HCC incidence in patients treated with DAA for chronic hepatitis C compared to PEG-interferon/ribavirin treated patients: HORRID study.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 219-219
Author(s):  
Alexander Rheinhard Siebenhuener
Keyword(s):  
Liver Transplantation ◽  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Hazard Model ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Cox Proportional Hazard ◽  
Significant Difference

219 Background: Direct antiviral agents (DAA) have revolutionized the treatment of chronic hepatitis C (CHC) and have quickly become the standard of care. Despite this effective treatment CHC patients are known to have an increased risk to develop hepatocellular carcinoma (HCC). The incidence of HCC is about 3-5% in this population and regular surveillance is highly recommended. To date the correlation between eradication of viral hepatitis and the risk of HCC development in CHC patients is not well understood. Surprisingly several studies show a frequent incidence of HCC after DAA treatment. The aim of this study is to demonstrate treatment of CHC with DAA or PEG-INF/RBV and patients' outcome into context of HCC development and success of CHC treatment. Methods: We performed a retrospective analysis of 300 patients that received treatment with PEG-IFN and RBV and 346 patients that received DAA treatment for CHC in our institution. HCC viral load, genotype, treatment type, duration and outcome, fibrosis grade, age, gender, BMI as well as AFP and serum albumin were recorded. A Cox-proportional hazard model was fit to compare survival in patients treated with PEG-IFN and patients that received DAA regarding HCC, need for liver transplantation and death. Results: While death and need for liver transplantation was not different in both groups, there was a significant difference in the incidence of HCC. Patients that received DAA developed HCC post-treatment significantly earlier than PEG-IFN/RBV treated patients. In a Cox-proportional hazard model, DAA treatment remained a significant predictor for occurrence of HCC after adjusting for confounders. Conclusions: Our data demonstrates a significantly increased incidence of HCC in patients that were cured from CHC with DAA compared to patients after PEG-IFN/RBV treatment. In contrast to earlier studies using historic data, our study limited confounders by directly comparing HCC differential incidence of HCC after PEG-INF/RBV and DAA treatment within the same institution. Further prospective studies are warranted to precisely determine the HCC risk in patients that receive DAA for CHC.

Intrahepatic cholangiocarcinoma: Ambitious operations and outcomes.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 345-345
Author(s):  
Mustafa Raoof ◽  
Sinziana Dumitra ◽  
Philip HG Ituarte ◽  
Laleh Melstrom ◽  
Susanne Warner ◽  
...  
Keyword(s):  
Intrahepatic Cholangiocarcinoma ◽  
Health Planning ◽  
Hazard Model ◽  
Population Based ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Cox Proportional Hazard ◽  
Significant Difference ◽  
Specialized Institutions

345 Background: Data from specialized institutions suggests that resection for large ( > 7cm) and mutifocal intrahepatic cholangiocarcinoma (ICC) is safe and feasible. We aim to study this hypothesis using a population-based dataset. Methods: This is a study of a contemporary cohort from California Cancer Registry database (2004-2011) that was merged with Office of Statewide Health Planning and Development inpatient database. All patients with ICC that underwent resection or ablation were included. Tumors were classified into two groups; intrahepatic, small ( < 7cm) & solitary (ISS) vs. extrahepatic extension, large or multifocal (ELM). Mortality was recorded at 90 days. Overall survival (OS) analysis was performed using the Kaplan-Meier and Cox-proportional hazard model. Results: Of the total 275 patients that met the inclusion criteria, 55% were female, 52% were white and median age was 65 years (IQR 55-72). Majority of patients had > 3 segment resection 59% (Ablation 10%, 1-3 segments 30%). Portal lymphadenectomy was performed in 45% of patients. Vascular Invasion was found in 22% of patients, 14% were bilobar and 20% were node positive. Median follow up was 23 months (IQR 13-40). Number of ISS tumors (139, 50.5%) and ELM tumors (136, 49.5%) was similar. The two groups were comparable in regards to age, sex, race, comorbidities, extent of surgery, portal lymphadenectomy, node positivity. ELM tumors were more likely to have vessel invasion (27% vs. 17%, p = 0.048) and be bilobar (26% vs. 2%, p < 0.001). There was no significant difference in overall complication rate (ISS 34%, ELM 27%, p = 0.19) and mortality rate (both groups < 1%, p = 0.32). A multivariate Cox-proportional hazard model demonstrated that age > 60 years, > 1 comorbidity, high grade tumors, ELM tumors (HR 1.63: 95%CI 1.11-2.40; p = 0.013) and LN positivity (HR 2.30: 95%CI 1.49-3.54; p < 0.001) are independently associated with worse OS. Conclusions: Surgical resection of tumors > 7cm, multifocal lesions involving contiguous extrahepatic organs is safe with acceptable morbidity and mortality. Age > 60 years, grade, comorbidity, ELM tumors and LN positivity are independent predictors of worse OS.

scholarly journals A Study of Factors Affecting the Length of Hospital Stay of COVID-19 Patients by Cox-Proportional Hazard Model in a South Indian Tertiary Care Hospital

2021 ◽  
Vol 12 ◽  
pp. 215013272110002
Author(s):  
Gayathri Thiruvengadam ◽  
Marappa Lakshmi ◽  
Ravanan Ramanujam
Keyword(s):  
Hospital Stay ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Hazard Model ◽  
Cox Proportional Hazard Model ◽  
Care Hospital ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Cox Proportional Hazard ◽  
South Indian

Background: The objective of the study was to identify the factors that alter the length of hospital stay of COVID-19 patients so we have an estimate of the duration of hospitalization of patients. To achieve this, we used a time to event analysis to arrive at factors that could alter the length of hospital stay, aiding in planning additional beds for any future rise in cases. Methods: Information about COVID-19 patients was collected between June and August 2020. The response variable was the time from admission to discharge of patients. Cox proportional hazard model was used to identify the factors that were associated with the length of hospital stay. Results: A total of 730 COVID-19 patients were included, of which 675 (92.5%) recovered and 55 (7.5%) were considered to be right-censored, that is, the patient died or was discharged against medical advice. The median length of hospital stay of COVID-19 patients who were hospitalized was found to be 7 days by the Kaplan Meier curve. The covariates that prolonged the length of hospital stay were found to be abnormalities in oxygen saturation (HR = 0.446, P < .001), neutrophil-lymphocyte ratio (HR = 0.742, P = .003), levels of D-dimer (HR = 0.60, P = .002), lactate dehydrogenase (HR = 0.717, P = .002), and ferritin (HR = 0.763, P = .037). Also, patients who had more than 2 chronic diseases had a significantly longer length of stay (HR = 0.586, P = .008) compared to those with no comorbidities. Conclusion: Factors that are associated with prolonged length of hospital stay of patients need to be considered in planning bed strength on a contingency basis.

scholarly journals SMOKING STATUS AFFECTING SURVIVAL OF ADENOCARCINOMA LUNG CANCER PATIENTS IN KUALA LUMPUR, MALAYSIA

2017 ◽  
Vol 10 (9) ◽  
pp. 312
Author(s):  
Nida Sajid Ali Bangash ◽  
Natasha Hashim ◽  
Nahlah Elkudssiah Ismail
Keyword(s):  
Lung Cancer ◽  
Prognostic Significance ◽  
Hazard Model ◽  
Rank Test ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Kuala Lumpur ◽  
Proportional Hazard Model ◽  
Cox Proportional Hazard ◽  
Survival Difference

  Objective: Adenocarcinoma (AC) of the lung is now the most common histologic type of non-small cell lung cancer (NSCLC) worldwide since the past 20 years. This study was conducted to investigate survival difference among smoker and non-smoker lung AC patients.Methods: A retrospective observational study was conducted for 81 advanced NSCLC adult Malaysian patients in Radiotherapy and Oncology Clinic at Hospital Kuala Lumpur, Malaysia. A total of adult 30 Malaysian smokers and 51 non-smokers with lung AC were included. Ex-smokers were not included in the study. Demographic and clinical data were collected and described. For survival analysis, Kaplan–Meier test and log-rank test were used to calculate overall survival (OS) and analyse the difference in the survival curve. Cox proportional hazard model was used to identify prognostic significance of smoking status.Results: Non-smokers showed a significant association with female gender and Stage IV NSCLC. The median OS was higher for non-smokers (493 days) as compared to smokers (230 days). The Cox proportional hazard model showed higher hazard ratio for smokers.Conclusion: Non-smoking is an independent positive prognostic factor in lung AC.

scholarly journals Introduction of Two-Dose Mumps-Containing Vaccine into Routine Immunization Schedule in Quzhou, China, Using Cox-Proportional Hazard Model

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Zhiying Yin ◽  
Canjie Zheng ◽  
Quanjun Fang ◽  
Xiaoying Gong ◽  
Guoping Cao ◽  
...  
Keyword(s):  
Hazard Model ◽  
Routine Immunization ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Immunization Schedule ◽  
Proportional Hazard Model ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Routine Immunization Schedule ◽  
Different Doses

Mumps is a vaccine-preventable disease caused by the mumps virus, but the incidence of mumps has increased among the children who were vaccinated with one-dose measles-mumps-rubella (MMR) in recent years. In this study, we analyzed the influence of different doses of mumps-containing vaccine (MuCV) against mumps using Cox-proportional hazard model. We collected 909 mumps cases of children who were born from 2006 to 2010 and vaccinated with different doses of MuCV in Quzhou during 2006-2018, which were all clinically diagnosed. Kaplan-Meier survival methods and Cox-proportional hazard model were used to estimate the hazard probabilities. Kaplan–Meier curves showed that the cumulative hazard of male and female has no difference; lower hazards were detected among those who were vaccinated with two-dose MuCV, born in 2006, and infected after supplementary immunization activities (SIA). Cox-proportional hazard regression suggested that onset after SIA, born in 2006, and vaccinated with two-dose MuCV were protective factors against infection even after adjusting for potential confounding effects. Our study showed that it was necessary to revise the diagnostic criteria of mumps and identify RT-PCR as the standard for mumps diagnosis in China. We suggested that routine immunization schedule should introduce two doses of MMR and prevaccination screening should be performed before booster immunization in vaccinated populations.

scholarly journals The productive lifetime of sows on two farms from the aspect of reasons for culling

2015 ◽  
Vol 15 (3) ◽  
pp. 747-758 ◽  
Author(s):  
Peter Balogh ◽  
Wojciech Kapelański ◽  
Hanna Jankowiak ◽  
Lajos Nagy ◽  
Sandor Kovacs ◽  
...  
Keyword(s):  
Old Age ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Large White ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Breeding Farms ◽  
On Farm

Abstract The aim of this study was to compare the characteristics of the productive lifetime (PLT) of sows kept on two farms, from the aspect of reasons for culling. The study was based on data from animals from two breeding farms in Hungary, using the data of 3493 crossbred Dutch Large White and Dutch Landrace sows (DLW × DL) between their first farrowing until the time of culling (2006 and 2012). For six years, the annual culling rate for both farms averaged 45%. The most frequent reasons for removal on both farms were reproductive problems (40%, 51%), leg problems (29%, 23%) and mortality (19%, 15%). There was a significant difference between the distributions of reasons for culling on the two farms (χ2=41.7, P≤0.001). The distributions of reasons for culling differed in three periods of sow breeding (Farm A: χ2=264.7, P≤0.001; Farm B: χ2=511.1, P≤0.001). The percentage of main removal reasons decreased, whereas the frequency of culling due to age increased. Using survival analysis (Kaplan-Meier method and Cox proportional hazard model), significant differences were identified between the PLT of sows culled due to reproductive problems (P≤0.001), leg problems (P≤0.001) and old age (P≤0.001). Reproductive problems (HR: 1.34, P≤0.001) and leg problems (HR: 1.39, P≤0.001) were higher and culling due to old age (HR: 0.44, P≤0.001) was lower on Farm A compared to Farm B. There were no significant differences between the two farms in terms of mortality (HR: 0.99, P=0.923). Overall, the results can be useful for breeders of crossbred (DLW × DL) sow populations in more accurately defining their culling systems.

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