We herewith report 2 unusual cases of spontaneous peritoneal dialysis (PD) catheter fracture in intramural and intra-abdominal segments, respectively, in PD patients with long vintage. There were no associated infections or mechanical trauma. The patients presented with PD catheter outflow failure. Both the patients had their catheter replaced and resumed PD without any further issues. Probable causes and comparison with the reported cases are discussed.
e23557 Background: Leiomyosarcomas, are aggressive sarcomas with survival rates among the lowest of all soft tissue sarcomas. Patients with uterine leiomyosarcoma (ULMS) have worse overall survival (OS) than those with extra-uterine leiomyosarcoma (EULMS). The effect of several clinical factors on OS have been investigated, including age, tumor size, grade, stage, and use of chemotherapy. Looking at the epigenetics of the 2 diseases, differentially methylated regions (DMRs) were statistically significant between the 2 groups. Methods: The 2004-2016 National Cancer Database was queried for females with ULMS and EULMS. We investigated several factors as predictors of binary survival status (alive or dead): patient’s age, race, year at diagnosis, tumor grade, size and stage, receipt of surgical treatment, chemotherapy, palliative care, surgical margins and time to treatment in days. Univariate and backward stepwise multivariate logistic regression models were used to determine prognostic factors associated with survival in each group. Kaplan-Meier (KM) method with log-rank test was used to compare OS rates between the 2 groups. All analyses were conducted using Stata/SE 15.1. Results: The total number of subjects was 16883. The median OS was 36.7 months in ULMS vs 57.2 in EULMS (P < 0.001). Older age was associated with a lower likelihood of survival in both groups (OR = 0.95, P = 0.018 in ULMS; OR = 0.97, P < 0.001 in EULMS). Lymphovascular invasion and receipt of palliative care were associated with a relatively large decrease in survival in ULMS only (OR = 0.25, P < 0.001; OR = 0.13, P = 0.015 respectively). In the EULMS group, increased likelihood of survival was associated with later years of diagnosis (OR = 1.27; P < 0.001). Larger tumor size (OR = 0.39; P = 0.001), stages II-IV or unstageable disease (OR = 0.56; P < 0.001), positive surgical margins or margins that were unevaluable (OR = 0.87; P = 0.009) and receipt of systemic therapy (OR = 0.85; P = 0.016) were associated with a lower likelihood of survival. Conclusions: Our study reiterated that females with ULMS had worse OS than those with EULMS. this difference can be attributed to certain clinical risk factors, however, it may also be secondary to genetic and epigenetic factors. Surprisingly, the use of palliative care in this study was associated with poorer OS in the EULMS group. Further studies are needed to investigate the genetic map of these diseases and highlight certain potentially targetable prognostic and predictive factors. Study limitations: Our study did not stratify ULMS and EULMS according to the stage to examine if the aforementioned factors would still be relevant in the limited versus metastatic setting.
e17562 Background: Leiomyosarcomas (LMS) are one of the most frequently occurring subtypes of soft tissue sarcomas and are associated with poor prognosis and high risk of recurrence even in the early stages of the disease. Primary management involves surgical excision followed by chemotherapy for all stages. We sought to determine the prognostic factors on associated with leiomyosarcoma survival. Methods: The National Cancer Database from 2004-2016 was utilized to obtain demographics, tumor characteristics and treatment factors of LMS. LMS was divided into three groups for analysis- women with uterine LMS, women with ex-uterine LMS and men with LMS. Univariate and backward stepwise multivariate logistic regression models were used to determine prognostic factors associated with long-term survival in each group. Kaplan-Meier method with log rank test was used to compare overall survival (OS) rates among the three groups. Results: A total of 23194 patients were identified. Only 18.7% of men with LMS utilized chemotherapy as compared to 47.4% women with uterine and 25.0% with ex-uterine LMS. Both men and women had comparable palliative care use- 3.9% in women with uterine LMS, 3.5% in women with ex-uterine LMS and 3.0% in men with LMS. There were statistically significant differences (P=0.000) between overall survival among the three groups. Median OS was highest among men with LMS (72m) followed by women with ex-uterine LMS (57.2m) and women with uterine LMS (36.7 m). On multivariate analysis, in women with uterine LMS, increasing age (OR =0.95, P=0.018), presence of lymphovascular invasion (OR=0.25, P=0.000) were associated with decrease in the likelihood of survival. In women with ex-uterine LMS, increasing age (OR=0.97, P=0.000), increasing stage (I-IV) (OR=0.56, P=0.000), presence of tumor (OR=0.39, P=0.001), those with residual tumor and surgical margins (OR=0.87, P=0.009), and patients who received systemic therapy and surgery (OR= 0.85, P=.0016) had a reduced likelihood of survival. In men with LMS, factors such as increasing age (OR=0.96, P=0.000), increasing number of regional lymph nodes (OR=0.91, P=0.027), having had a surgical diagnostic or staging procedure (OR= 0.69, P=0.004), increasing stage (OR = 0.64, P=0.005), and residual tumor or margins (OR=-0.76, P=0.013) were associated with reduced likelihood of survival. Results also suggest that increasing year of diagnosis was associated with an increased likelihood of survival (OR=1.51; P=0.000). Conclusions: Women were found to comprise almost two third of the patient population with LMS. Men were found to have longer survival than women with LMS, despite low utilization of chemotherapy. It may be due to poor prognosis of LMS in the female reproductive organs while LMS in the extremities has better prognosis. Future prospective trials should stratify based on sex and in women location.
e23547 Background: The effect of gender in sarcoma patients in various organ systems has been the subject of several studies, many of which show no overall survival (OS) difference between male and female genders. Tumor size and grade have been noted to be independent predictors of local recurrence and disease specific survival in a prospective study of patients with non-uterine leiomyosarcoma by Gaddy et. al. however, gender had no effect on OS. Methods: The 2004-2016 National Cancer Database (NCDB) was queried for males with leiomyosarcoma (LMS) and females with extrauterine leiomyosarcoma (EULMS) using topographical codes C490-C496, and C498-C499. Data included: patient’s age, race, year at diagnosis, tumor grade, size and stage, lymph node involvement, receipt of surgical treatment, chemotherapy or palliative care treatment, surgical margins, time to treatment in days, OS (months between the date of diagnosis and date of death or censored at last contact), and long-term survival defined as survival for 60 months or more. Univariate analysis was used to determine significant predictors of binary survival status (i.e. alive or dead), significant factors were then included in a multivariate analysis. Using Stata/SE 15.1, Kaplan-Meier (KM) method with log-rank test was used to compare and estimate OS rates between the 2 groups. Results: The total number of patients was 13537, with 6311 males (46.6%) and 7226 females (53.4%). The OS in females was 57.2 months compared to 72.0 months in males (P < 0.001). Men were also more likely to achieve long-term survival (36.1%) compared to females (34.4%, P < 0.001). Men with LMS had a lower percentage of chemotherapy use compared to females (18.7% vs 25% respectively, P < 0.001) and palliative care use (3.0% vs 3.5%; P = 0.013). Lower likelihood of survival among both groups was noted in older age (OR = 0.96; P < 0.001 in males; OR = 0.97, P < 0.001 in females), tumor stage > I (OR = 0.64, P = 0.005 in males; OR = 0.56, P < 0.001 in females) and positive surgical margins (OR = 0.76, P = 0.013 in males; OR = 0.87, P = 0.009 in females). Contrarily, increasing year of diagnosis was associated with an increased likelihood of survival (OR = 1.51, P < 0.001 in males; OR = 1.27, P < 0.001 in females). Larger tumor size was also associated with decreased likelihood of survival, but only in the female group (OR = 0.39, P = 0.001). Conclusions: Our analysis shows that males with LMS had a higher OS and higher percentage of long-term survival compared to females. The only factor affecting survival that was different between the 2 groups was the tumor size, which was associated with significantly decreased likelihood of survival in females. No clear explanation for this different survival could be extrapolated from the clinical data collected. Further studies are recommended to investigate the genetic, epigenetic, and possibly hormonal factors that may affect survival in LMS.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.