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PubMed2006

Serum albumin as a significant prognostic factor for patients with gastric carcinoma.

BACKGROUND: The definition of prognostic factors in gastric carcinoma (GC) remains controversial. The potential of serum albumin as a prognostic factor for GC is emphasized because the technique to measure it is simple as well as being cheap and widely available. Our aim was to define the prognostic role of serum albumin in GC. METHODS: A cohort treated from January 1987 to December 2002 was studied. Relevant clinical, pathological and therapeutic variables were recorded. Kaplan-Meier and Cox's methods were used to define prognostic factors associated with cancer-related survival. RESULTS: One thousand and twenty-three patients were included. Serum albumin did impact survival, showing a dose-response effect. This effect was present after adjustment for other prognostic factors, including Tumor-Node-Metastasis (TNM) stage, surgical resection and type of lymphadenectomy. In multivariate analysis, TNM stage [Stage Ia and Ib Hazard Ratio [HR] 1, Stage II HR 1.6 (95% confidence interval [CI], 0.56-4.7), Stage IIIa HR 4.4 (95% CI 1.7-11.3), Stage IIIb HR 5.6 (95% CI 2.6-17.2), Stage IV HR 6.8 (95% CI 2.7-17.5), high albumin HR 1, medium albumin HR 1.2 (95% CI 0.8-1.7), low albumin HR 1.2 (95% CI 0.8-1.8), very low albumin HR 1.8 (95% CI 1.3-2.6), D2 dissection HR 1, D1 dissection HR 1.9 (95% CI 1.3-2.97), and no resection HR 3.7 (95% CI 2.4-5.7)] were the most significant prognostic factors associated to survival (model P = 0.00001). CONCLUSION: Pretherapeutic serum albumin level is a significant prognostic factor, which should be evaluated along with other well-defined prognostic factors in decisions concerning therapy for GC.

Adult↗

PubMed2005

Anemia in chronic heart failure patients: comparison between invasive and non-invasive prognostic markers.

BACKGROUND: The prognosis of chronic heart failure (CHF) remains poor despite advances in medical management. Several different variables determine prognosis. Recently anemia has emerged as an independent prognostic variable in the evaluation of CHF. It is therefore important to analyze the role of anemia in patients with mild to severe CHF already well characterized by hemodynamic, echo-Doppler, and cardiopulmonary exercise testing. OBJECTIVE: We performed this study to evaluate, in a large general cohort of CHF patients, the frequency of anemia and its correlation with their clinical profile. We assessed the prognostic value of anemia in relation to other known prognostic variables. METHODS: Two-dimensional echocardiography, right heart catheterization, cardiopulmonary tests and laboratory examinations were performed in a population of 980 consecutive patients with CHF (53 +/- 9.4 years, 85% male, LVEF 25 +/- 8%; 45% with NYHA class III-IV). A hemoglobin (Hb) concentration less than 12 g/dl was used to define anemic patients. The primary end point was cardiac death or urgent heart transplantation. RESULTS: Nineteen percent of patients were anemic. These patients had a lower body mass index (24 +/- 3 vs. 25 +/- 4 Kg/m2 p < 0.0004), a worse functional class (64% were in NYHA class III-IV vs 41% in the non-anemic group, p < 0.0001), poorer exercise capacity (12.4 vs. 14.8 ml/kg/min peak VO2, p < 0.0001) and increased right (7 +/- 5 vs. 5 +/- 4 mmHg, p < .0004) and left (21 +/- 9 vs. 19 +/- 10 p < 0.007) ventricular filling pressures. During a 3-year follow-up cardiac deaths occurred in 236 (24%) and 52 (5%) of patients received an urgent heart transplant. On univariate regression analysis anemia was significantly correlated with these "hard" cardiac events (39% of anemic patients vs 27% of non-anemic patients). By multivariate logistic regression analysis different prognostic models were identified using non-invasive, with or without peak VO2, or invasive parameters. The prognostic model including anemia (AUC(ROC): 0.720) showed similar accuracy in predicting cardiac events to other prognostic models with peak VO2 (AUC(ROC): 0.719) or invasive variables (AUC(ROC): 0.719). CONCLUSIONS: The present study demonstrates that anemia in CHF patients is associated with prognosis, worse NYHA functional class, exercise capacity and hemodynamic profiles. The relationship between anemia and mortality is independent of other simple non-invasive prognostic factors. Prognostic models with more complex or invasive independent predictors did not increase the accuracy to predict cardiac mortality or the need for urgent transplantation.

Anemia↗

PubMed1999

Prognostic factors in primary cutaneous lymphomas other than mycosis fungoides and the Sézary syndrome. The French Study Group on Cutaneous Lymphomas.

Prognostic studies of primary cutaneous lymphomas (PCL) other than mycosis fungoides (MF) and the Sézary syndrome (SS; non-MF/SS PCL) have been mainly performed on subgroups or on small numbers of patients by using univariate analyses. Our aim was to identify independent prognostic factors in a large series of patients with non-MF/SS PCL. We evaluated 158 patients who were registered in the French Study Group on Cutaneous Lymphomas database from January 1, 1986 to March 1, 1997. Variables analyzed for prognostic value were: age; sex; type of clinical lesions; maximum diameter, location, and number of skin lesions; cutaneous distribution (ie, local, regional, or generalized); prognostic group according to the European Organization for Research and Treatment of Cancer (EORTC) classification for PCL; B- or T-cell phenotype; serum lactate dehydrogenase (LDH) level; and B symptoms. Univariate and multivariate analyses were performed using a model of relative survival. Forty-nine patients (31%) died. The median relative survival time was 81 months. In univariate analysis, EORTC prognostic group, serum LDH level, B symptoms, and variables related to tumor extension (ie, distribution, maximum diameter, and number of skin lesions) were significantly associated with survival. When these variables were considered together in a multivariate analysis, EORTC prognostic group and distribution of skin lesions remained statistically significant, independent prognostic factors. This study confirms the good predictive value of the EORTC classification for PCL and shows that the distribution of skin lesions at initial evaluation is an important prognostic indicator.

Adolescent↗

PubMed2000

Validation of the international prognostic index in working formulation group A low-grade non-Hodgkin's lymphoma: retrospective analysis of 137 patients from the Gruppo Italiano per lo Studio dei Linfomi registry.

BACKGROUND AND OBJECTIVE: The subset of non-follicular non-Hodgkin's lymphoma (NHL) includes patients with varied prognoses, thus suitable for different therapeutic approaches. The International Prognostic Index (IPI), originally proposed for aggressive NHL, has been demonstrated to be of prognostic relevance also in follicular NHL. The main aim of the study was to validate the IPI in this histologic category; in addition, the specific prognostic classification, currently employed in the Gruppo Italiano per lo Studio dei Linfomi (GISL) prospective therapeutic trials and based on different features, more similar to those applied to chronic lymphocytic leukemia, was analyzed. DESIGN AND METHODS: The present series consists of 137 evaluable patients affected by Working Formulation group A NHL out of 256 cases referred to the GISL Registry. The retrospective prognostic study included the evaluation by both univariate and multivariate analyses of overall survival, response to therapy and response duration. The IPI was applied as originally proposed. The GISL definition of indolent and aggressive disease at diagnosis was based on the presence of B symptoms, bulky disease, anemia and thrombocytopenia. RESULTS: The distribution of patients in IPI risk groups was rather unbalanced with 18%, 47%, 28% and 7% of cases classified as low (L), intermediate-low (IL), intermediate-high (IH) and high (H) risk, respectively. The median overall survival was not reached in either L or IL risk groups, and was 84.1 and 7.4 months for IH and H risk groups, respectively (p=0. 0005). A simplified IPI model was designed merging patients in both intermediate risk groups and the statistical difference of survival retained its significance. GISL prognostic stratification was demonstrated to have a significant association with survival, with a median survival of 71.3 months in aggressive disease and a median survival not reached at 152 months in indolent disease. Both the simplified IPI model and the GISL risk definition retained their significance in multivariate analysis for overall survival, while for response to therapy only the simplified IPI model resulted to be of statistical significance. In addition, the GISL prognostic stratification identified patients with different outcomes within the IPI intermediate risk group, with a median survival of 70.2 months for patients with aggressive disease wheras the median survival for those with indolent disease was not reached. Finally, a prognostic score resulting from the integration of the simplified IPI and the GISL system was statistically validated. INTERPRETATION AND CONCLUSIONS: The retrospective analysis of this series demonstrates the validity of the IPI in non-follicular indolent NHL and the usefulness of integrating the IPI parameters with disease specific prognostic variables.

Lymphoma, Non-Hodgkin↗

PubMed1999

[Histological and molecular prognostic factors in esophageal cancer].

The prognostic impact of new histological and molecular parameters was tested retrospectively in a series of 149 patients with esophageal squamous cell carcinoma (SCC) who underwent potentially curative resection therapy (no distant metastases, no residual tumor, no radio- or chemotherapy). This analysis was performed in order to identify patients with increased risk for tumor-related death in spite of being treated by standard therapy and thus being candidates that most likely profit from postoperative adjuvant therapy. Additionally, the prognostic value of various molecular markers was investigated in a group of 38 patients with locally advanced esophageal SCC that have been treated with combined therapy modalities (radiochemotherapy and optionally surgery). Among surgically treated carcinomas, the following morphological parameters proved to be prognostically significant in univariate survival analysis and multivariate survival analysis: pattern of invasion, inflammatory response and lymphatic-vessel invasion. In contrast, the tumor grading according to the criteria of WHO and tumor cell proliferation did not show significant prognostic impact. Concerning the prognostic influence of molecular parameters strong expression of the proliferation-regulating molecule p21WAF1 and weak expression of the apoptosis-regulating molecule Bcl-XL were predictors of poor survival in univariate and multivariate survival analysis. No prognostic impact could be shown in relation to the expression of the proliferation-regulating molecule p53 and the apoptosis regulating-molecules Bcl-2 and Bax. Among multimodally treated esophageal cancer patients, again strong expression of p21WAF1 as well as accumulation of p53 were predictors of poor survival, whereas expression of Bcl-2, Bax and Bcl-XL did not show any prognostic influence. In conclusion, morphological and molecular parameters may provide important prognostic information for esophageal cancer patients.

Carcinoma, Squamous Cell↗

PubMedDate not supplied

LEA.135 expression: its comparison with other prognostic biomarkers for patients with primary breast carcinoma.

The purpose of this retrospective study was to examine the prognostic value of expression of luminal epithelial antigen (LEA.135) for recurrence and overall survival of patients with primary invasive breast carcinoma by both univariate and multivariate analyses. The possible prognostic value of LEA.135 was also compared with some widely utilized prognostic biomarkers such as c-erbB 2, topoisomerase II.alpha (TPII.alpha), MIB 1, estrogen receptor (ER) and progesterone receptor (PR), as well as age of the patients and clinicopathologic parameters. The study was carried out by immunohistochemical methods on formalin-fixed/paraffin-embedded tissue sections in a series of 225 patients with median follow-up of 8.5 years. Prognostic significance of the biomarkers was determined by two-sided p value. In this series of patients, among the age and clinicopathologic parameters, only age, was significantly associated with a decreased overall survival (logrank p = 0.027). Among the prognostic biomarkers, TPII a expression at high (> 50% positive cells) or moderate (6-50% positive cells) level was associated with an increased rate of recurrence (logrank p < 0.001). However, the association of TPII.alpha expression with a decreased overall survival failed to reach a statistically significance. Expression of c-erbB 2 showed a trend of being associated with an increased probability of recurrence, but the association did not reach statistical significance. The remaining biomarkers were not associated with either the probability of recurrence or overall survival. LEA.135 expression was observed in 163 (72.4%) of the 225 patients. The patients with high (> 50% positive cells) or moderate (6-50% positive cells) level of LEA.135-positive cancer cells showed a significantly decreased probability of recurrence (logrank p < 0.001) and an increased overall survival (logrank p < 0.001) compared with those with LEA.135-negative cancer cells. The association remained significant by multivariate analysis for recurrence (likelihood ratio test p < 0.001) and overall survival (likelihood ratio test p < 0.001) when assessed with other prognostic parameters. Furthermore, the combination of LEA.135 with other prognostic biomarkers stratified four subgroups of patients with distinct clinical outcome. The subgroup of patients who were LEA.135+/TPII.alpha- showed the lowest probability of recurrence and the longest overall survival compared with those who were LEA.135-/TPII.alpha+ (logrank p < 0.001). Interestingly, the patients whose cancer cells were LEA.135+/TPII.alpha+, LEA.135+ MIB.1+ or LEA.135+/c-erbB 2+ experienced a decreased probability of recurrence and an increased overall survival compared with those with LEA.135-/TPII.alpha+, LEA.135- MIB.1+ or LEA.135-/c-erbB 2+ (logrank p < 0.001). The results demonstrated that LEA.135 is an independent and favorable prognostic biomarker for patients with primary invasive breast carcinoma, that the loss of LEA.135 expression is associated with aggressive phenotype of cancer cells during the breast cancer progression, and that its continued expression seems to override the adverse effects of expression of an oncogene or cell proliferation-associated molecules.

Age Factors↗

PubMed2000

Polyadenylate polymerase enzymatic activity in mammary tumor cytosols: A new independent prognostic marker in primary breast cancer.

Polyadenylate polymerase (PAP) is one of the enzymes involved in the formation of the polyadenylate tail of the 3' end of mRNA. High levels of PAP activity were associated with rapidly proliferating cells. Here we evaluate the prognostic value of PAP activity in breast cancer patients. PAP specific activity values were measured by a highly sensitive assay in the tumor cytosols of 228 women with primary breast cancer. The median follow-up period was 58 months. PAP specific activity values ranged from 2.1-39.4 units/mg protein in the breast tumor cytosols, and the activity was correlated with the level of expression of the antigen. An optimal cutoff value of 5.5 units/mg extracted protein was first defined by statistical analysis. PAP status was then compared with other established prognostic factors in terms of relapse-free survival (RFS) and overall survival (OS). PAP activity levels had a tendency to increase with tumor-node-metastasis (TNM) stage and were higher in node-positive patients. Evaluation of the prognostic value of PAP was performed using univariate and multivariate analyses. Univariate analysis showed that PAP-positive patients had a less favorable prognosis for both RFS (relative risk (RR) = 2.35; P < 0.001] and OS (RR = 3.15; P < 0.001). PAP significantly added to the prognostic power for RFS (RR = 2.51; P = 0.0012) and OS (RR = 4.21; P < 0.001) in multivariate analysis, whereas patient age, tumor size, and nodal and ER status remained independent factors for predicting survival. When only node-negative patients were examined, PAP was found to be an independent factor for predicting RFS (RR = 3.68; P = 0.0032) and OS (RR = 4.81; P < 0.001). PAP did not appear to have a prognostic significance for node-positive patients. PAP is a new prognostic factor for early recurrence and death in breast cancer patients. Our results suggest that PAP may be used as an independent unfavorable prognostic factor in node-negative breast cancer patients because there were no significant associations between PAP and the other prognostic indicators evaluated in this group of patients.

Adult↗

PubMed2003

p53 overexpression as a prognostic indicator in endometrial carcinoma.

PURPOSE: To investigate the prognostic value of p53 overexpression in endometrial adenocarcinoma cases of different stages and histologic subtypes. METHODS: One hundred and eleven surgically staged endometrial carcinoma (EC) cases from 1996 to 2000 constituted this retrospective study group. Prognostic factors determined through the evaluation of surgery specimens by co-author pathologist, were surgical stage, tumor size, histology, histologic and nuclear grade, myometrial invasion, adnexal/serosal metastasis, peritoneal cytology, retroperitoneal lymph node involvement p53 overexpression was assessed via immunohistochemical staining. Tissues that expressed p53 were considered as positive p53 staining. In terms of degree of staining, 1-29%, 30-90% and 80-100% of tumoral tissue stained with p53 were considered to be mild, moderate and high p53 staining, respectively. RESULTS: Mean age and follow-up period of the study group were 58.2 +/- 10.6 years and 33.4 +/- 2.7 months, respectively. Percentages of cases surgically staged as early (I-II) and advanced (III-IV) FIGO stages were 65.8% (n: 73) and 34.2% (n: 38), respectively. Cases with positive p53 staining had a significantly high mean survival period compared with those with negative p53 staining (86.6 +/- 6.0 vs 49.1 +/- 8.1, p < 0.001). p53 overexpression was statistically detected to be high in Stage III-IV tumors, non-endometrioid histologic subtypes (p = 0.019), histologic and nuclear grade 2-3 tumors (p < 0.001), adnexal/serosal metastasis (p = 0.001), lymph node involvement (p = 0.012), and positive peritoneal cytology (p = 0.017). The degree of p53 staining was remarkably correlated with survival. In cases with mild and high p53 staining, mean survival times were 47.1 +/- 7.0 months and 57.0 +/- 13.1 months, respectively (p = 0.0003) compared to those with high p53 staining. On univariate analysis, all of the prognosticators, including p53 staining (p < 0.001) and degree of p53 staining (p < 0.001) appeared to be independent risk factors for poor prognosis. On multivariate analysis, only pelvic lymph node involvement (p = 0.03), serosal/adnexal involvement (p = 0.004), and positive peritoneal cytology (p = 0.01) were found to be independent prognosticators of survival while p53 expression (p = 0.743) and degree of p53 staining (p = 0.802) were not detected as independent prognosticators. CONCLUSION: p53 overexpression is strongly related to poor prognostic indicators in endometrial adenocarcinoma. Although in this study p53 overexpression was not detected as an independent prognosticator, additional studies with large data set are needed to evaluate the prognostic value of p53 expression.

Adenocarcinoma↗

PubMed2004

Prognostic significance of seizure in patients with glioblastoma multiforme.

BACKGROUND: Several prognostic factors have been described but there are few studies evaluating the prognostic importance of seizure in patients with glioblastoma multiforme (GBM). AIMS: To evaluate the prognostic importance of seizure at the time of the diagnosis of glioblastoma multiforme (GBM) and compare it with other known prognostic factors. SETTINGS AND DESIGN: Between January 1994 and December 2000, 81 patients underwent irradiation for intracranial GBM at our institution. The criteria for inclusion in this study were biopsy-proven GBM, being treated for primary disease. Seventy-six patients were retrospectively evaluated and the remaining five patients could not be enrolled due to lack of details. MATERIAL AND METHODS: The prognostic importance of age, sex, performance status, a history of seizure at diagnosis, extent of surgery, radiotherapy field and dose were studied. STATISTICAL ANALYSIS: The Kaplan-Meier method, the Log rank test, the Cox proportional hazard model and the Mann-Whitney U test were used for statistical analysis. RESULTS: Survival at first and second years was 19.74% and 4.81%, respectively. Univariate analysis revealed age, performance status, history of seizure, and radiotherapy dose as significant prognostic factors and with multivariate analysis age, history of seizure and radiotherapy dose were positive prognostic factors. CONCLUSION: This study concluded that in GBM, history of seizure prior to diagnosis of GBM was a positive prognostic factor.

Adult↗

PubMed2004

18F-FDG PET in patients with esophageal squamous cell carcinoma undergoing curative surgery: prognostic implications.

UNLABELLED: We investigated whether the standardized uptake value (SUV) of the primary tumor, the tumor length measured on a PET image, the number of (18)F-FDG PET-positive nodes, and the PET stage were independent prognostic predictors over other clinical variables in patients with esophageal squamous cell carcinoma who were undergoing curative surgery. METHODS: Sixty-nine patients with newly diagnosed esophageal squamous cell carcinoma who underwent preoperative (18)F-FDG PET and curative esophagectomy were included. The events for survival analysis were defined as recurrence or metastasis and cancer-related death. The disease-free and overall survival rates of each variable were estimated by the Kaplan-Meier method. The Cox proportional hazards model was used to evaluate independent prognostic variables for multivariate survival analysis. RESULTS: Using univariate survival analysis, the presence of adjuvant therapy, pathologic stage, number of CT-positive nodes (0, 1, > or =2), tumor length on PET (cutoff: 3 cm, 5 cm), number of PET-positive nodes (0, 1, 2, > or =3), and PET stage (N0 M0, N1 M0, M1) were significant prognostic predictors for disease-free survival. However, only the number of PET-positive nodes was an independent significant prognostic predictor for disease-free survival in multivariate analysis (hazard ratio = 1.87, P < 0.001). In univariate survival analysis, the sex, presence of adjuvant therapy, clinical and pathologic stages, number of CT-positive nodes, maximum SUV of the primary tumor (cutoff: 6.3, 13.7), tumor length on PET, number of PET-positive nodes, and PET stage were significant prognostic predictors for overall survival. In contrast, the clinical stage (hazard ratio = 0.53, P < 0.05), pathologic stage (hazard ratio = 3.14, P < 0.005), tumor length by PET (hazard ratio = 2.74, P = 0.01), and number of PET-positive nodes (hazard ratio = 1.71, P < 0.05) were independent significant prognostic predictors for overall survival in multivariate analysis. CONCLUSION: In addition to the pathologic stage, (18)F-FDG PET provides noninvasively independent prognostic information using the number of positive lymph nodes and the tumor length on the PET image in preoperative esophageal squamous cell carcinoma. A revised TNM classification system for esophageal carcinoma may consider tumor length and the number of positive lymph nodes as important prognostic factors.

Adult↗

PubMedDate not supplied

CD44v6 as a prognostic factor in cervical carcinoma FIGO stage IB.

The aim of our study was to clarify whether CD44v6 evaluation can serve as a universally applicable prognostic factor in patients with FIGO stage IB cervical carcinoma. A retrospective study was performed on 178 FIGO stage IB (142 IB N0, 36 IB N1) radically operated cervical carcinoma patients. The expression of CD44v6 was investigated by immunohistochemistry (IHC). The prognostic significance of established prognostic factors and CD44v6 expression was analyzed by univariate and multivariate analyses. To test the reproducibility and to account for interobserver variability, all specimens were evaluated independently at two institutions. Two different IHC scoring systems, several cut-off levels for CD44v6 positivity and several statistical methods for IHC results evaluation were used. In a univariate analysis, the most significant prognostic factor for overall survival (OS) was lymph node status (p<0.001) followed by tumor volume, LVSI, GOG score (p<0.01) and a deep stromal invasion (p = 0.06). We found a strong correlation between CD44v6 expression and squamous cell carcinoma (SCC) (SCC vs. adenocarcinoma - p<0.001) and between CD44v6 expression and deep stromal invasion, LVSI and GOG score (p<0.05). The CD44v6 expression was not a statistically significant prognostic factor for OS in a univariate analysis (p=0.39 Vienna; p=0.54 Freiburg). In a multivariate analysis, the most significant prognostic factor for OS was lymph node status (p =0.002), followed by tumor diameter and LVSI (p<0.05). CD44v6 expression was not a statistically significant prognostic factor for OS or disease-free interval (DFI) independent of the scoring method used. In conclusion, we demonstrated that CD44v6 expression is associated with LVSI, deep stromal invasion and SCC, but has no prognostic influence on OS and DFI in a population of 178 women with FIGO stage IB cervical carcinoma.

Adenocarcinoma↗

PubMed2005

[Significance of medical data availability for the assessment of prognostic factors in cancer patients. Analysis based on a study of cervical cancer population].

The aim of this study was to estimate the availability of medical records (MR) in population study based on Cancer Registries (CR) data, and to investigate weather the availability of MR correlates with favourable prognostic factors in cervical cancer patients. The cohort consisted of 1386 patients diagnosed between 1993 and 1996 and registered at CR in three Polish cities: Kielce, Opole and Warsaw. Population of these areas covers about 10% of Polish population. The data became amended with information from MR on stage, histopathology and first treatment. The place of living and availability of MR were also considered as prognostic factors. Chi square test was used to compare the differentiation of distribution of prognostic factors between two groups: patients for whom MR were available and remaining group with information available from CR only. A multivariate regression analysis was applied for the evaluation of prognostic factors. MR, available for 75,4% patients, combined with CR data, formed the high quality database allowing analysis of prognostic factors. The availability of MR correlated with more favourable prognostic factors (p<0.0001): earlier stage of disease, younger age and category of microscopic diagnosis. Multivariate analysis confirmed the prognostic meaning of the stage of disease, place of living and availability of MR, however, the last factor was not significant. The analysis confirmed the necessity of including selected clinical prognostic factors into routinely collected data by population CR to allow monitoring of effectiveness of any cancer control project and evaluation of cancer health indicators as recommended by IARC/WHO in EUROCHIP Project.

Adenocarcinoma↗

PubMed2005

[Multivariate analysis of prognostic factors in colorectal cancer patients with different ages].

OBJECTIVE: To investigate the prognostic factors of young, middle-age and old-age colorectal cancer patients in order to improve the treatment in the future. METHODS: Colorectal cancer patients (n = 842) who had undergon curative resection were divided into three groups according their age: young group (< or = 40 years), middle-age group (41 to 64 years) and old group (> o = 65 years). Thirty-five clinical factors in the three groups were analyzed and compared by univariate survival and multivariate analysis. Cox proportional hazards regression model was used with SPSS statistic software. RESULTS: The overall 5-, 10- and 15-year survival rates were 66.3%, 54.2% and 48.5% respectively. The 5- and 10-year survival rates were 53.0% and 42.7% in the young group, which were lower than those in the other two groups. Cox proportional hazards regression model demonstrated that Dukes stage and family history of cancer were common prognostic factors in both young and middle-age groups; chronic constipation was an independent prognostic factor in middle-age group; bowel obstruction, length of operating time and number of metastatic lymph nodes were prognostic factors in the older group. In the young group, the symptomatic duration was not demonstrated as a prognostic factor. The 5- and 10-year survival rates were 82.6% and 64.5% in Dukes A stage; 73.3% and 67.4% in B stage; 37.3% and 27.0% in C stage; 33.3% and 22.2% in D stage. The survival rates in Dukes A and B stages were similar, but in Dukes C and D stages they were lower than those of the middle-age and older groups if the patient had the same stage of disease. In the young colorectal cancer patients with family cancer history, the 5- and 10-year survival rates were 73.1% and 64.5%, which were better than those of patients without it (48.1% and 37.3%). CONCLUSION: In young colorectal cancer patients, the survival rate is lower than those in the middle-age and old patients. Family cancer history and/or advanced Dukes stage are poor prognostic factors, whereas the symptomatic duration is not demonstrated as a poor prognostic factor. The prognostic factors affecting the survival after surgical treatment may be different in different age groups of colorectal cancer patients.

Adult↗

PubMed2006

Prognostic factors for primary superficial transitional cell carcinoma of the bladder: a retrospective cohort study.

BACKGROUND: Previous studies showed that the prognostic factors for superficial transitional cell carcinoma of the bladder varied with the findings of different cohorts. Few multivariate analyses of prognostic factors for superficial bladder tumors have been reported in China and bladder preservation as a prognostic index of superficial bladder tumors is limited and scarce in Chinese patients. This study was conducted to analyze a group of risk factors for prognostic outcomes for patients with primary superficial transitional cell carcinoma of the bladder. METHODS: Between January 1980 to December 2000, 198 patients [172 men and 26 women; mean age (52.98 +/- 11.28) years] with primary superficial transitional cell carcinoma who were pathologically classified as Ta or T1 in Hunan Provincial Tumor Hospital (Changsha, China) were enrolled in this study. Surgical methods included local resection and electric coagulation of bladder tumors, transurethral resection of bladder tumors and partial cystectomy. After initial surgical treatment, patients were followed through a cystoscopy every three months during the first two years and every six months thereafter in the design of retrospective cohort. Survival analysis was performed to analyze risk factors of the prognostic outcomes for transitional cell carcinoma of the bladder. Canonical correlation analysis was conducted to present and interpret synthetically the multi-correlation between all kinds of prognostic outcomes and risk factor in multiply dimensions. RESULTS: The average follow-up period was (6.65 +/- 4.74) years. Assessments at three, five, and 10 years showed recurrence rates, respectively, of (28.32 +/- 3.45)%, (35.31 +/- 3.83)%, and (42.48 +/- 4.40)%; progression rates of (8.89 +/- 2.14)%, (15.16 +/- 2.94)%, and (23.88 +/- 4.19)%; bladder-preservation rates of (94.68 +/- 1.74)%, (93.87 +/- 1.91)%, and (91.51 +/- 2.49)%; metastasis rates of (8.25 +/- 2.05)%, (11.24 +/- 2.47)%, and (28.94 +/- 4.93)%; and cancer-related survival rates of (95.02 +/- 1.62)%, (90.70 +/- 2.45)%, and (77.14 +/- 4.88)%. The main risk factors for recurrence were histological grade, blood transfusion during surgery and the duration of symptoms. Progression was affected by blood transfusion during surgery, histological grade, the number of re-examinations, and the length of the recurrence-free period. Metastasis was associated with tumor multifocality, hydronephrosis, microscopic growth pattern, and the recurrence-free period. Cancer-related survival was influenced by microscopic growth pattern and the recurrence-free period. Bladder preservation involved only the recurrence-free period. The comprehensive results from canonical correlation analysis showed that the main prognostic outcomes were cancer-related survival, metastasis and progression respectively, while the dominate risk factors were histological grade, tumor multifocality and blood transfusion. CONCLUSIONS: The risk factors were different for each prognostic outcome of transitional cell carcinoma of the bladder. This is helpful for predicting the prognosis of transitional cell carcinoma of the bladder and designing therapeutic and follow-up strategies for this cancer.

Adult↗

PubMed2006

[Prognostic predictors of nasal NK/T cell lymphoma detected by immunohistochemical staining].

OBJECTIVE: To investigate the prognostic predictors of nasal NK/T cell lymphoma. METHODS: The clinicopathologic feature data of 61 patients with nasal NK/T cell lymphoma proven by pathological examination from Jan. 1997 to Jan. 2005 were collected. Expression of survivin, CD44, nm23, p53, Ki-67, MDR-1 and CD95 was detected by immunohistochemical staining in 30 patients with available histologic specimens. The correlation between these factors and prognosis were analyzed. RESULTS: In univariate analysis, performance status, LDH level, clinical stage, initial treatment response, CD56, Ki-67 and CD95 were found to be the prognostic factors associated with time to progression (TTP) in nasal NK/T cell lymphoma, while the performance status, B symptoms, LDH level, initial treatment response, Ki-67 and CD95 were demonstrated as prognostic factors related to overall survival. In multivariate analysis, clinical stage, initial treatment response and performance status were independent prognostic factors for TTP, while the latter two factors were independent prognostic factors of overall survival. CONCLUSION: Clinical stage and initial treatment response, and performance status are found to be independent prognostic factors for TTP, whereas the latter two factors are demonstrated as independent prognostic factors of the overall survival. Overexpression of Ki-67 may be an unfavorable prognostic factor, but overexpression of CD95 may be a favorable one.

Adolescent↗

PubMed1991

Analysis of prognostic factors in squamous cell carcinomas of the head and neck.

It appears that prognostic factors of proven value in the management of other malignancies have marginal value in the treatment of patients with squamous cell carcinomas of the head and neck (SCCHN). For example, age, sex, and performance status do not correlate with treatment outcome. Similarly, histologic differentiation has little predictive value, with undifferentiated carcinomas of nasopharyngeal origin being a possible exception. On the other hand, primary tumor site may be an important prognostic factor, with tumors arising from the nasopharynx, oral cavity, and possibly the oropharynx having a more favorable outcome, whereas tumors of the hypopharynx appear to be the least favorable. A tumor's TNM stage is also highly predictive of response to treatment and survival. Overall stage of disease is an effective predictor of relapse and survival only for patients with limited disease and only after the primary site is specified. Independent of primary tumor site, an inverse correlation clearly exists between T and N stage and either response to treatment or overall survival. Flow cytometry, a relatively new test, appears to be one of the most significant predictors of response to chemotherapy, relapse, and survival in patients with SCCHN. As a prognostic factor, DNA tumor content may be independent of all other known clinical and pathologic factors. Patients with diploid tumors have a superior relapse-free and overall survival as compared with patients whose tumors are aneuploid. Another parameter of significant value is the patient's response to induction chemotherapy, with responding patients demonstrating a far superior relapse-free and overall survival compared with nonresponders. In summary, the site of the primary tumor, its T stage, N stage, and DNA content, and the magnitude of its response to induction chemotherapy are the most valuable prognostic factors in SCCHN. It is assumed, however, that as new and more effective therapies are developed for patients with SCCHN, previously significant prognostic factors will cease to have clinical or scientific value. Similarly, as new diagnostic tests and staging tools are developed, a new generation of prognostic factors with greater biologic and clinical relevance is likely to emerge. In the evolution of new therapies for patients with SCCHN, prognostic factors such as those mentioned here or ones yet to be evaluated will be central to the design of clinical studies and the identification of specific patients for specific therapies. Once treatment is initiated, treatment-related prognostic factors may further identify patients for whom modifications of the initial therapeutic plan would be appropriate.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1980

Prognostic factors for survival in patients with inoperable lung cancer.

Seventy-seven prognostic factors were considered in an evaluation of more than 5,000 patients with inoperable bronchogenic carcinoma of the lung; these patients were entered on the Veterans Administration Lung Group protocols 9-15 (1968-78). Fifty prognostic factors for survival were identified, and their relative contributions to patient survival were considered. The three most important prognostic factors affecting survival were the Karnofsky initial performance status score, extent of disease, and weight loss in the previous 6 months. These factors denoted three general prognostic components: current physical status, current disease status, and prior physical status. Initial performance status was the dominant prognostic factor. Characterization of patient's function status with the use of the Karnofsky scale was preferred to a summarized scale or a dichotomization into ambulatory versus nonambulatory. The current practice of dichotomizing factors resulted in the loss of much prognostic information. Other factors, such as tumor size, histologic type, and institution, appeared to be important when considered alone. However, their contribution was relatively minor after a correction was made for the effects of initial performance status, extent of disease, and prior weight loss. Depending on these three prognostic factors alone, median survival varied between 6 weeks and over a year. Reporting of results without the consideration of such prognostic factors severly hampers any comparisons that may be made between investigations.

Actuarial Analysis↗

PubMed1982

A study on prognostic factors of uterine cervical cancer.

Prognostic factors of cancer of the cervix were studied in 286 cases treated by radiotherapy. The four items stated below relating to morphological characteristics and found to be comparatively easy to determine clinically were selected as prognostic factors. The factors are (1) clinical stage, (2) morphology of the uterine cervix, (3) histological type of cancer and (4) radiosensitivity. Each prognostic factor and prognosis indicated in every case by chi-square test (chi 2 test) a risk rate lower than 0.1%, a significant difference. Furthermore, every prognostic factor was given points according to their grade, and the total points were expressed as a prognostic index. The prognostic index was classified into the mold zone (from 1 to 8 points), the moderate zone (from 9 to 10 points), and the severe zone (from 11 to 18 points), and the five year survival rate of each zone was observed to be 91.5%, 56.1% and 18.9% respectively. Thus, at a risk of less than 0.1%, a significant difference was observed. By setting up the prognostic index, it was possible to estimate the prognosis of every case of cervical carcinoma, which to date had been nearly impossible to estimate by each prognostic factor alone.

Adenocarcinoma↗