scholarly journals A Constructed and Validated Nomogram for Preoperatively Predicting Cancer-specific Survival Rates in Pediatric Patients with Brainstem Malignant Gliomas: A SEER-based Study

2021 ◽  
Author(s):  
wenqiang Che ◽  
Jun Lyu ◽  
Chengzhuo Li ◽  
Xiangyu Wang
Keyword(s):  
Regression Analysis ◽  
Pediatric Patients ◽  
Cox Regression ◽  
Characteristic Curve ◽  
Malignant Gliomas ◽  
Survival Rates ◽  
Cancer Specific Survival ◽  
Cox Regression Analysis ◽  
Calibration Curves ◽  
Practical Tool

Abstract Purpose: Pediatric patients diagnosed with brainstem malignant gliomas (BSMGs) have a poor prognosis. Our study aimed to construct and validate a prognostic nomogram to preoperatively predict the cancer‐specific survival (CSS) rates in these patients.Methods: From 1998 to 2016, we extracted patients' data from Surveillance Epidemiology and End Results (SEER) database. A total of 1160 patients were enrolled and randomly divided into training and validating groups. Subsequently, the Cox regression analysis was used to screen variables. Then, the nomogram was constructed. Lastly, we calculated C-indexes and plotted calibration curves and the utility of decision curve analyses (DCAs) to assess our survival model's benefits.Result: Here, after multivariate cox regression analysis, we established four variables for constructing nomogram for CSS rates. Subsequently, the C-index, the area under the receiver operating characteristic curve, and calibration curves were used to confirm the nomogram's good performance. DCAs of the nomogram indicated that both groups obtained good 1-, 3-, and 5-year net benefits. Conclusion: The nomogram model for preoperatively predicting CSS provided a convenient and practical tool to assess pediatric patients' prognosis with BSMG.

scholarly journals Preoperative Risk-Stratification of Pediatric Malignant Brainstem Glioma based on a validated nomogram: A SEER based Analysis

2021 ◽  
Author(s):  
wenqiang Che ◽  
Jun Lyu ◽  
Chengzhuo Li ◽  
Xiangyu Wang
Keyword(s):  
Regression Analysis ◽  
Risk Stratification ◽  
Pediatric Patients ◽  
Cox Regression ◽  
Characteristic Curve ◽  
Malignant Gliomas ◽  
Cancer Specific Survival ◽  
Cox Regression Analysis ◽  
Calibration Curves ◽  
Practical Tool

Abstract Purpose: Pediatric patients diagnosed with brainstem malignant gliomas (BSMGs) have a poor prognosis. Our study aimed to construct and validate a prognostic nomogram to predict the cancer‐specific survival preoperatively (CSS) rates and then a risk-stratification given to these patients.Methods: From 1998 to 2016, we extracted patients' data from Surveillance Epidemiology and End Results (SEER) database. A total of 1160 patients were enrolled and randomly divided into training and validating groups. Subsequently, the Cox regression analysis was used to screen variables. Then, the nomogram was constructed. Lastly, we calculated C-indexes and plotted calibration curves and the utility of decision curve analyses (DCAs) to assess our survival model's benefits.Result: Here, after multivariate cox regression analysis, we established four variables for constructing nomogram for CSS rates. Subsequently, the C-index, the area under the receiver operating characteristic curve, and calibration curves were used to confirm the nomogram's good performance. DCAs of the nomogram indicated that both groups obtained good 1-, 3-, and 5-year net benefits. Conclusion: The nomogram model for preoperatively predicting CSS provided a convenient and practical tool to assess pediatric patients' prognosis with BSMG.

scholarly journals Identification and Analysis of Three Hub Prognostic Genes Related to Osteosarcoma Metastasis

2021 ◽  
Vol 2021 ◽  
pp. 1-16
Author(s):  
Jianye Tan ◽  
Haofeng Liang ◽  
Bingsheng Yang ◽  
Shuang Zhu ◽  
Guofeng Wu ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Cox Regression ◽  
Survival Rates ◽  
Prognostic Biomarkers ◽  
Messenger Rnas ◽  
Hub Genes ◽  
Cox Regression Analysis ◽  
Expression Levels ◽  
Kaplan Meier ◽  
Before And After

Osteosarcoma (OS) often occurs in children and often undergoes metastasis, resulting in lower survival rates. Information on the complexity and pathogenic mechanism of OS is limited, and thus, the development of treatments involving alternative molecular and genetic targets is hampered. We categorized transcriptome data into metastasis and nonmetastasis groups, and 400 differential RNAs (230 messenger RNAs (mRNAs) and 170 long noncoding RNAs (lncRNAs)) were obtained by the edgeR package. Prognostic genes were identified by performing univariate Cox regression analysis and the Kaplan–Meier (KM) survival analysis. We then examined the correlation between the expression level of prognostic lncRNAs and mRNAs. Furthermore, microRNAs (miRNAs) corresponding to the coexpression of lncRNA-mRNA was predicted, which was used to construct a competitive endogenous RNA (ceRNA) regulatory network. Finally, multivariate Cox proportional risk regression analysis was used to identify hub prognostic genes. Three hub prognostic genes (ABCG8, LOXL4, and PDE1B) were identified as potential prognostic biomarkers and therapeutic targets for OS. Furthermore, transcriptions factors (TFs) (DBP, ESX1, FOS, FOXI1, MEF2C, NFE2, and OTX2) and lncRNAs (RP11-357H14.16, RP11-284N8.3, and RP11-629G13.1) that were able to affect the expression levels of genes before and after transcription were found to regulate the prognostic hub genes. In addition, we identified drugs related to the prognostic hub genes, which may have potential clinical applications. Immunohistochemistry (IHC) and quantitative real-time polymerase chain reaction (qRT-PCR) confirmed that the expression levels of ABCG8, LOXL4, and PDE1B coincided with the results of bioinformatics analysis. Moreover, the relationship between the hub prognostic gene expression and patient prognosis was also validated. Our study elucidated the roles of three novel prognostic biomarkers in the pathogenesis of OS as well as presenting a potential clinical treatment for OS.

Pediatric Patients with Adrenal Neuroblastoma: A SEER Analysis, 2004–2013

2020 ◽  
Vol 86 (2) ◽  
pp. 127-133
Author(s):  
Shengxiang Chen ◽  
Wenfeng Tang ◽  
Randong Yang ◽  
Xiaoxiao Hu ◽  
Zhongrong Li
Keyword(s):  
Overall Survival ◽  
Pediatric Patients ◽  
Cox Regression ◽  
Demographic Data ◽  
Survival Rates ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Survival Difference ◽  
Tumor Management ◽  
End Results

Adrenal neuroblastoma (NB) is a relatively common malignancy in children. The Surveillance, Epidemiology, and End Results database was used to present demographic data and a survival analysis with the aim of making tumor management better. The Surveillance, Epidemiology, and End Results database was used to search pediatric patients (age £16 years) with NB from 2004 to 2013. The Kaplan-Meier method was used to calculate the overall survival. And, we used Cox regression analysis to determine hazard ratios for prognostic variables. Independent prognostic factors were selected into the nomogram to predict individual's three-, five-, and seven-year overall survival. The study included a total of 1870 pediatric patients with NB in our cohort. Overall, three-, five-, and seven-year survival rates for adrenal NB were 0.777, 0.701, and 0.665, respectively, whereas the rates for nonadrenal NB were 0.891, 0.859, and 0.832, respectively. The multivariate analysis identified age >1 year, no complete resection (CR)/CR, radiation, and regional/distant metastasis as independent predictors of mortality for adrenal NB. Concordance index of the nomogram was 0.665 (95% confidence interval, 0.627–0.703). Pediatric patients with adrenal NB have significantly worse survival than those with nonadrenal NB. Adrenal NB with age <1 year, treated with surgery, no radiation, and localized tumor leads to a better survival. There was no survival difference for patients to receive CR and no CR.

Oncological outcomes of neoadjuvant chemotherapy in patients with locally advanced upper tract urothelial carcinoma: A multicenter study.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 429-429
Author(s):  
Shingo Hatakeyama ◽  
Yuka Kubota ◽  
Hayato Yamamoto ◽  
Takahiro Yoneyama ◽  
Yasuhiro Hashimoto ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Neoadjuvant Chemotherapy ◽  
Urothelial Carcinoma ◽  
Lymphovascular Invasion ◽  
Cox Regression ◽  
Locally Advanced ◽  
Upper Tract Urothelial Carcinoma ◽  
Cancer Specific Survival ◽  
Cox Regression Analysis ◽  
Oncological Outcomes

429 Background: The clinical impact of neoadjuvant chemotherapy (NAC) on oncological outcomes in patients with locally advanced upper tract urothelial carcinoma (UTUC) remains unclear. We investigated the oncological outcomes of platinum-based NAC for locally advanced UTUC. Methods: A total of 426 patients who underwent radical nephroureterectomy at five medical centers between January 1995 and April 2017 were examined retrospectively. Of the 426 patients, 234 were treated for a high-risk disease (stages cT3–4 or locally advanced [cN+] disease) with or without NAC. NAC regimens were selected based on eligibility of cisplatin. We retrospectively evaluated post-therapy pathological downstaging, lymphovascular invasion, and prognosis stratified by NAC use. Multivariate Cox regression analysis was performed for independent factors for prognosis. Results: Of 234 patients, 101 received NAC (NAC group) and 133 did not (Control [Ctrl] group). The regimens in the NAC group included gemcitabine and carboplatin (75%), and gemcitabine and cisplatin (21%). Pathological downstagings of the primary tumor and lymphovascular invasion were significantly improved in the NAC than in the Ctrl groups. NAC for locally advanced UTUC significantly prolonged recurrence-free and cancer-specific survival. Multivariate Cox regression analysis using an inverse probability of treatment weighted (IPTW) method showed that NAC was selected as an independent predictor for prolonged recurrence-free and cancer-specific survival. However, the influence of NAC on overall survival was not statistically significant. Conclusions: Platinum-based NAC for locally advanced UTUC potentially improves oncological outcomes. Further prospective studies are needed to clarify the clinical benefit of NAC for locally advanced UTUC.

scholarly journals Influence of Waist-to-Hip Ratio on the Prognosis of Heart Failure Patients With Revascularized Coronary Heart Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Yingyue Zhang ◽  
Yan Zhang ◽  
Yajun Shi ◽  
Wei Dong ◽  
Yang Mu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Heart Disease ◽  
Regression Analysis ◽  
Heart Disease ◽  
Cox Regression ◽  
Characteristic Curve ◽  
Cardiac Events ◽  
Cox Regression Analysis ◽  
Waist To Hip Ratio

Background: Heart failure (HF) is considered one of the most common complications of coronary heart disease (CHD), with a higher incidence of readmission and mortality. Thus, exploring the risk factors related to the prognosis is necessary. Moreover, the effect of the waist-to-hip ratio (WHR) on HF patients with revascularized CHD is still unclear. Thus, we aimed to assess the influence of WHR on the prognosis of HF patients with revascularized CHD.Methods: We collected data of HF patients with revascularized CHD who were referred to the Cardiac Rehabilitation Clinic of PLA Hospital from June 30, 2015, to June 30, 2019. Cox proportional hazard regression analysis was used to determine the relationship between WHR and prognosis of HF patients with revascularized CHD. Patients were divided into higher and lower WHR groups based on the cutoff WHR value calculated by the X-tile software. Cox regression analysis was used to analysis the two groups. We drew the receiver operating characteristic curve (ROC) of WHR and analyzed the differences between the two groups. Endpoints were defined as major adverse cardiac events (MACE) (including all-cause mortality, non-fatal myocardial infarction, unscheduled revascularization, and stroke).Results: During the median follow-up of 39 months and maximum follow-up of 54 months, 109 patients were enrolled, of which 91.7% were males, and the mean age was 56.0 ± 10.4 years. WHR was associated with the incidence of MACE in the Cox regression analysis (p = 0.001); an increase in WHR of 0.01 unit had a hazard ratio (HR) of 1.134 (95%CI: 1.057–1.216). The WHR cutoff value was 0.93. Patients in the higher WHR group had a significantly higher risk of MACE than those in the lower WHR group (HR = 7.037, 95%CI: 1.758–28.168). The ROC area under the curve was 0.733 at 4 years. Patients in the higher WHR group had a higher body mass index (BMI; 26.7 ± 3.5 vs. 25.4 ± 2.4, P = 0.033) than patients in the lower WHR group.Conclusions: WHR is an independent risk factor of the long-term prognosis of Chinese HF patients with revascularized CHD. Patients with WHR ≥ 0.93 require intensified treatment. Higher WHR is related to higher BMI and ΔVO2/ΔWR.

scholarly journals Identification and validation of a prognostic 5-protein signature for biochemical recurrence following radical prostatectomy in prostate cancer

2020 ◽  
Author(s):  
Xiangkun Wu ◽  
Wenjie Li ◽  
Daojun Lv ◽  
Yongda Liu ◽  
Di Gu
Keyword(s):  
Prostate Cancer ◽  
Regression Analysis ◽  
Biochemical Recurrence ◽  
Cox Regression ◽  
Characteristic Curve ◽  
Cox Proportional Hazards ◽  
The Cancer Genome Atlas ◽  
Medical Decision ◽  
Cox Regression Analysis ◽  
Protein Signature

Abstract Background : Biochemical recurrence (BCR) is considered as an indicator for prostate cancer (PCa)-specific recurrence and mortality. However, lack of effective prediction model to assess the prognosis of patients for optimization of treatment. The aim of this work was to construct a protein-based nomogram that could predict BCR for PCa.Materials and methods: Univariate Cox regression analysis was conducted to identify candidate proteins from the Cancer Genome Atlas (TCGA) database. LASSO Cox regression was further conducted to pick out the most significant prognostic proteins and formulate the proteins signature for predicting BCR. Additionally, a nomogram was constructed by multivariate Cox proportional hazards regression.Results: We established a 5‐protein-based signature which was well used to identify PCa patients into high‐ and low‐risk groups. Kaplan-Meier analysis demonstrated patients with higher BCR generally had significantly worse survival than those with lower BCR (p<0.0001). Time-dependent receiver operating characteristic curve expounded that ours signature had excellent prognostic efficiency for 1‐, 3‐ and 5‐year BCR (area under curve in training set: 0.691, 0.797, 0.808 and 0.74, 0.739, 0.82 in the test set). Univariable and multivariate Cox regression analysis showed that this 5‐protein signature was an independent of several clinical signatures including age, Gleason score, T stage, N status, PSA and residual tumor. Moreover, a nomogram was constructed and calibration plots confirmed the its predictive value in 3-, 5- and 10-year BCR overall survival.Conclusion: Our study identified a 5-protein-based signature and constructed a prognostic nomogram that reliably predicts BCR in prostate cancer. The findings might be of paramount importance in tumor prognosis and medical decision-making.

scholarly journals Development of an immune-related gene pairs signature for predicting clinical outcome in lung adenocarcinoma

2020 ◽  
Author(s):  
Chunlei Wu ◽  
Quanteng Hu ◽  
Dehua Ma
Keyword(s):  
Regression Analysis ◽  
Lung Adenocarcinoma ◽  
Cox Regression ◽  
Characteristic Curve ◽  
Lasso Regression ◽  
Related Gene ◽  
Cox Regression Analysis ◽  
Gene Pairs ◽  
Immune Related Gene ◽  
Pathological Subtype

Abstract Background Lung adenocarcinoma (LUAD) is the main pathological subtype of Non-small cell lung cancer. The aim of this study was to establish an immune-related gene pairs (IRGPs) signature for predicting the prognosis of LUAD patients.Methods We downloaded the gene expression profile and immune-related gene set from TCGA and ImmPort database, respectively, to establish IRGPs. Then, IRGPs subjected to univariate Cox regression analysis, LASSO regression analysis and multivariable Cox regression analysis to screen and develop a IRGPs signature. The receiver operating characteristic curve (ROC) was applied for evaluating the predicting accuracy of this signature by calculating the area under ROC (AUC) and data from GEO was used to validate this signature.Results A IRGPs signature with 8 IRGPs was constructed. The AUC for 1- and 3-year overall survival in TCGA set was 0.867 and 0.870, respectively. Similar result was observed in the AUC of GEO set and Total set (GEO set [1-year: 0.819; 3-years: 0.803]; Total set [1-year: 0.845; 3-years: 0.801]). Survival analysis of three sets demonstrated high-risk LUAD patients exhibited poorer prognosis. The multivariable Cox regression indicated that risk score was independent prognostic factors.Conclusions We developed a novel IRGPs signature for predicting prognosis of LUAD.

Impact of cytoreductive surgery on outcomes of metastatic appendiceal carcinoma: a real-world, population-based study

2020 ◽  
Vol 9 (6) ◽  
pp. 431-439
Author(s):  
Omar Abdel-Rahman
Keyword(s):  
Overall Survival ◽  
Regression Analysis ◽  
Metastatic Disease ◽  
Cytoreductive Surgery ◽  
Mucinous Adenocarcinoma ◽  
Cox Regression ◽  
Cancer Specific Survival ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Appendiceal Carcinoma

Aim: To evaluate the impact of cytoreductive surgery on the outcomes of patients with metastatic appendiceal carcinoma. Methods: Surveillance, Epidemiology and End Results (SEER) database was accessed and patients with metastatic appendiceal carcinoma diagnosed (2010–2015) were reviewed. Kaplan–Meier survival estimates/log-rank testing were then used to assess overall survival outcomes according to cytoreductive surgery. Multivariable Cox regression analysis was then used to evaluate factors affecting cancer-specific survival. Factors included in this model were age, race, sex, stage and histology and cytoreductive surgery. Results: A total of 1339 patients with metastatic appendiceal carcinoma were included in the current study. Using Kaplan–Meier survival estimates to evaluate overall survival, patients with surgery for metastatic disease have better overall survival compared with patients without surgery for metastatic disease (p < 0.001). Stratifying survival analysis according to histology, the overall survival benefit from surgery for the metastases seems to be limited to patients with mucinous adenocarcinoma (p = 0.002) rather than patients with nonmucinous adenocarcinoma (p = 0.401). Multivariable Cox regression analysis was then conducted to evaluate factors predicting cancer-specific survival. The following factors were associated with worse cancer-specific survival: African-American race (hazard ratio [HR]: 1.356; 95% CI: 1.036–1.774; p = 0.026), more advanced stage (HR: 3.910; 95% CI: 2.735–5.588; p < 0.001), nonmucinous adenocarcinoma (HR for signet ring carcinoma vs mucinous adenocarcinoma: 2.119; 95% CI: 1.674–2.683; p < 0.001) and no surgical resection of metastatic disease (HR: 1.273; 95% CI: 1.067–1.519; p < 0.001). Conclusion: The current study suggests that among patients with metastatic appendiceal carcinoma, surgical cytoreduction of metastatic disease is associated with improved outcomes for patients with mucinous adenocarcinoma but not in patients with nonmucinous adenocarcinoma.

P6331Influence of dynapenia and obesity on prognoses of elderly heart failure patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Uchida ◽  
K Kamiya ◽  
N Hamazaki ◽  
R Matsuzawa ◽  
K Nozaki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Regression Analysis ◽  
Muscle Strength ◽  
Cox Regression ◽  
Handgrip Strength ◽  
Survival Rates ◽  
The Other ◽  
Rank Test ◽  
Protective Effects ◽  
Cox Regression Analysis

Abstract Background In elderly people, a decline in activities of daily living is more closely associated with low muscle strength (dynapenia) than with low muscle mass. Moreover, the combination of low muscle strength and obesity (dynapenic obesity) is associated with a higher risk of mortality than dynapenia or obesity alone, but its influence on prognosis is still unknown in elderly heart failure (HF) patients. To clarify these relationships may contribute to the development of rehabilitation programs for elderly HF patients and the improvement their prognoses in the future. Purpose We aimed to investigate the influence of dynapenia and obesity on prognoses of elderly HF patients. Methods We evaluated 1006 elderly HF patients aged ≥65 years (76.5±6.9 years, 579 males) who were admitted to our hospital and participated in an inpatient cardiac rehabilitation program. We assessed patients' characteristics, including body mass index (BMI) and handgrip strength during hospitalization. Patients with low handgrip strength (<26 kg and <18 kg in males and females, respectively) and high BMI (≥25 kg/m2) were considered to have dynapenia and obesity, respectively. Moreover, patients fulfilling the above two criteria (dynapenia, obesity) were considered to have dynapenic obesity. Patients were divided into four groups: normal, dynapenia only, obesity only, and dynapenic obesity. We compared survival rates among the four groups using the Kaplan-Meier method and log-rank test. To identify predictors for all-cause mortality, we performed Cox regression analysis. Results During the 8-year follow-up period, 228 patients (21.2%) died. Eight-year cumulative incidences of mortality were 35.4%, 26.0%, 62.6%, and 33.1% in the normal, obesity only, dynapenia only, and dynapenic obesity groups, respectively. Significantly lower survival rates were observed in the dynapenia only group than in the other 3 groups (log-rank: 28.893, P<0.001). Cox regression analysis, after adjusting for age and sex, showed significantly poor prognosis in the dyanapenia only group than in the other 3 groups (normal group, hazard ratio [HR] = 0.684, 95% confidence interval [CI] = 0.488–0.959, P=0.028; obesity only group, HR = 0.330, 95% CI = 0.182–0.598, P<0.001; dynapenic obesity group, HR = 0.390, 95% CI = 0.206–0.739, P=0.004). Conclusion Elderly HF patients with dynapenia alone had poor prognoses. Obesity may have protective effects on the survival of dynapenia patients with HF.

Differences in Survival Rates for Patients with Hodgkin Lymphoma, Who Were Treated Inside vs. Outside Therapy Optimisation Protocols in Germany.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2321-2321
Author(s):  
Corinne Brillant ◽  
Claudia Terschueren ◽  
Sylke Gierer ◽  
Jeremy Franklin ◽  
Stephanie Heidelbach ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Regression Analysis ◽  
Hodgkin Lymphoma ◽  
Cox Regression ◽  
Survival Rates ◽  
Observation Time ◽  
Advanced Stage ◽  
Exclusion Criteria ◽  
Cox Regression Analysis ◽  
Risk Of Death

Abstract Introduction: Despite the improvements and knowledge brought by clinical trials to cancer treatment, it remained unclear how beneficial participation in a clinical trial with Therapy Optimisation Protocol (TOP) is for patients (pts) with Hodgkin Lymphoma (HL) in relation to pts treated outside of trials. In the TOPiCS project, trial participants (TOP) were compared with non-trial pts (non-TOP). Methods: In the population-based survey NLL, which aimed to register all incident HL-cases 356 pts were recorded in six counties of northern Germany with a first diagnosis of HL in 1988–1998. Data on staging, therapy, adverse events and survival were collected. The dataset was additionally screened for patients fulfilling inclusion and exclusion criteria for clinical trials of the German Hodgkin Study Group (GHSG). A total of 328 pts were documented of whom 198 pts (60%) met the inclusion criteria of the GHSG. Of these, 125 pts (63%) have not been recruited into GHSG trials (non-TOP pts). They were compared retrospectively with 4963 TOP pts randomised nation-wide between 1988–1998 in the GHSG trials HD4-HD9. Endpoints were Overall Survival (OS) and Progression Free Survival (PFS) which considered progression, relapse and death of any cause as events. Survival analysis was performed using Kaplan-Meier method and log-rank tests. Cox regression analysis was used for multivariable modelling of risk of death or progression and included 118 non-TOP pts and 4958 TOP pts. Results: The demographic parameters were not well balanced between the two groups: TOP pts were younger, had more often advanced stage and diagnosis in the later study generation than the non-TOP pts. The median observation time for OS was 7 yrs for the TOP group and 10 yrs for the non-TOP group. The 5-yrs OS for TOP pts is 89% (95%–CI [88–90]) and for non-TOP 89% (95%-CI [82–94])(p=0.63). The 5-year PFS for TOP pts is 79% (95%–CI [78–80]) and for non-TOP pts 68% (95%–CI [59–76])(p&lt;0.001). According to Cox-regression analysis, 5 parameters were significantly (p&lt;0.01) associated with poor OS and PFS: male sex, older age, advanced stage (according to DHSG classification considering Ann Arbor stage, B-symptoms and risk factors) and earlier study generation. Participation in a TOP-trial did not contribute independently for OS (Hazard Ratio (HR)=1.12, 95%–CI [0.71–1.79]) but contributed independently and positively for PFS (HR=0.66, 95%–CI [0.49–0.89]). The difference is mainly due to a higher number of relapses. Conclusion: For German patients fulfilling inclusion and exclusion criteria for TOP, a participation in therapy optimisation protocols results in a higher PFS, allowing for the influence of other factors, than for patients who were treated outside of TOP-trials. However, no difference was observed in OS.

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