Treatment of patients with locally advanced Merkel cell carcinoma: A multicenter study.

e21566 Background: Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer with a high risk of recurrence and poor prognosis. The treatment of locally advanced disease includes surgery (SUR) and radiotherapy (RTH) to achieve high locoregional control rates. The sentinel lymph node biopsy (SLNB) is recommended procedure in cases without clinical nodal involvement. In selected cases, chemotherapy (CHT) may also be considered, but its role is not confirmed. This study aimed to analyze outcomes for locally advanced MCC pts treated in routine clinical practice. Methods: We conducted the retrospective analysis of data from 156 MCC pts treated with curative surgery in four oncological centers, diagnosed between 01/2010 and 12/2019, with data cut-off on 31/12/2020. The data collected included epidemiological and clinical information. Survival analyses were performed using the Kaplan-Meier method, log-rank test and multivariate Cox regression. Results: The median patient age at diagnosis was 72 years (30-94); 50.6% were male. The primary tumor (PT) locations were lower limbs (33.3%), upper limbs (30.1%), and head and neck (28.2%). MCC with no PT was diagnosed in 3.9%. In 62.0% the PT was located in the sun-exposed skin. The median tumor size was 25 mm (4-170). Lymph node (LN) involvement (clinical or positive SLNB or LND) at diagnosis was found in 26.9% (n = 42). The scar excision was done in 50.0% (positive in 16.6%), SLNB in 36.5% (positive in 10.5 %), 51.9% of pts received perioperative treatment, including RTH- 86.4%, CHT- 21%. The relapse rate was 38.3% (35.8% local-regional, 11.1% distant). With the median follow-up of 2.2-years, the median disease-free survival (DFS), local relapse-free survival (LRFS), and distant metastases-free survival (DMFS) were not reached. The 1-year DFS, LRFS and DMFS rates were 65%, 68%, and 90%. The negative independent risk factors for DFS were male gender (HR 1.42, 95%CI 1.06-3.01), metastases in LN at diagnosis (HR 5.41, 95%CI 2.39-12.26), no SLNB in pts with no clinical metastases in LN (HR 5.45, 95%CI 2.41-12.3), and no perioperative RTH (HR 2.19, 95%CI 1.29-3.76). The median overall survival (OS) was 6.9 years (95%CI 4.64-9.15). The negative independent risk factors for OS were male gender (HR 1.95, 95%CI 1.16-3.27), age above 70 (HR 2.0, 95%CI 1.15-3.48), metastases in LN at diagnosis (HR 3.15, 95%CI 1.49-6.68), and no SLNB in pts with no clinical metastases in LN (HR 2.30, 95%CI 1.10-4.82). PT location, UV-exposure, and perioperative CHT or RTH were not independent risk factors for OS. Conclusions: Our results confirm that the MCC treatment should be done in an experienced multidisciplinary team. Male gender, nodal involvement at diagnosis, and no SLNB in pts without clinical metastases in LN are associated with poor prognosis in DFS and OS. The perioperative RTH improves the treatment outcomes and reduces disease progression risk but does not impact OS. Perioperative CHT does not affect pts survival.

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Treatment of Locally Advanced Merkel Cell Carcinoma—A Multi-Center Study

Cancers ◽

10.3390/cancers14020422 ◽

2022 ◽

Vol 14 (2) ◽

pp. 422

Author(s):

Monika Dudzisz-Sledz ◽

Paweł Sobczuk ◽

Katarzyna Kozak ◽

Tomasz Switaj ◽

Hanna Kosela-Paterczyk ◽

...

Keyword(s):

Risk Factors ◽

Lymph Node ◽

Cell Carcinoma ◽

Merkel Cell Carcinoma ◽

Locally Advanced ◽

Real Life ◽

Male Gender ◽

Nodal Metastases ◽

Merkel Cell ◽

Independent Risk Factors

Merkel cell carcinoma (MCC) is a rare, aggressive skin cancer with a high risk of recurrence and poor prognosis. The treatment of locally advanced disease involves surgery and radiotherapy. To analyze real-life treatment patterns and clinical outcomes, we conducted a retrospective analysis of data from 161 MCC patients treated with curative intent in four oncological centers in Poland. The median age at diagnosis was 72 years (30–94); 49.7% were male. Lymph node (LN) involvement at diagnosis was found in 26.9% of patients. Sentinel lymph node biopsy (SLNB) was performed in 36.5% of patients (positive in 10.5%), and 51.9% of patients received perioperative treatment. The relapse rate was 38.3%. With the median follow-up of 2.3 years, the median disease-free survival (DFS) was not reached, and the 1-year rate was 65%. The negative independent risk factors for DFS were male gender, metastases in LN at diagnosis, no SLNB in patients without clinical nodal metastases, and no perioperative radiotherapy. The estimated median overall survival (OS) was 6.9 years (95%CI 4.64–9.15). The negative independent risk factors for OS were male gender, age above 70, metastases in LN at diagnosis, and no SLNB in patients without clinical nodal metastases. Our results confirm that the MCC treatment should be conducted in an experienced multidisciplinary team; however, the outcomes are still unsatisfactory.

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Multifocal Papillary Thyroid Carcinoma，Hashimoto's Thyroiditis and Lymph Node Metastasis：A Retrospective Cohort Study

10.21203/rs.3.rs-194311/v1 ◽

2021 ◽

Author(s):

Denghui Wang ◽

Jiang Zhu ◽

Chang Deng ◽

Zhixin Yang ◽

Daixing Hu ◽

...

Keyword(s):

Risk Factors ◽

Lymph Node ◽

Lymph Node Metastases ◽

Protective Factor ◽

Roc Curves ◽

Multivariate Logistic Regression ◽

Lateral Lymph Node ◽

Node Metastases ◽

Independent Risk Factors ◽

Central Lymph

Abstract Objective: Few studies have evaluated the influence of HT and Multifocality on central lymph node metastases(CLNM) and lateral lymph node metastases(LLNM) of PTC. The present study focused on risk factors for lymph node metastasis in PTC according to the presence of HT or multifocality. Materials and methods:1413 patients were identified.The relationship between HT or multifocality and lymph nodemetastasis was analyzed by univariate and multivariate logistic regression, ROC curves were constructed to show the predictive effect of each variable on the target outcome.Results: The PTCs with HT were more likely to be multifocal.(40.0% versus 17.5%,P ＜0.001). Compared to MPTC without HT, MPTC with HT showed a lower number of metastatic CLNs and LLNs (P < 0.05). HT was identifified as an independent protective factor for CLNM in all PTC patients (OR, 0.480; 95% CI, 0.359-0.643; P< .001) and in MPTC patients (OR, 0.094; 95% CI, 0.044-0.204; P < 0.001), the multicocality was independent risk factors for CLNM(OR, 2.316; 95% CI, 1.667-3.217; P< 0.001) and LLNM(OR, 2.004; 95% CI, 1.469-2.733; P< 0.001).The variables concluded HT or MPTC were screened to predict CLNM in all patients, CLNM in patients with MPTC and LLNM in all patients (AUCs: 0.731, 0.843 and 0.696, respectively, P < 0.0001). The two type of diseases existed concurrently may result in the decrease of CLNM and LLNM, AUCs of ROC to predict CLNM and LLNM are 0.696 and 0.63(P<0.0001). Conclusions: Our study identified multifocality as an independent risk factor predicting CLNM and LLNM in PTC patients. HT was proven to be a protective factor that reduced the CLNM risk in all patients and in patients with MPTC. The existence of both type of diseases can result in the reduction of CLNM and LLNM.

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Prognostic significance of advanced lung cancer inflammation index (ALI) in multiple myeloma patients – a retrospective study

10.21203/rs.3.rs-288915/v1 ◽

2021 ◽

Author(s):

Junxia Huang ◽

Juanjuan Hu ◽

Yan Gao ◽

Fanjun Meng ◽

Tianlan Li ◽

...

Keyword(s):

Risk Factors ◽

Lung Cancer ◽

Multiple Myeloma ◽

Overall Survival ◽

Progression Free Survival ◽

Advanced Lung Cancer ◽

Free Survival ◽

Factors Influencing ◽

Independent Risk Factors ◽

Cancer Inflammation

Abstract Background: Advanced lung cancer inflammation index (ALI) is known to predict the overall survival of patients having some solid tumors or B-cell lymphoma. The study investigates the predictive value of ALI in multiple myeloma (MM) patients and the correlation between ALI and prognosis.Methods: A database of 269 MM consecutive patients who underwent chemotherapy between December 2011 and June 2019 in the Affiliated Hospital of Qingdao University was reviewed. ALI cut-off value calculated before the initial chemotherapy and post 4 courses treatment were identified according to the receiver operating characteristic (ROC) curve, and its association with clinical characteristics, treatment response, overall survival (OS), and progression-free survival (PFS) were assessed.Results: Patients in the low ALI group (n=147) had higher risk of β2 microglobulin elevation, more advanced ISS (International Classification System stage), and TP53 gene mutation, with significantly lower median overall survival (OS; 36.29 vs. 57.92 months, P = 0.010) and progression-free survival (PFS; 30.94 vs. 35.67 months, P = 0.013). Independent risk factors influencing the OS of MM patients were ALI (P = 0.007), extramedullary infiltration (P = 0.001), TP53 (P = 0.020), Plt (P = 0.005), and bone destruction (P = 0.024). ALI (P = 0.005), extramedullary infiltration (P = 0.004), TP53 (P = <0.001), Plt (P = 0.017), and complex chromosome karyotype (P = 0.010) were independent risk factors influencing the PFS of MM patients.Conclusions: ALI is a potential independent risk factor predicting the prognosis of newly diagnosed MM patients.

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Examination of main lymph node (No.253) metastasis in left colorectal cancer: A retrospective analysis of a single-institution cohort

10.21203/rs.3.rs-1019251/v1 ◽

2021 ◽

Author(s):

Takefumi Yoshida ◽

Fumihiko Fujita ◽

Dai Shida ◽

Kenichi Koushi ◽

Kenji Fujiyoshi ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Lymph Node ◽

Lymph Nodes ◽

Poor Prognosis ◽

Advanced Colorectal Cancer ◽

D3 Lymphadenectomy ◽

Positive Group ◽

Factors Associated

Abstract Background. The extent of lymph node dissection in advanced colorectal cancer varies according to regional guidelines. D3 lymphadenectomy is routinely performed in Japan but is associated with several risk factors. Metastases of the main lymph nodes (No.253 lymph nodes), which are located at the root of the inferior mesenteric artery, are rare in left-sided colorectal cancer. Tumor depth (T4) is an identifier of No.253 lymph node metastasis (LNM) risk, but other risk factors associated with No.253 LNM are unclear. This study was undertaken to investigate the frequency of No.253 LNM and to identify other clinicopathological risk factors associated with No.253 LNM in left-sided colorectal cancer. In this study, we aimed to evaluate the clinical benefit of routine D3 lymphadenectomy in surgically treated advanced colorectal cancer. Methods. A retrospective database of patients with colorectal cancer who underwent D3 dissection and R0 resection at Kurume University Hospital from 1978 to 2017 was constructed and used to search for the frequency and risk factors of No.253 LNM to investigate long-term prognosis. Clinicopathological factors associated with No.253 LNM, including age, sex, tumor location, T stage, tumor diameter, carcinoembryonic antigen levels, and various dissected lymph nodes, were analyzed. Results. Among 1,614 consecutive patients, No.253 LNM was observed in 23 cases (1.4%). The presence of three or more regional LNMs was an independent risk factor for No.253 LNM (odds ratio: 26.8). The 5-year overall survival rate was 49.1% in the No.253 LNM-positive group and 78.4% in the No.253 LNM-negative group (p=0.002). Conclusion. In left-sided colorectal cancer, No.253 LNM was a poor prognosis factor, and three or more regional LNMs were a risk factor for No.253 LNM. The No.253 LNM-positive group had a poor prognosis, but there are cases of long-term survival, with a 5-year survival rate of 49%. D3 lymphadenectomy is suitable when three or more metastatic LNs are identified prior to surgery.

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Age-Related Risk Factors and Complications of Patients With COVID-19: A Population-Based Retrospective Study

Frontiers in Medicine ◽

10.3389/fmed.2021.757459 ◽

2022 ◽

Vol 8 ◽

Author(s):

Han Zhang ◽

Yingying Wu ◽

Yuqing He ◽

Xingyuan Liu ◽

Mingqian Liu ◽

...

Keyword(s):

Risk Factors ◽

Retrospective Study ◽

Age Groups ◽

Clinical Manifestations ◽

Population Based ◽

Male Gender ◽

Poor Correlation ◽

Age Related ◽

Related Risk ◽

Independent Risk Factors

Objective: To study the differences in clinical characteristics, risk factors, and complications across age-groups among the inpatients with the coronavirus disease 2019 (COVID-19).Methods: In this population-based retrospective study, we included all the positive hospitalized patients with COVID-19 at Wuhan City from December 29, 2019 to April 15, 2020, during the first pandemic wave. Multivariate logistic regression analyses were used to explore the risk factors for death from COVID-19. Canonical correlation analysis (CCA) was performed to study the associations between comorbidities and complications.Results: There are 36,358 patients in the final cohort, of whom 2,492 (6.85%) died. Greater age (odds ration [OR] = 1.061 [95% CI 1.057–1.065], p < 0.001), male gender (OR = 1.726 [95% CI 1.582–1.885], p < 0.001), alcohol consumption (OR = 1.558 [95% CI 1.355–1.786], p < 0.001), smoking (OR = 1.326 [95% CI 1.055–1.652], p = 0.014), hypertension (OR = 1.175 [95% CI 1.067–1.293], p = 0.001), diabetes (OR = 1.258 [95% CI 1.118–1.413], p < 0.001), cancer (OR = 1.86 [95% CI 1.507–2.279], p < 0.001), chronic kidney disease (CKD) (OR = 1.745 [95% CI 1.427–2.12], p < 0.001), and intracerebral hemorrhage (ICH) (OR = 1.96 [95% CI 1.323–2.846], p = 0.001) were independent risk factors for death from COVID-19. Patients aged 40–80 years make up the majority of the whole patients, and them had similar risk factors with the whole patients. For patients aged <40 years, only cancer (OR = 17.112 [95% CI 6.264–39.73], p < 0.001) and ICH (OR = 31.538 [95% CI 5.213–158.787], p < 0.001) were significantly associated with higher odds of death. For patients aged >80 years, only age (OR = 1.033 [95% CI 1.008–1.059], p = 0.01) and male gender (OR = 1.585 [95% CI 1.301–1.933], p < 0.001) were associated with higher odds of death. The incidence of most complications increases with age, but arrhythmias, gastrointestinal bleeding, and sepsis were more common in younger deceased patients with COVID-19, with only arrhythmia reaching statistical difference (p = 0.039). We found a relatively poor correlation between preexisting risk factors and complications.Conclusions: Coronavirus disease 2019 are disproportionally affected by age for its clinical manifestations, risk factors, complications, and outcomes. Prior complications have little effect on the incidence of extrapulmonary complications.

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Identifying Risk Factors for a High Lymph Node Ratio (over 0.8) in Papillary Thyroid Carcinoma Patients

10.21203/rs.3.rs-68492/v1 ◽

2020 ◽

Author(s):

Yuewu Liu ◽

LY Zhang ◽

xiaoyi li ◽

hongfeng liu

Keyword(s):

Risk Factors ◽

Lymph Node ◽

Lymph Node Ratio ◽

Male Gender ◽

Chronic Lymphocytic Thyroiditis ◽

Papillary Thyroid ◽

Central Lymph Node ◽

Lymphocytic Thyroiditis ◽

Node Ratio ◽

Central Lymph

Abstract Background Despite the majority of papillary thyroid carcinoma (PTC) patients has an excellent prognosis, central lymph node metastases (CLNM) are common. The relationship between CLNM and prognosis is still controversial, however, a certain lymph node ratio (LNR) has been reported to show significantly worse prognosis for PTC patients. Therefore, the extent of CLNM seems to play an important role in predicting the recurrence and survival of PTC. The aim of this study is to determine the risk factors for a high LNR (over 0.8) in central compartment in PTC patients. Methods A retrospective cohort study was conducted on PTC patients who underwent total thyroidectomy or lobectomy plus central lymph node dissection (CLND) between January 2011 and December 2015. Patients with an LNR over 0.8 was defined as Group A, and patients with an LNR 0 was defined as group B. The clinical and pathological factors such as gender, age, tumor size, tumor number, extracapsular spread (ECS), MACIS score, and co-existence of chronic lymphocytic thyroiditis （CLT）were compared between different LNR groups.Results Univariate analysis found high LNR to be associated with male gender, young age(<40 years) ,larger tumor (≥1 cm), ECS and absence of chronic lymphocytic thyroiditis. Multivariate logistic regression showed male gender (p = 0.007, OR = 3.79), young age(<40 years) (p = 0.000, OR = 0.159), larger tumor (≥1 cm) (p =0.033, OR = 2.530), and absence of chronic lymphocytic thyroiditis (p = 0.036, OR = 0.321) to be independent predictors for high LNR in PTC patients Conclusions Male gender, younger age (<40 years), larger tumor (≥1 cm) and absence of chronic lymphocytic thyroiditis were risk factors of high LNR. We recommend a prophylactic CLND should be considered in PTC patients with such risk factors.

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High Platelet-to-Lymphocyte Ratio Predicts Poor Prognosis and Clinicopathological Characteristics in Patients with Breast Cancer: A Meta-Analysis

BioMed Research International ◽

10.1155/2017/9503025 ◽

2017 ◽

Vol 2017 ◽

pp. 1-11 ◽

Cited By ~ 10

Author(s):

Miao Zhang ◽

Xuan-zhang Huang ◽

Yong-xi Song ◽

Peng Gao ◽

Jing-xu Sun ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Node ◽

Poor Prognosis ◽

Meta Analysis ◽

Disease Free Survival ◽

Clinicopathological Characteristics ◽

Platelet To Lymphocyte Ratio ◽

Free Survival ◽

Node Negative ◽

Lymphocyte Ratio

Background. We aimed to evaluate the correlation of platelet-to-lymphocyte ratio (PLR) with prognosis and clinicopathological characteristics of breast cancer. Methods. The PubMed and Embase databases were searched. Hazard ratio (HR) with 95% confidence interval (CI) was used to summarize disease-free survival (DFS) and overall survival (OS). Odds ratio (OR) was used to summarize tumor clinicopathological characteristics. Results. High PLR was associated with poor DFS and OS (DFS: HR = 1.47, 95% CI = 1.16–1.85, and Tau2 = 0.070; OS: HR = 1.88, 95% CI = 1.27–2.80, and Tau2 = 0.192). A Galbraith plot indicated that the studies by Allan et al. and Cihan et al. contributed the heterogeneity of DFS and OS, respectively. There were significant differences in the incidence of high PLR between stage II–IV and stage I groups (OR = 1.86, 95% CI = 1.20–2.90, and Tau2 < 0.001), between lymph node-positive and lymph node-negative groups (OR = 1.52, 95% CI = 1.22–1.91, and Tau2 =0.014), and between metastasis-positive and metastasis-negative groups (OR = 4.24, 95% CI = 2.73–6.59, and Tau2 < 0.001). Conclusions. Our results indicated that PLR was associated with poor prognosis of breast cancer and adequately predicted clinicopathological characteristics.

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Comparative study of preoperative prediction scores for lymph node metastasis in gastric and colon cancer patients

10.21203/rs.3.rs-37182/v2 ◽

2020 ◽

Author(s):

Xiangjian Zheng ◽

Xiaodong Chen ◽

Min Li ◽

Chunmeng Li ◽

Xian Shen

Keyword(s):

Risk Factors ◽

Colon Cancer ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Cancer Patients ◽

Serum Markers ◽

Tumor Characteristics ◽

Node Metastasis ◽

Preoperative Prediction ◽

Independent Risk Factors

Abstract Background: Surgery combined with chemo-radiotherapy is a recognized model for the treatment of gastric and colon cancers. Lymph node metastasis determines the patient's surgical or comprehensive treatment plan. This analytical study aims to compare preoperative prediction scores to better predict lymph node metastasis in gastric and colon cancer patients.Methods: This study comprised 768 patients, which included 312 patients with gastric cancer and 462 with colon cancer. Preoperative clinical tumor characteristics, serum markers, and immune indices were evaluated using single-factor analysis. Logistic analysis was designed to recognize independent predictors of lymph node metastasis in these patients. The independent risk factors were integrated into preoperative prediction scores, which were accurately assessed using receiver operating characteristic (ROC) curves.Results: Results showed that serum markers (CA125, hemoglobin, albumin), immune indices (S100, CD31, d2–40), and tumor characteristics (pathological type, size) were independent risk factors for lymph node metastasis in patients with gastric and colon cancer. The preoperative prediction scores reliably predicted lymph node metastasis in gastric and colon cancer patients with a higher area under the ROC curve (0.901). The area was 0.923 and 0.870 in gastric cancer and colon cancer, respectively. Based on the ROC curve, the ideal cutoff value of preoperative prediction scores to predict lymph node metastasis was established to be 287. Conclusion: The preoperative prediction scores is a useful indicator that can be applied to predict lymph node metastasis in gastric and colon cancer patients.

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Analysis of Multiple Factors Involved in Pertussis-Like Coughing

Clinical Pediatrics ◽

10.1177/0009922820905871 ◽

2020 ◽

Vol 59 (7) ◽

pp. 641-646

Author(s):

Jiaying Cao ◽

Lu Xu ◽

Jiahua Pan

Keyword(s):

Risk Factors ◽

Bordetella Pertussis ◽

Poor Prognosis ◽

Clinical Symptoms ◽

Lymphocyte Ratio ◽

Study Results ◽

Independent Risk Factors ◽

Wbc Count ◽

Case Data ◽

Inhaled Glucocorticoids

Objectives. To identify risk factors associated with the prognosis of pertussis-like coughing. Methods. A retrospective study on children hospitalized with pertussis-like coughing from 2018 to 2019. We collected all the case data from medical records including age, gender, vaccination, clinical symptoms, complication, pathogens, white blood cell (WBC) count, lymphocyte ratio, application of macrolide antibiotics, usage of sulfamethoxazole, and usage of inhaled glucocorticoids. Logistic regression was used in this study. Results. A total of 213 hospitalized children with pertussis-like coughing were included in this study. About 70 children were cured within 2 weeks. One120 children were cured from 2 weeks to 3 months, including cases of initial attack and relapse. Symptoms lasting longer than 3 months accounts for 10.8%. Bordetella pertussis, WBC count >20 × 109/L and lymphocyte ratio >60% were associated with poor prognosis ( P < .05). Conclusions. Bordetella pertussis, WBC count, and lymphocyte ratio are independent risk factors for poor prognosis.

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