox regression model were analyzed.ResultsOut of 1616 elderly people who were evaluated in the current study, 501 (31%) had diabetes. The results showed that diabetes significantly increased the mortality rate (adjusted hazard ratio [HR] = 2.10; 95% confidence interval [CI]: 1.57–2.81; P < 0.001). Furthermore, overweight (HR = 0.41; 95%CI: 0.24–0.75; P = 0.002), obesity (HR = 0.30; 95% CI: 0.41–0.63; P = 0.002), history of diabetes (HR = 0.56; 95%CI: 0.34–0.93; P = 0.024), moderate and high physical activity level (HR = 0.36; 95%CI: 0.13–0.99; P = 0.049) decreased the risk of mortality and central obesity (HR = 1.76; 95% CI: 1.01–3.11; P = 0.049), fasting blood sugar ≥200 (HR = 2.46; 95% CI: 1.46–4.15; P < 0.001), brain stroke, and neurological diseases (HR = 3.12; 95% CI: 1.78–5.49; P < 0.001) increased the risk of mortality.ConclusionAlthough overweight and obesity significantly improved the risk of mortality in elderly patients with diabetes, central obesity is still considered as an important risk factor.

Validation and Refinement of the Age, Comorbidities, and Albumin Index in Elderly Patients with Diffuse Large B-Cell Lymphoma: An Effective Tool for Comprehensive Geriatric Assessment.

We aimed to validate and refine the Age, Comorbidities, and Albumin (ACA) index in elderly Chinese patients with diffuse large B-cell lymphoma (DLBCL) and propose a more effective method for comprehensive geriatric assessment (CGA). Patients ≥65 years of age who had been diagnosed with de novo DLBCL in the Institute of Hematology, Beijing Hospital, were screened for eligibility (n = 99). Based on the ACA index, 39, 31, 26, and 3 patients were categorized into the "excellent," "good," "moderate," and "poor" groups, respectively. The 2-year treatment-related mortality rate was significantly higher and the survival rates poorer in the ACA "moderate to poor" group compared with those of the ACA "good" and "excellent" groups. Multivariable model analysis identified two independent predictors of overall survival: the instrumental activities of daily living (IADL) scale and the ACA index. IADL scores of 6 to 7 and the ACA "good" group were assigned 1 point; IADL scores ≤5 and the ACA "moderate to poor" group were assigned 2 points. Based on these data, we created a three-category system (IADL ACA index [IACA index]): low risk, score 0; intermediate risk, score 1 to 2; and high risk, score 3 to 4. The IACA index could effectively discriminate the response rates, overall survival, and progression-free survival rates in elderly patients with DLBCL. We observed that the ACA index could partially predict the clinical outcomes of elderly DLBCL patients in China. Based on this index, we proposed the IACA index as an effective tool for CGA in DLBCL. Diffuse large B-cell lymphoma (DLBCL) is one of the most frequent types of malignant lymphoma in elderly people, and identifying patients suitable for curative therapy is critical in the improvement of clinical outcomes. Recently, some authors proposed the Age, Comorbidities, and Albumin (ACA) index. Combining the use of the instrumental activities of daily living (IADL) scale and the ACA index, this article describes the IADL ACA index (IACA index), which is an effective tool for comprehensive geriatric assessment in DLBCL.

Clinicopathological Characteristics and Prognoses of Elderly Gastric Cancer Patients after R0 Resection: A Multicenter Study in China.

The number of elderly gastric cancer (GC) patients has been rapidly increasing worldwide, but inadequate understanding regarding elderly GC patients has led to the paucity of appropriate treatment decisions. Our study evaluates clinicopathological characteristics and prognoses of elderly GC patients after R0 resection. Overall, 1877 consecutive GC patients who underwent R0 gastrectomy at four centers were enrolled. We divided patients into three groups according to age: young, middle, and elderly. We then analyzed clinicopathological characteristics and prognoses. Compared to the middle-aged group, the elderly group had a higher male-to-female ratio and number of patients with cardiac GC, trend of more advanced pathological stage, lower ratio of poor to moderate tumor grade, and fewer patients who received adjuvant chemotherapy or chemoradiotherapy. Moreover, 5 yr disease-free survival and overall survival rates of elderly patients were significantly less than those of middle-aged patients. A Cox analysis of middle-aged and elderly patients revealed that age and adjuvant chemotherapy were independent prognostic factors. Adjuvant chemotherapy improved long-term survival of elderly patients with stage III cancer. Elderly GC patients who underwent R0 resection had unique characteristics and poor long-term survival. We found that subjects should be stratified into the three aforementioned age groups when analyzing survival rates of GC patients. In addition, reasonable adjuvant treatment is recommended for elderly patients.

Survival of elderly patients with advanced hepatocellular carcinoma with distant metastasis in pre- and post- sorafenib era: A population based study.

e15643 Background: Sorafinib was approved for advanced hepatocellular carcinoma in 2007. This study was conducted to study relative survival in elderly patients with advanced hepatocellular carcinoma in presorafinib and sorafinib era. Methods: We selected elderly patients (age ≥ 65 years) with advanced hepatocellular carcinoma (distant metastasis based on SEER’s LRD staging) from the Surveillance, Epidemiology, and End Results (SEER) database diagnosed during January 2000 to December 2013. We calculated one year and five year relative survival rates in pre- (2000-2006) and post- sorafinib (2008-2013) era by sex and ethnicity (Caucasians, African-Americans (AA) &amp; Other) using SEER*Stat software. Results: There were total of 1533 patients in presorafinib era and 1694 patients in postsorafinib era. Of the total population, 71.30% were male and 28.70% female, 71% were Caucasian, 10% African-American and 19% were other race. Median age of patients was 73 years (65-99 years) and medial follow up period was 3 months (0-167 months) Survival rates improved significantly from pre- to post- sorafenib era (1 year RS: 10.60% ±0.80% vs 12.10±0.90%, p value = 0.001; 5 year RS: 1.10%±0.30% vs 1.8%±0.6%, p value = 0.001 ). The survival rate improved significantly for male (1 year RS: 11.60%±1.00% vs 12.30%±1.00%, p value = 0.006; 5 year RS: 1.00%±0.40% vs 1.3%± 0.6% , p value = 0.007) and Caucasian (1 year RS: 10.60%±1.00% vs 12.60%±1.10%, p value = 0.0008; 5 year RS: RS = 1.20%±0.40% vs 1.4%±0.7%, P value = 0.001) patients in post sorafenib era. There was no significant difference in the survival rates among any other cohorts examined.However in black (N = 153 vs 158 , RS = 6.80%±2.10% vs 7.80%±2.40% , p value = 0.77) or other races (N = 311 vs 311, RS = 12.20%±1.90% vs 12.80%±2.10%, p value = 0.30 ) , no significant improvement in survival was noted. Conclusions: Our study showed that relative survival rates of elderly patients with advanced hepatocellular carcinoma with distant metastasis has improved in the post-sorafenib compared to pre-sorafenib era. The improvement in survival is limited to male and Caucasian patients.

External beam radiation and high-dose-rate brachytherapy for elderly patients with gastroesophageal junction adenocarcinoma.

PurposeThe aim of this study was to retrospectively observe and analyze the long-term treatment outcomes of 96 elderly patients with gastroesophageal junction adenocarcinoma (GEJAC) who were treated with californium-252 (252Cf) neutron brachytherapy (NBT) in combination with external beam radiotherapy (EBRT) with or without chemotherapy.Material and methodsFrom January 2002 to November 2012, 96 patients with GEJAC underwent treatment. The total radiation dose to the reference point via NBT was 8-25 Gy-eq in 2 to 5 fractions, with 1 fraction per week. The total dose via EBRT was 40-54 Gy, which was delivered over a period of 4 to 5.5 weeks with normal fraction.ResultsThe median survival time for the 96 patients was 15.3 months, and the 1-, 2-, 3-, and 5-year rates of overall survival (OS) were 62.5%, 33.7%, 20.1%, and 7.9%, respectively. The 1-, 2-, 3-, and 5-year rates for local-regional control (LRC) were 78.7%, 57.9%, 41.8%, and 26.4%, respectively. The patients’ age was an independent factor that was significantly associated with OS (p = 0.006) and LRC (p = 0.0005), according to univariate analysis. The 3-year OS (LRC) was 31.9% (62.9%) for patients aged 70-74 years and 16.1% (19.5%) for patients aged ≥ 75 years. From the time of treatment completion to the development of local-regional recurrence or death, 5 (5.2%) patients experienced fistula and 7 (7.3%) experienced massive bleeding.ConclusionsThe clinical data indicated that NBT in combination with EBRT produced favorable local control and long-term survival rates for elderly patients with GEJAC, and that the side effects were tolerable. The patient’s age could be used to select the appropriate treatment in an elderly patient.

Safety and outcome of external beam radiation and neutron brachytherapy in elderly patients with esophageal squamous cell cancer.

PurposeThe aim of this study was to retrospectively observe and analyze the long-term treatment outcomes of 191 elderly patients with esophageal squamous cell cancer (ESCC) who were treated with californium-252 (252Cf) neutron brachytherapy (NBT) in combination with external beam radiotherapy (EBRT).Material and methodsFrom January 2002 to November 2012, 191 patients with ESCC underwent NBT in combination with EBRT. The total radiation dose to the reference point via NBT was 8-25 Gy-eq in two to five fractions with one fraction per week. The total dose via EBRT was 50-60 Gy, which was delivered over a period of 5 to 6 weeks with normal fractionation.ResultsThe median survival time for the 191 patients was 23.6 months, and the 5-year rates for overall survival (OS) and local-regional control (LRC) were 28.7% and 54.2%, respectively. The patients’ age was a factor that was significantly associated with OS (p = 0.010), according to univariate analysis. The 5-year OS (LRC) was 37.3% (58.6%) for patients aged 70-74 years and 14.5% (47.9%) for patients aged > 74 years (p = 0.010 and p = 0.038). In multivariate analysis, age and clinical N stage were associated with OS and LRC (p = 0.011 [0.041] and p = 0.005 [0.005]). From the time of treatment completion to the development of local-regional recurrence or death, 5 (2.6%) patients experienced fistula and 15 (7.9%) experienced massive bleeding. The incidence of severe late complications was related to older age (p = 0.027), higher NBT dose/fraction (20-25 Gy/5 fractions), and higher total dose (> 66 Gy).ConclusionsThe clinical data indicated that NBT in combination with EBRT produced favorable local control and long-term survival rates for elderly patients with ESCC, and that the side effects were tolerable. Patient’s age, clinical stage N status, and radiation dose could be used to select the appropriate treatment for elderly patients.

Outcome and 2-Year Survival Rate in Elderly Patients With Lateral Compression Fractures of the Pelvis.

Introduction:Osteoporotic pelvic ring fractures are a rising problem for surgeons in industrialized countries. There is no evidence-based treatment strategy especially for lateral compression (LC) fractures involving the sacrum. The aim of this study was to evaluate and compare outcome and survival rate of nonoperative and operative treatment strategies for lateral compression fractures.Patients and Methods:In a retrospective study, 128 patients (aged ≥65 years) with an Orthopedic Trauma Association (OTA) types B2.1 and B3.3 fracture were included and analyzed regarding demographic and treatment data and adverse events. After a follow-up period of at least 2-year survival rate, quality of life and pain were evaluated using the EuroQol-5D and Short Form–12 questionnaires and the visual analog scale.Results:Fifty patients (78.3 ± 7.6 years) obtained operative treatment and 77 patients (82.7 ± 7.9 years) obtained nonoperative treatment. One died within 24 hours after admission. High rates of complications occurred in both groups (operative group: 18% and nonoperative group: 8%). Eighteen percent (14 of the 77) of conservatively treated patients needed operative treatment after discharge due to worsening pain and mobilization. The 2-year follow-up showed a high overall mortality (30%), with a significant higher survival rate for operatively treated patients (2-year survival: operatively treated 82% vs conservative 61%). No difference was found in pain and quality of life.Discussion:Elderly patients display a high rate and variety of complications and mortality in the aftermath of lateral compression fractures of the pelvis. Although a significantly higher 2-year survival rate for operatively treated patients was found, this study cannot give proof of superior position for operative treatment. Due to lacking data for alternative treatment algorithms especially for fracture-related immobilized patients, we recommended operative treatment with the aim to reduce complications related to prolonged bed rest and ensure early mobilization.

Survival Trends Among Patients with High Risk Myelodysplastic Syndrome in Pre- and Post-Hypomethylating Era: A SEER Population Based Study.

Background:The myelodysplastic syndrome (MDS) includes a diverse group of clonal hematopoietic stem cell malignancies primarily affecting older individuals. It is characterized by bone marrow failure, peripheral blood cytopenias, and reduced survival. Treatment is based on prognostic scoring system and the pathology. Higher-risk disease carries a significant risk of progression to Acute Myelogenous Leukemia (AML). In these patients, treatment includes either an allogeneic stem cell transplantation (SCT) or a hypo-methylatingagent. Elderly patients with MDS usually are not a suitable candidate for allogeneic stem cell transplant given their age and other associated comorbidities. In this subset of patients, hypomethylatingagents, namely azacitidineor decitabineare the preferred treatment options. The effect of the introduction of therapeutic advances has not been well understood at the population level.We conducted this study to compare relative survival rates of elderly patients (≥65 years) with MDS in pre- and post- hypomethylatingagent era.Methodology:We utilized the National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER-18) database to identify patients diagnosed with MDS. MDS subtype, namely Refractory anemia with excess blasts [Code: 9983/3] and Refractory anemia with excess blasts in transformation [Code: 9984/3] have the highest risk rate of transformation to AML. We opted to focus on these high risk MDS subtype. We limited our analysis to patients who are ≥ 65 years of age. On May 19, 2004, the U.S. Food and Drug Administration approvedazacitidinefor MDS. We defined our timeframes as follows: pre-hypomethylatingera (from 1994 to 2003) and post-hypomethylatingera (from 2005 to 2011). We analyzed one- and two-year relative survival rates (RS) of MDS patients. Several cohorts categorized by race (Caucasians and African Americans), gender and age (65-80, ≥ 80) were compared to assess the survival differences across our two defined eras. Z-test was used to compare the survival rates.Results:The database comprised of 2,665 patients (691 in pre and 1,974 in post). Overall there was an improved survival in post-hypomethylatingera (1-year: 43.8±2.0% vs. 50.2±1.2, Z-score= 2.993, p-value=0.0028; 2-year: 22.3±1.7 vs. 26.9±1.1, Z score= 3.202, p value=0.0014). There was a significant improvement in 1-year RS for males and 2-year RS for females. Elderly Caucasians also had survival benefit in post-hypomethylatingera. There was no survival benefit observed for African Americans however this did not reach statistical significance. A survival benefit was observed for elderly (65-79 years) and very elderly (≥ 80 years, only 2-year RS) population.Conclusion:The survival of myelodysplastic syndrome has improved significantly in post-hypomethylatingera. Improvements in supportive care, utilization of allogeneic stem cell transplant, andhypomethylatingagetnsmay all have contributed to this observation. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Clinical and prognostic features of surgical treatment in gastric cancer in aged patients

The incidence of gastric cancer in the elderly is increasing because of increased life expectancy and improved medical care. Gastric cancer in the elderly is characterized by specific clinicopathological features, including a male-predominance gender tendency, more comorbid diseases, more advanced clinical stage, distinct histopathological findings, absence of family history, etc. The incidence of surgery-related post-operative complication shows no significant difference between elderly and non-elderly patients. However, the incidence of non-surgery-related complications is relatively higher in elderly patients. Although the overall survival rate of elderly patients is lower, the disease-specific survival rate of elderly patients is comparable with non-elderly patients. Therefore, surgery is still an effective way to improve the prognosis of elderly gastric cancer patients, and care should be taken while dealing with the comorbid diseases in elderly gastric cancer patients to improve the survival.

MINIMALLY-INVASIVE SURGERY FOR COLLORECTAL CANCER IN ELDERLY PATIENTS

Introduction. The patient’s age is one of the major risk factors of death from colorectal cancer. The role of laparo- scopic radical surgeries in the treatment of colorectal cancer in elderly patients is being studied. The purpose of the study was to evaluate the experience of surgical treatment for elderly patients with colorectal cancer. material and methods. The treatment outcomes of 106 colorectal cancer patients aged 75 years or over, who underwent surgery between 2013 and 2015 were presented. Out of them, 66 patients underwent laparatomy and 40 patients underwent laparoscopy. Patients were matched for ASA and CR-PОSSUM scales, age-and body mass index, dis- ease stage and type of surgery. Results. The mean duration of surgery was significantly less for laparoscopy than for laparotomy (127 min versus 146 min). Intraoperative blood loss was higher in patients treated by laparotomy than by laparoscopy (167 ml versus 109 ml), but the differences were insignificant (р=0.36). No differences in lymphodissection quality and adequate resection volume between the groups were found. The average hospital stay was not significantly shorter in the laparoscopic group (р=0.43). Complications occurred with equal frequency in both groups (13.6 % compared to 15.0 %). The median follow-up time was 16 months (range, 6-30 months). The number of patients died during a long-term follow-up was 2 times higher after laparotomic surgery than after laparoscopic surgery, however, the difference was not statistically significant. Conclusion. Postoperative compli- cations in elderly patients with colorectal cancer did not exceed the average rates and did not depend on the age. Both groups were matched for the intraoperative bleeding volume and quality of lymphodenectomy. Significantly shorter duration of laparoscopic surgery was explained by the faster surgical access however, it showed no benefit in reducing the average length of hospital stay and decreasing the number of complications. The choice of surgi- cal access had no impact on life quality of patients after treatment. There was a tendency toward an increase in the percentage of deaths in a long-term follow-up due to causes not related to colorectal cancer, thus, resulting in the decreased overall survival rate in elderly patients treated by laparatomy.

Impact of Hemodynamic Instability and Organ Malperfusion in Elderly Surgical Patients Treated for Acute Type A Aortic Dissection.

Recent studies indicate acceptable survival rates in elderly patients treated surgically for acute type A aortic dissection (aTAAD). However, the impact of preoperative hemodynamic compromise or organ malperfusion on outcomes of such patients is still unclear. In a retrospective study of 341 patients, 101 qualified as elderly (≥70 years old). Subjects were further grouped by clinical presentation, using the Penn classification. Univariate and multivariable analyses were conducted to identify variables reflecting in-hospital and long-term mortality. Relative to younger subjects, elderly patients showed significantly higher rates of in-hospital mortality (24.8% vs. 14.6%, p = 0.025) and DeBakey type 2 dissections at presentation (40% vs. 18% p < 0.001), with significantly fewer presenting as Penn class Ab (p = 0.010). Penn class Ac was identified as an independent predictor of in-hospital mortality at all ages. Estimated long-term survival was poorer in the elderly (log rank p < 0.001); but in-hospital mortality, based on Penn classification, was similar for both age groups. Survival rates of Penn class Aa subjects at one, five, and 10 years were lower in elderly (vs. younger) patients (79 ± 5.6% vs. 90 ± 2.7%, 68 ± 6.7% vs. 80 ± 3.9%, and 39 ± 10.3% vs. 75 ± 4.6%, respectively; log rank p < 0.001). Overall in-hospital mortality is higher in elderly patients surgically treated for aTAAD. Malperfusion and/or hemodynamic instability at presentation confer a dismal prognosis, independent of patient age.

Doença renal crônica e tratamento em idosos: uma revisão integrativa

ResumoO envelhecimento populacional, juntamente com a crescente incidência de doenças crônicas, tem contribuído para o aumento mundial da prevalência da doença renal crônica (DRC). O objetivo deste estudo foi realizar uma revisão integrativa sobre os tratamentos propostos para idosos portadores de DRC na fase não dialítica. Foi efetuada uma busca na literatura, considerando-se o período entre janeiro de 2002 e maio de 2013, nas bases de dados eletrônicas MEDLINE, LILACS, SciELO e Science Direct, a partir das palavras-chave: chronic kidney disease, treatment e elderly. Foram incluídos os artigos livremente disponíveis e completos. Inicialmente, foram identificados 215 artigos. Após a etapa de elegibilidade, 13 artigos foram incluídos nessa revisão integrativa. As intervenções terapêuticas recomendadas para a gestão da DRC incluem o controle de hipertensão arterial, diabetes e dislipidemia, alterações alimentares, redução de peso e abstinência do fumo. Em relação ao tratamento, para muitos idosos com DRC, uma abordagem individualizada centrada no paciente pode ter mais a oferecer do que a abordagem tradicional orientada na doença. Quanto ao encaminhamento precoce ao nefrologista, esse parece ser um procedimento que apresenta benefícios na gestão da doença renal. Embora haja um esforço aparente dos pesquisadores em instituir abordagens terapêuticas mais adequadas, ainda são escassas as evidências de intervenções que melhorem a sobrevida de pacientes idosos com DRC. Contudo, algumas intervenções evitam agudizações e retardam a evolução da DRC. Nesse sentido, há necessidade da realização de estudos randomizados controlados de longo prazo incluindo indivíduos idosos com DRC, a fim de se conhecer procedimentos terapêuticos mais eficazes para o controle dessa doença.

The postoperative survival rate analysis of elderly patients with hip fracture

Objective To study the postoperative survival rate of elderly patients with hip fracture at different time and its related factors. Methods We conducted the follow-up studies of 255 elderly hip fracture patients from June 2008 to June 2011 in our hospital. The survival rates of patients at 6 months, 1, 2 and 3 years after operation and their related factors were studied. Results The survival rate was 96.5%, 89.8%, 78.0% and 69.4% at 6 months, 1, 2 and 3 years after operation respectively in 255 elderly hip fracture patients. Survival analysis showed that many kinds of preoperative comorbidities, low albumin level, old age and severe anemia were the risk factors for survival. Good activity of daily living before injury was a protective factor for survival. Gender, fracture type, the American Society of Anesthesiologists (ASA) classification, time from injury to surgery, anesthesia type, surgical approach, operative time, blood loss and hospital stay periods had no effect on survival after operation. Conclusions The survival rate in elderly patients with hip fracture after surgery is affected by many factors. Preoperative comorbidities, anemia and hypoalbuminemia should be actively treated, the activity of daily living should be improved by the directed therapy and rehabilitation, in order to improve the survival rate in elderly patients with hip fracture. Key words: Hip Fracture; Survival analysis; Risk factors

Prognostic value of the expression of phosphatase and tensin homolog and CD44 in elderly patients with refractory acute myeloid leukemia.

The leukemic stem cell marker CD44, has been reported to have prognostic significance in hematological malignancies. The present study therefore aimed to evaluate whether the expression levels of CD44 and the associated pathway components are associated with the survival rate of elderly patients with refractory acute myeloid leukemia (AML). A total of 20 elderly patients diagnosed with refractory AML were divided into two groups, following induction chemotherapy: Complete remission (CR, n=9) and non-remission (NR. n=11). Bone marrow biopsy specimens were collected, expression levels of CD44, phosphatase and tensin homolog (PTEN), mammalian target of rapamycin (mTOR) and nuclear factor-κB (NF-κB) were analyzed by immunohistochemistry and the captured images were analyzed in a blinded manner using Image Pro Plus software, version 6.0. The overall survival rates (OS) of the patients were then analyzed with log rank, and the correlation between CD44, PTEN, mTOR and NF-κB expression levels and patients survival rates were statistically analyzed using Pearson's method. Significant differences were observed between the CR and NR groups for PTEN (P=0.025) and CD44 (P=0.020) expression levels. Positive CD44 expression was significantly correlated with poor overall survival, with a hazard ratio of 6.281 (95% CI, 1.78-22.12; P=0.0042). The mean OS was 4.00 months for patients that demonstrated positive CD44 expression, compared with 9.27 months for patients that demonstrated negative CD44 expression. A tendency towards reduced survival rates was also observed in patients negative for PTEN expression, when compared with that of PTEN-positive patients. The mean OS was 4.81 months in PTEN-negative patients vs. 8.8 months in PTEN-positive patients, with a hazard ratio of 2.689 (95%CI, 0.89-8.08; P=0.078). Patients that exhibited PTEN-positive and CD44-negative expression, survived significantly longer than patients that demonstrated PTEN-negative and CD44-positive expression (mean OS, 9.86 vs 2.67 months; hazard ratio=0.037; 95% CI, 0.006-0.222, P=0.0006). The expression levels of NF-κB and mTOR were slightly increased in the NR group compared with those of the CR group, although no significant differences were identified. PTEN and CD44 expression levels demonstrated trends towards negative correlation. In conclusion, the expression levels of CD44 and PTEN may be useful markers to predict the prognosis of elderly patients with refractory AML.

Survival rate analysis in elderly patients with long-term catheters hemodialysis

Objective To investigate the survival rate in elderly patients with long-term catheters hemodialysis. Methods A total of 127 elderly patients receiving maintained hemodialysis were included in this study. Patients were divided into two groups according to catheter location: long-term indwelling internal jugular vein catheter group and long-term indwelling vena iliac external catheter group. The baseline anthropometric and 1aboratory parameters were measured. The catheter dysfunction and catheter related complications were observed. Results The incidence of catheter dysfunction was higher in iliac vein catheter group than in internal jugular vein catheter group (51.5% vs. 24.5%, χ2=8.459, P=0.015), and there were no significant differences in the catheter related infection rate and cardiovascular (CVD) event rate between the two groups. Kaplan-Meier survival curves showed that mean survival time was lower in vena iliac external catheter group than in internal jugular vein catheter group (1.9 years vs. 2.5 years, χ2=10.847, P=0.001), and still was lower after controlling the catheter dysfunction and cardiovascular events (χ2=9.915, P=0.002; χ2=4.368, P=0.037). Multivariate logistic regression analysis showed that levels of hemoglobin, creatinine, systolic blood pressure, parathormone and age were the independent risk factors for mortality in elderly patients with long-term catheter hemodialysis. Conclusions There is a high incidence of CVD events in elderly patients with long-term catheter hemodialysis. The incidence of catheter dysfunction is higher and the survival rate is lower in elderly patients with long-term indwelling vena iliac external catheter hemodialysis. Key words: Hemodialysis; Catheterization; Central vein; Catheters, indwelling

Overall survival and renal function after partial and radical nephrectomy among older patients with localised renal cell carcinoma: A propensity-matched multicentre study

BackgroundThis study aimed to evaluate the overall survival (OS) rate and renal function after radical nephrectomy (RN) and partial nephrectomy (PN) in patients aged ⩾65years. MethodsPatients who underwent RN (n=622) or PN (n=622) for renal cell carcinoma (pT1N0M0) between 1999 and 2011 were propensity-score matched in our multicentre database. To investigate the relative effect of PN on OS according to age, we divided the patients into two age subgroups (<65 and ⩾65years). The 5-year OS rates and probabilities of freedom from chronic kidney disease (CKD III or IV) were estimated using the Kaplan–Meier method and separate Cox proportional hazards models. ResultsThe 5-year OS rates after surgery were 94.7% for PN and 91.9% for RN in the older patients (P=0.698). The corresponding rates in the younger patients were 99.7% for PN and 96.3% for RN (P=0.015). In separate Cox hazards models for OS, the older patients who underwent PN were not significantly different from their RN-treated counterparts (hazard ratio (HR): 0.960; 95% confidence interval (CI): 0.277–2.321, P=0.797). Kidney function was significantly better preserved after PN than after RN at all ages. However, stage IV CKD in the older patients did not occur more frequently in the RN arm than in the PN arm. ConclusionsAlthough PN was associated with improved renal function compared with RN, it did not confer a benefit of higher survival rate in elderly patients (⩾65yearsold).

Major causes of impractical brachytherapy in elderly patients with uterine cervical cancer.

Incomplete brachytherapy is a major risk factor for recurrence. However, high-dose-rate intracavitary brachytherapy has not been assessed adequately in elderly patients with invasive cervical cancer. The present study investigated the clinical importance of intracavitary brachytherapy and risk factors of incomplete intracavitary brachytherapy in elderly patients with cervical cancer. Subjects were 76 patients aged 70-89 years old with invasive cervical cancer. All subjects were recruited between January 1997 and September 2010, and were planning to receive external beam radiation therapy followed by high-dose-rate intracavitary brachytherapy. Survival rates and the incidence of complications were compared between the 70s and 80s age groups. Risk factors for recurrence in elderly patients were evaluated using multivariate analysis, and risk factors for impractical intracavitary brachytherapy were also estimated. No significant differences were observed in 3-year progression-free survival rates or the incidence of complications in the two age groups. Cox multivariate analysis showed that histology (non-squamous cell carcinoma), incomplete intracavitary brachytherapy, and lymph node swelling were significant prognostic factors for recurrence. Impractical application was the major reason for incomplete treatment. Multiple logistic regression analysis revealed that a previous history without vaginal births (P = 0.016) was an independent risk factor for the impractical application, independent of tumor diameter ≥ 4 cm (P = 0.007). Incomplete intracavitary brachytherapy decreased the survival rates of elderly patients. Larger tumors and patients without a history of vaginal births were the two major causes of impractical intracavitary brachytherapy, which may be fatal, especially in elderly patients with bulky tumors.

Factors affecting long-term survival in elderly patients undergoing radiotherapy for esophageal carcinoma.

This study was conducted with the aim to analyze the factors affecting the 1-, 3- and 5-year survival rate of elderly patients with esophageal carcinoma. Between 2004 and 2008, a total of 371 patients aged ≥70 years treated with radiotherapy alone were enrolled in this study. The clinical characteristics and radiotherapy dose were evaluated by survival rate and the 1-, 3- and 5-year overall survival (OS) rates were found to be 42, 13.2 and 9.16%, respectively. The univariate analysis revealed significant differences in T, N, M and clinical stage and radiotherapy dose (all P-values <0.05) and no significant differences in gender (all P-values >0.05). There was a difference in tumor location when only comparing the 3- and 5-year OS rates (P=0.031 and P=0.025, respectively). The multivariate analysis identified clinical stage as an independent factor for the 1-year OS rate (P=0.003), whereas radiotherapy dose and clinical stage were found to be independent factors for the 3- and 5-year OS rates (all P-values 0.05). In the analysis of radiotherapy dose, we observed no significant difference in the 1-year OS rate between the radiation dose (DT) >60 Gy and the 50 Gy≤DT<60 Gy groups (P=0.363); however, there were statistically significant differences in the 3-year OS rate between the 50 Gy≤DT<60 Gy and the other groups (P=0.039 and P=0.032); there were no significant differences in the 5-year OS rate among the dose groups (all P-values >0.05). In conclusion, according to the findings of this retrospective study, radiotherapy alone for elderly patients with esophageal cancer does not appear to be acceptable and there is a need for a more effective treatment. T, N, M and clinical stage and radiotherapy dose were identified as factors significantly affecting the 1-, 3- and 5-year OS in elderly patients with esophageal carcinoma, although a higher radiotherapy dose with normal fractionation did not appear to improve the OS rate.

Surgical Outcomes of Gastrectomy for Elderly Patients with Gastric Cancer

This study was designed to determine the surgical outcomes of gastric cancer in elderly patients. This information can help establish appropriate treatment for these patients. A total of 1,193 patients with gastric cancer who underwent gastrectomy between 1995 and 2010 were enrolled in this retrospective study. The clinicopathologic features of 104 elderly patients (aged ≥80 years) were compared with those of 1,089 nonelderly patients. (1) Tumors located in the lower-third of the stomach, differentiated cancer, and surgery with limited lymph node dissection were more common in elderly patients. However, there was no difference in the proportion of laparoscopic gastrectomy between elderly and nonelderly patients. (2) Although surgical complication rates were similar in the two groups, the operative mortality rate was higher in elderly patients (1.9 %) than in nonelderly patients (0.7 %). (3) Elderly patients had a significantly poorer overall survival rate, whereas the disease-specific survival rates of the two groups were similar. Limited lymph node dissection did not influence the disease-specific survival rate of elderly patients. (4) The median life expectancy of elderly gastric cancer survivors was 9.8 years in patients aged 80-84 years and 6.0 years in those ≥85 years. The patients with limited lymph node dissection had slightly better prognosis. The treatment results in elderly patients were comparable to those in nonelderly patients. These findings suggest that R0 resection with at least limited lymph node dissection according to Japanese guidelines should be considered, even for elderly patients.

Pulmonary Arterial Hypertension in the Elderly-Clinical Characteristics and Long-Term Survival

Recent registries describe a significant prevalence of pulmonary arterial hypertension (PAH) in the elderly, but little is known of their characteristics. We aimed to examine the features and prognostic factors of long-term survival in elderly (≥65 years) PAH patients. Clinical, echocardiographic, angiographic, hemodynamic, treatments, and survival data were reviewed in consecutive patients over the course of 20 years. Elderly PAH patients (n = 47) were compared to younger PAH patients (n = 107). At presentation, elderly patients were more likely to have hypertension, diabetes, dyslipidemia, coronary disease, and PAH associated with scleroderma (42.6 vs. 24.3 %; p = 0.02) than younger patients. Prior to PAH therapy, elderly patients had better right ventricular myocardial performance index (RV-MPI; 0.48 ± 0.20 vs. 0.62 ± 0.23, p = 0.006) and lower mean pulmonary arterial pressure (PAP; 45.0 ± 11.1 vs. 49.2 ± 11.8 mmHg, p = 0.04). Elderly patients were treated less often with epoprostenol (8.5 vs. 29 %, p = 0.006) or trepostinil (8.5 vs. 23.4 %, p = 0.04). The 1, 3, and 5 year survival rates of elderly patients were estimated to be 76.4, 50.5, and 37.6 %, respectively. In comparison, younger patients had survival estimates of 92.2, 74.2 and 64.0 % (p = 0.002). Baseline right atrial pressure, mean PAP, cardiac index, and RV-MPI were associated with survival in elderly patients; however in these patients, survival was not affected by any PAH subgroup or age (per year) by itself. The diagnosis of PAH in elderly patients is associated with poorer survival which is in part explained by a greater vulnerability to the hemodynamic disturbances of PAH.