Clinical, radiological, and pathological features in 43 cases of intracranial subependymoma

2015 ◽  
Vol 122 (1) ◽  
pp. 49-60 ◽  
Author(s):  
Zhiyong Bi ◽  
Xiaohui Ren ◽  
Junting Zhang ◽  
Wang Jia
Keyword(s):  
Multivariate Analysis ◽  
Tumor Recurrence ◽  
Univariate Analysis ◽  
Intracranial Tumor ◽  
Pathological Examination ◽  
Intracranial Tumors ◽  
Pathological Features ◽  
Total Removal ◽  
Term Survival ◽  
Intracranial Subependymoma

OBJECT Intracranial subependymomas are rarely reported due to their extremely low incidence. Knowledge about subependymomas is therefore poor. This study aimed to analyze the incidence and clinical, radiological, and pathological features of intracranial subependymomas. METHODS Approximately 60,000 intracranial tumors were surgically treated at Beijing Tiantan Hospital between 2003 and 2013. The authors identified all cases in which patients underwent resection of an intracranial tumor that was found to be pathological examination demonstrated to be subependymoma and analyzed the data from these cases. RESULTS Forty-three cases of pathologically confirmed, surgically treated intracranial subependymoma were identified. Thus in this patient population, subependymomas accounted for approximately 0.07% of intracranial tumors (43 of an estimated 60,000). Radiologically, 79.1% (34/43) of intracranial subependymomas were misdiagnosed as other diseases. Pathologically, 34 were confirmed as pure subependymomas, 8 were mixed with ependymoma, and 1 was mixed with astrocytoma. Thirty-five patients were followed up for 3.0 to 120 months after surgery. Three of these patients experienced tumor recurrence, and one died of tumor recurrence. Univariate analysis revealed that shorter progression-free survival (PFS) was significantly associated with poorly defined borders. The association between shorter PFS and age < 14 years was almost significant (p = 0.51), and this variable was also included in the multivariate analysis. However, multivariate analysis showed showed only poorly defined borders to be an independent prognostic factor for shorter PFS (RR 18.655, 95% CI 1.141–304.884, p = 0.040). In patients 14 years of age or older, the lesions tended to be pure subependymomas located in the unilateral supratentorial area, total removal tended to be easier, and PFS tended to be longer. In comparison, in younger patients subependymomas tended to be mixed tumors involving the bilateral infratentorial area, with a lower total removal rate and shorter PFS. CONCLUSIONS Intracranial subependymoma is a rare benign intracranial tumor with definite radiological features. Long-term survival can be expected, although poorly defined borders are an independent predictor of shorter PFS. All the features that differ between tumors in younger and older patients suggest that they might have different origins, biological behaviors, and prognoses.

scholarly journals F-FDG Uptake Is Predictive of Poor Survival After Surgery for Large-CellNeuroendocrine-Carcinomas of The Lung: A Bicentric Analysis

2019 ◽  
pp. 1-8
Author(s):  
Ludovic Fournel ◽  
Angelina Filice ◽  
Audrey Lupo ◽  
Aurélie Janet-Vendroux ◽  
Cristian Rapicetta ◽  
...  
Keyword(s):  
Cox Regression ◽  
Univariate Analysis ◽  
Pathological Examination ◽  
Positive Staining ◽  
Pathological Features ◽  
Poor Survival ◽  
Term Survival ◽  
Female Ratio ◽  
Long Term Survival

Introduction: Large cell neuroendocrine carcinoma (LCNEC) represents a relatively rare and poorly studied entity whose management is not clearly established. The aim of this study was to explore the relationship between preoperative 18F-FDG-PET results, pathological features and long-term survival in a large surgical cohort of LCNEC. Methods: From 06/08 to 06/17, the clinical, radiometabolic, pathological and surgical aspects of 121 LCNEC-patients surgically treated in 2 tertiary centers were retrieved. A Cox regression model was used to identify predictors of survival and Kaplan-Meier method to summarize overall survivals. Results: Mean age and male/female ratio were 63.4±8.3 and 3:1, respectively. The main clinical, radiometabolic and surgical characteristics are reported in Tab.1. Most patients were active/former smokers and presented symptoms at diagnosis. 18FDG-PET/Scan was performed in 65 patients (53.7%) with a mean SUVmax of 10.1 (SD±4.6). Higher SUVmax values (SUVmax >10) were detected in tumors with larger size (p=0.004), advanced p-Stages (p=0.019), presenting necrosis (p=0.077) and with positive staining for CD56 (p=0.025) and TTF-1 (0.063). After surgery (R0 in 91% of cases), 52 (43%) patients had pStage-I while about 35% of patients presented with N1-2 disease. Median, 3-yrs and 5-yrs overall survival was 40 months, 52.2% and 44.6%, respectively. At univariate analysis, the survival was significantly influenced by SUVmax values (p=0.009) and by the presence of vascular invasion at pathological examination (p=0.024). Multivariate analysis showed as the FDG-SUVmax was the only independent variable affecting long-term survival (HR:2.86;C.E.: 1.09-7.47;p=0.032). Conclusions: Patients underwent surgical resection for LCNEC of the lung experienced a poor prognosis (5-yrs survival = 44.6% in this study). High-level FDG accumulation (SUVmax >10) correlates with pathological features and results to be independently predictive of poor survival after surgery. This parameter should be taking into account when planning the best strategy of care.

507 NEOADJUVANT AND ADJUVANT CHEMOTHERAPIES FOR PATIENTS WHO UNDERWENT RESECTION FOR SQUAMOUS CELL CARCINOMA CF THE THORACIC ESOPHAGUS

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
J Liu ◽  
Y Wang
Keyword(s):  
Squamous Cell Carcinoma ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Survival Rate ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Univariate Analysis ◽  
Entire Group ◽  
Thoracic Esophagus ◽  
Term Survival

Abstract   The efficacy of neo-adjuvant chenmotherapy (NCT) and adjuvant chemotherapy (ACT) for squamous cell carcinoma (SCC) of the esophagus has not been fully expounded. This study analyzed the prognostic factors of patients who underwent esophagectomy for SCC of the thoracic esophagus, specially focused on NCT and ACT. Methods From January 2008 to January 2016, 1075 consecutive patients underwent esophgagectomy for stage T3-T4 SCC of the thoracic esophagus. Propensity-score matching (PSM) analyses were conducted in patients who underwent NCT, surgery alone (SA) and ACT. After PSM, there were 83 patients in NCT, 249 patients in SA and 249 patients in ACT group. Postoperative outcomes and prognostic factors of patients in the three groups were analyzed. Univariate analysis was performed using the Kaplan–Meier method and multivariate analysis using the Cox proportional hazard model. Differences were considered to be statistically significant when P &lt; 0.05. Results The incidence of main postoperative complications was 9.6% (8/83) in NCT group compared to 6.8% (34/498) in SA and ACT groups (P = 0.834). In NCT group, 20 patients (24.1%) were downstaged by NCT and 63 patients (75.9%) remained stable. The 3-year survival rate of the entire group was 51.0%, and the 5-year survival rate was 33.4%. The 5-year survival rate was 32.2% in NCT group, 50.9% in ACT, and 19.5% in SA patients. In univariate analysis, both NCT and ACT were associated with long-term survival. In multivariate analysis, however, ACT rather than NCT was independent prognostic factor. Conclusion This study supports the use of postoperative ACT for patients with stage T3 or T4 SCC of the thoracic esophagus, but the effect of NCT needs further study.

scholarly journals The immunohistochemical expression of SSTR2A is an independent prognostic factor in meningioma

2021 ◽  
Author(s):  
Christina Fodi ◽  
Marco Skardelly ◽  
Johann-Martin Hempel ◽  
Elgin Hoffmann ◽  
Salvador Castaneda ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Intensity Distribution ◽  
Tumor Recurrence ◽  
Univariate Analysis ◽  
Somatostatin Receptors ◽  
Tumor Grade ◽  
Neurofibromatosis Type ◽  
Prognostic Impact ◽  
Immunohistochemical Expression ◽  
Who Grade

AbstractThe expression of somatostatin receptors in meningioma is well established. First, suggestions of a prognostic impact of SSTRs in meningioma have been made. However, the knowledge is based on few investigations in small cohorts. We recently analyzed the expression of all five known SSTRs in a large cohort of over 700 meningiomas and demonstrated significant correlations with WHO tumor grade and other clinical characteristics. We therefore expanded our dataset and additionally collected information about radiographic tumor recurrence and progression as well as clinically relevant factors (gender, age, extent of resection, WHO grade, tumor location, adjuvant radiotherapy, neurofibromatosis type 2, primary/recurrent tumor) for a comprehensive prognostic multivariate analysis (n = 666). The immunohistochemical expression scores of SSTR1, 2A, 3, 4, and 5 were scored using an intensity distribution score ranging from 0 to 12. For recurrence-free progression analysis, a cutoff at an intensity distribution score of 6 was used. Univariate analysis demonstrated a higher rate of tumor recurrence for increased expression scores for SSTR2A, SSTR3, and SSTR4 (p = 0.0312, p = 0.0351, and p = 0.0390, respectively), while high expression levels of SSTR1 showed less frequent tumor recurrences (p = 0.0012). In the Kaplan–Meier analysis, a higher intensity distribution score showed a favorable prognosis for SSTR1 (p = 0.0158) and an unfavorable prognosis for SSTR2A (0.0143). The negative prognostic impact of higher SSTR2A expression remained a significant factor in the multivariate analysis (RR 1.69, p = 0.0060). We conclude that the expression of SSTR2A has an independent prognostic value regarding meningioma recurrence.

scholarly journals Factors affecting serum lactate in patients with intracranial tumors – A report of our series and review of the literature

2020 ◽  
Vol 11 ◽  
pp. 39
Author(s):  
Eleonora Ioannoni ◽  
Giuseppe Grande ◽  
Alessandro Olivi ◽  
Massimo Antonelli ◽  
Anselmo Caricato ◽  
...  
Keyword(s):  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Malignant Neoplasm ◽  
Serum Lactate ◽  
Intracranial Tumor ◽  
Intracranial Tumors ◽  
Factors Affecting ◽  
Preoperative Serum ◽  
Postoperative Serum ◽  
Lactate Levels

Background: A hyperlactemia may occur in the presence of tissue hypoperfusion, in diseases affecting metabolism and in cases of malignant neoplasm. However, the factors affecting the serum lactate levels in patients submitted to craniotomy for the resection of an intracranial tumor have been investigated only marginally. Here, we assessed the factors possibly affecting the levels of serum lactate in intracranial tumors and carried out a thorough literature review on this topic. Methods: All patients submitted to elective craniotomy from January 2017 to August 2018 for the resection of a glioblastoma (GBM; 101 cases) and a benign meningioma (WHO I; 105 cases) were included in this study. The sex, age, histological diagnosis, body mass index (BMI), and diabetes were assessed as possible factors affecting the level of the preoperative and postoperative serum lactate in these patients. Results: We found that preoperative hyperlactemia (> 2 mmol/l) was more frequent in patients with GBM than in patients with meningioma (P = 0.0003). Moreover, a strong correlation between a preoperative lactemia and postoperative lactemia (P < 0.0001) was observed. On univariate analysis, we found increased preoperative serum lactate levels in GBM patients (P = 0.0022) and in patients with a BMI ≥30 (P = 0.0068). Postoperative serum lactate levels were significantly higher in GBM patients (P = 0.0003). On multivariate logistic regression analysis, a diagnosis of GBM was an independent factor for higher level of preoperative (P = 0.0005) and postoperative (P < 0.0001) serum lactate. Conclusion: The malignant phenotype of GBM is the strongest factor associated with a pre- and postoperative hyperlactemia in patients submitted to craniotomy for the resection of an intracranial tumor.

Incidence and causes of perioperative mortality after primary surgery for intracranial tumors: a national, population-based study

2012 ◽  
Vol 116 (4) ◽  
pp. 825-834 ◽  
Author(s):  
Ole Solheim ◽  
Asgeir Store Jakola ◽  
Sasha Gulati ◽  
Tom Børge Johannesen
Keyword(s):  
Quality Indicator ◽  
Mortality Rates ◽  
Population Based ◽  
Intracranial Tumor ◽  
Surgical Mortality ◽  
Intracranial Tumors ◽  
Perioperative Mortality ◽  
Term Survival ◽  
Long Term Survival

Object Surgical mortality is a frequent outcome measure in studies of volume-outcome relationships, and the Agency for Healthcare Research and Quality has endorsed surgical mortality after craniotomies as an Inpatient Quality Indicator. Still, the frequency and causes of 30-day mortality after neurosurgical procedures have not been much explored. The authors sought to study the frequency and possible causes of death following primary intracranial tumor operations. They also sought to explore a possible predictive value of perioperative mortality rates from neurosurgical centers in relation to long-term survival. Methods Using population-based data from the Norwegian cancer registry, the authors identified 15,918 primary operations for primary CNS tumors treated in Norway in the period from August 1955 through December 2008. Patients were followed up until death, emigration, or September 2009. Causes of mortality as indicated on death certificates were studied. Factors associated with an increased risk of perioperative death were identified. Results The overall risk of perioperative death after first-time surgery for primary intracranial tumors is currently 2.2% and has decreased over the last decades. An age ≥ 70 years and histopathological entities with poor long-term prognoses are risk factors. Overlapping lesions are also associated with excess risk, indicating that lesion size or multifocality may matter. The overall risk of perioperative death is also higher in biopsy cases than in resection cases. Perioperative mortality rates of the 4 Norwegian neurosurgical centers were not predictive of their respective long-term survival rates. Conclusions Although considered surgically related if they occur within the first 30 days of surgery, most early postoperative deaths can happen independent of the handiwork of the operating surgeon or anesthesiologist. Overall prognosis of the disease seems to be a strong predictor of perioperative death—perhaps not surprisingly since the 30-day mortality rate is merely the intonation of the Kaplan-Meier curve. Both referral and treatment policies at a neurosurgical center will therefore markedly affect such early outcomes, but early deaths may not necessarily reflect overall quality of care or long-term results. The low incidence of perioperative death in intracranial tumor surgery also greatly limits the statistical power in comparative analyses, such as between published patient series or between centers and certainly between surgeons. Therefore the authors question the value of perioperative mortality rates as a quality indicator in modern neurosurgery for tumors.

Intrathecal Morphine Administration Does Not Affect Survival After Liver Resection for Hepatocellular Carcinoma

2019 ◽  
Vol 23 (3) ◽  
pp. 309-318 ◽  
Author(s):  
Natalie K. Smith ◽  
Samuel Demaria ◽  
Daniel Katz ◽  
Parissa Tabrizian ◽  
Myron Schwartz ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Multivariate Analysis ◽  
Tumor Recurrence ◽  
Intrathecal Morphine ◽  
Univariate Analysis ◽  
Matched Pairs ◽  
Morphine Group ◽  
Morphine Administration ◽  
Propensity Matching ◽  
Artery Disease

Introduction. Opioids may influence tumor recurrence and cancer-free survival in hepatocellular carcinoma (HCC). The relationship between intrathecal morphine administration, tumor recurrence, and patient survival after hepatectomy for HCC is unknown. Patients and Methods. This single-center, retrospective study included 1837 liver resections between July 2002 and December 2012; 410 cases were incorporated in the final univariate and multivariate analysis. Confirmatory propensity matching yielded 65 matched pairs (intrathecal morphine vs none). Primary outcomes were recurrence of HCC and survival. Secondary outcomes included characterization of factors associated with recurrence and survival. Results. Groups were similar except for increased coronary artery disease in the no intrathecal morphine group. All patients received volatile anesthesia. Compared with no intrathecal morphine (N = 307), intrathecal morphine (N = 103) was associated with decreased intraoperative intravenous morphine administration (median difference = 12.5 mg; 95% confidence interval [CI] = 5-20 mg). There was no difference in blood loss, transfusion, 3- or 5-year survival, or recurrence in the univariate analysis. Multivariate analysis identified covariates that significantly correlated with 5-year survival: intrathecal morphine (hazard ratio [HR] = 0.527, 95% CI = 0.296-0.939), lesion diameter (HR = 1.099, 95% CI = 1.060-1.141), vascular invasion (HR = 1.658, 95% CI = 1.178-2.334), and satellite lesions (HR = 2.238, 95% CI = 1.447-3.463). Survival analysis on the propensity-matched pairs did not demonstrate a difference in 5-year recurrence or survival. Discussion and Conclusion. Multivariate analysis revealed a significant association between intrathecal morphine and 5-year survival. This association did not persist after propensity matching. The association between intrathecal morphine and HCC recurrence and survival remains unclear and prospective work is necessary to determine whether an association exists.

scholarly journals Factors Related to Long-Term Survival in Patients Affected by Well-Differentiated Endocrine Tumors of the Pancreas

ISRN Surgery ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Riccardo Casadei ◽  
Claudio Ricci ◽  
Paola Tomassetti ◽  
Davide Campana ◽  
Francesco Minni
Keyword(s):  
Multivariate Analysis ◽  
Who Classification ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Endocrine Tumors ◽  
Term Survival ◽  
Long Term Survival ◽  
Pancreatic Endocrine Tumors ◽  
Well Differentiated

Aim. To identify factors related to survival in patients affected by well-differentiated PETs (benign, uncertain behavior, and carcinoma) who underwent R0 pancreatic resection. Methods. Retrospective study of 74 consecutive patients followed up from January 1980 to December 2011. Prognostic factors were sex, age, type of tumor, presence of symptoms, type of surgical procedure, size of tumor, lymph nodes status, WHO classification, and TNM stage. Overall survival was evaluated using the Kaplan-Meier method. Cox regression analyses were used to identify the factors associated with prognosis in univariate and multivariate analysis. Results. The mean follow-up of all the patients was months. The 5–10-year long-term survival was 90.9% and 79.1%, respectively. At univariate analysis, patient age <55 years was significantly related to a better long-term survival compared to patients age ≥55 years ( months versus months; ). Multivariate analysis showed that female gender (), patients without comorbidities (), and patients affected by well-differentiated benign pancreatic endocrine tumors ( and in relation to tumors with uncertain behavior and carcinomas, resp.) were factors significantly related to a better long-term survival. Conclusions. Patients factors were strongly related to a better long-term survival in patients observed. WHO classification is a very useful prognostic tool for well-differentiated PETs.

scholarly journals Prognostic significance of tumor regression in locally advanced rectal cancer after preoperative radiochemotherapy

2017 ◽  
Vol 52 (1) ◽  
pp. 30-35 ◽  
Author(s):  
Mirko Omejc ◽  
Maja Potisek
Keyword(s):  
Rectal Cancer ◽  
Multivariate Analysis ◽  
Tumor Regression ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Preoperative Radiochemotherapy ◽  
Term Survival

AbstractBackgroundThe majority of rectal cancers are discovered in locally advanced forms (UICC stage II, III). Treatment consists of preoperative radiochemotherapy, followed by surgery 6–8 weeks later and finally by postoperative chemotherapy. The aim of this study was to find out if tumor regression affected long-term survival in patients with localy advanced rectal cancer, treated with neoadjuvant radiochemotherapy.Patients and methodsPatients with rectal cancer stage II or III, treated between 2006 and 2010, were included in a retrospective study. Clinical and pathohistologic data were acquired from computer databases and information about survival from Cancer Registry. Survival was estimated according to Kaplan-Meier method. Significance of prognostic factors was evaluated in univariate analysis; comparison was carried out with log-rank test. The multivariate analysis was performed according to the Cox regression model; statistically significant variables from univariate analysis were included.ResultsTwo hundred and two patients met inclusion criteria. Median follow-up was 53.2 months. Stage ypT0N0 (pathologic complete response, pCR) was observed in 14.8% of patients. Pathohistologic stage had statistically significant impact on survival (p = 0.001). 5-year survival in patients with pCR was>90%. Postoperative T and N status were also found to be statistically significant (p = 0.011 for ypT and p < 0.001 for ypN). According to multivariate analysis, tumor response to neoadjuvant therapy was the only independent prognostic factor (p = 0.003).ConclusionsPathologic response of tumor to preoperative radiochemotherapy is an important prognostic factor for prediction of long-term survival of patients with locally advanced rectal cancer.

scholarly journals The influence of racial disparity on oncologic outcomes for patients with penile cancer: a SEER population-based study

2020 ◽  
Author(s):  
Xiaohong Su ◽  
Kaihui Wu ◽  
Shuo Wang ◽  
Bingkun Li ◽  
Chuanyin Li ◽  
...  
Keyword(s):  
United States ◽  
Multivariate Analysis ◽  
Racial Differences ◽  
Racial Disparity ◽  
Penile Cancer ◽  
Univariate Analysis ◽  
The United States ◽  
Term Survival ◽  
Race Ethnicity ◽  
Hispanic White

Abstract Purpose: Penile cancer (PC) is an uncommon malignancy in the urinary system of males. The present study aims to compare survival outcomes of PC patients among racial/ethnic groups in the United States. Methods and materials: Patients with PC were identified in the Surveillance, Epidemiology, and End Results (SEER) registries from 2004 to 2015. The SEER database represents 28% of the U.S. population. Race/ethnicity was categorized as non-hispanic white (NHW), hispanic white (HW), black, Asian/Pacific Islander (A/PI), or American Indian/Alaskan native (AI/AN). Kaplan-Meier method with the log-rank test was used to assess cancer-specific survival (CSS) and overall survival (OS). Multivariate analysis was conducted using Cox’s proportional hazard model. Results: A total of 3955 patients with PC were included. There were significant differences in age, marital status, tumor location, histology, grade, lymphadenectomy, and radiotherapy according to race/ethnicity. Univariate analysis revealed that A/PIs were significantly associated with better CSS (p= 0.005) and OS (p= 0.025) for most subtypes. The 5-year CSS rates for NHWs, HWs, blacks, A/PIs and AI/ANs were 79.4%, 74.2%, 75.9%, 87.1%, and 78.9%, respectively. The 5-year OS rates for NHWs, HWs, blacks, A/PIs and AI/ANs were 63.4%, 64.1%, 60.5%, 73.0%, and 70.9%, respectively. After adjusting for other factors, racial disparity was an independent risk factor for CSS and OS in the multivariate analysis (p=0.010 and p=0.017, respectively). Conclusions: Our results suggested that racial differences existed among PC patients in the United States with respect to patient clinicopathological features and survival. Long-term survival disparities were evident in PC patients, that the survival of NHWs, HWs, and blacks was worse than that of A/PIs.

P1844Blood erythropoietin independently predicts mid-term survival after post-procedural recovery from transcatheter aortic valve replacement in aortic stenosis: a prospective study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Mas-Peiro ◽  
P C Seppelt ◽  
J Yogarajah ◽  
T Walther ◽  
P Meybohm ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Iron Deficiency ◽  
Aortic Stenosis ◽  
Predictive Value ◽  
Independent Predictor ◽  
Univariate Analysis ◽  
Term Survival ◽  
Cox Regression Analysis ◽  
Kaplan Meier

Abstract Background Erythropoietin (EPO) is an independent predictor for survival in chronic heart failure, myocardial infarction and other cardiac disorders. In a prospective observational study, independent prognostic value of EPO levels in patients with symptomatic aortic stenosis undergoing TAVR was investigated. Methods All consecutive patients undergoing TAVR in a high-volume centre in a 19-month period were included. A 1-year follow-up was completed. Patients with eGRF <30 mL/min/1.73m2 were excluded. WHO guidelines were used to define anaemia (Hb <12mg/dl for women, <13mg/dl for men). Chronic kidney disease (CKD) stages were used to classify eGFR: CKD 1 (>90), 2 (60–90), 3a (45–59), 3b (30–44). Pre-procedural anaemia status, EPO levels and iron deficiency were compared in 1-year survivors vs. non-survivors. Log-EPO levels were used for a univariate Cox regression analysis of 1-year mortality. Baseline variables considered to be clinically relevant or found significant in univariate analysis were included in multivariate analysis. Kaplan-Meier curves were constructed for patients in each EPO quartile. Results 185 patients with complete data were included in analyses. Mean age was 81.8 years, 58.4% were male, and 72.4% had NYHA III/IV. Baseline anaemia was present in 51.4% and iron deficiency in 49.2%. Median ferritin was 149.5 (16–1995) μg/L, mean transferrin saturation index was 150±46.7% and median EPO was 13.8 (2.7–231.6) mU/mL. Thirty-day and 1-year mortality were 3.8%, and 18.9%. Baseline anaemia was significantly associated to 1-year mortality: 29.5% vs 7.8%, p=0.001. Iron deficiency had no impact on mortality (18.1% vs 19.8%, p=ns). At 1 year, pre-procedural EPO levels in non-survivors were significantly higher than in survivors: median 20.30 (6.1–231.6) vs 12.9 (2.7–136) mU/mL; p=0.001. Higher log-EPO levels predicted 1-year mortality in univariate analysis (HR 6.1, 95% CI 2.5–14.9, p=0.0001). Other significant univariate predictors were pre-procedural anaemia (HR 4.2, 95% CI 1.8–9.7, p=0.001), eGFR, EuroSCORE II, body mass index, and previous atrial fibrillation. A multivariate analysis of EPO after adjusting for such factors was also significant (HR 3.1, 95% CI 1.06–8.9, p=0.039). Kaplan-Meier analyses showed early diverging curves for anaemia vs non-anaemia, whereas the curves for patients in various EPO level quartiles started to diverge at about 100 days after the intervention, with differences consistently increasing during the whole follow-up period. Curve slopes were increasingly higher in successively higher quartiles (figure). 1-year Kaplan-Meier for EPO and anemia Conclusion Differently from anaemia, a strong predictor for both early and late mortality after TAVR, high pre-procedural EPO levels were an independent predictor for mid-term mortality, with its predictive value only emerging after post-procedural recovery was completed. EPO predictive value was independent from anaemia or renal dysfunction.

Sign in / Sign up

Export Citation Format

Share Document