scholarly journals Blood Transfusion and Survival for Resected Adrenocortical Carcinoma: A Study from the United States Adrenocortical Carcinoma Group

2017 ◽  
Vol 83 (7) ◽  
pp. 761-768 ◽  
Author(s):  
Caroline E. Poorman ◽  
Lauren M. Postlewait ◽  
Cecilia G. Ethun ◽  
Thuy B. Tran ◽  
Jason D. Prescott ◽  
...  
Keyword(s):  
United States ◽  
Blood Transfusion ◽  
Adrenocortical Carcinoma ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Vena Cava ◽  
Stage Iv ◽  
The United States ◽  
Curative Intent ◽  
Stage 4

Perioperative blood transfusion is associated with decreased survival in pancreatic, gastric, and liver cancer. The effect of transfusion in adrenocortical carcinoma (ACC) has not been studied. Patients with available transfusion data undergoing curative-intent resection of ACC from 1993 to 2014 at 13 institutions comprising the United States Adrenocortical Carcinoma Group were included. Factors associated with blood transfusion were determined. Primary and secondary end points were recurrence-free survival (RFS) and overall survival (OS), respectively. Out of 265 patients, 149 were included for analysis. Out of these, 57 patients (38.3%) received perioperative transfusions. Compared to nontransfused patients, transfused patients more commonly had stage 4 disease (46% vs 24%, P = 0.01), larger tumors (15.8 vs 10.2 cm, P < 0.001), inferior vena cava involvement (24.6% vs 5.4%, P = 0.002), additional organ resection (78.9% vs 36.3%, P < 0.001), and major complications (29% vs 2%, P < 0.001). Transfusion was associated with decreased RFS (8.9 vs 24.7 months, P = 0.006) and OS (22.8 vs 91.0 months, P < 0.001). On univariate Cox regression, transfusion, stage IV, hormonal hypersecretion, and adjuvant therapy were associated with decreased RFS. On multivariable analysis, only transfusion [hazard ratio (HR) = 1.7, 95% confidence interval (CI) 51.0–2.9, P = 0.04], stage IV (HR = 3.2, 95% CI = 1.7–5.9, P < 0.001), and hormonal hypersecretion (HR = 2.6, 95% CI = 1.5–4.2, P < 0.001) were associated with worse RFS. When applying this model to OS, similar associations were seen (transfusion HR = 2.0, 95% CI = 1.1–3.8, P = 0.02; stage 4 HR = 6.2, 95% CI = 3.1–12.4, P < 0.001; hormonal hypersecretion HR = 3.5, 95% CI = 1.9–6.4, P < 0.001). There was no difference in outcomes between patients who received 1 to 2 units versus >2 units of packed red blood cells in median RFS (8.9 vs 8.4 months, P = 0.95) or OS (26.5 vs 18.6 months, P = 0.63). Peri-operative transfusion is associated with earlier recurrence and decreased survival after curative-intent resection of ACC. Strategies and protocols to minimize blood transfusion should be developed and followed.

Effect of hospital volume on outcome of stage IV pancreatic cancer.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 123-123
Author(s):  
Suleyman Yasin Goksu ◽  
Muhammet Ozer ◽  
Busra N Bacik Goksu ◽  
Syed Mohammad Ali Kazmi ◽  
Nina Niu Sanford ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Hospital Volume ◽  
Treatment Initiation ◽  
Cox Regression ◽  
Private Insurance ◽  
Multivariable Analysis ◽  
Stage Iv ◽  
Time To Treatment ◽  
Stage 4 ◽  
Chemotherapy Initiation

123 Background: The effect of hospital volume on the outcome of stage 4 pancreatic cancer is not well known. We evaluated the effect of hospital volume on time to treatment and survival in patients with stage 4 pancreatic adenocarcinoma (PDAC). Methods: We used the National Cancer Database, including 1,319 hospitals to identify the study population. Adult (≥ 18 years) patients with stage 4 PDAC were included. We excluded the patients who had other histologies, unknown follow-up, and survival of less than 30 days. We categorized the hospital volume as three groups: low- (<25th centile), medium- (25th–75th centile), and high-volume hospitals (HVH) (>75th centile). Time from diagnosis to chemotherapy initiation was classified as early (≤ 6 weeks) or late (> 6 weeks). Kaplan-Meier and Cox regression methods were used to evaluate the overall survival (OS) between HVH and low-volume hospital (LVH) groups. Results: Among 72,531 patients with stage 4 PDAC; 65% received chemotherapy. Patients treated at HVH had higher rates of chemotherapy ( 73% vs. 60%, p<.001), and late chemotherapy initiation ( 27% vs. 20%, p<.001) compared to LVH. Patients at HVH were more likely to be younger, have less comorbidity score, private insurance, treated at the academic center, and need to travel more than 50 miles (all p<.001). Patients treated at HVH had better OS than LVH (6 vs. 4 months, p<.001). In multivariable analysis, HVH was independently associated with better OS versus LVH ( HR 0.79 [0.72-0.87]). In addition, HVH was associated with better OS in patients who received chemotherapy ( HR 0.78 [0.69-0.88]), while early treatment initiation, age, black race, uninsured status was not. Conclusions: Treatment at an HVH is independently associated with improved survival among patients with stage 4 PDAC. Patients seen at HVH had a higher rate of chemotherapy administration but a longer time to treatment initiation. [Table: see text]

scholarly journals Dietary patterns related to total mortality and cancer mortality in the United States

2021 ◽  
Author(s):  
Marcela R. Entwistle ◽  
Donald Schweizer ◽  
Ricardo Cisneros
Keyword(s):  
United States ◽  
Dietary Patterns ◽  
Cancer Mortality ◽  
Cox Regression ◽  
Total Mortality ◽  
Principal Component ◽  
The United States ◽  
Red Meat ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Purpose This study investigated the association between dietary patterns, total mortality, and cancer mortality in the United States. Methods We identified the four major dietary patterns at baseline from 13,466 participants of the NHANES III cohort using principal component analysis (PCA). Dietary patterns were categorized into ‘prudent’ (fruits and vegetables), ‘western’ (red meat, sweets, pastries, oils), ‘traditional’ (red meat, legumes, potatoes, bread), and ‘fish and alcohol’. We estimated hazard ratios for total mortality, and cancer mortality using Cox regression models. Results A total of 4,963 deaths were documented after a mean follow-up of 19.59 years. Higher adherence to the ‘prudent’ pattern was associated with the lowest risk of total mortality (5th vs. 1st quintile HR 0.90, 95% CI 0.82–0.98), with evidence that all-cause mortality decreased as consumption of the pattern increased. No evidence was found that the ‘prudent’ pattern reduced cancer mortality. The ‘western’ and the ‘traditional’ patterns were associated with up to 22% and 16% increased risk for total mortality (5th vs. 1st quintile HR 1.22, 95% CI 1.11–1.34; and 5th vs. 1st quintile HR 1.16, 95% CI 1.06–1.27, respectively), and up to 33% and 15% increased risk for cancer mortality (5th vs. 1st quintile HR 1.33, 95% CI 1.10–1.62; and 5th vs. 1st quintile HR 1.15, 95% CI 1.06–1.24, respectively). The associations between adherence to the ‘fish and alcohol’ pattern and total mortality, and cancer mortality were not statistically significant. Conclusion Higher adherence to the ‘prudent’ diet decreased the risk of all-cause mortality but did not affect cancer mortality. Greater adherence to the ‘western’ and ‘traditional’ diet increased the risk of total mortality and mortality due to cancer.

Patterns of Care and Survival of Cutaneous Angiosarcoma of the Head and Neck

2020 ◽  
Vol 162 (6) ◽  
pp. 881-887 ◽  
Author(s):  
Clifford Chang ◽  
S. Peter Wu ◽  
Kenneth Hu ◽  
Zujun Li ◽  
David Schreiber ◽  
...  
Keyword(s):  
Head And Neck ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Multimodality Treatment ◽  
The Elderly ◽  
Hazard Ratio ◽  
Patterns Of Care ◽  
Definitive Treatment ◽  
National Cancer Database ◽  
Curative Intent

Objective To analyze the patterns of care and survival of cutaneous angiosarcomas of the head and neck. Study Design Retrospective cohort study. Setting National Cancer Database. Methods The National Cancer Database was queried to select patients with cutaneous angiosarcoma of the head and neck between 2004 and 2015. For survival analysis, patients were included only if they received definitive treatment and complete data. Prognostic factors were analyzed by univariate and multivariable Cox regression. Results We identified 693 patients diagnosed with head and neck angiosarcomas during the study period. The majority were male (n = 489, 70.6%) and elderly (median, 77 years). A total of 421 patients (60.8%) met the criteria for survival analyses. These patients were treated with surgery and radiation (n = 178, 42.3%), surgery alone (n = 138, 32.8%), triple-modality therapy (n = 48, 11.4%), surgery and chemotherapy (n = 29, 6.9%), and chemoradiation (n = 28, 6.7%). With a median follow-up of 29 months, the 3-year survival was 50.1%. Patients undergoing surgery had better median survival than those who did not (38.1 vs 21.0 months, P = .04). Age, comorbidity, tumor size, and surgical margins were significant factors in univariate analyses. On multivariable analysis, age ≥75 years (hazard ratio, 2.65; 95% CI, 1.80-3.88; P < .001) and positive margins (hazard ratio, 1.91; 95% CI, 1.44-2.51; P < .001) predicted worse overall survival. Conclusion Angiosarcoma of head and neck is a rare malignancy that affects the elderly. Surgical treatment with negative margins is associated with improved survival. Even with curative-intent multimodality treatment, the survival of patients aged ≥75 years is limited.

The rise and fall of late Paleozoic trilobites of the United States

1999 ◽  
Vol 73 (2) ◽  
pp. 164-175 ◽  
Author(s):  
David K. Brezinski
Keyword(s):  
United States ◽  
North America ◽  
Sea Level ◽  
Adaptive Radiation ◽  
The United States ◽  
Upper Permian ◽  
Late Paleozoic ◽  
Lower Permian ◽  
Stage 4 ◽  
Stage 1

Based on range data and generic composition, four stages of evolution are recognized for late Paleozoic trilobites of the contiguous United States. Stage 1 occurs in the Lower Mississippian (Kinderhookian-Osagean) and is characterized by a generically diverse association of short-ranging, stenotopic species that are strongly provincial. Stage 2 species are present in the Upper Mississippian and consist of a single, eurytopic, pandemic genus, Paladin. Species of Stage 2 are much longer-ranging than those of Stage 1, and some species may have persisted for as long as 12 m.y. Stage 3 is present within Pennsylvanian and Lower Permian strata and consists initially of the eurytopic, endemic genera Sevillia and Ameura as well as the pandemic genus Ditomopyge. During the middle Pennsylvanian the very long-ranging species Ameura missouriensis and Ditomopyge scitula survived for more than 20 m.y. During the late Pennsylvanian and early Permian, a number of pandemic genera appear to have immigrated into what is now North America. Stage 4 is restricted to the Upper Permian (late Leonardian-Guadalupian) strata and is characterized by short-ranging, stenotopic, provincial genera.The main causal factor controlling the four-stage evolution of late Paleozoic trilobites of the United States is interpreted to be eustacy. Whereas Stage 1 represents an adaptive radiation developed during the Lower Mississippian inundation of North America by the Kaskaskia Sequence, Stage 2 is present in strata deposited during the regression of the Kaskaskia sea. Stage 3 was formed during the transgression and stillstand of the Absaroka Sequence and, although initially endemic, Stage 3 faunas are strongly pandemic in the end when oceanic circulation patterns were at a maximum. A mid-Leonardian sea-level drop caused the extinction of Stage 3 fauna. Sea-level rise near the end of the Leonardian and into the Guadalupian created an adaptive radiation of stentopic species of Stage 4 that quickly became extinct with the latest Permian regression.

The CRIT Study: Anemia and blood transfusion in the critically ill—Current clinical practice in the United States*

2004 ◽  
Vol 32 (1) ◽  
pp. 39-52 ◽  
Author(s):  
Howard L. Corwin ◽  
Andrew Gettinger ◽  
Ronald G. Pearl ◽  
Mitchell P. Fink ◽  
Mitchell M. Levy ◽  
...  
Keyword(s):  
United States ◽  
Clinical Practice ◽  
Blood Transfusion ◽  
Critically Ill ◽  
The United States ◽  
Current Clinical Practice

scholarly journals Clinical Course and Outcomes of Sickle Cell Disease Patients with COVID-19 at a New York Hospital

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 34-36
Author(s):  
Anita Mazloom ◽  
Neil Nimkar ◽  
Sonal Paul ◽  
Ayanna Baptiste
Keyword(s):  
United States ◽  
New York ◽  
Mechanical Ventilation ◽  
Sickle Cell Disease ◽  
Blood Transfusion ◽  
Hospital Stay ◽  
Clinical Course ◽  
The United States ◽  
Acute Chest Syndrome ◽  
Cell Disease

Introduction: The outbreak of a novel infection, COVID-19, has greatly impacted the well-being of individuals worldwide. Persons with sickle cell disease (SCD) constitute a vulnerable population, subject to health disparities, who may have worse outcomes from COVID-19. Within the United States, New York has a large population of patients with SCD. Here, we analyze the clinical course and outcomes of SCD patients with COVID-19 who were admitted to a community teaching hospital in Brooklyn, NY. Methods: We conducted a retrospective chart review of adult patients with SCD hospitalized with laboratory- confirmed COVID-19. Electronic health records were reviewed to identify patients and analyze their clinical course. Clinical characteristics, laboratory and radiology data were assessed. Rates of acute chest syndrome (ACS), acute kidney injury (AKI) and venous thromboembolism (VTE) were determined. ACS was defined by the presence of fever and/or respiratory symptoms accompanied by a new pulmonary infiltrate on chest Xray. Data on use of blood transfusion, treatments, length of stay and mortality were collected. Results: Between March 1 to June 30, 2020, 53 adults with SCD were hospitalized at our institution. Of these, 13 patients had COVID-19 infection. The mean (±SD) age of the COVID-19 patients was 34±10 years (range, 22 to 50) with 54% being female. Seven patients (54%) were Hb SS, and 6 patients (46%) were Hb SC. Comorbid conditions included Diabetes Mellitus (1 patient), SLE (1), End-stage renal disease (1), prior VTE (4) and Avascular necrosis of hip (3). Four patients were on hydroxyurea. Clinical, laboratory and radiological findings are summarized in Table 1. While all the Hb SS patients presented with vaso-occlusive crisis, 4 of the 6 patients with Hb SC did not have symptoms of pain crisis. Chest pain and cough were the most common symptoms at presentation. During the hospital stay, 12 patients (92%) had at least one febrile episode &gt;38°C, with 77% having recurrent fevers above 38.5°C. Eleven patients (85%) met criteria for ACS. Seventy-seven percent of all patients required supplemental oxygen. Nine patients (69%) were transfused, with 4 patients undergoing exchange transfusion. Sixty-seven percent of the transfused patients were transfused within 48 hours of admission. No patients required intubation or mechanical ventilation and none were admitted to the intensive care unit (ICU). Five patients (38.5%) received hydroxychloroquine while 84.6% were treated with antibiotics. No patient received remdesivir. Three patients (23%) developed AKI: of these, one patient required acute hemodialysis, the other two cases were mild with peak creatinine less than 2.0 mg/dl. Ninety-two percent of patients received prophylactic anticoagulation with either unfractionated heparin, enoxaparin or fondaparinux. One patient who did not receive an anticoagulant due to thrombocytopenia developed an acute deep vein thrombosis which was also catheter-related. Of note, during the initial phase of the pandemic standard dosing of prophylactic anticoagulants were used but in the later months, some patients received higher prophylactic doses in keeping with hospital protocol. The median length of hospital stay was 9.4 days (interquartile range, 8.1 to 13.3). There were no deaths - all patients were discharged home. Summary: Panepinto et al (Emerg Infect Dis.) reported a mortality of 7% in 178 SCD patients with COVID-19 in the United States. Other published reports have detailed more favorable outcomes (Arlet et al, Lancet and Appiah-Kubi et al, Br J Haematol.). In this small retrospective analysis of hospitalized SCD patients, there was no mortality. Acute chest syndrome was the most common complication observed. VTE and severe AKI were infrequent. Blood transfusion was performed in the majority of patients (69%); two thirds of the patients transfused received blood within 48 hours of hospitalization. There were no ICU admissions and no use of mechanical ventilation indicative perhaps of less severe COVID-19 disease. This may have been due to the young age of the cohort. Early use of blood transfusion may have been a factor in reducing disease severity and improving outcomes. The best approach to managing these patients is unclear. We advocate for the development and dissemination of evidence-based guidelines to manage SCD patients with COVID-19 to reduce morbidity and mortality in this at-risk population. Disclosures No relevant conflicts of interest to declare.

Breast Cancer

2018 ◽  
Author(s):  
Nancy E Davidson
Keyword(s):  
Breast Cancer ◽  
United States ◽  
Cancer Incidence ◽  
Hormone Replacement ◽  
Breast Cancer Incidence ◽  
Stage Iv ◽  
The United States ◽  
Rate Of Increase ◽  
Stage Iv Breast Cancer ◽  
Incidence And Mortality

Invasive breast cancer, the most common nonskin cancer in women in the United States, will be diagnosed in 266,120 In 2018, along with 63,960 new cases of non-invasive (in situ) breast cancer. Incidence and mortality reached a plateau and appear to be dropping in both the United States and parts of western Europe. This decline has been attributed to several factors, such as early detection through the use of screening mammography and appropriate use of systemic adjuvant therapy, as well as decreased use of hormone replacement therapy. However, the global burden of breast cancer remains great, and global breast cancer incidence increased from 641,000 in 1980 to 1,643,000 in 2010, an annual rate of increase of 3.1%. This chapter examines the etiology, epidemiology, prevention, screening, staging, and prognosis of breast cancer. The diagnoses and treatments of the four stages of breast cancer are also included. Figures include algorithms used for the systemic treatment of stage IV breast cancer and hormone therapy for women with stage IV breast cancer. Tables describe selected outcomes from the National Surgical Adjuvant Breast and Bowel Project (NSABP) P-1 and P-2 chemoprevention trials, tamoxifen chemoprevention trials for breast cancer, the TNM staging system and stage groupings for breast cancer, some commonly used adjuvant chemotherapy regimens, an algorithm for suggested treatment for patients with operable breast cancer from the 2011 St. Gallen consensus conference, guidelines for surveillance of asymptomatic early breast cancer survivors from the American Society of Clinical Oncology, and newer agents for metastatic breast cancer commercially available in the United States. This review contains 2 highly rendered figures, 8 tables, and 108 references.

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