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Ozer M, Goksu SY, Lin RY, Ayasun R, Kahramangil D, Rogers SC, Fabregas JC, Ramnaraign BH, George TJ, Feely M, Cabrera R, Duarte S, Zarrinpar A, Sahin I. Effects of Clinical and Tumor Characteristics on Survival in Patients with Hepatocellular Carcinoma with Bone Metastasis. J Hepatocell Carcinoma 2023; 10:1129-1141. [PMID: 37489126 PMCID: PMC10363394 DOI: 10.2147/jhc.s417273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023] Open
Abstract
Background Advanced hepatocellular carcinoma (HCC) generally has a dismal prognosis. Bone metastases from HCC are infrequent, with a poorer prognosis. However, the survival influencing factors are not yet well understood. Aim The aim of the present study was to assess the clinical features and tumor characteristics of HCC patients with bone metastasis. Methods A cohort of 170,576 adult patients with HCC was studied using the National Cancer Database (NCDB) spanning from 2010 to 2019, and within this group, 5285 patients (3.1%) were diagnosed with bone metastasis. We performed the Kaplan-Meier method to calculate the median overall survival (OS). We included demographics (age at diagnosis, gender, race, insurance status), comorbidity score, and treatment characteristics. Results Of a total of 5285 HCC patients with bone metastasis, 86.2% were male and 61.2% were non-Hispanic white. Most patients (55.1%) were below 65, and 89% had a total Charlson-Deyo comorbidity score of under 3. Among patients with known tumor grade, 24.8% had well-differentiated tumors, and 36.1% had poorly differentiated tumors. Chemotherapy was administrated to 39.5% of patients. In univariate analysis, patients with well-differentiated tumors had better OS compared to poorly differentiated tumors (5.4 months vs 3.0 months, p = 0.001). Patients who received single or multiagent chemotherapy were significantly associated with improved OS compared to patients who did not receive chemotherapy (7.0 and 8.5 months vs 1.94 months, respectively). We also found mortality difference between age, comorbidity scores, facility types and race groups. Conclusion In this cohort analysis of NCDB data, we found better OS in treatment receipt, lower tumor grade, younger age, non-Hispanic Black and Hispanic race, treatment at academic facility and lower comorbidity score in HCC patients with bone metastasis. The study results may have a consequential impact on the treatment decisions for HCC patients with bone metastasis.
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Affiliation(s)
- Muhammet Ozer
- Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Suleyman Yasin Goksu
- Division of Hematology/Oncology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Rick Y Lin
- Department of Medicine, University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Ruveyda Ayasun
- Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, NY, USA
| | - Doga Kahramangil
- Division of Hematology/Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Sherise C Rogers
- Division of Hematology/Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA
- University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Jesus C Fabregas
- Division of Hematology/Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA
- University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Brian H Ramnaraign
- Division of Hematology/Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA
- University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Thomas J George
- Division of Hematology/Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA
- University of Florida Health Cancer Center, Gainesville, FL, USA
| | - Michael Feely
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, FL, USA
| | - Roniel Cabrera
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, FL, USA
| | - Sergio Duarte
- Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ali Zarrinpar
- Department of Surgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Ilyas Sahin
- Division of Hematology/Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA
- University of Florida Health Cancer Center, Gainesville, FL, USA
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Fayed N, Elkhadry SW, Garling A, Ellerkmann RK. External Validation of the Revised Cardiac Risk Index and the Geriatric-Sensitive Perioperative Cardiac Risk Index in Oldest Old Patients Following Surgery Under Spinal Anaesthesia; a Retrospective Cross-Sectional Cohort Study. Clin Interv Aging 2023; 18:737-753. [PMID: 37197404 PMCID: PMC10183631 DOI: 10.2147/cia.s410207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/02/2023] [Indexed: 05/19/2023] Open
Abstract
Background The Revised Cardiac Risk Index (RCRI) and the Geriatric Sensitive Cardiac Risk Index (GSCRI) estimate the risk of postoperative major adverse cardiac events (MACE) regardless of the type of anesthesia and without specifying the oldest old patients. Since spinal anesthesia (SA) is a preferred technique in geriatrics, we aimed to test the external validity of these indices in patients ≥ 80 years old who underwent surgery under SA and tried to identify other potential risk factors for postoperative MACE. Methods The performance of both indices to estimate postoperative in-hospital MACE risk was tested through discrimination, calibration, and clinical utility. We also investigated the correlation between both indices and postoperative ICU admission and length of hospital stay (LOS). Results The MACE incidence was 7.5%. Both indices had limited discriminative (AUC for RCRI and GSCRI were 0.69 and 0.68, respectively) and predictive abilities. The regression analysis showed that patients with atrial fibrillation (AF) were 3.77 and those with trauma surgery were 2.03 times more likely to exhibit MACE, and the odds of MACE increased by 9% for each additional year above 80. Introducing these factors into both indices (multivariable models) increased the discriminative ability (AUC reached 0.798 and 0.777 for RCRI and GSCRI, respectively). Bootstrap analysis showed that the predictive ability of the multivariate GSCRI but not the multivariate RCRI improved. Decision curve analysis (DCA) showed that multivariate GSCRI had superior clinical utility when compared with multivariate RCRI. Both indices correlated poorly with postoperative ICU admission and LOS. Conclusion Both indices had limited predictive and discriminative ability to estimate postoperative in-hospital MACE risk and correlated poorly with postoperative ICU admission and LOS, following surgery under SA in the oldest-old patients. Updated versions by introducing age, AF, and trauma surgery improved the GSCRI performance but not the RCRI.
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Affiliation(s)
- Nirmeen Fayed
- Anethesia and Critical Care Department, Klinikum Dortmund, Dortmund, Germany
- Anesthesia and Critical Care Department, National Liver Institute Menoufia University, Shebin-Alkoom, Egypt
- Correspondence: Nirmeen Fayed, Anesthesia Department Klinikum Dortmund, Germany, Mollwitzer Straße 4, Dortmund, 44141, Germany, Tel +49 17647154842, Email
| | - Sally Waheed Elkhadry
- Epidemiology and Preventive Medicine Institute, National Liver Institute, Menoufia University, Shebin-Alkoom, Egypt
| | - Andreas Garling
- Anethesia and Critical Care Department, Klinikum Dortmund, Dortmund, Germany
| | - Richard K Ellerkmann
- Anethesia and Critical Care Department, Klinikum Dortmund, Dortmund, Germany
- Anesthesia and Critical Care Department, Bonn University, Bonn, Germany
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Zhang Y, Cui C, Wang L, Yu X, Wang Y, Wang X. The Mediating Role of Hope in the Relationship Between Perceived Stress and Post-Traumatic Stress Disorder Among Chinese Patients with Oral Cancer: A Cross-Sectional Study. Cancer Manag Res 2021; 13:393-401. [PMID: 33488121 PMCID: PMC7814276 DOI: 10.2147/cmar.s281886] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/31/2020] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Cancer diagnosis and treatment are long-term traumatic stressors. Depression and anxiety are known to be prevalent in patients with cancer, but post-traumatic disorder (PTSD) has been overlooked frequently in this population. This study aimed to estimate the prevalence of PTSD and examined the mediating role of hope in the relationship between perceived stress and PTSD symptoms in Chinese patients with oral cancer. METHODS A total of 230 oral cancer patients were recruited to complete a questionnaire including the Posttraumatic Stress Checklist-Civilian Version (PCL-C), the Perceived Stress Scale-10 (PSS-10) and the Herth Hope Index (HHI). Analysis of variances (ANOVA)/t-test, Person's r and hierarchical linear regression analysis methods were conducted to assess the associations among perceived stress, hope and PTSD symptoms. Asymptotic and resampling strategies were used to explore the mediating role of hope. RESULTS The prevalence of PTSD symptoms was 6.05% in Chinese patients with oral cancer. Perceived stress was positively related to PTSD symptoms, explaining 39.9% of the variance. In addition, hope was negatively related to PTSD symptoms, explaining 5.9% of the variance. Besides, the proportion of mediation of hope was 30.06%. CONCLUSION Perceived stress was positively associated with PTSD symptoms, and hope was negatively associated with PTSD symptoms. Furthermore, hope played partial mediating role in the relationship between perceived stress and PTSD symptoms. Thus, more attention should be paid to patients' PTSD status, and take measures is to relieve stress and increase hope.
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Affiliation(s)
- Ying Zhang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Chunying Cui
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Lie Wang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Xiaosong Yu
- Department of General Practice, The First Affiliated Hospital, China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Yu Wang
- Department of Social Medicine, School of Public Health, China Medical University, Shenyang, Liaoning, People’s Republic of China
| | - Xiaoxi Wang
- Medical Basic Experimental Teaching Center, China Medical University, Shenyang, Liaoning, People’s Republic of China
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