A contemporary population-based study of testicular sex cord stromal tumours: Presentation, treatment patterns, and predictors of outcome

Introduction: We aimed to characterize demographic distribution, patient outcomes, and prognostic features of testicular sex cord stromal tumours (SCST) using a large statewide database.Methods: Adult male patients diagnosed with SCST between 1988 and 2010 were identified within the California Cancer Registry (CCR). Baseline demographic variables and disease characteristics were reported. Primary outcome measures were cancer-specific survival (CSS) and overall survival (OS). Bivariate and multivariate Cox proportional hazards models were employed to identify predictors of survival.Results: A total of 67 patients with SCST were identified, of which 45 (67%) had Leydig cell and 19 (28%) had Sertoli cell tumours. Median age was 40 years and the majority of patients (84%) presentedwith localized disease. Following orchiectomy, nine patients (15%) underwent retroperitoneal lymph node dissection (RPLND), whereas 54 patients (80%) had no further treatment. With a median followup of 75 months, two-year OS and CSS was 91% and 95%, respectively, for those presenting with stage I disease. For those presenting with stage II disease, two-year OS and CSS was 30%. Predictors of worse OS included age >60 (hazard ratio [HR] 5.64; p<0.01) and metastatic disease (HR 8.56; p<0.01). Presentation with metastatic disease was the only variable associated with worse CSS (HR 13.36; p<0.01). Histology was not found to be a significant predictor of either CSS or OS.Conclusions: We present the largest reported series to date for this rare tumour and provide contemporary epidemiological and treatment data. The primary driver of prognosis in patients with SCSTis disease stage, emphasizing the importance of early detection and intervention.

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The Longitudinal Association of Vision Impairment with Transitions to Cognitive Impairment and Dementia: Findings from The Aging, Demographics and Memory Study

The Journals of Gerontology Series A ◽

10.1093/gerona/glab157 ◽

2021 ◽

Author(s):

Joshua R Ehrlich ◽

Bonnielin K Swenor ◽

Yunshu Zhou ◽

Kenneth M Langa

Keyword(s):

Visual Acuity ◽

Logistic Regression ◽

Cognitive Impairment ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Vision Impairment ◽

Logistic Regression Models ◽

Cox Proportional Hazards Models ◽

Longitudinal Association

Abstract Background Vision impairment (VI) is associated with incident cognitive decline and dementia. However, it is not known whether VI is associated only with the transition to cognitive impairment, or whether it is also associated with later transitions to dementia. Methods We used data from the population-based Aging, Demographics and Memory Study (ADAMS) to investigate the association of visual acuity impairment (VI; defined as binocular presenting visual acuity <20/40) with transitions from cognitively normal (CN) to cognitive impairment no dementia (CIND) and from CIND to dementia. Multivariable Cox proportional hazards models and logistic regression were used to model the association of VI with cognitive transitions, adjusted for covariates. Results There were 351 participants included in this study (weighted percentages: 45% male, 64% age 70-79 years) with a mean follow-up time of 4.1 years. In a multivariable model, the hazard of dementia was elevated among those with VI (HR=1.63, 95%CI=1.04-2.58). Participants with VI had a greater hazard of transitioning from CN to CIND (HR=1.86, 95%CI=1.09-3.18). However, among those with CIND and VI a similar percentage transitioned to dementia (48%) and remained CIND (52%); there was no significant association between VI and transitioning from CIND to dementia (HR=0.94, 95%CI=0.56-1.55). Using logistic regression models, the same associations between VI and cognitive transitions were identified. Conclusions Poor vision is associated with the development of CIND. The association of VI and dementia appears to be due to the higher risk of dementia among individuals with CIND. Findings may inform the design of future interventional studies.

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Abstract P005: Comparative Effectiveness of Rivaroxaban versus Warfarin for the Treatment of Patients with Non-valvular Atrial Fibrillation

Circulation ◽

10.1161/circ.133.suppl_1.p005 ◽

2016 ◽

Vol 133 (suppl_1) ◽

Author(s):

Faye L Norby ◽

Lindsay G Bengtson ◽

Lin Y Chen ◽

Richard F MacLehose ◽

Pamela L Lutsey ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Real World ◽

Proportional Hazards ◽

Large Population ◽

Population Based ◽

Cox Proportional Hazards ◽

Gi Bleeding ◽

Cox Proportional Hazards Models ◽

The Us

Background: Rivaroxaban is a novel oral anticoagulant approved in the US in 2011 for prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF). Information on risks and benefits among rivaroxaban users in real-world populations is limited. Methods: We used data from the US MarketScan Commercial and Medicare Supplemental databases between 2010 and 2013. We selected patients with a history of NVAF and initiating rivaroxaban or warfarin. Rivaroxaban users were matched with up to 5 warfarin users by age, sex, database enrollment date and drug initiation date. Ischemic stroke, intracranial bleeding (ICB), myocardial infarction (MI), and gastrointestinal (GI) bleeding outcomes were defined by ICD-9-CM codes in an inpatient claim after drug initiation date. Cox proportional hazards models were used to assess the association between rivaroxaban vs. warfarin use and outcomes adjusting for age, sex, and CHA2DS2-VASc score. Separate models were used to compare a) new rivaroxaban users with new warfarin users, and b) switchers from warfarin to rivaroxaban to continuous warfarin users. Results: Our analysis included 34,998 rivaroxaban users matched to 102,480 warfarin users with NVAF (39% female, mean age 71), in which 487 ischemic strokes, 179 ICB, 647 MI, and 1353 GI bleeds were identified during a mean follow-up of 9 months. Associations of rivaroxaban vs warfarin were similar in new users and switchers; therefore we pooled both analyses. Rivaroxaban users had lower rates of ICB (hazard ratio (HR) (95% confidence interval (CI)) = 0.72 (0.46, 1.12))) and ischemic stroke (HR (95% CI) = 0.88 (0.68, 1.13)), but higher rates of GI bleeding (HR (95% CI) = 1.15 (1.01, 1.33)) when compared to warfarin users (table). Conclusion: In this large population-based study of NVAF patients, rivaroxaban users had a non-significant lower risk of ICB and ischemic stroke than warfarin users, but a higher risk of GI bleeding. These real-world findings are comparable to results reported in published clinical trials.

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Abstract T MP48: Androgen Suppression in Patients with Prostate Cancer Increases Incidence of Combined Cardiovascular Outcomes

Stroke ◽

10.1161/str.46.suppl_1.tmp48 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Zuber S Ali ◽

Danielle M Greere ◽

Robyn L Shearer ◽

Syed Ali Gardezi ◽

Arshad Jahangir

Keyword(s):

Prostate Cancer ◽

Proportional Hazards ◽

Age Groups ◽

The Elderly ◽

Cox Proportional Hazards ◽

Cardiovascular Outcomes ◽

Elevated Risk ◽

Disease Stage ◽

Cox Proportional Hazards Models ◽

Androgen Suppression

Introduction: Androgen suppression therapy for prostate cancer is controversial due to adverse fatal and non-fatal cardiovascular outcomes reported in some studies. However, effects of androgen suppression on stroke have not been fully assessed in the elderly. Methods: Patients diagnosed with prostate cancer during 2007-2013 in a large community-based healthcare system were identified from the Cancer Registry, electronic records, and billing codes. Those who underwent androgen suppression therapy with Gonadotropin-releasing hormone agonist (GnRH) were propensity-matched to patients treated without androgen suppression therapy by age at cancer diagnosis, race/ethnicity, disease stage and outcome, body mass index and use of surgery, radiation, and chemotherapy. Tests of independence and Cox proportional hazards models were used to examine effects of hormone therapy on acute myocardial infarction (AMI), stroke, and mortality outcomes. Models also adjusted for patient comorbidities. Results: A total of 1282 patients and 641 matched-pairs were identified, with mean diagnosis age of 69 yr and follow-up period of 3.05 yr. Effects of androgen suppression therapy on AMI (P=0.051) and stroke (P=0.062) were of marginal to non-significance, but adjusted-odds of death and combined AMI, stroke, and death were 1.61 times (P=0.002; odds ratio [OR] 95% CI: 1.19-2.18) and 1.70 times (P<0.001; OR 95% CI: 1.26-2.28) greater, respectively, for men with than without androgen suppression. An interaction of androgen suppression and age-group (<65 yr, 65-74 yr, >74 yr) was discovered for combined outcomes, suggesting increased probability of AMI, stroke, and/or death with age (8.6-20.0%; P=0.003) for patients without androgen suppression but elevated risk of outcomes across all age groups (18.3-22.4%; P=0.546) for men treated with androgen suppression therapy. Conclusion: Endogenous androgen suppression presents elevated risk of combined cardiovascular and death outcomes, especially for men <65 yr.

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Plant-Based Diets and Incident CKD and Kidney Function

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.12391018 ◽

2019 ◽

Vol 14 (5) ◽

pp. 682-691 ◽

Cited By ~ 36

Author(s):

Hyunju Kim ◽

Laura E. Caulfield ◽

Vanessa Garcia-Larsen ◽

Lyn M. Steffen ◽

Morgan E. Grams ◽

...

Keyword(s):

Kidney Function ◽

Proportional Hazards ◽

Population Based ◽

Vegetarian Diet ◽

Cox Proportional Hazards ◽

Healthy Plant ◽

Atherosclerosis Risk In Communities ◽

Plant Foods ◽

Cox Proportional Hazards Models ◽

Middle Aged Adults

Background and objectivesThe association between plant-based diets, incident CKD, and kidney function decline has not been examined in the general population. We prospectively investigated this relationship in a population-based study, and evaluated if risk varied by different types of plant-based diets.Design, setting, participants, & measurementsAnalyses were conducted in a sample of 14,686 middle-aged adults enrolled in the Atherosclerosis Risk in Communities study. Diets were characterized using four plant-based diet indices. In the overall plant-based diet index, all plant foods were positively scored; in the healthy plant-based diet index, only healthful plant foods were positively scored; in the provegetarian diet, selected plant foods were positively scored. In the less healthy plant-based diet index, only less healthful plant foods were positively scored. All indices negatively scored animal foods. We used Cox proportional hazards models to study the association with incident CKD and linear mixed models to examine decline in eGFR, adjusting for confounders.ResultsDuring a median follow-up of 24 years, 4343 incident CKD cases occurred. Higher adherence to a healthy plant-based diet (HR comparing quintile 5 versus quintile 1 [HRQ5 versus Q1], 0.86; 95% confidence interval [95% CI], 0.78 to 0.96; P for trend =0.001) and a provegetarian diet (HRQ5 versus Q1, 0.90; 95% CI, 0.82 to 0.99; P for trend =0.03) were associated with a lower risk of CKD, whereas higher adherence to a less healthy plant-based diet (HRQ5 versus Q1, 1.11; 95% CI, 1.01 to 1.21; P for trend =0.04) was associated with an elevated risk. Higher adherence to an overall plant-based diet and a healthy plant-based diet was associated with slower eGFR decline. The proportion of CKD attributable to lower adherence to healthy plant-based diets was 4.1% (95% CI, 0.6% to 8.3%).ConclusionsHigher adherence to healthy plant-based diets and a vegetarian diet was associated with favorable kidney disease outcomes.

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Physical activity types and atrial fibrillation risk in the middle-aged and elderly: The Rotterdam Study

European Journal of Preventive Cardiology ◽

10.1177/2047487318780031 ◽

2018 ◽

Vol 25 (12) ◽

pp. 1316-1323 ◽

Cited By ~ 7

Author(s):

Marijn Albrecht ◽

Chantal M Koolhaas ◽

Josje D Schoufour ◽

Frank JA van Rooij ◽

M Kavousi ◽

...

Keyword(s):

Physical Activity ◽

Atrial Fibrillation ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Total Physical Activity ◽

Rotterdam Study ◽

Cox Proportional Hazards Models ◽

Activity Types ◽

Study Population

Background The association between physical activity and atrial fibrillation remains controversial. Physical activity has been associated with a higher and lower atrial fibrillation risk. These inconsistent results might be related to the type of physical activity. We aimed to investigate the association of total and types of physical activity, including walking, cycling, domestic work, gardening and sports, with atrial fibrillation. Design Prospective cohort study. Methods Our study was performed in the Rotterdam Study, a prospective population-based cohort. We included 7018 participants aged 55 years and older with information on physical activity between 1997–2001. Cox proportional hazards models were used to examine the association of physical activity with atrial fibrillation risk. Models were adjusted for biological and behavioural risk factors and the remaining physical activity types. Physical activity was categorised in tertiles and the low group was used as reference. Results During 16.8 years of follow-up (median: 12.3 years, interquartile range: 8.7–15.9 years), 800 atrial fibrillation events occurred (11.4% of the study population). We observed no association between total physical activity and atrial fibrillation risk in any model. After adjustment for confounders, the hazard ratio and 95% confidence interval for the high physical activity category compared to the low physical activity category was: 0.71 (0.80–1.14) for total physical activity. We did not observe a significant association between any of the physical activity types with atrial fibrillation risk. Conclusion Our results suggest that physical activity is not associated with higher or lower risk of atrial fibrillation in older adults. Neither total physical activity nor any of the included physical activity types was associated with atrial fibrillation risk.

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Effect of Sociodemographic Factors on Surgical Consultations and Hip or Knee Replacements Among Patients with Osteoarthritis in British Columbia, Canada

The Journal of Rheumatology ◽

10.3899/jrheum.100456 ◽

2010 ◽

Vol 38 (3) ◽

pp. 503-509 ◽

Cited By ~ 30

Author(s):

M. MUSHFIQUR RAHMAN ◽

JACEK A. KOPEC ◽

ERIC C. SAYRE ◽

NELSON V. GREIDANUS ◽

JAAFAR AGHAJANIAN ◽

...

Keyword(s):

British Columbia ◽

Proportional Hazards ◽

Population Data ◽

Sociodemographic Factors ◽

Population Based ◽

Cox Proportional Hazards ◽

Orthopedic Surgeons ◽

Cox Proportional Hazards Models ◽

Knee Replacements ◽

Stratified Analysis

Objective.To quantify the effect of demographic variables and socioeconomic status (SES) on surgical consultation and total joint arthroplasty (TJA) rates among patients with osteoarthritis (OA), using population-based administrative data.Methods.A cohort study was conducted in British Columbia using population data from 1991 to 2004. From April 1996 to March 1998, we documented 34,420 new patients with OA and these patients were followed to March 2004 for their first surgical consultation and TJA. Effects of age, sex, and SES were evaluated by Cox proportional hazards models after adjusting for comorbidities and pain medication used.Results.During a mean 5.5-year followup period, 7475 patients with OA had their first surgical consultations and 2814 patients received TJA within a 6-year mean followup period. Crude hazards ratio (HR) for men compared to women was 1.25 (95% CI 1.20–1.31) for surgical consultation and was 1.14 (95% CI 1.06–1.23) for TJA. The interaction between sex and SES was significant. Stratified analysis showed among men an HR of 1.42 (95% CI 1.27–1.58) and 1.52 (95% CI 1.26–1.83) for surgical consultations and TJA, respectively, for the highest SES compared with the lowest SES quintiles. Similarly significant results were observed among women.Conclusion.Differential access to the healthcare system exists among patients with OA. Women with OA were less likely than men to see an orthopedic surgeon as well as to obtain TJA. Patients with higher SES consulted orthopedic surgeons more frequently and received more TJA than those with the lowest SES.

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Dietary selenium intake and mortality in two population-based cohort studies of 133 957 Chinese men and women

Public Health Nutrition ◽

10.1017/s1368980016001130 ◽

2016 ◽

Vol 19 (16) ◽

pp. 2991-2998 ◽

Cited By ~ 7

Author(s):

Jiang-Wei Sun ◽

Xiao-Ou Shu ◽

Hong-Lan Li ◽

Wei Zhang ◽

Jing Gao ◽

...

Keyword(s):

Cancer Mortality ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Sensitivity Analyses ◽

Health Study ◽

Chinese Populations ◽

Urban City ◽

Cox Proportional Hazards Models ◽

Hazard Ratios

AbstractObjectiveTo investigate the potential influence of dietary Se intake on mortality among Chinese populations.DesignWe prospectively evaluated all-cause, CVD and cancer mortality risks associated with dietary Se intake in participants of the Shanghai Women’s Health Study (SWHS) and the Shanghai Men’s Health study (SMHS). Dietary Se intake was assessed by validated FFQ during in-person interviews. Cox proportional hazards models were used to calculate hazard ratios (HR) and 95 % CI.SettingUrban city in China.SubjectsChinese adults (n 133 957).ResultsDuring an average follow-up of 13·90 years in the SWHS and 8·37 years in the SMHS, 5749 women and 4217 men died. The mean estimated dietary Se intake was 45·48 μg/d for women and 51·34 μg/d for men, respectively. Dietary Se intake was inversely associated with all-cause mortality and CVD mortality in both women and men, with respective HR for the highest compared with the lowest quintile being 0·79 (95 % CI 0·71, 0·88; Ptrend<0·0001) and 0·80 (95 % CI 0·66, 0·98; Ptrend=0·0268) for women, and 0·79 (95 % CI 0·70, 0·89; Ptrend=0·0001) and 0·66 (95 % CI 0·54, 0·82; Ptrend=0·0002) for men. No significant associations were observed for cancer mortality in both women and men. Results were similar in subgroup and sensitivity analyses.ConclusionsDietary Se intake was inversely associated with all-cause and cardiovascular mortality in both sexes, but not cancer mortality.

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Long-term cardiovascular and cerebrovascular morbidity in Israeli thyroid cancer survivors

Endocrine Connections ◽

10.1530/ec-19-0038 ◽

2019 ◽

Vol 8 (4) ◽

pp. 398-406 ◽

Cited By ~ 1

Author(s):

Elena Izkhakov ◽

Joseph Meyerovitch ◽

Micha Barchana ◽

Yacov Shacham ◽

Naftali Stern ◽

...

Keyword(s):

Thyroid Cancer ◽

Thyroid Disease ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Control Group ◽

Study Group ◽

American Thyroid Association ◽

Cox Proportional Hazards Models ◽

Increased Risk

Objective Thyroid cancer (TC) survivors may be at risk of subsequent cardiovascular and cerebrovascular (CaV&CeV) morbidity. The 2009 American Thyroid Association (ATA) guidelines recommended less aggressive treatment for low-risk TC patients. The aim of this study was to assess the atherosclerotic CaV&CeV outcome of Israeli TC survivors compared to individuals with no thyroid disease, and the atherosclerotic CaV&CeV outcome before (2000–2008) and after (2009–2011) implementation of the 2009 ATA guidelines. Methods All members of the largest Israeli healthcare organization who were diagnosed with TC from 1/2000 to 12/2014 (study group) and age- and sex-matched members with no thyroid disease (controls) were included. Adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated using Cox proportional hazards models. Results The mean follow-up was 7.6 ± 4.2 and 7.8 ± 4.1 years for the study (n = 5,677, 79% women) and control (n = 23,962) groups, respectively. The former had an increased risk of new atherosclerotic CaV&CeV events (adjusted HR 1.26, 95% CI 1.15–1.39). The 5-year incidence of CaV&CeV was lower (adjusted HR 0.49, 95% CI 0.38–0.62) from 2009 to 2011 compared to 2000 to 2008, but remained higher in the study group than in the control group (adjusted HR 1.5, 95% CI 1.14–1.69). Conclusions This large Israeli population-based cohort study showed greater atherosclerotic CaV&CeV morbidity in TC survivors compared to individuals with no thyroid diseases. There was a trend toward a decreased 5-year incidence of atherosclerotic CaV&CeV events among TC survivors following the implementation of the 2009 ATA guidelines, but it remained higher compared to the general population.

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Relationship Between Fish Oil Use and Incidence of Primary Liver Cancer: Findings From a Population-Based Prospective Cohort Study

Frontiers in Nutrition ◽

10.3389/fnut.2021.771984 ◽

2021 ◽

Vol 8 ◽

Author(s):

Wei Jiang ◽

Fu-Rong Li ◽

Huan-Huan Yang ◽

Guo-Chong Chen ◽

Yong-Fei Hua

Keyword(s):

Liver Cancer ◽

Fish Oil ◽

Lower Risk ◽

Proportional Hazards ◽

Dietary Habits ◽

Primary Liver Cancer ◽

Population Based ◽

Cox Proportional Hazards ◽

Histological Subtypes ◽

Cox Proportional Hazards Models

Background: N-3 long-chain polyunsaturated fatty acids (LCPUFAs) prevented non-alcoholic steatohepatitis (NASH) and hepatocellular carcinoma (HCC) in studies of mouse models. We examined prospective relationships between fish oil use and risk of primary liver cancer and the major histological subtypes, such as HCC and intrahepatic cholangiocarcinoma (ICC).Methods: We included 434,584 middle-aged and older men and women who were free of cancer at recruitment of the UK Biobank (2006–2010). Information on fish oil use and other dietary habits was collected via questionnaires. Cox proportional hazards models were used to compute the hazard ratio (HR) and 95% CI of liver cancer associated with fish oil use, with adjustment for socio-demographic, lifestyle, dietary, and other clinical risk factors.Results: At baseline, 31.4% of participants reported regular use of fish oil supplements. During a median of 7.8 years of follow-up, 262 incident liver cancer cases were identified, among which 127 were HCC and 110 were ICC cases. As compared with non-users, fish oil users had a significantly 44% (95% CI: 25–59%) lower risk of total liver cancer, and 52% (95% CI: 24–70%) and 40% (95% CI: 7–61%) lower risk of HCC and ICC, respectively. Higher intake of oily fish also was associated with a lower risk of HCC (≥2 vs. <1 serving/week: HR = 0.46; 95% CI: 0.23–0.96; P-trend = 0.027) but not ICC (P-trend = 0.96).Conclusion: Habitual use of fish oil supplements was associated lower risk of primary liver cancer regardless of cancer histological subtypes, potentially supporting a beneficial role of dietary n-3 LCPUFAs in liver cancer prevention.

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Visual impairment and risk of dementia in two population-based prospective cohorts: UK Biobank and EPIC-Norfolk

The Journals of Gerontology Series A ◽

10.1093/gerona/glab325 ◽

2021 ◽

Author(s):

Thomas J Littlejohns ◽

Shabina Hayat ◽

Robert Luben ◽

Carol Brayne ◽

Megan Conroy ◽

...

Keyword(s):

Visual Impairment ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Uk Biobank ◽

Cox Proportional Hazards Models ◽

Hazard Ratios ◽

Promising Target ◽

Increased Risk

Abstract Visual impairment has emerged as a potential modifiable risk factor for dementia. However, there are a lack of large studies with objective measures of vison and with more than ten years of follow-up. We investigated whether visual impairment is associated with an increased risk of incident dementia in UK Biobank and EPIC-Norfolk. In both cohorts, visual acuity was measured using a “logarithm of the minimum angle of resolution” (LogMAR) chart and categorised as no (≤0.30 LogMAR), mild (>0.3 - ≤0.50 LogMAR), and moderate to severe (>0.50 LogMAR) impairment. Dementia was ascertained through linkage to electronic medical records. After restricting to those aged ≥60 years, without prevalent dementia and with eye measures available, the analytic samples consisted of 62,206 UK Biobank and 7,337 EPIC-Norfolk participants, respectively. In UK Biobank and EPIC-Norfolk. respectively, 1,113 and 517 participants developed dementia over 11 and 15 years of follow-up. Using multivariable cox proportional-hazards models, the hazard ratios for mild and moderate to severe visual impairment were 1.26 (95% Confidence Interval [CI] 0.92-1.72) and 2.16 (95% CI 1.37-3.40), in UK Biobank, and 1.05 (95% CI 0.72-1.53) and 1.93 (95% CI 1.05-3.56) in EPIC-Norfolk, compared to no visual impairment. When excluding participants censored within 5 years of follow-up or with prevalent poor or fair self-reported health, the direction of the associations remained similar for moderate impairment but were not statistically significant. Our findings suggest visual impairment might be a promising target for dementia prevention, however the possibility of reverse causation cannot be excluded.

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