scholarly journals Impact of lymphopenia on survival for elderly patients with glioblastoma: A secondary analysis of the CCTG CE.6 (EORTC 26062-22061, TROG03.01) randomized clinical trial.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2547-2547
Author(s):  
Andrew Jehyun Song ◽  
Keyue Ding ◽  
Normand Laperriere ◽  
James R. Perry ◽  
Warren P. Mason ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Regression Models ◽  
Cox Regression ◽  
Multinomial Logistic Regression ◽  
Secondary Analysis ◽  
Extent Of Resection ◽  
Logistic Regression Models ◽  
Short Course ◽  
Grade 3 ◽  
The Impact

2547 Background: Lymphopenia (LMP) may lead to worse outcomes for patients with glioblastoma (GBM). This study is a secondary analysis of the CCTG CE.6 trial evaluating the impact of chemotherapy and radiation on LMP, as well as the association of LMP with overall survival. Methods: CCTG clinical trial CE.6 randomized elderly GBM patients (≥ 65 yrs) to short course radiation alone (RT) or short course radiation with temozolomide (RT + TMZ). In this study LMP (mild-mod: grade 1-2; severe: grade 3-4) was defined per CTCAE v3.0 criteria, and measured at baseline, 1 wk and 4 wks post-RT. Pre-selected key factors for the analysis included age, sex, ECOG, extent of resection, MGMT methylation, MMSE, and steroid use. Multinomial logistic regression models were used to identify factors associated with LMP and multivariable Cox regression models were used to study effect of LMP on survival. Results: A total of 562 patients were included for analysis (281 RT vs 281 RT+TMZ). At baseline, both arms (RT vs RT+TMZ) had similar rates of mild-mod (21.4% vs 21.4%) and severe (3.2% vs 2.9%) LMP. The 1 wk post-RT LMP rates were also similar (p = 0.25). However, RT+TMZ pts were more likely to develop both mild-mod LMP (18.2% vs 27.9%) and severe LMP (1.8% vs 9.3%) [p < 0.001] at 4 wks post-RT. Developing mild-mod and severe LMP post-RT were both associated with baseline LMP (p < 0.001) and RT+TMZ (p < 0.001). Severe LMP at 4 wks post-RT was also associated with biopsy only (p < 0.02). After adjusting for confounding factors, 4 wks post-RT LMP was not significantly associated with PFS or OS regardless of severity. However, baseline LMP (HR 1.3) was significantly associated with worse OS (HR: 1.30, 95% C.I.: 1.05-1.62, p = 0.02), regardless of MGMT status. Other factors significantly associated with worse outcome included: males (HR 1.41), biopsy only (HR 1.59), and lower MMSE (HR 1.03). Conclusions: Short course RT alone does not lead to LMP after treatment. Development of LMP post-RT is associated with addition of TMZ and baseline LMP. However, only baseline LMP is associated with worse OS regardless of MGMT status. This may be considered as a prognostic biomarker for elderly GBM patients and warrants further validation. Clinical trial information: NCT00482677 .

scholarly journals Impact of lymphopenia on survival for elderly patients with glioblastoma: A secondary analysis of the CCTG CE.6 (EORTC 26062-22061, TROG03.01) randomized clinical trial

2021 ◽  
Author(s):  
Andrew J Song ◽  
Keyue Ding ◽  
Iyad Alnahhas ◽  
Normand J Laperriere ◽  
James Perry ◽  
...  
Keyword(s):  
Regression Models ◽  
Cox Regression ◽  
Prognostic Biomarker ◽  
Multinomial Logistic Regression ◽  
Secondary Analysis ◽  
Key Factors ◽  
Short Course ◽  
Grade 3 ◽  
The Impact ◽  
Severe Grade

Abstract Background Lymphopenia may lead to worse outcomes for glioblastoma patients. This study is a secondary analysis of the CCTG CE.6 trial evaluating the impact of chemotherapy and radiation on lymphopenia, and effects of lymphopenia on overall survival (OS). Methods CCTG CE.6 randomized elderly glioblastoma patients (≥ 65 yrs) to short course radiation alone (RT) or short course radiation with temozolomide (RT + TMZ). Lymphopenia (mild-moderate: grade 1-2; severe: grade 3-4) was defined per CTCAE v3.0, and measured at baseline, 1 wk and 4 wks post-RT. Pre-selected key factors for analysis included age, sex, ECOG, resection extent, MGMT methylation, MMSE, and steroid use. Multinomial logistic regression and multivariable Cox regression models were used to identify lymphopenia-associated factors and association with survival. Results 562 patients were analyzed (281 RT vs 281 RT+TMZ). At baseline, both arms had similar rates of mild-moderate (21.4% vs 21.4%) and severe (3.2% vs 2.9%) lymphopenia. However, at 4 weeks post-RT, RT+TMZ was more likely to develop lymphopenia (mild-moderate: 27.9% vs 18.2%; severe: 9.3% vs 1.8%; p&lt;0.001). Developing any lymphopenia post-RT was associated with baseline lymphopenia (p&lt;0.001). Baseline lymphopenia (HR 1.3) was associated with worse OS (HR: 1.30, 95% C.I. 1.05-1.62; p = 0.02), regardless of MGMT status. Conclusions Development of post-RT lymphopenia is associated with addition of TMZ and baseline lymphopenia and not with RT alone in patients treated with short-course radiation. However, regardless of MGMT status, only baseline lymphopenia is associated with worse OS, which may be considered as a prognostic biomarker for elderly glioblastoma patients.

Comorbidity is associated with disease activity in MS

Neurology ◽  
2020 ◽  
Vol 95 (5) ◽  
pp. e446-e456 ◽  
Author(s):  
Amber Salter ◽  
Kaarina Kowalec ◽  
Kathryn C. Fitzgerald ◽  
Gary Cutter ◽  
Ruth Ann Marrie
Keyword(s):  
Clinical Trial ◽  
Disease Activity ◽  
Cox Regression ◽  
Secondary Analysis ◽  
Large Trial ◽  
Comorbid Conditions ◽  
Comorbidity Burden ◽  
Concomitant Medications ◽  
Comorbidity Status ◽  
The Impact

ObjectiveTo determine whether comorbidity is associated with clinical (relapses, disability worsening) and MRI outcomes in multiple sclerosis (MS) by conducting a secondary analysis of the CombiRx clinical trial.MethodsCombiRx compared interferon beta-1a, glatiramer acetate, and the combination of these agents. For participants eligible for evaluation of 6-month confirmed disability worsening, we used medical history, concomitant medications, and adverse events to ascertain comorbidity status. Comorbid conditions evaluated included hypertension, dyslipidemia, diabetes mellitus, depression, anxiety disorders, and migraine. Clinical outcomes included disease activity consisting of protocol-defined relapses, disability worsening, and MRI activity. We summarized the prevalence of these comorbid conditions and their association with disease activity and its components using multivariable Cox regression.ResultsOf the 1,008 participants randomized, 959 (95.1%) were eligible for assessment of 6-month disability worsening; for this subgroup, the median length of follow-up was 3.4 years (range 0.5–6.9 years). Overall, 55.1% of participants had ≥1 comorbidity at enrollment. After adjustment, anxiety (hazard ratio [HR] 1.25, 95% confidence interval [CI] 1.01–1.55) and dyslipidemia (HR 1.32, 95% CI 1.01–1.72) were associated with an increased hazard of any disease activity, while migraine (HR 0.80, 95% CI 0.67–0.97) was associated with a decreased hazard.ConclusionsIn this large trial population with rigorously obtained outcomes, comorbid conditions were common among participants and influenced disease outcomes, including relapses. The comorbidity burden of clinical trial participants with MS may be an important factor in the outcome of clinical trials. Additional investigations of the impact of comorbidity on clinical trial outcomes and response to disease-modifying therapies are warranted.

scholarly journals To Move Home or Move On? Investigating the Impact of Recovery Aid on Migration Status as a Potential Tool for Disaster Risk Reduction in the Aftermath of Volcanic Eruptions in Merapi, Indonesia

2019 ◽  
Author(s):  
Jonathan A. Muir ◽  
Michael R. Cope ◽  
Jorden E. Jackson ◽  
Leslie R. Angeningsih
Keyword(s):  
Risk Reduction ◽  
Regression Models ◽  
Multinomial Logistic Regression ◽  
Forced Migration ◽  
Volcanic Eruptions ◽  
Migration Status ◽  
Logistic Regression Models ◽  
The Impact ◽  
Financial Recovery ◽  
Potential Tool

Disasters are associated strongly with forced migration. Indeed, migration is a standard survival strategy for those facing disruptions of this kind. Such is the case with Mt. Merapi, Indonesia, where a series of eruptions occurred in 2010. Mechanisms related to forced migration in such scenarios are fairly well understood, yet it remains less clear what factors may influence return migration. Given local interest in facilitating resettlement out of hazardous areas as a means of risk reduction, we seek to better understand the extent to which recovery aid may create incentives for households to move on rather than move home. We draw upon data collected from a pilot study in the aftermath of the 2010 eruptions and use multinomial logistic regression models to explore the influence of various forms of aid on migration status. Of the various forms of aid considered, financial recovery aid provided to households was consistently associated with moving on. The combination of financial recovery aid with remittances resulted in an association with having moved on that was even stronger than just receiving financial recovery aid. Ultimately, analyses of "aid packages'" suggest that a combination of most, if not all, of the aid was relatively more effective in fostering resettlement, suggesting that while food and health recovery aid as well as remittances may not have been sufficient in and of themselves to increase resettlement, they may enhance the effect of financial recovery aid.

Destination labels for historic villages: The impact on perception, experience, and satisfaction

2021 ◽  
pp. 146735842110207
Author(s):  
Cecilia Chirieleison ◽  
Alessandro Montrone ◽  
Luca Scrucca
Keyword(s):  
Regression Models ◽  
Multinomial Logistic Regression ◽  
Policy Implications ◽  
Logistic Regression Models ◽  
Personal Involvement ◽  
Destination Competitiveness ◽  
Quality Rating ◽  
Tourism Destinations ◽  
The Impact

Many historic villages are trying to exploit the appeal of cultural heritage, an authentic atmosphere, and beautiful landscapes to emerge as rural tourism destinations. This study investigated the capacity of destination certifications and labels to positively influence tourists’ perceptions, experiences, and satisfaction from the perspective of destination competitiveness. As a case study, we selected an Italian village which was awarded the label of one of ‘The Most Beautiful Villages in Italy’. Multinomial logistic regression models were fitted to investigate differences in the ratings of tourists who were or were not aware of the label. The results suggested that the label could provide a significant competitive advantage to tourism in historic villages. Indeed, tourists who were aware of the label were more likely to rate their experience higher in terms of authenticity, personal involvement, and memorability. They also reported higher overall satisfaction and re-visit intentions. A relationship between tourists’ awareness of the label and the likelihood of a positive quality rating emerged only for those attributes strictly related with the main focus of the label. The findings of this study have important policy implications for historic villages’ tourism development.

scholarly journals INFLUENCE OF HOSPITALIZATION UPON DIAGNOSIS ON THE RISK OF TUBERCULOSIS CLUSTERING

2013 ◽  
Vol 5 (1) ◽  
pp. e2013071 ◽  
Author(s):  
Giuseppe Lapadula ◽  
Fabio Zanini ◽  
Luigi Codecasa
Keyword(s):  
Regression Models ◽  
Fragment Length Polymorphism ◽  
Multivariable Analysis ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Short Course ◽  
Mdr Tb ◽  
The Impact ◽  
Culture Positive ◽  
Design Restriction

Setting: Culture-positive tuberculosis (TB) diagnosed in the metropolitan area of Milan (Italy) over a 5-year period (1995-1999). Objective: To assess the impact of short-course hospitalization upon diagnosis on the overall risk of TB clusterization. Design: Restriction fragment length polymorphism profiles with a similarity of 100% defined a cluster. Uni- and multivariable logistic regression models were performed to assess factors associated with clusterization. Results: Among 1139 patients, 392 (34.4%) were hospitalized before or soon after diagnosis, 405 (35.6%) received domiciliary treatment since the diagnosis and 392 (30%) had no information about initial clinical management. One hundred fifteen molecular clusters involving 363 patients were identified. Using multivariable analysis, hospitalization was not significantly associated with clusterization (OR 1.06, 95%CI 0.75-1.50, p=0.575). Subjects aged >65 years old (OR 0.60; 95CI%:0.37-0.95; p=0.016) and non-Italian born patients (OR 0.56; 95%CI:0.41-0.76; p<0.001) were running a lower risk of clusterization. Conversely, HIV co-infected patients (OR 1.88, 95%CI:1.20-2.95, p=0.006) and those with MDR TB (OR 2.50, 95%CI:1.46-4.25, p=0.001) were significantly more likely to be involved in clusters. Conclusion: In our cohort, domiciliary treatment was not associated with TB clusterization. Expanding domiciliary treatment upon diagnosis appears as an advisable measure to reduce unnecessary costs for the health care system.

Impact of the addition of bevacizumab (Bev) to chemotherapy on survival in metastatic colorectal cancer (MCRC): A real-world population-based analysis.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18215-e18215
Author(s):  
Sunand Nageswaran Kannappan ◽  
Rahul Krishan Arora ◽  
Winson Y. Cheung
Keyword(s):  
Real World ◽  
Systemic Therapy ◽  
Regression Models ◽  
Cox Regression ◽  
Single Agent ◽  
Population Based ◽  
World Population ◽  
Entire Cohort ◽  
Logistic Regression Models ◽  
The Impact

e18215 Background: The addition of bev to IFL chemotherapy in MCRC was shown to improve survival in clinical trials, but its benefit in the real-world where it is frequently used with other systemic therapy regimens has not been fully evaluated. We aimed to assess the impact of bev on MCRC outcomes in a population-based setting. Methods: We examined all patients diagnosed with MCRC from a large Canadian province between 2004 and 2016. We categorized cases based on receipt of bev. Predictors of bev use were examined with multivariate logistic regression models. We also determined correlates of overall survival (OS) and disease specific survival (DSS) using Kaplan-Meier methods and Cox regression models, adjusting for measured confounders. Results: In total, 1,324 MCRC patients received systemic therapy. Median age was 68 years and 728 (55.0%) were men. Among them, 310 (23.4%) received bev. Younger age and better Charlson comorbidity score were associated with a higher likelihood of bev treatment (all p < 0.05). In multivariate analysis, bevacizumab receipt did not correlate with OS or DSS for the entire cohort or for those who received bev with single agent chemotherapy (see Table). However, use of bev was correlated with improved outcomes for patients treated with oxaliplatin-based chemotherapy (HR for OS: 0.751 [0.571 – 0.987], p = 0.040; HR for DSS: 0.680 [0.502 – 0.920], p = 0.013), but worse outcomes for irinotecan-based chemotherapy (HR for OS: 1.327 [1.083 – 1.628], p = 0.006; HR for DSS: 1.309 [1.054 – 1.627], p = 0.015). Conclusions: Bev was only associated with improved survival when used with specific chemotherapy regimens. Table: Univariate and multivariate survival analysis for MCRC patients based on receipt of bevacizumab. m = median; (m) = months; HR = hazard ratio [Table: see text]

Head Circumference within the Normal Range and Neurodevelopmental Outcomes in Preterm Infants

2021 ◽  
Author(s):  
Elisa T. Bushman ◽  
Christina Blanchard ◽  
Rachael G. Sinkey ◽  
Stacy Harris ◽  
Brian Casey ◽  
...  
Keyword(s):  
Head Circumference ◽  
Regression Models ◽  
Controlled Trial ◽  
Secondary Analysis ◽  
Continuous Variable ◽  
Linear Regression Models ◽  
Normal Range ◽  
Neurodevelopmental Outcomes ◽  
Logistic Regression Models ◽  
The Impact

Objective We sought to determine if variation in head circumference (HC) within the range of normal (5th–10th and 90th–95th percentile) is associated with poor neurodevelopmental outcomes (NDO), which defined as mild or moderate delay by Bayley II psychometrics (BSID-II). Study Design This is a secondary analysis of a randomized controlled trial assessing the benefits of magnesium for the prevention of cerebral palsy. Fetuses with a normal HC at birth defined as within 5th to 95th percentile were included. NDO were assessed at age 2 with BSID-II. Moderate delay was defined as a score <70 and mild delay as <85. HC was classified as small normal (5th–10th percentile), normal (10th–90th percentile), and large normal (90th–95th percentile). Logistic regression models adjusted for confounding. Linear regression models estimated the impact for every 1 cm of change in HC. Results Of 1,236 included infants, 111 (8%) had small normal HC; 1,058 (85%) had normal HC; and 67 (5%) had large normal HC. Baseline characteristics were similar between groups. There was no association with changes in HC within the range of normal and developmental indices. When considered as a continuous variable, every 1 cm increase in HC was also not associated with a significant change in developmental indices. Conclusion Within the normal range (5th–95th percentile), changes in HC did not correlate with changes in NDO at 2 years as measured by Bayley II scales. Key Points

The impact of SPY angiography on intraoperative decision making and outcomes for post-mastectomy reconstruction

2019 ◽  
pp. 1-5
Keyword(s):  
Decision Making ◽  
Logistic Regression ◽  
Skin Necrosis ◽  
Regression Models ◽  
Multivariable Analysis ◽  
P Value ◽  
Flap Necrosis ◽  
Single Institution ◽  
Logistic Regression Models ◽  
The Impact

Objective: While the use of intraoperative laser angiography (SPY) is increasing in mastectomy patients, its impact in the operating room to change the type of reconstruction performed has not been well described. The purpose of this study is to investigate whether SPY angiography influences post-mastectomy reconstruction decisions and outcomes. Methods and materials: A retrospective analysis of mastectomy patients with reconstruction at a single institution was performed from 2015-2017.All patients underwent intraoperative SPY after mastectomy but prior to reconstruction. SPY results were defined as ‘good’, ‘questionable’, ‘bad’, or ‘had skin excised’. Complications within 60 days of surgery were compared between those whose SPY results did not change the type of reconstruction done versus those who did. Preoperative and intraoperative variables were entered into multivariable logistic regression models if significant at the univariate level. A p-value <0.05 was considered significant. Results: 267 mastectomies were identified, 42 underwent a change in the type of planned reconstruction due to intraoperative SPY results. Of the 42 breasts that underwent a change in reconstruction, 6 had a ‘good’ SPY result, 10 ‘questionable’, 25 ‘bad’, and 2 ‘had areas excised’ (p<0.01). After multivariable analysis, predictors of skin necrosis included patients with ‘questionable’ SPY results (p<0.01, OR: 8.1, 95%CI: 2.06 – 32.2) and smokers (p<0.01, OR:5.7, 95%CI: 1.5 – 21.2). Predictors of any complication included a change in reconstruction (p<0.05, OR:4.5, 95%CI: 1.4-14.9) and ‘questionable’ SPY result (p<0.01, OR: 4.4, 95%CI: 1.6-14.9). Conclusion: SPY angiography results strongly influence intraoperative surgical decisions regarding the type of reconstruction performed. Patients most at risk for flap necrosis and complication post-mastectomy are those with questionable SPY results.

Short-term outcomes associated with temozolomide or PCV chemotherapy for 1p/19q-codeleted WHO grade 3 oligodendrogliomas: a national evaluation

2022 ◽  
Author(s):  
Nayan Lamba ◽  
Malia McAvoy ◽  
Vasileios K Kavouridis ◽  
Timothy R Smith ◽  
Mehdi Touat ◽  
...  
Keyword(s):  
Cox Regression ◽  
Extent Of Resection ◽  
First Line ◽  
Short Term ◽  
Who Grade ◽  
Cox Regression Analysis ◽  
Significant Difference ◽  
Pcv Chemotherapy ◽  
Grade 3 ◽  
National Analysis

Abstract Background The optimal chemotherapy regimen between temozolomide and procarbazine, lomustine, and vincristine (PCV) remains uncertain for W.H.O. grade 3 oligodendroglioma (Olig3) patients. We therefore investigated this question using national data. Methods Patients diagnosed with radiotherapy-treated 1p/19q-codeleted Olig3 between 2010-2018 were identified from the National Cancer Database. The OS associated with first-line single-agent temozolomide vs. multi-agent PCV was estimated by Kaplan-Meier techniques and evaluated by multivariable Cox regression. Results 1,596 radiotherapy-treated 1p/19q-codeleted Olig3 patients were identified: 88.6% (n=1,414) treated with temozolomide and 11.4% (n=182) with PCV (from 5.4% in 2010 to 12.0% in 2018) in the first-line setting. The median follow-up was 35.5 months (interquartile range [IQR] 20.7-60.6 months) with 63.3% of patients alive at time of analysis. There was a significant difference in unadjusted OS between temozolomide (5yr-OS 58.9%, 95%CI: 55.6-62.0) and PCV (5yr-OS 65.1%, 95%CI: 54.8-73.5; p=0.04). However, a significant OS difference between temozolomide and PCV was not observed in the Cox regression analysis adjusted by age and extent of resection (PCV vs. temozolomide HR 0.81, 95%CI: 0.59-1.11, p=0.18). PCV was more frequently used for younger Olig3s, but otherwise was not associated with patient’s insurance status or care setting. Conclusions In a national analysis of Olig3s, first-line PCV chemotherapy was associated with a slightly improved unadjusted short-term OS compared to temozolomide; but not following adjustment by patient age and extent of resection. There has been an increase in PCV utilization since 2010. These findings provide preliminary data while we await the definitive results from the CODEL trial.

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