Search PubMed⌕ Search

Biomedical subjects

D A Swanson

Publications and source records attributed to D A Swanson.

At least 73 records · Page 4Linked to original sources
PubMed1989

Renal cell carcinoma. A clinicopathologic and DNA flow cytometric analysis of 103 cases.

Renal cell carcinoma is unpredictable in outcome, although the best predictor is tumor stage, followed by histologic grade. The authors retrospectively assessed the clinicopathologic features and DNA ploidy of 103 cases of renal cell carcinoma, the latter determined by flow cytometry of formalin-fixed, paraffin-embedded tissue. The study group comprised 63 men and 40 women (age, 28-80 years; mean, 57 years). Robson stage at diagnosis was Stage I in 52 patients, Stage II in 21, and Stage III in 30. Statistically significant variables in predicting outcome were Robson stage (P less than 0.0001), DNA ploidy (P = 0.0008), mitotic rate (MR, P less than 0.0001), worst nuclear grade (WNG, P = 0.00009), predominant nuclear grade (P = 0.019), and sex (P = 0.044). Tumor size, cell type, and architectural pattern were also assessed but did not prove to be significant. Statistically significant associations occurred between DNA ploidy and WNG (P less than 0.0001), stage (P = 0.0037), and MR (P = 0.015); between WNG and MR (P less than 0.0001) and stage (P = 0.0007); and between stage and MR (P = 0.002). Cox proportional hazards regression analysis of all significant variables showed Robson stage, tumor ploidy, and MR to be independent, significant predictors of outcome. If ploidy data had not been available, WNG would have been independently significant. The authors conclude that DNA ploidy analysis provides significant predictive information on renal cell carcinoma.

Adult↗
PubMed1989

DNA flow cytometry as a predictor of outcome of stage I renal cell carcinoma.

The features most frequently used in predicting the outcome of renal cell carcinoma are stage at presentation and nuclear grade. Recently DNA ploidy pattern, as detected by DNA flow cytometry has also been shown to be predictive. In this study DNA flow cytometry was performed on formalin-fixed paraffin-embedded tissue from 50 patients with Stage I renal cell carcinoma for whom long-term follow-up data were available. Two were eliminated for technical reasons. Of the 48 evaluable tumors, 25 (52%) were diploid, 19 (40%) were nondiploid, and in four, (8%) the ploidy was uncertain. The ploidy pattern was statistically significantly associated with nuclear grade (P less than 0.02), and primary tumor size (P less than 0.05) but did not correlate with cell type, microscopic growth pattern, or the presence or absence of mitotic activity. In the group as a whole, ten patients (21%) died of renal cell carcinoma, seven of 19 (37%) with nondiploid tumor patterns, and two of 25 (8%) with a diploid pattern (P less than 0.03). One of four patients (25%) with tumors of uncertain ploidy also died. However, only two factors, nuclear grade and primary tumor size, were independent predictors of outcome. For Stage I renal cell carcinoma, ploidy can significantly predict patient outcome and correlates with nuclear grade and tumor size, but is not an independent predictive variable.

Carcinoma, Renal Cell↗
PubMed1989

Role of nuclear grading in stage I renal cell carcinoma.

Through a retrospective histologic analysis of 55 cases of Stage I renal cell carcinoma, we evaluated the usefulness of the nuclear grading system (Fuhrman, Lasky, Limas) in identifying those tumors that will eventually metastasize and kill the patient. The difference in five-year survival rates between patients with combined nuclear grade 1-3 tumors (n = 50, 91%) and grade 4 tumors (n = 5, 9%) was significant (P less than 0.0046). Other predictors of death due to renal cell carcinoma included: tumor size greater than 8 cm (P less than 0.001) and mitoses greater than one per 10 high-power field (P less than 0.01). Within Stage I tumors, therefore, nuclear grade is an important morphologic variable for predicting long-term survival. Identification of nuclear grade 4 neoplasms may become prognostically indispensable to determine the metastatic potential of early-stage tumors and thereby to institute appropriate systemic therapy.

Adult↗
PubMed1989

Identifying patients with low-risk clinical stage I nonseminomatous testicular tumors who should be treated by surveillance.

We examined the records of 82 patients with clinical Stage I nonseminomatous germ cell tumors of the testis who, after radical orchiectomy, were treated by surveillance at M.D. Anderson Cancer Center between October, 1981, and March, 1987. Our purpose was to determine whether or not patients with a low risk of relapse can be identified at the time of the initial staging evaluation. In 30 of 82 patients (Group 1), embryonal carcinoma constituted less than 80 percent of the tumor, no vessel invasion was present, and the preorchiectomy serum AFP level was less than 80 ng/dL. No relapses occurred in this group. Fifty-two patients (Group 2) had more than 80 percent embryonal carcinoma or vessel invasion or a serum AFP level higher than 80 ng/dL. Relapse occurred in 24 (46%) of these patients. The difference in the rate of relapse between patients in Group 1 and Group 2 was statistically significant (P less than 0.00001). A separate analysis of teratoma as a predictor of nonrelapse showed that the orchiectomy specimens of 30 of the 82 patients contained more than 50 percent teratoma. Only 1 relapse occurred among 25 patients with more than 50 percent teratoma and no vessel invasion. Our data show that there is a subgroup of patients with clinical Stage I nonseminomatous germ cell tumor who have a very low rate of relapse. We believe these patients can be effectively treated by surveillance and should be spared the morbidity of an unnecessary retroperitoneal lymph node dissection.

Humans↗
PubMed1989

Impact of census error adjustments on state population projections: the case of Ohio.

National undercount adjustment factors from the 1970 and 1980 U.S. censuses are used to prepare population projections for Ohio, which are in turn compared with unadjusted projections. "The findings suggest that decisions concerning adjustment factors have varying effects on short-term, long-term, and strategic forecasting. These effects are particularly salient for selected age-groups and the impact on state government budget decisions typically associated with these age-groups. We recommend that the effects of alternative adjustment possibilities be examined by state demographic centers and budget offices."

Age Distribution↗
PubMed1989

A state-based regression model for estimating substate life expectancy.

Life expectancy is an important indicator of the level of mortality in a population. However, the conventional way of calculating life expectancy--constructing a life table--has rigorous data requirements. As a consequence, life expectancy data are not usually available for substate areas. In this article, a regression model for estimating life expectancy is constructed, using state-level data, and is tested against two sets of 1980 life expectancy data: (1) a nationwide sample of metropolitan areas and (2) selected cities, their suburbs, and rural counties in Ohio. An additional test shows the sensitivity of the model's accuracy to errors in one of its input data elements. The results suggest that the model should be given serious consideration for generating life expectancy estimates for substate areas.

Demography↗
PubMed1988

Clinical stage I nonseminomatous and mixed germ cell tumors of the testis. A clinicopathologic study of 93 patients on a surveillance protocol after orchiectomy alone.

This study of 93 patients with Stage I nonseminomatous and mixed germ cell testicular tumors who were placed in a surveillance study following orchiectomy was designed to evaluate pathologic prognostic factors. Follow-up was at least 12 months post-orchiectomy except for one patient who was followed for 9 months. Lymphatic invasion was identified in 26 patients, 62% of whom developed distant metastases; metastasis developed in only 18% of 67 patients without lymphatic invasion (P less than 0.01). Relapse was also associated with the presence of embryonal carcinoma. Of 81 patients with an embryonal carcinoma component, 35% developed metastases, whereas none of those without an embryonal carcinoma developed metastasis (P = 0.05). Effects of other histologic features and tumor size were not significant. Lymphatic invasion appeared to be a significant poor prognostic factor, and embryonal carcinoma was an independent poor prognostic factor.

Adolescent↗
PubMed1988

Interferon therapy for metastatic renal cell carcinoma.

We have used multiple interferon protocols to treat 274 patients who had metastatic renal cell carcinoma. Leukocyte (alpha) interferon in 50 patients produced 3 complete responses (CR) and 10 partial responses (PR), a 26% response rate that was nearly matched among the next 89 patients treated with recombinant alpha interferon (2 CR, 17 PR, 21%). Other types and combinations of interferon, even when coupled with cytotoxic chemotherapy or other biologic agents, did not produce better results. Interferon has definite activity against renal cell carcinoma, but clinical experience has not yet defined the optimal type, dose, and treatment schedule.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

Effective outpatient use of polyethylene glycol-electrolyte bowel preparation for radical cystectomy and ileal conduit urinary diversion.

In this prospective study we examined the oral electrolyte-overload method of bowel preparation for patients who were to undergo radical cystectomy and ileal conduit urinary diversion. We found it to be a safe and effective mechanical bowel preparation that can be used by outpatients. It was well tolerated and resulted in adequate bowel cleansing and a low incidence of postoperative wound infections and pyelonephritis. A major advantage of this method is that it reduced the period of preoperative hospitalization.

Ambulatory Care↗
PubMed1988

Medical castration using megestrol acetate and minidose estrogen.

Sixty-two men who presented with previously untreated metastatic carcinoma of the prostate (D0: 10 patients; D1: 29 patients; D2: 23 patients) received oral megestrol acetate (80 mg twice daily) and minidose estrogen (diethylstibestrol 0.1 mg or ethinyl estradiol 0.05 mg once daily) as a means of achieving total androgen ablation (testicular and adrenal). A high incidence of feminizing side effects (70-74%), a higher than expected rate of cardiovascular complications (18%), an unexpected need for cortisone replacement (13%), and failure of patients with Stage D2 disease to obtain results better than those of standard therapy during the first year of observation suggest this regimen offers no advantage over other more conventional therapy.

Adenocarcinoma↗
PubMed1988

Adjuvant cyclophosphamide, doxorubicin, and cisplatin chemotherapy for bladder cancer: an update.

Seventy-one patients received adjuvant Cytoxan (cyclophosphamide; Bristol-Myers Co, Evansville, IN), Adriamycin (doxorubicin; Adria Laboratories, Columbus, OH), and cisplatin (CISCA) chemotherapy between March 1981 and March 1986. Patients received adjuvant CISCA chemotherapy if they had pathological findings that were thought to predict for high likelihood of relapse. These included the presence of resected nodal metastases, extravesicular involvement of tumor, lymphatic/vascular permeation of the primary tumor, or pelvic visceral invasion. Sixty-two patients at a similar high risk for recurrence did not receive adjuvant CISCA chemotherapy because they refused, had medical contraindications to therapy, or were not referred for chemotherapy. Two-hundred six patients had a cystectomy performed during the same study period but had none of the poor prognostic features suggesting a high risk for relapse. Sixty-two percent of the patients receiving adjuvant chemotherapy are alive and disease-free for a mean follow-up of 118 weeks (range, 28 to 310 weeks). A survival advantage exists for the adjuvant-treated patients when compared with those with unfavorable pathological findings who did not receive adjuvant chemotherapy (70% v 37%) (P = .00012): no difference exists in long-term disease-free survival for those with favorable pathological findings (long-term disease-free survival 76%) v those who received adjuvant chemotherapy (70%) (P = .33). Adjuvant CISCA chemotherapy prolongs the disease-free survival of some patients following a cystectomy. Patients who benefitted from adjuvant CISCA chemotherapy included those with resected nodal metastases, extra-vesicular involvement of tumor, and direct invasion of the pelvic viscera. Patients not benefitting from adjuvant CISCA chemotherapy in this analysis included those with lymphatic/vascular invasion in their primary tumor as the sole manifestation of high risk for relapse.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

Surgery of metastatic renal cell carcinoma and use of renal infarction.

Surgery can play an important role in selected patients with metastatic renal cell carcinoma although nephrectomy alone neither promotes regression of metastases nor improves survival. However, nephrectomy preceded by renal infarction and followed by medroxyprogesterone acetate produced ten complete responses, nine partial responses, and 22 stabilizations among 145 patients (CR + PR = 13%; overall response rate = 28%). Only patients with parenchymal pulmonary metastases without adenopathy, pleural effusion, or other organ involvement responded consistently (23% objective, 41% overall), and we currently recommend this combination therapy only for this group. However, infarction alone is an easy way to palliate symptoms due to primary or secondary tumors.

Carcinoma, Renal Cell↗
PubMed1987

Sarcomatoid renal cell carcinoma. A treatable entity.

Of 920 patients with histologically confirmed renal cell carcinoma (RCC) seen at University of Texas M. D. Anderson Hospital over a 10-year period, 44 (4.8%) had the sarcomatoid variant. The authors show that, although sarcomatoid RCC has as common denominators with classic RCC in certain epidemiologic parameters such as age and sex, its biologic behavior is different. It is more malignant, has a higher metastatic rate, ultimate recurrence in localized disease which translates to a shorter survival time. Metastasis at presentation, advanced age (older than 59 years) and female sex were a associate with a worse prognosis. This entity is characterized by a high incidence of bone metastasis at presentation (48%) and by a tendency toward pathologic bone fractures. All of the untreated patients died very soon after diagnosis (median, 3.8 months), whereas all of the patients treated with the various systemic modalities initiated only in the presence of metastatic disease survived significantly longer (median, 13.0 months). Of the eight patients who were treated with doxorubicin HCI chemotherapy regimens two (on CYVADIC) showed complete responses and are the only survivors (50, 65 months). Four patients treated with interferon had the longest median survival (41.0 months). These results suggest that CYVADIC chemotherapy should be combined with interferon in this entity. Since surgery is not curative in early stages of sarcomatoid RCC, adjuvant therapy with those agents should be considered.

Adult↗
PubMed1987

Strategies of management for advanced or recurrent kidney, adrenal, and miscellaneous genitourinary cancers.

To formulate reasonable strategies of management requires critical appraisal of all available treatments and determination of the goals of therapy, which may be definitive, investigative, or palliative. Definitive therapy is given to eradicate all known disease in patients without clinically apparent metastases. Investigative therapy has the same intent but there is less assurance of success because therapy is untested or inconsistently effective; surgery for patients with metastatic disease and all protocols for chemohormonal therapy, immunotherapy, and biologic response modifiers are examples. Palliative therapy intends to relieve but not cure, a most worthwhile goal in patients whose comfort and sense of well-being are so often threatened. Strategies for palliation include surgery, irradiation, embolization/infarction, chemotherapy, hormonal therapy, and observation with only symptomatic relief. The last may be optimal for some patients since potential benefits must always outweigh the expected morbidity for therapy to be appropriate.

Adrenal Gland Neoplasms↗
PubMed1987

Sarcomatoid renal cell carcinoma: clinicopathologic. A study of 42 cases.

Forty-two cases of sarcomatoid renal cell carcinoma were reviewed clinicopathologically. Twenty-four patients were men, and 18 women; average age was 56.2 years (range, 30-81 years). Eight, 9, 13, and 12 cases were Stages I, II, III, and IV, respectively. Three morphologic patterns of sarcomatoid components were identified: malignant fibrous histiocytomatous (26 cases), fibrosarcomatous (6 cases), and unclassified sarcomatoid (10 cases). Mitotic count, degree of pleomorphism, cellularity, and amount of tumor matrix in the sarcomatoid areas, and similar morphologic parameters in the carcinomatous component all failed to correlate with prognosis, as did tumor size and renal vein involvement by tumor. Clinicopathologic stage was a most significant prognostic factor, with a survival of 49.7 months for Stage I and 6.8 months for combined Stages II, III, and IV. Tumor necrosis in the sarcomatoid area and proportion of sarcomatoid components were also poor prognostic factors. When these factors were compared to the stage, necrosis was an independent variable, however, proportion of sarcomatoid components was a poor prognostic indicator only for Stages I and II.

Carcinoma, Renal Cell↗
PubMed1987

Incidence, extent and location of unsuspected pelvic lymph node metastasis in patients undergoing radical cystectomy for bladder cancer.

Between March 1, 1983 and December 31, 1985, 18 of 130 patients (14 per cent) undergoing radical cystectomy had unsuspected metastasis. In 17 patients (94 per cent) only 1 or 2 nodes were involved. The mean size of the involved nodes was 0.81 cm. and the mean size of metastasis was 0.39 cm. In patients with 1 or 2 positive nodes metastasis was not observed above the bifurcation of the common iliac arteries or lateral to the external iliac arteries. In patients in whom the primary bladder tumor was localized clearly to 1 side of the bladder unsuspected metastasis was observed only in ipsilateral lymph nodes. In accordance with these findings, we advocate a restricted pelvic lymphadenectomy in patients in whom gross examination reveals no evidence of nodal metastasis at radical cystectomy.

Humans↗
PubMed1987

Primary chemotherapy for clinical stage II nonseminomatous germ cell tumors of the testis: a follow-up of 50 patients.

Fifty patients with clinical stage II nonseminomatous germ cell tumor of the testis (NSGCTT) were treated with primary chemotherapy followed by a retroperitoneal lymph node dissection (RPLND) in selected patients. The study population included 34 patients with retroperitoneal masses and elevated levels of serum biomarkers (alpha-fetoprotein [AFP] and beta-human chorionic gonadotropin [BHCG] ), five with needle aspiration biopsy-proven retroperitoneal metastases but normal levels of biomarkers, and 11 in whom there were rising levels of serum biomarkers but no radiographic evidence of retroperitoneal metastases. Forty-eight patients (96%) achieved a complete response (CR), with a mean disease-free survival of 132 weeks (range, 55 to 273 weeks). Two patients developed recurrent disease. One died and one achieved a second CR with further therapy (48 + weeks). Postchemotherapy RPLND was required in 11 patients (22%). Patients with embryonal carcinoma had a lower frequency of RPLND (8%) than patients with teratomatous elements in their primary tumor [36%, P = .014]. To reduce the frequency of double therapy (surgery +/- chemotherapy), we propose individualized therapy. Patients presenting with clinical stage II embryonal carcinoma of the testis should receive primary chemotherapy. Patients with clinical stage II NSGCTT and teratomatous elements in their primary tumor continue to require an RPLND. Those patients with intermediate volume disease (greater than 2 cm less than or equal to 5 cm in maximum diameter) may be treated with an RPLND only. Patients with higher volume teratomatous elements (greater than 5 cm less than or equal to 10 cm in maximum diameter) are likely to require the combination of chemotherapy and surgery.

Antineoplastic Combined Chemotherapy Protocols↗