Abstract TMP5: Vessel Status Findings in Patient Candidates Transferred for Endovascular Treatment. Data From Catalonia’s Code Stroke Registry

The aim of this study was to determine changes in vessel status between PSC and CSC according to site and occlusion level, rtPA-treatment, and pre-specified time intervals. Methods: Observational, multicenter study, from a prospective, government-mandated, population-based registry. We selected data from candidates to EVT with documented LVO at PSC who were transferred to CSC from January 2017 to June 2019. We used clinical variables and time intervals as the Symptom-Onset to Vascular-Imaging at CSC (SOTVI2). The primary endpoint was defined as no-occlusion/distal occlusion ineligible for EVT at CSC arrival (NOEVTatCSC) as was utilized. Results: From 589 patients, 37% received rtPA. Rate of NOEVTatCSC was 10.5% (n: 62) and 87% were treated with rtPA, being 35.8% of causes to exclude EVT at CSC arrival. In univariate analysis, lower baseline-NIHSS (median 12 vs. 16 p<0.01), RACE-scale (median 5 vs. 6; p=0.04) and SOTVI2-time (mean-minutes 268.7 vs. 317.2; p=0.04), rtPA treatment (13.7% Vs. 5.0%; p<0.01), and M2 occlusion (16.8% Vs. 9%; p= 0.02) were associated with NOEVTatCSC. In multivariate analysis, only rtPA-treatment was associated with NOEVTatCSC (OR: 4.65, 95%CI: 1.73-12.4, p= 0.003). In the rtPA subgroup, Basilar occlusion (28% Vs. 12%; p=0.04), lower baseline-NIHSS (13 Vs. 16; p<0.01) and SOTVI2 times ≤240 minutes (28.9% Vs. 15.4%; p=0.02) were associated with NOEVTatCSC. In Multivariate analysis SOVI2 ≤240 minutes (OR: 2.109 95%CI: 1.008-4.401, p=0.04) emerged as the only predictor of NOEVTatCSC. Changes in the vessel status according to initial occlusion at PSC in anterior circulation were observed, and occurred in both; proximal and distal direction. In 11.2% of cases, occlusion site at CSC was more proximal than at PSC. Conclusion: In patient candidates for EVT transferred from PSC to CSC, NOEVTatCSC is infrequent making the need of a second vascular study before the angiogram at CSC arguable. Despite of its modest effect, tPA-treatment at PSC is the only factor associated with NOEVTatCSC. This could be most relevant in basilar occlusions and in the first 4-hours. Changes in the vessel status according to initial occlusion in PSC occur in anterior circulation. Future studies addressed to determine factors related to these changes are warranted.

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Abstract 17: Prehospital Deterioration During Transport by Emergency Medical Services for Stroke Patients: A Population-Based Study

Stroke ◽

10.1161/str.48.suppl_1.17 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Sabreena J Gillow ◽

Heidi Sucharew ◽

Kathleen Alwell ◽

Charles J Moonmaw ◽

Daniel Woo ◽

...

Keyword(s):

Atrial Fibrillation ◽

Multivariate Analysis ◽

Univariate Analysis ◽

Onset Time ◽

Population Based ◽

Neurological Deterioration ◽

Stroke Patients ◽

Stroke Subtype ◽

Hospital Arrival ◽

Neurologic Deterioration

Introduction: Stroke patients can experience neurological change in the prehospital setting. We sought to identify factors associated with prehospital neurologic deterioration. Methods: Among the Greater Cincinnati/Northern Kentucky region (pop. ~1.3 million), we screened all 15 local hospitals’ admissions from 2010 for acute stroke, and included patients with age ≥20 and complete EMS records. Glasgow Coma Scale (GCS) at hospital arrival was compared with GCS evaluated by EMS, with decrease ≥2 points considered neurologic deterioration. Data obtained included age, sex, race, medical history, antiplatelet or anticoagulant use, stroke subtype [ischemic (IS), ICH, or SAH] and IS subtype (e.g., small vessel, large vessel, cardioembolic), seizure at onset, time from symptom onset to EMS arrival, time from EMS to hospital arrival, blood pressure and serum glucose on EMS arrival, and EMS level of training. Univariate analysis was completed using Wilcoxon rank sum test for continuous measures and chi-square or Fisher’s exact test for categorical measures. Multivariate analysis was completed on variables with p ≤ 0.20 in the univariate analysis. Results: Of 2708 total stroke patients, 1097 (870 IS, 176 ICH, 51 SAH) had EMS records (median [IQR] age 74 [61, 83] years; 56% female; 21% black). Onset to EMS arrival was ≤4.5 hours for 508 cases (46%), and median time from EMS to hospital arrival was 26 minutes. Neurological deterioration occurred in 129 cases (12%), including 9.1% of IS and 22% of ICH/SAH. In multivariate analysis, black race, atrial fibrillation, ICH or SAH subtype, and ALS transport were associated with neurological deterioration. Conclusion: Atrial fibrillation may predict prehospital deterioration in stroke, and preferential transport of patients with acute worsening to centers capable of managing hemorrhagic stroke may be justifiable. Further studies are needed to identify why race is associated with deterioration and potential areas of intervention.

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Evaluation of Endovascular Treatment for Acute Basilar Occlusion in a State-Wide Prospective Stroke Registry

Frontiers in Neurology ◽

10.3389/fneur.2021.678505 ◽

2021 ◽

Vol 12 ◽

Author(s):

Katharina Gruber ◽

Björn Misselwitz ◽

Helmuth Steinmetz ◽

Waltraud Pfeilschifter ◽

Ferdinand O. Bohmann

Keyword(s):

Endovascular Therapy ◽

Binary Logistic Regression ◽

Population Based ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Stroke Registry ◽

Best Medical Treatment ◽

Subgroup Analyses

Context: Despite overwhelming evidence for endovascular therapy in anterior circulation ischemic stroke due to large-vessel occlusion, data regarding the treatment of acute basilar artery occlusion (BAO) are still equivocal. The BASICS trial failed to show an advantage of endovascular therapy (EVT) over best medical treatment (BMT). In contrast, data from the recently published BASILAR registry showed a better outcome in patients receiving EVT.Objective: The aim of the study was to investigate the safety and efficacy of EVT plus BMT vs. BMT alone in acute BAO.Methods: We analyzed the clinical course and short-term outcomes of patients with radiologically confirmed BAO dichotomized by BMT plus EVT or BMT only as documented in a state-wide prospective registry of consecutive patients hospitalized due to acute stroke. The primary endpoint was a favorable functional outcome (mRS 0–3) at hospital discharge assessed as common odds ratio using binary logistic regression. Secondary subgroup analyses and propensity score matching were added. Safety outcomes included mortality, the rate of intracerebral hemorrhages, and complications during hospitalization.Results: We included 403 patients with acute BAO (2017–2019). A total of 270 patients (67%) were treated with BMT plus EVT and 133 patients (33%) were treated with BMT only. A favorable outcome (mRS 0–3) was observed in 33.8% of the BMT and 26.7% of the BMT plus EVT group [OR.770, CI (0.50–1.2)]. Subgroup analyses for patients with a NIHSS score > 10 at admission to the hospital revealed a benefit from EVT [OR 3.05, CI (1.03–9.01)].Conclusions: In this prospective, quasi population-based registry of patients hospitalized with acute BAO, BMT plus EVT was not superior to BMT alone. Nevertheless, our results suggest that severely affected BAO patients are more likely to benefit from EVT.

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Vascular Occlusion Evolution in Endovascular Reperfusion Candidates Transferred from Primary to Comprehensive Stroke Centers

Cerebrovascular Diseases ◽

10.1159/000511063 ◽

2020 ◽

Vol 49 (5) ◽

pp. 550-555

Author(s):

Alan Flores ◽

Xavier Ustrell ◽

Laia Seró ◽

Anna Pellisé ◽

Paula Rodriguez ◽

...

Keyword(s):

Clinical Improvement ◽

Independent Predictor ◽

Univariate Analysis ◽

Vascular Occlusion ◽

Population Based ◽

Large Vessel Occlusion ◽

Time Intervals ◽

Vessel Occlusion ◽

Population Based Registry ◽

Modest Effect

Background: The evolution of the symptomatic intracranial occlusion during transfers from primary stroke centers (PSCs) to comprehensive stroke centers (CSCs) for endovascular treatment (EVT) is not widely known. Our aim was to identify factors related to partial or complete recanalization (REC) at CSC arrival in patients with a documented large vessel occlusion (LVO) in PSC transferred for EVT evaluation to better define the workflow at CSC of this group of patients. Methods: We conducted an observational, multicenter study from a prospective, government-mandated, population-based registry of stroke patients with documented LVO at PSC transferred to CSC for EVT from January 2017 to June 2019. The primary end point was defined as partial or complete REC that precluded EVT at CSC arrival (REC). We evaluated the association between baseline, treatment variables and time intervals with the presence of REC. Results: From 589 patients, the rate of REC at CSC was 10.5% in all LVO patients transferred from PSC to CSC for EVT evaluation. On univariate analysis, lower PSC-NIHSS (median 12vs.16, p = 0.001), tPA treatment at PSC (13.7 vs. 5.0%; p = 0.001), presence of M2 occlusion on PSC (16.8 vs. 9%; p = 0.023), and clinical improvement at CSC arrival (21.7 vs. 9.6% p = 0.001) were associated with REC at CSC. On multivariate analysis, clinical improvement at CSC arrival (p < 0.001, OR: 5.96 95% CI: 2.5–13.9) and PSC tPA treatment predicted REC (p = 0.003, OR: 4.65, 95% CI: 1.73–12.4). Conclusion: REC at CSC arrival occurs exceptionally in patients with a documented LVO on PSC. Repeating a second vascular study before EVT would not be necessary in most patients. Despite its modest effect, tPA treatment at PSC was an independent predictor of REC.

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The risk of debilitating falls in Manitobans living with prostate cancer (pc).

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.6_suppl.244 ◽

2013 ◽

Vol 31 (6_suppl) ◽

pp. 244-244

Author(s):

Joel Roger Gingerich ◽

Pascal Lambert ◽

Malcolm Doupe ◽

Paul Joseph Daeninck ◽

Marshall W. Pitz ◽

...

Keyword(s):

Multivariate Analysis ◽

Cumulative Incidence ◽

Large Population ◽

Univariate Analysis ◽

Population Based ◽

Community Dwelling ◽

Low Grade ◽

Population Based Study ◽

Increased Risk

244 Background: Falls and fall-related injuries are important patient safety problems. Some studies suggest that pc patients have higher fall rates, however the severity of these falls is unknown. We sought to measure if pc patients are at increased risk of a debilitating fall requiring hospitalization. Methods: This is a retrospective population-based study utilizing the Manitoba Cancer Registry and Manitoba Health administrative databases. Our cohort consists of all community-dwelling patients living in Manitoba Canada who were diagnosed with pc between 2004 and 2008. These individuals were matched by age, sex, and time of diagnosis with up to three cancer-free controls. Debilitating falls were defined as falls/fractures requiring hospitalization and were identified using ICD-9 and -10 billing codes. A competing risk model was used to compare debilitating falls between the pc and cancer-free cohorts and expressed as sub-hazard ratios. Follow-up ended December 31, 2009. Results: 2,903 pc patients were identified along with 8,686 matched controls. The mean age was 69.3 and 68.8 respectively. The median follow-up was 3.05 years. Debilitating falls were identified in 109 patients (3.8%) with pc and 345 (4%) matched controls. The cumulative incidence of debilitating falls for those with pc vs cancer-free controls were: 1.08% vs. 1.13% at 1-year and 5.25% vs. 5.96% at five years of follow-up (SHR = 0.95, 95% CI = 0.77 – 1.18, p = 0.65). On univariate analysis, patients with stage IV pc were at higher risk of falls compared to matched controls. This difference was not significant on multivariate analysis though (SHR = 1.19, 95% CI = 0.74 – 1.89, p = 0.48). On multivariate analysis, patients with a Gleason score of ≤6 experienced a reduced risk of debilitating falls compared to matched controls (SHR = 0.44, 95% CI = 0.27 – 0.72, p = 0.001), whereas patients with other Gleason scores did not. The analysis was similar when patients with fractures were excluded. Conclusions: In this large population-based study, the 1- and 5-year cumulative incidence of debilitating falls did not differ significantly for patients with vs without pc. In fact, compared to matched controls, low grade pc patients were less likely to experience a debilitating fall.

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Geographic and demographic disparities in colorectal cancer: A population-based study.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e19047 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e19047-e19047

Author(s):

Navpreet Kaur Rana ◽

Rohit Gosain ◽

Riccardo Lemini ◽

Chong Wang ◽

Steven J. Nurkin ◽

...

Keyword(s):

Colorectal Cancer ◽

Multivariate Analysis ◽

Native American ◽

Urban Areas ◽

Univariate Analysis ◽

Population Based ◽

Lower Income ◽

Related Data ◽

Rural And Urban Areas ◽

The Impact

e19047 Background: Colorectal cancer is one of the leading causes of cancer deaths in the US. Area of residence affects survival in many cancers, though largely unknown in colorectal cancer. The purpose of this study is to evaluate disparities between the metropolitan, urban and rural populations and the impact on survival in colorectal cancer. Methods: Data was obtained from the National Cancer Database (NCDB) colon, rectosigmoid, and rectal data sets. Patients (pts) were categorized by area of residence: metropolitan (MA), urban (UA), or rural (RA). Gender, race, insurance status, income, marital status, and tumor related data was collected. Univariate and multivariate analyses were performed to evaluate variables affecting overall survival (OS). Results: A total of 973,139 pts, spanning 2004-2013 were included in the study, 83% MA, 15% UA, 2% RA. RA and UA pts were more likely to be white than MA pts (92.7 v 91.4% v 83%). RA and UA were more likely to have lower income, with slightly lesser amounts of women and pts with no comorbidities. Uninsured rates were similar (3.3%). On univariate analysis, OS was worse for RA (HR 1.10) and UA (1.06) pts, as compared with MA. On multivariate analysis, small differences persisted with worse OS for RA (HR 1.02, p = .043) and UA (HR 1.01, p = .003). Black (HR 1.14) and native American (HR 1.17) pts had worse outcomes, while Asian (HR 0.8) pts had improved OS. Women (HR 0.88) and pts with higher incomes ( > 46K or 63K) had improved OS (HR 0.88). Conclusions: This study identifies socio-demographic disparities in colorectal cancer outcomes. Pts from rural and urban areas had worse OS, even though the proportion of minority pts with poor outcomes was lower. The difference in OS for RA and UA remained statistically significant in multivariate analysis, though it was largely corrected when adjusting for influencing variables. Part of this difference may be due to economic disparities, as lower income was linked to worse OS. This can independently limit access to care, especially for geographically isolated individuals. Additional research efforts are needed in order for us to better understand the key issues facing and the optimal means to improve outcomes in at risk populations.

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Adjuvant chemotherapy in nonmetastatic goblet cell carcinomas: A population-based analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e16203 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e16203-e16203

Author(s):

Valentina Tateo ◽

Elisa Andrini ◽

Davide Campana ◽

Giuseppe Lamberti

Keyword(s):

Multivariate Analysis ◽

Adjuvant Chemotherapy ◽

Lymph Nodes ◽

Univariate Analysis ◽

Population Based ◽

Tumor Diameter ◽

Nodal Involvement ◽

Metastatic Lymph Nodes ◽

Risk Of Death ◽

Metastatic Lymph

e16203 Background: Goblet cell carcinoma (GCC) is a rare mixed endocrine-neuroendocrine tumor arising almost exclusively in the appendix. The optimal management of these patients is still unclear, given GCC rarity and the difficulty in proper pathology diagnosis. We sought to explore the efficacy of adjuvant chemotherapy (ACT) in GCC extracted from the Surveillance, Epidemiology and End Result (SEER) US registry. Methods: Patients with pathology diagnosis of GCC were identified in the SEER registry by the 8243 ICD-09 code. Data about sex, age, tumor stage at diagnosis, number of analyzed and positive lymph-nodes, chemotherapy and survival were collected. Lymph node ratio (LNR) was calculated as the ratio between the number of metastatic lymph-nodes and removed lymph nodes. The best cutoff to predict survival state at 5-year from diagnosis was calculated. The primary endpoint was overall survival (OS). Results: Overall, 1055 GCC patients (51.7% male, median age 57 years) were identified. The median tumor diameter was 20 mm. According to the American Joint Committee on Cancer staging manual 7th edition, 128 patients (12.1%) had nodal involvement (N+): 95 were N1 and 33 were N2, while 66 (6.3%) had distant metastasis (M+). Prognostic LNR cutoff was 0.16. Using this cutoff, LNR was ≤0.16 in 674 patients (63.9%), and > 0.16 in 125 patients (11.8%). The median OS was 232 months (95% confidence interval [95%CI]: 153.4-310.5). Overall, 5-year survival rate (OS-5) was 73.4% (N = 453). At univariate analysis age, tumor diameter, M+, N+, number of lymph nodes removed, number of metastatic lymph nodes and LNR were significantly associated with the risk of death. At multivariate analysis, age, M+, N+, number of removed lymph nodes, and number of metastatic lymph nodes retained their association. After excluding M+ and N+ patients, 897 localized GCC patients (52.8% male) were analyzed. Fifty-five patients (6.1%) received ACT and OS-5 was 83.8% (N = 425). CT was administered more often in tumors with higher histological grade, higher T stage and greater tumor diameter. At the multivariate analysis, only age and number of removed lymph nodes were independently associated with the risk of death. Notably, ACT was not associated with increased survival. Ninety-two patients (57.6% male) had nodal involvement without distant metastases: 73 were N1 and 19 were N2. In 56 patients (60.9%) LNR was ≤0.16, while it was > 0.16 in 35 (38.0%). Thirty-five patients (38%) received ACT, without significant imbalances. OS-5 was 45.2% (N = 28). At univariate analysis, age, N2, number of metastatic lymph nodes and LNR were significantly associated with the risk of death. At multivariate analysis, only the number of metastatic lymph nodes retained its association. Of note, ACT was not associated with increased survival. Conclusions: In GCC, ACT was not associated with increased survival in our population-based analysis, irrespective of nodal involvement.

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Abstract W P6: North American Solitaire Stent-Retriever Acute Stroke Registry: Choice of Anesthesia and Outcomes

Stroke ◽

10.1161/str.45.suppl_1.wp6 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Alex Abou-Chebl ◽

Osama O Zaidat ◽

Alicia C Castonguay ◽

Guilherme Dabus ◽

Michael T Froehler ◽

...

Keyword(s):

Multivariate Analysis ◽

Ischemic Stroke ◽

Clinical Outcome ◽

North American ◽

Primary Outcome ◽

Negative Impact ◽

Outcome Data ◽

Anterior Circulation ◽

Stroke Registry ◽

Guide Catheter

Background and Purpose: Previous work has suggested that general anesthesia (GA) may have a negative impact on outcomes in acute ischemic stroke (AIS) patients undergoing endovascular therapy, however, those data predated the availability of the safer and possibly more effective stentriever devices. Methods: The investigator-initiated NASA Registry recruited North American sites to submit demographic, clinical, procedural (including use of GA versus local anesthesia [LA]), and site-adjudicated angiographic and clinical outcome data on consecutive patients treated with the Solitaire™ FR device. The primary outcomes were mRS at 90-days, mortality, and sICH. Results: A total of 281 patients from 18 centers were enrolled in this sub-study. GA was utilized in 69.8% (196/281) of patients. Baseline demographics were comparable between the LA and GA groups, except the former demonstrated a longer time to groin puncture (395.4±254 versus 337.4±208min, p=0.04) and slightly lower NIHSS (16.2±5.8 versus 18.8±6.9, p=0.002). Procedural factors were also similar, although lower balloon-guide catheter usage (22.4% versus 49.2%, p=0.0001) and longer fluoroscopy times (39.5±33 versus 28±22.8min, p=0.008) were seen in the LA versus GA cohorts, respectively. Recanalization (TICI≥2a) success (91.8 versus 86.8%, p=0.3) and the rate of sICH (7.1% versus 11.2%, p=0.4) were similar between the LA and GA patients, respectively. The primary outcome of mRS≤2 was achieved in 52.6% and 35.6% (OR 1.4[1.1-1.8], p=0.01) of LA and GA patients, respectively. In a multivariate analysis, hypertension, NIHSS, unsuccessful revascularization, and GA use (OR 3.3(1.6-7.1), p=0.001) were associated with death. To account for potential confounders, when only anterior circulation patients and patients who were electively intubated were included, there was a persistent difference in good outcomes in favor of the LA patients (50.7% versus 35.5%, OR 1.3[1.01-1.6], p=0.04). Conclusions: The NASA Registry has demonstrated that clinical outcomes and survival are significantly better in patients treated without GA without any increase in sICH. Future AIS trials should prospectively evaluate the effect of GA on outcomes.

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Association between schizophrenia and an autoimmune bullous skin disease-pemphigus: a population-based large-scale study

Epidemiology and Psychiatric Sciences ◽

10.1017/s204579601700052x ◽

2017 ◽

Vol 28 (2) ◽

pp. 191-198 ◽

Cited By ~ 5

Author(s):

K. Kridin ◽

S. Zelber-Sagi ◽

D. Comaneshter ◽

A. D. Cohen

Keyword(s):

Multivariate Analysis ◽

Large Scale ◽

Matched Control ◽

Univariate Analysis ◽

Real Life ◽

Population Based ◽

Cross Sectional Study ◽

Control Group ◽

Cross Sectional ◽

Wide Range

Aims.Immunological hypotheses have become increasingly prominent suggesting that autoimmunity may be involved in the pathogenesis of schizophrenia. Schizophrenia was found to be associated with a wide range of autoimmune diseases. However, the association between pemphigus and schizophrenia has not been established yet. We aimed to estimate the association between pemphigus and schizophrenia using a large-scale real-life computerised database.Methods.This study was conducted as a cross-sectional study utilising the database of Clalit Health Services. The proportion of schizophrenia was compared between patients diagnosed with pemphigus and age-, gender- and ethnicity-matched control subjects. Univariate analysis was performed usingχ2and Student'st-test and a multivariate analysis was performed using a logistic regression model.Results.A total of 1985 pemphigus patients and 9874 controls were included in the study. The prevalence of schizophrenia was greater in patients with pemphigus as compared to the control group (2.0%v. 1.3%, respectively;p= 0.019). In a multivariate analysis, pemphigus was significantly associated with schizophrenia (OR, 1.5; 95% CI, 1.1–2.2). The association was more prominent among females, patients older than 60 years, and Jews.Conclusions.Pemphigus is significantly associated with schizophrenia. Physicians treating patients with pemphigus should be aware of this possible association. Patients with pemphigus should be carefully assessed for comorbid schizophrenia and be treated appropriately.

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Neoadjuvant radiotherapy followed by surgery compared with surgery alone in the treatment of retroperitoneal sarcoma: a population-based comparison

Current Oncology ◽

10.3747/co.26.5185 ◽

2019 ◽

Vol 26 (6) ◽

Cited By ~ 3

Author(s):

B. T. Turner ◽

L. Hampton ◽

D. Schiller ◽

L. A. Mack ◽

C. Robertson-More ◽

...

Keyword(s):

Multivariate Analysis ◽

Local Recurrence ◽

Tumour Size ◽

Univariate Analysis ◽

Multivisceral Resection ◽

Population Based ◽

Retroperitoneal Sarcoma ◽

Fisher Exact Test ◽

Tumour Grade ◽

Neoadjuvant Radiotherapy

Introduction Retroperitoneal sarcoma (rps) encompasses a heterogeneous group of malignancies with a high recurrence rate after resection. Neoadjuvant radiotherapy (nrt) is often used in the hope of sterilizing margins and decreasing local recurrence after excision. We set out to compare local recurrence-free survival (lrfs) and overall survival (os) in patients treated with or without nrt before resection.Methods Patients diagnosed with rps from February 1990 to October 2014 were identified in the Alberta Cancer Registry. Patients with complete gross resection of rps and no distant disease were included. Patient, tumour, treatment, and outcomes data were abstracted in a primary chart review. Baseline characteristics were compared using the Wilcoxon nonparametric test for continuous data and the Fisher exact test for dichotomous and categorical data. Survival was analyzed using Kaplan–Meier curves with log-rank test. Cox regression was performed to control for age, sex, tumour size, tumour grade, date of diagnosis, multivisceral resection, and intraoperative rupture.Results Resection alone was performed in 62 patients, and resection after nrt, in 40. Use of nrt was associated with multivisceral resection and negative microscopic margins. On univariate analysis, nrt was associated with superior median lrfs (89.3 months vs. 28.4 months, p = 0.04) and os (119.4 months vs. 75.9 months, p = 0.04). On multivariate analysis, nrt, younger age, and lower tumour grade predicted improved lrfs and os; sex, tumour size, date of diagnosis, multivisceral resection, and tumour rupture did not.Conclusions In this population-based study, nrt was associated with superior lrfs and os on both univariate and multivariate analysis. When feasible, nrt should be considered until a randomized controlled trial is completed.

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Evaluating malignant intraductal papillary mucinous neoplasm: A population-based study.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.324 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 324-324

Author(s):

Carrie Luu ◽

Rebecca A. Nelson ◽

Byrne Lee ◽

Gagandeep Singh ◽

Joseph Kim

Keyword(s):

Multivariate Analysis ◽

Lymph Nodes ◽

Intraductal Papillary Mucinous Neoplasm ◽

Univariate Analysis ◽

Survival Rates ◽

Tumor Grade ◽

Population Based ◽

Curative Surgery ◽

Mucinous Neoplasm ◽

Invasive Ipmn

324 Background: Intraductal papillary mucinous neoplasm (IPMN) of the pancreas has been increasingly recognized. Due to a paucity of evidence, the management and treatment of IPMN is still under debate. We hypothesize that with increased awareness, the incidence and resection rates for IPMN would increase. Using a population-based cancer registry, we examined incidence, prognostic factors, and survival for IPMN. Methods: Patients diagnosed with invasive IPMN from 1988 to 2009 were identified by the Surveillance, Epidemiology, and End Results (SEER) database. Patient demographics, clinical and pathologic factors, and therapies received (surgery and/or radiation) were analyzed. Survival was assessed by Kaplan-Meier method; Cox proportional hazard modeling was used for multivariate analysis. Results: 2,987 patients were identified. Over the study period, there was a decrease in age-adjusted incidence. The overall resection rate was 20.6% with an increase in annual rates of resection. On univariate analysis, age greater than 65 years, tumor location, poorly differentiated tumor grade, higher T stage, and positive lymph nodes predicted worse survival; more recent diagnosis, higher number of lymph nodes examined, and surgery were indicators of improved survival. On multivariate analysis, curative surgery remained predictive of survival. Patients who underwent surgery had median survival rates of 87, 18, and 14 months compared to 6, 7, and 5 months in the no surgery group for stages I, II, and III, respectively. Conclusions: Although recent reports show increasing incidence of IPMN, our study involving a population-based cohort demonstrates decreasing incidence of malignant IPMN. This may be accounted for by increased detection of non-malignant disease. It is imperative that we identify patients with invasive IPMN early so that they may benefit from the survival advantage conferred by curative resection.

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