scholarly journals Examining the impact of body mass index on overall survival in vulvar, vaginal and other mucosal melanomas: a retrospective cohort study

2020 ◽  
Vol 18 (2) ◽  
pp. e43-e45
Author(s):  
Sheida Naderi-Azad ◽  
◽  
Faisal Sickandar ◽  
Rossanna C. Pezo ◽  
◽  
...  
Keyword(s):  
Body Mass Index ◽  
Overall Survival ◽  
Cohort Study ◽  
Body Mass ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Mucosal Melanoma ◽  
The Body ◽  
Rank Test ◽  
The Impact

Aim of the study: In this retrospective cohort study we have examined differences in survival profiles with respect to the body mass index in patients with mucosal melanoma on immune checkpoint inhibitor therapy. Materials and methods: The primary outcome included the association between the body mass index and overall survival in patients with metastatic mucosal melanoma. The secondary outcomes included the clinical presentation and management of vulvar and vaginal melanomas with oral and anorectal mucosal melanomas, as well as the surgical and radiological management of vulvar and vaginal melanomas. Kaplan–Meier analysis and log-rank test were used for the assessment of overall survival. Results: The results showed that patients with mucosal melanoma whose body mass index was ≥25 had better overall survival (p = 0.02). Overall survival was different between vulvar/vaginal vs. oral mucosal melanoma (p = 0.02). Overall survival was not different between vulvar/vaginal vs. anorectal melanoma (p = 0.77). Some immune toxicities were specific to patients with vulvar/vaginal melanoma. Conclusions: Obesity is associated with improved survival in patients with metastatic mucosal melanoma, although findings can be heterogeneous depending on the subtype of mucosal melanoma.

Impact of Body Mass Index and Comorbidities on Outcomes in Upper Extremity Nerve Transfers

2021 ◽  
Author(s):  
Linden K. Head ◽  
Maria C. Médor ◽  
Aneesh Karir ◽  
Gerald Wolff ◽  
Kirsty U. Boyd
Keyword(s):  
Body Mass Index ◽  
Cohort Study ◽  
Upper Extremity ◽  
Body Mass ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Nerve Transfer ◽  
Nerve Transfers ◽  
The Impact

Abstract Background There is a paucity of research investigating the impact of patient comorbidities, such as obesity and smoking, on nerve transfer outcomes. The objective of this retrospective cohort study was to evaluate the impact of body mass index (BMI) and comorbidities on the clinical outcomes of upper extremity nerve transfers. Methods A retrospective cohort study was executed. Patients were eligible for inclusion if they had an upper extremity nerve transfer with a minimum of 12-months follow-up. Data was collected regarding demographics, comorbidities, injury etiology, nerve transfer, as well as preoperative and postoperative clinical assessments. The primary outcome measure was strength of the recipient nerve innervated musculature. Statistical analysis used the Mann-Whitney U test, Wilcoxon signed-rank test, and Spearman's rho. Results Thirty-eight patients undergoing 43 nerve transfers were eligible for inclusion. Patients had a mean age of 48.8 years and a mean BMI of 27.4 kg/m2 (range:19.7–39.0). Injuries involved the brachial plexus (32%) or its terminal branches (68%) with the most common etiologies including trauma (50%) and compression (26%). Anterior interosseous nerve to ulnar motor nerve (35%) was the most common transfer performed. With a mean follow-up of 20.1 months, increased BMI (p = 0.036) and smoking (p = 0.021) were associated with worse postoperative strength. Conclusion This retrospective cohort study demonstrated that increased BMI and smoking may be associated with worse outcomes in upper extremity nerve transfers—review of the literature yields ambiguity in both regards. To facilitate appropriate patient selection and guide expectations regarding prognosis, further experimental and clinical work is warranted.

scholarly journals Overall survival based on oncologist density in the United States: A retrospective cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0250894
Author(s):  
Sudeep K. Siddappa Malleshappa ◽  
Smith Giri ◽  
Smit Patel ◽  
Tapan Mehta ◽  
Leonard Appleman ◽  
...  
Keyword(s):  
Primary Care ◽  
Overall Survival ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Health Care Services ◽  
The United States ◽  
Rank Test ◽  
Care Services ◽  
The Impact

Medically underserved areas (MUA) or health professional shortage areas (HPSA) designations are based on primary care health services availability. These designations are used in recruiting international medical graduates (IMGs) trained in primary care or subspecialty (e.g., oncology) to areas of need. Whether the MUA/HPSA designation correlates with Oncologist Density (OD) and supports IMG oncologists’ recruitment to areas of need is unknown. We evaluated the concordance of OD with the designation of MUAs/HPSAs and evaluated the impact of OD and MUA/HPSA status on overall survival. We conducted a retrospective cohort study of patients diagnosed with hematological malignancies or metastatic solid tumors in 2011 from the Surveillance Epidemiology and End Results (SEER) database. SEER was linked to the American Medical Association Masterfile to calculate OD, defined as the number of oncologists per 100,000 population at the county level. We calculated the proportion of counties with MUA or HPSA designation for each OD category. Overall survival was estimated using the Kaplan-Meier method and compared between the OD category using a log-rank test. We identified 68,699 adult patients with hematologic malignancies or metastatic solid cancers in 609 counties. The proportion of MUA/HPSA designation was similar across counties categorized by OD (93.2%, 95.4%, 90.3%, and 91.7% in counties with <2.9, 2.9–6.5, 6.5–8.4 and >8.4 oncologists per 100K population, p = 0.7). Patients’ median survival in counties with the lowest OD was significantly lower compared to counties with the highest OD (8 vs. 11 months, p<0.0001). The difference remained statistically significant in multivariate and subgroup analysis. MUA/HPSA status was not associated with survival (HR 1.03, 95%CI 0.97–1.09, p = 0.3). MUA/HPSA designation based on primary care services is not concordant with OD. Patients in counties with lower OD correlated with inferior survival. Federal programs designed to recruit physicians in high-need areas should consider the availability of health care services beyond primary care.

scholarly journals Sociodemographic Characteristics as Predictors of Outcomes in Hepatocellular Carcinoma: A Retrospective Cohort Study

2020 ◽  
Vol 27 (1) ◽  
pp. 107327482095661
Author(s):  
Bryce D. Beutler ◽  
Mark B. Ulanja ◽  
Rohee Krishan ◽  
Vijay Aluru ◽  
Munachismo L. Ndukwu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Cohort Study ◽  
Native American ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Private Insurance ◽  
Insurance Status ◽  
The Impact ◽  
To Receive

Background: Race, gender, insurance status, and income play important roles in predicting health care outcomes. However, the impact of these factors has yet to be fully elucidated in the setting of hepatocellular carcinoma (HCC). Methods: We designed a retrospective cohort study utilizing data from the Surveillance, Epidemiology, and End Results (SEER) program to identify patients diagnosed with resectable HCC (N = 28,518). Demographic factors of interest included race (Asian/Pacific Islander [API], African American [AA], Native American/Alaska Native [NA], or White [WH]) and gender (male [M] or female [F]). Insurance classifications included those having Medicare/Private Insurance [ME/PI], Medicaid [MAID], or No Insurance [NI]. Median household income was estimated for all diagnosed with HCC. Endpoints included: (1) overall survival; (2) likelihood of receiving a recommendation for surgery; and (3) specific surgical intervention performed. Multivariate multinomial logistic regression for relative risk ratio (RRR) and Cox regression models were used to identify pertinent associations. Results: Race, gender, insurance status, and income had statistically significant effects on the likelihood of surgical recommendation and overall survival. API were more likely to receive a recommendation for hepatic resection (RRR = 1.45; 95% CI: 1.31-1.61; Reference Race: AA) and exhibited prolonged overall survival (HR = 0.77; 95% CI: 0.73-0.82; Reference Race: AA) as compared to members of any other ethnic group; there was no difference in these endpoints between AA, NA, or WH individuals. Gender also had a significant effect on survival: Females exhibited superior overall survival (HR = 0.89; 95% CI: 0.85-0.93; Reference Gender: M) as compared to males. Patients who had ME/PI were more likely than those with MAID or NI to receive a surgical recommendation. ME/PI was also associated with superior overall survival. Conclusions: Race, gender, insurance status, and income have measurable effects on HCC management and outcomes. The underlying causes of these disparities warrant further investigation.

Sociodemographic characteristics as predictors of outcomes in hepatocellular carcinoma: A retrospective cohort study.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 503-503
Author(s):  
Bryce David Beutler ◽  
Mark Bilinyi Ulanja ◽  
Vijay Aluru ◽  
Nageshwara Gullapalli
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Household Income ◽  
Retrospective Cohort ◽  
Insurance Status ◽  
Socioeconomic Class ◽  
The Impact ◽  
To Receive

503 Background: It has been established that race, insurance status, and socioeconomic class play an important role in predicting health care outcomes. However, the impact of these factors has yet to be investigated in the setting of hepatocellular carcinoma (HCC). Methods: We designed a retrospective cohort study utilizing data from the SEER program (2007-2015) to identify patients with resectable HCC (N = 28518). Exposures of interest were race (Asian [AS], Black [BL], Native American/Alaska Native [NA/AN], or White [WH]), insurance status (Medicare/Private Insurance [ME/PI], Medicaid [MAID], or No Insurance [NI]), and median household income. Endpoints included: (1) likelihood of surgical recommendation and (2) overall survival. Multinomial logistic regression for relative risk ratio (RRR) and Cox models were used to identify pertinent associations. Results: Race, insurance status, and socioeconomic class had statistically significant effects on the likelihood of surgical recommendation and overall survival. AS were more likely to receive a recommendation for hepatic resection (RRR = 1.60; 95% CI: 1.42 – 1.80; Reference Race: BL) and exhibited prolonged overall survival (HR = 0.77; 95% CI: 0.73 – 0.82) as compared to members of other ethnic groups; there was no difference in these endpoints between BL, NA/AN, or WH individuals. Patients who had ME/PI were more likely than those with MAID or NI to receive a surgical recommendation. ME/PI was also associated with superior overall survival. Individuals with a household income in the highest quintile were less likely to receive a surgical recommendation than those in the lower quintiles, but nevertheless demonstrated prolonged survival. Conclusions: Race, insurance status, and socioeconomic class have measurable effects on HCC management and outcomes. The underlying causes of these disparities warrant further investigation. [Table: see text]

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