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Results for “Multivariate response regression”

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PubMed2003

Prediction of treatment outcome in patients with chronic hepatitis C: significance of baseline parameters and viral dynamics during therapy.

In patients with chronic hepatitis C virus (HCV) infection scheduled for a 48-week treatment period, premature discontinuation of treatment was previously recommended if HCV-RNA levels remained detectable at week 24 of therapy. Considering the number of side effects and treatment costs, measurement of initial viral decline during therapy may identify virologic nonresponse earlier than 24 weeks. We retrospectively analyzed 260 European patients treated with standard or pegylated interferon alfa (IFN-alpha) and ribavirin for 24 to 48 weeks. Early prediction of virologic response by HCV-RNA decline at weeks 4 and 12 (Versant Quantitative [branched DNA (bDNA) 3.0]; Bayer Diagnostics, Emeryville, CA; and Qualitative [transcription-mediated amplification (TMA)] HCV RNA assay; Bayer Diagnostics) as well as clinical, biochemical, virologic, and histologic baseline parameters were analyzed by logistic regression and receiver operating characteristic (ROC) curves. A viral load at treatment week 4 above 450,000 IU/mL and at week 12 above 30,000 IU/mL was 100% predictive for virologic nonresponse in all patients. From multivariate logistic regression analysis of all patients, independent predictors for sustained virologic response were: genotypes 2 and 3 (P <.0001), a low baseline gamma-glutamyltransferase (GGT) level (P <.0001), a high baseline alanine aminotransferase level (P =.002), and a low baseline viral load (P =.04). None of the latter 3 factors were predictive for sustained virologic response when analysis was restricted to the subgroup of genotypes 2- and 3-infected patients. In conclusion, virologic nonresponse can be predicted early at week 12 of treatment independent from the applied therapeutic regimen based on a cutoff level for HCV RNA of 30,000 IU/mL. This algorithm recognizes 53.7% of nonresponders previously identified at week 24 of treatment.

Adult↗

PubMed1995

Breast tumour response to primary chemotherapy predicts local and distant control as well as survival.

The purpose of the present paper was to evaluate correlations between clinical response to chemotherapy and outcome in a subgroup analysis of premenopausal patients with tumours considered too large for breast conserving surgery, treated with primary chemotherapy (n = 200) from a previously published trial (Scholl S.M., Fourquet A., Asselain B, et al. Eur J Cancer 1994, 30A, 645-652). Objective response rates amounted to 65% following four courses. In a multivariate Cox regression analysis, comparing seven parameters, the following variables were associated with poor survival: clinically involved nodes [N1b:RR: 2.7 (95% CI 1.3-5.3)], the failure to respond to chemotherapy [D:RR: 2.62 (95% CI 1.3-5)] and a raised S phase fraction [SPF > 5%: RR: 2.4 (95% CI 1.2-5)]. Parameters associated with increased metastatic recurrence rates, by order of entry in the model, were: young age [< 35: RR: 2.46 (95% CI 1.2-5)], large clinical tumour size [T3: RR: 2.02 (95% CI 1.2-3.4)], poor histological grade (SBR III: RR: 1.93 (95% CI 1.1-3.3)] and the failure to respond to chemotherapy [D: RR: 1.91 (95% CI 1-3.4)]. The assessment of both tumour cell proliferation rates as well as possibly drug resistance markers (although not available in the present study) should be helpful in selecting patients likely to benefit from intensified chemotherapy regimens. The most accurate predictor of response in the present study appeared to be the response to chemotherapy treatment itself.

Adult↗

PubMed1999

Urinary tract infection in geriatric patients.

Elderly patients with urinary tract infection (UTI) are believed less likely to be cured by antimicrobial therapy than younger patients. The reasons for this poorer outcome have not yet been clarified. We have investigated the effect of antimicrobial therapy in elderly patients with complicated UTI. Four-hundred and eighty patients, 244 men and 236 women, who had complicated UTI (266 symptomatic and 236 asymptomatic) and were 20-79 years of age, were treated with one of three different drugs; one was a newer quinolone and two were oral cephems. Multivariate logistic regression analysis of treatment outcome revealed that the clinical response was significantly related to general underlying diseases and diseases of the urinary tract, but not to age, symptomatic or asymptomatic UTI, or infection site such as the kidney or bladder. We concluded that the clinical effectiveness of an antimicrobial agent was not directly related to age, and that urological examination for underlying diseases and control of them is quite important for effective treatment and control of complicated UTIs, especially in elderly patients.

4-Quinolones↗

PubMed1999

The DiSC assay. A cost-effective guide to treatment for chronic lymphocytic leukemia?

The differential staining cytotoxicity (DiSC) assay involves in vitro drug panel testing against patient tumor cells to identify optimal therapy. This observational study investigated whether DiSC assay guided treatment could improve outcome in patients with chronic lymphocytic leukemia. A cohort of 178 patients were categorized either as sensitive to drugs in vitro and receiving a sensitive drug in vivo, sensitive in vitro but not treated with a sensitive drug, or having disease resistant to all drugs tested in vitro. Response and survival for these patient categories were compared using multivariate regression techniques. Patients receiving a sensitive drug, compared with those who though having sensitivity did not, had a higher remission rate (odds ratio, 6.5; 95% CI, 2.91-14.53) and reduced death rate (hazard ratio, 0.29; 95% CI, 0.16-0.53). Having adjusted for all known confounding factors, the results suggest that in vitro drug sensitivity is an important independent prognostic variable to include in future trials, and that the DiSC assay may be a cost-effective use of health resources: the estimated incremental cost-effectiveness was 1,470 Pounds per life-year gained. A randomized controlled trial is required to confirm the benefit and estimate reliably the potential impact of assay-guided choice of therapy.

Aged↗

PubMed2004

Worker performance and ventilation in a call center: analyses of work performance data for registered nurses.

UNLABELLED: We investigated the relationship between ventilation rates and individual work performance in a call center, and controlled for other factors of the indoor environment. We randomized the position of the outdoor air control dampers, and measured ventilation rate, differential (indoor minus outdoor) carbon dioxide (DeltaCO(2)) concentration, supply air velocity, temperature, humidity, occupant density, degree of under-staffing, shift length, time of day, and time required to complete two different work performance tasks (talking with clients and post-talk wrap-up to process information). DeltaCO(2) concentrations ranged from 13 to 611 p.p.m. We used multivariable regression to model the association between the predictors and the responses. We found that agents performed talk tasks fastest when the ventilation rate was highest, but that the relationship between talk performance and ventilation was not strong or monotonic. We did not find a statistically significant association between wrap-up performance and ventilation rate. Agents were slower at the wrap-up task when the temperature was high (> 25.4 degrees C). Agents were slower at wrap-up during long shifts and when the call center was under-staffed. PRACTICAL IMPLICATIONS: The productivity benefits of ventilation rates that exceed common standards such as ASHRAE Standard 62 may be small (0-2%), and other factors may have a larger impact on productivity. Understaffing and long shifts should be avoided because both showed a negative impact on performance. In this study, high temperature had the largest statistically significant impact on productivity and was caused by occupants fighting over the thermostat setpoint. Care should be taken to avoid high temperatures in call centers. If occupants are allowed to adjust temperature setpoints, then the size and/or duration of the setpoint change should be restricted.

Humans↗

PubMed2005

Association of pretreatment serum interferon gamma inducible protein 10 levels with sustained virological response to peginterferon plus ribavirin therapy in genotype 1 infected patients with chronic hepatitis C.

BACKGROUND: Increased serum and intrahepatic interferon gamma inducible protein 10 (IP-10) levels in patients with chronic hepatitis C (CHC) have been described. AIM: To analyse the possible association of serum IP-10 levels with different outcomes to antiviral therapy. PATIENTS: A total of 137 CHC patients treated with peginterferon plus ribavirin. METHODS: Serum IP-10 levels were determined by enzyme linked immunosorbent assay before therapy, after 12 weeks of treatment, and 24 weeks after cessation of therapy. Variables significantly associated with a sustained virological response (SVR) on univariate analysis were included in a multivariate logistic regression model. RESULTS: Pretreatment serum IP-10 levels in patients with SVR were significantly lower than in non-responders (NR) (332.4 (222.1) v 476.8 (305.3) pg/ml, respectively; p=0.004). Serum IP-10 concentrations significantly decreased in patients with SVR (pretreatment: 332.4 (222.1) pg/ml; post-treatment: 170.2 (140.1) pg/ml; p<0.001) but not in NR (pretreatment: 476.8 (305.3) pg/ml; post treatment: 387.3 (268.1) pg/ml; p=0.06). By multivariate analysis, non-1 genotype (odds ratio (OR) 3.5 (95% confidence interval (CI) 1.1-10.4); p=0.003) and low viral load at baseline (OR 0.34 (95% CI 0.14-0.79); p=0.01) were independent predictors of SVR in all patients. When multivariate analysis was restricted to patients with genotype 1, only baseline viral load (OR 0.38 (95% CI 0.155-0.96); p=0.04) and pretreatment serum IP-10 levels (OR 0.99 (95% CI 0.996-0.999); p=0.03) were identified as predictive factors of SVR. CONCLUSION: Pretreatment serum IP-10 behaves as a predictive factor of SVR to peginterferon plus ribavirin therapy in genotype 1 infected patients.

Adult↗

PubMed2006

WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity.

BACKGROUND: Health care planning for chronic pelvic pain (CPP), an important cause of morbidity amongst women is hampered due to lack of clear collated summaries of its basic epidemiological data. We systematically reviewed worldwide literature on the prevalence of different types of CPP to assess the geographical distribution of data, and to explore sources of variation in its estimates. METHODS: We identified data available from Medline (1966 to 2004), Embase (1980 to 2004), PsycINFO (1887 to 2003), LILACS (1982 to 2004), Science Citation index, CINAHL (January 1980 to 2004) and hand searching of reference lists. Two reviewers extracted data independently, using a piloted form, on participants' characteristics, study quality and rates of CPP. We considered a study to be of high quality (valid) if had at least three of the following features: prospective design, validated measurement tool, adequate sampling method, sample size estimation and response rate >80%. We performed both univariate and multivariate meta-regression analysis to explore heterogeneity of results across studies. RESULTS: There were 178 studies (459975 participants) in 148 articles. Of these, 106 studies were (124259 participants) on dysmenorrhoea, 54 (35973 participants) on dyspareunia and 18 (301756 participants) on noncyclical pain. There were only 19/95 (20%) less developed and 1/45 (2.2%) least developed countries with relevant data in contrast to 22/43 (51.2%) developed countries. Meta-regression analysis showed that rates of pain varied according to study quality features. There were 40 (22.5%) high quality studies with representative samples. Amongst them, the rate of dysmenorrhoea was 16.8 to 81%, that of dyspareunia was 8 to 21.8%, and that for noncyclical pain was 2.1 to 24%. CONCLUSION: There were few valid population based estimates of disease burden due to CPP from less developed countries. The variation in rates of CPP worldwide was due to variable study quality. Where valid data were available, a high disease burden of all types of pelvic pain was found.

Chronic Disease↗

PubMed2026

Toward a Better Paradigm for Head and Neck Cancer Treatment Applying AI (HNC-TACTIC): Protocol for an International Cohort Study of Electronic Health Records.

BACKGROUND: Head and neck squamous cell carcinomas (HNSCCs) cause considerable morbidity and mortality. Multimodal treatment strategies can cause significant toxicity, and therapy options are limited for recurrent disease. Immunotherapy has emerged as a promising approach. However, patient response variability underscores the need for better predictive markers. OBJECTIVE: This study aims to use artificial intelligence to develop two predictive models in patients with HNSCC to assess (1) progression or recurrence following primary curative treatment and (2) long-term survival after immunotherapy schemes in recurrent and metastatic disease. This study will also describe the characteristics of patients with early, locally advanced, and recurrent or metastatic cancers. METHODS: This is a retrospective, observational study of data captured in electronic health records (EHRs) from participating hospitals between January 1, 2014, and December 31, 2021. This study's population comprises adults diagnosed with HNSCC at any stage. Study variables, including demographics, comorbidities, clinical variables, treatments, and outcomes, will be extracted using EHRead, a technology that applies natural language processing and machine learning to extract and analyze structured and unstructured clinical information in deidentified EHRs. Predictive models based on dynamic risk stratification for treatment response and progression or recurrence will be developed using multivariable logistic regressions, decision tree classifiers, and random forest approaches. Descriptive and outcome analyses will be shown for different anatomic subsites and stratified by stage and treatment. RESULTS: This study began enrolling sites in July 2021 and is currently ongoing. By December 2025, data from 10 centers has been collected, comprising a total of 151,934,990 EHRs from 2,159,719 patients. CONCLUSIONS: Development of predictive models using artificial intelligence will advance clinical understanding of HNSCC to improve patient outcomes.

Humans↗

PubMed1988

Esophagovisceral anastomotic leak. A prospective statistical study of predisposing factors.

An esophagovisceral anastomotic leak is a life-threatening postoperative complication, especially in the mediastinum. Of the 242 patients who underwent intrathoracic esophagogastric anastomosis for esophageal carcinoma (182 patients) and adenocarcinoma of the cardia (60 patients) between January 1980 and June 1985, 14 (5.8%) had esophageal anastomotic leakage and two died (0.8%). Various clinical and biologic parameters and aspects of operative technique were studied prospectively and analyzed statistically to identify possible factors responsible for leaks. Both bivariate and multivariate statistical analysis with logistic regression showed that the following clinical and biologic factors do not influence anastomotic leakage: tumor stage, the curative or palliative purpose of resection, neoplastic permeation of anastomotic margins, total protein concentration below 5 gm/dl, albumin concentration below 3 gm/dl, patient's age, diabetes, high blood pressure, cirrhosis of the liver, and cardiac, respiratory, or renal diseases. Technical factors, on the contrary, were statistically significant and of great clinical importance: manual as opposed to mechanical suturing (chi 2 = 8.8, p = 0.013) and single-layer as opposed to double-layer suturing (chi 2 = 9.9, p = 0.043). The level of the anastomosis was found to be a further statistically significant factor: The incidence of leakage was greater when the anastomosis was located between the azygos vein and the lower pulmonary vein (chi 2 = 15.5, p = 0.004) than above the azygos vein or below the lower pulmonary vein.

Adenocarcinoma↗

PubMedDate not supplied

Tuberculous meningitis among adults with and without HIV infection. Experience in an urban public hospital.

BACKGROUND: Tuberculous meningitis remains a frequently diagnosed entity in urban US hospitals, with the incidence increasing as a consequence of infection with the human immunodeficiency virus (HIV). OBJECTIVE: To describe the occurrence, characteristics, and therapeutic responses of tuberculous meningitis among adult patients of an urban public hospital, with special attention to the effects of HIV infection. DESIGN: Retrospective clinical review of all cases identified among adults over a 12-year interval, collecting demographic and clinical variables. SETTING: A 550-bed urban teaching hospital. MAIN OUTCOME MEASURE: Nine-month outcome stratified by survival. RESULTS: Among 31 adult patients identified as having definite or probable tuberculous meningitis, a majority (n = 20 [65%]) were infected with HIV. Cumulative rates of occurrence per 100 000 persons over the 12 years of the study were estimated at 1.72 for those without HIV infection and 400 for those with HIV infection. The most common symptoms at presentation were fever (83% [24/ 29]) and abnormal mental status (71% [20/28]). One or more abnormalities were present in the cerebrospinal fluid of 97% (30/31) of subjects, and 74% (23/31) had cerebrospinal fluid cultures positive for Mycobacterium tuberculosis. Neuroimaging of 28 patients revealed 1 or more abnormalities in 82% (n = 23). Among 30 patients with available outcome data at 9 months, 43% (n = 13) had died, 40% (n = 12) had survived without sequelae, and 17% (n = 5) had survived with morbidity. HIV infection had no discernible effect on findings. CONCLUSIONS: Tuberculous meningitis remains relatively common among indigent urban nonwhite populations. While HIV infection has contributed to the increased incidence of tuberculous meningitis, it has not significantly altered the presenting clinical, laboratory, or radiographic findings or the response to therapy of this disease. Parameters associated in a multivariate regression analysis with mortality at 9 months were black race and the absence of corticosteroid use.

Adult↗

PubMed1996

Clinical and morphological predictors of renal outcome in adult patients with focal and segmental glomerulosclerosis (FSGS).

In this retrospective study, we examined 35 adult patients with biopsy-proven, primary focal and segmental glomerulosclerosis (FSGS) and nephrotic syndrome to determine whether any of the clinical and morphological features of FSGS were associated with a higher risk of a poor renal outcome. Clinical factors assessed were the age, sex, amount of urinary protein, and presence of microscopic hematuria, hypertension and renal dysfunction at onset in each patient. Morphological parameters included the number of segmental sclerosis and global sclerosis, sclerosis score, location of segmental sclerosis, mean glomerular diameter, grade of tubulo-interstitial changes, and presence of vascular lesions. Twenty-three patients (66%) were in complete or incomplete (partial) remission, and 12 (34%) were non-responders at the end of follow-up. On univariate analysis, the age at onset, sclerosis score, mean glomerular diameter, and grade of tubulo-interstitial changes in no response were significantly greater than those parameters in remission. Multivariate logistic regression analysis revealed that the degree of tubulo-interstitial changes and mean glomerular diameter were independent risk factors for a poor renal outcome. These findings suggest that the estimation of these latter two parameters allows the nephrologist to predict the probable course and prognosis of an adult with FSGS. Intensive and prolonged therapy is recommended for patients without these two morphological features.

Adult↗

PubMed1995

Some recent developments for regression analysis of multivariate failure time data.

Cox's seminal 1972 paper on regression methods for possibly censored failure time data popularized the use of time to an event as a primary response in prospective studies. But one key assumption of this and other regression methods is that observations are independent of one another. In many problems, failure times are clustered into small groups where outcomes within a group are correlated. Examples include failure times for two eyes from one person or for members of the same family. This paper presents a survey of models for multivariate failure time data. Two distinct classes of models are considered: frailty and marginal models. In a frailty model, the correlation is assumed to derive from latent variables ("frailties") common to observations from the same cluster. Regression models are formulated for the conditional failure time distribution given the frailties. Alternatively, marginal models describe the marginal failure time distribution of each response while separately modelling the association among responses from the same cluster. We focus on recent extensions of the proportional hazards model for multivariate failure time data. Model formulation, parameter interpretation and estimation procedures are considered.

Clinical Trials as Topic↗

PubMed2005

Preoperative radiochemotherapy and radical resection for stages II to IV oral and oropharyngeal cancer: grade of regression as crucial prognostic factor.

The purpose of this study was to assess the prognostic value of histological response to preoperative radiochemotherapy in an established multimodal therapy concept for advanced oral and oropharyngeal cancer. Two hundred and twenty-two patients who underwent preoperative radiochemotherapy (RCT: 50 Gy, mitomycin C and fluorouracil) and radical surgery were retrospectively evaluated. Resected tumours of all patients were histologically analysed and response to RCT was classified in histopathological grades of regression (RG). In a multivariate statistical analysis, RG was compared with established factors regarding their predictive value for overall and disease-specific survival. The 5-year overall survival probability in the different groups of histopathological regression grades were: RG1 (no vital tumour): 73.4%, RG2 (minimal tumour remnants encompassing less than 5%): 72.1%, RG3 (5-50% vital tumour cells): 41.9%, RG4 (more than 50% vital tumour): 37.9%. For disease-specific survival probability no significant differences were found between both groups of "responders" (RG1 and RG2) nor between "non-responders" (RG3 and RG4), whereas responders and non-responders differed significantly from each other (log-rank test; p < 0.001). T-classification, N-classification and disease stage, histological grading, tumour site, age, and sex had less prognostic value than RG in a Cox regression model. In the neoadjuvant multimodal therapy concept, histological response to preoperative RCT is a crucial prognostic factor even when surgical R0-resection is accomplished. Thus, non-responders have to be regarded as high-risk patients for recurrence and may benefit from further therapy.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2004

Assessing response bias from missing quality of life data: the Heckman method.

BACKGROUND: The objective of this study was to demonstrate the use of the Heckman two-step method to assess and correct for bias due to missing health related quality of life (HRQL) surveys in a clinical study of acute coronary syndrome (ACS) patients. METHODS: We analyzed data from 2,733 veterans with a confirmed diagnosis of acute coronary syndromes (ACS), including either acute myocardial infarction or unstable angina. HRQL outcomes were assessed by the Short-Form 36 (SF-36) health status survey which was mailed to all patients who were alive 7 months following ACS discharge. We created multivariable models of 7-month post-ACS physical and mental health status using data only from the 1,660 survey respondents. Then, using the Heckman method, we modeled survey non-response and incorporated this into our initial models to assess and correct for potential bias. We used logistic and ordinary least squares regression to estimate the multivariable selection models. RESULTS: We found that our model of 7-month mental health status was biased due to survey non-response, while the model for physical health status was not. A history of alcohol or substance abuse was no longer significantly associated with mental health status after controlling for bias due to non-response. Furthermore, the magnitude of the parameter estimates for several of the other predictor variables in the MCS model changed after accounting for bias due to survey non-response. CONCLUSION: Recognition and correction of bias due to survey non-response changed the factors that we concluded were associated with HRQL seven months following hospital admission for ACS as well as the magnitude of some associations. We conclude that the Heckman two-step method may be a valuable tool in the assessment and correction of selection bias in clinical studies of HRQL.

Acute Disease↗

PubMed2003

Factors associated with humoral response to ESAT-6, 38 kDa and 14 kDa in patients with a spectrum of tuberculosis.

SETTING: Tertiary care chest hospital in Montreal, Canada, where the average annual incidence of TB is 10/100,000 population. OBJECTIVES: To evaluate the clinical correlates of humoral response to three Mycobacterium tuberculosis antigens. METHODS: Humoral response to three M. tuberculosis antigens, 38 kDa, 14 kDa and ESAT-6, was measured with ELISA in patients with a spectrum of TB-related conditions. The association of positive tests for each antigen, defined with receiver operator characteristics (ROC) analysis, and patient characteristics was assessed in multivariate regression. RESULTS: A total of 383 patients underwent serologic testing. In multivariate analysis, humoral response to 38 kDa was associated with active disease, response to 14 kDa was associated with inactive TB and female sex, and response to ESAT-6 with inactive TB, female sex, prior contact with TB, and recent arrival in Canada from high prevalence countries. CONCLUSIONS: Response to the 38 kDa antigen was associated with current active disease, and was very different from response to the 14 kDa and ESAT-6 antigens. These latter two antigens were associated with risk factors for future active, but not current disease, suggesting that they might be useful to identify persons with higher risk of reactivation of latent TB.

Adult↗

PubMedDate not supplied

Covariates of infant mortality in China: an exploratory approach.

To elucidate the nature of the relationship between infant mortality in China and a variety of covariates using data from the 2/1000 Chinese Fertility Survey, we use a logistic regression model where the covariates are transformed with the help of Alternating Conditional Expectation (ACE) algorithm. This approach is used to overcome the general problem in multivariate regression analysis of coding the independent variables so that relationship between independent variables and response variables is best described, rather than coding such variables in an arbitrary way. The study demonstrates the procedures and usefulness of the ACE guided transformation in multivariate analysis. The transformed covariates are then used to estimate the effects of a series of socioeconomic and demographic factors collected in the study of infant death in China. The study shows that after appropriate transformations, all the demographic and socioeconomic variables selected have statistically significant and direct influence on infant death.

China↗

PubMed1998

p53 protein accumulation predicts poor response to tamoxifen therapy of patients with recurrent breast cancer.

PURPOSE: Mutations of the p53 gene are frequently observed in primary breast cancer and accumulation of p53 protein has been used as a surrogate marker of p53 inactivation. Previous studies have shown that p53 accumulation is related to poor prognosis in primary breast cancer. We studied whether p53 protein accumulation is a predictive factor for response to tamoxifen treatment in patients with recurrent breast cancer. PATIENTS AND METHODS: Levels of p53, estrogen receptor (ER), progesterone receptor (PgR), and urokinase-type plasminogen activator (uPA) were assayed in cytosolic extracts derived from primary tumors of 401 tamoxifen-naive patients who developed recurrent disease. All patients in the study received tamoxifen therapy upon relapse (median follow-up, 69 months). Association of tested factors with response to tamoxifen treatment was studied by logistic regression analysis, and with survival after the start of treatment by Cox univariate and multivariate regression analysis. RESULTS: p53 levels (median, 0.23 ng/mg protein) were not related to ER or PgR levels, but positively correlated with uPA (P < .0001). In a test for trend, we observed an association of p53 protein levels with response to tamoxifen therapy. When dichotomized (at the median value), 42% in the p53-high versus 56% in the p53-low group showed a response. In multivariate analysis, including patient and tumor characteristics, p53 accumulation retained significance with the rate of response (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.31 to 0.74; P < .001). Also in multivariate analysis, reduced survival after the start of tamoxifen therapy was observed in the p53-high group (relative hazards rate [RHR], 1.56, 95% CI, 1.17 to 2.10; P = .002). A statistically significant association between p53 levels and decreased tamoxifen response was seen only in the subset of patients whose tumors expressed low levels of ER or PgR (<75 fmol/mg protein). CONCLUSION: Measurement of primary tumor p53 levels may be effective in predicting response to tamoxifen therapy in recurrent breast disease. However, more confirming studies on the association between p53 protein accumulation and response to antiestrogen therapy are needed before tumor p53 levels can be used in routine clinical practice.

Adult↗

PubMed1989

[Effect of the transfusion of blood and hemoderivatives on the prognosis of colorectal cancer].

In recent years in the literature several investigators described a negative effect of perioperative transfusion of blood and hemoderivatives on the prognosis of malignant tumors. Concerning the patients with colorectal carcinoma operated between 1979 and 1983 at Erlangen University Hospital these results could be proven. We observed a significantly worse 5-year survival rate for patients who received perioperative blood transfusion. However, multivariant analysis in Cox-regression model revealed other factors like tumor stage and localisation responsible for the poorer prognosis. Therefore blood transfusion seems not to have any influence on the prognosis itself. Furthermore we observed a significantly poorer prognosis concerning patients who perioperatively received fresh frozen plasma (FFP). Surprisingly multivariant analysis showed that FFP substitution in contrast to blood transfusion has an own prognostic influence. This difference in prognosis cannot be explained by selection criteria. The mechanism of the negative influence of FFP on the prognosis of colorectal carcinoma remains unclear and is investigated currently in prospective studies.

Aged↗