Univariate Cox Proportional Hazards Analyses Research Articles

Effect of absolute monocyte count post-transplant on the outcome of patients with acute myeloid leukemia undergoing myeloablative allogeneic hematopoietic stem cell transplant with busulfan and cyclophosphamide conditioning

Peripheral monocytes have recently been evaluated as a prognostic factor in different types of hematological malignancies. This study assessed the prognostic value of absolute monocyte count (AMC) post-transplant on the clinical outcomes of 59 patients with acute myeloid leukemia (AML) who had undergone myeloablative conditioning (MAC) allogeneic hematopoietic stem cell transplant (allo-HSCT) with busulfan and cyclophosphamide (Bu/Cy). Kaplan-Meier analysis showed that patients with a high AMC (≥ 0.57 × 109/L) on post-transplant day (PTD) 15 had a significantly worse overall survival (OS) compared to patients with a low AMC (< 0.57 × 109/L) on PTD 15 (P = .0049). Univariate Cox proportional hazard analyses revealed that only high AMC on PTD 15 was a poor prognostic factor for OS (P = .008) and post-relapse survival (P = .030). We conclude that AMC ≥ 0.57 × 109/L on PTD 15 is associated with more deaths in patients with AML who have undergone MAC allo-HSCT with Bu/Cy.

Long-term Follow-up After Pediatric Liver Transplantation: Predictors of Growth.

The aim of the study was to describe long-term growth postpediatric liver transplantation and to conduct bivariate and multivariate analysis of factors that may predict post-transplantation growth in children who received a liver transplant from January 1999 to December 2008 at the Hospital for Sick Children. A retrospective cohort study was conducted with follow-up of up-to 10 years post-transplantation. Mean height and weight z scores and annual differences in mean z scores were plotted against time after transplantation. A 1-way analysis of variance was conducted. Multivariate and univariate Cox proportional hazards analyses were conducted to determine factors associated with reaching the 50th and 25th percentiles for height. A total of 127 children met eligibility criteria. The mean height z score at time of transplantation was -2.21 which by the second year post-transplantation increased significantly to -0.66 (mean increase of 1.55 standard deviation units). There were no further significant increases in mean height z score from 2 years post-transplantation until the end of follow-up at year 10. In multivariate analysis, height at transplant was the most important predictor of linear growth post-transplantation. Children who underwent liver transplantation had significant catch-up growth in the first 2 years post-transplantation followed by a plateau phase. Increased height z-score at transplantation is the most important predictor of long-term growth.

P16 and HPV-DNA Tests Discordance in Human Papilloma Virus (HPV)-Associated Oropharyngeal Cancer: Results From a Case-matched Study

HPV-associated oropharyngeal cancer (OPC) has been associated with improved prognosis compared to HPV-negative OPC. Concomitant HPV DNA and p16 testing has been shown to improve sensitivity and specificity; however, the prognostic significance of discordant testing (i.e., p16+/HPV DNA or p16-/HPV DNA+) in OPC patients has not been quantitatively studied due to inadequate sample sizes. We aim to determine whether there is a prognostic significance for discordant p16/HPV-DNA test results for OPC patients receiving curative intent radiation treatment. A case-control study design was used to retrospectively analyze 136 patients with pathologically proven oropharyngeal cancer (OPC) treated with curative intent radiation therapy at our institution between the years 2005 and 2012. HPV DNA status was evaluated using in-situ hybridization (ISH) methods, and p16 status was identified via immunohistochemistry (IHC). Two subgroups were identified: concordant (p16+/HPV DNA+) and discordant (p16+/HPV DNA- or p16-/HPV DNA+) subgroups, with the former serving as control. Characteristics including sex, age at diagnosis, ethnicity, smoking status, cancer stage, and treatment modality were identified. Kaplan-Meier survival analysis and univariate Cox proportional hazard analysis were performed. Patient characteristics, including age, sex, smoking status, stage, pathological grade, tumor subsite within oropharynx, treatment modality, and follow-up duration were well-matched between the concordant and discordant subgroups. Survival analysis failed to show any statistically significant difference between the concordant and discordant subgroups in terms of overall survival, local, locoregional, or distant control. The discordant subgroup was comprised entirely of p16+/HPV DNA- patients; no patients in the discordant subgroup were found to be p16-/HPV DNA+. Univariate analysis demonstrated statistically significant correlation between overall survival and N-category in the discordant group (P = .024 by Effect Wald Test), in contrast to the concordant group (P = .18). This study suggests that HPV test discordance is not correlated with differential treatment outcomes as compared to HPV test concordance. p16 testing by IHC has been previously shown to be more sensitive and specific than HPV DNA testing by ISH. This study further validates this observation and suggests that p16 may be used as a standalone test in the diagnosis of HPV in HNC patients.

Clinical significance of random bladder biopsy in primary T1 bladder cancer.

The clinical significance of random bladder biopsies in primary non-muscle-invasive bladder cancer is unclear. The present study investigated the significance of positive random bladder biopsies in primary T1 NMIBC. The present study retrospectively reviewed the records of 71 patients with primary pT1N0M0 bladder cancer who underwent transurethral resection of the bladder tumor (TURBT) and concomitant random bladder biopsy. A total of 12 patients who received cystectomy immediately following the TURBT were excluded, and the remaining 59 patients were included in the analysis. Random bladder biopsy was defined as a cold-cup biopsy of pre-specified normal-looking areas in the bladder. The association of clinicopathological factors, including random biopsy results, with intravesical recurrence were assessed by univariate and multivariate Cox proportional hazards analyses. Of the 59 patients, 15 (25%) demonstrated carcinoma in situ (CIS) lesions on random bladder biopsy: Five (33%) in biopsy specimens alone and the remaining 10 (67%) in biopsy and TUR specimens. Positive random biopsy was associated with preoperative positive urine cytology (P=0.011) and small size of the main tumor (P=0.008). Multivariate analysis demonstrated positive random biopsy as the sole independent poor prognostic factor for intravesical recurrence (hazard ratio: 4.69, P=0.014). The five patients who had CIS detected in biopsy specimens alone had worse, although non-significantly worse, recurrence-free survival compared with those with CIS detected in biopsy and TUR specimens (P=0.100). In conclusion, positive bladder random biopsy, equivalent to the presence of CIS, was an independent predictor of recurrence in primary T1 bladder cancer. Given that one-third of CIS lesions could not have been detected without biopsy, random bladder biopsy should be considered for patients with T1 tumors.

MiR-429 expression in bladder cancer and its correlation with tumor behavior and clinical outcome

We previously showed that microRNA-429 (miR-429) played an important role in epithelial–mesenchymal transition (EMT) of urothelial cell carcinoma of the bladder. We herein evaluated the expression of miR-429 in bladder cancer and its potential relevance to clinicopathological characteristics and patient survival. Relative expression levels of miR-429 in surgical bladder cancer tissue specimens obtained from 76 patients with bladder cancer were measured by chromogenic in situ hybridization. miR-429 expression was significantly higher in specimens from alive patients than expired patients in both of 5-year overall survival (OS) (0.59 ± 0.09 vs. 0.27 ± 0.12; p < 0.05) and 5-year recurrence-free survival (RFS) (0.63 ± 0.10 vs. 0.33 ± 0.10; p < 0.05). The univariate Cox proportional hazards analysis revealed that tumor grade, stage, and miR-429 expression were significantly associated with patient survival. In multivariate analysis, tumor stage and miR-429 expression were significantly associated with 5-year OS (hazard ratio [HR] 4.70, p < 0.001) and 5-year-RFS (HR 2.20, p < 0.05). The Kaplan–Meier analysis showed that patients with miR-429 expression had significantly better 5-year OS and 5-year RFS rates than those without miR-429 expression (84.4% vs. 61.4%, p < 0.05 and 71.9% vs. 45.5%, p < 0.05, respectively). miR-429 may be considered as an adjunctive prognostic marker in addition to tumor grade and stage in bladder cancer.

Co-expression Network Analysis Identified COL8A1 Is Associated with the Progression and Prognosis in Human Colon Adenocarcinoma.

Human colon adenocarcinoma is one of the major causes of tumor-induced death worldwide. A complicated gene interconnection network significantly regulates its progression and prognosis. The aim of our study was to find hub genes associated with the progression and prognosis of colon adenocarcinoma and to illustrate the underlying mechanisms. A weighted gene co-expression network analysis was performed in our study to identify significant gene modules and hub genes associated with the TNM stage of colon adenocarcinoma (n=441). In the turquoise module of interest, 23 hub genes were initially selected, and 10 of them were identified as "real" hub genes with high connectivity in the protein-protein interaction network. In the terms of validation, COL8A1 had the highest correlation with clinical traits among all of the hub genes. Data obtained from the Oncomine and GEPIA databases showed a higher expression of COL8A1 in colon adenocarcinoma tissues compared with normal colon tissues. Kaplan-Meier survival curves showed that higher expression of COL8A1 resulted in a shorter overall survival time and disease-free survival time. Univariate and multivariate Cox proportional hazards analyses indicated that the COL8A1 expression was an independent prognostic factor for survival in colon adenocarcinoma patients. Finally, gene set enrichment analysis indicated that the gene sets associated with focal adhesion were significantly enriched in colon adenocarcinoma samples with COL8A1 highly expressed. COL8A1 was identified and proved to be correlated with the progression and prognosis of human colon adenocarcinoma, probably through regulating focal adhesion-related pathways.

Combined Assessment of the Red Cell Distribution Width and B-type Natriuretic Peptide: A More Useful Prognostic Marker of Cardiovascular Mortality in Heart Failure Patients.

Objective An increased red cell distribution width (RDW) has been reported to be associated with adverse outcomes in patients with heart failure (HF). This study aimed to evaluate the prognostic power of the combined measurement of RDW and B-type natriuretic peptide (BNP) concentrations in patients with HF. Methods and Results We retrospectively studied 116 patients (mean age, 63.7±14.3 years) who were admitted for the treatment of HF. Data including demographic information, vital signs, and laboratory and echocardiographic measurements at admission were collected from medical records. The observational period was defined as the number of days from hospitalization, and the study endpoint was defined as cardiovascular death. The mean RDW and BNP concentration at admission were 14.5±2.0% and 626±593 pg/mL, respectively. During a median observation period of 1,046 days, 22 patients died of cardiovascular disease. A univariate Cox proportional hazard analysis revealed that both RDW [hazard ratio (HR) 1.252, p = 0.0391] and BNP (HR 1.001, p = 0.0445) were significant prognostic indices for cardiovascular death. A receiver operating characteristic curve analysis revealed that the optimal cut-off RDW and BNP values for cardiovascular death were 14.9% and 686 pg/mL, respectively. The Kaplan-Meier survival curve revealed that the survival rate of patients with both RDW ≥ 14.9% and BNP ≥ 686 pg/mL showed the poorest prognosis in comparison to the patients in the other groups. Conclusion The combined assessment of the RDW and BNP concentrations may be useful for predicting mortality in patients with HF.

Perirenal Adiposity is Associated With Lower Progression-Free Survival From Ovarian Cancer.

Abdominal obesity is linked with a higher risk of developing ovarian cancer. However, the link between abdominal obesity and survival after diagnosis of ovarian cancer is unknown. The purpose of this study was to determine the impact of abdominal obesity on progression-free survival in patients with ovarian cancer. Among 258 patients, visceral and subcutaneous adipose tissue volume, along with perirenal adipose tissue thickness (a visceral adiposity proxy measure) was retrospectively measured from abdominal computed tomography (CT) scans obtained within 6 months of ovarian cancer diagnosis. Progression-free survival was computed using the Kaplan-Meier method and log-rank tests. Univariate and multivariate Cox proportional hazards analysis was used to determine relationships between measures of abdominal obesity and clinical variables in relation to progression-free survival. Patients with perirenal adipose tissue thickness greater than 5 mm(median) had lower rates of progression-free survival at 5 years compared with patients with perirenal adipose tissue thickness less than 5 mm (45.6% vs 53.8%, respectively). Perirenal adipose tissue thickness less than 5 mm was associated with lower rates of progression-free survival on multivariate analysis (hazard ratio = 1.37; 95% confidence interval, 1.03-1.82). There was no correlation with other metrics of abdominal adiposity on progression-free survival in univariate or multivariate analysis. Our data suggest that perirenal adipose, but not body mass index, visceral, or subcutaneous fat volume that were measured within 6 months from diagnosis, is associated with lower rates of progression-free survival in ovarian cancer.

Progressive Sarcopenia in Patients With Colorectal Cancer Predicts Survival.

The purpose of this study was to evaluate the relationship between sarcopenia and overall and progression-free survival in patients with colorectal cancer. This study was retrospective and complied with HIPAA. Patients with colorectal cancer who underwent CT at the time of and 6-18 months after diagnosis were included. Patients were followed for at least 5 years after diagnosis. Skeletal muscle index (SMI) and mean muscle attenuation of the psoas and paraspinal muscles at the L4 level determined the degree of sarcopenia. Composite measurements combining psoas and paraspinal muscles (total muscle) were also obtained. Univariate and multivariate Cox proportional hazard analysis was performed to evaluate the association between survival and changes in SMI and changes in attenuation. Kaplan-Meier analysis was also performed. A total of 101 patients were included (mean age ± SD, 63.7 ± 13.7 years; 68 men, 33 women). The hazard ratios for overall survival were 2.27, 1.68, and 1.54 for changes in SMI of the psoas muscle, paraspinal muscle, and total muscle (all p < 0.05). The hazard ratios for overall survival were 1.14, 1.18, and 1.24 for changes in attenuation of the psoas muscle, paraspinal muscle, and total muscle, respectively (all p < 0.05). The hazard ratios for progression-free survival were 1.33, 1.41, and 1.23 for changes in SMI of the psoas muscle, paraspinal muscle, and total muscle (not statistically significant). The hazard ratios for progression-free survival were 1.10, 1.21, and 1.23 for changes in attenuation of the psoas muscle, paraspinal muscle, and total muscle, respectively (p < 0.05). Kaplan-Meier analysis showed significant differences in overall and progression-free survival based on sex-specific quartiles of muscle quantity and quality. Progressive sarcopenia after diagnosis of colorectal cancer has a significant negative prognostic association with overall and progression-free survival.

Elevated Serum IL-17 Expression at Cessation Associated with Graves' Disease Relapse.

Background Antithyroid drug (ATD) treatment occupies the cornerstone therapeutic modality of Graves' disease (GD) with a high relapse rate after discontinuation. This study aimed to assess potential risk factors for GD relapse especially serum interleukin-17 (IL-17) expression. Methods Consecutive newly diagnosed GD patients who were scheduled to undergo ATD therapy from May 2011 to May 2014 were prospectively enrolled. Risk factors for GD relapse were analyzed by univariate and multivariate Cox proportional hazard analyses. The association between serum IL-17 expression at cessation and GD relapse was analyzed with relapse-free survival (RFS) by the Kaplan–Meier survival analysis and log-rank test. Results Of the 117 patients, 72 (61.5%) maintained a remission for 12 months after ATD withdrawal and 45 (38.5%) demonstrated GD relapse. The final multivariate Cox analysis indicated elevated IL-17 expression at cessation to be an independent risk factor for GD relapse within 12 months after ATD withdrawal (HR: 3.04, 95% CI: 1.14–7.67, p = 0.021). Patients with higher expressions of IL-17 (≥median value) at cessation demonstrated a significantly higher RFS than those with lower levels by the Kaplan–Meier analysis and log-rank test (p = 0.028). Conclusions This present study indicated elevated serum IL-17 expression at cessation to be a predictor for GD relapse within 12 months.

Predictive value of excision repair cross-complementation group 1 protein in locoregionally advanced nasopharyngeal carcinomas receiving cisplatin-based concurrent chemoradiotherapy.

To investigate the ability of excision repair cross-complementation group 1 (ERCC1) protein to predict cisplatin-based concurrent chemoradiotherapy (CCRT) response in locoregionally advanced nasopharyngeal carcinoma (NPC). The clinical data of 205 patients with locoregionally advanced NPC, who received cisplatin-based CCRT, were analyzed retrospectively. Immunohistochemical analysis was used to assess the ERCC1 expression in nasopharyngeal tumor tissues. Receiver operating characteristic (ROC) curve analysis, univariate and multivariate Cox proportional hazards analyses were performed to evaluate the association between ERCC1 expression and failure-free survival (FFS), overall survival (OS), locoregional-FFS (L-FFS), and distant-FFS (D-FFS). Our results revealed that although the overall response rate in patients with high-ERCC1 expression (97.3%) and those with low-ERCC1 expression (100.0%) were not statistically different, but treatment-sensitive group displayed significantly lower ERCC1 expression in comparison to the treatment-resistant group (P = 0.001). The Kaplan-Meier plots revealed that the low-ERCC1 expression was significantly associated with better L-FFS, FFS, and OS of locally advanced NPC patients receiving cisplatin-based CCRT. Both univariate and multivariate analysis demonstrated that the ERCC1 expression, tumor node metastasis stage and performance status were independent predictors of OS and FFS. ERCC1 expression may be a useful predictive marker in patients with locoregionally advanced NPC, who are receiving cisplatin-based CCRT.

Lymphocyte to Monocyte Ratio and Modified Glasgow Prognostic Score Predict Prognosis of Lung Adenocarcinoma Without Driver Mutation

BackgroundNeutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR) and modified Glasgow prognostic score (mGPS) are useful prognostic markers based on host-related systemic inflammatory response. They have been shown as independent prognostic biomarkers in various cancers, including non-small cell lung cancer. However, there has been little evidence for a specific population of pulmonary adenocarcinoma without active epidermal growth factor receptor (EGFR) mutation.MethodsWe retrospectively reviewed 159 patients who met the following criteria: histologically or cytologically diagnosed adenocarcinoma, confirmed wild-type EGFR, started first-line cytotoxic chemotherapy between July 2007 and March 2017 at our hospital, and c-stage IIIB or IV. We compared overall survival (OS) between dichotomized groups by the optimal cut-off points of NLR and LMR, and mGPS 0 - 1 vs. 2. Univariate and multivariate Cox proportional hazard analyses also detected prognostic factors for OS.ResultsAs favorable prognostic factors for OS, multivariate analysis detected Eastern Cooperative Oncology Group performance status (ECOG PS) 0 - 1 (hazard ratio (HR) 3.43, 95% confidence interval (CI): 2.12 - 5.53; P < 0.01), LMR ≥ 1.97 (HR 0.39, 95% CI: 0.21 - 0.72; P < 0.01) and mGPS 0 - 1 (HR 1.95, 95% CI: 1.20 - 3.16; P < 0.01). The OS of LMR ≥ 1.97 and mGPS 0 - 1 groups were significantly longer than those of LMR < 1.97 and mGPS 2 groups, respectively. We divided 159 patients into three groups, both LMR ≥ 1.97 and mGPS 0 - 1, either LMR ≥ 1.97 or mGPS 0 - 1 and both LMR < 1.97 and mGPS 2. The OS of both LMR < 1.97 and mGPS 2 was significantly shorter than the other two groups. After adjustment for age, sex, ECOG PS, sodium, alkaline phosphatase and NLR, multivariate analysis found both LMR < 1.97 and mGPS 2 as an independent poor prognostic combination in comparison with both LMR ≥ 1.97 and mGPS0-1 (HR 5.98, 95% CI: 2.64 - 13.5; P < 0.01).ConclusionsLMR and mGPS are independent prognostic markers for pulmonary adenocarcinoma with wild-type EGFR. Combination of LMR and mGPS can stratify patients according to prognosis.

A Volumetric Computed Tomography Analysis of the Normal Lung in Idiopathic Pulmonary Fibrosis: The Relationship with the Survival.

Objective An image analysis of high-resolution computed tomography (HRCT) can provide objective quantitation of the disease status in idiopathic pulmonary fibrosis (IPF). However, to our knowledge, no reports have investigated the utility of the normal lung volume for evaluating mortality from IPF. This study aimed to evaluate the relationship between the normally attenuated lung volume on HRCT as a percentage of whole-lung volume (NL%) and IPF mortality. Methods The NL% was determined by HRCT (between -950 and -701 Hounsfield units) using a density mask technique and volumetric software. The NL%, visual assessments of the normal lung by two radiologists, pulmonary function variables, and the gender, age, and physiology (GAP) index were retrospectively evaluated for 175 patients with IPF. Uni- and multivariate Cox proportional hazards analyses and C statistics for mortality were performed. Results The univariate Cox proportional hazards analysis identified the NL% as a prognostic factor [hazard ratio, 0.949; 95% confidence interval (CI), 0.936-0.964; p<0.0001]. In the multivariate analysis, the NL% was a prognostic factor, but the radiologists' visual assessment scores of normal lung were not. The C index increased when the NL% was included in the models of the pulmonary function variables. Furthermore, the C index for a combined model of GAP stage and categorized NL% (0.758; 95% CI, 0.751-0.762) was higher than for the model with the GAP stage alone (0.689; 95% CI, 0.672-0.709). Conclusion The NL% was a prognostic factor in our study population. Quantification of the normal lung using our method may help improve the IPF staging systems.

Role of Concurrent Systemic Therapy with Adjuvant Radiation Therapy for Locally Advanced Cutaneous Head and Neck Squamous Cell Carcinoma

ObjectiveTo evaluate the role of concurrent systemic therapy to postoperative radiation therapy (RT) for locally advanced cutaneous head and neck squamous cell carcinoma (LA-cHNSCC).Materials and methodsA retrospective study of 32 patients with LA-cHNSCC receiving postoperative RT with and without systemic therapy was conducted. Patients with LA-cHNSCC after surgical resection with one or more high risk features were evaluated. Local regional control (LRC), distant control (DC), and acute and late toxicities were evaluated with Fisher exact tests. Progression-free survival (PFS) and overall survival (OS) were evaluated utilizing Kaplan Meier and log-rank analyses. Univariate Cox proportional hazard analyses were used to examine patient, disease, and treatment-related factors with OS and PFS.ResultsWhile comparing patients receiving RT with systemic therapy (n = 14) vs RT alone (n = 18), LRC was 92.9% vs 72.2% (p = 0.20), DC 92.9% vs 94.4% (p = 1.0), median PFS 17.7 months vs 34.4 months (p = 0.48), and median OS 20.9 months vs 34.4 months (p = 0.03), respectively. On univariate analyses, use of concurrent systemic therapy was associated with an increased risk of death with an HR of 3.5 [95% confidence interval (CI): 1.04 - 11.6] (p = 0.04), while patients treated for recurrent disease who had previously treated superficial primaries had improved OS with an HR of 0.10 [95% CI: 0.01-0.80] (p = 0.03). There were no significant differences in acute or chronic toxicities between groups.ConclusionsPatients receiving postoperative RT alone for LA-cHNSCC had better OS than patients receiving concurrent systemic therapy. There were no differences in any other endpoints evaluated.

Radiotherapy for Esophageal Cancer in Patients 80 Years of Age or Older: A 16-Year Experience

Recently some studies showed that esophagectomy and (chemo-)radiation with curative intent were tolerable for older patients with EC, while octogenarian and nonagenarian are often excluded from these researches. The purpose of this study was to evaluate the tolerance and the long-term overall survival (OS) of patients, diagnosed at age ≥ 80, undergoing definitive radiotherapy (RT). 219 consecutive EC patients over 80 years old treated with curative intent RT between February 1999 and December 2015 at a single institution were retrospectively reviewed. Information on patients’ age, gender, tumor location, medical comorbidity, the length of lesion instead of T stage (T stage was not available as endoscopic ultrasound was performed for very few patients), lymph node status, histology, treatment regimen, acute toxicities and tumor response (judged by barium swallow X-ray performed after RT and categorized into 4 grades according to Zhengzhou Meeting criteria) were obtained from medical records. Patients had a follow-up visit every 3 months for the first 2 years and then every 6 months until to death. Clinical prognostic variables were analyzed against OS in univariable and multivariable Cox proportional hazards analysis. Among the patients, 155 were male and 64 were female. 196 patients (89.5%) finished the definitive RT (median: 60Gy,range: 50Gy – 70Gy) without grade 4 or higher acute toxicities including esophagitis, cardiac event, infections and sudden death. Tumor disappearance in barium swallow X-ray image was observed in 82 patients (37.4%) after RT. With a median follow up of 11 months (range: 0 –153 months), overall 171 deaths (78.1%) were observed. The OS rates were 50.6%, 17.7% and 13.3% at 1, 3 and 5-year, respectively. In the univariable analysis, significant prognostic factors were gender (female vs male), tumor location (upper vs middle and lower), length of lesion (continuous data) and treatment response (continuous data). In the multivariable analysis, tumor location, length of lesion and treatment response were significantly associated with OS. Rates of middle or lower EC patients hazard increased by 75% compared with upper EC (hazard ratio(HR), 1.75; 95% confidence interval (CI):1.11-2.75, p = 0.016) , while mortality increased by 15% with per centimeter longer length of lesion (HR, 1.15; 95%CI : 1.06-1.24 ,p = 0.001) and decreased by 48% per treatment response grade (HR, 1.48; 95%CI : 1.19-1.83 , p <0.001). Definitive RT could be considered as an effective treatment for EC patients older than 80 years and 50-60Gy seems to be the reasonable dose for them. Long-term OS can be expected once better tumor response is obtained for patients with upper EC, shorter tumor length and better tumor response to RT. These prognostic factors may improve clinicians' abilities to predict individualized survival and to make treatment recommendations for elderly EC patients.

Incidence and clinical features of the incidentally found vascular stump thrombus during routine follow up after oncologic lung surgery.

ObjectivesWe aimed to evaluate the incidence and clinical features of vascular stump thrombus after oncologic lung surgery.MethodsA retrospective analysis of records from our institutional database dated between 2009 and 2016 was performed. Data regarding demographics, clinical presentation, medication use, operative findings, pathology, and radiologic findings were retrieved.ResultsThe study cohort consisted of 648 oncologic surgeries for primary lung cancer. The incidence of thrombus in the entire population was 5.7% (37/648). Most thrombi were incidentally found on follow-up chest computed tomography scans. Univariate Cox proportional hazard analysis showed that age (p = 0.02), adjuvant therapy (p <0.001), neoadjuvant therapy (p = 0.04), left-sided surgery (p = 0.02), complex surgery greater than simple lobectomy or segmentectomy (p <0.001), advanced stages (p <0.001), non-adenocarcinoma (p = 0.003), and thoracotomy approach (p = 0.009) were associated with an increased risk of vascular stump thrombus. There were no embolic events in our cohort, except for a case of pulmonary thromboembolism. During follow-up, 43.2% (16/37) of thrombi had completely resolved, 48.6% (18/37) showed partial regression and stabilization, and 8.1% (3/37) had progressed.ConclusionsThe incidence of vascular stump thrombus in our study was not negligible. The clinical course of stump thrombus appears to be benign in most cases. Anticoagulation may be used with caution based on an individual basis depending on each patient’s risk factors.

High peak PaO2 values associated with adverse outcome in patients treated with noninvasive ventilation for acute cardiogenic pulmonary edema and pneumonia.

Noninvasive ventilation (NIV) has a sigificant impact on mortality in acute respiratory failure (ARF). Predictive parameters for mortality are of high interest. We retrospectively analyzed 3759 blood gas analysis and clinical parameters of 475 patients presenting with ARF based on acute cardiogenic pulmonary edema and/or pneumonia. The influence of peak arterial oxygen partial pressure levels (PaO2) with respect to its predictive value for in-hopital and long-term mortality was investigated. Overall intra-hospital mortality was 24%. Peak PaO2 levels in kPa were significantly higher in non-survivors (20.01±10.11) compared to survivors (15.65±6.79, P<0.001). A univariate Cox proportional-hazards analysis for long-term mortality revealed associations with maximum PaO2 levels (overall cohort: HR= 1.02; 95% CI: 1.007-1.03; P=0.003; CPE: HR= 1.02; 95% CI: 0.99-1.04, P=0.05, pneumonia: HR= 1.02; 95% CI: 1-1.4, P=0.02). A PaO2 cut-off value of 13 kiloPascal (kPa) was calculated by means of Youden Index and remained true even after correction for APACHE 2 Score (HR= 1.50; 95% CI: 1.00-2.25; P=0.05) and for PaCO2 (HR= 1.63; 95% CI: 1.14-2.33; P=0.01). Peak PaO2 levels were associated with worse in-hopital and long-term mortality in patients treated with NIV due to ARF. These findings may indicate that application of high oxygen may be detrimental in such patients.

Squamous differentiation in patients with superficial bladder urothelial carcinoma is associated with high risk of recurrence and poor survival

BackgroundThe independent prognostic role of squamous differentiation in pT1 bladder urothelial carcinoma has not been reported in previous studies. This article describes the impact of squamous differentiation on tumor recurrence and survival, and whether this histologic variant could indeed alter definitive treatment, based on single center-based retrospective data.MethodsTotally, we retrieved (1)1449 histologically confirmed pT1 bladder urothelial carcinoma patients without histologic variants; (2)227 pT1 bladder urothelial carcinoma patients with squamous differentiation in our institution, from May 2004 to Oct 2015. The total amount of high/low grade urothelial carcinoma patients was 991/685 respectively. Transurethral resection of bladder tumor (TURBT) and intravesical chemotherapy were performed as initial treatments for all the patients. The clinical and pathological characteristics, treatment and survival outcomes were compared between squamous differentiation-positive and squamous differentiation-negative patients.ResultsIn our study, 14% urothelial carcinoma patients were detected with squamous differentiation. The mean age of all the patients examined was 66.4, of whom 82% were males. The 5-year cancer specific survival rates were 69% for squamous differentiation-positive patients and 91% for squamous differentiation-negative patients (p < 0.001). Recurrence proved to be more common in squamous differentiation-positive patients than in negative patients. In the results of the univariate and multivariate Cox proportional hazard analysis, tumor size, lymphovascular invasion, recurrence and squamous differentiation were confirmed to be the prognostic factors associated with patients’ survival.ConclusionsSquamous differentiation in pT1 bladder urothelial carcinoma is correlated to high risk of recurrence and poor prognosis as an independent prognostic factor. Radical cystectomy is essential for recurred high grade pT1 bladder urothelial carcinoma with squamous differentiation accompanied by lymphovascular invasion.

Impact of time of admission on short- and long-term mortality in the Vienna STEMI registry

BackgroundSeveral studies have shown contradictive findings regarding mortality and hospital admission time in patients presenting with ST-elevation myocardial infarction (STEMI). The aim of this study was to assess the impact of “on-” or “off-hour” admission on short- and long-term all-cause mortality of patients in the advanced Vienna STEMI network between 2003 and 2009. Methods and resultsIn total, 2829 patients were included into this analysis. Patients were stratified according to admission time into “on-hour” admission (07:30 until 15:00h on weekdays) and “off-hour” admission (15:00–7:30h on weekdays and 24h on weekends). As endpoint of interest, all-cause mortality was investigated after 30days and 3years of follow-up, the latter for all patients and as Landmark analysis for survivors of the index event.Mean age was 60.5±13.3years, 2048 (72.4%) patients were male and 1260 (44.5%) patients presented with anterior wall infarction. 683 (24.1%) patients were admitted “on-hours”, 2146 (75.9%) patients were admitted “off-hours”. All-cause death occurred in 176 (6.2%) patients after a follow-up of 30days and in 337 (11.9%) patients after 3years.For short- and long-term all-cause mortality no significant differences could be detected between “on-” and “off-hour” admission in univariate and multivariate Cox proportional hazard analyses as well as for propensity score adjusted outcome analysis. ConclusionIn the Vienna STEMI network, “on-” or “off-hour” admission had no impact on short- and long-term mortality for all-comers presenting with acute STEMI. Our findings confirm the imperative need for well-structured STEMI networks of care, as previous data repeatedly demonstrated increased adverse cardiovascular outcome for “off-hour” admission.

Preoperative SYNTAX score to assess the late outcomes after coronary endarterectomy for the diffusely diseased left anterior descending artery†

To evaluate whether the preoperative Synergy between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery (SYNTAX) score was associated with late outcomes of coronary endarterectomy (CE) for the diffusely diseased left anterior descending artery (LAD). We retrospectively analysed 205 of 212 patients undergoing CE for the diffusely diseased LAD between September 2004 and May 2016, excluding 2 patients without preoperative angiographic data and 5 redo cases. The mean SYNTAX score was 34.6. Patients were divided into 3 groups according to their SYNTAX score: low (≤22, n = 26), intermediate (23-32, n = 58) and high (≥33, n = 121). The study end-points were cardiac death and major adverse cardiac and cerebrovascular events, defined as all-cause death, cerebrovascular accidents, non-fatal myocardial infarction and repeat revascularization. All CEs involved long arteriotomy and the reconstruction of the endarterectomized LAD using the skeletonized internal thoracic artery. Postoperative mortality and morbidity were similar between the groups. The median follow-up period was 5.4 years. We found no significant difference in the cumulative cardiac death-free survival rate at 5 years (91.1% vs 100% vs 98.3%; log-rank, P = 0.196) or major adverse cardiac and cerebrovascular events (61.6% vs 71.5% vs 76.7%; log-rank, P = 0.258) in the low, intermediate and high SYNTAX score groups, respectively. Univariate and multivariate Cox proportional hazard analyses revealed no significant association between the study end-points and individual components of the SYNTAX score for the LAD. The preoperative SYNTAX score and its individual components for the LAD were not associated with late outcomes following CE for the diffusely diseased LAD.