The Real-World status and risk factors for a poor prognosis in elderly patients with primary central nervous system malignant lymphomas: a multicenter retrospective cohort study of the Tohoku Brain Tumor Study Group

Abstract Introduction The number of elderly patients with primary central nervous system malignant lymphoma(EL-PCNSL) has been increasing. However, due to their poor pre-treatment Karnofsky Performance Status(KPS) and many comorbidities, it is possible that sufficient treatment has not been performed. We therefore conducted a retrospective cohort study to evaluate risk factors associated with a poor prognosis of the Real-World status of EL-PCNSL in the Tohoku Brain Tumor Study Group. Methods Patients aged ≥ 71 years with PCNSL were enrolled from 8 centers. Univariate analysis was performed by the log-rank test. A Cox proportional hazards model was used for multivariate analysis. Results Three of total 142 cases received best supportive care(BSC) from the beginning. Treatment was given to 30 cases without a pathological diagnosis, 3 cases with a cerebrospinal fluid diagnosis, and 100 cases with CD20-positive DLBCL diagnosis. Total 133 cases(median age 76 years) were included. The median pre-treatment KPS was 50%. There were 117(88.0%) patients with 213 pre-treatment comorbidities(1.8 comorbidities per patient). PFS and OS were 16 months and 24 months, respectively. Risk factors associated with poor prognosis on Cox proportional hazards model were pre-treatment cardiovascular disease and central nervous system disease comorbidities, post-treatment pneumonia and other infections, and the absence of radiation or chemotherapy. Conclusions EL-PCNSL was actively treated and BSC was only a few. Pre-treatment comorbidities and post-treatment complications would influence the prognosis. Radiation and chemotherapy were found to be effective, but no conclusions could be drawn regarding the content of chemotherapy and whether additional radiation therapy should be used.

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Effect of access to care on outcomes of rural and elderly patients with primary central nervous system lymphoma.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e14008 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e14008-e14008

Author(s):

Scott C. Howard ◽

Nicholas Napier ◽

Xueyuan Cao ◽

Ryan Combs ◽

Mark Layton Watson ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Central Nervous System Lymphoma ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Research Network ◽

High Dose ◽

Hazards Model

e14008 Background: Primary central nervous system lymphoma (PCNSL) can often be cured, especially in younger patients, but requires intense chemotherapy with high-dose methotrexate (HDMTX) and rituximab to optimize outcomes. Toxicities can lead to dose reduction or omission that may increase relapse risk, or lead clinicians to select less effective regimens that do not contain HDMTX. Methods: Anonymized, de-identified data of patients from 110 community oncology practices of the Guardian Research Network (GRN, www.GuardianResearch.org ) was analyzed to determine treatments, toxicities, and outcomes of adults with PCNSL. All data from the medical record is available from GRN (diagnoses, demographics, labs, medicines, toxicities, radiology, pathology, procedures, and encounters), so each patient’s journey can be fully characterized. Results: Of 533805 adults with cancer, 49 were treated for PCNSL with HDMTX-containing regimens (n = 35), other chemotherapy regimens (n = 3), or radiation therapy (RT) alone (n = 11). HDMTX patients received HDMTX only in 8 cases, HDMTX plus rituximab in 23 cases, addition of RT in 11 cases, and HDMTX with other chemotherapy but no rituximab in 3 cases. Survival at 5 years was 53% (standard error [SE] 8.6%) for patients treated with HDMTX versus 33% (SE 13%) for those treated with other therapies. Of those treated with HDMTX, survival was 0% for patients who experienced early toxicity that required cessation of HDMTX prior to receiving 3 doses and having response evaluated versus 62% (SE 9.1%) for patients who received 3 or more courses of HDMTX (p < 0.001). In a multivariable Cox proportional hazards model including completion of at least 3 doses of HDMTX, age, race, and sex, only lack of HDMTX toxicity was associated with survival (hazard ratio 0.22, 95% confidence interval 0.07 to 0.70, p = 0.01). Conclusions: Use of HDMTX and prevention of toxicity improves outcomes for PCNSL patients treated in the community.

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A promising predictor of mortality— A cohort study (Preprint)

10.2196/preprints.28633 ◽

2021 ◽

Author(s):

Ji Ha Ling

Keyword(s):

Intensive Care ◽

Poor Prognosis ◽

Medical Information ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Hazards Model ◽

Clinical Biomarker ◽

Secondary Result

UNSTRUCTURED Severe inflammation leads to poor prognosis for intensive care unit hospitalized patients. The is a biomarker used to monitor inflammation and immune response, which can predict poor prognosis of various diseases. However, it is unclear whether NLR is associated with all-cause mortality in ICU patients. This study investigated the correlation between MLR and ICU results. Extract clinical data from Medical Information Mart for Intensive Care III (MIMIC-III) database, which contains health data of more than 50,000 patients. The main result was 30-day mortality, and the secondary result was 90-day mortality. Use the Cox proportional hazards model to reveal the association between MLR and results. Multivariable analyses were used to control for confounders. NLR is a promising clinical biomarker, which can be used as a available predictor of ICU mortality.

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Risk factors for disease progression in low-teens normal-tension glaucoma

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-313375 ◽

2019 ◽

Vol 104 (1) ◽

pp. 81-86 ◽

Cited By ~ 2

Author(s):

Sung Uk Baek ◽

Ahnul Ha ◽

Dai Woo Kim ◽

Jin Wook Jeoung ◽

Ki Ho Park ◽

...

Keyword(s):

Risk Factors ◽

Disease Progression ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Normal Tension Glaucoma ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Hazards Model ◽

Diurnal Iop

Background/AimsTo investigate the risk factors for disease progression of normal-tension glaucoma (NTG) with pretreatment intraocular pressure (IOP) in the low-teens.MethodsOne-hundred and two (102) eyes of 102 patients with NTG with pretreatment IOP≤12 mm Hg who had been followed up for more than 60 months were retrospectively enrolled. Patients were divided into progressor and non-progressor groups according to visual field (VF) progression as correlated with change of optic disc or retinal nerve fibre layer defect. Baseline demographic and clinical characteristics including diurnal IOP and 24 hours blood pressure (BP) were compared between the two groups. The Cox proportional hazards model was used to identify the risk factors for disease progression.ResultsThirty-six patients (35.3%) were classified as progressors and 66 (64.7%) as non-progressors. Between the two groups, no significant differences were found in the follow-up periods (8.7±3.4 vs 7.7±3.2 years; p=0.138), baseline VF mean deviation (−4.50±5.65 vs −3.56±4.30 dB; p=0.348) or pretreatment IOP (11.34±1.21 vs 11.17±1.06 mm Hg; p=0.121). The multivariate Cox proportional hazards model indicated that greater diurnal IOP at baseline (HR=1.609; p=0.004), greater fluctuation of diastolic BP (DBP; HR=1.058; p=0.002) and presence of optic disc haemorrhage during follow-up (DH; HR=3.664; p=0.001) were risk factors for glaucoma progression.ConclusionIn the low-teens NTG eyes, 35.3% showed glaucoma progression during the average 8.7 years of follow-up. Fluctuation of DBP and diurnal IOP as well as DH were significantly associated with greater probability of disease progression.

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Incidence and Survival Changes in Patients with Esophageal Adenocarcinoma during 1984–2013

BioMed Research International ◽

10.1155/2019/7431850 ◽

2019 ◽

Vol 2019 ◽

pp. 1-11 ◽

Cited By ~ 1

Author(s):

Zhang Haiyu ◽

Pei Xiaofeng ◽

Mo Xiangqiong ◽

Qiu Junlan ◽

Zheng Xiaobin ◽

...

Keyword(s):

United States ◽

Risk Factors ◽

Esophageal Adenocarcinoma ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

The United States ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Hazards Model ◽

Potential Risk Factors

Purpose. The morbidity of esophageal adenocarcinoma (EAC) has significantly increased in Western countries. We aimed to identify trends in incidence and survival in patients with EAC in the recent 30 years and then analyzed potential risk factors, including race, sex, age, and socioeconomic status (SES). Methods. All data were collected from the Surveillance, Epidemiology, and End Results or SEER database. Kaplan–Meier analysis and the Cox proportional hazards model were conducted to compare the differences in survival between variables, including sex, race, age, and SES, as well as to evaluate the association of these factors with prognosis. Results. A total of 16,474 patients with EAC were identified from 1984 to 2013 in the United States. Overall incidence increased every 10 years from 1.8 to 3.1 to 3.9 per 100. Overall survival gradually improved (p<0.0001), which was evident in male patients ((hazard ratio (HR) = 1.111; 95% confidence interval (CI) (1.07, 1.15)); however, the 5-year survival rate remained low (20.1%). The Cox proportional hazards model identified old age, black ethnicity, and medium/high poverty as risk factors for EAC (HR = 1.018; 95% CI (1.017, 1.019; HR = 1.240, 95% CI (1.151,1.336), HR = 1.000, 95% CI (1.000, 1.000); respectively). Conclusions. The incidence of EAC in the United States increased over time. Survival advantage was observed in white patients and patients in the low-poverty group. Sex was an independent prognostic factor for EAC, but this finding has to be confirmed by further research.

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Risk Factors for Mortality in Chinese Patients on Continuous Ambulatory Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.3747/pdi.2013.00164 ◽

2015 ◽

Vol 35 (2) ◽

pp. 199-205 ◽

Cited By ~ 8

Author(s):

Fan Zhang ◽

Hong Liu ◽

Xiaoli Gong ◽

Fuyou Liu ◽

Youming Peng ◽

...

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Patient Survival ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Hazards Model ◽

Kaplan Meier

ObjectiveThe intent of this study was to evaluate the clinical outcome and risk factors affecting mortality of the continuous ambulatory peritoneal dialysis (CAPD) patients in a single peritoneal dialysis (PD) center over a period of 10 years.Patients and methodsWe retrospectively analyzed patients on PD from June 2001 to June 2011. The clinical and biochemical data were collected from the medical records. Clinical variables included gender, age at the start of PD, smoking status, body mass index (BMI), cause of end-stage renal disease (ESRD), presence of diabetes mellitus and blood pressure. Biochemical variables included hemoglobin, urine volume, residual renal function (RRF), serum albumin, blood urea nitrogen (BUN), creatinine, total cholesterol, triglyceride, comorbidities, and outcomes. Survival curves were made by the Kaplan-Meier method. Univariate and multivariate analyses to identify mortality risk factors were performed using the Cox proportional hazard regression model.ResultsA total of 421 patients were enrolled, 269 of whom were male (63.9%). The mean age at the start of PD was 57.9 ± 14.8 years. Chronic glomerulonephritis was the most common cause of ESRD (39.4%). Estimation of patient survival by Kaplan-Meier was 92.5%, 80.2%, 74.4%, and 55.7% at 1, 3, 5, and 10 years, respectively. Patient survival was associated with age (hazard ratio [HR]: 1.641 [1.027 – 2.622], p = 0.038), cardiovascular disease (HR: 1.731 [1.08 – 2.774], p = 0.023), hypertriglyceridemia (HR: 1.782 [1.11 – 2.858], p = 0.017) in the Cox proportional hazards model analysis. Estimation of technique survival by Kaplan-Meier was 86.7%, 68.8%, 55.7%, and 37.4% at 1, 3, 5, and 10 years, respectively. In the Cox proportional hazards model analysis, age (HR: 1.672 [1.176 – 2.377], p = 0.004) and hypertriglyceridemia (HR: 1.511 [1.050 – 2.174], p = 0.026) predicted technique failure.ConclusionThe PD patients in our center exhibited comparable or even superior patient survival and technical survival rates, compared with reports from other centers in China and other countries.

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Increased Visceral Adipose Tissue and Hyperinsulinemia Raise the Risk for Recurrence of Non-B Non-C Hepatocellular Carcinoma after Curative Treatment

Cancers ◽

10.3390/cancers13071542 ◽

2021 ◽

Vol 13 (7) ◽

pp. 1542

Author(s):

Kenji Imai ◽

Koji Takai ◽

Takao Miwa ◽

Toshihide Maeda ◽

Tatsunori Hanai ◽

...

Keyword(s):

Risk Factors ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Curative Treatment ◽

Decision Tree Analysis ◽

Tree Analysis ◽

Hazards Model ◽

Visceral Adipose

We investigated the factors affecting recurrence-free survival in patients with non-B non-C hepatocellular carcinoma (HCC) who received curative treatment. Decision-tree analysis was performed in 72 curative cases of non-B non-C HCC to extract the risk factors for recurrence. The reliability of the extracted risk factors was evaluated using the Kaplan–Meier method and the Cox proportional hazards model. The decision-tree analysis extracted three factors—visceral adipose tissue (VAT) index (VATI; <71 and ≥71 cm2/m2), which was the cross-sectional areas of VAT on the computed tomographic image at the umbilical level, normalized by the square of the height, fasting immunoreactive insulin (FIRI; <5.5 and ≥5.5 µU/mL), and alpha-fetoprotein (AFP; <11 and ≥11 ng/mL). The Cox proportional hazards model showed that VATI (hazard ratio (HR): 2.556, 95% confidence interval (CI): 1.191–5.486, p = 0.016), FIRI (HR: 3.149, 95% CI: 1.156–8.575, p = 0.025), and AFP (HR: 3.362, 95% CI: 1.550–7.288, p = 0.002) were all independent risk factors for HCC recurrence. Non-B non-C HCC patients with a higher VATI (≥71 cm2/m2) or higher FIRI (≥5.5 µU/mL) and AFP (≥11 ng/mL) if VATI was <71 cm2/m2 are prone to recurrence after curative treatment.

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Efficacy Analysis of Multidisciplinary Treatment for Wilm’s Tumor in Single Center

10.21203/rs.3.rs-1185550/v1 ◽

2022 ◽

Author(s):

Bing Yan ◽

Fengming Ji ◽

Chengchuang Wu ◽

Ye Li ◽

Haoyu Tang ◽

...

Keyword(s):

Risk Factors ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Multidisciplinary Treatment ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Histological Type ◽

Factors Affecting ◽

Hazards Model ◽

Kaplan Meier

Abstract Objective: To analyze the efficacy of multidisciplinary treatment (MDT) for Wilm’s tumor (WT) in Kunming Children’s Hospital, and investigate the risk factors affecting the prognosis of WT.Method: The clinic-pathological data were collected and analyzed in patients with unilateral WT treated in Kunming Children's Hospital from January 2017 to July 2021. Research objects were selected according to inclusion criteria and exclusion criteria. The risk factors and independent risk factors that affect the prognosis of patients with WT were determined by Kaplan-Meier survival analysis and Cox proportional hazards model, respectively. Outcome: A total of 68 children were included in this study, and the 5-year overall survival (OS) rate was 92.65%. Kaplan-Meier survival analysis results showed that ethnicity (P=0.020), the tumor volume of resection (P=0.001), histological type (P<0.001), and postoperative recurrence (P<0.001) were the factors affecting the prognosis of children with WT. The results of the Cox proportional hazards model showed that only the histological type (P=0.028) was the independent risk factor for the prognosis of WT.Conclusion: The efficacy of MDT for WT was satisfying. The histological type has important predictive value for the prognosis of WT, and the patient with unfavorable histology has a poor prognosis.

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Management and 30-Day Mortality of Acute Coronary Syndrome in a Resource-Limited Setting: Insight From Ethiopia. A Prospective Cohort Study

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.707700 ◽

2021 ◽

Vol 8 ◽

Author(s):

Korinan Fanta ◽

Fekadu Bekele Daba ◽

Elsah Tegene Asefa ◽

Tsegaye Melaku ◽

Legese Chelkeba ◽

...

Keyword(s):

Risk Factors ◽

Clinical Characteristics ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Reperfusion Therapy ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Coronary Syndrome ◽

Hazards Model ◽

All Cause Mortality

Background: Despite the fact that the burden, risk factors, and clinical characteristics of acute coronary syndrome (ACS) have been studied widely in developed countries, limited data are available from sub-Saharan Africa. Therefore, this study aimed at evaluating the clinical characteristics, treatment, and 30-day mortality of patients with ACS admitted to tertiary hospitals in Ethiopia.Methods: A total of 181 ACS patients admitted to tertiary care hospitals in Ethiopia were enrolled from March 15 to November 15, 2018. The clinical characteristics, management, and 30-day mortality were evaluated by ACS subtype. The Cox proportional hazards model was used to determine the predictors of 30-day all-cause mortality. A p-value < 0.05 was considered statistically significant.Results: The majority (61%) of ACS patients were admitted with ST-segment elevation myocardial infarction (STEMI). The mean age was 56 years, with male predominance (62.4%). More than two-thirds (67.4%) of patients presented to hospital after 12 h of symptom onset. Dyslipidemia (48%) and hypertension (44%) were the most common risk factors identified. In-hospital dual antiplatelet and statin use was high (>90%), followed by beta-blockers (81%) and angiotensin-converting enzyme inhibitors (ACEIs; 72%). Late reperfusion with percutaneous coronary intervention (PCI) was done for only 13 (7.2%), and none of the patients received early reperfusion therapy. The 30-day all-cause mortality rate was 25.4%. On multivariate Cox proportional hazards model analysis, older age [hazard ratio (HR) = 1.03, 95% CI = 1.003–1.057], systolic blood pressure (HR = 0.99, 95% CI = 0.975–1.000), serum creatinine (HR = 1.32, 95% CI = 1.056–1.643), Killip class > II (HR = 4.62, 95% CI = 2.502–8.523), ejection fraction <40% (HR = 2.75, 95% CI = 1.463–5.162), and STEMI (HR = 2.72, 95% CI = 1.006–4.261) were independent predictors of 30-day mortality.Conclusions: The 30-day all-cause mortality rate was unacceptably high, which implies an urgent need to establish a nationwide program to reduce pre-hospital delay, promoting the use of guideline-directed medications, and increasing access to reperfusion therapy.

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Up-Regulation of Long Non-Coding RNA ZEB2-AS1 in Tissue is Correlated with Tumor Progression and Poor Prognosis in Non-Small Cell Lung Cancer

Journal of Biomaterials and Tissue Engineering ◽

10.1166/jbt.2020.2374 ◽

2020 ◽

Vol 10 (8) ◽

pp. 1149-1153

Author(s):

Jinchen Du ◽

Dong Chao ◽

Gawei Hu ◽

Yulian Ban ◽

Bin Zhang ◽

...

Keyword(s):

Tumor Progression ◽

Poor Prognosis ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Expression Level ◽

Normal Lung ◽

Hazards Model ◽

Nsclc Patients

Objective: ZEB2-AS1 has been suggested as an oncogene in some types of cancers, and it was also found to be up-regulated in NSCLC tissues compared with corresponding normal lung tissues. However, study on the clinical significance and prognostic value of ZEB2-AS1 in NSCLC is lacking. Patients and Methods: 129 NSCLC patients who underwent surgery between January 2013 to March 2018 were included in the present study. The Chi-square test was used to investigate the significance of tissue ZEB2-AS1 expression level as correlated with clinicopathologic features. The survival curves of the NSCLC patients were plotted and analyzed by Kaplan-Meier method and the survival rates were compared by the log-rank test. The Cox proportional hazards model was used for univariate and multivariate regression analyses. Results : ZEB2-AS1 level was significantly up-regulated in NSCLC tissues compared with matched adjacent lung tissues (P < 0 001). ZEB2-AS1 expression level was significantly correlated with tumor differentiation (P = 0 004), lymph node metastasis (P = 0 003), and TNM stage (P < 0 001). Both univariate and multivariate Cox proportional hazards model analysis showed that ZEB2-AS1 expression was independently associated with overall survival of patients with NSCLC (univariate analysis: HR = 2.117, 95% CI: 1.092–11.885, P = 0 019, multivariate analysis: HR = 1.925, 95% CI: 1.472–10.663, P = 0 036). Conclusions: Our study demonstrates that ZEB2-AS1 is up-regulated in NSCLC tissues and its up-regulation is correlated with tumor progression and poor prognosis in NSCLC.

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Clinical course and risk factors of fatal adverse outcomes in COVID-19 patients in Korea: a nationwide retrospective cohort study

Scientific Reports ◽

10.1038/s41598-021-89548-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Juhyun Song ◽

Dae Won Park ◽

Jae-hyung Cha ◽

Hyeri Seok ◽

Joo Yeong Kim ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Retrospective Cohort ◽

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Proportional Hazards ◽

Adverse Outcomes ◽

Cox Proportional Hazards Model ◽

Icu Admission ◽

Hazards Model

AbstractWe investigated association between epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19) patients and clinical outcomes in Korea. This nationwide retrospective cohort study included 5621 discharged patients with COVID-19, extracted from the Korea Disease Control and Prevention Agency (KDCA) database. We compared clinical data between survivors (n = 5387) and non-survivors (n = 234). We used logistic regression analysis and Cox proportional hazards model to explore risk factors of death and fatal adverse outcomes. Increased odds ratio (OR) of mortality occurred with age (≥ 60 years) [OR 11.685, 95% confidence interval (CI) 4.655–34.150, p < 0.001], isolation period, dyspnoea, altered mentality, diabetes, malignancy, dementia, and intensive care unit (ICU) admission. The multivariable regression equation including all potential variables predicted mortality (AUC = 0.979, 95% CI 0.964–0.993). Cox proportional hazards model showed increasing hazard ratio (HR) of mortality with dementia (HR 6.376, 95% CI 3.736–10.802, p < 0.001), ICU admission (HR 4.233, 95% CI 2.661–6.734, p < 0.001), age ≥ 60 years (HR 3.530, 95% CI 1.664–7.485, p = 0.001), malignancy (HR 3.054, 95% CI 1.494–6.245, p = 0.002), and dyspnoea (HR 1.823, 95% CI 1.125–2.954, p = 0.015). Presence of dementia, ICU admission, age ≥ 60 years, malignancy, and dyspnoea could help clinicians identify COVID-19 patients with poor prognosis.

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