Identification of Prognostic Factors in 61 Patients With Posttransplantation Lymphoproliferative Disorders

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.

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Onodera’s prognostic nutritional index is a strong prognostic indicator for patients with hepatocellular carcinoma after initial hepatectomy, especially patients with preserved liver function

10.21203/rs.3.rs-28900/v1 ◽

2020 ◽

Author(s):

Akihiro Tanemura ◽

Shugo Mizuno ◽

Aoi Hayasaki ◽

Kazuyuki Gyoten ◽

Takehiro Fujii ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Prognostic Factors ◽

Prognostic Factor ◽

Liver Function ◽

Survival Time ◽

Median Survival ◽

Median Survival Time ◽

Prognostic Nutritional Index ◽

Nutritional Index ◽

Initial Hepatectomy

Abstract Background Several inflammation-based scores are used to assess the surgical outcomes of hepatocellular carcinoma (HCC). The aim of the present study was to elucidate the prognostic value of the prognostic nutritional index (PNI) in HCC patients who underwent hepatectomy with special attention to preoperative liver functional reserve.Methods Preoperative demographic and tumor-related factors were analyzed in 189 patients with HCC undergoing initial hepatectomy from August 2005 to May 2016 to identify significant prognostic factors.Results Multivariate analysis for overall survival (OS) revealed that female gender (p=0.005), tumor size (p<0.001) and PNI (p=0.001) were independent prognostic factors. Compared to the High PNI group (PNI ≥37, n=172), the Low PNI group (PNI <37, n=17) had impaired liver function and significantly poorer OS (13% vs. 67% in 5-year survival, p=0.001) and recurrence-free survival (RFS) (8 vs. 25 months in median survival time, p=0.002). In the subgroup of patients with a preserved liver function of LHL15 ≥0.9, PNI was also independent prognostic factor, and OS (21% vs. 70% in 5-year survival, p=0.008) and RFS (8 vs. 28 months in median survival time, p=0.018) were significantly poorer in the Low PNI group than the High PNI group.Conclusions PNI was an independent prognostic factor for HCC patients who underwent hepatectomy. Patients with PNI lower than 37 were at high risk for early recurrence and poor patient survival, especially in the patients with preserved liver function of LHL ≥0.9.

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Survival Benefit of Intervention Treatment in Advanced Anaplastic Thyroid Cancer

International Journal of Surgical Oncology ◽

10.1155/2021/5545127 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Pornthep Kasemsiri ◽

Pimpika Chaisakgreenon ◽

Patravoot Vatanasapt ◽

Supawan Laohasiriwong ◽

Watchareeporn Teeramatwanich ◽

...

Keyword(s):

Prognostic Factors ◽

Survival Rate ◽

Survival Time ◽

Median Survival ◽

Median Survival Time ◽

Anaplastic Thyroid Cancer ◽

Overall Survival Rate ◽

Intervention Treatment ◽

One Year ◽

Postoperative Chemoradiation

Background. The management of anaplastic thyroid cancer (ATC) is controversial; thus, proper treatment and prognostic factors should be investigated. Objectives. To compare the survival outcomes of the intervention and palliative treatment in ATC patients. Methods. A hospital-based retrospective study was conducted at a single tertiary university hospital. The medical record charts were retrieved from November 20, 1987, to December 31, 2016. The final follow-up ended by December 31, 2017. The patients’ demographic data, laboratory data, clinical presentation, and treatment modality results were analyzed. Results. One hundred twenty-one records were analyzed with a one-year overall survival rate of 3.5% (median survival time: 77 days); however, 16 cases had insufficient data to classify staging and treatment modalities. Therefore, 105 ATC patients (37 with stage IVa, 39 with stage IVb, and 29 with stage IVc disease) were included with a one-year overall survival rate of 4.0% (median survival time of 82 days). Intervention treatment allowed longer median survival times ( p < 0.05 ) and a better survival rate ( p < 0.05 ). Among the interventional treatment groups, postoperative chemoradiation yielded the longest median survival time (187 days) and the highest survival rate (20%) ( p < 0.05 ). The intervention modality allowed a better median survival time at all stages, particularly in stage IVa ( p < 0.05 ). Unfavorable prognostic factors were adjusted for in a multiple Cox regression model showing that significant factors included age ≥65 years (hazard ratio HR: 2.57), palliative treatment (HR: 1.85), and leukocytosis ≥10,000 cells/mm3 (HR: 2.76). Conclusions. Intervention treatment provided a better survival outcome in all stages, particularly in stage IVa, with a significantly better median survival time. Among interventional treatments, postoperative chemoradiation led to the longest survival rate, suggesting that this treatment should be considered in ATC patients with resectable tumors and no poor prognostic factors, such as older age and leukocytosis.

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Outcome Of MDS and AML With MDS-Related Changes: Treatment Versus Prognostic Factors

Blood ◽

10.1182/blood.v122.21.5223.5223 ◽

2013 ◽

Vol 122 (21) ◽

pp. 5223-5223

Author(s):

Nadja Jaekel ◽

Susann Schulze ◽

Cora Graneist ◽

Rainer Krahl ◽

Wolfram Poenisch ◽

...

Keyword(s):

Multivariate Analysis ◽

Prognostic Factors ◽

Survival Time ◽

Median Survival ◽

Median Survival Time ◽

Conflicts Of Interest ◽

Negative Impact ◽

Allogeneic Hct ◽

Comorbidity Burden ◽

The Impact

Abstract The significance of host- and disease-related prognostic factors on outcome in patients (pts) with MDS and AML with MDS-related changes (sAML) depends on the treatment given. The impact of therapy opposed to prognostic variables on the heterogeneity of MDS and sAML was investigated. Patients and methods From January, 2004-August, 2012, 367 pts (MDS, n=208; sAML, n=159) consecutively treated (median age 63y) at the University of Leipzig were included. Patients (84%) with marrow blasts >10% received induction chemotherapy (CT; 59%) or azacitidine (AZA; 25%) (after its approval in the EU in January, 2009) with the intention of performing a subsequent allogeneic hematopoietic cell transplantation (HCT) in pts <70y. Up-front HCT was scheduled if blasts were <10% (n=56). Cytogenetics were categorized according to Schanz et al, JCO 2012 for MDS and the WHO classification for sAML. As confounders in the estimation of therapy, host- and disease-related features were investigated in a multistep process. 38% of pts had >2 comorbidities with no difference between MDS and sAML. The sAML group (median blasts 40%) included 69 and 81 pts with previous MDS and MDS-related cytogenetic abnormality respectively. Cytogenetics were poor and very poor in 34% of MDS. Outcome at two years are presented. Results Median interval between diagnosis of MDS and therapy was 3.6 months. Median survival time for sAML was 15 vs 72 months for MDS (p<0.0005). Overall, age was higher (median 68y) and blasts lower (median 13%) in the AZA group compared to CT (62y and 27%) (p<0.0005). Cytogenetics and the comorbidity burden (CB) were comparable. OS with AZA was similar to up-front HCT (68%) and superior to CT (48%) (p=0.01). OS was 50% if HCT was performed after CT (136 pt) compared to CT alone (p=0.01). In the 20% of pts >70y, AZA was given to 52% and CT to 48%. OS was 55% and best with AZA (p=0.01). Median survival times were 30 for AZA/MDS, 27 for AZA/AML, 15 for CT/AML, and 5 months for CT/MDS. Of the 110 pts <70y with MDS, AZA was given to 50 (45%) and CT to 60 (55%). The IPSS, cytogenetics, CB, BM blasts (10% vs 11.5%) were similar in both groups. With a median age of 63y, the AZA/MDS group was older than the CT/MDS group (median age 60y) (p=0.005). OS for both groups was 68%. NRM (16%) and RI (38% vs 34%) were alike. For the 114 pts <70y with sAML (median age 62%; median blasts 44%) treated with CT, OS was 40% and inferior to MDS (AZA/MDS, p=0.007; CT/MDS, p=0.01) due to higher RI (57%) (p=0.008). Overall, 218 (78%) pts <70y received HCT (after a median of 3 AZA cycles for AZA/MDS). Ferritin, cytogentics, CB, type of donor, and blasts at HCT (median 4%) were comparable in the transplant groups (AZA/MDS, CT/MDS, HCT up-front, CT/sAML). Irrespective of prior therapy (p=0.6), interval between therapy and HCT, and blasts <5 vs >5-<10%, outcome in the MDS groups (OS, 60%, NRM 29%, RI, 32%) was similar. In multivariate analysis, >2 comorbidities and very poor cytogenetics were associated with an inferior OS (p=0.001)and a higher RI (p=0.003). With a median survival time of 11 months for sAML and a RI of 49%, outcome after HCT for sAML was inferior to MDS (p=0.005). In multivariate analysis, blasts <5%, >2 comorbidities were associated with a poor outcome. For MDS/CT and sAML/CT, a complex karyotype (38%) tended to decrease OS (p=0.06) and increase RI (p=0.01) after HCT. Conclusions Treatment was able to reduce the significance of most negative host- and disease-specific prognostic factors on outcome in MDS. AZA is superior to CT in elderly patients and equal to CT in younger patients with MDS and seems to have no negative impact on outcome after HCT. Despite the improvement achieved with allogeneic HCT, AML with MDS-related changes remains a distinct clinic-pathologic entity associated with a worse outcome. Genetics rather than marrow blasts are an important determinant of prognosis after treatment including allogeneic HCT. Disclosures: No relevant conflicts of interest to declare.

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The impact of aggressive debulking surgery and cisplatin-based chemotherapy on progression-free survival in stage III and IV ovarian carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.1988.6.6.983 ◽

1988 ◽

Vol 6 (6) ◽

pp. 983-989 ◽

Cited By ~ 109

Author(s):

M S Piver ◽

S B Lele ◽

D L Marchetti ◽

T R Baker ◽

Y Tsukada ◽

...

Keyword(s):

Survival Rate ◽

Complete Remission ◽

Ovarian Carcinoma ◽

Survival Time ◽

Median Survival ◽

Median Survival Time ◽

Residual Disease ◽

Progression Free Survival ◽

Debulking Surgery ◽

Free Survival

Forty consecutive patients with stage III and IV invasive ovarian carcinoma were treated on a phase II protocol consisting of optimal debulking surgery, induction cisplatin, cisplatin, doxorubicin, and cyclophosphamide (PAC) chemotherapy, 6-month interval laparoscopy, reinduction cisplatin, PAC chemotherapy, and second-look procedure. All 40 patients have either disease progression or have completed the 12-month protocol. Eighty-seven percent of the patients (35) underwent optimal (less than or equal to 2 cm residual) debulking surgery before chemotherapy, in spite of the fact that 50% (20) were referred to Roswell Park Memorial Institute (RPMI) as inoperable after initial surgery elsewhere. There were no postoperative deaths and chemotherapy was started in less than or equal to 14 days in 97% of the patients. Of the 40 patients, 30% (12) achieved a pathologic complete remission (11) or a clinical complete remission (one patient refused second-look surgery). The estimated 3-year survival rate was 62%, but the 3-year progression-free survival rate was only 29%. The median survival time was 48 months. The estimated 3-year progression-free survival rate was 31% for residual disease less than or equal to 2 cm. For the five patients with residual disease greater than 2 cm, four died within 3 years. The median survival time of patients with less than or equal to 2 cm residual disease was 48 months, as compared with 21 months for those with greater than 2 cm residual disease. Although the estimated 3-year survival rate of 62% is noteworthy, the 3-year progression-free survival rate of only 29% is probably indicative that in spite of extensive debulking surgery and cisplatin-based chemotherapy as used in this protocol, the long range proportion of patients "cured" will remain small.

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Cyclophosphamide, Methotrexate, 5-Fluorouracil (CMF) in Advanced Gastrointestinal Cancer

Tumori Journal ◽

10.1177/030089167906500113 ◽

1979 ◽

Vol 65 (1) ◽

pp. 111-117 ◽

Cited By ~ 2

Author(s):

Alberto Scanni ◽

Maurizio Tomirotti ◽

Arina Margulis ◽

Maurizio Biraghi ◽

Guglielmo Curtarelli

Keyword(s):

Complete Remission ◽

Survival Time ◽

Median Survival ◽

Gastrointestinal Cancer ◽

Median Survival Time ◽

Partial Remission ◽

Median Response ◽

Response Period ◽

Objective Improvement

The effectiveness of the cyclophosphamide + methotrexate + 5-fluorouracil schedule (CMF) in 28 patients with advanced gastrointestinal cancer has been studied. No complete remission was obtained; partial remission and objective improvement constituted 56%. The median response period is calculated at a minimum of 12 months, without significant differences between the group of patients previously subjected to palliative canalization surgery and the group of patients not subjected to this operation. The overall median survival time is 10.8 months. On the basis of the data given, the authors conclude by stressing that the CMF combination should be studied more fully in relation to its use in gastrointestinal forms of cancer.

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Circuit Survival during Continuous Venovenous Hemodialysis versus Continuous Venovenous Hemofiltration

Blood Purification ◽

10.1159/000504037 ◽

2020 ◽

Vol 49 (3) ◽

pp. 281-288 ◽

Cited By ~ 2

Author(s):

Alfonso Maria Califano ◽

Laurent Bitker ◽

Ian Baldwin ◽

Nigel Fealy ◽

Rinaldo Bellomo

Keyword(s):

Survival Time ◽

Median Survival ◽

Median Survival Time ◽

Univariate Analysis ◽

Continuous Venovenous Hemofiltration ◽

Mixed Effect ◽

Continuous Venovenous Hemodialysis ◽

Before And After ◽

Effect Regression ◽

Before And After Study

Background: Continuous renal replacement therapy (CRRT) technique may affect circuit lifespan. A shorter circuit life may reduce CRRT efficacy and increase costs. Methods: In a before-and-after study, we compared circuit median survival time during continuous venovenous hemofiltration (CVVH) versus continuous venovenous hemodialysis (CVVHD). We performed log-rank mixed effects univariate analysis and Cox mixed effect regression modeling to define predictors of circuit lifespan. Results: We compared 197 CVVHD and 97 CVVH circuits in 39 patients. There was no overall difference in circuit lifespan. When no anticoagulation was used, median circuit survival time was shorter for CVVH circuits (5 h, 95% CI 3–7 vs. 10 h, 95% CI 8–13, p < 0.01). Moreover, CVVHD, lower platelets levels, and longer activated partial thromboplastin time independently predicted longer circuit median survival time. Conclusions: CVVHD is associated with longer circuit median survival time than CVVH when no anticoagulation is used and is an independent predictor of circuit survival.

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Clinical Characteristics and Prognosis of Renal Cell Carcinoma With Spinal Bone Metastases

Frontiers in Oncology ◽

10.3389/fonc.2021.659779 ◽

2021 ◽

Vol 11 ◽

Author(s):

Jianpo Zhai ◽

Ning Liu ◽

Hai Wang ◽

Guanglin Huang ◽

Libo Man

Keyword(s):

Renal Cell Carcinoma ◽

Regression Analysis ◽

Prognostic Factors ◽

Survival Time ◽

Median Survival ◽

Median Survival Time ◽

Clinical Characteristics ◽

Cox Regression ◽

Visceral Metastasis ◽

Cox Regression Analysis

BackgroundThe prognosis of renal cell carcinoma (RCC) with spinal bone metastasis (sBM) varies greatly. In this study, we aimed to define the clinical characteristics and prognostic factors of RCC with spinal bone metastasis (sBM) in our center.MethodsThe clinical and medical records of RCC patients with sBMs were collected. The gender, age, time of BM, the extent of BM, the number of BMs, the presence or absence of visceral metastasis, and the pathological type of BM were investigated. All patients were followed up regularly. Overall survival (OS) was calculated from the date of BMs diagnosis to death or last follow-up using Kaplan-Meier method and modelled with Cox regression analysis.ResultsForty-three RCC patients with sBM were collected. sBM was found synchronously in 30 patients (70%) and metachronously in 13 patients (30%). The median survival time was 30 months in 13 patients (30%) with solitary sBM and 19 months in 30 patients (70%) with multiple sBMs (P = 0.002). Visceral metastasis occurred in 12 patients (28%) with the median survival time of 17 months, while the other 31 patients (72%) had no visceral metastasis with the median survival time of 29 months (P<0.001). En-block resection was done in 10 patients with median survival time of 40.1 months. Non-en-block resection were done in 33 patients with median survival time of 19.7 months (P<0.001). Multivariate COX regression analysis showed that MSKCC score, number of BM, visceral metastasis, and en-block resection are the independent prognosis factors of RCC patients with sBM.ConclusionsMSKCC risk stratification, number of sBM, visceral metastasis and en-block resection are significant prognostic factors for OS in RCC patients with spinal BM. Therefore, for selected patients who has solitary spinal BM with no visceral metastasis, en-block resection of spinal BM can potentially prolong survival and is the treatment of choice.

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Variation in Survival Among Patients With Acute Lymphocytic Leukemia

Blood ◽

10.1182/blood.v37.1.59.59 ◽

1971 ◽

Vol 37 (1) ◽

pp. 59-72 ◽

Cited By ~ 44

Author(s):

C. ZIPPIN ◽

S. J. CUTLER ◽

W. J. REEVES ◽

D. LUM

Keyword(s):

Prognostic Factors ◽

Survival Time ◽

Median Survival ◽

Median Survival Time ◽

Acute Lymphocytic Leukemia ◽

Lymphocytic Leukemia ◽

Age Group ◽

Disease Characteristics ◽

Survival Pattern ◽

Selection Of

Abstract Survival of 873 acute lymphocytic leukemia patients has been reviewed in relation to a number of patient and disease characteristics at first hospital admission. Study of survival by individual years of age at diagnosis led to the selection of five age intervals: 1-3, 4-10, 11-19, 20-49, and 50 years and over. For each sex the survival after age 10 was considerably poorer than for the younger ages. The best survival for any age-sex group was that for girls 4-10, who had a median survival time of 14.0 months compared with an overall median survival time of 7.8 months for patients of both sexes over 1 year of age. We attempted to determine whether a favorable distribution of other factors related to survival might work to the advantage of girls in the 4-10 year age group. However, in studying factors such as symptoms and hematological characteristics it was the pattern, rather than the exception, to find within most levels of a characteristic under study, that girls 4-10 had the best survival. It would be interesting and potentially valuable to see whether the findings in this study are confirmed in other series. If a specific age-sex group tends to maintain a superior survival pattern, additional exploration of prognostic factors may uncover important leads concerning the biology of the disease.

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Survival Benefit of Intervention Treatment in Advanced Anaplastic Thyroid Cancer

10.21203/rs.3.rs-120518/v1 ◽

2020 ◽

Author(s):

PORNTHEP KASEMSIRI ◽

Pimpika Chaisakgreenon ◽

Patravoot Vatanasapt ◽

Supawan Laohasiriwong ◽

Watchareeporn Teeramatwanich ◽

...

Keyword(s):

Prognostic Factors ◽

Survival Rate ◽

Survival Time ◽

Median Survival ◽

Median Survival Time ◽

Anaplastic Thyroid Cancer ◽

Treatment Modalities ◽

Overall Survival Rate ◽

Intervention Treatment ◽

One Year

Abstract Background Management of anaplastic thyroid cancer (ATC) is a controversial issue; thus, proper treatment and prognostic factors should be investigated. Objectives To compare the survival outcomes of intervention and palliative treatment in ATC patients. Methods A hospital-based retrospective study was conducted in a single tertiary university hospital. The medical record charts were retrieved from November 20, 1987 to December 31, 2016. The final follow-up was ended by December 31, 2017. Patients’ demographic data, laboratory data, clinical presentation, and results of treatment modalities were analyzed. Results One hundred twenty-one records were analyzed that one-year overall survival rate of 3.5% (median survival time of 77 days); however, there was insufficient data on 16 cases to classify staging and treatment modalities. Therefore 105 ATC patients (37 stage IVa, 39 stage IVb, 29 stage IVc) were included with one-year overall survival rate of 4.0% (median survival time of 82 days). Intervention treatment allowed longer median survival times (p < 0.05) and a better survival rate (p < 0.05). Among the intervention treatment group, post-operative chemoradiation yielded the longest median survival time (187 days) and the longest survival rate (20%) (p < 0.05). At all stages, intervention modality allowed better median survival time, especially in stage IVa (p < 0.05). Unfavorable prognostic factors were adjusted with multiple cox regression model that showed significant factors included age ≥ 65 years (HR of 2.57), palliative treatment (HR of 1.85), and leukocytosis ≥ 10,000/mm3(HR of 2.76). Conclusions Intervention treatment provided a better survival outcome in all stages, especially in stage IVa with a significantly better median survival time. Among intervention treatments, postoperative chemoradiation offered the longest survival rate; thus, suggesting this should be considered in ATC patients who have resectable tumors and no poor prognostic factors such as older age and leukocytosis.

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Survival and prognostic factors of patients with esophageal fistula in advanced esophageal squamous cell carcinoma

Bioscience Reports ◽

10.1042/bsr20193379 ◽

2020 ◽

Vol 40 (1) ◽

Cited By ~ 2

Author(s):

Xin Guan ◽

Chao Liu ◽

Tianshuo Zhou ◽

Zhigang Ma ◽

Chunhui Zhang ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Prognostic Factors ◽

Esophageal Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Survival Time ◽

Median Survival ◽

Squamous Cell ◽

Median Survival Time ◽

Esophageal Fistula ◽

Kaplan Meier

Abstract The aim of the present study was to investigate the survival and prognostic factors of patients who were with advanced esophageal squamous cell carcinoma (ESCC) and developed an esophageal fistula. The data from 221 patients with advanced ESCC developed esophageal fistula from January 2008 to December 2017 at the Harbin Medical University Cancer Hospital was retrospectively analyzed. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by the Cox proportional hazard models. The median survival time after a diagnosis of the esophageal fistula was calculated using the Kaplan–Meier method. We found that the pathogens infected by patients are common bacteria in nosocomial infection. Besides, the incidence rate of esophagomediastinal fistula was the highest (54.2%) in the lower third of the esophagus. Kaplan–Meier analysis revealed a median survival time of 11.00 months and a median post-fistula survival time of 3.63 months in patients who developed esophageal fistula in advanced esophageal cancer. In the univariate analysis, gender, therapies for ESCC before the development of fistula, type of esophageal fistula, treatment of esophageal fistula and hemoglobin (Hb) level were the factors with significant prognostic value. Gender, type of esophageal fistula and Hb level were identified as independent prognostic factors in further multivariate analysis. In summary, our study demonstrated that several factors are significantly related to patients with esophageal fistula and should be concerned about in clinical practice.

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