Long-term outcomes of distal locking in extracapsular fractures treated with trochanteric Gamma3 nails

Abstract Background Few publications have assessed long-term results of distal locking of short endomedullary nails for extracapsular hip fracture. Virtually all of them focus on immediate differences. Criteria for the use of static or dynamic locking are unclear in most nailing systems, and use is advised in unstable fracture patterns or with risk of bell-clapper effect, but often influenced by the “orthopaedic school”. Materials and methods This is a historical cohort study on patients diagnosed and operated in 2014 and followed up until endpoint, considered as consolidation or major complication, plus evaluation of overall long-term survival. They were categorised as static distal locking (ST) or dynamic distal locking (DN). Both are comparable, except for all stable pre-operative classifications, Fracture Mobility Score (FMS) at discharge, and immediate post-operative loading, all of which were in favour of DN. Results Consolidation took place in > 95% of patients, with a non-statistically significant delay trend in ST. Less than 6% in both ST and DN had major complications, with no differences. Most cases suffered early cut-out. Significant fracture collapse was the most frequent minor complication. There were more statistically significant minor and total complications in ST. Infection, without differences, can precede cut-out. Lateral thigh pain was similar and could be related to back-out. In DN, 21.1% of cases were truly dynamised. We did not find differences in mobility or in long-term survival. Conclusions Any type of distal locking seems to be safe for consolidation, despite a slightly longer consolidation time in static locking. Early cut-out was the main complication, while others were very infrequent, which is an advantage over helical blade devices. There was a higher rate of minor and overall mechanical complications in ST, but infection and lateral thigh pain were similar. Most non-traumatic mechanical complications occurred around 5–6 weeks. About one in five of the DN truly dynamised, with all cases occurring before 8 weeks. Mobility until endpoint and overall long-term survival were not influenced by the locking mode used. Level of evidence Therapeutic study, level 2b.

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A New Aortic Arch Dissection Classification: The Fuwai Classification

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.710281 ◽

2021 ◽

Vol 8 ◽

Author(s):

Juntao Qiu ◽

Xinjin Luo ◽

Jinlin Wu ◽

Wei Pan ◽

Qian Chang ◽

...

Keyword(s):

Carotid Artery ◽

Aortic Arch ◽

Survival Rates ◽

Innominate Artery ◽

Long Term Results ◽

Surgical Mortality ◽

Left Carotid Artery ◽

Term Survival ◽

Long Term Survival

Aims: We describe a new aortic arch dissection (AcD) classification, which we have called the Fuwai classification. We then compare the clinical characteristics and long-term prognoses of different classifications.Methods: All AcD patients who underwent surgical procedures at Fuwai Hospital from 2010 to 2015 were included in the study. AcD procedures are divided into three types: Fuwai type Cp, Ct, and Cd. Type Cp is defined as the innominate artery or combined with the left carotid artery involved. Type Cd is defined as the left subclavian artery or combined with the left carotid artery involved. All other AcD surgeries are defined as type Ct. The Chi-square test was adopted for the pairwise comparison among the three types. Kaplan-Meier was used for the analysis of long-term survival and survival free of reoperation.Results: In total, 1,063 AcD patients were enrolled from 2010 to 2015: 54 patients were type Cp, 832 were type Ct, and 177 were type Cd. The highest operation proportion of Cp, Ct and Cd were partial arch replacement, total arch replacement, and TEVAR. The surgical mortality in type Ct was higher compared to type Cd (Ct vs. Cd = 9.38 vs. 1.69%, p < 0.01) and type Cp (Ct vs. Cp = 9.38 vs. 1.85%, p = 0.06). There was no difference in surgical mortality of type Cp and Cd (p = 0.93). There were no significant differences in the long-term survival rates (p = 0.38) and free of aorta-related re-operations (p = 0.19).Conclusion: The Fuwai classification is used to distinguish different AcDs. Different AcDs have different surgical mortality and use different operation methods, but they have similar long-term results.

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Long‐Term Survival and Risk of Institutionalization in Onco‐Geriatric Surgical Patients: Long‐Term Results of the PREOP Study

Journal of the American Geriatrics Society ◽

10.1111/jgs.16384 ◽

2020 ◽

Vol 68 (6) ◽

pp. 1235-1241

Author(s):

Monique G. Huisman ◽

Federico Ghignone ◽

Giampaolo Ugolini ◽

Grigory Sidorenkov ◽

Isacco Montroni ◽

...

Keyword(s):

Surgical Patients ◽

Long Term Results ◽

Term Survival ◽

Long Term Survival

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Evolving impact of long-term survival results on metastatic melanoma treatment

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2020-000948 ◽

2020 ◽

Vol 8 (2) ◽

pp. e000948 ◽

Cited By ~ 1

Author(s):

Olivier Michielin ◽

Michael B Atkins ◽

Henry B Koon ◽

Reinhard Dummer ◽

Paolo Antonio Ascierto

Keyword(s):

Targeted Therapies ◽

Survival Data ◽

Long Term Results ◽

Tumor Type ◽

Term Survival ◽

Long Term Survival ◽

The Past ◽

Number Of Patients ◽

Melanoma Treatment

Melanoma treatment has been revolutionized over the past decade. Long-term results with immuno-oncology (I-O) agents and targeted therapies are providing evidence of durable survival for a substantial number of patients. These results have prompted consideration of how best to define long-term benefit and cure. Now more than ever, oncologists should be aware of the long-term outcomes demonstrated with these newer agents and their relevance to treatment decision-making. As the first tumor type for which I-O agents were approved, melanoma has served as a model for other diseases. Accordingly, discussions regarding the value and impact of long-term survival data in patients with melanoma may be relevant in the future to other tumor types. Current findings indicate that, depending on the treatment, over 50% of patients with melanoma may gain durable survival benefit. The best survival outcomes are generally observed in patients with favorable prognostic factors, particularly normal baseline lactate dehydrogenase and/or a low volume of disease. Survival curves from melanoma clinical studies show a plateau at 3 to 4 years, suggesting that patients who are alive at the 3-year landmark (especially in cases in which treatment had been stopped) will likely experience prolonged cancer remission. Quality-of-life and mixture-cure modeling data, as well as metrics such as treatment-free survival, are helping to define the value of this long-term survival. In this review, we describe the current treatment landscape for melanoma and discuss the long-term survival data with immunotherapies and targeted therapies, discussing how to best evaluate the value of long-term survival. We propose that some patients might be considered functionally cured if they have responded to treatment and remained treatment-free for at least 2 years without disease progression. Finally, we consider that, while there have been major advances in the treatment of melanoma in the past decade, there remains a need to improve outcomes for the patients with melanoma who do not experience durable survival.

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Relapse Rate and Long-Term Survival of AL Amyloidosis Patients Treated with High-Dose Melphalan and Autologous Stem Cell Transplantation (HDM/SCT).

Blood ◽

10.1182/blood.v108.11.3094.3094 ◽

2006 ◽

Vol 108 (11) ◽

pp. 3094-3094

Author(s):

David C. Seldin ◽

Martha Skinner ◽

Betul Oran ◽

Karen Quillen ◽

Kathleen T. Finn ◽

...

Keyword(s):

Median Survival ◽

Plasma Cell ◽

Relapse Rate ◽

Long Term Results ◽

High Dose ◽

Al Amyloidosis ◽

Term Survival ◽

Long Term Survival ◽

Early Results

Abstract AL amyloidosis is a plasma cell dyscrasia in which clonal immunoglobulin light chains misfold and are deposited in tissues, leading to organ failure in untreated patients, with median survival of only ~1 year. Oral melphalan and prednisone is minimally effective for the disease, with an increase in median survival to ~1.5 years, and a low rate of hematologic complete responses (CRs). Twelve years ago, we began treating patients with AL amyloidosis with HDM/SCT. In the plasma cell malignancy multiple myeloma, this approach produces hematologic CRs and improves survival, but is not curative, as all patients eventually relapse. In AL amyloidosis, the relapse rate and long-term survival have not been studied, but early results are promising, with most centers reporting CR rates of ~40% and excellent survival in responding patients. To address the durability and long-term results of treatment with HDM/SCT, here we report on the outcome for AL amyloidosis patients treated at Boston Medical Center with HDM/SCT >10 years ago. The first autologous transplant took place on July 18, 1994 in two years, by July 18, 1996, 43 patients with AL amyloidosis without myeloma or other hematologic disease had been treated with HDM/SCT, receiving 100–200 mg/m2 melphalan depending upon age and protocol. Of the 43 patients treated in this 2 yr period, 76% of the patients were male, 81% had a lambda monoclonal disease, and their median age was 52 (range, 29–71). In these first 43 patients, the 100 day peri-transplant mortality rate was 16%. Nineteen of the 43 patients (44%) achieved a hematologic CR after treatment. In annual followup, 4 of 19 patients (21%) eventually relapsed. Fourteen of 43 patients (33%) are still alive; 12 of 19 patients who achieved a CR (63%) are still alive, while only 2 of 34 patients who did not (6%) are still alive. Although there were fewer (8) patients with kappa clonal disease, they had a better outcome, with an 87% CR rate vs. 34% for lambda (P=0.006); 75% of the kappa patients are still alive, vs. 23% of the lambda patients (P=0.005). The median survival of all 43 patients is 4.7 years. Thus, treatment of AL amyloidosis patients with HDM/SCT produces a high CR rate that is durable and is associated with excellent 10 year survival, particularly for those patients achieving a hematologic CR and for patients with kappa clonal disease. Ongoing clinical trials of HDM/SCT, along with strategies to reduce morbidity and mortality and to improve the CR rate, incorporating additional cycles of HDM/SCT or new anti-plasma cell agents, appear to be well-justified by these results.

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Long-Term Follow-Up Confirms the Benefit of All-Trans Retinoic Acid (ATRA) and Arsenic Trioxide (As2O3) as Front Line Therapy for Newly Diagnosed Acute Promyelocytic Leukemia (APL).

Blood ◽

10.1182/blood.v108.11.565.565 ◽

2006 ◽

Vol 108 (11) ◽

pp. 565-565 ◽

Cited By ~ 6

Author(s):

Yuan-Fang Liu ◽

Yong-Mei Zhu ◽

Zhan-Zhong Shi ◽

Jun-Min Li ◽

Li Wang ◽

...

Keyword(s):

Remission Induction ◽

Newly Diagnosed ◽

Front Line ◽

Current Group ◽

Historical Cohort ◽

Term Survival ◽

Long Term Survival ◽

Historical Group

Abstract PURPOSE: To further confirm the benifit of front-line use of all-trans retinoic acid (ATRA) combined with arsenic trioxide (As2O3) in patients with newly diagnosed acute promyelocytic leukemia (APL), we observed the long-term survival of the current group (median follow-up: 48 months) and compared it with our historical control. PATIENTS AND METHODS: There were two groups of patients with newly diagnosed APL enrolled in this analysis. The current cohort of patients includes 60 patients since April 2001. The historical cohort of patients included 56 patients from May 1998 to March 2001. No statistically significant differences were found between these two groups in terms of clinical characteristics including sex and age distribution or hematological data before treatment. For the current cohort of patients, all patients received 25mg/m2 ATRA orally and 0.16mg/kg As2O3 intravenously per day till CR. Once CR achieved, they were given 3 courses of consolidation chemotherapy and then 5 cycles of sequential treatment of ATRA, As2O3 and 6-MP/MTX. For the historical group, ATRA was given either 25mg/m2 daily till CR, chemotherapy was added in case of leukocytosis. The post-remission therapy consists of chemotherapy with or without ATRA. Quantitative real-time reverse transcription-polymerase chain reaction (RQ-RT-PCR) measurements of PML-RARa mRNA were retrospectively assessed before treatment, after CR, after consolidation, after maintenance and during follow-up period. The efficacy of these two protocol in terms of remission induction, molecular response and long-term survival were compared with our historical control. RESULT: In the current group, 56 (93.3%) patients achieved CR, and the median time to CR was 27 days. Compared with the historical group, the combined therapy induced an early hematological response. Till the last follow-up at April 2006, two patients underwent extramedullary relapse, one of them also relapsed in marrow thereafter, one patient died from CNS leukemia, and all the other patients were alive and remained in hematological remission. With a median follow-up of 48 months (25 to 60 months), the 4-year OS and EFS was estimated 98.1%±1.8% and 94.2%±3.3%. For the historical group, after a median follow-up of 56 months (12 to 79 months), the 4-year OS and EFS was estimated 83.4%±5.4% (P=0.012) and 45.6%±7.6% (P<0.00001). For the current group, PML-RARa normalized dose was more significantly decreased after remission induction and after consolidation as compared with the historical cohort. In the last follow-up, all of the available event-free patients of the current group remain in molecular remission (PML-RARa DoseN undetectable). CONCLUSION: These 4-year data of follow-up demonstated a benefit of front-line combination of ATRA and As2O3 regarding long-term survival (OS or EFS) of patients with newly diagnosed APL. With prolonged follow-up, we might be able to find a better chance of curing the disease.

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Factors Affecting the Long-Term Survival of Kidney Transplanta-tion in Northeastern of Iran between 2000 and 2015

Iranian Journal of Public Health ◽

10.18502/ijph.v50i10.7508 ◽

2021 ◽

Author(s):

Rasoul Alimi ◽

Maryam Hami ◽

Monavar Afzalaghaee ◽

Fatemeh Nazemian ◽

Mahmood Mahmoodi ◽

...

Keyword(s):

Kidney Transplantation ◽

Survival Rate ◽

Kidney Transplant ◽

Cox Regression ◽

Historical Cohort ◽

Term Survival ◽

Long Term Survival ◽

Effective Factors ◽

Transplant Survival

Background: Graft and patient survival are of great importance after transplantation. This study aimed to determine the long-term survival rate of kidney transplantation and its effective factors among transplanted patients in Mashhad transplantation centers in northeastern Iran. Methods: Overall, 618 kidney transplant recipients were examined in different transplantation centers during the years from 2000 to 2015 in a historical cohort study. The Kaplan-Meier method and the Log-rank test were used to calculate the survival rate of the kidney transplant, and to check the difference between survival curves respectively. Modeling of effective factors in survival rate was performed using Cox regression model. Results: Overall, 1, 3, 5, 7, 10, and 15-year survival rate of kidney transplantation were 99%, 98%, 97%, 93%, 88 and 70% respectively. The adjusted hazard ratio indicated that variables such as recipient age >40 yr [HR=0.22, 95% CI=(0.071,0.691)], serum creatinine after transplantation >1.6 Mg/dl [HR=3.03, 95% CI=(1.284,7.125)], history of hypertension [HR=6.70, 95% CI=(2.746,16.348)], and BMI [HR (normal weight versus underweight)=0.26, 95% CI=(0.088,0.761), HR (over weight versus underweight)=0.13,95% CI=(0.038,0.442)] were significant factors on kidney transplant survival rate. Conclusion: The short-term transplant survival rate was good in transplant patients. What's more, through a consideration of variables such as age, creatinine serum after transplantation, history hypertension and body mass index, as well as proper planning to control their effect, it is possible to improve the long-term graft survival rate.

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Treatment of brain metastases in patients with testicular cancer.

Journal of Clinical Oncology ◽

10.1200/jco.1997.15.4.1449 ◽

1997 ◽

Vol 15 (4) ◽

pp. 1449-1454 ◽

Cited By ~ 79

Author(s):

C Bokemeyer ◽

P Nowak ◽

A Haupt ◽

B Metzner ◽

H Köhne ◽

...

Keyword(s):

Brain Metastases ◽

Testicular Cancer ◽

Combination Chemotherapy ◽

Univariate Analysis ◽

Long Term Results ◽

Term Survival ◽

Long Term Survival ◽

Brain Irradiation ◽

Chemotherapy Patients

PURPOSE Despite improved cure rates for patients with metastatic testicular cancer with cisplatin-based combination chemotherapy, patients who develop brain metastases are generally considered to possess a poor prognosis. This report summarizes the long-term results in 44 patients with brain metastases from testicular cancer treated between 1978 and 1995 at Hannover University Medical School. PATIENTS AND METHODS Histologically, 42 patients (95%) had a nonseminomatous germ cell cancer and two patients (5%) a seminoma. Thirty-nine patients (89%) had lung metastases and 37 (84%) fulfilled the criteria for advanced disease according to the Indiana University classification even without considering the brain metastases. Eighteen patients (41%) presented with brain metastases at primary diagnosis (group 1), four (9%) developed brain metastases at relapse after a previous favorable response to combination chemotherapy (group 2), and 22 (50%) developed brain metastases during or directly after cisplatin-based chemotherapy. Chemotherapy consisted of cisplatin-based combination treatment and radiotherapy was given as whole-brain irradiation of 30 to 40 Gy and in single cases combined with a boost of 10 Gy to single lesions. RESULTS Overall, 10 patients achieved long-term survival (23%; 95% confidence interval [CI], 10.1% to 35.4%). The prognosis was significantly better for patients in groups 1 and 2, with six of 18 (33%) and three of four (75%) patients alive, compared with only one of 22 (5%) in group 3 (P < .01). Patients treated with either chemotherapy or radiotherapy alone did not achieve long-term survival, while nine of 28 (32%) who received treatment with both modalities with or without surgery achieved sustained long-term survival. During univariate analysis, patients with the diagnosis of brain metastases at first presentation (P < .01), patients with a single brain lesion (P < .02), and patients who received combined chemotherapy and radiotherapy (P < .03) had a significantly improved outcome. CONCLUSIONS Long-term survival can be achieved in approximately 25% of patients with brain metastases from testicular cancer by combined treatment with brain irradiation and aggressive cisplatin-based chemotherapy. Patients who develop brain metastases during systemic treatment should receive only palliative radiation therapy, since sustained survival will not be reached.

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Liver Transplantation for Cholangiocarcinoma

European Oncology & Haematology ◽

10.17925/eoh.2012.08.3.173 ◽

2012 ◽

Vol 08 (03) ◽

pp. 173

Author(s):

Armin Thelen ◽

Christoph Benckert ◽

Sven Jonas ◽

◽

...

Keyword(s):

Liver Transplantation ◽

Long Term Results ◽

Treatment Modalities ◽

Neoadjuvant Radiochemotherapy ◽

Organ Shortage ◽

Remnant Liver ◽

Term Survival ◽

Treatment Protocols ◽

Long Term Survival

The treatment of intra- and extrahepatic cholangiocarcinomas remains a medical challenge. Due to the poor efficacy of conventional chemotherapy, surgical treatment modalities represent the only chance of attaining long-term survival and cure. The introduction of new procedures, in particular extended liver resections – which were enabled by increasing surgical expertise and the implementation of multimodal treatment protocols – led to an increasing number of curatively treated patients and significant improvements in long-term results after curative resection. However, numerous patients are not suitable for radical resection because of local tumour growth, intrahepatic metastases, infiltration of main vascular and biliary structures or insufficient remnant liver function. In unresectable tumours, liver transplantation is a curative treatment option for many patients and represents the only chance to achieve long-term survival and cure. Yet, cholangiocarcinomas are not currently a standard indication for liver transplantation, because of the organ shortage and the resulting necessity to allocate available organs to patients with the best prognosis. In recent years, the results of liver transplantation for the different types of cholangiocarcinoma have improved following the application of new treatment protocols. The most promising long-term results were achieved in hilar cholangiocarcinoma by using neoadjuvant radiochemotherapy prior to transplantation. Long-term survival rates were not inferior to those seen in patients receiving a transplantation for benign liver diseases or early-stage hepatocellular carcinoma. The improved long-term outcomes of transplantation for intra- and extrahepatic cholangiocarcinomas have led to a renewed interest for liver transplantation as a treatment for these tumour entities.

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Long-term disease-free survival in small-cell carcinoma of the lung: a study of clinical determinants.

Journal of Clinical Oncology ◽

10.1200/jco.1986.4.9.1307 ◽

1986 ◽

Vol 4 (9) ◽

pp. 1307-1313 ◽

Cited By ~ 85

Author(s):

K Osterlind ◽

H H Hansen ◽

M Hansen ◽

P Dombernowsky ◽

P K Andersen

Keyword(s):

Disease Free Survival ◽

Small Cell ◽

Long Term Results ◽

Disease Extent ◽

Term Survival ◽

Free Survival ◽

Long Term Survival ◽

Stage Disease ◽

Disease Free

The influence of treatment and of pretreatment patient characteristics on the probability of long-term disease-free survival in small-cell lung cancer (SCLC) was investigated in a consecutive series of 874 patients. The patients were included in six controlled treatment trials from 1973 to 1981, using different combinations of chemotherapy with or without irradiation. All patients underwent pretreatment staging, including bronchoscopy, peritoneoscopy with liver biopsy, and bone marrow examination. The same procedures were repeated in patients without overt signs of disease 18 months from initiation of treatment, and patients without evidence of SCLC were regarded as long-term survivors. Seventy-two patients were disease-free at restaging, corresponding to 13% of 443 patients with limited-stage disease and 3% of 431 patients with extensive-stage disease. The possible relationship between different pretreatment variables and the probability of 18 months' disease-free survival was investigated by multiple regression analysis. Disease extent was the most important determinant of long-term survival. Being a woman was a positive factor and hypouricemia had negative influence on the long-term results, while features such as performance status and serum lactate dehydrogenase (LDH) did not have significant influence in the regression model. Differences between the efficacy of the applied treatment regimens were less in limited disease than they were in extensive disease, in which six-agent regimens of alternating chemotherapy was significantly better than treatment with three- or four-agent regimens. Accordingly, disease extent seems to be the most pivotal determinant of long-term survival in SCLC, but influence of the patient's sex and serum urate concentration should also be considered.

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Sequential Versus Single High-Dose Chemotherapy in Patients With Relapsed or Refractory Germ Cell Tumors: Long-Term Results of a Prospective Randomized Trial

Journal of Clinical Oncology ◽

10.1200/jco.2011.38.6391 ◽

2012 ◽

Vol 30 (8) ◽

pp. 800-805 ◽

Cited By ~ 68

Author(s):

Anja Lorch ◽

Antje Kleinhans ◽

Andrew Kramar ◽

Christian K. Kollmannsberger ◽

Jörg T. Hartmann ◽

...

Keyword(s):

Germ Cell ◽

Survival Rates ◽

Germ Cell Tumors ◽

High Dose Chemotherapy ◽

Long Term Results ◽

Rank Test ◽

High Dose ◽

Term Survival ◽

Long Term Survival

Purpose To evaluate the long-term survival rates in patients with relapsed or refractory germ cell tumors (GCTs) after single or sequential high-dose chemotherapy (HDCT). Patients and Methods Between November 1999 and November 2004, 211 patients with relapsed or refractory GCT were randomly assigned to treatment with either one cycle of cisplatin 100 mg/m2, etoposide 375 mg/m2, and ifosfamide 6 g/m2 (VIP) plus three cycles of high-dose carboplatin 1,500 mg/m2 and etoposide 1,500 mg/m2 (CE, arm A) or three cycles of VIP plus one cycle of high-dose carboplatin 2,200 mg/m2, etoposide 1,800 mg/m2, and cyclophosphamide 6,400 mg/m2 (CEC, arm B) followed by autologous stem-cell reinfusion. Long-term progression-free survival (PFS) and overall survival (OS) 6 years after random assignment of the last patient were compared by using the log-rank test. Results Overall, 108 and 103 patients were randomly assigned to arms A and B, respectivelyl. The study was stopped prematurely because of excess treatment-related mortality in arm B (14%) compared with that in arm A (4%; P = .01). As of December 2010, nine (5%) of 211 patients were lost to follow-up; 94 (45%) of 211 are alive and 88 (94%) of 94 patients are progression free. Five-year PFS is 47% (95% CI, 37% to 56%) in arm A and 45% (95% CI, 35% to 55%) in arm B (hazard ratio [HR], 1.16; 95% CI, 0.79 to 1.70; P = .454). Five-year OS is 49% (95% CI, 40% to 59%) in arm A and 39% (95% CI, 30% to 49%) in arm B (HR, 1.42; 95% CI, 0.99 to 2.05; P = .057). Conclusion Patients with relapsed or refractory GCT achieve durable long-term survival after single as well as sequential HDCT. Fewer early deaths related to toxicity translated into superior long-term OS after sequential HDCT.

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