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PurposeTo calculate the overall incidence of uveal melanoma in Germany and to compare incidences in different German states. In addition, we computed the overall and cancer-specific survival rates nationwide.MethodsIncidence data for the period between 2009 and 2015, covering the entire German population, was collected through the German Center for Cancer Registry. ICD-O-3 topography codes C69.3-C69.4 and histology codes for melanoma subtypes were used to collect the incidence data. Confidence Intervals with a level of 95% (95% CI) were calculated for rates. Survival was calculated using the Kaplan–Meier. The log-rank test was used for survival comparisons.ResultsThis study comprised 3654 patients with uveal melanomas, including 467 (12.8%) with iridial and ciliary body tumors. The overall age-standardized incidence rate (ASIR) was 6.41 person per million. Generally, the ASIR was higher in males than females (6.67 (95% CI 6.37–6.98) vs. 6.16 (95% CI 5.88–6.45 per million). Higher crude incidence rates were noted in the northeastern states (12.5 per million (95% CI 10.5–14.7) in Mecklenburg-Vorpommern) compared with the southwestern states (2.1 per million (95% CI 1.7–2.6) in Hessen). The 5-year overall survival stood at 47%, while the cancer-specific survival stood at 84%. Multivariate analysis showed that women, younger patients, and patients living in Berlin achieved significantly higher overall survival.ConclusionOverall ASIR of uveal melanoma in Germany indicates that the disease is more common in males and that it follows the same geographical distribution previously noted in central European countries, with the highest incidence in northern parts of Germany.

Background Transitional cell carcinoma (TCC) accounts for around 95% of bladder cancers and is the 4th most common cancer among men and the tenth most common in women, in the US. There is a constant need to clarify current TCC incidence and mortality rates among different population groups for better clinical practice guidelines. We aimed to describe the TCC incidence and incidence-based mortality by demographic and tumor-related characteristics over the last 40 years in the US. Methods We obtained data from the SEER 18 registries to study TCC cases that were diagnosed between the years 1973 and 2014. We calculated incidence rates and incidence-based mortality rates in different demographic and tumor-related characteristics and expressed rates by 100,000 person-years. We then calculated the annual changes in incidence and incidence-based mortality rates and displayed them as annual percent changes (APCs). Results There were 182,114 patients with TCC between 1973 and 2014 in the United States. Overall incidence rates of TCC increased 0.16% (95% CI, 0.02–0.30, p  = .02) per year over the study period. However, the incidence declined significantly since 2007; (95%CI,-1.89- -0.77, p  < .001), except among the elderly and African Americans, which increased significantly over the study period. Overall TCC mortality rates did not change over the study period. However, since 2000 it started to decrease significantly. Conclusion TCC incidence and incidence-based mortality rates had been showing significant increases over the previous decades. However, significant declines in both incidence and incidence-based mortality rates have been observed over the recent years, except in some patients with certain racial groups. Improved understanding of the etiological and ecological factors of TCC could lead to further declines in incidence and incidence-based mortality rates.

Background Pancreatic cancer is the fourth-leading cause of cancer deaths in the United States. The silent nature of the disease and its poor prognosis, the need for further research, along with the need to assess the outcomes of current approaches necessitate an ongoing evaluation of the epidemiology and mortality-trends of this malignancy. Continuous monitoring of disease-patterns, on population-levels, may help scientists assess the quality of healthcare delivery, boost their understanding of diseases' characteristics and risk factors, and detect gaps whereby further research is needed. None of the previous reports shed light on pancreatic adenocarcinomas (PAC), the most common type of Pancreatic Cancer, as the primary outcome. In this study we aim to investigate PAC’s incidence and mortality trends over the last four decades in the United States. Methods We used SEER 9 database to study PAC cases during 1974-2014. Incidence and mortality rates were calculated by sex, age, race, state and stage of PAC. Annual percent change (APC) was calculated using joinpoint regression software. Results We reviewed 67,878 PAC cases; most of these cases were in the head of pancreas. Overall PAC incidence rates increased 1.03% (95% CI, 0.86-1.21, p <.001) per year over the study period. Rates of adenocarcinoma of the head of pancreas increased 0.87% (95% CI, 0.68-1.07, p <.001), and rates of adenocarcinoma of the body and tail of pancreas increased 3.42% (95% CI, 3.06-3.79, p <.001) per year during 1973-2014. PAC incidence-based mortality increased 2.22% (95% CI, 1.93-2.51, p <.001) per year. However, during 2012-2014 there was a statistically significant decrease in PAC incidence-based mortality; APC, -24.70% (95% CI, -31.78 - -16.88, p <.001). Conclusion PAC’s incidence and mortality rates have been increasing for decades. However, the last few years have shown a promising decrease in mortality. We believe that further advances in healthcare delivery and research can lead to a further mortality decrease. Future studies can use this paper as a baseline to keep monitoring the outcomes of PAC's therapy.

Owing to improved survival among US patients with prostate cancer (PC), patients tend to live long enough after a PC diagnosis for non-cancer-related comorbidities to be associated with their overall survival. Although studies have investigated causes of death among patients with localized PC, data are lacking regarding causes of death among patients with metastatic PC. To assess causes of death among US patients with metastatic PC from 2000 to 2016. This retrospective cohort study used data from the Surveillance, Epidemiology, and End Results Program database to analyze a sample of 26 168 US men who received a diagnosis of metastatic PC from January 1, 2000, to December 31, 2016. Data were analyzed from February 2 to July 28, 2020. Diagnosis of metastatic PC. Standardized mortality ratios (SMRs) for different causes of death were calculated by dividing the observed number of deaths from each cause of death by the expected number of deaths in the age-matched US male population for the same period, adjusting for age and race/ethnicity. Of 26 168 patients with metastatic PC included in the analysis, 48.9% were aged 50 to 70 years (mean age at diagnosis, 70.83 years); 74.5% were White individuals, and 72.7% received a diagnosis of stage M1b metastatic PC. A total of 16 732 patients (63.9%) died during the follow-up period. The mean age at death was 74.13 years. Most deaths (59.0%) occurred within the latency period of 2 years after diagnosis of metastatic PC, whereas 31.6% occurred 2 to 5 years after diagnosis and 9.4% occurred more than 5 years after diagnosis. Of the total deaths, 13 011 (77.8%) were from PC, 924 (5.5%) were from other cancers, and 2797 (16.7%) were from noncancer causes. During all latency periods, the most common noncancer causes of death were cardiovascular diseases (SMR, 1.34; 95% CI, 1.26-1.42), chronic obstructive pulmonary disease (SMR, 1.19; 95% CI, 1.03-1.36), and cerebrovascular diseases (SMR, 1.31; 95% CI, 1.13-1.50). In this cohort study, deaths from noncancer causes, including cardiovascular disease, constituted a substantial number of deaths among men with metastatic PC. Therapy and follow-up should be tailored to the needs of each patient with metastatic PC, and counseling regarding future health risks should be provided.

ObjectiveCalcium metabolism has long been implicated in aortic stenosis (AS). Studies assessing the long-term safety of oral calcium and/or vitamin D in AS are scarce yet imperative given the rising use among an elderly population prone to deficiency. We sought to identify the associations between supplemental calcium and vitamin D with mortality and progression of AS.MethodsIn this retrospective longitudinal study, patients aged ≥60 years with mild-moderate native AS were selected from the Cleveland Clinic Echocardiography Database from 2008 to 2016 and followed until 2018. Groups were stratified into no supplementation, supplementation with vitamin D alone and supplementation with calcium±vitamin D. The primary outcomes were mortality (all-cause, cardiovascular (CV) and non-CV) and aortic valve replacement (AVR), and the secondary outcome was AS progression by aortic valve area and peak/mean gradients.ResultsOf 2657 patients (mean age 74 years, 42% women) followed over a median duration of 69 months, 1292 (49%) did not supplement, 332 (12%) took vitamin D alone and 1033 (39%) supplemented with calcium±vitamin D. Calcium±vitamin D supplementation was associated with a significantly higher risk of all-cause mortality (absolute rate (AR)=43.0/1000 person-years; HR=1.31, 95% CI (1.07 to 1.62); p=0.009), CV mortality (AR=13.7/1000 person-years; HR=2.0, 95% CI (1.31 to 3.07); p=0.001) and AVR (AR=88.2/1000 person-years; HR=1.48, 95% CI (1.24 to 1.78); p<0.001). Any supplementation was not associated with longitudinal change in AS parameters in a linear mixed-effects model.ConclusionsSupplemental calcium with or without vitamin D is associated with lower survival and greater AVR in elderly patients with mild-moderate AS.

Background Most clinical trials on colorectal cancer (CRC) exclude cases who have history of a prior malignancy. However, no prior research studied this history’s actual impact on the survival of CRC. In the paper, we study the effects of having a malignancy preceding CRC diagnosis on its survival outcomes. Methods CRC patients diagnosed during 1973–2008 were reviewed using the SEER 18 database. We calculated overall survival and cancer-specific survival of subsequent CRC, and more specifically stage IV CRC, using Kaplan-Meier test and adjusted Cox models. Results A total 550,325 CRC patients were reviewed, of whom 31,663 had history of a prior malignancy. The most commonly reported sites of a prior malignancy were: prostate, breast, urinary bladder, lung, and endometrium. Patients with history of a prior non-leukemic malignancy or history of a prior leukemia were found to have worse overall survival (HR = 1.165 95%CI = 1.148–1.183, P  < 0.001) and (HR = 1.825 95%CI = 1.691–1.970, P  < 0.001), respectively. However, CRC patients with history of a prior non-leukemic malignancy showed an improved colorectal cancer-specific survival (HR = .930 95%CI = .909–.952, P  < 0.001). Analysis of stage IV CRC patients showed that patients with history of any non-leukemic malignancy did not have a significant change in overall survival. Whereas, patients with a prior leukemia showed a worse overall survival (HR = 1.535, 95%CI = 1.303–1.809, P  < 0.001). When analyzed separately, right CRC and left CRC showed similar survival patterns. Conclusion A prior malignancy before CRC -in general- can be associated with worse clinical survival outcomes. These worse outcomes are not observed in stage IV CRC. Considering these results when including/excluding stage IV CRC patients with prior malignancies in clinical trials may play help improve their generalizability.

In the Sentinel trial, the largest randomized trial (n = 363) so far, the device was successfully deployed in 94.7% of patients.2 At our institution, the Sentinel device has been applied routinely for all transfemoral (TF)-TAVRs since 2018. Because available real-world data lack clarity with regard to the reasons for failure to successfully deploy the device, we aimed to investigate the feasibility of Sentinel device deployment and further clarify the reasons for infeasible deployment. Because procedural stroke after TAVR is largely unpredictable due to the absence of established predictors,6–8 all patients, including those with higher STS-PROM, should be considered for the use of the Sentinel device. Sentinel cerebral embolic protection device Deployed Not deployed n = 1,633 n = 93 p Value Age, years, mean±SD 78.5±9.3 78.6±10.4 0.85 Female 655 (40.1%) 55 (59.1%) <0.001 Body mass index, kg/m2, mean±SD 29.1±6.7 29.5±7.4 0.62 STS-PROM, %, median (IQR) 4.4 (2.9–7.0) 6.5 (4.6–9.8) <0.001 Prior PPM/ICD implantation 230 (14.1%) 13 (14.0%) 1.00 Prior coronary artery bypass grafting 388 (23.8%) 24 (25.8%) 0.62 Prior percutaneous coronary intervention 501 (30.7%) 30 (32.3%) 0.73 Prior myocardial infarction 334 (20.5%) 15 (16.1%) 0.35 Prior stroke 202 (12.4%) 13 (14.0%) 0.63 History of atrial fibrillation/flutter 707 (43.3%) 43 (46.2%) 0.59 Carotid artery disease 305 (18.7%) 19 (20.4%) 0.68 Hypertension 1,461 (89.5%) 82 (88.2%) 0.73 Diabetes mellitus 606 (37.1%) 35 (37.6%) 0.91 Current or recent (<1 y) smoker 61 (3.7%) 4 (4.3%) 0.78 End-stage renal disease on dialysis 45 (2.8%) 7 (7.5%) 0.019 Porcelain aorta 20 (1.2%) 0 (0%) 0.62 Table 1 Comparison of patient characteristics between patients with and without deployment of Sentinel cerebral embolic protection

INTRODUCTION:Acute pancreatitis (AP) is a well-recognized and generally serious complication following liver transplantation. We sought to assess AP following adult liver transplantation to describe the risk factors, natural history of the disease and outcomes.METHODS:Data from Nationwide Readmission database from 2010 to 2015 was analyzed. All adult patients who were hospitalized for a primary diagnosis of acute pancreatitis were identified and patients who had a history of liver transplantation were compared to patients with no transplantation, using the appropriate ICD 9 codes. Continuous variables were expressed as means ± standard deviation or median (IQR), and categorical variables were expressed as percentages. All statistical tests were two-sided.RESULTS:1,575,148 AP patients were included, and out of those 1581 patients (0.1%) had a history of liver transplantation. Patients with a history of transplantation had higher rates of hypertension 59.1% vs. 53.8%, P-value < 0.001, uncomplicated diabetes mellitus, 32.6% vs. 22.9%, P-value < 0.001, diabetes mellitus with chronic complications, 5.8% vs. 3.8%, P-value < 0.001, chronic pancreatitis, 18.2% vs. 16.1%, P-value = 0.02, chronic renal failure 39.6% vs. 7.9%, P-value < 0.001. Transplant patients had higher rates of in-hospital AP complications: acute kidney injury 20.3% vs. 8.3%, P-value < 0.001, transfusion requirement 7.2% vs. 3.0%, P-value < 0.001. No significant difference in the rates of systemic inflammatory response syndrome (SIRS), 2.1% vs. 2.1%, P-value = 0.929, or ileus, 4.0% vs. 3.7%, P-value = 0.595. Transplant patients had lower rates of acute respiratory distress syndrome and/or ventilation need, 0.6% vs. 2.3%, P-value < 0.001, and sepsis 0.5% vs. 1.6%, P-value < 0.001. In-hospital mortality was higher in patients with history of liver transplantation 0.8%vs. 0.3%, P-value = 0.053. Median length of stay was not significantly different 3.00 (2–6) days vs. 3.00 (2–5), P-value = 0.17. Charges of hospitalization were significantly higher in the transplantation group 23,615 USD vs. 21,020 USD, P-value < 0.001.CONCLUSION:Post-liver transplant AP carries significant morbidity and mortality. The extensive nature of the anatomical dissection around the pancreas, the type of biliary reconstruction and anastomosis, chronic immunosuppression medications, associated comorbidities, could be contributing factors. Our study highlights possible areas for further investigation in the liver transplant population.

INTRODUCTION:Cirrhosis affects the outcome of non–liver-related illnesses requiring hospitalization, but its impact on acute pancreatitis (AP) patients requiring hospitalization has not yet been studied. We aim to investigate the prevalence of cirrhosis among AP patients and outcomes of mortality, morbidity and cost.METHODS:Data from Nationwide Readmission database from 2010 to 2015 was analyzed. All adult patients who were hospitalized for a primary diagnosis of acute pancreatitis were identified and patients who had a history of cirrhosis were compared to patients with no cirrhosis, using the appropriate ICD 9 codes. Continuous variables were expressed as means ± standard deviation or median (IQR), and categorical variables were expressed as percentages. All statistical tests were two-sided.RESULTS:A total of 1,575,148 patients were admitted for AP were included in this cohort, and out of those 46,904 patients (3.0%) had a history of cirrhosis. Patients in the cirrhosis group were significantly older, mean age 53.42 ± 11.885 vs. 51.55 ± 17.627 years, P-value < 0.001, mostly males 62.0% vs. 52.3%, P-value < 0.001, and admitted emergently, 97.0% vs. 95.5%, P-value < 0.001. Alcohol abuse was more common among cirrhosis patients 69.1% vs. 28.7%, P-value < 0.001 as well as drug abuse, 12.1% vs. 6.7%, P-value < 0.001. Cirrhosis patients had higher rates of in-hospital AP complications: acute kidney injury 11.7% vs. 8.2%, P-value < 0.001, pneumonia 3.6% vs. 2.8%, P-value < 0.001, acute respiratory distress syndrome and/or ventilation need, 3.0% vs. 2.2%, P-value < 0.001, transfusion requirement 8.9% vs. 2.8%, P-value < 0.001, sepsis, 2.1% vs. 1.6%, P-value < 0.001. SIRS: no difference. In-hospital mortality was higher in patients with cirrhosis 1.8% vs. 0.8%, P-value < 0.001. Median length of stay (LOS) was not significantly different 4.00 (2–6) days vs. 4.00 (2–6), P-value = 0.751. Charges of hospitalization were significantly higher in the cirrhosis group 24,819 USD vs. 20,918 USD, P-value < 0.001.CONCLUSION:Acute pancreatitis patients with liver cirrhosis have higher mortality, possibly related to cirrhosis-related comorbidities (sepsis, AKI, GI bleed/transfusion requirement, and ARDS) and not due to AP. Interestingly, they had lower prevalence of SIRS and LOS was not different.