scholarly journals Development of a Prognostic Nomogram and Risk Stratification System for Upper Thoracic Esophageal Squamous Cell Carcinoma

2021 ◽  
Author(s):  
Yu Lin ◽  
Binglin Zheng ◽  
Junqiang Chen ◽  
Qiuyuan Huang ◽  
Yuling Ye ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Prognostic Factors ◽  
Esophageal Squamous Cell Carcinoma ◽  
Risk Stratification ◽  
Risk Groups ◽  
Training Cohort ◽  
Stratification System ◽  
Ajcc Staging ◽  
Upper Thoracic ◽  
Risk Stratification System

Abstract BackgroundEffective tools evaluating the prognosis for patients with upper thoracic esophageal carcinoma is lacking. We aimed to develop a nomogram model to predict overall survival (OS) and construct a risk stratification system of upper thoracic esophageal squamous cell carcinoma (ESCC) patients.MethodsNewly diagnosed 568 patients with upper thoracic ESCC at Fujian Medical University Cancer Hospital between February 2004 and December 2016 was taken as a training cohort, and additional 155 patients with upper ESCC from Sichuan Cancer Hospital Institute between January 2011 and December 2013 were used as a validation cohort. A nomogram was established using Cox proportional hazard regression to identify prognostic factors for OS. The predictive power of nomogram model was evaluated by using 4 indices: concordance statistics (C-index), time-dependent ROC (ROCt) curve, net reclassification index (NRI) and integrated discrimination improvement (IDI). Decision curve analysis (DCA) was used to evaluate clinical usefulness of prediction models. Patients were categorized into three risk groups by X-tile software on the survival scores of the training cohort.ResultsMultivariate analysis revealed that gender, clinical T stage, clinical N stage and primary gross tumor volume (GTVp) were independent prognostic factors for OS in the training cohort. The nomogram based on these factors showed favorable prognostic efficacy in the both training and validation cohorts, with C-index of 0.622, 0.713, and AUC value of 0.709, 0.739, respectively, which appeared superior to those of the American Joint Committee on Cancer (AJCC) staging system. In addition, NRI and IDI of the nomogram presented better discrimination ability to predict survival than those of AJCC staging. Furthermore, DCA curve of the nomogram exhibited greater clinical performance than that of AJCC staging. Finally, the nomogram fairly distinguished the OS rates among low, moderate, and high risk groups, whereas the OS curves of clinical stage could not be well separated among clinical AJCC stage. ConclusionsWe built an effective nomogram model for predict OS of upper thoracic ESCC, which may improve clinicians’ abilities to predict individualized survival and facilitate to further stratify the management of patients at risk.

scholarly journals Risk Stratification for Diffuse Large B-Cell Lymphoma by Integrating Interim Evaluation and International Prognostic Index: A Multicenter Retrospective Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Xue Shi ◽  
Xiaoqian Liu ◽  
Xiaomei Li ◽  
Yahan Li ◽  
Dongyue Lu ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Stratification ◽  
Risk Group ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
B Cell Lymphoma ◽  
Risk Groups ◽  
High Risk Group ◽  
Stratification System ◽  
Risk Stratification System

The baseline International Prognostic Index (IPI) is not sufficient for the initial risk stratification of patients with diffuse large B-cell lymphoma (DLBCL) treated with R‐CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone). The aims of this study were to evaluate the prognostic relevance of early risk stratification in DLBCL and develop a new stratification system that combines an interim evaluation and IPI. This multicenter retrospective study enrolled 314 newly diagnosed DLBCL patients with baseline and interim evaluations. All patients were treated with R-CHOP or R-CHOP-like regimens as the first-line therapy. Survival differences were evaluated for different risk stratification systems including the IPI, interim evaluation, and the combined system. When stratified by IPI, the high-intermediate and high-risk groups presented overlapping survival curves with no significant differences, and the high-risk group still had >50% of 3-year overall survival (OS). The interim evaluation can also stratify patients into three groups, as 3-year OS and progression-free survival (PFS) rates in patients with stable disease (SD) and progressive disease (PD) were not significantly different. The SD and PD patients had significantly lower 3-year OS and PFS rates than complete remission and partial response patients, but the percentage of these patients was only ~10%. The IPI and interim evaluation combined risk stratification system separated the patients into low-, intermediate-, high-, and very high-risk groups. The 3-year OS rates were 96.4%, 86.7%, 46.4%, and 40%, while the 3-year PFS rates were 87.1%, 71.5%, 42.5%, and 7.2%. The OS comparison between the high-risk group and very high-risk group was marginally significant, and OS and PFS comparisons between any other two groups were significantly different. This combined risk stratification system could be a useful tool for the prognostic prediction of DLBCL patients.

PO-1380 Adjuvant radiotherapy of prostate cancer: a risk stratification system based on prognostic factors

2021 ◽  
Vol 161 ◽  
pp. S1129-S1130
Author(s):  
S. Bisello ◽  
A. Arcelli ◽  
F. Deodato ◽  
N. Dominsky ◽  
G. Tarantino ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prognostic Factors ◽  
Risk Stratification ◽  
Adjuvant Radiotherapy ◽  
Stratification System ◽  
Risk Stratification System

PO-1391 Curative radiotherapy of prostate cancer: a risk stratification system based on prognostic factors

2021 ◽  
Vol 161 ◽  
pp. S1141-S1142
Author(s):  
S. Bisello ◽  
A. Arcelli ◽  
F. Deodato ◽  
N. Dominsky ◽  
G. Tarantino ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prognostic Factors ◽  
Risk Stratification ◽  
Curative Radiotherapy ◽  
Stratification System ◽  
Risk Stratification System

scholarly journals A Nomogram for Predicting Survival in Patients With Breast Cancer Liver Metastasis: A Population-Based Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Yu Xiong ◽  
Xia Shi ◽  
Qi Hu ◽  
Xingwei Wu ◽  
Enwu Long ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Liver Metastasis ◽  
Risk Stratification ◽  
Staging System ◽  
Tnm Staging ◽  
Tnm Staging System ◽  
Stratification System ◽  
Breast Cancer Liver Metastasis ◽  
Risk Stratification System

ObjectiveThe prognosis of patients with breast cancer liver metastasis (BCLM) was poor. We aimed at constructing a nomogram to predict overall survival (OS) for BCLM patients using the SEER (Surveillance Epidemiology and End Results) database, thus choosing an optimized therapeutic regimen to treat.MethodsWe identified 1173 patients with BCLM from the SEER database and randomly divided them into training (n=824) and testing (n=349) cohorts. The Cox proportional hazards model was applied to identify independent prognostic factors for BCLM, based on which a nomogram was constructed to predict 1-, 2-, and 3-year OS. Its discrimination and calibration were evaluated by the Concordance index (C-index) and calibration plots, while the accuracy and benefits were assessed by comparing it to AJCC-TNM staging system using the decision curve analysis (DCA). Kaplan-Meier survival analyses were applied to test the clinical utility of the risk stratification system.ResultsGrade, marital status, surgery, radiation therapy, chemotherapy, CS tumor size, tumor subtypes, bone metastatic, brain metastatic, and lung metastatic were identified to be independent prognostic factors of OS. In comparison with the AJCC-TNM staging system, an improved C-index was obtained (training group: 0.701 vs. 0.557, validation group: 0.634 vs. 0.557). The calibration curves were consistent between nomogram-predicted survival probability and actual survival probability. Additionally, the DCA curves yielded larger net benefits than the AJCC-TNM staging system. Finally, the risk stratification system can significantly distinguish the ones with different survival risk based on the different molecular subtypes.ConclusionWe have successfully built an effective nomogram and risk stratification system to predict OS in BCLM patients, which can assist clinicians in choosing the appropriate treatment strategies for individual BCLM patients.

PO-1392 Salvage radiotherapy of prostate cancer: a risk stratification system based on prognostic factors

2021 ◽  
Vol 161 ◽  
pp. S1142-S1143
Author(s):  
S. Bisello ◽  
A. Arcelli ◽  
F. Deodato ◽  
N. Dominsky ◽  
G. Tarantino ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Prognostic Factors ◽  
Risk Stratification ◽  
Salvage Radiotherapy ◽  
Stratification System ◽  
Risk Stratification System

Conventional Cytogenetics, Molecular Profiling, and Flow Cytometric Response Data Allow the Creation of a Two-Tiered Risk-Group System for Risk-Based Therapy Allocation In Childhood AML- a Report From the Children's Oncology Group

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 761-761 ◽  
Author(s):  
Todd A. Alonzo ◽  
Phoenix A. Ho ◽  
Robert B. Gerbing ◽  
Alan S. Gamis ◽  
Susana C. Raimondi ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Conflicts Of Interest ◽  
Prognostic Significance ◽  
Risk Groups ◽  
Phase Iii ◽  
Monosomy 7 ◽  
Specific Risk ◽  
Conventional Cytogenetics ◽  
Stratification System ◽  
Risk Stratification System

Abstract Abstract 761 Conventional cytogenetics and morphologic response to induction chemotherapy have historically provided the tools for predicting outcome in patients with acute myeloid leukemia (AML). Several mutations are predictive of clinical outcome and have provided additional tools to help predict outcome in patients with AML without other risk features. Despite these recent advances, our ability to identify specific risk groups has been limited to a subset of patients, and nearly half of the patients with AML are regarded as having standard-risk (SR) disease. We inquired whether adding response by multidimensional flow cytometry (MDF) to data from conventional cytogenetics analysis and presence/absence of genomic alterations of FLT3 (FLT3-ITD), CEBPA, and NPM would provide a more robust risk-stratification system for risk-based therapy allocation. COG AML protocol AAML03P1 collected comprehensive cytogenetics characteristics, mutation profile (FLT3/ITD, CEBPA, and NPM mutation status), and MDF data on most of the 340 eligible patients enrolled on the study. Molecular and cytogenetic data were available for 275 of the 293 (94%) patients with responsive disease at the end of induction I. Disease-free survival (DFS) from the end of induction I was determined based on a combined molecular and cytogenetic risk profile. Risk status was defined based on the presence of t(8;21), inv(16), NPMc, and CEBPA mutations (favorable risk, FR) or the presence of monosomy 7, monosomy 5/del5q, and high allelic ratio FLT3-ITD (high risk, HR). On the basis of this allocation, 88 (32%) patients had FR AML, and 26 (10%) had HR AML. The remaining 161 (59%) patients without specific risk features were considered to have SR AML. DFS at 2 years from the end of induction I was 70%±12% for the FR cohort, 55% ±9% for the SR cohort, and 17%±20% for the HR cohort (p<0.001). The prevalence and prognostic significance of minimal residual disease (MRD) were assessed in the 103 patients with SR disease; 31 (30%) had evidence of MRD by MDF. DFS at 3 years from the end of induction I was significantly worse for those with MRD than for those without it (26%±21% vs. 67%±13%, p=0.01). Corresponding relapse risk in patients with or without MRD was 69%±21% and 30%±13%, respectively (p=0.011). We assessed the clinical impact of MRD in patients with HR or FR disease. Of the 18 patients with HR AML who had MRD data, 8 (44%) had MRD. DFS at 2 years for patients with HR disease with or without MRD was not significantly different (13%±23% vs. 36%±40%; p=0.127). Of the 73 patients with FR AML, MRD was detected in 12 (16%); MRD did not significantly influence DFS at 3 years from the end of induction I in those patients (45%±33% vs. 72%±17%, p=0.138). Thus, although the presence of MRD was significantly associated with worse outcome in patients with SR AML, similar significance could not be demonstrated in the FR or HR cohorts. Clinical outcomes of risk groups were reassessed after combining the MRD data with specific cytogenetic and molecular risk groups, i.e., patients with SR AML and MRD were added to the HR cohort, and those without MRD were added to the FR cohort. In the new risk-stratification system, 57 of 217 (26%) patients were in the HR cohort, and the remaining 160 (74%) patients were in the FR cohort. DFS at 3 years from induction I was 68%±9% for the FR cohort and 20%±16% (p<0.001) for the HR cohort. Cumulative incidence of relapse at 3 years from the end of induction I for those with FR or HR disease was 27%±9% and 71%±17%, respectively (p<0.001). Cytogenetics, molecular genotyping, and post-induction MDF analysis provide a robust means of stratifying all pediatric patients with AML into 2 risk groups with significantly different outcomes. This novel risk-allocation schema will be implemented in the upcoming COG Phase III AML trial. Disclosures: No relevant conflicts of interest to declare.

Abstract P376: Impact of Selected Differences Between Automated versus Conventional Office Blood Pressure and Adherence on the Prevalence of SPRINT Eligibility in Korean Population

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Jinho Shin ◽  
Sung-Il Choi ◽  
Sungha Park ◽  
Ki Chul Sung ◽  
Kwang-il Kim ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Health Insurance ◽  
General Population ◽  
Risk Stratification ◽  
Risk Groups ◽  
National Sample ◽  
Intervention Trial ◽  
Korean National Health Insurance ◽  
Stratification System ◽  
Risk Stratification System

Background: For the applicability of Systolic Blood Pressure (BP) Intervention Trial (SPRINT) is controversial due to regional cardiovascular (CV) risk stratification system, AHM adherence, and the automated office BP (AOBP) methodology. Method: General population aged 30 or more (n=205282) and 55208 hypertension subject in Korean National Health Insurance Service - National Sample Cohort (NHIS-NSC) 2010 data were analyzed. Three BP criteria 1, 2, and 3 according to the selected difference between office BP and AOBP of 0 mmHg, 5 mmHg, and 10 mmHg, respectively. Also according to the risk groups and adherence status, prevalence of SPRINT eligible subjects were investigated. Results: SPRINT eligibility subjects were observed in 6.5[6.4~6.7]% vs 5.6[5.5~5.7]% in the general population 15.9[15.7~16.0]% vs 14.8[14.7~15.0]% in hypertension patients by KSH vs. FRS, respectively ([ ], 95% confidence interval). According to BP criteria 1 to 3, SPRINT eligibilities by KSH were different significantly in the general population (6.5[6.4~6.7]%, 4.0[3.9~4.1]%, and 2.7[2.6~2.7]%, respectively) and in hypertension patients (15.9[15.7~16.0]%, 11.8[11.7~12.0]%, and 9.9[9.8~10.0]%, respectively). When the SPRINT eligibility was allowed only in PDC >= 300 days per year in hypertension patients, the prevalence according to the BP criteria 1 to 3 were 8.0[7.7~8.2]%, 5.4[4.3~4.7]%, and 4.1[3.9~4.2]%, respectively by KSH and 8.1[7.8~8.3]%, 5.7[5.5~5.9]%, and 4.4[4.3~4.6]%, respectively by FRS. Conclusion: SPRINT eligibility can be markedly differed not by the risk stratification systems but by the application of AOBP to conventional office BP and adherence.

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