Clinical features and tumor mutational profile of younger versus older patients with cholangiocarcinoma (CCA).

240 Background: As seen in lung cancer, young patients with cancer can have different risk factors, presentation, and tumor genotype than older patients with the same disease. The clinical and molecular features of young patients with CCA have yet to be well characterized. Methods: Retrospective chart review was performed on patients with intrahepatic (ICC) or extrahepatic cholangiocarcinoma (ECC) across 5 institutions. Data on demographics, risk factors, treatments, pathology, and overall survival (OS) were collected. Tumor genotyping results from MGH SNaPShot and Foundation Medicine were analyzed. Log-rank tests and Kaplan-Meier survival curves were used for statistical analysis. Results: Of 567 patients analyzed, 134 (23.6%) were < 50 years old (yo) and 455 (80.2%) had ICC. When assessed for risk factors, younger patients ( < 50yo) were more likely to have primary sclerosing cholangitis (PSC) (p < 0.001) and less likely to have diabetes (p = 0.05), compared to older patients ( ≥ 50yo). Surgical resection rates were similar in younger vs older patients (41.9 vs 42.6%, p = 0.890), but younger patients had larger tumors (median size 7.1 vs 5.3cm p = 0.012). Younger patients were also more likely to receive palliative systemic chemotherapy (p < 0.001) and more lines of therapy (median, 2 vs 1 line, p < 0.001). Frequency of treatment with liver directed therapy did not differ between the two groups. Molecular testing was performed on 222/567 (39.1%) patients of which 84/134 (62.7%) were younger patients and 138/433 (31.9%) were older patients. FGFR aberrations were more common in younger patients versus older patients (17.6 vs. 5.7%, p = 0.002). Targeted therapy was given to 15/84 (17.9%) younger and 28/138 (20.3%) older patients based on results of mutational profiling. Finally, no significant difference was seen in OS between younger and older patients (22.9 vs 22.7 months, p = 0.89). Conclusions: Younger patients with CCA may have different risk factors, tumor biology, and tolerance of systemic therapy compared to older patients. Further study is needed as referral patterns to tertiary care centers and motivation of younger patients to seek tertiary care may impact these results.

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Risk factors and coronary angiographic profile in young STEMI patients: results from a tertiary care centre in south-central India

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20215040 ◽

2021 ◽

Vol 10 (1) ◽

pp. 111

Author(s):

Abhishek Golla ◽

Parvaiz Kadloor ◽

Rajashekar R. Gurrala ◽

Kazi Jawwad Hussain ◽

Kolli Sivadayal ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery ◽

Tertiary Care ◽

Young Patients ◽

Tertiary Care Centre ◽

Circumflex Artery ◽

Younger Patients ◽

Left Circumflex Artery ◽

South Central ◽

2D Echocardiography

Background: Compared to older counterparts, a significant distinction has been found related to risk factors, clinical presentation, and prognosis of ST-segment elevation myocardial infarction (STEMI) in younger patients. To date, a lack of studies has been looked, specifically at-risk factors and angiographic profile of STEMI among younger patients; with this in mind, we conducted the present study.Methods: This hospital-based, cross-sectional, open-label study was carried out at Deccan College of Medical Sciences between April 2018 and December 2019. Patients under 40 years with the presentation of STEMI were included. All patients were subjected to electrocardiography, 2D echocardiography, and coronary angiogram. Baseline demographics, risk factors, and procedural characteristics were recorded.Results: Of 51 young STEMI patients, 41 (80.4%) were male and 10 (19.6%) were female. The most common risk factors associated with the development of STEMI in young patients were smoking (58.8%), followed by diabetes (45.1%), and dyslipidaemia (45.1%). Anterior wall MI was the most frequent presentation (84.3%). The left anterior descending artery was the most frequently (62.8%) involved vessel, followed by left circumflex artery (9.8%), and right coronary artery (5.9%).Conclusions: Insights gained from the study can aid in identifying clinical characteristics of STEMI in young patients, which may be beneficial to achieve appropriate and timely management. Further, the young population should be educated as to control modifiable risk factors and smoking cessation to prevent coronary artery disease since they belong to the highly productive group in the community.

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Characteristics and outcomes of young patients with ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: retrospective analysis in a multiethnic Asian population

Open Heart ◽

10.1136/openhrt-2020-001437 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001437

Author(s):

Benjamin WL Tung ◽

Zhe Yan Ng ◽

William Kristanto ◽

Kalyar Win Saw ◽

Siew-Pang Chan ◽

...

Keyword(s):

Risk Factors ◽

Older Patients ◽

Young Patients ◽

Coronary Intervention ◽

Younger Patients ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Percutaneous Coronary ◽

History Of

ObjectiveST segment elevation myocardial infarction (STEMI) is associated with significant mortality leading to loss of productive life years, especially in younger patients. This study aims to compare the characteristics and outcomes of young versus older patients with STEMI undergoing primary percutaneous coronary intervention (PPCI) to help focus public health efforts in STEMI prevention.MethodsData from the Coronary Care Unit database of the National University Hospital, Singapore from July 2015 to June 2019 were reviewed. Patients were divided into young (<50 years old) or older (≥50 years old) groups.ResultsOf the 1818 consecutive patients with STEMI who underwent PPCI, 465 (25.6%) were <50 years old. Young compared with older patients were more likely to be male, current smokers, of Indian ethnicity, have family history of ischaemic heart disease (IHD) and had lower 1 year mortality (3.4% vs 10.4%, p<0.0001). Although diabetes, hypertension or dyslipidaemia was less common among young patients, the prevalence of having any one of these risk factors was high in the range of 28% to 38%. Age was an independent predictor of mortality in the older but not younger patients with STEMI, and diabetes showed a trend towards mortality in both groups.ConclusionYoung patients with STEMI are more often smokers, of Indian ethnicity and had family history of IHD, although cardiometabolic risk factors are also prevalent. Mortality is lower, but not negligible, among the young patients with STEMI. Public health efforts are needed to reduce the prevalence of these risk factors among the constitutionally susceptible population.

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Acute Diverticulitis in the Young: The Same Disease in a Different Patient

Gastroenterology Research and Practice ◽

10.1155/2013/867961 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 8

Author(s):

Adolfo Pisanu ◽

Valentina Vacca ◽

Isabella Reccia ◽

Mauro Podda ◽

Alessandro Uccheddu

Keyword(s):

Risk Factors ◽

Older Patients ◽

Acute Diverticulitis ◽

Young Patients ◽

Cross Sectional Study ◽

Prior History ◽

Cross Sectional ◽

High Fiber ◽

Recurrent Diverticulitis ◽

Significant Difference

Background. Natural history and risk factors for diverticulitis in young patients are still debatable. This study aimed to assess whether difference exists in patients aged 50 and younger when compared to older patients and to identify risk factors for acute diverticulitis in the young.Patients and Methods. From January 2006 to December 2011, 80 patients were admitted to our department for acute diverticulitis. We carried out a cross-sectional study in 23 patients (28.7%) aged 50 and younger and 57 older patients (71.3%).Results. Acute diverticulitis in the young was not more aggressive than in the older patient. Diverticulitis at patient’s admission was similar with respect to Hinchey’s stage and prior history of diverticulitis. No significant difference was found for both medical and surgical treatment. The rate of recurrent diverticulitis in nonoperated patients was similar. Male gender, body mass index ≥25, and assumption of alcohol were independent risk factors for the occurrence of an acute diverticulitis in the young.Conclusions. The same disease seems to be affecting young patients such as overweight or obese male individual. Current policies to prevent diverticular disease and its related complications must include obesity control together with high-fiber diet and regular exercise.

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Emerging transcriptional landscape and putative therapeutic targets in young patients with metastatic colorectal cancer (CRC).

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.605 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 605-605 ◽

Cited By ~ 1

Author(s):

Christopher Hanyoung Lieu ◽

Todd M. Pitts ◽

Jihye Kim ◽

Aik-Choon Tan ◽

Wells A. Messersmith ◽

...

Keyword(s):

Pilot Study ◽

Older Patients ◽

Cellular Proliferation ◽

Expression Profiles ◽

Tumor Biology ◽

Young Patients ◽

Therapeutic Targets ◽

Gene Expression Profiles ◽

Illumina Hiseq ◽

Younger Patients

605 Background: Patients younger than 50 yrs of age comprise roughly 10% of the total incidence of CRC, but the incidence in the younger population is increasing. Recent data suggest that younger patients are at higher risk of progression of disease and death from CRC. The purpose of this pilot study was to investigate genomic differences between younger and older CRC tumors to generate hypotheses regarding potential differences in tumor biology that may explain worse outcome in young patients. Methods: To determine genomic differences in tumors from younger and older patients with CRC, a cohort of metastatic microsatellite stable CRC tumors was selected using tumors from 9 younger patients (< 35 yrs) and 7 older patients (> 70 yrs). Total RNA was extracted from tumor tissues and sequenced with Illumina HiSeq 2000. On average, 45 million reads were obtained from individual tumor samples. Sequencing reads were mapped to the reference genome using Bowtie; exon junctions were mapped using TopHat and transcript assembly was performed using Cufflinks. Results: The median ages for the younger and older cohorts were 31 and 73, respectively. From the RNA-seq analysis, gene expression profiles from younger patients were enriched for pathways involved in cell proliferation. Specifically ERBB2, NOTCH3, CAV1 were upregulated in multiple pathways in young patients (p < 0.00001). The expression pattern was noted to be different in older patients with enrichment for CDX2, HMGB3, and EPHB2 within pathways involved in regulation of cell differentiation (p = 0.07). In total 77 genes were noted to be enriched in younger patients compared with older patients and 23 genes were enriched in older patients compared with young patients (FDR < 0.05). These data, although preliminary, may provide support to explore ERBB2, NOTCH, and downstream signaling pathways as therapeutic targets for younger patients. Conclusions: In this pilot study, patients < 35 yrs with metastatic CRC exhibited gene sets enriched for several cellular proliferation pathways, including significant upregulation of ERRB2, NOTCH3, and CAV1. These results are hypothesis generating and are being investigated further in a larger validation cohort.

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Comparison of Different Risk Factors and Coronary Angiographic Profile in Younger and Older Patients with Ischeamic Heart Disease

Cardiovascular Journal ◽

10.3329/cardio.v8i1.24764 ◽

2015 ◽

Vol 8 (1) ◽

pp. 23-29 ◽

Cited By ~ 1

Author(s):

Kazi Nazrul Islam ◽

Abdul Wadud Chowdhury ◽

Azizul Hasan Khandaker ◽

Khandker Md Nurus Sabah ◽

Md Gaffar Amin ◽

...

Keyword(s):

Risk Factors ◽

Heart Disease ◽

Older Patients ◽

Homocysteine Level ◽

Young Patients ◽

High Serum ◽

Younger Patients ◽

Vessel Disease ◽

Serum Homocysteine ◽

Group I

Background: Due to socio-economic improvement and changes in the life style, ischeamic heart disease is becoming a major burden to our health care system. In recent years, the incidence is increasing among younger age groups as well.Methods: A total of 120 patients with ischeamic heart disease admitted for coronary angiogram were included in the study and were divided into two groups. Among them, 60 younger patients were in Group-I (d 40 years of age); 60 older patients in Group-II (>40 years of age). We compared demographic profiles, different risk factors and angiographic profiles between two age groups.Results: Among the common risk factors, smoking (63.3% vs 40%, p=0.011) & family history of ischeamic heart disease (21.7% vs 8.3%, p=0.040) were more common in younger group. Whereas, hypertension (41.7% vs 65.0%, p=0.010) and DM (18.3% vs 36.7%, p=0.024) were more common in older patients. Serum Homocysteine level was found significantly higher in younger patients (30.0% vs 13.3%, p=0.026). In group-I. coronary angiography revealed normal coronaries in 15 patients (25%), single vessel disease in 29 (48.3%) and multi-vessel disease in 16 patients (26.6%). Whereas, 40(66.6%) patients in group-II were found to have multi-vessel disease and 2 of them had significant left main coronary disease. However, young patients who had high serum homocysteine level showed more angiographic severity than older patients.Conclusion: There are significant differences in the clinical, biochemical and angiographic profile of young patients with ischeamic heart disease as compared to older patients. Young patients with ischeamic heart disease has got less angiographic severity, except in those with high serum homocysteine level.Cardiovasc. j. 2015; 8(1): 23-29

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Clinical Characteristics and Prognostic Factors of Early-Onset Pancreatic Neuroendocrine Tumors

Cancer Control ◽

10.1177/1073274820986827 ◽

2021 ◽

Vol 28 ◽

pp. 107327482098682

Author(s):

Min Shi ◽

Biao Zhou

Keyword(s):

Prognostic Factors ◽

Neuroendocrine Tumors ◽

Early Onset ◽

Older Patients ◽

Clinical Characteristics ◽

Clinicopathological Characteristics ◽

Pancreatic Neuroendocrine Tumors ◽

Chi Square ◽

Younger Patients ◽

Significant Difference

Background: The incidence of pancreatic neuroendocrine tumors (PNETs) has increased significantly. The purpose of this study was to analyze the clinical characteristics and prognosis of patients under 50 years old. Methods: Patients with PNETs recorded in the Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2015 were analyzed. The clinical characteristics were analyzed by Chi-square test. The Kaplan-Meier method was used to estimate overall survival (OS). Multivariate Cox proportional risk regression analysis was used to determine independent prognostic factors. Results: 2,303 patients included, of which 547 (23.8%) patients were younger than 50 years old. The number of younger patients has increased steadily, while the proportion in total PNETs decreased recently. Compared with older group, the proportion of the Black, grade I/II, and surgery were higher in early-onset PNETs. Liver was the most frequent metastatic site. There was no significant difference in the incidence of different metastatic sites between younger and older PNETs patients, while younger patients had better OS (P < 0.05). Grade, N stage, M stage, and surgery were independent prognostic factors for OS in early-onset PNETs. Conclusions: Younger patients have unique clinicopathological characteristics compared with older patients in PNETs. Better OS was observed in younger patients which might due to the higher proportion of well-differentiated tumor and surgery than older patients.

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Characteristics, outcomes, and risk factors of ICANS after axicabtagene ciloleucel: Does age matter?

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e19556 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e19556-e19556

Author(s):

Kitsada Wudhikarn ◽

Radhika Bansal ◽

Arushi Khurana ◽

Matthew Hathcock ◽

Michael Ruff ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Older Patients ◽

Clinical Course ◽

International Prognostic Index ◽

Age Groups ◽

Central Nervous System Involvement ◽

Microvascular Disease ◽

B Cell Lymphoma ◽

Younger Patients

e19556 Background: CD19 chimeric antigen receptor T cell therapy possesses unique side effects including cytokine release syndrome (CRS) and immune effector cell associated neurotoxicity syndrome (ICANS). Age is a major risk factor for ICANS. However, whether ICANS in older patients is different compared to younger patients is unknown. Herein, we report clinical course, outcomes and risk factors for ICANS in older patients with large B cell lymphoma (LBCL) treated with axicabtagene ciloleucel (axi-cel). Methods: We comprehensively reviewed detailed clinical courses of ICANS in 78 adult patients with LBCL treated with axi-cel between June 2016 and October 2020. Incidence, manifestation, risk factors, treatment, and outcomes of ICANS were compared between patients age ≥60 (n=32) and <60 (n=46) years old. Results: Baseline characteristics were comparable between older and younger patients except higher proportion of high international prognostic index and underlying cerebral microvascular disease in older patients. ICANS was observed in 16 patients in the older and 24 patients in the younger age group, with a 30-day incidence of 52% and 50%, respectively. Median time to CRS and ICANS were similar between 2 age groups. The most common initial neurological findings included aphasia, dysgraphia and encephalopathy in both age groups. Table summarizes the characteristics, clinical course and interventions of ICANS in older and younger patients. In Cox regression model, the presence of CRS was the only factor associated with ICANS in both age groups. Age, history of central nervous system involvement and cerebral microvascular disease were not associated with ICANS. Importantly, all patients had complete resolution of ICANS. No elderly patients in our cohort experienced seizure as a manifestation of ICANS. Conclusions: In our study, older age was not a risk factor for ICANS. CRS was the only factor associated with ICANS in both younger and older patients. Incidence, clinical course and neurological outcomes of ICANS in older patients treated with axi-cel were comparable to younger patients. [Table: see text]

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Abstract WP116: Patterns of Vascular Calcification in Young Patients With Intracranial Stenosis

Stroke ◽

10.1161/str.47.suppl_1.wp116 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Tamara Strohm ◽

Irene Katzan ◽

Ken Uchino

Keyword(s):

Risk Factors ◽

Vascular Calcification ◽

Young Patients ◽

Vascular Risk Factors ◽

Intracranial Stenosis ◽

Intracranial Calcification ◽

Vascular Risk ◽

Atherosclerotic Stenosis ◽

Significant Difference ◽

Determine Mechanism

Introduction: Intravascular calcification is thought to be a marker of atherosclerosis in patients with stenosis and vascular risk factors. Little is known about the utility of quantifying intracranial calcification to help determine mechanism of stenosis. The objective of our study was to compare presence and patterns of intracranial calcification in patients with intracranial stenosis due to atherosclerosis and other etiologies. Methods: Retrospective cohort study of 89 patients < 50 years with diagnosis of intracranial stenosis who had undergone CT angiogram from 2008-2013; 44 had presumed atherosclerosis as etiology ( > 3 vascular risk factors with no other identified cause). CTAs were reviewed for presence and location of intracranial calcification. Results: Of patients with atherosclerotic stenosis, 28 (64%) had intravascular calcification compared to 16 (36%) of those with stenosis of other etiologies (P=0.0039). There was no significant difference in pattern or location of stenosis between groups. One-third had calcification outside the region of stenosis in both groups. Distal internal carotid artery and distal vertebral artery were the most common sites of intracranial calcification (Table). Conclusion: Intracranial calcification is more commonly seen in patients < 50 years old with stenosis secondary to atherosclerosis, but the pattern and location was similar between groups. More research is needed to determine the utility of using the presence of vascular calcification to help determine mechanism of intracranial stenosis in the young.

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Abstract TMP19: Intravenous Recombinant Tissue-type Plasminogen Activator Use in Young Adults With Acute Ischemic Stroke

Stroke ◽

10.1161/str.48.suppl_1.tmp19 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Jodi A Dodds ◽

Ying Xian ◽

Shubin Sheng ◽

Gregg Fonarow ◽

Ronald A Matsouaka ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Plasminogen Activator ◽

Older Patients ◽

Young Patients ◽

Tissue Type ◽

Stroke Patients ◽

Younger Patients ◽

Tissue Type Plasminogen Activator ◽

Type Plasminogen Activator

Background: Intravenous recombinant tissue-type plasminogen activator (rt-PA) administration improves outcomes in acute ischemic stroke. However, young patients (<40 years old) presenting with stroke symptoms may experience delays in treatment due to misdiagnosis or a reluctance to treat since they do not fit the profile of a typical stroke patient. Methods: We analyzed data from the large national Get With The Guidelines–Stroke registry for acute ischemic stroke patients hospitalized between January 2009 and September 2015. Multivariable models with generalized estimating equations (GEE) were used to test for differences between younger (age 18-40) and older (age > 40) acute ischemic stroke patients, controlling for patient and hospital characteristics including stroke severity. Results: Of 1,320,965 AIS patients admitted to participating hospitals, 2.3% (30,448) were aged 18-40. Among these patients, 12.5% received rt-PA versus 8.8% of those aged >40 (p<0.001). Of patients arriving within 3.5 hours of symptom onset without contraindications, 68.7% of younger patients received IV rt-PA versus 63.3% of older patients (adjusted OR [aOR] 1.30, 95% CI 1.21 to 1.40), without evidence that age-related differences varied by sex (interaction p-value 0.25). Odds ratios of achieving target door-to-CT times and door-to-needle (DTN) times, and outcomes of rtPA-treated patients, are shown in the Table. Conclusions: Young acute ischemic stroke patients did not receive rt-PA treatment at lower rates than older patients. Outcomes were better and the rate of symptomatic intracranial hemorrhage was lower in the young patients. However, younger patients had significantly longer door-to-CT and DTN times, providing an opportunity to improve the care of these patients.

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Abstract 14178: Characteristics and Outcomes of Young ST Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Intervention

Circulation ◽

10.1161/circ.142.suppl_3.14178 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Benjamin W Tung ◽

Zhe Yan Ng ◽

William Kristanto ◽

Kalyar W Saw ◽

winnie C sia ◽

...

Keyword(s):

Myocardial Infarction ◽

Older Patients ◽

Young Patients ◽

Percutaneous Intervention ◽

Old Patients ◽

Younger Patients ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Primary Percutaneous Intervention

Introduction: ST-segment elevation myocardial infarction (STEMI) is associated with significant morbidity and mortality leading to loss of productivity and productive life years, especially in younger patients. Understanding the characteristics of younger patients with STEMI and their outcomes could help focus public health efforts in STEMI prevention within a population. Aim: This study aims to compare the characteristics and outcomes of younger versus older patients with STEMI undergoing primary percutaneous intervention (PPCI). Methods: Data from the Coronary Care Unit database of the National University Hospital between July 2015 to June 2019 was reviewed. Patients were divided into Young (<50 years old) or Old (≥50 years old) groups. Results: Of the 1818 consecutive patients with STEMI and underwent PPCI, 465 (25.6%) were Young patients with mean age 43±4.9 years old as compared to Old patients with mean age 63.2±9.4 years old. Young patients were more likely to be male (94% vs. 85%, p<0.0001), current smokers (61.1% vs. 42.6%, p<0.0001), of Indian ethnicity (32% vs. 16.3%, p<0.0001), and had family history of myocardial infarction (MI) (18.1% vs. 9.5%, p<0.0001). Compared to Old patients, Young patients had better post-MI left ventricular ejection fraction (49.5±10.7 vs. 47.8±11.6, p=0.007) with fewer of them suffered from cardiogenic shock (7.1% vs. 13.2%, p<0.0001), and had lower mortality at one year (3.4% vs. 10.4%, p<0.0001). Although diabetes, hypertension and hyperlipidemia was less common among the Young patients when compared to the Old, the prevalence was high in the range of 28 to 38% (Table 1). Conclusions: A sizable proportion of STEMI patients are younger than 50 years old. The risk profile of these younger patients can be attributed to constitutional factors and smoking but other cardiovascular risk factors are also prevalent among them. Although mortality is lower among the younger than the older patients, it is not negligible.

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