Radical Versus Non-Radical Resection for Early-Stage Retroperitoneal Sarcoma: A Propensity Score-Matched Analysis

BackgroundThe appropriate surgical procedure for early-stage retroperitoneal sarcoma (RPS) is unclear. Thus, we used a national database to compare the outcomes of radical and non-radical resection in patients with early stage RPS.MethodsThis retrospective study included 886 stage I RPS patients from 2004 to 2015 in the SEER database. Outcomes were compared using the multivariate Cox proportional hazards models and the results were presented as adjusted hazards ratio (AHR) with corresponding 95% confidence intervals (95%CIs). Propensity score-matched analyses were also performed for sensitive analyses.ResultsFor the 886 stage I RPS patients, 316 underwent radical resection, and 570 underwent non-radical resection, with a median follow-up of 4.58 (2.73-8.35) years. No difference was observed in overall mortality (AHR 0.84, 95%CI 0.62-1.15; P = 0.28) or RPS-specific mortality (AHR 0.88, 95%CI 0.57-1.36; P = 0.56) between groups. The results were similar in propensity score-matching analyses. However, subgroup analysis revealed that radical resection was associated with significantly decreased risks of overall mortality in male (AHR 0.61, 95%CI 0.38-0.98; P = 0.04) and in patients with radiotherapy (AHR 0.56, 95%CI 0.32-0.98; P = 0.04).ConclusionRadical resection did not improve midterm survival outcomes compared with non-radical resection in overall patients with early stage RPS. However, male patients or patients who received radiotherapy might benefit from radical resection with improved overall survival.

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The impact of palliative resection (PR) of the primary tumor on overall survival (OS) in metastatic colorectal cancer (mCRC).

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.4_suppl.509 ◽

2013 ◽

Vol 31 (4_suppl) ◽

pp. 509-509

Author(s):

Gillian Gresham ◽

Daniel John Renouf ◽

Matthew Chan ◽

Winson Y. Cheung

Keyword(s):

Propensity Score ◽

Primary Tumor ◽

Proportional Hazards ◽

Early Stage ◽

Significant Proportion ◽

Population Based ◽

Cox Proportional Hazards ◽

Entire Cohort ◽

Cox Proportional Hazards Models ◽

The Impact

509 Background: The role of PR of the primary tumor in mCRC remains unclear. Using population-based data, we explored the impact of PR on OS. Methods: Patients (pts) with mCRC who were referred to 1 of 5 regional cancer centers in British Columbia between 2006 and 2008 were reviewed (n=802). Pts with prior early stage CRC who relapsed with mCRC were excluded (n=285). We conducted survival analysis using Kaplan Meier methods and determined adjusted hazard ratios (HR) for death using Cox proportional hazards models. A secondary propensity score matched analysis was performed to control for baseline differences between pts who underwent PR and those who did not. Results: A total of 517 pts with mCRC were identified: median age was 63 years (range 23-93), 54% were men, 55% had ECOG 0-1, 76% had a colon primary, and 31% had >1 metastatic site. The majority (n=378; 73%) underwent PR of the primary tumor and a significant proportion (n=327; 63%) received palliative chemotherapy (CT). Compared to pts without PR, those with PR were more likely to be men (62 vs 51%, p=0.03), aged <65 years (63 vs 52%, p=0.03), ECOG 0-1 (61 vs 38%, p<0.0001), and receive palliative CT (68 vs 50%, p=0.0004). PR was associated with improved median OS across groups (Table). The benefit of PR on prognosis persisted in multivariate analysis (HR for death 0.56, 95%CI 0.43-0.72, p<0.0001 for entire cohort; HR 0.51, 95%CI 0.37-0.70, p<0.0001 for individuals who were treated with CT; and HR 0.54, 95%CI 0.34-0.84, p=0.007 for those who did not receive CT). In a propensity score matched analysis that considered age, gender, ECOG, and receipt of palliative CT, prognosis continued to be more favorable in the PR group (HR 0.66, 95% CI 0.50-0.86, p=0.0019). Conclusions: In this population-based analysis, PR of the primary tumor in mCRC was associated with a significant OS benefit. [Table: see text]

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A Motion of No Confidence: Leadership and Rebel Fragmentation

Journal of Global Security Studies ◽

10.1093/jogss/ogz060 ◽

2020 ◽

Vol 5 (4) ◽

pp. 598-616 ◽

Cited By ~ 3

Author(s):

Austin C Doctor

Keyword(s):

Civil War ◽

Proportional Hazards ◽

Original Data ◽

Cox Proportional Hazards ◽

Stage I ◽

Logistic Regression Models ◽

Structure And Agency ◽

Rebel Groups ◽

Cox Proportional Hazards Models ◽

War Experiences

Abstract Why do rebel organizations splinter into competing factions during civil war? To explain this outcome, I leverage variation in rebel leadership. I argue that rebel leaders draw on their pre-war experiences—i.e., their military and political experiences—to manage their organizations during conflict. These experiences bear unique patterns of rebel management and, thus, corresponding risks of fragmentation. Empirical evidence comes from a two-stage research design and original data featuring over 200 rebel leaders from 1989 to 2014. In the first stage, I estimate the probability of group fragmentation with a series of logistic regression models. In the second stage, I use Cox proportional-hazards models to estimate leadership effects on the rate of group fragmentation. Results indicate that variation in rebel leadership corresponds with unique risks of fragmentation. In particular, the results suggest that leaders with real military experience are best equipped to maintain group cohesion. This study offers insight into the processes by which rebel groups splinter into armed factions. In addition, it makes an important contribution to the broader discussion on the roles of structure and agency in shaping the dynamics of civil war.

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Abstract 2791: Silent Brain Infarction Predicts Cardiovascular Events And Mortality In Long-term Hemodialysis Patients

Circulation ◽

10.1161/circ.116.suppl_16.ii_620 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Toru Aoyama ◽

Hideki Ishii ◽

Hiroshi Takahashi ◽

Takanobu Toriyama ◽

Toru Aoyama ◽

...

Keyword(s):

Proportional Hazards ◽

Brain Infarction ◽

Cox Proportional Hazards ◽

Powerful Predictor ◽

Cardiac Events ◽

Cox Proportional Hazards Models ◽

Silent Brain Infarction ◽

Cv Disease ◽

Overall Mortality

Background: The cardiovascular (CV) events and mortality are significantly higher in hemodialysis (HD) patents compared to the general population. Although it is of clinical concern to predict the occurrence of CV events in long-term HD patients, more powerful predictor has under exploration. We investigated as to whether silent brain infarction (SBI) would be a predictable factor for future CV events and mortality in a large cohort of patients with long-term HD patients. Methods: After cranial magnetic resonance imaging to detect SBI, 202 long-term HD patients (7.1 ± 5.9 years) without symptomatic stroke were prospectively followed up until the incident of CV events (stroke, cardiac events, and death). We analyzed the prognostic role of SBI in CV events with the Kaplan-Meier method and Cox proportional hazards analysis. Results: The prevalence of SBI was quite higher compared to the previous reports (71.8% in all the patients). In overall patients, 60 patients suffered from CV disease (31 for coronary artery disease, 7 for congestive heart failure, 14 for symptomatic stroke) and 29 patients died (16 for CV death) during a follow up period (mean= 23 ± 13 months). In subgroup analysis regarding the presence of SBI, CV event-free survival rate for 4 years was significantly lower in the patients with SBI compared to those without SBI (54.6% vs. 86.7%, p=0.0003). CV and overall mortality were also significantly higher in SBI patients compared with No-SBI patients (CV mortality; 20.5 % vs. 4.3 %, overall mortality; 29.0% vs. 9.1% p< 0.01, respectively). Cox proportional hazards models showed that the presence of SBI was a significant predictor of cerebrovascular and CV events and CV and overall mortality even after adjustment for other CV risk factors listed on the Table . Conclusion: SBI detected with MRI would be powerful predictor of CV events and mortality in long-term HD patients. Hazard ratio (HR) of SBI for future events and mortality

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Comparing Retreatments and Expenditures in Flow Diversion Versus Coiling for Unruptured Intracranial Aneurysm Treatment: A Retrospective Cohort Study Using a Real-World National Database

Neurosurgery ◽

10.1093/neuros/nyz377 ◽

2019 ◽

Vol 87 (1) ◽

pp. 63-70

Author(s):

Haruhisa Fukuda ◽

Daisuke Sato ◽

Yoriko Kato ◽

Wataro Tsuruta ◽

Masahiro Katsumata ◽

...

Keyword(s):

Linear Models ◽

Proportional Hazards ◽

National Level ◽

Cox Proportional Hazards ◽

National Database ◽

Healthcare Expenditures ◽

Cox Proportional Hazards Models ◽

Hazard Ratios ◽

Unruptured Intracranial Aneurysms ◽

Economic Perspectives

Abstract BACKGROUND Flow diverters (FDs) have marked the beginning of innovations in the endovascular treatment of large unruptured intracranial aneurysms, but no multi-institutional studies have been conducted on these devices from both the clinical and economic perspectives. OBJECTIVE To compare retreatment rates and healthcare expenditures between FDs and conventional coiling-based treatments in all eligible cases in Japan. METHODS We identified patients who had undergone endovascular treatments during the study period (October 2015-March 2018) from a national-level claims database. The outcome measures were retreatment rates and 1-yr total healthcare expenditures, which were compared among patients who had undergone FD, coiling, and stent-assisted coiling (SAC) treatments. The coiling and SAC groups were further categorized according to the number of coils used. Retreatment rates were analyzed using Cox proportional hazards models, and total expenditures were analyzed using multilevel mixed-effects generalized linear models. RESULTS The study sample comprised 512 FD patients, 1499 coiling patients, and 711 SAC patients. The coiling groups with ≥10 coils and ≥9 coils had significantly higher retreatment rates than the FD group with hazard ratios of 2.75 (1.30-5.82) and 2.52 (1.24-5.09), respectively. In addition, the coiling group with ≥10 coils and SAC group with ≥10 coils had significantly higher 1-year expenditures than the FD group with cost ratios (95% CI) of 1.30 (1.13-1.49) and 1.31 (1.15-1.50), respectively. CONCLUSION In this national-level study, FDs demonstrated significantly lower retreatment rates and total expenditures than conventional coiling with ≥ 9 coils.

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Effects of metformin and sulfonylureas on overall and colorectal cancer-specific mortality.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.2599 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 2599-2599

Author(s):

Susan Spillane ◽

Kathleen Bennett ◽

Linda Sharp ◽

Thomas Ian Barron

Keyword(s):

Colorectal Cancer ◽

Colon Cancer ◽

Proportional Hazards ◽

Early Stage ◽

Population Based ◽

Cox Proportional Hazards ◽

Stage I ◽

Early Stage Disease ◽

All Cause Mortality ◽

Specific Mortality

2599 Background: Preclinical studies have suggested a role for metformin in the treatment of colorectal cancer (CRC). Associations between metformin versus sulfonylurea exposure and mortality (all-cause and colorectal cancer specific) are assessed in this population-based study of patients with a diagnosis of stage I-IV CRC. Methods: National Cancer Registry Ireland records were linked to prescription claims data and used to identify a cohort of patients with incident TNM stage I-IV CRC diagnosed 2001-2006. From this cohort, 2 patient groups were identified and compared for outcomes - those who received a prescription for metformin +/- a sulfonylurea (MET) or a prescription for sulfonylurea alone (SUL) in the 90 days pre CRC diagnosis. Adjusted hazard ratios (HR) with 95% confidence intervals (CI) were estimated using Cox proportional hazards models adjusted for age, sex, stage, grade, site, comorbidities, year of diagnosis, and insulin, aspirin or statin exposure. Analyses were repeated stratifying by stage and site. Results: 5,617 patients with stage I-IV CRC were identified, of whom 369 received a prescription for metformin or a sulfonylurea in the 90 days pre diagnosis (median follow-up 1.6 years; MET: n=257; SUL: n=112). In adjusted analyses metformin exposure was associated with a 28% lower risk of all-cause mortality relative to sulfonylurea exposure (HR 0.72, 95% CI 0.53-0.98) and a non-significant 24% reduction in CRC-specific mortality (HR 0.76, 95% CI 0.52-1.13). In analyses stratified by site, in colon cancer, metformin exposure was associated with a significant one-third reduction in all-cause mortality (HR 0.66, 95% CI 0.46-0.95) and a non-significant reduction in site-specific mortality (HR 0.64, 95% CI 0.40-1.02). No mortality benefit was observed for rectal cancer. The association between metformin exposure and reduced mortality was strongest for stage I/II disease (all-cause mortality: HR 0.56, 95% CI 0.32-0.98; CRC-specific mortality: HR 0.48, 95% CI 0.21-1.11). Conclusions: Pre-diagnosis metformin exposure in CRC patients was associated with a significant reduction in mortality relative to sulfonylurea exposure. This benefit was greatest in patients with colon cancer and early stage disease.

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Comparative analysis of treatments, utilization, and survival benefit in HCC patients: A real-world analysis of SEER Medicare.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.214 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 214-214

Author(s):

Fadia T. Shaya ◽

Ian Michael Breunig ◽

C. Daniel Mullins ◽

Naimish B. Pandya ◽

Viktor Chirikov ◽

...

Keyword(s):

Radiation Therapy ◽

Health Status ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

External Beam Radiation ◽

Beam Radiation ◽

Cox Proportional Hazards Models ◽

Severe Liver Dysfunction ◽

Related Mortality ◽

Overall Mortality

214 Background: We explore various treatments at all stages of Hepatocellular Carcinoma (HCC), in a SEER (Surveillance, Epidemiology and End-Results Program) Medicare population and assess their impact on HCC-specific and overall survival. Methods: Medicare enrollees, older than 65, with an initial diagnosis of a primary HCC between 2000-07 were followed up through end of 2009. Data are from the SEER and linked Medicare databases, with claims generated from Medicare parts A and B. Using multivariate Cox-proportional hazards models, we assessed overall and HCC-related mortality in relation to receipt of treatment/no treatment, adjusting for demographics, general health status (CCI), cancer stage and liver conditions. Results: Out of the 9054 HCC patients, older than 65, who did not get a liver transplant, 76% were Caucasian, 8% African American (AA), 63% male, and 37% got treatment [12% transarterial chemoembolization (TACE), 12% systemic chemotherapy, 1.5% selective internal radiation therapy (SIRT), 9% external beam radiation therapy (EBRT), 8% surgical resection and 9% ablative therapy]. Treatment was associated with a reduction of overall (HR=0.35, P= <0.001) and HCC-related (0.33, <0.001) mortality. HCC-related mortality was significantly reduced in those getting resection (0.38, <0.001), ablation (0.59, <0.001), TACE (0.76, <0.001), EBRT (0.85, 0.017), or chemotherapy (0.85, 0.013). Significant reduction in overall mortality was seen with resection, ablation and TACE but not with chemotherapy, EBRT or SIRT. No particular treatment was associated with greater mortality reduction in early vs advanced stages. Patients with poor underlying health status (CCI>1) had higher mortality (1.27, <0.001). Alcohol related disease, Hep C, and moderate/severe liver dysfunction were not significantly associated with overall or HCC related mortality. Caucasians and non-African Americans had lower overall mortality (0.87, <0.001). Conclusions: In HCC SEER Medicare patients, all treatments except SIRT were associated with a significant reduction in HCC related mortality. A limitation of this study is that, through the data, we cannot accurately depict the severity of the disease.

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Circulating tumor cell status and benefit of radiotherapy in stage I breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.11524 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 11524-11524

Author(s):

Chelain Rae Goodman ◽

Brandon-Luke L Seagle ◽

Eric Donald Donnelly ◽

Jonathan Blake Strauss ◽

Shohreh Shahabi

Keyword(s):

Breast Cancer ◽

Tumor Cell ◽

Proportional Hazards ◽

Early Stage ◽

Cohort Analysis ◽

Metastatic Breast ◽

Circulating Tumor Cell ◽

Cox Proportional Hazards ◽

Stage I ◽

Matched Cohort

11524 Background: Circulating tumor cell (CTC) status has been shown to be prognostic of decreased survival in non-metastatic breast cancer. While up to 20-30% of patients with early breast cancer have detectable CTCs, less is known regarding the role of CTC-status in guiding clinical management. Methods: An observational cohort study was performed on women with stage I breast cancer evaluated for CTCs from the 2004-2014 National Cancer Database. Logistic regression was used to explore clinicopathological associations with CTC-status. Kaplan-Meier and multivariable Cox proportional-hazards survival analyses were used to estimate associations of CTC-status with overall survival using a propensity score-adjusted and inverse probability-weighted matched cohort. Results: Of the stage I breast cancer women evaluated for CTCs, 23.1% (325/1,407) were CTC-positive. Age, histology, receptor status, and nodal stage were associated with CTC-status. CTC-status was an effect modifier of the radiotherapy-survival association: CTC-positive women who did not receive radiotherapy had an increased hazard of death compared to CTC-negative women who also did not receive radiotherapy (four-year survival: 85.7% vs. 93.3%, HR = 2.92, CI = 1.43-5.98, P = 0.003). CTC-positive patients treated with radiotherapy did not have decreased survival compared to CTC-negative patients not treated with radiotherapy (HR = 0.67, CI = 0.28-1.65, P = 0.40). From the matched cohort analysis, CTC-positive women who did not receive radiation had a 4.82-fold increased hazard of death compared to CTC-positive women treated with radiotherapy (four-year survival: 83.2% vs. 96.6%; CI = 2.62-8.85, P < 0.001). Conclusions: Treatment with adjuvant radiotherapy was associated with improved survival in CTC-positive women with stage I breast cancer. If prospectively validated, CTC-status may be valuable as a predictor of benefit of radiotherapy in early stage breast cancer.

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The Association between Homocysteinemia and Mortality in Pre-dialysis CKD patients: A Propensity-Score Matched Analysis Using NHANES-National Death Index Link

10.21203/rs.3.rs-948936/v1 ◽

2021 ◽

Author(s):

Je Hun Song ◽

Hyuk Huh ◽

Eunjin Bae ◽

Jeonghwan Lee ◽

Jung Pyo Lee ◽

...

Keyword(s):

Risk Factor ◽

Propensity Score ◽

Proportional Hazards ◽

Cox Regression ◽

Cox Proportional Hazards ◽

Mortality Data ◽

Protein Energy Wasting ◽

Cox Regression Analysis ◽

Cox Proportional Hazards Models ◽

All Cause Mortality

Abstract Background: Hyperhomocysteinemia (HHcy) is considered a risk factor for cardiovascular disease (CVD) including chronic kidney disease (CKD). In this study, we investigated the association between serum homocysteine (Hcy) level and mortality according to the presence of CKD.Methods: Our study included data of 9,895 participants from the 1996–2016 National Health and Nutrition Examination Surveys (NHANES). Moreover, linked mortality data were included and classified into four groups according to the Hcy level. Multivariable-adjusted Cox proportional hazards models using propensity-score were used to examine dose-response associations between Hcy level and mortality.Results: Of 9,895 participants, 1032 (21.2%) participants were diagnosed with CKD. In a multivariate Cox regression analysis including all participants, Hcy level was associated with all-cause mortality, compared with the 1st quartile in Model 3 (2nd quartile: hazard ratio (HR) 1.751, 95% confidence interval (CI) 1.348-2.274, p<0.001; 3rd quartile: HR 2.220, 95% CI 1.726-2.855, p<0.001; 4th quartile: HR 3.776, 95% CI 2.952-4.830, p<0.001). In the non-CKD group, there was a significant association with all-cause mortality; however, this finding was not observed in the CKD group. The observed pattern was similar after propensity score matching. In the non-CKD group, overall mortality increased in proportion to Hcy concentration (2nd quartile: HR 2.195, 95% CI 1.299-3.709, p = 0.003; 3rd quartile: HR 2.607, 95% CI 1.570-4.332, p<0.001; 4th quartile: HR 3.720, 95% CI 2.254-6.139, p<0.001). However, the risk of all-cause mortality according to the quartile of Hcy level did not increase in the CKD groupConclusion: This study found a correlation between the Hcy level and mortality rate only in the non-CKD group. This altered risk factor patterns may be attributed to protein-energy wasting or chronic inflammation status that is accompanied by CKD.

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Waist Circumference and Mortality or Cardiovascular Events in a General Korean Population

10.21203/rs.3.rs-926930/v1 ◽

2021 ◽

Author(s):

Do Kyeong Song ◽

Young Sun Hong ◽

Yeon-Ah Sung ◽

Hyejin Lee

Keyword(s):

Waist Circumference ◽

National Health ◽

Proportional Hazards ◽

Positive Association ◽

Cox Proportional Hazards ◽

Korean Population ◽

Health Examination ◽

Men And Women ◽

Cox Proportional Hazards Models ◽

Overall Mortality

Abstract Obesity is associated with cardiovascular diseases (CVD). However, body mass index (BMI) has a limited ability to measure abdominal obesity. We aimed to evaluate the associations between waist circumference (WC) and mortality or CVD incidence in a general Korean population. We analyzed a total of 204,068 adults older than 40 years of age who had undergone a national health examination in the Korean National Health Insurance Service Cohort. Hazard ratios for death and CVD incidence were calculated using Cox proportional hazards models after adjustment for age, smoking, alcohol consumption status, levels of physical activity, total cholesterol, hypertension, and diabetes mellitus status. In men, WC and overall mortality showed a reverse J-shaped association. For both men and women, WC was not associated with risk of cardiovascular mortality. Contrary to mortality trend, CVD incidence was positively associated with WC in both men and women, and risk of the CVD incidence was the lowest in subjects with a WC < 80 cm. WC exhibited a significant J-shaped association with overall mortality in men. The risk of incident CVD showed a positive association with central obesity, where the lowest risk was observed for subjects in the lowest WC group in a general Korean population.

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Impact of clinical and pathological variables on stage I non-small cell lung cancer outcomes.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e21071 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e21071-e21071

Author(s):

Matthew C Lee ◽

Dimitre C Stefanov ◽

Mallorie B Angert ◽

Erica C Cohn ◽

Nina Kohn ◽

...

Keyword(s):

Proportional Hazards ◽

Cox Regression ◽

Neuroendocrine Differentiation ◽

Clinical Importance ◽

Recurrence Risk ◽

Cox Proportional Hazards ◽

Stage I ◽

Rank Test ◽

Histological Features ◽

Cox Proportional Hazards Models

e21071 Background: Stage I patients (pts) have 5-year survival ranging 50-75% suggesting heterogeneity within. While American Joint Committee on Cancer 8th edition upstages tumors with visceral pleural invasion (VPI) to IB, other histological features namely lymphovascular invasion (LVI), micropapillary pattern (MIP), spread through airspace (STAS) & neuroendocrine differentiation (NE) may also affect prognosis. This retrospective single institution study evaluated influence of these factors along with pt variables age, gender, smoking, Charleston comorbidity index (CCI) & chemotherapy (CT) on recurrence & mortality. Methods: 351 resected stage I cases from 2015-2019 were included. Data was summarized as means (standard deviation/SD) or percentages. Association between variables & outcomes (measured from diagnosis till event or last visit if no event) were investigated using Univariate & Multiple Cox proportional hazards models. Survival curves were compared using the Log-Rank test when the assumption for the proportional hazards was not satisfied. All predictors were included in the multiple Cox regression models based on their clinical importance. P < 0.05 was considered statistically significant. SAS 9.4 (SAS Institute, Cary, NC) was used for the analysis. Results: Mean age was 69.62 years (9.83). Majority were female (57.3%), smokers (76.9%), & had adenocarcinoma (AC) (78.6%). 39% had COPD & mean CCI was 6.3 (1.74). 193 (55%) pts had lobectomy or larger procedure while 158 (45%) had sub-lobar resection. 45 (12.8%) pts received CT. Recurrence & death occurred in 33 (9.4%) & 15 (4.3%) pts respectively. Univariate models indicated higher recurrence risk with NE (HR = 4.18 95% CI 1.47-11.9, p = 0.0075), LVI (HR = 2.68, 95% CI 1.03-6.94, p = 0.0423), COPD (HR = 3.28 95% CI 1.56-6.9, p = 0.0017), age (HR = 1.05 95% CI 1.01-1.09, p = 0.0212), & CCI (HR = 1.57 95% CI 1.35-1.83, p < .0001). CT was also associated with increased recurrence risk (HR = 8.61, 95% CI 4.28-17.33, p < .0001). Multivariable model for recurrence retained significance for CT & CCI. Age (HR = 1.07 95% CI 1.01-1.14, p = 0.0312), CCI (HR = 1.27 95 % CI 1.02-1.59, p = 0.0347) were associated with mortality in univariate models. Multivariate analysis for mortality wasn’t feasible due to few events. Conclusions: Histological features other than VPI may be associated with recurrence. Pts who received CT had increased recurrence but they possibly had multiple risk factors or other adverse features not assessed here. Limitations included retrospective nature, limited sample size & small number of events.

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