Independent Factor For Progression Research Articles

Risk of Tumor Progression after Microsurgery for Parasellar Meningioma Invading the Cavernous Sinus.

Parasellar meningiomas, which may invade the cavernous sinus, pose a significant challenge to neurosurgeons due to the high risk of postoperative neurological deficits associated with aggressive resection of the intracavernous part of the tumour. Therefore, subtotal tumour removal followed by observation or radiotherapy for the residual meningioma in the cavernous sinus is recommended. This retrospective study aimed to identify prognostic factors influencing recurrence and progression-free survival (PFS) in parasellar meningiomas invading the cavernous sinus after incomplete surgical treatment. This study included adult patients diagnosed with benign parasellar meningioma (WHO Grade I) invading the cavernous sinus, treated at our institution between 2006 and 2020, and with a postsurgical follow-up of at least 3 years. Surgical treatment involved near-total resection (NTR) with an intracavernous residual tumour or subtotal resection (STR) with additional extracavernous tumour left in place. Kaplan-Meier analysis estimated PFS rates, and Cox regression tested survival time differences between groups. Among the 32 patients, the estimated median PFS was 11 years. Radiotherapy improved 5-year PFS only in patients with STR (p = 0.003). The univariate analysis identified preoperative tumour size, low preoperative Karnofsky Performance Score (KPS), and marked brain oedema as significant factors affecting meningioma progression after surgery. The multivariate analysis confirmed tumour size as an independent factor for progression (p = 0.012). For patients with parasellar meningioma invading the cavernous sinus, extracavernous tumour removal followed by close radiological surveillance of the residual intracavernous meningioma is a safe and appropriate strategy. When an extracavernous tumour component is left, adjuvant stereotactic radiotherapy or radiosurgery is recommended to control tumour growth.

Risk Factors for the Progression of Varus Ankle Osteoarthritis.

With the increase in life expectancy, the prevalence of ankle osteoarthritis (OA) is also expected to increase in the future. Functional disability and diminished quality of life associated with end-stage ankle OA are comparable to those associated with end-stage hip or knee OA. However, there are few reports on the natural history and progression of patients with ankle OA. Hence, this study aimed to evaluate the risk factors for progression in patients with varus ankle OA. We evaluated 68 ankles from 58 patients diagnosed with varus ankle OA using radiography performed at intervals over at least 60 months. The mean follow-up period was 99 ± 40 months. Narrowing of the joint space and increasing osteophyte formation were defined as ankle OA progression. Multivariate analysis was performed using logistic regression to predict the odds of progression; the model included 2 clinical variables and 7 radiographic variables. Of the 68 ankles, 39 (57%) progressed. In multivariable logistic regression analyses, patient's age (odds ratio [OR] 0.92, 95% CI 0.85-0.99, P < .03), and the talar tilt (TT; OR 2.2, 95% CI 1.39-3.42, P = .001) were found to be independent factors for progression. The area under the curve (AUC) of the receiver operating characteristic curve for TT was 0.844, and the cutoff value was 2.0 degrees. TT was found to be a primary factor associated with varus ankle OA progression. The risk appeared higher in patients with a TT more than 2.0 degrees. Level III, retrospective case control study.

Prognostic factors after isolated ipsilateral local and regional recurrence in HER2-negative luminal breast cancer: a multi-center retrospective study

BackgroundAlthough the incidence of isolated ipsilateral local and regional recurrence (IILRR) in human epidermal growth factor 2 (HER2)-negative luminal breast cancer is low, it is important because of its potential risk of distant metastasis and breast cancer related mortality. The aim of this study was to investigate prognostic factor and survival of IILRR using a large multi-center cohort.MethodsData on patients with HER2-negative luminal breast cancer between 2005 and 2015 were retrieved. The endpoint was IILRR rate, post-recurrence progression-free survival (P-PFS), and post-recurrence overall survival (P-OS). Prognostic factors for progression and overall survival (OS) after IILRR were assessed by multivariate analysis.ResultsEighty (2.37%) patients experienced IILRR. Of them, 27 (33.7%) experienced a disease progression, including 23 (85.2%) who had distant metastasis. The median DFS was 48.5 months (range, 4–138 months). In 72.5% of cases, the first IILRR occurred after 3 years. Estimated 5-year P-PFS rates were 86.2%, 69.7%, 69.0%, 42.7%, and 82.2% for patients with age < 40 at diagnosis (p = 0.015), T1 stage (p = 0.012), stage I (p < 0.001), lymphovascular invasion (p = 0.003), and patients with post-recurrence endocrine therapy (p < 0.001), respectively. The 5-year Kaplan–Meier P-OS rate for patients was 81.4%. Post-recurrence endocrine therapy was independent factor for progression (HR: 0.176, p < 0.001) and OS (HR: 0.080, p < 0.001).ConclusionsAlthough there is no standardized treatment for IILRR yet, endocrine therapy after local resection plays a more important role in improving prognosis than chemotherapy or radiotherapy in HER2-negative luminal breast cancer.

PD26-12 HIVEC-E: SPANISH MULTICENTER PROSPECTIVE EXPERIENCE WITH RECIRCULANT HYPERTHERMIC MMC WITH COMBAT BRS HIVEC SYSTEM

PD26-12 HIVEC-E: SPANISH MULTICENTER PROSPECTIVE EXPERIENCE WITH RECIRCULANT HYPERTHERMIC MMC WITH COMBAT BRS HIVEC SYSTEM

In-hospital outcomes and delayed neurologic sequelae of seizure-related endosulfan poisoning

PurposeThis study investigated the predictive factors for progression from seizure-related endosulfan poisoning to status epilepticus (SE) and refractory SE (RSE). This study also investigated delayed neurologic sequelae in seizure-related endosulfan poisoning. MethodsThis retrospective, observational case series consisted of 73 patients who developed at least one seizure after endosulfan ingestion. ResultsThe progression rates from seizure-related endosulfan poisoning to SE and from SE-related endosulfan poisoning to RSE were 78.1% and 54.4%, respectively. The SE and RSE fatality rates were 19.2% and 41.9%, respectively. No patients reported the development of delayed neurological sequelae at least six months after discharge. Glasgow coma scale (GCS) score were identified as an independent factor for progression from seizure-related endosulfan poisoning to SE and from SE-related endosulfan poisoning to RSE. Lorazepam administration was independently associated with preventing progression from SE-related endosulfan poisoning to RSE. ConclusionSeizure-related endosulfan poisoning had higher progression rates to SE and RSE and higher fatality rates than other drug-induced seizures. However, delayed neurologic sequelae after discharge were not demonstrated. Due to the high progression rates from seizure-related endosulfan poisoning to SE and RSE and the absence of an established treatment for SE-related endosulfan poisoning, physicians should aggressively treat patients who experience a seizure after endosulfan poisoning and who present with decreased GCS score. Lorazepam should be considered a first-line anti-epileptic drug for controlling seizures in patients with endosulfan poisoning.

Radiographic changes and factors associated with subsequent progression of damage in weight-bearing joints of patients with rheumatoid arthritis under TNF-blocking therapies—three-year observational study

Objectives: The long-term effects of tumor necrosis factor (TNF)-blocking therapies on weight-bearing joints in patients with rheumatoid arthritis (RA) have not been fully characterized. The purpose of this study was to assess the radiographic changes of weight-bearing joints in patients with RA during 3-year of TNF-blocking therapies and to identify factors related to the progression of joint damage.Methods: Changes in clinical variables and radiological findings in 243 weight-bearing joints (63 hips, 54 knees, 71 ankles, and 55 subtalar joints) in 38 consecutive patients were investigated during three years of treatment with TNF-blocking agents. Multivariate logistic regression analysis was used to identify risk factors for the progression of weight-bearing joint damage.Results: Seventeen (14.5%) of proximal weight-bearing joints (hips and knees) showed apparent radiographic progression during three years of treatment, whereas none of the proximal weight-bearing joints showed radiographic evidence of improvement or repair. In contrast, distal weight-bearing joints (ankle and subtalar joints) displayed radiographic progression and improvement in 20 (15.9%) and 8 (6.3%) joints, respectively. Multivariate logistic analysis for proximal weight-bearing joints identified the baseline Larsen grade (p < 0.001, OR:24.85, 95%CI: 5.07–121.79) and disease activity at one year after treatment (p = 0.003, OR:3.34, 95%CI:1.50–7.46) as independent factors associated with the progression of joint damage. On the other hand, multivariate analysis for distal weight-bearing joints identified disease activity at one year after treatment (p < 0.001, OR:2.13, 95%CI:1.43–3.18) as an independent factor related to the progression of damage.Conclusions: Baseline Larsen grade was strongly associated with the progression of damage in the proximal weight-bearing joints. Disease activity after treatment was an independent factor for progression of damage in proximal and distal weight-bearing joints. Early treatment with TNF-blocking agents and tight control of disease activity are necessary to prevent the progression of damage of the weight-bearing joints.

Diabetes onset before or after the age of 65-does it affect the progression of renal and cardiovascular diseases in the elderly patient?

Type 2 diabetes (T2D) is common in the elderly and more than half of the people with diabetes are over 65 years old.[1],[2] Elderly diabetic patients have a higher frequency of hypertension, coronary artery disease and chronic kidney disease than non-diabetic elderly patients and the risk of these complications increases with patient age, duration of the diabetes and glycated hemoglobin values. Besides the known classical factors of renal disease progression, can one suppose that the age of onset of diabetes may also affect renal disease progression in elderly diabetic patients? The aim of this study was to determine clinical and biological parameters at admission and throughout evolution of elderly diabetic patients with T2D diagnosed before vs. after age 65 years. This is a prospective study started in January 2009 and conducted at the Reference Center for Chronic Diseases in Oujda, Morocco (Eastern Morocco). The Ethics Committee of Morocco's Mohammed V University in Rabat approved the study protocol (University Mohamed V Souissi, Rabat). Verbal informed consent was required from all participants. Inclusion criteria targeted patients who were aged 65 years and older with confirmed T2D at the time of enrollment of the study, and who had been regularly followed in nephrology consultation for at least 36 months. Cardiac events were defined by history of angina, myocardial infarction, heart failure and/or coronary revascularization. Two groups of patients were studied according to age at the time of diabetes diagnosis (before age 65 years vs. after age 65 years). Excluded from the study were T2D patients who had conditions other than diabetes and hypertension capable of altering renal function. Data were analyzed using the Statistical Package for Social Sciences version 13.0 (SPSS, Inc., Chicago, IL). Comparison of quantitative variables between paired groups was performed by analysis of the Student's t test. Comparison of qualitative variables between paired groups was performed using the Chi-Square test. All P values were two-sided and P < 0.05 was considered statistically significant. In a total cohort of 637 T2D patients with regular follow-up in nephrology, 368 were elderly, representing an incidence of 57% of all diabetic patients. 20.5%, 59.2% and 20.3% of all patients were negative for albuminuria ( 300 mg/d) respectively. Table 1 shows the comparison of clinical and biological parameters in the two groups of elderly diabetic patients according to the age of onset of diabetes, both at the time of enrollment in the study and at the end of the study. In multivariate analysis and adjusting for diabetes duration, the independent factors were as follows: for terminal chronic kidney disease, a low estimated glomerular filtration rate (eGFR, OR = 0.73, 95% CI: 0.62–0.86, P ≤ 0.001) and albuminuria (OR = 01.00, 95% CI: 1.000–1.002, P = 0.03); for rapid progression of renal disease a low eGFR (OR = 0.90, 95% CI: 0.88–0.92, P ≤ 0.001) and albuminuria (OR = 1.00, 95% CI: 1.000–1.002, P = 0.01) and for cardiac disease a history of cardiac events (OR = 20.2, 95% CI: 8.6–547.4, P ≤ 0.001). Table 1. Comparison of clinical and biological characteristics in the two groups of elderly diabetic patients according to the age of onset of type 2 diabetes (n = 368). Approximately one third of elderly T2D patients are positive for albuminuria and 15% have a low eGFR.[3],[4] In our series, more than two thirds of patients were positive for albuminuria and one third had a low eGFR. This high incidence may be partly explained by the selective method of recruitment and partly by the high incidence of hypertension. The prevalence of hypertension varies from 60% to 82% in elderly patients with T2D according to the different series.[5] On admission, diabetic retinopathy, diabetic neuropathy, poor glycemic control, poor blood pressure control and increased cholesterol were higher among T2D patients diagnosed before the age of 65 years. For the most part, this may be explained by the duration of diabetes, which was greater in this group of patients. However, after an average follow-up of 36 months, rapid progression of renal disease and the occurrence of cardiac events were identical in the two groups of patients, despite the difference observed between the two groups at the end of follow-up regarding the incidence of hypertension and poor glycemic control. In conclusion, the age at diagnosis of diabetes after the age of 65 does not seem to affect the progression of renal and cardiovascular disease, which in our series, remain mainly related to low eGFR and smoking. Finally, low eGFR and albuminuria remain powerful independent factors for progression of renal disease at any age of diabetes onset in the elderly diabetic patient.

Proliferating‐cell nuclear antigen (PCNA) as an independent prognostic marker in patients after prostatectomy: a comparison of PCNA and Ki‐67

To investigate the prognostic value of prostatic tumour cell proliferation, as measured by Ki-67 and proliferating cell nuclear antigen (PCNA), and to compare these measures in men at low and high risk for progression of tumour. Two groups of patients with prostate cancer, i.e. 'metastatic' (M, 22) who had pT3b-4aN0M0 and pTanyN1M0, and 'nonmetastatic' (NM, 18), who had < or =pT3aN0M0 disease, were selected from a well-examined and mapped group of 114 treated by radical prostatectomy. Patients in the NM group were selected by the criteria of having a Gleason score of < or = 7. To assess proliferation, 1000 cells were counted at x 400 magnification by two observers and the percentage of tumour cells positively stained with Ki-67 and PCNA defined as the Ki-67 and PCNA labelling index (LI), respectively. The two LI were compared in the NM and M groups, and the correlation of the LIs with pathological stage, progression and prostate-specific antigen (PSA)-free survival evaluated. Prognostic values of the LI were analysed using multivariate analysis. The mean (range) follow-up was 33 (4-78) months. The mean LIs were higher in the M than the NM group for both PCNA and Ki-67 (P = 0.02 and 0.019, respectively). Both LIs were markedly different between the groups when stratified by progression, with both significantly higher in men with progression in the NM group. Both LIs had a significant association with Gleason score, pathological stage, progression and PSA-free survival. In multivariate analysis the PCNA LI, surgical margin status and pathological stage were independent factors for progression. Tumour cell proliferation as assessed by Ki-67 or PCNA correlate significantly with progression. The PCNA LI was an independent predictor of progression, especially in patients with a low risk of progression according to predefined criteria.

Seminal vesicle involvement after radical prostatectomy: predicting risk factors for progression

Objectives To evaluate and study the factors for progression after radical prostatectomy with seminal vesicle invasion in a cohort of European and American patients. Methods The data of 137 patients with isolated seminal vesicle invasion who underwent radical retropubic prostatectomy between 1988 and 2001 were analyzed. The Gleason score of the specimen, presence of capsular invasion, and surgical margin status were noted. Follow-up data were obtained through routine serum prostate-specific antigen (PSA) assays and digital rectal examinations. A defining criterion for progression was a postoperative serum PSA level greater than 0.2 ng/mL or any postoperative radiotherapy or hormonal treatment. Kaplan-Meier analysis was used to determine the actuarial biochemical recurrence-free likelihood, and the log-rank test was used to compare these results. Differences were considered statistically significant when the P value was less than 0.05. Results After a mean follow-up of 4.9 years (range 0.9 to 13.4), 70 patients (51.9%) had progression. The biochemical 5-year progression-free survival rate was 33.8%. In univariate and multivariate analyses, only preoperative PSA level ( P = 0.001) and Gleason score of the specimen ( P = 0.01) were independent predictors of progression. Neither capsular invasion nor positive surgical margins predicted progression. When an analysis was performed according to the major Gleason grade of the radical prostatectomy specimen, Gleason grade 5 was associated with a worse prognosis compared with Gleason grade 3 and 4 ( P = 0.01). The mean time to progression was 20.5, 17.1, and 10.1 months for Gleason grade 3, 4, and 5, respectively. Conclusions Seminal vesicle invasion after radical prostatectomy has historically been associated with a poor prognosis. However, in the present study, seminal vesicle invasion was associated with a 34% rate of freedom from progression at 5 years after surgery alone. Preoperative PSA and Gleason score of the radical prostatectomy specimen were independent factors for progression in the present study, which described the largest patient group to date. The Gleason grade of the radical prostatectomy specimen distinguished among different times to progression.

Determination of Prognosis in Patients With Prostate Cancer Treated With Radical Prostatectomy: Prognostic Value of CD44v6 Score

A third of the patients treated with radical prostatectomy experience progression even when tumors are confined pathologically to the prostate. CD44 may be a promising prognostic marker for determining malignant potential. However, there has not been a standard scoring system because of its heterogeneous staining pattern. Thus, we developed an objective scoring system to evaluate reliably CD44v6 (Bender Medsystems, Vienna, Austria) as a prognostic marker for prostate cancer. A total of 22 patients with metastatic stage pT3bN0M0 or any pTN1M0 disease and 18 with nonmetastatic disease less than stage pT3bN0M0 were selected from a well examined group of 114 who underwent radical retropubic prostatectomy. Mean followup was 33 months (range 4 to 78). A combined CD44v6 score was determined by adding the scores of the primary and secondary areas. CD44v6 expression in terms of the CD44v6 score in primary and metastatic tissues was examined. The relationships of CD44v6 expression with pathological stage, progression and PSA-free survival were also evaluated. The prognostic value of the CD44v6 score for progression was analyzed by multivariate analysis. Progression in the metastatic group was significantly higher than in the nonmetastatic group (p <0.0001). CD44v6 expression of the primary tumors differed significantly in the 2 groups (p = 0.014). The CD44v6 score in primary tumor tissues inversely correlated with pathological stage (p = 0.004) and progression (p = 0.035), and positively correlated with PSA-free survival (p = 0.041). Furthermore, patients in the nonmetastatic group with a CD44v6 score of greater than 75 (cutoff value) had a significantly better prognosis (log rank test p = 0.0022), while those with a CD44v6 score of less than 75 had a prognosis similar to those in the metastatic group. On multivariate analysis pathological stage and surgical margin positivity were independent factors for progression but the CD44v6 score was not. According to our results the suggested CD44v6 score system is useful. A CD44v6 score of less than 75 may be a predictor of poor prognosis in the nonmetastatic group and this property may have potential application for planning adjuvant therapy.

Significance of Bladder Neck Involvement on Progression in Superficial Bladder Cancer

Objectives: To determine the significance of bladder neck involvement in predicting disease progression in superficial (stage Ta and T1) transitional cell carcinoma (TCC) of the urinary bladder. Patients and Methods: A series of 277 patients with newly diagnosed superficial TCCs of the bladder was reviewed, and disease progression (to T2 or worse) was considered. The significance of several risk factors including bladder neck involvement was assessed in univariate and multivariate analysis. Results: Progression occurred in 28 (10.1%) of 277 patients during a median follow-up period of 7.7 years. Nineteen died of bladder cancer. The following variables were found to be statistically significant at the univariate analysis (p < 0.05): irritative symptoms, urine cytology, tumor stage, involvement of the bladder neck, and tumor grade. Indeed, only involvement of the bladder neck, tumor stage, and grade retained their value as independent factors for progression at multivariate analysis. Patients were divided into three groups according to the number of independent risk factors they had. Groups having none, one, and two or three risk factors included 129, 99, and 49 patients with 5-year progression rates of 0.8, 4.6 and 27.5%, and 15-year rates of 4.0, 20.1 and 42.7%, respectively. Conclusion: Involvement of the bladder neck is a significant and independent risk factor for progression of superficial TCCs in addition to the histologic grade and stage. The combination of these three risk factors offers better prediction of progression in an individual patient.

Quality of life in patients with prostatic carcinoma: a review and results of a study in N+ disease. Prostate-specific antigen as predictor of quality of life.

Clinical evaluation in oncology has typically focused on outcome indicators, while less attention has been paid to how treatment affects quality of life (QOL) of the patient. In this article some general aspects of quality of life are discussed, a short review of published data on QOL in patients with prostate cancer is given and results of a QOL study executed by the authors on patients with lymph node positive prostatic cancer are presented. The purpose of the study was to examine the impact of immediate or delayed treatment (after objective progression) in patients with prostatic carcinoma (T1-3 N1-3 M0) on quality of life parameters. To this end an extended questionnaire was constructed. Fifty-five patients participated. Assessment was performed twice, in 1994 and 1995. The comparison between patients with and patients without treatment showed in 1994 as well as in 1995 significant differences for hormonal treatment side effects such as sexual functioning and hot flushes, all of which were experienced more frequently by treated patients. In 1994 the treated patients experienced more psychological distress while in 1995 they showed worse physical function, less energy and more fatigue when compared to patients under surveillance. The premise that active treatment would improve the psychological quality of life was not sustained. In addition global health status and quality of life were identified as independent factors for progression in untreated patients with lymph node positive prostate cancer. Finally, an increase in prostate-specific antigen (PSA) in hormonally treated patients not only indicated hormonal escape but also a decrease in QOL.

Serum lipoprotein(a) concentrations are related to coronary disease progression without new myocardial infarction.

To examine the association between serum lipoprotein(a) and angiographically assessed coronary artery disease progression without new myocardial infarction. 85 patients with coronary artery disease who underwent serial angiography with an interval of at least two years were studied. Progression of coronary artery disease was defined as an increase in diameter stenosis of 15% or more. Vessels on which angioplasty had been performed were excluded from the analysis. The patients were classified into two groups: a progression group without new myocardial infarction (n = 48) and non-progression group (n = 37). Risk factors including lipoprotein(a) were evaluated to see how they were related to progression without myocardial infarction. There were no differences between the two groups in the following factors: age, gender, the time interval between the angiographic studies, the distribution of the analysed coronary arteries, and history of well established coronary risk factors. Univariate analysis showed that serum lipoprotein(a) (P = 0.0002), cigarette smoking between the studies (P = 0.002), serum high density lipoprotein (P = 0.003), and serum low density lipoprotein (P = 0.01) were related to progression without myocardial infarction. Multivariate analysis selected two independent factors for progression without myocardial infarction: serum lipoprotein(a) (P = 0.003) and serum high density lipoprotein (P = 0.03). Serum lipoprotein(a) concentrations are closely related to the progression of coronary artery disease without new myocardial infarction. Lipoprotein(a) lowering treatment may be needed to prevent disease progression in patients with coronary artery disease and high serum lipoprotein(a).