Difference In Specific Survival Research Articles

Organ Preservation in Patients With Advanced Laryngeal Tumours. Results of Induction Chemotherapy Versus Chemoradiotherapy in Actual Clinical Practice

Introduction and objectivesA high percentage of patients with locally advanced laryngeal carcinoma are candidates for inclusion in organ preservation protocols. The aim of this study was to compare in actual clinical practice the results of two preservation schemes, induction chemotherapy versus chemoradiotherapy, in patients with locally advanced laryngeal carcinoma. MethodsRetrospective study conducted in 157 patients with locally advanced laryngeal tumours (T3-T4) treated with induction chemotherapy (n=121) or chemoradiotherapy (n=36). ResultsOf the 121 patients who started treatment with induction chemotherapy, 6 died as a result of toxicity, 37 were treated with surgery, and 78 completed the preservation scheme; 36 patients were treated with chemoradiotherapy. There was no significant difference in specific survival at 5 years according to whether the patients had started treatment with either induction chemotherapy or chemoradiotherapy (68.9% versus 75.7%, P=.259). A total of 45.9% of the patients achieved preservation of laryngeal function. There was a tendency for patients treated with chemotherapy to achieve laryngeal dysfunction-free survival at 5 years, which was higher than the patients treated with induction chemotherapy (55.6% versus 44.8%, P=.079). ConclusionThe patients included in a preservation protocol achieved 45.9% laryngeal dysfunction-free survival at 5 years. No significant difference in specific survival was observed between patients treated with induction chemotherapy or chemoradiotherapy.

Keratin 17 identifies the most lethal molecular subtype of pancreatic cancer

Although the overall five-year survival of patients with pancreatic ductal adenocarcinoma (PDAC) is dismal, there are survival differences between cases with clinically and pathologically indistinguishable characteristics, suggesting that there are uncharacterized properties that drive tumor progression. Recent mRNA sequencing studies reported gene-expression signatures that define PDAC molecular subtypes that correlate with differences in survival. We previously identified Keratin 17 (K17) as a negative prognostic biomarker in other cancer types. Here, we set out to determine if K17 is as accurate as molecular subtyping of PDAC to identify patients with the shortest survival. K17 mRNA was analyzed in two independent PDAC cohorts for discovery (n = 124) and validation (n = 145). Immunohistochemical localization and scoring of K17 immunohistochemistry (IHC) was performed in a third independent cohort (n = 74). Kaplan-Meier and Cox proportional-hazard regression models were analyzed to determine cancer specific survival differences in low vs. high mRNA K17 expressing cases. We established that K17 expression in PDACs defines the most aggressive form of the disease. By using Cox proportional hazard ratio, we found that increased expression of K17 at the IHC level is also associated with decreased survival of PDAC patients. Additionally, within PDACs of advanced stage and negative surgical margins, K17 at both mRNA and IHC level is sufficient to identify the subgroup with the shortest survival. These results identify K17 as a novel negative prognostic biomarker that could inform patient management decisions.

Ethnic specific differences in survival of patients with type 2 diabetes: Analysis of data collected from an Australian multi-ethnic cohort over a 25 year period

AimsTo examine the survival of patients with type 2 diabetes from 7 ethnic groups, living in the shared environment of an Australian city. MethodsHazard ratio of death (HR) after diagnosis of diabetes was compared between Anglo-Celtic (n=5433), Indigenous Australian (n=439), Pacific Islander (n=354), Mediterranean (n=3138), Arabic (n=768), Indian (n=702) and Chinese (n=1632) patients who live in metropolitan Sydney. Mortality was ascertained by data-linkage with the Australian National Death Index. The modulating effects of glycaemic control, diabetes/vascular complications and risk factors, year of diabetes diagnosis and duration of diabetes on ethnic differences were analysed by Cox regression. Socio-economic status and competence in English were also examined. ResultsThere were significant differences in survival between the ethnic groups; the Indigenous Australians had the highest HR for death (2.3, 95% CI 1.7–3.0) and the Chinese the lowest (0.4, 95% CI 0.4–0.5). The survival of the Anglo-Celtics (HR 1) was surprisingly poorer than for Indian (0.6, 95% CI 0.5–0.8), Arab (0.7, 95% CI 0.6–0.8) and Mediterranean groups (0.8, 95% CI 0.7–0.9). Prevalence of smoking and albuminuria were strongly associated with HR. The better survival of Chinese and Arab and the worse survival of Indigenous Australians remained after adjustment of risk factors. Need for an interpreter was a favourable risk factor for survival. ConclusionsEthnicity is a significant determinant of survival in type 2 diabetes and this is substantially but not completely mediated by smoking and vascular risk factors. The favourable impact associated with less competence in English may represent a Healthy-migrant effect.

A discordant histological risk classification in preoperative and operative biopsy in endometrial cancer is reflected in metastatic risk and prognosis

IntroductionIn endometrial cancer, tissue for histological evaluation is obtained preoperatively (endometrial biopsy) and operatively (hysterectomy specimen). We investigated if a discordant risk classification based on preoperative and operative biopsy is reflected in metastatic risk and prognosis. Patients and methodsOne thousand three hundred and seventy-four patients were prospectively included in a multicentre setting (Molecular Markers for Treatment of Endometrial Cancer (MoMaTEC) study). Preoperative and operative specimens were classified as high risk if non-endometrioid histology or endometrioid grade 3; otherwise low risk. Disease specific survival differences were calculated by means of Kaplan–Meier and Cox proportional hazard models. ResultsDiscordant risk was found in 207 (16%) cases. Lymph node metastases were detected in 7% and 23% of patients with concordant low and high risk respectively versus 14% and 20% in the discordant groups (p<0.001). Five-year disease specific survival in the discordant groups proved intermediate (75–80%) to concordant low (94%) or high (58%) risk. Both operative and preoperative biopsy high-risk results have independent prognostic impact on disease specific survival with adjusted hazard ratios of 2.4 (95% confidence interval (95% CI) 1.5–3.9) and 2.1 (95% CI 1.3–3.2) respectively by Cox analysis. ConclusionsDiscordant risk in preoperative biopsy and hysterectomy identifies an intermediate group with respect to disease spread and prognosis. Preoperative biopsy results remain important also with the hysterectomy histology available.

Gender and ploidy in cancer survival

BackgroundFemales carry a better prognosis than men for many cancer types. We hypothesized that chromosomal changes, in particular numerical alterations of the sex chromosomes or the presence of near-triploidy may contribute to these gender differences.MethodsTo characterize the influence of gender a literature search was performed for survival data of 27 tumor types. All entities were categorized by the strength of evidence for differences in survival between females and males. To test our hypothesis the Mitelman database of chromosomal alterations was evaluated for the major tumor types occurring in both women and men. Numerical gonosome alterations were documented and mean chromosome numbers were converted into histograms to provide insight into the ploidy level of 37 cancer types.ResultsIn general, a survival advantage of women could be shown for most, but not all cancer types. In addition, 36.859 karyograms were analyzed. Numerical gonosome alterations were more frequent in males than females indicating a potential link with gender differences in survival. Neartriploidy was a common phenomenon in many cancer types suggesting that it represents a metastable condition of the cancer genome. It was not related to gender differences in survival. However, the extent of triploidy and aneuploidy was associated with poor prognosis in carcinomas. There was no single case in the Mitelman database with normal chromosome number (n = 46) that did not carry at least one structural or numerical aberration.ConclusionsOur study highlights the importance of chromosomal changes in tumor formation and progression. In addition, it suggests potential associations with gender specific differences in survival.Electronic supplementary materialThe online version of this article (doi:10.1007/s13402-011-0013-0) contains supplementary material, which is available to authorized users.

1595 EXTENDED LYMPHADENECTOMY AND CHEMOTHERAPY OFFER SURVIVAL ADVANTAGE IN MUSCLE-INVASIVE BLADDER CANCER

You have accessJournal of UrologyBladder Cancer: Invasive1 Apr 20111595 EXTENDED LYMPHADENECTOMY AND CHEMOTHERAPY OFFER SURVIVAL ADVANTAGE IN MUSCLE-INVASIVE BLADDER CANCER Peter J. Bostrom, Tuomas Mirtti, Martti Nurmi, Matti Laato, Bas W.G van Rhijn, Neil E. Fleshner, Antonio Finelli, Michael A Jewett, and Alexandre R. Zlotta Peter J. BostromPeter J. Bostrom Toronto, Canada More articles by this author , Tuomas MirttiTuomas Mirtti Helsinki, Finland More articles by this author , Martti NurmiMartti Nurmi Turku, Finland More articles by this author , Matti LaatoMatti Laato Turku, Finland More articles by this author , Bas W.G van RhijnBas W.G van Rhijn Toronto, Canada More articles by this author , Neil E. FleshnerNeil E. Fleshner Toronto, Canada More articles by this author , Antonio FinelliAntonio Finelli Toronto, Canada More articles by this author , Michael A JewettMichael A Jewett Toronto, Canada More articles by this author , and Alexandre R. ZlottaAlexandre R. Zlotta Toronto, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1645AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The role of extended pelvic lymph node dissection (ePLND) and adjuvant chemotherapy in the treatment of muscle-invasive bladder cancer (BC) remain unclear. Our large database from two centers (Turku, Finland and Toronto, Canada) offer an opportunity to study these factors, as there have been different institutional practice policies. In Turku, ePLND was not common practice and adjuvant chemotherapy was nearly never offered whereas standard of care in Toronto included ePLND and adjuvant chemotherapy when indicated. METHODS Consecutive BC patients undergoing radical cystectomy in UHN, Toronto, Canada (1992–2008) and University of Turku, Turku, Finland (1986–2005) were studied. After exclusion of non-urothelial cases and neoadjuvant treatment, 563 patients were available for analysis. Clinicopathological variables, the rate and extent of PLND and the rate of adjuvant cisplatin-based chemotherapy were analyzed using the Chi-squared-test. Kaplan-Meier method and multivariate Cox regression analysis were used to analyze survival. RESULTS In the Toronto cohort, patients were older (mean age 68 vs. 63y, p<0.001), had more extensive PLNDs (>10 nodes removed, 58% vs. 8%, p<0.001), had more nodal metastasis (26% vs. 7%, p<0.001), and adjuvant chemotherapy was administered more often (21% vs. 1%, p<0.001). Positive margin rate was similar (4% in both centers). No BC specific survival differences could be demonstrated in ≤ pT2a tumors or in pT4a/b tumors. In contrast, there was a trend for improved survival in pT2b tumors (10y BC specific survival 65% vs. 42%, p=0.23) and a significant difference favouring the Toronto cohort in pT3a and pT3b tumors (55% vs. 31%, p=0.025; 43% vs. 28% p=0.06, respectively). In multivariate analysis, pT-stage (HR 1.8, 95% CI 1.2–2.8; p<0.005), N-stage (HR 2.5, 95% CI 1.5–4.1; p<0001), and ePLND (HR 0.53, 95% CI 0.31–0.93, p=0.026) significantly affected disease specific survival. Adjuvant chemotherapy offered borderline significant benefit (HR 0.61, 95% CI 0.36–1.05, p=0.072). An interaction model combining ePLND and chemotherapy was significant when ePLND with more than 10 nodes removed and adjuvant chemotherapy were combined (HR 0.49, 95% CI 0.26–0.92, p=0.026). CONCLUSIONS With the limitations of not being a randomized study but with an unique setting as our study centers had opposite management in terms of ePLND and adjuvant chemotherapy, our results show that the combination of ePLND and adjuvant chemotherapy offer a survival advantage in muscle-invasive BCs treated with RC. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e640 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Peter J. Bostrom Toronto, Canada More articles by this author Tuomas Mirtti Helsinki, Finland More articles by this author Martti Nurmi Turku, Finland More articles by this author Matti Laato Turku, Finland More articles by this author Bas W.G van Rhijn Toronto, Canada More articles by this author Neil E. Fleshner Toronto, Canada More articles by this author Antonio Finelli Toronto, Canada More articles by this author Michael A Jewett Toronto, Canada More articles by this author Alexandre R. Zlotta Toronto, Canada More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Characterizing genotype specific differences in survival, growth, and reproduction for field grown, rapid cycling Brassica rapa

Rapid cycling Brassica rapa (RCBr) develops rapidly, and has both small adult size and a brief life cycle. Yet, in spite of many investigations using RCBr, extremely few plant ecologists have used this plant in the field. This study is the first to describe the genotype specific variation in traits describing survival, growth, and reproduction for field grown, RCBr. I also identify traits associated with fitness. Five genotypes of RCBr were used: standard, anthocyaninless, yellow-green, anthocyaninless and hairless, and anthocyaninless and yellow-green. Plants were grown outside in a “common garden”. Eight plant traits were measured: life span, height, growth rate, leaf size, number of flowers and fruits, fruit set, and fitness. All traits, except life span, differed significantly among the five plant genotypes. Correlation analysis revealed that fitness increased as each of these of seven plant traits increased. This study demonstrates that RCBr can serve as a model organism in ecological field studies.

ANNUAL SURVIVAL OF ADULT AMERICAN REDSTARTS AND OVENBIRDS IN THE SOUTHERN BOREAL FOREST

Using constant effort (1993–1996) and playback mist netting with color banding (1996–1999), we estimated annual survival rates of Ovenbirds (Seiurus aurocapillus) and American Redstarts (Setophaga ruticilla) at four sites in the boreal forest of central Saskatchewan. For both species, the model that best described our data included a residency index that differentiated individuals caught more than once within the breeding season of initial capture (residents) from individuals caught only once (transients). Transients had considerably lower recapture rates than residents. The residency index was a more effective means of addressing violations of the homogeneity of capture assumption inherent in Cormack-Jolly-Seber models than a two-stage or age-structured model. We detected no significant differences in survival or recapture rate of male Ovenbirds between constant effort and playback mist netting techniques, although our estimate of annual survival for male Ovenbirds captured using playback (0.62 ± 0.06 SE) was higher than when we used constant effort netting (0.44 ± 0.13 SE). We observed no significant differences in survival between male (n = 99) and female (n = 113) American Redstarts or between second-year (n = 50) and after-second-year (n = 49) American Redstart males (overall survival = 0.55 ± 0.09 SE). For Ovenbirds, the model that best fit the data incorporated sex specific differences in survival with females (n = 76) having lower survival (0.21 ± 0.09 SE) than males (n = 197, 0.60 ± 0.12 SE). Without accounting for the presence of transient birds in our models, our estimates of survival would have been unrealistically low. Residency indices based on the number of times an individual was captured within a season seem to provide an effective means to account for transients.

The Influence of Pnx/Pn0 Grouping in a Multivariate Setting for Outcome Modeling in Patients with Clear Cell Renal Cell Carcinoma

Lymphadenectomy, especially extended lymphadenectomy, is not commonly performed in patients undergoing a radical nephrectomy for clear cell renal cell carcinoma. Surgeons may sample suspicious regional lymph nodes, but the lymph node status of many patients with renal cell carcinoma remains unknown, termed stage pNx. Outcome models based on large institutional reviews have been criticized for grouping stages pNx and pN0 cases because of concern that the pNx category may include unrecognized stages pN1/pN2 disease. We evaluated cancer specific survival differences in patients with clear cell renal cell carcinoma and a lymph node stage of pNx, pN0 or pN1/pN2. We searched the registry at our institution for patients who underwent radical nephrectomy for clear cell histology renal cell carcinoma between 1970 and 1998. Those with distant metastases at surgery were excluded from study. Clinical features obtained from the medical record included age at surgery, history of tobacco use, hypertension and symptomatic disease at presentation. A single urological pathologist reviewed all tumor specimens for nuclear grade, tumor necrosis, surgical margin status, 1997 tumor stage and lymph node status. These features were compared in patients with stages pNx and pN0 tumors. Cox proportional hazards models were used to compare cancer specific survival in univariate fashion, and after adjusting for tumor stage and grade. The study cohort consisted of 1,535 patients with sporadic, unilateral clear cell renal cell carcinoma who underwent radical nephrectomy. There were 600 patients (39%) with stage pNx, 870 (57%) with stage pN0 and 65 (4%) with stages pN1/pN2 tumors. At an average of 4.2 years after surgery 414 patients died of renal cell carcinoma. On univariate analysis patients with stage pN0 tumors were significantly more likely to die of renal cell carcinoma than those with stage pNx tumors (risk ratio 1.40, 95% confidence interval 1.12 to 1.75, p = 0.003). However, after adjusting for tumor stage and nuclear grade the difference in outcome for stages pNx and pN0 tumors was not statistically significant (risk ratio 1.07 95% confidence interval 0.85 to 1.34, p = 0.583). Patients with stage pNx disease were significantly less likely to be symptomatic at presentation (p = 0.002), have tumors that were less than 5 cm. (p <0.001) and of lower stage (p <0.001) and grade (p = 0.005), and to have tumors with necrosis (p = 0.024) than patients with stage pN0 disease. Combining stages pNx and pN0 cases to create outcome prediction models after radical nephrectomy for clear cell renal cell carcinoma is appropriate in a multivariate setting that includes tumor stage and grade. Clinical features available preoperatively and during surgery can help guide the decision to perform limited lymph node sampling. When the tumor is 5 cm. or greater, shows pathological necrosis or is advanced grade 3 or 4, lymph node sampling adds little prognostic information.

Freeze Preservation of Cultured Plant Cells

AbstractA basic technique for successful freeze preservation and storage at ‐196°C of cultured plant cells and an assay of percentage survival following the freezing‐storage‐thawing procedure are described. These techniques have been applied to suspension cultures of carrot (3 cell lines), belladonna and sycamore. Dimethyl sulfoxide (DMSO) and glycerol, when appropriately applied, were the most effective cryoprotectants tested. Although these cryoprotectants were of low toxicity and did not cause alterations in the cytology and growth potential of the recovered cells, the cell lines differed in their sensitivity to the toxicity of these cryoprotectants. Small meristematic cells survived the freezing‐thawing procedure better than larger more highly vacuolated cells. Specific differences in survival are in part explained in terms of differences in cell morphology.