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Median Follow-up Duration (median + follow-up_duration)
Selected AbstractsElevated serum urate concentration independently predicts poor outcome following stroke in patients with diabetesDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 1 2006Edward J. Newman Abstract Background Type 2 diabetes is a risk factor for stroke and confers increased risk of poor outcome and further vascular events following stroke. Hyperuricaemia occurs commonly in patients with type 2 diabetes, but its significance as a predictor of outcome following stroke is uncertain. We sought to investigate the prognostic significance of elevated serum urate concentration in diabetic subjects following stroke. Methods We studied a cohort of type 2 diabetes patients presenting to our unit with computed tomography-confirmed acute stroke. Fasting blood samples were drawn within 24 h of admission for urate concentration and standard battery of biochemistry and hematological tests. Information on age, stroke type, prior hypertension, smoking status, resolution time of symptoms and National Institutes of Health Stroke Score was collated. The main outcome event was time to myocardial infarction, recurrent stroke or vascular death, as defined in the CAPRIE trial. Stepwise proportional hazards regression was used to estimate the effect of the above variables on event-free survival following stroke. Results One hundred and forty patients were studied. Median follow-up duration was 974 days (IQR 163 to 1830 days). Sixty-four patients suffered an outcome event. Urate levels of greater than 0.42 mmol/L (p < 0.001) and an increasing NIHSS score (p < 0.001) independently predicted increased likelihood of suffering an event. Conclusion Elevated urate concentration is significantly and independently associated with increased risk of future vascular events in diabetic stroke patients. Further studies to elucidate the mechanism of this observation are required. Copyright © 2005 John Wiley & Sons, Ltd. [source] Long-term outcome of tenofovir disoproxil fumarate use against hepatitis B in an HIV-coinfected cohortHIV MEDICINE, Issue 5 2009G Alvarez-Uria Objectives Tenofovir disoproxil fumarate (TDF) is active against hepatitis B virus (HBV) and HIV. However, the long-term efficacy of tenofovir disoproxil fumarate (TDF) is not well known and the appearance of resistance is a major concern. We have studied the efficacy of TDF against HBV in patients treated at an Infectious Diseases Unit. Methods We carried out a retrospective observational study of the efficacy of TDF against HBV replication in a cohort of 52 HIV-coinfected patients who received TDF for at least 6 months. Results The median duration of follow-up of TDF treatment was 34 months. Forty-one patients (79%) were positive for HBV envelope antigen (HBeAg) and 35 had received previous lamivudine monotherapy for a median duration of 32 months. Virological breakthrough was observed in nine cases (17%). At the end of the follow-up period, HBV DNA levels were <1000 copies/mL in 42 patients (81%) and <200 copies/mL in 31 patients (60%). There were no significant differences between the lamivudine-naïve and lamivudine-experienced groups. In the lamivudine-experienced group, the duration of previous lamivudine monotherapy was associated with failure to achieve HBV DNA levels <200 copies/mL (P=0.036). Adding lamivudine or emtricitabine to TDF did not improve virological suppression. In 39 patients who achieved <200 HBV DNA copies/mL during TDF treatment, virological breakthrough was seen only in two patients (5%) after a median follow-up duration of 39.7 months. Conclusions TDF was able to control HBV replication in most HIV-coinfected patients after a median follow-up duration of 34 months, regardless of previous lamivudine treatment. However, a sizeable proportion of patients developed virological breakthrough. [source] Synovial sarcoma in children and adolescents: Thirty three years of experience with multimodal therapy,PEDIATRIC BLOOD & CANCER, Issue 2 2001M. Fatih Okcu MD Abstract Background Synovial sarcoma (SS) is the most common type of non-rhabdomyosarcoma soft tissue sarcoma in childhood, with controversies about its prognosis and treatment. Procedure We reviewed medical records of 42 children and adolescents with SS treated at our institution between 1966 and 1999 to determine treatment results and assess prognostic factors. Results With a median follow-up duration of 7.8 years (range 0.2,22.4 years), 5-year progression free survival (PFS) and overall survival (OS) rates were 75.6% (95% Confidence Interval [CI] 62,89.2%) and 87.7% (95% CI 77.3,98.1%) respectively. Eleven patients were dead and four others had progressed but were alive without evidence of disease after further therapy. IRS grouping and tumor invasiveness were found to be significant prognostic indicators (P,<,0.01 and =,0.02, respectively). Patients with initial gross total resection (IRS I and II) and non-invasive tumors (T1) were most likely to have prolonged PFS and OS. Patients with small tumors (<,5 cm) (P,=,0.09) or with monophasic histology (P,=,0.14) had better PFS and OS. Conclusions Achieving a complete resection or gross total resection with microscopic residual disease is vital for survival of patients with localized SS. Patients with localized disease who received radiotherapy had improved local control. Chemotherapy did not seem to impact PFS or OS. Future large multi-institutional trials are needed to address whether post-operative chemotherapy is necessary for patients with localized, surgically removed tumors, whether radiotherapy is necessary for patients with completely resected tumors, and to ascertain the order of importance of all the candidate prognostic markers. Med Pediatr Oncol 2001;37:90,96. © 2001 Wiley-Liss, Inc. [source] SIGNIFICANCE OF TUMOUR VOLUME MEASUREMENTS IN TONGUE CANCER: A NOVEL ROLE IN STAGINGANZ JOURNAL OF SURGERY, Issue 8 2007Min H. Chew Background: Tongue cancers are staged by the American Joint Committee on Cancer and the Union Internationale Contre le Cancer TNM staging systems. Cancer, however, evolves in a 3-D plane. Hence, using the largest tumour diameter will not reflect total cancer volume. We aim to evaluate the use of tongue cancer tumour volume (Tv) as a prognostic predictor of disease recurrence and survival. Methods: The study is a retrospective analysis of patients in Singapore General Hospital who underwent complete resection for histologically proven tongue carcinoma from 2000 to 2002. The Tv was measured on staging T2 -weighted magnetic resonance imaging datasets by semiautomated methods. Results: Seventeen patients with a median follow-up duration of 57.9 months were studied. A wide range of volumes was noted in each T stage. The median time to relapse was 8.6 months for those with Tv , 13 cc but was not achieved for those with Tv < 13 cc. The hazard ratio comparing Tv ,13 cc versus <13 cc is 9.02 (95% confidence interval (CI) 1.70,47.94, P = 0.014). Of the seven deaths reported, five patients had Tv , 13 cc. The median overall survival was 15.8 months for those with Tv , 13 cc but was not achieved for those with Tv < 13 cc. The hazards of death for Tv , 13 cc was 3.91 times that of Tv < 13 cc (95%CI 0.86,17.86, P = 0.078). Conclusion: Tongue cancer Tv measurement allows a more refined and accurate assessment of tumour status. This can be a possible prognostic indicator and be used in a novel staging method for the future. [source] Prognostic role of insulin-like growth factor receptor-1 expression in small cell lung cancerAPMIS, Issue 12 2009MYUNG HEE CHANG Insulin-like growth factor receptor-1 (IGFR-1) is a cellular membrane receptor which is overexpressed in many tumors and seems to play a critical role in anti-apoptosis. The insulin-like growth factor binding protein-3 (IGFBP-3) is known as a growth suppressor in multiple signaling pathways. The aim of this study was to determine IGFR-1 and IGFBP-3 expression in small-cell lung cancer (SCLC) and analyze the prognostic value in patients with SCLC. We analyzed IGFR-1 and IGFBP-3 expression in 194 SCLC tissues by immunohistochemical staining. Correlative analyses between IGFR-1 and IGFBP-3 expression in SCLC and clinicopathologic factors were performed. A total of 117 patients had extensive disease (ED) (60.3%) and 77 had limited disease (39.7%). With the median follow-up duration of 49.5 months (24,82 months), the median progression-free survival (PFS) and overall survival (OS) were 7.2 months [95% confidence interval (CI): 6.4,8.0 months] and 14.4 months (95% CI: 12.7,16 months), respectively. IGFR-1 expression was observed in 154 of the 190 tumor tissues, whereas there was no IGFBP-3 expression. Multivariate analysis showed that stage (p < 0.001), response rate (p < 0.001), and lactate dehydrogenase (LDH) levels (p < 0.001) were the independent prognostic factors for PFS, and age (p = 0.014), LDH level (p < 0.001), and stage (p < 0.001) for OS. The IGFR-1 positivity was not associated with PFS or OS in the entire cohort. Subgroup analysis revealed that OS was significantly longer in patients with IGFR-1-positive tissue than IGFR-1-negative tissue in SCLC-ED (p = 0.034). These results suggest that IGFR-1 expression may be useful as a prognostic marker in patients with SCLC-ED. [source] Results of breast-conserving therapy for multifocal or multicentric breast cancersASIA-PACIFIC JOURNAL OF CLINICAL ONCOLOGY, Issue 3 2009Eui Kyu CHIE Abstract Aim: To evaluate the outcome of breast-conserving treatment including adjuvant radiotherapy in patients with multifocal or multicentric breast cancers. Methods: Between February 1996 and January 2002 13 patients presented with multifocal or multicentric breast tumors underwent breast-conserving therapy. Their median age was 44 years (range; 32,56). Nine patients had T1 disease and four had T2 disease. Nodal involvement was confirmed in three patients. All patients had breast-conserving surgery and axillary lymph node dissection with clear resection margin. Whole breast irradiation was given up to 50.4 Gy in 28 fractions followed by 10 Gy boost to tumor bed. Twelve patients received adjuvant systemic therapy: chemotherapy in four patients, hormonal therapy in five patients and both in three patients. Results: At a median follow-up duration of 70 months, all patients were alive without evidence of disease. The cosmetic outcome was evaluated in 11 patients. Cosmesis was excellent in two patients, good in six patients and fair in three patients. Conclusion: Multifocal and/or multicentric breast cancers can be successfully treated with breast-conserving surgery and adjuvant radiotherapy when complete microscopic resection and contemporary systemic therapy are given. [source] A phase II trial of arsenic trioxide in patients with metastatic melanomaCANCER, Issue 8 2005Kevin B. Kim M.D. Abstract BACKGROUND Arsenic trioxide induces growth inhibition and apoptosis in human melanoma cell lines. Therefore, a Phase II trial was conducted to evaluate the efficacy and toxicity of single-agent arsenic trioxide in patients with Stage IV melanoma. METHODS Twenty patients, 10 with metastatic melanoma of cutaneous origin and 10 with metastatic melanoma of choroidal origin, received arsenic trioxide 0.25 mg/kg/day for 5 days, followed by a maintenance dose of 0.35 mg/kg/day twice a week. All patients with melanoma of cutaneous origin and four patients with melanoma of choroidal origin had received prior therapy. RESULTS Single-agent arsenic trioxide did not induce clinical response in this patient population. Eight patients (five with melanoma of cutaneous origin, and three with melanoma of choroidal origin) had disease stabilization for at least six weeks. The median overall survival duration for patients with melanoma of cutaneous origin was 7.9 months, and that of patients with melanoma of choroidal origin has not been reached at a median follow-up duration of 11.8 months. Grade 3 toxicity included neutropenia, fatigue, abdominal pain, and arthralgia. Grade 4 toxicity did not occur. CONCLUSIONS Single-agent arsenic trioxide was generally well tolerated; however, no tumor regression was observed in this patient population. Future clinical trials should evaluate arsenic trioxide in combination with other anticancer drugs that may improve its clinical activity in melanoma. Cancer 2005. © 2005 American Cancer Society. [source] Long-term results of high-dose rate intracavitary brachytherapy for squamous cell carcinoma of the uterine cervixCANCER, Issue 1 2005Takashi Nakano M.D. Abstract BACKGROUND The authors performed a long-term follow-up study to evaluate the efficacy and late toxicity of high-dose rate intracavitary brachytherapy (HDR-ICBT) for cervical carcinoma. METHODS From 1968 to 1986, 1148 patients with Stage IB to IVB squamous cell carcinoma of the cervix (staging was performed according to the International Federation of Gynecology and Obstetrics) were treated with a combination of external beam radiotherapy (EBRT) and HDR-ICBT. For patients with early-stage disease, 20 gray (Gy) of EBRT was delivered to the whole pelvis, followed by 24 Gy/4 fractions of HDR-ICBT and 30 Gy of central-shielding EBRT. For patients with advanced-stage disease, 20,40 Gy of whole pelvic EBRT was administered, followed by 24 Gy/4 fractions of ICBT and 30,10 Gy of central-shielding EBRT. The overall treatment time was approximately 6 weeks. Among survivors, the follow-up rate was 98% and the median follow-up duration was 22 years. RESULTS The 10-year pelvic tumor control rates were 93% for patients with Stage IB disease, 82% for patients with Stage II disease, and 75% for patients with Stage III disease. The 10-year overall and cause-specific survival rates were 74% and 89% for patients with Stage IB disease, 52% and 74% for patients with Stage II disease, and 42% and 59% for patients with Stage III disease, respectively. The 10-year actuarial rates of major complications were 4.4% in the rectosigmoid colon, 0.9% in the bladder, and 3.3% in the small intestines. CONCLUSIONS The results of the current study suggest that the combination of EBRT and HDR-ICBT according to the authors' protocol provided outcomes that were comparable to those of the conventional low-dose rate brachytherapy with acceptable rates of late complications in the treatment of cervical carcinoma. Cancer 2005. © 2004 American Cancer Society. [source] Complex of urokinase-type plasminogen activator with its type 1 inhibitor predicts poor outcome in 576 patients with lymph node,negative breast carcinomaCANCER, Issue 3 2004Peggy Manders M.Sc. Abstract BACKGROUND The ability of a solid tumor to grow and metastasize has a significant dependence on protease systems, such as the plasminogen activation system. The plasminogen activation system includes the urokinase-type plasminogen activator (uPA) and plasminogen activator inhibitor type 1 (PAI-1), among other molecules. Both uPA and PAI-1 are established prognostic factors for patients with breast carcinoma. In the current study, the authors investigated whether the complex of uPA with PAI-1 is also associated with the natural course of this malignancy. METHODS Cytosolic levels of uPA, PAI-1, and the uPA:PAI-1 complex were measured in tumor tissue from 576 patients with lymph node,negative invasive breast carcinoma using quantitative enzyme-linked immunosorbent assays. Patients did not receive adjuvant systemic therapy, and the median follow-up duration was 61 months (range, 2,187 months) after primary diagnosis. Correlations with well known clinicopathologic factors were assessed, and univariate and multivariate survival analyses were performed. RESULTS uPA:PAI-1 complex levels were positively associated with adverse histologic grade and inversely correlated with estrogen and progesterone receptor status. On univariate analysis, increased levels of the uPA:PAI-1 complex were found to be associated with reduced recurrence-free survival (RFS) and overall survival (OS) rates. On multivariate analysis, uPA:PAI-1 complex levels were found to be an independent predictor of OS (P = 0.039), but not RFS (P = 0.240). When uPA and PAI-1 levels were not included in the multivariate analysis, uPA:PAI-1 complex levels became a significant predictor of both RFS and OS (P = 0.029 and P = 0.007, respectively). CONCLUSIONS The results of the current study demonstrate that uPA:PAI-1 complex levels have prognostic value on univariate analysis. In addition, increased uPA:PAI-1 complex levels were significantly associated with poor OS on multivariate analysis. Increased uPA:PAI-1 complex levels were also significantly associated with reduced RFS rates after the exclusion of uPA and PAI-1 levels from the multivariate analysis model. Cancer 2004. © 2004 American Cancer Society. [source] Clinical predictors of self-limited urinalysis abnormality in childhood Henoch-Schönlein purpura nephritisACTA PAEDIATRICA, Issue 3 2006Shuo-Hsun Hung Abstract Background and aim: The majority of patients (85,95%) with Henoch-Schönlein purpura nephritis (HSPN) suffer from a prolonged course of urinalysis abnormality. We sought to identify favourable prognostic factors predicting a self-limited urinalysis abnormality within 1 y. Methods: Fifty-eight HSPN patients admitted to the University Hospital between 1990 and 2003 were retrospectively analysed. Detailed information on clinical and laboratory manifestations on admission and sequential follow-up clinics were recorded. The ,2 or Fisher's exact test were used for univariate analysis, and multiple logistic regression was used for multivariate analysis. Results: The study cohort included 31 boys and 27 girls, with a mean age of onset of 8.0±4.3 y and a median follow-up duration of 5.9 y (range 1 to 25). Of 58 patients, 39 (67.3%) had a self-limited urinalysis abnormality within 1 y. On multivariate analysis, onset age less than 9 (p=0.038), low-grade proteinuria (p=0.044) and interval between purpura onset and renal manifestations less than 2 wk (p=0.005) predicted self-resolved urinalysis abnormality within 1 y. With two or more predictive factors, the sensitivity for short-term course was 84.6%, the specificity was 73.7%, and the positive predictive value was 84.8%. Conclusion: A small number of variables were important for detecting a favourable short-term course of urinalysis abnormality. [source] The incidence and consequences of mental disturbances in elderly patients post cardiac surgery,a comparison with younger patientsCLINICAL CARDIOLOGY, Issue 7 2000J. A. Heijmeriks M.D. Abstract Background: Limited data exist about the incidence and consequences of mental confusion following open heart surgery in different age groups. Likewise, little is known about preoperative predictors of mental confusion. Methods: Two-hundred consecutive patients, aged ,,75 years (Group 1), and 400 procedure- and gender-matched younger patients (Group 2) who underwent coronary or valvular surgery were included in a prospective study. The relation between postoperative mental confusion, mortality, morbidity, and quality of life was studied. Results: Mental confusion was present in 11.8% Group 2 and 22.6% Group 1 patients. The incidence was higher after valvular surgery. Preoperative risk factors in Group 1 patients were diabetes mellitus, a history of heart failure, weak carotid pulsations, and repeat surgery. Late mortality, after a median follow-up duration of 31 months, was significantly worse in patients who were confused, which was related to the underlying disease. Recovery of quality of life was clearly diminished in elderly patients with confusion in contrast to younger patients. Conclusion: Postoperative mental confusion has a high incidence in the elderly population and is associated with a diminished quality of life. [source] | ||||||||||