Is cancer stage data missing completely at random? A report from a large population-based cohort of non-small cell lung cancer

IntroductionPopulation-based datasets are often used to estimate changes in utilization or outcomes of novel therapies. Inclusion or exclusion of unstaged patients may impact on interpretation of these studies.MethodsA large population-based dataset in Ontario, Canada of non-small cell lung cancer patients was examined to evaluate the characteristics and outcomes of unstaged patients compared to staged patients. Multivariable Poisson regression was used to evaluate differences in patient-level characteristics between groups. Kaplan-Meier estimates of survival and log-rank statistics were utilized.ResultsIn our Ontario cohort of 51,152 patients with NSCLC, 11.2% (n=5,707) were unstaged, and there was evidence that stage data was not missing completely at random. Those without assigned stage were more likely than staged patients to be older (RR [95%CI]), (70-79 vs. 20-59: 1.51 [1.38-1.66]; 80+ vs. 20-59: 2.87 [2.62-3.15]), have a higher comorbidity index (Score 1-2 vs 0: 1.19 [1.12-1.27]; 3 vs. 0: 1.49 [1.38-1.60]), and have a lower socioeconomic class (4 vs. 1 (lowest): 0.91 [0.84-0.98]; 5 vs. 1 (lowest): 0.89 [0.83-0.97]). Overall survival of unstaged patients suggested a mixture of early and advanced stage, but with a large proportion that are probably stage IV patients with more rapid death than those with reported stage IV disease.ConclusionIn this case study, evaluation of stage-specific health care utilization and outcomes for staged patients with stage IV disease at the population level may have a bias as a distinct subset of stage IV patients with rapid death are likely among those without a documented stage in administrative data

Correlation of Oncotype DX Recurrence Score with Histomorphology and Immunohistochemistry in over 500 Patients

Oncotype Dx is used to determine the recurrence risk (RR) in patients with estrogen receptor positive (ER+) and lymph node negative (LN−) breast cancer. The RR is divided into low (0-17), intermediat

Comparison of Patient Outcomes in Female Patients Undergoing SLAP Repair or Biceps Tenodesis for the Treatment of SLAP Lesions

Background: There is no consensus on whether SLAP repair (SR) or biceps tenodesis (BT) yields superior long-term outcomes in managing superior labrum anterior to posterior (SLAP) tears. No previous study has examined outcomes of these procedures in female patients. Hypothesis/Purpose: The purpose of this study was to compare outcomes following SR and BT for SLAP tears in females. The authors hypothesized there would be no difference in outcomes between patients who underwent SR or BT. Study Design: Retrospective Cohort (level III) Methods: Female patients who underwent SR or BT for treatment of SLAP tears between 1/1/2014 and 9/1/2019 were retrospectively reviewed. Patients undergoing a concomitant procedure were excluded. Patients completed American Shoulder and Elbow Surgeons (ASES), single assessment numerical evaluation (SANE), and visual analog scale (VAS), and a custom return to activity surveys at a minimum 2 years post-operatively. Results: The study included 65 female patients; 38 (58.4%) underwent arthroscopic SR and 27 (41.5%) underwent open- or arthroscopic-BT. There was no significant difference in laterality of procedure but patients in the SR group were significantly younger (36.7±8.44 years vs. 44.4±10.4 years, P = .003). At minimum 2-year follow-up, there was no significant difference in ASES scores (SLAP: 78.3 vs BT: 80.0, P = .591), SANE scores (77.0 vs 80.1, P = .722) or VAS scores (26.4 vs 24.4, P = .530). Furthermore, rates of participation in sports prior to surgery (58.8%vs 37.0%, P = .152) and rates of return-to-sport after surgery (75.0% vs 80.0%, P = 1.000) did not significantly differ. Conclusion: Female patients undergoing surgical treatment of SLAP lesions with either SR or BT show comparable subjective outcomes and return to sport at minimum 2 years. These results are comparable to those seen in prior studies focusing on predominantly male cohorts. Further research is necessary to define precise treatment indications for this pathology in this specific female patient population

Project DyAdd : Non-linguistic Theories of Dyslexia Predict Intelligence

Two themes have puzzled the research on developmental and learning disorders for decades. First, some of the risk and protective factors behind developmental challenges are suggested to be shared and some are suggested to be specific for a given condition. Second, language-based learning difficulties like dyslexia are suggested to result from or correlate with non-linguistic aspects of information processing as well. In the current study, we investigated how adults with developmental dyslexia or ADHD as well as healthy controls cluster across various dimensions designed to tap the prominent non-linguistic theories of dyslexia. Participants were 18-55-year-old adults with dyslexia (n= 36), ADHD (n= 22), and controls (n= 35). Non-linguistic theories investigated with experimental designs included temporal processing impairment, abnormal cerebellar functioning, procedural learning difficulties, as well as visual processing and attention deficits. Latent profile analysis (LPA) was used to investigate the emerging groups and patterns of results across these experimental designs. LPA suggested three groups: (1) a large group with average performance in the experimental designs, (2) participants predominantly from the clinical groups but with enhanced conditioning learning, and (3) participants predominantly from the dyslexia group with temporal processing as well as visual processing and attention deficits. Despite the presence of these distinct patterns, participants did not cluster very well based on their original status, nor did the LPA groups differ in their dyslexia or ADHD-related neuropsychological profiles. Remarkably, the LPA groups did differ in their intelligence. These results highlight the continuous and overlapping nature of the observed difficulties and support the multiple deficit model of developmental disorders, which suggests shared risk factors for developmental challenges. It also appears that some of the risk factors suggested by the prominent non-linguistic theories of dyslexia relate to the general level of functioning in tests of intelligence.Peer reviewe

Foveal changes in aquaporin‐4 antibody seropositive neuromyelitis optica spectrum disorder are independent of optic neuritis and not overtly progressive

Background and purpose: Foveal changes were reported in aquaporin-4 antibody (AQP4-Ab) seropositive neuromyelitis optica spectrum disorder (NMOSD) patients; however, it is unclear whether they are independent of optic neuritis (ON), stem from subclinical ON or crossover from ON in fellow eyes. Fovea morphometry and a statistical classification approach were used to investigate if foveal changes in NMOSD are independent of ON and progressive. Methods: This was a retrospective longitudinal study of 27 AQP4-IgG + NMOSD patients (49 eyes; 15 ON eyes and 34 eyes without a history of ON [NON eyes]), follow-up median (first and third quartile) 2.32 (1.33-3.28), and 38 healthy controls (HCs) (76 eyes), follow-up median (first and third quartile) 1.95 (1.83-2.54). The peripapillary retinal nerve fibre layer thickness and the volume of combined ganglion cell and inner plexiform layer as measures of neuroaxonal damage from ON were determined by optical coherence tomography. Nineteen foveal morphometry parameters were extracted from macular optical coherence tomography volume scans. Data were analysed using orthogonal partial least squares discriminant analysis and linear mixed effects models. Results: At baseline, foveal shape was significantly altered in ON eyes and NON eyes compared to HCs. Discriminatory analysis showed 81% accuracy distinguishing ON vs. HCs and 68% accuracy in NON vs. HCs. NON eyes were distinguished from HCs by foveal shape parameters indicating widening. Orthogonal partial least squares discriminant analysis discriminated ON vs. NON with 76% accuracy. In a follow-up of 2.4 (20.85) years, no significant time-dependent foveal changes were found. Conclusion: The parafoveal area is altered in AQP4-Ab seropositive NMOSD patients suggesting independent neuroaxonal damage from subclinical ON. Longer follow-ups are needed to confirm the stability of the parafoveal structure over time