Mid-term results of modified L-shaped incision technique for supracardiac total anomalous pulmonary venous connection

Abstract OBJECTIVES Surgical outcomes of supracardiac total anomalous pulmonary venous connection (TAPVC) repair by the posterior technique (PT) remain unsatisfactory. This study aimed to compare the outcomes of the modified L-shaped incision technique with the PT for supracardiac TAPVC repair. METHODS From January 2009 to December 2019, 121 consecutive patients with supracardiac TAPVC undergoing surgical repair in our institution were included (L-group, n = 53; PT group, n = 68). A propensity score-matched analysis was performed. Patients with single-ventricle physiology or atrial isomerism were excluded. All clinical data were retrospectively analysed. RESULTS In the unmatched cohort, the median follow-up duration was 33 months (interquartile range 26–65 months). There were 5 operative mortalities (4.1%) and 12 late mortalities (9.9%). Postoperative pulmonary venous obstruction (PVO) was documented in 21 patients. After matching (52 pairs), the overall survival rate in the L-group was 88.2% at both 3 and 5 years. For the propensity score-matched patients with preoperative PVO (n = 20), statistically significant differences (P = 0.002) were found by Kaplan–Meier curves with freedom from death and postoperative PVO at 1 and 3 years of 100% and 85.7% [standard deviation (SD): 13.2%] in the L-group and 90% (SD: 9.5%) and 22.9% (SD: 14.1%) in the PT group, respectively. Multivariable analysis revealed that the use of the PT was an independent risk factor for death and postoperative PVO (hazard ratio 4.12, 95% confidence interval 1.12–15.16; P = 0.03). CONCLUSIONS The modified L-shaped incision technique provided an acceptable outcome for supracardiac TAPVC repair. Compared with PT, the modified L-shaped incision technique was significantly associated with decreased death and postoperative PVO in patients with obstructed supracardiac TAPVC.

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Apex rotation as a risk factor for total anomalous pulmonary connection repair in single ventricle

10.22541/au.162127822.20134393/v1 ◽

2021 ◽

Author(s):

Hidetsugu Asai ◽

Yasushige Shingu ◽

Jin Ikarashi ◽

Yuchen Cao ◽

Daisuke Takeyoshi ◽

...

Keyword(s):

Risk Factor ◽

Vertebral Body ◽

Single Ventricle ◽

Right Atrial ◽

Pulmonary Venous Obstruction ◽

Sutureless Technique ◽

High Incidence ◽

Atrial Isomerism ◽

Anomalous Pulmonary Venous Connection

Background: The high incidence of postoperative pulmonary venous obstruction (PVO) is a major mortality-associated concern in patients with right atrial isomerism and extracardiac total anomalous pulmonary venous connection (TAPVC). We evaluated new anatomical risk factors for reducing the space behind the heart after TAPVC repair. Methods: 18 patients who underwent TAPVC repair between 2014 and 2020 were enrolled. Sutureless technique was used in 12 patients and conventional repair in six patients. The angle between the line perpendicular to the vertebral body and that from the vertebral body to the apex was defined as the “vertebral-apex angle (V-A angle).” The ratio of post- and preoperative angles, indicating the apex’s lateral rotation, was compared between patients with and without PVO. Results: The median (interquartile range) age and body weight at repair were 102 (79-176) days and 3.8 (2.6-4.8) kg, respectively. The 1-year survival rate was 83% (median follow-up, 29 [11-36] months). PVO occurred in seven patients (39%), who showed an obstruction of one or two branches in the apex side. The postoperative V-A angle (46° [45°-50°] vs. 36° [29°-38°], P = 0.001) and the ratio of post- and preoperative V-A angles (1.27 [1.24-1.42] vs. 1.03 [0.98-1.07], P = 0.001) were significantly higher in the PVO group than in the non-PVO group. The cut-off values of the postoperative V-A angle and ratio were 41° and 1.17, respectively. Conclusions: A postoperative rotation of the heart apex into the ipsilateral thorax was a risk factor for branch PVO after TAPVC repair.

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The Efficacy of Etoposide-Based Therapy in Adult Secondary Hemophagocytic Lymphohistiocytosis

Acta Haematologica ◽

10.1159/000514920 ◽

2021 ◽

pp. 1-9

Author(s):

Leonard Naymagon ◽

Douglas Tremblay ◽

John Mascarenhas

Keyword(s):

Hemophagocytic Lymphohistiocytosis ◽

Proportional Hazards ◽

Multivariable Analysis ◽

Cox Proportional Hazards ◽

Rank Test ◽

Kaplan Meier ◽

Hazard Ratios ◽

Significant Difference ◽

The Impact

Data supporting the use of etoposide-based therapy in hemophagocytic lymphohistiocytosis (HLH) arise largely from pediatric studies. There is a lack of comparable data among adult patients with secondary HLH. We conducted a retrospective study to assess the impact of etoposide-based therapy on outcomes in adult secondary HLH. The primary outcome was overall survival. The log-rank test was used to compare Kaplan-Meier distributions of time-to-event outcomes. Multivariable Cox proportional hazards modeling was used to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs). Ninety adults with secondary HLH seen between January 1, 2009, and January 6, 2020, were included. Forty-two patients (47%) received etoposide-based therapy, while 48 (53%) received treatment only for their inciting proinflammatory condition. Thirty-three patients in the etoposide group (72%) and 32 in the no-etoposide group (67%) died during follow-up. Median survival in the etoposide and no-etoposide groups was 1.04 and 1.39 months, respectively. There was no significant difference in survival between the etoposide and no-etoposide groups (log-rank <i>p</i> = 0.4146). On multivariable analysis, there was no association between treatment with etoposide and survival (HR for death with etoposide = 1.067, 95% CI: 0.633–1.799, <i>p</i> = 0.8084). Use of etoposide-based therapy was not associated with improvement in outcomes in this large cohort of adult secondary HLH patients.

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PET-directed chemoradiation (CRT) with induction FOLFOX compared to induction carboplatin/paclitaxel (CP) in patients with locally advanced esophageal adenocarcinoma (EA).

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.4554 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 4554-4554

Author(s):

Rebecca Carr ◽

Meier Hsu ◽

Kay See Tan ◽

Manjit S. Bains ◽

Matthew Bott ◽

...

Keyword(s):

Locally Advanced ◽

Multivariable Analysis ◽

Disease Free Survival ◽

Complete Response ◽

Rank Test ◽

Complication Rates ◽

Trimodality Therapy ◽

Kaplan Meier ◽

Multivariable Analyses

4554 Background: Induction chemotherapy with PET-directed CRT and surgery is the standard treatment for locally advanced EA at our institution. Following results of the CALGB 80803 trial, FOLFOX has recently replaced CP as the preferred induction regimen. Methods: We retrospectively evaluated patients with locally advanced EA treated with induction CP vs FOLFOX, followed by trimodality therapy between January 2010 and June 2019. Patients treated with CP with RT followed by surgery without induction chemo were also included. We compared pathological complete response (pCR) and near pCR (ypN0 with ≥90% response) rates in the induction FOLFOX group to the induction CP and no-induction groups. Univariable and multivariable analyses were used to adjust for confounding factors. Disease-free survival (DFS) was estimated by the Kaplan-Meier method and compared between groups using max-combo weighted log rank test. Results: 445 patients were included. Patients in the induction FOLFOX group had significantly higher pCR and near pCR rates vs induction CP patients. Notably, pCR rate was 38% among FOLFOX PET responders vs 19% in non-responders. In multivariable analysis, compared to induction CP, induction FOLFOX administration was an independent predictor of near pCR (OR: 2.22, 95%CI: 1.20-4.20, p = 0.012). Compared to 24% pCR rate among no-induction patients, induction FOLFOX pCR rate was slightly higher at 32%. DFS by 2-years was higher in induction FOLFOX compared to no-induction-treated patients (62% vs. 42%, p = 0.05). Postoperative complication rates were similar among the three groups. Conclusions: PET-directed CRT with FOLFOX instead of CP improves pCR and near pCR rates. Improved DFS was observed in the FOLFOX vs no-induction patients. Longer follow-up is needed to confirm any survival benefits. [Table: see text]

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Impact of adjuvant chemotherapy and cumulative cisplatin dose in locally advanced nasopharyngeal carcinoma (LA-NPC) treated with definitive chemoradiotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.6046 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 6046-6046

Author(s):

Marc Oliva Bernal ◽

Shao Hui Huang ◽

Rachel Taylor ◽

Jie Su ◽

Wei Xu ◽

...

Keyword(s):

Adjuvant Chemotherapy ◽

Locally Advanced ◽

Multivariable Analysis ◽

Stage Iv ◽

Stage Ii ◽

Rank Test ◽

High Dose ◽

Free Survival ◽

Kaplan Meier

6046 Background: Total cumulative cisplatin dose (CDDP-D) (concurrent/induction/adjuvant) in multimodality therapy for LA-NPC has been associated with survival at centers in Asia. We evaluated the survival impact of adjuvant chemotherapy (adj chemo) and total CDDP-D in a large, single institution Canadian cohort of LA-NPC. Methods: Patients (Pts) withWHO type II and III LA-NPC treated with concurrent IMRT with high-dose CDDP and adj chemo with CDDP/Carboplatin and 5-FU (maximum total/adjuvant CDDP-D= 540/240 mg/m2) between 2003-2016 were analyzed. EBER status was tested by ISH. Staging was classified by UICC/AJCC7thedition TNM. Kaplan-Meier 5-year (5y) for overall survival (OS) and recurrence-free survival (RFS) were calculated and compared by log-rank test betweenstage, adj chemo (yes vs no) and total CDDP-D (>300 vs ≤300mg/m2). Multivariable analysis (MVA) identified survival predictors. Results: A total of 312 pts were evaluated: median age = 49.8 (range 17.4-75.9); EBER+/-/unknown=67%/1%/32%; stage II/III/IV=2%/51%/47%; T4=36%; N3=17%; adj chemo=83% (21% switched to carboplatin); median total/adjuvant CDDP-D=380/160 mg/m2; median follow-up 7.6 years (range 0.6-14.9). 5y OS differed by stage II-III vs IV (95% vs 80%, p<0.001) and total CDDP-D >300 vs ≤300mg/m2 (89% vs 83%, p=0.02). Adj chemo and total CDDP-D impacted 5y OS in stage IV (table). 5y RFS was higher in stage IV with total CDDP-D >300 vs ≤300mg/m2 (74% vs 59%, p=0.03), with a trend in locoregional control (LRC) (91% vs 80%, p=0.05) but not significant on distant control (DC) (78% vs 72%, p=0.36). Conclusions: Total CDDP-D >300 mg/m2 impacts OS in the overall cohort. The benefit of adj chemo and total CDDP-D on OS and RFS is significant in stage IV but not stage II-III LA-NPC, mainly due to higher LRC rather than DC. [Table: see text]

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MO361INCIDENCE AND RISK FACTORS OF INFECTION AFTER AN EPISODE OF ACUTE KIDNEY INJURY DURING HOSPITALIZATION

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab082.0015 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Ana Sanchez ◽

Alicia Cabrera ◽

Laura Salanova Villanueva ◽

Patricia Muñoz Ramos ◽

Pablo Ruano ◽

...

Keyword(s):

Acute Kidney Injury ◽

Functional Dependence ◽

Multivariable Analysis ◽

Kidney Injury ◽

Peak Level ◽

Factors Associated ◽

Kaplan Meier ◽

Previous Diagnosis ◽

Independent Association

Abstract Background and Aims Acute kidney injury (AKI) is a major risk factor for development and progression to chronic kidney disease (CKD). The aim of the present study is to assess the incidence of infections after an admission for AKI. Method In this retrospective study all patients who developed AKI during hospitalization and were discharged from 2013 to 2014 were included. Factors associated to infections were evaluated. The mean follow-up after discharge was 39±30 months. Results We included 1255 patients with a mean age of 75±13 years, of which 692 (55%) were men. At baseline, 944 (75%) patients presented with hypertension, 379 (30%) with diabetes, 560 (44%) with hypercholesterolemia and 543 (43%) with CKD. Mean baseline creatinine was 1,3±1,8 mg/dl (glomerular filtration rate [eGFR] estimated by CKD-EPI was 55±25 ml/min/1,73m2). The peak level of creatinine reached during AKI was 2,47±1,97 mg/dl (eGFR 30±18 ml/min/1,73m2). At discharge, creatinine was 1,62 mg/dL and eGFR 53±27 ml/min/1,73m2. Seven hundred and seventy-three (62%) patients presented an eGFR inferior to 60 ml/min/1,73m2. During follow-up, 681(54%) patients presented an infectious event. Urinary tract infection was the most frequent infection (286 patients, 23%) followed by respiratory infection (214 patients, 17%). Factors associated with infection were age (p<0,001), hypertension (p=0,03), atrial fibrillation (p=0,014), functional dependence measured by Barthel index (p=0,03), previous diagnosis of CKD (p=0,01), baseline eGFR (p>0,001) and eGFR at discharge (p=0,002). Survival analysis using Kaplan-Meier demonstrated an existing association between eGFR inferior to 60 ml/min/1,73m2 and infections (LogRank 12,2, p<0,001, figure 1). Adjusted multivariable analysis demonstrated that age (HR 1,01 [CI95% 1,00-1,02], p=0,009) and the presence of eGFR inferior to 60 ml/min/1,73 m2 (HR 1,45 [CI95% 1,04-2,02], p=0,02) were independent predictors of infection after AKI episode. Conclusion The existence of eGFR inferior to 60 ml/min/1,73 m2 after an hospitalization with AKI shows an independent association with presenting an infection afterwards.

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Repair of a mixed form of supracardiac total anomalous pulmonary venous connection

Cardiology in the Young ◽

10.1017/s1047951120003625 ◽

2020 ◽

pp. 1-3

Author(s):

Yuki Kawasaki ◽

John N. Dentel ◽

Henry L. Walters ◽

James M. Galas ◽

Daisuke Kobayashi

Keyword(s):

Superior Vena ◽

Pulmonary Veins ◽

Vena Cava ◽

Right Atrial ◽

Pulmonary Venous Obstruction ◽

Mixed Form ◽

Vertical Vein ◽

Vena Cava Superior ◽

Anomalous Pulmonary Venous Connection

Abstract Total anomalous pulmonary venous connection is a rare congenital heart defect. We report an infant with a mixed form of supracardiac TAPVC, in whom all pulmonary veins, except the right upper, entered a pulmonary venous confluence that is connected to a vertical vein and drained into the superior vena caval–right atrial junction. Several segmental right upper pulmonary veins entered the superior vena cava, superior to the entry of the vertical vein. Surgical repair consisted of the Warden procedure combined with direct anastomosis of the vertical vein to the left atrium. Separate pulmonary venous drainage pathways decreased the risk of post-operative pulmonary venous obstruction. Our patient had an uneventful post-operative course and encouraging 2-month follow-up echocardiography. Careful follow-up is warranted to detect post-operative complications, including obstruction of the pulmonary venous and cavoatrial anastomoses.

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6029Invasive versus medical management for non-ST elevation myocardial infarction in the elderly (SENIOR-NSTEMI study)

European Heart Journal ◽

10.1093/eurheartj/ehz746.0113 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Kaura ◽

J Sterne ◽

A Mulla ◽

V Panoulas ◽

B Glampson ◽

...

Keyword(s):

Myocardial Infarction ◽

Propensity Score ◽

Elderly Patients ◽

Medical Management ◽

Health Informatics ◽

Survival Curves ◽

Unmeasured Confounding ◽

Kaplan Meier ◽

Invasive Management

Abstract Background Trials and registry studies suggest lower long-term mortality after invasive than medical management among patients with non-ST elevated myocardial infarction (NSTEMI), but elderly patients were underrepresented. Purpose To estimate the effect of invasive compared with medical management on survival in patients with NSTEMI aged ≥80 years, using routine clinical data. Methods We used National Institute for Health Research Health Informatics Collaborative data to identify eligible patients admitted during 2010–2017 at five tertiary centres. We compared patients who did and did not have invasive management within 3 days of their peak troponin level. To limit the effect of immortal time bias, follow-up started 3 days after peak troponin: deaths within three days were excluded. We conducted intention-to-treat analyses. Propensity scores were derived from a logistic regression model based on pre-treatment variables: patient demographics, blood test results, cardiovascular risk factors, history of cardiovascular disease and other comorbidities. We modelled non-linear relationships using splines. Patients with high probability (based on propensity score) of medical or invasive intervention were excluded. We used Cox models to estimate hazard ratios (HR) comparing invasive with medical management. Three methods were used to control confounding; multivariable-adjusted, multivariable-adjusted additionally for continuous propensity score (primary analysis), and inverse-probability-of-treatment (IPT) weighting. Kaplan-Meier survival curves were plotted. The robustness of the results to unmeasured confounding was assessed in sensitivity analyses. Results The 2,239 patients (61.3% medical management) included in analyses had a median age of 85 (IQR 82–89) years. During a median follow-up of 32.1 (IQR 11.1–54.3) months, there were 1,015 (45.3%) deaths. At 3-years, cumulative survival was 78.9% and 50.3% in the invasive and medical management groups, respectively (Figure 1). The crude HR comparing invasive with medical management was 0.34 (95% CI 0.29–0.40). The multivariable-adjusted HR was 0.44 (95% CI 0.36–0.53), was unchanged with additional adjustment for propensity score, and was 0.46 (95% CI 0.39–0.56) in the IPT-weighted model (all p<0.0001). The E-value for the point estimate was 2.91: this implies that residual confounding could explain the association if there is an unmeasured covariate with a relative risk of at least 2.91 for both mortality and undergoing invasive management. The highest mortality HR for comorbidities included in our model were aortic stenosis 1.66 (95% CI 1.28–2.14) and obstructive lung disease 1.50 (95% CI 1.16–1.94). Figure 1. Kaplan-Meier survival curves Conclusion This study provides evidence that the survival advantage from invasive management may extend to elderly patients with NSTEMI. Future research should address the possibility of unmeasured confounding, including by post-admission prognostic factors that affect choice of invasive or medical management. Acknowledgement/Funding Funded by NIHR Imperial Biomedical Research Centre (BRC) using NIHR Health Informatics Collaborative data service, supported by OUH, GSTT & UCLH BRCs

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Association between pre-ablation bariatric surgery and atrial fibrillation recurrence in morbidly obese patients undergoing atrial fibrillation ablation

EP Europace ◽

10.1093/europace/euz183 ◽

2019 ◽

Vol 21 (10) ◽

pp. 1476-1483 ◽

Cited By ~ 19

Author(s):

Eoin Donnellan ◽

Oussama M Wazni ◽

Mohamed Kanj ◽

Bryan Baranowski ◽

Paul Cremer ◽

...

Keyword(s):

Atrial Fibrillation ◽

Bariatric Surgery ◽

Propensity Score ◽

Multivariable Analysis ◽

Morbidly Obese ◽

Obese Patients ◽

Af Ablation ◽

The Impact ◽

Af Recurrence

Abstract Aims Obesity decreases arrhythmia-free survival after atrial fibrillation (AF) ablation by mechanisms that are not fully understood. We investigated the impact of pre-ablation bariatric surgery (BS) on AF recurrence after ablation. Methods and results In this retrospective observational cohort study, 239 consecutive morbidly obese patients (body mass index ≥40 kg/m2 or ≥35 kg/m2 with obesity-related complications) were followed for a mean of 22 months prior to ablation. Of these patients, 51 had BS prior to ablation, and our primary outcome was whether BS was associated with a lower rate of AF recurrence during follow-up. Adjustment for confounding was performed with multivariable Cox proportional hazard models and propensity-score based analyses. During a mean follow-up of 36 months after ablation, 10/51 patients (20%) in the BS group had recurrent AF compared with 114/188 (61%) in the non-BS group (P < 0.0001). In the BS group, 6 patients (12%) underwent repeat ablation compared with 77 patients (41%) in the non-BS group, (P < 0.0001). On multivariable analysis, the association between BS and lower AF recurrence remained significant. Similarly, after weighting and adjusting for the inverse probability of the propensity score, BS was still associated with a lower hazard of AF recurrence (hazard ratio 0.14, 95% confidence interval 0.05–0.39; P = 0.002). Conclusion Bariatric surgery is associated with a lower AF recurrence after ablation. Morbidly obese patients should be considered for BS prior to AF ablation, though prospective multicentre studies should be performed to confirm our novel finding.

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Recurrence and new tumor development after frontline intravenous chemotherapy for retinoblastoma: Risk factors and treatment results

European Journal of Ophthalmology ◽

10.1177/11206721211023311 ◽

2021 ◽

pp. 112067212110233

Author(s):

Ahmet Kaan Gündüz ◽

Ibadulla Mirzayev ◽

Handan Dinçaslan ◽

Funda Seher Özalp Ateş

Keyword(s):

Risk Factors ◽

Multivariable Analysis ◽

Tumor Development ◽

Primary Treatment ◽

Intravenous Chemotherapy ◽

Kaplan Meier ◽

Risk Factors For Recurrence ◽

The Mean ◽

Mean Time

Purpose: To evaluate the risk factors leading to recurrence and new tumor (NT) development in patients with retinoblastoma after intravenous chemotherapy (IVC) and to review the treatment outcomes. Materials and methods: The records of 166 retinoblastoma cases (having 246 affected eyes) who underwent six-cycle IVC (vincristine, etoposide, and carboplatin) as primary treatment between October 1999 and August 2020 were reviewed retrospectively. Results: The mean ages at presentation were 9.0 (median: 8.0) and 9.2 (median: 8.5) months in cases with recurrence and NTs respectively. Recurrence was detected in 40 (16.3%) eyes, NTs in 29 (11.8%), and both recurrence/NTs in 24 (9.8%). The mean time elapsed till recurrence and NT was 10.7 months. Multivariable analysis showed that the factors predictive of recurrence were largest tumor base diameter (LTBD) >12 mm ( p = 0.039) and presence of subretinal seeds at diagnosis ( p = 0.043). Multivariable risk factors for the development of NTs were bilateral familial retinoblastoma ( p = 0.001) and presence of subretinal seeds at diagnosis ( p = 0.010). Mean follow-up was 80.1 (median: 72.5) months. By Kaplan-Meier analysis, the 1-, 3-, and 6-year recurrence and NT rates were 21.2%, 28.1%, and 28.7% and 14.9%, 22.6%, and 23.9% respectively. The most common treatment methods used for recurrent and/or NTs included cryotherapy, transpupillary thermotherapy, and intra-arterial chemotherapy. Enucleation was eventually required in 24/93 (25.8%) eyes. No patient developed metastasis. Discussion: Development of recurrence and/or NT after IVC was noted in 38% of all retinoblastoma eyes. Bilateral familial disease, LTBD >12 mm, and presence of subretinal seeds at baseline were risk factors for recurrence and NTs in this study.

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First analysis of an international pediatric melanoma and atypical melanocytic neoplasm database

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.9013 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 9013-9013

Author(s):

B. J. Averbook ◽

D. Jukic ◽

J. S. Rao ◽

A. Panneerselvam ◽

K. Delman ◽

...

Keyword(s):

Multivariable Analysis ◽

Stage Iv ◽

Nodal Metastasis ◽

International Database ◽

Rank Tests ◽

University Of Pittsburgh ◽

Kaplan Meier ◽

The University

9013 Background: Pediatric melanoma (PM) care has been extrapolated from adult melanoma data. PM and atypical melanocytic neoplasms (AMNs) appear to have different biology. An international database (DB) was developed to clarify their behavior. Methods: IRB approval was obtained at 12 institutions. An SQL-DB was developed for web entry of de-identified demographic and pathologic data for PM and AMN patients (pts) < 21yr through an honest broker system at the University of Pittsburgh. Institutions retained a key of pts entered with assigned numbers for quality assurance and updates. Statistical analysis used Kaplan-Meier survival curves, univariate linear trends and log rank tests. In situ melanoma was excluded from PM survival analysis. Results: 828 pts were registered as of 31 Oct 2008 (ages 11mo-23; median 15yr). 34 pts 21–23yr entered were left in the DB for statistical comparison. Diagnosis years ranged from 1936–2008. 455 pts had complete follow-up. Too few AMN pts had complete follow-up for analysis (18/208). After excluding 32 in situ and 40 with other incomplete data, 365 PM out of 415 total PM were evaluable for OS and 351 for DFS (Stage IV removed). Mean/median age for evaluable PM pts was 16.44/17-yrs (range 1–21yr). 591 pts were age 10–20 while 203 were < 10. Sentinel lymph node (SLN) biopsy showed spread in 30.1 % PM pts (compared to 50% [4/8] of AMN SLN pts). 10-yr PM OS was 80.6%, and pts 0–10 yr had 100% 10-yr OS compared to 69.6% for pts age 10–15 and 79.49% for age 15–20 (p= 0.1473). OS did not differ significantly by gender. Stage predicted OS (p<0.0001). 10-yr OS was 94.13% for Stage I (n=174), 79.62% for stage II (n=67) & 77.14% for stage III (n=75). Thickness affected 10-yr OS: 0–1mm=97% (n=147), 1.1–2mm 70% (n=84), 2.01–4mm 78% (n=71) & >4mm 81% (n=25), p= 0.0099. Survival was similar for pts with PM > 1mm of the several T stage groupings. Ulceration adversely affected OS (p=0.022). Mitosis, defined as present/absent did not alter survival. Nodal metastasis correlated with worse OS (p= 0.170). Conclusions: Stage, thickness, ulceration, and nodal status are significant predictors of OS for PM. Further study will focus on multivariable analysis of PM and AMNs after updating pts, increasing accrual, and cleaning data. No significant financial relationships to disclose.

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