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PubMed1990

Analysis of prognostic factors and clinicopathological staging of thymoma.

The prognostic value of four clinical variables (age and sex of patients, association with myasthenia gravis, and clinical stage) and histological type was analyzed in 83 consecutive patients with thymoma, histologically classified as cortical, medullary, and mixed. Age, sex, and association with myasthenia gravis did not prove to represent significant prognostic factors; clinical stage and histological type, on the contrary, had a highly significant prognostic value (p less than 0.001). A model of clinicopathological staging, based on both clinical stage and histological type, in which three major prognostic groups are considered is proposed. The degree of significance of this model is higher (p less than 0.0001) than that of clinical stage and histological type considered individually; its validity is further supported by the results of multivariate analysis according to the Cox regression model (p = 0.0001). We think it represents a prognostically valuable approach to the problem of management of thymoma.

Actuarial Analysis↗

PubMed1995

Preoperative CA 125: an independent prognostic factor in patients with stage I epithelial ovarian cancer.

OBJECTIVE: To evaluate the prognostic importance of preoperative CA 125 levels in patients with International Federation of Gynecology and Obstetrics (FIGO) stage I epithelial ovarian cancer in comparison with the established prognostic factors: degree of differentiation, FIGO substage, and age. METHODS: In a retrospective analysis, the traditional prognostic factors and CA125 levels (cutoff value 65 U/mL) were studied in 201 patients who were treated in five centers during 1984-1993. Patients with borderline tumors or non-epithelial ovarian carcinomas were excluded, as were women in whom CA 125 had not been determined preoperatively. RESULTS: In univariate analysis (Mantel test), overall survival decreased significantly in patients positive for CA 125 (P < .001). Substage (P = .004) and histologic grade (P = .01) also significantly influenced survival prognosis. When the effects of preoperative CA 125 levels were correlated with histologic grade, all three subgroups with CA 125 levels equal to or greater than 65 U/mL were associated with a decreased survival probability (grade 1, P = .04; grade 2, P = .003; grade 3, P = .01). Multivariate analysis (Cox model) identified preoperative CA 125 as the most powerful prognostic factor for survival (P < .001), the risk of dying of disease being 6.37 times higher (95% confidence interval 2.39-16.97) in CA 125-positive patients. Although FIGO substage retained its significant influence on survival (P = .03), histologic grade and age were not prognostically important. CONCLUSION: Randomized trials investigating the efficacy of adjuvant treatment in patients with FIGO stage I epithelial ovarian cancer should also include stratification by preoperative CA 125 levels.

Age Factors↗

PubMed1991

Monoclonal antibodies in myeloid diseases: prognostic use in acute myeloid leukaemia.

Bone marrow cells from 109 patients (median age 60) with newly diagnosed acute myeloid leukaemia (AML) were prospectively immunophenotyped (IP) and the prognostic value of monoclonal antibody (MAB) reactivities was analysed to detect differences in complete remission rates and survival, not only between groups of MAB + and - bone marrow cells, but also in cases with or without prominent MAB reactivity as compared to normal BM reactivity of the respective MABs. This approach was based on the assumption that the qualitative expression of antigens is not an all or none phenomenon, but that different degrees of expression of antigens exist. Patients with significantly elevated CD13 (MY7+) cells in bone marrows (CD13 greater than reference value + one standard deviation) (S.D.) showed decreased probability of entering CR (p less than 0.05) and a significantly shorter survival (p less than 0.05). Superior CR rates (p less than 0.05) without difference in long-term survival were seen in patients with low CD33 (MY9) or low HLA-DR expression, while high CD14 (MY4) expression showed a trend towards an adverse factor (p = 0.12). No other antibody reactivities showed differences in CR rates (CD3, CD20, CDw65 (VIM-2) and NAT-9). The more prominent bone marrow expression of CD33 antigen than CD13 (CD33/CD13 greater than 1) correlated to a better chance of entering CR (p = 0.01) and to improved survival (p = 0.002), while the expression of high numbers of VIM-2+ cells was a favourable prognostic factor regarding length of survival (p = 0.002). The importance of a high CD33/CD13 ratio as a positive prognostic factor was evaluated using stratified analysis according to age or leucocyte counts at presentation. In both cases, CD33/CD13 was associated with longer survival (age: p = 0.05, leucocyte counts: p = 0.03). A Cox multiparameter analysis revealed that the CD33/CD13 ratio was a favourable prognostic factor (p = 0.03) together with age (p = 0.001) and leucocyte counts in peripheral blood (p less than 0.01). We conclude that establishing the immunologic phenotype can be of prognostic value in cases of AML, especially with regard to the relationship between the CD33 and CD13 antigens.

Acute Disease↗

PubMed1993

Carcinoembryonic antigen (CEA), tissue polypeptide antigen (TPA) and other prognostic indicators in squamous cell lung cancer.

Multivariate models of survival have been established for both small cell and non-small cell lung cancers. So far, no study has focussed on squamous cell types. Previous demonstrations of the prognostic value of the tissue polypeptide antigen (TPA) and, partially, of the carcinoembryonic antigen (CEA) are based on univariate analyses of survival. These analyses do not account for the other prognostic factors. In the present study, we report the combined influence of various clinical and biological characteristics on the survival duration of 360 patients with a newly diagnosed squamous cell carcinoma of the lung. The study comprised 29 variables, including age, sex, smoking habit (SH), symptoms at diagnosis, the Karnofsky performance status (KPS), weight loss (WL), radiological findings, various disease extent parameters (DEP), CEA and TPA. Preliminary univariate analyses showed that 20 variables were survival-related. The Cox proportional hazards regression analysis selected stage of disease, KPS, TPA, WL, the existence of bone metastases, and SH as independent factors of prognosis (global chi-square: 122.40, P = 0.0000). A second multivariate analysis, performed with the same covariates but excluding DEP, revealed previous pulmonary diseases and CEA to be, in addition to KPS, TPA, SH, and WL the next most influential prognostic determinants. Also in squamous cell lung cancer, classifications based on the Cox's prediction equation may improve individual counseling and patient selection for therapeutic trials. In this malignancy, TPA shows an independent and strong prognostic significance while CEA shares informations of diverse other prognostic factors and seems to be less important.

Adult↗

PubMed1989

Prognostic value of estrogen and progesterone receptors in primary infiltrating ductal breast cancer. A sequential multivariate analysis of 1262 patients.

Nine prognostic variables were evaluated for their significance in predicting the overall survival (OS), the length of disease-free survival (DFS) and the length of metastasis-free survival (MFS) of 1262 patients with primary breast cancer. The variables studied were: UICC clinical stage; menopausal status; histologic grade; number of involved nodes; anatomic tumor size; estrogen and progesterone receptors; local and adjuvant therapies. Three sequential multivariate analyses, at 2, 5 and 10 years, using the Cox proportional hazard regression model, were carried out to identify those variables most highly related to the criteria studied (overall, disease-free, metastasis-free survivals) and especially to fully evaluate the effects of hormonal receptors on prognosis and their stability over time. Our results showed that number of involved nodes and histologic grade were the most significant prognostic factors for all periods of time and whatever the criterion studied; ER had no predictive value while PR was an independent prognostic factor for metastasis-free survival at 2 years (P = 0.01) and 5 years (P = 0.02) but lost its significance at 10 years (P = 0.06). In the subgroup of 261 patients who received prolonged post-operative adjuvant chemotherapies, PR was the main prognostic factor for MFS at 2 years (P = 0.03) and the second at 5 years (P = 0.05) just after number of involved nodes. In the 1001 patients who did not receive prolonged post-operative adjuvant chemotherapies ER was significant for MFS at 5 and 10 years. The present data urge the need for a periodic redefinition of prognostic factors in primary breast cancer.

Adult↗

PubMed1986

Prognostic indicators in diffuse large-cell (histiocytic) lymphoma.

Identification of prognostic groups among patients with diffuse large-cell (histiocytic) lymphoma (DHL) would help to select specific therapy for individual patients and allow comparisons among combination chemotherapy clinical trials. The Ann Arbor staging system is of limited value in predicting outcome in diffuse histiocytic lymphoma. Prognostic factors have been examined by various groups without a consensus of reliable prognostic indicators. This study was undertaken to examine the validity of a predictive model for response to treatment and survival in DHL. Eighty-six patients with the diagnosis of DHL treated with combination chemotherapy between the years 1976 and 1982 were examined for prognostic variables influencing response to treatment and survival. The variables examined included: age, sex, presence or absence of systemic symptoms, serum lactic dehydrogenase (LDH), sites of disease involvement, bulk of disease, prior therapy, stage of disease, according to the Ann Arbor classification, and pathological criteria, according to the Lukes Collins classification. Factors achieving a p-value in the 0 to 0.05 range with univariate analysis for predicting response were age and systemic symptoms. Factors significant for overall survival were age and bone marrow involvement. These factors have been found to influence survival in previous studies, but there has not been a consistency regarding the importance of these factors. Large numbers of patients must be examined for various factors in order to allow identification of prognostic groups among patients with DHL.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1996

Hypofractionated radiation therapy in patients with glioblastoma multiforme: results of treatment and impact of prognostic factors.

PURPOSE: Median survival of patients with glioblastoma multiforme (GBM) is only about 4 months with surgery and about 9 months for surgery followed by radiotherapy. Prolonged treatment is futile for many patients and the time of treatment and hospitalization should be minimized. METHODS AND MATERIALS: This was a prospective, nonrandomized study of 30 patients treated with a hypofractionated radiation scheme (42 Gy in 14 fractions). RESULTS: Median survival was 36 weeks. Age, Karnofsky performance status (KPS) and extent of surgery were strongly interrelated and all correlated with survival (p < 0.05). Three prognostic groups were identified. Patients with three favorable prognostic factors (age <50, KPS 80-100, and > or = 75% of the tumor removed) had the best prognosis (median survival 50 weeks). Patients with no favorable prognostic factors (age > or = 50, KPS < or = 70, and < 75% of the tumor removed) had the worst prognosis (median survival 25 weeks). Median survival of the intermediate group (with one or two favorable prognostic factors) was 38 weeks. No severe acute or late toxicity was observed. CONCLUSION: The treatment results are comparable to those achieved with conventional radiotherapy schemes. Based on the number of favorable prognostic factors (age < 50, KPS 80-100 and > or = 75% of tumor resected) the radiation schedule should be selected.

Adult↗

PubMed1995

Incremental value of prognostic testing in patients with known or suspected ischemic heart disease: a basis for optimal utilization of exercise technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography.

OBJECTIVES: This study assessed the incremental prognostic implications of normal and equivocal exercise technetium-99m (Tc-99m) sestamibi single-photon emission computed tomography (SPECT) and sought to determine its incremental prognostic value, impact on patient management and cost implications. BACKGROUND: The prognostic implications of Tc-99m sestamibi SPECT are not well defined, and risk stratification using this test has not been explored. METHODS: We studied 1,702 patients referred for exercise Tc-99m sestamibi SPECT who were followed up for a mean (+/- SD) of 20 +/- 5 months. Patients with previous percutaneous transluminal coronary angioplasty or coronary artery bypass surgery were excluded. The SPECT studies were assessed using semiquantitative visual analysis. Cardiac death and myocardial infarction were considered "hard" events, and coronary angioplasty and bypass surgery > 60 days after testing were considered "soft" events. RESULTS: Of the 1,702 patients studied, 1,131 had normal or equivocal scan results. A total of 10 events occurred in this group (1 cardiac death and 1 myocardial infarction [0.2% hard events]; 4 coronary angioplasty and 4 bypass surgery procedures [0.7% soft events]). The rates of hard events and referral to catheterization after SPECT were similarly low in patients with a low (< 0.15), intermediate (0.15 to 0.85) and high (> 0.85) post-exercise treadmill test (ETT) likelihood of coronary artery disease. With respect to scan type, patients with normal, probably normal or equivocal scan results had similarly low hard event rates. In the 571 patients with abnormal scan results, there were 43 hard events (7.5%) and 42 soft events (7.4%) (p < 0.001 vs. 1,131 patients with normal scan results for both). When the complete spectrum of scan responses was considered, SPECT provided incremental prognostic value in all patient subgroups analyzed. However, the nuclear scan was cost-effective only in patients with interpretable exercise ECG responses and an intermediate to high post-ETT likelihood of coronary artery disease and in those with uninterpretable exercise ECG responses and an intermediate to high pre-ETT likelihood of coronary artery disease. CONCLUSIONS: Normal or equivocal exercise Tc-99m sestamibi study results are associated with a benign prognosis, even in patients with a high likelihood of coronary artery disease. Although incremental prognostic value is added by nuclear testing in all patient subgroups, a testing strategy incorporating nuclear testing proved to be cost-effective only in the groups with an intermediate to high likelihood of coronary artery disease before scanning.

Aged↗

PubMed1993

The changing importance of prognostic factors in bladder cancer during a long-term follow-up.

A cohort of 505 patients with a transitional cell bladder cancer were followed up for over 9 years and clinical, histological and morphometric factors were related to survival. Several survival analyses were done by moving the start of the follow-up so that the first analysis started at the time of primary therapy and the last one after 9 years follow-up. T-category, WHO grade, papillary status and the density of tumour infiltrating lymphocytes had independent short-term prognostic value whereas mitotic index and standard deviation (S.D.) of nuclear area were independent long-term predictors up to 7 years after diagnosis. In papillary tumours S.D. of nuclear area and mitotic index were independent long-term predictors in contrast to T-category and WHO grade which were both short-term prognostic factors. In superficial tumours only mitotic index had independent long-term prognostic value. The results show that the prognostic information from the primary tumour biopsy specimen has long-term prognostic significance in transitional cell bladder cancer. The results particularly emphasize the importance of factors related to cancer cell proliferation as long-term predictors.

Aged↗

PubMed1992

Tissue polypeptide antigen in breast cancer cytosol: a new effective prognostic indicator.

Since 1982 we have been evaluating oestrogen and progesterone receptors (PgR), cathepsin D and the cytosolic levels of the tumour marker, tissue polypeptide antigen (TPA), in 257 patients radically resected for breast cancer (follow-up 24-81 months). TPA was measured by an immunoradiometric assay previously validated for cytosol. No significant associations were found between cytosolic TPA and age, tumour size, lymph-node status, receptor status and cathepsin D. TPA+ cases showed a significantly longer disease-free survival (DFS) and overall survival (OS) than TPA-patients (log-rank P < 0.0001). The prognostic value of cytosolic TPA was also demonstrated after stratification by nodal status, PgR and cathepsin D. The prognostic value of TPA was independent of the other prognostic indicators, being the most powerful among the evaluated indices (Cox multivariate analysis: chi 2 15.5 for DFS, 11.4 for OS). We conclude that cytosolic TPA is a powerful additional prognostic factor in primary breast cancer. Its prognostic role should therefore be extensively evaluated.

Antigens, Neoplasm↗

PubMed1994

Prognostic value in predicting overall survival of two mucinous markers: CA 15-3 and CA 125 in breast cancer patients at first relapse of disease.

The role of circulating tumour markers in providing prognostic information has been scarcely studied. We evaluated the prognostic significance of two mucinous markers: CA 15-3 and CA 125 in 115 breast cancer patients at first recurrence of disease. At diagnosis of advanced disease bone involvement was found in 64 patients, lung in 57, skin lymph nodes in 21, liver in 20, and brain in 5. Patients were recruited and treated in the same institution with conventional chemo- or endocrine therapy. The follow-up ranged from 3 to 54+ months (median 35). Serum samples were drawn at first recurrence of disease before the start of any endocrine and/or chemotherapy. Patients with CA 15-3 < 30 U/ml survived significantly longer than those with CA 15-3 > 30 U/ml (median 50+ versus 26 months, P < 0.02). Similarly, overall survival of patients with CA 125 < 35 U/ml was significantly higher in comparison with patients with CA 125 > 35 U/ml (median 34.5 versus 18.5 months, P < 0.001). CA 125, but not CA 15-3, maintained its prognostic value in the subgroup of patients with visceral metastases. Both markers were found to be independent prognostic variables in multivariate analysis according to Cox's model. CA 15-3 and CA 125 appeared to be powerful prognostic indicators, in addition to visceral metastases, in patients with advanced breast cancer.

Adult↗

PubMed1995

Expression of insulin-like growth factor I (IGF-I) in female breast cancer as related to established prognostic factors and long-term prognosis.

The expression of insulin-like growth factor I (IGF-I) was analysed immunohistochemically in a series of 211 breast cancers with special emphasis on its relationship to conventional prognostic factors and long-term prognosis. Altogether, IGF-I was expressed by the tumour cells in 91% of the breast carcinomas, and by stromal cells in 29%. The expression of IGF-I in cancer cells was weakly related to a high proportion of intraductal growth (P = 0.032), distinct tumour margins (P = 0.048) and high S-phase fraction (P = 0.074). In a univariate analysis, IGF-I expression in cancer cells was significantly related to a high survival probability in the entire cohort (P = 0.0144) as well as in the axillary lymph node positive tumours (P = 0.0286). Alternatively, expression of IGF-I in the stromal cells was related to metastasis at the time of diagnosis (P = 0.05), tumour diameter (P = 0.04), DNA ploidy (P = 0.07) and nuclear pleomorphism (P = 0.025), but it was without prognostic significance in a univariate analysis (P > 0.1). In a multivariate analysis, the conventional prognostic factors were superior to IGF-I expression in predicting the disease outcome, albeit expression of IGF-I in tumour stroma showed some independent prognostic significance in axillary lymph node negative tumours. The results suggest that IGF-I expression is related to malignant histopathological features in breast cancer, and expression of IGF-I has independent prognostic significance in the early phases of the disease.

Adult↗

PubMed1995

p53 overexpression as a prognostic factor for advanced stage bladder cancer.

Overexpression of the TP53 gene protein detected by immunohistochemistry appears to identify those patients with superficial bladder cancer at risk of the development of muscle invasive or metastatic disease. However, the role of p53 overexpression in patients with advanced or metastatic bladder cancer is not yet well established. In the present study, 44 specimens from 44 patients with advanced stage bladder tumours (T2-T4) undergoing radical cystectomy were investigated for different biological and clinical characteristics as possible prognostic factors: sex, age, depth of tumour infiltration, T-stage, histological grade, lymph node status, application of adjuvant systemic chemotherapy (MVAC), proliferative activity (staining for proliferating cell nuclear antigen (PCNA) by monoclonal antibody (PC10) as well as overexpression of the p53 oncoprotein (monoclonal antibody pAb 1801)). After a median follow-up of 22 months, 16 of the 23 patients (70%) with more than 40% of tumour cells stained positively for p53 (Group B) died from tumour progression compared with 7 of the 21 patients (33%) with less than 40% of tumour cells positive for p53. During univariate analysis, p53 overexpression (P = 0.008), staining for PCNA (> or = 80% of cells positive) (P = 0.01) and tumour stage (P = 0.01) were significant prognostic factors for survival, among which p53 overexpression (P = 0.023) as well as T-stage (P = 0.012) remained independent significant predictors during multivariate analysis. Prospective studies are needed to confirm the independent prognostic potential of p53 overexpression in patients with advanced bladder cancer. The availability of more refined prognostic factors should assist decision making regarding the value of more aggressive treatment options, such as adjuvant or neoadjuvant chemotherapy, for prognostically defined subgroups of patients.

Adult↗

PubMed2006

The additional prognostic value of coronary flow reserve on left anterior descending artery in patients with negative stress echo by wall motion criteria. A Transthoracic Vasodilator Stress Echocardiography Study.

BACKGROUND: Vasodilator stress echocardiography allows imaging of left anterior descending (LAD) coronary flow reserve (CFR), which may provide additional prognostic information over regional wall motion. AIM: To assess the prognostic value of CFR in patients with known or suspected coronary artery disease (CAD) and negative stress echo. METHODS: We studied 329 consecutive patients (193 men, age 61 +/- 13 years) with known (n = 101) or suspected (n = 228) CAD and negative stress echo by standard wall motion criteria. All patients underwent dipyridamole (up to 0.84 mg/kg in 10 minutes) stress echo with CFR evaluation of LAD by Doppler. RESULTS: During follow-up (28 +/- 10 months), 22 events occurred: 1 cardiac death, 6 nonfatal myocardial infarctions, 5 unstable anginas, and 10 late (> 6 months) coronary revascularizations. Moreover, 9 patients underwent early (< 6 months) revascularization and were censored. Using a receiver operating characteristic analysis, CFR < or = 1.92 was the best predictor of future events (area under the curve = 0.80, sensitivity = 77%, specificity = 85%) and was taken as criterion for reduced CFR accordingly. Sixty-three (19%) patients had reduced and 266 (81%) had normal CFR on LAD. The 36-month event-free survival was higher in patients with normal and lower in patients with reduced CFR (98% vs 64%, P < .0001). At Cox analysis, CFR of LAD (hazard ratio [HR] 16.52, 95% CI 5.76-47.40, P < .0001), left ventricular mass index (HR 1.03 per unit increment, 95% CI 1.00-1.05, P = .01), and smoking habit (HR 3.00, 95% CI 1.24-7.23, P = .01) were independent prognostic indicators. Using an interactive stepwise procedure, CFR on LAD provided additional prognostic information to clinical, resting echo, and angiographic findings. CONCLUSIONS: In patients with known or suspected CAD and negative stress echocardiography by wall motion criteria, CFR provides independent information for prognostic stratification, and a reduced CFR is associated with a less benign long-term outcome.

Coronary Artery Disease↗

PubMed2004

Preoperative pulmonary function as a prognostic factor for stage I non-small cell lung carcinoma.

BACKGROUND: The aim of this study was to clarify preoperative lung function as a prognostic factor for the long-term survival of, and to discuss the appropriateness of lobectomy for, patients with stage I non-small cell lung carcinoma who have poor preoperative pulmonary function. METHODS: The study group consisted of 402 lobectomized patients with stage I non-small cell lung carcinoma treated by complete resection from 1985 to 1997. Preoperative percent forced vital capacity [(forced vital capacity/predicted forced vital capacity) x 100], FEV(1)% [(forced expiratory volume in 1 second/forced vital capacity) x 100], arterial carbon dioxide tension, and smoking were statistically analyzed as prognostic factors together with other host and tumor biologic factors. RESULTS: Multivariate analysis demonstrated that tumor size (p < 0.0001) was the most significant prognostic factor for survival from primary lung cancer. Age (p < 0.0001), sex (p = 0.0036), and FEV(1)% (p = 0.0046) were found to be independent prognostic factors for survival from death by nonprimary lung cancer-related causes. Smoking was highly correlated with FEV(1)% (correlation coefficient = -0.511; p < 0.0001). The 100 patients with a preoperative FEV(1)% less than 70% included 34 patients with nonprimary lung cancer-related deaths, whereas the 302 patients with an FEV(1)% of 70% or greater included only 23 patients (p < 0.0001). CONCLUSIONS: Along with tumor size, FEV(1)% is the most significant prognostic factor for patients with stage I non-small cell lung carcinoma with regard to survival from death by other causes. Lobectomy may not be preferred as an appropriate surgical modality for patients with stage I non-small cell lung carcinoma with small peripheral nodules who exhibit poor pulmonary function, especially lowered FEV(1)%.

Adult↗

PubMed2006

Prognostic significance of metastasis to the highest mediastinal lymph node in nonsmall cell lung cancer.

BACKGROUND: We have tried to clarify the prognostic significance of metastasis to the highest mediastinal (HM) lymph node in patients with N2 lung cancer who underwent complete dissection of superior mediastinal (including HM) lymph nodes. METHODS: This study analyzed 53 patients with N2 nonsmall cell lung cancer who underwent surgical procedures such as lobectomy plus hilar and mediastinal node dissection (T4, neoadjuvant therapy cases were excluded). For patients whose cancer was in the left lung, we performed surgery through the median sternotomy in order to dissect superior mediastinal nodes. The clinicopathologic records of the patients were examined for prognostic factors such as age, sex, side, histology, tumor location, tumor size, clinical node (cN) number, preoperative serum carcinoembryonic antigen level, number of metastatic stations, and HM lymph node involvement. RESULTS: A univariate analysis showed that tumor size (T1/T2-3), cN factor (cN1-2/cN0), N2 level (multiple/single), and metastasis to the HM node were significant prognostic factors. In the multivariate analysis, metastasis to the HM lymph node remained a significant prognostic factor (p = 0.026). The 3-year survival rates were 52% in patients without metastasis to the HM lymph node and 21% in patients with metastasis to the HM lymph node (p < 0.001). Furthermore, when HM nodal involvement was absent, the 5-year survival rate was 33% even in patients with multilevel N2 status, 45% in patients with cN1-2 status, and 47% in patients with pT2-3 tumor status. CONCLUSIONS: Highest mediastinal lymph node involvement is prognostic of highly advanced N2 disease resulting in poor outcome. The results also suggest that patients with no involvement of the HM lymph node can experience acceptable postoperative outcomes even if they have multilevel N2 status, positive cN status, or T2-3 tumor status.

Adenocarcinoma↗

PubMed2006

Does high-sensitivity C-reactive protein add prognostic value to the TIMI-Risk Score in individuals with non-ST elevation acute coronary syndromes?

BACKGROUND: C-reactive protein (CRP) measured at hospital arrival of patients with non-ST elevation acute coronary syndromes (ACS) may add prognostic information to the TIMI-Risk Score. METHODS: Eighty-six consecutive patients admitted with unstable angina or non-ST-elevation acute myocardial infarction and symptoms onset within the prior 48 h were included. Recurrent cardiovascular events during hospitalization were defined as non-fatal myocardial infarction or death. Serum CRP was measured immediately at hospital arrival and its prognostic value in relation to in-hospital cardiovascular events was tested by the area under the ROC curve and adjusted for TIMI risk predictors by logistic regression analysis. In addition, a CRP modified TIMI-Risk score was created by adding 2 points if CRP greater than the cut-off proposed by the ROC curve analysis. The accuracy of this new score was compared with the usual TIMI-Risk Score. RESULTS: A significant predictive value of CRP in relation to in-hospital cardiovascular events was indicated by an area under the ROC curve of 0.80 (95% CI=0.66 to 0.93, p=0.009). C-reactive protein cut-off point of best prognostic performance was 7.2 mg/l. In the multivariate analysis, increased CRP (>7.2 mg/l) remained a significant predictor of events after adjustment for TIMI risk predictors (OR=14; 95% CI=1.6-121; p=0.018). The area under the ROC curve for the TIMI-Risk Score was 0.87 (95% CI=0.76-0.99, p=0.001). The addition of CRP to the TIMI-Risk Score improved its prognostic value (area under the ROC curve=0.93; 95% CI=0.87-0.99, p<0.001). The additional value of the new score is demonstrated by a higher specificity (86% vs. 63%, p<0.001) and positive predictive value (39% vs. 19%) in relation to the TIMI-Risk Score. CONCLUSIONS: CRP measured at admission of patients with non-ST-elevation acute coronary syndromes adds prognostic information to the TIMI-Risk Score. Additionally, the incorporation of this variable into the TIMI-Risk Score calculation is an effective manner to utilize CRP for risk stratification.

Aged↗

PubMed2005

Bioelectric impedance and individual characteristics as prognostic factors for post-operative complications.

BACKGROUND AND AIMS: Malnutrition increases morbidity and mortality in surgical patients, and for this reason, several nutritional markers have been used as prognostic tools to identify surgical patients under a higher risk to develop complications in post-operative period. Few studies show the impact of nutritional markers after controlling for others variables, such as age and severity of disease. A new method, bioelectric impedance analysis (BIA), and its parameter, phase angle, have been described as a prognostic tool in several clinical situations, but they have never been studied in surgical population. The objective of this work is to assess the importance of nutritional variables and parameters from BIA as predictors of post-operative complications in a multivariable regression model. METHODS: The nutritional status of 225 adult patients scheduled to undergo gastrointestinal surgery was assessed by several methods, including bioelectric impedance analysis and subjective global assessment. Potential confounding factors were also studied. Patients were screened for post-operative complications until hospital discharge. RESULTS: Weight loss greater than 10%, subjective global assessment, nutritional risk assessment, ECM/BCM ratio and phase angle (from BIA) were the prognostic factors significantly associated with post-operative complications in the crude analysis. After adjusting for sex, age, marital status, tumors and pre-operative infections, only phase angle remained as a prognostic factor (RR=4.3; CI95% 1.6-11.8 for phase angle <-0.8 sd), while the other nutritional variables lost their association with post-operative complications. CONCLUSION: Phase angle remains as an important prognostic factor for postoperative complications, even after adjusting for other individual predictors and confounders. Its utility in the identification of patients eligible for nutritional therapy has now to be evaluated.

Adolescent↗