scholarly journals Mortality calculator as a possible prognostic predictor of overall survival after gastrectomy in elderly patients with gastric cancer

2020 ◽  
Author(s):  
Hidenori Akaike ◽  
Yoshihiko Kawaguchi ◽  
Suguru Maruyama ◽  
Katsutoshi Shoda ◽  
Ryo Satio ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Elderly Patients ◽  
Performance Status ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Clinical Database ◽  
National Clinical Database ◽  
Cox Proportional Hazard

Abstract Background: The number of elderly patients with gastric cancer has been increasing. Most elderly patients have associated reduced physiologic functions, that can sometimes become an obstacle to safe surgical treatment. The National Clinical Database Risk Calculator, which based on a large Japanese surgical database, provides predicted mortality and morbidity in each case as the surgical-related risks. The purpose of this study was to investigate the clinical significance of the risk for operative mortality (NRC-mortality), as calculated by the National Clinical Database Risk Calculator, during long-term follow-up after gastrectomy for elderly patients with gastric cancer.Methods: We enrolled 73 patients aged ≥80 years and underwent gastrectomy at our institution. Their surgical risk was evaluated based on the NRC-mortality. Several clinicopathologic factors, including NRC-mortality, were selected, and analyzed as the possible prognostic factors for elderly patients who have undergone gastrectomy for gastric cancer. Statistical analysis was performed using the log-rank test and Cox proportional hazard model.Results: NRC-mortality ranged from 0.5% to 10.6%, and the median value was 1.7%. Dividing the patients according to mortality, the overall survival was significantly worse in the high mortality group (≥1.7%, n = 38) than in the low mortality group (<1.7%, n = 35), whereas disease-specific survival was not different between the two groups. In the Cox proportional hazard model, multivariate analysis revealed NRC-mortality, performance status, and surgical procedure as the independent prognostic factors for overall survival. For disease-specific survival, the independent prognostic factors were performance status and pathological stage but not NRC-mortality.Conclusion: The NRC-mortality might be clinically useful for predicting both surgical mortality and overall survival after gastrectomy in elderly patients with gastric cancer.

scholarly journals Mortality calculator as a possible prognostic predictor of overall survival after gastrectomy in elderly patients with gastric cancer

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Hidenori Akaike ◽  
Yoshihiko Kawaguchi ◽  
Suguru Maruyama ◽  
Katsutoshi Shoda ◽  
Ryo Saito ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Elderly Patients ◽  
Performance Status ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Clinical Database ◽  
National Clinical Database ◽  
Cox Proportional Hazard

Abstracts Background The number of elderly patients with gastric cancer has been increasing. Most elderly patients have associated reduced physiologic functions that can sometimes become an obstacle to safe surgical treatment. The National Clinical Database Risk Calculator, which based on a large Japanese surgical database, provides predicted mortality and morbidity in each case as the surgical-related risks. The purpose of this study was to investigate the clinical significance of the risk for operative mortality (NRC-mortality), as calculated by the National Clinical Database Risk Calculator, during long-term follow-up after gastrectomy for elderly patients with gastric cancer. Methods We enrolled 73 patients aged ≥ 80 years and underwent gastrectomy at our institution. Their surgical risk was evaluated based on the NRC-mortality. Several clinicopathologic factors, including NRC-mortality, were selected and analyzed as the possible prognostic factors for elderly patients who have undergone gastrectomy for gastric cancer. Statistical analysis was performed using the log-rank test and Cox proportional hazard model. Results NRC-mortality ranged from 0.5 to 10.6%, and the median value was 1.7%. Dividing the patients according to mortality, the overall survival was significantly worse in the high mortality group (≥ 1.7%, n = 38) than in the low mortality group (< 1.7%, n = 35), whereas disease-specific survival was not different between the two groups. In the Cox proportional hazard model, multivariate analysis revealed NRC-mortality, performance status, and surgical procedure as the independent prognostic factors for overall survival. For disease-specific survival, the independent prognostic factors were performance status and pathological stage but not NRC-mortality. Conclusion The NRC-mortality might be clinically useful for predicting both surgical mortality and overall survival after gastrectomy in elderly patients with gastric cancer.

scholarly journals Mortality calculator as a possible prognostic predictor of overall survival after gastrectomy in elderly patients with gastric cancer

2020 ◽  
Author(s):  
Hidenori Akaike ◽  
Yoshihiko Kawaguchi ◽  
Suguru Maruyama ◽  
Katsutoshi Shoda ◽  
Ryo Satio ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Elderly Patients ◽  
Performance Status ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Clinical Database ◽  
National Clinical Database ◽  
Cox Proportional Hazard

Abstract Background: The number of elderly patients with gastric cancer has been increasing. Most elderly patients have associated reduced physiologic functions, that can sometimes become an obstacle to safe surgical treatment. The National Clinical Database Risk Calculator, which based on a large Japanese surgical database, provides mortality and morbidity as the surgical-related risks. The purpose of this study was to investigate the clinical significance of the risk for operative mortality (NRC-mortality), as calculated by the National Clinical Database Risk Calculator, during long-term follow-up after gastrectomy for elderly patients with gastric cancer.Methods: We enrolled 73 patients aged ≥80 years and underwent gastrectomy at our institution. Their surgical risk was evaluated based on the NRC-mortality. Several clinicopathologic factors, including NRC-mortality, were selected, and analyzed as the possible prognostic factors for elderly patients who have undergone gastrectomy for gastric cancer. Statistical analysis was performed using the log-rank test and Cox proportional hazard model.Results: NRC-mortality ranged from 0.5% to 10.6%, and the median value was 1.7%. Dividing the patients according to mortality, the overall survival was significantly worse in the high mortality group (≥1.7%, n = 38) than in the low mortality group (<1.7%, n = 35), whereas disease-specific survival was not different between the two groups. In the Cox proportional hazard model, multivariate analysis revealed NRC-mortality, performance status, and surgical procedure as the independent prognostic factors for overall survival. For disease-specific survival, the independent prognostic factors were performance status and pathological stage but not NRC-mortality.Conclusion: The NRC-mortality might be clinically useful for predicting both surgical mortality and overall survival after gastrectomy in elderly patients with gastric cancer.

scholarly journals Mortality calculator as a possible prognostic predictor for overall survival after gastrectomy in elderly patients with gastric cancer

2020 ◽  
Author(s):  
Hidenori Akaike ◽  
Yoshihiko Kawaguchi ◽  
Suguru Maruyama ◽  
Katsutoshi Shoda ◽  
Ryo Satio ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Elderly Patients ◽  
Rank Test ◽  
Proportional Hazard ◽  
Mortality And Morbidity ◽  
Neutrophil Lymphocyte Ratio ◽  
Cox Proportional Hazard ◽  
Long Term Follow Up

Abstract Background The number of elderly patients with gastric cancer (elderGC) has been increasing. Most of elderly patients were associated with reduced physiological functions, which sometimes constitute an obstacle to safe surgical treatments. The risk calculator of National Clinical Database (NRC), a Japanese surgical big database, provides mortality and morbidity as surgical-related risks. The purpose of this study is to investigate clinical significance of operative mortality calculated by NRC (NRC-mortality) during long-term follow-up after gastrectomy for elderGC.Methods We enrolled 73 patients aged 80 or over who underwent gastrectomy at our institution. Their surgical risk was evaluated based on the NRC-mortality. Several clinicopathological factors including NRC-mortality were selected and analyzed as possible prognostic factors for elderGC after gastrectomy. Statistical analysis was performing using the log-rank test and Cox proportional hazard model.Results NRC-mortality ranged 0.5 to 10.6%, and median value was 1.7%. Dividing elderGC into high- (1.7% or more, n=38) and low- (less than 1.7%, n=35) mortality groups, high-mortality group showed a significantly poor prognosis in overall survival (OS) than the low-mortality group, whereas there was no difference between the two groups in disease specific survival (DSS). In the analysis of Cox proportional hazard model, multivariate analysis revealed that NRC-mortality was an independent prognostic factor as well as neutrophil-lymphocyte ratio and surgical procedure in OS. In contrast, PS and pStage were independent prognostic factors in DSS, but not NRC-mortality.Conclusions The NRC-mortality might be clinical useful for not only predicting surgical mortality but also OS after gastrectomy in elderGC.

Clinical prognostic factors associated with survival and a survival score for patients with brain metastases

2019 ◽  
Vol 15 (22) ◽  
pp. 2619-2634 ◽  
Author(s):  
Patricia Șuteu ◽  
Nicolae Todor ◽  
Radu-Mihai Ignat ◽  
Viorica Nagy
Keyword(s):  
Prognostic Factors ◽  
Brain Metastases ◽  
Prognostic Score ◽  
Performance Status ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Single Institution ◽  
Factors Associated ◽  
Cox Proportional Hazard ◽  
Status Number

Aim: To identify prognostic factors of survival in patients with brain metastases (BM) and to devise a prognostic score. Patients & methods: In this single-institution retrospective study, we analyzed potential clinical prognostic factors in 1363 patients with BM. Based on the Cox proportional hazard model, we devised a BM score with three classes (score <5, 5–6 and >6). Results: The 1-year overall survival (OS) was 26%. Independent prognostic factors of OS were: age, gender, Karnofski performance status, number of BM, control of primary, presence of extracerebral metastases and type of primary tumor. The 1-year OS was 56% for score <5; 21% for score 5–6 and 4% for score >6 (p < 0.01). Conclusion: The BM score we propose is effective in grouping patients according to their prognosis and can help decision making regarding treatment adjustments.

scholarly journals Prognostic nomogram for patients with non-metastatic HER2 positive breast cancer in a prospective cohort

2019 ◽  
Vol 34 (1) ◽  
pp. 41-46 ◽  
Author(s):  
Chuanxu Luo ◽  
Xiaorong Zhong ◽  
Zhu Wang ◽  
Yu Wang ◽  
Yanping Wang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Prospective Cohort ◽  
Proportional Hazard ◽  
Her2 Positive ◽  
Her2 Positive Breast Cancer ◽  
Cox Proportional Hazard ◽  
Cox Proportional Hazard Regression ◽  
Positive Breast Cancer

Purpose: A nomogram is a reliable tool to generate individualized risk prediction by combining prognostic factors. We aimed to construct a nomogram for predicting the survival in patients with non-metastatic human epidermal growth factor receptor 2 (HER2) positive breast cancer in a prospective cohort. Methods: We analyzed 1304 consecutive patients who were diagnosed with non-metastatic HER2 positive breast cancer between January 2008 and December 2016 in our institution. Independent prognostic factors were identified to build a nomogram using the COX proportional hazard regression model. The prediction of the nomogram was evaluated by concordance index (C-index), calibration and subgroup analysis. External validation was performed in a cohort of 6379 patients from the Surveillance, Epidemiology, and End Results (SEER) database. Results: Through the COX proportional hazard regression model, five independent prognostic factors were identified. The nomogram predicting overall survival achieved a C-index of 0.78 in the training cohort and 0.74 in the SEER cohort. The calibration plot displayed favorable accordance between the nomogram prediction and the actual observation for 3-year overall survival in both cohorts. The quartiles of the nomogram score classified patients into subgroups with distinct overall survival. Conclusion: We developed and validated a novel nomogram for predicting overall survival in patients with non-metastatic HER2 positive breast cancer, which presented a favorable discrimination ability. This model may assist clinical decision making and patient–clinician communication in clinical practice.

Survival outcomes of schirrhus gastric cancer treated by multidisciplinary treatments: Putative impact on prognosis by DCS NAC.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 128-128
Author(s):  
Keishi Yamashita ◽  
Kei Hosoda ◽  
Natsuya Katada ◽  
Hiromitsu Moriya ◽  
Hiroaki Mieno ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Prognostic Factors ◽  
Hazard Model ◽  
Margin Status ◽  
Negative Margin ◽  
University Hospital ◽  
Proportional Hazard ◽  
Late Period ◽  
Proportional Hazard Model ◽  
Multivariate Proportional Hazard

128 Background: Among gastric cancer, schirrhus exhibited the poorest prognosis, and many patients die even after curative resection due to recurrence. Although progress of multidisciplinary treatments of advanced gastric cancer is outstanding, recent clinical outcome is obscure by such intensive treatments. Methods: Among the 5,664 gastric cancer patients who underwent gastrectomy between 1971 and 2013 in the Kitasato University Hospital, 287 of shirrhus gastric cancer were included (5%). We divided the total periods into early (1971-2004) and late period (2005-2013), and compared their prognosis. Multivariate proportional hazard model was applied to the significant univariate prognostic factors (p<0.05), and identified independent prognostic factors (IPFs). Finally we compared the IPFs in terms of periods, and discuss the most appropriate treatments. Results: (1) Five-year survival rate was 13% and 31% in the early and late periods, respectively (p=0.0010). Between the periods, there were significant differences of pT (p=0.013), CY (p<0.0001), and Margin status (p=0.041). (2) Univariate prognostic factors were age (p=0.032), pT (p=0.0009), pN (p<0.0001), P (p=0.0033), CY (p=0.0002), and Margin status (p<0.0001). Multivariate proportional hazard model elucidated IPFs of pN (pN0-2 vs pN3a-X, p<0.0001) and Margin status (positive vs negative, p=0.0003). If the 2 factors were combined, patients with pN0-2 plus margin negative showed much better survival (about 40% of 5-year OS) than otherwise cases (below 10%)(p<0.0001). (3) Comparison of the IPFs between early and late periods, margin positive cases were significantly less infrequent in the late period. This may be aggressive application of neoadjuvant chemotherapy of DCS (Docetaxel/CDDP/S1). Conclusions: Due to recent progress of multidisciplinary treatments of preoperative aggressive chemotherapy and surgery with curative intent for negative margin for schirrhus gastric cancer, its 5-year survival was dramatically improved. pN0-2 patients were promising for reasonable prognosis if negative margin is secured, so intraoperative diagnosis must be urgently developed.

Optimal indications for palliative chemotherapy in elderly patients with metastatic or recurrent gastric cancer.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 207-207
Author(s):  
Hiroko Hasegawa ◽  
Kazumasa Fujitani ◽  
Aya Sugimoto ◽  
Shoichi Nakazuru ◽  
Motohiro Hirao ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Elderly Patients ◽  
Primary Tumor ◽  
Multivariate Analyses ◽  
Performance Status ◽  
First Line ◽  
Recurrent Gastric Cancer ◽  
Significant Difference ◽  
Line Chemotherapy

207 Background: Gastric cancer is the second causes of cancer-related deaths in the world and its incidence of advanced gastric cancer (AGC) in the elderly is increasing as a result of increased life expectancy. However, elderly patients have been underrepresented in many kinds of chemotherapy clinical trials. Therefore it is difficult to evaluate the efficacy and safety of chemotherapy for elderly patients and select the appropriate patients aged 70 years or older who are likely to benefit from the chemotherapy. Methods: There were 265 patients with primary unresectable or recurrent gastric cancer treated at our institution between April 2007 and March 2014. Of all, 90 patients aged 70 years or older were retrospectively identified. We evaluated the efficacy of the chemotherapy and prognostic significance of clinico-pathologic factors to identify the optimal indications for chemotherapy. Univariate and multivariate analyses were perfomed on the base-line characteristics such as patient’s performance status (PS), gender, chemotherapy regimens, history of gastrectomy, presense of co-morbidity, serum LDH level, serum C reactive protein, and nutritional status, at the initiation of the first-line chemotherapy. Results: The median overall survival time (OS) was 343 days and the median TTF on first-line chemotherapy was 111 days. The toxicity was mild and tolerable. There were no significant difference in overall survival between patients receiving monotherapy and combination therapy. On multivariate analyses, PS 1 or 2 (hazard ratio (HR), 1.883; 95% confidence interval (CI), 1.047–3.390), presence of primary tumor (HR, 1.916; 95% CI, 1.063–3.448) at the initiation of the first- line chemotherapy were identified as significant independent poor prognostic factors for overall survival. Especially in patients aged 75 years or older, only PS was an independent prognostic factor for OS (HR, 3.703; 95% CI, 1.314–9.900). Conclusions: Analysis of our results shows that patients aged 70 years or older with good performance status and absence of primary tumor might achieve clinical benefit from chemotherapy.

scholarly journals Prognostic Factors for Elderly Gastric Cancer Patients who Underwent Gastrectomy

2021 ◽  
Author(s):  
Shunji Endo ◽  
Tomoki Yamatsuji ◽  
Yoshinori Fujiwara ◽  
Masaharu Higashida ◽  
Hisako Kubota ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Performance Status ◽  
Postoperative Mortality ◽  
Prognostic Nutritional Index ◽  
Pathological Stage ◽  
Mortality And Morbidity ◽  
Operative Severity Score

Abstract Background: Patients with gastric cancer are aging in Japan. It is not clear which patients and which surgical procedures have survival benefits after gastrectomy. A multivariate analysis was performed.Methods: The medical records of 166 patients aged ≥80 years who underwent gastrectomy without macroscopic residual tumors were retrospectively reviewed. Univariate and multivariate analyses using Cox proportional hazard models were performed to detect prognostic factors for overall survival.Results: In univariate analyses, age (≥90 vs. ≥80, <85), performance status (3 vs. 0), the physiological score of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) (≥40 vs. ≥20, ≤29), Onodera’s prognostic nutritional index (<40 vs. ≥45), American Society of Anesthesiologists physical status (ASA-PS) (3, 4 vs. 1, 2), surgical approach (laparoscopic vs. open), extent of gastrectomy (total, proximal vs. distal), extent of lymphadenectomy (D1 vs. ≥D2), pathological stage (II-IV vs. I), and residual tumor (R1 vs. R0) were significantly correlated with worse overall survival. Multivariate analysis revealed that ASA-PS [3, 4 vs. 1, 2, hazard ratio (HR) 2.30, 95% confidence interval (CI) 1.24-4.24], extent of gastrectomy (total vs distal, HR 2.17, 95% CI 1.10-4.31), (proximal vs. distal, HR 4.05, 95% CI 1.45-11.3), extent of lymphadenectomy (D0 vs. ≥D2, HR 12.4, 95% CI 1.58-97.7) and pathological stage were independent risk factors for mortality.Conclusions: ASA-PS was a useful predictor for postoperative mortality. Gastrectomy including cardia and excessive limitation of lymphadenectomy are best avoided.

Experience with Hemophagocytic Lymphohistiocytosis in Adults: A Retrospective Study of 56 Patients in a Single Institute of China

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4727-4727
Author(s):  
Xiao Shuai ◽  
Ting Liu ◽  
Ting Niu ◽  
Hong Chang ◽  
Jianjun Li ◽  
...  
Keyword(s):  
Overall Survival ◽  
Retrospective Study ◽  
Clinical Features ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Nk Cell ◽  
Cox Proportional Hazard Model ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Cox Proportional Hazard

Abstract Abstract 4727 Hemophagocytic lymphohistiocytosis (HLH) is a rare but potentially life-threatening condition. HLH can be classified as primary one and secondary one (sHLH). sHLH is an aetiologically heterogeneous entity, including infection (infection-associated HLH, IHLH), malignancy (malignancy-associated HLH, MHLH), and connective tissue disease (CTD). The majority of previous cases in the literature are paediatric HLH. Published data on HLH in adults are limited. In addition, present clinical data are mostly from western countries and Japan. There are few studies of HLH in China. Here, we present a retrospective study of 56 adult HLH patients in a single institute of China, to evaluate the underlying causes, clinical features, medical intervention, outcome and prognosis of HLH in the Chinese adult population. We searched the hospital registry and identified 56 consecutive patients diagnosed as HLH in our institute, between Jun 2008 and Jun 2011. The diagnosis of HLH was based on the HLH-04 criteria. We retrospectively collected data on demographics, etiology, clinical features, laboratory tests, treatment and outcome. SPSS 13.0 software was used for statistical analysis. The Mann-Whitney test was used to compare variables. Curves for overall survival were plotted according to Kaplan-Meier test, and compared by log-rank test. Prognostic factors were determined by Cox proportional hazard model. The median age at diagnosis was 34 (range, 14–83 years). The male to female ratio was 1.95:1. Regarding etiologies, 43 patients (76.8%) were MHLH, 4 patients (7.1%) were IHLH, 1 patient (1.8%) had CTD, and for the remaining 8 patients (14.3%) the underlying cause could not be determined. Of the 43 cases of MHLH, 23 patients (53.5%) had Mature T- and NK-cell neoplasms; 10 patients (23.2%) had mature B-cell neoplasms; 1 patients (2.3%) had B lymphoblastic leukaemia; 2 patients (4.7%) had Hodgkin lymphomas, and the remaining 7 patients (16.3%) had unclassified hematological malignancies. The clinical characteristics and laboratory findings were summarized in Table. 1, and compared with literature (GE Janka, 2007) our patients had lower triglycerides and higher ferritin levels. The median time from symptoms to diagnosis was 1.4 months (range, 0.1–24.0 months), the median time from admission to diagnosis was 2 days (range, 0–30 days). Interestingly, patients admitted to departments other than the hematology department had significantly longer time for diagnosis (16 versus 2 days, P<0.001). Most patients were treated with HLH-04 based therapy, including steroid (54/56, 96.4%), cyclosporine (36/56, 64.3%), and etoposide (29/56, 51.8%). In MHLH patients, 19/43 patients (44.2%) received chemotherapy. Infection complicated the course in 45/56 (80.4%) patients. The median follow-up time of the survived patients was 300 days (range, 63–825 days). Seven patients lost follow-up, 38 patients died, 11 patients survived. The median survival time was 28 days (range, 0–825 days). The modality rate was 67.9%, and the major cause of death was multiple organs failure. MHLH had significantly shorter survival time than non-malignancy HLH (P=0.05, Figure 1). Cox proportional hazard model indicated that age, hypoalbuminemia and hypofibrinogenemia were the risk factors of poor prognosis.Table 1.Main clinical features and lab tests of the 56 patientsN(%)MedianRangeClinical featuresFever56 (100.0)NANANeurological symptom11 (19.6)NANASplenomegaly51 (91.1)NANALaboratory TestsHemoglobin (g/dL)42 (75.0)8.34.8–12.2Platelet count (per mm3)54 (96.4)27,0002,000–289,000Neutrophils count (per mm3)32/55 (58.2)90030–15,7300Triglycerides (mmol/L)23 (41.1)2.511.02–8.05Albumin (g/L)54 (96.4)26.315.0–37.0Fibrinogen (g/L)36 (64.3)1.300.50–5.85Ferritin (ng/mL)40/41 (97.6)>2000.0373.0->2000.0Hemophagocytosis42/54 (77.8)NANAEBV infection24/34 (70.6)NANANA indicates not applicable; EBV, Epstein-Barr virus.Figure 1.Overall Survival of Patients with MHLH and non-MHLHFigure 1. Overall Survival of Patients with MHLH and non-MHLH Our study reveals that three-quarter causes of adult HLH in our institute are malignancies, especially T/NK-cell neoplasms, co-infection with EBV is common. Age, albumin and fibrinogen levels are the most important factors for prognosis. More educational and research work about HLH should be conducted in developing countries. Disclosures: No relevant conflicts of interest to declare.

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