scholarly journals Correlação da infiltração das células Natural Killer (NK) CD 57+ no prognóstico do adenocarcinoma gástrico

2012 ◽  
Vol 25 (2) ◽  
pp. 114-117 ◽  
Author(s):  
Déborah Rosso ◽  
Moacyr P. Rigueiro ◽  
Paulo Kassab ◽  
Elias Jirjoss Ilias ◽  
Osvaldo A. P. Castro ◽  
...  
Keyword(s):  
Natural Killer ◽  
Hazard Ratio ◽  
Kaplan Meier ◽  
Adenocarcinoma Gástrico

OBJETIVO: Avaliar a concentração da célula Natural Killer (NK) no adenocarcinoma gástrico operado, e sua correlação com fatores prognósticos e sobrevida MÉTODOS: Foram estudados 72 doentes portadores de adenocarcinoma gástrico e que foram submetidos à gastrectomia com linfadenectomia D2. A concentração de célula NK foi avaliada por técnica de imunoistoquímica pelo reagente CD57. Os doentes foram divididos em dois grupos: alta concentração de células (n=32) (>15 células /10 campos de grande aumento) e baixa concentração (≤ 15 células/10 campos de grande aumento). Esses dois grupos foram comparados com seguintes fatores prognósticos: gênero, idade, localização do tumor, grau de diferenciação celular, classificação de Lauren, estádio, disseminação linfática, metástases e sobrevida. A curva de Kaplan-Meier foi empregada para avaliação de sobrevida e a análise multivariada para avaliação dos fatores prognósticos. RESULTADOS: Não houve relação das células NK com as diversas variáveis estudadas, a não ser com o estádio, onde houve significância (p<0,02), quando houve alta concentração nos estádios mais avançados. A sobrevida foi maior (p=0,0025) no grupo de Alta concentração de NK. Na análise de sobrevida no estádio tardio, o grupo de alta concentração obteve sobrevivência maior (p<0.0001). E na análise multivariada a concentração de células NK foi um fator prognóstico independente (p=0,0027, hazard ratio = 0.343). CONCLUSÕES: A concentração de células NK não difere entre as variáveis prognósticas, com exceção do estadiamento. Doentes com alta concentração de células NK apresentaram maior sobrevida quando comparados aos de baixa concentração, principalmente no estádio tardio.

Falls Predict Acute Hospitalization in Parkinson’s Disease

2021 ◽  
pp. 1-20
Author(s):  
Diego Santos García ◽  
Teresa de Deus Fonticoba ◽  
Carlos Cores ◽  
Ester Suárez Castro ◽  
Jorge Hernández Vara ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cox Regression ◽  
Independent Predictor ◽  
Hazard Ratio ◽  
Acute Hospitalization ◽  
Baseline Visit ◽  
Kaplan Meier ◽  
Non Motor Symptoms

Background: There is a need for identifying risk factors for hospitalization in Parkinson’s disease (PD) and also interventions to reduce acute hospital admission. Objective: To analyze the frequency, causes, and predictors of acute hospitalization (AH) in PD patients from a Spanish cohort. Methods: PD patients recruited from 35 centers of Spain from the COPPADIS-2015 (COhort of Patients with PArkinson’s DIsease in Spain, 2015) cohort from January 2016 to November 2017, were included in the study. In order to identify predictors of AH, Kaplan-Meier estimates of factors considered as potential predictors were obtained and Cox regression performed on time to hospital encounter 1-year after the baseline visit. Results: Thirty-five out of 605 (5.8%) PD patients (62.5±8.9 years old; 59.8% males) presented an AH during the 1-year follow-up after the baseline visit. Traumatic falls represented the most frequent cause of admission, being 23.7% of all acute hospitalizations. To suffer from motor fluctuations (HR [hazard ratio] 2.461; 95% CI, 1.065–5.678; p = 0.035), a very severe non-motor symptoms burden (HR [hazard ratio] 2.828; 95% CI, 1.319–6.063; p = 0.008), falls (HR 3.966; 95% CI 1.757–8.470; p = 0.001), and dysphagia (HR 2.356; 95% CI 1.124–4.941; p = 0.023) was associated with AH after adjustment to age, gender, disease duration, levodopa equivalent daily dose, total number of non-antiparkinsonian drugs, and UPDRS-IIIOFF. Of the previous variables, only falls (HR 2.998; 95% CI 1.080–8.322; p = 0.035) was an independent predictor of AH. Conclusion: Falls is an independent predictor of AH in PD patients.

scholarly journals Prognostic implications of depression and inflammation in patients with metastatic lung cancer

2020 ◽  
Author(s):  
Daniel C McFarland ◽  
Rebecca M. Saracino ◽  
Andrew H. Miller ◽  
William Breitbart ◽  
Barry Rosenfeld ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Hazard Ratio ◽  
Proportional Hazard ◽  
Metastatic Lung Cancer ◽  
Proportional Hazard Models ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Metastatic Lung ◽  
Cox Proportional Hazard Models ◽  
Prognostic Implications

Background: Lung cancer-related inflammation is associated with depression. Both elevated inflammation and depression are associated with worse survival. However, outcomes of patients with concomitant depression and elevated inflammation are not known. Materials & methods: Patients with metastatic lung cancer (n = 123) were evaluated for depression and inflammation. Kaplan–Meier plots and Cox proportional hazard models provided survival estimations. Results: Estimated survival was 515 days for the cohort and 323 days for patients with depression (hazard ratio: 1.12; 95% CI: 1.05–1.179), 356 days for patients with elevated inflammation (hazard ratio: 2.85, 95% CI: 1.856–4.388), and 307 days with both (χ2 = 12.546; p < 0.001]). Conclusion: Depression and inflammation are independently associated with inferior survival. Survival worsened by inflammation is mediated by depression-a treatable risk factor.

scholarly journals Lugar de residencia y grado de marginación como factores pronóstico de supervivencia al cáncer de próstata en Veracruz, México

2020 ◽  
Vol 37 (3) ◽  
pp. 423-30
Author(s):  
Richy Rogelio Gutiérrez-Juárez ◽  
María Teresa Álvarez-Bañuelos ◽  
Jaime Morales-Romero ◽  
Christian S. Ortiz-Chacha ◽  
Clara Luz Sampieri-Ramírez
Keyword(s):  
Hazard Ratio ◽  
Factores Pronósticos ◽  
Cáncer De Próstata ◽  
Kaplan Meier

Objetivos: Determinar si el lugar de residencia y el grado de marginación se encuentran asociados a la supervivencia al cáncer de próstata. Materiales y métodos: Se incluyeron a todos los pacientes diagnosticados con cáncer de próstata (CP) en el periodo 2013-2017 en un hospital de tercer nivel de atención de Veracruz, México. Los casos expuestos fueron los pacientes que habitualmente residían en zonas rurales, los no expuestos fueron los de zonas urbanas. Se recolectaron variables según características clínico epidemiológicas e histopatológicas. Para medir la supervivencia se utilizó el método de Kaplan Meier y la prueba de Log Rank. Los factores pronósticos fueron determinados calculando hazard ratio ajustado (HRa) en un análisis multivariado mediante el método de riesgos proporcionales de Cox. Resultados: Se analizaron 186 casos de CP. La supervivencia global a 5 años fue de 48,3%. Los hombres que residían en zonas urbanas tuvieron una probabilidad de supervivencia mayor que quienes residían en zonas rurales (HRa 1,67, IC 95%: 1,16-2,41). Asimismo, las personas que vivían en lugares catalogados como zonas de baja marginación tuvieron una mayor probabilidad de supervivencia que quienes vivían en zonas de alta marginación (HRa 2,32, IC 95%: 1,47-3,66). Conclusiones: El lugar de residencia rural se identificó como un factor de mal pronóstico para la supervivencia de pacientes con CP independientemente de otras variables sociodemográficas y clínicas; los pacientes que vivían en lugares con grados de marginación más elevados tuvieron un pronóstico desfavorable de supervivencia.

Predictors of Recurrence, Progression, and Retreatment in Basilar Tip Aneurysms: A Location-Controlled Analysis

2018 ◽  
Vol 16 (4) ◽  
pp. 435-444 ◽  
Author(s):  
Isaac Josh Abecassis ◽  
Rajeev D Sen ◽  
Jason Barber ◽  
Rakshith Shetty ◽  
Cory M Kelly ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Outcome ◽  
Hazard Ratio ◽  
Anterior Communicating Artery ◽  
Multivariate Modeling ◽  
Ruptured Aneurysms ◽  
Endovascular Interventions ◽  
Kaplan Meier ◽  
Event Rates

Abstract BACKGROUND Endovascular treatment of intracranial aneurysms is associated with higher rates of recurrence and retreatment, though contemporary rates and risk factors for basilar tip aneurysms (BTAs) are less well-described. OBJECTIVE To characterize progression, retreatement, and retreated progression of BTAs treated with microsurgical or endovascular interventions. METHODS We retrospectively reviewed records for 141 consecutive BTA patients. We included 158 anterior communicating artery (ACoA) and 118 middle cerebral artery (MCA) aneurysms as controls. Univariate and multivariate analyses were used to calculate rates of progression (recurrence of previously obliterated aneurysms and progression of known residual aneurysm dome or neck), retreatment, and retreated progression. Kaplan–Meier analysis was used to characterize 24-mo event rates for primary outcome prediction. RESULTS Of 141 BTA patients, 62.4% were ruptured and 37.6% were unruptured. Average radiographical follow-up was 33 mo. Among ruptured aneurysms treated with clipping, there were 2 rehemorrhages due to recurrence (6.1%), and none in any other cohorts. Overall rates of progression (28.9%), retreatment (28.9%), and retreated progression (24.7%) were not significantly different between surgical and endovascular subgroups, though ruptured aneurysms had higher event rates. Multivariate modeling confirmed rupture status (P = .003, hazard ratio = 0.14) and aneurysm dome width (P = .005, hazard ratio = 1.23) as independent predictors of progression requiring retreatment. In a separate multivariate analysis with ACoA and MCA aneurysms, basilar tip location was an independent predictor of progression, retreatment, and retreated progression. CONCLUSION BTAs have higher rates of progression and retreated progression than other aneurysm locations, independent of treatment modality. Rupture status and dome width are risk factors for progression requiring retreatment.

Gait speed and adverse outcomes following hospitalised exacerbation of COPD

2021 ◽  
pp. 2004047
Author(s):  
Jessica A. Walsh ◽  
Ruth E. Barker ◽  
Samantha S.C. Kon ◽  
Sarah E. Jones ◽  
Winston Banya ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Gait Speed ◽  
Surrogate Marker ◽  
Performance Measure ◽  
Cox Proportional Hazards ◽  
Hazard Ratio ◽  
Adverse Outcomes ◽  
Competing Risk ◽  
Subdistribution Hazard ◽  
Kaplan Meier

Four-metre gait speed (4MGS) is a simple physical performance measure and surrogate marker of frailty that is associated with adverse outcomes in older adults. We aimed to assess the ability of 4MGS to predict prognosis in patients hospitalised with acute exacerbations of COPD (AECOPD).213 participants hospitalised with AECOPD (52% male, mean age and FEV1, 72 years and 35% predicted) were enrolled. 4MGS and baseline demographics were recorded at hospital discharge. All-cause readmission and mortality were collected for 1 y after discharge, and multivariable Cox-proportional hazards regression were performed. Kaplan-Meier and Competing risk analysis was conducted comparing time to all-cause readmission and mortality between 4MGS quartiles.111 participants (52%) were readmitted, and 35 (16%) died during the follow-up period. 4MGS was associated with all-cause readmission, with an adjusted subdistribution hazard ratio of 0.868 (95% CI 0.797–0.945; p=0.001) per 0.1 m·s−1 increase in gait speed, and with all-cause mortality with an adjusted subdistribution hazard ratio of 0.747 (95% CI: 0.622–0.898; p=0.002) per 0.1 m·s−1 increase in gait speed. Readmission and mortality models incorporating 4MGS had higher discrimination than age or FEV1% predicted alone, with areas under the receiver operator characteristic curves of 0.73 and 0.80 respectively. Kaplan-Meier and Competing Risk curves demonstrated that those in slower gait speed quartiles had reduced time to readmission and mortality (log rank both p<0.001).4MGS provides a simple means of identifying at-risk patients with COPD at hospital discharge. This provides valuable information to plan post-discharge care and support.

scholarly journals Sex-specific differences and survival in patients with idiopathic pulmonary arterial hypertension 2008–2016

2019 ◽  
Vol 5 (3) ◽  
pp. 00075-2019 ◽  
Author(s):  
Barbro Kjellström ◽  
Magnus Nisell ◽  
David Kylhammar ◽  
Sven-Erik Bartfay ◽  
Bodil Ivarsson ◽  
...  
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Survival Rates ◽  
Idiopathic Pulmonary Arterial Hypertension ◽  
Hazard Ratio ◽  
Kaplan Meier ◽  
Comorbidity Burden ◽  
Pulmonary Arterial ◽  
Cox Proportional Hazard Regression ◽  
New Treatments

BackgroundWomen with idiopathic pulmonary arterial hypertension (IPAH) have been found to have a worse haemodynamic status at diagnosis, but better survival than men. Over the past decade, demographics have changed and new treatments have become available. The objective of this study was to investigate sex differences in an incident IPAH population diagnosed between 2008 and 2016.MethodsDifferences in clinical characteristics of patients included in the Swedish Pulmonary Arterial Hypertension Register (SPAHR) were analysed at the time of diagnosis. Survival by sex was investigated using Cox proportional hazard regression and Kaplan–Meier curves.ResultsThe study included 271 patients diagnosed with IPAH, median age was 68 (1st–3rd quartiles 54–74) years and 56% were women. At diagnosis, women were younger, had lower pulmonary vascular resistance and fewer comorbidities and more often received a combination of PAH-targeted therapies than men. Men had worse survival rates than women (hazard ratio 1.49; CI 1.02–2.18; p=0.038), but this difference did not remain after adjustment for age (hazard ratio 1.30; CI 0.89–1.90; p=0.178).ConclusionsMen with incident IPAH have worse crude survival than women. This is due to women being younger with a less pronounced comorbidity burden than men at the time of diagnosis.

Valor da Ressonância Magnética Cardíaca no Diagnóstico e no Prognóstico de Pacientes com Infarto Agudo do Miocárdio sem Doença Arterial Coronariana Obstrutiva (MINOCA)

2020 ◽  
Vol 33 (4) ◽  
pp. 1-7
Author(s):  
Márcio Vinícius Lins de Barros ◽  
◽  
Carlos Eduardo Ornelas ◽  
Maria Helena Albernaz Siqueira ◽  
Rochelle Coppo Militão ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Hazard Ratio ◽  
Kaplan Meier

Fundamento: O infarto do miocárdio é uma das principais causas de morbimortalidade no mundo, e 13,2% dos pacientes com síndrome coronariana aguda apresentam coronárias sem obstrução significativa, denominada MINOCA (do inglês Myocardial Infarction with Non-Obstructive Coronary Artery, Infarto do Miocárdio sem Doença Coronariana Obstrutiva). Apesar do MINOCA ter evolução mais favorável que o infarto do miocárdio por obstrução coronariana, seu prognóstico não é benigno. A ressonância magnética cardíaca é o exame que apresenta importância no diagnóstico das diversas causas de MINOCA, e seu valor prognóstico não está completamente elucidado. Objetivo: Avaliar o valor prognóstico da ressonância magnética cardíaca na detecção de eventos adversos maiores em pacientes com MINOCA. Métodos: Coorte prospectiva por meio de coleta de dados de pacientes admitidos na urgência de pacientes com hospital terciário, diagnosticados com MINOCA, no período de 2012 a 2019. Resultados: Foram avaliados 179 pacientes com seguimento médio de 45 ± 21 meses, sendo 52% do sexo masculino, com idade média de 57,3 ± 15,5 anos. Observou-se incidência de eventos adversos maiores de 17,9%. A taxa de mortalidade ao final do acompanhamento foi de 3,8%. Na análise multivariada, apenas a ressonância magnética cardíaca com resultado normal se mostrou como preditor independente de bom prognóstico (hazard ratio: 0,09; intervalo de confiança de 95% 0,01- 0,88; p = 0,04), com curva de Kaplan-Meier apresentando diferença significativa (log-rank x2 = 9,83; p = 0,02) na predição de eventos adversos maiores. Conclusão: A ressonância magnética cardíaca normal mostrou-se como variável independente de bom prognóstico nessa população, podendo ser útil na estratificação de risco de pacientes com MINOCA

Invasive penile carcinoma: Are p16, p53 and HPV ISH prognostically significant?

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 394-394
Author(s):  
Jasreman Dhillon ◽  
Anders E. Berglund ◽  
Julio Pow-Sang ◽  
Philippe E. Spiess ◽  
Anthony M. Magliocco
Keyword(s):  
Tumor Cells ◽  
Staining Intensity ◽  
Hpv Infection ◽  
Clinicopathological Characteristics ◽  
Hazard Ratio ◽  
Penile Carcinoma ◽  
P53 Expression ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Low Incidence

394 Background: Penile carcinoma accounts for 0.4% to 0.6% of all malignancies in men. Due to its low incidence the prognostic role of clinicopathological characteristics, p16, p53 and HPV infection remains unclear. We report our experience with p16, p53 and HPV ISH (types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58 and 66) in determining the aggressive nature of this carcinoma. Methods: A tissue microarray (TMA) of 57 cases of invasive penile squamous cell carcinomas was immunohistochemically stained with immunohistochemical stains p16 and p53. HPV ISH was performed as well. The TMA slides were scored semi quantitatively by a specialized genitourinary surgical pathologist. The H score was calculated for p53 using a combination of staining intensity and extent according to the following formula: H score = 1 x % of tumor cells with weak staining + 2 x % of tumor cells with moderate staining + 3 x % of tumor cells with strong staining, resulting in a total score of 0 – 300. Calculations for p53 were done considering values above 0 as positive. For p16 and HPV ISH, the results were recorded as negative or positive. The overall survival curves for up to 60 months were estimated by Kaplan-Meier (KM) method. Results: HPV ISH was positive in 23 cases and p16 was positive in 23 cases as well. However, there were 9 discordant cases between the two (p16+/HPV ISH- = 5; p16-/HPV ISH+ = 4). p53 was positive in 39 cases. Tumors positive for HPV ISH had a better survival as compared to HPV ISH negative tumors (p = 0.0040; Hazard ratio 4.991). Whereas p16 (p = 0.206; Hazard ratio 1.838) and p53 (p = 0.1582; Hazard ratio 0.5198) were not significantly associated with survival at 60 months. Conclusions: Overall HPV positive penile carcinomas appear to have a distinct biology with better prognosis. There is no significant difference in survival for tumors with different p16 and p53 expression.

Incidence, 10-year recidivism rate and prognostic factors for cholesteatoma

2017 ◽  
Vol 131 (4) ◽  
pp. 319-328 ◽  
Author(s):  
A Britze ◽  
M L Møller ◽  
T Ovesen
Keyword(s):  
Prognostic Factors ◽  
Incidence Rate ◽  
Knowledge Exchange ◽  
Incidence Rates ◽  
Hazard Ratio ◽  
Recidivism Rate ◽  
Recidivism Rates ◽  
Erosion Hazard ◽  
Kaplan Meier ◽  
Canal Wall Up

AbstractObjective:Cholesteatoma patients have a high risk of recurrence with complications, and knowledge exchange is a prerequisite for improving treatment. This study aimed to apply appropriate statistics to provide meaningful and transferable results from cholesteatoma surgery, to highlight independent prognostic factors, and to assess the incidence rate.Methods:Incidence rates were assessed for the district of Aarhus, Denmark. From 147 patients operated on mainly with canal wall up mastoidectomies for debuting cholesteatomas, 10-year Kaplan–Meier recidivism rates were calculated and independent prognostic factors for the recidivism were identified by Cox multivariate regression analyses.Results:Incidence rate was 6.8 per 100 000 per year. The 10-year cumulative recidivism rate was 0.44 (95 per cent confidence interval, 0.37–0.53). Independent prognostic factors for the recidivism were: age below 15 years (hazard ratio = 2.2; p > z = 0.002), cholesteatoma localised to the mastoid (hazard ratio = 1.7; p > z = 0.04), stapes erosion (hazard ratio = 1.9; p > z = 0.02) and incus erosion (hazard ratio = 1.9; p > z = 0.04).Conclusion:The recidivism rate is influenced by several factors that are important to observe, both in the clinic and when comparing results from surgery.

scholarly journals Resultados do tratamento do refluxo de veias safenas com endolaser 1.470 nm e correlação com o grau de insuficiência venosa

2021 ◽  
Vol 20 ◽  
Author(s):  
Ana Paula Pires Silva ◽  
Daniel Mendes Pinto ◽  
Vanessa Aline Miranda Vieira Milagres ◽  
Leonardo Ghizoni Bez ◽  
Júlio César Arantes Maciel ◽  
...  
Keyword(s):  
Severity Score ◽  
Hazard Ratio ◽  
Clinical Severity ◽  
Clinical Severity Score ◽  
Kaplan Meier ◽  
Venous Clinical Severity Score

Resumo Contexto Pacientes com doença venosa crônica avançada são mais propensos a exigir outros procedimentos para recidiva de veias varicosas. Ainda não está estabelecido se a gravidade da insuficiência venosa é um fator que influencia a taxa de oclusão de veias safenas tratadas por endolaser. Objetivos Analisar a taxa de oclusão dos segmentos venosos tratados com endolaser e correlacionar com o Venous Clinical Severity Score (VCSS) e a classificação Clínica-Etiológica-Anatômica-Patológica (CEAP) dos pacientes. Métodos Análise retrospectiva de coorte de pacientes operados com endolaser 1.470 nm entre novembro/2012 a março/2020. Foram realizadas estatística descritiva e curva de sobrevida de Kaplan-Meier com regressão de Cox para grupos de VCSS e CEAP. Resultados Foram analisados 170 pacientes e 180 segmentos venosos; a idade média foi de 44,3 ± 9,2, sendo a maioria do sexo feminino (71%). A densidade de energia média utilizada na veia safena magna foi 49,2 ± 8,3 J/cm. As principais complicações foram dor no trajeto da safena (12,2%) e parestesias após 6 meses (17,2%). Não houve diferença na taxa de oclusão venosa entre grupos com VCSS ≤ 7 e VCSS > 7 (p = 0,067). O grupo de pacientes com CEAP agrupada C4-C5-C6 teve taxa de oclusão menor em relação ao grupo C2-C3 [hazard ratio (HR) = 3,22; intervalo de confiança (IC) 1,85, 5,61; p = 0,001]. Conclusões As taxas de oclusão de segmentos venosos tratados com endolaser foram menores na presença de classificações CEAP avançadas. Nesses pacientes, provavelmente deve-se despender mais energia para o tratamento eficaz das safenas.

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