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Féray C, Campion L, Mathurin P, Archambreaud I, Mirabel X, Bronowicki JP, Rio E, Perret C, Mineur L, Oberti F, Touchefeu Y, Gournay J, Regnault H, Edeline J, Rode A, Hillion P, Blanc JF, Khac EN, Azoulay D, Luciani A, Preglisasco AG, Faurel-Paul E, Auble H, Mornex F, Merle P. TACE and conformal radiotherapy vs. TACE alone for hepatocellular carcinoma: A randomised controlled trial. JHEP Rep 2023; 5:100689. [PMID: 36937990 PMCID: PMC10017427 DOI: 10.1016/j.jhepr.2023.100689] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/22/2022] [Accepted: 01/16/2023] [Indexed: 01/30/2023] Open
Abstract
Background & Aims Transcatheter arterial chemoembolisation (TACE) is recommended for patients with hepatocellular carcinoma devoid of macrovascular invasion or extrahepatic spread but not eligible for curative therapies. We compared the efficacy and safety of the combination of a single TACE and external conformal radiotherapy (CRT) vs. classical TACE. Methods TACERTE was an open-labelled, randomised controlled trial with a 1:1 allocation rate to two or three TACE (arm A) or one TACE + CRT (arm B). Participants had a mean age of 70 years, and 86% were male. The aetiology was alcohol in 85%. The primary endpoint was liver progression-free survival (PFS) in the intention-to-treat population. The typical CRT schedule was 54 Gy in 18 sessions of 3 Gy. Results Of the 120 participants randomised, 64 were in arm A and 56 in arm B; 100 participants underwent the planned schedule and defined the 'per-protocol' group. In intention-to-treat participants, the liver PFS at 12 and 18 months were 59% and 19% in arm A and 61% and 36% in arm B (hazard ratio [HR] 0.69; 95% CI 0.40-1.18; p = 0.17), respectively. In the per-protocol population, treated liver PFS tended to be better in arm B (HR 0.61; 95% CI 0.34-1.06; p = 0.081) than in arm A. Liver-related grade III-IV adverse events were more frequent in arm B than in arm A. Median overall survival reached 30 months (95% CI 23-35) in arm A and 22 months (95% CI 15.7-26.2) in arm B. Conclusions Although TACE + CRT tended to improve local control, this first Western randomised controlled trial showed that the combined strategy failed to increase PFS or overall survival and led more frequently to liver-related adverse effects. Impact and implications Hepatocellular carcinoma is frequently treated by arterial embolisation of the tumour and more recently by external radiotherapy. We tried to determine whether combination of the two treatments (irradiation after embolisation) might produce interesting results. Our results in this prospective randomised study were not able to demonstrate a beneficial effect of combining embolisation and irradiation in these patients. On the contrary, we observed more adverse effects with the combined treatment. Clinical Trials Registration NCT01300143.
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Key Words
- 3-DCRT, three-dimensional conformal radiotherapy
- AE, adverse event
- ALBI, albumin–bilirubin
- BCLC, Barcelona Clinic Liver Cancer
- CRT, conformal radiotherapy
- CT, computed tomography
- CTV, clinical tumour volume
- Conformal external radiotherapy
- ECOG, Eastern Cooperative Oncology Group
- HCC, hepatocellular carcinoma
- HR, hazard ratio
- Hepatocellular carcinoma
- ITT, intention-to-treat
- OS, overall survival
- PFS, progression-free survival
- PS, propensity score
- RILD, radio-induced liver disease
- SBRT, stereotaxic body radiation therapy
- TACE, transcatheter arterial chemoembolisation
- TTP, time to tumour progression
- mRECIST, modified Response Evaluation Criteria in Solid Tumour
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Affiliation(s)
- Cyrille Féray
- Centre Hepato-Biliaire, Hôpital Paul Brousse, APHP, Université Paris-Saclay, INSERM 1193, Villejuif, France
- Corresponding author. Address: Centre Hépato Biliaire, Hôpital Paul Brousse. Villejuif, 94800. France. Tel.: +33 1 45596780.
| | - Loic Campion
- Department of Biostatistics, Institut de Cancérologie de l'Ouest, Université Nantes, INSERM U307, Nantes, France
| | - Philippe Mathurin
- Service des Maladies de l'Appareil Digestif, Hôpital Huriez, Université Lille, INSERM 1286, Lille, France
| | | | - Xavier Mirabel
- Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
| | | | - Emmanuel Rio
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Saint Herblain, France
| | | | - Laurent Mineur
- Digestive Oncology, Institut Sainte Catherine, Avignon, France
| | - Frédéric Oberti
- Department of Gastroenterology and Hepatology, Centre Hospitalo-universitaire, Angers, France
| | - Yann Touchefeu
- Institut des Maladies de l'Appareil Digestif, Hôtel-Dieu, Nantes, France
| | - Jérôme Gournay
- Institut des Maladies de l'Appareil Digestif, Hôtel-Dieu, Nantes, France
| | - Hélène Regnault
- Department of Gastroenterology and Hepatology, Hôpital Henri Mondor, APHP, Université Paris Est, Creteil, France
| | - Julien Edeline
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Agnès Rode
- Radiology Department, Hôpital de la Croix-Rousse, Hospice Civil de Lyon; Lyon, France
| | - Patrick Hillion
- Department of Gastroenterology and Hepatology, Centre Hospitalo-universitaire, Dijon, France
| | - Jean Frédéric Blanc
- Department of Gastroenterology and Hepatology, Hôpital Sud Haut-Lévêque, Bordeaux, France
| | - Eric Nguyen Khac
- Department of Gastroenterology and Hepatology, Centre Hospitalo-universitaire, Université Amiens, Amiens, France
| | - Daniel Azoulay
- Centre Hepato-Biliaire, Hôpital Paul Brousse, APHP, Université Paris-Saclay, INSERM 1193, Villejuif, France
| | - Alain Luciani
- Radiology Department, Hôpital Henri Mondor, APHP, Créteil, France
| | | | | | - Hélène Auble
- Direction de la Recherche Medicale, Hôtel-Dieu, Nantes, France
| | - Françoise Mornex
- Department of Radiation Oncology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon, EMR 3738, Lyon, France
| | - Philippe Merle
- Hepatology and Gastroenterology Unit, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard, INSERM U1052, Lyon, France
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Brumbaugh JE, Ball CT, Crook JE, Stoppel CJ, Carey WA, Bobo WV. Poor Neonatal Adaptation After Antidepressant Exposure During the Third Trimester in a Geographically Defined Cohort. Mayo Clin Proc Innov Qual Outcomes 2023; 7:127-139. [PMID: 36938114 PMCID: PMC10017424 DOI: 10.1016/j.mayocpiqo.2023.02.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Objective To examine the associations between antidepressant exposure during the third trimester of pregnancy, including individual drugs, drug doses, and antidepressant combinations, and the risk of poor neonatal adaptation (PNA). Patients and Methods The Rochester Epidemiology Project medical records-linkage system was used to study infants exposed to selective serotonin reuptake inhibitors (SSRIs; n=1014), bupropion, (n=118), serotonin-norepinephrine reuptake inhibitors (n=80), antidepressant combinations (n=20), or other antidepressants (n=22) during the third trimester (April 11, 2000-December 31, 2013). Poor neonatal adaptation was defined based on a review of medical records. Poisson regression was used to examine the risk of PNA with serotonergic antidepressant and drug combinations compared with that with bupropion monotherapy as well as with high- vs standard-dose antidepressants. When possible, analyses were performed using propensity score (PS) weighting. Results Forty-four infants were confirmed cases of PNA. Serotonin-norepinephrine reuptake inhibitor monotherapy, antidepressant combinations, and paroxetine monotherapy were associated with a significantly higher risk of PNA than bupropion monotherapy in unweighted analyses. High-dose SSRI exposure was associated with a significantly increased risk of PNA in unadjusted (relative risk, 2.61; 95% confidence interval, 1.35-5.04) and PS-weighted models (relative risk, 2.29; 95% confidence interval, 1.17-4.48) compared with standard-dose SSRI exposure. The risk of PNA was significantly higher with high-dose paroxetine and sertraline than with standard doses in the PS-weighted analyses. The other risk factors for PNA included maternal anxiety disorders. Conclusion Although the frequency of PNA in this cohort was low (3%-4%), the risk of PNA was increased in infants exposed to serotonergic antidepressants, particularly with SSRIs at higher doses, during the third trimester of pregnancy compared with that in infants exposed to standard doses. Potential risk factors for PNA also included third-trimester use of paroxetine (especially at higher doses) and maternal anxiety.
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Affiliation(s)
- Jane E. Brumbaugh
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Colleen T. Ball
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | - Julia E. Crook
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, FL
| | | | - William A. Carey
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - William V. Bobo
- Department of Psychiatry & Psychology, Mayo Clinic, Jacksonville, FL
- Correspondence: Address to William V. Bobo, MD, MPH, Mayo Clinic Florida, Davis 4N, 4500 San Pablo Road, Jacksonville, FL 32224.
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Pedersini R, Cosentini D, Rinaudo L, Zamparini M, Ulivieri FM, di Mauro P, Maffezzoni F, Monteverdi S, Vena W, Laini L, Amoroso V, Simoncini EL, Farina D, Mazziotti G, Berruti A. Assessment of DXA derived bone quality indexes and bone geometry parameters in early breast cancer patients: A single center cross-sectional study. Bone Rep 2023; 18:101654. [PMID: 36700242 PMCID: PMC9868326 DOI: 10.1016/j.bonr.2023.101654] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 01/12/2023] Open
Abstract
Background Bone mineral density (BMD) lacks sensitivity in individual fracture risk assessment in early breast cancer (EBC) patients treated with aromatase inhibitors (AIs). New dual-energy X-ray absorptiometry (DXA) based risk factors are needed. Methods Trabecular bone score (TBS), bone strain index (BSI) and DXA parameters of bone geometry were evaluated in postmenopausal women diagnosed with EBC. The aim was to explore their association with morphometric vertebral fractures (VFs). Subjects were categorized in 3 groups in order to evaluate the impact of AIs and denosumab on bone geometry: AI-naive, AI-treated minus (AIDen-) or plus (AIDen+) denosumab. Results A total of 610 EBC patients entered the study: 305 were AI-naive, 187 AIDen-, and 118 AIDen+. In the AI-naive group, the presence of VFs was associated with lower total hip BMD and T-score and higher femoral BSI. As regards as bone geometry parameters, AI-naive fractured patients reported a significant increase in femoral narrow neck (NN) endocortical width, femoral NN subperiosteal width, intertrochanteric buckling ratio (BR), intertrochanteric endocortical width, femoral shaft (FS) BR and endocortical width, as compared to non-fractured patients. Intertrochanteric BR and intertrochanteric cortical thickness significantly increased in the presence of VFs in AIDen- patients, not in AIDen+ ones. An increase in cross-sectional area and cross-sectional moment of inertia, both intertrochanteric and at FS, significantly correlated with VFs only in AIDen+. No association with VFs was found for either lumbar BSI or TBS in all groups. Conclusions Bone geometry parameters are variably associated with VFs in EBC patients, either AI-naive or AI treated in combination with denosumab. These data suggest a tailored choice of fracture risk parameters in the 3 subgroups of EBC patients.
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Key Words
- AI, aromatase inhibitor
- AIDen+, aromatase inhibitor with denosumab
- AIDen-, aromatase inhibitor without denosumab
- Aromatase inhibitors
- BMD, bone mineral density
- BMI, body-mass index
- BR, buckling ratio
- BSI, bone strain index
- Bone strain index
- CSA, cross-sectional area
- CSMI, cross-sectional moment of inertia
- DXA, dual-energy X-ray absorptiometry
- Dual-energy X-ray absorptiometry
- EBC, early breast cancer
- FS, femoral shaft
- HAL, hip axis length
- HR, hormone receptor
- HSA, Hip Structure Analysis
- IT, intertrochanteric
- NN, narrow neck
- NSA, neck shaft angle
- PS, propensity score
- ROC, receiver operator characteristic
- TBS, trabecular bone score
- VF, vertebral fracture
- Vertebral fractures
- Z, modulus
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Affiliation(s)
- Rebecca Pedersini
- Medical Oncology, ASST Spedali Civili, Brescia, Italy
- Breast Unit, ASST Spedali Civili, Brescia, Italy
- Corresponding author at: Oncologia Medica, ASST Spedali Civili di Brescia, Piazzale Spedali Civili 1, 20123, Brescia, Italy.
| | - Deborah Cosentini
- Medical Oncology, ASST Spedali Civili, Brescia, Italy
- Breast Unit, ASST Spedali Civili, Brescia, Italy
| | | | | | | | | | | | | | - Walter Vena
- Endocrinology, Diabetology and Medical Andrology Unit, Metabolic Bone Diseases and Osteoporosis Section, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - Lara Laini
- Medical Oncology, ASST Spedali Civili, Brescia, Italy
| | - Vito Amoroso
- Medical Oncology, ASST Spedali Civili, Brescia, Italy
| | | | - Davide Farina
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Gherardo Mazziotti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
- Endocrinology, Diabetology and Medical Andrology Unit, Metabolic Bone Diseases and Osteoporosis Section, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
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Shah SC, Canakis A, Halvorson AE, Dorn C, Wilson O, Denton J, Hauger R, Hunt C, Suzuki A, Matheny ME, Siew E, Hung A, Greevy RA, Roumie CL. Associations Between Gastrointestinal Symptoms and COVID-19 Severity Outcomes Based on a Propensity Score-Weighted Analysis of a Nationwide Cohort. Gastro Hep Adv 2022; 1:977-984. [PMID: 35966642 PMCID: PMC9357443 DOI: 10.1016/j.gastha.2022.06.015] [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] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/30/2022] [Indexed: 01/25/2023]
Abstract
Background and Aims Gastrointestinal (GI) symptoms are well-recognized manifestations of coronavirus disease 2019 (COVID-19). Our primary objective was to evaluate the association between GI symptoms and COVID-19 severity. Methods In this nationwide cohort of US veterans, we evaluated GI symptoms (nausea/vomiting/diarrhea) reported 30 days before and including the date of positive SARS-CoV-2 testing (March 1, 2020, to February 20, 2021). All patients had ≥1 year of prior baseline data and ≥60 days follow-up relative to the test date. We used propensity score (PS)-weighting to balance covariates in patients with vs without GI symptoms. The primary composite outcome was severe COVID-19, defined as hospital admission, intensive care unit admission, mechanical ventilation, or death within 60 days of positive testing. Results Of 218,045 SARS-CoV-2 positive patients, 29,257 (13.4%) had GI symptoms. After PS weighting, all covariates were balanced. In the PS-weighted cohort, patients with vs without GI symptoms had severe COVID-19 more often (29.0% vs 17.1%; P < .001). When restricted to hospitalized patients (14.9%; n=32,430), patients with GI symptoms had similar frequencies of intensive care unit admission and mechanical ventilation compared with patients without symptoms. There was a significant age interaction; among hospitalized patients aged ≥70 years, lower COVID-19-associated mortality was observed in patients with vs without GI symptoms, even after accounting for COVID-19-specific medical treatments. Conclusion In the largest integrated US health care system, SARS-CoV-2-positive patients with GI symptoms experienced severe COVID-19 outcomes more often than those without symptoms. Additional research on COVID-19-associated GI symptoms may inform preventive efforts and interventions to reduce severe COVID-19.
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Key Words
- BMI, body mass index
- CDW, Corporate Data Warehouse
- COVID-19
- COVID-19, coronavirus disease 2019
- Epidemiology
- GI, gastrointestinal
- ICD, International Classification of Diseases
- ICU, intensive care unit
- Infectious diseases
- OMOP, Observational Medical Outcomes Partnership
- OR, odds ratios
- Outcomes
- PCR, polymerase chain reaction
- PS, propensity score
- RAASi, renin-angiotensin-aldosterone system inhibitors
- SARS-CoV-2
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
- SD, standard deviation
- SDR, Shared Data Resource
- SMD, standardized mean differences
- VHA, Veterans Health Administration
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Affiliation(s)
- Shailja C Shah
- Gastroenterology Section, VA San Diego, San Diego, California
- Division of Gastroenterology, University of California, San Diego, San Diego, California
| | - Andrew Canakis
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Alese E Halvorson
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chad Dorn
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Otis Wilson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jason Denton
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Richard Hauger
- Department of Psychiatry, University of California San Diego, La Jolla, California
- Center of Excellence for Stress and Mental Health, San Diego, California
| | - Christine Hunt
- Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina
- Gastroenterology Section, Durham VA Health Care System, Durham, North Carolina
| | - Ayako Suzuki
- Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina
- Gastroenterology Section, Durham VA Health Care System, Durham, North Carolina
| | - Michael E Matheny
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- VA Tennessee Valley Healthcare System, Health Services Research and Development, Nashville, Tennessee
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Edward Siew
- VA Tennessee Valley Healthcare System, Health Services Research and Development, Nashville, Tennessee
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adriana Hung
- VA Tennessee Valley Healthcare System, Health Services Research and Development, Nashville, Tennessee
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert A Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
- VA Tennessee Valley Healthcare System, Clinical Services Research and Development, Nashville, Tennessee
| | - Christianne L Roumie
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- VA Tennessee Valley Healthcare System, Clinical Services Research and Development, Nashville, Tennessee
- VA Geriatrics Research Education and Clinical Center (GRECC), VA Tennessee Valley Health System, Nashville, Tennessee
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Hong D, Lee SH, Shin D, Choi KH, Kim HK, Park TK, Yang JH, Song YB, Hahn JY, Choi SH, Gwon HC, Lee JM. Prognosis and Medical Cost of Measuring Fractional Flow Reserve in Percutaneous Coronary Intervention. JACC Asia 2022; 2:590-603. [PMID: 36518721 PMCID: PMC9743455 DOI: 10.1016/j.jacasi.2022.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/17/2022] [Accepted: 04/13/2022] [Indexed: 02/07/2023]
Abstract
Background There are limited data regarding comparative prognosis and medical cost between fractional flow reserve (FFR)-based and angiography-based percutaneous coronary intervention (PCI) among revascularized patients. Objectives This study evaluates prognosis and medical cost of FFR use in revascularized patients by PCI. Methods Using the National Health Insurance Service database, stable or unstable angina patients who underwent PCI from 2011 to 2017 were evaluated. Eligible patients were divided into 2 groups according to use of FFR in PCI. Primary outcome was a composite of all-cause death or spontaneous myocardial infarction (MI). Secondary outcomes included individual components of the primary outcome, unplanned revascularization, and medical costs. Results Among 134,613 eligible patients, PCI was performed based on angiography (n = 129,497) and FFR (n = 5,116). During the study period, both the annual number and proportion of use of FFR in PCI increased (all P for trend <0.001). The FFR group showed significantly lower risk of the primary outcome (7.0% vs 9.5%; P < 0.001), all-cause death (5.8% vs 7.7%; P = 0.001), and spontaneous MI (1.6% vs 2.2%; P = 0.022) than the angiography group. Although the FFR group showed higher medical cost during index admission than angiography group (median: $6,265.10 vs $5,385.60; P < 0.001), cumulative medical cost after index admission was significantly lower ($2,696.50 vs. $3,142.10; P < 0.001). Conclusions Use of FFR in PCI in stable or unstable angina patients showed significantly lower risk of all-cause death and spontaneous MI compared to angiography-based PCI. Although the FFR group had higher initial medical cost than the angiography group, cumulative medical cost after index admission was significantly lower.
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Affiliation(s)
- David Hong
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung Hun Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Doosup Shin
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Ki Hong Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Kuk Kim
- Department of Internal Medicine and Cardiovascular Center, Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Republic of Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Bin Song
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joo-Yong Hahn
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea,Address for correspondence: Dr Joo Myung Lee, Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea.
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Kohsaka S, Okami S, Kanda E, Kashihara N, Yajima T. Cardiovascular and Renal Outcomes Associated With Hyperkalemia in Chronic Kidney Disease: A Hospital-Based Cohort Study. Mayo Clin Proc Innov Qual Outcomes 2021; 5:274-285. [PMID: 33997627 PMCID: PMC8105529 DOI: 10.1016/j.mayocpiqo.2020.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective To examine the association between hyperkalemia and long-term cardiovascular and renal outcomes in patients with chronic kidney disease. Patients and Methods An observational retrospective cohort study was performed using a Japanese hospital claims registry, Medical Data Vision (April 1, 2008, to September 30, 2018). Of 1,208,894 patients with at least 1 potassium measurement, 167,465 patients with chronic kidney disease were selected based on International Classification of Diseases, Tenth Revision codes or estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2. Hyperkalemia was defined as at least 2 potassium measurements of 5.1 mmol/L or greater within 12 months. Normokalemic controls were patients without a record of potassium levels of 5.1 mmol/L or greater and 3.5 mmol/L or less. Changes in eGFRs and hazard ratios of death, hospitalization for cardiac events, heart failure, and renal replacement therapy introduction were assessed between propensity score–matched hyperkalemic patients and normokalemic controls. Results Of 16,133 hyperkalemic patients and 11,898 normokalemic controls eligible for analyses, 5859 (36.3%) patients and 5859 (49.2%) controls were selected after propensity score matching. The mean follow-up period was 3.5 years. The 3-year eGFR change in patients and controls was −5.75 and −1.79 mL/min/1.73 m2, respectively. Overall, hyperkalemic patients had higher risks for death, hospitalization for cardiac events, heart failure, and renal replacement therapy introduction than controls, with hazard ratios of 4.40 (95% CI, 3.74 to 5.18), 1.95 (95% CI, 1.59 to 2.39), 5.09 (95% CI, 4.17 to 6.21), and 7.54 (95% CI, 5.73 to 9.91), respectively. Conclusion Hyperkalemia was associated with significant risks for mortality and adverse clinical outcomes, with more rapid decline of renal function. These findings underscore the significance of hyperkalemia as a predisposition to future adverse events in patients with chronic kidney disease.
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Key Words
- ACEi, angiotensin-converting enzyme inhibitor
- ARB, angiotensin receptor blocker
- CKD, chronic kidney disease
- DM, diabetes mellitus
- HDL, high-density lipoprotein
- HF, heart failure
- ICD-10, International Classification of Diseases, Tenth Revision
- LDL, low-density lipoprotein
- MDV, Medical Data Vision
- MRA, mineralocorticoid receptor antagonist
- PS, propensity score
- RAASi, renin-angiotensin-aldosterone system inhibitor
- RRT, renal replacement therapy
- S-K, serum potassium
- eGFR, estimated glomerular filtration rate
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Affiliation(s)
- Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Suguru Okami
- Cardiovascular, Renal, and Metabolism, Medical Affairs, AstraZeneca KK, Osaka, Japan
| | - Eiichiro Kanda
- Medical Science, Kawasaki Medical School, Okayama, Japan
| | - Naoki Kashihara
- Department of Nephrology and Hypertension, Kawasaki Medical School, Okayama, Japan
| | - Toshitaka Yajima
- Cardiovascular, Renal, and Metabolism, Medical Affairs, AstraZeneca KK, Osaka, Japan
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Hui VW, Chan SL, Wong VW, Liang LY, Yip TC, Lai JC, Yuen BW, Luk HW, Tse YK, Lee HW, Chan HL, Wong GL. Increasing antiviral treatment uptake improves survival in patients with HBV-related HCC. JHEP Rep 2020; 2:100152. [PMID: 33024950 DOI: 10.1016/j.jhepr.2020.100152] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 12/27/2022] Open
Abstract
Background & Aims Antiviral treatment is known to improve survival in patients with chronic hepatitis B (CHB)-related hepatocellular carcinoma (HCC). Yet, the treatment uptake in CHB patients remains low. We aimed to report the secular trend in antiviral treatment uptake from 2007-2017, and to compare the effect of different nucleos(t)ide analogue (NA) initiation times (before vs. after HCC diagnosis) on survival. Methods A 3-month landmark analysis was used to compare overall survival in patients not receiving NA treatment (i.e. no NA), patients receiving NAs after their first HCC treatment (i.e. post-HCC NA), and patients receiving NAs ≤3 months before their first HCC treatment (i.e. pre-HCC NA). A propensity score-weighted Cox proportional hazards model was used to balance clinical characteristics between the 3 groups and to estimate hazard ratios (HRs). Results The uptake of antiviral treatment in HCC patients increased from 47.3% in 2007 to 98.3% in 2017. The pre-HCC NA group contributed mostly to the uptake rate, which increased from 72.7% to 96.0% in the past decade. In addition, 3,843 CHB patients (407 no NA; 2,932 pre-HCC NA; 504 post-HCC NA) with HCC, receiving at least 1 type of HCC treatment, were included in the analysis. Lack of NA treatment at the time of HCC diagnosis increased the risk of death (weighted HR 3.05; 95% CI 2.70-3.44; p <0.001). The impact of the timing of NA treatment was insignificant (weighted HR 0.90; 95% CI 0.78-1.04; p = 0.161). Conclusions The uptake of antiviral treatment in HCC patients increased over the past decade. NA treatment, regardless of whether it was initiated before or after HCC diagnosis, improved survival. It is never too late to initiate NA treatment, even after HCC diagnosis. Lay summary More and more patients who have hepatitis B-related liver cancer received antiviral treatment over the past decade. The timing of starting antiviral treatment, regardless of whether it was before or after liver cancer happens, does not really matter in terms of survival benefits.
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Key Words
- AFP, alpha-fetoprotein
- ALT, alanine aminotransferase
- ASMD, absolute standardised mean difference
- CDARS, Clinical Data Analysis and Reporting System
- CHB, chronic hepatitis B
- Entecavir
- GGT, gamma-glutamyl transpeptidase
- HCC, hepatocellular carcinoma
- HR, hazard ratio
- Hazard ratio
- ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification
- IPTW, inverse probability of treatment weighting
- IQR, inter-quartile range
- KS, Kolmogorov-Smirnov
- Lamivudine
- Local ablative therapy
- MICE, multivariate imputation by chained equations
- NA, nucleos(t)ide analogue
- PS, propensity score
- Propensity scores
- Surgical resection
- TACE, transarterial chemoembolisation
- TDF, tenofovir disoproxil fumarate
- Transarterial chemoembolisation
- aHR, adjusted hazard ratio
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Ueki Y, Vögeli B, Karagiannis A, Zanchin T, Zanchin C, Rhyner D, Otsuka T, Praz F, Siontis GCM, Moro C, Stortecky S, Billinger M, Valgimigli M, Pilgrim T, Windecker S, Suter T, Räber L. Ischemia and Bleeding in Cancer Patients Undergoing Percutaneous Coronary Intervention. JACC CardioOncol 2019; 1:145-55. [PMID: 34396175 DOI: 10.1016/j.jaccao.2019.11.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 10/31/2019] [Accepted: 11/02/2019] [Indexed: 01/06/2023]
Abstract
Objectives The purpose of this study was to evaluate ischemic and bleeding outcomes of unselected cancer patients undergoing percutaneous coronary intervention (PCI). Background The number of cancer patients undergoing PCI is increasing despite concerns regarding ischemic and bleeding risks. Methods Between 2009 and 2017, consecutive patients undergoing PCI were prospectively included in the Bern PCI Registry. Cancer-specific data including type, date of initial diagnosis, and health status at index PCI were collected. We performed propensity score matching to adjust for baseline differences between patients with and without cancer. The primary ischemic endpoint was the device-oriented composite endpoint (cardiac death, target vessel myocardial infarction, target lesion revascularization) at 1 year, and the primary bleeding endpoint was Bleeding Academic Research Consortium (BARC) 2 to 5 at 1 year. Results Among 13,647 patients, 1,368 (10.0%) had an established diagnosis of cancer. The 3 leading cancer types were prostate (n = 294), gastrointestinal tract (n = 188), and hematopoietic (n = 177). At index PCI, 179 (13.1%) patients were receiving active cancer treatment. In matched analysis, there was no significant difference in device-oriented composite endpoint (11.5% vs. 10.2%; p = 0.251), whereas cardiac death and BARC 2 to 5 bleeding occurred more frequently among patients with cancer compared with those without cancer (6.8% vs. 4.5%; p = 0.010 and 8.0% vs. 6.0%; p = 0.026, respectively). Cancer diagnosis within 1 year before PCI emerged as an independent predictor for cardiac death and BARC 2 to 5 bleeding at 1 year. Conclusions Cancer patients carry an increased risk of cardiac mortality that was not associated with stent-related ischemic events among patients undergoing PCI in routine clinical practice. Higher risk of bleeding in cancer patients undergoing PCI deserves particular attention. (CARDIOBASE Bern PCI Registry; NCT02241291)
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Key Words
- BARC, Bleeding Academic Research Consortium
- CAD, coronary artery disease
- CI, confidence interval
- DAPT, dual antiplatelet therapy
- DES, drug-eluting stent
- DOCE, device-oriented composite endpoint
- HR, hazard ratio
- IPTW, inverse probability of treatment weighting
- MI, myocardial infarction
- PCI, percutaneous coronary interventions
- PS, propensity score
- bleeding
- cancer
- coronary artery disease
- ischemia
- percutaneous coronary intervention
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Kajiyama H, Yoshihara M, Tamauchi S, Yoshikawa N, Suzuki S, Kikkawa F. Fertility-Sparing surgery for young women with ovarian endometrioid carcinoma: a multicenteric comparative study using inverse probability of treatment weighting. Eur J Obstet Gynecol Reprod Biol X 2019; 4:100071. [PMID: 31517302 PMCID: PMC6728721 DOI: 10.1016/j.eurox.2019.100071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 12/30/2022] Open
Abstract
Introduction The aim of this study was to evaluate the oncologic outcome of women with stage I ovarian endometrioid carcinoma (EC) who underwent fertility-sparing surgery (FSS). Materials and nethods Between 1986 and 2017, a total of 3227 patients with epithelial ovarian carcinoma were retrospectively evaluated based on a central pathological review and search of the medical records from multiple institutions. We identified 24 and 54 patients with stage I EC who underwent FSS and conventional radical surgery (CRS), respectively. Inverse probability of treatment weighting (IPTW)–adjusted Kaplan-Meier and Cox regression analyses were employed to compare OS between the two groups. Results With follow-up of a total of 78 patients, 9 patients (11.5%) developed recurrence. In addition, 5 patients (6.4%) died of the disease. Recurrence was noted in 3 (10.7%) patients in the FSS group and 6 (11.1%) patients in the CRS group. Death was noted in 2 (8.3%) patients in the FSS group and 3 (5.6%) patients in the CRS group. In the original cohort, there was no significant difference in overall survival (OS) or recurrence-free survival (RFS) between the FSS and RS groups {Log-rank: OS (P = 0.630), RFS (P = 0.757)}. In the IPTW-adjusted cohort, the 5-year OS rates were 96.6 and 92.4% in patients with FSS and CRS, respectively (P = 0.319). Furthermore, the 5-year RFS rate was 88.6% for the FSS group and 88.1% for the CRS group (Log-rank: P = 0.556). Conclusions Young women with stage I EC undergoing FSS showed a relatively satisfactory prognosis, equal to those receiving CRC.
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Affiliation(s)
- Hiroaki Kajiyama
- Corresponding author at: Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Tsuruma-cho 65, Showa-ku, Nagoya, 466-8550, Japan.
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