Predictors of opioid use for rib fractures in a regional Australian hospital

BACKGROUND

Rib fractures (RFs) are the leading type of single serious injury in New South Wales trauma patients. Uncontrolled pain drives the sequelae of atelectasis, pneumonia, respiratory failure, and death in severe cases. Opioids are the mainstay of management; however, they carry numerous adverse effects. Understanding patient or injury factors which predict opioid requirement is important to tailor management. Existing evidence is limited to metropolitan trauma centres (MTCs).

METHODS

We conducted an observational, retrospective, single-centre cohort study of all admissions to Albury Wodonga Health diagnosed with one or more RFs and discharged between January 1st, 2017, and December 31st, 2022, inclusive. Data collected included demographics, injury characteristics, and management, including analgesia. LASSO regression was performed to determine predictors of average daily opioid use for the first five days of admission in oral morphine equivalents (mg). R2 and root mean square error (RMSE) were calculated to assess model performance.

RESULTS

We included 624 patients. LASSO selected number of RFs, fracture displacement score, pulmonary contusion, new injury severity score, age, chest tube use, chronic pain history, opioid history and upper or middle lateral RF location categories as predictors. Sex, middle anterior, middle posterior, and lower RF location categories were excluded by LASSO. The out of sample R2 was 28.6 %. On the scale of log OME, the RMSE was 1.08.

CONCLUSION

The model is effective at identifying predictors of opioid use in this regional centre, which are similar to those described in evidence from MTCs. However, the low R2 with wide prediction intervals limits its utility on an individual level.

Intraoperative methadone for day-case gynaecological laparoscopy: A double-blind, randomised controlled trial

Optimal pain relief in day-case surgery is imperative to patient comfort and timely discharge from hospital. Short-acting opioids are commonly used for analgesia in modern anaesthesia, allowing rapid recovery after surgery. Plasma concentration fluctuations from repeated dosing of short-acting opioids can cause patients to oscillate between analgesia with potential adverse effects, and inadequate analgesia requiring rescue dosing. Methadone's unique pharmacology may offer effective and sustained analgesia with less opioid consumption, potentially reducing adverse effects. Using a double-blind, randomised controlled trial, we compared post-anaesthesia care unit opioid consumption between day-case gynaecological laparoscopy patients who received either intravenous methadone (10 mg), or short-acting opioids intraoperatively. The primary outcome was post-anaesthesia care unit opioid consumption in oral morphine equivalents. Secondary outcomes included total opioid consumption, discharge opioid consumption, pain scores (0-10) until discharge, adverse effects (respiratory depression, postoperative nausea and vomiting, excess sedation), and rate of admission. Seventy patients were randomly assigned. Patients who received methadone consumed on average 9.44 mg fewer oral morphine equivalents in the post-anaesthesia care unit than the short-acting group (18.02 mg vs 27.46 mg, respectively, 95% confidence interval 0.003 to 18.88, P = 0.050) and experienced lower postoperative pain scores at every time point, although absolute differences were small. There was no evidence of lower hospital or discharge opioid consumption. No significant differences between the methadone and short-acting groups in other outcomes were identified: respiratory depression 41.2% versus 31.4%, Padjusted >0.99; postoperative nausea and vomiting 29.4% versus 42.9%, Padjusted >0.99; overnight admission 17.7% versus 11.4%, Padjusted >0.99; excess sedation 8.82% versus 8.57%, Padjusted >0.99. This study provides evidence that, although modestly, methadone can reduce post-anaesthesia care unit opioid consumption and postoperative pain scores after day-case gynaecological laparoscopy. There were no significant differences in any secondary outcomes.

What is the prevalence of orthostatic hypotension in an Australasian emergency department population?

OBJECTIVE

Orthostatic hypotension (OH) is associated with increased morbidity and there is limited research on the prevalence in the Australian ED population. The aim was to determine the prevalence of OH in an Australian ED population. Secondary outcomes included any associations of OH with symptoms, presenting complaints, patient demographics, or hospital admission, and the timing of OH findings.

METHODS

Patients presenting to a regional Australasian ED underwent orthostatic measurements at 1, 3 and 5 min of standing following 5 min of supine bed rest. OH was defined as a drop in systolic and/or diastolic blood pressure by ≥20 and ≥10 mmHg, respectively.

RESULTS

Of the 312 patients who were enrolled in the study, 69 (22.1%, 95% confidence interval 17.7-27.2%) had OH and 76.8% of cases were detected after 3 min of standing. There was evidence of difference in the prevalence of OH with age (P < 0.001). Similarly, there was evidence of a difference in supine systolic and diastolic blood pressure measurements (P = 0.012 and P < 0.001, respectively) between orthostatic and normotensive subjects. No association was found with OH and hospital admission, presenting complaints or comorbid medical illnesses.

CONCLUSIONS

In this single Australian ED population, there was a high prevalence of OH (22.1%) with most cases detected within 3 min of standing. A higher-powered study across multiple sites would better substantiate these findings.

Self-reported intimate partner violence among men who have sex with men at an urban Australian sexual health clinic

BACKGROUND

In Australia, 17% of women and 6% of men have experienced intimate partner violence (IPV). Although most IPV research has focused on heterosexual partnerships, studies suggest that men who have sex with men (MSM) may experience IPV at similar or higher rates than those documented among women. IPV may also take different forms among MSM and have different health and social impacts. This study aims to assess the utility of a screening tool for identifying and responding to IPV among MSM attending a sexual health clinic in Sydney, Australia.

METHODS

Between 1 June 2020 and 30 June 2022, MSM clients were screened using standardised questions to identify IPV experienced within the preceding 12months. Answers to the screening questions were correlated with data collected routinely at the initial clinic visit, including age, employment, country of birth, drug and alcohol use, sexual partner numbers, and any history of sex work, pre-exposure prophylaxis use and HIV status, as well as any bacterial STI diagnosed at the initial visit.

RESULTS

There were 2410 eligible clients and of these, 2167 (89.9%) were screened during the study period. A total of 64 men (3.0%) (95% CI 2.3-3.8%) reported experiencing physical violence or intimidation in the past 12months. Controlling for age, men who were born in Australia were 2.03 (95% CI: 1.04-3.01) times more likely to report IPV, and men who had Medicare were 2.43 (95% CI: 0.95-3.90) times more likely to report IPV than those who did not. Those who had ever injected drugs were 5.8 (95% CI: 1.87-9.73) times more likely to report IPV, and men with sexualised drug use were 4.11 (95% CI: 2.03-6.19) times more likely. Those that were employed or studying were 72% (95%CI: 0.13-0.42) less likely to report IPV.

CONCLUSIONS

The prevalence of reported IPV in our study was lower than that reported by others, which may be due to differences in recruitment methods and questions asked. Associations between IPV in MSM and injecting drug use and sexualised drug use highlight that clinicians should be aware of the impact and potential for IPV particularly in those with risk factors.

Decreased rates of hospital-acquired infection after introduction of an active surveillance, virtual glucose management system

Addition of an active surveillance virtual glucose management (VGM) system to usual consultation-based diabetes inpatient care at our hospital was associated with a decrease in hospital-acquired infection from 8.7% (17/196) to 3.5% (6/172) with an adjusted odds ratio of 0.17 (95%CI: 0.05-0.61), and a reduction in hypoglycemic and hyperglycemic patient-stay days.

CCNE1 and survival of patients with tubo-ovarian high-grade serous carcinoma: An Ovarian Tumor Tissue Analysis consortium study

BACKGROUND

Cyclin E1 (CCNE1) is a potential predictive marker and therapeutic target in tubo-ovarian high-grade serous carcinoma (HGSC). Smaller studies have revealed unfavorable associations for CCNE1 amplification and CCNE1 overexpression with survival, but to date no large-scale, histotype-specific validation has been performed. The hypothesis was that high-level amplification of CCNE1 and CCNE1 overexpression, as well as a combination of the two, are linked to shorter overall survival in HGSC.

METHODS

Within the Ovarian Tumor Tissue Analysis consortium, amplification status and protein level in 3029 HGSC cases and mRNA expression in 2419 samples were investigated.

RESULTS

High-level amplification (>8 copies by chromogenic in situ hybridization) was found in 8.6% of HGSC and overexpression (>60% with at least 5% demonstrating strong intensity by immunohistochemistry) was found in 22.4%. CCNE1 high-level amplification and overexpression both were linked to shorter overall survival in multivariate survival analysis adjusted for age and stage, with hazard stratification by study (hazard ratio [HR], 1.26; 95% CI, 1.08-1.47, p = .034, and HR, 1.18; 95% CI, 1.05-1.32, p = .015, respectively). This was also true for cases with combined high-level amplification/overexpression (HR, 1.26; 95% CI, 1.09-1.47, p = .033). CCNE1 mRNA expression was not associated with overall survival (HR, 1.00 per 1-SD increase; 95% CI, 0.94-1.06; p = .58). CCNE1 high-level amplification is mutually exclusive with the presence of germline BRCA1/2 pathogenic variants and shows an inverse association to RB1 loss.

CONCLUSION

This study provides large-scale validation that CCNE1 high-level amplification is associated with shorter survival, supporting its utility as a prognostic biomarker in HGSC.

MCM3 is a novel proliferation marker associated with longer survival for patients with tubo-ovarian high-grade serous carcinoma

Tubo-ovarian high-grade serous carcinomas (HGSC) are highly proliferative neoplasms that generally respond well to platinum/taxane chemotherapy. We recently identified minichromosome maintenance complex component 3 (MCM3), which is involved in the initiation of DNA replication and proliferation, as a favorable prognostic marker in HGSC. Our objective was to further validate whether MCM3 mRNA expression and possibly MCM3 protein levels are associated with survival in patients with HGSC. MCM3 mRNA expression was measured using NanoString expression profiling on formalin-fixed and paraffin-embedded tissue (N = 2355 HGSC) and MCM3 protein expression was assessed by immunohistochemistry (N = 522 HGSC) and compared with Ki-67. Kaplan-Meier curves and the Cox proportional hazards model were used to estimate associations with survival. Among chemotherapy-naïve HGSC, higher MCM3 mRNA expression (one standard deviation increase in the score) was associated with longer overall survival (HR = 0.87, 95% CI 0.81-0.92, p < 0.0001, N = 1840) in multivariable analysis. MCM3 mRNA expression was highest in the HGSC C5.PRO molecular subtype, although no interaction was observed between MCM3, survival and molecular subtypes. MCM3 and Ki-67 protein levels were significantly lower after exposure to neoadjuvant chemotherapy compared to chemotherapy-naïve tumors: 37.0% versus 46.4% and 22.9% versus 34.2%, respectively. Among chemotherapy-naïve HGSC, high MCM3 protein levels were also associated with significantly longer disease-specific survival (HR = 0.52, 95% CI 0.36-0.74, p = 0.0003, N = 392) compared to cases with low MCM3 protein levels in multivariable analysis. MCM3 immunohistochemistry is a promising surrogate marker of proliferation in HGSC.

Born to Be Wild: Evaluating the Zoo-Based Regent Honeyeater Breed for Release Program to Optimise Individual Success and Conservation Outcomes in the Wild

Evaluating the effectiveness of captive breeding programs is central to improving conservation outcomes in released animals. However, few studies have assessed the impact of the strategies and trade-offs involved in husbandry decisions and the selection of traits on the success of breeding programs. This study evaluated a range of husbandry features including an animal's environment, health, and traits of the released individual and its parents involved in the zoo-based Regent Honeyeater breed for release program to optimise individual reproductive success and survivability, leading to improved conservation outcomes in the wild. We analysed 285 birds using a penalised Cox proportional hazard model to assess survival and an ordinal logistic model to evaluate the reproductive success of zoo bred birds released to the wild. Key features identified by the study highlight the importance of having parents that are successful breeders and parents that have an overall higher lifetime reproductive output. However, there were associated quantity-quality trade-offs, as the success of young (i.e., released birds) produced by parents was negatively associated to the number of clutches per year (where one clutch per year was found optimal). The study demonstrated the importance of considering the parental effects on the traits of its offspring beyond its pedigree information and found there was an associated decline in fitness of its offspring with older fathers. Song tutoring using wild Regent Honeyeaters was also important for increased survival post-release. Other important factors are discussed within the review. In general, the study recommended that a multi-faceted approach in the assessment and evaluation of the captive breeding program, to identify markers that will improve conservation outcomes of future releases.

Macroelements versus toxic elements in selected wild edible mushrooms of the Russulacea family from Serbia

Three edible mushrooms of the Russulacea family (Lactarius deliciosus, Lactarius sanguifluus and Lactarius semisanguifluus), most frequently consumed in Serbia, were analyzed using the ICP-OES technique to evaluate the content of K, P, Ca, Mg, Na, Al, As, Cd and Pb, both in cap and stipe. Corresponding soils were analyzed, too. Based on the obtained values for the elemental composition of the mushrooms and the soil, bioaccumulation and translocation factors were calculated. All the examined mushrooms species were recognized as bioexclusors of analyzed toxic elements, but bioaccumulators of K, P and Ca. The studied mushrooms are good sources of macroelements. One portion of 300 g of fresh mushrooms had a significant contribution of K and P, exceeding 15 % of the recommended daily intake for the elements. On the contrary, mushrooms had a low potential to bioaccumulate toxic elements, and presented results indicated the regular consumption of wild edible mushrooms is safe for human health. Correlation analysis was applied to determine phosphorus?s influence on the elements? content in the mushrooms and corresponding soils, demonstrating the most remarkable mushrooms' tendency to accumulate phosphorus.

Serum concentrations of estriol vary widely after application of vaginal oestriol cream

AIMS

The aim of this study was to establish the pharmacokinetic profile of serum oestriol (E₃ ) concentrations over 24 h following application of vaginal E₃ in chronic users (>12 weeks of E₃ use). The interindividual and intraindividual differences before and after E₃ were examined.

METHODS

Ten women participated. Vaginal cream was omitted for ≥36 h prior to the study days. Blood sampling was performed for E₃ , oestradiol and oestrone concentrations prior to cream application and at 1, 2, 3, 5, 8, 10, 12 and 24 h afterwards. In five women, all samples were repeated on a separate day.

RESULTS

E₃ was absorbed rapidly in most women. Peak serum E₃ concentration occurred around 2 h (range 1-5 h). The decline in E₃ concentrations was also rapid: falling <100 pmol L^-1 in six out of ten women within 8 h and returning to ≤ 10 pmol L^-1 at 24 h in nine out of the ten patients. Interindividual variability for peak concentrations was considerable (mean 546 pmol L^-1 ; 95% CI 349-743). Area under the concentration-time curve (AUC) values over a dosage interval also varied widely: mean 2145 pmol.h L^-1 ; 95% CI 1422-3233. However, repeated measurements in the same woman were highly (peaks: ρ = 0.94) or moderately (AUC: P = 0.74) correlated.

CONCLUSIONS

Postmenopausal E₃ concentrations are negligible. Serum E₃ concentrations of chronic users of E₃ cream varied greatly; however, concentrations declined rapidly within 8 h, generally reaching 'postmenopausal' levels by 24 h. The basis for the variation between subjects needs further elucidation. Additional research is required to establish the safety of topical E₃ .

Systemic Anti-Cancer Therapy Use in Palliative Care Outpatients With Advanced Cancer

PURPOSE

To evaluate factors associated with continuation of systemic anti-cancer therapy (SACT) after palliative care consultation, and SACT administration in the last 30 days of life, in outpatients with cancer referred to palliative care. Timing of referral was of particular interest.

METHODS

Patient, disease, and treatment-related factors associated with SACT before and after palliative care, and in the last 30 days of life, were identified using 3-level multinomial logistic regression. Referral to palliative care was categorized by time from death as early (>12 months), intermediate (6-12 months), and late (≤6 months).

RESULTS

Of the 337 patients, 240 (71.2%) received SACT for advanced cancer; of these, 126 (52.5%) received SACT only prior to palliative care while 114 (47.5%) also received SACT afterward. Only 35/337 (10.4%) received SACT in the last 30 days of life. On multivariable analysis, factors associated with continuing SACT after palliative care consultation were a cancer diagnosis for <1 year (OR 3.09, p = 0.01), breast primary (OR 11.88, p = 0.0008), and early (OR 28.8, p < 0.001) or intermediate (OR 6.67, p < 0.001) referral timing. No factors were significantly associated with receiving SACT in the last 30 days versus earlier, but the median time from palliative care referral to death in those receiving SACT in the last 30 days versus stopping SACT earlier was 1.78 versus 4.27 months.

CONCLUSION

Patients who received SACT following palliative care consultation were more likely to be referred early; however, patients receiving SACT in their last 30 days tended to be referred late.

Determinants of cognitive performance and decline in 20 diverse ethno-regional groups: A COSMIC collaboration cohort study

BACKGROUND

With no effective treatments for cognitive decline or dementia, improving the evidence base for modifiable risk factors is a research priority. This study investigated associations between risk factors and late-life cognitive decline on a global scale, including comparisons between ethno-regional groups.

METHODS AND FINDINGS

We harmonized longitudinal data from 20 population-based cohorts from 15 countries over 5 continents, including 48,522 individuals (58.4% women) aged 54-105 (mean = 72.7) years and without dementia at baseline. Studies had 2-15 years of follow-up. The risk factors investigated were age, sex, education, alcohol consumption, anxiety, apolipoprotein E ε4 allele (APOE*4) status, atrial fibrillation, blood pressure and pulse pressure, body mass index, cardiovascular disease, depression, diabetes, self-rated health, high cholesterol, hypertension, peripheral vascular disease, physical activity, smoking, and history of stroke. Associations with risk factors were determined for a global cognitive composite outcome (memory, language, processing speed, and executive functioning tests) and Mini-Mental State Examination score. Individual participant data meta-analyses of multivariable linear mixed model results pooled across cohorts revealed that for at least 1 cognitive outcome, age (B = -0.1, SE = 0.01), APOE*4 carriage (B = -0.31, SE = 0.11), depression (B = -0.11, SE = 0.06), diabetes (B = -0.23, SE = 0.10), current smoking (B = -0.20, SE = 0.08), and history of stroke (B = -0.22, SE = 0.09) were independently associated with poorer cognitive performance (p < 0.05 for all), and higher levels of education (B = 0.12, SE = 0.02) and vigorous physical activity (B = 0.17, SE = 0.06) were associated with better performance (p < 0.01 for both). Age (B = -0.07, SE = 0.01), APOE*4 carriage (B = -0.41, SE = 0.18), and diabetes (B = -0.18, SE = 0.10) were independently associated with faster cognitive decline (p < 0.05 for all). Different effects between Asian people and white people included stronger associations for Asian people between ever smoking and poorer cognition (group by risk factor interaction: B = -0.24, SE = 0.12), and between diabetes and cognitive decline (B = -0.66, SE = 0.27; p < 0.05 for both). Limitations of our study include a loss or distortion of risk factor data with harmonization, and not investigating factors at midlife.

CONCLUSIONS

These results suggest that education, smoking, physical activity, diabetes, and stroke are all modifiable factors associated with cognitive decline. If these factors are determined to be causal, controlling them could minimize worldwide levels of cognitive decline. However, any global prevention strategy may need to consider ethno-regional differences.

Patient-Reported Functional Status in Outpatients With Advanced Cancer: Correlation With Physician-Reported Scores and Survival

CONTEXT

Performance status measures are increasingly completed by patients in outpatient cancer settings, but are not well validated for this use.

OBJECTIVES

We assessed performance of a patient-reported functional status measure (PRFS, based on the Eastern Cooperative Oncology Group [ECOG]), compared with the physician-completed ECOG, in terms of agreement in ratings and prediction of survival.

METHODS

Patients and physicians independently completed five-point PRFS (lay version of ECOG) and ECOG measures on first consultation at an oncology palliative care clinic. We assessed agreement between PRFS and ECOG using weighted Kappa statistics, and used linear regression to determine factors associated with the difference between PRFS and ECOG ratings. We used the Kaplan-Meier method to estimate the patients' median survival, categorized by PRFS and ECOG, and assessed predictive accuracy of these measures using the C-statistic.

RESULTS

For the 949 patients, there was moderate agreement between PRFS and ECOG (weighted Kappa 0.32; 95% CI: 0.28-0.36). On average, patients' ratings of performance status were worse by 0.31 points (95% CI: 0.25-0.37, P < 0.0001); this tendency was greater for younger patients (P = 0.002) and those with worse symptoms (P < 0.0001). Both PRFS and ECOG scores correlated well with overall survival; the C-statistic was higher for the average of PRFS and ECOG scores (0.619) than when reported individually (0.596 and 0.604, respectively).

CONCLUSION

Patients tend to rate their performance status worse than physicians, particularly if they are younger or have greater symptom burden. Prognostic ability of performance status could be improved by using the average of patients and physician scores.

Characteristics and predictors of pain in patients with newly diagnosed and relapsed acute leukemia (AL)

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Background: AL is a hematopoietic stem cell malignancy associated with substantial morbidity and mortality. The prevalence, correlates and causes for pain in this population have not been well studied. We present the results of a large cross-sectional study of pain in individuals with AL. Methods: Patients with newly-diagnosed or recently-relapsed AL admitted to a large tertiary cancer center completed the Memorial Symptom Assessment Scale (MSAS, which has subscales of prevalence, severity, frequency and distress, with ratings of 0 = none, 1 = mild, 2 = moderate, 3 = severe, 4 = very severe). Demographic information, and disease and treatment variables were recorded. Two raters completed chart reviews in duplicate (with discussion of discordant results) for patients with severe pain (MSAS severity ≥3/4) to assess the site of pain. Results: A total of 362 patients were recruited from January 2008 to October 2013: 249 (68.8%) with AML, 80 (22.1%) ALL and 33 (9.1%) APL. Of these, 326 (90.1%) were newly diagnosed and 36 (9.9%) had relapsed disease; 346 (95.6%) were treated with (re)induction chemotherapy. Of 360 who completed the MSAS, pain was reported in 174 (48.3%), of whom 34.4% scored ≥3/4 on severity, 43.1% on frequency, and 44.3% on distress related to the pain. On multivariable analysis, patients reporting pain were more likely to be younger (OR 0.98 old vs young, p < 0.001), and to have ALL (OR 0.57 AML vs ALL, p < 0.05); duration of illness, gender, education, income and treatment intensity were not associated with pain. Pain was correlated with difficulty sleeping, worrying, difficulty concentrating, and feeling sad, nervous or irritable (all p < 0.001). Of the 60 patients reporting severe pain (≥3/4), its site was identified in 53 (88.3%). The most common sites were oropharynx (29.7%), head (18.9%), abdomen (14.9%) and musculoskeletal (12.2%). Only 1.1% (4/362) of the cohort was referred to the palliative care/symptom control team over the month prior to or following assessment. Conclusions: Pain is a frequent and distressing symptom in patients with newly diagnosed or relapsed AL. Further research is needed to assess the efficacy of supportive care interventions in this population.

Agreement between physician and patient performance status ratings in an outpatient setting

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Background: Performance status (PS) scores are generally completed by physicians, although patient PS measures are increasingly available. The objective of this study was to assess agreement between physician-recorded Eastern Cooperative Oncology Group (ECOG) PS and a patient-rated measure of performance status based on the ECOG measure in an outpatient oncology palliative care clinic. Methods: Physicians recorded ECOG PS for every patient as part of routine clinical practice. Patients recorded their PS using a measure based on the ECOG, where 0 = normal with no limitations; 1 = not my normal self, but able to be up and about with fairly normal activities; 2 = not feeling up to most things, but in bed or chair less than half the day; 3 = able to do little activity and spend most of the day in bed or chair; and 4 = pretty much bedridden, rarely out of bed. Patients also completed the ESAS-CS measure. Medical and demographic data were abstracted from the patients’ charts. We examined correlation between physician and patient PS measures as well as factors associated with a difference in patient versus physician measures for 949 patients with a visit between August 1, 2013 and December 31, 2014. Results: Weighted Kappa statistics indicated moderate inter-rater agreement at 0.32 (95%CI: 0.28-0.36). On average, patients rated their ECOG higher by 0.31 (95%CI: 0.25-0.37, p < 0.0001); 40.7% of patients rated their PS worse, 41.9% the same, and 17.3% better than did physicians. Worst agreement was for ECOG 0 (5 of 25 patients rated 0 by physicians also rated 0 themselves, 20% agreement); the highest agreement was in those with physician-rated ECOG 3 (87/136 patients, 64% agreement). Older patients reported better PS than physicians (p = 0.002) while those with worse ESAS distress scores reported worse ECOG than physicians (p < .0001). Conclusions: Patients tend to rate their PS as worse than rated by physicians, particularly those with greater symptom burden. However, older patients tend to rate their PS as better. This could be due to age bias of physicians or due to older patients assessing their PS optimistically. Future research will assess the survival data of participants to assess correlation of PS assessments of each group with prognosis.

Atelectasis: positive or negative prognostic factor on outcome of patients with non-small cell lung cancer?

PURPOSE

the aim of this study was to evaluate the influence of atelectasis (AT) on overall survival of patients with non small cell lung cancer (NSCLC).

METHODS

the study included patients of both sexes with unresectable stage III and IV NSCLC with good performance status (PS) (ECOG ≤ 2). Patients were divided into two groups: with AT (AT+) and without AT (AT-): Factors analyzed included sex, age, histologic type, ECOG performance status, stage of disease and treatment modality. Overall survival was estimated according to Kaplan-Meier method, and multivariate analysis was used to identify independent prognostic factors.

RESULTS

we evaluated 247 patients (83% males and 17% females); 47/247 (19%) of patients belonged to AT+ group. In this group 21% of patients had stage IIIA, 46% IIIB stage, and 33% IV stage. Overall survival was significantly longer in the AT+ group (15.23 vs. 9.03 months, p=0.001). AT+ patients in stages III and IV had significantly longer overall survival than AT- patients in the same stages (p=0.001, p=0.002, respectively). Multivariate analysis showed that atelectasis (p=0.001), stage of disease (p=0.001), and treatment modality (p=0.005) were independent prognostic factors associated with survival.

CONCLUSION

atelectasis is favorable prognostic factor concerning overall survival in patients with NSCLC.