Univariate Analysis Of Predictors Research Articles

Validation of the Cancer and Aging Research Group (CARG) model to identify risks of chemotherapy toxicities in Asian older adults.

12043 Background: Older adults are at an increased risk of chemotherapy related toxicities. Identification of risk factors can facilitate oncologists in tailoring treatment, potentially mitigate the risk of chemotherapy toxicity and improve social economic outcomes. Tools like the Karnofsky Performance Status (KPS) and Geriatric Assessment (GA) are used in clinical practice to guide treatment decisions for older adults with cancer. The CARG model incorporating the GA and clinical variables was developed and validated to predict for grade 3-5 toxicities, although this has not yet been validated in Asians. Methods: Patients ≥70 years old with solid malignancies receiving chemotherapy at the National University Cancer Institute, Singapore were recruited between June 2017 and January 2018. The study aims to verify the application of the CARG model, KPS, GA and oncologists’ estimate of toxicity in a multi-ethnic Asian population. The risks of chemotherapy toxicity were calculated using the CARG model (low risk: 0-5, medium risk: 6-9, high risk: ≥10). A GA including a physician rated KPS score (low risk: 90-100, medium risk:80, high risk: ≤70) and a timed up and go (TUG) test (low risk: ≤12s, high risk: > 12s) were performed for all patients. The attending oncologist (blinded to the CARG score) was asked to give an estimated likelihood (low/medium/high) of chemotoxicity. Chemotherapy related toxicities were captured by chart review based on the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. The area under the receiver operating characteristic (ROC) curve and a univariate analysis of predictors of toxicity were calculated. Results: A total of 200 patients were included. Median age was 74 (range: 70-89). The ethnic makeup of the population consisted of Chinese (N = 177; 88.5%), Malay (N = 17; 8.5%), Indians (N = 4; 2%) and other ethnicities. Majority of patients were males (N = 110; 55%), had metastatic disease at diagnosis (N = 114; 57%) and had gastrointestinal cancers (N = 80; 40%). 75% (N = 150) had polychemotherapy and 55% (N = 110) received full dose chemotherapy. More than half of patients (68.5%) experienced G3-5 toxicities, with 65.5% requiring hospitalization. The CARG model predicted 22.5% of patients as low, 50.5% as medium and 27% as high risk of chemotoxicity. The area under ROC for the CARG model was 0.74 (95% CI, 0.67-0.82). A one-point increase in the CARG score was associated with a 15% increase in the odds of G3-5 toxicities. 84.5% of patients needed > 12s for the TUG test. The TUG score, KPS and oncologist’s prediction of toxicity was predictive of an increased risk of G3-5 toxicities (p < 0.01). Conclusions: This study confirms the validity of the CARG predictive model in Asians and can streamline healthcare delivery in older adults. Development of a more robust predictive model incorporating the KPS and TUG into the CARG model could be considered.

Type of fiducial marker and clinical outcomes in stereotactic body radiation therapy for pancreatic cancer.

414 Background: Stereotactic body radiation therapy (SBRT) for pancreatic cancers has been shown to improve local control, and is an important option for treatment, especially for unresectable disease. Verifying the tumor location prior to delivery of SBRT is challenging, so fiducial markers are used to track tumor location. There is currently no standard of which fiducials to use in treatment. This study would like to compare outcomes of patients treated with SBRT using different fiducial markers. Methods: Records of patients diagnosed with primary pancreas cancer who were treated with chemotherapy and SBRT were reviewed from 2006-2019. Patients were excluded if they were treated with Cyberknife, were metastatic at presentation, recurrence /persistent disease after Whipple/radiation therapy, were secondary metastatic disease (from another primary), and if they were resected after SBRT. Patients were categorized according to the fiducial used for tumor tracking during SBRT treatment: gold seeds, intrabiliary stent, or both. Cumulative incidence of local recurrence (CIR) was analyzed with death as competing event, and time to over-all survival was estimated using Kaplan-Meier curves. Results: A total of 129 patients with available fiducial information were included in this study, of which 64 (49.6%) were treated with SBRT using gold seeds, 23 (17.8%) using intrabiliary stent, and 42 (32.6%) using both the seeds and stent. There were no difference between groups in terms of baseline characteristics such as age (p = 0.169), sex (p = 0.293), and stage grouping (p = 0.293). Median follow-up time was 15 months (range: 0.3-37.3 months). The 6- and 12-month CIR were 1.5% (95%CI, 0.1%-7.4%) and 11% (95%CI, 4.8%-20.2%) for patients treated with seeds, 4.3% (95%CI, 0.2%-18.6%) and 30.4% (95%CI, 13.1%-49.8%) for patients treated with stent, and 4.8% (95%CI, 0.8%-14.6%) and 19.5% (95%CI, 9.0%-32.9%) for patients treated with both (p = 0.007). Median time to overall survival was 15.3 months (95%CI, 13-17.8 months) for patients treated with seeds, 21.3 months (95%CI, 14.7-29.6 months) for patients treated with stent, and 15.7 months (95%CI, 11.5-19.7 months) for patients treated with both (p = 0.307). Univariate analysis for predictors of local failure did not show significance for age (p = 0.812), or advanced stage (p = 0.483), but was significant for the presence of seeds (p = 0.006). Conclusions: The type of fiducial marker used for tracking during pancreas SBRT treatment was associated with local failure but no difference in overall survival. Further analysis is warranted to see which clinical factors contribute to this difference.

Utilization of Guidelines-recommended secondary cardiovascular preventive medications in a decade or more survivors after coronary revascularization in the Middle East; analysis form the DECADE PLUS S

Abstract Background There is scarcity of studies from the Middle East had address the use of guideline-recommended secondary cardiovascular prevention medications among individuals who survived at least one decade after coronary revascularization (CR) by percutaneous coronary intervention (PCI) or coronary bypass graft surgery (CABG). Purpose An objective of the DECADE-PLUS study was to evaluate the use of antiplatelet agents (APA), statins, beta blockers (BB) and renin-angiotensin system inhibitors (RASI) in such patients. Methods We enrolled consecutive patients seen at ambulatory or in-patient settings with the following inclusion criteria: patient had PCI or CABG >10 years ago, age >18 years at the time of the index CR, and availability of data of currently used medications. Results Of 892 patients enrolled, 600 (67.3%) had PCI and 292 (32.7%) had CABG. Patients had CR >20 years ago (100; 11.2%), 11–19 years ago (536; 60.1%) or 10 years ago (256; 28.7%). Women comprised 13.8% of the whole cohort, and mean age at index CR was 53.4+9.4 years. Hypertension, diabetes mellitus, and dyslipidemia were present in 398 (44.6%), 351 (39.3%) and 290 (32.5%), respectively at the time of CR. Overall, aspirin was used in 745 (83.5%), and a second APA in 329 (36.9%). Statins, BB and RASI were used in 83.7%, 71.7% and 54.3%, respectively. Univariate analysis of predictors of lower rates of use of these medications showed that survival time (10 years vs. >20 years), and revascularization type (PCI vs. CABG) had no impact on use of these medications. However, nondiabetics were less often prescribed second APA (odds ratio (OR) 0.78, p=0.005) and RASI (OR 0.85, p=0.007) compared with diabetics. Furthermore, compared with men, women were less often prescribed aspirin (OR 0.66, p<0.0001), statin (OR 0.67, p<0.0001), BB (OR 0.71, p=0.005), and RASI (OR 0.79, p=0.005). Conclusion Middle East patients surviving at least one decade after coronary revascularization have a high rate of utilization of secondary cardiovascular medications compared with western data. However, women and non-diabetic individuals have lower rate of use of these medications compared with diabetics and men, respectively. Larger studies are warranted to explore the reasons behind these discrepancies and thus represent potential targets for positive intervention. Funding Acknowledgement Type of funding source: None

Pneumonia risk factors in stroke patients

ABSTRACT Purpose: to assess the demographic and clinical characteristics associated with the development of pneumonia in post-stroke patients hospitalized in a tertiary hospital, located in the Vale do São Francisco, that covers the states of Pernambuco and Bahia, Brazil. Methods: a unicentric, observational, analytical, cross-sectional study, based on the medical records of patients diagnosed with stroke and included in the Stroke Registry (RAVESS study). The statistical analysis was made with the chi-square test, Fisher’s exact test, and the analysis of variance, with the Bonferroni’s post-test, and P≤0.05. Results: data from 69 patients presented with acute stroke were collected, aged 63.2±16.8 years; 37 (53.6%) were females; the prevalence of pneumonia during hospital stay was estimated at 31.9% (95% confidence interval: 21.2-44.2%). In the univariate analysis of predictors for post-stroke pneumonia, the following were identified: older age (72.6±17.9 vs. 58.8±14.5; P = 0.001), lower response signal to the Glasgow Coma Scale at admission (11.3±1.8 vs. 13.3±2.1; P = 0.001), and higher frequency of dysarthria at admission (61.9% vs. 27.9%; P = 0.009). Conclusion: pneumonia was a prevalent complication in post-stroke patients at a Brazilian tertiary hospital. It was related to the patient’s older age and the severity of the cerebral event.

Preventive Scleral Buckling and Silicone Oil Tamponade Are Important for Posttraumatic Endophthalmitis Successfully Managed with Vitrectomy

Aims: Posttraumatic endophthalmitis (PTE) managed with pars plana vitrectomy (PPV) and a variety of other methods often resulted in retinal detachment (RD), which deteriorates postoperative visual acuity (VA). We investigated initial ocular conditions, surgical management and outcomes of PTE patients and analyzed their relationship in order to find the necessary management for different patients’ conditions. Methods: Retrospective study. Medical records of 62 consecutive patients who were diagnosed with PTE and managed with PPV were retrospectively analyzed. The included patients were divided into two groups depending on their initial VA, with light perception (LP) as borderline: group A (12 cases; VA = LP) and group B (50 cases; VA > LP). Specific variables related to surgical outcomes were analyzed, including: initial VA; intraocular foreign body; location and length of the wound; microbiologic test; cataract extraction; scleral buckling; silicon oil tamponade; gas tamponade, and retinal restoration. Data were statistically analyzed by the χ² test, by univariate analysis for predictors and by multivariate logistic regression analysis. Results: RD happened in 19 (30.6%) of the 62 cases included. There were 6 cases (50%) in group A and 13 cases (26%) in group B which resulted in RD. Statistical analysis demonstrated that none of the related factors were correlated to the occurrence of RD (all factors: p > 0.05) in group A, but in group B, scleral buckling (with: 2/22, 9%; without: 11/28, 39%; p < 0.05) and silicone oil tamponade (with: 0/6; without: 13/44, 30%; p < 0.05) were statistically significantly correlated to the occurrence of RD. Conclusions: Preventive scleral buckling and silicone oil tamponade are important for patients with good initial VA (VA > LP) to be successfully managed by PPV.