Predicting survival in metastatic non-small cell lung cancer patients with poor ECOG-PS: A single-arm prospective study.

BACKGROUND: Patients with advanced non-small cell lung cancer (NSCLC) are a heterogeneous population with short lifespan. We aimed to develop methods to better differentiate patients whose survival was >90 days. METHODS: We evaluated 83 characteristics of 106 treatment-naïve, stage IV NSCLC patients with Eastern Cooperative Oncology Group Performance Status (ECOG-PS) >1. Automated machine learning was used to select a model and optimize hyperparameters. 100-fold bootstrapping was performed for dimensionality reduction for a second ("lite") model. Performance was measured by C-statistic and accuracy metrics in an out-of-sample validation cohort. The "lite" model was validated on a second independent, prospective cohort (N = 42). Network analysis (NA) was performed to evaluate the differences in centrality and connectivity of features. RESULTS: The selected method was ExtraTrees Classifier, with C-statistic of 0.82 (p < 0.01) and accuracy of 0.81 (p = 0.01). The "lite" model had 16 variables and obtained C-statistic of 0.84 (p < 0.01) and accuracy of 0.75 (p = 0.039) in the first cohort, and C-statistic of 0.706 (p < 0.01) and accuracy of 0.714 (p < 0.01) in the second cohort. The networks of patients with lower survival were more interconnected. Features related to cachexia, inflammation, and quality of life had statistically different prestige scores in NA. CONCLUSIONS: Machine learning can assist in the prognostic evaluation of advanced NSCLC. The model generated with a reduced number of features showed high accessibility and reasonable metrics. Features related to quality of life, cachexia, and performance status had increased correlation and importance scores, suggesting that they play a role at later disease stages, in line with the biological rationale already described.

Evaluation of Overground Endoscopy Findings in Colombian Criollo Paso Horses.

The dynamic upper airway functional (URT) problems of Colombian paso horses (CPH) have not been investigated in literature up to date. These horses perform special walking gaits with high poll flexion of the neck. Our goal is to evaluate the upper airway mechanics in CPH, showing abnormal respiratory sounds and poor performance during exercise. Resting and overground endoscopy was performed in 40 CPHs. Statistical analyses were performed using the sciPy package. One-tailed Fisher exact tests were used to check for positive contingency between each pair of upper respiratory tract disorder (P < .05). Arytenoid cartilage collapse was observed in 35 of 40 cases during exercise. Among these, dynamic laryngeal collapse (DLC) was the most significant finding, but ventromedial luxation of the apex of the corniculate process of the arytenoid and recurrent laryngeal neuropathy was also observed. Dorsal displacement of the soft palate was only detected in 4 of 40 cases. DLC was significantly associated with vocal cord collapse, nasopharyngeal collapse, and medial collapse of the margins of the epiglottis, and medial collapse of the margins of the epiglottis was associated with nasopharyngeal collapse. DLC is only a typical feature in some special breeds worldwide. We suggest that the extensive poll flexion and the relatively small laryngeal lumen and high intensitivity workload are the most important predisposing factors of DLC. Ventromedial luxation of the apex of the corniculate process of the arytenoid was over-represented in our caseload, compared with other studies. Whereas, despite the intensive workload, dorsal displacement of the soft palate was relatively uncommon. We presume that this could also be tailored to the high poll flexion performed during the special gaits.

Lombalgia em equinos de vaquejada: achados clínicos, ultrassonográficos e resultados terapêuticos de 25 casos / Back pain in vaquejada horses: clinical, ultrasound findings and therapeutic outcome in 25 cases

Vinte e cinco equinos da raça Quarto de Milha, em atividade esportiva na modalidade de vaquejada no estado do Rio Grande do Norte, Brasil, 15 machos e 10 fêmeas, com idade média de 7,91 + 3,26 anos, foram examinados na propriedade de origem ou centro de treinamento para diagnóstico de baixo desempenho associado a dor lombar. O exame clínico da região toracolombar foi realizado por meio da inspeção, palpação, ultrasonografia, testes de mobilização (ventro e dorsoflexão toracolombar; flexão lateral e rotação toracolombar; flexão lateral e rotação cervical e torácica) além de análise do animal em movimento. As principais alterações encontradas foram miosite epaxial, desmite supra-espinhosa, além de atrofia do músculo multifidus. O tratamento clínico consistiu na administração de injeções periespinhais de Acetonida de triancinolona numa dose total de 200mg, além de exercício controlado. Após o tratamento, todos os animais retornaram a desempenhar suas atividades atlética em nível de desempenho superior ou igual ao demonstrado antes do diagnóstico e tratamento da lombalgia.

Twenty five horses of the Quarter horse breed, in sporting activity in the vaquejada modality in the state of Rio Grande do Norte, Brazil, 15 males and 10 females, with an average age of 7.91 + 3.26 years, were examined in the property of origin or training center for low performance diagnosis associated with low back pain. The clinical examination of the thoracolumbar region was performed through inspection, palpation, ultrasonography, mobilization tests (ventral and thoracolumbar dorsoflexion; lateral flexion and thoracolumbar rotation; lateral flexion and cervical and thoracic rotation) in addition to analysis of the animal in motion. The main changes found were epaxial myositis, supraspinatus desmite, as well as atrophy of the multifidus muscle. Clinical treatment consisted of administering perispinal injections of triamcinolone Acetonide in a total dose of 200mg, in addition to controlled exercise. After treatment, all animals returned to performing their athletic activities at a performance level greater than or equal to that demonstrated before the diagnosis and treatment of low back pain.

Lombalgia em equinos de vaquejada: achados clínicos, ultrasonográficos e resultados terapêuticos de 25 casos / Back pain in vaquejada horses: clinical, ultrasound findings and therapeutic outcome in 25 cases

25 equinos da raça Quarto de Milha, em atividade esportiva na modalidade de vaquejada no estado do Rio Grande do Norte, Brasil, ambos os sexos, com idade média de 7,91 + 3,26 anos, foram examinados na propriedade de origem ou centro de treinamento para diagnóstico de baixo desempenho associado a dor lombar. O exame clínico da região toracolombar foi realizado por meio da inspeção, palpação, testes de mobilização (ventro e dorsoflexão toracolombar; flexão lateral e rotação toracolombar; flexão lateral e rotação cervical e torácica) além de análise do animal em movimento. As principais alterações encontradas foram miosite epaxial, desmite ligamento supra-espinhoso, além de atrofia do músculo multifidus. O tratamento clínico consistiu na administração de injeções periespinhais de triancinolona numa dose total de 200mg, além de exercício controlado. Após o tratamento, todos os animais retornaram a desempenhar suas atividades atlética em nível de desempenho superior ou igual ao demonstrado antes do diagnóstico e tratamento da lombalgia.

Twenty five horses of the Quarter horse breed, in sporting activity in the vaquejada modality in the state of Rio Grande do Norte, Brazil, 15 males and 10 females, with an average age of 7.91 + 3.26 years, were examined in the property of origin or training center for low performance diagnosis associated with low back pain. The clinical examination of the thoracolumbar region was performed through inspection, palpation, ultrasonography, mobilization tests (ventral and thoracolumbar dorsoflexion; lateral flexion and thoracolumbar rotation; lateral flexion and cervical and thoracic rotation) in addition to analysis of the animal in motion. The main changes found were epaxial myositis, supraspinatus desmite, as well as atrophy of the multifidus muscle. Clinical treatment consisted of administering perispinal injections of triamcinolone Acetonide in a total dose of 200mg, in addition to controlled exercise. After treatment, all animals returned to performing their athletic activities at a performance level greater than or equal to that demonstrated before the diagnosis and treatment of low back pain.

Lombalgia em equinos de vaquejada: achados clínicos, ultrasonográficos e resultados terapêuticos de 25 casos / Back pain in vaquejada horses: clinical, ultrasound findings and therapeutic outcome in 25 cases

25 equinos da raça Quarto de Milha, em atividade esportiva na modalidade de vaquejada no estado do Rio Grande do Norte, Brasil, ambos os sexos, com idade média de 7,91 + 3,26 anos, foram examinados na propriedade de origem ou centro de treinamento para diagnóstico de baixo desempenho associado a dor lombar. O exame clínico da região toracolombar foi realizado por meio da inspeção, palpação, testes de mobilização (ventro e dorsoflexão toracolombar; flexão lateral e rotação toracolombar; flexão lateral e rotação cervical e torácica) além de análise do animal em movimento. As principais alterações encontradas foram miosite epaxial, desmite ligamento supra-espinhoso, além de atrofia do músculo multifidus. O tratamento clínico consistiu na administração de injeções periespinhais de triancinolona numa dose total de 200mg, além de exercício controlado. Após o tratamento, todos os animais retornaram a desempenhar suas atividades atlética em nível de desempenho superior ou igual ao demonstrado antes do diagnóstico e tratamento da lombalgia.

Twenty five horses of the Quarter horse breed, in sporting activity in the vaquejada modality in the state of Rio Grande do Norte, Brazil, 15 males and 10 females, with an average age of 7.91 + 3.26 years, were examined in the property of origin or training center for low performance diagnosis associated with low back pain. The clinical examination of the thoracolumbar region was performed through inspection, palpation, ultrasonography, mobilization tests (ventral and thoracolumbar dorsoflexion; lateral flexion and thoracolumbar rotation; lateral flexion and cervical and thoracic rotation) in addition to analysis of the animal in motion. The main changes found were epaxial myositis, supraspinatus desmite, as well as atrophy of the multifidus muscle. Clinical treatment consisted of administering perispinal injections of triamcinolone Acetonide in a total dose of 200mg, in addition to controlled exercise. After treatment, all animals returned to performing their athletic activities at a performance level greater than or equal to that demonstrated before the diagnosis and treatment of low back pain.(AU)

Palliative chemotherapy outcomes in patients with ECOG-PS higher than 1.

PURPOSE: Although patients with incurable disease and Eastern Cooperative Oncology Group performance status (ECOG-PS ≥ 2) are underrepresented in clinical trials, they are frequently offered palliative chemotherapy (pCT) in daily clinical practice in order to improve symptoms and quality of life. In this case-control retrospective analysis, our goal was to identify factors associated with poorer survival and lack of benefit of pCT in this population. PATIENTS AND METHODS: We evaluated 2,514 patients who died between August 2011 and July 2012 in an academic cancer care institution and its hospice. A total of 301 patients with solid tumours and ECOG-PS ≥ 2 at prescription of pCT were selected for this case-control retrospective analysis. Cases were defined as patients who survived less than 90 days after the first cycle of first line pCT, and controls were those who had a longer survival. RESULTS: 142 cases and 159 controls were included. Cases were more likely to experience grade ≥ 3 toxicity (43% versus 28%; p = 0.005), die of toxicity (16% versus 6%; p < 0.001) and not be offered best supportive care (BSC) only (47% versus 71%; p < 0.001). Median overall survival was 204 among controls and 34 days in cases (hazard ratio = 0.177; 95%, confidence interval = 0.015-0.033, p < 0.001). Logistic regression analysis identified ECOG-PS > 2 (odds ratio (OR) = 2.3, p = 0.044) and serum creatinine (sCr) > 1 mg/dL (OR = 11.2, p < 0.001) as independent predictors of 90-day mortality. CONCLUSIONS: The independent predictors of short survival (less than 3 months) after initiation of pCT in this population were ECOG-PS > 2 and elevated sCr. Therefore, patient selection is crucial, as pCT may be deleterious in ECOG-PS ≥ 2 pts.

Treatment of patients with metastatic colorectal cancer and poor performance status: current evidence and challenges

Patients with unresectable metastatic colorectal cancer live for a median of three years when treated with standard therapies. While the evidence guiding cancer-directed treatment of this disease comes from phase III trials that have mostly enrolled patients with good performance status, some patients present with poor clinical conditions. The best treatment for these patients remains to be determined. We performed a systematic review of the treatment outcomes of patients with metastatic colorectal cancer and poor performance status, defined as Eastern Cooperative Oncology Group performance status ≥2. Eligible articles were prospective or retrospective studies or case reports published in English, Portuguese or Spanish. We searched PubMed, EMBASE, LILACS and the Cochrane Library from onset until October 2017 using specific keywords for each search. We found a total of 18 publications, mostly case reports and retrospective studies (14 articles). One was an uncontrolled prospective trial, two were observational studies and one was an individual patient meta-analysis. Although some studies suggested benefits in terms of symptomatic response with standard chemotherapy, with good safety profiles when dose-reduced regimens were administered, a true survival gain could not be demonstrated. The scientific evidence for treating metastatic colorectal cancer patients with poor performance status is scarce, and more studies evaluating treatment for this population are necessary since this condition is not uncommon in clinical practice, particularly in the public healthcare system and developing countries and among destitute populations.