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Abstract: Treatment of early-stage non-small cell lung cancer (NSCLC) is rapidly evolving. When introducing novelties, real-life data on effectiveness of currently used treatment strategies are needed. The present study evaluated outcomes of stage I–IIIA NSCLC patients treated with upfront radical surgery in everyday clinical practice, between 2010–2017. Data of 539 consecutive patients were retrieved from a prospective hospital-based registry. All diagnostic, treatment and follow-up procedures were performed at the same thoracic oncology centre according to the valid guidelines. The primary outcome was overall survival (OS) analysed by clinical(c) and pathological(p) TNM (tumour, node, metastases) stage. The impact of clinicopathological characteristics on OS was evaluated using univariable (UVA) and multivariable regression analysis (MVA). With a median follow-up of 53.9 months, median OS and 5-year OS rate in the overall population were 90.4 months and 64.4%. Five-year OS rates by pTNM stage I, II and IIIA were 70.2%, 60.21%, and 49.9%, respectively. Both cTNM and pTNM stages were associated with OS; but only pTNM retained its independent prognostic value (p = 0.003) in MVA. Agreement between cTNM and pTNM was 69.0%. Next to pTNM, age (p = 0.001) and gender (p = 0.004) retained their independent prognostic value for OS. The study showed favourable outcomes of resectable stage I–IIIA NSCLC treated with upfront surgery in real-life. Relatively low agreement between cTNM and pTNM stages and independent prognostic value of only pTNM, observed in real-life data, suggest that surgery remains the most accurate provider of the anatomical stage of disease and important upfront therapy.
Keywords: resectable NSCLC, upfront surgery, real-life data, overall survival, prognostic factors
Published in DiRROS: 25.07.2024; Views: 285; Downloads: 224
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Abstract: In the setting of primary hyperparathyroidism (PHPT), [18F]fluorocholine PET/CT (FCH-PET) has excellent diagnostic performance, with experienced practitioners achieving 97.7% accuracy in localising hyperfunctioning parathyroid tissue (HPTT). Due to the relative triviality of the task for human readers, we explored the performance of deep learning (DL) methods for HPTT detection and localisation on FCH-PET images in the setting of PHPT. Patients and methods. We used a dataset of 93 subjects with PHPT imaged using FCH-PET, of which 74 subjects had visible HPTT while 19 controls had no visible HPTT on FCH-PET. A conventional Resnet10 as well as a novel mPETResnet10 DL model were trained and tested to detect (present, not present) and localise (upper left, lower left, upper right or lower right) HPTT. Our mPETResnet10 architecture also contained a region-of-interest masking algorithm that we evaluated qualitatively in order to try to explain the model’s decision process. Results. The models detected the presence of HPTT with an accuracy of 83% and determined the quadrant of HPTT with an accuracy of 74%. The DL methods performed statistically worse (p < 0.001) in both tasks compared to human readers, who localise HPTT with the accuracy of 97.7%. The produced region-of-interest mask, while not showing a consistent added value in the qualitative evaluation of model’s decision process, had correctly identified the foreground PET signal. Conclusions. Our experiment is the first reported use of DL analysis of FCH-PET in PHPT. We have shown that it is possible to utilize DL methods with FCH-PET to detect and localize HPTT. Given our small dataset of 93 subjects, results are nevertheless promising for further research
Keywords: primary hyperparathyroidism, deep learning, nuclear medicine
Published in DiRROS: 25.07.2024; Views: 396; Downloads: 142
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Abstract: Background. Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are effective treatments for EGFR mutation-positive (EGFRm) non-small cell lung cancer (NSCLC). However, routine clinical practice is different between countries/institutions. Patients and methods. The REFLECT study (NCT04031898) is a retrospective medical chart review that explored real-life treatment and outcomes of EGFRm NSCLC patients receiving first-line (1L) first-/second-generation (1G/2G) EGFR TKIs in 8 countries. This study included adult patients with documented advanced/metastatic EGFRm NSCLC with 1L 1G/2G EGFR TKIs initiated between Jan 2015 – Jun 2018. We reviewed data on clinical characteristics, treatments, EGFR/T790M testing patterns, and survival outcomes. Here, we report data from 120 medical charts in 3 study sites from Slovenia. Results. The Slovenian cohort (median age 70 years, 74% females) received 37% erlotinib, 32% afatinib, 31% gefitinib. At the time of data collection, 94 (78%) discontinuations of 1L TKI, and 89 (74%) progression events on 1L treatment were reported. Among patients progressing on 1L, 73 (82%) were tested for T790M mutation yielding 50 (68%) positive results, and 62 (85%) received 2L treatment. 82% of patients received osimertinib. Attrition rate between 1L and 2L was 10%. The median (95% CI) real-world progression free survival on 1L EGFR TKIs was 15.6 (12.6, 19.2) months; median overall survival (95% CI) was 28.9 (25.0, 34.3) months. Conclusions. This real-world study provides valuable information about 1G/2G EGFR TKIs treatment outcomes and attrition rates in Slovenian EGFRm NSCLC patients. The reduced attrition rate and improved survival outcomes empha-size the importance of 1L treatment decision.
Keywords: real-world study, non-small cell lung cancer, epidermal growth factor receptor, lung cancer
Published in DiRROS: 25.07.2024; Views: 241; Downloads: 111
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Abstract: Background: Cerebral venous thrombosis (CVT) is a rare cerebral vascular disease, the presentation of which is highly variable clinically and radiologically. A recent study demonstrated that isolated subarachnoid hemorrhage (iSAH) in CVT is not as rare as thought previously and may have a good prognostic significance. Hemorrhagic venous infarction, however, is an indicator of an unfavorable outcome. We therefore hypothesized that patients who initially suffered iSAH would have a better clinical outcome than those who suffered hemorrhagic cerebral infarction. Patients and methods: We selected patients hospitalized due to CVT, who presented either with isolated SAH or cerebral hemorrhagic infarction at admission or during the following 24 hours: 23 (10 men) aged 22-73 years. The data were extracted from hospital admission records, our computer data system, and the hospital radiological database. Results: The iSAH group consisted of 8 (6 men) aged 49.3 ± 16.2 and the hemorrhagic infarction group included 15 (4 men) aged 47.9 ± 16.8. Despite having a significantly greater number of thrombosed venous sinuses/deep veins (Mann-Whitney Rank Sum Test, p = 0.002), the isolated SAH group had a significantly better outcome on its modified Rankin Score (mRs) than the hemorrhagic infarction group (Mann-Whitney Rank Sum Test, p = 0.026). Additional variables of significant impact were edema formation (p = 0.004) and sulcal obliteration (p = 0.014). Conclusions: The patients who suffer iSAH initially had a significantly better outcome prognosis than the hemorrhagic infarction patients, despite the greater number of thrombosed sinuses/veins in the iSAH group. A possible explanation might include patent superficial cerebral communicating veins.
Keywords: cerebral venous thrombosis, hemorrhagic brain infarction, subarachnoid hemorrhage
Published in DiRROS: 25.07.2024; Views: 286; Downloads: 153
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Abstract: In this paper, we study the bivariate truncated moment problem (TMP) on curves of the form $y = q(x), q(x) \in \mathbb{R} [x], \deg q ≥ 3$ and $yx^\ell = 1, \ell \in \mathbb{N}$ \ $\{1\}$. For even degree sequences, the solution based on the size of moment matrix extensions was first given by Fialkow [Fialkow L. Solution of the truncated moment problem with variety $y = x^3$. Trans Amer Math Soc. 2011;363:3133–3165.] using the truncated Riesz–Haviland theorem [Curto R, Fialkow L. An analogue of the Riesz–Haviland theorem for the truncated moment problem. J Funct Anal. 2008;255:2709–2731.] and a sum-of-squares representations for polynomials, strictly positive on such curves [Fialkow L. Solution of the truncated moment problem with variety $y = x^3$. Trans Amer Math Soc. 2011;363:3133–3165.; Stochel J. Solving the truncated moment problem solves the moment problem. Glasgow J Math. 2001;43:335–341.]. Namely, the upper bound on this size is quadratic in the degrees of the sequence and the polynomial determining a curve. We use a reduction to the univariate setting technique, introduced in [Zalar A. The truncated Hamburger moment problem with gaps in the index set. Integral Equ Oper Theory. 2021;93:36.doi: 10.1007/s00020-021-02628-6.; Zalar A. The truncated moment problem on the union of parallel lines. Linear Algebra Appl. 2022;649:186–239. doi.org/10.1016/j.laa.2022.05.008.; Zalar A. The strong truncated Hamburger moment problem with and without gaps. J Math Anal Appl. 2022;516:126563. doi: 10.1016/j.jmaa.2022. 126563.], and improve Fialkow’s bound to $\deg q − 1$ (resp. $\ell + 1$) for curves $y = q(x)$ (resp. $yx^\ell = 1$). This in turn gives analogous improvements of the degrees in the sum-of-squares representations referred to above. Moreover, we get the upper bounds on the number of atoms in the minimal representing measure, which are $k \deg q$ (resp. $k(\ell+ 1)$) for curves $y = q(x)$ (resp. $yx^\ell = 1$) for even degree sequences, while for odd ones they are $k \deg q − \bigl \lceil \frac{\deg q}{2} \bigr \rceil$ (resp. $k(\ell + 1) − \bigl \lfloor \frac{\ell}{2} \bigr \rfloor + 1$) for curves $y = q(x)$ (resp. $yx^\ell = 1$). In the even case, these are counterparts to the result by Riener and Schweighofer [Riener C, Schweighofer M. Optimization approaches to quadrature:a new characterization of Gaussian quadrature on the line and quadrature with few nodes on plane algebraic curves, on the plane and in higher dimensions. J Complex. 2018;45:22–54., Corollary 7.8], which gives the same bound for odd degree sequences on all plane curves. In the odd case, their bound is slightly improved on the curves we study. Further on, we give another solution to the TMP on the curves studied based on the feasibility of a linear matrix inequality, corresponding to the univariate sequence obtained, and finally we solve concretely odd degree cases to the TMP on curves $y = x^\ell, \ell = 2, 3,$ and add a new solvability condition to the even degree case on the curve $y = x^2$.
Keywords: truncated moment problems, K-moment problems, K-representing measure, minimal measure, moment matrix extensions, positivstellensatz, linear matrix inequality
Published in DiRROS: 25.07.2024; Views: 281; Downloads: 194
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