scholarly journals Preoperative Anemia and Thrombocytosis Predict Adverse Prognosis in Non-Metastatic Renal Cell Carcinoma With Tumor Thrombus

2020 ◽  
Author(s):  
Lulin Ma ◽  
Xiao Ruotao ◽  
Xu Chuxiao ◽  
He Wei ◽  
Liu Lei ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Cell Carcinoma ◽  
Prognostic Factors ◽  
Tumor Thrombus ◽  
Preoperative Anemia ◽  
Factors Associated ◽  
Node Metastasis ◽  
Kaplan Meier ◽  
Metastatic Rcc ◽  
Grade Iii

Abstract Objection: The aim of the study was to determine the prognostic value of preoperative blood parameters in patients with renal cell carcinoma (RCC) and tumor thrombus (TT) treated surgically.Method: we retrospectively analyzed 152 patients diagnosis with RCC and TT and treated surgically. Clinicopathologic data and blood parameter were obtained. Univariable and multivariable analysis using the Cox regression model were performed to determine risk factors that were associated with progression-free survival (PFS) and overall survival (OS). Kaplan-Meier curve and logistic regression were performed to analyze the risk factors.Results: Preoperative Hgb＜120g/L (HR=2.48, P=0.024) and lymph node metastasis (HR=3.98, P=0.032) were an independent prognostic factors associated with OS. Preoperative PLT≥300×109/L (HR=2.10, P=0.014) and lymph node metastasis (HR=3.42, P=0.021) were an independent prognostic factors associated with PFS. In Kaplan–Meier survival analysis, preoperative anemia had worse OS than without anemia (P=0.003) and thrombocytosis had worse PFS than without thrombocytosis (P=0.001). Preoperative anemia were associated with more symptomatic (P=0.009), surgical time≥6h (P=0.016), Blood loss≥1000ml (P=0.014), transfusion(P=0.012), higher thrombus level (III-IV) (P=0.004) and higher nuclear grade (III-IV) (P=0.002) while thrombocytosis were associated with more symptomatic (P=0.008) and higher nuclear grade (III-IV) (P=0.042)Conclusions: Preoperative anemia and thrombocytosis was associated with adverse prognosis in patients with non-metastatic RCC with TT. Both preoperative hemoglobin level and platelet count may be clinical useful for risk stratifying patients receiving operation for non-metastatic RCC with TT.

scholarly journals Preoperative anaemia and thrombocytosis predict adverse prognosis in non‐metastatic renal cell carcinoma with tumour thrombus

BMC Urology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ruotao Xiao ◽  
Chuxiao Xu ◽  
Wei He ◽  
Lei Liu ◽  
Hongxian Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prognostic Factors ◽  
Predictive Accuracy ◽  
Blood Parameters ◽  
Tumour Thrombus ◽  
Factors Associated ◽  
Node Metastasis ◽  
Kaplan Meier ◽  
Metastatic Rcc ◽  
Preoperative Anaemia

Abstract Background  This study aimed to determine the prognostic value of preoperative blood parameters in renal cell carcinoma (RCC) and tumour thrombus (TT) patients that were surgically treated. Method We retrospectively analysed clinicopathological data and blood parameters of 146 RCC and TT patients that were surgically treated. Univariate or multivariate Cox regression analyses were performed to determine the risk factors associated with progression-free survival (PFS) and overall survival (OS). Kaplan-Meier analysis and logistic regression were performed to study the risk factors. Receiver operating characteristic curves were applied to test improvements in the predictive accuracy of the established prognosis score. Results On univariate and multivariate analysis, anaemia (HR 2.873, P = 0.008) and lymph node metastasis (HR 4.811, P = 0.015) were independent prognostic factors linked to OS. Besides, thrombocytosis (HR 2.324, P = 0.011), histologic subtype (HR 2.835, P = 0.004), nuclear grade (HR 2.069, P = 0.033), and lymph node metastasis (HR 5.739, P = 0.001) were independent prognostic factors associated with PFS. Kaplan–Meier curves revealed that patients with anaemia exhibited worse OS than those without it (P = 0.0033). Likewise, patients with thrombocytosis showed worse PFS than those without it (P < 0.0001). Adding the anaemia and thrombocytosis to the SSIGN score improved its predictive accuracy related to OS and PFS. Preoperative anaemia was linked to more symptom at presentation (OR 3.348, P = 0.006), longer surgical time (OR 1.005, P = 0.001), more blood loss (OR 1.000, P = 0.018), more transfusion (OR 2.734, P = 0.004), higher thrombus level (OR 4.750, P = 0.004) and higher nuclear grade (OR 3.449, P = 0.001) while thrombocytosis was associated with more symptom at presentation (OR 7.784, P = 0.007). Conclusions Preoperative anaemia and thrombocytosis were adverse prognostic factors in non-metastatic RCC patients with TT. Also, both preoperative anaemia and thrombocytosis can be clinically used for risk stratification of non-metastatic RCC and TT patients.

Prognostic factors for development of acute respiratory distress syndrome following traumatic injury – a systematic review and meta-analysis

2021 ◽  
pp. 2100857
Author(s):  
Alexandre Tran ◽  
Shannon M. Fernando ◽  
Laurent J. Brochard ◽  
Eddy Fan ◽  
Kenji Inaba ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Respiratory Distress Syndrome ◽  
Prognostic Factors ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Traumatic Injury ◽  
Clinical Risk Factors ◽  
Factors Associated ◽  
Post Traumatic

PurposeTo summarise the prognostic associations between various clinical risk factors and the development of the acute respiratory distress syndrome (ARDS) following traumatic injury.MethodsWe conducted this review in accordance with the PRISMA and CHARMS guidelines. We searched six databases from inception through December 2020. We included English language studies describing the clinical risk factors associated with the development of post-traumatic ARDS, as defined by either the American-European Consensus Conference or the Berlin definition. We pooled adjusted odds ratios for prognostic factors using the random effects method. We assessed risk of bias using the QUIPS tool and certainty of findings using GRADE methodology.ResultsWe included 39 studies involving 5 350 927 patients. We identified the amount of crystalloid resuscitation as a potentially modifiable prognostic factor associated with the development of post-traumatic ARDS (adjusted odds ratio [aOR] 1.19 for each additional liter of crystalloid administered within first 6 h after injury, 95% CI 1.15 to 1.24, high certainty). Non-modifiable prognostic factors with a moderate or high certainty of association with post-traumatic ARDS included increasing age, non-Hispanic white race, blunt mechanism of injury, presence of head injury, pulmonary contusion, or rib fracture; and increasing chest injury severity.ConclusionWe identified one important modifiable factor, the amount of crystalloid resuscitation within the first 24 h of injury, and several non-modifiable factors associated with development of post-traumatic ARDS. This information should support the judicious use of crystalloid resuscitation in trauma patients and may inform the development of a risk-stratification tools.

scholarly journals Advanced and metastatic renal cell carcinoma – Ain Shams Clinical Oncology Department Experience

2020 ◽  
Vol 10 (1) ◽  
pp. 18
Author(s):  
Ahmed Nagy ◽  
Mona Kamal ◽  
Hesham El Halawani
Keyword(s):  
Risk Factors ◽  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Clinical Oncology ◽  
Renal Cell ◽  
Older Patients ◽  
Treatment Options ◽  
Tumor Grade ◽  
Kaplan Meier ◽  
Younger Age

Background: Renal cell carcinoma is a rare tumor and till recently few treatment options were available. It is poorly understood why people develop RCC since only a few etiologic factors have been clinically identified as risk factors for RCC.Purpose: To analyze our experience at Ain Shams University Clinical Oncology department in Egypt with patients presenting with advanced renal cell carcinoma to provide a correlations between clinic-pathological factors, treatment and survival outcomes.Methodology: Retrospective review of the data of 54 patients who were diagnosed as RCC and presented to Ain Shams University Clinical Oncology department in Egypt from 1 May 2013 till 1 May 2015. Descriptive and clinic-pathological data were described using simple and relative frequencies. Survival outcome for the patients will be described using Kaplan Meier curves stratified according to morphology, age group and treatment received.Results: The sample included 54 patients (53.7% were males) of whom 14.3% were less than 40 years and 3.7% were elderly (≥ 70 years old). The median age was 55.5 years (SD ± 13.6 , range 19-71). Median PFS was 6.5 months (SD ± 12.3846 Range 43) while the median OS was 13 months (SD ± 12.161 Range 46). PFS in patients aged below 55.5 years was 9 months (95% CI=6.509-11.491) compared to 4 months (95% CI=2.704-5.296) in older patients (p = .004). PFS in patients who achieved PR after sunitinb was 17 months (95% CI=6.916-27.084) compared to 5 months (95% CI=3.699-6.301) in patients who didn’t achieved PR (p < .001). OS in patients aged below 55.5 years was 15 months (95% CI=9.131-20.869) compared to 11 months (95% CI=8.947-13.053) in older patients (p = .012). Favorable pathology status was associated with prolonged OS of 14 months (95% CI= 9.403-18.597) versus 11 months (95% CI=8.363-13.637) for unfavourable pathology status (p = .11). Low grades histopathogy was associated with prolonged OS of 44 months (95% CI= 38.456-49.544) versus 12 months (95% CI=10.077-13.923) for higher grades (p = < .001).Conclusion: Multivariate analyses supported a conclusion that younger age was an independent prognostic factor for survival along with other known risk factors such as tumor grade and pathology status.

Intracranial hematoma following ruptured anterior communicating artery aneurysms: risk factors, outcome, and prognostic factors after management of coiling first

2021 ◽  
pp. neurintsurg-2021-017506
Author(s):  
Heng Ni ◽  
Lin-Bo Zhao ◽  
Sheng Liu ◽  
Zhen-Yu Jia ◽  
Yue-Zhou Cao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Prognostic Factors ◽  
Neurological Status ◽  
External Ventricular Drainage ◽  
Anterior Communicating Artery ◽  
Intracranial Hematoma ◽  
Factors Associated ◽  
Independent Variable ◽  
Logistic Regressions ◽  
Significant Factors

BackgroundTo determine the risk factors for intracranial hematoma (ICH) development following ruptured anterior communicating artery (AcomA) aneurysms and to determine prognostic factors associated with unfavorable outcomes after coiling first.MethodsFrom March 2014 to February 2020, 235 patients with ruptured AcomA aneurysms underwent endovascular treatment in our department. The clinical and radiographic conditions were collected retrospectively. Modified Rankin Scale (mRS) scores of ≤ 2 were accepted as favorable outcomes. Univariate and multivariate logistic regressions were performed to identify significant factors contributing to the incidence of ICHs and to unfavorable outcomes.ResultsOf these 235 patients, 68 had additional ICHs. A posterior orientation of ruptured AcomA aneurysms was the independent variable associated with the incidence of ICHs (OR 3.675; p<0.001). Furthermore, having preoperative Hunt–Hess grades Ⅳ–Ⅴ was an independent variable associated with unfavorable outcomes for ICH patients (OR 80.000; p<0.001). Among the 68 patients with ICHs, 40% (27/68) had Hunt–Hess grades IV–V. Four percent of patients (3/68) underwent surgical hematoma evacuation after the coiling procedure and 15% of the patients (10/68) underwent external ventricular drainage. A favorable outcome was achieved in 72% (49/68) of patients with ruptured AcomA aneurysms. The mortality rate was 21% (14/68) at 6 months.ConclusionA posterior orientation of ruptured AcomA aneurysms was associated with the incidence of ICHs. Coiling first with surgical management if necessary seems to be an acceptable treatment for ruptured AcomA aneurysms with ICHs. The clinical outcome was associated with the clinical neurological status on admission.

Outcomes and prognostic factors of patients with anti-melanoma differentiation-associated protein 5 and anti-aminoacyl-RNA synthetase antibodies positive idiopathic inflammatory myopathies in intensive care unit

2020 ◽  
Author(s):  
Shiyao Wang ◽  
Xinran Zhang ◽  
Yanhong Ren ◽  
Yi Zhang ◽  
Ye Tian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Prognostic Factors ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Serum Ferritin ◽  
Factors Associated ◽  
Overall Mortality

Abstract Background: This study aims to identify prognostic factors for mortality of patients with anti-melanoma differentiation-associated protein 5 (anti-MDA5) or anti-aminoacyl-RNA synthetase (anti-ARS) antibodies positive and acute respiratory failure in the intensive care unit.Methods: Clinical characteristics, laboratory test findings, imaging performance, and management were retrospectively collected in all cases with anti-MDA5 and anti-ARS antibodies positive, as well as follow-up survival data. Risk factors related to prognosis were identified by Cox regression analysis.Results: The 28-day mortality of all patients was 68.8% (n=44/64). The patients who died were more likely to have anti-MDA5 antibody(p<0.001), presented more Gottron papules(p=0.021) or heliotrope rash(p=0.008), had a relatively lower level of WBC(p=0.038), CRP(p=0.004), and had a higher level of LDH(p=0.029), serum ferritin(p=0.002). The main risk factors associated with 28-day mortality were anti-MDA5 antibody positive [HR 10.827 (95% CI: 4.261-27.514), p<0.001], presence of Gottron papules [2.299 (1.203-4.394), p=0.012], heliotrope rash [3.423 (1.773-6.606), p<0.001], and arthritis/arthralgia [2.365 (1.130-4.948), p=0.022). At a median of 14 (IQR 6.33-35.0) months of follow-up, the overall mortality of all patients was 75.0% (n=48/64). The non-survivors were more likely to own anti-MDA5 antibody(p<0.001), had a higher rate of Gottron papules(p=0.020) or heliotrope rash(p=0.014), had lower PFR(p=0.032) while ICU admission, and existed a higher level of serum ferritin(p=0.005). Main risk factors associated with overall mortality were consistent with risk factors for 28-day mortality. Conclusions: Anti-MDA5 antibody positive, presence of Gottron papules, heliotrope rash, or arthritis/arthralgia were the main independent risk factors of poor prognosis for IIM patients admitted to the ICU due to acute respiratory failure.

scholarly journals Prognostic Factors in Canine Mammary Carcinomas and HER2 Expression Relationship

2017 ◽  
Vol 45 (1) ◽  
pp. 9 ◽  
Author(s):  
Nicolle Pereira Soares ◽  
Alessandra Aparecida Medeiros ◽  
Igor De Paula Castro ◽  
Taís Meziara Wilson ◽  
Taís De Almeida Moreira ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Histological Grade ◽  
Her2 Expression ◽  
Mammary Carcinomas ◽  
Node Metastasis ◽  
In Situ Carcinoma ◽  
Grade Iii

Background: The human epidermal growth factor type 2 (HER2) receptor is a membrane glycoprotein tyrosine kinase. In woman, HER2 expression is diagnosed in 30% of breast carcinomas and it is associated with a worse prognosis, higher rate of recurrence and mortality. In the bitch, the HER2 overexpression in canine mammary tumors is still controversial and the prognostic value remains uncertain. Thus, we aimed to verify the HER2 expression in canine mammary carcinomas and relate it to the type and histological grade, lymph node metastasis and clinical staging.Materials, Methods & Results: Ninety bitches diagnosed with mammary carcinoma were included in this study. The inclusion criteria were bitches with complete clinical examination, thoracic radiographic examination and submitted unilateral or bilateral mastectomy. Ninety-nine samples of mammary carcinoma were used and the fragments of tumor and regional lymph nodes were fixed in 10% neutral formalin for histopathological and immunohistochemistry analysis. The lesions were evaluated by two pathologists and classified according to the type and histological grade. HER2 expression was performed by semi-quantitative analysis of the slides according to the HerceptTestTM (Dako) recommended score. Simple carcinomas were the most frequent (51.51%) followed by complex carcinomas (46.47%) and in situ carcinoma (2.02%). The histological grade of 97 carcinoma samples was attributed, except in situ carcinoma, 37 (38.14%) of the neoplasms were grade I, 50 (51.55%) grade II and only 10 (10.31%) tumors were classified as grade III. Forty bitches were submitted to clinical staging (TNM) and 42.50% of the bitches received staging in grade I and, 25% of the bitches staged in grade IV and V, with metastases. The HER2 expression, 13/99 samples (13.13%) received score +2, 19/99 (19.19%) score +1 and absence of marking (score 0) was identified in 67 samples (67.80 %). Immunostaining in hyperplastic or normal epithelial cells was evidenced, often in association with weak or moderate cytoplasmic labeling. Of the samples expressing +2 score for HER2 (n = 13), eight samples (17.39%) were complex carcinoma and five (9.80%) simple carcinomas. There was no relationship between HER2 immunostaining with age, tumor size, TNM, histological type, histological gradation, lymph node metastasis and distance. Animals with lymph node metastasis, as well as those diagnosed with distant metastasis, did not present HER2 expression in the tumors.Discussion: The simple carcinoma seems to be the most frequent type histological diagnosed in canine mammary carcinomas, followed by carcinoma in mixed tumor and complex carcinoma. Tubulopapillary carcinomas are more invasive in the female dogs as well as in the woman. Carcinomas grade I and II are more frequent and present a better prognosis for the dog. However, bitches with grade III carcinoma survived for a shorter time when compared to dogs with grade I or II tumors. A factor that may have contributed to the lower number of bitches at worst prognostic stage (EC IV and V) is the current owners’ awareness that they have sought veterinary help earlier, as soon as they detect small nodules in mammary gland. Overexpression of HER2 in women breast cancer is diagnosed in 20-30% of cases, whereas in bitches, this expression is variable. Also the different percentages of canine HER2 immunostaining are due to the lack of standardization for the analysis of the immunostaining, the immunohistochemical techniques employed and the non-specificity of the HER2 antibody. In canine mammary carcinomas the HER2 expression in low and this immunostaining is not related to other established prognostic factors. This study reinforces the hypothesis put forward by other authors that in the bitch the expression of HER2 may not be related to malignancy and tumor progression.

Pathological determinants of oncologic outcomes in stage II renal cell carcinoma: An international multicenter analysis.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 535-535
Author(s):  
Zachary Hamilton ◽  
Daniel Han ◽  
Alp Tuna Beksac ◽  
Sean Berquist ◽  
Abd−elrahma Hassan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Stage ◽  
Tumor Grade ◽  
Stage Ii ◽  
Positive Margins ◽  
Factors Associated ◽  
Oncological Outcomes ◽  
Multicenter Analysis ◽  
Grade 3 ◽  
Grade Iii

535 Background: Clinical Stage II Renal Cell Carcinoma (RCC) is a heterogeneous disease characterized by disparate oncological outcomes. The risk of progression and recurrence can vary widely. We analyzed risk factors associated with oncological outcomes in a contemporary cohort. Methods: Retrospective multicenter analysis of patients who underwent surgical excision of clinical stage 2 (T2) renal mass between 1998-2015. Patients with tumors amenable to nephron−sparing surgery, baseline chronic kidney disease, or bilateral renal masses were provided an option for partial nephrectomy (PN), otherwise radical nephrectomy (RN) was performed. Lymphadenectomy (LND) was performed at the discretion of the surgeon due to concern for lymphadenopathy on preoperative imaging or at time of surgery. Patients with pN+ disease and pathological pT upstaging/downstaging were excluded. Primary endpoint was Recurrence Free Survival (RFS). Univariable linear regression, Kaplan−Meier Analysis (KMA) log−rank test, and multivariable analysis (MVA) for factors related to RFS and overall survival (OS) were performed. Results: 695 patients were analyzed (mean age 59.3 years, median follow up 49.6 months, 61.4% male/38.6% female, 545 RN/150 PN, 193 LND/502 no LND). MVA for factors associated with worsened RFS revealed lymphovascular invasion (LVI, HR 2.27, p=0.002), positive margins (HR 2.67, p=0.008), and tumor grade 3/4 (HR 2.04, p<0.008). MVA for decreased OS revealed LVI (HR 2.58, p=0.003), positive margins (HR 2.34, p=0.044), and tumor grade 3/4 (HR 2.08, p=0.023) as risk factors. KMA revealed 5 year RFS of 76.1% for LVI negative and 46% for LVI positive patients (p<0.001), and 5 year RFS of 78.1% for Tumor Grade I/II and 53.7% for Tumor Grade III/IV (p<0.001). KMA revealed 5 year OS of 79.2% for LVI negative and 60.6% for LVI positive patients (p<0.001). Conclusions: For Stage II RCC, LVI, positive margin, and tumor grade III/IV are independently associated with worsened RFS and OS. Further investigation is requisite and may add weight to consider these specific stage II RCC patients as a higher risk subgroup with implications for staging revision and clinical trial design.

Does increasing time to surgery affect survival in stage I renal cell carcinoma? Analysis of the national cancer database.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 635-635
Author(s):  
Brittney Cotta ◽  
Stephen Ryan ◽  
Ahmed Eldefrawy ◽  
Reith Sarkar ◽  
Aaron Bradshaw ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Surgical Treatment ◽  
Multivariable Analysis ◽  
Surgical Care ◽  
National Cancer Database ◽  
Factors Associated ◽  
Time To Surgery ◽  
Kaplan Meier ◽  
Stage 1

635 Background: Optimal timing for surgical treatment of localized renal cell carcinoma (RCC) remains undefined. We sought to determine the survival impact of time to definitive surgical treatment for Stage 1 RCC and elucidate factors associated with a delay in surgical care utilizing the National Cancer Database (NCDB). Methods: The NCDB was queried for Stage 1 RCC cases (cT1N0M0) from 2004-2013 treated with partial or radical nephrectomy. Quartiles were formed from the range of time to surgery of the entire cohort in days: early defined as the first two quartiles and delayed as the fourth. Descriptive analyses were conducted between early and delayed groups. Overall survival (OS) between early and delayed groups was calculated with Kaplan-Meier analysis. Multivariable analysis was performed to determine factors associated with delay in surgical care. Results: 38,859 patients were analyzed. Median time to treatment was 40 days (IQR 22-68). Early (≤40 days, n = 23,712) and delayed ( > 68 days, n = 15,147) groups had a median follow-up of 44.8 and 41 months, respectively (p < 0.001). Delayed surgery was more frequent with African-Americans (14.8% vs. 9.1%, p < 0.001), patients with government or no insurance (53.7% vs. 45.1%, p < 0.001), males (60.7% vs. 58.3%, p = 0.001), and Charlson Comorbidity Index (CCI) ≥2 (9.7% vs. 6.7%, p < 0.001). Kaplan-Meier analysis demonstrated survival benefit to the earlier treatment group, with 5 year OS of 85.5% and 80.9% (p < 0.001; Figure). On multivariable analysis, increasing age (OR = 1.001, p = 0.015), African-American race (OR = 1.5, p < 0.001), increasing distance from treatment center (OR = 1.005, p = 0.001), residence in areas with low high school graduation rates (OR = 1.42, p < 0.001), residence in an area of > 1 million population (OR = 1.6, p < 0.001), and CCI ≥2 (OR = 1.4, p < 0.001) were independently associated with increasing time to surgery. Conclusions: Surgery of T1 RCC carried out beyond 9 weeks after diagnosis is associated with reduced overall survival compared to patients treated within 6 weeks. Time to definitive surgical treatment should be a quality of care metric, with special attention given to populations most at risk for delays in care.

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