Factors For Progression In Patients Research Articles

Su1470 Predictive Factors for Disease Progression in Patients With Branch Duct Intraductal Papillary Mucinous Neoplasm

Su1470 Predictive Factors for Disease Progression in Patients With Branch Duct Intraductal Papillary Mucinous Neoplasm

Significance of peak height velocity as a predictive factor for curve progression in patients with idiopathic scoliosis

Significance of peak height velocity as a predictive factor for curve progression in patients with idiopathic scoliosis

Factors Affecting Response to Bacillus Calmette-Guérin Plus Interferon for Urothelial Carcinoma in Situ

The unpredictable behavior of carcinoma in situ and its high potential for recurrence and progression make identifying patient characteristics predicting a poor prognosis a priority. We assessed which factors affect the response to bacillus Calmette-Guérin plus interferon-α therapy in patients with urothelial carcinoma in situ. We analyzed data on a subset of 231 patients with carcinoma in situ enrolled in a multicenter, phase II trial of bacillus Calmette-Guérin plus interferon-α therapy for nonmuscle invasive bladder cancer. Analysis included patients who were bacillus Calmette-Guérin naïve and those with previous exposure to failed bacillus Calmette-Guérin therapy. We evaluated factors potentially affecting the bacillus Calmette-Guérin plus interferon-α response, including patient age, gender, tumor stage, multifocality, prior tumor stage, the previous bacillus Calmette-Guérin failure pattern, courses and maintenance, and prior chemotherapy. The complete response rate at 3 and 6 months in naïve vs previously failed bacillus Calmette-Guérin cases was 76% and 70% vs 76% and 66%, respectively. The 24-month disease-free rate was decreased in the 53 patients with a history of 2 or more failed bacillus Calmette-Guérin courses vs that in the 71 with a history of 1 failed course and bacillus Calmette-Guérin naïve patients (23% vs 57% and 60%, respectively). The 22 patients with refractory carcinoma in situ had the worst outcome of a 23% disease-free rate at 24 months while the 59 with relapse within 1 year had an intermediate outcome of 42% vs 59% in the 33 with relapse after 1 year. Patients with a history of papillary disease did better than those without such a history (p=0.019). Factors associated with a poor response to bacillus Calmette-Guérin plus interferon-α therapy in patients with carcinoma in situ are prior tumor stage, 2 or more prior bacillus Calmette-Guérin failures and a bacillus Calmette-Guérin failure pattern.

TCT-138: Risk Factors for Coronary Plaque Progression in Patients with Far East Asians; A Serial Volumetric IVUS Analysis

TCT-138: Risk Factors for Coronary Plaque Progression in Patients with Far East Asians; A Serial Volumetric IVUS Analysis

Risk Factors for Progression in Patients with Early-stage Chronic Kidney Disease in the Japanese Population

Chronic kidney disease (CKD) is an important worldwide health problem. The incidence of end-stage renal disease (ESRD) is increasing steadily around the world, however few studies have discussed the risk factors for progression in patients with early-stage CKD. Therefore, we designed a retrospective cohort study of patients with early-stage CKD to identify the risk factors influencing the annualized slope of the estimated glomerular filtration rate (eGFR). In this longitudinal cohort study, baseline examination was conducted in 2012 outpatients treated at the Kidney Center, Tokyo Women's Medical University. Follow-up examinations were completed in 485 patients with stage 1 and stage 2 CKD within the study period (2002-2007). The conventional risk factors for CKD progression, such as proteinuria, blood pressure, serum triglyceride, serum HDL, fasting plasma glucose, smoking habit, hypertension or treatment with antihypertensive medication and body mass index, were examined. The annualized eGFR slope was calculated at the start and end of the study period. Multivariate analysis was performed to determine the associations of the eGFR slope with the predisposing risk factors. The mean annualized eGFR slope was -1.64 mL/min/1.73 m(2)/year. Concerning the relationship between etiology and the GFR decreasing slope, IgA nephropathy was defined as the worst (-1.80 mL/min/year) due to the high ratio of proteinuria. Proteinuria (-2.13 mL/min/1.73 m(2)/year, p=0.005), smoking habit (-2.06 mL/min/1.73 m(2)/year, p=0.014), low serum HDL (-1.95 mL/min/1.73 m(2)/year, p=0.035), and hypertension (-1.73 mL/min/1.73 m(2)/year, p=0.045) were all significantly related to the eGFR slope. The estimated GFR for the highest BMI quartile was significantly higher than that of the eGFR for the lowest BMI. Proteinuria, smoking habit, hypertension and low HDL were clearly related to accelerated disease progression in patients with early-stage CKD. Therefore, aggressive treatment of these risk factors is essential in the early stages of CKD.

Analysis of incidence and risk factors for progression in patients with intracranial steno-occlusive lesions by serial magnetic resonance angiography

Objectives Conventional angiography and transcranial Doppler ultrasonography have usually been used for serial observation of cerebral atherosclerotic diseases. This study used magnetic resonance (MR) angiography to monitor serial changes in steno-occlusive lesions of the major intracranial arteries to elucidate the incidence of progression and investigate the risk factors for progression. Patients and Methods The 151 consecutive patients, 78 males and 73 females aged 42–92 years (mean 71.1 ± 10.2 years), were followed up by serial MR angiography for 5–34 months (mean 14.4 ± 5.78 months). Progression was defined as increased stenosis or occlusion, or new stenotic lesion. Age, sex, duration of MR angiography follow up, hypertension, diabetes mellitus, hyperlipidemia, hyperuricemia, current smoking, and atrial fibrillation were chosen as risk factors for multiple logistic analysis. Results Twenty-three of the patients (15.2%) had progression, caused by total occlusion in 10, increased stenosis in 10, and new stenosis in 3, 15 patients had regression, and 113 patients had no change. Diabetes (odds ratio: 6.771, p value: 0.0004) and current smoking (odds ratio: 7.574, p value: 0.0019) were determined as significant risk factors for progression. Conclusions Patients with intracranial steno-occlusive lesion and either diabetes or smoking habit should be carefully followed up by serial MR angiography.

Predictive Factors for Progression in Patients with Clinical Stage T1a Prostate Cancer in the PSA Era

ObjectiveIn the literature, most data regarding the outcome of patients with clinical stage T1a prostate cancer were established before the prostate-specific antigen (PSA) era. The aim of our study was to determine the predictive factors of progression in patients with T1a prostate cancer diagnosed in the PSA era. MethodsConsecutive patients (n=144) with newly diagnosed T1a prostate cancer (tumor involving ≤5% of the resected prostatic tissue) were included. None of them was treated before evidence of tumor progression confirmed by prostate needle biopsies. The associations between tumor characteristics and time to cancer progression were assessed using Cox regression analysis. ResultsWith a mean follow-up of 5.1 yr, 30 patients (21%) experienced cancer progression. Five adverse parameters were significantly associated with cancer progression: preoperative PSA≥10ng/ml, postoperative PSA≥2ng/ml, prostate weight ≥60g, weight of resected tissue ≥40g, and Gleason score≥6. The 5-yr progression rate was 12% if fewer than two of these parameters were present, whereas it was 47% if two or more parameters were present (p<0.001). ConclusionIn the PSA era the risk of progression associated with T1a prostate cancer can be predicted using five criteria, and two groups of patients can be defined. The patients at low risk of progression may be good candidates for surveillance. In those with a high risk of progression, a more aggressive treatment should be discussed.

Editorial Comment on: Predictive Factors for Progression in Patients with Clinical Stage T1a Prostate Cancer in the PSA Era

Editorial Comment on: Predictive Factors for Progression in Patients with Clinical Stage T1a Prostate Cancer in the PSA Era

Editorial Comment on: Predictive Factors for Progression in Patients with Clinical Stage T1a Prostate Cancer in the PSA Era

Editorial Comment on: Predictive Factors for Progression in Patients with Clinical Stage T1a Prostate Cancer in the PSA Era

Monoclonal Gammopathy of Undetermined Significance (MGUS): Predictors of Outcome and Recognition of an Evolving Type.

MGUS occurs in up to 3% of persons older than 50 years and the probability of malignant evolution is 1% per year. The risk of progression from MGUS to a symptomatic monoclonal gammopathy has been investigated in a number of series. However, only the presenting features have been considered while the evolutive pattern during the first years of follow-up has not been taken into account. The aim of our study was to investigate the predictors of outcome considering both the initial features and the pattern of evolution of the M-protein size during the first three years in a large series of patients with MGUS with long follow-up. Three-hundred and fifty nine patients (160 M, 199 F; median age 66 yrs) diagnosed with MGUS at a single institution were included in the study. Patients who showed an inequivocal increase in their M-protein size at the serum electrophoresis during the first three years of follow-up were considered as evolving while the remainders were considered as non-evolving. In the overall series the median values for serum M-protein level and for the proportion of bone marrow plasma cells (BMPC) were 14.8 g/L and 4%, respectively. Three hundred an thirty patients had a non-evolving MGUS while 29 fulfilled the criteria for the evolving type. The M-protein size and the proportion of BMPC at diagnosis were similar in both types of MGUS. The IgG type was more frequent in the non-evolving (65% vs. 45%, p=0.005) whereas the IgA and IgM type were more frequent in the evolving type (55% vs. 32%, p=0.04). Overall, 32 patients developed malignant transformation after a median follow-up of 93 months. Fourteen of the 29 (48%) evolving patients developed symptomatic multiple myeloma while only 18 out of the 330 (5%) remaining patients with non-evolving MGUS progressed to a malignant condition. The progression rate at 10 and 20 years of follow-up for the evolving and the non-evolving types was 55% vs. 10% and 80% vs. 13%, respectively. No patient in the non-evolving type evolved to a malignant condition after the first 12 years of follow-up. The predictors for malignant transformation at the univariate analysis were: the type of MGUS (evolving vs. non-evolving, p<0.001), a proportion of BMPC higher than 5% (p=0.001), the immunoglobulin isotype (IgA vs. IgG, p=0.007) and the M-protein size greater than 15 g/L (p=0.05). At the multivariate analysis the features significantly associated to a higher risk of progression were: the evolving type (RR 12.1, p<0.001,), the IgA type (RR 2.9, p=0.006) and the M-protein concentration (RR 2.2, p=0.044).Conclusions: The evolutive pattern of the serum M-protein during the first years of follow-up is the most important risk factor for progression in patients with MGUS.

Factors Influencing the Rate of Fibrosis Progression in Chronic Hepatitis C

Alcohol consumption, age at infection, and male gender have been identified as risk factors for faster fibrosis progression in patients with chronic hepatitis C (CHC). Yet the influence of liver steatosis, light to moderate alcohol consumption, or iron overload on this progression remains controversial. To analyze the effect of individual risk factors and their interaction on fibrosis progression in a group of patients with CHC and a definite date of infection, we studied 133 consecutive untreated patients. Covariates included were age, body mass index (BMI), gender, age at infection, alcohol intake, serum lipids, glycemia, serum ALT, AST, GGT, iron, and ferritin, grade and stage (METAVIR and Scheuer), and hepatic stainable iron (Perl's stain). The rate of fibrosis progression was inferred from the METAVIR score. By logistic regression analysis, hepatic steatosis (odds ratio [OR], 3.035; 95% confidence interval [CI], 1.16-7.93), serum ferritin levels higher than 290 ng/ml (OR, 5.5; 1.6-18.65), and light to moderate ethanol intake (1-50 g/day) (OR, 5.22; 1.5-17.67) were independently associated with faster fibrosis progression. There was no effect of interaction between these variables on the rate of fibrosis progression. Liver steatosis, serum ferritin levels, and light to moderate alcohol intake are associated with faster fibrosis progression in chronic hepatitis C. Combination of these factors did not further accelerate this progression. The impact of modification of these factors on progression should be tested in longitudinal studies.

147 Risk factors for disease progression in patients with lower urinary tract symptoms/benign prostatic hyperplasia; A systematic analysis of expert opinion

147 Risk factors for disease progression in patients with lower urinary tract symptoms/benign prostatic hyperplasia; A systematic analysis of expert opinion

Percent Gleason Grade 4/5 as Prognostic Factor in Prostate Cancer Diagnosed at Transurethral Resection

We investigated the value of percent Gleason grade 4/5 as a predictor of long-term outcome in men with prostate cancer diagnosed at transurethral resection who received deferred treatment. A series of 305 men with prostate cancer diagnosed at transurethral resection from 1975 to 1990 who had subsequent expectancy was analyzed. Mean patient age at diagnosis was 74 years (range 52 to 95). Slides were reviewed, and the Gleason score, percent Gleason grade 4/5 and modified Gleason score (the sum of the dominant and worst grades) were assessed. At followup 271 men (89%) had died, including 110 (36%) of prostate cancer. Gleason score, percent Gleason grade 4/5 and modified Gleason score were significant predictors of disease specific survival (p <0.001). Of all men 34% had tumors without any grade 4/5 pattern, of whom only 8% died of prostate cancer compared with 52% with any grade 4/5 pattern (p <0.001). Gleason score 6 tumors with focal grade 4 (less than 5%) had a worse prognosis than pure Gleason score 3 + 3 = 6 tumors (p = 0.008). There was nonsignificantly shorter survival for Gleason score 4 + 3 = 7 than for Gleason score 3 + 4 = 7 disease (p = 0.19). In Cox models including all possible pairs of Gleason score, percent Gleason grade 4/5 and modified Gleason score the percent Gleason grade 4/5 and modified Gleason score were stronger than Gleason score, although all 3 were independently significant prognosticators. Percent Gleason grade 4/5, modified Gleason score and Gleason score are predictors of disease specific survival in patients with prostate cancer on deferred treatment. Our study indicates that any grade 4/5 pattern impairs the prognosis significantly.

The 9 months clinical response to intravesical BCG-therapy as a predictive factor for progression in patients with T1 superficial bladder cancer: report of 228 patients

The 9 months clinical response to intravesical BCG-therapy as a predictive factor for progression in patients with T1 superficial bladder cancer: report of 228 patients

PREDICTING PROSTATE SPECIFIC ANTIGEN OUTCOME PREOPERATIVELY IN THE PROSTATE SPECIFIC ANTIGEN ERA

We evaluated the ability of previously defined risk groups to predict prostate specific antigen (PSA) outcome 10 years after radical prostatectomy in patients diagnosed with clinically localized prostate cancer during the PSA era. Between 1989 and 2000, 2,127 men with clinically localized prostate cancer underwent radical prostatectomy, including 1,027 at Hospital of the University of Pennsylvania (study cohort) and 1,100 at Brigham and Women's Hospital (validation cohort). Cox regression analysis was done to calculate the relative risk of PSA failure with the 95% confidence interval (CI) in patients at intermediate and high versus low risk. The Kaplan-Meier actuarial method was used to estimate PSA outcome 10 years after radical prostatectomy. Compared with low risk patients (stages T1c to 2a disease, PSA 10 ng./ml. or less and Gleason score 6 or less) the relative risk of PSA failure in those at intermediate (stage T2b disease or PSA greater than 10 to 20 ng./ml. or less, or Gleason score 7) and high (stage T2c disease, or PSA greater than 20 ng./ml. or Gleason score 8 or greater) risk was 3.8 (95% CI 2.6 to 5.7) and 9.6 (95% CI 6.6 to 13.9) in the study cohort, and 3.3 (95% CI 2.3 to 4.8) and 6.3 (95% CI 4.3 to 9.4) in the validation cohort. The 10-year PSA failure-free survival rate in the 1,020 patients in the low, 693 in the intermediate and 414 in the high risk groups was 83%, 46% and 29%, respectively (p <0.0001). Based on 10-year actuarial estimates of PSA outcome after radical prostatectomy 3 groups of patients were identified using preoperative PSA, biopsy Gleason score and 1992 clinical T category.

PROGNOSTIC FACTORS FOR SURVIVAL OF PATIENTS WITH PATHOLOGICAL GLEASON SCORE 7 PROSTATE CANCER: DIFFERENCES IN OUTCOME BETWEEN PRIMARY GLEASON GRADES 3 AND 4

We evaluated differences in clinical and pathological outcomes between Gleason 3 + 4 and 4 + 3 prostate cancer. The radical prostatectomy whole mounted specimens from 263 men with pathological Gleason 7 tumors were identified. Gleason 3 + 4 and 4 + 3 tumors were compared in regard to pathological variables and outcome. Significance of clinical and pathological data on progression-free survival was analyzed. Of the tumors 34% had a primary Gleason grade of 4, and were more likely than those with primary grade 3 to have seminal vesicle involvement (34% versus 18%, p = 0.006), a higher pathological stage (pT3 55% versus 42%, N+ 13% versus 3%, 0.001), extraprostatic extension (58% versus 38%, 0.001) and higher median preoperative prostate specific antigen (PSA) (13.5 versus 9.0 ng./ml., respectively <0.001). Mean followup plus or minus standard deviation was 6.8 +/- 1.9 years. The overall 10-year crude, cancer specific and progression-free survival rates were 83%, 99% and 58%, respectively. Primary Gleason grade was significantly associated with progression-free (risk ratio 1.6, 95% confidence interval 1.08 to 2.5, p = 0.02) but not crude and cancer-specific survival. Univariately, primary Gleason grade 4 was associated with progression-free survival, as were percent Gleason 4, seminal vesicle invasion, lymph node involvement, pT stage, margin status, DNA ploidy, preoperative PSA, cancer volume and extent of extraprostatic extension. Multivariately, only preoperative PSA (p <0.001), seminal vesicle invasion (<0.001) and DNA ploidy (0.002) were associated with progression-free survival. Primary Gleason grade and percent Gleason 4 were not identified as independently associated with progression-free survival. In patients with Gleason 7 score prostate cancer primary Gleason grade 3 and 4 cancers are different in pathological parameters and prognosis. However, primary Gleason grade does not provide any additional information than other known prognostic factors, such as preoperative PSA, seminal vesicle invasion and DNA ploidy.

LONG-TERM HAZARD OF PROGRESSION AFTER RADICAL PROSTATECTOMY FOR CLINICALLY LOCALIZED PROSTATE CANCER: CONTINUED RISK OF BIOCHEMICAL FAILURE AFTER 5 YEARS

Cure from malignancy is commonly defined as a disease-free state lasting 5 years after treatment. We analyzed clinical and biochemical progression rates after radical prostatectomy for men with clinically localized prostate cancer with particular attention to recurrence beyond 5 years. Annual hazard rates of progression were calculated to determine the probability of recurrence at specific intervals following surgery. The records of 2,782 men with clinically localized prostate cancer (cT1-T2) undergoing radical prostatectomy between 1987 and 1993 were reviewed. All patients were treated in the prostate specific antigen (PSA) era so that serial followup PSA values were available from the time of surgery. Analysis was limited to patients who did not receive adjuvant treatment within 90 days of radical prostatectomy. Disease progression was defined as documented local recurrence, systemic progression and/or PSA 0.4 ng./ml. or greater. Lymph node positive cases were eliminated from analysis since almost all received adjuvant hormonal therapy. Annual hazard rates for progression were calculated using the formula: [No. events / No. patients at risk] x 100. Progression-free survival probabilities were determined using the Kaplan-Meier method. Pathological stage was pT2a-b, N0 (68%), pT3a, N0 (21%) and pT3b, N0 (11%). Biochemical progression-free survival at 5 and 10 years was 76% and 59%, respectively, for the entire study population while those with pathologically organ confined (pT2, N0) cancers had progression-free survival rates of 82% and 68% at 5 and 10 years, respectively. A total of 819 patients (29%) eventually had disease progression, including 160 (6%) with progression after 5 years. Annual hazard rates were highest during the first 2 years after radical prostatectomy for the entire population. Patients with adverse prognostic features (pT3b, PSA 10 ng./ml. or greater, Gleason score 8-10 and nondiploid cancers) had high initial hazard rates that decreased with time to lower levels. Those with pathologically organ confined cancer had low but constant hazard rates throughout followup. Although progression after radical prostatectomy usually occurs early, reflecting the impact of clinical under staging, a significant number of men, including those with organ confined cancers, will continue to have disease progression after 5 years. Patients undergoing radical prostatectomy should be subjected to long-term followup to allow the option of early intervention should progression occur.

NOVEL STAGING TOOL FOR LOCALIZED PROSTATE CANCER: A PILOT STUDY USING GENETIC ADAPTIVE NEURAL NETWORKS

An estimated $1.5 billion is spent annually for direct medical expenses and an additional $2.5 billion for indirect costs for the management of prostate cancer. Today there are several procedures for staging prostate cancer, including lymph node dissection. Despite these procedures, the accuracy of predicting extracapsular disease remains low (range 37 to 63, mean 45%). Use of multiple staging procedures adds significantly to the costs of managing prostate cancer. Recently artificial intelligence based neural networks have become available for medical applications. Unlike traditional statistical methods, these networks do not assume linearity or homogeneity of variance and, thus, they are more accurate for clinical data. We applied this concept to staging localized prostate cancer and devised an algorithm that can be used for prostate cancer staging. Our study comprised 1,200 men with clinically organ confined prostate cancer who underwent preoperative staging using serum prostate specific antigen, systematic biopsy and Gleason scoring before radical prostatectomy and lymphadenectomy. The performance of the neural network was validated for a subset of patients and network predictions were compared with actual pathological stage. Mean patient age was 62.9 years, mean serum prostate specific antigen 8.1 ng./ml. and mean biopsy Gleason 6. Of the patients 55% had organ confined disease, 27% positive margins, 8% seminal vesicle involvement and 7% lymph node disease. Of margin positive patients 30% also had seminal vesicle involvement, while of seminal vesicle positive patients 50% also had positive margins. The sensitivity of the network was 81 to 100%, and specificity was 72 to 75% for various predictions of margin, seminal vesicle and lymph node involvement. The negative predictive values tended to be relatively high for all 3 features (range 92 to 100%). The neural network missed only 8% of patients with margin positive disease, and 2% with lymph node and 0% with seminal vesicle involvement. Our study suggests that neural networks may be useful as an initial staging tool for detection of extracapsular extension in patients with clinically organ confined prostate cancer. These networks preclude unnecessary staging tests for 63% of patients with clinically organ confined prostate cancer.

Risk factors for progression in patients with prostate cancer treated by radical prostatectomy

The use of radical prostatectomy as a form of treatment in prostate cancer has increased dramatically. In recent years, outcomes of this surgical form of treatment were reported on large series of patients. This gives the opportunity to evaluate the well documented recurrence and survival rates in relation to the widely used factors of prognosis. Although radical prostatectomy is a well established option for curative treatment, both the patient and the urologist should be aware of the fact that randomized trials to compare different forms of treatment (i.e. radiotherapy and radical prostatectomy) for prostate cancer have not been conducted.

Analysis of Risk Factors for Progression in Patients with Pathologically Confined Prostate Cancers After Radical Retropubic Prostatectomy

Purpose Up to 26 percent of patients with pathologically organ confined prostate cancer will experience clinical progression after radical prostatectomy. We attempted to identify patients at greatest risk for future clinical failure despite a favorable pathological outcome. Materials and Methods The study group included 904 patients treated with bilateral pelvic lymphadenectomy and radical retropubic prostatectomy for disease confined to the prostate gland. Preoperative serum prostate specific antigen (PSA), clinical stage, pathological grade and stage, and deoxyribonucleic acid (DNA) ploidy were evaluated by multivariate analysis to determine relative value in predicting treatment failure. A prognostic scoring system was created using the regression coefficients from the Cox multivariate model to classify patients further according to risk of progression. Results Preoperative PSA concentration, clinical stage, grade and DNA ploidy were significant univariate predictors of progression (p less than 0.0001), whereas pathological stage was not (p = 0.2). Multivariate analysis identified pathological grade (p less than 0.0001), preoperative serum PSA concentration (p = 0.0006) and DNA ploidy (p = 0.0089) as independent predictors of progression. The prognostic scoring system separated the patients into 5 distinct groups. Patients with the lowest score had a 92 percent progression-free survival rate at 5 years, compared to only 39 percent of those with the highest scores. Conclusions Patients believed to be at higher risk for cancer progression despite having organ confined disease might be targeted for adjuvant therapy and closer surveillance, while those at low risk may be followed less often.