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2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 303-303
Author(s):  
Lawson Eng ◽  
Rinku Sutradhar ◽  
Yue Niu ◽  
Ning Liu ◽  
Ying Liu ◽  
...  

303 Background: ICIs are a common therapeutic option for many solid tumors. While prior studies have shown that ATB exposure may negatively impact ICI outcomes through gut microbiome changes, many were small studies with heterogeneity in ATB classes and exposure windows. Here, we performed a population level retrospective cohort study to evaluate the impact of ATB exposure prior to ICI on OS. Methods: We used administrative data to identify a cohort of cancer patients > 65 years of age receiving ICIs from June 2012 to October 2018 in Ontario, Canada and deterministically linked with databases to obtain socio-demographic and clinical co-variates and ATB prescription claims. Multivariable cox-proportional hazard models evaluated the impact of ATB exposure both within 1 year and 60 days prior to starting ICI on OS, adjusted for age, gender, body mass index, comorbidities, autoimmune history, hospitalization in the past year and treatment facility level at start of ICI therapy. Results: Among 2737 patients, median age 73; 43% received Nivolumab, 41% Pembrolizumab and 13% Ipilimumab; 53% were lung cancer, 34% melanoma. Median ATB treatment duration for patients receiving ATB within 1 year (59%) and 60 days (19%) prior to ICI were 14 days (SD = 32) and 9 days (SD = 13) respectively. Median OS estimate was 306 days. Any ATB exposure within 1 year prior to ICI was associated with worse OS (aHR = 1.12 95% CI [1.12-1.23] p = 0.03). A non significant dose effect was seen based on weeks of ATB exposure 1 year prior to ICI (aHR = 1.01 per week [1.00-1.02] p = 0.10). ATB class analysis identified fluoroquinolone exposure within 1 year (aHR = 1.26 [1.13-1.40] p < 0.001) and 60 days before ICI (aHR = 1.20 [0.99-1.45] p = 0.06) were associated with worse OS; with a dose effect based on total weeks of exposure over 1 year (aHR = 1.07 per week [1.03-1.11] p < 0.001) and 60 days (aHR = 1.12 per week [1.03-1.23] p = 0.01). Subgroup analysis showed similar results for patients receiving anti-PD1 ICIs, where patients exposed to fluoroquinolone both 1 year (aHR = 1.28 [1.15-1.44] p < 0.001) and 60 days (aHR = 1.19 [0.98-1.44] p = 0.08) before ICIs had poorer OS with dose effects observed based on weeks of fluoroquinolone exposure. Similarly, subgroup analyses based on disease site identified that lung cancer patients exposed to fluoroquinolones 1 year before starting ICIs (aHR = 1.22 [1.06-1.39] p = 0.005) and melanoma patients exposed to fluoroquinolones 60 days before starting ICIs (aHR = 1.66 [1.12-2.47] p = 0.01) had poorer OS. Conclusions: Exposure to ATBs and specifically fluoroquinolones prior to ICI therapy is associated with worse OS. Interventions aimed at altering the gut microbiome may be required to help improve outcomes for patients on ICIs with prior ATB exposure.


2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 90-90
Author(s):  
Diana Nguyen ◽  
Ghader Jamjoum ◽  
Ari N. Meguerditchian

90 Background: Treatment-related infertility is an important cause of distress in young women with breast cancer (YWBC) that is preventable by fertility preservation (FP) prior to initiating therapy. This study assesses FP service use by YWBC in Quebec (Canada). Methods: Administrative claims for women ≤ 40 diagnosed between 01-04-2012 and 31-03-2018 were identified using Quebec’s universal health services database (RAMQ). Access to and use of FP services were ascertained by identifying claims for a visit with an obstetrician/gynecologist (OB/GYN) ≤ 90 days of diagnosis, followed by claims for ovarian stimulation, ovule harvesting or artificial insemination. Patient, disease and treatment-related predictors were estimated using logistic regression. Results: 1 616 YWBC were treated. Mean age was 36 (SD 4.1), 72.1% had a CCI = 0, 84.5% were urban residents, and 72.2% experienced some form of socioeconomical disadvantages. Stage distribution was: 0.93%, 68.8, and 30.3% for stages 0, 1-2, and 3 respectively. 53.0% had a mastectomy, 40.8% received chemotherapy (CT), 70.7% received radiotherapy, 20.9% initiated anti-estrogen therapy. 387 YWBC consulted an OB/GYN within 90 days of diagnosis and 155 subsequently received FP services. Predictors associated with FP use included: decreased age (OR= 0.82, 95CI = 0.79-0.86), type of surgery (OR = 0.46, CI = 0.22-0.97), social isolation (OR =1.39, 95CI = 0.99-1.96) and receipt of chemotherapy (OR = 1.74, 95CI = 1.10-2.76). Conclusions: Only 23.9% of eligible YWBC in Quebec accessed FP specialists. Of these, 40.1% chose to move forward with FP. These findings raise important questions on how to optimize access to FP expertise. [Table: see text]


2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 304-304
Author(s):  
Lawson Eng ◽  
Rinku Sutradhar ◽  
Yue Niu ◽  
Ning Liu ◽  
Ying Liu ◽  
...  

304 Background: ICIs are becoming a common therapeutic option for many solid tumors. Prior studies have shown that ATB exposure can negatively impact ICI outcomes through gut microbiome changes leading to poorer overall survival; however, less is known about the potential impact of ATB exposure on toxicities from ICI. We undertook a population-based retrospective cohort study in patients receiving ICIs to evaluate the impact of ATB exposure on early acute care use, defined as emergency department visit or hospitalization, within 30 days of initiation of ICI therapy. Methods: Administrative data was utilized to identify a cohort of cancer patients > 65 years of age receiving ICIs from June 2012 to October 2018 in Ontario, Canada. We linked databases deterministically to obtain socio-demographic and clinical co-variates, ATB prescription claims and acute care utilization. Patients were censored if they died within 30 days of initiating ICI therapy. The impact of ATB exposure within 60 days prior to starting ICI on early acute care use was evaluated using multi-variable logistic regression models, adjusted for age, gender, rurality, recent hospitalization within 60 days prior to starting ICI and comorbidity score. Results: Among 2737 patients (median age 73 years), 43% received Nivolumab, 41% Pembrolizumab and 13% Ipilimumab, most commonly for lung cancer (53%) or melanoma (34%). Of these patients, 19% had ATB within 60 days prior to ICI with a median ATB treatment duration of 9 days (SD = 13). 647 (25%) patients had an acute care episode within 30 days of starting ICIs; 182 (7%) patients passed away within 30 days without acute care use and were censored from further analyses. Any ATB exposure within 60 days prior to ICI was associated with greater likelihood of acute care use (aOR = 1.34 95% CI [1.07-1.67] p = 0.01). A dose effect was seen based on weeks of ATB exposure within 60 days prior to ICI (aOR = 1.12 per week [1.04-1.21] p = 0.004) and early acute care use. ATB class analysis identified that exposure to penicillins (aOR = 1.54 [1.11-2.15] p = 0.01) and fluoroquinolones (aOR = 1.55 [1.11-2.17] p = 0.01) within 60 days of starting ICIs were associated with a greater likelihood of acute care use, while there was no significant association between cephalosporin exposure and early acute care use (p > 0.05). Conclusions: Exposure to ATBs, specifically fluoroquinolones and penicillins, prior to ICI therapy is associated with greater likelihood of hospitalization or emergency room visits within 30 days after initiation of ICIs, even after adjustment for relevant co-variates including age, comorbidity score and recent hospitalization prior to ICI initiation. Further studies are required to better understand the mechanisms of recent ATB exposure on early acute care use among patients receiving ICIs.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mario Kasović ◽  
Lovro Štefan ◽  
Vilko Petrić

Abstract Background The 6-min walk test (6MWT) has become an established measure for assessing exercise capacity in children with chronic diseases. However, little evidence has been provided regarding population-based normal data in healthy children. The main purpose of the study was to provide normative data in a large sample of children. Methods In this cross-sectional study, 4352 children between 11 and 14 years were recruited (66% girls). The main outcome measure was the distance walked for six minutes. Sex- and age-specific percentile values (5th, 15th, 25th, 50th, 75th, 85th and 95th) for the 6MWT were created and the differences and correlations were examined by the analysis of variance and Pearson’s coefficient of correlation. Results The mean distance walked in 6 min was 576 ± 93 m in boys and 545 ± 92 m in girls, respectively. The mean walking speed for boys and girls was 98 ± 5 m/min and 91 ± 6 m/min. Older boys and girls performed better, compared to their younger counterparts (p for age < 0.001). The 6MWT was significantly correlated with age (r = 0.24, p < 0.001), height (r = 0.09, p < 0.001), weight (r =  − 0.13, p < 0.001) and body-mass index (r =  − 0.26, p < 0.001). Conclusions This is the first population-based study aiming to provide normative data for the 6MWT in healthy children between 11 to 14 years. Children in lower percentiles are ‘target groups’ for special intervention aiming to enhance the performance.


2021 ◽  
Vol 11 ◽  
Author(s):  
Keyi Wang ◽  
Yongzhe Gu ◽  
Jinliang Ni ◽  
Houliang Zhang ◽  
Jinbo Xie ◽  
...  

BackgroundSarcopenia as the loss of skeletal muscle mass is related with poor postoperative survival. This work purposed to evaluate the prognostic prediction of the total psoas index (TPI), albumin–globulin score (AGS), and the combination of TPI and AGS (CTA) in bladder cancer (BCa) patients after radical cystectomy.MethodsBCa patients that received radical cystectomy between 2012 and 2020 were retrieved from our medical center. The calculation of TPI was based on the plain computed tomography images. The predictive effects of TPI, AGS, and CTA grade on survival of BCa patients were analyzed and compared with the albumin–globulin ratio (AGR) through the receiver operating characteristic (ROC) curves. A nomogram was further established based on the Cox regression results from CTA grade and clinicopathological characteristics, which are verified by the decision curve analysis (DCA).ResultsA total of 112 eligible patients diagnosed as BCa were included in this study for retrospective analysis. The patients with lower TPI or higher AGS grade (1/2) contained poorer overall survival (OS) and disease-free survival (DFS). Divided by CTA grade, there were 35 (31.25%) patients in grade 1 associated with the best postoperative prognosis, which was accompanied with increased TPI and decreased AGS. The CTA grade could better predict postoperative outcomes compared with TPI, AGR, and AGS for the highest area under the curve (AUC; 0.674 of OS and 0.681 of DFS). The 3- and 5-year OS and DFS nomograms were conducted based on CTA grade and clinical variables, with a higher predictive performance than the TNM stage.ConclusionThis study revealed that the novel index CTA functioned as an effective prognostic predictor for postoperative OS and DFS of BCa patients after radical cystectomy. Preoperative assessment of CTA would contribute to optimizing clinical therapies.


Thyroid ◽  
2021 ◽  
Author(s):  
Rodrigo Moreno-Reyes ◽  
Bernard Corvilain ◽  
Caroline Daelemans ◽  
Fleur Wolff ◽  
Camilo Fuentes Peña ◽  
...  

Author(s):  
Farhad Pourfarzi ◽  
Alireza Sadjadi ◽  
Hossein Poustchi ◽  
Firouz Amani

Background: Overweight and obesity and its problems are the most important health and nutrition issues of adolescents in developed and developing countries. This study aimed to determine prevalence of overweight and obesity among studied population.Design and Methods: This Persian Cohort Study is a population-based study of 10,000 men and women, aged 35-70 years in northwest of Iran. Anthropometric parameters such as height, weight, waist circumference and hip circumference were measured by interviewers. Body Mass Index (BMI) and waist-to-hip ratio (WHR) were used to assess the overweight and obesity.Results: The mean age of all participants was 49.1±8.7 and 56.1% of them were female.  The mean height of participants was 162.5±9.4 kg in range 126-196 and the mean weight of them was 78.5±13.1 cm in range 40-164. According to BMI, 42.7% of all participants had overweight and 45% had obesity. According to the WHR, 71.8% of male and 97.9% of female had high WHR (abdominal obesity).Conclusions: Results showed that the rate of overweight and obesity in studied people was more than country rate. So programing for raising their Quality of Life (QoL) and life style and also change their poor nutritional habits is essential in area healthy people.


2021 ◽  
Author(s):  
Atefeh Talebi ◽  
Nasrin Borumandnia ◽  
Somayeh Abbasi ◽  
Hassan Doosti ◽  
Mohamad Amin Pourhoseingholi ◽  
...  

Abstract Gastric cancer (GC) is the fifth most frequent malignancy worldwide and the third leading cause of cancer-associated mortality. The study’s goal was to construct a predictive model and nomogram to predict the survival of GC patients. This historical cohort study assessed 733 patients who underwent treatments for GC. The univariate and multivariable Cox proportional hazard (CPH) survival analyses were applied to identify the factors related to overall survival (OS). A dynamic nomogram was developed as a graphical representation of the CPH regression model. The internal validation of the nomogram was evaluated by Harrell’s concordance index (C-index) and time-dependent AUC. The results of the multivariable Cox model revealed that the age of patients, body mass index (BMI), grade of tumour, and depth of tumour elevate the mortality hazard of gastric cancer patients (P < 0.05). The built nomogram had a discriminatory performance, with a C-index of 0.64 (CI: 0.61, 0.67). We constructed and validated an original predictive nomogram for OS in patients with GC. Furthermore, nomograms may help predict the individual risk of OS in patients treated for GC.


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