Evolving Epidemiology ofStaphylococcus aureusBacteremia

2015 ◽  
Vol 36 (12) ◽  
pp. 1417-1422 ◽  
Author(s):  
Yoona Rhee ◽  
Alla Aroutcheva ◽  
Bala Hota ◽  
Robert A. Weinstein ◽  
Kyle J. Popovich
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Illicit Drugs ◽  
Bloodstream Infections ◽  
Usa300 Strain ◽  
Risk Factor Data ◽  
Strain Type ◽  
Epidemiologic Risk ◽  
Over Time

BACKGROUNDMethicillin-resistantStaphylococcus aureus(MRSA) infections due to USA300 have become widespread in community and healthcare settings. It is unclear whether risk factors for bloodstream infections (BSIs) differ by strain type.OBJECTIVETo examine the epidemiology ofS. aureusBSIs, including USA300 and non-USA300 MRSA strains.DESIGNRetrospective observational study with molecular analysis.SETTINGLarge urban public hospital.PATIENTSIndividuals withS. aureusBSIs from January 1, 2007 through December 31, 2013.METHODSWe used electronic surveillance data to identify cases ofS. aureusBSI. Available MRSA isolates were analyzed by pulsed-field gel electrophoresis. Poisson regression was used to evaluate changes in BSI incidence over time. Risk factor data were collected by medical chart review and logistic regression was used for multivariate analysis of risk factors.RESULTSA total of 1,015 cases ofS. aureusBSIs were identified during the study period; 36% were due to MRSA. The incidence of hospital-onset (HO) MRSA BSIs decreased while that of community-onset (CO) MRSA BSIs remained stable. The rate of CO– and HO– methicillin-susceptibleS. aureusinfections both decreased over time. More than half of HO-MRSA BSIs were due to the USA300 strain type and for 4 years, the proportion of HO-MRSA BSIs due to USA300 exceeded 60%. On multivariate analysis, current or former drug use was the only epidemiologic risk factor for CO- or HO-MRSA BSIs due to USA300 strains.CONCLUSIONSUSA300 MRSA is endemic in communities and hospitals and certain populations (eg, those who use illicit drugs) may benefit from enhanced prevention efforts in the community.Infect. Control Hosp. Epidemiol.2015;36(12):1417–1422

scholarly journals Proposal for the use of echocardiography in bloodstream infections due to different streptococcal species

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sandra Chamat-Hedemand ◽  
Niels Eske Bruun ◽  
Lauge Østergaard ◽  
Magnus Arpi ◽  
Emil Fosbøl ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Bloodstream Infections ◽  
Low Risk ◽  
Moderate Risk ◽  
Streptococcal Species ◽  
Very High

Abstract Background Infective endocarditis (IE) is diagnosed in 7–8% of streptococcal bloodstream infections (BSIs), yet it is unclear when to perform transthoracic (TTE) and transoesophageal echocardiography (TOE) according to different streptococcal species. The aim of this sub-study was to propose a flowchart for the use of echocardiography in streptococcal BSIs. Methods In a population-based setup, we investigated all patients admitted with streptococcal BSIs and crosslinked data with nationwide registries to identify comorbidities and concomitant hospitalization with IE. Streptococcal species were divided in four groups based on the crude risk of being diagnosed with IE (low-risk < 3%, moderate-risk 3–10%, high-risk 10–30% and very high-risk > 30%). Based on number of positive blood culture (BC) bottles and IE risk factors (prosthetic valve, previous IE, native valve disease, and cardiac device), we further stratified cases according to probability of concomitant IE diagnosis to create a flowchart suggesting TTE plus TOE (IE > 10%), TTE (IE 3–10%), or “wait & see” (IE < 3%). Results We included 6393 cases with streptococcal BSIs (mean age 68.1 years [SD 16.2], 52.8% men). BSIs with low-risk streptococci (S. pneumoniae, S. pyogenes, S. intermedius) are not initially recommended echocardiography, unless they have ≥3 positive BC bottles and an IE risk factor. Moderate-risk streptococci (S. agalactiae, S. anginosus, S. constellatus, S. dysgalactiae, S. salivarius, S. thermophilus) are guided to “wait & see” strategy if they neither have a risk factor nor ≥3 positive BC bottles, while a TTE is recommended if they have either ≥3 positive BC bottles or a risk factor. Further, a TTE and TOE are recommended if they present with both. High-risk streptococci (S. mitis/oralis, S. parasanguinis, G. adiacens) are directed to a TTE if they neither have a risk factor nor ≥3 positive BC bottles, but to TTE and TOE if they have either ≥3 positive BC bottles or a risk factor. Very high-risk streptococci (S. gordonii, S. gallolyticus, S. mutans, S. sanguinis) are guided directly to TTE and TOE due to a high baseline IE prevalence. Conclusion In addition to the clinical picture, this flowchart based on streptococcal species, number of positive blood culture bottles, and risk factors, can help guide the use of echocardiography in streptococcal bloodstream infections. Since echocardiography results are not available the findings should be confirmed prospectively with the use of systematic echocardiography.

Diverging trends in US male-female condom use by STI risk factors: a nationally representative study

2020 ◽  
pp. sextrans-2020-054642
Author(s):  
Casey E Copen ◽  
Patricia J Dittus ◽  
Jami S Leichliter ◽  
Sagar Kumar ◽  
Sevgi O Aral
Keyword(s):  
Risk Factors ◽  
Condom Use ◽  
Illicit Drugs ◽  
Female Condom ◽  
Cross Sectional ◽  
The Past ◽  
Representative Study ◽  
The Usa ◽  
Over Time ◽  
Sex Partner

ObjectiveCondom use behaviours are proximal to recent STI increases in the USA, yet it remains unclear whether the use of condoms has changed over time among unmarried, non-cohabiting young men who have sex with women (MSW) and how this variability is influenced by STI risk factors.MethodsTo examine condom use over time among MSW aged 15–29, we used three cross-sectional surveys from the 2002, 2006–2010 and 2011–2017 National Survey of Family Growth. We estimated weighted percentages, adjusted prevalence ratios (APRs) and 95% confidence intervals (CI) to assess changes in condom use, stratified by whether MSW reported any STI risk factors in the past 12 months (ie, perceived partner non-monogamy, male-to-male sex, sex in exchange for money or drugs, sex partner who injects illicit drugs, or an HIV-positive sex partner).ResultsWe observed a divergence in trends in condom use at last sex between men aged 15 –29 with STI risk factors in the past 12 months and those without such history. We saw significant declines in condom use from 2002 to 2011–2017 among men with STI risk factors (APR=0.80, 95% CI 0.68 to 0.95), specifically among those aged 15–19 (APR=0.73, 95% CI 0.57 to 0.94) or non-Hispanic white (APR=0.71, 95% CI 0.54 to 0.93). In contrast, trends in condom use among men with no STI factors remained stable or increased. Across all time periods, the most prevalent STI risk factor reported was perception of a non-monogamous female partner (23.0%–26.9%). Post-hoc analyses examined whether condom use trends changed once this variable was removed from analyses, but no different patterns were observed.ConclusionsWhile STIs have been increasing, men aged 15–29 with STI risk factors reported a decline in condom use. Rising STI rates may be sensitive to behavioural shifts in condom use among young MSW with STI risk factors.

scholarly journals Patterns of Cardiovascular Risk Factors in the Years Before Pregnancy in Nulliparous Women With and Without Preterm Birth and Small‐for‐Gestational‐Age Delivery

2021 ◽  
Author(s):  
Ravi Retnakaran ◽  
Baiju R. Shah
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cardiovascular Risk ◽  
Preterm Delivery ◽  
Alanine Aminotransferase ◽  
Fasting Glucose ◽  
Glycosylated Hemoglobin ◽  
Density Lipoprotein ◽  
Nulliparous Women ◽  
Over Time

Background Women with either preterm or small‐for‐gestational‐age (SGA) delivery have an elevated lifetime risk of cardiovascular disease that has been attributed to the accrual of vascular risk factors over time. We sought to determine whether an adverse cardiovascular risk factor profile develops in the years before pregnancies complicated by preterm delivery or SGA. Methods and Results Using administrative databases, we identified all 156 278 nulliparous women in Ontario, Canada, who had singleton pregnancies between January 2011 and December 2018 and ≥2 measurements of the following analytes between January 2008 and the start of pregnancy: glycosylated hemoglobin, glucose, lipids, and alanine aminotransferase. There were 11 078 women with preterm delivery and 19 367 with SGA. The 2 most recent pregravid tests were performed at median 0.6 (interquartile range, 0.3–1.4) and 1.9 (interquartile range, 1.1–3.3) years before pregnancy, respectively. Women with preterm delivery had higher pregravid glycosylated hemoglobin, glucose, low‐density lipoprotein cholesterol, triglycerides, and alanine aminotransferase, and lower high‐density lipoprotein cholesterol, than those without preterm delivery. In contrast, women with SGA had lower pregravid fasting glucose, random glucose, and triglycerides than those without SGA. In the years before pregnancy, women with preterm delivery had higher annual increases than their peers in glycosylated hemoglobin (0.7‐times higher), triglycerides (7.9‐times higher), and alanine aminotransferase (2.2‐times higher). During this time, fasting glucose increased in women who developed preterm delivery but decreased in their peers. Conclusions An adverse cardiovascular risk factor profile evolves over time in the years before pregnancy complicated by preterm delivery, but does not necessarily precede SGA.

Abstract P602: Stroke Risk Factors Among the Young Over Time in the GCNKSS

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Tracy E Madsen ◽  
Jane C Khoury ◽  
Kathleen S Alwell ◽  
Opeolu M Adeoye ◽  
Felipe De Los Rios La Rosa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Stroke Risk ◽  
Large Population ◽  
High Cholesterol ◽  
Stroke Incidence ◽  
Stroke Risk Factors ◽  
Obesity And Diabetes ◽  
Trends Over Time ◽  
Over Time

Background: Data from the Greater Cincinnati Northern Kentucky Stroke Study (GCNKSS) have demonstrated stable or increasing stroke incidence rates in young adults with differences by sex and race, suggesting the need for targeted approaches to stroke prevention in the young. We aimed to describe trends over time in prevalence of stroke risk factors among adults ages 20-54 with stroke by sex and race. Methods: Cases of incident stroke (IS, ICH, SAH) occurring in those 20-54 years old and living in a 5-county area of southern Ohio/northern Kentucky were ascertained during 5 study periods (1993-1994, 1999, 2005, 2010, 2015). All physician-adjudicated inpatient events and a sampling of outpatient events were included, excluding nursing home events. Data on risk factors (hypertension, diabetes, obesity (BMI≥30), and high cholesterol) diagnosed prior to stroke were abstracted from medical records, and prevalence of each risk factor was reported over time in race/sex groups. Trends over time were examined using the Cochran-Armitage test. Results: Over the 5 study periods, 1204 incident strokes were included; 49% were women, 33% were black, and mean age was 46 (SD 7) years. Premorbid hypertension increased over time in Black women (48% in 1993/4 to 76% in 2015, p=0.005) but not in any other race/sex group (all p>0.05). Premorbid high cholesterol increased significantly in all race/sex groups (Figure, all p<0.05) except for White men (p=0.06). There were no significant trends over time in pre-stroke diagnoses of diabetes or obesity in any of the race/sex groups (Figure). Conclusions: Among patients aged 20-54 with incident stroke in a large population-based study, the change in the prevalence of hypertension and high cholesterol differed by sex and race, while obesity and diabetes were stable over time in all race/sex groups. Future research is needed to address risk factor control at a population level and to understand the role of undiagnosed pre-stroke risk factors in the young.

scholarly journals Risk factors for post-bronchoscopy pneumonia: a case–control study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yu Sato ◽  
Kengo Murata ◽  
Miake Yamamoto ◽  
Tsukasa Ishiwata ◽  
Miyako Kitazono-Saitoh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Independent Risk Factor ◽  
Case Control Study ◽  
Case Control ◽  
Control Group ◽  
Tracheobronchial Stenosis ◽  
Control Study ◽  
Age And Sex

AbstractThe bronchoscopy, though usually safe, is occasionally associated with complications, such as pneumonia. However, the use of prophylactic antibiotics is not recommended by the guidelines of the British Thoracic Society. Thus far there are few reports of the risk factors for post-bronchoscopy pneumonia; the purpose of this study was to evaluate these risk factors. We retrospectively collected data on patients in whom post-bronchoscopy pneumonia developed from the medical records of 2,265 patients who received 2666 diagnostic bronchoscopies at our institution between April 2006 and November 2011. Twice as many patients were enrolled in the control group as in the pneumonia group. The patients were matched for age and sex. In total, 37 patients (1.4%) had post-bronchoscopy pneumonia. Univariate analysis showed that a significantly larger proportion of patients in the pneumonia group had tracheobronchial stenosis (75.7% vs 18.9%, p < 0.01) and a final diagnosis of primary lung cancer (75.7% vs 43.2%, p < 0.01) than in the control group. The pneumonia group tended to have more patients with a history of smoking (83.8% vs 67.1%, p = 0.06) or bronchoalveolar lavage (BAL) (4.3% vs 14.9%, p = 0.14) than the control group. In multivariate analysis, we found that tracheobronchial stenosis remained an independent risk factor for post-bronchoscopy pneumonia (odds ratio: 7.8, 95%CI: 2.5–24.2). In conclusion, tracheobronchial stenosis was identified as an independent risk factor for post-bronchoscopy pneumonia by multivariate analysis in this age- and sex- matched case control study.

scholarly journals Trends in the co-occurrence of cardiovascular risk factors by education in Finland, 1997–2017

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
L Paalanen ◽  
T Härkänen ◽  
J Kontto ◽  
H Tolonen
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Factor Score ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Education Group ◽  
Educational Differences ◽  
Risk Factor Score ◽  
Education Groups ◽  
Over Time

Abstract Background Understanding on sociodemographic variation of the co-occurrence of cardiovascular disease (CVD) risk factors is crucial for planning public health policy and future prevention strategies. We aimed at examining 1) the co-occurrence of smoking, hypertension, elevated cholesterol and obesity by education, and 2) the trends in educational differences in the co-occurrence of these risk factors in Finland. Methods We used cross-sectional health examination surveys carried out every five years among the general adult population: for 1997-2012 the National FINRISK Study and for 2017 the FinHealth 2017 Survey. Respondents aged 25-64 years were included in the analyses (n = 25,036). Current smoking, obesity (BMI≥30 kg/m2), hypertension (≥140/≥90 mmHg or medication) and elevated serum total cholesterol (≥5.0 mmol/l or medication) were used for the risk factor accumulation score with categories 1) zero, 2) one, 3) two, and 4) three or four elevated risk factors. Multinomial logistic regression was used to estimate predicted probabilities for each category. Results Overall, the risk factor score was more favourable among women than men, and among high education groups than low education groups in both sexes. The lowest risk factor score class became more prevalent in all education groups in both sexes over time. The change in educational differences was not significant. However, the intermediate education group approached the highest education group over time. Conclusions Our data indicate an overall transition towards a more favourable risk factor score in Finland, in 1997-2017. The score among the intermediate education group approached that among the highest education group. The tendency of risk factor accumulation among those with least education remained during the study period, which raises a need to develop and implement interventions and public health policies that would be effective in decreasing the risk factor burden particularly in this group. Key messages Overall, a favourable trend of diminishing risk factor prevalence was seen. The tendency of accumulation of major CVD risk factors among the least educated subjects remained from 1997 to 2017.

Longitudinal Evolution of Risk of Coronary Heart Disease in Systemic Lupus Erythematosus

2012 ◽  
Vol 39 (5) ◽  
pp. 968-973 ◽  
Author(s):  
IGOR KARP ◽  
MICHAL ABRAHAMOWICZ ◽  
PAUL R. FORTIN ◽  
LOUISE PILOTE ◽  
CAROLYN NEVILLE ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Coronary Heart Disease ◽  
Risk Factor ◽  
Heart Disease ◽  
Blood Glucose ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Chd Risk ◽  
Over Time

Objective.To produce evidence on the longitudinal evolution of risk factors for coronary heart disease (CHD) in patients with systemic lupus erythematosus (SLE).Methods.Based on data for 115 patients from the Montreal General Hospital Lupus Clinic (1971–2003) and for 4367 control subjects from the Framingham Offspring Study (1971–1994), we investigated the temporal evolution of total serum cholesterol, systolic blood pressure (SBP), body mass index (BMI), blood glucose, and estimated risk for CHD (reflecting the balance of changes in different risk factors). In analyses limited to patients with SLE, we assessed the effect of SLE duration on each risk factor, adjusting for age, calendar time, sex, baseline level of the risk factor, and medication use. Next, we assessed how the adjusted difference in the values of the risk factors between SLE and controls changes over time.Results.Among patients with SLE, longer disease duration was independently associated with higher SBP and blood glucose levels. Compared with controls, these patients appeared to have accelerated rates of increase in total cholesterol, blood glucose, and overall estimated CHD risk. The rate of increase in BMI was lower in patients with SLE than in controls.Conclusion.Elevated CHD risk in patients with SLE appears to be at least partially mediated by accelerated increases in some CHD risk factors, longitudinal trajectories of which increasingly diverge over time from those of population controls.

Donor Selection For Haploidentical Hematopoietic Stem Cell Transplantation: Who Is The Better – Donor-Recipient Risk Factor Analysis

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 705-705
Author(s):  
Yu Wang ◽  
Xiao Jun Huang
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Stem Cell ◽  
Lower Incidence ◽  
Family Relationship ◽  
Donor Age ◽  
Sibling Donor ◽  
The Difference ◽  
Grade 3

Abstract Background many aspects should be considered when selecting an ideal donor. The progress made in haploidentical HSCT in recent years offers almost unlimited donor and availabilities of more than one donor at many occasions. To date, there have been no studies to answer the question of apart from HLA disparity, whether one donor should be preferred over another among various haploidentical donors available. The goal of the current study was to attempt to answer the question by analyzing the data on haploidentical HSCT without in-vitro T cell depletion modality. Methods Consecutive patients with leukemia or MDS who received HSCT from 3-5 of 6 HLA loci-matched family donors excluding collateral relatives between May 2002 and December 2010 were enrolled in this study (n=749). The stem cell source was G-CSF mobilized BM combined with PB. The conditioning regimen was modified BUCY plus ATG with 10mg/kg in total dosage. Patients receiving prophylactic DLI for prevention of leukemia relapse were excluded. Donor-recipient risk factors relevant to selection of optimal donor for haploidentical HCT were analyzed. Results (1)donor sex: male donor had lower incidence of both grade 2-4 (39% vs. 46%, p=.07) and grade 3-4 acute GVHD (aGVHD) (11% vs. 17%, p=.04), lower rate of NRM (16% vs. 24%, p=.006) and higher probabilities of OS (70% vs. 62%, p=.02) and LFS (67% vs. 60%, p=.03), compared with female donor. In multivariate analysis, donor sex was still a risk factor for GVHD, NRM and survival. However, if mother donor was excluded, all the difference became no longer significant. (2) Donor age: donor younger than 30 years old had lower incidence of both grade 2-4 (25% vs. 48%, p<.0001) and grade 3-4 aGVHD (5% vs. 16%, p=.0005), lower rate of NRM (12% vs. 22%, p=.007) and higher probabilities of OS (78% vs. 64%, p=.001) and LFS (76% vs. 64%, p=.002), compared with donor older than 30 years old. In multivariate analysis, donor age was a more prominent risk factor for GVHD, NRM and survival compared with donor sex. And if mother donor was excluded, all the difference remained significant both in univariate and multivariate analysis. (3)The rate of GVHD was not associated with the extent of HLA disparity or any individual allele disparity. (4) comparison between mother and father: father donor had lower incidence of both grade 2-4 (45% vs. 56%, p=.03) and grade 3-4 aGVHD (13% vs. 22%, p=.007), lower rate of NRM (14% vs. 26%, p=.003) and higher probabilities of OS (70% vs. 57%, p=.007) and LFS (67% vs. 57%, p=.03), compared with mother donor. In multivariate analysis, mother donor was still a risk factor for GVHD, NRM and survival. (5) comparison between offspring and sibling: offspring donor had significant lower incidence of grade 2-4 aGVHD (16% vs. 37%, p=.002), lower NRM and higher survival, although not reaching statistical significance, compared with sibling donor. In multivariate analysis, sibling donor was still a risk factor for GVHD. (6) comparison among sibling and father donors: donor older than 30 years old was the most important risk factor affecting GVHD, NRM and survival while the rates between father and sibling donor were comparable. Conclusions Not abiding by the rule of HLA disparity, this study was the first one to confirm that significant different outcomes were achieved among various haploidentical donors and proved once again that haploidentical HSCT overcame HLA barriers. Instead of HLA disparity, donor age and the family relationship were important risk factors under our treatment modality. The underlying mechanisms of crossing human leukocyte antigen barriers need further investigation and to be validated by other treatment modalities. Figure impact of donor age and family relationship on GVHD This work was partly supported by The Key Program of National Natural Science Foundation of China (Grant No. 81230013), Beijing Municipal Science & Technology Commission (No.Z121107002812033) and Beijing Municipal Science & Technology Commission(No. Z121107002612035). Disclosures: No relevant conflicts of interest to declare.

Advanced stage, elevated LDH, primary sites, but not adolescent (A) age (≥ 15 years) as risk factors for disease progression in childhood (C) and adolescent (A) mature B-NHL: Report of the FAB/LMB 96 international trial

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 10032-10032
Author(s):  
M. S. Cairo ◽  
R. Sposto ◽  
M. Gerrard ◽  
I. Waxman ◽  
S. Goldman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Risk Group ◽  
Significant Risk ◽  
High Risk Group ◽  
Stage Iii ◽  
Group A ◽  
Independent Risk Factors ◽  
Group B

10032 Background: We recently reported the results in C & A with low risk (group A), intermediate risk (group B) and high risk (group C) mature B-NHL treated on FAB/LMB 96 (Gerrard et al, Br J Haematol, 2008; Patte et al, Blood, 2007; Cairo et al, Blood, 2007, respectively). Adolescent age (15–21 yrs) has historically been considered to be an independent risk factor for poor outcome in subsets of mature B-NHL (Hochberg/Cairo et al, Br J Haematol, 2008; Burkhardt et al, Br J Haematol 2005; Cairo et al, Br J Haematol, 2003). Methods: We analyzed the EFS of all pts treated on FAB/LMB 96 and the following risk factors were significant in a univariate and Cox multivariate analysis: age (<15 vs ≥15 yrs), stage I/II vs III/IV, primary sites, LDH <2 vs ≥2 NL and histology (DLBCL vs BL/BLL). Results: 1111 pts (15%, 15–21 years) were treated with group A (N = 132), group B (N = 744), and group C (N = 235) therapy. Five year EFS (CI95) for all, A, B, C pts was 86% (84%,88%), 98% (93%, 100%), 87%% (84%, 89%), and 79%% (73%,84%), respectively. Age (≥15 yrs), LDH ≥2NL, stage III/IV, and BM+/CNS+ and histology were significant univariate risk factors for decreased EFS (P<0.045, <0.0001, <0.0001, <0.0001, and <0.0001 respectively). Multivariate analysis demonstrated age ≥15 yrs and DLBCL histology were no longer independent significant risk factors (p = .82 and 0.08, respectively), but LDH (RR 2.0, p = .001), stage III/IV (RR 3.8, p<0.001), and primary sites including PMBL (RR 4.0, p<.001) and BM+/CNS+ (RR 2.8, p<0.001) were independent significant risk factors for poorer outcome. Conclusions: With the use of modern short but intense FAB-LMB 96 therapy, adolescent age is no longer a poor risk factor in children with mature B-NHL. The independent risk factors identified in this study (stage, LDH, primary site) for decreased EFS in C & A mature B-NHL will form the basis of the next risk adapted international pediatric mature B-NHL trial. No significant financial relationships to disclose.

Risk factors for peritoneal recurrence in serosa-negative gastric cancer.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 19-19 ◽  
Author(s):  
Hayato Omori ◽  
Yuichiro Miki ◽  
Wataru Takagi ◽  
Fumiko Hirata ◽  
Taichi Tatsubayashi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Independent Risk Factor ◽  
Peritoneal Recurrence ◽  
Node Metastasis ◽  
Gastric Cancer Patients

19 Background: Peritoneal recurrence is often observed in gastric cancer patients without serosal invasion. It is difficult for pathologists to evaluate whether tumor cells penetrate serosa or not, because the subserosa layer is very thin. We evaluated the incidence and risk factors of peritoneal recurrence in serosa -negative gastric cancer patients to clarify the mechanism of peritoneal recurrence in these patients. Methods: A total of 1,745 gastric cancer patients underwent R0 resection from 2002 to 2009 were enrolled. The incidence of peritoneal recurrence according to tumor depth was analyzed. In serosa-nagative patients, the univariate and multivariate analysis were performed to identify the risk factors for peritoneal recurrence. Results: Peritoneal recurrence was observed in 64 (3.7 %) out of 1,745 patients. The incidence of peritoneal recurrence according to depth of tumor invasion was in 0 / 466 in T1a, 5 / 567 (0.88 %) in T1b, 4 / 187 (2.1 %) in T2, 31 / 360 (7.9 %) in T3, 20 / 108 (15.9 %) in T4a, and 4 / 12 (25 %) in T4b, respectively (p<0.001). As for the risk factor for peritoneal recurrence in T3 patients, histologically undifferentiated type, negative lymphatic invasion, scirrhous type, invasive infiltrating growth pattern were the significant factors identified by univariate analysis. Only the invasive infiltrating growth pattern (OR3.44 p0.038) was selected as significant independent risk factor for peritoneal recurrence by multivariate analysis. In T1b / T2 patients, massive lymph node metastasis (N3a, 3b), scirrhous type were the significant factor for peritoneal recurrence by univariate analysis. Only massive lymph node metastasis (OR25.1 p<0.001) was selected as the significant independent risk factor by multivariate analysis. Conclusions: The incidence of peritoneal recurrence increases in proportion to the tumor depth. Invasive infiltrating growth pattern was selected as an independent risk factor for peritoneal recurrence in T3 patients, while it was massive lymph node metastasis in T1b / T2 patients. The results suggest the possibility that microscopic serosal invasion in T3 tumor and lymphatic progression in T1b / T2 tumor may contribute to peritoneal recurrence in gastric cancer.

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