Purpose The Coronavirus Disease 2019 (COVID-19) may result not only in acute symptoms such as severe pneumonia, but also in persisting symptoms after months. Here we present a 1 year follow-up of a patient with a secondary tension pneumothorax due to COVID-19 pneumonia. Case presentation In May 2020, a 47-year-old male was admitted to the emergency department with fever, dry cough, and sore throat as well as acute chest pain and shortness of breath. Sputum testing (polymerase chain reaction, PCR) and computed tomography (CT) confirmed infection with the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). Eleven days after discharge, the patient returned to the emergency department with pronounced dyspnoea after coughing. CT showed a right-sided tension pneumothorax, which was relieved by a chest drain (Buelau) via mini open thoracotomy. For a period of 3 months following resolution of the pneumothorax the patient complained of fatigue with mild joint pain and dyspnoea. After 1 year, the patient did not suffer from any persisting symptoms. The pulmonary function and blood parameters were normal, with the exception of slightly increased levels of D-Dimer. The CT scan revealed only discrete ground glass opacities (GGO) and subpleural linear opacities. Conclusion Tension pneumothorax is a rare, severe complication of a SARS-CoV-2 infection but may resolve after treatment without negative long-term sequelae. Level of evidence V.
4095 Background: The aim of the study is to determine whether the achievement of an objective response to first-line chemotherapy is prognostic of patient’s outcome in gastric/EGJ adenocarcinoma. Methods: Individual patient (pts) data from prospective first-line trials conducted by a single study group were used. Patients received platin/5-FU based chemotherapy with or without docetaxel. Responses were evaluated according to WHO criteria in all trials. Response data, patients’ characteristics (age, sex, entity, histological type, primary location, ECOG PS, and type and number of metastatic sites), type of chemotherapy, and overall survival data were analyzed. Results: 612 pts were included. Median age was 66 yrs; 31.5% had ECOG status 0, 58.3% ECOG 1, and 9.8% ECOG 2 & 3. Gastric primaries were found in 44.4% and EGJ in 35.8% of pts (19.7% were overlapping/not evaluable). According to Lauren classification, 36.8% had intestinal, 32.4% diffuse, and 8.5% mixed types (22.4% were not classifiable). 64.5% had positive non-regional lymph nodes (LN) involvement, 14.1% LN involvement without other metastases, 33.3% had peritoneal carcinomatosis, 44.0% liver and 16.7% lung metastases. Response rates were complete (CR) in 3.1%, partial (PR) in 36.4%, stable disease (SD) in 34.5%, and progressive disease (PD) in 15.0% pts (10.9% were not evaluable). Overall response rate (OR; CR + PR) was 39.5%. Median overall survival times in pts with CR vs PR vs SD vs PD were 37.9 vs 14.7 vs 10.9 vs 5.2 months, respectively; p=1.26 x 10-33). OR (CR or PR) also strongly predicted OS (16.7 vs 8.1 months in pts with vs no OR, p=1.08 x 10-17). OR remained the strongest predictor of OS in the multivariate analysis (p=6.55 x 10-7) including all baseline criteria mentioned above followed by ECOG PS (p=0.048) and the presence of non-regional LN as the only site of metastasis (p=0.034). Conclusions: The achievement of an objective response is the strongest predictor of survival in pts with gastric and EGJ cancer and could serve as a surrogate marker if validated.
57 Background: The aim of the study is to determine whether the achievement of an objective response to 1st line chemotherapy is prognostic of patient’s outcome in gastric/EGJ adenocarcinoma. Methods: Individual patient (pts) data from prospective 1st line trials conducted by a single study group were used. Response data, pts’ characteristics, type of chemotherapy and overall survival (OS) data were analyzed. Responses were evaluated according to WHO criteria in all trials and landmark analysis conducted. Results: Response rates were complete (CR) in 3.1%, partial (PR) in 37.7%, stable disease (SD) in 33.8% and progressive disease (PD) in 15.4% pts (9.9% were not evaluable). Overall response rate (OR= CR + PR) was 40.8%. Median OS in pts with CR vs. PR vs. SD vs. PD were 28.9 vs. 14.8 vs. 10.8 vs. 5.2 months, respectively; p= 2.6 x 10-42. OR also strongly predicted OS (16.7 vs. 8.6 months in pts with vs. no OR; p= 9.0 x 10-14). Landmark studies were established with landmarks set on 2 and 4 months. Median OS at landmark point 2 months in pts with CR vs. PR vs. SD vs. PD were 17.3 vs. 14.5 vs. 11.1 vs. 5.4 months, respectively; p= 3,7 x 10-12. Pts with OR vs. no OR had a median OS of 14.7 vs. 10.9 months, p= 0.0001. Median OS at landmark point 4 months in pts with CR vs. PR vs. SD vs. PD were 23.9 vs. 14.8 vs. 11.8 vs. 7.7 months, respectively; p= 1.2 x 10-10. Pts with OR vs. no OR had a median OS of 16.1 vs. 11.1 months, p= 7.0 x 10-6. OR remained the strongest predictor of OS in the multivariate analysis (p= 6.3 x 10-7) followed by the presence of non-regional LN as the only site of metastasis (p= 8.2 x 10-5) and ECOG (p= 0.002). Conclusions: The achievement of an objective response is the strongest predictor of survival in pts with gastric and EGJ cancer and could serve as surrogate marker if validated.
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