The aim of the study was to evaluate risk factors for long-term mortality and progressive chronic kidney disease (CKD) after cardiac surgery in patients with normal preoperative renal function and postoperative acute kidney injury (AKI). From April 2009 to December 2012, we prospectively enrolled 3245 cardiac surgery patients of our hospital. The primary endpoints included survival rates and the secondary endpoint was the incidence of progressive chronic kidney disease (CKD) in a follow-up period of 2 years. Acute kidney injury was staged by KDIGO classification. Progressive CKD was defined as GFR ≤ 30 mL/min/1.73 m2 or end-stage renal disease (ESRD) (starting renal replacement therapy or renal transplantation).The AKI incidence was 39.9% (n = 1295). The 1 and 2 year overall survival (OS) rates of AKI patients were significantly lower than that for non-AKI patients (85.9% and 82.3% vs 98.1% and 93.7%, P < 0.001), even after complete recovery of renal function during 2 years after intervention (P < 0.001). The 2-year overall survival (OS) rates of patients with AKI stage 1, 2, and 3 were 89.9%, 78.6%, and 61.4% (P < 0.001), respectively. Multivariate Cox regression analysis of factors for 2-year survival rates revealed that besides age (P < 0.001), chronic cardiac failure (P < 0.001), diabetes (P < 0.001), cardiopulmonary bypass time (P < 0.01), and length of intensive care unit (ICU) stay (P = 0.004), AKI was a significant risk factor for reducing 2-year survival rates even after complete recovery of renal function (P < 0.001). The accumulated progressive CKD prevalence was significantly higher in AKI than in non-AKI patients (6.8% vs 0.2%, P < 0.001) in the 2 years after surgery. Even with complete recovery of renal function at discharge, AKI was still a risk factor for accumulated progressive CKD (RR 1.92, 95% CI 1.37–2.69).The 2-year mortality and progressive CKD incidence even after complete recovery of renal function were significantly increased in cardiac surgery patients with postoperative AKI.
The aim of the study was to explore the clinicopathological characteristics of sacrococcygeal yolk sac tumor (SYST) associated with relapse. Methods: We collected clinical data regarding patients aged <18 years with SYST treated at Sun Yat-sen University Cancer Center between 2007 and 2018. We investigated prognostic factors of age, stage, initial tumor size, pathological response to neoadjuvant chemotherapy and alfa fetoprotein (AFP) in univariate and multivariate analysis. The Kaplan-Meier method was used to estimate the relapse-free survival (RFS). Results: We enrolled 26 patients with SYST (median age 1.7 years; range, 2 months to 5 years). Patients with predominance of female had elevated AFP at diagnosis (median 50,480 ng/ml, range 1,200-80,300,000). Twelve patients were stage IV. Neoadjuvant chemotherapy was administered to 20 cases. Six patients underwent resection as initial therapy. Resected tumor size at upfront resection was measured < 4.0cm × 3.0cm. No patient died of disease at last follow-up. Relapse occurred in 12 patients. Patients with specimen exhibiting no malignant component after chemotherapy didn't experience recurrence. Frequencies of recurrence were once in 5 patients, 3 in 2 patients, 2 in 3 patients, 4 in 1 patient and 6 in 1 patient, respectively. All relapsed patients still achieved partial remission (PR) or complete remission (CR) after salvage therapy. The cohort reached a 5-year RFS of 55.2% (median follow-up 59.5 months; range, 16-155). Univariate analysis identified sex as a significant prognostic factor of RFS (P = 0.02). In multivariate Cox regression, no variables had statistically significance. Patients with > 2 factors (boy, initial tumor size > 4cm×3cm, AFP > 60,000 ng/ml and poor pathological response) had poor RFS. Conclusion: Sex is a predictive factor of RFS in SYST. Girls with smaller initial tumor size, lower AFP and good pathological response have better RFS. Salvage chemotherapy can benefit patients.
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