cox proportional hazards regression
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2022 ◽  
pp. jech-2021-218278
Author(s):  
Chioma Adanma Nwaru ◽  
Ailiana Santosa ◽  
Stefan Franzén ◽  
Fredrik Nyberg

BackgroundResearch on occupation and risk of COVID-19 among foreign-born workers is lacking. We investigated whether working in essential occupations was associated with COVID-19 diagnosis, hospitalisation and intensive care unit (ICU) admission and whether foreign-born workers in similar occupations as Swedish-born individuals had a higher risk of the studied outcomes.MethodsOccupational data (2018–2019) of 326 052 employees (20–65 years) who were resident in Sweden as of 1 January 2020 were linked to COVID-19 data registered from 1 January 2020 to 28 February 2021. We analysed the risk of COVID-19 outcomes in different occupational groups and in four immigrant/occupation intersectional groups using Cox proportional hazards regression with adjustments for sociodemographic and socioeconomic characteristics and pre-existing comorbidities.ResultsWe identified 29797, 1069 and 152 cases of COVID-19 diagnosis, hospitalisations and ICU admissions, respectively, in our cohort. Workers in essential occupations had an elevated risk of COVID-19 diagnosis, hospitalisation, and ICU admissions. Healthcare workers had a higher risk of all the outcomes compared with other essential workers. Relative to Swedish-born workers in non-essential occupations, foreign-born workers in essential occupations had 1.85 (95% CI 1.78 to 1.93), 3.80 (95% CI 3.17 to 4.55) and 3.79 (95% CI 2.33 to 6.14) times higher risk of COVID-19 diagnosis, hospitalisation and ICU admission, respectively. The corresponding risks among Swedish-born workers in essential occupations were 1.44 (95% CI 1.40 to 1.49), 1.30 (95% CI 1.08 to 1.56) and 1.46 (95% CI 0.90 to 2.38).ConclusionOccupation was associated with COVID-19 outcomes and contributed to the burden of COVID-19 among foreign-born individuals in this study.


2022 ◽  
Vol 11 ◽  
Author(s):  
Shigeo Ishikawa ◽  
Masahiro Sugimoto ◽  
Tsuneo Konta ◽  
Kenichiro Kitabatake ◽  
Shohei Ueda ◽  
...  

This study aimed to identify salivary metabolomic biomarkers for predicting the prognosis of oral squamous cell carcinoma (OSCC) based on comprehensive metabolomic analyses. Quantified metabolomics data of unstimulated saliva samples collected from patients with OSCC (n = 72) were randomly divided into the training (n = 35) and validation groups (n = 37). The training data were used to develop a Cox proportional hazards regression model for identifying significant metabolites as prognostic factors for overall survival (OS) and disease-free survival. Moreover, the validation group was used to develop another Cox proportional hazards regression model using the previously identified metabolites. There were no significant between-group differences in the participants’ characteristics, including age, sex, and the median follow-up periods (55 months [range: 3–100] vs. 43 months [range: 0–97]). The concentrations of 5-hydroxylysine (p = 0.009) and 3-methylhistidine (p = 0.012) were identified as significant prognostic factors for OS in the training group. Among them, the concentration of 3-methylhistidine was a significant prognostic factor for OS in the validation group (p = 0.048). Our findings revealed that salivary 3-methylhistidine is a prognostic factor for OS in patients with OSCC.


Author(s):  
Jiazhe Lin ◽  
Nuan Lin ◽  
Wei-jiang Zhao

IntroductionGliomas account for 75% of the primary malignant brain tumors. The prognosis and treatment planning vary in lower-grade gliomas (LGG) due to their heterogeneous clinical behaviors. The dysregulation of autophagy-related (ATG) lncRNAs plays a crucial role in LGG. We aimed to develop and validate an ATG lncRNA risk signature, and a survival nomogram with integration of novel prognostic for LGG patients.Material and methodsDifferentially expressed ATG lncRNAs were screened out based on TCGA and GTEx RNA-seq databases. ATG lncRNA prognostic signature was then established by Kaplan–Meier, univariate Cox proportional hazards regression, Least absolute shrinkage and selection operator (LASSO) regression and multivariate Cox proportional hazards regression, with its predictive value validated by time-dependent receiver operating characteristic (ROC) curves. Kaplan–Meier, univariate Cox regression and multivariate Cox proportional hazards regression were used to screen out clinical and molecular variables. A nomogram was developed and internally validated by ROC and calibration plots.ResultsAn ATG lncRNA risk signature was constructed with six differentially expressed lncRNAs (LINC00599, LINC02609, AC021739.2, AL118505.1, AL354892.2, and AL590666.2). Based on the risk signature, a nomogram was developed by addition of the significant prognostic clinical variables (age and grade) and molecular variables (IDH status and MGMT status).ConclusionsWe identified an ATG lncRNA risk signature and develop a nomogram for individualized survival prediction in LGG patients. A user-friendly free online calculator to facilitate the use of this nomogram among clinicians is also provided: https://linstu2009.shinyapps.io/LGGPRODICTORapp/?_ga=2.3154800.1506830296.1588641469-159983587.1588641469.


2021 ◽  
Author(s):  
Jingjing Hu ◽  
Ling Gu ◽  
Yueming Shao ◽  
Renfang Zhang ◽  
Tangkai Qi ◽  
...  

Abstract Background Few data are available regarding the long-term case-fatality rate (CFR) among people living with HIV (PLWH) with nontuberculous mycobacteria (NTM) disease. Objectives To analyze the long-term CFR in patients with NTM disease and to identify risk factors for their death. Methods A retrospective cohort study of 379 cases of microbiologically confirmed NTM disease in PLWH was conducted during January 1, 2012 to December 31, 2020 in Shanghai, China. We used Kaplan-Meier survival analysis and log-rank test to compare long-term CFR in patients with disseminated NTM (DNTM) and localized NTM disease. Univariate Cox proportional hazards regression analysis and stepwise Cox proportional hazards regression model were used to estimate the predictors of long-term CFR. Results The cohort was follow-up for a median of 26 months. The total CFR was 15.7% by one year and increased to 22.6% at 5 years after the diagnosis of NTM disease. The 5-year CFR of PLWH with DNTM was significantly higher than that of localized NTM (26.7% vs. 19.6% for DNTM and localized NTM disease, respectively). Older age (hazard ratio [HR] = 1.04, 95% confidence interval [CI]: 1.02-1.06, P < 0.001), comorbidity (HR = 2.05, 95% CI: 1.21-3.49, P < 0.01), DNTM (HR = 2.08, 95% CI: 1.17-3.68, P < 0.05), and HIV viral load (HR = 1.32, 95% CI: 1.12-1.55, P < 0.001) were all independent risk factors of long-term CFR. In the subgroup analysis, time to culture positivity was negatively correlated with CFR in patients with DNTM (HR = 0.90, 95% CI: 0.82-0.98, P < 0.05). Conclusions NTM was associated with significantly high long-term CFR in PLWH. Further approaches to prevent NTM disease in PLWH are urgently needed.


2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 701-702
Author(s):  
Samuel Miller ◽  
Lauren Wilson ◽  
Melissa Greiner ◽  
Jessica Pritchard ◽  
Tian Zhang ◽  
...  

Abstract Renal dysfunction is a driver of dementia. It is also associated with renal cell carcinoma, possibly the result of the tumor itself or from cancer treatment. This study evaluates metastatic renal cell carcinoma (mRCC) as a risk factor for developing mild cognitive impairment or dementia (MCI/D) as well as the impact of RCC-directed therapies on the development of MCI/D. We identified all patients diagnosed with mRCC in SEER-Medicare from 2007-2015. The main outcome was incident MCI/D within one year of mRCC diagnosis or cohort entry. Exclusion criteria included age &lt;65 at mRCC diagnosis and diagnosis of MCI/D within preceding year of mRCC diagnosis. Patients with mRCC (n=2,533) were matched to non-cancer controls (n=7,027) on age, sex, race, comorbidities and year. Cox proportional hazards regression showed that having mRCC (HR 8.52, 95% MCI/D 6.49-11.18, p&lt;0.001) and being older (HR 1.05 for 1-year age increase, 95% MCI/D 1.03-1.07, p&lt;0.001) were predictive of developing MCI/D. A second Cox proportional hazards regression of only patients with mRCC revealed that neither those initiating treatment with oral anticancer agents (OAAs) nor those who underwent nephrectomy were more likely to develop MCI/D. Black patients had a higher risk of dementia compared to white patients (HR 1.92, 95% MCI/D 1.02-3.59, p=0.047). In conclusion, patients with mRCC were more likely to develop MCI/D than those without mRCC. The medical and surgical therapies evaluated were not associated with increased incidence of MCI/D. The increased incidence of MCI/D in older adults with mRCC may be the result of the pathology itself.


2021 ◽  
Author(s):  
Gregory P. Lekovic ◽  
Nida Fatima ◽  
Anne K. Maxwell ◽  
Gautam U. Mehta ◽  
Zachary R. Barnard ◽  
...  

Abstract OBJECTIVE Cerebellopontine angle (CPA) meningioma can affect hearing function and require expeditious treatment to prevent permanent hearing loss. The authors sought to determine the factors associated with hearing functional outcome in CPA meningioma patients treated with surgery and/or radiation therapy either stereotactic radiosurgery or stereotactic radiation therapy. METHODS Consecutive patients with CPA meningioma who had presented at our hospital from 2008 to 2018 were identified through retrospective chart review. Hearing function-pure tone audiogram (PTA) and speech discrimination score (SDS)-was assessed before and after surgery for CPA meningioma. Hearing function with PTA>50 dB and SDS<69% were defined as poor hearing functional outcome. Multivariable Cox Proportional Hazards Regression model was used to assess the associations between pre-operative hearing functional assessment and post-operative hearing functional outcomes. RESULTS The study cohort included 31 patients (80.6% females, with a mean age of 61.3±15.2 years) with a median clinical follow-up of 5 months (range, 1 week-98 months). The mean pre-operative PTA and SDS were 23.8±11.2 dB and 64.4±22.2% respectively. At the last visit, there was a significant hearing recovery, with an improvement of 29.7±18.0 dB (p<0.001) and 87.6±17.8% (p<0.001) in PTA and SDS respectively. Multivariable cox proportional hazards regression model was conducted after adjusting for age, gender, tumor volume, location, and classification of the tumor, which revealed that patients undergoing surgery through retro sigmoid approach [Hazards Ratio (HR): 32.1, 95% Confidence Interval (CI): 2.11-491.0, p=0.01] and gross total resection (GTR) (HR: 2.99, 95%CI: 1.09-9.32, p=0.05) had significantly higher risk of poor hearing functional outcome. Moreover, patients with poor preoperative hearing had 85% higher chances of poor hearing functional outcome post operatively (HR: 0.15, 95%CI: 0.03-0.59, p=0.007). CONCLUSION Postoperative improvement in hearing is a reasonable expectation following surgery for CPA meningioma. Preoperative hearing, surgical approach and extent of surgical resection are predictive of postoperative hearing function outcome and can identify patients at higher risk of hearing loss.


2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yunpeng Zhao ◽  
Lei Shan ◽  
Chuanliang Peng ◽  
Bo Cong ◽  
Xiaogang Zhao

Abstract Purpose Minimally invasive oesophagectomy is a technically demanding procedure, and the learning curve for this procedure should be explored. A survival analysis should also be performed. Methods A total of 214 consecutive patients who underwent minimally invasive oesophagectomy were retrospectively reviewed. To evaluate the development of thoracoscopic-laparoscopic oesophagectomy and compare mature minimally invasive oesophagectomy and open oesophagectomy, we comprehensively studied the clinical and surgical parameters. The cumulative sum (CUSUM) plot was used to evaluate the learning curve for systemic lymphadenectomy. Cox proportional hazards regression analysis was performed to explore the clinical factors affecting survival. Results The bleeding volume, operation time, and postoperative mortality within 3 months significantly decreased after 20 patients. The rise point for node dissection was visually determined to occur at patient 57 in the CUSUM plots. Patients who underwent mature thoracoscopic-laparoscopic oesophagectomy had better surgical data and short-term benefits than patients who underwent an open procedure. Cox proportional hazards regression analysis showed that the maximum diameter of the tumour cross-sectional area and the number of positive nodes significantly influenced survival. Conclusions The results suggest that thoracoscopic-laparoscopic oesophagectomy has short-term benefits. There was no evidence that it was associated with a significantly better prognosis for patients with oesophageal cancer. ClinicalTrials Gov ID: NCT04217239; January 2, 2020 retrospectively registered.


Cancers ◽  
2021 ◽  
Vol 13 (21) ◽  
pp. 5425
Author(s):  
Laura Susok ◽  
Celine Nick ◽  
Jürgen C. Becker ◽  
Falk G. Bechara ◽  
Markus Stücker ◽  
...  

Complete lymph node dissection (CLND) following positive sentinel lymph node (SLN) biopsy has been the standard of care for decades. We aimed to study melanoma patients with an emphasis on the outcome of patients with versus without CLND following positive SLN biopsy. SLN-positive patients with or without CLND were compared regarding important prognostic clinical and histological characteristics. Ten-year and 20-year survival curves for melanoma relapse and melanoma-specific survival (MSS) were determined by the Kaplan-Meier method and Cox proportional-hazards regression. We studied 258 patients who had micrometastases in their SLN biopsy. CLND was performed in 209 of 258 patients (81%). Hence, in 49 of 258 patients (19%) with SLN micrometastases, CLND was not performed. These patients did not significantly (p > 0.05) differ from patients with CLND in regard to age, gender, tumor thickness, tumor ulceration, capsule infiltration of SLN, or invasion level of SLN. On 10-year analysis, we did not observe a significantly increased risk for melanoma relapse and worse in MSS in patients who did not undergo CLND (hazard ratio: 1.1 (95% CI 0.67 to 1.7) and 1.1 (95% CI 0.67 to 1.9), respectively). On 20-year survival analysis, we confirmed that the risk of melanoma relapse and impaired MSS does not significantly increase in patients without CLND (hazard ratio: 1.2 (95% CI 0.8 to 1.9) and 1.3 (95% CI 0.8 to 2.3), respectively). On 10-year as well as 20-year multivariable follow-up analysis (including several important prognostic factors), Cox proportional-hazards regression showed that the status of CLND did not remain in the regression model (p > 0.1). Our 10-year data give conclusive support to previous investigations indicating that waiving CLND in patients with SLN micrometastases does not affect MSS. More importantly, our long-term follow-up data confirm for the first time the 10-year survival data of previous investigations.


2021 ◽  
Author(s):  
Xianglan Jin ◽  
Xiangyu Jin ◽  
Xiaoyun Wu ◽  
Luguang Chen ◽  
Tiegong Wang ◽  
...  

Abstract Background: Fractional flow reserve derived from computed tomography (FFRCT) has been demonstrated significantly improved identification of lesion-specific ischemia compared with coronary computed tomography angiography (CCTA). It remains unclear the distribution of FFRCT values in obstructive stenosis between patients who received percutaneous coronary intervention (PCI) or not in routine clinical practice, as well as its association with clinical outcome. This study aims to reveal the distribution of FFRCT value in patients with single obstructive coronary artery stenosis, and explored the independent factors for predicting major adverse cardiac events (MACE). Methods: This was a retrospective study of adults with non-ST-segment elevation acute coronary syndrome undergoing FFRCT assessment by using CCTA data from January 1, 2016 to December 31, 2020. Propensity score matching (PSM) method was used to account for patient selection bias. The risk factors for predicting MACE were evaluated by a Cox proportional hazards regression analysis. Results: Overall, 655 patients with single obstructive (³ 50%) stenosis shown on CCTA were enrolled and divided into PCI group (376 cases) and conservative group (279 cases) according to treatment. The PSM cohort analysis demonstrated that the difference in history of unstable angina, CCSC and FFRCT between PCI group (188 cases) and conservative group (315 cases) was statistically significant, with all P values < 0.05, while the median follow-up time between them was no statistically significant (24 months vs 22.5months, P = 0.912). The incidence of MACE in PCI group and conservative group were 14.9% (28/188) and 23.5% (74/315) respectively, P = 0.020. Multivariate analysis of Cox proportional hazards regression revealed that history of unstable angina (adjusted odds ratio (adjOR), 3.165; 95% confidence interval (CI), 2.087-4.800; P < 0.001), FFRCT £ 0.8 (OR, 1.632;95% CI, 1.095-2.431; P = 0.016), and PCI therapy (OR, 0.481; 95% CI, 0.305-0.758) were the independent factors for MACE. Conclusions: History of unstable angina and FFRCT value of £ 0.8 were the independent risk factors for MACE, while PCI therapy was the independent protective factor for MACE.


2021 ◽  
Vol 2021 ◽  
pp. 1-16
Author(s):  
Zheng Xiao ◽  
Kechao Nie ◽  
Tong Han ◽  
Lin Cheng ◽  
Zheyu Zhang ◽  
...  

In this study, a comprehensive analysis of TNF family members in colorectal cancer (CRC) was conducted and a TNF family-based signature (TFS) was generated to predict prognosis and immunotherapy response. Using the expression data of 516 CRC patients from The Cancer Genome Atlas (TCGA) database, TNF family members were screened to construct a TFS by using the univariate Cox proportional hazards regression and the least absolute shrinkage and selection operator- (LASSO-) Cox proportional hazards regression method. The TFS was then validated in a meta-Gene Expression Omnibus (GEO) cohort ( n = 1162 ) from the GEO database. Additionally, the tumor immune characteristics and predicted responses to immune checkpoint blockade in TFS-based risk subgroups were analyzed. Eight genes (TNFRSF11A, TNFRSF10C, TNFRSF10B, TNFSF11, TNFRSF25, TNFRSF19, LTBR, and NGFR) were used to construct the TFS. Compared to the high-risk patients, the low-risk patients had better overall survival, which was verified by the GEO data. In addition, a high TFS risk score was associated with high infiltration of regulatory T cells (Tregs), nonactivated macrophages (M0), natural killer cells, immune escape phenotypes, poor immunotherapy response, and tumorigenic and metastasis-related pathways. Conversely, a low TFS risk score was related to high infiltration of resting CD4 memory T cells and resting dendritic cells, few immune escape phenotypes, and high sensitivity to immunotherapy. Thus, the eight gene-based TFS is a promising index to predict the prognosis, immune characteristics, and immunotherapy response in CRC, and our results also provide new understanding of the role of the TNF family members in the prognosis and treatment of CRC.


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