Combination of AST to ALT and neutrophils to lymphocytes ratios as predictors of locally advanced disease in patients with bladder cancer subjected to radical cystectomy: Results from a single-institutional series

2021 ◽  
pp. 039156032110351
Author(s):  
Alessandro Uleri ◽  
Rodolfo Hurle ◽  
Roberto Contieri ◽  
Pietro Diana ◽  
Nicolòmaria Buffi ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Radical Cystectomy ◽  
Advanced Disease ◽  
Independent Predictor ◽  
Small Sample Size ◽  
Statistical Significance ◽  
Locally Advanced ◽  
Small Sample ◽  
Locally Advanced Disease ◽  
Increased Risk

Background: Bladder cancer (BC) staging is challenging. There is an important need for available and affordable predictors to assess, in combination with imaging, the presence of locally-advanced disease. Objective: To determine the role of the De Ritis ratio (DRR) and neutrophils to lymphocytes ratio (NLR) in the prediction of locally-advanced disease defined as the presence of extravescical extension (pT ⩾ 3) and/or lymph node metastases (LNM) in patients with BC treated with radical cystectomy (RC). Methods: We retrospectively analyzed clinical and pathological data of 139 consecutive patients who underwent RC at our institution. Logistic regression models (LRMs) were fitted to test the above-mentioned outcomes. Results: A total of 139 consecutive patients underwent RC at our institution. Eighty-six (61.9%) patients had a locally-advanced disease. NLR (2.53 and 3.07; p = 0.005) and DRR (1 and 1.17; p = 0.01) were significantly higher in patients with locally-advanced disease as compared to organ-confined disease. In multivariable LRMs, an increasing DRR was an independent predictor of locally-advanced disease (OR = 3.91; 95% CI: 1.282–11.916; p = 0.017). Similarly, an increasing NLR was independently related to presence of locally-advanced disease (OR = 1.28; 95% CI: 1.027–1.591; p = 0.028). In univariate LRMs, patients with DRR > 1.21 had a higher risk of locally advanced disease (OR = 2.83; 95% CI: 1.312–6.128; p = 0.008). Similarly, in patients with NLR > 3.47 there was an increased risk of locally advanced disease (OR = 3.02; 95% CI: 1.374–6.651; p = 0.006). In multivariable LRMs, a DRR > 1.21 was an independent predictor of locally advanced disease (OR = 2.66; 95% CI: 1.12–6.35; p = 0.027). Similarly, an NLR > 3.47 was independently related to presence of locally advanced disease (OR = 2.24; 95% CI: 0.95–5.25; p = 0.065). No other covariates such as gender, BMI, neoadjuvant chemotherapy or diabetes reached statistical significance. The AUC of the multivariate LRM to assess the risk of locally advanced disease was 0.707 (95% CI: 0.623–0.795). Limitations include the retrospective nature of the study and the relatively small sample size.

Thromboembolic events associated with cisplatin chemotherapy in patients with gastric and esophageal cancer: A single-institution experience.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 146-146
Author(s):  
Aine O'Reilly ◽  
Mark Doherty ◽  
William Grogan ◽  
Oscar S. Breathnach
Keyword(s):  
Platelet Count ◽  
Haemoglobin Level ◽  
Clinical Laboratory ◽  
Advanced Disease ◽  
Leukocyte Count ◽  
Locally Advanced ◽  
Artery Occlusion ◽  
Thromboembolic Events ◽  
Locally Advanced Disease ◽  
Increased Risk

146 Background: Upper gastrointestinal tract malignancy, specifically gastric cancer (GC) , is associated with an increased risk of thromboembolic events (TEs). Cisplatin is important in the treatment of GC and oesophageal cancer (OC) but is associated with an increased risk of TEs. We aimed to characterise our experience of thromboembolism in patients (pts) with GC and OC receiving cisplatin. Methods: Patients with GC or OC who received cisplatin based chemotherapy from January 2011 to August 2013 were included in analysis. Retrospective review of patient’s clinical, laboratory and radiological data was pursued. Results: Seventy-four pts, 27 patients with GC and 47 pts with OC, received cisplatin based chemotherapy between January 2011 and August 2013. The median age at the start of chemotherapy was 67 (range 43-86), 48 patients (66%) were male. Nine pts experienced a TE. Seven pts experienced a venous TE (5 deep vein thrombosis (DVT), 1 pulmonary embolism (PE)), 1 pt experienced a middle cerebral artery occlusion and subsequently developed a PE while on therapeutic anticoagulation and 1 pt experienced 2 DVTs, the second occurred while therapeutically anticoagulated. Six pts received cisplatin in the context of metastatic GC, 3 (50%) pts experienced at least one TE. Haemoglobin level, leukocyte count, platelet count and body mass index (BMI) were not associated with TE risk. Twenty-one pts received cisplatin neoadjuvantly for locally advanced GC. Four pts (19%) in this subgroup experienced a least one TE. Haemoglobin level, leukocyte count and BMI were not associated with an increased risk of TE. Patients with a platelet count > 350,000/mm3 experienced more TEs (p<0.05). Forty seven pts were treated for OC, 7 pts with metastatic disease and 40 pts with locally advanced disease. Two pts experienced a single VTE (DVTs), both had locally advanced disease. Conclusions: Thromboembolic events are common in pts with metastatic and locally advanced GC, receiving cisplatin based chemotherapy. Future studies should focus on characterising the role of prophylactic anticoagulation in this subgroup and identifying biomarkers associated with increased risk of TE.

scholarly journals Impact of Salvage Cytotoxic Chemotherapy on Prognosis in Patients with Recurrence After Radical Cystectomy: A Multi-Institutional Retrospective Study

2022 ◽  
Author(s):  
Dai Koguchi ◽  
Kazumasa Matsumoto ◽  
Masaomi Ikeda ◽  
Yoshinori Taoka ◽  
Takahiro Hirayama ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Liver Metastasis ◽  
Radical Cystectomy ◽  
Treatment Effect ◽  
Advanced Disease ◽  
Locally Advanced ◽  
Cytotoxic Chemotherapy ◽  
Locally Advanced Disease ◽  
Clinicopathologic Factors

Abstract Background In patients experiencing disease recurrence after radical cystectomy (RC) for bladder cancer, data about the impact of clinicopathologic factors, including salvage treatment using cytotoxic chemotherapy, on the survival are scarce. We investigated the prognostic value of clinicopathologic factors and the treatment effect of salvage cytotoxic chemotherapy (SC) in such patients. Methods In this retrospective study, we evaluated the clinical data for 86 patients who experienced recurrence after RC. Administration of SC or of best supportive care (BSC) was determined in consultation with the urologist in charge and in accordance with each patient’s performance status, wishes for treatment, and renal function. Statistical analyses explored for prognostic factors and evaluated the treatment effect of SC compared with BSC in terms of cancer-specific survival (CSS). Results Multivariate analyses showed that liver metastasis after RC (hazard ratio [HR]: 2.13; 95% confidence interval [CI]: 1.17 to 3.85; P = 0.01) and locally advanced disease at RC (HR: 1.92; 95% CI: 1.06 to 3.46; P = 0.03) are independent risk factors for worse CSS in patients experiencing recurrence after RC. In a risk stratification model, patients were assigned to one of two groups based on liver metastasis and locally advanced stage. In the high-risk group, which included 68 patients with 1–2 risk factors, CSS was significantly better for patients receiving SC than for those receiving BSC (median survival duration: 9.4 months vs. 2.4 months, P = 0.005). The therapeutic effect of SC was not related to a history of adjuvant chemotherapy. Conclusions The present study indicated the potential value of 1st-line SC in patients experiencing recurrence after RC even with advanced features, such as liver metastasis after RC and locally advanced disease at RC.

Association of losartan use with outcomes in metastatic pancreatic cancer patients treated with chemotherapy.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16738-e16738
Author(s):  
Jessica Allen ◽  
Kathan Mehta ◽  
Shrikant Anant ◽  
Prasad Dandawate ◽  
Anwaar Saeed ◽  
...  
Keyword(s):  
Small Sample Size ◽  
Metastatic Cancer ◽  
Statistical Significance ◽  
Objective Response ◽  
Locally Advanced ◽  
Small Sample ◽  
Ductal Adenocarcinoma ◽  
Control Group ◽  
100Mg Dose ◽  
Significant Difference

e16738 Background: A phase II trial has shown improved efficacy of neoadjuvant therapy when combined with losartan (by remodeling desmoplasia) in locally advanced pancreatic ductal adenocarcinoma (PDA). However, role of losartan is unknown in metastatic PDA. We examined the relationship between the use of the angiotensin II receptor antagonist, losartan, at time of diagnosis with clinical outcomes in metastatic PDA pts that received chemo. Methods: We retrospectively evaluated 114 metastatic PDA pts treated at our center between Jan 2000 and Nov 2019. We compared OS, PFS, objective response rate (ORR), and disease control rate (DCR) between pts using losartan at time of cancer diagnosis and a control group of pts not on losartan. A subanalysis was performed based on losartan dose: 100mg dose versus control pts. and based on chemo: FOLFIRINOX or gemcitabine+abraxane. Results: Table shows baseline demographics. No significant difference was found in OS [p = 0.455] or PFS [p = 0.919] in pts on losartan (median 274d, 83d) vs control (median 279d, 111d) [p = 0.466]. No significant difference was found in ORR [p = 0.621] or in DCR [p = 0.497]. No significant difference was found in OS [p = 0.771] or PFS [p = 0.064] in losartan pts (median 347d, 350d) vs control (median 333d, 101d) treated with FOLFIRINOX. No significant difference was found in OS [p = 0.916] or PFS [p = 0.341] in losartan (median 312d, 69d) vs control (median 221d, 136d) [p = 0.916] treated with gemcitabine+abraxane. No significant difference was found in OS [p = 0.727] or PFS [p = 0.790] in 100mg losartan pts (median 261d, 84d) vs control (median 279d, 111d). Conclusions: Pts on losartan at time of diagnosis had no significant difference in OS, PFS, ORR, DCR than control pts. However, a subanalysis of pts treated with FOLFIRINOX revealed a longer PFS with losartan than control but did not meet statistical significance, likely due to small sample size. To confirm if the benefit of losartan + FOLFIRINOX seen in neoadjuvant setting for locally advanced cancer also applies to metastatic cancer, our findings need to be validated in a larger cohort. [Table: see text]

scholarly journals A preliminary study on the efficacy and safety of 3-hole VS 5-hole laparoscopic radical cystectomy

2021 ◽  
Author(s):  
longfei peng ◽  
liangkuan bi ◽  
dexin yu ◽  
jinyou wang
Keyword(s):  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Small Sample Size ◽  
Statistical Significance ◽  
Operation Time ◽  
Small Sample ◽  
Efficacy And Safety ◽  
Ventilation Time ◽  
Basic Characteristics

Abstract Objective To investigate the efficacy and safety of three hole laparoscopic radical cystectomy(LRC) in comparison with five hole LRC. Methods The patients who underwent radical cystectomy from January 2019 to March 2021 in our hospital were retrospectively analyzed.Basic information and preoperative and postoperative data were collected(such as gender, age, hemoglobin, creatinine, operation time, blood loss, ventilation time, etc).Statistical analysis was used to determine whether there was statistical significance between the two groups(3-hole VS 5-hole). Results A total of 99 patients with radical cystectomy and urinary diversion were collected.Three hole laparoscopy included 33 cases and five hole laparoscopy included 66 cases.The basic characteristics of the two groups of data did not have significant statistical significance.The operation time and exsufflation time of 3-hole method were significantly shorter than that of 5-hole method in patients with ileal conduit. In patients with orthotopic neobladder, the exsufflation time and postoperative hospital stay of 3-hole method were significantly shorter than that of 5-hole method.Total laparoscopic surgery has shorter ventilation time than in vitro urinary diversion. Conclusions Compared with 5-hole LRC, 3-hole LRC can reduce the operation time, shorten the hospitalization time, reduce the hospitalization cost and save medical resources. However, due to the small sample size and short follow-up time, the long-term benefits need to be further observed.

Abstract 17107: CHA2DS2VASC Score and Frailty Index as Mortality Predictors in Patients Hospitalized With SARS-CoV-2 Infection

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ibett Colina ◽  
Efehi Igbinomwanhia ◽  
Alejandro Sanchez ◽  
Miguel Treminio Quezada ◽  
Christopher Kabir ◽  
...  
Keyword(s):  
Small Sample Size ◽  
Statistical Significance ◽  
Frailty Index ◽  
Small Sample ◽  
Hospital Treatment ◽  
Multivariate Logistic Regression Model ◽  
Point Increase ◽  
Increased Risk ◽  
The Mean ◽  
Frailty Score

Introduction: The current pandemic with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has impacted healthcare around the globe. The CHADS2VASC and frailty scores have not been studied as tool predictors for outcomes in this population. Hypothesis: CHA2DS2VASC and frailty scores can be used as predictors of mortality and unfavorable outcomes in patients hospitalized with SARS-CoV-2 infection. Methods: We included patients ages 18 years and older who required in-hospital treatment for SARS-CoV-2 infection at a Community Hospital between February and April of 2020. CHA2DS2VASC score and frailty index (FI) were calculated at time of admission and were used as continuous variables in a multivariate logistic regression model. Cardiovascular (CV) outcome was a composite variable that included non-fatal MI, decompensated heart failure, unstable arrhythmia and CVA. Results: Amongst 109 patients, 55% were male, mean age was 61.7 years (standard deviation 17.7) and 73% of the patients were admitted from home. 21.1% (23) of the patients died during their stay. The mean CHA2DS2VASC score was 2.5 (SD 1.7). For every point increase in the CHA2DS2VASC score the odds of mortality increased by 78% (aOR 1.78; 95% CI; 1.07-2.97). The mean frailty score was 6.2 (SD 5.7). For every point increase in the frailty score the odds of mortality increased by 22% (aOR: 1.22; 95% CI 1.07-1.39) [Figure]. There was a trend between higher CHA2DS2VASC and frailty scores with worse CV outcomes during hospital stay but this did not meet statistical significance (aOR: 1.31; 95% CI 0.86-2.0, aOR: 1.04; CI 0.93-1.17 respectively). Conclusions: Higher CHA2DS2VASC and frailty scores are associated with increased risk of mortality. Although statistical significance was not reached for predicting CV outcomes, this was likely related to a small sample size. CHA2DS2VASC and frailty scores are a readily available and novel tool that can be used to predict mortality in hospitalized patients.

scholarly journals The incidence and prevalence of cardiovascular diseases in gout: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Peter Cox ◽  
Sonal Gupta ◽  
Sizheng Steven Zhao ◽  
David M. Hughes
Keyword(s):  
Systematic Review ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Cardiovascular Diseases ◽  
Small Sample Size ◽  
Meta Analysis ◽  
Random Effect ◽  
Small Sample ◽  
Future Research ◽  
Increased Risk

AbstractThe aims of this systematic review and meta-analysis were to describe prevalence of cardiovascular disease in gout, compare these results with non-gout controls and consider whether there were differences according to geography. PubMed, Scopus and Web of Science were systematically searched for studies reporting prevalence of any cardiovascular disease in a gout population. Studies with non-representative sampling, where a cohort had been used in another study, small sample size (< 100) and where gout could not be distinguished from other rheumatic conditions were excluded, as were reviews, editorials and comments. Where possible meta-analysis was performed using random-effect models. Twenty-six studies comprising 949,773 gout patients were included in the review. Pooled prevalence estimates were calculated for five cardiovascular diseases: myocardial infarction (2.8%; 95% confidence interval (CI)s 1.6, 5.0), heart failure (8.7%; 95% CI 2.9, 23.8), venous thromboembolism (2.1%; 95% CI 1.2, 3.4), cerebrovascular accident (4.3%; 95% CI 1.8, 9.7) and hypertension (63.9%; 95% CI 24.5, 90.6). Sixteen studies reported comparisons with non-gout controls, illustrating an increased risk in the gout group across all cardiovascular diseases. There were no identifiable reliable patterns when analysing the results by country. Cardiovascular diseases are more prevalent in patients with gout and should prompt vigilance from clinicians to the need to assess and stratify cardiovascular risk. Future research is needed to investigate the link between gout, hyperuricaemia and increased cardiovascular risk and also to establish a more thorough picture of prevalence for less common cardiovascular diseases.

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