scholarly journals UNRESECTABLE HEPATOBLASTOMA, LIVING DONATION AND PRE-TRANSPLANT FACTORS ASSOCIATED WITH EVENT-FREE SURVIVAL

2021 ◽  
Author(s):  
Joao Seda-Neto ◽  
Flávia Feier ◽  
Renata Pugliese ◽  
Helry Candido ◽  
Rodrigo Vincenzi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Risk Factor ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Event Free Survival ◽  
Free Survival ◽  
Donor Liver Transplantation ◽  
Factors Associated ◽  
Number Of Patients

Background: Hepatoblastoma (HB) treatment has improved over time with established chemotherapy (Qtx) protocols, and liver resection or liver transplantation (LT). However, the right timing for LT and adequate patient selection are key to achieve acceptable disease-free survival rates in patients with unresectable HB. Few groups have reported such factors in the setting of living donor liver transplantation (LDLT). Procedure: This single-center retrospective analysis of 28 children with HB submitted to LDLT aimed at determining the pre-transplant factors associated with worse post-transplant event-free survival. Results: Patients were divided in groups according to the occurrence of the event (recurrence/death) after LDLT – 10 patients in the event-yes and 18 patients in the event-no. Probability of 5-y event-free survival was 63.9%. Alpha-fetoprotein (AFP) reduction post-Qtx > 70% had a good performance for the occurrence of the event, with a calculated AUC of 0.8. A scoring system was derived from the pre-transplant risk factors (AFP reduction < 70%, time from diagnosis to LDLT > 12 months, rescue LT) for the probability of the event: no risk factor present (15.4%), one risk factor present (33.3%), and > 2 risk factors present (66.7%), (p=0.02). Conclusion: LDLT for HB is the preferred treatment option for unresectable HB, with no distant metastasis and adequate response to Qtx. The pre-transplant factors composing the risk score should be critically evaluated in order to move forward with the LDLT. However, due to the limited number of patients in this study, a larger number of patients is required to corroborate these findings.

scholarly journals Risk Factors Associated With Sino-Nasal Polyposis And Its Relationship With The Occupational Inhalants

2019 ◽  
Vol 09 (04) ◽  
pp. 290-293
Author(s):  
Qaisar Sajad ◽  
Ayub Musani ◽  
Faheem Ahmed Khan
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Nasal Polyposis ◽  
Local Population ◽  
Tertiary Care ◽  
Nasal Allergy ◽  
Care Hospital ◽  
Common Risk Factor ◽  
Factors Associated ◽  
Number Of Patients

Objective: To determine the risk factors associated with sino-nasal polyposis and its relationship with the exposure of occupational inhalants in patients presenting in a tertiary care hospital of Karachi. Study design and Settings: Cross-sectional study conducted at department of otorhino-laryngology Karachi Medical & Dental College and Abbasi Shaheed Hospital Karachi for a period of two and a half years from October 2015 to April 2018. Methodology: Total number of patients included for this study were 221 patients with diagnosis of bilateral and multiple nasal polyposis with age greater than 10 years. Specifically, designed proforma was used for data collection specially in relation with occupation and exposure to different occupational inhalants and entered in SPSS version 23 for analysis. Results: There were 133 male and 88 female patient with a mean age was 36.16 ± 12.33 years. Mostly patients belonged to poor socio-economic status i.e. 133 (60.70%). Allergic rhinitis or nasal allergy was the most common risk factor present in 114 patients (51.6%) while aspirin hypersensitivity was the least common risk factor present in only 19 patients (8.5%). Most of the patients (76 or 34.4%) were related with one or the other form of agriculture and were exposed to different occupational inhalants like mud, pollens, animals and plants. Conclusions: Nasal allergy is the most common risk factor and occupational inhalant specially related with agriculture, poultry and pets are the common agents responsible for nasal polyposis in our local population.

scholarly journals Long-term Oncologic Outcome of Postoperative Complications After Colorectal Cancer Surgery

2020 ◽  
Vol 36 (4) ◽  
pp. 273-280
Author(s):  
Chang Kyu Oh ◽  
Jung Wook Huh ◽  
You Jin Lee ◽  
Moon Suk Choi ◽  
Dae Hee Pyo ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Postoperative Complications ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Major Complication ◽  
Cancer Surgery ◽  
Colorectal Cancer Surgery ◽  
Free Survival ◽  
Disease Free

Purpose: The impact of postoperative complications on long-term oncologic outcome after radical colorectal cancer surgery is controversial. The aim of this study was to examine the risk factors and oncologic outcomes of surgery-related postoperative complication groups.Methods: From January 2010 to December 2010, 310 patients experienced surgery-related postoperative complications after radical colorectal cancer surgery. These stage I–III patients were classified into 2 subgroups, minor (grades I, II) and major (grades III, IV) complication groups, according to extended Clavien-Dindo classification system criteria. Clinicopathologic differences between the 2 groups were analyzed to identify risk factors for major complications. The diseasefree survival rates of surgery-related postoperative complication groups were also compared.Results: Minor and major complication groups were stratified with 194 patients (62.6%) and 116 patients (37.4%), respectively. The risk factors influencing the major complication group were pathologic N category and operative method. The prognostic factors associated with disease-free survival were preoperative perforation, perineural invasion, tumor budding, and receiving neoadjuvant therapy. With a median follow-up period of 72.2 months, the 5-year disease-free survival rates were 84.4% in the minor group and 78.5% in the major group, but there was no statistical significance between the minor and major groups (P = 0.392).Conclusion: Advanced cancer and open surgery were identified as risk factors for increased surgery-related major complications after radical colorectal cancer surgery. However, severity of postoperative complications did not affect disease-free survival from colorectal cancer.

scholarly journals INFLUENCE OF RISK FACTORS FOR DISEASE PROGRESSION ON TREATMENT RESULTS IN PATIENTS WITH PROSTATE CANCER

2021 ◽  
Vol 20 (3) ◽  
pp. 48-55
Author(s):  
R. M. Isargapov ◽  
M. O. Vozdvizhensky ◽  
A. L. Gorbachev
Keyword(s):  
Prostate Cancer ◽  
Risk Factors ◽  
Radiation Therapy ◽  
Disease Progression ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Adjuvant Radiation ◽  
Cancer Specific Survival ◽  
Free Survival ◽  
Disease Free

The purpose of the study was to optimize treatment of patients with prostate cancer at high risk of disease progression using a quantitative assessment of risk factors and the treatment method.Material and methods. Immediate outcomes were analyzed in 107 patients with pt3a-bn0m0g2–4 prostate cancer, who were treated in samara regional clinical oncological dispensary between 2010 and 2012. All patients were divided into 2 groups. Group i patients underwent surgery alone and group ii patients underwent surgery followed by radiation therapy. All patients were at high risk of disease progression according to the d’amico classification. Onlyone risk factor was identified in 64 patients, two risk factors in 37 patients, and three risk factors in 6 cases. The overall survival, cancer-specific survival and disease-free survival were analyzed.Results. In cases with one and two risk factors, the overall, disease-free and cancer-specific survival rates were statistically higher than in cases with three risk factors in the entire cohort (p<0.05). In the subgroups with one, two, and three risk factors, there were no statistically significant differences in overall and cancer-specific survival rates (p>0.05). Disease-free survival rates in the presence of one factor were not statistically different (p=0.920). In the presence of two and three factors, the relapse-free survival rates were statistically higher in group ii patients (surgical with adjuvant radiation therapy, p=0.049, p=0.025).Conclusion. The presence of three risk factors significantly increased the likelihood of a poor prognosis compared with one or two factors. Adjuvant radiation therapy improved survival rates in prostate cancer patients.

Stage is a prognostic factor for surgically treated patients with early-stage lip cancer for whom a ‘wait and see’ policy in terms of neck status has been implemented

2017 ◽  
Vol 131 (10) ◽  
pp. 889-894 ◽  
Author(s):  
G Eskiizmir ◽  
E Ozgur ◽  
G Karaca ◽  
P Temiz ◽  
N Hacioglu Yanar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Locoregional Recurrence ◽  
Early Stage ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Tumour Stage ◽  
Lip Cancer ◽  
Free Survival ◽  
Wait And See ◽  
Disease Free

AbstractObjectives:To determine the locoregional control and survival rates (in terms of risk factors) of patients who underwent surgical resection of early-stage lip cancer and for whom a ‘wait and see’ policy in terms of neck status had been implemented.Methods:The sociodemographic data, tumour stage, tumour characteristics and histopathological features of 41 patients with early-stage lip cancer were evaluated. Factors predictive of survival and locoregional recurrence were analysed. The five-year overall survival and disease-free survival rates were determined, and the prognostic risk factors were compared.Results:The mean follow-up period was 60.5 months (range, 4–92 months). Age, sex, tumour stage, tumour thickness and volume, and perineural involvement were not predictive of locoregional recurrence or survival. Pathological tumour stage (T1vsT2) was a prognostic factor for both five-year overall survival (87.3vs65.6 per cent,p= 0.042) and disease-free survival (88.6vs65.6 per cent,p= 0.037).Conclusion:Tumour stage was clearly a major factor affecting the prognosis of surgically treated patients with early-stage lip cancer for whom a ‘wait and see’ policy in terms of neck status had been implemented.

Risk Factors for Graft-versus-Host Disease (GVHD) Following Myeloablative HLA-Identical Sibling Transplantation with Allogeneic Peripheral Blood Stem Cells (PBSC): An Analysis of 546 Patients.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3318-3318
Author(s):  
Mohamad Mohty ◽  
Keyword(s):  
Risk Factors ◽  
Myeloid Leukemia ◽  
Acute Gvhd ◽  
Individual Patient Data ◽  
Chronic Gvhd ◽  
Disease Free Survival ◽  
Free Survival ◽  
Post Transplant ◽  
Factors Associated ◽  
Disease Free

G-CSF-mobilized PBSCs are increasingly used in allogeneic transplantation. In comparison to bone marrow (BM), PBSCs have been shown to allow faster engraftment, but also can lead to more chronic GVHD. Our current knowledge of risk factors for GVHD is based primarily on historical analyses performed using BM as the stem cell source. This analysis sought to identify potential risk factors predicting for the development of acute and chronic GVHD after related HLA-identical PBSC transplantation (PBSCT). We analyzed the outcome of 546 patients who were part of an international database bringing together individual-patient data from nine randomized trials. Median age of recipients was 39 years. 180 (33%) patients had acute myeloid leukemia (AML), 237 (43%) had chronic myeloid leukemia (CML) and 129 patients had other hematological malignancies. 398 (73%) patients had standard risk disease at time of PBSCT and 218 (41%) patients received TBI-based myeloablative conditioning. 312 (57%) patients received short-course methotrexate (days 1, 3, 6) as GVHD prophylaxis, while 234 (43%) received long-course methotrexate (days 1, 3, 6, 11). 190 (35%) patients received G-CSF post-transplant. An ANC of >500/μL was reached at a median of 16 (range, 8–50) days. Platelet recovery occurred at a median of 15 (range, 5–376) days. The incidence of grades II-IV acute GVHD was 44% (95%CI, 40–48%), while the incidence of extensive chronic GVHD was 40% (95%CI, 36%–44%). In a Cox multivariate analysis, the incidence of acute GVHD was significantly associated with age (P=0.001; RR=1.60 for age >40; 95%CI, 1.2–2.1), and TBI-based conditioning (P=0.0009; RR=1.7; 95%CI, 1.2–2.2). The main risk factors associated with an increased risk of extensive chronic GVHD in a Cox multivariate analysis were grade II-IV acute GVHD and a female donor (P=0.009; RR=1.5; 95%CI, 1.1–2.0; and P<0.0001; RR=2.2; 95%CI, 1.6–2.9 respectively). At a median follow-up of 35 months, disease-free survival (DFS) was significantly higher in patients with extensive chronic GVHD compared to patients without extensive chronic GVHD (P=0.03). G-CSF post-transplant (P=0.0027; RR=1.9; 95%CI, 1.2–2.9), disease status at transplant ((P<0.0001; RR=2.9 for advanced diseases; 95%CI, 1.9–4.3), and a diagnosis of acute leukemia (AML or ALL; P<0.0001; RR=3.5; 95%CI, 2.2–5.6) were the major factors associated with worsened disease-free-survival. In conclusion, although the use of PBSCs is associated with more frequent and clinically more severe chronic GVHD, this large-scale analysis based on individual-patient data demonstrates that some risk factors for GVHD after PBSCT are qualitatively comparable to those observed with BM-derived stem cells and might be determinant for the ultimate outcome. Most importantly, extensive chronic GVHD is associated with significantly improved DFS, while the use of G-CSF post-transplant might be detrimental.

Impact of up-to-seven criteria and neutrophil-to-lymphocyte ratio in liver transplantation for patients who received pretreatment for hepatocellular carcinoma.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14536-e14536
Author(s):  
Tomoharu Yoshizumi ◽  
Toru Ikegami ◽  
Shohei Yoshiya ◽  
Takashi Motomura ◽  
Yohei Mano ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Multivariate Analysis ◽  
Tumor Recurrence ◽  
Survival Rates ◽  
Neutrophil To Lymphocyte Ratio ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Lymphocyte Ratio

e14536 Background: There is currently no consensus on how to manage patients with hepatocellular carcinoma (HCC) while awaiting liver transplantation (LT). The guideline published in UK states that locoregional therapy should be considered for all listed patients with HCC. Living donor LT (LDLT) is a choice for treating HCC patients in organ shortage era. The aim of the present study is to clarify the risk factors of tumor recurrence after LDLT in patients who had received pre-transplant treatments (pre-Tx) for HCC. Methods: One hundred two adult patients (39 females and 63 males) who had undergone LDLT due to end-stage liver disease with recurrent HCC after pre-Tx were enrolled. The primary end-point of this study was HCC recurrence after LDLT. Recurrence-free survival rates after LDLT were calculated. Risk factors of tumor recurrence were identified using univariate and multivariate analysis. Results: The 1-, 3-, and 5-year recurrence-free survival rates were 89.4%, 80.7%, and 78.8%, respectively. Seventy-four of 102 patients underwent pre-Tx more than twice. Moreover, the times of pre-Tx, the interval between the first treatment and LDLT, and the interval between the last treatment and LDLT did not affect the outcome of LDLT. On univariate analysis, the factors affecting recurrence-free survival were exceeding the up-to-seven criteria (p<0.0001), exceeding the Kyushu University criteria (p<0.0001), neutrophil-to-lymphocyte ratio (NLR) > 4 (p=0.0001), Alpha-fetoprotein > 400 ng/ml (p<0.0001), and bilobar tumor distribution (p=0.047). A multivariate analysis identified independent risk factors for post-LDLT tumor recurrence were exceeding the up-to-seven criteria (p=0.001) and NLR > 4 (p=0.002). The 1- and 3-year recurrence-free survival rates in the recipients with exceeding the up-to-seven criteria and NLR > 4 were 30.0% and 15.0%, respectively. Conclusions: The kind or duration of pre-Tx did not affect the outcome of LDLT, but LDLT should not be performed for the patients with exceeding the up-to-seven criteria and NLR more than 4 after pre-Tx for HCC to prevent tumor recurrence.

scholarly journals Cholangiocarcinoma as an Indication for Liver Transplantation in the Era of Transplant Oncology

2020 ◽  
Vol 9 (5) ◽  
pp. 1353
Author(s):  
Enrico Gringeri ◽  
Martina Gambato ◽  
Gonzalo Sapisochin ◽  
Tommy Ivanics ◽  
Erica Nicola Lynch ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Oncological Surgery ◽  
Free Survival ◽  
Current Role ◽  
Specific Protocol ◽  
Disease Free

Cholangiocarcinoma (CCA) arises from the biliary tract epithelium and accounts for 10–15% of all hepatobiliary malignancies. Depending on anatomic location, CCA is classified as intrahepatic (iCCA), perihilar (pCCA) and distal (dCCA). The best treatment option for pCCA is liver resection and when a radical oncological surgery is obtained, 5-year survival rate are around 20–40%. In unresectable patients, following a specific protocol, liver transplantation (LT) for pCCA showed excellent long-term disease-free survival rates. Fewer data are available for iCCA in LT setting. Nevertheless, patients with very early unresectable iCCA appear to achieve excellent outcomes after LT. This review aims to evaluate existing evidence to define the current role of LT in the management of patients with CCA.

scholarly journals Circuitous Path to Live Donor Liver Transplantation from the Coordinator’s Perspective

2021 ◽  
Vol 11 (11) ◽  
pp. 1173
Author(s):  
Hui-Ying Lin ◽  
Cheng-Maw Ho ◽  
Pei-Yin Hsieh ◽  
Min-Heuy Lin ◽  
Yao-Ming Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Live Donor Liver Transplantation ◽  
Live Donor ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Factors Associated ◽  
Live Donor Liver ◽  
Live Donation ◽  
Transplant Candidates

Background: The live donor liver transplantation (LDLT) process is circuitous and requires a considerable amount of coordination and matching in multiple aspects that the literature does not completely address. From the coordinators’ perspective, we systematically analyzed the time and risk factors associated with interruptions in the LDLT process. Methods: In this retrospective single center study, we reviewed the medical records of wait-listed hospitalized patients and potential live donors who arrived for evaluation. We analyzed several characteristics of transplant candidates, including landmark time points of accompanied live donation evaluation processes, time of eventual LDLT, and root causes of not implementing LDLT. Results: From January 2014 to January 2021, 417 patients (342 adults and 75 pediatric patients) were enrolled, of which 331 (79.4%) patients completed the live donor evaluation process, and 205 (49.2%) received LDLT. The median time from being wait-listed to the appearance of a potential live donor was 19.0 (interquartile range 4.0–58.0) days, and the median time from the appearance of the donor to an LDLT or a deceased donor liver transplantation was 68.0 (28.0–188.0) days. The 1-year mortality rate for patients on the waiting list was 34.3%. Presence of hepatitis B virus, encephalopathy, and hypertension as well as increased total bilirubin were risk factors associated with not implementing LDLT, and biliary atresia was a positive predictor. The primary barriers to LDLT were a patient’s critical illness, donor’s physical conditions, motivation for live donation, and stable condition while on the waiting list. Conclusions: Transplant candidates with potential live liver donors do not necessarily receive LDLT. The process requires time, and the most common reason for LDLT failure was critical diseases. Aggressive medical support and tailored management policies for these transplantable patients might help reduce their loss during the process.

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