Ten-year Survival Research Articles

Time Trends in Male Breast Cancer Incidence, Mortality, and Survival in Austria (1983-2017).

Male breast cancer (MBC) comprises less than 1% of all breast cancer cases globally and remains understudied with persisting sex-specific survival disadvantages. We aim to contribute to better understanding of MBC with a comprehensive analysis of time-trends over several decades in Austria. We used Austrian National Cancer Registry data on 1648 cases of MBC cases diagnosed between 1983 and 2017 in Austria. Overall incidence, mortality, and survival rates, as well as age-, stage-, and period-specific incidence and survival rates were calculated. Joinpoint regression was performed to assess trends. MBC incidence rates increased throughout the whole observation period (1983-2017) with an annual percent change (APC) of 1.44% (95% confidence interval, CI: 0.77 to 2.11). During the same period, morality rates were stable (APC: -0.25, 95% CI: -0.53 to 0.60). Ten-year survival rates showed three phases of decreasing increases with an average APC of 2.45%, 1983-2009 (95% CI: 2.1 to 2.74). Five-year survival rates improved until 2000 (APC: 2.31, 95% CI: 1.34 to 3.30) and remained stable thereafter (APC: 0.10, 95% CI: -0.61 to 0.80). Stage-specific analyses showed a single trend of stable incidence rates of distant disease MBC (APC: -0.03, 95% CI: -1.67 to 1.65). Further, we observed increases in localised, regional, and unknown stage cancer incidence and increases in incidence rates across all age groups over the whole observation period. However, the estimates on these subgroup-specific trends (according to age- and stage) show wider 95% CIs and lower bounds closer to zero or negative in comparison to our findings on overall incidence, mortality, and survival. Despite improvements in survival rates, MBC mortality rates remained largely stable between 1983 and 2017 in Austria, possibly resulting from a balance between increasing overall incidence and stable incidence rates of distant disease MBC.

Current and future therapy for BRAF-mutant pediatric glioma

Current and future therapy for BRAF-mutant pediatric glioma Professor Peter J. Houghton from the Greehey Children’s Cancer Research Institute discusses new approaches to pediatric cancer treatment specifically for BRAF-mutant pediatric glioma. Low-grade glioma (LGG) is the most frequently diagnosed brain tumor in children, and although five and ten-year survival is quite high, this does not reveal the toxicity of current therapies. Conventional treatment includes intensive chemo-radiation therapy that can lead to cognitive decline, malignant transformation, and other life-debilitating or -threatening sequelae. (1) The 15-year incidence of adverse outcomes such as blindness, hearing loss, obesity, and hormonal imbalance is 18%, 22%, 53%, and approximately 25%, respectively. Among survivors assessed for intellectual function, 34% had an intelligence quotient (IQ) below average. Treatment-resistant progressive disease is the most common cause of death. (2)

Ten-year overall survival of localized lower thoracic and esophagogastric junction carcinoma receiving trimodality therapy: A National Cancer Database analysis.

278 Background: Trimodality therapy, consisting of chemotherapy and radiation followed by esophagectomy, represents the prevailing standard of care for most patients with localized lower thoracic and esophagogastric junction (EGJ) carcinoma. However, robust data reporting the survival of this patient group treated in the real-world setting is lacking. The primary objective of the current study was to comprehensively analyze the long-term survival of this patient population receiving treatment in a real-world setting and the variables that significantly influence the survival. Methods: We identified adult patients in the National Cancer Database with localized (cT1N+M0 or cT2-T4N+/-M0) lower thoracic or EGJ adenocarcinoma (AC) or squamous cell carcinoma (SCC) receiving trimodality therapy between 2004 and 2020 with multi-agent chemotherapy and ≥ 4139 cGy of radiation followed by esophagectomy. The primary endpoint of the analysis was overall survival (OS), estimated using the Kaplan-Meier method. The impact of clinical and demographic features on OS was determined using the log-rank test. We performed a multivariable (MV) Cox analysis to evaluate the independent association of clinical and demographic variables on OS (data presented as hazard ratio [HR] and 95% Confidence Interval [CI]). Results: The analysis included 21,965 patients, characterized by a median age of 63 years, predominance of males (85.9%), non-Hispanic white patients (89.4%), and AC histology (93.6%). Most patients had T2/T3 tumors (87.3%) and regional lymph node (LN) involvement (62.1%). The 10-year OS for the entire cohort was 27.6% (95% CI, 26.8%-28.5%), with a median OS of 40.7 months (95% CI, 39.7-41.6). For patients aged ≤ 65, the 10-year OS was 31.2% (95% CI, 30.2%-32.3%), with a median OS of 44.1 months (95% CI, 42.8-45.5). On MV analysis, the following factors were associated with inferior OS with CI in the parenthesis: age ≥ 66 years (1.17, 1.11-1.22); male gender (1.13, 1.08-1.19); histology, AC vs. SCC (1.19, 1.10-1.28); T4 vs. T1-T3 tumor stage (1.20, 1.07-1.34); lymph node involvement (1.22, 1.18-1.27); Charlson-Deyo score ≥ 2 (1.23, 1.15-1.32); uninsured vs private insurance (1.20, 1.05-1.36); and low-volume facility (1.08, 1.01-1.16). Furthermore, patients treated after 2012 (2013-2019) had modestly improved OS (0.87, 0.84-0.90), perhaps reflecting the impact of the CROSS trial result published in 2012. Conclusions: This study illustrates the grim long-term survival of patients with localized lower thoracic and EGJ cancer undergoing standard trimodality therapy, underscoring the urgent necessity for innovative therapeutic approaches for this patient group. The improvement in OS following the publication of the CROSS trial was modest.

Optimal Cumulative I-131 Activity in Metastatic Differentiated Thyroid Cancer: Balancing Efficacy and Adverse Events.

The optimal cumulative activity (CA) of I-131 therapy for patients with metastatic differentiated thyroid cancer (mDTC) remains contentious. This study aimed to determine the maximum CA of I-131 that could be administered without a significant increase in adverse events (AEs) by analyzing a long-term cohort of patients. Data from mDTC patients treated with I-131 therapy and followed for at least two years from 1967 to 2019 were reviewed. Patients were categorized into three groups based on the received CA: Group-A (≤600mCi), Group-B (>600-1000mCi), and Group-C (>1000mCi). The study assessed long-term AEs and survival outcomes. The study included 671 adult mDTC patients (mean age 48 years, range: 19-81) with a median follow-up of 122 months (IQR: 82-180). Group A, Group B, and Group C comprised 269 (40.0%), 212 (31.6%), and 190 (28.4%) patients, respectively. Ten-year survival rates were 72%, 42.7%, and 29% in Groups A, B, and C, respectively. A total of 40/671 (6%) AEs were observed in 38 patients: 3 (1.1%), 12 (5.7%), and 25 (13.2%) in Groups A, B, and C, respectively. Five patients developed second primary malignancy (SPM): 3 in Group A and one each in Group B and C. However, CA >1000mCi of I-131 was associated with significant increase in bone marrow suppression, decreased pulmonary function, and xerostomia (p < 0.001). The study suggests that a maximum CA of up to 1000mCi strikes a favorable balance between keeping AEs low and benefiting a subset of patients with extensive metastases showing intense I-131 concentration.

Ten-year clinical outcome and survival rate of cemented total hip arthroplasty in Yaoundé

Ten-year clinical outcome and survival rate of cemented total hip arthroplasty in Yaoundé

Outcome of Hairy Cell Leukemia: A Single-center Study

Abstract: BACKGROUND: Hairy cell leukemia (HCL) is a rare chronic B-cell lymphoproliferative disorder. Modern therapy with purine analogs and immunotherapy can provide long-term remission, but the risk of recurrence remains about 40%–50%. The aim of this study was to evaluate the outcome of patients with HCL who received treatment in Nanakali Hospital. PATIENTS AND METHODS: A retrospective cross-sectional study was carried out on 50 patients of HCL diagnosed from 2004 to 2022 in Nanakali Hospital in Erbil City, Kurdistan Region, Iraq. Demographics, clinical presentation, treatment data, complications, response, recurrence, and survival data were collected from medical records. The results were presented with descriptive statistics. Variables were compared by Chi-square analysis. RESULTS: The mean age was 52.64 ± 12.37 years, and 84% were male. The most common presenting symptoms were splenomegaly (18%) and fatigue (14%). The majority (69.6%) received cladribine; the response rate was 73.9%, with a complete remission (67.4%). 47.8% had recurrent disease. The most common adverse effects were febrile neutropenia (58.7%) and Grade III and IV hematologic toxicity (41.3%). The results were significantly associated with ANC pretreatment (P = 0.019), comorbidity (P = 0.001), and treatment response (P = 0.004). Cladribine–rituximab combination resulted in complete remission (100%). Ten-year overall survival was 70%. CONCLUSIONS: The results were broadly consistent with literature reports, demonstrating the efficacy and safety of cladribine with/without rituximab as first-line therapy for HCL but with a 30% mortality of concern. Further studies should identify modifiable factors that affect poor prognosis in subgroups to guide improvements in risk management of HCL.

Reconstruction following oncological iliosacral resection.

The sacroiliac joint (SIJ) is the only mechanical connection between the axial skeleton and lower limbs. Following iliosacral resection, there is debate on whether reconstruction of the joint is necessary. There is a paucity of data comparing the outcomes of patients undergoing reconstruction and those who are not formally reconstructed. A total of 60 patients (25 females, 35 males; mean age 39 years (SD 18)) undergoing iliosacral resection were reviewed. Most resections were performed for primary malignant tumours (n = 54; 90%). The mean follow-up for surviving patients was nine years (2 to 19). Overall, 27 patients (45%) were reconstructed, while 33 (55%) had no formal reconstruction. There was no difference in the use of chemotherapy (p = 1.000) or radiotherapy (p = 0.292) between the groups. Patients with no reconstruction had a mean larger tumour (11 cm (SD 5) vs 8 cm (SD 4); p = 0.014), mean shorter operating times (664 mins (SD 195) vs 1,324 mins (SD 381); p = 0.012), and required fewer blood units (8 (SD 7) vs 14 (SD 11); p = 0.012). Patients undergoing a reconstruction were more likely to have a deep infection (48% vs 12%; p = 0.003). Nine reconstructed patients had a hardware failure, with five requiring revision. Postoperatively 55 (92%) patients were ambulatory, with no difference in the proportion of ambulatory patients (89% vs 94%; p = 0.649) or mean Musculoskeletal Tumor Society Score (59% vs 65%; p = 0.349) score between patients who did or did not have a reconstruction. The ten-year disease-specific survival was 69%, with no difference between patients who were reconstructed and those who were not (78% vs 45%; p = 0.316). There was no difference in the rate of metastasis between the two groups (hazard ratio (HR) 2.78; p = 0.102). Our results demonstrate that SIJ reconstruction is associated with longer operating times, greater need for blood transfusion, and more postoperative infections, without any improvement in functional outcomes when compared to patients who did not have formal SIJ reconstruction.

Fifteen-year results of bilateral and unilateral internal mammary artery grafting

To evaluate the clinical effectiveness of bilateral internal mammary artery grafting over long-term (15 years) postoperative period. There were 276 patients divided into two groups: 135 patients (group A) underwent bilateral internal mammary artery grafting and 141 patients (group B) underwent unilateral internal mammary artery grafting together with venous bypass grafts. On-pump surgeries and cardioplegia, parallel CPB and on-pump procedures were performed in equal proportions. Mean age of patients was 57.3±7.6 years. Diabetes mellitus was detected in 21 (15.5%) and 24 (19.1%) patients, respectively (p>0.05). Mean LV ejection fraction was 55.4±9.9%, revascularization index - 3.1±0.8 and 3.0±0.7, respectively. In the 1st group, 43 patients underwent bilateral internal mammary artery grafting alone. Autovenous grafts were additionally used in other 84 patients. Ten-year survival exceeded 90% in both groups. Freedom from adverse cardiac events after 15 years was significantly higher in group A (77.3% vs. 59.3%, p=0.018). In group A, 16 patients died throughout this period due to cancer (50%), myocardial infarction (12.5%), stroke (18.8%) and complications of diabetes mellitus (6.3%). In group B, 22 patients died mainly from cardiac causes (myocardial infarction - 40.9%, cancer - 27.3%). Bilateral internal mammary artery grafting has obvious advantages over traditional coronary artery bypass grafting. If we take into account higher proportion of cardiac causes in structure of mortality in group B, we can talk about positive impact of bilateral internal mammary artery grafting not only on the quality of life, but also on life expectancy in long-term postoperative period.

Out-of-hospital cardiac arrest: Survival in children and young adults over 30 years, a nationwide registry-based cohort study

ObjectivesWe studied short-term (30-day) and long-term (up to ten-year) survival among children and young adults following out-of-hospital cardiac arrest (OHCA) in Sweden over the course of the past 30 years. We also studied the causes of OHCA in children and examined predictors of survival. SettingThis was a nationwide, registry-based cohort study, using the Swedish Registry of Cardiopulmonary Resuscitation. Our study comprised a cohort of 4,804 individuals aged 0 to 30 years who suffered OHCA between 1990 and 2020, in whom cardiopulmonary resuscitation (CPR) was initiated. We stratified the study cohort to distinct age groups and time periods. ResultsWe found an increase in 30-day survival from 7% to 20% over the span of 30 years. In those under 1 year of age, survival increased from 2% to 19%. Time to CPR decreased from 14 to 2 min. The 10-year survival was high among those who survived 30 days. The etiology of cardiac arrests exhibited significant variations across different age groups but remained relatively consistent over time. Causes linked to mental illness constituted a substantial percentage of these cases. Compared to the reference period (1990–1994), the odds of survival in 2015–2020 was 3.00 (95% CI: 1.43, 6.94; p = 0.006). ConclusionSurvival rate after OHCA in children and young adults has increased three-fold over the past 30 years. Still overall mortality is high underscoring the need for continued efforts to mitigate risk factors and optimize survival.

IMMEDIATE AND LONG-TERM RESULTS OF MINIMALLY INVASIVE AORTIC VALVE REPLACEMENT: SINGLE CENTER RETROSPECTIVE STUDY

HighlightsWe have conducted a retrospective analysis of patients who underwent minimally invasive aortic valve replacement, and evaluated immediate and long-term results of the surgery. AbstractAim. To study the immediate and long-term results of minimally invasive aortic valve (AV) replacement.Methods. The retrospective study included 208 patients with AV stenosis undergoing minimally invasive aortic valve replacement in the period from 2010 to 2019. The ratio of men to women was 1:1. The mean age of the patients was 63 (58–68) years old, with the minimum age being 29 years and the maximum being 81 years. The median follow-up period was 45.5 (11–68) months. Endpoints were as follows: hospital mortality, postoperative complications, long-term outcome (long-term survival, freedom from reoperation). Inclusion criteria were as follows: patients aged 18 years and older undergoing minimally invasive aortic valve replacement. Exclusion criteria were as follows: AVNeo, Ross procedure and AV replacement with aortic homograft, combined interventions (except for intervention on the ascending aorta), and standard access site.Results. The majority of patients (199 (95.7%) underwent “J”-shaped ministernotomy through the III-IV intercostal space. As a part of the combined intervention, ascending aorta replacement was performed in 6 (2.9%) patients. The duration of cardiopulmonary bypass and aortic cross-clamping was 91 (78–106) min and 68 (60–78) min, respectively. Due to conduction disorders, implantation of a pacemaker was performed in 5 (2.4%) patients, stroke was diagnosed in 1 (0.5%) patient, resternotomy for bleeding was performed in 4 (1.9%) patients, cardiac tamponade in 2 (1 %) patients, sternal infection was found in 1 (0.5%) patient. There were no complications such as AKI, perioperative MI, or hospital mortality in any patient. Five- and ten-year survival after surgical treatment of patients was 88.2% and 80.5%, respectively. Five- and ten-year freedom from reoperation on AV was 96.2% and 96.2%.Conclusions. Minimally invasive AV replacement is a measurable procedure with negligible complication rates. Minimally invasive aortic valve replacement has shown its effectiveness in the long-term period with acceptable rates of survival and freedom from reoperation.

Dermatofibrosarcoma protuberans in adult diagnose by a single biopsy

Dermatofibrosarcoma Protuberans (DFSP) is a rare cutaneous sarcoma with an overall incidence of 4.1 cases per million/year according to the largest population-based study of DFSP. This cutaneous sarcoma has an overall ten-year survival of 99.1% [1].

Oncological and functional outcomes after resection of malignant tumours of the scapula.

The scapula is a rare site for a primary bone tumour. Only a small number of series have studied patient outcomes after treatment. Previous studies have shown a high rate of recurrence, with functional outcomes determined by the preservation of the glenohumeral joint and deltoid. The purpose of the current study was to report the outcome of patients who had undergone tumour resection that included the scapula. We reviewed 61 patients (37 male, 24 female; mean age 42 years (SD 19)) who had undergone resection of the scapula. The most common resection was type 2 (n = 34) according to the Tikhoff-Linberg classification, or type S1A (n = 35) on the Enneking classification. The ten-year disease-specific survival was 76%. High tumour grade (hazard ratio (HR) 4.27; p = 0.016) and a total resection of the scapula (HR 3.84; p = 0.015) were associated with worse survival. The ten-year metastasis-free and local recurrence-free survivals were 82% and 86%, respectively. Total scapular resection (HR 6.29; p = 0.004) was associated with metastatic disease and positive margins were associated with local recurrence (HR 12.86; p = 0.001). At final follow-up, the mean shoulder forward elevation and external rotation were 79° (SD 62°) and 27° (SD 25°), respectively. The most recent functional outcomes evaluated included the mean Musculoskeletal Tumor Society Score (76% (SD 17%)), the American Shoulder and Elbow Score (73% (SD 20%)), and the Simple Shoulder Test (7 (SD 3)). Preservation of the glenoid (p = 0.001) and scapular spine (p < 0.001) improved clinical outcomes; interestingly, preservation of the scapular spine without the glenoid improved outcomes (p < 0.001) compared to preservation of the glenoid alone (p = 0.05). Resection of the scapula is a major undertaking with an oncological outcome related to tumour grade, and a functional outcome associated with the status of the scapular spine and glenoid. Positive resection margins are associated with local recurrence.

Sternal Metastasis in Follicular Thyroid Carcinoma: An Atypical Presentation

Follicular Thyroid Carcinoma (FTC), the second most common type of thyroid cancer, accounts for 10-20% of thyroid cancers, primarily affecting individuals over 40, and it tends to spread hematogenously to various organs. It often metastasizes to the lungs (49%) and bones (7-28%), including the spine, pelvis, skull, long bones, and rarely, the sternum. Metastatic FTC carries a poor prognosis, with a 3-21% ten-year survival rate when bone metastases are present. Sternal metastasis from thyroid carcinoma is exceptionally rare and significantly impacts prognosis. In this article, we present an unusual case of a 65-year-old patient who presented with a year-long compressive goiter. Examination revealed a firm, painless nodular goiter and a sternal mass. Tests showed a low TSH, normal T4, and thyroid nodules. Following thyroidectomy, a 7cm vesicular thyroid carcinoma was diagnosed. Sternal metastasis was confirmed through biopsy. The patient underwent sternal mass excision, responded well, and was referred for radioactive iodine therapy. Treatment options for metastases in FTC include surgery, radioactive iodine therapy and radiation. Surgical removal of metastases is crucial in such cases, as it can enhance the effectiveness of subsequent treatments and improve patient outcomes. This comprehensive management approach can offer a better quality of life and extended survival for patients facing this uncommon but challenging situation.

The Treatment of Burkitt Lymphoma with the Berlin-Frankfurt-Münster Protocol with Rituximab and Autologous Transplantation

Intensive treatment approaches are required for adult Burkitt lymphoma (BL), although a univocal standard of care still does not exist. The use of frontline autologous transplantation is debated. Between 2004 and 2020, 50 HIV-negative BL patients were treated with the Berlin-Frankfurt-Münster (BFM) protocol at our institution. Treatment plan consisted of 3 blocks, A (ifosfamide, vincristine, methotrexate, etoposide, cytarabine), B (vincristine, cyclophosphamide, methotrexate, doxorubicin) and C (vindesine, methotrexate, etoposide, cytarabine), each repeated twice, every 28 days. Patients elder than 60 years did not receive block C, thus blocks A and B were repeated 3 times. Rituximab was given at day 1 each block. Intrathecal prophylaxis was given once per each block. Autologous stem cells were reinfused (ASCT) at the end of the 6-blocks after BEAM (carmustine, etoposide, cytarabine, melphalan) conditioning, when feasible. Median age at onset was 38 years (range 16-72); 38 patients were male and 12 female. Stage III-IV disease was observed in 82% of cases; bulky disease occurred in 44% of the patients, with B-symptoms in 38%. Two patients did not receive rituximab because of adverse reaction and early death. Intrathecal prophylaxis was given in 96% of patients. Stem cell harvest was performed in 70% of patients, who all received a subsequent ASCT. The full 6-blocks treatment was completed in 70% of the patients; 8% received 5 cycles and 22% received ≤ 3 cycles. Early treatment interruption occurred because of disease progression (12%), toxicity (8%), death (4%) or other causes (4%). The overall response rate was 74%, with a complete response rate of 60%. Three patients could not be evaluated because of early progression/death. Ten-year overall survival and progression-free survival were 83.7% and 76.0%, respectively, with both curves exhibiting a plateau (Figure). Ten-year disease-free survival was 80.3%. Eight patients had died because of disease progression (3 patients), infection or sepsis (4 patients) or cardiac arrest (1 patient). Grade 3-4 neutropenia, thrombocytopenia, anemia and mucositis were seen in 96%, 60%, 32% and 24% of patients. Infections occurred in 60% of patients; grade 4 and fatal sepsis in 14% and 8% of cases. Intensive treatment according to BFM protocol, with rituximab and ASCT, appears feasible, safe and highly effective in adult patients with BL, as confirmed by long-term survival rates.

Acute Myeloid Leukemia (AML) from Older HSCs Is Resistant to Chemotherapy and Has an Altered DNA Damage Response

Acute myeloid leukemia (AML) is an aggressive malignancy that leads to the accumulation of immature myeloid precursors, resulting in progressive marrow failure and death. AML arises from the hematopoietic stem cell (HSC), either directly or through an early myeloid precursor. HSCs must survive for the entire human lifespan to provide the 200+ billion blood cells that are produced daily. They are subjected to the entirety of the aging process. Further, while AML is diagnosed in every age range, it disproportionately affects older patients, with a median age at diagnosis of 68. Older age, typically defined as 60 years of age or older, is a powerful, poor prognostic factor. Clinical trials show an estimated 5-year survival of less than 10% in these patients. Ten-year survival is even worse with one study estimating 2.4% of patients over 60 years of age alive at ten years when treated with chemotherapy. Importantly, this poor outcome is the result of disease that is significantly more resistant to therapy. Even though this clinical data is well known the underlying mechanisms of therapy resistance in older AML are unknown. To address this, we generated genetically identical AML cells from fetal, 12-week-old (Young) or 24-month-old (Old) murine HSCs. Retroviral vectors were used to express the oncogenic MLL-ENL fusion protein and NRas G12D. AML was confirmed by morphology, immunophenotype and all AML cells were lethal when injected into syngeneic recipients. Old AML cells demonstrated reduced autophagy, decreased NAD levels and impaired mitochondria consistent with a significant effect of biological aging. When treated with DNA damaging chemotherapy, Old AML cells were significantly more resistant than either Young or Fetal cells to both cytarabine and the anthracycline doxorubicin. To examine the DNA damage response AML cells were treated with doxorubicin and stained for the early DNA damage marker gH2AX. Old AML cells generated significantly more gH2AX than either Fetal or Young AML cells (Figure 1). We next examined the induction of p53 in response to treatment and in contrast to the gH2AX results Old AML cells induced the least amount of p53 in response to doxorubicin treatment (Figure 2). This data demonstrates that Old AML cells were more adept at recognizing DNA damage but least likely to induce p53 in response to it suggesting a difference in DNA repair. To better understand these differences RNA sequencing was performed and differentially expressed genes (DEGs) identified. When Fetal and Young AML cells were compared, no DEGs reached the false discovery threshold for significance, demonstrating that Fetal and Young AMLs have highly similar gene expression profiles. In contrast, when Old AML cells were compared to either Young or Fetal cells, hundreds of highly significant DEGs were identified, and KEGG pathway enrichment analysis revealed that several DNA repair pathways were significantly upregulated in Old AML. These include base excision repair (FDR p= 8.60E-06), mismatch repair (FDR p=3.26E-05), and nucleotide excision repair (FDR p= 0.00043). To further validate these pathways, the Beat AML TCGA dataset was assessed for the prognostic effect of increased expression of key genes in these pathways. Patients with increased expression of these genes had a trend toward worse survival (p=0.07) consistent with these pathways being clinically relevant. These data suggest that AML arising in older patients may overexpress DNA damage repair pathways leading to chemotherapy resistance and poor outcomes. Additional work on ways to increase sensitivity to Old AML cells is in progress.

Unsolved Issues in Thymic Epithelial Tumour Stage Classification: The Role of Tumour Dimension.

According to the different classifications now in use, thymic tumours are staged by the extent of local invasiveness, and tumour size is not included as a major determinant for the T category. The aim of this double-site retrospective study is to analyse the correlation between tumour dimension and overall survival (OS) in patients who underwent surgical treatment. From January 2000 to December 2020, patients with thymic epithelial tumours who underwent surgical resection were included in this study. Data from a total of 332 patients were analysed. Five- and ten-year overall survival (5-10 YOS) was 89.26% and 87.08%, respectively, while five- and ten-year disease-free survival (DFS) was 88.12% and 84.2%, respectively. Univariate analysis showed a significant correlation between male sex (p-value 0.02), older age (p-value < 0.01), absence of myasthenia gravis (p-value < 0.01), increase in pTNM (pathological Tumor Node Metastasis) (p-value 0.03) and increase in the number of infiltrated organs (p-value 0.02) with an increase in tumour dimension. Tumour dimension alone was not effective in the prediction of DFS and OS, both when considered as a continuous variable and when considered with a cut-off of 3 and 5 cm. However, with multivariate analysis, it was effective in predicting OS in the aforementioned conditions (p-value < 0.01). Moreover, multivariate analysis was also used in the thymoma and Masaoka I subgroups. In our experience, the role of tumour dimension as a descriptor of the T parameter of the TNM (Tumor Node Metastasis) staging system seemed to be useful in improving this system.

Use and Outcomes of Hepatitis B Virus-positive Grafts for Kidney or Heart Transplantation in the United States From 1999 to 2021.

The gap between demand and supply for solid organ transplants requires strategies to expand the donor pool. Successful use of hepatitis B virus (HBV)-positive grafts has been reported in liver transplantation. In this United Network for Organ Sharing database (January 1999 to June 2021) retrospective cohort study, outcomes of kidney transplant (KT) or heart transplant (HT) recipients with HBV donor grafts (hepatitis B surface antigen and/or for HBV nucleic acid test-positive) were examined. Propensity score matching was performed for HBV-positive to negative graft recipients (1:5 for renal transplantation and 1:10 for HT). Of 448 HBV-positive donors with 896 kidneys, 352 kidneys (39.3%) and 56 hearts (12.5%) were transplanted. Of these, 312 kidneys (88.6%) and 45 hearts (80.3%) were transplanted in hepatitis B surface antigen-negative recipients. Ten-year graft survival was 47.1% and 49% (log-rank P = 0.353), and patient survival was 58% and 59% ( P = 0.999) for KT recipients. Similar figures among HT recipients were 41.9% and 38.9% for graft survival ( P = 0.471), and 54.3% and 61.2% for patient survival ( P = 0.277). Subgroup analyses in recipients with HBV nucleic acid test-positive grafts irrespective of antibodies to HBV core antigen-positive status, and recipients negative for anti-HBs (548 renal transplantation and 209 HT) were similar. Although we are limited by lack of available data on posttransplant anti-HBV treatment, the study observations suggest that using HBV-positive grafts is a reasonable strategy to expand the donor pool among candidates waiting for KT or HT.

Outcomes following cardiac resynchronisation therapy in older people.

Older patients may be less likely to receive cardiac resynchronisation therapy (CRT) for the management of heart failure. We aimed to describe the differences in clinical response, complications, and subsequent outcomes following CRT implantation compared to younger patients. We conducted a retrospective cohort study of unselected, consecutive patients implanted with CRT devices between March 2008 and July 2017. We recorded complications, symptomatic and echocardiographic response, hospitalisation for heart failure, and all-cause mortality comparing patients aged <70, 70-79 and ≥ 80years. Five hundred and seventy-four patients (median age 76years [interquartile range 68-81], 73.3% male) received CRT. At baseline, patients aged ≥80years had worse symptoms, were more likely to have co-morbidities, and less likely to be receiving comprehensive medical therapy, although left ventricular function was similar. Older patients were less likely to receive CRT-defibrillators compared to CRT-pacemakers. Complications were infrequent and not more common in older patients. Age was not a predictor of symptomatic or echocardiographic response to CRT (67.2%, 71.2% and 62.6% responders in patients aged <70, 70-79 and ≥ 80years, respectively; P = 0.43), and time to first heart failure hospitalisation was similar across age groups (P = 0.28). Ten-year survival was lower for older patients (49.9%, 23.9% and 6.8% in patients aged <70, 70-79 and ≥ 80years, respectively; P < 0.001). The benefits of CRT on symptoms and left ventricular function were not different in older patients despite a greater burden of co-morbidities and less optimal medical therapy. These findings support the use of CRT in an ageing population.

Factors associated with survival in patients with clear cell sarcoma.

Clear cell sarcoma (CCS) of soft-tissue is a rare melanocytic subtype of mesenchymal malignancy. The aim of this study was to investigate the clinical and therapeutic factors associated with increased survival, stratified by clinical stage, in order to determine the optimal treatment. The study was a retrospective analysis involving 117 patients with histologically confirmed CCS, between July 2016 and November 2017, who were enrolled in the Bone and Soft Tissue Tumour Registry in Japan. The five- and ten-year survival rates were 41% (95% confidence interval (CI) 29 to 52) and 37% (95% CI 25 to 49), respectively. On multivariable analysis, the size of the tumour of > 10 cm (p = 0.006), lymph node metastasis at the time of diagnosis (p < 0.001), distant metastases at the time of diagnosis (p < 0.001), and no surgery for the primary tumour (p = 0.019) were independently associated with a poor survival. For N0M0 CCS (n = 68), the development of distant metastases was an independent prognostic factor for survival (early (< 12 months), hazard ratio (HR) 116.78 (95% CI 11.69 to 1,166.50); p < 0.001; late (> 12 months), HR 14.79 (95% CI 1.66 to 131.63); p = 0.016); neoadjuvant/adjuvant chemotherapy (p = 0.895) and/or radiotherapy (p = 0.216) were not significantly associated with survival. The five-year cumulative incidence of local recurrence was 19% (95% CI 8 to 35) and the size of the tumour was significantly associated with an increased rate of local recurrence (p = 0.012). For N1M0 CCS (n = 18), the risk of mortality was significantly lower in patients who underwent surgery for both the primary tumour and lymph node metastases (HR 0.03 (95% CI 0.00 to 0.56); p = 0.020). For M1 CCS (n = 31), excision of the primary tumour was independently associated with better survival (HR 0.26 (95% CI 0.09 to 0.76); p = 0.013). There was no significant difference in survival between the different types of systemic treatment (p = 0.523). Complete excision of the primary tumour and lymph nodes is associated with a better survival in patients with CCS. Systemic treatment appears to provide limited benefits, demonstrating a pressing need for novel systemic agents.

Radioactive iodine administration is not associated with improved disease-specific survival in classic papillary thyroid carcinoma greater than 4 cm confined to the thyroid

BackgroundWe aimed to evaluate the impact of radioactive iodine on disease-specific survival in intrathyroidal (N0M0) papillary thyroid carcinoma >4 cm, given conflicting data in the American Thyroid Association guidelines regarding their management. MethodsThe Surveillance, Epidemiology, and End Results database was queried for N0M0 classic papillary thyroid carcinoma >4 cm. Kaplan-Meier estimates were performed to compare disease-specific survival between radioactive iodine-treated and untreated groups. A multivariable Cox regression was performed to identify predictors of disease-specific survival. ResultsThere were more patients aged ≥55 (41.7% vs 32.3%, P = .001) and fewer multifocal tumors (25.3% vs 30.6%, P = .006) in the no radioactive iodine group. Ten-year disease-specific survival was similar between the radioactive iodine treated and untreated groups (97.2% vs 95.6%, P = .34). Radioactive iodine was not associated with a significant disease-specific survival benefit (adjusted hazard ratio = 0.78, confidence interval [0.39–1.58], P = .49). Age ≥55 (adjusted hazard ratio = 3.50, confidence interval [1.69–7.26], P = .001) and larger tumor size (adjusted hazard ratio = 1.04, confidence interval [1.02–1.06], P < .001) were associated with an increased risk of disease-specific death. Subgroup analyses did not demonstrate improved disease-specific survival with radioactive iodine in patients ≥55 and in tumors >5 cm. ConclusionAdjuvant radioactive iodine administration in classic papillary thyroid carcinoma >4 cm confined to the thyroid did not significantly impact disease-specific survival. Thus, these patients may not require routine treatment with adjuvant radioactive iodine.