Relationship between treatment duration and outcomes in patients receiving concurrent chemoradiotherapy (CCRT) and surgery for locoregionally advanced (LRA) esophageal and gastroesophageal junction (E/GEJ) adenocarcinoma (ACA).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14665-e14665
Author(s):  
Michael J. McNamara ◽  
Lisa A. Rybicki ◽  
Thomas W. Rice ◽  
Cristina P. Rodriguez ◽  
Gregory M.M. Videtic ◽  
...  
Keyword(s):  
Treatment Duration ◽  
Recursive Partitioning ◽  
Gastroesophageal Junction ◽  
Cleveland Clinic ◽  
Prolonged Treatment ◽  
Rank Test ◽  
Short Treatment ◽  
Kaplan Meier ◽  
Before And After ◽  
Complete Treatment

e14665 Background: Retrospective studies in breast, colon, and head and neck cancer have suggested that delays in administration of adjuvant chemotherapy result in inferior outcomes. We explore this question in patients with LRA E/GEJ ACA. Methods: From 11/99 to 7/06, 152 patients with cT3, N1, or M1a disease were enrolled on one of two clinical trials at the Cleveland Clinic. Two courses of CCRT consisting of 30Gy radiation (@1.5Gy BID) with continuous infusion cisplatin (20mg/m2/day x 4 days) and 5Fu (1000mg/m2/d x 4 days) were given both before and after surgical resection. In the second trial, 75 patients also received gefitinib during the 4 week induction and for a total of two years postoperatively. Using recursive partitioning analysis (RPA), we retrospectively explored the relationship between treatment duration and loco-regional control (LRC), distant metastatic control (DMC), freedom from recurrence (FFR), and overall survival (OS) in the 115 patients (76%) who completed all treatment. Outcomes were estimated using the Kaplan-Meier method and compared among groups using the log-rank test. Results: RPA analysis identified three groups of patients: 19 patients in whom resection occurred ≤45 days from the start of CCRT to resection (short treatment), 63 patients who underwent resection >45 days from the start of CCRT and required <50 days to complete treatment after surgery (intermediate treatment), and 33 patients who underwent resection >45 days from the start of CCRT but required ≥50 days to complete treatment after surgery (prolonged treatment). With a median follow-up of 90 (range 57-126) months, we found that patients with shorter treatment times had better 5 year DMC [64% (short) v 26% (intermediate) v 16% (prolonged); p=0.004], FFR [57% (short) v 23% (intermediate) v 16% (prolonged); p=0.015)], and OS [42% (short) v 30% (intermediate) v 12% (prolonged); p=0.08]. LRC was not different between the groups. Conclusions: Treatment delays in patients receiving multimodality therapy for LRA E/GEJ ACA may result in a greater risk of recurrence and decreased survival.

scholarly journals The Poor Survival among Pulmonary Tuberculosis Patients in Chiapas, Mexico: The Case of Los Altos Region

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
J. C. Nájera-Ortiz ◽  
H. J. Sánchez-Pérez ◽  
H. Ochoa-Díaz-López ◽  
G. Leal-Fernández ◽  
A. Navarro-Giné
Keyword(s):  
Pulmonary Tuberculosis ◽  
Treatment Duration ◽  
Cox Regression ◽  
Rank Test ◽  
Poor Survival ◽  
Tuberculosis Patients ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Complete Treatment

Objective. To analyse survival in patients with pulmonary tuberculosis (PTB) and factors associated with such survival.Design. Study of a cohort of patients aged over 14 years diagnosed with PTB from January 1, 1998 to July 31, 2005. During 2004–2006 a home visit was made to each patient and, during 2008-2009, they were visited again. During these visits a follow-up interview was administered; when the patient had died, a verbal autopsy was conducted with family members. Statistical analysis consisted of survival tests, Kaplan-Meier log-rank test and Cox regression.Results. Of 305 studied patients, 68 had died due to PTB by the time of the first evaluation, 237 were followed-up for a second evaluation, and 10 of them had died of PTB. According to the Cox regression, age (over 45 years) and treatment duration (under six months) were associated with a poorer survival. When treatment duration was excluded, the association between poorer survival with age persisted, whereas with having been treated via DOTS strategy, was barely significant.Conclusions. In the studied area it is necessary that patients receive a complete treatment scheme, and to give priority to patients aged over 45 years.

scholarly journals Prognosis of patients with acute exacerbation of combined pulmonary fibrosis and emphysema: A retrospective single-center study

2020 ◽  
Author(s):  
Yuichi Ikuyama ◽  
Atsuhito Ushiki ◽  
Makoto Kosaka ◽  
jumpei Akahane ◽  
Yuichi Mukai ◽  
...  
Keyword(s):  
Pulmonary Fibrosis ◽  
Acute Exacerbation ◽  
White Blood Cells ◽  
University Hospital ◽  
Rank Test ◽  
Clinical Prognosis ◽  
Kaplan Meier ◽  
Median Serum ◽  
Respiratory Management ◽  
Before And After

Abstract Background: Previous analyses of combined pulmonary fibrosis and emphysema (CPFE) cohorts have provided conflicting data on the survival of patients with CPFE. Therefore, the aim of this study was to investigate the clinical prognosis of acute exacerbation (AE) of CPFE. Methods : We retrospectively reviewed the medical records of patients who had been treated at Shinshu University Hospital (Matsumoto, Japan) between 2003 and 2017. We identified 21 patients with AE of CPFE and 41 patients with AE of idiopathic pulmonary fibrosis (IPF) and estimated their prognoses using the Kaplan–Meier method. Results : Treatment content and respiratory management were not significantly different between the two groups before and after exacerbation. At the time of AE, the median serum Krebs von den Lungen-6 level was significantly lower in the CPFE group (Krebs von den Lungen-6: 966 U/µL; white blood cell count: 8810 /µL) than that in the IPF group (Krebs von den Lungen-6: 2130 U/µL, p < 0.001; white blood cells: 10809/µL, p = 0.0096). The baseline Gender-Age-Physiology score was not significantly different between the two groups (CPFE, 4.5 points; IPF, 4.7 points; p = 0.58). Kaplan–Meier curves revealed that the survival time after AE for patients with CPFE was longer than that for patients with IPF ( p < 0.001, log-rank test). Conclusions : Survival prognoses after AE were significantly better for patients with CPFE than that for patients with IPF. Our findings may improve the medical treatment and respiratory management of patients with AE-CPFE.

Data-Derived Treatment Duration Goal for Cervical Cancer: Should 8 Weeks Remain the Target in the Era of Concurrent Chemoradiation?

2017 ◽  
pp. 1-15 ◽  
Author(s):  
Julian C. Hong ◽  
Jonathan Foote ◽  
Gloria Broadwater ◽  
Julie A. Sosa ◽  
Stephanie Gaillard ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Treatment Duration ◽  
Cross Validation ◽  
Recursive Partitioning ◽  
Hazard Ratio ◽  
Recursive Partitioning Analysis ◽  
Rank Test ◽  
Cut Points ◽  
Cut Point ◽  
Lower Stage

Purpose Prior studies have demonstrated the importance of treatment duration (TD) in radiation therapy (RT) for cervical cancer, with an 8-week goal based primarily on RT alone. This study uses a contemporary cohort to estimate the time point by which completion of chemoradiation therapy is most critical. Patients and Methods The National Cancer Database was queried for women with nonmetastatic cervical cancer diagnosed from 2004 to 2012 who underwent chemotherapy, external beam RT, and brachytherapy. Data-derived TD cut points for overall survival (OS) were computed by using recursive partitioning analysis with bootstrapped aggregation (bagging) and 10-fold cross-validation. Models were independently trained with 70% of the population and validated on 30% of the population by log-rank test with and without propensity matching. Multivariable Cox proportional hazards regression was performed for the entire cohort. Results In all, 7,355 women were identified with a median TD of 57 days. Bagged recursive partitioning analysis converged to a mean cut point of 66.6 days (median, 64.5 days; interquartile range, 63.5 to 68.5 days). Cross-validation yielded a cut point of 63.3 days. Both cut points differentiated OS in validation. Younger age, recent diagnosis, geographic region, nongovernment insurance, shorter distance to treatment facility, metropolitan location, lower comorbidity, squamous cell carcinoma, lower stage, negative lymph nodes, and shorter TD were independently associated with longer OS. With adjustment, TD within the mean cut point (64.9 days; hazard ratio, 0.79; 95% CI, 0.73 to 0.87) and 56 days (hazard ratio, 0.87; 95% CI, 0.80 to 0.95) were associated with longer OS. Exploratory stratification suggested increasing OS detriment beyond 64 days. Conclusion Shorter chemoradiation TD in cervical cancer is associated with longer survival, and TD should be minimized as much as possible. The data-derived cut point was distributed around 64 days, with a continuous relationship between shorter TD and longer OS.

Pattern of local-regional relapse and survival after bimodality therapy for esophageal cancer: Implications for the surveillance strategy.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 4083-4083 ◽  
Author(s):  
Kazuki Sudo ◽  
Lianchun Xiao ◽  
Roopma Wadhwa ◽  
Takashi Taketa ◽  
Mariela A. Blum ◽  
...  
Keyword(s):  
Gastroesophageal Junction ◽  
Distant Metastases ◽  
Rank Test ◽  
Evidence Based ◽  
Test Results ◽  
Surveillance Strategy ◽  
Gastroesophageal Junction Cancer ◽  
Kaplan Meier ◽  
Regional Disease

4083 Background: Evidence for definitive chemoradiotherapy (bimodality therapy [BMT]) has been established for patients with esophageal and gastroesophageal junction cancer (EGEJC) who do not qualify for surgery. Surveillance for these patients is often recommended but the literature lacks guidance for an evidence-based surveillance strategy after BMT. Methods: We analyzed 276 patients with EGEJC who underwent BMT and had pre- and postchemoradiation endoscopic biopsies and imaging studies available for review. Patients who underwent planned surgery or salvage surgery (SS) within 6 months from BMT were excluded. We reviewed the pattern of relapse over time. Local-regional disease (LRD) after BMT was classified as regional disease (RD) or luminal-only disease (LD). Overall survival (OS) probabilities were estimated using the Kaplan-Meier method and compared using the log-rank test. Results: For 276 patients, the median follow-up time was 53.0 months (95% confidence interval [CI], 47.3-58.7). A total of 184 (66.7%) patients had a persistent disease or relapse after BMT: 120 distant metastases (43.5% of 276) and 64 LRD (23.2% of 276). Of 64 LRD, 58 (91%) were diagnosed within 2 years of BMT and 63 (98%) were diagnosed within 3 years (see Table). Twenty-three of 64 LRD patients underwent SS. For patients with SS, the median OS time from diagnosis of LRD was 58.0 months (95% CI, not reached), and that for patients without SS was 9.0 months (95% CI, 7.3-10.7); this difference was highly significant (p < 0.001). Conclusions: Our data suggest that 91% of LRD occurred within 2 years after BMT and the OS with SS for LRD was better than that without SS. These data can contribute to the development of an evidence-based surveillance strategy. [Table: see text]

Is there an interaction between epidermal growth factor receptor (EGFR) inhibition and p16-status in patients (pts) with oropharyngeal squamous cell cancer: A retrospective analysis.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6061-6061
Author(s):  
Tobenna Igewonu Nwizu ◽  
Lisa A. Rybicki ◽  
Deborah Chute ◽  
Cristina P. Rodriguez ◽  
Shlomo A. Koyfman ◽  
...  
Keyword(s):  
Squamous Cell ◽  
Cell Cancer ◽  
Cleveland Clinic ◽  
Growth Factor Receptor ◽  
Rank Test ◽  
Biopsy Material ◽  
Egfr Inhibition ◽  
Kaplan Meier ◽  
Epidermal Growth ◽  
Retrospective Nature

6061 Background: Conflicting data exists about whether EGFR inhibition is more or less effective in pts with p16 positive or negative oropharynx cancer (OPC). We update results from two institutional clinical trials in pts with locoregionally advanced head and neck squamous cell carcinoma (LRA HNSCC) given chemoradiotherapy either with or without the oral EGFR inhibitor gefitinib (G), with specific attention to the subset of pts with p16-defined OPC. Methods: Between 1996-2000, 44 pts with LRA HNSCC were treated on a Cleveland Clinic IRB-approved protocol using concurrent cisplatin, fluorouracil and radiation without G (G- cohort). Between 2003-2007, 60 similar pts were treated using the same chemoradiotherapy regimen with the addition of G 250 mg daily for 2 years beginning on day 1 of radiation (G+ cohort). Available biopsy material from 64 OPC pts (23 G-, 41 G+) was retrieved and tested by immunohistochemistry for p16 (as a surrogate for human papillomavirus) positivity. Kaplan-Meier outcome projections were compared using the log-rank test. Results: With a median follow-up in excess of 7 years for all pts, survival and patterns of failure did not differ between the two trials. The 5-year overall survivals (OS) were 68% vs. 64% (p=0.73) and relapse-free survivals (RFS) 65% vs. 63% (p=0.85) in the G+ and G- cohorts respectively. OPC was more frequent in the more recently treated G+ cohort (68% vs. 53%). Excluding 14 pts for whom tumor was unavailable, OPC p16-positivity was also more frequent in the G+ cohort (74% vs. 63%). As expected, outcomes in the p16+ OPC pts were significantly better than in the p16- OPC pts including OS (66% vs. 58%, p=0.049) and RFS (69% vs. 56% p=0.027). However, in comparing the G+ and G- cohorts, the use of G did not significantly alter any survival outcome or pattern of failure in either the p16+ or p16- OPC pts. Conclusions: Although the retrospective nature of this analysis limits the strength of our conclusions, in the definitive management of LRA HNSCC, we could identify no effect of oral EGFR inhibition on any outcome. In subset analysis there was also no differential impact found in either the p16+ or p16- OPC pts. Clinical trial information: NCT00352105.

scholarly journals Occlusal outcome after orthodontic treatment with preadjusted straight-wire and standard edgewise appliances

2021 ◽  
Author(s):  
Spyridon N. Papageorgiou ◽  
Raphael Tilen ◽  
Vaska Vandevska-Radunovic ◽  
Theodore Eliades
Keyword(s):  
Treatment Duration ◽  
Orthodontic Treatment ◽  
Prolonged Treatment ◽  
Average Difference ◽  
Similar Treatment ◽  
Straight Wire ◽  
Premolar Extraction ◽  
Significant Difference ◽  
Objective Grading System ◽  
Complete Treatment

Abstract Purpose Orthodontic fixed appliances have been proven to be effective in treating a wide variety of malocclusions, and different types of appliances have emerged during recent decades. However, the comparative effects of different appliances have not been adequately assessed. Thus, the aim was to assess the occlusal outcome of orthodontic treatment with preadjusted straight-wire (SWIRE) and standard edgewise (SEDGE) appliances. Methods In all, 56 patients (mean age: 13.5 years; 45% male) receiving extraction-based treatment with either SWIRE or SEDGE appliances were included. Between-group differences in the occlusal outcome assessed with the American Board of Orthodontists Objective Grading System (ABO-OGS) and treatment duration were analyzed statistically at the 5% level. Results The average ABO-OGS score was 31.3 ± 7.2 points and 34.0 ± 10.4 points in the SWIRE and SEDGE groups with no statistically significant difference between groups (P = 0.26). Treatment duration was significantly shorter in the SWIRE group compared to the SEDGE group, with an average difference of −6.8 months (95% confidence interval [95% CI] = −9.6 to −4.0 months; P < 0.001). Likewise, fewer visits were needed with SWIRE compared to SEDGE appliances with an average difference of −7.2 visits (95% CI = −10.3 to −4.2 visits; P < 0.001). Adjusting for the influence of any potential confounders did not considerably impact the results. Conclusion Similar treatment outcomes were observed after premolar extraction treatment with SWIRE and SEDGE appliances. On the other hand, SEDGE appliances were associated with prolonged treatment duration and more visits needed to complete treatment compared to SWIRE appliances.

scholarly journals Survival Comparability Between Thalassemia Major Versus Thalassemia Intermedia

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2141-2141
Author(s):  
Angela Vitrano ◽  
Giuseppina Calvaruso ◽  
Eliana Lai ◽  
Grazia Colletta ◽  
Alessandra Quota ◽  
...  
Keyword(s):  
Causes Of Death ◽  
Thalassemia Major ◽  
Rank Test ◽  
P Value ◽  
Thalassemia Intermedia ◽  
Survival Curves ◽  
Risk Of Death ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Before And After

Abstract Introduction. In the last few decades, the life expectancy of Thalassemia Major (TM) patients has progressively been increasing. The improvement can be due to several factors, including introduction of chelation treatment (Deferoxamine 1965, Deferiprone 1987, Deferasirox 2006), screening of blood for the most common viral agents, aggressive treatment of infection and improved treatment of cardiac complications. However, no comparative survival curves between TM versus Thalassemia Intermedia (TI) have been so far reported. Moreover, no data on life expectancy, after introduction of chelation treatment have been described. Methods. Data coming from several randomized clinical trials, carried ahead by Campus of Hematology Franco and Piera Cutino-A.O.O.R Villa Sofia-V. Cervello, Palermo (Italy), were retrospectively considered for this study. Primary goal of the study was to provide evidence of possible differences in survival curves between TM versus TI. Survival curves in TM versus TI patients were compared using Kaplan-Meier method and the log-rank test before and after the introduction of Deferoxamine (DFO) (1965). Moreover, Cox regression model was even used to explore risk of death between the two diagnoses. Each dead patient was observed from its birth to its death, and each alive patient was observed from its birth to June 30, 2015. Results. Three hundred seventy-nine patients with TM (n=284, dead 40) and TI (n=95, dead 13) entered into the study. Males were 50.7% of this cohort of patients. Among the cohort of dead patients, 15% (6/40) TM and 76.9% (10/13) TI patients were born before introduction of DFO (1965) . The mean age survival was 50.6 (SE 0.9) and 70.6 (SE 1.7) for TM and TI, respectively. Table 1 shows the main causes of death. In TM patients the most common causes of death were heart damage (16 cases, 40%, Tab. 1), followed by cancer (3 cases, 7.5%, Tab. 1), liver cirrhosis (3 cases, 7.5%, Tab. 1) and infections (3 cases, 7.5%, Tab. 1). In TI patients the most common causes of death were cancer (2 cases, 38.5%, Tab. 1), followed by infections (3 cases, 23.1% , Tab. 1), heart damage (2 case, 15.4%, Tab. 1). Kaplan-Meir curves showed statistically significant difference in TM versus TI survival (log-rank test, p- value<0.0001; Figure 1A). Survival was higher for TI subjects (median age was 73.6 years). Cox regression models of TM versus TI suggested that risk of death for TM patients was 6.8 times higher than TI patients (HR 6.8 (3.3), p- value<0.0001). However, the introduction of chelation treatment (DFO, 1965), changed the Kaplan-Meier curves showing that there was not statistically significant difference between TM versus TI patients in life expectancy ( log-rank test, p- value=0.086; Fig. 1B). Conclusion. These results suggest as TM survival, after the introduction of chelation treatment, improved so much that nowadays it is not different in comparison with TI one's. Moreover, the TM risk of death has been decreased from 6.8 to 2.8 (Cox Model HR 2.8 (1.7), p- value=0.099). These findings, if further confirmed, suggest as, in Western countries, our approach for genetic counselling of "at risk couples" for TM should be reconsidered. Table 1. Causes of death in Thalassemia Major and Thalassemia Intermedia patients. Diagnosis Causes of Death TM n (%) TI n (%) Cancer 3 (7,5) 5 (38,5) Heart Damage 16 (40,0) 2 (15,4) Infection 3 (7,5) 3 (23,1) Multi Organ Failure 1 (2,5) 0 (0,0) Stroke 1 (2,5) 0 (0,0) Liver Failure 3 (7,5) 1 (7,7) Not Available 11 (27,5) 1 (7,7) Other complications not related to Thalassemia 2 (5,0) 1 (7,7) Total 13 40 Figure 1. Kaplan-Meier Survival curves of Thalassemia Major versus Thalassemia Intermedia patients before and after the introduction of chelation treatment (DFO, 1965). Figure 1. Kaplan-Meier Survival curves of Thalassemia Major versus Thalassemia Intermedia patients before and after the introduction of chelation treatment (DFO, 1965). Disclosures Pepe: Chiesi: Speakers Bureau; ApoPharma Inc: Speakers Bureau; Novartis: Speakers Bureau.

Abstract 19129: Does System Modification “Really” Modify Survival in Patients With High Defibrillation Threshold? Probably Not

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Najmul Siddiqi ◽  
Salim Ahmed ◽  
Rohan Bhojwani ◽  
Mohammed Kanj ◽  
Patrick Tchou ◽  
...  
Keyword(s):  
Cleveland Clinic ◽  
Cardiac Resynchronization ◽  
Rank Test ◽  
Mortality Data ◽  
Defibrillation Threshold ◽  
Kaplan Meier ◽  
The Social ◽  
Social Security Death Index ◽  
Significant Difference

Introduction: Defibrillation threshold (DFT) testing is a routine part of implantable cardiac defibrillator (ICD) placement at most centers. If a patient is found to have a high DFT, many physicians perform system modification by adding subcutaneous or transvenous shocking coil to the ICD in an attempt to lower DFT. It is not clear how patients with system modification fare compared to patients without such modification. Hypothesis: System modification should have an effect of reducing mortality in patients high DFT when compared with those who don’t undergo it. Methods: We retrospectively reviewed demographic and procedural data from 6520 patients who underwent ICD implant at the Cleveland Clinic, between August 1996 and November 2010. The Social Security Death Index was queried to obtain mortality data. High DFT was defined as DFT greater than 25 joules. Among patients with high DFT, survival was compared between those who underwent system modification versus those who did not, using the log-rank test. Results: 191 patients had a high DFT (mean DFT 30.6+/- 3.4J). The types of ICDs were single chamber 64 (33.5%); dual chamber 72 (37.7%) and cardiac resynchronization or CRT-D 55 (28.8%). 120 patients underwent a system modification (mean DFT after modification was 24.3+/- 5.6J). The commonest system modification was subcutaneous coil (70 patients; Medtronic 6996SQ-58). Median follow-up was 1788 days. Kaplan-Meier survival curves of these two groups exhibited no significant difference in mortality between patients with and without system modification (Mantel-Cox Log-rank, p = 0.731). Conclusions: Patients with high DFT at ICD implant managed by system modification have mortality similar to patients without it. This questions the practice of system modification & calls for further analysis.

scholarly journals Clinical Efficiency of Two Sequences of Orthodontic Wires to Correct Crowding of the Lower Anterior Teeth

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Cláudia Maria de Castro Serafim ◽  
Júlio de Araújo Gurgel ◽  
Carollyne Mota Tiago ◽  
Rudys Rodolfo de Jesus Tavarez ◽  
Etevaldo Matos Maia Filho
Keyword(s):  
Rank Test ◽  
Orthodontic Wires ◽  
Clinical Trial Registration ◽  
Anterior Crowding ◽  
Anterior Teeth ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Complete Treatment

This study compared time to correction of mandibular anterior crowding using two arch wire sequences, one with conventional nickel-titanium (NiTi) arch wires and the other with conventional and NiTi heat-activated arch wires. Twenty-two boys and girls (mean age: 16.68 ± 2.66) with moderate crowding (3–6 mm) were assigned randomly to one of two groups and followed up for five months (six assessments) when arch wires were changed. Time to crowding correction was analyzed statistically using the Kaplan-Meier method. Data were collected during the five-month follow-up, and time to correction was compared between groups using the log rank test. At the end of follow-up, mandibular crowding was corrected in 100% of the cases in the group treated with the sequence that included NiTi heat-activated arch wires, whereas about 30% of those treated with NiTi arch wires were not completely corrected. There was a significant difference in time to complete treatment between groups (log rank = 5.996;p<0.05). In the group treated with the sequence that included heat-activated wires, alignment and leveling of mandibular anterior teeth were completed earlier than in the group treated only with conventional NiTi arch wires. Clinical trial registration is found atRBR-7g5zng.

scholarly journals Prognosis of patients with acute exacerbation of combined pulmonary fibrosis and emphysema: A retrospective single-center study

2020 ◽  
Author(s):  
Yuichi Ikuyama ◽  
Atsuhito Ushiki ◽  
Makoto Kosaka ◽  
jumpei Akahane ◽  
Yuichi Mukai ◽  
...  
Keyword(s):  
Pulmonary Fibrosis ◽  
White Blood Cells ◽  
University Hospital ◽  
Rank Test ◽  
Clinical Prognosis ◽  
Kaplan Meier ◽  
Median Serum ◽  
Respiratory Management ◽  
Acute Exacerbations ◽  
Before And After

Abstract Background: Previous analyses of combined pulmonary fibrosis and emphysema (CPFE) cohorts have provided conflicting data on the survival of patients with CPFE. Therefore, the aim of this study was to investigate the clinical prognosis of acute exacerbations (AE) of CPFE.Methods: We retrospectively reviewed the medical records of patients who had been treated at the Shinshu University Hospital (Matsumoto, Japan) between 2003 and 2017. We identified 21 patients with AE of CPFE and 41 patients with AE of idiopathic pulmonary fibrosis (IPF) and estimated their prognoses using the Kaplan–Meier method.Results: Treatment content and respiratory management were not significantly different between the two groups before and after exacerbation. At the time of AE, the median serum Krebs von den Lungen-6 level was significantly lower in the CPFE group (Krebs von den Lungen-6: 966 U/µL; white blood cell count: 8810 /µL) than that in the IPF group (Krebs von den Lungen-6: 2130 U/µL, p < 0.001; white blood cells: 10809/µL, p = 0.0096). The baseline Gender-Age-Physiology scores were not significantly different between the two groups (CPFE, 4.5 points; IPF, 4.7 points; p = 0.58). Kaplan–Meier curves revealed that the survival time after AE for patients with CPFE was longer than that for patients with IPF (p < 0.001, log-rank test).Conclusions: Survival prognoses after AE were significantly better for patients with CPFE than that for those with IPF. Our findings may improve the medical treatment and respiratory management of patients with AE-CPFE.

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