Long-term outcomes of primary cardiac malignant tumors: Difference between African American and Caucasian population

BACKGROUND: The survival outcome for primary cardiac malignant tumors (PMCTs) based on race has yet to be fully elucidated in previously published literature. This study aimed to address the general long-term outcome and survival rate differences in PMCTs among African Americans and Caucasian populations. METHODS: The 18 cancer registries database from the Surveillance, Epidemiology, and End Results (SEER) Program from 1975 to 2016 were utilized. Ninety-four African American (AA) and 647 Caucasian (CAU) patients from the SEER registry were available for survival analysis. The log-rank test was used to compare the difference in mortality between two populations and presented by the Kaplan-Meier curves. A multivariate Cox proportional hazards regression was used to determine the independent predictors of all-cause mortality. RESULTS: The overall 30-day, 1-year, and 5-year survival rates were 74%, 44.3%, and 16.6%, respectively, with a median survival of 10 months. There was no significant difference in survival rate between the two races (p-value = 0.55). The 1-year survival rate improved significantly during the study timeline in the AA population (13.3% during 1975-1998, 40.9% during 1999-2004, 50% during 2005-2010, and 59.7% during 2011-2016, p-value = 0.0064). Age of diagnosis, type of tumor, disease stage, and chemotherapy administration are the main factors that predict survival outcomes of PMCT patients. Interactive nomogram was developed based on significant predictors. CONCLUSIONS: PMCTs have remained one of the most lethal diseases with poor survival outcome. Survival rate improved during the timeline in AA patients, but in general, racial differences in survival outcome were not observed

Clinicopathological implications of prkar1a mutation in patients with cardiac myxoma: Pooled data analysis from 101 myxoma cases

Background PRKAR1A is a novel genetic mutation traditionally linked to Carney Complex (CNC) and cardiac myxoma. We hypothesized that presence of PRKAR1A mutation (Mut+) identifies a subset of cardiac myxoma patients with distinct clinicopathologic features from those without the mutation (Mut-). Methods We searched PubMed, Web of Science, and Scopus from inception to September 2019 to identify individual patient data of cardiac myxoma cases. Cases were included if the mutational status of PRKAR1A gene was reported. Extracted data included: mutational status, age at diagnosis, gender, location of myxoma, multifocality, recurrence, and concomitant extra-cardiac myxomas. Results Twenty-six articles reporting on 101 individual myxoma cases with known PRKAR1A mutational status were identified. Mean age at diagnosis was 36.6 ± 16.1 years. Two-third of the cases were females (n=62), 82% of cases were Mut+ (n=83), and 93.9% (n=78) met criteria for CNC. Mean age at diagnosis for the Mut+ group and Mut- group were 35.2 and 43.3 years, retrospectively (p-value = 0.058). Overall, left atrium was the most common location for myxomas (58%). While all myxoma cases in the Mut- group were localized to the left atrium, multi-chamber myxomas occurred exclusively in patients with the mutation (p-value= 0.003). Similarly, 96% of all cases of multiple cardiac myxomas occurred in the Mut+ group. The risk of developing multiple myxomas was significantly higher in the Mut+ compared to Mut- group (RR= 4.1, p-value= 0.03). Myxoma recurrence after resection occurred in 20.8% (n=21) of all cases, 20 of them were in the Mut+ group. Time duration from surgical resection to recurrence had a mean of 7.3 ± 5.7 years. Similarly, Mut+ carried a significantly higher risk of developing extra-cardiac myxomas compared to Mut- (p-value= 0.009), as 90.6% of extra-cardiac myxomas occurred in individuals harboring the mutation. Conclusion PRKAR1A mutation identifies a subset of cardiac myxoma patients with dismal clinicopathologic features, including higher risk for multifocality, recurrence, and developing extra-cardiac myxomas. Screening for PRKAR1A mutation might need to be considered routinely at the time of diagnosis

An observational study of breakthrough SARS-CoV-2 Delta variant infections among vaccinated healthcare workers in Vietnam

Background Data on breakthrough SARS-CoV-2 Delta variant infections in vaccinated individuals are limited. Methods We studied breakthrough infections among Oxford-AstraZeneca vaccinated healthcare workers in an infectious diseases hospital in Vietnam. We collected demographic and clinical data alongside serial PCR testing, measurement of SARS-CoV-2 antibodies, and viral whole-genome sequencing. Findings Between 11th–25th June 2021 (7-8 weeks after the second dose), 69 staff tested positive for SARS-CoV-2. 62 participated in the study. Most were asymptomatic or mildly symptomatic and all recovered. Twenty-two complete-genome sequences were obtained; all were Delta variant and were phylogenetically distinct from contemporary viruses obtained from the community or from hospital patients admitted prior to the outbreak. Viral loads inferred from Ct values were 251 times higher than in cases infected with the original strain in March/April 2020. Median time from diagnosis to negative PCR was 21 days (range 8–33). Neutralizing antibodies (expressed as percentage of inhibition) measured after the second vaccine dose, or at diagnosis, were lower in cases than in uninfected, fully vaccinated controls (median (IQR): 69.4 (50.7-89.1) vs. 91.3 (79.6-94.9), p=0.005 and 59.4 (32.5-73.1) vs. 91.1 (77.3-94.2), p=0.043). There was no correlation between vaccine-induced neutralizing antibody levels and peak viral loads or the development of symptoms. Interpretation Breakthrough Delta variant infections following Oxford-AstraZeneca vaccination may cause asymptomatic or mild disease, but are associated with high viral loads, prolonged PCR positivity and low levels of vaccine-induced neutralizing antibodies. Epidemiological and sequence data suggested ongoing transmission had occurred between fully vaccinated individuals