Effect of pregnancy, in the year prior and after treatment for breast carcinoma, on survival and recurrence in women with breast cancer younger than 35 years. GETNA GROUP

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 553-553 ◽  
Author(s):  
R. Largillier ◽  
A. Savignoni ◽  
J. Gligorov ◽  
P. Chollet ◽  
M. Guillaume ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Breast Carcinoma ◽  
Local Recurrence ◽  
Tumor Size ◽  
Univariate Analysis ◽  
Axillary Node ◽  
Diagnosis And Treatment ◽  
Risk Of Death ◽  
Node Positive ◽  
Annual Risk

553 Background: The goal of this study was to assess the effect of pregnancy on the subsequent risk of recurrences after treatment for breast carcinoma, adjusted on established prognostic factors Methods: Between 1990 and 1999, 908 patients aged under 35 years old were treated for a non metastatic and unilateral invasive breast carcinoma in eight french hospitals, members of the GETNA association. The median follow-up period was 87 months. Mean age was 31.4 years old. Estrogen receptor (ER) status, lymph node involvement, tumor size, histological grade and pregnancy were evaluated as potential risk factors for recurrence and death in a multivariate analysis. A modified model was constructed using the four independent variables derived from the previous multivariate Cox model and the annual risk of death and recurrences were studied. Results: Women who gave birth within one year prior to diagnosis (n=105, 11, 8%) were more likely to have axillary node positive (> N1:48%, vs 35%, p=0.009) important tumor size (>T2:75% vs 55%, p=0.0002), and ER negative (54%, vs 42%, p=0.031). In univariate analysis, pregnancy the year before carcinoma diagnosis increased the risk of death, HR=1.5 [1.05–2.20] (p=0.028) and local recurrence, HR=1.71 [1.06–2.76] (p=0.027). In multivariate analysis, only influence on local recurrence is confirmed, HR=1.75 [1.08–2.84] (p=0.006). Patients who experienced a pregnancy after diagnosis and treatment (n=118, 13.4%) did not tend to have better prognosis regarding axillary node positive (> N1:71%, vs 61%, p=0.051), tumour size (> T2:53.4% vs 59.2%, p=0.49), ER negative (ER:44.2% vs 43.6%, p=0.92) and were significantly younger (<30 years old 52.5% vs 28%, p<10−4). The overall survival after five years was 97% for women who experienced a pregnancy and only 80% for those who did not (p< 0.0001). Conclusions: In this large study population, pregnancy was not associated with poorer survival and the healthy mother effect was studied. For the purpose of advising women on the decision to go forward with pregnancy, was studied after the diagnosis and treatment of breast carcinoma, the annual risk of recurrences. Study granted by Sanofi-Aventis. Acknoledgements to OSMO for its operational support. No significant financial relationships to disclose.

Tumor microvessel density, p53 expression, tumor size, and peritumoral lymphatic vessel invasion are relevant prognostic markers in node-negative breast carcinoma.

1994 ◽  
Vol 12 (3) ◽  
pp. 454-466 ◽  
Author(s):  
G Gasparini ◽  
N Weidner ◽  
P Bevilacqua ◽  
S Maluta ◽  
P Dalla Palma ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Breast Carcinoma ◽  
Protein Expression ◽  
Microvessel Density ◽  
Tumor Size ◽  
Lymphatic Vessel ◽  
P53 Protein ◽  
Univariate Analysis ◽  
P53 Expression ◽  
Node Negative

PURPOSE To determine the absolute and relative value of microvessel density (MVD), p53 and c-erbB-2 protein expression, peritumoral lymphatic vessel invasion (PLVI), and conventional prognosticators in predicting relapse-free (RFS) and overall survival (OS) rates in patients with node-negative breast carcinoma (NNBC). PATIENTS AND METHODS We monitored 254 consecutive patients with NNBC for a median of 62 months. Intratumoral MVD was measured after microvessels were immunostained using anti-CD31 antibody. p53 and c-erbB-2 protein and hormone receptors were also determined immunocytochemically. Results were analyzed by both univariate and multivariate statistical analysis. RESULTS Univariate analysis showed that MVD was significantly predictive of both RFS (odds ratio [OR], 8.30; P = .0001) and OS (OR, 4.50; P = .012) when tested as a continuous or dichotomous variable. Likewise, tumor size (OR, 3.16; P = .0012), PLVI (OR, 4.36; P = .0009), estrogen receptor (ER) status (OR, 2.35; P = .016), progesterone receptor (PR) status (OR, 2.00; P = .017), and expression of p53 protein (OR, 2.82; P = .004) were significantly associated with RFS. Tumor size (OR, 3.80; P = .0038) and expression of p53 protein (OR, 2.58; P = .024) were significantly associated with OS by univariate analysis. Multivariate analysis showed that MVD (P = .0004), p53 protein expression (P = .0063), tumor size (P = .0144), and PLVI (P = .0033) were all significant and independent prognostic factors for RFS. However, only tumor size (P = .004) and MVD (P = .047) were independent predictors for OS. c-erbB2 expression was not associated with outcome by either univariate or multivariate analysis. CONCLUSION MVD, p53 expression, PLVI, and tumor size are independent prognostic indicators of recurrence, which are useful in selection of high-risk NNBC patients who may be eligible to receive adjuvant therapies.

scholarly journals Risk Factors for Progression in Vestibular Schwannomas After Incomplete Resection: A Single Center Retrospective Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Jiuhong Li ◽  
Xueyun Deng ◽  
Daibo Ke ◽  
Jian Cheng ◽  
Si Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Tumor Size ◽  
Tumor Volume ◽  
Univariate Analysis ◽  
Residual Tumor ◽  
Vestibular Schwannomas ◽  
Incomplete Resection ◽  
Cystic Component

Background and Purpose: The risk factors for progression in vestibular schwannomas (VSs) after incomplete resection (IR) remain to be elucidated. The purpose of this study was to investigate the risk factors for progression in remnant VSs after surgery.Methods: From January 2009 to January 2018, 140 consecutive patients who underwent IR of VSs via suboccipital retrosigmoid approach in our institution were retrospectively analyzed. During follow-up, if progression was detected, the patient was classified into Progressive Group (PG); if the residual tumor was stable or shrank, the patient was classified into Stable Group (SG). Univariate analysis and multivariate analysis were used to evaluate the risk factors for progression after IR of VSs.Results: After a mean follow-up of 80.4 months (range, 24–134 months), 35 (25.0%) patients (PG) had a progression, and no progression was detected in 105 (75.0%) patients (SG). The average tumor size was 36.5 ± 8.9 mm in PG and 31.0 ± 9.8 mm in SG, respectively. The residual tumor volume was 304.6 ± 443.3 mm3 in PG and 75.9 ± 60.0 mm3 in SG, respectively. Univariate analysis showed that preoperative tumor size, residual tumor volume, and irregular internal auditory canal (IAC) expansion were significantly different between the two groups, whereas gender, age, cystic component, or Ki-67 labeling index (LI) did not differ significantly between the two groups. Multivariate analysis showed residual tumor volume was the independent risk factor for progression.Conclusions: VSs that underwent IR with larger preoperative size, greater residual tumor volume, or irregular IAC expansion may have a higher progression rate. Strict follow-up with shorter interval in these patients to detect early progression is necessary.

Clinical significance of HER-2/neu oncogene amplification in primary breast cancer. The South Australian Breast Cancer Study Group.

1993 ◽  
Vol 11 (10) ◽  
pp. 1936-1942 ◽  
Author(s):  
R Seshadri ◽  
F A Firgaira ◽  
D J Horsfall ◽  
K McCaul ◽  
V Setlur ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Multivariate Analysis ◽  
Tumor Size ◽  
Copy Number ◽  
Node Negative ◽  
Node Positive ◽  
Oncogene Amplification ◽  
Her 2 ◽  
Neu Oncogene

PURPOSE To determine prospectively the prognostic significance of HER-2/neu oncogene amplification in the primary tumors of breast cancer patients. METHODS HER-2/neu amplification in tumor DNA was determined by the slot-blot technique in 1,056 patients with breast cancer (stage I to III) diagnosed between 1987 and 1990. Parameters such as estrogen receptor (ER) and progesterone receptor (PgR) levels, tumor size, axillary nodal involvement, tumor grade, and time to relapse were prospectively obtained. RESULTS HER-2/neu oncogene amplification, > or = 2, > or = 3, and > or = 5 copy number, was detected in 21%, 11%, and 7% of patients, respectively. In a test set of 529 patients, Cox multivariate analysis showed HER-2/neu copy number > or = 3 or > or = 5 was associated with shorter disease-free survival (DFS) duration. HER-2/neu copy number > or = 3 correlated significantly with pathologic stage of disease, number of axillary nodes with tumor, histologic type, and absence of ER and PgR. For all patients, after a median follow-up duration of 39 months, Kaplan-Meier univariate analysis indicated that tumor oncogene copy number > or = 3 correlated with shorter DFS in both node-negative and node-positive patients. In Cox multivariate analysis, HER-2/neu copy number > or = 3 was associated with shorter DFS, independent of nodal status, ER level, and tumor size. CONCLUSION Although the follow-up duration of this study is relatively short, we conclude that HER-2/neu amplification is an independent predictor of shorter DFS in both node-negative and node-positive patients.

Pathological prognostic factors in stage I (T1N0M0) and stage II (T1N1M0) breast carcinoma: a study of 644 patients with median follow-up of 18 years.

1989 ◽  
Vol 7 (9) ◽  
pp. 1239-1251 ◽  
Author(s):  
P P Rosen ◽  
S Groshen ◽  
P E Saigo ◽  
D W Kinne ◽  
S Hellman
Keyword(s):  
Prognostic Factors ◽  
Breast Carcinoma ◽  
Local Recurrence ◽  
Median Survival ◽  
Tumor Size ◽  
Stage I ◽  
Axillary Lymph ◽  
Axillary Lymph Node Metastases ◽  
Systemic Recurrence

Prognostic factors have been examined in 644 patients with tumor-node-metastasis (TNM) stage T1 breast carcinoma treated by mastectomy and followed for a median of 18.2 years. Overall, 148 patients (23%) died of recurrent breast carcinoma. Eighteen (3%) were alive with recurrent disease and 478 (74%) were alive or died of other causes without recurrence. Unfavorable clinicopathologic features were larger tumor size (1.1 to 2.0 cm v less than or equal to 1 cm), perimenopausal menstrual status, the number of axillary lymph node metastases, poorly differentiated grade, presence of lymphatic tumor emboli (LI) in breast tissue near the primary tumor, blood vessel invasion (BVI), and an intense lymphoplasmacytic reaction around the tumor. Median survival after recurrence for the entire series was 2 years. This was not significantly influenced by tumor size, the number of axillary nodal metastases, the type of treatment for recurrence, or the interval to recurrence. The proportions surviving 5 and 10 years after recurrence were 17% and 5%, respectively. Among T1N0M0 cases, the chance of a local recurrence was 2.8% within 20 years. Median survival of T1N0M0 cases after local recurrence (4.5 years) was significantly longer than after systemic recurrence (1.5 years). A similar trend (3.7 v 2.0 years), not statistically significant, was seen in T1N1M0 patients, who had a 6.5% chance of local recurrence within 20 years. Median survival following systemic recurrence detected 10 or more years after diagnosis in T1N0M0 and in T1N1M0 patients was significantly longer than the median survival for systemic recurrences found in the first decade of follow-up. This difference did not apply following local recurrence in either T1N0M0 or T1N1M0 cases. It is evident that patients with T1 breast carcinoma can be subdivided into differing prognostic groups and this must be taken into account when considering the role of adjuvant chemotherapy for stage I disease. Systemic adjuvant treatment may prove to be beneficial for patients with unfavorable prognostic factors, while women with an especially low risk for recurrence (eg, T1N0M0 tumor 1.0 cm or less) might be spared such treatment.

Impact of surgery and chemotherapy on survival in patients with advanced cholangiocarcinoma: A multivariate analysis in a cohort of 242 consecutive patients

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4133-4133
Author(s):  
C. Dreyer ◽  
C. Le Tourneau ◽  
S. Faivre ◽  
V. Paradis ◽  
Q. Zhan ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Lymph Node ◽  
Median Survival ◽  
Tumor Size ◽  
Positive Impact ◽  
Univariate Analysis ◽  
Lymph Node Involvement ◽  
Node Involvement ◽  
The Impact

4133 Background: Cholangiocarcinoma remains an orphan disease for which prospective studies are missing to evaluate the impact of systemic chemotherapy on survival. Methods: Univariate and multivariate analysis of parameters that might impact survival were analyzed in a cohort of 242 consecutive patients with cholangiocarcinoma treated in a single institution between 2000 and 2004. Variables were WHO performance status (PS), age, symptoms, tumor size, extent of the disease, lymph node involvement, site of metastasis, tumor markers, pathology, and type of treatment including surgery, chemotherapy and radiotherapy. Results: Statistically significant prognostic factors of survival in univariate analysis are displayed in the table : In multivariate analysis, PS, tumor size and surgery were independent prognostic factors. Subgroup analysis demonstrated that in patients with advanced diseases (lymph node involvement, peritoneal carcinomatosis and/or distant metastasis), patients who had no surgery benefited of chemotherapy (median survival 13.1 versus 7.4 months in patients with/without chemotherapy, p = 0.006). Moreover, survival was further improved when patients could benefit of chemotherapy following total and/or partial resection (median survival 22.9 versus 13.0 months in patients with/without chemotherapy, p = 0.03). Conclusions: This study strongly suggests the positive impact on survival of multimodality approaches including surgery and chemotherapy in patients with advanced cholangiocarcinoma. [Table: see text] No significant financial relationships to disclose.

scholarly journals Influence of the time between surgery and radiotherapy on local recurrence in patients with lymph node-positive, early-stage, invasive breast carcinoma undergoing breast-conserving surgery

Cancer ◽  
2005 ◽  
Vol 104 (2) ◽  
pp. 240-250 ◽  
Author(s):  
Mohamed Benchalal ◽  
Elisabeth Le Prisé ◽  
Brigitte de Lafontan ◽  
Dominique Berton-Rigaud ◽  
Yazid Belkacemi ◽  
...  
Keyword(s):  
Lymph Node ◽  
Breast Carcinoma ◽  
Local Recurrence ◽  
Early Stage ◽  
Breast Conserving Surgery ◽  
Invasive Breast Carcinoma ◽  
Node Positive ◽  
Lymph Node Positive

Prognostic Factors Influencing Progression-Free Survival Determined From a Series of Sporadic Desmoid Tumors: A Wait-and-See Policy According to Tumor Presentation

2011 ◽  
Vol 29 (26) ◽  
pp. 3553-3558 ◽  
Author(s):  
Sébastien Salas ◽  
Armelle Dufresne ◽  
Binh Bui ◽  
Jean-Yves Blay ◽  
Philippe Terrier ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Tumor Size ◽  
Univariate Analysis ◽  
Progression Free Survival ◽  
Surgical Margins ◽  
Desmoid Tumors ◽  
Tumor Site ◽  
Free Survival ◽  
Wait And See

Purpose Desmoid tumors are mesenchymal fibroblastic/myofibroblastic proliferations with locoregional aggressiveness and high ability to recur after initial treatment. We present the results of the largest series of sporadic desmoid tumors ever published to determine the prognostic factors of these rare tumors. Patients and Methods Four hundred twenty-six patients with a desmoid tumor at diagnosis were included, and the following parameters were studied: age, sex, delay between first symptoms and diagnosis, tumor size, tumor site, previous history of surgery or trauma in the area of the primary tumor, surgical margins, and context of abdominal wall desmoids in women of child-bearing age during or shortly after pregnancy. We performed univariate and multivariate analysis for progression-free survival (PFS). Results In univariate analysis, age, tumor size, tumor site, and surgical margins (R2 v R0/R1) had a significant impact on PFS. PFS curves were not significantly different for microscopic assessment of surgical resection quality (R0 v R1). In multivariate analysis, age, tumor size, and tumor site had independent values. Three prognostic groups for PFS were defined on the basis of the number of independent unfavorable prognostic factors (0 or 1, 2, and 3). Conclusion This study clearly demonstrates that there are different prognostic subgroups of desmoid tumors that could benefit from different therapeutic strategies, including a wait-and-see policy.

scholarly journals Human Kallikrein Gene 5 (KLK5) Expression by Quantitative PCR: An Independent Indicator of Poor Prognosis in Breast Cancer

2002 ◽  
Vol 48 (8) ◽  
pp. 1241-1250 ◽  
Author(s):  
George M Yousef ◽  
Andreas Scorilas ◽  
Lianna G Kyriakopoulou ◽  
Laura Rendl ◽  
Maria Diamandis ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Breast Carcinoma ◽  
Univariate Analysis ◽  
Specific Antigen ◽  
Cancer Cell Line ◽  
Rt Pcr ◽  
Node Positive ◽  
Reverse Transcription Pcr ◽  
Hazard Ratios ◽  
Cox Analysis

Abstract Background: KLK5 is a newly discovered human kallikrein gene. Many kallikrein genes have been found to be differentially expressed in various malignancies, and prostate-specific antigen (PSA; encoded by the KLK3 gene) is the best tumor marker for prostate cancer. Like the genes that encode PSA and other kallikreins, the KLK5 gene was found to be regulated by steroid hormones in the BT-474 breast cancer cell line. Methods: We studied KLK5 expression in 179 patients with different stages and grades of epithelial breast carcinoma by quantitative reverse transcription-PCR (RT-PCR), using LightCycler® technology. An optimal cutoff point equal to the detection limit (65th percentile) was used. KLK5 values were then compared with other established prognostic factors in terms of disease-free (DFS) and overall survival (OS). Results: High KLK5 expression was found more frequently in pre-/perimenopausal (P = 0.026), node-positive (P = 0.029), and estrogen receptor-negative (P = 0.038) patients. In univariate analysis, KLK5 overexpression was a significant predictor of reduced DFS (P &lt;0.001) and OS (P &lt;0.001). Cox multivariate analysis indicated that KLK5 was an independent prognostic factor for DFS and OS. KLK5 remained an independent prognostic variable in the subgroups of patients with large tumors (&gt;2 cm) and positive nodes. Hazard ratios derived from Cox analysis and related to DFS and OS were 2.48 (P = 0.005) and 2.37 (P = 0.009), respectively, for the node-positive group and 3.03 (P = 0.002) and 2.94 (P = 0.002), respectively, for patients with tumor sizes &gt;2 cm. KLK5 expression was also associated with statistically significantly shorter DFS (P = 0.006) and OS (P = 0.004) in the subgroup of patients with grade I and II tumors. Conclusions: KLK5 expression as assessed by quantitative RT-PCR is an independent and unfavorable prognostic marker for breast carcinoma.

Comparing clinicopathologic feature and treatment outcome of patients who underwent surgical resection or liver transplant for nonalcoholic fatty liver disease (NAFLD)-related and non-NAFLD related hepatocellular carcinoma (HCC).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16675-e16675
Author(s):  
Surendra Pal Chaudhary ◽  
Lipika Goyal ◽  
Matthew L Chase ◽  
Andrew X. Zhu ◽  
Nikroo Hashemi ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Liver Transplant ◽  
Tumor Size ◽  
Massachusetts General Hospital ◽  
Disease Recurrence ◽  
Large Tumor ◽  
Nonalcoholic Fatty Liver ◽  
Risk Of Death ◽  
Clinicopathologic Feature ◽  
Significant Difference

e16675 Background: NAFLD associated HCC is rapidly increasing in frequency worldwide. In this study, we evaluated potential differences in clinical characteristics and outcomes of patients who underwent surgery or liver transplant for NAFLD-associated HCC compared to HCC from other etiologies. Methods: Demographic, clinicopathological features and outcomes of patients with HCC who underwent liver resection or liver transplant at Massachusetts General Hospital and Brigham and Women’s Hospital were collected (January 2004 - April 2018). Of 713 patients screened, 481were eligible: 260 underwent resection [NAFLD (n = 61), viral (n = 150), cryptogenic (CC) (n = 49)]. 221 underwent transplant [(NAFLD (n = 14), viral (n = 201), CC (n = 6)]. Results: In the Resected cohort, NAFLD patients presented with median age of (71.5 years) compared with Viral (63.4) and Cryptogenic (68.4). NAFLD patients had significantly higher Body Mass Index (BMI) > 28.8 39(66%) p = < 0.001, while patients with cryptogenic HCC presented with large tumor size (>5cm) 37(75%) p = 0.001. In multivariate analysis, tumor size 5cm (HR1.78,p = 0.002), R1 or R2 resection (HR 2.48, p = < 0.001and 2.8,p = 0.007), low platelet count (HR 2.8,p = 0.002) and diabetes (HR 1.5,p = 0.025) were poor prognostic factors in resection cohort. Median overall survival (OS) was not significantly different between NAFLD, Cryptogenic and Viral (47.2, 69.7 and 69.0 months, p = 0.18) etiologies, respectively. In the Transplant cohort, NAFLD patients had a median age of 65.5 and cryptogenic, viral (61.3 and 58.5 years) respectively. NAFLD and Cryptogenic HCC patients compared with viral HCC patients had low AFP median 3.7, 3.9 and 7.5 ng/mL(p = 0.012) respectively. In multivariate analysis patients with perineural invasion (HR 20.7,p = 0.009), disease recurrence (HR 2.5,p = 0.001) and high AFP (HR 2.1,p = 0.001) were at higher risk of death among transplant patients. No significant difference in median OS was seen between NAFLD, cryptogenic and viral (69.1,92.3 and 88.0 months, p = 0.38). Conclusions: NAFLD patients had higher BMI and had a lower AFP than viral and CC. NAFLD had similar median OS following resection and transplant when compared to those with Viral and CC.

Early Completion of Medical Orders for Life-Sustaining Treatment (MOLST) and Hospice Enrollment Are Associated with Improved End of Life (EOL) Quality Metrics in Acute Myeloid Leukemia (AML) and Myelodysplastic Syndromes (MDS)

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 20-21
Author(s):  
Marissa Locastro ◽  
Kah Poh Loh ◽  
Andrea M. Baran ◽  
Jane L. Liesveld ◽  
Michael W. Becker ◽  
...  
Keyword(s):  
Palliative Care ◽  
Multivariate Analysis ◽  
Lower Risk ◽  
Univariate Analysis ◽  
Quality Metrics ◽  
Hospital Death ◽  
High Quality ◽  
Risk Of Death ◽  
Life Sustaining Treatment ◽  
Eol Care

Introduction: EOL care in patients (pts) with hematologic malignancies (HM) has been inadequately studied. Available data suggest that pts with HM are more likely to be hospitalized and receive chemotherapy at EOL, and less likely to be enrolled in hospice relative to pts with solid tumors. Better understanding of the barriers to high-quality EOL care is needed for HM pts. The aim of this study was to identify potential barriers to high-quality EOL care for pts with AML and MDS. Methods: We conducted a retrospective study of pts aged ≥18 years with AML or MDS who were evaluated at Wilmot Cancer Institute and its affiliates, and died between Jan 1, 2014 and Dec 31, 2019. We collected the following EOL metrics: 1) Hospice enrollment; 2) Palliative care (PC) referral; 3) MOLST form completion and do-not-resuscitate orders; 4) Chemotherapy administration within the last 14 days of life; 5) Utilization of the emergency department (ED), hospital, intensive care unit (ICU), and life-sustaining treatments (LSTs) within the last 30 days of life; 6) Transfusion within the last 7 days of life; 7) Place of death; and 8) Time from MOLST form completion, PC referral, and hospice enrollment to date of death. Fisher's exact tests were used to compare EOL metrics between pts with MDS and AML. We used cumulative incidence functions to estimate the probability of PC referral and MOLST form completion within 12 weeks of the first hematology visit, accounting for the competing risk of death. We analyzed the univariate and multivariate associations of timing (&gt;30 days vs never/30 days prior to death) of MOLST form completion, PC referral, and hospice enrollment with utilization of the ED, hospital, ICU, and LSTs at EOL. We evaluated the associations of MOLST form completion, PC referral, and hospice enrollment with hospital death. Results: We included 120 pts with MDS (mean age 73.6; range 25-93) and 238 pts with AML (mean age 65.7; range 20-95). EOL metrics by diagnosis are shown in Table 1. The probability of PC referral within 12 weeks of the first hematology visit was 16.7% [95% Confidence Interval (CI) 12.2-21.9%] and 7.1% (95% CI 3.3-12.9%) for AML and MDS, respectively. The probability of MOLST form completion within 12 weeks of the first hematology visit was 23.7% (95% CI 18.3-29.4%) and 11.9% (95% CI 6.7-18.8%) for AML and MDS, respectively. A MOLST form was completed early (&gt;30 days before death) in 33.3% (N=115/345) of pts. In univariate analysis, these pts were less likely to be hospitalized (78.1 vs 89.3%, p&lt;0.01), be admitted to the ICU (13.9 vs 45.1%, p&lt;0.01), and to utilize LSTs at EOL (13.9 vs 46.7%, p&lt;0.01). Early hospice enrollment (&gt;30 days before death) occurred in 3.8% (N=13/340) of pts. In univariate analysis, these pts were less likely to visit the ED (0 vs 46.6%, p&lt;0.01), be hospitalized (26.7 vs 87.9%, p&lt;0.01), be admitted to the ICU (0 vs 36.5%, p&lt;0.01) and to utilize LSTs at EOL (0 vs 37.5%, p&lt;0.01). Early PC referrals (&gt;30 days before death) occurred in 21.4% (N=73/341) of pts and was not associated with EOL metrics in univariate analysis. In multivariate analysis, after adjusting for age and diagnosis, early MOLST form completion was associated with a lower risk of ICU admission [Odds Ratio (OR) 0.23, p&lt;0.01] and lower risk of utilization of LSTs (OR 0.21, p&lt;0.01). Early hospice enrollment was associated with a lower risk of ED visitation (OR 0.04, p=0.03) and hospitalizations (OR 0.05, p&lt;0.01). Hospice enrollment at any time was associated with a lower risk of death in the hospital (OR 0.14, p&lt;0.01), while MOLST form completion (OR 5.26, p&lt;0.01) and PC referral (OR 4.44, p&lt;0.01) were associated with a higher risk of death in the hospital (likely reflecting the fact that many were done close to EOL in the hospital). There was not a significant association between early PC and EOL metrics in multivariate analysis. Conclusion: We found a high rate of ED visits, hospitalizations, ICU admissions, and use of LSTs at EOL in pts with MDS and AML. The majority of these pts died in the hospital. While most patients completed MOLST forms and had palliative care referrals, these events generally occurred very late in the disease course, often close to EOL. Early MOLST form completion and early hospice enrollment were associated with better EOL quality metrics. Interventions to promote timely completion of orders for life-sustaining treatment, PC referrals, and hospice enrollments may improve EOL care among pts with AML and MDS. Table Disclosures Loh: Pfizer: Consultancy; Seattle Genetics: Consultancy. Liesveld:Abbvie: Honoraria; Onconova: Other: data safety monitoring board. Aljitawi:Sanatela Medical: Patents & Royalties: Patent pending. Mendler:Jazz Pharmaceuticals: Speakers Bureau; GLG: Consultancy.

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