Analysis Of Clinical Prognostic Factors Research Articles

Comparative efficacy of immune checkpoint inhibitors combined with chemotherapy in patients with advanced driver-gene negative non-small cell lung cancer: A systematic review and network meta-analysis

ObjectiveTo evaluate the efficacy of different combinations of immune checkpoint inhibitors (ICIs) and chemotherapy (CT) in the treatment of advanced non-small cell lung cancer (NSCLC). MethodsWe obtained relevant randomized controlled trials (RCTs) from databases such as PubMed, Embase, Web of Science, and The Cochrane Library up to May 31, 2023. The analysis of clinical prognostic factors was performed using R 4.2.3 and STATA 15.0. The main outcomes measured were overall survival (OS) and progression-free survival (PFS), while secondary outcomes included the objective response rate (ORR), disease control rate (DCR), and treatment-related adverse events of grade 3–5 severity (Grade ≥3 TRAE). ResultsA total of 17 randomized controlled trials (RCTs) were conducted between 2012 and 2023, involving 7792 patients. These trials evaluated 11 different treatment methods. The results of these trials showed that in terms of overall survival (OS) and progression-free survival (PFS), the combination of tislelizumab with chemotherapy and the combination of camrelizumab with chemotherapy were particularly effective. Moreover, when compared with other combination therapies, pembrolizumab combined with chemotherapy showed superiority in terms of disease control rate (DCR) and objective response rate (ORR). Subgroup analyses further demonstrated that the addition of immune checkpoint inhibitors (ICIs) to chemotherapy significantly improved PFS and OS in patients without liver metastasis and in those with brain metastasis. Additionally, carboplatin-based combination therapy was found to confer favorable survival benefits in terms of PFS, while cisplatin-based combination therapy showed the most favorable outcomes in terms of OS. The results of subgroup analyses for overall survival (OS) showed that the combination of immunotherapy and chemotherapy yielded positive outcomes in specific subgroups. These subgroups were characterized by PD-L1 Tumor Proportion Score (TPS) of 50 % or higher, usage of anti-PD-1 medications, age below 65, male gender, smoking history, and non-squamous cell carcinoma histology. Superior effectiveness was demonstrated only in extending the progression-free survival (PFS) of female patients and patients with squamous carcinoma. Meanwhile, other patient cohorts did not show the same level of improvement. ConclusionsTislelizumab, camrelizumab or pembrolizumab combined with chemotherapy may be the optimal first-line treatment strategies for NSCLC.

Analysis of clinical characteristics and prognostic factors in elderly patients with acute myeloid leukemia

Objective To investigate the clinical characteristics and prognostic factors in elderly patients with acute myeloid leukemia(AML). Methods Clinical data of 232 patients with acute myelocytic leukemia(AML, except for acute promyelocytic leukemia) admitted in our hospital from January 2012 to December 2015 were retrospectively analyzed.Factors affecting complete remission(CR) were analyzed by using χ2 test, and Kaplan-Meier survival analysis was conducted.Univariate and multivariate analysis of prognostic factors were performed by using Log-Rank test and Cox regression model respectively. Results Of 232 patients, 195 patients received induction chemotherapy, among whom 8 patients died in early phase, efficacy could not be evaluated in 25 cases, with 162 patients for final statistical study.The CR rate was 37.0%(60/162) after the first therapy course, and overall CR rate was 54.9%(89/162). Thirty-seven patients received palliative treatment, among whom 6 patients died in early phase and none achieved CR.Therefore, the 162 patients receiving an induction chemotherapy, whose efficacy can be evaluated, could be clinically analyzed.They were in 60-69 years old(χ2=4.102, P=0.043), with ECOG score≤2(χ2=9.917, P=0.002), NPM1+ FLT3-ITD-(χ2=6.423, P=0.038), favorable karyotypes(χ2=6.033, P=0.049), and related to a higher CR rate.The median overall survival(OS) was 205 days in the 232 patients.Univariate analysis results demonstrated that age(χ2=8.700, P=0.003), white blood cell(WBC) count≥100×109/L(χ2=4.249, P=0.039), karyotypes(χ2=4.807, P=0.028), palliative treatment(χ2=191.221, P=0.000) were influencing factors for the prognosis.Multivariable analysis showed that age(HR=0.464, 95%CI: 0.245-0.877, P=0.018), karyotypes(HR=3.618, 95%CI: 1.491-6.728, P=0.003) and whether or not to receive induction chemotherapy(HR=0.076, 95%CI: 0.030-0.194, P=0.000) were independent influencing factors for OS in elderly patients with AML. Conclusions The prognosis of elderly patients with AML is affected by multiple factors.Age, karyotypes and whether or not to receive induction chemotherapy are independent influencing factors for OS in elderly patients with AML. Key words: Leukemia, myeloid, acute; Prognosis

Analysis of clinical efficacy and prognostic factors of apatinib in the treatment of advanced malignant tumors

Objective To observe the clinical efficacy and safety of apatinib in the treatment of advanced malignant tumors and to analyze the prognostic indicators affecting the survival of patients. Methods A total of 100 patients with advanced malignant tumors who were treated with apatinib at Jinan Central Hospital Affiliated to Shandong University from February 2015 to July 2018 were enrolled and their data were analyzed retrospectively. The clinical efficacy was evaluated and the related adverse reactions were recorded. Single and multiple factor analyses were performed by Cox regression model. The predictive factors of progression-free survival (PFS) and overall survival (OS) were analyzed. Results One-hundred patients with advanced malignant tumors who were treated with second-line and above treatment were collected. All patients were assessable for response, no complete response was observed, 22 patients (22%) achieved partial remission, 58 patients (58%) in stable disease, and 20 patients (20%) appeared progressive disease. The objective response rate was 22% (22/100), the disease control rate was 80% (80/100), the median PFS was 3.6 months (95%CI: 2.7-4.5 months), and the median OS was 7.0 months (95%CI: 4.7-9.3 months). Univariate analysis showed that Eastern Cooperative Oncology Group (ECOG) score (HR=0.340, 95%CI: 0.211-0.546, P<0.001), tumor primary site (HR=1.757, 95%CI: 1.053-2.932, P=0.031), neutrophil to lymphocyte ratio (NLR) (HR=0.389, 95%CI: 0.227-0.666, P=0.001), hemoglobin (HR=1.696, 95%CI: 1.023-2.813, P=0.041) and proteinuria (HR=1.790, 95%CI: 1.105-3.155, P=0.044) were related to PFS; age (HR=2.082, 95%CI: 1.320-3.285, P=0.002), ECOG score (HR=0.206, 95%CI: 0.123-0.344, P<0.001), tumor primary site (HR=1.784, 95%CI: 1.077-2.954, P=0.025), NLR (HR=0.410, 95%CI: 0.238-0.704, P=0.001), hemoglobin (HR=1.958, 95%CI: 1.175-3.264, P=0.010) and albumin (HR=0.467, 95%CI: 0.277-0.787, P=0.004) were related with OS. Multivariate analysis showed that PFS was related to ECOG score (HR=0.254, 95%CI: 0.123-0.523, P<0.001) and NLR (HR=0.378, 95%CI: 0.161-0.888, P=0.026), and OS was related to ECOG score (HR=0.147, 95%CI: 0.067-0.326, P<0.001), NLR (HR=0.327, 95%CI: 0.140-0.765, P=0.010) and hemoglobin (HR=1.975, 95%CI: 1.101-3.543, P=0.022). In term of safety, the most common adverse events among 100 cases of treated patients with advanced malignant tumors were hypertension (53, 53%), anorexia (51, 51%), fatigue (51, 51%) and anemia (50, 50%), among which the most common ones of grade 3 and 4 were hypertension (10, 10%), thrombocytopenia (8, 8%), leukopenia (7, 7%) and hand-foot syndrome (6, 6%). Conclusion Apatinib has certain clinical efficacy and manageable adverse events in the treatment of advanced malignant tumors at and above second-line treatment. ECOG score and NLR are independent predictors of PFS and OS in patients with advanced malignant tumors treated with apatinib. Key words: Neoplasms; Treatment outcome; Drug-related side effects and adverse reactions; Apatinib; Prognosis

Analysis of clinical efficacy, failure pattern and prognostic factors of comprehensive treatment for malignant mucosal melanoma of head and neck

Objective To evaluate the clinical efficacy, failure pattern and prognostic factors of the malignant mucosal melanoma of the head and neck (MMHN) in a single center. Methods The treatment pattern, clinical efficacy, failure pattern and prognostic factors of 194 M0 MMHN patients admitted to our institution from 1982 to 2017 were retrospectively analyzed. Results The 5-year overall survival (OS), local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS) and distant metastasis-free survival (DMFS) were 41.4%, 57.8%, 76.5% and 46.5%, respectively. The failure rate was calculated as 74.6%(141/189). Among them, 40%(56/141) had distant metastasis as the first pattern of treatment failure, 37%(52/141) had local relapse, 15%(21/141) had regional relapse, 5%(7/141) had concurrent distant metastasis and local/regional relapse and 3%(5/141) had concurrent local and regional relapse. Multivariate analysis demonstrated that surgical margins (P=0.001) and adjuvant radiotherapy (P=0.000) were the independent prognostic factors for LRFS. Conclusions Surgery combined with radiotherapy can yield relatively high LRFS in the comprehensive treatment of MMHN.Distant metastasis is the major failure pattern. Key words: Head neck neoplasmsm/radiotherapy; Melanoma/radiotherapy; Prognosis

Analysis of clinical features and prognostic factors on reoperation patients with postoperative recurrence or metastasis of gastrointestinal stromal tumor

To investigate the clinical characteristics and prognostic factors of reoperation patients with postoperative recurrence or metastasis of gastrointestinal stromal tumor (GIST). A retrospective case-control study was performed on the clinical data of 31 patients with GIST who had recurrence or metastasis after the first surgery and underwent one or more operations again from February 2003 to January 2016 at Ruijin Hospital, Shanghai Jiaotong University School of Medicine. The clinical characteristics of these patients were analyzed. Kaplan-Meier survival curve was used to calculate the survival rate, Cox univariate and multivariate regression model was applied to prognosis analysis. Age of these 31 patients at the first operation was 35-78 (median 49) years, including 17 males (54.8%) and 14 females (45.2%). The tumors of 21 cases located in small intestines (67.7%), 2 cases in stomach (6.5%), 4 cases (12.9%) in colorectum and of 4 cases (12.9%) in other sites. According to NIH criteria, risk assessment indicated 26 cases were(83.8%) with high risk, 3 cases (9.7%) with moderate risk, and 2 cases (6.5%) with low risk. After the first operation, 15 cases received the IM (imatinib) therapy regularly based on NCCN guideline,10 cases received the therapy irregularly, and the other 6 cases did not receive the therapy. R0 resection was performed in 29 cases (93.5%) and R1/R2 resection was performed in 2 cases (6.5%). The median interval between the first operation to the recurrence was 32.3 (5.2-117.6) months and the median age of recurrence was 56 years old. Refer to the recurrent location, 28 cases (90.3%) were found in the same location or liver, 1 case in greater omentum, and 2 cases in pelvic cavity. The median diameter of the tumor in reoperation was 6.5 cm. Twenty-three cases(74.2%) received R0 excision and the other 8 cases(25.8%) received R1/R2 excision. At diagnosis of tumor recurrence, 20 cases (64.5%) received the second surgery immediately and the other 11 cases received surgery after imatinib or sunitinib treatment. Twenty-nine (93.5%) patients were followed up for 7.3 to 160.3 (median 49.5) months. After the second surgery, the relapse-free survival (RFS) of the whole group was 3.2 to 148.6(median: 29.7) months. Till the end of follow-up, 9 cases died of recurrence. Among 20 alive cases, 8 cases were living with the tumor, 1 case received the third surgery. The median overall survival (OS) time was 38.4(6.2-160.3) months. The 5-year RFS and the 5-year OS of 15 cases who received regular targeted therapy after the first operation were 73.4% and 81.7% respectively, significantly higher than those of the other 16 cases who received irregular or no targeted therapy(37.6%, P=0.015 and 38.9%,P=0.023,respectively). The 5-year RFS rate and the 5-year OS rate of the 11 patients who were diagnosed or complicated with liver metastasis were 29.8% and 32.2% respectively, which were significantly lower than those of the 20 patients without liver metastasis (79.1% and 88.1% respectively, both P<0.001). Cox model for OS, the results showed that regular targeted therapy after first surgery(HR=0.362, 95%CI:0.210-1.074, P=0.089) and the liver metastasis (HR=5.342, 95%CI: 0.902-12.580, P=0.057) were not the independent risk factors. Regular targeted therapy according to the guideline after the first operation for GIST patients with recurrence or metastasis may improve the prognosis. Prognosis of GIST patients with postoperative liver metastasis is poor.

Exploratory Analysis of Clinical Prognostic Factors in Patients with Advanced Cancer Using Computational Text Mining of Routine Digitised Oncology Correspondence

Exploratory Analysis of Clinical Prognostic Factors in Patients with Advanced Cancer Using Computational Text Mining of Routine Digitised Oncology Correspondence

Analysis of clinical efficacy and prognostic factors of double autologous hematopoietic stem cell transplantation in treatment of aggressive non-Hodgkin lymphoma

Objective To investigate the clinical efficacy and prognostic factors of double autologous hematopoietic stem cell transplantation (DAHSCT) in treatment of aggressive non-Hodgkin lymphoma (NHL). Methods From March 2001 to December 2014, a total of 48 patients with aggressive NHL who underwent scheduled DAHSCT in Tangdu Hospital, the Fourth Military Medical University were selected as the study subjects. Among them, 29 patients were male and 19 cases were female; and 22 patients were with B-cell non-Hodgkin lymphoma (B-NHL), 26 cases were with T-cell non-Hodgkin lymphoma (T-NHL). All 48 patients underwent the second autologous hematopoietic stem cell transplantation (auto-HSCT) within 2 to 6 months after receiving the first auto-HSCT. Retrospective analysis was used to collect clinical data from all patients, including age, occurrence of B symptoms, clinical staging of Ann Arbor/Cotswolds staging system, level of serum lactate dehydrogenase (LDH), international prognostic index (IPI) score, occurrence of extra-nodal lesions, and remission status of disease before the first and second auto-HSCT, etc.. Kaplan-Meier method was used to analyze the survival of 48 NHL patients. Univariate Cox regression analysis was used to analyze the factors that may influence the overall survival (OS) period of NHL patients after DAHSCT. According to the available research results and clinical experience, the further multivariate Cox regression analysis was carried out for the factors that were statistically significant in the univariate analysis, as well as some factors that were not statistically significant in the univariate analysis, but with clinical significance. Results ① All 48 aggressive NHL patients were collected enough peripheral blood stem cells, and got hematopoietic reconstitution after receiving auto-HSCT. In this study, the median number of CD34+ cells transfused was 3.40×106/kg [(2.70-8.70)×106/kg] in the first auto-HSCT and 3.68×106/kg [(2.95-8.00)×106/kg] in the second auto-HSCT, respectively. And the median time of platelet reconstruction was 12.0 d (9.0-17.0 d) in the first auto-HSCT and 14.0 d (9.0-18.0 d) in the second auto-HSCT, respectively. The median time of neutrophil reconstruction after transplantation was 12.0 d (9.0-16.0 d) in the first auto-HSCT and 13.0 d (9.0-16.0 d) in the second auto-HSCT, respectively. ② For all 48 patients, the overall response rate of DAHSCT was 93.8% (45/48) after receiving DAHSCT. The median follow-up time was 78.0 months (42.0-105.0 months). In this study, the rates of disease-free survival, recurrence and mortality were 64.6% (31/48), 16.7% (8/48) and 22.9% (11/48), respectively. ③ In this study, 5-year OS rate was 76.6% and 5-year progression-free survival (PFS) rate was 65.8%. ④ Results of univariate Cox regression analysis showed that achievement of complete remission (CR) before the second auto-HSCT was a protective influencing factor of OS period for aggressive NHL patients (HR=0.174, 95%CI: 0.051-0.598, P=0.005). And multivariate Cox regression analysis of factors that may influence the OS period of NHL patients showed that achievement of CR before the second auto-HSCT was an independent protective influencing factor of OS period for aggressive NHL patients (HR=5.046, 95%CI: 1.031-24.683, P=0.046). Conclusions DAHSCT treatment for aggressive NHL has good efficacy, especially for the patients with CR before the second auto-HSCT. However, whether DAHSCT deserves further clinical application in treatment of aggressive NHL patients still needs further study to confirm. Key words: Lymphoma, non-Hodgkin; Hematopoietic stem cell transplantation; Transplantation, autologous; Autologous hematopoietic stem cell transplantation

Analysis of the clinical features and prognostic factors of patients with gastroesophageal reflux disease

Objective To investigate the clinical features and prognostic factors of patients with gastroesophageal reflux disease(GERD). Methods The clinical data of 62 cases of GERD patients with esomeprazole therapy(GERD group) in the Central Hospital of Chaoyang from February 2012 to December 2015 was analyzed, and 65 cases of chronic superficial gastritis were served as control group.The Hamilton Depression Scale(HAMD) and Hamilton Anxiety Scale (HAMA) score of two groups were observed.The relationship between RDQ score, HAMD score and HAMA score in patients with GERD was analyzed, and the influence factors of the treatment efficacy were analyzed by Logistic. Results HAMD score, HAMA score of GERD group were (19.8 ±7.9) points, (15.9 ±5.6) points, and of control group were (7.9± 1.2) points, (6.7 ±1.0) points, the difference between the two groups was statistically significant(P<0.05 ). HAMD, HAMA and RDQ scores were positively correlated of GERD group(correlation coefficients were 0.401, 0.382, P<0.05). Two months after treatment with esomeprazole, there were 34 cases with markedly effective, 10 cases with effective, 18 cases with invalid, and the remission rate was 71%(44/62). Multivariate logistic regression analysis showed that non erosive peptic esophagitis(NERD)(OR=2.483, 95%CI: 1.247-4.944, P<0.05) and female(OR=2.421, 95% CI: 1.259-4.657, P<0.01) were the independent predictor of esomeprazole in the treatment. Conclusion GERD patients are accompanied by depression and anxiety and other psychological symptoms, the clinical symptoms of some patients with PPI treatment still cannot be alleviated.NERD subtype, female and depression anxiety are the main factors affecting the treatment effect. Key words: Gastroesophageal reflux disease; Non erosive gastro esophagitis; Reflux esophagitis; Esomeprazole; Logistic regression analysis

Analysis of the clinical features and prognostic factors of pulm- onary mucinous carcinoma

Objective The aim of the present study was to explore the clinical features of Pulmonary mueoepidermoid carcinoma (PMEC) and to analysis the tumor's treatment and prognosis factors, to improve the awareness of the disease and the level of diagnosis and treatments. Methods To collect nearly 5 years of Fuzhou general hospital of Nanjing military region which were diagnosed with PMEC underwent 9 cases and the last decade of 292 literature cases collected from CNKI. The patients were classified into low-grade group and high-grade group, based on histological grades. The clinical data, radiological manifestation, pathological findings, treatment strategy, and prognoses of all patients were analyzed retrospectively. Results Surgical treatment were 198 cases, 34 cases from these cases accepted postoperative radiation or chemotherapy, Comprehensive radiation and chemotherapy included 56 cases, 6 patients by targeting therapy, and 41 cases give up treatment; the 5 year survival rate was 43.6%. High-grade PMEC often with high malignant, and was more common in patient with advanced tumor-node-metastasis (TNM) stage and lymph node metastasis respectively(all P<0.000 1). Log-rank test analysis showed that age, pathological grade, lymph node metastasis and TNM stage were correlated with the survival of PMEC patients. In the forward conditional Cox regression model, lymph node metastasis was the most important influencing factors (HR, 0.358, 95%CI, 0.114~0.265, P<0.000 1). Conclusions Lung mucous epidermoid carcinoma is a rare tumor, prognosis is influenced by many factors, and lymph node metastasis is one of the most important influencing factors. The surgical treatment is still the only effective means at present. And the curative effect of radiation and chemotherapy and there is no unified conclusion, targeted therapy is a promising treatment. Key words: Mucinous carcinoma of the lung; Clinical features; Chest CT manifestations; Prognostic factors

Analysis of clinical features and prognostic factors of 512 cases with kidney clear cell renal carcinoma

Objective To evaluate the clinical diagnosis, treatment and prognostic factors of kidney clear cell renal carcinoma(KIRC) in international sample database. Methods From 1998 to 2012, consecutive patients with KIRC who diagnosed and treated in TCGA organizations were enrolled.Clinical characteristics, objective response and survival time were evaluated, and correlation analysis with lncRNA urothelial cancer associated 1 (UCA1) gene was performed. Results 512 patients with KIRC were enrolled.35.4% of patients were female, 59.6% of stage Ⅰ-Ⅱ, 90.0% of white and 45.1% of grade 1-2.Comprehensive treatment was consistent with the clinical guidelines.Significant correlation was found between UCA1 expression and 4 mRNA subtype, 30 genes mRNA expression, mir-101-1 expression and PBRM1 mutation.And patients with UCA1 overexpression could achieve poor prognosis. Conclusion Diagnosis and treatment of the international TCGA-KIRC research meets clinical guidelines.UCA1 overexpression is an important poor prognostic factor.Combined with the clinical relevance of other important driver genes, UCA1 may be significantly valuable for further study. Key words: Clear cell carcinoma, kidney; Diagnosis; Treatment; Prognosis

Clinical analysis of prognostic factors in 166 cases with endometrial carcinoma

Objective To explore the prognostic factors of endometrial carcinoma. Methods 166 patients with endometrial carcinoma in Cancer Hospital of Shantou University Medical College from May 1996 to June 2009 were analyzed retrospectively. Prognostic factors were analyzed by univariate analysis. Results The total 5-year survival rate of 166 cases was 86.7 %. The univariate analysis showed that the age, deep myometrial invasion, lymph-node metastasis and operative-pathological staging were significantly associated with the prognosis (P< 0.05). As well as, according to muhivariate Cox proportional-hazard model, 3 independent factors as the age, deep myometrial invasion and lymph-node metastasis were related significantly to overall survival (P< 0.05). Conclusions The 5-year survival rate of endometrial carcinoma is high. The age, deep myometrial invasion and lymph-node metastasis are independent prognostic factors of endometrial carcinoma. Key words: Endometrial neoplasm; Age; Lymphatic metastasis; Prognosis

Analysis of clinical characteristics and prognostic factors of primary mediastinal T-cell lymphoblastic lymphoma.

Lymphoblastic lymphoma (LBL) comprises 2% to 4% of non-Hodgkin lymphomas cases in adults, of which 85% to 90% of LBL in adults is of T-cell phenotype. This study was aimed to evaluate the clinical characteristics and prognostic factors of patients with mediastinal T-LBL. Based on the retrospective analysis of the clinical data of 35 patients with mediastinal T-LBL during the period from January 1998 to January 2011, the clinical characteristics and prognostic factors of mediastinal T-LBL were summarized. The results showed that the total of 35 patients were identified (male 24 and female 11), with a median age of 19 (5 - 52) years. The majority of patients were in stage III/IV, 16 cases (45.7%) presented bulky mediastinal mass. Intrathoracic effusions (pleural, pericardial) were not uncommon (62.9%). Overall survival rate (OS) and progression-free survival rate (PFS) at 3 years for the entire cohort were 36% and 24%, respectively. OS and PFS at 5 years were 25% and 16.7%, respectively. Anemia at diagnosis were an important, independent predictor of OS (P = 0.048). Bulky mass (P = 0.048), superior vena cava syndrome (P = 0.021), and abnormal PLT count at diagnosis was the independent prognostic factors for PFS (P = 0.021). It is concluded that the patients with primary mediastinal T-LBL are characterized by a low incidence, bad prognosis, and short survival. For patients accompanying with anemia, bulky mass and superior vena cava syndrome, their prognosis is worse.

Analysis of Clinical Prognostic Factors for Adult Patients with Head and Neck Sarcomas

To evaluate the treatment, outcome, and prognostic factors in patients with head and neck sarcomas treated in an academic medical center. Case series. Academic medical center. We performed a retrospective analysis of adult patients (n = 97) with primary head and neck sarcomas treated between 2000 and 2012. We analyzed the treatment, outcome, and potential factors predictive of disease-free survival and disease-specific survival. We also evaluated the outcome and prognostic factors in patients with bone and soft tissue sarcomas. The median overall survival was 6.8 years, with 2-year and 5-year overall survival rates of 78% (95% confidence interval [CI], 66%-86%) and 59% (95% CI, 44%-72%), respectively. Univariable analysis revealed that age at diagnosis (>60 years: hazard ratio [HR], 2.7; 95% CI, 1.2-6.2; P = .01), surgical intervention (HR, 8.3; 95% CI, 3.5-19.5; P < .001), and metastatic disease (HR, 4.3; 95% CI, 1.3-13.6; P = .01) were significantly associated with disease-specific survival. In this study, patients over the age of 60 years at diagnosis and those with inoperable disease at initial presentation had significantly worse disease-specific survival. Surgical intervention remains the optimal treatment modality for those with resectable disease and was associated with significantly better survival in this heterogeneous series. Further multi-institutional studies are required to better define prognostic factors in individual histological subtypes.

Analysis of Clinical Features and Prognostic Factors of Male Breast Cancer:A Review of 40 Cases

Analysis of Clinical Features and Prognostic Factors of Male Breast Cancer:A Review of 40 Cases

Analysis of clinical features and prognostic factors of allopurinol hypersensitivity syndrome

Objective To study the clinical features and prognostic factors of allopurinol hypersensitivity syndrome (AHS). Methods Clinical data on 52 patients with AHS were collected and analyzed retrospectively. Results AHS was an acute severe drug reaction with characteristic symptoms, including generalized skin eruption, fever, lymphadenectasis, eosinophilia, and multiple visceral involvement. Renal inadequacy was observed in 88% of the patients prior to the occurrence of AHS. After the onset of AHS, serum creatinine increased from 271 to 668 μmol/L (t=3.46, P<0.05), while glomerular filtration rate dropped from 37 to 14 ml/min (t=2.87, P<0.05 ) in patients. Multivariate logistic regression analysis revealed that the prognosis of AHS was associated with the severity of renal inadequaey prior to the onset ofAHS (r=2.56, P<0.05 ), severity of skin eruption (r=2.34, P<0.05 ), systemic and regular administration of adequate glucocorticoids (r=2.05 ,P<0.05 ), Conclusions AHS is a severe idiosyncratic drug reaction and commonly seen in patients with renal inadequacy. Severe renal inadequacy and skin eruption often predict a poor prognosis. Systemic glucocorticoid is effective for AHS. Key words: Allopurinol; Drug hypersensitivity; Prognosis

What Constitutes “Improved Prognosis”?

What Constitutes “Improved Prognosis”?

Clinical Prognostic Factors in Chemosensitive Multiple Myeloma (MM) Patients Intensified with High Dose Therapy/Stem Cell Support (HDT/SCS): Results of the Spanish Trial (PETHEMA/GEM2000).

Autologous stem cell transplantation (ASCT) has become the standard of care for young MM pts. The analysis of prognostic factors will contribute to identify which pts benefit more from this procedure. However, in this type of analysis it is important that all pts receive uniform treatment, and since primary refractory pts have a different prognosis from pts sensitive to initial chemotherapy, our policy was to use up-front a more intensive treatment approach for the refractory pts. In this report we will focus on the analysis of clinical prognostic factors in sensitive MM pts to induction chemotherapy. The Spanish PETHEMA/GEM2000 trial included untreated MM pts younger than 70 years and consisted on six alternating cycles of chemotherapy VBMCP/VBAD followed by high dose therapy (BuMel or Mel200) supported with ASCT. Pts achieving CR IF- or CR IF+ after the first transplant received maintenance treatment with interferon/prednisone, while pts with a remaining visible M-spike (partial or minimal response) received a second HDT/SCS with CBV (cyclophosphamide, etoposide and BCNU) or a dose-reduced intensity allogeneic transplant if donor is available. Between January 2000 and December 2004, 803 pts were considered to have chemosensitive disease and were transplanted as above described. Median age at time of diagnosis was 59 y (range: 31–70). Baseline characteristics were similar to those previously reported in other series in which young patients were included. Following initial chemotherapy, the response rate was: 13.6% CRIF-, 14% CRIF+ and 60% PR. Response rate increased after HDT/SCS: CRIF-, CRIF+ and PR rates were 38%, 20% and 35%, respectively. Early death rate, occurring during the first two months after ASCT was 3,5% (28 pts). 207 out of 803 pts received a second HDT/SCS. 531 pts (66%) started maintenance therapy after transplant with interpheron and prednisone in most of them (77%). After a median follow-up of 45 months (range: 6–91), the median EFS time for the 803 pts was 45 months (95% CI: 40,5–49,1), defining event as relapse/progression or death; median OS time has not been reached and the estimated 8-year EFS and OS were 30 and 53%, respectively. Univariate analysis identified the following adverse prognostic factors for EFS: age ≥ 59 y, advanced Durie and Salmon stage, advanced ISS stage, Monoclonal component ≥ 30g/l, Hemoglobin (Hb) level < 11 g/dl, creatinine > 1,5 mg/dl, Bone Marrow Plasma cells infiltration ≥ 45%, performance status according to EGOG 3–4, and failure to achieve CR IF- after induction chemotherapy or after the first transplant. The same prognostic factors were identified in the univariate analysis for OS. On multivariate analysis only five variables retained an independent prognostic influence on EFS and OS: age ≥ 59 y (p:0,04), Hb < 11 g/dl p:0,000), advanced ISS stage (p:0,03) and lack of CRIF- after transplant (p:0,000). The three ISS stages could be subdivided into two subgroups using the variables selected in the multivariate analysis. Thus pts who didn't achieve CR IF- after transplantation and had an additional adverse factor (either age or anemia) showed a significant different outcome within the ISS stage I, II and III.

Clinical analysis of prognostic factors for stage III ovarian epithelial carcinoma

To evaluate the prognostic factors for stage III ovarian epithelial carcinoma so as to provide scientific basis for further reasonable therapy. The clinical records of 369 patients with stage III ovarian epithelial carcinoma, aged 53 +/- 9 (22-77), were reviewed retrospectively. SPSS 10.0 was utilized to analyze the possible prognostic factors statistically. All patients received cytoreductive surgery, 289 cases (71.8%) of which achieved optimal cytoreduction. During the operation, 150 cases (41.8%) and 265 cases (71.8%) were found with intestinal and diaphragmatic involvement respectively. Pathologic results showed that serous type was the most common histological type (48.9%) and mucinous type was the least one (2.2%). The grades G1, G2, and G3 accounted for 1.7%, 42.7%, and 55.6% respectively. 290 cases with effective response to surgery underwent chemotherapy for 3-22 (10 +/- 4) courses. Recurrence was recorded in 190 cases (51.5%) and death was recorded in 152 cases (41.2%). Multivariate analysis revealed that intestinal involvement, diaphragmatic invasion, tumor residuals, and course number of chemotherapy were significantly correlated with prognosis (P < 0.01, < 0.05, < 0.01, and < 0.01 respectively). Cytoreduction for the tumor in peritoneal cavity and positive chemotherapy should be emphasized sufficiently and may be helpful for the prognosis of stage III ovarian epithelial carcinoma.

The addition of continuous infusion 5-FU to preoperative radiation therapy increases tumor response, leading to increased sphincter preservation in locally advanced rectal cancer

Purpose To compare the outcome from preoperative chemoradiation (CXRT) and from radiation therapy (RT) in the treatment of rectal cancer in two large, single-institutional experiences. Patients and methods Between 1978 and 1995, 403 patients with localized, nonmetastatic, clinically staged T3 or T4 rectal cancer patients were treated with preoperative RT alone at two institutions. Patients at institution 1 ( n = 207) were treated with pelvic CXRT exclusively, and patients at institution 2 were treated (except for 8 given CXRT) with pelvic RT alone ( n = 196). In addition, a third group ( n = 61) was treated with CXRT at institution 2 between 1998 and 2000 after a policy change. Both institutions delivered 45 Gy in five fractions as a standard dose, but institution 2 used 20 Gy in five fractions in selected cases ( n = 26). At both institutions, concurrent chemotherapy consisted of a continuous infusion of 5-fluorouracil (5-FU) at a dosage of 1500 mg/m 2/week. The end points were response, sphincter preservation (SP), relapse-free survival (RFS), pelvic disease control (PC), and overall survival (OS). Results Median follow-up was 63 months for all living patients at institution 1 and in the primary group of institution 2. Multivariate analysis of the patients in these groups showed that the use of concurrent chemotherapy improved tumor response (T-stage downstaging, 62% vs. 42%, p = 0.001, and pathologic complete response, 23% vs. 5% p < 0.0001), but did not significantly improve LC, RFS, or OS. Follow-up for the secondary group at institution 2 was insufficient to allow the analysis of these endpoints. In the subset of patients receiving 45 Gy who had rectal tumors ≤6 cm from the anal verge (institution 1: n = 132; institution 2 primary: n = 79; institution 2 secondary: n = 33), there was a significant improvement in SP with the use of concurrent chemotherapy (39% at institution 1 compared with 13% in the primary group at institution 2, p < 0.0001). A logistic regression analysis of clinical prognostic factors indicated that the use of concurrent chemotherapy independently influenced SP in these low tumors ( p = 0.002). This finding was supported by a 36% SP rate in the secondary group at institution 2. Thus SP increased after the addition of chemotherapy at institution 2. Conclusions The use of concurrent 5-FU with preoperative radiation therapy for T3 and T4 rectal cancer independently increases tumor response and may contribute to increased SP in patients with low rectal cancer.

Multivariate analysis of clinical prognostic factors in patients with glioblastoma multiforme treated with a combined modality approach.

We investigated the influence of various clinical prognostic factors in patients with glioblastoma multiforme (GBM) treated with a combined modality approach. A total of 175 patients with GBM was treated in four consecutive prospective phase II studies using surgery, hyperfractionated or accelerated hyperfractionated radiotherapy (RT) and either adjuvant or concurrent or pre-irradiation chemotherapy (CHT) between January 1988 and December 1993. The median survival time for all 175 patients was 14 months and 1-3-year survival (OS) rates were 57%, 34% and 24%, respectively. The median time to tumour progression was 12 months, and 1-3-year progression-free survival (PFS) rates were 43%, 11% and 7%, respectively. Survival analysis showed that of all investigated prognostic factors, only gender did not influence survival. Patients </=55 years did better than those >55 years; patients with KPS 80-100 did better than those with KPS 50-70; patients with frontal tumours did better than those with tumours in other locations; patients with tumours up to 4 cm did better than those with larger tumours, as did patients with either subtotal or gross total tumour resection when compared to those undergoing biopsy only. Multivariate analysis showed that gender and tumour location did not independently influence survival. When PFS was used as the endpoint, only gender did not influence PFS, as confirmed by multivariate analysis.