Consolidation chemoradiation improves survival in responders to first-line chemotherapy (CT) in locally advanced GBC (LA-GBC).

97 Background: CT is the standard of care in advanced GBC [LA-GBC and metastatic GBC (M-GBC)]. The survival rates with CT are better in LA-GBC than M-GBC. Should responders to CT with good performance status (PS) be offered consolidation chemo-radiation (cCTRT) to delay progression and improve survival? There is scarcity of literature on this approach in the literature. We present our experience with this approach in LA-GBC which presents in endemic proportions in this region. Methods: We reviewed the records of consecutive GBC patients over 3 year period (2014-2016) after ethics approval. Out of 550 patients, 145 were LA-GBC who were treated with radical intent. Patients with good PS and responders to CT (partial and stable disease) but unresectable, were treated with cCTRT. Radiotherapy was given to GB bed, peri-portal, common hepatic, coeliac, superior mesentric and para aortic lymph-nodes (upto L2 vertebra) upto a dose of 45-54 Gy in 25 to 28 fractions along with concurrent capecitabine @ 1250 mg/m2. Response to treatment was categorised according to RECIST criteria based on CECT abdomen. Treatment toxicity, OS and factors affecting OS were computed by Cox-Regression analysis. Results: Burden of disease was [T3 (55%), T4 (45%), N1 (30%), N2 (70%)]. 65% patients underwent CT alone and 35% received CT followed by cCTRT. 10 patients underwent Radical Surgery ( 6 after CT and 3 after cCTRT). The incidence of grade 2 toxicity were: gastritis (10%) and diarrhoea (5%). 65% patients achieved partial response (PR), 12% static disease (SD), 10% progressive disease (PD) and 13% were non-evaluable (NE) [ did not complete 6 cycles CT or lost to follow-up]. At a median follow-up of 8 months (IQR 5-15 months), the median OS was 9 months for all, 7 months with CT and 14 months with cCTRT arm (p=0.04).The median OS was 57 months for CR, 12 months for PR and SD, 7 months for PD and 5 months for NE (p=0.008). OS was 10 months for KPS >80 and 5 months for KPS <80 (p=0.008). Type of treatment and response to treatment were retained as independent prognostic factors affecting OS. Conclusions: CT followed by cCTRT doubles survival in responders with good PS. This innovative approach should be tested in a randomised study.

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Clinical factors affecting prognosis of limb osteosarcoma in China: a multicenter retrospective analysis

Journal of International Medical Research ◽

10.1177/0300060520920053 ◽

2020 ◽

Vol 48 (8) ◽

pp. 030006052093085

Author(s):

Jia Han ◽

Yiyang Yu ◽

Sujia Wu ◽

Zhen Wang ◽

Weibin Zhang ◽

...

Keyword(s):

Overall Survival ◽

Survival Rate ◽

Cox Regression ◽

Survival Rates ◽

Treatment Method ◽

Overall Survival Rate ◽

Clinical Factors ◽

Standard Chemotherapy ◽

Factors Affecting ◽

Cox Regression Analysis

Objective This study was performed to explore the relationship between various clinical factors and the prognosis of limb osteosarcoma. Methods We retrospectively analyzed the clinical data of 336 patients with limb osteosarcoma treated from June 2000 to August 2016 at 7 Chinese cancer centers. Data on the patients’ clinical condition, treatment method, complications, recurrences, metastasis, and prognosis were collected and analyzed. Kaplan–Meier analysis and Cox regression models were used to analyze the data. Results The patients comprised 204 males and 132 females ranging in age from 6 to 74 years (average, 21.1 years). The overall 3- and 5-year survival rates were 65.0% and 55.0%, respectively. The 5-year overall survival rate was 64.0% with standard chemotherapy and 45.6% with non-standard chemotherapy. Cox regression analysis demonstrated that standard chemotherapy, surgery, recurrence, and metastasis were independent factors associated with the prognosis of limb osteosarcoma. Conclusion The survival of patients with limb osteosarcoma can be significantly improved by combining standard chemotherapy and surgery. The overall survival rate can also be improved by adding methotrexate to doxorubicin–cisplatin–ifosfamide triple chemotherapy.

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The prognostic value of polymorphisms in the insulin-like growth factor receptor (IGFR) pathway in patients with locally advanced pancreatic cancer (LAPC)

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.4500 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 4500-4500

Author(s):

R. T. Shroff ◽

M. M. Javle ◽

X. Dong ◽

V. S. Kumar ◽

S. Krishnan ◽

...

Keyword(s):

Pancreatic Cancer ◽

Induction Chemotherapy ◽

Prognostic Value ◽

Cox Regression ◽

Karnofsky Performance Status ◽

Performance Status ◽

Locally Advanced ◽

Advanced Pancreatic Cancer ◽

Rank Test ◽

Cox Regression Analysis

4500 Background: The IGFR pathway is activated in pancreatic cancer and may result in aggressive disease course. The study of single nucleotide polymorphisms (SNPs) involved in this pathway may provide prognostic information and predict response to IGFR directed agents. We investigated IGFR pathway SNPs in patients with LAPC. Methods: We evaluated 39 SNPs from 7 candidate genes in the IGFR pathway (IGF1R, IGF2R, IGF1, IGF2, IRS1, IRS2, IGFBP3) in 105 LAPC patients. DNA extraction from whole blood was performed using the Qiagen Flexigene DNA and Promega Maxwell 16 kits. Genotyping was performed using the Sequenom method. Overall survival was measured from date of diagnosis to date of death or last follow-up. Kaplan-Meier plot, log-rank test, and Cox regression were used to compare survival of patients according to genotype corrected for previously identified prognostic factors, including induction chemotherapy, CA 19–9, albumin, LDH, hemoglobin and Karnofsky performance status (KPS). Results: Median survival time (MST) was 15 months (95% CI 13.3–16.7). Induction chemotherapy, LDH, CA 19–9 level, hemoglobin, and KPS were not significantly associated with survival. Serum albumin and three SNPs of the IGF pathway (IGF1R IVS20–3431A>G, IRS1 G971R, and IGF2 *4352A>G) were significantly associated with prognosis ( Table ). Two of the three genotypes remained as significant predictors for survival in Cox regression analysis when adjusted for clinical factors. A significant combined genotype effect was observed wherein patients with all three deleterious alleles had significantly worse survival than those with only two or one (10 vs. 16.3 vs. 21.3 months, p< 0.0001). Conclusions: These data suggest that SNPs in the IGFR pathway genes may have prognostic value for LAPC patients. This information may identify population subgroups that could benefit from IGFR-targeted agents. [Table: see text] No significant financial relationships to disclose.

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Patterns of radiotherapy and its impact on survival in patients with locally advanced gastric and gastroesophageal junction adenocarcinoma: Before and after the publication of the MAGIC trial.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.125 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 125-125

Author(s):

Chi Lin ◽

Abhijeet Bhirud ◽

Nathan Ronald Bennion

Keyword(s):

Gastroesophageal Junction ◽

Locally Advanced ◽

Survival Rates ◽

Tumor Resection ◽

Standard Of Care ◽

Multivariate Regression Analysis ◽

Gastroesophageal Junction Adenocarcinoma ◽

Impact On Survival ◽

Postoperative Chemoradiation

125 Background: The intergroup 0116 trial for locally advanced gastric (GA) and gastroesophageal junction adenocarcinoma (GEJA) established postoperative chemoradiation therapy as the standard of care. However, since the publication of the MAGIC trial in 2006, some physicians prefer perioperative chemotherapy rather than postoperative chemoradiation. The goal of this study is to examine the use of radiotherapy (RT) and its impact on survival in patients diagnosed 3 years prior to and after the publication of the MAGIC trial. Methods: Patients with stage T2-4 or N+ and M0 GA (3339) or GEJA (1868) diagnosed between 2004 and 2009 who have had a primary tumor resection with at least 3 years of follow up were identified from the SEER database. Regression models were used to analyze factors influencing the use of RT and its effect on survival. Kaplan Meier plots and log-rank tests were used for survival comparisons. Results: From 2004 to 2009, there was no change in the ratio of RT/no RT. About 33% of patients with GA and 53% with GEJA received RT. Multivariate regression analysis showed that patients with T2-3 disease, N+ disease, and younger patients were more likely to receive RT in both GA and GEJA. The median follow-up for GA and GEJA, was 73 and 68 months and median survivals of 27 and 26 months respectively. RT improved median survivals from 20 to 46 months for GA and from 20 to 31 months for GEJA (p < 0.0001). After adjusting for stage and age, patients who received RT had higher odds of surviving 3 years or longer for both GA (OR 2.20, 95% CI 1.86-2.60) and GEJA (OR 1.46, 95% CI 1.19-1.80). Further analysis revealed that RT improved survivals in patients diagnosed either before or after 2006 for both GA and GEJA. Conclusions: The publication of MAGIC trial in 2006 has not affected the patterns of using RT on locally advanced GA or GEJA. Patients who did not receive RT after 2006 continue to have worse survival rates compared to those who have had RT. Further studies are warranted to evaluate the effect of combining the MAGIC chemotherapy regimen and RT on survival and quality of life of these patients.

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Validation of the Revised International Prognostic Scoring System in 2582 Patients with Myelodysplastic Syndrome: A Multicenter Study By the Hellenic MDS Study Group

Blood ◽

10.1182/blood.v128.22.2004.2004 ◽

2016 ◽

Vol 128 (22) ◽

pp. 2004-2004

Author(s):

Athanasios Galanopoulos ◽

Christos K. Kontos ◽

Nora-Athina Viniou ◽

Ioannis Kotsianidis ◽

Vassiliki Pappa ◽

...

Keyword(s):

Regression Analysis ◽

Prognostic Value ◽

Cox Regression ◽

Performance Status ◽

Scoring Systems ◽

Ecog Performance Status ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

Transfusion Dependency

Abstract Introduction - Aims: Several prognostic scoring systems have been developed for patients with myelodysplastic syndromes (MDS), including the International Prognostic System (IPSS), the WHO Prognostic Scoring System (WPSS) and the Revised IPSS (IPSS-R). We evaluated the prognostic value of the IPSS-R on an independent group of 2,582 Greek patients with MDS, registered in the Hellenic National MDS Registry. The aim of this multicenter study was to validate the IPSS-R as a predictor for leukemia-free survival (LFS) and overall survival (OS), in newly-diagnosed MDS patients and to compare its prognostic significance with that of IPSS and WPSS. Moreover, to investigate the predictive value of IPSS-R in association with other recognized prognostic variables, such as patient's age, baseline serum lactate dehydrogenase (LDH), and ferritin concentrations, IPSS, WPSS, Eastern Cooperative Oncology Group (ECOG) performance status, transfusion dependency, and response to first-line treatment. Methods: Clinicopathological data from 2,582 MDS patients, diagnosed between 1/2000 - 1/2015 and registered in the Hellenic National MDS Registry were analyzed. Patients with MDS/MPN were excluded. Data included age, gender, date of diagnosis, clinical characteristics, WHO-2008 classification, laboratory parameters, transfusion dependency, bone marrow aspirate and biopsy morphology, cytogenetic findings, and type of treatment. LFS was calculated from the date of initial diagnosis of MDS until bone marrow blast increased to ≥20% [transformation to acute myeloid leukemia (AML), according to the WHO classification], or last contact. OS was defined as the time from MDS diagnosis to death, or last contact. Patients alive and not having developed AML until last follow-up were censored for OS and LFS, respectively. Kaplan-Meier survival analysis and Cox regression analysis were performed with regard to LFS and OS. Differences between Kaplan-Meier curves were evaluated using the Mantel-Cox (log-rank) test. All significant variables identified by univariate Cox regression analysis and clinical factors important for MDS were used to build the multivariate Cox regression models. Multivariate Cox regression analysis included only those patients for whom the status of all variables was known, and comprised age, serum LDH, and ferritin levels, transfusion dependency, response to first-line treatment, IPSS, WPSS, and IPSS-R. Confidence intervals (CI) were estimated at the 95% level; all tests were two-sided, accepting p<0.05 as indicative of a statistically significant difference. All statistical analyses were performed with the statistical software SPSS (version 21). Results: 1,623 male (62.9%) and 959 female MDS patients with a median age of 74 years at diagnosis were included in the current study. Complete follow-up information was available for 2,376 patients. The estimated median OS was 58 months (95% CI = 52.9 - 63.1 months). For 1,974 patients, data used in the calculation of all three scoring systems were complete, thus allowing risk score calculation and comparison of the three risk assessment systems. Median OS was significantly different in patient subgroups classified according to IPSS, WPSS, and IPSS-R, as shown by the Kaplan-Meier survival analysis (p<0.001). Fig. 1 shows Kaplan-Meier OS curves of MDS patients stratified according to IPSS-R (p<0.001). Moreover, the comparison of the prognostic value of the IPSS, WPSS, and IPSS-R revealed that the IPSS-R was significantly superior to both, WPSS and IPSS (p<0.001 in all cases). Multivariate Cox regression analysis demonstrated that the high prognostic value of IPSS-R, in terms of LFS and OS, was independent of patient's age, serum LDH, and ferritin concentration, ECOG performance status, and transfusion dependency (p<0.001). Interestingly, besides IPSS-R, patient age and transfusion dependency retain their small - yet significant - prognostic impact in the multiparametric models, thus implying that these two parameters could add prognostic value to the IPSS-R. Conclusions: Our data support the notion that all three prognostic scores are very useful predictors for both, LFS and OS in MDS, yet IPSS-R is superior to IPSS and WPSS as a prognostic tool, with regard to OS. Disclosures No relevant conflicts of interest to declare.

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The Extent of Lymphadenectomy does Affect Cancer Specific Survival in Pathologically Confirmed T4 Renal Cell Carcinoma

Urologia Journal ◽

10.5301/ru.2012.9255 ◽

2012 ◽

Vol 79 (2) ◽

pp. 109-115 ◽

Cited By ~ 15

Author(s):

Umberto Capitanio ◽

Rayan Matloob ◽

Nazareno Suardi ◽

Firas Abdollah ◽

Fabio Castiglione ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Cell Carcinoma ◽

Renal Cell ◽

Cox Regression ◽

Locally Advanced ◽

Survival Rates ◽

Cancer Specific Survival ◽

Retroperitoneal Lymphadenectomy ◽

Fuhrman Grade

Background Controversies exist regarding the effect of lymphadenectomy (LND) in renal cell carcinoma (RCC). We hypothesized that patients with locally advanced cancer invading beyond Gerota's fascia (pT4 Nany Many RCC) might benefit from an extended LND not only for staging but also for survival purposes. Materials and Methods Clinical and pathologic data were prospectively gathered in 1.847 patients treated at a single Academic Center, between 1987 and 2011. Only patients with pT4 RCC (TNM 2009, n=44, 2.4%) were included. Univariable (UVA) and multivariable (MVA) Cox regression analyses targeted the association between the number of lymph nodes removed and cancer specific mortality (CSM). Analyses were adjusted for age, Fuhrman grade, symptoms at presentation, metastases at diagnosis, ECOG performance status, tumor size, number of positive nodes, and presence of necrosis or sarcomatoid features. Results Mean number of nodes removed was 11.8 (median 8, range 1–37). Mean number of positive nodes was 4.8 (median 2, range 0–36). Cancer-specific survival rates at 1, 2 and 3 years of follow-up were 39.3%, 25.0% and 8.6%, respectively. When stratified for nodal status, cancer-specific survival rates at 1, 2 and 3 years of follow-up were 65.0, 36.1, and 9.0% vs. 13.3, 13.0, and 6.7%, for pN0 vs. pN+ cases, respectively (p=0.004). At MVA, after adjusting for all the possible confounders, the number of positive nodes resulted independently associated with CSM (HR 1.25, p=0.001). Interestingly, at MVA, the number of nodes removed achieved the independent predictor status, as well (HR 0.84, p=0.007) showing a protective effect on survival. The risk of dying increased of 16% every positive node found (p<0.001), and decreased of 8% every node removed (p=0.02) (Table II). Conclusions A more extended retroperitoneal lymphadenectomy at the time of nephrectomy statistically significantly decreased CSM in pT4 cases.

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Reoperation for recurrent glioblastomas: What to expect?

Surgical Neurology International ◽

10.25259/sni_538_2020 ◽

2021 ◽

Vol 12 ◽

pp. 42

Author(s):

Iuri Santana Neville ◽

Alexandra Gomes dos Santos ◽

Cesar Cimonari Almeida ◽

Leonardo Bilich Abaurre ◽

Samia Yasin Wayhs ◽

...

Keyword(s):

Cox Regression ◽

Karnofsky Performance Status ◽

Performance Status ◽

Survival Rates ◽

Weibull Model ◽

University Hospital ◽

Current Standard ◽

Weibull Regression ◽

Cox Regression Analysis ◽

Kaplan Meier

Background: The current standard treatment for glioblastoma (GBM) is maximal safe surgical resection followed by radiation and chemotherapy. Unfortunately, the disease will invariably recur even with the best treatment. Although the literature suggests some advantages in reoperating patients harboring GBM, controversy remains. Here, we asked whether reoperation is an efficacious treatment strategy for GBM, and under which circumstances, it confers a better prognosis. Methods: We retrospectively reviewed 286 consecutive cases of newly diagnosed GBM in a single university hospital from 2008 to 2015. We evaluated clinical and epidemiological parameters possibly influencing overall survival (OS) by multivariate Cox regression analysis. OS was calculated using the Kaplan–Meier method in patients submitted to one or two surgical procedures. Finally, the survival curves were fitted with the Weibull model, and survival rates at 6, 12, and 24 months were estimated. Results: The reoperated group survived significantly longer (n = 63, OS = 20.0 ± 2.3 vs. 11.4 ± 1.0 months, P < 0.0001). Second, the multivariate analysis revealed an association between survival and number of surgeries, initial Karnofsky Performance Status, and age (all P < 0.001). Survival estimates according to the Weibull regression model revealed higher survival probabilities for reoperation compared with one operation at 6 months (83.74 ± 3.42 vs. 63.56 ± 3.59, respectively), 12 months (64.00 ± 4.85 vs. 37.53 ± 3.52), and 24 months (32.53 ± 4.78 vs. 12.02 ± 2.36). Conclusion: Our data support the indication of reoperation for GBM, especially for younger patients with good functional status. Under these circumstances, survival can be doubled at 12 and 24 months.

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First-Line Treatment with Rituximab Improves Survival of Patients with Post-Transplant Lymphoproliferative Disease (PTLD).

Blood ◽

10.1182/blood.v104.11.1406.1406 ◽

2004 ◽

Vol 104 (11) ◽

pp. 1406-1406 ◽

Cited By ~ 7

Author(s):

E. Gonzalez-Barca ◽

E. Domingo-Domenech ◽

J. Gomez-Codina ◽

F. Capote ◽

E. Flores ◽

...

Keyword(s):

Prognostic Factors ◽

Causes Of Death ◽

Cox Regression ◽

Performance Status ◽

B Cell Lymphoma ◽

Response To Treatment ◽

Rank Test ◽

Prognostic Impact ◽

Cox Regression Analysis ◽

Disseminated Disease

Abstract Purpose: to compare the response rate and survival between patients diagnosed of PTLD and treated with front-line rituximab and those not treated with rituximab. Patients and Methods: 108 patients with PTLD have been studied from January 1996 to January 2004. Survival curves were expressed as Kaplan-Meier plots and were compared by the Log-rank test. A multivariate Cox regression analysis was performed to asses the effect of prognostic factors on survival. Results: median age was 55 years (limits: 18–73). 70% were males. The transplanted organ was: kidney 46%, liver 28%, heart 16%. Median time between transplant and PTLD was 59 months, 25% were diagnosed during the first year after the transplant. The most frequent histological subtypes were: large B-cell lymphoma 53% and polymorphic SLPT 13%. 70% were EBV +. Clinical characteristics at diagnosis were: disseminated disease: 52%, extra-nodal disease: 81%, ECOG 3 2: 43%, LDH >N: 60%, IPI 3 3: 40%. Treatments used were: reduction of immunosuppression 91%, chemotherapy 59%, rituximab 33%, antiviral 13%. Response to treatment was: CR 46%, PR 13% failure 11%, not evaluable (early deceased): 29%. With a median follow-up of 15,2 months, survival was: OS 21% and EFS 15%. Forty-six (43%) patients died. The causes of death were: lymphoma progression 15 (33%), infection 15 (33%), toxicity 16 (34%). Survival of patients treated with rituximab was significantly better than the general group: OS 76% (p=0.007) and EFS 70% (p=0.02). Among patients treated with rituximab, 8 (23%) patients died. The significant bad prognostic factors for EFS in the multivariate analysis were: disseminated disease (RR: 2, 95% IC:1,02–3,8; p=0,04), ECOG 3 2 (RR: 5, 95% IC:2,6–9,8; p=0,0001), not been treated with rituximab (RR: 3,8, 95% IC: 1,7–10; p=0,001). IPI did not have prognostic impact. Conclusions: survival of patients with PTLD is low with conventional therapy, and the main causes of death are toxicity and infections. Treatment with Rituximab significantly improves their survival. Patients with disseminated disease and bad performance status have worse prognosis. IPI is not a useful index of prognosis in patients with PTLD.

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Prognostic Role and Significance of Paraneoplastic Syndromes in Hepatocellular Carcinoma

The American Surgeon ◽

10.1177/000313481408000230 ◽

2014 ◽

Vol 80 (2) ◽

pp. 191-196 ◽

Cited By ~ 3

Author(s):

Qiang Qu ◽

Shaobin Wang ◽

Shuguang Chen ◽

Li Zhou ◽

Jing-An Rui

Keyword(s):

Hepatocellular Carcinoma ◽

Cox Regression ◽

Clinical Course ◽

Survival Rates ◽

Paraneoplastic Syndromes ◽

Large Tumor ◽

Cox Regression Analysis ◽

Independent Risk Factors

Patients with hepatocellular carcinoma (HCC) may develop paraneoplastic syndromes in the clinical course. These syndromes include hypercholesterolemia, hypoglycemia, hypercalcemia, and erythrocytosis, among others. This study was designed to assess the role of prognostic influence of paraneoplastic syndromes in patients with HCC. In a cohort of 175 patients with HCC patients, we compared the clinical features of patients with HCC with or without paraneoplastic syndromes. In addition, survival rates of patients with individual paraneoplastic syndromes and those without were also evaluated. Moreover, factors independently predicting prognosis among patients with HCC with or without paraneoplastic syndromes were analyzed. Among 175 patients with HCC, 54 patients presented paraneoplastic syndromes, and the prevalence was 30.9 per cent. There was no difference of clinical characteristics between patients with HCC with and without paraneoplastic syndromes on diagnosis. However, the patients with paraneoplastic syndromes had a significantly less survival rate comparing with those without during a 5-year follow-up. Cox regression analysis demonstrated that high Child-Pugh grade, large tumor size, portal vein tumor thrombosis, and distant metastasis were all independent unfavorable prognostic factors for survival of patients with HCC. Paraneoplastic syndromes as independent risk factors play a significant role in the progress of HCC and lead to poor prognosis in patients with HCC.

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POS0871 CHARACTERISTICS OF INTERSTITIAL LUNG DISEASE IN PATIENTS WITH SYSTEMIC SCLEROSIS DURING LONG TERM FOLLOW-UP, SINGLE CENTER EXPERIENCE

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3105 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 691-692

Author(s):

S. Keret ◽

Y. Braun-Moscovici ◽

M. Yigla ◽

V. Shataylo ◽

L. Guralnik ◽

...

Keyword(s):

Regression Analysis ◽

Disease Duration ◽

Cox Regression ◽

Survival Rates ◽

Male Gender ◽

Lung Involvement ◽

Muscle Involvement ◽

Cox Regression Analysis ◽

Decline Rate

Background:ILD is one the leading causes of morbidity and mortality in patients with SSc. Diagnosis of SScILD is based on signs of fibrosis on chest x-rays or HRCT. Particular measurement of lung volumes by FVC and in gas exchange by DLCO supports the diagnosis. Associations between clinically significant SSc ILD and male gender, age, DcSSc, topoisomerase antibodies, low FVC at baseline, widespread lung involvement on baseline HRCT, and higher decline rate of FVC and DLCO during followup were reported. A standardized approach to assessing and treating SSc and SScILD in particular have been proposed. Main treatment regimens include cyclophosphamide and mycophenolate mofetil; recently antifibrotic drug nintedanib showed significant efficacy in hindering FVC decline rate in patients with SSc ILD. The data on survival changes in SSc generally and SScILD are conflicting.Objectives:To analyze demographic and clinical features and mortality of patients with SSc ILD.Methods:A retrospective study on Rambam Health Care Campus prospective cohort of SSc patients fulfilled ACR and EULAR Classification Criteria 2013 for the period between January 2000 and September 2020 was performed. Patients were recruited at one of their early visits to the clinic. The majority of recruited patients were included into EUSTAR prospective cohort 042, since 2004 the Rheumatology Institute at Rambam is affiliated to EUSTAR registry project. Data on patients not registered in EUSTAR database but treated at our institution was extracted via hospital electronic records. Patients with lung involvement underwent baseline and annual HRCT and pumonary function tests in addition to clinical assessment during their visit to combined rheumatology-pulmonology clinic. We registered age, gender, ethnicity, date of SSc diagnosis and ILD diagnosis, disease duration, SSc subset, pulmonary, cardiac, renal, and muscle involvement, treatment used, autoantibodies, FVC, DLCO, HRCT and pulmonary artery pressure. Statistical analysis included t-test, Pearson’s Chi-squared test, Fisher’s test, and Cox Regression analysis with p value less than 0.05 as significant.Results:Among 446 SSc patients (female 82.3%, mean age 46.5 and disease duration 11.6 years, DcSSc 39.2%; 27.4% dead during follow-up) 141 patients had ILD. Comparison between patient with ILD and witout ILD showed significant differences in term of nationality (Arabs 34% vs 18.7%), SSc related death 78.3% vs 50.7%), DcSSc (68.8% vs 25.6%), topoisomerase antibodies (61.7% vs 24.9%), myopathy (21.3% vs 10.2%) and pulmonary hypertension (34.8% vs 22.3%). Significantly more SSc ILD patients were treated with cyclophosphamide, mycophenolate mofetil and azathioprine. Survival Kaplan-Meier curve patiets demonstrate reduced survival in patients with ILD (p<0.01). Five years survival rates between years 2000 and 2015 have not changed significant. Mortality risk assessed with Cox regression analysis in the whole group was significantly higher in males, Arabs, DcSSc, elder age, heart and muscle involvement, and treatment with CYC. In the ILD group, the mortality was significantly higher in Arabs (3.3 times), elder age (8.9 times), presence of PAH (3.1 times) and treatment with CYC (2.8 times) compared to patients without ILD.Conclusion:In our SSc cohort, ILD affected about third of patients and had major impact on patients’ outcome. Male gender, Arab nationality, elder age, DcSSc, topoisomerase antibodies, heart and muscle involvement were significantly associated with worst prognosis. Despite active approach to assessing and treatment, survival rates of patients with SSc and SSc-ILD have not improved in last decades. Enrichment of the cohort with severe patients to a tertiary center due to reference bias and low efficacy of existed immunomodulatory drugs in SSc and in SSc related ILD particularly, could explain our results.Disclosure of Interests:None declared

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Factors affecting the healing of the perineum following surgery

Annals of The Royal College of Surgeons of England ◽

10.1308/003588413x13511609958451 ◽

2013 ◽

Vol 95 (4) ◽

pp. 252-257 ◽

Cited By ~ 2

Author(s):

B Ip ◽

M Jones ◽

P Bassett ◽

R Phillips

Keyword(s):

Odds Ratio ◽

Cox Regression ◽

Multivariate Analyses ◽

Causative Factor ◽

Ileoanal Pouch ◽

Factors Affecting ◽

Cox Regression Analysis ◽

Factors Associated ◽

Inflammatory Bowel

Introduction The aim of this study was to establish patient and procedural factors associated with the development of an unhealed perineum in patients undergoing a proctectomy or excision of an ileoanal pouch. Methods A review of 194 case notes for procedures performed between 1997 and 2009 was carried out. All patients had at least 12 months’ follow-up. Univariate and multivariate analyses were performed in 16 parameters. For those patients who developed an unhealed perineum, Cox regression analysis was performed to establish healing over a 12-month period. Results Two hundred patients were included in the study, of which six had unknown wound status and were subsequently excluded. This left 194 study patients. Of these, 86 (44%) achieved primary wound healing with a fully healed perineum and 108 (56%) experienced primary wound failure. With reference to the latter, 63 (58%) healed by 12 months. Comparing patients with an initially intact perineum with those with initial wound failure showed pre-existing sepsis was highly relevant (odds ratio: 4.32, 95% confidence interval [CI]: 2.16–8.62, p<0.001). In patients who had an unhealed perineum initially, perineal sepsis and surgical treatment were both significantly associated with time to healing (hazard ratio [HR]: 0.54, 95% CI: 0.31–0.93, p=0.03; and HR: 0.42, 95% CI: 0.21–0.84, p=0.01). Conclusions The presence of pre-existing perineal sepsis is associated with an unhealed perineum following proctectomy in inflammatory bowel disease (IBD) and non-IBD surgery. Further studies are indicated to establish perineal sepsis as a causative factor.

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