ANZ JOURNAL OF SURGERY, Issue 1-2 2008
Esther W. L. Chuwa
Background: Breast cancer is the most common cancer among Singapore women and ductal carcinoma in situ (DCIS) is believed to be the precursor of most invasive breast cancers. The incidence of DCIS has increased dramatically with mammographic screening, but its treatment remains controversial. Further, results of treatment for DCIS in Asians, and in particular Singapore women, are lacking. We review our institution's results treating a predominantly Chinese population with DCIS of the breast before the introduction of mammographic screening and aim to determine treatment outcomes and identify prognostic factors for disease recurrence. Methods: Between January 1994 and December 2000, 170 consecutive patients with DCIS were treated at our institution. One hundred and three (60.5%) were managed with breast conservation (17 with local wide excision alone and 86 with adjuvant irradiation following wide excision) whereas 67 (39.4%) underwent mastectomy. Of those who underwent wide local excision, 56 (54.3%) underwent re-excision for margin clearance. Overall, the axilla was surgically staged in 47 (27.6%) and no nodal involvement was found in all cases. Pathological specimens were reviewed by one of the authors. Median follow up was 86 months (range 4,151 months). Results: Sixty-two patients (36%) were asymptomatic at presentation whereas most (64%) presented with clinical symptoms; out of these more than half (54%) presented with a palpable lump. The median size of tumours was 13 mm (range 1.5,90 mm). Patients who underwent breast conservation surgery had oncologically more favourable lesions , with a significantly higher incidence of smaller and non-palpable lesions and lesions of lower nuclear grade. However, there was also a significantly higher incidence of local recurrence in this group. At the end of follow up, there were 12 patients (7.1%) who developed local recurrence and 8 patients (4.7%) developed contralateral disease. The crude incidence of all breast events (including both local failure and contralateral events) at 5 years was 5.6%. Median time to the development of any breast event (local recurrence or contralateral disease) was 60 months (range 12,120 months). The cumulative 5-year recurrence-free survival for patients who underwent breast conservation surgery was 94%. Factors influencing local recurrence rate were close or involved margins (,1 mm) and lack of adjuvant radiotherapy. There were no cancer-specific deaths during the period of follow up. Conclusion: Our results indicate that rates of cancer-specific survival were similar after mastectomy and breast conserving surgery. However, a close or involved margin (,1mm) and lack of adjuvant radiotherapy were associated with local recurrence, with margin status being the independent predictor for local recurrence. Our results reinforce that optimizing local therapy is crucial to improve local control rates in women treated with DCIS in our population. [source]

HP37 PROGNOSTIC FACTORS IN OESOPHAGEAL CANCER: NUMBER OF LYMPH NODES AND EXTRACAPSULAR LYMPH NODE INVASION , AN INTERIM ANALYSIS

ANZ JOURNAL OF SURGERY, Issue 2007
S. K. Thompson
Purpose Controversy exists over the 2nd edition of the TNM staging system introduced by the American Joint Committee in Cancer in 1988, and revised in 2002. Prognostic pathological factors such as the number of positive lymph nodes and any extracapsular lymph node invasion may refine this current staging system and optimize patient treatment. Methodology All patients who underwent surgical resection for oesophageal cancer were identified in a prospectively-maintained database. Patients without invasive adenocarcinoma or squamous cell cancer were excluded. Pathology slides were reviewed by a single pathologist. Survival data was calculated using Kaplan-Meier curves, and prognostic factors were examined using the log rank test. Results 235 surgical specimens met inclusion criteria, and 95 specimens have been reviewed so far. The 5-yr overall survival rate was 43% (median 31.4 months). Subdividing pN-stage into 1,2 positive nodes and >2 positive nodes showed significant differences in 5-yr survival between both groups: 41% vs. 6.0%, respectively (P = 0.0003). Similarly, including absence and presence of extracapsular lymph node invasion into our pathology review showed significant differences in 5-yr survival: 40% vs. 7.8%, respectively (P < 0.01). A negative circumferential margin, and the absence of both vascular and perineural invasion were also found to significantly improve survival rates. Conclusions The number and characteristics of metastatic invasion of lymph nodes should be included in current oesophageal cancer staging systems. Clinicians will then have more accurate prognostic information, and treatment can be better tailored to patients' needs. [source]

Galectin-9, a Novel Prognostic Factor with Antimetastatic Potential in Breast Cancer

THE BREAST JOURNAL, Issue 2006
Akira Yamauchi MD
Abstract: Galectin-9, a member of the ,-galactoside-binding animal lectin family, is involved in various cellular biological events, including aggregation and apoptosis, adhesion of cancer cells, and dendritic cell maturation. We recently reported the relationship between galectin-9 expression in tumor tissue and distant metastasis in breast cancer. Tumors in 42 of the 84 patients were galectin-9-positive, and tumors in 19 of the 21 patients with distant metastasis were galectin-9-negative, assessed by immunohistochemistry. The cumulative distant metastasis-free survival ratio for galectin-9-positive patients was better than for the galectin-9-negative group (p < 0.0001). Multivariate analysis revealed that galectin-9 status influenced distant metastasis independent of and much more than lymph node metastasis. MCF-7 subclones with a high level of galectin-9 expression formed tight clusters during proliferation in vitro, whereas a subclone (K10) with the lowest level of galectin-9 expression did not. However, K10 cells stably transfected with a galectin-9 expression vector aggregated in nude mice as well as in culture. Ectopic expression of galectin-9 also reduced MCF-7 cell adhesion to extracellular matrix proteins., [source]

MUM1/IRF4 Expression Is an Unfavorable Prognostic Factor in B-Cell Chronic Lymphocytic Leukemia (CLL)/Small Lymphocytic Lymphoma (SLL)

CANCER SCIENCE, Issue 6 2002
Masato Ito
B-Cell chronic lymphocytic leukemia (B-CLL)/small lymphocytic lymphoma (SLL) consists of heterogeneous diseases that are distinguished by morphological, immunophenotypic and molecular features. MUM1 (multiple myeloma oncogene 1) is a protooncogene that is deregulated as a result of (6;14)(p25;q32) chromosomal translocation in multiple myeloma, and is also expressed in a variety of malignant lymphoma entities. We examined the expression of MUM1 in B-CLL/SLL, and found that 2 of 4 B-CLL-derived cell lines and 14 of 29 patients' specimens expressed MUM1 by immunohistochemical analysis. MUM1 expression was not associated with CD38 expression, somatic hypermutation of immunoglobulin heavy chain gene variable region (IgVH), or any other clinical characteristics of the patients. Interestingly, the patients who were positive for MUM1 showed shorter overall survival tunes than those who were negative for MUM1 (50% survival: 22 months vs. 82 months) (P=0.0008, log-rank test). Multivariate analysis by Cox's proportional-hazards regression model showed that MUM1 expression and unmutated IgVH status were independent unfavorable prognostic factors in patients with B-CLL/SLL. These findings suggest that MUM1 expression is a useful prognostic factor in B-CLL/SLL. The biological role and mechanism of action of MUM1 in B-CLL/SLL need to be clarified for the development of therapies for patients with the poor prognostic subtype. [source]

Outcomes and Prognostic Factors of Systolic as Compared With Diastolic Heart Failure in Urban America

CONGESTIVE HEART FAILURE, Issue 1 2005
Peter A. McCullough MD
We sought to describe a large heart failure (HF) population with respect to systolic and diastolic abnormalities in terms of demographics, echocardiographic parameters, and survival. Using data abstracted from the Resource Utilization Among Congestive Heart Failure (REACH) study, a targeted subpopulation of 3471 patients had electrocardiographic, echocardiographic, and clinical data taken from automated sources during the first year of diagnosis. Among the HF population, 1811 (52.2%) had diastolic HF. Prevalence of diastolic HF trended with age, from 46.4% in those less than 45 years to 58.7% in those 85 years or older (p=0.001 for trend). Patients with diastolic HF had a higher mean ejection fraction (55.7% vs. 28.0%), lower left ventricular end-systolic diameter (3.11 vs. 4.74 cm), and lower left atrium: aortic outlet ratio (1.28 vs. 1.38) (p=0.001 for each comparison). Annualized age, sex, and race-adjusted mortality were 11.2% and 13.0% for those with diastolic and systolic HF, respectively (p=0.001). In a large, racially mixed, urban HF population, those with diastolic HF predominate and enjoy better-adjusted survival than counterparts with systolic HF. [source]

Prognostic Factors for the Surgery for Mesial Temporal Lobe Epilepsy: Longitudinal Analysis

EPILEPSIA, Issue 8 2005
Sang-Wuk Jeong
Summary:,Purpose: Determining long-term prognostic factors of surgery for mesial temporal lobe epilepsy (MTLE) is important for identifying ideal candidates and predicting the prognosis for individual patients. We tried to identify the prognostic factors of anterior temporal lobectomy (ATL) for MTLE with longitudinal multivariate analysis. Methods: Two hundred twenty-seven patients with MTLE were included in this study. The primary outcome variable was patient status 1,5 years after surgery: seizure free, or not. Clinical characteristics and recent diagnostic modalities were considered as prognostic factors. Univariate and standard multiple logistic-regression analysis for outcome at 1 and 5 years after surgery and the generalized estimation equation (GEE) model for longitudinal multiple logistic regression of the 5-year follow-up period were used. Results: The seizure-free rate at 1 year was 81.1% and decreased to 75.2% at 5 years after surgery. By the univariate or standard multiple logistic-regression analysis, age at surgery or hippocampal sclerosis on magnetic resonance imaging (MRI) ipsilateral to surgery was significant for the postsurgical outcome. However, the longitudinal analysis by the GEE model revealed that younger age at surgery [odds ratio (OR), 0.59; 95% confidence interval (CI), 0.43,0.81], absence of secondarily generalized tonic,clonic seizure (2°GTCS; OR, 0.45; 95% CI, 0.26,0.79), and hippocampal sclerosis on MRI (OR, 2.44; 95% CI, 1.11,5.26) were significant predictors of a good surgical outcome. Conclusions: Age at surgery, presence of 2°GTCS, and hippocampal sclerosis on MRI are independent prognostic factors for ATL in MTLE. These findings suggest that MTLE is a progressive disorder, and surgical outcome is better when early ATL is performed. [source]

Prognostic Factors for Mortality and Thromboembolism in Canine Immune-Mediated Hemolytic Anemia: A Retrospective Study of 72 Dogs

JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 5 2002
Anthony P. Carr
Medical records of 72 dogs diagnosed with immune-mediated hemolytic anemia (IMHA) were reviewed to find risk factors for the disease, for mortality, and for thromboembolism. Coagulation data of 32 patients were evaluated for mortality or thromboembolism risk factors. Cocker Spaniels were at increased risk for IMHA (P= .012). Timing of vaccination was not associated with development of IMHA. PCV ranged from 5 to 33%, with a mean of 16 ± 5%. Autoagglutination was present in 42% of the dogs. Platelet counts (n = 60) varied from 3,000 to 793,000/,L (mean, 160,117 ± 133,571; median, 144,000). Thrombocytopenia (platelet count, <200,000/,L) was present in 70% of the dogs, with severe thrombocytopenia (platelet count, <50,000/,L) being present in 22%. One-step prothrombin time (OSPT) was prolonged in 28% of the dogs tested, and activated partial thromboplastin time (APTT) was prolonged in 47% of the dogs tested. Fibrin(ogen) degradation products (FDPs) were detected in 16 of 28 dogs tested (57%). Disseminated intravascular coagulation (DIC) was diagnosed in 10 of 31 (32%) dogs and was suspected in 8 dogs. Thromboemboli were found in 20 of 25 dogs given postmortem examinations. Mortality rate was 58%. Thrombocytopenia (P= .008) and serum bilirubin concentration of >5 mg/dL (P= .015) were risk factors for mortality, and hypoalbuminemia approached significance (P= .053). Severe thrombocytopenia (P= .046), serum bilirubin concentration of >5 mg/dL (P= .038), and hypoalbuminemia (P= .016) were risk factors for thromboembolism. On evaluation of continuous data, decreased platelet count (P= .057), increased bilirubin (P= .062), and decreased albumin (P= .054) approached significance for decreased survival. A higher risk for thrombosis was found with increased alkaline phosphatase (ALKP) (P= .042), increased bilirubin (P= .047), and decreased albumin (P= .012). [source]

Isolated Tumor Cells in Bone Marrow and its Relation with known Prognostic Factors in Breast Cancer Patients

THE BREAST JOURNAL, Issue 2 2009
Renata Sánchez MD
No abstract is available for this article. [source]

ORIGINAL RESEARCH,MEN'S SEXUAL HEALTH: Orgasmic Dysfunction After Open Radical Prostatectomy: Clinical Correlates and Prognostic Factors

THE JOURNAL OF SEXUAL MEDICINE, Issue 3 2010
Yvette Dubbelman MD
ABSTRACT Introduction., Erectile function after radical retropubic prostatectomy (RRP) is extensively discussed in literature. However, less is known about orgasm after RRP. Aim., To analyze sexual function, in particularly orgasmic function, in men before and after RRP. Methods., Between 1977 and 2007 a RRP was performed in 1,021 men. All men were interviewed by their follow-up physician using a standardized interview about sexual function before and after RRP at regular intervals during a 2-year follow-up. The questions were related to sexual interest, sexual activity, spontaneous erections, and orgasmic function. Main Outcome Measures., Sexual function, in particularly orgasmic function, before and after RRP. Factors potentially influencing orgasmic function, such as patients age, type of operation, pathological stage and continence status were analyzed for their predictive value. Results., Information about preoperative and postoperative sexual activity and spontaneous erection was available in 596 and 698 men, respectively. Additional questions were asked on sexual interest (N = 425) and orgasmic function (N = 458). Pre-operatively, sexual interest, sexual activity, spontaneous erections and orgasmic function were normal in 99%, 82.1%, 90.0% and 90% of men, respectively. After operation these values decreased to 97.2%, 67.3%, 29.4% and 66.8%, respectively. Orgasmic function was preserved in 141 of 192 men (73.4%) after a bilateral nerve sparing procedure, in 90 out of 127 men (70.9%) after a unilateral nerve-sparing procedure and in 75 of 139 men (54.0%) after non-nerve sparing technique. Postoperatively, orgasm was present in 123 (77.4%) men below the age of 60 years and in 183 (61.2%) men of 60 years and older (P < 0.0001). Orgasmic function was significantly affected by age ,60 years, non-nerve sparing procedure and severe incontinence (more than two pads/day). Conclusions., After RRP, orgasmic function is still present in the majority of men. A non-nerve sparing operation, age, and severe urinary incontinence are risk factors for orgasmic dysfunction after RRP. Dubbelman Y, Wildhagen M, Schröder F, Bangma C, and Dohle G. Orgasmic dysfunction after open radical prostatectomy: Clinical correlates and prognostic factors. J Sex Med 2010;7:1216,1223. [source]

Lateral Tympanoplasty for Total or Near-Total Perforation: Prognostic Factors,

THE LARYNGOSCOPE, Issue 9 2006
Dr. Simon I. Angeli MD
Abstract Objective: To identify prognostic factors affecting outcome in lateral tympanoplasty for total or near-total tympanic membrane perforation. Study Design: Retrospective case series. Methods: Patients were those presenting with total or near-total tympanic membrane perforation undergoing lateral tympanoplasty from 1999 to 2004. We systematically collected demographic, clinical, audiologic, and outcome information. Student t test was used to determine group differences. Logistic regression analysis was used to examine the relationship between success of grafting (dependent variable) and the independent variables. Multiple regression analysis was used to examine the relationship between postoperative air-bone gap (ABG) and independent variables. Results: There were seventy-seven cases (58 primary and 19 revision cases) with average follow-up of 17 months. Successful tympanic membrane grafting occurred in 91% of cases. None of the independent variables studied was predictive of the success of graft incorporation (P > .05). The mean preoperative ABG was 29.8 ± 10 dB and improved to a postoperative ABG of 16.5 ± 11 dB (P < .001). Smaller preoperative ABG and normal malleus handle were associated with smaller postoperative ABG. In revision cases, mastoidectomy was associated with better functional results. Conclusions: Successful grafting of near-total and total tympanic membrane perforations occurred in 91% of the cases and was independent of demographic, disease, and technical variables. Disease variables (preoperative ABG and status of malleus handle) had a greater prognostic value on postoperative ABG than other variables. In revision tympanoplasty, mastoidectomy is associated with a better functional outcome. [source]

Implications of Prognostic Factors and Risk Groups in the Management of Differentiated Thyroid Cancer,

THE LARYNGOSCOPE, Issue 3 2004
Ashok R. Shaha MD
Abstract Objectives/Hypothesis The outcome in differentiated thyroid cancer generally depends on the stage of the disease at the time of presentation; prognostic factors such as age, grade, size, extension, or distant metastasis; and risk groups (eg, low or high risk). The author has reviewed a large number of patients with differentiated thyroid cancer to analyze their hypothesis and to confirm that various risk groups have a major implication in relation to extent of the treatment and outcome. Differentiated thyroid cancers make up 90% of all thyroid tumors. The prognostic factors are well defined, such as age, size of the tumor, extrathyroidal extension, presence of distant metastasis, histological appearance, and grade of the tumor. The author has previously divided the risk groups into low-, intermediate-, and high-risk categories based on prognostic factors. The study describes the author's treatment approach related to the extent of thyroidectomy and adjuvant therapy based on various risk groups and the long-term survival. Study Design Retrospective. Methods In a retrospective review of 1038 patients with differentiated thyroid carcinoma, various prognostic factors were studied by univariate and multivariate analysis. The significant prognostic factors were studied in detail and, based on these prognostic factors, the patients were divided into low-, intermediate- and high-risk groups. The survival curves were plotted by Kaplan-Meier method. Results The long-term survivals in low-, intermediate- and high-risk groups were 99%, 87%, and 57% respectively. Based on these risk groups, a decision tree was made regarding extent of thyroidectomy and adjuvant treatment. In the high-risk group and selected patients in the intermediate-risk group, aggressive surgery including removal of all gross disease and extrathyroidal extension with postoperative radioactive iodine ablation is recommended. In the low-risk group and selected patients in the intermediate-risk group, lobectomy appears to be satisfactory with excellent long-term outcome. The surgical treatment offers the best long-term results in low-risk patients, and the role of adjuvant treatment in this group is questionable. Conclusion The decisions in the management of well-differentiated thyroid cancer should be based on various prognostic factors and risk groups. The long-term survival in the low-risk group is excellent, and consideration should be given to conservative surgical resection depending on the extent of the disease. In the high-risk group and selected patients in the intermediate-risk group, total thyroidectomy with radioactive ablation is warranted. A consideration may be given to external-beam radiation therapy in selected high-risk patients. It is apparent, based on the author's clinical experience and critical retrospective analysis, that the author's hypothesis that risk groups are extremely important in the long-term outcome of patients with differentiated thyroid cancer is correct. Based on various risk groups, the author currently is able to guide the treatment policies for thyroid cancer. [source]

Prognostic Factors for Adult Patients Receiving Extracorporeal Membrane Oxygenation as Mechanical Circulatory Support,A 14-Year Experience at a Medical Center

ARTIFICIAL ORGANS, Issue 2 2010
Chinchun Lan
Abstract Extracorporeal membrane oxygenation (ECMO) is a resource-consuming and highly invasive treatment. There were 1100 ECMO cases at the National Taiwan University Hospital between August 1994 and November 2008. Of these, 607 were adults (>18 years old) who received ECMO as mechanical circulatory support. In this study, patient characteristics and complications during the ECMO course were evaluated for their correlation with prognosis. The following factors were significantly different between survivors and nonsurvivors: age, coronary artery disease, diabetes mellitus, brain death, stroke during ECMO, the need for dialysis during ECMO, pre-ECMO infection, hypoglycemia, acidosis, alkalosis, the need for a distal perfusion catheter, and the amount of red blood cells transfused. Six independent predictors of mortality were identified: age, stroke, the need for dialysis during ECMO, pre-ECMO infection, hypoglycemia, and alkalosis. Our institution has comparatively extensive experience with adult patients, which may be quite different from other medical centers with respect to distribution of patient age. The findings should lead to better utilization of ECMO for adult patients in the future. [source]

Evaluation of the American Joint Committee on Cancer Staging System for Cutaneous Squamous Cell Carcinoma and Proposal of a New Staging System

DERMATOLOGIC SURGERY, Issue 11 2005
Scott M. Dinehart MD
Purpose. To identify and propose corrections for deficiencies in the American Joint Committee on Cancer (AJCC) system for staging cutaneous squamous cell carcinoma (CSCC). Materials and Methods. Prognostic factors for CSCC were identified by retrospective analysis of the published literature. Limitations and deficiencies in the current AJCC staging system for CSCC were then determined using these prognostic factors. Results. Size, histologic differentiation, location, previous treatment, depth of invasion, tumor thickness, histologic subtype, perineural spread, and scar etiology are the most powerful tumor prognostic indicators in patients with localized disease. The most important prognostic factors for patients with nodal metastases are the location, number, and size of the positive lymph nodes. Proposed changes for the T classification include increased stratification of tumor size, identification of patients with perineural invasion, and the addition of tumor thickness or depth of invasion. The N classification has been expanded to include the number and size of nodal metastases. Conclusion. The current AJCC staging system for carcinoma of the skin has deficiencies that limit its use for CSCC. The proposed TMN staging system for CSCC more accurately reflects the prognosis and natural history of CSCC. SCOTT M. DINEHART, MD, AND STEVEN PETERSON, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source]

Prognostic factors of radiotherapy in patients with node-positive thoracic esophageal squamous cell carcinoma after radical surgery

DISEASES OF THE ESOPHAGUS, Issue 6 2009
Jin-Cheng Lu
SUMMARY The aim of this study was to retrospectively analyze and assess the outcomes and prognostic factors of radiotherapy in patients with node-positive thoracic esophageal squamous cell carcinoma after radical surgery. One hundred twenty-six patients with node-positive thoracic esophageal squamous cell carcinoma who had undergone adjuvant therapy (postoperative radiotherapy alone or postoperative sequential chemoradiotherapy without receiving postoperative concurrent chemoradiotherapy) after radical surgery, were retrospectively reviewed from January 1996 to December 2003. Univariate and multivariate analyses were performed using log-rank and Cox proportional hazard models, and survival curves were estimated using the Kaplan-Meier method. The 1-, 3- and 5-year overall survival rates of all 126 patients were 71.4, 39.1, and 22.0%, and disease-free survival rates were 64.3, 36.4, and 21.5%, respectively. Lymph node ratio (the ratio of the number of metastatic lymph nodes to the number of lymph nodes removed, LNR) ,0.2 (P= 0.006), pT3 + pT4 (P= 0.06) and sequential chemoradiotherapy (P= 0.08) were associated with a poorer survival by univariate analysis. In multivariate analysis, LNR (P= 0.01, hazard ratio = 0.57, 95% confidence interval, 0.37,0.87) and tumor depth of invasion (P= 0.03, hazard ratio = 0.62, 95% confidence interval, 0.41,0.96) were the independent predictors of survival. Sequential chemoradiotherapy receded survival tendency without significant difference (P= 0.09, hazard ratio = 0.64, 95% confidence interval, 0.37,1.08). Therefore, LNR and tumor depth of invasion were the independent prognostic factors of radiotherapy in patients with node-positive thoracic esophageal squamous cell carcinoma after radical surgery. The addition of chemotherapy does not seem to confer a survival benefit. [source]

Prognostic factors for classifying extranodal NK/T cell lymphoma, nasal type, as lymphoid neoplasia

EUROPEAN JOURNAL OF HAEMATOLOGY, Issue 1 2007
Im I. Na
Abstract This study evaluated the applicability of prognostic factors commonly used for diagnosis of classical lymphoma outcomes to extranodal NK/T cell lymphoma, nasal type (NTCL). Clinical features and their associations with lactate dehydrogenase (LDH) were evaluated in 70 patients. RLDH was defined as the ratio of LDH to the upper normal limit. RLDH was associated with stage (I,II vs. III,IV), lymph node involvement (LNI), and International Prognostic Index score (<2 vs. ,2). Poor performance status and advanced stage were common in patients with local tumor invasiveness (LTI). LDH level, classified into three levels (low, high, and very high) was associated with survival (P < 0.001). In multivariate analysis, the predictive values of LDH level, B symptom, performance status, and stage remained significant whereas those of LTI and LNI did not. Scoring was performed by weighting each factor with 0.5 or 1.0 according to its hazard ratio. Scores were classified into four groups. Groups with high scores were associated with unfavorable outcomes (P < 0.001). Current study suggests that prognostic factors for NHL may be useful to predict the outcome of NTCL but the model should take LDH level and the prognostic weight of each factor into account. [source]

Autologous transplantation in relapsed and refractory Hodgkin's disease

EUROPEAN JOURNAL OF HAEMATOLOGY, Issue 2005
Andreas Josting
Abstract:, The current data support the use of high-dose chemotherapy (HDCT) and autologous stem cell transplantation (ASCT) as standard procedure for the majority of patients with Hodgkin's disease (HD) relapsing or progressing after combination chemotherapy. Prognostic factors reflecting unfavourable prognostic features of the disease as well as resistance to conventional salvage therapy have been identified. Preliminary data suggests a high efficacy of high-dose sequential chemotherapies in these patients. An ongoing randomized trial is comparing standard HDCT versus sequential HDCT in patients with relapsed HD. [source]

Prognostic factors in advanced stage Hodgkin's lymphoma: the significance of the number of involved anatomic sites

EUROPEAN JOURNAL OF HAEMATOLOGY, Issue 5-6 2001
T.P. Vassilakopoulos
Abstract:Background: Advanced Hodgkin's lymphoma (HL) is curable by conventional chemotherapy in 60,70% of patients. The pretreatment identification of a sizeable subgroup of patients with sufficiently low failure-free survival (FFS) to be eligible for investigational treatment is necessary. Objectives: To determine the prognostic significance of the number of involved sites (NIS) in patients with advanced HL and its relationship to the International Prognostic Score (IPS). Methods: A retrospective review of patients with advanced HL, defined as Ann Arbor stage (AAS) IB, IIB, III or IV, treated with anthracycline-based regimens. The end-point was FFS. Results: We identified 277 patients with a median age of 32 yr (14,78), 57% of whom were males. AAS was I in 4% of patients, II in 29%, III in 38% and IV in 29%. B-symptoms were recorded in 81%. Most patients had nodular sclerosis (64%) and mixed cellularity (26%) histology. IPS was ,3 in 44% of 242 evaluable patients. The NIS was ,5 in 32% of the patients and 20% of all patients had both ,5 involved sites and IPS ,3. The 10-yr FFS was 67%, being 76% vs. 50% for patients with ,4 vs. ,5 involved sites (P < 0.0001). The NIS (, 5), AAS IV and anemia were independent predictors of FFS in multivariate analysis. The NIS remained significant along with IPS, when the latter was included in the analysis. Patients with ,5 involved sites and IPS ,3 had 10-yr FFS overall, and relapse-free survival of 41%, 45% and 49%, respectively. Conclusions: The NIS was associated with FFS in advanced HL, was independent of IPS, and led to the identification of a sizeable subgroup of patients with 10-yr FFS of approximately 40%. This factor should be evaluated during the development of prognostic systems. [source]

Transoral laser microsurgery for T3 laryngeal tumors: Prognostic factors

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 7 2010
Isabel Vilaseca MD
Abstract Background. The objective of this study was to evaluate the outcomes of transoral laser microsurgery (TLM) in T3 laryngeal carcinomas and to identify prognostic factors for survival and laryngeal preservation. Methods. This study aimed to provide a retrospective analysis of 147 consecutive patients, evaluating their overall survival, disease-specific survival, laryngectomy-free survival, and function preservation rate. Results. Five-year overall, disease-specific, and laryngectomy-free survivals were 53.1%, 70.2%, and 62.3%, respectively. Disease-specific survival differed between glottic and supraglottic tumors (86.3% vs 61.8%; p = .015). Function preservation was 65.5% in supraglottic and 49.1% in glottic tumors (p = .002). Disease-specific survival was not related to pre-epiglottic involvement, cord fixation, or focal cartilage infiltration (p > .05). Vocal cord fixation and cartilage infiltration were independent negative prognostic factors for organ preservation (odds ratio [OR] = 0.184; 95% confidence interval [CI] = 0.082,0.411; p = .000 and OR = 0.331; 95% CI = 0.139,0.789; p = .013, respectively). Conclusion. Our conclusion is that TLM is a good alternative in a large number of T3 laryngeal tumors, with adequate survival and organ preservation rates above 60%. © 2009 Wiley Periodicals, Inc. Head Neck, 2010 [source]

Prognostic factors for the malignant triton tumor of the head and neck

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2009
Andrej Terzic MD
Abstract Background. Malignant triton tumors are rare neoplasias consisting of a malignant peripheral nerve sheath tumor with additional rhabdomyoblastic differentiation. These tumors are highly aggressive and prognosis is poor. Our aim is to describe the outcome and to identify potential prognostic factors. Methods. From 1993 to 2005, 7 patients with a malignant triton tumor of the head and neck were treated at our institution. A literature search revealed another 46 published cases. All these cases were analyzed for outcome and prognostic factors. Results. Patients with primary tumors involving the nose and paranasal sinuses have better, patients involving the neck a poor prognosis. All other locations show an intermediate course. Complete surgical removal is of crucial importance. Additional radiation or chemotherapy show little effect. Conclusion. Location of the primary tumor is a key factor for prognosis. Complete surgical removal is the only treatment associated with survival.© 2009 Wiley Periodicals, Inc. Head Neck, 2009 [source]

Prognostic factors in salvage surgery for recurrent oral and oropharyngeal cancer

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 2 2006
Ivan Marcelo Gonçalves Agra MD
Abstract Background. Therapeutic decisions in recurrent oral and oropharyngeal squamous carcinoma (SCC) remain controversial. Methods. Two hundred forty-six consecutive patients who underwent salvage surgery for recurrent squamous cell carcinoma (SCC) of the oral cavity and oropharynx were studied. The tumor sites were lip, 33 cases; oral cavity, 143; oropharynx, 70. The previous treatment was surgery in 73 patients, radiotherapy in 96, combined surgery and radiotherapy in 76, and chemotherapy in one. The clinical stage of recurrence was I/II in 51 cases and III/IV in 195 cases. The disease-free interval (DFI) was less than 1 year in 156 cases and greater than 1 year in 90 cases. Results. The rate of recurrence was 54.9%, and the overall 5-year actuarial survival rate was 32.3%. The significant prognostic factors in multivariate analysis were restage (p = .049) and DFI (p = .045). Conclusion. Patients with recurrent oral and oropharyngeal SCC at initial clinical stages (rCS I and II) and with a DFI greater than 1 year had a favorable prognosis. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source]

Postoperative brachytherapy alone and combined postoperative radiotherapy and brachytherapy boost for squamous cell carcinoma of the oral cavity, with positive or close margins,

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 3 2004
Michel Lapeyre MD
Abstract Background. Postoperative radiotherapy is necessary for squamous cell carcinoma (SCC) of the oral cavity with positive or close margins. The aim of the study is to define the indications of postoperative brachytherapy (BRT). Methods. From 1979 to 1993, 82 patients with positive or close margins had postoperative BRT (58 T1,2, 24 T3,4, 45 mobile tongue, 37 floor of mouth). Forty-six patients had combined radiotherapy (RT) with a mean dose of 48 Gy, and BRT boost with a mean dose of 24 Gy. Thirty-six patients had BRT alone with a mean dose of 60 Gy. BRT was performed with interstitial low dose rate Iridium 192. Results. Overall survival (OS), cause-specific survival (CSS), and local control (LC) at 5 years were, respectively, for T1,2/N0N, with BRT, 75%, 85%, and 88%,and with RT-BRT 70%, 92%, and 92%; for T1,2/N+ with RT-BRT, 44%, 67%, and 78%; for T3,4/N, with RT-BRT, 42%, 90%, and 80%; and for T3,4/N+ with RT-BRT, 22%, 43%, and 57%. Prognostic factors for OS, CSS, and LC were N+ (p , .009), extracapsular spread (ECS+;p , .000001), and T stage for LC only (p = .02). Prognostic factors for complications were a high number of wires with a cutoff at five wires (p = .008), a high dose rate with a cutoff at 0.57 Gy/hr (p = .01), and a high total dose (BRT + RT) with a cutoff at 71 Gy (p = .07). Conclusions. BRT alone for SCC T1,2/N0N, is better than RT-BRT because, with equivalent results, it avoids the adverse events of postoperative RT (xerostomia) and permits the treatment of a second head and neck primary in nonirradiated tissue. The results for the T3,4/N, are acceptable with this approach (ie, RT-BRT) but may be improved for N+. © 2004 Wiley Periodicals, Inc. Head Neck26: 216,223, 2004 [source]

Prognostic factors of clinically stage I and II oral tongue carcinoma,A comparative study of stage, thickness, shape, growth pattern, invasive front malignancy grading, martinez-gimeno score, and pathologic features

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 6 2002
Anthony Po Wing Yuen FHKAM(ORL)
Abstract Purpose This study aims at evaluation of the different prognostic models, including stage, tumor thickness, shape, malignancy grading of tumor invasive front, Martinez-Gimeno score, and pathologic features in the prediction of subclinical nodal metastasis, local recurrence, and survival of early T1 and T2 oral tongue squamous cell carcinoma. The results will have important implication for the management of patients. Patients and Methods Seventy-two clinically T1 and T2 glossectomy specimens of oral tongue carcinoma were serially sectioned in 3-mm thickness for the evaluation of various pathologic features. The prognostic value in the prediction of subclinical nodal metastasis, local recurrence, and survival of different models were compared. Results Among all the tumor parameters and predictive models being evaluated, tumor thickness was the only significant factor that had significant predictive value for subclinical nodal metastasis, local recurrence, and survival. With the use of 3-mm and 9-mm division, tumor of up to 3-mm thickness has 8% subclinical nodal metastasis, 0% local recurrence, and 100% 5-year actuarial disease-free survival; tumor thickness of more than 3 mm and up to 9 mm had 44% subclinical nodal metastasis, 7% local recurrence, and 76% 5-year actuarial disease-free survival; tumor of more than 9 mm had 53% subclinical nodal metastasis, 24% local recurrence, and 66% 5-year actuarial disease-free survival. Conclusions Tumor thickness should be considered in the management planning of patients with early oral tongue carcinoma. © 2002 Wiley Periodicals, Inc. Head Neck 24: 513,520, 2002 [source]

Prognostic factors for patients with acute myeloid leukaemia or high-risk myelodysplastic syndromes undergoing myeloablative or non-myeloablative allogeneic blood stem cell transplantation

HEMATOLOGICAL ONCOLOGY, Issue 4 2007
Thorsten Graef
Abstract In this uni-centre retrospective study, we studied 120 adults with acute myeloid leukaemia (AML) (n,=,88) and myelodysplastic syndrome (MDS) (n,=,32) who received first allogeneic HSCT to determine prognostic factors which are correlated with the outcome after myeloablative (MA) or non-myeloablative (non-MA) allogeneic HSCT. The median age of our cohort was 44 years. Fifty-nine per cent of the patients were transplanted in complete remission (CR) and 41% were in relapse or refractory to induction or salvage therapy. A total of 97 patients received a MA regimen and 23 were treated with a non-MA regimen. The prognostic impact for several parameters was assessed by univariate and by multivariate analyses using the Cox regression model. Three-year probabilities of non-relapse mortality (34 vs. 54%; p,=,0.9) did not differ in the MA and non-MA groups, but differences were observed in the disease-free survival (DFS) (43 vs. 17%; p,=,0.1) and the relapse rate (RR) (29 vs. 62%; p,=,0.01). Independently from the regimen, in uni- and multivariate analysis, survival was best in those patients who were transplanted in CR and experienced cGvHD. Interestingly, outcome of patients with complex cytogenetic aberrations was identical to that of better prognostic subgroups. In this study, the clinical benefit of a lower toxicity regimen was offset by higher RR resulting in inferior results in the non-MA group, especially when no CR was achieved by prior induction or salvage therapy. Copyright © 2007 John Wiley & Sons, Ltd. [source]

Hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma: Is the addition of subcutaneous interferon-,-2b beneficial?

HEPATOLOGY RESEARCH, Issue 3 2009
Satoe Takaki-Hamabe
Aim:, We previously reported the benefits of hepatic arterial infusion chemotherapy (HAIC) using cisplatin (CDDP), 5-fluorouracil (5-FU) [low-dose FP], and leucovorin/isovorin for advanced hepatocellular carcinoma (HCC). In this study, we investigated the efficacy of combination therapy with HAIC and subcutaneous interferon (IFN)- ,-2b in patients with advanced HCC. Methods:, Of the 48 patients, 31 received low-dose FP with leucovorin/isovorin (HAIC group) and 17 received combination therapy comprising low-dose FP with isovorin and subcutaneous IFN-,-2b (combination group). Prognostic factors were evaluated by univariate and multivariate analyses of the patient and the disease characteristics. Results:, There were no significant differences in the response rate (patients with complete or partial response/all patients; P = 0.736) and survival (P = 0.399) between both groups. Univariate analysis revealed that IFN therapy was not a significant prognostic factor. Multivariate analysis showed 3 variables, namely, Child,Pugh score (P = 0.010), ,-fetoprotein level (P = 0.0047), and additional therapy (P = 0.002), to be significant prognostic factors. Conclusions:, We considered that combination therapy with HAIC and subcutaneous interferon (IFN)-,-2b was not beneficial for advanced HCC. [source]

Prognostic factors in lymph node metastases of prostatic cancer patients: the size of the metastases but not extranodal extension independently predicts survival

HISTOPATHOLOGY, Issue 4 2008
A Fleischmann
Aims:, To analyse tumour characteristics and the prognostic significance of prostatic cancers with extranodal extension of lymph node metastases (ENE) in 102 node-positive, hormone treatment-naive patients undergoing radical prostatectomy and extended lymphadenectomy. Methods and results:, The median number of nodes examined per patient was 21 (range 9,68), and the median follow-up time was 92 months (range 12,191). ENE was observed in 71 patients (70%). They had significantly more, larger and less differentiated nodal metastases, paralleled by significantly larger primary tumours at more advanced stages and with higher Gleason scores than patients without ENE. ENE defined a subgroup with significantly decreased biochemical recurrence-free (P = 0.038) and overall survival (P = 0.037). In multivariate analyses the diameter of the largest metastasis and Gleason score of the primary tumour were independent predictors of survival. Conclusions:, ENE in prostatic cancer is an indicator lesion for advanced/aggressive tumours with poor outcome. However, the strong correlation with larger metastases suggests that ENE may result from their size, which was the only independent risk factor in the metastasizing component. Consequently, histopathological reports should specify the true indicator of poor survival in the lymphadenectomy specimens, which is the size of the largest metastasis in each patient. [source]

Prognostic factors and outcome after drowning in an adult population

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2009
M. Á. BALLESTEROS
Background: Drowning remains an actual problem. Although medical assistance has improved, it still has high rates of morbidity and mortality. We set out to explore the clinical characteristics and outcome of drowning patients admitted to the intensive care unit (ICU) of tertiary-care university hospital. Methods: We designed a retrospective observational study to analyse all drowning patients admitted to our ICU after successful cardiopulmonary resuscitation. The study was conducted during 1 January 1992,31 December 2005. There was no exclusion. We used a univariate analysis to evaluate the effect on patient and management characteristics on survival. Results: There were 43 patients (five children and 38 adults), with male predominance. Fifteen patients, all adults (34.9%), died. Submersion time, age, Glasgow Coma Score (GCS), pupillary reactivity and acute physiology and chronic health evaluation (APACHE II) at ICU admission were related to mortality. Non-survivors presented a higher glycaemia level at ICU admission than survivors (P=0.005). Conclusions: The outcome is closely related to the patient's clinical status on arrival to the hospital. We have found that submersion time, age, GCS, pupillary reactivity and APACHE II at ICU admission were related to mortality. Further research in prospective studies is needed. [source]

Prognostic factors in patients with small hepatocellular carcinoma treated by percutaneous ethanol injection

JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 11 2002
Hitoshi Kuriyama
Abstract Background: Percutaneous ethanol injection (PEI) has been widely performed and is now accepted as a viable alternative to hepatic resection in patients with small hepatocellular carcinomas (HCC). However, only a few extensive investigations have been conducted regarding the prognostic factors for HCC patients treated with PEI. Methods: We investigated the prognostic factors in 100 patients with small HCC who had undergone PEI. Univariate analysis and multivariate analysis with Cox's proportional hazards model were used to determine the factors potentially related to survival. For clinical application, a prognostic index was calculated based on the regression coefficients of the independent variables identified from the multivariate analysis. Results: Median survival time and 1, 3 and 5 year survival rates were 71 months and 100, 84 and 62%, respectively. Among the 15 potential prognostic variables investigated, only three variables, namely a serum albumin level ,,3.5 g/dL, the presence of tumor stain and a serum glutamic oxaloacetic transaminase level>,66 IU/L, were identified as factors independently associated with a shorter survival. A prognostic index based on the regression coefficients of these three factors was proposed to classify patients into three groups, those with a good (5 year survival rate 91%), intermediate (64%) and poor prognosis (22%). Conclusions: The results of the present study may be useful in predicting the survival of HCC patients treated with PEI and in the design and analysis of future clinical trials of PEI for HCC. © 2002 Blackwell Publishing Asia Pty Ltd [source]

Prognostic factors of long-term CD4+count-guided interruption of antiretroviral treatment

JOURNAL OF MEDICAL VIROLOGY, Issue 3 2009
L. Sarmati
Abstract Aim of the study was to determine predictors of the duration of antiretroviral treatment interruption in patients infected with HIV. This pilot prospective, open-label, multicenter trial comprised 62 HIV-seropositive subjects who decided voluntarily to interrupt therapy after two or more years of successful HAART. The primary end-point was the time to patients being free of therapy before reaching a CD4+ cell count ,350/µl. Fifteen of 62 patients remained in treatment interruption for more than 180 days. Patients restarting therapy had higher HIV-DNA levels (P,=,0.05), were treated more frequently with NNRTI-drugs (P,=,0.02), had a shorter period of HAART (P,=,0.046), and lower CD4+ cell counts after day 14 of interruption of treatment (P,=,0.04). Multivariate regression analysis showed that less than 323 baseline proviral HIV-DNA cp/106 PBMCs and more than 564 CD4 cells/µl at day 14 after interruption were associated independently with a reduced risk of restarting treatment (P,=,0.041 and P,=,0.012, respectively). A score based on CD4+ cell counts at nadir, at baseline, at week 2 of treatment interruption, and on baseline HIV-DNA values can identify patients with a prolonged period free safely of treatment. J. Med. Virol. 81:481,487, 2009. © 2009 Wiley-Liss, Inc. [source]

Prognostic factors in endometrial carcinoma

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2008
Peter Uhar
Abstract Endometrial carcinoma is the most common malignancy of the female genital tract in industrialized countries, and occurs predominantly after the menopause. Although most endometrial carcinomas are detected at low stage, there is still a significant mortality from the disease. In postmenopausal women, prolonged life expectancy, changes in reproductive behavior and prevalence of overweight and obesity, as well as hormone replacement therapy use, may partially account for the observed increases of incidence rates in some countries. In order to improve treatment and follow-up of endometrial carcinoma patients, the importance of various prognostic factors has been extensively studied. The identification of high-risk groups would make it possible to avoid unnecessary adjuvant treatment among patients with a good prognosis. Over the past few decades, several studies have demonstrated the prognostic importance of different parameters including lymph node status, histological type of carcinoma (serous carcinoma and clear cell carcinomas are poor prognostic types), histological grade, stage of disease, depth of myometrial invasion, lymphovascular space involvement and cervical involvement. Other factors currently being investigated are estrogen and progesterone receptor status, p53 status, flow cytometric analysis for ploidy and S-phase fraction, and oncogenes such as HER-2/neu (c-erbB-2). [source]

Erratum: Primary and recurrent retroperitoneal soft tissue sarcoma: Prognostic factors affecting survival

JOURNAL OF SURGICAL ONCOLOGY, Issue 6 2008
Antonio Chiappa MD, FACS
When this article was originally published in J Surg Oncol. 2006 May 1;93(6):456,63 (2006), Ugo Pace's name appeared reversed in the byline. The correct name appears above. [source]