Multivariate analysis versus multiple univariate analyses.

Author(s):  
Carl J. Huberty ◽  
John D. Morris
Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3036-3036
Author(s):  
Franca Fagioli ◽  
Paola Quarello ◽  
Marco Zecca ◽  
Edoardo Lanino ◽  
Carla Rognoni ◽  
...  

Abstract Abstract 3036 Children with acute lymphoblastic leukemia (ALL) in first complete remission (CR1) and high risk (HR) characteristics can benefit from allogeneic hematopoietic stem cell transplantation (HSCT). We carried out a retrospective, multicenter study to analyze the outcome of 211 consecutive ALL pediatric patients who received either related or unrelated (UD) HSCT for ALL in CR1 and were reported to the Italian Association of Pediatric Hematology and Oncology (AIEOP)-HSCT Registry between 1990 and 2008. Sixty-nine patients (33%) were transplanted between 1990 and 1999, 58 (27%) between 2000 and 2005, and 84 (40%) between 2005 and 2008. A matched family donor (MFD) was employed in 138 patients (65%) and an UD in 73 (35%). The 10-year probability of overall survival and disease-free survival (DFS) was 63.4% (95% CI, 57–70) and 61% (95% CI, 54–68), respectively. In univariate analyses, the donor type had an impact on DFS only for patients transplanted between 1990 and 1999 (MFD: 65% [95% CI, 53–77], UD: 33% [95% CI, 3–64], p=0.06). There were no differences between MFD and UD for patients who underwent HSCT after 2000. DFS was better in patients with grade 0-II aGvHD than in those with grade III-IV aGvHD (65% [95% CI, 58–62] and 40% [95% CI, 22–58], p=0.002). In multivariate analyses, the occurrence of grade IV aGvHD (RR=3.8 [95% CI, 1.58–9.20], p=0.002) was an independent factor associated with worse DFS. On the contrary, the occurrence of grade I and II aGvHD (RR=0.54 [95% CI, 0.29–0.99], p=0.05; RR=0.56 [95% CI 0.30–0.98], p=0.07) were independent favorable prognostic variables for DFS. The 10-year cumulative incidence of relapse incidence (RI) was 24% (95% CI, 19–30). In univariate analyses patients who experienced grade 0-I aGvHD (30% [95% CI, 23–40]) had higher RI than patients with grade II-IV aGvHD (15% [95% CI, 9–25) (p=0.013). In multivariate analysis, the occurrence of aGvHD remained an independent prognostic variable for RI. The 10-year cumulative incidence of transplant-related mortality (TRM) was 15% (95% CI, 11–21). In univariate analyses, TRM was lower for children aged 1–9 years at diagnosis as compared with those aged 10–14 years or older than 15 years (8% [95% CI, 4–15], 18% [95% CI, 11–31], and 54% [95% IC, 34–84], respectively, p<0.00001). The impact of donor type on TRM was only observed for patients transplanted between 1990 and 1999 (UD: 44%, [95% IC, 21–92], MFD: 8% [95% IC, 4–19], p=0.0043). Patients with grade III and IV aGvHD had TRM of 32% (95% CI, 16–61) and 82% (95% CI, 62–100), respectively, versus 13% (95% CI, 7–25), 3% (95% CI, 1–14) and 12% (95% CI, 6–26) of patients with grade II, I and 0 aGvHD, respectively (p<0.00001). In multivariate analysis the strongest predictors of TRM were grade IV aGvHD (RR 18.1 [95% IC, 4.37–75.3], p<0.00001) and UD donor for HSCT performed between 1990 and 1999 (RR 4.83 [95% IC, 1.43–16.3], p=0.01).In this study, 27 and 73 out of the 100 patients investigated had minimal residual disease (MRD)-intermediate risk (IR) and MRD-high risk (HR) features, respectively. The 27 with MRD-IR were given the allograft for the presence of other characteristics rendering them classifiable as HR. The probability of DFS and RI of MRD-IR and MRD-HR was comparable. Thus, although the number of patients investigated was limited, our results seem to suggest that HSCT could reduce or, at best, abrogate the effects of MRD on patient outcome. Our results suggest that after 1999 transplant outcomes are remarkably similar in recipients of UD and MFD. No advantage of total body irradiation (TBI) over chemotherapy in the conditioning regimen in terms of DFS, RI and TRM was found. The benefit offered by the occurrence of GvHD in terms of reduction of disease recurrence was, however, offset by a higher incidence of TRM. Indeed, taking patients who did not have aGvHD as the reference group, a better probability of DFS was observed only in patients who developed grade I-II aGvHD, this suggesting that only GvHD of mild/moderate severity can favorably impact on disease outcome. In conclusion, our data support the choice of performing allogeneic HSCT in pediatric and adolescent patients with HR ALL in CR1 from either MFD or UD. Randomized prospective cooperative group studies are desirable to establish the role of TBI-based conditioning in these patients. Disclosures: No relevant conflicts of interest to declare.


Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 63-63
Author(s):  
Chezi Ganzel ◽  
Judith Manola ◽  
Dan Douer ◽  
Jacob M. Rowe ◽  
Hugo F Fernandez ◽  
...  

Abstract Background Extramedullary disease (EMD) of acute myeloid leukemia (AML) was described decades ago but the incidence of this phenomenon and its prognostic impact are not clear. It is also uncertain whether every site of EMD has the same significance. This study explored these questions using a large cohort of AML patients treated on consecutive Eastern Cooperative Oncology Group (ECOG) frontline clinical trials. Methods For AML patients enrolled into ECOG clinical trials, the presence of EMD was captured at baseline on case report forms. From patients with newly diagnosed AML, age 15 and above, who were treated on 11 consecutive different clinical trials, we identified those with or without EMD, defined by physical examination, laboratory findings and imaging, without necessarily a biopsy. We used descriptive statistics to summarize patient and disease characteristics. Univariate analyses of potential prognostic factors were done. The Kaplan-Meier method was used to estimate median overall survival (OS) within each prognostic category and differences were explored using the log-rank test. Cox proportional hazards models were used to examine the effect of one-unit increases in continuous variables on OS and for multivariable analyses. Multivariate models were built using backward selection. Factors (or groups of factors) significant at the 0.10 level in univariate analyses were tested for inclusion in the model, and retained if they were significant at the 0.05 level. Results Of the 3,522 patients enrolled in 11 different AML clinical trials, we excluded 281; for diagnosis of other types of leukemia (n=220), no EMD evaluation at baseline (n=41) or no survival data (n=20). The overall incidence of EMD was 23.8% (770 out of the remaining 3,241 patients). The sites involved were: lymph nodes 367 (11.3%) patients, spleen 234 (7.2%), liver 173 (5.3%), skin 146 (4.5%), gingiva 104 (3.2%), central nerve system (CNS) 32 (1%), peripheral nerve system (PNS) 8 (0.2%) and other sites 134 (4.1%). In 65 cases (8.4%) EMD was confirmed by biopsy. Most of the patients (64.4%) had only one site of EMD, 163 (21.2%) had 2 sites, 75 (9.7%) - 3 sites, 28 (3.6%) - 4 sites, and 4 patients (0.5%) each had 5 or 6 sites. EMD patients compared to those without EMD; tend to be younger (median age 45.7 vs 52.9 years); male (57.7% vs 52%); poorer ECOG performance status (76.4% with ECOG 0-1 vs 85.9%) and with higher white blood cell count (WBC) at diagnosis (median of 41.6/µl vs 10.2/µl). In univariate analysis, having EMD was associated with a shorter OS (P=0.006). Examination of individual EMD sites revealed that skin (P=0.002), spleen (P=0.0002) and liver (P=0.0007) but not CNS (P=0.35), PNS (P=0.53), nodal involvement (P=0.85) and gingival hypertrophy (P=0.14), were associated with poorer OS. Using proportional hazards models for continuous factors, each additional site of EMD conferred a 9.4% increase in the risk of death. In a multivariable model, after adjusting for known prognostic factors (such as: age, WBC count and cytogenetic risk group), the presence of EMD, number of EMD sites and any specific EMD site were not independently prognostic. Of 165 patients with known favorable cytogenetics EMD was present in only 22 patients (13%). This group appeared to have a worse prognosis, but the numbers are too small for a definitive assessment (figure 1). Conclusions Extramedullary disease is common in newly diagnosed AML with an incidence of almost 24%, but CNS involvement is very rare (0.95%). In contrast to published data, no site of EMD was found to have an independent prognostic impact in multivariate analysis. This large dataset emphasizes the importance of evaluating large number of patients and considering all known risk factors in the multivariate analysis. Disclosures: No relevant conflicts of interest to declare.


2021 ◽  
Author(s):  
Dalvinder Mandair ◽  
Lukasz Kamieniarz ◽  
Michail Pizanias ◽  
Martin Weickert ◽  
Akshay Narayan ◽  
...  

Abstract Background Duodenal neuroendocrine neoplasms (dNENs) are rare neoplasms but their incidence is on the rise. They are classified into 5 sub-types but there remains much heterogeneity in behaviour in particular of non-functioning dNENs. Aim To retrospectively analyse outcomes for all types of dNENs, and highlight prognostic factors associated with worse outcome Results 102 (57m/45f) patients were identified with mean age at diagnosis 62 (range 32-87) years. The majority were non-functioning tumours 87/102 and median size was 10mm (range 0.9-130mm). 83 patients had Stage I or II disease, of which 17 underwent endoscopic resection with R1 rate of 45% and complication rate 12%. 36 patients were kept under endoscopic surveillance. There were 11 deaths of which 4 were disease related. Age and Ki67 > 20% were associated with worse OS in all dNENs. In non-functioning dNENs Ki67 >3% was a predictor of lymph nodes metastases with OR 18.2 (2.54-13)(p < 0.005) in univariate analyses and liver metastases with OR 6.79 (1.56-29.5)( p < 0.05) in the multivariate analysis. Lesions 11 - 20 mm in size had OR 11.1 (1.16-106) compared to lesions <11mm for the prediction of lymph node metastases in the multivariate analysis (p < 0.05). ROC analysis of size of non-functioning dNENs to predict LN metastases found <15mm had an AUROC of 0.9 (0.81-0.99) with a sensitivity of 85% and specificity of 88%. Conclusion dNENs are increasing in incidence, however low grade and smaller lesions have an indolent course and the role of endoscopic resection and active surveillance needs to be reviewed.


Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1528-1528
Author(s):  
Tomoyasu Jo ◽  
Kazuya Sakai ◽  
Hiroyuki Muranushi ◽  
Yusuke Okamoto ◽  
Taku Tsukamoto ◽  
...  

Abstract Background The Wilms' tumor gene (WT1), originally discovered as a tumor suppressor has been proven to have an oncogenic role in leukemia and several other cancers. WT1 mRNA expression levels in peripheral blood (PBWT1) has been reported as a useful marker for the risk evaluation of myelodysplastic syndrome (MDS). In the era of hypomethylating agents, the significance of PBWT1 on MDS prognosis is still unknown. This study aimed to clarify the impact of pre-treatment PBWT1 levels on overall response (OR) and overall survival (OS) in MDS patients treated with azacitidine (AZA). Patients and Methods We retrospectively analyzed all patients from March 2011 to March 2013 with World Health Organization 2008 defined MDS, CMML or AML with 20–30% bone marrow blasts who received AZA treatment in our department for at least one cycle (37.5–75.0 mg/m2/day during 7 days, every 28 days). Patients' peripheral blood specimens were collected before AZA initiation, mRNA was extracted from leukocytes using the RNeasy Mini-Kit (Qiagen, Valencia, CA), and the amount containing WT1 mRNA was measured using a WT1 mRNA Assay Kit (Otsuka Pharmaceutical Co., Ltd., Tokyo, Japan). Hematologic response was evaluated according to International Working Group 2006. OR was defined as a best overall response of complete remission (CR), partial remission, marrow CR, or hematologic improvement. Univariate analyses for OR were carried out using Fisher's exact test. Factors associated with at least borderline significance (p < 0.10) were subjected to a multivariate analysis, using logistic regression model. OS was estimated according to the Kaplan-Meier method. Multivariate analysis was performed with proportional hazard Cox model, including all variables with p < 0.10 in univariate analyses. Results Of 55 patients enrolled, pre-treatment PBWT1 levels were available in 41 patients and the median level was 790 copies/µg RNA (range, less than 50–310000). Baseline characteristics according to PBWT1 levels (≤ 790 [lower group] [n = 21] and > 790 [higher group] [n = 20]) are summarized in Table 1. Median number of AZA treatment cycles was 4 (range, 1–18). Four patients (2 in higher group, and 2 in lower group) received allogeneic stem cell transplantation (alloSCT) after AZA treatment. OR rates were significantly lower in PBWT1 higher group than lower group (30.0 vs 71.4%, p = 0.03). In univariate analysis, other significant risk factors or with borderline significance for OR were higher serum ferritin levels (> 1000 ng/ml) and RBC transfusion dependency ≥ 4 units/8 weeks. In multivariate analysis, higher PBWT1 levels independently predicted reduced likelihood of OR (odds ratio = 0.212, 95% CI 0.01-0.95, p = 0.02). OS was significantly inferior in PBWT1 higher group as shown in Figure 1. In univariate analysis, other significant factor was Revised International Prognostic Scoring System (IPSS-R) risk groups (high risk defined as IPSS-R high or higher, and low risk defined as IPSS-R intermediate or lower). In multivariate analysis, higher PBWT1 levels (hazard ratio [HR] = 9.75, 95% CI 1.22-77.58, p = 0.03) and IPSS-R high risk (HR=7.04, 95% CI 1.43-34.48, p = 0.02) were independent predictors for OS. Conclusion Our results suggest that PBWT1 can predict both response and survival of MDS patients treated with AZA. Although salvage therapy including alloSCT can affect the survival, poor survival might result from inferior response rates in PBWT1 high patients. In MDS with high PBWT1, restoration of epigenetically silenced tumor suppressor genes with AZA might not induce apoptosis. We propose that alternative therapeutic strategies should be sought in MDS patients with high PBWT1 levels. Disclosures: No relevant conflicts of interest to declare.


2017 ◽  
Vol 05 (03) ◽  
pp. E172-E178 ◽  
Author(s):  
Fahd Jowhari ◽  
Wilma Hopman ◽  
Lawrence Hookey

Abstract Background and study aims Endoscopic retrograde cholangiopancreatgraphy (ERCP) carries a radiation risk to patients undergoing the procedure and the team performing it. Fluoroscopy time (FT) has been shown to have a linear relationship with radiation exposure during ERCP. Recent modifications to our ERCP suite design were felt to impact fluoroscopy time and ergonomics. This multivariate analysis was therefore undertaken to investigate these effects, and to identify and validate various clinical, procedural and ergonomic factors influencing the total fluoroscopy time during ERCP. This would better assist clinicians with predicting prolonged fluoroscopic durations and to undertake relevant precautions accordingly. Patients and methods A retrospective analysis of 299 ERCPs performed by 4 endoscopists over an 18-month period, at a single tertiary care center was conducted. All inpatients/outpatients (121 males, 178 females) undergoing ERCP for any clinical indication from January 2012 to June 2013 in the chosen ERCP suite were included in the study. Various predetermined clinical, procedural and ergonomic factors were obtained via chart review. Univariate analyses identified factors to be included in the multivariate regression model with FT as the dependent variable. Results Bringing the endoscopy and fluoroscopy screens next to each other was associated with a significantly lesser FT than when the screens were separated further (–1.4 min, P = 0.026). Other significant factors associated with a prolonged FT included having a prior ERCP (+ 1.4 min, P = 0.031), and more difficult procedures (+ 4.2 min for each level of difficulty, P < 0.001). ERCPs performed by high-volume endoscopists used lesser FT vs. low-volume endoscopists (–1.82, P = 0.015). Conclusions Our study has identified and validated various factors that affect the total fluoroscopy time during ERCP. This is the first study to show that decreasing the distance between the endoscopy and fluoroscopy screens in the ERCP suite significantly reduces the total fluoroscopy time, and therefore radiation exposure to patients and staff involved in the procedure.


1989 ◽  
Vol 105 (2) ◽  
pp. 302-308 ◽  
Author(s):  
Carl J. Huberty ◽  
John D. Morris

Retos ◽  
2019 ◽  
pp. 233-237
Author(s):  
Martha Ornelas Contreras ◽  
Omar Solis ◽  
Natalia Solano Pinto ◽  
Judith Margarita Rodríguez-Villalobos

El presente estudio evaluó la percepción sobre su imagen corporal actual, ideal, social e inconformidad corporal entre adolescentes mexicanas deportistas vs no-deportistas. La muestra fue obtenida por conveniencia con un total de 408 mujeres con una edad de M= 14.24 y DE= 1.69 años; 198 de ellas conforman el grupo de deportistas (M=14.30 y DE= 1.57) ya que practican algún deporte y participan regularmente en torneos o competencias deportivas, las otras 210 participantes son del grupo de no deportistas (M= 14.18 y DE= 1.79). Todas contestaron la Escala Informatizada para la Estimación del Contorno de la Figura (EIECF) adaptada e informatizada. Los resultados del análisis de la varianza, muestran que las adolescentes no deportistas son quienes eligen modelos más gruesos para su figura actual y social, además de mostrar mayor inconformidad corporal. Resultados que permiten concluir que, en general, las personas activas tienen una mejor percepción de su imagen corporal, que las sedentarias.Abstract. This study consisted in determining differences and similarities between Mexican adolescents who practice a sport and those who do not with regard to their perception of their actual, ideal, and social body image, as well as their body dissatisfaction. A total sample of 408 female teenagers aged 12-17 years old participated in this study; 198 of them practiced a sport and regularly participated in tournaments or competitions. All the participants completed the Contour Drawing Rating Scale adapted and computerized by Gastélum and Blanco (2006). The results of the one-way multivariate analysis of variance, followed by the one-way univariate analyses of variance, showed that adolescents who do not regularly participate in sports show thicker models in their present and social body image, in addition to displaying higher body dissatisfaction.


2003 ◽  
Vol 46 (4) ◽  
pp. 507-514 ◽  
Author(s):  
Luiz Antônio dos Santos Dias ◽  
Júlio Pontes Barriga ◽  
Paulo Yoshio Kageyama ◽  
Caio Márcio Vasconcellos Cordeiro de Almeida

A sample of 64 progenies (320 cacao trees as a whole) from four Brazilian Amazon basins was collected and evaluated on the basis of 15 fruit and seed traits. Nested univariate analyses of variance showed significant variation across progenies and basins. However, most of the variability appeared to be due to among trees and basins differences. The multivariate analysis showed that the differentiation in cacao populations occurred among basins. Since cacao diversity was predominantly found in trees within basins and among basins, one should optimize the collecting process by taking as many trees as possible starting from few progenies and many river basins. These findings seemed to validate gene conservation efforts made to date to preserve the cacao genetic resources and provide insight into the cacao genetic structure aiming cacao collection, management and improvement.


Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2330-2330
Author(s):  
Gheath Alatrash ◽  
Michael J. Keating ◽  
Susan O’Brien ◽  
Xuemei Wang ◽  
Taghi Manshouri ◽  
...  

Abstract The CD52 and CD20 antigens are ubiquitously expressed on CLL B cells and are important therapeutic targets for the monoclonal antibodies alemtuzumab and rituximab, respectively. Circulating soluble CD52 (sCD52) and CD20 (sCD20) have been shown to have prognostic value in CLL, non-Hodgkin’s lymphoma and Hodgkin’s disease (Blood101:2507, 2003; Br J Haem123:850, 2003). The pharmacokinetics and therapeutic efficacy of these mAbs may be adversely affected by circulating sCD52 and sCD20. Using the previously described ELISAs, we measured levels of sCD52 and sCD20 at various time points in blood (PB) and bone marrow (BM) of chemotherapy-naïve patients treated with FCR. Treatment consisted of fludarabine 25 mg/m2 d1-3, cyclophosphamide 250mg/m2 d1-3, and rituximab 375–500mg/m2 d1 as previously described (JCO23:4079, 2005). Courses were repeated every 4 weeks for a total of 6 courses. Univariate and multivariate Cox proportional hazards models were fit to evaluate the correlations of sCD52 and sCD20 and baseline characteristics with progression free survival (PFS) and overall survival (OS). A total of 291 patients were included, pretreatment characteristics [median (range)] were as follows: age=57yrs (17–86); WBC=76.9K/μL(2.1–619.5); ALC=66.7K/μL(0.8–558); HGB=12.4g/dL(6.1–18.7); PLT=155K/μL(8–406); ß2M= 3.7mg/L(1.6–16.4); LDH=550 IU/L(103–1828). Patients with Rai stage 0=8; I–II=186; and III–IV=97. The median follow-up time for all patients is 56 months. Of the 278 responding patients, 88 (31.7%) have progressed; the median time to progression has not been reached. To date, the median survival time for the 291 patients has not been reached; 57 (19.6%) patients have died. Pretreatment characteristics analyzed included age, gender, PS, WBC, ALC, HGB, PLT, ß2M, and RAI stage; post-treatment factors included PCR for IgVH in BM, and sCD52 and sCD20 (BM and PB) levels at response. Univariate analyses identified the following predictors for PFS (p < .05): age, HGB, ß2M, PCR for IgVH at response, and PB sCD20 at response. Independent predictors for PFS identified in multivariate analysis included PCR for IgVH and PB sCD20 level at response. For OS, significant (p < .05) factors in univariate analyses included: age, HGB, ß2M, PCR for IgVH at response, and BM sCD52 at response. Independent predictors for OS identified in multivariate analysis included age and BM sCD52 level at response. Residual sCD52 at response may reflect residual disease, therefore correlating with shorter OS. We are currently evaluating sCD52 and sCD20 as prognostic factors for clinical outcomes in previously treated patients that received FCR as salvage therapy.


2001 ◽  
Vol 89 (3) ◽  
pp. 659-662 ◽  
Author(s):  
Nerella V. Ramanaiah ◽  
Jennifer K. Rielage ◽  
J. Patrick Sharpe

The hypothesis that High and Low Spiritual Well-being groups have different personality profiles was tested with 319 psychology undergraduates (132 men and 187 women) who completed the Revised NEO Personality Inventory and the Spiritual Well-being Scale for partial course credit. Univariate analyses of variance indicated that the High Spiritual Well-being group scored lower on Neuroticism and higher or Extraversion, Agreeableness, and Conscientiousness than the Low Spiritual Well-being group. Multivariate analysis of variance indicated that the two groups had significantly different personality profiles, supporting the hypothesis.


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