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At least 19 recordsLinked to original sources

Prognostic factors in stroke.

Prognostic factors in 137 patients with acute ischaemic infarction of the cerebral hemisphere were examined in a prospective study with particular reference to acute mortality, delayed mortality and the ability to regain independent living. Adverse factors in the examination on admission to hospital with regard to all these aspects were found to be a reduction of the level of consciousness to any degree and paralysis of conjugate gaze. A severe hemiplegia and advancing age indicated a bad prognosis for delayed mortality and severe disability in survivors, but did not affect acute mortality. At three weeks after the onset, inability to walk unaided, a useless hand and or urinary incontinence was associated with an increased probability of death in the next few months and of failure to regain independence in the survivors. These adverse factors appeared to correlate with infarction extending beyond the middle cerebral artery territory, severe brain swelling and recent occlusion of the internal carotid artery.

Age Factors

[Prognostic factors in epitheliomas of the breast].

Prognostic factors in breast carcinoma were studied on material which consisted of 733 patients with a follow-up of over 5 years and on 361 with a follow-up of over 10 years. In the first part of the study the prognostic factors are related to the physical characteristics of the primary tumour such as its situation and size and its relationship to skin and deep tissues. Clinical examination of the axilla, studied in detail, has proved a reliable guide to prognosis. The second part deals with such factors as age, hormonal status, age at first pregnancy and parity. A critical analysis of the T.N.M. classification ends the study, with special reference to the prognostic factors which relate to the primary tumour.

Adult

Prognostic factors in absence seizures.

A prospective follow-up study was conducted on 48 epileptic patients (22 males and 26 females) who had participated in a collaborative study of absence seizures about 7 years earlier. Multivariate analysis showed that the significant prognostic factors for absence seizures were normal or above normal intelligence and normal electroencephalographic background activity. For any seizure type, significant prognostic factors were a negative history of generalized tonic-clonic seizures, normal or above normal intelligence, and a negative family history of seizure disorders. Nearly 90 percent of the patients with all significant prognostic factors for both absence seizures and seizures of all types ceased having seizures.

Adolescent

Prognostic factors in polyarteritis.

The clinical course of 40 patients with polyarteritis was reviewed to determine prognostic factors and response to treatment. The first three months were the most critical to survival. Survivorship was 57 per cent at five years. Older age of onset, involvement of skeletal muscle and presence of peripheral neuropathy weighted against a satisfactory outcome. Cutaneous vasculitis was associated with a more benign course. Myocardial disease, central nervous system involvement, or hypertension were not invariably poor prognostic factors. Muscle biopsies, even in the absence of clinical involvement, were a useful diagnostic procedure, and renal angiograms were found to be a valuable alternative to renal biopsy. An unequivocal distinction on clinical and histopathologic criteria could not be made among polyarteritis nodosa, hypersentitivity angiitis, and allergic granulomatosis. Australia antigenemia occurred in six per cent of patients. Although evaluation of therapy was difficult, data from this study did not show a superiority of high vs. low dosage of corticosteroids in suppressing active disease.

Adult

Prognostic factors for patients with brain tumors.

Patient characteristics of 225 patients entered into a clinical trial conducted by the Brain Tumor Study Group (69-01) were examined for their relationship to survival time. In the clinical study, all patients received surgery and were randomized to control treatment (no further treatment), X-ray therapy (XRT), 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU), or BCNU + XRT. When treatment was considered as a possible prognostic factor, the patient characteristics most related to survival were: XRT (receiving XRT favorable), age (young, favorable), symptoms of seizures and cranial nerves (both favorable), BCNU treatment (yes, favorable), encapsulated tumor (yes, favorable), and parietal tumor (no, favorable). When treatment was not considered a possible prognostic factor, the patient characteristics most related to survival were: age (young, favorable), biopsy (operation biopsy only, unfavorable), seizures (yes, favorable), cranial nerve symptoms (yes, favorable), and parietal location of tumor (yes, unfavorable). Knowledge of prognostic factors can be used for stratifying patients in clinical studies, for testing the comparability of groups of patients, and in the analysis of the results of clinical studies.

Age Factors

High-grade astrocytoma with piloid features: a clinical and genomic analysis of prognostic factors using a large cohort.

BACKGROUND: High-grade astrocytoma with piloid features (HGAP) is a recently defined tumor type that is not well-understood. Prognostic factors of clinical outcomes are not well-established. METHODS: Methylation profiling was performed on tumor samples, many at the National Cancer Institute (NCI) Laboratory of Pathology, and others from publicly available sources. Methylation classifier scores of ≥ 0.90 to the HGAP class on the NCI-Bethesda classifier version 3 were included. Clinical features were collected from the medical record. Survival analyses were performed using the Kaplan-Meier and Cox-proportional hazards methods. RESULTS: The cohort comprised 421 patients. There were high rates of ATRX alteration (62%), CDKN2A/B homozygous loss (78%) and MGMT promoter methylation (53%). MAPK alterations were identified in 74% of evaluable samples. The median age was 46 years, and posterior fossa location was predominant (52%). The median overall survival (OS) was 88 months. Older age (p = 0.01) and the presence of an ATRX alteration (p = 0.04) were found to be negative prognostic factors. The presence of cystic features on magnetic resonance imaging (MRI) was found to be favorably prognostic (p = 0.01). Factors that were not significantly associated with prognosis included histologic high-grade features, CDKN2A/B homozygous deletion, MGMT promoter methylation, extent of resection, and presence of NF1 syndrome. CONCLUSIONS: This large cohort establishes relative frequencies of several important markers. Additionally, older age, the presence of an ATRX alteration, and cystic features on MRI were found to be prognostic. Our work may aid in optimizing treatment regimens for patients with this tumor type.

ATRX alteration

Disseminated intravascular coagulation in patients with meningococcal infection: laboratory diagnosis and prognostic factors.

In 36 patients with meningococcal infection a close association between the laboratory evidence of disseminated intravascular coagulation (DIC) and unfavourable prognostic factors was established. Patients with platelet count lessthan 100000/microliter, Normotest lessthan 50% and plasma fibrinogen concentration less than 100 mg/dl had a serious prognosis. No significant differences could be extablished between patients with infection from serogroup A and B meningococci for either laboratory evidence of DIC or prognostic factors.

Adolescent

[Unstable angina with threatening coronary lesions turned down for surgery. Outcome and prognostic factors].

The aim of this study based on a series of 200 patients, was to define the outcome and the prognostic factors of patients presenting with unstable angina, according to Bertolazi's criteria [3] and at least one stenosis greater than 80% on a proximal segment of a main coronary trunc, and to determine which factors should eventually be taken into consideration in the discussion of surgical indications. 70 out of 200 patients (35%) were turned down for direct revascularisation surgery because of an ejection fraction less than 0,35 and/or a poor arterial run off. Coronary arteriography showed 30% patients with a menacing stenosis (greater than 80%) on all three vessels, 36% on two vessels and 22% on a single vessel. The distribution and the extent of the lesions was about the same as in the operated patients. 20% patients had an ejection fraction less than 0,35, 24% between 0,34 and 0,50, and 56% greater than 0,50. At patient, the follow up period ranges from 22 to 66 months (average 32 months). In this group, the hospital mortality was 2,9%, the secondary cardiac deaths 16% and the global mortality 19% compared to 12,6% for the operated patients in the same period. The incidence of secondary non-fatal infarction was low (9%). 52% of survivors have persistent angina, 39% severe (Class II or III). Two prognostic factors were detected from this study: the type of angina: the intermediary syndrome had a bad prognosis, 38,5% mortality compared to 13% for aggravated chronic angina; and the ventriculography: patients with ejection fractions less than 0,35 had 64% mortality compared to 7,3% for those with ejection fractions greater than 0,40. The number of menacing lesions, the extent of the lesions of the artery involved did not affect the prognosis when severe abnormalities of left ventricular function were absent.

Adrenergic beta-Antagonists

Prognostic factors in pediatric cases of drowning and near-drowning.

Ninety-three cases of drowning or near-drowning in the pediatric age group between 1972 and 1976 were reviewed. A scoring system for prognostic factors was developed using one point for each of five unfavorable factors involved in the drowning or near-drowning of each patient. The prognostic factors were 1) age less than three years; 2) maximum submersion time estimated longer than five minutes; 3) resuscitation not attempted for at least ten minutes after rescue; 4) patient in coma on admission to hospital, and 5) arterial blood pH of less than or equal to 7.10. This scoring system significantly predicted the eventual outcome of patients who had experienced the postsubmersion syndrome. Patients with scores of less than or equal to 2 had a 90% chance of full recovery; those with scores of greater than or equal to 3 had only a 5% probability of survival. The early institution of resuscitative efforts was the single most important factor influencing survival.

Adolescent

Radical radiation therapy of advanced lung cancer: evaluation of prognostic factors and results of continuous and split course treatment.

One hundred patients with inoperable (80) or unresectable (20) bronchogenic carcinoma without evidence of spread beyond the thorax and supraclavicular nodes were planned for radical radiotherapy. Seventy-six patients received continuous irradiation (6000 rads in 30 treatments in 6 weeks, TDF 99) and 24 received split course therapy (2 courses of 2500 rads in 10 treatments with a 3 week break between courses, TDF 88). Forty-three patients had squamous cell carcinoma or adenocarcinoma and were considered to have favorable prognostic factors, while 57 patients had unfavorable prognostic factors: undifferentiated large cell or small cell carcinoma, supraclavicular metastases, SVC obstruction, superior sulcus tumors, or bone erosion in continuity with the tumor. Ninety-two patients completed the planned course of treatment. In patients completing treatment, local control of cancer within the irradiated volume was achieved in 58.5% of continuously irradiated patients and 45.4% of patients receiving split course therapy. Median survival was 1.2 months in patients not completing treatment and 12 months for the patients who completed treatment; 19% of the total group survived 3 years. Median and 3 year survivals of 14 months and 20.4% and of 9 months and 11% were observed for patients treated continuously and by the split course techniques, respectively. Corresponding survival figures for patients with favorable and unfavorable prognostic signs were 21 months and 26%, and 4 months and 11%, respectively. Implications of these data for treatment planning and patient selection for radical radiotherapy in bronchogenic carcinoma are discussed.

Adenocarcinoma

Prognostic factors affecting remission, remission duration, and survival in adult acute nonlymphocytic leukemia.

The medical records of 94 consecutive patients with acute nonlymphocytic leukemia (ANLL) were reviewed to identify significant prognostic factors. The data were analyzed using 1) Cox's linear hazard and linear logistic models, 2) chi-square comparison of the groups living longer than 2 years and those living less than 2 years, and 3) the Gehan-Breslow test of equal survival curves. The only statistically significant finding was that the presence of promyelocytic cell type and complete remission correlated with increased survival (p less than .05), but this was negated by the small number of patients with this cell type. There was a suggestive association between higher initial hemoglobin and survival (p = .09). The Gehan-Breslow test revealed a possible difference in survival between those patients more than 51 years of age and those less than 51 (p = .10). Thus none of the commonly accepted prognostic factors in acute nonlymphocytic leukemia was definitely shown to be useful. The findings of this study support an aggressive approach toward all patients with this disease.

Adolescent

Clinical prognostic factors in osteosarcoma.

Clinical characteristics thought to be of prognostic importance for patients with osteosarcoma are reviewed. The importance of considering prognostic factors in the evaluation of new therapies when no concurrent control group is available is emphasized.

Adult

[Prognostical factors of breast neoplasms without metastasis. Synthesis by a multifactoral analysis].

Multifactorial analysis by dichotomous split was applied to a consecutive series of 541 female breast cancer patients without detectable metastasis at onset of treatment. These patients were entirely treated in the same institution (Fondation Bergonié), in the years 1960-1974. This multifactorial analysis sets a hierarchical order among the different prognostic factors and defines groups of patients homogeneous for metastatic risks. The significant prognostic factors in these series are : number of malignant axillary nodes; location and size of tumour; state of adjacent skin; relations with thoracic wall; pre or post-menopausal status; inflammatory signs; thermographic and mammographic data.

Adult

Prognostic factors for advanced diffuse histiocytic lymphoma following treatment with combination chemotherapy.

Combination chemotherapy can dramatically improve the survival of those patients with advanced diffuse histiocytic lymphoma who enter complete remission. The age, sex, stage, constitutional symptoms, sites of disease and tumor mass of 56 consecutive patients with advanced diffuse histiocytic lymphoma were analyzed as prognostic factors. Twenty-four patients received cytoxan, vincristine, procarbazine and prednisone (C-MOPP) and 32 patients received bleomycin, adriamycin, cytoxan, vincristine and prednisone (BACOP). In 26 of 56 (46 per cent) a complete remission was achieved, in 21 of 56 (38 per cent) a partial remission and in nine of 56 (16 per cent) no response. Median survival with a complete remission was not reached at three years with 82 per cent still alive, but was significantly greater than with a partial remission (7.6 months median) or no response (3.2 months median). Survival of those with a partial remission and no response did not differ statistically. Stage IV disease, bone marrow involvement, gastrointestinal involvement and a tumor mass greater than 10 cm in diameter in a single location were all poor prognostic factors. No other analyzed factor significantly affected survival in this study. Complete response rates and survival curves for patients treated with C-MOPP were similar to those treated with BACOP.

Adult

Clinical and molecular prognostic factors in newly diagnosed pediatric T-cell lymphoblastic lymphoma: a prospective, multicenter, single-arm phase 2 clinical trial.

BACKGROUND: Poor early treatment response in T-cell lymphoblastic lymphoma (T-LBL) is associated with an unfavorable prognosis. This multicenter prospective study evaluated the efficacy of the response-adjusted Chinese Children's Cancer Group (CCCG-LBL-2016) protocol for pediatric T-LBL and examined clinical and molecular prognostic factors. METHODS: Clinical and laboratory data from seven pediatric oncology centers were analyzed. A sub-cohort of 23 patients underwent exploratory integrated genomic analysis, including targeted next-generation sequencing, RNA sequencing, and copy-number array analysis. Survival was evaluated using the Kaplan-Meier method, and prognostic factors were analyzed using multivariable Cox proportional hazards regression. RESULTS: A total of 163 patients (median age: 108&#xa0;months; 116 males, 47 females) were enrolled, most with advanced disease (stage III: 81.0%; stage IV: 17.8%). Patients were stratified into the low-risk (R1, n&#x2009;=&#x2009;2) and intermediate-risk groups (R2, n&#x2009;=&#x2009;161); thirty one patients in the R2 group were escalated to the high-risk intensified regimen (R3) due to poor early response. The 3-year overall survival (OS) was 78.6%&#x2009;&#xb1;&#x2009;3.3% and event-free survival (EFS) was 73.9%&#x2009;&#xb1;&#x2009;3.5%. Outcomes differed by risk group (P&#x2009;<&#x2009;0.05), with 3-year OS and EFS of 100% and 100% in R1, 82.6%&#x2009;&#xb1;&#x2009;3.4% and 79.5%&#x2009;&#xb1;&#x2009;3.4% in R2, and 58.6%&#x2009;&#xb1;&#x2009;9.1% and 48.3%&#x2009;&#xb1;&#x2009;9.1% in R3. Progression or recurrence occurred in 42 patients (median: 7&#xa0;months; 3-year OS: 17.1%&#x2009;&#xb1;&#x2009;6.3%). Clinical risk factors included R3 assignment and elevated lactate dehydrogenase. In the exploratory molecular sub-cohort, recurrent alterations included CDKN2A (39.1%), NOTCH1 (26.1%), FBXW7 (21.7%), and MTAP/PIK3R1/NRAS (13.0%). Exploratory multivariable Cox regression analysis identified that CDKN2A alteration was associated with an increased risk of progression or recurrence (hazard ratio&#x2009;=&#x2009;35.89, 95% confidence interval: 3.07-419, P&#x2009;=&#x2009;0.004). CONCLUSIONS: Adjusting the risk stratification based on treatment response significantly improved the overall prognosis of T-LBL. However, survival rates remain very low among patients who experience disease progression or recurrence. The preliminarily explored molecular genetic risk factors might contribute to further risk stratification and provide potential therapeutic targets.

Humans

Prognostic factors in acquired aplastic anemia. A study of 352 cases.

The prognostic factors of short- and long-term survival have been studied in 352 patients with aplastic anemia of all grades of severity. This group was homogeneous with regard to the clinical and laboratory survey, and the treatment used [high-dose androgen therapy]. The "hierarchy" of the individual prognostic parameters has been established: current severe infection, granulocyte count, percentage of the nonmyeloid cells on the bone marrow slides, platelet count, reticulocyte count, 59Fe utilization, and stromal disorganization on the bone marrow biopsy specimen. As these parameters are interrelated, a multiparametric analysis enables us to define groups of patients with different short-term evolution and to derive a prognostic index from these data. The use of such an index, however, allows a correct prediction in only 73 per cent of the cases, better in the milder than in the more severe cases. It is possible that the short-term evolutive tendency (improvement or worsening during the first six weeks of therapy) may contribute supplementary information useful for prognosis and the choice of treatment. After the first three months critical period, the mortality rate no longer depends on the initial severity of the disease but exclusively on the clinical and hematologic improvement. Thus, comparing the hematologic data obtained initially and after three months of androgen therapy allows us to correctly predict the long-term evolution.

Aged

Encirclement versus 360 degrees buckling and prognostic factors in retinal separation surgery.

In 554 consecutive primary cases, adverse prognostic factors for successful retinal detachment surgery were aphakic retinal detachment, severe vitreous traction creating retinal breaks, especially with lattice degeneration, long-standing retinal separations, choroidal or combined detachments, giant tears, Marfan's syndrome, and preoperative massive vitreous retraction (MVR). Vitreous haemorrhage was of secondary importance, and not a primary cause of MVR. The use of therapeutic encirclement is unnecessary and does not prevent the proliferative process of MVR. The few indications for cerclage, such as total retinal separation with no detectable breaks, total retinal separation with breaks in all quadrants, and MVR, are more effectively treated by 360 degrees scleral buckling. Encirclement should not be used as a constriction to obtain a buckle or to compensate for lost intraocular volume after drainage of subretinal fluid.

Humans

Established and emerging prognostic factors in mycosis fungoides and S&#xe9;zary syndrome.

Mycosis fungoides (MF) and S&#xe9;zary syndrome (SS) are the most common subtypes of cutaneous T-cell lymphoma (CTCL), characterized by heterogeneous clinical behavior and variable prognosis. Accurate prognostication is essential for risk-adapted management. This review synthesizes emerging evidence on prognostic factors in MF and SS, with a focus on recent genomic advances. Traditional prognostic frameworks are outlined, highlighting the prognostic impact of demographics, stage, clinical features, and histologic findings. More advanced prognostics are then outlined, including genomic alterations and impact of the tumor microenvironment. We highlight realms in which integration of traditional and more biological prognostic frameworks can support more individualized treatment strategies.

S&#xe9;zary syndrome