This study aimed to investigate the impact of adjuvant chemotherapy on long-term survival in unselected patients with high-risk stage II colon cancer including an analysis of each high-risk feature.Data from the Danish Colorectal Cancer Group, the National Patient Registry and the Danish Pathology Registry from 2014 to 2018 were merged. Patients surviving > 90 days were included. High-risk features were defined as emergency presentation, including self-expanding metal stents (SEMS)/loop-ostomy as a bridge to resection, grade B or C anastomotic leakage, pT4 tumors, lymph node yield < 12 or signet cell carcinoma. Eligibility criteria for chemotherapy were age < 75 years, proficient MMR gene expression, and performance status ≤ 2. The primary outcome was 5-year overall survival. Secondary outcomes included the proportion of eligible patients allocated for adjuvant chemotherapy and the time to first administration.In total 939 of 3937 patients with stage II colon cancer had high-risk features, of whom 408 were eligible for chemotherapy. 201 (49.3%) patients received adjuvant chemotherapy, with a median time to first administration of 35 days after surgery. The crude 5-year overall survival was 84.9% in patients receiving adjuvant chemotherapy compared with 66.3% in patients not receiving chemotherapy, p < 0.001. This association corresponded to an absolute risk difference of 14%.5-year overall survival was significantly higher in patients with high-risk stage II colon cancer treated with adjuvant chemotherapy compared with no chemotherapy. Adjuvant treatment was given to less than half of the patients who were eligible for it.
This study aimed to investigate the impact of adjuvant chemotherapy on long-term survival in unselected patients with high-risk stage II colon cancer including an analysis of each high-risk feature. Data from the Danish Colorectal Cancer Group, the National Patient Registry and the Danish Pathology Registry from 2014 to 2018 were merged. Patients surviving > 90 days were included. High-risk features were defined as emergency presentation, including self-expanding metal stents (SEMS)/loop-ostomy as a bridge to resection, grade B or C anastomotic leakage, pT4 tumors, lymph node yield < 12 or signet cell carcinoma. Eligibility criteria for chemotherapy were age < 75 years, proficient MMR gene expression, and performance status ≤ 2. The primary outcome was 5-year overall survival. Secondary outcomes included the proportion of eligible patients allocated for adjuvant chemotherapy and the time to first administration. In total 939 of 3937 patients with stage II colon cancer had high-risk features, of whom 408 were eligible for chemotherapy. 201 (49.3%) patients received adjuvant chemotherapy, with a median time to first administration of 35 days after surgery. The crude 5-year overall survival was 84.9% in patients receiving adjuvant chemotherapy compared with 66.3% in patients not receiving chemotherapy, p < 0.001. This association corresponded to an absolute risk difference of 14%. 5-year overall survival was significantly higher in patients with high-risk stage II colon cancer treated with adjuvant chemotherapy compared with no chemotherapy. Adjuvant treatment was given to less than half of the patients who were eligible for it.
Iron deficiency anemia is common in patients with colorectal cancer and affects postoperative outcomes. Preoperative intravenous iron supplementation corrects anemia effectively; however, the effect on the postoperative clinical course is unclear. The aim of this study was to investigate the effects of implementing a screening program for iron deficiency anemia and correction in patients with colorectal cancer.
Abstract Background Body composition predicts cardiovascular outcomes, but it is uncertain whether anthropometric measures can replace the more expensive serum total cholesterol for cardiovascular risk stratification in low resource settings. Purpose The purpose of the study was to compare the additive prognostic ability of serum total cholesterol with that of body mass index (BMI), waist/hip ratio (WHR), and estimated fat mass (EFM, calculated using a validated prediction equation), individually and combined. Methods We used data from the MORGAM (MONICA, Risk, Genetics, Archiving, and Monograph) Prospective Cohort Project, an international pooling of cardiovascular cohorts, to determine the relationship between anthropometric measures, serum cholesterol, and cardiovascular events, using multivariable Cox proportional-hazards regression analysis. We further investigated the ability of these measures to enhance prognostication beyond a simpler prediction model, consisting of age, sex, smoking status, systolic blood pressures, and country, using comparison of area under the receiver operating characteristics curve (AUCROC) derived from binary logistic regression models. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of death from coronary heart disease, myocardial infarction, or stroke. Results The study population consisted of 52,188 apparently healthy subjects (56.3% men) aged 47±12 years ranging from 20 to 84, derived from 37 European cohorts, with baseline between 1982–2002 all followed for 10 years during which MACE occurred in 2465 (4.7%) subjects. All anthropometric measures (BMI: hazard ratio (HR) 1.04 [95% confidence interval (CI): 1.03–1.05] per kg/m2; WHR: HR 7.5 [4.0–14.0] per unit; EFM: HR 1.02 [1.01–1.02] per kg) as well as serum total cholesterol (HR 1.20 [1.16–1.24] per mmol/l) were significantly associated with MACE (P<0.001 for all), independently of age, sex, smoking status, systolic blood pressures, and country. The addition of serum cholesterol significantly improved the predictive ability of the simple model (AUCROC 0.818 vs. 0.814, P<0.001), as did the combination of WHR, BMI, and EFM (AUCROC 0.817 vs. 0.814, P=0.004). When assessed individually, BMI (AUCROC 0.816 vs. 0.814, P=0.004) and WHR (AUCROC 0.815 vs. 0.814, P=0.02) improved model performance, while EFM narrowly missed significance (AUCROC 0.815 vs. 0.814, P=0.06). There was no significant difference in the predictive ability of a model including serum cholesterol versus that including all three anthropometric measures (AUCROC 0.818 vs. 0.817, P=0.13). The figure shows the pertinent areas under the ROC curve in predicting MACE. Conclusion In this large population-based cohort study, the addition of a combination of anthropometric measures, i.e. BMI, WHR, and EFM, raised the predictive ability of a simple prognostic model comparable to that obtained by the addition of serum total cholesterol. Figure 1 Funding Acknowledgement Type of funding source: None
This review assesses the latest evidence and guidelines related to the use of aspirin for primary prevention among patients with Type 2 diabetes (T2D) without overt cardiovascular disease. The global burden of T2D is steadily increasing and most deaths among patients with T2D are attributed to cardiovascular events. Furthermore, several haemostatic abnormalities have been shown in this group of patients, including increased platelet turnover and aggregation.
Abstract Background Cardiac troponin elevation is associated with adverse short-term prognosis in patients with pulmonary embolism (PE). However, it is unknown whether high-sensitivity troponin concentrations predict long-term outcomes and whether serial measurements offer additional prognostic information in this setting. Purpose To determine short- and long-term prognostic implications of high-sensitivity troponin-T (hsTnT) concentrations and their changes from baseline, in patients with acute PE. Methods Retrospective cohort study based on Danish national registries. We identified all patients discharged from the hospital with a PE from 2013 through 2019 and merged them with all records of at least one hsTnT (99th percentile upper reference limit, 13.5 ng/l) measurement obtained during the same hospitalization. Absolute and relative risks for death from any cause at days 0-30 and 31-365 were calculated through multivariable logistic regression with average treatment effect modeling. Moreover, we tested whether hsTnT changes (in those who had a second measurement available ≥1 hour and ≤7 hours after the first measurement) were associated with additional prognostic information. Results At least one hsTnT measurement was available in 4611 individuals. Median age (25th-75th percentile) was 70.8 (58.6-79.5) years, and 2312 (50.1%) were women. One-hundred and forty-one (3.1%) patients had a prior venous thromboembolic event, 731 (15.9%) had known coronary artery disease, and 1001 (21.7%) had a history of cancer. Median baseline hsTnT was 29 (25th-75th percentile, 14-79) ng/l, and 1082 (76.5%) had an elevated concentration. Four-hundred and thirty-one (9.3%) individuals had died at 30 days, while an additional 614 (14.7% of 30-day survivors) died between days 31-365. hsTnT concentration displayed a significant, non-linear association with death (P<0.001). Figure 1 shows the unadjusted 30-day risk of death stratified for hsTnT quartiles, while Figure 2 shows the risk at days 31-365 (with 0 on the x-axis representing day 30 from the index event). Upon multivariable adjustment (including absence or presence of acute cor pulmonale), the risk of death at both timepoints remained significantly higher among individuals in each of quartiles 3 and 4 versus quartile 1 (P<0.05), with quartile 2 showing a trend (P=0.06 and P=0.07 for short- and long-term death, respectively). In 1247 subjects with two hsTnT measurements available, absolute and relative changes from baseline did not appear to carry additional prognostic information, nor did switching from normal to elevated hsTnT or vice versa, though the latter was only observed in very few persons. Conclusions In patients with acute PE, elevated hsTnT concentrations were associated with both short- and long-term mortality, but unlike in acute coronary syndromes, the utility of drawing a second sample appeared limited.Figure 1Figure 2
To assess whether anthropometric measures (body mass index [BMI], waist-hip ratio [WHR], and estimated fat mass [EFM]) are independently associated with major adverse cardiovascular events (MACE), and to assess their added prognostic value compared with serum total-cholesterol. The study population comprised 109,509 individuals (53% men) from the MORGAM-Project, aged 19-97 years, without established cardiovascular disease, and not on antihypertensive treatment. While BMI was reported in all, WHR and EFM were reported in ∼52,000 participants. Prognostic importance of anthropometric measurements and total-cholesterol was evaluated using adjusted Cox proportional-hazards regression, logistic regression, area under the receiver-operating-characteristic curve (AUC
It is unclear how serial high-sensitivity troponin-I (hsTnI) concentrations affect long-term prognosis in individuals with suspected acute coronary syndrome (ACS).
Abstract Massive, submassive, and nonmassive pulmonary embolism relate to the hemodynamic state, while saddle pulmonary embolus is a purely radiologic term. Patients with saddle embolus often present with hemodynamic compromise. However, treatment depends on the clinical presentation, and stable patients with a saddle pulmonary embolus can respond well to conventional anticoagulation.
