scholarly journals Risk stratification and prognostic nomogram for post-recurrence overall survival in patients with recurrent extrahepatic cholangiocarcinoma

HPB ◽  
2017 ◽  
Vol 19 (5) ◽  
pp. 421-428 ◽  
Author(s):  
Byoung Hyuck Kim ◽  
Kyubo Kim ◽  
Eui Kyu Chie ◽  
Jeanny Kwon ◽  
Jin-Young Jang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Risk Stratification ◽  
Extrahepatic Cholangiocarcinoma

scholarly journals Identifying Risk Stratification Associated With a Cancer for Overall Survival by Deep Learning-Based CoxPH

IEEE Access ◽  
2019 ◽  
Vol 7 ◽  
pp. 67708-67717 ◽  
Author(s):  
Cheng-Hong Yang ◽  
Sin-Hua Moi ◽  
Fu Ou-Yang ◽  
Li-Yeh Chuang ◽  
Ming-Feng Hou ◽  
...  
Keyword(s):  
Overall Survival ◽  
Deep Learning ◽  
Risk Stratification

scholarly journals Risk stratification in pediatric low-grade glioma and glioneuronal tumor treated with radiation therapy: an integrated clinicopathologic and molecular analysis

2020 ◽  
Vol 22 (8) ◽  
pp. 1203-1213 ◽  
Author(s):  
Sahaja Acharya ◽  
Jo-Fen Liu ◽  
Ruth G Tatevossian ◽  
Jason Chiang ◽  
Ibrahim Qaddoumi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiation Therapy ◽  
High Risk ◽  
Risk Stratification ◽  
Risk Groups ◽  
Low Risk ◽  
Glioneuronal Tumor ◽  
Low Grade ◽  
Diffuse Astrocytoma ◽  
Prognostic Features

Abstract Background Management of unresectable pediatric low-grade glioma and glioneuronal tumor (LGG/LGGNT) is controversial. There are no validated prognostic features to guide use of radiation therapy (RT). Our study aimed to identify negative prognostic features in patients treated with RT using clinicopathologic and molecular data and validate these findings in an external dataset. Methods Children with non-metastatic, biopsy-proven unresectable LGG/LGGNT treated with RT at a single institution between 1997 and 2017 were identified. Recursive partitioning analysis (RPA) was used to stratify patients into low- and high-risk prognostic groups based on overall survival (OS). CNS9702 data were used for validation. Results One hundred and fifty patients met inclusion criteria. Median follow-up was 11.4 years. RPA yielded low- and high-risk groups with 10-year OS of 95.6% versus 76.4% (95% CI: 88.7%–98.4% vs 59.3%–87.1%, P = 0.003), respectively. These risk groups were validated using CNS9702 dataset (n = 48) (4-year OS: low-risk vs high-risk: 100% vs 64%, P < 0.001). High-risk tumors included diffuse astrocytoma or location within thalamus/midbrain. Low-risk tumors included pilocytic astrocytoma/ganglioglioma located outside of the thalamus/midbrain. In the subgroup with known BRAF status (n = 49), risk stratification remained prognostic independently of BRAF alteration (V600E or fusion). Within the high-risk group, delayed RT, defined as RT after at least one line of chemotherapy, was associated with a further decrement in overall survival (P = 0.021). Conclusion A high-risk subgroup of patients, defined by diffuse astrocytoma histology or midbrain/thalamus tumor location, have suboptimal long-term survival and might benefit from timely use of RT. These results require validation.

Examining Measures of Proliferation for Use in Risk Stratification of Myeloma

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 5093-5093
Author(s):  
Mark R.E. Coyne ◽  
Linda Wellik ◽  
Esteban Braggio ◽  
Michael E O'Dwyer ◽  
Corrado Santocanale ◽  
...  
Keyword(s):  
Overall Survival ◽  
Risk Stratification ◽  
Relative Increase ◽  
Cell Labelling ◽  
Time To Progression ◽  
Minichromosome Maintenance ◽  
Proliferation Indices ◽  
Similar Correlation ◽  
R Value ◽  
Stratification System

Abstract Abstract 5093 A relative increase in proliferation is now accepted as the most important measure in risk stratification of myeloma. Attempts to include measures of proliferation in different stratification strategies have been met with obstacles largely influenced by their practicality and economic viability in the clinical setting. The plasma cell labelling index (PCLI) is the gold standard used in myeloma; however it is still only used in a minority of centers across the globe. New surrogate markers of proliferation, such as serum biomarkers and transcription-based methods, are under investigation but few have evolved to become part of a uniform strategy in the stratification of myeloma. The gene-expression based proliferation indices (gPI) described by Bergsagel et al, Shaughnessy et al and Hose et al all show similar correlation with PCLI. Studies comparing all currently available methods are lacking. In a cohort of 70 patients, PCLI and gPI were compared with two immunohistochemistry-based methods of measuring proliferation, Ki67 and a more specific measure of S-phase entry – phosphorylation of minichromosome maintenance protein 2 (pMcm2) at serine 40/41, combined with dual staining of CD138. We observed a similar correlation of gPI wth PCLI to that previously reported (r value; CI – 0.43;0.21–0.61). Both Ki67 and pMcm2 staining showed a stronger correlation with PCLI than with gPI and PCLI (r value; CI – 0.81;0.71–0.88 and 0.86; 0.78 – 0.91 respectively). PCLI and gPI have already been shown to be an independent predictor of time to progression and overall survival. Although this sample size was too small to test for time to progression or overall survival and thus independence, a logical extrapolation would indicate similar independence and predictions on survival and time to progression. As Ki67 is routinely used for more proliferative cancers in the clinic, the extension of its use as part of a new stratification system in myeloma provides interesting possibilities for further exploration. Disclosures: O'Dwyer: Novartis: Honoraria, Research Funding.

Ph-Negative Chronic Myeloproliferative Neoplasms – Population Analysis, a Single Center 10-years’ Experience

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5556-5556
Author(s):  
Vasily Shuvaev ◽  
Irina Martynkevich ◽  
Alla Abdulkadyrova ◽  
Vera Udaleva ◽  
Tatyana Zamotina ◽  
...  
Keyword(s):  
Overall Survival ◽  
Risk Stratification ◽  
Molecular Mechanisms ◽  
Conflicts Of Interest ◽  
Risk Group ◽  
Myeloproliferative Neoplasms ◽  
Population Analysis ◽  
Myelogenous Leukemia ◽  
Rank Test ◽  
Chronic Myeloproliferative Neoplasms

Abstract Objectives and background. Nowadays chronic myeloproliferative neoplasms (MPN) other than chronic myelogenous leukemia undergo renaissance of interest. It results from advances in decryption of molecular mechanisms of pathogenesis and invention of target drugs. Epidemiological information is needed to assess potential effect and additional costs of new diagnostic and therapeutic techniques. The objective of our study was to review experience of MPN diagnostic and treatment in our center for past ten years. Methods. Our institution serves as primary hematological outpatient department for a half of Saint-Petersburg city with about 2 million inhabitants. We reviewed patients' charts to obtain information about incidence, symptoms, diagnostic test results, treatment options and relationship to prognostic factors. Statistical methods included descriptive statistics, nonparametric ANOVA for frequencies comparisons and Kaplan-Meyer method with log-rank test for survival comparisons in Statistica 7.0 package. Results. Since 2004 to 2013 there were 570 newly diagnosed MPN patients (pts) in our center. This group consisted of primary myelofibrosis (PMF) (203 pts; 126 female, 77 male; median age 63 years, range 16-83 years), essential thrombocythemia (ET) (201 pts; 146 female, 55 male; median age 58 years, range 23-78 years), polycythemia vera (PV) (166 pts; 96 female, 70 male; median age 57 years, range 20-85 years). The incidence rates were stable during study period: PMF incidence varied from 0.65 to 1.35 with mean of 1.01 new patient per 100 000 inhabitants per year; ET had incidence from 0.60 to 2.1 with mean of 1.00 and PV had incidence from 0.5 to 1.15 with mean of 0.83. The most prevalent symptoms of disease were: splenomegaly (65.5%), constitutional symptoms (fever, night sweats, weight loss) (31.0%), anemia (36.3%) thrombosis (24.1%) for PMF; fatigue (33.2%), headache and dizziness (25.6%), arthralgia (21.8%), erythromelalgia (15.8%) for ET; plethora (82.5%), headache and dizziness (52.4%), fatigue (31.3%) for PV. JAK2V617F was detected in 49.7% of PMF pts, 57.8% of ET pts and in 97.7% of PV pts. Thrombosis rates according WHO IPSET-thrombosis system risks` groups of ET and PV pts were: low-risk group 3.33% (3/90), intermediate-risk group 11.1% (13/117) and 39.4% (63/160) in high-risk group with highly significant (p<0.0001) differences between risks' groups. There were 169 lethal outcomes in the analysed group (102 PMF; 31 ET; 36 PV). Ten-years overall survival rates were 49.8% in PMF pts, 84.6% in ET pts and 78.3% in PV pts. (fig.1). Overall survival in PMF was significantly influenced by risk stratification as IPSS, DIPSS and DIPSS+. Survival curves according DIPSS+ groups are presented in fig.1. Conclusions. Patients with MPN are presented in substantial number; therefore need much finance for novel therapy introduction. Risk stratification systems has high predictive value. Innovative drugs treatment results should be evaluated in comparison with historical control. Figure1 Overall survival in PMF patients according to DIPPS+ stratification groups. Figure1. Overall survival in PMF patients according to DIPPS+ stratification groups. Disclosures No relevant conflicts of interest to declare.

Correlation of Cks1 and p27kip1 with tumor biologic aggressiveness and survival in gastrointestinal stromal tumor

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e15549-e15549
Author(s):  
J. W. Horvath ◽  
W. Frankel ◽  
A. Bellizzi ◽  
K. Guenterberg ◽  
O. H. Iwenofu
Keyword(s):  
Overall Survival ◽  
Risk Stratification ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Low Risk ◽  
Negative Regulator ◽  
High Expression ◽  
Continuous Variables ◽  
Actuarial Survival ◽  
Tumor Risk

e15549 Background: The biologic behavior of gastrointestinal stromal tumors (GIST) based upon morphologic parameters is unpredictable. Cyclin dependent kinase-1 (Cks1) plays an important role in the ubiquitination and proteolysis of p27kip1, a negative regulator of protein kinase Cdk2/cyclin E and Cdk2/cyclin A. This study was to ascertain whether Cks1 overexpression and p27kip1 downregulation were predictive of biologic aggressiveness and overall survival in GIST. Methods: Tissue microarray was built from 61 patients with GIST. Pathology reports as well as clinical follow-up were retrieved. Sections were stained with antibodies to p27kip1 and Cks1. Staining was scored for quantity of tumor cells (%) and intensity (0, 1+ weak staining, 2+ strong staining), and a score was calculated from the product of intensity and %. Tumors were evaluated for correlation of p27kip1 and Cks1 expression level with overall survival time and tumor risk stratification. Tumor risk stratification was classified into very low risk, low risk, intermediate risk, and high risk, and is reflective of intrinsic biologic aggressiveness. Actuarial survival curves were estimated using Kaplan Meier method. Results: The tumors show a high frequency of Cks1 expression (92%; 1+, n=39; 2+, n=17). The % expression ranged from 0–90% (mean 37%). The p27kip1 positive rate is 85% (1+, n=20; 2+, n=32). The % expression ranged from 0–90% (mean 48%). Overall survival ranged from 0.1–10.7 years. By univariate analysis of overall survival using Cox regression model, increased p27kip1 expression (continuous variable) is significantly correlated with overall survival (p=0.04), but Cks1 expression does not (p=0.84). In a univariate analysis of p27kip1 and Cks1 (continuous variables) with risk stratification of the tumor using F-test, higher tumor grade has significantly higher Cks1 expression values (p=0.0045). Conclusions: Our study shows that with univariate analysis high expression of Cks1 expression is significantly associated with increased intrinsic biologic aggressiveness, while high expression of p27kip1 is associated with increased overall survival. The lack of correlation of Cks1 and p27kip1 suggests additional p27kip1 independent mechanisms might play a role in the oncogenesis of GIST. No significant financial relationships to disclose.

Enhancing risk stratification in primary mediastinal nonseminomatous germ cell tumors (PMNSGCT): A 27-year experience at a tertiary cancer center.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 373-373
Author(s):  
Andrea Necchi ◽  
Salvatore Lo Vullo ◽  
Patrizia Giannatempo ◽  
Elena Farè ◽  
Daniele Raggi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Risk Stratification ◽  
Elevated Serum ◽  
Germ Cell Tumors ◽  
Good Prognosis ◽  
Rank Test ◽  
Cancer Center ◽  
High Survival ◽  
Prognostic Impact ◽  
Final Histology

373 Background: Mediastinal GCTs and PMNSGCTs poorly benefit from CT and half of patients (pts) still die for disease. Enhancing the risk stratification may result in tailoring a personalized treatment strategy since diagnosis. Methods: Between 1985 and 2012, 87 pts with PM-GCT were treated at our center. Of them, pure seminomatous histology was excluded. Cox proportional hazards regression analysis was conducted to examine the prognostic impact of these candidate factors on overall survival (OS): type of 1st-line CT (high [HDCT] vs conventional dose [CDCT]), post-CT surgery, type of baseline elevated serum tumor marker (STM), presence of lung or liver-bone-brain metastases (LBB), STM response (still elevated vs normal or normalized), and histology (viable cancer [VC] vs necrosis/teratoma [NT]). OS curves were compared by Kaplan Meier method with the log-rank test. Results: The study included 68 cases with PMNSGCT. Median age was 28.5 yrs (IQR: 23-35). 12 pts (17.7%) presented with mediastinal syndrome, 23 (33.8%) had lung and 7 (10.3%) LBB metastases. 12 pts received upfront HDCT and 45 pts (66.2%) underwent post-CT surgery. The final model of poor prognostic factors included no surgery (HR: 8.74, 95%CI, 1.77-43.01), surgery + VC (HR: 6.97, 95%CI, 1.46-33.30), and lung metastases (HR: 2.92, 95%CI, 0.99-8.64). The model demonstrated moderate discriminatory ability for OS (c-statistic=0.68). A risk stratification model based on the combination of these factors and accounting for a 50% five-year survival cutoff identified 2 groups (poor prognosis, N=28 vs good prognosis, N=26) with distinct overall survival curves (p<0.001). Pre-operative STM and final histology were not associated (p=0.574 at Chi squared test). 5-yr OS after receiving 2nd line CT (n=25) was 18.7% (95%CI, 7.9-44.5). Results are limited by small numbers. Conclusions: Pts with PMNSGCT classified as having a good prognosis in this model had a fairly high survival estimate, while a strategy of consolidation CT for pts with poorest risk features warrants investigation, once the model is confirmed. The effect of surgery on survival was independent of post-CT STM, which also poorly predicted final histology.

Evaluation of serial measurements of C-reactive protein: Albumin ratio in patients with clear cell renal cell carcinoma.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 695-695
Author(s):  
Dattatraya H Patil ◽  
Ella N Anastasiades ◽  
Mersiha Torlak ◽  
Aaron Lay ◽  
Mehrdad Alemozaffar ◽  
...  
Keyword(s):  
Overall Survival ◽  
Risk Stratification ◽  
Repeated Measures ◽  
Clear Cell ◽  
Surgical Stress ◽  
C Reactive Protein ◽  
Albumin Ratio ◽  
Reactive Protein ◽  
T Stage ◽  
Clear Cell Rcc

695 Background: Sequential measurements of prognostic markers is an important protocol for accurate prediction of clinical outcomes in clear cell RCC. We propose that change in value of C-Reactive Protein to albumin ratio before and after surgery would be a good prognostic indicator for assessment of overall survival and risk stratification in clear cell RCC. Methods: Patients that underwent nephrectomy for clear cell RCC between 2007 and 2016 were followed up with CRP-Albumin measurements for 3 post-op visits (1, 3, 6 months). All measurements between post-op day 1 to 21 were excluded from analysis owing to possible confounding effect due to surgical stress. We assessed if change in CRP-Albumin ratio from pre-operative level is associated with any patient and tumor characteristics by fitting linear regression generalized estimating equations models to account for correlation in repeated measures. Average change in level for each post-op visit was used to stratify for an eventual end of follow-up outcome. Results: 302 clear cell RCC patients were treated with nephrectomy with mean age at surgery was 59.9±11 years, and mean BMI of 30.1± 6.6. 103 patients had at least 2 time-points available after surgery. Table 1 depicts mean CRP-Albumin ratio with 95% CI for each visit stratified with vital status. A linear GEE model fitted for baseline factors affecting change in ratio , identified t-stage, Fuhrman nuclear grade, gender, and BMI as significantly associated (p < 0.05). Conclusions: Serial measurement of CRP/Albumin ratio is useful factor for personalized risk-stratification for prognosticating overall survival as well as recurrence in patients with clear cell RCC. Significant effect of T-stage, tumor grade, and BMI depicts close relationship of CA-ratio and established risk predictors. [Table: see text]

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