Multivariable analysis for complete resection rate of 10-20 mm non-metastatic rectal neuroendocrine tumors: a retrospective clinical study

Background: This retrospective study aimed to identify key factors affecting the rate of complete resection for non-metastatic rectal neuroendocrine tumors (NETs) using both transanal local excision (TLE) and endoscopic submucosal dissection (ESD). Methods: Records in the past 10 years were retrieved, for a total of 95 patients diagnosed with non-metastatic rectal NETs sized between 10-20 mm. Treatment outcomes were first compared between TLE and ESD to identify significantly associated factors. Monofactor analysis was then performed between complete and local resections to identify risk factors, which were then subjected to a multivariable analysis to identify independent risk factors. Results: Treatment outcomes between TLE and ESD were significantly associated with depth of invasion (P=0.039) and complete/local resection (P=0.048). By monofactor analysis between complete and local resections, depth of invasion, tumor size, tumor stage and endoscopic manifestation were identified to be risk factors (P=0.014, 0.003, 0.002 and 0.028, respectively). In subsequent multivariable analysis, depth of invasion and tumor size were independent risk factors, with odds ratio of 18.838 and 37.223, and 95% confidence interval of 1.242-285.800 and 2.839-488.078, respectively. Conclusion: Depth of invasion and tumor size were independent risk factors that significantly affect the complete resection rate of 10-20 mm non-metastatic rectal NETs.

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Analysis of Predictors for Lymph Node Metastasis in Patients with Superficial Esophageal Carcinoma

Gastroenterology Research and Practice ◽

10.1155/2016/3797615 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Ruzhen Jia ◽

Qinsong Luan ◽

Jing Wang ◽

Dongsheng Hou ◽

Shulei Zhao

Keyword(s):

Risk Factors ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Prediction Model ◽

Esophageal Carcinoma ◽

Tumor Size ◽

Depth Of Invasion ◽

Node Metastasis ◽

Superficial Esophageal Carcinoma ◽

Independent Risk Factors

In order to predict related risk factors for lymph node metastasis (LNM) in patients with superficial esophageal carcinoma (SEC) and provide reference for endoscopic minimally invasive treatment, we included a total of 93 patients with superficial esophageal carcinoma who have underwent esophagectomy and lymph node dissection from 2010 to 2015. The depth of invasion was remeasured and classified into 6 groups according to their wall penetration. The prediction model was founded based on the independent risk factors. The results shows that lymph node metastasis of m1, m2, m3, sm1, sm2, and sm3 of superficial esophageal carcinoma was 0%, 0%, 5.3%, 8.7%, 17.6%, and 37.5%, respectively. The tumor size, differentiation, and lymphvascular invasion were also significantly related to lymph node metastasis by univariate analysis. Multivariate analysis showed that the depth of invasion and lymphovascular invasion were independent risk factors of lymph node metastasis. A prediction model for lymph node metastasis was established as follows: p=ex/(1+ex), and x = −5.469 + 0.839 × depth of invasion + 1.992 × lymphavascular metastasis. The area under ROC curve was 0.858 (95% CI: 0.757–0.959). It was also shown that the depth of invasion was related to tumor differentiation, macroscopic type, and tumor size.

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Thromboembolic Events in Patients with Testicular Germ Cell Tumours Are Predominantly Triggered by Advanced Disease and by Central Venous Access Systems

Urologia Internationalis ◽

10.1159/000512055 ◽

2020 ◽

pp. 1-7

Author(s):

Klaus-Peter Dieckmann ◽

David Marghawal ◽

Uwe Pichlmeier ◽

Christian Wülfing

Keyword(s):

Risk Factors ◽

Central Venous Access ◽

Multivariable Analysis ◽

Venous Access ◽

Germ Cell Tumours ◽

Thromboembolic Events ◽

Central Venous ◽

Testicular Germ Cell ◽

Testicular Germ Cell Tumours ◽

Independent Risk Factors

Background: Thromboembolic events (TEEs) may significantly complicate the clinical management of patients with testicular germ cell tumours (GCTs). We analysed a cohort of GCT patients for the occurrence of TEEs and looked to possible pathogenetic factors. Patients, Methods: TEEs occurring within 6 months after diagnosis were retrospectively analysed in 317 consecutive patients with testicular GCT (median age 37 years, 198 seminoma, 119 nonseminoma). The following factors were analysed for association with TEE: histology, age, clinical stage (CS), chemotherapy, use of a central venous access device (CVA). Data analysis involved descriptive statistical methods with multivariable analysis to identify independent risk factors. Results: Twenty-three TEEs (7.3%) were observed, 18 deep vein thromboses, 4 pulmonary embolisms, and 1 myocardial infarction. Univariable risk calculation yielded the following odds ratios (ORs) : >CS1 OR = 43.7 (95% confidence intervals [CIs] 9.9–191.6); chemotherapy OR = 7.8 (95% CI 2.3–26.6); CVA OR = 30.5 (95% CI 11.0–84.3). Multivariable analysis identified only CS > 1 (OR = 16.9; 95% CI 3.5–82.4) and CVA (OR = 9.0; 95% CI 2.9–27.5) as independent risk factors. Conclusions: Patients with CSs >CS1 are at significantly increased risk of TEEs even without chemotherapy. Particular high risk is associated with the use of CVA devices for chemotherapy. Caregivers of GCT patients must be aware of the particular risk of TEEs.

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90 Socio-Demographic and Medical Factors in A Multi-Ethnic Cohort of COVID Deaths

Age and Ageing ◽

10.1093/ageing/afab030.51 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

pp. i12-i42

Author(s):

M Patel ◽

U Umasankar ◽

B McCall

Keyword(s):

Risk Factors ◽

South Asian ◽

Multivariable Analysis ◽

Uneventful Recovery ◽

Asian Ethnicity ◽

Black African ◽

Medical Factors ◽

Multivariable Analyses ◽

Independent Risk Factors ◽

Medical Wards

Abstract Introduction Whilst most patients during the COVID pandemic made an uneventful recovery,there was a significant minority in whom the disease was severe and unfortunately fatal. This survey aims to examine and evaluate risk factors for those patients who died of COVID and to identify any markers for improvement in the management of such patients during future COVID surges. Methods Medical records of all patients who died within a multi-ethnic, inner city acute district general hospital over a 6-week period in 2020 were examined. Data collected included demographic details, medical comorbidities, and type of ward where they received care. Multivariable analysis using stepwise backward logistic regression was conducted to examine independent risk factors for these patients. Results Of 275 deaths,204 were related to COVID. Compared to non-COVID deaths(n = 71), there were no age differences. There were significantly more deaths in males (58%vs39%,P < 0.001)) and in Black African and South Asian groups. 18% of COVID deaths were those who were not frail (Frailty Rockwood Scale 1–3) whereas there were no non-COVID deaths in this group(P < 0.001). 69% of COVID deaths occurred in general medical wards whereas 19% in critical care units (90% and 7% for non-COVID deaths,p < 0.001). COVID patients died more quickly compared to non-COVID patients (length of stay mean, 11vs21,p < 0.001). Medical factors prevalent in >20% of COVID deaths included Diabetes, Hypertension, Chronic Heart Disease, Chronic Kidney Disease,and Dementia. Multivariable analyses showed males (OR 1.9), age > 70(OR 2.0), frailty (OR 2.3) were independent risk factors for COVID deaths. Discussion Compared to non-COVID deaths,COVID deaths were more common in previously well individuals,males,Black African and South Asian ethnicity, but multivariable analyses showed males, age > 70 and frailty were independent risk factors for COVID deaths. This survey indicates that greater psychological support may be required for healthcare workers on general medical wards who looked after greater proportion of COVID deaths.

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Risk factors and prognosis of nosocomial pneumonia in patients undergoing extracorporeal membrane oxygenation: a retrospective study

Journal of International Medical Research ◽

10.1177/0300060520964701 ◽

2020 ◽

Vol 48 (10) ◽

pp. 030006052096470

Author(s):

Jianrong Wang ◽

Jinyu Huang ◽

Wei Hu ◽

Xueying Cai ◽

Weihang Hu ◽

...

Keyword(s):

Risk Factors ◽

Extracorporeal Membrane Oxygenation ◽

Nosocomial Pneumonia ◽

Discharge Rate ◽

Multivariable Analysis ◽

Ventilator Support ◽

Membrane Oxygenation ◽

Independent Risk Factors ◽

Medical University ◽

Vv Ecmo

Objective We aimed to examine the risk factors and prognosis of nosocomial pneumonia (NP) during extracorporeal membrane oxygenation (ECMO). Methods We retrospectively analyzed data of patients who received ECMO at the Affiliated Hangzhou Hospital of Nanjing Medical University between January 2013 and August 2019. The primary outcome was the survival-to-discharge rate. Results Sixty-nine patients who received ECMO were enrolled, median age 42 years and 26 (37.7%) women; 14 (20.3%) patients developed NP. The NP incidence was 24.7/1000 ECMO days. Patients with NP had a higher proportion receiving veno-venous (VV) ECMO (50% vs. 7.3%); longer ECMO support duration (276 vs. 140 hours), longer ventilator support duration before ECMO weaning (14.5 vs. 6 days), lower ECMO weaning success rate (50.0% vs. 81.8%), and lower survival-to-discharge rate (28.6% vs. 72.7%) than patients without NP. Multivariable analysis showed independent risk factors that predicted NP during ECMO were ventilator support duration before ECMO weaning (odds ratio [OR] = 1.288; 95% confidence interval [CI]: 1.111–1.494) and VV ECMO mode (OR = 10.970; 95% CI: 1.758–68.467). Conclusion NP during ECMO was associated with ventilator support duration before ECMO weaning and VV ECMO mode. Clinicians should shorten the respiratory support duration for patients undergoing ECMO to prevent NP.

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Retrospective analysis of LNM risk factors and the effect of chemotherapy in early colorectal cancer: A Chinese multicenter study

BMC Cancer ◽

10.1186/s12885-020-07363-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Chunyan Zeng ◽

Dandan Xiong ◽

Fei Cheng ◽

Qingtian Luo ◽

Qiang Wang ◽

...

Keyword(s):

Colorectal Cancer ◽

Risk Factors ◽

Multicenter Study ◽

Tumor Size ◽

Lymphovascular Invasion ◽

Univariate Analysis ◽

Tumor Location ◽

Early Colorectal Cancer ◽

Depth Of Invasion ◽

Significant Difference

Abstract Background Estimating the risk of lymph node metastasis (LNM) is crucial for determining subsequent treatments following curative resection of early colorectal cancer (ECC). This multicenter study analyzed the risk factors of LNM and the effectiveness of postoperative chemotherapy in patients with ECC. Methods We retrospectively analyzed the data of 473 patients with ECC who underwent general surgery in five hospitals between January 2007 and October 2018. The correlations between LNM and sex, age, tumor size, tumor location, endoscopic morphology, pathology, depth of invasion and tumor budding (TB) were directly estimated based on postoperative pathological analysis. We also observed the overall survival (OS) and recurrence in ECC patients with and without LNM after matching according to baseline measures. Results In total, 473 ECC patients were observed, 288 patients were enrolled, and 17 patients had LNM (5.90%). The univariate analysis revealed that tumor size, pathology, and lymphovascular invasion were associated with LNM in ECC (P = 0.026, 0.000, and 0.000, respectively), and the multivariate logistic regression confirmed that tumor size, pathology, and lymphovascular invasion were risk factors for LNM (P = 0.021, 0.023, and 0.001, respectively). There were no significant differences in OS and recurrence between the ECC patients with and without LNM after matching based on baseline measures (P = 0.158 and 0.346, respectively), and no significant difference was observed between chemotherapy and no chemotherapy in ECC patients without LNM after surgery (P = 0.729 and 0.052). Conclusion Tumor size, pathology, and lymphovascular invasion are risk factors for predicting LNM in ECC patients. Adjuvant chemotherapy could improve OS and recurrence in patients with LNM but not always in ECC patients without LNM.

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Association of Image-Guided Navigation With Complete Resection Rate in Patients With Locally Advanced Primary and Recurrent Rectal Cancer

JAMA Network Open ◽

10.1001/jamanetworkopen.2020.8522 ◽

2020 ◽

Vol 3 (7) ◽

pp. e208522 ◽

Cited By ~ 3

Author(s):

Esther N. D. Kok ◽

Ruben van Veen ◽

Harald C. Groen ◽

Wouter J. Heerink ◽

Nikie J. Hoetjes ◽

...

Keyword(s):

Rectal Cancer ◽

Locally Advanced ◽

Complete Resection ◽

Recurrent Rectal Cancer ◽

Resection Rate ◽

Image Guided ◽

Complete Resection Rate

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Neoadjuvant therapy for thymic neoplasms reduces tumor volume per 3D-reconstructed images but does not improve the complete resection rate

PLoS ONE ◽

10.1371/journal.pone.0214291 ◽

2019 ◽

Vol 14 (3) ◽

pp. e0214291

Author(s):

Jee Won Suh ◽

Seong Yong Park ◽

Chang Young Lee ◽

Seung Hwan Song ◽

Dae Joon Kim ◽

...

Keyword(s):

Neoadjuvant Therapy ◽

Tumor Volume ◽

Complete Resection ◽

Resection Rate ◽

Complete Resection Rate

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A clinical prediction model for estimating the risk of developing uveitis in patients with juvenile idiopathic arthritis

Rheumatology ◽

10.1093/rheumatology/keaa733 ◽

2020 ◽

Author(s):

Joeri W van Straalen ◽

Gabriella Giancane ◽

Yasmine Amazrhar ◽

Nikolay Tzaribachev ◽

Calin Lazar ◽

...

Keyword(s):

Risk Factors ◽

Prediction Model ◽

Protective Factor ◽

Prediction Models ◽

Characteristic Curve ◽

Multivariable Analysis ◽

Information Criterion ◽

Logistic Regression Models ◽

Adjusted Risk ◽

Independent Risk Factors

Abstract Objective To build a prediction model for uveitis in children with JIA for use in current clinical practice. Methods Data from the international observational Pharmachild registry were used. Adjusted risk factors as well as predictors for JIA-associated uveitis (JIA-U) were determined using multivariable logistic regression models. The prediction model was selected based on the Akaike information criterion. Bootstrap resampling was used to adjust the final prediction model for optimism. Results JIA-U occurred in 1102 of 5529 JIA patients (19.9%). The majority of patients that developed JIA-U were female (74.1%), ANA positive (66.0%) and had oligoarthritis (59.9%). JIA-U was rarely seen in patients with systemic arthritis (0.5%) and RF positive polyarthritis (0.2%). Independent risk factors for JIA-U were ANA positivity [odds ratio (OR): 1.88 (95% CI: 1.54, 2.30)] and HLA-B27 positivity [OR: 1.48 (95% CI: 1.12, 1.95)] while older age at JIA onset was an independent protective factor [OR: 0.84 (9%% CI: 0.81, 0.87)]. On multivariable analysis, the combination of age at JIA onset [OR: 0.84 (95% CI: 0.82, 0.86)], JIA category and ANA positivity [OR: 2.02 (95% CI: 1.73, 2.36)] had the highest discriminative power among the prediction models considered (optimism-adjusted area under the receiver operating characteristic curve = 0.75). Conclusion We developed an easy to read model for individual patients with JIA to inform patients/parents on the probability of developing uveitis.

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Lack of Anatomical Concordance between Preablation and Postablation CT Images: A Risk Factor Related to Ablation Site Recurrence

International Journal of Hepatology ◽

10.1155/2012/870306 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 4

Author(s):

Petra G. Kele ◽

Eric J. Van der Jagt ◽

Paul F. M. Krabbe ◽

Koert P. de Jong

Keyword(s):

Risk Factors ◽

Tumor Size ◽

Tumour Size ◽

Tumor Location ◽

Ct Images ◽

Cox Proportional Hazard ◽

Independent Risk Factors ◽

Index Tumor ◽

Index Tumour

Objective. Variation in the position of the liver between preablation and postablation CT images hampers assessment of treatment of colorectal liver metastasis (CRLM). The aim of this study was to test the hypothesis that discordant preablation and postablation imaging is associated with more ablation site recurrences (ASRs).Methods. Patients with CRLM were included. Index-tumor size, location, number, RFA approachs and ablative margins were obtained on CT scans. Preablation and postablation CT images were assigned a “Similarity of Positioning Score” (SiPS). A suitable cutoff was determined. Images were classified as identical (SiPS-id) or nonidentical (SiPS-diff). ASR was identified prospectively on follow-up imaging.Results. Forty-seven patients with 97 tumors underwent 64 RFA procedures (39 patients/63 tumors open RFA, 25 patients/34 tumours CT-targeted RFA, 12 patients underwent >1 RFA). Images of 52 (54%) ablation sites were classified as SiPS-id, 45 (46%) as SiPS-diff. Index-tumor size, tumor location and number, concomitant partial hepatectomy, and RFA approach did not influence the SiPS. ASR developed in 11/47 (23%) patients and 20/97 (21%) tumours. ASR occurred less frequently after open RFA than after CT targeted RFA (P<0.001). ASR was associated with larger index-tumour size (18.9 versus 12.8 mm,P=0.011). Cox proportional hazard model confirmed SiPS-diff, index-tumour size >20 mm and CT-targeted RFA as independent risk factors for ASR.Conclusion. Variation in anatomical concordance between preablation and postablation images, index-tumor size, and a CT-targeted approach are risk factors for ASR in CRLM.

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Submucosal Injection Solution for Endoscopic Resection in Gastrointestinal Tract: A Traditional and Network Meta-Analysis

Gastroenterology Research and Practice ◽

10.1155/2015/702768 ◽

2015 ◽

Vol 2015 ◽

pp. 1-10 ◽

Cited By ~ 15

Author(s):

Zhang Yu Huai ◽

Wei Feng Xian ◽

Luo Chang Jiang ◽

Wang Xi Chen

Keyword(s):

Gastrointestinal Tract ◽

Endoscopic Resection ◽

Meta Analysis ◽

Complete Resection ◽

Analysis Method ◽

Injection Solution ◽

Resection Rate ◽

En Bloc ◽

Submucosal Injection ◽

Complete Resection Rate

Objective. To explore and define the current optimal submucosal injection solution used in ESD and EMR for gastrointestinal tract neoplasms in terms of clinical outcomes and other aspects.Methods. PubMed, Cochrane Library, Embase, and clinical trials register center were searched with terms of “endoscopic resection” and “submucosal injection solution” to identify relevant randomized controlled trials (RCTs). Both direct comparison using traditional meta-analysis method and indirect comparison using network meta-analysis method were performed.Results. A total of 11 RCTs with 1152 patients were included. Meta-analysis showed that, compared with normal saline, other submucosal injection solutions induced a significant increase in terms ofen blocresection rate(I2=0%, OR = 2.11, 95% CI (1.36, 3.26), andP= 0.008)and complete resection rate(I2=0%, OR = 2.14, 95% CI (1.41, 3.24), andP= 0.0003); and there was no significant difference in the incidence of total complications(I2=0%, OR = 0.87, 95% CI (0.59, 1.29), andP= 0.49).Conclusions. Other newly developed submucosal injection solutions significantly increaseden blocresection rate and complete resection rate and decreased bleeding rate and finical cost of endoscopic resection in gastrointestinal tract, while current evidence did not find the difference between them, which need to be explored by further studies.

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