Statin Use Significantly Improves Overall Survival in High-Grade Endometrial Cancer

2016 ◽  
Vol 26 (9) ◽  
pp. 1642-1649 ◽  
Author(s):  
Christine H. Feng ◽  
Charlie M. Miller ◽  
Meaghan E. Tenney ◽  
Nita K. Lee ◽  
S. Diane Yamada ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Endometrial Cancer ◽  
High Risk ◽  
Confidence Interval ◽  
Hazard Ratio ◽  
Rank Test ◽  
Log Rank Test ◽  
Definitive Therapy ◽  
Statin Use

ObjectivePreclinical data and recent epidemiological studies suggest that statins have antiproliferative and antimetastatic effects in various cancer cells, and reduce cancer mortality and recurrence. We study the effect of statin use on survival outcomes and recurrence rates in patients with endometrial cancer with high-risk histology.Materials and MethodsAll patients receiving definitive therapy for high-risk endometrial cancer from 1995 to 2014 were retrospectively reviewed. Health characteristics at baseline were collected, and statin use was determined from medical records. Overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method and compared using the log-rank test. Cox proportional hazards regression models were used for univariate and multivariate analysis to determine independent factors associated with OS and PFS.ResultsA total of 199 patients were included in the study, of which 76 were hyperlipidemic and 50 used statins. The median follow-up time was 31 months from time of diagnosis. Hyperlipidemic patients who used statins had improved OS compared with hyperlipidemic patients not using statins (hazard ratio, 0.42; 95% confidence interval, 0.20–0.87;P= 0.02). Statin use was also associated with improved PFS (hazard ratio, 0.47; 95% confidence interval, 0.23–0.95;P= 0.04) on multivariate analysis. Hyperlipidemic patients who used statins had borderline improved freedom from local failure compared with hyperlipidemic cases not using statins (P= 0.08, log-rank test). Statin use was not found to be associated with improved cancer-specific mortality.ConclusionsStatin use is independently associated with significant improvements in PFS for the overall group and PFS and OS in the hyperlipidemic group.

scholarly journals Prognostic value of CD34 expression status in patients with myxofibrosarcomas and undifferentiated pleomorphic sarcomas

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yoshiya Sugiura ◽  
Rikuo Machinami ◽  
Seiichi Matsumoto ◽  
Hiroaki Kanda ◽  
Keisuke Ae ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factor ◽  
Confidence Interval ◽  
Prognostic Value ◽  
Cox Model ◽  
Hazard Ratio ◽  
Rank Test ◽  
Log Rank Test ◽  
Cd34 Expression ◽  
Expression Status

AbstractIt is controversial whether patients with myxofibrosarcomas (MFSs) have better prognoses than those with undifferentiated pleomorphic sarcomas (UPSs). No useful prognostic factors have been established to date. We therefore aimed to evaluate the prognostic value of CD34 expression status in 192 patients with MFSs and UPSs. Using the log-rank test, we showed that patients with MFSs had a significantly better overall survival than did those with UPSs when defining the former as having a > 10% myxoid component (p = 0.03), but not when defining it as having a > 50% myxoid component (p = 0.1). Under the definition of MFSs as > 10% myxoid component, the log-rank test revealed that the diagnosis of the UPS and the CD34 loss (p < 0.001) were significant adverse predictors of overall survival. As per the Cox model, the CD34 loss remained an independent prognostic factor (hazard ratio = 3.327; 95% confidence interval 1.334–8.295), while the diagnosis of the UPS was a nonsignificant confounding factor (hazard ratio = 1.084; 95% confidence interval 0.679–1.727). In conclusion, CD34 expression status is a useful prognostic factor in patients with MFS and UPS, and it should be incorporated into grading systems that are used to predict outcomes.

scholarly journals Radical Hysterectomy Versus Simple Hysterectomy and Brachytherapy for Patients with Stage II Endometrial Cancer

2020 ◽  
Author(s):  
Ming Wang ◽  
Ran Ran ◽  
Yumei Wu
Keyword(s):  
Overall Survival ◽  
Endometrial Cancer ◽  
High Risk ◽  
Radical Hysterectomy ◽  
Low Risk ◽  
Stage Ii ◽  
External Beam Radiation ◽  
Rank Test ◽  
Log Rank Test ◽  
Cause Specific Survival

Abstract BACKGROUND: To compare the survival outcome between radical hysterectomy and simple hysterectomy with implants radiation in patients with stage II endometrial cancer.METHODS: This is a retrospective cohort study. We identified 1349 patients diagnosed with stage II endometrial cancer from Jan 1, 1988 to Dec 31 2015 in the Surveillance, Epidemiology, and End Results. Patients were divided into two groups based on the primary treatment (simple hysterectomy combined with brachytherapy or radical hysterectomy). The primary outcome was the rate of overall survival and cause-specific survival of two groups.RESULTS: A total of 1349 patients were enrolled in the study, 117(7.35%) patients received radical hysterectomy and 460 patients who received simple hysterectomy and vaginal brachytherapy were selected as control. All patients received external beam radiation therapy after the surgery. Overall, the median follow-up duration was 82.77±1.44months (95%CI: 79.94-85.61months). There was no difference in the baseline information between two groups, including ages, ethnicity, and rates of histologic subtypes. The 5-year mortality was 62.31% among women who underwent radical hysterectomy which was lower than 78.48% among those who underwent simple hysterectomy and vaginal brachytherapy (HR, 2.22; 95% CI, 1.52 to 3.24; P <0.001 by the log-rank test). Women who underwent radical hysterectomy also had shorter 5-year cause-specific survival (74.60 vs.85.38%; HR, 1.91; 95% CI, 1.13 to 3.23; P =0.01 by the log-rank test) than those who underwent simple hysterectomy and vaginal brachytherapy. However, the negative outcomes were further validated in patients with high-risk endometrial cancer, not in patients with grade 1-2 low-risk EC both on cause-specific survival and overall survival. Grade 3 low-risk endometrial cancer was only found with lower overall survival not cause-specific survival.CONCLUSIONS: This study revealed that in patients’ stage II high-risk endometrial cancer, radical hysterectomy radiation was associated with shorter overall survival and cause-specific survival than simple hysterectomy and vaginal brachytherapy.

Impact of Cognitive Dysfunction on Survival in Patients With and Without Statin Use Following Carotid Endarterectomy

Neurosurgery ◽  
2015 ◽  
Vol 77 (6) ◽  
pp. 880-887 ◽  
Author(s):  
Eric J. Heyer ◽  
Joanna L. Mergeche ◽  
Shuang Wang ◽  
John G. Gaudet ◽  
E. Sander Connolly
Keyword(s):  
Confidence Interval ◽  
Carotid Endarterectomy ◽  
Cognitive Dysfunction ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Rank Test ◽  
Term Survival ◽  
Asymptomatic Patients ◽  
Statin Use

BACKGROUND: Early cognitive dysfunction (eCD) is a subtle form of neurological injury observed in ∼25% of carotid endarterectomy (CEA) patients. Statin use is associated with a lower incidence of eCD in asymptomatic patients having CEA. OBJECTIVE: To determine whether eCD status is associated with worse long-term survival in patients taking and not taking statins. METHODS: This is a post hoc analysis of a prospective observational study of 585 CEA patients. Patients were evaluated with a battery of neuropsychometric tests before and after surgery. Survival was compared for patients with and without eCD stratifying by statin use. At enrollment, 366 patients were on statins and 219 were not. Survival was assessed by using Kaplan-Meier methods and multivariable Cox proportional hazards models. RESULTS: Age ≥75 years (P = .003), diabetes mellitus (P &lt; .001), cardiac disease (P = .02), and statin use (P = .014) are significantly associated with survival univariately (P &lt; .05) by use of the log-rank test. By Cox proportional hazards model, eCD status and survival adjusting for univariate factors within statin and nonstatin use groups suggested a significant effect by association of eCD on survival within patients not taking statin (hazard ratio, 1.61; 95% confidence interval, 1.09–2.40; P = .018), and no significant effect of eCD on survival within patients taking statin (hazard ratio, 0.98; 95% confidence interval, 0.59–1.66; P = .95). CONCLUSION: eCD is associated with shorter survival in patients not taking statins. This finding validates eCD as an important neurological outcome and suggests that eCD is a surrogate measure for overall health, comorbidity, and vulnerability to neurological insult.

P2609H2FPEF score as a prognostic value in HFpEF patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Sueta ◽  
T Nishihara ◽  
E Yamamoto ◽  
K Tsujita
Keyword(s):  
Confidence Interval ◽  
Cardiovascular Events ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
Left Ventricular Ejection ◽  
Rank Test ◽  
Characteristic Analysis ◽  
Simple Method ◽  
Log Rank Test ◽  
Cerebrovascular Events

Abstract Background The H2FPEF score is recognized as a simple method to diagnose heart failure (HF) with preserved left ventricular ejection fraction (HFpEF). Purpose We investigated the value of the H2FPEF score in predicting subsequent cardiovascular events in HFpEF patients. Methods This study was a retrospective, single-center, observational study. We calculated the H2FPEF scores for 404 consecutive HFpEF patients. Subjects were subdivided into low- (0–3), intermediate- (4–6), and high-score (7–9) groups and followed for 50-months. The primary and secondary endpoints were composite cardiovascular/ cerebrovascular events (cardiovascular death, non-fatal myocardial infarction, unstable angina pectoris, hospitalization for HF decompensation and non-fatal stroke) occurrence and HF-related events (hospitalization for HF decompensation) occurrence at 50-months, respectively. Results Kaplan–Meier analyses demonstrated a significantly higher incidence of cardiovascular/cerebrovascular events in proportion to a higher H2FPEF score (log-rank test, P=0.005). The HF-related event rate was higher in proportion to the H2FPEF score (log-rank test, P<0.001). Multivariate Cox hazard analyses identified the H2FPEF score (per 1 point) as an independent predictor of cardiovascular and HF-related events (Table, hazard ratio, 1.179; 95% confidence interval, 1.066–1.305; P=0.001 and hazard ratio, 1.288; 95% confidence interval, 1.134–1.463; P=0.001, respectively). Receiver operating characteristic analysis showed that the H2FPEF significantly predicted cardiovascular events (Figure A, AUC 0.626, 95% CI 0.557–0.693; P<0.001) and HF-related events (Figure B, AUC 0.680, 95% CI 0.600–0.759; P<0.001). The cutoff H2FPEF score was 5.5 for the identification of cardiovascular and HF-related events. Conclusion The H2FPEF score is a potentially useful marker for the prediction of cardiovascular and HF-related events in HFpEF patients.

The Absolute Monocyte and Lymphocyte Counts at Diagnosis Predict Survival and Identify High-Risk Patients In Diffuse Large-B-Cell Lymphoma

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3088-3088
Author(s):  
Ryan A. Wilcox ◽  
Kay Ristow ◽  
Thomas M. Habermann ◽  
David James Inwards ◽  
Ivana Micallef ◽  
...  
Keyword(s):  
Overall Survival ◽  
High Risk ◽  
Confidence Interval ◽  
Prognostic Index ◽  
B Cell Lymphoma ◽  
Hazard Ratio ◽  
Poor Risk ◽  
Large B Cell Lymphoma ◽  
Risk Patients ◽  
Good Risk

Abstract Abstract 3088 Background: Despite the use of modern immunochemotherapy (R-CHOP) regimens, almost 50% of patients with diffuse large-B-cell lymphoma (DLBCL) will relapse. Current prognostic models, most notably the International Prognostic Index, are comprised of patient and tumor characteristics and are unable to identify patients with less than a 50% chance of long-term survival. However, recent observations demonstrate that factors related to host adaptive immunity and the tumor microenvironment are powerful prognostic variables in non-Hodgkin lymphoma Methods: We retrospectively examined the absolute neutrophil count (ANC), monocyte count (AMC) and lymphocyte count (ALC), obtained from an automated complete blood count with differential, as prognostic variables in a cohort of 255 consecutive DLBCL patients that were uniformly treated with R-CHOP between 2000 and 2007 at a single institution. The primary study objective was to assess if ANC, AMC, and ALC at diagnosis were predictors of overall survival (OS) in DLBCL. Results: At diagnosis, the median ANC was 4720/uL (range 1190–17690), the median AMC was 610/uL (range 30–4040), and the median ALC was 1220/uL (range 140–5410). The median follow-up for these patients was 48 months. In the univariate analysis, each of these variables predicted OS as continuous variables. As dichotomized variables, an elevated ANC (≥5500/μL; hazard ratio 1.75, 95% confidence interval 1.14–2.60, p=0.01) and AMC (≥610/μL; hazard ratio 3.36, 95% confidence interval 2.10–5.59, p<0.0001) were each associated with inferior OS. In contrast, the presence of lymphopenia, defined as an ALC ≤1000/uL, was associated with inferior OS (hazard ratio 2.21, 95% confidence interval 1.43–3.39, p=0.0004). When components of the IPI were included on multivariate analysis only the AMC and ALC were independently significant prognostic factors for OS, with hazard ratios of 3.37 (95% confidence interval 2.05–5.74, p<0.0001) and 2.19 (95% confidence interval 1.38–3.44, p=0.0009), respectively. The dichotomized AMC and ALC generated the AMC/ALC prognostic index (PI) and stratified patients into 3 risk groups: very good (AMC <610/uL and ALC >1000/uL), good (AMC ≥610/uL or ALC ≤1000/uL), and poor-risk (AMC ≥610/uL and ALC ≤1000/uL) populations. For both the very good (n=79) and good-risk (n=134) groups median OS has not been reached with estimated 5-year overall survival of 88% and 69%, respectively. Median OS for poor-risk (n=42) patients was 1.7 years (95% confidence interval 1.1–2.7 years) with an estimated 5-year overall survival of 28% (p<0.0001). By comparison, the R-IPI was unable to identify a group of patients with a median survival less than 8 years. The estimated 5-year OS was 93%, 71% and 53% for very good, good and poor-risk patients, respectively. We sought to determine whether the AMC/ALC PI may provide additional prognostic information when combined with the R-IPI. To test this possibility, the 171 very good/good risk and 84 poor risk patients identified by the R-IPI were subsequently risk stratified using the AMC/ALC PI. Among R-IPI very good/good risk patients a subset of poor risk patients (n=21) with a median OS of 2.2 years (95% confidence interval 1.1–6.6 years) and 35% 5-year OS could be identified with the AMC/ALC PI. In contrast, 5-year OS ranged from 75%-88% among very good and good risk patients. Similarly, stratification of R-IPI poor risk patients by the AMC/ALC PI identified subsets of very good (n=19) and good risk (n=44) patients with median OS that had not been reached and 86% and 55% 5-year OS, respectively. High risk (n=21) patients had a median OS of 1.4 years (95% confidence interval 0.9–2.2 years) and an estimated 5-year OS of less than 25%. Conclusions: Measurement of AMC and ALC at diagnosis is widely applicable, cost effective, predicts OS, and identifies high-risk patients with DLBCL. Disclosures: No relevant conflicts of interest to declare.

Impact of Smoking History on Pulmonary Metastasis-free Survival in Patients With Soft-tissue Sarcoma

2021 ◽  
Vol 1 (2) ◽  
pp. 89-94
Author(s):  
MASATAKE MATSUOKA ◽  
MASANORI OKAMOTO ◽  
TAMOTSU SOMA ◽  
ISAO YOKOTA ◽  
RYUTA ARAI ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Confidence Interval ◽  
Pulmonary Metastasis ◽  
Hazard Ratio ◽  
Smoking History ◽  
Free Survival ◽  
The Impact

Background/Aim: Although smoking history is predictive of poor pulmonary metastasis-free survival (PMFS) in patients with epithelial tumors, the impact of smoking history on PMFS in those with soft-tissue sarcoma (STS) is not known. Patients and Methods: Patients undergoing treatment for STS at our institutes between 2008 and 2017 were enrolled. Patients were excluded if they had metastatic lesion, or had a histopathological classification demonstrating small round-cell sarcoma. The impact of smoking history on PMFS and overall survival was examined with multivariate analysis using a Cox proportional hazards model. Results: A total of 250 patients were retrospectively reviewed. Patients with smoking history had worse PMFS on multivariate analysis (hazard ratio=2.00, 95% confidence interval=1.12-3.60). On the other hand, smoking history did not significantly affect overall survival (hazard ratio=1.26, 95% confidence interval=0.61-2.58). Conclusion: Patients with STS need to be followed-up by frequent clinical assessments if they have a smoking history.

GATA-3 or T-Bet Expression In PTCL-U Identify High-Risk Patients with Poor Outcomes and Distinct Clinical Characteristics Suggesting Their Derivation From Specific Subsets of T Helper Cells

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4125-4125
Author(s):  
Ryan A. Wilcox ◽  
Andrew L Feldman ◽  
Kay Ristow ◽  
Thomas M. Habermann ◽  
Steven Ziesmer ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
High Risk ◽  
Confidence Interval ◽  
Median Overall Survival ◽  
Performance Status ◽  
Univariate Analysis ◽  
Tumor Stage ◽  
Hazard Ratio ◽  
T Helper

Abstract Abstract 4125 Background: With the exception of angioimmunoblastic T-cell lymphomas, which are thought to derive from follicular helper T cells, little is known about the cell of origin for the most common peripheral T-cell lymphoma (PTCL), PTCL-unspecified (PTCL-U). Following appropriate antigenic stimulation, naïve CD4+ T helper (TH) cells differentiate into effector cells that secrete TH cytokines under the transcriptional regulation of subset-specific transcription factors. Methods: PTCL-U patients (n=53) from a single institution were retrospectively identified and immunohistochemical analysis of Foxp3, T-bet and GATA-3 expression performed on diagnostic biopsy specimens. Immunohistochemical staining was reviewed in a blinded fashion by a hematopathologist and all specimens with greater than 10% staining were scored as positive. Transcription factor expression was correlated with patient characteristics and clinical outcomes. Results: GATA-3 expression was observed in 22 (42%) patients, T-bet expression in 17 (32%) patients and Foxp3 expression in 4 (7%) patients. In order to determine the prognostic significance of GATA-3 or T-bet expression, overall survival was compared between patients with GATA-3 (or T-bet) positive or negative tumors. The median overall survival (OS) was 2 years (95% confidence interval 0.7–12.8 years) for patients with GATA-3 negative tumors, compared with a median OS of 0.9 years (95% confidence interval 0.5–1.2 years, p=0.02) for GATA-3 positive cases. The median overall survival was 1.6 years (95% confidence interval 1.0–6.8 years) for patients with T-bet negative tumors, compared with a median overall survival of 0.7 years (95% confidence interval 0.3–0.9 years, p=0.005) for T-bet positive cases. As a subset of tumors coexpressed GATA-3 and T-bet, both of which are adverse prognostic factors, we examined survival outcomes between those patients with tumors expressing either GATA-3 or T-bet (n=29) and those with tumors which do not express either transcription factor (n=24). The median OS and PFS observed for patients with positive tumors was 0.7 years (95% confidence interval 0.6–1.1 years) and 0.7 years (95% confidence interval 0.5–0.9 years), respectively. In contrast, patients with GATA-3/T-bet negative tumors experienced markedly superior survival, with a median OS and PFS of 3.8 years (95% confidence interval 1.6–12.9 years, p<0.0001) and 2.0 years (95% confidence interval 1.5–12.8 years, p<0.0001), respectively. Four-year estimates of overall and progression-free survival were less than 10% for patients with GATA-3/T-bet positive tumors, whereas 4-year OS and PFS were 49% and 32%, respectively, for those with negative tumors. Both GATA-3 and T-bet expression were associated with advanced age and tumor stage. Therefore, we analyzed GATA-3/T-bet expression as a prognostic factor for survival on both univariate and multivariate analyses, adjusting for pertinent risk factors, including patient age and tumor stage. On univariate analysis, GATA-3/T-bet expression was associated with inferior overall survival (hazard ratio 4.4, 95% confidence interval 2.1–10.4, p<0.0001). Patient age (>60 years), poor performance status (ECOG performance status >1), and stage III/IV disease were also associated with inferior overall survival on univariate analysis. However, when adjusting for these latter adverse prognostic factors on multivariate analysis, GATA-3/T-bet expression remained an independent predictor of poor overall survival in PTCL-U (adjusted hazard ratio 3.2, 95% confidence interval 1.4–8.5, p=0.008). Similarly, when adjusting only for high-risk features (>2 adverse prognostic factors), as defined by the Prognostic Index in PTCL-U (PIT), GATA-3/T-bet expression remained an independent predictor of inferior overall survival on multivariate analysis (adjusted hazard ratio 4.9, 95% confidence interval 2.2–11.5, p<0.0001). Conclusions: GATA-3 and T-bet expression identify subsets of high-risk PTCL-U patients who may benefit from alternative treatment strategies. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Removal of Endobronchial Malignant Mass by Cryotherapy Improved Performance Status to Receive Chemotherapy

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Yueh-Fu Fang ◽  
Meng-Heng Hsieh ◽  
Tsai-Yu Wang ◽  
Horng-Chyuan Lin ◽  
Chih-Teng Yu ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Survival Curve ◽  
Performance Status ◽  
Hazard Ratio ◽  
Rank Test ◽  
Minor Bleeding ◽  
Log Rank Test ◽  
Improved Performance ◽  
And Performance ◽  
To Receive

Although malignant endobronchial mass (MEM) has poor prognosis, cryotherapy is reportedly a palliative treatment. Clinical data on postcryotherapy MEM patients in a university-affiliated hospital between 2007 and 2011 were evaluated. Survival curve with or without postcryotherapy chemotherapy and performance status (PS) improvement of these subjects were analyzed using the Kaplan-Meier method. There were 59 patients (42 males), with median age of 64 years (range, 51–76, and median performance status of 2 (interquartile range [IQR], 2-3). Postcryotherapy complications included minor bleeding (n=12) and need for multiple procedures (n=10), while outcomes were relief of symptoms (n=51), improved PS (n=45), and ability to receive chemotherapy (n=40). The survival of patients with chemotherapy postcryotherapy was longer than that of patients without such chemotherapy (median, 534 versus 106 days; log-rank test,P=0.007; hazard ratio, 0.25; 95% confidence interval, 0.10–0.69). The survival of patients with PS improvement postcryotherapy was longer than that of patients without PS improvement (median, 406 versus 106 days; log-rank test,P=0.02; hazard ratio, 0.28; 95% confidence interval, 0.10–0.81). Cryotherapy is a feasible treatment for MEM. With better PS after cryotherapy, further chemotherapy becomes possible for patients to improve survival when MEM caused dyspnea and poor PS.

scholarly journals Risk Factors for Venous Thromboembolism in Endometrial Cancer

2020 ◽  
Vol 27 (4) ◽  
pp. 198-203 ◽  
Author(s):  
S. Pin ◽  
J. Mateshaytis ◽  
S. Ghosh ◽  
E. Batuyong ◽  
J.C Easaw
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Endometrial Cancer ◽  
Venous Thromboembolism ◽  
Confidence Interval ◽  
Significant Risk ◽  
Hazard Ratio ◽  
Cox Proportional Hazards Model ◽  
Risk Of Death ◽  
Kaplan Meier

Background: Venous thromboembolism (VTE) in malignancy is associated with poor outcomes. We conducted a retrospective review of VTE in patients with endometrial cancer to characterize the VTE incidence, identify factors that contribute to VTE risk, and compare survival outcomes in patients with and without VTE. Methods: A retrospective chart review identified 422 eligible patients who underwent surgery for endometrial cancer (1 January 2014 to 31 July 2016). The primary outcome was VTE. Binary logistic regression identified risk factors for VTE; significant risk factors were included in a multivariate analysis. Kaplan–Meier estimates are reported, and log rank tests were used to compare the Kaplan–Meier curves. Risk-adjusted estimates for overall survival based on VTE were determined using a multivariate Cox proportional hazards model. Results: The incidence of VTE was 6.16% overall and 0.7% within 60 days postoperatively. Non-endometrioid histology, stages 3 and 4 disease, laparotomy, and age (p < 0.1) were identified as factors associated with VTE and were included in a multivariate analysis. The overall death rate in patients with VTE was 42% (9% without VTE): hazard ratio, 5.63; 95% confidence interval, 2.86 to 11.08; p < 0.0001. Adjusting for age, stage of disease, and histology, risk of death remained significant for patients with a VTE: hazard ratio, 2.20; 95% confidence interval, 1.09 to 4.42; p = 0.0271. Conclusions: A method to identify patients with endometrial cancer who are at high risk for VTE is important, given the implications of VTE for patient outcomes and the frequency of endometrial cancer diagnoses. Factors identified in our study might assist in the recognition of such patients.

scholarly journals Clinical Features and Prognostic Assessment in 233 Patients with Therapy-Related Myelodysplastic Syndromes: The IPSS-R Is a Powerful Predictor of Outcome

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4636-4636
Author(s):  
Meritxell Nomdedeu ◽  
Xavier Calvo ◽  
Arturo Pereira ◽  
Dolors Costa ◽  
Carmen Pedro ◽  
...  
Keyword(s):  
Overall Survival ◽  
High Risk ◽  
Clinical Features ◽  
Median Survival ◽  
Myelodysplastic Syndromes ◽  
De Novo ◽  
Prognostic Score ◽  
Rank Test ◽  
Combined Modality Treatment ◽  
Log Rank Test

Abstract Background Therapy-related Myelodysplastic Syndromes (t-MDS) are those MDS occurring after cytotoxic and/or radiation therapy administered for a prior neoplastic or non-neoplastic disorder. Their prognosis is generally very poor. The commonly used risk prognostic models for MDS (IPSS and IPSS-R) are not validated in this entity as they were developed after the exclusion of therapy-related cases (Greenberg et al. Blood 1997; Greenberg et al. Blood 2012). Aims The main aims of this study are: a) to report clinical findings and overall survival on 233 patients with t-MDS, and to compare them with a large series of de novo cases; b) to test if IPSS-R is applicable to t-MDS patients. Patients and methods The study is based on the Spanish Registry for MDS, a retrospective database that includes more than 10000 cases. The investigators were asked to fill in a questionnaire regarding prior disease (PD) and prior therapy in those cases reported to be t-MDS. Herein are described the clinical features and overall survival of the first 233 cases with the required information, and compared with patients with de novo MDS from a single center series (n=725). Log Rank test was applied to asses IPSS-R in t-MDS group. Results The 233 reported patients were diagnosed between January 1993 and February 2014. The series includes 104 women (44,6%) and 129 men (55,4%). One hundred and two patients (43.9%) had a primary hematologic malignancy, 119 (51%) had a solid tumor, and 12 (5.1%) received cytotoxic therapy for autoimmune disorders. Ninety eight patients (42.6%) received only chemotherapy (CT), 45 (19.6%) received only radiotherapy (RT), 44 (19.1%) received combined modality treatment (CMT), and 43 (18.6%) received an autologous stem cell transplantation (ASCT). The median time of latency between PD and diagnosis in t-MDS group was 4.56 years (range: 0.03-29.63) in patients previously treated with CT or CMT, significantly lower than the observed after RT (8.54; range 0.83-23.02) or ASCT (8.64; range 2.87-28.32) groups (p=0.023 and p<0.0001, respectively). Median age, hemoglobin concentration, platelet count and absolute neutrophil count at diagnosis were significantly lower in t-MDS compared with de novo MDS, while bone marrow blast cell count was significantly higher. A higher proportion of high risk karyotypes (intermediate, poor and very poor categories of R-IPSS for cytogenetics) in t-MDS than in de novo MDS was observed (45.5% versus 25.6% respectively, p<0.0001). Within t-MDS cases, those patients who had received CT, CMT or ASCT also presented a higher proportion of high risk karyotypes compared with t-MDS after RT (52.1 vs 24.1% respectively, p=0.006). There was a significantly shorter median overall survival in patients treated with CT/CMT or ASCT in comparison with de novo patients or t-MDS patients treated with RT (14.88 versus 25.06 versus 47.18 months, respectively (log rank test < 0, 0001). In contrast, no difference between de novo and t-MDS after RT was found (median survival 53.6 months vs. 47.17 months, respectively, n.s). These findings are in concordance with previously published data (Nardi et al, JCO 2012) suggesting that some t-MDS after RT may not be truly t-MDS, but just coincidental. The IPSS-R prognostic score could separate t-MDS patients into five risk groups in terms of overall survival, with a median survival of 76.68 months, 38.73 months, 16.59 months, 13.3 months and 6.37 months, respectively (p<0.0001; Figure 1). A shorter overall survival for each category was found in t-MDS in comparison with de novo MDS, reaching statistical significance in the intermediate and high risk category and showing a trend towards significance in the very low and low risk categories (Figure 2). Conclusions In conclusion, our data supports the notion that t-MDS may contain entities with heterogeneous prognosis due to a diverse biological basis. The capacity of the IPSS-R for separating good prognostic from bad prognostic cases shown in this study could be very useful in the clinical setting in order to offer risk-adapted treatments to patients, although the development of a specific prognostic score for these entities would be needed. <![if !vml]><![endif]> Disclosures No relevant conflicts of interest to declare.

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