Propensity Score-Matched Comparison of Stenting as Bridge to Surgery and Emergency Surgery for Acute Malignant Left-Sided Colonic Obstruction

Abstract PurposeBridge to elective surgery (BTS) using self-expanding metal stents (SEMS) is a common alternative to emergency surgery (ES) for acute malignant left-sided colonic obstruction (AMLCO). However, the study regarding long-term impact of BTS is limited and unclear.MethodsA multicenter observational study was performed at three hospitals from April 2012 to December 2019. Propensity score matching (PSM) was introduced to minimize selection bias. The primary endpoint was overall survival. The secondary endpoints included surgical approaches, primary resection types, total stent related adverse effects (AEs), surgical AEs, length of hospital stay, 30-day mortality and tumor recurrence.Results49 patients in both BTS and ES group were matched. Patients in the BTS group more often underwent laparoscopic resection (31 [63.3%] vs 8 [16.3%], p<0.001), less likely to have a primary stoma (13 [26.5%] vs 26 [53.1%], p=0.007) and more often had perineural invasion (25 [51.0%] vs 13 [26.5%], p=0.013). The median overall survival was significantly lower in patients with stent insertion (41 vs 65 months, p=0.041). 3-year overall survival (53.0% vs 77.2%, p=0.039) and 5-year overall survival (30.6% vs 55.0%, p=0.025) were significantly less favorable in the BTS group. In the multivariate Cox regression analysis, stenting (hazard ratio(HR)= 2.309(1.052-5.066), p=0.037), surgical AEs (HR=1.394(1.053-1.845), p=0.020) and pTNM stage (HR=1.706(1.116-2.607), p=0.014) were positively correlated with overall survival in matched patients. ConclusionsSelf-expanding metal stents as “a bridge to surgery” is associated with more perineural invasion, higher recurrence rate and worse overall survival in patients with acute malignant left-sided colonic obstruction compared with emergency surgery.

Download Full-text

Propensity score‐matched comparison of stenting as a bridge to surgery and emergency surgery for acute malignant left‐sided colonic obstruction

BMC Surgery ◽

10.1186/s12893-021-01144-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yuepeng Cao ◽

Qing Chen ◽

Zhizhan Ni ◽

Feng Wu ◽

Chenshen Huang ◽

...

Keyword(s):

Overall Survival ◽

Propensity Score ◽

Emergency Surgery ◽

Perineural Invasion ◽

Cox Regression ◽

Colonic Obstruction ◽

Metal Stents ◽

Bridge To Surgery ◽

Cox Regression Analysis ◽

Self Expanding Metal Stents

Abstract Background Bridge to elective surgery (BTS) using self-expanding metal stents (SEMSs) is a common alternative to emergency surgery (ES) for acute malignant left-sided colonic obstruction (AMLCO). However, studies regarding the long-term impact of BTS are limited and have reported unclear results. Methods A multicenter observational study was performed at three hospitals from April 2012 to December 2019. Propensity score matching (PSM) was introduced to minimize selection bias. The primary endpoint was overall survival. The secondary endpoints included surgical approaches, primary resection types, total stent-related adverse effects (AEs), surgical AEs, length of hospital stay, 30-day mortality and tumor recurrence. Results Forty-nine patients in both the BTS and ES groups were matched. Patients in the BTS group more often underwent laparoscopic resection [31 (63.3%) vs. 8 (16.3%), p < 0.001], were less likely to have a primary stoma [13 (26.5%) vs. 26 (53.1%), p = 0.007] and more often had perineural invasion [25 (51.0 %) vs. 13 (26.5 %), p = 0.013]. The median overall survival was significantly lower in patients with stent insertion (41 vs. 65 months, p = 0.041). The 3-year overall survival (53.0 vs. 77.2%, p = 0.039) and 5-year overall survival (30.6 vs. 55.0%, p = 0.025) were significantly less favorable in the BTS group. In multivariate Cox regression analysis, stenting (hazard ratio(HR) = 2.309(1.052–5.066), p = 0.037), surgical AEs (HR = 1.394 (1.053–1.845), p = 0.020) and pTNM stage (HR = 1.706 (1.116–2.607), p = 0.014) were positively correlated with overall survival in matched patients. Conclusions Self-expanding metal stents as “a bridge to surgery” are associated with more perineural invasion, a higher recurrence rate and worse overall survival in patients with acute malignant left-sided colonic obstruction compared with emergency surgery.

Download Full-text

Surgical Resection Significantly Promotes the Overall Survival of Patients with Hepatocellular Carcinoma: A Propensity Score Matching Analysis

10.21203/rs.3.rs-148506/v1 ◽

2021 ◽

Author(s):

Pei-Min Hsieh ◽

Hung-Yu Lin ◽

Chao-Ming Hung ◽

Gin-Ho Lo ◽

I-Cheng Lu ◽

...

Keyword(s):

Risk Factors ◽

Hepatocellular Carcinoma ◽

Overall Survival ◽

Propensity Score ◽

Propensity Score Matching ◽

Surgical Resection ◽

Cox Regression ◽

Survival Rates ◽

Hbv Infection ◽

Cox Regression Analysis

Abstract Background: The benefits of surgical resection (SR) for various Barcelona Clinic Liver Cancer (BCLC) stages of hepatocellular carcinoma (HCC) remain unclear. We investigated the risk factors of overall survival (OS) and survival benefits of SR over nonsurgical treatments in patients with HCC of various BCLC stages.Methods: Overall, 2316 HCC patients were included, and their clinicopathological data and OS were recorded. OS was analyzed by the Kaplan-Meier method and Cox regression analysis. Propensity score matching (PSM) analysis was performed.Results: In total, 66 (2.8%), 865 (37.4%), 575 (24.8%) and 870 (35.0%) patients had BCLC stage 0, A, B, and C disease, respectively. Furthermore, 1302 (56.2%) of all patients, and 37 (56.9%), 472 (54.6%), 313 (54.4%) and 480 (59.3%) of patients with BCLC stage 0, A, B, and C disease, respectively, died. The median follow-up duration time was 20 (range 0-96) months for the total cohort and was subdivided into 52 (8-96), 32 (1-96), 19 (0-84), and 12 (0-79) months for BCLC stages 0, A, B, and C cohorts, respectively. The risk factors for OS were 1) SR and cirrhosis; 2) SR, cirrhosis, and Child-Pugh (C-P) class; 3) SR, hepatitis B virus (HBV) infection, and C-P class; and 4) SR, HBV infection, and C-P class for the BCLC stage 0, A, B, and C cohorts, respectively. Compared to non-SR treatment, SR resulted in significantly higher survival rates in all cohorts. The 5-year OS rates for SR vs non-SR were 44.0% vs 28.7%, 72.2% vs 42.6%, 42.6% vs 36.2, 44.6% vs 23.5%, and 41.4% vs 15.3% (all p-values<0.05) in the total and BCLC stage 0, A, B, and C cohorts, respectively. After PSM, SR resulted in significantly higher survival rates compared to non-SR treatment in various BCLC stages.Conclusion: SR conferred significant survival benefits to patients with HCC of various BCLC stages and should be considered a recommended treatment for select HCC patients, especially patients with BCLC stage B and C disease.

Download Full-text

Comparison of overall survival on surgical resection versus transarterial chemoembolization with or without radiofrequency ablation in intermediate stage hepatocellular carcinoma: A propensity score matching analysis

10.21203/rs.2.22284/v2 ◽

2020 ◽

Author(s):

Chih-Wen Lin ◽

Yaw-Sen Chen ◽

Gin-Ho Lo ◽

Yao-Chun Hsu ◽

Chia-Chang Hsu ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Radiofrequency Ablation ◽

Propensity Score ◽

Propensity Score Matching ◽

Surgical Resection ◽

Cox Regression ◽

Cox Regression Analysis ◽

Tace Group ◽

The Impact

Abstract Background: Patients with Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC) are recommended to undergo transcatheter arterial chemoembolization (TACE). However, TACE in combination with radiofrequency ablation (RFA) is not inferior to surgical resection (SR), and the benefits of surgical resection (SR) for BCLC stage B HCC remain unclear. Hence, this study aims to compare the impact of SR, TACE+RFA, and TACE on analyzing overall survival (OS) in BCLC stage B HCC. Methods: Overall, 428 HCC patients were included in BCLC stage B, and their clinical data and OS were recorded. OS was analyzed by the Kaplan-Meier method and Cox regression analysis. Results: One hundred forty (32.7%) patients received SR, 231 (53.9%) received TACE+RFA, and 57 (13.3%) received TACE. The OS was significantly higher in the SR group than that in the TACE+RFA group [hazard ratio (HR): 1.78; 95% confidence incidence (CI): 1.15-2.75, p=0.009]. The OS was significantly higher in the SR group than that in the TACE group (HR: 3.17; 95% CI: 2.31-4.36, p<0.0001). Moreover, the OS was significantly higher in the TACE+RFA group than that in the TACE group (HR: 1.82; 95% CI: 1.21-2.74, p=0.004). The cumulative OS rates at 1, 3 and 5 years in the SR, TACE+RFA, and TACE groups were 89.2%, 69.4% and 61.2%, 86.0%, 57.9% and 38.2%, and 69.5%, 37.0% and 15.2%, respectively. After propensity score matching, the SR group still had a higher OS than those of the TACE+RFA and TACE groups. The TACE+RFA group had a higher OS than that of the TACE group. Conclusion: The SR group had higher OS than the TACE+RFA and TACE groups in BCLC stage B HCC. Furthermore, the TACE+RFA group had higher OS than the TACE group.

Download Full-text

Inferior outcome of neuroendocrine tumor patients negative on somatostatin receptor imaging

Endocrine Related Cancer ◽

10.1530/erc-20-0340 ◽

2020 ◽

Vol 27 (11) ◽

pp. 615-624

Author(s):

Julie Refardt ◽

Wouter T Zandee ◽

Tessa Brabander ◽

Richard A Feelders ◽

Gaston J H Franssen ◽

...

Keyword(s):

Overall Survival ◽

Propensity Score ◽

Median Overall Survival ◽

Cox Regression ◽

Somatostatin Receptor ◽

Somatostatin Analogs ◽

Tumor Biology ◽

Survival Rates ◽

Receptor Imaging ◽

Cox Regression Analysis

Sufficient expression of somatostatin receptor (SSTR) in well-differentiated neuroendocrine tumors (NETs) is crucial for treatment with somatostatin analogs (SSAs) and peptide receptor radionuclide therapy (PRRT) using radiolabeled SSAs. Impaired prognosis has been described for SSTR-negative NET patients; however, studies comparing matched SSTR-positive and -negative subjects who have not received PRRT are missing. This retrospective analysis of two prospectively maintained NET databases aimed to compare matched metastatic grade 1 or 2 SSTR-positive and –negative NET patients. SSTR-negativity was defined as having insufficient tumor uptake on diagnostic SSTR imaging. Patients that underwent PRRT were excluded. Seventy-seven SSTR-negative and 248 SSTR-positive grade 1–2 NET patients were included. Median overall survival rates were significantly lower for SSTR-negative compared to SSTR-positive NET patients (53 months vs 131 months; P < 0.001). To adjust for possible confounding by age, gender, grade and site of origin, 69 SSTR-negative NET patients were propensity score matched to 69 SSTR-positive NET patients. Group characteristics were similar, with the exception of SSTR-negative patients receiving more often chemotherapy and targeted treatment. The inferior survival outcome of SSTR-negative compared to SSTR-positive NET patients persisted with a median overall survival of 38 months vs 131 months (P = 0.012). This relationship upheld when correcting for the main influencing factors of having a higher grade tumor or receiving surgery in a multivariate Cox regression analysis. In conclusion, we showed that propensity score-matched SSTR-negative NET patients continue to have a worse prognosis compared to SSTR-positive NET patients despite receiving more aggressive treatment. Differences in tumor biology likely underlie this survival deficit.

Download Full-text

Treatment of cancer of the anal canal. The Hamburg experience

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.14062 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 14062-14062

Author(s):

V. Rudat ◽

S. Streller ◽

D. Rades

Keyword(s):

Overall Survival ◽

Prognostic Factors ◽

Anal Canal ◽

Survival Data ◽

Cox Regression ◽

Haemoglobin Concentration ◽

International Standards ◽

Surgical Approaches ◽

Rank Test ◽

Cox Regression Analysis

14062 Background: To compare surgical and non-surgical treatment approaches for anal cancer and to identify prognostic factors. Methods: Survival data of 214 patients with cancer of the anal canal were reviewed who were referred for radiotherapy to the Department of Radiation Oncology of the University of Hamburg, Germany between 1/88 and 3/05. 75 patients received a definitive radiochemotherapy (RCT) with 5-FU and MMC according to international standards, 43 an operation followed by RCT (OP+RCT), 37 an operation followed by irradiation (OP+RT), 25 an irradiation alone (RT) and 34 an operation alone because they refused a planned adjuvant RCT or RT. The operations had been performed by different referring hospitals in and around Hamburg. Results: The median follow-up time of the living patients was 67 months (1–200 months). The 10 year overall survival rate for RCT was 0.62 (95%CI 0.46–0.77), for OP+RCT 0.65 (95%CI 0.47–0.83), for OP+RT 0.55 (95%CI 0.37–0.74), for OP alone 0.51 (95%CI 0.26–0.75) and for RT alone 0.27 (95%CI 0.05–0.48). There was no statistical difference between the overall survival of patients who received RCT, OP+RCT and OP+RT according to Kaplan Meier analysis (log rank test, p = 0.71). Cox regression analysis was used to examine the simultaneous influence of the prognostic factors T, N, age, haemoglobin concentration before radiotherapy, gender, and grading on the survival of patients who were treated with RCT. The model (p = 0.015) revealed T and N to be the only statistically significant prognostic factors. Conclusions: The different surgical and non-surgical approaches to treat cancer of the anal canal in Hamburg obviously reflect the individual preferences of the different physicians. Statistical analysis did not show a benefit of an OP added to RCT. Prognostic factors for survival after RCT were the T- and N-stage. No significant financial relationships to disclose.

Download Full-text

Comparison of overall survival on surgical resection versus transarterial chemoembolization with or without radiofrequency ablation in intermediate stage hepatocellular carcinoma: A propensity score matching analysis

10.21203/rs.2.22284/v1 ◽

2020 ◽

Author(s):

Chih-Wen Lin ◽

Yaw-Sen Chen ◽

Gin-Ho Lo ◽

Yao-Chun Hsu ◽

Chia-Chang Hsu ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Radiofrequency Ablation ◽

Propensity Score ◽

Propensity Score Matching ◽

Surgical Resection ◽

Cox Regression ◽

Cox Regression Analysis ◽

Tace Group ◽

The Impact

Abstract Background: Patients with Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC) are recommended to undergo transcatheter arterial chemoembolization (TACE). However, TACE in combination with radiofrequency ablation (RFA) is not inferior to surgical resection (SR), and the benefits of surgical resection (SR) for BCLC stage B HCC remain unclear. Hence, this study aims to compare the impact of SR, TACE+RFA, and TACE on analyzing overall survival (OS) in BCLC stage B HCC.Methods: Overall, 428 HCC patients were included in BCLC stage B, and their clinical data and OS were recorded. OS was analyzed by the Kaplan-Meier method and Cox regression analysis. Results: One hundred forty (32.7%) patients received SR, 231 (53.9%) received TACE+RFA, and 57 (13.3%) received TACE. The OS was significantly higher in the SR group than that in the TACE+RFA group [hazard ratio (HR): 1.78; 95% confidence incidence (CI): 1.15-2.75, p=0.009]. The OS was significantly higher in the SR group than that in the TACE group (HR: 3.17; 95% CI: 2.31-4.36, p<0.0001). Moreover, the OS was significantly higher in the TACE+RFA group than that in the TACE group (HR: 1.82; 95% CI: 1.21-2.74, p=0.004). The cumulative OS rates at 1, 3 and 5 years in the SR, TACE+RFA, and TACE groups were 89.2%, 69.4% and 61.2%, 86.0%, 57.9% and 38.2%, and 69.5%, 37.0% and 15.2%, respectively. After propensity score matching, the SR group still had a higher OS than those of the TACE+RFA and TACE groups. The TACE+RFA group had a higher OS than that of the TACE group. Conclusion: The SR group had higher OS than the TACE+RFA and TACE groups in BCLC stage B HCC. Furthermore, the TACE+RFA group had higher OS than the TACE group.

Download Full-text

Propensity score matching analysis of ovarian cancer patients with multiple primary malignant neoplasms using multicenter real-world data.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e17501 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e17501-e17501

Author(s):

Qing-lei Gao ◽

Xiaofei Jiao ◽

Ruyuan Li ◽

Shaoqing Zeng ◽

Yingjun Zhao ◽

...

Keyword(s):

Breast Cancer ◽

Ovarian Cancer ◽

Overall Survival ◽

Propensity Score ◽

Propensity Score Matching ◽

Cancer Patients ◽

Cox Regression ◽

Malignant Neoplasms ◽

Cox Regression Analysis ◽

Multiple Primary

e17501 Background: Multiple primary malignant neoplasms (MPMNs) in patients with ovarian cancer is rare and has not attracted enough attention. It is unclear how the MPMNs affect the prognosis of ovarian cancer (OC) patients. Methods: This is a multicenter retrospective analysis of 5, 268 ovarian cancer patients from six centers who was diagnosed with ovarian cancer from January 1, 1989 to August 21, 2020. Propensity score matching was used to balance the baseline characteristics between patients with and without MPMNs. Cox regression analysis was utilized to analyze the influence of MPMNs on overall survival (OS). Results: After excluding unqualified medical record, totally 4, 848 patients were analyzed and 240 were concurrent at least one MPMNs other than OC. Ten patients had two MPMNs and one patient had three. The most common concurrent cancer was breast cancer (111/240, 46.25%), followed by endometrial cancer (37/240, 15.42%), and cervical cancer (30/240, 12.50%). Patients with MPMNs were elder than those without MPMNs (52 vs. 51, P = 0.03) when ovarian cancer was diagnosed. And the proportion of early-stage cases was lower in patients with MPMNs (25.8% vs. 27.2%, P < 0.001). Patients with breast cancer had a higher proportion of high-grade serous ovarian cancer (HGSOC) than those without MPMNs. After using the propensity score matching method adjusting age, pathological type, grade, and stage, concurrent MPMNs, including breast cancer, had no effect on OS of ovarian cancer patients. Among 240 patients with MPMNs, patients with breast cancer shared similar age and stage compared with the rest patients, while their proportion of HGSOC was higher than patients with other cancer (68.4% vs. 51.1%, P = 0.028). However, the median OS of those two groups were similar (27.3 m vs.27.1 m, P = 0.744). In addition, 94 patients were diagnosed with breast cancer prior to ovarian cancer, seven diagnosed posteriorly to ovarian cancer, four diagnosed simultaneously, and six had no precise diagnosed dates. There was no remarkable difference in clinical characteristics between the prior and posterior groups, however, the median OS of those seven patients was significantly longer than the prior group (76.0 m vs. 25.4 m, P = 0.002). Conclusions: The MPMNs showed no influence on the overall survival of ovarian cancer patients. The order of diagnosis of ovarian cancer and breast cancer might affect the prognosis.

Download Full-text

Surgical resection significantly promotes the overall survival of patients with hepatocellular carcinoma: a propensity score matching analysis

BMC Gastroenterology ◽

10.1186/s12876-021-01807-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yaw-Sen Chen ◽

Pei-Min Hsieh ◽

Hung-Yu Lin ◽

Chao-Ming Hung ◽

Gin-Ho Lo ◽

...

Keyword(s):

Risk Factors ◽

Hepatocellular Carcinoma ◽

Overall Survival ◽

Propensity Score ◽

Propensity Score Matching ◽

Surgical Resection ◽

Cox Regression ◽

Survival Rates ◽

Hbv Infection ◽

Cox Regression Analysis

Abstract Background The benefits of surgical resection (SR) for various Barcelona Clinic Liver Cancer (BCLC) stages of hepatocellular carcinoma (HCC) remain unclear. We investigated the risk factors of overall survival (OS) and survival benefits of SR over nonsurgical treatments in patients with HCC of various BCLC stages. Methods Overall, 2316 HCC patients were included, and their clinicopathological data and OS were recorded. OS was analyzed by the Kaplan-Meier method and Cox regression analysis. Propensity score matching (PSM) analysis was performed. Results In total, 66 (2.8%), 865 (37.4%), 575 (24.8%) and 870 (35.0%) patients had BCLC stage 0, A, B, and C disease, respectively. Furthermore, 1302 (56.2%) of all patients, and 37 (56.9%), 472 (54.6%), 313 (54.4%) and 480 (59.3%) of patients with BCLC stage 0, A, B, and C disease, respectively, died. The median follow-up duration time was 20 (range 0–96) months for the total cohort and was subdivided into 52 (8–96), 32 (1–96), 19 (0–84), and 12 (0–79) months for BCLC stages 0, A, B, and C cohorts, respectively. The risk factors for OS were (1) SR and cirrhosis; (2) SR, cirrhosis, and Child–Pugh (C–P) class; (3) SR, hepatitis B virus (HBV) infection, and C–P class; and (4) SR, HBV infection, and C–P class for the BCLC stage 0, A, B, and C cohorts, respectively. Compared to non-SR treatment, SR resulted in significantly higher survival rates in all cohorts. The 5-year OS rates for SR vs. non-SR were 44.0% versus 28.7%, 72.2% versus 42.6%, 42.6% versus 36.2, 44.6% versus 23.5%, and 41.4% versus 15.3% (all P values < 0.05) in the total and BCLC stage 0, A, B, and C cohorts, respectively. After PSM, SR resulted in significantly higher survival rates compared to non-SR treatment in various BCLC stages. Conclusions SR conferred significant survival benefits to patients with HCC of various BCLC stages and should be considered a recommended treatment for select HCC patients, especially patients with BCLC stage B and C disease.

Download Full-text

Prognostic Association between Common Laboratory Tests and Overall Survival in Elderly Men with De Novo Metastatic Castration Sensitive Prostate Cancer: A Population-Based Study in Canada

Cancers ◽

10.3390/cancers13112844 ◽

2021 ◽

Vol 13 (11) ◽

pp. 2844

Author(s):

Christopher J. D. Wallis ◽

Bobby Shayegan ◽

Scott C. Morgan ◽

Robert J. Hamilton ◽

Ilias Cagiannos ◽

...

Keyword(s):

Prostate Cancer ◽

Overall Survival ◽

Clinical Decision Making ◽

Cox Regression ◽

De Novo ◽

Population Based ◽

Population Based Study ◽

Cox Regression Analysis ◽

Lymphocyte Ratio ◽

Laboratory Markers

De novo cases of metastatic prostate cancer (mCSPC) are associated with poorer prognosis. To assist in clinical decision-making, we aimed to determine the prognostic utility of commonly available laboratory-based markers with overall survival (OS). In a retrospective population-based study, a cohort of 3556 men aged ≥66 years diagnosed with de novo mCSPC between 2014 and 2019 was identified in Ontario (Canada) administrative database. OS was assessed by using the Kaplan–Meier method. Multivariate Cox regression analysis was performed to evaluate the association between laboratory markers and OS adjusting for patient and disease characteristics. Laboratory markers that were assessed include neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), albumin, hemoglobin, serum testosterone and PSA kinetics. Among the 3556 older men with de novo mCSPC, their median age was 77 years (IQR: 71–83). The median survival was 18 months (IQR: 10–31). In multivariate analysis, a statistically significant association with OS was observed with all the markers (NLR, PLR, albumin, hemoglobin, PSA decrease, reaching PSA nadir and a 50% PSA decline), except for testosterone levels. Our findings support the use of markers of systemic inflammation (NLR, PLR and albumin), hemoglobin and PSA metrics as prognostic indicators for OS in de novo mCSPC.

Download Full-text

Diabetes mellitus was not associated with lower amputation-free survival after open revascularization for chronic limb-threatening ischemia – A nationwide propensity score adjusted analysis

Vascular Medicine ◽

10.1177/1358863x211008249 ◽

2021 ◽

pp. 1358863X2110082

Author(s):

Erika Lilja ◽

Anders Gottsäter ◽

Mervete Miftaraj ◽

Jan Ekelund ◽

Björn Eliasson ◽

...

Keyword(s):

Diabetes Mellitus ◽

Propensity Score ◽

Vascular Surgery ◽

Incidence Rate ◽

Cox Regression ◽

Major Amputation ◽

Incidence Rates ◽

Major Adverse Cardiovascular Events ◽

Cox Regression Analysis ◽

Number Of Patients

The risk of major amputation is higher after urgently planned endovascular therapy for chronic limb-threatening ischemia (CLTI) in patients with diabetes mellitus (DM). The aim of this nationwide cohort study was to compare outcomes between patients with and without DM following urgently planned open revascularization for CLTI from 2010 to 2014. Out of 1537 individuals registered in the Swedish Vascular Registry, 569 were registered in the National Diabetes Register. A propensity score adjusted Cox regression analysis was conducted to compare outcome between the groups with and without DM. Median follow-up was 4.3 years and 4.5 years for patients with and without DM, respectively. Patients with DM more often had foot ulcers ( p = 0.034) and had undergone more previous amputations ( p = 0.001) at baseline. No differences in mortality, cardiovascular death, major adverse cardiovascular events (MACE), or major amputation were observed between groups. The incidence rate of stroke was 70% higher (95% CI: 1.11–2.59; p = 0.0137) and the incidence rate of acute myocardial infarction (AMI) 39% higher (95% CI: 1.00–1.92; p = 0.0472) among patients with DM in comparison to those without. Open vascular surgery remains a first-line option for a substantial number of patients with CLTI, especially for limb salvage in patients with DM. The higher incidence rates of stroke and AMI among patients with DM following open vascular surgery for infrainguinal CLTI require specific consideration preoperatively with the aim of optimizing medical treatment to improve cardiovascular outcome postoperatively.

Download Full-text