scholarly journals Predictors and Long Term Outcomes for DLBCL Patients Undergoing Surgery Prior to Systemic Therapy

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 11-11
Author(s):  
Thejus Jayakrishnan ◽  
Yazan Samhouri ◽  
Veli Bakalov ◽  
Zena Chahine ◽  
Rodney E Wegner ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Systemic Therapy ◽  
Endocrine System ◽  
P Value ◽  
Term Survival ◽  
Comorbidity Score ◽  
System P ◽  
Brain And Spinal Cord

Background Diffuse Large B-Cell Lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma (NHL), accounting for approximately 22% of newly diagnosed non-Hodgkin's lymphoma per year in the United States. Combination chemoimmunotherapy with or without radiation therapy is recommended for the upfront treatment of DLBCL (Yang Liu, AJH,2019). A minority of patients undergo surgery prior to the initiation of systemic therapy for symptom relief or treatment of complications related to the disease. There are concerns on the delay in initiation of systemic therapy when surgery is performed and the potential impact on long term survival in this aggressive chemosensitive disease. We aimed to explore the characteristics of patients undergoing surgery prior to systemic therapy (sxfirst), the predictors for sxfirst and the survival outcomes. Methods We queried the National Cancer Database for patients with DLBCL (ICD-0-3 code 9680) diagnosed from 2006-2015. Inclusion criteria were patients that received systemic therapy as first-line course of treatment and excluded patients with incomplete or missing data for disease stage, treatment characteristics and follow-up. We also excluded patients who underwent biopsy procedures for diagnosis and local procedures such as tumor destruction or ablation. Subgroup analysis of patients that received sxfirst was performed. Time-to-initial therapy (TTI) was defined as time in days (d) from diagnosis to systemic therapy. Survival was measured in terms of months (m) from the day of diagnosis. Stepwise multivariate logistic regression analysis for predictors of sxfirst and propensity score adjusted survival analysis was performed. Results Of 208,748 patients with DLBCL, 138,096 patients met the inclusion criteria of whom 6,381 (4.6%) were sxfirst. The characteristics of sxfirst are summarized in Table 1. Median age was 66 (interquartile range IQR 55-75) years and 61.1% were males. Majority were non-Hispanic whites, had private or medicare insurance, had comorbidity score of 0 and stage I disease. Most patients were treated in comprehensive community cancer centers. The top 5 extra-nodal disease sites were gastrointestinal (26.2%), male reproductive system (16.4%), brain and spinal cord (6.4%), endocrine system (4.1%) and head and neck (3.0%). The median follow up was 47.6 (IQR 14.0-78.9) months. The predictors for sxfirst are described in Table 2. The following disease sites were associated with higher likelihood of sxfirst: male reproductive system (p-value<0.005), gastrointestinal system (p-value<0.005), endocrine system (p-value<0.005), brain and spinal cord (p-value=0.01) and head and neck (p-value=0.02) while the following factors were associated with lower likelihood of sxfirst - medicaid insurance (p-value=0.01), comorbidity score >=3 (p-value 0.007), more recent year of diagnosis, advanced stages of disease and presence of B-symptoms. The TTI for systemic therapy was delayed in sxfirst group - 34 (IQR 22-51) days vs. 21 (IQR 11-35) days, p-value<0.005. The 5-year overall survival for the sxfirst group was 64% (95% CI 62-65%) vs. 57% (95% CI 56-57%)- HR 0.75 (95% CI 0.71 - 0.81). The factors associated with increased mortality were advanced age, higher comorbidity score, lower educational status, advanced clinical stage of the disease, presence of B-symptoms , disease primarily located in the bone, brain and spinal cord. Conclusion The findings of the present study are twofold. First, the present study describes the characteristics and predictors of sxfirst among DLBCL patients. Second, if surgery is absolutely necessary prior to systemically treating DLBCL, the study suggests that the delay does not seem to impact long term survival of these patients and is similar to the 5-year overall survival (64%) reported for DLBCL when all stages and treatment strategies are combined (seer.cancer.gov/statfacts/dlbcl). While there are unmeasured confounding factors as a result of the absence of adequate prognostic markers and treatment characteristics in the database, it is possible that surgery truly doesn't impact the survival outcomes significantly. Further evaluation of this practical question is warranted in large scale prospective studies. Disclosures Khan: Abbvie: Honoraria; Genentech: Honoraria; AstraZeneca: Honoraria; Takeda: Honoraria; Celgene: Honoraria; Karyopharm: Honoraria; Beigene: Honoraria; Seattle Genetics: Honoraria. Fazal:Stemline: Consultancy, Speakers Bureau; Jazz Pharma: Consultancy, Speakers Bureau; Jansen: Speakers Bureau; Karyopham: Speakers Bureau; Incyte Corporation: Consultancy, Honoraria, Speakers Bureau; Takeda: Consultancy, Speakers Bureau; Agios: Consultancy, Speakers Bureau; Glaxosmith Kline: Consultancy, Speakers Bureau; Gilead/Kite: Consultancy, Speakers Bureau; Novartis: Consultancy, Speakers Bureau; Celgene: Speakers Bureau; Amgen: Consultancy, Speakers Bureau; BMS: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.

scholarly journals Pleural infection—an indicator of morbidity and increased burden on health care

2020 ◽  
Vol 31 (4) ◽  
pp. 513-518
Author(s):  
Antti I Lehtomäki ◽  
Riikka M Nevalainen ◽  
Vesa J Toikkanen ◽  
Emilia S Pohja ◽  
Jaakko J Nieminen ◽  
...  
Keyword(s):  
Emergency Room ◽  
Survival Data ◽  
Healthcare Services ◽  
University Hospital ◽  
P Value ◽  
Term Survival ◽  
Frequent Use ◽  
Clinic Visits

Abstract OBJECTIVES Patients with pleural infections frequently have several comorbidities and inferior long-term survival. We hypothesized that these patients represent a vulnerable cohort with high rates of hospitalization and frequent use of healthcare services. This study aims to ascertain the need for and causes of treatment episodes after pleural infections during long-term follow-up. METHODS Patients treated for pleural infections at Tampere University Hospital between January 2000 and December 2008 (n = 191, 81% males, median age 58 years) were included and compared to a demographically matched population-based random sample of 1910 controls. Seventy percent of the pleural infections were caused by pneumonias and 80% of the patients underwent surgery. Information regarding later in-hospital periods and emergency room and out-patient clinic visits, as well as survival data, was obtained from national registries and compared between patients and controls. RESULTS Patients treated for pleural infections had significantly higher rates of hospitalizations (8.19 vs 2.19), in-hospital days (88.5 vs 26.6), emergency room admissions (3.18 vs 1.45), out-patient clinic visits (41.1 vs 11.8) and procedures performed (1.26 vs 0.55) per 100 patient-months when compared to controls during 5-year follow-up, in addition to having increased mortality (30% vs 11%), P-value <0.00001 each. Particularly, episodes due to respiratory and digestive diseases, malignancies and mental disorders were more frequent. The patients’ comorbidities, such as alcoholism or chronic pulmonary disease, were associated with more frequent use of healthcare services. CONCLUSIONS Patients treated for pleural infections have high rates of hospitalizations, emergency room admissions and out-patient clinic visits during follow-up.

Abstract 15869: Off-Pump Coronary Artery Bypass Grafting is Associated With Higher Rate of Percutaneous Coronary Intervention at 8-Year Follow-Up

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Fabio Barili ◽  
Stefano Rosato ◽  
Paola D’Errigo ◽  
Alessandro Parolari ◽  
Lorenzo Menicanti ◽  
...  
Keyword(s):  
Risk Factor ◽  
Univariate Analysis ◽  
Hazard Ratio ◽  
P Value ◽  
Term Survival ◽  
Off Pump ◽  
Pump Cabg ◽  
The Impact

Introduction: The debate on the advantages and limitations of off-pump (OPCAB) vs on pump CABG has not still arrived to a conclusion and concerns still exist on graft patency. This study was designed to compare the impact on mortality and morbidity of OPCAB and on-pump CABG, with a specific focus on mid-term need for percutaneous cardiac intervention (PCI). Methods: The PRIORITY project was designed to evaluate the mid-long term outcomes of 2 large prospective multicenter cohort studies on CABG conducted between 2002-2004 and 2007-2008. Data on isolated CABG performed both on-pump and off-pump were derived from clinical dataset and linked to 2 administrative datasets. Time-to event analyses were performed in a competing risk framework to evaluate the potential role of surgical techniques on outcomes. Results: The population consisted of 11020 patients who underwent isolated CABG (27.2% OPCAB). Several risk factor but surgical technique independently affected in-hospital mortality. The incidence of postoperative PCI was significantly higher in OPCAB group (p<0.05) and the multivariate logistic regression demonstrated that on-pump CABG was the only factor that protects from PCI after surgery (OR 0.61). Although unadjusted long-term survival was significantly worst for OPCAB (Log-rank p-value 0.00), the adjustment for factors found significant in the univariate analysis did not confirm OPCAB as a risk factor for mortality (hazard ratio was 0.96 ± 0.05, p-value 0.407). On the contrary, the significantly better cumulative incidence function of hospitalization for PCI at follow-up (Gray test p-value 0.00) in the on-pump group was confirmed even by the adjustment for confounding factors (p-value 0.00, adjusted hazard ratio 0.70 ± 0.07) and hence OPCAB was demonstrated to be an independent risk factor for PCI with an hazard that is 42% higher than on-pump CABG. Conclusions: This study demonstrated that OPCAB did not affect short and long-term mortality. Nonetheless, it was a risk factor for re-hospitalization for PCI.

Association of chronic co-morbidities with long term survival with metastatic renal cell carcinoma (mRCC).

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 472-472
Author(s):  
Matthew T. Campbell ◽  
Amishi Yogesh Shah ◽  
Kirtan Das Nautiyal ◽  
Neda Hashemi ◽  
Paul Gettys Corn ◽  
...  
Keyword(s):  
Targeted Therapy ◽  
Systemic Therapy ◽  
De Novo ◽  
Mtor Inhibitors ◽  
Descriptive Statistics ◽  
Term Survival ◽  
Long Term Survivors ◽  
New Onset

472 Background: Since the introduction of targeted therapy, patients (pts) with mRCC are living longer. Cumulative toxicities of sequential targeted therapies remain an area largely unexplored. Methods: A retrospective review of consecutive mRCC pts evaluated at MDACC from 1/1/2001 to 12/31/2008 was conducted. We characterized pts who lived >4 yrs with metastatic disease. In the table below, de novo hypertension (HTN) refers to new onset HTN on VEGF or mTOR targeted therapy (TT), HTN exacerbation refers to HTN in pts with already documented HTN on TT, HTN exacerbation after de novo HTN refers to pts who had exacerbations during subsequent TT after de novo HTN on TT. Descriptive statistics were used. Results: 205 pts with evaluable initial data were characterized for baseline co-morbidities listed in the table below; 37 pts did not have adequate follow up. Of the remaining 168 pts, 12 were managed with surgical resections only and did not receive any systemic therapy, 12 pts received systemic therapy (Tx), but not TT, and 144 received TT: 142 pts (84.5%) received at least 1 VEGF-directed agent, 115 pts (68.5%) received multiple VEGF-directed agents, 75 pts (44.6%) received mTOR inhibitors. Conclusions: Development of HTN and HTN exacerbations are markers of treatment efficacy. The long-term survivors identified in our series had high rates of HTN, hyperlipidemia, hypothyroidism, and VTE. Toxicity cost is an important aspect of long-term survivorship and warrants continued study. [Table: see text]

Central nervous system gangliogliomas

1993 ◽  
Vol 79 (6) ◽  
pp. 867-873 ◽  
Author(s):  
Frederick F. Lang ◽  
Fred J. Epstein ◽  
Joseph Ransohoff ◽  
Jeffrey C. Allen ◽  
Jeffrey Wisoff ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Survival Rate ◽  
Brain Stem ◽  
Cerebral Hemisphere ◽  
Histological Grade ◽  
Event Free Survival ◽  
Term Survival ◽  
Free Survival

The records of 58 patients with gangliogliomas surgically treated between January 1, 1980, and June 30, 1990, were retrospectively reviewed in order to determine long-term survival, event-free survival, and functional outcome resulting after radical resection and to assess the impact of histological grading on outcome. Tumors were located in the cerebral hemisphere in 19 cases, the spinal cord in 30, and the brain stem in nine. Forty-four patients had gross total resection and 14 had radical subtotal resection. Only six patients underwent postoperative irradiation or chemotherapy and, therefore, the outcome was generally related to surgery alone. Of the 58 gangliogliomas, 40 were classified as histological grade I, 16 were grade II, and two were grade III. The median follow-up period was 56 months. There were no operative deaths, and the operative morbidity rate was 5%, 37%, and 33% for cerebral hemisphere, spinal cord, and brain-stem gangliogliomas, respectively. The 5-year actuarial survival rates for cerebral hemisphere, spinal cord, and brain-stem gangliogliomas were 93%, 84%, and 73%, respectively (p = 0.7). The event-free survival rate at 5 years was 95% for cerebral hemisphere gangliogliomas and 36% for spinal cord gangliogliomas (p < 0.05); for brain-stem gangliogliomas the event-free survival rate at 3 years was 53% (p < 0.05). Neurological function at recent follow-up evaluation was stable or improved in 81% of patients. Multivariate analysis (Cox linear regression) revealed tumor location to be the only variable predictive of outcome, with spinal cord and brain-stem gangliogliomas having a 3.5- and 5-fold increased relative risk of recurrence, respectively, compared to cerebral hemisphere gangliogliomas. Histological grade was not predictive of outcome, although in each location there was a trend for higher-grade tumors to have a shorter time to recurrence. It is concluded that radical surgery leads to long-term survival of patients with gangliogliomas, regardless of location, and adjuvant therapy can probably be reserved for special cases.

Surgical reconstruction for unilateral iliac artery lesions in patients younger than 50 years

VASA ◽  
2011 ◽  
Vol 40 (6) ◽  
pp. 474-481 ◽  
Author(s):  
Radak ◽  
Babic ◽  
Ilijevski ◽  
Jocic ◽  
Aleksic ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Limb Salvage ◽  
Iliac Artery ◽  
Graft Patency ◽  
Long Term Results ◽  
Surgical Reconstruction ◽  
Safe Procedure ◽  
Term Survival

Background: To evaluate safety, short and long-term graft patency, clinical success rates, and factors associated with patency, limb salvage and mortality after surgical reconstruction in patients younger than 50 years of age who had undergone unilateral iliac artery bypass surgery. Patients and methods: From January 2000 to January 2010, 65 consecutive reconstructive vascular operations were performed in 22 women and 43 men of age < 50 years with unilateral iliac atherosclerotic lesions and claudication or chronic limb ischemia. All patients were followed at 1, 3, 6, and 12 months after surgery and every 6 months thereafter. Results: There was in-hospital vascular graft thrombosis in four (6.1 %) patients. No in-hospital deaths occurred. Median follow-up was 49.6 ± 33 months. Primary patency rates at 1-, 3-, 5-, and 10-year were 92.2 %, 85.6 %, 73.6 %, and 56.5 %, respectively. Seven patients passed away during follow-up of which four patients due to coronary artery disease, two patients due to cerebrovascular disease and one patient due to malignancy. Limb salvage rate after 1-, 3-, 5-, and 10-year follow-up was 100 %, 100 %, 96.3 %, and 91.2 %, respectively. Cox regression analysis including age, sex, risk factors for vascular disease, indication for treatment, preoperative ABI, lesion length, graft diameter and type of pre-procedural lesion (stenosis/occlusion), showed that only age (beta - 0.281, expected beta 0.755, p = 0.007) and presence of diabetes mellitus during index surgery (beta - 1.292, expected beta 0.275, p = 0.026) were found to be significant predictors of diminishing graft patency during the follow-up. Presence of diabetes mellitus during index surgery (beta - 1.246, expected beta 0.291, p = 0.034) was the only variable predicting mortality. Conclusions: Surgical treatment for unilateral iliac lesions in patients with premature atherosclerosis is a safe procedure with a low operative risk and acceptable long-term results. Diabetes mellitus and age at index surgery are predictive for low graft patency. Presence of diabetes is associated with decreased long-term survival.

Long-Term Follow-Up After Spinal Cord Injury in Canada

2006 ◽  
Author(s):  
Mark I. Tonack ◽  
Sander L. Hitzig ◽  
B. Catharine Craven ◽  
Kent A. Campbell ◽  
Kathryn A. Boschen ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cord Injury ◽  
Long Term Follow Up

OPEN HAEMORRHOIDS SURGERY IN SPINAL CORD INJURY PATIENTS

2020 ◽  
Vol 4 (11) ◽  
Author(s):  
Khaled Hassan
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Anal Fissure ◽  
Open Surgery ◽  
Anal Fissures ◽  
Cord Injury ◽  
Long Term Follow Up ◽  
Grade Iii

This Pilot retrospective research conducted on the results of open surgery in patients with Grade III and IV haemorrhoids With SCI. No major complications had arisen at 6 weeks post-operative and all wounds had healed, but 1 patient Anal fissure recurrence. 75% of patients reported a substantial increase in anorectal anorexia during long-term follow-up. With symptoms. Five patients reported recurrences: three haemorrhoids (18 percent) and two anal fissures (25 percent).   Keywords: Haemorrhoids, Pilot retrospective research, Anorectal Anorexia.

Role of Closed Mitral Commissurotomy for Mitral Stenosis: Mid- and Long-term Surgical Outcome of 36 Patients

2005 ◽  
Vol 8 (1) ◽  
pp. 55 ◽  
Author(s):  
Azman Ates ◽  
Yahya �nl� ◽  
Ibrahim Yekeler ◽  
Bilgehan Erkut ◽  
Yavuz Balci ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Stenosis ◽  
Operating Time ◽  
Term Survival ◽  
Long Term Outcome ◽  
Mitral Commissurotomy ◽  
Closed Mitral Commissurotomy

Purpose: To evaluate long-term survival and valve-related complications as well as prognostic factors for mid- and long-term outcome after closed mitral commissurotomy, covering a follow-up period of 14 years. Material and Methods: Between 1989 and 2003, 36 patients (28 women and 8 men, mean age 28.8 6.1 years) underwent closed mitral commissurotomy at our institution. The majority of patients were in New York Heart Association (NYHA) functional class IIB, III, or IV. Indication for closed mitral commissurotomy was mitral stenosis. Closed mitral commissurotomy was undertaken with a Tubbs dilator in all cases. Median operating time was 2.5 hours 30 minutes. Results: After closed mitral commissurotomy, the mitral valve areas of these patients were increased substantially, from 0.9 to 2.11 cm2. No further operation after initial closed mitral commissurotomy was required in 86% of the patients (n = 31), and NYHA functional classification was improved in 94% (n = 34). Postoperative complications and operative mortality were not seen. Follow-up revealed restenosis in 8.5% (n = 3) of the patients, minimal mitral regurgitation in 22.2% (n = 8), and grade 3 mitral regurgitation in 5.5% (n = 2) patients. No early mortality occurred in closed mitral commissurotomy patients. Reoperation was essential for 5 patients following closed mitral commissurotomy; 2 procedures were open mitral commissurotomies and 3 were mitral valve replacements. No mortality occurred in these patients. Conclusions: The mitral valve area was significantly increased and the mean mitral valve gradient was reduced in patients after closed mitral commissurotomy. Closed mitral commissurotomy is a safe alternative to open mitral commissurotomy and balloon mitral commissurotomy in selected patients.

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