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PubMed1998

Translocation (3;21;8)(q21;q22;q22) in a patient with acute myeloid leukemia. A case report and review of prognostic indicators.

We report a patient with acute myeloid leukemia (AML) and t(3;21;8)(q21;q22;q22). This translocation has not been previously described in de novo or relapsed AML. The patient is a 25-year-old woman who presented with WBC 6.2 x 10(9)/L, Hgb 10.2 g/dL, Hct 28.4%, and platelets 67 x 10(9)/L. A bone marrow biopsy revealed a 70% hematopoietic cellularity with 65% blasts. Immunophenotyping showed aberrant expression of lymphoid-associated marker CD19. Cytogenetic analysis on a 72-hour culture of bone marrow cells supplemented with conditioned media was evaluated by G-banding at about the 400-band level. The patient's age, cytogenetics, WBC, and immunophenotype at diagnosis would seem to suggest a favorable prognosis, according to previous studies of prognostic indicators. She was treated with induction and consolidation chemotherapy, followed by myeloablative conditioning and autologous peripheral blood stem cell transplant (PBSCT). Despite multiple favorable prognostic factors, the patient relapsed 7 months after PBSCT. Translocation of chromosomes 8 and 21 is common in AML and is generally considered a good prognostic factor. We suspect that the effect of the 3q21 translocation in an otherwise favorable translocation of chromosomes 8 and 21 may be responsible for this patient's early relapse.

Adult↗
PubMed2005

Longterm results and prognostic indicators after cryotherapy and hepatic arterial chemotherapy with or without resection for colorectal liver metastases in 224 patients: longterm survival can be achieved in patients with multiple bilateral liver metastases.

BACKGROUND: Only a minority of patients are suitable for liver resection for colorectal liver metastases. Cryotherapy was the first widely used ablative technique, achieving a median survival of more than 2 years. Patient selection is important, but the prognostic criteria have been controversial. The combined treatment modality of cryotherapy, resection, and hepatic arterial chemotherapy has been used in treating unresectable liver disease. Many centers would not surgically treat patients with multiple (five or more lesions) bilateral liver metastases. This series reports on longterm results after cryotherapy and hepatic arterial chemotherapy with or without liver resection in 224 patients with colorectal liver metastases, especially in patients with multiple bilateral liver disease, and identifies important prognostic determinants for survival. STUDY DESIGN: A longterm retrospective analysis was performed of prospectively collected clinical data of 224 patients with colorectal liver metastases who received cryotherapy and hepatic arterial chemotherapy with or without resection. Morbidity, mortality, recurrence, and survival rates were reported and Kaplan-Meier and Cox regression analysis were used to identify prognostic indicators. RESULTS: Median length of followup was 26 months (range 1 to 130 months). Perioperative mortality rate was 0.4% and morbidity rate was 21%. Cryosite, remaining liver, and extrahepatic recurrence rates were 39%, 62%, and 67%, respectively. Median survival was 31 months (range 1 to 130 months) with 1-, 3-, and 5-year survival rates of 87%, 43%, and 23%, respectively. Ninety-one patients had five or more bilateral lesions. Median and 5-year survival was 31 months (2 to 88 months) and 26%, respectively. Four factors were independently associated with favorable survival outcomes: cryotherapy with resection, complete tumor eradication, low pre- and postoperative CEA levels. CONCLUSIONS: Cryotherapy and hepatic arterial chemotherapy with or without resection can achieve long survival advantage in patients with unresectable colorectal liver metastases.

Aged↗
PubMed2000

VEGF, flt-1, and KDR/flk-1 as prognostic indicators in endometrial carcinoma.

OBJECTIVE: Tumor angiogenesis is a highly regulated process under the influence of the host microenvironment and mediators. Studies of breast cancer and, more recently, ovarian and cervical cancer, demonstrate that neovascularization correlates with the likelihood of metastasis and recurrence. Vascular endothelial growth factor (VEGF), an important regulator of tumor angiogenesis in the endometrium, flt-1, and KDR/flk-1 are good markers of vascular proliferation. Being that angiogenesis is a precursor to the development of progressive disease, we hypothesize that quantifying VEGF, flt-1, and KDR/flk-1 expression in uterine malignancies is a superior predictor of metastatic potential and survival than is FIGO grade of tumor, depth of invasion, and histology. METHODS: The histologic slides of 47 patients with uterine malignancies (35 adenocarcinomas, 6 papillary serous, and 6 carcinosarcomas) were reviewed. The paraffin blocks from the primary tumor were obtained. Immunohistochemistry staining was performed for VEGF, flt-1, and KDR/flk-1. Microvessel density, used to analyze VEGF and receptor concentrations, was determined by two independent investigators, who were blinded to the patients clinical status. The impact of VEGF, flt-1, and KDR/flk-1 as well as stage, grade, depth of invasion, and nodal status on the incidence of metastases, recurrence, and survival was determined using logistic regression analysis and product limit life system survival analysis, respectively. RESULTS: Results indicated that when evaluating all three histologic types, only stage and grade of tumor were found to impact upon the incidence of recurrence and survival. When patients with carcinosarcoma and papillary serous adenocarcinoma were excluded from the analysis, once again only stage and grade of tumor were significant prognostic indicators of recurrence and survival. Only grade of tumor and depth of uterine invasion were significant predictors of a tumor's metastatic potential. VEGF, flt-1, and KDR/flk-1 proved to be of little significance in predicting metastases, recurrence, and survival. Patients with advanced disease in all three histologic subtypes often had low VEGF and receptor positivity. CONCLUSIONS: In this study, VEGF, flt-1, and KDR/flk-1 receptor concentrations did not correlate with the incidence of metastases, recurrence, and survival.

Adenocarcinoma↗
PubMed1987

Carcinoembryonic antigen as a prognostic indicator in the radiotherapeutic management of rectal cancer.

Carcinoembryonic antigen (CEA) levels have been assessed retrospectively in a group of 32 patients with inoperable or recurrent carcinoma of the rectum treated with radiotherapy. Complete clinical regression of pelvic disease was only achieved in patients with pre-treatment CEA levels less than 30 ng/ml when no metastases were present. Pre-treatment CEA assay has a place as a prognostic indicator in the radiotherapeutic management of inoperable or recurrent carcinoma of the rectum.

Carcinoembryonic Antigen↗
PubMed2003

Des-gamma-carboxy prothrombin (DCP) ratio, a novel parameter measured by monoclonal antibodies MU-3 and 19B7, as a new prognostic indicator for hepatocellular carcinoma.

BACKGROUND/AIM: Recently, a novel des-gamma-carboxy prothrombin (DCP) antibody named 19B7 has been developed. It has been reported that the DCP ratio defined by DCP measured by MU-3 antibody/DCP measured by 19B7 antibody demonstrated differences between hepatocellular carcinoma and vitamin K deficiency. The aim of this study was to clarify the relationship between the DCP ratio and tumour malignancy, as well as the prognostic significance of the DCP ratio after hepatectomy for hepatocellular carcinoma. METHODS: From January 1996 to December 1999, 79 patients diagnosed with hepatocellular carcinoma underwent hepatectomy. To detect DCP in the plasma before surgery, we used a new EIA kit, Eitest PIVKA-II kit (Eisai, Tokyo, Japan) with both MU-3 and 19B7 antibody. The DCP ratio was calculated using the formula: DCP ratio = DCP level measured by MU-3 antibody (mAU/ml)/DCP level measured by 19B7 antibody (mAU/ml). Pathologic findings using resected specimens were classified according to the Japanese General Rules for Primary Liver Cancer. RESULTS: Among DCP-positive patients, the DCP ratio was significantly higher in those with tumour thrombus in the portal vein (vp) or with a moderately or poorly differentiated hepatocellular carcinoma than in those without vp or with a well-differentiated carcinoma (P = 0.0162, 0.0109, respectively). Patients with DCP ratio > 3 had a significantly higher incidence of vp than those with DCP ratio < or = 3 (P = 0.0027). The survival rate was significantly higher in patients with DCP ratio < or = 3 than in those with DCP ratio > 3 (P = 0.0002). This result was the same as in DCP positive cases (P = 0.0027). CONCLUSIONS: The DCP ratio can distinguish DCP produced by hepatoma cells from DCP produced by normal hepatocytes in vitamin K deficiency. The DCP ratio is a useful prognostic indicator that can be assessed before hepatectomy.

Aged↗
PubMed2003

Retinoic acid receptor-alpha as a prognostic indicator in oral squamous cell carcinoma.

Retinoids reverse potentially malignant lesions and inhibit the development of second primary tumors in oral cancer patients by binding to nuclear retinoid receptors. Alterations in the expression of retinoid receptor-alpha are implicated in tumor progression. Herein, we hypothesized that increased expression of RARalpha protein in oral squamous cell carcinoma (SCC) is associated with a poor clinical outcome and thus may serve as a prognostic factor. Retrospective immunohistochemical analysis of RARalpha protein expression was carried out in paraffin-embedded tissue sections from 115 patients with completely resected oral SCCs for whom clinical follow-up data were available. Increased expression of RARalpha protein was observed in 67/115 (58%) oral SCCs (weakly positive in 38 patients and strongly positive in 29 patients). Kaplan-Meier analysis showed that patients with RARalpha positivity had significantly shorter disease-free survival time (median time 40 months vs. 86 months, p = 0.0229). Furthermore, disease-free survival time of the 29 patients with strongly positive RARalpha was significantly worse than for the 86 patients with weak or undetectable levels of RARalpha (p = 0.0328). Strong RARalpha expression in oral SCCs was associated with a significantly worse disease-free survival, suggesting that RARalpha may serve as a prognostic indicator of poor clinical outcome. Further studies are warranted to determine its utility in identifying the subset of patients who would benefit from use of retinoids as adjuvant in chemotherapy or chemopreventive approaches.

Adult↗
PubMed1977

The multiple techniques approach to behavioural psychotherapy: a retrospective evaluation of effectiveness and an examination of prognostic indicators.

A retrospective evaluation of the multiple techniques approach to behaviour therapy is described. The effectiveness of the approach seems to compare favourably with a single-technique approach as far as can be ascertained. The observed improvement can be attributed to some aspect of the treatment package and not to 'spontaneous remission' factors. A prospective trial would not seem valuable, providing the problems of replication can be solved. An examination of prognostic indicators reveals a range of variables associated with outcome. Amongst the diagnostic groups, the 'social phobics' and 'anxiety states' did poorly. A number of general adjustment variables also seemed important, particularly marriage, and social and vocational adjustment. The implications of these findings for the nature and deployment of services and briefly discussed.

Adult↗
PubMedDate not supplied

New prognostic indicators in resectable breast cancer (review).

Despite advances in early diagnosis and primary treatment of breast cancer with surgery, radiation therapy or both modalities, more than one-third of newly diagnosed patients will develop recurrent or systemic disease and ultimately die. In recent years, systemic adjuvant treatment has shown positive results in high-risk women and tumor mortality has significantly decreased in patients entered clinical trials. This review outlines old and new prognostic indicators which will enable clinicians to improve the selection of patients who are real candidates to adjuvant chemotherapy and/or hormonal therapy.

Antibodies, Monoclonal↗
PubMed1996

C-erbB-3 in human breast carcinoma: expression and relation to prognosis and established prognostic indicators.

A series of 346 patients with primary operable breast cancer and a series of 145 patients with advanced breast cancer were investigated for c-erbB-3 protein expression using the monoclonal antibody RTJ1. Formalin-fixed, paraffin-embedded tumour samples were stained using a standard immunochemical method and staining was assessed on a four-point scale. The study aimed to observe the expression of the c-erbB-3 protein and investigate any relationship between expression and established prognostic indicators and prognosis. In both the primary and advanced series breast tumour tissue was found to stain heterogeneously for c-erbB-3. The staining was observed to be predominantly cytoplasmic and the majority of tumours exhibited moderate positivity. However, 15% and 35% of cases in the primary operable and advanced series respectively displayed strong positive staining. No significant difference was found between the staining in the primary and advanced series. In the primary operable breast cancers, no significant associations were demonstrated with overall survival, disease-free interval, regional recurrence, the presence of distant metastases, age, menopausal status, oestrogen receptor status, histological grade, lymph node stage, vascular invasion and c-erbB-2 protein expression. However, a significant association was seen between the degree of c-erbB-3 immunoreactivity and both tumour size (P < 0.01) and tumour type prognostic group (P = 0.05). No overall association with local recurrence was seen when the four groups of c-erbB-3 expression were analysed (P = 0.12), but when those tumours showing no or weak staining were compared with those showing moderate and strong immunoreactivity it was seen that the latter were significantly more likely to develop local recurrence (P = 0.03). In the series of patients with advanced disease, no significant associations were demonstrated with survival, UICC criteria, age, menopausal status, oestrogen receptor status, histological grade, c-erbB-2 status or the presence of vascular invasion. In conclusion this study found variable expression of c-erbB-3 protein in human breast carcinoma and an association with some recognised prognostic factors in those patients with primary operable breast carcinoma. It seems, however, unlikely that c-erbB-3 protein expression will emerge as a powerful enough prognostic factor to be of value in clinical practice.

Adult↗
PubMed1993

Thymidine uptake in vitro as a prognostic indicator for primary gastric cancer.

BACKGROUND: Prognostic significance of in vitro thymidine uptake by cancer cells remains unclear in patients with gastric cancer. METHODS: In 173 patients with operable gastric cancer, the relations between thymidine uptake by gastric cancer cells in semi-solid media and their clinicopathologic features as well as their survival lengths were studied. RESULTS: There were significant correlations between in vitro thymidine uptake and such clinicopathologic features as lymph node metastasis (P = 0.00002), lymphatic invasion (P = 0.003), vessel invasion (P = 0.006), peritoneal metastasis (P = 0.010), depth of invasion (P = 0.011), and hepatic metastasis (P = 0.032). Ninety-five of 173 cancers (54.9%) that incorporated 1000 or more cpm in a single well were designated as being a high uptake group. Other gastric cancers (78 of 173; 45.1%) were designated as being a low uptake group. The overall survival rate of the patients was demonstrated to be significantly longer in the group with a low thymidine uptake than with a high uptake (P < 0.00001). The multivariate analysis showed that thymidine is one of the two variables that are the most highly correlated with the probability of patient death (P = 0.00044). CONCLUSIONS: These results indicated that in vitro thymidine uptake is an independent prognostic parameter for gastric cancer and may be useful for selecting patients who would benefit from more intensive therapy.

Aged↗
PubMed1998

A prospective study of the significance of gene and chromosome alterations as prognostic indicators of breast cancer patients with lymph node metastases.

In 150 surgically resected primary breast carcinomas that had axillary lymph-node metastases, we examined the incidence of loss of heterozygosity on chromosomes 16p, 16q, 17p, 17q, and 18q, point mutation of the p53 tumor-suppressor gene, nuclear immunoreaction of p53 protein, and amplifications of the c-erbB-2 and int-2 oncogenes by Southern blotting, single-strand conformation polymorphism analysis, and immunohistochemistry. We analyzed the association of these factors and conventional prognostic parameters with outcome of the patients, using Cox's univariate and multivariate analyses. The univariate analysis revealed that nuclear p53 immunoreaction, p53 mutation, and c-erbB-2 amplification as well as the number of metastatic lymph nodes, histological grade, and hormone-receptor statuses were significant prognostic indicators for both recurrence and cancer death. p53 immunoreaction was correlated more strongly with a poor prognosis than p53 mutations. The combination of p53 and c-erbB-2 effectively identified the high-risk patient group, and even among Grade 3 cases the subgroup with these alterations tended to have poorer clinical outcomes. The multivariate analysis including p53, c-erbB-2, and conventional factors. Lymph node status, grade, and p53 had independent impacts on the survival of patients. Under identical adjuvant systemic therapies, prognoses differed between the patient groups with and without alterations of p53 or c-erbB-2. Appropriate combinations of conventional factors with nuclear p53 immunoreaction and c-erbB-2 amplification would help to identify highly aggressive node-positive breast carcinomas and would aid stratification of patient groups in randomized clinical trials of adjuvant systemic therapies.

Adult↗
PubMed2004

Influence of abnormal screens on delays and prognostic indicators of screen-detected breast carcinoma.

BACKGROUND: Delay to diagnosis following an abnormal screening result is associated with morbidity such as anxiety, but its effect on prognosis is unknown. METHODS: Using data from the Somme area breast cancer screening programme (France), we identified 29,511 women aged 50-69 years who underwent screening between 1996 and 2000. We prospectively followed women with an abnormal screening result until completion of the assessment process and evaluated the effect of delay to notification, diagnosis and treatment on prognostic indicators. RESULTS: Women with high-suspicion screens (n=976) compared with those with intermediate-suspicion screens (n=1008) were investigated more promptly, presented larger tumours (62% vs 42%, p=0.03), and were more likely to be lymph node positive (36% vs 17%, p=0.02). Compared with a delay to diagnosis </=1 month, the odds ratio for tumour size greater than 10 mm was 1.4 (95% confidence interval[CI], 0.90-1.90) for a delay of 1 to </=6 months, and 1.8 (95% CI, 1.02-2.85) for a delay >6 months. Similarly, a 1.4-fold and 2-fold increased risk of lymph node involvement was observed for delays of >3 to </=6 months and >6 months, respectively, compared with the reference interval. CONCLUSION: The authors' findings suggest that women with high-suspicion mammograms were investigated more promptly, and that delays to diagnosis of asymptomatic breast carcinoma >6 months were associated with progression of the cancer measured by tumour size >10 mm and lymph node metastasis.

Aged↗
PubMed1980

Prognostic indicators in ocular hypertension.

Decreased pupil size and lens opacity, rather than high intraocular pressure, have been cited as reasons for the concentric constriction of the visual field occurring in eyes with suspected glaucoma. We studied a group of eyes showing ocular hypertension and found increased concentric constriction of the visual field when compared with that of healthy control eyes. While the degree of constriction and patient age tended to predict the transition to glaucoma, we found the absence of hypermetropia to be a strong prognostic indicator.

Adult↗
PubMed1997

Comparative analysis of prognostic indicators of aspergillosis in haematological malignancies and HIV infection.

The objective of this study was to identify the prognostic factors influencing the outcome of aspergillosis in two models of immunodeficiency, namely haematological malignancies and HIV infection. The study is based on a 5 year prospective logistic regression analysis of risk factors, clinical features, radiological findings and therapy affecting the prognosis of aspergillosis in 43 patients, i.e. 27 haematological neoplastic patients (group A) and 16 HIV infected patients (group B). Univariate analysis indicated that neutropenia (P = 0.02), haemoptysis (P = 0.03) and concomitant AIDS (P = 0.02), negatively influenced the prognosis of aspergillosis. Comparing the two groups of patients, significant differences emerged in the prognostic indicators. In particular respiratory failure (P = 0.02) and radiological bilateral involvement of the lungs were associated with a poor prognosis in group A (P = 0.04) and low (2100/mm3) T CD4+ cell count in group B (P = 0.02). At variance, a better prognosis was documented in patients treated with sequential therapy (amphotericin B and itraconazole) only within the group of haematological patients (P = 0.003). On multivariate analysis sequential therapy (P = 0.01) and AIDS (P = 0.03) were independent prognostic indicators of aspergillosis. In conclusion, our prospective study indicates that aspergillosis, although an uncommon event in patients with HIV infection, has a more severe prognosis in comparison to haematological patients. Future prospective clinical trials are necessary to confirm the real importance of the sequential therapy, with amphotericin B and itraconazole, in patients with aspergillosis.

Adult↗
PubMed1996

[The expression of c-myc protein in uterine cervical cancer: a possible prognostic indicator].

Forty-eight cases of human uterine cervical cancer were examined for the expression of c-myc protein by immunohistochemical staining. The overexpression of c-myc was detected in 17 of 48 cases (35%), which is consistent with previous reports. The frequency of c-myc overexpression was not associated with the clinical stage. Relapse was observed in 7 of 15 cases (47%) which had overexpression of c-myc (mean follow-up period: 35 months), whereas relapse was observed in only 3 of 30 cases (10%) which did not overexpress c-myc (mean follow-up period: 33 months). The five-year survival rate was significantly lower in the cases overexpressing c-myc than in those not overexpressing it. This indicates that the overexpression of c-myc may be associated with a high risk of relapse and poor prognosis. We also analysed the correlation between lymph node metastasis, cervical stromal invasion and c-myc overexpression, and did not find any correlation between them. These results suggest that the overexpression of c-myc in cervical cancer may be a prognostic indicator for predictive testing.

Adenocarcinoma↗
PubMedDate not supplied

Plasma enzymes and metabolites as potential prognostic indices of ovine pregnancy toxaemia--a preliminary study.

Three ewes with naturally occurring pregnancy toxaemia and increased plasma glucose concentrations within 24 h of the onset of clinical signs, made a complete recovery following treatment with a concentrated oral rehydration solution. Four ewes in which plasma glucose concentrations fell did not recover. Ewes with elevated plasma alkaline phosphatase concentrations were slower to recover than ewes with normal plasma alkaline phosphatase concentrations. These findings suggest that plasma alkaline phosphatase concentration and change in plasma glucose concentration might offer useful prognostic indices in cases of ovine pregnancy toxaemia, and influence a decision to perform an elective caesarean operation. Further studies using a larger number of ketotic ewes are necessary before firm conclusions can be made.

Alkaline Phosphatase↗
PubMed1992

Expression of oncogenic antigen 519 (OA-519) in prostate cancer is a potential prognostic indicator.

Predicting the prognosis of patients with prostate cancer is a clinically important problem. Previous studies have indicated that the expression of haptoglobin-related protein epitopes in samples of breast cancer in early stages was associated with earlier relapses and higher risk for tumor recurrence. Oncogenic antigen 519 (OA-519) is the new marker designation for molecules expressing haptoglobin-related protein epitopes. The objective of this immunohistochemical study was to examine OA-519 expression in prostate cancer samples and its relationship to the established prognostic indicators of tumor grade, tumor volume, and clinical stage. Forty-two consecutive tissue samples of prostate adenocarcinoma were examined using an affinity-purified anti-OA-519 antibody. Twenty specimens (48%) tested positive, whereas 22 (52%) tested negative. No staining was observed in normal or hyperplastic prostate tissue. Staining occurred in 6 of 9 (67%) grade III, 14 of 23 (61%) grade II, and in none of 10 (0%) grade I cases (I vs. II and/or III: Fisher exact test, P less than 0.006). Twenty-three of the 42 samples were transurethral resection specimens with cancer; 11 (48%) of these tested positive. The mean percentage of tissue chips with tumor, a measure of tumor volume, was significantly higher in the positive group (57%) than in the negative group (15%) (P = 0.004). The proportion of positively stained cases increased with advancing clinical stage, with 25% of Stage A cases expressing OA-519, and 46%, 67%, and 64% of Stages B, C, and D, respectively, expressing OA-519. OA-519 expression correlates with higher tumor grades, larger tumors, and possibly with advanced stage, and thus, it is potentially of prognostic value in prostate cancer.

Antigens, Neoplasm↗
PubMed1987

The ratio of lipidperoxides to superoxide dismutase activity in the skin lesions of patients with severe skin diseases: an accurate prognostic indicator.

We studied 35 patients with active inflammatory skin diseases, measuring the levels of lipidperoxides and of the oxygen radical scavenging enzyme superoxide dismutase (SOD) in biopsy specimens of skin lesions. Lipidperoxide levels were markedly elevated in all patients. In fifteen patients with disease that was severe and highly resistant to therapy, SOD activity was only slightly increased, in comparison with normal controls. In contrast, in the twenty patients with mild disease that responded well to therapy, SOD activity was markedly elevated. The ratio of lipidperoxide levels to SOD activity was thus an accurate prognostic indicator, being elevated only in the group not responding to treatment. These findings suggest that the severity of allergic inflammatory skin disease and/or the response to treatment may in part be governed by the degree to which the patient's SOD activity is up-regulated in response to the generation of tissue-damaging substances such as lipidperoxides. Interestingly, our studies revealed the SOD activities of both normal and inflamed skin to be unexpectedly high; our data suggest that SOD plays a critical role in protecting the skin from the effects of oxygen radicals and ultraviolet light.

Adolescent↗