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PubMed1998

Construction and validation of a practical prognostic index for patients with metastatic breast cancer.

PURPOSE: To identify the readily available prognostic factors most helpful in predicting survival and to construct and validate a prognostic index for metastatic breast cancer (MBC) patients. PATIENTS AND METHODS: Data from 233 MBC patients, accrued on a multiinstitutional randomized phase III trial (Japan Clinical Oncology Group [JCOG] study 8808), were analyzed to identify significant prognostic factors and a prognostic index was constructed by incorporating these prognostic factors. For validation of the prognostic index, another data set from 315 consecutive MBC patients, who had been treated with standard anthracycline-containing regimens, was analyzed. RESULTS: In multivariate regression analyses, history of adjuvant chemotherapy (ADJCT) (P = .0005), presence of distant lymph nodes (DLNs) (P = .0117) and liver (HEP) (P = .0099) metastases, elevation of serum lactate dehydrogenase (LDH) (P < .0001), and shorter disease-free interval (DFI) (P < .0001) significantly contributed to poorer survival. The prognostic index was constructed as follows: Prognostic Index = ADJCT (not received = 0, received = 1) + DLNs (absent = 0, present = 1) + HEP (absent = 0, present = 1) + LDH (< or = one times normal = 0, > one times normal = 1) + DFI (> or = 24 months = 0, < 24 months = 2). With this prognostic index, patients could be stratified into three risk groups. The median survival times (MSTs) of low-, intermediate- and high-risk groups were 45.5, 24.6, and 10.6 months, respectively (P < .0001). This prognostic index was applied to the validation patients. The respective MSTs for each risk group were 49.6,22.8, and 10.0 months (P < .0001). CONCLUSION: ADJCT, DLNs, HEP, LDH, and DFI were important prognostic factors for MBC patients. The prognostic index readily enables MBC patients to be stratified into three risk groups and is worth considering for future clinical trials.

Analysis of Variance↗
PubMed2003

Usefulness of a new Doppler index for assessing both ventricular functions and pulmonary circulation in newborn piglet with hypoxic pulmonary hypertension.

Persistent pulmonary hypertension of the newborn is a clinical syndrome associated with a variety of cardiopulmonary diseases. Serial evaluation of pulmonary circulation and cardiac function is important, but available imaging techniques have been limited. A new Doppler index combining systolic and diastolic time intervals (the Tei index, which is a simple and noninvasive measurement) has been reported to be useful for the assessment of global cardiac function in adults and children. The purpose of this study was to test the effectiveness of the Tei index in prospectively assessing ventricular function and pulmonary circulation in a newborn piglet model with hypoxic pulmonary hypertension. One-day-old piglets (1.1-1.6 kg) were intubated and prepared for the experiments under room air and hypoxia. A complete two-dimensional Doppler echocardiographic examination was performed. Common hemodynamic variables were measured continuously throughout the study. The right ventricle (RV) Tei index under hypoxia (fraction of inspired oxygen = 0.10) was significantly higher than the value under air ventilation (medians, 0.38 versus 0.56; p < 0.05). Moreover, there was a significant correlation between RV Tei index and mean pulmonary artery pressure and positive linear correlation between individual changes in RV Tei index and changes in mPAP (r2 = 0.799, p < 0.05). We conclude that the Tei index is useful for assessing the function of the RV and the left ventricle and pulmonary circulation in a newborn piglet model with hypoxic pulmonary hypertension. These results suggest that the Tei index will become an objective method of assessing patients with persistent pulmonary hypertension of the newborn.

Animals↗
PubMed2005

Effects of exercise training on left ventricular function evaluated by the Tei index in patients with myocardial infarction.

BACKGROUND: This study investigated the influence of exercise training on left ventricular (LV) function in patients with acute myocardial infarction (AMI) using a new index of cardiac function, the Tei index. METHODS AND RESULTS: The study enrolled 53 consecutive patients (36 males, 17 females; mean age: 65+/-10 years) with AMI. Exercise training was performed for 6 months; peak VO2 and the Tei index were measured at the start of the cardiac rehabilitation program and 1, 3, and 6 months later. The peak VO2 improved from 14.3+/-3.3 to 18.5+/-5.2 ml.min -1.kg-1 after 6 months (p<0.01). Although there were no significant changes in LV ejection fraction over the 6 months, the Tei index improved from 0.50+/-0.18 to 0.41+/-0.19 (p<0.05). When the DeltaTei index was compared among the 3 groups classified by the Tei index at baseline, the values improved in the groups with high/slightly high values compared with the normal group. CONCLUSION: Both cardiac function, as evaluated by the Tei index, and exercise capacity improved after exercise training in patients with AMI. The greater improvement was seen in the population with the higher value (lower cardiac function) according to this index.

Acute Disease↗
PubMed1994

Graded-index model of a fish double cone exhibits differential polarization sensitivity.

The close apposition of the inner segments of the two cones that combine to form a double cone causes the pair of cone inner segments to guide light as a unitary structure whose transverse sections are roughly elliptical. Electron micrographs of the photoreceptors of a green sunfish (Lepomis cyanellus) retina provide evidence that the refractive index in the ellipsoid region of the inner segments of the double cones is higher in the center than at the perimeter. The hypothesis that the shape and refractive-index gradient could confer differential polarization sensitivity on double cones is examined with a two-dimensional waveguide model of a double-cone inner segment. The model has a dielectric constant that varies parabolically along the narrowest (x) dimension, leading to the index profile: n(x) = nmax[1-(x/x0)2]1/2, where nmax is the peak value of the index and x0 is a parameter specifying the rate at which the index decreases with increasing magnitude of x. A quantity, the polarization contrast, is introduced as a measure of the differential polarization sensitivity of adjacent receptors in the square mosaic of double cones in the sunfish retina. Polarization contrast is proportional to the relative difference in power absorbed by two double cones oriented with their shortest axes orthogonal to each other and stimulated by a field of uniform polarization. Polarization contrast is computed as a function of wavelength for appropriate values of nmax and x0. For normally incident light polarized parallel to one of the two axes of the double cones' cross sections, the polarization contrast is generally between 1% and 5% for wavelengths ranging from 550 to 750 nm. Over most of those wavelengths the polarization contrast of the graded-index-model double cone is approximately five times as large as that of a homogeneous-slab model of the same size and average refractive index. Additional benefits of a graded index, optical isolation of adjacent photoreceptors and antireflection at the photoreceptor entrance, are also discussed.

Animals↗
PubMed2004

The ponderal index in triplets: I. Relationship to small for gestational age neonates.

The aim of the study was to examine the ponderal index in small for gestational age (SGA) triplets. Prospectively collected data from a cohort of triplets born at 28 to 37 weeks were analyzed. A low neonatal ponderal index (birth weight/[length]3) was defined as less than 1 SD below the mean (2.0), and SGA was considered as birth weight below the 10th percentile by triplet standards. We studied 2181 sets of triplets. Triplets delivered at < or = 33 weeks have a lower mean ponderal index compared with those delivered at > 33 weeks. About 70% of SGA triplets do not have a low ponderal index, whereas 79.2% of infants with a low ponderal index are not SGA by triplet standards. Both the frequency of a low ponderal index and the frequency of infants with a low ponderal index who are not SGA decrease with increasing gestational age. We conclude that the majority of triplets with a low ponderal index might not be considered growth restricted, supporting the concept that reduced fetal weight of triplets is more likely a physiological rather than a pathological phenomenon.

Anthropometry↗
PubMed1999

Estimation of left ventricular function in right ventricular volume and pressure overload. Detection of early left ventricular dysfunction by Tei index.

Although the effects of right ventricular (RV) volume and pressure overload (RVVO and RVPO) on ventricular septal motion are different, the differential effect on left ventricular (LV) function is still controversial. The Doppler-derived index (Tei index) combining systolic and diastolic ventricular function, defined as the sum of isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT) divided by ejection time (ET), has been demonstrated to be a useful index to estimate LV function and to predict the prognosis of patients with congestive heart failure. This study was designed to evaluate the differential effects of RVVO and RVPO on LV function using the Tei index. Study patients consisted of 26 age-matched normal subjects, 22 patients with atrial septal defect (ASD) with normal or borderline RV pressure and 25 with primary pulmonary hypertension (PPH). All subjects had normal LV ejection fractions measured with 2-dimensional echocardiogram using biplane Simpson's method (61 +/- 4 vs 61 +/- 4 vs 63 +/- 8%, normal vs ASD vs PPH). Tei index was easily obtained in all subjects from transthoracic Doppler echocardiogram of LV inflow and outflow. Patients with ASD had normal ICT, IRT and ET, resulting in normal Tei index, however, patients with PPH had significantly prolonged ICT and IRT with shortened ET, resulting in a significant increase in Tei index (0.38 +/- 0.04 vs 0.36 +/- 0.03 vs 0.61 +/- 0.22, p < 0.001). Although RVVO due to ASD has no significant effects on LV function, RVPO due to PPH can adversely affect LV function. The Tei index is a simple and sensitive measure to assess LV function caused by RVVO or RVPO.

Adult↗
PubMed1993

[Experiment on validity of skin resistance level as an index of arousal level].

It is important in establishing and improving work management and work planning to estimate the arousal level of workers during operation and monitoring tasks. This paper proposes a technique based on experimental results to estimate the arousal level during job execution. In this experiment, both a monotonous low workload task which degrades the arousal level and a high workload task which has an awakening action were alternately applied to five subjects for three hours. Skin resistance level (SRL) as an index of arousal level of the autonous nervous system was measured with subjective drowsiness and task performance, that is, signal omission probability for low workload task and both reaction time and error probability for high workload task, as indexes of arousal level of the central nervous system. The following results were obtained. (1) The results suggested that SRL as an index of arousal level of the autonous nervous system is significantly related and correlated with subjective drowsiness and signal omission probability as indexes of arousal level of the central nervous system. (2) The average reaction time and the error probability tended to increase by the application of high workload when the arousal level was degraded. The influence of degraded arousal continued for a short time and showed an unfavorable effect on task execution. The degree of this influence, however, differed between subjects. (3) SRL can be used as an index of arousal level of the autonous nervous system because the measurement is comparatively easy and is little influenced by artifacts due to body movements. (4) Using SRL at initial high workload period as the standard value, it is possible to quantify the SRL value at arbitrary time by estimating how many times the standard value goes into the SRL value. Based on this quantified value as an index of arousal level, comparison with task performance can be made. The proposed index of arousal level of the autonous nervous system showed a significant correlation with indexes of the central nervous system. This technique can be applied to various kinds of estimation on human characteristics accompanied with changes in arousal level.

Adult↗
PubMedDate not supplied

Site-specific phosphorus application based on the kriging fertilizer-phosphorus availability index of soils.

Site-specific phosphorus management is done to optimize crop production and minimize P loss from soils. The spatial variability of the available P prior to fertilizer application and the P-fixation tendency of soil both need to be taken into account for variable-rate P application. The objectives of this research were to document the spatial variability of the fertilizer-P availability index, which shows the P-fixation tendency, and to develop a strategy that takes the spatial distribution of this index into account for site-specific phosphorus application. In this study, the spatial patterns of the fertilizer-P availability index were characterized by using geostatistics. The ordinary kriging was used for spatial interpolation of the fertilizer-P availability index. Because the fertilizer-P availability index of soil is related to oxalate-extractable Fe and Al and because measuring oxalate-extractable Fe and Al is much easier than directly determining the fertilizer-P availability index, the spatial distribution of the fertilizer-P availability index can be obtained using the oxalate-extractable Fe and Al data. The spatial distribution of Olsen-extractable P, which was used to measure the available-P status prior to fertilizer-P application, was also estimated by using ordinary kriging. The required fertilizer-P amounts were then determined using the kriging estimates of the fertilizer-P availability index and Olsen-extractable P. A fertilizer-P recommendation map for the 430-ha study site in Changhua county, Taiwan was generated by using this approach for illustration. The proposed method for generating fertilizer-P recommendation maps can be used for variable-rate application to maintain an adequate P status for crop production and to potentially reduce the P loss from soils.

Agriculture↗
PubMedDate not supplied

Evaluation of the phosphorus source component in the phosphorus index for pastures.

A phosphorus (P) index for pastures was developed to write nutrient management plans that determine how much P can be applied to a given field. The objectives of this study were to (i) evaluate and compare the P index for pastures, particularly the P source component, and an environmental threshold soil test P level by conducting rainfall simulations on contrasting soils under various management scenarios; and (ii) evaluate the P index for pastures on field-scale watersheds. Poultry litter was applied to 12 small plots on each of six farms based on either an environmental threshold soil test P level or on the P index for pastures, and P runoff was evaluated using rainfall simulators. The P index was also evaluated from two small (0.405 ha) watersheds that had been fertilized annually with poultry litter since 1995. Results from the small plot study showed that soil test P alone was a poor predictor of P concentrations in runoff water following poultry litter applications. The relationship between P in runoff and the amount of soluble P applied was highly significant. Furthermore, P concentrations in runoff from plots with and without litter applications were significantly correlated to P index values. Studies on pastures receiving natural rainfall and annual poultry litter applications indicated that the P index for pastures predicted P loss accurately without calibration (y = 1.16x - 0.23, r(2) = 0.83). These data indicate that the P index for pastures can accurately assess the risk of P loss from fields receiving poultry litter applications in Arkansas and provide a more realistic risk assessment than threshold soil test P levels.

Agriculture↗
PubMed1997

Glycaemic index and optimal performance.

It is widely documented that athletes should consume carbohydrates prior to, during and after exercise. Ingestion of carbohydrates at these times will optimise performance and recovery. In spite of this knowledge, there is a paucity of information available to athletes concerning the types of carbohydrate foods to select. Therefore, it is suggested that the glycaemic index may be an important resource when selecting an ideal carbohydrate. The glycaemic index categories foods containing carbohydrates according to the blood glucose response that they elicit. Carbohydrate foods evoking the greatest responses are considered to be high glycaemic index foods, while those producing a relatively smaller response are categorised as low glycaemic index foods. Athletes wishing to consume carbohydrates 30 to 60 minutes before exercise should be encouraged to ingest low glycaemic index foods. Consuming these types of foods will decrease the likelihood of creating hyperglycaemia and hyperinsulinaemia at the onset of exercise, while providing exogenous carbohydrate throughout exercise. It is recommended that high glycaemic index foods be consumed during exercise. These foods will ensure rapid digestion and absorption, which will lead to elevated blood glucose levels during exercise. Post-exercise meals should consist of high glycaemic index carbohydrates. Low glycaemic foods do not induce adequate muscle glycogen resynthesis compared with high glycaemic index foods.

Blood Glucose↗
PubMed1994

Sonography of ovarian masses: poor sensitivity of resistive index for identifying malignant lesions.

OBJECTIVE: Current research suggests that the resistive index of adnexal masses is a sensitive measure for distinguishing between benign and malignant ovarian masses. We devised a study to determine how morphologic findings on sonograms compare with the resistive index of benign and malignant lesions. SUBJECTS AND METHODS: Pelvic sonograms were obtained in 34 women with 36 adnexal masses that were likely neoplastic or non-self-limiting (such as an endometrioma). Transabdominal and transvaginal sonograms were obtained, and the resistive index was calculated. A threshold resistive index of 0.4 was used to differentiate benign from malignant lesions. Masses were characterized prospectively as probably benign or possibly malignant on the basis of their sonographic appearance. Pathologic proof was obtained for 35 masses, and one mass was diagnosed on the basis of CT findings. RESULTS: Seventeen lesions were deemed probably benign, and pathologic examination showed that all 17 were benign. The resistive index was greater than 0.4 in 14 of these 17 cases. Nineteen lesions were characterized as possibly malignant. On pathologic examination, six were benign neoplasms, five were nonneoplastic masses, and eight were malignant neoplasms. The resistive index was greater than 0.4 in 10 of the 11 benign lesions. It was less than 0.4 in only two of the eight lesions that were classified as malignant on the basis of both morphologic and pathologic findings. CONCLUSION: Sonography is sensitive but not specific for distinguishing between benign and malignant ovarian neoplasms. Although use of the resistive index might improve specificity in the assessment of possibly malignant lesions, reliance on this parameter is potentially misleading, as six of eight malignant lesions in this series were miscategorized on the basis of their resistive index.

Adult↗
PubMed1992

A numerical prognostic index for clinical use in identification of poor-risk patients with Hodgkin's disease at diagnosis. The Scotland and Newcastle Lymphoma Group (SNLG) Therapy Working Party.

The aim of this study was to assess the feasibility of using objective data obtained at the time of diagnosis of Hodgkin's disease to predict those patients who were likely to die of progressive disease within four years. Ninety-two consecutive patients from one centre (Newcastle upon Tyne) were used to construct a numerical index based on disease stage (Ann Arbor), age, haemoglobin and absolute lymphocyte count. Weight was assigned according to a predictive value from univariate and multivariate analyses based on survival. The index produced was then validated on a separate patient set (455) from other centres within the Scotland and Newcastle Lymphoma Group (SNLG) on whom the same prospective information was available. The index produced provided a useful separation of those patients destined to die of disease. In 101 patients with index > 0.5, 62 (61.4%) were dead at four years, whereas with index < 0.5, 61 (18%) of 336 patients were dead at four years. The index includes Ann Arbor stage but possesses additional practical prognostic value which allows identification of patients with early stage destined to die of disease. Of 149 patients with Stage IA and IIA disease 15 patients had index > 0.5, and 10 (60%) have died, whereas the remaining patients had survival of 90% and 85% respectively. This numerical index has now been strengthened by an added factor for bulk disease > 10 cms and in the SNLG it has replaced Ann Arbor staging for selection of patients requiring aggressive therapy. A randomized study of chemotherapy versus chemotherapy plus autotransplant in first remission using high dose melphalan and VP16 is currently in progress.

Bone Marrow Transplantation↗
PubMed2004

Significance of effector protease receptor-1 expression and its relationship with proliferation and apoptotic index in patients with primary advanced gastric adenocarcinoma.

AIM: To investigate the expression of effector protease receptor-1 (EPR-1), proliferative index ki-67 and apoptosis index in patients with primary advanced gastric adenocarcinoma and to clarify the significance of EPR-1 expression and its correlationship with the proliferation and apoptosis indexes. METHODS: Using immunohistochemical staining and terminal deoxynucleotidyl transferase mediated nick end labelling (TUNEL) technique, we determined the expression of EPR-1, proliferative index (Ki-67) and apoptotic index (AI) in 120 paraffin-embedded specimens of primary advanced gastric adenocarcinoma as well as lymph node metastasis and adjacent normal tissues. RESULTS: EPR-1 expression was distributed in the cytoplasm of normal gastric mycoderma, carcinoma cells and smooth muscle cells. The positive rate of EPR-1 expression in the primary gastric adenocarcinomas, invasion tumor node and lymph node metastasis was 65.83%, 55.29% and 68%, respectively. While the positive rate in normal gastric mycoderma and smooth muscle cells was 46.7% and 53.3%, respectively. The average positive rate of ki-67 in EPR-1-positive tumors was 7.00% which was significantly lower than that of 8.53% in EPR-1-negative tumors, but the average AI in EPR-1-positive tumors was 1.25%, which was significantly higher than that of 1.00% observed in EPR-1-negative tumors. On the other hand, the average positive labeling index for Ki-67 (ki-67) in EPR-1-positive lymph node metastasis was 7.65%, which was significantly lower than that of 9.44% observed in EPR-1-negative lymph node metastasis. However, the average AI in EPR-1-positive lymph node metastasis tumors was 0.99%, which was significantly higher than that of 0.67% observed in EPR-1-negative lymph node metastasis. CONCLUSION: The frequency of EPR-1 expression was significantly higher in primary gastric adenocarcinoma and in its lymph node metastasis than that in normal gastric mucosa. Expression of EPR-1 was significantly correlated with tumor histological subtypes and tumor differentiation. Weighted EPR-1 Score is positively correlated with apoptosis index, but is negatively related with proliferative index. Thus, Weighted EPR-1 Score and EPR-1 expression in gastric adenocarcinoma cells maybe a potential marker in clinical setting.

Adenocarcinoma↗
PubMedDate not supplied

Refractive index of the human corneal epithelium and stroma.

BACKGROUND: The refractive index of the cornea must be determined to optically perfect keratorefractive procedures. There are very few empirical measurements of the human corneal refractive index described in the literature. Throughout its depth, the cornea demonstrates regional variations in physiological properties such as swelling/de-swelling characteristics. These properties suggest there may be a difference in the refractive index between the anterior and posterior corneal surfaces. METHODS: The refractive index of the human corneal epithelium of 10 eyes was measured, in vivo, using a modified hand-held refractometer. The refractive indices of the anterior and posterior surfaces of the bare stroma of fresh human corneas were measured using a bench model Abbe refractometer. RESULTS: The mean refractive index of the epithelium, stromal anterior and posterior surfaces were 1.401 (SD +/- 0.005), 1.380 (SD +/- 0.005), and 1.373 (SD +/- 0.001) respectively. CONCLUSIONS: The refractive index of the cornea is not uniform. The calculated dioptric power of the corneal epithelium is approximately -1.40 diopters (D). The varying refractive index does not significantly affect the total dioptric power of the cornea. The varying refractive index of the cornea has the potential to significantly contribute to the overall optical performance of the eye in relation to refractive surgery. The results should be incorporated into mathematical models, comparing and contrasting the optical performance of the eye before and after surgery.

Adult↗
PubMed2006

Work ability index of young employees and their sickness absence during the following year.

OBJECTIVES: The work ability index is widely used in occupational health care. The aim of this study was to determine the extent to which a low index among young employees is predictive of sickness absence during the following year. METHODS: Altogether 3725 employees aged 31 years were followed from 1997 to 1999 as part of the northern Finland birth cohort 1966 study. The participants' self-administered questionnaires at baseline and a 1-year follow-up period with comprehensive sickness absence records was obtained from the Social Insurance Institution of Finland. The records contained only medically certified long-term sickness absences (>9 days). A multivariable logistic regression was used to examine how the work ability index and covariates were associated with sickness absence during the following year. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated for the index and its covariates. RESULTS: In a comparison with an excellent index score (>44 points), a low score (<37 points) was associated with sickness absence for both the men (OR 3.6, 95% CI 1.6-7.9) and the women (OR 6.2, 95% CI 2.9 to 13.5) after adjustment for occupation, control over work, social support at work, marital status, number of children at home, physical activity, body mass index, and alcohol consumption. Of the 518 participants with a low index, 90 had long-term sickness absence, giving a positive predictive value of 17.4% (95% CI 14.1-20.6). The negative predictive value was 93.1% (95% CI 92.3-94.0). CONCLUSIONS: For young employees, the work ability index is a practical tool for predicting long-term sickness absence, but it does not predict "no sickness absence".

Female↗
PubMed2002

Resistive index in chronic nephropathies: predictive value of renal outcome.

UNLABELLED: The study of renovascular resistances by color Doppler ultrasound has become a useful diagnostic resource for nephrologists. In recent nephrological literature, many papers deal with the correlations between resistive index, anatomo-pathological patterns and renal function. AIMS: In our study, we have tried to discover if resistive index represents a prognostic index of progressive renal failure. MATERIAL AND METHODS: To this purpose we compared renal resistive index and blood creatinine obtained from 28 nephropathic patients at their first control, with blood creatinine values after a 3-year follow-up period. Using a linear regression test, we found a strong correlation between the initial value of resistive index and the value of creatinine variation (p = 0.006). RESULTS: All of the patients with normal resistive index at the beginning maintained a stable renal function. Conversely, the patients with high resistive index at their first control showed a progressive renal failure. CONCLUSION: Our study shows the reliability of resistive index in the prognostic evaluation of renal outcome.

Adolescent↗
PubMed1986

Scientific and clinical problems in indexes of functional disability.

Indexes of functional disability are being used increasingly to rate the status of patients studied in clinical research or treated in clinical practice. To determine why so many indexes have been developed and to evaluate their scientific quality, we reviewed the construction and other attributes of 43 indexes that offer ratings for activities of daily living. The six most prominent problems, and some proposed solutions, are as follows: Ratings for the magnitude of performed tasks will be misleading unless the patient's effort or collaboration is suitably considered. Each patient's preferences should be sought to determine which types of disability are the most important goals of therapy. Special transition indexes should be developed if subtle or overt changes are not discerned from the repeated use of single-state indexes. Hierarchical scale arrangements can avoid the loss of descriptive power that occurs when multiple variables are aggregated merely as summations. Documentary evidence can be required to demonstrate the anticipated achievements of an index. New indexes can be constructed if the high statistical "reliability" and "validity" of established indexes are not accompanied by satisfactory clinical "sensibility."

Activities of Daily Living↗
PubMedDate not supplied

The role of MIB-1 index in the prognosis of resectable pancreatic head cancer.

BACKGROUND/AIMS: Cell kinetics are important indicators of the biological behavior of various human tumors. In this study, we evaluated the prognostic values of the proliferative factors including MIB-1 index, DNA ploidy and S-phase fraction, and further determined the independent prognostic factors in pancreatic head cancer after pancreatoduodenectomy. METHODOLOGY: Patients with pancreatic head cancer undergoing pancreatoduodenectomy were included. Cell proliferative parameters including MIB-1 index, DNA ploidy and S-phase fraction measured by flow cytometry were evaluated and compared with the conventional clinicopathologic factors. RESULTS: There were 21 resectable pancreatic head cancers. By univariate analysis MIB-1 index, cell differentiation and lymphovascular invasion were significant prognostic factors. The 5-year survival rate was 22.2% for overall patients and 29.2% for patients with MIB-1 < or = 11%, while it was 0% for MIB-1 index > 11%, p=0.011. Tumors without lymphovascular invasion had significantly better prognosis than those with lymphovascular invasion (median survival: 38 vs. 10 months, p=0.009). The median survival was significantly longer for well-differentiated cancers than for moderately and poorly differentiated cancers (44 vs. 11 and 9 months, p=0.038). There was no correlation between the MIB-1 index and the other 2 conventional prognostic factors. After multivariate analysis, only the MIB-1 index emerged as the independent prognostic factor. CONCLUSIONS: MIB-1 index played a significant role in the prognosis of the resectable pancreatic head cancer and could potentially complement the conventional factors in predicting the prognosis and determining the optimal treatment strategy. MIB-1 index was also an important independent prognostic factor.

Adult↗