A preoperative clinical staging and metabolic imaging model to predict prognosis in early-stage esophageal adenocarcinoma.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 63-63
Author(s):  
Richard Calvin Turkington ◽  
Jaine K. Blayney ◽  
Awais Jalil ◽  
Rebecca Barbara Goody ◽  
Anastasia Papafili ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Esophageal Adenocarcinoma ◽  
Prognostic Model ◽  
Early Stage ◽  
Multivariate Model ◽  
Clinical Staging ◽  
Metabolic Imaging ◽  
Significant Prognostic Factor ◽  
Patient Counseling ◽  
Final Multivariate Model

63 Background: Accurate prediction of outcome for neo-adjuvant therapy in early stage esophageal adenocarcinoma (EAC) is essential for clinical trial design, patient counseling and treatment decisions. The use of 18F-fluorodeoxyglucose positron emission tomography (PET) has improved the staging of EAC and can predict pathological response and survival. Our aim was to develop a pre-operative prognostic model based on metabolic imaging and clinical parameters. Methods: Between April 2004 and December 2010, 118 patients with early stage adenocarcinoma of the distal esophagus or gastro-esophageal junction were treated with platinum and fluorouracil-based combination chemotherapy prior to surgical resection. Patients were staged by endoscopic ultrasound and PET/CT was performed prior to, and upon completion of, chemotherapy. A metabolic response was defined as a >35% reduction in the maximum standard uptake variable (SUVmax). The final prognostic model was selected by multivariate Cox regression analyses and the concordance-index (c-index) was used to assess the fit of the final multivariate model. Results: In both the univariate and multivariate analysis of patient prognosis post-surgery, five pre-surgery factors were included: clinical T and N staging, PET response, neutrophil-lymphocyte ratio and albumin levels. The majority of the patients were T3 (82.1%) and N1 (73.7%) and 69.8% of patients demonstrated a PET response. In the univariate analysis PET response was the only significant prognostic factor with a median overall survival (OS) of 60.4 months for responders compared to 23.3 months for non-responders (p=0.0241). The final multivariate model of T staging and PET response had a c-index of 0.624 with T3/PET non-response resulting in a poorer prognosis compared to T3/PET response and T2/PET responder or non-responder (median OS 11.5 vs 44.5 vs undefined months; p=0.0284). We seek to validate our model in an independent patient dataset to assess its predictive capability. Conclusions: Metabolic imaging and clinical staging can be combined in a prognostic model in early stage EAC. Our model can inform patient counseling and the development of clinical trial strategies.

scholarly journals A simple prognostic model for overall survival in metastatic renal cell carcinoma

2016 ◽  
Vol 10 (3-4) ◽  
pp. 113 ◽  
Author(s):  
Hazem I. Assi ◽  
Francois Patenaude ◽  
Ethan Toumishey ◽  
Laura Ross ◽  
Mahmoud Abdelsalam ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Cell Carcinoma ◽  
Median Survival ◽  
Renal Cell ◽  
Prognostic Model ◽  
Risk Group ◽  
Multivariate Model ◽  
Final Multivariate Model

<p><strong>Introduction:</strong> The primary purpose of this study was to develop a simpler prognostic model to predict overall survival for patients treated for metastatic renal cell carcinoma (mRCC) by examining variables shown in the literature to be associated with survival.</p><p><strong>Methods:</strong> We conducted a retrospective analysis of patients treated for mRCC at two Canadian centres. All patients who started first-line treatment were included in the analysis. A multivariate Cox proportional hazards regression model was constructed using a stepwise procedure. Patients were assigned to risk groups depending on how many of the three risk factors from the final multivariate model they had.</p><p><strong>Results:</strong> There were three risk factors in the final multivariate model: hemoglobin, prior nephrectomy, and time from diagnosis to treatment. Patients in the high-risk group (two or three risk factors) had a median survival of 5.9 months, while those in the intermediate-risk group (one risk factor) had a median survival of 16.2 months, and those in the low-risk group (no risk factors) had a median survival of 50.6 months.</p><p><strong>Conclusions:</strong> In multivariate analysis, shorter survival times were associated with hemoglobin below the lower limit of normal, absence of prior nephrectomy, and initiation of treatment within one year of diagnosis.</p>

scholarly journals Effect of Baduanjin exercise intervention on cognitive function and quality of life in women with breast cancer receiving chemotherapy: study protocol of a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Xiao-Lin Wei ◽  
Ru-Zhen Yuan ◽  
Yong-Mei Jin ◽  
Shu Li ◽  
Ming-Yue Wang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Clinical Trial ◽  
Cognitive Function ◽  
Exercise Intervention ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Pharmacological Intervention ◽  
Control Group

Abstract Background More than 50% cognitive impairment was reported by cancer patients before and after medical treatment. However, there are no effective interventions to manage the cognitive problem in women with breast cancer. This pilot study was designed to evaluate the protective effect of Baduanjin exercise on cognitive function and cancer-related symptoms in women with early-stage breast cancer undergoing chemotherapy. Method A single-blinded, randomized control trial was designed. The trial will recruit 70 patients with early-stage breast cancer scheduled to receive chemotherapy from Shanghai in China. All participants will be randomly assigned to (1:1) the supervised Baduanjin group (5 times/week, 30 min each time) or the wait-list control group for 3 months. The effect of Baduanjin exercise intervention will be evaluated by outcome measures including subjective and objective cognitive function, symptoms (fatigue, depression, and anxiety), and health-related quality of life at pre-intervention (T0), 8 weeks (T1), and 12 weeks (T2). The PCI score in the FACT-Cog as the primary cognitive outcome will be reported descriptively, while effect sizes and 95% confidence intervals (CIs) will be calculated. The collected data will be analyzed by using an intention-to-treat principle and linear mixed-effects modeling. Discussion This is the first randomized clinical trial to investigate whether Baduanjin exercise will have a positive role in improving cognitive function in women with breast cancer receiving chemotherapy. If possible, Baduanjin exercise will be a potential non-pharmacological intervention to manage cognitive dysfunction and promote survivorship care among breast cancer survivors. Trial registration Chinese Clinical Trial Registry (ChiCTR) ChiCTR2000033152. Registered on 22 May 2020

Defining low-risk lesions in early-stage esophageal adenocarcinoma

2020 ◽  
Author(s):  
Smita Sihag ◽  
Sergio De La Torre ◽  
Meier Hsu ◽  
Tamar Nobel ◽  
Kay See Tan ◽  
...  
Keyword(s):  
Esophageal Adenocarcinoma ◽  
Early Stage ◽  
Low Risk

scholarly journals Prevalence of skin tears in hospitalized adults and older adults

2021 ◽  
Vol 55 ◽  
Author(s):  
Luccas Melo de Souza ◽  
Gabriela da Silva Teixeira ◽  
Débora Monteiro da Silva ◽  
Letícia da Silva Ruiz ◽  
Isabella dos Santos Coppola ◽  
...  
Keyword(s):  
Older Adults ◽  
Medical Records ◽  
Care Setting ◽  
Prevalence Ratio ◽  
Multivariate Model ◽  
Bivariate Analysis ◽  
Related Factors ◽  
Final Multivariate Model ◽  
Robust Variance ◽  
Skin Tears

ABSTRACT Objective: To identify the prevalence, related factors and to classify Skin Tears in hospitalized adults and older adults. Method: Prevalence study with adults and older adults in inpatient and intensive care units of a hospital in the South Region of Brazil. The STAR Skin Tear Classification System was used to analyze the lesions. Data were collected by physical examination and consultation of medical records. The Poisson Regression Prevalence Ratio with robust variance was calculated. Results: The participants were 148 patients. There were 29 Skin Tears (mean 1.6 ± 0.7) in 18 individuals (prevalence of 12.2%). The variables age, friable skin, enteral feeding catheter, degree of dependence, use of antihypertensives, micronutrients, diuretics, antidepressants, and antifungals were associated with lesions in the bivariate analysis. In the final multivariate model, antihypertensives PR 2.42 (95%CI 1.01-5.77), antidepressants PR 2.72 (95%CI 1.1-6.33) and micronutrients PR 4.93 (95%CI 1.64-14.80) maintained a relationship. Conclusion: The prevalence of injuries was 12.2%, showing they are present in the health care setting, especially in nursing care. Care protocols need to be developed for the prevention, identification and early treatment of ST.

scholarly journals Telemanagement of Home-Isolated COVID-19 Patients Using Oxygen Therapy With Noninvasive Positive Pressure Ventilation and Physical Therapy Techniques: Randomized Clinical Trial (Preprint)

2020 ◽  
Author(s):  
Aya Sedky Adly ◽  
Mahmoud Sedky Adly ◽  
Afnan Sedky Adly
Keyword(s):  
Health Care ◽  
Clinical Trial ◽  
Physical Therapy ◽  
Randomized Clinical Trial ◽  
Health Care System ◽  
Oxygen Therapy ◽  
Early Stage ◽  
Home Based ◽  
Group A ◽  
Group B

BACKGROUND With the growing stress on hospitals caused by the COVID-19 pandemic, the need for home-based solutions has become a necessity to support these overwhelmed hospitals. OBJECTIVE The goal of this study was to compare two nonpharmacological respiratory treatment methods for home-isolated COVID-19 patients using a newly developed telemanagement health care system. METHODS In this single-blinded randomized clinical trial, 60 patients with stage 1 pneumonia caused by SARS-CoV-2 infection were treated. Group A (n=30) received oxygen therapy with bilevel positive airway pressure (BiPAP) ventilation, and Group B (n=30) received osteopathic manipulative respiratory and physical therapy techniques. Arterial blood gases of PaO<sub>2</sub> and PaCO<sub>2</sub>, pH, vital signs (ie, temperature, respiratory rate, oxygen saturation, heart rate, and blood pressure), and chest computed tomography scans were used for follow-up and for assessment of the course and duration of recovery. RESULTS Analysis of the results showed a significant difference between the two groups (<i>P</i>&lt;.05), with Group A showing shorter recovery periods than Group B (mean 14.9, SD 1.7 days, and mean 23.9, SD 2.3 days, respectively). Significant differences were also observed between baseline and final readings in all of the outcome measures in both groups (<i>P</i>&lt;.05). Regarding posttreatment satisfaction with our proposed telemanagement health care system, positive responses were given by most of the patients in both groups. CONCLUSIONS It was found that home-based oxygen therapy with BiPAP can be a more effective prophylactic treatment approach than osteopathic manipulative respiratory and physical therapy techniques, as it can impede exacerbation of early-stage COVID-19 pneumonia. Telemanagement health care systems are promising methods to help in the pandemic-related shortage of hospital beds, as they showed reasonable effectiveness and reliability in the monitoring and management of patients with early-stage COVID-19 pneumonia. CLINICALTRIAL ClinicalTrials.gov NCT04368923; https://clinicaltrials.gov/ct2/show/NCT04368923

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