Predictor Of Long-term Survival Research Articles

Predictors of Long-Term Survival in Patients with Lung Cancer Included in the Randomized Spanish Lung Cancer Group 0008 Phase II Trial Using Concomitant Chemoradiation with Docetaxel and Carboplatin plus Induction or Consolidation Chemotherapy

Purpose The aim of this study was to analyze prognostic variables associated with long-term survival in patients with stage III non–small-cell lung cancer enrolled in a Spanish Lung Cancer Group (SLCG) phase II trial. Patients and Methods Between May 2001 and June 2006, 139 patients were enrolled. The initial design included 3 arms: sequential chemotherapy (CT) followed by standard thoracic radiation therapy (TRT; RT), concomitant CT/TRT followed by consolidation CT, or induction CT followed by CT/TRT. Based on the results of the Radiation Therapy Oncology Group 9410 trial, the sequential arm was closed. Induction or consolidation therapy comprised docetaxel plus gemcitabine. Concomitant treatment comprised docetaxel plus carboplatin plus 60 Gy TRT. A univariate and a Cox proportional hazard regression analysis of the following 11 variables were performed: age, sex, Eastern Cooperative Oncology Group performance status (PS), histology, forced expiratory volume in 1 second, disease stage, nodal status, hemoglobin level, completion of RT treatment, completion of induction or consolidation plus concomitant treatment, and RT delay. Results With a median follow-up of 23 months for living patients, median survival was 13.07 months for the consolidation arm and 14.65 months for the induction arm. The 4-year survival rates were 25.37% and 32.35%, respectively. Only RT treatment completion ( P < .0001) and induction or consolidation plus concomitant treatment completion ( P < .0001) were associated with longer survival. Conclusion Based on this retrospective analysis of patients enrolled in the SLCG 0008 randomized phase II study, age, sex, PS, and clinical parameters are not good predictors of overall survival; however, completion of treatment is needed to achieve long-term results.

Natural Killer Cell IFN-γ Levels Predict Long-term Survival with Imatinib Mesylate Therapy in Gastrointestinal Stromal Tumor–Bearing Patients

Clinical outcomes of gastrointestinal stromal tumor (GIST)-bearing patients treated with imatinib mesylate (IM) are variable. Other than the site of mutation within the c-kit gene, prognostic features of GIST remain undefined. IM can exhibit off-target effects such as triggering natural killer (NK) cell activity. We addressed whether NK cell functions could predict long term survival with IM. NK cell functions were followed up in 77 GIST patients enrolled onto two phase III trials. "Immunologic responders" were defined as patients whose NK cell IFN-gamma values after 2 months of IM were higher than or equal to the baseline value at entry into the trial. The prognostic effect of IFN-gamma on progression-free survival was assessed by a Wald test in a Cox regression analysis using the landmark method and stratified by trial and on the c-kit mutational status. Fifty-six patients were evaluable for the NK cell IFN-gamma responses at baseline and 2 months. Their median follow-up for progression-free survival was 3.7 years. Thirty-four of 56 patients were immunologic responders to IM. In the Cox regression analysis, immunologic responders possessed a hazard ratio of progression or death equal to 0.29 (95% confidence interval, 0.12-0.70; P = 0.006) compared with nonresponders. Kaplan-Meier 2-year survival estimates were 85% for immunologic responders and 50% for nonresponders. Moreover, the immunologic response added prognostic value to the c-kit mutation. The NK cell IFN-gamma production after 2 months of treatment could be considered an independent predictor of long term survival in advanced GISTs treated with IM.

Prognostic Interactions between Statins and In-Hospital Revascularisation on the Outcome of Acute Coronary Syndrome

To examine if the prognostic benefit of in-hospital revascularisation on survival among patients with acute coronary syndrome (ACS) was influenced by the use of statins at the initial hospital discharge. All ACS survivors discharged from Dunedin and Invercargill coronary care units between the years 2000 and 2002 were included. Of the 1057 hospital survivors with ACS (age 64.9+/-12.6 years, 63% male), 481 (45.5%) had in-hospital revascularisation (CABG in 123 patients and PCI in 377, including 19 with both procedures). Statins were prescribed at discharge in 47% of patients without and 73% of patients with revascularisation. Revascularisation was associated with lower mortality up to 5 years of follow-up (hazard ratio 0.29, 95% confidence interval 0.20-0.42). After adjusting for baseline differences and the use of statins, the hazard ratio was 0.39 (95% confidence interval 0.27-0.58). While the use of statins was a predictor for long-term survival (p<0.001), no significant interaction was found between the use of statins and in-hospital revascularisation in predicting survival. Both in-hospital revascularisation and the use of statins at hospital discharge independently improved outcome over a follow-up period of 2-5 years. There was no prognostic interaction detected between these two beneficial therapies.

Liver Transplantation for Hepatocellular Carcinoma in the MELD Era: Leading Roles of MELD Score, AFP Level, and Recipient Age as Predictors of Survival

Dear Editor, Adequate patient selection criteria and predictors of long-term survival are topics of major interest and discussion in liver transplantation (LT) for hepatocellular carcinoma (HCC). In a recent publication in Digestive Diseases and Sciences, in a study performed by our group on live-donor liver transplantation under a liberal HCC policy, sophisticated multivariable statistical analysis showed that while patient age [60 years and MELD [22 were negative predictors of short-term outcome, patient age [60 years and AFP [400 ng/ml inversely correlated with long-term survival [1, 2]. The above-mentioned cut-off values were statistically derived and not arbitrarily defined. We were very excited to find out that almost the same predictors were defined by the largest contemporary series under a conservative HCC transplant policy, including 5,776 HCC transplant recipients [3]. Indeed, in a quasisimultaneous publication in Gastroenterology, Ioannou and co-workers reviewed the United Network for Organ Sharing (UNOS) database for LT performed between 1997 and 2007 and concluded that the adoption of MELD led to a 6fold increase in the transplantation of HCC patients [3]. They also observed that recipients with solitary HCC 3– 5 cm in size, a-fetoprotein (AFP) levels C455 ng/ml (hazard ratio, 2.15; 95% CI: 1.5–2.0), MELD scores C20 (hazard ratio, 1.61; 95% CI: 1.3–2.1), age (hazard ratio, 1.32; 95% CI: 1.0–1.7 for age [61 years), and AFP C455 ng/ml combined with MELD C20 had a detrimental effect on survival [3]. The observation that MELD scores and AFP levels are predictors of survival is certainly of great clinical importance. Since age [60 years was also associated with diminished survival in the UNOS series, it would be interesting to have the risk of death in the UNOS recipients when combining AFP C455 ng/ml, MELD C20, and age C61, which is unfortunately not provided. However, as it is clearly shown by these two contemporary and simultaneous studies, with liberal or conservative transplant HCC policy in Europe and USA, respectively, this new combination could prove to be an even better and applicable tool to evaluate patients with HCC and cirrhosis!

Analysis of the surgical outcome and prognostic factors for hilar cholangiocarcinoma

To assess the therapeutic strategies and prognostic factors which influence on clinical outcome of hilar cholangiocarcinoma. A total of 144 patients with hilar cholangiocarcinoma underwent operation between January 1990 and December 2005 were analyzed, including 102 males and 42 females with 36- 74-years-old. All patients underwent resection among which 86 cases (59.7%) had an R0 resection (negative histologic margins), 34 cases (23.6%) had an R1 resection (positive histologic margins), 24 cases (16.7%) had an R2 resection. The Bismuth-Corlette classification of group R0 and R1: 28 cases (23.3%) in type I , 49 cases (40.8%) in type II, 10 cases (8.3%) in type III A, 19 cases (15. 8%) in type III B and 14 cases (11.7%) in type IV. The TNM stages of group R0 and R1: 19 cases (15.8%) in stage I, 80 cases in stage II (66.7%), 16 cases in stage III (13.3%), 5 cases in stage IV (4.2%). In group R0 and R1, there were 41 cases with well differentiated and 79 cases with moderately and poorly differentiated, 62 cases (51.7%) with negative lymph nodes and 58 cases (48.3%) with positive lymph nodes, 42 cases in stage T1 and 78 cases in stage T2-3, 86 cases with negative blood vessel metastasis and 34 cases with positive blood vessel metastasis. The median survival time was 46.8 months after R0 resection, 18.3 months after R1 resection, and 11.2 months after R2 resection. The 1-, 3- and 5-year cumulative survival rates of the patients were 60.2%, 36.1% and 29.4%. Survival rates after resection in patients with negative lymph nodes (n = 62) were significantly longer than that in those with positive lymph nodes (n = 58) (P < 0.01). The T stage system predicted respectability and the likelihood of an R0 resection and correlated with survival (P = 0.030). Patients requiring portal vein resection had a worse prognosis than those without vascular resection (P = 0.047) but still survived longer than patients who were unresectable (P < 0.01). Negative histologic margins, concomitant partial hepatectomy, and well-differentiated tumor histology are associated with improved outcome after all hilar cholangiocarcinoma resections. In patients who underwent an R0 resection, concomitant partial hepatectomy is the only independent predictor of long-term survival.

QS316. Predictors of Long-Term Survival After Distal Pancreatectomy for Pancreatic Adenocarcinoma

QS316. Predictors of Long-Term Survival After Distal Pancreatectomy for Pancreatic Adenocarcinoma

Prediction of long-term survival and coagulation factor VIII levels: interactions with gender in a large hospital-based cohort

Elevated coagulation factor VIII activity (FVIII:C) has been associated with increased risk for both venous and arterial thrombosis. The current study evaluated the influence of factor VIII levels and interactions with gender on all-cause mortality in a large Austrian cohort.

Pulmonary Vascular Reactivity and Prognosis in Patients With Chronic Thromboembolic Pulmonary Hypertension

Surgical pulmonary endarterectomy is the preferred treatment for chronic thromboembolic pulmonary hypertension. Persistent pulmonary hypertension after pulmonary endarterectomy has been recognized as a major determinant of poor outcome. We tested whether acute vasoreactivity identifies chronic thromboembolic pulmonary hypertension patients prone to develop persistent/recurrent pulmonary hypertension after pulmonary endarterectomy and whether the degree of acute vasoreactivity affects survival or freedom from lung transplantation. Right-sided heart catheterization at baseline and after inhalation of 40 ppm nitric oxide for 20 minutes was performed in 103 patients (56.3+/-15.3 years old, 53 women). Reductions in mean pulmonary arterial pressure (DeltamPAP; -8.8+/-12.6%; P<0.0001) and pulmonary vascular resistance (-16.1+/-18.1%; P<0.0001) and an increase in mixed venous saturation during inhaled nitric oxide (9.1+/-11.6%; P<0.0001) were observed. Sixty-two patients underwent pulmonary endarterectomy after a median of 49 days (25th and 75th percentiles: 24 and 123 days). Operated patients were followed up for a median of 70.9 months (25th and 75th percentiles: 14 and 97 months). Change in mPAP during inhaled NO was identified as a predictor of persistent/recurrent pulmonary hypertension after pulmonary endarterectomy. Patients experiencing a reduction in mPAP >10.4% with nitric oxide inhalation had a better postoperative outcome. A significant correlation was found between DeltamPAP and immediate postoperative pulmonary vascular resistance (r=0.5, P<0.0001). A total of 80 (77.7%) of 103 patients demonstrated acute pulmonary vascular reactivity of some degree. A decrease in mPAP >10.4% under inhaled nitric oxide is a predictor of long-term survival and freedom from lung transplantation in adult patients with chronic thromboembolic pulmonary hypertension who are undergoing pulmonary endarterectomy.

Abstract 2865: Enhanced Left Ventricular Mass Regression Following Aortic Valve Replacement is Associated with Improved Long-Term Survival: A 15-year Study

Background Aortic valve replacement (AVR) is followed by regression of LVH. More complete resolution of LVH is suggested to be associated with superior clinical outcomes, however its impact on long-term survival following AVR has not been investigated. Methods Demographic and clinical data were obtained retrospectively through casenote review. Transthoracic echocardiography was used to measure LVM pre-operatively and at annual follow-up visits. Patients were grouped according to their reduction in LVM at late follow-up: Group A &lt; 25 grams, Group B 25–150 grams and Group C &gt; 150 grams. Results 211 patients underwent AVR between 1 st January 1991 and 1 st January 2001. Pre-operative LVM was 295 ± 118 g in A (n=63), 346 ± 97 g in B (n=75) and 539 ± 175 g in C (n=73), P &lt;0.001. Mean time to last echocardiogram was 6.4 ± 3.3 years. LVM at late follow-up was 351 ± 160 g in A, 265 ± 95 g in B and 270 ± 90 g in C, P &lt;0.001. Transvalvular gradients at follow-up were not significantly differerent between groups (A: 21 ± 21 mm Hg, B: 20 ± 15 mm Hg, C: 14 ± 11 mm Hg), P = 0.10. There was no difference in the prevalence of other factors influencing LVM regression such as IHD or hypertension. Ten year actuarial survival was significantly greater in patients with enhanced LVM regression when compared with the log-rank test (A: 49% ± 7, B: 67%± 6, C: 75% ± 6), P =0.03 (Figure 1 ). LVM reduction &gt; 150 grams was an independent predictor of long-term survival on multivariate analysis (P = 0.03). Conclusion Enhanced LVM regression at late follow-up in patients undergoing AVR is associated with improved long-term survival. Strategies to optimize post-operative LVM regression should be considered in view of potential prognostic benefit.

Ectopic Lymph Nodes Within Human Solid Tumors

Ectopic Lymph Nodes Within Human Solid Tumors

Predictors of Long-Term Survival After Liver Transplantation for Metastatic Endocrine Tumors: An 85-Case French Multicentric Report

Liver transplantation (LTx) for metastatic endocrine tumors (MET) remains controversial due to the lack of clear selection criteria. From 1989 to 2005, 85 patients underwent LTx for MET. The primary tumor was located in the pancreas or duodenum in 40 cases, digestive tract in 26 and bronchial tree in five. In the remaining 14 cases, primary location was undetermined at the time of LTx. Hepatomegaly (explanted liver > or =120% of estimated standard liver volume) was observed in 53 patients (62%). Extrahepatic resection was performed concomitantly with LTx in 34 patients (40%), including upper abdominal exenteration (UAE) in seven. Postoperative in-hospital mortality was 14%. Overall 5-year survival was 47%. Independent factors of poor prognosis according to multivariate analysis included UAE (relative risk (RR): 3.72), primary tumor in duodenum or pancreas (RR: 2.94) and hepatomegaly (RR: 2.63). After exclusion of cases involving concomitant UAE, the other two factors were combined into a risk model. Five-year survival rate was 12% for the 23 patients presenting both unfavorable prognostic factors versus 68% for the 55 patients presenting one or neither factor (p < 10(-7)). LTx can benefit selected patients with nonresectable MET. Patients presenting duodeno-pancreatic MET in association with hepatomegaly are poor indications for LTx.

Predictors of long-term survival in lung cancer patients (p) included in the randomized Spanish Lung Cancer Group 0008 phase II trial using concomitant chemoradiation with docetaxel (D) and carboplatin (Cb) plus induction (I) or consolidation (C) chemotherapy (CT) with docetaxel and gemcitabine (G)

7574 Background: There is little information about prognostic variables associated with long term survival in stage III NSCLC p treated with concomitant chemoradiotherapy. Methods: Unresectable stage III p with IK ≥ 70, forced expiratory volume in 1 second (FEV1) of ≥ 1L and weight loss < 5% were initially randomized to sequential treatment (arm A), concurrent CT/TRT followed by consolidation CT (arm B) or induction CT followed by CT/TRT (arm C). Based on RTOG 9410 results, arm A was closed and the study continues with two concomitant arms (B, C). All p receive 2 cycles of D 40 mg/m2 d1, 8 plus G 1,200 mg/m2 d1, 8 as I or C therapy. Concomitant treatment includes D 20 mg/m2 and Cb AUC 2 weekly plus 60 Gy TRT. In order to identify factors that affected survival duration an univariate analysis and a Cox proportional hazards regression were performed including the following variables: age (< 70 or > 70), sex, ECOG (0 vs 1), FEV1 (>2 L vs 1–2 L), stage III (A vs B), N disease (N0 vs N1–2 vs N3), Hb level (≥12 gr/dl vs < 12 gr/dl), RT treatment completed (yes vs no), I or C plus concomitant treatment completed (yes vs no) and prolonged RT delay (≥ 7 days vs > 7 d). Results: From May 01 to Jun 06, 151 p were included (A: 19, B: 66, C: 66). Efficacy and survival data were already presented. With a median follow-up of 23 months (m), no statistically significant differences in terms of MST (13.7 m [B] and 14.6 m [C]) or 4-years survival (27% [B] and 34% [C]) were found. In the Cox regression analysis only RT treatment completed (p < 0.0001) and I or C plus concomitant treatment completed (p < 0.0001) were associated with improved survival. Conclusions: Based in this retrospective analysis neither age, sex, ECOG nor clinical parameters are good predictors for OS in p candidate to concomitant treatment whereas finishing the treatment is needed for achieve long term results. No significant financial relationships to disclose.

Functional Outcome 3 Months after Stroke Predicts Long-Term Survival

Background: When reporting stroke survival and prognostic factors with a possible effect on outcome, the starting point for the observation of a clinical cohort usually is the onset of stroke or the acute admission of a patient. Thus, acute and early mortality inflict prognosis on long-term outcome. In order to give a more robust analysis of long-term survival after the acute period we chose to start our observation with 3-month survivors. Methods: We used data from Riks-Stroke, the Swedish quality register for stroke care, together with survival information from the Swedish population register to explore the influence of disability level 3 months after stroke on long-term survival. The main analysis included 15,959 stroke patients, registered during 2001–2002, who had been independent in primary activities of daily living before stroke, had suffered an ischaemic or a haemorrhagic stroke and reported no previous stroke. Results: Impaired functional outcome after stroke was an independent predictor of poor survival. Patients with modified Rankin scale (mRS) grades 3, 4 and 5 had hazard ratios of 1.7, 2.5 and 3.8, respectively, as compared with patients with lower mRS grades. In addition to high mRS, male sex, high age, diabetes, smoking, hypertension therapy at stroke onset, atrial fibrillation and depressed mood were also recognized as significant predictors of poor survival using a multiple Cox regression model. Conclusion: The influence of disability on survival is stronger than that of several other well-known prognostic factors. This finding indicates that any intervention in the acute phase that may improve functional status at 3 months will also have favourable secondary effects on survival in the long term.

Health-related quality of life and long-term prognosis in chronic hypercapnic respiratory failure: a prospective survival analysis

BackgroundHealth-related quality of life (HRQL) is considered as an important outcome parameter in patients with chronic diseases. This study aimed to assess the role of disease-specific HRQL for long-term survival in patients of different diagnoses with chronic hypercapnic respiratory failure (CHRF).MethodsIn a cohort of 231 stable patients (chronic obstructive pulmonary disease (COPD), n = 98; non-COPD (obesity-hypoventilation syndrome, restrictive disorders, neuromuscular disorders), n = 133) with CHRF and current home mechanical ventilation (HMV), HRQL was assessed by the disease-specific Severe Respiratory Insufficiency (SRI) questionnaire and its prognostic value was prospectively evaluated during a follow-up of 2–4 years, using univariate and multivariate regression analysis.ResultsHRQL was more impaired in COPD (mean ± SD SRI-summary score (SRI-SS) 52.5 ± 15.6) than non-COPD patients (67.6 ± 16.4; p < 0.001). Overall mortality during 28.9 ± 8.8 months of follow-up was 19.1% (31.6% in COPD, 9.8% in non-COPD). To identify the overall role of SRI, we first evaluated the total study population. SRI-SS and its subdomains (except attendance symptoms and sleep), as well as body mass index (BMI), leukocyte number and spirometric indices were associated with long-term survival (p < 0.01 each). Of these, SRI-SS, leukocytes and forced expiratory volume in 1 s (FEV1) turned out to be independent predictors (p < 0.05 each). More specifically, in non-COPD patients SRI-SS and most of its subdomains, as well as leukocyte number, were related to survival (p < 0.05), whereas in patients with COPD only BMI and lung function but not SRI were predictive.ConclusionIn patients with CHRF and HMV, the disease-specific SRI was an overall predictor of long-term survival in addition to established risk factors. However, the SRI predominantly beared information regarding long-term survival in non-COPD patients, while in COPD patients objective measures of the disease state were superior. This on one hand highlights the significance of HRQL in the long-term course of patients with CHRF, on the other hand it suggests that the predictive value of HRQL depends on the underlying disease.

Lessons About Brain Vascular Disease From Another Pulsating Organ, the Kidney

See related article, pages 55–61. Because of similarities in the vascular supply to kidney and brain, information about vascular disease in one organ may inform us about vascular disease in the other, and such knowledge may shed light on ways to treat or prevent these diseases. Unlike most organs, both kidney and brain are low resistance end-organs and are exposed to high-volume blood flow throughout the cardiac cycle, explaining their pulsating nature.1 For the kidney, impairments from vascular disease manifest as problems with glomerular filtration, detected clinically by biochemical makers such as serum creatinine, urinary albumin, and serum cystatin C. For the brain, impairments manifest with overt focal neurological deficits, such as with stroke or transient ischemic attack, or as covert global deficits affecting cognition, mobility and mood, such as has been suggested with small-vessel disease. In humans, investigation of brain vascular disease and how it causes impairment of brain function often entails looking at the structure of the brain with MRI for infarctions, white matter lesions, and volumes of brain, ventricles and sulci. Given the difficulty in getting tissue, exploration of cause usually does not include microscopic examination of brain tissue, although microinfarcts inapparent on MRI can be identified.2 For investigation of vascular disease in the kidney, structural changes detectable on imaging are limited primarily to decrements in kidney size due to chronic fibrosis and atrophy. On the other hand, tissue is more …

The risk of cardiovascular death following the first acute ischaemic syndrome: experience in Kaunas between 1997 and 2001

The aim of our study was twofold: initially to investigate the effects of the informative value of the variables of the acute period on the risk of cardiovascular death during the long-term period following the first acute coronary syndrome, and then to determine the long-term survival rate in different risk groups.Methods — The prospective five-year observational study included 732 patients with acute coronary syndrome who had survived the hospital period. Employing multivariable Cox’s proportional-hazard analysis, the most informative variables were selected, the risk score index was calculated, the risk groups for the prediction of cardiovascular death were identified, long-term survival (4.5 ± 2.1 years) in different risk groups was determined and internal validation of the model was performed.Results — During the observational period, 84 patients (11.5%) died due to cardiovascular causes. Cox proportional-hazard models demonstrated that six variables had significant influence on long-term survival during the five-year period after an acute coronary syndrome. These variables were: age [1-5 points], the presence of pathologic Q wave in > 2 ECG leads [2 points], Killip class II-IV [24 points], left ventricular ejection fraction < 35% [2-4 points], proximal stenosis of coronary arteries [2-4 points], absence of myocardial revascularization in the acute period [2 points].Three strata for risk of cardiovascular death were identified [0-5 points - 14.1% patients, 6-10 points - 62.6%, > 10 points - 23.3%].The probability of survival within the period of five years was found to be favourable for the majority of patients in the low- and medium-risk groups, while the number of such patients in the high-risk group was significantly lower [97.0% vs. 89.0% vs. 73.0%, P< 0.0000].The difference in the survival probability was negligible in developmental and validation sets.Conclusion — The risk score derived from clinical variables of first acute coronary syndromes permits a reliable determination of risk for cardiovascular death as well as the prediction of long-term survival in different risk groups.

Influence of Preoperative Atrial Fibrillation on Late Results of Mitral Repair: Is Concomitant Ablation Justified?

There is considerable interest in atrial fibrillation (AF) ablation during cardiac operations, but there are few studies addressing the impact of preoperative AF on late outcome of surgery. We therefore investigated AF prevalence in nonrheumatic mitral regurgitation and its effect on late survival and morbidity after repair. From 1993 through 2002, 36% of 2,821 patients with mitral regurgitation had preexisting AF. A cohort of these was matched with controls in sinus rhythm (SR) for age, gender, and ejection fraction. Follow-up was by questionnaire. Outcomes were compared between 231 AF and 229 SR patients, and patients with different types of preoperative AF. Patients with preoperative AF were more symptomatic and frequently had cardiomegaly, heart failure, and higher mean pulmonary artery systolic pressure. Operative mortality was higher for AF patients (2% vs 0, p = 0.05). More AF patients had late adverse cardiac events and stroke (63% vs 31%, p < 0.0001). Five- and ten-year survival was, respectively, 95% and 88% for SR patients compared with 90% and 70% (p = 0.01) for the AF group. By multivariate analysis, preoperative AF was not a predictor of long-term survival but was an independent risk factor for late adverse cardiac events and stroke. Preoperative AF is a marker for increased surgical risk of mitral regurgitation repair, and a risk factor for late adverse cardiac events and stroke. Although the independent contribution of AF to late survival is uncertain, preoperative AF increases postoperative morbidity independently; therefore, corrective intervention would be expected to benefit patients in this regard.

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8123 Background: The high-dose sequential (HDS) chemotherapy approach, including early dose-intensification and autograft with peripheral blood progenitor cells (PBPC), was introduced several years ago (Gianni &amp; Bonadonna, 1989); subsequently, it has been broadly used in the management of both non-Hodgkin s (NHL) and Hodgkin s Lymphoma (HL). The outcome of a large series of lymphoma patients treated with the HDS approach at 10 GITIL Centers is reported. Methods: Data have been collected on 1,266 patients, who received either the original or slightly modified HDS regimens. There were 213 HL and 1,053 NHL (630 intermediate/high-grade, 423 low-grade); median age was 46 yrs. Overall, 671 (53%) patients had refractory/relapsed disease, 595 (47%) were at diagnosis. Most patients were autografted with PBPC; 158 (12%) patients did not undergo autografting due to toxicity, disease progression or poor harvests. Results: Overall, 1,013 (80%) patients reached Complete Remission (CR) following HDS. As to December 2006, 93 (7%) patients died for early/late toxicities, 328 (26%) died for lymphoma, 844 are known to be alive. At a lead follow-up of 18 years, and a median follow-up of 5 yrs, the 5-yr Overall Survival (OS) projection is 64% (S.E.: 2%). The long-term survival was quite favorable in patients achieving a Complete Remission (CR), with a 5-yr OS projection of 76%. The prolonged OS in patients achieving CR was consistent in all lymphoma subtypes, i.e. both low and high-grade NHL (5-yr OS: 77% in both), and HL (5-yr OS: 72%). Patients at diagnosis had a significantly better outcome compared to patients treated for relapsed/refractory disease, again CR achievement was associated with prolonged survival in both subgroups (82% and 69%, respectively, at 5 yrs.). On multivariate Cox survival analysis, CR achievement was the most powerful predictor of long-term survival (HR 0.13, c.i.: 0.10–0.17). Lastly, achieving substantial tumor reduction before autografting had a major influence on the clinical outcome. Conclusions: 1. the HDS program is feasible in a multicenter setting; 2. the long-term outcome is well influenced by the CR status after HDS; 3. the influence of CR achievement on the long-term survival holds true in all lymphoma subtypes, including indolent lymphomas; 4. an adequate pre-autograft tumor debulking may contribute to a favorable long-term outcome. [Table: see text]

Ventricular long-axis function is of major importance for long-term survival in patients with heart failure

Objective:To assess the importance of ventricular systolic and diastolic long-axis (LAX) function in comparison with short-axis (SAX) function for prediction of long-term survival in patients with heart failure.Design:Prospective epidemiological study.Setting:University...

Rectal Cancer: MR Imaging before Neoadjuvant Chemotherapy and Radiation Therapy for Prediction of Tumor-Free Circumferential Resection Margins and Long-term Survival1

To retrospectively evaluate the prognostic importance of involvement of the circumferential resection margin predicted by using magnetic resonance (MR) imaging before neoadjuvant treatment in patients with rectal cancer. The local institutional review board approved the retrospective analysis of the data and waived informed consent. Sixty-eight patients (52 men, 16 women; mean age +/- standard deviation, 58.9 years +/- 9.4) with cT3 NX M0 tumors were included. T2-weighted MR images were analyzed in consensus by two radiologists with respect to the shortest distance between the outermost parts of the tumor to the adjacent mesorectal fascia (as the potential circumferential resection margin in total mesorectal excision). Histopathologic and follow-up data were available for all patients (mean follow-up time, 54 months; range, 31-77 months). To compare local recurrence and survival rates, the population was divided into three groups categorized according to the minimum distance of the tumor to the mesorectal fascia (group 1, <or=1 mm; group 2, >1 to 5 mm; group 3, >5 mm). Univariate Cox and multivariate proportional hazard regression models were used to test the prognostic importance of clinical, histopathologic regression, and histopathologic tumor parameters. MR imaging led to accurate prediction of a histologically involved circumferential resection margin (sensitivity, 100%; specificity, 88%). The rates for local recurrence (group 1, 33%; group 2, 5%; group 3, 6%; P<.02) and 5-year overall survival (group 1, 39%; group 2, 70%; group 3, 90%; P<.001) differed significantly among the predefined groups. The distance to the mesorectal fascia was an independent prognostic parameter in multivariate analysis (P<.001), and histopathologic response to treatment provided no additional information. Prediction of the tumor-free circumferential resection margin assessed with MR imaging before initiation of neoadjuvant chemotherapy and radiation therapy proved to be a prognostic factor in rectal cancer.