scholarly journals A retrospective analysis of the role of proton pump inhibitors in colorectal cancer disease survival

2016 ◽  
Vol 23 (6) ◽  
pp. 583 ◽  
Author(s):  
C. Graham ◽  
C. Orr ◽  
C.S. Bricks ◽  
W.M. Hopman ◽  
N. Hammad ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Proportional Hazards ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Retrospective Chart Review ◽  
Cox Proportional Hazards ◽  
Lymph Node Status ◽  
Cancer Disease ◽  
Cox Regression Analysis ◽  
Tumour Characteristics

BackgroundProton pump inhibitors (ppis) are a commonly used medication. A limited number of studies have identified a weak-to-moderate association between ppi use and colorectal cancer (crc) risk, but none to date have identified an effect of ppi use on crc survival. We therefore postulated that an association between ppi use and crc survival might potentially exist.Methods We performed a retrospective chart review of 1304 crc patients diagnosed from January 2005 to December 2011 and treated at the Cancer Centre of Southeastern Ontario. Kaplan–Meier analysis and Cox proportional hazards regression models were used to evaluate overall survival (os).Results We identified 117 patients (9.0%) who were taking ppis at the time of oncology consult. Those taking a ppi were also more often taking asa or statins (or both) and had a statistically significantly increased rate of cardiac disease. No identifiable difference in tumour characteristics was evident in the two groups, including tumour location, differentiation, lymph node status, and stage. Univariate analysis identified a statistically nonsignificant difference in survival, with those taking a ppi experiencing lesser 1-year (82.1% vs. 86.7%, p = 0.161), 2-year (70.1% vs. 76.8%, p = 0.111), and 5-year os (55.2% vs. 62.9%, p = 0.165). When controlling for patient demographics and tumour characteristics, multivariate Cox regression analysis identified a statistically significant effect of ppi in our patient population (hazard ratio: 1.343; 95% confidence interval: 1.011 to 1.785; p = 0.042).Conclusions Our results suggest a potential adverse effect of ppi use on os in crc patients. These results need further evaluation in prospective analyses.

scholarly journals Effect of Health Care Provider Delays on Short-Term Outcomes in Patients With Colorectal Cancer: Multicenter Population-Based Observational Study

10.2196/15911 ◽  
2020 ◽  
Vol 9 (3) ◽  
pp. e15911
Author(s):  
Ahmed Abdulaal ◽  
Chanpreet Arhi ◽  
Paul Ziprin
Keyword(s):  
Colorectal Cancer ◽  
Observational Study ◽  
Proportional Hazards ◽  
Cox Regression ◽  
Diagnostic Delay ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Treatment Delays ◽  
Cox Regression Analysis ◽  
Kaplan Meier

Background The United Kingdom has lower survival figures for all types of cancers compared to many European countries despite similar national expenditures on health. This discrepancy may be linked to long diagnostic and treatment delays. Objective The aim of this study was to determine whether delays experienced by patients with colorectal cancer (CRC) affect their survival. Methods This observational study utilized the Somerset Cancer Register to identify patients with CRC who were diagnosed on the basis of positive histology findings. The effects of diagnostic and treatment delays and their subdivisions on outcomes were investigated using Cox proportional hazards regression. Kaplan-Meier plots were used to illustrate group differences. Results A total of 648 patients (375 males, 57.9% males) were included in this study. We found that neither diagnostic delay nor treatment delay had an effect on the overall survival in patients with CRC (χ23=1.5, P=.68; χ23=0.6, P=.90, respectively). Similarly, treatment delays did not affect the outcomes in patients with CRC (χ23=5.5, P=.14). The initial Cox regression analysis showed that patients with CRC who had short diagnostic delays were less likely to die than those experiencing long delays (hazard ratio 0.165, 95% CI 0.044-0.616; P=.007). However, this result was nonsignificant following sensitivity analysis. Conclusions Diagnostic and treatment delays had no effect on the survival of this cohort of patients with CRC. The utility of the 2-week wait referral system is therefore questioned. Timely screening with subsequent early referral and access to diagnostics may have a more beneficial effect.

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 Effect of Health Care Provider Delays on Short-Term Outcomes in Patients With Colorectal Cancer: Multicenter Population-Based Observational Study (Preprint)

2019 ◽  
Author(s):  
Ahmed Abdulaal ◽  
Chanpreet Arhi ◽  
Paul Ziprin
Keyword(s):  
Colorectal Cancer ◽  
Observational Study ◽  
Proportional Hazards ◽  
Cox Regression ◽  
Diagnostic Delay ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Treatment Delays ◽  
Cox Regression Analysis ◽  
Kaplan Meier

BACKGROUND The United Kingdom has lower survival figures for all types of cancers compared to many European countries despite similar national expenditures on health. This discrepancy may be linked to long diagnostic and treatment delays. OBJECTIVE The aim of this study was to determine whether delays experienced by patients with colorectal cancer (CRC) affect their survival. METHODS This observational study utilized the Somerset Cancer Register to identify patients with CRC who were diagnosed on the basis of positive histology findings. The effects of diagnostic and treatment delays and their subdivisions on outcomes were investigated using Cox proportional hazards regression. Kaplan-Meier plots were used to illustrate group differences. RESULTS A total of 648 patients (375 males, 57.9% males) were included in this study. We found that neither diagnostic delay nor treatment delay had an effect on the overall survival in patients with CRC (χ<sup>2</sup><sub>3</sub>=1.5, <i>P</i>=.68; χ23=0.6, <i>P</i>=.90, respectively). Similarly, treatment delays did not affect the outcomes in patients with CRC (χ<sup>2</sup><sub>3</sub>=5.5, <i>P</i>=.14). The initial Cox regression analysis showed that patients with CRC who had short diagnostic delays were less likely to die than those experiencing long delays (hazard ratio 0.165, 95% CI 0.044-0.616; <i>P</i>=.007). However, this result was nonsignificant following sensitivity analysis. CONCLUSIONS Diagnostic and treatment delays had no effect on the survival of this cohort of patients with CRC. The utility of the 2-week wait referral system is therefore questioned. Timely screening with subsequent early referral and access to diagnostics may have a more beneficial effect.

Thrombocytosis as a predictor of poor prognosis in colorectal cancer patients.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 540-540
Author(s):  
Ravi Ramjeesingh ◽  
Amie Jones ◽  
Christine Orr ◽  
Corey Sean Bricks ◽  
Wilma M Hopman ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Platelet Count ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Retrospective Chart Review ◽  
Cancer Center ◽  
Cox Regression Analysis ◽  
Survival Difference ◽  
Stage 4 ◽  
Significant Difference

540 Background: Thrombocytosis has been identified as a prognostic factor in many cancer types including ovarian, breast, and lung cancers. In colorectal cancer (CRC), the literature is divided. Several smaller case studies suggest a negative prognosis in CRC patients with pre-operative thrombocytosis, a larger population study contradicts this. Methods: We performed a retrospective chart review of CRC patients treated at the Cancer Center of Southeastern Ontario diagnosed from January 2005 to December 2011. 1304 confirmed CRC patient charts were identified and patient, tumor, blood work and treatment variables were extracted. Results: 1,096 patients had platelet count available at the time of oncology consult. 222 (20.3%) were characterized as having thrombocytosis (>400x109/L). No difference was identified between those with normal and with thrombocytosis with regards to age, sex, comorbidities, and BMI. However, a statistically significant difference was identified when looking at several pathological characteristics. Significantly more patients with thrombocytosis presented with stage 4 disease (p<0.0001). Additionally less early T-stage (T1: p<0.05, T2: p<0.001), lymph node positivity (p<0.05) and LVI (p<0.05) was identified. Univariate analysis identified a significant difference in survival (1yr: 71.6% vs 88.1%, p<0.0001; 2 yr: 58.1% vs 78.1%, p<0.0001; 5yr: 48.2% vs 64.7%, p<0.0001). Multivariate Cox regression analysis, identified a statistically significant effect of thrombocytosis on risk of dying (HR=1.434, C.I 1.153-1.784, p=0.001). A survival difference was primarily identified in the Stage 4 population (1yr: 55.8% with thrombocytosis vs 72.9% with normal platelet count, p=0.0058; 2 yr: 36.0% vs 50.2%, p=0.0388; 5yr: 26.7% vs 32.0%, p=0.4042). There were no differences in the number of metastatic sites or the number of days on chemotherapy to account for the survival difference. Conclusions: Thrombocytosis, at the time of oncology consultation appears to predict a lower chance of survival in CRC patients, especially in the stage 4 population. Further work is required to elucidate the mechanism of action between elevated platelet counts and survival.

scholarly journals SELE gene as a characteristic prognostic biomarker of colorectal cancer

2021 ◽  
Vol 49 (4) ◽  
pp. 030006052110043
Author(s):  
Na Li ◽  
Honghe Xiao ◽  
Jiangli Shen ◽  
Ximin Qiao ◽  
Fenjuan Zhang ◽  
...  
Keyword(s):  
Gene Expression ◽  
Colorectal Cancer ◽  
Proportional Hazards ◽  
Cox Regression ◽  
Expression Profiles ◽  
Immunohistochemical Analysis ◽  
Cox Proportional Hazards ◽  
The Cancer Genome Atlas ◽  
Clinical Value ◽  
Cox Regression Analysis

Objective To investigate the expression and clinical value of the E-selectin gene ( SELE) in colorectal cancer (CRC). Methods Using gene expression profiles and clinicopathological data for patients with CRC from The Cancer Genome Atlas, and tumor and adjacent normal tissues from 31 patients with CRC from Xianyang Central Hospital, we studied the correlation between SELE gene expression and clinical parameters using Kaplan–Meier and Cox proportional hazards regression analyses. Results Higher expression of SELE was significantly associated with a poorer prognosis and shorter survival in patients with CRC. The median expression level of SELE was significantly higher in CRC tissues compared with healthy adjacent tissue. Cox regression analysis showed that the prognosis of CRC was significantly correlated with the expression of SELE. Immunohistochemical analysis also showed that positive expression of E-selectin increased significantly in line with increasing TNM stage. Conclusion: This study confirmed that SELE gene expression is an independent prognostic factor in patients with CRC.

scholarly journals Relationship Between Creatinine and Body Weight Ratio and Diabetes Mellitus in a Chinese Cohort Study

2021 ◽  
Author(s):  
Xinyu Wang ◽  
Zhuangsen Chen ◽  
Fan Yang ◽  
Xiaohan Ding ◽  
Changchun Cao ◽  
...  
Keyword(s):  
Body Weight ◽  
Missing Values ◽  
Proportional Hazards ◽  
Cox Regression ◽  
Weight Ratio ◽  
Cox Proportional Hazards ◽  
Additive Models ◽  
Cox Regression Analysis ◽  
Non Linear ◽  
The Relationship

Abstract Background: Research on the relationship between Creatinine to Body Weight Ratios (Cre/BW ratios) and the prevalence of diabetes is still lacking. The aim of this study was to investigate the potential association between Cre/BW ratios and incident of diabetes in Chinese adults.Methods: This retrospective study was conducted in 199,526 patients from Rich Healthcare Group in China from 2010 to 2016. The participants were divided into quartiles of the Cre/BW ratios. Multivariate multiple imputation and dummy variables were used to handle missing values. Cox proportional-hazards regression was used to investigate the association of Cre/BW and diabetes. Generalized additive models(GAM) were used to identify non-linear relationships.Results: Of all participants,after handling missing values and adjustment for potential confounders, the multivariate Cox regression analysis results showed that Cre/BW ratios was inversely associated with diabetes risk( HR: 0.268; 95% CI:0.229 to 0.314, P < 0.00001).For men, the hazard ratios(HRs) of incident diabetes was 0.255(95%CI: 0.212-0.307);and for women HR= 0.297 (95%CI: 0.218-0.406).Moreover, sensitivity analysis confirmed the stability of the results. Furthermore, GAM revealed a saturation effect on the independent association between Cre/BW and incident of diabetes.Conclusions: This study demonstrated that increased Cre/BW is negatively correlated with incident of diabetes in Chinese for the first time. And we found that the relationship between Cre/BW and incident of diabetes was non-linear.

Bypass Grafting vs Endovascular Therapy in Patients With Non-Dialysis-Dependent Chronic Kidney Disease and Chronic Limb-Threatening Ischemia (CRITISCH Registry)

2020 ◽  
Vol 27 (4) ◽  
pp. 599-607
Author(s):  
Konstantinos Stavroulakis ◽  
Asimakis Gkremoutis ◽  
Matthias Borowski ◽  
Giovanni Torsello ◽  
Dittmar Böckler ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Chronic Kidney Disease ◽  
Overall Survival ◽  
Kidney Disease ◽  
Endovascular Therapy ◽  
Proportional Hazards ◽  
Cox Regression ◽  
Cox Proportional Hazards ◽  
Bypass Grafting ◽  
Cox Regression Analysis

Purpose: To report the outcomes of bypass grafting (BG) vs endovascular therapy (EVT) in patients with non-dialysis-dependent chronic kidney disease (CKD) and chronic limb-threatening ischemia (CLTI). Materials and Methods: The CRITISCH Registry is a prospective, national, interdisciplinary, multicenter registry evaluating the current practice of all available treatment options in 1200 consecutive CLTI patients. For the purposes of this analysis, only the 337 patients with non-dialysis-dependent CKD treated by either BG (n=86; median 78 years, 48 men) or EVT (n=251; median age 80 years, 135 men) were analyzed. The primary composite outcome was amputation-free survival (AFS); secondary outcomes were overall survival (OS) and amputation-free time (AFT). All outcomes were evaluated in Cox proportional hazards models; the results are reported as the hazard ratio (HR) and 95% confidence interval (CI). Results: The Cox regression analysis revealed a significantly greater hazard of amputation or death after BG (HR 1.78, 95% CI 1.05 to 3.03, p=0.028). The models for AFT and overall survival also suggested a higher hazard for BG, but the differences were not significant (AFT: HR 1.66, 95% CI 0.78 to 3.53, p=0.188; OS: HR 1.41, 95% CI 0.80 to 2.47, p=0.348). The absence of runoff vessels (HR 1.73, 95% CI 1.15 to 2.60, p=0.008) was associated with a decreased AFS. The likelihood of amputation was higher in male patients (HR 2.21, 95% CI 1.10 to 4.45, p=0.027) and was associated with a lack of runoff vessels (HR 1.95, 95% CI 0.96 to 3.95, p=0.065) and myocardial infarction (HR 3.74, 95% CI 1.23 to 11.35, p=0.020). Death was more likely in patients without runoff vessels (HR 1.76, 95% CI 1.11 to 2.80, p=0.016) and those with a higher risk score (HR 1.73, 95% CI 1.03 to 2.91, p=0.038). Conclusion: This analysis suggested that BG was associated with poorer AFS than EVT in patients with non-dialysis-dependent CKD and CLTI. Male sex, previous myocardial infarction, and the absence of runoff vessels were additionally identified as predictors of poorer outcomes.

scholarly journals The Association between Survival and the Pathologic Features of Periampullary Tumors Varies over Time

HPB Surgery ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Jennifer K. Plichta ◽  
Anjali S. Godambe ◽  
Zachary Fridirici ◽  
Sherri Yong ◽  
James M. Sinacore ◽  
...  
Keyword(s):  
Perineural Invasion ◽  
Proportional Hazards ◽  
Strong Association ◽  
Univariate Analysis ◽  
Retrospective Chart Review ◽  
Cox Proportional Hazards ◽  
Multiple Time ◽  
Periampullary Tumors ◽  
Pathologic Features ◽  
Overall Mortality

Introduction. Several histopathologic features of periampullary tumors have been shown to be correlated with prognosis. We evaluated their association with mortality at multiple time points. Methods. A retrospective chart review identified 207 patients with periampullary adenocarcinomas who underwent pancreaticoduodenectomy between January 1, 2001 and December 31, 2009. Clinicopathologic features were assessed, and the data were analyzed using univariate and multivariate methods. Results. In univariate analysis, perineural invasion had a strong association with 1-year mortality (OR 3.03, CI 1.42–6.47), and one lymph node (LN) increase in the LN ratio (LNR) equated with a 5-fold increase in mortality. In contrast, LN status (OR 6.42, CI 3.32–12.41) and perineural invasion (OR 5.44, CI 2.81–10.52) had the strongest associations with mortality at 3 years. Using Cox proportional hazards, perineural invasion (HR 2.61, CI 1.77–3.85) and LN status (HR 2.69, CI 1.84–3.95) had robust associations with overall mortality. Recursive partitioning analysis identified LNR as the most important risk factor for mortality at 1 and 3 years. Conclusions. Overall mortality was closely related to the LNR within the first year, while longer follow-up periods demonstrated a stronger association with perineural invasion and overall LN status. Therefore, the current staging for periampullary tumors may need to be updated to include the LNR.

scholarly journals Integrated Analysis of lncRNA-Associated ceRNA Network Identifies Two lncRNA Signatures as a Prognostic Biomarker in Gastric Cancer

2021 ◽  
Vol 2021 ◽  
pp. 1-16
Author(s):  
Shuyan Zhang ◽  
Shanshan Li ◽  
Jian-Lin Guo ◽  
Ningyi Li ◽  
Cai-Ning Zhang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Proportional Hazards ◽  
Cox Regression ◽  
Cox Proportional Hazards ◽  
Integrated Analysis ◽  
Survival Prediction ◽  
Survival Prognosis ◽  
Cox Regression Analysis ◽  
Cerna Network

Background. Gastric cancer (GC) is a malignant tumour that originates in the gastric mucosal epithelium and is associated with high mortality rates worldwide. Long noncoding RNAs (lncRNAs) have been identified to play an important role in the development of various tumours, including GC. Yet, lncRNA biomarkers in a competing endogenous RNA network (ceRNA network) that are used to predict survival prognosis remain lacking. The aim of this study was to construct a ceRNA network and identify the lncRNA signature as prognostic factors for survival prediction. Methods. The lncRNAs with overall survival significance were used to construct the ceRNA network. Function enrichment, protein-protein interaction, and cluster analysis were performed for dysregulated mRNAs. Multivariate Cox proportional hazards regression was performed to screen the potential prognostic lncRNAs. RT-qPCR was used to measure the relative expression levels of lncRNAs in cell lines. CCK8 assay was used to assess the proliferation of GC cells transfected with sh-lncRNAs. Results. Differentially expressed genes were identified including 585 lncRNAs, 144 miRNAs, and 2794 mRNAs. The ceRNA network was constructed using 35 DElncRNAs associated with overall survival of GC patients. Functional analysis revealed that these dysregulated mRNAs were enriched in cancer-related pathways, including TGF-beta, Rap 1, calcium, and the cGMP-PKG signalling pathway. A multivariate Cox regression analysis and cumulative risk score suggested that two of those lncRNAs (LINC01644 and LINC01697) had significant prognostic value. Furthermore, the results indicate that LINC01644 and LINC01697 were upregulated in GC cells. Knockdown of LINC01644 or LINC01697 suppressed the proliferation of GC cells. Conclusions. The authors identified 2-lncRNA signature in ceRNA regulatory network as prognostic biomarkers for the prediction of GC patient survival and revealed that silencing LINC01644 or LINC01697 inhibited the proliferation of GC cells.

scholarly journals The Association between Homocysteinemia and Mortality in Pre-dialysis CKD patients: A Propensity-Score Matched Analysis Using NHANES-National Death Index Link

2021 ◽  
Author(s):  
Je Hun Song ◽  
Hyuk Huh ◽  
Eunjin Bae ◽  
Jeonghwan Lee ◽  
Jung Pyo Lee ◽  
...  
Keyword(s):  
Risk Factor ◽  
Propensity Score ◽  
Proportional Hazards ◽  
Cox Regression ◽  
Cox Proportional Hazards ◽  
Mortality Data ◽  
Protein Energy Wasting ◽  
Cox Regression Analysis ◽  
Cox Proportional Hazards Models ◽  
All Cause Mortality

Abstract Background: Hyperhomocysteinemia (HHcy) is considered a risk factor for cardiovascular disease (CVD) including chronic kidney disease (CKD). In this study, we investigated the association between serum homocysteine (Hcy) level and mortality according to the presence of CKD.Methods: Our study included data of 9,895 participants from the 1996–2016 National Health and Nutrition Examination Surveys (NHANES). Moreover, linked mortality data were included and classified into four groups according to the Hcy level. Multivariable-adjusted Cox proportional hazards models using propensity-score were used to examine dose-response associations between Hcy level and mortality.Results: Of 9,895 participants, 1032 (21.2%) participants were diagnosed with CKD. In a multivariate Cox regression analysis including all participants, Hcy level was associated with all-cause mortality, compared with the 1st quartile in Model 3 (2nd quartile: hazard ratio (HR) 1.751, 95% confidence interval (CI) 1.348-2.274, p<0.001; 3rd quartile: HR 2.220, 95% CI 1.726-2.855, p<0.001; 4th quartile: HR 3.776, 95% CI 2.952-4.830, p<0.001). In the non-CKD group, there was a significant association with all-cause mortality; however, this finding was not observed in the CKD group. The observed pattern was similar after propensity score matching. In the non-CKD group, overall mortality increased in proportion to Hcy concentration (2nd quartile: HR 2.195, 95% CI 1.299-3.709, p = 0.003; 3rd quartile: HR 2.607, 95% CI 1.570-4.332, p<0.001; 4th quartile: HR 3.720, 95% CI 2.254-6.139, p<0.001). However, the risk of all-cause mortality according to the quartile of Hcy level did not increase in the CKD groupConclusion: This study found a correlation between the Hcy level and mortality rate only in the non-CKD group. This altered risk factor patterns may be attributed to protein-energy wasting or chronic inflammation status that is accompanied by CKD.

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