scholarly journals The association between neutrophil-to-albumin ratio and mortality in patients with cardiogenic shock: a cohort study

2019 ◽  
Author(s):  
Yangpei Peng ◽  
Yangjing Xue ◽  
Jinsheng Wang ◽  
Huaqiang Xiang ◽  
Kangting Ji ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cardiogenic Shock ◽  
Primary Outcome ◽  
Proportional Hazards ◽  
Statistical Significance ◽  
Cox Proportional Hazards ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Albumin Ratio

Abstract Background Cardiogenic shock (CS) is a lethal complication. Given the poor outcome of CS, we performed a retrospective cohort study to identify whether the neutrophil-to-albumin ratio (NAR) was significantly associated with mortality from CS. Methods All patient data were extracted from the MIMIC III version 1.3. Comparisons between groups was made using the chi-square or Fisher’s exact tests for categorical variables and the variance analysis or the Kruskal-Wallis test was used for continuous variables. The primary outcome was 30-day mortality and the secondary ones were 90-day and 365-day mortality. We used Cox proportional hazards models to evaluate the association between the various categories of NAR and survival. To further identify the association, subgroup analyses were performed. Results A total of 475 patients with CS were enrolled. A significant positive correlation between NAR levels and 30-day, 90-day or 365-day mortality was observed. For the primary outcome of 30-day mortality, the HR (95% CI) values given NAR levels 23.54–27.86 and > 27.86 were 1.72 (1.17, 2.53) and 1.96 (1.34, 2.87) compared with the reference (NAR < 23.47) in tertile analysis. In multivariate analyses, the HR (95% CI) values were still of statistical significance[1.98 (1.25, 3.15) and 2.03 (1.26, 3.26)]. When quintiles were applied to grouping patients according to NAR level, similar associations were also observed. For the secondary outcomes, the upward trend remained statistically significant. Conclusions NAR level was associated with survival from CS. NAR appeared to be an independent and readily-available prognostic biomarker of mortality in patients with CS.

scholarly journals Epilepsy as a Comorbidity in Polymyositis and Dermatomyositis—A Cross-Sectional Study

2021 ◽  
Vol 18 (8) ◽  
pp. 3983
Author(s):  
Ella Nissan ◽  
Abdulla Watad ◽  
Arnon D. Cohen ◽  
Kassem Sharif ◽  
Johnatan Nissan ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Cross Sectional Study ◽  
Cox Proportional Hazards ◽  
Categorical Variables ◽  
Rank Test ◽  
Control Group ◽  
Multivariable Logistic Regression Analysis ◽  
Positive Trend ◽  
Continuous Variables ◽  
Cross Sectional

Polymyositis (PM) and dermatomyositis (DM) are autoimmune-mediated multisystemic myopathies, characterized mainly by proximal muscle weakness. A connection between epilepsy and PM/DM has not been reported previously. Our study aim is to evaluate this association. A case–control study was conducted, enrolling a total of 12,278 patients with 2085 cases (17.0%) and 10,193 subjects in the control group (83.0%). Student’s t-test was used to evaluate continuous variables, while the chi-square test was applied for the distribution of categorical variables. Log-rank test, Kaplan–Meier curves and multivariate Cox proportional hazards method were performed for the analysis regarding survival. Of the studied 2085 cases, 1475 subjects (70.7%) were diagnosed with DM, and 610 patients (29.3%) with PM. Participants enrolled as cases had a significantly higher rate of epilepsy (n = 48 [2.3%]) as compared to controls (n = 141 [1.4%], p < 0.0005). Using multivariable logistic regression analysis, PM was found only to be significantly associated with epilepsy (OR 2.2 [95%CI 1.36 to 3.55], p = 0.0014), whereas a non-significant positive trend was noted in DM (OR 1.51 [95%CI 0.99 to 2.30], p = 0.0547). Our data suggest that PM is associated with a higher rate of epilepsy compared to controls. Physicians should be aware of this comorbidity in patients with immune-mediated myopathies.

Digoxin exposure and prostate cancer mortality: A matched cohort study.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e13096-e13096 ◽  
Author(s):  
Evelyn Flahavan ◽  
Kathleen Bennett ◽  
Linda Sharp ◽  
Thomas Ian Barron
Keyword(s):  
Prostate Cancer ◽  
Cohort Study ◽  
Proportional Hazards ◽  
Statistical Significance ◽  
Hypoxia Inducible Factor ◽  
Epidemiological Studies ◽  
Cox Proportional Hazards ◽  
Response Analysis ◽  
Covariate Balance ◽  
Exposure Response

e13096 Background: Digoxin (DIG) exposure has been associated with reduced prostate cancer (PC) incidence in epidemiological studies. Preclinical data suggests that this anti-cancer effect is mediated through the inhibition of hypoxia-inducible factor 1-α by DIG. This retrospective cohort study examines associations between DIG exposure and mortality in men with PC. Methods: Men diagnosed with PC during 2001–2006 were identified from National Cancer Registry Ireland records and linked prescription claims data. Propensity scores for DIG exposure in the 90 days prior to PC diagnosis were estimated. DIG exposed and unexposed men were matched (1:1) within a calliper of 0.2 standard deviations of the propensity score logit, using greedy matching without replacement. Standardized differences were used to assess covariate balance (z-score <0.1) between matched cohorts. Hazard ratios (HR) for associations between DIG exposure and all-cause (ACM) or PC-specific (PCM) mortality were estimated using Cox proportional hazards models adjusted for age, comorbidity, tumour stage and grade. Categorical exposure-response analyses were carried out using tertiles of exposure (low, intermediate, high) in the 90 days pre-diagnosis. Results: 5734 PC cases were identified from the linked database. 395 cases received DIG in the 90 days pre-diagnosis, of which 391 were matched to unexposed controls. Matched covariate balance was acceptable. In adjusted analyses, DIG exposure was not associated with ACM (HR 1.06, 95% CI 0.88-1.27) but was associated with a small but non-significant reduction in the risk of PCM (HR 0.89, 95% CI 0.68-1.17). In the exposure-response analysis, DIG exposure in the highest tertile, but not in the intermediate or lower tertiles, was associated with a reduced risk of PCM approaching statistical significance (HR 0.69, 95% CI 0.47-1.01, p=0.059). Men in the high DIG exposure group received a supply of DIG for 98% of their eligible follow up in the year post diagnosis. Post diagnostic DIG exposure in the intermediate and lower tertiles was 94% and 80% respectively. Conclusions: DIG exposure was associated with a non-significant decrease in PCM. Stratification by exposure suggests the presence of an exposure-response relationship.

Vanishing congenital lung malformations: What is the incidence of true regression?

2021 ◽  
pp. 1-7
Author(s):  
C. Griggs ◽  
M. Schmaedick ◽  
C. Gerall ◽  
W. Fan ◽  
C. Orlas ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Statistical Significance ◽  
Multivariable Analysis ◽  
Retrospective Chart Review ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Exact Test ◽  
Congenital Lung Malformation ◽  
Nicu Admission

BACKGROUND: A congenital lung malformation (CLM) that is diagnosed on prenatal ultrasound exam may subsequently become undetectable on later scans, a “vanishing” CLM. OBJECTIVE: The purpose of our study is to characterize the prenatal natural history and postnatal outcomes of “vanishing” lesions treated at our institution. METHODS: We performed a retrospective chart review of 107 patients diagnosed prenatally with CLM at our institution. Comparisons were made using Kruskal-Wallis or t-test for continuous variables and Fisher’s exact test or Chi-Square test for categorical variables. Multivariable analysis using logistic regression was performed. RESULTS: Of the 104 patients, 59 (56.7%) had lesions that became sonographically undetectable on serial ultrasound scans. Patients with lesions that vanished prenatally tended to need less Neonatal Intensive Care Unit (NICU) admission at birth (persistent CLM: 54.8%vs vanished CLM: 28.8%), decreased need for supplemental O2 at birth (persistent CLM: 31.0%vs vanished CLM: 11.9%), and decreased delay in feeds (persistent CLM: 26.2%vs vanished CLM: 8.5%) compared to those with persistent CLM. After multivariate analysis controlling for maternal steroid administration and sex, admission to NICU maintained a slight statistical significance, with patients in the vanishing CLM group 2.5 times less likely to be admitted to the NICU. None of our patients whose lesions vanished prenatally required mechanical ventilation. Eighty-six patients underwent postnatal computed tomography (CT) chest. Only 2 patients had lesions that regressed on postnatal CT. CONCLUSION: Lesions that vanish on prenatal imaging may be associated with improved clinical outcomes. The rate of true regression at our institution was as low as 2.3%.

Abstract TP236: Eval to Groin Puncture Times: Efficiencies and Deficiencies of Live Physician vs Telemedicine Triage

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
David Rosenbaum-Halevi ◽  
Sujan T Reddy ◽  
Alyssa D Trevino ◽  
Muhammad Bilal Tariq ◽  
Mahan Shahrivari ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Specific Level ◽  
Site Specific ◽  
Exact Test ◽  
Wilcoxon Rank Sum Test ◽  
Significant Difference ◽  
A Site

Introduction: Telemedicine (TM) is increasingly implemented in community hospitals acute ischemic stroke (AIS). The efficiency of TM to facilitate thrombectomy (IAT) is unknown. We addressed this question by studying our spoke hospitals which are staffed by both in-person (IP) consultation (Day: 8am-5pm) and TM (Night: 5pm-8am) to analyze differences between TM and IP and comparing to our university hub which has IP staffing day and night. Methods: We performed a retrospective analysis from 3/2016 to 3/2019 of all IAT cases directly admitted to 4 IAT capable centers (1 hub + 3 spokes) in our system. Demographic, clinical, and time metrics were analyzed. Primary outcome was door to groin (DTG) time. Continuous variables were analyzed with Wilcoxon rank sum test, and categorical variables with chi-square or Fischer’s exact test. Results: Table 1 summarizes the cohort. Eval to tPA (ETPA) time was faster at spokes vs hub (p < 0.0001), with no significant difference in DTG between spoke and hub (p= 0.444). At spokes, while DTPA times were no different between IP and TM at spokes, IP achieved faster DTG times (p<0.0001) (Fig.1A). DTG was equal during day vs. night at the hub. At the spokes, day (IP) DTG times were faster than night (TM) at some but not all spokes (Fig.1B). TPA administration did not delay DTG at either the hub or the spokes (Fig. 1C). At spokes, TM-TPA cases were associated with faster DTG than TM-noTPA (Fig. 1D). Conclusions: While no difference is noted between TM and IP in rapid TPA treatment, our data show delayed DTG at spokes during the TM day and night service. While DTG in TM was prolonged, differences in spoke metrics imply that availability of staff and resources play a significant role. Further analysis is needed to identify factors that prolong DTG at a site-specific level.

scholarly journals Dietary Acrylamide Intake and the Risk of Hematological Malignancies: The Japan Public Health Center-Based Prospective Study

Nutrients ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 590
Author(s):  
Ling Zha ◽  
Rong Liu ◽  
Tomotaka Sobue ◽  
Tetsuhisa Kitamura ◽  
Junko Ishihara ◽  
...  
Keyword(s):  
Public Health ◽  
Prospective Study ◽  
Health Center ◽  
Hematological Malignancies ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Public Health Center ◽  
Dietary Acrylamide

Acrylamide, which is present in many daily foods, is a probable human carcinogen. In 2002, it was identified in several common foods. Subsequently, western epidemiologists began to explore the relationship between dietary acrylamide exposure and cancer risk; however, limited suggestive associations were found. This prospective study aimed to examine the association between dietary acrylamide intake and the risk of hematological malignancies, including malignant lymphoma (ML), multiple myeloma (MM), and leukemia. We enrolled 85,303 participants in the Japan Public Health Center-based Prospective study on diet and cancer as from 1995. A food frequency questionnaire that included data on acrylamide in all Japanese foods was used to assess dietary acrylamide intake. We applied multivariable adjusted Cox proportional hazards models to reckon hazard ratios (HRs) for acrylamide intake for both categorical variables (tertiles) and continuous variables. After 16.0 median years of follow-up, 326 confirmed cases of ML, 126 cases of MM, and 224 cases of leukemia were available for final multivariable-adjusted analysis. HRs were 0.87 (95% confidence interval [CI]: 0.64–1.18) for ML, 0.64 (95% CI: 0.38–1.05) for MM, and 1.01 (95% CI: 0.71–1.45) for leukemia. Our results implied that acrylamide may not be related to the risk of hematological malignancies.

scholarly journals Comparison of Uncomfortable Loudness Level in Stapedotomy with or without Stapedial Tendon Preservation

2021 ◽  
Vol 27 (2) ◽  
pp. 117-123
Author(s):  
Tamanna Nawshin ◽  
Kanu Lal Saha ◽  
Shah Sohel ◽  
Sabyasachi Talukdar ◽  
Sheikh Mohammad Tanjil Ul Alam
Keyword(s):  
Statistical Significance ◽  
Pure Tone Audiometry ◽  
Neck Surgery ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Group I ◽  
Loudness Level ◽  
Group Ii

Background: Otosclerosis is one of the commonest diseases of the ear mostly involves the otic capsule. Most often otosclerotic foci appear in stapes region leading to stapes fixation, predominantly affect the adolescence female. The most common presenting symptom of clinical otosclerosis is conductive deafness. The mainstay of treatment for otosclerosis is surgery. Surgical options include stapedectomy, stapedotomy with or without stapedial tendon preservation. The latter being is the procedure of choice. Aim: The aim of this study is to compare the outcome of uncomfortable loudness level in stapedotomy with or without stapedial tendon preservation. Methods: A prospective observational study was conducted in the Department of Otolaryngology-Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka for 18 months in patients with otosclerosis. Total 30 subjects were selected based on the inclusion and exclusion criteria. All patients were assessed pre-operatively by clinical examination, otoscopy and microscopic examination. Hearing was assessed by pure tone audiometry. Uncomfortable level and stapedial reflex threshold were tested in all cases. The selected cases were placed into two groups. Stapedial tendon resection in Group-I and stapedial tendon preservation in Group-II. Post-operative follow up was done at 3 months and 6 months. Hearing and uncomfortable loudness level were evaluated with PTA during follow up by calculating the average of 500Hz, 1000Hz, 2000Hz and 4000HZ. The data were calculated manually. The statistical significance was set to P< 0.05. Results of the study were expressed as mean, standard deviation (± SD), frequency and percentages. Means and standard deviations were reported for continuous variables. Frequencies and percentages were reported for categorical variables. Unpaired Student’s t test was done to compare the continuous variables and Chi Square test was done to compare the categorical variables. Results: In this study preoperative average ABG for group I and group II were 35 ± 4.57 dB and 34 ± 4.17 dB respectively. In group I, post operative average ABG after 3 months and 6 months were 14 ± 3.7 dB and 13±3.3 dB respectively. Post operative average ABG after 3 months was 13 ± 5.7 dB and was 12 ± 4.4 dB for group II. But the hearing improvement between two groups was not statistically significant. In case of preoperative mean UCL was 95 ± 1.8 dB and 96 ± 2.5 dB for group I and group II respectively. Postoperative mean UCL after 3 months was 96 ± 3.57 dB and after 6 months was 99 ± 6.28 dB in group I. For group II, postoperative mean UCL after 3 months and 6 months was 107±4.2 dB and 113 ± 3.2 dB respectively. Here mean UCL was on average 11 dB higher for group II in 3 months and additional 6 dB improvement noted after 6 months, but show minimal change in group I. This finding was statistically significant. Conclusion: Preservation of the stapedial tendon is the choice in the surgical treatment of otosclerosis which helps to improve functional outcomes as well as to provide the more physiologic protection of middle ear. Postoperative discomfort threshold levels were increased in patients who had their stapedial tendon restored. Bangladesh J Otorhinolaryngol 2021; 27(2): 117-123

Abstract 15463: Pre-procedural Inr, Bleeding, and Mortality in the Catheterization Lab: Does INR Still Matter in the Radial First Era?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Shantum Misra ◽  
Bruce W Andrus ◽  
James T Devries
Keyword(s):  
Hospital Mortality ◽  
Statistical Significance ◽  
Coronary Intervention ◽  
Mitigation Strategies ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Access Site ◽  
Chi Square ◽  
Increased Risk ◽  
Chi Square Analysis

Background: Warfarin anticoagulation presents a common barrier to undergoing cardiac catheterization procedures. Using radial access and other bleeding mitigation strategies, it is not known if elevated INR truly portends an increased risk of adverse events. We sought to understand the relationship between in hospital mortality and bleeding with INR in patients undergoing coronary interventional catheterization procedures. Methods: The prospectively-collected Dartmouth Dynamic Registry was queried for all patients who underwent catheterization with coronary intervention from 2014 to 2018. Of the 5015 patients identified, 2120 patients had a recorded INR value within 24 hours of the procedure. Demographics, procedural variables, and in hospital outcomes were collected. Patients were divided into two groups: INR &lt1.8 and INR &gt1.8. Incidence of bleeding (access site hematoma &gt5cm, post procedure blood transfusion) as well as in-hospital mortality were queried for each group. Stata was used to determine statistical significance, using chi-square analysis for categorical variables and standard t-test for continuous variables. Results: Of the 2120 patients with INR values, 1968 patients were identified with INR &lt1.8 (median INR 1.1; range 0.7-1.7) and 152 patients with INR &gt1.8 (median INR 2.2; range 1.8-11.1). Patients with elevated INRs had higher acuity (urgent or emergent cases) and were older. Other baseline and procedural characteristics were similar. Outcomes between those with elevated INR and those with lower INR values were similar, including access site injury, hematoma, and need for transfusion (Table I). Overall mortality did not differ between the two groups. Conclusion: When compared to patients with INR &lt1.8, patients with INR &gt1.8 are more likely to undergo coronary intervention on an urgent or emergent basis. Despite this, there is no difference in bleeding, need for transfusion, or overall in-hospital mortality.

scholarly journals 575. Effectiveness of Short vs Long Course Perioperative Antibiotics in Lung Transplant Recipients with Donor Positive Respiratory Cultures

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S352-S352
Author(s):  
Lindsey T Groff ◽  
Erica E Reed ◽  
Kelci E Coe ◽  
Zeinab El Boghdadly ◽  
Brian C Keller ◽  
...  
Keyword(s):  
Lung Transplant ◽  
Primary Outcome ◽  
Statistical Significance ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Transplant Recipients ◽  
Short Course ◽  
Increased Risk ◽  
Lung Transplant Recipients ◽  
Long Course

Abstract Background Lung transplant recipients are at increased risk for infection in the early post-operative phase. Perioperative antibiotic (POA) practices are variable among transplant centers with sparse data regarding optimal antibiotic prophylaxis duration. This study aimed to evaluate the efficacy of short course (SC) (≤10 days) vs long course (LC) (≥11 days) POA in lung transplant patients. Methods This was a single-center, retrospective study of non-cystic fibrosis first time lung transplant recipients with donor positive cultures between Aug 2013 and Sept 2019. Patients who died within 14 days of transplant were excluded. Data collected included baseline characteristics, donor and recipient cultures, POA, and hospitalization details. The primary outcome was 30-day recipient freedom from donor-derived respiratory bacterial infection. Secondary outcomes included development of Clostridioides difficile infection (CDI), cumulative time on ventilator, post-op time to extubation, in-hospital all-cause mortality, and 30-day development of POA resistance. Descriptive statistics were used for analysis. Continuous variables were compared using the Wilcoxon rank sum test while categorical variables were compared using the chi-square or Fisher’s exact test. Statistical significance was defined as p&lt; 0.05. Results A total of 147 patients were included (58 SC vs 89 LC). Median POA duration in the SC group was 6.5 days vs 13 days in the LC group (p&lt; 0.0001). The primary outcome of 30-day freedom from donor-derived respiratory infection was present in 56 (97%) patients in the SC vs. 85 (96%) patients in the LC group (p= 1). There was no difference in development of CDI (p = 0.4), mortality (p = 1), or resistant organisms (p=0.28) while cumulative ventilator time and time to post-op extubation were longer in the LC group (p = 0.002 & 0.007, respectively). Methicillin-sensitive Staphylococcus aureus was the most common organism isolated from donors in the SC (23, 40%) and LC (48, 54%) groups. Conclusion Among lung transplant recipients with positive donor cultures, short course POA was as effective as long course in preventing donor-derived bacterial pneumonia. Further studies are needed to assess heterogeneity in POA practices and optimal duration among transplant centers. Disclosures Brian C. Keller, MD, PhD, CareDx, Inc. (Grant/Research Support) Bryan A. Whitson, MD, PhD, Abbott Laboratories (Consultant)TransMedics OCS (Other Financial or Material Support, Serves on the Clinical Events Committee)

Incidence and survival of patients with T0N1 breast cancers.

2014 ◽  
Vol 32 (26_suppl) ◽  
pp. 56-56
Author(s):  
Shoko Emily Abe ◽  
Kendall W. Carpenter ◽  
Yimei Han ◽  
Teresa Flippo ◽  
Terry Sarantou ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Proportional Hazards ◽  
Statistical Significance ◽  
Breast Cancer Incidence ◽  
Cox Proportional Hazards ◽  
Breast Cancers ◽  
Chi Square ◽  
Cox Proportional Hazards Models ◽  
Seer Data ◽  
Chi Square Test

56 Background: As imaging modalities have improved, breast cancers are increasingly detected at earlier stages. Patients rarely present with axillary disease but no mammographically evident breast tumor. Based on analysis of Surveillance, Epidemiology and End Results (SEER) data, we determined that there has been an increase in incidence of T1aN1 breast cancers. In response, we hypothesize that T0N1 breast cancer incidence has decreased with increased MRI use. Moreover, SEER analysis showed that T1aN1 patients have worse survival than T1bN1 patients. We thus hypothesize that T0N1 patients have worse survival than T1N1 patients. Methods: We identified 36,093 female patients diagnosed with T0-1 N1 invasive breast cancer from the SEER database. We compared patient and tumor characteristics: age, race, histology, hormone receptor status, and diagnosis year group (1990-1994, 1995-1999, 2000-2005, 2006-2010) – by TN category (T0N1/T1aN1/T1bN1/T1cN1) using chi-square test and ANOVA. Kaplan-Meier method was used to estimate disease specific survival (DSS) for each TN category and diagnosis year group separately. Adjusted hazard ratios were estimated using Cox proportional hazards models. Results: Stage distribution was: T0N1=129, T1aN1=1294, T1bN1=6731, and T1cN1=27942 patients. Median ages were 59.6, 56.3, 59.1, and 58.1, respectively. Time trend analysis of T0N1 cancers showed an increase in incidence from 1990 to 1999 and stability after 2000. Five-year DSS was significantly worse for patients with T0N1 tumors than T1aN1 tumors (84.5% versus 94.1%, HR 0.513, p < 0.0001). T0N1 tumors were more likely to be ER negative than T1b-cN1 tumors (23% versus 16%, p < 0.0001). T0N1 tumors were also more likely to be ER negative than T1aN1 tumors, but did not reach statistical significance (23% vs. 20%, p = 0.09). The proportion of lobular cancers was significantly higher in T0N1 than T1aN1 or T1b-cN1 patients (18% versus 8%, p < 0.0001). Conclusions: Our analysis suggests that T0N1 tumors may differ biologically from T1N1 tumors. Although the incidence of T0N1 tumors did not decrease, it remained stable after 2000 when the use of MRI for occult breast cancers became widely accepted. Our second hypothesis that survival is worse in patients with T0N1 tumors was confirmed by our analysis.

Survival benefit of systemic chemotherapy given as adjuvant (ACT) after thoracic surgery for N0-1 non-small cell lung cancer (NSCLC) patients (pts) with synchronous brain metastasis (SBM).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 8525-8525
Author(s):  
Sarah Shin ◽  
Saikrishna S. Yendamuri ◽  
Adrienne Groman ◽  
Grace K. Dy
Keyword(s):  
Thoracic Surgery ◽  
Proportional Hazards ◽  
Early Stage ◽  
Group Versus ◽  
Final Analysis ◽  
Nodal Status ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Early Stage Nsclc

8525 Background: Pts with solitary SBM and otherwise early-stage NSCLC demonstrate prolonged survival with surgical resection of both primary and metastatic disease. The role of “ACT” after thoracic surgery in this circumstance is not well-defined. We seek to determine the effect on overall survival(OS) of ACT after resection of primary tumor in pts with surgically resectable primary NSCLC and SBM. Methods: The National Cancer Database (NCDB) was queried to identify pts who underwent resection of NSCLC as the primary cancer (without other malignancies) from years 2010-2014 (n = 90,518). We then focused on pts who also were diagnosed with SBM (n = 807). Only patients with pathologically confirmed N stage 0 (n = 419) or 1 (n = 101) status were included in the final analysis. Patients who received platinum-based ACT within 3 months after surgery were considered to have received ACT. Associations between treatment groups were analyzed using the Chi-square test for categorical variables and Wilcoxon Rank Sum test for continuous variables. Univariate and multivariate proportional hazards modeling results were used to assess the effect of treatment and the confounding variables on OS. Relative prognosis was summarized using estimates and 95% confidence interval(CI) for the hazard ratio (HR). Unadjusted differences in OS between the treatments are shown using Kaplan-Meier methods. All analyses were performed using SAS version 9.4. Results: There is no imbalance in terms of gender, race, income, nodal status, histology between groups. Non-ACT pts were older (n = 181, median 64 vs 58 years in ACT group, p < 0.001). Age, nodal status, ACT, and histology were associated with OS in both univariate and multivariate analysis, with OS HR 0.51 (95% CI 0.39-0.66) in favor of ACT (n = 339). One- and 5-year survival in ACT group versus non-ACT group was 83% (95% CI 78%-87%) and 33% (25%-40%), versus 57%(95% CI 48%-65%) and 18% (95% CI 11%-26%), respectively. Conclusions: ACT after thoracic surgery for N0-1 NSCLC with SBM is associated with improved OS in this analysis.

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