Possible Prognostic Factors In Patients Research Articles

Mean Platelet Volume Used as a Potential Negative Predictor in Patients with Heart Failure; Hypothesis Based on Statistical Modeling

(1) Background: Heart failure (HF) remains one of the most frequent public health problems, with high mortality and hospitalization rates. Identifying an indicator with a prognostic role in patients with HF could represent a salutary solution in the future, as it could identify patients with a negative prognosis. Thus, our study focused on mean platelet volume (MPV) as a possible prognostic factor in patients with HF. (2) Methods: The research was a type of correlational study, which was conducted in a retrospective manner on 260 patients with chronic HF. The statistical analysis assessed whether there was a plausible relationship between the MPV value and several target variables based on a regression model analysis. (3) Results: Using logistic and linear regression models, we estimated the impact of the MPV value on certain events and the probabilities of these events depending on MPV value. The results obtained using regression model analysis were considered statistically significant (α = 0.05) based on a p-value below 0.05. The results showed that patients with class IV NYHA HF or acute pulmonary edema had higher MPV than class II NYHA HF, and that patients with higher MPV had a greater probability of having certain events, represented by 3-month hospitalization, 6-month rehospitalization, 1-year death, and prolonged hospitalization. (4) Conclusions: Using statistical modeling based on regression model analysis, our study showed that certain negative events in HF patients could be predicted based on the MPV value.

Identifying important factors for successful surgery in patients with lateral temporal lobe epilepsy.

Lateral temporal lobe epilepsy (LTLE) has been diagnosed in only a small number of patients; therefore, its surgical outcome is not as well-known as that of mesial temporal lobe epilepsy. We aimed to evaluate the long-term (5 years) and short-term (2 years) surgical outcomes and identify possible prognostic factors in patients with LTLE. This retrospective cohort study was conducted between January 1995 and December 2018 among patients who underwent resective surgery in a university-affiliated hospital. Patients were classified as LTLE if ictal onset zone was in lateral temporal area. Surgical outcomes were evaluated at 2 and 5 years. We subdivided based on outcomes and compared clinical and neuroimaging data including cortical thickness between two groups. Sixty-four patients were included in the study. The mean follow-up duration after the surgery was 8.4 years. Five years after surgery, 45 of the 63 (71.4%) patients achieved seizure freedom. Clinically and statistically significant prognostic factors for postsurgical outcomes were the duration of epilepsy before surgery and focal cortical dysplasia on postoperative histopathology at the 5-year follow-up. Optimal cut-off point for epilepsy duration was eight years after the seizure onset (odds ratio 4.375, p-value = 0.0214). Furthermore, we propose a model for predicting seizure outcomes 5 years after surgery using the receiver operating characteristic curve and nomogram (area under the curve = 0.733; 95% confidence interval, 0.588-0.879). Cortical thinning was observed in ipsilateral cingulate gyrus and contralateral parietal lobe in poor surgical group compared to good surgical group (p-value < 0.01, uncorrected). The identified predictors of unfavorable surgical outcomes may help in selecting optimal candidates and identifying the optimal timing for surgery among patients with LTLE. Additionally, cortical thinning was more extensive in the poor surgical group.

Patients with brain metastases from gastric cancer.

The aim of this study was to retrospectively evaluate the treatment strategies and possible prognostic factors in patients with brain metastases from gastric cancers. We retrospectively reviewed 24 patients with brain metastases from gastric cancer who were treated at our center between January 2014 and March 2020. Clinicopathological characteristics and clinical outcomes were analyzed. The median follow-up time was six months (range, 1-40). The median survival time after diagnosis of brain metastases was six months (95% confidence interval: 1.33-10.66). The one- and two-year survival rates were 30.7% and 5.1%, respectively. On univariate analyses, absence of extracranial metastases was significantly associated with better overall survival (OS) but not intracranial progression-free survival (iPFS), while Eastern Cooperative Oncology Group performance status (ECOG PS), whole brain radiotherapy (WBRT) and systemic treatments were significantly associated with better iPFS and OS. Multivariate analysis showed that ECOG PS, extracranial disease and systemic treatments were independent prognostic factors, while only systemic treatment influenced the iPFS. Two patients achieved partial response, 12 patients had progressive disease, and 10 patients remained stable. Local tumor control in our series was achieved in 50%. One patient, who received a combination of camrelizumab and apatinib therapy following whole brain radiotherapy, achieved an obvious partial response. ECOG PS, extracranial disease and systemic treatments were independent prognostic factors for gastric cancer patients with brain metastases. The present best treatment for this group of patients was individual comprehensive therapy according to the different situation of each patient.

Clinical Features and Possible Prognostic Factors in Patients with Marginal Zone Lymphoma: Retrospective Analysis from Two Centers

Objective: Marginal zone lymphoma accounts 5%-17% of all non-Hodgkin lymphomas and has an indolent clinical course. The parameters that predict prognosis and the need for treatment are still unclear. The aim of the current study was to examine the impact of parameters on the course of disease and the need for treatment in marginal zone lymphoma. Patients and Methods: A retrospective study was conducted with marginal zone lymphoma patients in the hematology departments of two centres between 2010 and 2018. The demographic and disease characteristics, and also hematological and biochemical parameters at the time of diagnosis were examined. The effect of the parameters on overall survival and need for treatment were analyzed. Fourty patients were included in this study. Results: A total of 40 MZL patients, 25 (62.5%) women and 15 (37.5%) men, were evaluated. During the follow-up, 25 patients required treatment and 15 patiens were followed up without treatment. overall survival of all marginal zone lymphoma patients was 58.4 months. Overall survival was significantly higher in patients with nodal marginal zone lymphoma than in extranodal and splenic marginal zone lymphoma patients. The platelet count of untreated patients at the time of diagnosis were significantly higher than patients who received treatment (p= 0.04). Conclusion: We demonstrated platelet count at the time of diagnosis as a predictive factor for future treatment need. It is an objective and simple blood test that may be helpful to predict the course of the disease although further studies are warranted.

Radiotherapy for vertebral hemangioma: the single-center experience of 80patients.

This study aimed to evaluate the therapeutic effect of radiotherapy and to determine possible prognostic factors in patients with painful vertebral hemangioma. In the last two decades, 80patients with vertebral hemangioma who received radiotherapy in our institute were evaluated in terms of pain response, treatment-related side effects, and prognostic factors. All patients were questioned 3months after radiotherapy for the evaluation of pain response and were divided into threegroups (complete response, partial response, and no change). Moreover, the visual analog scale (VAS) was used for pain response assessment in 46patients. Pain status was assessed to detect recurrence at each clinical examination during the follow-up period. Possible prognostic factors such as gender, size of the hemangioma, location, multilevel involvement and additional musculoskeletal disease on pain response were analyzed. In this study, 45individuals had lesions in the lumbar spine, 28in the thoracic, and 7in the cervical region. Furthermore, 51patients had additional musculoskeletal conditions such as disc herniation, degenerative diseases, spondylolisthesis, and compression fracture. Radiotherapy was performed with amedian daily dose of 2 Gy and amedian total dose of 40 Gy. Complete pain response occurred in 58.8% of patients, 26.2% of patients had partial pain response, and 15% of patients had no pain response. The overall response rate was 85%, and 7patients showed recurrent pain symptoms in the overall response group at routine follow-up. Additional musculoskeletal disorders were found to be the only prognostic factor associated with pain response. The median follow-up time was 60months. Secondary malignancy was not found in any of the patients in this short follow-up time. No acute or late radiation-associated side effects greater than gradeII were observed. To our best knowledge, this study is one of the largest single-institution radiotherapy series on vertebral hemangiomas reported to date. The obtained data support the efficacy and safety of radiotherapy in the treatment of painful vertebral hemangioma. Our study showed that additional musculoskeletal disease plays an important role in pain response. Other prognostic factors and treatment of vertebral hemangioma with stereotactic radiosurgery should be investigated in future studies.

OP-34 - Clinical features and possible prognostic factors in patients with marginal zone lymphoma: retrospective analysis from two centers

OP-34 - Clinical features and possible prognostic factors in patients with marginal zone lymphoma: retrospective analysis from two centers

Prognostic factors for the survival of patients with papillary renal cell carcinoma after surgical management.

To examine the possible prognostic factors in patients with type 1 and type 2 papillary renal cell carcinoma (pRCC) after surgical management and to identify the independent predictive factors of the prognosis. From 2010 to 2017, 1405 patients underwent surgery for renal cell carcinoma, of whom 114 had type 1 or type 2 pRCC and follow-up data were available for 88 patients. Clinicopathological and prognostic parameters were compared between type 1 and type 2 pRCC. Possible prognostic factors were retrospectively analyzed by univariate and multivariate analyses with Cox regression. The study included 63 males and 25 females with a mean age of 54.27 ± 12.91. 53 patients were diagnosed by regular physical examination and others presented with hematuria or lumbago. 53 (60.2%) underwent radical nephrectomy and 35 (39.8%) underwent nephron sparing surgery. After a mean follow-up of 46.08 ± 22.65months, 16 patients died of pRCC metastasis and the 5-year disease-specific survival was 79.3%. The comparison of the 39 (44.3%) type 1 and 49 (55.7%) type 2 pRCCs revealed that type 2 pRCC had significantly higher grade and worse prognosis. Univariate analysis showed that symptomatic diagnosis, type, grade, and tumor stage were prognostic factors. Multivariate analysis identified that type and tumor stage were independent factors of the prognosis. Pathological type and tumor stage could serve as independent factors for the prognosis of patients with pRCC.

Prognostic factors for recurrence and survival in uterine leiomyosarcoma: Korean single center experience with 50 cases.

ObjectiveThe aim of this study was to determine the possible prognostic factors in patients with uterine leiomyosarcoma (LMS).MethodsThis study retrospectively investigated 50 patients with uterine LMS treated at the Samsung Medical Center between 2001 and 2017. To analyze the prognostic significance of factors for recurrence-free survival (RFS), overall survival (OS), and survival after recurrence, the log-rank test and Cox proportional hazards model were used for univariate and multivariate analysis.ResultsOf the 50 patients, 30 (60.0%) experienced recurrence and 16 (32.0%) died within a median follow-up period of 21 (range, 3–99) months. Multivariate analysis revealed that older age, absence of residual tumor after surgery, lower mitotic count, and a history of adjuvant radiotherapy at first treatment were significantly associated with better RFS. Presence of residual tumor after surgery and severe nuclear atypia were associated with poor OS. In the analysis of survival after recurrence, hematogenous recurrence, severe nuclear atypia, and presence of residual tumor at primary surgery were significantly associated with worse prognosis. Notably, residual tumor status at primary surgery was associated with RFS, OS, and survival after recurrence.ConclusionWe demonstrated the possible prognostic factors for RFS, OS, and survival after recurrence for patients with LMS. These results may provide useful information for patients with LMS.

AmotP130 regulates Rho GTPase and decreases breast cancer cell mobility.

Angiomotin (Amot) is a newly discovered, multifunctional protein that is involved in cell migration and angiogenesis. However, the role of its isoform, AmotP130, in the regulation of cytoskeleton and metastasis of breast cancer, is unclear. The aim of this study was to investigate the role of AmotP130 in the reorganization of the actin cytoskeleton and the changes of morphology in breast cancer cells through the Rho pathway that influences the invasion and migration of cells. The results suggested that AmotP130 suppressed the invasion ability through remodelling the cytoskeleton of breast cancer cells, including the actin fibre organization and focal adhesion protein turnover. Global transcriptome changes in breast cancer cells following knockdown of AmotP130 identified pathways related with the cytoskeleton and cell motility that involved the Rho GTPase family. From database analyses, changes in the Rho GTPase family of proteins were identified as possible prognostic factors in patients with breast cancer. We have been suggested that AmotP130 suppressed the invasion ability through remodelling of the cytoskeleton of breast cancer cells, involving regulation of the Rho pathway. The cytoskeleton‐related pathway components may provide novel, clinically therapeutic targets for breast cancer treatment.

Prognostic factors in patients with penile cancer after surgical management.

To examine the possible prognostic factors in patients with penile cancer after surgical management and to identify the independent predictive factors of the prognosis. Clinical data of 135 patients with penile cancer who underwent surgical management in two medical centers were collected. Follow-up data were available for 103 patients. Possible prognostic factors including patient's age; smoking or not; course of disease; phimosis or not; type of surgery; tumor stage; nodal stage; tumor grade and pathological lymph nodes metastasis were retrospectively analyzed by univariate and multivariate analyses with Cox regression. Five-year cancer-specific survival (CSS) and 1-year CSS were 88.5 and 98.1%, respectively. Univariate Cox analysis revealed that nodal stage and pathological lymph nodes metastasis were significant prognostic factors. Multivariate Cox analysis revealed pathological lymph nodes metastasis was the independent predictive factor of the prognosis. Pathological lymph nodes metastasis is the independent predictive factor worsening the prognosis in patients with penile cancer.

The Prognostic Role of Tumor Volume in the Outcome of Patients with Single Brain Metastasis After Stereotactic Radiosurgery.

Patients with single brain metastasis (SBM) have better outcomes after stereotactic radiosurgery (SRS). We analyzed our SRS database to evaluate possible prognostic factors in patients with SBM. A total of 584 patients with SBM were treated with SRS at our institution (2000-2012). Study end points were overall survival (OS), and distant and local intracranial progression-free survival (DPFS and LPFS, respectively). Multivariable analysis was performed to develop prognostic models. Median OS was 10.8 months. A total of 196 patients (36.7%) had distant progression and 102 patients (19.2%) had local progression. New SBM prognostic indices (SPIs) were devised for OS, DPFS, and LPFS. Graded prognostic assessment, neurologic symptoms (P= 0.01), and tumor volume (P= 0.02) were independently associated with OS. The SPI for OS was defined: unfavorable (OS, 7.3 months), intermediate (OS, 10.6 months), and favorable (OS, 19.8 months). For DPFS, age (P= 0.0029), tumor volume (P= 0.0002), and previous whole-brain radiotherapy (P= 0.027) were prognostic and were used to define SPI for DPFS: favorable (6-month cumulative incidence failure [CIF], 10.9%), intermediate (6-month CIF, 16.7%), and unfavorable (6-month CIF, 26.0%) (P < 0.001). For LPFS, graded prognostic assessment (P= 0.0012) and tumor volume (P= 0.0004) were significant, and defined 2 groups in the LPFS SPI: unfavorable (6-month CIF, 12.3%) and favorable (6-month CIF, 6%) (P < 0.001). This is the largest series of patients with SBM treated with SRS analyzed for OS, LPFS, and DPFS. SPI was devised for end points. Tumor volume had a significant association with all 3 end points. Neurologic symptoms, age, and previous whole-brain radiotherapy were also found to be prognostic.

Surgical Treatment of Nonlesional Neocortical Epilepsy

The proportion of surgery for nonlesional neocortical epilepsy has recently increased, with a decrease in surgery for mesial temporal lobe epilepsy. However, there are only a few studies regarding the long-term surgical outcome and the potential prognostic factors for patients with nonlesional neocortical epilepsy. To evaluate the long-term surgical outcome and to identify possible prognostic factors in patients with nonlesional neocortical epilepsy. In a surgical cohort from September 1995 to December 2005 at the Seoul National University Hospital, we included 109 consecutive patients without lesions identifiable by magnetic resonance imaging who underwent focal surgical resection for drug-resistant neocortical epilepsy. Follow-up information for at least 10 years was available for all but 1 patient. Univariate and standard multiple logistic regression analyses were performed to identify the predictors of surgical outcomes, and a generalized estimation equation model was used for the longitudinal multiple logistic regression analysis of up to 21 years of follow-up. The patients consisted of 64 men and 45 women with ages at surgery ranging from 7 to 56 years (mean [SD], 27.1 [7.8] years). At 1 year after surgery, 59 of 109 patients (54.1%) achieved seizure freedom, and 64 of 108 patients (59.3%) achieved seizure freedom at the last follow-up. Only 11 of 108 patients (10.2%) experienced definite changes in postoperative seizure status. Localizing patterns in functional neuroimaging (strongest odds ratio [OR], 0.30 [95% CI, 0.14-0.66] for fluorodeoxyglucose-positron emission tomography; 0.37 [95% CI, 0.15-0.87] for ictal single-photon emission computed tomography), concordant results in presurgical diagnostic evaluations (OR, 3.15 [95% CI, 1.42-7.02]), the presence of aura (OR, 3.49 [95% CI, 1.54-7.92]), and complete resection of areas of ictal onset with frequent interictal spikes during the intracranial electroencephalographic study (OR, 0.37 [95% CI, 0.16-0.85]) were favorable surgical outcome predictors. Our study showed that nearly 60% of patients with nonlesional neocortical epilepsy achieved freedom from long-term seizure, and that changes in postoperative seizure status were rarely observed. Several predictors of favorable surgical outcomes were identified, which can help select optimal candidates for surgical treatment among patients with nonlesional neocortical epilepsy.

2360 Progranulin as a possible prognostic factor in patients with advanced biliary tract carcinoma

2360 Progranulin as a possible prognostic factor in patients with advanced biliary tract carcinoma

Patients with brain metastases derived from gastrointestinal cancer: clinical characteristics and prognostic factors.

This study seeks to evaluate the natural history, outcome, and possible prognostic factors in patients with brain metastases derived from gastrointestinal cancers. The clinical features, prognostic factors, and the effects of different treatment modalities on survival were retrospectively investigated in 103 patients with brain metastases derived from gastrointestinal cancers. The median time from diagnosis of primary tumor to brain metastasis was 22.00 months. The interval between diagnosis of primary tumor relapse and brain metastasis was 8.00 months. The median follow-up time was 7.80 months. The median survival time after diagnosis of brain metastases was 4.10 months for all patients and 1.17 months for patients who received only steroids (36.9 %), 3.97 months for patients who only received whole-brain radiation therapy (WBRT 31.1 %), 11.07 months for patients who received gamma-knife surgery alone or/and WBRT (20.4 %), and 13.70 months for patients who underwent surgery and radiotherapy (12 patients, 11.6 %) (P < 0.001). Multivariate analysis revealed that recursive partitioning analysis (RPA) class, extracranial metastasis, and chemotherapy were independent prognostic factors. Brain metastasis derived from gastrointestinal tract cancer is rare, and overall patient survival is poor. RPA class, chemotherapy after brain metastases, and treatment regimens were independent prognostic factors for the survival of patients with brain metastases derived from gastrointestinal cancers.

Prognostic factors for temporal lobe epilepsy surgery in a tertiary center.

Temporal lobe epilepsy (TLE) represents the most common type of partial epilepsy. Early age of onset, a history of febrile convulsions, epileptiform discharges on electroencephalography, duration of epilepsy, number of generalized seizures and severity of psychiatric disorders are possible prognostic factors in patients with mesial temporal sclerosis. The aim of this study is to review the findings of clinical research, semiotic, psychological, electrophysiological and neuroradiological, and to relate these findings with the prognosis of patients with TLE who underwent anteromedial temporal lobectomy (ATL). Of 1214 patients evaluated for surgery in the epilepsy Center of the São Jose do Rio Preto Faculty of Medicine (Faculdade de Medicina de São José do Rio Preto - FAMERP), a tertiary Brazilian epilepsy center, 459 underwent ATL for TLE. Exams and clinical data were analyzed and compared with Engel classification for outcome. Of all the items analyzed, the MRI showed a greater influence on the outcome of patients and for clinical evaluation and pathological antecedents, age at surgery, the epilepsy duration, seizure frequency, mesial temporal sclerosis, dysplasia, perinatal insults, vascular insults, a family history of epilepsy, febrile seizures, neuropsychological abnormalities and presence of generalized tonic-clonic seizure has a statistical significance. In order to identify the most appropriate candidates for ATL, it is very important to consider the prognostic factors associated with favorable for counseling patients in daily practice.

Natural history and risk factors of long-term mortality in acute coronary syndrome patients with cardiogenic shock

PurposeCardiogenic shock (CS) is a severe complication of acute coronary syndromes (ACS). Intra-aortic balloon pump (IABP) is considered important mechanical therapy for acute CS. We aimed to analyze the natural history and possible prognostic factors in patients with CS complicating ACS. Patients/methodsAll 126 patients (mean age 65.8±12.5 years), who were hospitalized in single center due to an episode of CS in the course of ACS, had IABP and were scheduled for coronary angiography. The assessed end-point was 5-year death from any cause. ResultsMedian left ventricle ejection fraction (LVEF) 28% (interquartile range (IQR) 23–35%), 39 patients (31%) were female, in 91 (72%) the initial diagnosis was ST-elevation myocardial infarction (STEMI). Mean time on the IABP was 3.8±3 days. During index hospitalization there were 56 deaths (44%). Other 27 patients (out of 70 discharged – 38.5%) died during 5-year follow-up. In univariate logistic regression, the significant effect on long term mortality had age, female gender, reduced ejection fraction below 31% and hypotension on admission. The out of hospital survival was also determined by age, gender and hypotension, while LVEF lost its predictive value The multivariate survival analysis both in whole group and in patients discharged from hospital was independently affected by age and hypotension on the admission. ConclusionsThe mortality of patients with CS despite treatment with IABP remains very high, especially during the in-hospital period and early after discharge. Among assessed parameters age and hypotension on the admission are the most important predictors of adverse long term prognosis.

Evaluation of possible prognostic factors in patients with acute myeloid leukemia (univariate and multivariate analysis).

e18015 Background: Malnutrition is a common complication in critically ill and in-patients with malignancy, associated increase the hospital stay and adding more financial burden to the health care...

Prognostic Factors in Patients Presenting with Pleural Effusion Revealing Malignancy

Background: The survival of patients with malignant pleural effusion is considered generally poor. Most of the studies reporting results of prognostic factors are retrospective, using pleural thoracentesis for diagnosis. The objectives of our study were to reveal possible prognostic factors in patients initially presenting with undiagnosed pleural effusion proven to be malignant by diagnostic thoracoscopy. Methods: Ninety consecutive patients, 48 of whom were male (53%), with a median age of 69 years (range 37-93) and a performance status (PS) of 0/1 (63%) and with initially undiagnosed pleural effusion that was proven to be malignant by thoracoscopy were evaluated. Survival time was defined as the time from thoracoscopic diagnosis to death or the last follow-up. A regression analysis was used to determine significant clinical and biological prognostic factors. Results: Lung carcinoma (44.4%), breast carcinoma (24.4%), and mesothelioma (12.2%) were the most frequent tumors diagnosed. The median overall survival was 11 months (range 0.5-55). The survival of the patients was related to the following factors: histology of the primary tumor (p = 0.008), PS (p < 0.001), white blood cells (p = 0.018), and the blood neutrophil-to-lymphocyte (N/L) ratio (p = 0.002). Multiple regression showed PS, histology, and the N/L ratio. Conclusion: The factors affecting survival in our patients were PS, primary tumor histology, and the N/L ratio. These factors may help physicians select patients for treatment and/or interventional procedures.

Quantification of residual risk of relapse in breast cancer patients optimally treated

Despite remarkable improvements in breast cancer survival in the last decades, a proportion of patients still relapse after treatment for early disease. Different prognostic parameters may permit to roughly quantify the residual risk of relapse after (neo)adjuvant therapy. They include: tumor stage and classical molecular features at baseline, newly proposed prognosticators (such as tumor-infiltrating lymphocytes and integrated genomic tools) and the evaluation of tumor response after primary systemic therapy. However, the performance of these factors is still suboptimal and should be improved. Further research aimed to discover new possible prognostic factors in patients who received optimal systemic therapy is needed. Moreover, to exploit at the best the potential of each of these parameters, they should be integrated into algorithms to guide treatment decisions and to select those patients who may deserve the inclusion in clinical trials.

Prognostic factors of visual field improvement after trans-sphenoidal approach for pituitary macroadenomas: review of the literature and analysis by quantitative method

The objective of the study was to evaluate the preoperative visual field defect, the postoperative outcome and the possible prognostic factors in patients with pituitary macroadenoma, using a quantitative method (the mean deviation = MD), and to review the literature. A total of 73 patients, operated trough trans-sphenoidal approach, were selected, and data in single eyes were analysed by calculating the frequency and the degree of postoperative improvement (relative improvement). The visual field defect improved in 95.7% of eyes: The recovery was complete in 48.9% and partial in 46.8%. Multivariate logistic regression showed that factors, independently predictive for complete recovery, were as follows: low preoperative MD absolute value (p = 0.008), low cranio-caudal diameter of tumour (p = 0.02) and young age (p = 0.0001). The mean relative improvement in visual field defect (dMD%) was correlated with the preoperative visual acuity (p = 0.0001) and inversely related with the preoperative MD (p = 0.007) and the age (p = 0.017). The relative improvement was higher in tumours with a smaller cranio-caudal diameter (p = 0.0185). In conclusion, using a quantitative method, we can measure the degree of the postoperative visual field defect improvement. Predictive factors for a complete recovery were good preoperative visual function, young age and low cranio-caudal tumour.