Treatment Decisions For Patients Research Articles

Improved lung cancer clinical outcomes in patients with autoimmune rheumatic diseases

PurposeConcomitant autoimmune rheumatic diseases (ARD) can add morbidity and complicate treatment decisions for patients with lung cancer. We evaluated the tumour characteristics at diagnosis and clinical outcomes in lung cancer...

Comparison of health care costs and resource utilization for commonly used proteasome inhibitor-immunomodulatory drug-based triplet regimens for the management of patients with relapsed/refractory multiple myeloma in the United States.

BACKGROUND: Economic differences among currently available proteasome inhibitors (PI)-based lenalidomide-dexamethasone (Rd)-backbone triplet regimens-ixazomib (I), bortezomib (V), and carfilzomib (K) plus Rd-remain poorly understood. OBJECTIVE: To assess health care resource utilization (HCRU) and health care costs of patients with relapsed/refractory multiple myeloma (RRMM) in the United States treated with IRd, VRd, and KRd. METHODS: This retrospective longitudinal cohort study using IQVIA PharMetrics Plus adjudicated claims US data (January 1, 2015, to September 30, 2020) included adult patients with all available data who initiated IRd, VRd, or KRd in second line of therapy or later (LOT2+) on or after September 1, 2015. The index date was the treatment initiation date for each LOT (multiple LOTs per patient were included) and the baseline was 6 months pre-index. MM-related and all-cause HCRU/costs were assessed during follow-up and reported per patient per month (PPPM; 2020 US Dollars). For MM-related costs only, treatment administration costs were excluded from outpatient (OP) costs and instead summed with pharmacy costs. HCRU/costs were compared between treatment groups using generalized linear models (GLMs). Cost variables were compared using 2-part models and GLM with log transformation and γ distribution. Inverse probability of treatment weighting (IPTW) adjusted for imbalance of baseline confounders across treatment groups. RESULTS: The study included 511 patients contributing 542 LOTs (IRd: n = 153; VRd: n = 262; KRd: n = 127). Before IPTW, mean observed time spent on therapy was 8.5, 9.3, and 7.3 months for the IRd, VRd, and KRd cohorts, respectively. During follow-up and after IPTW, IRd and VRd were associated with significantly fewer OP visits vs KRd. Post-IPTW comparisons of MM-related costs for IRd vs KRd yielded lower OP costs for IRd (mean diff. PPPM: -$3,428; P < 0.001), contributing to lower total medical costs (-$3,813; P < 0.001) and total health care cost savings with IRd vs KRd (-$5,813; P = 0.001). MM-related OP costs were lower for VRd (mean diff. PPPM: -$3,543; P < 0.001) than KRd, reducing its total MM-related medical costs (-$3,997; P = 0.002), leading to total MM-related health care cost savings with VRd vs KRd (-$12,357; P < 0.001). All-cause cost comparisons yielded similar results (total health care cost savings for IRd and VRd vs KRd: -$6,371 and -$13,629, respectively; all P < 0.001). CONCLUSIONS: From the US insurance-payer perspective, patients treated with IRd and VRd had significant medical cost savings vs KRd due to lower OP costs when excluding treatment administration costs. The differential economic impacts of PI-Rd regimens in this study may help to inform treatment decisions for patients with MM. DISCLOSURES: This study and article were supported by Takeda Development Center Americas, Inc. Dr Sanchez has no conflicts to declare. Dr Chari has the following relationships: Research Support/Principal Investigator: Amgen, Array Biopharma, Celgene, Glaxo Smith Klein, Janssen, Millenium/Takeda, Novartis Pharmaceuticals, Oncoceutics, Pharmacyclics, Seattle Genetics; Consultant: Amgen, Bristol-Myers Squibb, Celgene, Millenium/Takeda, Janssen, Karyopharm; Scientific Advisory Board: Amgen, Celgene, Millenium/Takeda, Janssen, Karyopharm, Sanofi, Seattle Genetics. Drs Cherepanov, Huang, Dabora, and Noga are current employees of Takeda, while Drs Stull and Young are ex-employees of Takeda; Drs Cherepanov and Huang also own stocks in Takeda. Dr DerSarkissian, Ms Cheng, Ms Zhang, Mr Banatwala, and Dr Duh are employees of Analysis Group, Inc. (AG), a consulting firm that received funding from Takeda to conduct this study. Ms Pi was an employee of AG at the time of the study. Dr Ailawadhi has the following relationships to declare: Research Support and Consulting for BMS, GSK, and Janssen; Research Support from AbbVie, Arch Oncology, Cellectar, Medimmune, Pharmacyclics, and Xencor; Consulting for Beigene, Oncopeptides, Regeneron, Sanofi, and Takeda.

Dentists' Approaches to Treatment Decision-Making for People with Dementia: A Qualitative Study.

Globally, the number of people living with dementia (PLwD) is projected to increase substantially. Dentists will encounter an increasing number of PLwD retaining natural teeth who need dental care. Dental treatment planning can be complex for PLwD as both oral diseases and dental treatment can be detrimental to patients' oral and social function and comfort. In addition, patients may lack the capacity to make decisions about their treatment, posing further challenges for dentists. This study aimed to explore dentists' approach to treatment decision-making with or for PLwD. Semistructured one-to-one interviews were completed with 22 dentists between April 2020 and March 2021. Data generation and analysis followed the principles of constructivist grounded theory with data being collected and analyzed simultaneously using a maximum variation sample. Interviews were recorded, transcribed verbatim, and then analyzed, leading to a theoretical understanding of how dentists approach treatment decisions for PLwD. Four data categories describe dentists' approaches to treatment decision-making for PLwD. Dentists sought to provide individualized care for PLwD. However, they described planning care based on risk-benefit analyses that primarily considered biomedical factors and generic assumptions. There was an underemphasis on the psychological or social implications of dental care or its delivery. Furthermore, while some dentists attempted to involve patients in treatment decisions, they reported fewer attempts to identify the views and preferences of PLwD identified as lacking decisional capacity. In this scenario, dentists reported leading the decision-making process with little regard for patients' known or identified preferences and minimal involvement of PLwD's family. Dentists acknowledge the complexity in treatment decision-making for PLwD yet focused heavily on biomedical considerations, with an underemphasis on individuals' preferences and autonomy. Considering psychosocial aspects of care alongside biomedical factors is essential to support holistic person-centered care for this growing patient cohort. This study highlighted that dentists may only be considering biomedical aspects of care when considering what treatment is appropriate for people living with dementia. When making or supporting treatment decisions, dentists should explore patients' preferences and actively consider relevant psychosocial factors. These can be actively identified through considered discussions with patients as well as their family members. Gathering this information should support more person-centered and value-concordant decision-making for people living with dementia.

Prospective Trial of Using Imaging to Predict Pathologic Response and Clinical Outcomes in Locally Advanced Esophageal Cancer

Trimodality therapy with chemoradiation (CRT) followed by esophagectomy is the standard of care for locally advanced esophageal cancer. An unresolved question is whether pathologic complete response (pCR) can be assessed non-invasively for patients post-CRT. In this study, we assessed whether diffusion-weighted imaging (DWI) with MRI or PET can be used as predictors of pCR and other clinical outcomes after CRT. Patients were enrolled on a single-arm institutional trial (PA13-0380) assessing the role of imaging in predicting outcomes in potentially resectable esophageal patients undergoing trimodality therapy. All patients received neoadjuvant CRT, and 29 patients had subsequent surgery. DWI MRI and PET scans were obtained at baseline, 2 weeks after the start of CRT (interim) and 4 to 6 weeks after completion of CRT (follow up). Apparent diffusion coefficients (ADCs) were calculated based on DWI images. Circulating tumor DNA was obtained for 27 patients post-radiation using CAPP-Seq. Mann-Whitney tests compared imaging changes associated with pCR. Discrimination of pCR by imaging changes was quantified by received operating characteristics. Youden's index was applied to select optimal thresholds. Kaplan-Meier analysis was performed to assess differences in overall survival (OS) and progression-free survival (PFS) by changes in DWI, PET, and ctDNA parameters. Our cohort of 60 patients had a median follow up of 42.7 months, age of 65.4 yrs, and ECOG of 1 at completion of CRT. 90% were male, 58% had a history of smoking, and 85% were white. 83% had adenocarcinoma with the rest squamous cell carcinoma. Stages of the patients ranged from IIA to IIIB. All had moderately (47%) or poorly (53%) differentiated disease. All received 41.4-50.4 Gy in 1.8 Gy fractions with the majority receiving 50.4 Gy (95%). 29 patients underwent surgery after CRT of which 8 (27.6%) had pCR. Mean ΔADC from baseline to mid-treatment was most associated with pCR (AUC = 0.98, p<0.001) for patients undergoing surgery. Max ΔADC from baseline to first follow-up was most associated with OS (p = 0.002) and PFS (p<0.001) for the whole cohort. 27 patients had ctDNA analyzed after RT with the presence of ctDNA significantly associated with worse OS (HR = 0.12, p = 0.05) and PFS (HR = 0.10, p = 0.002). Combining ctDNA and max ΔADC generated a model that was more predictive of OS and PFS than either alone. We found that neither the PET parameters of TLG or SUV max at baseline or changes in these parameters from baseline to mid-treatment or first follow-up were as predictive as DWI. We show that changes in DWI is associated with pCR, OS, and PFS in resectable esophageal cancer patients undergoing CRT. DWI was more predictive than PET and a model combining DWI and ctDNA was the most predictive of clinical outcomes. This study shows the significant promise of using DWI in potentially guiding treatment decisions in esophageal cancer patients and will require validation in a larger cohort.

Evaluation of remote radiologist-interpreted point-of-care ultrasound for suspected dengue patients in a primary health care facility in Colombia

BackgroundEarly identification of plasma leakage may guide treatment decisions in dengue patients. This study evaluated the value of point-of-care ultrasound (POCUS) to detect plasma leakage and predict hospitalization or referral to a higher level of care in suspected dengue patients under routine conditions at a primary care facility in Colombia.MethodsWe conducted a cohort study between April 2019 and March 2020 in a primary care hospital in Cali, Colombia. We prospectively included and followed 178 patients who were at least 2 years old with fever of less than 10 days and clinician-suspected dengue. A trained general practitioner performed a standardized POCUS protocol. Images were quality-rated and overread by an expert radiologist, and her results and those of the general practitioner were compared using the Kappa index. Logistic regression was used to identify factors associated with plasma leakage at enrollment and explore its prognostic value regarding hospital admission or referral to a higher level of care.ResultsHalf (49.6%) POCUS images were of suitable quality to be interpreted. The proportion of plasma leakage reported by the radiologist was 85.1% (95% CI: 78.6–90.2%) and 47.2% by the study physician (Kappa = 0.25, 95% CI: 0.15–0.35). The most frequent ultrasound findings were ascites (hepatorenal 87.2%, splenorenal 64%, or pelvic 21.8%) and gallbladder wall thickening (10.5%). Plasma leakage was higher in subjects with thrombocytopenia (aOR = 4, 95% CI: 1.3–12.1) and lower in patients 30–59 years old (aOR = 0.1, 95% CI: 0.0–0.4) than in those 18 years old or younger. POCUS evidence of plasma leakage (aOR = 8.2, 95% CI: 2.2–29.9), thrombocytopenia (aOR = 6.3, 95% CI: 2.4–16.0) and pulse pressure (aOR = 1.1, 95% CI: 1.07–1.2) were associated with hospital admission or referral to a higher level of care.ConclusionsUltrasound is useful to detect plasma leakage in primary care and, challenges remain to guarantee high-quality images and diagnostic accuracy, for which a standardized dengue POCUS protocol and training program is needed.Graphical

Evidence-Based Management of Chronic Lymphocytic Leukemia: Consensus Statements from the Gulf Region

Introduction: Despite recent advances in diagnosis, prognostication, and treatment options, chronic lymphocytic leukemia (CLL) is still a largely incurable disease. New concepts on diagnosis, staging, treatment, and follow-up on CLL have been incorporated throughout recent years. The lack of regional consensus guidelines has led to varying practices in the management of patients with CLL in the region. This manuscript aims to reach a consensus among expert hematologists regarding the definitions, classifications, and related practices of CLL. The experts developed a set of statements utilizing their personal experience together with the current literature on CLL management. This consensus aims to provide guidance for healthcare professionals involved in the management of CLL and serves as a step in developing regional guidelines. Methods: Eight experts responded to 50 statements regarding the diagnosis, staging, treatment, and prognosis of CLL with three potential answering alternatives ranging between agree, disagree, and abstain. This consensus adopted a modified Delphi consensus methodology. A consensus was reached when at least 75% of the agreement to the answer was reached. This manuscript presents the scientific insights of the participating attendees, panel discussions, and the supporting literature review. Results: Of the 50 statements, a consensus was reached on almost all statements. Statements covered CLL-related topics, including diagnostic evaluation, staging, risk assessment, different patient profiles, prognostic evaluation, treatment decisions, therapy sequences, response evaluation, complications, and CLL during the COVID-19 pandemic. Conclusion: In recent years, CLL management has progressed significantly, with many diagnostic tests and several novel treatments becoming available. This consensus gathers decades of consolidated principles, novel research, and promising prospects for the management of this disease.

Fluoroquinolone-associated adverse events of interest among hospitalized veterans affairs patients with community-acquired pneumonia who were treated with a fluoroquinolone: Afocus on tendonitis, Clostridioides difficile infection, and aortic aneurysm.

The objectives of this study were to (i) quantify the incidence of three concerning fluoroquinolone adverse events of interest (FQAEI, i.e., adverse tendon event (TE), clostridioides difficile infection (CDI), and aortic aneurysm/dissection (AAD)), (ii) identify the patient-level factors that predict these events, and (iii) develop clinical risk scores to estimate the predicted probabilities of each FQAEI based on patient-level covariates available on clinical presentation. Retrospective cohort study. Upstate New York Veterans' Healthcare Administration from 2011 to 2016. Hospitalized patients with community-acquired pneumonia receiving care in the Upstate New York Veterans' Healthcare Administration from 2011 to 2016. N/A. The outcomes of interest for this study were the occurrence of TE, CDI, and AAD. We also evaluated a composite of these three outcomes, FQAEI. The study population consisted of 1071 patients. The overall incidence of FQAEI, TE, AAD, and CDI was 6.5%, 1.8%, 4.5%, and 0.3%, respectively. For each outcome evaluated, the probability of the event of interest was predicted by the presence of certain comorbidities, previous healthcare exposure, choice of specific FQ antibiotic, or therapy duration. Concomitant steroids, pneumonia in preceding 180 days, and creatinine clearance <30 mL/min predicted FQAEI. Individual frequencies of three important FQAEIs were quantified, and risk scores were developed to estimate the probabilities of experiencing these events to help clinicians individualize treatment decisions for patients and reduce the potential risks of select FQAEIs.

Understanding the role of radiologists in complex treatment decisions for patients with hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver and represents a significant global health burden. Management of HCC can be challenging due to multiple factors, including variable expectations for treatment outcomes. Several treatment options are available, each with specific eligibility and ineligibility criteria, and are provided by a multidisciplinary team of specialists. Radiologists should be aware of the types of treatment options available, as well as the criteria guiding the development of individualized treatment plans. This awareness enables radiologists to contribute effectively to patient-centered multidisciplinary tumor boards for HCC and play a central role in reassessing care plans when the treatment response is deemed inadequate. This comprehensive review aims to equip radiologists with an overview of HCC staging systems, treatment options, and eligibility criteria. The review also discusses the significance of imaging in HCC diagnosis, treatment planning, and monitoring treatment response. Furthermore, we highlight the crucial branch points in the treatment decision-making process that depend on radiological interpretation.

Abstract PR09: Detection of minimal residual disease in post-surgical drain fluid can predict locoregional recurrence in HPV-negative head and neck cancer patients

Abstract Introduction: Locoregional cancer relapse remains a major cause of failure in head and neck squamous cell carcinoma (HNSCC), particularly for HPV-negative patients whose 3-year locoregional failure rate is 32.5%. There is a major unmet need for an accurate diagnostic test that predicts risk of locoregional recurrence prior to adjuvant therapy selection. We present a novel proximal assay for minimal residual disease (MRD) profiled in lymphatic exudate collected via surgical drains (“lymph”). Methods: Lymph, plasma, and peripheral blood were collected from 22 HPV-negative HNSCC patients postoperatively at 24 hours along with resected tumor. Cell-free DNA was extracted from lymph and plasma and sequenced using the TruSeq Oncology 500 panel to a depth of &amp;gt;100 million reads. One plasma sample failed due to inadequate coverage. Two patients were censored due to lack of clinical data, yielding 9 patients with disease recurrence (REC) and 11 with no evidence of disease (NED) with &amp;gt;1 year of follow-up. Somatic mutations were identified from exome sequencing (200x) in tumor with matched blood. Tumor-specific variants were force-called in lymph and plasma using a custom bioinformatic pipeline. Mutation calls were filtered by a base-specific error model to eliminate artifacts. Student’s t-test was used for group comparisons. The Kaplan-Meier (KM) estimator with log-rank test and Cox proportional-hazards model were used for survival analyses. Results: ctDNA allelic fraction was 1.5x higher in lymph than in plasma (lymph = 0.11% ± 0.16%; plasma = 0.076% ± 0.12%. p = 0.018, N = 100 mutations). Significantly more mutations were detected in REC lymph compared to NED (p = 0.009), but not in plasma REC vs. NED (p = 0.16). We classified patients as positive (&amp;gt;1) or negative (£1) for detected mutations in each analyte and performed a KM survival analysis, showing lymph could accurately predict recurrence (sensitivity = 89%, specificity = 82%; p &amp;lt; 0.005) while plasma could not (sensitivity = 67%, specificity = 40%; p = 0.59). The hazard ratio in lymph was 12.52 (95% CI 1.54-101.61). We stratified REC patients by locoregional or locoregional + distant relapse and observed significantly more mutations detected in lymph (p = 0.01) from locoregional relapse while lymph and plasma performed similarly for locoregional + distant relapse (p = 1.0). We compared lymph MRD outcomes to extranodal extension (ENE), a high-risk pathologic feature. Lymph was concordant with ENE in 12/20 patients and identified an additional 6 ENE-negative relapse cases. Conclusion: Postoperative ctDNA analysis of lymph from surgical drains represents a novel MRD approach in HPV-negative HNSCC. Lymph significantly outperforms plasma for prediction of recurrence, particularly in patients with locoregional relapse. Accurate MRD identification in patients with lower risk pathologic features suggests that postoperative lymph MRD testing has the potential to significantly augment traditional pathology and provide more personalized adjuvant treatment decision-making in patients with HPV-negative HNSCC. Citation Format: Aadel A. Chaudhuri, Zhuosheng Gu, Damion Whitfield, Noah Earland, Adam Harmon, Megan Long, Peter Harris, Zhongping Xu, Ricardo Ramirez, Sophie Gerndt, Maciej Pacula, Marra S. Francis, Wendy Winckler, Jose P. Zevallos. Detection of minimal residual disease in post-surgical drain fluid can predict locoregional recurrence in HPV-negative head and neck cancer patients [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Innovating through Basic, Clinical, and Translational Research; 2023 Jul 7-8; Montreal, QC, Canada. Philadelphia (PA): AACR; Clin Cancer Res 2023;29(18_Suppl):Abstract nr PR09.

Real-world survival outcome comparing abiraterone acetate plus prednisone and enzalutamide for nonmetastatic castration-resistant prostate cancer.

There is little evidence of abiraterone acetate (AA) plus prednisone for patients with non-metastatic castration-resistant prostate cancer (nmCRPC). In this study, we conducted a comparative analysis of real-world survival outcomes between AA plus prednisone and enzalutamide (Enz) in patients with nmCRPC, utilizing our consortium dataset. The clinical records of 133 nmCRPC patients treated with first-line Enz or AA plus prednisone were analyzed. The primary endpoints of the study were overall survival (OS) and cancer-specific survival (CSS). Cumulative incidence function (CIF) using Fine and Gray models was also utilized to assess non-cancer-caused death considering the competing risk of cancer-caused death. During a median follow-up of 36 months, 34 patients (25.6%) had deceased, with a median OS of 99 months in the entire cohort. There were no significant differences in comorbidities between the Enz and AA groups. Time to PSA progression (TTPP: HR 0.81, 95% CI 0.51-1.30, P = 0.375) and CSS (HR 1.32, 95% CI 0.55-3.44, P = 0.5141) were comparable between the two groups. However, intriguingly, there was a trend towards shorter OS in patients treated with AA plus prednisone compared to Enz (HR 0.57, 95% CI 0.29-1.12, P = 0.0978, median of 99 and 69 months in Enz and AA groups, respectively). CIF analysis revealed that nmCRPC patients treated with AA plus prednisone were more likely to result in non-cancer-caused death than those treated with Enz (HR 5.22, 95% CI 1.88-14.50, P = 0.0014). Our real-world survival analysis suggests that while AA plus prednisone may demonstrate comparable treatment efficacy to Enz in the context of nmCRPC, there may be an increased risk of non-cancer-caused death. Physicians should take into consideration this information when making treatment decisions for patients with nmCRPC.

The role of low health literacy in shared treatment decision-making in patients with kidney failure.

The classic paternalist medicine in nephrology has been modified to a shared decision-making model that clearly offers a benefit in patients with kidney disease. One of the cornerstones of shared treatment decision in patients with kidney failure is the understanding of kidney disease. As kidney disease is silent until advanced stages and is also an entity with a complex pathophysiology with little knowledge in the general population, its presence and understanding are difficult for most people. Health literacy (HL) plays a crucial role in the care of patients with kidney disease and the shared treatment decision. Limited HL has been associated with inefficient use of health services, non-compliance of medications, worse quality of life and increased mortality. In this review, we will address the importance of low HL in nephrology in terms of diagnosis, measurement, its effect on shared decision-making and how to increase it in people with kidney disease.

P11.69.B INTRAVENOUS THROMBOLYSIS WITH OR WITHOUT ENDOVASCULAR TREATMENT FOR SUSPECTED ISCHEMIC STROKE IN PATIENTS WITH INTRACRANIAL TUMORS

Abstract BACKGROUND: AND OBJECTIVES Intravenous thrombolysis (IVT) for suspected ischemic stroke in patients with intracranial neoplasms is off-label. However, data on risks of intracranial hemorrhage (ICH) is scarce. METHODS In a multicenter registry-based analysis within the European Thrombolysis in Ischemic Stroke Patients (TRISP) collaboration, we assessed frequencies of symptomatic and fatal ICH after IVT for suspected ischemic stroke in patients with intracranial tumors by descriptive statistics and analyzed associations with clinical and imaging characteristics by binary logistic regression. Definition of symptomatic ICH was based on the clinical criteria of the European Cooperative Acute Stroke-II trial including hemorrhage at any site in cranial imaging and concurrent clinical deterioration. RESULTS Screening data of 21,289 patients from 14 centers, we identified 105 patients receiving IVT, among them 29 patients (28%) with additional endovascular treatment, with suspected, i.e. imaging-based, or histologically confirmed diagnosis of intracranial tumors. Among 104 patients with CT or MRI after IVT available, symptomatic and fatal ICH were observed in nine and four patients (9% and 4%). Among 82 patients with suspected or confirmed meningioma, symptomatic and fatal ICH occurred in six and three patients (7% and 4%). In 18 patients with intra-axial suspected or confirmed primary or secondary brain tumors, there was one symptomatic nonfatal ICH (6%). Out of four patients with tumors of the pituitary region, two patients (50%) had symptomatic ICH including one fatal ICH (25%). Tumor size was not associated with occurrence of symptomatic ICH (Odds ratio 2.8, 95% CI 0.3-24.8, p=0.34). CONCLUSION In our dataset from routine clinical care, we provide insights on the safety of IVT for suspected ischemic stroke in patients with intracranial tumors, a population that is commonly withheld thrombolysis in clinical practice and prospective trials. Except for a potential high risk of symptomatic ICH after IVT in patients with tumors of the pituitary region, frequencies of symptomatic ICH in patients with intracranial tumors in our cohort appear to be in the upper range of rates observed in previous studies within the TRISP cooperation. These results may guide individual treatment decisions in patients with acute stroke and intracranial tumors with potential benefit of IVT.

P15.08.A MRI PHENOTYPES OF GLIOBLASTOMAS EARLY AFTER TREATMENT ARE SUGGESTIVE OF OVERALL PATIENT SURVIVAL

Abstract BACKGROUND Distinguishing between true tumor progression (TP) and treatment induced abnormalities (e.g. pseudo-progression (PP) after radiotherapy) early after treatment on conventional MRI scans remains challenging for glioblastomas (GBM). Despite MRI perfusion techniques being promising in differentiating between TP and PP, individual imaging markers have only showed a modest association with tumor progression and overall survival. Therefore, we aimed to establish brain MRI phenotypes of glioblastomas early after treatment by combined analysis of radiological scoring of structural and perfusion tumor characteristics and assessed the relation with recurrence rate and overall-survival time. MATERIAL AND METHODS MR images and clinical data were retrospectively collected from 67 histologically confirmed GBM patients. Non-invasive (arterial spin labeling, ASL) and contrast-based (dynamic susceptibility contrast DSC) perfusion MRI, T2-FLAIR and post-contrast 3D-T1w scans were acquired on a 3T-MR scanner at around 3 months post-radiotherapy. Structural (presence and type of (enhancing) lesion patterns) and perfusion (increase, decrease or iso) MRI markers (MRIm) were visually scored by a neuroradiologist. Additionally, volume and eccentricity of the enhancing and T2-hyperintense areas were calculated.Subsequently, patients were grouped based on their similarity on tumor perfusion and structural brain MRIm by means of hierarchical clustering. These subgroups were then compared using a chi-square test and one way ANOVA. Survival outcome was assessed using a multivariate cox proportional hazard model, both unadjusted and adjusted for age, KPS and extension of resection. Progression at 9 months (when unavailable at 3/6 months) post-radiotherapy and clinical parameters were compared between subgroups using a chi-square test. RESULTS Four subgroups of patients were established with significantly different tumor perfusion and structural radiological markers (p≤0.05) and therefore showed distinct MRI phenotypes of GBM. Subgroup 1 had less aggressive MRIm with mostly nodular enhancing lesions; subgroup 2 had the least aggressive MRIm with mostly patchy enhancing lesions; subgroup 3 showed the most aggressive MRIm and subgroup 4 showed moderately aggressive MRIm. TP and PP did not differ significantly between subgroups (p = 0.775). However, after performing an adjusted and unadjusted cox regression analysis we found that subgroup 1 and 3 were at increased risk of mortality, respectively (subgroup 1 - HR: 2.649 (95% CI: 1.119 - 6.270; subgroup 3 - HR: 2.363 (95% CI: 1.110 - 5.030); p=0.03). CONCLUSION Our study suggests that differences in MRI phenotypes of GBM at 3 months post-radiotherapy can be indicative of overall patient survival. The early prognostic information our method provides might in the future be beneficial for treatment decisions in GBM patients.

JS03.7.A INTERPLAY BETWEEN SELF-REPORTED AND PERFORMANCE-BASED SYMPTOMS IN PATIENTS WITH GLIOMA AND MENINGIOMA - A NETWORK ANALYSIS AND COMPARISON BETWEEN DIAGNOSES

Abstract BACKGROUND Patients with brain tumors show complex symptomatology often involving self-reported complaints, e.g., concerning self-perceived cognitive function (SCF), fatigue or mood, as well as deficits in cognitive performance. Understanding the interplay between symptoms across diagnoses is crucial for intervention, but remains challenging. This study used network analysis to 1) uncover unique relationships between various multidimensional self-reported symptoms and cognitive performances in patients with meningioma and glioma, and 2) investigate differences in symptom networks between diagnoses. MATERIAL AND METHODS We used pre-surgical data from patients with meningioma (n=240) and glioma (n=208). Two Gaussian graphical models were constructed to explore conditional relationships among symptoms in the two samples. Included as symptoms in the networks were ten patient-reported measures: SCF (3 nodes), Anxiety, Depression, and Fatigue (5 nodes), and 5 cognitive performance measures: Inhibition, Cognitive flexibility, Verbal memory, Processing speed and Psychomotor speed. We evaluated the importance of the symptoms with three centrality indices; node strength, betweenness and closeness. We compared features of the networks between the diagnoses with a Network Comparison Test. RESULTS In both samples, particularly strong connections existed between Anxiety and Depression, Forgetfulness and False Triggering (SCF nodes), and General Fatigue and Physical Fatigue. These positive relationships were significantly stronger than most of the other relationships. The most central symptoms, based on the strength of their connections with other symptoms, were Forgetfulness, General Fatigue and Inhibition in glioma patients, and Forgetfulness, Physical Fatigue and Depression in meningioma patients. Activity-related fatigue appeared as the least central symptom in the glioma network, but it was in the top 5 in the meningioma network. The difference in the number of relationships found (meningioma: 49 vs. glioma: 41), was not significant. Visual inspection of the networks suggested additional connections between multiple fatigue and cognition nodes in meningioma that were absent in glioma. Significant differences were found between the networks regarding strength of the relationships General Fatigue-Physical Fatigue (stronger in glioma), and Physical Fatigue-Activity-related Fatigue (stronger in meningioma), p’s &amp;lt; .01. CONCLUSION While symptom networks of patients with glioma and meningioma show similarities, they appear to differ with regard to which symptoms play a more central role and how strongly some symptoms are related. Particularly fatigue subtypes may carry different importance. Information that multidimensional symptom networks provide about how symptoms interact can guide treatment decisions for patients with different diagnoses.

Meta-analysis of the effect of laparoscopic surgery and open surgery on long-term quality of life in patients with colorectal cancer.

To compare the effect of laparoscopic surgery and open surgery on the quality of life of patients with colorectal cancer (CRC) in the growth period after the operation, and to provide a reference for surgical treatment decisions of patients with CRC. PubMed/MEDLINE, EMBASE, Web of Science, and Cochrane databases were searched through May 7, 2022 for clinical studies comparing the postoperative quality of life in CRC patients who underwent laparoscopic surgery with those who underwent open surgery. Data were extracted from eligible studies following rigorous quality review. All studies included patient numbers, surgery type, follow-up length, and quality of life scores. A total of 6 studies were included, resulting in significantly better physical functioning scores with laparoscopic versus open surgery. (Standardized mean difference = 0.45; 95% CI (0.15, 0.75), P = .003). However, in general health, social functioning, bodily pain, vitality, quality of life index, Global Quality Scale, physical component summary and mental component summary, there was no telling difference between the 2 surgical therapies. Compared with open surgery, laparoscopic surgery has weak advantages. There was no noteworthy difference in the long-term quality of life between the 2 surgical treatments for CRC patients. Whether laparoscopic surgery can bring more improvement to the quality of life of patients with CRC needs more high-quality clinical randomized studies to verify.

Prevention of Radiographic Progression in Higher-Risk Patients with Rheumatoid Arthritis Using Filgotinib in PhaseIII Studies: Narrative Review of PostHoc Analyses.

Filgotinib is an oral preferential Janus kinase1 inhibitor that demonstrated significant reductions in radiographic progression, with an acceptable tolerability and safety profile, vs placebo in patients with rheumatoid arthritis (RA) and an inadequate response to methotrexate (MTX-IR; FINCH1) and vs MTX in MTX-naïve patients with RA (FINCH3). International treatment guidelines identify multiple poor prognostic factors (PPFs) associated with worse disease outcomes among patients with RA. However, questions remain both about the clinical utility of considering PPFs and about which PPFs should drive treatment decisions. Additionally, the role of radiographic findings in clinical practice continues to be discussed and to evolve. This review examines radiographic results from posthoc analyses of phase3 trials of filgotinib that examined subgroups with 4PPFs or with baseline estimated rapid radiographic progression (e-RRP). In MTX groups, there were trends toward greater progression among patients with 4PPFs or e-RRP, suggesting these subgroups may comprise a higher-risk population. Results show general consistency for the efficacy of filgotinib 200mg plus MTX vs placebo plus MTX/MTX monotherapy on radiographic assessments, including change from baseline in modified total Sharp score and proportions without radiographic progression, even among MTX-IR or MTX-naïve patients with 4PPFs or e-RRP who may be at higher risk of bone damage. Multivariate analysis identified multiple factors associated with baseline e-RRP status. This summary of the current understanding of benefits associated with filgotinib on radiographic progression and the relevance of baseline factors to these benefits may help inform treatment decisions for patients facing high risk of radiographic progression.

The role of PSMA PET/CT to predict upgrading in patients undergoing radical prostatectomy for ISUP grade group 1 prostate cancer.

To investigate the additive role of prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) independent from multiparametric magnetic resonance imaging (mpMRI) and clinical-pathological parameters to predict pathological upgrading in patients with ISUP grade group (GG) 1 prostate cancer (PCa) at prostate biopsy. A total of 41 patients who underwent robotic radical prostatectomy (RP) for GG1 disease at prostate biopsy with preoperative PSMA PET/CT and mpMRI images available for central review were included in the study. Univariate and multivariate logistic regression analyses were performed to determine the independent predictors of pathological upgrading (GG ≥ 2). Final RP pathology revealed upgrading in 26 patients (65.9%); to GG 2 disease in 25 cases and GG 4 disease in one case. International Society of Urological Pathology (ISUP) upgrading rates for prostate imaging-reporting and data system (PIRADS)-5, PIRADS-4, and PIRADS ≤ 3 lesions were 78%, 74%, and 38%, respectively. Fourteen out of 15 (93.3%) patients with an SUVmax ≥ 5.6 and all patients with an SUVmax ≥ 6.5 (n = 10) had pathological upgrading. The upgrading rate in patients with SUV < 5.6 was 46.2% (12/26). Intraprostatic SUVmax ≥ 5.6 was found as the only independent predictor of pathological upgrading in multivariate analysis. High prostatic PSMA uptake was found to be a very reliable predictor of pathological upgrading, but low PSMA uptake cannot exclude pathological upgrading. Intraprostatic PSMA uptake along with previously known mpMRI and biopsy-related parameters should be considered when making a treatment decision in patients with GG1 PCa at prostate biopsy.

P-464 Treatment decision-making in patients diagnosed with multiple myeloma

P-464 Treatment decision-making in patients diagnosed with multiple myeloma

A Comparative Analysis of Perioperative Complications in Octogenarians and Patients under 60 Years of Age after Primary Cemented Total Knee Arthroplasty.

Introduction: Knee arthroplasty is exposed to demographic changes as patients age. An analysis of risk factors for surgical treatment decisions in patients over 80 years old is crucial. This study compared perioperative complications between groups of patients undergoing primary knee arthroplasty, under 60 years old and over 80 years old.Materials and Methods: For this retrospective study, data from 400 patients with primary cemented bi- and unicondylar total knee endoprosthesis during inpatient stay from 2017 to 2018 were analyzed. Patients aged 61-79 years (257) were excluded. An analysis of the remaining 143 patients was performed. The incidence of surgery-related and systemic complications (eg, urinary tract infections, electrolyte imbalances, and cases of pneumonia), the blood supply and C-reactive protein (CRP) as well as hemoglobin progression were compared across both age groups. Furthermore, a correlation between prevalent diseases and systemic complications were investigated. Statistical analysis was performed using IBM SPSS (Armonk, US).Results: Data analyses showed a significant difference in the occurrence of systemic complications and blood transfusion between the age groups (P = 0.001, phi = 0.44; phi= 0.55, P = 0.001). Surgical complications did not differ significantly between the age groups. Age-typical pre-existing conditions, especially arterial hypertension (P = 0.003), showed a significant association with the occurrence of systemic complications. In addition, high postoperative CRP values in elderly patients revealed an association to systemic complications (P = 0.008).Discussion and Conclusion: The study shows that primary cemented knee arthroplasty is a safe procedure without an increased incidence of surgical complications, even in elderly patients. The increased incidence of internal complications in octogenarians, in turn, should receive more attention in the perioperative course. The interdisciplinary preoperative optimization of pre-existing conditions and drug therapy, as well as close interdisciplinary assessments of elderly patients, should be ensured.

DYNAMIC PREDICTION OF RESIDUAL LIFE WITH LONGITUDINAL COVARIATES USING LONG SHORT-TERM MEMORY NETWORKS.

Sepsis, a complex medical condition that involves severe infections with life-threatening organ dysfunction, is a leading cause of death worldwide. Treatment of sepsis is highly challenging. When making treatment decisions, clinicians and patients desire accurate predictions of mean residual life (MRL) that leverage all available patient information, including longitudinal biomarker data. Biomarkers are biological, clinical, and other variables reflecting disease progression that are often measured repeatedly on patients in the clinical setting. Dynamic prediction methods leverage accruing biomarker measurements to improve performance, providing updated predictions as new measurements become available. We introduce two methods for dynamic prediction of MRL using longitudinal biomarkers. in both methods, we begin by using long short-term memory networks (LSTMs) to construct encoded representations of the biomarker trajectories, referred to as "context vectors." In our first method, the LSTM-GLM, we dynamically predict MRL via a transformed MRL model that includes the context vectors as covariates. In our second method, the LSTM-NN, we dynamically predict MRL from the context vectors using a feed-forward neural network. We demonstrate the improved performance of both proposed methods relative to competing methods in simulation studies. We apply the proposed methods to dynamically predict the restricted mean residual life (RMRL) of septic patients in the intensive care unit using electronic medical record data. We demonstrate that the LSTM-GLM and the LSTM-NN are useful tools for producing individualized, real-time predictions of RMRL that can help inform the treatment decisions of septic patients.