scholarly journals Tumor burden as the most important prognostic factor in early stage Hodgkin's disease.Relations to other prognostic factors and implications for choice of treatment

Cancer ◽  
1988 ◽  
Vol 61 (8) ◽  
pp. 1719-1727 ◽  
Author(s):  
Lena Specht ◽  
Axel M. Nordentoft ◽  
Soren Cold ◽  
Nielsaage Toffner Clausen ◽  
Nis I. Nissen ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Prognostic Factor ◽  
Early Stage ◽  
Tumor Burden ◽  
Important Prognostic Factor ◽  
Choice Of Treatment

Prognostic Factors in Early-Stage Leiomyosarcoma of the Uterus

2009 ◽  
Vol 19 (3) ◽  
pp. 385-390 ◽  
Author(s):  
Manuela Pelmus ◽  
Frédérique Penault-Llorca ◽  
Louis Guillou ◽  
Françoise Collin ◽  
Gérard Bertrand ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Prognostic Factor ◽  
Vascular Invasion ◽  
Early Stage ◽  
Prognostic Significance ◽  
Figo Stage ◽  
Stage I ◽  
Free Interval ◽  
Important Prognostic Factor ◽  
Pathologic Features

Uterine leiomyosarcomas (LMSs) are rare cancers representing less than 1% of all uterine malignancies. Clinical International Federation of Gynecology and Obstetrics (FIGO) stage is the most important prognostic factor. Other significant prognostic factors, especially for early stages, are difficult to establish because most of the published studies have included localized and extra-pelvian sarcomas. The aim of our study was to search for significant prognostic factors in clinical stage I and II uterine LMS. The pathologic features of 108 uterine LMS including 72 stage I and II lesions were reviewed using standardized criteria. The prognostic significance of different pathologic features was assessed. The median follow-up in the whole group was 64 months (range, 6-223 months). The 5-year overall survival (OS) and metastasis-free interval and local relapse-free interval rates in the whole group and early-stage group (FIGO stages I and II) were 40% and 57%, 42% and 50%, 56% and 62%, respectively. Clinical FIGO stage was the most important prognostic factor for OS in the whole group (P = 4 × 10−15). In the stage I and II group, macroscopic circumscription was the most significant factor predicting OS (P = 0.001). In the same group, mitotic score and vascular invasion were associated with metastasis-free interval (P = 0.03 and P = 0.04, respectively). Uterine LMSs diagnosed using standardized criteria have a poor prognosis, and clinical FIGO stage is an ominous prognostic factor. In early-stage LMS, pathologic features such as mitotic score, vascular invasion, and tumor circumscription significantly impact patient outcome.

Colorectal treatment effectiveness in a population-based registry: A 1991-1994 and 2001-2005 comparison.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 647-647
Author(s):  
Ge Lin
Keyword(s):  
Prognostic Factors ◽  
Prognostic Factor ◽  
Early Stage ◽  
Multivariate Logistic Regression Analysis ◽  
Marked Change ◽  
Survival Advantage ◽  
Treatment Modalities ◽  
Outcome Variable ◽  
Important Prognostic Factor ◽  
Time Periods

647 Background: Providing state and regional cancer treatment prognoses, and comparing them over time are important for both local patients and physicians. The present study is the first in Nebraska, US to compare the change in prognostic factors for five-year survival of CC patients to those of RC patients from two time periods, 1991-1994 to 2001-2005. Methods: CC and RC Patients aged 19 years and older were selected from the Nebraska Cancer Registry the two time periods. The outcome variable was five-year survival (survived or not) from the date of diagnosis up to five years or more. Treatment was divided into five groups: surgery alone, surgery with chemotherapy and radiation therapy (S+CT+RT), surgery with chemotherapy (S+CT), other treatments, and no treatment. Multivariate logistic regression analysis was used to examine the effect of prognostic factors on five-year survival. Results: There was a 7% five-year survival improvement in RC patients from time 1 to time 2 but no survival improvement in CC patients. Younger age, female, being married, and early stage at diagnosis were associated with CC survival advantage in time 1 and time 2. In contrast, for RC patients, female had no survival advantage in time 2 while those in the 65-74 age group showed improved survival with time. With regard to treatment, surgery alone was the most consistent prognostic factor through time, while S+ CT+RT became the most important prognostic factor for survival in RC in time 2, and S+CT became the most important prognostic factor for survival in CC in time 2. Conclusions: There was marked change in treatment modalities for both CC and RC patients between the 1991-1995 and 2001-2005 periods, with a general trend toward better five-year survival prognosis. The most effective treatments for CC and RC patients in the most recent period are Surg+CT and S+CT+RT, respectively.

Predicting Time to Initial Treatment in Early Stage CLL - Integration of Classical and Novel Prognostic Factors.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 2093-2093
Author(s):  
Michael J. Keating ◽  
Susan Lerner ◽  
Xuemei Wang ◽  
Laura Z. Rassenti ◽  
Susan O’Brien ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Lymph Node ◽  
Initial Treatment ◽  
Early Stage ◽  
Tumor Burden ◽  
Fish Cytogenetics ◽  
Watch And Wait ◽  
Mutation Status ◽  
Beta 2 ◽  
Beta 2 Microglobulin

Abstract CLL patients (pts) who are not eligible for initiation of treatment by the NCI Working Group criteria (1996) are traditionally monitored on a “watch and wait” approach. There is increasing interest in initiating therapy earlier in pts who are considered high risk. The most important advice pts require in the “watch and wait” category is whether they will need treatment and when. There are a number of traditional prognostic factors that potentially identify those “watch and wait” (W&W) pts most likely to need treatment. These have recently been amplified by the discovery of new prognostic factors such as the immunoglobulin (IgVH) mutation status, FISH cytogenetics, ZAP-70, and CD38 expression on CLL cells. Most reports have emphasized the new prognostic factors without consideration of traditional characteristics such as tumor burden, stage, etc. Since January 2004 FISH, IgVH mutation status, ZAP-70, and CD38 were characterized for most pts presenting to M. D. Anderson Cancer Center. We identified an early stage low tumor burden group of 826 pts (W&W) defined with as having lymph nodes < 3 cm in the longest dimension, splenomegaly < 5 cm, and Rai stage 0 – II. Twenty-four percent of these pts have received treatment in the first two years of follow-up. From the traditional prognostic factors, number of lymph node sites (cervical, axillary, and inguinal), absolute lymphocyte count (ALC), serum beta-2-microglobulin (B2M) levels were highly correlated with time-to-initial treatment (P<.001). The predictive power of these characteristics was also confirmed in an earlier historic patient population. When these three characteristics are evaluated in multivariate analysis, IgVH mutation status, ZAP-70, and FISH cytogenetics all add independent prognostic power. When these three novel characteristics were evaluated in multivariate model with the traditional characteristics, the most important were the number of node sites, ALC, B2M, FISH, IgVH mutation status, and then ZAP-70. Clinical only +Mutation Status +ZAP 70 +FISH + All 3 No. Lymph Node Sites 1 1 1 1 1 ALC 2 2 2 2 2 Beta-2-microglobulin 3 4 4 4 4 Mutation Status -- 3 -- -- 5 ZAP-70 -- -- 3 -- 6 FISH -- -- -- 3 3 Integration of novel prognostic factors into readily clinically available characteristics will enable us to develop a nomogram for predicting probability of each patient requiring therapy at one year, two years, and eventually five years. This nomogram will be presented when completed and then will be available for validation in independent patient populations studied by other groups.

The Interaction of Response and FISH-Based Risk Stratification to Better Define Clinical Outcome in Myeloma

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1823-1823
Author(s):  
Kevin D Boyd ◽  
Fiona M Ross ◽  
Mark T Drayson ◽  
Roger G Owen ◽  
Alex J Szubert ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
High Risk ◽  
Prognostic Factor ◽  
Induction Therapy ◽  
Response Rates ◽  
Phase Iii ◽  
Prognostic Impact ◽  
Cell Transplant ◽  
Important Prognostic Factor

Abstract Abstract 1823 Background: The achievement of a complete response (CR) is an important prognostic factor in myeloma. The international staging system (ISS) and tumor genetic lesions detected by FISH also impact survival. It is not known whether response rates are adversely affected by these factors, whether achieving CR overcomes the adverse prognosis associated with these factors, or if achievement of CR is more important in a specific biological subgroup. We have examined the importance of CR in the context of these other prognostic factors in the intensive arm of a phase III randomized trial, MRC Myeloma IX, in which all patients were planned to proceed to autologous stem cell transplant (ASCT) after induction. Patients and Methods: Patients were randomized to a conventional or thalidomide-based induction regimen followed by ASCT, with a second randomization to maintenance thalidomide versus no maintenance. Response was assessed after completion of induction therapy and 100 days post-ASCT. iFISH was performed on diagnostic bone marrow samples and genetic lesions associated with adverse progression free survival (PFS) were defined as t(4;14), t(14;16), t(14;20), +1q and 17p-. Results: To confirm that CR was prognostically important in the data set, patients with a CR at 100 days post-ASCT (N=355) were compared to non-CR (N=344) (comprising VGPR, PR and SD). CR was strongly associated with improved PFS (median 30.8 months vs 38.7 months, P<0.001) but was not associated with improved OS at median follow-up of 3.7 years. Response rates were assessed in the context of other prognostic factors. Interestingly, the presence of high risk FISH lesions was not associated with impaired CR rates following induction therapy (P=0.584) or following ASCT (P=0.314). Patients without adverse genetic lesions had a CR rate of 11.1% post-induction which improved to 48.3% post-ASCT. In comparison, patients with adverse FISH lesions had a 13.3% CR rate, rising to 44.9% post ASCT. Similarly, there was no correlation between ISS stage and response. The absence of adverse FISH lesions (hazard ratio (HR) 2.68 (1.94-3.70) P<0.001) and achievement of CR (HR 1.58 (1.15-2.17) P=0.005) were independently associated with improved PFS in multivariate analysis. The prognostic impact of achieving CR was assessed in various prognostic groups. CR was associated with improved PFS in patients with no adverse FISH lesions (N=179)(median PFS 58.4 vs 37.1 months, P=0.031), and in ISS I (N=182)(median PFS 51.2 vs 33.2 months, P=0.008). In patients with adverse FISH lesions, and in ISS II and III, there was a trend towards improved PFS with CR that was not significant. For patients achieving CR as their maximum response (N=398), in a multivariate analysis including the ISS, the presence of high risk FISH lesions was the most significant factor associated with impaired PFS and OS. Patients with more than 1 adverse FISH lesion were associated with an especially high risk of progression or death (PFS HR 6.63 (3.23-13.53) P<0.001; OS HR 5.35 (1.98-14.45) P=0.001). Conclusion: These data show that attainment of CR is an important prognostic factor associated with improved PFS in patients treated with ASCT, and this benefit was most significant in patients with favorable prognostic factors such as lack of adverse FISH lesions and ISS I. The presence of t(4;14), t(14;16), t(14;20), +1q or 17p- was also strongly associated with PFS, and the impaired outcome associated with these adverse genetic lesions was not overcome by achievement of CR, within the context of the therapies used in this trial. The presence of more than 1 adverse FISH lesion identified a patient group with an especially poor prognosis, despite achieving CR. However, CR rates within these high risk patients were similar to patients without adverse genetic features, showing that they were sensitive to chemotherapy, but progressed quickly after therapy was stopped. The implication of these data is that it may be possible to improve the poor outcome of this genetically-defined high risk group with an alternative treatment strategy aimed at maintaining these responses. Disclosures: Gregory: Celgene: Honoraria. Child:Celgene: Honoraria.

Sentinel Node Tumor Burden According to the Rotterdam Criteria Is the Most Important Prognostic Factor for Survival in Melanoma Patients

2008 ◽  
Vol 248 (6) ◽  
pp. 949-955 ◽  
Author(s):  
Alexander C. J. van Akkooi ◽  
Zbigniew I. Nowecki ◽  
Christiane Voit ◽  
Gregor Schäfer-Hesterberg ◽  
Wanda Michej ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Sentinel Node ◽  
Tumor Burden ◽  
Important Prognostic Factor ◽  
Melanoma Patients ◽  
Rotterdam Criteria

scholarly journals Integrating Pathology, Chromosomal Instability and Mutations for Risk Stratification in Early-stage Endometrioid Endometrial Carcinoma

2020 ◽  
Author(s):  
Yuan Li ◽  
Jiaqi Li ◽  
Ensong Guo ◽  
Jia Huang ◽  
Guangguang Fang ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Prognostic Factor ◽  
Risk Stratification ◽  
Endometrial Carcinoma ◽  
Molecular Pathology ◽  
Chromosomal Instability ◽  
Risk Model ◽  
Early Stage ◽  
Molecular Characteristics ◽  
Molecular Stratification

Abstract Background: Risk stratifications for endometrial carcinoma (EC) depend on histopathology and molecular pathology. Histopathological risk stratification lacks reproducibility, neglects heterogeneity and contributes little to surgical procedures. Existing molecular stratification is useless in patient with specific pathological or molecular characteristics, and cannot guide postoperative adjuvant radiotherapies. Chromosomal instability (CIN), the numerical and structural alterations of chromosome resulting from ongoing errors of chromosome segregation, is an intrinsic biological mechanism for the evolution of different prognostic factors of histopathology and molecular pathology, which may be applicable to the risk stratification of EC.Results: By analysis of CIN25 and CIN70, two reliable gene expression signatures for CIN, we found that EC with unfavorable prognostic factors of histopathology or molecular pathology had serious CIN. However, POLE-mutant, as a favorable prognostic factor, had elevated CIN signatures, and CTNNB1-mutant, as an unfavorable prognostic factor, had decreased CIN signatures. Only if these two mutations were excluded were CIN signatures strongly prognostic for outcomes in different adjuvant radiotherapy subgroups. Integrating pathology, CIN signatures and POLE / CTNNB1 mutation stratified stageⅠendometrioid EC into four groups with improved risk prognostication and treatment recommendations.Conclusions:We revealed the possibility of integrating histopathology and molecular pathology by CIN for risk stratification in early-stage EC. Our integrated risk model deserves for further improvement and validation.

Metabolic Tumor Volume Has Potential Clinical Impact Compared with SUVmax in Primary Gastrointestinal Diffuse Large B Cell lymphoma

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4983-4983
Author(s):  
Moo-Kon Song ◽  
Joo-seop Chung ◽  
Ho-Jin Shin ◽  
Joon Ho Moon ◽  
Jeong Ok Lee ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Prognostic Factor ◽  
Tumor Volume ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Metabolic Tumor Volume ◽  
Tumor Burden ◽  
Large B Cell Lymphoma ◽  
18F Fdg ◽  
Large B Cell

Abstract Abstract 4983 Background: Primary gastrointestinal (GI) lymphoma is the most commonly involved extranodal site and represents 10–15% of all Non-Hodgkin's Lymphoma cases. Recent studies showed that the prognostic value of early 18F-FDG PET using maximum standardized uptake volume (SUVmax) on pretreatment was important prognostic factor in primary GI diffuse large B cell lymphoma (DLBCL). However, initial tumor burden is still an important subject associated with prognosis even extranodal DLBCL. The purpose of this study was to assess the prognostic impact of metabolic tumor volume (MTV) as tumor burden using by PET scan technique compared with initial SUVmax in primary GI DLBCL. Patients and methods: From April, 2006 to July, 2009, 125 stage IE (58 patients) or IIE (67 patients) primary GI DLBCL patients with localized lymph node involvement were enrolled and assigned to 6 or 8 cycles of R-CHOP therapy. Median follow-up was 36 months. Median age was 62 years (range, 20–79 years). Seventy-four patients were male and remainders were female. Numbers of patients above 60 years were 71. Twenty-five patients had an Eastern Cooperative Oncology Group performance status of more than two. Calculatory system by computer automatically delineated a extranodal target lesions above SUV, 2.5 and MTV of GI lesion was 3-dimensional reconstructed by fusion software. The SUVmax was collected from predominant GI lesion and calculated based on the attenuation-corrected images, the amount of injected 18F-FDG and body weight. Results: The extranodal sites of GI tract were included stomach and duodenum (64 patients, 51.2%), jejunum (10 patients, 8%), terminal ileum (30 patients, 24%), cecum (7 patients, 5.6%), ascending colon (8 patients, 6.4%), transverse colon (3 patients, 2.4%) and decending colon (3 patients, 2.4%). We used ROC curve analysis. 158.3cm3 was decided as best ideal cut-off value of MTV and 15.5 was decided as the cut-off value of SUVmax. Several factors (age, sex, disease status and IPI score) between high MTV (≥158.3cm3) and low MTV group (<158.3cm3) were not significantly different. However, SUVmax higher in high MTV group than low MTV group (p<0.001). In response by revised International Workshop Criteria, low MTV group had excellent response rates than high MTV group (CR, p<0.001; PR, p=0.014; SD & PD, p<0.001). Moreover, 3-year PFS was higher in low MTV group than high MTV group (low MTV group, 96.7%; high MTV group, 37.1%; p<0.001) and 3-year OS was also higher in low MTV group than high MTV group (low MTV group, 97.8%; high MTV group, 42.9%; p<0.001). The PFS and OS were higher in low SUVmax group (<15.5) than high SUVmax group (≥15.5) (p<0.001, p<0.001, respectively). In univariate analysis, high IPI score is still important prognostic factor for PFS and OS (PFS: HR, 4.181 [1.844-9.478] p=0.001 & OS: HR, 4.300 [1.801-10.263] p=0.001). High MTV and high SUVmax were also poor prognostic factors for PFS and OS (high MTV; PFS: HR, 26.543 [7.923-88.231] p<0.001 & OS: HR, 32.458 [7.579-139.018] p<0.001) (high SUVmax; PFS: HR, 6.998 [2.399-20.418] p<0.001 & OS: HR, 13.976 [3.257-59.979] p<0.001). In multivariate analysis, high MTV group (PFS: HR, 19.850 [5.193-75.870] p<0.001 & OS: HR, 17.918 [3.694-86.904] p<0.001) and high IPI score (PFS: HR, 2.659 [1.136-6.223] p=0.024 & OS: HR, 2.866 [1.175-6.989] p=0.021) were independent prognostic factors for PFS and OS. However, SUVmax had not significant value for survival. Conclusion: In primary GI DLBCL, high MTV is very important and potential prognostic factor compared with SUVmax for predicting the survival. Therefore, more aggressive treatment strategy would be performed in primary GI DLBCL patients having initial high tumor burden. Disclosures: No relevant conflicts of interest to declare.

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