Immediate Postoperative Coagulopathy Predicts the Long-term Survival of Traumatic Brain Injury Patients: a Retrospective Cohort Study

Abstract Objective: To assess the association between immediate postoperative coagulopathy and the long-term survival of traumatic brain injury (TBI) patients undergoing surgery, as well as to explore predisposing risk factors of immediate postoperative coagulopathy.Methods: This retrospective study included 352 TBI patients from January 1, 2015, to April 25, 2019. The log-rank test and a Cox proportional hazard model were conducted to assess the relationship between immediate postoperative coagulopathy and the long-term survival of TBI patients. Furthermore, a multivariate logistic regression model was performed to identify the underlying risk factors for postoperative coagulopathy.Results: Of the 352 patients analyzed, the median age was 50 (41,60) years, and 82 (23%) patients were female. By May 26, 2019, 117 (33.24%) patients had died, 195 (55.40%) had survived, and 40 (11.36%) had been lost to follow-up. The median follow-up time was 773 days. In the log-rank test, immediate postoperative coagulopathy was significantly associated with the survival of TBI patients (P = 0.002). A Cox proportional hazard model identified immediate postoperative coagulopathy (HR, 1.471; 95% CI, 1.011-2.141; P = 0.044) as an independent risk factor for survival following TBI. According to multivariate logistic regression analysis, abnormal ALT and RBC at admission, intraoperative infusion of crystalloid solution > 2900 mL, infusion of colloidal solution > 1100 mL and intraoperative bleeding > 950 mL were identified as independent risk factors for immediate postoperative coagulopathy.Conclusions: Those who suffered from immediate postoperative coagulopathy due to TBI were at higher risk of poor prognosis than those who did not.

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The St. Jude Toronto stentless bioprosthesis: Up to 20 years follow-up in younger patients

The Heart Surgery Forum ◽

10.1532/hsf.1252 ◽

2015 ◽

Vol 18 (4) ◽

pp. 129 ◽

Cited By ~ 8

Author(s):

Torsten Christ ◽

Benjamin Claus ◽

Robin Borck ◽

Wolfgang Konertz ◽

Herko Grubitzsch

Keyword(s):

Valve Replacement ◽

Artery Bypass ◽

Rank Test ◽

Term Survival ◽

Younger Patients ◽

Long Term Survival ◽

Stentless Bioprosthesis ◽

Log Rank Test

Background:A retrospective long-term evaluation of the St. Jude Toronto stentless bioprosthesis in patients aged 60 years or younger.Methods:From 1994 to 1997, 50 patients underwent aortic valve replacement with the prosthesis. Patients mean age at surgery was 54.5±6.3 years. Follow-up data were acquired by patient file research and telephone interviews. Morbidity and mortality were evaluated with time-to-event analyses using the Kaplan-Meier-method. The log-rank test was used to determine influencing factors for long-term survival and reoperation.Results:Mean follow-up was 13.5±6.3 years with a total follow-up of 661.8 patient-years and a maximum of 20.0 years. Follow-up was 97.8% complete. Associated procedures were performed in 12 patients (24%), including coronary artery bypass grafting, mitral valve replacement and replacement of the ascending aorta. Freedom from reoperation at 10 and 15 years was 76.0±6.7% and 44.1±8.9%, respectively. Reoperations (n=26) started 4.4 years after implantation and were necessary due to: valve degeneration with regurgitation in 79.2% and stenosis in 12.5%, endocarditis in 4.2% and sinus valsalva aneurysm in 4.2% of the cases. The log-rank test revealed that only body-mass-index>25 lowered freedom-from-reoperation, while renal dysfunction, diabetes mellitus and arterial hypertension were not. Overall long-term survival at 10 and 20 years was 82.3±5.7% and 49.9±8.9%, respectively.Conclusion:In younger patients the Toronto-bioprosthesis provided reliable long-term survival despite limited durability.

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O33 Earlier cancer diagnosis after myositis onset is associated with improved long term survival: results from UK, French and Czech cohorts

Rheumatology ◽

10.1093/rheumatology/keaa110.032 ◽

2020 ◽

Vol 59 (Supplement_2) ◽

Author(s):

Alexander Oldroyd ◽

Paul New ◽

Janine Lamb ◽

William Ollier ◽

Robert Cooper ◽

...

Keyword(s):

Cancer Screening ◽

Cancer Diagnosis ◽

Proportional Hazard ◽

Term Survival ◽

Cancer History ◽

Long Term Survival ◽

Cox Proportional Hazard ◽

Female Cohort

Abstract Background The idiopathic inflammatory myopathies (IIMs) are associated with cancer. Cancer screening is advocated in new IIM cases; however no study has investigated if this confers improved long-term survival. This study aimed to investigate if a shorter time between IIM onset and cancer diagnosis is associated with improved survival. Methods Verified adult-onset IIM (dermatomyositis, polymyositis, anti-synthetase syndrome) cases, according to the International Myositis Classification Criteria, were recruited from three separate UK (UKMYONET), France and Czech-based cohort studies. Only cases with cancer diagnosis following IIM onset were included in analysis. The time between IIM onset and cancer diagnosis was calculated for each case. The relationship between survival at the end of follow up and time between IIM onset and cancer diagnosis was quantified via calculation of hazard ratios using a Cox-proportional hazard model, adjusted for age and gender. Results A total of 193 (66% female) IIM cases with a total of 1,395 person-years follow up were included in the analysis (Table 1). Data of 120 UK, 45 Czech and 28 French participants were analysed. Breast was the most common site of cancer (16%), followed by lung (9%) and bowel (6%). Forty six (24%) deaths occurred within the follow up period. The IIM onset to cancer diagnosis time was shorter for those that survived at the end of follow up, compared to those that died: 4.6 years (IQR 1.2, 10.7), vs 5.8 years (IQR 1.6, 13.8), respectively. Cox-proportional hazard modelling, indicated that a longer time between IIM onset and cancer diagnosis was significantly associated with death (HR 1.06 [95% CI 1.02, 1.10]). This significant relationship was only demonstrated in the female cohort when analysed separately: female HR 1.06 (95% CI 1.01, 1.10), male HR 1.08 (95% CI 0.98, 1.18). Conclusion Using data from three international cohorts, this study has, for the first time, identified that earlier cancer diagnosis after IIM onset is associated with improved long term survival. This finding was observed in the female cohort only. This study therefore indicate that cancer screening in newly diagnosed IIM cases without a preceding cancer history should be carried out, especially in female cases. Disclosures A. Oldroyd None. P. New None. J. Lamb None. W. Ollier None. R. Cooper None. K. Mariampillai None. O. Benveniste None. J. Vencovský None. H. Mann None. H. Chinoy None.

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Assessing Long-Term Survival Benefits of Immune Checkpoint Inhibitors Using the Net Survival Benefit

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djz030 ◽

2019 ◽

Vol 111 (11) ◽

pp. 1186-1191 ◽

Cited By ~ 2

Author(s):

Julien Péron ◽

Alexandre Lambert ◽

Stephane Munier ◽

Brice Ozenne ◽

Joris Giai ◽

...

Keyword(s):

Treatment Effect ◽

Survival Benefit ◽

Rank Test ◽

Cure Rate ◽

Term Survival ◽

Long Term Survival ◽

Delayed Treatment ◽

Net Survival ◽

Log Rank Test

Abstract Background The treatment effect in survival analysis is commonly quantified as the hazard ratio, and tested statistically using the standard log-rank test. Modern anticancer immunotherapies are successful in a proportion of patients who remain alive even after a long-term follow-up. This new phenomenon induces a nonproportionality of the underlying hazards of death. Methods The properties of the net survival benefit were illustrated using the dataset from a trial evaluating ipilimumab in metastatic melanoma. The net survival benefit was then investigated through simulated datasets under typical scenarios of proportional hazards, delayed treatment effect, and cure rate. The net survival benefit test was computed according to the value of the minimal survival difference considered clinically relevant. As comparators, the standard and the weighted log-rank tests were also performed. Results In the illustrative dataset, the net survival benefit favored ipilimumab [Δ(0) = 15.8%, 95% confidence interval = 4.6% to 27.3%, P = .006]. This favorable effect was maintained when the analysis was focused on long-term survival differences (eg, >12 months, Δ(12) = 12.5% (95% confidence interval = 4.4% to 20.6%, P = .002). Under the scenarios of a delayed treatment effect and cure rate, the power of the net survival benefit test compared favorably to the standard log-rank test power and was comparable to the power of the weighted log-rank test for large values of the threshold of clinical relevance. Conclusion The net long-term survival benefit is a measure of treatment effect that is meaningful whether or not hazards are proportional. The associated statistical test is more powerful than the standard log-rank test when a delayed treatment effect is anticipated.

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The oncologic impact of pancreatic fistula after pancreatectomy in patients with pancreatic cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.426 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 426-426

Author(s):

Manabu Kawai ◽

Yoshiaki Murakami ◽

Seiko Hirono ◽

Ken-Ichi Okada ◽

Fuyuhiko Motoi ◽

...

Keyword(s):

Pancreatic Cancer ◽

Pancreatic Fistula ◽

Hazard Analysis ◽

High Volume ◽

Postoperative Management ◽

Proportional Hazard ◽

Term Survival ◽

Long Term Survival ◽

Cox Proportional Hazard

426 Background: There is a few reports that evaluates the association between pancreatic and long-term survival after pancreatectomy in patients with pancreatic cancer. The aim of this study was to elucidate the oncological impact of pancreatic fistula (PF) on long-term survival after pancreatectomy in patients with pancreatic cancer by performing a survey of high volume centers for pancreatic resection in Japan. Methods: Between January 2001 and December 2012, 1,369 patients who underwent pancreatectomy for pancreatic cancer at 7 high-volume centers in Japan were retrospectively reviewed. Results: Pancreatic fistula(PF) occurred in 320 of 1,369 patients (23.5%), and these were classified based ISGPF as follows; grade A in 10.2%, grade B in 10.7%, and grade C in 2.6% of the patients. Median survival time (MST) in no fistula/grade A, grade B and grade C were 24.0, 26.3 and 11.0 months, respectively. MST in grade B PF was similar with that in no fistula/grade A. However, patients with grade C PF had a significantly poorer survival than those without (P<0.001). In the multivariate cox proportional hazard analysis, grade C PF was detected as an independent prognostic factor after pancreatectomy for pancreatic cancer (hazard ratio (HR) 2.15; 95% confidence interval (CI) 1.40-3.29; P< 0.001). Conclusions: Grade C PF adversely affects long-term survival of patients with pancreatic cancer undergoing pancreatectomy, although patients with grade B PF have similar prognosis with no fistula/grade A. Postoperative management to prevent grade C PF is important to improve prognosis in patients with pancreatic cancer undergoing pancreatectomy.

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LONG-TERM SURVIVAL AND PROGNOSTIC FACTORS FOR UNFAVORABLE OUTCOME IN PATIENTS WITH SYSTEMIC SCLEROSIS.A PROSPECTIVE SINGLE-CENTER STUDY

Romanian Journal of Rheumatology ◽

10.37897/rjr.2017.2.3 ◽

2017 ◽

Vol 26 (2) ◽

pp. 60-64

Author(s):

Alexandra Daniela Radu ◽

◽

Ana Maria Gheorghiu ◽

Raida Oneata ◽

Alina Soare ◽

...

Keyword(s):

Risk Factors ◽

Prognostic Factors ◽

Systemic Sclerosis ◽

Lung Involvement ◽

Term Survival ◽

Long Term Survival ◽

Male Sex ◽

Cox Analysis

Background. Systemic sclerosis (SSc) is a complex chronic autoimmune disease, with an unpredictable evolution and high morbidity and mortality rates. Objective. Evaluation of long-term survival and identification of prognostic factors in patients with systemic sclerosis. Methods. All patients with SSc of the EUSTAR100 center, having at least one visit between 2004 and 2016, were included. Data were analyzed for survival, cause of death, as well as for the following events defining disease worsening: increase in modified Rodnan score (mRSS) with at least 25% and 5 points (compared to baseline visit), decrease with at least 10% (compared to baseline) of predicted forced vital capacity (FVC) and predicted diffusing capacity of the lungs for carbon monoxide (DLCO), and presence of new digital ulcers (DUs). Logistic regression (LR), Cox proportional hazards regression and Kaplan-Meier survival curves were used in univariate and multivariate analysis to study survival and identify prognostic factors. Results. 137 patients were included in the study (89.1% females, mean age ± SD 56.7 ± 12.6 years, disease duration 9.7 ± 7.1 years), with a follow-up duration of up to 19 years. 96 patients had at least one follow-up visit and 66 (not including patients who died earlier than 2 years after the first presentation) had follow-up data at 2 years (± 6 months) after the first visit in the clinic. There were 19 reported deaths (13.9%), 11 attributed to SSc (of whom 8 were due to lung involvement). Risk factors for death were diffuse cutaneous subset and mRSS>14 at baseline (identified by LR adjusted for age and sex), male sex and proteinuria (Cox analysis). While in over half of the patients FVC and mRSS were stable or improved (86% and 96% respectively), and no new DUs occurred (64%), 52% of the patients presented significant worsening of DLCO during the entire followup. Risk factors for DLCO worsening at 2 years, by LR adjusted for sex and age, were male sex and diffuse cutaneous subset, while Cox analysis identified only male sex. The only risk factor identified for appearance of new DUs was the history of DUs at the first presentation. Conclusions. SSc often presents an unfavorable disease course, particularly due to lung involvement. Risk factors for disease worsening were male sex, diffuse cutaneous subset, and mRSS>14 at baseline. SSc-related deaths were mainly due to lung involvement, thus underlining the necessity of identifying predictive factors for lung function deterioration at the first presentation.

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Patterns of mortality after prolonged follow-up of a randomized trial using granulocyte colony-stimulating factor (G-CSF) to maintain chemotherapy dose intensity in non-Hodgkin lymphoma (NHL)

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.7590 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 7590-7590

Author(s):

A. R. Clamp ◽

S. Bhattacharya ◽

D. W. Ryder ◽

R. Pettengell ◽

J. A. Radford

Keyword(s):

Randomized Trial ◽

Dose Intensity ◽

Rank Test ◽

Second Malignancies ◽

Term Survival ◽

Log Rank Test ◽

Chemotherapy Dose ◽

Chemotherapy Dose Intensity

7590 Background: Recombinant G-CSF is commonly used to maintain chemotherapy dose intensity and reduce the incidence of infective complications in the management of NHL. The possible impact of this effect on mortality patterns after prolonged follow-up is worthy of investigation. We investigated the long-term survival and incidence of second malignancies in the first randomized trial utilising recombinant G-CSF in NHL (Pettengell R et al Blood 1992, 80: 1430–1436). Methods: Data on overall survival (OS), progression-free survival (PFS), freedom from progression (FFP) and the incidence of second malignancies were extracted from medical records and cancer registry databases for 80 patients with aggressive subtypes of NHL, who had previously been randomised to receive either VAPEC-B chemotherapy alone (39 patients) or VAPEC-B with G-CSF (41 patients). 10 year survival figures were extracted and Kaplan-Meier survival curves were drawn for the above parameters and compared between treatment groups using the log-rank test. Results: Median follow-up was 11.8 years for surviving patients (range 7.8–13.1 yrs). Patients receiving G-CSF achieved a 12% higher median dose intensity of chemotherapy. No significant differences were found in PFS or OS but 10 year FFP appeared to be better in the G-CSF arm (60.8%) compared with the control arm (45.6%) (log-rank test p=0.12). Eleven deaths from non-NHL causes occurred in the G-CSF arm compared with three in the control arm (log- rank test p=0.06). Five second malignancies were detected on long-term follow-up in the G-CSF arm compared with two in the control arm. Conclusions: The demonstration of different mortality patterns in the two arms may be related to the greater dose intensity of chemotherapy received in the G-CSF arm. Although, our study has insufficient statistical power to draw definite conclusions, this finding warrants further investigation. No significant financial relationships to disclose.

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Randomized trial of amifostine in locally advanced non-small cell lung cancer (NSCLC) patients receiving chemotherapy and hyperfractionated radiation (HRT): Long-term survival results of Radiation Therapy Oncology Group (RTOG) 9801

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.7529 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 7529-7529

Author(s):

B. Movsas ◽

J. Moughan ◽

C. Langer ◽

M. Werner-Wasik ◽

N. Nicolaou ◽

...

Keyword(s):

Locally Advanced ◽

Radiation Therapy Oncology Group ◽

Disease Free Survival ◽

Rank Test ◽

Term Survival ◽

Long Term Survival ◽

Patient Reported ◽

Nsclc Patients

7529 Purpose: This analysis was conducted to address the potential antitumor effect of amifostine (AM) in NSCLC patients enrolled on RTOG-9801. The long-term survival results of RTOG-9801 are presented here. Methods: 243 patients (pts) with stage II/IIIAB NSCLC received induction paclitaxel (P) 225 mg/m2IV days 1, 22 and carboplatin (C) AUC 6 days 1, 22 and then concurrent weekly P (50 mg/m2) and C (AUC 2) and HRT (69.6 Gy at 1.2 Gy BID). Pts were randomly assigned to AM 500 mg IV 4x/week or no-AM during chemoradiation. Treatment differences for overall and disease-free survival (OS & DFS) were analyzed with the log-rank test; Gray's test was used for time to progression (TTP). Results: 118 pts were randomly assigned to receive AM and 121 to no-AM (4 pts were ineligible). The median follow-up for pts still alive is 52.3 months (mo) for the AM-arm and 58.3 mo for the no-AM arm (16.6 vs 17.9 for all pts). There are no significant differences in OS, DFS or TTP between arms. The median survival, 3-yr, and 5-yr OS are 17.1 mo, 27% and 17% (AM-arm) vs 18.4 mo, 28% and 16% (no-AM arm) (p=0.97). Grade 3/4/5 late-RT toxicities are similar (11%/3%/2% AM-arm vs 14%/4%/2% no-AM arm). Conclusion: While an earlier publication reported that amifostine did not reduce objective measures of severe esophagitis in RTOG-9801, patient-reported outcome analyses suggested a possible advantage to AM with decreased pain and swallowing symptoms (J Clin Oncol 23:2145–2154, 2005). This long-term follow-up analysis on survival shows no evidence of tumor radioprotection due to amifostine. The promising 5-yr OS suggests that induction paclitaxel/carboplatin (P/C) followed by concurrent RT and weekly low-dose P/C is comparable to other regimens using cisplatin doublets at higher dosages every 3–4 weeks. Research supported by NCI and Medimmune Oncology. No significant financial relationships to disclose.

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Intraperitoneal Chemotherapy for Ovarian Carcinoma: Results of Long-Term Follow-Up

Journal of Clinical Oncology ◽

10.1200/jco.2002.20.3.694 ◽

2002 ◽

Vol 20 (3) ◽

pp. 694-698 ◽

Cited By ~ 41

Author(s):

Richard R. Barakat ◽

Paul Sabbatini ◽

Dharmendra Bhaskaran ◽

Margarita Revzin ◽

Alex Smith ◽

...

Keyword(s):

Ovarian Cancer ◽

Prognostic Factors ◽

Residual Disease ◽

Term Survival ◽

Long Term Survival ◽

Cox Proportional Hazard ◽

Kaplan Meier ◽

Long Term Follow Up

PURPOSE: To determine long-term survival and predictors of recurrence in a retrospective cohort of patients with epithelial ovarian cancer treated with intraperitoneal (IP) chemotherapy. PATIENTS AND METHODS: Records were reviewed of 433 patients who received IP therapy for ovarian cancer between 1984 and 1998; follow-up data were available for 411 patients. IP therapy was provided as consolidation therapy (n = 89), or for treatment of persistent (n = 310) or recurrent (n = 12) disease after surgery and initial systemic therapy; therapy usually consisted of platinum-based combination therapy. Statistical analysis included tests for associations between potential prognostic factors, and between prognostic factors and survival. Survival probabilities were estimated by Kaplan-Meier methods, and prognostic factors for survival were evaluated by a Cox proportional hazard model. RESULTS: The mean age of patients was 52 years (range, 25 to 76 years). Distribution by stage and grade was as follows: stage I, 7; II, 24; III, 342; IV, 52; not available (NA), 8; and grade 1, 30; 2, 99; and 3, 289; NA, 15. The median survival from initiation of IP therapy by residual disease was none, 8.7 years; microscopic, 4.8 years; less than 1 cm, 3.3 years; more than 1 cm, 1.2 years. In a multivariate analysis, the only significant predictors of long-term survival were grade and size of residual disease at initiation of IP therapy. CONCLUSION: Prolonged survival was observed in selected patients receiving IP platinum-based therapy. It is not possible to determine the contribution of IP therapy to survival in this study. A relationship between size of disease at the initiation of IP therapy and long-term survival was demonstrated.

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