Gastric cancer staging in the era of neoadjuvant therapy and its prognostic implications.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 22-22
Author(s):  
Gina Kim ◽  
Patricia Friedmann ◽  
Peter Muscarella ◽  
John Christopher McAuliffe ◽  
Haejin In
Keyword(s):  
Gastric Cancer ◽  
Regression Model ◽  
Neoadjuvant Therapy ◽  
Cox Regression ◽  
Prognostic Information ◽  
Logrank Test ◽  
Cox Regression Model ◽  
Cancer Data ◽  
C Statistic ◽  
The Relationship

22 Background: Increasingly patients are undergoing neoadjuvant therapy for gastric cancer. The relationship between stage-based prognostic information available prior to treatment (cStage), after surgery (ypStage), and difference between cStage and ypStage (delta) remains unclear. We aim to describe the relationship between cStage and ypStage as relates to survival for gastric cancer patients. Methods: Data from the National Cancer Data Base (NCDB) from 2004-2015 was used for the analysis. Patients with gastric adenocarcinoma who received neoadjuvant therapy then underwent surgery were included. Kaplan Meier curves were used to model survival. Harrell’s C-statistics obtained from Cox Regression models were reported. Results: 9,959 patients met our inclusion criteria. Increases in cStage, ypStage and delta (ypStage-cStage) were associated with worse survival. Median overall survivals for cStages 1-4 were: 53.8, 39.5, 29.2, 20.9 months (logrank test, p<0.0001). Median survivals for ypStage 0-4 were: 95.4, 89.7, 36.9, 23.4, 16.0 months (logrank test, p<0.0001). Survival was further stratified by delta. A representative table comparing cStage 2 and ypStage 2 is shown below. A cox regression model with cStage as predictor of survival yielded a Harrell’s C-statistic of 0.555; when delta was added to the model, the C-statistic increased to 0.638. Separately, a Cox-regression model with ypStage as predictor yielded a C-statistic of 0.632; when delta was added to this model, the C-statistic increased negligibly to 0.638. Conclusions: Prognostic accuracy using cStage prior to treatment improved when tumor responsiveness was considered while this was not the case for ypStage. Pre-surgical prognostic information should be provided with a caveat that treatment response will influence survival. Post-surgery, the clinical stage is less relevant and ypStage can be used alone in providing prognostic information. [Table: see text]

scholarly journals Glioblastoma Distance From the Subventricular Neural Stem Cell Niche Does Not Correlate With Survival

2020 ◽  
Vol 10 ◽  
Author(s):  
Akshitkumar M. Mistry ◽  
Nishit Mummareddy ◽  
Sanjana Salwi ◽  
Larry T. Davis ◽  
Rebecca A. Ihrie
Keyword(s):  
Overall Survival ◽  
Stem Cell ◽  
Regression Model ◽  
Neural Stem Cell ◽  
Stem Cell Niche ◽  
Tumor Volume ◽  
Cox Regression ◽  
Cox Regression Model ◽  
Cell Niche ◽  
The Relationship

ObjectiveTo determine the relationship between survival and glioblastoma distance from the ventricular-subventricular neural stem cell niche (VSVZ).Methods502 pre-operative gadolinium-enhanced, T1-weighted MRIs with glioblastoma retrieved from an institutional dataset (n = 252) and The Cancer Imaging Atlas (n=250) were independently reviewed. The shortest distance from the tumor contrast enhancement to the nearest lateral ventricular wall, the location of the VSVZ, was measured (GBM-VSVZDist). The relationship of GBM-VSVZDist with the proportion of glioblastomas at each distance point and overall survival was explored with a Pearson’s correlation and Cox regression model, respectively, adjusting for the well-established glioblastoma prognosticators.Results244/502 glioblastomas had VSVZ contact. The proportion of non-VSVZ-contacting glioblastomas correlated inversely with GBM-VSVZDist (partial Pearson’s correlation adjusted for tumor volume R=-0.79, p=7.11x10-7). A fit of the Cox regression model adjusted for age at diagnosis, Karnofsky performance status score, post-operative treatment with temozolomide and/or radiotherapy, IDH1/2 mutation status, MGMT promoter methylation status, tumor volume, and extent of resection demonstrated a significantly decreased overall survival only when glioblastoma contacted the VSVZ. Overall survival did not correlate with GBM-VSVZDist.ConclusionsIn the two independent cohorts analyzed, glioblastomas at diagnosis were found in close proximity or in contact with the VSVZ with a proportion that decreased linearly with GBM-VSVZDist. Patient survival was only influenced by the presence or absence of a gadolinium-enhanced glioblastoma contact with the VSVZ. These results may guide analyses to test differential effectiveness of VSVZ radiation in VSVZ-contacting and non-contacting glioblastomas and/or inform patient selection criteria in clinical trials of glioblastoma radiation.

scholarly journals Synergetic Effect of Lipoprotein(a) and Lipoprotein-Associated Phospholipase A2 on Functional Outcomes in Patients with Ischemic Stroke

2021 ◽  
Author(s):  
Lemin Zheng ◽  
Xue Jiang ◽  
Jie Xu ◽  
Xiwa Hao ◽  
Jing Xue ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Regression Model ◽  
Functional Outcome ◽  
Functional Outcomes ◽  
Cox Regression ◽  
Synergetic Effect ◽  
Cox Regression Model ◽  
Lipoprotein A ◽  
Relationship Of ◽  
The Relationship

Abstract Background:The relationship of lipoprotein(a) [Lp(a)] and stroke functional outcomes was conflicting. The relationship of Lp(a) and Lp-PLA2 levels to functional outcomes is unclear. The aim was to clarify whether high Lp(a) is associated with poor functional outcomes and examine the relationship of Lp(a) and Lp-PLA2 to functional outcomes in patients with ischemic stroke.Methods：A total of 10,422 individuals from the third China National Stroke Registry cohort were recruited. Plasma level of Lp(a) at admission was measured with enzyme-linked immunosorbent assay. The cut-off was set at the median for Lp(a). Functional outcome was assessed using the modified Rankin scale (mRS) at 3 months after stroke. The association between Lp(a) and stroke functional outcomes was evaluated using a multivariate Cox regression model.Results：The median age was 63.0 years, and 31.6% participants were women. Patients in higher Lp(a) group had higher incidences of poor functional outcome at 3 months (P<0.0001). In multivariate cox regression model, elevated Lp(a) levels were associated with poor functional outcomes at 3 months (Q4 vs. Q1: hazard ratio 1.39, 95% confidence interval 1.11-1.75). Subgroup analysis showed the significant effect of interaction of Lp-PLA2 level with Lp(a) level on functional outcomes (p=0.008). After stratification by Lp(a) and Lp-PLA2, the Lp(a) high/ Lp-PLA2 high group showed the highest incidence of poor functional outcomes at 3 months.Conclusions:Elevated Lp(a) level is associated with poor functional outcomes in patients with ischemic stroke. Lp(a) has a synergetic effect with Lp-PLA2 on functional outcomes after ischemic stroke.

scholarly journals RORα and REV-ERBα are Associated With Clinicopathological Parameters and are Independent Biomarkers of Prognosis in Gastric Cancer

2021 ◽  
Vol 20 ◽  
pp. 153303382110396
Author(s):  
Xiaoshan Wang ◽  
Ru Jia ◽  
Ke Chen ◽  
Jingjing Wang ◽  
Kai Jiang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Regression Model ◽  
Cox Regression ◽  
Histological Grade ◽  
Model Analysis ◽  
Tnm Stage ◽  
Clinicopathological Parameters ◽  
Cox Regression Model ◽  
Expression Levels ◽  
Node Metastasis

Retinoid-related orphan receptor alpha (RORα) and nuclear receptor subfamily 1 group D member 1 (REV-ERBα) play critical roles in many human cancers. Whether RORα and REV-ERBα expression levels are associated with clinical characteristics are poorly understood, and they may be independent predictors of overall survival (OS) and progression-free survival (PFS) in gastric cancer (GC). This study aimed to investigate the correlation of RORα and REV-ERBα expression levels with clinicopathological parameters, OS, and PFS in GC. Immunohistochemistry and quantitative reverse transcription-polymerase chain reaction (qRT-PCR) were employed to assess the expression levels of RORα and REV-ERBα, which were downregulated in GC tissues compared with normal gastric tissues ( P < .001; P < .001) and were associated with several clinicopathological parameters, including histological grade ( P = .032; P < .001), preoperative carcinoembryonic antigen (CEA) levels ( P = .004; P < .001), and tumor-node-metastasis (TNM) stage ( P = .015; P < .001). Additionally, low RORα and REV-ERBα expression levels were associated with poor OS and PFS in GC patients, respectively ( P < .001; P = .001). Furthermore, univariate Cox regression model analysis showed that histological grade ( P < .001; P < .001), preoperative CEA levels ( P < .001; P = .001), TNM stage ( P < .001; P < .001), lymph node metastasis ( P = .002; P = .002), RORα expression levels ( P = .001; P < .001), and REV-ERBα expression levels ( P < .001; P = .001) were associated with OS and PFS in GC. Multivariate Cox regression model analysis indicated that RORα expression levels and REV-ERBα expression levels are independent factors of OS and PFS in GC. Besides, RORα and REV-ERBα expression may be positively correlated (χ2 = 6.835; P = .009), and GC patients with both high RORα and REV-ERBα expression levels had the best prognosis. In conclusion, RORα and REV-ERBα may coparticipate in tumor activities and show potential to estimate the prognosis of GC.

scholarly journals Prevalence and prognostic value of cardiac troponin in elderly patients hospitalized for COVID-19

2020 ◽  
Author(s):  
Vincenzo De Marzo ◽  
Antonio Di Biagio ◽  
Roberta Della Bona ◽  
Antonio Vena ◽  
Eleonora Arboscello ◽  
...  
Keyword(s):  
Regression Model ◽  
Cardiac Troponin ◽  
Cox Regression ◽  
Elderly Subjects ◽  
Initial Increase ◽  
Prognostic Information ◽  
Cox Regression Model ◽  
Reference Limit ◽  
Risk Of Death ◽  
Upper Reference Limit

Abstract Background: Increases in cardiac troponin (cTn) in coronavirus disease 2019 (COVID-19) have been associated with worse prognosis. Nonetheless, data about the significance of cTn in elderly subjects with COVID-19 are lacking.Methods: From a registry of consecutive patients with COVID-19 admitted to a hub hospital in Italy from 25/02/2020 to 03/07/2020, we selected those ≥60 year-old and with cTnI measured within 3 days from the molecular diagnosis of SARS-CoV-2 infection. When available, a second cTnI value within 48 hours was also extracted. The relationship between increased cTnI and all-cause in-hospital mortality was evaluated by a Cox regression model and restricted cubic spline functions with three knots.Results: Of 343 included patients (median age 75.0 (68.0-83.0) years, 34.7% men), 88 (25.7%) had cTnI above the upper-reference limit (0.046 µg/L). Patients with increased cTnI had more comorbidities, greater impaired respiratory exchange and higher inflammatory markers on admission than those with normal cTnI. Furthermore, they died more (73.9% vs. 37.3%, p<0.001) over 15 (6-25) days of hospitalization. The association of elevated cTnI with mortality was confirmed by the adjusted Cox regression model (HR: 1.61, 95%CI: 1.06-2.52, p=0.039) and was linear until 0.3 µg/L, with a subsequent plateau. Of 191 (55.7%) patients with a second cTnI measurement, 49 (25.7%) had an increasing trend, which was not associated with mortality (univariate HR 1.39, 95%CI 0.87-2.22, p=0.265).Conclusions: In elderly COVID-19 patients, an initial increase in cTn is common and predicts a higher risk of death. Serial cTn testing may not confer additional prognostic information.

scholarly journals Prognostic and Predictive Value of m6A “Eraser” Related Gene Signature in Gastric Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Xin Xu ◽  
En Zhou ◽  
Jun Zheng ◽  
Chihao Zhang ◽  
Yinghua Zou ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Prognostic Factors ◽  
Regression Model ◽  
Cox Regression ◽  
Risk Group ◽  
Critical Role ◽  
Predictive Tool ◽  
Cox Regression Model ◽  
Risk Genes ◽  
Related Risk

BackgroundN6-methyladenosine (m6A) RNA modification plays a critical role in gastric cancer (GC). However, the relationship between the m6A “eraser”, FTO, and ALKBH5, and the prognosis of GC still remains unclear. This study aimed to evaluate the effect of FTO and ALKBH5 on the prognosis of patients and their potential roles in GC.Materials and MethodsA total of 738 GC samples with clinical information obtained from two independent datasets were included and divided into training set and testing set. Differential expression analysis of the m6A “eraser” related genes was performed. The LASSO Cox regression model was constructed to analyze the m6A “eraser” related risk genes. The univariate and multivariate Cox regression model were employed to identify the independent prognostic factors. Kaplan-Meier method was used for survival analysis. A nomogram model was then carried out to predict the prognosis of GC patients. Additionally, GO and KEGG analyses were conducted to identify the potential role of the m6A “eraser” related genes in GC. The relative proportion of 22 different genotypes in immune infiltrating cells was calculated by CIBERSORT algorithm.ResultsIn total, nine m6A “eraser” related risk genes and risk scores were obtained and calculated. Patients in high-risk group demonstrated significantly worse prognosis than those in low-risk group. Age, stage, and risk score were considered as independent prognostic factors. The nomogram model constructed accurately predicted the 3-year and 5-year overall survival (OS) of patients. Furthermore, m6A “eraser” might play a functional role in GC. The expression of m6A “eraser” leads to changes in tumor immune microenvironment.ConclusionsFTO and ALKBH5 showed association with the prognosis of GC. The m6A “eraser” related genes, which is considered as a reliable prognostic and predictive tool, assists in predicting the OS in GC patients.

scholarly journals 813. The Reduction of the acquisition rate of carbapenem resistant Acinetobacter baumannii after room privatization in the intensive care unit

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S448-S449
Author(s):  
Jongtak Jung ◽  
Pyoeng Gyun Choe ◽  
Chang Kyung Kang ◽  
Kyung Ho Song ◽  
Wan Beom Park ◽  
...  
Keyword(s):  
Regression Model ◽  
Acinetobacter Baumannii ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Intervention Group ◽  
Feeding Tube ◽  
Control Group ◽  
Cox Regression Model ◽  
Carbapenem Resistant ◽  
Hospital Acquired

Abstract Background Acinetobacter baumannii is one of the major pathogens of hospital-acquired infection recently and hospital outbreaks have been reported worldwide. On September 2017, New intensive care unit(ICU) with only single rooms, remodeling from old ICU with multibed bay rooms, was opened in an acute-care tertiary hospital in Seoul, Korea. We investigated the effect of room privatization in the ICU on the acquisition of carbapenem-resistant Acinetobacter baumannii(CRAB). Methods We retrospectively reviewed medical records of patients who admitted to the medical ICU in a tertiary care university-affiliated 1,800-bed hospital from 1 January 2015 to 1 January 2019. Patients admitted to the medical ICU before the remodeling of the ICU were designated as the control group, and those who admitted to the medical ICU after the remodeling were designated as the intervention group. Then we compared the acquisition rate of CRAB between the control and intervention groups. Patients colonized with CRAB or patients with CRAB identified in screening tests were excluded from the study population. The multivariable Cox regression model was performed using variables with p-values of less than 0.1 in the univariate analysis. Results A total of 1,105 cases admitted to the ICU during the study period were analyzed. CRAB was isolated from 110 cases in the control group(n=687), and 16 cases in the intervention group(n=418). In univariate analysis, room privatization, prior exposure to antibiotics (carbapenem, vancomycin, fluoroquinolone), mechanical ventilation, central venous catheter, tracheostomy, the presence of feeding tube(Levin tube or percutaneous gastrostomy) and the length of ICU stay were significant risk factors for the acquisition of CRAB (p&lt; 0.05). In the multivariable Cox regression model, the presence of feeding tube(Hazard ratio(HR) 4.815, 95% Confidence interval(CI) 1.94-11.96, p=0.001) and room privatization(HR 0.024, 95% CI 0.127-0.396, p=0.000) were independent risk factors. Table 1. Univariate analysis of Carbapenem-resistant Acinetobacter baumannii Table 2. Multivariable Cox regression model of the acquisition of Carbapenem-resistant Acinetobacter baumannii Conclusion In the present study, room privatization of the ICU was correlated with the reduction of CRAB acquisition independently. Remodeling of the ICU to the single room would be an efficient strategy for preventing the spreading of multidrug-resistant organisms and hospital-acquired infection. Disclosures All Authors: No reported disclosures

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