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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↗

PubMed1988

Biochemical markers in multiple myeloma: a multivariate analysis.

The analysis of individual biochemical and clinical variables in 121 patients with multiple myeloma showed that serum beta 2-microglobulin (S-beta 2m) had the most significant relation to survival. Other variables such as serum thymidine kinase (S-TK), serum lactate dehydrogenase (S-LDH), S-creatinine, haemoglobin (Hb), ESR, S-albumin, age and clinical stage were also significant. No such relationship was found with M-component, presence of light chains in urine, type of secreted immunoglobulin or S-calcium. The exclusion of clinical stage in the first multivariate analysis resulted in a model consisting of S-beta 2m, age and S-TK, none of the other variables gave additional information. When in the second multivariate analysis the basic variables involved in staging procedure were excluded and clinical stage included, stage III, but not stage II, was found to give additional information to the model described above. Individual analysis of the variables showed that Hb had the most significant relation to effect of initial therapy. Other significant variables were S-TK, S-beta 2m and age. When using the multivariate approach, Hb alone was found to contain all the relevant information.

Adult↗

PubMed1987

Multivariate analysis of antibiograms for typing Pseudomonas aeruginosa.

A method for typing Pseudomonas aeruginosa using antibiotic susceptibility patterns is presented, which allows recognition of clusters of the same strain among clinical isolates from different patients, thus indicating whether cross infection has occurred. An index of similarity (the euclidean or the oblique distance), which includes all the differences of disk zone sizes among isolates, is computed and then elaborated by a clustering algorithm that successively groups all the isolates in larger clusters. The results of clustering are presented as dendrograms, whose terminal branches are pruned down to a level below which differences are casual; isolates that still appear on a common branch are considered identical. The reliability of this technique for detecting nosocomial cross infections was assessed by comparing its results with that of serotyping and pyocin typing. Only 2 of 31 (6.4%) clusters detected by multivariate analysis were not confirmed, while 4 of 33 (12.1%) clusters were recognized by serotyping and pyocin typing, but not by multivariate analysis. In at least two instances the differences in susceptibility patterns were due to cytoplasmic R factors. The routine use of antibiogram data for typing purposes should be considered an essential part of nosocomial infection control.

Anti-Bacterial Agents↗

PubMed1984

Multivariate analysis of factors affecting postoperative survival in malignant astrocytoma. Importance of DNA quantification.

Fifty-eight patients with supratentorial malignant astrocytoma were analyzed statistically to evaluate the factors most important for predicting postoperative survival. Clinical information such as age, sex, duration of preoperative symptom, Karnofsky score at admission and at discharge, location of tumor, amount of tumor removal, number of operations, and postoperative survival in months, together with data on radiation and chemotherapy were analyzed by chi square test, t-test, and multivariate analysis. Cytofluorometric DNA quantification using paraffin embedded specimens was also performed in 20 cases and these data were also evaluated. Multiple correlation coefficient, and therefore the total statistical accuracy, increased to 0.824 when data of DNA quantification, percentages of S phase cells and of polyploid cells, were included. Multivariate analysis revealed that 6 items were the major factors for predicting postoperative survival, i.e. the location of tumor, the Karnofsky score at discharge, the percentage of S phase cells, the number of operations, the percentage of polyploid cells, and the amount of tumor removed. Based on this analysis, the estimated survival time could be expressed as a formula.

Adolescent↗

PubMed1988

An interactive multivariate analysis of FCM data.

The procedure and results of the interactive multivariate analysis of FCM data are described. Using principal-components analysis, cluster analysis, and interactive maneuvers, this procedure facilitates an effective data compression from a four-dimensional space into two-dimensional space, then allows cluster separation. The procedure is especially effective for separating clusters, which are degenerated in the usual scattergrams. Programs were mostly written in C language on MS-DOS and were tested on four-dimensional analysis of the blood cells, which resulted in a successful separation of the degenerated clusters.

Cell Separation↗

PubMed1981

Congenital malformations and maternal occupation in Finland: multivariate analysis.

The Finnish Register of Congenital Malformations was used in a multivariate analysis to explore the associations between maternal occupation in industry and children born with central nervous system (CNS) or musculoskeletal or oral cleft malformations. Possible confounding factors were selected in preliminary screening of risk indicators for malformations. These factors included characteristics of the mother, the child, and the family; maternal illnesses; an maternal medication at the time of pregnancy. Tobacco smoking was a confounding factor for all type of malformations; number of children born to the mother, maternal age, malformations in the family, number of rooms occupied by the family, sex of the child, threatened abortion, and continuous medication of the mother during the first trimester confounded the association for certain type of malformations. After adjusting for confounding factors, maternal occupation in industrial trades significantly correlated with CNS, oral cleft, and musculoskeletal malformation in the offspring. Maternal occupation in industry and construction only was significantly associated with CNS malformations in the offspring but the associations with oral cleft and musculoskeletal malformations were not significant.

Adult↗

PubMed1989

Multivariate analysis of factors influencing the results of restorative proctocolectomy.

Univariate and multivariate analysis has been used to assess the influence of 14 variables on the results of 65 consecutive ileoanal pouch procedures over 5 years. There were 9 failures requiring intubation, ileosomy or pouch excision. There was a significant association between failure and pelvic sepsis (p less than 0.05; n = 8), endoanal mucosectomy (p less than 0.05; n = 7), preservation of a long rectal cuff (p less than 0.05; n = 5) and lack of experience with the operation (p less than 0.05; n = 8). Of 49 patients with preoperative evidence of ulcerative colitis, 3 are now known to have Crohn's disease. The only factor having a significant adverse influence on complications was endoanal mucosectomy (p less than 0.01). Functional outcome was significantly impaired in patients who developed pelvic sepsis (p less than 0.001), a post-operative fistula (p less than 0.05) and who had an endoanal mucosectomy (p less than 0.05). Success with ileo-anal pouch reconstruction increases with experience. Avoidance of sepsis is associated with a lower failure rate, improved functional results and reduced hospital stay. Preliminary colectomy is also advised to exclude Crohn's disease if the diagnosis is in question.

Adult↗

PubMed1995

Small cell lung cancer with and without superior vena cava syndrome: a multivariate analysis of prognostic factors in 408 cases.

PURPOSE: Patients with small cell lung cancer (SCLC) and superior vena cava syndrome (SVCS) are widely believed to have a grave prognosis. The purpose of this study was to determine the prognosis of patients with SCLC and SVCS as compared to SCLC without SVCS. METHODS AND MATERIALS: A retrospective analysis of 408 cases of SCLC +/- SVCS was performed. Three- hundred and sixty showed no clinical signs of SVCS and 43 (11%) had SVCS; in 5 patients no adequate information was available about clinical signs of SVCS. All patients were classified as limited disease cases. About 98% received chemotherapy usually as the first treatment followed by radiotherapy. A median total dose of 46 Gy (range 30 to 70 Gy) was given at 2.0 Gy per fraction five times weekly. A prophylactic cranial irradiation was applied if a complete remission was achieved after chemotherapy or after 30 Gy of irradiation. Kaplan-Meier survival curves are shown and comparisons were made by the log-rank and the Gehan/Wilcoxon test. To adjust for prognostic factors, a proportional hazards analysis was done. RESULTS: Patients without SVCS had 5-year survival rates ( +/- SE) and a median survival time (MST; 95% confidence intervals) of 11% +/- 2% and 13.7 months (12.7-14.5) in UICC Stage I to III; in Stage III the figures were 9% +/- 2% and 12.6 months (11.2-13.7). In comparison, SCLC with SVCS had 5-year survival rates of 15% +/- 7% and MST of 16.1 months (13.8-20.5). The difference was significant in univariate analysis (Stage II disease: p = 0.008 by the log-rank test). In a multivariate analysis of all patients, Stage (Stage I + II > III; p = 0.0003), SVCS (yes > no; p = 0.005), and Karnofsky performance status ( < or = 70 < 80-100%; p = 0.008) were of significant importance. CONCLUSIONS: SVCS is a favorable prognostic sign in SCLC. The treatment should be curatively intended.

Adult↗

PubMed1991

Multivariate analysis of cardiovascular reflexes applied to the diagnosis of autonomic neuropathy.

A battery of cardiovascular reflex tests is usually performed for the diagnosis of autonomic neuropathy. The tests discriminate well between normal and definitely abnormal autonomic function. However, in some patients the results are borderline and their autonomic status cannot be better defined. We performed multivariate statistical analysis of six cardiovascular autonomic tests with the aim of increasing their diagnostic efficiency. Eighty-five healthy subjects and 95 patients at risk for autonomic neuropathy were studied. Principal component analysis and two pattern recognition methods, the Bayesian technique and the SIMCA method, were applied. It was found that: (1) normal models obtained by Bayesian analysis showed very high specificity and sensitivity; (2) a battery of two tests for parasympathetic function (R-R interval variation test, deep breathing) and two tests for sympathetic function (blood pressure responses to standing and to sustained handgrip) provide an appropriate diagnostic approach, if multivariate analysis is used; (3) multivariate analysis allows a more precisely defined assessment of autonomic nervous system function in so-called borderline patients.

Adult↗

PubMed1995

A multivariate analysis of clinical and pathological factors that predict for prostate specific antigen failure after radical prostatectomy for prostate cancer.

A Cox regression multivariate analysis was done to determine the clinical and pathological indicators that predict for prostate specific antigen (PSA) failure in 347 patients who underwent radical prostatectomy for clinically localized prostate cancer between 1989 and 1993. In the patient subgroups (PSA less than 20 ng./ml. and biopsy Gleason sum 5 to 7 or PSA more than 10 to 20 ng./ml. and biopsy Gleason sum 2 to 4) not classifiable into those at high and low risk for postoperative PSA failure using PSA and biopsy Gleason sum, the status of the seminal vesicles and prostatic capsule on endo-rectal coil magnetic resonance imaging (MRI) allowed for this categorization. Specifically, 2-year actuarial PSA failure rates were 84% versus 23% in patients with and without seminal vesicle invasion, respectively, on MRI (p < 0.0001) and 58% versus 21% in those with and without extracapsular extension, respectively (p = 0.0001). In patients with extracapsular extension but without pathological involvement of the seminal vesicle(s) or poorly differentiated tumors (pathological Gleason sum 8 to 10), the 2-year actuarial PSA failure rates were 50% (margin positive), 28% (margin negative with established extracapsular disease) and 9% (margin negative with focal microscopic extracapsular disease). Therefore, endo-rectal coil MRI showing seminal vesicle invasion or extracapsular extension when the PSA level is less than 20 ng./ml. and the biopsy Gleason sum is 5 to 7 or the PSA level is more than 10 but less than 20 ng./ml. and the biopsy Gleason sum is 2 to 4 predicted for PSA failure. In patients with extracapsular extension who had pathological Gleason sum less than 8 disease with uninvolved seminal vesicles, the margin status and extent of extracapsular disease predicted for PSA failure.

Actuarial Analysis↗