In-Hospital and Long-Term Outcomes in Patients with Head and Neck Cancer Bleeding

Yen, Chieh-Ching; Ho, Che-Fang; Wu, Chien-Hung; Tsao, Yu-Ning; Chaou, Chung-Hsien; Chen, Shou-Yen; Ng, Chip-Jin; Yeh, Heng Liang

doi:10.3390/medicina58020177

Cited by 3 publications

(2 citation statements)

References 28 publications

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“…Second, all significant variables from the univariable analyses were inputted into the multivariable logistic regression model to further examine their statistical association. Continuous variables were categorized as a priori using either the standard threshold values established in our laboratory settings or thresholds associated with poor outcomes, as identified in the existing literature [17][18][19][20][21][22][23][24]. In the multivariable model, a p-value of < 0.05 was set as the threshold for the incorporation of variables into the final prediction score.…”

Section: Derivation Stagementioning

confidence: 99%

Novel Prediction Score for Arterial–Esophageal Fistula in Patients with Esophageal Cancer Bleeding: A Multicenter Study

Lu,

Niu,

Pai

et al. 2024

Cancers

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Purpose: To develop and internally validate a novel prediction score to predict the occurrence of arterial–esophageal fistula (AEF) in esophageal cancer bleeding. Methods: This retrospective cohort study enrolled patients with esophageal cancer bleeding in the emergency department. The primary outcome was the diagnosis of AEF. The patients were randomly divided into a derivation group and a validation group. In the derivation stage, a predictive model was developed using logistic regression analysis. Subsequently, internal validation of the model was conducted in the validation cohort during the validation stage to assess its discrimination ability. Results: A total of 257 patients were enrolled in this study. All participants were randomized to a derivation cohort (n = 155) and a validation cohort (n = 102). AEF occurred in 22 patients (14.2%) in the derivation group and 14 patients (13.7%) in the validation group. A predictive model (HEARTS-Score) comprising five variables (hematemesis, active bleeding, serum creatinine level >1.2 mg/dL, prothrombin time >13 s, and previous stent implantation) was established. The HEARTS-Score demonstrated a high discriminative ability in both the derivation and validation cohorts, with c-statistics of 0.90 (95% CI 0.82–0.98) and 0.82 (95% CI 0.72–0.92), respectively. Conclusions: By employing this novel prediction score, clinicians can make more objective risk assessments, optimizing diagnostic strategies and tailoring treatment approaches.

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Section: Derivation Stagementioning

confidence: 99%

Novel Prediction Score for Arterial–Esophageal Fistula in Patients with Esophageal Cancer Bleeding: A Multicenter Study

Lu,

Niu,

Pai

et al. 2024

Cancers

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“…HNC bleeding is a significant source of psychological burden for patients and their families, and acute, catastrophic bleeding can be challenging for frontline physicians [9,10]. Prior studies have evaluated clinical outcomes in patients with HNC bleeding [4,7,8,[11][12][13][14][15]. However, until now, no studies have analyzed risk factors for patients who are at increased risk of rebleeding.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for rebleeding and long-term outcomes in patients with head and neck cancer bleeding: a multicenter study

Wang

Niu

et al. 2022

BMC Cancer

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Background Acute, catastrophic bleeding in patients with head and neck cancer (HNC) is challenging and also a burden for their families and frontline physicians. This study analyzed the risk factors for rebleeding and long-term outcomes in these patients with HNC. Methods Patients who presented to the emergency department (ED) with HNC bleeding were enrolled in this study (N = 231). Variables of patients with or without rebleeding were compared, and associated factors were investigated using Cox’s proportional hazard model. Results Of the 231 patients enrolled, 112 (48.5%) experienced a recurrent bleeding event. The cumulative rebleeding incidence rate was 23% at 30 days, 49% at 180 days, and 56% at 1 year. Multivariate Cox regression analyses demonstrated that overweight-to-obesity (HR = 0.52, 95% CI 0.28–0.98, p = 0.043), laryngeal cancer (hazard ratio [HR] = 2.13, 95% confidence interval [CI] 1.07–4.23, p = 0.031), chemoradiation (HR = 1.49, 95% CI 1.001–2.94, p = 0.049), and second primary cancer (HR = 1.75, 95% CI 1.13–2.70, p = 0.012) are significant independent predictors of rebleeding, and the prognostic factors for overall survival included underweight (HR = 1.89, 95% CI 1.22–2.93, p = 0.004), heart rate > 110 beats/min (HR = 1.58, 95% CI 1.04–2.39, p = 0.032), chemoradiation (HR = 2.31, 95% CI 1.18–4.52, p = 0.015), and local recurrence (HR = 1.74, 95% CI 1.14–2.67, p = 0.011). Conclusions Overweight-to-obesity is a protective factor, while laryngeal cancer, chemoradiation and a second primary cancer are risk factors for rebleeding in patients with HNC. Our results may assist physicians in risk stratification of patients with HNC bleeding.

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Clinical characteristics and risk factors for 30-day mortality in esophageal cancer patients with upper gastrointestinal bleeding: a multicenter study

Pai

Yang

et al. 2023

Front. Oncol.

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BackgroundEsophageal cancer is a highly malignant neoplasm with poor prognosis. Of its patients, upper gastrointestinal bleeding (UGIB) is one of the most challenging and threatening conditions in the emergency department (ED). However, no previous studies have analyzed the etiologies and clinical outcomes in this specific population. This study aimed to identify the clinical characteristics and risk factors for 30-day mortality in esophageal cancer patients with UGIB.MethodsThis retrospective cohort study enrolled 249 adult patients with esophageal cancer presenting with UGIB in the ED. Patients was divided into the survivor and non-survivor groups, and their demographic information, medical history, comorbidities, laboratory parameters, and clinical findings were recorded. The factors associated with 30-day mortality were identified using Cox’s proportional hazard model.ResultsAmong the 249 patients in this study, 30-day mortality occurred in 47 patients (18.9%). The most common causes of UGIB were tumor ulcer (53.8%), followed by gastric/duodenal ulcer (14.5%), and arterial-esophageal fistula (AEF) (12.0%). Multivariate analyses indicated that underweight (HR = 2.02, p = 0.044), history of chronic kidney disease (HR = 6.39, p < 0.001), active bleeding (HR = 2.24, p = 0.039), AEF (HR = 2.23, p = 0.046), and metastatic lymph nodes (HR = 2.99, p = 0.021) were independent risk factors for 30-day mortality.ConclusionsThe most common cause of UGIB in esophageal cancer patients was tumor ulcer. AEF, accounting for 12% of UGIB in our study, is not an uncommon cause. Underweight, underlying chronic kidney disease, active bleeding, AEF, and tumor N stage > 0 were independent risk factors for 30-day mortality.

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In-Hospital and Long-Term Outcomes in Patients with Head and Neck Cancer Bleeding

Cited by 3 publications

References 28 publications

Novel Prediction Score for Arterial–Esophageal Fistula in Patients with Esophageal Cancer Bleeding: A Multicenter Study

Novel Prediction Score for Arterial–Esophageal Fistula in Patients with Esophageal Cancer Bleeding: A Multicenter Study

Risk factors for rebleeding and long-term outcomes in patients with head and neck cancer bleeding: a multicenter study

Clinical characteristics and risk factors for 30-day mortality in esophageal cancer patients with upper gastrointestinal bleeding: a multicenter study

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