Malignant melanoma in the elderly.

1987 ◽  
Vol 5 (1) ◽  
pp. 100-106 ◽  
Author(s):  
H J Cohen ◽  
E Cox ◽  
K Manton ◽  
M Woodbury
Keyword(s):  
Malignant Melanoma ◽  
Prognostic Factor ◽  
Older Patients ◽  
Cox Model ◽  
Primary Site ◽  
Older Age ◽  
Age Group ◽  
Superficial Spreading ◽  
Poor Prognostic Factor ◽  
Male Predominance

Advancing age is associated with poorer prognosis in malignant melanoma. We studied 3,872 cases of malignant melanoma to evaluate whether the effect of age could be analyzed relative to sex, tumor depth, primary site, and other clinical and pathologic variables. The sex distribution by age shows a slight female predominance in the early and late decades but male predominance in the middle years. The percentage of patients with metastatic disease at initial diagnosis did not vary with age, despite greater diameter and depth of lesions in the older patients. In fact, in the older age groups, initial nodal metastasis occurred slightly less frequently. Trunk primaries decreased in frequency with increasing age, while extremity lesions remained relatively constant, and face, nose, and ear lesions increased. This was in part related to the histopathologic type, as lentigo maligna lesions increased in frequency with age, superficial spreading lesions were somewhat less frequent in the older age group and nodular types were fairly constant. On the basis of both Clark's level and Breslow thickness, there was an increasing proportion of deeper penetrating lesions in the older age group. The mean diameter of these lesions on the skin surface was also greater for the older patients. This would suggest that lesions in the older individual remain confined to the local site longer, penetrate and spread, but do not necessarily metastasize more rapidly. Cox model regression analysis of survival time within stage showed that age was highly significant as a poor prognostic factor. Though the adverse relation of advancing age with survival was partially explained by predominance of other unfavorable factors, such as primary site, depth of lesion, or histologic type, age remained an independent poor prognostic factor (chi 2 = 5.3; P = .02) for death due to melanoma.

Is older age a poor prognostic factor in stage I and II endometrioid endometrial adenocarcinoma?

2011 ◽  
Vol 120 (2) ◽  
pp. 189-192 ◽  
Author(s):  
Nicole D. Fleming ◽  
Scott E. Lentz ◽  
Ilana Cass ◽  
Andrew J. Li ◽  
Beth Y. Karlan ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Endometrial Adenocarcinoma ◽  
Older Age ◽  
Stage I ◽  
Poor Prognostic Factor

Prognostic impact of chemoradiation-related lymphopenia in patients with gastric and gastroesophageal cancer.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 249-249
Author(s):  
Daniel W Kim ◽  
Grace Lee ◽  
Theodore S. Hong ◽  
Guichao Li ◽  
Eric Roeland ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Cox Model ◽  
Gastroesophageal Junction ◽  
Concurrent Chemotherapy ◽  
Rank Test ◽  
Prognostic Impact ◽  
Poor Prognostic Factor ◽  
Risk Of Death ◽  
Increased Risk ◽  
Ecog Ps

249 Background: Limited data exists on how chemoradiation (CRT)-induced lymphopenia affects survival outcomes in patients with gastric and gastroesophageal junction (GEJ) cancer. We evaluated the association between severe lymphopenia and its association with survival in gastric and GEJ cancer patients treated with CRT. We hypothesized that severe lymphopenia would be a poor prognostic factor. Methods: We performed a retrospective analysis of 154 patients with stage 1-3 gastric or GEJ cancer who underwent CRT at our institution. Patients underwent photon-based radiation therapy (RT) with a median dose of 50.4 Gy (IQR 45.0-50.4 Gy) over 28 fractions and concurrent chemotherapy (CTX) with carboplatin/paclitaxel, 5-fluorouracil based regimen, or capecitabine. 49% received CTX prior to RT. 84% underwent surgical resection, 57% pre-CRT and 26% post-CRT. Absolute lymphocyte count (ALC) at baseline and at 2 months since initiating RT were analyzed. Severe lymphopenia, defined as Grade 3 or worse lymphopenia (ALC < 0.5 k/μl), was analyzed for any association with overall survival (OS). Results: Median time of follow up was 48 months. Median age was 65. 77% were male and 86% were Caucasian. ECOG PS was 0 or 1 in 90% and 2 in 10%. Tumor location was stomach in 38% and GEJ in 62%. Timing of CRT was preoperative among 68% and postoperative among 32%. The median ALC at baseline for the entire cohort was 1.6 k/ul (range 0.3-7.0 k/ul). At 2 months post-CRT, 49 (32%) patients had severe lymphopenia. Patients with severe lymphopenia post-CRT had a slightly lower baseline TLC compared to patients without severe lymphopenia (median TLC 1.4 k/ul vs. 1.6 k/ul; p = 0.005). There were no differences in disease and treatment characteristics between the two groups. On the multivariable Cox model, severe lymphopenia post-CRT was significantly associated with increased risk of death (HR = 3.99 [95% CI 1.55-10.28], p = 0.004). ECOG PS 2 (HR = 34.97 [95% CI 2.08-587.73], p = 0.014) and postoperative CRT (HR = 5.55 [95% CI 1.29-23.86], p = 0.021) also predicted worse OS. The 4-year OS among patients with severe lymphopenia was 41% vs. 61% among patients with vs. without severe lymphopenia (log-rank test p = 0.041). Conclusions: Severe lymphopenia significantly correlated with poorer OS in patients with gastric or GEJ cancer treated with CRT. CRT-induced lymphopenia may be an important prognostic factor for survival in this patient population. Closer observation in high-risk patients and treatment modifications may be potential approaches to mitigating CRT-induced lymphopenia.

Older Age Is An Independent Risk Factor in AML

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 555-555
Author(s):  
Thomas Buchner ◽  
Wolfgang E. Berdel ◽  
Claudia Haferlach ◽  
Susanne Schnittger ◽  
Torsten Haferlach ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Patients ◽  
Normal Karyotype ◽  
Older Age ◽  
Age Group ◽  
Risk Profiles ◽  
Mutation Status ◽  
Younger Patients ◽  
Age Related ◽  
Younger Age

Abstract Among the entire patients with AML the majority is 60 years of age or older. In present German multicenter AML Cooperative Group (AMLCG) trial the proportion of these older patients amounts to 54% of all 2734 patients enrolled and receiving intensive chemotherapy. While older age AML is increasingly recognized as a main challenge the therapeutic outcome unlike that in younger patients has remained constantly poor. Thus, the patients of ≥ 60y show an overall survival (OS) of 13% and a relapse rate (RR) of 82% at 5y versus 40% and 52% in younger patients. Age related differences in treatment and in risk profiles are commonly used to explain the differences in outcome. In the AMLCG 99 trial including 2734 patients 16 to 85 (median 61) years of age we investigated factors determining the disease biology and outcome. For induction treatment patients received standard dose TAD and high-dose AraC 3 (age &lt; 60y) and 1 (≥ 60y) g/m² × 6/mitoxantrone (HAM) or randomly HAM-HAM, for consolidation TAD, and for maintenance monthly reduced TAD randomized (in patients &lt; 60y) against autologous SCT. When compared with patients younger than 60y older patients had more frequent secondary AML (29% vs 17%, p&lt; 0.0001), unfavorable cytogenetics (29% vs 23%, p= 0.0004), less frequent favorable cytogenetics (4% vs 12%, p&lt; 0.0001), and NPM1mut/FLT3-ITDneg status (26% vs 34%, p&lt; 0.009) in those with normal karyotype, and overall even lower median WBC (7.360 vs 12.600/μl, p&lt; 0.0001) and LDH (340 vs 413 U/l, p&lt; 0.0001). A multivariate analysis identified independent risk factors determining therapeutic endpoints such as CR rate, OS, RR, and RFS. With similar results across all endpoints, risk factors for OS were age ≥ 60y (HR 1.96, 95% CI 1.75–2.17), AML secondary to MDS or cytotoxic treatment (1.28, 1.14–1.45), unfavorable karyotype (2.17, 1.92– 2.44), WBC &gt; 20×10³/μl (1.15, 1.02– 1.30), LDH &gt; 700U/L (1.32, 1.15– 1.52), favorable karyotype (0.49, 0.38– 0.63) and female gender (0.90, 0.81– 0.99). In the 891 patients with normal karyotype and complete mutation status risk factors for OS were age ≥ 60y (2.00, 1.64– 2.44), and NPM1mut/FLT3-ITDneg (0.39, 0.30– 0.49). Risk factors for RR overall were age ≥ 60y (2.04, 1.75– 2.38), unfavorable karyotype (2.08, 1.47– 2.13), LDH (1.41, 1.16– 1.72) and favorable karyotype (0.40, 0.29– 0.56). In patients with normal karyotype and complete mutation status risk factors for RR were age ≥ 60y (2.00, 1.56– 2.63), and NPM1mut/FLT3-ITDneg (0.32, 0.23– 0.43). Testing the role of older age in favorable subgroups, the 198 patients with CBF leukemia show an OS at 5 years of 27.5 (95% CI 12.0– 43.0) % in the older versus 69.4 (60.7– 78.2) % in the younger age group, and a RR of 56.6 (35.7– 77.3) % versus 25.0 (15.6– 34.4) %. Comparatively, the 264 patients with a normal karyotype and NPM1mut/FLT3-ITDneg show an OS of 37.1 (26.6– 47.5) % in the older versus 71.9 (63.4– 80.4) % in the younger age group, and a RR of 61.0 (47.8– 74.2) % versus 23.0 (14.0– 32.0) %. There was no influence by randomized treatment variables on any therapeutic endpoint. Conclusion: Considering the prognostic spectrum of all major historic or genetic subgroups older age maintains its dominant role not explained by age related differences in risk profiles. Even within CBF leukemias and sole NPM1 mutation as the best prognostic categories older age predicts for markedly shorter OS and higher RR. Thus, understanding older age AML requires further genetic and epigenetic work.

Is older age a poor prognostic factor in stage I and II endometrioid endometrial adenocarsinoma?

2010 ◽  
Vol 116 (3) ◽  
pp. 594
Author(s):  
N. Fleming ◽  
S. Lentz ◽  
S. Vasilev ◽  
M. Ellison ◽  
I. Cass ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Older Age ◽  
Stage I ◽  
Poor Prognostic Factor

Age at diagnosis does not adversely affect outcome in patients with Hodgkin's Disease (HD) after autologous transplantation

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e19507-e19507
Author(s):  
U. R. Popat ◽  
R. Saliba ◽  
C. Hosing ◽  
I. Khouri ◽  
A. M. Alousi ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Cumulative Incidence ◽  
Reference Group ◽  
Univariate Analysis ◽  
Autologous Transplantation ◽  
Disease Status ◽  
Older Age ◽  
Age At Diagnosis ◽  
High Dose ◽  
Poor Prognostic Factor

e19507 Background: Age at diagnosis is a poor prognostic factor for overall survival after standard therapy for HD. Whether older age is a prognostic factor for outcome after autologous transplantation is not known. We sought to evaluate the effect of older age at diagnosis on transplant outcome. Patients and Methods: All patients with HD undergoing autologous transplantation with BEAM conditioning (BCNU, Etoposide, Cytarabine, and Melphalan) between January 1996 and December 2007 were included in this study. During these 12 years, 248 patients (103 males) underwent autologous transplantation. Seventy two patients (29%) were older than 40 years of age at the time of initial diagnosis. Median age at transplantation was 31 years (range 11–74). At transplantation, 63 (25%) were in complete remission (CR); 148 (60%) were in partial remission (PR); and 37 (15%) had stable (SD) or progressive disease (PD). Forty-six patients (19%) had received more than 3 courses of chemotherapy prior to transplantation. LDH was elevated in 131 (53%). Peripheral blood stem cells were used as stem cell source in 241 (97%) patients. Results: With a median follow up of 48 months (range, 1–143 months), the 48-month overall (OS) and event-free survival (EFS) were 72% (95% CI; 65%-77%) and 57% (95% CI; 50%-63%), respectively. The cumulative incidence of non-relapse mortality at 1 year was 1.6%. The cumulative incidence of secondary MDS or AML was 8%. In univariate analysis, disease status (p<0.001) and number of prior chemotherapy regimens (p=0.007) were the only factors significantly predicting OS. Disease status was the only factor significant (p<0.01) in a multivariate analysis with a hazard ratio of 2.7 (1.1–6.9) and 9.2 (3.4–25) for patients in PR, and SD/PD respectively (CR reference group). Age at diagnosis was not a significant factor (see table ). Conclusions: High-dose chemotherapy and autologous transplantation abrogate the adverse impact of age at diagnosis in patients with HD. [Table: see text] No significant financial relationships to disclose.

Prognostic factors and therapeutic options for epithelioid hemangioendothelioma (EHE): A multicenter analysis of a series of fifty-seven cases.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11062-11062
Author(s):  
Aurore Vozy ◽  
Audrey Simonaggio ◽  
Philippe Terrier ◽  
Valerie Paradis ◽  
Nicolas Penel ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Prognostic Factor ◽  
Active Surveillance ◽  
Soft Tissues ◽  
Cox Model ◽  
Univariate Analysis ◽  
Poor Prognostic Factor ◽  
Free Survival ◽  
The Impact

11062 Background: EHE is a rare vascular mesenchymal tumor for which there is currently no standard for treatment particularly for metastatic disease. EHE often present metastatic evolution but metastases are not a poor prognostic factor. The aim of this study was to improve knowledge of outcome of EHE patients and see the impact of active surveillance on outcome for metastatic EHE patients. Methods: Patients with EHE treated at three centers in France were included in this retrospective cohort. Univariate analysis of prognostic factors was performed using the Cox model. Survival was estimated using the Kaplan-Meier method and long rank analysis. Results: Fifty-seven patients with EHE were collected in this analysis: 27 (47%) women and 30 (53%) men, with a median age at diagnosis of 39 years (range, 12-83). At diagnosis, 17 (29.8%) patients had a localized tumor, while 40 (70.2%) patients had synchronous metastases. The most commonly affected organs were liver (29.8%), bones (14.0%), skin, lungs and soft tissues (10.5% each). For the 17 patients with localized EHE, the median distant recurrence-free survival after resection of primary was 64.6 months, 95% CI [29.4, NA], (median follow-up of 62.7 months, range, 12.5-234.8). For the 40 patients with metastatic EHE, the median progression-free survival (PFS) was 59.0 months, 95% CI [21.3, NA], (median follow-up of 121.1 months, range, 1.0-202.0). No prognostic factor was identified for localized EHE. For metastatic EHE, age was associated with progression (p = 0.019), and presence of pleural/ascites/pericarditis effusion adversely affected overall survival (OS) (p = 0.002). An initial “wait and see” attitude was proposed to 23 patients (57.5%) while 17 patients (42.5%) were treated at diagnosis with local or systemic treatment (monotherapy or combination of chemotherapy with anthracyclin, taxane, cyclophosphamide). OS were similar in both groups of patients, 174months and 121months for chemotherapy treated patients and active surveillance patients respectively (p = 0.56). Conclusions: Presence of effusion was a significant poor prognostic factor in metastatic EHE patients. Active surveillance could be proposed for asymptomatic patients without effusion but this strategy need to be confirmed in largest or prospective randomized trials.

scholarly journals Characteristics of the treatment of perennial allergic rhinitis in patients of the older age group

2018 ◽  
pp. 107-110
Author(s):  
K. I. Sapova ◽  
S. V. Ryazantsev
Keyword(s):  
Allergic Rhinitis ◽  
Clinical Study ◽  
Older Patients ◽  
Older Age ◽  
Age Group ◽  
Perennial Allergic Rhinitis ◽  
Physiological Factors ◽  
Age Related ◽  
Persistent Allergic Rhinitis ◽  
Multicenter Clinical Study

Recent studies show that perennial allergic rhinitis is prevalent among older people, but the management of this disease is underestimated and not determined. This article describes the persistent allergic rhinitis in patients of the older age group and identifies the primary goals of treatment based on the age-related physiological factors, concomitant conditions and the use of other drugs. Special attention is paid to the various options for the drug therapy in elderly patients over the age of 60 years. The second-generation antihistamines and intranasal glucocorticosteroids also have primacy over other drugs, when supervising older patients. A randomized open multicenter clinical study showed that Momate Rhino Advance (a combination of intranasal antihistamines (azelastine) and intranasal glucocorticosteroids (mometasone) for the treatment of allergic rhinitis) made by Indian Glenmark Pharmaceuticals Ltd. is effective and safe in patients aged 60 years and older, who are diagnosed with the above disease.

Distribution of Underlying Causative Organisms, Patient Age, and Survival in Spontaneous spondylodiscitis with Special Focus on Elderly Patients

2021 ◽  
Author(s):  
Stephan Lackermair ◽  
Hannes Egermann ◽  
Adolf Müller
Keyword(s):  
Drug Abuse ◽  
Elderly Patients ◽  
Clinical Data ◽  
Older Patients ◽  
Older Age ◽  
Special Focus ◽  
Age Group ◽  
Infectious Agents ◽  
Ct Guided ◽  
Iv Drug Abuse

Abstract Background and Objective spondylodiscitis is becoming a more frequently encountered diagnosis in our clinical practice. Multimorbid and especially older patients build up a relevant portion of cases. The goal of our study was to evaluate our clinical data and to reveal specifics concerning elderly patients with spontaneous spondylodiscitis. Patients and Methods We retrospectively analyzed clinical data for the years from 2012 to 2014. The search was conducted on the basis of the International Classification of Diseases, 10th Revision (ICD-10) diagnoses for spondylodiscitis. Postoperative infections were not included in this study. All cases were evaluated in terms of infectious agents (in blood culture and/or computerized tomography [CT]-guided or surgical biopsy), age, and overall survival. Results Fifty-one patients with spontaneous spondylodiscitis were identified. The most frequent pathogen was methicillin-sensitive Staphylococcus aureus (MSSA; n = 21; 41.17%). Escherichia coli and S. epidermidis were each found in four patients each (7.84%). Methicillin-resistant S. aureus (MRSA), Pseudomonas aeruginosa, and S. hominis were found in three cases (5.88%). Other bacteria were found in one case (each 1.96 %). In 12 cases, there was no bacteria growth (23.53%). One of these patients revealed to have a tuberculosis infection, diagnosed after the study period (in 2015). Two-thirds of the patients were ≥65 years old (n = 34). All three patients with MRSA were >65 years old. Three of seven patients <50 years had IV drug abuse (42.86%). In these patients, rather rare infectious agents for spondylodiscitis were found (P. aeruginosa, S. hominis, Citrobacter). Mortality was 7.84% (n = 4). All of these patients were ≥67 years old, three of four (75%) were ≥75 years old. Conclusion Our study of spontaneous spondylodiscitis showed a stronger representation of older patients (>65 years). Lethal outcome exclusively concerned the older age group. S. aureus was the most frequent pathogen as shown previously. MRSA infections might be more common in the older age group. Rare causative organisms mainly occurred in patients with iv drug abuse. Further evaluation through randomized multicenter studies focusing on the different subgroups and comorbidities in larger populations and correlation with appropriate treatment options is necessary.

scholarly journals Colorectal cancer in younger adults (<50 years); a retrospective study on its clinicopathological characteristics

2021 ◽  
Vol 9 (1) ◽  
pp. 25
Author(s):  
J. Kannan ◽  
Deepak George ◽  
Srigopal Mohanty ◽  
N. Ingersal ◽  
Amit Saklani
Keyword(s):  
Colorectal Cancer ◽  
Retrospective Study ◽  
Primary Tumor ◽  
Older Patients ◽  
Positive Family History ◽  
Clinicopathological Characteristics ◽  
Older Age ◽  
Age Group ◽  
Younger Adults ◽  
Female Ratio

Background: Colorectal cancer (CRC) is a common cancer worldwide with significant geographical variation in its incidence. CRC among young adults is not well reported in Indian patients.Methods: A retrospective study was performed to determine the burden and to analyze the clinicopathological characteristics of newly diagnosed CRC among younger adults (<50 years). Chi-square method was used to analyze the clinicopathological characteristics. P≤0.05 was considered statistically significant.Results: CRC among younger adults comprised 40.3% of total patients median age of 40 years at diagnosis, was associated with predominantly male patients with male: female ratio of 1.8:1, positive family history, lesser co-morbidities (p=0.000), majority left sided primary tumor with left: right ratio of 4.6:1, more frequent high grade histology compared to older age group (p=0.000), advanced primary tumor and nodal metastasis. Approximately one third patients had distant metastasis at diagnosis compared to in one fourth patients in older patients. Peritoneal metastasis was significantly higher among younger adults compared to older patients (p=0.000). Significantly greater proportion of patients among younger adults initially presented with bowel obstruction (p=0.034), for which upfront emergency surgical procedures was performed in significantly higher proportion of patients compared to the older age group (p=0.007).Conclusions: Advanced stage and aggressive disease biology of CRC in younger adult warrants inclusion of one decade younger age group into present screening recommendation. 

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