scholarly journals Chemotherapy burden of risk-adapted treatment verse surveillance for clinical stage I pediatric testicular cancer: A decision tree model analysis

2019 ◽  
Author(s):  
Yunlin Ye ◽  
Hong-chao Li ◽  
Ji Zhang ◽  
Hai-tao Liang ◽  
Zike Qin ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
High Risk ◽  
Testicular Cancer ◽  
Decision Analysis ◽  
Relapse Rate ◽  
Risk Group ◽  
Clinical Stage ◽  
Low Risk ◽  
Stage I ◽  
Risk Patients

Abstract Background Different from adult clinical stage I (CS1) testicular cancer, surveillance was recommended for CS1 pediatric testicular cancer. This study was to compare chemotherapy exposure between risk-adapted treatment and surveillance in CS1 pediatric testicular cancer.Methods We collected clinical utilities from literature and survey. Using decision analysis model, we compared chemotherapy exposure between risk-adapted treatment and surveillance and sensitivity analysis was performed.Results In base case decision analysis of CS1 pediatric testicular cancer, risk-adapted treatment preferred lower exposure of chemotherapy than surveillance (average: 0.7965 cycle verse 1.3419 cycles). The sensitivity analysis demonstrated that when relapse rate after primary chemotherapy ≤0.10 and the relapse rate of high-risk group ≥0.40, risk-adapted treatment would expose lower chemotherapy, without association of the proportion of low-risk patients, the relapse rate of low-risk group, relapse rate after salvage chemotherapy and toxicity utility of second-line chemotherapy compared to salvage chemotherapy.Conclusion Decision analysis demonstrated that risk-adapted treatment was associated with lower exposure of chemotherapy for patients with CS1 pediatric testicular cancer. This might decrease chemotherapy-related toxicity for these high-risk patients and further clinical study was needed.

scholarly journals Chemotherapy burden of risk-adapted treatment verse surveillance for clinical stage I pediatric testicular cancer: A decision tree model analysis

2020 ◽  
Author(s):  
yunlin ye ◽  
Zhuang-fei Chen ◽  
Jun Bian ◽  
Hai-tao Liang ◽  
Zi-ke Qin
Keyword(s):  
High Risk ◽  
Testicular Cancer ◽  
Decision Analysis ◽  
Relapse Rate ◽  
Risk Group ◽  
Clinical Stage ◽  
Low Risk ◽  
Stage I ◽  
Decision Analysis Model ◽  
Risk Patients

Abstract Background Different from adult clinical stage I (CS1) testicular cancer, surveillance was recommended for CS1 pediatric testicular cancer. For high-risk children, greater than 50% of them suffered relapse and progress during surveillance and adjuvant chemotherapy was administrated. Risk-adapted treatment might reduce chemotherapy burden for those children.Methods Using decision analysis model, we collected clinical utilities from literature and survey and compared chemotherapy exposure between risk-adapted treatment and surveillance.Results In base case decision analysis of CS1 pediatric testicular cancer, risk-adapted treatment preferred lower exposure of chemotherapy than surveillance (average: 0.7965 cycle verse 1.3419 cycles). The sensitivity analysis demonstrated that when relapse rate after primary chemotherapy ≤ 0.10 and the relapse rate of high-risk group ≥ 0.40, risk-adapted treatment would expose lower chemotherapy, without association of the proportion of low-risk patients, the relapse rate of low-risk group, relapse rate after salvage chemotherapy and toxicity utility of second-line chemotherapy compared to salvage chemotherapy.Conclusions Risk-adapted treatment might decrease chemotherapy-related toxicity for these high-risk patients and further clinical study was needed.

scholarly journals Risk-adapted treatment reduced chemotherapy exposure for clinical stage 1 pediatric testicular cancer

2020 ◽  
Author(s):  
yunlin ye ◽  
Zhuang-fei Chen ◽  
Jun Bian ◽  
Hai-tao Liang ◽  
Zi-ke Qin
Keyword(s):  
High Risk ◽  
Testicular Cancer ◽  
Decision Analysis ◽  
Relapse Rate ◽  
Risk Group ◽  
Clinical Stage ◽  
Second Line ◽  
First Line ◽  
Risk Patients ◽  
Line Chemotherapy

Abstract Background: Different from adult clinical stage I (CS1) testicular cancer, surveillance was recommended for CS1 pediatric testicular cancer. For high-risk children, greater than 50% of them suffered relapse and progress during surveillance and adjuvant chemotherapy was administrated. Risk-adapted treatment might reduce chemotherapy exposure for those children.Methods: The decision model was designed and calculated using TreeAge Pro 2011 software. Clinical utilities such as relapse rates of different groups during surveillance or after chemotherapy were collected from literatures. And a survey to urologist was performed to evaluate the toxicity of the first-line and second-line chemotherapy. Using decision analysis model, chemotherapy exposure between risk-adapted treatment and surveillance were compared based on this series of clinical utilities. One-way and two-way tests were administrated to check the feasibility.Results: In base case decision analysis of CS1 pediatric testicular cancer, risk-adapted treatment preferred lower exposure of chemotherapy than surveillance (average: 0.7965 cycle verse 1.3419 cycles). The sensitivity analysis demonstrated that when relapse rate after primary chemotherapy ≤0.10 and the relapse rate of high-risk group ≥0.40, risk-adapted treatment would expose lower chemotherapy, without association of the proportion of low-risk patients, the relapse rate of low-risk group, relapse rate after salvage chemotherapy and toxicity utility of second-line chemotherapy compared to first-line chemotherapy.Conclusions: Using decision analysis, risk-adapted treatment might decrease chemotherapy exposure for these high-risk patients and precious evaluation after orchiectomy was critical to this process. Further clinical study was needed to validate this statement.

scholarly journals Risk-adapted treatment reduced chemotherapy exposure for clinical stage 1 pediatric testicular cancer

2020 ◽  
Author(s):  
yunlin ye ◽  
Zhuang-fei Chen ◽  
Jun Bian ◽  
Hai-tao Liang ◽  
Zi-ke Qin
Keyword(s):  
High Risk ◽  
Testicular Cancer ◽  
Decision Analysis ◽  
Relapse Rate ◽  
Risk Group ◽  
Clinical Stage ◽  
Second Line ◽  
First Line ◽  
Risk Patients ◽  
Line Chemotherapy

Abstract Background: Different from adult clinical stage I (CS1) testicular cancer, surveillance has been recommended for CS1 pediatric testicular cancer. However, among high-risk children, more than 50% suffer a relapse and progression during surveillance, and adjuvant chemotherapy needs to be administered. Risk-adapted treatment might reduce chemotherapy exposure among these children.Methods: A decision model was designed and calculated using TreeAge Pro 2011 software. Clinical utilities such as the relapse rates of different groups during surveillance or after chemotherapy were collected from the literature. A survey of urologists was conducted to evaluate the toxicity of first-line and second-line chemotherapy. Using the decision analysis model, chemotherapy exposure of the risk-adapted treatment and surveillance strategies were compared based on this series of clinical utilities. One-way and two-way tests were applied to check the feasibility.Results: In the base case decision analysis of CS1 pediatric testicular cancer, risk-adapted treatment resulted in a lower exposure to chemotherapy than surveillance (average: 0.7965 cycles verse 1.3419 cycles). The sensitivity analysis demonstrated that when the relapse rate after primary chemotherapy was ≤0.10 and the relapse rate of the high-risk group was ≥0.40, risk-adapted treatment would result in a lower exposure to chemotherapy, without any association with the proportion of low-risk patients, the relapse rate of the low-risk group, the relapse rate after salvage chemotherapy or the toxicity utility of second-line chemotherapy compared to first-line chemotherapy.Conclusions: Based on the decision analysis, risk-adapted treatment might decrease chemotherapy exposure for these high-risk patients, and an evaluation after orchiectomy was critical to this process. Additional clinical studies are needed to validate this statement.

scholarly journals Risk-adapted treatment reduced chemotherapy exposure for clinical stage 1 pediatric testicular cancer

2020 ◽  
Author(s):  
yunlin ye ◽  
Zhuang-fei Chen ◽  
Jun Bian ◽  
Hai-tao Liang ◽  
Zi-ke Qin
Keyword(s):  
High Risk ◽  
Testicular Cancer ◽  
Decision Analysis ◽  
Relapse Rate ◽  
Risk Group ◽  
Clinical Stage ◽  
Second Line ◽  
First Line ◽  
Risk Patients ◽  
Line Chemotherapy

Abstract Background: Different from adult clinical stage I (CS1) testicular cancer, surveillance was recommended for CS1 pediatric testicular cancer. For high-risk children, greater than 50% of them suffered relapse and progress during surveillance and adjuvant chemotherapy was administrated. Risk-adapted treatment might reduce chemotherapy exposure for those children. Methods: The decision model was designed and calculated using TreeAge Pro 2011 software. Clinical utilities such as relapse rates of different groups during surveillance or after chemotherapy were collected from literatures. And a survey to urologist was performed to evaluate the toxicity of the first-line and second-line chemotherapy. Using decision analysis model, chemotherapy exposure between risk-adapted treatment and surveillance were compared based on this series of clinical utilities. One-way and two-way tests were administrated to check the feasibility. Results: In base case decision analysis of CS1 pediatric testicular cancer, risk-adapted treatment preferred lower exposure of chemotherapy than surveillance (average: 0.7965 cycle verse 1.3419 cycles). The sensitivity analysis demonstrated that when relapse rate after primary chemotherapy ≤0.10 and the relapse rate of high-risk group ≥0.40, risk-adapted treatment would expose lower chemotherapy, without association of the proportion of low-risk patients, the relapse rate of low-risk group, relapse rate after salvage chemotherapy and toxicity utility of second-line chemotherapy compared to first-line chemotherapy. Conclusions: Using decision analysis, risk-adapted treatment might decrease chemotherapy exposure for these high-risk patients and precious evaluation after orchiectomy was critical to this process. Further clinical study was needed to validate this statement.

scholarly journals Risk-adapted treatment reduced chemotherapy exposure for clinical stage I pediatric testicular cancer

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Yun-lin Ye ◽  
Zhuang-fei Chen ◽  
Jun Bian ◽  
Hai-tao Liang ◽  
Zi-ke Qin
Keyword(s):  
High Risk ◽  
Testicular Cancer ◽  
Decision Analysis ◽  
Relapse Rate ◽  
Risk Group ◽  
Clinical Stage ◽  
Second Line ◽  
First Line ◽  
Risk Patients ◽  
Line Chemotherapy

Abstract Background Different from adult clinical stage I (CS1) testicular cancer, surveillance has been recommended for CS1 pediatric testicular cancer. However, among high-risk children, more than 50% suffer a relapse and progression during surveillance, and adjuvant chemotherapy needs to be administered. Risk-adapted treatment might reduce chemotherapy exposure among these children. Methods A decision model was designed and calculated using TreeAge Pro 2011 software. Clinical utilities such as the relapse rates of different groups during surveillance or after chemotherapy were collected from the literature. A survey of urologists was conducted to evaluate the toxicity of first-line and second-line chemotherapy. Using the decision analysis model, chemotherapy exposure of the risk-adapted treatment and surveillance strategies were compared based on this series of clinical utilities. One-way and two-way tests were applied to check the feasibility. Results In the base case decision analysis of CS1 pediatric testicular cancer, risk-adapted treatment resulted in a lower exposure to chemotherapy than surveillance (average: 0.7965 cycles verse 1.3419 cycles). The sensitivity analysis demonstrated that when the relapse rate after primary chemotherapy was ≤ 0.10 and the relapse rate of the high-risk group was ≥ 0.40, risk-adapted treatment would result in a lower exposure to chemotherapy, without any association with the proportion of low-risk patients, the relapse rate of the low-risk group, the relapse rate after salvage chemotherapy or the toxicity utility of second-line chemotherapy compared to first-line chemotherapy. Conclusions Based on the decision analysis, risk-adapted treatment might decrease chemotherapy exposure for these high-risk patients, and an evaluation after orchiectomy was critical to this process. Additional clinical studies are needed to validate this statement.

scholarly journals Risk-adapted treatment reduced chemotherapy exposure for clinical stage 1 pediatric testicular cancer

2020 ◽  
Author(s):  
yunlin ye ◽  
Zhuang-fei Chen ◽  
Jun Bian ◽  
Hai-tao Liang ◽  
Zi-ke Qin
Keyword(s):  
High Risk ◽  
Testicular Cancer ◽  
Decision Analysis ◽  
Relapse Rate ◽  
Risk Group ◽  
Clinical Stage ◽  
Second Line ◽  
First Line ◽  
Risk Patients ◽  
Line Chemotherapy

Abstract Background: Different from adult clinical stage I (CS1) testicular cancer, surveillance was recommended for CS1 pediatric testicular cancer. For high-risk children, greater than 50% of them suffered relapse and progress during surveillance and adjuvant chemotherapy was administrated. Risk-adapted treatment might reduce chemotherapy exposure for those children. Methods: The decision model was designed and calculated using TreeAge Pro 2011 software. Clinical utilities such as relapse rates of different groups during surveillance or after chemotherapy were collected from literatures. And a survey to urologist was performed to evaluate the toxicity of the first-line and second-line chemotherapy. Using decision analysis model, chemotherapy exposure between risk-adapted treatment and surveillance were compared based on this series of clinical utilities. One-way and two-way tests were administrated to check the feasibility. Results: In base case decision analysis of CS1 pediatric testicular cancer, risk-adapted treatment preferred lower exposure of chemotherapy than surveillance (average: 0.7965 cycle verse 1.3419 cycles). The sensitivity analysis demonstrated that when relapse rate after primary chemotherapy ≤0.10 and the relapse rate of high-risk group ≥0.40, risk-adapted treatment would expose lower chemotherapy, without association of the proportion of low-risk patients, the relapse rate of low-risk group, relapse rate after salvage chemotherapy and toxicity utility of second-line chemotherapy compared to first-line chemotherapy. Conclusions: Using decision analysis, risk-adapted treatment might decrease chemotherapy exposure for these high-risk patients and precious evaluation after orchiectomy was critical to this process. Further clinical study was needed to validate this statement.

Open versus laparoscopic retroperitoneal lymph node dissection (RPLND) in clinical stage I nonseminomatous germ-cell tumors (NSGCTs): Two contemporary series from a single institution

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5084-5084
Author(s):  
N. Nicolai ◽  
D. Biasoni ◽  
J. Piedra Aguilera ◽  
A. Necchi ◽  
L. Piva ◽  
...  
Keyword(s):  
High Risk ◽  
Clinical Stage ◽  
Operating Time ◽  
Case Series ◽  
Median Number ◽  
Low Risk ◽  
Stage I ◽  
Nodal Metastases ◽  
Risk Patients

5084 Background: Primary RPLND is our choice for clinical stage I (CSI) NSGCTs. Open RPLND (O-RPLND) has been our standard policy since 1985, while laparoscopic RPLND (L-RPLND) has been introduced since the late-1990s. Methods: Between June 2003-March 2008, 150 consecutive CSI NSGCT patients (pts) have been submitted to O-RPLND (n = 91) or L-RPLND (n = 59). Pts with high risk disease (vascular invasion/embryonal carcinoma > 90% in the primary tumor) were more frequently offered O-RPLND, while pts with low risk disease (none of the 2 above) were usually considered for L-RPLND. We reviewed our data focusing on: complications, operating time (OT), hospital stay (HS), number of removed nodes, occurrence of nodal metastases as well as of metastasis during follow-up and global need of chemotherapy (CT). Results: O-RPLND (91). 59/91 (64.8%) were high-risk patients. Median OT was 140 min (IQR 110–150). Five (5.5%) complications occurred: 4 lymphorrea and 1 hemorrhage. Median HS was 6 days (IQR 5–7). Nodal metastases were found in 24 (26.4%) pts. Median number of removed nodes was 20 (IQR 14–25). L-RPLND (59). 54/59 (91.2%) were low-risk patients. Median OT was 210 min (IQR 180–240). Ten (16.9%) complications occurred: 5 required conversions to open procedure due to intraoperative bleeding (4) or technical impossibility to conclude the procedure (1). Median HS was 4 days (IQR 4–5). Nodal metastases were found in 5 (8.5%) pts: 2 of them received immediate adjuvant CT. Median number of removed nodes was 14 (IQR 11–20). OT and HS were significantly better in O-RPLND and L-RPLND series, respectively (p.0001 at Mann Whitney test). After a median follow-up of 15.1 months (1–52), distant metastases were observed in 10 (0.7%) pts: 7/91 (7.7%) following O-RPLND and 1/59 (1.7%) following L-RPLND. CT was administered to 7 (7.7%) pts following O-RPLND and to 3 (5.1%) pts following L-RPLND. Conclusions: In this large case-series, no excess of recurrences but a higher rate of complications were recorded in L-RPLND pts. O-RPLND had a significant better OT while HS was shorter in L-RPLND series. Both procedures are still being applied: pts are currently offered one of the 2 modalities after counseling. No significant financial relationships to disclose.

Adjuvant Chemotherapy after Orchiectomy in High-Risk Patients with Clinical Stage I Non-Seminomatous Testicular Cancer

1993 ◽  
Vol 23 (4) ◽  
pp. 444-449 ◽  
Author(s):  
Urs E. Studer ◽  
Martin F. Fey ◽  
Antonello Calderoni ◽  
Rainer Kraft ◽  
Luca Mazzucchelli ◽  
...  
Keyword(s):  
High Risk ◽  
Adjuvant Chemotherapy ◽  
Testicular Cancer ◽  
Clinical Stage ◽  
Stage I ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals Echocardiography and EuroSCORE II for the stratification of low-gradient severe aortic stenosis and preserved left ventricular ejection fraction

2021 ◽  
Author(s):  
Yan Fan ◽  
Hong Shen ◽  
Brandon Stacey ◽  
David Zhao ◽  
Robert J. Applegate ◽  
...  
Keyword(s):  
High Risk ◽  
Left Ventricular Ejection Fraction ◽  
Risk Group ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
High Risk Group ◽  
Low Risk ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Risk Patients

AbstractThe purpose of this study was to explore the utility of echocardiography and the EuroSCORE II in stratifying patients with low-gradient severe aortic stenosis (LG SAS) and preserved left ventricular ejection fraction (LVEF ≥ 50%) with or without aortic valve intervention (AVI). The study included 323 patients with LG SAS (aortic valve area ≤ 1.0 cm2 and mean pressure gradient < 40 mmHg). Patients were divided into two groups: a high-risk group (EuroSCORE II ≥ 4%, n = 115) and a low-risk group (EuroSCORE II < 4%, n = 208). Echocardiographic and clinical characteristics were analyzed. All-cause mortality was used as a clinical outcome during mean follow-up of 2 ± 1.3 years. Two-year cumulative survival was significantly lower in the high-risk group than the low-risk patients (62.3% vs. 81.7%, p = 0.001). AVI tended to reduce mortality in the high-risk patients (70% vs. 59%; p = 0.065). It did not significantly reduce mortality in the low-risk patients (82.8% with AVI vs. 81.2%, p = 0.68). Multivariable analysis identified heart failure, renal dysfunction and stroke volume index (SVi) as independent predictors for mortality. The study suggested that individualization of AVI based on risk stratification could be considered in a patient with LG SAS and preserved LVEF.

Multiple Immunofluorescence Imaging Analysis Reveals Differential Expression of Disialogangliosides GD3 and GD2 in Neuroblastomas

2021 ◽  
pp. 109352662110487
Author(s):  
Haruna Nishimaki ◽  
Yoko Nakanishi ◽  
Hiroshi Yagasaki ◽  
Shinobu Masuda
Keyword(s):  
High Risk ◽  
Risk Group ◽  
Staging System ◽  
Low Risk ◽  
Overall Survival Rate ◽  
Imaging Analysis ◽  
Tissue Samples ◽  
Risk Patients ◽  
Neuroblastic Tumors ◽  
Expression Status

Background Peripheral neuroblastic tumors (pNTs) are the most common childhood extracranial solid tumors. There are several therapeutic strategies targeting disialoganglioside GD2. Disialoganglioside GD3 has become a potential target. However, the mechanism by which pNTs express GD3 and GD2 remains unclear. We investigated the combined expression status of GD3 and GD2 in pNTs and delineated their clinicopathological values. Methods GD3 and GD2 expression was examined in pNT tissue samples (n = 35) using immunohistochemistry and multiple immunofluorescence imaging. Results GD3 and GD2 expression was positive in 32/35 and 25/35 samples, respectively. Combinatorial analysis of GD3 and GD2 expression in neuroblastoma showed that both were heterogeneously expressed from cell to cell. There were higher numbers of GD3-positive and GD2-negative cells in the low-risk group than in the intermediate-risk ( P = 0.014) and high-risk ( P = 0.009) groups. Cases with high proportions of GD3-positive and GD2-negative cells were associated with the International Neuroblastoma Staging System stage ( P = 0.004), Children’s Oncology Group risk group ( P = 0.001), and outcome ( P = 0.019) and tended to have a higher overall survival rate. Conclusion We demonstrated that neuroblastomas from low-risk patients included more GD3-positive and GD2-negative cells than those from high-risk patients. Clarifying the heterogeneity of neuroblastoma aids in better understanding the biological characteristics and clinical behavior.

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