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PubMed1995

Prognostic factors predictive of survival for truncal and retroperitoneal soft-tissue sarcoma.

OBJECTIVE: The authors identified prognostic factors relevant to clinical outcomes (especially survival) in truncal and retroperitoneal soft-tissue sarcoma. SUMMARY BACKGROUND DATA: These results can be used to optimize surgical management and select patients most likely to benefit from novel therapeutic strategies in future trials. METHODS: A retrospective analysis was performed of a prospectively compiled database of 183 consecutive patients with truncal and retroperitoneal sarcomas seen at the Brigham and Women's Hospital and the Dana Farber Cancer Institute between 1970 to 1994. RESULTS: For truncal sarcoma, multivariate analysis showed that high-grade histology was associated with an eightfold increased risk of death compared with low-grade histology (p = 0.001). In addition to grade, gross positive margin of resection (p = 0.001), microscopic positive margin (p = 0.023), and tumors greater than 5 cm in size (p = 0.018) were important independent prognostic factors for survival. In this series, postoperative radiation therapy for truncal sarcoma was associated with a 2.4-fold decreased risk of death compared with truncal sarcoma patients receiving no adjuvant radiation therapy, having adjusted for the other prognostic factors (p = 0.030). In contrast, for retroperitoneal sarcoma, multivariate analysis showed that high-grade and intermediate-grade histology were associated with a five- to sixfold increased risk of death compared with low-grade histology (p = 0.009). In addition to grade, gross positive margin of resection (p = 0.001) and microscopic positive margin (p = 0.004) were important independent prognostic factors for survival in retroperitoneal sarcoma. Patients who received either preoperative or postoperative chemotherapy for retroperitoneal sarcoma had a 4.6-fold (p = 0.002) and 3-fold (p = 0.010) increased risk of death, respectively, compared with patients receiving no adjuvant chemotherapy, having adjusted for the other prognostic factors. CONCLUSIONS: The histologic grade and the margin of resection are prognostic for survival in both truncal and retroperitoneal soft-tissue sarcoma. Tumor size was an independent prognostic factor for truncal sarcoma, but not for retroperitoneal sarcoma. Postoperative adjuvant radiation was beneficial to overall survival for truncal sarcoma. In this series of patients receiving a heterogeneous mixture of chemotherapeutic regimens-either as preoperative "neoadjuvant" therapy or as postoperative "adjuvant" therapy, there were no beneficial effects on survival compared with nonrandomized patients not receiving chemotherapy.

Adult↗

PubMed2006

Prognostic factors for progression of childhood optic pathway glioma: a systematic review.

A systematic literature review was carried out to evaluate best existing evidence on prognostic factors for progression of childhood optic pathway glioma. Databases were searched for relevant articles and articles selected independently by two authors. Information about study design, population, treatment, outcome and prognostic analysis were abstracted and the quality of each article was assessed. A total of 23 articles met the inclusion criteria. Many studies had important methodological limitations, regarding external and internal validity. Eleven studies evaluated possible prognostic factors in a multivariate analysis. Three high-quality studies indicated age<1 year as an independent prognostic factor for a worse progression-free survival. Three studies with multivariate analysis, including one high-quality study, found that children with neurofibromatosis type 1 (NF-1) have a better progression-free survival than those without NF-1. Two studies with multivariate analysis found tumour site to be a prognostic factor, both with some methodological limitations. In conclusion, this systematic review demonstrates that only a few of the prognostic factors proposed have been proven to be clinically relevant. Age<1 year is a clear and independent prognostic factor for progression-free survival. Other prognostic factors, such as NF-1, tumour site and others, are suggested, but are still without solid evidence and need further high-quality studies to be clearly proven.

Disease Progression↗

PubMed1990

Blood analyses as prognostic factors in primary lung cancer.

The prognostic value of some pretreatment blood tests was analysed in a follow-up study of 189 patients with non-small cell lung cancer diagnosed in West-Norway between 1976 and 1985. At diagnosis 100 patients had stage III/IV disease. Five-year survival calculated with the life-table method was 12%. In univariate survival analyses significant prognostic factors were stage III/IV disease, weight loss, elevated lactate dehydrogenase, gamma glutamyl transferase, erythrocyte sedimentation rate and alkaline phosphatase, thrombocytosis, leukocytosis and anaemia. In multivariate survival analyses with the Cox's regression model stage III/IV disease, elevated lactate dehydrogenase, thrombocytes and erythrocyte sedimentation rate were significant prognostic factors. It is concluded that these blood analyses at diagnosis in non-small cell lung cancer patients may give additional prognostic information. The need for multivariate analyses is also demonstrated.

Adult↗

PubMed1990

[Evaluation of prognostic factors in early lung cancer].

We evaluated the prognostic factors in 52 cases of resected early lung cancer: hilar early lung cancers 9 cases and peripheral early lung cancers 43 cases. All hilar lesions were squamous cell carcinoma, and peripheral lesions were adenocarcinoma (31 cases), squamous cell carcinoma (10 cases), large cell carcinoma (2 cases) and carcinoid (1 case). No relapse was found in hilar lesions, but 7 relapses and 5 deaths were found in peripheral lesions. Prognostic factors were examined in these cases. Location of lung cancer (hilar or peripheral) was found to be important in early lung cancer. In addition, age was a significant prognostic factor in peripheral early lung cancer with multivariate analysis. No other significant factor was found in our cases. Twelve out of 52 cases with lung cancer had other malignancies after or before operation. These were cancers of second primary lung, colo-rectal, uterus, stomach, breast, thyroid, liver and malignant melanoma. Therefore, we have to carefully observe other parts even after resection of early lung cancer.

Adenocarcinoma↗

PubMed2000

[Multivariate analysis of prognostic factors in renal cell carcinoma].

OBJECTIVE: To assess the effect of prognostic factors on renal cell carcinoma (RCC). METHODS: 316 cases of RCC were reviewed retrospectively. Their survival rates were calculated by Kaplan-Meier method and statistical differences were determined by Log-rank test. Significant prognostic factors were evaluated by Cox's multivariate proportional hazard model. RESULTS: After 40.3 +/- 18.5 month follow-up, the overall 5-year survival rate was 62.3%. By multivariate analysis, nine factors were included in Cox's multivariate proportional hazard model. M was the most important prognostic factor in RCC (P = 0.0013), and the others in turn were T (P = 0.0182), age (P = 0.0347), performance status (P = 0.0423), N (P = 0.0471), lymphadenectomy (P = 0.0542), grade (P = 0.0775), serum albumin (P = 0.1536), and serum creatinine (P = 0.4543). CONCLUSIONS: The significant prognostic factors in RCC were T, N, and M. Age and performance status showed the effect on prognosis of RCC. Lymph-node dissection also revealed a meaningful effect on relative lower stage of RCC.

Adult↗

PubMed1993

Multivariate analysis of prognostic factors in patients with non HIV-related primary cerebral lymphoma. A proposal for a prognostic scoring.

Between 1982 and 1991, 41 patients were treated for non HIV related primary cerebral lymphoma (PCL) in our institute. The purpose of this study was to perform a multivariate analysis of prognostic factors for survival in these patients. The presence of a CSF protein level over 0.6 g l-1 at diagnosis was found to be the most significant unfavourable prognostic factor in univariate analysis and had not previously been reported. Among the five significant prognostic factors at diagnosis, (age over 60 years, performance status--ECOG scale--over 2, memory dysfunction, non hemispheric tumour site, CSF protein level over 0.6 g l-1 at the diagnosis), three independent factors were identified in multivariate analysis: (1) CSF protein level (P = 0.007; RR = 4.7); (2) PS > 2 (P = 0.04, RR = 2.65); (3) age over 60 (P = 0.08; RR = 2.43). Using the regression coefficient of these three parameters, we determined a prognostic index which allowed us to distinguish three risk groups whose theoretical median survival is 4, 20 and 54, months respectively in patients with non HIV related PCL. These results indicate that PCL is an heterogeneous disease in terms of the prognostic in which three subgroups with discriminant survival can be identified.

Adolescent↗

PubMed2006

Vascular endothelial growth factor (VEGF): can we use it as prognostic factor in endometrial cancer?

AIM: The aim of the study was to investigate if VEGF levels reflect the severity of endometrial cancer and the clinic relationship between microvasal density (MVD) and concentration of VEGF in tumor. METHODS: The study was conducted on 22 patients affected by endometrial cancer who were submitted to total abdominal radical hysterectomy plus bilateral salpingo-ophorectomy. VEGF (pg/mL) and MVD values were measured on histologic specimens of endometrial cancer obtained during the surgical treatment. The means and standard deviations of estimated values were calculated and a statistical comparison was effected by student t test for not coupled data. Pearson correlation test was used to analyze the eventual correlation among VEGF and MVD values in overall patients. RESULTS: We have documented that VEGF expression and MVD change according to FIGO stage, lympho-vascular infiltration and lymph node involvement. Pearson correlation test shows a good linear positive correlation in overall patients between VEGF and MVD values. CONCLUSIONS: Results obtained show a possible use of VEGF as prognostic factor in endometrial cancer. Confirmation of these data may permit both to identify high-risk patients, who must be treated with a more aggressive treatment, and to use an angiogenic therapy in endometrial cancer.

Adenocarcinoma↗

PubMed2001

Tissue factor expression in coronary circulation as a prognostic factor for late restenosis after coronary angioplasty.

We investigated changes in blood coagulation in the coronary circulation after percutaneous transluminal coronary angioplasty (PTCA) and its clinical significance. We examined 43 patients with ischemic heart disease who underwent elective PTCA of isolated stenotic lesions in the left coronary artery. Ten patients underwent PTCA alone, 15 received percutaneous transluminal rotational atherectomy (PTRA) and 18 stent implantation. Blood samples were drawn from the coronary sinus before and immediately after PTCA, as well as 4 and 24 h later. Plasma levels of tissue factor (TF), thrombin-antithrombin III complex (TAT) and prothrombin fragment 1+2 (F 1+2) were measured by enzyme-linked immunosorbent assay. Follow-up coronary angiography was performed 6 months after PTCA. Minimal luminal diameter was assessed by quantitative coronary angiography to evaluate late loss index. TF, TAT and F 1+2 levels in the coronary sinus blood showed significant increases 24 h after PTCA. A significant positive correlation was found between changes in TF levels 24 h after PTCA and late loss index 6 months after the procedure. TF levels in the coronary sinus blood were significantly higher in patients with late restenosis than in those without restenosis. These results suggest that TF expression in the coronary circulation after PTCA is a prognostic factor for late restenosis.

Adult↗

PubMedDate not supplied

General and specific prognostic factors of early gastric carcinoma treated with curative surgery.

BACKGROUND/AIMS: In Western countries as well as in Japan, the percentages of early gastric cancer (EGC) have been increasing. This study was performed to clarify the general and specific prognostic factors of EGC. METHODOLOGY: General prognostic factors were evaluated in 601 EGC patients treated with curative surgery, including those who died of unrelated causes, and specific prognostic factors were evaluated in 471 EGC patients, excluding those dying of unrelated causes, using univariate and multivariate analysis. RESULTS: The overall 5- and 10-year survival rates in the EGC patients were 86.7% and 76.6% respectively. In all 601 patients, including those who died of other causes, general prognostic factors, according to multivariate analysis, were sex, age, primary malignant diseases other than the original EGC, depth of invasion, and lymph node metastasis. The specific prognostic factor was lymph node metastasis with a risk ratio of 18.6-fold against patients without lymph node metastasis, according to multivariate analysis. CONCLUSIONS: The worst prognostic factors in all EGC patients were male sex, age 60 years and over, presence of primary malignant disease other than original EGC, submucosal cancer, and lymph node metastasis. Lymph node metastasis was specifically related to EGC recurrence. Thus, lymph node dissection is indispensable for the treatment of early gastric cancer, and the surveillance of other organs or the residual stomach for primary malignancy is particularly important after surgery.

Adenocarcinoma↗

PubMed1998

[Prognostic factors in stomach carcinoma].

The classical prognostic factors of the pTNM system are still most valid. Nevertheless, vascular invasion as well as the molecular marker E-cadherin proved to be independent new prognostic factors responsible for a significant shift in patient survival. Thus, in pTNM-stage II patients, a highly significant drop in survival is observed when patients showing no E-cadherin expression and at the same time vascular invasion are compared with E-cadherin-positive patients who do not show vascular invasion (Fig. 11). These conspicious shifts in survival underline the necessity to continue our search for new molecular and non-molecular markers which in future may help us to predict the outcome of gastric cancer patients more precisely and more individually.

Antigens, CD↗

PubMed1990

[Kaposi's sarcoma associated with the acquired immunodeficiency syndrome. An analysis of 67 cases with a study of the prognostic factors].

The features and prognostic factors of 67 cases of Kaposi's sarcoma (KS) associated to the acquired immunodeficiency syndrome (AIDS) diagnosed at the Hospital Clinic, Barcelona, are analyzed. All the patients were male; mean age was 39.7 years, ranging from 22 and 62 years. 64 were homosexuals (95.5%), two were homosexual-drug addicts (3%) and one was drug addict (1.5%). Prevalence of cytomegalovirus and herpes virus infections were 91.1% and 89.5% respectively. In 42 cases (62.7%) KS was the initial AIDS presentation. The most common localization was the skin (89.5%), followed by the digestive tract (52.2%) and the lymph nodes (22.4%). Staging distribution was: 20 patients (29.8%) were in stage I, 11 patients (16.4%) in stage II, 7 patients (10.4%) in stage III, and 29 patients (43.2%) in stage IV. Constitutional symptoms associated to KS were found in 37 patients (55%). Overall 39 patients have already died, and the actuarial survival possibility of these 67 cases was 55% after 12 months. Univariant statistical analysis showed the presence of six variables with prognostic significance (p less than 0.05): staging, symptomatology, total white blood count, total lymphocyte count, T helper lymphocyte count and hemoglobin. Multivariant statistical analysis only chose the staging and symptomatology variables as independent (p less than 0.01 and p less than 0.001, respectively).

Acquired Immunodeficiency Syndrome↗

PubMed1995

Prognostic factors and risk group analysis in follicular carcinoma of the thyroid.

BACKGROUND: The understanding of prognostic factors has facilitated stratification of risk groups in differentiated carcinoma of the thyroid. The prognostic factors have clearly identified the risk groups as low, intermediate, and high risk. Risk group categorization has facilitated a selective surgical approach for thyroid carcinoma. METHODS: A retrospective review of 228 patients with follicular carcinoma of the thyroid was undertaken. Various prognostic factors and risk groups were analyzed. Univariate and multivariate analyses were performed, and the survival curves were plotted by the Kaplan-Meier method. Fifty-nine (26%) patients presented with Hürthle cell histology. The risk groups revealed 62 patients in the low, 84 in the intermediate, and 82 in the high risk groups. RESULTS: The 10-year survival for low, intermediate, and high risk groups was 98%, 88%, and 56%, respectively, and the 20-year survival for the same groups was 97%, 87%, and 49%, respectively. Adverse prognostic factors included age older than 45 years (p < 0.001), Hürthle cell variety (p = 0.05), extrathyroidal extension, tumor size exceeding 4 cm, and the presence or absence of distant metastasis (p < 0.001). Gender, focality, and presence of lymph node metastasis had no significant impact on prognosis. CONCLUSIONS: Patients in the low risk group have excellent survival, whereas the high risk group behaves poorly. Appropriate selection of treatment for the primary disease and adjuvant therapy should be considered on the basis of the prognostic factors and risk group analysis.

Adenocarcinoma, Follicular↗

PubMed2006

Lateral tympanoplasty for total or near-total perforation: prognostic factors.

OBJECTIVE: To identify prognostic factors affecting outcome in lateral tympanoplasty for total or near-total tympanic membrane perforation. STUDY DESIGN: Retrospective case series. METHODS: Patients were those presenting with total or near-total tympanic membrane perforation undergoing lateral tympanoplasty from 1999 to 2004. We systematically collected demographic, clinical, audiologic, and outcome information. Student t test was used to determine group differences. Logistic regression analysis was used to examine the relationship between success of grafting (dependent variable) and the independent variables. Multiple regression analysis was used to examine the relationship between postoperative air-bone gap (ABG) and independent variables. RESULTS: There were seventy-seven cases (58 primary and 19 revision cases) with average follow-up of 17 months. Successful tympanic membrane grafting occurred in 91% of cases. None of the independent variables studied was predictive of the success of graft incorporation (P > .05). The mean preoperative ABG was 29.8 +/- 10 dB and improved to a postoperative ABG of 16.5 +/- 11 dB (P < .001). Smaller preoperative ABG and normal malleus handle were associated with smaller postoperative ABG. In revision cases, mastoidectomy was associated with better functional results. CONCLUSIONS: Successful grafting of near-total and total tympanic membrane perforations occurred in 91% of the cases and was independent of demographic, disease, and technical variables. Disease variables (preoperative ABG and status of malleus handle) had a greater prognostic value on postoperative ABG than other variables. In revision tympanoplasty, mastoidectomy is associated with a better functional outcome.

Adolescent↗

PubMedDate not supplied

Survival and prognostic factors in thyroid carcinoma.

A multivariate analysis of prognostic factors and survival was carried out in a series of 200 patients with thyroid carcinoma. The cumulative survival rate corrected for intercurrent deaths was higher for papillary carcinoma than for follicular carcinoma both at 5 years (92% vs 74%) and at ten years (87% vs 66%) after the diagnosis. Seventeen of the eighteen patients with anaplastic carcinoma died within 24 months after the diagnosis. The most important independent prognostic factor in patients with papillary or follicular carcinoma, by multivariate analysis, was age at time of diagnosis, followed by tumor penetration beyond the thyroid capsule and follicular histologic type. When different types of treatment were included in the analysis, age at diagnosis still remained the most important prognostic factor. Misdiagnosed intercurrent deaths in the elderly did not explain the negative effect of age on survival.

Adenocarcinoma↗

PubMed1996

Initial prognostic factors in small-cell lung cancer patients predicting quality of life during chemotherapy. Swiss Group for Clinical Cancer Research (SAKK).

The question of whether initial prognostic factors in small-cell lung cancer patients have a predictive value for patients' quality of life (QL) during chemotherapy is addressed in the context of a randomised clinical trial comparing early and late alternating chemotherapy (SAKK protocol 15/84). The relative impact of initial tumour stage and performance status, previous weight loss, sex and age on patient-rated QL was analysed over six chemotherapy cycles in 124-130 patients (according to available QL data) with more than 400 questionnaires. Fatigue/malaise, personal functioning, emotional and general well-being were prospectively selected as QL indicators. Predefined summary measures (average QL score over chemotherapy cycles, 'minimum', 'maximum' and 'final' improvement) were analysed separately by scale in various patient groups. General linear models adjusted for treatment arm and response were used to confirm the univariate findings. Within the overall sample, the average QL scores over six cycles were predicted by initial prognostic factors. Patients with poor prognostic factors reported worse QL. Within a limited sample (with baseline QL), patients with poor prognostic factors reported worse QL at baseline and greater improvement under treatment. Graphical comparison of QL patterns over cycles showed permanent discrimination by levels of prognostic factors. The impact of initial prognostic factors was consistently confirmed in the three analyses. Levels of performance status and weight loss best discriminated QL. Initial tumour stage, performance status and previous weight loss can predict QL in small-cell lung cancer during chemotherapy, even after controlling for response to treatment. Our results may contribute to clinical decision-making with regard to the intensity of chemotherapy and QL outcome, especially in patients with extensive disease.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2006

Prognostic factors for pulmonary metastasectomy in hepatocellular carcinoma.

PURPOSE: To identify the prognostic factors for pulmonary metastasectomy (PM-ectomy) in hepatocellular carcinoma (HCC). PATIENTS AND METHODS: We conducted a retrospective review of patients with pulmonary metastases (PM) from HCC who had undergone curative PM-ectomy at National Taiwan University Hospital between 1990 and 2004. Univariate (log-rank) and multivariate (Cox's model) analyses of survival were used to identify the significant prognostic factors. RESULTS: In total, 34 patients were eligible for curative PM-ectomy. The overall survival rates (Kaplan-Meier) after PM-ectomy were 65.2% and 27.5% at 2 and 5 years, respectively. High alpha-fetoprotein level, positive hepatic resection margin, and short disease-free interval (DFI) were unfavorable factors for overall survival from univariate analysis, however, only DFI (P = 0.028) was identified as an independently prognostic factor by multivariate analysis. Bilateral distribution and more PMs were unfavorable factors for PM-free survival from univariate analysis, with only PM number identified as an independent prognostic factor by multivariate analysis (P = 0.017). CONCLUSION: Patients with longer DFIs and fewer PMs can benefit from PM-ectomy in HCC.

Adult↗

PubMed1985

Longitudinal studies of drug abuse in a fifteen-year-old population. 5. Prognostic factors.

In an attempt to identify prognostic factors, non-drug users and abusers in the Gothenburg year cohort of 1953 were compared with reference to background data. Individuals with chronic abuse differed most from the "normal" group. Prognostic factors for drug abuse were: member of a multiproblem family, child psychiatric care, contact with the Social Welfare Administration at an early age, truancy, placement in special class, premature drop-out from school, admitted high-frequency drug use in a school questionnaire, for boys early registration for crimes and for girls nervous complaints. The results indicate the necessity of earlier and more effective prevention.

Adolescent↗

PubMed1987

Prognostic factor in neuroblastoma.

Known prognostic factors in neuroblastoma were analyzed in 124 children to determine which were independent and which were most useful in predicting outcome. The following factors were analyzed: age, sex, stage of disease, serum neuron-specific enolase (NSE), serum ferritin, E-rosette inhibition, urinary catecholamines, and histologic type according to the criteria of Shimada. Estimates of survival were calculated using the method of Kaplan and Meier. The overall survival for 124 patients was 60% at 2 years. There were significant differences in survival by pathology, age, NSE, ferritin, vanilmandelic acid (VMA): homovanillic acid (HVA) ratio, and stage. There was a strong association among NSE, age, stage, and ferritin. Using the recursive partitioning approach, it was possible to subdivide patients into three groups (based on diagnostic values of ferritin, age, and stage) with a good, intermediate, and poor prognosis and estimated 2-year survival of 100%, 62%, and 19%, respectively. Further analysis could not be done because of small numbers in the subgroups, but the results suggest that combinations of age, stage, serum ferritin, and histologic type may be able to define two populations: favorable with 80% + 2-year survival and unfavorable with less than 20%.

Child, Preschool↗