scholarly journals Does Hemoperfusion Increase Survival in Acute Paraquat Poisoning? A Retrospective Multicenter Study

Toxics ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 84
Author(s):  
Ying-Tse Yeh ◽  
Chun-Kuei Chen ◽  
Chih-Chuan Lin ◽  
Chia-Ming Chang ◽  
Kai-Ping Lan ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Retrospective Study ◽  
Confidence Interval ◽  
Cox Regression ◽  
Severity Index ◽  
Cox Regression Analysis ◽  
Medical Centers ◽  
Paraquat Poisoning ◽  
Significant Difference ◽  
Retrospective Multicenter Study

The efficacy of hemoperfusion (HP) in patients with acute paraquat poisoning (PQ) remains controversial. We conducted a multi-center retrospective study to include acute PQ-poisoned patients admitted to two tertiary medical centers between 2005 and 2015. We used the Severity Index of Paraquat Poisoning (SIPP) to stratify the severity of PQ-poisoned patients. The indication to start HP was a positive result for the semiquantitative urine PQ test and presentation to the hospital was within 24 h. Early HP was defined as the first session of HP performed within five hours of PQ ingestion. A total of 213 patients (100 HP group, 113 non-HP group) were eligible for the study. The overall 60-day mortality of poisoned patients was 75.6% (161/213). Multivariate Cox regression analysis showed no statistically significant difference in 60-day survival between HP and non-HP groups (95% confidence interval (CI): 0.84–1.63, p = 0.363). Further subgroup analysis in the HP group showed early HP (95% CI: 0.54–1.69, p = 0.880), and multiple secessions of HP (95% CI: 0.56–1.07, p = 0.124) were not significantly related to better survival. Among acute PQ-poisoned patients, this study found that HP was not associated with increased 60-day survival. Furthermore, neither early HP nor multiple secessions of HP were associated with survival.

scholarly journals The prognostic and diagnostic significance of the neutrophil-to-lymphocyte ratio in hepatocellular carcinoma: a prospective controlled study

2021 ◽  
Author(s):  
Philip J. Johnson ◽  
Sofi Dhanaraj ◽  
Sarah Berhane ◽  
Laura Bonnett ◽  
Yuk Ting Ma
Keyword(s):  
Hepatocellular Carcinoma ◽  
Regression Analysis ◽  
Prognostic Factor ◽  
Cox Regression ◽  
Prognostic Models ◽  
Controlled Study ◽  
Cox Regression Analysis ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Significant Difference

Abstract Background The neutrophil–lymphocyte ratio (NLR), a presumed measure of the balance between neutrophil-associated pro-tumour inflammation and lymphocyte-dependent antitumour immune function, has been suggested as a prognostic factor for several cancers, including hepatocellular carcinoma (HCC). Methods In this study, a prospectively accrued cohort of 781 patients (493 HCC and 288 chronic liver disease (CLD) without HCC) were followed-up for more than 6 years. NLR levels between HCC and CLD patients were compared, and the effect of baseline NLR on overall survival amongst HCC patients was assessed via multivariable Cox regression analysis. Results On entry into the study (‘baseline’), there was no clinically significant difference in the NLR values between CLD and HCC patients. Amongst HCC patients, NLR levels closest to last visit/death were significantly higher compared to baseline. Multivariable Cox regression analysis showed that NLR was an independent prognostic factor, even after adjustment for the HCC stage. Conclusion NLR is a significant independent factor influencing survival in HCC patients, hence offering an additional dimension in prognostic models.

National trends in local excision and esophagectomy for cT1N0 esophageal cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 62-62 ◽  
Author(s):  
Emily C. Sturm ◽  
Whitney Zahnd ◽  
John D. Mellinger ◽  
Sabha Ganai
Keyword(s):  
Esophageal Cancer ◽  
Regression Analysis ◽  
Local Excision ◽  
Clinical Characteristics ◽  
Cox Regression ◽  
Chi Square ◽  
Cox Regression Analysis ◽  
Significant Difference ◽  
Chi Square Analysis ◽  
Over Time

62 Background: Esophageal cancer management has evolved due to improvements in staging and treatment strategies. Endoscopic local excision presents an attractive option for definitive management of T1 cancers, avoiding the morbidity of esophagectomy. We hypothesized that for cT1N0 cancers, patients who underwent local excision would have lower survival compared to esophagectomy due to potential discordant staging. Methods: The National Cancer Database was queried for esophageal squamous cell carcinoma (SCC) and adenocarcinoma (AC) with AJCC T1N0 clinical stage who underwent local excision (n = 1625) or esophagectomy (n = 3255) between 1998 and 2012. Chi-square analysis was used to compare demographic and clinical characteristics by procedure. Chi-square trend analysis was performed to assess trends in procedure type over time. Cox Regression analysis was performed to assess survival by procedure controlling for demographic and clinical characteristics. Results: Between 1998 and 2012, the proportion of patients who underwent local excision increased from 12% to 50% for all patients (p < 0.001); from 17% to 40% for SCC patients (p < 0.001); and from 9% to 51% for AC patients (p < 0.001). Surgical procedure varied significantly by demographic, socioeconomic status, facility, and tumor-related factors. 65% of cT1N0 cancers had concordant clinical and pathological staging after esophagectomy, with 11% having positive nodal disease; 44% were concordant after local excision. While no significant difference was seen in unadjusted survival, adjusted Cox Regression analysis indicated worse survival after esophagectomy compared to local excision for all cases (HR 1.67; 95% CI, 1.40-2.00) and for ACs with concordant staging (HR 1.54; 95% CI, 1.11-2.14). Conclusions: Local excision for cT1N0 esophageal cancer has increased over time. Staging concordance for esophagectomy is seen in two-thirds of cases. Contrary to our hypothesis, patients undergoing local excision for T1N0 cancers have better overall survival than those undergoing esophagectomy, which may reflect early differences in mortality and/or selection bias. As this study was unable to distinguish T1a from T1b, further analysis is warranted.

Evolution of clinical outcomes of metastatic pancreatic adenocarcinoma: A 10-year single-institution retrospective study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16760-e16760
Author(s):  
Moataz Ellithi ◽  
Mohamed A. Abdallah ◽  
Mahum Shahid ◽  
Isaak Ailts ◽  
Kate Waligoske ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Clinical Outcomes ◽  
Pancreatic Adenocarcinoma ◽  
Cox Regression ◽  
The United States ◽  
Wilcoxon Test ◽  
Cox Regression Analysis ◽  
Metastatic Pancreatic Adenocarcinoma ◽  
Significant Difference ◽  
Before And After

e16760 Background: Pancreatic adenocarcinoma represents the fourth leading cause of cancer-related death in the United States. A majority of patients have locally advanced or metastatic disease at the time of diagnosis. For many years, gemcitabine monotherapy was the standard of care for advanced disease, until recent studies demonstrated survival benefits for FOLFIRINOX (5-FU, leucovorin, irinotecan, and oxaliplatin) and Gem/nab-P (gemcitabine/nab-paclitaxel). In this study, we evaluated the clinical outcomes in patients with metastatic pancreatic adenocarcinoma in a single health system before and after the incorporation of these newer treatments into practice. Methods: A retrospective study of metastatic pancreatic adenocarcinoma patients diagnosed between January 2009 to December 2018 with follow up until December 2019. Overall survival (OS) and progression-free survival (PFS) were calculated using Kaplan-Meier survival analysis. Univariate and multivariable Cox regression analyses were used to explore predictors of survival. Results: 394 patients were diagnosed with metastatic pancreatic adenocarcinoma at Sanford Health hospitals during the study period. There was no statistically significant difference in OS between the cohort diagnosed between 2009-2013 compared to 2014-2018, with median OS of 4.7 and 3.6 months respectively; in those receiving at least one line of chemotherapy, the median OS was 6.7 and 7.3 months. While subgroup analysis of all study population based on the type of first-line chemotherapy showed improved survival with FOLFIRINOX and Gem/nabP as compared to gemcitabine monotherapy [10.7, 6.9, 4 months respectively] (Wilcoxon Test of Homogeneity of Survival Curves p = 0.0002). Univariate and multivariate Cox regression analysis of all study data revealed that at the time of the diagnosis, age (HR: 1.021, p = 0.0013), ECOG performance status > 1 (HR: 3.47, p = 0.0001), serum albumin (HR: 0.708, p = 0.0002), Neutrophil-to-Lymphocytes ratio (HR: 1.076, p≤0.0001) and platelets-to-lymphocyte ratio (HR: 0.998, p = 0.0031) were predictors of survival. Conclusions: Although newer treatments appear to offer improved survival for eligible patients, overall outcomes for metastatic pancreatic adenocarcinoma in this cohort were similar before and after the incorporation of newer treatment regimens. Further advances in the treatment and early detection of pancreatic cancer are needed to improve clinical outcomes.

scholarly journals Treatment outcomes and its associated factors among breast cancer patients at Kitui Referral Hospital

2022 ◽  
Vol 10 ◽  
pp. 205031212110678
Author(s):  
Mwendwa Dickson Wambua ◽  
Amsalu Degu ◽  
Gobezie T Tegegne
Keyword(s):  
Breast Cancer ◽  
Regression Analysis ◽  
Confidence Interval ◽  
Treatment Outcomes ◽  
Cancer Patients ◽  
Medical Records ◽  
Cox Regression ◽  
Breast Cancer Patients ◽  
Cox Regression Analysis ◽  
Study Setting

Objectives: Despite breast cancer treatment outcomes being relatively poor or heterogeneous among breast cancer patients, there was a paucity of data in the African settings, especially in Kenya. Hence, this study aimed to determine treatment outcomes among breast cancer patients at Kitui Referral Hospital. Methods: A hospital-based retrospective cohort study design was conducted among adult patients with breast cancer. All eligible breast cancer patients undergoing treatment from January 2015 to June 2020 in the study setting were included. Hence, a total of 116 breast cancer patients’ medical records were involved in the study. Patients’ medical records were retrospectively reviewed using a predesigned data abstraction tool. The data were entered, cleaned, and analyzed using SPSS (Statistical Package for Social Sciences) version 26 software. Descriptive analysis—such as percentage, frequency, mean, and figures—was used to present the data. Kaplan–Meier survival analysis was used to estimate the mean survival estimate across different variables. A Cox regression analysis was employed to determine factors associated with mortality. Results: The study showed that the overall survival and mortality rate was 62.9% (73) and 37.1% (43), respectively. The regression analysis showed that patients who had an advanced stage of disease had a 3.82 times risk of dying (crude hazard ratio= 3.82, 95% confidence interval = 1.5–9.8) than an early stage of the disease. Besides, patients with distant metastasis had 4.4 times more hazards of dying than (crude hazard ratio = 4.4, 95% confidence interval = 2.1–9.4) their counterparts. Conclusion: The treatment outcome of breast cancer patients was poor, and its overall mortality among breast cancer patients was higher in the study setting. In the multivariate Cox regression analysis, the tumor size was the only statistically significant predictor of mortality among breast cancer patients. Stakeholders at each stage should, therefore, prepare a relevant strategy to improve treatment outcomes.

scholarly journals Cardio-pulmonary transit-time by cardiac magnetic resonance imaging: associates to infarct severity and adverse events after reperfused STEMI

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
F Troger ◽  
M Reindl ◽  
M Pamminger ◽  
C Tiller ◽  
M Holzknecht ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Confidence Interval ◽  
Ejection Fraction ◽  
Infarct Size ◽  
Transit Time ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Lv Ejection Fraction

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiac magnetic resonance (CMR) data on cpTT and its associates with infarct characteristics and clinical outcome after reperfused ST-elevation myocardial infarction (STEMI) are lacking so far. Purpose To investigate cardiopulmonary-transit-time (cpTT) and its value as surrogate parameter for integrative cardiac performance and its link to heart failure. Methods A total of 207 patients (179 men [87%], median age 55 [interquartile range (IQR) 49-64] with acute STEMI underwent CMR on day 3 [IQR 2-4] and 4 months (m) [IQR 4-5] after primary percutaneous coronary intervention. cpTT was taken as the time between the peaks of time-intensity curves of gadolinium contrast to pass from the right ventricle (RV) to the left ventricle (LV). Infarct size, extent of microvascular obstruction (MVO), RV and LV dimensions and function were assessed at both occasions. Results cpTT decreased significantly between baseline and 4m CMR scan (8.6 seconds [IQR 7.5-9.6] to 7.8 sec [IQR 7-8.7], respectively, p &lt; 0.0001). Patients with presence of MVO had significantly prolonged cpTT at baseline and 4m follow-up (all p &lt; 0.022). According to Cox regression analysis ("functional model") baseline cpTT (hazard ratio (HR) 1.5, 95% confidence interval (CI) 1.1–2.2; p= 0.008) remained significantly associated to the occurrence of major adverse cardiac events (MACE) after adjustment for LV ejection fraction (EF) and cardiac index. According to Cox regression analysis ("tissue model") baseline cpTT (HR 1.462, 95% CI 1.02–2.09, p= 0.039) as well as extent of MVO (HR 1.196, 95% CI 1.081–1.324, p= 0.001) remained significantly associated to MACE after adjustment for infarct size. Baseline cpTT (area under the curve [AUC]: 0.725, 95% confidence interval [CI] 0.57-0.88; p &lt; 0.009) was significantly higher for the prediction of MACE compared to LV ejection fraction (AUC: 0.686, 95% CI 0.51-0.87; p = 0.031. AUC difference: 0.039, p &lt; 0.03). In Kaplan-Meier analysis, cpTT ≥9 sec was associated with clinical adverse cardiovascular events (p = 0.008). Conclusion Following reperfused STEMI, cpTT predicts prognosis independently of infarct size and systolic function. Moreover, cpTT provides significantly higher prognostic implication in comparison with LV ejection fraction.

Cardiotoxicity and related risk factors in long-term trastuzumab (T) administration for metastatic breast cancer (MBC): A retrospective analysis.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e11616-e11616
Author(s):  
Barbara Pistilli ◽  
Andrea Marcellusi ◽  
Michele Valeri ◽  
Umberto Torresi ◽  
Dania Nacciarriti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Cardiac Disease ◽  
Cox Regression ◽  
Significant Risk ◽  
Concomitant Chemotherapy ◽  
Cox Regression Analysis ◽  
Significant Difference ◽  
History Of

e11616 Background: Continuing T beyond progression has become a common strategy in the treatment of human epidermal growth receptor 2- overexpressing (HER2) MBC. However, T administered for several years with concomitant chemotherapy elicits concern about cardiac safety especially in patients (pts) with risk factors. Methods: Cardiac events (CEs) and survival of HER2 MBC pts treated with T +/- chemotherapy at our institution from Dec 2003 to Jun 2012 were evaluated. CEs were graded by NCI-CTCAE v 3.0. Risk factors assessed for cardiotoxicity were: age, body mass index, antihypertensive therapy, history of cardiac disease, diabetes, hypothyroidism, smoking, prior radiotherapy on the chest wall, prior cumulative dose of anthracycline(A), interval between last A dose and first T dose, baseline LVEF, continued/interrupted T exposure, concomitant chemotherapy. Chi-square test was used to compare distribution of CEs over different times of T exposure (p≤ 0.05). Univariate and multivariate Cox regression analysis were used to assess the effect of risk predictors. Results: Sixty-two pts assessable. Median age 52 years (range, 29 to 76), median cumulative time receiving T 29.5 months (range, 3 to 99 months); 40 pts (64.5%) received T without interruption and 19 pts (30.6%) were treated for more than 36 months. CEs occurred in 11 out of all pts (17.7%): grade 1 in 3 pts (4.8%), grade 2 in 5 (8.1%) and grade 3 in 3 (4.8%). The rate of CEs showed no statistically significant difference in pts receiving T for up to 36 months and over: 7/43 (16.3%) and 4/19 (21%), respectively, (p =0.724). In univariate Cox regression analysis significant risk factors were: history of cardiac disease (HR 6,814, 95% CI: 1,384-33,542) and smoking (HR 5,228, 95% CI: 1,403-19,491). In multivariate analysis smoking was the only independent predictor (HR 5,886, 95% CI: 1,479-23,247). Median survival from MBC diagnosis was 50 months (range, 6 to 101 months). Conclusions: Despite the limited sample size, our analysis suggests that cardiotoxicity does not hamper a long-term use of T, since the rate of CEs did not increase in pts treated over 36 months. Moreover, smoking appears to be a predictive factor of T cardiotoxicity.

A novel signature based on m6A related genes as the potential prognostic factor in hepatocellular carcinoma.

2020 ◽  
Author(s):  
Zhuomao Mo ◽  
Shaoju Luo ◽  
Hao Hu ◽  
Ling Yu ◽  
Zhirui Cao ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Regression Analysis ◽  
Roc Curve ◽  
Cox Regression ◽  
Risk Group ◽  
Immune Therapy ◽  
The Cancer Genome Atlas ◽  
Cox Regression Analysis ◽  
Potential Biomarker ◽  
Significant Difference

Abstract Background Many different signatures and models have been established for patients with hepatocellular carcinoma (HCC), but no signature based on m6A related genes was developed. The objective of this research was to establish the signature with m6A related genes in HCC. Methods Data from 377 HCC patients from The Cancer Genome Atlas (TCGA) database was downloaded. The included m6A related genes were selected by Cox regression analysis and the signature was verified by survival analysis and multiple receiver operating characteristic (ROC) curve. Furthermore, the nomogram was constructed and evaluated by C-index, calibration plot and ROC curve. Results The signature was established with the four m6A related genes (YTHDF2, YTHDF1, METTL3 and KIAA1429). Under the grouping from signature, patients in high risk group of showed the poor prognosis than those in low risk group. And significant difference was found in two kinds of immune cells (T cell gamma delta and NK cells activated) between two groups. The univariate and multivariate Cox regression analysis indicated that m6A related signature can be the potential independent prognosis factor in HCC. Finally, we developed a clinical risk model predicting the HCC prognosis and successfully verified it in C-index, calibration and ROC curve. Conclusion Our study identified the m6A related signature for predicting prognosis of HCC and provided the potential biomarker between m6A and immune therapy.

Pre-Transplant Weight Loss Influences Outcome of Patients with Myelodysplastic Syndrome Undergoing Allogeneic Stem Cell Transplantation

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 3950-3950
Author(s):  
Aleksandar Radujkovic ◽  
Natalia Becker ◽  
Axel Benner ◽  
Sascha Dietrich ◽  
Olaf Penack ◽  
...  
Keyword(s):  
Weight Loss ◽  
Regression Analysis ◽  
Stem Cell ◽  
Retrospective Study ◽  
Stem Cell Transplantation ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Donor Type ◽  
Unrelated Donors ◽  
Weight Data

Abstract Introduction: Myelodysplastic syndromes (MDS) are clonal stem cell disorders associated with bone marrow failure. Allogeneic stem cell transplantation (alloSCT) is currently the only curative therapy option for patients with MDS. However, on the one hand, most MDS patients are older than 60 years and non-relapse mortality (NRM) remains a significant problem. Therefore, only patients with higher risk MDS according to IPSS (intermediate-2 or higher) appear to profit from alloSCT. On the other hand, higher risk MDS patients have increased relapse rates following alloSCT. In order to optimize the application of alloSCT in this disease, both relapse and NRM rates need to be reduced. We have recently provided evidence that weight loss and minor metabolic changes prior to alloSCT were able to predict relapse and death of acute myeloid leukemia patients using data from two independent patient cohorts This retrospective study investigated the influence of pre-transplant weight loss on clinical outcome of MDS patients after alloSCT in three independent cohorts. Patients and methods: A total of 110 patients (59% male) with a median age of 53 years were included into the analysis. Patients have been diagnosed with MDS according to WHO criteria and received an alloSCT between 2000 and 2012 in three different German referral centers (Heidelberg, Dresden and Berlin). Patient data was retrospectively collected by medical chart review according to the declaration of Helsinki and with approval of the local Ethics committees. Weight data were raised from medical records by three independent researchers in three independent institutions. Weight loss (expressed in percent) was calculated on the basis of recorded weight data at the time of alloSCT and the maximum weight in the time period of 3-6 months prior to alloSCT. The MDS WHO subtype was RA(RS)/RCMD in 31 patients (28%), RAEB1 in 30 patients (27%) and RAEB2 in 49 patients (45%). According to IPSS 31%, 47% and 22% of the patients were in the risk groups intermediate-1, intermediate-2 and high, respectively. The majority of the patients (n=71, 65%) was previously untreated. Twenty-four patients (22%) and 14 patients (13%) received hypomethylating agents and classic chemotherapy prior to alloSCT, respectively. Thirty-one patients (28%) received transplants from related donors (RD), 58 patients (53%) from matched unrelated donors (MUD) and 21 (19%) from mismatched unrelated donors (MMUD). Ninety-three patients (85%) received reduced intensity conditioning (RIC) and 17 patients (15%) received standard myeloablative conditioning (MAC). Survival times were measured from date of alloSCT. Overall survival (OS), relapse-free survival (RFS), NRM and were calculated from date of alloSCT to the appropriate endpoint. Cox regression analysis was applied for OS, NRM and RFS. Relapse and NRM were considered as competing risks. As confounding prognostic factors we included weight loss (continuous), IPSS score, pretreatment, donor type, sex mismatch with the donor and type of conditioning. Results: Median follow-up time was 36 months. For both endpoints OS and NRM multivariate analysis revealed a significant interaction between weight loss and donor type (p<0.01). In Cox regression analysis with the endpoint RFS only weight loss (p=0.05) was associated with significantly shorter RFS. The prognostic effect of pre-transplant weight loss on OS, NRM and RFS and the increasing hazard ratios (HR) with corresponding confidence intervals (CI) for different percentages of weight loss are given in Table 1 (multivariate Cox regression). In a mixed effect model with weight loss as outcome age, recipient sex and pretreatment had no significant impact on weight loss. However, there was a trend towards increased weight loss in patients with high risk MDS according to IPSS (p=0.07). Conclusion: Our retrospective study suggests that in MDS patients pre-transplant weight loss is associated with both higher disease recurrence and higher NRM resulting in survival disadvantage after alloSCT. Prospective studies addressing pre-transplant nutritional interventions in order to improve the outcome of MDS patients are highly warranted. Table 1. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Use of Adjuvant Chemotherapy, Radiation Therapy, or Combined Modality Therapy and the Impact on Survival for Uterine Carcinosarcoma Limited to the Pelvis

2017 ◽  
Vol 27 (6) ◽  
pp. 1171-1177 ◽  
Author(s):  
Andrew T. Wong ◽  
Yi-Chun Lee ◽  
David Schwartz ◽  
Anna Lee ◽  
Meng Shao ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Regression Analysis ◽  
Confidence Interval ◽  
Cox Regression ◽  
National Cancer Data Base ◽  
Uterine Carcinosarcoma ◽  
Cox Regression Analysis ◽  
Cancer Data ◽  
Impact On Survival ◽  
The Impact

ObjectiveClinical outcomes for patients with uterine carcinosarcoma are poor after surgical management alone. Adjuvant therapies including chemotherapy (CT) and/or radiation therapy (RT) have been previously investigated, but the optimal management of this disease remains controversial. The purposes of this study were to analyze the patterns of use of adjuvant CT and RT and to assess the impact on survival of each of these treatment regimens using the National Cancer Data Base.Methods/MaterialsThe National Cancer Data Base was queried for patients given a diagnosis of uterine carcinosarcoma confined to the pelvis who underwent total hysterectomy/bilateral salpingo-oophorectomy between 2004 and 2011. Patients were excluded if they survived less than 4 months after diagnosis. Data regarding CT and RT use were collected. Overall survival (OS) was analyzed using the Kaplan-Meier method. Multivariable Cox regression analysis was performed to evaluate the effect of covariates on OS.ResultsA total of 4906 patients were included in this study. Median age was 67 years (interquartile range, 60–75 years). Median follow-up was 28.9 months (interquartile range, 15.4–52.9 months). There were 1777 patients (36.2%) who received no adjuvant treatment, 971 (19.8%) who received CT alone, 1060 (21.6%) who received RT alone, and 1098 (22.4%) who received both RT and CT. The 5-year OS for patients receiving no adjuvant therapy, adjuvant RT alone, adjuvant CT alone, and combined CT and RT were 44.9%, 47.1%, 47.5%, and 62.9%, respectively. On pairwise analysis, combined CT and RT was associated with improved survival compared with all other subgroups (P < 0.001). On multivariable Cox regression analysis, combined CT and RT (hazard ratio, 0.50; 95% confidence interval, 0.44–0.57; P < 0.001) and CT alone (hazard ratio, 0.78; 95% confidence interval, 0.69–0.88; P < 0.001) were significantly associated with improved OS, whereas RT alone was not.ConclusionsCombination therapy with CT and RT was associated with significantly improved 5-year OS compared with no further therapy, RT alone, or CT alone.

scholarly journals Clinical impact of abdominal versus mediastinal metastases as a prognostic factor for poor outcomes following esophageal cancer surgery: a retrospective study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yutaka Miyawaki ◽  
Hiroshi Sato ◽  
Shuichiro Oya ◽  
Hirofumi Sugita ◽  
Yasumitsu Hirano ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Regression Analysis ◽  
Lymph Node ◽  
Prognostic Factor ◽  
Cox Regression ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
Systemic Recurrence ◽  
Significant Difference

Abstract Background Surgery is still the mainstay of radical treatment for resectable esophageal cancer (EC). It is apparent that the presence or spread of lymph node metastasis (LNM) is a powerful prognostic factor in patients with EC who are eligible for curative treatment. Although the importance and efficacy of lymph node dissection in radical esophagectomy have been reported, the clinical or prognostic relevance of specific metastatic patterns within the mediastinal cavity and abdomen remains unclear. Methods We retrospectively analyzed the association of postoperative survival with clinical mediastinal LNM (cMLNM) and abdominal LNM (cALNM) in 157 patients who underwent radical EC surgery at our hospital between May 2012 and March 2018. Results A significant difference in cause-specific survival (CSS) was observed between patients with and without cALNM (log-rank p = 0.000). A multivariate Cox regression analysis revealed that cALNM and thoracic surgery (mediastinal lymphadenectomy via conventional open right thoracotomy or video-assisted thoracoscopic surgery) independently predicted CSS (p = 0.0007 and 0.021, respectively). Moreover, a significant difference in systemic recurrence-free survival was observed between those with and without cALNM (log-rank p = 0.000). Multivariate Cox regression analysis revealed that cALNM and sex independently predicted systemic recurrence-free survival (p = 0.000 and 0.015, respectively). Conclusion cALNM was an independent poor prognostic factor for CSS after EC surgery. It may also be an independent prognostic factor for postoperative systemic recurrence, which can shorten the CSS. For patients with cALNM-positive EC who have a high potential risk of systemic metastases, more extensive treatment besides the conventional perioperative systemic chemotherapy may be necessary.

Sign in / Sign up

Export Citation Format

Share Document