scholarly journals The Predictive Value of Return to Work Self-efficacy for Return to Work Among Employees with Cancer Undergoing Chemotherapy

2020 ◽  
Vol 30 (4) ◽  
pp. 665-678 ◽  
Author(s):  
Rikke Rosbjerg ◽  
Dorte Gilså Hansen ◽  
Robert Zachariae ◽  
Inger Hoejris ◽  
Thomas Lund ◽  
...  
Keyword(s):  
Return To Work ◽  
Predictive Value ◽  
Self Efficacy ◽  
Statistical Significance ◽  
Performance Status ◽  
Univariate Analysis ◽  
Predictor Variable ◽  
Cox Proportional Hazards ◽  
Treatment Modalities ◽  
Related Factors

AbstractPurpose The aim of the present study was to examine the predictive value of Return to Work Self-efficacy (RTWSE) on Return to Work (RTW) among employees undergoing chemotherapy for cancer and to examine the relative contribution of RTWSE as predictor variable compared to personal, health-related, illness- and treatment-related and work-related factors. Methods A sample of 114 sickness absent employees with various cancers (age 18–62) included in the study on average 33 days after initiating chemotherapy were followed for 15 months. Data sources included patient questionnaires (RTWSE, depression, fatigue, performance status), sociodemographic factors (age, sex, job type, and perceived support from the workplace), patient records (type of cancer, treatment intention, number of treatment modalities, time since diagnosis and time since initiation of chemotherapy), and Danish national registries (RTW and education). Associations between RTWSE at baseline and weeks until full RTW during 15-months follow-up were analyzed using Cox proportional hazards regression. Results In the univariate analysis, high RTWSE was associated with shorter time to RTW (Hazard Ratio (HR) 1.84, 95% confidence interval (CI) 1.12–3.03). In the multivariate model, RTWSE failed to reach statistical significance (HR 1.12, 95% CI 0.62–2.02), whereas female sex (HR 0.30, 95% CI 0.15–0.60) and receiving palliative treatment (HR 0.15, 95% CI 0.05–0.44) were significantly associated with later RTW. Conclusion Compared to other factors of significance, RTWSE was not the strongest predictor of RTW when examined among employees undergoing chemotherapy for cancer. Before using the RTWSE questionnaire to identify employees with cancer at risk of late RTW, it is important to recognize that the predictive value of RTWSE may be different for employees on sick leave due to cancer than for other sickness absence populations.

Prognostic factors for survival in patients with stage (stg) IV malignant melanoma (MM)

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9072-9072
Author(s):  
N. Seetharamu ◽  
H. Hamilton ◽  
T. Tu ◽  
P. Christos ◽  
I. Osman ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Univariate Analysis ◽  
Primary Melanoma ◽  
Stage Iv ◽  
Female Gender ◽  
Cox Proportional Hazards ◽  
Independent Effect ◽  
P Value ◽  
Related Factors ◽  
Ajcc Staging

9072 Background: Prognosis for survival in MM is not uniform with some pts being long-term survivors. Identifying this subset of pts may have implications on surveillance and treatment (tx). Unfortunately, prognostic data available for MM and the utility of AJCC staging in predicting survival is limited. We analyzed prospectively collected data from the NYUCI Interdisciplinary Melanoma Cooperative Group program (IMCG) to identify clinicopathological variables predictive of MM survival. Methods: We identified 185 pts enrolled in the IMCG with MM diagnosed and treated at NYUCI. Demographic, clinical, and tx-related factors were included in the analysis. Kaplan-Meier (KM) survival analysis was used to identify univariate predictors of post-stage IV survival and their independent effect was assessed in a multivariate Cox proportional hazards regression model. Results: Median age at diagnosis (dx) of metastatic MM was 64 years (22–92). Median overall survival: 13.8 months(m) (128 deaths and a median follow up of 18.6 m (4–141) for survivors). Factors identified on univariate analysis at p<0.20 were evaluated in the multivariate model ( table ). Co-morbidities, site and histology of primary melanoma, initial staging, prior loco-regional recurrences, and adjuvant tx of primary melanoma were not associated with MM survival. Univariate analysis also showed significant survival advantage (p value 0.0011) for patients with AJCC stages M1a and M1b (21.6 m and 17.2 m respectively) over those with AJCC stage M1c (9 m). Conclusions: This cohort study of MM identified female gender, nl serum LDH, nl albumin, and solitary organ involvement as independent survival predictors. Patients who received systemic therapy± local measures had survival benefit over those that had surgery and/or radiation alone suggesting a role for systemic treatment in MM. Patients with personal history of another malignancy (n=37) showed a trend towards improved survival. This novel observation needs to be validated and studied further. [Table: see text] No significant financial relationships to disclose.

Bone metastases treated with immune checkpoint inhibitors: A single center experience.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e14105-e14105 ◽  
Author(s):  
Punita Grover ◽  
Vidhya Karivedu ◽  
Zheng Zhu ◽  
Roman Jandarov ◽  
Trisha Michel Wise-Draper
Keyword(s):  
Bone Metastases ◽  
Checkpoint Inhibitors ◽  
Small Cell Lung Carcinoma ◽  
Performance Status ◽  
Univariate Analysis ◽  
Additional Treatment ◽  
Treatment Modalities ◽  
Combination Immunotherapy ◽  
Cell Lung Carcinoma ◽  
Combination Methods

e14105 Background: We conducted a retrospective study to analyze the overall survival (OS) and progression free survival (PFS) among patients with bone metastases (BMs) from Non Small Cell Lung Carcinoma (NSCLC), Melanoma, Head and Neck Squamous Cell Carcinoma (HNSCC) and others (including genitourinary carcinoma) treated with immunotherapy (Nivolumab, Pembrolizumab, Ipilimumab or a combination). Methods: We retrospectively evaluated patients with BMs treated at our institute from 2012-2017 who received either immunotherapy alone or in combination with other therapies for BMs including: medical therapy (zoledronic acid or denosumab), radiation or surgery. Univariate analysis was utilized to analyze OS and PFS. Results: A total of 58 patients were identified, median age at diagnosis of BMs was 61 years (range 29 – 94). 39 patients were male (67.2%) and 47(81%) patients had good performance status (KPS 70-100) at the time of immunotherapy initiation. The median time to diagnosis of BMs was 11.4 months. 20 patients had a single BM, 16 had 2-4 BMs and 22 had ≥5 BMs. Axial-only BMs were seen in 27 patients, appendicular-only in 8 and both in 23 patients. 40 patients were symptomatic and 28 patients had skeletal events (pathological fractures, spinal cord compression or hypercalcemia). 51 patients had other metastatic sites at the time of initiation of immunotherapy. 25 patients received nivolumab, 20 patients received pembrolizumab and 4 patients received combination immunotherapy. 41 patients received additional treatments for BMs. The median OS from the start of immunotherapy was 5.15 months and median PFS was 3 months. On univariate analysis male sex (p = 0.03) and combination immunotherapy (p = 0.06) were associated with better OS. Patients who received additional treatments for BMs (p = 0.04) and combination immunotherapy (p = 0.02) had better PFS. Conclusions: Combination immunotherapy and use of additional treatment modalities for BMs is associated with better survival. Further analysis is required to validate these results. [Table: see text]

Prognostic Impact of Clinico-Pathological Parameters on the Outcome of Multiple Myeloma Patients: A Single-Center Analysis on 143 Consecutive Patients Treated with Standard Versus Intensive Chemotherapy.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5436-5436
Author(s):  
Truc Ngo ◽  
Martina Kleber ◽  
Barbara Deschler ◽  
Gabriele Ihorst ◽  
Monika Engelhardt
Keyword(s):  
Multiple Myeloma ◽  
Prognostic Factors ◽  
Statistical Significance ◽  
Performance Status ◽  
Stage Ii ◽  
Treatment Modalities ◽  
High Dose ◽  
Prognostic Impact ◽  
Group A ◽  
Group B

Abstract Multiple myeloma (MM) remains an incurable disease, with significant variation in the response and survival even with current treatment modalities, such as high-dose chemotherapy (CTx) and autologous stem cell transplantation (auto-SCT), novel drugs and intensive supportives. Hence, prognostic parameters that help to predict the benefit of different therapeutics are of utmost importance to be defined further. The objective of this analysis was to determine whether treatment selection and response are markedly influenced by specific clinico-pathological parameters and how these effect overall survival (OS). Of 143 consecutive MM patients (pts) receiving either standard therapy (Std-CTx, group A, n=79) or auto-SCT (group B, n=64) at our center between 1997–2003, gender, age, MM-type, -stage, number of CTx lines, LDH,β 2-MG and bone marrow (BM) infiltration were evaluated on response and survival in uni- and multivariate analyses and hazard ratios (HR) were determined. To further pay tribute to pts’ average age, as MM is primarily a disease of the elderly, special attention was paid to the influence of the performance status (Karnofsky Index=KI) and number of concurrent diagnoses (CD). Pts in groups A and B were comparable in terms of gender distribution, MM type, CD and LDH-level. However, group A as compared to B pts were older (65 vs. 56 yrs), had received more radiation (26 vs. 19%) and showed higher β2-MG (5 vs. 2.3g/L; respectively). Moreover, pts in group B as compared to A had more advanced disease (Durie and Salmon [D&S] stage II/III: 92 vs. 65%), a higher BM-infiltration (40 vs. 30%), and were treated later in their disease course. In group A pts, HR were increased for β2-MG>3, D&S stage II/III, stage B disease, CD>1, LDH>200U/L and age >60y, and HR decreased for females and KI>80%, reaching significance for β2-MG, D&S stage II/III, stage B disease, CD and KI. Although these HR were also observed for group B pts, none of these prognostic factors reached statistical significance. Multivariate analysis on all pts identified β2-MG >3mg/L and age >60y as independent prognostic factors, with HRs of 3.6 (95% CI 1.6–8.1) and 2.1 (CI 0.9–5.0), respectively. Of note, current CR/PR rates for group A and B pts are 4 vs. 20%, and at last follow-up (6/2006) median OS from treatment initiation is 49.5% vs. 61.4%, respectively. Our data show that an elevated β2-MG, D&S stage II/III, stage B disease, more than 1 CD and reduced performance status before therapy, negatively influence response and OS in Std-group pts, whereas these do not significantly impact HR in auto-SCT pts. We conclude that MM pts benefit from auto-SCT independently of prognostic factors which, however, do impact outcome with Std-CTx alone. Since randomized trials have repetitively shown response and survival with auto-SCT to be superior to Std-CTx, we propose that pts with the above prognostic factors should be carefully evaluated for intensive therapies, as this analysis accentuates that auto-SCT is the treatment of choice for eligible MM pts.

scholarly journals Growth hormone and prolactin-staining tumors causing acromegaly: a retrospective review of clinical presentations and surgical outcomes

2019 ◽  
Vol 131 (1) ◽  
pp. 147-153 ◽  
Author(s):  
Jonathan Rick ◽  
Arman Jahangiri ◽  
Patrick M. Flanigan ◽  
Ankush Chandra ◽  
Sandeep Kunwar ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Logistic Regression ◽  
Pituitary Adenomas ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Cox Proportional Hazards ◽  
Serum Prolactin ◽  
Tumor Diameter ◽  
Multiple Logistic Regression ◽  
Clinical Presentations

OBJECTIVEAcromegaly results in disfiguring growth and numerous medical complications. This disease is typically caused by growth hormone (GH)–secreting pituitary adenomas, which are treated first by resection, followed by radiation and/or medical therapy if needed. A subset of acromegalics have dual-staining pituitary adenomas (DSPAs), which stain for GH and prolactin. Presentations and treatment outcomes for acromegalics with DSPAs are not well understood.METHODSThe authors retrospectively reviewed the records of more than 5 years of pituitary adenomas resected at their institution. Data were collected on variables related to clinical presentation, tumor pathology, radiological size, and disease recurrence. The Fisher’s exact test, ANOVA, Student t-test, chi-square test, and Cox proportional hazards and multiple logistic regression were used to measure statistical significance.RESULTSOf 593 patients with pituitary adenoma, 91 presented with acromegaly. Of these 91 patients, 69 (76%) had tumors that stained for GH only (single-staining somatotrophic adenomas [SSAs]), while 22 (24%) had tumors that stained for GH and prolactin (DSPAs). Patients with DSPAs were more likely to present with decreased libido (p = 0.012), signs of acromegalic growth (p = 0.0001), hyperhidrosis (p = 0.0001), and headaches (p = 0.043) than patients with SSAs. DSPAs presented with significantly higher serum prolactin (60.7 vs 10.0 µg/L, p = 0.0002) and insulin-like growth factor-1 (IGF-1) (803.6 vs 480.0 ng/ml, p = 0.0001), and were more likely to have IGF-1 levels > 650 ng/ml (n = 13 [81.3%] vs n = 6 [21.4%], p = 0.0001) than patients with SSAs despite similar sizes (1.8 vs 1.7 cm, p = 0.5). Patients with DSPAs under 35 years of age were more likely to have a recurrence (n = 4 [50.0%] vs n = 3 [11.1%], p = 0.01) than patients with SSAs under the age of 35. DSPA patients were less likely to achieve remission with surgery than SSA patients (n = 2 [20%] vs n = 19 [68%], p = 0.01). Univariate analysis identified single-staining tumors (p = 0.02), gross-total resection (p = 0.02), and tumor diameter (p = 0.05) as predictors of surgical remission. Multiple logistic regression demonstrated that SSAs (p = 0.04) were independently associated with surgical remission of acromegaly. Kaplan-Meier analysis revealed that DSPAs had more time until disease remission (p = 0.033).CONCLUSIONSAcromegalics with tumors that stain for prolactin and GH, which represented almost a quarter of acromegalics in this cohort, had more aggressive clinical presentations and postoperative outcomes than SSAs. Prolactin staining provides useful information for acromegalics undergoing pituitary surgery.

Prognostic model for primary CNS lymphoma (PCNSL): Recursive partitioning analysis (RPA) of the MSKCC PCNSL population

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 1531-1531 ◽  
Author(s):  
L. E. Abrey ◽  
L. Benporat ◽  
K. S. Panageas ◽  
J. Yahalom ◽  
L. M. Deangelis
Keyword(s):  
Overall Survival ◽  
Prognostic Model ◽  
Proportional Hazards ◽  
Prognostic Score ◽  
Performance Status ◽  
Univariate Analysis ◽  
Primary Cns Lymphoma ◽  
Cox Proportional Hazards ◽  
Cns Lymphoma ◽  
Analysis And Design

1531 Background: Increasingly there is a need to develop a simple prognostic score that can be used in the analysis and design of PCNSL studies as well as for clinical management. Recently the IELSG published a 3 group prognostic model incorporating patient age, performance status, serum LDH, location of brain lesions and CSF total protein; however, only 105 of their 378 patients had all of the variables available to develop this score. Methods: We analyzed 338 patients (median age 60; median KPS 70) seen and treated for PCNSL at MSKCC between 1983 and 2003. The median survival was 37 months and median follow up of surviving patients is 35 months. Univariate analysis of potential prognostic factors was performed using the Kaplan Meier product limit method. Significant univariate variables were included in a multivariate analysis using the Cox proportional hazards regression model. Patients were separately analyzed using the IELSG prognostic score. Finally, RPA was employed as an independent method of developing specific prognostic categories. Results: In the univariate analysis, age, hemiparesis, mental status changes, creatinine clearance and KPS were significant predictors of overall survival; in the multivariate model only age and KPS remained as significant predictors. 113 patients had adequate information (all 5 variables) to be analyzed using the IELSG prognostic score; while this correlated significantly with overall survival, the comparison between groups 2 and 3 was not statistically significant (p = 0.10). RPA of all 338 patients identified 3 subgroups: age ≤ 50 (median OS 9.2 y), age > 50 and KPS ≥ 70 (median OS 3.2 y) and age > 50 and KPS < 70 (median OS 1 y) that significantly separated our entire PCNSL population (p < 0.001). Conclusions: The use of RPA allows for easy discrimination of 3 prognostic groups of patients with PCNSL. In contrast to the IELSG score the MSK RPA classification includes information that is readily available on all patients and can be easily incorporated into the analysis or design of clinical research. No significant financial relationships to disclose.

Malignant pleural mesothelioma: a disease unaffected by current therapeutic maneuvers.

1988 ◽  
Vol 6 (3) ◽  
pp. 527-535 ◽  
Author(s):  
A S Alberts ◽  
G Falkson ◽  
L Goedhals ◽  
D A Vorobiof ◽  
C A Van der Merwe
Keyword(s):  
Malignant Pleural Mesothelioma ◽  
Early Stage ◽  
Performance Status ◽  
Univariate Analysis ◽  
Treatment Modalities ◽  
Pleural Mesothelioma ◽  
Phase Ii Trials ◽  
Duration Of Symptoms ◽  
Histologic Subtype ◽  
Treatment Groups

From 1965 to 1985, 262 patients with malignant pleural mesothelioma were treated with cytostatics only; radiotherapy (RT); RT and cytostatics; or decortication plus RT plus cytostatics. The median survival (MS) from diagnosis was 9.6 months. This was similar for all comparable treatment groups. In a univariate analysis, significant favorable prognostic factors were good performance status (PS), duration of symptoms greater than 6 months at the time of diagnosis, early stage of disease, white race, and female sex. In a multivariate analysis, PS, race, duration of symptoms, and stage were of significance for a favorable prognosis. Age, pain as first symptom, histologic subtype, and RT dose were not of prognosis significance in this study. The stepwise addition of treatment modalities did not increase survival, which remained the same as that reported for untreated patients. Therefore, phase II trials of new agents offer the only hope for advance in the treatment of this disease.

scholarly journals Glycemic Control as an Early Prognostic Marker in Advanced Pancreatic Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Ipek Alpertunga ◽  
Rabail Sadiq ◽  
Deep Pandya ◽  
Tammy Lo ◽  
Maxim Dulgher ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Proportional Hazards ◽  
Performance Status ◽  
Univariate Analysis ◽  
Advanced Pancreatic Cancer ◽  
Community Setting ◽  
Cox Proportional Hazards ◽  
Ductal Adenocarcinoma ◽  
Rank Test ◽  
Pre Treatment

PurposeImpaired glucose metabolism is present in most patients with pancreatic ductal adenocarcinoma (PDAC). Whereas previous studies have focused on pre-treatment glycemic indices and prognosis in those with concomitant diabetes, the effects of glycemic control during chemotherapy treatment on prognosis, in patients with and without diabetes, have not been well characterized. We examined the relationship between early glycemic control and overall survival (OS) in a cohort of patients with advanced PDAC treated in a community setting.Patients and MethodsSeventy-three patients with advanced PDAC (38% with diabetes) receiving chemotherapy while participating in a biobanking clinical trial were included. Clinical characteristics and laboratory results during 1 year were obtained from the electronic medical record. Kaplan-Meier estimate, log-rank test and hazard ratios were computed to assess the effect of glycemic control on OS. The Cox proportional hazards regression model was applied to ascertain the significance of glycemic control with other survival variables.ResultsOne thousand four hundred eighteen random blood glucose (RBG) values were analyzed. In accord with previous findings, a 50% decline in the serum tumor marker CA 19-9 at any time was predictive of survival (P=0.0002). In univariate analysis, an elevated pre-treatment average RBG, 3-month average RBG (RBG-3) and the FOLFIRINOX regimen were associated with longer survival. Based on ROC analysis (AUC=0.82), an RBG-3 of 120 mg/dl was determined to be the optimal cutoff to predict 12-month survival. In multivariate analysis that included age, stage, BMI, performance status, presence of diabetes, and chemotherapy regimen, only RBG-3 maintained significance: an RBG-3 ≤120 mg/dl predicted for improved OS compared to &gt;120 mg/dl (19 vs. 9 months; HR=0.37, P=0.002). In contrast, an early decline in CA 19-9 could not predict OS.ConclusionLower glucose levels during the first 3 months of treatment for advanced PDAC predict for improved OS in patients both with and without diabetes. These results suggest that RBG-3 may be a novel prognostic biomarker worthy of confirmation in a larger patient cohort and that studies exploring a possible cause and effect of this novel survival-linked relationship are warranted.

scholarly journals Surgery for advanced oropharyngeal cancer

2018 ◽  
Vol 8 (3) ◽  
pp. 37-45
Author(s):  
A. V. Karpenko ◽  
R. R. Sibgatullin ◽  
A. A. Boyko ◽  
N. S. Chumanikhina ◽  
E. Yu. Lomteva ◽  
...  
Keyword(s):  
Oropharyngeal Cancer ◽  
Imaging Techniques ◽  
Univariate Analysis ◽  
Combined Treatment ◽  
Early Postoperative Period ◽  
Treatment Modalities ◽  
Adjuvant Radiation ◽  
Related Factors ◽  
Study Objective ◽  
Strict Adherence

The study objectiveis to assess the results of this approach and identifications of factors that may influence the effectiveness of such an approach.Materials and methods. Since 2009 through 2016 72 patients with stage III and IV aged between 42 and 77 years underwent upfront surgery.Anatomical sites included 34 (46 %) tonsil, 24 (33 %) base of tongue and 14 (21 %) soft palate cases. Transcervical sparing the mandible,mandibulectomy and transoral approaches were used in 42 (58 %), 11 (15 %) and 7 (10 %) patient, respectively. Total glossectomy was performed in 4 (5.5 %) cases. Tumor extension necessitated extended laryngectomy in 8 patients (11.5 %). Primary closure of the pharyngeal wound was possible in 30 patients (42 %). Reconstruction with distant flaps was performed in the remaining 42 patients. Both free (anterolateral thigh – 19, radial forearm flap – 10) and flaps with axial blood supply (pectoralis major – 9, supraclavicular flap – 4) were used. There were 6 T1, 12 T2, 28 T3 and 20 T4 tumors; 62 patients were N-positive: N1 – 10 cases, N2 – 51, N3 – 1. Positive surgical margins were diagnosed in 13 cases (18 %) including 3 cases of R2 resection. Adjuvant radiation therapy with or without chemotherapy was completed in 45 patients (63.4 %). Survival was calculated according to Kaplan–Mayer method.Results.There was 1 death in early postoperative period. Mean follow-up for the remaining patients (n = 71) was 27 months (1–94). Median survival was 27 months (95 % CI 11.5–42.5); 3-year overall survival was 44 %; 33 out of 34 still alive patients are capable to take food orally. Only 1 (2.9 %) patient is gastrostomy tube dependent. Univariate analysis revealed that positive margins (p <0.0001) and completeness of combined treatment (p <0.01) are the main factors that have statistically significan impact on prognosis.Conclusion.Combined approach with upfront surgery is one of the main treatment modalities for advanced oropharyngeal cancer. Modern reconstructive options and strict adherence to a proper surgical technique give a high chance for a valuable rehabilitation for the vast majority of patients. Scrupulous planning of the resection of the primary tumor based on modern imaging techniques and encouraging patients to complete all prescribed treatments are the main physician-related factors that influence survival outcome.

scholarly journals NCOG-35. PREDICTORS OF POSTOPERATIVE SEIZURES IN PATIENTS WITH GLIOBLASTOMA MULTIFORME

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii136-ii137
Author(s):  
Yue Zhang ◽  
Alper Dincer ◽  
Noah Feld ◽  
Matthew Carr ◽  
Lily Zhang ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Univariate Analysis ◽  
Cox Proportional Hazards ◽  
Neurocognitive Deficits ◽  
Clinical Tool ◽  
Related Factors ◽  
Factors Associated ◽  
History Of ◽  
Postoperative Seizure ◽  
Overall Risk

Abstract INTRODUCTION Seizures are a major cause of morbidity in patients with GBM, resulting in neurocognitive deficits and reduced QOL. There are limited studies on the predictors of postoperative seizures in these patients. Furthermore, there is no consensus among neurosurgeons on the timing of perioperative use of antiepileptic drugs (AEDs). The objective of this study is to determine patient- and tumor-related factors associated with postoperative seizures in GBM patients who undergo surgical resection. METHODS Our patient data registry was queried for adult patients treated for GBM at VCU from 2005 to 2014. Univariate and multivariable logistic regression analyses were performed to identify patient and tumor factors associated with postoperative seizure within a 12 month period. Cox proportional hazards regression analysis was used to evaluate the overall risk of postoperative seizure. RESULTS 146 patients met the criteria for the study. Of these, 39 patients (27%) experienced a postoperative seizure within 12 months. On univariate analysis, factors significantly associated with postoperative seizure within 12-months included percent (%) of FLAIR volume resected (OR: .81; CI: 0.65-0.99; p=.046), history of AED use (OR: 2.51; CI: 1.20-5.25; p = 0.015), and history of seizure (OR: 2.26, CI: 1.07-4.76; p=0.033). On multivariate analysis, % FLAIR resection maintained significance. (OR of 0.79; CI: .63-.99; p = 0.044). The increased overall risk of postoperative seizure was associated with preoperative seizure &lt; 30 days before surgery. (HR:6.65, CI: 1.02-43.36, p=0.048). DISCUSSION Our study found that the increased extent of resection of FLAIR volume correlates with decreased odds of seizure occurrence in the 12-month postoperative period. Epileptogenesis of GBM seizures within this time period may be due to tumor-related edema or infiltrative tumor cells. Evaluation of FLAIR imaging postoperatively may be a useful clinical tool to guide AED management in high-risk patients.

scholarly journals Low Serum Albumin Level Predicts the Risk of Azacitidine Early Discontinuation in MDS, CMML and 20-30% AML Patients- Results from the Polaza, the Retrospective Study of the Polish Adult Leukemia Group

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5421-5421
Author(s):  
Krzysztof Madry ◽  
Karol Lis ◽  
Andrzej Tukiendorf ◽  
Pawel Szwedyk ◽  
Katarzyna Kapelko-Słowik ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Serum Albumin Level ◽  
Statistical Significance ◽  
Performance Status ◽  
Univariate Analysis ◽  
Albumin Level ◽  
Drug Discontinuation ◽  
Early Failure ◽  
Adult Leukemia ◽  
Leukemia Group

Background: Azacitidine is the current standard of care for higher risk MDS patients (HR MDS) changing the natural course of diseases. Early drug discontinuation (receiving less than 4 azacitidine cycles - early failure - EF) is a poor prognostic marker, while factors affecting early failure are largely unknown. Objectives: To identify predictive factors for early azacitidine failure in MDS/CMML/low blast percentage AML patients Methods: The study included retrospectively MDS/CMML and 20-30% bone marrow blasts AML patients treated from 2008 to 2019 in 12 Polish hematologic centers cooperating within Polish Adult Leukemia Group (PALG). Baseline demographic, laboratory, clinical and treatment characteristics were obtained and were evaluated as potential EF predictors. Cox proportional hazard models were used to define statistical significance of variables using the R statistical platform. Results: We collected data on 315 patients with MDS (67%), CMML (12%) and with AML (21%). Median age was 69 years and 61% were male. Median number of azacitidine cycles was 7 (1-69) and 84 patients (29%) received maximum 3 cycles. Patients achieved more than 3 cycles showed better OS compared to those ≤ 3 cycles (20 months vs 4 months)(p<0.05)( Figure 1). In univariate analysis the following features were significantly predictive for early failure: poorer cytogenetics IPSS (OR 1.87, 95% CI 1.36-2.56; p<0.001), poorer cytogenetics IPSS R (OR 1.52, 95% CI 1.21-1.89; p< 0.001), poorer IPSS score (OR 1.77, 95% CI 1.18-2.66; p0.006), poorer ISS R score (OR 1.51, 95% CI 1.07-2.14; p=0.02), earlier treatment (OR 2.43, 95% CI 1.33-4.44; p=0.004), serum albumin level (OR 0.44, 95% CI 0.27-0.74; p=0.002), coexistence of autoimmune disease (OR 1.49, 95% CI 1.12-1.99; p=0.007), ECOG performance status (OR 1.49, 95% CI 1.12-1.99, p=0.007) and ativiral prophylaxis management (OR 0.40, 95% CI 0.19-0.87, p=0.020). In the multivariate analysis only serum albumin level retained its significance as independent factor affecting the risk of EF (OR 0.30, 95% CI 0.13-0.7; p=0.005). Decrease of albumin level by 1 g/dL rises the risk of EF occurence by 70%. Conclusions: Our analysis confirmed that patients with premature azacitidine treatment discontinuation ≤ 3 cycles have worse outcome. The pretreatment lower serum albumin level was identified as an independent predictor of early failure occurence. Figure 1. Overall survival in patients treated with ≤ 3 azacitidine cycles and > 3 cycles Disclosures Golos: Novartis: Honoraria. Basak:Celgene: Honoraria; Teva: Honoraria.

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