Effect of Preoperative Hydronephrosis on Ureteral Stenosis after Flexible Ureteroscopy: A Propensity Scores Matching Analysis

2021 ◽  
Author(s):  
Yuefan Shen ◽  
Anping Xiang ◽  
Sihi Shao
Keyword(s):  
Cumulative Incidence ◽  
Mucosal Injury ◽  
Important Predictor ◽  
Flexible Ureteroscopy ◽  
Ureteral Stricture ◽  
Ureteral Stenosis ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Propensity Matching

Abstract OBJECTIVES: Ureteral stenosis is a serious complication after flexible ureteroscopy. Other studies have confirmed that stone impaction and intraoperative ureteral injury are important factors causing stricture, and how to predict the occurrence of stricture before surgery may be an important topic. This study retrospectively studied the influence of preoperative hydronephrosis degree on ureteral stenosis after flexible ureteroscopy to explore whether preoperative hydronephrosis degree could predict postoperative ureteral stenosis. METHODS: A retrospective study was conducted on patients who received flexible ureteroscopy in our hospital for upper ureteral calculi from January 2015 to June 2018. The postoperative follow-up was performed for 36 months, and intraoperative and postoperative complications were recorded. According to the degree of hydronephrosis, the patients were divided into mild hydronephrosis group and moderate and severe hydronephrosis group. Preoperative clinical baseline data of the patients were adjusted by propensity matching score, and differences in intraoperative mucosal injury, operative time, incidence of postoperative ureteral stricture, and SFR 1 month after surgery were statistically analyzed. Kaplan-Meier method and Log-rank test were used to compare the differences in the cumulative incidence of ureteral stenosis between the two groups. Cox regression analysis was used to compare the hazard ratio of ureteral stenosis between the two groups. RESULTS: A total of 447 patients with 469 sides surgery were included, including 349 sides in the mild hydronephrosis group and 120 sides in the moderate and severe hydronephrosis group. 30 sides in 29 patients developed ureteral stenosis. The stenosis rate before propensity matching analysis was 6.4%, and 8% after propensity matching analysis. However, the SFR and operation time were not statistically consistent. Kaplan-Meier showed a significant difference in the cumulative incidence of ureteral stenosis between the two groups.CONCLUSIONS: Preoperative patients with moderate to severe hydronephrosis are more likely to have intraoperative mucosal injury, and the incidence of ureteral stricture is higher after flexible ureteroscopy. Preoperative hydronephrosis is an important predictor of ureteral stricture. Preoperative hydronephrosis is an important predictor of ureteral stricture.

scholarly journals Preoperative hydronephrosis is a predictive factor of ureteral stenosis after flexible ureteroscopy: a propensity scores matching analysis

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuefan Shen ◽  
Anping Xiang ◽  
Sihai Shao
Keyword(s):  
Cumulative Incidence ◽  
Propensity Scores ◽  
Cox Regression ◽  
Operation Time ◽  
Ureteral Injury ◽  
Rank Test ◽  
Flexible Ureteroscopy ◽  
Ureteral Stricture ◽  
Ureteral Stenosis ◽  
Significant Difference

Abstract Objectives Ureteral stenosis is a serious complication of flexible ureteroscopy. How to predict the possibility of stricture before surgery is an important topic. This research retrospectively studied the influence of preoperative hydronephrosis on ureteral stenosis after flexible ureteroscopy, to explore whether the preoperative hydronephrosis could predict postoperative ureteral stenosis. Methods We conducted a retrospective study on patients who received flexible ureteroscopy in our hospital for upper ureteral calculi from January 2015 to June 2018. Patients were followed-up for 36 months after surgery, and intraoperative and postoperative complications were recorded. We divided patients into the mild hydronephrosis group and moderate to severe hydronephrosis group. Preoperative clinical baseline data of the patients were adjusted by propensity matching score analysis. Differences of intraoperative ureteral injury, operative time, postoperative ureteral stricture, and SFR one month after surgery was statistically analyzed. Kaplan–Meier’s method and Log-rank test were used to compare the differences in the cumulative incidence of ureteral stenosis between the two groups. Cox regression was used to compare the hazard ratio of ureteral stenosis between the two groups. Results A total of 447 patients with 469 sides surgery were included, including 349 sides in the mild hydronephrosis group and 120 sides in the moderate to severe hydronephrosis group. Twenty-nine patients with 30 sides developed ureteral stenosis. Before and after propensity, the incidence of ureteral stricture matching analysis was 6.4% and 8%, respectively. There were statistical differences in ureteral stricture and injury, but the statistical differences in SFR and operation time were inconsistent. Kaplan–Meier showed a significant difference in the cumulative incidence of ureteral stenosis between the two groups. Conclusions Patients with moderate to severe hydronephrosis before surgery were more likely to have an intraoperative ureteral injury and postoperative ureteral stricture after FRUS. Preoperative hydronephrosis is an important predictor of ureteral stricture.

Clinical Factors Associated with Progression to AIDS in the Italian Cohort of HIV-Positive Hemophiliacs

1994 ◽  
Vol 72 (01) ◽  
pp. 033-038 ◽  
Author(s):  
N Schinaia ◽  
A M G Ghirardini ◽  
M G Mazzucconi ◽  
G Tagariello ◽  
M Morfini ◽  
...  
Keyword(s):  
Cumulative Incidence ◽  
National Registry ◽  
Factor Ix ◽  
Clotting Factor ◽  
Coagulation Disorders ◽  
Factors Associated ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Congenital Coagulation Disorders ◽  
Clotting Factor Concentrates

SummaryThis study updates estimates of the cumulative incidence of AIDS among Italian patients with congenital coagulation disorders (mostly hemophiliacs), and elucidates the role of age at seroconversion, type and amount of replacement therapy, and HBV co-infection in progression. Information was collected both retrospectively and prospectively on 767 HIV-1 positive patients enrolled in the on-going national registry of patients with congenital coagulation disorders. The seroconversion date was estimated as the median point of each patient’s seroconversion interval, under a Weibull distribution applied to the overall interval. The independence of factors associated to faster progression was assessed by multivariate analysis. The cumulative incidence of AIDS was estimated using the Kaplan-Meier survival analysis at 17.0% (95% Cl = 14.1-19.9%) over an 8-year period for Italian hemophiliacs. Patients with age greater than or equal to 35 years exhibited the highest cumulative incidence of AIDS over the same time period, 32.5% (95% Cl = 22.2-42.8%). Factor IX recipients (i.e. severe B hemophiliacs) had higher cumulative incidence of AIDS (23.3% vs 14.2%, p = 0.01) than factor VIII recipients (i.e. severe A hemophiliacs), as did severe A hemophiliacs on less-than-20,000 IU/yearly of plasma-derived clotting factor concentrates, as opposed to A hemophiliacs using an average of more than 20,000 IU (18.8% vs 10.9%, p = 0.02). No statistically significant difference in progression was observed between HBsAg-positive vs HBsAg-negative hemophiliacs (10.5% vs 16.4%, p = 0.10). Virological, immunological or both reasons can account for such findings, and should be investigated from the laboratory standpoint.

scholarly journals The prognosis of hepatoid adenocarcinoma of the stomach: a propensity score-based analysis

2020 ◽  
Author(s):  
Kai Zhou ◽  
Anqiang Wang ◽  
Sheng Ao ◽  
Jiahui Chen ◽  
Ke Ji ◽  
...  
Keyword(s):  
Propensity Score ◽  
Cox Regression ◽  
Radical Surgery ◽  
Survival Rates ◽  
Cancer Type ◽  
Radical Gastrectomy ◽  
Hepatoid Adenocarcinoma ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Propensity Matching

Abstract Background : To investigate whether there is a distinct difference in prognosis between hepatoid adenocarcinoma of the stomach ( HAS) and non-hepatoid adenocarcinoma of the stomach (non-HAS) and whether HAS can benefit from radical surgery. Methods : We retrospectively reviewed 722 patients with non-HAS and 75 patients with HAS who underwent radical gastrectomy between 3 November 2009 and 17 December 2018. Propensity score matching (PSM) analysis was used to eliminate the bias among the patients in our study. The relationships between gastric cancer type and overall survival (OS) were evaluated by the Kaplan-Meier method and Cox regression. Results : Our data demonstrate that there was no statistically significant difference in the OS between HAS and non-HAS {K-M, P=log rank (Mantel-Cox), (before PSM P=0.397); (1:1 PSM P=0.345); (1:2 PSM P=0.195)}. Moreover, there were no significant differences in the 1-, 2-, or 3-year survival rates between patients with non-HAS and patients with HAS (before propensity matching, after 1:1 propensity matching, and after 1:2 propensity matching). Conclusion : HAS was generally considered to be an aggressive gastric neoplasm, but its prognosis may not be as unsatisfactory as previously believed.

Assessment of Losartan 50 mg on Survival of Post-Dialysis Euvolemic Hypertensive Patients: Findings from HELD Trial

2019 ◽  
Vol 48 (3) ◽  
pp. 233-242
Author(s):  
Raja Ahsan Aftab ◽  
Amer Hayat Khan ◽  
Azreen Syazril Adnan ◽  
Syed Azhar Syed Sulaiman ◽  
Tahir Mehmood Khan
Keyword(s):  
Cox Regression ◽  
Dialysis Session ◽  
Hypertensive Patients ◽  
Cox Regression Analysis ◽  
Probability Of Survival ◽  
End Point ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Single Blind

Aims and objective: To estimate the effect of losartan 50 mg on survival of post-dialysis euvolemic hypertensive patients. Methodology: A single center, prospective, single-blind randomized trial was conducted to estimate the survival of post-dialysis euvolemic hypertensive patients when treated with lorsartan 50 mg every other day. Post-dialysis euvolemic assessment was done by a body composition monitor. Covariate Adaptive Randomization was used for allocation of participants to the standard or intervention arm, and the follow-up duration was twelve months. The primary end point was achieving targeted blood pressure (BP) of <140/90 mm Hg and maintaining for 4 weeks, whereas secondary end point was all cause of mortality. Pre-, intra-, and post-dialysis session BP measurements were recorded, and survival trends were analyzed using Kaplan-Meier analysis. Results: Of the total 229 patients, 96 (41.9%) were identified as post-dialysis euvolemic hypertensive. Final samples of 88 (40.1%) patients were randomized into standard (n = 44) and intervention arms (n = 44), and 36 (81.8%) patients in each arm completed a follow-up of 12 months. A total of eight patients passed away during the 12-month follow-up period (6 deaths among standard arm and 2 in intervention arm). However, the probability of survival between both arms was not significant (p = 0.13). Cox regression analysis revealed that chances of survival were higher among the patients in the intervention (OR 3.17) arm than the standard arm (OR 0.31); however, the survival was found not statistically significant. Conclusion: There was no statistical significant difference in 1 year survival of post-dialysis euvolemic hypertensive patients when treated with losartan 50 mg.

scholarly journals DOP72 Perianal Crohn’s Disease in the biologic era: A population-based cohort study

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S105-S107
Author(s):  
P Jenkinson ◽  
N Plevris ◽  
M Lyons ◽  
S Siakavellas ◽  
I Arnott ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Cumulative Incidence ◽  
Population Based ◽  
Incidence Rates ◽  
Percentage Change ◽  
Prescription Data ◽  
Annual Percentage Change ◽  
Kaplan Meier ◽  
Significant Difference

Abstract Background Peri-anal Crohn’s disease (pCD) significantly affects quality of life in patients with CD. The natural history of pCD in the era of biologic therapy is poorly understood. Perianal surgery includes examination under anaesthesia (EUA), drainage of peri-anal sepsis, seton instertion and fistula manipulation. EUA forms part of the standard of care at diagnosis of pCD and therefore can be used as a proxy for incidence of pCD. Methods CD patients were identified from the Lothian IBD registry, a physician validated registry of all IBD cases within Lothian which has been shown to be 94.3% complete. Prospectively collected coding data was used to identify peri-anal surgery, which was validated by review of the electronic health record. Biologic prescription data was extracted from the Lothian biologics database; a physician validated, prospectively collected registry. Time trend analysis was performed for the period 2000 to 2017 by 1) calculating annual incidence rates of peri-anal interventions for all patients with CD and estimating annual percentage change and 2) by calculating cumulative incidence of pCD and biologic prescription in newly diagnosed CD and 3) stratifying by era of diagnosis (Cohort 1: 2000–2008 and Cohort 2: 2009–2017. Results 2937 patients with CD were identified in the study period, with 1108 operations for pCD performed on 381 patients. Rates of surgery fell from 5.1 to 2.0 operations per 100 CD patients per year between 2000 and 2017 (p&lt;0.001) giving an annual percentage change of -3.4% (-4.9% to -1.9% 95% CI) (fig 1). 1753 new diagnoses of CD were made of whom 247 developed pCD. 5 year risk of pCD was 12.8% (9.5–16.6%) with no significant difference identified between cohort 1 (11.5%) and cohort 2 (13.8%) (p=0.116) (fig 2). The 5 year incidence of biologic prescription for patients with pCD increased from 11.2% in cohort 1 to 58.1% in cohort 2 (p&lt;0.001) (fig 3). Figure 1: Number of peri-anal interventions per 100 CD patients per year (multiple procedures per patient included). Figure 2: Kaplan Meier curves showing cumulative incidence of pCD stratified by era of diagnosis. Figure 3: Kaplan Meier curves showing cumulative incidence of biologic prescription in patients with CD stratified by era of diagnosis and presence of pCD. Conclusion The incidence of pCD remains unchanged over time. Although we cannot ascribe causality, the overall decrease in surgery for pCD has been paralleled by a marked increase in the use of biologic medication.

Clinical course of pulmonary embolism patients treated with DOACs: comparing prognosis, recurrent thromboembolism, and major bleeding between patients with and without cancer

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Nakano ◽  
R Imai ◽  
M Yoshida ◽  
S Shimokata ◽  
S Adachi ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Major Bleeding ◽  
Cumulative Incidence ◽  
Clinical Course ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Patients With Cancer ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Recurrent Vte

Abstract Background Venous thromboembolism (VTE) is the third frequent acute cardiovascular syndrome in the Europe and Japan. Since direct oral anticoagulants (DOACs) are widely used now, the morbidity and mortality of pulmonary embolism (PE) patients especially associated with cancer needs to be re-evaluated. Purpose We evaluated the clinical course of patients with PE mainly treated with DOACs. Methods This retrospective observational study was conducted in a single center. The data were collected from the medical record of consecutive patients who received inpatient treatment of PE. In this study, we have compared PE patients with cancer (cancer PE) to those without cancer (non-cancer PE) and evaluated the mortality, recurrent of VTE and major bleedings. Results In total, 140 patients were enrolled: 94 patients were cancer-related, and 46 patients were without cancer (Table). The type of the tumor in cancer PE patients were as follows: gastric 8 (9%), esophageal 5 (5%), pancreatic 12 (13%), lung 14 (15%), lymphoma 2 (2%), gynecologic 17 (18%), renal 2 (2%), bile duct 8 (9%), colon 12 (13%), and others 17 (18%). Kaplan-Meier curve showed that the cumulative all-cause mortality was significantly higher in the cancer PE group (35/94 (37%) vs. 2/46 (4%), P&lt;0.001 (log rank), HR 10.3 [95% CI:2.5–43.3]). The cumulative incidence of recurrent VTE was significantly higher in the cancer PE group (7/94 (7%) vs. 0/46, P=0.03 (log rank)). There was no significant difference in the cumulative incidence of major bleeding between the cancer PE group and the non-cancer PE group (8/94 (9%) vs. 5/46 (11%)). Conclusions The risk of recurrent VTE was still higher in cancer PE patients compared to non-cancer PE patients, although DOACs were used. Meanwhile the incidence of major bleeding was comparable in both groups, the risk of bleeding might be acceptable with using DOACs especially in cancer PE patients. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals The role of radiotherapy in neuroendocrine cervical cancer: SEER-based study

2021 ◽  
Vol 104 (2) ◽  
pp. 003685042110093
Author(s):  
Meilian Dong ◽  
Xiaobin Gu ◽  
Taoran Ma ◽  
Yin Mi ◽  
Yonggang Shi ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cox Regression ◽  
Local Treatment ◽  
Seer Database ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Chi Squared ◽  
Seer Data

Background: There are few randomised prospective data or guidelines for the treatment of neuroendocrine cervical cancer (NECC). In addition, the role of radiotherapy (RT) in NECC remains controversial. We used the Surveillance Epidemiology and End Results (SEER) database to investigate the role of RT for the treatment of NECC. Particular attention was paid to the different role of RT in patients with or without a metastasis (M1 or M0). Methods: The SEER database was queried for studies on NECC. We limited the year of diagnosis to the years 2000 to 2015. A Pearson’s two-sided Chi-squared test, the Kaplan–Meier method and Cox regression analysis models were used for statistical analyses. The overall survival (OS) was studied for the overall group and between-subgroup groups. Results: NECC was an aggressive disease with a mean OS of only 46.3 months (range of 0–196 months, median of 23 months). No significant differences were shown between the surgery (S) and S + RT groups ( p = 0.146) in the M0 (without metastasis) arm. However, there was a statistically significant difference in OS between the S and S + RT groups in the M1 (with metastasis) arm (median of 44.6 months for the S group and 80.9 months for the S + RT group), p = 0.004. The mean survival was significantly longer for M0 patients than for M1 patients when treated with S only (S arm), that is, 82.1 months versus 44.6 months, respectively (log-rank p = 0.000). We also noted that when patients received adjuvant RT (S + RT arm), there were no significant differences between the M0 and M1 groups (median of 90.6 and 81.0 months, p = 0.704, respectively). Age at diagnosis, chemotherapy, T stage and N stage were significant factors for OS in the M0 arm. Interestingly, radiotherapy was the only significant factor for OS with a multivariate HR for death of 0.502 (95% CI 0.206–0.750, p = 0.006) in the M1 arm. Conclusions: RT may be carefully used in patients who are negative for metastases. Using SEER data, we identified a significant survival advantage with the combination of radiotherapy and surgery in NECC with metastases. This suggests that active local treatment should be conducted and has a significant impact on OS, even if a distant metastasis has occurred.

Presence of CTCs and its prognostic potential compared to AR-V7 expression in mCRPC undergoing androgen-deprivation therapy.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e17032-e17032
Author(s):  
Katrin Schlack ◽  
Konstantin Seitzer ◽  
Verena Humberg ◽  
Neele Wüstmann ◽  
Norbert Grundmann ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Regression Analysis ◽  
Regression Models ◽  
Cox Regression ◽  
Androgen Deprivation ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Psa Response ◽  
Visceral Metastases

e17032 Background: Biomarkers predicting response to mCRPC treatment are rare. CTCs and AR-V7 status have been discussed as potential prognosticators. Methods: We evaluated 64 patients (pts.) treated with abiraterone (n=47) or enzalutamide (n=17), determined CTCs and analyzed AR-V7 status in correlation with survival using Kaplan-Meier-estimates and Cox-regression-models. Results: For PSA response, CTC- vs. CTC+ were not different (p=0.25) whereas AR-V7 status was predictive (68.2% AR-V7- and 33.3% AR-V7+ pts. (p=0.01)). Median PSA PFS was 17 mo. (CI 9.5-24.5) for CTC- and 6 (CI 5.2-6.9) for CTC+ pts. (p<0.01) with 9 mo. (CI 4.2-13.8) for CTC+/AR-V7- and 5 (CI 3.0–7.0) for CTC+/AR-V7+ pts. (p=0.04). In univariate cox regression analysis (UV), prior abiraterone or enzalutamide (A/E) (p=0.01), bone metastases (p=0.03), CTC+ (p=0.01), AR-V7+ (p=0.01), Hb ≤12 g/dl (p=0.01) and PSA decline ≥50% (p<0.01) were significant prognosticators. Within the CTC+ subgroup, AR-V7+ (p=0.02) and PSA decline ≥50% (p=0.03) showed a relevant difference. In multivariate analysis (MV), for CTC+ pts, AR-V7+ (p=0.02), PSA decline ≥50% (p=0.02) and visceral metastases (p=0.02) remained independent prognosticators. The analysis for PFS resulted in 22 mo. (CI NA) for CTC- compared to 9 (CI 7.7-10.3) for CTC+ (p=0.01) and 10 mo. (CI 8.2-11.8) for CTC+/AR-V7- vs. 6 (CI 1.9-10.1) for CTC+/AR-V7+ (p=0.07). Performing UV, prior A/E (p<0.01), CTC+ (p=0.01), AR-V7+ (p=0.01), Hb ≤12 (p<0.01), PSA decline ≥50% (p<0.01) and ALP elevated at baseline (p=0.03) showed statistically significant differences. Within the CTC+ subgroup, prior A/E (p=0.01), visceral metastases (p=0.02), Hb ≤12 (p=0.01) and PSA decline ≥50% (p=0.03) were significant prognosticators, whereas AR-V7+ was not. In MV of CTC+ pts, visceral metastases (p=0.02), PSA decline ≥50% (p=0.02) and Hb ≤12 (p=0.05) remained independent prognosticators. Median OS was not reached for CTC- and 17 mo. (CI 9.8–24.2) for CTC+ (p<0.01) with 27 (CI 10.6-43.4) vs. 14 (CI 10.4-17.7) mo. for AR-V7- and AR-V7+, respectively (p=0.06). UV resulted in statistically relevant differences for prior docetaxel (p=0.01), prior A/E (p<0.01), visceral metastases (p=0.02), CTC+ (p=0.01), AR-V7+ (p<0.01) and Hb ≤12 (p< 0.01). Within CTC+, prior docetaxel (p<0.01), prior A/E (p=0.01), visceral metastases (p<0.01) and Hb ≤12 (p<0.01) were statistically relevant parameters. UV for AR-V7 status did not result in a significant difference for OS either. In MV, CTC status as well as Hb ≤12 remained independent prognosticators (p=0.04 and p<0.01, respectively). For MV of CTC+, visceral metastases (p=0.01), Hb ≤12 (p<0.01) and prior docetaxel (p=0.01) were independent prognosticators of OS. Conclusions: Presence of CTCs seems to prognosticate PFS and OS in mCRPC patients undergoing Androgen-deprivation while presence of AR-V7 does not despite its predictive potential.

83 The prognostic significance of peripheral blood biomarkers in patients with advanced non-small cell lung cancer treated with pembrolizumab: a clinical study

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A91-A91
Author(s):  
Kira MacDougall ◽  
Muhammad Niazi ◽  
Jeff Hosry ◽  
Sylvester Homsy ◽  
Alexander Bershadskiy
Keyword(s):  
Peripheral Blood ◽  
Lymphocyte Count ◽  
Advanced Nsclc ◽  
Cox Regression ◽  
Absolute Lymphocyte Count ◽  
Blood Biomarkers ◽  
Cox Regression Analysis ◽  
Start Date ◽  
Kaplan Meier ◽  
Significant Difference

BackgroundPembrolizumab is an anti-programmed cell death protein 1 (PD-1) antibody used for the treatment of advanced non-small cell lung carcinoma (NSCLC). Systemic inflammation has long been associated with poor outcomes in many types of solid tumors.1 Peripheral blood biomarkers such as absolute lymphocyte count (ALC) and absolute neutrophil count to absolute lymphocyte count ratio (ANC/ALC) serve as surrogate markers of inflammation. The aim of this study is to investigate ALC and ANC/ALC in patients with advanced NSCLC receiving pembrolizumab and determine if there is a correlation between these biomarkers and overall survival (OS).MethodsA total of 240 patients with advanced NSCLC treated with pembrolizumab at Northwell Health hospital centers were included. The ALC and ANC/ALC were examined at initiation of pembrolizumab and after 6 weeks on treatment. The prognostic role of these peripheral blood biomarkers on OS were examined with Kaplan-Meier curves and a multivariable cox regression analysis.ResultsOf the 240 patients, the majority were male (52%), with a median age of 67 years (interquartile range [IQR] 59–73 years), had a diagnosis of adenocarcinoma (76%), with stage IV disease (82%). PDL-1 expression was >50% in 44% of the patients. The median time on treatment with pembrolizumab was 5.7 months [IQR: 2.7–12.5]. The median ALC and ANC/ALC were significantly lower at 6 weeks of pembrolizumab compared to the start date of treatment (1.38 vs. 1.4, p<0.001) and (3.6 vs. 4.6, p<0.001) respectively. An ALC greater than 1.4 was associated with an increased OS (figure 1), at 6 weeks after initiation of pembrolizumab (p=0.046), but not at the start of treatment (p=0.095). An ANC/ALC less than 5 was associated with improved OS (figure 2), both at initiation of pembrolizumab (p=0.003) and at 6 weeks after initiation of treatment (p = 0.028). Likewise, after adjusting for potential cofounders with a multivariate analysis (table 1), a baseline ANC/ALC of 5 or higher had a significantly increased risk of death (hazards ratio (HR)=1.84; 95% confidence interval (CI), 1.21–2.79; p=0.004), compared with patients with a lower ratio.ConclusionsHigh ALC at time of diagnosis as well as low ANC/ALC at baseline and at 6 weeks on treatment correlated with an increased OS in patients with advanced NSCLC treated with pembrolizumab. These findings represent a readily available predictive biomarker for oncologists and may help with risk stratification and strategizing treatment plans.Abstract 83 Figure 1Kaplan-Meier survival estimates between groups with different ALC at the start date of pembrolizumab and at 6 weeks after initiation of pembrolizumab. There is a statistically significant difference in OS between patients with ALC < 1.4 and patients with ALC ≥ 1.4 at 6 weeks after initiation of pembrolizumab (p = 0.046), but not at the start of treatment (p = 0.095).Abstract 83 Figure 2Kaplan-Meier survival estimates between groups with different ANC/ALC ratio at the start date of pembrolizumab and at 6 weeks after initiation of pembrolizumab. There is a statistically significant difference in OS between patients with ANC/ALC < 5 and patients with ALC ≥ 5, both at the start date of pembrolizumab (p = 0.003) and at 6 weeks after initiation of pembrolizumab (p = 0.028).Abstract 83 Table 1Multivariable cox regression analysis for association of baseline peripheral blood biomarkers and overall survival.Legend: HR, hazards ratio; CI, confidence interval; CNS, central nervous system, ANC/ALC, absolute neutrophil count to absolute lymphocyte count ratio; PDL-1, programmed death-1 ligand 1; ECOG, Eastern Cooperative Oncology Group performance scale.Ethics ApprovalThe study was approved by Zucker School of Medicine at Hofstra/Northwell at Staten Island University Hospital’s IRB #: 19–0922ReferenceMantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008;454(7203):436–44.

scholarly journals The prognosis of hepatoid adenocarcinoma of the stomach: a propensity score-based analysis

2020 ◽  
Author(s):  
Kai Zhou ◽  
Anqiang Wang ◽  
Sheng Ao ◽  
Jiahui Chen ◽  
Ke Ji ◽  
...  
Keyword(s):  
Propensity Score ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Survival Rates ◽  
Hepatoid Adenocarcinoma ◽  
Chi Square ◽  
Clinical Indicators ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Propensity Matching

Abstract Background To investigate whether there is a distinct difference in prognosis between hepatoid adenocarcinoma of the stomach (HAS) and non-hepatoid adenocarcinoma of the stomach (non-HAS) and whether HAS can benefit from radical surgery. Methods We retrospectively reviewed 722 patients with non-HAS and 75 patients with HAS who underwent radical gastrectomy between 3 November 2009 and 17 December 2018. Propensity score matching (PSM) analysis was used to eliminate the bias among the patients in our study. First, univariate analysis, including the chi-square and Mann-Whitney U tests, was used to investigate the relationship between all included clinical indicators and dependent variables, and some clinical indicators that might be meaningless were excluded. Then, clinical indicators with statistical and clinical significance were included in the logistic regression analysis to obtain more reliable results. The relationships between gastric cancer types and overall survival (OS) were evaluated by the Kaplan-Meier method and Cox regression models. Results Our data demonstrate that there is no statistically significant difference in the OS between HAS and non-HAS {K-M, P=log rank (Mantel-Cox), (before PSM P=0.490); (1:1 PSM P=0.345); (1:2 PSM P=0.195)}. Moreover, there were no significant differences in the 1-, 2-, or 3-year survival rates between patients with non-HAS and patients with HAS (before propensity matching, after 1:1 propensity matching, and after 1:2 propensity matching). Conclusion HAS is generally considered to be an aggressive gastric neoplasm, but its prognosis may not be as unsatisfactory as previously believed.

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