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Background. The use of bevacizumab for recurrent glioblastoma is controversial. Here we show data on patients who responded to bevacizumab, then stopped bevacizumab for any reason other than progression and were rechallenged with bevacizumab at the time of subsequent progression. Methods. This retrospective study included 28 patients, classified in 2 cohorts: those for whom the first exposure to bevacizumab (BEV-1) was first-line treatment for newly diagnosed glioblastoma (Bev-F; N = 12) and those for whom BEV-1 was second- or third-line treatment for recurrent disease after standard treatment (Bev-S; N = 16). Results. All patients received standard radiotherapy plus temozolomide. Bev-F patients also received concomitant bevacizumab. All 28 patients received a total of 57 treatment lines with bevacizumab (12 first-line and 45 second- or further-line). Twenty-nine lines were rechallenges (BEV-2 [N = 26] or BEV-3 [N = 3]). Objective response to rechallenge was 58.6% and clinical benefit was 89.6%. Overall survival (OS) was 55 months for RPA class IV and 26.7 months for RPA class V patients (P = .01). OS was 26.7 months for Bev-F patients and 52.1 months for Bev-S patients (P = .004). Post-progression survival was 20 months for Bev-F patients and 39.6 months for Bev-S patients (HR = 0.26; P = .007). Conclusion. This is the largest study to examine the impact of a bevacizumab rechallenge in glioblastoma patients who had responded to previous bevacizumab treatment but who stopped before progression. Our findings indicate that these patients can attain a second response or clinical benefit from re-introduction of bevacizumab. The potential benefit from intermittent versus continuous treatment warrants comparison in clinical trials. [ABSTRACT FROM AUTHOR]

Background: A number of studies have investigated the effect of perioperative blood transfusion (PBT) for patients after radical prostatectomy (RP), with some reporting conflicting results. A systematic review of the literature and a meta-analysis were conducted to explore the association between PBT (autologous or allogeneic) and biochemical recurrence-free survival (BRFS), overall survival (OS) and cancer-specific survival (CSS) in patients undergoing RP. Methods: The PubMed, Medline, Cochrane Library, and Embase databases were searched for published controlled clinical studies on perioperative allogeneic or autologous blood transfusion (BT) and patient survival after RP. STATA software version 12.0 was used for data analysis. We used hazard ratios (HRs) and 95% confidence intervals (CIs) to test the correlation between BT and patient survival after RP. Results: Data from a total of 26,698 patients in ten published studies were included in the meta-analysis. The meta-analysis results showed that autologous BT was not associated with BRFS (HR: 1.06; 95% CI: 0.96–1.18; Z = 1.17; P = 0.24), OS (HR: 0.86; 95% CI: 0.71–1.04; Z = 1.58; P = 0.11), or CSS (HR: 0.98; 95% CI: 0.49–1.96; Z = 0.05; P = 0.96). Allogeneic BT exhibited a significant association with worse BRFS (HR: 1.09; 95% CI: 1.01–1.16; Z = 2.37; P = 0.02), OS (HR: 1.43; 95% CI: 1.24–1.64; Z = 4.95; P<0.01) and CSS (HR: 1.74; 95% CI: 1.18–2.56; Z = 2.81; P = 0.005). Conclusion: Our data showed an association between allogeneic BT and reduced BRFS, OS and CSS in patients after RP. These findings indicate that perioperative blood conservation strategies are important for decreasing the allogeneic BT rate. [ABSTRACT FROM AUTHOR]

Background/aim: There is limited information about the rate and modifiers of mortality in noncystic fibrosis bronchiectasis. Materials and methods: This study enrolled a total of 56 bronchiectasis patients. Patients’ body mass index, smoking habit, previous therapies, comorbid disorders, history of vaccination, bronchiectasis type and radiological extent, arterial blood gas analysis, respiratory function tests, and laboratory results were recorded. Results: After a follow-up of 65.38 ± 18.62 months the overall mortality rate was 35.7%. The mean survival duration was 46.42 ± 8.25 months. Advanced age significantly increased mortality (HR: 2.031; CI: 0.991-4.072, P = 0.035). A significant correlation was found between mortality rate and the partial oxygen pressure level (HR: 0.886 (CI: 0.817-0.960); P = 0.039). Pulmonary artery pressure was directly proportional to mortality rate (HR: 9.015 (CI: 3.272-94.036); P = 0.03). There was also a significant correlation between Pseudomonas aeruginosa proliferation in sputum and mortality (HR: 7.014 (CI: 2.812-17.962); P = 0.00). Comorbidities increased mortality (HR: 1.984 (CI: 0.972-2.996); P = 0.04). Conclusion: Bronchiectasis is a disease with high mortality. Advanced age, comorbid conditions, reduced partial oxygen pressure, pulmonary hypertension, and Pseudomonas aeruginosa proliferation in sputum increase its mortality rate. [ABSTRACT FROM AUTHOR]

Background: Current prognostication models for survival estimation in patients with metastatic spine disease lack accuracy. Identifying new risk factors could improve existing models. We assessed factors associated with survival in patients surgically treated for spine metastases, created a classic scoring algorithm, nomogram, and boosting algorithm, and tested the predictive accuracy of the three created algorithms at estimating survival.Methods: We included 649 patients from two tertiary care referral centers in this retrospective study (2002 to 2014). A multivariate Cox model was used to identify factors independently associated with survival. We created a classic scoring system, a nomogram, and a boosting (i.e., machine learning) algorithm and calculated their accuracy by receiver operating characteristic analysis.Results: Older age (hazard ratio [HR], 1.01; p = 0.009), poor performance status (HR, 1.54; p = 0.001), primary cancer type (HR, 1.68; p < 0.001), >1 spine metastasis (HR, 1.32; p = 0.009), lung and/or liver metastasis (HR, 1.35; p = 0.005), brain metastasis (HR, 1.90; p < 0.001), any systemic therapy for cancer prior to a surgical procedure (e.g., chemotherapy, immunotherapy, hormone therapy) (HR, 1.65; p < 0.001), higher white blood-cell count (HR, 1.03; p = 0.002), and lower hemoglobin levels (HR, 0.92; p = 0.009) were independently associated with decreased survival. The boosting algorithm was best at predicting survival on the training data sets (p < 0.001); the nomogram was more reliable at estimating survival on the test data sets, with an accuracy of 0.75 (30 days), 0.73 (90 days), and 0.75 (365 days).Conclusions: We identified risk factors associated with survival that should be considered in prognostication. Performance of the boosting algorithm and nomogram were comparable on the testing data sets. However, the nomogram is easier to apply and therefore more useful to aid surgical decision-making.Level Of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Recent advances in the treatment of multiple myeloma (MM) have been associated with improved survival, predominantly among young and white patients. The authors hypothesized that sociodemographic factors, adjusted for race/ethnicity, influence the survival of younger patients with MM.Methods: Overall survival (OS) data were obtained for individuals included in the Surveillance, Epidemiology, and End Results (SEER-18) program who were diagnosed with MM before the age of 65 years between 2007 and 2012. The sociodemographic variables addressed were marital status, insurance status, median household income, and educational achievement in the county of residence. Race/ethnicity was defined as a self-reported construct including Hispanic (regardless of race), non-Hispanic black, non-Hispanic white, and other.Results: There were 10,161 cases of MM included with a median follow-up of 27 months (range, 0-71 months; 22,179 person-years). Using multivariable Cox proportional hazards analysis, SEER registry; age; male sex; and 3 sociodemographic factors including marital status (other than married), insurance status (uninsured or Medicaid), and county-level income (lowest 2 quartiles), but not race/ethnicity, were found to be associated with an increased risk of death. The 4-year estimated OS rate was 71.1%, 63.2%, 53.4%, and 46.5% (P<.001), respectively, for patients with 0, 1, 2, or 3 adverse sociodemographic factors. Hispanic and non-Hispanic black individuals were found to have more adverse sociodemographic factors and worse OS. However, when the population was stratified by the cumulative number of sociodemographic factors, no consistent association between race/ethnicity and OS was observed after adjustment for confounders.Conclusions: Sociodemographic factors that potentially affect care, but not race/ethnicity, were found to influence the survival of younger patients with MM. Cancer 2016;122:3183-90. © 2016 American Cancer Society. [ABSTRACT FROM AUTHOR]

Background: Survival of glioma patients with the same tumor histology and grade can vary significantly, and some low-grade gliomas transform to a more malignant phenotype. There is a need of molecular signatures, which are better predictors of the patient diagnosis, outcome of treatment, and prognosis than the diagnosis provided by histopathology. We propose CHI3L1 mRNA expression as a prognostic biomarker for patients with glioma. Methods: We measured CHI3L1 expression with quantitative real time-polymerase chain reaction (qRT-PCR) in the cohort of 98 patients with different grade glioma: 10 grade I pylocytic astrocytomas, 30 grade II diffuse astrocytomas, 20 grade III anaplastic astrocytomas, and 38 grade IV astrocytomas (glioblastomas). Statistical analyses were conducted to investigate the association between CHI3L1 mRNA expression levels and patient clinical variables. Results: We demonstrated that mRNA expression of CHI3L1 was evidently higher in glioblastoma than in lower grade glioma tissues. We evaluated correlations between CHI3L1 expression, clinicopathological characteristics, and the outcomes of the patients. Patients with high CHI3L1 expression had a shorter overall survival (p < 0.001). Conclusions: Findings presented in our study showed that increased mRNA level of CHI3L1 could be associated with the progression of astrocytoma and poor patient survival not only for glioblastoma, but for lower grade astrocytoma tumors as well. Further investigation will be required to evaluate CHI3L1 value as a molecular marker for astrocytoma prognoses and for novel treatment strategies against all grade astrocytomas. [ABSTRACT FROM AUTHOR]

Motivation: Technological advances that allow routine identification of high-dimensional risk factors have led to high demand for statistical techniques that enable full utilization of these rich sources of information for genetics studies. Variable selection for censored outcome data as well as control of false discoveries (i.e. inclusion of irrelevant variables) in the presence of highdimensional predictors present serious challenges. This article develops a computationally feasible method based on boosting and stability selection. Specifically, we modified the component-wise gradient boosting to improve the computational feasibility and introduced random permutation in stability selection for controlling false discoveries. Results: We have proposed a high-dimensional variable selection method by incorporating stability selection to control false discovery. Comparisons between the proposed method and the commonly used univariate and Lasso approaches for variable selection reveal that the proposed method yields fewer false discoveries. The proposed method is applied to study the associations of 2339 common single-nucleotide polymorphisms (SNPs) with overall survival among cutaneous melanoma (CM) patients. The results have confirmed that BRCA2 pathway SNPs are likely to be associated with overall survival, as reported by previous literature. Moreover, we have identified several new Fanconi anemia (FA) pathway SNPs that are likely to modulate survival of CM patients. [ABSTRACT FROM AUTHOR]

This analysis was performed to create a scoring system to estimate the survival of patients with non-small cell lung cancer ( NSCLC). Data from 1274 NSCLC patients were analyzed to create and validate a scoring system. Univariate ( UV) and multivariate ( MV) Cox models were used to evaluate the prognostic importance of each baseline factor. Prognostic factors that were significant on both UV and MV analyses were used to develop the score. These included quality of life, age, performance status, primary tumor diameter, nodal status, distant metastases, and smoking cessation. The score for each factor was determined by dividing the 5-year survival rate (%) by 10 and summing these scores to form a total score. MV models and the score were validated using bootstrapping with 1000 iterations from the original samples. The score for each prognostic factor ranged from 1 to 7 points with higher scores reflective of better survival. Total scores (sum of the scores from each independent prognostic factor) of 32-37 correlated with a 5-year survival of 8.3% (95% CI = 0-17.1%), 38-43 correlated with a 5-year survival of 20% (95% CI = 13-27%), 44-47 correlated with a 5-year survival of 48.3% (95% CI = 41.5-55.2%), 48-49 correlated to a 5-year survival of 72.1% (95% CI = 65.6-78.6%), and 50-52 correlated to a 5-year survival of 84.7% (95% CI = 79.6-89.8%). The bootstrap method confirmed the reliability of the score. Prognostic factors significantly associated with survival on both UV and MV analyses were used to construct a valid scoring system that can be used to predict survival of NSCLC patients. Optimally, this score could be used when counseling patients, and designing future trials. [ABSTRACT FROM AUTHOR]

This study examines functional outcome (speech and swallowing), survival, and disease control in patients receiving an intensified treatment regimen with primary aggressive surgery, and postoperative radiotherapy or postoperative concomitant chemoradiotherapy, for previously untreated, resectable, stage III and IV squamous cell carcinoma (SCC) of the tongue base. Sixty-six consecutive patients treated from June 1997 to June 2006 were followed prospectively through the Multidisciplinary Head and Neck Surgery Reconstruction Clinic. Speech and swallowing data were gathered at four evaluation times during the first year. Speech assessment was conducted by PERCI, Nasometer, and C-AIDS and swallowing assessment by Modified barium swallow, Diet survey and G-tube. Also, the overall survival, disease-specific survival and loco regional control were measured. The average age of the patients was 56.8, 85 % male and 15 % female. All patients had primary surgical resection and 83 % received postoperative radiotherapy and 17 % chemoradiation therapy. Overall survival at 3 years was 80.3 % and 5 years 52.2 %. Disease-specific survival at 3 years was 86.7 % and 5 years was 77.5 %. Local control was 94 %. Distal metastasis and second primary were found to be 7.5 % each. Primary surgical treatment of advanced BOT cancer offers excellent functional outcome, local control and disease-specific survival. [ABSTRACT FROM AUTHOR]

Purpose We assessed the quality of life (QOL) of nasopharyngeal carcinoma (NPC) survivors with a survival time of more than 2 years in Fujian, China, and we analyzed factors influencing QOL. Methods We calculated the prevalence of psychological distress and radiotherapy (RT)--induced symptoms in 216 NPC survivors who participated in a cross-sectional survey. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (version 3.0) was used to assess the QOL of NPC survivors. Multiple linear regression was applied to analyze the factors influencing QOL. Results The prevalence rates of RT-induced symptoms and psychological problems were 11.58% (95% CI: 7.21% to 15.58%) for difficulty in swallowing, 17.59% (95% CI: 12.51% to 22.67%) for mouth dryness or sores, 13.89% (95% CI: 9.28% to 18.50%) for nasal dryness or congestion, 18.52% (95% CI: 13.34% to 23.70%) for fatigue, 11.11% (95% CI: 6.92% to 15.30%) for frequent dizziness, 18.06% (95% CI: 12.93% to 23.19%) for decline in hearing, 14.81% (95% CI: 10.07% to 19.55%) for poor sleep quality, 18.52% (95% CI: 13.34% to 23.70%) for worry about disease recurrence, 18.98% (95% CI: 13.75% to 24.21%) for anxiety, and 25.00% (95% CI: 19.23% to 30.77%) for depression. Mean survival times were 4.32 ± 2.63 years in patients with mouth dryness or sores, 4.26 ± 2.90 years in patients with fatigue, and 5.60 ± 2.94 years in patients with a decline in hearing. The mean global QOL score was 74.21 (95% CI: 72.22 to 76.20). At a significance level of α = 0.05, the factors influencing QOL were age (p = 0.032), education level (p = 0.001), anxiety score (p < 0.001), depression score (p < 0.001), mouth dryness or sores (p < 0.001), fatigue (p = 0.027), and disease stage (p = 0.044). Conclusions The prevalence rates of mouth dryness or sores, fatigue, decline in hearing, depression, and anxiety were high in NPC survivors with a survival time of more than 2 years. These RT-induced symptoms and psychological problems can last for many years after RT. The QOL of the NPC survivors was good. Factors influencing QOL were age, education level, anxiety, depression, mouth dryness or sores, fatigue, and disease stage. Our results suggest that during clinical treatment, doctors should minimize the radiation dose to the ears of patients. In addition, our results emphasize the importance of providing oral and ear nursing and psychological care to NPC survivors. [ABSTRACT FROM AUTHOR]

Background The endpoints of progression-free survival (PFS) and time-to-progression (TTP) are frequently used to evaluate the clinical benefit of anticancer drugs. However, the surrogacy of those endpoints for overall survival (OS) is not validated in all cancer settings. In the present study, we used a trial-based approach to assess the relationship between median PFS or TTP and median OS in chronic lymphocytic leukemia (CLL). Methods The PICO (population, interventions, comparators, outcomes) method was used to conduct a systematic review of the literature. The population consisted of patients with CLL; the interventions and comparators were standard therapies for CLL; and the outcomes were median PFS, TTP, and OS. Two independent reviewers screened titles, abstracts, and full papers for eligibility and then extracted data from selected studies. Correlation coefficients were calculated to assess the relationship between median PFS or TTP and median OS. Subgroup correlation analyses were also conducted according to the characteristics of the selected studies (such as line of treatment and type of treatment under investigation). Results Of the 1263 potentially relevant articles identified during the literature search, twenty-three were included. On average, median PFS or TTP was 16.0 months (standard deviation: 12.4 months) and median OS was 43.5 months (standard deviation: 31.2 months). Results of the correlation analysis indicated that median PFS or TTP is highly correlated with median OS (Spearman correlation coefficient: 0.813; p ≤ 0.001). A significant correlation between median PFS or TTP and median OS was observed in second- and subsequent-line therapies, but not in the first-line setting. Conclusions Our study demonstrates a strong correlation between median PFS or TTP and median OS in previously treated CLL, which reinforce the hypothesis that PFS and TTP could be adequate surrogate endpoints for OS in this cancer setting. [ABSTRACT FROM AUTHOR]

Background Long-term outcome of chronic hepatitis C patients with successful viral eradication seems to be promising. Aim To evaluate mortality, incidence of hepatocellular carcinoma ( HCC), liver failure and liver transplantation in sustained virological responders ( SVR) and non- SVR patients with different stages of fibrosis. Methods Seven hundred and fourteen patients with a follow-up of 7.2 (1-21.1) years (age: 51.4 ± 12.0 years, 276 female, IFN-monotherapy: n = 19, IFN/ RBV: n = 122, peg- IFN/ RBV: n = 573, SVR: 551, non- SVR: 163) were studied. Two hundred and ten of 540 patients with a liver biopsy prior to treatment had advanced stages of fibrosis (Metavir F3/F4). Results Forty-eight patients died during follow-up, 15 with SVR and 33 without ( P < 0.001). Five- and 10-year mortality rates were 1.8% (10/551) and 2.7% (15/551) in the SVR group and 8.6% (14/163) and 19.1% (31/163) in the non- SVR patients ( P < 0.001). In 29 patients, decompensation of liver disease [ SVR: 9 (1.6%) vs. non- SVR: 20 (12.3%); P < 0.001] occurred and in 29 patients, HCC developed during follow-up [ SVR: 10 (1.8%) vs. non- SVR: 19 (11.7%); P < 0.001]. Non- SVR was an independent predictor for developing (i) HCC [ HR: 2.36 (95% CI: 1.07-5.23; P = 0.034], (ii) liver-related complications [ HR: 2.62; (95% CI: 1.18-5.81; P = 0.018] and (iii) mortality ( HR: 3.46; 95% CI: 1.91-6.29; P < 0.001). For patients with early stages of fibrosis (F0-F2), a survival benefit of SVR patients could not be demonstrated. Conclusions Successful anti-viral therapy decreases mortality, incidence of hepatocellular carcinoma and liver failure in patients with advanced fibrosis. However, hepatocellular carcinoma development or liver failure are not prevented completely, and further follow-up of patients is advisable. [ABSTRACT FROM AUTHOR]

The Krukenbergtumor (KT) represents a metastatic lesion to the ovary from a primary gastrointestinal tumor (GI) most frequently the stomach being the site from which the malignant cells disseminate to the ovaries. KT are generally bilateral metastatic ovarian tumors which are associated with a low overall survival rate and a poor prognosis. Usually, it develops in women at the age of 40-50 years. The purpose of this article is to review the prognostic factors for KT, the surgical treatment and its impact on survival in women with KT of the ovary. A Pubmed database search for English language articles using key words (e.g''ovarian cancer", "Krukenberg tumors'', ''treatment'', ''surgery) has been conducted. Systematic reviews, retroprospective studies, controlled and randomized clinical trials were selected if the research subjects were treated with surgery. Detection of a unilateral KT, the absence of any other metastases, the primary tumor originating in the colon or rectum as well as the identification of the primary GI tumor during the resection of the KT have been recognized as favourable prognostic factors associated with the postoperative evolution of women diagnosed with KT.A complete resection of the KT (negative margins, R0) improves the overall survival rate especially in women with colorectal cancer and no other medical or surgical comorbidities. In women with gastric cancer and metachronous KT, the absence of any other distant visceral metastastes represents an indication for the complete resection of the KT. Women with primary gastric cancer and KT s have generally a poor prognostic. [ABSTRACT FROM AUTHOR]

Introduction. Therapy of high risk myelodysplastic syndromes (MDS) remains unsatisfactory. The only treatment that alters the natural history of the disease is allogeneic stem-cell transplantation, which can be offered to a limited number of young patients. Modern therapy predominantly focuses on prolonging survival, postponing potential acute myeloid leukaemia (AML) transformation and improving quality of life (QoL). New epigenetic therapy, especially methyltransferase inhibitors, has achieved these goals. Here, we present the experience of the Czech MDS Cooperative Group with 5-azacitidine treatment of patients with intermediate II and high risk MDS patients (IPSS), chronic myelomonocytic leukaemia II (CMML II) and AML with less than 30% myeloblasts in the bone marrow. Patients and results. Between October 2008 and June 2012, we used azacitidine treatment in 111 patients (66 M, 45 F), median age 68 years (range 48-85) with the diagnosis: 44 RAEB II, 13 RAEB I, 9 CMML II, 6 RCMD, 28 AML < 30% MB, 7 AML > 30% MB and 4 MDS/MPS. Median follow-up was 8.8 month (range 1-32), median number of cycles of azacitidine was 5 (range 1-28). The most common adverse events included haematological toxicity with neutropenia grade (Gr) 3/4 in 54.9% and thrombocytopenia Gr 3/4 in 70.3%. Non-haematological side effects, mostly only Gr1/2, were gastrointestinal in 21.6% and local reactions and fatigue in 31.5%. Response. The overall response rate (ORR) was 42.4% (CR 19.6%, CRi 6.5%, PR 16.3%), stable disease (SD) was achieved in 19.6% and haematological improvement (HI) in 57.4%. After one year, based on Kaplan-Meier estimates, 67.8% of patients were alive and the median overall survival (OS) was 16.4 months. We also analysed several clinical parameters collected at the start of azacitidine treatment as prognostic factors for OS (age, sex, ECOG performance status (PS), transfusion dependency, peripheral blast percentage, neutrophil count, platelet count, bone marrow blast percentage, fibrosis, percentage of erythroid precursors in bone marrow, cytogenetic data, WHO classification, IPSS, primary and secondary aetiology of MDS). Conclusion. Our results correlate very well with other published data (AZA 001, CALGB 9221). OS data are comparable with other "real life" studies. It is also important to take into consideration that our group also included very high risk patients (relapsed, refractory to previous treatment, post-transplant patients and AML with more than 30% myeloblasts). Nevertheless, our results are very promising and support the positive effect of azacitidine compared to standard therapy in high risk MDS patients. The analysis performed so far shows that from the aspect of OS, best response correlates with: cytogenetic aberration, peripheral blast count, neutrophil count and ECOG PS. [ABSTRACT FROM AUTHOR]

Abstract: Background: Atrial flutter and fibrillation are being increasingly reported in patients with pulmonary hypertension but little is known about their clinical implications. We sought to determine the incidence and clinical impact of these arrhythmias in patients with pulmonary hypertension. Methods: In a 5-year, prospective study, we assessed the incidence of new-onset atrial flutter and fibrillation as well as risk factors, clinical consequences, management, and impact on survival in patients with pulmonary arterial hypertension (PAH, n=157) or inoperable chronic thromboembolic pulmonary hypertension (CTEPH, n=82). Results: The cumulative 5-year incidence of new-onset atrial flutter and fibrillation was 25.1% (95% confidence interval, 13.8–35.4%). The development of these arrhythmias was frequently accompanied by clinical worsening (80%) and signs of right heart failure (30%). Stable sinus rhythm was successfully re-established in 21/24 (88%) of patients initially presenting with atrial flutter and in 16/24 (67%) of patients initially presenting with atrial fibrillation. New-onset atrial flutter and fibrillation were an independent risk factor of death (p=0.04, simple Cox regression analysis) with a higher mortality in patients with persistent atrial fibrillation when compared to patients in whom sinus rhythm was restored (estimated survival at 1, 2 and 3years 64%, 55%, and 27% versus 97%, 80%, and 57%, respectively; p=0.01, log rank analysis). Conclusions: Atrial flutter and fibrillation develop in a sizable number of patients with PAH or inoperable CTEPH and often lead to clinical deterioration and right heart failure. Mortality is high when sinus rhythm cannot be restored. [Copyright &y& Elsevier]

Abstract: From the comprehensive MM registries of the Singapore (SG) and South Korea (SK) MM study groups, we study the survival data of 432 unselected and previously untreated MM patients diagnosed from 2006 to 2009. Although novel agents were introduced to both countries which have compatible healthcare standards at the same time, MM patients with high-risk features in SG could receive frontline bortezomib while bortezomib could only be approved for salvage setting in SK. After a median follow-up of 19 months, despite 26% of patients in SG versus none in SK having received frontline bortezomib, the overall bortezomib-exposure rate was higher in SK (60% versus 47%, p <0.001). Significantly more patients had no response to induction in SK. Although the median overall survival (OS) of patients in SG and SK was not significantly different (not reached versus 4.83 years respectively, p =0.2), corresponding 2-year OS for high-risk ISS patients treated in SG and SK was 81% and 67% respectively (p =0.01). On multivariate analysis stratified by country, the attainment of ≥VGPR was the only significant prognostic factor in SG while the presence of high-risk ISS has significant early prognostic impact in SK. Frontline use of bortezomib compared to its sequential may avert early mortality especially among patients with high-risk MM. [Copyright &y& Elsevier]

Purpose: We evaluated the attitude in using chemotherapy near the end of life in advanced pancreatic adenocarcinoma (PAC). Clinical and laboratory parameters recorded at last chemotherapy administration were analyzed, in order to identify risk factors for imminent death. Methods: Retrospective analysis of patients who underwent at least one line of palliative chemotherapy was made. Data concerning chemotherapy (regimens, lines, and date of last administration) were collected. Clinical and laboratory factors recorded at last chemotherapy administration were: performance status, presence of ascites, hemoglobin, white blood cell (WBC), platelets, total bilirubin, albumin, LDH, C-reactive protein (C-rp), and Ca 19.9. Results: We analyzed 231 patients: males/females, 53/47 %; metastatic/locally advanced disease, 80/20 %; and median age, 66 years (range 32-85). All patients died due to disease progression. Median overall survival was 6.1 months (95 % CI 5.1-7.2). At the last chemotherapy delivery, performance status was 0-1 in 37 % and 2 in 63 %. Fifty-nine percent of patients received one chemotherapy line, while 32, 8, and 1 % had second-, third-, and fourth line, respectively. The interval between last chemotherapy administration and death was <4 weeks in 24 %, ≥4-12 in 47 %, and >12 in 29 %. Median survival from last chemotherapy to death was 7.5 weeks (95 % CI 6.7-8.4). In a univariate analysis, ascites, elevated WBC, bilirubin, LDH, C-rp and Ca 19.9, and reduced albumin were found to predict shorter survival; however, none of them remained significant in a multivariate analysis. Conclusions: A significant proportion of patients with advanced PAC received chemotherapy within the last month of life. The clinical and laboratory parameters recorded at last chemotherapy delivery did not predict shorter survival. [ABSTRACT FROM AUTHOR]

ABSTRACT: Aim: The long-term survival of Taiwanese children with end-stage renal disease (ESRD) has not been reported before. This study aimed to determine the long-term survival, mortality hazards and causes of death in paediatric patients receiving dialysis. Methods: Paediatric patients (aged 19 years and younger) with incident ESRD who were reported to the Taiwan Renal Registry from 1995 to 2004 were included. A total of 319 haemodialysis (HD) and 156 peritoneal dialysis (PD) patients formed the database. After stratification by dialysis modality, multivariate Cox proportional-hazards model was constructed with age, sex and co-morbidity as predictive variables. Results: The annual paediatric ESRD incidence rate was 8.12 per million of age-related populations. The overall 1-, 5-, and 10-year survival rates for PD patients were 98.1%, 88.0% and 68.4%, respectively, and were 96.9%, 87.3% and 78.5% for HD patients. The survival analysis showed no significant difference between HD and PD ( P = 0.4878). Using '15-19 years' as a reference group, the relative risk (RR) of the youngest group (0-4 years) was 6.60 (95% CI: 2.50-17.38) for HD, and 5.03 (95% CI: 1.23-20.67) for PD. The death rate was 24.66 per 1000 dialysis patient-years. The three major causes of death were infection (23.4%), cardiovascular disease (13.0%) and cerebrovascular disease (10.4%). Hemorrhagic stroke (87.5%) was the main type of foetal cerebrovascular accident. Conclusion: We conclude that there was no significant difference of paediatric ESRD patient survival between HD and PD treatment in Taiwan. The older paediatric ESRD patients had better survival than younger patients. [ABSTRACT FROM AUTHOR]

Background: The life span of cancer patients has improved due to advancements in cancer management. With long survival periods, more patients show metastatic disease. Osteolytic tumours of spine are generated by metastatic deposits or primary tumours of the spine. A prospective study was performed to evaluate the efficacy and safety of percutaneous kyphoplasty in patients with osteolytic tumours of the thoracic and lumbar spine. Materials and methods: Eleven patients (age range 52-77/average 65 years; 7 female, 4 male) with osteolytic tumours of the spine were treated with kyphoplasty. The main Tokuhashi score was registered preoperatively. Outcome was assessed prospectively by visual analogue scale (VAS) for pain, ECOG performance status, walking distance, standing and sitting time. Results: Preoperative VAS (average 7.5; range 2.6-10) dropped to 3.0, 5 days postoperatively and remained below 5 for follow-up. Main Tokuhashi score was 6.3, ranging from 3 to 9. Survival time ranged from 2 to 293 (average 74.4) weeks. Average walking distance, standing and sitting time and ECOG performance score showed improvement. All patients returned home and no patient required re-operation or readmission due to local disease progression or recurrence. Conclusion: Kyphoplasty is a suitable palliative treatment option for patients with advanced metastatic disease of the spine even with low Tokuhashi scores allowing rapid pain relief and mobilisation to increase the quality of life. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the incidence and impact of early post-chemoradiation (cRT) 'pseudoprogression' (PsPD) amongst glioblastoma multiforme (GBM) patients treated with the current standard of care - 60 Gy conformal radiotherapy with concurrent low-dose temozolomide, followed by six cycles of high-dose temozolomide (the 'Stupp protocol'). Methods: Clinical notes and radiology reports for GBM patients treated as per the Stupp protocol were reviewed. PsPD was defined as apparent radiological progression on the first post-cRT scan, with further imaging within 3 months being stable or improving, while true early progression (ePD) was confirmed by continued progression in the subsequent 3 months following the first post-cRT scan. Results: Of the 68 patients evaluated, 14 (21%) and 27 (40%) experienced PsPD and ePD, respectively; 3/14 (21%) patients experiencing PsPD and 14/27(52%), ePD were symptomatic for progression on first post-cRT follow-up ( P = 0.096 for difference). Median survival for patients with ePD, PsPD and neither were 10.4, 27.4 and 13.0 months, respectively ( P = 0.003 for ePD vs. PsPD, P = 0.19 for neither vs. PsPD groups). Conclusion: These data confirm a significant incidence of PsPD in post-cRT GBM patients, associated with improved median survival compared with those with neither ePD nor PsPD (not statistically significant). It appears likely that PsPD actually represents tumour response, conflicting with the traditional notion that increase in lesion size on contrast-enhanced imaging represents disease progression. Early post-cRT imaging should thus be interpreted with caution. Accompanying clinical symptoms are more commonly associated with ePD, but do not reliably distinguish PsPD from ePD. [ABSTRACT FROM AUTHOR]

The article presents an analysis on survival differences by ethnicity and race in patients diagnosed with metastatic non-small cell lung cancer (NSCLC) in the U.S. The Surveillance, Epidemiology and End Results (SEER) started to gather data on cancer diagnosed on January 1, 1973, enabling the analysis of longitudinal trends. The American Indians/Alaskan natives population showed the worst outcomes in the cumulative survival at all time points equated with the Caucasians. The Japanese, Filipino and Chinese subpopulations showed the most favorable results.

The article cites a study of exercise testing to estimate survival in pulmonary hypertension (PH). The study aims to compare prognostic value of different exercise parameters in PH and to assess whether cardiopulmonary exercise test (CPET) adds prognostic value to the information from the 6-minute walk distance (6MWD). The result of the study showed that only multivariate Cox regression with a forward selection procedure showed that only peak pulse improved the univariate 6MWD prediction model. It concludes that CPET parameters predicts survival in PH patients and add marginally to the prognostic value of the 6MWD.

Object To investigate the incidence, comorbidities, mortality, and causes of death in idiopathic normal pressure hydrocephalus (iNPH). Methods A cohort of 536 patients with possible NPH from a defined population with a median follow-up time of 5.1 years, (range 0.04–19.9 years) was included in the study. Patients were evaluated by brain imaging and intraventricular pressure monitoring, with a brain biopsy specimen immunostained against amyloid-β and hyperphosphorylated τ. Hospital records were reviewed for vascular diseases and type 2 diabetes mellitus (T2DM). Death certificates and yearly population of the catchment area were obtained from national registries. Results A total of 283 patients had a clinical diagnosis of iNPH, leading to a median annual incidence of 1.58 iNPH patients per 100,000 inhabitants (range, 0.8–4.5). Alzeimer disease–related brain biopsy findings were less frequent in iNPH patients than in non-iNPH patients ( P < 0.05). An overrepresentation of hypertension (52% vs. 33%, P < 0.001) and T2DM (23% vs. 13%, P = 0.002) was noted in iNPH patients. Age (hazard ratio [HR] 1.04/year, 95% confidence interval [CI] 1.03–1.06, P < 0.001) and T2DM (HR 1.63, 95% CI 1.23–2.16, P < 0.001) increased the risk of death in the iNPH patients and in the total population. iNPH was associated with decreased risk of death (HR 0.63, 95% CI 0.50–0.78, P < 0.001). The most frequent causes of death were cardiovascular and cerebrovascular disease. Dementia as a cause of death was more common in non-iNPH patients (27% vs. 10%, P < 0.001). Conclusions Hypertension and T2DM are common in iNPH and the latter causes excess mortality in the affected patients. [ABSTRACT FROM AUTHOR]

The author comments on a study published within the issue which revealed that patients with coronary heart disease who have favorable expectations for function and survival were significantly more likely to experience better long-term function and to survive longer. He notes that intense optimism may leave patients unready, alone and distressed when the reality of their situation sets in. According to him, clinicians, patients and families need to affirm the importance of hope and realism instead of choosing between the two.

The article focuses on the long-term survival of myelodysplastic (MDS) patients with macrocytosis. The patients with less than 55 myeloblasts were stratified into two groups using mean corpuscular volume values (MCV). It showed significantly longer survival periods. MCV is regarded as an elastic parameter and it may be a poor indicator of physiological cell size, especially when measured by machines that manipulate the cell volume in vitro. Results are not necessarily reproducible from one machine to another.

A response from the authors of the article "Disparity in Renal Cell Carcinoma Patient Survival According to Demographic and Clinical Characteristics" in the 2013 issue, which discusses the contribution of nonbiologic factors to racial disparity in the survival of renal cancer patient is presented.

In this article, the authors present their views on a study related to racial disparity in renal cell carcinoma patient survival conducted by the National Cancer Institute of the U.S. They state that survival of the American patients with renal cell carcinoma is more than that of the African American patients. They also talk about a recent study related to outcomes, income, socioeconomic status and access to medical care.