Risk factors for recurrence of radically resected mucinous colorectal adenocarcinoma

Abstract Background Local recurrence and distant metastasis are major challenges to overcome in order to improve the survival of patients with colorectal cancer (CRC) after surgery. Mucinous adenocarcinoma (MA) is a subtype of CRC associated with a higher incidence of local extension and worse survival compared to non-mucinous adenocarcinoma, but few studies have investigated predictors for poor clinical outcome of MA. Therefore, we aimed to elucidate the predictors for local recurrence and remote metastasis of MA after surgery.Methods This study retrospectively analyzed 162 patients with mucinous colorectal adenocarcinoma (MAC) after radical resection. Analysis variables included demographics, clinical indicators, pathologic stage, surgical procedure, adjuvant therapy, and recurrence. Univariate and multivariate analyses were performed to investigate the risk factors for local and distant tumor relapse.Results A total of 162 patients (86 male) with a mean age of 58.26 years were included; 70.37% of patients had colonic tumors, and 29.63% had rectal tumors. The 5-year disease-free survival (DFS) rates for these patients were as follows: 100% for TNM stage I, 71.2% for stage II, and 47.8% for stage III. Five-year DFS rates of MAC, colonic and rectal MA were 62.0%, 65.8%, and 51.7%, respectively. Local recurrence occurred in 38 patients (23.5%) and distant metastasis in 33 patients (20.4%). In univariate analysis, predictors for local recurrence of MAC were intra-operative blood loss (p=0.004, OR=1.005), intra-operative transfusion (p=0.002, OR=5.179), and N2 stage (p=0.000, OR=4.643), and predictors for distant metastasis were male sex (p=0.035, OR=2.410), CA199 (p=0.011, OR=1.004), CEA (p=0.020, OR=1.010), intra-operative blood loss (p=0.022, OR=1.003), T4 stage (p=0.007, OR=4.125), and N2 stage (p=0.018, OR=3.4). In multivariate analysis, predictors for local recurrence of colorectal MA were intra-operative transfusion (p=0.04, OR=4.175) and N2 stage (p=0.000, OR=5.291), and predictors for distant metastasis were male sex (p=0.049, OR=2.410), CA199 (p=0.02, OR=1.003), and T4 stage (p=0.007, OR=4.006).Conclusions Intra-operative transfusion and N2 stage were significant predictors for local recurrence. Male sex, CA199, and T4 stage were significant predictors for distant metastasis. Knowledge of the risk factors for postoperative recurrence provides a basis for logical approaches to treatment and follow-up of mucinous colorectal adenocarcinoma.

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The risk factors of local recurrence and distant metastasis on pT1/T2N0 mid-low rectal cancer after total mesorectal excision

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02223-4 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

I-Li Lai ◽

Jeng-Fu You ◽

Yih-Jong Chern ◽

Wen-Sy Tsai ◽

Jy-Ming Chiang ◽

...

Keyword(s):

Risk Factors ◽

Rectal Cancer ◽

Local Recurrence ◽

Distant Metastasis ◽

Resection Margin ◽

Radical Resection ◽

Hazard Ratio ◽

Low Rectal Cancer ◽

Distal Resection Margin ◽

Lymph Node Yield

Abstract Background Radical resection is associated with good prognosis among patients with cT1/T2Nx rectal cancer. However, still some of the patients experienced cancer recurrence following radical resection. This study tried to identify the postoperative risk factors of local recurrence and distant metastasis separately. Methods This retrospective, single-center study comprised of 279 consecutive patients from Linkou branch of Chang Gung Memorial Hospital in 2005–2016 with rectal adenocarcinoma, pT1/T2N0M0 at distance from anal verge ≤ 8cm, who received curative radical resection. Results The study included 279 patients with pT1/pT2N0 mid-low rectal cancer with median follow-up of 73.5 months. Nineteen (6.8%) patients had disease recurrence in total. Nine (3.2%) of them had local recurrence, and fourteen (5.0%) of them had distant metastasis. Distal resection margin < 0.9 (cm) (hazard ratio = 4.9, p = 0.050) was the risk factor of local recurrence. Preoperative carcinoembryonic antigen (CEA) ≥ 5 ng/mL (hazard ratio = 9.3, p = 0.0003), lymph node yield (LNY) < 14 (hazard ratio = 5.0, p = 0.006), and distal resection margin < 1.4cm (hazard ratio = 4.0, p = 0.035) were the risk factors of distant metastasis. Conclusion For patients with pT1/pT2N0 mid-low rectal cancer, current multidisciplinary treatment brings acceptable survival outcome. Insufficient distal resection margin attracted the awareness of risk factors for local recurrence and distant metastasis as a foundation for future research.

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Risk factors for postoperative systemic complications in elderly patients with brain tumors

Journal of Neurosurgery ◽

10.3171/2008.10.17669 ◽

2009 ◽

Vol 111 (2) ◽

pp. 258-264 ◽

Cited By ~ 7

Author(s):

Kenichiro Asano ◽

Takahiro Nakano ◽

Tetsuji Takeda ◽

Hiroki Ohkuma

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Brain Tumors ◽

Blood Loss ◽

Elderly Patients ◽

Univariate Analysis ◽

Intraoperative Blood Loss ◽

Systemic Complications ◽

Level Difference ◽

Cutoff Values

Object In elderly patients with brain tumors, the prevention of postoperative systemic complications is extremely important, and identification of the risk factors would be useful for planning therapy. The authors investigated ways to avoid postoperative complications by identifying risk factors. Methods The study population included 84 patients, 70 years of age or older, who underwent surgical brain tumor removal. The following independent factors were assessed by univariate and multivariate analyses: sex, age, preoperative underlying diseases and complications, histopathological findings, preoperative Karnofsky Performance Scale (KPS) score, preoperative whole blood hemoglobin (Hb) level, preoperative serum total protein (TP) level, operation time, intraoperative blood loss, change in Hb level (difference between pre- and postoperative values), and change in TP level (difference between pre- and postoperative values). The cutoff values for significant independent factors were also determined. Results Overall, 35 (41.7%) of the 84 patients had a total of 56 postoperative systemic complications. Univariate analysis identified the preoperative KPS score, intraoperative blood loss, change in Hb level, and change in TP level as risk factors for postoperative complications, and multivariate analysis extracted the following risk factors: the preoperative KPS score (p = 0.0450, OR 4.020), intraoperative blood loss (p = 0.0104, OR 6.571), and change in Hb levels (p = 0.0023, OR 9.301). The cutoff values were: KPS score < 80%, intraoperative blood loss ≥ 350 ml, and change in Hb level ≥ 2.0 g/dl. Conclusions In elderly patients with brain tumors, low preoperative KPS score, high intraoperative blood loss, and a large difference between pre- and postoperative Hb levels are significant risk factors for postoperative systemic complications.

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Predictors for local recurrence and distant metastasis of mucinous colorectal adenocarcinoma

Surgery ◽

10.1016/j.surg.2017.11.028 ◽

2018 ◽

Vol 164 (1) ◽

pp. 56-65 ◽

Cited By ~ 2

Author(s):

Sameh Hany Emile ◽

Alaa Magdy ◽

Waleed Elnahas ◽

Omar Hamdy ◽

Mahmoud Abdelnaby ◽

...

Keyword(s):

Local Recurrence ◽

Distant Metastasis ◽

Colorectal Adenocarcinoma

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Risk Stratification for Survival and Leukemic Transformation in Essential Thrombocythemia: A Single Institutional Study of 605 Patients.

Blood ◽

10.1182/blood.v108.11.3599.3599 ◽

2006 ◽

Vol 108 (11) ◽

pp. 3599-3599

Author(s):

Naseema Gangat ◽

Alexandra Wolanskyj ◽

Rebecca F. McClure ◽

Chin Y. Li ◽

Susan M. Schwager ◽

...

Keyword(s):

Risk Factors ◽

High Risk ◽

Univariate Analysis ◽

Low Risk ◽

Prognostic Models ◽

Intermediate Risk ◽

Prognostic Variables ◽

Leukemic Transformation ◽

Male Sex

Abstract Background It is widely recognized that advanced age and prior thrombosis predict recurrent thrombosis in essential thrombocythemia (ET) and are used to risk-stratify patients. However, the paucity of large sample size and long-term follow-up has limited the development of similar prognostic models for survival and leukemic transformation (LT). Methods Data was abstracted from the medical records of a consecutive cohort of patients with WHO-defined ET seen at the Mayo Clinic. Cox proportional hazards was used to determine the impact of clinical and laboratory variables on survival and LT. Overall survival and leukemia-free survival was estimated by Kaplan-Meier plots. Results i. Patient characteristics and outcome The study cohort included 605 patients of which 399 (66%) were females (median age, 57 years; range 5–91). Median follow-up was 84 months (range; 0–424). During this period, 155 patients (26%) have died and LT was documented in 20 patients (3.3%) occurring at a median of 138 months (range; 23–422) from ET diagnosis. ii. Prognostic variables for overall survival Univariate analysis of parameters at diagnosis identified age ≥ 60 years, hemoglobin less than normal (defined as < 12 g/dL in females and < 13.5 g/dL in males), leukocyte count ≥ 15 x 109/L, tobacco use, diabetes mellitus, thrombosis, male sex, and the absence of microvascular symptoms as independent predictors of inferior survival. All of the above except the last two (i.e. male sex and the absence of microvascular symptoms) sustained their prognostic significance on multivariate analysis. Based on the first three prognostic variables: age, hemoglobin level, and leukocyte count, we constructed a prognostic model for survival: low-risk (none of the risk factors), intermediate-risk (1of 3 risk factors), and high-risk (≥ 2 risk factors). The respective median survivals were 278, 200, and 111 months (p<0.0001; Figure 1) iii. Prognostic variables for leukemic transformation On univariate analysis of parameters at ET diagnosis, LT was significantly associated with platelet count ≥ 1000 x 109/L, hemoglobin less than normal, and exposure to P-32. However, on multivariate analysis, only hemoglobin less than normal and platelet count ≥ 1000 x 109/L maintained independent prognostic value. Accordingly, we utilized these two variables, to construct a prognostic model for LT: low-risk (none of the risk factors), intermediate-risk (1 risk factor), and high-risk (both risk factors). Only 1 of the 239 patients (0.4%) in the low-risk group vs. 14 of the 289 (4.8%) in the intermediate-risk and 5 of the 77 (6.5%) in the high-risk group underwent LT (p=0.0009; Figure 2). Conclusion The current study provides clinician-friendly prognostic models for both survival and LT in ET. Figure 1 Figure 1. Figure 2 Figure 2.

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Risk factors of severe adult-onset asthma: a multi-factor approach

10.21203/rs.3.rs-91441/v1 ◽

2020 ◽

Author(s):

Sanna Toppila-Salmi ◽

Riikka Lemmetyinen ◽

Sebastien Chanoine ◽

Jussi Karjalainen ◽

Juha Pekkanen ◽

...

Keyword(s):

Risk Factors ◽

Severe Asthma ◽

Professional Training ◽

Univariate Analysis ◽

Personal Characteristics ◽

Population Based ◽

Additional Risk Factor ◽

Adult Onset ◽

Asthma Symptoms ◽

Male Sex

Abstract Background The aim was to identify risk factors of severe adult-onset asthma. Methods We used data from 1350 population-based asthmatics (Adult Asthma in Finland) with adult-onset asthma (age range 31-93 years) from Finnish national registers. Severe asthma was defined as self-reported severe asthma AND asthma symptoms causing much harm AND regular impairment AND (≥1 oral corticosteroid course/year OR regular oral corticosteroids OR wake up in the night due to asthma symptoms/wheezing attach ≥ a few times/month). Sixteen covariates covering several domains (personal characteristics, education, life-style, early life factors, asthma characteristics and multimorbidities) were selected based on literature and were studied in association with severe asthma using logistic regressions. Results The study population included 100 (7.4%) individuals with severe asthma. In a univariate analysis, severe asthma was associated with male sex, age, low education, no professional training, ever smoking, ≥ 2 siblings, ≥ 1 chronic comorbidity and Non-steroidal anti-inflammatory drug (NSAID) -exacerbated respiratory disease (NERD) (p<0.05); and trends for association (p<0.2) were observed for severe childhood infection, presence of chronic rhinosinusitis with nasal polyps, and being the 1 st child. The 10 variables (being 1 st child was removed due to multicolinearity) were thus entered in a multivariate regression model and severe asthma was significantly associated with male sex (OR [CI95%] = 1.96 [1.16-3.30]), ever smoking (1.98 [1.11-3.52]), chronic comorbidities (2.68 [1.35-5.31]), NERD (3.29 [1.75-6.19]), and ≥ 2 siblings (2.51 [1.17-5.41]). There was a dose-response effect of the total sum of these five factors on severe asthma (OR [CI95%] = 2.30 [1.81-2.93] for each increase of one unit of the score). Conclusions Male sex, smoking, NERD, comorbidity, age and number of siblings were independent risk factors for self-reported severe asthma. The effects of these factors seem to be additive; each additional risk factor gradually increase with the risk of severe asthma.

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Risk factors of blood transfusion in knee arthroplasty

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00018 ◽

2020 ◽

Vol 8 (5_suppl5) ◽

pp. 2325967120S0001

Author(s):

Pruk Chaiyakit ◽

Weeranate Umpanpong ◽

Tawipat Watcharotayangkoon

Keyword(s):

Risk Factors ◽

Surgical Technique ◽

Blood Transfusion ◽

Knee Arthroplasty ◽

Significant Relationship ◽

Univariate Analysis ◽

Hemoglobin Level ◽

Operative Blood Loss ◽

Preoperative Hemoglobin ◽

Preoperative Hemoglobin Level

Objectives: The amount of blood transfusion after knee arthroplasty seem to vary in different reported study. We carried out a retrospective study to analysis pre-operative risk factors for blood transfusion in patient whom underwent knee arthroplasty in our institution. Methods: A retrospective study of 190 patients treated with 194 procedure (186 unilateral knee arthroplasty, 4 bilateral knee arthroplasty) from November 2014 to October 2015 was analyzed. A univariate analysis was performed to establish the relationship between all variables and the need for postoperative transfusion. Variables that were determined to have significant relationship were include in a multivariable analysis.. Results: The univariate analysis revealed a significant relationship between need for postoperative blood transfusion and preoperative hemoglobin levels, surgical technique, arthrotomy approach, DVT prophylaxis, operative blood loss, surgical technique and surgeon experience. The multivariate analysis identified a significant relationship between need for transfusion and preoperative hemoglobin level, surgical technique and operative blood loss. Patients with a preoperative hemoglobin less than 12 g/dL had a 5.1 times greater risk of having a transfusion than those with a hemoglobin level ≥ 12 g/dL. The surgical technique with computer assisted surgery had a 0.15 times lesser risk of having a transfusion than those with the conventional technique. Conclusion: The preoperative hemoglobin level < 12 g/dL was shown to increase risk of the need for blood transfusion after knee arthroplasty, while computer assist surgery total knee arthroplasty was shown to decrease risk of blood transfusion. We suggest that patients with preoperative hemoglobin < 12 g/dL need to be crossmatching PRC in pre-operative steps.

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Local Recurrence (LR) after Breast Conserving Therapy (BCT); risk factors predicting for subsequent distant metastasis

European Journal of Cancer ◽

10.1016/s0959-8049(99)80724-2 ◽

1999 ◽

Vol 35 ◽

pp. S88-S89

Author(s):

P.H.M. Elkhuizen ◽

J. Hermans ◽

J.W.H. Leer ◽

L.C.J.M. van den Broek ◽

M.J. van de Vijver

Keyword(s):

Risk Factors ◽

Local Recurrence ◽

Distant Metastasis ◽

Breast Conserving Therapy

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Risk Factors for Severe 30-d Complications After Minimally Invasive Radical Cystectomy With Ileal Conduit

10.21203/rs.3.rs-111286/v1 ◽

2020 ◽

Author(s):

Ming Xiao ◽

Zhaohui Zhong ◽

Jiannan Ren ◽

Wei Xiong

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Blood Loss ◽

Minimally Invasive ◽

Radical Cystectomy ◽

Ileal Conduit ◽

Univariate Analysis ◽

Comprehensive Complication Index ◽

Estimated Blood Loss ◽

Independent Risk Factors

Abstract Background: To investigate the risk factors for severe complications within 30 days in patients receiving minimally invasive radical cystectomy with ileal conduit(MIRCIC).Methods: 270 consecutive patients who underwent MIRCIC between January 1, 2013 and August 1, 2020 were included. All complications were graded according to the Clavien-Dindo classification(CDC). The comprehensive complication index(CCI) for all complications in each patient was calculated. CDC ≥ Ⅲ or CCI > 33.7 were considered to be severe complications. Univariate and multivariate analysis were conducted by SPSS26.Results: A total of 691 complications were collected from 236 patients and the corresponding overall complications rate was 87.41% (236/270). Patients with CDC ≥ Ⅲ accounted for 23.70% and the incidence of CCI > 33.7 was 22.96%. For the highest CDC grade ≥ Ⅲ, in univariate analysis, the following seven variants were enrolled in a multivariate analysis: BMI (P=0.010), baseline albumin(P=0.065), pT (P=0.082), pN (P=0.026), pTNM (P=0.016), intraoperative blood transfusion (P=0.031), estimated blood loss (P=0.001). In multivariate analysis, BMI ≥ 30kg/m2 (P=0.012) and estimated blood loss ≥ 400ml (P=0.005) were the independent risk factors of CDC ≥ Ⅲ. Hydronephrosis (P=0.050), BMI (P=0.006), pT (P=0.004), pN (P=0.019), pTNM (P=0.000), operative time (P=0.030), estimated blood loss (P=0.001) were the relevant factors in CCI > 33.7. However, BMI ≥ 30kg/m2 (P=0.004) and estimated blood loss (P=0.002) were the independent risk factors of CCI > 33.7.Conclusion: BMI ≥ 30kg/m2 and estimated blood loss ≥ 400ml were found to be independent predictors of 30-d severe complications (CDC ≥ Ⅲ or CCI > 33.7) in patients who underwent MIRCIC.

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What Are the Results of Limb Salvage Surgery for Primary Malignant Bone Tumor in the Forearm?

10.21203/rs.3.rs-103567/v1 ◽

2020 ◽

Author(s):

Weifeng Liu ◽

Yongkun Yang ◽

Tao Jin ◽

Yang Sun ◽

Yuan Li ◽

...

Keyword(s):

Local Recurrence ◽

Limb Salvage ◽

Distant Metastasis ◽

Salvage Surgery ◽

Univariate Analysis ◽

Survival Rates ◽

Surgical Margin ◽

Functional Results ◽

Limb Salvage Surgery ◽

Proximal Ulna

Abstract Background The forearm primary malignant bone tumor is rare and limb salvage is difficult. The purpose of this study was to analyze epidemiological characteristics of forearm primary malignant bone tumors and to explore oncological and functional results of limb salvage surgery in forearm.Methods 369 patients with primary forearm malignant bone tumors were retrospectively analyzed from 2000 to 2017. There were 266 patients with radius tumor and 46 (17.3%) of them were malignancy, while 103 patients with ulna lesion and 22 (21.4%) of them were malignant tumor. The oncological results, prognostic factors and functional results after limb salvage surgery of forearm malignancy were analyzed.Results A total of 60 patients received limb salvage surgery. Fifty-six patients followed more than 12 months or progressions within 12 months were included in final evaluation. Radius resection was performed in 38 patients and distal radius (25 patients) was most frequent. Ulna resection was performed in 18 patients and proximal ulna (13 patients) was most frequent. The surgical margin contained intracapsular resection in 3 patients, marginal resection in 8 patients and wide resection in 45 patients. The follow-up averaged 72.1 (7-192, median 62.5) months. Local recurrence occurred in 11 patients (19.6%) and distant metastasis occurred in 14 patients (25%). The 5-year recurrence free survival rates was 79.8%. Univariate analysis showed history of unplanned resection, tumor located in ulna, tumor located in proximal forearm and inadequate surgical margin were associated with recurrence. The overall 5-year and 10-year survival rates were 83.5% and 71.7%, respectively. Univariate analysis showed inadequate surgical margin, local recurrence and distant metastasis were associated with death. Forty-two patients were evaluated by MSTS score with an average of (93.0 ± 5.1) %.Conclusions The incidence of radius malignant tumor is higher than that of ulna. The distal radius and proximal ulna are most frequency involved sites. Unplanned resection, tumor located in ulna, tumor located in proximal forearm and inadequate surgical margin are risk factors for local recurrence; local recurrence and distant metastasis are independent prognostic factors of death. The oncology control and function result of limb salvage surgery was satisfactory.

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Carotid Artery Disease in Subjects with Type 2 Diabetes: Risk Factors and Biomarkers

Journal of Clinical Medicine ◽

10.3390/jcm11010072 ◽

2021 ◽

Vol 11 (1) ◽

pp. 72

Author(s):

Vadim V. Klimontov ◽

Elena A. Koroleva ◽

Rustam S. Khapaev ◽

Anton I. Korbut ◽

Alexander P. Lykov

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Carotid Artery ◽

Carotid Artery Disease ◽

Univariate Analysis ◽

Diabetes Duration ◽

Matrix Metalloproteinase 2 ◽

Male Sex ◽

Artery Disease

Carotid atherosclerosis (CA) and, especially, carotid artery stenosis (CAS), are associated with a high risk of cardiovascular events in subjects with type 2 diabetes (T2D). In this study, we aimed to identify risk factors and biomarkers of subclinical CA and CAS in T2D individuals. High-resolution ultrasonography of carotid arteries was performed in 389 patients. Ninety-five clinical parameters were evaluated, including diabetic complications and comorbidities; antihyperglycemic, hypolipidemic, and antihypertensive therapy; indices of glycemic control and glucose variability (GV); lipid panels; estimated glomerular filtration rate (eGFR); albuminuria; blood cell count; and coagulation. Additionally, serum levels of calponin-1, relaxin, L-citrulline, and matrix metalloproteinase-2 and -3 (MMP-2, -3) were measured by ELISA. In univariate analysis, older age, male sex, diabetes duration, GV, diabetic retinopathy, chronic kidney disease, coronary artery disease, peripheral artery disease, and MMP-3 were associated with subclinical CA. In addition to these factors, long-term arterial hypertension, high daily insulin doses, eGFR, and L-citrulline were associated with CAS. In multivariate logistic regression, age, male sex, BMI, GV, and eGFR predicted CA independently; male sex, BMI, diabetes duration, eGFR, and L-citrulline were predictors of CAS. These results can be used to develop screening and prevention programs for CA and CAS in T2D subjects.

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