Three-year Patient Survival Rates Research Articles

Multislice helical computed tomography imaging diagnosis and surgical treatment of primary tracheal tumor in cardiothoracic surgery.

it aimed to explore the value of multislice helical computed tomography (MSCT) in the diagnosis and surgical treatment of primary tracheal tumors. 64 patients with the primary tracheal tumor who were diagnosed in Wuxi Second People's Hospital from March 2020 to March 2021 were selected as the research objects. MSCT imaging was performed on all patients, and suitable surgical methods. The pathological results were compared with original CT, CT virtual endoscopy (CTVE), and Comparisons were made using CT three-dimensional reconstruction images to evaluate the accuracy of MSCT diagnosis. Parameters such as postoperative complications and survival rates were observed to assess surgical effectiveness and safety. Compared with original CT images (70%, 72%, 70%), the diagnostic accuracy of VR images (80%, 80%, 80%), MPVR images (85%, 90%, 92%), and CTVE images (100%, 100%, 100%) was remarkably improved (P<0.05). The three-year survival rate of patients with smooth muscle tumors, malignant tumors, salivary gland adenoma, papillary tumors, and inflammatory polyp was markedly lower than that of the one-year survival rate, with a significant difference (P<0.05). The incidence of postoperative complications was 14.1%, with three cases resulting in complication-related deaths. the diagnostic accuracy of MSCT imaging of primary tracheal tumor was high. The diagnostic accuracy of CTVE was higher than that of VR and MPVR. Besides, surgical treatment of primary tracheal tumor had a substantial effect, with no serious postoperative complications.

Influence of depressive disorders on quality of life and three-year survival of patients with coronary heart disease

Abstract Background/Introduction Depressive disorders (DD) affect more than 350 million people in the general population, especially among patients with cardiovascular diseases. World Health Organization predicts that by 2030 coronary heart disease (CHD) and DD will become the leading causes of disability in the civilized countries of the world. This fact indicates the need to identify DR at the early stages of examination of patients with CHD for timely correction and improvement of prognosis. Purpose of the work To assess the quality of life and three-year survival rate of patients with CHD in combination with DR. Methods 122 patients with chronic CHD (with exertional angina of II-III functional classes) were included in the study on the basis of the cardiology department. The presence and level of depression, anxiety, and social adaptation were assessed using the Beck Depression Scales (BDI), Sheehan Anxiety (ShARS), Social Adaptation (Bosc). The three-year survival rate was also investigated. Two groups were formed: the first – 58 patients with CHD with DD and the second – 64 patients with CHD without DD. Data were presented as M ± SD. The difference was considered statistically significant at p&amp;lt;0.05. The 3-year survival rate of patients was assessed using the Kaplan-Meier method with the determination of differences between groups using the Wilcoxon-Gehan test. Results The groups were comparable in terms of the main clinical and demographic characteristics and concomitant therapy. In patients with depression, compared with patients without it, was identified an increased level of depression (BDI – 7.3±4.3 points vs 2.3±1.6 points, p=0.ehab724.275201) and anxiety (Shikhana – 37.6±20.3 points vs 18.3±12.4 points, p=0.0002); lower level of social functioning (Bosc – 35.0±7.3 points vs 39.3±5.8 points, p=0.04). The 3-year survival rate was 92.6% (113 people), of which in the first group – 87.9% (51 people), in the second – 96.9% (62 people). The worst survival rate (Gehan-Wilcoxon test, p=0.03) was noted in the group of CHD with DD. Conclusion(s) In patients with chronic CHD in combination with DD, an increased level of anxiety and a lower quality of life were revealed, which can worsen the course of CHD. The 3-year survival rate is significantly worse in patients with CHD with a DD in comparison with patients without mental disorders. Funding Acknowledgement Type of funding sources: None.

Результати ендопротезування суглобів при хондросаркомі кістки

У статті повідомляється про результати ендопротезування суглобів при хондросаркомі кістки. У результаті проведеного ендопротезування суглобів у 28 хворих ортопедичні ускладнення спостерігалися у 2 (7,1 %) пацієнтів та рецидиви пухлини у 2 (7,1 %) пацієнтів. Інфекційні ускладнення спостерігалися в 1 хворого, виконано видалення ендопротеза, встановлено цементний спейсер, через 6 місяців виконано реедопротезування кульшового суглоба. Асептична нестабільність ніжки ендопротеза спостерігалася в 1 пацієнта після ендопротезування колінного суглоба, виконано реендопротезування суглоба. При рецидиві хондросаркоми, який виявлено у 2 хворих в строки від 18 до 53 місяців, 1 пацієнту виконано ампутацію нижньої кінцівки на рівні середньої третини стегна, 1 пацієнту виконано ампутацію нижньої кінцівки на рівні нижньої третини стегна, у 3 хворих при дедиференційованій та мезенхімальній хондросаркомі з метастазами в легені проводились курси поліхіміотерапії з наступною метастазектомією. Функціональний результат кінцівки залежно від локалізації пухлини (за шкалою MSTS) після ендопротезування становив від 68,4 до 89,2%. Якість життя хворих за опитувальником EORTC QLQ-30 підвищилась з 40–50 балів до ендопротезування і становила в середньому 85–90 балів після ендопротезування. Загальна трирічна виживаність пацієнтів при хондросаркомі — 95,3 ± 1,7 %, п’ятирічна — 89,7 ± 2,1 %. При мезенхімальній і дедиференційованій хондросаркомі трирічна виживаність становила 0 %.

Prognostic value of infarct-related-lead Tpeak-Tend/QT ratio in patients with ST-segment elevation myocardial infarction.

Tpeak-Tend/QT ratio (Tp-e/QT) in patients with ST-segment elevation myocardial infarction (STEMI) is reportedly associated with major adverse cardiac events (MACEs). However, Tp-e/QT measurement methods are controversial, and few studies have clarified the effect of different Tp-e/QT measures on prognosis. Our study is the first to investigate the advantages of the Tp-e/QT measured by infarct-related-lead method in predicting MACEs during hospitalization and long-term mortality in patients with STEMI. A total of 427 STEMI patients undergoing primary percutaneous coronary intervention (PCI) were included in this study. The Tp-e/QT before PCI was measured by traditional 12-lead method and infarct-related-lead method. Outcomes were tested using comparative statistics, logistic regression, receiver operating characteristic (ROC) curve and Kaplan-Meier survival analysis. There were 62 (14.5%) patients who had MACEs in-hospital. Logistic regression showed that the Tp-e/QT in infarct-related-lead was an independent predictor (p < 0.001). The area under the ROC curve (AUC) of the Tp-e/QT in infarct-related-lead was larger than that in the Tp-e/QT in traditional 12-lead (0.889 vs 0.741), and the optimal cutoff value was 0.32. The three-year survival rate of patients in the infarct-related-lead Tp-e/QT < 0.32 group was better than Tp-e/QT ≥ 0.32 group in Kaplan-Meier survival analysis (93.9 vs 87.0%). When stratified according to infarct-related arteries, the results showed that the common odds ratio of patients in Tp-e/QT ≥ 0.32 group occurred MACEs was 1.562, P = 0.038. The infarct-related-lead Tp-e/QT performed better than the traditional 12-lead Tp-e/QT in predicting poor prognosis.

Circular RNA Hsa_circRNA_101996 promotes the development of Gastric Cancer via Upregulating Matrix Metalloproteinases-2/Matrix Metalloproteinases-9 through MicroRNA-143/Ten-eleven translocation-2 Pathway.

Background: The long-term survival rate of gastric cancer (GC) patients at advanced stages remains low worldwide. Circular RNAs (circRNAs) a newly studied type of non-coding RNA that play an important role in the pathogenesis and diagnosis of various diseases. In this research, we aimed to explore the functions of hsa_circRNA_101996 in GC cells and an animal model of GC.Methods: The expression of hsa_circRNA_101996, microRNA (miR)-143, and ten-eleven translocation (TET)-2 in GC tissues, the adjacent tissues, and cell lines were determined by quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Transwell assays were used to analyze the knockdown effects of hsa_circRNA_101996, miR-143, and overexpression of TET2 on cell proliferation, migration, and invasion abilities. Western blotting was used to analyze the expression of matrix metalloproteinases (MMP)2/MMP9. Binding interactions between, hsa_circRNA_101996 and miR-143 and between, miR-143 and TET2 were detected by Dual-luciferase reporter assays. Levels of protein expression were analyzed by Western blotting. Tumor models were established by subcutaneous injection of tumor cells in Bl6/Rag2/GammaC double knockout mice.Results: The result showed that hsa_circRNA_101996 expression was significantly upregulated in GC tissues compared to that in the adjacent tissues, and its level in cancer tissue was correlated with tumor size, lymphatic metastasis, and distant metastasis. Compared with the low hsa_circRNA_101996 expression group, the three-year survival rate of patients in the high hsa_circRNA_101996 expression group was significantly lower. The knockdown of hsa_circRNA_101996 dramatically suppressed the cell migration, invasion, and proliferation of GC cells by sponging to absorb miR-143 and elevated the expression of TET2. In vivo studies showed that the knockdown of hsa_circRNA_101996 delayed tumor growth. Furthermore, we revealed that TET2 regulates MMP2/MMP9 expression through the DNA demethylation pathway.Conclusion: Our findings indicate that hsa_circRNA_101996 promotes GC development by upregulating MMP2/MMP9 through miR-143/TET2 pathway, which may provide a novel target for GC.

Serum TSGF and miR-214 levels in patients with hepatocellular carcinoma and their predictive value for the curative effect of transcatheter arterial chemoembolization.

The purpose of this study is to evaluate the expression of tumor-specific growth factor (TSGF) and microRNA-214 (miR-214) in the serum of patients with primary hepatocellular carcinoma (PHC) and their predictive values for the curative effect of transcatheter arterial chemoembolization (TACE). A retrospective analysis of the clinical data of 87 PHC patients were treated with TACE. According to the curative effect 1 month after TACE, PHC patients were divided into disease control group (n=56) and disease progression group (n=31). The expression levels of TSGF and miR-214 were detected by qRT-PCR before or after treatment with TACE in disease control group and disease progression group. The predictive value of TSGF and miR-214 for the efficacy of TACE were evaluated by the receiver operating characteristic (ROC) curve. The Kaplan-Meier survival curve was drawn according to the critical value of ROC. The effect of pretreatment levels of TSGF and miR-214 was analyzed on the three-year survival rate of patients. After TACE treatment, the mRNA expressive of serum TSGF were increased in progression group, while the levels of miR-214 were decreased compared with control group (P<0.05). Importantly, at one month after TACE treatment, the levels of TSGF were decreased in control group and progression group, while the expression of miR-214 was increased compared with in both groups before TACE treatment(P<0.05). The result of ROC analysis showed that for predicting the curative effect of TACE, the levels of TSGF and miR-214 expression were (181.32, 0.63) (0.849 and 0.807) and (0.759-0.938, 0.707-0.907) in the cutoff values, AUCs and 95% confidence intervals, respectively. The result of Kaplan-Meier analysis showed that the 3-year survival rate of the low TSGF group was up-regulated than that of the high TSGF group [65.12% (31/44) vs. 30.23% (13/43); χ2=5.014; P=0.025]. The 3-year survival rate of the miR-214 high expression group was up-regulated than that of the miR-214 low expression group [61.70% (29/47) vs. 30.00% (12/40); χ2=6.928; P=0.008]. Serum TSGF and miR-214 could be used as potential biomarkers for PHC diagnosis and prognosis.

The expression of SOX9, Tiam1, and PTEN is correlated with angiogenesis and prognosis in gastric cancer.

BackgroundWith a high rate of metastasis and recurrence, gastric cancer (GC), a common malignant tumor, often has a poor prognosis. GC tissues have abnormal expressions of the Sry-related HMG-box family of transcription factors (SOX9), T-lymphoma invasion and metastasis-inducing factor 1 (Tiam1), and phosphatase and tensin homolog deleted on chromosome ten (PTEN). Meanwhile, vascular endothelial growth factor (VEGF) have been reported to play an important role in tumor angiogenesis. This study aimed to analyze the correlation of SOX9, Tiam1, and PTEN with angiogenesis and prognosis in GC.MethodsA total of 90 patients who underwent GC surgery at our hospital between January 2017 and October 2018 were enrolled. The expressions of SOX9, Tiam1, PTEN, and VEGF in GC tissues and adjacent normal tissues were detected by immunohistochemistry and the differences were analyzed. Spearman’s correlation coefficient was applied to analyze the relationship between the expression levels of SOX9, Tiam1, PTEN, and VEGF. The patients were followed-up.ResultsThe positive expression rates of SOX9, Tiam1, PTEN, and VEGF in GC tissues were 75.56%, 61.11%, 52.22%, and 48.89%, respectively, compared with 6.67%, 4.44%, 97.78%, and 2.22%, respectively, in the adjacent normal tissues (P<0.05). Spearman’s correlation analysis showed that the expression of SOX9 (r=0.349, P=0.001) and Tiam1 (Tiam1: r=0.370, P=0.000) in GC tissues was positively correlated with VEGF expression; however, PTEN was negatively correlated with VEGF (r=−0.311, P=0.000). There were no significant differences in SOX9, Tiam1, or PTEN expression in GC tissues from patients of different genders or ages (P>0.05). When the tumor was low differentiated, with lymph node metastasis or high TNM staging, the positive expression rates of SOX9 and Tiam1 were significantly increased (P<0.05), while the positive expression rate of PTEN was significantly decreased (P<0.05). The log-rank test results showed that the three-year survival rates of the groups with positive SOX9 (54.41%) and Tiam1 expression (49.09%) were significantly lower than those of the groups with negative SOX9 and Tiam1 expression (77.27% and 77.13%, respectively; P<0.05). The 3-year survival rate in the PTEN positive expression group was significantly higher than that of the PTEN negative expression group (76.60% vs. 41.80%; P<0.05).ConclusionsSOX9 and Tiam1 are highly expressed, in GC tissues while there is a low expression of PTEN. The expression levels of SOX9, Tiam1, and PTEN are all linearly correlated with VEGF expression, and they have important effects on angiogenesis and is closely related to the three-year survival rate of patients with GC.

Ischemic cardiomyopathy: blood monocytes and mediators of their differentiation

BACKGROUND: The three-year survival rate of patients with ischemic cardiomyopathy (ICMP) is 535 %; its pathogenesis is poorly understood. Violation of cytokine-dependent differentiation of monocytes/macrophages involved in atherogenesis may play an important role in the development of ICMP.&#x0D; AIMS: To characterize the disorders of monocytes subpopulation composition and mediators spectrum of blood in patients with coronary heart disease (CHD), associated with the development of ICMP.&#x0D; METHODS: A one-stage, clinical, controlled (case-control) study was conducted from February 2017 to December 2018. 45 patients with CHD (all men), who were in a cardiac surgery hospital, were examined before coronary bypass surgery: 19 people suffering from ICMP, and 26 people who do not suffer from ICMP, as well as 14 healthy men. In the blood of the examined individuals CD14++CD16-, CD14++CD16+, CD14+CD16++ and CD14+CD16- monocytes were determined with respect to all CD14-positive cells by flow cytometry, in blood plasma ― concentration of galectin 2 and 9, IL-4, IL-10, IFN-, M-CSF, HIF-1 by enzyme-linked immunosorbent assay (ELISA).&#x0D; RESULTS: The development of the ICMP accompanied by deficiency of HIF-1 and CD14+CD16++ monocytes (0.037 [0.020; 0.045] ng/ml, p = 0.019, and 5.05 [4.08; 6.58] %, p = 0.011) in combination with an excess of IL-10 (30.05 [24.75; 33.50] ng/ml, p = 0.042) in the blood. It is shown in blood of patients without ischemic cardiomyopathy the increase in the content of CD14++CD16+ cells and lack of CD14+CD16- monocytes (25.27 [15.78; 31.39] %, p = 0.038, and 2.68 [2.63; 4.09] %, p = 0.027) at normal concentration of IL-10 and HIF-1. In patients with CHD and ischemic cardiomyopathy and without ICMP in the blood the concentration of M-CSF and galectin-2 (2.00 [1.21; 3.24] pg/ml, p = 0.028, and 0.40 [0.12; 2.37] ng/ml, p = 0.004; 3.00 [1.90; 4.05] pg/ml, p = 0.003, and 3.20 [2.07; 4.00] ng/ml, p = 0.002, respectively) is reduced at normal content of galectin-9, and CD14++CD16- monocytes. IL-4 and IFN- in blood plasma are not determined (zero values).&#x0D; CONCLUSIONS: The development of ICMP is associated with excess of IL-10 and HIF-1 deficiency, which is accompanied by inhibition of CD14+CD16++ monocytes maturation.

TOTAL MESORECTUMECTOMY IN THE SURGICAL TREATMENT OF RECTAL CANCER: OPEN OR LAPAROSCOPIC?

The OBJECTIVE of the work was to evaluate the long-term results of surgical treatment of patients underwent open and laparoscopic TME for rectal cancer.MATERIAL AND METHODS. The analysis of the results of surgical treatment of 103 patients aged from 20 to 70 years with rectal cancer was presented. Depending on the methods of total mesorectumectomy (ТМЕ), patients were divided into 2 groups. The 1st group included 47 (45.6 %) patients who had underwent laparoscopic total mesorectumectomy (LTME). The 2nd group included 56 patients who had underwent open total mesorectumectomy (OTME). In all patients, the histological structure of the tumor was represented by adenocarcinoma of varying degrees of differentiation. Long-term results of surgical treatment with actual and relapse-free 3-and 5-years survival were observed in 97 (94.2 %) patients.RESULTS. The frequency of local relapses of RC after OTME and LTME was 11.5 % (6 patients) and 11.1 % (5 patients). Distant metastases were detected in 7.7 (4 patients) and 6.7 % (3 patients) of cases, respectively. The actual 3-year survival rate of patients after LTME was 80 %/, 5-year-57.8 %. In patients underwent OTME, these indicators were 81.8 and 54.5 %, respectively.CONCLUSION. A significant correlation was found between the recurrence rate and distant metastases of the RC and the histological structure and degree of tumor differentiation. The differences between the three-year survival rates of patients in both groups are not statistically significant (p&gt;0.05).The authors declare no conflict of interest.The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study. Author Guidelines contains the detailed information.

The frequency and characteristics of regional metastases and their impact on the survival of patients with T1 and T2 laryngeal cancer

The presence of regional metastases of laryngeal cancer differs depending on the location of the tumor and has an influence on the overall survival. The aim of this work is to analyze the frequency and characteristics of regional metastases T1 and T2 of laryngeal carcinoma in relation to the primary tumor location, and their effect on the overall survival. A retrospective study, conducted in the period between 2002 and 2012, that analyzed 445 patients who were surgically treated for laryngeal cancer of T1 and T2 category. The first group consisted of 397 patients without regional metastases, while the second group consisted of 48 patients with regional metastases. A three-year survival is followed, as well as the testing of potential predictors of outcomes by methods of regression. Regional metastases were present in 3.1% of patients with glottic carcinoma of T1 and T2 category, while 43.5% of patients with T1 and T2 supraglottis carcinoma had regional metastases. In the group with regional metastases, there is no statistically significant difference in the occurrence of extracapsular extension in relation to the tumor location, p = 0.7027. The three-year survival rate of patients without regional metastasis is 93.95%, while the survival of patients with regional metastases is 68,75%, p = 0.000. The tumor location (95% CI -1.4716 to -0.0497, P = 0.0369), and the presence of regional metastases (95% CI -1.6300 to -0.0253, P = 0.0443), were identified as predictors of outcomes by multifactorial analysis. Regional metastases in T1 and T2 laryngeal cancer are more common in patients with supraglottic carcinoma. The presence of regional metastases significantly reduces the three-year overall survival.

Beneficial effect of arterial embolization with warmed miriplatin for multiple hepatocellular carcinoma

The effect of transcatheter arterial chemoembolization (TACE) is not necessarily sufficient in patients with multiple hepatocellular carcinoma (HCC). We evaluated the antitumor activity and adverse events of TACE using warmed miriplatin suspension for multiple HCC. Seventy patients with multiple HCC received TACE using warmed miriplatin/lipiodol suspension, including patients who were TACE-naïve (group A, n = 5), those undergoing initial TACE after radical therapies (group B, n = 31), and those with a history of repeated TACE (group C, n = 34). Median tumor size was 19.5mm and a median of four nodules. Complete necrosis (TE 4) and partial necrosis (TE 3) of 50% or more were attained in 24 and 19 patients at 3months after TACE, respectively. Response rates (TE 4 + TE 3) were 60.0% in group A, 83.9% in group B, and 41.2% in group C (P = 0.038). Survival rates of all patients after TACE were 82.6% after 1year, 65.6% after 2years, and 47.7% after 3years. Three-year survival rates of patients in groups A, B, and C were 53.3%, 78.8%, and 29.7%, respectively (P = 0.0029). Transcatheter arterial chemoembolization using warmed miriplatin induced high response rate in multiple HCC, and the rate was significantly high in those patients with recurrent multiple HCCs after curative therapies.

Expression of KIF18A in gastric cancer and its association with prognosis

To explore the expression of KIF18A gene protein in gastric cancer tissues and its association with the prognosis of patients. Twenty fresh paired gastric cancer specimens and adjacent normal mucosa(at least 5 cm from the edge of tumor) from 20 gastric cancer patients undergoing operation in Department of General Surgery at the First Affiliated Hosptial of Anhui Medical University between March 2015 and July 2015 were collected. Real-time PCR was used to examine KIF18A mRNA expression in above specimens. Meanwhile, paraffin embedded cancer tissue samples from 129 gastric cancer patients undergoing operation and 23 samples of randomly selected normal gastric tissue(adjacent non-cancer tissue) were collected to establish the microarray. Immunohistochemistry method was applied to detect the KIF18A protein expression in the microarray after confirmation by pathologists. Association of KIF18A expression with clinicopathological features in gastric cancer patients was evaluated. Cox proportional hazard model was used to identify prognostic risk factors. Among 20 fresh paired gastric cancer specimens, mRNA expression of KIF18A in 16 specimens was obviously lower than that in adjacent normal tissues. The positive rate of KIF18A protein expression in gastric cancer tissues was significantly lower than that in normal gastric tissues in microarray[45.0%(58/129) vs. 69.6%(16/23), P=0.041]. KIF18A protein expression was significantly associated with invasion depth (P=0.008) and TNM staging (P=0.032). The median overall survival of all the 129 patients was 44.0(95% CI: 39.78-49.24) months. The three-year survival rates of patients with high and low KIF18A expression were 67.2% and 36.6% respectively(P=0.020). Cox regression analysis showed that KIF18A expression was an independent protective factor of the prognosis of gastric cancer patients (HR=0.570, 95% CI:0.335 to 0.970). KIF18A expression is down-regulated in gastric cancer tissue, which may play a critical role in gastric cancer carcinogenesis. Lower expression of KIF18A is associated with poor prognosis of gastric cancer patients. KIF18A may be a potential prognostic marker of gastric cancer.

Spindle cell carcinoma of the breast: a comprehensive analysis

BackgroundBreast spindle cell malignancies are rare. No standard treatment exists. MethodsThe Surveillance, Epidemiology, and End Results database was used to identify patients with breast spindle cell malignancies, 1992 to 2011. Descriptive statistical analysis and survival analysis were performed. ResultsA total of 286 patients were identified (98.6% female). Approximately, 15% had estrogen receptor–positive tumors and 12.5% had progesterone receptor–positive tumors. Nearly 38% underwent partial mastectomy, whereas 55.5% underwent mastectomy. The frequency of partial mastectomy has increased in more recent years. One-third received radiation. Lymph node metastases were infrequent (9.3%) and distant metastases were uncommon (6.1%). Ten-year survival rates for patients with early-stage (I and II) disease were 83.9% after partial mastectomy, 86.7% after partial mastectomy plus radiation, and 71.6% after complete mastectomy. Three-year survival rates for patients with late-stage (III and IV) disease were low with 40.0% after complete mastectomy and 0% after complete mastectomy plus radiation. ConclusionsThis nationally representative analysis demonstrates that early-stage spindle cell carcinoma of the breast is adequately treated by partial mastectomy. Radiation may be considered for small, potentially early survival benefit. For late stage disease, complete mastectomy is appropriate; however, survival is poor, and radiation contributes no significant additional benefit.

Low Hemoglobin Levels and Hypo‐Responsiveness to Erythropoiesis‐Stimulating Agent Associated With Poor Survival in Incident Japanese Hemodialysis Patients

Although erythropoiesis-stimulating agents (ESAs) are effective at treating anemia, the association between hemoglobin (Hb) levels and survival is still unclear, especially for the incident Japanese hemodialysis (HD) population. The Japan Erythropoietin Treatment (JET) Study is an open multi-center, prospective, observational study designed to evaluate the relationship between the maintenance of Hb levels and new HD patient prognosis after the first administration of epoetin beta. Landmark analyses were performed to examine the relationship between Hb levels at 6 months and survival. Among a total of 10,310 patients, 6631 completed the initial 6 months of epoetin beta treatment (induction phase) and were followed up for a further 2.5 years (maintenance phase). Three-year survival rate of patients with <9 g/dL Hb levels after 6 months was 74.1%, which was significantly lower than 89.3% for patients with Hb levels 10 to 11 g/dL; the adjusted hazard ratio (HR) was 2.08 (95% CI, 1.57-2.77; P < 0.0001). Moreover, the 3-year survival rate for poor responders defined by Hb levels <10 g/dL and weekly epoetin beta doses ≥ 9000 IU during the induction phase was 71.6%, which was significantly lower than 89.4% for the group, which had Hb levels 10 to 11 g/dL excluding poor responders and those with excursion; the HR was 1.71 (95% CI, 1.13-2.60; P = 0.0118). Adverse events related to the treatment were reported in 71 of 10,310 patients (0.69%). These findings suggest that the achieved low Hb levels and poor response to ESA therapy are significantly associated with high mortality.

Intestinal and Multivisceral Transplantation Immunosuppression Protocols—Literature Review

IntroductionCurrently the most used techniques for small bowel transplant are isolated intestinal transplantation, multivisceral transplantation (MVT), and modified multivisceral transplantation. One important factor is early diagnosis of acute cellular rejection (ACR). In addition, improvements in immunosuppression have recently reduced the number and enhanced treatment of ACR episodes, enabling graft recovery. ObjectiveWe analyzed immunosuppression protocols of leading transplantation centers in the last 5 years. MethodWe reviewed papers published in PubMed from major multivisceral and intestinal transplantation centers from 2006 to 2010 in adult recipients. The 211 adults transplanted in seven centers were divided into three groups according to the immunosuppression protocol used: protocol 1: daclizumab induction with tacrolimus and steroid maintenance; protocol 2: alemtuzumab and tacrolimus; and protocol 3: thymoglobulin and rituximab and tacrolimus. ResultsProtocol 2 showed the lowest rate of ACR (34%). Protocols 1 and 3 displayed 54% and 48% ACR rates; respectively. However, protocol 1 patients developed only mild ACR, whereas those in protocols 2 and 3 developed moderate ACR in 26.3% and 11.7%, and severe ACR in 7.9% and 47% of cases, respectively. The infection rate was considerably lower in protocol 3 (7.4%). Protocols 1 and 2 showed infection rates of 62.5% and 52%, respectively. One-year patient survival rates were 70%, 79% and 81%, respectively. Three-year patient survival rates were 62%, 56%, and 78% for protocols 1, 2 and 3, respectively. ConclusionProtocol 2 was the strongest immunosuppressive regimen capable of reducing ACR rates when compared with the other protocols, but the strong effect resulted in high infection rate that impacts 1-year patient survival. Protocol 3 seems to be the best available one balancing ACR and infection rates.

Kidney Transplantation Alone in ESRD Patients With Hepatitis C Cirrhosis

Kidney transplantation (KTx) alone in patients with cirrhosis and renal failure (end-stage renal disease [ESRD]) infected with hepatitis C virus (HCV) is controversial. The aim of this study was to compare outcomes of HCV+ patients with ESRD and cirrhosis (C group) versus HCV+ patients with ESRD but with no cirrhosis (NC group) listed for KTx. Ninety HCV+ patients with ESRD were evaluated for KTx between 2003 and 2010. Listed patients underwent transjugular liver biopsy with hepatic portal venous gradient (HPVG) measurements. Only patients with HPVG less than 10 mm Hg were considered for KTx alone. We analyzed patient demographics, waitlist/liver disease characteristics, and posttransplant outcomes between groups. Sixty-four patients listed for KTx alone were studied. Twelve patients (18.75%) showed biopsy-proven cirrhosis. Thirty-seven patients underwent KTx alone (9 from C and 28 from NC). No patients developed decompensation of their liver disease, although one patient for NC group developed metastatic hepatocellular carcinoma 16 months after transplantation. One- and three-year graft survival rates were 75% and 75% versus 92.1% and 75.1% for groups C and NC, respectively (P=0.72). One- and three-year patient survival rates were 88.9% and 88.9% versus 96.3% and 77.9% for groups C and NC, respectively (P=0.76). Only increasing recipient age and decreasing albumin levels were significantly associated with worse graft and patient survival. Our study suggests that KTx alone may be safe in patients with compensated HCV, cirrhosis, and ESRD with HPVG less than 10 mm Hg. A simultaneous liver-kidney transplantation may be an unnecessary use of a liver allograft in these patients.

Survival Outcomes in Renal Transplantation in Trinidad and Tobago ― SORTTT Study

To assess patient and graft survival outcomes of renal transplant recipients from the National Organ Transplant Unit, Trinidad and Tobago. A retrospective descriptive analysis of renal transplants performed within five and half years (January 2006-June 2011) at the National Organ Transplant Unit was conducted. The age, gender ethnicity, cause of renal failure, donor type, outcome and complications were examined. The one, two and three-year patient and graft survival rates were analysed and factors affecting them were discussed. A total of 73 renal transplantations were done. Seventy (95.9%) were from live donors and 3 (4.1%) from deceased donors. Thirty-eight patients (52.1%) were males and 35 (47.9%) were females. The one-year, two-year and three-year patient survival rates were 91.46% (SE 0.04), 89.51% (SE 0.04) and 86.31% (SE 0.05), respectively. The one-year graft survival rate was 94.34% (SE 0.03). The two-year and three-year graft survival rates were the same at 92.69% (SE 0.03). The most significant complications seen in the recipients were those related to infections and cardiovascular disease: 47.9% of patients had a urinary tract infection, with the majority occurring at twelve months and 32.5% developed dyslipidaemia for the first time at six months. Seven patients developed erythrocytosis. The patient and graft survival rates in this new transplant programme are acceptable. Complications which can occur in transplant recipients are common and have a significant impact on post-transplantation quality of life and survival. Thus, continuing assessment of co-morbid factors pre and post-transplantation as well as the analysis of donor and recipient factors will lead to an increase in both patient and graft survival.

Surgery for Locally Recurrent Rectal Cancer in the Era of Total Mesorectal Excision

To evaluate the perioperative outcome and long-term survival of patients who underwent surgical resection for recurrent rectal cancer within a multimodal approach in the era of total mesorectal excision (TME). Introduction of TME has reduced local recurrence and improved oncological outcome of patients with rectal cancer. Local recurrence after TME still occurs in 2% to 8% of patients and presents a challenge to surgical and medical oncologists. However, there has been very limited data on the perioperative and long-term outcome of patients who are operated for local recurrence in the era of TME. A total of 107 patients who were identified from a prospective rectal cancer database underwent surgical exploration for recurrent rectal cancer after previous TME between October 2001 and April 2009. Risk factors of perioperative morbidity were analyzed using a multivariate logistic regression model. Independent predictors of disease-specific survival were identified by a Cox proportional hazards regression model, as were those of local recurrence and disease recurrence at any site. Surgical resection was performed in 92 patients and negative resection margins were achieved in 54 (58.7%) of these. Recurrent disease was located intraluminally and extraluminally in 35 (38.0%) patients and 57 (62.0%) patients, respectively. A total of 19 (20.6%) patients had metastatic extrapelvic disease at the time of surgery. Perioperative surgical morbidity and in-hospital mortality accounted for 42.4% and 3.3%, respectively. On multivariate analysis, partial sacrectomy was associated with surgical morbidity (P = 0.004). Three- and 5-year disease-specific survival rates were 61% and 47%. Three-year survival rate of patients with extrapelvic disease who underwent R0 resection was 42%. On multivariate analysis, surgical morbidity (P = 0.001), presence of extrapelvic disease (P = 0.006), and noncurative (R1; R2) resection (P < 0.0001) were identified as independent adverse predictors of disease-specific survival, whereas a transabdominal resection (as opposed to an abdominoperineal resection/pelvic exenteration) was associated with a more favorable prognosis (P = 0.04). Surgical resection of local recurrence from rectal cancer in the era TME can be carried out with acceptable morbidity and curative resection rates. Curative resection remains the major prognostic factor and may enable long-term survival even in patients with extrapelvic disease.

Associated factors and prognosis of residual cancer after esophagectomy for squamous cell carcinoma of the esophagus

To analyze associated factors and the prognosis of patients with residual cancer after esophagectomy for squamous cell carcinoma of the esophagus, and to assess outcomes after salvage treatment. Clinical and pathological data of 1074 patients with squamous cell carcinoma of the esophagus who underwent esophagectomy in the Cancer Center of Sun Yat-sen University from 1997 to 2003 were analyzed retrospectively. The relationship between the associated factors (differentiation, location, length of the lesion, surgical route, anastomosis site, T stage, N stage) and the incidence of residual cancer was analyzed, using the chi-squared test and Logistic regression analysis methods. The value and the modality of the salvage treatment were investigated. Forty-four patients had residual cancer (4.3%). Cancers in the upper esophagus were associated with the highest incidence of residual cancer on esophageal stump (6.5%), while the lower esophagus had the highest incidence of residual cancer on gastric stump (0.78%). The Incidence correlated with T and N stage. Logistic regression analysis showed that T and N stage were the risk factors of residual cancer. Three-year survival rate was 22.7% in patients with residual cancer. The mean survival time was 25.2+/-3.3 months. Three-year survival rates of patients with and without salvage treatment were 53.2% and 7.8%, respectively (P=0.027). Three-year survival rate of patients with salvage radiotherapy was 56.0%. Advanced T and N stage are the risk factors of residual cancer after esophagectomy in the patients with squamous cell carcinoma of the esophagus. Salvage treatment can improve the survival of the patients.

Validation of the BCLC Prognostic System in Surgical Hepatocellular Cancer Patients

Background/Aim Prognosis assessment in surgical patients with hepatocellular carcinoma (HCC) remains controversial. The most widely used HCC prognostic tool is the Barcelona Clinic Liver Cancer (BCLC) classification, but its prognostic ability in surgical patients has not been yet validated. The aim of this study was to investigate the value of known prognostic systems in 400 Italian HCC patients treated with radical surgical therapies. Methods We analyzed a prospective database collection (400 surgical, 315 nonsurgical patients) observed at a single institution from 2000 and 2007. By using survival times as the only outcome measure (Kaplan–Meier method and Cox regression), the performance of the BCLC classification was compared with that of Okuda, Cancer of the Liver Italian Program, United Network for Organ sharing TNM, and Japan Integrated Staging Score staging systems. Results Two hundred twenty-five patients underwent laparotomy resection; 55, laparoscopic procedures (ablation and/or resection); and 120, liver transplantations. In the surgical group, BCLC proved the best HCC prognostic system. Three-year survival rates of patients in BCLC Stages A, B, and C were 81%, 56%, and 44% respectively, ( P < .01); whereas all other tested staging systems did not show significant stratification ability. When all 715 HCC patients were considered, surgery proved to be a significant survival predictor in each BCLC stage (A, B, and C). Conclusions BCLC staging showed the best interpretation of the survival distribution in a surgical HCC population. The BCLC treatment algorithm should consider the role of surgery also for intermediate-advanced stages of liver disease.