Improved prognostic precision in uveal melanoma through a combined score of clinical stage and molecular prognostication

2021 ◽  
Author(s):  
Andrew W. Stacey ◽  
Vaidehi S. Dedania ◽  
Miguel Materin ◽  
Hakan Demirci
Keyword(s):  
Uveal Melanoma ◽  
Risk Score ◽  
Clinical Stage ◽  
Case Series ◽  
Clinical Staging ◽  
Molecular Testing ◽  
Total Risk ◽  
Retrospective Case ◽  
Simple Method ◽  
Kaplan Meier

Introduction: Prognosis of uveal melanoma (UM) is assessed using clinical staging or molecular testing. Two modalities often used for prognostication are the American Joint Committee on Cancer (AJCC) staging and a tumor gene expression profile (GEP), the outcomes of which are often discordant. This paper discusses a Total Risk Score created to combine the discordant information from both sources. Methods: A retrospective case series was conducted of all patients presenting with UM over six years to two referral centers. Each tumor was classified using the AJCC and the GEP. A Total Risk Score was calculated for each patient using results from both AJCC and GEP. Kaplan-Meier analysis of metastasis free-survival was used to compare groups. Results: A total of 294 patients were included in the study. Kaplan-Meier estimates showed significant curve separation between individual AJCC and GEP risk groups. The combined Total Risk Score provided an accurate estimate of prognosis that incorporated results from both AJCC and GEP. Conclusions: Clinical staging and molecular prognostication of UM can be discordant. There is important information provided by each system that is not provided by the other. The Total Risk Score provides a simple method to combine information from both the AJCC stage and the GEP class in order to provide patients and care teams with a more complete understanding of metastatic risk.

Ultrasound Biomicroscopy Documented Anterior Uveal Melanoma Regression after Ruthenium-106 Plaque Therapy

2021 ◽  
pp. 1-9
Author(s):  
Biljana Kuzmanović Elabjer ◽  
Mladen Bušić ◽  
Andrej Pleše ◽  
Mirjana Bjeloš ◽  
Daliborka Miletić ◽  
...  
Keyword(s):  
Uveal Melanoma ◽  
Tumor Regression ◽  
Corneal Thickness ◽  
Case Series ◽  
Ultrasound Biomicroscopy ◽  
Close Monitoring ◽  
Single Institution ◽  
Retrospective Case ◽  
Caucasian Patients

<b><i>Introduction:</i></b> Ultrasound biomicroscopy (UBM) is the only widely used method for the evaluation of anterior uveal melanoma (AUM). <b><i>Objective:</i></b> Documentation of regression of AUM treated with ruthenium-106 (Ru-106) plaque types CCB and CCC using UBM. <b><i>Methods:</i></b> This single institution-based retrospective case series involved 10 Caucasian patients with AUM followed after brachytherapy with UBM from January 2014 until February 2019. The largest prominence of the tumor perpendicular to the sclera or the cornea (including scleral/corneal thickness) (<i>D</i>) and the largest basal dimension (<i>B</i>) were measured in millimeters with UBM for all patients prior to the brachytherapy and at 4-month interval follow-up. Tumor regression was calculated as a percentage of decrease in the initial <i>D</i> and <i>B</i> values. <b><i>Results:</i></b> The study involved 10 patients with a mean age of 64.4 years (yr) (range 46–80 yr). <i>D</i> ranged from 1.82 to 5.5 mm (median 2.99 mm) and <i>B</i> from 2.32 to 12.38 mm (median 4.18 mm). The apical radiation dose in all patients was 100 Gy. The median follow-up was 42.02 months. Regression for <i>D</i> was 21.11 ± 13.66%, 31.09 ± 14.66%, and 34.92 ± 19.86% at 1st, 2nd, and 3rd year of the follow-up, respectively, while for <i>B</i> it was 21.58 ± 16.05%, 28.98 ± 17.71%, and 32.06 ± 18.96%, respectively. Tumor recurrence was documented in 2/10 patients. <b><i>Conclusion:</i></b> The major regression of AUM, treated with Ru-106 plaque types CCB and CCC, was documented in the first 2 years after brachytherapy in our study group. In the following years, only minimal regression was documented that warns of the need for close monitoring and active search for local recurrences.

scholarly journals EXPERIENCE WITH USING RAPID MOLECULAR TESTING IN DIAGNOSING PULMONARY AND EXTRA-PULMONARY PEDIATRIC TUBERCULOSIS IN A NON-ENDEMIC SETTING - A RETROSPECTIVE CASE SERIES

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e44-e45 ◽  
Author(s):  
Hana Mijovic ◽  
Yossef Al-Nasser ◽  
Ghada Al-Rawahi ◽  
Ashley Roberts
Keyword(s):  
Case Series ◽  
Pericardial Fluid ◽  
Diagnosis And Treatment ◽  
Molecular Testing ◽  
Retrospective Case ◽  
Detection Rates ◽  
Endemic Setting ◽  
Number Of Patients ◽  
Small Patient Population ◽  
Extra Pulmonary

Abstract BACKGROUND Tuberculosis (TB) is a rare but potentially devastating infection among Canadian children. Accurate diagnosis and initiation of treatment are limited in part by the fact that it takes 2–6 weeks for culture results to be confirmed. Xpert MTB/RIF (Xpert) is a rapid, automated molecular assay that has been validated for diagnosing pulmonary but not extra-pulmonary TB in children. OBJECTIVES This was a retrospective study of children investigated for active TB at our facility in order to: 1.Outline demographic characteristics and describe clinical presentations of children diagnosed with active TB. 2.Compare performance of molecular testing (Xpert) to stain and Mycobacterium tuberculosis culture on pulmonary and extra-pulmonary specimens. DESIGN/METHODS We conducted a retrospective chart review of all paediatric patients investigated for active TB at our facility with stain, culture and molecular (Xpert) testing between January 2015 and August 2017. Due to a small number of patients, our data analysis was limited to narrative summary and descriptive statistics. RESULTS A total of 10 children were diagnosed with active TB, including 3 cases of pulmonary, 4 extra-pulmonary and 3 disseminated disease. Age range at diagnosis was 2 months to 16 years, with 3 children younger than 1 year. Most children contracted TB while travelling to and/or being exposed to an index case from endemic areas, including East Asia/Western Pacific (5), South Asia (2) and Africa (1). All children were HIV negative. Time from symptom onset to TB diagnosis and treatment ranged from approximately 4 days to 5 months. Multi-drug resistant TB was confirmed in 1 child. Sadly, 1 child passed away from TB related complications. AFB stain was positive on at least one specimen in 4/10 cases, cultures were positive in 8/10 and molecular testing (Xpert) in 7/10 cases. Time to positive cultures ranged from 10 to 35 days, with an average of 19 days. All cases positive on Xpert were also culture positive. Xpert test diagnosed TB in 5/6 of extra-pulmonary specimens submitted, including pericardial fluid, lymph node tissues and cerebrospinal fluid. CONCLUSION Many paediatric TB patients at our facility are children who have traveled to/have contacts from TB endemic regions, emphasizing the need for obtaining thorough exposure and travel history. Culture and molecular testing demonstrated similar TB detection rates, albeit based on a small patient population. While cultures remain the most reliable diagnostic method, molecular testing may facilitate rapid diagnosis and treatment of pulmonary and extra-pulmonary paediatric TB in a non-endemic setting.

scholarly journals Nivolumab and Ipilimumab in the Treatment of Metastatic Uveal Melanoma: A Single-Center Experience

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Vidhya Karivedu ◽  
Ihab Eldessouki ◽  
Ahmad Taftaf ◽  
Zheng Zhu ◽  
Abouelmagd Makramalla ◽  
...  
Keyword(s):  
Partial Response ◽  
Clinical Outcome ◽  
Uveal Melanoma ◽  
Stable Disease ◽  
Checkpoint Inhibitors ◽  
Evaluation Criteria ◽  
Treatment Strategies ◽  
Case Series ◽  
Retrospective Case ◽  
Study Results

Background. Metastatic uveal melanoma (MUM) is associated with a poor prognosis, with a median overall survival (OS) of 4–15 months. Despite new insights into the genetic and molecular background of MUM, satisfactory systemic treatment approaches are currently lacking. The study results of innovative treatment strategies are urgently needed. Patients and Methods. This was a retrospective case series of 8 patients with MUM managed at the University of Cincinnati between January 2015 and January 2018. The immune-related Response Evaluation Criteria in Solid Tumors (irRECIST) 1.1 criteria were used for patient evaluation, and magnetic resonance imaging was used for evaluation at treatment checkpoints. Objective. To assess the clinical outcome of patients with MUM treated with a combination of checkpoint inhibitors. Results. The series included eight patients, six men and two women, with MUM. Their median age at MUM diagnosis was 69 (range, 55–77) years. All patients were treated with ipilimumab and nivolumab combination along with transarterial chemoembolization (TACE), followed by nivolumab maintenance and monthly TACE procedures. The majority of patients had a partial response or stable disease. Two of the patients had partial response, while four others had stable disease. Two other patients experienced disease progression. Conclusion. We report the outcomes of eight patients with MUM treated with the combination of ipilimumab and nivolumab. We report the clinical outcome and toxicity associated with this treatment approach. Further studies are warranted to explore immunotherapy in MUM. These findings support the consideration of immunotherapy in MUM.

Case series of ventriculopleural shunts in adults: a single-center experience

2016 ◽  
Vol 126 (6) ◽  
pp. 2010-2016 ◽  
Author(s):  
Claudia Craven ◽  
Hasan Asif ◽  
Amna Farrukh ◽  
Flavia Somavilla ◽  
Ahmed K. Toma ◽  
...  
Keyword(s):  
Survival Rates ◽  
Case Series ◽  
Mantel Test ◽  
Single Center ◽  
Retrospective Case ◽  
Distal Catheter ◽  
Single Center Experience ◽  
Kaplan Meier ◽  
Shunt Survival ◽  
Ventriculopleural Shunt

OBJECTIVEThe peritoneal cavity is widely used as the destination of choice for cerebrospinal fluid shunts. Various alternative sites have been used, particularly in the presence of certain contraindications. The pleural cavity has been used; however, a paucity of evidence details ventriculopleural (VPL) shunt survival, complication, and revision rates in adults. The aim of this study was to present a single center's experience with VPL shunts, identifying complication, revision, and survival rates.METHODSA single-center, retrospective case series analysis was conducted for VPL shunt insertions and revisions over a period of 5 years. Demographic as well as clinical data were collected. Ventriculopleural shunt survival was assessed using Kaplan-Meier curves and the log rank (Cox-Mantel) test.RESULTSTwenty-two VPL shunts were inserted in 19 patients. Median survival of the VPL shunts was 14 months. Pathological indication for the VPL shunt did not significantly affect survival. A total of 10 complications was observed: 2 infections, 2 cases of overdrainage, 2 obstructions, 1 distal catheter retraction, 2 symptomatic pleural effusions, and 1 asymptomatic pleural effusion.CONCLUSIONSVentriculopleural shunting is a safe and viable second-line procedure for cases in which ventriculoperitoneal shunts are unsuitable. While VPL shunts have a high revision rate, their complication rate is comparable to that of VP shunts. Ventriculopleural shunt survival can be improved by careful patient selection and the implementation of a combination of valves with antisiphon devices.

scholarly journals A Novel Ferroptosis-Related Long Non-coding RNA Prognostic Risk Model for Gastric Cancer

2021 ◽  
Author(s):  
Shenglan Huang ◽  
Dan Li ◽  
Lingling Zhuang ◽  
Liying Sun ◽  
Jianbing Wu
Keyword(s):  
Gastric Cancer ◽  
Risk Score ◽  
Roc Curve ◽  
Cox Regression ◽  
Risk Group ◽  
Clinical Stage ◽  
Curve Analysis ◽  
Clinicopathological Features ◽  
Roc Curve Analysis ◽  
Kaplan Meier

Abstract Background：Gastric cancer (GC) is one of the most common malignant tumors with a poor prognosis. Ferroptosis is a novel and distinct type of non-apoptotic cell death that is closely associated with metabolism, redox biology, and tumor prognosis. Recently, ferroptosis-related long non-coding RNAs (lncRNAs) have received increasing attention in predicting cancer prognosis. Thus, we aimed to construct an ferroptosis-related lncRNAs signature for predicting the prognosis of patients with gastric cancer.Methods：We built an ferroptosis-related lncRNA risk signature by using Cox regression based on TCGA database. Kaplan-Meier survival analysis was conducted to compare the overall survival (OS) in different risk groups. Cox regression was performed to explore whether the signature could be used as an independent factor. A nomogram was built involving the risk score and clinicopathological features. Furthermore, we explored the biological functions and immune states in two groups.Results：Eight ferroptosis-related lncRNAs were obtained for constructing the prognosis model in gastric cancer. Kaplan–Meier curve analysis revealed that patients in the high-risk group had worse survival than those in the low-risk group. The survival outcome was also appropriate for subgroup analysis, including age, sex, grade, and clinical stage. Multivariate Cox regression analysis and receiver operating characteristic (ROC) curve analysis demonstrated that the risk score was an independent prognostic factor and superior to traditional clinicopathological features in predicting GC prognosis. Next, we established a nomogram according to clinical parameters (age, sex, grade, and clinical stage) and risk score. All the verified results, including ROC curve analysis, calibration curve, and decision curve analysis, demonstrated that the nomogram could accurately predict the survival of patients with gastric cancer. Gene set enrichment analysis revealed that these lncRNAs were mainly involved in cell adhesion, cancer pathways, and immune function regulation.Conclusion: We established a novel ferroptosis-related prognostic risk signature including eight lncRNAs and constructed a nomogram to predict the prognosis of gastric cancer patients, which may improve prognostic predictive accuracy and guide individualized treatment for patients with GC.

scholarly journals Intraocular Schwannoma: Case Series of 28 Patients and Literature Review

2021 ◽  
Author(s):  
Yue-Ming Liu ◽  
Li Dong ◽  
Xiao-Lin Xu ◽  
He-Yan Li ◽  
Qiong Yang ◽  
...  
Keyword(s):  
Literature Review ◽  
Uveal Melanoma ◽  
Light Transmission ◽  
Case Series ◽  
Visual Field Loss ◽  
Common Symptom ◽  
Retrospective Case ◽  
Melanoma Tumor ◽  
Intraocular Tumor ◽  
Age Range

Abstract Background: Intraocular schwannoma is a rare intraocular tumor, which is often misdiagnosed. We aimed to analyze the demographics and clinical characteristics of patients with intraocular schwannoma.Methods: Retrospective case series were collected from May 2005 to July 2021 in Beijing Tongren Hospital. Then a literature review was also performed.Results: A total of 28 patients were diagnosed with intraocular schwannoma histopathologically. The median age (range) of the included patients was 39 (12-64) years old, among whom half subjects were female. The most common symptom was visual loss (75.0%), followed by visual field loss (10.7%). Intraocular schwannoma presented as nonpigmented mass, which occurred mainly in ciliary body (42.9%), followed by choroid (32.1%) and ciliochoroid (25.0%).16 patients (57.1%) were clinically misdiagnosed as uveal melanoma. Tumor excision was performed for all patients and increased light transmission was detected in half cases. In the consecutive follow-up (median: 6.0 years, range: 0.5-16.0 years), no recurrence or metastasis case was detected.Conclusions: Intraocular schwannoma is a rare benign intraocular tumor. It usually presents as nonpigmented mass, which is easily misdiagnosed as nonpigmented uveal melanoma.

The impact of clinical stage on renal cell carcinoma outcomes: Implications for neoadjuvant trial design.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 482-482
Author(s):  
Mark Wayne Ball ◽  
Michael A Gorin ◽  
Phillip M Pierorazio ◽  
Hans J. Hammers ◽  
Lauren Christine Harshman ◽  
...  
Keyword(s):  
Trial Design ◽  
Clinical Stage ◽  
High Rate ◽  
Clinical Staging ◽  
Survival Models ◽  
Patient Counseling ◽  
Cancer Specific Survival ◽  
Pathologic Stage ◽  
Kaplan Meier ◽  
The Impact

482 Background: Outcomes for patients with RCC are reported by pathologic stage; however, determination of therapy and patient counseling are based on clinical staging. Moreover, the development of neoadjuvant therapies that may requires knowledge of clinical stage-specific outcomes for trial design. Because of a paucity of reported outcomes, we characterized pathologic upstaging, recurrence-free survival (RFS) and cancer-specific survival (CSS) by stage at our institution. Methods: Our renal mass registry was queried for patients with localized RCC who underwent extirpative surgery with from 2003-2013 stratified by clinical stage. The proportion of cases upgraded by stage were determined. Survival outcomes were analyzed using the Kaplan-Meier method. Results: A total of 2,144 cases were captured during the study period. Median follow-up was 44.5 months. Clinical to pathologic upstaging is listed in the table. The highest degree of upstaging occured in cT2 cases, with 47% of cT2a and 48% of cT2b upstaged to ≥cT3a. RFS at 60 months for cT1a was 98.4%, cT1b 95.5%, cT2a 78.4%, cT2b 74.4%, cT3a 68.0%, cT3b 63.5%, cT3c 27.8%. CSS at 60 months for cT1a was 99.3%, cT1b 96.3%, cT2a 82.7%, cT2b 81.7%, cT3a 88.7%, cT3b 66.8%, and cT3c 76.9%. Harrell's C index for CSS was similar for both clinical (0.68) and pathologic stage (0.75). Conclusions: While the rate of upstaging increases markedly with increasing clinical stage, survival models based on clinical stage perform as well as those based on pathologic staging. The high rate of upstaging in cT2 disease supports enrollment of these patients in adjuvant clinical trials. Knowledge of these clinical stage-specific outcomes may be helpful for trial design. [Table: see text]

Accuracy of clinical staging in stage I and IIa/b testicular nonseminomatous germ cell tumors (NSGCT) and implications on survival.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e17058-e17058
Author(s):  
Arnav Srivastava ◽  
Hiren V. Patel ◽  
Sinae Kim ◽  
Isaac Kim ◽  
Eric A. Singer ◽  
...  
Keyword(s):  
Overall Survival ◽  
Imaging Techniques ◽  
Clinical Stage ◽  
Germ Cell Tumors ◽  
Stage I ◽  
Clinical Staging ◽  
Retroperitoneal Lymph Node Dissection ◽  
Kaplan Meier ◽  
Nonseminomatous Germ Cell Tumors

e17058 Background: Clinical stage (CS) dictates treatment in men with testicular cancer and its inaccuracy may affect clinical outcome. We evaluate the accuracy of clinical staging in men with CS I and CS IIA/B NSGCT and explore the implications of inaccurate staging on overall survival. Methods: Using the National Cancer Database (NCDB), we abstracted all patients with clinical Stage I-IIB NSGCT who received a primary retroperitoneal lymph node dissection (RPLND) from 2004 to 2014. Primary RPLND was defined as RPLND performed for CS I-IIB patients without prior chemotherapy. CS was cross-tabulated with pathologic nodal staging data. Survival for patients who were accurately staged (CS I patients with pN0 disease, CS IIA patients with pN1 disease) and for CS I patients found to have pN+ disease was determined using the Kaplan Meier method. Results: 1,639 CS I-IIB patients underwent primary RPLND. Among CS I patients, 23% had upstaging of disease (pN1-3), of which 13.9%, 8%, and 1.1% were pN1, pN2, and pN3, respectively (Table). Pathologic N1-3 disease was higher in CS IB vs. CS IA patients (35.1% vs 14.2%, respectively). Of CS IIA patients, 23.1% had pN0 disease, while 44.8%, 13.4%, and 1.3% had pN1, pN2, and pN3 disease, respectively. At a median follow-up of 56.3 months, mortality rates for CS I patients who had pN1, pN2, and pN3 disease were 2.8%, 4%, and 9.1%, respectively, and < 1% for men with pN0 disease. 10-year overall survival for CS1 patients was significantly less favorable if upstaged to pN2 or pN3 disease after RPLND vs. pN0 or pN1. Conclusions: Nearly a quarter of patients with CS I NSGCT are under-staged and are found to have pN1-3 after RPLND. Nodal disease burden is associated with survival. Novel imaging techniques and biomarkers are needed to improve the sensitivity of detecting NSGCT. [Table: see text]

scholarly journals Pregnancy outcomes from a restorative infertility treatment model: a single centre case series

2021 ◽  
Author(s):  
Gabriel James ◽  
Lucas A McLindon ◽  
Joshua Hatch ◽  
Ben W Mol ◽  
Joseph Turner
Keyword(s):  
Live Birth ◽  
Birth Rate ◽  
Case Series ◽  
Live Birth Rate ◽  
Cumulative Live Birth Rate ◽  
Retrospective Case ◽  
Medical Issues ◽  
Kaplan Meier ◽  
Assisted Reproductive Treatment ◽  
Personalized Approach

Background: Infertility is a significant problem with multiple causes and a corresponding array of therapeutic options. In an era of increasing assisted reproductive treatments, few studies examine the role of conventional non-assisted reproductive treatments to address underlying behavioural, lifestyle and medical issues. Aim: To assess outcomes from a conventional or non-assisted reproductive treatment approach Materials and Methods: Retrospective case series of 162 couples that attended an Australian, hospital-based, multidisciplinary fertility clinic between 2005 and 2010. Results: There were 58 live births for all couples giving a crude live birth rate of 35.4% over a 24-month analysis period. When adjusted by Kaplan-Meier method, a 57.4% cumulative live birth rate (CLBR) was achieved. Couples had a median 33.9 months duration of infertility and the median female age was 33.7. For the 74 couples with an unexplained infertility diagnosis, 32 achieved a live birth at a crude rate of 43.2% or 71.2% CLBR when adjusted by Kaplan-Meier method. Conclusions: This observational data indicates that reproductive medicine should have a personalized approach in which alternatives for immediate IVF are considered.

scholarly journals 2381. Epidemiology of Clostridium difficile Infection in Patients Receiving Interleukin-2 Therapy

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S822-S822
Author(s):  
Aldon Li ◽  
Nga Nguyen
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Laboratory Testing ◽  
Interleukin 2 ◽  
Case Series ◽  
Mortality Data ◽  
Molecular Testing ◽  
Retrospective Case ◽  
Bowel Movements ◽  
The Difference

Abstract Background Clostridium difficile infection (CDI) has been associated with interleukin-2 (IL2) therapy, possibly leading to unnecessary testing and treatment of colonized patients receiving IL2 therapy. Since the debut of IL2 therapy for renal cell carcinoma (RCC) and metastatic melanoma (MM), only one study with 6 patients has shown a relationship between CDI and IL2 treatment, and no mortality data were reported. Because of the rising concern for appropriate testing and treatment of CDI, further studies looking at the correlation between IL2 therapy and CDI are needed. This study aims to describe CDI rates among a larger cohort of IL2 treated patients and to include mortality data. Methods Retrospective case series. A case of CDI was defined as (1) Bowel movements >3 or stool output >600 mL WITH, (2) positive laboratory test, either through toxin detection via ELISA prior to 2010 or molecular testing via PCR after 2010. Results During the study period from 2008 to 2015, 359 patients with RCC or MM receiving IL2 treatment were evaluated with a total of 294 patients undergoing Clostridium difficile testing (CDT). Median age was 52 (range 24–69), 33% female. An average IL2 dose of 27 million international units (MIU) was given in this population. 15% (45/294) had a positive CDT, but 7% (21/294) were found to have CDI. All patients with CDI had antibiotic exposure within the last 30 days of diagnosis. Of the patients who developed CDI, 24% (5/21) had a previous CDI episode within the last 90 days. None of the patients developed megacolon. Developing CDI lead to an all-cause mortality of 24% (5/21). Conclusion The results of this study show a lower CDI rate (7%, 21/294) than previously reported in IL2-treated patients (66%, 4/6), but this difference is likely due to the difference in population size. In addition to CDI rate, this study adds information about mortality in IL2-treated patients with CDI, which was not previously described in the literature. Applying a clinical criterion to laboratory testing results revealed a difference in laboratory testing positivity and actual infection rates, suggesting 8% of this population maybe colonized with Clostridium difficile, providing further evidence for Antibiotic Stewardship Committees to put in place local guidelines to avoid indiscriminate CDT in this population. Disclosures All authors: No reported disclosures.

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