169 Background: Prostate cancer is the most common cancer in men in the United States. Death in prostate cancer patients is often related to other medical conditions and not prostate cancer itself. Hence, it is important to optimize other co-morbidities, such as hyperlipidemia, hypertension, and cardiovascular diseases in these patients. However, there are numerous studies portraying the ability of statins to increase progression free survival and overall survival of prostate cancer. This has led to significant interest of statins having anti-cancer properties and ultimately improving long term outcomes. Methods: This is a retrospective observational study with chart review of 1,011 patients diagnosed with prostate cancer from 1995 to 2010 in a VA Hospital in San Antonio, Texas. Variables included age at diagnosis, statin use, type of statin (1st, 2nd, or 3rd generation), dose of statin (4 dosage levels), length of statin use, time followed in months (from diagnosis to death or end of study period), death, cause of death, and time to first progressive disease. Progressive disease was defined using PSWG2 guidelines which is PSA increase > / = 25% and at least 2ng/dl above the nadir. The Cox proportional hazards regression model was used to estimate the hazard function, with age, co-morbities and other cancers used as a covariate. End points were death by prostate cancer (56), death by any cancer (140), and death by all causes (484). We also looked at the effects of statins on progression free survival of prostate cancer. Results: The hazard ratio (HR) for use of statins and death by prostate cancer was 0.35, 95% confidence interval (CI): 0.20-0.62 (p = 0.0003), indicating that statin use has a statistically significant positive effect at delaying death by prostate cancer. Death by any cancer was significantly affected by statins with a HR of 0.47, 95% CI: 0.32-0.65 (p < 0.0001). Death by all causes was also affected significantly by statins with a HR of 0.64, 95% CI: 0.53-0.78 (p < 0.0001). Length of statin use, shorter versus longer than 4 years, showed an inverse association with our primary end point with a HR of 0.53, 95% CI: 0.40-0.69 (p < 0.0001). Dose level of statin, fourth level vs 1, 2, and 3, also showed an inverse association with our primary end point with a HR of 0.73, 95% CI: 0.57-0.94 (p = 0.014). Lastly, statin exposure significantly increased progression-free survival with a HR of 0.71, 95% CI: 0.53-0.95 (p < 0.021). Conclusions: It is clear that concomitant statin use increases overall survival in patients with prostate cancer, potentially even having anti-cancer protective effects against mortality. Longer duration of statin use and higher dose levels of statins increase length of overall survival in patients with prostate cancer. As mortality is often not due to prostate cancer, more interestingly, statin exposure is also shown to increase progression-free survival.
We present a unique case of a 68‐year‐old male who was diagnosed with COVID‐19. His hospital course was complicated by widespread thrombosis, renal failure, and thrombocytopenia. Thrombotic thrombocytopenic purpura was initially suspected, yet plasma exchange and steroids did not improve his disease. Ultimately, he was diagnosed with COVID‐19‐induced thrombotic microangiopathy.
Introduction Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL), constituting 25% of NHL cases (Teras, 2016). Although survival rates have improved, with a 5-year relative survival of 63.8% in the United States (SEER Cancer Statistics, 2018), outcomes in DLBCL remain heterogeneous with inferior survival amongst some patient subgroups. Racial and ethnic disparities in access to care and outcomes are well-established and are critical issues across a number of malignancies, including NHL (Shenoy, 2011; Griffiths, 2010). The purpose of this study was to assess for racial and ethnic differences in patient and disease characteristics at diagnosis, and in outcomes for patients diagnosed with DLBCL within the Veterans Health Administration (VHA), where access to care may be less susceptible to other socioeconomic factors. Methods Trained abstractors performed a retrospective chart review of 2036 randomly selected patients seen in the VHA nationwide who were diagnosed with lymphoma between 01/01/2011 and 12/31/2017. We included patients diagnosed with DLBCL and excluded patients based on the criteria in Figure 1. We evaluated baseline patient and disease characteristics, including Eastern Cooperative Oncology Group (ECOG) performance status, stage at diagnosis, International Prognostic Index (IPI) score, pathology reports to identify high-grade lymphomas, and response to first-line treatment. Results A total of 971 patients met inclusion criteria for analysis. Patients were predominantly male, white, had a median age of 67, and presented primarily with advanced disease (Table 1). Patients in each subgroup presented with similar rates of stage III and IV disease, with no statistically significant difference in stage at presentation amongst each racial subgroup (white vs black, P=0.85; white vs Hispanic, P=0.30; white vs other, P=0.11). Most patients in each racial/ethnic group had a good performance status at diagnosis, with ECOG 0-2 in 75.4 - 82.5% of patients in each subgroup. The entire study population had an objective response rate (ORR) of 87.4% (complete response (CR) rate 66%) (Table 2). Response rates were similar across the 4 subgroups, with the majority of patients achieving a complete response (CR) after first-line therapy (66.7%, 68.9%, 65.3%, and 70% for black, Hispanic, white, and other/unknown patients, respectively). There were no statistically significant differences in ORR amongst subgroups (white vs black, P=0.28; white vs Hispanic, P=0.75; white vs other, P=0.75). Median overall survival (OS) from the time of diagnosis was 40.5 months for the entire study population (Table 2). OS rates were similar regardless of race with a median OS of 43 months for black patients, 49.2 months for Hispanic patients, 40.5 months for white patients, and 33.3 months for other/unknown patients (Figure 2). There was no statistically significant difference in median OS between subgroups (white vs black, P= 0.84; white vs Hispanic, P=0.39; white vs other, P=0.18). The 1-year survival rates were similar at 75.8%, 72.1%, 76.4%, and 71.7% for black, Hispanic, white, and other/unknown patient subgroups, respectively. Between 60 - 68.5% of patients in each subgroup remained alive at 2 years, with no significant differences in survival rates at 1 or 2 years. Conclusions In this retrospective study of patients diagnosed with DLBCL in the VHA nationwide, we found that there were no statistically significant differences in baseline patient characteristics at diagnosis or in response rates to first-line chemotherapy, 1- and 2-year OS rates, or median OS amongst each racial subgroup. Potential limitations of this study include that the population is predominantly male and therefore, may not be applicable to the female population, and that there was missing/incomplete data for pathologic assessment of high grade lymphoma in 68.5% of our population, which could provide important data about expected outcomes. Further studies with a longer follow-up period are needed to help characterize potential differences in outcomes and relapse rates. Our data suggest that when standard of care therapy is given equally to patients with DLBCL, similar outcomes occur for black, Hispanic, and white patients. The development of interventions to address healthcare disparities and to ensure access to appropriate and timely care for all patient populations is of paramount importance. Disclosures No relevant conflicts of interest to declare.
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