scholarly journals P0276SERUM C3 LEVELS AND THE PROGNOSIS OF ANCA-ASSOCIATED VASCULITIS: A SINGLE-CENTER RETROSPECTIVE STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Annalisa Carta ◽  
Elisa Russo ◽  
Leda Cipriani ◽  
Daniela Picciotto ◽  
Michela Saio ◽  
...  
Keyword(s):  
Renal Damage ◽  
Alternative Pathway ◽  
Rapidly Progressive Glomerulonephritis ◽  
Renal Outcome ◽  
Secondary Outcome ◽  
Rank Test ◽  
P Value ◽  
Risk Of Death ◽  
Anca Associated Vasculitis

Figure: Background and Aims Despite improved survival, patients affected by ANCA-associated vasculitis (AAV) presenting with rapidly progressive glomerulonephritis (RPGN) still remain at a higher risk of death relative to the general population. Recent findings suggest a role for the activation of the complement alternative pathway in the pathogenesis of the disease. We aimed to retrospectively evaluate the presentation and outcome of a cohort of patients with AAV and RPGN according to ANCA specificity, investigating the role of complement pathways. Method We retrospectively examined 1,547 biopsies performed between 1996 and 2019 in our center, which included 124 patients presenting with paucimmune RPGN. Patients without ANCA serology and/or with missing data (n=44), ANCA negative RPGN (n=15) and anti-GBM disease (n=2) were excluded from our analysis. Seventy-eight patients with AAV and RPGN (63 biopsy proven) were analysed and compared according to ANCA serotype (n=30 MPO, n=21 PR3). Furthermore, data were analysed on the basis of median levels of serum C3 (1.05 g/l). Statistical analysis Data are mean ± SD or median and interquartile range for variables not normally distributed. Groups were compared using ANOVA after logarithmic transformation of skewed variables. Primary endpoint was renal survival defined as need for renal replacement therapy (NRRT); secondary outcome was patient survival. Cumulative and renal survivals were calculated using Kaplan-Meier method and differences between groups were analysed with the log-rank test. Multivariate Cox proportional hazard analysis for time to NRRT was performed to determine the significance of different risk factors in renal outcome. A p value of < 0.05 was considered statistically significant. Results Patients had a mean age of 64± yrs and eGFR ±15 ml/min at diagnosis. Patients with MPO-AAV were older (69±11 vs. 61±14 yrs, p=0.02) and showed lower levels of C3 (1.0±0.22 vs 1.25±0.2 g/l, p=0.009) as compared to PR3 patients. Moreover, those presenting with C3 levels lower than median value had more advanced renal damage at diagnosis (eGFR 7± ml/min vs 15.5± ml/min, p= 0.04). Serum C3, but not C4 levels, significantly correlated with eGFR, proteinuria and serum uric acid at diagnosis. Twenty-seven (39.7%) reached ESRD requiring RRT. The 1-, 5- and 10- yrs patients renal survivals were 81%, 62.9 % and 52.4%. Renal outcome was neither influenced by ANCA serotype nor gender but patients with C3 levels below median value exhibited a worse renal prognosis (Log rank p=0.02) and a 5 times higher risk of NRRT (HR 5.1, 95% CI 1.4-18.7, p=0.01) independently by potential confounding factors. Conclusion Referral to the nephrologist was late, at an advanced stage of disease, indicating the need to improve the awareness of AAV and RPGN in order to favour early treatment. In this cohort, low C3 indicated a more severe renal damage and predicted poorer renal outcome thus suggesting a role of complement activation in the pathogenesis and progression of these nephritides.

scholarly journals Clinical and Histological Outcome Predictors in Renal Limited Pauci-Immune Crescentic Glomerulonephritis: A Single Centre Experience

2012 ◽  
Vol 25 (1) ◽  
pp. 287-292 ◽  
Author(s):  
A. Gigante ◽  
C. Salviani ◽  
K. Giannakakis ◽  
E. Rosato ◽  
B. Barbano ◽  
...  
Keyword(s):  
Serum Creatinine ◽  
Crescentic Glomerulonephritis ◽  
Alternative Pathway ◽  
Rapidly Progressive Glomerulonephritis ◽  
Renal Outcome ◽  
Fibrinoid Necrosis ◽  
Histological Features ◽  
Systemic Involvement ◽  
University Of Rome

Renal-limited vasculitis is a pauci-immune crescentic glomerulonephritis with no signs of systemic involvement, representing one of the most common causes of rapidly progressive glomerulonephritis. The study aims to examine clinical and histological features in twenty-four patients with RLV diagnosed by the Nephrology Department of Sapienza University of Rome, Italy, evaluating the role of these parameters in predicting renal survival. Patients details, clinical and histological features and outcomes were recorded at the time of renal biopsy and over a mean follow-up period of 36±6 months. In our study, serum creatinine at presentation was significantly higher in patients who had a poor outcome than in those who survived with independent renal function (6.3±2.47 mg/dl vs 2.84±2.01 mg/dl, P= 0.002). The presence of C3c was found in the area of glomerular fibrinoid necrosis and in small arteries and arterioles with fibrinoid necrosis in 17 patients (P= 0.018). In conclusion, serum creatinine at presentation and focal C3c depositions in areas of glomerular and arteriolar fibrinoid necrosis were the best determinants of poor renal outcome, maybe underlining the pathogenic role of alternative pathway activation of complement system but also demonstrating the focal distribution of necrotizing lesions.

scholarly journals Hubungan Beban Kerja Perawat Dengan Peran Perawat Anak Dalam Pendampingan Terapi Bermain

JKEP ◽  
2019 ◽  
Vol 4 (2) ◽  
pp. 104-113
Author(s):  
Ririn Nur Indah sari ◽  
Sari Windyastuti ◽  
Tri Sakti Widyaningsih
Keyword(s):  
Play Therapy ◽  
Sampling Technique ◽  
Rank Test ◽  
P Value ◽  
Test Statistic ◽  
Cross Sectional ◽  
Test Analysis ◽  
Spearman Rank ◽  
Nurse Workload

Nurse workload is very influential on child play therapy assistance caused by workload excessive workload, lack of facilities and infrastructure, nothing schedule for play therapy and the number of nurses  only 18 nurses, According to theory Gilles with the number of beds 34 needed 29 nurses. The purpose of this research is to know the Relationship of Nurse Workload with The Role of Child’s Nurse in Mentoring Play Therapy in Room Dahlia RSUD Dr. H Sewondo Kendal. This type of research is descriptive correlation with cross sectional. The sampling technique with total sampling, a sample is 18 respondents. Retrieval data using questionnaires and then tested into Spearman Rank test statistic. Based on research found 10 respondents (55,6%) have hard workload and 8 respondents (44,4%) have a light workload. The role of nurses in good categories 5 respondents (27,8%) and categories less is 13 respondents (72,2%). From result of Spearman Rank test analysis, get result of coefficient correlation value -868 in category very strong and obtained p value = 0,000 < 0,05 it’s mean Ha accepted and H0 rejected. There is a relantionship between the nurses workload with the role of child nurses in mentoring play therapy.

Relationship between high microRNA-200C expression and the risk of death from disease in muscle-invasive urothelial carcinoma of the bladder.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 279-279 ◽  
Author(s):  
Neema Navai ◽  
Michael Brandon Williams ◽  
Sijin Wen ◽  
Arlene O. Siefker-Radtke ◽  
David James McConkey ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Urothelial Carcinoma ◽  
Multivariable Analysis ◽  
Surrogate Marker ◽  
Rank Test ◽  
P Value ◽  
Fisher Exact Test ◽  
Mesenchymal Transition ◽  
Risk Of Death ◽  
Muscle Invasive

279 Background: Bladder cancer represents both a common and highly morbid disease with limited tools for prognostication. Recently molecular studies have led to promising targets to inform disease behavior, including microRNAs (miRNA). miRNAs are non-coding RNAs, with widespread effects on cellular function. Our group has demonstrated that the miR200 family members play an integral role in epithelial to mesenchymal transition (EMT) via an inverse relationship with ZEB1 and a direct relationship with E-cadherin. EMT is seen as a necessary step for invasion and metastasis, however, studies have indicated a significant role for mesenchymal to epithelial transition (MET) to drive proliferation after cells have reached metastatic locations. Members of the miR200 family have been shown to induce MET and we hypothesize that miR200c, as a surrogate marker for MET, and will predict disease survival in muscle invasive urothelial carcinoma (MIUC). Methods: A clinically diverse sample set was obtained consisting of 101 unique specimens upon which real-time PCR miRNA analysis was performed. Regression tree analysis and best-fit modeling was used to establish the most discriminating relative miR200c expression level to predict disease specific survival. Fisher exact test was carried out to compare clinical variables, Kaplan-Meier estimate of survival distribution based on miR200c expression and univariate log-rank test was used to compare survival distributions between groups. Multivariate analysis was done via the proportional hazards model. A p-value of <0.05 was considered significant for all statistical analyses. Results: Patients with high miRNA200c had significantly more deaths (69 vs. 47%). In multivariable analysis of patients with MIUC miR200c expression was associated with the highest risk of death (RR 2.7). Lymph node involvement (RR 2.0) and age > 65yrs (RR 2.4) were also strong predictors of survival. High miR200c had lower median survival for all patients (59 vs 16 months; p = 0.039) and those with MIUC (41 vs 8 months; p = 0.0004). Conclusions: High miR200c expression is associated with a higher risk of death from bladder cancer in patients with muscle invasive disease.

Platelets release proinflammatory microparticles in anti-neutrophil cytoplasmic antibody-associated vasculitis

Rheumatology ◽  
2019 ◽  
Vol 58 (8) ◽  
pp. 1432-1442 ◽  
Author(s):  
Di Miao ◽  
Tian-Tian Ma ◽  
Min Chen ◽  
Ming-Hui Zhao
Keyword(s):  
Renal Damage ◽  
Potential Role ◽  
Biological Functions ◽  
Active Stage ◽  
Array Analysis ◽  
Antibody Microarrays ◽  
Bioactive Proteins ◽  
Anca Associated Vasculitis ◽  
Proinflammatory Molecules

Abstract Objective The biological functions of the platelets contributing to ANCA-associated vasculitis (AAV) are largely unclear. The current study aimed to investigate the potential role of platelet-derived microparticles (PMPs) in AAV. Methods In the current study, microparticles in AAV patients were analysed by flow cytometry, and PMPs were probed for relative levels of 640 bioactive proteins secreted from patients’ platelets using antibody microarrays. These data were then correlated with clinical and pathological parameters. Results PMPs were significantly increased in 69 AAV patients, predominantly MPO-ANCA positive patients in active stage compared with in remission [4406.8/μl (2135.4, 5485.0) vs 549.7/μl (350, 708.5), P < 0.0001], and 43% of microparticles in active AAV were PMPs. Compared with 15 patients in remission, highly expressed proinflammatory molecules in the microparticles from platelets in 15 AAV patients in active stage revealed that potential functions of PMPs were promotion of the effect of chemotaxis, adhesion, growth and apoptosis (all the patients for array analysis were MPO-ANCA positive). The level of PMPs had a significant association with disease activity, inflammation, and renal damage. Conclusion PMPs may serve as inflammatory propagators through their wide production of proinflammatory cytokines in AAV, potentially providing a novel therapeutic target.

Colorectal cancer lung metastasis: Could multidisciplinary management suggest the right strategy?

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15039-e15039
Author(s):  
Ina Valeria Zurlo ◽  
Michele Basso ◽  
Maria Teresa Congedo ◽  
Maria Letizia Vita ◽  
Leonardo Petracca Ciavarella ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Multivariate Analysis ◽  
Lung Metastasis ◽  
Rank Test ◽  
P Value ◽  
Multidisciplinary Management ◽  
Ras Status ◽  
The Right ◽  
The Impact

e15039 Background: Unlike liver metastases surgery, the resection of colorectal cancer lung metastasis (CCLM) is not standardized and data are still poor. Therefore, we conducted a retrospective analysis to evaluate the management of CCLM at our Centre. Methods: We retrospectively analyzed patients (pts) with CCLM treated at our Institution from Jan-2007 to Jan-2017. Aim of the study was to evaluate the impact of clinical and pathological features with survival outcomes (DFS and OS). Differences were compared with the use of log-rank test and parameters considered statistically significant ( p value < 0.5) at univariate were compared at multivariate analysis. Results: 141 pts were included in the analysis. 87 pts received a preoperative chemotherapy (pCT) and 54 an adjuvant (a)CT. In the whole population median DFS (mDFS) was 24 m (20-24) and median OS (mOS) 54 m (46-82), while 21 m (20-34) and 65 m (45-108) for pts undergoing pCT and 15 m (20-28) and 53 m (38 – 76) for those receiving aCT respectively, without statistically significant differences (p=0.4). Age, gender, PS, disease-free interval (DFI) (> or <24 months), primary tumor sidedness, mucinous histology, grading, RAS status, timing of lung metastasis (metachronous vs synchronous), number of lesions (>2), metastasis location (uni vs bilateral) and liver resection were evaluated at univariate and multivariate analysis. DFS was correlated with DFI > 24m (p=0.02), timing (p=0.03), number (p<0,0001) of metastasis and metastasis location (p=0.01) whereas OS was associated to DFI (p=0.02), number (p=0.0005), metastasis location (p=0.037) and RAS status (p=0.05) at univariate. At multivariate analysis, number of lesions correlated to DFS (p=0.0006) while DFI (p=0.0034) and RAS status (p=0.05) to OS. Conclusions: Our single Centre retrospective experience suggests an important clinical impact from surgery of CCLM based on mOS of the whole population. These data strengthen the role of a multidisciplinary management to allow pts to achieve surgery whenever possible, regardless of previous liver surgery, metachronous vs synchronous metastasis, DFI and RAS status.

Abstract 12936: Impact of Mitral Regurgitation on Heart Failure Hospitalization and Mortality in Older Age Adults With a Preserved Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ginger Y Jiang ◽  
Warren J Manning ◽  
Lawrence Markson ◽  
A. R Garan ◽  
Marwa A Sabe ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Primary Outcome ◽  
Secondary Outcome ◽  
P Value ◽  
Preserved Ejection Fraction ◽  
Risk Of Death ◽  
Increased Risk ◽  
All Cause Mortality

Background: The effect of mitral regurgitation (MR) severity on heart failure (HF) hospitalization and mortality in individuals with a preserved ejection fraction (LVEF) and no prior HF history is uncertain. Methods: Transthoracic echocardiogram (TTE) reports from patients with an LVEF > 50% at our institution were linked to complete Medicare inpatient claims, 2003-2017. Patients with HF hospitalization within the 12 months prior to TTE were excluded. We evaluated the relationship of baseline MR severity and time to the composite of all-cause mortality or HF hospitalization using the Kaplan-Meier technique. Secondary outcomes included the individual components of all-cause mortality and HF hospitalization, adjusting for the competing risk of death with Fine-Gray methods. Results: A total of 18,315 individuals met inclusion criteria (77.6 ±7.7 years, 54.3% female). Over a median follow-up time of 6.5 (IQR 3.0 to 10.2) years, the primary endpoint occurred in 7566 individuals (50.6%) of whom 6,927 (37.8%) died and 1703 (13.9%) were admitted for HF at a median of 1.4 (IQR 0.2 to 4.3) years and 1.6 (IQR 0.2 to 4.3) years respectively ( Figure ). After multivariable adjustment, MR severity was not associated with the primary or secondary outcome at 1-, 3-, 5-, or 10-years after TTE (p > 0.05 for all). Mitral valve prolapse (MVP) was associated with decreased risk of the primary outcome at 1-year and 3-years (interaction p-value = 0.04 for both). Jet eccentricity did not impact the observed relationship (interaction p-value > 0.05). Conclusions: In this large, single institution echocardiographic study of individuals with preserved ejection fraction and no prior history of HF, MR severity was not associated with an increased risk of all-cause mortality or HF hospitalization. Presence of MVP was associated with decreased risk of the primary outcome with increasing MR severity.

Association of HIPEC with survival in patients with ovarian metastases of gastrointestinal origin.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15124-e15124 ◽  
Author(s):  
Srividya Srinivasamaharaj ◽  
Dhruv Ranchhodbhai Chaudhary ◽  
Xiaoyong Wu ◽  
Shesh Rai ◽  
Mary Ann Sanders ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Chart Review ◽  
Rank Test ◽  
P Value ◽  
Chi Square ◽  
Ovarian Metastases ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Ovarian Involvement

e15124 Background: Metastatic ovarian involvement in primary gastrointestinal (GI) carcinomas (CA) is associated with a poor prognosis. We performed a survival analysis in patients with ovarian metastases, based on site of primary GI CA (appendiceal, colorectal (CRC), gastric, and pancreatic). We also examined the association between hyperthermic intraperitoneal chemotherapy (HIPEC) and death in these patients. Methods: A search was conducted in a single institution pathology database for patients with primary GI CA and ovarian metastases diagnosed from 2010 to 2017. The search yielded 39 patients, and data pertaining to tumor characteristics and treatment were obtained by chart review. Chi-square (log rank) test was used to test for associations between both site of primary GI CA and HIPEC, and death, and Kaplan-Meier analysis was done. P-value < 0.05 was deemed statistically significant. Results: CRC accounted for the majority of patients (51.29%) with appendiceal CA accounting for 23.08% and gastric and pancreatic cancer making up the remainder. Primary site of malignancy was associated with survival (p = 0.036), favoring those with appendiceal and colorectal primaries. A total of 30 patients (76.92%) received HIPEC. Having undergone HIPEC was significantly associated with survival (p = 0.017). Conclusions: Ovarian metastases secondary to gastric and pancreatic cancer were associated with inferior survival as compared to those with appendiceal or colorectal primaries. A significant association was demonstrated between HIPEC and survival. Further investigation to define the role of HIPEC in the treatment of carcinomas of gastrointestinal primaries is warranted.

P0010INCREASED SERUM URIC ACID LEVELS ARE ASSOCIATED TO RENAL ARTERIOLOPATHY AND PREDICT POOR OUTCOME IN IGA NEPHROPATHY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Elisa Russo ◽  
Stefania Drovandi ◽  
Gennaro Salvidio ◽  
Michela Saio ◽  
Elisabetta Bussalino ◽  
...  
Keyword(s):  
Uric Acid ◽  
Iga Nephropathy ◽  
Serum Uric Acid ◽  
Renal Damage ◽  
Primary Outcome ◽  
Receiver Operating Curve ◽  
Renal Outcome ◽  
Rank Test ◽  
Log Rank Test ◽  
Gender Specific

Abstract Background and Aims IgA nephropathy (IgAN) is the most common primary glomerulonephritis worldwide and a leading cause of End Stage Renal Disease (ESRD). In addition to the classical progression factors, including hypertension, proteinuria, and decreased renal function, other atherosclerosis-related factors, such as hypertriglyceridemia, have been reported to the renal progression of IgAN. Above all, many studies have indicated an association between hyperuricemia and progression of IgAN. Increased serum uric acid (SUA) levels are also well known to be associated with hypertension, endothelial dysfunction and development of cardiovascular and kidney diseases both in general population and high-risk patients. Previous studies suggested that uric acid induces proliferation of vascular smooth muscle cells, activates the renin–angiotensin–aldosterone system (RAAS) and also reduces the synthesis of nitric oxide. Furthermore, there is evidence that uric acid can promote the oxygenation of low-density lipoproteins (LDL) and increase the production of free oxygen radicals, increasing inflammation and oxidative stress. In consequence of these processes, SUA might specifically promote atherosclerosis and arteriolar damage, possibly playing a major role in pathogenesis and progression of IgAN. The aim of the present study was to explore the correlation between SUA levels, renal damage and its implication for renal outcome and all cause death in IgAN patients. Method The data for clinical features, laboratory and renal pathological examination were collected from 145 renal biopsy-proven IgAN patients and were retrospectively analyzed to determine the correlation between SUA levels, renal damage and overall outcome. Hyperuricemia (HU) was defined as the highest SUA gender-specific tertile. Biopsy-proven arteriolar damage was defined by the presence of arteriolar hyalinosis or intimal thickening. The primary outcome was death or ESRD. Results The mean baseline serum uric acid levels of the 42 female and 103 male patients at the time of kidney biopsy were 5.4 ±1.7 and 7.2 ±1.8 mg/dL, respectively. HU was &gt;7.7 mg/dl for males and &gt; 6.2 mg/dl for females. Patients were stratified on the basis of baseline gender-specific SUA level tertiles. Clinical and histologic characteristics are described in table 1. The higher the gender-specific SUA tertile, the greater the prevalence of arteriolar damage (p=0.02). No other histologic feature was significantly correlated with uric acid levels, therefore we analyzed laboratory and clinical characteristics on the basis of the presence/absence of biopsy-proven arteriolar damage (Table 2). At logistic regression analyses SUA was associated with arteriolar damage at univariate (OR 1.45 CI [1.12-1.87], p=0.004) and multivariate analyses (OR 1.75 CI [1.10-2.93], p=0.03), recorded in Table 3. Receiver Operating Curve (ROC) was performed and the sensitivity and specificity of SUA for predicting arteriolar damage were showed in Figure 1. The area under the ROC curve was 0.67 (IC95% 0.61 to 0.73) indicating that SUA is a fair test for detecting arteriolar damage. Patients with arteriolar damage had a worst outcome compared to patients without it (Kaplan Maier survival analysis, log rank test p=0.002, Figure 2a). HU and arteriolar damage had a synergic impact on progression of IgAN. Patients having both arteriolar damage and HU, showed a reduced survival free from the primary outcome as compared to those having only one risk factor or neither (log rank test p=0.003, Figure 2b). Conclusion SUA levels are directly associated with arteriolar damage and poor prognosis in patients with IgAN. Our study suggests the presence of higher SUA levels in IgAN patients identifies a sub-population at increased risk of progressing to ESRD or death, for whom a particular surveillance is warranted, possibly because of the pathogenetic role of SUA on arteriolar damage.

scholarly journals Survival Comparability Between Thalassemia Major Versus Thalassemia Intermedia

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2141-2141
Author(s):  
Angela Vitrano ◽  
Giuseppina Calvaruso ◽  
Eliana Lai ◽  
Grazia Colletta ◽  
Alessandra Quota ◽  
...  
Keyword(s):  
Causes Of Death ◽  
Thalassemia Major ◽  
Rank Test ◽  
P Value ◽  
Thalassemia Intermedia ◽  
Survival Curves ◽  
Risk Of Death ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Before And After

Abstract Introduction. In the last few decades, the life expectancy of Thalassemia Major (TM) patients has progressively been increasing. The improvement can be due to several factors, including introduction of chelation treatment (Deferoxamine 1965, Deferiprone 1987, Deferasirox 2006), screening of blood for the most common viral agents, aggressive treatment of infection and improved treatment of cardiac complications. However, no comparative survival curves between TM versus Thalassemia Intermedia (TI) have been so far reported. Moreover, no data on life expectancy, after introduction of chelation treatment have been described. Methods. Data coming from several randomized clinical trials, carried ahead by Campus of Hematology Franco and Piera Cutino-A.O.O.R Villa Sofia-V. Cervello, Palermo (Italy), were retrospectively considered for this study. Primary goal of the study was to provide evidence of possible differences in survival curves between TM versus TI. Survival curves in TM versus TI patients were compared using Kaplan-Meier method and the log-rank test before and after the introduction of Deferoxamine (DFO) (1965). Moreover, Cox regression model was even used to explore risk of death between the two diagnoses. Each dead patient was observed from its birth to its death, and each alive patient was observed from its birth to June 30, 2015. Results. Three hundred seventy-nine patients with TM (n=284, dead 40) and TI (n=95, dead 13) entered into the study. Males were 50.7% of this cohort of patients. Among the cohort of dead patients, 15% (6/40) TM and 76.9% (10/13) TI patients were born before introduction of DFO (1965) . The mean age survival was 50.6 (SE 0.9) and 70.6 (SE 1.7) for TM and TI, respectively. Table 1 shows the main causes of death. In TM patients the most common causes of death were heart damage (16 cases, 40%, Tab. 1), followed by cancer (3 cases, 7.5%, Tab. 1), liver cirrhosis (3 cases, 7.5%, Tab. 1) and infections (3 cases, 7.5%, Tab. 1). In TI patients the most common causes of death were cancer (2 cases, 38.5%, Tab. 1), followed by infections (3 cases, 23.1% , Tab. 1), heart damage (2 case, 15.4%, Tab. 1). Kaplan-Meir curves showed statistically significant difference in TM versus TI survival (log-rank test, p- value<0.0001; Figure 1A). Survival was higher for TI subjects (median age was 73.6 years). Cox regression models of TM versus TI suggested that risk of death for TM patients was 6.8 times higher than TI patients (HR 6.8 (3.3), p- value<0.0001). However, the introduction of chelation treatment (DFO, 1965), changed the Kaplan-Meier curves showing that there was not statistically significant difference between TM versus TI patients in life expectancy ( log-rank test, p- value=0.086; Fig. 1B). Conclusion. These results suggest as TM survival, after the introduction of chelation treatment, improved so much that nowadays it is not different in comparison with TI one's. Moreover, the TM risk of death has been decreased from 6.8 to 2.8 (Cox Model HR 2.8 (1.7), p- value=0.099). These findings, if further confirmed, suggest as, in Western countries, our approach for genetic counselling of "at risk couples" for TM should be reconsidered. Table 1. Causes of death in Thalassemia Major and Thalassemia Intermedia patients. Diagnosis Causes of Death TM n (%) TI n (%) Cancer 3 (7,5) 5 (38,5) Heart Damage 16 (40,0) 2 (15,4) Infection 3 (7,5) 3 (23,1) Multi Organ Failure 1 (2,5) 0 (0,0) Stroke 1 (2,5) 0 (0,0) Liver Failure 3 (7,5) 1 (7,7) Not Available 11 (27,5) 1 (7,7) Other complications not related to Thalassemia 2 (5,0) 1 (7,7) Total 13 40 Figure 1. Kaplan-Meier Survival curves of Thalassemia Major versus Thalassemia Intermedia patients before and after the introduction of chelation treatment (DFO, 1965). Figure 1. Kaplan-Meier Survival curves of Thalassemia Major versus Thalassemia Intermedia patients before and after the introduction of chelation treatment (DFO, 1965). Disclosures Pepe: Chiesi: Speakers Bureau; ApoPharma Inc: Speakers Bureau; Novartis: Speakers Bureau.

Percentage of sarcomatoid component as a prognostic indicator for survival in sarcomatoid renal cell carcinoma.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 499-499
Author(s):  
Mehrad Adibi ◽  
Arun Z. Thomas ◽  
Leonardo Borregales ◽  
Megan M. Merrill ◽  
Kanishka Sircar ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Metastatic Disease ◽  
Renal Cell ◽  
Clinical Stage ◽  
Disease Status ◽  
Patient Characteristics ◽  
Rank Test ◽  
P Value ◽  
Risk Of Death

499 Background: Renal cell carcinoma with sarcomatoid component (sRCC) is characterized by the microscopic spectrum of spindle cells within a background of RCC. The presence of sarcomatoid elements is associated with higher stage of presentation and decreased patient survival. The objective of this study is to examine the clinicopathological characteristics associated with overall survival (OS), specifically examining the percentage of sarcomatoid component (PSC) to stratify risk. Methods: We retrospectively reviewed data for all radical nephrectomy patients with pathologically confirmed sarcomatoid component from 1987−2011. All slides were re−reviewed by a GU pathologist to ascertain PSC. Patient characteristics were tabulated overall and by disease status (metastatic vs. localized). Cutpoints in the percent sarcomatoid providing a meaningful difference in OS were identified by recursive partitioning analysis (RPA) as univariate and combined with patient characteristics. Factors selected included age, gender, race, clinical stage, tumor histology, and treatment. The Kaplan−Meier method and two−sided log−rank test was used to assess differences in OS. Results: Among 186 patients with sRCC, 64 (34%) had localized and 122 (66%) metastatic disease. Patients were primarily white (76%) males (63%) with clear cell histology (73%), and did not receive neoadjuvant or adjuvant therapy (87%). The median follow−up time was 12.1 months (range, 0.1 to 242.2 months). The median OS was 12.6 months (95% confidence interval (CI) 10.7−14.9 months). Two subgroups were identified with a cut−point of 12.5% for PSC after univariate RPA. Patients with PSC ≥ %12.5 were at higher risk of death compared to patients with <%12.5 (45% vs. 61% 1 year OS; p value=0.04). Mutlivariate RPA revealed clinical stage and percent sarcomatoid were significantly associated with OS. Patients with localized disease were most likely to be alive at 1 year (74%). Among patients with metastatic disease with PSC<%42.5 had 1−year OS of 44% vs. 27% for patients with ≥%42.5 cutoff (p<0.001). Conclusions: The PSC appears to be a prognostic factor in the OS of patients with RCC, with larger percentage of involvement portending a worse survival.

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