Term Survival Of Patients Research Articles

Impact of Tumor Size and Differentiation Grade on Survival After Lobectomy and Segmentectomy for Patients with Early-Stage Lung Adenocarcinoma.

The purpose of this study was to investigate the effect of tumor size and differentiation grade on long term survival in patients with early-stage lung adenocarcinoma (LUAD) after lobectomy and segmentectomy. Patients with stage T1-2N0M0 LUAD who underwent lobectomy and segmentectomy were identified from the Surveillance, Epidemiology, and End Results database. Patients were stratified as grade I (well differentiated), grade II (moderately differentiated), and grade III/IV (poorly differentiated/undifferentiated) carcinomas. The effect of tumor size on overall survival (OS) and lung cancer-specific survival (LCSS) was evaluated using the multivariate Cox regression model, including the interaction between tumor size, type of surgery, and tumor differentiation grade. The inverse probability of treatment weighting method was used to adjust for bias between the groups. A total of 19,857 patients were identified, including 18,759 (94.4%) who underwent lobectomy and 1098 (5.5%) who underwent segmentectomy. A three-way interaction among tumor size, differentiation grade, and type of surgery was observed in the overall cohort. After stratifying by differentiation grade, plots of interaction revealed that lobectomy was associated with improved survival compared with segmentectomy when the tumor size exceeded 23 mm for grade I LUAD and 14 mm for grade II LUAD. No interaction was observed between the studied factors in grade III/IV carcinomas. This study interpreted the interaction between tumor size and type of surgery on long-term survival in patients with early stage LUAD and established a tumor size threshold beyond which lobectomy provided survival benefits compared with segmentectomy.

Development and validation of a clinical decision tool for preoperative micropapillary and solid pattern lung adenocarcinoma of CT≤2cm.

Micropapillary (MP) and solid(S) pattern adenocarcinoma are highly malignant subtypes of lung adenocarcinoma. In today's era of increasingly conservative surgery for small lung cancer, effective preoperative identification of these subtypes is greatly important for surgical planning and long term survival of patients. For this retrospective study, the presence of MP and/or S was evaluated in 2167 consecutive patients who underwent surgical resection for clinical stage IA1-2 lung adenocarcinoma. MP and/or S pattern-positive patients and negative-pattern patients were matched at a ratio of 1:3. The Lasso regression model was used for data dimension reduction and imaging signature building. Multivariate logistic regression was used to establish the predictive model, presented as an imaging nomogram. The performance of the nomogram was assessed based on calibration, identification, and clinical usefulness, and internal and external validation of the model was conducted. The proportion of solid components (PSC), Sphericity, entropy, Shape, bronchial honeycomb, nodule shape, sex, and smoking were independent factors in the prediction model of MP and/or S lung adenocarcinoma. The model showed good discrimination with an area under the ROC curve of 0.85. DCA demonstrated that the model could achieve good benefits for patients. RCS analysis suggested a significant increase in the proportion of MP and/or S from 11% to 48% when the PSC value was 68%. Small MP and/or S adenocarcinoma can be effectively identified preoperatively by their typical 3D and 2D imaging features.

Long term survival in patients with classic infantile Pompe disease reveals a spectrum with progressive brain abnormalities and changes in cognitive functioning.

The aim of this longitudinal cohort study, is to provide more insight into the pattern of brain abnormalities, and possible consequences for cognitive functioning, in patients with classic infantile Pompe disease. We included 19 classic infantile Pompe patients (median age last assessment 8.9 years, range 1.5-22.5 years; 5/19 CRIM negative), treated with ERT. Using MR imaging of the brain (T1, T2, and FLAIR acquisitions), we classified progression of brain abnormalities on a 12-point rating scale at multiple time points throughout follow-up. Additionally we noted specific white matter patterns and examined atrophy. Cognitive development was studied using Wechsler IQ assessments obtained by certified neuropsychologists. The association between age and cognitive functioning, and MRI ratings and cognitive functioning was assessed by linear regression models. All but one patient developed brain abnormalities. The abnormalities progressed in a similar pattern throughout the brain, with early involvement of periventricular white matter, later followed by subcortical white matter, gray matter structures, and juxtacortical U-fibers. We found a significant decline (p < 0.01), with increasing age for full scale IQ, performance IQ and processing speed, but not for verbal IQ (p = 0.17). Each point increment in the 12-point MRI rating scale was associated with a significant decline (3.1-6.0 points) in all the IQ index scores (p < 0.05). The majority of long-term surviving patients in our cohort develop incremental brain MRI abnormalities and decline in cognitive functioning. This highlights the need for new therapies that can cross the blood-brain barrier in order to treat this CNS phenotype.

Impact of Pacemaker Implantation After Transcatheter Aortic Valve Replacement on Long-Term Survival in Patients With Bicuspid Aortic Valve

Limited data are available about the impact of permanent pacemaker (PPM) implantation on long-term survival in patients with a bicuspid aortic valve (BAV) and severe aortic stenosis (AS) treated with transcatheter aortic valve replacement (TAVR). We aimed to evaluate the long-term clinical outcomes of patients with BAV with AS who underwent periprocedural PPM implantation after TAVR with a self-expandable prosthesis. Data from patients with BAV and severe AS who underwent TAVR between April 2009 and January 2022 and followed in the framework of the One Hospital ClinicalService-CoreValve Project were collected. Patients were categorized in 2 groups according to PPM implantation after TAVR ("PPM" group) or not ("no PPM" group). The coprimary end points were all-cause death and a composite of cardiac mortality, rehospitalization because of cardiac causes, stroke, and myocardial infarction. Overall, 106 patients were considered (74 in the "no PPM" group and 32 in the "PPM" group). No statistically significant difference was found between the groups in terms of follow-up and baseline characteristics. Patients in the PPM group were more likely to show baseline conduction abnormalities (p=0.023). Patients in the PPM group were more often treated with older generation prosthesis than those in the no PPM group (28.1% vs 5.4%, respectively, p=0.013). At 2years of follow-up, all-cause death in the no PPM and PPM groups occurred in 20.0% and 10.0% of patients, respectively (hazard ratio 0.37, 95% confidence interval 0.08 to 1.67). Similarly, no difference was evident for the composite end point between the 2 groups (no PPM vs PPM: 8 [14.6%] vs 6 [19.3%], hazard ratio 1.67, 95% CI 0.58 to 4.81). In conclusion, patients with severe AS and BAV treated with TAVR complicated by PPM implantation are not exposed to an increased risk of major adverse events at 2years of follow-up.

The Functional Erythropoetin rs1617640 Gene Polymorphism does not Affect Life Expectancy of Patients with Peripheral Arterial Disease.

A common functional variant (c.-1306A C, rs1617640) in the gene encoding erythropoietin (EPO) has been linked to expression of erythropoietin and markers of erythropoiesis. Aim of the current study was the analysis of the role of this polymorphism for long term survival of patients with peripheral arterial disease (PAD). EPO genotypes as well as biomarkers for erythropoiesis were analyzed in a cohort of 946 patients with PAD. Survival follow-up was performed 20 years af-ter recruitment of patients. Twenty years after recruitment, 752 (79.5%) patients were dead, 103 (10.9%) were still alive, and 91 (9.6%) were lost-to-follow up. In a Cox regression analysis including smoking habit, sex, type-2 diabetes, hypercholesterolemia and arterial hypertension, EPO genotypes were not associated with overall survival (Hazard ratio 0.63; 95% confidence interval 0.88-1.08, p = 0.63). The functional EPO rs1617640 gene polymorphism, irrespective of its association with markers of erythropoiesis, does not affect survival of PAD patients.

Long term survival in patients with bony oligometastatic breast cancer treated with curative intent: An institutional case series.

e12574 Background: Despite recent advances in treatment, metastatic breast cancer is widely recognized as a generally incurable condition. However, oligometastatic disease remains a poorly characterized condition with few clinical trials exploring treatments and outcomes. The term itself lacks a formal definition but is often used to refer to breast cancer displaying ≤5 metastatic sites, not necessarily in the same organ. Surgical management of discrete metastases has failed to demonstrate long-term benefit, while radiotherapy for isolated bone metastases has shown promise in some retrospective studies resulting in prolonged disease-free interval. Metastatic breast tumors overexpressing HER2 represent a category where systemic therapy may offer some prolonged remission or even cure. Methods: We are conducting a retrospective review of breast cancer patients with oligometastatic disease, as defined by ≤5 sites of disease, treated at Fred Hutch Comprehensive Cancer Center (FHCC) from 2000 to 2022; we will characterize FHCC provider practices, therapies delivered, goals of treatment, and long-term outcomes. This larger ongoing effort will be reported in a separate publication. Among a cohort of patients initially identified and undergoing record review, we reviewed all patients with bone-only disease and report their outcomes here. Results: We initially identified 17 cases of oligometastatic breast cancer currently undergoing treatment at FHCC. Of these, we noted that five patients had bone-only metastases and displayed marked similarities in treatment and outcome. All presented with de novo metastatic disease, and all five had ≤2 sites of metastasis, all in the axial skeleton. Four had HER2+ tumors; of these, three were also hormone-receptor positive. The remaining patient had triple-negative disease. All were treated with curative intent, with radiation to isolated bone metastases delivered concurrently with adjuvant radiation to breast/axilla. All are living today, with a median 56 months of follow up. One remains on a systemic metastatic regimen with a CDK4/6 inhibitor, while the rest are off therapy or are completing a standard adjuvant regimen. Conclusions: Oligometastatic breast cancer represents a heterogeneous entity that may in some instances be curable, but we lack sufficient data to identify which patients may benefit from therapy with curative intent. Standard curative treatment combined with radiotherapy to isolated bone metastases produced long-term survival in five current FHCC patients, which is consistent with other reports on patients with a low burden of bone-dominant metastatic disease. Further research is needed to validate curative approaches to therapy for this understudied population.

Pathologic response with neoadjuvant chemotherapy, immunotherapy, and chemo-immunotherapy for muscle-invasive bladder cancer (MIBC): A systematic review and meta-analysis.

531 Background: Neoadjuvant cisplatin-based chemotherapy (NAC) is established in the management of MIBC. Pathologic complete response (pCR, ypT0N0) and downstaging (&lt;ypT2N0) are associated with long term survival in patients with MIBC. Several trials have evaluated neoadjuvant immunotherapy (NAI) and chemoimmunotherapy (NACI) for MIBC. We aimed to conduct a meta-analysis of available trials to compare the incidence of pathological response with NAC, NAI and NACI in MIBC patients undergoing radical cystectomy. Methods: Phase II/III clinical trials assessing neoadjuvant systemic therapies (NAC, NAI, or NACI) in patients with MIBC undergoing radical cystectomy were identified through a systematic search of MEDLINE and EMBASE. Outcomes of interest included pCR and pathological downstaging. A DerSimonian and Laird random-effect meta-analysis was conducted to estimate pooled incidence of events using the Freeman-Tukey transformation. Clopper-Pearson method was used to estimate the associated 95% confidence intervals (CI). Results: Of the 5357 records initially identified, 28 trials with a total of 2138 patients were considered eligible for inclusion. Neoadjuvant chemotherapy was assessed in 15 trials (1535 patients), NAI in 5 (288 patients), and NACI in 8 (315 patients). The pooled incidence of patients experiencing a pCR was 30.91% (95% CI: 26.54%-35.45%) with NAC, 30.92% (23.22%-39.14%) with NAI, and 42.25% (36.6%-48.0%) with NACI. The difference in pCR among these therapies was statistically significant (p &lt;0.05). Similarly, the pooled incidence of achieving pathological downstaging was 40.91% (34.26%-47.72%) with NAC, 38.84% (26.73%-51.64%) with NAI, and 62.88% (57.22%-68.39%) with NACI. Consistently, there was statistically significant effect modification by the choice of neoadjuvant systemic therapy (p &lt;0.01). The results were consistent across different clinically important subgroups (Table). Conclusions: NACI may achieve better pCR and pathological downstaging than NAC and NAI alone in MIBC patients which may potentially be associated with long-term survival. Definitive data from phase III trials are pending. [Table: see text]

Does preoperative chemotherapy affect long term survival in patients with colorectal liver metastases? A real-world nationwide propensity-matched study.

Does preoperative chemotherapy affect long term survival in patients with colorectal liver metastases? A real-world nationwide propensity-matched study.

Altered mental status is an independent from age, gender, and low oxygen saturation risk factor for long term mortality in patients with COVID-19

Aim: The aim of the study was to determine the clinical characteristics and long term survival in patients with SARS-CoV-2 infection presenting with AMS. Material and methods: Retrospective analysis of the medical records was performed. The patients were divided into a group 1 with AMS and a group 2 without AMS. Demographics, the presence of concomitant diseases, systolic and diastolic blood pressure, heart rate and peripheral oxygen saturation (SpO2) were compared between the group that presented with AMS and the group that did not present with AMS. Survival analysis was performed with multiple regression models. The study was approved by Bioethical Commission. Results: The study group consisted of 174 patients aged 65±14 years. There were 88 (51%) women and 86 (49%) men. AMS at hospital admission was recognized in 14 (8%) patients. The patients with AMS were significantly older. Follow-up data were available for 163 patients. The median follow-up time was 467 (20-484) days. The 30 day mortality was 24% and the long term mortality was 30%. Conclusions: AMS occurs in about 8% of patients with COVID-19 admitted to the hospital. AMS is an independent from age, gender, and low oxygen saturation risk factor for long term mortality in patients with COVID-19 disease. Quarantine have the importance of early diagnosis of SARS-CoV-2 infection and patient monitoring in preventing deaths. The long term mortality in comparison to 30-day mortality doubled in patients with AMS and only slightly increased in patients without AMS.

Do Patient Delay and Diagnostic Delay Influence Long Term Survival in Patients with Gastric Cancer?

Gastric cancer is one of the most common malignancies, with an aggressive evolution and a poor long-term prognosis. No screening program is available in Europe for this pathology; therefore, the delay from the appearance of the first symptom until the initiation of treatment might influence the prognosis of gastric cancer patients. We aimed to investigate the impact on the prognosis of the delay in the presentation and diagnosis in patients with gastric adenocarcinoma. Our study is a retrospective, single-center, observational cohort study, based on patients diagnosed with gastric adenocarcinoma and operated in our institution between 2013 and 2021. We have defined patient delay as the time from the onset of symptoms to the first encounter with a health care provider and diagnosis delay as the time from the first consultation with a health care provider to the establishment of the final diagnosis. A total of 671 patients were included in our study. The survival rate at 5 years was 55% for the patients operated with curative intent and 7.4% for the patients operated with palliative intent. Patient delay and diagnosis delay were not correlated with the overall survival. A lower survival was observed for patients admitted through transfer (p<0.001) or the emergency department (p<0.001). No statistically significant relationship was identified between patient delay or diagnosis delay and the age, gender or area of origin of patients. Patients that experienced melena or hematemesis had a shorter patient delay, with a highly significant statistical relationship (p<0.01). Patients that experienced nausea, epigastric pain, palpable epigastric tumor mass or anorexia also had a highly significant statistical relationship between the symptoms and the patient delay interval. The overall survival is not influenced by the patient delay or diagnosis delay. An earlier presentation was correlated with some specific exhibited symptoms: upper gastro-intestinal bleeding, abdominal pain, palpable epigastric tumor, nausea.

Long term survival in patients who sustained in-hospital cardiac arrest

Introduction: Cardiopulmonary resuscitation can be termed successful only if the victim survives to hospital discharge and returns to a reasonable quality of life. Aim: The aim of this study was to determine long term survival and quality of life of patients who sustained in-hospital cardiac arrest. Patients and Methods: This was a prospective interventional study of 1955 patients who sustained in- hospital cardiac arrest at a tertiary hospital in India. Adult patients who sustained cardiac arrest in the hospital were included in the study and patients who were &lt; 18 years of age, cardiac arrest in operation theatre and patients who were brought in ‘near death’ state to the hospital were excluded. Parameters were collected during two periods, before and after introduction of Modified Early Warning Score (MEWS). Results: In the PreMEWS period, 228 out of 1135 (20%) patients had return of spontaneous circulation (ROSC), of whom 59 survived to discharge (5.19%), 51 patients (4.49%) were alive at 6 months and 45 patients (3.96%) were independent at activities of daily living (ADL). In the PostMEWS period, 202 out of 820 patients (24.6%) had ROSC, of whom 138 patients (16.82%) survived to discharge, 110 were alive at 6 months (13.41%) and 99 (12.07%) were independent at ADL. Conclusion: The rate of return of spontaneous circulation, survival to discharge rate, 6 month survival and independence at activities of daily living are all better with the use of modified early warning score.

The Abdominal Aortic Aneurysm Get Fit Trial: A Randomised Controlled Trial of Exercise to Improve Fitness in Patients with Abdominal Aortic Aneurysm

Ruptured abdominal aortic aneurysm (AAA) carries a mortality rate of up to 80%. Elective repair prevents rupture, but peri-operative mortality remains at 2% – 3%. This mortality rate and long term survival rate are associated with impaired peak oxygen uptake (peak VO2), oxygen uptake at anaerobic threshold (AT) and ventilatory equivalent for CO2 (VECO2) at AT on cardiopulmonary exercise testing (CPET). Improving fitness to optimise these variables could improve peri-operative and long term survival, but the required exercise training suitable for patients with AAA has yet to be established. This randomised controlled trial aimed to evaluate the effectiveness of 24 week, patient directed, community based exercise on CPET measured fitness in AAA surveillance patients. This was a prospective randomised controlled trial in a tertiary UK vascular centre conducted using CONSORT guidelines. Patients on AAA surveillance (n = 56) were randomly assigned to either (1) a 24 week community exercise programme (CEP) with choice of gym or home exercises, or (2) standard clinical care including advice on weight loss and exercise. The primary outcome was change in peak VO2 at 24 weeks, with secondary outcomes including AT, VECO2, cardiovascular biomarkers (lipid profile, pro-B-type natriuretic peptide, and high sensitivity C reactive protein, body mass index, and HRQoL. Follow up was at eight, 16, 24, and 36 weeks to evaluate duration of benefit. All analyses were performed on an intention to treat basis. CEP patients (n = 28) achieved mean (95% confidence interval [CI]) improvements from baseline in peak VO2 of 1.5 (95% CI 0.5 – 2.5), 2.1 (95% CI 1.1 – 3.2), 2.3 (95% CI 1.2 – 3.3), and 2.2 (95% CI 1.1, 3.3) mL/kg/min at 8, 16, 24, and 36 weeks, respectively. These changes in CEP patients were significantly greater than those seen in control patients at 16 (p = .002), 24 (p = .031), and 36 weeks (p < .001). There were also significant improvements in AT, triglyceride levels, and HRQoL in CEP patients. This CEP significantly improved those CPET parameters associated with impaired peri-operative and long term survival in patients following AAA repair. These improvements were maintained at 12 weeks following the end of the programme.

Chinese experts consensus on the prevention and treatment of complications caused by intraperitoneal perfusion chemotherapy for gastrointestinal tumors (2022 edition)

Peritoneal metastasis is one of the common metastasis of gastrointestinal malignancy. Intraperitoneal chemotherapy (including hyperthermic intraperitoneal chemotherapy and intraoperative intraperitoneal chemotherapy) not only can effectively increase the peritoneal drug concentration, but also can reduce side effects of systemic chemotherapy. It can significantly prolong the long term survival of patients with peritoneal metastasis and improve the quality of life. In order to standardize the popularization and application of intraperitoneal chemotherapy, relevant professional committees have formulated expert consensus on intraperitoneal chemotherapy. However, there is no systematic guidance on the prevention and treatment of related complications of intraperitoneal chemotherapy. Under the guidance of the Complications Management Committee of the Colorectal Cancer Professional Committee of the Chinese Medical Association and the Colorectal Cancer Professional Committee of the Chinese Anti-cancer Association, we organized domestic experts in relevant fields to formulate this consensus according to the procedural specifications and relevant literature reports. This consensus aims to summarize the causes of common complications of intraperitoneal chemotherapy such as pneumonia, intraperitoneal hemorrhage, fever, peritonitis, ileus, intestinal dysfunction, anastomotic bleeding, anastomotic leakage, leakage or infection of perfusion tube, nausea and vomiting, myelosuppression, hepatic or nephritic dysfunction. After repeatedly soliciting the opinions of domestic authoritative experts and their discussion and modification, a consensus was formed to provide effective reference for the prevention and treatment of complications.

Gene Mutation and MRD-Directed Risk Stratification Treatment Improves Long Term Survival of the Patients with AML1-ETO-Positive AML

Purpose: Aim to explore whether risk stratification treatment could improve the disease outcome of the patients with AML1-ETO-positive acute myeloid leukemia (AE-AML) based on gene mutation with next generation sequencing (NGS) and measurable residual disease (MRD) monitoring. Method: A prospective cohort study (NCT02936089) about newly diagnosed AE-AML was performed in five medical centers in China from October 2016 to December 2021. Gene mutations were detected with NGS. MRD monitoring of RUNX1-RUNX1T1 transcript was assessed with quantitative polymerase chain reaction. After two cycles of consolidation, patients received risk stratification treatment as follow. Low risk (LR) group (C-KIT-ASXL1- with main molecular response (MMR)) was recommended to chemotherapy or autologous hematopoietic stem cell transplantation (auto-HSCT). Intermediate risk (IR) group (C-KIT+/ASXL1+ with MMR) was suggested for auto-HSCT or HLA-matched sibling HSCT. High risk (HR) group (C-KIT+ASXL1+ or without MMR) was treated with allogeneic (allo-) HSCT. Result: Totally 198/207 patients including C-KIT-ASXL1- (n=100), C-KIT+/ASXL1+ (n=83) and C-KIT+ASXL1+ (n=15) were available for efficacy analysis in this study. Among the three groups, there was significantly different in the rate of 3-year overall survival (OS) (C-KIT-ASXL1-, 83.1% vs C-KIT+/ASXL1+, 67.4% vs C-KIT+ASXL1+, 23.0%，P<0.001) and cumulative incidence of relapse (CIR) (31.7% vs 33.9% vs 70.4%，P=0.001), while similar in the rate of CR and MRD negative after two cycles of induction (P>0.005). After two cycles of consolidation, the patients were stratified into LR (n=66), IR (n=57) and HR (n=72) groups.The 3-year OS rate (90.5% vs 71.4% vs 57.8%, P<0.001）and CIR (22.9% vs 31.9% vs 48.5%, P<0.001) were apparently different among the three groups. In the three risk groups, the patients following the treatment protocol all had significantly higher 3-year OS (LR 95.0% vs 86.1%，P=0.160; IR 92.3% vs 52.5%, P=0.006; HR 74.3% vs 25.0%, P<0.001) and lower CIR (LR 15.6% vs 27.2%，P=0.048; IR 15.0% vs 48.7%，P=0.006; HR 25.0% vs 84.1%，P<0.001) than those with bias treatment. Conclusion: AE-AML could be further risk stratified based on C-KIT/ASXL1 mutation status and MRD levels after two cycles of consolidation. Gene mutation and MRD-directed risk stratification treatment would improve the long term survival of AE-AML patients.

Cause Specific Analysis of Very Early and Early Mortality in Patients with Multiple Myeloma: Continued Improvements and Changes over Last 25 Years

Introduction: Long term survival of patients with Multiple Myeloma (MM) has been well studied and has improved over time owing to better understanding of disease biology, development of newer drugs, hematopoietic stem cell transplantation and surveillance. However, there is limited literature available looking into early mortality, even when a significant percentage of patients still die within a few years of diagnosis. Our objective was to determine the trend in MM and Non-MM related causes of very early (< 1 year) and early (1-5 years) mortality over the last 25 years. Methods: We identified patients with MM as first primary malignancy from the Surveillance, Epidemiology and End Results (SEER), 12 registries database for the 1992-2018 period using WHO ICD-O-3 codes. Demographic details, year of diagnosis, survival months, vital status and cause specific mortality until the study cutoff (December 31, 2019) were collected. Patients without survival months were excluded. The trend in overall survival over 1992-2000, 2001-2007, 2008-2014 and 2015-2018 time periods were compared by log rank test with p-value adjusted for multiple comparison between each time-period with Bonferroni correction. Non-Myeloma related causes including solid malignancies were categorized in broad 8 categories. Very early and early mortality were compared over the four time periods by Chi square method. P-values < 0.05 were considered statistically significant. Results: A total of 45,803 patients were identified in the SEER database. 811 patients with no survival data were excluded. A total of 44,992 patients were included in the final analysis. Among them, 28.6% (n=12,868) patients were of age up to 60 years, 42.24% (n=19,006) patients were of age 61-75 years and 29.16% (n= 13,118) patients were >75 years. 53.98% (n= 24,288) were Males. According to ethnicity, Non-Hispanic Whites were 62% (n=27,898), Non-Hispanic Blacks were 15.83% (n=7,124) and Hispanic were 12.45% (n= 5,603). Overall survival increased significantly over four time-period (adjusted p-value < 0.005 for all the comparison between each time-period). Median survival also increased from 1992-2000 to 2008-2014 time-period and not reached for 2015-2018 (Table). 72.68% (n= 32,695) patients died over the study duration. 72.42% (n=23,679) death were related to MM, whereas Non-MM related deaths were seen in 27.58% (n = 9,016) patients (Table). Among Non-Myeloma related deaths, the most common causes of very early mortality (<1 year) were CVS disease (9.85%), Infectious etiology (2.76%), CNS disease (1.51%) and Others (7.10%). The most common causes of early mortality (1-5 years) among non-myeloma related causes was CVS disease (9.9%), Infectious etiology (2.28%), Lung disease (1.81%) and others (7.22%) (Figure). Very early mortality was noted to decrease significantly from 31.89% for 1992-2000 to 19.55% for 2015-2018 (p-value 0.00). Early mortality improved significantly from 42.58% in 1992-2000 to 30.31% in 2008-2014 time-period (p-value 0.00). Proportion of myeloma related mortality decreased significantly for both very early (p-value - 0.001) and early mortality (p-value 0.000) for entire study duration. Conclusions: Early mortality in MM has been decreasing but remains a significant challenge. When compared to MM related causes, proportion of Non-MM related causes to early mortality have been increasing. Cause specific targeted approach like life style modification, screening and infection prevention should be implemented early to further improve the early mortality in this risk prone population. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Long Term Outcomes of Patients with Chronic Myeloid Leukemia Undergoing Allogeneic Hematopoietic Cell Transplantation in the Era of Oral Tyrosine Kinase Inhibitors

Introduction. Chronic Myeloid Leukemia (CML) is a myeloproliferative neoplasm (MPN) that without therapy is a uniformly lethal disease. Historically allogenic stem cell transplant (HCT) was the only curative therapy. In 2001 imatinib was the first CML specific oral tyrosine kinase inhibitor (TKI) approved and since then the treatment of CML has dramatically improved. Subsequently, 2nd and 3rd generation TKIs were developed and have been shown to be superior to imatinib either as initial therapy in certain high-risk patients and in other patients that fail imatinib. However, despite the advances in therapy, patients still die of CML, in fact, in 2020 it is estimated that 8,450 patients will be diagnosed with CML and 1,130 patients will die of CML. HCT remains a curative option for patients with CML. As the safety and availability of HCT improve, we aimed to describe the role of transplant in the modern era of CML therapy. Methods. We performed a retrospective chart review of patients who underwent their first HCT between June 28, 2006 and December 31, 2021 for CML in either chronic or accelerated phase at the time of transplant. Results. A total of 122 patients were identified. Patient and HCT characteristics are shown in Table 1. The median age at time of transplant was 45 (8-67), 72 (59%) are male. Fifty-four (44.3%) of patients received their transplant between 2006-2012 and 68 (55.7%) of patients received their transplants between 2013-2021. Fourteen (11.5%) patients were in accelerated phase CML at the time of HCT and the rest were in chronic phase. The median time from diagnosis to transplant was 23 months (1.8-307). Ninety-seven patients (79.5%) received ablative conditioning regimens. A total of 46 patients (37.7%) had matched related donors, 54 patients (44.3%) had matched unrelated donors, 14 patients (11.5%) had haploidentical donors, and 8 patients (6.7%) had a cord blood graft. 102 patients (83.6%) received peripheral blood stem cell grafts. GVHD prophylaxis always included a calcineurin inhibitor with the addition of methotrexate in 36 (29.5%) of patients, sirolimus in 60 (49.2%), Mycophenolate in 7 (5.7%), and post-transplant cyclophosphamide in 19 (15.6%) patients. Sixty-one patients (50%) had grade 2 or higher acute GVHD, and 19 (15.6%) had grade 3-4 acute GVHD. Extensive chronic GVHD was present in 81 (66.4%) of patients. Median follow-up of surviving patients was 59.3 months (3.3, 183.8) and overall the median follow-up was 30 months (0.55, 183.8). The estimated 12, 36, and 60-month Overall Survival (OS) of the cohort was 76.9% (95%CI 69.7-85), 66.1% (95% CI 57.7-75.6), and 58.4% (95% CI 49.4-69). Progression free survival (PFS) of the cohort at 12, 36, and 60 months was 71% (95% CI 63.2-79.7), 62% (95% CI 53.6-71.7) and 54.1% (45.1-65%) respectively. The median OS and PFS was not reached (Figure 1a,b). Fifty-two patients in the cohort died, 31 (59.6%) died of complications of treatment, 12 (23.1%) died of progression of disease, and 9 (17.3%) died of unknown causes. The day 100 cumulative incidence of non-relapse mortality (NRM) was 4.1% (1.7-9.7%) and the 1-year NRM was 17.2% (11.5-25.7%). Conclusion. This study shows excellent long term survival in patients who received an allo HCT for CML. And while, the modern treatment of CML largely relies on oral TKIs, in those patients who do not tolerate TKIs or fail available TKIs, allogeneic transplant remains an active, potentially curable therapy and should be considered. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Abstract 11310: Neurologic, Renal, and Visceral Malperfusion are Associated With Increased Mortality in Acute Type A Dissection but Not Lower Extremity Malperfusion

Introduction: The aim of this study was to evaluate malperfusion in patients presenting with acute type A dissection (ATAD) and correlate with mortality based on organ system involved. Methods: A registry of all patients who underwent ATAD repair at our tertiary referral center between 2002 and 2018 was retrospectively queried. Patients with type B aortic dissection and chronic type A aortic dissections (time from presentation &gt; 14 days) were excluded. Malperfusion syndromes at presentation including central nervous system (brain and spinal cord), visceral renal, and lower extremity (LE) were documented. Preoperative and intraoperative variables were analyzed, and post-operative outcomes were correlated with the malperfused organ system. Results: From 2002 to 2018, 378 patients underwent ATAD repair at our tertiary referral center. The average age was 57 years, 68% were male, and 51% were white. Approximately 70% of the cohort were transferred from an outside hospital. A total of 124 patients (33%) presented with malperfusion of at least one organ: 16% (N=62) LE, 8% (N=31) brain, 8% (N=30) renal, 3% (N=11) with visceral malperfusion, and 2% (N=8) with spinal cord malperfusion. On multivariate analysis, 30-day mortality was significantly increased in patients presenting with visceral ischemia (OR=3.7, P=0.04). The average follow-up was 2.3 years. Kaplan Meier survival curves showed a significant decrease in long term survival in patients presenting with brain (P=0.01), visceral (P=0.002), and renal ischemia (P&lt;0.001). No difference in short or long-term survival was seen in patients presenting with LE ischemia (P=0.28). Conclusions: In this review, 33% of ATAD patients presented with malperfusion of at least one organ system. Visceral malperfusion was associated with poor short-term survival, whereas CNS, renal, and visceral malperfusion had decreased long term survival. LE malperfusion had no association with short or long-term mortality.

CT analysis of left ventricular function predicts short term survival in patients following transcatheter aortic valve implantation: 1-year outcome data

Abstract Introduction Contrast-enhanced cardiac CT routinely performed prior to transcatheter aortic valve implantation (TAVI), allows assessment of cardiac morphology and function. We assessed left ventricular function in CT as a predictor of survival following TAVI. Methods 500 consecutive patients referred for CT assessment of aortic root anatomy prior to TAVI were screened for inclusion in this analysis. All CT data sets were acquired using a third-generation dual source system. For assessment of aortic root anatomy, acquisitions were acquired using ECG-gated retrospective spiral acquisition and multiphase reconstructions in 10% increments of the cardiac cycle were rendered (slice thickness 0.75, increment 0.4 mm). left ventricular endocardial contours were automatically traced by a dedicated software (syngo. via, Siemens Healthineers, Forchheim, Germany) throughout the cardiac cycle and manually adjusted if required. Global left ventricular function parameters (end-diastolic and end-systolic volumes, stroke volume, cardiac output and ejection fraction) were derived by volumetric assessment. Results Out of 500 patients, 439 patients (mean age 80±6 years, 56% males, and Log EuroScore 23±14%) were included in this analysis (61 patients were excluded due to poor CT image quality or missing outcome data). Previous cardiac surgery had been performed in 15% of the patients, 50% had obstructive CAD with previous interventional or surgical revascularisation and 18% had a previous acute coronary syndrome. One-year survival was 83% (366/439 patients). Parameters of left ventricular function were as follows: mean LVEDV 172±56 ml, mean LVESV 78±62 ml, mean LV ejection fraction 59±18%, mean LV stroke volume index 51±22 ml/m2, mean LV cardiac output 6.6±3.3 L/min and LV cardiac index 3.5±1.7 l/min/m2. Cluster analysis of multiple LV-function surrogate parameters identified a group of patients with higher 1-year mortality, with LVEF identified as a predictor of 1-year survival with a cut-0ff of ≥37% associated with an OR 0f 0.52 (95% CI 0.27 to 0.98). Conclusion Assessment of left ventricular function using functional CT data sets is feasible and allows risk stratification of patients following TAVI. Among LV functional parameters, CT derived LV-ejection fraction with a cut-off ≥37% identifies patients with better short-term outcome. Funding Acknowledgement Type of funding sources: None.

Medium term survival in patients over ninety years-old undergoing pacemaker implantation

Abstract Background According to the Italian National Statistical Institute, the 12-month probability of survival in the general population between 90 and 94 years-old is 26%. Pacemaker (PM) implantation is often an urgent and necessary intervention, but in these patients the benefit in terms of quality and duration of life is unclear. Purpose To analyze characteristics, outcome and factors associated with survival in patients who had turned 90 at the time of PM implant. Methods All the PM implants performed in patients ≥90 from 1/1/2019 to 12/31/2020 were analyzed. Clinical parameters, device characteristics and follow-up data were extrapolated from the SuitEstensa Ebit reporting system; the exitus was verified by analyzing data from the Regional Health System. Results During the study interval, among the 554 patients undergoing PM implantation in our Center, 69 (12%) were ≥90 years-old (mean age 92±2 years, 46% male; complete/advanced AV block in 76%). Twenty-six (38%) patients had history of atrial fibrillation and 19 (28%) ischemic heart disease. A cardiological co-morbidity (excluding AF) was present in 23 patients (33%). Oncological, pneumological and neurological comorbidities were present in 12 (18%), 19 (28%) and 32 (46%) respectively. Renal impairment was present in 25 patients (36%). In 47 patients (68%) there were at least 2 co-morbidities. After implantation (single-chamber in 36, dual-chamber in 25 and VDD single-lead dual-chamber in 8 patients) complications occurred in 3 patients (2 pneumothorax and 1 lead dislodgment). Remote monitoring was activated in 57 patients (83%). Within August 31st 2021 (mean follow-up 288±193 days) 24 patients died (35%, 219±241 days after implant). Five patients (19% of patients implanted in 2019) died within 12 months. No patients died for device malfunction. Three patients died because of COVID-19 pneumonia. Renal dysfunction (Hazard Ratio-HR 8.05, p=0.002) and the presence of 2 or more co-morbidities (HR 6.03; p=0.015) were associated with a higher risk of death at univariate analysis; other significant variables were diabetes (HR 2.34; p=0.038), left ventricular ejection fraction (LVEF) (HR 0.70 for 5% variation; p=0.005), walking impairment (HR 2.99, p=0.006), the presence of oncological (HR 2.21; p=0.003), pneumological (HR 2.55; p=0.024) and neurological (HR 1.90, p=0.007) comorbidities. At multivariable analysis the only significant parameter associated with survival was LVEF (0.76 for 5% difference; p=0.043) Conclusions At our Center, patients ≥90 years-old undergo PM implantation mainly for advanced AVB. The good survival in the medium term, even better than expected in the general population, does not justify a too conservative attitude especially, but exclusively, in patients with less comorbidities. Funding Acknowledgement Type of funding sources: None.

The influence of surgery quality on the longtime results of gastric cancer combination therapy

Introduction. The aim of this study was to analyze the influence of surgical center experience on the long term survival of patients with locoregionally advanced gastric adenocarcinoma undergoing primary surgery, followed by comple­mentary chemoradiotherapy according to MacDonald regimen. Material and methods. 154 patients treated surgically, including 75 (48.7%) at the Maria Sklodowska-Curie National Research Institute of Oncology (NIO-PIB) in Warsaw, and 79 (51.3%) outside this center. Both groups were retrospectively analyzed. The compared groups were statistically homogeneous. The following parameters were analyzed: age, gender, tumor differentiation, TNM VII (2010) staging, nodal index, radicality of surgical treatment, tumor type according to the Lauren classification, clinical stage, presence of prognostic factors, overall survival time. Results. Among those patients operated on at NIO-PIB, 71 (94.7%) patients underwent radical resection, 4 (5.3%) cases were microscopically non-radical resection had. There were no macroscopically non-radical resections (0%). For patients operated on outside NIO-PIB, 60 (75.9%) R0 resections, 15 (19%) R1 resections and 4 (5.1%) R2 resections were performed. The percentage of radical resections was significantly higher at NIO-PIB (p = 0.001). In 77% of patients operated on at NIO-PIB, disease progression in terms of feature could be established. This percentage for patients operated on outside the NIO-PIB was 54% and was significantly lower (p = 0.001). The probability of 5-year survival was 41.6% in total, with 45.3% for the group of patients operated on in the NIO-PIB and 38.0% for the group of patients operated on outside the NIO-PIB, respectively (p = 0.628). Conclusions. The quality of surgical treatment was significantly higher in NIO-PIB. The difference in 5-year overall survival (OS) between the compared groups is not statistically significant. Complementary treatment with chemoradiotherapy (CRT) according to MacDonald regimen reduces the shortcomings in the quality of surgical treatment in locoregionally advanced gastric adenocarcinoma.