Prevalence, Classification, and Risk Factors for Postoperative Lower Extremity Lymphedema in Women With Gynecologic Malignancies: A Retrospective Study

2015 ◽  
Vol 25 (4) ◽  
pp. 751-757 ◽  
Author(s):  
Hitoshi Hareyama ◽  
Kenichi Hada ◽  
Kumiko Goto ◽  
Sawako Watanabe ◽  
Minako Hakoyama ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lower Extremity ◽  
Lymph Nodes ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Cancer Type ◽  
Kaplan Meier ◽  
Gynecology And Obstetrics ◽  
Independent Risk Factors ◽  
Stage 1

ObjectiveLower extremity lymphedema (LEL) is a major long-term complication of radical surgery. We aimed to estimate the incidence and grading of LEL in women who underwent lymphadenectomy and to evaluate risk factors associated with LEL.Materials and MethodsWe retrospectively reviewed 358 patients with cervical, endometrial, and ovarian cancer who underwent transabdominal complete systematic pelvic and para-aortic lymphadenectomy between 1997 and 2011. Lower extremity lymphedema was graded according to criteria of the International Society of Lymphology. Incidence of LEL and its correlation with various clinical characteristics were investigated using Kaplan-Meier survival and Cox proportional hazards methods.ResultsOverall incidence of LEL was 21.8% (stage 1, 60%; stage 2, 32%; and stage 3, 8%). Cumulative incidence increased with observation period: 12.9% at 1 year, 20.3% at 5 years, and 25.4% at 10 years. Age, cancer type, stage (International Federation of Gynecology and Obstetrics), body mass index, hysterectomy type, lymphocyst formation, lymph node metastasis, and chemotherapy were not associated with LEL. Multivariate analysis confirmed that removal of circumflex iliac lymph nodes (hazard ratio [HR], 4.28; 95% confidence interval [CI], 2.09–8.77; P < 0.0001), cellulitis (HR, 3.48; 95% CI, 2.03–5.98; P < 0.0001), and number of removed lymph nodes (HR, 0.99; 95% CI, 0.98–0.99; P = 0.038) were independent risk factors for LEL.ConclusionsPostoperative LEL incidence increased over time. The results of the present study showed a significant correlation with removal of circumflex iliac lymph nodes and cellulitis with the incidence of LEL. Multicenter or prospective studies are required to clarify treatment efficacies.

scholarly journals Prevalence, Risk Factors, and Complications of Cholelithiasis in Adults With Short Bowel Syndrome: A Longitudinal Cohort Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Xuejin Gao ◽  
Li Zhang ◽  
Siwen Wang ◽  
Yaqin Xiao ◽  
Deshuai Song ◽  
...  
Keyword(s):  
Risk Factors ◽  
Short Bowel Syndrome ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Clinical Trial Registration ◽  
Short Bowel ◽  
Kaplan Meier ◽  
Clinical Consequences

Background: Patients with short bowel syndrome (SBS) are at a high risk of cholestasis or cholelithiasis. This study aimed to determine the incidence, risk factors, and clinical consequences of cholelithiasis in adults with SBS over an extended period.Methods: All eligible adults diagnosed with SBS and admitted to a tertiary hospital center between January 2010 and December 2019 were retrospectively identified from the hospital records database. Kaplan–Meier analysis was used to estimate the cumulative incidence of SBS during the 10-year period. For assessment the risk factors for cholelithiasis, we used multivariate Cox proportional hazards model with estimation of hazard ratio (HR) with 95% confidence intervals (95 %CI).Results: This study enrolled 345 eligible patients with SBS. Kaplan–Meier analysis revealed that 72 patients (20.9%) developed cholelithiasis during the 10-year observation period. In multivariate analyses using the Cox proportional hazard model revealed that the remnant jejunum (HR = 2.163; 95% confidence interval [CI]: 1.156–4.047, p = 0.016) and parenteral nutrition dependence (HR = 1.783; 95% CI: 1.077–2.952, p = 0.025) were independent risk factors for cholelithiasis in adults with SBS. Twenty-eight patients developed symptoms and/or complications in the cholelithiasis group. Proportions of acute cholecystitis or cholangitis and acute pancreatitis were significantly increased in the cholelithiasis group compared with the non-cholelithiasis group (31.9 vs. 7.7%, p &lt; 0.01; and 6.9 vs. 1.1%, p = 0.003, respectively).Conclusion: Because of the adverse clinical consequences of cholelithiasis, adult patients with SBS should be closely monitored, and preventive interventions should be considered.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT04867538.

scholarly journals Risk Factors and Prognostic Significance of Retropancreatic Lymph Nodes in Gastric Adenocarcinoma

2015 ◽  
Vol 2015 ◽  
pp. 1-7
Author(s):  
Lian Xue ◽  
Xiao-Long Chen ◽  
Wei-Han Zhang ◽  
Kun Yang ◽  
Xin-Zu Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lymph Nodes ◽  
Gastric Adenocarcinoma ◽  
Prognostic Significance ◽  
Metastatic Rate ◽  
Kaplan Meier ◽  
Independent Risk Factors ◽  
Pn Stage ◽  
Lymph Nodes Dissection ◽  
Worse Prognosis

Background. The studies on risk factors and metastatic rate of retropancreatic (number 13) lymph nodes in gastric adenocarcinoma were few and the results were still controversial. The aim of this study was to elucidate risk factors and prognostic significance of number 13 lymph nodes in gastric adenocarcinoma.Method. From January 2000 to December 2011, 114 patients who underwent gastrectomy with number 13 lymph nodes dissection were enrolled and followed up to January 2014. Patients were grouped according to whether number 13 lymph nodes were positive or negative.Results. The metastatic rate of number 13 lymph nodes was 22.8%. In multivariate analysis, pT stage (P=0.027), pN stage (P=0.005), and number 11p (P=0.015) lymph nodes were independent risk factors of positive number 13 lymph nodes. In all patients (P<0.001) and subpopulation with TNM III stage (P=0.007), positive number 13 lymph nodes had significantly worse prognosis than those of patients with negative number 13 LNs in Kaplan-Meier analysis.Conclusion. Number 13 lymph nodes had relatively high metastatic rate and led to poor prognosis. pT stage, pN stage, and number 11p lymph nodes were independent risk factors of positive number 13 lymph nodes.

scholarly journals Risk Factors of Delirium in Sequential Sedation Patients in Intensive Care Units

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Jie Yang ◽  
Yongfang Zhou ◽  
Yan Kang ◽  
Binbin Xu ◽  
Peng Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Sofa Score ◽  
Maintenance Dose ◽  
Proportional Hazards ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Cox Proportional Hazards ◽  
Older Age ◽  
Independent Risk Factors

Background. Delirium is a primary adverse event in ventilated patients who receive long-term monosedative treatment. Sequential sedation may reduce these adverse effects. This study evaluated risk factors for delirium in sequential sedation patients. Methods. A total of 141 patients who underwent sequential sedation were enrolled. Delirium was diagnosed using Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) scale. Univariate and multivariate Cox proportional hazards regressions were used to predict risk factors. Results. Older age (≥51) (RR = 2.432, 95% CL 1.316–4.494, p=0.005), higher SOFA score (≥14) (RR = 2.022, 95% CL 1.076–3.798, p=0.029), regular smoking (RR = 2.366, 95% CL 1.277–4.382, p=0.006), and higher maintenance dose of midazolam (RR = 1.052, 95% CL 1.000–1.107, p=0.049) and fentanyl (RR = 1.045, 95% CL 1.019–1.072, p=0.001) when patients met sequential criteria, were independent risk factors of delirium. Sequential sedation with dexmedetomidine (RR = 0.448, 95% CL 0.209–0.963, p=0.040) was associated with a lower risk of delirium. Conclusions. Older age, higher SOFA score, regular smoking, and higher maintenance dose of midazolam and fentanyl when patients met sequential criteria were independent risk factors of delirium in sequential sedation patients. Sequential sedation with dexmedetomidine reduced risk of delirium.

scholarly journals Risk Factors for Mortality in Chinese Patients on Continuous Ambulatory Peritoneal Dialysis

2015 ◽  
Vol 35 (2) ◽  
pp. 199-205 ◽  
Author(s):  
Fan Zhang ◽  
Hong Liu ◽  
Xiaoli Gong ◽  
Fuyou Liu ◽  
Youming Peng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Patient Survival ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Hazards Model ◽  
Kaplan Meier

ObjectiveThe intent of this study was to evaluate the clinical outcome and risk factors affecting mortality of the continuous ambulatory peritoneal dialysis (CAPD) patients in a single peritoneal dialysis (PD) center over a period of 10 years.Patients and methodsWe retrospectively analyzed patients on PD from June 2001 to June 2011. The clinical and biochemical data were collected from the medical records. Clinical variables included gender, age at the start of PD, smoking status, body mass index (BMI), cause of end-stage renal disease (ESRD), presence of diabetes mellitus and blood pressure. Biochemical variables included hemoglobin, urine volume, residual renal function (RRF), serum albumin, blood urea nitrogen (BUN), creatinine, total cholesterol, triglyceride, comorbidities, and outcomes. Survival curves were made by the Kaplan-Meier method. Univariate and multivariate analyses to identify mortality risk factors were performed using the Cox proportional hazard regression model.ResultsA total of 421 patients were enrolled, 269 of whom were male (63.9%). The mean age at the start of PD was 57.9 ± 14.8 years. Chronic glomerulonephritis was the most common cause of ESRD (39.4%). Estimation of patient survival by Kaplan-Meier was 92.5%, 80.2%, 74.4%, and 55.7% at 1, 3, 5, and 10 years, respectively. Patient survival was associated with age (hazard ratio [HR]: 1.641 [1.027 – 2.622], p = 0.038), cardiovascular disease (HR: 1.731 [1.08 – 2.774], p = 0.023), hypertriglyceridemia (HR: 1.782 [1.11 – 2.858], p = 0.017) in the Cox proportional hazards model analysis. Estimation of technique survival by Kaplan-Meier was 86.7%, 68.8%, 55.7%, and 37.4% at 1, 3, 5, and 10 years, respectively. In the Cox proportional hazards model analysis, age (HR: 1.672 [1.176 – 2.377], p = 0.004) and hypertriglyceridemia (HR: 1.511 [1.050 – 2.174], p = 0.026) predicted technique failure.ConclusionThe PD patients in our center exhibited comparable or even superior patient survival and technical survival rates, compared with reports from other centers in China and other countries.

Risk stratification in earl- stage luminal breast cancer patients treated with and without RT.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 568-568 ◽  
Author(s):  
Charlotta Wadsten ◽  
Pat W. Whitworth ◽  
Rakesh Patel ◽  
Jess Savala ◽  
Fredrik Warnberg ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Proportional Hazards ◽  
Risk Groups ◽  
Tissue Microarrays ◽  
Cox Proportional Hazards ◽  
Luminal Breast Cancer ◽  
Breast Cancer Patients ◽  
Luminal A ◽  
Kaplan Meier ◽  
Stage 1

568 Background: The goal was to develop and validate a biologic signature for 10-year ipsilateral invasive breast event (IBE) risk in luminal Stage 1 breast cancer (BC) patients treated surgically and either with or without radiation therapy (RT). Methods: This cohort was from Uppsala University and Västerås Hospitals diagnosed with Stage 1 BC and treated surgically between 1987 and 2004. Treatment was neither randomized nor strictly rules based, including adjuvant RT, Hormone Therapy (HT), and Chemotherapy (CT). Biomarkers (HER2, PR, Ki67, COX2, p16/INK4A, FOXA1 and SIAH2) were assessed on tissue microarrays in PreludeDx’s CLIA lab by board-certified pathologists. Risk groups were calculated using biomarkers and clinical factors age and size. A multivariate Cox proportional hazards analysis was used to determine hazard ratio for biologic signature. 10-year IBE risk was assessed using Kaplan-Meier survival analysis. Results: There were 423 luminal cases with biomarker data having 54 IBEs, and a median follow-up of 11.8 years. There were 372 patients treated with BCS and 51 with Mastectomy, and 325 received RT, 169 received HT, and 47 received CT. In a multivariate analysis, the biologic signature (HR = 1.6, p = 0.019) and RT (HR = 0.51, p = 0.027) were associated with IBE risk adjusting for other treatments (HT and CT) and Luminal A status (p = 0.37). For patients over 50 yrs of age with luminal A disease and treated without CT (n = 205), an elevated biologic signature identified a subset of patients with a 15% (+/- 14%) 10-year IBE risk without RT (n = 38) compared to a 4% (+/-6%) IBE risk with RT (n = 72), while patients with a low biologic signature had a 10-year IBE risk of 4% (+/- 4%) without RT (n = 26) and 3% (+/-5%) IBE risk with RT (n = 69). Conclusions: With further prospective validation, the biologic signature identified herein may provide a tool enabling improved management for women diagnosed with early luminal BC.

scholarly journals Faktor risiko loss to follow up terapi ARV pada pasien HIV

2017 ◽  
Vol 33 (4) ◽  
pp. 173
Author(s):  
Listy Handayani ◽  
Riris Andono Ahmad ◽  
Yanri Wijayanti Subronto
Keyword(s):  
Risk Factors ◽  
Health Insurance ◽  
Antiretroviral Therapy ◽  
Protective Factor ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Loss To Follow Up ◽  
Kaplan Meier ◽  
Adherence Counseling

Risk factors for loss to follow up of antiretroviral therapy in HIV patientsPurposeThis study aimed to determine risk factors for loss to follow-up of antiretroviral therapy among HIV-infected patients in Dr. Sardjito Yogyakarta, 2011-2014.MethodsA retrospective cohort study was conducted involving 499 HIV patients. Observations were conducted for four years using medical records. Data analysis was performed using Kaplan-Meier and Cox proportional hazards regression tests.ResultsThere were 190 loss to follow-up patients. Risk factors for loss to follow-up of ARV therapy were: a student (AHR = 2.42; 95% CI = 1.20-4.89), the distance ≥ 10 km (AHR = 1.58; 95% CI = 1:09 to 2:31), using health insurance (AHR = 1.67; 95% CI = 1:11 to 2:51) and homosexual as a protective factor of loss to follow-up of antiretroviral therapy (HR = 0:49; 95% CI = 0.30-0.80).ConclusionBeing a college student, the distance between home and ARV service ≥10 km and using health insurance were the risk factors for loss to follow-up of ARV treatment. Adherence counseling for students, cooperation with the drug taking supervisor and decentralization ARV service, as well as effective and efficient services for patients who use health insurance need to be strengthened.

Single institutional analysis of pancreatic cancer survival trends based on BMI.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 234-234
Author(s):  
Jeff Wiisanen ◽  
Robert R. McWilliams ◽  
William R Bamlet
Keyword(s):  
Pancreatic Cancer ◽  
Detrimental Effect ◽  
Cancer Survival ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Proportional Hazards Regression ◽  
Kaplan Meier ◽  
Time Period ◽  
Association Table ◽  
Stage 1

234 Background: Body mass index (BMI) has been reported to determine risk for pancreatic cancer in addition to outcome, as those with higher BMI have decreased survival. Since May 2011, therapy for pancreatic cancer has improved with the addition of FOLFIRINOX. This study looks at overall survival in relation to BMI since the advent of the FOLFIRINOX. Methods: 2,277 patients with pancreatic adenocarcinoma were identified through the Mayo Clinic SPORE pancreatic cancer registry from 2000-14. Usual adult and BMI at time of enrollment were utilized as a binary variable ( < 30, ≥30 kg/m2). These were analyzed for association with survival using Kaplan-Meier curves and Cox proportional hazards regression. Results: For the 2000-11 and 2011-14 groups, stage distribution was 4.4%, 34.7%, 21.6%, 39.2% and 1.2%, 39%, 22.2%, 37.6%, respectively for stage 1-4. Since pancreatic cancer commonly causes weight loss, more patients were in the higher usual adult BMI (34.6%) compared to enrollment (17.1%). For the period 2000-11, 33.8% of patients had a usual adult BMI of 30+ vs 37.8% for the 2011-14 patients. As previously reported, there was a difference in survival by BMI for the period 2000-May 2011, however, this was not seen for the period June 2011-14. Conclusions: Based on this cohort of patients, the previously reported detrimental effect of elevated BMI on survival in pancreatic cancer patients is no longer seen. This corresponds with the time period of improvement in pancreatic cancer treatment with FOLFIRINOX. Further studies should be performed to confirm our findings and to identify the causality of this association. [Table: see text]

scholarly journals Efficacy Analysis of Multidisciplinary Treatment for Wilm’s Tumor in Single Center

2022 ◽  
Author(s):  
Bing Yan ◽  
Fengming Ji ◽  
Chengchuang Wu ◽  
Ye Li ◽  
Haoyu Tang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Multidisciplinary Treatment ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Histological Type ◽  
Factors Affecting ◽  
Hazards Model ◽  
Kaplan Meier

Abstract Objective: To analyze the efficacy of multidisciplinary treatment (MDT) for Wilm’s tumor (WT) in Kunming Children’s Hospital, and investigate the risk factors affecting the prognosis of WT.Method: The clinic-pathological data were collected and analyzed in patients with unilateral WT treated in Kunming Children's Hospital from January 2017 to July 2021. Research objects were selected according to inclusion criteria and exclusion criteria. The risk factors and independent risk factors that affect the prognosis of patients with WT were determined by Kaplan-Meier survival analysis and Cox proportional hazards model, respectively. Outcome: A total of 68 children were included in this study, and the 5-year overall survival (OS) rate was 92.65%. Kaplan-Meier survival analysis results showed that ethnicity (P=0.020), the tumor volume of resection (P=0.001), histological type (P<0.001), and postoperative recurrence (P<0.001) were the factors affecting the prognosis of children with WT. The results of the Cox proportional hazards model showed that only the histological type (P=0.028) was the independent risk factor for the prognosis of WT.Conclusion: The efficacy of MDT for WT was satisfying. The histological type has important predictive value for the prognosis of WT, and the patient with unfavorable histology has a poor prognosis.

scholarly journals Contribution of hypertension and other risk factors to survival and mortality in the Russian population

2021 ◽  
Vol 20 (5) ◽  
pp. 3003
Author(s):  
Yu. A. Balanova ◽  
S. A. Shalnova ◽  
V. A. Kutsenko ◽  
A. E. Imaeva ◽  
A. V. Kapustina ◽  
...  
Keyword(s):  
Risk Factors ◽  
Survival Rate ◽  
Proportional Hazards ◽  
Antihypertensive Drugs ◽  
Antihypertensive Agents ◽  
Cox Proportional Hazards ◽  
Russian Population ◽  
Medical Community ◽  
Men And Women ◽  
Kaplan Meier

Aim. To study the contribution of hypertension (HTN) to survival and mortality in the Russian population.Material and methods. This prospective observational cohort included representative samples from 11 Russian regions (men and women aged 25-64 years, n=18251) examined in 2012-2014 as part of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study. The examination included a questionnaire (12 modules), anthropometric and blood pressure (BP) measurements, as well as biochemical blood tests. HTN was considered aa a systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg, or when a subject receives antihypertensives. Treatment efficacy was considered as the proportion of persons (%) who achieved target BP among those taking antihypertensives. Depending on HTN status, all participants were divided into 4 groups: 1) those without HTN;2)        those with HTN, taking antihypertensive agents and having systolic BP ≤140 mm H. and diastolic BP ≤90 mm Hg (effective therapy);3)        those with HTN, taking medications, but not achieving target BP (ineffective therapy); 4) those with HTN, not taking antihypertensives. The life status of participants was updated every 2 years. Kaplan-Meier survival curves, as well as univariate and multivariate Cox proportional hazards models were created.Results. The presence of HTN significantly reduced survival (p<0,001) in the cohort, which is significant when adjusted for age (men — relative risk (RR)=1,47, p<0,001, women — RR=1,17, p<0,001). In the multivariate model, the male sex (RR=2,3 p<0,001), age increase, smoking, tachycardia, and HTN are significant for all-cause mortality only for men, but not for women. However, for women, absence of higher education was significant. The presence of HTN significantly worsens cardiovascular survival in both sexes (p<0,0001). HTN increases the risk of a composite endpoint for both men and women (p<0,001). Analysis of Kaplan-Meier curves showed the worst survival rate in persons with HTN, taking antihypertensive drugs, but not reaching target BP levels.Conclusion. The presence of HTN significantly worsens the survival rate of men and women. Special attention of medical community should be directed to increasing the proportion of effectively treated patients with HTN.

Abstract 16415: Racial Differences in Incidence of Atrial Fibrillation After Cryptogenic Stroke

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
David B Laslett ◽  
Abdullah Haddad ◽  
Dianna Gaballa ◽  
Hardik Mangrolia ◽  
Olivia Follis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Racial Differences ◽  
Cumulative Incidence ◽  
Proportional Hazards ◽  
Current Knowledge ◽  
Cryptogenic Stroke ◽  
Cox Proportional Hazards ◽  
Kaplan Meier ◽  
Artery Disease

Introduction: The incidence of atrial fibrillation (AF) is lower among non-whites compared to whites, despite a higher burden of AF risk factors. Current knowledge of first detection of AF after cryptogenic stroke (CS) by an implantable cardiac monitor (ICM) is based on a predominantly white cohort. The incidence of new AF after CS among minorities is unknown. We hypothesized that the incidence of AF after CS would be lower in non-whites. Methods: We reviewed charts of all patients without a history of AF undergoing implantation of an ICM after CS at our hospital from July 2014 to December 2019. Incidence of AF was identified through review of ICM monitoring for each patient, including adjudication of AF episodes for accuracy. Kaplan Meier survival analysis was performed, and cumulative incidence of AF using adjusted Cox proportional hazards regression was compared by race. Results: We identified 417 patients who underwent ICM implant after CS during the study period, with a mean follow-up time of 1.5 ± 1.1 years. Mean age was 62 ± 12 years, and 46% (n=190) were male. The majority of patients were non-white (white, 15%, n=63; black, 59%, n=244; Hispanic, 26%, n=110). At baseline, blacks, Hispanics, and whites were of similar age (mean 62.2, 62.1, and 61.5 years, respectively), and blacks and Hispanics had more AF risk factors, including heart failure, hypertension, diabetes, chronic kidney disease, and higher BMI, than whites. Hispanics had more coronary artery disease than whites and blacks (25.5%, 17.5%, 9.1% respectively, p < 0.001). Among blacks, the cumulative incidence of newly detected AF at one, two, and three years was 13.0%, 18.9%, and 23%, which was similar to Hispanics (12.9%, 18.2%, and 20.9%). By comparison, the incidence in whites was significantly higher (20.8%, 34.3%, 40.3%; blacks p=0.02; Hispanics p=0.01) Conclusion: In patients undergoing ICM after CS, the incidence of newly detected AF is approximately double in whites compared to both blacks and Hispanics.

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