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PubMed1992

Multivariate analysis of the histopathologic prognostic factors of cervical cancer in patients undergoing radical hysterectomy.

Three hundred forty-five patients with invasive carcinoma of the uterine cervix, Stages Ib (211 patients) and II (134 patients), underwent radical hysterectomy and pelvic lymphadenectomy. The influence of histologic factors including histologic subtype, maximum depth of cervical stromal invasion, degree of stromal invasion, longitudinal tumor diameter, lymph-vascular space invasion, corpus invasion, parametrial invasion, vaginal invasion, and pelvic lymph node (PLN) metastases on survival were examined by multivariate analysis. Univariate analysis revealed that all the variables except corpus invasion and vaginal invasion were significant in survival (P less than 0.05). Among these variables, however, PLN metastases, histologic subtype, and longitudinal tumor diameter were identified as independent and significant prognostic factors by multivariate analysis using Cox regression models. The prognostic index (PI), defined by the model (an indicator of the patient's place in the prognostic spectrum), was able to divide the patients into three prognostic groups. The key factors in the definition of these groups were (1) squamous cell carcinoma, small tumor diameter, and no PLN metastases for the good prognostic group and (2) PLN metastasis in two or more node groups, adenocarcinoma with one positive PLN group, or squamous cell carcinoma with one PLN group and large diameter for the poor prognostic group. These prognostic findings could predict the prognosis more precisely than that of clinical staging.

Adult↗

PubMed1987

Multivariate analysis of lipoprotein cholesterol fractions.

Intervention and prevention of multifactorial diseases such as coronary heart disease can be effective only when the joint effects of multiple risk factors are known. This process is facilitated by multivariate analysis of correlated risk factors, such as the serum cholesterol fractions, high density lipoprotein (HDL), low density lipoprotein (LDL), and very low density lipoprotein (VLDL). Whereas evidence for genetic covariation provides focus for further refined biochemical analysis, covariation among environmental factors can point to efficacious intervention strategies. To assess sources of variation and covariation among HDL, LDL, and VLDL, a multivariate path model was developed and applied to family data. Phenotypic variance is due primarily to specific environmental influences with substantial genetic influences, with the common family environment contributing less than 10% of the variance. There are genetic correlations of -0.22 for HDL-VLDL and 0.35 for VLDL-LDL, consistent with the known inverse associations of HDL and VLDL and the precursor-product relationship between VLDL and LDL, whereas there is no evidence for a direct HDL-LDL genetic relationship. Strong specific environmental correlations are found between HDL and VLDL (-0.35 in children and -0.50 in adults). Thus, intervention focused primarily on one fraction (e.g., triglycerides and VLDL) might beneficially affect levels of both lipoproteins (e.g., lowering VLDL cholesterol and elevating HDL cholesterol). Multivariate analysis can facilitate understanding of the linked effects of intervention on lipoprotein cholesterols, and, hence, should benefit approaches to maximize the effects of lipoprotein cholesterol intervention on coronary heart disease morbidity and mortality.

Analysis of Variance↗

PubMed1989

Craniometrical estimation of the native Japanese Mishima cattle, using multivariate analysis.

The present study on measurement of the skull of Mishima cattle, which has been postulated as the only pure representative breed of native Japanese cattle, was performed using craniometrical multivariate analysis. The data of the skull of Mishima cattle was compared with 17 breeds of cattle, i.e. Korean cattle (Hamhung, Pyongyang, Chinju Suwon, and Kwangju), Mongolian cattle, Hainan Tao cattle, northeastern Chinese cattle (Shuangliao, Shenyang, Tongliao, Lüta, and Chilin), Astatic Water Buffalo, Yak, Bos Banteng, American Bison, and Holstein-Friesian. The Mishima cattle was included in the group of Korean breeds, especially it was closed on the group of Pyongyang and Chinju breeds. The distance on the craniometrical multivariate analyzing co-ordinate between Mishima cattle and Hainan Tao breed of Zebu cattle was larger than the distance between Mishima cattle and Korean breeds. While result, as a above the present study was very important for the origin of "Wagyu" (native Japanese cattle). Since the northern route theory of the origin of Mishima cattle has been reported on the type of serum enzymes and hemotypes. It was suggested that the craniometrical multivariate analysis supported to the northern route theory of the origin of Mishima cattle.

Animals↗

PubMed1990

[Therapeutic factors related to irradiation in primary and metastatic liver cancer using multivariate analysis].

Between December 1973 and August 1987, 21 patients with primary liver cancer and 41 patients with metastatic liver cancer were treated with external irradiation, intra-arterial infusion chemotherapy and/or trans-arterial embolization (TAE) at the National Medical Center Hospital, the National South Kyushu Central Hospital and the National Kure Hospital. They were all inoperable cases. We diagnosed the tumor site and the involved area with many imagings and we decided the target volume. 1. Primary liver cancer: the average survival period was 10.9 months, the 1-year survival rate was 28.6%, the 2-year survival rate was 14.3% and the 3-year survival rate was 4.7%. Using multivariate analysis, stage, cancer reduction rate, Child classification and field size were valuable factors of the prognosis in the arterial infusion group. In the TAE group, cancer reduction rate was the most valuable factor. 2. Metastatic liver cancer: The average survival period was 8.0 months, the 1-year survival rate was 19.5%, the 5-year survival rate was 2.4%. Using multivariate analysis, pre-treatment K.P.S, distant metastasis, H, Child classification were valuable factors and pre-treatment K.P.S. was most valuable factor. Although the indication of hepatic irradiation were generally thought to limit those cases which were Child A or B, H1 or H2 and the cases which have no distant metastasis, the case which have their main portal tumor thrombus were also the indication of this therapy.

Aged↗

PubMed1986

Is the EORTC prognostic index of thyroid cancer valid in differentiated thyroid carcinoma? Retrospective multivariate analysis of differentiated thyroid carcinoma with long follow-up.

The European Organization for Research on Treatment of Cancer (EORTC) Thyroid Cancer Cooperative Group presented a prognostic index in 1979 that included all histologic groups of thyroid carcinomas, and was based on a multivariate analysis of 507 patients with a median follow-up of 40 months. The current report not only uses a multivariate analysis to study the clinical validity and reproducibility of this index on case material consisting of 226 differentiated thyroid carcinomas with a considerably long follow-up (11 years), but also it investigates possible prognostic factors, other than those proposed by the EORTC. Three EORTC variables could be reproduced as important: age at diagnosis, locally advanced disease, and distant metastases. Of the additional histopathologic variables tested, microscopic tumor invasion beyond thyroid capsule (pT4) and marked cellular atypia (MCA) proved to be significant. When the effect of the age-correlated tumor factors pT4 and MCA of differentiated thyroid carcinomas were taken into consideration, age alone lost its prognostic importance as a guide for treatment.

Adult↗

PubMed1992

A population-based, multivariate analysis of the association between 911 access and per-capita county trauma death rates.

STUDY OBJECTIVE: Decreased response times for injury should decrease the morbidity and mortality of trauma. The 911 telephone access is designed to improve the response time for emergencies. The purpose of this study was to analyze the association between county 911 access and per-capita county trauma death rates. METHODS: Data on all trauma deaths from 1986 through 1988 were obtained from the North Carolina Medical Examiner's data base. Counties were divided into those that had 911 access during the entire study period (15), those that never had 911 access (62), and those that installed 911 during 1987 (ten). Counties obtaining 911 access in 1986 or 1988 were excluded (13). RESULTS: The per-capita trauma death rate in counties that had 911 access throughout the study was 4.3 +/- 0.8 versus 5.0 +/- 1.1 per 10,000 population in counties that never had 911 access (P less than .01). Compared with counties with 911 access, counties without 911 were more rural, were less likely to have a trauma center, and were less likely to have advanced life support certification (P less than .03 for all). Controlling for these other factors, multivariate analysis demonstrated that 911 access had no significant independent association with per-capita county trauma death rates. In the ten counties that implemented 911 access in 1987, no significant change occurred in per-capita county trauma death rates after implementation of 911. CONCLUSION: Although counties with 911 access had lower trauma death rates by t-test, multivariate analysis showed no significant independent association of 911 access with per-capita county trauma death rates. In the ten counties that implemented 911 access in 1987, no significant changes in trauma death rates occurred after implementation. Although other factors may explain these findings, this study showed no significant independent impact of 911 access on per-capita county trauma death rates.

Emergency Medical Service Communication Systems↗

PubMed1987

Multivariate analysis of karyotypic abnormality in leukemia facilitated by numerical encoding of cytogenetic data.

A system is proposed whereby human karyotype data is expressed in quantitative terms rather than in the ISCN (1985) terminology used at present. This recoding facilitates application of multivariate analysis using standard statistical packages. As an example, karyotypes of 714 cases from 11 leukemias (Mitelman, 1983) are here recorded and subjected to discriminant analysis (SPSSx, 1983). Significant karyotypic specificity is apparent in six of the 11 FAB leukemia types. Four others show insignificant levels of specificity, while the last is equivocal. These results merely confirm present views. However, their generation by means of computerized multivariate analysis is novel, and confirms the feasibility of the approach. In this quantitative form, karyotypic data may be combined with any other data of diagnostic or prognostic value. Given such a consolidated data set, desired information concerning any aspect of neoplasia could be extracted via a single procedure.

Acute Disease↗

PubMed1989

Chronic myelomonocytic leukemia--clinicobiological characteristics: a multivariate analysis in a series of 70 cases.

In a series of 70 patients diagnosed according to the FAB criteria, 42 clinical and biological disease characteristics were analyzed in order to identify significant prognostic factors by means of univariate and multivariate analysis. The univariate analysis identified ten parameters associated with poor prognosis: Symptoms of anemia, WBC over 10 x 10(9)/l, presence of blast cells, myeloid precursors or erythroblasts in peripheral blood (PB), high bone marrow (BM) cellularity, severe dysthrombopoiesis, percent of blast cells in BM and high serum levels of bilirubin and LDH. The Cox proportional hazards regression method revealed that the combination of high leukocyte counts and BM percentage of blast cells had the strongest predictive relation to survival length (p = 0.002 and p = 0.060 respectively). A new multivariate analysis treating the presence of myeloid and erythroid precursors in PB as a single variable selected only this as the most significant prognostic factor (p = 0.001). Both regression models allowed us to discriminate two significantly different risk groups of patients.

Actuarial Analysis↗

PubMed1989

Non-seminomatous testicular cancer clinical stage I: prediction of outcome by histopathological parameters. A multivariate analysis.

The clinical course of 186 orchiectomized patients with testicular non-seminoma clinical stage I (CSI) was reviewed together with a reevaluation of the haematoxylin-eosin-stained histological sections of the primary tumour. Treatment (1970-1980) was as follows: abdominal radiotherapy (group 1): 132 patients; observation only (group 2): 23 patients; retroperitoneal lymph node dissection (group 3): 31 patients. Failure of the management (diagnostic error/relapse after treatment) was defined as demonstration of retroperitoneal lymph node metastases (group 3) or relapse during follow-up (group 2 and 3). Ten of the 31 primarily operated patients had retroperitoneal lymph node metastases. (These patients received 3-4 cycles adjuvant cisplatin based on chemotherapy.) Forty-six patients relapsed after a median time of 6 months (range: 2-113). The 10-year cancer-related survival rates for group 1 and 2 were 85 and 73%, respectively. No cancer-related death occurred in group 3 within the first 5 years. In a univariate analysis the following parameters were significantly (p less than 0.05) correlated with management failure: vascular invasion (blood, lymphatic), the presence of syncytiotrophoblasts, the demonstration of the histological subtype MTU. In a multivariate analysis both lymphatic and blood vessel invasion significantly predicted management failure. In 80% of the non-seminoma patients with CSI and both lymphatic and blood vessels invasion in the primary tumour failure of the primary management must be expected. In the multivariate analysis the demonstration of MTU was a predictive factor only if no differentiation was made between lymphatic and blood vessel invasion. The presence or absence of endodermal sinus tumour was not correlated with the failure rate in non-seminoma CSI. Based on easily assessable histopathological parameters of the primary tumour (small vessel invasion in particular) it is possible to define subgroups of patients with non-seminoma CSI who have a high or a low risk of relapse or who are likely to have microscopic retroperitoneal lymph node metastases. Such a differentiation should have therapeutic consequences.

Humans↗

PubMed1988

Prognostic value of CEA and ferritin assay in breast cancer: a multivariate analysis.

The prognostic significance of preoperative serum carcinoembryonic antigen (CEA) and ferritin levels was evaluated in 191 women operated for breast cancer. The influence of CEA, ferritin and another 11 clinical and pathological features on the disease-free survival was investigated in a multivariate analysis, using Cox's proportional hazard model. Axillary node status (P = 0.004), CEA level (P = 0.011), and the histological grade of the tumor (P = 0.029) emerged as independent prognostic factors. By contrast, no significant relationship was found between ferritin and disease-free survival. These three parameters were used to derive a prognostic index (I) for each patient. Multivariate analysis showed that its prognostic value was better than the value of any single factor (P less than 0.0001). The I score was used to divide patients into groups at different risk of recurrence: low, moderate and high (97.5%, 45% and 22.5% of recurrence-free patients at 3 years respectively). The data showed that the prognosis of patients with different combinations of node status and tumor grade was related to the level of CEA. Only women with very good (node-negative with well-differentiated tumors) or very bad prognosis (node-positive with four or more metastatic nodes and poorly differentiated tumors) had a disease-free survival independent of CEA values. These findings suggest that the preoperative measurement of CEA enhances the possibility of correctly predicting outcome and hence could be of assistance in the planning of adjuvant therapies.

Adult↗

PubMed1991

Factors determining the occurrence of late potentials on the signal-averaged electrocardiogram after a first myocardial infarction: a multivariate analysis.

To determine the natural history of late potentials on the signal-averaged electrocardiogram (ECG), multivariate analysis was performed in 167 patients (138 men, 29 women) with a first anterior or inferior acute myocardial infarction. Seventy-four patients received thrombolytic therapy; the remaining 93 patients were treated conventionally. All patients underwent coronary angiography, left ventricular ejection fraction determination and signal-averaged ECG recording. Eight variables thought to be correlated with the presence of late potentials were studied; that is, age, infarct location, number of diseased coronary vessels, left ventricular ejection fraction, infarct-related coronary artery patency, treatment received, delay between admission and signal-averaged recording and delay between admission and coronary angiography. Statistical analysis showed that two independent factors (coronary artery occlusion and impaired left ventricular ejection fraction) were highly correlated with the incidence of late potentials. The occurrence of late potentials was multiplied by 5 in case of an occluded infarct-related vessel and by 1.75 each time the left ventricular ejection fraction value decreased by 0.10. This study suggests that coronary artery patency is the most important factor that decrease the rate of late potentials after a first acute myocardial infarction and it occurs independently of infarct location and left ventricular function.

Coronary Angiography↗

PubMed1976

Subjective multivariable analysis bu computer for evaluation of coronary artery bypass.

Subjective multivariable analysis by computer was utilized to evaluate the results in a series of 659 patients undergoing coronary artery saphenous vein bypass surgery. A video terminal gave access to a remote computer. The postoperative subjective response was evaluated by questionnaires sent to patients at 6- to 12-month intervals, and was augmented by treadmill testing and postoperative coronary arteriography. Operative risk and subjective response are related only to the degree of ventricular function lost prior to surgery. Long-term results were best in patients in whom complete revascularization was possible. Current operative risk is less than 1%; a five-year survival rate of 90% to 95% is predicted. More than 90% of patients were asymptomatic or "greatly improved." Postoperative treadmill tests were negative in 88% of patients in these groups. In patients who were only "slightly improved" or "not improved," repeat catherization showed a graft patency rate of 84%, suggesting that recurrent symptoms were related to the extent of preoperative disease or to the progression of disease in nongrafted vessels, rather than to graft occlusion.

Computers↗

PubMed1991

Treatment of oesophageal perforation: a multivariate analysis.

Perforation of the oesophagus was retrospectively analysed in 59 patients. Cause and extent of perforation, localization, quality of the oesophageal wall and therapeutic modes were subjected to univariate analysis. The perforations of the intrathoracic oesophagus (39) were also subjected to multivariate analysis. Perforation of the cervical oesophagus is seldom lethal and can be adequately treated conservatively in the majority of cases. Perforations of the intrathoracic oesophagus can be divided into two groups, with or without simultaneous perforation of the parietal pleura. The optimal treatment for the group with pleural perforation seems to be resection of the oesophagus and secondary reconstruction, although primary closure is indicated in selected early cases. Perforations of the intrathoracic oesophagus confined to the mediastinum can be adequately treated conservatively in most patients. Perforation of the intra-abdominal oesophagus should be treated like any other intra-abdominal visceral perforation, by closure or diversion, even if this results in resection of the oesophagus.

Adolescent↗

PubMed1991

The Swedish Childhood Diabetes Study--a multivariate analysis of risk determinants for diabetes in different age groups.

In a nationwide incident case-referent study stepwise univariate analysis has revealed several risk determinants for childhood diabetes mellitus. In a multivariate analysis we have determined the set of risk determinants that would independently predict childhood Type 1 (insulin-dependent) diabetes. Possible interactions between the risk determinants and differences in risk profiles with different ages at onset were also examined. Reported familial insulin-treated and non-insulin-treated diabetes were significant risk factors in all age groups, as was also a low frequency of milk intake. The frequency of infections and a high intake of foods rich in nitrosamine tended to interact (OR 11.8, p = 0.053) indicating a synergistic effect. A Cox regression analysis revealed that stressful life events during the last year was the only variable that tended to affect the age at onset (p = 0.055). This indicated that psychological stress may rather precipitate than induce Type 1 diabetes. A short breast-feeding duration (OR = 3.81), and an increased body height (OR = 3.82) contributed significantly to the predictive model in only the youngest age group (0-4 years). An increased frequency of infections in the year preceding onset (OR = 2.15) and no vaccination against measles (OR = 3.33) contributed significantly to the model only in the age group 5-9 years. Various nutrients had different impacts on the risk of developing Type 1 diabetes in different age groups. It is concluded that in the genetically susceptible child, risk factors which are associated with eating habits, frequency of infections, vaccination status, growth pattern and severe psychological stress affect the risk of developing diabetes independently of each other.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗

PubMedDate not supplied

Multivariate analysis of operative mortality and late outcome after coronary bypass surgery.

A multivariate discriminant analysis was made to find out the variables that could offer the greatest amount of predictive power on the long term results after myocardial revascularization. A total of 202 consecutive patients who underwent CABG operation in 1981 were reviewed 5 years later. Most of the patients (76.5%) had 3-vessel disease, previous AMI (70.2%), hypertriglyceridemia (61.7%), positive family history of CAD (68.0%) elevated blood cholesterol level (48.1%), hypertension (41.9%) or were smokers (61.9%). In 48.1% of the cases IMA was used for revascularization and in the rest saphenous vein graft alone. The 5-year survival of the entire group was 87%. The late mortality was related to 3 independent variables in multivariate analysis: 1) positive family history of CAD (p less than 0.05), 2) preoperative ejection fraction less than 0.30 (p less than 0.01) and 3) revascularization without IMA (p less than 0.02). The vast majority of patients (70%) had a better NYHA class 5 years postoperatively (the 95% confidence interval was 65-77%). These patients had experienced an average improvement of 2.0 NYHA categories. Eight per cent of patients had an unaltered and 5% a worse NYHA class than preoperatively. When the patients were grouped into those having a better NYHA class and into those who had an unchanged or worse NYHA class or who had died from CAD the only variable which was associated with poorer outcome appeared to be positive family history of CAD (p less than 0.01). It can be concluded that hereditary factors, utilization of internal mammary artery in revascularization and preoperative ejection fraction are the major predictors of late outcome after CABG.

Coronary Artery Bypass↗

PubMed1987

Value of flow cytometric determination of ploidy as a guide to prognosis in operable rectal cancer: a multivariate analysis.

The DNA content of 203 cases of rectal cancer, with at least 15 years follow-up, was analysed by flow cytometry. One hundred and twenty-nine (64%) were DNA aneuploid and corrected survivals were significantly influenced by ploidy distribution (p less than 0.01). The DNA content and details of stage and grade were subjected to multivariate analysis using the Cox regression model. Ploidy was entered into models including Dukes' stage alone, tumour differentiation alone, Dukes' stage and differentiation in combination and a more comprehensive range of discrete stage- and grade-related parameters. All four models demonstrated its independent contribution to survival. However, its contribution was very small (5%, 18%, 5%, 4% respectively). These findings illustrate that results based on new technological developments should not be viewed in isolation, but their values must be assessed in combination with traditionally available data by means of multivariate analysis.

Adenocarcinoma↗

PubMed1991

Transitional cell carcinoma of the urethra in men following cystectomy for bladder cancer: multivariate analysis for risk factors.

Multicentric development of transitional cell carcinoma in the urinary tract is well recognized. Of 169 male patients who underwent cystectomy for bladder cancer 18 (10.6%) demonstrated urethral cancer (all within 5 years after cystectomy). The risk factors involved in transitional cell carcinoma in regard to the occurrence of urethral cancer after cystectomy were examined by multivariate analysis. Characteristic patterns of bladder cancer in the cystectomy specimens were expressed by the grade, stage, number, size, location and gross pattern of the tumors. Significant risk factors in bladder cancer relating to the development of cancer in the retained urethra were papillary cancer, multiple cancers, and tumors in the bladder neck, prostatic urethra and prostatic gland. Among 19 patients with concomitant carcinoma in situ and/or multiple papillary tumors in the bladder who underwent simultaneous prophylactic urethrectomy with cystectomy in the same observed period 17 (89%) had no lesion in the resected urethra. The results of the multivariate analysis will be useful to avoid unnecessary prophylactic urethrectomy at cystectomy. However, further analysis and consideration of possible mechanisms of the secondary urethral cancer will be necessary to explain the discrepancy posed in the latter study involving 19 patients.

Adult↗

PubMed1987

Prognosis of dilated cardiomyopathy: from a retrospective to a prospective study employing multivariate analysis.

To determine the prognostic factors of dilated cardiomyopathy (DCM), a retrospective long-term investigation of 111 patients seen between 1967 and 1983 was carried out. Fifty-four deaths were divided into 3 subgroups: (1): sudden death (n = 6); (2): sudden death on the basis of heart failure (n = 17); (3): refractory heart failure death (n = 31). Multivariate analysis was employed to ascertain the prognostic score, which was constructed from the grading of the New York Heart Association functional classification, the cardiothoracic ratio, electrocardiographic findings and cardiac function. Individual variables were indicated on the first (I) and second (II) principal component axes. The mean center points for the death modes were as follows: (1): I = -0.4, II = +0.8, (2): I = +0.7, II = +1.1, (3): I = +1.4, II = -0.8. Surviving cases (n = 57) showed I = -0.6, II = +0.1. Forty-one cases examined during 1984-1985 were analyzed to evaluate the prognostic efficacy of this score. Fourteen of 17 cases (82%) located in the refractory heart failure death group died within one year after determination of the prognosis, showing thereby that the prognostic determination by multivariate analysis is effective.

Adult↗