scholarly journals Cine MR-Based Radiomics to Predict Myocardial Segments With Infarction

2021 ◽  
Author(s):  
Yongjia Peng ◽  
Yan Wang ◽  
Kongyang Wu ◽  
Yan Luo ◽  
Jing Liu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Pearson Correlation ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Rank Test ◽  
Good Prediction ◽  
Features Selection ◽  
Cine Mr ◽  
Radiomics Signature ◽  
Cine Cmr

Abstract Background: Although myocardial infarction (MI) can be assessed quantitatively and qualitatively by using late gadolinium-enhanced (LGE) cardiovascular magnetic resonance (CMR) imaging, intravenous administration of gadolinium can expose patients to high risk of nephrogenic systemic fibrosis, especially in those with cardiovascular diseases. The purpose of this study is to harness cine CMR-based radiomics for predicting MI without introducing gadolinium.Methods: In this retrospective study, we included 48 patients with acute myocardial infarction (AMI) confirmed by later gadolinium enhancement (LGE) at CMR. CMR examinations were performed within 2 to 6 days after PCI. According to the LGE, each myocardial segment was dichotomized into with and without MI. Radiomic features of myocardial segments were extracted from cine CMR images and the myocardial segments were divided into training and validation sets randomly at a ratio of 0.7:0.3. Pearson correlation and Mann-Whitney U rank test were used to eliminate redundant and irrelevant features. A least absolute shrinkage and selection operator (LASSO) algorithm was used for features selection in the training set. Radiomic signatures were constructed in both the training and validation sets and its predictive performance was assessed using area under the cure of receiver operating characteristic (AUC-ROC).Results：Of 768 myocardial segments in the 48 patients, there were 291 (38%) segments with MI and 477 (62%) segments without MI. After univariate analysis, there were 22 RFs related to MI with statistical significance. LASSO regression selected 18 RFs for radiomics signature builting. AUC-ROC of radiomic signatures in prediction of segments with MI was 0.74(95% CI:0.69-0.78)and 0.68 (95%CI: 0.60-0.75) in the training and validation sets, respectively. The difference was not statistically significant (p=0.14).Conclusion: Cine MR-based radiomics signature can achieve a good prediction performance for MI, which showed the potential to be a promising imaging biomarker for MI without the administration of contrast agent.

Analysis of Transfusion Dependency Development and Disease Evolution in Patients with MDS with 5q- and without Transfusion Needs at Diagnosis

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3180-3180
Author(s):  
Felix Lopez-Cadenas ◽  
Blanca Xicoy ◽  
Silvia Rojas P ◽  
Kaivers Jennifer ◽  
Ulrich Germing ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Board Of Directors ◽  
Research Funding ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Rank Test ◽  
Advisory Committees ◽  
Disease Evolution ◽  
Free Survival

Abstract Introduction: Myelodysplastic syndrome with del5q (MDSdel5q) is the only cytogenetically defined MDS category recognized by WHO in 2001, 2008 and 2016 and is defined as a MDS with deletion on the long arm of chromosome 5 and less than 5% of blast cells in bone marrow. It is known that for patients with MDSdel5q and transfusion dependence (TD), Len (LEN) is the first choice of treatment. However, data regarding factors that may impact on the development of TD or disease evolution in patients diagnosed without TD are scanty. In our study a retrospective multicenter analysis on patients with low-int 1 MDSdel5q without TD at diagnosis has been performed in order to answer these questions. Patients and methods: We performed a multicenter collaborative research from the Spanish (RESMD) and German MDS registries. Data from 153 low risk MDSdel5q without TD at diagnosis were retrospectively analyzed. Statistical analysis: Data were summarized using median, range, and percentage. The event of TD was defined as the development of TD according to the IWG criteria (2006) and/or the beginning of a treatment which could modify disease course (LEN or ESA). Transfusion or treatment free survival (TFS), overall survival (OS) and leukemia free survival (LFS) were measured from diagnosis to TD or treatment, the first occurred (or to last follow up if none), last follow up or death from any cause and evolution to AML, respectively. TFS, OS and LFS were analyzed using the Kaplan Ð Meier method. The Log-rank test was used to compare variables and their impact on survival for univariate analysis.Multivariate analysis was performed using Cox's proportional hazards regression model. For comparison of Kaplan Meier curves the long rank test was used, with statistical significance with p<0.05. Statistical analysis was performed using SPSS 20.0. Results: Main clinical and biological characteristics were summarizing in table 1. From the total of 153 patients, finally 121 were evaluable. During the study 56 patients (46.2%) became in TD and 47 (38.8%) did not develop TD but received a modified disease course treatment. In this sense, most of the patients developed relevant anemia regarding those data (103 out of 121 patients, 85%). Median time to TD or treatment (TFS) was 20 months (1-132) from diagnosis. Secondary MDS (p=0.02), thrombocytosis (>350 109/L) (p=0.007), and neutropenia (<1.5 x 109/L) (p=0.02) were associated with poorer TFS. Thrombocytosis and neutropenia retained statistical significance in the multivariate analysis (Table 2). Among the TD patients (N=56), 42 (75%) received treatment: 28 LEN, 7 ESA and 7 other treatments. Among patients that did not develop TD (N=65), 47 (72.3%) received treatment before TD development: 16 LEN, 28 ESA and 3 other treatments. In order to know the evolution of these patients, survival analysis was performed. Median follow up was 58.9 months among alive patients and 57% of them were alive at the time of the last follow up. Estimated OS at 2 and 5 years was 94% and 64%. Regarding Univariate analysis, platelet <100 x 109/L (p=0.03), patients older than 71 years (p=0.001), and progression into AML (p=0.02) were associated with poorer OS. On the contrary, patients who had received treatment showed better OS (p<0.0001). This benefit is more evident among patients receiving LEN, median OS for patients receiving LEN, ESA/other treatments and not treated group was 137 months (CI 95%: 59,4 -215,5), 99,3 months (CI 95%: 46,6 -152) and 57,9 months (CI 95%: 38,2 -77,6), respectively, p<0.0001 (Figure 1). In the multivariate analysis, patients older than 71 years and LEN treatment retained the statistical significant impact on OS (Table 2). Twenty-eight patients (23%) progressed into AML, median time to AML was 35 months (5-122). When univariate analysis was performed, variables with adverse impact on LFS were platelets <100 x 109/L(p=0.019), neutropenia < 0.8 x 109/L (p=0.026), an additional cytogenetic abnormality (p=0.013) while treatment with LEN had a favorable impact (p=0.035). In the multivariate analysis only the presence of additional cytogenetic abnormalities retained statistical significance (Table 2). CONCLUSIONS: Most of the patients with low risk del(5q) MDS and no TD at diagnosis developed symptomatic anemia very early after diagnosis (20 months). Carefully monitoring should be stablished in order to detect this time point. Outcome of this subset of patients could improve after target therapy. Figure 1 Figure 1. Disclosures Del Cañizo: Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; janssen: Research Funding; Astex: Membership on an entity's Board of Directors or advisory committees. Díez Campelo:celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau; Janssen: Research Funding; Astex: Membership on an entity's Board of Directors or advisory committees.

The predictive role of CA 19–9 kinetics for time-to-progression (TTP) and overall survival (OS) in patients receiving palliative first-line chemotherapy for advanced pancreatic cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15637-e15637
Author(s):  
M. Haas ◽  
S. Boeck ◽  
P. Stieber ◽  
R. P. Laubender ◽  
H. Buchner ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Advanced Pancreatic Cancer ◽  
Rank Test ◽  
First Line ◽  
Predictive Role ◽  
Pre Treatment ◽  
Line Chemotherapy

e15637 Background: Previous studies showed contradictory results for a predictive role of CA 19–9 kinetics during chemotherapy in patients (pts) with pancreatic cancer (PC). Methods: We performed a retrospective, multicenter study in order to evaluate the role of CA 19–9 as a biomarker for TTP and OS in PC. Main inclusion criteria: histological confirmed diagnosis of PC, treatment with first-line chemotherapy for advanced disease, pre-treatment CA 19–9 level of > 5.2 U/ml. As CA 19–9 measurements were conducted in different laboratories using different commercial assays, we defined a subgroup of pts where CA 19–9 was assessed exclusively by the Elecsys assay (Roche Diagnostics). For the analysis of CA 19–9 kinetics, at least one follow-up measurement between day 20 and 64 during first-line chemotherapy had to be available. Pts were divided into two subgroups of CA 19–9 responders and non-responders by cut-offs of a 25% and 50% decline, respectively. OS and TTP were estimated with the Kaplan-Meier-Method, differences between the subgroups were analyzed by using the log-rank test. Results: One hundred and eighty-six pts were included, 83 of them were tested with the Elecsys method. Median age was 63 years, 90 % of the pts were treated within prospective clinical trials. Median pre-treatment CA 19–9 was 1076 U/ml (range 5.7–100,000 U/ml), the median bilirubin was 0.6 mg/dl. Median OS and TTP were 9.8 months (mo) and 5.4 mo, respectively. In univariate analysis, pts with a CA 19–9 decline of at least 25% during chemotherapy lived significantly longer (11.9 mo vs. 8.2 mo, p=0.003) and had a significantly prolonged TTP (5.8 mo vs. 4.4 mo, p=0.018) than those with a lower decline or even CA 19–9 increase. Data for the Elecsys-measurements were comparable (OS: 13.4 mo vs. 8.6 mo, p=0.004; TTP: 7.0 mo vs. 2.6 mo, p=0.003). None of the analyses demanding a CA 19–9 drop of at least 50% reached the level of statistical significance. Conclusion: An early CA 19–9 decline of 25% during first-line chemotherapy may predict OS and TTP in pts with advanced PC. Innovative statistical methods are required to improve our understanding of the utility of CA 19–9 as a predictive biomarker in PC. [Table: see text]

scholarly journals Epidemiologic Features, Survival, and Prognostic Factors Among Patients With Different Histologic Variants of Glioblastoma: Analysis of a Nationwide Database

2021 ◽  
Vol 12 ◽  
Author(s):  
Li-Tsun Shieh ◽  
Chung-Han Ho ◽  
How-Ran Guo ◽  
Chien-Cheng Huang ◽  
Yi-Chia Ho ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Race And Ethnicity ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Rank Test ◽  
Poor Survival ◽  
Female Sex ◽  
Log Rank Test ◽  
Death Registry ◽  
Epidemiologic Features

Background: Glioblastoma (GBM) is the most common primary intracranial malignancy. Previous studies found incidence of GBM varies substantially by age, sex, race and ethnicity, and survival also varies by country, ethnicity, and treatment. Gliosarcoma (GSM) and giant cell glioblastoma (GC-GBM) are different histologic variants of GBM with distinct clinico-pathologic entities. We conducted a study to compare epidemiology, survival, and prognostic factors among the three.Methods: We identified GBM patients diagnosed between 2000 and 2016 using the Taiwan Cancer Registry and followed them using the death registry. Survival was compared among conventional GBM and two histologic variants. The potential confounding factors evaluated in this study included registered year, age, sex, and treatment modality (resection, radiotherapy, and chemotherapy).Results: We enrolled 3,895 patients, including 3,732 (95.8%) with conventional GBM, 102 (2.6%) with GSM, and 61 (1.6%) with GC-GBM. GC-GBM patients had younger mean age at diagnosis (49.5 years) than conventional GBM patients (58.7 years) and GSM patients (61.3 years) (p &lt; 0.01). The three groups had similar sex distributions (p = 0.29). GC-GBM had a longer median survival [18.5, 95% confidence interval (CI): 15.8–25.3 months] than conventional GBM (12.5, 95%CI: 12.0–13.0 months) and GSM (12.8, 95%CI: 9.2–16.2 months), and the differences in overall survival did not attain statistical significance (p = 0.08, log-rank test). In univariate analysis, GC-GBM had better survival than conventional GBM, but the hazard ratio (0.91) did not reach statistical significance (95%CI: 0.69–1.20) in the multivariate analysis. Young ages (≤ 40 years), female sex, resection, radiotherapy, and chemotherapy were factors associated with better survival in overall GBMs. In subtype analyses, these factors remained statistically significant for conventional GBM, as well as radiotherapy for GSM.Conclusion: Our analysis found conventional GBM and its variants shared similar poor survival. Factors with age ≤ 40 years, female sex, resection, radiotherapy, and chemotherapy were associated with better prognosis in conventional GBM patients.

The Role of Delayed Radiotherapy Initiation in Patients with Newly Diagnosed Glioblastoma with Residual Tumor Mass

2021 ◽  
Author(s):  
Johannes Kasper ◽  
Clara Frydrychowicz ◽  
Katja Jähne ◽  
Tim Wende ◽  
Florian Wilhelmy ◽  
...  
Keyword(s):  
Dna Methyltransferase ◽  
Tumor Volume ◽  
Cox Regression ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Residual Tumor ◽  
Rank Test ◽  
Survival Prediction ◽  
Newly Diagnosed ◽  
Entire Cohort

Abstract Objective Treatment for newly diagnosed isocitrate dehydrogenase (IDH) wild-type glioblastoma (GBM) includes maximum safe resection, followed by adjuvant radio(chemo)therapy (RCx) with temozolomide. There is evidence that it is safe for GBM patients to prolong time to irradiation over 4 weeks after surgery. This study aimed at evaluating whether this applies to GBM patients with different levels of residual tumor volume (RV). Methods Medical records of all patients with newly diagnosed GBM at our department between 2014 and 2018 were reviewed. Patients who received adjuvant radio (chemo) therapy, aged older than 18 years, and with adequate perioperative imaging were included. Initial and residual tumor volumes were determined. Time to irradiation was dichotomized into two groups (≤28 and >28 days). Univariate analysis with Kaplan–Meier estimate and log-rank test was performed. Survival prediction and multivariate analysis were performed employing Cox proportional hazard regression. Results One hundred and twelve patients were included. Adjuvant treatment regimen, extent of resection, residual tumor volume, and O6-methylguanine DNA methyltransferase (MGMT) promoter methylation were statistically significant factors for overall survival (OS). Time to irradiation had no impact on progression-free survival (p = 0.946) or OS (p = 0.757). When stratified for different thresholds of residual tumor volume, survival predication via Cox regression favored time to irradiation below 28 days for patients with residual tumor volume above 2 mL, but statistical significance was not reached. Conclusion Time to irradiation had no significant influence on OS of the entire cohort. Nevertheless, a statistically nonsignificant survival prolongation could be observed in patients with residual tumor volume > 2 mL when admitted to radiotherapy within 28 days after surgery.

scholarly journals Association of comorbidities in atrial fibrillation in acute myocardial infarction

2017 ◽  
Vol 4 (1) ◽  
pp. 143
Author(s):  
Irfan Ahamed H.B. ◽  
Bilal Bin Abdullah ◽  
Mohammed Ismail ◽  
Syed Aman Jagirdar
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Heart Rate ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Structural Heart Disease ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Time Of Presentation

Background: Atrial fibrillation is a most common arrhythmia in patients with and without structural heart disease with an increasing incidence mainly due to the aging population. As the population ages, one can expect that AF will remain a frequent and troublesome complication of AMI with comorbidities. Therefore, the present study was undertaken to investigate the association of co-morbidities in atrial fibrillation in acute myocardial infarction.Methods: The study was performed after the institutional ethical clearance and consent from all the patients. Heart rate, atrial fibrillation, blood pressure, ventricular fibrillation and stroke after acute myocardial infarction were recorded. The blood sugar and serum lipid levels were also measured using commercially available kit as per the manufacturer’s guidelines. The data was analyzed for statistical significance using univariate analysis and comparison was performed by Fisher Exact test and by using SPSS Version 20.Results: In our study, all the patients who developed AF after AMI were more than 60 years of age. Higher heart rate was more than or equal to 100 in 62.5% of the patients. 25% of patients had diabetes mellitus 75% of 8 patients had atrial fibrillation after acute myocardial infarction, 77% of patients without atrial fibrillation were known hypertensive’s. Out of the patients who had atrial fibrillation, 50% had hyperlipidemia and developed ventricular fibrillation.Conclusions: Higher heart rate (>100 bpm) at time of presentation is a risk factor for AF following to AMI. Patients with new onset AF after AMI had more complication during hospital stay. 

Extent of tumor removal and molecular markers in cerebral glioblastoma: a combined prognostic factors study in a surgical series of 105 patients

2012 ◽  
Vol 117 (2) ◽  
pp. 204-211 ◽  
Author(s):  
Maurizio Salvati ◽  
Angelo Pichierri ◽  
Manolo Piccirilli ◽  
Giacoma Maria Floriana Brunetto ◽  
Alessandro D'Elia ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Statistical Power ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Methylation Status ◽  
Progression Free Survival ◽  
Rank Test ◽  
Survival Prediction ◽  
Surgical Removal ◽  
Total Removal

Object In this paper, the authors' goal was to evaluate the prognostic value of YKL-40 expression as a prognostic factor for glioblastomas and to compare its validity to the already known MGMT. Methods Between January 2002 and January 2007, 105 patients were treated for cerebral glioblastoma. The extent of removal was classified in 4 groups. YKL-40 expression was evaluated by a semiquantitative immunohistochemical staining scale (0, no staining; 1, mild expression; and 2, strong expression). MGMT promoter methylation status was analyzed with methylation-specific polymerase chain reaction. All patients received adjuvant radiotherapy and chemotherapy. Kaplan-Meier curves were used to analyze progression-free survival (PFS) and overall survival (OS), and to compare these parameters between the subgroups stratified by extent of surgical removal, MGMT methylation, and YKL-40 expression. The log-rank test was used to determine statistical significance. A multivariate regression analysis was applied to extent of removal, YKL-40 expression, and MGMT status to check their specific statistical power and to test the independence of the variables. Results There were 55 men and 50 women with a mean age of 58 years. Extent of surgical removal is reported. The MGMT promoter was methylated in 48 patients and nonmethylated in 57. Analysis of YKL-40 expression is reported. The median PFS was 10.7 months (14.9 months in the gross-total removal subgroup) (p < 0.0001), and the median OS was 12.5 months (17.4 months in the gross-total removal group) (p < 0.0001). In the univariate analysis, OS was significantly correlated to the extent of resection (p < 0.0001), MGMT status (p < 0.0001), and YKL-40 (p < 0.0001). Multivariate analysis showed that all 3 factors reached statistical significance with respect to patient survival. In particular, surgical removal contributed more than the 2 other factors to the survival prediction (β = −0.6254). Interestingly, YKL-40 (β = −0.3867) contributed more than MGMT (β = −0.1705) to the predicted survival. Conclusions The extent of removal is the most important factor influencing the OS of patients harboring glioblastomas. When biological aggressiveness is taken into account, YKL-40 expression was found to be an independent prognostic factor that predicts OS better than MGMT status.

scholarly journals Refractory and Relapse Predictive Biomarkers in Hodgkin Lymphoma and Potential Directed-Therapy Targets

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2870-2870
Author(s):  
Angélica María Gamboa-Cedeño ◽  
Mariángeles Castillo ◽  
Victoria Otero ◽  
Natalia Paola Schutz ◽  
Dorotea Beatriz Fantl ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Alternative Pathway ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Disease Free Survival ◽  
Predictive Biomarkers ◽  
Rank Test ◽  
Therapy Targets ◽  
Log Rank Test ◽  
Bcl2 Expression

Abstract Despite 90% stage I Hodgkin Lymphoma (HL) patients can respond to current systemic therapy, this drops to 60%, when diagnosed in advanced stages. Nevertheless and independently of the lymphoma stage, the real challenge when treating these patients, is the refractory and relapsed disease. There is no molecular biomarker to identify patients that would be non-responsive to conventional treatment or that would relapse. Furthermore, rescue chemotherapy schemes for refractory and relapsed patients, associate with acute and late toxicity high risk. This highlights the need to deeper understand the HL molecular biology and the screening for predictive biomarkers as well as potential therapeutic directed-targets. We have previously reported that HL relies on the alternative NFkB pathway, mediated by RelB and NIK, to survive. Depletion of either RelB or NIK by shRNAs or pharmacological NIK inhibitors induce HL cell death. ChIP-Seq analysis uncovered RelB target genes showing RelB bound to BCL2 promoter. A significant downregulation of BCL2 mRNA and protein levels, following RelB or NIK knockdown was observed, indicating that RelB regulates BCL2 expression in human HL cell lines. Our molecular studies suggested that NFkB alternative pathway constitutive signaling could at least partially explain the non-responding HL cases. We aimed to analyze whether mediators of this pathway could be useful as predictive biomarkers and would represent potential targetable factors in both refractory and relapsed patients. We analyzed NIK and BCL2 citoplasm expression in Hodgkin Reed-Sternberg cells (HRS) in lymphatic node biopsies of 96 patients by inmunohistochemistry [50 female Md age and (range) 59 (6-82), 46 male 42 (9-78)]. The univariate analysis showed no correlation between NIK or BCL2 expression and the prognosis clinical and pathological parameters, neither the molecular markers routinely assayed. A positive correlation was found between NIK and BCL2 expression (p=0.01). NIK and BCL2 correlated with lack of response to conventional therapy and both early and late disease progression. The analysis of survival, applying the Kaplan-Meier Curves, showed > 60% NIK positive HRS cells associated with shorter Disease Free Survival (DFS) [Log Rank Test (p=0.000)] and predicted overall survival (OS) as well [Log Rank Test (p=0.01)]. Furthermore, > 60% BCL2 positive HRS cells correlated with poor prognosis in terms of OS [Log Rank Test (p=0.002)]. The statistical significance was maintained in the multivariate analysis [Cox Regression and Logistic Regression (p=0.001)]. NIK and BCL2 performed successfully as useful predictive markers to identify refractory or risk of relapse HL patients at diagnosis. They represent attractive molecules to further analyse their potential as directed-therapy targets, since we have already reported that HL is sensitive to NIK inhibitors and BCL2 blockers have already been approved for clinical use in other hematological pathologies. Disclosures Zerga: Bristol Myers Squibb: Other: Conference fees; Janssen: Other: Conference fees; Roche: Other: Conference fees; Takeda: Other: Conference fees.

Hodgkin Lymphoma Type Post-Transplant Lymphoproliferative Disorder (HL-PTLD) after Solid Organ Transplant (SOT): A Comprehensive and Comparative Analysis of Disease Characteristics, Prognosis, and Survival

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 502-502 ◽  
Author(s):  
Aaron S. Rosenberg ◽  
Andreas K. Klein ◽  
Robin Ruthazer ◽  
Andrew M. Evens
Keyword(s):  
Heart Transplant ◽  
Conflicts Of Interest ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Rank Test ◽  
Solid Organ ◽  
Risk Of Death ◽  
Increased Risk ◽  
Extranodal Disease

Abstract Background: HL-PTLD is a rare subtype of PTLD that carries an unknown prognosis as minimal clinical data are available. Furthermore, little is known regarding differences in clinical features between HL-PTLD and HL and the optimal treatment of HL-PTLD is not well defined. Methods: Patients (pts) diagnosed with HL-PTLD from 1/1999 - 4/2011 were identified in the Scientific Registry of Transplant Recipients, a prospective database of SOT recipients. Additionally, non-PTLD HL pts (n=13,847) were identified in the Surveillance, Epidemiology and End Results (SEER) Program. Baseline characteristics were compared using Wilcoxon and Chi square testing. Further, we compared cohorts of HL-PTLD and HL-SEER pts exactly matched on age, sex, and year (yr) of diagnosis. Overall survival (OS) rates were estimated using Kaplan-Meier and compared with log rank test. Cox proportional hazards models estimated hazard ratios (HR) and adjusted HR (aHR). Results: We identified 192 HL-PTLD pts. Compared with HL-SEER pts, HL-PTLD pts were older (median age 38 vs 51 yrs, respectively, P<0.04) and were more likely male (54% vs 73%, respectively, P<0.001), and had extranodal disease (3% vs 42%, respectively, P<0.001). Among pts with tumor Epstein-Barr Virus (EBV) status noted, 74% were positive. EBV negativity correlated with increased age (odds ratios/decade 1.52 (95% CI 1.20 – 1.99)). Median OS for the entire HL-PTLD cohort was 88 months and the 5-yr OS was 56% (95% CI 49% – 64%). In the exactly matched cohort, 5-yr OS for HL-PTLD (n=179) was significantly inferior compared with HL-SEER pts (n=1244) (57% vs 80%, respectively, P<0.001; see Fig 1). Further, the aHR of death for HL-PTLD compared with HL-SEER pts remained significantly increased after controlling for age, sex, race, extranodal disease, and yr of diagnosis (2.38, 95% CI 1.79 – 3.15). Detailed treatment data were available for 173 HL-PTLD pts. 75% (n=130) of pts had reduction in immune suppression (RIS) with 16% (n=27) having RIS + radiation (RT), 14% (n=24) RIS + rituximab (Rtx) and 60% (n=103) RIS with chemotherapy (Ctx). The other 24% (n=42) of pts received Ctx without RIS, while 1 pt received RT alone. In terms of all Ctx, 20% (n=38) of pts received ABVD or ABVD-like therapy and 13% (n=25) had other commonly utilized HL Ctx (eg, Stanford V, MOPP, BEACOPP); 18% of pts (n=35) received CHOP and 24% (n=47) had “other” non-traditional Ctx. Additionally, 17% (n=32) of all pts had Rtx and 18% (n=34) had RT as part of treatment. Among HL-PTLD pts, factors associated with decreased OS in univariate analysis were advanced age (HR 1.30/decade, 95% CI 1.15-1.45), heart transplant (HR 1.63, 95% CI 1.02 – 2.61), and increased baseline creatinine (Cr) (HR 1.78 per 0.1gm/dL increase, 95% CI 1.29 – 2.44). Karnofsky performance status (PS) <80 did not reach statistical significance (HR 1.50, 95% CI 0.80 – 2.73), but was entered into the multivariable models as part of a pre-specified analytic plan. In multivariable analysis, only age (aHR 1.26/decade, 95% CI 1.10 – 1.45) and elevated Cr (1.68/0.1gm/dL, 95% CI 1.15 – 2.46) remained significant for increased risk of death. In terms of treatment impact on HL-PTLD outcomes, use of any Ctx (n=144) was associated with improved OS (aHR 0.54 (95% CI 0.32 – 0.90)), while OS appeared inferior for pts who received CHOP or “other” Ctx (HRs (95% CI): 2.21 (1.11 – 4.39) and 2.07 (1.10 – 3.91; see Fig 2). Notably, after controlling for age, heart transplant, Cr, and poor PS on multivariable analysis, there was no statistical difference in OS for CHOP vs HL-specific regimens (aHR: 1.66, 95% CI 0.81 - 3.42); however, the risk of increased death for pts treated with “other” cytotoxic Tx or without Ctx remained significantly increased (aHR (95% CI) 2.01 (1.06 - 3.82) and 2.78 (1.43 - 5.40), respectively). Finally, treatment with RIS, RT, or Rtx were not associated with OS after controlling for age, heart transplant, Cr and PS. Conclusions: To the best of our knowledge, this is the largest cohort of HL-PTLD reported to date. When compared with HL-SEER pts, HL-PTLD pts were older, more likely male, and had higher frequency of extranodal disease. Furthermore, HL-PTLD pts had significantly inferior OS. Among HL-PTLD pts, clinical factors at diagnosis identified pts with markedly divergent outcomes. In addition, treatment without Ctx (including RIS alone) appeared insufficient, and moreover, treatment with HL-specific Ctx (and possibly CHOP) resulted in the most optimal outcomes. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Institutional retrospective analysis of definitive chemo-radiotherapeutic treatment (QRT) in locally advanced cervical cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e17016-e17016
Author(s):  
Tomas Jose Soule ◽  
Pablo Mando ◽  
Juan Pablo Sade ◽  
Gonzalo Giornelli Gomez ◽  
Sergio Gabriel Rivero ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Disease Recurrence ◽  
Cervix Cancer ◽  
Rank Test ◽  
Ct Dose ◽  
Platinum Group ◽  
Dose Reductions

e17016 Background: Retrospective analysis of toxicity and treatment impact of gemcitabine and platinum plus radiotherapy in patients with locally advanced cervix cancer. Methods: Descriptive, retrospective and observational study of patients with locally advanced cervix cancer (EIla/IVa).The analysis included toxicity Grade III/V and it impact in treatment. Results: We analyze 56 pts, median age: 46.5, median follow up: 24 months. Patients and tumoral characteristics are described in the table below. Regarding platinum group, 2pts required dose reductions of chemotherapy, 2pts suspended a cycle due to toxicity and 4pts needed RT split. 100% pts completed chemo radiotherapy concurrent treatment. Regarding platinum+gemcitabine group: 11pts required CT dose reductions, 14pts suspended a cycle due to toxicity and 5 didn´t complete CT due to toxicity; 6 had a RT split and 18 completed RT. Grade 3-4 toxicity was more frequent in the platinum+gemcitabine group (38.9% vs 73.7%, p=0.01) In platinum group, 14 pts presented disease recurrence. In the platinum + gem group 3pts had a recurrence. Median disease free interval (DFI) was not reached in both groups, but in the univariate analysis statistical significance was achieve, favouring the combine treatment (Log rank test, p=0.03). 2 year global survival rate was 82.1% in platinum group and 91.7% in platinum+gemcitabine groups. Conclusions: This report shows that the scheme of concurrent combine chemotherapy offers higher toxicity, requiring treatment discontinuation in some patients. Nevertheless, in a univariate analysis the platinum+gemcitabine group showed better results, even in a population with more advance disease with greater risk of relapse, understanding that the retrospective evaluation may miss confounders. A correct institutional manage of toxicities may allow the use of intense treatment to obtain potential benefits. [Table: see text]

scholarly journals Association between reduced preoperative serum albumin and prognosis in patients with adrenocortical carcinoma after primary resection: A retrospective study

2020 ◽  
Author(s):  
Fuxun Zhang ◽  
Zhihong Liu ◽  
Jiayu Liang ◽  
Shengzhuo Liu ◽  
Kan Wu ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Serum Albumin ◽  
Adrenocortical Carcinoma ◽  
Serum Albumin Level ◽  
Statistical Significance ◽  
Univariate Analysis ◽  
Albumin Level ◽  
Primary Resection ◽  
Rank Test ◽  
Preoperative Serum

Abstract Purpose To assess the correlation between preoperative serum albumin level and prognosis in patients with adrenocortical carcinoma after primary surgery. Methods We reviewed medical information of 71 included patients with diagnosis of ACC who underwent primary resection. Univariate and multivariate analysis were performed using Cox’s proportional hazards model. Survival analysis was conducted by Kaplan–Meier method with log-rank test. Receiver operating characteristic (ROC) curve and Jordan index were generated to explore cut-off value for serum albumin. Statistical significance was defined as P < 0.05. Results Among included patients, 33 patients (46.5%) relapsed at the end of follow-up, while 39 patients (54.9%) died. The median OS of overall included patients was 17 (range 1–104) months and median RFS was 10 (range 0–104) months. In univariate analysis, the albumin significantly associated with OS and RFS (HR:0.491, 95%CI: 0.260–0.930, P = 0.029 and HR:0.383, 95%CI: 0.192–0.766, P = 0.007, respectively). In multivariate analysis, the albumin level as an independent prognostic factor of OS was confirmed(HR:0.351, 95%CI: 0.126–0.982, P = 0.046). Meanwhile, the present results indicates the trend that albumin might be an independent predictor of RFS ( HR:0.423, 95%CI: 0.176–1.018, P = 0.055) Conclusion The preoperative serum albumin level is significantly correlated to prognosis of patients with ACC after primary resection. Reduced preoperative albumin level was proven to be a risk factor of clinical outcomes for ACC. Appropriate nutritional intervention prior to surgery may be beneficial to improve the prognosis of ACC patients.

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