scholarly journals 2542

2017 ◽  
Vol 1 (S1) ◽  
pp. 83-83
Author(s):  
Arnav Srivastava ◽  
Hiten Patel ◽  
Max Kates ◽  
Zeyad Schwen ◽  
Gregory Joice ◽  
...  
Keyword(s):  
Tumor Size ◽  
Proportional Hazards ◽  
Preoperative Staging ◽  
Cox Proportional Hazards ◽  
Cancer Specific Survival ◽  
Cox Proportional Hazards Models ◽  
Number Of Patients ◽  
Patients At Risk ◽  
Study Population ◽  
Similar Survival

OBJECTIVES/SPECIFIC AIMS: Due to increased experience and favorable outcomes, the use of partial nephrectomy (PN) to treat renal cell carcinoma has grown in the past decade, with expansion to larger tumors. Performing PN for larger tumors could potentially increase the number of patients up-staged to pT3a after surgery, who may have instead been treated with radical nephrectomy (RN), if known preoperatively. We aimed to estimate the proportion of patients up-staged to T3a disease after PN stratified by size. We also compared size-stratified survival outcomes of up-staged patients to those with T1a, T1b, or T2 kidney cancer. METHODS/STUDY POPULATION: From 1998 to 2013, patients undergoing PN or RN were identified from Surveillance Epidemiology and End Results registries. The proportion of patients receiving PN found to have pT3a disease was quantified by size. Cox proportional hazards models compared cancer-specific (CSS) and overall survival (OS) for PN patients with pT1a, pT1b, and pT2 disease with appropriately size-stratified pT3a patients. Also, PN patients with pT3a disease were compared to size-stratified RN patients with pT3a disease. Comparisons by size were performed within pT3a patients receiving PN. RESULTS/ANTICIPATED RESULTS: From a total of 28,854 patients undergoing PN, the estimated proportion up-staged to pT3a increased along with increasing tumor size: 4.2% for T1a, 9.5% for T1b, and 19.5% for T2. Among patients receiving PN, adjusted survival analysis demonstrated worse CSS for up-staged pT3a patients Versus appropriately stratified pT1a (CSS: HR=1.87, p=0.02), pT1b (CSS: HR=1.91, p=0.01), and pT2 (CSS: HR=2.33, p=0.01) patients. However, when assessing OS, only the size-stratified comparison of up-staged pT3a Versus pT1a disease demonstrated worse OS for the up-staged cohort (OS: HR=1.25, p=0.04). Comparing PN and RN for pT3a disease, size-adjusted analysis revealed no statistical difference in CSS or OS. Lastly, among patients undergoing PN with pT3a disease, patients with larger tumors, measuring 4–7 cm (CSS: HR=2.83, p<0.01; OS: HR=1.44, p=0.04) or 7–16 cm (CSS: HR=8.22, p<0.01; OS: HR=2.64, p<0.01), experienced worse survival than those with smaller pT3a tumors, <4 cm. DISCUSSION/SIGNIFICANCE OF IMPACT: A greater proportion of patients appear to experience T3a up-staging after PN with increasing initial T stage. Up-staged pT3a patients have worse cancer specific survival after PN compared to those with similarly sized localized tumors. Furthermore, the up-staged pT3a patients after PN appear to experience similar survival to pT3a patients undergoing RN. However, pT3a patients undergoing PN had worse survival with increasing tumor size, reinforcing the need for improvements in preoperative staging and identifying patients at risk of up-staging.

Incidence of T3a upstaging and survival after partial nephrectomy: Size-stratified rates and implications for prognosis.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 4588-4588
Author(s):  
Arnav Srivastava ◽  
Hiten Patel ◽  
Max Kates ◽  
Zeyad Schwen ◽  
Gregory Joice ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Tumor Size ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
The Past ◽  
Cox Proportional Hazards Models ◽  
Number Of Patients ◽  
Patients At Risk ◽  
Similar Survival ◽  
Patients Experience

4588 Background: The use of partial nephrectomy (PN) to treat renal cell carcinoma has grown in the past decade, with expansion to larger tumors. Performing PN for larger tumors may increase the number of patients up-staged to pT3a after surgery, who may have underwent radical nephrectomy (RN), if known preoperatively. We aimed to estimate the proportion of patients up-staged to T3a disease after PN, stratified by size. We also compared size-stratified survival of up-staged pT3a patients to those with T1a, T1b, or T2 disease. Methods: From 1998 – 2013, we identified patients undergoing PN or RN from the Surveillance Epidemiology and End Results registries. The proportion of patients receiving PN found to have pT3a disease was quantified by size. Cox proportional hazards models compared cancer-specific (CSS) and overall survival (OS) for PN patients with pT1a, pT1b, and pT2 disease to size-stratified pT3a patients. Also, we compared PN patients with pT3a disease to RN patients with pT3a disease. Results: From the 28,854 patients undergoing PN, the estimated proportion up-staged to pT3a increased along with tumor size: 4.2% for T1a, 9.5% for T1b, and 19.5% for T2. Among those receiving PN, survival analysis showed worse CSS for up-staged pT3a patients versus stratified pT1a (HR = 1.87, p = 0.02), pT1b (HR = 1.91, p = 0.01), and pT2 (HR = 2.33, p = 0.01) patients. When assessing OS, only in tumors < 4cm did the pT3a cohort demonstrate worse OS (HR = 1.25, p = 0.04). Comparing PN and RN for pT3a disease, size-adjusted analysis revealed no difference in CSS or OS. Lastly, among pT3a patients undergoing PN, patients with larger tumors, measuring 4 – 7cm (OS: HR = 1.44, p = 0.04) or 7 – 16cm (OS: HR = 2.64, p < 0.01), had worse survival than those with tumors < 4cm. Conclusions: A greater proportion of patients experience T3a up-staging after PN with increasing initial T stage. Up-staged pT3a patients have worse CSS after PN compared to those with similarly sized localized tumors. Also, pT3a patients after PN showed similar survival to pT3a patients after RN. However, pT3a patients undergoing PN had worse survival with increasing tumor size, reinforcing the need for improvements in identifying patients at risk of up-staging.

scholarly journals Physical activity types and atrial fibrillation risk in the middle-aged and elderly: The Rotterdam Study

2018 ◽  
Vol 25 (12) ◽  
pp. 1316-1323 ◽  
Author(s):  
Marijn Albrecht ◽  
Chantal M Koolhaas ◽  
Josje D Schoufour ◽  
Frank JA van Rooij ◽  
M Kavousi ◽  
...  
Keyword(s):  
Physical Activity ◽  
Atrial Fibrillation ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Total Physical Activity ◽  
Rotterdam Study ◽  
Cox Proportional Hazards Models ◽  
Activity Types ◽  
Study Population

Background The association between physical activity and atrial fibrillation remains controversial. Physical activity has been associated with a higher and lower atrial fibrillation risk. These inconsistent results might be related to the type of physical activity. We aimed to investigate the association of total and types of physical activity, including walking, cycling, domestic work, gardening and sports, with atrial fibrillation. Design Prospective cohort study. Methods Our study was performed in the Rotterdam Study, a prospective population-based cohort. We included 7018 participants aged 55 years and older with information on physical activity between 1997–2001. Cox proportional hazards models were used to examine the association of physical activity with atrial fibrillation risk. Models were adjusted for biological and behavioural risk factors and the remaining physical activity types. Physical activity was categorised in tertiles and the low group was used as reference. Results During 16.8 years of follow-up (median: 12.3 years, interquartile range: 8.7–15.9 years), 800 atrial fibrillation events occurred (11.4% of the study population). We observed no association between total physical activity and atrial fibrillation risk in any model. After adjustment for confounders, the hazard ratio and 95% confidence interval for the high physical activity category compared to the low physical activity category was: 0.71 (0.80–1.14) for total physical activity. We did not observe a significant association between any of the physical activity types with atrial fibrillation risk. Conclusion Our results suggest that physical activity is not associated with higher or lower risk of atrial fibrillation in older adults. Neither total physical activity nor any of the included physical activity types was associated with atrial fibrillation risk.

Current treatments, determinants of use, and survival for patients with hepatoma in the United States from 1998–2002

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4138-4138
Author(s):  
A. B. Siegel ◽  
R. McBride ◽  
D. Hershman ◽  
R. S. Brown ◽  
J. Emond ◽  
...  
Keyword(s):  
Tumor Size ◽  
Proportional Hazards ◽  
Case Series ◽  
Tumor Grade ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Data Set ◽  
Cox Proportional Hazards Models ◽  
Highly Correlated ◽  
The Impact

4138 Background: Multiple case series have described the use of current therapies for hepatocellular carcinoma (HCC), but recent estimates of treatment utilization in the general population and the impact of various treatments on survival are not known. Methods: We first identified 2898 adults diagnosed with HCC with known tumor size and stage in the Surveillance, Epidemiology, and End-Results Program (SEER), from 1998–2002. Treatment was categorized as transplant, resection, ablation, or none of these. We created a second data set of 1856 HCC patients who were potentially operable, as defined by SEER. We used these patients to construct Kaplan-Meier survival curves and adjusted Cox proportional hazards models. Results: The median age of the larger cohort at HCC diagnosis was 62 (range:18–96). Approximately 42% were white, 32% Asian, 16% Hispanic, and 10% African American. Overall, 10% received a transplant, 18% resection, 8% ablation, and 65% none of these. Only 5% of African Americans with HCC received a transplant, versus 12% of whites, 10% of Hispanics, and 8% of Asians. Asians were most likely to receive resection (24%) and ablation (9%), and least likely to have non-surgical treatment (60%). Using the restricted cohort, improved survival in the multivariate analysis was seen with later year of diagnosis, younger age, female sex, Asian race, smaller tumor size, lower tumor grade, and localized disease. Treatment was highly correlated with survival. This was greatest in the transplanted group (1, 3, and 5-year survivals 93%, 79%, and 71%), followed by resection (70%, 45%, and 29%), and ablation (71%, 33%, and 18%). The non-surgical group had poor survival (33%, 9%, and 0%). Conclusions: Transplantation yields excellent survival on a population scale, similar to reported series, and resection gives relatively good outcomes as well. Asians are more likely to be resected and ablated than other groups. They also had better survival than other groups, perhaps due to underlying etiology of HCC (hepatitis B) and better preserved liver function. No significant financial relationships to disclose.

Differences in survival for metastatic colorectal cancer patients by lines of therapy received.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14016-e14016
Author(s):  
Brian S. Seal ◽  
Benjamin Chastek ◽  
Mahesh Kulakodlu ◽  
Satish Valluri
Keyword(s):  
Proportional Hazards ◽  
Survival Rates ◽  
Patient Characteristics ◽  
Cox Proportional Hazards ◽  
Research Database ◽  
First Line ◽  
Cox Proportional Hazards Models ◽  
Stage 4 ◽  
Similar Survival ◽  
The Impact

e14016 Background: Improvements in survival for advanced-stage CRC patients who receive chemotherapy have been reported. We compared survival rates for patients with 3+ vs. <3 lines of therapy. Methods: Adult patients with a diagnosis of CRC between 01/01/05 and 05/31/10 were identified from the Impact Intelligence Oncology Management (IIOM) registry. Patients with either stage 4 CRC at original diagnosis or development of metastasis were included. Registry data included original stage and date of diagnosis. Linked healthcare claims from the Life Sciences Research Database, a large US health insurance database affiliated with OptumInsight, were used to identify lines of therapy after metastases and patient characteristics. Death data were obtained from the Social Security Administration’s master death file. Patients were categorized by number of lines of therapy received (0, 1, 2, 3+) and original stage at diagnosis (0-2, 3, 4, unknown). Survival following metastases was evaluated using Cox proportional hazards models controlling for lines of therapy received, stage, and other patient characteristics. Results: 598 patients, followed for a mean of 653 days after becoming metastatic, were included. Mean unadjusted length of follow-up was lowest among patients who received no chemotherapy (516 days) or only 1 line (511 days), and increased to 627 days for those with 2 lines and 930 days for those with 3+ lines. However, multivariate analysis indicated that patients with 3+ lines had comparable survival vs. those with 0 (HR=0.79), 1 (HR=1.59), or 2 (HR=1.15) lines of therapy (p>0.05 for all comparisons). Compared to patients who presented with stage 4 CRC, those who progressed from stage 0-2 (HR=1.22), stage 3 (HR=0.83), or unknown stage (HR=1.18) had similar survival after metastases (p>0.05 for all comparisons). After excluding 94 patients who didn’t receive chemotherapy, patients treated with an oxaliplatin-based regimen (HR=1.28; p=0.24) in first line had similar survival compared to patients treated with an irinotecan-based or anti-EGFR regimen in first line. Conclusions: Lines of therapy received and initial stage were not associated with survival after development of metastases.

scholarly journals Endoscopic and Surgical Treatment of T1N0M0 Colorectal Neuroendocrine Tumors: A Population-Based Comparative Study

2020 ◽  
Author(s):  
Hanlong Zhu ◽  
Si Zhao ◽  
Kun Ji ◽  
Wei Wu ◽  
Jian Zhou ◽  
...  
Keyword(s):  
Neuroendocrine Tumors ◽  
Tumor Size ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Treatment Modalities ◽  
Cancer Specific Survival ◽  
Term Survival ◽  
Population Based Study

Abstract Background: With the rapid advances in endoscopic technology, endoscopic therapy (ET) is increasingly applied to the treatment of small (≤20 mm) colorectal neuroendocrine tumors (NETs). However, long-term data comparing ET and surgery for management of T1N0M0 colorectal NETs are lacking. The purpose of this work was to compare overall survival (OS) and cancer-specific survival (CSS) of such patients with ET or surgery.Methods: Patients with T1N0M0 colorectal NETs were identified within the Surveillance Epidemiology and End Results (SEER) database (2004-2016). Demographics, tumor characteristics, therapeutic methods, and survival were compared. Propensity score matching (PSM) was used 1:3 and among this cohort, Cox proportional hazards regression models were performed to evaluate correlation between treatment and outcomes.Results: Of 4487 patients with T1N0M0 colorectal NETs, 1125 were identified in the matched cohort, among whom 819 (72.8%) underwent ET and 306 (27.2%) underwent surgery. There was no difference in the 5-year and 10-year OS and CSS rates between the 2 treatment modalities. Likewise, analyses stratified by tumor size and site showed that patients did not benefit more from surgery compared with ET. Moreover, multivariate analyses found no significant differences in OS [Hazard Ratio (HR) = 0.857, 95% Confidence Interval (CI): 0.513–1.431, P = 0.555] and CSS (HR = 0.925, 95% CI: 0.282–3.040, P = 0.898) between the 2 groups. Similar results were observed when comparisons were limited to patients with different tumor size and site.Conclusions: In this population-based study, patients treated endoscopically had comparable long-term survival compared with those treated surgically, which demonstrates ET as an alternative to surgery in T1N0M0 colorectal NETs.

scholarly journals A contemporary population-based study of testicular sex cord stromal tumours: Presentation, treatment patterns, and predictors of outcome

2017 ◽  
Vol 11 (9) ◽  
pp. E344-9
Author(s):  
Lindsay M. Yuh ◽  
Primo N. Lara Jr ◽  
Rebecca M. Wagenaar ◽  
Christopher P. Evans ◽  
Marc A. Dall'era ◽  
...  
Keyword(s):  
Metastatic Disease ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Disease Stage ◽  
Retroperitoneal Lymph Node Dissection ◽  
Cancer Specific Survival ◽  
Rare Tumour ◽  
Prognostic Features ◽  
Cox Proportional Hazards Models

Introduction: We aimed to characterize demographic distribution, patient outcomes, and prognostic features of testicular sex cord stromal tumours (SCST) using a large statewide database.Methods: Adult male patients diagnosed with SCST between 1988 and 2010 were identified within the California Cancer Registry (CCR). Baseline demographic variables and disease characteristics were reported. Primary outcome measures were cancer-specific survival (CSS) and overall survival (OS). Bivariate and multivariate Cox proportional hazards models were employed to identify predictors of survival.Results: A total of 67 patients with SCST were identified, of which 45 (67%) had Leydig cell and 19 (28%) had Sertoli cell tumours. Median age was 40 years and the majority of patients (84%) presentedwith localized disease. Following orchiectomy, nine patients (15%) underwent retroperitoneal lymph node dissection (RPLND), whereas 54 patients (80%) had no further treatment. With a median followup of 75 months, two-year OS and CSS was 91% and 95%, respectively, for those presenting with stage I disease. For those presenting with stage II disease, two-year OS and CSS was 30%. Predictors of worse OS included age >60 (hazard ratio [HR] 5.64; p<0.01) and metastatic disease (HR 8.56; p<0.01). Presentation with metastatic disease was the only variable associated with worse CSS (HR 13.36; p<0.01). Histology was not found to be a significant predictor of either CSS or OS.Conclusions: We present the largest reported series to date for this rare tumour and provide contemporary epidemiological and treatment data. The primary driver of prognosis in patients with SCSTis disease stage, emphasizing the importance of early detection and intervention.

Changes in Oral Anticoagulation Therapy over One Year in 51,000 Atrial Fibrillation Patients at Risk for Stroke: A Practice-Derived Study

2019 ◽  
Vol 119 (06) ◽  
pp. 882-893 ◽  
Author(s):  
Stefan H. Hohnloser ◽  
Edin Basic ◽  
Michael Nabauer
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Proportional Hazards ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Cox Proportional Hazards ◽  
Bleeding Events ◽  
Patients At Risk ◽  
Study Population ◽  
Treatment Changes

Background This study assessed changes in anticoagulation therapy over time in patients with atrial fibrillation (AF). Methods Analyses were performed on a claims-based dataset of 4 million health-insured individuals. The study population consisted of patients newly initiating a non-vitamin-K oral anticoagulants (NOACs) or vitamin K antagonist (VKA) for AF between 2013 and 2016. The study outcomes consisted of the proportion of patients who had (1) discontinued OAC treatment, (2) switched from VKA to NOAC, (3) switched from NOAC to VKA or (4) switched from one NOAC to another. Predictors of discontinuation or switching of OAC treatment were determined by Cox proportional hazards regression models with time-independent and time-dependent covariates. Results The study population comprised 51,606 AF patients initiating VKA (n = 21,468, 41.6%), apixaban (n = 8,832, 17.1%), dabigatran (n = 3,973, 7.7%) or rivaroxaban (n = 17,333, 33.6%). After 1 year, 29.9% of VKA and 29.5% of NOAC patients had discontinued OAC treatment without switching to another anticoagulant. A total of 10.7% of VKA patients switched to NOACs within 1 year, whereas 4.9% NOAC patients had switched to VKA. Of AF patients who were initiated on a NOAC, 5.2% switched to another NOAC. Treatment changes among NOAC starters were strongly associated with occurrence of stroke, myocardial infarction and gastrointestinal bleeding after treatment initiation. For VKA starters switching to a NOAC, stroke and bleeding events were associated with an increased likelihood of switching. Conclusion Overall discontinuation rates of VKA and NOACs are comparable over the first year of therapy, while switching from VKA to NOAC was more common than from NOAC to VKA. The majority of treatment changes were associated with clinical events.

scholarly journals Radiotherapy Plus Chemotherapy Is Associated With Improved Survival Compared to Radiotherapy Alone in Patients With Primary Vaginal Carcinoma: A Retrospective SEER Study

2020 ◽  
Vol 10 ◽  
Author(s):  
Wei-li Zhou ◽  
Yang-yang Yue
Keyword(s):  
Tumor Size ◽  
Proportional Hazards ◽  
Risk Model ◽  
Figo Stage ◽  
Cox Proportional Hazards ◽  
Stage I ◽  
Rank Test ◽  
Cancer Specific Survival ◽  
Vaginal Carcinoma ◽  
Radiotherapy Alone

BackgroundThe efficacy of radiotherapy plus chemotherapy (RTCT) versus radiotherapy alone (RT) in the treatment of primary vaginal carcinoma has been controversial. We aimed to evaluate the up-to-date efficacy of RTCT on primary vaginal carcinoma in a real-world cohort.MethodsWe performed a retrospective analysis in patients with primary vaginal carcinoma retrieved from the Surveillance, Epidemiology, and End Results Program database from 2004 to 2016. Kaplan–Meier survival curves were plotted and compared by the log-rank test. Inverse probability weighting (IPW)-adjusted multivariate Cox proportional hazards and Fine-Gray competing-risk model was applied.ResultsOf the 1,813 qualified patients with primary vaginal carcinoma from 2004 to 2016, 1,137 underwent RTCT and 676 underwent RT. The median survival time was 34 months for the RT group and 63 months for the RTCT group. RTCT was significantly associated with improved overall survival (unadjusted HR = 0.71, 95% CI 0.62–0.82, p &lt; 0.001; adjusted HR = 0.73, 95% CI 0.63–0.84, p &lt; 0.001) and cancer-specific survival (unadjusted sHR = 0.81, 95% CI 0.69–0.95, p = 0.012; adjusted sHR = 0.81, 95% CI 0.69–0.96, p = 0.016). Age, histological type, tumor size, surgery, and FIGO stage were all independent prognostic factors for survival (p &lt; 0.05 for all). Subgroup analysis demonstrated that RTCT was significantly associated with better survival in most subgroups, except for those with adenocarcinoma, tumor size &lt;2 cm, or FIGO stage I. Moreover, sensitivity analysis did not alter the beneficial effects of RTCT.ConclusionRTCT is significantly correlated with prolonged survival in patients with primary vaginal carcinoma. RTCT should be applied to most patients with primary vaginal carcinoma instead of RT alone, except for those with adenocarcinoma, tumor size &lt;2 cm, or FIGO stage I.

scholarly journals Survival and Analysis for Mixed Medullary-Follicular Thyroid Carcinoma: based on SEER database

2020 ◽  
Author(s):  
Zheng Wan ◽  
Bing Wang ◽  
Xin Miao ◽  
Zhida Chen ◽  
Sisi Huang ◽  
...  
Keyword(s):  
Tumor Size ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Extrathyroidal Extension ◽  
Diagnostic Tools ◽  
Continuous Variables ◽  
Seer Database ◽  
Cancer Specific Survival ◽  
Internal Validation ◽  
Ajcc Staging

Abstract PurposeDue to lack of proper diagnostic tools, we aimed to establish a nomogram for Mixed Medullary-Follicular Thyroid (MMFTC) and comparison with AJCC staging in prognosis. MethodsData regarding 203 patients with MMFTC (ICD-O-3 codes 8346, 8347) between 2000 and 2016 from The Surveillance, Epidemiology, and End Results (SEER) database. X-tile program was used to evaluate the optimal cut-off values for continuous variables. Univariate and multivariate regression analyses were performed with the Cox proportional hazards regression model to analyze the independent factors related to prognosis. Construct cancer-specific survival (CSS) and overall survival (OS) were analyzed. The resulting values were compared with the nomogram and the American Joint Committee on Cancer (AJCC) staging using C-index, verification curve, internal validation and decision curve analysis (DCA).ResultsThe CSS nomogram presented the prognostic factors including year of diagnosis (p = 0.045), tumor size (p = 0.003), extrathyroidal extension (p = 0.009) and pN stage (p = 0.008), while the OS nomogram showed the prognosis factors including year of diagnosis (p = 0.011), age at diagnosis (p = 0.010), tumor size (p = 0.013), extrathyroidal extension (p = 0.008), pT2 stage (p = 0.021) and Radioactive implants or Radioisotopes (p = 0.031).The C-index, verification curve, internal validation and DCA for these nomograms showed better performance in comparisons with the AJCC staging.ConclusionThe more appropriate and efficient therapeutic strategies were showed by the two nomograms for clinical prediction of OS and CSS in MMFTC.

scholarly journals Serum choline is associated with hepatocellular carcinoma survival: a prospective cohort study

2020 ◽  
Author(s):  
Zhao-Yan Liu ◽  
Dinuerguli Yishake ◽  
Ai-Ping Fang ◽  
Dao-Ming Zhang ◽  
Gong-Cheng Liao ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cancer ◽  
High Performance ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
C Reactive Protein ◽  
Cancer Specific Survival ◽  
Reactive Protein ◽  
Cox Proportional Hazards Models ◽  
Hazard Ratios

Abstract Background: Higher choline/betaine levels have been linked to lower risk of liver cancer, whereas existing data in relation to hepatocellular carcinoma (HCC) prognosis are scarce. Our objective was to examine the associations of the serum choline and betaine with HCC survival. Methods: 866 newly diagnosed HCC patients were enrolled in the Guangdong Liver Cancer Cohort. Serum choline and betaine were assessed using high-performance liquid chromatography with online electro-spray ionization tandem mass spectrometry. Liver cancer-specific survival (LCSS) and overall survival (OS) were calculated. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). Results: Both LCSS (T3 vs. T1: HR=0.69, 95% CI: 0.51-0.94; P-trend <0.05) and OS (T3 vs. T1: HR=0.73, 95% CI: 0.54-0.99; P-trend <0.05) were better with sex-specific tertiles of serum choline levels. The associations were not significantly modified across strata of selected prognostic factors, except in the different C-reactive protein (CRP) levels, the favorable associations between serum choline and LCSS and OS were only existed among patients with CRP ≥3.0 mg/L. No significant associations were found between serum betaine levels and either LCSS or OS. Conclusions: This study revealed that higher serum choline levels were associated with better HCC survival, especially in HCC patients with systemic inflammation status. No significant associations were found between serum betaine and HCC survival. Our finding might open new prospect in understanding the benefits of choline on HCC survival. Registration: The Guangdong Liver Cancer Cohort was registered at clinicaltrials.gov as NCT 03297255.

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