Prognostic factors for metastatic colorectal cancer with and without bevacizumab therapy.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14163-e14163
Author(s):  
Ikenna Osuorji ◽  
Greg Dyson ◽  
Durga Yerasuri ◽  
Philip Agop Philip ◽  
Anthony Frank Shields ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Platelet Count ◽  
Regression Model ◽  
Median Survival ◽  
Cox Regression ◽  
Hazard Ratio ◽  
Colorectal Disease ◽  
Cox Regression Model ◽  
Platelet Counts ◽  
The Impact

e14163 Background: Metastatic colorectal disease is generally incurable and treatment is palliative with the intent to balance toxicity with quality of life. Coin 3 trial showed that pre-chemotherapy platelet counts > 400,000 per μL were associated with poor survival when intermittent chemotherapy was used, whereas patients with lower platelet counts did not have any significant difference between the intermittent and continuous chemotherapy arms. Methods: We reviewed retrospectively 775 stage IV colorectal cancer patients at Karmanos Cancer Center over a 10 year period to see if high platelet count was associated with a poor outcome irrespective of treatment. Our analysis included 480 patients with adenocarcinoma who had not received chemotherapy prior to referral, and where information on the baseline platelet count, race, and age was available. We also analyzed the impact of race, age and bevacizumab use. We used Cox regression model for analysis. Results: Among the patients 48.3% were African American (AA) and 51.7% were Caucasians (C). 34.4 % had had PLT > 400,000 per μL. For those with lower platelet counts the median survival was 26.2 months in the C and 14.1 months in the AA groups respectively. Patients with platelet above 400,000 had a median survival of 15.2 months for C and 12.6 months for AA. Cox regression analysis, showed hazard ratios for outcome of death were; 1.16(1.07-1.26) p<0.001 for age (per 10 yrs), 1.60(1.31-1.94) [AA versus C(ref)] p< 0.001 for race and 1.35(1.10-1.65)[>400 versus <] p<0.004 for platelet count. In subset analysis, 296(61.7%) patients who received chemotherapy had data regarding use of bevacizumab (B). Among the 31.7% who received B, the median survival was 25.6 months compared to14.1 months in the no B arm. A Cox regression model using B as a stratification variable showed that the impact of race {hazard ratio = 1.32 (1.02-1.69) p =0.03} and platelet count {hazard ratio = 1.27(0.97-1.65) p =0.08} were much less. Conclusions: Pre-chemotherapy Platelet count< 400,000, C race and younger age are associated with improved survival. Use of bevacizumab may mitigate the impact of these factors.

scholarly journals Impact of old age on resectable colorectal cancer outcomes

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e6350 ◽  
Author(s):  
Jianfei Fu ◽  
Hang Ruan ◽  
Hongjuan Zheng ◽  
Cheng Cai ◽  
Shishi Zhou ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Regression Model ◽  
Old Age ◽  
Older Patients ◽  
Cox Regression ◽  
External Validation ◽  
Seer Database ◽  
Cancer Specific Survival ◽  
Cox Regression Model ◽  
The Impact

Objective This study was performed to identify a reasonable cutoff age for defining older patients with colorectal cancer (CRC) and to examine whether old age was related with increased colorectal cancer-specific death (CSD) and poor colorectal cancer-specific survival (CSS). Methods A total of 76,858 eligible patients from the surveillance, epidemiology, and end results (SEER) database were included in this study. The Cox proportional hazard regression model and the Chow test were used to determine a suitable cutoff age for defining the older group. Furthermore, a propensity score matching analysis was performed to adjust for heterogeneity between groups. A competing risk regression model was used to explore the impact of age on CSD and non-colorectal cancer-specific death (non-CSD). Kaplan–Meier survival curves were plotted to compare CSS between groups. Also, a Cox regression model was used to validate the results. External validation was performed on data from 1998 to 2003 retrieved from the SEER database. Results Based on a cutoff age of 70 years, the examined cohort of patients was classified into a younger group (n = 51,915, <70 years of old) and an older group (n = 24,943, ≥70 years of old). Compared with younger patients, older patients were more likely to have fewer lymph nodes sampled and were less likely to receive chemotherapy and radiotherapy. When adjusted for other covariates, age-dependent differences of 5-year CSD and 5-year non-CSD were significant in the younger and older groups (15.84% and 22.42%, P < 0.001; 5.21% and 14.21%, P < 0.001). Also an age of ≥70 years remained associated with worse CSS comparing with younger group (subdistribution hazard ratio, 1.51 95% confidence interval (CI) [1.45–1.57], P < 0.001). The Cox regression model as a sensitivity analysis had a similar result. External validation also supported an age of 70 years as a suitable cutoff, and this older group was associated with having reduced CSS and increased CSD. Conclusions A total of 70 is a suitable cutoff age to define those considered as having elderly CRC. Elderly CRC was associated with not only increased non-CSD but also with increased CSD. Further research is needed to provide evidence of whether cases of elderly CRC should receive stronger treatment if possible.

scholarly journals 551. Remdesivir and Tocilizumab for the Treatment of Severe COVID-19 in a Community Hospital: A Retrospective Cohort Study

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S378-S379
Author(s):  
Guillermo Rodriguez-Nava ◽  
Goar Egoryan ◽  
Daniela Patricia Trelles-Garcia ◽  
Maria Adriana Yanez-Bello ◽  
Qishuo Zhang ◽  
...  
Keyword(s):  
Regression Model ◽  
Community Hospital ◽  
Cox Regression ◽  
Hazard Ratio ◽  
Rank Test ◽  
Hospital Death ◽  
P Value ◽  
Survival Curves ◽  
Cox Regression Model ◽  
Kaplan Meier

Abstract Background Growing evidence supports the use of remdesivir and tocilizumab for the treatment of hospitalized patients with severe COVID-19. The purpose of this study was to evaluate the use of remdesivir and tocilizumab for the treatment of severe COVID-19 in a community hospital setting. Methods We used a de-identified dataset of hospitalized adults with severe COVID-19 according to the National Institutes of Health definition (SpO2 &lt; 94% on room air, a PaO2/FiO2 &lt; 300 mm Hg, respiratory frequency &gt; 30/min, or lung infiltrates &gt; 50%) admitted to our community hospital located in Evanston Illinois, between March 1, 2020, and March 1, 2021. We performed a Cox proportional hazards regression model to examine the relationship between the use of remdesivir and tocilizumab and inpatient mortality. To minimize confounders, we adjusted for age, qSOFA score, noninvasive positive-pressure ventilation, invasive mechanical ventilation, and steroids, forcing these variables into the model. We implemented a sensitivity analysis calculating the E-value (with the lower confidence limit) for the obtained point estimates to assess the potential effect of unmeasured confounding. Figure 1. Kaplan–Meier survival curves for in-hospital death among patients treated with and without steroids The hazard ratio was derived from a bivariable Cox regression model. The survival curves were compared with a log-rank test, where a two-sided P value of less than 0.05 was considered statistically significant. Figure 2. Kaplan–Meier survival curves for in-hospital death among patients treated with and without remdesivir The hazard ratio was derived from a bivariable Cox regression model. The survival curves were compared with a log-rank test, where a two-sided P value of less than 0.05 was considered statistically significant. Results A total of 549 patients were included. The median age was 69 years (interquartile range, 59 – 80 years), 333 (59.6%) were male, 231 were White (41.3%), and 235 (42%) were admitted from long-term care facilities. 394 (70.5%) received steroids, 192 (34.3%) received remdesivir, and 49 (8.8%) received tocilizumab. By the cutoff date for data analysis, 389 (69.6%) patients survived, and 170 (30.4%) had died. The bivariable Cox regression models showed decreased hazard of in-hospital death associated with the administration of steroids (Figure 1), remdesivir (Figure 2), and tocilizumab (Figure 3). This association persisted in the multivariable Cox regression controlling for other predictors (Figure 4). The E value for the multivariable Cox regression point estimates and the lower confidence intervals are shown in Table 1. Figure 3. Kaplan–Meier survival curves for in-hospital death among patients treated with and without tocilizumab The hazard ratio was derived from a bivariable Cox regression model. The survival curves were compared with a log-rank test, where a two-sided P value of less than 0.05 was considered statistically significant. Figure 4. Forest plot on effect estimates and confidence intervals for treatments The hazard ratios were derived from a multivariable Cox regression model adjusting for age as a continuous variable, qSOFA score, noninvasive positive-pressure ventilation, and invasive mechanical ventilation. Table 1. Sensitivity analysis of unmeasured confounding using E-values CI, confidence interval. Point estimate from multivariable Cox regression model. The E value is defined as the minimum strength of association on the risk ratio scale that an unmeasured confounder would need to have with both the exposure and the outcome, conditional on the measured covariates, to explain away a specific exposure-outcome association fully: i.e., a confounder not included in the multivariable Cox regression model associated with remdesivir or tocilizumab use and in-hospital death in patients with severe COVID-19 by a hazard ratio of 1.64-fold or 1.54-fold each, respectively, could explain away the lower confidence limit, but weaker confounding could not. Conclusion For patients with severe COVID-19 admitted to our community hospital, the use of steroids, remdesivir, and tocilizumab were significantly associated with a slower progression to in-hospital death while controlling for other predictors included in the models. Disclosures All Authors: No reported disclosures

scholarly journals Long Term Outcome Prediction in Stemi/Nstemi Patients By Means of the Model Consisting of Simple Clinical Parameters

2021 ◽  
Vol 8 (3) ◽  
pp. 159-170
Author(s):  
Paweł Korczyc ◽  
Jędrzej Chrzanowski ◽  
Arkadiusz Stasiak ◽  
Joanna Stasiak ◽  
Andrzej Bissinger ◽  
...  
Keyword(s):  
Regression Model ◽  
Cox Regression ◽  
Everyday Practice ◽  
Syntax Score ◽  
Clinical Parameters ◽  
Observation Study ◽  
Cox Regression Model ◽  
Long Term Outcome ◽  
The Impact

Aim: Our study aimed to identify the clinical variables associated with long-term mortality after MI and to construct a simple, easy to use clinical practice model for the prediction of 5 year mortality after MI. Material and Methods: This is a prospective 5-year observation study of MI patients admitted to the Department of Cardiology at the Copernicus Memorial Hospital in Lodz in 2010 and 2011. The data were collected during hospitalization and again after a period of 1 and 5 years. A multi-factor multi-level Cox regression model was constructed to investigate the impact of clinical factors on long-term survival.results: 92 patients (39 STEMI, 53 NSTEMI) were included in the study and their data were used to construct a Cox regression model with satisfactory fit (R 2 =0.7945). Factors associated with a decrease in 5-year risk are: age (1.06, 95%CI: 1.01-1.11), SYNTAX score (1.05, 95%CI: 1.02-1.08), WBC level (1.16, 95%CI: 1.08-1.26), and glycemia at enrollment (1.01, 95%CI: 1.01-1.01). Higher values of HDL at enrollment were associated with a decrease in 5-year risk (HR=0.97, 95%CI: 0.93-0.99).conclusion: The model we created is a valuable tool that is useful and easy to employ in everyday practice for assessing the 5-year prognosis of patients after MI. What is new: The study presents the new model for prediction of 5-year mortality after myocardial infarction. This model is based on simple clinical parameters and may by applied in everyday practice.

scholarly journals The main contributor to the upswing of survival in locally advanced colorectal cancer: an analysis of the SEER database

2019 ◽  
Vol 12 ◽  
pp. 175628481986215 ◽  
Author(s):  
Yuqiang Li ◽  
Lilan Zhao ◽  
Cenap Güngör ◽  
Fengbo Tan ◽  
Zhongyi Zhou ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Colon Cancer ◽  
Regression Model ◽  
Advanced Colorectal Cancer ◽  
Cox Regression ◽  
Locally Advanced ◽  
Seer Database ◽  
Cox Regression Model ◽  
Main Contributor ◽  
Locally Advanced Colorectal Cancer

Background: There is no conclusion about the most important contributor to the upswing of locally advanced colorectal cancer (LACRC) survival. Methods: Data from the Surveillance, Epidemiology, and End Results (SEER) database was extracted to identify colorectal adenocarcinoma cancer patients at stage II and III diagnosed in the two periods 1989–1990 and 2009–2010. The statistical methods included Pearson’s chi-squared test, log-rank test, Cox regression model and propensity score matching. Results: The Cox regression model showed that hazard ratio (HR) of non-surgery dropped from 11.529 to 3.469 in right colon cancer (RCC), 5.214 to 2.652 in left colon cancer (LCC) and 3.275 to 3.269 in rectal cancer (RC) from 1989–1990 to 2009–2010. The 95% confidence intervals (CIs) for surgical resection in 2009–2010 were narrower than those in 1989–1990. HR became greater in LACRC without chemotherapy (from 1.337 to 1.779 in RCC, 1.269 to 2.017 in LCC, 1.317 to 1.811 in RC). There was no overlapping about the 95% CI of chemotherapy between the two groups. The progress of surgery was not linked to the improvement of overall survival (OS) of RCC ( p = 0.303) and RC ( p = 0.660). Chemotherapy had a significant association with OS of all colorectal cancer (CRC) patients ( p = 0.017 in RCC; p = 0.006 in LCC; p = 0.001 in RC). Conclusions: Advancements in chemotherapy regimen were the main contributor to the upswing of CRC survival. The improvements in surgery had a limited effect on improvements in CRC survival.

Racial/ethnic disparities in lung cancer stage of diagnosis and survival

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 8080-8080
Author(s):  
L. E. Raez ◽  
T. Koru-Sengul ◽  
G. Allen ◽  
J. Clarke ◽  
E. S. Santos ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Regression Model ◽  
Median Survival ◽  
Cox Regression ◽  
Early Stage ◽  
Ethnic Disparities ◽  
Female Gender ◽  
Cox Regression Model ◽  
Referent Group ◽  
Racial Ethnic

8080 Background: There are differences in the treatment outcome of non-small cell lung cancer (NSCLC) patients (pts) between non-Hispanic whites (NHW) and African Americans (AA). Little is known regarding the outcomes of Hispanics (H). Methods: Registry data on 2,696 pts with NSCLC treated during 1999–2006 was obtained. The objective of the study was to evaluate differences in NSCLC survival according to different ethnicities. Chi-square was used to compare distribution of tumor stage. Survival curves were compared using log-rank test for each of the tumor stages. Adjusted hazard ratios (AHR) and 95% confidence intervals (95% CI) were reported based on the results of a multivariate Cox regression model for overall survival (OS) with adjustment for gender, age at diagnosis, and race. Results: Most pts had stage III/IV at diagnosis; majority of the AA or HW presented in advanced stage compared with NHW. Significantly higher proportions of AA and H were diagnosed with stage IV compared to NHW ( Table ). Mean age at diagnosis was 62 yrs (AA 58, H 60, and NHW 66yrs) and it was significantly different among the 3 groups (one-way ANOVA, p<0.0001). AA and H have significantly shorter stage-specific median survival for early stage compared to that in NHW ( Table ). In pts with advanced stages the pattern was similar: AA and H have a significantly shorter median survival than that in NHW. In early-stage pts, significant predictors for OS from multivariate Cox regression model were female gender (AHR=0.65; p<0.001), AA (NHW as the referent group; AHR=2.67; p<0.0001), and H (NHW as the referent group; AHR=2.01; p<0.0001). In late-stage pts, significant predictors for OS were female gender (AHR=0.79; p=0.0002), AA (NHW as the referent group; AHR=1.53; p<0.0001, and H (NHW as the referent group; AHR=1.28; p=0.0006). Conclusions: NHW pts had better OS than H and AA; we will evaluate whether gene expression profiles or presence of EGFR overexpression have an impact on racial/ethnic disparities in the outcome of NSCLC. [Table: see text] No significant financial relationships to disclose.

scholarly journals First and second waves among hospitalised patients with COVID-19 with severe pneumonia: a comparison of 28-day mortality over the 1-year pandemic in a tertiary university hospital in Italy

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e054069
Author(s):  
Marianna Meschiari ◽  
Alessandro Cozzi-Lepri ◽  
Roberto Tonelli ◽  
Erica Bacca ◽  
Marianna Menozzi ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Regression Model ◽  
Cox Regression ◽  
Severe Pneumonia ◽  
University Hospital ◽  
P Value ◽  
Cox Regression Model ◽  
Hospitalised Patients ◽  
The Impact ◽  
Second Wave

ObjectiveThe first COVID-19–19 epidemic wave was over the period of February–May 2020. Since 1 October 2020, Italy, as many other European countries, faced a second wave. The aim of this analysis was to compare the 28-day mortality between the two waves among COVID-19 hospitalised patients.DesignObservational cohort study. Standard survival analysis was performed to compare all-cause mortality within 28 days after hospital admission in the two waves. Kaplan-Meier curves as well as Cox regression model analysis were used. The effect of wave on risk of death was shown by means of HRs with 95% CIs. A sensitivity analysis around the impact of the circulating variant as a potential unmeasured confounder was performed.SettingUniversity Hospital of Modena, Italy. Patients admitted to the hospital for severe COVID-19 pneumonia during the first (22 February–31 May 2020) and second (1 October–31 December 2020) waves were included.ResultsDuring the two study periods, a total of 1472 patients with severe COVID-19 pneumonia were admitted to our hospital, 449 during the first wave and 1023 during the second. Median age was 70 years (IQR 56–80), 37% women, 49% with PaO2/FiO2 <250 mm Hg, 82% with ≥1 comorbidity, median duration of symptoms was 6 days. 28-day mortality rate was 20.0% (95% CI 16.3 to 23.7) during the first wave vs 14.2% (95% CI 12.0 to 16.3) in the second (log-rank test p value=0.03). After including key predictors of death in the multivariable Cox regression model, the data still strongly suggested a lower 28-day mortality rate in the second wave (aHR=0.64, 95% CI 0.45 to 0.90, p value=0.01).ConclusionsIn our hospitalised patients with COVID-19 with severe pneumonia, the 28-day mortality appeared to be reduced by 36% during the second as compared with the first wave. Further studies are needed to identify factors that may have contributed to this improved survival.

scholarly journals Impact of Non-synchronous Diagnostic Ureteroscopy on Intravesical Recurrence in Patients Underwent Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Propensity-Score Matched Analysis

2019 ◽  
Author(s):  
Huamao Ye ◽  
Xiang Feng ◽  
Yang Wang ◽  
Rui Chen ◽  
Meimian Hua ◽  
...  
Keyword(s):  
Propensity Score ◽  
Regression Model ◽  
Urothelial Carcinoma ◽  
Cox Regression ◽  
Upper Tract Urothelial Carcinoma ◽  
Control Group ◽  
Radical Nephroureterectomy ◽  
Cox Regression Model ◽  
Upper Tract ◽  
The Impact

Abstract Background: The effect of diagnostic ureteroscopy (DURS) on intravesical recurrence (IVR) after radical nephroureterectomy (RNU) were controversial. To investigate the impact of DURS, we carried out this single-center retrospective study by applying propensity-score matching (PSM) and Cox regression model. Patients and Methods: The data of 160 patients with pTa-pT3 upper tract urothelial carcinoma (UTUC) were analyzed. Eighty-six patients underwent DURS (DURS group) and 74 patients without DURS (control group). The DURS group was further sub-grouped into synchronous DURS group (DURS followed by immediate RNU, n=45) and non-synchronous DURS group (DURS followed by delayed RNU, n=41). Baseline confounders were corrected by PSM. The impact of DURS on IVR was assessed by Kaplan-Meier analysis in PSM cohort and by Cox regression model in the full data set. Results: The median follow-up time was 40.4 months. No difference of the 3-year IVRFS between DURS group and control group (72.6% vs. 65.3%, p=0.263). In subgroup analysis, the 3-year IVR-free survival of non-synchronous DURS group (51.4%) was significantly lower than that of synchronous DURS (78.3%) or control group (72.6%) (p=0.027). Further Cox regression analysis showed that non-synchronous DURS (HR 1.481, 95% CI 1.031-2.127, p=0.034) was independent risk factors for postoperative IVR. Conclusions: Non-synchronous DURS was not recommended for the diagnosis and preoperative evaluation of UTUC, because it could raise the risk of IVR after RNU. For UTUC patients in need of DURS, synchronous DURS could be a safer choice than the non-synchronous DURS in terms of lowering the IVR risk.

scholarly journals Peran Bersihan Laktat pada Kesintasan Pasien Sepsis Berat

2016 ◽  
Vol 3 (1) ◽  
pp. 38
Author(s):  
Wirawan Hambali ◽  
Lie Khie Chen ◽  
Djoko Widodo ◽  
Esthika Dewiasty ◽  
Herdiman T Pohan ◽  
...  
Keyword(s):  
Survival Rate ◽  
Mortality Rate ◽  
Regression Model ◽  
Median Survival ◽  
Cox Regression ◽  
Lactate Clearance ◽  
Hazard Ratio ◽  
Rank Test ◽  
Log Rank Test ◽  
High Lactate

Pendahuluan. Sepsis Berat merupakan masalah kesehatan dengan tingkat mortalitas yang tinggi serta insiden yang terus meningkat. Bersihan laktat menggambarkan kinetika metabolisme anaerob pasien sepsis berat dan merupakan parameter yang potensial untuk mengevaluasi kondisi penyakit dan intervensi pengobatan yang didapat pasien. Namun demikian, hubungan antara bersihan laktat terhadap terjadinya kematian pasien sepsis berat belum diketahui. Berdasarkan hal tersebut, penelitian ini dilakukan untuk mengetahui pengaruh bersihan laktat terhadap kesintasan pasien dengan sepsisberat, serta faktor-faktor perancu yang mempengaruhi hubungan tersebut.Metode. Penelitian ini merupakan penelitian kohort prospektif yang dilaksanakan di Unit Gawat Darurat dan ruang perawatan Rumah Sakit dr. Cipto Mangunkusumo (RSCM) pada bulan Maret-Mei 2011. Pasien termasuk dalam kelompok bersihan laktat tinggi bila terdapat perbedaan kadar laktat ≥10% dalam 6 jam pertama pengobatan, sedangkan perbedaan <10% termasuk ke dalam kelompok bersihan laktat rendah. Selanjutnya, dilakukan observasi terhadap terjadinya kematian dalam 10 hari pertama perawatan pada kedua kelompok. Data yang terkumpul selanjutnya dianalisis mengunakan uji statistik log-rank test, serta dicari nilai hazard ratio dengan menggunakan uji cox regression model. Selanjutnya, dilakukan analisis variabel perancu dengan menggunakan uji cox regression.Hasil. Laju kesintasan kelompok bersihan laktat tinggi dan rendah masing-masing sebesar 60,0% dan 26,7% (p=0,004). Median kesintasan yaitu 3 hari pada bersihan laktat rendah, sedangkan kematian tidak mencapai 50% pada bersihan laktat tinggi. Interkuartil I kedua kelompok berturut-turut sebesar 1 dan 4 hari. Dari analisis didapatkan hazard ratio sebesar 2,87 (IK 95%; 1,41-5,83). Pada analisis multivariat keberadaan syok sepsis, skor SOFA, penggunaan vasopresor/inotropik, transfusi dan cairan resusitasi, tidak ada yang mengubah nilai hazard ratio >10%. Oleh karena itu, tidak ada yang memenuhi syarat untuk disebut sebagai perancu.Simpulan. Pasien bersihan laktat tinggi memiliki kesintasan lebih tinggi dibandingkan pasien bersihan laktat rendah dan hubungan tersebut tidak dipengaruhi perancu. Kata Kunci: bersihan laktat, kesintasan, sepsis berat The Role of Lactate Clearance in Severe Septic Patients SurvivalIntroduction. Severe Sepsis is a major health problem that known to results high mortality rate, and still its incidents continue to rise. Lactate clearance represents kinetics alteration of anaerobic metabolism in severe septic patients that makes it to become a potential parameter to evaluate severity of one’s illness and intervention adequacy that received by the patient. However, the relationship between lactate clearance and occurrence of death in severe septic patients is still unknown.Methods. This is a prospective cohort study that conducted in Ciptomangunkusumo Hospital, from March to May 2011. Patients were categorized into high lactate clearance group if there were differences in lactate levels ≥ 10% in which occurred within the first 6 hours of the treatment, and contrary were categorized into low lactate clearance group. Occurrences of death were observed within the first 10 days. Afterward, the data were analyzed by means of survival analysis, Kapplan Meier curve were made, survival rate and median survival rate were determined, statistical test were calculated using log-rank test, and hazard ratios were calculated using Cox regression model test. Analysis of Confounder Variable was also performed using multivariate Cox regression testResults. The survival rate for high and low lactate clearance group were 60.0% vs. 26.7%, respectively (p=0,004). In low lactate clearance group the median survival was 3 days, while the mortality rate did not reach 50% in high lactate clearance group. The first Interquartile for these two groups was 1 day and 4 days, respectively. The hazard ratio that obtained from the analysis was 2.87 (95% CI, 1.41 - 5.83). On multivariate analysis the presence of septic shock, SOFA score, the use of vasopresor/inotropic, blood transfusion, fluid resuscitation didn’t change the hazard ratio value more than 10%. For that reason, these parameters were not considered as confounder.Conclusions. Patients with high lactate clearance have a better survival rate compared to patients with low lactate clearance, and its relationship is not influenced by confounder.

The outcome of patients with advanced hepatocellular carcinoma (HCC) in pre- and post-sorafenib eras using the SEER database.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 276-276
Author(s):  
Jiahuai Tan ◽  
Minsig Choi ◽  
Philip Agop Philip ◽  
Gregory Dyson ◽  
Anthony Frank Shields ◽  
...  
Keyword(s):  
Overall Survival ◽  
Median Survival ◽  
Cox Regression ◽  
Hazard Ratio ◽  
Phase Iii ◽  
Advanced Hepatocellular Carcinoma ◽  
Sorafenib Treatment ◽  
Advanced Hcc ◽  
Number Of Patients ◽  
The Impact

276 Background: HCC is the third most common cause of cancer-related death globally. Prognosis for advanced HCC is dismal due to lack of effective treatment options for the majority of patients who present with advanced disease. Sorafenib was the first agent reported to improve overall survival in patients with good liver function enrolled in phase III clinical trials. However, survival impact of sorafenib on the general population with advanced HCC has not been studied to date. Methods: Sorafenib was approved for patients with advanced HCC and Child-Pugh A liver disease in 2007. We analyzed 2005-2006 and 2008-2009 clinical outcome data from the SEER to compare the impact of this targeted therapy in the population based setting. The Kaplan-Meier method was used to estimate the median survival and 95% confidence intervals (CI). The log-rank test was used to test the difference in survival curves. Cox regression analyses were utilized for the estimation of hazard ratios. Results: We identified 2297 and 2808 stage III and IV HCC cases diagnosed in [2005, 2006] and [2008, 2009], respectively. Seventy-seven percent of the patients were male and the median age was 61 years old for males and 66 for females. The median survival estimates (95% CIs) are 3 (3, 4) months and 4 (4, 4) months for patients diagnosed in [2005, 2006] and [2008, 2009], respectively. The hazard ratio (95% CI) for overall survival comparing [2008, 2009] to [2005, 2006] was 0.92 (0.87, 0.98, p-value = 0.01). We performed multivariable Cox regression modeling and African American patients have a hazard ratio of death [1.14 (1.06, 1.23)] as compared to European American patients. Younger females have a decreased hazard of dying relative to younger men, while older females have an increase hazard of dying relative to older men. Conclusions: The approval of sorafenib treatment produced very modest median survival gain in advanced HCC patients based on SEER population study. However, the small benefit in hazard ratio may have been impacted by small number of patients with advanced HCC who are being treated or are able to be treated with sorafenib in this era.

Sign in / Sign up

Export Citation Format

Share Document