.
Background and Purpose In the ESCAPE-NA1 (Efficacy and Safety of Nerinetide for the Treatment of Acute Ischaemic Stroke) trial, treatment with nerinetide was associated with improved outcomes in patients who did not receive intravenous alteplase. We compared the effect of nerinetide on clinical outcomes in patients without concurrent intravenous alteplase treatment within different patient subgroups. Methods ESCAPE-NA1 was a multicenter randomized trial in which acute stroke patients with baseline Alberta Stroke Program Early CT Score (ASPECTS) >4 undergoing endovascular treatment (EVT) were randomized to intravenous nerinetide or placebo. The primary outcome was independence (modified Rankin Scale [mRS] score 0-2) at 90 days. We assessed baseline, clinical, and imaging variables as predictors of outcome and for evidence of treatment effect modification. We constructed two multivariable models using variables known prior to randomization and variables known immediately post-EVT procedure to provide adjusted estimates of effect. We assessed for evidence of treatment effect modification using multiplicative interaction terms within each model. Results Four hundred forty-six patients were included in the analysis. Clinical outcomes were better in patients randomized to the nerinetide arm (mRS 0-2: 59.4% vs. 49.8%). There was possible treatment effect modification by ASPECTS score; patients with ASPECTS 8-10 showed a larger treatment effect compared to those with lower ASPECTS score. Younger age, lower NIHSS score, lower baseline serum glucose, absence of atrial fibrillation at baseline, higher ASPECTS score, middle cerebral artery (vs. internal carotid artery) occlusion, use of conscious or no sedation (vs. general anesthesia), and faster treatment were all predictors of favorable outcome. Conclusion Patients in the nerinetide arm who were not treated with concurrent alteplase showed improved clinical outcomes and the treatment effect was larger among patients with favorable ASPECTS profiles.
e22517 Background: Tracheal, Bronchus, and Lung Cancer (TBL) are the primary causes of death and disability in the United States, accounting for nearly 25% of all neoplasm-related deaths. Among various risk factors, occupational exposure (OE) to carcinogens is a growing concern. Methods: Using Standardized global burden of disease methodologies, we estimated death, disability adjusted life years (DALYs), years lived with disability (YLDs), due to TBL cancer attributable to OC stratified by age, sex, year and location across the USA from 1990-2021. Results: From 1990-2021, the annual percentage change (APC) showed a general decline, with total number of deaths decreasing by -0.35%, DALYs by -0.86%, and YLDs by -0.17%. At the regional level, notable variations were observed: Alaska experienced the highest increase in death APC due to arsenic exposure +0.97%, while all states showed a decrease attributable to asbestos. Nevada recorded the highest increase in death APC from beryllium exposure (+0.09%) with a general increasing trend across all states. Both Wyoming and Nevada observed a +0.02% increase due to cadmium exposure. South Dakota saw a +0.17% increase due to chromium, and Alabama recorded a +0.43% increase from diesel engine exhaust. A declining trend was noted for nickel across all states. Utah had a +0.23% increase due to exposure to polycyclic aromatic hydrocarbons (PAH), and Alaska showed a significant rise of +1.19% from silica exposure. Age-wise, those 55 and older saw reductions in APC for deaths (-0.28%), DALYs (-0.75%), and YLDs (-0.09%). The 20-54 year age group noted more pronounced declines in death (-2.87%), DALYs (-2.95%), and YLDs (-2.28%). Gender analysis revealed that females had increased APC for deaths (+0.92%), DALYs (+0.35%), and YLDs (+1.15%), while males exhibited a declining trend. Conclusions: The study demonstrates an overall reduction in health burdens from 1990-2021, marked by declines in deaths, DALYs, and YLDs. Despite these gains, regional and demographic disparities highlight the continued impact of OE, particularly in states like Alaska and Nevada, and among different age groups and genders. These findings stress the need for targeted policies and improved safety standards to address persistent occupational health risks and achieve equitable health outcomes. Annual percentage of change in total number of deaths, DALYs and YLDs due to TBL cancer attributable to occupational carcinogens from 1990-2021. TBL cancer Attributable to OC APC (%), (1990-2021)Deaths APC (%),(1990-2021), (DALYs) APC (%),(1990-2021), (YLDs) Arsenic -0.43 -0.67 +0.05 Asbestos -0.35 -0.93 -0.22 Beryllium +0.04 -0.19 +0.55 Cadmium -0.35 -0.59 +0.13 Chromium -0.24 -0.48 +0.25 Diesel engine exhaust +0.11 -0.13 +0.61 Nickel -0.55 -0.79 -0.08 Polycyclic aromatic hydrocarbons (PAH) -0.18 -0.42 +0.32 Silica -0.59 -0.83 -0.12
e22589 Background: Various studies have examined the relationship between dietary zinc (Zn) intake and cancer risk. While some have shown no substantial link, others have proposed an inverse association with colorectal and pancreatic cancers. Given these inconsistencies, we aimed to assess the relationship between dietary Zn intake and cancer diagnosis while adjusting for demographic variables. Methods: A retrospective analysis was conducted using data from the National Health and Nutrition Examination Survey (NHANES) of the U.S. population from 2021 to 2023. Participants' Zn intake and cancer diagnoses were assessed through surveys. Chi-square tests were used to examine the association followed by logistic regression analyses to adjust for potential confounders, including age, gender, and smoking status. A stratified analysis by age groups was conducted to explore potential age-related differences, with a p-value <0.05 being significant. Results: A total of 11,933 respondents' data was analyzed consisting of a majority of females(53.28%). Non-Hispanic whites(52.10%) were the most common ethnicity and 60–79 years(33.75%) represented the most common age group. 61.35% had low Zn intake with the mean ± SD value being 8.12 ± 2.5 mg/day. The chi-square test showed a significant association between Zn intake and cancer diagnosis(χ²=223.5478, p<0.0001). Logistic regression analysis revealed that age was the strongest predictor of cancer diagnosis with individuals aged 60–79 years having significantly higher odds compared to those under 20(OR<0.001, p<0.0001). Zn intake and smoking were not significantly associated, although light smokers showed a marginally protective effect(OR=0.431, 95% CI=0.190–0.979). Stratified analysis showed an inverse association between Zn intake and cancer among the 41-60 age group(p=0.0114). The ROC curve analysis indicated poor predictive ability of Zn intake for cancer diagnosis(c-statistic of 0.520). Conclusions: Unlike previous studies showing a protective effect of Zn intake against various cancers, our findings indicate no overall significance. A notable inverse relationship was observed in the 41–60 age group, suggesting potential age-dependent effects. These findings challenge existing data and the complex relationship between Zn and cancer risk. Further studies are needed to explore the findings.
e16336 Background: Liver cancer is a significant global health burden with racial and ethnic disparities affecting disease outcomes, healthcare resource utilization, and associated cardiovascular complications. Major adverse cardiovascular and cerebrovascular events (MACCE) contribute to morbidity and mortality in liver cancer patients, necessitating further investigation into racial differences. This study utilizes the National Inpatient Sample (NIS) from 2016–2021 to assess racial disparities in MACCE, mortality, and healthcare utilization among hospitalized liver cancer patients. Methods: A retrospective cohort study was conducted using the NIS database to identify adult liver cancer patients. Demographic and clinical characteristics, including race, socioeconomic status, and comorbidities, were compared. Key outcomes included in-hospital mortality, myocardial infarction (MI), stroke, intracranial hemorrhage, sudden cardiac arrest, arrhythmia, and healthcare utilization metrics (length of stay [LOS]). Multivariable logistic regression models adjusted for confounders to evaluate racial disparities in these outcomes. Results: Among 340,172 liver cancer patients, the racial distribution included White (56.5%), Black (15.0%), Hispanic (17.7%), Asian or Pacific Islander (6.6%), Native American (0.9%), and Other (3.8%). Black (OR 1.24, p < 0.001), Asian or Pacific Islander (OR 1.18, p = 0.002), and Other racial groups (OR 1.23, p = 0.004) had significantly higher odds of mortality compared to White patients. Hispanic and Asian patients had a lower risk of MI (OR 0.773, p = 0.002; OR 0.775, p = 0.03, respectively). However, Black (OR 1.85, p < 0.001), Hispanic (OR 1.398, p < 0.001), and Asian or Pacific Islander (OR 1.757, p < 0.001) patients were more likely to experience sudden cardiac arrest. Black and Hispanic patients had significantly lower odds of cerebral artery stenosis (OR 0.486, p < 0.001; OR 0.452, p < 0.001), while Black patients had an increased risk of acute congestive heart failure (OR 1.562, p = 0.029). LOS was significantly longer in Black patients (0.418 days, p < 0.001), while Asian patients had a shorter LOS (-0.246 days, p = 0.03). Conclusions: This study identifies significant racial disparities in MACCE outcomes, mortality, and healthcare utilization among liver cancer patients. Black and Asian patients experienced higher mortality and an increased risk of sudden cardiac arrest, while Hispanic and Asian patients exhibited a lower risk of MI. Differences in LOS underscore healthcare inequities. These findings highlight the need for targeted interventions to address disparities and improve outcomes for racial and ethnic minority populations with liver cancer.
e20072 Background: Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. However, a comparative survival impact of its histological variants remains understudied in the US population. Methods: Using the National Cancer Database, we identified patients diagnosed with NSCLC histological subtypes (Adenocarcinoma, Adenosquamous, Squamous, Large cell, Pseudosarcomatous, Anaplastic, Pleomorphic, Giant cell, & Spindle cell carcinomas) between 2010 and 2017. Strobe guidelines were followed for reporting purposes. Unadjusted median overall survival (mOS) was estimated using Kaplan-Meier survival analysis. A multivariate regression analysis was conducted with an accelerated failure time model to estimate hazard ratios adjusted for covariates. Covariates included were age, sex, race, tumor grade, TNM stage, Charlson Comorbidity Index, insurance status, year of diagnosis, facility type, and treatment modality. Adenocarcinoma served as the reference arm for HR calculations. Results: A total of 708,671 patients were included in the study. Of these, 481,991 (68.01%) were aged ≥65 years, 344,131 (48.6%) were female, 608,012 (85.8%) were white, and 458,591 (64.7%) had Medicare insurance. Adenocarcinoma (n= 443,900; 62.64%) demonstrated the best outcome with mOS of 24.4 months (p<0.05), followed by Pleomorphic carcinoma (n= 1,089; 0.15%) with mOS of 16.0 months (HR = 1.14, p<0.01). Adenosquamous carcinoma (n= 12,211; 1.72%) had mOS of 19.0 months (HR = 1.18, p<0.01). Squamous cell carcinoma (n= 240,447; 33.93%) demonstrated an mOS of 17.25 months (HR = 1.23, p<0.01), while large cell carcinoma (n= 6,417; 0.91%) showed an mOS of 9.17 months (HR = 1.26, p<0.01). Of all, the worst outcomes were observed in Pseudosarcomatous carcinoma (n= 3,080; 0.43%), with a mOS of 5.98 months (HR = 1.53, p<0.01). Other histologies associated with poorer prognosis included Undifferentiated/anaplastic carcinoma (n= 399; 0.06%) with mOS of 5.98 months (HR = 1.32, p<0.01), Giant cell carcinoma (n= 395; 0.06%) with mOS of 7.16 months (HR = 1.32, p<0.01), and Spindle cell carcinoma (n= 733; 0.10%) with mOS of 6.37 months (HR = 1.35, p<0.01). Conclusions: NSCLC histological variants exhibit distinct survival outcomes, with adenocarcinoma showing the best prognosis and Pseudosarcomatous carcinoma the poorest. These results stress the importance of further research to develop therapies tailored to specific histological variants. Histology HR CI P value Adenocarcinoma ref Pleomorphic 1.14 1.06-1.22 <0.01 Adenosquamous 1.18 1.15-1.20 <0.01 Squamous cell 1.23 1.22-1.24 <0.01 Large cell 1.26 1.23-1.30 <0.01 Pseudosarcomatous 1.53 1.47-1.59 <0.01 Anaplastic 1.32 1.19-1.48 <0.01 Giant cell 1.32 1.19-1.48 <0.01 Spindle cell 1.35 1.25-1.46 <0.01
