Prognostic Parameter In Patients Research Articles

Prognostic parameters and outcome after re-irradiation for progressive glioblastoma.

In progressive glioblastoma, salvage treatment remains unstandardized, response is highly variable, and detailed analysis of individual approaches is mandatory. Re-irradiation is an established option in the therapy of progressive glioblastoma. Thus, we analysed outcome and prognostic parameters of patients with re-irradiated glioblastoma treated at our institution since 1998. In a total of 51 patients, clinical and treatment parameters were collected and analysed retrospectively. Re-irradiation protocols included radiosurgery, hypofractionated radiotherapy or normofractionated radiotherapy. Outcome was analysed regarding prognostic factors in this highly selected cohort. Median overall survival after primary diagnosis was 28.8months. Patients re-irradiated with single-dose stereotactic radiosurgery or hypofractionated regimes showed a superior overall survival after primary diagnosis compared to normofractionated treatment. Positive prognostic factors included a smaller gross tumour volume and younger age. A methylated MGMT promoter approached statistical significance as a positive factor regarding overall survival after re-irradiation. Further well-known prognostic factors as extension of the initial resection and the concomitance of temozolomide with the initial radiation treatment only appeared relevant in a subgroup of four long-term survivors. The favourable results regarding overall survival are probably due to patient selection for re-irradiation. If technically feasible, stereotactic radiosurgery or hypofractionated regimes should be preferred. In this highly selected re-irradiation cohort, only some of the well-known prognostic factors of the primary tumour setting were found to influence overall survival significantly. In contrast, also some patients presenting with unfavourable predictive parameters showed an encouraging course of disease and thus should not be excluded from re-irradiation.

Clinical outcome and prognostic factors in hepatocellular carcinoma patients with bone metastases medicated with zoledronic acid.

We retrospectively analyzed the clinical outcome and prognostic parameters in patients with hepatocellular carcinoma (HCC) and bone metastases who had received treatment with zoledronic acid (ZOL). Ninety-nine HCC patients with bone metastases who had been treated with ZOL were enrolled in this retrospective cohort study. We analyzed the prognostic factors, including serum N-telopeptide of type I collagen (NTX) levels, as bone metabolism markers. The median overall survival (OS) time was 11.5months. Child-Pugh grade A (P = 0.004) and intrahepatic tumor stage (IHTS) T0-3 (P = 0.010) correlated significantly with favorable OS. In 46 patients with grade A and T0-3, receiver operating characteristic curve analysis defined 16nmolBCE/L serum NTX as the cut-off level for median OS. Multivariate analysis identified baseline serum NTX <16nmolBCE/L (P = 0.045) as the only significant and independent determinant of OS. Low baseline serum NTX level correlated with favorable outcome in bone metastatic HCC patients with Child-Pugh grade A and IHTS T0-3 treated with ZOL.

330PD - Temporal muscle thickness (TMT) is an independent prognostic parameter in patients with newly diagnosed brain metastases (BM) of breast cancer (BC)

330PD - Temporal muscle thickness (TMT) is an independent prognostic parameter in patients with newly diagnosed brain metastases (BM) of breast cancer (BC)

Clinical significance of BRAF V600E mutational status in capsular nevi of sentinel lymph nodes in patients with primary cutaneous melanoma

Capsular nevi (CN) are clusters of benign melanocytes situated in the capsule of lymph nodes and occur in up to 20% of lympadenectomy specimens. The molecular profile of CN in relation to prognostic parameters in patients with primary cutaneous melanoma (PCM) has not been previously investigated. We assessed BRAF V600E mutation by immunohistochemistry (IHC) in the CN of sentinel lymph nodes (SLN) in PCM patients and correlated the findings with demographic characteristics, PCM histopathologic and molecular features, and clinical outcome parameters. Seventy-eight cases of CN involving SLN of PCM patients were evaluated for BRAF V600E mutation by IHC. The results were correlated with patient demographics, PCM histopathologic and molecular features, and outcome measures. Thirty-six (46%) of 78 CN cases expressed BRAF V600E mutation by IHC. Nineteen (53%) of those BRAF-positive CN cases were from patients with at least American Joint Committee on Cancer stage II melanoma, whereas 62% of BRAF-negative CN cases (26/42) were from patients with stage I melanoma (P = .013). Twelve (33%) of the 36 BRAF-positive CN cases had metastatic melanoma involving lymph nodes, compared with 14% (6/42) of BRAF-negative CN cases (P = .061). CN mutation status was not associated with patient demographics, histopathologic or molecular features of the PCM, or survival outcomes. A high percentage of CN identified in the SLN of patients with PCM harbor BRAF V600E mutation. Positive mutation was associated with adverse clinicopathological parameters, specifically increased tumor stage and lymph node metastasis. These findings suggest that BRAF V600E mutation in CN of SLN may be useful as an adverse predictive biomarker in patients with melanoma.

Prognostic Significance of Pre-treatment Serum C-Reactive Protein Level in Patients with Adenocarcinoma of the Uterine Cervix.

To evaluate pre-treatment serum C-reactive protein (CRP) level as a prognostic parameter in patients with adenocarcinoma of the uterine cervix. Pre-treatment CRP levels were analyzed to determine potential associations with clinicopathological parameters and to assess prognostic value in 46 patients with sole adenocarcinoma of the uterine cervix. The mean (±SD) pre-treatment serum CRP level was 5.82 (7.21) mg/l. Serum CRP concentration significantly correlated positively with age at diagnosis (p=0.001), lymphovascular space invasion (p=0.0026), recurrent disease (p=0.0001) and International Federation of Gynecology and Obstetrics (FIGO) stage (p=0.0002). In multivariate Cox regression models with age, FIGO stage, histological grade and lymph node status, elevated CRP and cancer antigen 125 levels were associated with shortened survival (p<0.05). Overall 5-year survival rate of patients with pre-treatment serum CRP level <5.0 mg/l was 100% compared to 46.9% for patients with pre-treatment CRP level ≥5.0 mg/l. Serum CRP level can be seen as an additional independent prognostic parameter in patients with the rare histological subtype adenocarcinoma of the uterine cervix.

Prognostic significance of metastatic lymph node ratio in squamous cell carcinoma of the cervix.

PurposeMetastatic lymph node ratio (MLNR) was reported to be an important prognostic factor in several tumors. However, depth of primary tumor invasion is also important in cervical cancer prognostic analysis. In this study, the objective was to determine if MLNR can be used to define a high-risk category of patients with squamous cell carcinoma of the cervix (SCC). And we combined MLNR and depth of invasion to investigate whether prognosis of SCC can be predicted better.Patients and methodsWe performed a retrospective review of patients with SCC who underwent radical hysterectomy and pelvic lymphadenectomy at QiLu Hospital of Shandong University from January 2007 to December 2009. Prognostic factors for disease-free survival (DFS) and overall survival (OS) were identified by univariate and multivariate analyses.ResultsOne hundred and ninety-eight patients met the inclusion criteria and were included in the analysis. By cut-point survival analysis, MLNR cutoff was designed as 0.2. On multivariate analysis, an MLNR >0.2 was associated with a worse OS (hazard ratio [HR] =2.560, 95% CI 1.275–5.143, P=0.008) and DFS (HR =2.404, 95% CI 1.202–4.809, P=0.013). Depth of invasion cutoff was designed as invasion >1/2 cervix wall and was associated with a worse OS (HR =1.806, 95% CI 1.063–3.070, P=0.029) and DFS (HR =1.900, 95% CI 1.101–3.279, P=0.021). In addition, subgroup analysis revealed significant difference in OS and DFS rates between different MLNR categories within the same depth of invasion category (P<0.05), however, not between different depth of invasion categories within the same MLNR category (P>0.05).ConclusionMLNR may be used as the independent prognostic parameter in patients with SCC. Combined MLNR and depth of invasion can predict both OS and DFS better in SCC than one factor. Besides, MLNR appears to be a better prognostic value than depth of invasion for SCC.

High Incidence of De Novo and Subclinical Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy and Cardiac Rhythm Management Device.

Atrial fibrillation (AF) is an important prognostic parameter in patients with hypertrophic cardiomyopathy (HCM). Though cardiac rhythm management (CRM) devices (e.g., ICD, pacemaker or implantable loop recorder) can detect subclinical AF, data describing the incidence of AF are rare. We therefore investigated the incidence and clinical impact of de novo and subclinical AF detected by CRM devices in patients with HCM. In our retrospective single-center study, we included patients with HCM and need for CRM devices. The primary endpoint of the study was the incidence of clinical and subclinical de novo AF. During follow-up, patients were screened for adverse events like stroke, ventricular arrhythmia, heart failure, or death. From 192 HCM patients, 44 patients received a CRM device (38 ICDs, 5 pacemakers, 1 implantable loop recorder). In 14 of these patients (32%), AF had been documented before device implantation. Thirty (68%) patients were free from AF at the time of implantation. During a median follow-up of 595 days (interquartile range, 367-890 days), de novo AF was recorded in 16 of these 30 patients (53%). Fourteen (88%) of the 16 patients with de novo AF were free from any clinical symptoms, so these patients were classified to have subclinical AF. In logistic regression analysis, age was the only significant predictor for an increased risk of AF. AF is common in patients with HCM who need a CRM device. More than 50% of these patients develop de novo AF that was predominantly subclinical in our cohort.

SNPs in IL-10, TNF-Alfa, and NFkB1 Genes and Their Association with Prognostic Parameters in Patients with Hodgkin Lymphoma

Hodgkin lymphoma (cHL) is a malignant lymphoid neoplasia that shows aberrant expression of cytokines, including IL-10 and TNF-a. Single nucleotide polymorphisms (SNPs) in genes encoding IL-10 and TNF-a or their regulatory proteins, such as NFkB, may impact cHL pathobiology. In this study, SNPs in the promoter regions of genes encoding for IL-10 (SNP/pIL-10 -592, rs1800872; and SNP/pIL-10 -1082, rs1800896), and TNF-a (SNP/pTNF-a -238, rs361525; and SNP/pTNF-a -862, rs1800630), as well as in the intronic region of the NFkB1 gene (SNP/iNFkB1, rs1585215) were genotyped in 73 patients with cHL and evaluated against clinical and laboratory prognostic parameters for the disease. SNPs/pIL-10 AA were significantly associated with higher leukocyte and lower lymphocyte counts at diagnosis. In case of TNF-a, SNP/pTNF-a -238 AG was associated with EBV infection while SNP/pTNF-a -862 CC presented more frequently with leukocytosis. SNP/iNFkB1 AA generally had stage IV and extranodal disease at diagnosis. Nonetheless, none of the studied SNPs had effect on treatment outcome. This study shows that some SNPs genotypes for IL-10 and TNF-a genes are associated with prognostic parameters in cHL; furthermore, this is the first time that the SNP/iNFkB1 (rs1585215) was implicated in clinical features of the disease. DisclosuresNo relevant conflicts of interest to declare.

Vitamin D Status and Mortality: Meta-Analysis of Individual Participant Data Confirms Strong Association.

Scientists and physicians have suggested that poor vitamin D intake can result in increased cardio-vascular mortality. Also total mortality appears to be increased with poor vitamin D status. A research team of the German Cancer Research Center in Heidelberg (DKFZ) headed by Ben Schöttker was able to demonstrate this association in a meta-analysis of 8 European and US-based cohort studies. In addition, serum 25(OH)D concentration (calcidiol) was shown to constitute a prognostic parameter in patients with a history of cancer.

Evaluation of Thymidylate Synthase Expression in Prostate Cancer

Thymidylate synthase (TS), a key enzyme in DNA synthesis, is over-expressed in a variety of cancer cells. 5-Fluorouracil, an anticancer agent clinically used against various cancers, including prostate cancer, inhibits DNA synthesis by binding TS. In this study, we investigated expression of TS in prostate cancer and its prognostic significance. Seventy-five prostatic tissue specimens were obtained from patients who had undergone prostate biopsy for diagnosis of prostate cancer. We analyzed the cancerous tissue specimens for TS expression using immunohistochemistry. TS expression was significantly increased in patients with bone metastasis. No relationship was found between expression of TS and the other clinicopathological findings. Because TS expression could be used as a prognostic parameter in patients with prostate cancer, an accurate prediction of prognosis might help to select patients for more intensive surgical, hormonal, or chemotherapeutic approaches, including 5-fluorouracil. Additional prospective studies are warranted to define the role of TS in selecting patients for adjuvant therapy for prostate cancer.

Stage, age, and EBV status impact outcomes of plasmablastic lymphoma patients: a clinicopathologic analysis of 61 patients.

BackgroundPlasmablastic lymphoma (PBL) is a rare aggressive neoplasm with lymphoid and plasmacytic differentiation that is commonly associated with immunodeficiency and an unfavorable prognosis. Clinicopathologic features have been largely derived from cases reports and small series with limited outcome analyses.Patients and methodsThe demographic, clinicopathologic features, and clinical outcomes of a cohort of 61 patients with PBL were reviewed and analyzed.ResultsPatients had a median age of 49 years (range 21–83 years) and most (49/61; 80 %) were men. Human immunodeficiency virus (HIV) status was available for 50 patients: 20 were HIV-positive and 30 HIV-negative. Twenty-three patients were immunocompetent. Abdominal/gastrointestinal complaints were the most common presenting symptoms, reported in 14 of 47 (30 %) of patients. At presentation, 24 of 43 (56 %) patients had stage III or IV disease. Epstein-Barr virus (EBV) was detected in 40 of 57 (70 %) cases. MYC rearrangement was identified in 10/15 (67 %) cases assessed, and MYC overexpression was seen in all cases assessed regardless of MYC rearrangement status. HIV-positive patients were significantly younger than those who were HIV-negative (median 42 vs. 58 years; p = 0.006). HIV-positive patients were also significantly more likely to have EBV-positive disease compared with HIV-negative patients (19/19, 100 % vs. 15/29, 52 %; p = 0.002). Patients who received CHOP chemotherapy tended to have better overall survival (OS) compared with those who received hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper-CVAD) (p = 0.078). HIV status had no impact on OS. Patients with EBV-positive PBL had a better event-free survival (EFS) (p = 0.047) but not OS (p = 0.306). Notably, OS was adversely impacted by age ≥50 years (p = 0.013), stage III or IV disease (p = <0.001), and lymph node involvement (p = 0.008).ConclusionsThe most significant prognostic parameters in patients with PBL are age, stage, and, to a lesser extent, EBV status. In this study, two-thirds of PBL cases assessed were associated with MYC rearrangement and all showed MYC overexpression.Electronic supplementary materialThe online version of this article (doi:10.1186/s13045-015-0163-z) contains supplementary material, which is available to authorized users.

Flow cytometric maturity score as a novel prognostic parameter in patients with acute myeloid leukemia.

The European LeukemiaNet (ELN) classification is widely accepted for risk stratification of patients with acute myeloid leukemia (AML). In order to establish immunophenotypic features that predict prognosis, the expression of single AML blast cell antigens has been evaluated with partly conflicting results; however, the influence of immunophenotypic blast maturity is largely unknown. In our study, 300 AML patients diagnosed at our institution between January 2003 and April 2012 were analyzed. A flow cytometric maturity score was developed in order to distinguish "mature" AML (AML-ma) from "immature" AML (AML-im) by quantitative expression levels of early progenitor cell antigens (CD34, CD117, and TdT). AML-ma showed significantly longer relapse-free survival (RFS) and overall survival (OS) than AML-im (p < 0.001). Interestingly, statistically significant differences in RFS and OS were maintained within the "intermediate-risk" group according to ELN (RFS, 7.0 years (AML-ma) vs. 3.3 years (AML-im); p = 0.002; OS, 5.1 years (AML-ma) vs. 3.0 years (AML-im); p = 0.022). Our novel flow cytometric score easily determines AML blast maturity and can predict clinical outcome. It remains to be clarified whether these results simply reflect an accumulation of favorable molecular phenotypes in the AML-ma subgroup or whether they rely on biological differences such as a higher proportion of leukemia stem cells and/or a higher degree of genetic instability within the AML-im subgroup.

The Prognostic Factor of Malignancy of Undefined Primary Origin in Spinal Metastases

Introduction Malignancy of undefined primary origin is metastatic malignancy identified on the basis of a limited number of tests, without an obvious primary site, before comprehensive investigation.2 Patients who harbor spinal epidural neoplastic metastases with malignancy of undefined primary origin are common in the clinical scenario of installed paraplegia within 24 hours or rapid progressive paraparesis. Acute spinal nervous tissue compression is an indication for urgent surgery and should be performed within 24 hours of hospitalization. In this urgent clinical situation, time-consuming neoplastic disease staging may not be feasible. An estimated 3-month postoperative survival period seems reasonable for the decision-making process regarding whether surgery should be performed. The physician may reason that if the knowledge of the primary tumor site is not a prognostic factor for survival in preoperative urgent surgery for spinal epidural neoplastic metastases, then surgery must not be postponed. The objective of this study is to compare the postoperative survival between patients with defined and undefined malignancy of primary origin as a prognostic factor for survival in spinal metastases. Material and Methods This study was a retrospective chart review of patients who underwent surgery for spinal epidural neoplastic metastases between February 1997 and January 2011. The inclusion criteria were as follows: known postoperative survival period, a Karnofsky performance score equal to or greater than 30 points, and a postoperative neoplastic metastasis histological type. The Kaplan–Meier method was used to estimate the postoperative survival and the log-rank test was used for statistical inference. Results A total of 52 patients who underwent 52 surgical procedures were identified. The mean age at the time of spinal surgery was 53.92 years (standard deviation 19.09). The median survival after surgery was 70 days (95% CI: 49.97–90.02) and postoperative mortality occurred within 6 months in 38 patients (73.07%). The primary neoplasm site and histological type were unknown in 36 (69.23%) of the patients in the preoperative period. The following primary tumor types were identified after the surgery: myeloma (8 patients), lung carcinoma (6), sarcoma (5), prostate carcinoma (5), lymphoma (4), undifferentiated carcinoma (4), thyroid carcinoma (1), pineal germinoma (1), gastric adenoma (1), and kidney blastoma (1). Cancer type was the strongest overall survival indicator in this study ( p = 0.023). The median postoperative survival for the 16 patients (30.77%) with known preoperative primary tumors was 59 days (95% CI: 11.96–106.04) and it was 72 days (95% CI: 51.45–92.54) for the 36 patients (69.23%) with unknown tumors. The statistical inference was p = 0.719 and statistically insignificant for postoperative survival between the known and unknown primary tumor site. The median postoperative survival in patients with elective surgery was 76 days (95% CI: 53.571–98.429) and for urgent surgery was 45 days (95% CI: 3.553–86.447). The statistical inference was p = 0.124 for postoperative survival between the elective and urgent surgery patients. Conclusion Undefined malignancy of primary origin is not a prognostic factor for survival in patients who harbor spinal epidural neoplastic metastases when compared with those with a defined malignancy of primary origin in this research study. References Daniel JW. Survival prognostic parameters in patients with spinal column epidural metastatic neoplasms [PhD thesis]. São Paulo, SP, Brazil: Santa Casa de São Paulo, Faculty of Medical Sciences; 2013 National Institute for Health and Clinical Excellence. 2010. Metastatic malignant disease of unknown primary origin. London: NICE clinical guideline. Available at: https://www.nice.org.uk/search?q=Metastatic+malignant+disease+of+unknown+primary+origin. Accessed September 20, 2014

18F-fluoro-2-deoxy-D-glucose retention index as a prognostic parameter in patients with pancreatic cancer.

The objective of this study was to determine the most effective way to use dual-phase F-fluoro-2-deoxy-D-glucose (F-FDG) PET/computed tomography (CT) semiquantitative indices to predict prognosis in patients with pancreatic cancer and to guide treatment. Prognostic parameters were retrospectively analyzed in 40 patients with histologically proven pancreatic cancer who received F-FDG PET/CT at Ruijin Hospital. Maximum standardized uptake values (SUVs) were determined at 1 h (SUV1) and 2 h (SUV2) after F-FDG injection. The retention index (RI) was defined as the percentage change between SUV1 and SUV2. RI less than 17% was explored as having a significant independent correlation with prolonged patient survival (P<0.05). Patients with tumor resection and RI less than 17% survived significantly longer than those with or without tumor resection and RI of 17% or higher (P<0.05). Neither SUV1, nor SUV2 showed any prognostic significance, but they did show a positive correlation with tumor diameter (P1<0.01; P2<0.05); RI had a strong positive correlation with tumor, node, and metastasis stage (P<0.01). Two factors were found to be associated with RI, including pancreatitis (P<0.05) and diabetes (P<0.01). RI served as the most accurate parameter to predict disease prognosis in pancreatic cancer and to identify patients who could benefit from surgery. However, pancreatitis and diabetes had a potential impact on RI, reflecting the influence of tumor pathophysiological changes on the metabolism of glucose in pancreatic tumor cells. Therefore, further comprehensive analyses are required.

P1-16-3 - Brain Metastases From Nsclc: a Monocentric Experience

Background: Non-small cell lung cancer (NSCLC) is the most common primary tumor developing brain metastases. However, prognostic parameters in patients with brain metastasis from NSCLC are not well defined. The aim of our study was to establish the correlation between age, gender, Performance Score (PS), number of involved extracranial organs and survival (progression-free survival (PFS) and overall survival (OS)) in Moroccan patients with brain metastases from NSCLCMethods: We reviewed retrospectively 50 cases of metastatic NSCLC with cerebral metastases diagnosed between January 2009 to June 2012 in the Medical Oncology Department at Hassan II University Hospital in Morocco. Potential prognostic factors were investigated. Kaplan-Meier method was used to estimate median PFS and OS durations from the time of first cycle of chemotherapy. The Cox proportional hazards regression model was used to determine the effect of potential prognostic factors on PFS and OS.Results: Median age was 56 years. Sex ratio male/female was 3.9. PS was 0-1 in 63,7% of cases. 45% of patients had more than one site of metastasis. All patients received bi-chemotherapy based on platinum in combination with a third generation drug. The objective response rate was 33.5%. Median duration of follow-up was 6.4 months (range: 1-36 months). The median PFS was 4 months [1-26] and median OS was 5 months [1-36]. Patients with involved extracranial organs had lower PFS (mean: 3 vs 4 months) and lower OS (mean: 4,8 versus 8 months). However, this correlation was not statistically significant (p = 0.5 and p = 0.07 respectively). Besides, PFS and OS were not significantly different based on the other potential prognostic factors.Conclusion: In this study, there were a trend toward a correlation between OS and presence of extracranial metastasis in patients with brain metastases from NSCLC. However, we failed to demonstrate any prognostic role of age, gender and Performance Score in this population.

Two-dimensional speckle tracking echocardiography prognostic parameters in patients after acute myocardial infarction.

The aim of the study was to evaluate the left ventricle (LV) function with speckle tracking echocardiography (STE) and to assess its relation to prognosis in patients after acute myocardial infarction (AMI). Sixty-three patients (F/M = 16/47 pts; 62.33 ± 11.85 years old) with AMI (NSTEMI/STEMI 24/39 pts) and successful percutaneous coronary intervention (PCI) with stent implantation (thrombolysis in myocardial infarction; TIMI 3 flow) were enrolled in this study. All patients underwent baseline two-dimensional conventional echocardiography and STE 3 days (baseline) and 30 days after PCI. All patients were followed up for cardiovascular clinical endpoints, major adverse cardiovascular endpoint (MACE), and functional status (Canadian Cardiovascular Society and New York Heart Association). During the follow-up (31.9 ± 5.1 months), there were 3 cardiovascular deaths, 15 patients had AMI, 2 patients had cerebral infarction, 24 patients reached the MACE. Baseline LV torsion (P = 0.035), but none of the other strain parameters were associated with the time to first unplanned cardiovascular hospitalization. Univariate analysis showed that baseline longitudinal two-chamber and four-chamber strain (sLa2 0 and sLa4 0) and the same parameters obtained 30 days after the AMI together with transverse four-chamber strain (sLa2 30, sLa4 30, and sTa4 30) were significantly associated with combined endpoint (MACE). The strongest association in the univariate analysis was found for the baseline sLa2. However, in multivariable analysis only a left ventricular remodeling (LVR - 27% pts) was significantly associated with MACE and strain parameters were not associated with the combined endpoint. The assessment of LV function with STE may improve cardiovascular risk prediction in postmyocardial infarction patients.

A Pilot Study for the Detection of FLT3-ITD Mutation Frequency in 25 Iraqi Patients With Acute Lymphoid Leukemia in 2 Iraqi Hospitals

This study was conducted to evaluate the frequency of FLT3-ITD mutation in acute lymphoid leukemia (ALL) patients using conventional polymerase chain reaction (PCR) in Iraq, and to correlate this mutation with prognostic parameters of patients. A total of 25 individuals were enrolled (16 children with ALL and 9 adult with ALL), attending 2 teaching hospitals in Baghdad. Hematological investigations including complete blood picture, and bone marrow aspiration were performed. FLT3-ITD mutation was detected utilizing conventional PCR technology using specific primers. Two of 25 ALL patients (8%) showed a mutated band of FLT3-ITD mutation representing 12.5% of pediatric patients, and all the other ALL cases showed the absence of this mutation. These cases were an 8-year-old girl and a 7-year-old boy, L2 subtype, who had achieved complete hematological remission throughout the study. In conclusion, FLT3-ITD mutation was found in 2 morphologically appearing pediatric ALL patients that was higher than previously reported worldwide. Bilineage cases could not be excluded owing to absence of flow cytometer analysis. A larger number of Iraqi ALL patients confirmed by flow cytometer is necessary to evaluate the prognostic effect of this mutation in pediatric age group, especially FLT3 tyrosine kinase inhibitors might represent a promising target in ALL patients and can be used as minimal residual disease marker.

N-terminal pro-brain natriuretic peptide is a useful prognostic marker in patients with pre-capillary pulmonary hypertension and renal insufficiency.

N-terminal pro-brain natriuretic peptide (NT-proBNP) is a routinely used prognostic parameter in patients with pre-capillary pulmonary hypertension (PH). As it accumulates in the presence of impaired renal function, the clinical utility of NT-proBNP in PH patients with concomitant renal insufficiency remains unclear. In a retrospective approach, patients with pre-capillary PH (group I or IV) and concomitant renal insufficiency at time of right heart catheterization (glomerular filtration rate (GFR) ≤60 ml/min/1.73 m2) were identified out of all prevalent pre-capillary PH patients treated at a single center. Forty patients with renal insufficiency (25.8%) were identified and matched regarding hemodynamic parameters with a control group of 56 PH patients with normal renal function (GFR >60 ml/min/1.73 m2). Correlations of NT-proBNP levels with hemodynamic and prognostic parameters (time to clinical worsening and overall survival) were assessed. Overall, GFR correlated inversely with NT-proBNP and had the strongest influence on NT-proBNP levels in a stepwise multiple linear regression model including hemodynamic parameters and age (r2 = 0.167). PH patients with renal insufficiency had significant higher levels of NT-proBNP (median: 1935 ng/l vs. 573 ng/l, p = 0.001). Nevertheless, NT-proBNP correlated with invasive hemodynamic parameters in these patients. Using higher cut-off values than in patients with preserved renal function, NT-proBNP levels were significantly associated with time to clinical worsening (>1660 ng/l, p = 0.001) and survival (>2212 ng/l, p = 0.047) in patients with renal insufficiency. Multivariate Cox’s proportional hazards analysis including established prognostic parameters, age and GFR confirmed NT-proBNP as an independent risk factor for clinical worsening in PH patients with renal insufficiency (hazard ratio 4.8, p = 0.007). Thus, in a retrospective analysis we showed that NT-proBNP levels correlated with hemodynamic parameters and outcome regardless of renal function. By using higher cut-off values, NT-proBNP seems to represent a valid clinical marker even in PH patients with renal insufficiency.

Goseki Grade and Tumour Location Influence Survival of Patients with Gastric Cancer

Owing to the variability of histopathological features and biological behaviour in gastric carcinoma, a great number of categorisation methods such as classical histopathologic grading, Lauren classification, the TNM staging system and the newly presented Goseki grading method are used by pathologists and other scientists. In our study, we aimed to investigate whether Goseki grade and tumour location have an effects on survival of gastric cancer cases. Eighty-four patients with gastric adenocarcinoma were covered in the investigation. The importance of Goseki grading system and tumour location were analysed in addition to the TNM staging and other conventional prognostic parameters. The median survival time in our patients was 35 months (minimum: 5, maximum: 116). According to our findings, there was no relation between survival and tumour size (p=0.192) or classical histological type (p=0.270). In contrast, the Goseki grade and tumour location significantly correlated with survival (p=0.007 and p<0.001, respectively). Additionally, tumours of the intestinal type had a longer median survival time (60.0 months) than diffuse tumours (24.0 months). In addition to the TNM staging system, tumour location and the Goseki grading system may be used as significant prognostic parameters in patients with gastric cancer.

Monosomal and complex karyotypes as prognostic parameters in patients with International Prognostic Scoring System higher risk myelodysplastic syndrome treated with azacitidine.

BackgroundAzacitidine (AZA) is standard care for patients with myelodysplastic syndrome (MDS) who have not had allogeneic stem cell transplantation. Chromosomal abnormalities (CA) including complex karyotype (CK) or monosomal karyotype (MK) are associated with clinical outcome in patients with MDS.MethodsWe investigated which prognostic factors including CAs would predict clinical outcomes in patients with International Prognostic Scoring System (IPSS) higher risk MDS treated with AZA, retrospectively. CK was defined as the presence of three or more numerical or structural CAs. MK was defined as the presence of two or more distinct autosomal monosomies or single autosomal monosomy with at least one additional structural CA.ResultsA total of 243 patients who treated with AZA, were enrolled. CK was present in 124 patients and MK was present in 90 patients. Bone marrow blasts ≥15% and CK were associated with poorer response (P=0.038, P=0.007) and overall survival (OS) (P<0.001, P<0.001) independently. Although MK in CK group was not associated with prognosis, non-MK status in non-CK group reflected favorable OS (P=0.005). The group including >3 CAs was associated with poorer OS (group including <3 CAs vs. only three CAs, P=0.001; group with >3 CAs vs. only three CAs, P=0.001).ConclusionCK was an important prognostic parameter associated with worse outcome. MK may predict poor survival in only non-CK status. The higher number of CAs was associated with poorer survival.