Assessment Of Survival In Patients Research Articles

Clinical and morphological features and the assessment of survival in patients with iris melanoma

Purpose. To analyze how the clinical and morphological features are associated with vital prognosis of iris melanoma patients.Material and methods. A retrospective analysis included 84 patients (54 women and 30 men) with iris melanoma treated between 2005 and 2019.The mean age at the time of treatment was 52.3 ± 14.5 years. All patients underwent standard and special ophthalmological examination, including ultrasound biomicroscopy, and followed up for 32 to 196 months (103.1 ± 44 months) after hospital discharge.Results. Pigmented tumors predominated (72.6% of patients), while others showed a slightly pigmented (15.4%) and nonpigmented forms (12.0%). Most of the patients (67.9%) received an organ preserving treatment, while others (32.1%) had to have a liquidating treatment (enucleation) due to anular tumor growth and secondary complications. Uveal melanoma was morphologically verified in all cases: spindle cell type A (14.3%), spindle cell type B (31.0%), mixed cell (42.8%), epithelioid cell (11.9%). The epithelioid cell type of tumor was more common when the tumor spread to the ciliary body rather than in iris melanoma (p = 0,046), but the spindle cell and mixed cell types were more common than the epithelioid cell type in both groups. An anular growth was typical for the epithelioid cell type of tumor (p = 0.006). The presence of vessels in tumor stroma was found to be more frequent in pigmented (p = 0.005) and non-pigmented forms (p = 0.0009). For pigmented tumors, spreading into the ciliary body was characteristic (p = 0.024).Conclusion. A retrospective analysis of clinical and morphological factors of iris melanoma patients with an iridociliary localization should that the specific survival was 98.8%, and overall survival was 87%. The data obtained indicated the importance of timely diagnosis of iris tumors for an organ preservation treatment.

Curative Potential of Axicabtagene Ciloleucel (Axi-Cel): An Exploratory Long-Term Survival Assessment in Patients with Refractory Large B-Cell Lymphoma from ZUMA-1

Background: Axi-cel is an autologous anti-CD19 chimeric antigen receptor (CAR) T-cell therapy approved for patients with relapsed or refractory (R/R) large B-cell lymphoma (LBCL). Long-term results from ZUMA-1, a multicenter, single-arm, Phase 1/2 study of axi-cel in patients with refractory LBCL, demonstrated sustained overall survival (OS), with a median of 25.8 months and a 5-year estimate of 43% (Neelapu SS, et al. Blood. 2023). Initial assessments of disease-specific survival (DSS) in ZUMA-1 suggested axi-cel may be curative for a subset of patients. However, endpoints defining curative potential in patients with LBCL are not yet clearly established. Here, we report exploratory analyses from the Phase 2 portion of ZUMA-1 using proposed endpoints to measure cure along with survival analyses with up to 6 years of follow-up. Methods: Eligible adults in the pivotal Phase 2 Cohorts (1 and 2) of ZUMA-1 had refractory LBCL (diffuse LBCL, primary mediastinal B-cell lymphoma, or transformed follicular lymphoma). Patients were leukapheresed at enrollment, then received lymphodepletion and axi-cel infusion (2×10 6 CAR T cells/kg; Neelapu et al. N Engl J Med. 2017). Exploratory analyses to assess curative potential included lymphoma-related event-free survival (LREFS), duration of complete response (DOCR), and DSS. LREFS was defined as the time from axi-cel infusion until disease progression, initiation of new lymphoma therapy, autologous stem cell transplantation, or death due to progression, whichever was earliest. DSS was defined as time from axi-cel infusion to death due to progression or axi-cel-related adverse events (AEs). Outcomes were analyzed via Kaplan-Meier (KM) estimates and competing risk analyses. Landmark analyses were used to explore prognostic potential of disease status at Week 4 and Months 3, 6, 12 and 24. Results: At a median follow-up of 63.1 months in the 5-year analysis (data cutoff on August 11, 2021), median LREFS was 5.8 months (95% CI, 3.4-13.9) and the 60-month LREFS rate by KM estimate was 33.5%. Among patients who achieved a complete response (CR) as best response (n=59), median DOCR was not reached (95% CI, 12.9 months-not estimable). Median LREFS among those with a CR was not reached (95% CI, 18.4 months-not estimable) and the 60-month LREFS rate was 56.8%. Among those with a CR at Months 12 and 24, 60-month estimated rates of LREFS and ongoing CR were >80% (Table 1). All 3 lymphoma-related events that occurred after Month 24 in those with a CR were disease progression. Among those with a partial response at Week 4 (n=33) and Month 3 (n=10), estimates of 60-month LREFS were 27.3% and 45.0%, respectively. The data cutoff date for the 6-year survival analysis was August 11, 2022. Median OS was 25.8 months (95% CI, 12.8-63.7). In a competing risk assessment of OS, the cumulative incidence of death at 72 months was 61.6%. Between Months 24 and 72, there appeared to be an increase of 6% in the cumulative incidences of death due to progression (40.6% and 46.6%, respectively) and other reasons (5.0% and 11%, respectively), while deaths due to axi-cel-related AEs remained 4.0% at each timepoint. Among patients with a best response of a CR, the cumulative incidence rates of death at Month 24 and Month 72 were 20.3% and 27.2% for progression, 3.4% (both timepoints) for axi-cel-related AEs, and 0% and 10.4% for other reasons, respectively. Those who had a CR at Months 12 and 24 had a 72-month cumulative incidence of death of 18.4% and 14.2%, respectively (Table 2). Additionally, those who had a CR at 12 and 24 months had 72-month KM-estimated DSS of 94.4% and 100%, respectively. Among those with a partial response at Week 4 and Month 3, 72-month cumulative incidences of death were 72.7% and 50.0%, respectively. Conclusion: In this post hoc analysis of ZUMA-1 with up to 6 years of follow-up, axi-cel had long-term LREFS in a substantial proportion of patients, with a 5-year rate of 34% (57% among patients who achieved a CR). Additionally, a CR at 12 and 24 months may be predictive of extended OS. Among patients who achieved a CR, deaths due to axi-cel-related AEs mainly occurred before Month 24. These results demonstrate the curative potential of axi-cel in a subset of patients with R/R LBCL.

The Role of the p16 and p53 Tumor Suppressor Proteins and Viral HPV16 E6 and E7 Oncoproteins in the Assessment of Survival in Patients with Head and Neck Cancers Associated with Human Papillomavirus Infections.

The role of HPV in the survival prognosis of patients with head and neck squamous cell carcinoma, especially patients with laryngeal squamous cell carcinoma (LSCC) and hypopharyngeal squamous cell carcinoma (HPSCC), is still somewhat ambiguous. The present study aimed to explore the significance of tumor suppressor proteins and HPV16 E6 and E7 oncoproteins in the assessment of survival in patients with oropharyngeal squamous cell carcinoma (OPSCC), LSCC, and HPSCC associated with high-risk (HR-) and low-risk (LR-) HPV infections. By utilizing molecular and immunohistochemical investigations of HNSCC samples and patient data, univariate and multivariate survival analyses were conducted. The presence of HPV DNA (LR- and HR-HPV) was associated with a better 5-year OS and DSS for OPSCC and LSCC. The IHC overexpression of HPV16 E6 protein and p16 protein was associated with better survival in the univariate (for OPSCC) and multivariate (OPSCC and HPSCC) survival analyses. The overexpression of p53 was associated with better survival in OPSCC. HPV infection plays a significant role in the tumorigenesis of HNSCC, and the immunohistochemical assessment of HPV16 E6 protein expression should be interpreted as a useful prognostic marker for OPSCC and HPSCC.

Significance of radiation esophagitis: Conditional survival assessment in patients with non-small cell lung cancer

PurposeThis study aimed to examine the effect of radiation esophagitis (RE) and the dynamics of RE on subsequent survival in non-small cell lung cancer (NSCLC) patients who underwent radiotherapy. Experimental DesignPatients with NSCLC treated with fractionated thoracic radiotherapy enrolled in prospective trials were eligible. RE was graded prospectively according to Common Terminology Criteria for Adverse Events (CTCAE) v3.0 per protocol requirement weekly during-RT and 1 month after RT. This study applied conditional survival assessment which has advantage over traditional survival analysis as it assesses the survival from the event instead of from the baseline. P-value less than 0.05 was considered to be significant. The primary endpoint is overall survival. ResultsA total of 177 patients were eligible, with a median follow-up of 5 years. The presence of RE, the maximum RE grade, the evolution of RE and the onset timing of RE events were all correlated with subsequent survival. At all conditional time points, patients first presented with RE grade1 (initial RE1) had significant inferior subsequent survival (multivariable HRs median: 1.63, all P-values<0.05); meanwhile those with RE progressed had significant inferior subsequent survival than those never develop RE (multivariable HRs median: 2.08, all P-values<0.05). Multivariable Cox proportional-hazards analysis showed significantly higher C-indexes for models with inclusion of RE events than those without (all P-values<0.05). ConclusionThis study comprehensively evaluated the impact of RE with conditional survival assessment and demonstrated that RE is associated with inferior survival in NSCLC patients treated with RT.

1164P - Development and validation a nomogram based on pathological microscopic features to predict survival in nasopharyngeal carcinoma and guide treatment decision

BackgroundIn various types of solid tumor, pathological microscopic features can be used as prognostic biomarkers. We intended to develop a pathological microscopic features (PMFs) pattern for individual survival assessment in patients with nasopharyngeal carcinoma (NPC). MethodsWe retrospectively included 1229 patients with NPC who had received radical radiotherapy with/without chemotherapy. The PMFs differently digitized were extracted using the software QuPath (version 0.1.2.Queen’s University Belfast, Belfast, Northern Ireland, UK) in the training cohort (Guangzhou training cohort, n=739) to bulid a pathological feature classifier using a penalized regression model. The prognostic accuracy of the pathological feature classifier was validated in the internal validation cohort (Guangzhou validation cohort, n=316) and one external validation cohort (Chenzhou validation cohort, n=170).The primary end point was progression-free survival (PFS) and distant metastasis-free survival (DMFS). ResultsWe found 143 PMFs in the H&E image of NPC with the whole slide image (WSI) scanning. In the training cohort a pathological micromarker of survival risk in NPC (PMSRN) that consisted of 14 PMFs was generated to classify patients into high-risk and low-risk groups. Patients with high-risk scores in the training cohort had shorter PFS (HR 2.16, 1.61 -2.89; p=0.000), and DMFS (HR 1.87, 1.27 -2.75; p=0.001) than patients with low-risk scores. We developed a nomogram based on the PMSRN and other variables that predicted an individual’s survival risk and the c-index of this nomogram (C-index=0.759, 95% CI: 0.717 -0.801) was equal to other nomograms. Furthermore, among patients with high-risk scores in the combined training and internal cohorts, ICT had better PFS to those who received CCRT alone (p=0.033), whereas those with low-risk scores ICT had similar PFS to CCRT alone (p=0.363). These results were validated in the internal external validation cohort. ConclusionsThe PMSRN is a reliable prognostic tool for survival risk in NPC patients and might be able to predict which patients need to receive ICT or not. It might guide treatment decisions for NPC patients. Clinical trial identificationChiECRCT20190034. Legal entity responsible for the studySun Yet-sen University Cancer Center. FundingNational Natural Science Foundation of China. DisclosureAll authors have declared no conflicts of interest.

To treat or not to treat? A retrospective multicenter assessment of survival in patients with IDH-mutant low-grade glioma based on adjuvant treatment.

The level of evidence for adjuvant treatment of diffuse WHO grade II glioma (low-grade glioma, LGG) is low. In so-called "high-risk" patients most centers currently apply an early aggressive adjuvant treatment after surgery. The aim of this assessment was to compare progression-free survival (PFS) and overall survival (OS) in patients receiving radiation therapy (RT) alone, chemotherapy (CT) alone, or a combined/consecutive RT+CT, with patients receiving no primary adjuvant treatment after surgery. Based on a retrospective multicenter cohort of 288 patients (≥ 18 years old) with diffuse WHO grade II gliomas, a subgroup analysis of patients with a confirmed isocitrate dehydrogenase (IDH) mutation was performed. The influence of primary adjuvant treatment after surgery on PFS and OS was assessed using Kaplan-Meier estimates and multivariate Cox regression models, including age (≥ 40 years), complete tumor resection (CTR), recurrent surgery, and astrocytoma versus oligodendroglioma. One hundred forty-four patients matched the inclusion criteria. Forty patients (27.8%) received adjuvant treatment. The median follow-up duration was 6 years (95% confidence interval 4.8-6.3 years). The median overall PFS was 3.9 years and OS 16.1 years. PFS and OS were significantly longer without adjuvant treatment (p = 0.003). A significant difference in favor of no adjuvant therapy was observed even in high-risk patients (age ≥ 40 years or residual tumor, 3.9 vs 3.1 years, p = 0.025). In the multivariate model (controlled for age, CTR, oligodendroglial diagnosis, and recurrent surgery), patients who received no adjuvant therapy showed a significantly positive influence on PFS (p = 0.030) and OS (p = 0.009) compared to any other adjuvant treatment regimen. This effect was most pronounced if RT+CT was applied (p = 0.004, hazard ratio [HR] 2.7 for PFS, and p = 0.001, HR 20.2 for OS). CTR was independently associated with longer PFS (p = 0.019). Age ≥ 40 years, histopathological diagnosis, and recurrence did not achieve statistical significance. In this series of IDH-mutated LGGs, adjuvant treatment with RT, CT with temozolomide (TMZ), or the combination of both showed no significant advantage in terms of PFS and OS. Even in high-risk patients, the authors observed a similar significantly negative impact of adjuvant treatment on PFS and OS. These results underscore the importance of a CTR in LGG. Whether patients ≥ 40 years old should receive adjuvant treatment despite a CTR should be a matter of debate. A potential tumor dedifferentiation by administration of early TMZ, RT, or RT+CT in IDH-mutated LGG should be considered. However, these data are limited by the retrospective study design and the potentially heterogeneous indication for adjuvant treatment.

DEPENDENCE OF OVERALL AND RELAPSE-FREE PATIENTS SURVIVAL FROM MOLECULAR GENETIC SUBTYPE OF ESOPHAGEAL SQUAMOUS CELL CANCER

Esophageal squamous cell carcinoma (ESCC) is a group of heterogeneous tumors with a different prognosis. In recent years, various molecular signatures of ESCC have been identified, which are different in different populations. The aim of the study was the molecular typing of ESCC patients in southern Russia and the assessment of patient survival, taking into account the identified tumor molecular genetic subtype. The material for the study was the sections of FFPE-blocks of 124 patients with ESCC. Tumor and non-tumor esophagus cells isolation was carried out by laser microdissection with contactless capture. 248 DNA samples were extracted from the cells by the phenol-chloroform method. For molecular typing of ESCC, the relative copy number variation (CNV) of 8 genes (CUL3, ATG7, SOX2, TP63, YAP1, VGLL4, CDK6, KDM6A) was determined by Real-Time qPCR and 7 single nucleotide polymorphisms (SNP) (NFE2L2 (c.85G&gt; A), NOTCH1 ( c.1379C&gt; T), NOTCH1 (c.1451G&gt; T), ZNF750 (c.414C&gt; A), ZNF750 (c..1621G&gt; A), SMARCA4 (p.Q758 *, c.2272C&gt; T), KMT2D (Q5170 *, c.15508C&gt; T)) were determined by the method of Sanger direct sequencing. During the study, in ESCC patients of the Southern Russia population identified SNP in genes NFE2L2, NOTCH1, SMARCA4, KMT2D and CNV of genes CUL3, ATG7, SOX2, TP63, YAP1, VGLL4, CDK6 and KDM6A, earlier described for populations of Eastern Europe, Canada and the USA. Three molecular genetic subtypes of ESCC were verified, based on the differences in SNP and CNV of these genes: ESCC1 was verified in 31.5%, ESCC2 in 66.1%, and ESCC3 in 2.4% of patients. At the same time, higher survival rates were established in ESCC patients with the molecular genetic subtype ESCC2, as compared with ESCC1 and ESCC3. Differences in survival between the three groups were statistically significant (p = 0.00001). Thus, the determination of the molecular genetic subtype of ESCC is an important approach to improve the prediction of the course of this disease and the possibility of adjusting the appropriate therapy.

Systematic review of defibrotide studies in the treatment of veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS)

Veno-occlusive disease (VOD), also called sinusoidal obstruction syndrome (SOS), is a potentially life-threatening complication of hematopoietic stem cell transplantation (HSCT) conditioning or high-dose nontransplant chemotherapy. VOD/SOS with multi-organ dysfunction (MOD) is associated with a mortality rate of > 80%. Defibrotide (25 mg/kg/day) is approved to treat hepatic VOD/SOS with renal or pulmonary dysfunction post HSCT in the United States and to treat severe hepatic VOD/SOS in patients > 1 month of age in the European Union. A random effects model was used for pooling data from 17 systematically chosen defibrotide studies. For patients in these reports (n = 2598), and those in the subset of 10 reports of patients treated with ~ 25 mg/kg/day (n = 1691), estimated Day + 100 survival rates were 54% and 56%, respectively. Among those patients treated with ~ 25 mg/kg/day, estimated Day + 100 survival was 44% among patients with MOD and 71% in patients without MOD; survival was 41% and 70%, respectively, for the population of patients receiving any dose of defibrotide. Safety results were not pooled owing to differences in reporting methodology but were generally consistent with the known tolerability profile of defibrotide. This analysis provides the largest assessment of survival in patients treated with defibrotide for VOD/SOS with or without MOD.

Assessment of survival in patients with idiopathic pulmonary fibrosis using quantitative HRCT indexes

Background: The assessment of Idiopathic Pulmonary Fibrosis (IPF) using HRCT requires great experience and is limited by a significant inter-observer variability, even between trained radiologists. The evaluation of HRCT through automated quantitative analysis may hopefully solve this problem. The accuracy of CT-histogram derived indexes in the assessment of survival in IPF patients has been poorly studied. Methods: Forty-two patients with a diagnosis of IPF and a follow up time of 3 years were retrospectively collected; HRCT and Pulmonary Function Tests (PFTs) performed at diagnosis time were analysed; the extent of fibrotic disease was quantified on HRCT using kurtosis, skewness, Mean Lung Density (MLD), High attenuation areas (HAA%) and Fibrotic Areas (FA%). Univariate Cox regression was performed to assess hazard ratios for the explored variables and a multivariate model considering skewness, FVC, DLCO and age was created to test their prognostic value in assessing survival. Through ROC analysis, threshold values demonstrating the best sensitivity and specificity in predicting mortality were identified. They were used as cut-off points to graph Kaplan-Meier curves specific for the CT-indexes. Results: Kurtosis, skewness, MLD, HAA% and FA% were good predictors of mortality (HR 0.44, 0.74, 1.01, 1.12, 1.06; p = 0.03, p = 0.01, p = 0.02, p = 0.02 and p = 0.017 respectively). Skewness demonstrated the lowest Akaike’s information criterion value (55.52), proving to be the best CT variable for prediction of mortality. Significant survival differences considering proposed cut-off points were also demonstrated according to kurtosis (p = 0. 02), skewness (p = 0.005), MLD (p = 0.003), HAA% (p = 0.009) and FA% (p = 0.02) – obtained from quantitative HRCT analysis at diagnosis time. Conclusions: CT-histogram derived indexes may provide an accurate estimation of survival in IPF.

Assessment of survival in patients with idiopathic pulmonary fibrosis using quantitative HRCT indexes

BackgroundThe assessment of Idiopathic Pulmonary Fibrosis (IPF) using HRCT requires great experience and is limited by a significant inter-observer variability, even between trained radiologists. The evaluation of HRCT through automated quantitative analysis may hopefully solve this problem. The accuracy of CT-histogram derived indexes in the assessment of survival in IPF patients has been poorly studied.MethodsForty-two patients with a diagnosis of IPF and a follow up time of 3 years were retrospectively collected; HRCT and Pulmonary Function Tests (PFTs) performed at diagnosis time were analysed; the extent of fibrotic disease was quantified on HRCT using kurtosis, skewness, Mean Lung Density (MLD), High attenuation areas (HAA%) and Fibrotic Areas (FA%). Univariate Cox regression was performed to assess hazard ratios for the explored variables and a multivariate model considering skewness, FVC, DLCO and age was created to test their prognostic value in assessing survival. Through ROC analysis, threshold values demonstrating the best sensitivity and specificity in predicting mortality were identified. They were used as cut-off points to graph Kaplan-Meier curves specific for the CT-indexes.ResultsKurtosis, skewness, MLD, HAA% and FA% were good predictors of mortality (HR 0.44, 0.74, 1.01, 1.12, 1.06; p = 0.03, p = 0.01, p = 0.02, p = 0.02 and p = 0.017 respectively). Skewness demonstrated the lowest Akaike’s information criterion value (55.52), proving to be the best CT variable for prediction of mortality. Significant survival differences considering proposed cut-off points were also demonstrated according to kurtosis (p = 0.02), skewness (p = 0.005), MLD (p = 0.003), HAA% (p = 0.009) and FA% (p = 0.02) – obtained from quantitative HRCT analysis at diagnosis time.ConclusionsCT-histogram derived indexes may provide an accurate estimation of survival in IPF patients. They demonstrate a correlation with PFTs, highlighting their possible use in clinical practice.

EP-1476: A qRT-PCR assay for assessment of survival in patients with locally advanced rectal cancer

EP-1476: A qRT-PCR assay for assessment of survival in patients with locally advanced rectal cancer

A Proposal for Progression-Free Survival Assessment in Patients with Early Progressive Cancer.

Progression-free survival (PFS), which is evaluated in oncology clinical trials, is determined based on tumor progression evaluated according to an assessment schedule. There is possibly a bias in median PFS and hazard ratio (HR) for PFS depending on the assessment schedule referring to randomized controlled trials (RCTs) in patients with metastatic colorectal cancer. We re-analyzed the PFS in the FTD/TPI phase 2 trial by changing the assessment schedule. To assess biases in median PFS and HR for PFS resulting from different assessment schedules, we performed a computational simulation. The reanalysis of FTD/TPI phase 2 trial and the simulation results showed that there were biases in median PFS and HR for PFS. In RCTs for early progressive cancer, median PFS is dependent on the assessment schedule; however, HR for PFS can be assessed without clinically-meaningful differences between assessment schedules, regardless of biomarker assumptions.

Assessment of survival in patients with cervical cancer in a hospital based cohort in Southern Brazil

Assessment of survival in patients with cervical cancer in a hospital based cohort in Southern Brazil

Clinical outcome of elderly peritoneal dialysis patients with assisted care in a single medical centre: A 25 year experience

Peritoneal dialysis (PD) is an alternative treatment for elderly patients with end-stage renal disease (ESRD). In Taiwan, non-professional personnel are employed to provide assisted care for elderly patients. Whether assisted care is appropriate for elderly patients is unknown. The aim of this paper is to evaluate the outcomes of assisted care in a single centre. This is a retrospective cohort study in a single medical centre. The outcomes were derived from the assessment of patient survival, technique survival and peritonitis incidence between self-care patients and assisted-care patients. From 1984 to 2010, there were 138 elderly PD patients at Taichung Veterans General Hospital, of which 70% were assisted-care patients and 30% self-care patients. The mean duration of PD survival was 49.2 months in self-care patients, which was significantly longer than the 17.0 months of assisted-care patients (P < 0.05). Using the multivariate Cox proportion regression model to adjust for risk factors, it was found that self-care patients had a lower risk in both patient survival (Hazard Ratio 0.15; 95% confidence interval (CI) 0.2-0.94, P < 0.05) and technique survival (Hazard ratio; 0.11, 95% CI 0.1-0.9, P < 0.05). Fluid overloading was the major cause of technique failure in assisted-care patients. Type of assistance was not a risk factor for PD-related peritonitis. Our elderly assisted care had patients had a poorer survival and technique survival rates than those of the self-care patients. We argue that this is because early recognition of medical deterioration and early medical intervention are necessary for a better outcome for elderly PD patients.

Alpha-fetoprotein: A controversial prognostic biomarker for small hepatocellular carcinoma

The assessment of the prognosis in patients with early hepatocellular carcinoma represents a hot-topic issue that requires further improvements and clarifications. The life expectancy of the patients has been shown to depend on several clinical and histological parameters (such as patient's general conditions, macroscopic tumor morphology and histopathology). Recently, the prognostic role of some biomarkers [i.e., alpha-fetoprotein (AFP)] has been also investigated with controversial findings mainly on the assessment of patient survival. The study by Giannini et al failed to show a prognostic value of AFP on survival of patients with well-compensated cirrhosis and small hepatocellular carcinoma. Since the study presents some limitations, a larger clinical trial is needed to clarify the potential prognostic role of serum AFP levels in these patients.

Size isn’t everything

Size isn’t everything

Computed tomography pulmonary embolism index for the assessment of survival in patients with pulmonary embolism

This study was an analysis of the correlation between pulmonary embolism (PE) and patient survival. Among 694 consecutive patients referred to our institution with clinical suspicion of acute PE who underwent CT pulmonary angiography, 188 patients comprised the study group: 87 women (46.3%, median age: 60.7; age range: 19-88 years) and 101 men (53.7%, median age: 66.9; age range: 21-97 years). PE was assessed by two radiologist who were blinded to the results from the follow-up. A PE index was derived for each set of images on the basis of the embolus size and location. Results were analyzed using logistic regression, and correlation with risk factors and patient outcome (survival or death) was calculated. We observed no significant correlation between the CTPE index and patient outcome (p = 0.703). The test of logistic regression with the sum of heart and liver disease or presence of cancer was significantly (p< 0.05) correlated with PE and overall patient outcome. Interobserver agreement showed a significant correlation rate for the assessment of the PE index (0.993; p< 0.001). In our study the CT PE index did not translate into patient outcome. Prospective larger scale studies are needed to confirm the predictive value of the index and refine the index criteria.

N-Terminal Pro-B-Type Natriuretic Peptide as an Indicator of Disease Severity in a Heterogeneous Group of Patients With Chronic Precapillary Pulmonary Hypertension

N-terminal-pro-B-type natriuretic peptide (NT-pro-BNP) is well established as a predictor of prognosis in patients with left ventricular dysfunction. Although a similar prognostic significance has been suggested in 1 study of right ventricular failure and idiopathic pulmonary arterial hypertension, NT-pro-BNP has not been assessed as a marker of disease severity in a more heterogenous group of patients with chronic precapillary pulmonary hypertension (PH). Hence, this study assessed plasma NT-pro-BNP and other clinical variables in 61 consecutively recruited patients with various forms of chronic precapillary PH. Right-sided cardiac catheterization and cardiopulmonary exercise testing were performed at baseline, and the prognostic significance of NT-pro-BNP was investigated with a mean follow-up of 25 months. Compared with age-matched controls (n = 10), plasma NT-pro-BNP was significantly greater in those with idiopathic pulmonary arterial hypertension (n = 16), chronic precapillary PH associated with other diseases (n = 26), and chronic thromboembolic disease (n = 19) and was correlated with hemodynamic variables and functional capacity. In 17 medically treated patients, the significant decrease in NT-pro-BNP levels correlated with improved hemodynamics. During follow-up, 15 patients died from cardiopulmonary causes. Baseline NT-pro-BNP was an independent predictor of mortality. Kaplan-Meier survival analysis according to the median value of NT-pro-BNP (168 pmol/L) demonstrated a significantly higher mortality rate in those with supramedian values than in those with low plasma levels (p = 0.010). In conclusion, these findings suggest that in a heterogenous group of patients with chronic precapillary PH, plasma NT-pro-BNP can be used to determine the clinical severity of disease and is independently associated with long-term mortality.

The relative role of the Child-Pugh classification and the Mayo natural history model in the assessment of survival in patients with primary sclerosing cholangitis.

The Child-Pugh classification is a simple, convenient prognostic measure in patients with liver cirrhosis. We investigated the relative role of the Child-Pugh classification and the Mayo model in the assessment of survival in patients with primary sclerosing cholangitis (PSC). Of the 173 patients described in the original Mayo PSC natural history model, 147 patients had sufficient information in the medical record to allow computation of the Child-Pugh score. We used our most recent modification of the Mayo model to compute the risk score, based on patient's age, serum levels of bilirubin, albumin, and aspartate aminotransferase and history of variceal bleeding. Using the risk score (R), patients were divided into the low- (R < 0), intermediate- (0 </= R < 2), and high-risk (R >/= 2) groups. Kaplan-Meier estimates and proportional hazards analysis were used to evaluate the two prognostic models. Although there was a statistically significant correlation between the Child-Pugh and Mayo risk scores, two-thirds of the patients had a Child-Pugh score of 5 or 6 and a relatively wide range of risk scores (-1.1-4.3). The probability of survival for 7 years in patients in the low-, intermediate-, and high-risk groups was 92%, 74%, and 40% for Child-Pugh class A (n = 96) and 100%, 62%, and 28% for Child-Pugh class B patients (n = 44), respectively. There were only a small number (n = 7) of Child-Pugh class C patients. In our age-adjusted multivariate analysis, each unit increase in the Mayo risk score was associated with a 2.5-fold increase in the risk of death (95% confidence interval: 1.8-3.4, P <.01), whereas Child-Pugh classification had no significant impact on survival (Child-Pugh B vs. A: risk ratio = 1.1 [95% confidence interval: 0.6-2.0]; Child-Pugh C versus A: risk ratio = 0.6 [95% confidence interval: 0. 2-1.8]). In contrast to the Child-Pugh classification, which was developed for advanced liver cirrhosis, the Mayo model provides valid survival information, particularly in patients early in the course of PSC.