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Background: Enhanced recovery after surgery (ERAS) pathways represent a comprehensive approach to optimizing perioperative management and reducing hospital stay and cost. In living donor kidney transplantation, key impediments to postoperative discharge include pain, and opioid associated complications such as nausea, vomiting, and the return of gastrointestinal function. Methods: In this randomized controlled trial, living kidney transplantation donors were assigned to either the ERAS or control group. The ERAS group patients received 15 preoperative, 17 intraoperative, 19 postoperative element intervention. The control group received standard care. The ERAS group received a multimodal opioid sparing pain management including an intraoperative transverse abdominis plane block. Our primary outcome measure was postoperative opioid consumption. The secondary outcome measures were postoperative pain scores, first oral intake, and hospital length of stay. Results: There were no significant differences in demographics between the 2 groups. The ERAS group had a statistically significant reduction in total postoperative opioid consumption calculated in intravenous morphine equivalents (24.2â ±â 20.2 versus 71â ±â 39.5 mg, Pâ <â 0.01). Postoperative pain scores were significantly lower (Pâ <â 0.001) from 1 h postoperatively to 48 h. Surgical time was 45 min shorter (Pâ =â 0.037). Intraoperative PlasmaLyte administration was lower (PlasmaLyte: 1444â ±â 907 versus 2168â ±â 1347 mL, Pâ =â 0.049). Time to tolerating regular diet was shorter by 2 h (Pâ <â 0.008), and length of hospital stay was decreased by 10.1 h. Conclusions: The ERAS group experienced superior postoperative analgesia and a shorter length of hospital stay compared with controls.
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BACKGROUND: Persistent inflammation is associated with adverse health outcomes, but its impact on mortality has not been investigated previously among hip fracture patients. This article aims to investigate the influence of changes in levels of cytokines in the 2 months after a hip fracture repair on 5-year mortality. METHODS: This is a prospective cohort study from the Baltimore Hip Studies (BHS) with 191 community-dwelling older men and women (≥65 years) who had recently undergone surgical repair of an acute hip fracture, with recruitment from May 2006 to June 2011. Plasma interleukin-6 (IL-6), soluble tumor necrosis factor alpha receptor1 (sTNFα-R1), and interleukin-1 receptor agonist (IL-1RA) were obtained within 22 days of admission and at 2 months. All-cause mortality over 5 years was determined. Logistic regression analysis tested the associations between the cytokines' trajectories and mortality over 5 years, adjusted for covariates (age, sex, education, body mass index, lower extremity physical activities of daily living, and Charlson comorbidity index). RESULTS: High levels of IL-6 and sTNFα-R1 at baseline with small or no decline at 2 months were associated with higher odds of 5-year mortality compared with those with lower levels at baseline and greater decline at 2 months after adjustment for age, and other potential confounders (OR = 4.71, p = 0.01 for IL-6; OR = 15.03, p = 0.002 for sTNFα-R1). Similar results that failed to reach significance were found for IL-1RA (OR = 2.40, p = 0.18). Those with higher levels of cytokines at baseline with greater decline did not have significantly greater mortality than the reference group, those with lower levels at baseline and greater decline. CONCLUSION: Persistent elevation of plasma IL-6 and sTNFα-R1 levels within the first 2 months after hospital admission in patients with hip fracture is associated with higher 5-year mortality. These patients may benefit from enhanced care and earlier intensive interventions to reduce the risk of death.
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Fraturas do Quadril , Interleucina-6 , Humanos , Masculino , Feminino , Fraturas do Quadril/mortalidade , Fraturas do Quadril/sangue , Estudos Prospectivos , Idoso , Interleucina-6/sangue , Baltimore/epidemiologia , Receptores Tipo I de Fatores de Necrose Tumoral/sangue , Idoso de 80 Anos ou mais , Biomarcadores/sangueRESUMO
The production of coffee leaf tea (Coffea arabica) in El Salvador and the influences of processing steps on non-volatile compounds and volatile aroma-active compounds were investigated. The tea was produced according to the process steps of conventional tea (Camellia sinensis) with the available possibilities on the farm. Influencing factors were the leaf type (old, young, yellow, shoots), processing (blending, cutting, rolling, freezing, steaming), drying (sun drying, oven drying, roasting) and fermentation (wild, yeast, Lactobacillus). Subsequently, the samples were analysed for the maximum levels of caffeine, chlorogenic acid, and epigallocatechin gallate permitted by the European Commission. The caffeine content ranged between 0.37-1.33 g/100 g dry mass (DM), the chlorogenic acid was between not detectable and 9.35 g/100 g DM and epigallocatechin gallate could not be detected at all. Furthermore, water content, essential oil, ash content, total polyphenols, total catechins, organic acids, and trigonelline were determined. Gas chromatography-mass spectrometry-olfactometry and calculation of the odour activity values (OAVs) were carried out to determine the main aroma-active compounds, which are ß-ionone (honey-like, OAV 132-927), decanal (citrus-like, floral, OAV 14-301), α-ionone (floral, OAV 30-100), (E,Z)-2,6-nonadienal (cucumber-like, OAV 18-256), 2,4-nonadienal (melon-like, OAV 2-18), octanal (fruity, OAV 7-23), (E)-2 nonenal (citrus-like, OAV 1-11), hexanal (grassy, OAV 1-10), and 4-heptenal (green, OAV 1-9). The data obtained in this study may help to adjust process parameters directly to consumer preferences and allow coffee farmers to earn an extra income from this by-product.
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OBJECTIVES: This study describes prevention behavior and psychosocial health among people living with HIV (PLHIV) and HIV-negative people during the early wave of the coronavirus disease 2019 (COVID-19) pandemic in the United States. We assessed differences by HIV status and associations between social disruption and psychosocial health. DESIGN: A cross-sectional telephone/videoconference administered survey of 3411 PLHIV and HIV-negative participants in the Multicenter AIDS Cohort Study/WIHS Combined Cohort Study (MWCCS). METHODS: An instrument combining new and validated measures was developed to assess COVID-19 prevention efforts, social disruptions (loss of employment, childcare, health insurance, and financial supports), experiences of abuse, and psychosocial health. Interviews were performed between April and June 2020. Associations between social disruptions and psychosocial health were explored using multivariable logistic regression, adjusting for sociodemographics and HIV status. RESULTS: Almost all (97.4%) participants reported COVID-19 prevention behavior; 40.1% participants reported social disruptions, and 34.3% reported health care appointment disruption. Men living with HIV were more likely than HIV-negative men to experience social disruptions (40.6% vs. 32.9%; P < 0.01), whereas HIV-negative women were more likely than women with HIV to experience social disruptions (51.1% vs. 39.8%, P < 0.001). Participants who experienced ≥2 social disruptions had significantly higher odds of depression symptoms [aOR = 1.32; 95% confidence interval (CI): 1.12 to 1.56], anxiety (aOR = 1.63; 95% CI: 1.17 to 2.27), and social support dissatisfaction (aOR = 1.81; 95% CI: 1.26 to 2.60). CONCLUSIONS: This study builds on emerging literature demonstrating the psychosocial health impact related to the COVID-19 pandemic by providing context specific to PLHIV. The ongoing pandemic requires structural and social interventions to decrease social disruption and address psychosocial health needs among the most vulnerable populations.
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COVID-19/epidemiologia , Soronegatividade para HIV , Soropositividade para HIV/epidemiologia , Soropositividade para HIV/psicologia , Saúde Mental/estatística & dados numéricos , COVID-19/psicologia , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Prevalência , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Chronic nonsteroidal anti-inflammatory drug (NSAID) use is associated with gastrointestinal bleeding via inhibition of endogenous mucosal protection and platelet aggregation. This study aimed to determine whether extended NSAIDs after joint arthroplasty is associated with increased risk of gastrointestinal bleeding. METHODS: This was a retrospective study examining 28,794 adults who underwent joint arthroplasty by one of 50 surgeons from 2016 to 2018. Episodes of gastrointestinal bleeding within 90 days postoperatively were identified prospectively. Postoperative medications were reported directly by patients with electronic questionnaires. The primary analysis was performed using binary logistic regression. RESULTS: A total of 74 (0.26%) episodes of gastrointestinal bleeding occurred within 90 days (median 8 days) postoperatively. Of 5086 patients with complete data included in the primary analysis, 59.6% had used NSAIDs with median duration of 2 weeks (interquartile range, 0-6 weeks). Patients with gastrointestinal bleeding were significantly older (71.3 vs 67.0 years), required longer hospitalizations (2.1 vs 1.5 days), and more commonly had a history of peptic ulcers (10.8% vs 0.9%). However, there was no positive association between NSAID use and gastrointestinal bleeding. In fact, the odds of gastrointestinal bleeding were lower in patients taking NSAIDs. Gastrointestinal bleeding was associated with anticoagulants, antiplatelet agents, and, to a lesser extent, aspirin. CONCLUSION: NSAIDs were not associated with gastrointestinal bleeding and may be prescribed safely for a majority of patients after joint arthroplasty. The greatest odds of gastrointestinal bleeding occurred in patients with peptic ulcer disease and those who received antiplatelet and anticoagulation agents. Increasing age and bilateral surgery were also associated with gastrointestinal bleeding. LEVEL OF EVIDENCE: Level III.
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Analgesia , Preparações Farmacêuticas , Adulto , Anti-Inflamatórios não Esteroides , Artroplastia , Hemorragia Gastrointestinal , Humanos , Estudos Retrospectivos , Fatores de RiscoRESUMO
AIMS: This paper presents updated prevalence estimates of awareness, ever-use, and current use of nicotine vaping products (NVPs) from 14 International Tobacco Control Policy Evaluation Project (ITC Project) countries that have varying regulations governing NVP sales and marketing. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: A cross-sectional analysis of adult (≥ 18 years) current smokers and ex-smokers from 14 countries participating in the ITC Project. Data from the most recent survey questionnaire for each country were included, which spanned the period 2013-17. Countries were categorized into four groups based on regulations governing NVP sales and marketing (allowable or not), and level of enforcement (strict or weak where NVPs are not permitted to be sold): (1) most restrictive policies (MRPs), not legal to be sold or marketed with strict enforcement: Australia, Brazil, Uruguay; (2) restrictive policies (RPs), not approved for sale or marketing with weak enforcement: Canada, Malaysia, Mexico, New Zealand; (3) less restrictive policies (LRPs), legal to be sold and marketed with regulations: England, the Netherlands, Republic of Korea, United States; and (4) no regulatory policies (NRPs), Bangladesh, China, Zambia. Countries were also grouped by World Bank Income Classifications. Country-specific weighted logistic regression models estimated adjusted NVP prevalence estimates for: awareness, ever/current use, and frequency of use (daily versus non-daily). FINDINGS: NVP awareness and use were lowest in NRP countries. Generally, ever- and current use of NVPs were lower in MRP countries (ever-use = 7.1-48.9%; current use = 0.3-3.5%) relative to LRP countries (ever-use = 38.9-66.6%; current use = 5.5-17.2%) and RP countries (ever-use = 10.0-62.4%; current use = 1.4-15.5%). NVP use was highest among high-income countries, followed by upper-middle-income countries, and then by lower-middle-income countries. CONCLUSIONS: With a few exceptions, awareness and use of nicotine vaping products varied by the strength of national regulations governing nicotine vaping product sales/marketing, and by country income. In countries with no regulatory policies, use rates were very low, suggesting that there was little availability, marketing and/or interest in nicotine vaping products in these countries where smoking populations are predominantly poorer. The higher awareness and use of nicotine vaping products in high income countries with moderately (e.g. Canada, New Zealand) and less (e.g. England, United States) restrictive policies, is likely due to the greater availability and affordability of nicotine vaping products.
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Comércio/legislação & jurisprudência , Sistemas Eletrônicos de Liberação de Nicotina , Ex-Fumantes/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Política Pública/legislação & jurisprudência , Fumantes/estatística & dados numéricos , Vaping/epidemiologia , Adulto , Austrália/epidemiologia , Bangladesh/epidemiologia , Brasil/epidemiologia , Canadá/epidemiologia , China/epidemiologia , Estudos Transversais , Inglaterra/epidemiologia , Feminino , Humanos , Modelos Logísticos , Malásia/epidemiologia , Masculino , Marketing/legislação & jurisprudência , México/epidemiologia , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Nova Zelândia/epidemiologia , Prevalência , República da Coreia/epidemiologia , Estados Unidos/epidemiologia , Uruguai/epidemiologia , Zâmbia/epidemiologiaRESUMO
OBJECTIVES: Carbon monoxide poisoning affects 50,000 per year in the United States alone. Mortality is approximately 3%, and up to 40% of survivors suffer from permanent neurocognitive and affective deficits. Hyperbaric oxygen therapy has shown benefit on reducing the long-term neurologic sequelae of carbon monoxide poisoning but has not demonstrated improved survival. The objective of this study is to assess the efficacy of hyperbaric oxygen for acute and long-term mortality in carbon monoxide poisoning using a large clinical databank. DESIGN: Retrospective analysis. SETTING: University of Pittsburgh Medical Center healthcare system (Pittsburgh, PA). PATIENTS: One-thousand ninety-nine unique encounters of adult patients with carbon monoxide poisoning. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Baseline demographics, laboratory values, hospital charge transactions, discharge disposition, and clinical information from charting were obtained from the electronic medical record. In propensity-adjusted analysis, hyperbaric oxygen therapy was associated with a reduction in inpatient mortality (absolute risk reduction, 2.1% [3.7-0.9%]; p = 0.001) and a reduction in 1-year mortality (absolute risk reduction, 2.1% [3.8-0.4%]; p = 0.013). CONCLUSIONS: These data demonstrate that hyperbaric oxygen is associated with reduced acute and reduced 1-year mortality. Further studies are needed on the mortality effects of hyperbaric oxygen therapy in carbon monoxide poisoning.
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Intoxicação por Monóxido de Carbono/terapia , Oxigenoterapia Hiperbárica , Adulto , Intoxicação por Monóxido de Carbono/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Comparative effectiveness research (CER) is imperative for objective and balanced assessment of treatment outcomes. CER that uses administrative databases (AD-CER) affords unique opportunities for large scale data analyses that potentially transcend limitations of small institutional datasets. Prostate cancer has received much attention from the AD-CER research community, whereas non-prostate genitourinary malignancies are less well-studied. The objective of this article is to review the currently available AD-CER that has been published in the non-prostate genitourinary malignancies space.
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Pesquisa Comparativa da Efetividade/métodos , Conjuntos de Dados como Assunto , Sistema de Registros/estatística & dados numéricos , Neoplasias Urogenitais/terapia , Humanos , Masculino , Resultado do Tratamento , Neoplasias Urogenitais/mortalidadeRESUMO
When used in appropriate patient populations, fast-track extubation (FTE) anesthetic techniques and intensive care unit (ICU) protocols safely reduce intubation times, ICU length of stay, and resource utilization. The authors hypothesized that perioperative provider debriefing on success or failure of FTE would improve FTE success. This retrospective observational study included consecutive patients undergoing elective coronary artery bypass graft (CABG), valve, or combined CABG/valve surgery between February 2015 and May 2016 (N = 313). Throughout the intervention period, a briefing was distributed on postoperative day 1 to the anesthesiology providers responsible for operative care of the patient detailing success or failure of FTE and perioperative characteristics. The preintervention FTE success rate of 55.6% significantly improved to 72.8% in the intervention group ( P = .022). When combined with a continuous interdepartmental review process, provider debriefing improved FTE success. Perioperative provider debriefing requires minimal resources for implementation and can easily be replicated in other cardiac surgery centers.
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Centros Médicos Acadêmicos , Extubação/métodos , Procedimentos Cirúrgicos Cardíacos , Idoso , Ponte de Artéria Coronária , Feminino , Humanos , Comunicação Interdisciplinar , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Assistência Perioperatória , Estudos Retrospectivos , Fatores de TempoRESUMO
Opioid-induced constipation has a negative impact on quality of life for patients with chronic pain and can affect more than a third of patients. A related but separate entity is postoperative ileus, which is an abnormal pattern of gastrointestinal motility after surgery. Nonselective µ-opioid receptor antagonists reverse constipation and opioid-induced ileus but cross the blood-brain barrier and may reverse analgesia. Peripherally acting µ-opioid receptor antagonists target the µ-opioid receptor without reversing analgesia. Three such agents are US Food and Drug Administration approved. We reviewed the literature for randomized controlled trials that studied the efficacy of alvimopan, methylnaltrexone, and naloxegol in treating either opioid-induced constipation or postoperative ileus. Peripherally acting µ-opioid receptor antagonists may be effective in treating both opioid-induced bowel dysfunction and postoperative ileus, but definitive conclusions are not possible because of study inconsistency and the relatively low quality of evidence. Comparisons of agents are difficult because of heterogeneous end points and no head-to-head studies.
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Analgésicos Opioides/efeitos adversos , Constipação Intestinal/induzido quimicamente , Constipação Intestinal/tratamento farmacológico , Íleus/tratamento farmacológico , Antagonistas de Entorpecentes/administração & dosagem , Complicações Pós-Operatórias/tratamento farmacológico , Constipação Intestinal/diagnóstico , Humanos , Íleus/diagnóstico , Íleus/etiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodosRESUMO
PURPOSE: Racial disparities in complication rates have been demonstrated for a variety of surgical procedures. We hypothesized that African American (AA) patients experience higher postoperative complication rates than whites following urologic oncology procedures. MATERIALS AND METHODS: Patients in American College of Surgeons National Surgical Quality Improvement Program who underwent radical prostatectomy (RP), radical or partial nephrectomy (RN/PN), and radical cystectomy (RC) between 2005 and 2013 were included. Complications were grouped as minor (Clavien I-II), major (Clavien III-IV), or death (Clavien V). A 30-day complication rates and disparities in preoperative comorbidity burden were compared by race. After adjustment for comorbidity burden, multivariable logistic regression was performed to test the association between race and risk of complication. RESULTS: Of 38,642 patients included in the analysis, 90% were white and 10% were AA. In unadjusted analysis, there were no significant differences in complication rates between AA and white patients for any Clavien grade in the procedures queried (RP: P = 0.07; RN/PN: P = 0.70; RC: P = 0.12). After controlling for a higher comorbidity burden among AA patients, AA race was again not independently associated with 30-day postoperative complications for RP (odds ratio [OR] = 1.08, 95% CI: 0.92-1.29), RN/PN (OR = 0.98, 95% CI: 0.84-1.13), or RC (OR = 1.10, 95% CI: 0.84-1.43). CONCLUSION: Despite a higher comorbidity burden, AA patients in American College of Surgeons National Surgical Quality Improvement Program are not at increased risk of 30-day postoperative complications following major urologic cancer surgery. These findings suggest that comorbidity burden, as opposed to race, is most strongly associated with the risk of postoperative complications. To minimize perioperative risk, clinicians should strive to preoperatively optimize medical comorbidities in all patients undergoing urologic cancer surgery.
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Cistectomia/métodos , Nefrectomia/métodos , Complicações Pós-Operatórias/etnologia , Prostatectomia/métodos , Neoplasias Urológicas/cirurgia , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Cistectomia/efeitos adversos , Cistectomia/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Nefrectomia/efeitos adversos , Nefrectomia/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Prostatectomia/efeitos adversos , Prostatectomia/estatística & dados numéricos , Fatores de Risco , Estados Unidos , População Branca/estatística & dados numéricosAssuntos
Disfunção Cognitiva/diagnóstico , Ponte de Artéria Coronária/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/psicologia , Ponte de Artéria Coronária/tendências , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/psicologia , Resultado do TratamentoRESUMO
BACKGROUND AND OBJECTIVES: The paradoxical rise in overall and cancer-specific mortality despite increased detection and treatment of renal cell carcinoma (RCC) is termed "treatment disconnect." We reassess this phenomenon by evaluating impact of missing data and rising incidence on mortality trends. RESEARCH DESIGN, SUBJECTS, AND MEASURES: Using Surveillance, Epidemiology, and End Results data, we identified patients with RCC diagnosis from 1973 to 2011. We estimated mortality rates by tumor size after accounting for lags from diagnosis to death using multiple imputations for missing data from 1983. Mortality rates were estimated irrespective of tumor size after adjustment for prior cumulative incidence using ridge regression. RESULTS: A total of 78,891 patients met inclusion criteria. Of 70,212 patients diagnosed since 1983, 10.4% had missing data. Significant attenuation in cancer-specific mortality was noted from 1983 to 2011 when comparing observed with imputed rates: Δobs0.05 versus Δimp0.10 (P=0.001, <2 cm tumors); Δobs0.29 versus Δimp0.18 (P=0.005, 2-4 cm tumors); Δobs0.46 versus Δimp-0.20 (P<0.001, 4-7 cm tumors); Δobs0.93 versus Δimp-0.15 (P<0.001, >7 cm tumors). Holding incidence of RCC constant to 2011 rates, temporal increase in overall mortality for all patients was attenuated (P<0.001) when comparing observed estimates (3.9-6.8) with 2011 adjusted estimates (5.9-7.1), suggesting that rapidly rising incidence may influence reported overall mortality trends. These findings were supported by assessment of mortality to incidence ratio trends. CONCLUSIONS: Missing data and rising incidence may contribute substantially to the "treatment disconnect" phenomenon when examining mortality rates in RCC using tumor registry data. Caution is advised when basing clinical and policy decisions on these data.
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Carcinoma de Células Renais/mortalidade , Carcinoma de Células Renais/terapia , Neoplasias Renais/mortalidade , Neoplasias Renais/terapia , Mortalidade/tendências , Sistema de Registros , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Programa de SEER , Taxa de Sobrevida , Estados Unidos/epidemiologiaAssuntos
Prostatectomia/métodos , Neoplasias da Próstata/secundário , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos de Citorredução/métodos , Procedimentos Cirúrgicos de Citorredução/mortalidade , Intervalo Livre de Doença , Estudos de Viabilidade , Humanos , Masculino , Prostatectomia/mortalidade , Neoplasias da Próstata/mortalidade , Fatores de Risco , Resultado do TratamentoRESUMO
INTRODUCTION: The purpose of this study was to evaluate if time to treatment (TTT) has an effect on outcomes for patients with localized prostate cancer treated with definitive external beam radiation therapy (EBRT). PATIENTS AND METHODS: We included 4064 patients (1549 low-risk, 1612 intermediate-risk, and 903 high-risk) treated with EBRT. For each National Comprehensive Cancer Network (NCCN) risk group, TTT (defined as the time between initial positive prostate biopsy and start of RT) was analyzed in 4 intervals: < 3, 3-6, 6-9, and 9-24 months. We recorded the use of androgen deprivation therapy among patients with intermediate-risk and high-risk disease. RESULTS: The median TTT was 3.3 months (range, 0.6-23.5 months), and it was similar for each risk group (range, 3.3-3.4 months). The median follow up was 64 months. There were no significant differences in biochemical failure, distant metastasis, or overall survival for patients with TTT < 3, 3-6, 6-9, or 9-24 months for each risk group. There were also no significant differences in the outcomes at 5 years when patients with TTT > 3.3 months were compared with those with TTT ≤ 3.3 months for each risk group. For high-risk men, 328 of 450 (72.9%) with TTT > 3.3 months were on androgen deprivation therapy (ADT) versus 299 of 453 (66%) with TTT ≤ 3.3 months. Among men with high-risk cancer treated without ADT, there remained no significant difference in outcomes between TTT > 3.3 months and TTT ≤ 3.3 months. CONCLUSION: TTT was not associated with significant differences in outcomes among each risk group of men with localized prostate cancer treated with EBRT. Among the high-risk patients, there were no observed detriments in outcomes with TTT > 3.3 months regardless of androgen deprivation therapy use.
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Antígeno Prostático Específico/metabolismo , Neoplasias da Próstata/radioterapia , Radioterapia Conformacional/métodos , Idoso , Antagonistas de Androgênios/uso terapêutico , Intervalo Livre de Doença , Humanos , Masculino , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/metabolismo , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada , Estudos Retrospectivos , Análise de Sobrevida , Tempo para o Tratamento , Resultado do TratamentoRESUMO
OBJECTIVE: To examine the utilization of radiation therapy (RT) in patients with renal cell carcinoma (RCC) using a large national tumor registry. MATERIALS AND METHODS: Patients diagnosed with RCC were identified using the National Cancer Data Base. Our primary objective was to assess temporal trends in the utilization of RT. Our secondary objective was to identify patient and treatment factors associated with receipt of RT. The Cochran-Armitage test was used for trend analysis. Multivariable logistic regression was performed to identify factors associated with RT use. RESULTS: A total of 279,427 patients were diagnosed with RCC from 1998 to 2010. A total of 233,572 (83.6%) had localized or locally advanced disease, whereas the remaining 45,855 (16.4%) had metastatic disease. There was a decrease in radiotherapy across all patients during this period (1.5%-0.6%, P <.001); as salvage or adjuvant therapy with surgery (1.3%-0.3%, P <.001), and in patients with metastatic disease (33.3%-28.5%, P <.001). Factors associated with increased RT use in patients with nonmetastatic RCC included male gender, receipt of systemic therapy, higher stage, higher grade, nonacademic treatment facility, facility location, and sarcomatoid or other histology. CONCLUSION: In the National Cancer Data Base, we observed a decrease in the use of RT for patients with RCC from 1998 to 2010. Patients with more aggressive disease characteristics were more likely to receive RT. Well-designed clinical trials are needed to clarify the role of RT in the management of these patients.
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Carcinoma de Células Renais/radioterapia , Neoplasias Renais/patologia , Neoplasias Renais/radioterapia , Idoso , Antineoplásicos/uso terapêutico , Carcinoma de Células Renais/secundário , Carcinoma de Células Renais/terapia , Feminino , Humanos , Neoplasias Renais/terapia , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Radioterapia/estatística & dados numéricos , Radioterapia/tendências , Radioterapia Adjuvante/estatística & dados numéricos , Sistema de Registros , Terapia de Salvação , Fatores Sexuais , Estados UnidosRESUMO
OBJECTIVE: To examine relative contributions of functional parenchymal preservation and renal ischemia following nephron-sparing surgery (NSS). While residual functional parenchymal volume (FPV) is proposed as the key factor in predicting functional outcomes following NSS, efforts to curtail ischemia time continue to add technical complexity to partial nephrectomy. METHODS: Our kidney cancer database was queried for patients who underwent NSS with warm ischemia time (WIT). Patients with cross-sectional imaging for FPV calculation were included. Cylindrical volume approximation methodology was used to calculate FPV, accounting for the volume of tumor's endophytic component. Percent estimated glomerular filtration rate (eGFR) preservation, perioperatively and at 6 months, was the outcome metric. Spearman correlation and linear regression analyses were used to evaluate associations of WIT and %FPV preservation with renal function preservation. RESULTS: Of the 179 patients included, median preoperative eGFR was 88.4 (9.5% chronic kidney disease III or IV), tumor size was 2.7 cm (interquartile range [IQR] 2.0-3.6 cm), and R.E.N.A.L. nephrometry was low in 34%, intermediate in 57%, and high in 9%. Median WIT was 30 minutes (IQR 24-36), resulting in 97.4% FPV preservation. Median postoperative eGFR at 6.4 months was 80.5 (19.1% chronic kidney disease III or IV), a median of 93.1% eGFR preservation (IQR 85.1-101.7). At discharge, WIT (P <.001), not %FPV (P = .112), was associated with %eGFR preservation. However, 6 months following surgery, on multivariable analysis, both preoperative eGFR (linear regression coefficient = -0.208, P = .006) and %FPV preservation (linear regression coefficient = 0.491, P = .001), but not WIT (P = .946), demonstrated statistically significant association with %eGFR preservation. CONCLUSION: Residual FPV, and not WIT, appears to be the main predictor of ultimate renal function following NSS.