Background
Patients with lower socioeconomic status (SES), ethnic minorities and elevated neutrophil–lymphocyte ratio (NLR) have been suggested to have worse outcomes in hepatocellular carcinoma ...(HCC). However, how changes in NLR after intervention relate to survival has not been elucidated.
Objectives
We evaluated the association of NLR with overall survival (OS) and progression-free survival (PFS) in a large institutional cohort of HCC.
Methods
We reviewed all patients diagnosed with HCC between 2005–2016. The association between elevated NLR (> 4) and survival was examined with univariable and multivariable Cox regression.
Results
We identified 991 patients diagnosed with HCC. Lower SES and Hispanic and non-Hispanic Black ethnicity were significantly associated with lower NLR (
p
= 0.015 and 0.019, respectively). Elevated NLR, but not SES or ethnicity, was an independent predictor of worse OS (HR = 1.66,
p
< 0.001) and PFS (HR = 1.25,
p
= 0.032). The median OS in patients with elevated NLR was 8 months, compared to 42 months in patients with normal NLR. Patients with elevated NLR unresponsive to treatment and those with NLR that became elevated after treatment had significantly worse 3-year OS (47% and 44%, respectively), compared to patients whose NLR remained normal or normalized after treatment (72% and 80%, respectively;
p
< 0.01).
Conclusions
Our study showed that elevated NLR, but not SES or ethnicity, is an independent prognostic marker for OS and PFS in patients with HCC. NLR trends following intervention were highly predictive of outcome. NLR is easy to obtain and would provide valuable information to clinicians in evaluating prognosis and monitoring response after procedures.
Abstract We aimed to investigate the impact of the new kidney allocation system (KAS) on the rate of transplantation of sensitized patients at our center. Pre-KAS and post-KAS intervals were Jan 1st ...to Dec 3rd 2014 and Jan 1st 2015 to Dec 3rd 2015, respectively. The number of deceased-donor crossmatches performed by flow cytometry increased from 715 pre-KAS to 1188 post-KAS. The percent of crossmatches performed for sensitized patients with calculated panel reactive antibody (cPRA) >0% increased from 19% pre-KAS to 26% post-KAS (p<0.0001). The number of deceased-donor kidney transplants performed at our center increased from 115 pre-KAS to 125 post-KAS (9% increase). There was a significant increase in the percentage of deceased-donor kidney transplants received by sensitized candidates (from 14% to 26% pre- and post-KAS, respectively; p<0.0001). The highest increase was seen in the patients with cPRA>98%, from 0% to 9%, followed by the group with cPRA 50-79%, from 5% to 8%. This increase was balanced by a decrease of 12% in the percentage of non-sensitized recipients, and a modest decrease of 1% in the group with cPRA 1-49%. In conclusion, transplant rate has increased in sensitized patients after KAS. The highest increase was observed among highly sensitized patients (cPRA>98%).
Background:
Transplant recipients are susceptible to cardiovascular complications, obesity, and increased insulin resistance after transplant. Here we assess weight gain in diabetic recipients after ...pancreas transplantation.
Methods:
This is a single-center study of 32 simultaneous pancreas and kidney and 5 pancreas after kidney transplant recipients from 2014 to 2018. Starting C-peptide levels ≤ 0.1 ng/mL were used to denote insulin nondetectability (n = 25) and C-peptide levels > 0.1 ng/mL as insulin detectability (n = 12). Hemoglobin A1c, body mass index (BMI), and weight following transplantation were assessed.
Results:
Hemoglobin A1c at 1 year was 5.9% in the insulin nondetectable recipients and 5.6% in the insulin detectable group (P = .56). Average BMI after transplant was higher in the insulin detectable group 28.6 versus 24.4 kg/m2 (P = .03) despite no difference in starting BMIs (24.9 versus 24.0 kg/m2, P = .42). The insulin detectable group also had a larger percentage weight change from their starting weight 13.1% versus 0.9 % at 1 year (P = .02). Linear regression demonstrated that starting C-peptide was a significant predictor of weight gain posttransplant.
Conclusions:
Patients with elevated C-peptides at time of transplant are susceptible to rapid weight gain postoperatively. These patients may benefit from aggressive nutritional management.
No prior studies have shown that pre‐operative loco‐regional therapy for hepatocellular carcinoma (HCC) improves survival following orthotopic liver transplantation (OLT). We performed subgroup ...analyses according to pathologic HCC stage among 168 patients who underwent OLT to test the hypothesis that pre‐operative loco‐regional therapy confers a survival advantage in a subgroup at intermediate risk for HCC recurrence. Patients with pathologic T3 HCC meeting the proposed UCSF expanded criteria (single lesion not exceeding 6.5 cm or two to three lesions none > 4.5 cm with total tumor diameter within 8 cm) had a similar 5‐year recurrence‐free survival as patients with pathologic T2 HCC (88.5% vs. 93.8%; p = 0.56). In the subgroup with pathologic T2 or T3 HCC, the 5‐year recurrence‐free survival was 93.8% for the 85 patients who received pre‐operative loco‐regional therapy, versus 80.6% for the other 41 patients without treatment (p = 0.049). The treatment benefit, according to 5‐year recurrence‐free survival, appeared greater for pathologic T3 (85.9% vs. 51.4%; p = 0.05) than T2 HCC (96.4% versus 87.1%; p = 0.12). In conclusion, although the lack of a randomized controlled design precludes drawing firm conclusions, our results suggest that pre‐operative loco‐regional therapy may confer a survival benefit after OLT in the subgroup with pathologic T2 and T3 HCC.
Abstract We investigated the prevalence and the strength of anti-HLA-Cw and DP antibodies and clinical outcomes in kidney transplant recipients with isolated donor-specific anti-HLA-Cw antibodies. ...Patients on the waiting list were screened by Luminex single antigen beads (One Lambda). The strength of antibodies was determined by mean fluorescence intensity (MFI) values of the beads. Of the 1069 patients on the waiting list, 251 (24%) were sensitized with calculated panel reactive antibody >0%. The frequency and the median MFI values of anti-HLA antibodies to Cw (56%, 4955) and DP (35%, 2945) were lower than anti-HLA-A (79%, 10,194), B (86%, 11,235), DR (66%, 7866) and DQ (69%, 8283) ( p <0.01). Among three major sensitizing events, only previous transplant was associated with development of all anti-HLA antibodies and history of pregnancy was associated only with development of anti-HLA-A antibodies. Eight patients with donor-specific anti-HLA-Cw antibodies received transplantation. During a median 6 months of follow-up (range 3–24 months), patient and graft survival was 100% without any acute rejection. In summary, the prevalence and the strength of anti-HLA-Cw and HLA-DP were lower compared to anti-HLA-A, B, DR, and DQ antibodies and previous organ transplantation was the main sensitizing event in our cohort of patients.
Abstract The incidence of hepatocellular cancer (HCC) in the Bronx is 61% higher than the rest of New York State. Underserved populations are not well represented in clinical trials of immune ...checkpoint inhibitors. The purpose of this study is to analyze the efficacy of immunotherapy treatment in a diverse and underserved patient population in the Bronx. Study demographics include 194 patients treated with ICI at the Montefiore Einstein Comprehensive Cancer Center (MECCC) between 2017 and 2022. A retrospective electronic medical record (EMR) review was conducted of all adult patients and this sample size was identified as having advanced HCC treated with immunotherapy. Outcome parameters such as overall survival and disease control rate assessed by radiologists using the Modified Response Evaluation Criteria in Solid Tumors (mRECIST 1.1) were reported. Survival was evaluated using parameters such as baseline serum alpha-fetaprotein(AFP) level, its evolution at the 3-month re-evaluation mark, the Child-Pugh(CP) class and MELD-Na score at the time of diagnosis. Categorical variables were analyzed by Chi-squared test and survival was analyzed using Kaplan-Meier (KM) curves. MECCC patients were 40.7% Hispanic and 20.6% Black, compared with 3% and 2% respectively in the landmark IMbrave 150 study. Median overall survival (mOS) on ICI was 9.0 months, 25.0 months for the 100 (51.5%) favorable-prognosis Child Pugh A (CPA) patients included in HCC clinical trials. Disease control rate (DCR) was 58.5% among 123 evaluable patients per mRECIST 1.1. Baseline liver function, as defined by CP and Model for End Stage Liver Disease-Sodium (MELD-Na), correlated with survival (p<0.001). Hepatitis C Virus (HCV) and alcoholism were over-represented relative to National Cancer Institute (NCI) data (56.2% vs 4.7% and 38.7% vs 8.2%, respectively). HCV treatment correlated with prolonged survival in infected patients (p=0.0017). AFP decline correlated with response (p=0.001). Hispanic patients lived longer when clinical variables were controlled for (mOS 52 vs 23 months; p=0.011). In summary, our patient population differed significantly in racial composition and etiology of liver disease from clinical trial populations on which ICI was tested. In an underserved HCC population, ICI yielded a DCR of 58.5% and low rates of severe toxicity. This work highlights ICI efficacy in minority groups, a need for earlier HCC diagnosis and for studies of genetics and environmental factors in Hispanics with HCC. Citation Format: Fernand Bteich, Lydia Bioh, Kush Desai, Chenxin Zhang, Anahat Kaur, Rahel A. Levy, Aaron Wang, Sharmin Sultana, Andreas Kaubisch, Milan M. Kinkhabwala, Sarah Bellemare, Shabnam A. Fidvi, Devaraju Kanmaniraja, Robert G. Berkenblit, Jee-Young Moon, Adebola A. Adedimeji, Clara Y. Tow, Yvonne M. Saenger. Immunotherapy efficacy in advanced hepatocellular carcinoma in a diverse and underserved population in the United States abstract. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3722.
Current opinions in organ allocation
American journal of transplantation,
November 2018, 2018-11-00, 20181101, Letnik:
18, Številka:
11
Journal Article
Recenzirano
Odprti dostop
Existing methods of academic publication provide limited opportunity to obtain stakeholder input on issues of broad interest. This article reports the results of an experiment to produce a ...collaborative, crowdsourced article examining a current controversial issue in transplant medicine (hereby referred to as the “C4 Article”). The editorial team as a whole selected the topic of organ allocation, then divided into six sections, each supported by an individual editorial team. Widely promoted by the American Journal of Transplantation, the C4 Article was open for public comment for 1 month. The nonblinded editorial teams reviewed the contributions daily and interacted with contributors in near–real time to clarify and expand on the content received. Draft summaries of each section were posted and subsequently revised as new contributions were received. One hundred ninety‐four individuals viewed the manuscript, and 107 individuals contributed to the manuscript during the submission period. The article engaged the international transplant community in producing a contemporary delineation of issues of agreement and controversy related to organ allocation and identified opportunities for new policy development. This initial experience successfully demonstrated the potential of a crowdsourced academic manuscript to advance a broad‐based understanding of a complex issue.
The C4 Article editorial team provides an executive summary after authors throughout the transplantation field contributed to the C4 Article on the topic of organ allocation. See Kirk's comments on this article on page 2619
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