SEARCH · PubMed Health

Results for “Prognostics”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 451 records · Page 25Linked to original sources

PubMed2004

Histopathological prognostic factors in patients with cervical cancer treated with radical hysterectomy and postoperative radiotherapy.

BACKGROUND: Many studies have been performed, on the clinical outcome and prognostic factors in patients with cervical cancer treated with radical hysterectomy and postoperative radiotherapy, but no useful method for predicting the risk of recurrence has been established. The purpose of this study was to analyze histopathological prognostic factors. In addition, we proposed a new risk classification and evaluated its usefulness. METHODS: One hundred and thirty patients with stage I-II uterine cervical cancer were treated with radical hysterectomy and postoperative radiotherapy at Ehime University Hospital between 1978 and 1997. All surgical specimens were reviewed, and the relationship between histopathological factors and the clinical outcome was analyzed. RESULTS: Of the histopathological prognostic factors of the surgical specimens analyzed, six factors (parametrial invasion, venous infiltration, pelvic lymph node metastases, thickness of the residual muscular layer, tumor depth, and tumor growth pattern) were significant prognostic factors. In particular, venous infiltration and pelvic lymph node metastases were strongly correlated with recurrence. Using the above five factors (excluding the thickness of the residual muscle layer), all patients were scored based on the total number of poor prognostic factors, and were classified into three groups. Patients with a score of 0-1 were classified as the low-risk group, those with a score of 2 as the intermediate group, and those with a score of 3-5 as the high-risk group. The 5-year disease-free survival rates were 93% in the low-risk group, 82% in the intermediate group, and 56% in the high-risk group (P < 0.05). CONCLUSION: Six prognostic factors were found. Our risk classification seems to be clinically useful to predict which patients are at risk of recurrence.

Adult↗

PubMed2004

Prognostic value of matrix metalloproteinases (MMP-2 and MMP-9) in patients with lymph node-negative breast carcinoma.

Twenty-five to thirty percent of patients with node-negative breast cancer are expected to relapse following surgery, therefore great efforts have been made to identify new prognostic markers that could be useful in defining patients for additional therapy. The expression of MMP-2 and MMP-9 has been associated with high potential of metastasis in several human carcinomas including breast cancer. In the present study we examined the prognostic value of immunoreactive MMP-2/MMP-9 protein in 270 consecutive lymph node negative cases who received radical mastectomy or modified radical mastectomy. Among the patients, 211 cases received adjuvant endocrine therapy and/or adjuvant chemotherapy. Using immunohistochemical assay, we found that 56.7% of the resected tumors were positive for MMP-2 whereas 59.6% of the samples were positive for MMP-9. Chi2 test demonstrated a significant direct association between MMP-2 and MMP-9 (p < 0.001); positive immunostaining of MMP-2 was significantly related to higher tumor grade (p < 0.001) and larger tumor size (p = 0.012); positive immunostaining of MMP-9 was significantly related to higher tumor grade (p = 0.002). In univariate analysis, using Cox-proportional hazard model we found MMP-2, MMP-9 and the co-expression of MMPs (MMP2/MMP9) were significantly associated with patients' relapse free survival (p = 0.016, 0.015 and 0.013 respectively) but not overall survival (p = 0.122, 0.320 and 0.091 respectively). Log-rank test also showed that MMP-2, MMP-9 or the co-expression of MMP2/MMP9 was unfavorable prognostic factor for relapse free survival but not overall survival. In subgroup analysis, we found MMPs were more prognostic for patients with no adjuvant treatment than for patients with adjuvant therapy. In multivariate analysis, using Cox-proportional hazard model we found co-expression of MMPs, larger tumor size and higher tumor grade were unfavorable for relapse free survival (p = 0.038, 0.007 and 0.015 for each). We concluded that MMP-2 and MMP-2 are unfavorable prognostic factors in breast cancer patients. They might be potential predictive factor for adjuvant systemic therapy. The co-expression of MMP-2 and MMP-9 has significantly prognostic value in node-negative patients.

Antineoplastic Agents, Hormonal↗

PubMed2005

The time-related changes of the importance of prognostic factors in breast cancer. A sequential multivariate analysis of 1423 Japanese patients.

The value of individual prognostic factors may change dependent on the length of the follow-up period, if some factors have their greatest prognostic potential immediately after operation. It is not clear how long these factors keep their prognostic relevance. We retrospectively examined data on 1423 surgically treated Japanese patients with primary breast cancer between 1983 and 2002. Survival analysis was done starting at 2.5-yearly intervals after operation and follow-up in the first analysis started at the time of the operation. The changing importance of the prognostic factors during different follow-up periods was investigated by univariate and multivariate analysis. Based on multivariate analysis, tumor size retained its prognostic value even up to 7.5 years after operation, whereas the age, vascular involvement, ER and PgR showed a changing influence on prognosis dependent on the length of the follow-up period. The prognosis of patients some years after operation is necessarily different from the initial prognosis established after operation. Detecting the changing importance of prognostic factors could provide new biological insights that might otherwise be missed, and may help determine the most appropriate clinical use of various factors.

Adult↗

PubMed1992

Prognostic importance of quantitative analysis of coronary cineangiograms.

Many studies have shown the prognostic value of angiographic data, but few have examined quantitative parameters of wall motion and shape or coronary stenosis severity. To determine whether these parameters have prognostic importance, baseline angiograms of 283 patients with up to 11.2 years (mean 8.3) of follow-up were quantitated. Event-free survival curves were constructed using log-rank testing. These indexes were also considered in 2 predictive models (Cox regression models): 1 with ("clinical") and 1 without ("quantitative") subjective angiographic analysis and clinical information. Regional shape (anterior and inferior walls) and motion (anterior wall only) indexes were predictive of event-free survival when considered singly. But these parameters were not of independent prognostic importance in the regression models. The most important independent parameters in the quantitative model for predicting overall cardiac mortality or an initial lethal cardiac event were the ejection fraction and the percent diameter narrowing of each major coronary artery. Myocardial infarction was predicted by the percent diameter stenosis of the left main and left anterior descending arteries but not the ejection fraction. In the clinical model, the factors of overriding prognostic importance were the ejection fraction and the subjective determination of the number of vessels involved with "significant" stenoses. Quantitative coronary arteriography still contributed independent prognostic value. Thus, quantification of the ejection fraction and severity of coronary lesions were of independent, prognostic importance, whereas indexes of regional function and shape were not.

Adult↗

PubMed1993

Validation of a pneumonia prognostic index using the MedisGroups Comparative Hospital Database.

PURPOSE: Our purpose was to validate a previously developed pneumonia-specific prognostic index in a large, multicenter population. PATIENTS AND METHODS: We developed a pneumonia-specific prognostic index in a prospective, multicenter study of 346 patients with clinical and radiographic evidence of pneumonia admitted to 3 Pittsburgh hospitals (the derivation cohort), and validated the index in 14,199 patients with a principal ICD-9-CM diagnosis of pneumonia admitted to 78 hospitals in the 1989 MedisGroups Comparative Hospital Database (the validation cohort). The prognostic index classified patients into five ordered risk classes based on six predictors of mortality: age greater than 65 years, pleuritic chest pain, a vital sign abnormality, altered mental status, neoplastic disease, and high-risk pneumonia etiology. Each patient in the validation cohort was assigned to a risk class by obtaining values for the index's six predictors in the MedisGroups population. The performance of the prognostic index in the derivation and validation cohorts was assessed by comparing hospital mortality rates within each of the index's five prognostic risk classes. RESULTS: The hospital mortality rate was 13.0% in the derivation cohort, and 11.1% in the validation cohort (p = 0.26). The agreement in the risk class-specific mortality rates was striking with the exception of class V: in class I, mortality was 0% in the derivation cohort versus 1% in the validation cohort; in class II, 0% versus 1.1%; class III, 10.9% versus 8.6%; class IV, 21.8% versus 26.2%; and class V, 73.7% versus 37.7%. There were no statistically significant differences in mortality rates within the first four risk classes, which represented the vast majority of patients in the derivation (94%) as well as the validation (98%) cohorts. CONCLUSIONS: These data support the generalizability of a pneumonia-specific prognostic index. This index, which performs exceptionally well in classifying low-risk patients, may help physicians identify patients with community-acquired pneumonia who could safely be managed in the ambulatory setting, or if hospitalized, the patients that could be treated with abbreviated inpatient care.

Adult↗

PubMed1993

Analysis of prognostic factors in stage I epithelial ovarian carcinoma: importance of degree of differentiation and deoxyribonucleic acid ploidy in predicting relapse.

OBJECTIVES: Our purpose was to identify prognostic factors in stage I epithelial invasive ovarian carcinoma. STUDY DESIGN: The traditional clinical and pathologic prognostic variables and deoxyribonucleic acid ploidy were analyzed in a group of 290 patients. RESULTS: A multivariate analysis identified degree of differentiation as the most powerful prognostic indicator of disease-free survival, followed by deoxyribonucleic acid ploidy and, finally, International Federation of Gynecology and Obstetrics (1986) stage. Tumors with clear cell carcinoma elements were not graded, and in this subgroup International Federation of Gynecology and Obstetrics (1986) stage was the most important prognostic characteristic. When the effects of the three most important factors were accounted for in graded tumors, then none of the following were prognostic: histologic type, dense adhesion, extracapsular growth, ascites, rupture during surgery, International Federation of Gynecology and Obstetrics (1973) stage, size of tumor, and age and type of adjuvant treatment. None of 77 patients with well differentiated deoxyribonucleic acid diploid tumors had relapses. CONCLUSION: Deoxyribonucleic acid ploidy is an important new independent prognostic factor in stage I ovarian carcinoma.

Cell Differentiation↗

PubMed1991

Prognostic flow cytometric information in cervical squamous cell carcinoma: a multivariate analysis of 307 patients.

In a prospective study of 307 patients with invasive squamous cell carcinoma of the uterine cervix, the prognostic impact of flow cytometric parameters (ploidy level and the fraction of S-phase cells) and clinical variables was evaluated using univariate and multivariate analyses (Cox model). Mean follow-up time as 39 (4-84) months. A total of 93 patients died from their disease during the follow-up. The S-phase fraction was evaluable in 242 cases. By means of univariate models, lethality rate was found to increase significantly with increasing age, postmenopausal status, advancing stage, and increasing S-phase fraction. In a multivariate analysis of the clinical variables of age, stage, and grade, only clinical stage was prognostic. The inclusion of ploidy level in the analysis gave no additive prognostic information. In a multivariate analysis including all variables mentioned above, stage was the strongest predictor of survival. S-phase fraction was significantly related to survival both when studied as a continuous variable (P = 0.006) and when studied as a categorized variable (10, 15, 20% as cutoff points), and in this special analysis ploidy level was of prognostic interest with a poorer survival for near-diploid cases. The outcome was poorer with increasing age. The prognostic impact of the S-phase fraction remained highly significant in separate analyses of the clinically interesting stages Ib-IIb (P less than 0.001). We conclude that measurement of the S-phase fraction is of prognostic interest and may be used for the identification of high-risk patients within a given stage, whereas ploidy level yields little information.

Adult↗

PubMed1984

Prognostic scoring using cytomorphometry and lymph node status of patients with breast carcinoma.

Applying morphometry on FNA smears may lead to meaningful prognostic subgrouping of breast carcinomas. A statistical analysis of the cytomorphometric and clinical data of 73 patients with breast carcinoma was performed. By multivariate analysis, taking into account various prognostic factors, it was shown that variations in nuclear area and the presence of axillary metastases were the most important prognosticators. By weighing these factors a prognostic score was obtained. According to that score the patients were classified into 4 score groups: the decreasing survival with increasing score was evident. The prognostic score was also related to the metastasis-free period. This prognostic scoring is relatively easy to perform, and can be done in routine pathology laboratories.

Aged↗

PubMed1991

A meta-analysis of reported correlations between prognostic factors in breast cancer: does axillary lymph node metastasis represent biology or chronology?

A statistical overview of published results on correlations between various prognostic factors in breast cancer was undertaken. A distinction was made between clinical (or anatomical) prognostic factors--namely, axillary lymph node status and tumour size--and eight different biological prognostic factors. The latter included: tumour grade, oestrogen and progesterone receptor status, thymidine labelling index, DNA ploidy, S-phase fraction, epidermal growth factor receptor expression and c-erbB-2 gene amplification (or overexpression). 139 articles were eligible for review which reported a total of 432 individual correlations. A simple form of meta-analysis was employed: the counting method, in which the number of studies achieving a statistically significant correlation or not were counted. For each possible correlation examined, the proportion of studies showing a statistically significant correlation was calculated and an exact binomial 99% confidence interval determined for that proportion. If the 99% confidence interval included 5% (the proportion of correlations that would be expected to be statistically significant if the null hypothesis was true), it was taken as failing to exclude the null hypothesis of a zero correlation, while if it excluded 5% it was taken as rejecting the null hypothesis of a zero correlation. A broad agreement was found among published reports on the existence of a statistically significant correlation between the various biological prognostic factors in breast cancer. Of the 20 correlations examined, 18 had a 99% confidence interval excluding 5%, thus rejecting the null hypothesis of a zero correlation. On the other hand, a completely different result was obtained when reports on possible correlations between lymph node status and tumour size on the one hand and the eight biological prognostic factors on the other were analysed. Of the 16 correlations examined, 13 had a 99% confidence interval including 5%, failing to reject the null hypothesis of a zero correlation. These observations suggest the hypothesis that the prognostic influence of node status and tumour size cannot be explained by an analysis of the biology of breast cancer; and is compatible with the contention that axillary node status is merely a reflection of the relative chronological age of breast cancer.

Breast Neoplasms↗

PubMed1993

Independent and incremental prognostic value of exercise single-photon emission computed tomographic (SPECT) thallium imaging in coronary artery disease.

OBJECTIVES: The objective of this study was to examine the independent and incremental prognostic value of exercise single-photon emission computed tomographic (SPECT) thallium imaging in patients with angiographically defined coronary artery disease. BACKGROUND: Previous studies showed the importance of exercise thallium-201 in risk stratification. However, most of these studies used planar imaging techniques. METHODS: Follow-up data were obtained in 316 medically treated patients with coronary artery disease. Cox proportional hazards regression models were used to examine the independent and incremental prognostic values of clinical, exercise, thallium and cardiac catheterization data. RESULTS: There were 35 events (cardiac death or nonfatal myocardial infarction) at a mean follow-up time of 28 months. Univariate analysis showed that gender (chi-square = 5.1), exercise work load (chi-square = 3.1), extent of coronary artery disease and left ventricular ejection fraction (chi-square = 14.8) and thallium variables (chi-square = 22.7) were prognostically important. The thallium data provided incremental prognostic value to catheterization data (chi-square = 33.7, p < 0.01). The extent of the perfusion abnormality was the single best predictor of prognosis (chi-square = 14). Patients with a large perfusion abnormality had a worse prognosis than that of patients with a mild or no abnormality (Mantel-Cox statistics = 10.6, p < 0.001). CONCLUSIONS: In medically treated patients with coronary artery disease, exercise SPECT thallium imaging provides independent and incremental prognostic information even when catheterization data are available. The extent of the perfusion abnormality is the single most important prognostic predictor.

Aged↗

PubMed1995

Long-term prediction of major ischemic events by exercise thallium-201 single-photon emission computed tomography. Incremental prognostic value compared with clinical, exercise testing, catheterization and radionuclide angiographic data.

OBJECTIVES: This study sought to evaluate the prognostic role of exercise thallium-201 (Tl-201) single-photon emission computed tomography (SPECT) in patients with known or suspected coronary artery disease. BACKGROUND: Compared with planar Tl-201 scintigraphy, Tl-201 SPECT allows enhanced assessment of myocardial perfusion abnormalities. However, the long-term prognostic value of exercise Tl-201 SPECT has not been ascertained and compared with that of other techniques of investigation. METHODS: Predictors of ischemic events were sought in 217 patients with known or suspected coronary artery disease who underwent exercise Tl-201 SPECT, coronary angiography and rest radionuclide angiography and who initially received medical therapy. Predictive values were determined using Cox proportional hazards regression models. RESULTS: During a mean (+/- SD) follow-up period of 70 +/- 19 months, 29 patients had a major ischemic event (cardiac death or myocardial infarction). Total extent of exercise defects was the best independent predictor by Tl-201 SPECT of major events (p < 0.001) and provided additional prognostic information compared with clinical, exercise testing and catheterization variables (p < 0.02). Extent of reversible Tl-201 SPECT perfusion defects provided additional prognostic information compared with extent of irreversible defects (p < 0.001) and was the sole Tl-201 SPECT variable providing additional prognostic information compared with radionuclide left ventricular ejection fraction (p < 0.02). CONCLUSIONS: Total extent of exercise Tl-201 SPECT defects is a powerful long-term predictor of major ischemic events that enhances the prediction provided by clinical, exercise testing and coronary angiographic data. In view of its prognostic significance, extent of reversible Tl-201 SPECT defects might provide original information about improving prognosis by coronary revascularization.

Age Factors↗

PubMed1994

Prognostic assessment from studies with non-randomized treatment assignment.

In clinical practice, prognostic factors are primarily used to identify and select patients with a relatively poor prognosis who may need more aggressive treatment in order to improve their prognosis. Preferably, assessment of the ability of prognostic factors to distinguish these high risk patients from low risk patients should take place in the absence of such prognosis-modifying adjuvant therapy. Adjuvant therapy may dilute the effect of prognosticators (covariate-treatment interactions) and such a situation may go unnoticed in tests for interaction because of their low statistical power. These undetected covariate-treatment interactions will bias the estimated effects of prognostic factors in both studies with randomized and non-randomized treatment assignment but the bias will usually be greater in studies when treatment was not randomized. For the evaluation of prognostic factors, it is therefore argued that the study population should be restricted to patients who do not received adjuvant therapy. This restriction might result in a less powerful analysis, but it carries the advantage that undetectable biases are avoided. Non-random treatment assignment will not invalidate this restriction analysis provided that all the prognostic factors on which treatment choice was based, are known and incorporated into the analysis.

Bias↗

PubMed1994

Survival in patients with recurrent glioma as a measure of treatment efficacy: prognostic factors following nitrosourea chemotherapy.

The assessment of efficacy of treatment in patients with recurrent glioma is notoriously difficult, and survival is the most objective endpoint. Between 1970 and 1992, a cohort of 211 patients with recurrent glioma received nitrosourea-based chemotherapy at the time of disease progression. The median survival from the start of chemotherapy was 7 months, with 30% 1-year and 10% 2-year survival probabilities. One-year survival was 22% in 147 patients with recurrent high-grade astrocytoma, 41% in 37 patients with low-grade astrocytoma and 45% in 24 patients with oligodendroglioma. Age, histological grade and Karnofsky performance status (KPS) at recurrence were independent prognostic factors for survival on multivariate analysis. Based on patients' age, tumour grade and KPS, it was possible to define three distinct prognostic groups with 1-year survival probabilities of 60, 21 and 17% (P < 0.005). Response to chemotherapy was difficult to assess but correlated with prognostic subgroup, with highest response rate (46%) in the most favourable group and lowest (13%) in the poor prognostic group. In patients with recurrent glioma, patient and tumour parameters are the major determinants of outcome which are identical to prognostic factors at the time of primary diagnosis. They can be used to provide prognostic information for the individual patient, and to stratify patients particularly in trials assessing the efficacy of novel treatments.

Adolescent↗

PubMed1994

Prognosis and treatment of T1G3 bladder tumours. A prognostic factor analysis of 121 patients. Dutch South Eastern Bladder Cancer Study Group.

Patients with T1G3 bladder cancer have a considerable risk for recurrence and/or progressive disease. Until now no consensus has been achieved on the optimal treatment. Within the Dutch South Eastern Bladder Cancer Study Group, 155 patients with a T1G3 bladder tumour were seen between 1983 and 1988. After review of histology, 121 could be evaluated and recurrence-free interval was studied with regard to prognostic factors. Prognostic factors such as sex, age, blood group, abnormalities on intravenous urography, pretreatment tumour configuration, number of tumours, number of locations involved in the bladder, voided urine cytology, results of random biopsies and mitotic index were evaluated, using a multivariate analysis with the Cox proportional hazard model. During the follow-up period, 70 (58%) patients had recurrent bladder cancer, and of these 30 (43%) had progression into invasive disease. Of the possible prognostic factors analysed, only multiplicity (P = 0.03) and the number of locations of the tumours (P = 0.03) were independent prognostic factors in relation to the risk of recurrence. The recurrence-free interval was influenced by the therapy. For T1G3 tumours, additional intravesical immunotherapy/chemotherapy or radiotherapy after transurethral resection (TUR) increased the recurrence-free interval significantly. Because most other parameters did not show additional prognostic value, the T1G3 tumours can be considered as homogeneous with regard to prognosis. Only multiplicity and the number of locations involved added to the prognostic significance of patients with these bladder tumours. In addition, it is advisable to give patients with T1G3 tumours additional treatment after the initial TUR.

Adult↗

PubMed1990

Prognostic value of pS2 protein and receptors for epidermal growth factor (EGF-R), insulin-like growth factor-1 (IGF-1-R) and somatostatin (SS-R) in patients with breast and ovarian cancer.

The prognostic value of EGF-R, IGF-1-R and SS-R, and of cytosolic estrogen-regulated pS2 protein, was studied in patients (pts) with primary breast and advanced ovarian cancer. Ovarian cancer tissues were negative for pS2 (by immunoradiometric assay) IGF-1-R and EGF-R contents (by ligand binding assay, LBA) were of no or moderate prognostic value for breast cancer pts (n = 214). For advanced ovarian cancer pts, EGF-R content determined by LBA (n = 55) showed no prognostic value, whereas EGF-R status (n = 35) determined by immunohistochemistry (MoAb 2E9) significantly correlated with progression of disease (P less than 0.05). In breast cancer pts, both SS-R and pS2 showed no association with tumor size, nodal status and grade. For pS2 the best cut-off level with respect to relapse-free (RFS) and overall survival (OS) was found to be 11 ng/mg protein. Both SS-R (1 g% SS-R+, n = 135; P less than 0.04) and pS2 (27% pS2+, n = 197; P less than 0.001), which were mainly positive in ER+ tumors, were of prognostic value, especially within the subgroups with ER+/PgR+ tumors. Also within N+ and No pts the 5-yr RFS and OS showed a difference between pS2+ and pS2- (33 and 54% for N+, and 31 and 13% difference for No pts). In summary, SS-R and pS2 are valuable prognosticators in breast cancer pts, and prognostic significance of EGF-R in ovarian cancer pts needs further study.

Biomarkers, Tumor↗

PubMed1995

Prognostic value of plasma catecholamines, plasma renin activity, and plasma atrial natriuretic peptide at rest and during exercise in congestive heart failure: comparison with clinical evaluation, ejection fraction, and exercise capacity.

Survival in congestive heart failure is related to plasma catecholamines and atrial natriuretic peptide at rest, but the prognostic importance of changes during exercise is unknown. The aim of this study was to evaluate the prognostic value of catecholamines and atrial natriuretic peptide at rest and during maximal exercise in congestive heart failure, and to compare it to clinical and exercise test variables and left ventricular ejection fraction. One hundred ninety consecutive patients (136 men and 54 women; median age, 66 years; range, 42-75 years) with clinically stable congestive heart failure were included. Sixteen patients were in New York Heart Association class I, 87 in class II, 83 in class III, and 4 in class IV. Left ventricular ejection fraction was 0.30 (range, 0.06-0.74). Total survival after 1 year was 79%, after 2 years, it was 68%. Prognostic variables at univariate analysis were: plasma noradrenaline at rest (P < .0001), plasma adrenaline at rest (P = .049), and atrial natriuretic peptide at rest (P = .016). During exercise, plasma catecholamines and plasma atrial natriuretic peptide increased significantly; the change, however, was not related to survival. Six variables carried significant, independent prognostic information in a multivariate analysis: left ventricular ejection fraction (P = .03), plasma noradrenaline at rest (P = .009), New York Heart Association class III + IV (P = .005), increase in heart rate during exercise < or = 35 min-1 (P < .0001), serum creatinine > 121 mumol/L (P = .004), and serum urea > 7.6 mmol/L (P = .007). Patients with congestive heart failure have a poor survival despite intensive medical treatment. Plasma catecholamines and plasma atrial natriuretic peptide are elevated at rest and rises further during exercise; the increase, however, is not related to mortality. Plasma noradrenaline at rest contributes with further prognostic information despite knowledge of clinical and exercise variables and was the only neurohormonal variable with independent, significant prognostic information on survival.

Adult↗

PubMed2006

Prognostic factors and clinicopathologic characteristics of invasive adenocarcinoma of the uterine cervix.

OBJECTIVE: The purpose of this study was to evaluate the outcome of patients with cervical adenocarcinoma and to determine the characteristics and the prognostic factors of this entity. STUDY DESIGN: This retrospective study was done in the Department of Surgical Oncology of the Salah Azaiz Institute of Tunis with 79 cases of invasive adenocarcinoma of the uterine cervix that were collected from 1990 to 1999. Survival was analyzed according to the Kaplan-Meier method. Univariate analysis of prognostic factors was performed with the test of log rank. Cox regression model was used in multivariate analysis of prognostic factors. RESULTS: Mean age was 50 years, and metrorrhagia was mostly revealing in 73% of the cases. Early stages (I, IIa, IIb with 1/3 proximal parametrial invasion) and "pure" type adenocarcinoma were found in 78% and 87% of the cases, respectively. Treatment consisted of a radiosurgical combination in 52 cases; exclusive radiotherapy was practiced with 17 patients. The 5 year-overall and disease-free survival percentages were, respectively, 68% and 72.4%. Poor prognostic factors were age >50 years, tumor size >4 cm, advanced stage, tumor grade, and lymph nodes and lymph-vascular space involvement. With the use of multivariate analysis, only stage and lymph node metastases remained significant prognostic factors. CONCLUSION: This report shows survival and prognostic factors that are similar to those found in previous studies, but unlike the Western countries, our results demonstrate a high rate of early stages and no increase in frequency of cervical adenocarcinoma.

Adenocarcinoma↗

PubMed2005

Multivariate prognostic evaluation of the mitotic activity index and fibrotic focus in node-negative invasive breast cancers.

We validated with univariate and multivariate (Cox) analysis, the prognostic value of the mitotic activity index (MAI), the fibrotic focus (FF) and other prognosticators in 448 patients with lymph node-negative (LN-) invasive breast cancer <55 years without adjuvant systemic treatment (72.5 months median follow-up, range 4-119). Of these patients, 24.8% developed distant and 1.6% loco-regional recurrence. FF showed excellent inter-observer reproducibility (kappa = 0.93). Strong prognosticators were MAI, grade, nuclear atypia, FF and the St. Gallen criterion (SG). The subgroup with excellent survival selected by SG was only 16% of all patients, implying over-treatment of more than 70% of all LN- patients when using SG as adjuvant therapy selection criterion. If MAI <10, 13% showed distant metastases, contrasting with 41% if MAI > or = 10. FF was prognostic in the ductal and mixed ductal cancers, but not in the lobular and other subtype cancers. Patients with invasive (mixed) ductal cancers with FF absent, FF < 1/3 or FF > 1/3 of the tumour area, had distant metastasis rates of 17%, 35% and 48%; in MAI < 10 and FF absent, FF < 1/3 or FF > 1/3, metastasis rates were 11%, 13% and 42% and if MAI > or = 10, metastasis rates were 31%, 48% and 50%, respectively. In the 12 patients with MAI < 10 and a large FF > 1/3, event-free survival was similar to patients with MAI > or = 10. With multiple regression MAI < 10 versus > or = 10 is the strongest prognosticator (also stronger than the SG). The FF may be important as it has additional prognostic value to the MAI in the small subgroup of invasive ductal or mixed-ductal breast cancer patients with combined MAI < 10 and an FF > 1/3 of the tumour area.

Adult↗