Community-acquired pneumonia in the elderly: A multivariate analysis of risk and prognostic factors.

e15170 Background: In Japan, the elderly population is increasing, and steadily increase the number of deaths in the elderly gastric cancer patients. However, the standard treatment of elderly gastric cancer has not been established, either treatment of S-1 or SP is carried out in the clinical practice, while SP is considered as standard therapy in the young people. Now, we investigated the impact of S-1 and SP on survival time in clinical practice. Methods: Between 2003 and 2012, advanced gastric cancer patients over 70 years of age received S-1 or SP as first line therapy were retrospectively reviewed to investigate clinical outcomes. Patient characteristics analyzed included age, gender, performance status (PS), tumor histology, renal function and metastatic site. In addition, we have analyzed prognostic factors in multivariate analysis. Results: Among 93 patients (pts), 67 pts (72%) received S-1 and 26 pts (28%) received SP. Patient characteristics between the two groups showed no significant differences in gender, histology, metastatic site, or creatinine clearance level, but did show an imbalance in PS (tended with better at SP group) and age (tended with younger at SP group), significantly. Even though the background factors were favorable results in SP group, there were no significant differences in median progression-free survival (median 139 vs. 102 days; p = 0.96) and overall survival (median 330 vs. 263 days; p = 0.55) between S-1 and SP group, respectively. Grade 3-4 neutropenia (10 vs. 27%, p < 0.05) , fatigue (3 vs. 15%, p < 0.05) and Grade 1-2 creatinine increased (9 vs. 31%, p < 0.01) were more frequent in the SP group than in the S-1 group, respectively. According to the multivariate analysis, exposure to CDDP was not independently associated with a better prognosis. Conclusions: Despite the obvious limitations of this analysis, there does not appear to be a benefit for the addition of CDDP in the elderly gastric cancer patients due to the increase of toxicity. A randomized controlled trial in this age group is warranted. We will also report the results of clinically meaningful prognostic factors associated with the primary treatment at annual meeting.

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Prevalence and Prognostic Factors of EBV-Positive DLBCL of the Elderly In Peru

Blood ◽

10.1182/blood.v116.21.4166.4166 ◽

2010 ◽

Vol 116 (21) ◽

pp. 4166-4166

Author(s):

Brady Beltran ◽

Domingo Morales ◽

Pilar Quinones ◽

Aly Gallo ◽

Marco Lopez-Ilasaca ◽

...

Keyword(s):

Multivariate Analysis ◽

Survival Analysis ◽

Prognostic Factors ◽

Clinical Stage ◽

Performance Status ◽

Univariate Analysis ◽

B Cell Lymphoma ◽

The Elderly ◽

Female Ratio ◽

Immunohistochemical Profile

Abstract Abstract 4166 Background: EBV-positive diffuse large B-cell lymphoma (DLBCL) of the elderly is an entity recently described and included in the WHO classification of lymphomas. It usually affects patients older than 50 years with poor responses to chemotherapy and short survival. However, the majority of the cases are from Asian origin. In fact, in Western countries the incidence of EBV in patients with DLBCL is reported as <5%. The primary objective of this study is to establish the prevalence of EBV in patients with DLBCL and identify prognostic factors in these patients. Patients and methods: We investigated the EBV status by detection of EBV-encoded RNA (EBER) using a chromogenic in situ hybridization (CISH) technique in newly diagnosed patients with primarily nodal DLBCL, identified between January 2002 and December 2009. Clinical data were reviewed retrospectively and biopsies were analyzed for the presence of EBER by CISH and the immunohistochemical expression of BCL6, CD10 and MUM-1/IRF4 using standard procedures. Chi-square was used to compare the characteristics between EBER-positive and EBER-negative cases and to evaluate the association between complete response (CR) to chemotherapy and other clinical variables. Univariate survival estimates in patients who received chemotherapy were obtained using the Kaplan-Meier method. The multivariate survival analysis was performed using the Cox proportional-hazard regression test. Results: A total of 134 consecutive patients were eligible and were included in the comparative clinical analysis. In this cohort, the median age was 71 years (range 23–84) with a male-to-female ratio of 1.1 (71 male and 65 female cases) and a median overall survival (OS) of 47 months. 75% of the cases were 60 years or older, 62% had advanced clinical stage (III or IV), 63% has elevated LDH levels, 13% had involvement of 2 or more extranodal sites, 48% had an ECOG performance status of 2 or higher and 71% had a non-germinal center (NGC) immunohistochemical profile. Nineteen patients were positive for EBER but only 17 patients were included in the analysis because 2 patients were older than 50 years. When comparing EBER-positive and EBER-negative cases, there was an association between EBER expression and a worse outcome (p=0.003). EBER expression was not associated with gender, age, performance status, LDH levels, clinical stage, number of extranodal sites, B symptoms, immunohistochemical profile, overall response rate (ORR), CR rate, exposure to chemotherapy or IPI score. The only factors associated with CR were IPI score (p=0.047) and B symptoms (p=0.0004). Ninety nine patients received chemotherapy and were included in our survival analysis. In the univariate analysis, age over 60, performance status, LDH levels, number of extranodal sites, clinical stage, immunohistochemical profile and EBER expression were associated with OS. EBER-positive patients had a median OS of 12 months vs. 47 months in EBER-negative patients (p=0.045; Figure). In the multivariate analysis, performance status, LDH levels and EBER expression were independent factors for OS (p=0.02, 0.01 and 0.006, respectively). When evaluating EBER expression against the IPI score, both were independent prognostic factors for OS (p=0.002 and 0.03, respectively). Conclusions: The prevalence of EBV-positive DLBCL of the elderly in Peru is the highest reported in the world (13%). DLBCL patients expressing EBER had a worse outcome in comparison to EBER-negative DLBCL patients. In the multivariate analysis, EBER expression in the tumoral cells was an independent prognostic factor for OS along with the IPI score. Disclosures: No relevant conflicts of interest to declare.

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Defining prognostic factors in the elderly with community acquired pneumonia: a case controlled study of patients aged ≥75 yrs

CrossRef Listing of Deleted DOIs ◽

10.1183/09031936.01.17202000 ◽

2001 ◽

Vol 17 (2) ◽

pp. 200-205 ◽

Cited By ~ 54

Author(s):

W-S. Lim ◽

J.T. Macfarlane

Keyword(s):

Prognostic Factors ◽

The Elderly ◽

Community Acquired Pneumonia ◽

Controlled Study

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Prognostic Significance of Metabolic Parameters by 18F-FDG PET/CT in Thymic Epithelial Tumors

Cancers ◽

10.3390/cancers13040712 ◽

2021 ◽

Vol 13 (4) ◽

pp. 712

Author(s):

Joohee Lee ◽

Young Seok Cho ◽

Jhingook Kim ◽

Young Mog Shim ◽

Kyung-Han Lee ◽

...

Keyword(s):

Multivariate Analysis ◽

Prognostic Factors ◽

Fdg Pet ◽

Univariate Analysis ◽

Thymic Epithelial Tumors ◽

Epithelial Tumors ◽

Masaoka Stage ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

Background: Imaging tumor FDG avidity could complement prognostic implication in thymic epithelial tumors. We thus investigated the prognostic value of volume-based 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT parameters in thymic epithelial tumors with other clinical prognostic factors. Methods: This is a retrospective study that included 83 patients who were diagnosed with thymic epithelial tumors and underwent pretreatment 18F-FDG PET/CT. PET parameters, including maximum and average standardized uptake values (SUVmax, SUVavg), metabolic tumor volume (MTV), and total lesion glycolysis (TLG), were measured with a threshold of SUV 2.5. Univariate and multivariate analysis of PET parameters and clinicopathologic variables for time-to-progression was performed by using a Cox proportional hazard regression model. Results: There were 21 low-risk thymomas (25.3%), 27 high-risk thymomas (32.5%), and 35 thymic carcinomas (42.2%). Recurrence or disease progression occurred in 24 patients (28.9%). On univariate analysis, Masaoka stage (p < 0.001); histologic types (p = 0.009); treatment modality (p = 0.001); and SUVmax, SUVavg, MTV, and TLG (all p < 0.001) were significant prognostic factors. SUVavg (p < 0.001) and Masaoka stage (p = 0.001) were independent prognostic factors on multivariate analysis. Conclusion: SUVavg and Masaoka stage are independent prognostic factors in thymic epithelial tumors.

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10. Kinetics of Post-Vaccination Seroprotection to S. Pneumonia for the Immune-Compromised and Vaccine-Naïve Populations

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.055 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S27-S28

Author(s):

Jeffrey Gruenglas ◽

James Mond ◽

Micaela Scobie ◽

Cynthia Tolman ◽

Joseph Martinez

Keyword(s):

Capsular Polysaccharide ◽

The Elderly ◽

Community Acquired Pneumonia ◽

Prior History ◽

Antibody Activity ◽

Vaccine Response ◽

Serum Samples ◽

Opsonic Activity ◽

And Control

Abstract Background S. pneumonia infection presents a significant challenge, accounting for 20–38% of hospital-acquired pneumonia, and the leading cause of community-acquired pneumonia despite availability of effective vaccines. Incidence is highest in children under 2 years, the immunocompromised, and elderly. CDC has reported the emergence of antibiotic resistance in ~30% of cases, adding to risk of morbidity and mortality. Fewer than half of the elderly are vaccinated and vulnerable to infection on admission. Passive immunotherapy as an adjunct to vaccines may improve outcomes in such populations. The objective of this study was to evaluate whether seroprotective response induced with a pneumococcal conjugate vaccine could rapidly yield protective opsonic levels of antibody within anticipated duration of hospitalization. Methods Healthy donors (n=30) were immunized with Prevnar. Blood was drawn on days 0, 3, 7, 10, 14, 21, and 28. Samples were pooled and tested for presence of functional opsonic antibodies recognizing capsular polysaccharides. Clearance mechanism of S. pneumonia was based on antibody recognition to pneumococcal capsular polysaccharide and opsonic titers used as an in vitro surrogate to evaluate the efficacy of vaccine. Results There was little to no opsonic activity against most serotypes on day 0, except for low antibody activity with serotypes 1, 3, 4, and 5. Titers increased, with protective levels achieved by day 10 for most serotypes (except 14 and 18C), peaking at day 14 or after across serotypes (Figures 1 and 2). Average titers rose from log2 titer 2 on day 0 to log2 titer 8 on days 21 and 28. Titers against most serotypes reached log2 10 (titer 1024) or higher. Patients remained susceptible to nosocomial infection for at least 10 days post admission until protective titers are reached. OPK titers (log2 scale) for serum samples on day 0 (pre), day 3, 7, 10, 14, 21, 28, and control for S. pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V. N=2. OPK titers (log2 scale) for serum samples on day 0 (pre), day 3, 7, 10, 14, 21, 28, and control for S. pneumoniae serotypes 14, 18C, 19A, 19F, and 23F. N=2. Conclusion Patients with no prior history of vaccination (or inability to mount response) with Prevnar or pneumovax remain vulnerable to S. pneumonia infection even if vaccinated on entry, due to delayed kinetics in reaching protective titers. These patients may require prophylactic intervention of hyperimmune Ig with high opsonic titers to S. pneumonia, providing protection until vaccine response elicits protective antibodies. Disclosures All Authors: No reported disclosures

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PROGNOSTIC FACTORS OF RENAL TUMOR RECURRENCE AFTER RADICAL NEPHRECTOMY

British Journal of Surgery ◽

10.1093/bjs/znab160.044 ◽

2021 ◽

Vol 108 (Supplement_3) ◽

Author(s):

G Martínez Izquierdo ◽

A R Arnaiz Pérez ◽

E Escolano Fernández ◽

M Merayo Álvarez ◽

B Carrasco Aguilera ◽

...

Keyword(s):

Multivariate Analysis ◽

Prognostic Factors ◽

Radical Nephrectomy ◽

Univariate Analysis ◽

Malignant Neoplasms ◽

Histopathological Analysis ◽

Chi Square ◽

Renal Sinus ◽

Chi Square Test

Abstract INTRODUCTION Renal cell carcinoma (RCC) represents 3% of overall malignant neoplasms in adults. However, its aetiology has not been clearly established. Although surgery represents the cornerstone in treatment, recurrence postoperative rates are around 20-30%, what implies prognostic factors search must be mandatory in order to help to plan de follow-up and the different adjuvant therapy possibilities available in case they were necessary. MATERIAL AND METHODS A retrospective observational study was carried out in 110 patients who underwent radical nephrectomy between 2004 and 2018, with the aim of identifying possible prognostic factors of recurrence of RCC after these surgeries. Preoperative data (epidemiological, comorbidities and laboratory tests), surgical, pathological and variables related to follow-up were taken into account. A univariate and multivariate analysis were performed, using chi-square test and logistic regression, respectively. RESULTS The median follow-up time was 53.5 months (SD = 35.8), time in which 19 patients had a recurrence of RCC after radical nephrectomy (17.2%). Histopathological items such as the surgical piece size, the nodal and microvascular invasion, the renal sinus invasion and the presence of necrosis in the surgical piece were associated with RCC recurrence in the univariate analysis, while only the presence of necrosis in the surgical piece showed a significant result in the multivariate analysis (p = 0.004). CONCLUSIONS Histopathological analysis, highlighting the presence of necrosis in the histological sample, was proved to be the main risk factor of RCC recurrence.

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