Abstract 17068: Do Post-Operative Nitrates Increase Mortality in Non-Cardiac Surgery Patients With Perioperative Myocardial Injury?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Harsh R Barot ◽  
Parag A Chevli ◽  
Abhishek Dutta ◽  
Padageshwar Sunkara ◽  
Geeth Sandeep Nadella ◽  
...  
Keyword(s):  
Large Scale ◽  
Myocardial Injury ◽  
Final Analysis ◽  
Isosorbide Mononitrate ◽  
Coronary Syndrome ◽  
Cardiac Procedures ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Cox Proportional Hazard Models ◽  
Adjusted Model

Introduction: Myocardial injury after noncardiac surgery (MINS) is strongly associated with 30-day mortality, and data on its management is scarce. We hypothesized that postoperative nitrates (Isosorbide mononitrate, Isosorbide dinitrate, and scheduled Nitroglycerine) increase mortality in MINS patients. Methods: We used data from the Wake-Up T2MI registry, which is a single center, retrospective cohort of adults with elevated troponin (cTn) I (>0.04 ng/dL) during hospitalization without acute coronary syndrome in a 2-year period (2009-2010). Cardiac procedures were excluded. Kaplan-Meier curves and a multivariate-adjusted Cox-proportional hazard models were performed to assess all-cause mortality at 90-days and 1-year among patients with and without nitrates upon discharge. Results: Total of 457 MINS patients were included in the final analysis. There was no significant difference in baseline characteristics and peak cTn among patients stratified by nitrates status. Prevalence of mortality in the nitrates group was significantly higher at 90-days (35.7% vs 10%, p = 0.002) and non-significantly higher at 1-year (42.9% vs. 22.4%, p = 0.073) compared to non-nitrates group. Survival benefit was significantly lower in the nitrates group at 90-days (log-rank p = 0.002) and at 1-year (log-rank p = 0.031) (Figure 1). In a multivariate-adjusted model, nitrates had a HR of 3.032 (1.018 - 9.026; p = 0.046) at 90-days and HR of 2.022 (0.809 - 5.054; p = 0.132) at 1-year (Figure 2). Conclusion: Nitrates on discharge were associated with increased mortality at 3-months and at 1-year in MINS patients. Further large-scale studies are required to validate our results.

Abstract 17389: Antiplatelets Agents Decreases 30-days Mortality in Myocardial Injury After Noncardiac Surgery

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hanumantha R Jogu ◽  
Parag A Chevli ◽  
Geeth Sandeep Nadella ◽  
Tareq S Islam ◽  
Abhishek Dutta ◽  
...  
Keyword(s):  
Myocardial Injury ◽  
Final Analysis ◽  
Antiplatelet Agents ◽  
Noncardiac Surgery ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Cardiac Procedures ◽  
Kaplan Meier ◽  
Cox Proportional Hazard Models ◽  
Poor Outcomes

Introduction: Despite being frequent and associated with poor outcomes, no guidelines exist addressing the management of myocardial injury after noncardiac surgery (MINS). We hypothesized that Antiplatelets (ATP) agents reduce 30-days mortality in MINS patients. Methods: We used data from the Wake-Up T2MI registry, which is a single-center, retrospective cohort of hospitalized adults with elevated troponin (cTn) I (> 99 th percentile reference upper limit is >0.04 ng/dL) without acute myocardial infarction in a 2-year period. Patients with the cardiac procedures were excluded and cTn obtained during hospitalization. MINS is defined as abnormally elevated cTn levels during or within 30 days after surgery. Kaplan-Meier curve and multivariate-adjusted Cox-proportional hazard models were performed to assess all-cause mortality at 30-days, 90-days, and 1-year among patients with and without ATPs upon discharge. Results: A total of 457 patients were included in the final analysis. There was no difference in sex, race, BMI, and peak cTn, except age among patients stratified by ATP on discharge. Prevalence of mortality was significantly lower at 30-days (2.6% vs 7%, p = 0.028), it was not significant at 90-days (9.6% vs. 11.8%, p = 0.440) and at 1-year (21.4% vs. 24.6%, p=0.421) in patients who were discharged on ATPs compared to non-ATPs. Survival benefit was significant at 30-days (log-rank p = 0.022), non-significant at 90-days (log-rank p = 0.292) and at 1-year (log-rank p = 180) in ATPs group compared to non-ATPs. In a multivariate-adjusted (adjusted for age, sex, race, and peak cTn) model, patients who were discharged on ATPs had a HR of 0.31 (0.120 - 0.799; p = 0.015) at 30 days, HR of 0.64 (0.363 - 1.136; p = 0.128) at 90 days (Figure 1), and HR of 0.69 (0.472 - 1.025; p = 0.066) at 1 year. Conclusions: In conclusion, antiplatelet agents on discharge were associated with decreased 30-days mortality in MINS patients. Further studies are needed to validate our results.

Pancreas cancer: Influence of gender and other demographic and clinical parameters on survival.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e12529-e12529 ◽  
Author(s):  
Patricia Renee Blank ◽  
Thomas D. Szucs
Keyword(s):  
Pancreatic Cancer ◽  
Gender Difference ◽  
Pancreas Cancer ◽  
Cox Regression ◽  
Total Sample ◽  
Cancer Prognosis ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Cox Proportional Hazard Models

e12529 Background: Research suggests that lower excess mortality risk for females compared to men do exist for several cancer types. The primary aim of this study was to investigate whether gender affects pancreatic cancer prognosis. In addition, the relationship of sex and survival adjusted for clinical and demographic factors was assessed. Methods: The Surveillance, Epidemiology, and End Results (SEER) database (version 1973-2009) was used to identify patients with primary histological confirmed pancreas cancer (≥18 years, 80,689 males and 82,356 females). The analysis was stratified by five different stages (in situ, locally invasive, regional, distant, unstaged). The crude effect of gender was assessed in the total sample and in age-stratified Kaplan-Meier Curves (<55 years) in all five stages, respectively. Univariate and multivariate Cox proportional hazard models were run within the local stage. The predictors included in the models were demographic and clinical factors. P-values (2-sided) of 0.05 were assumed as statistical significant. Results: Between 1973 and 2009, 128,645 pancreas cancer-related deaths were reported. The median follow-up time of the censored patients was 13 months. The Kaplan-Meier curves showed a significant difference in survival among men and female in the locally invasive group (median survival in male and female: 7 months; 1-year survival: 35.5% and 35.1% among female and men, respectively; Log-Rank: p=0.0072). Of the remaining strata, all others had non-significant differences, except the unstaged group (Log-Rank: p= <.0001). The univariate Cox-regression indicated a 5.6% (95%CI: 1.4%, 9.9%, p=0.0081) higher rate of dying among men compared to female (local recurrence). Among the younger population (<55 years), the gender difference was significant across all disease stages, except the in situ group. Histology grade, age, race, and marital status was associated with survival from pancreatic cancer in the multivariate analysis. Conclusions: The present study indicates a gender difference in survival among pancreas cancer patients. The study findings are, however, preliminary and hypothesis generating and a matter for further investigation to give a distinct conclusion.

Pancreas cancer: Influence of gender and other demographic and clinical parameters on survival.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 200-200 ◽  
Author(s):  
Patricia Renee Blank ◽  
Thomas D. Szucs
Keyword(s):  
Pancreas Cancer ◽  
Total Sample ◽  
The United States ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Cox Proportional Hazard Models ◽  
Male Patients ◽  
Disease Stages ◽  
Relationship Of

200 Background: Research suggests that lower excess mortality risk for females compared to men do exist for several cancer types. The primary aim of this study was to investigate whether gender affects pancreas cancer (PC) prognosis. In addition, the relationship of gender and survival adjusted for clinical and demographic factors was assessed. Methods: The SEER database (version 1973-2009) was used to identify patients with primary histological confirmed PC (≥18 years, 80,689 males and 82,356 females) in the United States. The analysis was stratified by five different stages according to the categories of the American Joint Committee on Cancer (in situ, locally invasive, regional, distant, unstaged). The crude effect of gender was assessed in the total sample and in age-stratified Kaplan-Meier Curves (<55 years) in all five stages, respectively. Univariate and multivariate Cox proportional hazard models were run within the local stage at diagnosis. The predictors included in the models were demographic and clinical factors based on a prior clinical and scientific knowledge. Two-sided p-values of 0.05 were assumed as statistical significant. Results: In total, 128,645 PC-related deaths were reported with a median follow-up time of 13 months (censored patients). Kaplan-Meier curves showed a significant difference in survival among men and female in the locally invasive group (median survival in male and female: 7 months; 1-year survival: 35.5% and 35.1% among female and men, respectively; Log-Rank: p=0.0072). The remaining strata had non-significant differences (p= <.0001), except the unstaged group. The local recurrence group had a 5.6% (95%CI: 1.4%, 9.9%, p=0.0081) higher rate of dying among men compared to female. Among the population <55 years, the gender difference was significant across all disease stages, except the in situ group. Histology grade, age, race, and marital status was associated with survival from PC in the multivariate analysis. Conclusions: The present study indicates that male patients with PC have a worse prognosis than female patients. However, these results need validation and further studies are needed in the research on the prognostic value of gender in PC survival.

Racial disparities in immune-related adverse events (irAE) of immune checkpoint inhibitors (ICPi) and association with survival based on clinical and biochemical responses.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 7025-7025
Author(s):  
Monica Peravali ◽  
Cristiane Gomes-Lima ◽  
Eshetu Tefera ◽  
Mairead Baker ◽  
Mamta Sherchan ◽  
...  
Keyword(s):  
Large Scale ◽  
Checkpoint Inhibitors ◽  
Stage Iv ◽  
Positive Association ◽  
Progression Free Survival ◽  
P Value ◽  
Eligibility Criteria ◽  
Kaplan Meier ◽  
Comparison Results ◽  
Significant Difference

7025 Background: ICPi cause various irAE with thyroid dysfunction as a commonly reported abnormality. There is increasing evidence showing positive association with development of irAE and survival. However, prior trials with ICPi had underrepresentation of minorities with <5% African Americans (AA). Methods: We retrospectively reviewed patients (pts) with stage IV solid malignancies treated with PD1/PDL1 blockers between 1/2013-12/2018 across MedStar Georgetown Cancer Institute facilities. Pts treated with CTLA-4 inhibitors were excluded. Progression free survival (PFS) and overall survival (OS) were primary endpoints and were calculated using Kaplan-Meier methods and Wilcoxon rank sum test for comparison. Results: 293 pts met eligibility criteria. 91 pts (31%) had any grade irAE; most common AE were endocrine (40.7%) specifically TSH elevation, dermatological (23.1%) and rheumatologic (18.7%). Proportion of irAE was significantly higher in Caucasians versus AA (60.4% vs 30.8%), in pts with low PDL1, lower LDH, older age, and those who had more treatment cycles with ICPi. Rate of progression was lower in pts with irAE (30.8% vs 46.0%, p-0.0140). Median PFS (5.8 vs 3.0 months (mo), p- 0.0204) and OS (17.1 vs 7.2 mo, p value- <0.0001) were higher with irAE. Statistically significant difference in OS (17.1 vs 8.6 mo, p- 0.0002) but not in PFS (5.8 vs 3.3 mo, p: 0.0545) was noted with endocrine irAE. No differences in survival were observed among other commonly reported irAE. Differences in survival among subgroups of pts with irAE are detailed in table. Conclusions: Development of irAE positively correlated with improved PFS and OS as reported in previous studies. To our knowledge, this is the first study observing differences in OS favoring endocrine AE and Caucasian race. These factors may be potential surrogate markers of prognosis pending replication of these results in large-scale studies. [Table: see text]

scholarly journals Metformin and Diabetes Prevention in Patients with Prediabetes: Results from Isfahan Diabetes Prevention Study (IDPS)

2021 ◽  
pp. 65-74
Author(s):  
Parisa Khodabandeh Shahraki ◽  
Awat Feizi ◽  
Ashraf Aminorroaya ◽  
Mahboubeh Farmani ◽  
Massoud Amini
Keyword(s):  
Diabetes Prevention ◽  
Rank Test ◽  
Proportional Hazard ◽  
Medical Sciences ◽  
Cox Proportional Hazard ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Adjusted Model

Aim: Although, the effectiveness of metformin in diabetes treatment is well established, its preventive effect in the development of diabetes is still unclear in real world. We aimed to determine the effectiveness of metformin therapy as a single preventive agent in patients with prediabetes in a cohort study (IDPS). Study Design: In this prospective observational study. Place and Duration of Study: Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Methodology: We included 410 patients with prediabetes (168 metformin user, 242 non-users), who participated in IDPS. To determine the association between metformin use and incidence of type 2 diabetes, Cox proportional hazard method, Kaplan-Meier and log Rank test were used. Results: In fully adjusted model for all confounders, significant hazard ratio (HR) for staying prediabetes rather than returning to normal was detected in male group of metformin non-user (HR: 2·41 [95% CI 1.01-5.79]; P<0·05) and those metformin non-user who had both Impaired Fasting Glucose and Impaired Glucose Tolerance (IFG & IGT) (HR: 2.13 [95% CI 1.05-4.34]; P=0·04).  There was no significant difference in terms of developing diabetes risk between metformin users and non-users. Conclusion: This study evidenced that males and patients with IFG & IGT who had not used metformin are at higher risk to staying prediabetes than returning to normal.

P5513Relation of thyroid hormones level to the extent of myocardial injury in patients with acute coronary syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Badran ◽  
G Soltan ◽  
A Belal
Keyword(s):  
Acute Coronary Syndrome ◽  
Thyroid Hormones ◽  
Myocardial Injury ◽  
Troponin I ◽  
Thyroid Stimulating Hormone ◽  
Gensini Score ◽  
Thyroid Status ◽  
Free Triiodothyronine ◽  
Coronary Syndrome ◽  
Significant Difference

Abstract Objective Previous studies have identified that abnormal thyroid hormonal status is associated with worse prognosis especially in coronary artery disease (CAD). The present study further explores whether thyroid hormones associated with size of myocardial injury and extent of CAD in patients with acute coronary syndrome (ACS). Methods In this study, we enrolled 120 consecutive patients (52% male, mean age 54.2±6.4 years) who were admitted to ICU with ACS and having coronary angiography. All patients underwent testing for thyroid function status [thyroid stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4)], cardiac troponin I (cTnI), cardiac enzymes, C-reactive protein (CRP). Risk profile, clinical characteristics and angiographic results (Gensini score) were also analyzed. Results 43.3% of patients presented with STEMI, 33.3% with NSTEMI and 23.3% unstable angina. CK-MB, troponin and CRP were significantly higher in STEMI compared with NSTEMI group (P<0.0001). Abnormal thyroid status was prevalent in 13.4% of total population; Low FT3 syndrome in 6.7%, subclinical hypothyroidism in 5% and clinical hypothyroidism in 1.7%. Lower thyroid hormone levels showed significantly lower HDL (P<0.02), higher triglyceride level& CRP and cTnI (P<0.007), higher rate of in hospital complications including recurrent angina, CHF and cardiogenic shock (P<0.001) and more severe CAD using Gensini score (P<0.0001). However, there was no significant difference in abnormal thyroid status between STEMI and NSTEMI. After adjusting for conventional risk factors, FT3 showed direct correlation to LV EF% (r=0.62, P<0.000) and inverse correlation to LV internal dimension (r=−0.57, P<0.0001), troponin (r=−0.27, P<0.03), CRP (r=−0.39, P<0.003), Gensini score (r=−0.48, P<0.0001) and number of in hospital complications (r=−0.62, P<0.0001). From a linear stepwise regression analysis low EF% (β: 0.032, 95% CI: 0.009–0.055, P<0.007) and presence of complications (β: 0.625, 95% CI: 1.194–0.056, P<0.03) are independent predictors of low FT3. Conclusions In ACS, the lower thyroid hormones levels are associated with larger myocardial injury, more severe CAD and higher rate of complications especially during their hospital course.

scholarly journals Suppression of Menstrual-Related Migraine Attack Severity Using Pyridoxine, Thiamine, and Cyanocobalamin: A Quasi-Experimental Within-Subject Design

2020 ◽  
Vol 7 (3) ◽  
Author(s):  
Mansoureh Togha ◽  
Reza Rahmanzadeh ◽  
Shiva Nematgorgani ◽  
Zahra Yari ◽  
Soodeh Razeghi Jahromi ◽  
...  
Keyword(s):  
Chronic Migraine ◽  
Large Scale ◽  
Final Analysis ◽  
Episodic Migraine ◽  
Headache Severity ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Quasi Experimental ◽  
The Mean

Background: B-group vitamins can potentially contribute to migraine prophylaxis through various mechanisms. We conducted a quasi-experimental study to assess the efficacy and tolerability of a combination of vitamins B1, B6, and B12 (Neurobion) for prophylaxis of menstruation-related migraine attacks. Methods: Women diagnosed with menstrual-related migraine, both chronic and episodic headaches, were enrolled. The patients began Neurobion therapy one week before the menstruation cycle, and repeated the injection for three consecutive months; each ampoule contained 100 mg of vitamins B1 and B6 as well as 1000 μg of vitamin B12. Neurobion was used as an add-on therapy for patients receiving the same prophylactic therapy during the last two months before the start of the study. The outcome parameter examined the severity of menstrual-related migraine attacks on a 10-point visual analog scale (VAS). Results: Three hundred eighty-three patients (169 with chronic migraine and 214 with episodic migraine) were included in the final analysis. The patients received treatment with a combination of vitamins B1, B6, and B12 with positive results. The mean intensity of menstrual-related migraine attacks was reduced from 6.7 on the 10-point VAS to 3.2 (P < 0.001) in patients with chronic migraine. The mean severity of menstrual-related migraine attacks was also reduced from 7.2 to 3.7 in patients with episodic migraine (P < 0.001). There was no significant difference in the reduction of headache severity between the two groups of migraineurs (P = 0.985). Conclusions: Neurotropic vitamins, including pyridoxine, thiamine, and cyanocobalamin yielded significant reductions in the severity of menstrual-related migraine attacks. Neurobion as a combination of vitamins B1, B6, and B12 appears to be well-tolerated and beneficial as an adjuvant in treatment and prophylaxis of menstrual-related migraine attacks. Further large-scale trials with long-term follow-up will be required to confirm our results.

A single-center validation of the effectiveness in Obstructive Sleep Apnea screening with a photoplethysmography-based smart device

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Chen ◽  
W Wang ◽  
Y Guo ◽  
H Zhang ◽  
Y Chen ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sensitivity And Specificity ◽  
Large Scale ◽  
Final Analysis ◽  
Smart Devices ◽  
Smart Device ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
Significant Difference

Abstract Background Obstructive sleep apnea (OSA), the most common upper-airway disease, is closely associated with cardiovascular risk. However, the early detection of OSA is challenging, relying on polysomnography (PSG) or portable monitor (PM) in hospitals. A novel technology, photoplethysmography (PPG), has been developed for OSA screening. But there has been limited validation of PPG-based smart devices compared to PSG or PM. Objective This study aimed to investigate the feasibility and verify the validity of PPG-based smart devices in the detection of OSA in real-world settings. Methods A total of 119 consecutive outpatients, were recruited from the Chinese PLA General Hospital from Sep 29 to Nov 10, 2019. Participants were simultaneously tested with a smart watch, and PSG or PM for a whole night sleep. Results In all, 102 patients (48.5±13.7 years old, female 23.5%) were into the final analysis after excluding 17 patients with poor quality of PPG signals. Among them, 83 patients (81.3%) were diagnosed with OSA. Compared to PM, the corresponding accuracy, sensitivity and specificity of PPG-based smart device in predicting moderate to severe OSA patients ( Apnea Hypopnea Index, AHI ≥15) were 87.9% (95% Confidential Interval, CI: 78.8%–94.1%), 89.7% (95% CI: 75.8%–97.1%) and 86.0% (95% CI: 72.1%–94.7%), respectively. Compared to PSG, the accuracy, sensitivity and specificity in predicting all the sleep apnea patients (AHI ≥5) were 81.1% (95% CI: 72.1%–88.2%), 76.5% (95% CI: 50.1%–93.2%) and 100% (95% CI: 29.2%–100%), respectively. Moreover, for moderate to severe OSA patients (AHI ≥15), the predictive ability of PPG-based smart device in OSA was of no significant difference compared to PM (P=0.75) or PSG (P=0.52). Conclusions The PPG-based smart device demonstrated good performance in detecting OSA. Nevertheless, it requires further validation in a large-scale population on screening OSA. Funding Acknowledgement Type of funding source: None

P679Long-term cardiovascular outcomes after percutaneous coronary interventions in patients with acute coronary syndrome and cancer

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y Ma ◽  
Y J Cheng ◽  
B E Ohene ◽  
L X Yang ◽  
Y J Zhou
Keyword(s):  
Lung Cancer ◽  
Cardiovascular Death ◽  
Cardiovascular Outcomes ◽  
Smoking History ◽  
Coronary Syndrome ◽  
Cancer Group ◽  
Kaplan Meier ◽  
Significant Difference ◽  
History Of

Abstract Background Over time, the use of PCI increased and mortality decreased comparably in patients with ACS and cancers. Although the adverse cardiac effect of cancer has been widely reported, we know less on whether lung cancer confers worse clinical outcomes in patients with established ACS, particularly those undergoing PCI. Methods All cancer patients who were admitted in the hospital with ACS as initial diagnosis and underwent PCI from January 2006 to December 2016 were enrolled, and were divided into 2 groups according to their malignancy types: lung cancer and others. Population data was collected and clinical follow-up was performed by either telephone contact or office visit. Survival was graphically represented using Kaplan-Meier curves. Differences in survival rates were compared using the log-rank test. Analysis was performed with SPSS statistical software, version 22.0 for Windows. See Figure 1. Results 16,062 patients suffered from various cancers and 55,401 patients underwent PCI. After cross referencing the two patient lists, 337 patients were enrolled who underwent cancer prior to ACS, and 15.1% (n=51) had a medical history of lung cancer. See Figure 2 and 3. Male gender was more prevalent in the lung cancer group than other cancers group (84.3% vs 60.5%, P=0.01). There was no significant difference between lung cancer and other cancers group in the presence of traditional cardiovascular risk factors, such as hypertension, hyperlipidemia, obesity, diabetes mellitus, history of smoking, history of drinking and the family history of coronary artery disease (P>0.05 for all). Among all coronary complex lesions, calcified lesions was more prevalent in lung cancer group (21.6% vs 11.5%, P=0.04), although there was no significant difference between two groups in left main lesions, bifurcation lesions and CTO lesions (P>0.05 for all). For anticancer therapy, patients with lung cancer received more radiotherapy (29.4% vs 13.6%, P=0.01) and chemotherapy (37.3% vs 25.5%, P=0.08). Follow-up was available for 289 of the 337 patients (85.8%). See table 1. The incidence of cardiovascular death (5.9% vs 1.0%, P=0.02) was higher in the lung cancer group. As shown the Kaplan-Meier curves in Figure 1, the survival rate free from all-cause death (log rank P=0.034, Figure 4A) and cardiovascular death (log rank P=0.013, Figure 4B) was significantly lower in lung cancer group than in other cancers group during the follow-up. Figures and Table Conclusions Lung cancer has a non-negligible prevalence in patients with ACS undergoing PCI, with significantly worse long-term cardiovascular outcomes. The results of our study reinforce the importance of understanding to patients who need closer follow-up, careful evaluation, and intervention.

scholarly journals Decreased CD8+ Lymphocytic Infiltration in Multifocal and Multicentric Glioblastomas

2021 ◽  
Vol 11 ◽  
Author(s):  
Run Wang ◽  
Yifu Song ◽  
Tianhao Hu ◽  
Xiaoliang Wang ◽  
Yang Jiang ◽  
...  
Keyword(s):  
Survival Function ◽  
Tumor Infiltrating Lymphocytes ◽  
Lymphocytic Infiltration ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Unfavorable Clinical Outcome ◽  
Cox Proportional Hazard Models ◽  
Infiltrating Lymphocytes

PurposeMultifocal and multicentric glioblastomas (mGBMs) are associated with a poorer prognosis compared to unifocal glioblastoma (uGBM). The presence of CD8+ tumor-infiltrating lymphocytes (TILs) is predictive of clinical outcomes in human malignancies. Here, we examined the CD8+ lymphocytic infiltration in mGBMs.MethodsThe clinical data of 57 consecutive IDH wildtype primary mGBM patients with histopathological diagnoses were retrospectively reviewed. CD8+ TILs were quantitatively evaluated by immunohistochemical staining. The survival function of CD8+ TILs was assessed by Kaplan–Meier analysis and Cox proportional hazard models.ResultsNo significant difference in the concentration of CD8+ TILs was observed among foci from the same patient (P&gt;0.150). The presence of CD8+ TILs was similar between multifocal and multicentric GBMs (P=0.885). The concentration of CD8+ TILs was significantly lower in mGBMs than in uGBMs (P=0.002). In mGBM patients, the CD8+ TIL level was associated with preoperative KPS (P=0.018). The median overall survival (OS) of the 57 mGBMs was 9 months. A low CD8+ TIL level (multivariate HR 4.404, 95% CI 1.954-9.926, P=0.0004) was an independent predictor of poor OS, while postoperative temozolomide chemotherapy (multivariate HR 6.076, 95% CI 2.330-15.842, P=0.0002) was independently associated with prolonged OS in mGBMs.ConclusionsDecreased CD8+ TIL levels potentially correlate with unfavorable clinical outcome in mGBMs, suggesting an influence of the local immuno-microenvironment on the progression of mGBMs.

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