Prostatectomy in men with clinically positive lymph nodes.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 327-327
Author(s):  
Fady Ghali ◽  
Stephen Ryan ◽  
Moritz Hansen ◽  
Matthew Hayn ◽  
Jesse Sammon ◽  
...  
Keyword(s):  
High Risk ◽  
Lymph Nodes ◽  
Systemic Therapy ◽  
Clinical Staging ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Cox Proportional Hazard ◽  
Biopsy Gleason Score ◽  
Positive Lymph Nodes

327 Background: A prostate cancer (PCa) patient with non-metastatic but clinical positive lymph nodes (cN+) represents a difficult clinical scenario. We compared OS after RP in cN- (High Risk), cN+/pN- (Discordant), and cN+/pN+ (Concordant). Methods: The National Cancer Database was queried for all PCa patients from 2004-2013. Inclusion criteria were known age and PSA at diagnosis, biopsy Gleason score, TNM staging (cT1-3B, cN0/1, M0/X), margin, nodal status and primary treatment modality. cN+ was separated into two cohorts: pN- (Discordant) and pN+ (Concordant). RPs for High Risk PCa (cT3a/b or GS ≥ 8 or PSA > 20) with cN- was used as a comparison. OS was analyzed with Kaplan Meier (KMA) and Cox proportional hazard model combing demographic, clinical, and pathological factors. Results: 4944 cN+ men were identified (21.7% RP, 27.5% systemic therapy only). 794 RPs had completed records. Discordant and Concordant represented 18.8% and 81.2% with median follow-up 48 and 48.9 months, and 13 and 97 deaths, respectively. KMA pairwise OS of High Risk (n=35, 502) verses Discordant was not significant (p=0.28) but was significant verses Concordant (p < 0.001). There was no difference in OS on KMA between Discordant and Concordant (p=0.11). OS on Cox proportional hazard model, High Risk and Discordant had no observable difference (p=1.22). Concordant pathology had much worsened OS (HR 1.829, p < 0.001), as well as Medicaid/Medicare patients (HR 1.344, p < 0.001), biopsy Gleason score ≥ 8 (HR 1.350, p=0.0019), pathologic T stage (pT3a HR 1.567, pT3b 2.396, p < 0.001), and positive surgical margin (HR 1.257, p < 0.001). Conclusions: In a large cohort of nonmetastatic PCa patients with cN+ disease, > 27% were treated with systemic therapy based on clinical staging, but 18.8% of cN+ RPs were incorrectly staged. There was no difference in OS between cN- High Risk patients and pathologic Discordant (cN+/pN-) men, and the much worse OS in men with pN+. Study is needed for more accurate clinical staging tools to identify the pathologically discordant population.

scholarly journals Identification of Gene Markers for Survival Prediction of Lung Adenocarcinoma Patients Based on Integrated Multibody Data Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Yuwang Bao ◽  
Jianxiong Luo ◽  
Tianxing Yu ◽  
Yang Liu ◽  
Xiaohua Li ◽  
...  
Keyword(s):  
High Risk ◽  
Lung Adenocarcinoma ◽  
Risk Group ◽  
Clinical Information ◽  
High Risk Group ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Cox Proportional Hazard ◽  
Information Group

We constructed a prognostic-related risk prediction for patients with lung adenocarcinoma by integrating multiple omics information of lung adenocarcinoma clinical information group and genome and transcriptome. Blood samples and cancer and paracancerous lung tissue samples were collected from 480 patients with lung adenocarcinoma. DNA and RNA sequencing was performed on DNA samples and RNA samples. The first follow-up was carried out 3 months after discharge. Clinical information of patients including age, gender, smoking history, and TNM stage was collected. The Cox proportional hazard model evaluated more than 600 potential SNPs related to the prognosis of lung adenocarcinoma. After LASSO analysis, we obtained 4 SNPs related to the prognosis of lung adenocarcinoma (including rs1059292, rs995343, rs2013335, and rs8078328). Through the Cox proportional hazard model, 260 candidate genes related to the prognosis of lung adenocarcinoma were evaluated. After subsequent analysis, 3 genes related to the prognosis of lung adenocarcinoma (LDHA, SDHC, and TYMS) were obtained. All survived patients were spilt into a high-risk group ( n = 170 ) and a low-risk group ( n = 170 ) according to 4 SNPs and 3 genes related to the prognosis of lung adenocarcinoma. The overall survival rate of patients in the high-risk group was lower than that in the low-risk group. The prognostic risk prediction index constructed by combining clinical information group and genomic and transcriptome characteristics of multiomics information can effectively distinguish the prognosis of patients with lung adenocarcinoma, which will provide effective support for the precise treatment of patients with lung adenocarcinoma.

scholarly journals Molecular-Based Score Inspired on Metabolic Signature Improves Prognostic Stratification for Myelodysplastic Syndrome

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4257-4257
Author(s):  
Juan L Coelho-Silva ◽  
Douglas R. A. Silveira ◽  
Diego A Pereira-Martins ◽  
César Alexander Ortiz Rojas ◽  
Antonio R. Lucena-Araujo ◽  
...  
Keyword(s):  
Gene Expression ◽  
Overall Survival ◽  
Multivariate Analysis ◽  
High Risk ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Cox Proportional Hazard ◽  
C Statistic ◽  
Cd34 Cells

Background : The recent efforts to uncover the molecular heterogeneity of myelodysplastic syndromes (MDS), mainly by new sequencing technologies, allow the comprehensive identification of driver mutations and/or altered gene expression recurrently found in a recognizable fraction of patients. Ongoing efforts are being made to clarify the impact of molecular changes on clinical phenotype and prognosis, as well as their role in the pathogenesis of MDS. Refining risk stratification allows the proposition of risk-adapted therapy and may shed light in biology of MDS. Aims: Based on the gene expression of selected metabolic targets, we aimed to design a score system that improves MDS overall survival prediction. Patients and methods: Clinical, mutations and transcriptomic data from CD34+ cells from 159 MDS patients and 17 healthy volunteers freely available at Gene Expression Omnibus (GEO/NCBI: GSE58831) were used in the present work. Forty-one genes related to metabolic processes, previously demonstrated as deregulated among diverse neoplastic conditions, were ranked and asked for differential expression and prognostic impact. Each gene was dichotomized according to Receiving-Operating Curve (ROC) and Cox Proportional-Hazard Model was used for multivariate analysis using gender, age and IPSS-R as cofounders. Genes independently associated with overall survival (OS) were selected to compose the Molecular-Based Score (MBS) and integer weight of each one was defined according Hazard Ratio (HR). Survival curves were constructed using Kaplan-Meyer method and compared with Log-Rank Test. ROC c-statistic was used to measure the predictive function of MBS. Prediction accuracy of MBS was cross-validated by a nonparametric bootstrap procedure with 1,000 resamplings of the original cohort allowing replacement and also estimated their respective 95% confidence interval (95% CI) computing the bias-corrected and accelerated bootstrap interval. Results: Among selected genes, 18 were differentially expressed between CD34+ cells from MDS and healthy volunteers. Fifteen genes predict OS in univariate analysis, of which ACLY (HR: 0.48; 95%CI: 0.24 - 0.96; P=0.04), ANPEP (HR: 2.16; 95%CI: 1.08 - 4.31; P=0.02), PANK1 (HR: 0.43; 95%CI: 0.19 - 0.98; P=0.04), PKM (HR: 2.01; 95%CI: 1.02 - 3.93; P=0.04) and SLC25A5 (HR: 0.52; 95%CI: 0.27 - 0.99; P=0.05) were independently associated with OS. Higher expression of ANPEP and PKM, as well as lower expression of ACLY, PANK1 and SLC25A5 were considered to integer high risk being attributed weight 2 for each condition. MBS varied from 0 to 10 (median=2) and was calculated as: MBS Low-Risk =0 (MBS-LR; n=28); MBS Intermediate-Risk=2 and 4 (MBS-IR; n=90) and High-Risk: ≥6 (MBS-HR; n=48). The modeled MBS showed a ROC c-statistic of 0.699 (95%CI: 0.603 - 0.794) and HR=3.05 (95%CI: 1.81 - 5.05; P<0.001) and efficiently identified patients with different risk: MBS-LR (3-year OS: 100%; median time [MT]: not reached); MBS-IR (3-year OS: 66% [95%CI: 53% - 83%]; MT: 52.2 months [95%CI: 34.2 - 71.5]) and MBS-HR (3-year OS: 32% [95%CI: 17% - 61%]; MT: 23.5 months [95%CI: 11.6 - 35.4]). Using Cox Proportional Hazard Model for multivariate analysis, the proposed MBS (HR:2.5 [95%CI: 1.2-4.96]; P=0.008) was independently associated with OS using gender (HR:0.48 [95%CI: 0.21-1.06]; P=0.07), age (HR:1.03 [95%CI: 1.001-1.07]; P=0.02) and IPSS-R (HR:0.98 [95%CI: 0.69-1.36]; P=0.88) as confounders. The bootstrap resampling procedure validated the MBS and demonstrated the stability of its prediction (3-year OS for MBS-LR: 100% [95%CI: 100-100%]; MBS-IR: 66% [95%CI: 49-80%]; MBS-HR: 32% [95%CI: 13-54%]; P<0.001). Conclusions: The proposed Molecular-Based Score (MBS) independently predict OS with superior efficacy in comparison to the most clinically relevant prognostic factors, and reinforce the therapeutic opportunity of metabolic processes in MDS. Figure Disclosures No relevant conflicts of interest to declare.

Validation of a five reagent immunohistochemistry assay for prognostication of estrogen-receptor expressing breast cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10081-10081
Author(s):  
D. T. Ross ◽  
A. R. Frost ◽  
R. Beck ◽  
R. S. Seitz ◽  
B. Z. Ring
Keyword(s):  
Breast Cancer ◽  
Estrogen Receptor ◽  
High Risk ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Breast Cancer Patients ◽  
Proportional Hazard Model ◽  
Cox Proportional Hazard ◽  
Estrogen Receptor Positive ◽  
Risk Patients

10081 Background: We have previously reported the translation of gene expression data into a five reagent polyclonal antibody immunohistochemistry assay targeting p53, SLC7A5, NDRG1, HTF9C, and CEACAM5 whose staining results are combined using a Cox proportional hazard model for prognostication of estrogen receptor expressing breast cancer. Monoclonal antibodies targeting these genes have now been obtained and or produced. Methods: Paraffin blocks from 229 patients seen at the University of Alabama at Birmingham Clinical Cancer Center were assembled into tissue arrays and clinical follow-up data was collected by chart review. Immunohistochemical stains were performed and cases scored as positive or negative with the five monoclonal antibody assay. In order to further test the assays predictive value for assessing outcome, the prospectively defined Cox proportional hazard model and high, moderate, and low risk cutoffs were applied to the staining results on the estrogen receptor positive (ER+) patients for whom a assessment of death due to disease (DOD) and staining results for all five biomarkers were available. Results: The Kaplan-Meier estimates of outcome confirmed that the Cox model distinguished ER+ patients with poor outcomes. The five antisera algorithm identified high risk patients with a five year estimate of DOD of 41% compared to 20% for moderate and 9% for good (p=0.006) (79 patients total). In ER+ node negative patients the model identified high risk patients with a five year estimate of DOD of 50% compared to 18% for moderate and 5% for good (p=0.01) (40 patients total). The prognosticator was independent of age, pathological stage, and tumor size. Conclusions: A panel of five antibodies can significantly improve upon traditional prognosticators in predicting outcome for estrogen receptor positive breast cancer patients. This represents the third independent validation study performed on cohorts from different institutions. Retrospective studies on clinical trial cohorts and prospective studies should be performed to further establish the utility of this test in identifying early stage breast cancer patients at high risk for recurrence. [Table: see text]

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 POS1329 A COHORT STUDY ON THE RISK OF DEVELOPING OBSTRUCTIVE SLEEP APNEA, TEMPOROMANDIBULAR JOINT DISORDERS AND CRANIOFACIAL DEFORMITIES IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 947.1-947
Author(s):  
K. S. K. MA ◽  
L. T. Wang
Keyword(s):  
Obstructive Sleep Apnea ◽  
Cohort Study ◽  
Juvenile Idiopathic Arthritis ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Cox Proportional Hazard ◽  
Obstructive Sleep ◽  
Subgroup Analyses ◽  
Underlying Mechanisms

Background:Juvenile Idiopathic Arthritis (JIA), an autoimmune disease, has been proposed to be comorbid with obstructive sleep apnea (OSA).Objectives:We aimed at identifying the relationship between JIA and OSA.Methods:We performed a cohort study including JIA and OSA patients from 1999 to 2013. A total of 2791 patients diagnosed with OSA after JIA onset were recruited, which 11,164 eligible individuals without JIA history were selected as matched-controls. A Cox proportional hazard model was developed to estimate the risk of OSA in JIA patients. A cumulative probability model was adopted to assess the time-dependent effect of JIA on OSA development, implying the casual link of the association. To identify whether JIA patients have higher risks for developing temporomandibular joint (TMJ) disorders, craniofacial anomalies and deformities than non-JIA individuals, subgroup analyses was conducted. Finally, Ingenuity Systems Pathway Analysis (IPA) was conducted to identify underlying mechanisms of the above disease correlation among peripheral blood mononuclear cells (PBMCs) from rheumatic factor (RF)-positive and RF-negative JIA patients, and subcutaneous fat tissues from OSA patients, using p-value visualization for RNA-seq analyses.Results:The Cox proportional hazard model showed that JIA patients were more likely to have OSA than non-JIA individuals (adjusted hazard ratio =1.949, 95% CI =1.264–3.005). The incidence of developing OSA was particularly high among patients who developed JIA aged 18-30 years old (aHR= 2.034, 95% CI=1.305-3.169) and males (aHR=1.82, 95% CI=1.121-2.954). The risk of developing OSA increased within 0-36 months (aHR = 2.216, 95% CI = 1.001 – 4.907) and over 60 months (aHR = 2.558, 95% CI = 1.346 – 4.860) of follow-up duration after JIA onset. Subgroup analyses showed that JIA patients were more likely to have TMJ disorders (relative risk = 2.047, 95% CI = 1.446-2.898) and to receive treatment for craniofacial deformities (RR = 1.722, 95% CI = 1.38-2.148) than non-JIA controls. IPA analyses suggested that the underlying mechanisms involved activation of antigen presentation pathway followed by antigen presentation to CD4+ and CD8+ T lymphocytes, as well as B cell development.Conclusion:Our findings identified high risks of developing OSA, TMJ disorders, and craniofacial deformities following JIA onset, which the underlying mechanisms may involve both cellular and humoral immunity.Disclosure of Interests:None declared

scholarly journals Proton pump inhibitor is a risk factor for recurrence of common bile duct stones after endoscopic sphincterotomy – propensity score matching analysis

2017 ◽  
Vol 05 (04) ◽  
pp. E291-E296
Author(s):  
Nobuhiko Fukuba ◽  
Shunji Ishihara ◽  
Hiroki Sonoyama ◽  
Noritsugu Yamashita ◽  
Masahito Aimi ◽  
...  
Keyword(s):  
Bile Duct ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Common Bile Duct Stones ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Bile Duct Stones ◽  
Proportional Hazard Model ◽  
Propensity Score Matching Analysis ◽  
Cox Proportional Hazard

Abstract Background and study aims Recurrence of common bile duct stones (CBDS) in patients treated with endoscopic sphincterotomy (ES) can lead to deterioration in their quality of life. Although the pathology and related factors are unclear, we speculated that proton pump inhibiter (PPI) administration increases the risk of CBDS recurrence by altering the bacterial mixture in the bile duct. Patients and methods The primary endpoint of this retrospective study was recurrence-free period. Several independent variables considered to have a relationship with CBDS recurrence including PPI use were analyzed using a COX proportional hazard model, with potential risk factors then evaluated by propensity score matching analysis. Results A total of 219 patients were analyzed, with CBDS recurrence found in 44. Analysis of variables using a COX proportional hazard model demonstrated that use of PPIs and ursodeoxycholic acid (UDCA), as well as the presence of periampullary diverticula (PD) each had a hazard ratio (HR) value greater than 1 (HR 2.2, P = 0.007; HR 2.0, P = 0.02; HR 1.9, P = 0.07; respectively). Furthermore, propensity score matching analysis revealed that the mean recurrence-free period in the oral PPI cohort was significantly shorter as compared with the non-PPI cohort (1613 vs. 2587 days, P = 0.014). In contrast, neither UDCA administration nor PD presence was found to be a significant factor in that analysis (1557 vs. 1654 days, P = 0.508; 1169 vs. 2011 days, P = 0.121; respectively). Conclusion Our results showed that oral PPI administration is a risk factor for CBDS recurrence in patients who undergo ES.

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 Hospital admissions in children who had pelvicalyceal diltation detected on ultrasound scan during pregnancy: an e-cohort study

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Melissa Wright ◽  
Shantini Paranjothy ◽  
David Fone ◽  
Sinead Brophy ◽  
Joanne Demmler
Keyword(s):  
Hospital Admissions ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Ultrasound Scan ◽  
Second Trimester ◽  
Proportional Hazard Model ◽  
Activity Data ◽  
Cox Proportional Hazard ◽  
Uncertain Significance ◽  
The Impact

ABSTRACTObjectiveTo explore whether children with pelvicalyceal dilatation (PCD, a marker detected during the 18-20 week gestation ultrasound scan in which there is enlargement of tubes that collect urine in the kidney) have more hospital admissions for kidney problems in childhood compared to children without the marker. Approach We were funded by NISCHR to study outcomes associated with markers of uncertain significance at the second trimester anomaly scan (Welsh Study of Mothers and Babies). Data collected in the WSMB was uploaded to the Secure Anonymised Information Linkage (SAIL) databank and record linked to hospital activity data. Patterns of hospital admissions for renal causes were described and compared between those with no markers and those with PCD. Children were followed up from birth until 31st December 2014 or until the age of 5. A Cox Proportional Hazard Model was used to investigate the impact of PCD on time to first presentation. Results (Preliminary)Of the WSMB cohort, 20,834 children were eligible for inclusion in analyses. Those with PCD had 6.29 times the hazard of a renal admission compared to those without the marker (95% CI: 3.69 to 10.72). Children with PCD were more likely to have multiple renal admissions to hospital - median (interquartile range) number of renal admissions, 2.5 (1 to 5) compared to 1 (1 , 1) in children without markers. ConclusionPreliminary analysis suggests there is increased childhood renal morbidity associated with the presence of a PCD marker detected on the 18-20 week gestation ultrasound scan. These findings will inform the discussions clinicians have with parents when discussing the implications of this marker for the health of the chid.

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