Effect of Health Care Provider Delays on Short-Term Outcomes in Patients With Colorectal Cancer: Multicenter Population-Based Observational Study

Background The United Kingdom has lower survival figures for all types of cancers compared to many European countries despite similar national expenditures on health. This discrepancy may be linked to long diagnostic and treatment delays. Objective The aim of this study was to determine whether delays experienced by patients with colorectal cancer (CRC) affect their survival. Methods This observational study utilized the Somerset Cancer Register to identify patients with CRC who were diagnosed on the basis of positive histology findings. The effects of diagnostic and treatment delays and their subdivisions on outcomes were investigated using Cox proportional hazards regression. Kaplan-Meier plots were used to illustrate group differences. Results A total of 648 patients (375 males, 57.9% males) were included in this study. We found that neither diagnostic delay nor treatment delay had an effect on the overall survival in patients with CRC (χ23=1.5, P=.68; χ23=0.6, P=.90, respectively). Similarly, treatment delays did not affect the outcomes in patients with CRC (χ23=5.5, P=.14). The initial Cox regression analysis showed that patients with CRC who had short diagnostic delays were less likely to die than those experiencing long delays (hazard ratio 0.165, 95% CI 0.044-0.616; P=.007). However, this result was nonsignificant following sensitivity analysis. Conclusions Diagnostic and treatment delays had no effect on the survival of this cohort of patients with CRC. The utility of the 2-week wait referral system is therefore questioned. Timely screening with subsequent early referral and access to diagnostics may have a more beneficial effect.

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Effect of Health Care Provider Delays on Short-Term Outcomes in Patients With Colorectal Cancer: Multicenter Population-Based Observational Study (Preprint)

10.2196/preprints.15911 ◽

2019 ◽

Author(s):

Ahmed Abdulaal ◽

Chanpreet Arhi ◽

Paul Ziprin

Keyword(s):

Colorectal Cancer ◽

Observational Study ◽

Proportional Hazards ◽

Cox Regression ◽

Diagnostic Delay ◽

Population Based ◽

Cox Proportional Hazards ◽

Treatment Delays ◽

Cox Regression Analysis ◽

Kaplan Meier

BACKGROUND The United Kingdom has lower survival figures for all types of cancers compared to many European countries despite similar national expenditures on health. This discrepancy may be linked to long diagnostic and treatment delays. OBJECTIVE The aim of this study was to determine whether delays experienced by patients with colorectal cancer (CRC) affect their survival. METHODS This observational study utilized the Somerset Cancer Register to identify patients with CRC who were diagnosed on the basis of positive histology findings. The effects of diagnostic and treatment delays and their subdivisions on outcomes were investigated using Cox proportional hazards regression. Kaplan-Meier plots were used to illustrate group differences. RESULTS A total of 648 patients (375 males, 57.9% males) were included in this study. We found that neither diagnostic delay nor treatment delay had an effect on the overall survival in patients with CRC (χ23=1.5, P=.68; χ23=0.6, P=.90, respectively). Similarly, treatment delays did not affect the outcomes in patients with CRC (χ23=5.5, P=.14). The initial Cox regression analysis showed that patients with CRC who had short diagnostic delays were less likely to die than those experiencing long delays (hazard ratio 0.165, 95% CI 0.044-0.616; P=.007). However, this result was nonsignificant following sensitivity analysis. CONCLUSIONS Diagnostic and treatment delays had no effect on the survival of this cohort of patients with CRC. The utility of the 2-week wait referral system is therefore questioned. Timely screening with subsequent early referral and access to diagnostics may have a more beneficial effect.

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THE PROGNOSTIC SIGNIFICANCE OF CD3+, CD68+, CD20+ INTERSTITIAL CELLS IN PATIENTS WITH KIDNEY ALLOGRAFT GLOMERULITIS

Nephrology (Saint-Petersburg) ◽

10.24884/1561-6274-2018-22-6-47-55 ◽

2018 ◽

Vol 22 (6) ◽

pp. 47-55

Author(s):

V. A. Dobronravov ◽

A. O. Mukhametdinova ◽

M. S. Khrabrova ◽

A. Nabokow ◽

H. -J. Gröne ◽

...

Keyword(s):

Proportional Hazards ◽

Cox Regression ◽

Prognostic Significance ◽

Cox Proportional Hazards ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

Long Term Prognosis ◽

The Impact ◽

The Relationship

THE OBJECTIVEof the study was to assess the impact of the count of interstitial CD3+, CD68+ and CD20+ cells on long-term prognosis of renal allograft (RA).PATIENTS AND METHODS.86 RA recipients with biopsy-proven according to the Banff 2013- 2017 criteria glomerulitis were enrolled in this retrospective study. The patients were subdivided into the following groups: 1) isolated glomerulitis with negative donor-specific antibodies (DSA) at the biopsy (n=53); 2) glomerulitis with positive DSA (n=22); 3) glomerulitis with undetermined DSA (n=11). Quantitative assay of interstitial positive cells was performed after immunohistochemical staining for CD68+, CD3+, CD20+. The Kaplan-Meier method and Cox proportional hazards regression model were used for the analysis of the relationship between interstitial CD3+, CD68+, CD20+ cells and risk of RA loss.RESULTS.CD68+ and CD3+ cells prevailed in interstitium in RA glomerulitis. CD20+ infiltrates were found in 60% of cases. CD20+ cells tended to form infiltrates, in 9 cases these infiltrates reached large sizes (≥ 50 CD20+ lymphocytes) and formed nodular structures. There was no difference in the count of interstitial CD3+ and CD68+ cells and in the presence of CD20+ infiltrates between DSA subgroups. Interstitial CD68+ ≥ 5 cells per field of view (FOV) (x400) and CD3+ ≥ 8 cells per FOV (x400), as well as the presence of large CD20+ infiltrates were associated with a lower RA survival (plog-rank < 0,05). Interstitial CD68+ (≥ 5 cells/FOV), CD3 + (≥ 8 cells/FOV) and the presence of large CD20+ interstitial infiltrates were independently associated with the risk of RA loss in the multivariable Cox regression analysis adjusted for DSA, cold and warm ischemia time (p < 0.05). CONCLUSION. Grade of interstitial infiltration by CD68+, CD3+ and CD20+ cells in RA glomerulitis could be independent predictor of RA loss.

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Abstract 131: Cognitive Impairment Predicts Mortality in Patients with Heart Failure

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.9.suppl_2.131 ◽

2016 ◽

Vol 9 (suppl_2) ◽

Author(s):

Howard Lan ◽

Lee Ann Hawkins ◽

Helme Silvet

Keyword(s):

Heart Failure ◽

Cognitive Impairment ◽

Proportional Hazards ◽

Cox Regression ◽

Cox Proportional Hazards ◽

Mortality Data ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

Study Population

Introduction: In our previously published study, we evaluated a Veteran cohort of 250 outpatients with heart failure (HF) and found 58% (144 of 250) incidence of previously undiagnosed cognitive impairment (CI). Previous studies have suggested that HF patients with CI have worse clinical outcomes including higher mortality but this has not been studied in the Veteran population. Methods: Current study was designed to prospectively follow this cohort of 250 patients. Cognitive function was previously evaluated in all patients at baseline using the St. Luis University Mental Status (SLUMS) exam. The primary outcome for this follow-up study was all-cause mortality. Data analysis including Cox regression analysis and Kaplan-Meier curves were generated using SPSS. Results: The study population was predominantly Caucasian (72%, 179 of 250) and male (99%, 247 of 250) with mean age of 69 ± 10 years. Mean follow up was 31 ± 11 months. During follow up, 26% (64 of 250) of patients died. Univariate and multivariate Cox proportional hazards regression analyses were performed and shown in Table 1. Using the SLUMS score, subjects were stratified into three groups: no CI (42%, 106 of 250), mild CI (42%, 104 of 250), and severe CI (16%, 40 of 250). Kaplan-Meier survival curves were generated to compare the three CI groups in Figure 1. Conclusion: Current study demonstrates that CI is an independent risk factor for mortality in outpatient HF patients. This is an important finding because CI is commonly unrecognized in this vulnerable population. Routine CI screening could help to identify those who are at greater risk for worse outcomes. Future studies are needed to derive possible interventions to improve outcomes in these patients.

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SELE gene as a characteristic prognostic biomarker of colorectal cancer

Journal of International Medical Research ◽

10.1177/03000605211004386 ◽

2021 ◽

Vol 49 (4) ◽

pp. 030006052110043

Author(s):

Na Li ◽

Honghe Xiao ◽

Jiangli Shen ◽

Ximin Qiao ◽

Fenjuan Zhang ◽

...

Keyword(s):

Gene Expression ◽

Colorectal Cancer ◽

Proportional Hazards ◽

Cox Regression ◽

Expression Profiles ◽

Immunohistochemical Analysis ◽

Cox Proportional Hazards ◽

The Cancer Genome Atlas ◽

Clinical Value ◽

Cox Regression Analysis

Objective To investigate the expression and clinical value of the E-selectin gene ( SELE) in colorectal cancer (CRC). Methods Using gene expression profiles and clinicopathological data for patients with CRC from The Cancer Genome Atlas, and tumor and adjacent normal tissues from 31 patients with CRC from Xianyang Central Hospital, we studied the correlation between SELE gene expression and clinical parameters using Kaplan–Meier and Cox proportional hazards regression analyses. Results Higher expression of SELE was significantly associated with a poorer prognosis and shorter survival in patients with CRC. The median expression level of SELE was significantly higher in CRC tissues compared with healthy adjacent tissue. Cox regression analysis showed that the prognosis of CRC was significantly correlated with the expression of SELE. Immunohistochemical analysis also showed that positive expression of E-selectin increased significantly in line with increasing TNM stage. Conclusion: This study confirmed that SELE gene expression is an independent prognostic factor in patients with CRC.

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Wait Times from Presentation to Treatment for Colorectal Cancer: A Population-Based Study

Canadian Journal of Gastroenterology ◽

10.1155/2010/692151 ◽

2010 ◽

Vol 24 (1) ◽

pp. 33-39 ◽

Cited By ~ 22

Author(s):

H Singh ◽

C De Coster ◽

E Shu ◽

K Fradette ◽

S Latosinksy ◽

...

Keyword(s):

Colorectal Cancer ◽

Cox Regression ◽

Diagnostic Delay ◽

Wait Time ◽

Occult Blood ◽

Population Based ◽

Administrative Databases ◽

Wait Times ◽

Fecal Occult Blood ◽

Cox Regression Analysis

BACKGROUND: The wait time from cancer diagnosis to treatment has been a recent focus of cancer care in Canada.OBJECTIVE: To examine the trends in wait times from patient presentation to treatment (overall health system wait time [OWT]) for colorectal cancer (CRC).METHODS: Patients with colorectal adenocarcinomas, diagnosed between 2001 and 2005, and their first definitive treatments were identified from the population-based Manitoba Cancer Registry (Winnipeg, Manitoba). By linkage to Manitoba Health and Healthy Living’s administrative databases, a patient’s first gastrointestinal investigation (abdominal radiological imaging, lower gastrointestinal endoscopy or fecal occult blood test) before CRC diagnosis was identified. The index contact with the health care system was estimated from the date of the visit with the physician who ordered the first gastroenterological investigation. The OWT was defined as the time from the index contact to the first treatment, while diagnostic delay was defined as the time from the index contact to the diagnosis of CRC. Multivariate Cox regression analysis was performed to determine independent predictors of OWT.RESULTS: The OWT was estimated for 2552 cases of CRC over the five years that were examined. The median OWT increased from 61 days in 2001 to 95 days in 2005 (P<0.001). Most of the increase was in diagnostic wait times (median of 44 days in 2001 versus 64 days in 2005 [P<0.001]). Year of diagnosis, older age, urban residence and diagnosis at a teaching facility were independent predictors of OWT.CONCLUSIONS: The OWT from presentation to treatment of CRC in Manitoba steadily increased between 2001 and 2005, mostly due to diagnostic delays.

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Surgical Outcomes of Vaginal or Cervical Melanoma

Frontiers in Surgery ◽

10.3389/fsurg.2021.771160 ◽

2022 ◽

Vol 8 ◽

Author(s):

Hui Tian ◽

Xuan Wang ◽

Bin Lian ◽

Lu Si ◽

Min Gao ◽

...

Keyword(s):

Adjuvant Therapy ◽

Proportional Hazards ◽

Cox Regression ◽

Radical Resection ◽

Cox Proportional Hazards ◽

Cox Regression Analysis ◽

Resection Group ◽

Kaplan Meier ◽

Significant Difference ◽

Peking University

Objective: To evaluate the effectiveness of radical resection compared with non-radical resection for vaginal or cervical melanoma.Methods: We retrospectively analysed the clinical data of post-operative patients with primary lower genital tract melanoma hospitalised at Peking University Cancer Hospital between Jan 2014 and Dec 2020. The study endpoints were recurrence-free survival (RFS) and overall survival (OS). Kaplan–Meier method-plotted survival curves and univariate and multivariate Cox proportional hazards regression models were used to identify the factors associated with RFS and OS, and to calculate hazard ratios (HRs) and associated 95% confidence intervals (95% CIs).Results: A total of 80 patients were included. Thirty-one patients had received non-radical resection, and 49 patients had received radical resection. The median patient age was 55.5 (IQR 45.3–60.0) years. Sixty-two (77.5%) patients had vaginal melanoma. Sixty-four patients (80.0%) had received post-operative adjuvant therapy. The median follow-up time was 36.0 months (95% CI 10.1–62.1 months). Sixty-four patients developed recurrence, and 44 patients died. The median RFS (mRFS) was 6.0 months (95% CI 3.4–8.6 m), and the RFS for the radical resection group was longer than that for the non-radical resection group (9.5 vs. 5.3 m), with no significant difference (P > 0.05). The median OS (mOS) was 25.9 months (95% CI 14.4–37.4 m). The mOS was 24.6 months (95% CI 10.3–38.9 m) and 25.9 months (95% CI 10.9–40.9 m) in the non-radical resection group and the radical resection group, respectively. Multivariate Cox regression analysis showed that surgical approach, infiltration depth of the tumour, lymph node metastasis, and post-operative adjuvant therapy were independent risk factors for RFS and that post-operative adjuvant therapy was an independent risk factor for OS.Conclusion: By performing multivariate analysis, which corrected for potential confounding factors, we identified surgical procedures that were associated with RFS, and we found that RFS and OS in patients with vaginal melanoma and cervical melanoma benefitted from post-operative adjuvant therapy.

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Unplanned Reoperation After Trapeziometacarpal Arthroplasty: Rate, Reasons, and Risk Factors

Hand ◽

10.1177/1558944716679605 ◽

2016 ◽

Vol 12 (5) ◽

pp. 446-452 ◽

Cited By ~ 5

Author(s):

Suzanne C. Wilkens ◽

Zichao Xue ◽

Jos J. Mellema ◽

David Ring ◽

Neal Chen

Keyword(s):

Proportional Hazards ◽

Proportional Hazards Model ◽

Cox Regression ◽

Persistent Pain ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Cox Regression Analysis ◽

Factors Associated ◽

Hazards Model ◽

Kaplan Meier

Background: Trapeziometacarpal (TMC) arthritis is an expected part of ageing to which most patients adapt well. Patients who do not adapt to TMC arthritis may be offered operative treatment. The factors associated with reoperation after TMC arthroplasty are incompletely understood. The purpose of this study was to determine the rate of, the underlying reasons for, and the factors associated with unplanned reoperation after TMC arthroplasty. Methods: In this retrospective study, we included all adult patients who had TMC arthroplasty for TMC arthritis at 1 of 3 large urban area hospitals between January 2000 and December 2009. Variables were inserted into a multivariable Cox proportional hazards model to determine factors associated with unplanned reoperation, and the Kaplan-Meier curve was used to estimate and describe the probability of unplanned reoperation over time. Results: Among 458 TMC arthroplasties, 19 (4%) had an unplanned reoperation; 16 of 19 (84%) for persistent pain and two-thirds within the first year. The multivariate Cox regression analysis showed that unplanned reoperation was independently associated with younger age, surgeon inexperience, and index procedure type. Conclusions: Surgeons should be aware as well as patients should be informed that as many as 4% are offered or request a second surgery, usually for persistent pain and often within the 1-year window when additional improvement is anticipated.

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A retrospective analysis of the role of proton pump inhibitors in colorectal cancer disease survival

Current Oncology ◽

10.3747/co.23.3204 ◽

2016 ◽

Vol 23 (6) ◽

pp. 583 ◽

Cited By ~ 5

Author(s):

C. Graham ◽

C. Orr ◽

C.S. Bricks ◽

W.M. Hopman ◽

N. Hammad ◽

...

Keyword(s):

Colorectal Cancer ◽

Proportional Hazards ◽

Cox Regression ◽

Univariate Analysis ◽

Retrospective Chart Review ◽

Cox Proportional Hazards ◽

Lymph Node Status ◽

Cancer Disease ◽

Cox Regression Analysis ◽

Tumour Characteristics

BackgroundProton pump inhibitors (ppis) are a commonly used medication. A limited number of studies have identified a weak-to-moderate association between ppi use and colorectal cancer (crc) risk, but none to date have identified an effect of ppi use on crc survival. We therefore postulated that an association between ppi use and crc survival might potentially exist.Methods We performed a retrospective chart review of 1304 crc patients diagnosed from January 2005 to December 2011 and treated at the Cancer Centre of Southeastern Ontario. Kaplan–Meier analysis and Cox proportional hazards regression models were used to evaluate overall survival (os).Results We identified 117 patients (9.0%) who were taking ppis at the time of oncology consult. Those taking a ppi were also more often taking asa or statins (or both) and had a statistically significantly increased rate of cardiac disease. No identifiable difference in tumour characteristics was evident in the two groups, including tumour location, differentiation, lymph node status, and stage. Univariate analysis identified a statistically nonsignificant difference in survival, with those taking a ppi experiencing lesser 1-year (82.1% vs. 86.7%, p = 0.161), 2-year (70.1% vs. 76.8%, p = 0.111), and 5-year os (55.2% vs. 62.9%, p = 0.165). When controlling for patient demographics and tumour characteristics, multivariate Cox regression analysis identified a statistically significant effect of ppi in our patient population (hazard ratio: 1.343; 95% confidence interval: 1.011 to 1.785; p = 0.042).Conclusions Our results suggest a potential adverse effect of ppi use on os in crc patients. These results need further evaluation in prospective analyses.

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Hip, Vertebral, and Wrist Fracture Risks and Schizophrenia: A Nationwide Longitudinal Study

10.21203/rs.3.rs-460939/v1 ◽

2021 ◽

Author(s):

Yu-Wen Chu ◽

Wen-Pin Chen ◽

Albert C. Yang ◽

Shih-Jen Tsai ◽

Li-Yu Hu ◽

...

Keyword(s):

Proportional Hazards ◽

Cox Regression ◽

Health Care Expenditure ◽

Population Based ◽

Wrist Fracture ◽

Cox Proportional Hazards ◽

Research Database ◽

Cox Regression Analysis ◽

Fracture Risks

Abstract Background: Fractures are a great health issue associated with morbidity, quality of life, life span, and health care expenditure. Fractures are correlated with cardiovascular disease, type 2 diabetes mellitus, cerebrovascular disease, and some psychiatric disorders. However, representative national data are few, and longitudinal cohort studies on the association between schizophrenia and the subsequent fracture risk are scant. We designed a nationwide population-based cohort study to investigate the association of schizophrenia with hip, vertebral, and wrist fractures over a 10-year follow-up. Methods: Data of patients with schizophrenia (International Classification of Diseases, Ninth Revision, Clinical Modification code 295) and matched over January 2000–December 2009) were extracted from Taiwan National Health Insurance Research Database. A Cox proportional-hazards regression model was constructed to calculate hazard ratios (HRs) for fractures between the schizophrenia and control cohorts. Results: Of 2,028 people with schizophrenia (mean age: 36.3 years, 49.4% female), 89 (4.4%) reported newly diagnosed fractures—significantly higher than the proportion in the control population (257, 3.2%; P = 0.007). The incidences of hip (1.2%, P = 0.009) and vertebral (2.6%, P = 0.011) fractures were significantly higher in the schizophrenia cohort than in the control cohort. In Cox regression analysis, hip (adjusted HR: 1.78, 95% confidence interval [CI]: 1.08–2.93) and vertebral (adjusted HR: 1.40, 95% CI: 1.01–1.95) fracture risks were significantly higher in patients with schizophrenia. Furthermore, a sex-based subgroup analysis revealed that the risk of hip fracture remained significantly higher in female patients with schizophrenia (HR: 2.68, 95% CI: 1.32–5.44) than in female controls. On the other hand, there was no significant interaction between effects of sex and schizophrenia on the risk of fractures. Conclusions: Over a 10-year follow-up, hip and vertebral fracture risks were higher in the people with schizophrenia than in the controls. The risk of fractures in patients with schizophrenia does not differ between female and male.

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Mesangial IgM Deposition predicts renal outcome in patients with IgA nephropathy: A multicenter, prospective, observational study

10.21203/rs.3.rs-28079/v1 ◽

2020 ◽

Author(s):

Li Tan ◽

Yi Tang ◽

Gai-Qin Pei ◽

Zheng-Xia Zhong ◽

Jia-Xing Tan ◽

...

Keyword(s):

Observational Study ◽

Prospective Observational Study ◽

Cox Regression ◽

Cox Proportional Hazards ◽

Renal Outcome ◽

Matched Cohort ◽

Cox Regression Analysis ◽

Renal Outcomes ◽

Kaplan Meier ◽

Multicenter Prospective Observational Study

Abstract BackgroundMesangial IgM deposition is commonly found in patients with immunoglobulin A nephropathy (IgAN). This study aims to investigate the relationships between mesangial IgM deposition and disease progression in IgAN patients.MethodsA total of 1239 patients with biopsy-proven primary IgAN were enrolled in this multicenter, prospective, observational study between January 2013 and August 2017. According to the degree of IgM deposition, 1239 patients were divided into three groups: Grade 0 (no or trace; n = 713, 57.55%), Grade 1 (mild; n = 414, 33.41%), Grades 2 + 3 (moderate and marked; n = 112, 9.04%). Using a 1: 1 propensity score matching (PSM) method identifying age, gender, and treatment modality to minimize confounding factors, 1042 matched patients (out of 1239) with different degrees of IgM deposition were enrolled to evaluate the severity of baseline clinicopathological features and renal outcome: Grade 0 (n = 521, 50.00%), Grade 1 (n = 409, 39.25%), Grades 2 + 3 (n = 112, 10.75%). Kaplan–Meier and Cox proportional hazards analyses were performed to determine whether different degrees of mesangial IgM deposition are associated with varying renal outcomes in IgAN.ResultsDuring a mean follow-up of 48.90 ± 23.86 and 49.01 ± 23.73 months, before and after adjusting for propensity scores respectively, the rate of complete remission (CR) was progressively lower with increased IgM deposition in both unmatched (63.39%, 46.14%, 45.54%) and matched cohort (61.80%, 46.45%, 45.54%), whereas the proportion of patients progressing to end stage renal disease (ESRD) showed reverse correlation (P < 0.001). Kaplan–Meier analysis indicated negative correlation between the intensity of mesangial IgM deposits and cumulative renal survival (all P < 0.05). Moreover, Cox regression analysis revealed that the degree of mesangial IgM deposition predicted renal outcome independent of MESTC score and clinical variables in the unmatched (Grade 1, HR, 1.59; 95% CI, 1.11–2.29; P = 0.01; Grades 2 + 3, HR, 1.69; 95% CI, 1.02–2.08; P = 0.04) and matched cohort (Grade 1, HR, 1.84; 95% CI, 1.19–2.85; P = 0.01; Grades 2 + 3, HR, 1.91; 95% CI, 1.01–3.24; P = 0.04).ConclusionsMesangial IgM deposition plays an important role in renal prognosis and is independently associated with worse renal outcomes in patients with IgAN.Trial registration TCTR, TCTR20140515001. Registered May 15, 2014, http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=1074

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