The potential of psychiatric outpatient centers to reduce the length of stay in inpatient facilities and the negative impact of COVID-19 on the availability of psychiatric services: the case of Latvia.

The move from psychiatric hospitals to community-based care is the goal of policies in many countries. Latvia has attempted to reach this goal by establishing two outpatient centers in Riga. Since 2005, when the first outpatient centers opened, the ability of day clinics to reduce the total length of stay for hospital inpatients has been observed, although using the outpatient centers did not affect the number of patients treated. The open-door inpatient wards of the centers also attracted a new patient group. However, due to the COVID-19 pandemic, the number and length of stay of both outpatients and inpatients at psychiatric hospitals decreased. Therefore, other factors that can affect the move from psychiatric hospital inpatient care to outpatient centers should be further investigated.

The small trial problem.

BACKGROUND: Many randomized trials that aim to assess new or commonly used medical or surgical interventions have been so small that the validity of conclusions becomes questionable. METHODS: We illustrate the small trial problem using the power calculation of five Cochrane-reviewed studies that compared vertebroplasty versus placebo interventions. We discuss some of the reasons why the statistical admonition not to dichotomize continuous variables may not apply to the calculation of the number of patients required for trials to be meaningful. RESULTS: Placebo-controlled vertebroplasty trials planned to recruit between 23 and 71 patients per group. Four of five studies used the standardized mean difference of a continuous pain variable (centimeters on the visual analog scale (VAS)) to plan implausibly small trials. What is needed is not a mean effect at the population level but a measure of efficacy at the patient level. Clinical practice concerns the care of individual patients that vary in many more respects than the variation around the mean of a single selected variable. The inference from trial to practice concerns the frequency of success of the experimental intervention performed one patient at a time. A comparison of the proportions of patients reaching a certain threshold is a more meaningful method that appropriately requires larger trials. CONCLUSION: Most placebo-controlled vertebroplasty trials used comparisons of means of a continuous variable and were consequently very small. Randomized trials should instead be large enough to account for the diversity of future patients and practices. They should offer an evaluation of a clinically meaningful number of interventions performed in various contexts. Implications of this principle are not specific to placebo-controlled surgical trials. Trials designed to inform practice require a per-patient comparison of outcomes and the size of the trial should be planned accordingly.

Emergence of New Drugs for Intractable Diseases is Associated with an Increase in the Number of Patients Diagnosed Thereafter with Those Intractable Diseases.

BACKGROUND: Estimates of the prevalence of diseases can be affected by changes in the awareness of the diseases. The emergence of new drugs may affect the awareness of the diseases among patients and physicians. We have reported that the rate of increase in the number of drugs available was a statistically significant factor correlated with the rate of increase in the number of patients diagnosed thereafter. We aimed to investigate the impact of the emergence of new drugs on the number of patients diagnosed with individual intractable diseases and to determine the types of drugs that had a greater impact on these changes. METHODS: The number of patients, the number of drugs indicated and diagnostic and certification criteria for the diseases from 2004 to 2013 were collected from publicly available data. We compared the annual rate of increase in the number of patients before and after the emergence of new drugs. Factors affecting the annual rate of increase in the number of patients were investigated. RESULTS: The annual rate of increase in the number of patients was statistically significantly increased after the emergence of new drugs (Average increase of 0.9% per year, Wilcoxon signed-rank test; p = 0.035). The emergence of drugs with new active substances and drugs with new mechanisms of action were statistically significant factors correlated with the increase in the number of patients. CONCLUSION: The emergence of new drugs, especially drugs with new active substances and drugs with new mechanisms of action, was associated with an increase in the number of patients diagnosed thereafter.

Estimation of a Suitable Number of Patients for Selective Safety Data Collection (ICH E19 Draft Guideline): When is the Safety Profile of a Drug Well Characterized?

PURPOSE: We propose methods to estimate a suitable number of patients for implementing selective safety data collection (SSDC) in clinical investigations based on a confidence interval of the incidence rate or risk difference using Monte Carlo simulation. METHODS: The incidence rates and risk differences of adverse events (AEs) were based on the safety outcome measures. A suitable number of patients for implementing SSDC was estimated based on the probability that the half-width of the two-sided 95% confidence interval of incidence rate or risk difference was equal to or less than a pre-specified cut-off value (0.5-3.0%). Monte Carlo simulation was used to estimate the suitable number of patients at probabilities of 70%, 80%, and 90%. The applicability of our proposed method for estimating a suitable number of patients for SSDC implementation was confirmed based on the incidence rates or risk differences from actual clinical trial data for panitumumab. RESULTS: We demonstrated the performance of our proposed method in estimating a suitable number of patients to implement SSDC in several situations. Furthermore, according to the safety datasets of three phase III clinical trials, the number of suitable patients for implementing SSDC using incidence rates or risk differences of common AEs with panitumumab could confirm the applicability of our proposed method. CONCLUSION: A suitable number of patients estimated based on our proposed method may be one of the foundations for implementing SSDC, as additional data accrual may not impact the precision of the estimates of the frequency of common AEs.

Patient Flows, Patient Distribution Computations and Medicines Accounting in the Pharmacoeconomic Models Through Procurement Perspective.

PURPOSE: Stimulating cost reduction of pharmaceutical companies to optimize the structure of distribution of patients by the level of treatment costs in various programs. PATIENTS AND METHODS: In this article, we rise up the issues of pharmacoeconomic modeling related to the description of the patient flows in the pharmacoeconomic model and methods to determining the course dose of drugs under the restriction of integer computations. We established two possible ways of distributing patients through treatment regimens in pharmacoeconomic models, also analyzed the effects of simultaneous and uniform entry of patients into the model. Also, we considered the limitations and possibilities of calculations based on the active substance and packaging, as well as the transition factor of the remainder of the drug in the next time period. RESULTS: A mathematical model of the analysis of the system assessment of patients by the level of risk of abandoning a healthy lifestyle in connection with the growing problems of the difficult-to-control process is developed. The use of a rational data convolution mode allowed us to obtain a criterion for the optimality of the process and a logical point of stability of the pharmaceutical company by rationally applying treatment methods according to established standards (percentage base). This approach makes it possible to influence the management of private clinics through clear ideas on the algorithms for prescribing drugs in each group of patients and their zoning in the vector recovery mode. CONCLUSION: Initial data and sample size: 552 measurements of the intervals of changes in the subject's indicators in seconds (smoothing and scaling the data to the level of the base (analytical) period or the final (barrier) period). Regular use of this approach makes it possible to reserve the resources of the body of a healthy and physically active person in a timely manner for a very reliable functioning of all body systems, taking into account the dosed intake of prescribed drugs and the conditions of comfortable (decent) maintenance of patients during the course of treatment according to the method chosen by the doctor.

Increased availability of drugs is correlated with the number of patients diagnosed thereafter: Data analysis of 45 intractable diseases.

WHAT IS KNOWN: Estimates of the prevalence of diseases can be affected by non-biological factors such as change in diagnostic criteria and change in awareness of the diseases. The launch of a new drug is a potential contributory factor to the estimated prevalence of the target disease, but there appears to be no reports on this possible relationship. OBJECTIVE: To investigate the relationship between the change in the number of patients diagnosed and factors such as the number of drugs indicated and the number of relevant scientific articles, focused on 45 intractable diseases in Japan. METHODS: The number of patients with 1 of 45 intractable diseases from 2004 to 2013 was collected from publicly available data. The number of drugs indicated, the number of scientific articles, and diagnostic and certificate criteria for the disease were collected from publicly available sources from 2004 to 2013. Using these data, the correlation coefficient was calculated, and linear regression analyses were performed. RESULTS AND DISCUSSION: The rate of increase in the number of drugs and the increase rate of the number of articles were found to be associated with an increase in the number of patients from 2004 to 2013. Linear regression analysis showed that the increase rate of the number of drugs available (2004-2008) was a statistically significant factor correlated with the rate of increase in the number of patients diagnosed in the following period (2009-2013). However, the increase rate of the number of patients (2004-2008) was not associated with the rate of increase in the number of drugs (2009-2013). One possible reason as to why the number of new drugs was correlated with the patient diagnosis numbers thereafter was proposed to be due to an increased awareness of diseases among physicians. WHAT IS NEW AND CONCLUSION: This is the first study to investigate the relationship between the number of new drugs and the number of patients diagnosed based on data from multiple diseases. The investigation of data on 45 intractable diseases in Japan indicated that the increased availability of drugs was correlated with the increase in the number of patients in the future.

Safety and tolerability of venom immunotherapy: Evaluation of 581 rush- and ultra-rush induction protocols (safety of rush and ultra-rush venom immunotherapy).

BACKGROUND: Current literature is inconsistent regarding the risk of severe side effects using accelerated induction protocols in Hymenoptera venom immunotherapy (VIT). In addition, several data indicate the influence of purity grade of venom preparation on tolerability. We evaluated the safety and tolerability of ultra-rush and rush build-up protocols using purified and non-purified venom preparations. METHODS: Retrospective single-center study of 581 VIT inductions (325 ultra-rush and 256 rush protocols) from 2005 to 2018 in 559 patients with bee and vespid venom allergy using aqueous purified (ALK SQ®) for ultra-rush protocol and aqueous non-purified (ALK Reless®) venom preparations for rush protocol. RESULTS: Urticaria (8% vs. 3.1%, p = 0,013) and dose reductions (4.3% vs. 1.2%, p = 0,026) were significantly more frequent in the ultra-rush group. Overall rate of moderate-to-severe side effects (anaphylaxis ≥ grade 2 according to Ring and Meßmer) was low and did not differ significantly between protocols (p = 0.105). Severe events (grade 4 anaphylaxis) were not reported. Discontinuation rate was very low in both cohorts (0.6% vs 1.2%). The higher purity grade of venom preparations in the ultra-rush cohort did not improve tolerability. The bee venom group showed a non-significant trend towards higher incidence of mild reactions (urticaria), resulting in more frequent dose reductions and antiallergic therapy. CONCLUSION: Rush and ultra-rush protocols show an excellent safety profile with only infrequent and mild anaphylactic reactions in bee and vespid venom allergy. Ultra-rush immunotherapy reduces the duration of the inpatient build-up phase setting and thus is viewed by the authors as preferred treatment in Hymenoptera venom allergic patients.

Responsiveness, minimal important difference, minimal relevant difference, and optimal number of patients for a study.

Several terms are used to describe changes in PROM scores in relation to treatments. Whether the change is small, large, or relevant is defined in different ways, yet these change scores are used to recommend or oppose treatments. They are also used to calculate the necessary number of patients for a study. This article offers a theoretical explanation behind the terms responsiveness, minimal important difference (MID), minimal important change (MIC), minimal relevant difference (MIREDIF), and threshold of clinical importance. It also gives instructions on how these and the optimal number of patients for a study are calculated. Responses to two domains of the Knee Injury and Osteoarthritis Outcome Score (KOOS), before and 1 year after reconstruction of the anterior cruciate ligament of 164 patients, are used to illustrate the calculations. This paper presents the most common methods used to calculate and interpret MID. Results vary substantially across domains, patient location on the scale, and health conditions. The optimal number of patients depends on the minimal relevant difference (MIREDIF), the standard error of the measure (SEM), the desired statistical power for the measurement, and the responsiveness of the measurement instrument (the PROM). There is often uncertainty surrounding the calculation and interpretation of responsiveness, MID, and MIREDIF, as these concepts are complex. When MID is used to evaluate research results, authors should specify how the MID was calculated, and its relevance for the study population. These measures should only be used after thorough consideration to justify healthcare decisions.

Overcoming hurdles: measurement of health-related outcomes associated with national level medicines usage in Ireland.

Public discourse on medicine provision predominantly focuses on overall expenditure. However, current literature suggests measurement of alternative indicators can provide a method to benchmark or ameliorate medicine provision. Previous research has investigated the viability of using health-related outcome metrics, such as the number of patients treated, quality-adjusted life-year gain and life-year gain, to provide macro-level estimates on medicines' societal contributions. This editorial provides an overview of the evolving healthcare landscape surrounding medicine usage estimation and valuation in Ireland and offers recommendations on how improved methods of measuring health-related outcomes may help ameliorate efficiencies and the sustainability of a healthcare system.

Effects of sodium glucose cotransporter-2 inhibitors on serum uric acid in type 2 diabetes mellitus: A systematic review with an indirect comparison meta-analysis.

To describe the effects of sodium-glucose co-transporter 2 (SGLT2) inhibitors on serum uric acid (SUA) in patients with type 2 diabetes mellitus (T2DM). PubMed, EMBASE, and CENTRAL were searched for randomized controlled trials of SGLT2 inhibitors in patients with T2DM up to Aug 10, 2017, without language or date restrictions. Thirty-one studies totaling 13,650 patients were included. SGLT2 inhibitors significantly decreased SUA levels compared with placebo, canagliflozin WMD -37.02 µmol/L, 95% CI [-38.41, -35.63], dapagliflozin WMD -38.05 µmol/L, 95% CI [-44.47, -31.62], empagliflozin WMD -42.07 µmol/L, 95% CI [-46.27, -37.86]. The drug class effect of SUA reduction suggesting SGLT2 inhibitors might be beneficial for diabetic patients with hyperuricemia.

Estimating a price point for cost-benefit of bone morphogenetic protein in pseudarthrosis prevention for adult spinal deformity surgery.

OBJECTIVEBone morphogenetic protein (BMP) is associated with reduced rates of pseudarthrosis and has the potential to decrease the need for revision surgery. There are limited data evaluating the cost-benefit of BMP for pseudarthrosis-related prevention surgery in adult spinal deformity.METHODSThe authors performed a single-center retrospective review of 200 consecutive patients with adult spinal deformity. Demographic data and costs of BMP, primary surgery, and revision surgery for pseudarthrosis were collected. Patients with less than 12 months of follow-up or with infection, tumor, or neuromuscular disease were excluded.RESULTSOne hundred fifty-one patients (107 [71%] women) with a mean age of 65 years met the inclusion criteria. The mean number of levels fused was 10; BMP was used in 98 cases (65%), and the mean follow-up was 23 months. Fifteen patients (10%) underwent surgical revision for pseudarthrosis; BMP use was associated with an 11% absolute risk reduction in the rate of reoperation (17% vs 6%, p = 0.033), with a number needed to treat of 9.2. There were no significant differences in age, sex, upper instrumented vertebra, or number of levels fused in patients who received BMP. In a multivariate model including age, sex, number of levels fused, and the upper instrumented vertebra, only BMP (OR 0.250, 95% CI 0.078-0.797; p = 0.019) was associated with revision surgery for pseudarthrosis. The mean direct cost of primary surgery was $87,653 ± $19,879, and the mean direct cost of BMP was $10,444 ± $4607. The mean direct cost of revision surgery was $52,153 ± $26,985. The authors independently varied the efficacy of BMP, cost of BMP, and cost of reoperation by ± 50%; only reductions in the cost of BMP resulted in a cost savings per 100 patients. Using these data, the authors estimated a price point of $5663 in order for BMP to be cost-neutral.CONCLUSIONSUse of BMP was associated with a significant reduction in the rates of revision surgery for pseudarthrosis. At its current price, the direct in-hospital costs for BMP exceed the costs associated with revision surgery; however, this likely underestimates the true value of BMP when considering the savings associated with reductions in rehabilitation, therapy, medication, and additional outpatient costs.

Exploring the Effects of Online Rating and the Activeness of Physicians on the Number of Patients in an Online Health Community.

Introduction: With the rapid development of information technology and online communities, patients in growing numbers choose to consult physicians in online health communities (OHCs) for information and treatment. Although many researchers have examined OHCs, the impact of physicians' online rating and activeness on patient consultation choice, which is reflected by the number of patients in OHCs, has rarely been discussed.Methods: A computer program was developed to download the required data. We collected data from 8,401 physicians from an online health community, Good Doctor Online, and analyzed data with Stata. An empirical model was conducted to explore the factors that influence the number of patients who consult a physician in OHCs.Results: The results indicate that the online rating and activeness of physicians have positive effects on the number of patients. Furthermore, the physician's professional seniority and hospital rank significantly moderate this positive relationship. As hospital levels increase, the impacts of the online rating and activeness on the number of patients decrease. In addition, the online rating has a weaker influence on the number of patients when a physician has a high professional seniority.Conclusions: It is important to understand what factors influence the number of patients who choose to consult physicians in OHCs. This study aims to explore the effects of online rating and activeness of physicians on the number of patients, as well as the moderating effects of the physician's professional seniority and hospital rank. Our results have implications for existing health management and e-health literature, and OHC designers.

Nonlinear Modelling for Predicting Patient Presentation Rates for Mass Gatherings.

IntroductionMass gatherings are common in Australia. The interplay of variables, including crowd density and behavior, weather, and the consumption of alcohol and other drugs, can pose a unique set of challenges to attendees' well-being. On-site health services are available at most mass gatherings and reduce the strain on community health facilities. In order to efficiently plan and manage these services, it is important to be able to predict the number and type of presenting problems at mass gatherings.ProblemThere is a lack of reliable tools to predict patient presentations at mass gatherings. While a number of factors have been identified as having an influence on attendees' health, the exact contribution of these variables to patient load is poorly understood. Furthermore, predicting patient load at mass gatherings is an inherently nonlinear problem, due to the nonlinear relationships previously observed between patient presentations and many event characteristics. METHODS: Data were collected at 216 Australian mass gatherings and included event type, crowd demographics, and weather. Nonlinear models were constructed using regression trees. The full data set was used to construct each model and the model was then used to predict the response variable for each event. Nine-fold cross validation was used to estimate the error that may be expected when applying the model in practice. RESULTS: The mean training errors for total patient presentations were very high; however, the distribution of errors per event was highly skewed, with small errors for the majority of events and a few large errors for a small number of events with a high number of presentations. The error was five or less for 40% of events and 15 or less for 85% of events. The median error was 6.9 presentations per event. CONCLUSION: This study built on previous research by undertaking nonlinear modeling, which provides a more realistic representation of the interactions between event variables. The developed models were less useful for predicting patient presentation numbers for very large events; however, they were generally useful for more typical, smaller scale community events. Further research is required to confirm this conclusion and develop models suitable for very large international events.Arbon P, Bottema M, Zeitz K, Lund A, Turris S, Anikeeva O, Steenkamp M. Nonlinear modelling for predicting patient presentation rates for mass gatherings. Prehosp Disaster Med. 2018;33(4):362-367.

Systematic node management mechanism using ZigBee-based real-time vital sign information monitoring system to manage large numbers of patients.

BACKGROUND: Local hospitals must deal with large numbers of patients during mass casualty incidents, and the wireless sensor networks (WSNs) can help in these situations by monitoring vital signs. Conventional ZigBee nodes can obtain the ID of a device by assigning a unique 16-bit short address or by burning firmware into an IC. These methods tend to complicate node management and lack portability. OBJECTIVE: The study developed a node management mechanism to deal with a large number of patients in real-time, through the wireless monitoring of physiological signals. The mechanism proposed for the ZigBee WSN is based on a three-layer (Coordinator, Control Router, and End Device) tree topology. METHODS: The proposed system includes a node deployment process to formulate a ZigBee WSN as a tree topology, an algorithm to automatically number ZigBee nodes for monitoring and control system (MCS), and an algorithm to automatically obtain the short addresses of nodes for data collection. Specifically, an algorithm automatically collects data from ZigBee nodes for display on a computer graphical user interface (GUI). We also developed a reliable data transmission method capable of resolving the problem of packet loss. RESULTS: The proposed method has been applied in a local hospital. Our research findings provide a valuable reference for the development of ZigBee-based MCS. CONCLUSIONS: The proposed node management mechanism is faster, more reliable, and more intuitive to use, than traditional methods.

[Changes in the average interval since last visit and the number of repeat outpatients in the Patient Survey of Japan].

Objectives　The Patient Survey provides basic information on disease and injury statistics of patients in Japan, and an estimation of the number of patients by disease and injury can be made using this survey. In this survey, the number of outpatients with repeat visits affects the survey results. The average interval since last visit (AILV) and a correction factor are used to estimate the number of repeat outpatients. Patients with AILV > 30 days are not included in the survey. However, in the last years, AILV exceeded 30 days in many cases, suggesting that the current 30-day threshold is no longer suitable. Thus, this study investigated the AILV in the current patient population and the effect of the increase in AILV on the number of repeat outpatients.Methods　Patients Survey data of 1996-2011 were used to estimate the effect of changing the AILV threshold on the number of repeat outpatients.Results　AILV increased for patients with most diseases and injuries. Using the current 30-day threshold, the overall outpatient coverage rate decreased from 91% in 1996 to 78% in 2011. A higher AILV threshold was necessary to maintain the overall outpatient coverage rate. For example, a threshold of 90 days increased the coverage rate in 2011 to 96%. However, raising the threshold markedly increased the number of repeat outpatients. For example, the overall number of repeat outpatients in 2011 increased from 43.01 million with the current 30-day threshold to 71.03 million using the 90-day threshold. The peak of the AILV of outpatients was observed on the next day after the first visit and the peak of the AILV of outpatients was observed every other week.Conclusion　AILV increased over time and changing the AILV threshold markedly increased the number of repeat outpatients and total patients, indicating that there is a need to raise the AILV threshold.

Selecting the patients for morning report sessions: case-based vs. conventional method.

BACKGROUND: One of the most important issues in morning report sessions is the number of patients. The aim of this study was to investigate and compare the number of cases reported in the morning report sessions in terms of case-based and conventional methods from the perspective of pediatric residents of Mashhad University of Medical Sciences. METHODS: The present study was conducted on 24 pediatric residents of Mashhad University of Medical Sciences in the academic year 2014-2015. In this survey, the residents replied to a 20-question researcher-made questionnaire that had been designed to measure the views of residents regarding the number of patients in the morning report sessions using case-based and conventional methods. The validity of the questionnaire was confirmed by experts' views and its reliability by calculating Cronbach's alpha coefficients. Data were analyzed by t-test analysis. RESULTS: The mean age of the residents was 30.852 ± 2.506, and 66.6% of them were female. The results showed that there was no significant relationship among the variables of academic year, gender, and residents' perspective to choosing the number of patients in the morning report sessions (P > 0.05). T-test analysis showed a significant relationship among the average scores of residents in the selection of the case-based method in comparison to the conventional method (P < 0.001). CONCLUSION: From the perspective of residents, the case-based morning report was preferred compared to the conventional method. This method makes residents pay more attention to the details of patients' issues and therefore helps them to better plan how to address patient problems and improve their differential diagnosis skills.

The association of air pollution with the patients' visits to the department of respiratory diseases.

BACKGROUND: The objective of this study was to evaluate the impact of air particulate matter 2.5 (PM2.5) on the daily number of patients' visits to the Department of Respiratory Diseases in a local general hospital. METHODS: The number of patients in outpatient department of respiratory diseases (ODRD) in a general hospital of Jinan, China, the air quality and meteorological data were collected for 1 year. By controlling the confounding factors such as "day of the week" effects and the meteorological factors, the generalized additive Poisson regression analysis was conducted to evaluate the impact of PM2.5 on the number of patients' visits to the ODRD. RESULTS: Within two consecutive days, if the cumulative PM2.5 was less than 200 µg/m(3), the daily number of patients in the ODRD did not increase significantly; however, it increased dramatically when the concentration of PM2.5 particles reached the range between 200 and 400 µg/m(3). CONCLUSION: There is a non-linear relationship between the concentration of atmospheric PM2.5 particles and the daily number of patients in the ODRD.

Current status of patients with buerger disease in Japan.

THE PREVALENCE AND CLINICAL CHARACTERISTICS OF JAPANESE PATIENTS WITH BUERGER DISEASE (THROMBOANGIITIS OBLITERANS: TAO) were analyzed based on the Ministry of Health, Labour and Welfare (MHLW) database in 2009. A total of 129 new patients and 3639 patients in follow-up were selected according to the clinical criteria of TAO. The current number of patients with TAO in Japan is estimated at about 4000. The clinical course is relatively favorable, and the rates of limb morbidity and mortality were not completely discouraging.

Evaluation of outcome and prognostic factors in thoracic primitive neuroectodermal tumor: a study of 84 cases.

BACKGROUND: Data on thoracic primitive neuroectodermal tumor (PNET) treated with a uniform chemotherapy protocol are minimal in the literature. We analyzed patients with thoracic PNET for outcome and prognostic factors. METHODS: This is a single-institutional data review of patients treated between June 2003 and November 2011 with uniform neoadjuvant chemotherapy, surgical intervention, or radiotherapy (RT), or a combination of these treatments as local therapy followed by adjuvant chemotherapy. RESULTS: Thoracic PNET was found in 84 of 374 (22%) patients with PNET with a median age of 15 years (range, 3-40 years); 27 (32%) of these patients had metastases. Thirty patients underwent surgical resection; 27 patients received radical RT after neoadjuvant chemotherapy. The radical RT group did not have adverse tumor characteristics or poor response to neoadjuvant chemotherapy. At median follow-up of 20.8 months (range, 2-104.6 months), 5-year event-free survival (EFS), overall survival (OS), and local control rate (LCR) were 24.4% ± 5.9%, 47.9% ± 8.4%, and 59.3% ± 9%, respectively, for the entire cohort, and 31% ± 7.7%, 59% ± 10.4%, and 67% ± 9.7%, respectively, for the group with localized tumors. In multivariate analysis, symptom duration longer than 4 months (p = 0.03), primary tumor of skeletal origin (p = 0.03), and radical RT (p = 0.006) predicted inferior EFS in the entire cohort and those with localized disease; metastatic disease (p = 0.002) predicted inferior OS. Radical RT predicted inferior LCR in the entire cohort and the group with localized tumor; tumor diameter larger than 8 cm (p = 0.02) and symptom duration longer than 4 months (p = 0.02) predicted inferior LCR in the group with localized tumor. CONCLUSIONS: This is a single-institutional experience of 84 patients with thoracic PNETs who underwent a uniform chemotherapy protocol. Novel prognostic factors were identified for thoracic PNET. All efforts should be made to resect primary tumor after neoadjuvant chemotherapy because radical RT results in inferior EFS and LCR despite good response to neoadjuvant chemotherapy.