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PubMed1996

One-year prognosis of abdominal complaints in general practice: a prospective study of patients in whom no organic cause is found.

BACKGROUND: Data on the one-year prognosis of patients with non-organic, non-acute abdominal complaints in primary care are lacking. Knowledge of prognostic determinants could be helpful in management and health education. AIM: To describe the prognosis after one year of non-organic abdominal complaints in general practice, and to show how this relates to socio-demographic factors, medical history and psychological problems. METHODS: The one-year prognosis of patients with non-organic abdominal complaints in a primary care setting was analysed in a prospective study (n = 756). Clinical and psychological factors were measured and their relative risks regarding unfavourable prognosis were calculated one year after the first consultation. RESULTS: In 68% of the patients examined, the abdominal complaints had either improved or disappeared by the end of the first year. Female sex and depressive mental state were associated with an unfavourable prognosis. Clinical symptoms that were significantly associated with persisting complaints were a combination of abdominal pain, flatulence and bowel irregularities; a specific description of the character of the pain by the patient; looser stools at the onset of the pain; long duration or recurrence, pyrosis; absence of visible distension; and epigastric localization of the pain or tenderness. CONCLUSIONS: The prognosis after one year of non-acute abdominal pain in general practice is better than that reported from studies of outpatient populations. Female sex, depressive mood and some clinical parameters are associated with persistent complaints one year after presentation.

Abdominal Pain↗
PubMed1998

Prediction of prognosis in peripheral facial nerve paralysis using submandibular gland scintigraphy.

UNLABELLED: In this study, we evaluated the ability of submandibular gland scintigraphy to predict the prognosis of peripheral facial nerve paralysis. METHODS: Submandibular gland scintigraphy was performed in 78 patients with acute peripheral facial nerve paralysis. After injection of 180-370 MBq [99mTc]pertechnetate, serial 1-min images were acquired for 25 min. At 15 min after injection of radionuclide, ascorbic acid was administered intraorally to stimulate salivary secretion. Regions of interest were set manually on both submandibular glands, and time-activity curves were generated. The ratios of peak count density (PCR) and washout (WR) of the affected side to the normal side were calculated. Parameters of > or = 0.8 suggested normal affected submandibular function and indicated a good prognosis. RESULTS: Complete recovery of facial nerve paralysis was observed in 52 of 78 patients. The sensitivity, specificity and accuracy of PCR for a good prognosis were 79%, 50% and 69%, and those of WR were 85%, 77% and 82%, respectively. Positive and negative predictive values for a good prognosis were 76% and 54% in PCR and 88% and 71% in WR, respectively. When WR obtained within 14 days of the onset was used, positive and negative predictive values for a good prognosis were 94% and 73%, respectively. None of the eight patients who had values of <0.8 for both parameters within 14 days of the onset recovered completely. CONCLUSION: Submandibular gland scintigraphy can serve as a reliable indicator to predict the prognosis of acute peripheral facial nerve paralysis in its early symptomatic period.

Acute Disease↗
PubMed1998

Ratio of bcl-xshort to bcl-xlong is different in good- and poor-prognosis subsets of acute myeloid leukemia.

BACKGROUND: Acute myeloid leukemia (AML) is a heterogeneous collection of leukemic disorders ranging from chemotherapy-sensitive subsets [inversion 16 and t(8;21)], which often can be cured with cytosine arabinoside alone, to the most resistant subsets, which can survive even supralethal levels of combination alkylator chemotherapy (cytogenetic subsets monosomy 5 and monosomy 7). MATERIALS AND METHODS: To analyze the expression of BCL-2 family genes, which are expressed in these subsets of AML, we used PCR sequence amplification reactions that are dependent on oligonucleotide primers representing the BH1 and BH2 homology domains to generate the unique regions between BH1 and BH2. These primers are conserved among all members of the BCL-2 gene family and are separated by a 150 nucleotide region sequence between the BH1 and BH2 domains. The PCR products unique to each BCL-2 family member were cloned directionally into sequencing vectors. The identity of the insert of each clone was determined by slotblots of the DNA amplified from individual colonies and by hybridization with radioactive probes specific to the bcl-2, bcl-x, or bax genes. RESULTS: We found that bcl-2 is the predominant member expressed in AML samples with a poor prognosis (-5, -7), whereas the transcripts of bcl-x are higher than those of bcl-2 in the AML samples with a good prognosis [inv16, t(8;21)]. No significant difference in bax expression was detected between AML subsets of good and bad prognosis. The ratio of bcl-xlong, which inhibits apoptosis, to bcl-xshort, which promotes apoptosis, was determined by amplification with a pair of primers specific to bcl-x followed by separation of the PCR product on agarose gels. Bcl-xlong and bcl-xshort appeared as bands of different molecular mass on a molecular weight gel and were visualized by ethidium bromide staining or Southern blot analysis with a bcl-x-specific probe. CONCLUSIONS: We found that the ratio of bcl-x long to bcl-x short was higher in the AML patients with a poor prognosis. These experiments showed that the levels of BCL-2 family members in the leukemia cells of good- and poor-prognosis subsets are different. In addition, novel members of the BCL-2 family were isolated from the cells of AML patients of either prognosis.

Acute Disease↗
PubMed1997

[Prognosis and prognostic factor analysis epithelial ovarian cancer].

OBJECTIVE: To investigate the prognosis change and prognostic factors of advanced epithelial ovarian cancer in recent over twenty years. METHODS: One hundred and fourty patients with advanced epithelial ovarian cancer were analyzed. They were divided into two groups based on their operation time. 56 patients operated before Jan. 1980 were included in the first group, and the other 84 patients in the second group. Kaplan-Meier survival curves of the two groups were calculated, and Cox model was used to evaluate the prognostic factors of the disease at univariate and multivariate levels using SPSS and SURVCALC software. RESULTS: There was no pathological difference in between the two groups, but the patients in the second group received more aggressive chemotherapy. The overall 1-, 2-, and 5-year survival rates were 61.2%, 32.1%, and 8.5%, respectively. In the first group they were 42.3%, 29.6% and 4.5% respectively and in the second group 69.3%, 36.2%, and 11.2% respectively. The prognosis of the patients in the second group was better than that in the first group, P < 0.05. Univariate analysis revealed that stage, grade, residual tumor size and chemotherapy were significant predictors of patients' outcome. COX regression analysis identified that they were all independent prognostic factors. The patients with advanced, low grade, residual tumor (> 2 cm) had poor prognosis. The prognosis of the patients who received equal or more than four, especially six cycles combined chemotherapy was improved. CONCLUSION: The prognosis of the patients with advanced ovarian cancer has improved in recent over 10 years, higher optimal cytoreductive rate and equal or more than six cycles combined chemotherapy are important measures for the better prognosis of advanced ovarian cancer.

Adenocarcinoma, Mucinous↗
PubMed1998

[Long-term clinical course and prognosis of patients with Crohn's disease].

The aim of the present study is to clarify long-term clinical course, prognosis and factors influencing prognosis of patients with Crohn's disease suffering for more than 10 years. Sixty-eight patients (47 males, 21 females) with Crohn's disease in whom the clinical course could observed well at our hospital for more than 10 years were studied. We classified these patients into three groups (good, fair, bad) according to their changes of IOIBD assessment score. And we compaired some clinical factors in these groups to clarify factors influencing prognosis. The results were as follows: 1) Twelve patients (18%) were in good prognosis group, and 24 patients (35%) in fair one, and 32 patients (47%) in bad one. 2) IOIBD assessment score at the time of diagnosis, site of leision, and radiographic findings at the time of diagnosis showed significant difference between bad prognosis group and the other two groups. Although there have been many reports that Crohn's disease is generally progressive, our results indicated that more than half of the patients showed favorable prognosis during the follow-up period for more than ten years.

Adult↗
PubMed1998

Estimation of tumor necrosis factor-alpha in the diagnosis, the prognosis and the treatment follow-up of oral squamous cell carcinoma.

This study evaluated usefulness of serum tumor necrosis factor-alpha (TNF-alpha) levels in the diagnosis and prognosis of oral squamous cell carcinoma (O-SCC). We performed a clinico-pathological estimation of 38 patients with O-SCC and determined the more valuable factors in making a prognosis. The mean serum concentration of TNF-alpha for the patients with O-SCC (14.13 +/- 13.17 pg/ml) was significantly higher (p < 0.05) than that of the healthy controls (3.49 +/- 2.97 pg/ml). The mean serum concentrations of TNF-alpha were significantly higher (p < 0.05) in the good-prognosis group (16.73 +/- 18.64 pg/ml) than in the poor-prognosis group (9.62 +/- 5.92 pg/ml). The survival curve revealed a better prognosis for patients with serum TNF-alpha-positive than for patients with serum TNF-alpha negative. There was a significant correlation (p < 0.05) with serum TNF-alpha levels and two tumor markers (SCCA, IAP). These results of the present study suggest that a evaluation of serum TNF-alpha levels in O-SCC is a valuable tool as a tumor marker for the diagnosis, prognosis and treatment monitoring of O-SCC.

Adult↗
PubMed1996

Pulmonary carcinosarcoma: diagnostic problems and determinants of the prognosis.

OBJECTIVE: Bronchopulmonary carcinosarcoma is a very rare tumor and the prognosis of patients with carcinosarcoma is assessed as unfavourable. The problems concerning diagnosis, therapy, and prognosis after resection treatment are discussed with reference to our seven cases and with consideration of the pertinent literature. METHODS: The retrospective data of seven patients with pulmonary carcinosarcoma were analysed. All were staged postoperatively according to the international TNM staging system. The diagnosis was verified by immunohistochemical investigation. The prognosis of the patients with carcinosarcoma was compared with the prognosis of patients with non-small cell carcinoma of the lung. RESULTS: Whether lung resection is the treatment of choice for these patients is of no relevance, because in most cases the preoperative diagnosis is incomplete, as only one component of the tumor, namely the epithelial one, is found in the biopsy specimen. The complete and correct diagnosis in five of the seven cases was not made before the resection had been performed and in the remaining two patients it was only made when tumor recurrence or metastases occurred. The prognosis of patients with carcinosarcoma of the lung is assessed to be comparable to that of patients with other pulmonary carcinoma: in this study survival times ranged from only 3 months (T2N3) to 4 years 6 months (T3N1). The causes of death of the patients with carcinosarcoma were local recurrence in four patients and metastases at distant sites in two. Two recurrent tumors as well as the metastases consisted only of the sarcoma component of the primary tumor histologically. CONCLUSION: One may suggest that the prognosis of carcinosarcoma might be determined by the sarcoma component of the tumor. Therefore the generally accepted therapies of soft tissue sarcomas should be adopted for the follow-up treatment of patients with pulmonary carcinosarcoma.

Adult↗
PubMed2002

Long-term prognosis of primary biliary cirrhosis (PBC) in Japan and analysis of the factors of stage progression in asymptomatic PBC (a-PBC).

Objective: Based on data from a national survey of primary biliary cirrhosis (PBC), the pathology and prognosis of PBC in Japan were clarified. In particular, we tried to perform multivariate analysis of factors useful in determining prognosis of asymptomatic PBC (a-PBC). Methods: The survey was performed 10 times. Responses from 3778 of 4361 registered patients (416 institutions) were investigated (survey period: January 1968-December 1998). At the time of diagnosis, patients were classified as a-PBC or symptomatic PBC (s1-PBC; pruritus only, s2-PBC; jaundice and serum bilirubin level above 2 mg/dl). The survival rate was obtained by the Kaplan-Meier method. Logistic regression analysis was used in multivariate analysis of prognostic factors of a-PBC. Results: There were no significant differences in clinical findings from those in previous reports. The 5-year survival rates of patients with a-PBC, s1-PBC, and s2-PBC at the time of diagnosis were 97, 88, and 53%, respectively. Patients with a-PBC at the time of diagnosis were divided into groups: those in whom the disease progressed to s2-PBC (8%) and did not progress to s2-PBC (92%) at the final examination, and the prognosis was compared between groups. The prognosis was significantly poorer in the s2-PBC progression group. As a result of multivariate analysis for prediction of prognosis, levels at diagnosis of total serum bilirubin (T-Bil), albumin (Alb), total cholesterol (T-Cho), histological stage, and presence or absence of ursodeoxycholic acid (UDCA) administration were selected as significant factors (P<0.00001). Conclusion: Serum T-Bil, Alb, T-Cho, and histological stage at the time of diagnosis and presence or absence of UDCA administration were considered useful early prognostic indicators in patients diagnosed as having a-PBC whose prognosis may deteriorate with progression to s2-PBC.

Journal Article↗
PubMed1994

Five-year prognosis for depression in old age.

The 5-year prognosis for 264 depressed elderly Finns (60 years or older) living in the community and treated through the primary health care service is described. The majority of the patients were suffering from dysthymic disorder. It was found that 25% of the men and 35% of the women had recovered, 29% of the men and 24% of the women were still suffering from depression after the five-year period, 9% of the men and 11% of the women had become demented, 33% of the men and 26% of the women had died, and 4% of the cases were not contacted. The prognosis did not differ between the sexes, neither was it associated with age. Poor psychic health and pronounced depressive symptoms at the beginning of the treatment, and the occurrence of a serious disease or a decline in functional capacities during the follow-up were related to a poor prognosis in both sexes. The specific disease group related to a poor prognosis in women was that of cardiovascular diseases. A close connection between a poor prognosis and a low socioeconomic status was found in the depressed men, while a favorable prognosis was shown for relatively healthy, even widowed, depressed women who moved to live alone during the follow-up period, women who increased their amount of physical exercise, and men and women whose hobby activities increased.

Activities of Daily Living↗
PubMed1987

[Clinicopathological studies on adenocarcinoma of the lung--relationship between subclassification based on cell origin and prognosis of surgical patients].

The relationship between the light- and electron-microscopic subclassification of a tumor based on the morphological similarity to the cell origin and the prognosis of 67 surgical patients with adenocarcinoma of the lung was studied. The prognosis of patients with each subtype was different due to the frequency of metastasis into the lymph nodes. The bronchial gland cell type and the nonciliated bronchiolar cell type consisting of cuboidal cells showed a poorer prognosis than the bronchial surface epithelial cell type (both with and without mucus) and the nonciliated bronchiolar cell type composed of columnar cells. The more unfavorable type as far as prognosis was concerned frequently metastasized into the lymph nodes. In particular, the bronchial gland cell type metastasized into the mediastinal lymph nodes even if the tumors were small in size, and it included more fibrotic focus of the tumors. The cells of the bronchial gland cell type and the nonciliated bronchiolar cell type consisting of cuboidal cells were smaller in cellular size and were connected loosely, but they were arranged in a larger cluster. These findings might explain the reason why these cells frequently metastasized into the lymph nodes. The X-ray films revealed a characteristic appearance corresponding to the subtype. The radiographic findings of the patients with poorer prognosis tended to show three patterns of tumor shadows: more than 5 cm in diameter, dense with spicular radiation, ill-marginated, faint and pseudomorphic with pleural indentation. Subclassification based on cell origin was considered to reflect the degree of malignancy of adenocarcinoma of the lung, and it seemed possible to assess the prognosis of the patients by chest radiographic manifestations.

Adenocarcinoma↗
PubMed1993

Serum cortisol and cerebrospinal fluid beta-endorphins in status epilepticus. Their possible relation to prognosis.

OBJECTIVE: To determine if blood cortisol and cerebrospinal fluid beta-endorphin levels correlate with prognosis following status epilepticus. DESIGN: Twenty-seven adult patients with status epilepticus had blood cortisol and cerebrospinal fluid beta-endorphin levels measured within 12 hours after the cessation of clinical seizures. SETTING: Patients with status epilepticus as well as patients with non-status epilepticus seizures came from the Comprehensive Epilepsy Program at the Medical College of Virginia, Richmond. PATIENTS: Twenty-seven patients with status epilepticus. Control patients for the cortisol study were patients who had acute seizures who did not meet the criteria for status epilepticus. The cerebrospinal fluid control subjects were patients without neurologic symptoms undergoing spinal anesthesia. OUTCOME MEASURES: The clinical status of the patients 1 week after status epilepticus as well as the Glascow Outcome Score and the Glascow Coma Score 1 week after status epilepticus. RESULTS: The difference in blood cortisol levels in patients with status epilepticus with poor prognosis was significantly different from both patients with non-status epilepticus seizures (P < .001) and patients with status epilepticus with good prognosis (P < .01). Cerebrospinal fluid beta-endorphin levels were elevated in patients with status epilepticus patients vs control subjects (P < .05), but no significant difference was noted between the patients with status epilepticus with good and poor prognosis. CONCLUSIONS: Serum cortisol levels may provide a useful predictive indicator of prognosis in status epilepticus and cortisol level elevation may play a role in the pathophysiologic condition of status epilepticus.

Adult↗
PubMed1982

Absolute granulocyte, lymphocyte, and moncyte counts. Useful determinants of prognosis for patients with metastatic cancer of the stomach.

Pretreatment absolute granulocyte (less than 6,000/cu mm), lymphocyte (greater than 1,500/cu mm), and monocyte (300 to 900/cu mm) counts are three independent indicators of good prognosis for patients with metastatic gastric cancer. There tests improve the prediction of survival significantly compared with estimates based on ambulatory status alone. If the patient is completely ambulatory, median survival (MS) is 27.6 weeks, and it improves further to 37.6 weeks if results of two hematology tests indicate a good prognosis. If the patient is partially ambulatory, MS is 16.2 weeks; however, if results of two blood tests indicate a good prognosis, MS is 25.7 weeks, and if two tests indicate a poor prognosis, MS is only 11.1 weeks. The model corrected a false assessment of a poor prognosis for 56% of all patients.

Clinical Trials as Topic↗
PubMed2005

Prognosis and decision making in severe stroke.

CONTEXT: An increasing number of deaths following severe stroke are due to terminal extubations. Variation in withdrawal-of-care practices suggests the possibility of unnecessary prolongation of suffering or of unwanted deaths. OBJECTIVES: To review the available evidence on prognosis in mechanically ventilated stroke patients and to provide an overall framework to optimize decision making for clinicians, patients, and families. DATA SOURCES: Search of MEDLINE from 1980 through March 2005 for English-language articles addressing prognosis in mechanically ventilated stroke patients. From 689 articles identified, we selected 17 for further review. We also identified factors that influence, and decision-making biases that may result, in overuse or underuse of life-sustaining therapies, with a particular emphasis on mechanical ventilation. EVIDENCE SYNTHESIS: Overall mortality among mechanically ventilated stroke patients is high, with a 30-day death rate approximating 58% (range in literature, 46%-75%). Although data are limited, among survivors as many as one third may have no or only slight disability, yet many others have severe disability. One can further refine prognosis according to knowledge of stroke syndromes, early patient characteristics, use of clinical prediction rules, and the need for continuing interventions. Factors influencing preferences for life-sustaining treatments include the severity and pattern of future clinical deficits, the probability of these deficits, and the burdens of treatments. Decision-making biases that may affect withdrawal-of-treatment decisions include erroneous prognostic estimates, inappropriate methods of communicating evidence, misunderstanding patient values and expectations, and failing to appreciate the extent to which patients can physically and psychologically adapt. CONCLUSIONS: Although prognosis among mechanically ventilated stroke patients is generally poor, a minority do survive without severe disability. Prognosis can be assessed according to clinical presentation and patient characteristics. There is an urgent need to better understand the marked variation in the care of these patients and to reliably measure and improve the patient-centeredness of such decisions.

Communication↗
PubMed1993

Differential values of Ki-67 index and mitotic index of proliferating cell population. An assessment of cell cycle and prognosis in radiation therapy for cervical cancer.

BACKGROUND: Little is known about correlations between the growth fraction determined immunohistochemically with Ki-67 antibody and radiation response or prognosis after radiation therapy. METHODS: The prognostic value of the growth fraction determined by Ki-67 index and the mitotic index of proliferating cell population (pMI) were assessed in 45 cervical cancers treated with radiation therapy. The specimens from the cervix before radiation therapy were immunohistochemically stained with anti-Ki-67 antibody. RESULTS: The mean Ki-67 index and pMI for all patients were 36.0% and 2.74%, respectively. The patients with a Ki-67 index of 33% or greater showed significantly better histologic response to radiation at 30 Gy than those with less than 33%. The mean Ki-67 index for patients with good prognosis was significantly higher than for patients with tumor recurrence or metastasis later. Further, the mean values of pMI for patients with good prognosis were significantly lower than for patients with recurrence or metastasis. The 3-year survival rate for higher Ki-67 index (> or = 33%) was significantly better than lower Ki-67 index (less than 33%) (90.9% versus 34.8%; P < 0.001). However, the 3-year survival rate for higher pMI (> or = 3.5%) was significantly poorer than lower pMI (less than 3.5%) (8.3% versus 81.8%; P < 0.001). CONCLUSIONS: These results suggested that tumors with a high growth fraction showed a good prognosis with radiation therapy. In addition, the inverse prognostic correlation between the Ki-67 index and pMI suggested that both indices have independent values on radiation response and prognosis after radiation therapy.

Biomarkers, Tumor↗
PubMed2003

Single nucleotide polymorphism in fibroblast growth factor receptor 4 at codon 388 is associated with prognosis in high-grade soft tissue sarcoma.

BACKGROUND: A recent study revealed that single nucleotide polymorphism (SNP) at codon 388 (Gly or Arg) of fibroblast growth factor receptor 4 (FGFR4) was associated with prognosis in patients with carcinoma of the breast and colorectal carcinoma. The purpose of the current study was to investigate the correlation between codon 388 SNP and clinical prognosis in patients with sarcoma of the bone and soft tissues. METHODS: Tumor samples were obtained from 143 patients with high-grade bone and soft tissue sarcomas at Okayama University Hospital between 1986-2002, and from 102 healthy volunteers. SNP of codon 388 was detected by sequencing and fragment length of polymerase chain reaction products digested by restriction enzyme. The chi-square test was used to compare genotype distribution and the Kaplan-Meier method was used for survival analysis. RESULTS: With regard to FGFR4 genotypes in the 143 patients studied, 54 (37.8%) were Gly/Gly, 72 (50.3%) were Gly/Arg, and 17 (11.9%) were Arg/Arg, findings that were not significantly different from those of controls (P = 0.97). With regard to cumulative overall and metastasis-free survival, patients with the Gly/Gly genotype were found to have a better prognosis (P = 0.085 and P = 0.27, respectively). FGFR4 SNP was found to be correlated significantly with overall and metastasis-free survival in patients with soft tissue sarcomas (P = 0.029 and P = 0.045, respectively), but not in those patients with bone sarcomas (P = 0.88 and P = 0.75, respectively). CONCLUSIONS: In the current study, the authors found a significant correlation between FGFR4 SNP and prognosis in patients with soft tissue sarcoma, although the samples were comprised of various histologic types. This SNP might be used to improve the prediction of clinical prognosis and lead to new treatment strategies in patients with soft tissue sarcomas.

Adolescent↗
PubMed2006

High expression of leptin receptor mRNA in breast cancer tissue predicts poor prognosis for patients with high, but not low, serum leptin levels.

The association of mRNA expression levels of leptin receptors (long isoform: Lep-R(L) and short isoform: Lep-R(S)) in breast cancer tissue with patient prognosis was studied with special reference to the serum leptin level or the leptin mRNA level in tumor tissue. Lep-R(L), Lep-R(S) and leptin mRNA levels in breast cancer tissue (n = 91) were determined with a real-time PCR assay, and serum leptin levels in breast cancer patients (n = 67) with an enzyme-linked immunosorbent assay. Neither Lep-R(L) nor Lep-R(S) mRNA levels in tumor tissue were significantly associated with patient prognosis, but both intratumoral Lep-R(L) and Lep-R(S) mRNA high tumors were significantly (p < 0.01) associated with a poor prognosis. Multivariate analysis showed that a high level of both Lep-R (L) and Lep-R (S) mRNA in tumor tissue was a significant risk factor, independent of other risk factors. The subset analysis demonstrated that both intratumoral Lep-R(L) and Lep-R(S) mRNA high tumors were significantly associated with a poor prognosis for the subset of patients with high serum leptin or high intratumoral leptin mRNA levels but not in the subset of patients with low serum leptin or low intratumoral leptin mRNA levels. The association between both intratumoral Lep-R(L) and Lep-R(S) mRNA high tumors and a poor prognosis in the presence of high serum leptin or high intratumoral leptin mRNA levels seems to suggest that the leptin and Lep-R(L)/Lep-R(S) pathways are implicated in the growth stimulation of breast tumors. The well-established finding that obesity serves as a risk factor for relapse in breast cancer patients may thus be partially explained by the high serum leptin level seen in obese women.

Adult↗
PubMed2004

Obstetricians' agreement on fetal prognosis after ultrasound diagnosis of fetal anomalies.

INTRODUCTION: After ultrasound diagnosis of a severe fetal anomaly is made, difficult decisions may arise regarding obstetric management. Guidelines have been developed to support obstetricians in decision-making. However, it is unknown to what extent in the clinical situation, guidelines are actually supportive. OBJECTIVES: We aimed at: (1) determining whether obstetricians in the presence of a fetal anomaly are able to classify fetal prognosis according to guidelines; (2) establishing inter- and intra-observer agreement regarding fetal prognosis. METHODS: We used three categories of fetal prognosis: category 1: the infant has no chance of survival and the abnormalities cannot be treated (1.1); or the infant has a chance of extra-uterine survival but post-natal use of life-prolonging medical treatment is considered futile (1.2); category 2: the infant has a chance of extra-uterine survival and post-natal use of life-prolonging medical treatment, if necessary, is considered beneficial. Five senior obstetricians categorized 100 case descriptions of severe fetal abnormalities, which were classified again after five months. RESULTS: Four obstetricians were able to classify 98% or more of cases. In 67% of cases, four or all obstetricians agreed on fetal prognosis. The overall kappa coefficient was 0.48 (moderate agreement). The differences between obstetricians represented systematic differences in opinions on how to classify cases. Intra-observer agreement was 82 to 97%. CONCLUSION: Obstetricians were usually able to classify fetal prognosis according to guidelines, but in a substantial number of cases, there was a disagreement reflecting systematic differences between obstetricians.

Congenital Abnormalities↗
PubMed2002

Gestational trophoblastic tumors in Norway, 1968-1997: patient characteristics, treatment, and prognosis.

OBJECTIVES: The aim of this study was to give an overview of the Norwegian population of gestational trophoblastic tumors (GTT), diagnosed during 1968-1997 and treated with chemotherapy at the Norwegian Radium Hospital (NRH), with regard to patient characteristics, treatment, and prognosis. METHODS: The cases were grouped according to a modified version of the WHO scoring system. Staging was performed retrospectively according to the systems adopted by FIGO. Survival estimates were calculated by the method described by Kaplan and Meier. Cox regression models were used to find the best classification system with regard to prognosis (disease-free survival). RESULTS: A total of 141 cases, 106 invasive moles (IM) and 35 choriocarcinomas (CC), were diagnosed in Norway and treated with chemotherapy at the NRH in the period 1968-1997. Altogether, 56% of the patients were assigned to the low-risk category, 20% to the medium-risk category, and 15% to the high-risk category. Most cases were classified into the clinical stages I (69%) and III (23%). The overall 5-year survival rate was 96%. A more favorable prognosis was seen in patients diagnosed in the 1980s and 1990s compared with those diagnosed in the 1970s (P = 0.04). Five patients had progressive disease and died from the disease. Nine patients relapsed. The prognosis (disease-free survival) was more favorable for IM compared with CC (P < 0.01). The FIGO classification system seemed to be a better predictor of disease-free survival than the WHO scoring system. CONCLUSIONS: This study showed that the prognosis of patients with GTT improved in the 1980s and 1990s in Norway, and that the FIGO system might be the best predictor of disease-free survival.

Adolescent↗