Long-Term Prognostic Value of Hematological and “Old” Biological Parameters in CLL. Reflexions on 156 Patients with a Median Follow-Up Time More Than 6.5 Years.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4951-4951
Author(s):  
Réda Garidi ◽  
Ioana Vaida ◽  
Jean-Claude Capiod ◽  
Salhia Sid Idris ◽  
Bernard Desablens
Keyword(s):  
Prognostic Factors ◽  
Survival Time ◽  
Median Survival Time ◽  
Prognostic Value ◽  
Cox Model ◽  
Hematological Parameters ◽  
Biological Parameters ◽  
Prognostic System ◽  
System P

Abstract Waiting for a standardization of “modern” biological prognostic factors in CLL, such as mutational status, ZAP-protein, CD38… we review with a long median delay of survey, the prognostic value of classical hematological data and “old” biological parameters such as seric LDH, β2-microglobuline, sCD23 and sCD25. At time of diagnosis our 156 pts were aged from 39 to 80 yrs (median=66 yrs) and sex-ratio shows as usually a male predominance (M/F=1.40). According to Binet’s system we note 131 stages A (95 stages A0), 14 stages B and 11 stages C. With a median follow-up time more than 6.5 yrs, median survival time is 9.5 yrs and median “corrected” (i.e., without not CLL-related deaths including those due to a solid tumor because this complication is independent of initial prognostic factors of CLL) survival time is 10.2 yrs. When looking at “corrected” survival, best cut-off values for “old” biological factors are 1.25 N for LDH, 3 mg for β2-m, 33 U (=10 N) for sCD23 and 2282.5 U (=1.25 N) for sCD25. Cox model with these 4 pejorative factors (PF) retains sCD23 (p=0.00004), β2-m (p=0.00002) and LDH (p=0.001). When adding these 3 PF, we can build a very strong prognostic system: median survival time of the 117 pts with 0 or 1 PF is more than 11 yrs versus 4 yrs for the 39 pts with 2 PF or more (p<10−6). Among hematological parameters, Cox model retains 3 of them: platelets level at 2 cut-off values 150 and 100 G (p=0.000005 and 0.02); 3 or more lymphoid area according to Binet’s classification (p=0.0002) and hemoglobin level at cut-off value 120 g (p=0.03). DLT is also a strong prognostic factor (p= 0.002) but this value was missing for 47 pts. However Cox model done with DLT retains 3 factors: DLT (p=0.0003); hemoglobin at cut-off value 100 g (p=0.0003) and platelets at cut-off value 150 G (p=0.001). Cox model including “old” biological PF and classical hematological parameters without DLT, retains sCD23 (p=0.0003), platelet at cut-off value 150 G (p=0.0005) and 3 or more lymphoid areas (p = 0.003). Finally we test 3 clinical classifications (Rai, Binet and our local classification based on clinical examination, hemoglobin and platelet levels, and medullary examination) and 2 biological classifications (LDH+β2-m system and this new PF system). Cox model retains the sCD23+LDH+β2-m system (p=0.00009) and our local system (p=0.003) and when looking at global survival our prognostic system seems more performing than PF system: p=0.0007 and 0.001. Addition of LDT does not modify our results but this parameter is kept in Cox model too. We conclude on the necessity to clearly determine the best cut-off values for all prognostic parameters, classical and “old” and “new” biological ones. We also claim the usefulness to compare all prognostic factors of CLL together because “old” clinical system and DLT are perhaps more useful for clinical practice when patients are out of a prospective therapeutic trial.

Re-Evaluation of Prognostic Value of Seric LDH and β2-Microglobulin Levels among 248 CLL with a Median Follow-Up Time More Than 6 Years.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4441-4441
Author(s):  
Bernard Desablens ◽  
Réda Garidi ◽  
Bérengère Gruson ◽  
Iona Vaida ◽  
Marie Brevet
Keyword(s):  
Prognostic Factors ◽  
Survival Time ◽  
Median Survival ◽  
Prognostic Value ◽  
Cox Model ◽  
P Value ◽  
Survival Times ◽  
Prognostic System ◽  
Md Anderson

Abstract Except in MD Anderson Center, seric β2-m is not recognized as a strong prognostic factor in CLL and seric LDH too, despite this factor is more and more important among lymphoma with a continuous prognostic value. So we studied 248 CLL aged less than 75 yrs, without elevated creatininemia or evident hemolysis. There were 201 pts with stage A, 29 B and 18 C and sex-ratio M/F was 1.48. Median survival time is 10 yrs and median “corrected” (i.e., without not CLL-related deaths including those due to a solid tumor because this complication is independent of initial prognostic factors of CLL) survival time is 10.9 yrs. LDH values range from 0.55 to 3.54 N, and mean and median values are 1.05±0.40 and 0.96 N. LDH level is only correlated with blood lymphocytosis and hemoglobin levels studied as continuous values (p=0.015 and 0.002). When looking at “corrected” survival, all cut-off values from 0.75 N, N, 1.25 N… to 2.5 N are statistically significant but the best one is 1.25 N (p=6 10−6). β2-m values range from 0.81 to 16.5 mg per l, and mean and median values are 2.67±1.75 and 2.15 mg. When studied as continuous values, β2-m is linked to age, number of lymphoid areas according to Binet’s system, and hemoglobin and platelets levels (p=0.0009, <10−4, <10−4 and 0.003) but age was ruled out among patients less than 70 yrs. For “corrected” survival, all cut-off values except 1.25 mg were significant and for example p value at 4 mg level as usually used by MD Anderson Center, is 5 10−5. However we find that the best cut-off value is 3 mg (p<10−6) and this value is statistically independent from LDH one in Cox model. We tried to combine these 2 cut-off values. Product of observed LDH/1.25 N × observed β2-m/3 mg were pertinent to isolate pts with a very poor prognosis (median “corrected” survival time about 6 yrs) but size of pejorative subgroups were small (≈25% of all pts) and other subgroups were not statistically significant. When adding ratios, results were similar. So we find that the best system is to count the number of pejoratives factors, i.e., LDH > 1.25 N and β2-m > 3 mg. Global median survival times of the 3 defined groups were respectively > 10.8 yrs (160 pts), 6.5 yrs (68 pts) and 4.2 yrs (20 pts) with a p value < 10−6. This system is also efficient among stage A pts (p=10−5). When we compare this prognostic system with Binet’s and Rai’s prognostic systems, Cox model rules out Binet’s one and keeps Rai’s system and ours (p=0.01 and 0.0005). Among patients with stage A, Cox model keeps only this LDH and β2-m system. We conclude on the strong prognostic values of seric LDH and β2-m initial levels in CLL and we claim that these 2 simple biological parameters have to been compared with “modern” biological prognostic factors of CLL.

scholarly journals Can Allo-HSCT Improve the Poor Clinical Outcome of the “Internal Tandem Duplication” of the FLT3 Gene?

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5938-5938
Author(s):  
Paolo Bernasconi ◽  
Catherine Klersy ◽  
Anna Amelia Colombo ◽  
Daniela Caldera ◽  
Francesco Ripamonti ◽  
...  
Keyword(s):  
Survival Time ◽  
Median Time ◽  
Median Survival ◽  
Median Survival Time ◽  
Tandem Duplication ◽  
Cox Model ◽  
High Dose ◽  
Internal Tandem Duplication ◽  
Relapse Risk

Abstract AML patients (pts) with a normal chromosome pattern and the “Internal Tandem Duplication” (ITD) of the FLT3 gene have an overall and event-free survival (OS, EFS) inferior than those of pts with a FLT3 “wild-type” gene because of a higher relapse risk, are placed in the intermediate-1 prognostic category, and when in complete remission (CR) are candidates to allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, the role of allo-HSCT in ITD+ pts is still debated and a recent retrospective analysis has stated that FLT3/ITD adversely affected allo-HSCT outcome in the same direction as it does after chemotherapy. Thus, the present study was aimed to compare the OS, EFS and relapse risk of pts submitted to allo-HSCT in first CR or in initial relapse, defined by a 5-10% bone marrow blast cell percentage, with those of pts submitted to chemotherapy alone. The study cohort consisted of 54 chromosomally normal, ITD+ consecutive non-M3 AML pts who were included in 168 AML pts aged 18-66 years who came to our observation in the period January 2007-December 2013. At diagnosis median age was 48.6 years (range 18-66), 25 pts were males and 29 females. Median follow-up was 16.2 months (0.4-68.8): median follow-up for responsive pts was 7.15 months (range 0.26-27.6), for relapsed pts was 18.1 (range 1.9-68.8) and for transplanted pts was 9.1 months (range 2.9-26.8). All pts received the same induction treatment that consisted of standard Idarubicine+Ara-c “3+7” followed by two consolidation courses with high-dose Ara-c. Those who failed induction received other treatment schedules among which Fludarabine+Ara-c+Idarubicine was the most common. At the end of consolidation 38 pts were in first CR, achieved after 3+7 in 27 pts and after a second different course in 11. Sixteen pts had a resistant disease. After a median time of five months (range 1-21) 21/38 pts (55.2%) relapsed. All received a re-induction and 8/21 (38.1%) attained a second CR. Allo-HSCT was performed in a total of 23 pts: 12 first CRs, 6 second CRs and 5 initial relapses. The donor was a sibling in 7 pts, an unrelated donor in 13 and an haplo-identical donor in 3; the HSC source was the marrow in 6 pts, the peripheral blood in 16 and the cord blood (CB) in one. The Conditioning regimen was myeloblative (mainly Busulfan+Fludarabine) in 21 and non-myeloblative in 2; GvHD prophylaxis consisted of Cyclosporine A, steroids and methotrexate “short course”. The median number of CD34+ cells infused was 5.14x106/kg (1.3-12.7). All pts except that who received CB engrafted after a median time of 15 days (12-28); 21 were complete chimeras, two partial chimeras. Thirteen pts developed acute GvHD (grade I in 3 pts, grade II in 5, grade III in 2 and grade IV in 3) which totally/partially recovered after high dose steroids along with different immunosuppressive drugs in 4 and 9 pts respectively. Eleven pts developed a chronic GvHD which was the evolution of an aGvHD in 9, targeted different organs, was stable in 3 pts and completely/partially recovered in 4 and 2 pts respectively. Post-transplant relapse occurred in 3/12 first CRs, in none second CRs and in 3/5 initial relapse. The estimated response rate for CR pts submitted to allo-HSCT was 422.1 (95% CI: 262.4-679.1) versus 64.6 (95% CI: 40.7-102.6) for those submitted to chemotherapy alone with a median survival time of 7.2 months (range 5.3-8.8) versus not reached (1.9-not available); on univariable Cox model the HR of allo-HSCT pts was 37.9 (95% CI: 9.4-152.0) with p=0.0000. The estimated relapse rate for CR pts submitted to allo-HSCT was 8.6 (95% CI: 2.1-34.4) versus 44.3 (95% CI: 25.7-76.3) for those submitted to chemotherapy alone with a median survival time not reached (range not available) versus 13.2 (7.2-not available); on univariable Cox model the HR of allo-HSCT pts was 0.5 (95% CI: 0.2-1.1) with p=0.06. The estimated death rate for CR pts submitted to allo-HSCT was 28.7 (95% CI: 13.7-60.4) versus 49.7 (95% CI: 32.1-77.1) for those submitted to chemotherapy alone with a median survival time of 18.3 months (range 14.2-not available) versus 12.2 (8.8-18.9); on univariable Cox model the HR for allo-HSCT pts was 0.48 (95% CI: 0.2-1.1) with p=0.09. In conclusion, our series suggests that in ITD+ pts allo-HSCT significantly strengthens CR in pts who had already responded to conventional chemotherapy, but it presents only a trend towards significance when its superiority to prevent relapse was considered. Disclosures Castagnola: Gilead Sciences: Research Funding.

Prognostic Value of Seric Immunoglobulins in CLL: Analysis of 331 Patients with a Median Follow-Up Time of 7.5 Years.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4961-4961
Author(s):  
Réda Garidi ◽  
Marie-Noëlle Guilhaume ◽  
Ioana Vaida ◽  
Marie Brevet ◽  
Jean-Claude Mazière ◽  
...  
Keyword(s):  
Survival Time ◽  
Median Survival ◽  
Median Survival Time ◽  
Prognostic Value ◽  
Cox Model ◽  
Survival Rates ◽  
Initial Dosage ◽  
Mean Value ◽  
Survival Times ◽  
Global Survival

Abstract Prognostic value of seric immunoglobulins in CLL has been rarely studied. So we look at all our CLL and we find 331 pts with an initial dosage of IgG, IgA and IgM without M component at diagnosis or during the first year of survey. Ages at diagnosis range from 38 to 93 yrs and median age is 66 yrs. Sex ratio M/F is 1.55 and staging according to Binet’s system notes 264 stages A (188 stages A0), 43 stages B and 24 stages C. IgG levels range from 0.9 to 22.2 g per l with a mean value of 9.38±3.18 g. In logistic regression, IgG level is linked with sex, age, number of lymphoid area according to Binet’s system, blood lymphocytosis and hemoglobin levels used as continuous values. IgA range from 0.1 to 7.8 g (mean value=1.66±1.03 g) and is linked with the same parameters and platelet level too. At least, IgM range from 0 to 3.4 g (mean value=0.78±0.63 g) and is linked with age, number of lymphoid area, blood lymphocytosis and platelet levels. Immunoglobulins levels are also linked with LDH, β2-microglobulin, sCD23 and sCD25 values. Looking at “corrected” survival after exclusion of not CLL-related deaths including those due to a solid tumor because this complication is independent of initial prognostic factors of CLL, we find that the best cut-off values are 7 g for IgG and 2 g for IgA. For IgG, median survival time is 14.6 yrs for the 268 pts with initial IgG ≥ 7 g versus 6.5 yrs for the 63 other pts (p=0.00004). For IgA, the best cut-off value is 2 g: median survival time is >13.3 yrs for the 100 pts with IgA ≥ 2 g versus 10 yrs for the 231 other pts (p=0.04). These 2 cut-off values are independent and so we can build a prognostic system: 98 pts with IgG ≥ 7 g and IgA ≥ 2 g - 172 pts with IgG < 7 g or IgA < 2 g - 61 pts with low IgG and IgA levels. Median “corrected” survival times of these 3 groups are statistically different: > 13.3, 10.6 and 6.8 yrs (p=0.0009) and when we look at global survival, rates are more different: >13.3, 8.6 and 5.7 yrs (p=0.00009). Same data are noted among stage A patients only and among stage A0 too. So when we opposite this system and with Binet’s and Rai’s classifications, only Rai’s system is ruled out by Cox model looking at “corrected” or global survival. Curiously, this new system has no impact of initiation on treatment among stage A pts while it is linked to evolution to stage C (p=0.05). Finally, we find no correlation with occurrence of an M component or an immunological complication, and also with occurrence of a zoster infection or a Richter syndrome while it is a trend for occurrence of a second neoplasia (p=0.06).

scholarly journals An Evaluation of Survival of Space Maintainers: A Six-year Follow-up Study

2005 ◽  
Vol 6 (1) ◽  
pp. 74-84 ◽  
Author(s):  
Ozlem Tulunoglu ◽  
Tezer Ulusu ◽  
Yasemin Genç
Keyword(s):  
Survival Time ◽  
Success Rate ◽  
Median Survival ◽  
Median Survival Time ◽  
Age Groups ◽  
Age Group ◽  
Follow Up Study ◽  
Different Types ◽  
Lost To Follow Up

Abstract The aim of this study was to evaluate the median survival time of fixed and removable space maintainers related to age groups, gender, and their distribution in upper and lower dental arches. The adherence of patients to a periodic recall program and the success rate of different types of space maintainers related to different arches were also evaluated. This study included 663 patients aged between 4-15 years old that were treated between the years of 1997 and 2002. The patients were categorized into four main groups: lost to follow-up, failed, successful, and censored at the end of study. Three hundred forty-five space maintainers were considered lost to follow-up, 83 were considered failed, 206 successful, and 20 censored-at-end. The overall median survival time of the appliances was 6.51 months. Median survival time was 7.25 months in the 4-6 age group, 6.35 months in the 7-12 age group, and 7.0 months in the 13+ age groups. Median survival time was 5.76 months in girls and 7.11 months in boys. Median survival time of space maintainers was 7.17 months for maxilla and 6.69 months in the mandible. Median survival time was 5.25 months for space maintainers fabricated in both arches. Citation Tulunoglu Ö, Ulusu T, Genç Y. An Evaluation of Survival of Space Maintainers: A Six-year Follow-up Study J Contemp Dent Pract 2005 February;(6)1:074-084.

Repeat decompression surgery for recurrent spinal metastases

2010 ◽  
Vol 13 (1) ◽  
pp. 109-115 ◽  
Author(s):  
Ilya Laufer ◽  
Andrew Hanover ◽  
Eric Lis ◽  
Yoshiya Yamada ◽  
Mark Bilsky
Keyword(s):  
Spinal Cord ◽  
Survival Time ◽  
Median Survival ◽  
Spinal Cord Compression ◽  
Median Survival Time ◽  
Eastern Cooperative Oncology Group ◽  
Cord Compression ◽  
Decompression Surgery ◽  
High Grade

Object In this paper, the authors' goal was to determine the outcome of reoperation for recurrent epidural spinal cord compression in patients with metastatic spine disease. Methods A retrospective chart review was conducted of all patients who underwent spine surgery at the Memorial Sloan-Kettering Cancer Center between 1996 and 2007. Thirty-nine patients who underwent reoperation of the spine at the level previously treated with surgery were identified. Only patients whose reoperation was performed because of tumor recurrence leading to high-grade epidural spinal cord compression or recurrence with no further radiation options were included in the study. Patients who underwent reoperations exclusively for instrumentation failure were excluded. All patients underwent additional decompression via a posterolateral approach without removal of the spinal instrumentation. Results Patients underwent 1–4 reoperations at the same level. A median survival time of 12.4 months was noted after the first reoperation, and a median survival time of 9.1 months was noted after the last reoperation. At last follow-up 22 (65%) of 34 patients were ambulatory at the time of last follow-up or death, and the median time between loss-of-ambulation and death was 1 month. Functional status was maintained or improved by one Eastern Cooperative Oncology Group grade in 97% of patients. A major surgical complication rate of 5% was noted. Conclusions Reoperation represents a viable option in patients with high-grade epidural spinal cord compression who have recurrent metastatic tumors at previously operated spinal levels. In carefully selected patients, reoperation can prolong ambulation and result in good functional and neurological outcomes.

Identification of Prognostic Factors in 61 Patients With Posttransplantation Lymphoproliferative Disorders

2001 ◽  
Vol 19 (3) ◽  
pp. 772-778 ◽  
Author(s):  
Véronique Leblond ◽  
Nathalie Dhedin ◽  
Marie-France Mamzer Bruneel ◽  
Sylvain Choquet ◽  
Olivier Hermine ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Complete Remission ◽  
Survival Time ◽  
Median Survival ◽  
Median Survival Time ◽  
Univariate Analysis ◽  
Lymphoproliferative Disorders ◽  
Long Term Outcome ◽  
Pathologic Features ◽  
Risk Patients

PURPOSE: Prognostic studies of posttransplantation lymphoproliferative disorders (PTLDs) are hindered by the small number of cases at each transplant center. We analyzed prognostic factors and long-term outcome according to clinical manifestations, pathologic features, and treatment and investigated the prognostic value of the non-Hodgkin’s lymphoma International Prognostic Index (IPI) in 61 patients with PTLD. PATIENTS AND METHODS: We studied 61 patients in two institutions who developed PTLD and analyzed factors influencing the complete remission and survival rates. RESULTS: In univariate analysis, factors predictive of failure to achieve complete remission were performance status (PS) ≥ (P = .0001) and nondetection of Epstein-Barr virus (EBV) in the tumor (P = .01). Only a negative link with PS ≥ 2 was observed in multivariate analysis. In univariate analysis, factors predictive of lower survival were PS ≥ 2, the number of sites (one v > one), primary CNS localization, T-cell origin, monoclonality, nondetection of EBV, and treatment with chemotherapy. The IPI failed to identify a patient subgroup with better survival and was less predictive of the response rate than was a specific index using two risk factors (PS and number of involved sites), which defined three groups of patients: low-risk patients whose median survival time has not yet been reached, intermediate-risk patients with a median survival time of 34 months, and high-risk patients with a median survival time of 1 month. CONCLUSION: PS and the number of involved sites defined three risk groups in our population. The value of these prognostic factors needs to be confirmed in larger cohorts of patients treated in prospective multicenter studies.

scholarly journals Expression of Lewisa, Sialyl Lewisa, Lewisx, Sialyl Lewisx, Antigens as Prognostic Factors in Patients with Colorectal Cancer

2000 ◽  
Vol 14 (9) ◽  
pp. 753-760 ◽  
Author(s):  
Tohru Nakagoe ◽  
Kiyoyasu Fukushima ◽  
Atsushi Nanashima ◽  
Terumitsu Sawai ◽  
Takashi Tsuji ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Colorectal Carcinoma ◽  
Survival Time ◽  
Prognostic Value ◽  
Tumour Progression ◽  
Colorectal Carcinomas ◽  
Altered Expression ◽  
Sialyl Lewis ◽  
Positive Expression ◽  
Cox's Regression

BACKGROUND: Altered expression of blood group-related carbohydrate antigens such as sialyl Lewis (Le)xantigen in tumours is associated with tumour progression behaviour and subsequent prognosis. However, the prognostic value of the expression of Le-related antigens in colorectal tumours remains unclear.PURPOSE: To clarify the prognostic value of Lea, sialyl Lea, Lexand sialyl Lexexpression in colorectal carcinomas as prognostic factors after surgery.PATIENTS AND METHODS: Colorectal carcinoma samples from 101 patients with primary colorectal carcinoma who underwent surgical resection were subject to immunohistochemical analyses for Lea, sialyl Lea, Lexand sialyl Lexexpression with the respective monoclonal antibodies.RESULTS: Lea, sialyl Lea, Lexand sialyl Lexwere expressed in 69 (68.3%), 73 (72.3%), 66 (65.4%) and 76 (75.3%) carcinomas, respectively. The patients with sialyl Lex-expressing tumours had more advanced cancer than those with nonsialyl Lex-expressing tumours (P=0.0029). The survival time after surgery of patients with Lex- or sialyl Lex-expressing tumours was significantly shorter than the survival time of those with non-Lex- or nonsialyl Lex-expressing tumours, respectively (P=0.023 and P=0.0001, respectively). Cox’s regression analysis revealed that Lexand sialyl Lexexpression, separate from stage and histological type, were prognostic variables for patient survival (hazard ratio [HR] for sialyl Lex-positive expression to sialyl Lex-negative expression 2.90; HR for Lex-positive expression to Lex-negative expression 12.76 in stage I/IV, 0.63 in stage II and 1.69 in stage III).CONCLUSIONS: Lexexpression and sialyl Lexexpression in colorectal carcinomas are each associated with poor prognosis. These variables should be considered in the design of future trials.

Prognostic factors for overall survival in non-Hodgkin lymphomas: Nonlinear effect of continuous covariates.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e19538-e19538
Author(s):  
Claudio J. Flores ◽  
Luis Augusto Casanova
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Nonlinear Effect ◽  
Cox Model ◽  
Clinical Stage ◽  
Performance Status ◽  
P Value ◽  
Continuous Covariates ◽  
Ann Arbor

e19538 Background: To evaluate prognostic factors in patients with primary non-Hodgkin lymphomas (NHL). Methods: We retrospectively analyzed prognostic factors (PFs) for overall survival (OS) in 2160 patients (pts) with NHL treated at INEN between 1990-2002. PFs were determinate according to Cox model with P-splines. Results: The median age was 54 years (range 14 - 96) and 51% were male. The majority of the pts had good performance status (73%, WHO 0-1). The Ann Arbor stage was I-II in 51%, III-IV in 49% and B symptoms were present in 38% of the pts. The hemoglobin (Hb) was low in 48%. Leukocytes (WBC), lymphocytes and LDH were elevated in 17.7%, 7.7% and 60% of pts, respectively. Of all patients, 709 (32.8 %) pts had died. The median follow-up was 12.6 months, with a median survival of 61.8 months and the survival rate at 5 and 10 years of 51.2 % and 41.7 % respectively. PFs identified were: age, sex, zubrod, clinical stage, Hb, leukocytes, lymphocytes and LDH. The following table shows the p-value and hazard ratio (HR). The effect of continuous covariates in the log(HR) is non-linear. The cutoff points of highest (HR >1) match the clinically defined ones, which are: age >60yrs, Hb<12g/dl and LDH >240UI/L. Both leukocytes and lymphocytes have two higher risk breakpoints: leukocytes >3x103 and >10x103, lymphocytes <20% and >60%. Conclusions: PFs for OS in our group of pts were similar to other reports in NHL. Age, Hb, leukocytes, and lymphocytes are relevant to OS, which showed a nonlinear effect in the log (HR). [Table: see text]

How long have we got? The accuracy of physicians’ estimates and scenarios for survival time in 898 women with recurrent ovarian cancer (ROC).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 5549-5549
Author(s):  
Felicia Roncolato ◽  
Rachel O'Connell ◽  
Florence Joly ◽  
Anne Lanceley ◽  
Felix Hilpert ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Prognostic Factors ◽  
Survival Time ◽  
Cox Model ◽  
A Priori ◽  
Prognostic Significance ◽  
Recurrent Ovarian Cancer ◽  
Worst Case ◽  
Cox Models ◽  
Platinum Sensitive

5549 Background: Predicting, formulating, and communicating prognosis in women with ROC is difficult. Best-case, worst-case, and typical scenarios for survival time based on simple multiples of an individual’s expected survival time (EST) estimated by their oncologist have proven accurate and useful in a range of advanced cancers. We sought the accuracy and prognostic significance of such estimates in the GCIG Symptom Benefit Study: a multinational, prospective cohort study of women with ROC (platinum resistant and potentially platinum sensitive ROC who have had more than 2 lines of chemotherapy). Methods: Oncologists estimated EST at baseline for each woman they recruited to the GCIG Symptom Benefit Study in 11 countries. We hypothesised a priori that oncologists’ estimates of EST would be unbiased (equal proportions [approximately 50%] of women living longer versus shorter than their EST), imprecise ( < 33% living within 0.75 to 1.33 times their EST), and provide accurate scenarios for survival time (approximately 10% dying within ¼ of their EST, 10% living longer than 3 times their EST, and 50% living from half to double their EST). We also hypothesised that oncologists’ estimates of EST would be independently significant predictors of survival in a multivariable Cox model adjusting for prognostic factors established in previous studies. Results: Oncologists’ individualised estimates of EST in 898 women with ROC were unbiased (55% of women lived longer than their EST) and imprecise (23% lived within 0.75 to 1.33 times their EST). Scenarios for survival time based on oncologists’ estimates of EST were remarkably accurate: 7% of women died within ¼ of their EST, 13% lived longer than 3 times their EST, and 53% lived from half to double their EST. The median EST was 12 months (range 3-70), and median observed was 12.7 months. Oncologists’ estimates of EST were independently significant predictors of overall survival (HR 0.96, CI 0.94-0.98, p < 0.0001) in Cox models accounting for previously established prognostic factors. Conclusions: Oncologists’ estimates of EST were unbiased, imprecise, and independently significant predictors of survival time. Best-case, worst-case and typical scenarios based on simple multiples of EST were remarkably accurate, and provide a useful approach for predicting, formulating, and explaining prognosis in women with recurrent ovarian cancer. Clinical trial information: ACTRN: 12607000603415.

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