scholarly journals The Impact of Resection Margin and Microscopic Vascular Invasion for Patients with HBV-related Intrahepatic Cholangiocarcinoma

2020 ◽  
Author(s):  
Wen-Feng Lu ◽  
Pei-Qin Chen ◽  
Kai Yan ◽  
Ye-Chen Wu ◽  
Lei Liang ◽  
...  
Keyword(s):  
Intrahepatic Cholangiocarcinoma ◽  
Vascular Invasion ◽  
Resection Margin ◽  
Microscopic Vascular Invasion ◽  
B Virus ◽  
Independent Risk Factors ◽  
Long Term Prognosis ◽  
The Impact

Abstract Background and Aim: The resection margin (RM) status and microscopic vascular invasion (MVI) are known prognostic factors for intrahepatic cholangiocarcinoma (ICC). An enhanced understanding of their impact on long-term prognosis is required to improve oncological outcomes.Methods: We reviewed data on 711 consecutive patients who underwent curative liver resection for hepatitis B virus–related ICC. The different impact of the RM status (narrow, <1 cm, or wide, ≥ 1 cm) and MVI (positive, +, or negative, -) on overall survival (OS) and recurrence-free survival (RFS) were analyzed. Results: The 1-, 3-, and 5-year OS rates were 67.6%, 42.5% and 33.2% in wide RM & & MVI (-), 58.0%, 36.1% and 26.5% in narrow RM & MVI (-), 51.0%, 27.0% and 24.3% in wide RM & MVI (+), and 39.0%, 20.4% and 14.3% in narrow RM & MVI (+) (p < 0.001).The 1-, 3-, and 5-year RFS rates were 60.0%, 40.2% and 28.7% in wide RM & MVI (-), 45.2%, 34.3% and 24.2% in narrow RM & MVI (-), 40.0%, 18.5% and 12.3% in wide RM & MVI (+), and 28.2%, 11.5% and 9.8% in narrow RM & MVI (+) (p < 0.001). Multivariate analysis showed that RM & MVI were independent risk factors for the OS and RFS. Conclusions: Combined analysis of RM and MVI can better stratify the risks of postoperative death and recurrence in patients with HBV-related ICC, which may help subsequent adjuvant therapy and follow-up.

scholarly journals Concomitant tricuspid regurgitation severity and its secondary reduction determine long-term prognosis after transcatheter mitral valve edge-to-edge repair

2021 ◽  
Author(s):  
Martin Geyer ◽  
Karsten Keller ◽  
Kevin Bachmann ◽  
Sonja Born ◽  
Alexander R. Tamm ◽  
...  
Keyword(s):  
Tricuspid Regurgitation ◽  
Survival Data ◽  
Common Finding ◽  
Prognostic Impact ◽  
Term Survival ◽  
Long Term Prognosis ◽  
The Impact ◽  
Symptomatic Benefit

Abstract Background Concomitant tricuspid regurgitation (TR) is a common finding in mitral regurgitation (MR). Transcatheter repair (TMVR) is a favorable treatment option in patients at elevated surgical risk. To date, evidence on long-term prognosis and the prognostic impact of TR after TMVR is limited. Methods Long-term survival data of patients undergoing isolated edge-to-edge repair from June 2010 to March 2018 (combinations with other forms of TMVR or tricuspid valve therapy excluded) were analyzed in a retrospective monocentric study. TR severity was categorized and the impact of TR on survival was analysed. Results Overall, 606 patients [46.5% female, 56.4% functional MR (FMR)] were enrolled in this study. TR at baseline was categorized severe/medium/mild/no or trace in 23.2/34.3/36.3/6.3% of the cases. At 30-day follow-up, improvement of at least one TR-grade was documented in 34.9%. Severe TR at baseline was identified as predictor of 1-year survival [65.2% vs. 77.0%, p = 0.030; HR for death 1.68 (95% CI 1.12–2.54), p = 0.013] and in FMR-patients also regarding long-term prognosis [adjusted HR for long-term mortality 1.57 (95% CI 1.00–2.45), p = 0.049]. Missing post-interventional reduction of TR severity was predictive for poor prognosis, especially in the FMR-subgroup [1-year survival: 92.9% vs. 78.3%, p = 0.025; HR for death at 1-year follow-up 3.31 (95% CI 1.15–9.58), p = 0.027]. While BNP levels decreased in both subgroups, TR reduction was associated with improved symptomatic benefit (NYHA-class-reduction 78.6 vs. 65.9%, p = 0.021). Conclusion In this large study, both, severe TR at baseline as well as missing secondary reduction were predictive for impaired long-term prognosis, especially in patients with FMR etiology. TR reduction was associated with increased symptomatic benefit. Graphic abstract

Long-term prognosis of patients withJ-wave syndrome

Heart ◽  
2019 ◽  
Vol 106 (4) ◽  
pp. 299-306
Author(s):  
Tsukasa Kamakura ◽  
Tetsuji Shinohara ◽  
Kenji Yodogawa ◽  
Nobuyuki Murakoshi ◽  
Hiroshi Morita ◽  
...  
Keyword(s):  
High Amplitude ◽  
Long Term Study ◽  
St Segment ◽  
History Of ◽  
Provocation Testing ◽  
Long Term Prognosis ◽  
Electrocardiographic Parameters ◽  
The Impact

ObjectiveLimited data are currently available regarding the long-term prognosis of patients with J-wave syndrome (JWS). The aim of this study was to investigate the long-term prognosis of patients with JWS and identify predictors of the recurrence of ventricular fibrillation (VF).MethodsThis was a multicentre retrospective study (seven Japanese hospitals) involving 134 patients with JWS (Brugada syndrome (BrS): 85; early repolarisation syndrome (ERS): 49) treated with an implantable cardioverter defibrillator. All patients had a history of VF. All patients with ERS underwent drug provocation testing with standard and high intercostal ECG recordings to rule out BrS. The impact of global J waves (type 1 ECG or anterior J waves and inferolateral J waves in two or more leads) on the prognosis was evaluated.ResultsDuring the 91±66 months of the follow-up period, 52 (39%) patients (BrS: 37; ERS: 15) experienced recurrence of VF. Patients with BrS and ERS with global J waves showed a significantly higher incidence of VF recurrence than those without (BrS: log-rank, p=0.014; ERS: log-rank, p=0.0009). The presence of global J waves was a predictor of VF recurrence in patients with JWS (HR: 2.16, 95% CI 1.21 to 3.91, p=0.0095), while previously reported high-risk electrocardiographic parameters (high-amplitude J waves ≥0.2 mV and J waves associated with a horizontal or descending ST segment) were not predictive of VF recurrence.ConclusionsThis multicentre long-term study showed that the presence of global J waves was associated with a higher incidence of VF recurrence in patients with JWS.

scholarly journals Long-term prognosis for neck-shoulder pain and disorders: a 14-year follow-up study

2017 ◽  
Vol 75 (2) ◽  
pp. 90-97 ◽  
Author(s):  
Emma Lise Thorlund Jakobsen ◽  
Karin Biering ◽  
Anette Kærgaard ◽  
Annett Dalbøge ◽  
Johan Hviid Andersen
Keyword(s):  
Shoulder Pain ◽  
Physical Functioning ◽  
Sewing Machine ◽  
Follow Up Study ◽  
Machine Operators ◽  
Shoulder Disorders ◽  
Long Term Prognosis ◽  
The Impact

ObjectivesThe long-term prognosis for neck-shoulder pain and disorders and the impact of shoulder exposure among former sewing machine operators were investigated in a 14-year follow-up study.MethodsInformation on neck-shoulder pain and disorders was collected by questionnaire and clinical examination at baseline in 243 female sewing machine operators and by questionnaire 14 years later. During follow-up, information on comorbidity and job exposures was obtained from registers and by linking register-based D-ISCO 88 codes with a job exposure matrix. Logistic regression analyses were performed to examine associations between neck-shoulder pain and disorders at baseline and neck-shoulder pain and physical functioning at follow-up.ResultsWe found an association between neck-shoulder disorders at baseline and neck-shoulder pain at follow-up (OR 5.9;95% CI 1.9 to 17.7), and between neck-shoulder pain at baseline and neck-shoulder pain at follow-up (OR 8.2;95% CI 3.5 to 19.2). Associations between neck-shoulder disorders and pain at baseline and limited physical functioning at follow-up had ORs of 5.0 (95% CI 1.5 to 16.1) and 2.2 (95% CI 1.1 to 4.6), respectively. In women still working in 2008, the association between neck-shoulder pain in 1994 and in 2008 seemed to be stronger for those in jobs with high job shoulder exposure.ConclusionsThe results suggest a long-term adverse prognosis for neck-shoulder pain. High job shoulder exposure can worsen this prognosis for those who continue working. This knowledge could influence the counselling given to similar workers and emphasises the need to prevent neck-shoulder pain.

scholarly journals Hydrocephalus and hypothalamic involvement in pediatric patients with craniopharyngioma or cysts of Rathke's pouch: impact on long-term prognosis

2015 ◽  
Vol 172 (5) ◽  
pp. 561-569 ◽  
Author(s):  
A M M Daubenbüchel ◽  
A Hoffmann ◽  
U Gebhardt ◽  
M Warmuth-Metz ◽  
A S Sterkenburg ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Negative Impact ◽  
Neurological Deficits ◽  
Term Survival ◽  
Rathke’S Pouch ◽  
Rathke's Pouch ◽  
Long Term Prognosis ◽  
The Impact

ObjectivePediatric patients with sellar masses such as craniopharyngioma (CP) or cyst of Rathke's pouch (CRP) frequently suffer disease- and treatment-related sequelae. We analyzed the impact and prognostic relevance of initial hydrocephalus (HY) and hypothalamic involvement (HI) on long-term survival and functional capacity (FC) in children with CP or CRP.Subjects and methodsUsing retrospective analysis of patient records, presence of initial HY or HI was assessed in 177 pediatric patients (163 CP and 14 CRP). Twenty-year overall survival (OS) and progression-free survival (PFS), FC, and BMI were analyzed with regard to initial HY, degree of resection, or HI.ResultsOf the 177 patients, 105 patients (103/163 CP and 2/14 CRP) presented with initial HY and 96 presented with HI. HY at diagnosis was associated (P=0.000) with papilledema, neurological deficits, and higher BMI at diagnosis and during follow-up. OS, PFS, and FC were not affected by HY at initial diagnosis. HI at diagnosis (96/177) had major negative impact on long-term prognosis. Sellar masses with HI were associated with lower OS (0.84±0.04; P=0.021), lower FC (P=0.003), and higher BMI at diagnosis and last follow-up (P=0.000) when compared with sellar masses without HI (OS: 0.94±0.05). PFS was not affected by HI or degree of resection.ConclusionsInitial HY has no impact on outcome in patients with sellar masses. OS and FC are impaired in survivors presenting with initial HI. PFS is not affected by HY, HI, or degree of resection. Accordingly, gross-total resection is not recommended in sellar masses with initial HI to prevent further hypothalamic damage.

scholarly journals Modified Clavien-Dindo Classification to Analyze the Risk Factors of Early Complications after Radical Gastrectomy and the Impact of Complications on Long-Term Prognosis

2020 ◽  
Author(s):  
Jun Ma ◽  
Ying Wang ◽  
Shui-hong Yu ◽  
Chao-pin Zhou ◽  
Da-tian Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Blood Loss ◽  
Postoperative Hospital Stay ◽  
Radical Gastrectomy ◽  
Early Complications ◽  
Independent Risk Factors ◽  
Long Term Prognosis ◽  
The Impact

Abstract Background The modified Clavien-Dindo classification system was employed to investigate the occurrence of early complications along with the related risk factors following a radical gastrectomy procedure, with the view of conducting an analysis into the impact of complications on long-term prognosis. Methods The clinical data of 525 patients who had previously undergone a radical gastrectomy procedure for gastric cancer were analyzed in a retrospective fashion. Results Postoperative hospital stay: Complication group (17.88±8.472) days, severe complications group (23.10±7.594) days, significantly higher than non-complication group (10.26±1.973) days and non-severe complications group (11.47±4.712) days (P=0.000<0.05).Multivariate analysis: age (OR = 1.781, P = 0.013), preoperative comorbidity (OR = 1.765, P = 0.020), blood loss (OR = 2.153, P = 0.001), surgical approach (OR = 3.137, P = 0.000) were identified as an independent risk factor associated with early complications. Blood loss (OR=13.053, P=0.013), type of resection (OR=7.936, P=0.047) and nerve involvement (OR=3.670, P=0.009) were identified to be independent risk factors for severe complications.Severe postoperative complications (HR=1.595, P=0.107) and postoperative complications (HR=1.078, P=0.670) were not independent risk factors affecting the 5-year over survival rate. Conclusion Complications following radical gastrectomy were closely related to age, preoperative comorbidity, blood loss, and surgical approach; severe complications were closely related to blood loss, total gastrectomy, and nerve involvement; complications and severe complications were not found to be independent risk factors associated with long-term survival, that being said, they were significantly prolonged postoperative hospital stay.

scholarly journals Association of liver cirrhosis with the prognosis of patients with intrahepatic cholangiocarcinoma: a SEER-based cohort study

2020 ◽  
Author(s):  
Wei Li ◽  
Hong Wu ◽  
Yange Zhang
Keyword(s):  
Liver Cirrhosis ◽  
Intrahepatic Cholangiocarcinoma ◽  
Multivariable Analysis ◽  
Fibrosis Score ◽  
Multivariable Analyses ◽  
Long Term Prognosis ◽  
The Impact ◽  
The Relationship ◽  
Interaction Test

Abstract Background The association of liver cirrhosis with the prognosis of intrahepatic cholangiocarcinoma (ICC) remains controversial. We aimed to evaluate the relationship between liver cirrhosis (fibrosis score) and the long-term prognosis of patients with ICC. Methods SEER 18 registry from 2004 to 2015 was queried for this study. Propensity score matching (PSM) was performed to eliminate possible bias. In addition, multivariable analysis was utilized to adjust for potential confounders. The interaction test was performed to explore the impact of each stratified factor on the relationship between FS and patient survival. Overall survival (OS) and disease-specific survival (DSS) were the major endpoints. Results During the study period, 359 patients (66.5%) with lower fibrosis score (LFS; F0-4) and 181 patients (33.5%) with higher fibrosis score (HFS; F5-6) were enrolled. In the multivariable adjusted cohort (OS: n = 540; DSS: n = 417), patients with HFS had worse OS (HR, 1.43; 95% CI, 1.10 to 1.85; P = 0.007) and DSS (HR, 1.46; 95% CI, 1.08 to 1.97; P = 0.013) compared to patients with LFS. In the propensity-matched cohort, patients with HFS still had worse OS (HR, 1.50; 95% CI, 1.08 to 2.09; P = 0.016) and DSS (HR, 1.54; 95% CI, 1.05 to 2.26; P = 0.026) compared to patients with LFS. In multivariable analyses stratified by clinicopathologic features, patients with HFS were found to have significantly worse OS and DSS compared to those with LFS across all the subgroups. Conclusion Our outcomes indicated that fibrosis score is an independent risk factor for both overall and tumor-specific survival of ICC patients.

scholarly journals MO1049PROGRESSION OF CHRONIC KIDNEY DISEASE AND LONG-TERM MORTALITY IN PATIENTS HOSPITALIZED WITH TRICUSPID REGURGITATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Saban Elitok ◽  
Anja Haase-Fielitz ◽  
Martin Ernst ◽  
Michael Haase
Keyword(s):  
Risk Factors ◽  
Hemoglobin Concentration ◽  
Ckd Progression ◽  
Survival Status ◽  
Independent Risk Factors ◽  
Index Hospital ◽  
The Impact ◽  
Long Term Mortality

Abstract Background and Aims Uremic toxins negatively affect the cardiovascular system resulting in significant morbidity and mortality. However, independent risk factors for chronic kidney disease (CKD) and that of worsening CKD have not been studied in patients with tricuspid regurgitation (TR), yet. Accordingly, in this study, we aimed to assess independent risk factors for the development of progressive CKD in patients with TR. Also, the impact of progressive CKD on long-term mortality was evaluated. Method This retrospective, single-center study comprised 444 consecutive patients with TR who were hospitalized between January 2010 and June 2017. We excluded patients with CKD stage 5. Demographic data, comorbidities, type of admission, medication, echocardiographic and laboratory parameters, and survival status were obtained from patient medical record from index hospital admission through discharge. For at least three years, serum creatinine concentrations and survival status were collected from outpatient medical record. We identified independent risk factors for CKD progression. Also, we assessed the impact of CKD progression and other variables on 3-year mortality using multivariable logistic regression analysis. For analysis of 3-year mortality, we grouped patients according to different combinations of their TR grade and presence or absence of CKD progression. Results Stage of CKD at hospital admission (odds ratio 0.34 [95% confidence interval 0.24-0.50], p &lt; 0.001), baseline hemoglobin concentration (OR 0.72 [95% CI 0.57-0.92], p=0.006) and presence of diabetes type 2 (OR 1.81 [95% CI 1.08-3.03], p=0.024) were identified as independent risk factors for CKD progression. Progression of CKD during follow-up (OR 2.16 [95% CI 1.31-3.57], p=0.003), grade of TR and mitral regurgitation during index hospital stay and hemoglobin concentration at baseline were independent risk factors for 3-year mortality. Combination of TR grade and status of CKD progression showed a stepwise pattern for 3-year mortality (Figure 1). Patients with TR 1 and CKD progression had a similar 3-year mortality as patients with TR 2 or 3 but no CKD progression. In patients with TR 1, risk for 3-year mortality doubled if CKD progression occurred (OR 2.49 [95% CI 1.38-4.47], p=0.002). Conclusion Although retrospective studies cannot imply causal relationship, based on study findings, kidney follow-up especially in patients with mild TR may be advisable. If CKD progression can be prevented in patients with TR and if such kidney protection may reduce long-term mortality may be objective of future studies.

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