Secondary Colorectal Carcinoma After Childhood Cancer

Purpose Colorectal carcinoma (CRC) has been described as a subsequent malignant neoplasm (SMN), although little is known about associated risk factors. We aimed to quantify the long-term risk of secondary CRC and identify treatment-related risk factors. Patients and Methods In this nested case-control study, 19 cases of adenocarcinoma of the colon or rectum were identified from 13,048 oncology patients treated for childhood cancer at St Jude Children's Research Hospital. Group 1 controls (n = 148) were matched for age at primary malignancy and follow-up interval. Group 2 controls (n = 72) were matched on primary diagnosis in addition to group 1 criteria. Exact conditional logistic regression was performed to calculate odds ratios (ORs) for chemotherapy and radiation exposure. Results Forty-year cumulative incidence of secondary CRC was 1.4%. Standardized incidence ratio was 10.9 (95% CI, 6.6 to 17.0) compared with that in the general US population. Secondary CRC was more likely in an irradiated segment of the colon (group 1 OR, 7.7; P = .001; group 2 OR, 15.4; P = .002). Risk increased by 70% with each 10-Gy increase in radiation dose. Increasing radiation volume increased risk (group 1 OR, 1.5; P < .001; group 2 OR, 1.8; P < .001). Alkylating agent exposure was associated with an 8.8-fold increased risk of secondary CRC (P = .03). Conclusion In matched analyses, radiation and alkylator exposure are associated with secondary CRC. This risk is proportional to dose and volume of radiation. Surveillance should be initiated at a young age among survivors receiving high-risk exposures.

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Chorangiosis of Chorionic Villi: What Does It Really Mean?

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2015-0160-oa ◽

2016 ◽

Vol 140 (6) ◽

pp. 588-593 ◽

Cited By ~ 15

Author(s):

Jerzy Stanek

Keyword(s):

Risk Factors ◽

Low Grade ◽

Minimal Risk ◽

Pregnancy Risk ◽

Chorionic Villi ◽

Injury Group ◽

Increased Risk ◽

Group 3 ◽

Group 2 ◽

Group 1

Chorangiosis has been regarded as a result of low-grade placental hypoxia associated with pregnancy risk factors and abnormal outcomes. It is unknown whether these are a consequence of chorangiosis itself or of associated other placental pathology.Context.— To prove that chorangiosis itself does not portend an increased risk for pregnancy unless associated with other placental pathology.Objective.— This retrospective statistical study analyzes 1231 consecutive placentas with diffuse or focal hypervascularity of chorionic villi: 328 with preuterine pattern of chronic hypoxic placental injury (group 1), 297 with uterine type of chronic hypoxic placental injury (group 2), and 606 cases with chorangiosis (group 3) not fulfilling the inclusion criteria for groups 1 or 2.Design.— Group 2, with 33 cases of chorangiosis (11.1%), featured 10 and 11 statistically significant highest percentages of abnormal clinical and placental variables, respectively; group 3 featured the highest percentages of multiple pregnancy, the heaviest placentas, and the most common acute chorioamnionitis, fetal inflammatory response; and group 1 had the highest proportion of mild erythroblastosis of fetal blood. When comparing groups 1 and 3, 21 of 29 clinical risk factors/outcomes (72.4%) and 30 of 41 placental variables (73.2%) were more common in group 1.Results.— Presence of diffuse hypoxic patterns of placental injury adds prognostically negative significance to increased vascularity of chorionic villi. Chorangiosis without those patterns portends minimal risk for the pregnancy, and is associated with significantly fewer pregnancy risk factors, abnormal outcomes, and other placental abnormalities.Conclusions.—

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Lipoproteins and other Risk Factors for Cardiovascular Disease in a Student Population

Journal of Medical Biochemistry ◽

10.2478/jomb-2013-0002 ◽

2013 ◽

Vol 32 (2) ◽

pp. 140-145 ◽

Cited By ~ 3

Author(s):

Dragana Pap ◽

Emina Čolak ◽

Nada Majkić-Singh ◽

Gordana Grubor-Lajšić ◽

Sanja Vicković

Keyword(s):

Risk Factors ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Lipoprotein Cholesterol ◽

Low Density ◽

Low Density Lipoprotein Cholesterol ◽

Lipid Status ◽

Increased Risk ◽

Group 2 ◽

Group 1

Summary Background: Cardiovascular disease (CVD) is a major cause of mortality and morbidity in many populations, especially in developed countries. The aim of the study was to analyze the lipid status in a student population at increased risk for CVD in comparison with students who are not at increased risk for CVD. Methods: This study included 238 students from the University of Novi Sad of both sexes (126 men and 112 women), with a mean age of 22.32±1.85 years. According to the body mass index (BMI) lower and higher than 25 kg/m2 and waist circumference (WC) of less and more than 94 cm (80 cm for females) the whole group of 238 students was divided into 2 subgroups: the group at increased risk for CVD (Group 1) and the group at lower risk for CVD (Group 2). Total cholesterol - TCH, triglycerides - TG, high density lipoprotein cholesterol - HDL-c, low density lipoprotein cholesterol - LDL-c, very low-density lipoprotein cholesterol - VLDL-c concentrations were determined and the index of atherosclerosis (IA), established risk factors RF-TCH/HDL-c ratio and non-HDL-c/HDL-c ratio were mathematically calculated. Results: The values of TCH, LDL-c, non-HDL-c, VLDL-c and TG were significantly higher in Group 1 compared to Group 2 (P<0.001). IA, non-HDL-c/HDL-c and RF-TCH/HDL-c ratio were also significantly higher (P<0.001), while HDL-c was significantly lower (p<0.01) in Group 1 compared to controls. These results were not influenced by gender in both groups of subjects. Conclusions: The data suggest that increased anthropometric parameters are followed by increased lipoprotein status in the group of students at increased risk for CVD and screening of the lipid status is necessary in students, especially in those who are at increased risk for CVD.

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The impact of obesity to antioxidant defense parameters in adolescents with increased cardiovascular risk

Journal of Medical Biochemistry ◽

10.2478/jomb-2019-0051 ◽

2019 ◽

Vol 0 (0) ◽

Author(s):

Emina Čolak ◽

Dragana Pap ◽

Ljubinka Nikolić ◽

Sanja Vicković

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Inflammatory Markers ◽

Antioxidant Defense ◽

Hdl Cholesterol ◽

Increased Risk ◽

Group 2 ◽

The Impact ◽

Group 1

Summary Background The goal of this study was to assess the oxidative stress status through the values of antioxidant defense parameters: superoxide dismutase (SOD), glutathione peroxidase (GPx), glutathione reductase (GR) and total antioxidant status (TAS), as well as cardiovascular risk factors (total cholesterol, LDL-cholesterol, VLDL-cholesterol, non-HDL-cholesterol and triglycerides), anthropometric parameters (Body mass index-BMI, waist circumference-WC, hipp circumferemce-HC, waist-to-hipp ratio-WHR and inflammatory markers (high sensitive C-reactive protein) in a group of obese adolescents. Methods A total of 238 students of both sexes, age of 22.32 ± 1.85 yr. were included in the study. According to the values of BMI lower and higher than 25 kg/m2 and WC higher and lower than 94 cm (males)/80 cm (females) the tested group of students was divided into 2 subgroups: Group 1 (increased risk for CVD) and Group 2 (lower risk for CVD). Results Significantly reduced SOD and GPx with increased GR, TAS, inflammatory and lipoprotein parameters were obtained in Group 1 compared to Group 2. Significant positive association of hsCRP (OR:1.41; 95%CI 1.08–1.83; P=0.007), TAS (OR:827.2; 95%CI 19.27–35498; P=0.007) and GR (OR:1.13; 95%CI 1.05–1.21; P=0.002) and negative association of GPx (OR:0.97; 95%CI 0.94–1.003; P=0.043) and HDL-cholesterol (OR:0.41; 95%CI 0.176– 0.963; P=0.0014) with cardiovascular risk factors were found in obese students. According to the ROC analysis GR>44.8 U/L, TAS>1.35 mmol/L, hsCRP>1.71 mg/L and HDL-cholesterol <1.13 mmol/L have sufficient predictive ability for cardiovascular disease in obese students. Conclusions Significant association of antioxidant defense parameters with anthropometric, lipid and inflammatory markers in obese students with increased cardiovascular risk suggest that screening of these parameters is necessary and highly recommended.

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Increased risk of falls, fall-related injuries and fractures in people with type 1 and type 2 diabetes - a nationwide cohort study.

Current Drug Safety ◽

10.2174/1574886315666200908110058 ◽

2020 ◽

Vol 15 ◽

Author(s):

Nicklas Højgaard Rasmussen ◽

Jakob Dal ◽

Joop Van den Bergh ◽

Frank de Vries ◽

Morten Hasselstrøm Jensen ◽

...

Keyword(s):

Risk Factors ◽

Alcohol Abuse ◽

Increased Risk ◽

Risk Of Falls ◽

History Of ◽

Group 2 ◽

Risk Factors For Falls ◽

Group 1

Introduction: People with diabetes could have an increased risk of falls as they show more complications, morbidity and use of medication compared to the general population. This study aimed to estimate the risk of falls and to identify risk factors associated with falls in people with diabetes. The second aim was to estimate fall-related injuries including lesions and fractures including their anatomic localization in people with diabetes compared with the general population. Methods: From the Danish National Patient Register we identified people with Type 1 Diabetes (T1D) (n=12,896), Type 2 Diabetes (T2D) (n=407,009). The cohort was divided into two groups with respective control groups matched on age and sex (1:1). All episodes of people hospitalized with a first fall from 1996 to 2017 were analyzed using a Cox proportional-hazards model. Risk factors such as age, sex, diabetic complications, a history of alcohol abuse and the use of medication were included in an adjusted analysis. The incidence rate and rate ratio of falls and the anatomic localization of fall-related injuries as lesions and fractures were identified. Results and Discussion: The cumulative incidence, of falls requiring hospital treatment, was 13.3% in T1D, 11.9% in T2D. In the adjusted analysis T1D and T2D were associated with a higher risk of falls [T1D, Hazard Ratio (HR): 1.33 (95% CI: 1.25 - 1.43), T2D, HR: 1.19 (95% CI:1.16 - 1.22), respectively]. Women [group 1, HR 1.21 (CI:95%:1.13 – 1.29), group 2, HR 1.61 (CI:95%:1.58–1.64)], aged >65 years [groups 1, HR 1.52 (CI:95%:1.39 – 1.61), group 2, HR 1.32 (CI:95%:1.58–1.64)], use of selective serotonin receptor inhibitors (SSRI) [group 1, HR 1.35 (CI:95%:1.1.30 – 1.40), group 2, HR 1.32 (CI:95%:1.27–1.38)], opioids [group 1, HR 1.15 (CI:95%:1.12 – 1.19), group 2, HR 1.09 (CI:95%:1.05–1.12)] and a history of alcohol abuse [group 1, HR 1.77 (CI:95%:1.17 – 2.15), group 2, HR 1.88 (CI:95%:1.65–2.15)] were significantly associated with an increased risk of falls in both groups. The incidence rate ratios (IRR) of fall-related injuries as hip, pelvis/lower-back and skull/facial fractures were higher in people with T2D than controls [IRR 1.08 (CI:95%:1.02-1.15), IRR 1.21 (CI:95%: 1.12-1.48) and IRR 1.11 (CI:95%:1.02-1.21)]. Conclusion: People with diabetes have an increased risk of first fall and a higher incidence of fall-related injuries including fractures. Advanced aging and sex are non-modifiable risk factors, whereas diabetes, the use of SSRIs and opioids and alcohol abuse could be potentially modifiable risk factors for falls. Gaining information on risk factors for falls could guide the management of diabetes treatment i.e. choice of drugs, which enables us to improve treatment particularly in people with a high risk of falls and fractures associated with high mortality.

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Comparison of Risk Factors for Postoperative Complications Across Age Groups in Patients Undergoing ORIF of the Ankle

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00299 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0029

Author(s):

Haley McKissack ◽

Matthew Anderson ◽

John T. Wilson ◽

Leonardo V. M. Moraes ◽

Gean C. Viner ◽

...

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Elderly Patients ◽

Illicit Drugs ◽

Age Groups ◽

Wound Dehiscence ◽

Implant Failure ◽

Increased Risk ◽

Group 2 ◽

Group 1

Category: Ankle, Trauma Introduction/Purpose: Ankle fractures are commonly-seen orthopaedic injuries across all age groups, and often warrant operative management. Postoperative complications are particularly common among elderly patients, and can lead to a progressive culmination of negative outcomes. Although several studies have focused on the risk factors for and prevention of such complications in elderly patients, a paucity of literature exists addressing risk of postoperative complications in younger patient populations. The purpose of this study was to compare the incidence of and risk factors for various postoperative complications between younger and older patient populations. Methods: Patients who underwent open reduction and internal fixation for an ankle fracture at a single institution between the years 2008 and 2018 were retrospectively identified based on seven different Current Procedural Terminology (CPT) codes: 27829, 27784, 27822, 27814, 27769, 27792, and 27766. Patient charts were reviewed for demographic data and comorbid conditions. Patients with open fractures, pilon fractures, and polytraumatic injuries were excluded. The sample was stratified into two cohorts based on age in years: 18-49 (group 1), and 50 and older (group 2). Incidence of various postoperative complications—including infection, wound dehiscence, sepsis, DVT, implant failure, revision surgery, and non-union— was compared between groups. Secondary analysis was conducted to compare risk factors for these complications between ages 18- 49 and older than 50. Results: 881 patients were included. A significantly greater number of patients in group 2 experienced wound dehiscence (p = 0.033) and nonunion (p<0.001) postoperatively in comparison to those in group 1. Risk of infection was significantly increased among patients with hypertension, CHF, and CKD compared to patients without these comorbidities in both group 1 and group 2. Risk of wound dehiscence was significantly increased among patients using tobacco and illicit drugs in group 1 (RR=3.39, p=0.0223 and RR=3.07, p=0.0201 respectively), but not in group 2 (RR = 1.12, p = 0.8021 and RR = 1.77, p = 0.4203 respectively). Risk of implant failure was significantly increased among tobacco users in group 2 (RR=3.82, p = 0.0005), but not in group 1 (RR = 0.75, p=0.4709). Conclusion: Patients age 50 and older may be at significantly increased risk for postoperative wound dehiscence and nonunion in comparison to patients who are younger than 50. Additionally, younger patients who use tobacco and illicit drugs may be at increased risk of wound dehiscence, while tobacco use among patients 50 years and older may increase risk of implant failure. Understanding the risk factors associated with negative outcomes may help physicians to optimize individual patient care based on existing comorbidities and age.

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The Association of Fetal Congenital Cardiac Defects and Placental Vascular Malperfusion

Pediatric and Developmental Pathology ◽

10.1177/1093526620986497 ◽

2021 ◽

pp. 109352662098649

Author(s):

Tulin Ozcan ◽

Sandra Kikano ◽

Sarah Plummer ◽

James Strainic ◽

Sanjita Ravishankar

Keyword(s):

Risk Factors ◽

Heart Defects ◽

Maternal Risk Factors ◽

Placental Perfusion ◽

Maternal Risk ◽

Increased Risk ◽

Great Vessels ◽

Perfusion Defects ◽

Group 2 ◽

Group 1

Objectives Abnormal early angiogenesis appears to impact both placental disorders and fetal congenital heart defects (CHD). We sought to assess the association of placental perfusion defects (PPD) and fetal (CHD). Methods Singleton pregnancies with isolated severe fetal CHD were compared to controls without congenital anomalies or maternal malperfusion (MVM) risk factors. CHD was categorized into group 1: single left ventricle morphology and transposition of the great vessels (TGA) and group 2: single right ventricle and two ventricle morphology. Malperfusion was defined as fetal vascular malperfusion (FVM), MVM, and both FVM and MVM. Results PPD was increased for all CHD (n = 47), CHD with or without risk factors, and CHD groups compared to controls (n = 92). Overall CHD cases and CHD with risk factors had an increased risk of FVM (30% and 80% vs 14%), and MVM (43% and 50% vs 21%), respectively. MVM rates were similar in CHD with and without maternal risk factors. FVM (38% vs 14%) and MVM (44% vs 21%) were increased in Group 1. MVM (42% vs 21%) and both FVM and MVM (16% vs 3%) were increased in Group 2. Conclusions PPD risk is increased in severe isolated fetal CHD. The highest risk is seen in fetal CHD with maternal risk factors.

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Risk Factors for Malignant Gallbladder Polyps

Bakirkoy Tip Dergisi / Medical Journal of Bakirkoy ◽

10.5222/bmj.2021.60783 ◽

2021 ◽

Author(s):

Serhan Yılmaz ◽

Hakan Bölükbaşı ◽

Mehmet Abdussamet Bozkurt

Keyword(s):

Risk Factors ◽

Gallstone Disease ◽

Polyp Size ◽

Gallbladder Polyps ◽

Asymptomatic Patients ◽

Increased Risk ◽

Significant Difference ◽

Group 2 ◽

Malignant Polyps ◽

Group 1

PURPOSE: The aim of this study is to determine risk factors for malignancy in gallbladder polyps. METHODS: 92 patients who underwent laparoscopic cholecystectomy due to gallbladder polyp were retrospectively analyzed. Demographic data of the patients, size and number of polyp, the presence of gallstones and histopathological features of the polyps were recorded. RESULTS: 92 patients were included. Mean age was 45.78±11.21 years (21-72). 59 of the patients (64.1%) were female and 33 (35.9%) were male. Mean polyp size was 8.17±2.19 mm and 35 patients (38.0%) had a single polyp, while 57 (62.0%) had multiple polyps (≥2). 47 of the patients (51.1%) had gallstone disease, while 45 (48.9%) had no stone disease. Benign polyps (Group 1) were found in 79 patients (85.9%) and adenocarcinomas (Group 2) were found in 13 (14.1%). Of the benign polyps, 71 (77.1%) were non-neoplastic polyps and 8 (8.8%) were neoplastic polyps (adenomas). Of the 13 patients with adenocarcinomas, 11 (11.9%) were T1a and 2 (2.2%) were T1b. Mean age was 44.32±11.03 years in Group 1 and 54.61±8.07 years in Group 2, the latter being significantly older (p=0.002). Mean polyp size was 7.47±5.51 mm in Group 1 and 12.46±1.89 mm in Group 2, with a significant difference (p<0.001). The cut-off value to detect malignant polyps was a polyp size of 10.5 mm with 92.3% sensitivity, 84.8% specificity, and 0.934 accuracy (p< 0.001). The cut-off value to detect malignant polyps was an age of 50.5 years with 76.9% sensitivity, 67.1% specificity, and 0.767 accuracy (p=0.002). Polyp size and age were important risk factors for malignant gallbladder polyps (p<0.001, OR=2.313; 95% CI: 1.502–3.561), (p=0.004, OR=1.100, 95% CI: 1.030–1.175). CONCLUCISION: We recommend cholecystectomy for asymptomatic patients aged above 50 years with gallbladder polyps larger than 10 mm due to the increased risk of malignancy.

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Efficacy evaluation of the CEUS-LI-RADS-v2017 system in differential diagnosis of liver tumors

Medical Visualization ◽

10.24835/1607-0763-2019-4-57-67 ◽

2019 ◽

pp. 57-67

Author(s):

A. N. Katrich ◽

V. A. Porkhanov ◽

N. S. Ryabin

Keyword(s):

Risk Factors ◽

Differential Diagnosis ◽

Liver Tumors ◽

Morphological Data ◽

Malignant Neoplasms ◽

Diagnostic Efficiency ◽

Efficacy Evaluation ◽

General Group ◽

Group 2 ◽

Group 1

Objective: efficacy evaluation of the CEUS LI RADS v2017® system for differential diagnosis of liver tumors in patients with and without cirrhosis.Materials and methods. Retrospective analysis of diagnostic results of the 165 patients with liver tumors (177 nodules) was done. All patients underwent CEUS with results interpretation in accordance to the CEUS LIRADSv2017 ® criteria. Patients were divided into 2 groups based on clinical and morphological data. Group 1 included 62 patients with cirrhosis and/or CVH. Group 2 included 110 patients without risk factors for HCC.Results. Diagnostic efficiency of CEUS LI RADS v2017® for HCC identification was: group 1 – Se – 100%, Sp – 88%, Ac – 95.5%; group 2 – Se – 100%, Sp – 68.8%, Ac – 72.7%; general group Se – 100%, Sp – 72.2%, Ac – 81.4%. In the 2nd group, 21 out of 22 neoplasms, confirmed morphologically as FNH, we classified as LR 4. By applying benign character and specific contrasting patterns of FNG, they were transferred from LR 4 to LR 3. This allowed to increase sensitivity and specificity of differential diagnosis in group 2 (Se – 100%, Sp – 90.6%, Ac – 91.8%) and in general group (Se – 100%, Sp – 90.1%, Ac – 93.2%). Diagnostic efficiency of the criteria for non hepatocellular malignant neoplasms (LR M) was: group 1 – Se – 77.8%, Sp – 100%, Ac – 97%; group 2 – Se – 90%, Sp – 96.7%, Ac – 93.6%; general group- Se – 88.1%, Sp – 98.3%, Ac – 94.9%.Conclusion. Our study confirmed high accuracy of the CEUS LI RADS v2017® system in the differential diagnosis of focal liver tumors. Modification of the system (in particular, transfer of typical FNG forms from the LR 4 category) will make it possible to increase the accuracy of diagnostics by 20%. It will allow to use the LI RADS v2017® system for interpretation CEUS not only among patients with liver cirrhosis, but also in a general group without risk factors of GCC.

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SAT0306 SEMIQUANTITATIVE AND QUANTITATIVE ANALYSIS OF LUNG CT IN THE ASSESSMENT OF INTERSTITIAL LUNG DISEASE IN IDIOPATHIC INFLAMMATORY MYOPATHIES WITH A FOCUS ON ANTISYNTHETASE.

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4189 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1098.2-1098

Author(s):

S. Barsotti ◽

C. Roncella ◽

A. Valentini ◽

L. Cavagna ◽

R. Castellana ◽

...

Keyword(s):

Quantitative Analysis ◽

Interstitial Lung Disease ◽

Lung Disease ◽

Special Focus ◽

Idiopathic Inflammatory Myopathies ◽

Inflammatory Myopathies ◽

Increased Risk ◽

Group 2 ◽

Lung Ct ◽

Group 1

Background:Interstitial lung disease (ILD), is common in patients with idiopathic inflammatory myopathies (IIM) and strongly impact on patients’ morbidity and mortality. Patients with anti-aminoacyl-transfer RNA-synthetases (anti-ARS) antibodies are associated with an increased risk of ILD.Objectives:Defining the radiological characteristics of IIM patients, with special focus on serological groups, through qualitative, semiquantitative and quantitative analysis of lung CT.Methods:This was a prospective study conducted from 2016 to 2019. Ninety-eight IIM patients (35 men, 63 women) were included. Myositis specific autoantibodies (MSA) were assessed with Myositis Prophyle III (Euroimmune, Lubeck).Each patient had a baseline CT; the total score of Warrick (WS) was obtained at semiquantitative analysis. The radiological scores ILD% (interstitial lung disease %) and PVRS% (pulmonary vascular related structure) were the result of quantitative analysis in 61 patients (CALIPER). Pulmonary function tests (PFTs) included TLC%, FVC% and DLCO% (65 patients). The analysis was conducted in the whole group and divided in subgroups based on their MSA pattern: in particular anti-ARS (Group 1) and patients negative to MSA (Group 2) were analysed.Results:Positive correlations between ILD% and PVRS% (Rho=0.916; ρ=0.000), WS and ILD% (Rho=0.663; ρ=0.000) and WS and PVRS% (Rho=0.637; ρ<0.001) were found.The most relevant inverse correlations were found between ILD% and DLCO% (Rho=-0.590; ρ=0.001), PVRS% and DLCO% (Rho=-0.549; ρ<0.001) and WS and DLCO% (Rho=-0.471; ρ<0.001).Statistically significant higher values of WS, ILD% and PVRS% were found in Group 1 (WS=15, ILD%=11 and PVRS%=3.5), compared to Group 2 (WS=2.5, ILD%=0.84 and PVRS%=2.2). NSIP pattern resulted dominant represented in the two groups (80% Group 1, 75% Group 2). No statistically significant differences of DLCO%, FVC% and TLCO% were found.Conclusion:The inverse correlations between the radiological scores and the functional data TLC% and DLCO% (ρ<0.001) confirm the role of lung CT in the clinical management of ILD in IIM patients, and may represent a promising tool for clinical trials. For the first time anti-ARS and serological negative patients were defined through qualitative, semiquantitative and quantitative analysis of lung CT. Further study should be conducted in order to define the prognostic value of the quantitative analysis of lung CT in the follow up of IIM patients.Disclosure of Interests:None declared

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Abstract TP217: Cerebrovascular Events in Glioma Patients Treated with Bevacizumab

Stroke ◽

10.1161/str.44.suppl_1.atp217 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Donika K Patel ◽

Seby John ◽

Neda Hashemi-Sadraei ◽

Manmeet Ahluwalia

Keyword(s):

Risk Factors ◽

Tumor Progression ◽

Cerebrovascular Event ◽

Patient Demographics ◽

Randomized Controlled Studies ◽

Cerebrovascular Events ◽

Bevacizumab Treatment ◽

Increased Risk ◽

Group 2 ◽

Endothelial Growth Factor

Introduction: Bevacizumab, a humanized monoclonal anti-vascular endothelial growth factor antibody, was FDA approved in 2009 for progressive glioblastoma. Phase II clinical trials suggested an increased risk of ischemic stroke (IS) and intracranial hemorrhage (ICH) while on bevacizumab. The incidence, clinical characteristics, and neuroimaging of glioma patients who developed cerebrovascular events while on treatment is lacking. We report our experience using bevacizumab for glioma patients. Methods: A retrospective review of glioma patients treated with bevacizumab at our institution from July 2005 to June 2011 was studied. Patients with MRI-confirmed IS and/or ICH while on bevacizumab was investigated and compared to historical data. Patient demographics, vascular risk factors, clinical presentations, tumor characteristics, treatments (surgery, chemotherapy, and radiation), and treatment duration were collected. Results: A total of 162 patients (65% male) received bevacizumab and 23 (14%) developed a cerebrovascular event while on treatment, with 3 (2%) IS and 20 (12%) ICH. All IS and ICH patients received prior brain radiation. In the IS group, 2 (66%) patients were symptomatic, with 1 (33%) cardiembolic and 2 (66%) lacunar strokes. None had risk factors besides hypercoagulable state from malignancy. In the ICH group, 3 (15%) patients had a symptomatic bleed and 6 (30%) had associated hypertension. All ICHs were intratumoral and 16 (80%) associated with tumor progression. Median survival after stroke was 9.8 and 3.7 months in the IS and ICH groups, respectively. Length of bevacizumab treatment was not significantly associated with development of IS ( p = 0.6) and ICH ( p = 0.3). Conclusion: Glioma patients have an inherently elevated risk of IS and ICH because of disease- and treatment-related effects. In our study, 78% of the events were asymptomatic and diagnosed on serial imaging. ICHs were more common, but all were small intratumoral bleeds, mostly in the setting of tumor progression. Development of cerebrovascular events was not associated with the duration of bevacizumab treatment. Our study, however, cannot determine causality and randomized controlled studies are needed to determine the risk of IS and ICH with bevacizumab use.

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