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PubMed2006

Long-term, health-related, quality of life comparison in patients undergoing single stage vs staged resection for complicated diverticular disease.

OBJECTIVE: To evaluate long-term health-related quality of life, for single-staged and staged resections following reversal, for complicated diverticular disease. PATIENTS AND METHODS: Between 1981 and 2003, 188 patients undergoing single stage (n = 158) or staged resection (n = 30) completed the SF-36 questionnaire. Health-related quality of life (HRQL) was compared between the two groups and the US normal population based on the eight domains of the SF-36. HRQL analysis was also performed at various time intervals. The effect of age and postoperative complications on HRQL was also determined. Functional and postoperative outcomes were also assessed. RESULTS: The single and staged resection groups differed in the presence of comorbidity, degree of peritoneal contamination and operative urgency. No difference in functional outcomes or HRQL was found, even after analysing time-interval subgroups. Social functioning and general health was substantially worse in both groups when compared to US norms. Ageing was found to significantly reduce physical functioning (P < 0.001) and physical and emotional role limitations (P < 0.001 for both). Post-operative complications significantly reduced scores when compared to patients without complications, for physical functioning (63.57 vs 78.7, respectively; P < 0.001), physical role limitation (80.65 vs 86.9, respectively; P < 0.001) and bodily pain (66.67 vs 74.81, respectively; P < 0.01). CONCLUSIONS: No significant difference in long-term HRQL was found in patients undergoing single staged or staged resection for complicated diverticular disease. There was significant impact of ageing and postoperative complications on physical health. Prospective studies that include pre-operative data on HRQL are required to compare the two operative techniques, with emphasis on quality of life of patients left with a permanent stoma.

Age Factors↗

PubMed2005

Simplified methods of implant treatment in the edentulous lower jaw: a 3-year follow-up report of a controlled prospective study of one-stage versus two-stage surgery and early loading.

BACKGROUND: Interest in the use of one-stage surgery and immediate loading of oral implants has lately been increasing. PURPOSE: The aim of this study was to compare the 3-year results of one-stage surgery versus two-stage surgery, early loading versus loading after a 3-month healing period, and the use of one-piece implants versus the use of two-piece implants. MATERIALS AND METHODS: The study included 108 patients with edentulous mandibles. Each patient was treated with four Brånemark System implants (Nobel Biocare AB, Göteborg, Sweden) and with full fixed prostheses. Patients were consecutively treated and were distributed in four groups: group A (one-stage surgery), group B (control group with two-stage surgery), group C (one-piece implants), and group D (early loading). In groups A and B Brånemark Standard implants and standard abutments were used. In group C the conical one-piece Brånemark implant was used, and in group D the patients had Brånemark System Mk III implants together with multiunit abutments. All patients were observed for 3 years. RESULTS: Of the 432 inserted implants, 24 were lost. Survival rates in the three experimental groups ranged from 93.2 to 93.3% whereas the survival rate in group B (the control group with two-stage surgery) was 97.5%. The differences between the groups were not statistically significant. The changes in marginal bone level were measured from fixture insertion to the final follow-up at 3 years. The bone loss in group D (early loading) was significantly less than in group B (the control group) whereas there were no differences in marginal bone change between the other groups. CONCLUSIONS: Early loading seemed to give good results in the anterior part of the mandible. The survival rate of the early-loaded implants did not significantly differ from that of implants inserted with the conventional two-stage procedure, but the mean marginal bone loss around the surviving implants was less with early loading.

Adult↗

PubMed1998

Transgenic expression of a mosquito-stage malarial protein, Pbs21, in blood stages of transformed Plasmodium berghei and induction of an immune response upon infection.

Pbs21 is a surface protein of the ookinete of Plasmodium berghei, which can induce a potent transmission-blocking immune response. Pbs21 is normally expressed only by parasite stages in the mosquito, i.e., female gametes/zygotes, ookinetes, and oocysts. However, the Pbs21 gene is transcribed in female gametocytes which circulate in the bloodstream of the host, where translation of the resulting mRNA is totally repressed. Episomal transfection has been used to investigate whether expression of Pbs21 protein could be achieved in blood stages of the parasite. By using plasmid pMD221, the complete mRNA-encoding region of Pbs21, flanked only by 218 nucleotides (nt) of its promoter region and 438 nt of its 3' region downstream from the polyadenylation site, was introduced into the blood stages of gametocyte-producing and non-gametocyte-producing clones of P. berghei. In both of these transformed parasite lines, Pbs21 protein was expressed in asexual trophozoites, schizonts, and, when present, in both male and female gametocytes. Hence, the flanking regions present are sufficient to allow transcription but lack the elements that exert natural control of sex- and stage-specific transcription. The mRNA and the protein expressed by transformed blood stages were indistinguishable from the wild-type forms by the criteria tested, and the protein was recognized by both conformation-dependent and conformation-independent monoclonal antibodies raised against native Pbs21. In mice infected with transformed non-gametocyte-producing parasites, a Pbs21-specific immune response was induced and characterized with respect to isotype (IgG2a/IgG2b) and quantity (11. 5 +/- 10 microg/ml) of antibody produced. However, as found in previous studies, these antibody levels were insufficient to inhibit development of the parasites in the mosquito. The ability to express mosquito midgut-stage antigens in blood-stage parasites will facilitate further investigations of molecular and immunological properties of these proteins.

Animals↗

PubMed2005

Treated threshold stage 3 versus spontaneously regressed subthreshold stage 3 retinopathy of prematurity: a study of motility, refractive, and anatomical outcomes at 6 months and 36 months.

AIM: To compare the visual acuity (VA), spherical equivalent refractive error, motility, and anatomical outcomes in children with treated regressed threshold stage 3 retinopathy of prematurity (ROP) and those with spontaneously regressed subthreshold stage 3 ROP. METHOD: 6 month and 3 year data collected from infants examined between 1989 and 1999 with regressed stage 3 ROP, with or without treatment were retrospectively reviewed. RESULTS: 85 infants were included in this study. 40 eyes received cryotherapy, 81 eyes laser photocoagulation, and 34 eyes had spontaneously regressed subthreshold stage 3 ROP. Grating acuity score > or =2 cycles/degree (c/d) at 6 months was predictive of optotype acuity > or =6/9 in 69% of eyes and a score <2 c/d at 6 months was predictive of acuity < 6/9 in 88% of eyes. Eyes with subthreshold stage 3 ROP were twice as likely to have VA of 6/9 or better at 36 months than the treated eyes. The mean spherical equivalent refractive error at 36 months was -6.5 dioptres (D) (-21.5D to +1.38D) in cryotherapy treated eyes, -2.4D (-13D to +4D) in the laser group, and -0.22D (-9D to +2.25D) in the subthreshold group. Eyes within the treated groups were more myopic than the eyes within the spontaneously regressed group (p = 0.005). At 36 months, 42 out of the 85 infants (that is, 49%) had strabismus (44% in the cryotherapy group, 26% in the laser group, and 25% in the subthreshold group). There was a statistically significant association between the presence of strabismus and anisometropia (p = 0.016) and strabismus and intraventricular haemorrhage (IVH) (p = 0.005). There was a statistically significant difference in the incidence of strabismus between mild and moderate and severe grade IVH (p = 0.01). Eight out of 40 eyes in the cryotherapy group and six out of the 81 eyes in the laser group developed macular ectopia. None of the eyes in the spontaneously regressed group had macular dragging. CONCLUSIONS: In this study, the grating acuity at 6 months was a good predictor of the 3 year optotype acuity in all groups. Eyes with spontaneously regressed subthreshold stage 3 ROP were associated with better vision at 3 years of age and a lesser degree of myopia compared to the treated groups. Strabismus developed predominantly in the treated groups and was frequently associated with neurological damage and/or anisometropia. The spontaneously regressed subthreshold stage 3 group had a better anatomical outcome compared to the groups in which the retinopathy regressed following treatment.

Cryotherapy↗

PubMed1998

Successful treatment of stage III neuroblastoma based on prospective biologic staging: a Children's Cancer Group study.

PURPOSE: To identify a biologically favorable and unfavorable subset of patients with Evans stage III neuroblastoma and to determine whether treatment stratification would improve the event-free survival (EFS) for high-risk patients and maintain excellent EFS for the lower-risk patients. PATIENTS AND METHODS: Risk stratification was performed by age, MYCN gene copy number, Shimada histopathologic classification, and serum ferritin level. Lower-risk patients were treated on the less intensive Children's Cancer Group (CCG)-3881, whereas high-risk patients were treated on CCG-3891, which included more intensive multimodality therapy and, in some cases, autologous bone marrow transplantation (ABMT). RESULTS: Of 228 Evans stage III patients entered onto the study, 92% also met the definition of International Neuroblastoma Staging System (INSS) stage 3. One hundred forty-three patients met the lower-risk criteria, which included 89 patients less than 1 year of age and 54 patients 1 year of age or greater, and favorable biology, whereas 85 patients were 1 year of age or greater and biologically unfavorable. Biologically unfavorable patients 1 year of age or greater who underwent gross surgical resection had improved survival, whereas the outcome of infants or biologically favorable older patients did not change according to resection. The EFS rate at 4 years was 100% for the patients with favorable biology of any age, 90% for those less than 1 year of age but with at least one unfavorable characteristic, and 54% for Evans stage III patients 1 year of age or greater with unfavorable biology. Age, ferritin level, MYCN copy number, Shimada histopathology, primary site, and intraspinal extension were significant univariate prognostic factors for all patients, but only MYCN copy number and age were independent factors in multivariate analyses. CONCLUSION: The excellent survival of the biologically favorable group and the historically improved EFS of the biologically unfavorable group suggest that biologic staging should be used to define the prognosis and treatment of stage III neuroblastoma.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2002

Testing the requirements of stages of physical activity among adults: the comparative effectiveness of stage-matched, mismatched, standard care, and control interventions.

We tested the comparative efficacy of 4 interventions to increase the physical activity behavior of college personnel randomly assigned to one condition (N = 196, 74% female, M age = 43.4 years) for 16 weeks. Stage-matched and mismatched interventions were developed based on the stages of change from the Transtheoretical Model and were contrasted with standard care (action-oriented) and control interventions to test the requirements of a true stage behavior. Repeated measures of multivariate analyses of covariance indicated that the stage-matched and standard care interventions resulted in greater levels of both total and lifestyle physical activity compared with the mismatched and control interventions. The results supported the requirements of a stage behavior as defined by Weinstein, Rothman, and Sutton and the superiority of the stage-matched intervention versus the mismatched intervention. However, the standard care intervention performed as well as the matched intervention, suggesting the need for further investigation. The results are discussed with respect to the high proportion of individuals in the action-oriented stages and previous research findings in the smoking literature.

Adult↗

PubMed1990

Regulation of insulin-like growth factor I and stage-specific levels of epidermal growth factor in stage synchronized rat testes.

Stage synchronization of seminiferous epithelium after withdrawal and replenishment of vitamin A provides a valuable and powerful approach to the investigation of paracrine interactions within the testis. However, since the discovery of this model, little attention has been given to the events surrounding the synchronous reinitiation of spermatogenesis after depletion of vitamin A. Synchronization of spermatogenesis was observed in all animals previously deficient in vitamin A. However, the degree of synchrony observed, as assessed by a ratio of synchrony, decreased markedly with time. The possibility that spermatogenic synchrony decreases with time due to variability of the temporal duration of stages of the cycle of the seminiferous epithelium is supported by this observation. However, long-term studies are required to substantiate this point. After initiation of stage synchrony of spermatogenesis, increased testicular concentrations of epidermal growth factor (EGF) were observed in testes synchronized between stages IX-II than at other stages of the cycle of the seminiferous epithelium. This elevation in testicular EGF concentrations correlated well with mitotic division of type A spermatogonia at stages IX, XII, and XIV of the cycle of the seminiferous epithelium. Previous in vitro studies have implicated an EGF-like factor in the stimulation of type A spermatogonial division in the mouse. A significant increase in testicular insulin-like growth factor I (IGF-I) concentrations was observed in control animals 14 days after the injection of retinol acetate. In vitamin A deficient animals, a marked increase in testicular IGF-I concentrations was observed as compared to age-matched controls. Maximal levels of testicular IGF-I concentrations were present 14 and 28 days and again 126 days after re-supplementation with retinol acetate. No stage dependent changes in testicular IGF-I were observed but the data provided suggest the retinol may be one of the factors involved in the regulation of testicular IGF-I.

Aging↗

PubMed2006

Influence of developmental stage on sensitivity to ammonium nitrate of aquatic stages of amphibians.

In static renewal experiments, we studied how developmental stage influences the effect of ammonium nitrate on embryonic and larval stages of anuran amphibians. The observed lethal effects caused by ammonium nitrate increased with both concentration and duration of exposure. Significant differences were observed in sensitivity to ammonium nitrate as a function of developmental stage in Discoglossus galganoi, Pelobates cultripes, and Bufo calamita. In D. galganoi and P. cultripes, younger individuals displayed greater acute effects from the chemical fertilizer compared with older individuals. For example, 100% of P. cultripes hatchlings died after 4 d of exposure to a nominal concentration of 225.8 mg N-NO3NH4/L, whereas less than 40% of individuals from older larval stages died when exposed to this concentration. A delay of 4 d in the beginning of the exposure to the chemical was enough to cause significant differences in sensitivity. Bufo calamita showed a higher sensitivity in later larval stages after 12 d of exposure. Hyla meridionalis and B. calamita were less sensitive than the other two species. Peak ammonium nitrate concentrations usually occur when amphibians are breeding and, thus, when the most sensitive aquatic stage is in the water. The developmental stage of the test animals should be considered when evaluating the risk of ammonium nitrate to amphibians.

Animals↗

PubMed2005

Preliminary use of a hydrogel containing enzymes in the treatment of stage II and stage III pressure ulcers.

Considerable progress has been made in the prevention and treatment of pressure ulcers but they remain a significant healthcare problem, particularly among the elderly. Treatment may include the use of wound dressings such as hydrogels as well as debridement products that contain relatively high concentrations of various enzymes. Unlike enzymes found in debridement products, low concentrations of endopeptidase enzymes can cleave to denatured proteins. Many endopeptidases have been reported to enhance the healing process. To evaluate the effect of a hydrogel wound dressing containing a combination of endopeptidases on pressure ulcers, a 12-week prospective preliminary study was conducted involving 10 nursing home patients with Stage II (n = 3) or Stage III (n = 7) ulcers that had failed to respond to previous treatments. Seven subjects (three with Stage II ulcers and four with Stage III ulcers) completed the study. Healing was based on wound closure by re-epithelialization as determined by area measurement and clinical assessment. All three Stage II ulcers and two of the Stage III ulcers healed completely; four Stage III ulcers were categorized as healing (>60% improvement) after 12 weeks of care. No dressing-related adverse events occurred and subject acceptance of the product, including comfort, was high. These results suggest that additional studies designed to define the possible contribution of endopeptidase enzymes in wound healing are warranted.

Aged↗

PubMed1987

Hybridoma antibody characterization of stage-specific and stage-cross-reactive antigens of Eimeria tenella.

Hybridoma antibodies (HAb) have been raised against the sporozoite stage of 3 species of avian coccidia. These HAb were utilized in Western blot analysis, resulting in the immunoenzymatic detection of sporozoite and merozoite antigens of 1 species, Eimeria tenella. The 5 HAb specific for the sporozoite stage showed either single bands at 22 and 28 kDa or a large diffuse band in the 7-10-kDa range. The 4 HAb that cross-reacted with both asexual stages recognized either a single sporozoite or merozoite antigen of 90 kDa, or multiple antigens (47-69 kDa) for both stages. The 9 HAb demonstrated 5 different immunofluorescent antibody (IFA) patterns, and the 4 cross-reactive HAb showed similar IFA patterns with both asexual stages of E. tenella. The sporozoite-specific HAb which identified the 22, 7-10, and 7-8 kDa antigens showed surface, surface-internal, or internal IFA patterns. The other sporozoite-specific HAb, which labeled the 28-kDa antigen, stained the refractile body. The IFA of the 4 stage-cross-reactive HAb, which recognized the 45-60-kDa and the 90- or 47-69-kDa antigens, localized these antigens to the surface and tip, respectively. Rabbit anti-sporozoite serum appeared to recognize all of the sporozoite and merozoite antigens identified by the HAb as well as a variety of additional stage-cross-reactive antigens.

Animals↗

PubMed1985

One-stage versus two-stage bilateral autophor ceramic total hip arthroplasty.

Noncemented autophor ceramic total hip arthroplasty (ACTHA) has been developed in recent years for treatment of advanced hip diseases. Bilateral ACTHAs were routinely performed in two operations at a four- to six-month interval. There have been no reported series of one-stage bilateral ACTHAs. In this retrospective study, the authors compared 20 patients who had bilateral one-stage ACTHAs with 15 patients who had similar bilateral arthroplasties in two stages. The study revealed no significant differences in estimated intraoperative blood loss, postoperative hemovac drainage, total amount of blood transfusion, intra- or postoperative complications, or postoperative functional results in the two groups. There was no difference in achieving prosthesis stability by interface bone growth, in spite of a significant difference in weight-bearing status during the immediate postoperative period. The one-stage bilateral procedure, however, offered advantages over two-stage bilateral procedures, including shorter length of hospital stay (18 days versus 27 days), shorter operative time (148 minutes versus 245 minutes), shorter period of disability (86 days versus 202 days), and reduced economic costs (about 10% less). There was no increase in the risk of morbidity or mortality in the one-stage bilateral group. In selected cases, one-stage bilateral ACTHA would be preferable.

Adult↗

PubMed1995

Changes in mosquito populations with expansion of the Ross River Reservoir, Australia, from stage 1 to stage 2A.

Female mosquitoes were collected at 4 sites around the Ross River reservoir (Stage 2A) from 484 carbon dioxide-supplemented light traps. The seasonal abundance from these collections during 1991-93 was compared statistically with that for similar collections done for the Stage 1 reservoir in 1984-85. Principally due to clearing of the forest prior to the inundation of the Stage 2A, several tree hole/plant axil and shaded pool species are no longer present or are rare. Due to extensive loss of marginal emergent vegetation and creation of expanses of shallow muddy pools, mean number per trap of Anopheles amictus and Aedes normanensis increased up to 36- and 282-fold, respectively, from Stage 1 to 2A. For Culex annulirostris, mean abundance did not exceed densities recorded for Stage 1. However, from examination of trends from 1991 to 1993, mean catches of Culex, Anopheles spp., and Mansonia uniformis were increasing despite the progressive reduction of the inundated area of the reservoir. Cluster analysis of species abundance indicated broad similarities with Stage 1 data, and differences in faunal composition of the reservoir area compared with that around Townsville. In view of the continuing stabilization of the Stage 2A reservoir area, continued surveillance of major vector species is recommended.

Animals↗

PubMed1993

Proposed 'World Health Organization staging system for HIV infection and disease': preliminary testing by an international collaborative cross-sectional study. The WHO International Collaborating Group for the Study of the WHO Staging System.

OBJECTIVE: To evaluate a universally applicable staging system for HIV infection and disease proposed by the Global Programme on AIDS (GPA) of the World Health Organization (WHO). The system consists of both a 'clinical' and a 'laboratory' axis. The 'clinical axis' is represented by a sequential list of clinical conditions believed to have prognostic significance, which subdivides the course of HIV infection into four clinical stages. The 'laboratory axis' subdivides each clinical stage into three strata according to CD4+ cell or total lymphocyte count. DESIGN: International cross-sectional study. SETTING: Twenty-seven clinical centres in 20 countries. PATIENTS AND PARTICIPANTS: A total of 938 confirmed HIV-positive patients, aged at least 13 years. MAIN OUTCOME MEASURES: Presence of the clinical condition belonging to the highest stage and its correlation with recent laboratory data (CD4+ cell counts, total lymphocyte counts, beta 2-microglobulin levels, haemoglobin, haematocrit, erythrocyte sedimentation rate, p24 antigen, p24 antibody and delayed hypersensitivity skin test). RESULTS: There was general agreement between the proposed attribution of clinical conditions and the corresponding laboratory markers. Significant differences were observed between stages 3 and 4 for seven laboratory markers and between stages 2 and 3 for six, but not between stages 1 and 2, for any of the nine laboratory markers. CONCLUSIONS: Longitudinal studies are needed to assess whether the proposed system is useful in predicting survival time in patients with HIV disease.

Adolescent↗

PubMed1993

Independent regulation of two cytoplasmic processing stages of the intermediate filament-associated protein filaggrin and role of Ca2+ in the second stage.

One of the final events in cornification of epidermal cells is processing of profilaggrin to the keratin-associated protein filaggrin. Processing involves several proteolytic events and occurs in two discrete proteolytic stages (Resing, K. A., Walsh, K. A., and Dale, B. A. (1984) J. Cell Biol. 99, 1372-1378; Resing, K. A., Walsh, K. A., Haugen-Scofield, J., and Dale, B. A. (1989) J. Biol. Chem. 264, 1837-1846). In a keratinocyte cell line derived from newborn rat epidermis, these two stages are independently regulated. Profilaggrin was expressed when the cells reached confluence; processing to intermediates began 24-36 h later (stage one), with filaggrin appearing at 48 h (stage two). Stage two processing required calcium in the medium with maximum processing occurring at 5-10 mM. Furthermore, stage two processing was inhibited by nifedipine, a calcium channel blocker, suggesting that calcium influx activates this event. Second-stage processing was also inhibited by the protease inhibitor leupeptin, implicating calpain. Confluent cells had higher levels of calpain I than subconfluent cells; in confluent cells, two immunoreactive bands were detected, comigrating with inactive (80 kDa) and activated (78 kDa) calpain I. In cells processing profilaggrin, most of the calpain I was in the 78-kDa form, implying extensive activation, supporting a role for calpain in processing.

Animals↗

PubMed1998

Distinct stage-specific cis-active transcriptional mechanisms control expression of T cell coreceptor CD8 alpha at double- and single-positive stages of thymic development.

Developing thymocytes that give rise to CD8+ (cytotoxic) and CD4+ (helper) alpha beta-TCR T lymphocytes go through progressive stages of expression of coreceptors CD8 and CD4 from being negative for both (the double-negative stage), to coexpressing both (the double-positive (DP) stage), to a mutually exclusive sublineage-specific expression of one or the other (the single-positive (SP) stage). To delineate the mechanisms underlying regulation of CD8 during these developmental transitions, we have examined expression of a series of mouse CD8 alpha gene constructs in developing T cells of conventional and CD8 alpha "knock-out" transgenic mice. Our results indicate that cis-active transcriptional control sequences essential for stage- and sublineage-specific expression lie within a 5' 40-kb segment of the CD8 locus, approximately 12 kb upstream of the CD8 alpha gene. Studies to characterize and sublocalize these cis sequences showed that a 17-kb 5' subfragment is able to direct expression of the CD8 alpha gene up to the CD3intermediate DP stage but not in more mature DP or SP cells. These results indicate that stage-specific expression of CD8 alpha in developing T cells is mediated by the differential activity of multiple functionally distinct cis-active transcriptional control mechanisms. It will be important to determine the relationship of "switching" between these cis mechanisms and selection.

Animals↗

PubMed1978

Anatomical substages of stage III Hodgkin's disease: implications for staging, therapy, and experimental design.

Twenty-three patients with pathologic stage III Hodgkin's disease were classified with respect to the presence or absence of symptoms (III-A, III-B), the presence or absence of splenic involvement (IIIS+, IIIS-) and anatomic substage--the extent of disease within the abdomen (III1, III2). Stage III1 disease included disease limited to the upper abdomen, i.e., spleen, splenic node, celiac node, and/or portal node. All other more extensive disease was classified as stage III2. Symptoms and splenic involvement did not predict either disease-free survival or survival. However, 5 year actuarial disease-free survival was significantly better in III1 patients as compared to III2 patients (77% vs. 13%, p less than .001). Eight of nine stage III2 patients receiving total nodal radiotherapy alone relapsed. When considered along the previous studies of anatomic substage, these findings suggest that patients in stage III1 and III2 should receive different therapeutic approaches. Analysis of therapeutic results in stage III patients must consider anatomic substage.

Abdomen↗

PubMed1984

Stage Ib, IIa, and IIb cervix cancer, postsurgical staging, and prognosis.

Two hundred fifty-five cases of International Federation of Gynecology and Obstetrics (FIGO) Stage Ib, IIa, and IIb cases of cervical cancer were analyzed following radical surgery with regard to the extent of invasion into vagina, parametria, and pelvic lymph nodes. Restaging was carried out based on the findings. Discrepancies were found between FIGO stages and the actual extent of the disease, particularly in Stage IIb. Among 99 cases of Stage IIb, only 42.4% were correctly staged. The 5-year disease-free survival by FIGO and postsurgical stagings were, respectively: Ib, 88.4% and 87.0%; IIa, 85.2% and 95.0%; IIb, 70.7% and 62.3%. Prognostic significance in the pathologic examination of operated materials was demonstrated when there were deep stromal invasions of cancer cell or parametrial invasions or pelvic lymph node metastases. When cancer was present in both of the parametrium and pelvic lymph nodes, the prognosis of the patient worsened (5-year survival rate, 41.4%).

Adenocarcinoma↗

PubMed1985

Laparotomy-staged IA versus IIA Hodgkin's disease. A comparative study with evaluation of prognostic factors for stage IIA disease.

Ninety-one laparotomy-staged (LAP) IA and IIA Hodgkin's disease (HD) patients were analyzed to evaluate the prognostic significance of stage, mediastinal status, extranodal disease and histology. Forty IA patients were treated with radiotherapy (XRT) only; of 51 IIA patients, 44 received XRT only and 7 had additional chemotherapy. Disease-free survival (DFS) at 5 and 10 years was 81% and 70%, respectively, with overall survival (S) of 93% and 86%, respectively. Disease-free survival for IA patients (93% at 5 and 10 years) was significantly superior to IIA (73% at 5 years, 52% at 10 years). Survival differences were not statistically significant. For IIA patients receiving XRT only, large mediastinal disease was an adverse factor for DFS. Small mediastinal disease in IIA was significantly better than no mediastinal disease. For the whole group of LAP IA and IIA treated by XRT only, three prognostic groups were identified: (1) Stage IA and Stage IIA with mediastinal disease, but less than 7.5 cm in width was highly favorable with less than 10% relapse; (2) Stage IIA nonmediastinal had an intermediate prognosis with relapse in about 33%; (3) Stage IIA large mediastinal (greater than or equal to 7.5 cm) had an unfavorable DFS with relapse in about 55%. The third group contained a highly unfavorable subset with mediastinal masses greater than 10 cm, all of whom relapsed. Salvage therapy was successful in 60% of relapsing patients. In the context of relatively effective salvage therapy, the role of adjuvant chemotherapy in adverse prognostic groups is discussed and it is concluded that the only clearly justifiable use for adjuvant chemotherapy is in patients with massive (greater than 10 cm) mediastinal adenopathy.

Adult↗