Jay Parekh, Kaushal Parikh, Joshua E. Reuss, Alex Friedlaender, Alfredo Addeo
Zweck der Übersichtsarbeit: Seit Jahrzehnten ist das nicht kleinzellige Lungenkarzinom (non-small cell lung cancer, NSCLC) im Frühstadium potenziell heilbar, weist aber eine inakzeptabel hohe Rückfallrate auf. Jüngste Ergebnisse: Die Anti-PD-(L)1-Immuncheckpoint-Blockade (ICB) hat die Behandlung des fortgeschrittenen NSCLC revolutioniert. Mit den jüngsten Zulassungen im perioperativen Bereich ist sie nun in der Lage, das systemische Behandlungsparadigma für das lokalisierte und lokal fortgeschrittene NSCLC zu verändern.
< b >翻案的目的:< b >数十年来，这种不是小肿瘤的肺结核是可以治愈的早期肺结核但是会有不可接受的高复发率< b>最新成果:< / b>纽约警署(L)1免疫检查清单彻底改变了高级NSCLC的治疗方法有了最新的手术许可证，该指标已能够改变系统性治疗的结果，面向局部和本地的NSCLC。
{"title":"Aktuelle Ansätze zur neoadjuvanten Immuntherapie des resektablen nicht kleinzelligen Lungenkarzinoms","authors":"Jay Parekh, Kaushal Parikh, Joshua E. Reuss, Alex Friedlaender, Alfredo Addeo","doi":"10.1159/000533780","DOIUrl":"https://doi.org/10.1159/000533780","url":null,"abstract":"<b>Zweck der Übersichtsarbeit:</b> Seit Jahrzehnten ist das nicht kleinzellige Lungenkarzinom (non-small cell lung cancer, NSCLC) im Frühstadium potenziell heilbar, weist aber eine inakzeptabel hohe Rückfallrate auf. <b>Jüngste Ergebnisse:</b> Die Anti-PD-(L)1-Immuncheckpoint-Blockade (ICB) hat die Behandlung des fortgeschrittenen NSCLC revolutioniert. Mit den jüngsten Zulassungen im perioperativen Bereich ist sie nun in der Lage, das systemische Behandlungsparadigma für das lokalisierte und lokal fortgeschrittene NSCLC zu verändern.","PeriodicalId":477056,"journal":{"name":"Karger Kompass","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135968196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Die Immunglobulin-A-Vaskulitis (IgAV) ist eine systemische Vaskulitis der kleinen Gefäße mit Ig(Immunglobulin)A-Immunkomplexbildung und einem breiten Spektrum klinischer Konstellationen. Typische Manifestationen sind Purpura, Arthralgien oder Arthritiden, Enteritis und Glomerulonephritis. Die IgAV ist die häufigste Vaskulitis im Kindesalter mit meist unkompliziertem und selbstlimitierendem Verlauf. Erwachsene erkranken deutlich seltener an einer IgAV, wobei die Verläufe insbesondere bei renaler oder gastrointestinaler Manifestation komplizierter sind. Verschiedene Trigger der IgAV, darunter Infektionen, wurden beschrieben, wobei eine gestörte Glykosylierung von IgA1 mit konsekutiver Freilegung von Bindungsstellen für Autoantikörper die pathophysiologische Voraussetzung für die Vaskulitis ist. Therapeutische Strategien mit Immunsuppressiva sind bisher mit geringer Evidenz unterlegt, berücksichtigen die Schwere der Organmanifestationen und orientieren sich an den Empfehlungen zur Behandlung anderer Vaskulitiden der kleinen Gefäße. Benigne Verläufe werden symptomatisch behandelt. Die langfristige Prognose der IgAV ist von der renalen Manifestation beeinflusst.
{"title":"Update Immunglobulin-A-Vaskulitis","authors":"Thomas Neumann","doi":"10.1159/000533596","DOIUrl":"https://doi.org/10.1159/000533596","url":null,"abstract":"Die Immunglobulin-A-Vaskulitis (IgAV) ist eine systemische Vaskulitis der kleinen Gefäße mit Ig(Immunglobulin)A-Immunkomplexbildung und einem breiten Spektrum klinischer Konstellationen. Typische Manifestationen sind Purpura, Arthralgien oder Arthritiden, Enteritis und Glomerulonephritis. Die IgAV ist die häufigste Vaskulitis im Kindesalter mit meist unkompliziertem und selbstlimitierendem Verlauf. Erwachsene erkranken deutlich seltener an einer IgAV, wobei die Verläufe insbesondere bei renaler oder gastrointestinaler Manifestation komplizierter sind. Verschiedene Trigger der IgAV, darunter Infektionen, wurden beschrieben, wobei eine gestörte Glykosylierung von IgA1 mit konsekutiver Freilegung von Bindungsstellen für Autoantikörper die pathophysiologische Voraussetzung für die Vaskulitis ist. Therapeutische Strategien mit Immunsuppressiva sind bisher mit geringer Evidenz unterlegt, berücksichtigen die Schwere der Organmanifestationen und orientieren sich an den Empfehlungen zur Behandlung anderer Vaskulitiden der kleinen Gefäße. Benigne Verläufe werden symptomatisch behandelt. Die langfristige Prognose der IgAV ist von der renalen Manifestation beeinflusst.","PeriodicalId":477056,"journal":{"name":"Karger Kompass","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136013972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"VEXAS mit Präsentation von untypischen Knochenmarkgranulomen: Ein Fallbericht","authors":"Sabine Adler","doi":"10.1159/000534382","DOIUrl":"https://doi.org/10.1159/000534382","url":null,"abstract":"","PeriodicalId":477056,"journal":{"name":"Karger Kompass","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135968202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Following induction of remission with rituximab in anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) relapse rates are high, especially in patients with history of relapse. Relapses are associated with increased exposure to immunosuppressive medications, the accrual of damage and increased morbidity and mortality. The RITAZAREM trial compared the efficacy of repeat-dose rituximab to daily oral azathioprine for prevention of relapse in patients with relapsing AAV in whom remission was reinduced with rituximab. Methods: RITAZAREM was an international randomized controlled, open-label, superiority trial that recruited 188 patients at the time of an AAV relapse from 29 centres in seven countries between April 2013 and November 2016. All patients received rituximab and glucocorticoids to reinduce remission. Patients achieving remission by 4 months were randomised to receive rituximab intravenously (1000 mg every 4 months, through month 20) (85 patients) or azathioprine (2 mg/kg/day, tapered after month 24) (85 patients) and followed for a minimum of 36 months. The primary outcome was time to disease relapse (either major or minor relapse). Results: Rituximab was superior to azathioprine in preventing relapse: HR 0.41; 95% CI 0.27 to 0.61, p<0.001. 19/85 (22%) patients in the rituximab group and 31/85 (36%) in the azathioprine group experienced at least one serious adverse event during the treatment period. There were no differences in rates of hypogammaglobulinaemia or infection between groups.
{"title":"Was ist die beste Relapstherapie bei der ANCA-assoziierten Vaskulitis?","authors":"Sibylle von Vietinghoff","doi":"10.1159/000534353","DOIUrl":"https://doi.org/10.1159/000534353","url":null,"abstract":"<b>Objective:</b> Following induction of remission with rituximab in anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) relapse rates are high, especially in patients with history of relapse. Relapses are associated with increased exposure to immunosuppressive medications, the accrual of damage and increased morbidity and mortality. The RITAZAREM trial compared the efficacy of repeat-dose rituximab to daily oral azathioprine for prevention of relapse in patients with relapsing AAV in whom remission was reinduced with rituximab. <b>Methods:</b> RITAZAREM was an international randomized controlled, open-label, superiority trial that recruited 188 patients at the time of an AAV relapse from 29 centres in seven countries between April 2013 and November 2016. All patients received rituximab and glucocorticoids to reinduce remission. Patients achieving remission by 4 months were randomised to receive rituximab intravenously (1000 mg every 4 months, through month 20) (85 patients) or azathioprine (2 mg/kg/day, tapered after month 24) (85 patients) and followed for a minimum of 36 months. The primary outcome was time to disease relapse (either major or minor relapse). <b>Results:</b> Rituximab was superior to azathioprine in preventing relapse: HR 0.41; 95% CI 0.27 to 0.61, p&#x3c;0.001. 19/85 (22%) patients in the rituximab group and 31/85 (36%) in the azathioprine group experienced at least one serious adverse event during the treatment period. There were no differences in rates of hypogammaglobulinaemia or infection between groups.","PeriodicalId":477056,"journal":{"name":"Karger Kompass","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136013973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To investigate the differential diagnostic spectrum in patients with suspected Behçet’s syndrome (BS) in low prevalence regions. In addition, the number of patients fulfilling the ICBD criteria despite not having BS was evaluated. Methods: This retrospective analysis was performed in two referral centers for BS. Patients with confirmed BS (clinical diagnosis with fulfilment of ISG criteria or a score of ≥ 5 points in the ICBD criteria) were excluded. The remaining patients were divided into eleven differential diagnosis categories. If no definitive alternative diagnosis could be established, patients were termed ‘probable BS’ in case of (1) relapsing orogenital aphthosis in the absence of other causes and either HLA-B51 positivity, origin from an endemic area or presence of an additional typical BS symptom that is not part of the classification criteria or (2) with 3–4 points scored in the ICBD criteria. Results: In total 202 patients were included and categorized as follows: 58 patients (28.7%) as ‘probable BS’, 57 (28.2%) skin disease, 26 (12.9%) chronic pain syndrome, 14 (6.9%) eye disease, 11 (5.4%) spondyloarthropathy, 9 (4.5%) gastrointestinal disease, 7 (3.5%) neurological disease, 4 (2%) arthritis, 3 (1.5%) auto-inflammation, 3 (1.5%) connective tissue disease, 10 (5.0%) miscellaneous disease. HLA-B51 was positive in 55/132 (41.6%); 75/202 (37.1%) of the patients fulfilled the ICBD criteria.
{"title":"Morbus Behçet: Versorgung der Patienten in Spezialzentren ist notwendig","authors":"Carina Mihai","doi":"10.1159/000534166","DOIUrl":"https://doi.org/10.1159/000534166","url":null,"abstract":"<b>Objective:</b> To investigate the differential diagnostic spectrum in patients with suspected Behçet’s syndrome (BS) in low prevalence regions. In addition, the number of patients fulfilling the ICBD criteria despite not having BS was evaluated. <b>Methods:</b> This retrospective analysis was performed in two referral centers for BS. Patients with confirmed BS (clinical diagnosis with fulfilment of ISG criteria or a score of ≥ 5 points in the ICBD criteria) were excluded. The remaining patients were divided into eleven differential diagnosis categories. If no definitive alternative diagnosis could be established, patients were termed ‘probable BS’ in case of (1) relapsing orogenital aphthosis in the absence of other causes and either HLA-B51 positivity, origin from an endemic area or presence of an additional typical BS symptom that is not part of the classification criteria or (2) with 3–4 points scored in the ICBD criteria. <b>Results:</b> In total 202 patients were included and categorized as follows: 58 patients (28.7%) as ‘probable BS’, 57 (28.2%) skin disease, 26 (12.9%) chronic pain syndrome, 14 (6.9%) eye disease, 11 (5.4%) spondyloarthropathy, 9 (4.5%) gastrointestinal disease, 7 (3.5%) neurological disease, 4 (2%) arthritis, 3 (1.5%) auto-inflammation, 3 (1.5%) connective tissue disease, 10 (5.0%) miscellaneous disease. HLA-B51 was positive in 55/132 (41.6%); 75/202 (37.1%) of the patients fulfilled the ICBD criteria.","PeriodicalId":477056,"journal":{"name":"Karger Kompass","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136013975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Khiem T. Vu, Rachel M. Wolfe, Jonathan E. Lambird, Danielle L.V. Maracaja
Hintergrund: VEXAS ist eine kürzlich beschriebene entzündliche Erkrankung, die durch Mutationen im UBA1-Gen verursacht wird. Die Symptome sind vielfältig und umfassen Fieber, Knorpelentzündung, Lungenentzündung, Vaskulitis, neutrophile Dermatosen und makrozytäre Anämie. Zytoplasmatische Einschlüsse in myeloischen und erythroiden Vorläuferzellen im Knochenmark sind ein charakteristisches Merkmal. Hier berichten wir über den ersten Fall von VEXAS mit nicht verkäsenden Granulomen im Knochenmark. Fallvorstellung: Ein 62-jähriger asiatischer Mann stellte sich mit hohem Fieber, Erythema nodosum, entzündlicher Arthritis und periorbitaler Entzündung vor. Die Laborwerte wiesen anhaltend erhöhte Entzündungsmarker und eine makrozytäre Anämie auf. Im Laufe der Jahre verbesserten sich seine Symptome und Entzündungsmarker nur unter der Behandlung mit Glukokortikoiden und traten wieder auf, wenn die Prednison-Dosis unter 15–20 mg täglich gesenkt wurde. Er unterzog sich einer Knochenmarksbiopsie, die nicht verkäsende Granulome zeigte, und einer PET-Untersuchung, die eine hilar/mediastinale Lymphadenopathie ergab. Bei ihm wurde zunächst eine IgG4-bedingte Erkrankung (behandelt mit Rituximab) diagnostiziert und später eine Sarkoidose (behandelt mit Infliximab). Nachdem diese Mittel versagt hatten, wurde die Möglichkeit von VEXAS in Betracht gezogen und später durch molekulare Tests bestätigt.
{"title":"Ein Fall von VEXAS-Syndrom mit ungewöhnlichen Granulomen im Knochenmark: ein diagnostisches Dilemma","authors":"Khiem T. Vu, Rachel M. Wolfe, Jonathan E. Lambird, Danielle L.V. Maracaja","doi":"10.1159/000533597","DOIUrl":"https://doi.org/10.1159/000533597","url":null,"abstract":"<b>Hintergrund:</b> VEXAS ist eine kürzlich beschriebene entzündliche Erkrankung, die durch Mutationen im <i>UBA1</i>-Gen verursacht wird. Die Symptome sind vielfältig und umfassen Fieber, Knorpelentzündung, Lungenentzündung, Vaskulitis, neutrophile Dermatosen und makrozytäre Anämie. Zytoplasmatische Einschlüsse in myeloischen und erythroiden Vorläuferzellen im Knochenmark sind ein charakteristisches Merkmal. Hier berichten wir über den ersten Fall von VEXAS mit nicht verkäsenden Granulomen im Knochenmark. <b>Fallvorstellung:</b> Ein 62-jähriger asiatischer Mann stellte sich mit hohem Fieber, Erythema nodosum, entzündlicher Arthritis und periorbitaler Entzündung vor. Die Laborwerte wiesen anhaltend erhöhte Entzündungsmarker und eine makrozytäre Anämie auf. Im Laufe der Jahre verbesserten sich seine Symptome und Entzündungsmarker nur unter der Behandlung mit Glukokortikoiden und traten wieder auf, wenn die Prednison-Dosis unter 15–20 mg täglich gesenkt wurde. Er unterzog sich einer Knochenmarksbiopsie, die nicht verkäsende Granulome zeigte, und einer PET-Untersuchung, die eine hilar/mediastinale Lymphadenopathie ergab. Bei ihm wurde zunächst eine IgG4-bedingte Erkrankung (behandelt mit Rituximab) diagnostiziert und später eine Sarkoidose (behandelt mit Infliximab). Nachdem diese Mittel versagt hatten, wurde die Möglichkeit von VEXAS in Betracht gezogen und später durch molekulare Tests bestätigt.","PeriodicalId":477056,"journal":{"name":"Karger Kompass","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135968195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The diagnostic accuracy and safety of transbronchial lung cryobiopsy (TBLC) via a flexible bronchoscope under sedation compared with that of surgical lung biopsy (SLB) in the same patients is unknown. Methods: Retrospectively the data of fifty-two patients with interstitial lung diseases (median age: 63.5 years; 21 auto-antibody positive) who underwent TBLC followed by SLB (median time from TBLC to SLB: 57 days) was collected. The samples from TBLC and SLB were randomly labelled to mask the relationship between the two samples. Diagnosis was made independently by pathologists, radiologists, and pulmonary physicians in a stepwise manner, and a final diagnosis was made at multidisciplinary discussion (MDD). In each diagnostic step the specific diagnosis, the diagnostic confidence level, idiopathic pulmonary fibrosis (IPF) diagnostic guideline criteria, and treatment strategy were recorded. Results: Without clinical and radiological information, the agreement between the histological diagnoses by TBLC and SLB was 42.3% (kappa [κ] = 0.23, 95% confidence interval [CI]: 0.08–0.39). However, the agreement between the TBLC-MDD and SLB-MDD diagnoses and IPF/non-IPF diagnosis using the two biopsy methods was 65.4% (κ = 0.57, 95% CI: 0.42–0.73) and 90.4% (47/52), respectively. Out of 38 (73.1%) cases diagnosed with high or definite confidence at TBLC-MDD, 29 had concordant SLB-MDD diagnoses (agreement: 76.3%, κ = 0.71, 95% CI: 0.55–0.87), and the agreement for IPF/non-IPF diagnoses was 97.4% (37/38). By adding the pathological diagnosis, the inter-observer agreement of clinical diagnosis improved from κ = 0.22 to κ = 0.42 for TBLC and from κ = 0.27 to κ = 0.38 for SLB, and the prevalence of high or definite diagnostic confidence improved from 23.0% to 73.0% and from 17.3% to 73.0%, respectively. Of all 383 TBLC performed during the same period, pneumothorax occurred in 5.0% of cases, and no severe bleeding, acute exacerbation of interstitial lung disease, or fatal event was observed.
{"title":"ILD: Wann brauchen wir die chirurgische Lungenbiopsie in der Diagnostik?","authors":"Manfred Wagner","doi":"10.1159/000534325","DOIUrl":"https://doi.org/10.1159/000534325","url":null,"abstract":"<b>Background:</b> The diagnostic accuracy and safety of transbronchial lung cryobiopsy (TBLC) via a flexible bronchoscope under sedation compared with that of surgical lung biopsy (SLB) in the same patients is unknown. <b>Methods:</b> Retrospectively the data of fifty-two patients with interstitial lung diseases (median age: 63.5 years; 21 auto-antibody positive) who underwent TBLC followed by SLB (median time from TBLC to SLB: 57 days) was collected. The samples from TBLC and SLB were randomly labelled to mask the relationship between the two samples. Diagnosis was made independently by pathologists, radiologists, and pulmonary physicians in a stepwise manner, and a final diagnosis was made at multidisciplinary discussion (MDD). In each diagnostic step the specific diagnosis, the diagnostic confidence level, idiopathic pulmonary fibrosis (IPF) diagnostic guideline criteria, and treatment strategy were recorded. <b>Results:</b> Without clinical and radiological information, the agreement between the histological diagnoses by TBLC and SLB was 42.3% (kappa [κ] = 0.23, 95% confidence interval [CI]: 0.08–0.39). However, the agreement between the TBLC-MDD and SLB-MDD diagnoses and IPF/non-IPF diagnosis using the two biopsy methods was 65.4% (κ = 0.57, 95% CI: 0.42–0.73) and 90.4% (47/52), respectively. Out of 38 (73.1%) cases diagnosed with high or definite confidence at TBLC-MDD, 29 had concordant SLB-MDD diagnoses (agreement: 76.3%, κ = 0.71, 95% CI: 0.55–0.87), and the agreement for IPF/non-IPF diagnoses was 97.4% (37/38). By adding the pathological diagnosis, the inter-observer agreement of clinical diagnosis improved from κ = 0.22 to κ = 0.42 for TBLC and from κ = 0.27 to κ = 0.38 for SLB, and the prevalence of high or definite diagnostic confidence improved from 23.0% to 73.0% and from 17.3% to 73.0%, respectively. Of all 383 TBLC performed during the same period, pneumothorax occurred in 5.0% of cases, and no severe bleeding, acute exacerbation of interstitial lung disease, or fatal event was observed.","PeriodicalId":477056,"journal":{"name":"Karger Kompass","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136357084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Combination immunotherapy is widely used in clinical practice as the first-line treatment for advanced non-small-cell lung cancer (NSCLC). However, predictive factors associated with long-term response to combination immunotherapy have not been well investigated. Herein, we compared the clinical findings, including systemic inflammatory nutritional biomarkers, between responders and nonresponders to combination immunotherapy. In addition, we investigated the predictive factors associated with long-term response to combination immunotherapy. Methods: This study included a total of 112 previously untreated advanced NSCLC patients who received combination immunotherapy at eight institutions in Nagano prefecture between December 2018 and April 2021. The responders were defined as those who achieved progression-free survival for 9 months or longer with combined immunotherapy. We evaluated predictive factors associated with long-term response, and the favorable prognostic predictors associated with overall survival (OS) using statistical analyses. Results: The responder and nonresponder groups included 54 and 58 patients, respectively. Compared with the nonresponder group, the responder group had significantly younger age (p = 0.046), higher prognostic nutritional index (44.8 vs. 40.7, p = 0.010), lower C-reactive protein/albumin ratio (CAR) (0.17 vs. 0.67, p = 0.001), and a higher rate of complete plus partial response (83.3% vs. 34.5%, p < 0.001). The area under the curve and optimal cut-off value for CAR were 0.691 and 0.215, respectively. The CAR and best objective response were identified as independent favorable prognostic predictors associated with OS in the multivariate analyses.
{"title":"NSCLC: Unabhängige prädiktive Marker für Langzeitansprechen auf kombinierte Immuntherapie identifizieren","authors":"Miriam Möller, Wolfgang Schütte","doi":"10.1159/000534286","DOIUrl":"https://doi.org/10.1159/000534286","url":null,"abstract":"<b>Introduction:</b> Combination immunotherapy is widely used in clinical practice as the first-line treatment for advanced non-small-cell lung cancer (NSCLC). However, predictive factors associated with long-term response to combination immunotherapy have not been well investigated. Herein, we compared the clinical findings, including systemic inflammatory nutritional biomarkers, between responders and nonresponders to combination immunotherapy. In addition, we investigated the predictive factors associated with long-term response to combination immunotherapy. <b>Methods:</b> This study included a total of 112 previously untreated advanced NSCLC patients who received combination immunotherapy at eight institutions in Nagano prefecture between December 2018 and April 2021. The responders were defined as those who achieved progression-free survival for 9 months or longer with combined immunotherapy. We evaluated predictive factors associated with long-term response, and the favorable prognostic predictors associated with overall survival (OS) using statistical analyses. <b>Results:</b> The responder and nonresponder groups included 54 and 58 patients, respectively. Compared with the nonresponder group, the responder group had significantly younger age (p = 0.046), higher prognostic nutritional index (44.8 vs. 40.7, <i>p</i> = 0.010), lower C-reactive protein/albumin ratio (CAR) (0.17 vs. 0.67, <i>p</i> = 0.001), and a higher rate of complete plus partial response (83.3% vs. 34.5%, <i>p</i> &#x3c; 0.001). The area under the curve and optimal cut-off value for CAR were 0.691 and 0.215, respectively. The CAR and best objective response were identified as independent favorable prognostic predictors associated with OS in the multivariate analyses.","PeriodicalId":477056,"journal":{"name":"Karger Kompass","volume":"468 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135546530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction and objectives: High-flow nasal cannula oxygen therapy (HFNC) has been successfully used for the treatment of acute hypoxaemic respiratory failure (AHRF) secondary to SARS-CoV-2 pneumonia and being effective in reducing progression to invasive mechanical ventilation. The objective of this study was to assess the usefulness of HFNC on a hospital ward for the treatment of AHRF secondary to SARS-CoV-2 pneumonia and its impact on the need for intensive care unit (ICU) admission and endotracheal intubation. Other objectives include identifying potential physiological parameters and/or biomarkers for predicting treatment failure and assessing the clinical course and survival. Methods: Observational study based on data collected prospectively between March 2020 and February 2021 in a single hospital on patients diagnosed with AHRF secondary to SARS-CoV-2 pneumonia who received HFNC outside an ICU. Results: One hundred and seventy-one patients out of 1090 patients hospitalised for SARS-CoV-2 infection. HFNC was set as the ceiling of treatment in 44 cases; 12 survived (27.3%). Among the other 127 patients, intubation was performed in 25.9% of cases with a mortality of 11.8%. Higher creatinine levels (OR 1.942, 95% CI 1.04; 3.732; p = 0.036) and Comorbidity-Age-Lymphocyte-LDH (CALL) score (OR 1.273, 95% CI 1.033; 1.617; p = 0.033) were associated with a higher risk of intubation. High platelet count at HFNC initiation was predictive of good treatment response (OR 0.935, 95% CI 0.884; 0.983; p = 0.012).
简介和目标:</b>高流量鼻插管氧疗(HFNC)已成功用于治疗SARS-CoV-2肺炎继发性急性低氧性呼吸衰竭(AHRF)，并可有效减少进展为有创机械通气。本研究的目的是评估HFNC在医院病房治疗SARS-CoV-2肺炎继发AHRF的有效性及其对重症监护病房(ICU)入院和气管插管需求的影响。其他目标包括确定潜在的生理参数和/或生物标志物，以预测治疗失败，评估临床病程和生存期。& lt; b>方法:& lt; / b>基于2020年3月至2021年2月在一家医院前瞻性收集的数据，对在ICU外接受HFNC的诊断为SARS-CoV-2肺炎继发AHRF的患者进行观察性研究。& lt; b>结果:& lt; / b>在1090名SARS-CoV-2感染患者中，有171名患者住院。以HFNC为上限治疗44例;存活12例(27.3%)。在其他127例患者中，插管占25.9%，死亡率为11.8%。较高的肌酐水平(OR 1.942, 95% CI 1.04;3.732;p = 0.036)和comorbidi - age - lymphocyte - ldh (CALL)评分(OR 1.273, 95% CI 1.033;1.617;P = 0.033)与插管风险较高相关。HFNC开始时的高血小板计数预示着良好的治疗反应(OR 0.935, 95% CI 0.884;0.983;P = 0.012)。
{"title":"SARS-CoV-2-Pneumonie: Nasale Highflowtherapie als etablierter Baustein der Therapie des akuten hypoxämischen Atmungsversagens","authors":"Johannes Knoch","doi":"10.1159/000534290","DOIUrl":"https://doi.org/10.1159/000534290","url":null,"abstract":"<b>Introduction and objectives:</b> High-flow nasal cannula oxygen therapy (HFNC) has been successfully used for the treatment of acute hypoxaemic respiratory failure (AHRF) secondary to SARS-CoV-2 pneumonia and being effective in reducing progression to invasive mechanical ventilation. The objective of this study was to assess the usefulness of HFNC on a hospital ward for the treatment of AHRF secondary to SARS-CoV-2 pneumonia and its impact on the need for intensive care unit (ICU) admission and endotracheal intubation. Other objectives include identifying potential physiological parameters and/or biomarkers for predicting treatment failure and assessing the clinical course and survival. <b>Methods:</b> Observational study based on data collected prospectively between March 2020 and February 2021 in a single hospital on patients diagnosed with AHRF secondary to SARS-CoV-2 pneumonia who received HFNC outside an ICU. <b>Results:</b> One hundred and seventy-one patients out of 1090 patients hospitalised for SARS-CoV-2 infection. HFNC was set as the ceiling of treatment in 44 cases; 12 survived (27.3%). Among the other 127 patients, intubation was performed in 25.9% of cases with a mortality of 11.8%. Higher creatinine levels (OR 1.942, 95% CI 1.04; 3.732; p = 0.036) and Comorbidity-Age-Lymphocyte-LDH (CALL) score (OR 1.273, 95% CI 1.033; 1.617; p = 0.033) were associated with a higher risk of intubation. High platelet count at HFNC initiation was predictive of good treatment response (OR 0.935, 95% CI 0.884; 0.983; p = 0.012).","PeriodicalId":477056,"journal":{"name":"Karger Kompass","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135546794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Importance: There are few robust evaluations of disease-specific question prompt sheets (QPS) in patient-physician communication among patients with advanced cancer. Objective: To compare the patient perception of helpfulness, global evaluation, and preference for the QPS vs a general information sheet (GIS), and to examine the effect of the QPS on participants’ anxiety, participants’ speaking time, number of questions asked, and length of the clinical encounter. Design: , setting, and participants: This controlled, double-blind randomized clinical trial was conducted at an outpatient palliative and supportive care clinic in a cancer center in the US. Eligible patients were 18 years or older, had a cancer diagnosis, and were undergoing their first outpatient consultation visit with a palliative care physician from September 1, 2017, to May 31, 2019. Data analysis used a modified intention-to-treat design. Data were analyzed from May 18 to June 27, 2022. Intervention: QPS, a 25-item list of questions developed by expert palliative care clinicians using a Delphi process and tested among ambulatory advanced cancer patients. The control was GIS, generic information material given routinely to patients seen at the supportive care clinic. Main outcomes and measures: The main outcome was patient perception of helpfulness. Secondary outcomes included global evaluation and preference of QPS compared with GIS immediately after the encounter. Results: A total of 130 patients (mean [SD] age, 58.6 [13.3] years; 79 [60.8%] female) were randomized to receive either QPS (67 patients [51.5%]) or GIS (63 patients [48.5%]). Patients considered QPS and GIS equally helpful, with no statistically significant difference (mean [SD] helpfulness score, 7.2 [2.3] points vs 7.1 [2.7] points; P = .79). The QPS group, compared with the GIS group, had a higher global positive view of the material (mean [SD] global perception score, 7.1 [1.3] vs 6.5 [1.7]; P = .03) and felt it prompted them more to generate new questions (mean [SD] rating, 7.0 [2.9] vs 5.3 [3.5]; P = .005). Of 47 patients asked their preference between the items, more participants preferred the QPS to the GIS in communicating with their physicians (24 patients [51.1%] vs 7 patients [14.9%]; P = .01) at the 4-week follow-up. No significant differences between the QPS and GIS groups were observed regarding participant anxiety, speaking time, number of questions asked, or consultation length (eg, mean [SD] anxiety rating, 2.3 [3.7] vs 1.6 [2.7]; P = .19). Conclusions: and relevance: In this randomized clinical trial, participants perceived both QPS and GIS as equally helpful, but they had a more positive global view of and preferred the QPS. QPS facilitated generation of new questions without increasing patient anxiety nor prolonging the consultation. The findings provide support for increased adoption and integration of QPS into r
{"title":"Patienten-Arzt-Interaktion: Effektive Gesprächsführung bei fortgeschrittenen Krebserkrankungen","authors":"Claudia M. Witt","doi":"10.1159/000533756","DOIUrl":"https://doi.org/10.1159/000533756","url":null,"abstract":"<b>Importance:</b> There are few robust evaluations of disease-specific question prompt sheets (QPS) in patient-physician communication among patients with advanced cancer. <b>Objective:</b> To compare the patient perception of helpfulness, global evaluation, and preference for the QPS vs a general information sheet (GIS), and to examine the effect of the QPS on participants’ anxiety, participants’ speaking time, number of questions asked, and length of the clinical encounter. <b>Design:</b> , setting, and participants: This controlled, double-blind randomized clinical trial was conducted at an outpatient palliative and supportive care clinic in a cancer center in the US. Eligible patients were 18 years or older, had a cancer diagnosis, and were undergoing their first outpatient consultation visit with a palliative care physician from September 1, 2017, to May 31, 2019. Data analysis used a modified intention-to-treat design. Data were analyzed from May 18 to June 27, 2022. <b>Intervention:</b> QPS, a 25-item list of questions developed by expert palliative care clinicians using a Delphi process and tested among ambulatory advanced cancer patients. The control was GIS, generic information material given routinely to patients seen at the supportive care clinic. <b>Main outcomes and measures:</b> The main outcome was patient perception of helpfulness. Secondary outcomes included global evaluation and preference of QPS compared with GIS immediately after the encounter. <b>Results:</b> A total of 130 patients (mean [SD] age, 58.6 [13.3] years; 79 [60.8%] female) were randomized to receive either QPS (67 patients [51.5%]) or GIS (63 patients [48.5%]). Patients considered QPS and GIS equally helpful, with no statistically significant difference (mean [SD] helpfulness score, 7.2 [2.3] points vs 7.1 [2.7] points; <i>P</i> = .79). The QPS group, compared with the GIS group, had a higher global positive view of the material (mean [SD] global perception score, 7.1 [1.3] vs 6.5 [1.7]; <i>P</i> = .03) and felt it prompted them more to generate new questions (mean [SD] rating, 7.0 [2.9] vs 5.3 [3.5]; <i>P</i> = .005). Of 47 patients asked their preference between the items, more participants preferred the QPS to the GIS in communicating with their physicians (24 patients [51.1%] vs 7 patients [14.9%]; <i>P</i> = .01) at the 4-week follow-up. No significant differences between the QPS and GIS groups were observed regarding participant anxiety, speaking time, number of questions asked, or consultation length (eg, mean [SD] anxiety rating, 2.3 [3.7] vs 1.6 [2.7]; <i>P</i> = .19). <b>Conclusions:</b> and relevance: In this randomized clinical trial, participants perceived both QPS and GIS as equally helpful, but they had a more positive global view of and preferred the QPS. QPS facilitated generation of new questions without increasing patient anxiety nor prolonging the consultation. The findings provide support for increased adoption and integration of QPS into r","PeriodicalId":477056,"journal":{"name":"Karger Kompass","volume":"468 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135546662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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