Abstract 14746: A National Level Analysis of Long-term Outcomes in Patients With Carotid Body Tumors

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Edgar Aranda-Michel ◽  
Ibrahim Sultan ◽  
James Brown ◽  
Valentino Bianco ◽  
Andreas Habertheuer ◽  
...  
Keyword(s):  
Overall Survival ◽  
Carotid Body ◽  
Survival Benefit ◽  
Multimodal Therapy ◽  
Multivariable Analysis ◽  
Carotid Body Tumor ◽  
Long Term Outcomes ◽  
Kaplan Meier ◽  
Carotid Body Tumors

Introduction: Carotid body tumors represent the most common site for extra-adrenal paragangliomas. Surgical resection is the treatment of choice as a low percentage of these tumors are malignant. Here we present long-term outcomes of a contemporary cohort of patients with a carotid body tumor. Methods: The national cancer database was quired for all cases of a carotid body tumor between 2004-2015. All baseline variables were gathered from the database. Kaplan-Meier curves were generated for the entire cohort to assess overall survival. The group was split into surgical and non-surgical cohorts. Survival was assessed via Kaplan-Meier estimates. Patients that underwent surgery were divided based on isolated surgical therapy or multimodal therapy (surgery with radiation or chemotherapy). Cox multivariable analysis was used to determine independent predictors for mortality. Results: The search returned 130 patients with a carotid body tumor. The average age of this cohort was 47 years and the majority were women (58.5%). A small proportion (9.2%) of the cohort had a metastasis at the time of diagnosis. Most patients underwent surgery (80%) followed by radiation (44.6%). The overall survival of the cohort was 81.5% at 10 years (Figure 1A) . Long-Term survival was higher in the surgical cohort (P=0.001) (Figure 1B) . Patients with multimodal therapy survived longer than those that underwent surgery alone (P=0.007) (Figure 1C). On Cox multivariable analysis (Figure 1D) , only radiation was a predictor for survival (HR 0.25, P=0.008). Having a metastasis on the time of diagnosis was a predictor for worse outcomes (HR 4.45, P=0.03). Conclusions: While surgery had a survival benefit on Kaplan-Meier analysis, when risk adjusting for other variables, radiation was the only treatment that conferred a survival benefit; an interesting finding given the historical standard of surgical management. Despite improvements in therapeutic modalities, metastasis on diagnosis carries an increased mortality, favoring aggressive treatment.

scholarly journals Validation of Eurolung risk models in a Japanese population: a retrospective single-centre analysis of 612 cases

2019 ◽  
Vol 29 (5) ◽  
pp. 722-728 ◽  
Author(s):  
Akihiro Nagoya ◽  
Ryu Kanzaki ◽  
Takashi Kanou ◽  
Naoko Ose ◽  
Soichiro Funaki ◽  
...  
Keyword(s):  
Overall Survival ◽  
Mortality Rate ◽  
Japanese Population ◽  
Multivariable Analysis ◽  
Morbidity And Mortality ◽  
Risk Scores ◽  
Long Term Outcomes ◽  
Risk Models ◽  
Aggregate Risk

Abstract OBJECTIVES The objective of this study was to evaluate the validity of Eurolung risk models in a Japanese population and assess their utility as predictive indicators for the prognosis. METHODS Between 2007 and 2014, 612 anatomic lung resections were performed among 694 lung cancer patients in our institution. We analysed the cardiopulmonary morbidity and mortality and compared them with the predicted results. We also investigated the association between the Eurolung aggregate risk scores and the long-term outcomes using the Kaplan–Meier method and a multivariable analysis. RESULTS The percentage of cardiopulmonary complications was lower than that predicted by Eurolung 1 (22.4% vs 24.6%). The mortality rate was significantly lower than predicted by Eurolung 2 (0.7% vs 3.0%). The morbidity rate was stratified by Aggregate Eurolung 1. The stratification of the mortality rate by the Eurolung 2 aggregate score was also in line with the increase in score, although the observed number of deaths was quite small (4 cases). The 5-year overall survival was clearly separated according to the stratified Aggregate Eurolung 1 and 2 (P < 0.01 and P < 0.01, respectively). Besides pathological stage, both the Aggregate Eurolung 1 (score 0–7 vs 8–20) and 2 (score 0–8 vs 9–19) scores were shown to be independently associated with overall survival on multivariable. CONCLUSIONS Eurolung risk models cannot be directly applied to the patients in our institution. However, Eurolung aggregate risk scores were helpful not only for stratifying morbidity and mortality after anatomic lung resection but also for predicting the long-term outcomes.

scholarly journals Early and Long-Term Outcomes of Carotid Stenting and Carotid Endarterectomy in Women

2021 ◽  
Vol 8 ◽  
Author(s):  
Edoardo Pasqui ◽  
Gianmarco de Donato ◽  
Giuseppe Alba ◽  
Brenda Brancaccio ◽  
Claudia Panzano ◽  
...  
Keyword(s):  
Overall Survival ◽  
Transient Ischemic Attack ◽  
Carotid Stenting ◽  
Long Term Outcomes ◽  
Carotid Revascularization ◽  
Kaplan Meier ◽  
Cerebral Ischemic ◽  
Ischemic Attack ◽  
Perioperative Risks

Background: The role of carotid revascularization in women remains intensely debated because of the lower benefit and higher perioperative risks concerning the male counterpart. Carotid artery endarterectomy (CEA) and stenting (CAS) represent the two most valuable stroke prevention techniques due to large vessel disease. This study investigates the early and late outcomes in female sex in a real-world everyday clinical practice.Methods: Data were retrospectively analyzed from a single-center database prospectively compiled. A total of 234 procedures, both symptomatic and asymptomatic, were identified (98 CEAs and 136 CASs). Perioperative risks of death, cerebral ischemic events, and local complications were analyzed and compared between the two groups. Long-term outcomes were evaluated in overall survival, freedom from ipsilateral stroke/transient ischemic attack, and freedom from restenosis (&gt;50%) and reintervention.Results: Women who underwent CAS and CEA did not differ in perioperative ischemic cerebral events (2.2 vs. 0%, p = 0.26) and death (0.8 vs. 0%, p = 1). Other perioperative and 30-day outcomes were similarly distributed within the two groups. Kaplan–Meier curves between CAS and CEA groups highlighted no statistical differences at 6 years in overall survival (77.4 vs. 77.1%, p = 0.47) of ipsilateral stroke/transient ischemic attack (94.1 vs. 92.9%, p = 0.9). Conversely, significant differences were showed in 6 years freedom from restenosis (93.1 vs. 83.3%, p = 0.03) and reinterventions (97.7 vs. 87.8%, p = 0.015).Conclusion: Our results revealed that both CEA and CAS have acceptable perioperative risk in women. Long-term outcomes highlighted favorable indications for both procedures, especially for CAS, which seemed to be an excellent alternative to CEA in female patients when performed by well-trained operators.

Abstract 14685: Long-term Outcomes of Aortic Body Tumors: A Nationwide Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Edgar Aranda-Michel ◽  
Olugbenga T Okusanya ◽  
Arman Kilic ◽  
Derek Serna-Gallegos ◽  
James A Brown ◽  
...  
Keyword(s):  
Overall Survival ◽  
Case Reports ◽  
Multivariable Analysis ◽  
Academic Research ◽  
Treatment Modalities ◽  
National Database ◽  
Term Survival ◽  
Kaplan Meier ◽  
Limited Series

Introduction: Aortic body tumors are rare intrathoracic tumors. The majority of existing literature for aortic body tumors exists as case reports or a limited series. Our aim was to analyze a large national database, providing a contemporary view of this cancer. Methods: The national cancer database, which includes data from 1,500 cancer centers was queried to retrospectively review all aortic body tumors between 2004 and 2015. The cohort was divided into patients who underwent surgery versus those who were treated with chemotherapy or radiation. Cohorts were assigned a year range based on when they were diagnosed. Survival between these cohorts were compared using Kaplan-Meier survival estimates. Cox multivariable analysis was performed using baseline variables (age, year range, metastasis, surgery, radiation, and chemotherapy). Overall survival of the cohort was analyzed via Kaplan-Meier survival estimates. Results: A total of 87 patients who were diagnosed with an aortic body tumor were identified. The mean age was 51 ± 15.7 years and the majority of patients were female (51.7%). Most patients were treated at an academic/research center (62.7%) or a comprehensive community cancer program (25.4%). A significant portion of patients (19.5%) had metastatic disease on diagnosis. The treatment modalities utilized were surgery (54%), radiation (44.8%), and chemotherapy (20.7%). Long-term survival was 35.5% with a median survival of 8.25 years (Figure 1A) . Overall survival was significantly higher in the surgery cohort (p<0.001) (Figure 1B) . On Cox multivariable analysis (Figure 1C) , surgery (HR 0.32, p=0.01) was associated with increased survival. An independent predictor of mortality was having a metastasis on diagnosis (HR 8.49, p=0.001). Conclusion: The overall prognosis of aortic body tumors is poor, with metastasis on presentation significantly increasing mortality. Surgery provides a substantial benefit to these patients; however, this may be a result of selection bias. Aggressive surveillance in predisposed populations may be warranted given the grave prognosis once metastasis occurs.

scholarly journals Combination of the G-8 Screening Tool and Hand-Grip Strength to Predict Long-Term Overall Survival in Non-Small Cell Lung Cancer Patients Undergoing Stereotactic Body Radiotherapy

Cancers ◽  
2021 ◽  
Vol 13 (13) ◽  
pp. 3363
Author(s):  
Kristian Kirkelund Bentsen ◽  
Olfred Hansen ◽  
Jesper Ryg ◽  
Ann-Kristine Weber Giger ◽  
Stefan Starup Jeppesen
Keyword(s):  
Overall Survival ◽  
Grip Strength ◽  
Cancer Patients ◽  
Stereotactic Body Radiotherapy ◽  
Statistical Significance ◽  
Multivariable Analysis ◽  
Hand Grip Strength ◽  
Physical Test ◽  
Hand Grip

The Geriatric 8 (G-8) is a known predictor of overall survival (OS) in older cancer patients, but is mainly based on nutritional aspects. This study aimed to assess if the G-8 combined with a hand-grip strength test (HGST) in patients with NSCLC treated with stereotactic body radiotherapy can predict long-term OS better than the G-8 alone. A total of 46 SBRT-treated patients with NSCLC of stage T1-T2N0M0 were included. Patients were divided into three groups: fit (normal G-8 and HGST), vulnerable (abnormal G-8 or HGST), or frail (abnormal G-8 and HGST). Statistically significant differences were found in 4-year OS between the fit, vulnerable, and frail groups (70% vs. 46% vs. 25%, p = 0.04), as well as between the normal and abnormal G-8 groups (69% vs. 39%, p = 0.02). In a multivariable analysis of OS, being vulnerable with a hazard ratio (HR) of 2.03 or frail with an HR of 3.80 indicated poorer OS, but this did not reach statistical significance. This study suggests that there might be a benefit of adding a physical test to the G-8 for more precisely predicting overall survival in SBRT-treated patients with localized NSCLC. However, this should be confirmed in a larger study population.

Overall survival benefit from tebentafusp in patients with best response of progressive disease.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 9509-9509
Author(s):  
Anthony M. Joshua ◽  
Jean-Francois Baurain ◽  
Sophie Piperno-Neumann ◽  
Paul Nathan ◽  
Jessica Cecile Hassel ◽  
...  
Keyword(s):  
Overall Survival ◽  
Safety Profile ◽  
Progressive Disease ◽  
Analysis Data ◽  
Cell Receptor ◽  
Kaplan Meier ◽  
Immortal Time Bias ◽  
Best Response ◽  
Overall Survival Benefit

9509 Background: Tebentafusp (tebe) is the first T cell receptor (TCR) therapeutic to demonstrate an overall survival (OS) benefit in a randomized Phase 3 (Ph3) study [ NCT03070392 ]. In Ph2, 42% of pts with best overall response (BOR) of progressive disease (PD) survived > 1 year (yr), suggesting RECIST-based radiographic assessments underestimate OS benefit of tebe. Here we analyzed OS in the Ph3 study in a cohort of pts with BOR of PD by comparing tebe to the control arm of investigator’s choice (IC). Methods: 378 pts were randomized in a 2:1 ratio to tebe vs. IC. BOR was assessed by investigators using RECIST v1.1. Treatment beyond first disease progression (TBP) was permitted for both arms. On the IC arm, only patients receiving pembrolizumab (pembro) continued with TBP and were included in the TBP-related analyses. No crossover to tebe was permitted; investigators were free to choose subsequent therapy. This analysis was conducted on the first interim analysis (data extracted Nov-2020). Kaplan-Meier estimates of OS were based on Day 100 landmark to eliminate immortal time bias and to capture majority of the PDs. Results: By Day 100, PD as BOR occurred in 52% (130/252) of tebe pts (PD-tebe) vs. 60% (76/126) of IC pts (PD-IC). Key baseline characteristics including lactate dehydrogenase, alkaline phosphatase, ECOG performance, age, and sex were similar between PD-tebe vs PD-IC. The proportion of pts with PD due to progression of target lesions (TL), non-TL, or new lesions were also similar between the two groups. More pts received TBP among PD-tebe 53% (69/130) vs PD-pembro 16% (10/61). Median duration of TBP was longer for PD-tebe (7 weeks) vs PD-Pembro (3 weeks). The safety profile of PD-tebe pts during TBP was similar to all tebe-treated pts. OS was superior for PD-tebe vs PD-IC, HR = 0.41 (95%CI 0.25-0.66), even when considering key baseline covariates. While some pts had regression of TL despite diagnosis of PD ( < 10% of pts), the OS benefit remained even when limited to pts with best change of tumor growth of TL, HR 0.46 (0.29, 0.73). 58% (75/130) PD-tebe and 52% (40/76) PD-IC pts received subsequent therapies. In a landmark OS analysis of these pts beginning on 1st day of subsequent therapy, prior tebe was associated with better OS vs. prior IC, HR 0.59 (95%CI 0.36-0.96). Conclusions: Tebe is the first TCR therapeutic to demonstrate an OS benefit in a solid tumor. Surprisingly, a strong OS benefit from tebe is observed even in pts with BOR of PD, suggesting that RECIST-based radiographic assessments do not capture the complete benefit from tebe. The safety profile of tebe during TBP was consistent with that for long-term tebe treatment. Clinical trial information: NCT03070392.

scholarly journals Early and Long-Term Follow-Up for Chronic Type B and Type Non-A Non-B Aortic Dissection Using the Frozen Elephant Trunk Technique

2021 ◽  
Vol 8 ◽  
Author(s):  
Congcong Luo ◽  
Ruidong Qi ◽  
Yongliang Zhong ◽  
Suwei Chen ◽  
Hao Liu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Aortic Dissection ◽  
Type B ◽  
Frozen Elephant Trunk ◽  
Long Term Outcomes ◽  
Chronic Type ◽  
Elephant Trunk ◽  
Long Term Follow Up

Background: This study aimed to evaluate the early and long-term outcomes of a single center using a frozen elephant trunk (FET) procedure for chronic type B or non-A non-B aortic dissection.Methods: From February 2009 to December 2019, 79 patients diagnosed with chronic type B or non-A non-B aortic dissection who underwent the FET procedure were included in the present study. We analyzed operation mortality and early and long-term outcomes, including complications, survival and interventions.Results: The operation mortality rate was 5.1% (4/79). Spinal cord injury occurred in 3.8% (3/79), stroke in 2.5% (2/79), and acute renal failure in 5.1% (4/79). The median follow-up time was 53 months. The overall survival rates were 96.2, 92.3, 88.0, 79.8, and 76.2% at 1/2, 1, 3, 5 and 7 years, respectively. Moreover, 79.3% of patients did not require distal aortic reintervention at 7 years. The overall survival in the subacute group was superior to that in the chronic group (P = 0.047).Conclusion: The FET technique is a safe and feasible approach for treating chronic type B and non-A non-B aortic dissection in patients who have contraindications for primary endovascular aortic repair. The technique combines the advantages of both open surgical repair and endovascular intervention, providing comparable early and long-term follow-up outcomes and freedom from reintervention.

Factors Predictive of Outcomes after Cytoreductive Surgery and Heated Intraperitoneal Chemotherapy for Colon and Appendiceal Carcinomatosis: A Single-Institution Experience

2018 ◽  
Vol 84 (10) ◽  
pp. 1575-1579
Author(s):  
Blake Babcock ◽  
Brice Jabo ◽  
Matthew Selleck ◽  
Mark Reeves ◽  
Carlos Garberoglio ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lymph Node ◽  
Intraperitoneal Chemotherapy ◽  
Cytoreductive Surgery ◽  
Lymph Node Status ◽  
Long Term Outcomes ◽  
Node Status ◽  
Heated Intraperitoneal Chemotherapy ◽  
Short And Long Term

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC), although considered an acceptable treatment option in the management of selected patients with colon and appendiceal peritoneal carcinomatosis (PC), concerns about morbidity have limited its acceptance. Our objective was to evaluate the short- and long-term outcomes of CRS/HIPEC for appendix and colon PC performed at our institution and to elucidate factors predictive of patient outcomes. All patients who underwent CRS/HIPEC for appendix or colon PC from 2011 to 2017 were identified from our institution's prospective database. Postoperative outcomes, overall survival, and recurrence-free survival were assessed. Of 125 patients who underwent CRS/HIPEC during the study period, 45 patients were eligible (appendix n = 26; colon n = 19). The median postoperative length of stay was nine days (5–28 days). Grade III/IV complications occurred in 4/45 (8.8%) patients. There were no postoperative mortalities. Median DFS and overall survival have not yet been reached, in both the colon and appendix groups. As of the study conclusion date, 37/45 (82.2%) patients were alive with or without disease. Lymph node status was predictive of recurrence in appendix PC. In our experience, CRS/HIPEC can be safely performed with acceptable short- and long-term outcomes. Lymph node status is an important predictor of recurrence.

Antiphospholipid Antibody Profile Stability Over Time: Prospective Results from APS ACTION Clinical Database and Repository

2020 ◽  
pp. jrheum.200513
Author(s):  
Elena Gkrouzman ◽  
Ecem Sevim ◽  
Jackie Finik ◽  
Danieli Andrade ◽  
Vittorio Pengo ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
Primary Objective ◽  
Antiphospholipid Antibody ◽  
Long Term Outcomes ◽  
Glycoprotein I ◽  
Baseline Characteristics ◽  
Stored Blood ◽  
Over Time

Objective APS ACTION Registry studies long-term outcomes in persistently antiphospholipid antibody (aPL)-positive patients. Our primary objective was to determine whether clinically meaningful aPL profiles at baseline remain stable over time. Our secondary objectives were to determine a) whether baseline characteristics differ between patients with stable and unstable aPL profiles, and b) predictors of unstable aPL profiles over time. Methods Clinically meaningful aPL profile was defined as positive lupus anticoagulant (LA) test and/or anticardiolipin (aCL)/anti-β2 glycoprotein-I (aβ2GPI) IgG/M ≥40 U. Stable aPL profile was defined as a clinically meaningful aPL profile in at least two-thirds of follow-up measurements. Generalized linear mixed models with logit link were used for primary objective analysis. Results Of 472 patients with clinically meaningful aPL profile at baseline (median follow up: 5.1 years), 366/472 (78%) patients had stable aPL profiles over time, 54 (11%) unstable; and 52 (11%) inconclusive. Time did not significantly affect odds of maintaining a clinically meaningful aPL profile at follow-up in univariate (p=0.906) and multivariable analysis (p=0.790). Baseline triple aPL positivity decreased (Odds Ratio [OR] 0.25, 95% Confidence Interval [CI] 0.10-0.64, p=0.004) and isolated LA test positivity increased (OR 3.3, 95% CI 1.53-7.13, p=0.002) the odds of an unstable aPL profile over time. Conclusion Approximately 80% of our international cohort patients with clinically meaningful aPL profile at baseline maintain such at a median follow-up of five years; triple aPL-positivity increase the odds of a stable aPL profile. These results will guide future validation studies of stored blood samples through APS ACTION Core Laboratories.

Multimodal therapy for the management of primary, nonmetastatic Ewing's sarcoma of bone: a long-term follow-up of the First Intergroup study.

1990 ◽  
Vol 8 (10) ◽  
pp. 1664-1674 ◽  
Author(s):  
M E Nesbit ◽  
E A Gehan ◽  
E O Burgert ◽  
T J Vietti ◽  
A Cangir ◽  
...  
Keyword(s):  
Overall Survival ◽  
Local Recurrence ◽  
Multimodal Therapy ◽  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma ◽  
Patient Characteristics ◽  
Group I ◽  
Long Term Follow Up

A total of 342 previously untreated eligible children were entered into the first Intergroup Ewing's Sarcoma Study (IESS) between May 1973 and November 1978. In group I institutions, patients were randomized between treatment 1 (radiotherapy to primary lesion plus cyclophosphamide, vincristine, dactinomycin, and Adriamycin [doxorubicin; Adria Laboratories, Columbus, OH] [VAC plus ADR]) or treatment 2 (same as treatment 1 without ADR), and group II institutions randomized patients between treatment 2 or treatment 3 (same as treatment 2 plus bilateral pulmonary radiotherapy [VAC plus BPR]). The percentages of patients relapse-free and surviving (RFS) at 5 years for treatments 1, 2, and 3 were 60%, 24%, and 44%, respectively. There was strong statistical evidence of a significant advantage in RFS for treatment 1 (VAC plus ADR) versus 2 (VAC alone) (P less than .001) and 3 (P less than .05) and also of treatment 3 versus 2 (P less than .001). Similar significant results were observed with respect to overall survival. Patients with disease at pelvic sites have significantly poorer survival at 5 years than those with disease at nonpelvic sites (34% v 57%; P less than .001). Among pelvic cases, there was no evidence of differing survival by treatment (P = .81), but among nonpelvic cases, there was strong evidence of differing survival by treatment (P less than .001). The overall percentage of patients developing metastatic disease was 44%; the percentages by treatments 1, 2, and 3 were 30%, 72%, and 42%, respectively. The overall incidence of local recurrence was 15%, and there was no evidence that local recurrence rate differed by treatment. Patient characteristics related to prognosis, both with respect to RFS and overall survival experience, were primary site (nonpelvic patients were most favorable) and patient age (younger patients were more favorable).

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