Prognostic Stratification Of Patients Research Articles

Lung Carcinoma Staging Update.

- The International Association for the Study of Lung Cancer Staging Committee has prospectively created an international lung cancer database that was used to address many lung cancer staging questions, such as tumor size, nodal status, and metastatic disease. The proposed changes for the upcoming 8th edition of the cancer staging manual were based on survival data and better prognostic stratification of patients with lung cancer. - To review published recommendations for the revision of lung carcinoma TNM staging and to address potential challenges in pathologic staging. - PubMed available articles by the International Association for the Study of Lung Cancer Staging Committee were reviewed. - The TNM system remains the best prognosticator of lung cancer outcome. The recommendations are established on new prospective data analysis and reflect the improvements in prognostic separation of patients with lung cancer based on a multidisciplinary approach.

Cellular and viral microRNAs in sepsis: mechanisms of action and clinical applications.

Regardless of its etiology, once septic shock is established, survival rates drop by 7.6% for every hour antibiotic therapy is delayed. The early identification of the cause of infection and prognostic stratification of patients with sepsis are therefore important clinical priorities. Biomarkers are potentially valuable clinical tools in this context, but to date, no single biomarker has been shown to perform adequately. Hence, in an effort to discover novel diagnostic and prognostic markers in sepsis, new genomic approaches have been employed. As a result, a number of small regulatory molecules called microRNAs (miRNAs) have been identified as key regulators of the inflammatory response. Although deregulated miRNA expression is increasingly well described, the pathophysiological roles of these molecules in sepsis have yet to be fully defined. Moreover, non-human miRNAs, including two Kaposi Sarcoma herpesvirus-encoded miRNAs, are implicated in sepsis and may drive enhanced secretion of pro-inflammatory and anti-inflammatory cytokines exacerbating sepsis. A better understanding of the mechanism of action of both cellular and viral miRNAs, and their interactions with immune and inflammatory cascades, may therefore identify novel therapeutic targets in sepsis and make biomarker-guided therapy a realistic prospect.

Classification and Prognostic Evaluation of Left Ventricular Remodeling in Patients With Asymptomatic Heart Failure

Patients with asymptomatic heart failure (HF; stage A and B) are characterized by maladaptive left ventricular (LV) remodeling. Classic 4-group classification of remodeling considers only LV mass index and relative wall thickness as variables. Complex remodeling classification (CRC) includes also LV end-diastolic volume index. Main aim was to assess the prognostic impact of CRC in stage A and B HF. A total of 1,750 asymptomatic subjects underwent echocardiographic examination as a screening evaluation in the presence of cardiovascular risk factors. LV dysfunction, both systolic (ejection fraction) and diastolic (transmitral flow velocity pattern), was evaluated, together with LV remodeling. We considered a composite end point: all-cause death, myocardial infarction, coronary revascularizations, cerebrovascular events, and acute pulmonary edema. CRC was suitable for 1,729 patients (men 53.6%; age 58.3 ± 13years). Two hundred thirty-eight patients presented systolic dysfunction (ejection fraction <50%) and 483 diastolic dysfunction. According to the CRC, 891 patients were normals or presented with physiologic hypertrophy, 273 concentric remodeling, 47 eccentric remodeling, 350 concentric hypertrophy, 29mixed hypertrophy, 86 dilated hypertrophy, and 53 eccentric hypertrophy. Age and gender distribution was noticed (p <0.001). After a median follow-up of 21months, Kaplan-Meier analysis showed different survival distribution (p <0.001) of the CRC patterns. In multivariate Cox regression (adjusted for age, gender, history of stable ischemic heart disease, classic remodeling classification, systolic, and diastolic dysfunction), CRC was independent predictor of primary end point (p= 0.044, hazard ratio 1.101, 95% CI 1.003 to 1.21), confirmed in a logistic regression (p <0.03). In conclusion, CRC could help physicians in prognostic stratification of patients in stage A and B HF.

18F-FDG Uptake in Less Affected Lung Field Provides Prognostic Stratification in Patients with Interstitial Lung Disease.

Ninety patients (51 men, 39 women; mean age, 55.4 y; age range, 26-78 y) with ILD who underwent 18F-FDG PET/CT were retrospectively analyzed. SUVmean was defined as the mean SUV of the less-affected lung field, SUVTF as adjusted SUVmean using tissue fraction (TF), and CTmean as the mean attenuation of the corresponding region of interest on high-resolution CT. SUVmean, SUVTF, and CTmean were compared in the 90 ILD patients and in 15 age- and sex-matched controls. Correlations of SUVmax, SUVmean, SUVTF, and CTmean with clinical indicators, including estimated percentage of forced vital capacity (%FVC), estimated percentage of diffusion capacity of the lungs for carbon monoxide (%DLco), sialylated carbohydrate antigen Krebs von den Lungen-6 (KL-6), surfactant protein D (SP-D), C-reactive protein (CRP), lactate dehydrogenase (LDH), and ILD-sex-age-physiology (GAP) index, were evaluated using the Spearman rank correlation test and the Tukey-Kramer test. A Cox proportional hazards model was used for univariate and multivariate analyses of factors associated with lung transplantation-free survival. SUVmean, SUVTF, and CTmean were significantly higher in ILD patients than in healthy controls, except for CTmean in patients with a nonusual interstitial pneumonia pattern. SUVmean and CTmean were significantly correlated with %FVC, %DLco, KL-6, and SP-D; SUVTF was significantly correlated with %DLco, KL-6, SP-D, and LDH; and SUVmax was weakly correlated with KL-6 and CRP. Univariate analysis showed that SUVmean, SUVTF, sex, %FVC, %DLco, KL-6, and ILD-GAP index were significantly prognostic of lung transplantation-free survival; and multivariate analysis showed that SUVmean and ILD-GAP index were independently prognostic of lung transplantation-free survival. A higher SUVmean indicated a poorer prognosis, especially in patients with moderate risk based on ILD-GAP index. SUVmean was significantly but moderately correlated with clinical indicators, providing independent prognostic information in patients with ILD. 18F-FDG PET/CT may be helpful for monitoring and risk stratification of ILD patients.

Combining standardized uptake value of FDG-PET and apparent diffusion coefficient of DW-MRI improves risk stratification in head and neck squamous cell carcinoma.

To assess the independent prognostic value of standardized uptake value (SUV) and apparent diffusion coefficient (ADC), separately and combined, in order to evaluate if the combination of these two variables allows further prognostic stratification of patients with head and neck squamous cell carcinomas (HNSCC). Pretreatment SUV and ADC were calculated in 57 patients with HNSCC. Mean follow-up was 21.3months. Semiquantitative analysis of primary tumours was performed using SUVmaxT/B, ADCmean, ADCmin and ADCmax. The prognostic value of SUVmaxT/B, ADCmean, ADCmin and ADCmax in predicting disease-free survival (DFS) was evaluated with log-rank test and Cox regression models. Patients with SUVmaxT/B ≥5.75 had an overall worse prognosis (p = 0.003). After adjusting for lymph node status and diameter, SUVmaxT/B and ADCmin were both significant predictors of DFS with hazard ratio (HR) = 10.37 (95% CI 1.22-87.95) and 3.26 (95% CI 1.20-8.85) for SUVmaxT/B ≥5.75 and ADCmin ≥0.58 × 10-3 mm2/s, respectively. When the analysis was restricted to subjects with SUVmaxT/B ≥5.75, high ADCmin significantly predicted a worse prognosis, with adjusted HR = 3.11 (95% CI 1.13-8.55). The combination of SUVmaxT/B and ADCmin improves the prognostic role of the two separate parameters; patients with high SUVmaxT/B and high ADCmin are associated with a poor prognosis. • High SUV maxT/B is a poor prognostic factor in HNSCC • High ADC min is a poor prognostic factor in HNSCC • In patients with high SUV maxT/B , high ADC min identified those with worse prognosis.

Capítulo 3. Unidades de falla cardiaca: una propuesta para el sistema de salud colombiano

IntroductionHeart failure is a highly prevalent disease which generates large costs for the health system and is expected to affect a growing number of patients over the years to come. ObjetiveTo propose a care system of three levels of complexity to enable the diagnosis, treatment and prognostic stratification of patients with heart failure based on the needs of the Columbian health system. MethodologyNarrative review of the available literature. ConclusionThe care of patients with heart failure should be delivered from three levels of care. There should be a third level specialist care service with a multidisciplinary programme for patients with heart failure, which has a population catchment area set by the healthcare system and with two-way interrelation with a second level care service and even primary level care services. Thus, heart failure patients will be managed in a sectored way by catchment area in the form of an integrated care network, with unique and standardised care.

Inclusion of cytological features in tumor grading improves prognostic stratification of patients with colorectal cancer

Tumor grade is a traditional prognostic parameter in colorectal cancer. Remarkably, however, there is still no generally accepted consensus how to perform tumor grading. In this study, we systematically compared the prognostic value of traditional grading based upon histological features, that is, gland formation alone with grading based upon both histological and cytological features, such as nuclear pleomorphism and anaplasia ("alternative grade"). Three hundred eighty-one tumors of randomly selected patients were retrospectively reviewed. Traditional and alternative tumor grades were related to various clinicopathological features and to progression-free and cancer-specific survival applying both univariate and multivariate testing. Traditional and alternative tumor grades were significantly associated with T and N classification, tumor size, lymphovascular invasion, as well as both progression-free and cancer-specific survival. In Cox's proportional hazards regression models, the alternative grade was superior to the traditional tumor grade and was significantly associated with progression-free survival (hazard ratio 1.57, 95% confidence interval 1.04-2.35; p = 0.031), independent of patients' age and gender, T and N classification, and lymphovascular invasion. Likewise, patients with tumors with high alternative grade were more likely to die of disease (hazard ratio 1.30, 95% confidence interval 0.85-2.00), but this difference was not statistically significant (p = 0.22). Tumor grade based upon both histological and cytological features was superior to grade based upon histological features alone and proved to be an independent prognostic parameter. Thus, tumor grade based upon both histological and cytological features may help to improve prognostic stratification and may thereby affect clinical decision-making and patient management.

Cardiac Magnetic Resonance-Verified Myocardial Fibrosis in Chagas Disease: Clinical Correlates and Risk Stratification.

BackgroundChagas disease (CD) is an important cause of heart failure and mortality, mainly in Latin America. This study evaluated the morphological and functional characteristics of the heart as well the extent of myocardial fibrosis (MF) in patients with CD by cardiac magnetic resonance (CMR). The prognostic value of MF evaluated by myocardial-delayed enhancement (MDE) was compared with that via Rassi score.MethodsThis study assessed 39 patients divided into 2 groups: 28 asymptomatic patients as indeterminate form group (IND); and symptomatic patients as Chagas Heart Disease (CHD) group. All patients underwent CMR using the techniques of cine-MRI and MDE, and the amount of MF was compared with the Rassi score.ResultsRegarding the morphological and functional analysis, significant differences were observed between both groups (p < 0.001). Furthermore, there was a strong correlation between the extent of MF and the Rassi score (r = 0.76).ConclusionsCMR is an important technique for evaluating patients with CD, stressing morphological and functional differences in all clinical presentations. The strong correlation with the Rassi score and the extent of MF detected by CMR emphasizes its role in the prognostic stratification of patients with CD.

The Plasma Level of Proprotein Convertase FURIN in Patients with Suspected Infection in the Emergency Room: A Prospective Cohort Study.

There is an increasing need for novel biomarkers that enable better diagnostic and prognostic stratification of patients with suspected infection. A proprotein convertase enzyme FURIN is upregulated upon immune cell activation, and it promotes infectivity by cleaving and activating pathogens. In this study, we determined FURIN levels in plasma using ELISA from 537 patients that were admitted to emergency room with suspected infection. Patients were sorted to high- and low-level FURIN groups with a cut-off level of 370 pg/ml. The study cohort included five diagnostic groups: Group 1, no systemic inflammatory response syndrome (SIRS, n = 59 patients); Group 2, bacterial infection without SIRS (n = 67); Group 3, SIRS, but no bacterial infection (n = 308); Group 4, sepsis without organ failure (n = 308); and Group 5, severe sepsis (n = 49). Statistically significant associations were not found between the plasma level of FURIN and the prevalence of sepsis (P = 0.957), diagnostic group of a patient (P = 0.737) or the bacteria in blood culture (P = 0.499). Additionally, the concentration of FURIN did not predict the severity or case fatality of the infectious disease. However, statistically significant associations were found between high plasma level of FURIN and diagnosed rheumatic disease (P < 0.001) as well as with the prevalence of non-smokers (P = 0.034). Thus, albeit the plasma level of FURIN does not predict the severity of infectious disease, it may be of use in the diagnostics of autoimmune diseases.

Clinical Significance of Sentinel Node Positivity in Patients with Superficial Esophageal Cancer.

Sentinel node (SN) mapping in esophageal cancer has been reported to be technically feasible with an acceptable detection rate and accuracy. However, the clinical significance and survival analysis findings associated with the metastatic status of SNs in patients with early-stage esophageal cancer have not been clarified. In this study, we investigated the clinical significance and survival impact of SN mapping in early-stage esophageal cancer. Among patients who were diagnosed preoperatively with clinical T1N0M0 or T2N0M0 esophageal cancer and who underwent SN mapping, 70 consecutive patients who were diagnosed with pathological T1 primary thoracic esophageal cancer were enrolled in this study. Sixty-four (91 %) patients were diagnosed with squamous cell carcinoma while 5 (7 %) patients were with adenocarcinoma. Endoscopic injection of technetium-99m tin colloid was performed before surgery, and radioactive SNs were identified by preoperative lymphoscintigraphy and intraoperative gamma probing. Standard esophagectomy with lymphadenectomy was performed in all patients, and all resected nodes were evaluated by routine pathological examination. SNs were successfully detected in 65 (92.9 %) of 70 patients with pT1 esophageal cancer. The sensitivity to predict lymph node metastasis was 91.7 %, and the diagnostic accuracy based on SN status was 96.9 %. Although there was a wide distribution of SNs from cervical to abdominal areas, 84.5 % of the patients had no lymph node metastasis or had lymph node metastasis only in SN. The disease-specific survival of the patients with metastatic non-SNs was significantly worse relative to that of the patients with no lymph node metastasis or lymph node metastasis only in SN. This study demonstrated that radio-guided SN mapping is useful not only as an accurate diagnostic tool for detecting lymph node metastasis but also as a tool for prognostic stratification in patients with cN0 early esophageal cancer.

Abstract 5304: A serum protein test for improved prognostic stratification of patients with myelodysplastic syndrome (MDS)

Abstract While existing scoring systems provide physicians with methods of assessing prognosis of patients with MDS and help with the choice of appropriate treatment regimens, some patients defined as lower risk still have poor outcomes and tests which can refine current stratifications are of clinical interest. Serum samples, clinical and survival data were available from 106 MDS patients with refractory anemia (RA) (n = 46), RA with excess blasts (n = 29), RA with ring sideroblasts (n = 14), and chronic myelomonocytic leukemia (n = 17). The international prognostic scoring system (IPSS) score distribution 0/0.5/1/&amp;gt;1 was n = 36/23/24/12. Matrix assisted laser desorption/ionization (MALDI) mass spectra were acquired from the samples using the deep MALDI method1, allowing a deep probing of the proteome. The spectra were preprocessed and spectral features defined. The integrated intensities of these features were combined with the survival data using deep learning based machine learning techniques to create classifiers able to stratify patients into groups with better and worse survival. Patients in the good prognosis group had median survival of 52 months, compared with 23 months in the poor prognosis group (hazard ratio = 0.37, p &amp;lt; 0.001). Within the subgroup of patients with refractory anemia (n = 46) it was possible to identify a group of patients with no death events before 30 months, while median survival in the other patients was only 25 months. Multivariate analysis stratified by MDS subtype found that the mass spectral (MS) classification was a significant independent predictor of survival even when adjusted for international prognostic scoring system (IPSS) score and cytogenetic status. MS classification was able to separate low to intermediate risk (IPSS 0-1) and good karyotype subgroups into groups with significantly better and worse survival. If validated in an independent dataset, this serum test would provide complementary information for physicians to consider in addition to existing scoring systems to aid in planning treatment for MDS patients. 1. M Duncan et al, Proceedings of the 61st ASMS Conference on Mass Spectrometry and Allied Topics. Minneapolis, MN June 8-9, 2013 MP 181. Citation Format: Joanna Roder, Judith Löffler-Ragg, Reinhard Stauder, Ulrich Germing, Wolfgang R. Sperr, Peter Valent, Heinrich Roder, Arni Steingrimsson, Heinz Zwierzina. A serum protein test for improved prognostic stratification of patients with myelodysplastic syndrome (MDS). [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 5304. doi:10.1158/1538-7445.AM2015-5304

Is echocardiography still helpful in cardiac resynchronization therapy?

Cardiac resynchronization therapy is an established approach for the treatment of patients with heart failure and left ventricular systolic dysfunction. In most centers, these patients are usually evaluated by echocardiography, which allows collecting a number of cardiac anatomical and functional parameters in a non-invasive, repeatable way and without exposure to ionizing radiation. However, over the years, clinical studies have sometimes emphasized and sometimes reduced the role of this method in the setting of cardiac resynchronization therapy for cardiac dyssynchrony evaluation, prognostic stratification of patients, optimization of pacing, and follow-up. The purpose of this paper, therefore, is to review the current role of echocardiography before, during and after the implantation of a cardiac resynchronization therapy device.

Could semiquantitative FDG analysis add information to the prognosis in patients with stage II/III breast cancer undergoing neoadjuvant treatment?

We investigated whether maximum standardized uptake value (SUVmax), metabolic tumour volume (MTV), total lesion glycolysis (TLG) and whole-body (WB) SUVmax, WB MTV and WB TLG measured by (18)F-FDG PET/CT could improve prognostic stratification in patients with stage II/III breast cancer (BC). We prospectively enrolled 99 consecutive women (median age 50 years, range 27 - 77 years) with pathologically proven stage II/III BC who underwent pretreatment FDG PET/CT. WB SUVmax, WB MTV and WB TLG were measured in all malignant lesions. Survival was analysed using the Kaplan-Meier method. Cox proportional hazards models were constructed to test for relationships among WB SUVmax, WB MTV, WB TLG, and overall survival (OS) and disease-free survival (DFS), after adjustment for age, and histopathological and immunohistochemical features (oestrogen/progesterone and HER2 expression, proliferation index and grade). The median values of WB SUVmax, WB MTV and WB TLG were 16.2 (range 1.5 - 33.1), 14 cm(3) (range 0.03 - 708.6 cm(3)) and 62.5 (0.06 - 3869.4), respectively. All WB semiquantitative values were higher in patients with higher TNM stage, although not significantly (all p > 0.05). The median follow-up for surviving patients was 30 months, with a range of 13 - 45 months. Both PFS and OS of patients with low WB SUVmax, WB MTV and WB TLG were longer than that of patients with high WB values for progression, although not statistically significant. However, stratifying the patients in accordance with the stage of disease, both PFS and OS were significantly lower in patients with high WB TLG and stage III than in patients with stage II (p < 0.05). In multivariate analyses, WB MTV and WB TLG were independent prognostic factors for PFS (hazard ratio 1.004, 95% confidence interval 1.002 - 1.006, p < 0.001, and hazard ratio 1.001, 95% confidence interval 1.000 - 1.001, p = 0.011, respectively). The addition of WB TLG to clinical data may provide a more detailed prediction of outcome in patients with stage III BC. Moreover, WB MTV and WB TLG are independent factors predicting recurrence of BC. On the contrary, WB SUVmax has poor prognostic significance in this cohort of patients.

Implementation of diagnosis in asymptomatic patients with aortic stenosis: the Implementation of Diagnosis in asymptomatic patiEnts with Aortic Stenosis registry.

Frequently in clinical practice, some physicians refer patients with aortic stenosis for an invasive approach in the asymptomatic phase of the disease. This empirical behaviour, which is in contrast with the recommendations of the current international clinical guidelines, is due to the perception that the prognosis of these patients is truly worse than retained. Actually, the management of asymptomatic patients with aortic stenosis remains controversial, and there is no clear agreement on how to reduce excess clinical events associated with the presence of aortic stenosis mortality and morbidity demonstrated in these patients by recent randomized clinical trials. The prevailing attention of the attending physicians is often limited to the assessment of the aortic stenosis severity and appearance of symptoms, but it has been clearly shown, instead, that the prognosis of these patients is associated with excessive left-ventricular mass growth and increased atherosclerosis leading to coronary artery disease, heart failure, stroke and death. Thus, apart from the markers of faster aortic stenosis progression, many other clinical and echocardiographic variables should be considered, collected and used together with the clinical/echocardiographic prognostic scores recently validated by several authors in clinical practice, where the vast majority of these variables are guiltily not taken into any consideration. The registry on the Implementation of Diagnosis in asymptomatic patiEnts with Aortic Stenosis is a prospective study designed with the aim to improve the diagnostic evaluation and improve the prognostic stratification of patients with asymptomatic aortic stenosis.

FDG-PET/CT for pre-operative staging and prognostic stratification of patients with high-grade prostate cancer at biopsy.

BackgroundThe role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in prostate cancer (PCa) has not been well defined yet. Because high-grade PCa tends to exhibit increased glycolytic rate, FDG-PET/CT could be useful in this setting. The aim of this study was to assess the value of FDG-PET/CT for pre-operative staging and prognostic stratification of patients with high-grade PCa at biopsy.MethodsFifty-four patients with a Gleason sum ≥8 PCa at biopsy underwent FDG-PET/CT as part of the staging workup. Thirty-nine patients underwent radical prostatectomy (RP) and pelvic lymph node (LN) dissection, 2 underwent LN dissection only, and 13 underwent non-surgical treatments. FDG-PET/CT findings from clinical reports, blinded reading and quantitative analysis were correlated with clinico-pathological characteristics at RP.ResultsSuspicious foci of increased FDG uptake were found in the prostate, LNs and bones in 44, 13 and 6% of patients, respectively. Higher clinical stage, post-RP Gleason sum and pattern, and percentage of cancer involvement within the prostate were significantly associated with the presence of intraprostatic FDG uptake (IPFU) (P < 0.05 in all cases). Patients without IPFU who underwent RP were downgraded to Gleason ≤7 in 84.6% of cases, as compared to 30.8% when IPFU was reported (P = 0.003). Qualitative and quantitative IPFU were significantly positively correlated with post-RP Gleason pattern and sum, and pathological T stage. Absence and presence of IPFU were associated with a median 5-year cancer-free survival probability of 70.2 and 26.9% (P = 0.0097), respectively, using the CAPRA-S prognostic tool.ConclusionThese results suggest that, among patients with a high-grade PCa at biopsy, FDG-PET/CT could improve pre-treatment prognostic stratification by predicting primary PCa pathological grade and survival probability following RP.

Cardiac Imaging in Latin America: Chagas Heart Disease

Patients with Chagas heart disease can be evaluated for diagnostic and prognostic purposes using several imaging methods, including the plain chest radiography and various echocardiography techniques for biventricular systolic and diastolic function assessment, myocardial perfusion scintigraphy for uncovering microvascular disturbances, and 123iodine-MIBG labeling of sympathetic myocardial innervation, MRI for detection and quantitation of myocardial fibrosis, and coronary angiography during cardiac catheterization to characterize the mechanism of myocardial ischemia. Through the careful analysis and integration of findings provided by the application of these imaging methods to patients with various stages of chronic Chagas cardiomyopathy, it has been possible to improve considerably the understanding of some pathophysiological peculiarities of the disease. These include: (a) the predominant systemic congestion when cardiac failure supervenes, due to early impairment of RV function; (b) the early typical LV regional wall motion abnormalities, topographically correlated with microvascular ischemic defects despite normal coronary arteries, and preceded by local sympathetic denervation; (c) the characteristic extensive myocardial fibrosis that is a hallmark of the disease and is causally related to the frequent occurrence of sudden death even in patients with globally preserved LV systolic function. Ongoing research, mainly focused on the refinement of echocardiographic techniques and further exploration of nuclear and MRI methods, have the potential to contribute to a better prognostic stratification of patients with chronic Chagas cardiomyopathy.

Predictive value of serum insulin-like growth factor-1 in hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is the commonest primary malignant cancer of the liver in the world. Insulin-like growth factor-1 (IGF-1) levels reflect hepatic function and are inversely correlated with the severity of background chronic liver disease. This study evaluated whether basal serum IGF-1 levels can predict prognosis of HCC patients according to different risks of disease progression. A total of 89 patients with hepatocellular carcinoma (HCC) were recruited in 3 groups: Group I, 30 HCC patients receiving sorafinib; Group II, 30 HCC patients with best supportive care; and Group III include 29 patients undergoing transcatheter arterial chemoembolization (TACE). All patients were investigated for serum levels of AST, ALP, Bb, Cr, BUN, AFP and IGF-I. Patients with disease control had significantly higher baseline IGF-1 levels 210 (185-232.5) ng/mL (p value<0.01) than did patients without disease control. Low basal IGF-1 levels were associated with advanced HCC, such as multiple tumors and advanced stage, and low IGF-1 levels predicted shorter TTP and overall survival in patients treated with TACE. The levels of serum IGF-1, expressed as continuous values, may be helpful for accurately assessing hepatic function and the prognostic stratification of patients with HCC.

NI-82 * DIFFUSION AND CONVENTIONAL MR IMAGING GENOMIC BIOMARKER SIGNATURE FOR EGFR MUTATION IDENTIFICATION IN GLIOBLASTOMA

PURPOSE: To create a diffusion and conventional MR imaging biomarker signature in order to identify those Glioblastoma (GBM) patients with EGFR mutation status. EGFR is the cell-surface receptor for members of the epidermal growth factor family(EGF-family)of extracellular protein ligands,a subfamily of receptor tyrosine kinases. EGFR gene expression is present in 40% of GBM patients.Identification of EGFR as an oncogene has led to the development of anticancer therapeutics directed against EGFR.Thus,a non-invasive imaging surrogate that predicts EGFR mutation status will help stratify patients into therapy and clinical trials. MATERIALS AND METHODS: We identified 80 treatment-naive patients from TCGA who had both gene and microRNA expression profiles including the EGFR mutation status and pretreatment MRI from The Cancer Imaging Archive (TCIA). Qualitative VASARI imaging features for these 80 patients were assessed by 3 independent neuroradiologists and consensus was reached. Quantitative volumetric analysis was done in the 3D Slicer software 3.6 using segmentation module.Fluid Attenuated Inversion Recovery (FLAIR)was used for segmentation of the edema and post-contrast T1 weighted imaging(T1W1)for segmentation of enhancement and necrosis.Diffusion was analyzed in Olea Sphere 2.3 and Conventional FLAIR/post- contrast T1WI was registered to DWI/ADC maps. ADC, FLAIR, T1 Gadolinium enhancement values were measured using the ROI based method, in the perilesional edema/non-enhancing tumor and the enhancing tumor zones, dividing the perilesional edema/non-enhancing tumor into 3 zones each of 1 cm width, 3 ROI measurements were taken from each zone. Each quantitative feature was correlated to EGFR mutation status to create the imaging biomarker signature predictive of EGFR mutation status. Survival analysis was done in all cases. RESULTS: A diffusion and conventional MR imaging biomarker signature was created that predicted EGFR mutation status. CONCLUSIONS: EGFR mutation status plays an important role in predictive and prognostic stratification of patients with GBM. The identification of a non-invasive biomarker signature as a surrogate for EGFR mutation can help stratify patients in specific therapy and predict response to therapy.

A genomic and clinical prognostic index for hepatitis C-related early-stage cirrhosis that predicts clinical deterioration

ObjectiveThe number of patients with HCV-related cirrhosis is increasing, leading to a rising risk of complications and death. Prognostic stratification in patients with early-stage cirrhosis is still challenging. We aimed...

The Integral Nature of Cardiac Magnetic Resonance Imaging in the Work-up for Ischemic Heart Disease

imaging modality differs from others in that it can be used in a wide variety of ways and situations by using different types of sequences, all of which can be useful in the work-up of cardiac patients. Patients with ischemic heart disease are no exception; in the early 2000s, appropriate sequences were developed to visualize the presence of contrast abnormally retained by myocardial scar tissue. 3 The technique soon become the gold standard for diagnosis of myocardial necrosis and measurement of lesion extension. In what is probably the most significant article in the history of CMR, with more than 1000 citations, Kim and Wu 4 discussed the precision with the transmural distribution of myocardial scarring could be determined and the implications of transmurality for the potential viability of the lesioned myocardial segments. The possibility, unheard of at the time in live patients, of accurately quantifying the extent of infarcted myocardial tissue led in turn to studies that demonstrated the prognostic value of this parameter, which was greater than that of other prognostic factors available at the time. 5 This has all contributed to the widespread popularity of CMR for measuring cardiac function and viability. In this mode, CMR can generate precise and reproducible information on ventricular volume and function, as well as information on the presence of infarction and potential myocardial viability. Simple indices derived from such measurements are also useful in the prognostic stratification of patients after acute infarction. 6 Despite the importance of this information, appropriate clinical documentation of patients with suspected or confirmed coronary artery disease requires a demonstration of myocardial ischemia. Cardiac magnetic resonance also offers an alternative to recording sequences of first-pass kinetics of contrast agent under the action of a pharmacological stress agent. The technique has been available for many years 7 and was validated in Spain 10 years ago.