Prognostic Factors In Chinese Patients Research Articles

FLT3-ITD with DNMT3A R882 double mutation is a poor prognostic factor in Chinese patients with acute myeloid leukemia after chemotherapy or allogeneic hematopoietic stem cell transplantation.

To investigate clinical characteristics and outcomes of transplantation in AML patients with FLT3-ITD/DNMT3A double mutation, we retrospectively analyzed 206 Chinese patients with AML after Sanger sequencing. Our analysis showed that AML patients with FLT3-ITD and DNMT3A R882 mutations had a higher white blood cell count and a lower complete remission (CR) rate after first induction chemotherapy. All 206 patients received allogeneic hematopoietic stem cell transplantation (allo-HSCT) in status of CR. These results indicate that AML patients with FLT3-ITD and DNMT3A R882 double mutation show a higher 2-year cumulative incidence of relapse (CIR), lower 2-year overall survival (OS) rate, and lower 2-year leukocyte-free survival (LFS) after allo-HSCT. The univariate and multivariate analyses confirmed that disease status prior to transplantation, FLT3-ITD, FLT3-ITD, and DNMT3A R882 double mutation were independent factors for poor prognosis after allo-HSCT. In summary, the present cohort study demonstrated that FLT3-ITD and DNMT3A R882 double mutation predicts poor prognosis in Chinese AML patients receiving chemotherapy or allo-HSCT treatment.

Analysis of clinical features and prognostic factors in Chinese patients with rheumatic diseases in an intensive care unit

Aim of the workTo describe the clinical features and prognostic factors in patients with rheumatic diseases (RDs) admitted to the intensive care unit (ICU). Patients and methodsClinical data of 33 RD patients admitted to the ICU of Shenzhen Baoan Hospital were retrospectively analyzed regarding the causes for admission, medications received, duration of stay and the management required. Disease severity of the patients was assessed using the acute physiology and chronic health evaluation (APACHE-II) score. ResultsThe diagnoses of the patients included 16 (48.5%) systemic lupus erythematosus (SLE), 7 (21.2%) systemic vasculitis, 4 (12.1%) rheumatoid arthritis; 3 (9.1%) polymyositis/dermatomyositis; 2 (6.1%) Sjögren’s syndrome and 1 (3%) with systemic sclerosis. The mean APACHE-II score was mean 16.1±7.3. The main cause for ICU admission was infection in 12 (36.4%) patients, primary disease worsening in 8 (24.2%), infection associated with disease activity in 9 (27.3%) and 4 (12.1%) cases were hospitalized for other disease processes (including 1 case of subarachnoid hemorrhage, 1 case of acute myocardial infarction and 2 with hypovolemic shock). 31 (93.9%) had more than one organ involved. Mortality was 51.5% (17 cases); including 9 (27.3%) deaths from infection, 5 (15.2%) from primary diseases, and 3 (9.1%) from other causes. Primary disease worsening and APACHE-II score were significantly increased in the mortality cases (33.3% and 20±7.1) compared to survivors (13.3% and 10±1.2) (p=0.017 and 0.0001 respectively). ConclusionSLE was the most frequent cause of ICU admission; infections are the leading causes prompting admission. RDs patients often had multi-organ involvement with a high mortality rate.

Clinical Features and Prognosis Analysis of Hodgkin Lymphoma: A Multicenter Retrospective Study Over a Decade of Patients in China.

There is little information available regarding Chinese patients with Hodgkin lymphoma (HL). We analyzed the clinical features, outcome, and prognostic factors of Chinese patients with HL, aiming to establish a new risk model for better risk-adapted therapeutic strategy. Patients with newly diagnosed HL at 4 medical centers from January 2000 to August 2014 were recruited. A total of 150 patients were reviewed. The median age was 30 years (range, 15-91 years). At completion of initial therapy, 73.65% of patients achieved complete remission. The 5-year event-free survival (EFS) of the entire cohort was 61.1%, the overall survival was 84.7%, and the disease-free survival was 78.8%. B symptoms, extranodal involvement, and International Prognostic Score≥ 3 remained as independent prognostic factors of EFS. Patients who failed to reach complete remission on interim positron emission tomography/computed tomography or computed tomography had a significantly worse outcome than those who did. A new risk model incorporating traditional risk factors and interim response stratified patients into 3 classes, with a 5-year EFS of 100%, 83.1%, and 33.1%, respectively (P< .0001). General clinical features were comparable with those of Western patients, whereas therapeutic outcomes were slightly inferior. The novel risk assessment model showed potential as a more powerful prognostic tool by identifying 3 subsets of patients with significantly distinct outcomes, which warrants further validations.

Prognostic Value of Clinical and Pathological Features in Chinese Patients with Chromophobe Renal Cell Carcinoma: A 10-Year Single-Center Study.

Objective: To evaluate the prognostic significance of clinicopathological features in a large series of Chinese patients with chromophobe renal cell carcinoma (RCC).Materials and Methods: Patients with chromophobe RCC who were treated surgically for renal masses at Chinese PLA General Hospital from 2006 to 2015 were identified. Tissue slides were reviewed to verify diagnoses and collect clinicopathological variables. Cox proportional hazard regression models and the Kaplan-Meier method were performed to evaluate the significance of clinicopathological variables on survival outcomes.Results: A total of 209 patients with chromophobe RCC were enrolled in this study. There were only 13 cancer-specific events, which included 7 local recurrences and 6 metastases. The estimated 5-year and 10-year disease-free survival (DFS) rates were 92.4% and 83.1%, respectively. Univariate analysis indicated that tumor size, 2010 AJCC TNM stage, grade, sarcomatoid differentiation and urinary collecting system invasion were correlated with poor DFS. Multivariate analysis revealed that tumor size, 2010 AJCC TNM stage and grade were independent predictors of DFS.Conclusions: According to this long-term follow-up on a large number of Chinese patients, we found that chromophobe RCC was associated with a very low rate of cancer-specific events (6.2%) and has a better prognosis than clear cell RCC. Tumor size, 2010 AJCC TNM stage and grade were independent prognostic factors in Chinese patients with chromophobe RCC. The presence of these features in a nephrectomy specimen with chromophobe RCC warrants more active surveillance.

FLT3-ITD As a Prognostic Factor for Chinese Patients with Acute Myeloid Leukemia

Internal tandem duplication of the FLT3 gene (FLT3-ITD) is one of most common genetic mutations found in patients with acute myeloid leukemia (AML). Although FLT3-ITD has been widely studied and used as an important prognostic indicator of AML in the western world, its association with disease features and prognosis in Chinese AML patients to date has rarely been investigated.In this study, 177 Chinese patients with AML were enrolled including a FLT3-ITD mutation positive group (n = 83) and a FLT3-ITD mutation negative group (n = 94).In FLT3-ITD-positive AML patients, the number of patients whose peripheral blood leucocyte count (≥ 100 × 109/L) before treatment was significantly higher than in FLT3-ITD negative patients (32.1% vs 7.6%), but comparing to FLT3-ITD mutation negative patients, 1 year and 2 year event free survival rates (EFSR) of FLT3-ITD-positive AML patients was lower ((37.0% vs 56.0%) and (14.8% vs 38.4%)), and also their 1 year and 2 year OS rates were significantly lower ( (50% vs 100%) and (18.0% vs 36.5%)). However, it was found that the rate of induced remissions in FLT3-ITD-positive AML patients was much lower than in negative patients (39.4% vs 56.0%). The median survival time of the FLT3-ITD+/NPM1- group (n = 39) was superior to the FLT3-ITD+/NPM1+ group (n = 27) (16.1 months vs 5.8 months). Lastly, after comparing chemotherapy regimes, we found that the allogeneic hematopoietic stem cell transplantation treatment method significantly improved the survival rate of FLT-ITD positive AML patients (not reached vs 14.5 months). Therefore, for FLT3-ITD-positive Chinese patients with AML, the relative rate of complication with leucocyte was increased; both the event free and overall survival rates were lower, these characteristics are the same as the FLT3-ITD-positive patients in western countries. The lower induced remission rate and shorter survival time suggested FLT3-ITD+/NPM1+ mutation is inferior to FLT3-ITD+/NPM1- mutation, which is not consistant with most reports. In addition, allogeneic hematopoietic stem cell transplantation was clearly an effective treatment for patients with FLT-ITD positive AML in China. DisclosuresNo relevant conflicts of interest to declare.

Survival and prognostic factors in Chinese patients with osteosarcoma: 13-year experience in 365 patients treated at a single institution

This study was designed to retrospectively analyze the survival and prognostic factors in Chinese osteosarcoma patients received neoadjuvant chemotherapy or/and surgery in a single institution. A total of 365 patients with pathological proved osteosarcoma undergoing neoadjuvant chemotherapy or/and surgery in a single institution between December 1999 and December 2012 were retrospectively analyzed for the demographic, tumor-related, and treatment-related variables, prognostic factors for survival rate and chemotherapy response. There were 231 males and 134 females (ratio, 1.72:1). The average age was 21±10years, with peak age between 10 and 20 years old (62%, 226/365). Of 365 patients, 319 (87.4%) suffered from primary tumor only, and 46 (12.6%) had metastases upon initial presentation. The overall 5-year survival rate was 65%. Upon univariate analysis, tumor site (femur 60.3%; other long bone 70.2%; trunk 33.6%; P=0.012), primary metastases (yes 36.7%; no 68.9%; P=0.000), tumor response to preoperative chemotherapy (good 89.8%; poor 47.5%; P=0.001) and recurrence/metastases after treatment (yes 36.2%; no 63.8%; P=0.000) were associated with higher 5-year survival rate. All factors except tumor site maintained their significance in multivariate testing. Male sex and nonconventional subtype of tumor were related to a higher likelihood of poor chemotherapy response.The absence of metastases at initial presentation, negative local recurrence or metastases after treatment, and tumor response to chemotherapy are of independent prognostic value in osteosarcoma. The overall prognostic factors and survival in Chinese patients are similar to those patients reported in western countries.

Analysis of prognostic factors in Chinese patients with post-polycythemia vera myelofibrosis and post-essential thrombocythemia myelofibrosis

目的评估适用于原发性骨髓化(PMF)患者的国际预后积分系统(IPSS)、动态国际预后积分系统(DIPSS)、修订的动态国际预后积分系统(DIPSS plus)、基于我国PMF患者临床特征提出的修订IPSS(IPSS-Chinese)、修订DIPSS(DIPSS-Chinese)及针对欧美真性红细胞增多症(PV)后骨髓纤维化(post-PV MF)和原发性血小板增多症(ET)后骨髓纤维化(post-ET MF)患者制定的继发性骨髓纤维化预后模型(MYSEC-PM)对我国post-PV MF和post-ET MF患者的预后效力，并探讨post-PV/ET MF患者的预后因素。方法回顾性分析1984年3月至2013年12月期间连续收治的55例post-PV/ET MF患者的临床资料，使用IPSS、DIPSS、DIPSS plus、IPSS-Chinese、DIPSS-Chinese和MYSEC-PM对患者进行预后分组及评估，并对可能的预后因素进行分析。结果55例post-PV/ET MF患者中男20例、女35例，中位年龄59(20~88)岁。post-PV MF 32例(58.2%)，post-ET MF 23例(41.8%)。诊断PV/ET至转化为MF的中位时间为7.8(1.1~23.4)年。所有患者中位随访37(1~156)个月，44例(80.0%)存活，11例(20.0%)死亡，中位生存时间为110.0(95% CI 87.5~132.8)个月。采用IPSS、DIPSS、DIPSS plus、IPSS-Chinese及MYSEC-PM对患者进行预后分组，各组患者的生存预后差异均无统计学意义(P> 0.05)。单因素分析示HGB<100 g/L是post-PV/ET MF患者的不良预后因素(P=0.003)。结论适用于PMF患者的IPSS、DIPSS、DIPSS plus、IPSS-Chinese及MYSEC-PM不能准确地对我国post-PV/ET MF患者进行预后分组。HGB<100 g/L是post-PV/ET MF患者的不良预后因素，可作为制定治疗方案的参考。

The value of prognostic factors in Chinese patients with small cell lung cancer: A retrospective study of 999 patients.

Little is known about the prognostic factors for small cell lung cancer (SCLC) in Chinese patients. The aim of this retrospective study was to improve our understanding of overall survival (OS) and progression-free survival (PFS) prognostic factors in Chinese patients with SCLC. A retrospective analysis of 999 SCLC cases was performed. Patient characteristics, treatments, and laboratory data, including platelet counts and serum lactate dehydrogenase (LDH) and serum sodium levels, were collected. Potential prognostic factors for OS and PFS were evaluated by univariate and multivariate analyses. The median OS and PFS were 10.6 and 7.0 months, respectively. The multivariate Cox proportional hazards model was used to identify stage, serum LDH, and several therapy-relevant factors, including the initial chemotherapy regimen, number of initial chemotherapy cycles, and combination therapy, as independent prognostic factors for OS. Furthermore, female sex, normal LDH levels, a response to therapy, receiving six cycles of initial chemotherapy, and receiving chemotherapy combined with radiotherapy and/or surgery were favorable prognostic factors for PFS. In addition, patients with hyponatremia had a worse OS; therefore, hyponatremia could not influence survival when a good response to therapy was achieved, and it failed to predict PFS. This study demonstrated that several factors, including patient, tumor, and treatment characteristics and serum LDH levels are independent prognostic factors for OS and PFS in Chinese patients with SCLC. The identification of such factors will help physicians compare different populations and to interpret the contribution of treatment to differences in survival among groups.

Increased expression of MMP14 correlates with the poor prognosis of Chinese patients with gastric cancer

The role of matrix metalloproteinase 14 (MMP14) has been identified to involve tumor progression and prognosis. The purpose of this study is to investigate the role of MMP14 in tumor progression and prognosis of gastric cancer. This study indicated that MMP14 mRNA and protein were overexpressed in gastric cancer tissue (P<0.001 and P=0.037, respectively) and significantly associated with clinical stage (P=0.005), lymph node metastasis (P=0.003), and distant metastasis (P=0.017). Moreover, we found that the overexpression of MMP14 was a significant predictor of poor prognosis for gastric cancer patients (P<0.001). Furthermore, we performed a meta-analysis which included 594 cases from 3 studies and showed that MMP14 overexpression was a significantly poor prognostic factor in Chinese patients with gastric cancer and HR (95% CI) was 2.17 (1.64–2.86). In conclusion, MMP14 plays an important role on gastric cancer progression and prognosis and acts as a convictive biomarker for prognostic prediction for Chinese patients with gastric cancer.

Efficacy analysis and multi-factor retrospective study of third-line chemotherapy in 82 Chinese patients with small cell lung cancer ⁎

Abstract Objective As there is currently no clear recommendation for third-line chemotherapy for small cell lung cancer (SCLC), its efficacy is unknown. To date, there have rarely been reports of Chinese patients with SCLC who received third-line chemotherapy. Therefore, we investigated the efficacy, safety, and prognostic factors of Chinese patients with SCLC treated with third-line chemotherapy. Methods A retrospective analysis of patients with SCLC who received third-line chemotherapy was performed. Results Between 2007 and 2013, 82 patients [62 men (75.6%), 20 women (24.4%); median age at the time of diagnosis, 55 years] received third-line chemotherapy at our center. Of these patients, 44 had limited-stage disease and 38 had extensive-stage disease. On third-line chemotherapy, 55 (67.1%) patients had an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0-1, objective response rate of 15.9%, and median overall survival after third-line chemotherapy (OS-3) and median progression-free survival after third-line chemotherapy (PFS-3) of 5.6 months and 3.0 months, respectively. On univariate analysis, PFS-3 was significantly related with ECOG PS (P = 0.005), response to second-line chemotherapy (P = 0.002), response to third-line chemotherapy (P &lt; 0.001), and PFS after second-line chemotherapy (P = 0.026). OS-3 was significantly related with ECOG PS (P &lt; 0.001), response to thirdline chemotherapy (P = 0.033), PFS after first-line therapy (P = 0.044), and PFS after second-line therapy (PFS-2) (P = 0.007). On multivariate analysis, ECOG PS (P = 0.008) and response to third-line chemotherapy (P = 0.046) were independent prognostic factors for PFS-3, while ECOG PS (P = 0.007) and PFS-2 (P &lt; 0.001) were independent prognostic factors for OS-3. Conclusion Few patients with SCLC receive third-line chemotherapy. Our findings suggest that patients with an ECOG PS 0-1 and PFS-2 for &gt;3 months will be benefit from third-line chemotherapy, which should be actively offered to them.

BRAF V600E mutation and KRAS codon 13 mutations predict poor survival in Chinese colorectal cancer patients.

BackgroundMutations in KRAS, BRAF and PIK3CA are the most common somatic alterations found in the colorectal cancer (CRC) patients from Western countries; but their prevalence and prognostic value have not been adequately assessed in Asian patients. The aim of this study was to determine the mutation frequencies of these genes in Chinese CRC patients and to investigate their impact on prognosis.MethodsThe sequences of exon 2 of KRAS, exon 15 of BRAF and exons 9 and 20 of PIK3CA were evaluated by PCR and direct sequencing using DNA extracted from formalin-fixed paraffin-embedded (FFPE) tissues from primary CRC tumors of 214 patients (colon/rectum: 126/88).ResultsKRAS, BRAF and PIK3CA mutations were identified in 44.9% (96/214), 4.2% (9/214) and 12.3% (26/212) CRCs, respectively. The most frequent mutations in KRAS, BRAF and PIK3CA were G12D, V600E and H1047R, respectively. All BRAF and 80.8% PIK3CA mutations were from colon cancer patients. BRAF V600E was associated with advanced TNM (P < 0.001), more distant metastases (P = 0.025), and worse overall survival (OS, P < 0.001; multivariate HR = 4.2, P = 0.004) in colon cancer patients. Compared with KRAS wt/BRAF wt CRC patients (N = 109), those with KRAS codon 13 mutations (N = 25) had significantly worse OS (P = 0.016; multivariate HR = 2.7, P = 0.011), whereas KRAS codon 12-mutated cases were not significantly associated with survival. Among the three most common KRAS mutations, G13D (N = 23) showed significant association with poor OS (P = 0.024; multivariate HR = 2.6, P = 0.016) compared with KRAS wt/BRAF wt patients.ConclusionOur findings indicate that PI3K/RAS-RAF signaling pathway genes are frequently mutated in Chinese CRC patients, but have different characteristics than found in Western patients. BRAF V600E is an independent prognostic factor for Chinese patients. Our finding that KRAS codon 13 mutations (in particular G13D) are associated with inferior survival in BRAF wild-type CRCs in Chinese patients was not reported thus far. Our data emphasizes the importance of prospective evaluation of molecular features in CRC patients, because a single mutation type may represent a distinct biologic effect and clinical implication.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2407-14-802) contains supplementary material, which is available to authorized users.

Clinicopathological analysis of 273 cases of primary intestinal non-Hodgkin's lymphoma

To study the clinicopathological characteristics and prognostic factors in Chinese patients with primary intestinal non-Hodgkin's lymphomas (PINHL). The clinical symptoms, pathological features, diagnostic and prognostic factors of 273 cases diagnosed with PINHL from our center were analyzed. Among 273 cases, 189 were male and 84 female, the male to female ratio was 2.3:1. The age of patients ranged from 2 to 85 years old with the median age of 46. The most frequent site of the lesions was ileocecus (n=83, 30.4%). The clinical symptoms of PINHL were unspecific with abdominal mass frequently seen in B-cell lymphoma, and perforation, hypogastric pain and "B" symptoms more common in T-cell lymphoma. Endoscopic biopsy diagnosis rate was 90.3%. Of 273 cases, B-cell lymphoma (n=232, 85.0%) dominated PINHL with the most common subtype of diffuse large B-cell lymphoma-not otherwise specified (DLBCL-NOS) (n=132, 48.4%), while the T-cell lymphoma (n=41, 15.0%) were much less seen with the most common subtype of enteropathy-associated T-cell lymphoma (EATL) (n=15, 36.6%). There were 245 cases were followed up, including 206 cases of B-cell lymphoma and 39 cases of T-cell lymphoma, it was found that the prognosis of B-cell lymphoma is much better than that of T-cell lymphoma (P<0.05). Operation had no significant effect for the overall survival rate. But for patients with aggressive lymphoma, operation can improve the survival rate. It indicates that PINHL often occurs as B cell type, DLBCL-NOS is the most common histological type. Ileocecus is the most common site involved and enteroscope biopsy is a good method of diagnosis. Compared with T-cell lymphoma, B-cell lymphoma has different clinical manifestations and a better prognosis. Patients with aggressive lymphoma can benefit from operation.

Analysis on the Characteristics and Prognosis of Pulmonary Neuroendocrine Tumors

To retrospectively review the clinical characteristics and analyze the prognostic factors of Chinese patients with pulmonary neuroendocrine tumors. The clinical data of 176 patients with pulmonary neuroendocrine tumors in Chinese PLA General Hospital from Mar., 2000 to Oct., 2012 were retrospectively analyzed. The parameters were evaluated by univariate and multivariate analysis, including the gender, age, smoking history, family history, TNM staging, localization (central or peripheral), tumor size, nodal status, histological subtype and treatment (operation or non-operation). There were 23 patients with typical carcinoids (TC) (13.1%), 41 with atypical carcinoids (AC) (23.3%), 10 with large cell neuroendocrine carcinoma (LCNEC) (5.7%) and 102 with small cell lung cancer (SCLC) (57.9%). The median follow-up time was 64.5 months for AC, 38 months for LCNEC and 27 months for SCLC. The typical carcinoid censored data was 18 (more than 50% of the patients), so the median follow-up time was not obtained, and actuarial 5-year survivals for TC, AC, LCNEC and SCLC were 75.1%, 51.7%, 26.7% and 38.8%, respectively. COX univariate analysis revealed that the age (P=0.001), histological subtype (P=0.005), nodal status (P=0.000), treatment (P=0.000) and TNM staging (P=0.000) were the prognostic factors of the patients with pulmonary neuroendocrine tumors, whereas its multivariate analysis showed that only the age(P=0.001), TNM staging (P=0.002) and treatment (P=0.000) were independent prognostic factors. Radical surgery remains the treatment of choice, and is the only curative option. The age, TNM staging and treatment are confirmed to be the independent prognostic factors in multivariable models for pulmonary neuroendocrine tumors.

A study of prognostic factors in Chinese patients with diabetic foot ulcers.

ObjectiveFew studies have identified factors as predictors of clinical prognosis of patients with diabetic foot ulcers (DFUs), especially of Chinese patients. In this study, we assessed the prognostic factors of Chinese patients with DFUs.Methods and materialsThis was a retrospective study (January 2009–January 2011) of 194 DFUs conducted in an inpatient population at PLA 454 Hospital in Nanjing, China, to determine the prognostic influential factors of DFUs in Chinese patients. All of the studied patients were grouped into an amputation group, a non-healing group, and a cured group, according to the clinical prognosis. Patient parameters, including gender, age, smoking habits, education level, family history of diabetes mellitus, medical history, duration of foot lesions and complications, ankle-brachial index (ABI), transcutaneous oxygen pressure (TcPO2), urinary albumin/creatinine ratio (Alb/Cr), fundus oculi, electrocardiogram, DFU characteristics, bacterial nature, and neuropathy, were cross-studied among the three groups.ResultsCompared with the other two groups, the amputation group showed a higher number of males, older in age, lower ABI and TcPO2 levels, higher Wagner wound grading and size, and significantly higher urinary Alb/Cr ratio, blood urea nitrogen, serum creatinine, white blood cell count, and erythrocyte sedimentation rate. Compared to the cured group (162 patients), more patients with an older age, smoking, family history of diabetes mellitus, medical history of foot ulcerations, lower ABI and TcPO2 levels, higher urine Alb/Cr ratio, and serum creatinine were found in the non-healing group. Regression analysis was used to study the correlation between various factors and clinical prognosis, and the results were as follows: age, Wagner wound classification, and heel ulcerations were negatively correlated to the DFU prognosis, whereas the female population, ABI, and TcPO2 were positively correlated with DFU prognosis.ConclusionIn this retrospective study, we conclude that the DFU prognosis may be related to age, gender, wound location (heel), Wagner wound classification, ABI, and TcPO2 levels in the Chinese population.

Effects of low estimated glomerular filtration rate on outcomes after stroke: a hospital‐based stroke registry in China

As uncertainty persists over the prognostic significance of low estimated glomerular filtration rate (eGFR) in acute stroke, the effects of low eGFR on death/disability amongst participants with acute stroke in China were determined. Nanjing First Hospital stroke registry was a prospective cohort study of stroke patients. Patients with acute stroke (brain infarction, intracerebral hemorrhage or subarachnoid hemorrhage) within 7days of onset were recruited consecutively from 2004 to 2008. Baseline eGFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration equation. Outcomes were death/disability, defined by scores 3-6 on the modified Rankin Scale at 90days. A total of 1909 participants were included in the present analyses. Of them, 112 (5.9%) had baseline moderate to severe decrease in eGFR (G3b-4) and increasing risk of higher National Institutes of Health Stroke Scale (NIHSS) scores. Low eGFR was associated with increasing risk of death/disability at 90days [G3b-4, odds ratio 2.58 (95% confidence interval 1.71-3.91); G3a, 1.86 (1.35-2.56); G2, 1.21 (0.96-1.52); P trend <0.001). However, the association was not statistically significant after adjustment for demographic and clinical factors including NIHSS scores. There were no appreciable effects of low eGFR on death/disability at 90days independent of other prognostic factors in Chinese patients with acute stroke.

Prognostic Factors in Chinese Patients With Penile Invasive Squamous Cell Carcinoma

The incidence of penile cancer varies by ethnicity and is not well described among Chinese patients. We performed a retrospective study to assess the prognostic factors in Chinese patients with penile invasive squamous cell carcinoma (SCC). We reviewed the medical records of 83 consecutive patients treated at the National Urological Cancer Center (Beijing, China). The Kaplan-Meier method, log-rank test, and multivariate Cox proportional hazard model were used to identify the prognostic factors predicting for cancer-specific survival (CSS). Univariate and multivariate logistic regression analysis were used to analyze the predictive factors for lymph node metastasis (LNM). A total of 55 patients were followed. Twelve patients (20%) died from the disease during follow-up. By univariate analysis, older age (≥ 49 years; P = .048), radical resection (compared with local/partial resection; P = .040), high histological grade (P = .037), and LNM (P < .001) were each associated with poor prognosis. By multivariate analysis, chronological age (P = .011) and LNM (P = .002) were independent prognostic factors. High histological grade (P = .003) was an independent predictive factor for LNM. In our series, chronological age and LNM were independent prognostic factors for CSS. The histological grade, not the tumor stage, was still an influential predictive factor of LNM in Chinese patients with penile SCC.

Prognostic factors in Chinese patients with metastatic castration-resistant prostate cancer treated with docetaxel-based chemotherapy

This study aims to evaluate the potential value of patient characteristics in predicting overall survival (OS) in patients with metastatic castration-resistant prostate cancer (mCRPC) treated with docetaxel-based thermotherapy. A total of 115 patients with mCRPC undergoing a docetaxel q3w regimen were enrolled in this study. A survival analysis was performed using the Kaplan-Meier method. Cox proportional hazards models were used to evaluate the prognostic value of all covariates for OS. OS was also analysed after stratifying patients according to the results of multivariate analysis. The median OS for the entire cohort was 17.0 months. The multivariate analysis showed that the prostate-specific antigen doubling time (PSADT), baseline haemoglobin (Hb) concentration, alkaline phosphatase (ALP) concentration, cycles of chemotherapy and time to castration resistance were independent prognostic factors of OS. According to the presence of PSADT <46.3 days and baseline ALP ≥ 110 IU l(-1), all patients were divided into three risk groups: low-risk group (no risk factors), intermediate-risk group (one risk factor) and high-risk group (two risk factors). Median OSs for patients in low-, intermediate- and high-risk groups were 28.0 months (95% CI: 23.8-32.2), 21.0 months (95% CI: 18.9-23.1) and 11.0 months (95% CI: 7.6-14.4), respectively (P<0.001). In conclusion, PSADT, baseline Hb concentration, ALP concentration, cycles of chemotherapy and time to castration resistance were independent prognostic factors of OS in Chinese patients with mCRPC treated with docetaxel. PSADT combined with the baseline ALP concentration could be a useful risk stratification parameter for evaluating survival outcomes.

Low pretreatment serum total testosterone is associated with a high incidence of Gleason score 8–10 disease in prostatectomy specimens: data from ethnic Chinese patients with localized prostate cancer

What's known on the subject? and What does the study add? Previous data from clinically localized prostate cancer (PCa) series treated with radical prostatectomy (RP) have suggested that low preoperative serum total testosterone level is associated with more aggressive PCa; however, the definition of low preoperative total testosterone level varied among these studies (from 220 ng/dL to 387 ng/dL). Moreover, no relevant data exist in the literature regarding ethnic Chinese patients. The study shows that the most widely used threshold for low pretreatment total testosterone level (total testosterone < 300 ng/dL) is not appropriate for ethnic Chinese patients, because it could not distinguish patients with more aggressive PCa from those with less aggressive disease. Setting the threshold at the level of total testosterone < 250 ng/dL works better, because pretreatment total testosterone < 250 ng/dL is associated with a significantly higher incidence of Gleason score 8-10 disease in RP specimens. • To investigate the relationship between preoperative serum total testosterone level and prognostic factors of Chinese patients with clinically localized prostate cancer (PCa). • A total of 110 patients with localized PCa, treated by radical prostatectomy (RP), were included in this prospective study. • Clinical and pathological data from each patient were collected. Total testosterone was measured on the morning of surgery. • Total testosterone levels for each patient were compared using two thresholds: threshold 1 (total testosterone <300 ng/dL vs total testosterone ≥ 300 ng/dL) and threshold 2 (total testosterone <250 ng/dL vs total testosterone ≥ 250 ng/dL). • The median preoperative total testosterone level was 346 ng/dL. Gleason scores of ≤ 6, 7 and ≥ 8 were found in the RP specimens from 21 (19.1%), 67 (60.9%) and 22 (20.0%) patients, respectively. • Compared with those with low grade disease, patients with high grade disease (Gleason score ≥ 8) in RP specimens had a significantly lower preoperative total testosterone. • When comparing 35 patients with hypogonadism with 75 patients with eugonadism, classified by threshold 1, no significant relationships were found. • When comparing 18 patients with hypogonadism with 92 patients with eugonadism, classified by threshold 2, pathological Gleason score ≥ 8 tumours were more common in patients with hypogonadism. • Setting the threshold for hypogonadism at the level of pretreatment serum total testosterone <250 ng/dL is appropriate for ethnic Chinese patients with localized PCa, because patients with pretreatment total testosterone <250 ng/dL are associated with a higher incidence of Gleason score 8-10 disease in RP specimens.

Prognostic factors of Chinese patients with T/NK-cell lymphoma: a single institution study of 170 patients

T/natural killer-cell lymphoma (T/NKCL) is a heterogeneous group of lymphoma and has a higher incidence in Asia than in Western countries. T/NKCL is presented with various clinicopathologic features, and in general, associated with a poor clinical outcome. This study aims to analyze the clinical prognostic factors in patients with T/NKCL. From January 1999 to December 2009, a total of 170 patients with T/NKCL, except mycosis fungoides, were included in this retrospective study. The diagnosis was established according to World Health Organization classification. The clinical characteristics and prognostic factors were evaluated. Of the 170 patients, mainly peripheral T-cell lymphoma-unspecified (65 cases), precursor T-lymphoblastic lymphoma/leukemia (31 cases) and nasal NK/T-cell lymphoma (NKTCL, 19 cases), advanced disease (Ann Arbor stages III-IV) was presented in 68.8% and extranodal involvement was in 71.2% of the patients. According to the international prognostic index (IPI), 77 cases were categorized as high/intermediate or high-risk group. Using the prognostic index for peripheral T-cell lymphoma-unspecified (PIT), 87 cases were classified as group 3 or 4. Most of the initial regimens were CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone)-based chemotherapy (87.6%). Cumulative probability of overall survival at 5 years was 43%, and the median survival time was 44.5 months. Univariate analysis revealed that factors associated with a poor outcome were poor performance status (ECOG > 1) (P = 0.001), advanced disease (P = 0.009), the presence of B symptom (P = 0.001), multiple extranodal involvement (P = 0.005), bone marrow involvement (P = 0.003), elevated lactic dehydrogenase level (P = 0.019), IPI (P < 0.001), PIT (P < 0.001), abnormal white blood cell count (P = 0.016), decreased platelet count (P = 0.005) and serum Epstein-Barr virus (EBV) IgA positivity (P = 0.016). In the multivariate analysis, PIT (P < 0.001; relative risk, 3.221; 95% CI = 2.115-4.907) and EBV serum IgA (P = 0.049; relative risk, 1.901; 95% CI = 1.002-3.606) remained independent factors predictive for overall survival. The PIT may therefore be a useful index for risk stratification in patients with T/NKCL. The serum EBV antibody test could be a simple and quick marker to predict the outcome of the patients.

Polymorphisms and haplotypes in multidrug resistance 1 gene are not associated with chronic lymphocytic leukemia susceptibility and prognostic parameters of chronic lymphocytic leukemia in Chinese population

The human multidrug resistance (MDR1, ABCB1) gene encodes P-glycoprotein (P-gp), which affects the pharmacokinetics of many drugs. Here, we investigated whether common MDR1 single nucleotide polymorphisms (SNPs) (C1236T, C3435T, and G2677T/A) affect predisposition to chronic lymphocytic leukemia (CLL). Genotyping was performed in 150 patients with CLL and 117 controls using polymerase chain reaction (PCR)-based assays. Haplotypes were inferred using the PHASE algorithm. We found comparable allele and genotype frequencies among patients with CLL and controls. Moreover, patient and control groups did not differ regarding MDR1 haplotype distribution (p = 0.97). Furthermore, no correlation was shown between the MDR1 1236, 3435, or 2677 genotypes and Binet stage, unmutated immunoglobulin heavy-chain variable region (IGHV) status, CD38 expression, ZAP-70 expression, and p53 deletion. In conclusion, our results do not support a major influence of MDR1 variants on the risk of CLL, and these genomic polymorphisms are not associated with clinical prognostic factors in Chinese patients with CLL.