Comparison of Catheter-related Infection and Tip Colonization between Internal Jugular and Subclavian Central Venous Catheters in Surgical Neonates

Background The primary aim of this study was to compare catheter-associated infections and tip contaminations between percutaneously placed central venous catheters in the internal jugular and subclavian veins in surgical neonates undergoing major noncardiac surgery. Methods The prospectively computerized protocols of 295 procedures were analyzed retrospectively. Results One hundred twenty-nine internal jugular venous (group I) and 107 subclavian venous catheters (group S) were included. The median postconceptual age was 37 weeks in group I and 38 in group S. The weight ranged from 580 g to 4.5 kg in group I and from 820 g to 4.5 kg in group S at the time of insertion. Significantly more catheter-associated infections were observed in group I (15.5 vs. 4.7%; chi-square analysis: P < 0.01). The internal jugular venous catheters were also associated with a significantly increased probability of an earlier onset of a catheter-associated infection compared with the subclavian venous catheters (log rank test: P < 0.01; Cox model: P < 0.01). This probability was only slightly increased by a lower weight (Cox model: P = 0.075), and it was not increased by a lower age (Cox model: P = 0.93). Significantly more catheter tips were contaminated by pathogens in group I (55.8 vs. 33.6%; chi-square analysis: P < 0.01). Conclusion The internal jugular venous catheters were associated with a higher infection rate as well as earlier onset of catheter-associated infection compared with the subclavian venous catheters.

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Effectiveness of the Bactiseal Universal Shunt for reducing shunt infection in a sub-Saharan African context: a retrospective cohort study in 160 Ugandan children

Journal of Neurosurgery Pediatrics ◽

10.3171/2013.11.peds13394 ◽

2014 ◽

Vol 13 (2) ◽

pp. 140-144 ◽

Cited By ~ 19

Author(s):

Jordan D. Lane ◽

John Mugamba ◽

Peter Ssenyonga ◽

Benjamin C. Warf

Keyword(s):

Cohort Study ◽

Low Income ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Shunt Infection ◽

Low Income Countries ◽

Rank Test ◽

Log Rank Test ◽

Significant Difference ◽

Chi Square Analysis

Object Antibiotic-impregnated shunts have yet to find widespread use in the developing world, largely due to cost. Given potential differences in the microbial spectrum, their effectiveness in preventing shunt infection for populations in low-income countries may differ and has not been demonstrated. This study is the first to compare the efficacy of a Bactiseal shunt system with a non–antibiotic-impregnated system in a developing country. Methods The Bactiseal Universal Shunt (BUS) was placed in 80 consecutive Ugandan children who required a shunt. In this retrospective cohort study, the outcome for that group was compared with the outcome for the immediately preceding 80 consecutive children in whom a Chhabra shunt had been placed. The primary end points were shunt failure, shunt infection, and death. Shunt survival was analyzed using the Kaplan-Meier method. Significance of differences between groups was tested using the log-rank test, chi-square analysis, Fisher's exact test, and t-test. Results There was no difference between groups in regard to age, sex, or etiology of hydrocephalus. Mean follow-up for cases of nonfailure was 7.6 months (median 7.8 months, interquartile range 6.5–9.5 months). There was no significant difference between groups for any end point. The BUS group had fewer infections (4 vs 11), but the difference was not significant (p = 0.086, log-rank test). Gram-positive cocci were the most common culturable pathogens in the Chhabra group, while the only positive culture in the BUS group was a gram-negative rod. Conclusions These results provide equipoise for a randomized controlled trial in the same population and this has been initiated. It is possible that the observed trends may become significant in a larger study. The more complex task will involve determining not only the efficacy, but also the cost-effectiveness of using antibiotic-impregnated shunt components in limited-resource settings.

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The relationship of the prolonged PR interval with the long-term survival in patients with heart failure undergoing cardiac resynchronization therapy

Russian Journal of Cardiology ◽

10.15829/1560-4071-2020-1-3348 ◽

2020 ◽

Vol 25 (1) ◽

pp. 33-38

Author(s):

A. M. Soldatova ◽

V. A. Kuznetsov ◽

T. P. Gizatulina ◽

L. M. Malishevsky ◽

S. M. Dyachkov

Keyword(s):

Cardiac Resynchronization ◽

Rank Test ◽

Term Survival ◽

Log Rank Test ◽

Group I ◽

Pr Interval ◽

Qrs Duration ◽

Group Ii ◽

The Relationship

Aim. To assess the relationship between the prolonged PR interval (≥200 ms) and the long-term survival of patients undergoing cardiac resynchronization therapy (CRT).Material and methods. A total of 85 patients (mean age — 55,1Ѓ}9,9 years; men — 81,2%) with NYHA class II-IV heart failure (HF) were examined. The mean follow-up was 34,0Ѓ}21,2 months. Patients with PR<200 ms (n=52) made up group I, with PR≥200 ms (n=33) — group II. Then the patients were divided into subgroups depending on the QRS duration: ≥150 ms (n=33 in group I and n=14 in group II, respectively) <150 ms (n=19 in group I and n=19 in group II, respectively).Results. In patients of group II, a history of myocardial infarction (MI) was more often registered (p=0,005), left ventricular ejection fraction (LVEF) was lower (p=0,032). In a multivariate analysis, MI (OR 3,217; CI 95% 1,188-8,712; p=0,022) and LVEF value (OR 0,869; CI 95% 0,780-0,968; p=0,011) had a significant relationship with the PR interval prolongation (≥200 ms). The survival of patients of group I was 59,6%, group II — 18,2% (Log-rank test p<0,001). According to Cox regression model, the initial left ventricle end-systolic volume (OR 1,012; 95% CI 1,006-1,017; p<0,001), inferior wall MI (OR 1,690; 95% CI 1,131-2,527; p=0,011) and PR interval ≥200 ms (OR 2,179; 95% CI 1,213–3,915; p=0,009) were associated with long-term mortality. In patients with PR≥200 ms, survival rate was low, regardless of the QRS duration (21,4% in patients with QRS≥150 ms, 15,8% in patients with QRS<150 ms; Log-rank test p=0,698) In patients with PR<200 ms, the survival rate of patients with QRS≥150 ms was 72,7%, and for patients with QRS<150 ms — 36,8% (Log-rank test p=0,031).Conclusion. In HF patients, PR interval prolongation (≥200 ms) is associated with long-term mortality increase. The highest survival rates were observed in patients with PR<200 ms and QRS≥150 ms. In patients with QRS≥150 ms, the presence of PR≥200 ms should be considered as an additional criterion for CRT.

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Expression of Epstein-Barr Virus in Cell of Classical Hodgkin's Lymphoma Tumor

Blood ◽

10.1182/blood.v128.22.5358.5358 ◽

2016 ◽

Vol 128 (22) ◽

pp. 5358-5358

Author(s):

Abrahão Elias Hallack Neto ◽

Graziela Toledo Costa Mayrink ◽

Luciano J. Costa ◽

Kelli Borges dos Santos

Keyword(s):

Prognostic Factors ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Rank Test ◽

Chi Square ◽

Histologic Subtype ◽

Free Survival ◽

Barr Virus ◽

Log Rank Test ◽

Epstein Barr

Abstract Introduction: The association between classical Hodgkin's Lymphoma (cHL) and tumor Epstein-Barr virus (EBV) status is well established. However, the presence of EBV within Hodgkin/Reed-Sternberg (HRS) cells and its prognosis remains controversial, with conflicting findings from studies of various regions of the world. It is considered essential to deepen the understanding of the pathogenic role of EBV in cHL and its impact in prognosis. Methods: We assessed the correlation between EBV presence in HRS and outcomes in a cohort of Brazilian patients with cHL. EBV positivity was determined by in situ hybridization (ISH) for EBV-encoded RNA (EBER) and immunohistochemistry (IMH) for viral latent membrane protein (LMP-1). All cases were histologically confirmed by an expert hematopathologist who also performed the assays for EBV identification. We examined the prognostic impact of EBV status in 29 patients with cHL. The prognostic factors by IPS (International Prognostic Score) for patients with advanced stage and the risk factors by GHSG (German Hodgkin Study Group) for patients with limited stage were correlated with EBV status tumor cells. For associations between the presence of EBV and other categorical variables, we applied Chi-square or Fisher's exact tests. For describe the effect size (ES) measures for chi-square, we used Cramér's V (V) and odds ratios (OR) with the respective 95% Confidence Intervals (CIs). To evaluate the correlation between all methods of identification of EBV status and among evaluators in histological classification, we applied the Kappa test (K), which measures the degree of agreement these assessments. Differences in OS (overall survival) and EFS (event-free survival) Kaplan-Meier survival curves between EBV-positive and EBV-negative patients were compared statistically using the log-rank test. To evaluate the impact of EBV status on event-free survival controlling for prognostic factors and unfavorable risks, we applied Cox proportional hazards regression to determine hazards ratios (HR) and associated the respective 95% CIs. Multivariate analyses included variables significant at p ≤ 0.15 in univariate models. Results: The mean age at diagnosis was 33 years. Sixty-five percent of the patients had the Nodular Sclerosis histologic subtype and 62,1% had Ann Arbor stage I or II disease at diagnosis. According to GHSG, 88,3% of early-stage patients were classified with unfavorable risk (at least one risk factor) at diagnosis. Compared to advanced-stage patients, 81,9% were considered with favorable IPS (< 4 prognostic factors) at diagnosis. HRS cells were EBV-positive in 37.9% of cases. EBV-positive cHL cases were more frequent in patients ≥ 45 years (71,4% vs. 27,3%, p =0,07). Mixed cellularity (MC) histology subtype was more common in EBV-related tumor cells (p= 0,02) and its effect-size index was medium. The correlation between all methods of identification of EBV status was 96,5% (p< 0,001; K=0.93). The correlation among evaluators in histological classification was 89,6% (p< 0,001; K=0.79). In univariate analysis, age, stage, histologic subtype, nodal involvement, extranodal disease, sex, bulky disease, laboratory data were not associated with adverse EFS (p>0,05). EBV-positive HL seemed to have better EFS than EBV-negative HL (log-rank test, p = 0,07). Cox proportional hazards model confirmed that EBV-positive tumor status and prognosis factors did not impact HL outcome. Conclusions: Despite EBV status in HRS cells not being associated with adverse prognostic factors and not influencing the overall and event-free survivals, the presence of EBV was linked to MC subtype, showing possible implication in histological subtype and worse prognosis. Disclosures Costa: Sanofi: Honoraria, Research Funding.

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Hormone replacement therapy (HRT) and risk of distant recurrence in newly diagnosed ER+, node-negative (N-) breast-cancer (BC) patients: A retrospective population-based matched-cohort study.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.6591 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 6591-6591

Author(s):

Ariel Hammerman ◽

Ilan Feldhamer ◽

Sari Greenberg-Dotan ◽

Nicky Liebermann ◽

Rinat Yerushalmi

Keyword(s):

Breast Cancer ◽

High Risk ◽

Distant Recurrence ◽

Rank Test ◽

Matched Cohort ◽

Newly Diagnosed ◽

Chi Square ◽

Log Rank Test ◽

Chi Square Test ◽

Risk Patients

6591 Background: Observational studies have shown an increased risk of BC with use of HRT. However, data on the prognosis of BC that develop in HRT users are inconsistent. The association between HRT use and results of the 21-gene Recurrence Score (RS) assay (Oncotype DX, Genomic Health Inc.) has not been investigated. We aimed to analyze this association, and examine the actual rate of distant recurrence or death in this population. Methods: Clalit Health Services (CHS) is the largest health maintenance organization (HMO) in Israel. We identified all CHS newly diagnosed ER+, N- breast-cancer patients, aged 45-60 that performed a RS assay between 01/2006-12/2012 and that were treated for at least three months with HRT during the eight years before BC diagnosis. A 1:4 matched-cohort analysis was performed, with matching made according to age and year of BC diagnosis. Clinical and demographic data were extracted from the CHS centralized registry for all patients. RS assay scores was grouped according to the TAILORX categorization and distribution was compared using Chi-square test. Kaplan-Meier analysis with log-rank test was performed in order to compare time to a combined outcome of distant-recurrence and mortality. Results: A cohort of 259 HRT-treated patients was identified and matched with 1001 controls, not treated with HRT. The proportions of low-risk patients (RS 0-25) and high-risk patients (RS 26-100) were 76.8% and 23.2%, respectively, within HRT-treated patients, and 80.4% and 19.6% within controls. Chi square test was not found significant (χ2= 1.634, p = 0.201). The mean follow-up time was 148.4 months for the cases and 146.9 months for controls, with log-rank test not showing a significant difference between groups. Conclusions: These data did not show significant association between HRT use and higher RS assay scores, and also did not find an association between HRT use and actual distant recurrence or death. Although the proportion of patients with high risk RS appeared to be slightly higher within HRT treated patients, this difference had not reached significance and further studies are required.

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The alarming rise in gastric and colorectal cancers in young adult patients: Analysis of large databases.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.805 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 805-805

Author(s):

Amir Ali Khan ◽

Philip HG Ituarte ◽

Isaac Benjamin Paz ◽

Ajay Goel ◽

Lily L. Lai ◽

...

Keyword(s):

Young Adults ◽

Older Patients ◽

Health Planning ◽

Rank Test ◽

Chi Square ◽

Gastrointestinal Malignancies ◽

Investigation Methods ◽

Development Data ◽

Chi Square Analysis ◽

Histopathologic Features

805 Background: The alarming rise in the incidence of gastric (GC) and colorectal (CRC) adenocarcinomas in young adults (YA) over the past three decades is not well understood. How YA populations differ from older patients with the same gastrointestinal malignancies warrants further investigation. Methods: We retrospectively analyzed the California Cancer Registry and the Office of Statewide Health Planning and Development data for all GC and CRC cases from 2000 to 2012. Pearson’s Chi-square analysis was used to analyze differences in demographic, clinical and histopathologic features and log-rank test to compare survival between young (≤ 40 years old) and older adults (40-90 years old) with GC or CRC. Results: Of the GC (n = 19,368) and CRC (n = 117,415) patients included in the study, YA accounted for 4.5% (n = 883) of GC and 3.2% (n = 3723) of CRC. Hispanic ethnicity was more common in YA for both cancers compared to older patients (50.9% vs 26.8% GC, 29.6% vs. 15.7% CRC, p < 0.0001). YA were more likely to have poorly differentiated (74.6% vs. 59.8% GC, 22.5% vs 17.5% CRC, p < 0.0001), higher grade (77.0% vs 61.6% GC, 23.9% vs 18.6 CRC, p < 0.0001), and signet ring features (44.6% vs 21.0% GC, 3.2% vs 1.1% CRC, p < 0.0001) compared to older patients. Synchronous peritoneal metastases were more common in YA compared to older patients (32.1% vs. 14.1% GC, 8.8% vs 5.4% CRC, p < 0.0001). YA with GC or CRC had a greater 5-year survival compared with older patients with the same stage of malignancy. Subgroup analysis of Stage I GC demonstrated lower survival in YA compared with adults aged 41-49 and 50-64 years (65.1% vs. 70.7% and 69.1%, 95% CI 49.7-76.9%, 62.5-77.3%, 65.2-72.7% respectively). Conclusions: GC and CRC in young adults have distinctly worse clinical and histopathologic features compared to older patients with the same malignancy. Ethnic disparity exists in the YA patients. This study contributes to improving the understanding of younger versus older GI cancer patients.

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MicroRNA-124 alone might represent an indicator signifying cholangiocarcinoma prognosis

10.21203/rs.3.rs-33111/v1 ◽

2020 ◽

Author(s):

Ning Wang ◽

Yanni Li ◽

Yanfang Zheng ◽

Huoming Chen ◽

Xiaolong Wen ◽

...

Keyword(s):

Overall Survival ◽

Cox Regression ◽

Prognostic Biomarker ◽

Prognostic Indicator ◽

Rank Test ◽

Chi Square ◽

Log Rank Test ◽

Kaplan Meier ◽

Chi Square Test ◽

Polymerase Chain

Abstract Background: Previous studies have demonstrated that microRNAs (miRNAs) played a crucial role in various diseases, including cancers. The aim of the study was to evaluate the clinical significance of miR-124 in patients with cholangiocarcinoma (CCA).Methods: The expression pattern of miR-124 was detected in CCA tissues using quantitative reserve transcription polymerase chain reaction (qRT-PCR). The correlation of miR-124 expression with clinicopathological features and overall survival of patients were explored using chi-square test, Kaplan-Meier methods and Cox regression analyses.Results: The miR-124 expression level was strong down-regulated in CCA tissues compared with normal para-cancerous tissues (P<0.001). Moreover, aberrant miR-124 expression was significantly associated with differentiation (P=0.045) and lymph node metastasis (P=0.040). In addition, Kaplan-Meier method and log-rank test revealed that patients with low miR-124 expression has a poorer overall survival compared with those with high miR-124 expression (P=0.002). Furthermore, multivariate analysis confirmed that miR-124 expression (P=0.006; HR=2.006; 95%CI: 1.224-3.289) was an independent prognostic indicator in CCA.Conclusions: Collectively, our results defined miR-124 expression plays important roles in CCA patients. MiR-124 expression might used as a valuable prognostic biomarker for patients with CCA.

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Prognostic value of CD34 expression status in patients with myxofibrosarcomas and undifferentiated pleomorphic sarcomas

Scientific Reports ◽

10.1038/s41598-021-94834-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yoshiya Sugiura ◽

Rikuo Machinami ◽

Seiichi Matsumoto ◽

Hiroaki Kanda ◽

Keisuke Ae ◽

...

Keyword(s):

Overall Survival ◽

Prognostic Factor ◽

Confidence Interval ◽

Prognostic Value ◽

Cox Model ◽

Hazard Ratio ◽

Rank Test ◽

Log Rank Test ◽

Cd34 Expression ◽

Expression Status

AbstractIt is controversial whether patients with myxofibrosarcomas (MFSs) have better prognoses than those with undifferentiated pleomorphic sarcomas (UPSs). No useful prognostic factors have been established to date. We therefore aimed to evaluate the prognostic value of CD34 expression status in 192 patients with MFSs and UPSs. Using the log-rank test, we showed that patients with MFSs had a significantly better overall survival than did those with UPSs when defining the former as having a > 10% myxoid component (p = 0.03), but not when defining it as having a > 50% myxoid component (p = 0.1). Under the definition of MFSs as > 10% myxoid component, the log-rank test revealed that the diagnosis of the UPS and the CD34 loss (p < 0.001) were significant adverse predictors of overall survival. As per the Cox model, the CD34 loss remained an independent prognostic factor (hazard ratio = 3.327; 95% confidence interval 1.334–8.295), while the diagnosis of the UPS was a nonsignificant confounding factor (hazard ratio = 1.084; 95% confidence interval 0.679–1.727). In conclusion, CD34 expression status is a useful prognostic factor in patients with MFS and UPS, and it should be incorporated into grading systems that are used to predict outcomes.

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Transcriptomic Analysis Identified two Subtypes of Brain Tumor Characterized by Distinct Immune Infiltration and Prognosis

10.21203/rs.3.rs-630718/v1 ◽

2021 ◽

Author(s):

Xilin Shen ◽

Hongru Shen ◽

Mengyao Feng ◽

Dan Wu ◽

Yichen Yang ◽

...

Keyword(s):

Brain Tumor ◽

Clinical Decision Making ◽

Cox Regression ◽

Cox Model ◽

Gene Set Enrichment Analysis ◽

Rank Test ◽

Cancer Type ◽

Immune Infiltration ◽

Therapeutic Benefits ◽

Log Rank Test

Abstract Background Brain tumor ranks the most devastating cancer type. The complex tumor immune microenvironment prevents brain tumor from therapeutic benefits. The purpose of this study was to stratify brain tumors based on their distinct immune infiltration signatures to facilitate better clinical decision making and prognosis prediction.Methods We developed a deep learning model to characterize immune infiltration from transcriptome. The developed model was applied to distill expression signatures of transcriptome of brain tumor samples. We performed molecular subtyping with the extracted expression signatures to unveil brain tumor subtypes. Computational methods including gene set enrichment analysis, Kaplan-Meier survival and multivariate Cox regression analyses were employed.Results We identified two distinctive subtypes (i.e. C1/2) of brain tumor featured by distinct immune infiltration signatures. The C1 subtype is characterized by protective immune infiltration signatures, including high infiltration of CD8+ T cells and activation of CX3CL1. The C2 subtype has an extensive infiltration of tumor-associated macrophages and microglia, and was enriched with immune suppressive, wound healing and angiogenic signatures. The C1 subtype had significantly better prognosis as compared with C2 (Log-rank test, HR: 2.5, 95% CI: 2.2 – 2.7; P = 8.2e-78). This difference remained statistically significant (multivariate Cox model, HR: 2.2, 95% CI: 1.7 – 2.9; P = 3.7e-10) by taking into account age, gender, recurrent/secondary status at sampling time, tumor grade, histology, radio-chemotherapy, IDH mutation, MGMT methylation and co-deletion of 1p and 19q. This finding was validated in 6 datasets. The C2 subtype of glioblastoma patients with IDH mutation has poor survival analogous to those without IDH mutation (Log-rank test, adjusted P = 0.8), while C1 has favorable prognosis as compared with glioblastoma of C2 subtype with IDH mutation (Log-rank test, adjusted P = 1.2e-3) or without IDH mutation (Log-rank test, adjusted P = 1.3e-6).Conclusions We identified two distinctive subtypes of brain tumor with different immune infiltration signatures and prognosis. Our finding is helpful for better understanding of brain tumor and has potential clinical utilities.

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Updated result on the 2.5-year follow-up of GC0301/TOP-002: Randomized phase III study of irinotecan plus S-1 (IRI-S) versus S-1 alone as first-line treatment for advanced gastric cancer (AGC)

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.4544 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 4544-4544

Author(s):

A. Tsuburaya ◽

H. Narahara ◽

H. Imamura ◽

K. Hatake ◽

H. Imamoto ◽

...

Keyword(s):

Gastric Cancer ◽

Clinical Benefit ◽

Phase Iii ◽

Rank Test ◽

Diffuse Type ◽

Chi Square ◽

Log Rank Test ◽

Chi Square Test ◽

Significant Superiority

4544 Background: IRI-S had longer in median survival time (MST) than S-1 alone, and was well tolerated in previously untreated AGC, but not statistically significant. Considering 68 patients (pts) were censored, further follow-up was needed to confirm the OS with more precision (Imamura et al. ASCO-GI 2008). We now present updated results of OS and exploratory analysis with the prolonged 2.5 year follow-up data. Methods: Treatments Arm A (oral S-1 80 mg/m2/day from Day 1 to 28, q6w), or Arm B (IRI-S; oral S-1 80 mg/m2/day from Day 1 to 21 and intravenous irinotecan 80 mg/m2 on Days 1 and 15, q5w) were continued until disease progression or unacceptable toxicities were observed. The primary endpoint was to compare OS between groups. This updated result was regarded as exploratory position. Results: Although the MST of Arm A was 319 days (95%Cl: 286–395) and of Arm B was 389 days (95%Cl: 324–459), Arm B didn’t show statistically significant superiority to Arm A (log-rank test p=0.54; hazard ratio (HR) =0.93). The 1-year survival was 45.0% in Arm A and 52.0% in Arm B, and the 2-year survival was 22.5% and 18.0%, respectively. Response rate was significantly different (Arm A/B, 26.9%/41.5%; chi-square test p=0.04) in 187 patient evaluated by RECIST criteria. Time to treatment failure was also favored in Arm B (median=138 days) compared to Arm A (111 days; log-rank test p=0.16; HR=0.85). In subset analyses, two groups showed possibility of clinical benefit in Arm B. The HR of diffuse type group was 0.71 (95%Cl: 0.52–0.96), and of PS1, 2 group was 0.63 (95%Cl: 0.42–0.95). As post protocol treatment, 45.6% of Arm A patients received an irinotecan-based regimen, and the MST of them was 496 days (95%Cl: 395–573). Conclusions: IRI-S did not show statistically significant superiority to S-1 alone in OS with this follow-up data. Post protocol treatment, effective treatment after S-1 failure might have affected survival. According to exploratory analyses, IRI-S may have clinical benefit in early-term of treatment, group of the diffuse type and that of PS1, 2. We need more considering predictive factors, because the gastric cancer is heterogeneous adenocarcinoma. [Table: see text]

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Pathologic response, KRAS status, and bevacizumab: The Bermuda triangle for outcome prediction after hepatic colorectal cancer metastases (HCRM) resection.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e14716 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e14716-e14716

Author(s):

Giuseppe Fanetti ◽

Pamela Biondani ◽

Anna Tessari ◽

Flavia Melotti ◽

Massimo Milione ◽

...

Keyword(s):

Tumor Regression ◽

Cox Model ◽

Neoadjuvant Treatment ◽

Pathological Response ◽

Rank Test ◽

Tumor Regression Grade ◽

Wild Type ◽

Chi Square ◽

Metastatic Setting ◽

Chi Square Test

e14716 Background: Clinicopathologic factors are insufficient to stratify prognosis after HCRM resection. The identification of prognostic biomarkers is an unmet clinical need. Even if the prognostic role of KRAS mutations in the metastatic setting is controversial, recent data hypothesized a correlation to worse outcome after HCRM resections. This analysis evaluated the correlation between KRAS mutation, pathological response and outcome. Methods: Fifty-eight pts with HCRM were resected at National Cancer Institute of Milan from 2007 to 2012 following bevacizumab (Bev) (n=30) or cetuximab (Cmab) (n=28) based neoadjuvant regimens. Tumor regression grade (TRG) was classified from TRG 1 for pathological complete response (pCR), to TRG5 for no response; TRG 1-3 for response; TRG 4-5 for scarce/no response. KRAS exons 2 to 4 were sequenced by direct PCR. Results: KRAS missing in 3 pts (1 Bev/2 Cmab), mutated in 23 (42%) vs wild-type in 32 (58%), mutated in 18 (62%) of Bev group vs 5 (19%) of Cmab. Mean TRG: 2.9 (2.2-4) in Bev vs 3.8 (3-5) in Cmab group (p=0.04 at Kruskal-Wallis test). Pathological response higher for Bev vs Cmab (70% vs 39%; p=0.037 at Chi-square test). Bev also increased pCRs (20% vs 0%, p=0.024 at Fisher’s test). Pathological response higher for KRAS mutant vs wild-type (70% vs 41%; p=0.003 at Chi-square test). At log-rank test, DFS significantly shorter for KRAS mutated vs wild-type (7.6 vs 14.6 months; p=0.05), and for TRG4-5 vs TRG1-3 (8.1 vs 15.3 months; p=0.02), while no difference observed according to treatment. OS data are not mature. Multivariable Cox model for DFS shown in the Table. Conclusions: After Bev-based neoadjuvant treatment, patients with KRAS mutated HCRM and without good pathological response may have the worst outcome after curative resection. [Table: see text]

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