A prognostic nomogram for prediction of recurrence following surgical resection of desmoid tumors.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 10015-10015
Author(s):  
Aimee Marie Crago ◽  
Brian Denton ◽  
James J. Mezhir ◽  
Meera Hameed ◽  
Mithat Gonen ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Abdominal Wall ◽  
Cox Regression ◽  
Young Patients ◽  
Desmoid Tumors ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
Prospective Database ◽  
Systemic Therapies

10015 Background: Desmoid tumors can respond to novel chemotherapeutics (e.g., sorafenib). We sought to construct a postoperative nomogram identifying desmoid patients who are at high-risk for local recurrence and potential candidates for systemic therapy. Methods: Desmoid patients undergoing resection from 1982-2011 were identified from a single-institution prospective database. Cox regression analysis was used to create a desmoid-specific recurrence nomogram integrating clinical risk factors. Results: Desmoids were treated surgically in 495 patients (median follow-up 60 months). Of 439 patients undergoing complete gross resection, 100 recurred (92 within 5 years of operation). Five-year recurrence-free survival (RFS) was 71%. Only 8 patients died of disease, all after R2 resection (6 with intraabdominal desmoids). Radiation was associated with worse RFS (p<0.001). Multivariate analysis suggested associations between recurrence and extremity location, young age, and large tumors, but not margin (Table). Abdominal wall tumors had the best outcome (5-year RFS 92% vs. 34% in patients <25y.o. with large, extremity tumors). Age, site and size were used to construct an internally-validated nomogram (concordance index 0.703). Integration of margin, gender, depth, and presentation status (primary vs. recurrent disease) did not improve concordance significantly (0.707). Conclusions: A postoperative nomogram including only size, site and age predicts local recurrence and aids in counseling patients. Systemic therapies may be tested in young patients with large, extremity desmoids, but surgery alone is curative for most abdominal wall lesions. [Table: see text]

scholarly journals The impact of method of distal ureter management during radical nephroureterectomy on tumour recurrence

2014 ◽  
Vol 8 (11-12) ◽  
pp. 845 ◽  
Author(s):  
Anil Kapoor ◽  
Shawn Dason ◽  
Christopher B. Allard ◽  
Bobby Shayegan ◽  
Louis Lacombe ◽  
...  
Keyword(s):  
Cox Regression ◽  
Tumour Recurrence ◽  
Management Approach ◽  
Management Technique ◽  
Recurrence Free Survival ◽  
Radical Nephroureterectomy ◽  
Distal Ureter ◽  
Free Survival ◽  
Cox Regression Analysis

Introduction: Radical nephroureterectomy for upper tract urothelial carcinoma (UTUC) must include some form of distal ureter management to avoid high rates of tumour recurrence. It is uncertain which distal ureter management technique has the best oncologic outcomes. To determine which distal ureter management technique resulted in the lowest tumour recurrence rate, we analyzed a multiinstitutional Canadian radical nephroureterectomy database.Methods: We retrospectively analyzed patients who underwent radical nephroureterectomy with distal ureter management for UTUC between January 1990 and June 2010 at 10 Canadian tertiary hospitals. Distal ureter management approaches were divided into 3 categories: (1) extravesical tenting for ureteric excision without cystotomy (EXTRAVESICAL); (2) open cystotomy with intravesical bladder cuff excision (INTRAVESICAL); and (3) extravesical excision with endoscopic management of ureteric orifice (ENDOSCOPIC). Data available for each patient included demographic details, distal ureter management approach, pathology and operative details, as well as the presence and location of local or distant recurrence. Clinical outcomes included overall recurrence-free survival and intravesical recurrence-free survival. Survival analysis was performed with the Kaplan-Meier method. Multivariable Cox regression analysis was also performed.Results: A total of 820 patients underwent radical nephroureterectomy with a specified distal ureter management approach at 10 Canadian academic institutions. The mean patient age was 69.6 years and the median follow-up was 24.6 months. Of the 820 patients, 406 (49.5%) underwent INTRAVESICAL, 316 (38.5%) underwent EXTRAVESICAL, and 98 (11.9%) underwent ENDOSOPIC distal ureter management. Groups differed significantly in their proportion of females, proportion of laparoscopic cases, presence of carcinoma in situ and pathological tumour stage (p < 0.05). Recurrence-free survival at 5 years was 46.3%, 35.6%, and 30.1% for INTRAVESICAL, EXTRAVESICAL and ENDOSCOPIC, respectively (p < 0.05). Multivariable Cox regression analysis confirmed that INTRAVESICAL resulted in a lower hazard of recurrence compared to EXTRAVESICAL and ENDOSCOPIC. When looking only at intravesical recurrence-free survival (iRFS), a similar trend held up with INTRAVESICAL having the highest iRFS, followed by ENDOSCOPIC and then EXTRAVESICAL management (p < 0.05). At last follow-up, 406 (49.5%) patients were alive and free of disease.Conclusion: Open intravesical excision of the distal ureter (INTRAVESICAL) during radical nephroureterectomy was associated with improved overall and intravesical recurrence-free survival compared with extravesical and endoscopic approaches. These findings suggest that INTRAVESICAL should be considered the gold standard oncologic approach to distal ureter management during radical nephroureterectomy. Limitations of this study include its retrospective design, heterogeneous cohort, and limited follow-up.

scholarly journals Matrix metalloproteinase 12 is an independent prognostic factor predicting postoperative relapse of conventional renal cell carcinoma - a short report

2021 ◽  
Author(s):  
Bence Beres ◽  
Maria Yusenko ◽  
Lehel Peterfi ◽  
Gyula Kovacs ◽  
Daniel Banyai
Keyword(s):  
Renal Cell ◽  
Cox Regression ◽  
Tissue Array ◽  
Short Report ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
Conventional Renal Cell Carcinoma ◽  
Kaplan Meier ◽  
Matrix Metalloproteinase 12

Abstract Purpose Approximately 15% of clinically localised conventional renal cell carcinomas (cRCC) develop metastases within 5 years of follow-up. Sarcomatous cRCC is a highly malignant cancer of the kidney. The aim of our study was to identify biomarkers for estimating the postoperative progression of cRCCs. Methods Global microarray-based gene expression analysis of RCCs with and without sarcomatous changes revealed that a high MMP12 expression was associated with a sarcomatous histology. Additionally, we analysed MMP12 expression using a multi-tissue array comprising 736 cRCC patients without metastasis at the time of surgery. The median follow-up time was 66 ± 29 months. Results Immunohistochemistry revealed MMP12 expression in 187 of 736 cRCCs with good follow-up data. Subsequent Kaplan–Meier analysis revealed that patients with MMP12 positive tumours exhibited a significantly shorter tumour-free survival (p < 0.001). In multivariate Cox regression analysis a weak to strong MMP12 expression indicated a 2.4–2.8 times higher risk of postoperative tumour relapse (p < 0.001; p < 0.003, respectively). Conclusions MMP12 may serve as a biomarker to estimate postoperative cRCC relapse and as a possible target for penfluridol therapy.

Cognitive Impairments and Associated Factors After Ruptured Anterior Communicating Artery Aneurysm Treatment in Low-Grade Patients <60 Years: A Multicenter Retrospective Study

2020 ◽  
Author(s):  
Ning Ma ◽  
Xin Feng ◽  
Zhongxue Wu ◽  
Daming Wang ◽  
Aihua Liu
Keyword(s):  
Regression Analysis ◽  
Cognitive Impairment ◽  
Cox Regression ◽  
Cognitive Impairments ◽  
Young Patients ◽  
Endovascular Coiling ◽  
Anterior Communicating Artery ◽  
Cox Regression Analysis ◽  
Microsurgical Clipping

Abstract Background Aneurysmal subarachnoid hemorrhage (SAH) is a kind of destructive cerebrovascular disease which could affect people's cognition, even the life expectancy. People with SAH are considered in a fatal situation, especially in the young population. This study aimed to investigate cognitive impairment and related factors in young patients with ruptured anterior communicating artery (ACoA) aneurysms.Methods We conducted a multicentre retrospective follow-up study at three hospitals in China. The young patients (18-50 years) who underwent ruptured ACoA aneurysm treatment by microsurgical clipping or endovascular coiling at three academic institutions in China from January 2015 to November 2017 were recruited. Patient cognition and life quality were assessed by using modified Telephone Interview for Cognitive Status (TICS-m), the modified Rankin Scale (mRS), and the instrumental activities of daily living (IADL) scale 2. Multiple cox-regression analysis was used to identify variables independently associated with cognitive impairment.Results Of the total of 59 patients, 54 (91.5%) achieved good clinical outcomes (mRS score 0-2) and 51 (86.4%) had excellent quality of life (IADL score 8). Ten (16.9%) patients showed cognitive impairments (TICS-m<27). The multivariate COX regression analysis showed that mRS scores of 3-5 at discharge, female sex, and aneurysm size <5 mm was independently associated with cognitive impairment. TICS-m scores at the latest follow-up were similar after open surgery and coiling. Conclusion In this relatively young sample that excluded patients with very poor-grade SAH or serious complications, microsurgical clipping led to better clinical outcomes than endovascular coiling, while cognitive outcomes were similar across treatment modalities. These results are not completely consistent with previous studies, and should therefore be considered in the clinical practice as well as further investigated in larger patient samples.

Intensive Versus Double Intensive Therapy in Untreated Multiple Myeloma: Updated Analysis of the Randomized Phase III Study HOVON 24 MM.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 948-948 ◽  
Author(s):  
Pieter Sonneveld ◽  
Bronno van der Holt ◽  
Christine Segeren ◽  
Edo Vellenga ◽  
Reinier Raymakers ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Cox Regression ◽  
Intensive Therapy ◽  
Elevated Serum ◽  
Intensive Treatment ◽  
Phase Iii ◽  
Remission Induction ◽  
Free Survival ◽  
Cox Regression Analysis

Abstract In 1995 HOVON started a prospective randomized multicenter trial to compare the efficacy of intensified treatment followed by myelo-ablative therapy and stem cell transplantation (PBSCT) with intensified treatment alone in patients with myeloma. We now report the results of a second analysis in 441 eligible patients with stage II (22%) and III (78%) disease. The median age was 55 years. Remission induction consisted of 3 courses of VAD. 63 patients with an HLA identical sibling were candidates for an allogeneic transplantation. After VAD, patients without donor were randomized to melphalan 140 mg/m2 divided in 2 doses of 70 mg/m2 (IDM) without PBSCT (arm A) or this regimen followed by myelo-ablation with cyclophosphamide (120 mg/kg) and TBI with PBSCT (arm B). Peripheral stem cells were mobilized by cyclophosphamide and G-CSF after VAD. Interferon-a -2a was given as maintenance therapy in both arms. Of 441 patients, 303 were eligible for randomization. Patient characteristics were not significantly different between the two arms. The median follow-up from randomization was 56 months. 81% of patients received both cycles of IDM (79% in arm A and 83% in arm B) and 79% of patients received myeloablative therapy followed by autologous PBSCT in arm B. The median duration of maintenance treatment was 12 (arm A) vs 7 months (arm B). The CR rate was better in Arm B (28% vs 13% , p=0.002), while overall response rate (PR + CR) was not different (90% vs 86% , p=0.23). Median event-free survival (EFS) from randomization was 22 (arm B) vs 20 months (arm A) (logrank p=0.016). Median progression-free survival (PFS) was significantly better in patients treated with double intensification (24 vs 23 months, logrank p=0.036). Time to Progression (TTP) was significantly worse in arm A (median 25 vs 33 months, logrank p=0.001). The difference for EFS, PFS and TTP became only evident after at least 4 years of follow-up. Overall survival (OS) was not different (55 months in arm A vs 50 in arm B, logrank p=0.38). Multivariate analysis showed that treatment arm A, higher age, hemoglobin < 6.21 mmol/l, stage 3 and elevated serum LDH were significant adverse prognostic factors for EFS. Cytogenetic analysis, available in 151 registered patients was abnormal in 37% (45% del 13/13q-, 51% abnormal 1p/q, 33% del 6q, 89% complex abnormalities). Cox regression analysis showed that 1p/q was an independent unfavourable prognostic factor for OS, EFS, PFS and TTP (p<0.001), calculated from start VAD. Del 13/13q- was highly correlated with 1p/q abnormalities. By combining B2M > 3 mg/L with del13/13q- and 1p/q, prognostic groups could be defined with a significant impact on OS (p<0.000002), EFS (p< 0.0002), PFS (p <0.00006) and TTP (p<0.0000002). Quality of Life analysis showed significant improvement of disease-related variables in double intensive treatment. In conclusion, in this trial second intensification by myeloablative treatment with cyclophosphamide/TBI when added to intensified chemotherapy alone resulted in a superior EFS, PFS and TTP, but not OS. The results of this trial indicate that double intensive treatment results in superior outcome, but not cure in multiple myeloma.

scholarly journals Development and validation of a radiomics-based model to predict local progression-free survival after chemo-radiotherapy in patients with esophageal squamous cell cancer

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
He-San Luo ◽  
Ying-Ying Chen ◽  
Wei-Zhen Huang ◽  
Sheng-Xi Wu ◽  
Shao-Fu Huang ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Local Recurrence ◽  
Squamous Cell ◽  
Cox Regression ◽  
Validation Cohort ◽  
Cell Cancer ◽  
Clinical Factors ◽  
Free Survival ◽  
Training Cohort ◽  
Cox Regression Analysis

Abstract Purpose To develop a nomogram model for predicting local progress-free survival (LPFS) in esophageal squamous cell carcinoma (ESCC) patients treated with concurrent chemo-radiotherapy (CCRT). Methods We collected the clinical data of ESCC patients treated with CCRT in our hospital. Eligible patients were randomly divided into training cohort and validation cohort. The least absolute shrinkage and selection operator (LASSO) with COX regression was performed to select optimal radiomic features to calculate Rad-score for predicting LPFS in the training cohort. The univariate and multivariate analyses were performed to identify the predictive clinical factors for developing a nomogram model. The C-index was used to assess the performance of the predictive model and calibration curve was used to evaluate the accuracy. Results A total of 221 ESCC patients were included in our study, with 155 patients in training cohort and 66 patients in validation cohort. Seventeen radiomic features were selected by LASSO COX regression analysis to calculate Rad-score for predicting LPFS. The patients with a Rad-score ≥ 0.1411 had high risk of local recurrence, and those with a Rad-score < 0.1411 had low risk of local recurrence. Multivariate analysis showed that N stage, CR status and Rad-score were independent predictive factors for LPFS. A nomogram model was built based on the result of multivariate analysis. The C-index of the nomogram was 0.745 (95% CI 0.7700–0.790) in training cohort and 0.723(95% CI 0.654–0.791) in validation cohort. The 3-year LPFS rate predicted by the nomogram model was highly consistent with the actual 3-year LPFS rate both in the training cohort and the validation cohort. Conclusion We developed and validated a prediction model based on radiomic features and clinical factors, which can be used to predict LPFS of patients after CCRT. This model is conducive to identifying the patients with ESCC benefited more from CCRT.

scholarly journals Evaluation of pulse wave velocity for predicting major advanced cardiovascular events in patients with chronic myocardial infarction

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
Z Meiszterics ◽  
T Simor ◽  
R J Van Der Geest ◽  
N Farkas ◽  
B Gaszner
Keyword(s):  
Myocardial Infarction ◽  
Regression Analysis ◽  
Cardiovascular Events ◽  
Pulse Wave ◽  
Cox Regression ◽  
Event Free Survival ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
Kaplan Meier

Abstract Introduction Increased aortic pulse wave velocity (PWV) as a strong predictor of major advanced cardiovascular events (MACE) has a prognostic relevance in patients after myocardial infarction (MI). Several non-invasive methods have been proposed for the assessment of arterial stiffness, but the PWV values show significant differences according to the applied techniques. Cardiac magnetic resonance imaging (CMR) provides an accurate method to measure PWV and infarct size in patients after MI. Purpose Calculated PWV values of CMR based phase-contrast (PC) and invasively validated oscillometric methods were compared in this prospective observational study. We aimed to evaluate the cut-off PWV values for each method, while MACE predicted and validated the prognostic value of high PWV in post-infarcted patients in a 6-year follow-up. Methods 3D aortic angiography and PC velocity imaging was performed using a Siemens Avanto 1,5 T CMR device. Oscillometric based Arteriograph (AG) was used to assess PWV using direct body surface distance measurements. The comparison between the two techniques was tested. Patients received follow-up for MACE comprising all-cause death, non-fatal MI, ischemic stroke, hospitalization for heart failure and coronary revascularization. Event-free survival was analysed using Kaplan-Meier plots and log-rank tests. Univariable and multivariable Cox regression analysis was performed to identify outcome predictors. Results 75 patients (56 male, 19 female, average age: 56±13 years) referred for CMR were investigated, of whom 50 had coronary artery disease (CAD) including 35 patients with previous MI developing ischaemic late gadolinium enhancement (LGE) pattern. AG and CMR derived PWV values were significantly correlated (rho: 0,343, p&lt;0,05), however absolute PWV values were significantly higher for AG (median (IQR): 10,4 (9,2–11,9) vs. 6,44 (5,64–7,5); p&lt;0,001). Bland Altman analysis showed an acceptable agreement with a mean difference of 3,7 m/s between the two measures. In patients with CAD significantly (p&lt;0,01) higher PWV values were measured by AG and CMR, respectively. During the median follow-up of 6 years, totally 69 MACE events occurred. Optimized PWV cut-off values for MACE prediction were calculated (CMR: 6,47 m/s; AG: 9,625 m/s) by receiver operating characteristic analysis. Kaplan-Meier analysis in both methods showed a significantly lower event-free survival in case of high PWV (p&lt;0,01, respectively). Cox regression analysis revealed PWV for both methods as a predictor of MACE (PWV CMR hazard ratio (HR): 2,6 (confidence interval (CI) 1,3–5,1), PWV AG HR: 3,1 (CI: 1,3–7,1), p&lt;0,005, respectively). Conclusions Our study showed good agreement between the AG and CMR methods for PWV calculation. Both techniques are feasible for MACE prediction in postinfarcted patients. However, different AG and CMR PWV cut-off values were calculated to improve risk stratification. FUNDunding Acknowledgement Type of funding sources: None. Agreement between the two methods Kaplan-Meier event curves for MACE

P3107Effect of cardiac rehabilitation predicts event-free survival

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N Mikkelsen ◽  
H Rasmusen ◽  
J Reeh ◽  
C Cardarso-Suarez ◽  
O Lado-Baleato ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Cox Regression ◽  
Strong Predictor ◽  
Cardiopulmonary Exercise Test ◽  
Cardiac Patients ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
Cardiac Diagnosis ◽  
Multivariable Adjustment

Abstract Background Participation in cardiac rehabilitation (CR) improves prognosis. Whether more effect of exercise training also affects prognosis is unknown. Purpose To investigate whether change in VO2peak after CR is a predictor of future cardiovascular disease and/or mortality Methods Retrospective analysis on 1237 cardiac patients completing a CR program in Copenhagen in 2011–2017 with a cardiopulmonary exercise test performed at baseline and end of CR. The association between change in VO2peak and future risk of morbidity and mortality through registry linkage was assessed by Cox regression analysis adjusting for age, sex, cardiac diagnosis, comorbidities and baseline VO2peak. Results 1237 patients were included, mean was age 64 (±11) years and 75% were males. 30% of the patients did not improve in VO2peak. There were 166 events and 76 deaths during a median follow-up of 2.3 years. Both baseline VO2peak and change in VO2peak were significantly associated with risk after multivariable adjustment. Change in VO2peak: MACE and mortality Conclusion Improvement in VO2peak during a CR program is a strong predictor of subsequent prognosis in cardiac patients.

scholarly journals Development and Validation of a Radiomics-based Model to Predict Local Progression-free Survival After Chemo-radiotherapy in Patients With Esophageal Squamous Cell Cancer

2021 ◽  
Author(s):  
He-San Luo ◽  
Ying-Ying Chen ◽  
Sheng-Xi Wu ◽  
Shao-Fu Huang ◽  
Hong-Yao Xu ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Local Recurrence ◽  
Squamous Cell ◽  
Cox Regression ◽  
Validation Cohort ◽  
Cell Cancer ◽  
Clinical Factors ◽  
Free Survival ◽  
Training Cohort ◽  
Cox Regression Analysis

Abstract Purpose: To develop a nomogram model for predicting local progress-free survival (LPFS) in esophageal squamous cell carcinoma (ESCC) patients treated with chemoradiotherapy. Methods: We collected the clinical data of ESCC patients treated with CCRT in our hospital. Eligible patients were randomly divided into training cohort and validation cohort. The least absolute shrinkage and selection operator (LASSO) with COX regression was performed to select optimal radiomics features calculating Rad-score for predicting LPFS in the training cohort. The univariate and multivariate analysis were performed to identify the predictive clinical factors for developing a nomogram model. The C-index was used to assess the performance of the predictive model and calibration curve was used to evaluate the accuracy.Results: A total of 221 ESCC patients were included in our study, with 155 patients in training cohort and 66 patients in validation cohort. After LASSO COX regression analysis, seventeen radiomics features were selected to calculate Rad-score for predicting LPFS. The patients with a Rad-score≥0.1411 had high risk of local recurrence, and those with a Rad-score<0.1411 had low risk of local recurrence. Multivariate analysis showed that N stage, CR status and Rad-score were independent predictive factors for LPFS. A nomogram model was built based on the result of multivariate analysis. The C-index of the nomogram was 0.745 (95%CI: 0.7700 -0.790) in training cohort and 0.723(95%CI：0.654-0.791) in validation cohort. The 3-year LPFS rate predicted by the nomogram model was highly consistent with the actual 3-year LPFS rate both in the training cohort and the validation cohort.Conclusion: We developed and validated a prediction model based on radiomics features and clinical factors, which can be used to predict LPFS of patients after CCRT. This model is conducive to making individualized chemoradiotherapy strategy and providing scientific basis for subsequent intensive adjuvant therapy for ESCC patients.

scholarly journals Right ventricular reverse remodeling assessed by echocardiography as a new goal-oriented treatment strategy in PAH patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Fauvel ◽  
O Raitiere ◽  
N Si-Belkacem ◽  
C Viacroze ◽  
E Artaud-Macari ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Cox Regression ◽  
Conditional Inference ◽  
Reverse Remodeling ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
Mean Pulmonary Arterial Pressure ◽  
Conditional Inference Trees ◽  
Pulmonary Arterial

Abstract Background While in heart failure with reduced ejection fraction, left ventricular reverse remodeling assessed by transthoracic echocardiography (TTE) is associated with better prognosis, right ventricular reverse remodeling (RVRR) was less investigated in pulmonary arterial hypertension (PAH) Purpose We aimed to investigate whether RVVR assessed by echocardiography could help to stratify PAH patient's prognosis. Methods Between 2002 and 2019, all consecutive PAH patients were included, treated and followed in a single PAH center in accordance with the current ESC/ERS guidelines. In addition to regular risk stratification parameters, we measured several echocardiographic RV systolic function and size parameters, including tricuspid annular plane systolic excursion (TAPSE, mm) or RV-end diastolic area (cm2) from apical-4 chamber view both at baseline, 1-year of follow-up as well as their change. Primary composite outcome was three-year transplant-free survival and death from all cause from the 1-year evaluation. Conditional inference trees were used to determine which TTE parameters and cutoffs values were associated with primary outcome from hierarchy of multiple covariates in multivariable Cox regression analysis. Kaplan-Meier curves were then drawn and compared with log-rank test. Results 126 incident PAH patients were included (63% female, mean age 59±18 yo), mainly due to connectivite-tissue disease and idiopathic PAH (26% and 22% respectively). At baseline, mean pulmonary arterial pressure was 42 (33, 52) mmHg. At 1-y follow-up under pulmonary vasodilation therapy, NYHA (p&lt;0.01), NTproBNP (p&lt;0.01), mean pulmonary arterial pressure (p&lt;0.01) and cardiac index (p&lt;0.01) were significantly improved compared to baseline. Conditional inference trees showed that 1-year TAPSE gain &gt;1 mm and 1-year RV end-diastolic area decreased &gt;2 cm2 were associated with 3-year transplant-free survival in multivariable Cox regression analysis (HR=0.23, 95% CI [0.08–0.61] p=0,0035, HR=0.34, 95% CI [0.12–0.94], p=0.038). Simple score from 0 (absence of RVRR), 1 (partial RVRR) and 2 (complete RVRR), describing the number of TTE parameters reach at 1-year was then investigated. Patients with complete RVRR depicted better transplant-free survival than partial or absence of RVRR, log-rank p&lt;0.001 (figure). Conclusion Complete reverse remodeling from right ventricular size and function could represent a new goal-oriented treatment strategy in PAH patients. FUNDunding Acknowledgement Type of funding sources: None. RVRR survival curves

Prognostic Significance of Blasts in the Cerebrospinal Fluid Without Pleiocytosis or a Traumatic Lumbar Puncture in Children With Acute Lymphoblastic Leukemia: Experience of the Dutch Childhood Oncology Group

2006 ◽  
Vol 24 (15) ◽  
pp. 2332-2336 ◽  
Author(s):  
D. Maroeska W.M. te Loo ◽  
Willem A. Kamps ◽  
Anna van der Does-van den Berg ◽  
Elisabeth R. van Wering ◽  
Siebold S.N. de Graaf
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Lumbar Puncture ◽  
Cox Regression ◽  
Lymphoblastic Leukemia ◽  
Prognostic Significance ◽  
Event Free Survival ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
Significant Difference

Purpose To determine the significance of blasts in the CSF without pleiocytosis and a traumatic lumbar puncture in children with acute lymphoblastic leukemia (ALL). Patients and Methods We retrospectively studied a cohort of 526 patients treated in accordance with the virtually identical Dutch protocols ALL-7 and ALL-8. Patients were classified into five groups: CNS1, no blasts in the CSF cytospin; CNS2, blasts present in the cytospin, but leukocytes less than 5/μL; CNS3, blasts present and leukocytes more than 5/μL. Patients with a traumatic lumbar puncture (TLP; > 10 erythrocytes/mL) were classified as TLP+ (blasts present in the cytospin) or TLP− (no blasts). Results Median duration of follow-up was 13.2 years (range, 6.9 to 15.5 years). Event-free survival (EFS) was 72.6% (SE, 2.5%) for CNS1 patients (n = 304), 70.3% (SE, 4.7%) for CNS2 patients (n = 111), and 66.7% (SE, 19%) for CNS3 patients (n = 10; no significant difference in EFS between the groups). EFS was 58% (SE, 7.6%) for TLP+ patients (n = 62) and 82% (SE, 5.2%) for TLP− patients (n = 39; P < .01). Cox regression analysis identified TLP+ status as an independent prognostic factor (risk ratio, 3.5; 95% CI, 1.4 to 8.8; P = .007). Cumulative incidence of CNS relapses was 0.05 and 0.07 in CNS1 and CNS2 patients, respectively (not statistically significant). Conclusion In our experience, the presence of a low number of blasts in the CSF without pleiocytosis has no prognostic significance. In contrast, a traumatic lumbar puncture with blasts in the CSF specimen is associated with an inferior outcome.

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