Retrospective Analysis Of Prognostic Factors Research Articles

Retrospective analysis of prognostic factors associated with response and overall survival by baseline marrow blast percentage in patients with myelodysplastic syndromes treated with decitabine.

After the World Health Organization (WHO) changed the definition of acute myeloid leukemia (AML) to ≥ 20% blasts, the International Working Group (IWG) response criteria for myelodysplasia were updated. This retrospective analysis evaluated response to decitabine using updated IWG criteria in patients pooled from 2 decitabine trials. Outcomes for patients with myelodysplastic syndrome (MDS) with baseline marrow blasts ≥ 20% and < 30% (RAEB-t group) and < 20% (MDS group) were compared. Patients with RAEB-t (n = 26) had a significantly shorter time from diagnosis to study treatment (7.3 vs. 18.3 months), a higher International Prognostic Scoring System (IPSS) risk (77% vs. 16% high-risk patients), and lower median baseline platelet count (62.3 vs. 112.7 × 10(3)/μL) vs. patients with MDS (n = 157), yet no significant difference in overall response rate (ORR) (15.4% vs. 28.0%). Patients with MDS had better duration of response (9.9 vs. 5 months; P = .024) and overall survival (OS) (16.6 vs. 9.0 months; P = .021) compared with patients with RAEB-t. Decitabine is active in and may benefit patients with > 20% blasts (RAEB-t).

Retrospective Analysis of Prognostic Factors in 205 Patients with Laryngeal Squamous Cell Carcinoma Who Underwent Surgical Treatment

ObjectivesTo investigate the most important factors affecting the prognosis of the patients with squamous cell carcinoma (SCC) of the larynx.MethodsBased on the clinical and follow-up data, 205 patients with SCC of the larynx receiving total laryngectomy, partial laryngectomy, or CO2 laser surgery in GuangDong General Hospital were retrospectively analyzed. A survival analysis was performed by the Kaplan-Meier method and a multivariable analysis of prognostic factors was carried out using the Cox proportional hazard model.ResultsSubtypes of carcinoma included 69.8% glottic and 30.2% supraglottic. Most patients were in N0 stage (77.6%), and 22.4% patients were in N1∼N3 stage. Over half of the patients were in T1∼T2 stage (55.1%), 20.0% in T3, and 24.9% in T4. Mean follow-up duration was 49.2 months. The survival rates 1, 2, and 3 years after the surgery were 99.0%, 91.7%, and 81.5%, respectively. The survival rate for those patients with clinical stage IV was significantly lower than for those with clinical stage I and II (p<0.001 and p = 0.013, respectively). The disease-free progression rates 1, 2, and 3 years after the surgery were 83.9%, 74.6%, and 71.2%, respectively. Futhermore, those patients with a Charlson score of 1 to 2 and ≥3 had higher risk of mortality than those with a Charlson score of 0 (hazard ratios of 1.8 and 2.41 p = 0.042 and p = 0.008). Multivariable analysis revealed that clinical stage, surgical margin, and comorbidity were significantly associated with both mortality and disease-free progression.ConclusionThe surgical resection margin, clinical stage, and comorbidity were independent factors affecting the laryngeal cancer prognosis. The survival rates were lower for patients with advanced laryngeal cancer, positive surgical margins, or severe comorbidity, suggesting the importance of early diagnosis, early treatment, negative surgical margins, and conditions of comorbidity.

Retrospective analysis of prognostic factors for sixty osteosarcoma patients with local recurrence

Objective The aim of this study was to identify prognostic factors and imply the appropriate management for local recurrent osteosarcoma.

Diffuse brainstem glioma: prognostic factors

Brainstem gliomas were regarded as a single entity prior to the advent of MRI; however, several studies investigating MRI have recognized that these lesions are a heterogeneous group, and certain subgroups have a better prognosis for long-term survival. The aim of this study was to conduct a retrospective analysis of prognostic factors of patients with brainstem gliomas confirmed by histopathological diagnosis, particularly regarding assessment of whether histological grade, age, and MRI findings are prognostic factors for patient survival. The study evaluated 100 patients diagnosed with brainstem glioma. There were 63 adults (40 men and 23 women; age range 18-75 years, mean 41 years) and 37 children (19 boys and 18 girls; age range 2-12 years, mean 6.9 years). The mean overall survival of this population, measured from the date of biopsy, was 57 months for diffuse low-grade glioma and 13.8 months for diffuse high-grade glioma (p < 0.001). The mean survival among patients with nonenhancing contrast lesions on MRI was 54.2 months, whereas for patients with enhancing lesions, it was 21.7 months (p < 0.001). Comparisons between the Kaplan-Meier survival curves of adults and children revealed similar median survival periods of 25 and 16 months, respectively (p > 0.05). The multivariate analysis (Cox proportional hazards regression) revealed that only histological grade was a significant prognostic factor (p < 0.001). The study revealed that histological grade and MRI features were significant prognostic factors for survival in these patients, but in multivariate analysis, only histological grade remained a significant factor.

Retrospective analysis of prognostic factors for angioimmunoblastic T-cell lymphoma: a multicenter cooperative study in Japan

AbstractAngioimmunoblastic T-cell lymphoma (AITL) is a major type of peripheral T-cell lymphoma (PTCL). To elucidate the clinicopathologic characteristics and prognosis of AITL in Japan, we retrospectively analyzed 207 patients with AITL. The median patient age was 67 years (range, 34-91 years), with 73% of patients older than 60 years. With a median follow-up of 42 months in surviving patients, 3-year overall survival (OS) was 54% and progression-free survival (PFS) was 38%. The International Prognostic Index (IPI) and the prognostic index for PTCL, not otherwise specified (PIT) were predictive for OS in this analysis. Multivariate analysis found that age older than 60 years, elevated white blood cell (WBC) and IgA levels, the presence of anemia and thrombocytopenia, and extranodal involvement at > 1 site were significant prognostic factors for OS, and IgA, anemia, and mediastinal lymphadenopathy were significant prognostic factors for PFS. A novel prognostic model consisting of the prognostic factors for OS was successfully constructed. In conclusion, IPI and PIT were still useful for prognostication of AITL, and other factors, including those not used in IPI, such as IgA, anemia, WBC count, thrombocytopenia, and mediastinal lymphadenopathy, also significantly affected prognosis. Future investigations for IgA as a unique prognostic factor are warranted.

Chronic lymphocytic leukaemia with 17p deletion: a retrospective analysis of prognostic factors and therapy results

Patients with chronic lymphocytic leukaemia (CLL) whose tumour cells harbour a 17p deletion (17p-) are universally considered to have a poor prognosis. The deletion can be detected at diagnosis or during the evolution of the disease, particularly in patients who have received chemotherapy. We sought to evaluate the natural history of patients with 17p- CLL, identify predictive factors within this prognostic subgroup, and evaluate the results of different therapeutic approaches. Data from 294 patients with 17p- CLL followed up at 20 different institutions was retrospectively collected and analysed. Median age was 68 (range 27-98) years at the time of fluorescence in situ hybridization analysis. After 17p- documentation, 52% received treatment, achieving an overall response rate of 50%. Median overall survival was 41 months, and was significantly shorter in patients with elevated beta(2)-microglobulin concentration (P < 0·001), B symptoms (P = 0·016), higher percentage of cells with deletion (P < 0·001), and acquired deletions (P = 0·012). These findings suggest that patients with 17p- CLL have a variable prognosis that can be refined using simple clinical and laboratory features, including 17p- clone size, beta2-microglobulin concentration, presence of B symptoms and type of deletion (de novo versus acquired).

Prognostic Factors for Survival post Surgery for Patients with Gastrointestinal Stromal Tumors

Background: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms located in the alimentary tract. Our aim was to assess the influence of prognostic factors on survival in patients surgically treated for GISTs. Study: One hundred and five patients treated between January 1989 and December 2008 were available for study. A retrospective analysis of prognostic factors (age, gender, mitotic index, tumor location, tumor size, risk of malignant behavior, and coexisting other neoplasm) was performed. Univariate and multivariate survival analyses were undertaken. Results: Univariate analyses revealed the importance of patient gender (p = 0.007), disease location (p = 0.055), mitotic index (p = 0.054) and coexistence with other neoplasms (p = 0.004). However, multivariate analysis showed 3 independently statistically significant factors: coexistence with other neoplasm (RR = 3.53, p = 0.004), male gender (RR = 2.60, p = 0.011) and mitotic index ≧10/50 HPF, (RR = 2.60, p = 0.042). Conclusions: Our study has shown that male gender, a high mitotic index ≧10/50 HPF, and coexistence with other malignant neoplasms were independent poor prognostic factors in patients with GIST. The presence of middle or lower gut disease location leads to an increased risk of mortality when compared with the upper gut.

Retrospective Analysis of Prognostic Factors after Liver Transplantation for Intrahepatic Cholangiocarcinoma in China: A Single-Center Experience

This study aims to assess the prognosis of liver transplantation for ICC patients and try to identify prognostic factors that could influence survival for intrahepatic cholangiocarcinoma patients treated by liver transplantation. Between February 1999 and February 2010, 20 patients with ICC underwent liver transplantation. The Kaplan-Meier method was used to calculate the actuarial survival rate and tumor-free survival rate. Log-rank test was used to compare the differences between groups. Univariate Cox proportional hazard regression model was used to analyze each factor that might have influenced liver transplantation prognosis in ICC patients and to identify factors with statistical significance. Actuarial survival rate at 1, 2, 3 and 5 years achieved 84.2%, 43.7%, 32.7% and 21.8%, respectively. Tumor-free survival at 1, 2, 3 and 5 years was 55.6%, 43.2%, 28.8% and 18.8%, respectively. In univariate analysis, lobar distribution, multiple tumors, lymph node invasion, macrovascular invasion, advanced pTNM classification stages, neoadjuvant therapy and differentiation were associated significantly with survival, especially the former 6 factors. In multivariate analysis, lymph node invasion, macrovascular invasion and multiple tumors were the independent predictors of survival, especially lymph node invasion and multiple tumors. Liver transplantation in patients with ICC should be confined to highly discreetly selected cases. Consequently, liver transplantation combined with neoadjuvant treatment for these cases may achieve an improved survival.

Retrospective analysis of prognostic factors associated with response and overall survival in patients with RAEB-t MDS treated with decitabine.

6598 Background: Response to decitabine, a hypomethylating agent for treatment of MDS of all FAB subtypes and Intermediate-1, Intermediate-2 and High-risk IPSS groups, was assessed using IWG 2000 criteria. The revised WHO definition of AML is ≥20% blasts instead of ≥30% blasts, so IWG updated its response criteria in 2006. The current analysis updates response data using IWG 2006 criteria. Methods: A retrospective analysis was conducted of a pooled subset of patients with MDS from two decitabine trials: 3-day dosing (phase III) or 5-day dosing (phase II). Patients with baseline marrow blasts ≥20% receiving decitabine (RAEB-t group) were compared with patients with baseline marrow blasts <20% (MDS group). Comparisons were made of baseline characteristics (Fisher’s exact test and t test); overall response rates (ORR) (Fisher’s exact test); and overall survival (OS) (log-rank test; significance p<.05). Results: The RAEB-t group (n=26) had a significantly shorter time from MDS diagnosis (7.3 vs 18.3mo), higher IPSS risk (76.9% vs 15.9% of patients), and lower median baseline platelet count (62.3 vs 112.7 x103/mL) vs the MDS group (n=157), yet the two groups still had similar OIR, PR, mCR, HI, stable disease, and disease progression. Adverse events were similar between groups. Conclusions: Based on this retrospective analysis, decitabine yielded a similar response rate in RAEB-t patients as in other MDS patients, except for a lower CR rate, consistent with the higher proportion of IPSS high-risk. Moreover, the RAEB-t patients did not progress to AML (≥30% blasts) more rapidly than the MDS population. As such, clinical responses in the RAEB-t group are encouraging. RAEB-t (n=26) n (%) MDS (n=157) n (%) P* ORR (CR+mCR+PR) 4 (15.4) 44 (28.0) 0.2311 OIR (CR+mCR+PR+HI) 9 (34.6) 67 (42.7) 0.5223 CR 0 25 (15.9) 0.0278 mCR 2 (7.7) 14 (8.9) 1.0000 PR 2 (7.7) 5 (3.2) 0.2602 HI 5 (19.2) 23 (14.7) 0.5589 Stable disease 8 (30.8) 43 (27.4) 0.8137 Progressive disease 4 (15.4) 27 (17.2) 1.0000 Abbreviations: CR, complete response; HI, hematologic improvement; mCR, marrow complete response; OIR, overall improvement rate; PR, partial response. *Fisher’s exact test.

Surveillance for stage I testicular seminoma at a single institution in Japan: Retrospective analysis of prognostic factors for relapse.

234 Background: Treatment options for clinical stage I seminoma include adjuvant radiotherapy (RT) as well as surveillance and adjuvant chemotherapy (CT). Data available from the surveillance, adjuvant RT and adjuvant CT series suggest that all treatment strategies achieve a complete cure in almost 100% of the patients with stage I testicular seminoma. The success of surveillance of patients with stage I nonseminomatous germ cell tumors and the establishment of curative CT for advanced disease have led to re-examination of the standard treatment approach. We report the results of a retrospective analysis of the prognostic factors for stage I testicular seminoma. Methods: We retrospectively reviewed the survey of 87 patients with stage I testicular seminoma who were admitted in an institution between January 1982 and January 2009. We examined if the following tumor characteristics could possibly predict the relapse: age at diagnosis, tumor size, pathological T (pT) stage, elevation of beta-hCG level and/or LDH level, invasion of the rete testis, vascular invasion and lymphatic invasion. The cause-specific survival rate was calculated using the Kaplan-Meier method. Results: During a median follow-up of 8.1 years (range, 1.2-25.7 years), 13 (14.9%) relapses were observed, with an actuarial 5-year relapse-free rate (RFR) of 87.9%. The univariate analysis showed that the following characteristics were not predictive of relapse: age at diagnosis (RFR: 89% [&lt;36 years] vs. 88% [≥36 years]), tumor size (RFR: 90% [&lt;5.6 cm(median)] vs. 85% [≥5.6 cm]), pT stage (RFR: 91% [pT = 1] vs. 84% [pT = 2 and pT = 3]), elevation of beta-hCG level (RFR: 89% [normal] vs. 87% [elevated]), invasion of the rete testis (RFR:90% [absent] vs. 80% [present]), vascular invasion (RFR:86% [absent] vs. 87% [present]), and lymphatic invasion (RFR: 88% [absent] vs. 87% [present]). The overall 5-year survival rate was 97%. Conclusions: Prognostic factors for relapse could not be identified in this retrospective analysis of the patients admitted in a single institution. To identify the prognostic factors for risk-adapted treatment for stage I testicular seminoma, we need to study a large sample population in Japan. No significant financial relationships to disclose.

Outcome Analysis of Patients With Oral Cavity Cancer and Extracapsular Spread in Neck Lymph Nodes

Extracapsular spread (ECS) in neck lymph nodes is a major adverse prognostic factor in patients with oral cavity squamous cell carcinoma (OSCC). We conducted a retrospective analysis of prognostic factors in this patient group and tried to identify a subset of patients with a worse prognosis suitable for more aggressive therapeutic interventions. Enrolled in the study were 255 OSCC patients with ECS in neck nodes and without evidence of distant metastasis. All participants were followed-up for at least 2 years or censored at last follow-up. The 5-year rates of control, distant metastasis, and survival were the main outcome measures. Level IV/V lymph node metastases and tumor depth ≥12 mm were independent predictors of 5-year survival and identified three prognostic groups. In the low-risk group (no level IV/V metastases and tumor depth <12 mm), the 5-year disease-free, disease-specific, and overall survival rates were 60%, 66%, and 50%, respectively. In the intermediate-risk group (no level IV/V metastases and tumor depth ≥12 mm), the 5-year disease-free, disease-specific, and overall survival rates were 39%, 41%, and 28%, respectively. In the high-risk group (evidence of level IV/V metastases), the 5-year disease-free, disease-specific, and overall survival rates were 14%, 12%, and 10%, respectively. Among OSCC patients with ECS, those with level IV/V metastases appear to have the worst prognosis followed by without level IV/V metastases and tumor depth ≥12 mm. An aggressive therapeutic approach may be suitable for intermediate- and high-risk patients.

Low-grade gliomas in older patients: a retrospective analysis of prognostic factors

Low-grade gliomas (LGG) are increasingly being diagnosed in older patients (>or=60 years). The rising incidence is incompletely understood but demands an analysis of the natural history and prognostic factors to determine if there are differences compared to younger populations. We retrospectively review a consecutive series of 20 older patients who presented between 1991 and 2004 with LGG to characterize the presentation, management, outcomes, and prognostic factors in older patients with LGG. Median follow-up was 27.3 months. Thirty-five percent of patients harboured oligodendrogliomas. Patients presented in equal numbers with seizure, focal neurological deficit, and mental status change. Median overall survival (OS) was 27.3 months. Patients who survive beyond 2 years experience prolonged periods of progression-free survival. Younger age, seizure presentation, and radiation treatment were prognostic of OS on multivariate analysis. Similarities with previous reports of LGG suggest that age should not affect the management of LGG patients. Prospective studies of older patients with LGG are needed to further characterize the optimum management of these patients.

Surveillance for stage I testicular seminoma: Retrospective analysis of prognostic factors for relapse at a single institution in Japan

15630 Background: Treatment options for clinical stage I seminoma include adjuvant radiotherapy (RT) as well as surveillance and adjuvant chemotherapy. Although adjuvant RT remains the treatment of choice in most centers, the success of surveillance of patients with stage I nonseminomatous germ cell tumors and the establishment of curative chemotherapy for advanced disease have led to re-examination of the standard treatment approach. Data available from the surveillance and adjuvant RT series suggest that nearly 100% of patients with stage I testicular seminoma are cured, whichever approach is chosen. We report here results of a retrospective analysis of prognostic factors for stage I testicular seminoma. Methods: Between January 1980 and December 2004, surveillance was performed for 61 patients. Tumor characteristics (age at diagnosis, size, elevation of beta hCG level, invasion of the rete testis, vascular invasion, and lymphatic invasion) were examined as factors possibly predictive of relapse. Cause-specific survival rate was calculated using the Kaplan-Meier method. Results: With a median follow-up of 10.5 years (range, 2.35–20.8 years), 7 relapses were observed, with an actuarial 5- year relapse-free rate (RFR) of 89.2%. On univariate analysis, only tumor size (RFR: &lt;8cm, 96%; =8cm, 76%; p=0.029) was predictive of relapse. Age at diagnosis (RFR: &lt;36, 89%; =36, 91%), elevation of beta hCG level (RFR: 93% [normal] v 91% [elevated]), invasion of the rete testis (RFR:92% [absent] v 90% [present]), vascular invasion (RFR:89% [absent] v 86% [present]), and lymphatic invasion (RFR: 89% [absent] v 78% [present]) were not predictive of relapse. The overall relapse rate was 11.5%. Overall 5-year survival rate was 97%. Conclusions: Size of primary tumor was found to be predictive of relapse in patients with stage I seminoma managed with surveillance, on analysis at a single institution in Japan. No significant financial relationships to disclose.

P-438 A retrospective analysis of prognostic factors and rreatment outcomes of different chemotherapy regimens in patients with locally advanced (Stage IIIB) and metastatic (Stage IV) non-small cell lung cancer (NSCLC): A single Egyptian institution's experience

P-438 A retrospective analysis of prognostic factors and rreatment outcomes of different chemotherapy regimens in patients with locally advanced (Stage IIIB) and metastatic (Stage IV) non-small cell lung cancer (NSCLC): A single Egyptian institution's experience

Breast cancer in young women age &lt; 36 years: A retrospective analysis of prognostic factors in 926 patients in 8 french instituitions. GETNA group

9685 Background: Age ≤35 years is considered as a bad prognostic factor in women with breast cancer (BC). Methods: Clinical and pathological data of 926 women ≤35 years with invasive non metastatic BC, consecutively treated between 1990–99 in 8 french institutions were analysed. Clinical and pathological size, node involvement, histological type, SBR histological grading, hormone receptors (HR), and treatment characteristics were analysed for all patients. Distant Recurrence Free Survival (DRFS) and overall survival (OS) were analysed using Kaplan Meier estimates and comparisons were made using the logrank test. Multivariate analyses were carried out using Cox hazards model. Results: With a median FU of 87 months,239 deaths, 177 loco-regional and 323 distant recurrences were observed. Five and 10 years survival rates were 82.2% and 66.5%. Five and 10 years DRFS rates were 67.2% and 50.8%. No difference was observed according to age (≤30 years old, 31–33 and 34–35, p = 0.74) neither in DRFS nor in OS (p=0.99 and p = 0.74). Compared to T1, T2 was associated with a RR of 1.65 [1.23–2.22], and T3/T4 with a RR of 2.73 [1.92–3.88] for the OS (p<10-4) and T2 was associated with a RR of 1.57 [1.23–2.02], and T3/T4 with a RR of 2.25 [1.65–3.07] for the DRFS (p<10-4). Compared to negative node involvement, pN1 status was associated with a RR of 2.22 [1.60–3.09], and pN2 with a RR of 4.35 [3.14–6.03] in OS (p<10-4) and pN1 nodes involved was associated with a RR of 2.64 [2.01–3.47], and 4 and more with a RR of 4.22 [3.17–5.62] for the DRFS (p<10-4). Compared to positive HR, negative HR were respectively associated with a RR of 1.37 [1.05–1.82] (p=0.019), and 1.49 [1.14–1.96] (p<10-2) in OS. But no difference was observed according to HR in DRFS. Compared to grade I in SBR, grade II and III were respectively associated with a RR of 2.40 [1.35–4.27], and 2.61 [1.46–4.65] for the OS (p<10-3) and a RR of 1.86 [1.20–2.89], and 1.75 [1.12–2.72] in DRFS (p<10-3). Multivariate analysis results will be presented during the meeting. Conclusions: In these retrospective analyses, the most important prognostic factor for YA with breast cancer is tumour size followed by pathological grade (SBR), pN and HR status. No significant financial relationships to disclose.

Lack of Prognostic Factors in Follicular Lymphoma

We performed a retrospective analysis of prognostic factors in patients with stage III and IV and high-tumor burden follicular lymphoma (FL) treated with uniform schedules and with a long term follow-up. Eight-hundred and ten patients treated with intensive, anthracycline-based, chemotherapy and adjuvant radiotherapy to sites of initial bulky nodal disease were the basis of this analysis. Age >60 years, presence of B symptoms, bulky disease, >2 extranodal sites involved, high levels of LDH and the presence of serous effusions all identified as worse prognostic factors in univariate analysis were subject to multivariate analysis. Three factors remained significant: age >60 years old, presence of B symptoms and >2 extranodal sites involved and these were found to influence overall survival (OS) and progression-free survival (PFS). We developed a score system and only two groups (score 0 and 1 and score 2 and 3) showed statistical significance in OS. When the International Prognostic Index was applied to these patients, no statistical differences were observed in OS and PFS between the four groups. Comparison of our results with multiple previous studies showed a lack of uniform prognostic factors and adequate prognostic classification could not be performed. In conclusion, it is mandatory for multicentric international clinical analysis to define prognostic factors and search for a clinical classification, as in diffuse large B cell lymphoma, so as to define groups of FL for more aggressive or conservative therapy.

Primary thyroid lymphoma: a retrospective analysis of prognostic factors and treatment outcome for localized intermediate and high grade lymphoma.

Non-Hodgkin's lymphoma presenting in the thyroid gland is uncommon. A review of the King Faisal Specialist Hospital and Research Centre (KFSH & RC) experience was performed to assess treatment outcome and prognostic factors in this rare extranodal presentation of localized lymphoma. Sixty patients treated at KFSH & RC between 1975 and 1995 were identified, and their records were reviewed retrospectively. Eight patients who had stage III or IV disease, low grade, or did not complete their prescribed treatment were excluded from the study. There were 38 female and 14 male patients with a median age of 59.5 years at the time of diagnosis (range: 10-87 years). Thirty-five of the 52 patients underwent diagnostic partial or total thyroidectomy at other institutions based on a preoperative assumption of thyroid carcinoma. All 52 patients had non-Hodgkin's lymphoma of intermediate (94%) or high (6%) grade. Detailed staging was carried out in all patients; 16 patients (31%) had disease confined to the thyroid gland (stage IE), whereas 36 (69%) had associated disease in cervical lymph nodes and/or the mediastinum (stage IIE) disease. All patients were treated with curative intent. A total of 18 patients (35%) were treated with a single-modality treatment--radiotherapy alone in 2, chemotherapy alone in 13, and surgery alone in the remaining 3 patients. The majority of patients (34/52; 65%) were treated with a combined-modality approach. The overall relapse-free survival (RFS) and overall survival (OS) at 5 years were 72% and 88%, respectively. There were no significant differences in outcome between those treated with single-modality and those with combined-modality therapy. A univariate analysis showed that the presence of mediastinal lymph node involvement was the most important prognostic factor affecting both RFS and OS. Patients with Hashimoto thyroiditis and without "B" symptoms were found to have a significantly higher RFS without influence on the OS. However, patients who had a good performance status (PS) of 0, 1, and 2 were found to have a significantly higher overall survival in comparison to those with poor performance status. Age, sex, stage, histology, lactic acid dehydrogenase level, tumor bulk, and the treatment modality were not found to correlate with RFS or OS. Mediastinal involvement and PS were found to be the most important independent prognostic factors influencing RFS and OS.

Is preoperative portal vein embolization effective in improving prognosis after major hepatic resection in patients with advanced-stage hepatocellular carcinoma?

The impact of the use of preoperative portal vein embolization (PVE) on long-term survival after surgery was evaluated by retrospective analysis of prognostic factors in patients with advanced-stage hepatocellular carcinoma (HCC) who had undergone hepatic resection with or without PVE. The portal embolization group (Group P) consisted of 26 patients who had undergone major hepatectomy (more extensive than right hepatectomy) with PVE, and the nonembolized group (Group N) consisted of 43 patients who had undergone major hepatectomy without PVE. All patients were diagnosed with advanced HCC graded as Stage III or IV according to the International Union Against Cancer TNM classification system. Patient survival rates, recurrence rates, and recurrence sites after surgery in the two groups were evaluated and compared. The 1-year, 3-year, and 5-year cumulative disease specific survival rates in patients with TNM Stage III HCC, respectively, were 96.0%, 64.4%, and 52.7% in Group N and 92.9%, 57.1%, and 45.7% in Group P, whereas the corresponding values in patients with Stage IV HCC were 53.5%, 40.1%, and 26.8% in Group N and 63.5%, 50.8%, and 19.1% in Group P. There were no statistically significant differences in survival rates between Group P and Group N. Multivariate analysis showed that PVE was not a significant prognostic factor. The 1-year, 3-year, and 5-year cumulative recurrence rates for patients with both stages of disease combined were 44.1%, 80.2%, and 86.8% in Group N, respectively, and 39.9%, 72.2%, and 72.2% in Group P, respectively, with no statistically significant differences between the two groups. To date, 35 patients in Group N and 16 patients in Group P have had tumor recurrences in the liver remnant; of these, 27 patients in Group N and 12 patients in Group P had multiple recurrence foci in the liver remnant. No significant difference was seen between the two groups; however, 10 of 16 patients in Group P (62.5%) had remote organ metastasis in addition to recurrence in the liver remnant compared with only 6 of 35 patients in Group N (17.1%): This difference was significant statistically (P = 0.012). PVE during major hepatic resection neither improves nor worsens long-term prognosis but allows resection in a patient group that, otherwise, is considered as unresectable. Remote metastasis involving the lung, bone, or stomach was seen more frequently postoperatively in Group P compared with Group N, raising a possibly important issue regarding the use of this approach for the treatment of patients with hepatic malignancies, especially HCC.

Retrospective analysis of prognostic factors after liver resection and transplantation for cholangiocellular carcinoma.

Cholangiocellular carcinoma is an uncommon primary liver cancer, which may be mixed with hepatocellular carcinoma. A retrospective analysis was undertaken to evaluate the results of surgical treatment and to identify prognostic factors. Between 1978 and 1996, 162 patients underwent surgery for cholangiocellular carcinoma: liver resection (n = 95), liver transplantation (n = 24) and exploratory laparotomy with and without drainage (n = 43). Univariate and multivariate analyses of prognostic factors were performed. Overall survival was 47 per cent at 1 year, 28 per cent at 2 years and 13 per cent at 5 years. Survival rates for patients with resectable tumours were 64, 43 and 21 per cent respectively, and for those who underwent liver transplantation 21, 8 per cent and zero respectively. Univariate analysis showed that the following variables had an effect on survival: age, jaundice, liver resection, T, N and M stage in the tumour node metastasis classification, Union Internacional Contra la Cancrum (UICC) tumour stage, tumour-free margins, vascular infiltration, tumour number, tumour size and serum level of carcinoembryonic antigen. Multivariate analysis identified jaundice, N and M category, and UICC tumour stage as independent prognostic factors. The data underscore the importance and prognostic value of the UICC tumour classification for cholangiocellular carcinoma. The prognosis of mixed tumours is no different. Liver resection remains the treatment of choice; transplantation offers no solution for otherwise unresectable tumours.

Prognostic factors in brain metastases: should patients be selected for aggressive treatment according to recursive partitioning analysis (RPA) classes?

Purpose: To determine whether or not Radiation Therapy Oncology Group (RTOG) recursive partitioning analysis (RPA) derived prognostic classes for patients with brain metastases are generally applicable and can be recommended as rational strategy for patient selection for future clinical trials. Inclusion of time to non-CNS death as additional endpoint besides death from any cause might result in further valuable information, as survival limitation due to uncontrolled extracranial disease can be explored. Methods: We performed a retrospective analysis of prognostic factors for survival and time to non-CNS death in 528 patients treated at a single institution with radiotherapy or surgery plus radiotherapy for brain metastases. For this purpose, patients were divided into groups with Karnofsky performance status (KPS) <70% and KPS ≥70%, as proposed by the RTOG. Results: Median overall survival was 2.9 months (2.0 months for patients with KPS <70% and 3.6 months for patients with KPS ≥70%, p < 0.001). We did not find other variables splitting patients with KPS <70% in different prognostic groups. However, advanced age, multiple brain metastases, presence of extracranial metastases, and uncontrolled primary tumor each predicted shorter survival in patients with KPS ≥70%. When grouped into the original RTOG RPA classes, our data set split into three subgroups with different prognosis and median survival times of 10.5, 3.5, and 2 months, respectively ( p < 0.05). Only 3% of patients fell into the most favorable group. Median time to non-CNS death was 4.1 months (12.9 months in RPA class I, 4.9 months in RPA class II, and 3.8 months in RPA class III, respectively, p > 0.05 for RPA class II versus III). However, it was 8.5 months in RPA class II patients with controlled primary tumor, which was found to be the only prognostic factor for time to non-CNS death in patients with KPS ≥70%. In patients with KPS <70%, no statistically significant prognostic factors were identified for this endpoint. Conclusions: Despite some differences, this analysis essentially confirmed the value of RPA-derived prognostic classes, as published by the RTOG, when survival was chosen as endpoint. RPA class I patients seem to be most likely to profit from aggressive treatment strategies and should be included in appropriate clinical trials. However, their number appears to be very limited. Considering time to non-CNS death, our results suggest that certain patients in RPA class II also might benefit from increased local control of brain metastases.