Risk Factors for Hepatocellular Carcinoma After Splenectomy in Liver Cirrhotic Patients

Background Splenectomy is sometimes indicated for portal hypertension caused by cirrhosis, which is a risk for hepatic carcinogenesis. This study aimed to identify risk factors for hepatocellular carcinoma (HCC) development after splenectomy. Methods This retrospective study included 65 patients who underwent splenectomy for portal hypertension between 2009 and 2017. Cox regression analyses were performed to identify factors related to HCC development after splenectomy. The predictive index for HCC development was constructed from the results of multivariate analysis, and 3 risk-dependent groups were defined. Discrimination among the groups was estimated using Kaplan-Meier curves and the log-rank test. Results Post-splenectomy, 36.9% of patients developed HCC. In the univariate analysis, the etiology of cirrhosis (hepatitis C virus antibody, P = .005, and hepatitis B surface antigen, P = .008, referring to non-B and non-C patients, respectively), presence of HCC history ( P < .001), and preoperative hemoglobin level ( P = .007) were related to HCC development, and the presence of HCC history ( P = .002) and preoperative hemoglobin level ( P = .022) were independent risk factors. The predictive index classified three groups at risk; the hazards in each group were significantly different (low vs middle risk, P = .035, and middle vs high risk, P = .011). Discussion The etiology of cirrhosis, presence of HCC history, and hemoglobin level were associated with HCC development after splenectomy. The predictive model may aid in HCC surveillance after splenectomy for patients with portal hypertension.

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Risk factors of blood transfusion in knee arthroplasty

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00018 ◽

2020 ◽

Vol 8 (5_suppl5) ◽

pp. 2325967120S0001

Author(s):

Pruk Chaiyakit ◽

Weeranate Umpanpong ◽

Tawipat Watcharotayangkoon

Keyword(s):

Risk Factors ◽

Surgical Technique ◽

Blood Transfusion ◽

Knee Arthroplasty ◽

Significant Relationship ◽

Univariate Analysis ◽

Hemoglobin Level ◽

Operative Blood Loss ◽

Preoperative Hemoglobin ◽

Preoperative Hemoglobin Level

Objectives: The amount of blood transfusion after knee arthroplasty seem to vary in different reported study. We carried out a retrospective study to analysis pre-operative risk factors for blood transfusion in patient whom underwent knee arthroplasty in our institution. Methods: A retrospective study of 190 patients treated with 194 procedure (186 unilateral knee arthroplasty, 4 bilateral knee arthroplasty) from November 2014 to October 2015 was analyzed. A univariate analysis was performed to establish the relationship between all variables and the need for postoperative transfusion. Variables that were determined to have significant relationship were include in a multivariable analysis.. Results: The univariate analysis revealed a significant relationship between need for postoperative blood transfusion and preoperative hemoglobin levels, surgical technique, arthrotomy approach, DVT prophylaxis, operative blood loss, surgical technique and surgeon experience. The multivariate analysis identified a significant relationship between need for transfusion and preoperative hemoglobin level, surgical technique and operative blood loss. Patients with a preoperative hemoglobin less than 12 g/dL had a 5.1 times greater risk of having a transfusion than those with a hemoglobin level ≥ 12 g/dL. The surgical technique with computer assisted surgery had a 0.15 times lesser risk of having a transfusion than those with the conventional technique. Conclusion: The preoperative hemoglobin level < 12 g/dL was shown to increase risk of the need for blood transfusion after knee arthroplasty, while computer assist surgery total knee arthroplasty was shown to decrease risk of blood transfusion. We suggest that patients with preoperative hemoglobin < 12 g/dL need to be crossmatching PRC in pre-operative steps.

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The Indications for Hepatectomy for Multinodular Hepatocellular Carcinoma: Experience from a Single Institution

Digestive Surgery ◽

10.1159/000370128 ◽

2015 ◽

Vol 32 (2) ◽

pp. 82-89 ◽

Cited By ~ 1

Author(s):

Yuan-da Zhou ◽

Hui-kai Li ◽

Yun-long Cui ◽

Ti Zhang ◽

Qiang Li

Keyword(s):

Risk Factors ◽

Hepatocellular Carcinoma ◽

Univariate Analysis ◽

Prognostic Significance ◽

Disease Free Survival ◽

Rank Test ◽

Morbidity Rate ◽

Single Institution ◽

Multiple Tumor ◽

Prognostic Risk Factors

Aims: This study was conducted in order to investigate the indications for hepatecomy for multinodular hepatocellular carcinoma (MNHCC) in single institution. Methods: We retrospectively analyzed the medical records from 55 MNHCC patients, mainly with Child-Pugh A liver function, who underwent hepatectomy from January 2006 to December 2008. Both short- and long-term outcomes were analyzed. In addition, the prognostic significance of clinicopathological factors on overall survival (OS) was investigated by univariate analysis using the log-rank test. A Cox proportional hazards model was used in a subsequent multivariate analysis. Results: The perioperative morbidity rate (grade II or higher) was 18.2% (n = 10), and the in-hospital mortality rate was 3.6%. The median OS was 23.9 months (range, 2.5-84 months), whereas the median disease-free survival was 8.75 months (range, 1-65 months). Independent prognostic risk factors of 5-year OS included the number of tumors >2 (p = 0.032) and gross morphology indicating multiple tumor nodules scattered throughout the liver (p = 0.009). Conclusions: The postoperative morbidity and mortality rates were acceptable. The number of tumors >2 and gross morphology indicating multiple tumor nodules scattered throughout the liver were independent prognostic risk factors for patients with MNHCC after hepatectomy. Patients with both of these features had a very poor prognosis and were not considered suitable for surgery.

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PD-L1+NEUT, Foxp3+Treg, and NLR as New Prognostic Marker with Low Survival Benefits Value in Hepatocellular Carcinoma

Technology in Cancer Research & Treatment ◽

10.1177/15330338211045820 ◽

2021 ◽

Vol 20 ◽

pp. 153303382110458

Author(s):

Lin Zhou ◽

Jing Wang ◽

Shao-cheng Lyu ◽

Li-chao Pan ◽

Xian-jie Shi ◽

...

Keyword(s):

Risk Factors ◽

Hepatocellular Carcinoma ◽

Peripheral Blood ◽

Cox Regression ◽

Disease Free Survival ◽

Rank Test ◽

Cancer Tissue ◽

Cox Regression Analysis ◽

Poorly Differentiated ◽

Independent Risk Factors

Background: This presented study was aimed to evaluate the diagnostic and prognostic value of PD-L1+Neutrophils (PD-L1+NEUT) and neutrophil to lymphocyte ratio (NLR) based on our previous experience of Foxp3+Treg in transplantation. Methods: the NLR cutoff value of 1.79 was used to include 136 cases from the 204 patients with hepatocellular carcinoma (HCC) confirmed by clinical pathology, which were divided into highly-moderately and poorly differentiated HCC groups. The expressions of PD-L1+NEUT and Foxp3+Treg in peripheral blood and cancer tissue were detected with flow cytometry, meanwhile, PD-L1 and Foxp3 expressed in carcinoma and para-carcinoma tissues were marked by immunohistochemistry. Survival rates, including overall survival and disease-free survival, were calculated by the Kaplan–Meier curve and evaluated with the log-rank test. Finally, Cox risk regression model was used to analyze the independent risk factors for prognostic survival. Results: The level of PD-L1+NEUT, Foxp3+Treg, and NLR in peripheral blood of patients with poorly differentiated HCC were significantly increased (all P < .001). Both PD-L1+NEUT and NLR were positively correlated with Foxp3+Treg ( r = 0.479, P = .0017; r = 0.58, P < .0001). The level of PD-L1+NEUT and Foxp3+Treg as well as PD-L1 and Foxp3 in cancer tissue and patients with poorly differentiated HCC were obviously increased (all P < .01), respectively. Cox regression analysis indicated that PD-L1+NEUT, NLR, and Foxp3+Treg were independent risk factors for the prognosis ( P = .000, .000, .006) with a RR and 95%CI of 2.704-(2.155-3.393), 3.139-(2.361-4.173), 1.409-(1.105-1.798), respectively. Conclusion: PD-L1+NEUT, NLR, and Foxp3+Treg are independent risk factors for prognosis which maybe new marker of lower survival benefits.

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Preoperative anemia and total hospitalization time are the independent factors of preoperative deep venous thromboembolism in Chinese elderly undergoing hip surgery

BMC Anesthesiology ◽

10.1186/s12871-020-00983-2 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Long Feng ◽

Longhe Xu ◽

Weixiu Yuan ◽

Zhipeng Xu ◽

Zeguo Feng ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Operation Time ◽

Hemoglobin Level ◽

Preoperative Anemia ◽

Chinese Elderly ◽

Preoperative Hemoglobin ◽

Hospitalization Time ◽

Independent Risk Factors ◽

Preoperative Hemoglobin Level

Abstract Background This study was designed to explore the prevalence and risk factors of preoperative deep venous thromboembolism (DVT) in Chinese elderly with hip fracture. Methods From January 1, 2012, to December 31, 2018, 273 elderly patients over 70 years old with elective hip surgery were collected from the electronic medical records. Collected data included demographic characteristics, comorbidities, ASA classification, types of previous operations, types of anesthesia, operation time, fracture to operation time, preoperative hemoglobin level, anemia, blood-gas analysis, cardiac function, whether transfusion, preoperative hospitalization, postoperative hospitalization, electrocardiograph, lower limb venous ultrasonography and total hospitalization time. Results In these 273 patients, 15(5.6%) had ultrasonography evidence of DVT in affected limbs before surgery. Three of all patients received an temporary inferior vena cave filter placement preoperatively. Fracture to surgery time, preoperative hemoglobin level, anemia, preoperative hospitalization, pulmonary disease and total hospitalization time were statistically different between DVT group and non-DVT group (P < 0.05 for all). Moreover, preoperative anemia (OR: 0.144, 95%CI: 0.026–0.799, P = 0.027) and total hospitalization time (OR: 1.135; 95%CI: 1.023–1.259, P = 0.017) were the two independent risk factors for preoperative DVT. Conclusion Preoperative anemia and total hospitalization time were independent risk factors for venous DVT in Chinese elderly with hip fracture.

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ML-09 The REAL-WORLD of Elderly PCNSL Therapy in Tohoku and Niigata Area According to Retrospective Analysis: A Collaborative Investigation of the Tohoku Brain Tumor Study Group

Neuro-Oncology Advances ◽

10.1093/noajnl/vdaa143.072 ◽

2020 ◽

Vol 2 (Supplement_3) ◽

pp. ii17-ii17

Author(s):

Kenichiro Asano ◽

Yoji Yamashita ◽

Takahiro Ono ◽

Manabu Natsumeda ◽

Takaaki Beppu ◽

...

Keyword(s):

Risk Factors ◽

Central Nervous System ◽

Nervous System ◽

Real World ◽

Cox Regression ◽

Univariate Analysis ◽

Central Nervous System Lymphoma ◽

Rank Test ◽

Cox Regression Analysis ◽

The Real

Abstract Introduction: Recently, the number of cases of primary central nervous system lymphoma in elderly patients(EL-PCNSL) has been increasing. However, the treatment may be insufficient because of poor performance status and pre- and posttreatment complications. Therefore, we analyzed the risk factors for EL-PCNSL in the Tohoku and Niigata areas of Japan and clarified the REAL-WORLD of EL-PCNSL therapy. Materials & Methods: We investigated surgical and nonsurgical cases of patients aged 71 years or older from eight facilities during the last 8 years. We analyzed patient information, radiotherapy/chemotherapy or not, PFS, OS, RRs, second-line therapy, pre- and posttreatment complications, outcomes, and risk factors for poor prognosis. The log-rank test was used for univariate analysis, and Cox regression analysis was used for a multivariate analysis of risk factors. Results: Of the 142 cases registered, five differed from PCNSL pathologically, three receiving BSC were excluded, 31 were treated without biopsy, three were treated based on CSF-findings, and 100 were treated with biopsy. Total 134 cases were followed. The median age was 76 years, pretreatment KPS was 50%, and 118 cases(88%) had 217 pretreatment complications. The treatment contents consisted of various combinations depending on the attending physician. The retrospective overall PFS was 16 months and OS was 24 months. In the early treatment phase, out of 16 cases with dropout, four tumor and four complication deaths occurred. There were 77 deaths(58%), 39 internal tumor deaths(51%), and 33 complication deaths(43%). Poor prognostic risk factors were <60% posttreatment KPS, complications involving pretreatment cardiovascular and central nervous system disease, posttreatment pneumonia or severe infection, and absence of radiation or chemotherapy. Conclusions: Pretreatment KPS did not affect poor outcomes, but posttreatment KPS <60% and pre- and posttreatment complications did. Radiotherapy and chemotherapy are reportedly effective, but additional research to clarify the details of these modalities is needed.

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The Significance of Inflammatory Markers in the Prognosis of Newly Diagnosed Multiple Myeloma Patients

Blood ◽

10.1182/blood-2020-136326 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 15-15

Author(s):

Lin Gui ◽

Fei Wang ◽

Jinning Shi ◽

Baoan Chen

Keyword(s):

Risk Factors ◽

Multiple Myeloma ◽

Overall Survival ◽

Multivariate Analysis ◽

Survival Time ◽

Cox Regression ◽

Conflicts Of Interest ◽

Univariate Analysis ◽

Rank Test ◽

Newly Diagnosed

Objective: To explore the significance of the ratio of neutrophils to lymphocytes (NLR), monocytes to lymphocytes (MLR), and platelets to lymphocytes (PLR) in the prognosis of patients with newly diagnosed multiple myeloma. Methods: We retrospectively reviewed the data for 60 multiple myeloma patients who were diagnosed in Jiangning Hospital Affiliated to Nanjing Medical University from August 2011 to March 2020. According to NLR、MLR、PLR, the patients were divided into the low NLR group (NLR<3.61) or high NLR group (NLR≥3.61), low MLR group (MLR<0.33) or high MLR group (MLR ≥0.33), low PLR group (PLR< 129.78) and high PLR group (PLR ≥129.78). Overall survival time (OS) was used as the prognostic evaluation criteria, and Kaplan-Meier survival curve, Log-rank test and Cox regression model were used to carry out univariate and multivariate analysis on clinical and laboratory parameters. Results: Among the 60 patients, 33 were male and 27 were female, the median age of onset was 65 years old, 19 were in the high NLR group, 41 were in the low NLR group, 24 were in the high MLR group, 36 were in the low MLR group, 26 were in the high PLR group, and 34 were in the low PLR group. The univariate analysis showed the prognosis was influenced by factors including NLR, PLR, age, ISS stages, hemoglobin (HGB), albumin (ALT). MLR, type of immunoglobulin, white globulin ratio (A/G), gender, β2-microglobulin, lactate dehydrogenase (LDH) and creatinine were not correlated with the total survival time of patients. The multivariate analysis showed that ISS III stages, PLR≥129.78、HGB<100g/L were independent risk factors influencing the prognosis of MM patients. Conclusion: ISS III stages, PLR≥129.78、HGB<100g/L are independent prognostic risk factors in newly diagnosed multiple myeloma patients, which can be used as an economical and effective method for early evaluation of patient prognosis. Key Wordsmultiple myeloma; overall survival; NLR; PLR; MLR Disclosures No relevant conflicts of interest to declare.

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Rest Cardiac Power Predicts All-cause Death and Heart Failure Hospitalization in Heart Failure Patients With Preserved Ejection Fraction

10.21203/rs.3.rs-430111/v1 ◽

2021 ◽

Author(s):

Jianqiao Chen ◽

Huiying Li ◽

Benchuan Hao ◽

Yulun Cai ◽

Shiqi Wang ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Ejection Fraction ◽

Cox Regression ◽

Univariate Analysis ◽

Left Ventricular ◽

Community Dwelling ◽

Rank Test ◽

Preserved Ejection Fraction ◽

Cardiac Power

Abstract Background: Cardiac power as an integrated indicator of cardiac performance that incorporates both pressure and volume factors. It has been studied in patients with reduced left ventricular (LV) ejection fraction (EF), and in the present study we aimed to explore its significance and role in predicting adverse outcome in patients with heart failure with preserved ejection fraction (HFpEF).Methods: This retrospective cohort study included 2089 community-dwelling patients with HFpEF and without significant valve diseases or right ventricular dysfunction. We normalized cardiac power to LV mass and expressed it in W/100 g of LV myocardium. Univariate analysis with log-rank test and multivariate analysis with Cox regression model were used to evaluate the association between rest cardiac power/mass and all-cause death and heart failure (HF) hospitalization. Results: After a median follow-up of 4.4 (0.5–10.1) years, 331 (15.84%) experienced all-cause death and 391 (18.72%) experienced HF hospitalization. Patients with the lower rest power/mass were older and had higher New York Heart Association class, N-terminal pro-brain natriuretic peptide (NT-proBNP) level and more comorbidities. After adjusting for multiple covariates, rest power/mass ≤0.7 W/m2 was independently associated with all-cause death and HF hospitalization, with the hazard ratio (HR) of 1.753 [95% confidence interval (CI) 1.394–2.203, P<0.001] and 1.266 (95% CI 1.033–1.551, P=0.023), respectively. The C statistic increased significantly when the rest cardiac power/mass were incorporated into a model with established risk factors. For all-cause death, the continuous net reclassification index (NRI) after adding rest cardiac power/mass in the model with established risk factors and NT-proBNP was 17.0% (95% CI 11.4–28.3, P=0.04), and the integrated discrimination index (IDI) was 2.3% (95% CI 0.7–8.7, P=0.02); for HF hospitalization, the corresponding continuous NRI and IDI were 6.0% (95% CI 4.7–15.2, P=0.026) and 1.7% (95% CI 1.2–4.3, P=0.007), respectively.Conclusion: Rest cardiac power by non-invasive echocardiography is independently associated with risks of adverse outcomes in patients with HFpEF and provides incremental prognostic information.

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Preoperative anemia and hospitalization time are the independent factors of preoperative deep venous thromboembolism in Chinese elderly with hip fracture

10.21203/rs.2.12382/v1 ◽

2019 ◽

Author(s):

Long Feng ◽

Weixiu Yuan ◽

Mingda Duan ◽

Chaohai Jin ◽

Longhe Xu ◽

...

Keyword(s):

Risk Factors ◽

Hip Fracture ◽

Operation Time ◽

Hemoglobin Level ◽

Preoperative Anemia ◽

Chinese Elderly ◽

Preoperative Hemoglobin ◽

Hospitalization Time ◽

Independent Risk Factors ◽

Preoperative Hemoglobin Level

Abstract Aim This study was designed to explore the prevalence condition and risk factors of preoperative deep venous thromboembolism (DVT) in Chinese elderly with hip fracture. Methods From January 1, 2012, to December 31, 2018, 273 elderly over 70 years old with elective hip surgery were collected from the electronic medical records. Collected Data included demographic characteristics, comorbidities, ASA classification, types of surgeries, types of anesthesia, operation time, fracture to operation time, perioperative blood transfusion, preoperative hemoglobin level, anemia, blood-gas analysis, cardiac function, electrocardiograph, lower limb venous ultrasound and hospitalization time. Results In all patients, 15 patients (5.6%) had venographic evidence of DVT in affected limbs before surgery. Three of all patients received an temporary inferior vena cave filter placement. Fracture to surgery time, preoperative hemoglobin level, anemia, pulmonary disease and hospitalization time were statistically different between DVT group and non-DVT group (P<0.05 for all). Moreover, preoperative anemia (OR: 0.144, 95%CI: 0.026-0.799, P=0.027) and hospitalization time (OR: 1.135; 95%CI: 1.023-1.259, P=0.017) were the two independent risk factors for preoperative DVT. Conclusion Preoperative anemia and hospitalization time were independent risk factors for venous DVT in Chinese elderly with hip fracture.

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The Significance of Inflammatory Markers in the Prognosis of Newly Diagnosed Multiple Myeloma Patients

Clinical Oncology and Research ◽

10.31487/j.cor.2020.09.01 ◽

2020 ◽

pp. 1-6

Author(s):

Baoan Chen ◽

Lin Gin ◽

Jinning Shi ◽

Wei Zhang ◽

Wenjing Zhang ◽

...

Keyword(s):

Risk Factors ◽

Multiple Myeloma ◽

Multivariate Analysis ◽

Cox Regression ◽

Survival Curve ◽

Univariate Analysis ◽

Evaluation Criteria ◽

Rank Test ◽

Newly Diagnosed ◽

Early Evaluation

Objective: To explore the significance of the ratio of neutrophils to lymphocytes (NLR), monocytes to lymphocytes (MLR), and platelets to lymphocytes (PLR) in the prognosis of patients with newly diagnosed multiple myeloma. Methods: A total of 60 patients with MM who were diagnosed in Jiangning Hospital Affiliated to Nanjing Medical University and Zhongda Hospital Affiliated to Southeast University from August 2011 to March 2020 were retrospectively analysed. According to NLR, MLR, PLR, the patients were divided into the low NLR group (NLR < 3.61) or high NLR group (NLR ≥ 3.61), low MLR group (MLR < 0.33) or high MLR group (MLR ≥ 0.33), low PLR group (PLR < 129.78) and high PLR group (PLR ≥ 129.78). Overall survival (OS) was used as the prognostic evaluation criteria, and Kaplan-Meier survival curve, Log-rank test and Cox regression model were used to carry out univariate and multivariate analysis on clinical and laboratory parameters. Results: Among the 60 patients, 33 were male and 27 were female, the median age of the patients was 65 years old, 19 were in the high NLR group, 41 were in the low NLR group, 24 were in the high MLR group, 36 were in the low MLR group, 26 were in the high PLR group, and 34 were in the low PLR group. The univariate analysis showed the prognosis was influenced by factors including NLR, PLR, age, ISS stages, hemoglobin (HGB), albumin (ALT). MLR, type of immunoglobulin, white globulin ratio (A/G), gender, β2-microglobulin(β2-MG), lactate dehydrogenase (LDH) and creatinine were not correlated with the total survival time of patients. The multivariate analysis showed that ISS III stages, PLR ≥ 129.78, HGB < 100g/L were independent risk factors influencing the prognosis of MM patients. Conclusion: ISS III stages, PLR ≥ 129.78, HGB < 100g/L are independent prognostic risk factors in newly diagnosed multiple myeloma patients, which can be used as an economical and effective method for early evaluation of patient prognosis.

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Preoperative anemia and hospitalization time are the independent factors of preoperative deep venous thromboembolism in Chinese elderly undergoing hip surgery

10.21203/rs.2.12382/v2 ◽

2020 ◽

Author(s):

long feng(Former Corresponding Author) ◽

Longhe Xu ◽

Weixiu Yuan ◽

Zhipeng Xu ◽

ZeGuo Feng(New Corresponding Author) ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Operation Time ◽

Hemoglobin Level ◽

Preoperative Anemia ◽

Chinese Elderly ◽

Preoperative Hemoglobin ◽

Hospitalization Time ◽

Independent Risk Factors ◽

Preoperative Hemoglobin Level

Abstract Aim This study was designed to explore the prevalence condition and risk factors of preoperative deep venous thromboembolism (DVT) in Chinese elderly with hip fracture. Methods From January 1, 2012, to December 31, 2018, 273 elderly over 70 years old with elective hip surgery were collected from the electronic medical records. Collected Data included demographic characteristics, comorbidities, ASA classification, types of surgeries, types of anesthesia, operation time, fracture to operation time, perioperative blood transfusion, preoperative hemoglobin level, anemia, blood-gas analysis, cardiac function, electrocardiograph, lower limb venous ultrasonography and hospitalization time. Results In all patients, 15 patients (5.6%) had ultrasonography evidence of DVT in affected limbs before surgery. Three of all patients received an temporary inferior vena cave filter placement. Fracture to surgery time, preoperative hemoglobin level, anemia, pulmonary disease and hospitalization time were statistically different between DVT group and non-DVT group (P<0.05 for all). Moreover, preoperative anemia (OR: 0.144, 95%CI: 0.026-0.799, P=0.027) and hospitalization time (OR: 1.135; 95%CI: 1.023-1.259, P=0.017) were the two independent risk factors for preoperative DVT. Conclusion Preoperative anemia and hospitalization time were independent risk factors for venous DVT in Chinese elderly with hip fracture.

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