Combined Analysis of Intragastric Malignant Exfoliation and Ca 72.4 Concentration in Stomach Adenocarcinoma: The “GL1 Ca 72.4” Parameter

2020 ◽  
Vol 64 (6) ◽  
pp. 563-571
Author(s):  
Edoardo Virgilio ◽  
Enrico Giarnieri ◽  
Maria Rosaria Giovagnoli ◽  
Monica Montagnini ◽  
Sandra Villani ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Univariate Analysis ◽  
Gastric Lavage ◽  
Nodal Metastasis ◽  
Significant Prognostic Factor ◽  
Metastatic Node ◽  
Cytologic Examination ◽  
Kaplan Meier ◽  
Node Ratio ◽  
Stomach Adenocarcinoma

<b><i>Introduction/Objective:</i></b> Differently from other digestive malignancies, gastric cancer (GC) pathobiology is still little known and understood. Recently, cytopathology and molecular biology on gastric juice/gastric lavage (GJ/GL) of GC patients have provided novel and interesting results in terms of screening, diagnosis, prognosis, and therapy. However, entertaining cytologic examination and molecular test as a unified solo-run test is previously unreported. Our aim was to assess the new parameter “GL Ca 72.4” for GC patients. <b><i>Methods:</i></b> Between April 2012 and July 2013, GJ/GL obtained from 37 surgical GC patients were tested for the presence/absence (GL1/GL0) of exfoliated malignant cells along with the intragastric concentration of Ca 72.4 (normal value &#x3c;6.49 ng/mL: Ca 72.4n; elevated level ≥6.49 ng/mL: Ca 72.4+). <b><i>Results:</i></b> At a median follow-up of 79.3 months, all the GC alive patients were “GL0 Ca 72.4n.” The “GL1 Ca 72.4+” parameter, in comparison with GL0 Ca 72.4n, strongly correlated with deeper tumor invasion (<i>p</i> = 0.027), severe nodal metastasis (<i>p</i> = 0.012), worst metastatic node ratio (<i>p</i> = 0.041), higher number of metastatic lymph nodes (30 vs. 20 nodes, <i>p</i> = 0.014), angiolymphatic invasion (<i>p</i> = 0.044), advanced stage (<i>p</i> = 0.034), and adjuvant therapy (<i>p</i> = 0.044). The Kaplan-Meier model showed that GL1 Ca 72.4+ subjects had shorter overall survival (OS) than GL0 Ca 72.4n cases (9.7 vs. 43.2 months, respectively, <i>p</i> = 0.042). At univariate analysis, the GL1 Ca 72.4+ parameter resulted a significant prognostic factor for OS (<i>p</i> = 0.023). <b><i>Conclusions:</i></b> The combined cyto-molecular parameter “GL1 Ca 72.4+” appears to be a strong indicator of aggressive tumor behavior and a significant prognostic factor of poor survival for GC patients.

Prognostic Factors Associated with Outcomes in Small Bowel Neuroendocrine Tumors

2017 ◽  
Vol 83 (10) ◽  
pp. 1174-1178 ◽  
Author(s):  
Nicholas Manguso ◽  
Jeffrey Johnson ◽  
Attiya Harit ◽  
Nicholas Nissen ◽  
James Mirocha ◽  
...  
Keyword(s):  
Small Bowel ◽  
Neuroendocrine Tumors ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Disease Free Survival ◽  
Nodal Metastasis ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Open Operation ◽  
Recurrence Group

Small bowel neuroendocrine tumors (SBNET) account for most gastrointestinal neuroendocrine tumors. Patients often present with late-stage disease; however, there is little information regarding factors that contribute to recurrence. Database review identified 301 patients diagnosed with SBNET between 1990 and 2013. Univariate analysis included patients who underwent complete resection. Survival was estimated by the Kaplan–Meier method. A total of 147 patients met study criteria. Average age was 60 years (range 21–91); 49 per cent were male. Thirty-seven (25.3%) patients had laparoscopic resection, and 29 (19.9%) patients had only small bowel disease, whereas 108 (72.6%) had nodal metastasis. Five-year overall and disease-free survival were 97.5 and 73.5 per cent. Forty-seven (32%) patients had recurrence. The recurrence group was more likely to have an open operation (59.6 vs 32%, P < 0.01), mesenteric invasion, or lymphatic metastasis (87.2 vs 67%, P < 0.01) compared with the no-recurrence group. Cox regression analysis showed that variables associated with recurrence included nodal disease (HR 9.06, P = 0.03), lymphovascular invasion (LVI) (3.95, P < 0.01), perineural invasion (PNI) (3.48, P < 0.01), and mesenteric involvement (3.77, P = 0.03). Patients with SBNET presenting with nodal metastasis, mesenteric involvement, LVI, or PNI have a higher risk of recurrence. Closer surveillance should be considered after operative resection.

Regression Does Not Predict Nodal Metastasis or Survival in Patients with Cutaneous Melanoma

2011 ◽  
Vol 77 (8) ◽  
pp. 1009-1013 ◽  
Author(s):  
Alison L. Burton ◽  
Juliana Gilbert ◽  
Russell W. Farmer ◽  
Arnold J. Stromberg ◽  
Lee Hagendoorn ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Cutaneous Melanoma ◽  
Clinical Decision Making ◽  
Univariate Analysis ◽  
Disease Free Survival ◽  
Nodal Metastasis ◽  
Breslow Thickness ◽  
Significant Prognostic Factor ◽  
Superficial Spreading ◽  
Histologic Subtype

Controversy exists regarding the prognostic implications of regression in patients with cutaneous melanoma. Some consider regression to be an indication for sentinel lymph node (SLN) biopsy because regression may result in underestimation of the true Breslow thickness. Other data support regression as a favorable prognostic indicator, representing immune system recognition of the primary tumor. This analysis was performed to determine whether regression predicts nodal metastasis, disease-free survival (DFS), or overall survival (OS). Post hoc analysis was performed of a multicenter prospective randomized trial that included patients aged 18 to 70 years with cutaneous melanomas 1 mm or greater Breslow thickness. All patients underwent SLN biopsy; those with tumor-positive SLN underwent completion lymphadenectomy. Kaplan-Meier analysis of survival, univariate analysis, and multivariate analysis were performed. A total of 2220 patients (261 with regression; 1959 without regression) were included in this analysis with a median follow-up of 68 months. Patients with regression were more likely to be male, older than 50 years old, and have lower median Breslow thickness, superficial spreading histologic subtype, and a non-extremity anatomic location ( P < 0.05 in all cases). Regression was not significantly associated with Clark level, ulceration, lymphovascular invasion, number of SLNs removed, or SLN metastasis. On multivariate analysis, factors independently predictive of DFS included Breslow thickness, ulceration, and SLN status ( P < 0.05 in all cases); the same factors along with age, gender, and anatomic tumor location were significantly associated with OS ( P < 0.05 in all cases). Regression was not significantly associated with DFS (risk ratio [RR], 0.94; 95% confidence interval [CI], 0.67-1.27; P = 0.68) or OS (RR, 1.01; 95% CI, 0.76-1.32; P = 0.93). These data suggest that regression is not a significant prognostic factor for patients with cutaneous melanoma and should not be used to guide clinical decision-making for such patients.

scholarly journals De Ritis Ratio (Aspartate Transaminase/Alanine Transaminase) as a Significant Prognostic Factor in Patients Undergoing Radical Cystectomy with Bladder Urothelial Carcinoma: A Propensity Score-Matched Study

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Hyeong Dong Yuk ◽  
Chang Wook Jeong ◽  
Cheol Kwak ◽  
Hyeon Hoe Kim ◽  
Ja Hyeon Ku
Keyword(s):  
Prognostic Factor ◽  
Propensity Score ◽  
Radical Cystectomy ◽  
Cox Regression ◽  
Alanine Transaminase ◽  
Significant Prognostic Factor ◽  
Aspartate Transaminase ◽  
Cancer Specific Survival ◽  
T Stage ◽  
Kaplan Meier

Introduction. To investigate the correlation between preoperative De Ritis ratio (aspartate transaminase (AST)/alanine transaminase (ALT)) and postoperative outcome in patients with urothelial cell carcinoma (UC) treated with radical cystectomy. Materials and Methods. We analyzed the clinical and pathological data of 771 patients who underwent radical cystectomy for bladder UC. Patients were divided into two groups according to the optimal value of AST/ALT ratio. The effect of the AST/ALT ratio was analyzed using the Kaplan–Meier method and Cox regression hazard models for patients’ cancer-specific survival (CSS), overall survival (OS), and recurrence-free survival (RFS). In addition, propensity score matching of 1 : 1 was performed between the two groups. Results. Median follow-up was 84.0 (36–275) months. Mean age was 64.8±10.0 years. According to the receiver operating characteristic (ROC) analysis, the optimal threshold of the AST/ALT ratio was 1.1. In Kaplan–Meier analyses, the high AST/ALT group showed worse outcomes in CSS and OS (all P<0.001). Also, RFS (P=0.001) in the Cox regression models of clinical and pathological parameters was used to predict CSS, OS, and AST/ALT ratio (HR 2.15, 95% CI 1.23-3.73, P=0.007) and pathological T stage (HR 4.80, 95% CI 1.19-19.28, P=0.003). To predict OS and AST/ALT ratio (HR 2.05, 95% CI 1.65–2.56, P<0.001), pathological T stage (HR 2.96, 95% CI 0.57–17.09, P=0.037) and positive lymph node (HR 1.71, 95% CI 1.50–1.91, P=0.021) were determined as independent prognostic factors. Conclusion. Preoperative AST/ALT ratio could be an independent prognostic factor in patients with UC treated with radical cystectomy.

scholarly journals Lymph node ratio versus TNM system as prognostic factor in colorectal cancer staging. A single Center experience

Open Medicine ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. 523-531 ◽  
Author(s):  
Francesco Moccia ◽  
Salvatore Tolone ◽  
Alfredo Allaria ◽  
Vincenzo Napolitano ◽  
D’Amico Rosa ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Lymph Node ◽  
Prognostic Factor ◽  
Lymph Node Ratio ◽  
Univariate Analysis ◽  
Tnm Staging ◽  
Survival Prediction ◽  
Tnm System ◽  
Number Of Patients ◽  
Node Ratio

AbstractObjectiveThis study aims to establish the actual validity of the lymph node ratio (LNR) as a prognostic factor for colorectal cancer patients, and to verify differences of survival and disease-free interval.MethodsPatients referred with colorectal cancer who underwent potentially curative surgery between January 1997 and December 2011 were included. Lymph node ratio, TNM staging and survival were extracted from surgical, histological and follow-up records.ResultsTwo hundred eigthy six patients with different stages of colorectal cancer underwent surgery, with comparison of survival prediction based on lymph node ratio and TNM staging. The overall survival rate was 78.3%, the recurrence rate was 11.9% and the mortality rate was estimated as 21.7%. Univariate analysis in relation to survival was significant for the following variables: serum level of CEA, CA 19.9 value, degree of histological differentiation, and tumor growth. There weren’t any statistically significant differences for the LNR (LNR </ ≥0.16: p = 0.116). The TNM system was effective both in discriminating between survival stages (Stage II vs. Stage III: p = 0.05) and in differentiating sub-groups (p = 0.05).ConclusionsLNR alone could not be considered a better prognostic factor than the TNM system. However, future studies are needed in a larger number of patients with a standardized surgical, pathological and medical protocol.

Creatinine Clearance Is More Important Prognostic Factor Than ß2 Microglobulin in Multiple Myeloma.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4864-4864
Author(s):  
Jae-Pil Yun ◽  
Cheolwon Suh ◽  
Eunkyoung Lee ◽  
Jai Won Chang ◽  
Won Seok Yang ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Prognostic Factor ◽  
Creatinine Clearance ◽  
Survival Time ◽  
Univariate Analysis ◽  
Staging System ◽  
Rank Test ◽  
Significant Prognostic Factor ◽  
Important Prognostic Factor ◽  
Stage 1

Abstract In the new staging system of multiple myeloma (MM) by South West Oncology Group (SWOG), the concentration of serum β2 microglobulin (β2m) and serum albumin were focused as the most important prognostic factors for survival. However, serum concentration of β2m has been known as an indicator of glomerular filtration rate. The aim of this study was to compare the prognostic value of the level of β2m with that of creatinine clearance (Ccr) in patients with multiple myeloma. Retrospectively, from January 1, 1996 to November 30, 2003, we reviewed 176 MM patients (M: F 110:66 mean age: 58.5±11.0) whose 24-hour urinary creatinine clearance was available at the time of diagnosis. We collected clinical data such as hemoglobin, serum creatinine, calcium, albumin, β2m, creatinine clearance before chemotherapies, and patients’ survival time. Pretreatment β2m was inversely related to Ccr (Spearman’s correlation coefficient = −0.781, P <0.01). In univariate analysis, relative risk (RR) of death was 1.047 (p< 0.001) for β2m and 0.985 (p< 0.001) for Ccr. But multivariate analysis using Cox’s proportional hazard model showed β2m was not significant prognostic factor in patients’ survival after adjustment for Ccr (RR 1.025, p=0.054) but Ccr was an independent risk factor of death after adjustment for β2m (RR 0.990, p=0.013). And univariate analysis identified that RR for β2m is not significant in 88 MM patients (66 patients with β2m ≥ 2.5mg/l) with relatively normal renal function (Ccr ≥ 50 ml/min) (RR = 1.110, p=0.306) We could propose another new staging system with β2m replaced by Ccr in SWOG staging system. The stages were defined as: stage 1, Ccr ≥ 80ml/min; stage 2, 50< Ccr <80; stage 3, Ccr < 50 and albumin ≥ 3.0g/dl; and stage 4 Ccr < 50 ml/min and albumin< 3.0 g/dl. According to this proposed staging system, median survival time of each stage from 1 to 4 is 1475, 887, 513, and 196 days, respectively. (Log Rank test < 0.0001) In conclusion, Ccr could be more important prognostic factor than the level of β2m in patients of MM and we propose that Ccr should be reassessed as the component of staging system of MM.

The prognostic significance of the number of extranodal sites in the patients with disseminated diffuse large B-cell lymphoma treated with R-CHOP

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 8570-8570
Author(s):  
C. Yoo ◽  
B. Sohn ◽  
J. Kim ◽  
D. Yoon ◽  
J. Huh ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
B Cell ◽  
Cell Lymphoma ◽  
Univariate Analysis ◽  
B Cell Lymphoma ◽  
Risk Groups ◽  
Stage Iii ◽  
Significant Prognostic Factor ◽  
Large B Cell Lymphoma ◽  
Large B Cell

8570 Background: The combination of rituximab and CHOP chemotherapy (R-CHOP) has improved survival of patients with diffuse large B-cell lymphoma (DLBCL). Recently, several reports have shown that standard International Prognostic Index (IPI) became less powerful prognostic predictor in patients with DLBCL in the era of R-CHOP. We evaluated the prognostic factors of DLBCL patients treated with R-CHOP. Detailed analysis was planned regarding the number of extranodal sites because of its higher frequency in Korea. Methods: Between January 2002 and May 2008, 126 patients with stage III/IV DLBCL treated with R-CHOP were identified. We performed the retrospective analysis of the clinicopathologic factors and verified the predictive power of standard IPI and revised IPI (R-IPI) which was reported by the study group of British Columbia. Various numbers of extranodal sites were analyzed for further stratification and we set E-IPI as the IPI when the number of extranodal sites is stratified in ≤2 vs >2. Results: In the univariate analysis, the number of extranodal sites (≤2 vs >2) was a significant prognostic factor for complete response (CR) (p=0.04), event-free survival (EFS) (p=0.01) and overall survival (OS) (p<0.001). Age was also significant for EFS (p=0.03). When the number of extranodal site was stratified differently (0 vs >0, or ≤1 vs >1), these were not associated with CR, EFS and OS. On the multivariate analysis, the number of extranodal sites (≤2 vs >2) remained significant for EFS (p<0.01, HR 2.6) and OS (p<0.01, HR 3.5). The standard IPI identified 3 risk groups with 2-year EFS; 68%, 55%, 56% (p=0.17) and 2-year OS; 85%, 68%, 58%, respectively (p=0.04). The R-IPI classified 2 risk groups with 2-year EFS; 65%, 50% (p=0.02) and 2-year OS 76%, 62%, respectively (p=0.04). The E-IPI represented 3 risk groups with 2-year EFS; 79%, 56%, 42% (p=0.01) and 2-year OS; 86%, 70%, 39%, respectively (p=0.001). The patient group with survival of less than 50% was only recognized by E-IPI. Conclusions: The number of extranodal sites (≤2 vs >2) is the most significant prognostic factor of EFS and OS. Although all three indices remain predictive, E-IPI is the best model to identify the prognostic group in this cohort with stage III/IV DLBCL treated with R-CHOP. No significant financial relationships to disclose.

The Association Between Serum Leptin Levels and Cardiovascular Events in Patients with Rheumatoid Arthritis

2020 ◽  
Vol 52 (1) ◽  
pp. 86-92 ◽  
Author(s):  
Jiliang Chen ◽  
Zhiping Xie ◽  
Zou Bin
Keyword(s):  
Rheumatoid Arthritis ◽  
Prognostic Factor ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Elevated Serum ◽  
Confounding Factors ◽  
Serum Leptin ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Increased Risk

Abstract Objective Cardiovascular diseases (CVDs) are important complications for patients with rheumatoid arthritis (RA). The study aimed to explore whether serum leptin is associated with a increased risk of cardiovascular (CV) events in patients with RA. Methods Two hundred twenty-three patients with RA were followed for a mean of 40 (range = 8-42) months. Serum leptin levels were measured at baseline. Cox regression analysis was performed to assess the association between leptin levels and the risk of CV events. Results The univariate analysis showed that patients with RA with higher serum leptin levels had higher rates of CV events and CV mortality, respectively (P &lt;.001). The logistic regression model showed that leptin was independently related to CVD history (odds ratio = 1.603, 95% confidence interval [CI], 1.329–2.195; P =.005) after adjusting for confounding factors in patients with RA at baseline. The multivariate Cox proportional hazard model suggested that leptin was an independent prognostic factor for CV events in patients with RA after adjustments were made for clinical confounding factors (hazard ratio = 2.467, 95% CI, 2.019–4.495; P &lt;.001). The Kaplan-Meier analysis showed that compared with patients with RA with leptin levels below the median value (≤15.4 mg/L), patients with leptin above the median value (&gt;15.4 μg/L) had a higher rate of CV events (P &lt;.001). Conclusion Leptin was significantly associated with CV events in patients with RA. Elevated serum leptin levels may be a reliable prognostic factor for predicting CV complications in patients with RA.

Ovarian Yolk Sac Tumor: The Experience of a Regional Cancer Center

2016 ◽  
Vol 26 (5) ◽  
pp. 884-891 ◽  
Author(s):  
Xiaojing Wang ◽  
Zebiao Ma ◽  
Yanfang Li
Keyword(s):  
Prognostic Factor ◽  
Early Stage ◽  
Clinical Stage ◽  
Univariate Analysis ◽  
Yolk Sac ◽  
Stage I ◽  
Yolk Sac Tumor ◽  
Cancer Center ◽  
Significant Prognostic Factor ◽  
Early Stage Disease

ObjectiveThe aim of this study was to evaluate the clinicopathologic characteristics of patients with ovarian yolk sac tumor and the benefit of omentectomy in patients with clinical early-stage disease.MethodsThe medical records of 66 patients with ovarian yolk sac tumor were reviewed retrospectively.ResultsThere were 37, 8, 14, and 7 patients with stages I, II, III, and IV disease, respectively. Sixty-five patients received surgery and adjuvant chemotherapy, and 1 had chemotherapy only. The median follow-up was 78 months. The overall 5-year survival rate was 86.0%. Univariate analysis revealed that stage (P = 0 .022), age (P = 0.001), residual tumor (P = 0.036), and satisfactory α-fetoprotein (AFP) decline (defined as normalization of AFP after the first or second cycles of postsurgery chemotherapy, P = 0.006) were significant prognostic factors. Multivariate analysis revealed that satisfactory AFP decline was an independent significant prognostic factor for overall survival (P = 0.028). The postoperative pathology showed that only 1 (2.7%) of 37 patients who received omentectomy without gross spread had omentum metastasis microscopically. The 5-year survival rates were 89.2% and 100.0% for stage I-II patients with (36 cases) or without (9 cases) omentectomy, respectively (P > 0.05). Three of the 7 patients with recurrence were successfully salvaged and lived 38.0, 102.6, and 45.2 months after initial diagnosis.ConclusionsPostsurgery satisfactory AFP decline was an independent significant prognostic factor for patient survival. Omentectomy might not be of therapeutic significance for clinical stage I-II patients.

Preirradiation chemotherapy with cyclophosphamide, doxorubicin, vincristine, and dexamethasone for primary CNS lymphomas: initial report of radiation therapy oncology group protocol 88-06.

1996 ◽  
Vol 14 (2) ◽  
pp. 556-564 ◽  
Author(s):  
C Schultz ◽  
C Scott ◽  
W Sherman ◽  
B Donahue ◽  
J Fields ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Prognostic Factor ◽  
Univariate Analysis ◽  
Radiation Therapy Oncology Group ◽  
Primary Cns Lymphoma ◽  
Intrathecal Methotrexate ◽  
High Dose ◽  
Significant Prognostic Factor ◽  
Oncology Group ◽  
Initial Report

PURPOSE This study was a prospective phase I/II trial performed by the Radiation Therapy Oncology Group (RTOG) to test the tolerance and efficacy of preirradiation cyclophosphamide, doxorubicin, vincristine, and dexamethasone (CHOD) chemotherapy followed by large-volume, high-dose brain radiation therapy (RT) for patients with primary CNS lymphoma (PCNSL). PATIENTS AND METHODS Fifty-four (52 assessable) human immunodeficiency virus (HIV)-negative patients with PCNSL were entered on study and received two (n = 20) or three (n = 32) cycles of CHOD (six patients with positive CSF cytology received intrathecal methotrexate in addition to CHOD). Whole-brain RT to 41.4 Gy and tumor boost to 18 Gy (total dose, 59.4 Gy) followed chemotherapy. RESULTS As of July 1994, with a minimum potential follow-up time of 20 months, 12 of 52 assessable patients remain alive without evidence of progression. The median survival time for the entire group is 16.1 months, with a 2-year survival rate of 42%. By univariate analysis, patient age was found to be a significant prognostic factor with respect to survival (P = .005) in favor of age less than 60 years. Karnofsky performance status (KPS) was of borderline significance (P = .057). Survival for patients treated on RTOG 88-06 was compared with that of patients treated on RTOG 83-15, which tested RT alone. No difference in overall survival was found (P = .53). Grade 4 neutropenia developed in 29 of 51 patients during chemotherapy. There were two deaths during chemotherapy: one as a result of sepsis and one of a pulmonary embolus. The worst toxicity during RT was < or = grade 2 in 50 of 52 patients. CONCLUSION Preirradiation CHOD chemotherapy does not significantly improve survival over RT alone for patients with PCNSL. Age remains a powerful prognostic factor independent of therapy and must be considered in testing alternative combined approaches.

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