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The assessment of the prognosis of musculoskeletal conditions in older adults presenting to general practice: a research protocol.

BACKGROUND: Musculoskeletal conditions represent a common reason for consulting general practice yet with the exception of low back pain, relatively little is known about the prognosis of these disorders. Recent evidence suggests that common 'generic' factors may be of value when assessing prognosis, irrespective of the location of the pain. This study will test a generic assessment tool used as part of the general practice consultation to determine prognosis of musculoskeletal complaints. METHODS/DESIGN: Older adults (aged 50 years and over) presenting to six general practices with musculoskeletal complaints will be assessed as part of the routine consultation using a generic assessment of prognosis. Participants will receive a self-completion questionnaire at baseline, three, six and 12 months post consultation to gather further data on pain, disability and psychological status. The primary outcome measure is participant's global rating of change. DISCUSSION: Prognosis is considered to be a fundamental component of scientific medicine yet prognostic research in primary care settings is currently neglected and prognostic enquiry is disappearing from general medical textbooks. This study aims to address this issue by examining the use of generic prognostic factors in a general practice setting.

Age Factors↗

Integrated bioinformatics analysis and experimental validation reveal the relationship between ALOX5AP and the prognosis and immune microenvironment in glioma.

BACKGROUND: Treatment of gliomas, the most prevalent primary malignant neoplasm of the central nervous system, is challenging. Arachidonate 5-lipoxygenase activating protein (ALOX5AP) is crucial for converting arachidonic acid into leukotrienes and is associated with poor prognosis in multiple cancers. Nevertheless, its relationship with the prognosis and the immune microenvironment of gliomas remains incompletely understood. METHODS: The differential expression of ALOX5AP was evaluated based on public Databases. Kaplan-Meier, multivariate Cox proportional hazards regression analysis, time-dependent receiver operating characteristic, and nomogram were used to estimate the prognostic value of ALOX5AP. The relationship between ALOX5AP and immune infiltration was calculated using ESTIMATE and CIBERSORT algorithms. Relationships between ALOX5AP and human leukocyte antigen molecules, immune checkpoints, tumor mutation burden, TIDE score, and immunophenoscore were calculated to evaluate glioma immunotherapy response. Single gene GSEA and co-expression network-based GO and KEGG enrichment analysis were performed to explore the potential function of ALOX5AP. ALOX5AP expression was verified using multiplex immunofluorescence staining and its prognostic effects were confirmed using a glioma tissue microarray. RESULT: ALOX5AP was highly expressed in gliomas, and the expression level was related to World Health Organization (WHO) grade, age, sex, IDH mutation status, 1p19q co-deletion status, MGMTp methylation status, and poor prognosis. Single-cell RNA sequencing showed that ALOX5AP was expressed in macrophages, monocytes, and T cells but not in tumor cells. ALOX5AP expression positively correlated with M2 macrophage infiltration and poor immunotherapy response. Immunofluorescence staining demonstrated that ALOX5AP was upregulated in WHO higher-grade gliomas, localizing to M2 macrophages. Glioma tissue microarray confirmed the adverse effect of ALOX5AP in the prognosis of glioma. CONCLUSION: ALOX5AP is highly expressed in M2 macrophages and may act as a potential biomarker for predicting prognosis and immunotherapy response in patients with glioma.

Humans↗

Accuracy of general practitioner's prognosis of the 1-year course of depression and generalised anxiety.

BACKGROUND: A prognosis serves important functions for the management of common mental disorders in primary care. AIMS: To establish the accuracy of the general practitioner's (GP) prognosis. METHOD: The agreement between GP prognosis and observed course was determined for 138 cases of ICD-10 depression and 65 of generalised anxiety disorder, identified among consecutive attenders of 18 GPs. RESULTS: Modest agreement between GP prognosis and course was found, both for depression (kappa=0.21) and generalised anxiety (kappa=0.11). Better agreement (kappa=0.45 for depression, and kappa=0.33 for generalised anxiety) was observed between the course and predictions from a statistical model based on information potentially available to the GP at the time the prognosis was made. This model assesses attainable performance for GPs. CONCLUSIONS: General practitioners do a fair job in predicting the 1-year course of depression and generalised anxiety. Even so, their performance falls significantly short of attainable performance.

Adolescent↗

Intensive induction chemotherapy with CBOP/BEP in patients with poor prognosis germ cell tumors.

PURPOSE: Despite a high cure rate in patients with testicular cancer, there remain patients in the poor prognosis group who have a less favorable outcome. Intensive induction chemotherapy using a regimen consisting of carboplatin, bleomycin, vincristine, and cisplatin, followed by bleomycin, etoposide, and cisplatin (CBOP/BEP), developed at the Royal Marsden Hospital, is designed to overcome the rapid proliferation seen in germ cell tumors. This study assesses the outcome of patients with poor-prognosis nonseminomatous germ cell tumors (NSGCT) treated with CBOP/BEP. PATIENTS AND METHODS: Patients with NSGCT from three centers, classified as poor prognosis according to International Germ Cell Classification Consensus Group criteria, were treated with CBOP/BEP regimen during the period from 1989 to 2000. Data on treatment toxicity, relapse-free survival (RFS), and overall survival (OS) were collected prospectively on a hospital database. RESULTS: Fifty-four male patients with poor prognosis NSGCT were treated with CBOP/BEP. The RFS at 3 and 5 years for all patients was 83.2% (95% confidence interval [CI], 68.8% to 91.3%). After a median follow-up of 4 years, the OS of the 54 patients was 91.5% (95% CI, 78.6% to 96.8%) at 3 years and 87.6% (95% CI, 71.3% to 94.9%) at 5 years. Three-year OS in patients with a primary mediastinal germ cell tumor was 77.1% (95% CI, 34.5% to 93.9%) compared with 95.4% (95% CI, 82.8% to 98.8%) in patients with a testicular primary tumor (P =.24). CONCLUSION: The results reported here compare favorably with the historical results of alternative regimens used in the management of poor-prognosis NSGCT. We suggest a phase III trial to confirm our findings.

Adolescent↗

Communication about prognosis between parents and physicians of children with cancer: parent preferences and the impact of prognostic information.

PURPOSE: Concerns about the harms of prognostic information, including distress and loss of hope, cause some physicians to avoid frank disclosure. We aimed to determine parent preferences for prognostic information about their children with cancer and the results of receiving such information. PATIENTS AND METHODS: We surveyed 194 parents of children with cancer (overall response rate, 70%), treated at the Dana-Farber Cancer Institute and Children's Hospital (Boston, MA) and the children's physicians. Our main outcome measure was parent rating of prognostic information as extremely or very upsetting. RESULTS: The majority of parents desired as much information about prognosis as possible (87%) and wanted it expressed numerically (85%). Although 36% of parents found information about prognosis to be extremely or very upsetting, those parents were more likely to want additional information about prognosis than those who were less upset (P = .01). Parents who found information upsetting were no less likely to say that knowing prognosis was important (P = .39), that knowing prognosis helped in decision making (P = .40), or that hope for a cure kept them going (P = .72). CONCLUSION: Although many parents find prognostic information about their children with cancer upsetting, parents who are upset by prognostic information are no less likely to want it. The upsetting nature of prognostic information does not diminish parents' desire for such information, its importance to decision making, or parents' sense of hope.

Adolescent↗

Long-term prognosis of patients with paroxysmal atrial fibrillation depends on their response to antiarrhythmic therapy.

BACKGROUND: The rhythm control treatment strategy for persistent atrial fibrillation (AF) has been shown not to improve quality of life or prognosis any more than rate control. It is unclear whether the prognosis of the patients with paroxysmal AF (PAF) is influenced by the response to antiarrhythmic drug therapy (AAT). METHODS AND RESULTS: The relationship between the response to AAT and long-term prognosis was evaluated in 290 patients with PAF (mean age, 69 years). During a mean follow-up period of 51 months, 114 patients (39%) had no recurrence of AF (Group 1), 113 (39%) had repeated AF recurrence (Group 2), and the remaining 63 (22%) had permanent AF despite AAT (Group 3). The survival rate without any cardiovascular deaths at 60 months was 99% in Group 1, 95% in Group 2 and 94% in Group 3 (p=NS among 3 groups). Survival rate without symptomatic ischemic stroke was 99% in Group 1, 88% in Group 2 and 76% in Group 3 (p<0.05 Group 1 vs Groups 2 and 3). The annual rate of stroke in the patients with warfarin treatment was similar among the 3 groups, whereas that in the patients without warfarin was higher in Groups 2 and 3 than in Group 1. CONCLUSIONS: Long-term prognosis of patients with PAF varies with the response to AAT: When sinus rhythm is maintained, the prognosis is good even without anticoagulation therapy.

Adult↗

Factors affecting the prognosis of brachial plexus injuries.

The clinical results in a series of 131 patients with 134 brachial plexus injuries were analysed to determine the factors affecting prognosis. Isolated injuries to the upper trunk had the best prognosis, but the prognoses of isolated injuries to the cords, upper roots and lower trunk were not as good. Complete injuries of the plexus had the worst prognosis. Pain which persisted for more than six months was a bad prognostic sign for neurological recovery regardless of the location of the lesion. Horner's syndrome was not always accompanied by a bad prognosis. Operation did not affect the prognosis except in open lacerations. A pseudomeningocele detected by myelography usually precluded recovery in the root at the level of the pseudomeningocele.

Adolescent↗

Ethical aspects of determining and communicating prognosis in critical care.

Physicians have an ethical duty to accurately determine and clearly communicate a patient's prognosis because a patient's or surrogate's decision whether to consent for aggressive treatment rests largely on their understanding of the patient's diagnosis and prognosis. Pitfalls in determining prognosis include uniformed summary judgement based on faulty pattern recognition, inadequate outcome data, utter reliance on retrospective studies, statistical limitations, nongeneralizability of outcome data, and the fallacy of the self-fulfilling prophecy. Pitfalls in physicians' communication of prognosis include inadequate time spent in discussion, use of technical jargon, biased framing of decisions, unjustified physician bias, patient innumeracy, ethnicity barriers, and surrogates' unfounded intuitions about critical illness and death. Improving the recognition of and surmounting the barriers to accurate determination and clear communication of prognosis can make critical care physicians more scientific and virtuous.

Communication Barriers↗

Postoperative prognosis of node-negative breast cancers predicted by gene-expression profiling on a cDNA microarray of 25,344 genes.

BACKGROUND: In Japan, postoperative relapse occurs within five years in 9.2 to 16% of patients whose breast cancers have not metastasized to lymph nodes at the time of initial surgery(node-negative, n0). Attempts to find molecular markers able to classify n0 breast cancers in terms of postoperative prognosis have not been successful. METHODS: To identify molecular indicators of prognosis for this type of cancer, we used a cDNA microarray consisting of 25,344 human genes to investigate expression profiles of 12 primary breast cancers from patients whose tumors recurred within five years after surgery(5Y-R) and 12 from patients who survived disease-free for more than five years (5Y-F). RESULTS: Sets of genes characterizing each group in terms of expression patterns in the tumors were selected by Mann-Whitney and random-permutation tests: these panels included 21 genes expressed highly in 5Y-R tumors than in 5Y-F tumors, and 37 with higher expression in the 5Y-F group than in the 5Y-R group. CONCLUSIONS: We established a scoring system to prediction of postoperative prognosis which was 100% accurate as to the actual clinical outcomes of the 24 cases and therefore might be useful for predicting prognosis of n0 breast cancers in a clinical setting. The prognostic score system clearly separated the two groups without any overlap, and accurately predicted prognosis in 6 additional cases. Moreover, the extensive list of tumor-related genes identified in these experiments provides valuable information about progression of breast cancer and suggests potential target molecules for therapy of n0 breast cancers.

Adult↗

Tumor vascularity and lens culinaris agglutinin reactive alpha-fetoprotein are predictors of long-term prognosis in patients with hepatocellular carcinoma after percutaneous ethanol injection therapy.

Percutaneous ethanol injection therapy (PEIT) is now widely used for small hepatocellular carcinoma (HCC). However, only limited information is available regarding predictors of long-term prognosis of patients with small HCC after PEIT. The relationship of pretreatment clinicopathologic and biologic factors (age, sex, virus marker, Child-Pugh classification, tumor size, number of tumor, histologic grade, tumor staining, alpha-fetoprotein level, AFP-L3%, and Ki67 labelling index) to long-term prognosis in 41 patients with HCC were studied. Over-all survival rates of patients were 73.5% in 3-year, 34.7% in 5-year, and 27.0% in 7-year. Of the 12 variables investigated, Child-Pugh classification (p = 0.0243), histologic grade (p = 0.0098), tumor staining (p = 0.0012), AFP-L3% (0.0093), and Ki67 labelling index (p = 0.0467) were significantly associated with the long-term prognosis by univariate analysis. According to the multivariate analysis using Cox's proportional hazard model with step-wise method, tumor staining (p = 0.0024) and AFP-L3% (p = 0.0137) were significantly associated with the long-term prognosis after PEIT. In conclusion, the study found that positive tumor staining of HCC and positive AFP-L3% in serum were the predictor of poor prognosis in patients with HCC after PEIT.

Aged↗

Bell's palsy-beneficial effect of treatment with adrenocorticotrophic hormone (ACTH) in patients with a poor prognosis.

In 111 patients with idiopathic peripheral facial paralysis (Bell's palsy) the prognosis was established during the first days of the disease, using sialometry and the stapedius reflex test in 102 patients. A poor prognosis was indicated in 36 patients. Treatment with adrenocorticotrophic hormone (ACTH) was commenced within 10 days (in the majority within 5 days) of the onset of the paresis in 31 of those patients with a poor prognosis. The recovery rate in the ACTH-treated group was superior compared with the untreated control group of patients with a poor prognosis. The difference is statistically significant. Those patients with a good prognosis were not treated but merely followed up. Some factors which could influence the result of the treatment are considered.

Adrenocorticotropic Hormone↗

The postoperative prognosis of primary pulmonary sarcomas. A review with a comparison between the histological forms and the other primary endothoracal sarcomas based on 474 cases.

On the basis of 41 personally observed cases from 1957 to 1974 and 435 case reports in the literature from 1957 to 1972, a scale of malignancy of the histological forms of primary pulmonary sarcomas is presented. A fairly continuous rise in the rate of malignancy according to the differentiation of the tissues can be convincingly recognized. The more mature a pulmonary sarcoma is, the better is the postoperative prognosis. The rate of malignancy increases from the relatively differentiated and tissue matured fibrosarcomas over the spindle cell sarcomas and round cell sarcomas, to the completely non-differentiated polymorph cell sarcomas. Primary myosarcomas, neurosarcomas and reticulum sarcomas of the lungs take an isolated position within this scale of malignancy. Primary lymphosarcomas are the most common and have clearly the best postoperative prognosis. The greatest malignancy is found with the carcinosarcomas. The characteristics of each of the histomorphological forms of primary sarcoma of the lungs are discussed. At the same time it is shown that the postoperative prognosis of endothoracal sarcomas is determined not only by their histological structure, but also by their localization in the lungs, mediastinum, or chest wall. Forty-one primary pulmonary sarcomas were compared with 22 sarcomas of the mediastinum and 17 sarcomas of the chest wall. Due to their long period of development, with rare symptoms and late diagnosis, sarcomas of the lungs and the mediastinum have a similar postoperative prognosis, in contrast to the endothoracal sarcomas of the chest wall which have a clearly more favourable prognosis.

Fibrosarcoma↗

Bystander cells and prognosis in Hodgkin lymphoma. Review based on a doctoral thesis.

Hodgkin lymphoma (HL) is characterised histologically by a minority of malignant Hodgkin and Reed-Sternberg (HRS) cells surrounded by benign cells, and clinically by a relatively good prognosis. The treatment, however, leads to a risk of serious side effects. Knowledge about the biology of the disease, particularly the interaction between the HRS cells and the surrounding cells, is essential in order to improve diagnosis and treatment. HL patients with abundant eosinophils in the tumours have a poor prognosis, therefore the eosinophil derived protein eosinophil cationic protein (ECP) was studied. Serum-ECP (S-ECP) was elevated in most HL patients. It correlated to number of tumour eosinophils, nodular sclerosis (NS) histology, and the negative prognostic factors high erythrocyte sedimentation rate (ESR) and blood leukocyte count (WBC). A polymorphism in the ECP gene (434(G>C)) was identified and the 434GG genotype correlated to NS histology and high ESR. The poor prognosis in patients with abundant eosinophils in the tumours has been proposed to depend on HRS cell stimulation by the eosinophils via a CD30 ligand (CD30L)-CD30 interaction. However, CD30L mRNA and protein were detected in mast cells and the predominant CD30L expressing cell in HL is the mast cell. Mast cells were shown to stimulate HRS cell lines via CD30L-CD30 interaction. The number of mast cells in HL tumours correlated to worse relapse-free survival, NS histology, high WBC, and low blood haemoglobin. Survival in patients with early and intermediate stage HL, diagnosed between 1985 and 1992, was generally favourable and comparatively limited treatment was sufficient to produce acceptable results for most stages. The majority of relapses could be salvaged. Patients treated with a short course of chemotherapy and radiotherapy had an excellent outcome. In conclusion prognosis is favourable in early and intermediate stages and there are possibilities for further improvements based on the fact that mast cells and eosinophils affect the biology and prognosis of HL.

Animals↗

Diffuse bone metastasis with hematologic disorders from gastric cancer: clinicopathological features and prognosis.

Bone metastases diffusely invading the bone marrow from gastric cancer often manifest a rapid clinical course and the prognosis is very poor due to hematologic disorders such as DIC (disseminated intravascular coagulation) and/or MAHA (microangiopathic hemolytic anemia). The objective of this study was to clarify the clinicopathological features and prognosis of patients with gastric cancer in whom diffuse bone metastasis associated with hematologic disorders were evident. Thirty-eight patients with bone metastasis from a primary gastric cancer were thus selected and placed into 2 groups consisting of 15 with diffuse bone metastasis with DIC and/or MAHA, and 23 patients who had bone metastasis without hematological disorders. We compared the clinicopathological features and prognosis between the two groups. The clinicopathological features in patients with diffuse bone metastasis accompanied by hematologic disorders were significantly related to undifferentiated adenocarcinoma, a relatively younger age, elevated levels of serum ALP-BI and LDH, and a lower frequency of extraosseous metastasis. The median survival time after manifestation was 2 and 11 months for the patients with or without hematologic disorders, respectively. The prognosis was significantly worse in cases of DIC with the median survival being only one month. Since, prognosis of diffuse bone metastasis from gastric cancer is significantly poor, close attention should be directed to the specific clinicopathologic features related to diffuse bone metastasis plus hematologic disorders. Regarding high risk patients, a regular follow-up of the serum chemistry levels and a bone scan will aid in the early detection of the disease.

Adult↗

[Clinical studies on paraquat poisoning; prognosis and severity index of paraquat poisoning using the urine levels].

The prognosis of paraquat poisoning has been assessed from serum paraquat levels using e.g. produfoot survival curve. The prognosis of paraquat poisoning has not been investigated from urinary paraquat levels. The purpose of this study is to clarify whether the prognosis of paraquat poisoning can be determined by urinary paraquat levels or not. Urinary severity index of paraquat poisoning (U-SIPP) was employed. U-SIPP is calculated as hours between ingestion of paraquat and start of intensive treatment multiplied by the paraquat level in the urine at the same time. Urinary excretion of paraquat is correlated with renal function. The prognosis of paraquat poisoning using U-SIPP was further discussed, based on creatinine clearance (Ccr) and the relation between serum and urine paraquat levels. The following results were obtained. 1) When creatinine clearance was greater than 20 ml/min, patients who died of circulatory failure were with U-SIPP level over 1250, patients who died of respiratory failure were with U-SIPP level between 1250 and 250, and survivors were with U-SIPP below 250. 2) Survival duration was closely correlative with U-SIPP in cases with Ccr greater than 20 ml/min (r = 0.8123, p less than 0.025). 3) When Ccr was greater than 20 ml/min, urinary paraquat levels were correlated very well with the serum levels at admission, even during direct hemoperfusion (DHP) treatment. 4) When diuretic agents such as furosemide was effective, the assessment of the prognosis of paraquat poisoning using urinary paraquat levels seemed to be possible. Urinary paraquat level was approximately measured by an applied qualitative analysis method with using a dilution method.

Adolescent↗

[A case of adult Wilms' tumor--review of the literature on histopathological features and prognosis].

A case of Wilms' tumor in a 57-year-old woman is reported. She was with a complaint of a palpable mass on the right upper abdomen. CT scan showed a non-hemogenous mass arising from the lower pole of the right kidney. After transarterial embolization, right transabdominal radical nephrectomy was performed under the diagnosis of renal cancer. Histopathological study revealed Wilms' tumor stage 2. Over the two years after surgery the patient is disease-free. Wilms' tumor is rare in adults. The prognosis of adult Wilms' tumor is recognized to be poorer than that of children. Recently, Wilms' tumors in children are classified into two histopathological groups, that is "favorable histology" and "unfavorable histology" according to the cell differentiation. Based on a collection of the previous Japanese and English reports, we analyzed the relationship between the histopathological features and the prognosis in adult Wilms' tumor. Ten cases of unfavorable histology have very poor prognosis, with the two year survival rate of 22%. In contrast, that of 24 cases of favorable histology was 71%. In particular, all cases of the epithelial predominant type presenting favorable histology, including stag 4 cases, survived over two years. Our case was the epithelial predominent type presenting favorable histology. That is probably one of the chief reasons of the good prognosis. In conclusion, the above-mentioned results show that in adult Wilms' tumor, the prognosis of unfavorable histology is very poor, but that of a low stage or the epithelial type presenting favorable histology is, as in children, relatively good.

Aged↗

[Prognosis of renal cell carcinoma coexisting with renal cystic diseases--results of nation-wide survey in Japan].

OBJECTIVE: To study the outcome of the patients with renal cell carcinoma (RCC) coexisting with renal cystic disease. SUBJECTS AND METHODS: The nation-wide survey conducted in 1989 enrolled 223 patients with RCC coexisting with renal cystic disease. Of those 223, we could follow up 216 patients in the second survey in 1994. RESULTS: Renal cystic diseases coexisting with RCC included simple renal cysts in 69 cases, acquired cystic disease of the kidney (ACDK) in 61, cystic RCC in 54, multilocular renal cysts in 19, polycystic kidney in 3, miscellaneous cysts in 9, and unspecified cyst in 1. The overall 5-year survival was 84%. The mean survival of the patients without any symptoms was significantly higher than that of those with symptoms. The survival of those with ACDK was lowest, and that will cystic RCC was highest. The survival was significantly different between the two groups, however the disease specific survival excluding the effect of dialysis was not significantly different between the two groups. Regarding TNM category, those with pT1 or pT2, comprising 87% of the subjects, carried a prognosis more favorable than those with pT3 or pT4. Among those undergoing cyst puncture (47 patients), positive cytology resulted in poorer prognosis. However, there was no such difference in the prognosis between punctured group and non-punctured group. CONCLUSION: Those with RCC coexisting with renal cystic disease carried a favorable prognosis. Cyst puncture were not concluded to exert an unfavorable effect on the prognosis at least in this study.

Adult↗

[Study on the relationship between tumour necrosis factor gene polymorphism and prognosis in the patients with renal cell carcinoma].

BACKGROUND: Clinical significance of polymorphism of tumour necrosis factor (TNF) genes encoded on the short arm of the 6th chromosome in the patients with renal cell carcinoma (RCC) has not been evaluated well so far. We studied on the TNF genes polymorphism of RCC focusing on the relationship between the genetic polymorphism and the prognosis. METHODS: The subjects were seventy-three patients with RCC treated at our hospitals during the past 20 years. The genomic DNA was examined by the methods of polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) from frozen peripheral blood of these patients. The items examined were the genetic polymorphisms of TNF-alpha (alpha 1, alpha 2) and TNF-beta (beta 1, beta 2), and we tried to study on the prognostic outcome of RCC based upon each zygote of TNF. RESULTS: 1) The proportion of TNF-alpha and TNF-beta polymorphisms: We observed TNF-alpha 1/1 homozygote in 71 patients (97.3%). As to TNF-beta polymorphism, we observed TNF-beta 2/2 homozygote in 33 patients (45.2%), TNF-beta 1/2 heterozygote in 31 (42.5%) and TNF-beta 1/1 homozygote in 9 (12.3%). The proportion of TNF-beta polymorphism was almost the same as that of healthy Japanese. 2) PROGNOSIS: Regarding the 17-year survival, all patients with TNF-beta 1/1 homozygote were alive, and we observed a significantly favourable prognosis in the patients with TNF-beta 1/1 homozygote compared with other zygotes of TNF-beta polymorphism. The reasons for these favourable prognosis were thought that the patients with TNF-beta 1/1 homozygote showed much lower stage and/or grade than those of other zygotes. CONCLUSION: We conclude that the TNF-beta gene polymorphism is a useful marker for understanding the prognosis of RCC and a part of cellular immunity related to the tumour and its host.

Adult↗