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PubMed2000

Activity of extracranial metastases as a prognostic factor influencing survival after radiosurgery of brain metastases.

Information about prognostic factors influencing survival have been only occasionally reported in studies on the use of radiosurgery in the treatment of patients with brain metastasis. To answer the question of whether activity of extracranial metastases is an independent prognostic factor influencing survival in radiosurgery of brain metastases, a review of the literature was performed. Fourteen studies were identified in the English language literature that dealt with this topic. Only three studies showed borderline insignificance of the influence of activity of extracranial metastases when analysed by univariate methods. When multivariate analysis was used to test for the independent influence of this factor on survival, of nine studies that used that statistical approach eight showed that it is an independent prognosticator influencing survival, most often being the strongest one. This review of literature supports the view that the "activity of extracranial metastases" is an independent prognostic factor influencing survival of these patients as documented in published reports. However, prospective randomised trials are necessary to definitely establish the independent influence of this prognostic factor.

Analysis of Variance↗

PubMed2002

Recurrence-free survival and prognostic factors in resected pN2 non-small cell lung cancer.

OBJECTIVE: We sought to evaluate recurrence pattern and prognostic factors of recurrence-free survival in surgically resected N2 non-small cell lung cancer. METHODS: Between September 1994 and December 1999, 564 patients underwent operation for non-small cell lung cancer at our institute. Of these 564 patients, 101 patients were found to have pathologic N2 disease. Systematic mediastinal lymph node dissection was performed in all these patients. Recurrence was determined and nineteen clinicopathologic prognostic factors were evaluated in relation to recurrence-free survival. RESULTS: Complete resection rate was 83.2% and overall 5-year survival was 23.3%. Locoregional and distant metastasis were detected in 50 of 101 patients (49.5%) during follow-up. Five-year recurrence-free survival was 19.6%. Among 19 clinicopathologic prognostic factors, incomplete resection and non-downstaging after neoadjuvant therapy were unfavorable prognostic factors in univariate analyses. Clinical N2 status, multiple N2 nodes, and cell type of adenocarcinoma showed poor prognosis but were not statistically significant. Postoperative chemotherapy showed good prognosis but was not statistically significant. Multivariate analysis showed that significant favorable prognostic factors were complete resection and adjuvant chemotherapy. CONCLUSIONS: Complete resection and responsiveness to neoadjuvant therapy were the most important favorable prognostic factors in recurrence-free survival. Postoperative chemotherapy was also a favorable prognostic factor but not statistically significant in recurrence-free survival in pN2 non-small cell lung cancer.

Adult↗

PubMed2003

Local failure and prognostic factors in ductal carcinoma in situ: concentration on recent publications.

PURPOSE OF REVIEW: Traditional therapy for ductal carcinoma in situ has been mastectomy or conservative surgery plus radiation, but interest in more expeditious therapies such as conservative surgery alone is growing. A first step in considering changes in an already successful treatment is to evaluate tumor and patient factors that may predict outcome. Identifying and understanding these prognostic factors will aid researchers in designing new treatment paradigms. The purpose of this review is to assess the value of commonly accepted potential prognostic factors in patients with ductal carcinoma in situ. RECENT FINDINGS: During this past year several retrospective studies have evaluated putative prognostic factors in ductal carcinoma in situ. We will compare these later publications with results from prospective randomized trials and one meta-analysis. SUMMARY: There does not appear to be unanimous agreement on the prognostic factors associated with increased risk of local failure in patients treated with conservative surgery and radiation for ductal carcinoma in situ. In our chosen papers, however, comedonecrosis and positive margins are most likely prognostic factors for increased local failure.

Adult↗

PubMed1996

Community-acquired pneumonia in the elderly: A multivariate analysis of risk and prognostic factors.

To assess the risk and prognostic factors of community-acquired pneumonia occurring in the elderly (over age 65 yr) requiring hospitalization, two studies, case-control and cohort, were performed over an 8-mo period in a 1,000-bed university teaching hospital. We studied 101 patients with pneumonia (cases), age 78.5 +/- 7.9 yr (mean +/- SD). Each case was matched for sex, age (+/- 5 yr), and date of admission (+/- 2 d) with a control subject, without pneumonia during the preceding 3 yr, arriving at the emergency room. Etiologic diagnosis was obtained in 43 of 101 (42%) cases. The main microbial agents causing pneumonia were: Streptococcus pneumoniae (19 of 43, 44%), and Chlamydia pneumoniae (9 of 43, 21%). Gram-negative bacilli were uncommon (2 of 43, 5%). The multivariate analysis demonstrated that large-volume aspiration, and low serum albumin (< 30 mg/dl) were independent risk factors associated with the development of pneumonia. Crude mortality rate was 26% (26 of 101), while pneumonia-related mortality was 20% (20 of 101). The attributable mortality was 23% (odds ratio [OR]: 11.3; 95% confidence interval [CI]: 3.25 to 60.23; p < 0.0001). The multivariate analysis showed that patients had a worse prognosis if they were previously bedridden, had prior swallowing disorders, body temperature on admission was less than 37 degrees C, respiratory frequency was greater than 30/min or had three or more affected lobes on chest radiograph. Age by itself was not a significant factor related to prognosis. Among the significant risk factors, only nutritional status is probably amenable to medical intervention. The prognostic factors found in this study may help to identify, upon admission, those subjects at higher risk and who may require special observation.

Aged↗

PubMed2003

Prognostic factors in definitive radiotherapy of uterine cervical cancer.

PURPOSE: To determine the prognostic factors related to local control and survival in 257 patients with uterine cervical cancer treated with definitive radiotherapy (RT). MATERIALS AND METHODS: The medical records of 257 patients treated with definitive RT from January 1987 to December 1998 were reviewed retrospectively. Pretreatment and treatment parameters were analyzed to determine their prognostic value onlocal control and survival. Survival analyses were performed using the Kaplan-Meier method. The log-rank test was used for univariate analyses and the Cox regression model was used for multivariate analyses. RESULTS: Median age was 55 (range 25-82). Squamous cell carcinoma was the most common histologic type (89.1%). The distribution per FIGO Stage was IIA: 13.2%; IIB: 54.9%; IIIA: 3.9%; IIIB: 19.8%; IVA: 8.2%. Ninety-eight patients (38.1%) were treated with external RT alone; 134 (52.1%) received both external RT and intracavitary brachytherapy; 21 (8.2%) received external RT and chemotherapy and four (1.6%) received external RT, intracavitary brachytherapy and chemotherapy. Median follow-up duration was 50 months (range 24-155 months). The failure rate was 51.8% with 26.5% of patients having only local failure, 16.7% only distant failure and 8.6% both local and distant failure. Five-year local progression-free, disease-free and overall survival rates were 58.1%, 44% and 63.7%, respectively. In univariate analysis the prognostic factors identified for local progression-free survival were histology (p = 0.008), FIGO stage (p < 0.001), initial hemoglobin (Hgb) level (p = 0.001), total radiation dose (p = 0.039), use of brachytherapy (p = 0.001) and of chemotherapy (p = 0.037) and enlarged paraaortic nodes (p = 0.016). In multivariate analysis the prognostic factors were FIGO stage (p = 0.014), initial Hgb level (p = 0.040), and use of brachytherapy (p = 0.013). The prognostic factors identified for disease-free survival were histology (p = 0.011), FIGO stage (p < 0.001), initial Hgb level (p < 0.001), use of brachytherapy (p = 0.001) and of chemotherapy (p = 0.014) in univariate analysis; and FIGO stage (p < 0.001), initial Hgb level (p = 0.017), total tumor dose (p = 0.034), use of brachytherapy (p = 0.006) and of chemotherapy (p = 0.021) in multivariate analysis. Factors influencing overall survival were FIGO stage (p < 0.001), initial Hgb level (p = 0.006), overall treatment time (p = 0.028), total tumor dose (p = 0.007), use of brachytherapy (p < 0.001), enlarged paraaortic (p < 0.001) and pelvic nodes (p = 0.004) in univariate analysis; and FIGO stage (p < 0.001), overall treatment time (p = 0.031), enlarged paraaortic (p = 0.007) and pelvic lymph nodes (p = 0.043) in multivariate analysis. CONCLUSION: Definitive RT is an effective treatment for patients with uterine cervical cancer. There are many prognostic factors influencing treatment outcome. Brachytherapy and chemotherapy must be added in appropriate patients to improve the outcome. Future prospective trials should be undertaken to confirm the validity of these factors and to individualize the treatment strategy for every patient.

Adenocarcinoma↗

PubMed1990

Lung cancer prognostic factors from the Aichi Cancer Registry.

Lung cancer prognostic factors have been evaluated on the basis of three-year survival rates for 2,830 lung cancer patients diagnosed between 1983 and 1986 and reported to the Aichi Cancer Registry. In the univariate analyses, the former in each pair of following factors showed a significantly better prognosis than the latter: early vs. late stage of disease, surgically-treated vs. non-surgically-treated cases, adenocarcinoma and squamous cell carcinoma vs. large cell and small cell carcinoma, cases detected by screening vs. others, young vs. old patients, females vs. males, non-smokers vs. smokers. The association of prognosis with these factors, other than smoking and histological type, remained statistically significant throughout multivariate analysis. When analyzed according to histological type, disease stage was the most important prognostic factor, across all histological types, and surgery was the second most important prognostic factor, except in cases of small cell carcinoma. Sex and method of detection were significantly associated with survival rates in adenocarcinoma and small cell carcinoma, and the association with smoking was of borderline significance for adenocarcinoma.

Adenocarcinoma↗

PubMed2002

Molecular markers in breast cancer: can we use c-erbB-2, p53, bcl-2 and bax gene expression as prognostic factors?

We examined the prognostic value of c-erbB-2, p53, bcl-2 and bax overexpression in breast cancer. Immunostaining for c-erbB-2, p53, bcl-2 and bax gene expression was performed on 121 paraffin-embedded specimens of Stage I, II and III breast cancer patients diagnosed and treated in Hippokration Hospital, Athens Medical School, between 1986 and 1992. The primary tumor from 27 (24.1%), 69 (59%), 18 (15%) and 63 (53.4%) patients stained positively for c-erbB-2, p53, bcl-2 and bax gene expression, respectively. Significant correlations were found between bax overexpression and age (P=0.04), tumor size (P=0.02) and disease stage (P=0.001), while no other significant associations were found between other molecular markers and clinical or histological parameters. None of the individual molecular markers examined proved to be independent prognostic factor for patients with breast carcinoma. C-erbB-2, p53, bcl-2 and bax genes have limited prognostic value. An approach that combines several molecular markers with established clinicopathological criteria may help physicians make more accurate predictions of prognosis in patients with breast cancer.

Journal Article↗

PubMed1984

Prognostic factors with four treatment methods for phobic disorders.

The associations between prognostic factors and outcome with four treatment methods for phobic disorders were studied in 103 women. The prognostic factors were sociodemographic, intelligence, personality, early interpersonal relations, aspects of previous and current mental disorder, and intensity of symptoms at start of treatment. All patients received basal therapy, which implied information, advice on exposure in vivo, and anxiolytics. One group received this treatment only (B), while others received supplementary treatment, with therapist-directed prolonged exposure in vivo (PE), supportive therapy (ST) of dynamic type, or relaxation (R). The patients were treated for 3 months, with a 9-month follow-up period. Factors associated with a better outcome were: PE: greater needs for succourance and lower avoidance; ST: higher social class, better relations between parents and with father during childhood, inner conflicts as cause, and lower levels of free anxiety; R: satisfaction with contact when aged 15, bereavement as a cause, and lower levels of several symptoms; B: greater needs for order, stress at the onset, shorter duration and satisfaction with work. There were thus interactions between prognostic factors and type of treatment. The prognostic factors should be taken into account in the choice and design of treatment.

Adult↗

PubMed2004

[Prognostic factors of the cervical carcinoma].

OBJECTIVE: Review of prognostic factors of the cervical carcinoma, new perspective methods. SETTING: Department of Obstetrics and Gynecology, Medical Faculty Hospital, Plzen. DESIGN: Review article. RESULTS: The most important prognostic factors of the early cervical carcinoma are the stage and regional lymph node status followed by the depth of stromal invasion, tumor volume, and lymphovascular invasion. Other factors are still only subjects of research. CONCLUSION: A detailed knowledge of particular prognostic factors of the cervical carcinoma is necessary for optimal treatment and flow-up strategy.

Carcinoma↗

PubMedDate not supplied

Older age and second skin cancer as prognostic factors in localized malignant melanomas.

Of the numerous prognostic factors for patients with localized malignant melanoma (LMM), none is superior to the simple parameter of tumor thickness. The aim of the present study was to better define prognostic factors for this disease. Between January 1992 and December 1994, 188 consecutive patients with LMM were treated at the Rabin Medical Center. Patient and tumor characteristics were retrospectively examined as potential prognostic factors. Patients (n=173) who had had at least two-year follow-up were included in the overall survival (OS) analysis, and 159 patients for whom accurate data on recurrent disease were available were included in the disease-free survival (DFS) analysis. At a median follow-up of 85 months (range 24-114), 48 patients (30%) had recurrent disease which resulted in death in 35 (20%). The five-year OS and DFS rates for the entire group were 82 and 72%, respectively. On univariate analysis, female gender, age younger than 75 years, metachronous or synchronous second skin cancer (including melanoma), light skin color, tumor thickness and TNM stage were predictive of both OS and DFS. Tumor location and ulceration, correlated with only one endpoint, OS or DFS, respectively. On multivariate analysis, three factors retained statistical significance with regard to both OS and DFS: tumor thickness (p=0.000 for both), second skin cancer (p=0.02 for both), and age (p=0.04 for both). Alongside the well-established predictive factor of tumor thickness in LMM, older age and the presence of a second skin cancer also have prognostic significance. The prognostic importance of the latter is reported here for the first time.

Adolescent↗

PubMed2001

Prognostic factors in infiltrating lobular carcinoma.

Various prognostic factors viz. clinical details, histologic features including subtypes, elastosis, desmoplasia, in situ carcinoma, perineural and vascular invasion, Nottingham Prognostic Index (NPI), and menopausal status were evaluated in Infiltrating Lobular carcinoma (ILC) in the context of patient survival. 138 patients had presented with ILC over a period of 20 years. Histological subtypes of ILC and vascular invasion played a role in the biologic behaviour of the tumour. Interestingly premenopausal status protected against the risk for relapse, while being postmenopausal, increased the risk. NPI was demonstrated as an independent significant prognostic factor and was a good predictor for relapse. This study underlines the role of the pathologist in determination of the prognostic groups in Infiltrating lobular carcinoma.

Adult↗

PubMed1996

Prognostic factors in angiosarcoma: a multivariate analysis of 55 cases.

Data for prognostic factors in angiosarcoma (AS) are limited, prompting a large-scale study of AS with multivariate analysis. To analyze prognostic factors in angiosarcoma (AS), clinical and histologic findings in 55 patients collected from hospitals in Japan were reviewed. Prognostic factors were evaluated by univariate and multivariate Cox's proportional hazards models. The study involved 32 males and 23 females, ages 18-93 (median, 69) years. The primary sites of tumors included head and neck (32 cases), trunk (10), extremities (3), spleen (3), breast (3), and other (4). The overall 2-year survival rate was 21%. Univariate analysis of clinical factors including age, sex, size and depth of tumor, tumor-related symptoms, interval between onset of symptoms and admission, surgical procedures, adjuvant chemotherapy, and adjuvant radiotherapy showed that age, tumor size, and mode of treatment were significant for survival. Histologic factors analyzed were mitotic counts, cellularity, cellular pleomorphism, extent of necrosis, vascular differentiation, and nonspecific diagnosis. Only mitotic counts were significant for prognosis. Multivariate analysis on these four factors revealed that tumor size, mode of treatment, and mitotic counts were independent prognostic factors.

Adolescent↗

PubMed2005

[Analysis of prognostic factors in patients with cervical squamous cell carcinoma of stage Ib and IIa].

OBJECTIVE: To analyze the prognostic factors in patients with cervical squamous cell carcinoma of stage Ib and IIa treated by surgery, and to investigate their guide roles in available post-operation adjuvant therapy. METHODS: The clinicopathologic records of 306 patients with cervical squamous cell carcinoma of stage Ib and IIa who underwent radical hysterectomy and pelvic lymphadenectomy were retrospectively analyzed, and the prognostic factors were explored by univariate and multivariate methods. Independent prognostic factors were identified by COX proportional hazards regression model. RESULTS: The overall 5-year survival rate of these 306 patients was 78.1%. In univariate survival analysis, the poor prognostic factors included poor differentiation, positive pelvic lymph nodes, deep stromal invasion, parametrial extension, tumor size > or = 4 cm, and lymph vascular space involvement (P < 0.05). While in multivariate survival analysis, the independent prognostic factors included positive pelvic lymph nodes, deep stromal invasion and parametrial extension (P < 0.05). According to the risk factors, all patients were divided into low, intermediate and high risk groups with 5-year survival rate of 90.3%, 83.9% and 43.1%, respectively. In low risk group, no risk factor or only parametrial extension was involved, pelvic recurrence rate was only 2.2%. In intermediate risk group, deep stromal invasion or together with parametrial extension was involved. Pelvic recurrence rate and extra pelvic metastasis rate were 13.5% and 1.3%, respectively. In high risk group, lymph node metastasis or together with other high risk factors was involved, pelvic recurrence rate and extra pelvic metastasis rate were 25.9% and 48.3%, respectively, and 10.3% had both pelvic recurrence and extra pelvic metastasis. CONCLUSIONS: Lymph node metastasis, deep stromal invasion and parametrial extension were independent prognostic factors of stage Ib and IIa cervical squamous cell carcinoma patients undergoing radical hysterectomy and lymphadenectomy. The establishment of prognosis-predicting system based on high risk factors may be helpful to predict the risk of recurrence and metastasis, and guide adjuvant therapy after surgery.

Adult↗

PubMed2005

Is patient's age a prognostic factor for follicular thyroid carcinoma in the TNM classification system?

The knowledge of prognostic factors is essential for an optimal treatment of patients. The aim of our study was to find out if age is an independent prognostic factor for patients with follicular or Hürthle cell carcinoma. This retrospective study was carried out in 261 patients (median age, 62 years) with follicular or Hürthle cell thyroid carcinoma treated at our institute from 1972-2002. For all patients the follow-up was performed at our institute at least once per year. The data on gender and age of the patients, disease history, extent of disease, morphologic characteristics, mode of therapy, outcome, and survival were collected. Statistical correlation between possible prognostic factors and cause-specific survival was analyzed by univariate and Cox's multivariate survival analysis. The 10-year and 20-year survival of all 261 patients were 70% and 42%, respectively. Even 10 of 49 (20%) of our patients who were under 45 years of age (i.e., in stage II of the tumor, node, metastases [TNM] classification system) died of disease. Multivariate analysis showed that primary tumor size and distant metastases were independent prognostic factors for survival. Lymph node metastases as well as the age of patients were not found to be independent prognostic factors. Therefore, the patients with distant metastases or tumor stage T4 who are under 45 years of age cannot be considered to have favorable prognosis.

Adenoma, Oxyphilic↗

PubMed2000

Contribution of artificial intelligence to the knowledge of prognostic factors in laryngeal carcinoma.

Many studies have investigated prognostic factors in laryngeal carcinoma, with sometimes conflicting results. Apart from the importance of environmental factors, the different statistical methods employed may have influenced such discrepancies. A program based on artificial intelligence techniques is designed to determine the prognostic factors in a series of 122 laryngeal carcinomas. The results obtained are compared with those derived from two classical statistical methods (Cox regression and mortality tables). Tumor location was found to be the most important prognostic factor by all methods. The proposed intelligent system is found to be a sound method capable of detecting exceptional cases.

Aged↗

PubMed2001

Concentration of vascular endothelial growth factor in the tumour tissue as a prognostic factor of soft tissue sarcomas.

Previous studies have shown that the prognosis of patients who have tumours with high microvessel density (MVD) is worse than that of patients who have a lower density in a variety of cancers. In this study, we investigated the clinical relevance of neovascularity assessed by MVD and the concentration of vascular endothelial growth factor (VEGF) in the tumour tissue of patients with soft tissue sarcoma in comparison with major clinicohistologic parameters by univariate and multivariate analysis. In 115 patients with soft tissue sarcoma, MVD was measured by counting vessels stained with factor VIII antibody. The concentration of VEGF in the tumour tissue was determined by enzyme-linked immunosorbent assay. These parameters were then compared with disease outcome. The concentration of VEGF in the tumour tissue, but not MVD, was found to be correlated with disease outcome in patients with soft tissue, sarcoma. VEGF concentration in the tumour tissue showed a relationship with the clinical stage and histologic grade of the tumour. There was no significant difference in the levels of tissue VEGF concentration and MVD among soft tissue sarcomas classified according to histologic type. The level of tissue VEGF concentration in patients who had subsequent local recurrence and metastasis were significantly higher than the respective values in patients who did not have such disease outcome. No significant correlation existed between MVD and the concentration of VEGF in the tumour tissue. Univariate analysis showed that a high tissue VEGF concentration was associated with poor overall survival of the patient and a greater probability that local recurrence and metastasis had occurred. Multivariate analysis revealed that the tissue concentration of VEGF is an independent prognostic factor for the disease outcome of patients with soft tissue sarcoma. VEGF concentration in the tumour tissue, but not MVD, is an additional prognostic parameter for disease outcome in patients with soft tissue sarcoma, regardless of histologic type.

Adult↗

PubMed1996

Genitourinary group phase II study of chemotherapy in stage T3-4 N0-X M0 transitional cell cancer of the bladder: prognostic factor analysis.

The aim of this study was to examine prognostic factors for survival of patients with invasive bladder cancer who had received neoadjuvant chemotherapy followed by further treatment. From 1986 to 1990, 149 eligible patients with T3-4 N0-X M0 bladder cancer were entered into a phase II trial of neoadjuvant chemotherapy, consisting of cisplatin and methotrexate. Patients received two or four courses of chemotherapy, depending on the absence or presence, respectively, of a major clinical response after two courses. 136 patients were evaluable for clinical response after two courses of chemotherapy, and 75 patients were evaluable for pathological response after two or four courses. A multivariate analysis, based on pretreatment variables and the post-treatment variables, clinical response and pathological response, showed that performance status, tumour size and clinical response after two courses of chemotherapy were the only independent prognostic factors for all eligible patients. A second multivariate analysis in the selected subgroup of patients, who underwent a cystectomy, showed that the G-cagetory and pathological response were the only independent prognostic factors. In conclusion, in this group of patients, the response to chemotherapy was a strong and independent prognostic factor in addition to other independent variables. However, it was not accurate or strong enough to allow an impact on the choice of locoregional therapy.

Aged↗

PubMedDate not supplied

Analysis of the prognostic factors for liver metastasis of gastric cancer after hepatic resection: a multi-institutional study of the indications for resection.

BACKGROUND/AIMS: The number of reports of hepatic resection for metastatic gastric cancer is very small. The outcome and indications of hepatic resection for metastatic gastric cancer remains unknown. METHODOLOGY: A multi-institutional study was made. Thirty-six patients who underwent a hepatic resection for liver metastasis of gastric cancer with no residual tumor were included in this study. The clinicopathological factors were examined as prognostic factors by multivariate analyses. Thirty patients had recurrence and the recurrence pattern and risk factors for extrahepatic recurrence was examined. RESULTS: The overall survival rate was 64% at 1 year, 43% at 2 years, 26% at 3 years 26% at 5 years, and 26% at 10 years after hepatectomy. Multivariate analysis showed that lymphatic invasion, venous invasion of cancer cells of primary gastric cancer and the number of the liver metastasis (> 3) were independent poor prognostic factors after hepatic resection. The most common recurrence pattern was intrahepatic recurrence in 22 patients (73%). The risk factors for extrahepatic recurrence was serosal invasion, lymph node metastasis of primary gastric cancer, stage, and curability of operation. CONCLUSIONS: Hepatic resection for liver metastasis should be attempted in case primary gastric cancer has neither lymphatic invasion nor venous invasion. The most common recurrent site was the liver. In patients with advanced gastric cancer, having neither serosal invasion nor lymph node metastasis, who underwent a less curative operation, the intra-hepatic recurrence would be expected. Thus, aggressive adjuvant chemotherapy through the hepatic artery may improve the survival after hepatectomy in these patients.

Aged↗