Role Of Prognostic Markers Research Articles

Role of Prognostic Markers as a Predictor of Mortality and Short-Term Prognosis in COVID.19

Introduction: As the world is slowly out of its second wave wrecked by the Delta strain, the world population is now struck once again with a new strain of COVID-19. As the outbreak is spreading, prognostic markers such as C-reactive protein (CRP), D-dimer, and ferritin levels can help the physician in predicting clinical outcomes at an early stage. Materials and Methods: Our study made an analysis of patients presented to the emergency medicine department with positive COVID antigen or reverse transcriptase–polymerase chain reaction (RT-PCR) results. Patient demographic data, clinical profile, and values of D-dimer, CRP, and serum ferritin were obtained. All the patients were subjected to standard treatment according to COVID protocol. Results: Our study population was comprised of 312 patients. Among them, 162 (51.9%) were male, and 150 (48.1%) were female. Our study found that among 45 patients, who had expired, 38 (84.4%) patients had elevated D-dimer values, 45 (100%) patients had elevated CRP values, and 41 (91.1%) patients had elevated ferritin values. P =001, which is statistically significant. Conclusion: Our study found that values of prognostic markers such as D-dimer, CRP, and serum ferritin at the time of presentation can be used as a predictor of mortality and risk stratification and predict the probable need for prolonged hospital and intensive care unit stay. These values also correlate well with the disease severity of the patients. They can also be used to predict the probable need for respiratory support during the course of a stay in the hospital.

Prognostic role of systemic inflammatory markers in patients with metastatic MSI-h/dMMR colorectal cancer receiving immunotherapy.

3524 Background: Markers of systemic inflammation including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (LMR) are prognostic in patients with metastatic colorectal cancer receiving systemic chemotherapy. The presence of liver metastases has also been hypothesized to modulate response to immunotherapy. In this study, we assess the prognostic role of these markers in patients with microsatellite high (MSI-H)/deficient mismatch repair (dMMR) tumors receiving immunotherapy for metastatic or unresectable colorectal cancer (CRC). Methods: This was a single-institution retrospective analysis of patients with dMMR/MSI-H CRC who received anti-PD-(L)1 and/or anti-CTLA-4 therapy for metastatic or unresectable disease at between 2015 and 2021 (n = 59). NLR, PLR, and LMR were calculated based on the complete blood count obtained within 1 week prior to treatment. Patient and tumor characteristics were obtained from the clinical record. Patient characteristics were compared using Fisher’s exact test and Mann-Whitney U where appropriate. Progression free survival (PFS) and overall survival (OS) were the primary endpoints and log-rank test was used for comparison of survival distribution among groups. Results: 59 patients with metastatic dMMR/MSI-H CRC were identified. Median age was 60, 53% (n = 31) had right-sided tumors, 35% (n = 35) of patients with testing available had RAS-mutated tumors, and 37% (n = 22) received prior chemotherapy. Most common sites of metastatic disease were peritoneum (n = 23, 39%) and liver (n = 17, 29%). Patients were divided into NLR-High (NLR ≥ 3, n = 20) and NLR-Low (NLR < 3, n = 39), and both groups had similar baseline characteristics. The rate of progressive disease as best response was not different in NLR-Low versus NLR-High (15% vs 30%, p = 0.3). At a median follow-up of 32 months, neither median PFS nor median OS were reached. 74% (n = 29) remained progression free at 1 year in the NLR-Low group versus 60% (n = 12) in NLR-High group which was not statistically significant (p = 0.37); 90% (n = 35) remained alive at 2 years in the NLR-low versus 80% (n = 16) in the NLR-High group (p = 0.4). Similarly, using a cut-off of 150 and 3 for PLR and LMR respectively, there was no significant difference between PFS at 1 year in the PLR-Low (n = 32) vs PLR-High (n = 27) (66% vs 74%, p = 0.58) and LMR-Low (n = 35) vs LMR-High (n = 24) (60% vs 83%, p = 0.084) groups. The presence of liver metastasis or the presence of a RAS mutation did not influence PFS at 1 year (p = 0.35 and p = 1.00, respectively). Conclusions: Markers of systemic inflammation may have a limited prognostic role for patients with dMMR/MSI-H CRC receiving immunotherapy.

Spontaneous coronary artery dissection: Role of prognostic markers and relationship with genetic analysis

Spontaneous coronary artery dissection (SCAD) is increasingly recognized as an important cause of myocardial infarction (MI). Currently there is little knowledge about prognostic factors for unfavorable outcome at long term follow-up; furthermore, there is also little knowledge about the genetics of these patients. AimsThis observational and retrospective study describes long-term cardiovascular outcomes of a population affected by SCAD and assesses predictors of recurrent de novo SCAD and major adverse cardiovascular events (MACE). Furthermore, a correlation between genotype and adverse events at follow-up was sought. MethodsBaseline characteristics, angiographic features, use of medication and long-term cardiovascular events were systematically ascertained between 2000 and 2019.Next generation sequencing was performed with a panel consisting of twenty genes of interest. Variants found were filtered based on their frequency and only frequencies <1% in the general population were considered as “positive”. ResultsSeventy patients were enrolled and followed for a median time of 39.1 months. Median age was 52 years and the majority were women (86%). Use of hormone therapy (HT) (OR 3.64, p = 0.041) and presence of malignant ventricular arrhythmias (VAs) at onset (OR 7.03, p = 0.0073) were associated with a greater risk of recurrent de novo SCAD. Proximal type SCAD (OR 8.47, p < 0.0001) and presence of VAs at onset (OR 9.97, p = 0.047) were associated with a greater risk of MACE.A potential SCAD-associated mutation was detected in 27 patients (44%); 6 patients (22%) defined as genetically “positive” developed MACE vs. 2 patients (6%) defined as “negative” (p = 0.06 at univariate analysis). MACE at follow-up is reached earlier in genetically positive patients (7.9 vs. 42.5 months). Conclusionuse of HT and VAs at SCAD onset are prognostic factors for recurrent de novo SCAD. Proximal SCAD site and VAs at SCAD onset were prognostic factors for MACE. Analysis by molecular genetics seems to be a promising tool for the possible additional role it could play in MACE prediction.

Prognostic value of cancer stem cell markers and E-cadherin expression in non-small-cell lung cancer

IntroductionNon-small-cell lung cancer (NSCLC) is a common fatal malignancy worldwide and has a high mortality rate and poor prognosis.AimThe aim was to study the potential prognostic role of markers of cancer stem cells in NSCLC.Materials and methodsThe associations between the expression of CD44,

Diagnostic and prognostic role of markers of inflammation and vascular endothelial growth factor in infectious endocarditis

The peculiarities of primary and secondary infective endocarditis (IE) were studied in 62 patients with primary and secondary IE, uncomplicated and complicated disease treated in S. P. Botkin city clinical hospital including analysis of dynamics of tumor necrosis factor α (TNF α), interleukin-6 (IL-6), vascular endothelial growth factor (VEGF) within 3 weeks after the onset of antibiotic therapy. A rise in TNF α and IL-6 levels was shown to correlate with the severity of the disease and the development of infectious-toxic syndrome. Most patients had an increased level of VEGF, a mediator involved in the regulation of inflammation. It was shown that combination of high TNF-α and IL-6 levels with the initially low or gradually increasing VEGF levelsuggests the unfavourable prognosis characteristic of the most heavily diseased anddeceased patients.

Prognostic markers of sarcoidosis: an analysis of patients from everyday pneumological practice.

Although sarcoidosis is a well-known disease, sarcoidosis patient outcome and the role of prognostic markers in everyday practice have not yet been well described. Therefore, the goal of the present study was to analyse the fate of sarcoidosis patients and the factors influencing the disease's behaviour in routine practice. The study was a retrospective analysis of 306 consecutive patients (181 females and 125 males; median age 45 years) diagnosed with sarcoidosis in the years 2003-2012. Through the use of uniparametric analysis, it was determined that the stage of the disease, organ involvement, CD4/CD8 ratio in the bronchoalveolar lavage fluid (BALF), serum and urine calcium levels, smoking, and pulmonary functions had a significant influence on spontaneous sarcoidosis resolution. Multiparametric analysis revealed that spontaneous resolution was significantly positively influenced by female gender, a less advanced disease stage, a higher CD4/CD8 ratio in the BALF, lymphocytosis in the BALF and normal pulmonary functions at diagnosis. During follow-up, only three patients died. The causes of death were respiratory failure with pneumonia (n = 2) and heart attack caused by sarcoidosis heart involvement (n = 1). The data show sarcoidosis as a disorder with high variability in clinical and laboratory findings but with good general prognosis.

307 A comparison of clinical characteristics and the role of prognostic markers in 1757 MDS patients from Japan, Korea, and Germany

The current study aimed to assess the risk factors and preventive measures for valve inversion after lumboperitoneal shunt (LPS) construction.The medical records of patients who were admitted to Mito Brain Heart Center from July 2015 to October 2018 were retrospectively analyzed. Next, clinical and neuroimaging data were collected from electronic medical charts and operative notes. The cause of valve reversal was investigated. In addition, a simulated shunt device was established and the efficacy of countermeasures was evaluated.The mean age of the participants was 69.3 (range: 46–88) years, and there were 15 men and 22 women. In total, 20 and 17 patients presented with secondary and idiopathic normal pressure hydrocephalus, respectively. Further, 8 patients had valve reversal.The distance between the valve and spinous process was found to be significantly correlated with valve reversal. However, the condition can be prevented by fixing the tube at the nuchal ligament.

Extensive experience of disease control with gefitinib and the role of prognostic markers.

Traditionally, the efficacy of an anticancer agent has been measured by response rate. With the development of biological molecular-targeted agents, which have a different mechanism of action from conventional agents, it may be appropriate to consider alternative criteria that reflect the positive effect of these biological agents on disease control, palliation, symptom improvement and quality of life. One such targeted agent is the orally active epidermal growth factor receptor tyrosine kinase inhibitor gefitinib (‘Iressa’, ZD1839). This article reviews the clinical experience of patients with advanced/metastatic non-small-cell lung cancer, who have received gefitinib as part of a clinical trial or through the ‘Iressa’ Expanded Access Programme. Disease-control rates of ∼50% were observed in some Expanded Access Programme series, comparable with results obtained from Phase II trials. Symptom improvement was also reported. Information that will help identify those patients most likely to respond to treatment will become increasingly important. Therefore, the possible role of prognostic markers and the relationship between epidermal growth factor receptor status and response to gefitinib has been investigated. No clear association between epidermal growth factor receptor expression and response was observed. Future studies of other biomarkers in the epidermal growth factor receptor pathway should help to identify which patients are likely to benefit most from gefitinib.

Pleomorphic lobular carcinoma: morphology, immunohistochemistry, and molecular analysis.

Infiltrating pleomorphic lobular carcinoma (PLC) is an aggressive variant of infiltrating lobular carcinoma. Recently, in situ changes identical to PLC (PLCIS) have been described. The role of prognostic markers and their correlation with therapeutics, clinical outcome, and genetic changes is not well established in PLC. The authors examined 38 cases of this entity to understand better this tumor's biology. Immunohistochemical (IHC) analysis was performed in 21 specimens for estrogen and progesterone steroid receptors, p53, Her 2 (p185), and GCDFP-15. Genomic deoxyribonucleic acid was obtained from microdissected tumor as well as normal control cells, and loss of heterozygosity was investigated at the ESR (16q24), p53 (TP53 17p), Her 2 (17q 11-12), and BRCA 1 (17q12-25) loci. In this series, the average patient age was 57.5 years (age range, 24-92 years). Twenty-seven women were postmenopausal. Tumor size ranged from 1.2 to 25 cm. Six patients were a pathologic stage I; 19, stage II; 12, stage III; and one, stage IV. Histologically, multifocal nodular aggregates of discohesive pleomorphic tumor cells were seen interspersed in dense and fibrotic breast parenchyma. Twenty-nine percent of the specimens demonstrated associated signet ring cells. The remainder had dishesive, globoid, plasmacytoid cells with high-grade nuclear features. PLCIS was identified in 17 of 38 patients (45%), and lobular carcinoma in situ (LCIS) was noted in 8 patients (21%). IHC analysis showed estrogen immunoreactivity in 81%, progesterone in 67%, GCDFP-15 in 71%, and Her 2 in 81% (2+ to 3+ membranous staining) of specimens. Antibodies to p53 stained the tumor cell nuclei in 48% of the tumors. Loss of heterozygosity was identified in 52% of the specimens at the p53 locus, 18% at the ESR locus, 19% to 24% at the Her 2 loci, and 27% to 32% at the BRCA 1 locus. Follow-up was available in 19 patients and ranged from 12 months to 15 years (mean, 73 months). Seven patients had no evidence of disease at last examination (range, 1-15 years), three patients were alive with disease (range, 2-14 years), and nine patients were dead of disease (range, 2 months-9 years). Six patients had subsequent diagnoses of tumor in the contralateral breast. Analysis shows that PLC tends to appear in older postmenopausal women who present with locally advanced disease. PLCIS was found to be associated with PLC 45% of the time. The aggressive clinical course of patients with PLC is supported by tumor immunoreactivity with unfavorable markers Her 2 and p53. Overexpression of Her 2 in PLC may be therapeutically relevant, enabling the use of novel chemotherapeutic drugs like Herceptin. Interestingly, tumors that were Her 2 immunoreactive also maintained estrogen hormone immunoreactivity.

The benefits of participation in clinical trials

This editorial marks a change of editors for the trials section. It is intended to encourage surgeons to participate in clinical trials work. The recruitment of patients into clinical trials with strict protocols and quality control may be expected to lead to better outcomes. Well-conducted trials may also add to our understanding of tumour biology and the role of prognostic markers, and may lead to the standardization of definitions and medical terminology. This will help us to overcome uncertainties in current treatment protocols.