Peran Gejala Depresi sebagai Faktor Prediktor Kematian dalam Enam Bulan pada Lansia yang Menjalani Hemodialisis

Pendahuluan. Depresi merupakan gangguan mental yang banyak ditemukan baik pada kelompok lansia maupun pada pasien yang menjalani hemodialisis. Depresi berdampak buruk terhadap kualitas hidup pasien. Penelitian yang menghubungkan depresi sebagai faktor prediktor kematian dalam enam bulan pada lansia yang menjalani hemodialisis belum pernah dilakukan di Indonesia. Penelitian ini bertujuan untuk mengetahui peran gejala depresi sebagai faktor prediktor kematian dalam 6 bulan pada lansia yang menjalani hemodialisis.Metode. Penelitian dengan desain kohort prospektif dilakukan pada Februari – Agustus 2020 di Unit Hemodialisis Rumah Sakit Roemani Muhammadiyah Semarang. Adapun kriteria inklusi meliputi lansia (usia ≥60 tahun), menjalani hemodialisis ≥3 bulan, frekuensi hemodialisis 2 kali seminggu, bersedia mengikuti penelitian, dapat berkomunikasi dengan baik, dan tidak terdapat riwayat gangguan mental sebelumnya yang meliputi riwayat gangguan psikotik, dan gangguan mental akibat penggunaan zat. Sedangkan pasien dengan data tidak lengkap, pindah ke unit hemodialisis lain, HBsAg +, kadar Hemoglobin <7 mg/dl, skor RAPUH >2, dan memiliki stressor lain yang tidak terkait dengan hemodialisis atau Penyakit Ginjal Kronis (PGK) seperti faktor sosial, keluarga, dan pekerjaan dieksklusi dari penelitian ini. Depresi dinilai menggunakan kuesioner Beck Depression Inventory-II yang telah diterjemahkan ke dalam Bahasa Indonesia. Adapun pengisian kuesioner dilakukan oleh responden dengan panduan oleh peneliti dalam proses pengisiannya. Data yang terkumpul kemudian dianalisis menggunakan Kaplan Meier dan Cox Regression menggunakan SPSS 18.0.Hasil. Dari total 32 responden, mayoritas adalah laki-laki yaitu sebanyak 26 responden (81,3%). Rerata usia responden adalah 67,2 (simpang baku [SB] 7) tahun. Sebanyak 6 (18,7%) responden mengalami depresi dan 26 (81,3%) responden tidak mengalami depresi. Hasil analisis Cox Regression menunjukkan bahwa depresi berperan sebagai faktor prediktor kematian dalam 6 bulan pada lansia yang menjalani hemodialisis (p=0.012), dan hazard ratio=10,149.Simpulan. Depresi berperan sebagai faktor prediktor kematian dalam 6 bulan pada lansia yang menjalani hemodialisis.Kata Kunci: Depresi, geriatri, mortalitas, penyakit ginjal kronik, penyakit ginjal tahap akhirDepressive symptoms as a Predictor Factor of All-Cause Mortality within Six Months in Elderly Hemodialysis PatientsIntroduction. Depression is a mental disorder that is often found in the elderly and hemodialysis patients, resulting in bad effects on patients. There is no study on the relationship between depression and all-cause mortality risk in elderly hemodialysis patients in Indonesia. This study aimed to determine the role of depression as a predictor factor of all-cause mortality within 6 months in elderly hemodialysis patients. Methods. A prospective cohort study was conducted from February to August 2020 at the hemodialysis unit of Roemani Muhammadiyah Hospital, Semarang. The inclusion criteria were elderly patients (aged ≥60 years), undergoing hemodialysis ≥3 months, hemodialysis frequency twice a week, willing to participate in this study, able to communicate well, and has no history of mental disorders include a history of psychotic disorders and mental disorders due to substance use. Meanwhile, patients whose data were incomplete, transferred to another hemodialysis unit, HBsAg +, hemoglobin level <7 mg/dl. FRAILTY score >2, and had other stressors not related to hemodialysis or chronic kidney disease (CKD) such as social, family, and work factors were excluded from this study. Depression was assessed using the Beck Depression Inventory-II questionnaire. The collected data was then analyzed using Kaplan Meier and Cox Regression.Results. Of 32 respondents, most of them were male (81.3%). The mean age was 67.2 (SD 7) years. There were 6 (18.7%) respondents categorized into a depression group and 26 (81.3%) respondents into a non-depression group. Cox Regression analysis showed that depression was a predicting factor of all-cause mortality within six months in elderly hemodialysis patients (p value=0.012, and Hazard ratio=10.149). Conclusion. Depression is a predictor factor of all-cause mortality within six months in elderly hemodialysis patients.

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Comparison of 24-hour and Office Pulse Wave Velocity for Prediction of Mortality in Hemodialysis Patients

American Journal of Nephrology ◽

10.1159/000499532 ◽

2019 ◽

Vol 49 (4) ◽

pp. 317-327 ◽

Cited By ~ 10

Author(s):

Julia Matschkal ◽

Christopher C. Mayer ◽

Pantelis A. Sarafidis ◽

Georg Lorenz ◽

Matthias C. Braunisch ◽

...

Keyword(s):

Regression Analysis ◽

Pulse Wave Velocity ◽

Wave Velocity ◽

Cardiovascular Mortality ◽

Pulse Wave ◽

Cox Regression ◽

Hemodialysis Patients ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

All Cause Mortality

Background: Mortality in hemodialysis patients still remains unacceptably high. Enhanced arterial stiffness is a known cardiovascular risk factor, and pulse wave velocity (PWV) has proven to be a valid parameter to quantify risk. Recent studies showed controversial results regarding the prognostic significance of PWV for mortality in hemodialysis patients, which may be due to methodological issues, such as assessment of PWV in the office setting (Office-PWV). Method: This study cohort contains patients from the “Risk stratification in end-stage renal disease – the ISAR study,” a multicenter prospective longitudinal observatory cohort study. We examined and compared the predictive value of ambulatory 24-hour PWV (24 h-PWV) and Office-PWV on mortality in a total of 344 hemodialysis patients. The endpoints of the study were all-cause and cardiovascular mortality. Survival analysis included Kaplan-Meier estimates and Cox regression analysis. Results: During a follow-up of 36 months, a total of 89 patients died, 35 patients due to cardiovascular cause. Kaplan-Meier estimates for tertiles of 24 h-PWV and Office-PWV were similarly associated with mortality. In univariate Cox regression analysis, 24 h-PWV and Office-PWV were equivalent predictors for all-cause and cardiovascular mortality. After adjustment for common risk factors, only 24 h-PWV remained solely predictive for all-cause mortality (hazard ratio 2.51 [95% CI 1.31–4.81]; p = 0.004). Conclusions: Comparing both measurements, 24 h-PWV is an independent predictor for all-cause-mortality in hemodialysis patients beyond Office-PWV.

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Plasma syndecan-1 in hemodialysis patients associates with survival and lower markers of volume status

AJP Renal Physiology ◽

10.1152/ajprenal.00252.2018 ◽

2019 ◽

Vol 316 (1) ◽

pp. F121-F127 ◽

Cited By ~ 1

Author(s):

Josephine Koch ◽

Nienke M. A. Idzerda ◽

Wendy Dam ◽

Solmaz Assa ◽

Casper F. M. Franssen ◽

...

Keyword(s):

Cardiovascular Events ◽

Cox Regression ◽

Hemodialysis Patients ◽

Volume Status ◽

Cox Regression Analysis ◽

Endothelial Markers ◽

Kaplan Meier ◽

Dialysis Vintage ◽

All Cause Mortality ◽

Renal Tubular

Syndecan-1, a transmembrane heparan sulfate proteoglycan, associates with renal and cardiovascular functioning. We earlier reported syndecan-1 to be involved in renal tubular regeneration. We now examined plasma values of syndecan-1 in a hemodialysis cohort and its association with volume and inflammatory and endothelial markers in addition to outcome. Eighty-four prevalent hemodialysis patients were evaluated for their plasma syndecan-1 levels by ELISA before the start of hemodialysis, as well as 60, 180, and 240 min after start of dialysis. Patients were divided into sex-stratified tertiles based on predialysis plasma syndecan-1 levels. We studied the association between plasma levels of syndecan-1 and volume, inflammation, and endothelial markers and its association with cardiovascular events and all-cause mortality using Kaplan-Meier curves and Cox regression analyses with adjustments for gender, age, diabetes, and dialysis vintage. Predialysis syndecan-1 levels were twofold higher in men compared with women ( P = 0.0003). Patients in the highest predialysis plasma syndecan-1 tertile had a significantly higher ultrafiltration rate ( P = 0.034) and lower plasma values of BNP ( P = 0.019), pro-ANP ( P = 0.024), and endothelin ( P < 0.0001) compared with the two lower predialysis syndecan-1 tertiles. No significant associations with inflammatory markers were found. Cox regression analysis showed that patients in the highest syndecan-1 tertile had significantly less cardiovascular events and better survival compared with the lowest syndecan-1 tertile ( P = 0.02 and P = 0.005, respectively). In hemodialysis patients, higher plasma syndecan-1 levels were associated with lower concentrations of BNP, pro-ANP, and endothelin and with better patient survival. This may suggest that control of volume status in hemodialysis patients allows an adaptive tissue regenerative response as reflected by higher plasma syndecan-1 levels.

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P2659Difference of prognostic impact of Killip classification in ACS patients with or without hemodialysis

European Heart Journal ◽

10.1093/eurheartj/ehz748.0979 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Takasaki ◽

T Kurita ◽

J Masuda ◽

K Dohi ◽

K Hoshino ◽

...

Keyword(s):

Cox Regression ◽

Chronic Phase ◽

Prognostic Impact ◽

Chi Square ◽

Coronary Syndrome ◽

Kaplan Meier ◽

All Cause Mortality ◽

History Of ◽

Artery Disease

Abstract Background Cardiovascular deaths are more frequently in hemodialysis (HD) patients compared to general population. However, difference of prognosis of acute coronary syndrome (ACS) patients with or without HD were not well evaluated. Purpose The purpose of this study was to evaluate the clinical and prognostic characteristics of ACS patients with HD compared to that of ACS patients without HD. Methods We investigated 3427 ACS patients including 63 HD and 3364 non-HD patients between 2013 and 2017 using date from Mie ACS registry, a retrospective and multicenter registry. The primary outcome was defined as all-cause mortality. Results HD patients showed significantly higher prevalence of diabetes mellitus, past treatment of coronary artery disease, history of myocardial infarction and Killip ≥2 compared to non-HD patients (p<0.05, respectively). During the follow-up periods (median 719 days), 425 (12.4%) patients experienced all-cause death. HD patients demonstrated the higher all-cause mortality rate compared to that of non-HD patients during the follow-up (11.9% versus 38.1%, p<0.001, chi square). Kaplan Meier survival curves demonstrated that HD and non-HD patients with Killip 1 showed similar 30-day mortality, and Killip ≥2 patients also showed similar prognosis (Left side of figure). On the other hand, all cause mortality at 2 years were higher in Killip 1 HD patients compared to Killip 1 non-HD patients and similar between Killip 1 HD patients and Killip ≥2 non-HD patients in the 30 days landmark analysis (Right side of figure). In addition, cox regression analyses for all cause mortality demonstrated that HD was a strongest independent prognostic factor not of 30-day mortality but of after 30-day mortality with hazard ratio of 4.09 (95% confidential interval: 2.32–7.21, p<0.001). Figure 1 Conclusion Careful management are required in chronic phase for ACS patients with HD even in Killip 1 classification.

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Predictors of Survival in Chronic Hemodialysis Patients: A 10-Year Longitudinal Follow-Up Analysis

American Journal of Nephrology ◽

10.1159/000513951 ◽

2021 ◽

Vol 52 (2) ◽

pp. 108-118

Author(s):

Takuhiro Moromizato ◽

Kentaro Kohagura ◽

Kiyoyuki Tokuyama ◽

Yoshiki Shiohira ◽

Shigeki Toma ◽

...

Keyword(s):

Risk Factors ◽

Cox Regression ◽

Significant Risk ◽

Hemodialysis Patients ◽

Chronic Hemodialysis ◽

Regression Analyses ◽

All Cause Mortality ◽

History Of ◽

The Impact

Background: Risk factors of mortality in chronic hemodialysis patients have not yet been sufficiently evaluated. In particular, chronological transits and interactions of the impact of risk factors have rarely been described. Methods: This study is a post hoc analysis of the participants in the Olmesartan Clinical Trial in Okinawan Patients under OKIDS (OCTOPUS) study conducted between June 2006 and June 2011. We additionally followed up on the prognosis of the participants until July 31, 2018. Standardized univariable and multivariable Cox regression analyses were used to evaluate the influences of the participants’ baseline characteristics on all-cause mortality. We also evaluated chronological changes in the impacts of risk factors, interactions among predictors, and the influence of missing values using sensitivity analyses. Results: Of the 469 original trial participants, 461 participants were evaluated. The median time of follow-up was 10.2 years. A total of 211 (45.8%) participants were deceased. The leading causes of death were infection (n = 72, 34.1%) and cardiovascular disease (n = 66, 31.3%). Univariate and multivariate Cox regression analyses revealed that the impact of diabetes mellitus, history of coronary intervention, and hypoalbuminemia were significant risk factors for mortality during the whole follow-up period. During the early follow-up period (≤3 years), standardized univariate Cox regression analyses revealed that history of amputation (hazard ratio [HR] = 4.61, p < 0.001), lower dry weight, higher cardiothoracic ratio, and lower potassium levels were statistically significant risks. In those who survived for longer than 3 years, a history of stroke (HR = 1.73, p = 0.006), higher systolic blood pressure, lower serum sodium levels, and higher levels of hemoglobin, and serum phosphate were significant risks. We also observed a stable interaction between the impacts of serum phosphate and albumin on all-cause mortality. Conclusion: In chronic hemodialysis patients, targets to improve the short-term prognosis and long-term prognosis are not equivalent. Hyperphosphatemia was a significant risk factor for the all-cause mortality among patients with normal serum albumin levels but not among patients with compromised albumin levels.

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Natural history definition and a suggested clinical approach to Buerger's disease: a case-control study with survival analysis

Vascular ◽

10.1258/vasc.2011.oa0323 ◽

2012 ◽

Vol 20 (4) ◽

pp. 198-202 ◽

Cited By ~ 6

Author(s):

Bahare Fazeli ◽

Hassan Ravari ◽

Reza Assadi

Keyword(s):

Multivariate Analysis ◽

Natural History ◽

Cox Regression ◽

Major Amputation ◽

Clinical Approach ◽

Buerger’S Disease ◽

Buerger's Disease ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

History Of

The aim of this study was first to describe the natural history of Buerger's disease (BD) and then to discuss a clinical approach to this disease based on multivariate analysis. One hundred eight patients who corresponded with Shionoya's criteria were selected from 2000 to 2007 for this study. Major amputation was considered the ultimate adverse event. Survival analyses were performed by Kaplan–Meier curves. Independent variables including gender, duration of smoking, number of cigarettes smoked per day, minor amputation events and type of treatments, were determined by multivariate Cox regression analysis. The recorded data demonstrated that BD may present in four forms, including relapsing-remitting (75%), secondary progressive (4.6%), primary progressive (14.2%) and benign BD (6.2%). Most of the amputations occurred due to relapses within the six years after diagnosis of BD. In multivariate analysis, duration of smoking of more than 20 years had a significant relationship with further major amputation among patients with BD. Smoking cessation programs with experienced psychotherapists are strongly recommended for those areas in which Buerger's disease is common. Patients who have smoked for more than 20 years should be encouraged to quit smoking, but should also be recommended for more advanced treatment for limb salvage.

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Predictors of three-month mortality among hospitalized older adults in Togo

10.21203/rs.3.rs-38973/v2 ◽

2020 ◽

Author(s):

Fifonsi Adjidossi GBEASOR-KOMLANVI ◽

Martin Kouame TCHANKONI ◽

Akila Wimima BAKOUBAYI ◽

Matthieu Yaovi LOKOSSOU ◽

Arnold SADIO ◽

...

Keyword(s):

Older Adults ◽

Hospital Mortality ◽

Cox Regression ◽

Sub Saharan Africa ◽

Mortality Data ◽

Kaplan Meier ◽

All Cause Mortality ◽

Hospitalized Older Adults ◽

Sub Saharan

Abstract Background: Assessing hospital mortality and its predictors is important as some of these can be prevented through appropriate interventions. Few studies have reported hospital mortality data among older adults in sub-Saharan Africa. The objective of this study was to assess the mortality and associated factors among hospitalized older adults in Togo.Methods: We conducted a prospective cohort study from February 2018 to September 2019 among patients ≥50 years admitted in medical and surgical services of six hospitals in Togo. Data were recorded during hospitalization and through telephone follow-up survey within 90 days after admission. The main outcome was all-cause mortality at 3 months. Survival curves were estimated using the Kaplan-Meier method and Cox regression analyses were performed to assess predictors of mortality.Results: The median age of the 650 older adults included in the study period was 61 years, IQR: [55-70] and at least one comorbidity was identified in 59.7% of them. The all-cause mortality rate of 17.2% (95%CI: 14.4-20.4) and the majority of death (93.7%) occurred in hospital. Overall survival rate was 85.5% and 82.8% after 30 and 90 days of follow-up, respectively. Factors associated with 3-month mortality were the hospital level in the health pyramid, hospitalization service, length of stay, functional impairment, depression and malignant diseases.Conclusion: Togolese health system needs to adjust its response to an aging population in order to provide the most effective care.

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Predictive Value of Atrial Electromechanical Delay on Long-Term Cardiovascular Outcomes in Hemodialysis Patients

American Journal of Nephrology ◽

10.1159/000441099 ◽

2015 ◽

Vol 42 (3) ◽

pp. 239-249 ◽

Cited By ~ 2

Author(s):

Kultigin Turkmen ◽

Levent Demirtas ◽

Ergun Topal ◽

Abduzhappar Gaipov ◽

Ismail Kocyigit ◽

...

Keyword(s):

Regression Analysis ◽

Total Cholesterol ◽

Cox Regression ◽

Healthy Individuals ◽

Electromechanical Delay ◽

Cox Regression Analysis ◽

Atrial Electromechanical Delay ◽

Kaplan Meier ◽

All Cause Mortality ◽

Spearman Test

Background: Atrial electromechanical delay (AEMD) times were considered independent predictors of cardiovascular morbidity among the general population. We aimed at evaluating AEMD times and other risk factors associated with 2-year combined cardiovascular (CV) events in HD patients. Material and Methods: Sixty hemodialysis (HD) and 44 healthy individuals were enrolled in this prospective study. Echocardiography was performed before the mid-week dialysis session for HD patients. Data were expressed as mean ± SD. Spearman test was used to assess linear associations. Survival was examined with the Kaplan-Meier method. Multivariate Cox regression analysis was used to determine the predictors of combined CV events in this cohort. Results: At the beginning of the study, left intra-atrial-AEMD times were significantly longer in HD patients compared to the left intra-atrial-AEMD times in healthy individuals. After 24 months, 41 patients were still on HD treatment and 19 (31.6%) had died. Serum triglyceride, total cholesterol and albumin were found to be higher and C-reactive protein (CRP) levels, left intra-atrial EMD time (LIAT) and interatrial EMD times were found to be lower in survived HD patients. With the cut-off median values of 3.5 g/dl for albumin, 0.87 mg/dl for CRP, 157 mg/dl for total cholesterol and 151 mg/dl for triglyceride, the Kaplan-Meier curves demonstrated significant differences in terms of all-cause mortality. We also demonstrated the Kaplan-Meier survival curves of HD patients according to tertile values of LIAT. Cox regression analysis revealed that increased CRP and higher LIAT were found to be independent predictors of combined CV events. Conclusions: Increased LIAT and inflammation were found to be closely associated with 2 years combined CV events and all-cause mortality in HD patients.

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Mortality in Patients with Diabetic Foot Ulcers: Causes, Risk Factors, and Their Association with Evolution and Severity of Ulcer

Journal of Clinical Medicine ◽

10.3390/jcm9093009 ◽

2020 ◽

Vol 9 (9) ◽

pp. 3009

Author(s):

José Antonio Rubio ◽

Sara Jiménez ◽

José Luis Lázaro-Martínez

Keyword(s):

Diabetic Foot ◽

Cox Regression ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Cox Regression Analysis ◽

Kaplan Meier ◽

Hazard Ratios ◽

History Of

Background: This study reviews the mortality of patients with diabetic foot ulcers (DFU) from the first consultation with a Multidisciplinary Diabetic Foot Team (MDFT) and analyzes the main cause of death, as well as the relevant clinical factors associated with survival. Methods: Data of 338 consecutive patients referred to the MDFT center for a new DFU during the 2008–2014 period were analyzed. Follow-up: until death or until 30 April 2020, for up to 12.2 years. Results: Clinical characteristics: median age was 71 years, 92.9% had type 2 diabetes, and about 50% had micro-macrovascular complications. Ulcer characteristics: Wagner grade 1–2 (82.3%), ischemic (49.2%), and infected ulcers (56.2%). During follow-up, 201 patients died (59.5%), 110 (54.7%) due to cardiovascular disease. Kaplan—Meier curves estimated a reduction in survival of 60% with a 95% confidence interval (95% CI), (54.7–65.3) at 5 years. Cox regression analysis adjusted to a multivariate model showed the following associations with mortality, with hazard ratios (HRs) (95% CI): age, 1.07 (1.05–1.08); HbA1c value < 7% (53 mmol/mol), 1.43 (1.02–2.0); active smoking, 1.59 (1.02–2.47); ischemic heart or cerebrovascular disease, 1.55 (1.15–2.11); chronic kidney disease, 1.86 (1.37–2.53); and ulcer severity (SINBAD system) 1.12 (1.02–1.26). Conclusion: Patients with a history of DFU have high mortality. Two less known predictors of mortality were identified: HbA1c value < 7% (53 mmol/mol) and ulcer severity.

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Distribution and association of cancer with mortality in end-stage renal disease patients receiving dialysis

Journal of Nephrology ◽

10.1007/s40620-019-00649-4 ◽

2019 ◽

Vol 32 (6) ◽

pp. 1003-1009

Author(s):

Rajkumar Chinnadurai ◽

Emma Flanagan ◽

Philip A. Kalra

Keyword(s):

Cox Regression ◽

Matched Sample ◽

Cancer History ◽

Cancer Group ◽

All Cause Mortality ◽

History Of ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients

Abstract Background and aims Cancer in end-stage renal disease (ESRD) patients is an important comorbidity to be taken into consideration while planning for renal replacement therapy (RRT) options due to its associated increased mortality. This study aims to investigate the natural history and association of cancer with all-cause mortality in an ESRD population receiving dialysis. Method The study was conducted on 1271 ESRD patients receiving dialysis between January 2012 and December 2017. A comparative analysis was carried out between 119 patients with and 1152 without cancer history at entry into this study (baseline). A 1:2 (119 cancer: 238 no cancer) propensity score matched sample of 357 patients was also used for analysis. Cox-regression analysis was used to study the strength of the association between cancer and all-cause mortality. Kaplan–Meier (KM) analysis was used to demonstrate the difference in cumulative survival between the groups. A competing risk analysis was also carried out to calculate the probability of competing events (death, transplant and incident cancer). Results At baseline, 10.1% of the cohort had a history of cancer (current and past) with the annual incident rate being 1.3%. Urological cancers were the leading site of cancer. The median age of our cohort was 63 years with a predominance of males (63%) and Caucasians (79%). The majority (69%) of the cohort were receiving haemodialysis. 47% had a history of diabetes with 88% being hypertensive. During a median follow-up of 28 months, the proportion of deaths observed was similar between the groups in the matched sample (cancer 49.6 versus no-cancer 52.1%, p value 0.77). In a univariable Cox-regression model, there was no significant association between cancer and all-cause mortality (HR 1.28; 95% CI 0.97–1.67; p = 0.07). The KM estimates showed similar observations in the cumulative survival between the groups (matched sample log-rank, p value 0.85). In competing risk analysis, the cumulative probability of death at 5 years was non-significantly higher in the cancer group (cancer group 64% vs no cancer group 51%, p value 0.16). Conclusions In our real-world multi-morbid dialysis cohort of 119 cancer patients, baseline cancer history did not prove to be an independent risk factor for all-cause mortality in the first 5 years of follow-up, suggesting the need for a case-by-case approach in provision of RRT options, including transplantation.

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The clinical impact and outcomes of immunohistochemistry-only metastases in breast cancer

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.613 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 613-613

Author(s):

M. S. Pugliese ◽

M. M. Stempel ◽

S. M. Patil ◽

M. Hsu ◽

H. S. Cody ◽

...

Keyword(s):

Breast Cancer ◽

Cox Regression ◽

Rare Event ◽

Axillary Recurrence ◽

Unilateral Breast Cancer ◽

Prognostic Features ◽

Regression Methods ◽

Kaplan Meier ◽

History Of

613 Background: Modern surgical and pathologic techniques can detect small volume axillary metastases in breast cancer. The clinical significance of these metastases was evaluated in comparison to patients with negative sentinel lymph nodes (Neg-SN). Methods: Retrospective database review from 1997 through 2003 for eligible patients with unilateral breast cancer and no history of significant non-breast malignancy identified 232 patients with sentinel lymph node (SLN) metastases identified only by immunohistochemical stains (IHC-SN). They were compared to 252 Neg-SN controls selected at random from the same database population. Statistical analysis was performed with 2-sample tests, Kaplan-Meier, and Cox regression methods. Results: IHC-SN patients had worse prognostic features and received more systemic therapy than controls (Table). Age and ER status were similar. In 123 IHC-SN patients treated with axillary dissection (ALND), 16% had macrometastases in the non-SLNs. Only one axillary recurrence occurred in the group of IHC-SN patients without ANLD (n=109). With median follow up of 5 years (range 0.01–12.0), 28 recurrences and 25 deaths occurred. There were no differences between cases and controls for recurrence-free survival (RFS) or overall survival (OS) both by univariate and multivariate models that included variables such as age, tumor size, chemotherapy and hormone therapy [HR 0.99 (95%CI 0.43–2.28, p=0.99) for RFS, HR 2.06 (95%CI 0.79–5.35) p=0.14 for OS]. In IHC-SN patients treated with ALND, patients with positive non-SLNs (n=20) tended to have worse RFS than those with negative non-SLNs (n=103) [RFS 89% vs. 97% at 5 yrs (p=0.06)]. Conclusions: A significant number of IHC-SN patients had a macrometastasis identified at ALND. In patients not undergoing dissection, axillary recurrence was a rare event. However, failure to identify additional metastases by omitting ALND may result in understaging and inadequate systemic treatment in some patients. [Table: see text] No significant financial relationships to disclose.

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