Home About us Contact
|
Home About us Contact | ||
|
|
||
Possible Prognostic Factors (possible + prognostic_factor)
Selected AbstractsMulticentre study comparing aggressive behaviour of familial non-medullary thyroid carcinoma and sporadic thyroid cancerBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 9 2000O. Alsanea Background Familial non-medullary thyroid cancer represents about 5 per cent of all thyroid cancers of follicular cell origin. Whether familial non-medullary thyroid cancer is more aggressive than sporadic thyroid cancer is controversial. Methods Each patient with familial non-medullary thyroid cancer was matched with three controls for age, sex and tumour node metastasis (TNM) stage of disease. Possible prognostic factors were compared in relation to recurrence, metastases and mortality rate in both groups. Univariate analysis was performed using contingency table analysis and McNemar's ,2 test for paired measurements. Multivariate analysis was used to evaluate factors significant in univariate analysis. Results Forty-eight cases (ten men) and 144 matched controls (30 men) were analysed with a mean follow-up of 102 and 94 months respectively. The mean age was 39 years for cases and 46 years for controls. Some 29 per cent of the cases and 12 per cent of the controls had history of prior or coexistent benign thyroid disease (P < 0·05). Ninety-four per cent of cases and 90 per cent of controls had papillary cancers; the remainder were Hurthle cell cancers. Based on TNM staging, there were 66 per cent stage I, 21 per cent stage II and 13 per cent stage III tumours in the familial non-medullary thyroid cancer group; the distribution was similar in the control group. Modified radical neck dissection was performed in 42 per cent of cases and 22 per cent of controls. Multifocal or bilateral disease was seen in 75 per cent of cases and 41 per cent of controls (P < 0·05); 35 per cent of cases and 16 per cent of controls had at least one recurrence (P < 0·05). Ten per cent of cases and 2 per cent of controls developed distant metastases (P < 0·05). Six per cent of cases but no controls died from thyroid cancer (P < 0·05). In patients with familial non-medullary thyroid cancer aged over 45 years (n = 14), distant metastases affected four, of whom three died. In multivariate analysis, age was the only significant variable that affected the disease outcome (P < 0·01). Conclusion Familial non-medullary thyroid cancer is more aggressive than sporadic thyroid cancer and is associated with increased recurrence, metastasis and death, especially in patients over 45 years of age. © 2000 British Journal of Surgery Society Ltd [source] Prognostic significance of tumor grade for renal cell carcinomaINTERNATIONAL JOURNAL OF UROLOGY, Issue 1 2000Yasutada Onodera Abstract Background: The natural history and prognosis of renal cell carcinoma cannot be predicted. Based on the Japanese classification system, the value of nuclear grade were assessed as a possible prognostic factor for renal cell carcinomas. Methods: In this retrospective study of 116 patients with renal cell carcinoma, radical nephrectomy was performed. Survival rates were calculated using the Kaplan,Meier method and multivariate analysis was performed using Cox's proportional hazard model. Results: Distribution by stage and grade in the population of renal cell carcinomas was as follows: pT1 in 13 cases (11.3%), pT2 in 65 cases (56.5%), pT3 in 36 cases (31.3%) and pT4 in one case (0. 9%) and grade 1, 28 (24.1%), grade 2, 69 (59.5%) and grade 3, 16 (13.8%). Three cases could not be determined because of pre-operative embolization of the renal cell carcinomas. Nuclear grade was correlated with stage (P = 0.0002), the presence of perirenal fat involvement (P = 0.003) and metastases (P = 0.007). A significant difference in survival was found between grades 1 and 3 (P = 0.0001) and grades 2 and 3 (P = 0.0001), respectively. Survival was significantly correlated with sex (P = 0.0125), tumor size (P = 0.0001), the presence of lymph node metastasis (P = 0.0001), renal vein involvement (P = 0.0001), perirenal fat involvement (P = 0.002) or distant metastasis (P = 0.0001). The multivariate analysis showed that the occurrence of tumor grade (P = 0.0006) or distant metastasis were independent prognostic values. Conclusion: The observations lead us to conclude that the nuclear grade according to the Japanese classification system appears to be of reliable prognostic value for renal cell carcinomas. [source] Neurological recovery in obstetric brachial plexus injuries: an historical cohort studyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 2 2004Agnes F Hoeksma MD An historical cohort study was conducted to investigate the rate and extent of neurological recovery in obstetric brachial plexus injury (OBPI) and to identify possible prognostic factors in a cohort of children with OBPI from birth to 7 years. All children (n=56; 31 females, 25 males) with OBPI were evaluated at fixed time intervals by one examiner. They underwent a final neurological examination at a mean age of 3 years 10 months (range 1 to 7 years). Neurological outcome was not as favourable as is often reported: complete neurological recovery occurred in 37 out of 56 children (66%). In half of these there was delayed recovery, in which case complete neurological recovery was assessed from 1.5 to 16 months of age (median age 6.5 months, SD 4.2 months). External rotation and supination were the last to recover and recovered the least. Although biceps function at three months was considered to be the best indicator for operative treatment, external rotation and supination were found to be better in predicting eventual complete recovery. Initial symptoms directly post partum were not found to be prognostic. Functional outcome was mainly reported to be good. [source] Urinary incontinence after radical retropubic prostatectomy: the outcome of a surgical techniqueBJU INTERNATIONAL, Issue 4 2003A. Moinzadeh It is a reflection of the many manuscripts submitted on urological oncology in general, and prostate cancer in particular, that I am publishing 10 papers in this section this month. Seven of these relate to the latter subject. The authors from the Lahey Clinic describe their technique of radial prostatectomy and include a novel method of posterior bladder plication. They report an early return to continence and conclude that the technique is important in achieving their excellent results. In another study the group from Stockport show that patients often make decisions about types of treatment for prostate cancer having been strongly influenced by their partner, who in turn may have had pre-existing conceptions about this. They recommend early involvement of the partner to help in this very important decision-making. The two papers on bladder cancer describe possible prognostic factors, both clinical and laboratory-based, from a large experience in Hamburg and Mansoura. OBJECTIVE To analyse the incidence of incontinence after radical retropubic prostatectomy (RRP) and the time to return of continence, using an RRP technique including a novel posterior bladder plication PATIENTS AND METHODS We retrospectively reviewed the medical records of 200 consecutive patients who underwent RRP between September 1995 and February 1997, by one surgeon, at our institution. Patient characteristics including age, preoperative prostate-specific antigen (PSA) level and Gleason grade, were assessed. Continence was assessed before and after RRP by either a third-party patient interview or a prospective validated questionnaire. Continence was defined as not requiring the use of any sanitary pads or diapers. The continence rate was determined immediately after catheter removal, and at 3, 6, 12 and 15 months after RRP. RESULTS The mean age of the patients was 59.4 years, the preoperative PSA level 8.5 ng/mL and the Gleason grade 6.1. The time to continence and percentage of continent patients was 63.5% immediately, 82% at 3 months, 91% at 6 months, and 98.5% at 12 months after RRP. At 15 months, 199 of 200 consecutive patients were continent (99.5%). CONCLUSION With our technique there was an early return to continence and only a minor incontinence rate at 15 months. The cumulative effect of sequential technical manoeuvres in our RRP technique, including posterior bladder plication, is critical for continence after RRP. [source] Neoadjuvant chemotherapy: a new criterion for selection of candidate patients for surgery of low tumour burden metastases from malignant melanoma?BRITISH JOURNAL OF DERMATOLOGY, Issue 1 2010T. Jouary Summary Background, Surgery of limited metastatic lesions from malignant melanoma can achieve long-term remission and better survival than chemotherapy. Existing criteria for selection of candidate patients for this surgery do not seem sufficient to avoid useless excisions. Objectives, To test use of neoadjuvant chemotherapy as a new criterion in this setting. Methods, All patients who underwent thoracic surgery for one or two lung metastases from melanoma during 1999,2007 were included in the study. Demographic and medical data were collected and analysed. Several possible prognostic factors were evaluated based on the overall survival curves. Results, Thirteen patients were included in this retrospective study. All but two patients had no evidence of disease after surgery. Ten patients received neoadjuvant chemotherapy. Six responded (absence of progression) and four had progressive disease. Response to chemotherapy and no evidence of disease after surgery were predictive of long-term survival. Conclusions, Neoadjuvant chemotherapy can be considered as a new criterion for better selection of candidate patients for lung metastasis surgical resection. This would also avoid useless surgical procedures in rapidly progressive disease and give information on the chemosensibility of the metastatic disease. This study needs further confirmation, particularly with chemotherapy regimens that have demonstrated better objective responses. [source] | ||||||||||