Implementation of recommendations for the screening of hydroxychloroquine retinopathy: poor adherence of rheumatologists and ophthalmologists

The American Academy of Ophthalmology published in 2011 revised recommendations regarding screening for hydroxychloroquine (HCQ) toxicity. We aimed to assess implementation of these recommendations by rheumatologists and ophthalmologists. A questionnaire regarding screening practices for HCQ toxicity was distributed among all members of the Israeli societies of Rheumatology and Ophthalmology. A total of 128 physicians responded to the questionnaire (rheumatologists: 60, ophthalmologists: 68). Only 5% of the rheumatologists and 15% of the ophthalmologists are aware of ophthalmologic assessments recommended for baseline and follow-up evaluation. When an abnormal test is detected, even if inappropriate for HCQ toxicity screening, 60% of the responders recommend cessation of therapy. Only 13% of the responders recommend first follow-up after five years for patients without risk factors; the remainder recommend more frequent testing. Ninety-six percent of the responders are not aware of all of the known risk factors for HCQ toxicity. Use of inappropriate tests to detect HCQ retinal toxicity may lead to unnecessary cessation of beneficial treatment with risk of disease flare, while lack of consideration of risk factors may put patients at risk for toxicity. These results emphasize the importance of implementing the recommendations to ensure safe and effective use of this drug.

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OP0133 THE PREVALENCE AND RISK FACTORS OF RETINAL TOXICITY ASSOCIATED WITH LONG-TERM HYDROXYCHLOROQUINE USE

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.328 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 77-78

Author(s):

S. Do ◽

J. H. Du ◽

J. X. An ◽

J. Wang ◽

A. Lin

Keyword(s):

Risk Factors ◽

Cumulative Dose ◽

Daily Intake ◽

Retinal Toxicity ◽

Factors Associated ◽

Duration Of Therapy ◽

Increased Risk ◽

Hydroxychloroquine Retinopathy ◽

Risk Of Retinopathy

Background:Hydroxychloroquine (HCQ) is commonly used for the treatment of various autoimmune diseases. The medication is generally well-tolerated. However, long-term use after 5 years may increase the risk of retinopathy. One study in 2014 has demonstrated the risk can be as high as 7.5%. Optical Coherence Tomography (OCT) has become a major modality in screening retinopathy.Objectives:To evaluate the prevalence of retinal toxicity among patients using hydroxychloroquine and to determine various risk factors associated with hydroxychloroquine-associated retinal toxicity.Methods:We performed a retrospective chart review on a cohort of adult patients with long-term use (≥ 5 years cumulative) of HCQ between January 1st, 2011 to December 31st, 2018 from the Kaiser Permanente San Bernardino County and Riverside medical center areas in Southern California, USA. Patients were excluded if they had previously been diagnosed with retinopathy prior to hydroxychloroquine use, were deceased, or had incomplete OCT exam. Our primary endpoint was the prevalence of patients who developed retinal toxicity detected by OCT, and later confirmed by retinal specialist. Potential risk factors (age, duration of therapy, daily consumption per actual body weight, cumulative dose, confounding diseases and medication) for developing retinopathy were also evaluated. Univariable and multivariable logistic regression analyses were used to determine risk factors associated with retinal toxicity.Results:Among 676 patients exposed to more than 5 years of HCQ, the overall prevalence of retinal toxicity was 6.8%, and ranged from 2.5% to 22.2% depending on the age, weight-based dosing, duration of use and cumulative dose. Duration of therapy for 10 years or more increased risk of retinopathy by approximately 5 to 19 folds. Similarly, weight-based dose of 7 mg/kg/day or greater was assciated with increased risk of retinopathy by approximately 5 times. Patients with cumulative dose of 2000 grams or more had greater than 15 times higher risk of developing retinopathy. Duration of use for10 years or more (odd ratio 4.32, 95% CI 1.99 – 12.49), age (odd ratio 1.04; 95% CI 1.01 - 1.08), cumulative dose of more than 1500 g (odd ratio 7.4; 95% CI 1.40 – 39.04) and atherosclerosis of the aorta (odd ratio 2.59; 95% CI, 1.24 – 5.41) correlated with higher risk of retinal toxicity.Conclusion:The overall prevalence of retinopathy was 6.8%. Regular OCT screening, especially in patients with hydroxychloroquine use for more than 10 years, daily intake > 7 mg/kg, or cumulative dose > 1500 grams is important in detecting hydroxychloroquine-associated retinal toxicityReferences:[1]Hobbs HE. Sorsby A, & Freedman A. Retinopathy Following Chloroquine Therapy. The Lancet. 1959; 2(7101): 478-480.[2]Levy, G. D., Munz, S. J., Paschal, J., Cohen, H. B., Pince, K. J., & Peterson, T. Incidence of hydroxychloroquine retinopathy in 1,207 patients in a large multicenter outpatient practice. Arthritis & Rheumatism: 1997; 40(8): 1482-1486.[3]Ding, H. J., Denniston, A. K., Rao, V. K., & Gordon, C. Hydroxychloroquine-related retinal toxicity. Rheumatology. 2016; 55(6): 957-967.[4]Stelton, C. R., Connors, D. B., Walia, S. S., & Walia, H. S. Hydrochloroquine retinopathy: characteristic presentation with review of screening. Clinical rheumatology. 2013; 32(6): 895-898.[5]Marmor, M. F., Kellner, U., Lai, T. Y., Melles, R. B., & Mieler, W. F. Recommendations on screening for chloroquine and hydroxychloroquine retinopathy (2016 revision). Ophthalmology. 2016; 123(6): 1386-1394.[6]Melles, R. B., & Marmor, M. F. The risk of toxic retinopathy in patients on long-term hydroxychloroquine therapy. JAMA ophthalmology. 2014; 132(12): 1453-1460.Disclosure of Interests:None declared

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A high number of diseases and consultations: a warning signal for GPs when following up a multimorbid patient

10.21203/rs.2.13278/v1 ◽

2019 ◽

Author(s):

Paul Aujoulat ◽

Patrice NABBE ◽

Sophie LALANDE ◽

Delphine LE GOFF ◽

Jeremy DERRIENIC ◽

...

Keyword(s):

Risk Factors ◽

Primary Care ◽

Large Scale ◽

Cox Model ◽

Warning Signal ◽

Research Network ◽

P Value ◽

Patients At Risk ◽

Definition Of

Abstract Background: the European General Practitioners Research Network (EGPRN) designed and validated a comprehensive definition of multimorbidity using a systematic literature review and qualitative research throughout Europe. Detecting risk factors for decompensation would be an interesting challenge for family physicians (FPs) in the management of multimorbid patients. The purpose of the survey was to assess which items belonging to the EGPRN multimorbidity definition could help to identify patients at risk of decompensation in a cohort pilot study over a 24-month follow-up among primary care outpatients. Method : 131 patients meeting the multimorbidity definition were included using two inclusion periods between 2014 and 2015. Over a 24-month follow-up, the « decompensation » or « nothing to report » status was collected. A logistic regression, following a Cox model, was then performed to identify risk factors for decompensation. Results : After 24 months of follow-up, 120 patients were analyzed. 3 clusters were identified. 44 patients, representing 36.6 % of the population, were still alive and had not been hospitalized for a period exceeding 6 days. Two variables were significantly linked to decompensation: the number of visits to the FP per year (HR 1.06, IC 95 %, 1,03-1,10, p-value <0,001) and the total number of diseases (HR 1,12, IC 95 %, 1,013-1,33, p-value = 0,039). Conclusion: FPs should be aware that a high number of consultations and a high total number of diseases are linked to severe outcomes such as death or unplanned hospitalization. A large-scale cohort in primary care seems feasible to confirm these results.

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Anthracycline-Induced Clinical Heart Failure in a Cohort of 607 Children: Long-Term Follow-Up Study

Journal of Clinical Oncology ◽

10.1200/jco.2001.19.1.191 ◽

2001 ◽

Vol 19 (1) ◽

pp. 191-196 ◽

Cited By ~ 280

Author(s):

L. C.M. Kremer ◽

E. C. van Dalen ◽

M. Offringa ◽

J. Ottenkamp ◽

P. A. Voûte

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Cumulative Dose ◽

Cumulative Incidence ◽

Clinical Status ◽

Young Patients ◽

Increased Risk ◽

Patients At Risk ◽

Clinical Heart Failure

PURPOSE: To determine the early and late cumulative incidence of anthracycline-induced clinical heart failure (A-CHF) after anthracycline therapy in childhood and to identify associated risk factors. PATIENTS AND METHODS: The cumulative incidence of A-CHF and the risk factors of A-CHF were assessed in a cohort of 607 children who had been treated with anthracyclines between 1976 and 1996. For 96% of the cohort, we obtained the clinical status up to at least January 1997. The mean follow-up time was 6.3 years. RESULTS: The cumulative incidence of A-CHF was 2.8%, after a mean follow-up time of 6.3 years and a mean cumulative dose of anthracyclines of 301 mg/m2. A cumulative dose of anthracycline higher than 300 mg/m2 was associated with an increased risk of A-CHF (relative risk, 11.8; 95% confidence interval, 1.6 to 59.5) compared with a cumulative dose lower than 300 mg/m2. The estimated risk of A-CHF increased with time after the start of anthracycline chemotherapy to 2% after 2 years and 5% after 15 years. CONCLUSION: Up to 5% of patients will develop A-CHF 15 years after treatment, and patients treated with a cumulative dose of anthracyclines higher than 300 mg/m2 are at highest risk for A-CHF. This is thus a considerable and serious problem among these young patients. The findings reinforce the need for strategies for early detection of patients at risk for A-CHF and for the evaluation of other chemotherapeutic possibilities or cardioprotective agents in relation to the survival.

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Risk factors and frequency of postprocedural hemodynamic instability after carotid artery stent placement

Lekarz Wojskowy ◽

10.53301/lw.2100 ◽

2021 ◽

Vol 99 (4) ◽

pp. 162-168

Author(s):

Jarosław Świstak ◽

Aleksander Dębiec ◽

Wojciech Szypowski ◽

Piotr Piasecki ◽

Krzysztof Brzozowski ◽

...

Keyword(s):

Risk Factors ◽

Carotid Artery ◽

Hemodynamic Instability ◽

Neurological Complications ◽

Lesion Length ◽

Symptomatic Carotid ◽

Symptomatic Carotid Stenosis ◽

Before And After ◽

Patients At Risk

The frequency, risk factors and long term consequences of reflexive postprocedural hypotension (PH) following carotid artery stenting (CAS) are not well known. Prospective analysis of 30 patients with 6-month follow-up undergoing CAS with an emboli-protection device was performed. A validated 24-hour ABPM was taken 24 hours before and after CAS. PH was defined as systolic blood pressure (SBP) <90mm Hg, or decrease in mean arterial BP (MAP) of ≥20% or systolic BP (SBP) of ≥30 mm Hg of baseline BP reading. Neurological assessments were performed 24 hours after CAS and at 6 month follow-up visit. Median age was 69 years, 70% were male, 86% of patients had symptomatic carotid stenosis. Twenty patients (67%) experienced PH, 43% had transient bradycardia, 30% had both PH and bradycardia. The cumulated postprocedural mean SBP and DBP decreased from baseline 128/67 mm Hg to 108/54 mm Hg (p <0.01), mean day (69/min) and night HR (58/min) decreased to respectively 58/min and 49/min (p <0.01). We found no association of PH with age, ischemic heart disease, bifurcation involvement, balloon size, inflation pressure, longer lesion length. Patients with PH significantly (p <0.05) less often were treated with Ca-antagonist (25% vs 70%), more often had ipsilateral ulcerated plaque (85% vs 50%) and had hemodynamically significant stenosis of contralateral ICA (60% vs 30%). During 6 month follow-up only 1 case of neurological deterioration was noticed. PH was a common phenomenon after CAS, however it did not result in neurological complications. Patients at risk can be possibly identified through clinical and angiographic variables.

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Does This Patient Need Blood Cultures? A Scoping Review of Indications for Blood Cultures in Adult Nonneutropenic Inpatients

Clinical Infectious Diseases ◽

10.1093/cid/ciaa039 ◽

2020 ◽

Vol 71 (5) ◽

pp. 1339-1347 ◽

Cited By ~ 4

Author(s):

Valeria Fabre ◽

Sima L Sharara ◽

Alejandra B Salinas ◽

Karen C Carroll ◽

Sanjay Desai ◽

...

Keyword(s):

Risk Factors ◽

Scoping Review ◽

Primary Source ◽

Blood Cultures ◽

Source Control ◽

High Likelihood ◽

Source Of Infection ◽

Patients At Risk ◽

High Pretest Probability

Abstract Guidance regarding indications for initial or follow-up blood cultures is limited. We conducted a scoping review of articles published between January 2004 and June 2019 that reported the yield of blood cultures and/or their impact in the clinical management of fever and common infectious syndromes in nonneutropenic adult inpatients. A total of 2893 articles were screened; 50 were included. Based on the reported incidence of bacteremia, syndromes were categorized into low, moderate, and high pretest probability of bacteremia. Routine blood cultures are recommended in syndromes with a high likelihood of bacteremia (eg, endovascular infections) and those with moderate likelihood when cultures from the primary source of infection are unavailable or when prompt initiation of antibiotics is needed prior to obtaining primary source cultures. In syndromes where blood cultures are low-yield, blood cultures can be considered for patients at risk of adverse events if a bacteremia is missed (eg, patient with pacemaker and severe purulent cellulitis). If a patient has adequate source control and risk factors or concern for endovascular infection are not present, most streptococci or Enterobacterales bacteremias do not require routine follow-up blood cultures.

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A Scoring System Based on Clinical, Blood Count and Immunophenotypic Data Can Predict the Risk of Disease Progression in Patients with Chronic Lymphocytic Leukemia

Blood ◽

10.1182/blood.v112.11.4185.4185 ◽

2008 ◽

Vol 112 (11) ◽

pp. 4185-4185

Author(s):

Sina Alipour ◽

Heather Leitch ◽

Linda M Vickars ◽

Lynda M Foltz ◽

Paul F Galbraith ◽

...

Keyword(s):

Risk Factors ◽

Disease Progression ◽

Scoring System ◽

Doubling Time ◽

Univariate Analysis ◽

Progression Free Survival ◽

Lymphocytic Leukemia ◽

Free Survival ◽

Risk Of Disease

Abstract There is limited access to advanced molecular and immunophenotypic techniques such as immunoglobulin heavy chain variable mutational status and ZAP-70 expression analysis in many parts of the world. To facilitate the development of a clinical model based on readily available clinical and well-standardized pathological data, we analyzed the well known prognostic factors in chronic lymphocytic leukemia (CLL) and proposed a scoring system. We searched the CLL database and among 465 patients (pts) we included 128 pts where the staging, blood counts, immunophenotypic and follow up data are complete. The baseline characteristics of this group and the significance of the proposed factors on the progression-free survival on univariate analysis are summarized in the table. Progression–free survival (PFS) was defined as the time from diagnosis to the time where treatment for CLL is indicated and if no treatment id indicated, the time of last follow up. In this 5 point scoring system we added one point for the presence of each one of the following factors: male gender, Rai stage 1 or more, lymphocyte count of 20 ×109/l or higher, lymphocyte doubling time less than 12 m, CD 38 expression of 20% or more. We further lumped these groups into 3 groups: no risk factors, one risk factor and tow or more risk factors. Thirty eight patients (30%) were found to have no risk factors and their 5 and 10 year PFS was 100% and 100% respectively. Forty nine pts (38%) have at least one risk factor and their 5 and 10 y PFS was 92% and 81% respectively. Forty pts (31%) have two or more risk factors and their 5 and 10 y PFS was 48% and 20% respectively. Those differences in PFS were significant (p<0.00001). We conclude that readily available clinical and laboratory information in patients with CLL can be utilized to predict the risk of disease progression. Pts with no risk factors can be reliably reassured and do not require regular monitoring. Correlation of these findings with other molecular prognostic factors is needed. Table: Risk factors for disease progression Parameter N (%) 5-y PFS 10-y PFS p value (UVA)* *Univariate analysis Sex: Male 71 (56) 67% 43% 0.01 Female 56 (44) 91% 73% Rai stage: 0 103 (80) 87% 77% <0.0001 1,2,3,4 25 (20) 49% 18% Lymphocyte count: < 20×109/l 108 (84) 85% 60% <0.0001 ≥20×109/l 20 (16) 40% 40% Lymphocyte doubling time ≥ 12m 111 (87) 84% 68% 0.001 <12 m 17 (13) 50% 22% CD38 <20% 99 (77) 83% 67% 0.006 ≥20% 29 (23) 62% 36% Fig: Progression free survival based on the number of risk factors for disease progression (p<0.00001) Fig:. Progression free survival based on the number of risk factors for disease progression (p<0.00001)

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A predictive model to identify patients at risk of local recurrence following glansectomy for penile squamous cell cancer (SCC).

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.6_suppl.427 ◽

2017 ◽

Vol 35 (6_suppl) ◽

pp. 427-427

Author(s):

Maarten Albersen ◽

Arie Parnham ◽

Alex Freeman ◽

Raj Nigam ◽

Peter Malone ◽

...

Keyword(s):

Risk Factors ◽

At Risk ◽

Logistic Regression ◽

Local Recurrence ◽

Predictive Model ◽

Resected Specimen ◽

High Grade ◽

Multivariate Logistic Regression ◽

Patients At Risk

427 Background: Penile preserving surgery for penile cancer is associated with a higher risk of local recurrence (LR). This study developed a predictive model for LR following glansectomy and split skin graft reconstruction . Methods: Retrospective review performed of 177 patients undergoing glansectomy over a 10 year period. The clinicopathological features, LR patterns and cancer-specific survival (CSS) were recorded. Univariate and multivariate logistic regression was used to identify prognostic indicators for LR. The hazard ratio (HR) for LR was estimated using a KM analysis and based on these data we designed a postoperative model for the prediction of LR. Results: The median follow-up period following surgery was 41.4 (1.9-155) months. In total, 9.3 % of the patients developed a LR. Univariate, but not multivariate logistic regression identified perineural invasion (PNI), carcinoma in situ and high grade disease, but not basaloid variant, T stage, lymphovascular invasion and positive resection margins on the specimen to be predictors of LR. A risk model was designed using PNI, CIS and high grade disease in the resected specimen. KM analysis and log rank test revealed no significant differences in LR-free survival between patients with 0 vs 1 or 2 vs 3 risk factors whereas the chance of having local recurrence with 2 risk factors was significantly higher (HR = 5,75; 95% CI 1,43 to 23,15) than with 1 risk factor. A risk stratification model based on a cut-off score of > 1 out of 3 risk factors discriminated well between patients with a high vs low chance of recurrence in a Kaplan-Meier analysis (HR 9.18, 95% CI 3.29 to 25.65 P < 0.001). Indeed, ROC-curve analysis showed an optimal cut-off point of > 1 risk factors with an AUC of 0.77 (P < 0.001, specificity 63%, specificity of 85%) for prediction of LR. Conclusions: Although,LR after glansectomy does not affect the CSS, patients at risk of local recurrence can be identified when > 1 of the factors PNI, CIS and high grade are found on histopathological analysis of the glans. These findings can define the frequency of follow-up and -if validated on pre-op biopsy- potentially be helpful in planning the margins of surgical resection in patients with penile SCC.

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Long‐Term Fate of the Truncal Valve

Journal of the American Heart Association ◽

10.1161/jaha.120.019104 ◽

2020 ◽

Vol 9 (22) ◽

Author(s):

Laura Gellis ◽

Geoffrey Binney ◽

Laith Alshawabkeh ◽

Minmin Lu ◽

Michael J. Landzberg ◽

...

Keyword(s):

Risk Factors ◽

Cox Regression ◽

Truncus Arteriosus ◽

Valve Regurgitation ◽

Term Survival ◽

Factors Associated ◽

Patients At Risk ◽

Independent Risk Factors

Background Long‐term survival in patients with truncus arteriosus is favorable, but there remains significant morbidity associated with ongoing reinterventions. We aimed to study the long‐term outcomes of the truncal valve and identify risk factors associated with truncal valve intervention. Methods and Results We retrospectively reviewed patients who underwent initial truncus arteriosus repair at our institution from 1985 to 2016. Analysis was performed on the 148 patients who were discharged from the hospital and survived ≥30 days postoperatively using multivariable competing risks Cox regression modeling. Median follow‐up time was 12.6 years (interquartile range, 5.0–22.1 years) after discharge from full repair. Thirty patients (20%) underwent at least one intervention on the truncal valve during follow‐up. Survival at 1, 10, and 20 years was 93.1%, 87.0%, and 80.9%, respectively. The cumulative incidence of any truncal valve intervention by 20 years was 25.6%. Independent risk factors for truncal valve intervention included moderate or greater truncal valve regurgitation (hazard ratio [HR], 4.77; P <0.001) or stenosis (HR, 4.12; P <0.001) before full truncus arteriosus repair and moderate or greater truncal valve regurgitation at discharge after full repair (HR, 8.60; P <0.001). During follow‐up, 33 of 134 patients (25%) progressed to moderate or greater truncal valve regurgitation. A larger truncal valve root z ‐score before truncus arteriosus full repair and during follow‐up was associated with worsening truncal valve regurgitation. Conclusions Long‐term rates of truncal valve intervention are significant. At least moderate initial truncal valve stenosis and initial or residual regurgitation are independent risk factors associated with truncal valve intervention. Larger truncal valve root z ‐score is associated with significant truncal valve regurgitation and may identify a subset of patients at risk for truncal valve dysfunction over time.

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Outcome analysis and risk factors for postoperative colonic ischaemia after aortic surgery

Langenbeck s Archives of Surgery ◽

10.1007/s00423-020-01964-2 ◽

2020 ◽

Vol 405 (7) ◽

pp. 1031-1038

Author(s):

Dmitriy I. Dovzhanskiy ◽

Moritz S. Bischoff ◽

Christopher D. Wilichowski ◽

Fabian Rengier ◽

Anna Klempka ◽

...

Keyword(s):

Risk Factors ◽

Aortic Surgery ◽

Operation Time ◽

Matched Pair ◽

Outcome Analysis ◽

Stoma Creation ◽

Matched Pair Analysis ◽

Abdominal Aortic ◽

Patients At Risk

Abstract Purpose Colonic ischaemia (CI) represents a serious complication after aortic surgery. This study aimed to analyse risk factors and outcome of patients suffering from postoperative CI. Methods Data of 1404 patients who underwent aortic surgery were retrospectively analysed regarding CI occurrence. Co-morbidities, procedural parameters, colon blood supply, procedure-related morbidity and mortality as well as survival during follow-up (FU) were compared with patients without CI using matched-pair analysis (1:3). Results Thirty-five patients (2.4%) with CI were identified. Cardiovascular, pulmonary and renal comorbidity were more common in CI patients. Operation time was longer (283 ± 22 vs. 188 ± 7 min, p < 0.0001) and blood loss was higher (2174 ± 396 vs. 1319 ± 108 ml, p = 0.0049) in the CI group. Patients with ruptured abdominal aortic aneurysm (AAA) showed a higher rate of CI compared to patients with intact AAA (5.4 vs. 1.9%, p = 0.0177). CI was predominantly diagnosed by endoscopy (26/35), generally within the first 4 postoperative days (20/35). Twenty-eight patients underwent surgery, all finalised with stoma creation. Postoperative bilateral occlusion and/or relevant stenosis of hypogastric arteries were more frequent in CI patients (57.8 vs. 20.8%, p = 0.0273). In-hospital mortality was increased in the CI group (26.7 vs. 2.9%, p < 0.0001). Survival was significantly reduced in CI patients (median: 28.2 months vs. 104.1 months, p < 0.0001). Conclusion CI after aortic surgery is associated with considerable perioperative sequelae and reduced survival. Especially in patients at risk, such as those with rAAA, complicated intraoperative course, severe cardiovascular morbidity and/or perioperative deterioration of the hypogastric perfusion, vigilant postoperative multimodal monitoring is required in order to initiate diagnosis and treatment.

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Identifying Risk Factors and Patterns for Early Recurrence of Pancreatic Neuroendocrine Tumors: A Multi-Institutional Study

Cancers ◽

10.3390/cancers13092242 ◽

2021 ◽

Vol 13 (9) ◽

pp. 2242

Author(s):

Charlotte M. Heidsma ◽

Diamantis I. Tsilimigras ◽

Flavio Rocha ◽

Daniel E. Abbott ◽

Ryan Fields ◽

...

Keyword(s):

Risk Factors ◽

Neuroendocrine Tumors ◽

Multivariable Analysis ◽

Early Recurrence ◽

P Value ◽

Pancreatic Neuroendocrine Tumors ◽

Curative Intent ◽

Patients At Risk ◽

The Difference

Background: Identifying patients at risk for early recurrence (ER) following resection for pancreatic neuroendocrine tumors (pNETs) might help to tailor adjuvant therapies and surveillance intensity in the post-operative setting. Methods: Patients undergoing surgical resection for pNETs between 1998–2018 were identified using a multi-institutional database. Using a minimum p-value approach, optimal cut-off value of recurrence-free survival (RFS) was determined based on the difference in post-recurrence survival (PRS). Risk factors for early recurrence were identified. Results: Among 807 patients who underwent curative-intent resection for pNETs, the optimal length of RFS to define ER was identified at 18 months (lowest p-value of 0.019). Median RFS was 11.0 months (95% 8.5–12.60) among ER patients (n = 49) versus 41.0 months (95% CI: 35.0–45.9) among non-ER patients (n = 77). Median PRS was worse among ER patients compared with non-ER patients (42.6 months vs. 81.5 months, p = 0.04). On multivariable analysis, tumor size (OR: 1.20, 95% CI: 1.05–1.37, p = 0.007) and positive lymph nodes (OR: 4.69, 95% CI: 1.41–15.58, p = 0.01) were independently associated with ER. Conclusion: An evidence-based cut-off value for ER after surgery for pNET was defined at 18 months. These data emphasized the importance of close follow-up in the first two years after surgery.

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