Synergistic Benefit of Statin and Metformin in Gastrointestinal Malignancies

2016 ◽  
Vol 30 (2) ◽  
pp. 185-194 ◽  
Author(s):  
George K. Nimako ◽  
Zachary A. P. Wintrob ◽  
Dmitriy A. Sulik ◽  
Jennifer L. Donato ◽  
Alice C. Ceacareanu
Keyword(s):  
Proportional Hazards ◽  
Disease Free Survival ◽  
Clinical History ◽  
Cox Proportional Hazards ◽  
Cancer Prognosis ◽  
Cancer Outcomes ◽  
Gastrointestinal Malignancies ◽  
Treatment Groups ◽  
Kaplan Meier ◽  
Patients With Diabetes

Objectives: To evaluate whether statin use influences gastrointestinal cancer prognosis in patients with diabetes mellitus (DM). Methods: We reviewed all DM patients diagnosed at Roswell Park Cancer Institute with emergent gastrointestinal malignancy (January 2003 to December 2010) (N = 222). Baseline demographic, clinical history, and cancer outcomes were documented. Overall survival (OS) and disease-free survival (DFS) comparisons across various treatment groups were assessed by Kaplan-Meier and Cox proportional hazards. Results: Use of statin, alone or in combination, was associated with improved OS and DFS (hazard ratio [HR] = 0.65, P = .06; HR = 0.60, P < .02). We report similar OS and DFS advantage among users of mono- or combined metformin therapy (HR = 0.55, P < .01; HR = 0.63, P < .02). Concomitant use of metformin and statin provided a synergistic OS and DFS benefit (HR = 0.42, P < .01; HR = 0.44, P < .01). Despite significant tobacco and alcohol use history, patients with upper gastrointestinal cancers derived enhanced cancer outcomes from this combination (HR = 0.34, P < .01; HR = 0.43, P < .02), while receiving a statin without metformin or metformin without a statin did not provide significant cancer-related benefits. Conclusion: Use of statin and metformin provides a synergistic improvement in gastrointestinal malignancies outcomes.

Abstract WP164: National Estimates of Recurrent Ischemic Stroke Among Patients Undergoing Carotid Revascularization: Effect of Treatment Modality

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Yun Fang ◽  
Ameer E Hassan ◽  
Iqra N Akhtar ◽  
Mohammad Rauf A Chaudhry ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Carotid Stenosis ◽  
Proportional Hazards ◽  
Carotid Stenting ◽  
Cox Proportional Hazards ◽  
Carotid Revascularization ◽  
Treatment Groups ◽  
Kaplan Meier ◽  
Hospitalization Period ◽  
Nationally Representative

Background: The estimates of recurrent ischemic stroke in the post-hospitalization period among patients treated for carotid revascularization are not available outside clinical trials (real-world settings). Objective: To determine the rates of ischemic stroke-related hospitalization within 3 months post-hospitalization for treatment of carotid stenosis in a nationwide cohort. Methods: We identified all readmissions related to new ischemic stroke in the nationally representative data for all patients hospitalized for carotid revascularization using the Nationwide Readmissions Database (NRD) 2013 and 2014 for carotid stent placement (CAS) and carotid endarterectomy (CEA). Cox proportional hazards analysis was used to assess the relative risk (RR) of recurrent ischemic stroke for patients in treatment cohorts after adjusting for potential confounders. The survival was estimated for both treatment groups by using Kaplan-Meier survival method. Results: A total of 120, 923patients with carotid stenosis were treated with either CAS (n = 15, 819; 13.1%) or CEA (n = 105,103; 86.9%).- The estimated 3 month recurrent ischemic stroke free survival was 99.2% and 98.9% in patients who underwent CEA and CAS treatments, respectively (p= 0.014). After adjusting for age, and APDRG severity score, the RRs of recurrent any ischemic stroke was higher women (RR, 1.3; 95% confidence interval (CI), 1.1 -1.6), symptomatic patients (RR, 1.5; 95% CI, 1.1 -2.1) and weekend admission (RR, 1.6; 95% CI, 1.1 -2.3). Conclusion: Although the rates of recurrent ischemic stroke-related hospitalization were low among patients undergoing carotid revascularization, there were higher rates among women, symptomatic patients, undergoing carotid stenting and those admitted on weekends.

Management of Comorbidities in Diabetics With Renal Cell Carcinoma

2013 ◽  
Vol 27 (1) ◽  
pp. 31-39 ◽  
Author(s):  
Jonathan L. Rabey ◽  
Jingjing Yin ◽  
Tammy M. Kublas ◽  
Terry Mashtare ◽  
Alice C. Ceacareanu
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Proportional Hazards ◽  
Progression Free Survival ◽  
Clinical History ◽  
Cox Proportional Hazards ◽  
Rank Test ◽  
Cholesterol Lowering ◽  
Treatment Groups

Objectives: This study evaluated whether particular diabetes mellitus (DM), hyperlipidemia, or hypertension pharmacotherapy was associated with improved renal cell carcinoma (RCC) outcomes in diabetics with emergent RCC. Methods: All DM cases newly diagnosed with RCC at Roswell Park Cancer Institute (January 01, 2003-December 31, 2010) were included (n = 95). Baseline demographic information, clinical history, and cancer outcomes were documented after chart review. Fisher’s test was used for the analysis of categorical outcomes across different treatment groups. Univariate and multivariate analyses for the comparisons of the overall survival and progression-free survival across treatment groups were assessed using Kaplan-Meier log-rank test and Cox proportional hazards models. Results: We found that DM pharmacotherapy users, which may represent a more advanced disease as compared to those controlled by diet alone, displayed significantly greater mortality ( P = .01). Additionally, we found that cholesterol-lowering pharmacotherapy use was associated with decreased RCC mortality (hazard ratio = 0.54, P = .06). Individuals receiving combined hypertension regimens had a lower chance to present with baseline metastasis; however, hypertension pharmacotherapy use added no survival benefit. Conclusion: Reinforcing guidelines compliance for hyperlipidemia management in patients with DM may provide a considerable cancer benefit if diagnosed with RCC. Studies evaluating the need for cholesterol-lowering pharmacotherapy in guidelines-noncompliant DM cases upon RCC diagnosis are currently needed.

scholarly journals A retrospective study on the role of diabetes and metformin in colorectal cancer disease survival

2016 ◽  
Vol 23 (2) ◽  
pp. 116 ◽  
Author(s):  
R. Ramjeesingh ◽  
C. Orr ◽  
C.S. Bricks ◽  
W.M. Hopman ◽  
N. Hammad
Keyword(s):  
Colorectal Cancer ◽  
Proportional Hazards ◽  
Retrospective Chart Review ◽  
Positive Association ◽  
Cox Proportional Hazards ◽  
Diabetic Patients ◽  
Negative Effects ◽  
Cancer Disease ◽  
Kaplan Meier ◽  
Patients With Diabetes

Background Recent studies have suggested an effect of metformin on mortality for patients with both diabetes and colorectal cancer (crc). However, the literature is contradictory, with both positive and negative effects being identified. We set out to determine the effect of metformin with respect to prognosis in crc patients.Methods After a retrospective chart review of crc patients treated at the Cancer Centre of Southeastern Ontario, Kaplan–Meier analyses and Cox proportional hazards regression models were used to compare overall survival (os) in patients with and without diabetes.Results We identified 1304 crc patients treated at the centre. No significant differences between the diabetic and nondiabetic groups were observed with respect to tumour pathology, extent of metastatic disease, time or toxicity of chemotherapy, and the os rate (1-year os: 85.6% vs. 86.4%, p = 0.695; 2-year os: 73.6% vs. 77.0%, p = 0.265). In subgroup analysis, diabetic patients taking metformin survived significantly longer than their counterparts taking other diabetes treatments (os for the metformin group: 91% at 1 year; 80.5% at 2 years; os for the group taking other treatments, including diet control: 80.6% at 1 year, 67.4% at 2 years). Multivariate analysis suggests that patients with diabetes taking treatments other than metformin experience worse survival (p = 0.025).Conclusions Our results suggest that crc patients with diabetes, excluding those taking metformin, might have a worse crc prognosis. Taking metformin appears to have a positive association with prognosis. The protective nature of metformin needs further evaluation in prospective analyses.

scholarly journals 930. HCV Treatment Is Associated With a Reduced Risk of Cardiovascular Disease Events: Results From ERCHIVES

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S30-S31 ◽  
Author(s):  
Adeel Ajwad Butt ◽  
Peng Yan ◽  
Ashfaq Shuaib ◽  
Abdul-Badi Abou-Samra ◽  
Obaid Saikh ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Incidence Rate ◽  
Lower Risk ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Hcv Treatment ◽  
Free Survival ◽  
Treatment Groups ◽  
Kaplan Meier ◽  
Icd 10

Abstract Background Studies reporting on the association between HCV and cardiovascular disease (CVD), and effect of HCV treatment upon future risk of CVD have shown mixed results. Methods Within ERCHIVES (Electronically Retrieved Cohort of HCV Infected Veterans), we identified all persons treated for ≥7 weeks and propensity-score-matched group who never received HCV treatment. We excluded those with HIV, HBV, or previously diagnosed CVD. Incidence rate (per 1,000 person-years) and risk factors for CVD events (Cox proportional hazards analysis) were determined for various treatment groups. CVD events were identified using ICD-9CM/ICD-10 codes. Kaplan–Meier plots were generated to show and compare CVD-free survival by treatment status and attainment of SVR. Results Among 32,575 treated and same number of untreated persons in the final dataset, median age was 58 years, 27% were Black race, and 96% were male. The incidence rate for CVD events/1,000 person-years (95% CI) among the treated was 19.10 (17.79, 20.50) vs. 32.37 (30.51, 34.33) among the untreated (P &lt; 0.01). Treatment with a DAA regimen (vs. PEG/RBV; HR [95% CI] 0.68 [0.53,0.88]) and achieving SVR (HR [95% CI] 0.76 [0.63,0.92]) were associated with a lower risk of incidence CVD event (table). Kaplan–Meier curves demonstrated that untreated persons had a shorter CVD event-free survival during 30 months of follow-up compared with the treated persons. (figure; log-rank P &lt; 0.0001) Conclusion HCV treatment is associated with a reduction in incident CVD events. Directly acting antiviral regimens (vs. PEG/RBV) and attainment of SVR (vs. no SVR) are associated with a lower risk of incident CVD events. Disclosures A. Ajwad Butt, Gilead: Grant Investigator, Research grant.

scholarly journals Clinical features and prognostic factors of spinal fibroblastic/myofibroblastic tumors: a long-term, single-center, retrospective study

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e10530
Author(s):  
Haitao Sun ◽  
Shaohui He ◽  
Yuechao Zhao ◽  
Chen Ye ◽  
Xinghai Yang ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Proportional Hazards ◽  
Disease Free Survival ◽  
Cox Proportional Hazards ◽  
En Bloc ◽  
Ki 67 ◽  
Factors Affecting ◽  
Kaplan Meier ◽  
En Bloc Excision ◽  
Bloc Excision

Background Spinal fibroblastic and myofibroblastic tumors (FMTs) are extremely rare. Few studies have reported on the features and outcomes of this condition that affects the axial skeleton. We explored the clinical characteristics and factors affecting the prognosis of spinal FMTs. Methods We retroactively assessed the survival of 51 patients with spinal FMTs who underwent surgical and adjuvant treatments in our center between April 2006 and September 2018. Factors affecting disease-free survival (DFS) and overall survival (OS) were analyzed using the Kaplan–Meier method. Variables with p value ≤ 0.05 were subjected to multivariate analysis using the Cox proportional hazards regression model. A two-sided P value < 0.05 was considered statistically significant. Results The mean follow-up period was 50.8 ± 35.6 months (Range 4.2–172.6). Kaplan–Meier survival curves showed that the 5-year DFS was 10% (95% CI [31.09-42.56]) and the 5-year OS was 53% (95% CI [61.28–97.20]). Multivariate analysis showed that en bloc excision was associated with better DFS (HR 0.214, 0.011) and OS (HR 0.273, 0.043), radiotherapy negatively affected OS (HR 0.353, 0.033), and the recurrence and Ki-67 index <5% significantly affected DFS (HR 3.008, 0.008 and 2.754, 0.029). Conclusions Spinal FMTs are rare. Surgery is the treatment of choice and en bloc excision is strongly recommended to improve outcomes. Disease recurrence and the Ki-67 marker are correlated with the progression of these tumors.

Negative Effects of Transfused Blood Components after Hepatectomy for Metastatic Colorectal Cancer

2013 ◽  
Vol 79 (1) ◽  
pp. 35-39 ◽  
Author(s):  
Robert M. Cannon ◽  
Russell E. Brown ◽  
Charles R. Hill ◽  
Eric Dunki-Jacobs ◽  
Robert C. G. Martin ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Proportional Hazards ◽  
Disease Free Survival ◽  
Fresh Frozen Plasma ◽  
Cox Proportional Hazards ◽  
Colorectal Metastases ◽  
Blood Product Transfusion ◽  
Negative Effects ◽  
Kaplan Meier ◽  
Fresh Frozen

There has been conflicting evidence regarding negative effects of blood transfusion in oncology patients. This study was undertaken to determine any negative effects of specific blood product transfusion after resection of hepatic colorectal metastases (CRM). Retrospective review of patients undergoing hepatectomy for CRM from 1995 to 2009 at a single institution was performed. Specific attention was paid to the effect of blood transfusion within 30 days of operation on overall survival, disease-free survival (DFS), and complications. To mitigate the bias introduced by complications that require blood transfusion to treat, only nonbleeding complications were considered. Complications were analyzed with univariate and multivariate logistic regression. Survival was analyzed according to Kaplan-Meier and Cox proportional hazards. There were 239 patients included in the study. There were 64 (26.8%) receiving a transfusion of any kind with 25.5 per cent getting red cells (PRBCs), 7.11 per cent getting fresh-frozen plasma, and 3.77 per cent getting platelets. Multivariate analysis revealed only PRBC transfusion to be independently associated with nonbleeding complications (odds ratio, 1.980; 95% confidence interval, 1.094 to 3.582; P = 0.0239). There was no significant adverse effect of transfusion with any product on overall or DFS. PRBC transfusion appears to increase the risk of postoperative complications; thus, strategies to minimize blood use may be warranted.

Neoadjuvant radiotherapy to improve overall survival in resectable hepatocellular carcinoma.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16178-e16178
Author(s):  
Zhiwen Luo ◽  
Xu Che ◽  
Jianqiang Cai ◽  
Hong Zhao ◽  
Jing Jin ◽  
...  
Keyword(s):  
Overall Survival ◽  
Subgroup Analysis ◽  
Survival Benefit ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Sensitivity Analyses ◽  
Neoadjuvant Radiotherapy ◽  
Treatment Groups ◽  
Kaplan Meier ◽  
Cox Proportional Hazards Models

e16178 Background: There is little evidence for the association between neoadjuvant radiotherapy (NRT) and improved overall survival (OS) in patients with resectable hepatocellular carcinomas (HCCs). This study aimed to determine whether NRT provides a survival benefit in these patients. Methods: We enrolled patients with resected HCC identified in the Surveillance, Epidemiology, and End Results database (2004–2015). Multiple imputation plus inverse probability of treatment weighting (IPTW) reduced selection bias. IPTW-adjusted Kaplan-Meier curves and IPTW-adjusted Cox proportional hazards models compared OS between different treatment groups. Sensitivity analyses tested the robustness of the estimates. Subgroup analysis identified the patients who could benefit most from NRT. Results: We enrolled a total of 11920 patients diagnosed between 2004 and 2015 in the study. Of these, 134 patients underwent NRT, the others underwent surgery alone (SA). The median OS in NRT was not approached, whereas in SA it was 52.0 (interquartile range, 34.25, 100.75) months. The 5-year IPTW-adjusted rates of OS in NRT versus SA were 65.3% and 46.6%, respectively. In IPTW-adjusted Cox proportional hazards regression analysis, NRT was associated with a significant OS benefit (hazard ratio [HR], 0.549; 95% confidence interval [CI], 0.327-0.921; p = 0.023). The results were robust in sensitivity analysis (E-value 2.39). Subgroup analysis demonstrated improved OS in the NRT cohort among younger patients (HR, 0.46; 95% CI, 0.26-0.83), N0 status (HR, 0.51; 95% CI, 0.28-0.94), and alpha-fetoprotein (AFP)-positive patients (HR, 0.28; 95% CI, 0.12-0.65). Conclusions: Patients with resectable HCCs may derive a survival benefit from NRT. Younger age ( < 65 years) with a positive AFP level at N0 status could be indicators for NRT. These findings enlighten current guidelines to consider NRT in patients with resectable HCCs. The present study establishes a reasonable basis for further prospective studies.

scholarly journals Tumor-Associated CD204-Positive Macrophage Is a Prognostic Marker in Clinical Stage I Lung Adenocarcinoma

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Yanbin Sun ◽  
Shun Xu
Keyword(s):  
Lung Adenocarcinoma ◽  
Proportional Hazards ◽  
Clinical Stage ◽  
Disease Free Survival ◽  
Cox Proportional Hazards ◽  
Stage I ◽  
Biological Behavior ◽  
Smoking History ◽  
Kaplan Meier ◽  
Lung Adenocarcinomas

Objective. Macrophages are the dominant leukocytes in the tumor microenvironment. Accumulating evidence revealed that CD204-positive (CD204+) tumor-associated macrophages (TAMs) are associated with the aggressive behavior of various cancers; however, the clinical, pathological, and prognostic associations of CD204+ TAMs with the subtype of lung adenocarcinoma have not been reported. Methods. Tissue microarray and immunohistochemistry were constructed from clinical stage I lung adenocarcinomas with radical surgical resection. The intratumoral density of CD204+ cells was calculated using image analysis software for analyses. Survival analyses were performed using the Kaplan-Meier method and multivariate Cox proportional hazards regression models. Results. The intratumoral density of CD204 was correlated with T stage, nodal involvement, lymphovascular invasion, and cancer relapse after the surgery, but not with age, gender, or smoking history. The density of CD204 in non-LPD was significantly higher than that in LPD. The 5-year disease-free survival (DFS) rate of CD204 high-density group was significantly worse than that of CD204 low-density group. Conclusions. The expression of CD204 in TAMs is associated with the aggressiveness of lung adenocarcinoma. Our results suggest that a specific immune microenvironment may be associated with the biological behavior of lung adenocarcinoma.

Does Lymphadenectomy Improve Survival in Uterine Leiomyosarcoma?

2015 ◽  
Vol 25 (6) ◽  
pp. 1031-1036 ◽  
Author(s):  
Tolga Tasci ◽  
Alper Karalok ◽  
Salih Taskin ◽  
Isin Ureyen ◽  
Gunsu Kimyon ◽  
...  
Keyword(s):  
Lymph Node ◽  
Survival Benefit ◽  
Proportional Hazards ◽  
Disease Free Survival ◽  
Cox Proportional Hazards ◽  
Uterine Leiomyosarcoma ◽  
Lymph Node Count ◽  
Kaplan Meier

IntroductionThe role of lymphadenectomy in the management of uterine leiomyosarcoma (LMS) is controversial. We aimed to identify whether lymph node dissection (LND) has any survival benefit in uterine LMS.MethodsData of 95 patients with histologically proven uterine LMS from 2 tertiary centers (1993 through 2009) were retrospectively analyzed. Kaplan-Meier and Cox proportional hazards regression models were used for analyses.ResultsMean age was 51.5 years. Thirty-six (37.9%) underwent LND. The median lymph node count was 54. Eight (22.2%) patients had lymphatic metastasis. Median follow-up was 26 months. Sixty-two (65%) patients had recurrence and 48 (50.5%) died. Median disease-free survival (DFS) was 19 months for both group of patients who had or did not have LND, and median overall survival (OS) was 29 and 26 months, respectively (P= 0.4). Five-year DFS was 35.9% vs 26.8% (P= 0.4), and 5-year OS was 45.4% vs 43.8% (P= 0.22) for the groups. Multivariate analyses did not reveal a single independent prognostic factor in respect to DFS or OS.ConclusionHigher rate of lymph node metastasis in patients with extrauterine disease indicated the importance of LND in LMS. However, the survival benefit of lymphadenectomy could not be shown.

PETCO2 gradient: a novel prognostic parameter in cardiopulmonary exercise testing

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I.D Poveda Pinedo ◽  
I Marco Clement ◽  
O Gonzalez ◽  
I Ponz ◽  
A.M Iniesta ◽  
...  
Keyword(s):  
Exercise Testing ◽  
Proportional Hazards ◽  
Cardiopulmonary Exercise Testing ◽  
Cox Proportional Hazards ◽  
Prognostic Parameter ◽  
Cardiopulmonary Exercise ◽  
Proportional Hazards Regression ◽  
Kaplan Meier ◽  
Baseline Characteristics ◽  
The Difference

Abstract Background Previous parameters such as peak VO2, VE/VCO2 slope and OUES have been described to be prognostic in heart failure (HF). The aim of this study was to identify further prognostic factors of cardiopulmonary exercise testing (CPET) in HF patients. Methods A retrospective analysis of HF patients who underwent CPET from January to November 2019 in a single centre was performed. PETCO2 gradient was defined by the difference between final PETCO2 and baseline PETCO2. HF events were defined as decompensated HF requiring hospital admission or IV diuretics, or decompensated HF resulting in death. Results A total of 64 HF patients were assessed by CPET, HF events occurred in 8 (12.5%) patients. Baseline characteristics are shown in table 1. Patients having HF events had a negative PETCO2 gradient while patients not having events showed a positive PETCO2 gradient (−1.5 [IQR −4.8, 2.3] vs 3 [IQR 1, 5] mmHg; p=0.004). A multivariate Cox proportional-hazards regression analysis revealed that PETCO2 gradient was an independent predictor of HF events (HR 0.74, 95% CI [0.61–0.89]; p=0.002). Kaplan-Meier curves showed a significantly higher incidence of HF events in patients having negative gradients, p=0.002 (figure 1). Conclusion PETCO2 gradient was demonstrated to be a prognostic parameter of CPET in HF patients in our study. Patients having negative gradients had worse outcomes by having more HF events. Time to first event, decompensated heart Funding Acknowledgement Type of funding source: None

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