Prognostic factors in the persistence of posttraumatic epilepsy after penetrating head injuries sustained in war

Object The goal of this paper was to investigate the long-term outcome and the possible prognostic factors that might have influenced the persistence of posttraumatic epilepsy after penetrating head injuries sustained during the Iraq–Iran war (1980–1988). Methods In this retrospective study, the authors evaluated 189 patients who sustained penetrating head injury and suffered posttraumatic epilepsy during the Iraq–Iran war (mean 18.6 ± 4.7 years after injury). The probabilities of persistent seizures (seizure occurrence in the past 2 years) in different periods after injury were estimated using the Kaplan-Meier method. The possible prognostic factors (patients and injury characteristics, clinical findings, and seizure characteristics) were studied using log-rank and Cox regression analysis. Results The probability of persistent seizures was 86.4% after 16 years and 74.7% after 21 years. In patients with < 3 pieces of shrapnel or no sphincter disturbances during seizure attacks, the probability of being seizure free after these 16 and 21 years was significantly higher. Conclusions Early seizures, prophylactic antiepileptics drugs, and surgical intervention did not significantly affect long-term outcome in regard to persistence of seizures.

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Clinicopathological Features of Remnant Gastric Cancer After Gastrectomy

The American Surgeon ◽

10.1177/00031348211056281 ◽

2021 ◽

pp. 000313482110562

Author(s):

Kenichi Iwasaki ◽

Edward Barroga ◽

Yota Shimoda ◽

Masaya Enomoto ◽

Erika Yamada ◽

...

Keyword(s):

Medical Records ◽

Tumor Invasion ◽

Cox Regression ◽

Remnant Stomach ◽

Invasion Depth ◽

Term Outcome ◽

Long Term Outcome ◽

Cox Regression Analysis ◽

Tumor Invasion Depth

Background Remnant gastric cancer (RGC) encompasses all cancers arising from the remnant stomach. Various studies have reported on RGC and its prognosis, but no consensus on its surgical treatment and postoperative management has been reached. Moreover, the correlation between the clinicopathological characteristics and long-term outcomes of RGC remains unclear. This study investigated the clinicopathological factors associated with the long-term survival of RGC patients. Methods The medical records (March 1993-September 2020) of 104 RGC patients from Tokyo Medical University Hospital database were analyzed. Of these 104 patients, the medical records of 63 patients who underwent surgical curative resection were analyzed using R. Kaplan-Meier plots of cumulative incidence of RGC were made. Differences in survival rates were compared using the log-rank test. Prognostic factors were analyzed using multivariate Cox regression analysis ( P < .05). Results Of the 104 RGC patients, 63 underwent total remnant stomach excision. The median time from the first surgery to the total excision was 10 years. The 5-year survival rate of the 63 RGC patients was .55 ((95% CI); .417-.671). The clinicopathological factors that were significantly associated with the long-term outcome of the RGC patients were tumor diameter (≥3.5 cm), presence or absence of combined resection of multiple organs, tumor invasion (deeper than T2), TNM stage, and postoperative morbidity. The multivariate Cox regression analysis showed that tumor invasion depth was the only independent prognostic factor for RGC patients [HR (95% CI): 5.49 (2.629-11.5), P ≤ .005]. Conclusions Among prognostic factors, tumor invasion depth was the only independent factor affecting RGC’s long-term outcome.

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Multimodality treatment of non small cells lung cancer (NSCLC) brain metastases: Long term outcome

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.17046 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 17046-17046

Author(s):

A. Cassano ◽

A. Pompucci ◽

E. D’Argento ◽

G. Schinzari ◽

A. Di Chirico ◽

...

Keyword(s):

Lung Cancer ◽

Regression Analysis ◽

Brain Metastases ◽

Cox Regression ◽

Radical Surgery ◽

Therapeutic Option ◽

Term Outcome ◽

Long Term Outcome ◽

Cox Regression Analysis

17046 Background: Lung cancer is the most common cause of cancer deaths and has the highest incidence for brain metastases of all malignancies. The prognosis of these patients (pts) remain poor with a median survival of 4–5 months. Whole brain radiation therapy (WBRT) in inoperable brain metastases prolongs survival to 3–5 months. In pts with 1 or ≤ 3 brain metastases neurosurgical resection improves median survival to 3.5–8 months. The aim of this study was to evaluate the long-term outcome of patients with brain metastases from NSCLC treated with multimodal strategy, including systemic chemotherapy, neurosurgery and radiotherapy. Methods: From 1997 to 2005, 56 pts were considered. Inclusion criteria were: single or multiple NSCLC brain metastases suitable of surgery; Karnofsky performance status ≥ 70%; controlled extracranial disease with Cisplatin-based chemotherapy; life expectancy > 4 months. Surgery was followed by 40 Gy WBRT. Statistical analysis was performed using the Kaplan-Meier method and Cox-regression analysis. Results: The median age was 58.4 years. The histological types were adenocarcinoma in 35 pts (62.5%), squamous cell carcinoma in 11 pts (19.7%) and large cell carcinoma in 10 pts (17.8%). The lesions were single in 39/56 pts (69.6%) and multiple in the other pts (30.4%). Radical surgery was performed in 37 pts (66%), while surgical citoreduction was possible in 19 pts (34%). The median follow-up period was 22.12 months (range 2–90 months). Overall survival (OS) of the whole group was 12.8 months; OS of pts radically resected was 16.5 months while OS of pts partially resected was 7.2 months. Based on Cox-regression analysis, age < 65 years and radical resection were independent predictors of survival (respectively p = 0.004–95% CI 1.46–7.6 and p = 0.04–95% CI 1.03–4.97), while the number of lesions was not relevant in terms of OS. Conclusions: Analysis of long-term outcome seems to confirm that the combined treatment of NSCLC brain metastases is a primary therapeutic option. In our series of 56 patients, radical surgery, not the number of metastases, was related with prolonged survival. Further randomized studies comparing surgery+WBRT vs gamma-knife-radiosurgery could define the best therapeutic option in the different subsets of pts. No significant financial relationships to disclose.

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A Correlation Between Monocyte to Lymphocyte Ratio and Long-Term Prognosis in Patients With Coronary Artery Disease After PCI

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/1076029621999717 ◽

2021 ◽

Vol 27 ◽

pp. 107602962199971

Author(s):

Feng-Hua Song ◽

Ying-Ying Zheng ◽

Jun-Nan Tang ◽

Wei Wang ◽

Qian-Qian Guo ◽

...

Keyword(s):

Regression Analysis ◽

Cox Regression ◽

Cardiac Mortality ◽

Term Outcome ◽

Long Term Outcome ◽

Cox Regression Analysis ◽

Lymphocyte Ratio ◽

All Cause Mortality ◽

Long Term Prognosis

Monocyte to lymphocyte ratio (MLR) has been confirmed as a novel marker of poor prognosis in patients with coronary heart disease (CAD). However, the prognosis value of MLR for patients with CAD after percutaneous coronary intervention (PCI) needs further studies. In present study, we aimed to investigate the correlation between MLR and long-term prognosis in patients with CAD after PCI. A total of 3,461 patients with CAD after PCI at the First Affiliated Hospital of Zhengzhou University were included in the analysis. According to the cutoff value of MLR, all of the patients were divided into 2 groups: the low-MLR group (<0.34, n = 2338) and the high-MLR group (≥0.34, n = 1123). Kaplan–Meier curve was performed to compare the long-term outcome. Multivariate COX regression analysis was used to assess the independent predictors for all-cause mortality, cardiac mortality and MACCEs. Multivariate COX regression analysis showed that the high MLR group had significantly increased all-cause mortality (ACM) [hazard ratio (HR) = 1.366, 95% confidence interval (CI): 1.366-3.650, p = 0.001] and cardiac mortality (CM) (HR = 2.379, 95%CI: 1.611-3,511, p < 0.001) compared to the low MLR group. And high MLR was also found to be highly associated with major adverse cardiovascular and cerebrovascular events (MACCEs) (HR = 1.227, 95%CI: 1.003-1.500, p = 0.047) in patients with CAD undergoing PCI. MLR was an independent predictor of ACM, CM and MACCEs in CAD patients who underwent PCI.

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Arkansas Autotransplant (AT) Experience with > 2500 Myeloma (MM) Patients: Follow-Up Extending to >15 Years.

Blood ◽

10.1182/blood.v106.11.1149.1149 ◽

2005 ◽

Vol 106 (11) ◽

pp. 1149-1149

Author(s):

Frits van Rhee ◽

Guido Tricot ◽

Elias Anaissie ◽

Maureen Reiner ◽

Maurizio Zangari ◽

...

Keyword(s):

Cox Regression ◽

Standard Of Care ◽

Term Outcome ◽

Long Term Outcome ◽

Kaplan Meier ◽

Long Term Follow Up ◽

Previously Treated Patients ◽

The University

Abstract Background: AT’s have become the standard of care for MM. Long-term follow-up studies from large centers are critical to understand who benefits most and who should be considered for alternative treatment approaches. Patients and Methods: 2,605 MM patients receiving at least one AT at the University of Arkansas were considered for this study. Kaplan-Meier analysis was used to estimate median event-free (EFS) and overall survival (OS). Cox regression was used to evaluate independent prognostic factors of EFS and OS from AT. Results: Of the 2,605 patients, 891 were enrolled into front line Total Therapy (TT) protocols TT1/2/3 (TT); 1,012 were treated on protocols for previously treated patients (non-TT); and 702 were treated off protocol due to significant co-morbidities or patient/MD preference (non-P). Median EFS and OS for all patients are 29 mo and 51 mo; 10-yr EFS and OS are 18% and 23%; 12% survived >15yr. Features independently predicting superior survival included TT (HR 0.51, p<.001), absence of cytogenetic abnormalities (no CA) (HR 0.47, p<.001), timely application of 2nd transplant (< 6 months of 1st transplant) (HR 0.71, p<.001) as well as B2M < 3mg/L, CRP < 6mg/dL, albumin >=3g/dL, platelet count >=100.000/microL (all p<.001) and age <65yr (p=.008). The figure depicts survival (landmarked at 6 months after 1st transplant) according to the number of favorable features present of the 5 strongest predictors (TT, 2 transplants within 6 months, no CA, low B2M, low CRP). Conclusion: This large single institution experience demonstrates that > 10yr survival can be accomplished in over one-half of the patients presenting without CA (14%), with low levels of B2M and CRP and receiving TT and timely 2nd autotransplant. The worst constellation affected 5% of all patients presenting with at most 1 good-risk feature whose 5-yr survival was only 8%. Collectively, these data should serve as a standard for MM investigators and patients alike, against which long-term outcome of newer treatments should be measured. Figure Figure

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The role of fatal family history and mode of inheritance in prostate cancer for long-term outcomes following radical prostatectomy

World Journal of Urology ◽

10.1007/s00345-020-03147-6 ◽

2020 ◽

Vol 38 (12) ◽

pp. 3091-3099 ◽

Cited By ~ 1

Author(s):

Valentin H. Meissner ◽

Jamila G. H. Strüh ◽

Martina Kron ◽

Lea A. Liesenfeld ◽

Stephanie Kranz ◽

...

Keyword(s):

Prostate Cancer ◽

Prognostic Factors ◽

Family History ◽

Radical Prostatectomy ◽

Cox Regression ◽

Long Term Outcomes ◽

Long Term Outcome ◽

Kaplan Meier ◽

Mode Of Inheritance

Abstract Purpose To determine whether fatal family history (FFH) or mode of inheritance in prostate cancer (PCa) has an impact on long-term outcomes following radical prostatectomy (RP). Methods 1076 PCa patients after RP with at least one deceased first-degree relative with PCa were included and stratified by FFH (four subgroups: fraternal, paternal, multiple, and none) and by mode of inheritance (two subgroups: male to male, non-male to male). We compared clinicopathological characteristics between subgroups with Fisher’s exact or Chi-square tests. Biochemical recurrence-free survival (BRFS) and cancer-specific survival (CSS) were analyzed using the method of Kaplan and Meier. Simple and multiple Cox regression with backward elimination were performed to select prognostic factors for BRFS and CSS. Results Median age at surgery was 63.3 (range 35.9–79.4) years. The overall Kaplan–Meier estimated BRFS rate at 10 and 15 years was 65.6% and 57.0%, respectively. The overall Kaplan–Meier estimated CSS rate at 10 and 15 years was 98.1% and 95.7%, respectively. Neither FFH nor mode of inheritance were factors associated with worse BRFS. However, in multiple Cox regression, paternal FFH was an important prognostic factor for a better CSS (HR 0.19, CI 0.05–0.71, p = 0.014) compared to non-FFH. Conclusion FFH and mode of inheritance do not seem to be prognostic factors of worse long-term outcomes following RP. Rather, a paternal FFH was associated with a better CSS; however, the reasons remain unclear. Nevertheless, patients after RP and FFH could be reassured that their own PCa diagnosis is not associated with a worse long-term outcome.

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P4724Elevated mitral valve pressure gradient is predictive for long-term outcome after percutaneous edge-to-edge mitral valve repair (PMVR) in patients with degenerative MR, but not in functional MR

European Heart Journal ◽

10.1093/eurheartj/ehz745.1101 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J Patzelt ◽

W Zhang ◽

R Sauter ◽

M Mezger ◽

H Nording ◽

...

Keyword(s):

Mitral Valve ◽

Cox Regression ◽

Regression Analyses ◽

Valve Repair ◽

Term Outcome ◽

Long Term Outcome ◽

Patient Cohort ◽

Kaplan Meier ◽

Valve Pressure

Abstract Background To analyze the effects of residual mitral regurgitation (MR) and mean mitral valve pressure gradient (MVPG) after percutaneous edge-to-edge mitral valve repair (PMVR) using the MitraClip-system on long term outcome. Methods and results Two hundred fifty-five patients who underwent PMVR were analyzed. Kaplan-Meier and Cox regression analyses were performed to evaluate the impact of residual MR and MVPG on clinical outcome. A combined clinical endpoint (all-cause mortality, MV surgery, redo procedure, implantation of a left ventricular assist device) was used. After PMVR, mean MVPG increased from 1.6±1.0 mmHg to 3.1±1.5 mmHg (p<0.001). Reduction of MR severity to ≤2+ postintervention was achieved in 98.4% of all patients. In the overall patient cohort, residual MR was predictive for the combined endpoint while elevated MVPG >4.4 mmHg was not according to Kaplan-Meier and Cox regression analyses. We then analyzed the cohort with degenerative and that with functional MR separately to account for these different entities.In the cohort with degenerative MR, elevated MVPG was associated with increased occurrence of the primary endpoint, whereas this was not observed in the cohort with functional MR. Conclusions MVPG >4.4 mmHg after MitraClip-implantation was predictive for clinical outcome in the patient cohort with degenerative MR. In the patient cohort with functional MR, MVPG >4.4 mmHg was not associated with increased clinical events. Acknowledgement/Funding This study was supported by grants from the German Research Foundation (KFO 274), the Volkswagen Foundation (Lichtenberg Program) and the German Heart

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Pulmonary Artery Hypertension as A Risk Factor for Long-Term Survival after Heart Transplantation

The Heart Surgery Forum ◽

10.1532/hsf.3789 ◽

2021 ◽

Vol 24 (3) ◽

pp. E544-E549

Author(s):

Milos Matkovic ◽

Vladimir Milicevic ◽

Ilija Bilbija ◽

Nemanja Aleksic ◽

Marko Cubrilo ◽

...

Keyword(s):

Pulmonary Artery ◽

Cox Regression ◽

Pulmonary Artery Hypertension ◽

Heart Catheterization ◽

Hemodynamic Parameters ◽

Term Outcome ◽

Term Survival ◽

Long Term Outcome ◽

Cox Regression Analysis

Background: Heart failure is the most frequent cause of pulmonary artery hypertension (PAH) and its severity may predict the development of heart failure (HF) and is known to be a prognostic factor of poor outcome after heart transplant (HTx). The aim of this study was to investigate the impact of preoperative PAH related to left-sided HF on long-term survival after HTx and to identify the hemodynamic parameters of PAH that predict survival after HTx. Methods: A prospective observational trial was performed, and it included 44 patients subjected to heart transplantation. Patients were divided into two groups: The first one with the preoperative diagnosis of PAH and the second one without the PAH diagnosed prior to the HTx. The two groups were compared for baseline characteristics, operative characteristics, survival, and hemodynamic parameters obtained by right heart catheterization. Survival was analyzed using Kaplan Meyer analysis, and Cox regression analysis was performed to determine independent predictors of survival. Results: The median follow-up time was 637.4 days (1-2028 days). The median survival within the group of patients with preoperative PAH was 1144 days (95% CI 662.884-1625.116) and 1918.920 days (95% CI 1594.577-2243.263) within the group of patients without PAH (P = .023), HR 0.279 (95% [CI]: 0.086-0.910; P = .034. The 30-day mortality in patients within PAH group was significantly higher, six versus two patients in the non PAH group (χ2 = 5.103, P < .05), while the long-term outcome after this period did not differ between the groups. Patients with preoperative PAH had significantly higher values of MPAP, PCWP, TPG and PVRI, while CO and CI did not differ between the two groups. Mean PVRI was 359.1 ± 97.3 dyn·s·cm-5 in the group with preoperative PAH and 232.2 ± 22.75 dyn·s·cm-5 in the group without PAH, P < .001. TPG values were 11.95 ± 5.08 mmHg in the PAH group while patients without PAH had mean values of 5.16 ± 1.97 mmHg, P < .001. Cox regression analysis was done for the aforementioned parameters. Hazard ratio for worse survival after HTx for elevated values of PVRI was 1.006 (95% [CI]: 1.001-1.012; P = .018) TPG had a hazard ratio of 1.172 (95% [CI]: 1.032-1.233; P = .015). Conclusion: Pulmonary artery hypertension is an independent risk factor for higher 30-day mortality after HTx, while it does not affect the long-term outcome. Hemodynamic parameters obtained by right heart catheterization in heart transplant candidates could predict postoperative outcome. PVRI and TPG have been identified as independent predictors of higher 30-day postoperative mortality.

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