scholarly journals Oncologic outcomes comparison of partial ureterectomy and radical nephroureterectomy for urothelial carcinoma

BMC Urology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Shengxian Li ◽  
Yuchen Pan ◽  
Jinghai Hu
Keyword(s):  
Cox Regression ◽  
Oncologic Outcomes ◽  
Radical Nephroureterectomy ◽  
Cancer Specific Survival ◽  
Urothelial Carcinomas ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Function Preservation ◽  
The Mean

Abstract Background The appropriate application of various treatment for upper tract urothelial carcinomas (UTUCs) is the key to prolong the survival of UTUC patients. Herein, we used data in our database to assess the oncological outcomes between partial ureterectomy (PU) and radical nephroureterectomy (RNU). Methods From 2007 to 2014, 255 patients with UTUC undergoing PU or RNU in our hospital database were investigated. Perioperative, postoperative data, and pathologic outcomes were obtained from our database. Cancer-specific survival (CSS) was assessed through the Kaplan-Meier method with Cox regression models to test the effect of these two surgery types. Results The mean length of follow-up was 35.8 months (interquartile range 10–47 months). Patients with high pT stage (pT2–4) suffered shorter survival span (HR: 9.370, 95% CI: 2.956–29.697, P < 0.001). There were no significant differences in CSS between PU and RNU (P = 0.964). In the sub-analysis, CSS for RNU and PU showed no significant difference for pTa–1 or pT2–4 tumor patients (P = 0.516, P = 0.475, respectively). Conclusions PU is not inferior to RNU in oncologic outcomes. Furthermore, PU is generally recognized with less invasive and better renal function preservation compared with RNU. Thus, PU would be rational for specific patients with UTUCs.

scholarly journals 32-mm ceramic-on-ceramic total hip arthroplasty versus 28-mm ceramic bearings: 5- to 15-year follow-up study

2018 ◽  
Vol 29 (1) ◽  
pp. 65-71 ◽  
Author(s):  
Yoshitoshi Higuchi ◽  
Taisuke Seki ◽  
Yukiharu Hasegawa ◽  
Yasuhiko Takegami ◽  
Daigo Morita ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Harris Hip Score ◽  
Total Hip ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Average Patient ◽  
The Mean ◽  
Ceramic On Ceramic

Introduction: This study aimed to compare the clinical and radiographic results of 28-mm ceramic-on-ceramic (CoC) total hip arthroplasty (THA) to those of 32-mm CoC during a 5- to 15-year follow-up period. Methods: 107 joints (95 women and 6 men) underwent 28-mm CoC, and 60 (49 women and 7 men) underwent 32-mm CoC. The average patient age at the time of surgery was 56.1 and 55.7 years in the 28-mm and 32-mm CoC groups, respectively. Clinical and radiologic measurements of all patients were analysed. Results: The mean preoperative Harris hip score (HHS) was similar in the 2 groups (28-mm, 58.9; and 32-mm, 58.5). However, at final follow-up, the mean HHS of the 32-mm CoC (91.8) was significantly better than that of the 28-mm CoC (88.2) ( p = 0.003), as were the ranges of motion (ROM) for flexion (98.3 ± 13.5° vs. 87.3 ± 19.3°, p < 0.001) and abduction (27.8 ± 14.9° vs. 22.1 ± 19.3°, p = 0.007). The mean wear rate was 0.0044 mm/year for the 28-mm CoC and 0.0044 mm/year for the 32-mm CoC. No ceramic fractures were found in the 2 groups. One joint in the 28-mm CoC (0.9%) required revision owing to progressive osteolysis. Kaplan-Meier survival at 10 years, with implant loosening or revision THA as the endpoint, was 98.3% for 28-mm CoC and 100% for 32-mm CoC ( p = 0.465). Conclusion: There was no significant difference in ceramic-related complications between the 2 groups. Our study demonstrated that the 32-mm and 28-mm CoC are safe and are associated with good clinical outcomes.

Assessment of Losartan 50 mg on Survival of Post-Dialysis Euvolemic Hypertensive Patients: Findings from HELD Trial

2019 ◽  
Vol 48 (3) ◽  
pp. 233-242
Author(s):  
Raja Ahsan Aftab ◽  
Amer Hayat Khan ◽  
Azreen Syazril Adnan ◽  
Syed Azhar Syed Sulaiman ◽  
Tahir Mehmood Khan
Keyword(s):  
Cox Regression ◽  
Dialysis Session ◽  
Hypertensive Patients ◽  
Cox Regression Analysis ◽  
Probability Of Survival ◽  
End Point ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Single Blind

Aims and objective: To estimate the effect of losartan 50 mg on survival of post-dialysis euvolemic hypertensive patients. Methodology: A single center, prospective, single-blind randomized trial was conducted to estimate the survival of post-dialysis euvolemic hypertensive patients when treated with lorsartan 50 mg every other day. Post-dialysis euvolemic assessment was done by a body composition monitor. Covariate Adaptive Randomization was used for allocation of participants to the standard or intervention arm, and the follow-up duration was twelve months. The primary end point was achieving targeted blood pressure (BP) of <140/90 mm Hg and maintaining for 4 weeks, whereas secondary end point was all cause of mortality. Pre-, intra-, and post-dialysis session BP measurements were recorded, and survival trends were analyzed using Kaplan-Meier analysis. Results: Of the total 229 patients, 96 (41.9%) were identified as post-dialysis euvolemic hypertensive. Final samples of 88 (40.1%) patients were randomized into standard (n = 44) and intervention arms (n = 44), and 36 (81.8%) patients in each arm completed a follow-up of 12 months. A total of eight patients passed away during the 12-month follow-up period (6 deaths among standard arm and 2 in intervention arm). However, the probability of survival between both arms was not significant (p = 0.13). Cox regression analysis revealed that chances of survival were higher among the patients in the intervention (OR 3.17) arm than the standard arm (OR 0.31); however, the survival was found not statistically significant. Conclusion: There was no statistical significant difference in 1 year survival of post-dialysis euvolemic hypertensive patients when treated with losartan 50 mg.

scholarly journals Early and Midterm Outcome of TEVAR for Thoracic Aortic Pseudoaneurysm

2021 ◽  
Author(s):  
Hui Wang ◽  
Tun Wang ◽  
Hao He ◽  
Xin Li ◽  
Yuan Peng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Outcome ◽  
Cardiac Disease ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Aortic Pseudoaneurysm ◽  
Significant Difference ◽  
Independent Risk Factors ◽  
The Mean

Abstract Backgrounds: The prognosis of thoracic aortic pseudoaneurysm (TAP) after thoracic endovascular aortic repair (TEVAR) remains unclear. This study investigates the early and midterm clinical outcome as well as relevant risk factors of TAP patients following TEVAR therapy.Methods: From July 2010 to July 2020, 37 eligible TAP patients who underwent TEVAR were selected into our research. We retrospectively explored their baseline, perioperative and follow-up data. Fisher exact test and Kaplan-Meier method were applied for comparing difference between groups. Risk factors of late survival were discerned using Cox regression analysis.Results: There were 29 men and 12 women, with the mean age as 59.5±13.0 years (range, 30-82). The mean follow-up time was 30.7±28.3 months (range, 1-89). For early result, early mortality (≦30days) happened in 3(8.1%) zone 3 TAP patients versus 0 in zone 4 (p= 0.028); acute arterial embolism of lower extremity and type II endoleak respectively occurred in 1(2.7%) case. For midterm result, survival at 3 months, 1 year and 5 years was 88.8±5.3%, 75.9±7.5% and 68.3±9.9%, which showed significant difference between zone 2/3 versus zone 4 group (56.3±14.8% versus 72.9±13.2%, p= 0.013) and emergent versus elective TEVAR groups (0.0±0.0% versus 80.1±8.0%, p= 0.049). On multivariate Cox regression, lesions at zone 2/3 (HR 4.605, 95%CI 1.095-19.359), concomitant cardiac disease (HR 4.932, 95%CI 1.086-22.403) and emergent TEVAR (HR 4.196, 95%CI 1.042-16.891) were significant independent risk factors for worse late clinical outcome. Conclusions: TEVAR therapy is effective and safe with satisfactory early and midterm clinical outcome for TAP patients. Lesions at zone 2/3, concomitant cardiac disease and emergent TEVAR were independent risk factors for midterm survival outcome.

scholarly journals The right atrial diameter as a risk factor predicting recurrence of atrial fibrillation after catheter ablation at mid-term follow-up

2020 ◽  
Author(s):  
Wang Xiaofei ◽  
Wang Wenli ◽  
Zou Cao
Keyword(s):  
Risk Factor ◽  
Independent Risk Factor ◽  
Cox Regression ◽  
Survival Curve ◽  
Right Atrial ◽  
Cutoff Value ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Meier Survival Curve

Abstract Background Left atrial diameter (LAD) has been confirmed to predict recurrence of atrial fibrillation (AF) after catheter ablation (CA). The influence of right atrium (RA) size on the prognosis after CA was relatively unclear and lack of research. The objective of the present study was to investigate the relationship between right atrial diameter (RAD) and the mid-term outcome of AF after CA. Methods This study retrospectively examined 121 patients who underwent initial CA for symptomatic AF. Cox regression model was used to find risk factors of recurrence. Receiver operating characteristic (ROC) curve was used to evaluate predictive power and determine clinic cutoff value. Kaplan-Meier survival curve and log-rank test were used to analyze success rate. Results There were 94 (77.7%) patients of freedom from AF after 24.2 ± 4.5 months’ follow-up. Multivariate Cox regression analysis showed both hypertension and RAD were independent risk factors of arrhythmia recurrence after ablation regardless of AF type (HR: 4.915; 95% CI: 1.370-17.635; P = 0.015 and HR: 1.059; 95% CI: 1.001–1.120; P = 0.045, respectively). However, in patients with paroxysmal AF (par-AF), Multivariate analysis showed RAD become the only independent risk factor (HR: 1.031; 95% CI: 1.016–1.340; P = 0.029). ROC curve demonstrated the cutoff value of RAD was 35.5 mm with an area under the curve (AUC) of 0.715 (95% CI: 0.586–0.843, P = 0.009), sensitivity of 81.3% and specificity of 54.2%. Kaplan-Meier survival curve showed significant difference of freedom from par-AF (67.5 vs. 91.4%, log-rank, P = 0.015) between patients with RAD ≥ 35.5 mm and < 35.5 mm in this subgroup. Nevertheless, in patients with persistent AF (per-AF), no risk factor of arrhythmia recurrence was found. In addition, Kaplan-Meier survival curve showed no significant difference of freedom from per-AF (69.7 vs. 87.5%, log-rank, P = 0.31) between patients with RAD ≥ 35.5 mm and < 35.5 mm. Conclusions RAD was the independent risk factor predicting recurrence of AF after CA only in patients with par-AF. In patients with RAD < 35.5 mm, there was a significantly higher freedom from par-AF recurrence compared with RAD ≥ 35.5 mm after a mid-term follow-up.

scholarly journals The Efficacy of Chemotherapy in Survival of Esophageal Cancer With Bone Metastasis: A Propensity Score-Matched Analysis of The SEER Database

2021 ◽  
Author(s):  
junyuan chen ◽  
Jieruo Li ◽  
Tsz-Ngai Mok ◽  
Jiaquan Zhong ◽  
Guorong She ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Bone Metastasis ◽  
Propensity Score ◽  
Cancer Patients ◽  
Cox Regression ◽  
National Database ◽  
Cancer Specific Survival ◽  
Chemotherapy Group ◽  
Kaplan Meier ◽  
Significant Difference

Abstract Background The esophageal cancer patients with bone metastasis present with an extremely poor prognosis. The aim of this study was to establish a comprehensive insight into whether chemotherapy is justifiably being prescribed to esophageal cancer patients with bone metastasis. Methods A population-based retrospective study was conducted with data from the Surveillance, Epidemiology, and End Results (SEER) national database. By performing 1:1 paired match propensity score matching (PSM), we minimized the baseline discrepancies between groups. Univariate and multivariate Cox regression analyses were used to identify factors associated with survival. Kaplan–Meier survival curves were used to assess the effects of chemotherapy on survival. Results The final PSM cohort consisted of 730 patients, including 365 patients in the chemotherapy group and 365 patients in the non-chemotherapy group. There was a significant difference in overall survival (OS, p < 0.001) and cancer-specific survival (CSS, p < 0.001) between the two groups. The median OS time for the chemotherapy group was 9.8 (95% CI: 8.5–11.2) months, and it was decreased to 2.3 (95% CI 1.9–2.7) months in the non-chemotherapy group. Multivariate analysis confirmed that chemotherapy was an independent prognostic factor for OS (p < 0.001) and CSS (p < 0.001). Kaplan–Meier survival analysis suggested that chemotherapy could significantly improve OS (p < 0.001) and CSS (p < 0.001) both in squamous cell carcinoma or adenocarcinoma subgroup. However, there was no significant difference in both OS (p = 0.291) and CSS (p = 0.651) between the two groups for stage Ⅰ esophageal carcinoma. Conclusion Chemotherapy significantly improved OS and CSS in esophageal cancer patients with bone metastasis. However, chemotherapy might not improve the prognosis of grade I esophageal cancer.

scholarly journals Primary vs Secondary Osteochondral Autograft Transplantation in Patients with Large Sized OLT

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Kwang Hwan Park ◽  
Yeokgu Hwang ◽  
Yoo Jung Park ◽  
Dong-Woo Shim ◽  
Jin Woo Lee
Keyword(s):  
Clinical Outcomes ◽  
Bivariate Analysis ◽  
Clinical Failure ◽  
Aofas Score ◽  
Marrow Stimulation ◽  
Kaplan Meier ◽  
Operation Rate ◽  
Significant Difference ◽  
The Mean

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Osteochondral autograft transplantation (OAT) for large sized osteochondral lesions of the talus (OLT) has presented promising clinical results in recent studies. However, there was no study which has compared clinical outcomes between primary OAT and secondary OAT in the large sized OLT. The purpose of this study is to compare clinical outcomes between patients receiving primary transplantation and patients receiving secondary transplantation after failure of previous marrow stimulation for large sized OLT and investigate prognostic factor affecting clinical failures. Methods: Between 2005 and 2014, 18 patients with large sized OLT (=150 mm2) underwent primary OAT as a primary surgery (primary group) and 28 patients with large sized OLT underwent secondary OAT after a failure of arthroscopic marrow stimulation (secondary group). After arthroscopic inspection and debridement for concomitant soft tissue pathologies, conventional OAT procedures were performed. Clinical outcomes were assessed using visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS) and re-operation rate. Factors associated with clinical failure were evaluated using bivariate analysis and logistic regression analysis. Survival outcomes were compared using Kaplan-Meier analysis. Results: The mean follow-up time was 6.0 years (range 2.0-10.8) and the mean size of the lesion was 194.9 mm2 (range 151.7- 296.3). There was no significant difference in patients` demographics, and preoperative findings between primary and secondary groups. Postoperative VAS, AOFAS score, FAOS, and re-operation rate had no significant difference between primary and secondary groups at the last follow-up. According to bivariate analysis, significant factor associated with clinical failure was not prior marrow stimulation but more than 225 mm2 of lesion size in preoperative MRI. Logistic regression analysis revealed that preoperative AOFAS score was significant predictor of clinical failure after the OAT in this study. The survival probabilities were not significantly different between primary and secondary groups in Kaplan-Meier plots (P = .947). Conclusion: Outcomes of secondary OAT were comparable to those of primary OAT in the large sized OLT. Therefore, we suggested that symptomatic patients with large sized OLT could be initially treated by either arthroscopic marrow stimulation or OAT and if failed with marrow stimulation, secondary OAT could be considered.

scholarly journals Donepezil Adherence, Persistence and Time to First Discontinuation in a Three-Year Follow-Up of Older People

2015 ◽  
Vol 5 (3) ◽  
pp. 482-491 ◽  
Author(s):  
Henry C. Ndukwe ◽  
Prasad S. Nishtala
Keyword(s):  
Cox Regression ◽  
Cumulative Probability ◽  
Inception Cohort ◽  
Cox Regression Analysis ◽  
Adjusted Risk ◽  
Kaplan Meier ◽  
Moderate Dementia ◽  
The Mean ◽  
Minimum Dataset

Background: Donepezil is indicated for the management of mild to moderate dementia, particularly in Alzheimer's disease. Several studies have described low adherence rates with donepezil. Aim: To examine and measure donepezil adherence, persistence and time to first discontinuation in older New Zealanders. Methods: An inception cohort of 1,999 new users of donepezil, aged 65 years or older, were identified from the Pharmaceutical Collections and National Minimum Dataset from 1 November 2010 to 31 December 2013. Kaplan-Meier curves and Cox regression analysis were used to estimate the cumulative probability and risk of time to first discontinuation of donepezil therapy. Results: The mean age of the cohort was 79.5 ± 6.4 years and included 42.7% females. Adherence was high (89.0%), while the proportion of donepezil dispensings (81.0-32.5%) declined between 6 and 36 months. Persistence between the 1st and 6th dispensing visit decreased by 19.0%, and 11.0% of the total cohort had a gap of 31 days or more. The adjusted risk of time to first discontinuation in the non-adherent group was 2.2 times (95% CI 1.9-2.6) that of the adherent group. Conclusions: The non-adherent new donepezil users, on average, discontinued faster than the adherent group. Time to first discontinuation in this study was higher compared to discontinuation rates observed in clinical trials.

scholarly journals The impact of depression on survival of Parkinson's disease patients: a five-year study

2013 ◽  
Vol 62 (1) ◽  
pp. 8-12 ◽  
Author(s):  
Cláudia Débora Silberman ◽  
Cláudia Soares Rodrigues ◽  
Eliasz Engelhardt ◽  
Jerson Laks
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cox Regression ◽  
Rank Test ◽  
First Year ◽  
Kaplan Meier ◽  
Significant Difference ◽  
The Impact ◽  
Mean Time

OBJECTIVE: The aim of this study is to evaluate the survival rate in a cohort of Parkinson's disease patients with and without depression. METHODS: A total of 53 Parkinson's disease subjects were followed up from 2003-2008 and 21 were diagnosed as depressed. Mean time of follow up was 3.8 (SD 95% = 1.5) years for all the sample and there was no significant difference in mean time of follow up between depressed and nondepressed Parkinson's disease patients. Survival curves rates were fitted using the Kaplan-Meier method. In order to compare survival probabilities according to the selected covariables the Log-Rank test was used. Multivariate analysis with Cox regression was performed aiming at estimating the effect of predictive covariables on the survival. RESULTS: The cumulative global survival of this sample was 83% with nine deaths at the end of the study - five in the depressed and four in the nondepressed group, and 55.6% died in the first year of observation, and none died at the fourth and fifth year of follow up. CONCLUSION: Our finding point toward incremental death risk in depressed Parkinson's disease patients.

scholarly journals Influence of American Society of Anesthesiologists Score on Oncologic Outcomes in Patients With Upper Tract Urothelial Carcinoma After Radical Nephroureterectomy: A Large-Sample Study in Two Institutions

2021 ◽  
Vol 11 ◽  
Author(s):  
Yichu Yuan ◽  
Yiqiu Wang ◽  
Nan Zhang ◽  
Xiawa Mao ◽  
Yiran Huang ◽  
...  
Keyword(s):  
Cox Regression ◽  
Prognostic Significance ◽  
Oncologic Outcomes ◽  
Radical Nephroureterectomy ◽  
Free Survival ◽  
Upper Tract ◽  
Asa Score ◽  
Kaplan Meier ◽  
American Society ◽  
American Society Of Anesthesiologists

IntroductionAs a research team of urologists and an anesthetist, we sought to investigate the prognostic significance of American Society of Anesthesiologists (ASA) score in patients with upper tract urothelial cancer (UTUC) after radical nephroureterectomy (RNU). ASA physical status (ASA-PS) classification not only was found to be associated with increased comorbidities but also independently factors for predicting morbidity and mortality. Accurate risk assessment was being particularly important for patients being considered for surgery.MethodsRecords for 958 patients with UTUC who underwent RNU were reviewed. Clinicopathologic variables, including ASA-PS, were assessed at two institutions. Overall survival (OS), cancer-specific survival (CSS), intravesical recurrence-free survival (IRFS), and metastasis-free survival (MFS) were estimated using the Kaplan–Meier method and Cox regression analyses. We measured the independent predictive value of ASA-PS for mortality by multivariate regression. Association of ASA-PS and clinicopathologic variables was assessed.ResultsThe group of patients with ASA = 2/3 had a shorter 5-year OS (67.6% and 49.9%), CSS (72.9% and 58.1%), and MFS (75.1% and 58.5%). The median follow-up time was 39 months. Kaplan–Meier curves showed that the group with ASA = 2/3 had significantly poorer OS, CSS, and MFS. Adjusting for multiple potential confounding factors, multivariate analyses suggested that ASA score was an independent predictor of OS, CSS, and MFS (p = 0.004, p = 0.005, p &lt; 0.001).ConclusionHigher ASA scores were independently associated with lower survival rate. This capability, along with its simplicity, makes it a valuable prognostic metric. It should be seriously referenced in UTUC patients being considered for RNU.

Does treatment approach for small renal masses affect survival in patients 70 years old?

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 658-658
Author(s):  
Lukas Hockman ◽  
Tyler Haden ◽  
Alex Henderson ◽  
Naveen Pokala
Keyword(s):  
Overall Survival ◽  
Tumor Size ◽  
Cox Regression ◽  
Imaging Techniques ◽  
Low Grade ◽  
Small Renal Masses ◽  
Cancer Specific Survival ◽  
Renal Masses ◽  
Significant Difference ◽  
The Mean

658 Background: With the advent of modern imaging techniques small renal masses are being diagnosed more frequently. Many of these masses are benign, and those that are malignant are often low grade and rarely affect the survival. Surveillance is more commonly being advocated as an option for these masses. This study elucidates survival following different treatment approaches. Methods: SEER 18 data from 2004-13 identified 10,477 patients 70 years and older with renal cell carcinoma and tumors greater than or equal to 3 cm. Exclusion criteria included multiple primaries, distant metastasis and node positive disease. Data was collected on demographics, treatment patterns, overall survival and cancer specific survival. Kaplan-Meier analysis and Cox regression models were used to compare outcomes. Results: After exclusion 5084 patients remained. The mean age was 76.4 years. The mean tumor size was 2.3cm. Tumor laterality was right in 2610, left in 2467, bilateral in 2 and unspecified in 5. Racial analysis identified 84% of patients as white, 9% as black and 7% as other. Gender split was 51% male. Treatment methods included 791 ablations and 3324 surgical resections (radical or partial nephrectomy). The remaining 969 patients did not have treatment (surveillance). Survival was measured at 60 and 118 months. The overall survival was 75% and 54% respectively for ALL patients, 82% and 62% for ablation, 42% and 19% for surveillance and 82% and 62% for resection. Cancer specific survival was 97% and 96% for ablation, 83% and 74% for surveillance and 96% and 94% for resection. Surgical resection or ablation significantly improved survival at 5 and 10 years (p = < 0.0001). Multivariate analysis showed survival was affected by age and year of diagnosis, but not by tumor size. Conclusions: The significant difference in overall survival suggests appropriate selection of patients for surveillance based on medical comorbidities. Treatment with curative intent improves survival in patients with greater than or equal to 3 cm renal masses, even in patients 70 years and older, and must be offered to patients without significant comorbidities.

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