Higher Chronological Age Research Articles

Chronological age is not an independent predictor of clinical outcomes after radical nephroureterectomy

Higher chronological age has been suggested to confer worse prognosis in patients with upper tract urothelial carcinoma (UTUC). The aim of the current study was to test this hypothesis in a large multicenter external validation cohort of patients treated with radical nephroureterectomy (RNU) while controlling for patient performance status. We retrospectively reviewed the data from 1,169 patients treated with RNU for UTUC. Age at RNU was analyzed both as a continuous and categorical variable (<50years, n=66; 50-59.9years, n=185; 60-69.9years, n=367; 70-79.9years, n=419; ≥80years, n=132). Median follow-up was 37months. Actuarial recurrence-free, cancer-specific, and all-cause survival estimates at 5years after RNU were 69, 73, and 61%, respectively. Advanced age was associated with female gender, higher ECOG status, higher ASA score, and a lower probability of receiving adjuvant chemotherapy (all P values≤0.02). In multivariable analyses, advanced age was associated with decreased recurrence-free (P=0.021), cancer-specific (P=0.002), and all-cause survival (P<0.001) after controlling for the effects of gender, tumor location, number of lymph nodes removed, tumor grade, stage, architecture, necrosis, and lymphovascular invasion. After addition of ECOG status, age remained an independent predictor of only all-cause mortality (P>0.001). We confirmed that advanced patient age at the time of RNU is associated with worse clinical outcomes after surgery. However, ECOG performance status abrogated the association. Furthermore, a large proportion of elderly patients were cured with RNU. This suggests that chronological age alone is an inadequate indicator criterion to predict response of older UTUC patients to RNU.

Analysis of gonadotropin-releasing hormone (GnRH) test results in girls with precocious puberty

Purpose : The gonadotropin-releasing hormone (GnRH) test results of girls with precocious puberty were analyzed to determine whether this test can efficiently and clearly differentiate between central precocious puberty (CPP) and other disorders. Methods : Clinical and laboratory data of 54 girls with precocious pubertal signs were reviewed. Intravenous GnRH test was performed with blood samples obtained at 0, 30, 60, and 90 minutes. A peak luteinizing hormone (LH) level of ≥5.0 IU/L was indicative of CPP. Results : Of the 40 girls with CPP, 36 (90.0%), 3 (7.5%), and 1 (2.5%) showed peak LH levels at 30, 60, and 90 minutes, respectively. A percentage of girls whose peak LH ≥5.0 IU/L up to 30, 60, and 90 minutes was 92.5%, 100%, and 100%, respectively. The peak LH/follicle stimulating hormone (FSH) ratio of girls with CPP was 0.89±0.49 and was 1.0 showed higher chronological age (CA) (8.3±0.6 vs. 7.7±1.0 years, P=0.033), bone age (BA) (10.9±0.8 vs. 9.7±1.1 years, P=0.001), and BA-CA difference (2.6±0.7 vs. 2.0±0.7 years, P=0.009) than those of girls with peak LH/FSH ratio of ≤1.0. Higher percentage of girls with peak LH/FSH ratio of >1.0 showed advanced breast development (≥Tanner III) (93.7% vs. 41.7%, P=0.001). Conclusion : LH levels after 30 and 60 minutes of intravenous GnRH administration are the most useful for diagnosing CPP in girls. (Korean J Pediatr 2009;52:1377-1382)

Breast screening: Axillary lymph node status of interval cancers by interval year

The aim of this study was to determine whether the excess risk of axillary lymph node metastases (N+) differs between interval breast cancers arising shortly after a negative mammography and those presenting later. In a registry-based series of pT1a–pT3 breast carcinoma patients aged 50–74 years from the Italian screening programmes, the odds ratio (OR) for interval cancers ( n = 791) versus the screen-detected (SD) cancers ( n = 1211) having N+ was modelled using forward stepwise logistic regression analysis. The interscreening interval was divided into 1–12, 13–18, and 19–24 months. The prevalence of N+ was 28% among SD cancers. With a prevalence of 38%, 42%, and 44%, the adjusted (demographics and N staging technique) OR of N+ for cancers diagnosed between 1–12, 13–18, and 19–24 months of interval was 1.41 (95% confidence interval 1.06–1.87), 1.74 (1.31–2.31), and 1.91 (1.43–2.54), respectively. Histologic type, tumour grade, and tumour size were entered in turn into the model. Histologic type had modest effects. With adjustment for tumour grade, the ORs decreased to 1.23 (0.92–1.65), 1.58 (1.18–2.12), and 1.73 (1.29–2.32). Adjusting for tumour size decreased the ORs to 0.95 (0.70–1.29), 1.34 (0.99–1.81), and 1.37 (1.01–1.85). The strength of confounding by tumour size suggested that the excess risk of N+ for first-year interval cancers reflected only their higher chronological age, whereas the increased aggressiveness of second-year interval cancers was partly accounted for by intrinsic biological attributes.

Psychological well-being in women with Turner syndrome: Somatic and social correlates

Our aim was to examine possible somatic and social correlates to psychological well-being in adult women with Turner Syndrome (TS), including hormone replacement treatment. Sixty-three women with a diagnosis of TS (mean age, 31.5 years) participated in a cross-sectional study, using interview data, ratings on the Psychological General Well-being (PGWB) Index, and data from medical examinations and medical records. Statistical analysis was performed by bivariate and multivariate analyses. Lack of sex hormones during adult life and the presence of hearing impairment were related to lower psychological well-being, as were higher age at diagnosis, higher age at menarche or induced bleeding, higher chronological age and retrospectively reported difficulties with school subjects. Age at diagnosis and difficulties with school subjects explained 25% of the variation in psychological well-being. This study has identified some correlates to psychological well-being in women with TS, which are important when considering the clinical management of adult women with TS.

Age at Menopause in Central Andean Peruvian Women

The objective of the present study was to determine median age at natural menopause using the status quo method and the sociodemographic and reproductive variables that determine the age at natural menopause in Peruvian women from Lima and Cerro de Pasco. The study was performed in one urban area from Cerro de Pasco (4,340 m above sea level) and in one urban area from Lima (150 m above sea level). The total sample was 469 women aged 28–56 years, 216 from Cerro de Pasco and 253 from Lima. Median age at menopause was 47.1 years at sea level, and 46.14 years at high altitude (p = 0.0005). Results of the proportional hazard regression analysis showed that life at high altitude and lack of use of oral contraceptives were factors associated with early age at menopause, whereas later age at menarche and higher chronological age were associated with delayed age at menopause. In conclusion, altitude is a factor that independently accelerated age at natural menopause.

Effect of urinary bilharzial infection on male pubertal development and endocrine functions.

One hundred seventy-five males aged 9-20 years were selected. The subjects comprised two groups; controls and patients infected with urinary bilharziasis not associated with any other parasite. Pubertal development was assessed. Serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, and progesterone were determined by radioimmunoassay procedure. Delay in pubertal development was evident in the normal control group as indicated by higher chronological age mean values at the various stages as compared to other world norms. Urinary bilharziasis exaggerated the delay in pubertal development as compared to that in the control group. In relation to the control group, the group with urinary bilharziasis had higher levels of serum FSH and LH, which were significant only at stages III and IV. No significant difference was noted between the two groups for serum testosterone and progesterone levels, except for the high progesterone mean value at stage V in the group with urinary bilharziasis.