Use Of Clinical Stage Research Articles

Role of the combined use of clinical stage, serum PSA and Gleason score for the improvement of preoperative staging of prostate cancer

Role of the combined use of clinical stage, serum PSA and Gleason score for the improvement of preoperative staging of prostate cancer

Use of clinical staging in amyotrophic lateral sclerosis for phase 3 clinical trials

ObjectivesThe use of clinical staging in the fatal neurodegenerative disease amyotrophic lateral sclerosis would have value in optimising future therapeutic trials. We aimed to use previous clinical trial data to...

Total Lymphocyte Count and World Health Organization Pediatric Clinical Stage as Markers to Assess Need to Initiate Antiretroviral Therapy Among Human Immunodeficiency Virus-Infected Children in Moshi, Northern Tanzania

The World Health Organization (WHO) has recommended the use of clinical staging alone and with total lymphocyte count to identify HIV infected children in need of antiretroviral therapy (ART) in resource-limited settings, when CD4 cell count is not available. We prospectively enrolled children obtaining care for HIV infection at the Kilimanjaro Christian Medical Centre Pediatric Infectious Diseases Clinic in Moshi, Tanzania between March 2004 and May 2006 for this cohort study. One hundred ninety two (89.7%) of 214 children met WHO ART initiation criteria based on clinical staging or CD4 cell count. Several low-cost measures identified individuals who met WHO ART initiation criteria to the following degree: WHO stages 3 or 4 had 87.5% (95% CI, 82.8-92.1) sensitivity and, by definition, 100% (CI, 100-100) specificity; WHO recommended advance disease TLC cutoffs: sensitivity = 23.9% (95% CI, 17.3-30.5) specificity = 78.2% (95% CI, 67.3-89.1). Low TLC was a common finding, (50 of 214; 23%); however, it did not improve the sensitivity or specificity of clinical staging in identifying the severely immunosuppressed stage 2 children. Growth failure or use of total lymphocyte counts in isolation were not reliable indicators of severe immunosuppression or need to initiate ART. The use of total lymphocyte count does not improve the ability to identify children in need of ART compared with clinical staging alone. Low absolute lymphocyte count did not correlate with severe immunosuppression based on CD4 cell count in this cohort.

Adjuvant or neoadjuvant chemotherapy in early-stage non-small cell lung cancer (NSCLC): How would staging affect the patients (pts) treated?

7509 Background: Both adjuvant chemotherapy (ACT) (HR 0.89, Pignon 2006 ) and neoadjuvant chemotherapy (NCT) (HR 0.88, Gilligan 2007) appear to result in comparable survival benefit in pts with early stage NSCLC. ASCO currently recommends ACT for pts with completely resected stages pII-III NSCLC (Pisters, 2007), as the pooled benefit is largest in these stages. A formal large scale comparative trial between both approaches seems appropriate, albeit requiring a large sample size. We assume that the outcome of such a trial is likely to be confounded by clinicopathological stage migration, as the decision to give NCT is based on clinical staging, which is known to be inaccurate (D'Cunha, 2005). Methods: Exploratory analyses of the 463 pts (239 surgery alone (S), 224 NCT + surgery (NCT-S)) included in a large randomised trial investigating the role of platinum-based NCT (LU22-NVALT 2-EORTC 08012), in whom detailed clinical and pathological staging data [UICC-6, Mountain, 1997] is available, in order 1. to estimate the directions and magnitude of clinicopathological stage migration in pts with resectable NSCLC. 2. to assess its impact on the selection of pts receiving NCT or ACT according to the ASCO-guideline. Results: Clinical staging is well balanced between both treatment arms. Stage migration per stage and treatment arm is shown in the Table. 36% of S-pts and 25% of CT-S pts migrate up and 15% and 20% down, respectively. Applying the ASCO guideline, 119 (50%) S pts who had pathological stage II/III would receive ACT. However, the use of clinical staging to select pts for NCT would result in only 35% pts receiving this treatment. Conclusions: Besides the need for a large sample size, any future comparison between ACT and NCT in early stage NSCLC based on the current ASCO-guideline, will have to compensate for a selection bias by stage migration in favour of ACT. Clinical staging needs hence to be as accurate as possible. Clinical Staging S-pts (n= 239) NCT-S pts (n= 224) I II III I II III Pathological staging 0 0 0 0 5 (2%) 2 (1%) 1 (<1%) I 82 (34%) 26 (11%) 5 (2%) 95 (42%) 31 (14%) 6 (3%) II 34 (14%) 31 (13%) 5 (2%) 31 (14%) 19 (8%) 1 (<1%) III 26 (11%) 19 (8%) 4 (2%) 13 (6%) 11 (5%) 7 (3%) IV 2 (1%) 5 (2%) 0 2 (1%) 0 0 Total 144 (60%) 81 (34%) 14 (6%) 146 (65%) 63 (28%) 15 (7%) Figures are numbers and (%) of each treatment arm No significant financial relationships to disclose.

Perineural invasion and MIB-1 positivity in addition to Gleason score are significant preoperative predictors of progression after radical retropubic prostatectomy for prostate cancer.

We assessed the use of clinical stage, serum prostate specific antigen, DNA ploidy, proliferation, and traditional histologic findings from the biopsy to predict prostate cancer progression after radical retropubic prostatectomy. Between 1995 and 1998, 454 consecutive patients with cancer on biopsy were treated by radical retropubic prostatectomy. Preoperative serum prostate specific antigen, clinical stage, Gleason score, percentage of cores and surface area positive for cancer, perineural invasion, and DNA ploidy and MIB-1 immunostain quantitation by image analysis were evaluated in a multivariate Cox proportional hazards regression model to predict cancer progression. Cancer progression was defined as a postoperative serum prostate specific antigen level of > or = 0.4 ng/mL, local recurrence, or systemic progression. Mean follow-up was 3.4 years (range 17 days to 5.8 years). Cancer progression was observed in 73 patients with a mean time to progression of 2.1 years (range 33 days to 5.1 years). Gleason score (p <0.001), MIB-1 cancer proliferation (p = 0.008), and perineural invasion (p = 0.008) were significantly associated with progression. Patients with cancer Gleason scores of 7 and >7 had a 2.5-fold and nearly 4-fold increased risk, respectively, of cancer progression compared with patients with cancer Gleason scores of < or = 6. Patients with perineural invasion at biopsy were twice as likely to progress compared with patients without perineural invasion. Each 1-unit increase in MIB-1 on the natural logarithmic scale increased the risk of cancer progression by 64%. Cancer progression models that include serum prostate specific antigen and clinical stage may require revision to incorporate perineural invasion and MIB-1 proliferative activity in addition to Gleason score.

A proposal for basic management of HIV disease in west Africa: use of clinical staging and haemogram data.

Our objective was to propose a strategy to screen HIV-infected African people for biological immunodeficiency easily. In a cross-sectional study, we analysed the patterns of diseases and of CD4 counts among 266 HIV-infected adults. Peripheral facial paralysis and chronic cutaneo-mucous diseases were the earlier B-stage diseases. Pulmonary tuberculosis was close to B-stage diseases, and chronic diarrhoea was borderline between B and C stages. Cachexia was the most frequent C-stage symptom (47.8%). Ninety per cent of CDC-C stage people had CD4 counts below 350/microliter, whereas only 75% had CD4 counts below 200/microliter. Regression analysis identified the lymphocyte count, clinical stage and platelet count as predictors of CD4 count below 350/microliter. A simple score (lymphocyte count < or = 2500/microliter and clinical stage > or = B) is proposed to determine this CD4 threshold (positive predictive value: 83%) and to determine those patients needing treatment to prevent wasting and opportunistic infections.

Staging Laparotomy in the Management of Hodgkin's Disease: Is it Still Necessary?

Approximately 3,500 cases of stage I and II Hodgkin's disease are diagnosed each year in the United States. Traditionally, those patients who are considered candidates for primary radiation therapy undergo staging laparotomy (pathologic staging) to rule out definitively the presence of occult subdiaphragmatic disease. An appreciation of the risks of laparotomy and a recognition of the effectiveness of salvage chemotherapy in patients who fail primary radiation therapy have permitted the increased use of clinical staging as the basis for treatment of these patients. This article summarizes the literature regarding the need for staging laparotomy in early stage Hodgkin's disease and suggests alternative approaches to the management of these patients based on clinical criteria and prognostic factors.

Immunoglobulin-Producing Tumors

Multiple myeloma and macroglobulinemia are the most common immunoglobulin-producing neoplasms seen in the dog. Treatment with the alkylating agents in combination with prednisone may significantly prolong survival. Supportive management of associated complications is imperative to ensure that the individual case receives optimal care. The use of clinical staging seems to be of value in establishing prognosis; however, response to therapy may be more significant, for many dogs present with advanced disease. In the high-risk patient, one should consider using investigational combination drug protocols which are available at a referral center. Although a "cure" is unlikely, the prospect of the animal having a fairly normal, healthy life for an extended period of time (over a year in the majority of cases) should encourage veterinarians to recommend evaluation for treatment in dogs with multiple myeloma and macroglobulinemia.

A plea for increased use of clinical staging in the cancer patient.

The success of clinical staging for end-result reporting requires general acceptance of the criteria comprising each clinical stage and its widespread application. It is highly desirable that a common classification be included in all clinical reviews, and a plea is made that each radiation therapy department reassess its pretreatment clinical staging procedures and systematically record the data in order that future clinical studies will be of maximum value.