scholarly journals Perda de peso em pacientes oncológicos: prevalência e prognóstico relacionados a sexo, idade, localização do tumor e sintomas de impacto nutricional

2020 ◽  
Vol 35 (1) ◽  
pp. 84-92
Author(s):  
Dalton Luiz Schiessel ◽  
Amanda Kamitani Góis Orrutéa ◽  
Sabrina Eduarda da Silva ◽  
Mariana Abe Vicente Cavagnari ◽  
Caryna Eurich Mazur ◽  
...  
Keyword(s):  
Overall Survival ◽  
Weight Loss ◽  
Nutrient Intake ◽  
Primary Outcome ◽  
Multinomial Logistic Regression ◽  
Univariate Analysis ◽  
Tumor Location ◽  
Cancer Site ◽  
Grade Scheme ◽  
The City

ABSTRACT Introduction: Cancer causes an increase in nutritional demands and the presence of of nutritional impact symptoms (NIS) contributes to reduction of nutrient intake and absorption, leading to weight loss, malnutrition and predicting overall survival. Assess the prevalence and predict the weight loss related to cancer, the Grade Scheme and the NIS. Methods: Data were collected from 2012 to 2018 from the first nutritional consultation of cancer patients in a clinic linked to SUS in the city of Guarapuava-PR. The primary outcome was to determine the % of weight loss (% WL), NIS and by the Grade Scheme proposed by Martin et. al (2015) the prognosis was determined by univariate and multivariate Multinomial Logistic Regression (MLR) analysis (adjusted for age, sex and tumor location). Results: 1164 patients aged 56.9 years. In the first consultation, a 6.7 %WL was observed, and it was observed that 21.6% of the patients were underweight. The main sites and %WL were, respectively: Lung 140 (12.0%) and 9.4 %WL, Head and Neck 113 (9.7%) and 10.5 %WL, Colorectal 84 (7.2%) and 10.3 %WL, Stomach 90 (7.7%) and 13.7 %WL, Esophagus 85 (7.3%) and 14.0 %WL, Pancreas 24 (2.1%) and 16.1 %WL. The main NIS were: dry mouth (51.0%), abdominal pain (23.0%), constipation (21.7%), nausea (15.3%) and altered taste (10.5%). In the RML for univariate analysis, age, sex, cancer site and SIN and for multivariate analysis, all cancer locations showed significant OR to be classified in grades 3 and 4. Conclusion: Before chemotherapy, weight loss and malnutrition are present. The cancer site and SIN increase the chance of the patient being classified in grades 3 and 4, leading these patients to a worse nutritional status and contributing to adverse results.

The effect of gender on outcomes in esophageal cancer.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 170-170
Author(s):  
Jordan McDonald ◽  
Sabrina Saeed ◽  
Sarah E. Hoffe ◽  
Rutika Mehta ◽  
Jessica M. Frakes ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Neoadjuvant Therapy ◽  
Surgical Complications ◽  
Univariate Analysis ◽  
Tumor Location ◽  
Age At Diagnosis ◽  
Thoracic Esophagus ◽  
Female Patients ◽  
Upper Thoracic

170 Background: Few epidemiological studies address differences in outcomes by gender in locoregional esophageal cancer (LEC) for which the current standard of care is chemoradiation followed by surgical resection. Although male gender is associated with the majority of LEC cases, we sought to determine if gender could impact clinical presentation as well as surgical and oncologic outcomes in our single institution 20 year experience. Methods: A retrospective query of our institution’s IRB-approved database of patients that had surgical therapy between 2008 and 2019 for esophageal cancer (EC) was performed. Patients were stratified by gender and analyzed based on characteristics such as tumor histology, tumor location, clinical stage at presentation, age at diagnosis, receipt of neoadjuvant therapy, surgical intent, surgical complications, length of post-operative hospital stay, response to neoadjuvant therapy, final pathology, and recurrence. Chi-square, ANOVA and Kaplan Meier survival analysis were performed on the previously defined groups. Results: The cohort studied included 1180 patients with resection for EC. Of those, 1005 (85.2%) had adenocarcinoma, 145 (12.3%) had squamous cell cancer (SCC), 10 (0.8%) had adenosquamous carcinoma, and 20 (1.7%) had other histological variants. There were 985 (83.5%) male patients and 195 (16.5%) female patients. SCC was more common in females (29.2% in females vs. 8.9% in males, p = 0.000) and females tended to have tumor location in the upper thoracic esophagus more often (4.7% in females vs. 0.9% of males, p = 0.000). Additionally, females developed surgical complications more often than males (72.2% vs. 64.7%, p = 0.045). Staging at diagnosis (p = 0.508), receipt of neoadjuvant treatment (p = 0.676), and age at diagnosis (65.3 years in males vs. 66.3 years in females, p = 0.934) had no association with gender. Response to neoadjuvant therapy (p = 0.157) and cancer recurrence (p = 0.434) did not have significant associations with gender. The median overall survival was not statistically significantly different but trended to be longer for females (73.4 months in females [95% CI: 51.5-95.4] vs. 47.0 months in males [95% CI: 39.6-54.5], p = 0.160). Conclusions: Based on our high-volume cancer center study, female patients were more likely to have SCC, upper thoracic esophageal lesions, and surgical complications following resection. While univariate analysis did not demonstrate significant differences in overall survival between genders, there are plans to report additional data after controlling for other variables. Further studies are warranted to validate these findings, given the potential for higher prioritization of an organ preservation approach for this patient population.

Prognostic significance of malnutrition in metastatic esophageal squamous cell carcinoma.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 171-171
Author(s):  
Kirsty Taylor ◽  
Osvaldo Espin-Garcia ◽  
Di Maria Jiang ◽  
Daniel Yokom ◽  
Lucy Xiaolu Ma ◽  
...  
Keyword(s):  
Overall Survival ◽  
Weight Loss ◽  
Squamous Cell ◽  
Univariate Analysis ◽  
Cell Cancer ◽  
Screening Tools ◽  
Nutritional Risk ◽  
Significant Difference ◽  
Nutritional Risk Index ◽  
Ecog Ps

171 Background: Disease related symptoms including anorexia, nausea and dysphagia lead patients with esophageal cancer to become malnourished. Malnourishment can result in systemic inflammation, reduced treatment tolerance, poorer quality of life and decreased overall survival. Currently weight loss is the main clinical measure of malnutrition, and thus we set out to evaluate the prognostic utility of alternative screening tools of malnutrition. Methods: Patients with metastatic esophageal squamous cell cancer (MESCC) attending the Princess Margaret Cancer Centre, between January 2011 and December 2016, were identified from the institutional gastroesophageal database. Nutritional Risk Score (NRS), Nutritional Risk Index (NRI) and Neutrophil Lymphocyte Ratio (NLR) were calculated and correlated with clinical-pathological variables and survival. Malnutrition was defined as NRS ≥ 3, NRI < 97.5 and NLR ≥ 3. Results: Of the 64 consecutive patients, 30 (47%) presented with de novo metastatic disease and 34 (53%) with recurrence. The median age was 62 years (range 40-85), 47 patients were ECOG PS ≤ 2 and 29 (45%) received systemic chemotherapy. 90% of patients experienced weight loss > 5% prior to diagnosis and median BMI was 20.1 (range 14.3-34.9). NRI identified 37 (58%) and NRS 45 (70%) patients as malnourished. Both were associated with poorer ECOG PS (p = 0.012 and p = 0.027 respectively). No difference was identified with sex, smoking status or albumin with univariate analysis. NRI did not associate significantly with age. Median overall survival was 5months; 8.1-9 months with normal nutrition and 2.8-3.2 months in malnourished patients. Kaplan Meier analysis revealed significant difference in overall survival (malnutrition vs. normal nutrition) using NRS (p = 0.029) and NRI (p = 0.001) but not weight (p = 0.509) or NLR (p = 0.69). Conclusions: Patients with MESCC identified as malnourished at the time of diagnosis have inferior survival outcomes. Malnutrition tools are superior to weight alone with respect to discriminating outcomes in this patient population. Further investigation is needed in larger patient cohorts; to identify those at risk, initiate early supportive interventions and improve patient outcomes.

Type of fiducial marker and clinical outcomes in stereotactic body radiation therapy for pancreatic cancer.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 414-414
Author(s):  
J Richelcyn Baclay ◽  
Madeline Minneci ◽  
Dania Abid ◽  
Diego Augusto Santos Toesca ◽  
Rie von Eyben ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
Stereotactic Body Radiation Therapy ◽  
Univariate Analysis ◽  
Tumor Location ◽  
Fiducial Marker ◽  
Local Failure ◽  
Fiducial Markers ◽  
Stereotactic Body Radiation ◽  
Stage Grouping

414 Background: Stereotactic body radiation therapy (SBRT) for pancreatic cancers has been shown to improve local control, and is an important option for treatment, especially for unresectable disease. Verifying the tumor location prior to delivery of SBRT is challenging, so fiducial markers are used to track tumor location. There is currently no standard of which fiducials to use in treatment. This study would like to compare outcomes of patients treated with SBRT using different fiducial markers. Methods: Records of patients diagnosed with primary pancreas cancer who were treated with chemotherapy and SBRT were reviewed from 2006-2019. Patients were excluded if they were treated with Cyberknife, were metastatic at presentation, recurrence /persistent disease after Whipple/radiation therapy, were secondary metastatic disease (from another primary), and if they were resected after SBRT. Patients were categorized according to the fiducial used for tumor tracking during SBRT treatment: gold seeds, intrabiliary stent, or both. Cumulative incidence of local recurrence (CIR) was analyzed with death as competing event, and time to over-all survival was estimated using Kaplan-Meier curves. Results: A total of 129 patients with available fiducial information were included in this study, of which 64 (49.6%) were treated with SBRT using gold seeds, 23 (17.8%) using intrabiliary stent, and 42 (32.6%) using both the seeds and stent. There were no difference between groups in terms of baseline characteristics such as age (p = 0.169), sex (p = 0.293), and stage grouping (p = 0.293). Median follow-up time was 15 months (range: 0.3-37.3 months). The 6- and 12-month CIR were 1.5% (95%CI, 0.1%-7.4%) and 11% (95%CI, 4.8%-20.2%) for patients treated with seeds, 4.3% (95%CI, 0.2%-18.6%) and 30.4% (95%CI, 13.1%-49.8%) for patients treated with stent, and 4.8% (95%CI, 0.8%-14.6%) and 19.5% (95%CI, 9.0%-32.9%) for patients treated with both (p = 0.007). Median time to overall survival was 15.3 months (95%CI, 13-17.8 months) for patients treated with seeds, 21.3 months (95%CI, 14.7-29.6 months) for patients treated with stent, and 15.7 months (95%CI, 11.5-19.7 months) for patients treated with both (p = 0.307). Univariate analysis for predictors of local failure did not show significance for age (p = 0.812), or advanced stage (p = 0.483), but was significant for the presence of seeds (p = 0.006). Conclusions: The type of fiducial marker used for tracking during pancreas SBRT treatment was associated with local failure but no difference in overall survival. Further analysis is warranted to see which clinical factors contribute to this difference.

scholarly journals Survival of glioblastoma in relation to tumor location: a statistical tumor atlas of a population-based cohort

2021 ◽  
Author(s):  
Even Hovig Fyllingen ◽  
Lars Eirik Bø ◽  
Ingerid Reinertsen ◽  
Asgeir Store Jakola ◽  
Lisa Millgård Sagberg ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factor ◽  
Elderly Patients ◽  
Temporal Lobe ◽  
Third Ventricle ◽  
Tumor Location ◽  
Population Based ◽  
Independent Effect ◽  
Precentral Gyrus ◽  
The Third

Abstract Purpose Previous studies on the effect of tumor location on overall survival in glioblastoma have found conflicting results. Based on statistical maps, we sought to explore the effect of tumor location on overall survival in a population-based cohort of patients with glioblastoma and IDH wild-type astrocytoma WHO grade II–III with radiological necrosis. Methods Patients were divided into three groups based on overall survival: < 6 months, 6–24 months, and > 24 months. Statistical maps exploring differences in tumor location between these three groups were calculated from pre-treatment magnetic resonance imaging scans. Based on the results, multivariable Cox regression analyses were performed to explore the possible independent effect of centrally located tumors compared to known prognostic factors by use of distance from center of the third ventricle to contrast-enhancing tumor border in centimeters as a continuous variable. Results A total of 215 patients were included in the statistical maps. Central tumor location (corpus callosum, basal ganglia) was associated with overall survival < 6 months. There was also a reduced overall survival in patients with tumors in the left temporal lobe pole. Tumors in the dorsomedial right temporal lobe and the white matter region involving the left anterior paracentral gyrus/dorsal supplementary motor area/medial precentral gyrus were associated with overall survival > 24 months. Increased distance from center of the third ventricle to contrast-enhancing tumor border was a positive prognostic factor for survival in elderly patients, but less so in younger patients. Conclusions Central tumor location was associated with worse prognosis. Distance from center of the third ventricle to contrast-enhancing tumor border may be a pragmatic prognostic factor in elderly patients.

scholarly journals A Positive Dermcidin Expression Is an Unfavorable Prognostic Marker for Extramammary Paget’s Disease

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1086
Author(s):  
Shun Ohmori ◽  
Yu Sawada ◽  
Natsuko Saito-Sasaki ◽  
Sayaka Sato ◽  
Yoko Minokawa ◽  
...  
Keyword(s):  
Overall Survival ◽  
Therapeutic Option ◽  
Univariate Analysis ◽  
Paget’S Disease ◽  
Paget's Disease ◽  
Positive Staining ◽  
Extramammary Paget’S Disease ◽  
Potential Biomarker ◽  
The Impact ◽  
Extramammary Paget's Disease

Extramammary Paget’s disease is recognized as an apocrine-origin cutaneous tumor and is localized in the intraepithelial skin lesion. However, its advanced form is intractable, and there is currently no therapeutic option with a satisfactory level of clinical outcome. Therefore, it is of great importance to identify a potential biomarker to estimate tumor advancement in extramammary Paget’s disease. Dermcidin is an antimicrobial peptide derived from the eccrine gland and is identified as a biomarker in various malignancies. To investigate the potential of dermcidin in extramammary Paget’s disease, we investigated dermcidin expression in tumors using the immunostaining technique. Although previous studies have reported that extramammary Paget’s disease has no positive staining against dermcidin, 14 out of 60 patients showed positive staining of dermcidin in our study. To clarify the characteristics of positive dermcidin in extramammary Paget’s disease, we investigated the clinical characteristics of positive dermcidin extramammary Paget’s disease patients. Positive dermcidin patients showed a significantly high frequency of lymph node metastasis. We next investigated the impact of positive dermcidin on overall survival. Univariate analysis identified that positive dermcidin showed a significantly increased hazard ratio in overall survival, suggesting that dermcidin might be a prognostic factor for extramammary Paget’s disease.

scholarly journals 600. Decreased Hospital Readmission After Programmatic Strengthening of an Outpatient Parenteral Antimicrobial Therapy (OPAT) Program

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S362-S363
Author(s):  
Gaurav Agnihotri ◽  
Alan E Gross ◽  
Minji Seok ◽  
Cheng Yu Yen ◽  
Farah Khan ◽  
...  
Keyword(s):  
Hospital Readmission ◽  
Multinomial Logistic Regression ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Intervention Group ◽  
Care Hospital ◽  
Full Time ◽  
Post Intervention ◽  
Before And After ◽  
The Impact

Abstract Background Although it is recommended that an OPAT program should be managed by a formal OPAT team that supports the treating physician, many OPAT programs face challenges in obtaining necessary program staff (i.e nurses or pharmacists) due to limited data examining the impact of a dedicated OPAT team on patient outcomes. Our objective was to compare OPAT-related readmission rates among patients receiving OPAT before and after the implementation of a strengthened OPAT program. Methods This retrospective quasi-experiment compared adult patients discharged on intravenous (IV) antibiotics from the University of Illinois Hospital before and after implementation of programmatic changes to strengthen the OPAT program. Data from our previous study were used as the pre-intervention group (1/1/2012 to 8/1/2013), where only individual infectious disease (ID) physicians coordinated OPAT. Post-intervention (10/1/2017 to 1/1/2019), a dedicated OPAT nurse provided full time support to the treating ID physicians through care coordination, utilization of protocols for lab monitoring and management, and enhanced documentation. Factors associated with readmission for OPAT-related problems at a significance level of p&lt; 0.1 in univariate analysis were eligible for testing in a forward stepwise multinomial logistic regression to identify independent predictors of readmission. Results Demographics, antimicrobial indications, and OPAT administration location of the 428 patients pre- and post-intervention are listed in Table 1. After implementation of the strengthened OPAT program, the readmission rate due to OPAT-related complications decreased from 17.8% (13/73) to 6.5% (23/355) (p=0.001). OPAT-related readmission reasons included: infection recurrence/progression (56%), adverse drug reaction (28%), or line-associated issues (17%). Independent predictors of hospital readmission due to OPAT-related problems are listed in Table 2. Table 1. OPAT Patient Demographics and Factors Pre- and Post-intervention Table 2. Factors independently associated with hospital readmission in OPAT patients Conclusion An OPAT program with dedicated staff at a large academic tertiary care hospital was independently associated with decreased risk for readmission, which provides critical evidence to substantiate additional resources being dedicated to OPAT by health systems in the future. Disclosures All Authors: No reported disclosures

scholarly journals 1611. Evaluating Clinical Outcomes and Efficacy of Daptomycin in Combination with a Beta-Lactam for the Treatment of Vancomycin-Resistant Enterococcus (VRE) Bacteremia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S799-S800
Author(s):  
Nerea Irusta ◽  
Ana Vega ◽  
Yoichiro Natori ◽  
Lilian M Abbo ◽  
Lilian M Abbo ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Primary Outcome ◽  
Small Sample Size ◽  
Univariate Analysis ◽  
Small Sample ◽  
Significant Difference ◽  
Vancomycin Resistant ◽  
Secondary Outcomes ◽  
Related Mortality

Abstract Background In-vitro studies have shown synergistic bactericidal activity with daptomycin (DAP) plus β-lactam antimicrobials against vancomycin resistant enterococci (VRE). There is a paucity of data regarding clinical outcomes with this combination in VRE bloodstream infections (BSI). The purpose of this study was to assess the efficacy of DAP plus a β-lactam with in-vitro activity vs. other therapies for treatment of VRE BSI. Methods IRB-approved, single-center, retrospective study of patients with VRE BSI from 01/2018-09/2019. Patients were excluded if &lt; 18 years old, pregnant, or incarcerated. The primary outcome was time-to-microbiological clearance. Secondary outcomes included infection-related mortality, 30-day all-cause mortality, and incidence of recurrent BSI within 30 days of index culture. Targeted DAP doses were ≥ 8mg/kg and based on MIC. Factors associated with significance for outcomes, via univariate analysis, were evaluated with multivariable logistic regression (MLR), removed in a backward-step approach. Results A total of 85 patients were included, 23 of which received DAP plus a β-lactam. The comparator arm included linezolid or DAP monotherapy. Patients with combination therapy had significantly higher Charlson Comorbidity Index (CCI) (p=0.013) and numerically higher Pitt Bacteremia scores (PBS) (p=0.087) (Table 1). There was no difference seen in the primary outcome (Table 2). Secondary outcomes are provided in Table 2. The presence of polymicrobial infection and higher PBS were significantly associated with infection-related mortality (p=0.008 and p=0.005, respectively) by MLR. A Mann Whitney U test indicated that presence of infection-related mortality was greater for patients with higher MICS (U=20.5, p=0.06). The presence of an underlying source may be related to recurrence of BSI (p=0.075). Table 1: Patient Characteristics Table 2. Primary and Secondary Outcomes Conclusion We did not find a significant difference in time-to-microbiological clearance, although patients treated with DAP and a β-lactam had higher CCI and PBS. These results are limited by retrospective design, small sample size, and potential selection bias. Prospective randomized studies are needed to further validate these findings. Disclosures All Authors: No reported disclosures

scholarly journals Predictive CT features for the diagnosis of primary pulmonary mucoepidermoid carcinoma: comparison with squamous cell carcinomas and adenocarcinomas

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiaohua Ban ◽  
Xinping Shen ◽  
Huijun Hu ◽  
Rong Zhang ◽  
Chuanmiao Xie ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Roc Curve ◽  
Multinomial Logistic Regression ◽  
Univariate Analysis ◽  
Ct Imaging ◽  
Squamous Cell Carcinomas ◽  
Curve Analysis ◽  
Imaging Features ◽  
Roc Curve Analysis ◽  
Ct Features

Abstract Background To determine the predictive CT imaging features for diagnosis in patients with primary pulmonary mucoepidermoid carcinomas (PMECs). Materials and methods CT imaging features of 37 patients with primary PMECs, 76 with squamous cell carcinomas (SCCs) and 78 with adenocarcinomas were retrospectively reviewed. The difference of CT features among the PMECs, SCCs and adenocarcinomas was analyzed using univariate analysis, followed by multinomial logistic regression and receiver operating characteristic (ROC) curve analysis. Results CT imaging features including tumor size, location, margin, shape, necrosis and degree of enhancement were significant different among the PMECs, SCCs and adenocarcinomas, as determined by univariate analysis (P < 0.05). Only lesion location, shape, margin and degree of enhancement remained independent factors in multinomial logistic regression analysis. ROC curve analysis showed that the area under curve of the obtained multinomial logistic regression model was 0.805 (95%CI: 0.704–0.906). Conclusion The prediction model derived from location, margin, shape and degree of enhancement can be used for preoperative diagnosis of PMECs.

scholarly journals Incidence and frequency of cancer cachexia during chemotherapy for advanced pancreatic ductal adenocarcinoma

2020 ◽  
Vol 28 (11) ◽  
pp. 5271-5279 ◽  
Author(s):  
Shuichi Mitsunaga ◽  
Eiji Kasamatsu ◽  
Koji Machii
Keyword(s):  
Overall Survival ◽  
Weight Loss ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Cancer Cachexia ◽  
Ductal Adenocarcinoma ◽  
Cancer Therapies ◽  
First Line ◽  
Timing Of Onset ◽  
Line Chemotherapy

Abstract Purpose Cachexia influences the patient’s physical wellbeing and quality of life, and the patient’s ability to tolerate their cancer therapies, especially cytotoxic chemotherapy. The purpose of this study was to investigate the frequency and timing of onset of cancer cachexia during chemotherapy and its association with prognosis and toxicity in patients with pancreatic ductal adenocarcinoma (PDAC). Methods We performed a retrospective study in patients who underwent first-line chemotherapy after diagnosis of advanced PDAC between 6 June 2008 and 31 March 2017. Base cachexia (weight loss up to 6 months before starting first-line chemotherapy) and follow-up cachexia (after starting first-line chemotherapy) were defined as weight loss > 2% with a body mass index (BMI) < 20 kg/m2 or weight loss > 5%. Results A total of 150 patients were registered. The median age and BMI were 65 years and 21.7 kg/m2, respectively. Base cachexia occurred in 50% of patients. Follow-up cachexia occurred in 32% within 12 weeks of starting first-line chemotherapy, reaching 64% at 1 year. Overall survival was not significantly different between patients with and without follow-up cachexia, regardless of whether cancer cachexia occurred within 12, 24, or 48 weeks of starting first-line treatment. Appetite loss, fatigue, nausea, and diarrhea were more frequent in patients with follow-up cachexia than in those without follow-up cachexia. Conclusion Follow-up cachexia had an early onset, but was not a prognostic factor for overall survival in patients with PDAC. Some adverse events tended to be more frequent in patients with follow-up cachexia than in those without follow-up cachexia.

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