Abstract WP183: Borderzone Infarcts Predict Early Recurrence in Patients With Large Artery Atherosclerotic Subtype Despite Medical Treatment

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Alexandra Kvernland ◽  
Shyam Prabhakaran ◽  
Pooja Khatri ◽  
Adam De Havenon ◽  
Sharon Yeatts ◽  
...  
Keyword(s):  
High Risk ◽  
Medical Treatment ◽  
Cox Regression ◽  
Recurrent Stroke ◽  
Treatment Strategies ◽  
Surrogate Marker ◽  
Early Recurrence ◽  
Large Artery ◽  
Cerebrovascular Events ◽  
Increased Risk

Introduction: Large artery atherosclerosis subtype carries a high risk of early recurrent stroke despite medical management. Predictors of recurrence remain poorly understood. We hypothesized that borderzone infarcts are associated with a higher risk of recurrence. Objectives: We aim to investigate infarct patterns and 90-day recurrence in patients with symptomatic intracranial and/or extracranial atherosclerotic disease. Methods: We included consecutive patients admitted to NYU Langone Health (Manhattan and Brooklyn campuses) over 32-months with a diagnosis of acute ischemic stroke secondary to symptomatic intracranial or extracranial atherosclerosis. The primary predictor was infarct pattern (borderzone vs. non-borderzone infarction), defined in accordance to previous studies. Borderzone infarcts were divided into internal borderzone and cortical borderzone. We used univariate and multivariable cox-regression models to determine associations between infarct pattern and recurrent cerebrovascular events (RCVE) at 90-days. Results: Fifty-five patients met the inclusion criteria; 38 were intracranial, 3 tandem, 14 extracranial. Nearly 71% of patients were treated with dual antiplatelet therapy and 96% were treated with high intensity statin. The RCVE rate was 23.6%. In multivariable models, borderzone infarcts were associated with increased risk of RCVE (adjusted HR 9.8 95% CI 2.1-44.8, p=0.003). The risk of RCVE was highest among internal borderzone infarcts (47.3%) as opposed to cortical borderzone infarcts (33.3%) or non borderzone infarcts (18.8%). Conclusions: Borderzone (and particularly internal borderzone) infarcts are a surrogate marker of impaired distal blood flow and are associated with RCVE despite medical treatment. This highlights the need to develop alternate treatment strategies for this high-risk cohort.

Abstract P605: Border-Zone Infarcts Predict Early Recurrence in Patients With Large Artery Atherosclerotic Subtype Despite Medical Treatment

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Alexandra Kvernland ◽  
Shyam Prahbakaran ◽  
Pooja Khatri ◽  
Adam H De Havenon ◽  
Sharon D Yeatts ◽  
...  
Keyword(s):  
High Risk ◽  
Regression Models ◽  
Cox Regression ◽  
Surrogate Marker ◽  
Border Zone ◽  
Sensitivity Analyses ◽  
Large Artery ◽  
Intracranial Atherosclerotic Disease ◽  
Increased Risk ◽  
Tandem Lesions

Objective: We aim to investigate infarct patterns and 90-day recurrence in patients with symptomatic intracranial atherosclerotic disease. Background: Large artery atherosclerosis subtype carries a high risk of early recurrent stroke despite medical management. Predictors of recurrence remain poorly understood. We hypothesized that border-zone infarcts are associated with a higher risk of recurrence. Design/Methods: We included consecutive patients admitted to NYU Langone Health (Manhattan and Brooklyn campuses) over 32-months with a diagnosis of acute ischemic stroke secondary to symptomatic intracranial or tandem atherosclerosis. Patients with purely extracranial stenosis were excluded. The primary predictor was infarct pattern (border-zone vs. non-border-zone infarction), defined in accordance to previous studies. We used univariate and multivariable cox-regression models to determine associations between infarct pattern and recurrent cerebrovascular events (RCVE) at 90-days. Results: Ninety-nine patients met the inclusion criteria; 95 were intracranial and 4 were tandem lesions. The mean age was 70 years, 58.6% were men, 15.1% Black and 16.1% Asian. The median symptom onset to arrival time was 1 day, nearly 74.7% of patients were treated with dual antiplatelet therapy and 99% were treated with high intensity statin. Within 90 days of follow up, 19.2% (19/99) had RCVE. In univariate analyses, the only factor associated with RCVE was border-zone infarct pattern when compared to non-border-zone infarct pattern (30.2% vs. 10.7%, p=0.02). In cox regression models, after adjusting for age and sex, border-zone infarct pattern was associated with increased risk of RCVE (adjusted HR 3.21 95% CI 1.21-8.51, p=0.019). Sensitivity analyses excluding patients with tandem lesions (n = 4) did not meaningfully change our findings (adjusted HR 3.04 95% CI 1.11-8.31, p=0.031). Conclusions: In real world post-SAMMPRIS medically treated patients with ICAD, infarct pattern was predictive of 90-day RCVE. Border-zone infarcts are likely a surrogate marker of impaired distal blood flow, highlighting the importance of targeting stroke mechanisms and developing alternative treatment strategies for this high-risk cohort.

scholarly journals The Impact of Ischaemic Stroke Subtype on 30-day Hospital Readmissions

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Anna Therese Bjerkreim ◽  
Andrej Netland Khanevski ◽  
Henriette Aurora Selvik ◽  
Ulrike Waje-Andreassen ◽  
Lars Thomassen ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Functional Outcome ◽  
Cox Regression ◽  
Recurrent Stroke ◽  
Hospital Readmissions ◽  
Large Artery ◽  
Stroke Subtype ◽  
Increased Risk ◽  
One Year ◽  
The Impact

Background. Stroke aetiology may affect the risk and causes of readmission after ischaemic stroke (IS) and transient ischaemic attack (TIA) due to differences in risk factors, functional outcome, and treatment. We aimed to examine frequencies, causes, and risk of 30-day readmission by stroke subtype, determine predictors of 30-day readmission, and study the impact of 30-day readmissions on one-year mortality. Methods. All surviving patients admitted with IS or TIA from July 2007 to December 2013 were followed by review of medical records for all unplanned readmissions within 30 days after discharge. Stroke subtype was classified as large-artery atherosclerosis (LAA), cardioembolism (CE), small vessel occlusion (SVO), stroke of other determined aetiology (SOE), or stroke of undetermined aetiology (SUE). Cox regression analyses were performed to assess the risk of 30-day readmission for the stroke subtypes and identify predictors of 30-day readmission, and its impact on one-year mortality. Results. Of 1874 patients, 200 (10.7%) were readmitted within 30 days [LAA 42/244 (17.2%), CE 75/605 (12.4%), SVO 12/205 (5.9%), SOE 6/32 (18.8%), SUE 65/788 (8.3%)]. The most frequent causes of readmissions were stroke-related event, infection, recurrent stroke/ TIA, and cardiac disease. After adjusting for age, sex, functional outcome, length of stay, and the risk factor burden, patients with LAA and SOE subtype had significantly higher risks of readmission for any cause, recurrent stroke or TIA, and stroke-related events. Predictors of 30-day readmission were higher age, peripheral arterial disease, enteral feeding, and LAA subtype. Thirty-day readmission was an independent predictor of one-year mortality. Conclusions. Patients with LAA or SOE have a high risk of 30-day readmission, possibly caused by an increased risk of recurrent stroke and stroke-related events. Awareness of the risk of readmission for different causes and appropriate handling according to stroke subtype may be useful for preventing some readmissions after stroke.

Abstract TP84: Predictors of Outcomes From Carotid Endarterectomy and Implications of SAPPHIRE Risk Criteria for the 30 day MACCE Endpoint - a Prospective Evaluation

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Roland Richard Macharzina ◽  
Carolin Müller ◽  
Matthias Vogt ◽  
Steven R Messé ◽  
Werner Vach ◽  
...  
Keyword(s):  
High Risk ◽  
Carotid Endarterectomy ◽  
Cox Regression ◽  
Real Life ◽  
Limited Data ◽  
Term Outcome ◽  
Cerebrovascular Events ◽  
Improve Patient Selection ◽  
Increased Risk ◽  
Improve Patient

Introduction: Identifying factors associated with short term outcome following carotid endarterectomy (CEA) is important to improve patient selection. There are limited data assessing 30-day major adverse cardiac and cerebrovascular events (MACCE: stroke, myocardial infarction (MI) and death) in clinical practice. Hypothesis: We hypothesized that patients fulfilling SAPPHIRE high risk (SHR) or exclusion (SEC) criteria contribute to worse outcomes in a real-life cohort. Methods: Patients undergoing CEA at 2 centers between 1998 and 2010 were prospectively entered into a database. Baseline characteristics, comorbidities, SHR and SEC were assessed using Cox regression to determine predictors for the MACCE 30-day endpoint. Results: The analysis included 748 operations, 262 (35%) asymptomatic , 211 (28%) with previous strokes, and 278 (37%) with transient ischemic attacks (TIA). The overall MACCE rate was 6.7%, 5.0% of asymptomatic and 7.6% in symptomatic patients. SEC patients (n=137) had a MACCE rate of 14.7%; after exclusion, the MACCE rate of the remainder dropped to 4.9% (3.5% in asymptomatic and 5.4% in symptomatic patients). Hazard ratio (HR) for SEC was 3.605 (p=0.0001) after adjustment for symptomatic status. SHR patients did not show a significantly increased event rate (HR 1.714, p=0.16). In multivariate analysis diabetes (HR 2.019, p=0.02), symptomatic status (HR 2.015, p=0.049) and prior MI (HR 1.957, p=0.03) showed an independent influence on MACCE. Conclusion: High risk clinical characteristics, as defined by the SAPPHIRE study were not independently associated with 30-day increased risk of MACCE, although exclusion criteria from that study, diabetes, symptomatic status and prior MI were associated with outcomes.

Ischaemic stroke on anticoagulation therapy and early recurrence in acute cardioembolic stroke: the IAC study

2021 ◽  
pp. jnnp-2021-326166
Author(s):  
Shadi Yaghi ◽  
Nils Henninger ◽  
James A Giles ◽  
Christopher Leon Guerrero ◽  
Eva Mistry ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Cox Regression ◽  
Anticoagulation Therapy ◽  
Early Recurrence ◽  
Cardioembolic Stroke ◽  
Prevention Measures ◽  
Event Risk ◽  
Increased Risk ◽  
The Usa ◽  
Adjusted Model

Background and purposeA subset of ischaemic stroke patients with atrial fibrillation (AF) have ischaemic stroke despite anticoagulation. We sought to determine the association between prestroke anticoagulant therapy and recurrent ischaemic events and symptomatic intracranial haemorrhage (sICH).MethodsWe included consecutive patients with acute ischaemic stroke and AF from the Initiation of Anticoagulation after Cardioembolic stroke (IAC) study from eight comprehensive stroke centres in the USA. We compared recurrent ischaemic events and delayed sICH risk using adjusted Cox regression analyses between patients who were prescribed anticoagulation (ACp) versus patients who were naïve to anticoagulation therapy prior to the ischaemic stroke (anticoagulation naïve).ResultsAmong 2084 patients in IAC, 1518 had prior anticoagulation status recorded and were followed for 90 days. In adjusted Cox hazard models, ACp was associated with some evidence of a higher risk higher risk of 90-day recurrent ischaemic events only in the fully adjusted model (adjusted HR 1.50, 95% CI 0.99 to 2.28, p=0.058) but not increased risk of 90-day sICH (adjusted HR 1.08, 95% CI 0.46 to 2.51, p=0.862). In addition, switching anticoagulation class was not associated with reduced risk of recurrent ischaemic events (adjusted HR 0.41, 95% CI 0.12 to 1.33, p=0.136) nor sICH (adjusted HR 1.47, 95% CI 0.29 to 7.50, p=0.641).ConclusionAF patients with ischaemic stroke despite anticoagulation may have higher recurrent ischaemic event risk compared with anticoagulation-naïve patients. This suggests differing underlying pathomechanisms requiring different stroke prevention measures and identifying these mechanisms may improve secondary prevention strategies.

scholarly journals Concurrent intracranial and extracranial artery stenosis and the prognosis of transient ischaemic symptoms or imaging-negative ischaemic stroke

2020 ◽  
pp. svn-2020-000377
Author(s):  
Yue Suo ◽  
Jing Jing ◽  
Yuesong Pan ◽  
Weiqi Chen ◽  
Hongyu Zhou ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Cox Regression ◽  
Recurrent Stroke ◽  
Time Interval ◽  
Symptom Duration ◽  
Large Artery ◽  
Imaging Data ◽  
Vascular Events ◽  
Acute Infarction ◽  
Atherosclerotic Stenosis

Background and purposeTransient ischaemic attack (TIA), transient symptoms with infarction (TSI) and diffusion-weighted imaging (DWI)-negative acute ischaemic stroke (AIS) share similar aetiologies but are considered to have a rather benign prognosis. We intended to investigate the association between intracranial atherosclerotic stenosis (ICAS), extracranial atherosclerotic stenosis (ECAS) and the prognosis of patients with TIA, TSI and DWI-negative AIS.MethodsClinical and imaging data of eligible participants were derived from the Chinese Intracranial Atherosclerosis study, according to symptom duration, acute infarction on DWI and discharge diagnosis. Based on the severity and location of arterial atherosclerosis, we categorised the study population into four groups: no or <50% ICAS and no ECAS; ≥50% ICAS but no ECAS; no or <50% ICAS with ECAS; and concurrent ≥50% ICAS and ECAS. Using multivariable Cox regression models, we analysed the relationship between the severity and distribution of large artery atherosclerosis and the prognosis of TIA, TSI and DWI-negative AIS.ResultsA total of 806 patients were included, 67.3% of whom were male. The median age of the study participants was 63 years. Patients in the concurrent ≥50% ICAS and ECAS subgroup had both a significantly higher 1-year recurrence rate (adjusted HR 3.4 (95% CI 1.15 to 10.04), p=0.027) and a higher risk of composite vascular events (adjusted HR 3.82 (95% CI 1.50 to 9.72), p=0.005).ConclusionsConcurrent ICAS and ECAS is associated with a higher possibility of 1-year recurrent stroke or composite vascular events. Large artery evaluation is necessary to assess patients with transient ischaemic symptoms or DWI-negative AIS. Progress in shortening the time interval between symptom onset and large vessel evaluation is needed.

scholarly journals High-risk lifestyle and all-cause mortality in older Australians with stroke: A data linkage study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
W Peng ◽  
Andrew Hayen ◽  
J a n e Maguire ◽  
J o n Adams ◽  
David Sibbritt
Keyword(s):  
Public Health ◽  
High Risk ◽  
Cox Regression ◽  
Healthy Lifestyle ◽  
Lifestyle Factors ◽  
Stroke Survivors ◽  
Vigorous Exercise ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Background Stroke prevention via lifestyle modification is a public health priority in developed countries. Few studies have examined the association of high-risk lifestyle factors with long-term mortality of stroke survivors. Therefore, this study aims to explore the effect of key lifestyle factors on all-cause mortality after stroke. Methods Sample is derived from the 45 and Up Study, the largest ongoing study in the Southern Hemisphere focusing on the health of people aged 45 years and older living in NSW, Australia. The lifestyle data in the 45 and Up Study between 2006 to 2015 were linked with data from the NSW Registry of Births, Deaths and Marriages, NSW Cause of Death Unit Record File, and NSW Admitted Patient Data Collection by the Centre for Health Record Linkage. We defined a high-risk lifestyle as no vigorous exercise, smokers, or &gt; 10 alcoholic drinks/week. Multivariate Cox regression model is used to examine the effect of high-risk lifestyle on survival using 10-year all-cause mortality as the main outcome, adjusted for key confounders. Results We analysed information on 8410 adults with a stroke event occurring prior to the baseline 45 and Up Study, and 31% of them died in 10 years. 6219 participants were identified as having a high-risk lifestyle at baseline. Being a current smoker and without vigorous exercise were associated with 41% (95% CI: 16%, 73%) and 52% (95% CI: 30%, 78%) increase in the likelihood of death in 10 years, respectively. However, high-risk alcohol drinking was not significantly associated with survival. Of note, having cardiovascular-related comorbidities showed greater risks of mortality (HR range, 3.6-7.2). Conclusions High-risk lifestyle factors were associated with an increased risk of long-term all-cause mortality, suggesting that enhancing public health initiatives to promote 'healthy' lifestyle behaviours can be of great benefit to stroke survivors. Key messages It is essential for stroke survivors to maintain a healthy lifestyle to delay all-cause mortality. Stroke survivors with high-risk lifestyle may be associated with increased likelihood of death if they have comorbidities such as diabetes and hypertension.

scholarly journals Hospital Frailty Risk Score Is Independently Associated with Mortality and Encephalopathy in Hospitalized Patients with Hepatocellular Carcinoma

Biomedicines ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1693
Author(s):  
Daryl Ramai ◽  
Khoi P. Dang-Ho ◽  
Anjali Kewalramani ◽  
Praneeth Bandaru ◽  
Rodolfo Sacco ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Hepatic Encephalopathy ◽  
Length Of Stay ◽  
Risk Score ◽  
Cox Regression ◽  
Surrogate Marker ◽  
Hospital Length Of Stay ◽  
Frail Patients ◽  
Increased Risk ◽  
The Impact

Frailty represents a state of vulnerability to multiple internal physiologic factors, as well as external pressures, and has been associated with clinical outcomes. We aim to understand the impact of frailty on patients admitted with hepatocellular carcinoma (HCC) by using the validated Hospital Frailty Risk Score, which is implemented in several hospitals worldwide. We conducted a nation-wide retrospective cohort study to determine the effect of frailty on the risk of in-patient mortality, hepatic encephalopathy, length of stay and cost. Frailty was associated with a 4.5-fold increased risk of mortality and a 2.3-fold increased risk of hepatic encephalopathy. Adjusted Cox regression showed that frailty was correlated with increased risk of in-patient mortality (hazard ratio: 2.3, 95% CI 1.9–2.8, p < 0.001). Frail HCC patients had longer hospital stay (median 5 days) vs. non-frail HCC patients (median 3 days). Additionally, frail patients had higher total costs of hospitalization ($40,875) compared with non-frail patients ($31,667). Frailty is an independent predictor of hepatic encephalopathy and in-patient mortality. Frailty is a surrogate marker of hospital length of stay and cost.

scholarly journals A Nomogram for Predicting Stroke Recurrence Among Young Adults

Stroke ◽  
2020 ◽  
Vol 51 (6) ◽  
pp. 1865-1867
Author(s):  
Kang Yuan ◽  
Jingjing Chen ◽  
Pengfei Xu ◽  
Xiaohao Zhang ◽  
Xiuqun Gong ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Young Adults ◽  
Ischemic Stroke ◽  
High Risk ◽  
Smoking Status ◽  
Recurrent Stroke ◽  
Risk Groups ◽  
Risk Scores ◽  
Stroke Recurrence ◽  
Large Artery

Background and Purpose— This study aimed to develop and validate a nomogram for predicting the risk of stroke recurrence among young adults after ischemic stroke. Methods— Patients aged between 18 and 49 years with first-ever ischemic stroke were selected from the Nanjing Stroke Registry Program. A stepwise Cox proportional hazards regression model was employed to develop the best-fit nomogram. The discrimination and calibration in the training and validation cohorts were used to evaluate the nomogram. All patients were classified into low-, intermediate-, and high-risk groups based on the risk scores generated from the nomogram. Results— A total of 604 patients were enrolled in this study. Hypertension (hazard ratio [HR], 2.038 [95% CI, 1.504–3.942]; P =0.034), diabetes mellitus (HR, 3.224 [95% CI, 1.848–5.624]; P <0.001), smoking status (current smokers versus nonsmokers; HR, 2.491 [95% CI, 1.304–4.759]; P =0.006), and stroke cause (small-vessel occlusion versus large-artery atherosclerosis; HR, 0.325 [95% CI, 0.109–0.976]; P =0.045) were associated with recurrent stroke. Educational years (>12 versus 0–6; HR, 0.070 [95% CI, 0.015–0.319]; P =0.001) were inversely correlated with recurrent stroke. The nomogram was composed of these factors, and successfully stratified patients into low-, intermediate-, and high-risk groups ( P <0.001). Conclusions— The nomogram composed of hypertension, diabetes mellitus, smoking status, stroke cause, and education years may predict the risk of stroke recurrence among young adults after ischemic stroke.

External validation of the Glasgow prognostic score (mGPS) for renal cancer.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 378-378
Author(s):  
Viraj A. Master ◽  
Timothy V. Johnson ◽  
Omer Kucuk ◽  
Daniel Canter ◽  
John Pattaras ◽  
...  
Keyword(s):  
High Risk ◽  
Cox Regression ◽  
Inflammatory Responses ◽  
Prognostic Score ◽  
External Validation ◽  
Glasgow Prognostic Score ◽  
Low Risk ◽  
High Risk Patients ◽  
Increased Risk ◽  
Risk Patients

378 Background: Inflammation has been termed the 7th hallmark of cancer (Hanahan and Weinberg Cell 2011). Measurement of systemic inflammatory responses in malignancy is possible using a selective combination of two commonly available, cost-effective serum assays. The combination of these two serum markers, C-reactive protein (CRP) and albumin, is termed the modified Glasgow prognostic score (mGPS), and is strongly correlated with outcome in a variety of cancers, including mRCC. Recently, mGPS has been shown to be predictive of outcome in localized RCC (ASCO GU 2010 #390). We sought to externally validate these results. Methods: Nephrectomized patients with clinically localized (T1-T4N0M0) clear cell RCC with negative surgical margins were followed for a mean of 25 months (range: 1-81 months). Relapse and survival was identified through routine follow-up. Patients were categorized by mGPS score as Low Risk (mGPS = 0 points), Intermediate Risk (mGPS = 1 point), and High Risk (mGPS = 2 points). One point was assigned to patients for an elevated CRP (>10 mg/L) and hypoalbuminemia (<3.5 mg/dL). Patients with normal CRP and hypoalbuminemia were assigned 0 points. Kaplan-Meier and multivariate Cox regression analyses examined relapse-free survival (RFS) and overall survival (OS) across patient and disease characteristics. Results: Of 248 patients, 17.9% relapsed and 18.6% died. Of Low, Intermediate, and High Risk patients, 7.2%, 7.7%, and 45.5%, respectively relapsed and 5.2%, 15.4%, and 39.4%, respectively died during the study. In multivariate analysis including stage and grade, mGPS was significantly associated with RFS and OS. Compared to Low-Risk patients, High-Risk patients experienced a 3-fold (OR: 2.906, 95% CI: 1.055-8.001) increased risk of relapse and 4-fold (HR: 3.722, 95% CI: 1.046-13.245) increased risk of mortality. AUC is 0.813, which compares very favorably to existing prognostic algorithms. Conclusions: In this external validation cohort of US patients, mGPS continues to be a predictor of relapse and overall mortality following nephrectomy for localized RCC. Clinicians may consider using mGPS as an adjunct to identify high-risk patients for possible enrollment into clinical trials, or for patient counseling.

Risk factors associated with overall survival (OS) in recurrent pancreatic adenocarcinoma (PAC) following curative resection (CR).

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 437-437 ◽  
Author(s):  
Daniel H. Ahn ◽  
Chul Ahn ◽  
Kavya Krishna ◽  
Somashekar Krishna ◽  
Peter Muscarella ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cox Regression ◽  
Cox Model ◽  
Surgical Techniques ◽  
Surrogate Marker ◽  
Early Recurrence ◽  
Curative Intent ◽  
Cox Models ◽  
Factors Associated ◽  
Time To Recurrence

437 Background: Patients (pts) with localized pancreas cancer (LPAC) undergo CR with curative intent. Despite improvements in adjuvant treatment (trmt) and surgical techniques, the majority of pts succumb to recurrent disease (dx). The purpose of this study is to identify risk factors associated with OS in pts with recurrent PAC. Methods: Pt clinical and dx data was obtained by a retrospective review of patients with LPAC who underwent CR from 2004-2012 and had recurrent dx. Pts were subdivided into two groups, time to recurrence less/equal or greater than 6 months. Univariate and multivariate Cox regression models were used to determine the association between pt characteristics and OS. Results: 93 pts were identified with recurrent PAC. Select pt characteristics are listed in the Table. In univariate Cox models, only lymph node (LN) status is significantly associated with OS (HR 01.67; p=0.043). OS was 25.6 months (95% CI, 19.4-25.6) for LN positive tumors and 10.6 months (95% CI, 10.6-20.1) for LN negative tumors. In a multivariate Cox model adjusted for pt characteristics, LN status remained significant for OS (HR=1.67; p=0.043). Pts with early recurrent PAC (≤6 month) seem to follow patterns of distant metastatic dx while pts with later recurrence that of locoregional dx. Conclusions: LN involvement is associated with patterns of early recurrence with predominantly metastatic disease and decreased OS in pts with recurrent PAC. LN status may act as a surrogate marker for pattern of recurrence and merit consideration in the selection, stratification and trmt of patients in clinical trials. After CR, LN involvement may influence choice trmt and warrant more aggressive therapy. [Table: see text]

Sign in / Sign up

Export Citation Format

Share Document