Important Prognostic Factor For Survival Research Articles

Prior chemoradiotherapy adversely impacts outcomes of recurrent and second primary head and neck cancer treated with concurrent chemotherapy and reirradiation

It has been shown that concomitant chemotherapy (C) with reirradiation (ReRT) is feasible and effective for select patients with recurrent or second primary head and neck cancer (HNC). To examine potential prognostic factors associated with survival, the authors of this report retrospectively reviewed the outcomes of patients who received CReRT. The study cohort comprised previously irradiated patients with nonmetastatic disease from 9 consecutive phase 1 and 2 protocols for poor-prognosis HNC. For all patients, reirradiation (ReRT) was delivered with concurrent chemotherapy. Chemotherapy generally was 5-fluorouracil, hydroxyurea, and a third agent. One hundred sixty-six patients were identified, including 81 patients who underwent surgical resection or debulking before enrollment. The median ReRT dose was 66 gray. After a median follow-up of 53 months among surviving patients, the median overall survival (OS) was 10.3 months. The 2-year rates for OS, disease-free survival, locoregional control, and freedom from distant metastasis were 24.8%, 19.9%, 50.7%, and 61.4%, respectively. Thirty-three patients (19.9%) died of treatment-related toxicity. In subgroup analysis, survival was significantly reduced in patients who received previous concurrent chemoradiotherapy (CRT) compared with patients who were naive to CRT (2-year OS rate, 10.8% vs 28.4%; P = .0043). In multivariable analysis, prior CRT was associated independently with OS along with surgery before protocol treatment, full-dose ReRT, and radiotherapy interval. CReRT achieved a long-term cure for a small group of patients with recurrent or second primary HNC. Previous treatment with CRT was among the important prognostic factors for survival. Because of the associated risk of severe toxicity, CReRT should be limited only to carefully selected patients.

IGF-1R expression predicts clinical outcome in patients with locally advanced oral squamous cell carcinoma

To assess the expression of IGF-1R in oral cavity squamous cell carcinoma patients, to explore its relation with clinical and pathologic prognostic factors and its role in predicting clinical outcome. One hundred and thirty-one consecutive patients suffering from oral cavity squamous cell carcinoma were included in this study from July 1989 to April 2005. Follow-up was closed in May 2010. The mean follow-up for survivors was 110.26±47.42 months. Patients were staged following the TNM classification. Patients in tumour stages I and II were referred to surgery. Patients in stages III-IV were referred to postoperative radiotherapy. Radiation therapy was administered up to a mean dose of 62.13±7.74 Gy in 1.8-2 Gy fractions. IGF-1R expression was studied by immunohistochemistry in paraffin-embedded tumour tissue. IGF-1R was expressed in 101 patients (77.1%). IGF-1R expression was related to tumour grade (P=0.012). Tumour stage was the most important prognostic factor for survival. Low (negative and fairly) IGF-1R tumour expression was correlated to better long-term Local Disease Free Survival (P=0.016), Disease-Free Survival (P=0.029), and Survival (P=0.009) in patients achieving tumour stages III-IV. Low IGF-1R expression was related to better long-term control in patients suffering locally advanced oral carcinoma.

Lymphopenia and breast cancer subtypes as prognostic factors in patients with locally advanced breast cancer.

e21100 Background: Lymphopenia has been shown to be an important prognostic factor for survival in patients with lymphomas and solid tumors. The aim of this study was to evaluate if lymphopenia is a prognostic factor for survival in patients with locally advanced breast cancer after relapse or progression of disease. Methods: We retrospectively evaluated 163 consecutive locally advanced breast cancers patients who received preoperative treatment from January 2003 to December 2005 in the pre trastuzumab era. We classified them according to subtypes: Luminal A, Luminal B, HER2 and Triple Negative (TN). Lymphopenia at the time of relapse/progression was defined as an absolute lymphocyte count (ALC) < 1000/mm3. Kaplan-Meier, log-rank and Cox regression analysis were used to look for prognostic factors. Results: 101 (62%) patients were Luminal A, 35 (21%) were TN, 18 (11%) were Luminal B and 9 (6%) were HER-2. With a mean follow-up of 77.8 months, 83 patients (50.9%) relapsed or progressed during treatment with a median survival after relapse/progression of 22.6 months. 29 (34.9%) patients had lymphopenia with a median survival of 7.3 months, significantly lower than for those without lymphopenia (Not reached; p<0.0001). Median survival after relapse/progression was also different between subtypes, being significantly lower for TN patients with 10.6 months, compared to Luminal A with 44.7 months (p=0.025). Other variables such as age, histological grade, HER-2 status, ER status and visceral metastasis at the time of the occurrence of relapse/progression, did not influence survival. In the multivariate Cox regression analysis, lymphopenia (RR=3.6; 95% CI, 1.80-7.02; p<0.0001) and being a subtype other than Luminal A (RR=2.5; 95% CI, 1.28-5.07; p=0.008) were independent prognostic factors of survival. Conclusions: Lymphopenia is a prognostic factor of survival in patients with locally advanced breast cancer at the time of relapse or progression. Lymphopenia was a stronger prognostic factor than the different breast cancer subtypes, which could mean that the host immune response play an important role regardless of tumor biology. Studies with larger numbers of patients are needed to validate these results.

Retroperitoneal sarcomas: 20 years experience at a tertiary Asian center.

e20522 Background: Soft tissue sarcomas are rare and account for less than 1% of all newly diagnosed malignancies. Approximately 15% of soft tissue sarcomas arise in the retroperitoneum and they present complex clinical problems where surgery forms the mainstay of treatment. Previous studies have shown that high histologic grade and incomplete gross resection are the most important prognostic factors for survival. The study was conducted to evaluate the clinical results of an aggressive resection policy for retroperitoneal sarcomas in an Asian centre and to determine the prognostic factors for disease recurrence and patient survival. Methods: A prospective database was used to identify 112 patients with primary or recurrent retroperitoneal sarcoma treated between July 1990 and December 2009. Histology at primary presentation was reviewed and subtyped according to WHO classification. The influence of clinicopathological factors on disease free interval and overall survival was analysed using a multivariate...

Lymphopenia as a predictive factor of responsiveness to preoperative treatment in patients with locally advanced breast cancer.

e21096 Background: It has been suggested that lymphopenia is an important prognostic factor for survival in patients with advanced breast cancer. The aim of this study was to evaluate if lymphopenia could be a predictive factor of responsiveness to preoperative treatment in patients with locally advanced breast cancer. Methods: We retrospectively evaluated 163 consecutive locally advanced (T3-4, N0-3, M0) breast cancers patients who received preoperative treatment in our hospital from January 2003 to December 2005. We classified them according to the subtypes: Luminal A, Luminal B, HER2 and Triple Negative (TN). The absolute lymphocyte count (ALC) was recorded at the time of diagnosis and a cutoff value of 1500/mm3 was used to define lymphopenia. Kaplan Meier, log-rank and pairwise comparisons were used to compared overall survival (OS) and time to treatment failure (TTP) between subtypes and to look for predictive factors of progression during preoperative treatment. Results: Of the 163 patients, 101 (62%) were Luminal A, 35 (21%) were TN, 18 (11%) were Luminal B and 9 (6%) were HER-2. OS and TTP were significantly lower for TN and HER2 subtypes compared to Luminal A. Only 33 patients (20.2%) progressed during preoperative treatment. 34% of TN patients progressed during preoperative treatment; 28% of Luminal B; 15% of Luminal A; and 11% of HER2 patients. Based on lab data 28 (17.2%) patients had an ALC <1500/mm3. Of these, 43% progressed during preoperative treatment. On the other hand 16% of the patients with an ALC ≥1500/mm3 progressed (p=0.001). Other variables such as age, clinical T, clinical N, histological grade, HER-2 status, ER status and breast cancer subtypes did not predict failure to preoperative treatment significantly. Conclusions: Lymphopenia at the time of diagnosis could predict progression during preoperative treatment in patients with locally advanced breast cancer. These results suggest that the host immune response could play an important role in the response of chemotherapy. Studies with larger numbers of patients are needed to validate these results.

Macroscopic tumor size as an independent prognostic factor for stage II/III gastric cancer patients who underwent D2 gastrectomy followed by adjuvant chemotherapy with S-1

In patients with stage II/III gastric cancer, tumors often recur even after curative D2 gastrectomy followed by adjuvant S-1 chemotherapy. The objective of this retrospective study was to clarify the prognostic factors in these patients that might be useful for future patients. Overall survival (OS) was examined in 82 gastric cancer patients who underwent curative D2 surgery; were diagnosed with stage IIA, IIB, IIIA, IIIB, or IIIC pathologically; and received adjuvant S-1 after surgery between June 2002 and March 2010. When length of OS was evaluated by the log-rank test, significant differences were observed with regard to macroscopic tumor diameter and the depth of tumor invasion. A macroscopic tumor diameter >70 mm was regarded as a critical point of classification considering survival. Univariate and multivariate Cox's proportional hazard analyses demonstrated that macroscopic tumor diameter was the only significant independent prognosticator. The 5-year survival was 64.9% in patients with a macroscopic tumor diameter <70 mm, and 33.1% in patients with a macroscopic tumor diameter ≥70 mm (P = 0.022). The macroscopic tumor diameter was the most important prognostic factor for survival in patients with stage II/III gastric cancer who underwent D2 gastrectomy followed by adjuvant S-1 chemotherapy. Prognostic factors can be affected by adjuvant chemotherapy.

531 THE IMPACT OF COMORBIDITY ON COMPLICATIONS FOLLOWING NEPHRECTOMY

You have accessJournal of UrologyKidney Cancer: Evaluation and Staging1 Apr 2011531 THE IMPACT OF COMORBIDITY ON COMPLICATIONS FOLLOWING NEPHRECTOMY Pauline M.L. Hennus, Stephanie G.C. Kroeze, J.L.H. Ruud Bosch, and Judith J.M. Jans Pauline M.L. HennusPauline M.L. Hennus Utrecht, Netherlands More articles by this author , Stephanie G.C. KroezeStephanie G.C. Kroeze Utrecht, Netherlands More articles by this author , J.L.H. Ruud BoschJ.L.H. Ruud Bosch Utrecht, Netherlands More articles by this author , and Judith J.M. JansJudith J.M. Jans Utrecht, Netherlands More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1255AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES With the rising incidence of renal tumors preoperative decision making regarding patients who will benefit from surgical treatment is increasingly important. Comorbidity is an important prognostic factor for survival after nephrectomy and is therefore taken into account in surgical decision making. However, the impact of comorbidities on direct postoperative complications following nephrectomy remains unknown. Risk stratification of postoperative complications is clinically relevant for the determination of personalized treatment strategies. The aim of this study was to assess the effect of comorbidity on postoperative complications following nephrectomy. METHODS Medical records of 222 patients who underwent nephrectomy for a lesion suspected of renal cell carcinoma in a university medical center from January 1999 to December 2008 were reviewed retrospectively. Comorbidity was scored using the Charlson comorbidity index (CCI), postoperative complications with the modified Clavien classification adjusted for nephrectomy. The correlation of comorbidity and other clinical and pathological factors with complications severity was examined using the Fisher's exact test. RESULTS 180 (81%) patients underwent radical and 42 (19%) partial nephrectomy. Tumor stage was T1: 42%, T2: 12%, T3: 44%, T4: 2%. 5% of renal masses were benign. 13% of all patients had metastases at the time of nephrectomy. 46% of patients had no comorbidity, 43% had minor comorbidity (CCI≤3) and 11% major comorbidity (CCI>3). The overall complication rate was 38% of which 24% minor (grade 1 and 2) and 13% major (grade 3 to 5) requiring interventions, administration to the intensive care unit or death. Patients with a CCI>3 had significantly higher risk of major complications (Clavien grade ≥3, p=0.008). Mortality rates were also significantly higher (p=0.046). Furthermore, a 2 day longer hospital stay was seen in the major complications group, but was not significant. CONCLUSIONS This study reveals that major complications occur significantly more often when major comorbidities are present. This shows that in addition to influencing long term survival, comorbidity also directly impacts postoperative complications. Comorbidity scores could be used in risk stratification for complications and should be taken into account in preoperative decision making. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e216 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Pauline M.L. Hennus Utrecht, Netherlands More articles by this author Stephanie G.C. Kroeze Utrecht, Netherlands More articles by this author J.L.H. Ruud Bosch Utrecht, Netherlands More articles by this author Judith J.M. Jans Utrecht, Netherlands More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prognostic value of TNM stage and tumor necrosis for renal cell carcinoma

Our objective was to assess the value of tumor necrosis and other factors for predicting the outcome of renal cell carcinoma (RCC). Our study comprised 328 RCC patients who were surgically treated at this hospital between 2001 and 2006. The five-year survival data was analyzed using a Kaplan-Meier statistical analysis. The prognostic factors were evaluated with a univariate analysis using a log-rank test and multivariate analysis using the Cox proportional hazards regression method. The mean follow-up period for these patients was 46.5 months (median 45.2 months). The univariate analysis revealed that age, tumor stage, TNM stage, grade, tumor necrosis, and histological type were statistically significant prognostic factors. The multivariate analysis showed that the TNM stage and tumor necrosis were the most important predictive factors in the patients’ overall survival. In the TNM stage with and without tumor necrosis, the five-year overall survival rates in stages I + II were 80.5% and 89.2%, respectively ( p = 0.115), where as the five-year survival rates in stages III + IV were 32.7% and 84.0%, respectively ( p < 0.001). Collectively, our present data revealed that tumor necrosis was an important predictive factor for survival in advanced stage RCC. In conclusion, both the TNM stage and tumor necrosis provided the most important prognostic factors of survival in RCC. Tumor necrosis proved to be a poor prognostic factor in advanced RCCs.

Breast angiosarcoma that is not related to radiation exposure: A comprehensive review of the literature

Breast angiosarcomas that are not related to previous radiotherapy are very rare. Surgical resection is the primary treatment for these tumors, but there is no general agreement on the extent of surgery. The role of multimodality adjuvant treatment also remains controversial. The aim of this study was to summarize the available data from the largest published series of patients in terms of management and outcome. We also sought to identify prognostic factors influencing patient survival. We have included studies presenting detailed data on multimodality therapy and survival of patients with breast angiosarcoma. Ten studies presenting data on 280 patients were included in the review. Seventy-five percent of patients underwent a total mastectomy and 25% had breast-conserving treatment (BCT). In 42% of patients, an axillary node dissection was combined with mastectomy or BCT. Thirty-six percent of patients received chemotherapy and 35% were treated with radiotherapy in an adjuvant or neoadjuvant setting. Survival varied significantly according to tumor size and grade. Adjuvant multimodality therapy may improve the outcome in selected patients with breast angiosarcoma. Tumor size, grade, and margin status are the most important prognostic factors for survival.

Malignant Peripheral Nerve Sheath Tumor of the Mandible: A Case Report and Review of Literature

Malignant peripheral nerve sheath tumor of the mandible is an uncommon tumor. We describe a rare case of MPNST involving the mandible with chondrosarcomatous differentiation. It is important to recognize the sarcomatous origin in such tumors and distinguish it from the malignant divergent elements since the management strategy varies considerably. The difficulties faced in MPNST involving the head and neck region is to obtain adequate negative margins with surgery, since the most important prognostic factor for survival is positive margins. The treatment approach is similar to that of other soft tissue sarcomas. Adjuvant radiotherapy plays an important role in decreasing local recurrence. doi:10.4021/jnr74e

Analysis of clinicopathologic features and prognosis in 2414 patients with rectal cancer

To explore the clinicopathologic factors associated with prognosis in patients with rectal cancer. Clinicopathologic data of 2414 patients with rectal cancer, treated in the Affiliated Tumor Hospital of Harbin Medical University from May 1976 to December 2003, were analyzed retrospectively. Cox regression model was used to assess independent factors associated with prognosis. The median survival time was 58 months and the 5-year overall survival rate was 45.1%. Tumors were stage I( in 75.2%, stage II( in 48.1%, stage III( in 21.3%, and stage Ⅳ( in 8.8% of the patients. The 5-year overall survival rates during the three study periods were 41.2%(1976-1986), 43.0%(1987-1996), and 49.1%(1997-2003)(P<0.01). On univariate analysis, age, time at diagnosis, histological type, distant metastasis, type of surgery, intent of surgery, gross morphology, pathologic T stage, lymphatic invasion, bowel obstruction, and TNM stage showed statistically significant association with survival. Independent prognostic factors on multivariable analysis were gross tumor morphology chi-squared value(CV):68.744, pT(CV:81.344), lymphatic invasion(CV:42.951), bowel obstruction(CV:37.856) and TNM stage(CV:85.329). Survival in patients with rectal cancer is improved over time. TNM stage is the most important prognostic factor for survival in patients with rectal cancer.

Does the Metastatic Lymph Node Ratio Influence the Disease-Free Survival of Patients with Breast Cancer: Single-Center Experiences

Background: Axillary lymph nodes (ALNs) are the most important prognostic factor for survival in breast cancer. Pathological evaluation can affect the number of involved lymph nodes. In the current study, we evaluated whether the metastatic lymph node ratio (n ratio) is important in predicting disease-free survival (DFS) for breast cancer patients. Material and Methods: From 802 breast cancer cases, 427 patients with ALN metastasis were analyzed retrospectively. The n ratio was categorized as n ratio 1 (1–10%), n ratio 2 (10.01–50%) and n ratio 3 (>50%). DFS was established according to the Kaplan-Meier method. Predicting risk factors for relapse were analyzed using the Cox proportional hazards model. Results: The n ratio was significantly higher in breast cancer patients with advanced pathologic pT, pN and clinical stage, undifferentiated histology, lymphovascular and extracapsular invasion, more resected ALNs and positive progesterone receptor. In the univariate analysis, multicentricity, necrosis, grade, pN stage, estrogen receptor and progesterone receptor positivity, trastuzumab and neoadjuvant chemotherapy usage, the presence of inflammatory breast cancer and n ratio were found to be important factors in predicting DFS. Multivariate analysis indicated that multicentricity, neoadjuvant chemotherapy, trastuzumab usage and n ratio were significantly associated with prognosis. Conclusions: The n ratio is inexpensive, easily available and a simple prognostic factor for breast cancer patients with positive ALNs.

Toxicity and Response Among Octogenarians and Nonagenarians with Diffuse Large B Cell Lymphoma Treated with Rituximab-CHOP Therapy

AbstractAbstract 1778 Background:Diffuse large B-cell lymphoma (DLBCL) is the most common histological subtype of lymphoma diagnosed in the United States. Majority of patients diagnosed with DLBCL are in their seventh decade at the time of presentation. Previous studies demonstrate that relative dose intensity (RDI) is an important prognostic factor for survival in patients with DLBCL. Elderly patients who receive chemotherapy intensity comparable to younger patients demonstrate similar outcomes. In our experience, elderly patients appear to receive lower doses of anthracycline based chemotherapy secondary to significant toxicity, poor performance status, or comorbid conditions. We present our experience of RCHOP chemotherapy in the treatment of DLBCL among octogenarians and nonagenarians. Methods:The study population was selected using the Vanderbilt electronic medical record database. After obtaining IRB approval, 102 patients undergoing RCHOP therapy at a single institution between January 2000 and January 2010 were included in our analysis. Patients who were treated with RCHOP elsewhere were excluded from the study. Pre-treatment co-morbidities were identified and scored using the Cumulative Illness Rating Scale (CIRS). All data was compiled using Research Electronic Data Capture (REDCap). Descriptive statistics and multivariate logistic regression modeling were performed using SPSS software. Results:Of the 102 identified patients, 37 (36%) were aged 70 years or greater with a median age of 79 years (range 70–90). The median age of patients <70 years was 59 years (range 20–70). The majority had a diagnosis of DLBCL while eight (7.8%) patients had follicular grade 3b lymphoma. Differences in baseline BMI and body surface area (BSA) were statistically significant between age groups (70 years or greater: less than 70 years). All baseline laboratory data including absolute neutrophil count, absolute lymphocyte count, hemoglobin, blood albumin level, and LDH level were similar between groups. In addition, disease stage, International Prognostic Index (IPI), and age-adjusted IPI were not statistically different between the two age groups. Baseline comorbidities quantified with CIRS scoring showed that pts >70 had a higher average CIRS score (7.5 vs. 5.8, p <0.005), and a greater proportion had severe or not optimally controlled chronic baseline conditions (43% vs. 23 %, OR 2.5, p< 0.03). The two groups had a similar average number of chemotherapy cycles (5.8 vs. 5.7). The average chemotherapy dose intensity was lower in pts> 70 and experienced a greater frequency of dose reductions during treatment (73% vs. 18%, OR 12, p<0.001). The average relative dose intensity however remained greater than 70% of reference standard intensity in 32 of 37 aged patients (86%). Furthermore, only 4 of the aged patients (11%) received doxorubicin at an RDI < 10mg/m2/week. A complete response was observed in 92% of the patients and a difference was not observed between the two age groups (95% vs 91%). Frequency of neutropenia (grade 3–4) and febrile neutropenia was similar between age groups (43% vs. 45% for neutropenia, 22% vs. 17% febrile neutropenia). Prophylactic colony stimulating factors from the onset of RCHOP was more commonly administered among the elderly (92% vs. 28%, OR 29, p<0.001). Despite the use of early growth factors and dose reductions, the frequency of at least one hospitalization during chemotherapy was significantly higher among the octogenarians and nonagenarians (54% vs. 32%, OR 2.5, p<0.03). Multivariate logistic regression analysis was performed to identify age, BSA and comorbidity scoring as statistically significant predictors of any dose reduction after controlling for sex, LDH level, disease stage, performance status, and prophylactic G-CSF use. Conclusion:Our study identifies age as a predictor of dose reduction in RCHOP used to treat patients with aggressive lymphoma. The RDI of anthracycline among the vast majority of patients was maintained at greater than 10mg/m2/week and may help explain the high frequency of complete response observed in both age groups. We conclude that patients over the age of 70 years can receive an attenuated dose of chemotherapy without compromising the response rates while experiencing similar toxicities. Additional studies with expanded population size and extended outcome data could help identify target RCHOP intensity for elderly patients with DLBCL. Disclosures:No relevant conflicts of interest to declare.

Evaluación de factores histológicos pronósticos de sobrevida en melanoma maligno cutáneo, seguimiento de 13 años

Prognostic factors for survival of malignant melanomas Background: The incidence of malignant melanoma is increasing steadily. Aim: To study pathologi- cal prognostic factors in malignant melanomas. Material and Methods: Review of pathological records of cutaneous malignant melanomas diagnosed between 1995 and 2008. Medical records of patients were re- viewed and those with distant metastases at the moment of surgery were excluded. Follow up was performed contacting patients and reviewing death records at the Chilean National Identification Registry. The cause of death was classified as related to the melanoma or unrelated. Results: One hundred sixty two records, corres- ponding to patients aged from 13 to 93 years (51% women), were included in the study. Twenty nine percent of patients died during the follow up period that ranged from 1 to 127 months. Five and ten year's survival was 71 and 60% respectively. A multivariable Cox analysis demonstrated that only the TNM classification of the primary tumor, which is categorized using the Breslow maximal depth, had prognostic significance. Compared to women, men had a 1.97 higher relative risk of dying due to the melanoma. Conclusions: TNM classification of melanomas is the most important prognostic factor for survival.

Prognostic and predictive factors in resected non-small-cell lung cancer

Tumor staging is at present the most important prognostic factor for survival in resected non-small cell lung cancer (NSCLC). Recent studies in prognostic and predictive factors have focused on identifying molecular markers. This paper review current known molecular markers as a prognostic and predictive value. The biomarkers included nucleotide excision repair system (ERCC1, RRM1, BRCA1), cell cycle regulators and apoptosis (p53, p27, bcl-2, KRAS), tumor proliferation (Ki-67), angiogenesis (VEGF, microvessel density), molecular imaging ((18)F-FDG-PET), AKT/mTOR signaling pathway (AKT, mTOR) and EGFR mutation. Recent study has demonstrated that overexpression of nucleotide excision repair protein is predictive of the resistance of NSCLC to gemcitabine and platinum. Overexpression of p53 and p27 is also a predictive marker for predicting poor outcome after adjuvant chemotherapy. A meta-analysis indicated that VEGF, Ki-67 and (18)F-FDG uptake can be a prognostic factor. Although phospho-Akt and mTOR overexpression are associated with poor outcome, the prognostic significance is still controversial. EGFR mutation is described as being associated with a favorable prognostic factor in resected NSCLC, but it is not an independent factor. Search for new prognostic/predictive markers remains an important task for lung cancer diagnosis and treatment.

Volume-Related Weight Gain and Subsequent Mortality in Acute Renal Failure Patients Treated With Continuous Renal Replacement Therapy

Fluid overload is a frequent finding in critically ill patients suffering from acute kidney injury (AKI). To assess the impact of fluid overload on the mortality of AKI patients treated with continuous renal replacement therapy (CRRT), we used a registry of 81 critically ill patients with AKI initiated on CRRT assembled over an 18-month period to conduct a cross- sectional analysis using volume-related weight gain (VRWG) of > or =10% and > or =20% of body weight and oliguria (< or =20 ml/h) as the principal variables, with the primary outcome measure being mortality at 30 days. Mean Apache II scores were 27.5 +/- 6.9 with overall cohort mortality of 50.6%. Mean (+/-SD) VRWG was 8.3 +/- 9.6 kg, representing a 10.2% +/- 13.5% increase since admission. Oliguria was present in 65.4% of patients. Odds ratio (OR) for mortality on univariate analysis was increased to 2.62 [95% confidence interval (CI): 1.07-6.44] by a VRWG > or =10% and to 3.22 (95% CI: 1.23-8.45) by oliguria. VRWG > or =20% had OR of 3.98 (95% CI: 1.01-15.75; p = 0.049) for mortality. Both VRWG > or =10% (OR 2.71, p = 0.040) and oliguria (OR 3.04, p = 0.032) maintained their statistically significant association with mortality in multivariate models that included sepsis and Apache II score. In conclusion, fluid overload is an important prognostic factor for survival in critically ill AKI patients treated with CRRT. Further studies are needed to elicit mechanisms and develop appropriate interventions.

Pathological prognostic indicators in renal cell carcinoma

ObjectiveTo analyze histological factors not routinely assessed as potential prognostic factors in renal cell carcinoma, such as tumor necrosis, microscopic vascular invasion, and sinus fat invasion. Materials and methodsA retrospective, analytical study was conducted of surgical specimens from 139 patients with localized renal cell carcinoma who underwent nephrectomy from 1993 to 2005. Tumor necrosis, microscopic vascular invasion, and sinus fat invasion were analyzed and compared to the classical factors: TNM classification, Fuhrman grade, and tumor size. For statistical analysis, variables analyzed were categorized as pT1, 2 vs pT3, 4; Fuhrman grade 1, 2 vs 3, 4; tumor size <7cm vs ≥7cm; tumor necrosis vs no tumor necrosis; microvascular invasion of sinus fat vs no invasion. Cancer-specific survival probability and disease-free survival were calculated. A descriptive and analytical statistical analysis was performed using logistic regression for univariate and multivariate analyses. Dependent variables were used to analyze cancer-specific survival rates. Disease-free survival was estimated using a Cox regression model and Kaplan-Meier curves. ResultsIn the univariate analysis, all variables analyzed had a significant influence on death for renal cell carcinoma. In the multivariate analysis, the variable having the greatest influence was Fuhrman grade (p=0,032). The variables significantly influencing disease-free survival, estimated by the Cox method, were the pT stage (p=0.038) and Fuhrman grade (p=0.048). ConclusionsIn patients with clinically localized renal cell carcinoma undergoing nephrectomy, pT stage and Fuhrman grade are the most important prognostic factors for survival and disease-free survival. Tumor necrosis, microscopic vascular invasion, and sinus fat invasion are prognostic factors for death from renal carcinoma which are associated to TNM classification, Fuhrman grade, and tumor size

Differential Expression of SPARC in Intestinal-type Gastric Cancer Correlates with Tumor Progression and Nodal Spread

AIMS: Nodal spread is the single most important prognostic factor of survival in gastric cancer patients. In this study, genes that were upregulated in the lymph node metastases of gastric cancer were identified and may serve as putative novel therapeutic target. METHODS: Complementary DNA (cDNA) microarray analysis and quantitative real-time polymerase chain reaction of primary gastric carcinomas and matched lymph node metastasis were carried out. Immunohistochemistry with anti-SPARC antibodies was performed on large tissue sections of 40 cases with primary gastric carcinoma (20 diffuse, 20 intestinal) and the corresponding lymph node metastases, as well as on tissue microarrays of 152 gastric cancer cases. RESULTS: A cDNA microarray identified SPARC as being upregulated in primary gastric carcinoma tissue and the corresponding lymph node metastasis compared with the nonneoplastic mucosa. SPARC was expressed in fibroblasts and, occasionally, in tumor cells. However, the level of immunoreactivity was particularly strong in stromal cells surrounding the tumor. The level of expression of SPARC, determined by immunohistochemistry, correlated in intestinal-type gastric cancer with the local tumor growth, nodal spread, and tumor stage according to the International Union Against Cancer. CONCLUSIONS: Our study provides transcriptional and translational evidence for the differential expression of SPARC in gastric cancer tissue. On the basis of our observations and those made by others, we hypothesize that SPARC is a promising novel target for the treatment of gastric cancer.

Matrix metalloproteinase (MMP)-7 in salivary gland cancer

Introduction. High levels of certain matrix metalloproteinases (MMPs) have been detected in various human cancers. The purpose of this study was to analyze the expression of MMP-7 in salivary gland cancer (SGC) by immunohistochemistry and to associate the results with the clinical data and the 10-year survival of the SGC patients. Material and methods. Immunohistochemistry for MMP-7 was performed in a series of 107 paraffin-embedded sections of SGC. The samples represent the entire SGC population in Finland from 1991–1996. Mortality follow-up ended December 31, 2006. Results. The study population of 107 patients consisted of 47 male and 60 female subjects, ranging in age at the time of diagnosis between 23 and 90 years. The minimum follow-up time was 10.6 years and the maximum 15.9 years. By age-adjusted analysis lower staining intensity was associated with worse overall survival of patients with acinic cell carcinoma (p = 0.047, HR 6.5, 95% Cl 1.0–41.7) and in mucoepidermoid carcinoma (p = 0.010, HR 9.3, 95% CI 1.7–50.0). Low staining intensity was also associated with worse disease-specific survival of patients with acinic cell carcinoma (0–1 vs. 2–3; p = 0.047, HR 13.7, 1.0–200.0). VCI Ki-67 was an important prognostic factor for survival of the entire data set (p < 0.0001, HR 4.7, 95% Cl 2.3–9.8). Conclusions. MMP-7 is associated with the prognosis of patients with acinic cell and mucoepidermoid carcinoma.

Graft Versus Host Disease Correlates with Increased Survival After Allogeneic Stem Cell Transplant for Mature T-Cell Lymphomas: Evidence of Graft Versus T-Cell Lymphoma Effect.

Abstract 3367Poster Board III-255 Background:For aggressive lymphomas a T-cell phenotype confers a poor prognosis. Current therapeutic strategies for T-cell non-Hodgkin lymphoma (NHL) are poorly defined and are associated with a high rate of chemorefractory disease and relapse following chemotherapy +/- autologous stem cell rescue. Allogeneic related and unrelated stem cell transplantation (Allo-HCT) is a potentially curative option, with graft-versus-lymphoma effect as the suggested mechanism for long-term disease control. We report the results of patients with T-cell and NK/T-cell NHL who underwent Allo-HCT at City of Hope National Medical Center. Methods:A consecutive case-series of 38 patients with mature T-cell NHL who underwent Allo-HCT between 2000 and 2007 were included in this analysis. Histologies included: PTCL NOS (n=9); AILD (n=4); ALCL (n=7; four were alk+ and three were alk-); rare histologies (n=6) (NK/T cell nasal and extranasal, enteropathy type, hepatosplenic); and cutaneous T-cell (mycosis fungoides/Sezary syndrome) (n=12). Most patients (n=26, 68%) had advanced disease at the time of transplant. Disease status at transplant: CR1=3, CR2=4, PR after relapse=5, relapse or primary induction failure n=24 and progressive disease at the time of transplant =2. Conditioning regimens consisted of fully ablative regimens (TBI and non-TBI based) in 14 (37%), and reduced intensity (fludarabine/melphalan) in 24 (63%). Results:The median age at transplant was 43 years (range: 7-74), 74% were male (n=28). The stem cell sources were matched sibling (n=27, 71%) and unrelated donor 39%. The median number of prior regimens was 3 (range: 1-6); 1 patient had a prior autologous transplant. The median follow-up for the 20 (53%) surviving patients is 64 months (range: 16-100). Day 100 mortality was 18%. There were 18 deaths; 5 from disease progression and 13 from transplant-related mortality. A total of 29 patients (78%) developed graft versus host disease (GVHD); six developed only acute GVHD, 10 developed only chronic GVHD and the remaining 13 developed both acute and chronic. The 5-year probabilities of overall (OS) and disease-free (DFS) survival were 51% (95%CI: 42-59%) and 46% (95%CI: 38-53%), respectively. The relapse/progression and non-relapse mortality (NRM) rates at 5 years were 35% (95%CI: 25-48%) and 29% (95%CI: 20-42%) respectively. Analysis for prognostic factors considered predictive for survival showed that the presence or absence of any form of GVHD (either acute grade I-IV or chronic) significantly affected the outcome. The presence of GVHD was significantly associated with improved OS; the estimate OS at 5 years for those with GVHD was 59% (95% CI: 47-69%) versus 25% (95%CI: 18-33%) for those who did not develop acute or chronic GVHD, P=0.007. DFS showed a similar trend, the 5 year survival estimate was 52% (95%CI: 42-62%) for those with GVHD compared to 25% (95%CI: 18-33%) for those without GVHD, P=0.009. As expected the relapse/progression rate among those patients who did not develop acute or chronic GVHD was significantly higher (5 year estimate: 64%, 95%CI: 51-78%) than those who did develop acute and/or chronic GVHD (5 year estimate: 30%, 95%CI: 19-46%), P=0.01.There was no statistically significant difference between OS or DFS for patients who received a fully ablative or reduced intensity conditioning regimen. Conclusion:In this analysis, the presence of GVHD either acute or chronic was the most important prognostic factor for survival thus strongly supporting a graft-versus-lymphoma effect for T-cell lymphomas. Allo-HCT can confer long-term disease control even in advanced stage patients. Disclosures:No relevant conflicts of interest to declare.