scholarly journals Risk-adapted therapy for early-stage extranodal nasal-type NK/T-cell lymphoma: analysis from a multicenter study

Blood ◽  
2015 ◽  
Vol 126 (12) ◽  
pp. 1424-1432 ◽  
Author(s):  
Yong Yang ◽  
Yuan Zhu ◽  
Jian-Zhong Cao ◽  
Yu-Jing Zhang ◽  
Li-Ming Xu ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
High Risk ◽  
Multicenter Study ◽  
Cell Lymphoma ◽  
Risk Group ◽  
Early Stage ◽  
High Risk Group ◽  
Low Risk ◽  
Nasal Type ◽  
Key Points

Key Points Patients with early-stage extranodal nasal-type NKTCL were classified as low risk or high risk using 5 independent prognostic factors. Risk-adapted therapy of RT alone for the low-risk group and RT consolidated by CT for the high-risk group proved the most effective treatment.

Adjuvant Chemotherapy Guidance for pT1-3N0-1 Breast Cancer Patients with HR+, HER2- subtype: a study based on SEER database

2021 ◽  
Author(s):  
juanjuan Qiu ◽  
Li Xu ◽  
Yu Wang ◽  
Jia Zhang ◽  
Jiqiao Yang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
High Risk ◽  
Cancer Patients ◽  
Risk Group ◽  
High Risk Group ◽  
Low Risk ◽  
Rank Test ◽  
Breast Cancer Patients ◽  
Group Score

Abstract Background Although the results of gene testing can guide early breast cancer patients with HR+, HER2- to decide whether they need chemotherapy, there are still many patients worldwide whose problems cannot be solved well by genetic testing. Methods 144 735 patients with HR+, HER2-, pT1-3N0-1 breast cancer from the Surveillance, Epidemiology, and End Results database were included from 2010 to 2015. They were divided into chemotherapy (n = 38 392) and no chemotherapy (n = 106 343) group, and after propensity score matching, 23 297 pairs of patients were left. Overall survival (OS) and breast cancer-specific survival (BCSS) were tested by Kaplan–Meier plot and log-rank test and Cox proportional hazards regression model was used to identify independent prognostic factors. A nomogram was constructed and validated by C-index and calibrate curves. Patients were divided into high- or low-risk group according to their nomogram score using X-tile. Results Patients receiving chemotherapy had better OS before and after matching (p < 0.05) but BCSS was not significantly different between patients with and without chemotherapy after matching: hazard ratio (HR) 1.005 (95%CI 0.897, 1.126). Independent prognostic factors were included to construct the nomogram to predict BCSS of patients without chemotherapy. Patients in the high-risk group (score > 238) can get better OS HR 0.583 (0.507, 0.671) and BCSS HR 0.791 (0.663, 0.944) from chemotherapy but the low-risk group (score ≤ 238) cannot. Conclusion The well-validated nomogram and a risk stratification model was built. Patients in the high-risk group should receive chemotherapy while patients in low-risk group may be exempt from chemotherapy.

scholarly journals Validation of an Immune-related Gene Pair Index as a Prognostic Marker of Early-Stage Lung Squamous Cell Carcinoma

2020 ◽  
Author(s):  
Zihao Wang ◽  
Xuan Xiang ◽  
Xiaoshan Wei ◽  
Linlin Ye ◽  
Yiran Niu ◽  
...  
Keyword(s):  
High Risk ◽  
Validation Cohort ◽  
Risk Group ◽  
Early Stage ◽  
Lung Squamous Cell Carcinoma ◽  
High Risk Group ◽  
Low Risk ◽  
Data Sets ◽  
Related Gene ◽  
Immune Related Gene

Abstract Background. Lung squamous cell carcinoma (LUSC) is one of the subtypes of non-small-cell lung cancer (NSCLC) and accounts for approximately 20 to 30% of all lung cancers.Methods. In this study, we developed an immune-related gene pair index (IRGPI) for early-stage LUSC from 3 public LUSC data sets, including The Cancer Genome Atlas LUSC cohort and Gene Expression Omnibus data sets, and explored whether IRGPI could act as a prognostic marker to identify patients with early-stage LUSC at high risk.Results. IRGPI was constructed by 68 gene pairs consisting of 123 unique immune-related genes from TCGA LUSC cohort. In the derivation cohort, the hazard of death among high-risk group was 10.51 times that of the low-risk group (HR, 10.51; 95%CI, 6.96-15.86; p<0.001). The hazard of death among the high-risk group was 2.26 times that of the low-risk group (HR, 2.26; 95%CI, 1.2-4.25; p=0.009) in the GSE37745 validation cohort and was 3.2 times that of low-risk group (HR, 3.2; 95%CI, 0.98-10.4; p=0.042) in the GSE41271 validation cohort. The infiltrations of CD8+ T cells and T follicular helper cells were lower in the high-risk group, as compared with the low-risk group in the TCGA cohort (6.94% vs 9.63%, p=0.004; 2.15% vs 3%, p=0.002, respectively). The infiltrations of neutrophils, activated mast cells and monocytes were higher in the high-risk group, as compared with the low-risk group in the TCGA cohort (1.63% vs 0.72%, p=0.001; 1.64% vs 1.02%, p=0.007; 0.57% vs 0.35%, p=0.041, respectively).Conclusions. IRGPI is a significant prognostic biomarker for predicting overall survival in early-stage LUSC patients.

scholarly journals Comparison of Prognostic Stratification between IPI, PIT, and NCCN-IPI in the Treatment of Nodal Peripheral T-Cell Lymphomas

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 1657-1657
Author(s):  
Ho-Young Yhim ◽  
Yong Park ◽  
Joon Ho Moon ◽  
Ho-Jin Shin ◽  
Yoon Seok Choi ◽  
...  
Keyword(s):  
T Cell ◽  
High Risk ◽  
Cell Lymphoma ◽  
Risk Group ◽  
Prognostic Index ◽  
High Risk Group ◽  
Low Risk ◽  
Histologic Subtype ◽  
T Cell Lymphomas ◽  
Risk Patients

Abstract Background Nodal peripheral T-cell lymphomas (PTCLs) are a heterogeneous group of neoplasms, which include PTCL not otherwise specified (PTCL-NOS), angioimmunoblastic T-cell lymphoma (AITL), anaplastic large-cell lymphoma-anaplastic lymphoma kinase positive (ALCL, ALK-pos), and ALCL, ALK-neg. International prognostic index (IPI) is a widely used tool for risk stratification and has shown a strong association with survival in nodal PTCL. The prognostic index for PTCL-U (PIT) is a specific prognostication tool for PTCL and has also shown prognostic relevance in nodal PTCL. The National Comprehensive Cancer Network-IPI (NCCN-IPI) has recently been reported to show better discrimination in higher risk patients with diffuse large B-cell lymphoma, but has never been investigated in nodal PTCLs. Thus, the aim of this study was to validate and compare the usefulness of risk stratification using NCCN-IPI in comparison with the IPI and PIT in patients with newly diagnosed nodal PTCL, particularly in determining high-risk patients. Methods This retrospective analysis was conducted using patient-level data from one Korean multicenter retrospective cohort (cohort A; NCT03040206; Eur J Nucl Med Mol Imaging 2018 e-pub) and two prospective Samsung Medical Center Lymphoma I (cohort B) and II (cohort C) cohorts (NCT00822731 and NCT01877109; Blood Cancer J 2016;6:e395) that included nodal PTCL patients. Among those enrolled in the three cohorts, patients were eligible if they were newly diagnosed, were histologically confirmed with nodal PTCL and had received curative intent systemic chemotherapy. Patients were excluded if the histologic subtype was uncertain or primary extranodal mature T-cell or NK/T-cell neoplasms. The study also excluded ALCL, ALK-pos. Results A total of 531 patients were screened for eligibility (A [n=396], B and C [n=135]). Eighty-four patients were excluded from this analysis due to following reasons: relapsed nodal PTCL (n=14), no systemic lymphoma therapy (n=14), uncertain histology (n=8), primary extranodal mature T-cell or NK/T-cell neoplasms (n=9), and ALCL, ALK-pos (n=39). Thus, 447 patients were analyzed. Median age at diagnosis was 60 years (range, 19-86) and 285 (64%) were male. PTCL-NOS (n=237, 53%) was the most common histologic subtype included, and AITL (n=154, 35%) and ALCL, ALK-neg (n=56, 13%) followed. Three-fourths of the patients (n=337) were advanced stage and approximately one-fourth of the patients (n=127) had bone marrow involvement at diagnosis. The majority of the patients (n=422, 94%) were treated with anthracycline-based regimen as primary chemotherapy. 77 patients (17%) underwent up-front autologous stem cell transplantation. With a median follow-up of 55.7 months (IQR 32.7-83.5), 5-year progression-free survival rate was 35.9% (95% CI, 31.0-40.8) and overall survival (OS) rate was 46.0% (95% CI, 40.7-51.3). In the univariate analysis, all the risk stratifications, the IPI, PIT, and, NCCN-IPI, were significantly associated with OS (Fig 1A, B, C). However, the 5-yr OS rates of IPI, PIT, and NCCN-IPI differed substantially in the high-risk group,18.2% (95% CI, 9.6-26.8) vs 22.4% (95% CI, 14.0-30.8) vs 10.8% (95% CI, 2.4-19.2), as well as in the low-risk group, 77.1% (95% CI, 69.3-84.9) vs 75.9% (95% CI, 65.3-86.5) vs 85.8% (95% CI, 76.0-95.6; Table 1), respectively. The absolute difference in OS between the low-risk and high-risk groups was 75.0% with NCCN-IPI stratification compared with 58.9% and 53.5% with IPI and PIT stratifications. Notably, 13.4% of the patients were classified as high-risk group using the NCCN-IPI stratification, which was substantially different from stratifications using the IPI (19.2%) and PIT (24.2%). Finally, the NCCN-IPI and histologic subtypes were found to be independent prognostic variables for OS in multivariate analysis (for low-intermediate NCCN-IPI, hazard ratio [HR] 1.80, 95% CI 0.79-4.12; high-intermediate NCCN-IPI, HR 2.19, 95% CI 0.83-5.76; high NCCN-IPI HR 3.63, 95% CI 1.28-1032; P=0.038: for AITL, HR 1.12, 95% CI 0.69-2.01; PTCL-NOS, HR 1.96, 95% CI 1.18-3.27; P<0.001). Conclusion Our study shows that the NCCN-IPI is a more powerful tool than the IPI and PIT for predicting OS in patients with nodal PTCLs. Compared with the IPI and PIT, the NCCN-IPI also shows better discrimination between low-risk and high-risk nodal PTCL patients, and may be more useful to find truly high-risk patients. Disclosures No relevant conflicts of interest to declare.

Can high Ki67 predict distant recurrence in early-stage breast cancer with low Oncotype Dx score?

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e12561-e12561
Author(s):  
Parvaneh Fallah ◽  
Nasser Khleel Mulla ◽  
Raquel Aloyz ◽  
Olga Aleynikova ◽  
Anca Florea ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Risk Group ◽  
Early Stage ◽  
Recurrence Score ◽  
Distant Recurrence ◽  
High Risk Group ◽  
Low Risk ◽  
Oncotype Dx ◽  
Early Stage Breast Cancer

e12561 Background: Ki-67 is a marker of proliferating cells. The recurrence score based on the 21-gene breast cancer assay also called Oncotype Dx provides prognostic and predictive information for recurrence in early stage breast cancer patients. We previously showed that there is a moderate correlation between Ki67 and oncotype Dx recurrence score. In this retrospective study, we aimed to examine whether high Ki67 could predict the distant recurrence in early stage breast cancer with low oncotype Dx scores ( < 25). Methods: This retrospective study included 278 consecutive cases of hormone receptor-positive, HER2 negative (T1-2 N0 M0) breast cancer who were diagnosed between 2008 and 2015 with low oncotype Dx ( < 25). Patients’ clinical outcome in terms of distant recurrence after breast surgery was determined up to December 2020 (median follow-up of 7 years). Patients were divided in to low risk (Ki67 < 15%) and high risk (Ki67 > = 15%) groups. Results: Of 278 cases with average and median age of 59 and 60 respectively, 148 (53%) were in Ki67 low risk and 130 (47%) were in Ki67 high risk group. Average and median oncotype Dx were 13.86 and 15 respectively in Ki67 low risk versus 15.23 and 16 respectively in Ki67 high risk group. 13 patients (4%) experienced distant metastasis in lung, liver, bone and skin. Of these 13 cases with average and median oncotype Dx 15.84 and 19 respectively, 12 (92%) were in the Ki67 high risk group and only 1 (8%) belonged to the low risk category. High Ki67 patients were overrepresented in group with recurrent distant metastasis compare to group without recurrent disease (Pearson Chi-Square = 51.18 with 1 degree of freedom and P = < 0.001). Conclusions: Ki67 high patients in the low risk oncotype Dx group are relapsing at a significantly higher rate suggesting that Ki67 combined with low oncotype Dx further refines the risk of distant relapse.

Evaluation of Early Prognostic Factors in Patients With Pancreatic Ductal Adenocarcinoma Receiving Gemcitabine Together With Nab-paclitaxel

2021 ◽  
Vol 1 (5) ◽  
pp. 399-409
Author(s):  
WATARU IZUMO ◽  
RYOTA HIGUCHI ◽  
TORU FURUKAWA ◽  
TAKEHISA YAZAWA ◽  
SHUICHIRO UEMURA ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prognostic Factors ◽  
High Risk ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Risk Group ◽  
High Risk Group ◽  
Low Risk ◽  
Nutrition Status ◽  
Ductal Adenocarcinoma ◽  
Changing Rate

Background: Gemcitabine together with nab-paclitaxel (GnP) has been shown to improve outcomes in patients with pancreatic ductal adenocarcinoma (PDAC). However, the predictive markers for treatment effects remain unclear. This study aimed to identify early prognostic factors in patients with PDAC receiving GnP. Patients and Methods: We analyzed 113 patients who received GnP for PDAC and evaluated the relationship between clinical factors and outcomes. Results: The median survival time (MST) was 1.2 years. In multivariate analysis, baseline carbohydrate antigen 19-9 (CA19-9) ≥747 U/ml [hazard ratio (HR)=1.9], baseline controlling nutrition status (CONUT) score ≥5 (HR=3.7) and changing rate of CA19-9 after two GnP cycles ≥0.69 (HR=3.7) were independent risk factors for poor prognosis. When examining outcomes according to pre-chemotherapeutic measurable factors (baseline CA19-9 and CONUT), the MSTs of patients with pre-chemotherapeutic zero risk factors (pre-low-risk group, n=63) and one or more risk factors (pre-high-risk group, n=50) were 1.7 and 0.65 years (p<0.001), respectively. The MST for those with a changing rate of CA19-9 after two GnP cycles <0.69 and ≥0.69 was significantly different in both groups (2.0 and 1.2 years in the pre-low-risk group, p<0.001; 1.0 and 0.52 years in the pre-high-risk group, p<0.001). Conclusion: These results may be useful for decision-making regarding treatment strategies in patients with PDAC receiving GnP.

Relation of tumor-cell ploidy to survival in children with medulloblastoma.

1993 ◽  
Vol 11 (11) ◽  
pp. 2211-2217 ◽  
Author(s):  
A J Gajjar ◽  
R L Heideman ◽  
E C Douglass ◽  
L E Kun ◽  
E H Kovnar ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
High Risk ◽  
Tumor Cell ◽  
Risk Group ◽  
Univariate Analysis ◽  
Flow Cytometric Analysis ◽  
High Risk Group ◽  
Low Risk ◽  
Clinical High Risk ◽  
Clinical Risk

PURPOSE To assess the value of tumor-cell ploidy as a predictor of survival in medulloblastoma. PATIENTS AND METHODS Ploidy determinations were based on the flow-cytometric analysis of cellular DNA content in fresh tumor specimens taken from 34 consecutively treated children with newly diagnosed medulloblastoma. Patients were assigned a high or low risk of failure depending on tumor size and invasiveness, and the presence or absence of metastatic disease. Treatment consisted of radiotherapy, with or without chemotherapy, according to institutional or cooperative group protocols. RESULTS Univariate analysis of candidate prognostic factors showed that only tumor-cell ploidy and clinical risk group had a statistically significant influence on survival. Patients with hyperdiploid stem lines (n = 9) had significantly longer survival times (P = .04) than did those with diploid lines (n = 20). The estimated 5-year survival probabilities (+/- SE) for these two subgroups were 89% +/- 11% and 48% +/- 13%, respectively. Although clinical risk status (high v low) showed essentially the same predictive strength as ploidy, the two features identified largely nonoverlapping subgroups. Thus, within the clinical high-risk group, it was possible to distinguish hyperdiploid patients whose 5-year survival rate (83% +/- 15%) was comparable to that of patients with localized, low-risk tumors. CONCLUSION This prospective study indicates that both ploidy and clinical risk group are important prognostic factors in medulloblastoma. Their combined use at diagnosis would distinguish patients who require more aggressive therapeutic intervention (diploid, clinical high-risk group) from those who could be expected to benefit most from standard treatment.

Prognostic Factors in Primary Chronic Myelofibrosis in Patients Aged Less Than 70 Years: A Report on 207 Patients with the Description of a Scoring System and Its Validation on 100 Other Patients.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1524-1524 ◽  
Author(s):  
Tetsuya E. Tanimoto ◽  
Kazuya Shimoda ◽  
Takuhiro Yamaguchi ◽  
Takashi Okamura ◽  
Hideaki Mizoguchi ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
High Risk ◽  
Risk Group ◽  
Survival Rates ◽  
High Risk Group ◽  
Low Risk ◽  
Data Set ◽  
Hematopoietic Stem ◽  
External Data

Abstract Primary chronic myelofibrosis (PCMF) is a rare myeloproliferative disorder among young individuals. Conventional therapies are often ineffective and only palliative. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) using myeloablative or reduced-intensity conditioning offers the only possible curative treatment. However, the course of PCMF is highly variable from only a few months to more than a decade. To identify PCMF patients for allo-HSCT candidates, we analyzed a Japanese cohort aged less than 70 years and established a new prognostic system based on simple clinical parameters. In a training series, we used 207 patients with complete data, whose diagnoses were made over a period of 10 years (1988 to 1997) (Okamura T et al. Int J Hematol 2001). Patients who received allo-HSCT were not included. Using the Cox proportional hazard regression model, four initial variables were independently associated with shorter survival: Male sex (hazard ratio [HR], 2.26; 95% confidence interval [C.I.], 1.35–3.46), Hemoglobin < 10 g/dL (HR, 3.01; 95% C.I., 1.83–4.93), the presence of constitutional symptoms (fever, sweats and weight loss) (HR, 2.33; 95% C.I., 1.33–4.06), and circulating blasts ≥ 1% (HR, 1.53; 95% C.I., 1.00–2.33). Based on the above criteria, two groups were identified; a low-risk goup with up to one adverse prognostic factor and a high-risk group with two or more adverse prognostic factors. With the median follow-up time of 83 months, the median survival was 292 months in the low-risk group, and 66 months in the high-risk group, respectively (P <.0001, Figure). An external data set of 100 patients who diagnosed after 1999 was used for validation. The 4 prognostic systems separated the validation series in groups with significantly different survival rates despite the median follow-up time of 12 months. A simple prognostic model using the combination of sex, Hb level, constitutional symptoms and circulating blasts was developed and validated. This model might help to select patients with PCMF for treatment and to evaluate therapeutic results including allo-HSCT. Figure Figure

Bone Marrow Cellularity Is a Single Most Important Independent Prognostic Factor In AML Patients with t(8;21)

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1707-1707
Author(s):  
Ho-Jin Shin ◽  
Jooseop Chung ◽  
Hyeoung Joon Kim ◽  
Sang Kyun Sohn ◽  
Yoo-Hong Min ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
High Risk ◽  
Prognostic Factor ◽  
Risk Group ◽  
High Risk Group ◽  
Independent Prognostic Factor ◽  
Low Risk ◽  
Intermediate Risk ◽  
Group 5 ◽  
Wbc Count

Abstract Abstract 1707 Core binding factor AML including t(8;21) and inv(16) have been associated with a relatively favorable prognosis compared with patients with normal or adverse karyotypes, and treated similarly. However, both t(8;21) and inv(16) AML seem to differ with respect to several biologic features and several reports demonstrated inferior outcome of t(8;21) compared with inv(16). Advanced age, higher WBC or granulocytic count, as well as CD56 expression or granulocytic sarcoma have been reported as poor prognostic factors in t(8;21) patients. Higher bone marrow (BM) blasts, lower platelets, and non-white race in t(8;21) AML adversely affected the probability to achieve CR. The KIT mutation is associated with poor prognosis in AML1-ETO-positive AML. Five-year survival rate was only around 40% in patients with t(8;21) having poor prognostic factors. Several chemotherapeutic strategies have been reported, among which high-dose cytarabine (HDAC) is generally the most effective option for successful postremission therapy. Furthermore, none of the randomized studies disclosed an advantage of allogeneic SCT (alloSCT) in this group of patients, given the relatively high treatment-related death (TRD) rate. Patients with t(8;21) AML with unfavorable prognosis may benefit from intensive postremission therapy such as early hematopoietic SCT. We conducted a retrospective study to investigate whether postremission therapies impact on survival according to prognostic factors in 132 AML patients with t(8;21) achieving first CR. Univariate analyses of prognostic factors for survival were performed in the patients with t(8;21), as well as more limited population of chemotherapy (CTx) group according to postremission therapies. The BM cellularity was a single most important independent prognostic factor on survival when using BM cellularity cutoffs as 90%. The 5-year overall survival (OS) in patients with t(8;21) and CTx group were significantly lower at 49.7% and 44.3% in patients with ≥ 90% BM cellularity, compared with 81.4% and 81.9% in those with < 90% BM cellularity, respectively (P = 0.001 and 0.027, respectively). The only other prognostic factor that influenced OS in CTx group was WBC count with cutoffs as 9.1 × 109/L. High WBC count was trend towards poor OS in CTx group (P = 0.067). In multivariate analysis, BM cellularity appeared to be the only independent prognostic factor for OS in either AML patients with t(8;21) (P = 0.002) or CTx group (P = 0.055). Interestingly, we found positive correlation between BM cellularity and WBC count (P = 0.013), peripheral blood (PB) blast percentage (P = 0.001) and serum LDH level (P = 0.017) but not hemoglobin level and BM blast percentage in a linear regression model. And also, we confirmed negative correlation between BM cellularity and platelet count (P = 0.009). It is speculated that BM cellularity represents on poor prognostic factors including WBC and platelet counts, and PB blast percentage in patients with t(8;21). By combining dichotomized WBC count and BM cellularity in a univariate analysis for OS in CTx group, three risk groups could be established: low risk group, WBC count less than 9.1 × 109/L and BM cellularity less than 90%; intermediate risk group, WBC count ≥ 9.1 × 109/L and BM cellularity less than 90%; high risk group, BM cellularity ≥ 90%. In CTx group, 5-year OS was 81.9% in low risk group, 64.8% in intermediate group, and 32.1% in high risk group (P = 0.041). In alloSCT group, 5-year OS was 94.1% in low risk group, 29.1% in intermediate risk group, and 77.8% in high risk group (P = 0.042). In low risk group, 5-year OS was 81.9% in CTx group, 65.6% in autologous SCT (autoSCT) group, 94.1% in alloSCT group. In intermediate risk group, 5-year OS was 64.8% in CTx group, 29.1% in alloSCT group. In high risk group, 5-year OS was 32.1% in CTx group, 52.5% in autoSCT group, and 77.8% in alloSCT group. We found that BM cellularity was the most powerful independent prognostic factor in AML patients with t(8;21). The newly proposed model using BM cellularity and WBC count demonstrated a simple and valid measurement as main prognostic factor. We suggest a risk-adapted postremissin strategies based on this prognostic model for AML with t(8;21) such as low and intermediate risk patients receiving three cycles or more than three cycles of HDAC CTx and high risk patients undergoing SCT in first CR as postremission therapy. Disclosures: No relevant conflicts of interest to declare.

Enteropathy-Associated T-Cell Lymphoma: a Clinical Prognostic Model to Identify High Risk Patients

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3092-3092
Author(s):  
Laura R de Baaij ◽  
Jolanda MW van de Water ◽  
Wieke HM Verbeek ◽  
Otto J Visser ◽  
Dirk J Kuik ◽  
...  
Keyword(s):  
Risk Factors ◽  
T Cell ◽  
High Risk ◽  
Prognostic Model ◽  
Cell Lymphoma ◽  
Risk Group ◽  
High Risk Group ◽  
Low Risk ◽  
T Cell Lymphoma ◽  
Risk Patients

Abstract Abstract 3092 Enteropathy-associated T-cell lymphoma (EATL) is a rare intestinal lymphoma that arises from intraepithelial lymphocytes. In Western countries EATL accounts for 5% of all gastrointestinal lymphomas and in 80–90% of all cases this lymphoma is associated with celiac disease (CD). Based on clinical presentation, EATL can be divided into two subtypes: primary and secondary EATL. Primary EATL develops without a preceding history of CD. The first presentation is often perforation or obstruction, which leads to diagnosis of both EATL and CD. Secondary EATL is diagnosed in patients with well-established CD or refractory CD. These patients deteriorate and eventually develop EATL. The current standard treatment for both types of EATL consists of surgery and chemotherapy, but overall survival (OS) is poor and new therapeutic strategies are urgently needed. For risk-based selection of patients for new therapies and clinical trials, prognostic models as the International Prognostic Index (IPI) are generally used. Since IPI is not predictive for EATL, we determined a prognostic model specifically for EATL, which can identify high-risk patients who need more aggressive therapy. Forty-one patients were diagnosed with EATL and retrospectively analyzed. Two- and 5-years OS were 18% and 10% respectively (range: 0 – 97 months). In multivariate analysis, 3 risk factors were predictive for survival: serum LDH > normal (P < 0.001; RR 6.65; 95% CI 1.96 to 9.89), presence of B-symptoms (P < 0.001; RR 4.41; 95% CI 2.73 to 16.18) and subtype secondary EATL (P = 0.036; RR 2.33; 95% CI 1.06 to 5.13). A weighted point score was assigned to each of these 3 factors and a prognostic model was constructed. Four risk groups were identified (P < 0.0001). Group I showed most favorable outcome: 2- and 5-years OS were 55% and 30% respectively. Although survival rates in groups II, III and IV were significantly different, in none of these groups 2-years survival was achieved. Therefore, the model was simplified to a low risk and a high risk group (P < 0.0001, Figure 1). The low risk group represented patients with no risk factors, i.e. primary EATL with no B-symptoms and normal LDH. In the high risk group, patients had 1 or more of the risk factors elevated serum LDH, B-symptoms or subtype secondary EATL. The new prognostic model showed superior predictive capacity as compared to IPI. In conclusion, our new prognostic model clearly identifies a high and a low risk group. Patients with one or more of the risk factors serum LDH > normal, B-symptoms or subtype secondary EATL are at high risk, and therefore new therapies for this group are urgently needed. Figure 1: Survival in EATL. Low risk group = no risk factors. High risk group = presence of 1 or more of the following risk factors: serum LDH > normal, B-symptoms or subtype secondary EATL. Figure 1:. Survival in EATL. Low risk group = no risk factors. High risk group = presence of 1 or more of the following risk factors: serum LDH > normal, B-symptoms or subtype secondary EATL. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Echocardiography and EuroSCORE II for the stratification of low-gradient severe aortic stenosis and preserved left ventricular ejection fraction

2021 ◽  
Author(s):  
Yan Fan ◽  
Hong Shen ◽  
Brandon Stacey ◽  
David Zhao ◽  
Robert J. Applegate ◽  
...  
Keyword(s):  
High Risk ◽  
Left Ventricular Ejection Fraction ◽  
Risk Group ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
High Risk Group ◽  
Low Risk ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Risk Patients

AbstractThe purpose of this study was to explore the utility of echocardiography and the EuroSCORE II in stratifying patients with low-gradient severe aortic stenosis (LG SAS) and preserved left ventricular ejection fraction (LVEF ≥ 50%) with or without aortic valve intervention (AVI). The study included 323 patients with LG SAS (aortic valve area ≤ 1.0 cm2 and mean pressure gradient < 40 mmHg). Patients were divided into two groups: a high-risk group (EuroSCORE II ≥ 4%, n = 115) and a low-risk group (EuroSCORE II < 4%, n = 208). Echocardiographic and clinical characteristics were analyzed. All-cause mortality was used as a clinical outcome during mean follow-up of 2 ± 1.3 years. Two-year cumulative survival was significantly lower in the high-risk group than the low-risk patients (62.3% vs. 81.7%, p = 0.001). AVI tended to reduce mortality in the high-risk patients (70% vs. 59%; p = 0.065). It did not significantly reduce mortality in the low-risk patients (82.8% with AVI vs. 81.2%, p = 0.68). Multivariable analysis identified heart failure, renal dysfunction and stroke volume index (SVi) as independent predictors for mortality. The study suggested that individualization of AVI based on risk stratification could be considered in a patient with LG SAS and preserved LVEF.

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