Out With the Old and in With the New? Factors Involved in Migration of Older and Newer Generation Stereotactic Breast Biopsy Markers

2021 ◽  
Author(s):  
Brian Stahl ◽  
Yufeng Li ◽  
Brittany Hermecz ◽  
Stefanie Woodard
Keyword(s):  
Migration Rate ◽  
Breast Biopsy ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Patient Characteristics ◽  
P Value ◽  
Migration Distance ◽  
Stereotactic Breast Biopsy ◽  
And Migration ◽  
Breast Thickness

Abstract Objective The purpose of this study was to investigate four commonly used stereotactic biopsy markers, two older and two newer generation, assessing percentage migration and factors influencing migration distance. Methods This was an IRB–approved retrospective review of upright stereotactic breast biopsies from May 2018 to May 2020 involving either older (Cork, Hourglass) or newer (Vision, X-shaped) generation markers. Markers were assessed for migration rate by two-sample Z-test and migration distance by analysis of variance. Univariate analysis was used to assess relationships between marker type and generation, patient characteristics, breast composition and thickness, procedure techniques, trainee involvement, and complications, correlating with migration distance. Multivariable analysis was performed for variables with P-value < 0.1 on univariate analysis. Tukey’s test was used to compare all groups (P < 0.05). Results A total of 732 stereotactic biopsies were performed with 508 using a Cork, Hourglass, Vision, or X-shaped marker. Overall migration rate was 181/508 (35.6%) with no difference between markers. Breast thickness and density were negatively associated with migration distance in univariate analysis. Older marker migration distance was greater than newer (2.6 cm vs 1.9 cm, respectively), which was significant after adjusting for breast thickness and density (P = 0.037). Density was a significant factor in migration distance, comparing fatty to nonfatty breasts (P < 0.05) in univariate analysis. Conclusion No difference in migration rate was seen between the four biopsy markers. Vision and X-shaped markers demonstrate lower migration distance than Cork and Hourglass in multivariate analysis. There is an inverse relationship between breast density and marker migration distance.

Clip placement after an 11-gauge vacuum-assisted stereotactic breast biopsy: correlation between breast thickness and clip movement

Breast Cancer ◽  
2011 ◽  
Vol 19 (1) ◽  
pp. 30-36 ◽  
Author(s):  
Takayoshi Uematsu ◽  
Masako Kasami ◽  
Kaoru Takahashi ◽  
Junichiro Watanabe ◽  
Seiji Yamasaki ◽  
...  
Keyword(s):  
Breast Biopsy ◽  
Stereotactic Breast Biopsy ◽  
Breast Thickness

P3383Left atrial appendage and left atrial morphology is associated with cryptogenic stroke

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Adukauskaite ◽  
F Barbieri ◽  
T Senoner ◽  
F Plank ◽  
M Knoflach ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Left Atrial ◽  
Multivariable Analysis ◽  
Cryptogenic Stroke ◽  
Patient Characteristics ◽  
Atrial Appendage ◽  
P Value ◽  
Clinical Patient

Abstract Background Stroke causes a high burden of morbidity and mortality worldwide. Approximately 30% of stroke cases remain cryptogenic (CS), of which one third is due to occult atrial fibrillation (AF) with left atrial appendage (LAA) being the most frequent thrombus source. Hence, aim of our study was to assess if LAA morphological parameters analysed by computed tomography angiography (CTA) are associated with CS. Methods and materials In 184 patients (Table 1), 82 CS patients and 102 controls (age median 62 (52,2–72), 40.2% females), matched for BMI, a CTA was performed, and LAA morphology evaluated retrospectively. LAA morphology was classified into 5 types (Figure 1): Cactus, Cauliflower, Chicken-wing, Windsock and the new “Seahorse” with a distinctive tip angulation of ≤90° and 2 bends (Z-shape). Further measurements included: LAA tip angulation (≤90°, 91–110°, >110°), LAA lobe number, LAA ostium size (length) and angulation, left atrium wall thickness (LAWT). Results LAA and left atrium (LA) parameters associated with CS on multivariable analysis after adjusting for CHA2DS2-VASc score were: Chicken-wing type (OR 2.15; 95% CI: 1.01–4.56, p=0.046), a greater lobe number (OR 2.01; 95% CI: 1.52–2.64, p<0.001), a greater middle and mean LAWT (respectively, OR 2.13; 95% CI: 1.49–3.05, p<0.001, OR 2.64; 95% CI: 1.63–4.29, p<0.001), a larger (length, OR 1.08; 95% CI: 1.0–1.16, p=0.039) and a less bent LAA ostium (OR 1.02; 95% CI: 1.01–1.03, p=0.006). In contrast, a sharp-angled LAA tip (≤90°) was protective from CS (OR 0.43; 95% CI: 0.23–0.83, p=0.012) on multivariable analysis. Table1. Clinical patient characteristics CS (n=82) Non-stroke (n=102) p value Females 21 (25.6%) 53 (52%) p<0.001 Age, y 66.5 (57–73) 57.5 (50–70) 0.001 BMI, kg/m2 25.6 (23.9–28.2) 26 (23.3–30.1) 0.320 CHA2DS2-VASc score 2 (1–3) 2 (1–3) 0.387 AF (paroxysmal/permanent) 0 4 0.071 Hypertension 68 (82.9%) 54 (56.3%) p<0.001 Diabetes mellitus, type 2 16 (19.8%) 11 (11.5%) 0.145 Values are given in median ± IQR. AF, atrial fibrillation; BMI, body mass index. LAA and LA morphology in CTA. Conclusion In CS, a Chicken-wing LAA, a greater number of lobes and a thicker LA wall are independently associated with CS while a sharp LAA tip (≤90°) mostly seen in Seahorse type LAA is protective. Such “high-risk” LAA and LA morphology could help to select CS patients benefiting from extended rhythm-monitoring to detect an occult AF, however, further prospective studies are needed to confirm this hypothesis.

scholarly journals Atypical Ductal Hyperplasia after Vacuum-Assisted Breast Biopsy: Can We Reduce the Upgrade to Breast Cancer to an Acceptable Rate?

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1120
Author(s):  
Luca Nicosia ◽  
Antuono Latronico ◽  
Francesca Addante ◽  
Rossella De Santis ◽  
Anna Carla Bozzini ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Invasive Carcinoma ◽  
Breast Biopsy ◽  
Ductal Carcinoma ◽  
Atypical Ductal Hyperplasia ◽  
Univariate Analysis ◽  
Surgical Excision ◽  
P Value ◽  
Ductal Hyperplasia

(1) Background: to evaluate which factors can reduce the upgrade rate of atypical ductal hyperplasia (ADH) to in situ or invasive carcinoma in patients who underwent vacuum-assisted breast biopsy (VABB) and subsequent surgical excision. (2) Methods: 2955 VABBs were reviewed; 141 patients with a diagnosis of ADH were selected for subsequent surgical excision. The association between patients’ characteristics and the upgrade rate to breast cancer was evaluated in both univariate and multivariate analyses. (3) Results: the upgrade rates to ductal carcinoma in situ (DCIS) and invasive carcinoma (IC) were, respectively, 29.1% and 7.8%. The pooled upgrade rate to DCIS or IC was statistically lower at univariate analysis, considering the following parameters: complete removal of the lesion (p-value < 0.001); BIRADS ≤ 4a (p-value < 0.001); size of the lesion ≤15 mm (p-value: 0.002); age of the patients <50 years (p-value: 0.035). (4) Conclusions: the overall upgrade rate of ADH to DCIS or IC is high and, as already known, surgery should be recommended. However, ADH cases should always be discussed in multidisciplinary meetings: some parameters appear to be related to a lower upgrade rate. Patients presenting these parameters could be strictly followed up to avoid overtreatment.

scholarly journals Prevalence and patient characteristics associated with pleural tuberculosis in Nigeria

2010 ◽  
Vol 4 (04) ◽  
pp. 213-217 ◽  
Author(s):  
Olufemi O. Adewole ◽  
Greg E. Erhabor ◽  
Akinwumi B. Ogunrombi ◽  
Fehintola A. Awopeju
Keyword(s):  
Pulmonary Tuberculosis ◽  
Univariate Analysis ◽  
Patient Characteristics ◽  
Pleural Space ◽  
P Value ◽  
Hiv Seropositivity ◽  
Duration Of Symptoms ◽  
Significant Difference ◽  
Bonferroni Test ◽  
Pleural Involvement

Background: Tuberculosis is a leading cause of mortality worldwide, with a growing death rate. The pleural space is a common extrapulmonary site of involvement. The aim of this paper is to document prevalence and types of pleural involvement in pulmonary tuberculosis and patient characteristics associated with its occurrence. Methodology:  The study was conducted in a hospital outpatient clinic in which consecutive patients with pulmonary tuberculosis (PTB) or suspects were recruited and studied for the presence of co existing pleural disease or involvement (PD). Results:  Of 100 patients studied, eighty-two (82%) had PTB alone and six (6%) patients had PD. Pleural effusion was responsible for the majority of the cases, accounting for 67% of PD. There was no case of empyema. Mean age between patients with PTB and PTB/PD was similar.  On univariate analysis, patients with PD had a shorter duration of symptoms and increased reporting of fever (p value = .0.02) and were also different from those with only PTB in HIV seropositivity and sputum smear from AFB (p value = 0.02 and 0.00 respectively).  However, after adjustment for multiple comparisons using the Bonferroni test, the only significant difference between them was in the HIV seropositivity rate (p value < 0.012). Conclusion:  Less than one tenth of patients with PTB have co-existing and involvement of the pleural space. Pleural involvement is associated with HIV.

scholarly journals Venous Thromboembolic Events in Diffuse Large B Cell Lymphoma. Incidence, Risk Factors and Outcomes

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3968-3968
Author(s):  
Sabarish Ayyappan ◽  
Dhivya Prabhakar ◽  
Vinita Gupta ◽  
Brenda Cooper ◽  
Hillard M. Lazarus ◽  
...  
Keyword(s):  
Risk Factors ◽  
Univariate Analysis ◽  
B Cell Lymphoma ◽  
Patient Characteristics ◽  
Hematologic Malignancies ◽  
P Value ◽  
First Line ◽  
Bulky Disease ◽  
First Line Therapy ◽  
Line Therapy

Abstract Venous thromboembolism (VTE) is a frequent complication of hematologic malignancies, including lymphoid malignancies. VTE results in significant morbidity and mortality in lymphoma patients. There is limited information regarding the factors affecting the risk of VTE in diffuse large B cell lymphoma (DLBCL) patients treated with chemoimmunotherapy. We conducted a retrospective analysis to identify risk factors affecting the incidence of VTE and the effect of this complication on patient outcome. Methods: We searched the hematologic malignancies database of University Hospitals Seidman Cancer Center for patients newly diagnosed with DLBCL between 2004 and 2014. Records were reviewed for baseline demographics, evidence of known risk factors for VTE, disease characteristics, treatment history and baseline laboratory values. The univariate probability of overall survival (OS) and progression free survival (PFS) was estimated using the Kaplan-Meier method. The cumulative incidence procedure was used to estimate the incidence of VTE. To identify risk factors for VTE, univariate analysis was conducted on the potential risk factors for VTE and variables with P-value .25 were selected for analysis in the multivariate logistic regression model. Results: 204 patients diagnosed with DLBCL were included. Patient characteristics are presented in table 1. The median age at diagnosis was 66 years and 63% had advanced stage at diagnosis. After a median follow up was 27 months, 34 patients (16.6%) presented a VTE, with a 3-year cumulative incidence of 13.7% (95% CI 9.2-20.3%). The VTE was a pulmonary embolism in 12 subjects (35%) and deep venous thrombosis in 22 patients (65%). The diagnosis of VTE was done in the presence of active disease in 23 subjects (67%) and the first VTE occurred during the first line of chemotherapy in 16 patients (47% of VTE). Risk factors identified by univariate analysis (table 2) included previous history of VTE, coronary artery disease and congestive heart failure, bulky disease, and absence of a complete response. Treatment with an anthracycline - containing regimen resulted in decreased risk of VTE. In multivariate analysis, only the presence of bulky disease, progressive disease after first line therapy and treatment with anthracyclines retained statistical significance (p = 0.05, 0.05 and 0.006, respectively). After a median of 27 months of follow up 113 patients had presented progression after first line therapy and 72 had died. Overall, 3-year PFS was 58.6% (95% CI 51-66.2%), with lower PFS in patients experiencing VTE (3-year PFS: VTE 34.8%; no VTE 64.4%, p=0.002). 3-year OS for the whole cohort was 70.2% (95% CI 63.1-77.3%). Patients who presented VTE had a 3-year OS of 51.3% vs. 74.8% in patients without VTE (p=0.002). DLBCL patients present a high risk of VTE, with approximately half of all VTE events occurring early in the course of the disease. We were able to identify the presence of bulky disease at diagnosis and the absence of response to first line therapy as risk factors for developing VTE. The use of anthracycline-containing regimens was protective against VTE, likely because of the increased rates of disease response. Patients with VTE had worsened outcomes, likely a result of the presence of persistent disease, although a direct effect of VTE on long-term outcomes cannot be ruled out. Our results highlight the need for a heightened awareness of the increased risk of VTE in DLBCL patients and the need for prevention strategies. Table 1. Baseline patient characteristics Median age, years (range) 66 (20-92) Gender (%) Male Female 115 (56.3%) 89 (43.6%) Stage I II III IV 32 (15.9%) 43 (21.4%) 41 (20.4%) 85 (42.3%) R-IPI 0 1-2 3-5 18 (8.8%) 104 (51.0%) 80 (39.2%) Table 2. Risk Factors and results of univariate analysis Risk factor Odds Ratio p value Age > 65 1.179 0.661 Male gender 0.847 0.659 Prior congestive heart failure 5.69 0.009 Prior VTE 4.016 0.07 Increased creatinine 3.479 0.181 Morbid obesity 5.121 0.252 Prior malignancy 1.283 0.674 Bulky disease 2.425 0.035 Stage II vs. I III vs. I IV vs. I 3.742 1.343 1.906 0.058 0.703 0.338 Elevated LDH 1.329 0.450 Hemoglobin <10g/dl 0.902 0.236 Platelets < 150,000/mcl 1 0.108 Non - GCB molecular subtype 0.658 0.439 Positive FISH for t(8;14) 1.668 0.568 Anthracycline 0.383 0.050 Rituximab 5.454 0.265 Response PR vs. CR PD vs. CR SD vs. CR 0.843 0.986 0.850 0.863 1.013 1.550 Disclosures No relevant conflicts of interest to declare.

scholarly journals The Utilization of an Opioid-Free Anesthetic for Pediatric Circumcision in an Ambulatory Surgery Center

Children ◽  
2021 ◽  
Vol 8 (8) ◽  
pp. 678
Author(s):  
Laura E. Gilbertson ◽  
Chhaya Patel ◽  
Shuvro De ◽  
Wendy Lo ◽  
Michael Garcia-Roig ◽  
...  
Keyword(s):  
Fast Track ◽  
Ambulatory Surgery ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
P Value ◽  
Anesthesia Care ◽  
Post Anesthesia Care Unit ◽  
Ambulatory Surgery Center ◽  
Opioid Administration ◽  
Surgery Center

Circumcision is one of the most common urologic procedures performed at pediatric ambulatory centers. Emerging data on the short- and long-term effects of perioperative opioid administration has highlighted the importance of an opioid-free anesthetic regimen. We sought to evaluate the effectiveness of an opioid-free anesthetic in pediatric circumcision and its correlation with ambulatory surgery center efficiency. Patients, 3 years of age and younger, who underwent circumcision or circumcision revision by two surgeons pre and post introduction of an opioid-free anesthetic fast-track regimen at an outpatient surgical center were included. There were 100 patients included in this analysis, with 50 patients in each cohort. On univariate analysis, fast-tracking was associated with a decrease in median combined in-room and post-anesthesia care unit times (102.5 vs. 129.0 min, p-value < 0.001). This difference continued after multivariable analysis with an adjusted median combined in-room and post-anesthesia care unit time difference of −15.6 min (95% CI −34.2 to −12.7 min, p-value 0.018). In addition, the fast-track cohort received less intraoperative morphine equivalents without an increase in post-operative analgesic administration or change in postoperative questionnaire score. This demonstrates that opioid-free anesthesia may be used effectively in pediatric circumcision while also allowing for significant time savings for surgical centers.

The association of age with acute toxicities in NRG oncology combined modality lower GI cancer trials.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 649-649 ◽  
Author(s):  
Noam Avraham VanderWalde ◽  
Jennifer Moughan ◽  
Stuart M. Lichtman ◽  
Reshma Jagsi ◽  
Matthew T. Ballo ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Older Patients ◽  
Combined Modality Therapy ◽  
Performance Status ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Categorical Variables ◽  
P Value ◽  
Combined Modality ◽  
Grade 3

649 Background: This study sought to compare adverse events (AEs) of older and younger adults with lower gastrointestinal (GI) malignancies treated on NRG studies. Methods: Data from six NRG trials (RTOG 9811/0012/0247/0529/0822 & NSABP R-04), testing combined modality therapy (radiation and chemotherapy) in patients with anal or rectal cancer, were collected to test the hypothesis that older age was associated with increase in acute ( ≤ 90 days from treatment start) AEs. AEs were defined as GI, Genitourinary (GU), hematologic, or skin. AEs and compliance with protocol-directed therapy were compared between patients aged ≥ 70 years and < 70 years. Categorical variables were compared across age groups using the chi-square test. The association of age on AEs was evaluated using a covariate-adjusted logistic regression model, with odds ratio (OR) reported. To adjust for multiple comparisons, a p-value < 0.01 was considered statistically significant. Results: Data from 2525 patients were collected (43% female, 72% rectal cancer). There were 380 patients ≥ 70 years old (15%). Older patients were more likely to have worse baseline performance status (PS 1 or 2) (23% vs. 16%, p <0.01), but otherwise baseline characteristics were similar. Older patients were less likely to have completed their chemotherapy (78% vs. 87%, p < 0.01), but had similar median RT duration. On univariate analysis, patients ≥ 70 were more likely to experience grade ≥ 3 GI AEs (36% vs. 23%, OR 1.82, p < 0.001), and less likely to experience ≥ 3 skin AEs (8% vs. 14%, OR 0.56, p = 0.002). There was no difference between GU or hematologic AEs. On multivariable analysis, age ≥ 70 was associated with grade ≥ 3 GI AE (OR 1.80, 95% CI: 1.40, 2.31; p < 0.001) after adjusting for gender, PS, T stage, disease site, RT duration, and chemotherapy completion. Conclusions: Older patients with curable lower GI cancers who underwent combined-modality therapy were less likely to complete chemotherapy and were more likely to experience serious GI toxicity, whereas younger patients had higher rates of serious skin AEs.

scholarly journals 209. Methicillin-Sensitive Staphylococcus aureus (MSSA) Septicemia-Outcomes of Ceftriaxone Compared with Cefazolin and Oxacillin Outpatient Therapy from a Large National Sample

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S213-S213
Author(s):  
Yasir Hamad ◽  
Katelin B Nickel ◽  
Margaret A Olsen ◽  
Ige George
Keyword(s):  
Hospital Readmission ◽  
Proportional Hazards Model ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Cox Proportional Hazards Model ◽  
Older Age ◽  
P Value ◽  
Prosthetic Joint ◽  
Increased Risk ◽  
Prosthetic Joint Infections

Abstract Background Ceftriaxone has activity against MSSA and is convenient to use during outpatient parenteral antimicrobial therapy (OPAT). We examined outcomes of MSSA septicemia on patients receiving cefazolin, ceftriaxone or oxacillin OPAT using administrative data. Methods A large insurance claims database of privately insured patients (IBM MarketScan) aged 18 – 64 years from 2010 to 2018 was queried for patients with MSSA septicemia discharged from the hospital on cefazolin, ceftriaxone, or oxacillin OPAT. The primary endpoint was 90-day hospital readmission with same infection category as the index admission. Factors with significant association in univariate analysis were incorporated into a multivariable Cox proportional hazards model with sequential exclusion of variables with p &gt; 0.1. Results A total of 1,895 patients were included; the median age was 54 years and 62.9% were male. Primary outcome occurred in 366 (19.3 %). Factors associated with readmission in multivariable analysis included older age (61-64 years) (aHR 1.42 [CI 1.02-1.98]), obesity (1.31 [1.04-1.65]), intensive care unit (ICU) stay during index MSSA hospitalization (2.11 [1.68-2.65]), hospitalization in the month prior to index MSSA (1.46 [1.15-1.85]), central line associated bacteremia (1.72 [1.26-2.35]), endocarditis (1.56 [1.19-2.04]) and prosthetic joint infection (1.77 [1.26-2.50]). There was no difference in infection-associated readmission among patients treated with ceftriaxone compared to cefazolin or oxacillin (Figure 1). Conclusion Older age, ICU admission, obesity, endocarditis, and prosthetic joint infections were associated with increased risk of hospital readmission with infection following OPAT for MSSA septicemia. Treatment with ceftriaxone was not associated with worse outcomes compared to oxacillin or cefazolin. Figure 1. Kaplan Meier Survival Analysis for readmission free survival (log-rank P value 0.31) Disclosures Margaret A. Olsen, PhD, MPH, Pfizer (Consultant, Research Grant or Support)

Analysis of Impact of Comorbidities Constituting the HCT-CI Score on the Outcome of Patients Undergoing Allogeneic Hematopoietic Cell Transplant for Acute Myeloid Leukemia

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3201-3201
Author(s):  
Fotios V. Michelis ◽  
Hans A. Messner ◽  
Naheed Alam ◽  
Vikas Gupta ◽  
Dennis Dong Hwan Kim ◽  
...  
Keyword(s):  
Myeloid Leukemia ◽  
Research Funding ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Hematopoietic Cell ◽  
P Value ◽  
Cell Transplant ◽  
Hematopoietic Cell Transplant ◽  
Allogeneic Hematopoietic Cell Transplant ◽  
Cardiac Disorder

Abstract The Hematopoietic Cell Transplant Co-morbidity Index (HCT-CI, Sorror et al 2005) was developed as a prognostic tool for overall survival (OS) and non-relapse mortality (NRM) in allogeneic hematopoietic cell transplant (HCT) patients. The prognostic significance of the score for patients with acute myeloid leukemia (AML) undergoing HCT has been demonstrated, however reports are conflicting. The purpose of this single-center study was to retrospectively investigate the prognostic impact of the individual component co-morbidities of the HCT-CI on the outcome of 418 patients that underwent HCT for AML at our center between 2000 and 2013. Patients underwent HCT in first (CR1, n=303) and second (CR2, n=115) complete remission. Median age at HCT was 50 years (range 18-71), 212 (51%) patients were female. Myeloablative conditioning (MAC) was used in 283 (68%) patients, reduced-intensity (RIC) in 135 (32%) patients. Donors were related for 236 (56%) patients, unrelated for 182 (44%) patients. Grafts were peripheral blood stem cells (PBSC) in 339 (81%) patients and bone marrow in 79 (19%) patients. Median follow-up of patients alive was 62 months (range 12-168). Cytogenetics at diagnosis were available for 84% of patients, of which 31 (7%) were favorable, 246 (59%) were intermediate and 74 (18%) were unfavorable risk (MRC classification). HCT-CI scores were grouped as 0 (n=109, 26%), 1-2 (n=157, 38%) and ≥3 (n=152, 36%). A total of 171 patients (41%) underwent HCT during the years 2000-2006 and 247 patients (59%) during the years 2007-2013. The observed frequency of the co-morbidities composing the HCT-CI is summarized in Table 1. Univariate analysis for OS demonstrated the following significant variables: Age (HR=1.02, 95%CI=1.01-1.03, p=0.0002), CR status (HR=1.42 for CR2, 95%CI=1.08-1.87, P=0.01), donor type (HR=0.73 for related, 95%CI=0.57-0.94, p=0.02), HCT-CI group (overall p-value=0.004). For OS, univariate analysis of the impact of individual co-morbidities was performed for the components of the HCT-CI score that were observed in ≥5% of the patients (Table 1). All variables with a p-value ≤0.2 were introduced into the multivariable analysis (not including the HCT-CI itself), and these included cardiac disorder (CAD, CHF, MI or EF≤50%) (HR=1.65, 95%CI=1.17-2.32, p=0.004), prior solid tumor (HR=1.56, 95%CI=1.06-2.30, p=0.02) and diabetes (HR=1.40, 95%CI=0.89-2.19, p=0.14). In the multivariable analysis for OS, none of the aforementioned co-morbidities demonstrated independent prognostic relevance. For NRM, univariate analysis demonstrated cardiac disorder (HR=1.89, 95%CI=1.27-2.81, p=0.002), diabetes (HR=1.94, 95%CI=1.20-3.12, p=0.007) and moderate pulmonary (FEV1 and/or DLCO 66-80% or dyspnea on slight activity) (HR=1.31, 95%CI=0.93-1.84, p=0.12) to meet the significance criteria for inclusion in the multivariable analysis, which finally demonstrated diabetes (HR=2.17, 95%CI=1.31-3.60, p=0.003) and cardiac disorder (HR=1.78, 95%CI=1.15-2.76, p=0.01) to be independent predictors of NRM post-transplant. In conclusion, among the pre-transplant co-morbidities included in the HCT-CI, diabetes and cardiac dysfunction are independent prognostic indicators for NRM but not for OS. Pulmonary dysfunction does not seem to negatively influence outcomes in this cohort of patients. Disclosures Kim: Novartis Pharmaceuticals: Consultancy, Research Funding; Bristol-Myers Squibb: Consultancy, Research Funding.

scholarly journals Clinical Variables Associated with PSA Response to Lutetium-177-PSMA ([177Lu]-PSMA-617) Radionuclide Treatment in Men with Metastatic Castration-Resistant Prostate Cancer

Cancers ◽  
2020 ◽  
Vol 12 (5) ◽  
pp. 1078
Author(s):  
Moran Gadot ◽  
Tima Davidson ◽  
Margalit Aharon ◽  
Eshetu G. Atenafu ◽  
Avraham Malki ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Logistic Regression ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Real Life ◽  
Categorical Variables ◽  
P Value ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistant ◽  
Psa Response

Lutetium-177-PSMA ([177Lu]-PSMA-617), a radiolabeled small molecule, binds with high affinity to prostate-specific membrane antigen (PSMA), enabling targeted radiation therapy to metastatic prostate lesions. Our objective was to retrospectively analyze the activity of [177Lu]-PSMA-617 given off-trial to men with metastatic castration resistant prostate cancer (mCRPC) and identify clinical factors associated with PSA response. Electronic medical records of all men treated with [177Lu]-PSMA-617 were reviewed and analyzed. Overall survival was calculated using the Kaplan–Meier method. The association between potential variables and PSA response was analyzed by univariate analysis, using either logistic regression or χ2/Fisher’s exact test. Multivariable analysis was carried out using logistic regression on all categorical variables with a P-value of <0.1 on univariate analysis. Variables found to be statistically significant were then used to define a categorical score. A total of 52 patients received at least one cycle of [177Lu]-PSMA-617. Clinical benefit was observed in 28 patients (52%). PSA decline ≥20% and ≥50% was observed in 26 (50%) and 18 patients (35%), respectively. Achievement of any PSA decline at first measurement was significantly associated with survival. There was a negative association between the number of previous chemotherapy lines and PSA decline above 20%. Univariate analysis followed by multivariable analysis showed that older age and higher hemoglobin were significantly associated with a PSA decline >20%. A score combining these two parameters was significantly associated with PSA response. In summary, [177Lu]-PSMA-617 is active in the ‘real-life’ setting of heavily pretreated men with mCRPC.

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