2192 The association of preoperative functional capacity and outcomes for head and neck cancer patients undergoing definitive surgical treatment

OBJECTIVES/SPECIFIC AIMS: To study the role functional capacity plays in surgical outcomes for head and neck cancers. METHODS/STUDY POPULATION: In this single-institution cohort study, we combined preoperative anesthesia assessment information with oncology registry data for newly-diagnosed patients with squamous cell carcinoma of the oral cavity, pharynx, and larynx (HNSCC) treated with definitive surgery at Siteman Cancer Center from 2012 to 2016. Patient-reported exercise capacity was assessed as metabolic equivalents. Metabolic equivalents<4 was defined as poor functional capacity. The primary outcome measure was overall survival (OS). Kaplan-Meir survival analysis was used to compare the survival of patients with poor functional capacity (PFC) and patients with normal functional capacity (NFC). Cox proportional hazard regression was used to explore the independent prognostic role of functional capacity on overall survival after controlling for other factors. RESULTS/ANTICIPATED RESULTS: A total of 671 patients underwent surgical treatment for HNSCC. The average age was 62 years (range: 19–94 years). Majority of the patients were male (n=481; 72%), White race (n=589; 88%), and smokers (n=528; 79%). Of 671 patients, 22% (n=146) had PFC. Two-year OS rate in PFC patients was 70% compared with 85% in NFC patients (15% difference; 95% CI: 7%–23%). Unadjusted Cox proportional hazard analysis showed that PFC patients had 2.2 times higher risk of death (95% CI: 1.5–3.2) than NFC patients. After adjustment for age at surgery, BMI, preoperative weight loss, comorbidity score, tumor site, and TNM stage the magnitude of the association between functional capacity and OS decreased (aHR=1.3; 95% CI: 0.88–1.98). DISCUSSION/SIGNIFICANCE OF IMPACT: Poor functional capacity is associated with decreased overall survival, but the magnitude of the association, while clinically meaningful, decreases after controlling for other important patient and tumor factors. Nevertheless, we believe preoperative functional capacity status is an important patient factor to consider when discussing prognosis and attempting risk stratification. We also believe that functional capacity may be associated with 30-day unplanned readmissions and 90-day complications and are currently performing chart review to ascertain this information.

Download Full-text

Association of Dementia-Related Psychosis With Long-term Care Use and Death

Neurology ◽

10.1212/wnl.0000000000011632 ◽

2021 ◽

Vol 96 (12) ◽

pp. e1620-e1631

Author(s):

James B. Wetmore ◽

Yi Peng ◽

Heng Yan ◽

Suying Li ◽

Muna Irfan ◽

...

Keyword(s):

Long Term Care ◽

Fold Increase ◽

Proportional Hazard ◽

Comorbid Conditions ◽

Term Care ◽

Risk Of Death ◽

Cox Proportional Hazard ◽

Increased Risk ◽

Cox Proportional Hazard Regression

ObjectiveTo determine the association of dementia-related psychosis (DRP) with death and use of long-term care (LTC); we hypothesized that DRP would be associated with increased risk of death and use of LTC in patients with dementia.MethodsA retrospective cohort study was performed. Medicare claims from 2008 to 2016 were used to define cohorts of patients with dementia and DRP. Outcomes were LTC, defined as nursing home stays of >100 consecutive days, and death. Patients with DRP were directly matched to patients with dementia without psychosis by age, sex, race, number of comorbid conditions, and dementia index year. Association of DRP with outcomes was evaluated using a Cox proportional hazard regression model.ResultsWe identified 256,408 patients with dementia. Within 2 years after the dementia index date, 13.9% of patients developed DRP and 31.9% had died. Corresponding estimates at 5 years were 25.5% and 64.0%. Mean age differed little between those who developed DRP (83.8 ± 7.9 years) and those who did not (83.1 ± 8.7 years). Patients with DRP were slightly more likely to be female (71.0% vs 68.3%) and white (85.7% vs 82.0%). Within 2 years of developing DRP, 16.1% entered LTC and 52.0% died; corresponding percentages for patients without DRP were 8.4% and 30.0%, respectively. In the matched cohort, DRP was associated with greater risk of LTC (hazard ratio [HR] 2.36, 2.29–2.44) and death (HR 2.06, 2.02–2.10).ConclusionsDRP was associated with a more than doubling in the risk of death and a nearly 2.5-fold increase in risk of the need for LTC.

Download Full-text

Significance of Platelet and AFP Levels and Liver Function Parameters for HCC Size and Survival

The International Journal of Biological Markers ◽

10.5301/jbm.5000064 ◽

2014 ◽

Vol 29 (3) ◽

pp. 215-223 ◽

Cited By ~ 14

Author(s):

Brian I. Carr ◽

Vito Guerra ◽

Edoardo G. Giannini ◽

Fabio Farinati ◽

Francesca Ciccarese ◽

...

Keyword(s):

Tumor Size ◽

Blood Platelet ◽

Tumor Diameter ◽

Proportional Hazard ◽

Gamma Glutamyl Transpeptidase ◽

Vein Thrombosis ◽

Risk Of Death ◽

Cox Proportional Hazard ◽

Maximum Tumor Diameter ◽

Glutamyl Transpeptidase

Background Hepatocellular carcinoma (HCC) is a heterogeneous disease with both tumor and liver factors being involved. Aims To investigate HCC clinical phenotypes and factors related to HCC size. Methods Prospectively-collected HCC patients' data from a large Italian database were arranged according to the maximum tumor diameter (MTD) and divided into tumor size terciles, which were then compared in terms of several common clinical parameters and patients' survival. Results An higer MTD tercile was significantly associated with increased blood alpha-fetoprotein (AFP), gamma-glutamyl transpeptidase (GGTP), and platelet levels. Patients with higher platelet levels had larger tumors and higher GGTP levels, with lower bilirubin levels. However, patients with the highest AFP levels had larger tumors and higher bilirubin levels, reflecting an aggressive biology. AFP correlation analysis revealed the existence of 2 different groups of patients: those with higher and with lower AFP levels, each with different patient and tumor characteristics. The Cox proportional-hazard model showed that a higher risk of death was correlated with GGTP and bilirubin levels, tumor size and number, and portal vein thrombosis (PVT), but not with AFP or platelet levels. Conclusions An increased tumor size was associated with increased blood platelet counts, AFP and GGTP levels. Platelet and AFP levels were important indicators of tumor size, but not of survival.

Download Full-text

Prognostic nomogram for patients with non-metastatic HER2 positive breast cancer in a prospective cohort

The International Journal of Biological Markers ◽

10.1177/1724600818824786 ◽

2019 ◽

Vol 34 (1) ◽

pp. 41-46 ◽

Cited By ~ 2

Author(s):

Chuanxu Luo ◽

Xiaorong Zhong ◽

Zhu Wang ◽

Yu Wang ◽

Yanping Wang ◽

...

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Prognostic Factors ◽

Prospective Cohort ◽

Proportional Hazard ◽

Her2 Positive ◽

Her2 Positive Breast Cancer ◽

Cox Proportional Hazard ◽

Cox Proportional Hazard Regression ◽

Positive Breast Cancer

Purpose: A nomogram is a reliable tool to generate individualized risk prediction by combining prognostic factors. We aimed to construct a nomogram for predicting the survival in patients with non-metastatic human epidermal growth factor receptor 2 (HER2) positive breast cancer in a prospective cohort. Methods: We analyzed 1304 consecutive patients who were diagnosed with non-metastatic HER2 positive breast cancer between January 2008 and December 2016 in our institution. Independent prognostic factors were identified to build a nomogram using the COX proportional hazard regression model. The prediction of the nomogram was evaluated by concordance index (C-index), calibration and subgroup analysis. External validation was performed in a cohort of 6379 patients from the Surveillance, Epidemiology, and End Results (SEER) database. Results: Through the COX proportional hazard regression model, five independent prognostic factors were identified. The nomogram predicting overall survival achieved a C-index of 0.78 in the training cohort and 0.74 in the SEER cohort. The calibration plot displayed favorable accordance between the nomogram prediction and the actual observation for 3-year overall survival in both cohorts. The quartiles of the nomogram score classified patients into subgroups with distinct overall survival. Conclusion: We developed and validated a novel nomogram for predicting overall survival in patients with non-metastatic HER2 positive breast cancer, which presented a favorable discrimination ability. This model may assist clinical decision making and patient–clinician communication in clinical practice.

Download Full-text

High CXCR4 expression in adenoid cystic carcinoma of the head and neck is associated with increased risk of locoregional recurrence

Journal of Clinical Pathology ◽

10.1136/jclinpath-2019-206273 ◽

2020 ◽

Vol 73 (8) ◽

pp. 476-482 ◽

Cited By ~ 1

Author(s):

Thomas J W Klein Nulent ◽

Robert J J van Es ◽

Matthijs H Valstar ◽

Ludwig E Smeele ◽

Laura A Smit ◽

...

Keyword(s):

Adenoid Cystic Carcinoma ◽

Head And Neck ◽

Primary Tumour ◽

Treatment Options ◽

Cxcr4 Expression ◽

Proportional Hazard ◽

Free Survival ◽

Cox Proportional Hazard ◽

Adenoid Cystic ◽

Increased Risk

AimTreatment options for head and neck adenoid cystic carcinoma (AdCC) are limited in advanced disease. Chemokine receptor type 4 (CXCR4) is present in various tumour types, including AdCC. Upregulation is associated with tumour recurrence and metastasis. New CXCR4-specific diagnostic and therapeutic target agents have recently been available. This study aimed to analyse CXCR4 expression in a cohort of primary head and neck AdCC.MethodsAfter histopathological revision, tumour tissues of 73 consecutive patients with AdCC over 1990–2016 were sampled on a tissue microarray. Slides were immunohistochemically stained for CXCR4 and semiquantitatively scored. Associations between protein expression and cliniopathological parameters were tested. HRs were calculated using a Cox proportional hazard model.ResultsSixty-six tumours could be analysed. CXCR4 expression was present in 81% of the tumours with a median of 29% (IQR 1–70) positive cells. Expression was univariately correlated to perineural growth (Spearman ρ .26, p=0.04) and bone invasion (Spearman ρ .32, p=0.01), but not with tumour grade.CXCR4 expression in the primary tumour was significantly higher in tumours that recurred as compared with those that did not recur (median 60%, IQR 33–72 vs 12%, IQR 1–70, Kruskal-Wallis p=0.01). After dichotomisation, >25% of CXCR4 expressions proved an independent prognosticator for a reduced recurrence-free survival (RFS) (HR 7.2, 95% CI 1.5 to 72.4, p=0.04).ConclusionCXCR4 is expressed in the majority of primary AdCCs and independently correlated to worse RFS, suggesting CXCR4 as a target for imaging and therapy purposes in patients with advanced AdCC.

Download Full-text

Mortality calculator as a possible prognostic predictor of overall survival after gastrectomy in elderly patients with gastric cancer

World Journal of Surgical Oncology ◽

10.1186/s12957-020-02052-x ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Hidenori Akaike ◽

Yoshihiko Kawaguchi ◽

Suguru Maruyama ◽

Katsutoshi Shoda ◽

Ryo Saito ◽

...

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Prognostic Factors ◽

Elderly Patients ◽

Performance Status ◽

Proportional Hazard ◽

Proportional Hazard Model ◽

Clinical Database ◽

National Clinical Database ◽

Cox Proportional Hazard

Abstracts Background The number of elderly patients with gastric cancer has been increasing. Most elderly patients have associated reduced physiologic functions that can sometimes become an obstacle to safe surgical treatment. The National Clinical Database Risk Calculator, which based on a large Japanese surgical database, provides predicted mortality and morbidity in each case as the surgical-related risks. The purpose of this study was to investigate the clinical significance of the risk for operative mortality (NRC-mortality), as calculated by the National Clinical Database Risk Calculator, during long-term follow-up after gastrectomy for elderly patients with gastric cancer. Methods We enrolled 73 patients aged ≥ 80 years and underwent gastrectomy at our institution. Their surgical risk was evaluated based on the NRC-mortality. Several clinicopathologic factors, including NRC-mortality, were selected and analyzed as the possible prognostic factors for elderly patients who have undergone gastrectomy for gastric cancer. Statistical analysis was performed using the log-rank test and Cox proportional hazard model. Results NRC-mortality ranged from 0.5 to 10.6%, and the median value was 1.7%. Dividing the patients according to mortality, the overall survival was significantly worse in the high mortality group (≥ 1.7%, n = 38) than in the low mortality group (< 1.7%, n = 35), whereas disease-specific survival was not different between the two groups. In the Cox proportional hazard model, multivariate analysis revealed NRC-mortality, performance status, and surgical procedure as the independent prognostic factors for overall survival. For disease-specific survival, the independent prognostic factors were performance status and pathological stage but not NRC-mortality. Conclusion The NRC-mortality might be clinically useful for predicting both surgical mortality and overall survival after gastrectomy in elderly patients with gastric cancer.

Download Full-text

Prognosis of gastric cancer (GC) patients with positive peritoneal cytology.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.41 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 41-41

Author(s):

Hironori Shiozaki ◽

Elena Elimova ◽

Rebecca Slack ◽

Hsiang-Chun Chen ◽

Gregg A Staerkel ◽

...

Keyword(s):

Overall Survival ◽

Diagnostic Laparoscopy ◽

Cox Model ◽

Peritoneal Metastases ◽

Patient Treatment ◽

Cancer Center ◽

Peritoneal Cytology ◽

Term Survival ◽

Risk Of Death ◽

One Year

41 Background: Laparoscopic staging of patients with GC can disclose peritoneal metastases. Although this finding is associated with a poor prognosis, some patients achieve a long-term survival. In an attempt to provide explanation we compared the overall survival (OS) of patients with GC peritoneal metastases from two settings: cytology positive only (Cy+) and grossly positive (Gross+). Methods: 146 GC patients with peritoneal metastases were identified between 2000 and 2014. Cox-model regression was used for overall survival (OS) analyses. Results: Patient/treatment characteristics were as follows: males (66%), good ECOG scores (0-1; 89%), metastases confirmed by a diagnostic laparoscopy (84%), poorly differentiated histology(92%), received chemotherapy (89%), received chemoradiation (22%), and received surgery (10%). The median follow-up time for all patients was 12.9 months and median OS was 15 months. Patients with Gross+ were at higher risk of death compared to Cy+ patients (50% vs. 83%1-year OS, respectively). Only diagnostic laparoscopy and metastasis type (Gross+ vs. Cy+) were significant in both univariate and multivariate OS models. With both factors in the same model, patients with Gross+ were more than twice as likely to die when compared to those with Cy+ (HR=2.23; p=0.001) while patients having a diagnostic laparoscopy were half as likely to die (HR=0.52; p=0.01). Conclusions: The one-year OS of patients with Cy+ peritoneal metastases is significantly longer than those with Gross+ findings. As such, novel strategies for Cy+ patients may further prolong their survival. From U. T. M. D. Anderson Cancer Center (UTMDACC), Houston, Texas, USA. (Supported in part by UTMDACC, and CA 138671 and CA172741 from the NCI).

Download Full-text

Mortality calculator as a possible prognostic predictor for overall survival after gastrectomy in elderly patients with gastric cancer

10.21203/rs.3.rs-37671/v1 ◽

2020 ◽

Author(s):

Hidenori Akaike ◽

Yoshihiko Kawaguchi ◽

Suguru Maruyama ◽

Katsutoshi Shoda ◽

Ryo Satio ◽

...

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Prognostic Factors ◽

Elderly Patients ◽

Rank Test ◽

Proportional Hazard ◽

Mortality And Morbidity ◽

Neutrophil Lymphocyte Ratio ◽

Cox Proportional Hazard ◽

Long Term Follow Up

Abstract Background The number of elderly patients with gastric cancer (elderGC) has been increasing. Most of elderly patients were associated with reduced physiological functions, which sometimes constitute an obstacle to safe surgical treatments. The risk calculator of National Clinical Database (NRC), a Japanese surgical big database, provides mortality and morbidity as surgical-related risks. The purpose of this study is to investigate clinical significance of operative mortality calculated by NRC (NRC-mortality) during long-term follow-up after gastrectomy for elderGC.Methods We enrolled 73 patients aged 80 or over who underwent gastrectomy at our institution. Their surgical risk was evaluated based on the NRC-mortality. Several clinicopathological factors including NRC-mortality were selected and analyzed as possible prognostic factors for elderGC after gastrectomy. Statistical analysis was performing using the log-rank test and Cox proportional hazard model.Results NRC-mortality ranged 0.5 to 10.6%, and median value was 1.7%. Dividing elderGC into high- (1.7% or more, n=38) and low- (less than 1.7%, n=35) mortality groups, high-mortality group showed a significantly poor prognosis in overall survival (OS) than the low-mortality group, whereas there was no difference between the two groups in disease specific survival (DSS). In the analysis of Cox proportional hazard model, multivariate analysis revealed that NRC-mortality was an independent prognostic factor as well as neutrophil-lymphocyte ratio and surgical procedure in OS. In contrast, PS and pStage were independent prognostic factors in DSS, but not NRC-mortality.Conclusions The NRC-mortality might be clinical useful for not only predicting surgical mortality but also OS after gastrectomy in elderGC.

Download Full-text

Mortality among seafarers: a register-based follow-up study

Occupational Medicine ◽

10.1093/occmed/kqaa002 ◽

2020 ◽

Vol 70 (2) ◽

pp. 119-122 ◽

Cited By ~ 1

Author(s):

H Rinne ◽

M Laaksonen ◽

V Notkola ◽

R Shemeikka

Keyword(s):

Causes Of Death ◽

Sociodemographic Factors ◽

Proportional Hazard ◽

Proportional Hazard Model ◽

Occupational Risk Factors ◽

Risk Of Death ◽

Cox Proportional Hazard ◽

Changing Practices ◽

Healthy Behaviour

Abstract Background Seafarers are exposed to many occupational risk factors. Aims To study whether there are differences in mortality between seafarers and other employees, whether there are variations in seafarers’ mortality between different seafaring occupations and whether these differences can be explained by sociodemographic factors. Methods A register-based study of all seafarers aged 25–64 years, resident in Finland in 2000 with minimum 5 years of cumulative seafaring experience on Finnish vessels and other employees, followed for mortality 2001–13. Analysis methods included age standardized death rates, mortality ratios (SMR) and Cox proportional hazard model. Results During the follow-up period 2001–13, there were 81,035 person years and 382 deaths in the cohort of seafarers. Seafarers had 1.3 times higher risk of death (men SMR 132, 95% confidence intervals [CI] 118–147, women SMR 125, 95% CI 99–157) than other employees. Mortality was especially high in alcohol-related causes (men SMR 172, 95% CI 126–233, women SMR 262, 95% CI 131–525) and causes related to smoking. Controlling for sociodemographic characters strengthened the risk compared to other occupations. Mortality was high among male deck and engine crew and among male and female galley personnel. The mortality differences between different seafaring occupations were partly explained by adjustments of sociodemographic characters. Conclusions Seafarers still have increased mortality among men after adjustment of sociodemographic characters. Results by causes of death suggest that changing practices to enable healthy behaviour are important.

Download Full-text

Prediction of Minor Salivary Gland Carcinoma: A Novel Nomogram and Risk Classification System for Overall Survival and Cancer-Specific Survival

Otolaryngology ◽

10.1177/0194599820938323 ◽

2020 ◽

pp. 019459982093832

Author(s):

Ling-feng lan ◽

Chen-kai Gao ◽

Chao-wu Ma

Keyword(s):

Overall Survival ◽

Salivary Gland ◽

Minor Salivary Gland ◽

Proportional Hazard ◽

Seer Database ◽

Concordance Index ◽

Salivary Gland Carcinoma ◽

Cancer Specific Survival ◽

Cox Proportional Hazard ◽

Gland Carcinoma

Objective Minor salivary gland carcinoma (MiSGC) is rare, and the understanding of this disease is insufficient. This study aimed to identify independent risk factors and develop a nomogram for evaluating the overall survival (OS) and cancer-specific survival (CSS) of patients with MiSGC. Study Design Retrospective cohort study. Setting SEER database (Surveillance, Epidemiology, and End Results). Subjects and Methods We collected data from patients diagnosed with MiSGC between 2004 and 2015 from the SEER database. According to patient registration, all patients were randomly allocated to training sets and validation sets (2:1). Then, Kaplan-Meier product limit curves and Cox proportional hazard regressions were performed to estimate the prognostic effect of variables. Nomograms based on Cox proportional hazard regressions were established to estimate 3- and 5-year OS and CSS. Finally, the nomogram was developed by the training set, and validation was performed with the concordance index, calibration curves, and decision curve analyses. Results In total, 1787 MiSGC cases were registered in SEER. The concordance index for internal validation of OS and CSS prediction was 0.842 and 0.816; that of external validation was 0.871 and 0.831. The calibration plots showed good consistency between nomogram prediction and actual survival. The decision curve analysis showed substantial net benefits of the new predictive model. Conclusions We constructed nomograms and a corresponding risk classification system predicting the OS and CSS of patients with MiSGC. These tools can generate simple-to-use clinical risk grouping and determine the relationship between adjuvant therapy and active surveillance.

Download Full-text

Mortality calculator as a possible prognostic predictor of overall survival after gastrectomy in elderly patients with gastric cancer

10.21203/rs.3.rs-58126/v1 ◽

2020 ◽

Author(s):

Hidenori Akaike ◽

Yoshihiko Kawaguchi ◽

Suguru Maruyama ◽

Katsutoshi Shoda ◽

Ryo Satio ◽

...

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Prognostic Factors ◽

Elderly Patients ◽

Performance Status ◽

Proportional Hazard ◽

Proportional Hazard Model ◽

Clinical Database ◽

National Clinical Database ◽

Cox Proportional Hazard

Abstract Background: The number of elderly patients with gastric cancer has been increasing. Most elderly patients have associated reduced physiologic functions, that can sometimes become an obstacle to safe surgical treatment. The National Clinical Database Risk Calculator, which based on a large Japanese surgical database, provides mortality and morbidity as the surgical-related risks. The purpose of this study was to investigate the clinical significance of the risk for operative mortality (NRC-mortality), as calculated by the National Clinical Database Risk Calculator, during long-term follow-up after gastrectomy for elderly patients with gastric cancer.Methods: We enrolled 73 patients aged ≥80 years and underwent gastrectomy at our institution. Their surgical risk was evaluated based on the NRC-mortality. Several clinicopathologic factors, including NRC-mortality, were selected, and analyzed as the possible prognostic factors for elderly patients who have undergone gastrectomy for gastric cancer. Statistical analysis was performed using the log-rank test and Cox proportional hazard model.Results: NRC-mortality ranged from 0.5% to 10.6%, and the median value was 1.7%. Dividing the patients according to mortality, the overall survival was significantly worse in the high mortality group (≥1.7%, n = 38) than in the low mortality group (<1.7%, n = 35), whereas disease-specific survival was not different between the two groups. In the Cox proportional hazard model, multivariate analysis revealed NRC-mortality, performance status, and surgical procedure as the independent prognostic factors for overall survival. For disease-specific survival, the independent prognostic factors were performance status and pathological stage but not NRC-mortality.Conclusion: The NRC-mortality might be clinically useful for predicting both surgical mortality and overall survival after gastrectomy in elderly patients with gastric cancer.

Download Full-text