Significance of Platelet and AFP Levels and Liver Function Parameters for HCC Size and Survival

2014 ◽  
Vol 29 (3) ◽  
pp. 215-223 ◽  
Author(s):  
Brian I. Carr ◽  
Vito Guerra ◽  
Edoardo G. Giannini ◽  
Fabio Farinati ◽  
Francesca Ciccarese ◽  
...  
Keyword(s):  
Tumor Size ◽  
Blood Platelet ◽  
Tumor Diameter ◽  
Proportional Hazard ◽  
Gamma Glutamyl Transpeptidase ◽  
Vein Thrombosis ◽  
Risk Of Death ◽  
Cox Proportional Hazard ◽  
Maximum Tumor Diameter ◽  
Glutamyl Transpeptidase

Background Hepatocellular carcinoma (HCC) is a heterogeneous disease with both tumor and liver factors being involved. Aims To investigate HCC clinical phenotypes and factors related to HCC size. Methods Prospectively-collected HCC patients' data from a large Italian database were arranged according to the maximum tumor diameter (MTD) and divided into tumor size terciles, which were then compared in terms of several common clinical parameters and patients' survival. Results An higer MTD tercile was significantly associated with increased blood alpha-fetoprotein (AFP), gamma-glutamyl transpeptidase (GGTP), and platelet levels. Patients with higher platelet levels had larger tumors and higher GGTP levels, with lower bilirubin levels. However, patients with the highest AFP levels had larger tumors and higher bilirubin levels, reflecting an aggressive biology. AFP correlation analysis revealed the existence of 2 different groups of patients: those with higher and with lower AFP levels, each with different patient and tumor characteristics. The Cox proportional-hazard model showed that a higher risk of death was correlated with GGTP and bilirubin levels, tumor size and number, and portal vein thrombosis (PVT), but not with AFP or platelet levels. Conclusions An increased tumor size was associated with increased blood platelet counts, AFP and GGTP levels. Platelet and AFP levels were important indicators of tumor size, but not of survival.

scholarly journals Identification of Clinical Phenotypes and Related Survival in Patients with Large HCCs

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 592
Author(s):  
Brian I. Carr ◽  
Vito Guerra ◽  
Rossella Donghia ◽  
Fabio Farinati ◽  
Edoardo G. Giannini ◽  
...  
Keyword(s):  
Serum Albumin ◽  
Tumor Diameter ◽  
Clinical Phenotypes ◽  
Vein Thrombosis ◽  
Cox Proportional Hazard ◽  
Hazard Ratios ◽  
Tumor Multifocality ◽  
Serum Alpha Fetoprotein ◽  
Maximum Tumor Diameter ◽  
Cox Analysis

Background. Hepatocellular carcinoma (HCC) factors, especially maximum tumor diameter (MTD), tumor multifocality, portal vein thrombosis (PVT), and serum alpha-fetoprotein (AFP), influence survival. Aim. To examine patterns of tumor factors in large HCC patients. Methods. A database of large HCC patients was examined. Results. A multiple Cox proportional hazard model on death identified low serum albumin levels and the presence of PVT and multifocality, with each having a hazard ratio ≥2.0. All combinations of these three parameters were examined in relation to survival. Using univariate Cox analysis, the combination of albumin >3.5 g/dL and the absence of both PVT and multifocality had the best survival rate, while all combinations that included the presence of PVT had poor survival and hazard ratios. We identified four clinical phenotypes, each with a distinct median survival: patients with or without PVT or multifocality plus serum albumin ≥3.5 (g/dL), with each subgroup displaying high (≥100 IU/mL) or low (<100 IU/mL) blood AFP levels. Across a range of MTDs, we identified only two significant trends, blood AFP and platelets. Conclusions. Patients with large HCCs have distinct phenotypes and survival, as identified by the combination of PVT, multifocality, and blood albumin levels.

Association of Dementia-Related Psychosis With Long-term Care Use and Death

Neurology ◽  
2021 ◽  
Vol 96 (12) ◽  
pp. e1620-e1631
Author(s):  
James B. Wetmore ◽  
Yi Peng ◽  
Heng Yan ◽  
Suying Li ◽  
Muna Irfan ◽  
...  
Keyword(s):  
Long Term Care ◽  
Fold Increase ◽  
Proportional Hazard ◽  
Comorbid Conditions ◽  
Term Care ◽  
Risk Of Death ◽  
Cox Proportional Hazard ◽  
Increased Risk ◽  
Cox Proportional Hazard Regression

ObjectiveTo determine the association of dementia-related psychosis (DRP) with death and use of long-term care (LTC); we hypothesized that DRP would be associated with increased risk of death and use of LTC in patients with dementia.MethodsA retrospective cohort study was performed. Medicare claims from 2008 to 2016 were used to define cohorts of patients with dementia and DRP. Outcomes were LTC, defined as nursing home stays of >100 consecutive days, and death. Patients with DRP were directly matched to patients with dementia without psychosis by age, sex, race, number of comorbid conditions, and dementia index year. Association of DRP with outcomes was evaluated using a Cox proportional hazard regression model.ResultsWe identified 256,408 patients with dementia. Within 2 years after the dementia index date, 13.9% of patients developed DRP and 31.9% had died. Corresponding estimates at 5 years were 25.5% and 64.0%. Mean age differed little between those who developed DRP (83.8 ± 7.9 years) and those who did not (83.1 ± 8.7 years). Patients with DRP were slightly more likely to be female (71.0% vs 68.3%) and white (85.7% vs 82.0%). Within 2 years of developing DRP, 16.1% entered LTC and 52.0% died; corresponding percentages for patients without DRP were 8.4% and 30.0%, respectively. In the matched cohort, DRP was associated with greater risk of LTC (hazard ratio [HR] 2.36, 2.29–2.44) and death (HR 2.06, 2.02–2.10).ConclusionsDRP was associated with a more than doubling in the risk of death and a nearly 2.5-fold increase in risk of the need for LTC.

scholarly journals Gamma glutamyl transpeptidase as a prognostic biomarker in hepatocellular cancer patients especially with >5 cm tumors, treated by liver transplantation

2020 ◽  
Vol 35 (2) ◽  
pp. 91-95 ◽  
Author(s):  
Volkan Ince ◽  
Brian I. Carr ◽  
Harika Gozukara Bag ◽  
Cemalettin Koc ◽  
Sertac Usta ◽  
...  
Keyword(s):  
Prognostic Biomarker ◽  
Elevated Serum ◽  
Hepatocellular Cancer ◽  
Clear Correlation ◽  
Tumor Diameter ◽  
Gamma Glutamyl Transpeptidase ◽  
Gamma Glutamyl ◽  
Cell Lineages ◽  
Large Size ◽  
Glutamyl Transpeptidase

Background Serum AFP levels are typically elevated in less than 50% of hepatocellular cancer (HCC) patients. Gamma-glutamyl transpeptidase (GGT) levels have been suggested to be a potentially useful HCC biomarker. Aims To assess in a cohort of prospectively evaluated HCC patients who underwent liver transplant and whose survival was known; the occurrence, prognosis, and clinical characteristics of patients with elevated serum GGT levels. Results Serum GGT levels were found to be elevated in a higher proportion in patients with either small or large HCC than alpha-fetoprotein (AFP) levels, and were significantly related to prognosis in patients with large size HCCs. There was no clear correlation between GGT and AFP levels, likely reflecting different HCC characteristics or HCC cell lineages associated with these two markers. Furthermore, elevated GGT was found in 24% of low-AFP patients with small tumors and 46% with large tumors. Elevated GGT levels were also significantly associated with microvascular invasion and tumor diameter. Conclusions Elevated serum GGT levels were associated with HCC size and worse survival, and were unrelated to AFP levels. GGT may be a useful prognostic tumor marker, especially for low-AFP HCC patients.

Mortality among seafarers: a register-based follow-up study

2020 ◽  
Vol 70 (2) ◽  
pp. 119-122 ◽  
Author(s):  
H Rinne ◽  
M Laaksonen ◽  
V Notkola ◽  
R Shemeikka
Keyword(s):  
Causes Of Death ◽  
Sociodemographic Factors ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Occupational Risk Factors ◽  
Risk Of Death ◽  
Cox Proportional Hazard ◽  
Changing Practices ◽  
Healthy Behaviour

Abstract Background Seafarers are exposed to many occupational risk factors. Aims To study whether there are differences in mortality between seafarers and other employees, whether there are variations in seafarers’ mortality between different seafaring occupations and whether these differences can be explained by sociodemographic factors. Methods A register-based study of all seafarers aged 25–64 years, resident in Finland in 2000 with minimum 5 years of cumulative seafaring experience on Finnish vessels and other employees, followed for mortality 2001–13. Analysis methods included age standardized death rates, mortality ratios (SMR) and Cox proportional hazard model. Results During the follow-up period 2001–13, there were 81,035 person years and 382 deaths in the cohort of seafarers. Seafarers had 1.3 times higher risk of death (men SMR 132, 95% confidence intervals [CI] 118–147, women SMR 125, 95% CI 99–157) than other employees. Mortality was especially high in alcohol-related causes (men SMR 172, 95% CI 126–233, women SMR 262, 95% CI 131–525) and causes related to smoking. Controlling for sociodemographic characters strengthened the risk compared to other occupations. Mortality was high among male deck and engine crew and among male and female galley personnel. The mortality differences between different seafaring occupations were partly explained by adjustments of sociodemographic characters. Conclusions Seafarers still have increased mortality among men after adjustment of sociodemographic characters. Results by causes of death suggest that changing practices to enable healthy behaviour are important.

scholarly journals Maximum tumor diameter is associated with event-free survival in PET-negative patients with stage I/IIA Hodgkin lymphoma

2020 ◽  
Vol 4 (1) ◽  
pp. 203-206 ◽  
Author(s):  
Tim M. Illidge ◽  
Elizabeth H. Phillips ◽  
Nicholas Counsell ◽  
Ruth Pettengell ◽  
Peter W. M. Johnson ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Tumor Size ◽  
Stage I ◽  
Important Predictor ◽  
Tumor Diameter ◽  
Event Free Survival ◽  
Free Survival ◽  
Key Points ◽  
Maximum Tumor Diameter ◽  
Consolidation Radiotherapy

Key Points Baseline maximum tumor diameter is an important predictor of relapse for patients with ES-HL achieving complete metabolic remission. Patients with baseline tumor size ≥5 cm have worse outcomes with ABVD alone and are likely to benefit from consolidation radiotherapy.

Defining individual recurrence risk following surgery for high risk non-metastatic renal cell carcinoma.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 664-664
Author(s):  
Edwin J Abel ◽  
Jay D. Raman ◽  
Daniel D Shapiro ◽  
Wilson Chan ◽  
Glenn O. Allen ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Risk Model ◽  
Recurrence Risk ◽  
Tumor Diameter ◽  
Proportional Hazard ◽  
Curative Surgery ◽  
Cox Proportional Hazard ◽  
Rhabdoid Features ◽  
Metastatic Rcc

664 Background: Current models to estimate renal cell carcinoma (RCC) recurrence risk following surgery are derived from populations containing primarily low-risk patients. The objective of this study was to evaluate risk factors for recurrence among high risk non-metastatic RCC patients following attempted curative surgery. Methods: Data from 3 independent centers was analyzed for consecutive ≥ pT3a RCC patients without evidence of lymph node or distant metastases who were treated surgically from 2000-2016. Univariate and multivariate Cox proportional hazard models were used to evaluate associations of common clinical and pathological variables with recurrence risk. A risk model was constructed using independent predictors and recurrence risk was evaluated using Kaplan-Meier analysis. Results: Of 771 patients, 190 (24.6%) had RCC recurrence following attempted curative surgery at median 10.2 months (IQR 4.4-20.7). Median overall follow-up interval was 21.4 months (IQR 6.6-53.5). After multivariate Cox proportional hazard analysis, significant associations with RCC recurrence were not identified with: age, gender, race, systemic symptoms, local symptoms, pT stage, perinephric fat invasion, tumor thrombus, sinus fat invasion, serum hemoglobin, or serum albumin. Independent predictors included grade 4 HR 3.27 (95% CI 2.17, 4.92); tumor diameter > 7cm HR 1.70 (95% CI 1.18, 2.45), tumor necrosis HR 1.47 (95% CI 1.06, 2.02), and sarcomatoid/ rhabdoid features HR 1.86 (95% CI 1.12, 3.09) An unweighted risk model was created by assigning one point for each independent predictor. Estimated 3-year recurrence risk was 14%, 25%, 40%, 49%, and 69% for patients with 0,1,2,3 and 4 risk factors (p < 0.001) respectively. Conclusions: Independent predictors of recurrence for high risk non-metastatic RCC include: tumor diameter, necrosis, nuclear grade 4, and sarcomatoid/ rhabdoid features. This model may be used to estimate individual risk in RCC adjuvant therapy clinical trials.

Recurrence Rate and Hazard Modeling for Recurrence in Children with a First Episode of Venous Thromboembolism

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3392-3392
Author(s):  
Christine A. Sabapathy ◽  
Susan R. Kahn ◽  
Robert W Platt ◽  
Vicky Tagalakis
Keyword(s):  
Venous Thromboembolism ◽  
Recurrence Rate ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Recurrence Rates ◽  
Vein Thrombosis ◽  
Cox Proportional Hazard ◽  
All Cause Mortality ◽  
Incident Cases ◽  
First Time

Abstract Abstract 3392 Background: Pediatric venous thromboembolism (VTE), although rare, is associated with significant morbidity and mortality. A more thorough understanding of the epidemiology of pediatric VTE is needed to advance the field. Published recurrence rates in this age group vary widely, ranging from 5.5% to 18.5%, and currently studies assessing contributing risk factors for recurrence are sparse. Objectives: To describe the recurrence rate of venous thromboembolism after a first time episode of VTE in a provincial cohort of children aged 0–17 (inclusive) and determine predictors of recurrence after incident VTE. Methods: A retrospective cohort of children (ages 0–17 inclusive) with a first time diagnosis of VTE in the province of Quebec over an eleven-year period was obtained from a comprehensive administrative hospital database (Med-Echo). The study period began on January 1st, 1994 and ended on December 31st, 2004 for inclusion of incident cases. Subjects were followed from the time of their admission into the cohort (at time of incident VTE), until their first recurrence, death, emigration from the province or end of the study period (December 31st, 2005), whichever came first. The following demographic and risk factor information were extracted for the cohort: age, age category, sex, type of VTE at initial presentation, prior major surgery, prior major infection, prior congenital heart disease, prior central line, prior trauma, cancer or recent bone marrow transplantation, and diagnosis of a chronic disease. Chronic diseases extracted included systemic lupus erythematosus, inflammatory bowel disease, cystic fibrosis, nephrotic syndrome and sickle cell disease. Recurrence rates were then calculated and univariate Cox-proportional hazard model and log rank testing were used to assess which risk factors would be incorporated into the final multivariate Cox-proportional hazard model evaluating risk of VTE recurrence. Results: In total, 518 incident cases of VTE in children 0–17 years of age were documented. Median follow up time in cohort was 4.4 years (range 1 day – 12 years). Overall the cohort had a recurrence rate of 2.77 per 1000 person-months (95% confidence interval (CI) 2.2–3.4) (recurrence risk of 16%). Multivariate Cox proportional hazard modeling showed a statistically significant increased risk of recurrence with the presence of a chronic disease (HR 2.40; 95% CI 1.26–4.56) and a diagnosis of portal vein thrombosis as the initial VTE presentation (HR 3.29; 95% CI 1.30–8.34). Overall all-cause mortality was 6.4% with 33 deaths in the cohort. Conclusions: The risk of recurrence is comparable to those prior studies that had shown higher recurrence risks. The rate of VTE recurrence is higher in those with a pre-existing chronic illness or with an initial diagnosis of portal vein thrombosis. Overall all-cause mortality was lower in our cohort than prior large studies of VTE in this age group. Our findings highlight the need for future studies to determine effective secondary prophylaxis strategies in children at high risk for VTE recurrence. Disclosures: No relevant conflicts of interest to declare.

Low Alpha-Fetoprotein HCC and the Role of GGTP

2014 ◽  
Vol 29 (4) ◽  
pp. 395-402 ◽  
Author(s):  
Brian I. Carr ◽  
Vito Guerra ◽  
Edoardo G. Giannini ◽  
Fabio Farinati ◽  
Francesca Ciccarese ◽  
...  
Keyword(s):  
Survival Rates ◽  
Alpha Fetoprotein ◽  
Gamma Glutamyl Transpeptidase ◽  
Vein Thrombosis ◽  
Medical Centers ◽  
Tumor Multifocality ◽  
Small Hccs ◽  
Prognosis Marker ◽  
Glutamyl Transpeptidase

Background HCC patients are heterogeneous in terms of both tumor and liver factors. Alpha-fetoprotein (AFP) is an important prognostic tumor marker for those patients with elevated AFP levels. Aims To examine the differences in HCC patients with high or low AFP levels in blood and evaluate the prognostic parameters in low AFP patients. Methods A cohort of 2,440 HCC patients from 11 Italian medical centers was studied. AFP-positive patients were compared to AFP-negative ones, and the blood and tumor parameters of AFP-negative patients were examined. Results Low blood AFP levels were found in 58% of the total cohort, in 64% of patients with small HCCs, and in 51% of patients with large HCCs. In patients with large tumors, platelet and gamma glutamyl transpeptidase (GGTP) levels, tumor multifocality and portal vein thrombosis (PVT) incidence were all greater than in patients with small tumors, regardless of AFP status. Patients with higher AFP levels had worse survival rates than those with low AFP in each tumor size group. In patients with small tumors, the elevated AFP was associated with significantly increased PVT and worse survival. In patients with large tumors, the elevated AFP was associated with significantly higher GGTP, ALKP, and bilirubin levels, as well as with increased PVT and multifocality, and worse survival. Low-AFP patients with high GGTP levels had worse survival than patients with low GGTP levels. Conclusion Patients with low AFP were the majority in this cohort, and patients with elevated GGTP had worse prognosis than those with low GGTP. GGTP may be a useful tumor and prognosis marker in low-AFP patients. AFP-negative patients are important to identify due to their enhanced survival.

scholarly journals 2192 The association of preoperative functional capacity and outcomes for head and neck cancer patients undergoing definitive surgical treatment

2018 ◽  
Vol 2 (S1) ◽  
pp. 88-88
Author(s):  
Sampat Sindhar ◽  
Dorina Kallogjeri ◽  
Troy S. Wildes ◽  
Michael S. Avidan ◽  
Jay Piccirillo
Keyword(s):  
Overall Survival ◽  
Surgical Treatment ◽  
Head And Neck ◽  
Functional Capacity ◽  
Cancer Center ◽  
Proportional Hazard ◽  
Risk Of Death ◽  
Metabolic Equivalents ◽  
Cox Proportional Hazard ◽  
Patient Reported

OBJECTIVES/SPECIFIC AIMS: To study the role functional capacity plays in surgical outcomes for head and neck cancers. METHODS/STUDY POPULATION: In this single-institution cohort study, we combined preoperative anesthesia assessment information with oncology registry data for newly-diagnosed patients with squamous cell carcinoma of the oral cavity, pharynx, and larynx (HNSCC) treated with definitive surgery at Siteman Cancer Center from 2012 to 2016. Patient-reported exercise capacity was assessed as metabolic equivalents. Metabolic equivalents<4 was defined as poor functional capacity. The primary outcome measure was overall survival (OS). Kaplan-Meir survival analysis was used to compare the survival of patients with poor functional capacity (PFC) and patients with normal functional capacity (NFC). Cox proportional hazard regression was used to explore the independent prognostic role of functional capacity on overall survival after controlling for other factors. RESULTS/ANTICIPATED RESULTS: A total of 671 patients underwent surgical treatment for HNSCC. The average age was 62 years (range: 19–94 years). Majority of the patients were male (n=481; 72%), White race (n=589; 88%), and smokers (n=528; 79%). Of 671 patients, 22% (n=146) had PFC. Two-year OS rate in PFC patients was 70% compared with 85% in NFC patients (15% difference; 95% CI: 7%–23%). Unadjusted Cox proportional hazard analysis showed that PFC patients had 2.2 times higher risk of death (95% CI: 1.5–3.2) than NFC patients. After adjustment for age at surgery, BMI, preoperative weight loss, comorbidity score, tumor site, and TNM stage the magnitude of the association between functional capacity and OS decreased (aHR=1.3; 95% CI: 0.88–1.98). DISCUSSION/SIGNIFICANCE OF IMPACT: Poor functional capacity is associated with decreased overall survival, but the magnitude of the association, while clinically meaningful, decreases after controlling for other important patient and tumor factors. Nevertheless, we believe preoperative functional capacity status is an important patient factor to consider when discussing prognosis and attempting risk stratification. We also believe that functional capacity may be associated with 30-day unplanned readmissions and 90-day complications and are currently performing chart review to ascertain this information.

scholarly journals The Effect of Tegafur-Uracil on Survival in T Categories as Defined in the Eighth Edition of the TNM Classification: An Exploratory Analysis of Postoperative Adjuvant Tegafur-Uracil on Survival in Patients with Adenocarcinoma of the Lung

Chemotherapy ◽  
2017 ◽  
Vol 62 (6) ◽  
pp. 357-360
Author(s):  
Masahiro Tsuboi ◽  
Chikuma Hamada ◽  
Harubumi Kato ◽  
Mitsuo Ohta
Keyword(s):  
Tnm Classification ◽  
Tumor Diameter ◽  
Proportional Hazard ◽  
Adenocarcinoma Of The Lung ◽  
Proportional Hazard Models ◽  
Cox Proportional Hazard ◽  
Hazard Ratios ◽  
Cox Proportional Hazard Models ◽  
Eighth Edition ◽  
T Category

Background: Tegafur-uracil (UFT) improves survival in patients with stage I adenocarcinoma of the lung. We evaluated the effect of UFT on survival in maximum primary tumor diameter (T) categories as defined in the eighth edition of the TNM Classification (TNM8). Methods: Tumors were subgrouped on the basis of T category (TNM8) as follows: T1a, T ≤1 cm; T1b, 1 < T ≤2 cm; T1c, 2 < T ≤3 cm; T2a, 3 < T ≤4 cm; T2b , 4 < T ≤5 cm; T3, 5 < T ≤7 cm. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated by Cox proportional hazard models. Results: UFT was associated with improved survival. The adjusted HRs were as follows: for T1a, 0.79 (95% CI 0.14-4.50); for T1b, 1.16 (95% CI 0.63-2.12); for T1c, 0.74 (95% CI 0.43-1.27); for T2a, 0.45 (95% CI 0.21-0.96); for T2b, 0.55 (95% CI 0.10-3.07), and for T3, 0.70 (95% CI 0.20-2.50). Conclusions: The adjuvant chemotherapy with UFT tended to improve survival in patients with adenocarcinoma of the lung of each T category based on TNM8, except T1b.

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