Sidedness, mutations, and survival in stage IV colon cancer: A U.S. population-based study.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 742-742
Author(s):  
Albert Y. Lin ◽  
Amanda Kahl ◽  
Irena Gribovskaja-Rupp ◽  
Michele West ◽  
Charles F Lynch ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Proportional Hazards ◽  
Stage Iv ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Poor Prognostic Factor ◽  
Lower Odds ◽  
Proportional Hazards Models ◽  
Cox Proportional Hazards Models ◽  
Patterns Of Care Study

742 Background: Despite recent diagnostic and therapeutic advances in colon cancer (CC), it remains one of the leading causes for cancer-related deaths worldwide. At time of diagnosis, 20% of CC patients (PTS) present with de novo stage IV. In recent years, clinical trials have identified sidedness and several molecular biomarkers (MBM), such as microsatellite instability high (MSI-H), KRAS and BRAF mutations, as prognostic and predictive factors for treatment response in stage IV CC. However, their impact and interactions in the population-based setting remain elusive. Methods: The National Cancer Institute’s 2014 Patterns of Care study included a sample of 1,444 stage IV CC PTS from Surveillance, Epidemiology, and End Results registries, and captured MSI, BRAF and detailed chemotherapy information not available in the public-use dataset. Demographic, tumor, molecular and treatment data were compared using chi-square tests. Cox proportional hazards models were used to compare overall survival (OS) across subgroups of demographic, tumor, MBM and treatment characteristics. Results: Compared to left-sided (L) CC, PTS diagnosed with right-sided (R) CC tend to be older (median age: 65 vs 60, respectively; p < 0.001), more females (54% vs 44%, p = 0.001), African Americans (25% vs 22%, p = 0.001), have poorly or undifferentiated tumors (27% vs 15%, p = 0.001), and harbor MSI-H (14% vs 7%, p = 0.018), KRAS (52% vs 36%, p < 0.001) or BRAF (29% vs 11%, p = 0.001) mutations. FOLFOX, with or without bevacizumab, accounted for > 50% of the first-line regimens. Multivariable Cox proportional hazards models revealed the following poor risk factors: right-sidedness, poorly or undifferentiated tumor, no surgery, no chemotherapy, no cetuximab/panitumumab or no bevacizumab therapy. In separate models for LCC and RCC among those tested for KRAS (n = 689), treatment with bevacizumab was associated with lower odds of death in both models (p < 0.05). Cetuximab/panitumumab were nearly significantly associated with lower odds of death in LCC (p = 0.06) but not RCC (0.35). Conclusions: Right-sidedness is a poor prognostic factor in stage IV CC. Regardless of sidedness, stage IV CC PTS can benefit from surgery, chemotherapy, or bevacizumab.

scholarly journals Predictors of 10-year hospital use in a community-dwelling population of Brazilian elderly: the Bambuí cohort study of aging

2011 ◽  
Vol 27 (suppl 3) ◽  
pp. s336-s344 ◽  
Author(s):  
James Macinko ◽  
Vitor Camargos ◽  
Josélia O. A. Firmo ◽  
Maria Fernanda Lima-Costa
Keyword(s):  
Cohort Study ◽  
Chronic Conditions ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Community Dwelling ◽  
Proportional Hazards Models ◽  
Cox Proportional Hazards Models ◽  
Male Sex

We use data from a population-based cohort of elderly Brazilians to assess predictors of hospitalizations during ten years of follow-up. Participants were 1,448 persons aged 60 years and over at baseline (1997). The outcome was self-reported number of hospitalizations per year. Slightly more than a fifth (23%) experienced no hospitalizations during the 10 year follow-up. About 30% had 1-2 events, 31% had between 3 and 7 events, and about 18% had 8 or more events during this time. Results of multivariable hurdle and Cox proportional hazards models showed that the risk of hospitalization was positively associated with male sex, increased age, chronic conditions, and visits to the doctors in the previous 12 months. Underweight was a predictor of any hospitalization, while obesity was an inconsistent predictor of hospitalization.

scholarly journals Lower values of a novel index of Vagal-Neuroimmunomodulation are associated to higher all-cause mortality in two large general population samples with 18 year follow up

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Marc N. Jarczok ◽  
Julian Koenig ◽  
Julian F. Thayer
Keyword(s):  
General Population ◽  
Proportional Hazards ◽  
Population Studies ◽  
Large Population ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Proportional Hazards Models ◽  
Cox Proportional Hazards Models ◽  
All Cause Mortality

AbstractIn recent clinical practice, a biomarker of vagal neuroimmunomodulation (NIM), namely the ratio of vagally-mediated heart rate variability (vmHRV) and CRP, was proposed to index the functionality of the cholinergic anti-inflammatory pathway. This study aims to transfer and extend the previous findings to two general population-based samples to explore the hypothesis that NIM-ratio is associated with all-cause mortality. Two large population studies (MIDUS 2: N = 1255 and Whitehall II wave 5: N = 7870) with complete data from a total of N = 3860 participants (36.1% females; average age = 56.3 years; 11.1% deaths, last exit 18.1 years post inclusion) were available. NIM indices were calculated using the vagally-mediated HRV measure RMSSD divided by measures of CRP (NIMCRP) or IL-6 (NIMIL6). The NIM-ratios were quartiled and entered into age, ethnicity and body mass index adjusted Cox proportional hazards models. For NIMIL6 the lowest quartile was 45% more likely to die during the observed period (max. 18 years follow-up) compared to the highest quartile (HR = 0.55 CI 0.41–0.73; p < .0001). NIMCRP parallel these results. Here we show that an easily computable index of IL-6 inhibition is associated with all-cause mortality in two large general population samples. These results suggest that this index might be useful for risk stratification and warrant further examination.

scholarly journals Deriving a Passive Surveillance Stroke Severity Indicator From Routinely Collected Administrative Data: The PaSSV Indicator

2020 ◽  
Vol 13 (2) ◽  
Author(s):  
Amy Y. X. Yu ◽  
Peter C. Austin ◽  
Mohammed Rashid ◽  
Jiming Fang ◽  
Joan Porter ◽  
...  
Keyword(s):  
Administrative Data ◽  
Outcomes Research ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Stroke Severity ◽  
Stroke Outcomes ◽  
Proportional Hazards Models ◽  
Interhospital Transfer ◽  
Cox Proportional Hazards Models

Background: Adjusting for stroke severity is crucial for stroke outcomes research. However, this information is not available in administrative healthcare data. We aimed to derive an indicator of baseline stroke severity using these data. Methods and Results: We identified patients with stroke enrolled in a population-based registry in Ontario, Canada, and used the Canadian Neurological Scale (CNS), documented in the registry, as a measure of stroke severity. We derived an estimated CNS from a linear regression model in which we regressed the observed CNS on predictor variables: age, sex, arrival by ambulance, interhospital transfer, mechanical ventilation, and an emergency department triage score. The effect of stroke severity on the estimated hazard ratios for 30-day mortality was determined in 3 Cox-proportional hazards models with (1) no CNS, (2) observed CNS, and (3) estimated CNS, all adjusted for age, sex, Charlson index, and stroke type. We assessed model discrimination using C statistics. To assess for construct validity, we repeated these analyses in a subset of patients with documented National Institute of Health Stroke Scale and in a cohort of patients with stroke external to the registry. We derived the estimated stroke severity in 41 481 patients (48.7% female, median age of 75 years [interquartile range, 64– 83]). The magnitude of the association between stroke severity and mortality was similar for the observed and estimated CNS. The discriminative ability of the Cox-proportional hazards models to predict mortality was highest when the observed CNS was included (C statistic, 0.82 [95% CI, 0.81–0.82]), moderate with estimated CNS (0.76 [0.75–0.76]), and lowest without CNS (0.69 [0.69–0.70]. Our findings were replicated with the National Institute of Health Stroke Scale and in the external cohort. Conclusions: We derived an estimated measure of stroke severity using administrative data. This can be applied for risk adjustment in population-based stroke outcomes research and in assessments of health system performance.

Treatment Outcomes and Relative Dose Intensity of Chemotherapy in Slovene Patients With Advanced Hodgkin Lymphoma

2022 ◽  
Author(s):  
Samo Rozman ◽  
Nina Ružić Gorenjec ◽  
Barbara Jezeršek Novaković
Keyword(s):  
Hodgkin Lymphoma ◽  
Proportional Hazards ◽  
Stage Iv ◽  
Dose Intensity ◽  
Progression Free Survival ◽  
Cox Proportional Hazards ◽  
Relative Dose Intensity ◽  
Cox Proportional Hazards Models ◽  
Stage Disease ◽  
Stage Iv Disease

Abstract This retrospective study was undertaken to investigate the association of relative dose intensity (RDI) with the outcome of Hodgkin lymphoma (HL) patients with advanced stage disease receiving ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) and escalated BEACOPP regimen (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone). A total of 114 HL patients treated between 2004 and 2013 were enrolled for evaluation. RDI calculations were based on a Hryniuk's model. The association of variables with overall survival (OS) and progression-free survival (PFS) was analysed using univariate and multivariate Cox proportional hazards models. The median age of patients was 39 years, majority of patients were males and had stage IV disease. Fifty-four patients received ABVD and 60 received BEACOPP chemotherapy with 24 and 4 deaths, respectively. Patients in BEACOPP group were significantly younger with lower Charlson comorbidity index (CCI) in comparison with ABVD group, making the comparison of groups impossible. In ABVD group, RDI was not significantly associated with OS (p=0.590) or PFS (p=0.354) in a multivariate model where age was controlled. The low number of events prevented the analysis in the BEACOPP group. Patients' age was strongly associated with both OS and PFS: all statistically significant predictors for OS and PFS from univariate analyses (chemotherapy regimen, CCI, RDI) lost its effect in multivariate analyses where age was controlled. Based on our observations, we can conclude that RDI is not associated with the OS or PFS after the age is controlled, neither in all patients combined nor in individual chemotherapy groups.

The Longitudinal Association of Vision Impairment with Transitions to Cognitive Impairment and Dementia: Findings from The Aging, Demographics and Memory Study

2021 ◽  
Author(s):  
Joshua R Ehrlich ◽  
Bonnielin K Swenor ◽  
Yunshu Zhou ◽  
Kenneth M Langa
Keyword(s):  
Visual Acuity ◽  
Logistic Regression ◽  
Cognitive Impairment ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Vision Impairment ◽  
Logistic Regression Models ◽  
Cox Proportional Hazards Models ◽  
Longitudinal Association

Abstract Background Vision impairment (VI) is associated with incident cognitive decline and dementia. However, it is not known whether VI is associated only with the transition to cognitive impairment, or whether it is also associated with later transitions to dementia. Methods We used data from the population-based Aging, Demographics and Memory Study (ADAMS) to investigate the association of visual acuity impairment (VI; defined as binocular presenting visual acuity &lt;20/40) with transitions from cognitively normal (CN) to cognitive impairment no dementia (CIND) and from CIND to dementia. Multivariable Cox proportional hazards models and logistic regression were used to model the association of VI with cognitive transitions, adjusted for covariates. Results There were 351 participants included in this study (weighted percentages: 45% male, 64% age 70-79 years) with a mean follow-up time of 4.1 years. In a multivariable model, the hazard of dementia was elevated among those with VI (HR=1.63, 95%CI=1.04-2.58). Participants with VI had a greater hazard of transitioning from CN to CIND (HR=1.86, 95%CI=1.09-3.18). However, among those with CIND and VI a similar percentage transitioned to dementia (48%) and remained CIND (52%); there was no significant association between VI and transitioning from CIND to dementia (HR=0.94, 95%CI=0.56-1.55). Using logistic regression models, the same associations between VI and cognitive transitions were identified. Conclusions Poor vision is associated with the development of CIND. The association of VI and dementia appears to be due to the higher risk of dementia among individuals with CIND. Findings may inform the design of future interventional studies.

Abstract P005: Comparative Effectiveness of Rivaroxaban versus Warfarin for the Treatment of Patients with Non-valvular Atrial Fibrillation

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Faye L Norby ◽  
Lindsay G Bengtson ◽  
Lin Y Chen ◽  
Richard F MacLehose ◽  
Pamela L Lutsey ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Real World ◽  
Proportional Hazards ◽  
Large Population ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Gi Bleeding ◽  
Cox Proportional Hazards Models ◽  
The Us

Background: Rivaroxaban is a novel oral anticoagulant approved in the US in 2011 for prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF). Information on risks and benefits among rivaroxaban users in real-world populations is limited. Methods: We used data from the US MarketScan Commercial and Medicare Supplemental databases between 2010 and 2013. We selected patients with a history of NVAF and initiating rivaroxaban or warfarin. Rivaroxaban users were matched with up to 5 warfarin users by age, sex, database enrollment date and drug initiation date. Ischemic stroke, intracranial bleeding (ICB), myocardial infarction (MI), and gastrointestinal (GI) bleeding outcomes were defined by ICD-9-CM codes in an inpatient claim after drug initiation date. Cox proportional hazards models were used to assess the association between rivaroxaban vs. warfarin use and outcomes adjusting for age, sex, and CHA2DS2-VASc score. Separate models were used to compare a) new rivaroxaban users with new warfarin users, and b) switchers from warfarin to rivaroxaban to continuous warfarin users. Results: Our analysis included 34,998 rivaroxaban users matched to 102,480 warfarin users with NVAF (39% female, mean age 71), in which 487 ischemic strokes, 179 ICB, 647 MI, and 1353 GI bleeds were identified during a mean follow-up of 9 months. Associations of rivaroxaban vs warfarin were similar in new users and switchers; therefore we pooled both analyses. Rivaroxaban users had lower rates of ICB (hazard ratio (HR) (95% confidence interval (CI)) = 0.72 (0.46, 1.12))) and ischemic stroke (HR (95% CI) = 0.88 (0.68, 1.13)), but higher rates of GI bleeding (HR (95% CI) = 1.15 (1.01, 1.33)) when compared to warfarin users (table). Conclusion: In this large population-based study of NVAF patients, rivaroxaban users had a non-significant lower risk of ICB and ischemic stroke than warfarin users, but a higher risk of GI bleeding. These real-world findings are comparable to results reported in published clinical trials.

Death in Rural Georgia: A Historical Comparison of Georgians and Ossets in the Kistauri Commune

2020 ◽  
Vol 45 (4) ◽  
pp. 457-478
Author(s):  
Tinatin Zurabishvili ◽  
Rennie Lee ◽  
Rebecca Jean Emigh
Keyword(s):  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Republic Of Georgia ◽  
Age At Death ◽  
Proportional Hazards Models ◽  
Independent Variables ◽  
Historical Comparison ◽  
Factors Influencing ◽  
Cox Proportional Hazards Models ◽  
Residency Status

This article examines the factors influencing age at death in the multiethnic villages, comprised mostly of Georgians and Ossets, in the Kistauri commune in the eastern Republic of Georgia between 1897 and 1997. The data are analyzed with Cox proportional hazards models using age at death as the dependent variable, and ethnicity, gender, marital status, residency status, and year of birth as the independent variables. The results show that Georgians lived longer than Ossets. Individuals who had ever been married lived longer than those who had not. The results perhaps reflect harsher living conditions for Ossets, the ethnic minority, despite Soviet ideologies about equality.

scholarly journals The prognostic role of plasma fibrinogen in adult secondary hemophagocytic lymphohistiocytosis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Guangli Yin ◽  
Changfeng Man ◽  
Jiayu Huang ◽  
Shengen Liao ◽  
Xin Gao ◽  
...  
Keyword(s):  
Hemophagocytic Lymphohistiocytosis ◽  
Inflection Point ◽  
Proportional Hazards ◽  
Cubic Spline ◽  
Cox Proportional Hazards ◽  
Plasma Fibrinogen ◽  
Proportional Hazards Models ◽  
Cox Proportional Hazards Models ◽  
Cubic Spline Curve ◽  
Secondary Hemophagocytic Lymphohistiocytosis

Abstract Background In adult patients with secondary hemophagocytic lymphohistiocytosis (sHLH), no valid immune biomarker has been available for predicting the prognosis of untreated sHLH patients. Methods Circulating plasma levels of fibrinogen (FIB) were measured at diagnosis in 293 cases of adult sHLH. We categorized FIB levels into tertiles. Multivariable Cox proportional hazards models were used to evaluate the relationship between FIB and survival. Restricted cubic spline models and two-piecewise Cox proportional hazards models were used to address the nonlinear association between FIB and mortality. Results During a median follow-up of 52 (interquartile ranges, 18–221) days, 208 deaths occurred, with 137 deaths in malignancy-associated hemophagocytic lymphohistiocytosis (MHLH) and 71 deaths in non-malignancy-associated hemophagocytic lymphohistiocytosis (non-MHLH). After multivariable adjustment, compared with the highest tertile of FIB, the hazard ratios (HRs) with 95% confidence intervals (CIs) of survival for tertile 2 and tertile 1 were 1.06 (0.90–1.24) and 0.84 (0.71–0.98), respectively. The restricted cubic spline curve displayed a nonlinear and inverse relationship between FIB and mortality. Furthermore, the threshold effect analysis demonstrated that the inflection point for the curve was at an FIB level of 1.76 g/L. The HRs (95% CIs) for survival were 0.68 (0.55–0.83) and 1.08 (0.96–1.21) on the left and right side of the inflection point, respectively. Conclusions These results suggest that plasma fibrinogen is nonlinearly and inversely associated with the risk of mortality in adult secondary hemophagocytic lymphohistiocytosis.

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