Integration of Ki67 with residual cancer burden (RCB) compared to Ki67 or RCB alone to predict long-term term outcome following neoadjuvant chemotherapy.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 535-535
Author(s):  
Amna Sheri ◽  
Roger A'Hern ◽  
Robin Lewis Jones ◽  
William Fraser Symmans ◽  
Ashutosh Nerurkar ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Residual Disease ◽  
Statistical Significance ◽  
Cox Proportional Hazards Model ◽  
Prognostic Information ◽  
Residual Cancer ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cancer Burden

535 Background: RCB and Ki67 after neoadjuvant chemotherapy have each been shown to predict long-term outcome. Their combined use might provide greater prognostic information. RCB requires collection of data beyond that in routine pathological work-up of residual disease, which may not be required when Ki67 is added. Aims: (i) To test the hypothesis that combining Ki67 and RCB as the residual proliferative cancer burden (R-P-CB) provides significantly more prognostic information than either alone. (ii) To determine if a simplified algorithm integrating Ki67 and standard characteristics of residual disease can provide as much information. Methods: Cases at the Royal Marsden Hospital between 2002-2010 were identified and residual disease assessed. The primary endpoint of the study was time to recurrence. The primary analysis compared the prognostic information from Ki67, RCB and R-P-CB. Analyses employed a Cox proportional hazards model. Prognostic indices (PIs) were also created adding Ki67, grade and ER to the RCB and AJCC staging. Leave-one-out cross validation was used to reduce bias. The overall change in chi-square (ΔX2) of the best model for each index was used to compare the prognostic ability of the different indices a ΔX2 of more than 3.84 indicates statistical significance. Results: A total of 222 evaluable patients were included in the study, median age was 50 with a median follow up of 60 months. The addition of Ki67 improved the prognostic power of all indices. The R-P-CB (ΔX2=69.5) was significantly more prognostic than the RCB alone (ΔX2=35) and Ki67 alone (ΔX2=41.4). A novel proliferative residual cancer index (PRECI) using post-treatment values of T size, number of involved lymph nodes, grade, ER status (±) and Ki67 gave ΔX2=81.1 and performed similarly to a model including the RCB, Ki67, ER and grade (ΔX2=80.2). Conclusions: Addition of Ki67 to RCB improved prediction of long-term outcome. In this study, a novel index the PRECI provided as much prognostic information as a more complex assessment involving RCB and warrants further investigation for estimating post-neoadjuvant risk of recurrence.

scholarly journals Residual proliferative cancer burden to predict long-term outcome following neoadjuvant chemotherapy

2015 ◽  
Vol 26 (1) ◽  
pp. 75-80 ◽  
Author(s):  
A. Sheri ◽  
I.E. Smith ◽  
S.R. Johnston ◽  
R. A'Hern ◽  
A. Nerurkar ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cancer Burden

scholarly journals Two-component surface replacement implants compared with perichondrium transplantation for restoration of Metacarpophalangeal and proximal Interphalangeal joints: a retrospective cohort study with a mean follow-up time of 6 respectively 26 years

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Daniel Muder ◽  
Nils P. Hailer ◽  
Torbjörn Vedung
Keyword(s):  
Primary Outcome ◽  
Statistical Significance ◽  
Surface Replacement ◽  
Level Of Evidence ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Two Component ◽  
Pip Joint

Abstract Background The aim of our study was to compare the long-term outcome after perichondrium transplantation and two-component surface replacement (SR) implants to the metacarpophalangeal (MCP) and the proximal interphalangeal (PIP) joints. Methods We evaluated 163 joints in 124 patients, divided into 138 SR implants in 102 patients and 25 perichondrium transplantations in 22 patients. Our primary outcome was any revision surgery of the index joint. Results The median follow-up time was 6 years (0–21) for the SR implants and 26 years (1–37) for the perichondrium transplants. Median age at index surgery was 64 years (24–82) for SR implants and 45 years (18–61) for perichondium transplants. MCP joint survival was slightly better in the perichondrium group (86.7%; 95% confidence interval [CI]: 69.4–100.0) than in the SR implant group (75%; CI 53.8–96.1), but not statistically significantly so (p = 0.4). PIP joint survival was also slightly better in the perichondrium group (80%; CI 55–100) than in the SR implant group (74.7%; CI 66.6–82.7), but below the threshold of statistical significance (p = 0.8). Conclusion In conclusion, resurfacing of finger joints using transplanted perichondrium is a technique worth considering since the method has low revision rates in the medium term and compares favorable to SR implants. Level of evidence III (Therapeutic).

The Comparison of STA-MCA Bypass and BMT for Symptomatic Internal Carotid Artery Occlusion Disease A Systematic Review and Meta-analysis of Long-term Outcome

2020 ◽  
Author(s):  
Xinyu Yang ◽  
Shifei Cai ◽  
Hao Fan ◽  
Chao Peng ◽  
Yuzhang Wu
Keyword(s):  
Carotid Artery ◽  
Assessment Tool ◽  
Statistical Significance ◽  
Superficial Temporal Artery ◽  
Artery Occlusion ◽  
Carotid Artery Occlusion ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Symptomatic Carotid

Abstract Background: Superficial temporal artery (STA) - middle cerebral artery (MCA) bypass surgery now being widely used in moyamoya disease, and its therapeutic value in SICAO remains divergent. Methods: A systematic search was performed in PUBMED, EMBASE and Cochrane Databases in Feb.2020, and updated in Jun.2019. We have strict inclusion and exclusion criteria. Cochrane Bias Risk Assessment Tool was used to assess the quality of included RCTs. Review Manager 5.3 was used for analysis results in terms of comparing the STA-MCA bypass and BMT. For dichotomous variable outcomes, Risk Ratio (RRs) and 95% confidence intervals (95%CIs) were calculated for the assessment.Results: The total patient cohort consisted of 2419 patients, of whom 1188(49.1%) patients had been grouped in STA-MCA bypass, 1231(50.9%) patients had divided into BMT group. Mean follow-up of including patients was 29 months. The RRs of the seven studies was 1.01, and the 95% confidence interval was .89-1.15, with statistical significance, Z=.13, P=.89, sustaining that STA-MCA bypass was not superior to BMT in symptomatic carotid artery occlusion disease.Conclusion: STA-MCA bypass and BMT were associated with similar rates of a composite of long-term stroke. And the risk of long-term overall stroke was mildly higher with BMT. At present, each patient should receive more precise treatment, by reasonably assess the individual differences of each patient to reduce the recurrence rate of stroke.

Long-Term Outcome for Patients With Nonmetastatic Osteosarcoma of the Extremity Treated at the Istituto Ortopedico Rizzoli According to the Istituto Ortopedico Rizzoli/Osteosarcoma-2 Protocol: An Updated Report

2000 ◽  
Vol 18 (24) ◽  
pp. 4016-4027 ◽  
Author(s):  
Gaetano Bacci ◽  
Stefano Ferrari ◽  
Franco Bertoni ◽  
Pietro Ruggieri ◽  
Piero Picci ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Tumor Necrosis ◽  
Poor Responders ◽  
High Dose ◽  
Second Malignancies ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Long Term Follow Up

PURPOSE: To provide an estimate of long-term prognosis for patients with osteosarcoma of the extremity treated in a single institution with neoadjuvant chemotherapy and observed for at least 10 years. PATIENTS AND METHODS: Patients with nonmetastatic osteosarcoma of the extremity were preoperatively treated with high-dose methotrexate, cisplatin, and doxorubicin (ADM). Postoperatively, good responders (90% or more tumor necrosis) received the same three drugs used before surgery, whereas poor responders (less than 90% tumor necrosis) received ifosfamide and etoposide in addition to those three drugs. RESULTS: For the 164 patients who entered the study between September 1986 and December 1989, surgery was a limb salvage in 136 cases (82%) and a good histologic response was observed in 117 patients (71%). At a follow-up ranging from 10 to 13 years (median, 11.5 years), 101 patients (61%) remained continuously free of disease, 61 relapsed, and two died of ADM-induced cardiotoxicity. There were no differences in prognosis between good and poor responding patients. ADM-induced cardiotoxicity (six patients), male infertility (10 of the 12 assessable patients), and second malignancies (seven patients) were the major complications of chemotherapy. Despite the large number of limb salvages performed, only four local recurrences (2.4%) were registered. CONCLUSION: With an aggressive neoadjuvant chemotherapy, it is possible to cure more than 60% of patients with nonmetastatic osteosarcoma of the extremity and amputation may be avoided in more than 80% of them. Because local or systemic relapses, myocardiopathies, and second malignancies are possible even 5 years or more after the beginning of treatment, a long-term follow-up is recommended for these patients.

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