scholarly journals A Continuous Correlation Between Residual Tumor Volume and Survival Recommends Maximal Safe Resection in Glioblastoma Patients: A Nomogram for Clinical Decision Making and Reference for Non-Randomized Trials

2021 ◽  
Vol 11 ◽  
Author(s):  
Marco Skardelly ◽  
Marlene Kaltenstadler ◽  
Felix Behling ◽  
Irina Mäurer ◽  
Jens Schittenhelm ◽  
...  
Keyword(s):  
Overall Survival ◽  
Clinical Decision Making ◽  
Tumor Volume ◽  
Failure Time ◽  
Residual Tumor ◽  
Clinical Decision ◽  
Extent Of Resection ◽  
Accelerated Failure Time Model ◽  
Accelerated Failure Time ◽  
Time Model

ObjectiveThe exact role of the extent of resection or residual tumor volume on overall survival in glioblastoma patients is still controversial. Our aim was to create a statistical model showing the association between resection extent/residual tumor volume and overall survival and to provide a nomogram that can assess the survival benefit of individual patients and serve as a reference for non-randomized studies.MethodsIn this retrospective multicenter cohort study, we used the non-parametric Cox regression and the parametric log-logistic accelerated failure time model in patients with glioblastoma. On 303 patients (training set), we developed a model to evaluate the effect of the extent of resection/residual tumor volume on overall survival and created a score to estimate individual overall survival. The stability of the model was validated by 20-fold cross-validation and predictive accuracy by an external cohort of 253 patients (validation set).ResultsWe found a continuous relationship between extent of resection or residual tumor volume and overall survival. Our final accelerated failure time model (pseudo R2 = 0.423; C-index = 0.749) included residual tumor volume, age, O6-methylguanine-DNA-methyltransferase methylation, therapy modality, resectability, and ventricular wall infiltration as independent predictors of overall survival. Based on these factors, we developed a nomogram for assessing the survival of individual patients that showed a median absolute predictive error of 2.78 (mean: 1.83) months, an improvement of about 40% compared with the most promising established models.ConclusionsA continuous relationship between residual tumor volume and overall survival supports the concept of maximum safe resection. Due to the low absolute predictive error and the consideration of uneven distributions of covariates, this model is suitable for clinical decision making and helps to evaluate the results of non-randomized studies.

Multivariate analysis of prognostic variables associated with survival from a phase III study of cisplatin (P) plus etoposide (E) plus chest radiation (XRT) with or without consolidation docetaxel (D) in patients with unresectable stage III non-small cell lung cancer (NSCLC)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 7668-7668
Author(s):  
F. O. Ademuyiwa ◽  
T. E. Breen ◽  
C. Johnson ◽  
A. White ◽  
C. Yiannoutsos ◽  
...  
Keyword(s):  
Overall Survival ◽  
Failure Time ◽  
Smoking Status ◽  
Stage Iii ◽  
Accelerated Failure Time Model ◽  
Accelerated Failure Time ◽  
Time Model ◽  
Stage Iii Nsclc ◽  
Pre Treatment ◽  
Failure Time Model

7668 Background: Concurrent chemoradiation is standard treatment against stage III NSCLC. HOG LUN 01–24 examines whether consolidation therapy with D improves overall survival. We present an analysis investigating the association of patient characteristics with overall survival from patients on this study. Methods: Eligible patients had untreated stage III NSCLC, FEV1 ≥ 1 liter, PS of 0–1, and weight loss < 5%. Patients received P 50 mg/m2 days 1, 8, 29, 36 with E 50 mg/m2 days 1–5, 29–33, and concurrent 5,940 cGy XRT. Patients with non-progressive disease were randomized to D 75 mg/m2 q3wk X 3 cycles vs observation. A multivariable parametric accelerated failure time model was performed to identify factors that affected survival and to estimate the treatment effect adjusting for these factors. Results: A multivariate analysis was performed on 203 patients who were the subject of a DSMB interim analysis. Median follow up was 25.6 months. Variables analyzed included age (<70 vs ≥ 70), sex, race, body mass index, PS (0 vs 1), FEV-1 (> 2 vs ≤ 2), smoking status, hemoglobin (≥12 vs <12), and stage. A multivariable parametric accelerated failure time model demonstrated the association of age <70 vs =70 years (p=0.0447), FEV1 >2 vs =2 (p=0.0153), and pre-treatment hemoglobin values (p=0.0083) as independent prognostic factors for overall survival. The median survival for hemoglobin <12 was 16.8 vs 21.5 months for hemoglobin ≥12 (p=0.0432). Similarly, the median survival with FEV >2L was 21.6 vs 18.9 months for FEV =2 L. Survival was not significantly influenced by smoking status, sex, race, PS, stage, or BMI. Conclusions: This analysis suggests that age <70, FEV-1 >2L and higher pre-treatment hemoglobin values are associated with improved overall survival in patients with stage III NSCLC. No significant financial relationships to disclose.

Cognitive Activity and Onset Age of Incident Alzheimer Disease Dementia

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012388
Author(s):  
Robert S. Wilson ◽  
Tianhao Wang ◽  
Lei Yu ◽  
Francine Grodstein ◽  
David A. Bennett ◽  
...  
Keyword(s):  
Failure Time ◽  
Cognitive Activity ◽  
Older Age ◽  
Activity Score ◽  
Accelerated Failure Time Model ◽  
Accelerated Failure Time ◽  
Onset Age ◽  
Time Model ◽  
Dementia Onset

Objective:To test the hypothesis that higher level of cognitive activity predicts older age of dementia onset in Alzheimer's disease (AD) dementia.Methods:As part of a longitudinal cohort study, 1,903 older persons without dementia at enrollment reported their frequency of participation in cognitively stimulating activities. They had annual clinical evaluations to diagnose dementia and AD, and the deceased underwent neuropathologic examination. In analyses, we assessed the relation of baseline cognitive activity to age at diagnosis of incident AD dementia and to postmortem markers of AD and other dementias.Results:During a mean of 6.8 years of follow-up, 457 individuals were diagnosed with incident AD at a mean age of 88.6 (SD = 6.4; range: 64.1-106.5). In an extended accelerated failure time model, higher level of baseline cognitive activity (mean 3.2, SD = 0.7) was associated with older age of AD dementia onset (estimate = 0.026; 95% confidence interval: 0.013. 0.039). Low cognitive activity (score = 2.1, 10th percentile) was associated with a mean onset age of 88.6 compared to a mean onset age of 93.6 associated with high cognitive activity (score = 4.0, 90th percentile). Results were comparable in subsequent analyses that adjusted for potentially confounding factors. In 695 participants who died and underwent a neuropathologic examination, cognitive activity was unrelated to postmortem markers of AD and other dementias.Conclusion:A cognitively active lifestyle in old age may delay the onset of dementia in AD by as much as 5 years.

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