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PubMed1989

Factors predicting recurrent restenosis after percutaneous transluminal coronary balloon angioplasty.

To identify factors that predict a second restenosis after repeat percutaneous transluminal coronary balloon angioplasty (PTCA), the records of 196 consecutive patients undergoing redilation for treatment of a first restenosis were reviewed. Repeat PTCA was successful in 181 (92%) of these patients. After a successful second PTCA, 47 patients (26%) developed a second restenosis (recurrent restenosis group, group 1) and 134 (single restenosis group, group 2) did not. The 2 patient groups were compared with respect to clinical, angiographic and procedural factors at second PTCA. Univariate correlates of a second restenosis were younger age (54 +/- 10 vs 57 +/- 9 years, p less than 0.05), interval less than 60 days between initial PTCA and recurrence of anginal symptoms (55% of patients in group 1 vs 25% in group 2, p = 0.001), a greater number of inflations (6.3 +/- 4.2 vs 4.4 +/- 2.5, p less than 0.005) and a shorter maximal balloon inflation time (49 +/- 26 vs 69 +/- 36 seconds, p = 0.0006). With multivariate analysis, the 2 factors that emerged as independent predictors of recurrent restenosis were recurrence of symptoms less than 60 days after initial PTCA (p less than 0.004) and a greater number of inflations (p less than 0.04). These data suggest that younger age and rapid recurrence of anginal symptoms after first PTCA predict an increased likelihood that a second restenosis will occur after repeat PTCA and that certain procedural factors, in particular the greater number of balloon inflations and a shorter maximal balloon inflation time, may play an important role in the development of recurrent restenosis.

Angioplasty, Balloon↗
PubMed2004

Activated factor 12 (FXIIa) predicts recurrent coronary events after an acute myocardial infarction.

BACKGROUND: Activated factor XII (FXIIa) is involved in vascular injury and repair, participating in inflammation, thrombosis, and fibrinolysis. We wanted to test the hypothesis that FXIIa may predict an acute coronary syndrome (ACS) after a myocardial infarction (MI) and to evaluate whether FXIIa is related to global markers of end-stage coagulation and inflammation, including fibrin monomer (FM) and ultrasensitive C-reactive protein (microCRP). METHODS: In a prospective study of 300 patients with acute MI, we evaluated the predictive value of FXIIa in blood samples drawn 4 to 6 days after admission. Cardiac death, re-MI, and troponin-T-positive unstable angina pectoris were registered during a median follow-up period of 1.5 years. RESULTS: In the upper quartile of FXIIa (Q4) (> or =2.23 ng/mL) 32.0% of patients had an ACS as compared with 16.9% of patients with FXIIa in the three lower quartiles (Q1-3, P =.008). Relative risk of recurrent ACS for patients with FXIIa in the Q4 as compared with Q1-3 was 1.89 (95% CI, 1.22 to 2.93). A secondary ACS occurred earlier in patients with FXIIa in the Q4 as compared with those with FXIIa in the Q1-3 (P =.0039). Conventional risk factors as potential confounders were not associated with time to event. FXIIa did not correlate with FM or microCRP, and the FM and microCRP levels were of a similar magnitude in the Q4 as compared with the Q1 and the Q1-3 of FXIIa. CONCLUSIONS: FXIIa predicts recurrent coronary events after MI. The prognostic ability of FXIIa was not reflected by markers of hypercoagulability or inflammation.

Angina, Unstable↗
PubMed2003

Comparison of preoperative prostate specific antigen density and prostate specific antigen for predicting recurrence after radical prostatectomy: results from the search data base.

PURPOSE: Prostate specific antigen (PSA) density based on the surgical weight of the radical prostatectomy specimen has previously been shown to be an independent predictor of biochemical recurrence after radical prostatectomy. We determined whether preoperative PSA density calculated using transrectal ultrasound prostate volume was a better predictor of advanced pathological findings or biochemical recurrence after radical prostatectomy relative to PSA. MATERIALS AND METHODS: We examined 552 men from the newly established Shared Equal Access Regional Cancer Hospital data base of men treated with radical prostatectomy at equal access medical centers to determine whether preoperative PSA density was a significant predictor of an adverse pathological condition or PSA recurrence after radical prostatectomy. Models using PSA density were compared with models using PSA to determine whether PSA density improved risk stratification relative to PSA. PSA density was examined as a continuous and a categorical variable using cutoffs to separate patients into groups at different risks for PSA failure. RESULTS: PSA density and PSA were significant predictors of adverse pathological findings on univariate analysis. Using PSA density in the multivariate model resulted in slightly better but statistically insignificant improvement in prediction of positive surgical margins (p = 0.134) and extracapsular extension (p = 0.771) relative to using PSA in the model. Neither PSA nor PSA density were significant independent predictors of seminal vesicle invasion. Area under the ROC curves for predicting biochemical recurrence for PSA and PSA density were not significantly different (0.589 and 0.58, respectively, p = 0.691). On separate multivariate analyses PSA density and PSA were significant independent predictors of biochemical failure. The multivariate model using PSA density provided only slight improvement in risk assessment relative to the model using PSA (index C = 0.589 and 0.581, respectively). To determine whether using PSA density as a categorical variable would result in improved prognostication we evaluated PSA density to determine the cutoff points that would provide the greatest risk stratification. PSA density cutoffs of less than 0.4, 0.4 to 1 and greater than 1 ng./ml./cc separated patients into 3 distinct groups at increasing risk for biochemical failure (p <0.001). While these cutoffs provided better risk stratification than when PSA density was examined as a continuous variable (index C = 0.684 versus 0.58), they provided only marginal improvement relative to the standard PSA cutoffs of less than 10, 10 to 20 and greater than 20 ng./ml. (index C = 0.676). CONCLUSIONS: The use of preoperative PSA density relative to PSA provided only slight improvement for predicting adverse pathological findings and biochemical recurrence after radical prostatectomy. The minimal and statistically insignificant improvement in preoperative risk assessment provided by PSA density does not justify the time and effort necessary to calculate this value.

Humans↗
PubMed2003

C-myc, not HER-2/neu, can predict recurrence and mortality of patients with node-negative breast cancer.

BACKGROUND: At present, node-negative, high-risk breast cancer patients cannot be identified with sufficient accuracy. Consequently, further strong prognostic factors are needed. METHODS: Among 181 node-negative breast cancer (NNBC) patients, c-myc and HER-2/neu oncogenes were identified prospectively using double differential PCR. The possible impact of amplification of those oncogenes on disease-free survival (DFS) and overall survival was examined. Furthermore, the possible effects of adjuvant therapies on rate of recurrence and mortality in oncogene-amplified NNBC patients were investigated. RESULTS: The prevalence rates for amplification of c-myc and HER-2/neu were 21.5% and 30.4%, respectively. On univariate analysis, c-myc-amplified NNBCs were associated with significantly shorter DFS at 36 months after the initial diagnosis (85.3% versus 97.3%). As compared with nonamplified cancers, HER-2/neu-amplified NNBCs did not exhibit any significant differences after 36 months and 95 months. Multivariate analysis indicated that c-myc amplification and tumour size, in contrast to HER-2/neu amplification, oestrogen receptor status, grading and age, were the only independent parameters for DFS. During the period of observation, we found no evidence for an impact of amplification of the oncogenes on overall survival in all cases. With respect to various adjuvant systemic therapies such as chemotherapy (cyclophosphamide, methotrexate, 5-fluorouracil; fluorouracil, epirubicin, cyclophosphamide) and endocrine therapy (tamoxifen), no significant differences were identified in oncogene-amplified NNBC patients in terms of DFS and overall survival. However, those c-myc-amplified NNBC patients who did not receive adjuvant systemic therapy exhibited significantly shorter DFS and overall survival as compared with c-myc-nonamplified patients. CONCLUSION: C-myc amplification appears to be a strong prognostic marker with which to predict early recurrence in NNBC patients. C-myc-amplified NNBC patients without adjuvant systemic therapy experienced shorter DFS and overall survival.

Adult↗
PubMed2005

Phenotype at diagnosis predicts recurrence rates in Crohn's disease.

BACKGROUND: In Crohn's disease (CD), studies associating phenotype at diagnosis and subsequent disease activity are important for patient counselling and health care planning. AIMS: To calculate disease recurrence rates and to correlate these with phenotypic traits at diagnosis. METHODS: A prospectively assembled uniformly diagnosed European population based inception cohort of CD patients was classified according to the Vienna classification for disease phenotype at diagnosis. Surgical and non-surgical recurrence rates throughout a 10 year follow up period were calculated. Multivariate analysis was performed to classify risk factors present at diagnosis for recurrent disease. RESULTS: A total of 358 were classified for phenotype at diagnosis, of whom 262 (73.2%) had a first recurrence and 113 patients (31.6%) a first surgical recurrence during the first 10 years after diagnosis. Patients with upper gastrointestinal disease at diagnosis had an excess risk of recurrence (hazard ratio 1.54 (95% confidence interval (CI) 1.13-2.10)) whereas age >/=40 years at diagnosis was protective (hazard ratio 0.82 (95% CI 0.70-0.97)). Colonic disease was a protective characteristic for resective surgery (hazard ratio 0.38 (95% CI 0.21-0.69)). More frequent resective surgical recurrences were reported from Copenhagen (hazard ratio 3.23 (95% CI 1.32-7.89)). CONCLUSIONS: A mild course of disease in terms of disease recurrence was observed in this European cohort. Phenotype at diagnosis had predictive value for disease recurrence with upper gastrointestinal disease being the most important positive predictor. A phenotypic North-South gradient in CD may be present, illustrated by higher surgery risks in some of the Northern European centres.

Adult↗
PubMed1997

Proposal of invasiveness score to predict recurrence and survival after curative hepatic resection for hepatocellular carcinoma.

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the most malignant human tumors and is associated with a high incidence of postoperative recurrence. There is no generally accepted definition for HCC invasiveness. Moreover, the predictive value of the pathologic factors that reflect HCC invasiveness was previously studied as separate events, with much controversy among different study groups. In this study, we proposed an invasiveness scoring system based on the relative importance of six criteria for HCC invasiveness: portal vein invasion, intrahepatic metastasis, hepatic vein invasion, serosal invasion, absence of tumor capsule, or presence of capsular invasion. METHODS: A total of 137 patients (111 male and 26 female) who underwent curative hepatectomy for HCC were included. Scoring of the six pathologic parameters was based on the clinical significance of each parameter as a single predictor for recurrence after curative resection. According to our scoring system, the patients were divided into three groups: low invasive HCC group A with a total invasiveness score 0 to 1, moderately invasive group B with a score of 2 to 4, and highly invasive group C with a total score of 5 or greater (5 to 11 points). RESULTS: Evaluation of the current scoring system showed a significant stepwise increase in the incidence of recurrence as the invasiveness score increased. Moreover, disease-free survival was significantly different among the three groups (log rank p < 0.0001). The 1-, 3-, 5-, and 8-year disease-free survival rates were 89%, 59%, 54%, and 54% in group A; 72%, 32%, 12%, and 10% in group B; and 54%, 19%, 7%, and 0 in group C, respectively. Multivariate analysis showed that the patients of groups B and C had a significantly worse prognosis compared with those of group A (p < 0.0001). CONCLUSIONS: The current scoring system can classify HCCs into three invasive categories and predict more accurately recurrence and disease-free survival after curative hepatectomy compared with any single invasive parameter previously proposed. Moreover, this system can be used as a therapeutic guide during and after the surgical decision making.

Adult↗
PubMed2006

P wave dispersion predicts recurrence of paroxysmal atrial fibrillation in patients with atrioventricular nodal reentrant tachycardia treated with radiofrequency catheter ablation.

BACKGROUND: Paroxysmal atrial fibrillation (AF) recurs in up to one-third of patients with atrioventricular nodal reentrant tachycardia (AVNRT) treated with slow pathway ablation. Therefore, identification of patients at risk for recurrence of AF after slow pathway ablation is important because of the necessity for additional therapies. The purpose of this study was to determine whether successful slow pathway ablation influences P wave parameters and whether these parameters predict the recurrence of paroxysmal AF in patients with both AVNRT and paroxysmal AF after ablation. METHODS: Thirty-six patients with AVNRT and documented paroxysmal AF (Group 1) were compared to 36 age-matched controls with AVNRT only (Group 2). P wave durations and P dispersion were measured before and after ablation. RESULTS: No significant differences were observed between P wave parameters observed before and after ablation. Maximum P wave durations (Pmax) and P dispersion (Pdisp) were significantly higher in Group 1 than in Group 2 (P < 0.001 for both) whereas minimum P wave durations did not differ between groups, both before and after ablation. Ten patients (28%) in Group-1 had recurrence of AF during a mean follow-up of 34 +/- 11 months. Univariate predictors of AF recurrence were Pdisp > or =35.5 ms (P < 0.010), left atrial diameter >40 mm (P < 0.010), mitral or aortic calcification (P < 0.010), Pmax > or =112 ms (P < 0.050), valvular heart disease (P < 0.050), and atrial vulnerability (induction of AF lasting >30 second) after ablation (P < 0.050). However, only Pdisp > or =35.5 ms (P < 0.050) and left atrial diameter >40 mm (P < 0.010) were independent predictors of AF recurrences. CONCLUSION: This study suggests that P wave dispersion could identify patients with AVNRT susceptible to recurrence of AF after slow pathway ablation.

Adult↗
PubMed1981

Predicting recurrence of basal-cell carcinomas treated by microscopically controlled excision: a recurrence index score.

Despite the high cure rate achieved for basal-cell carcinomas treated with microscopically controlled excision, recurrences do occur. To determine if lesions that are likely to recur may be predicted at the time of surgery, data from 5020 patients with 7010 basal-cell carcinomas treated with Mohs' technique were reviewed. Two thousand nine hundred sixty (2960) lesions with five-year follow-up were studied (overall recurrence rate = 2.6%). Sex and age of the patients, size and location of lesions, types of previous therapy, and the number of surgical stages of microscopically controlled excision were all found to correlate significantly with recurrence rate (p less than 0.01). Multiple regression analysis was performed to determine the relative contribution of each of these variables to predictability of recurrences by a weighted scoring system. The derived model delineated the lesions into no-risk, low-, medium-, and high-risk groupings (p less than 0.000001). Lesions in the high-risk group had a recurrence rate of 10.1%, almost four times greater than the average. More aggressive microscopically controlled excisions and closer follow-up care are indicated for those lesions that can be predicted to result in a high-risk score.

Analysis of Variance↗
PubMed2003

Clinicopathological factors predicting recurrence of N0M0 renal cell carcinoma: a case series analysis of one facility.

BACKGROUND: Although many factors have been reported as predictors of the recurrence of renal cell carcinoma (RCC), none of the factors are consistent among different studies. In the study presented here, the potential clinicopathological predictors of the recurrence of N0M0 RCC were examined. METHODS: A total of 201 patients who underwent nephrectomy for N0M0 RCC were examined to determine the pathological tumor stage (pT stage), pathological tumor grade of malignancy (tumor grade), symptoms, and tumor size. RESULTS: RCC recurred in 29 patients (14.4%), 50% of whom developed new tumors within 24 months after nephrectomy. The disease-free 3- and 10-year survival rates declined as the pT stage and tumor grade increased: these rates were, respectively, 98.6% and 86.5% for pT1a; 93.7% and 87.9% for pT1b; 100% and 100% for pT2; 78.6% and 58.0% for pT3a; and 88.9% and 16.7% for pT3b. Significant differences in the recurrence rate were noted between pT3 and pT1 or pT2, as well as between grade 3 disease and grade 1 or grade 2 tumors. Multivariate analysis showed that a combination of the pT stage, grade, and presence of symptoms was useful for predicting the recurrence of RCC. CONCLUSION: The present study showed that patients undergoing nephrectomy for N0M0 RCC should be followed-up carefully for 2 years postoperatively with special attention to high pT stage, high grade, and the development of symptoms.

Adult↗
PubMed1997

Toward the validation of aneusomy detection by fluorescence in situ hybridization in bladder cancer: comparative analysis with cytology, cytogenetics, and clinical features predicts recurrence and defines clinical testing limitations.

Fluorescence in situ hybridization (FISH) is regarded as a potential new tool for the clinical management of bladder cancer that works by detecting cytogenetic aberrations in noncycling, exfoliated cells from bladder irrigations. However, clinical validation steps must be addressed to define the true predictive potential in a clinical setting. Toward the validation of FISH with the use of bladder washings and prior to incorporation into a large, prospective clinical trial, a pilot study was designed to determine its clinical potential, define testing limitations, optimize a panel of probes specific for bladder cancer detection, and outline protocol/data collection parameters. Correlations with standard cytogenetics and clinicopathological features of bladder cancer were investigated. Exfoliated cells obtained from benign bladder washings served as normal controls. The results of this pilot study suggest the following: (a) FISH and cytology are complementary testing procedures; however, the FISH data provided valuable ploidy and specific genotypic information for recurrent tumors in "suspicious" cases; (b) chromosomal aberrations defined by FISH are associated with tumor grade and stage (i.e., simple numerical aberrations were associated with low-grade tumors, and high-grade and invasive tumors exhibited multiple, nonrandom chromosomal aberrations and vast intratumor heterogeneity); (c) somatic pairing or homologous centromeric association can give a false-positive result and appears to be linked to prior therapy; (d) dual hybridization with reference gene-specific probes must be used to control for somatic pairing; and (e) focal, deep muscle invasive lesions, with no surface exposure, may yield false-negative results. The data suggest that FISH analysis, with the use of cells isolated from bladder washings, is a powerful technique holding promise for early cancer detection, monitoring treatment outcome, and predicting recurrence of disease.

Aneuploidy↗
PubMed1996

Exercise myocardial perfusion and wall motion imaging to predict recurrence of angina pectoris after successful angioplasty.

OBJECTIVES: This study investigates the predictive value of concurrent exercise radionuclide ventriculography and myocardial perfusion scintigraphy obtained six weeks after successful percutaneous transluminal coronary angioplasty for the recurrence of angina. METHODS: Both studies were obtained simultaneously with a single injection of technetium-99m sestamibi using the first-pass technique and the computerized tomographic technique, respectively. Ninety-five patients were investigated at rest and at maximal exercise 6 weeks after technically successful coronary angioplasty. RESULTS: Exercise-induced left ventricular dysfunction was present in 44 patients (46%). Exercise-induced myocardial perfusion defects were noted in 29 patients (30%). All patients underwent a six months follow-up. Seventeen patients (18%) had recurrent angina pectoris. Exercise-induced left ventricular dysfunction at six weeks after angioplasty was significantly associated with the recurrence of angina (p = 0.002), but exercise-induced perfusion defects were not. An abnormal left ventricular response to exercise was more sensitive than exercise-induced perfusion defects (82% versus 47%) to identify those patients with recurrent angina. The combination of both tests allows to select patients at a very high (40%) and very low (7%) risk of recurrent angina. CONCLUSION: Exercise-induced left ventricular dysfunction is more strongly associated with the recurrence of angina pectoris during a 6 month follow-up than are exercise-induced myocardial perfusion defects.

Adult↗
PubMed2006

Role of immunosuppression and tumor differentiation in predicting recurrence after liver transplantation for hepatocellular carcinoma: a multicenter study of 412 patients.

AIM: To assess pre-orthotopic liver transplantation (OLT) factors that could be evaluated pre-operatively or controlled post-operatively associated with hepatocellular carcinoma (HCC) recurrence and disease-free survival after liver transplantation (LT). METHODS: Four hundred and twelve patients transplanted for HCC between 1988 and 1998 in 14 French centers, who survived the postoperative period were studied. Kaplan Meier estimates were calculated for 24 variables potentially associated with recurrence of HCC. Uni- and multivariate analyses were conducted to identify independent predictors of recurrence. RESULTS: Overall 5-year disease-free survival was 57.1%. By univariate analysis, variables associated with disease-free survival were: presence of cirrhosis (P = 0.001), etiology of liver disease (P = 0.03), alpha fetoprotein level (< 200, 200 to 2000, or > 2000; P < 0.0001), gamma-GT activity (N, N to 2N or > 2N; P = 0.02), the number of nodules (1, 2-3 or > or = 4; P = 0.02), maximal diameter of the largest nodule (< 3 cm, 3 to 5 cm or > 5 cm; P < 0.0001), the sum of the diameter of the nodules (< 3 cm, 3 to 5 cm, 5 to 10 cm or > 10 cm; P < 0.0001), bi-lobar location (P = 0.01), preoperative portal thrombosis (P < 0.0001), peri-operative treatment of the tumor (P = 0.002) and chemoembolization (P = 0.03), tumor differentiation (P = 0.01), initial type of calcineurin inhibitor (P = 0.003), the use of antilymphocyte antibodies (P = 0.02), rejection episodes (P = 0.003) and period of LT (P < 0.0001). By multivariate analysis, 6 variables were independently associated with HCC recurrence: maximal diameter of the largest nodule (P < 0.0001), time of LT (P < 0.0001), tumor differentiation (P < 0.0001), use of anti-lymphocyte antibody (ATG) or anti-CD3 antibody (OKT3) (P = 0.005), preoperative portal thrombosis (P = 0.06) and the number of nodules (P = 0.06). CONCLUSION: This study identifies immunosuppression, through the use of ATG or OKT3, as a predictive factor of tumor recurrence, and confirms the prognostic value of tumor differentiation.

Analysis of Variance↗
PubMed1996

Significance of proliferating cell nuclear antigen in predicting recurrence of intracranial meningioma.

It is well known that the histological appearance of meningiomas often fails to predict accurately the clinical behavior of the tumor. Therefore, attention has turned from tumor histology to tumor biology. Proliferating cell nuclear antigen (PCNA), a cell cycle-regulated protein, has been recently characterized as the cofactor of DNA polymerase-delta, an enzyme required for DNA replication. The rate of synthesis of PCNA directly correlates with the proliferative state of cells. Immunohistochemical labeling of this antigen is now possible with monoclonal antibodies that allow for its demonstration in routinely fixed, paraffin-embedded specimens. In this study, the PCNA labeling index (LI) was determined for 83 meningiomas, including tumors with both benign and malignant clinical courses and with benign, atypical, and malignant histologies, apparent after total or subtotal resections. No statistical difference was found between the LI on recurrence and that found at initial presentation. In addition, stepwise multivariate regression analysis failed to identify any combination of factors (age, gender, race, age of specimen, tumor histology, Simpson grade of resection) that contributes to the predictive strength of the PCNA LI for tumor recurrence. However, for LIs less than 2%, only one of 26 gross totally resected tumors recurred (mean follow up 53 months); for LIs more than 7%, five of 13 gross totally resected tumors recurred (mean follow up 55 months). The difference in recurrence rates between gross totally resected meningiomas with PCNA LIs less than 2% and those with PCNA LIs more than 7% achieved statistical significance with a Fisher's exact probability equaling 0.011. The authors conclude that quantitative PCNA labeling of meningiomas is a promising technique that can provide meaningful prognostic information.

Adult↗
PubMed2004

Coexpression of hepatocyte growth factor/scatter factor (HGF/SF) and its receptor cMET predict recurrence of meningiomas.

Hepatocyte growth factor/scatter factor (HGF/SF) and its receptor, the cMET tyrosine kinase participate in cancer invasion, angiogenesis and metastasis in a wide variety of neoplastic cells. Meningioma is a bening tumour, however, it has a high rate of recurrence after surgery; the most important factor to predict relapse is the extent of surgical resection, several other potentially predictive factors have been studied with poor results. We examined by immunohistochemistry the expression of HGF/SF and its cMET receptor in a group of patients with benign meningioma with or without recurrence (n = 17 and n = 25, respectively), after a minimal follow-up of least 6 years. Expression and coexpression of HGF/SF and cMET were compared with cell proliferation index, vascular density and clinical outcome. Coexpression of HGF/SF and cMET in meningiomas had a significant association with cell proliferation index and with recurrence (P < 0.037). Determination of HGF and cMET coexpression in meningiomas could be used as a predictor of recurrence.

Adult↗
PubMed2005

Tumor doubling time predicts recurrence after surgery and describes the histological pattern of hepatocellular carcinoma on cirrhosis.

BACKGROUND/AIMS: Recurrence of hepatocellular carcinoma (HCC) following surgical resection is influenced by parameters detectable on the resection specimen or through a biopsy. The prognostic significance of HCC doubling time (DT) after surgery has never been investigated. METHODS: We evaluated 62 patients who underwent curative resection of a single HCC on cirrhosis; tumors were assessed before surgery on two subsequent occasions with the same imaging technique allowing the calculation of DT. The influence of tumor DT, clinical and pathological parameters on recurrence-rate and patients survival was assessed with uni- and multivariate analysis. Relationship between DT and pathological features was also analyzed. RESULTS: Three-year recurrence rate was 32.3% (20 patients): this was significantly higher in the presence of DT shorter than 100 days (58 versus 18% when equal to or longer; P=0.008), microvascular invasion (59 versus 17% when absent; P=0.008) or tumor undifferentiation (54 versus 25% when well/moderately differentiated; P=0.015). DT was the only independent predictor of recurrence (P=0.005). Patients survival was affected by Child-Pugh class only. DT was significantly shorter in tumors with microvascular invasion (P=0.007), undifferentiation (P=0.003) and high alpha-fetoprotein levels (P=0.011). CONCLUSIONS: DT is easy to estimate and indicates the prognosis of single HCCs prior to liver resection.

Aged↗
PubMed1998

Tumor vascularity predicts recurrence in differentiated thyroid carcinoma.

BACKGROUND: New prognosticators are necessary for optimizing the extent of thyroidectomy and adjuvant radiotherapy in differentiated thyroid carcinoma. METHODS: Tumor microvessel density (MVD), expression of thymidine phosphorylase (dThdPase) and CD68 stained macrophages were evaluated in 71 differentiated thyroid carcinomas by an immunohistochemical method. RESULTS: The recurrence-free survival was significantly (P <0.05) shorter in patients with hypervascular tumors but was not related to the dThdPase expression. Significant (R = 0.323, P <0.001) correlation between dThdPase expression score and increment in MVD was documented. Frequent high MVD and dThdPase expression were encountered in tumors >3 cm. Twenty-two of the 27 (82%) patients expressing high dThdPase were also evaluated positive for CD68 (P <0.001). CONCLUSIONS: Tumor MVD might be a new prognostic indicator of differentiated thyroid carcinoma, whereas dThdpase expression with high MVD might serve to identify a subgroup of thyroid carcinoma patients as potential candidates for adjuvant radiotherapy.

Adult↗
PubMed2000

The status of Fas and Fas ligand expression can predict recurrence of hepatocellular carcinoma.

The status of Fas and Fas ligand (Fas L) expression was investigated in this study for 103 hepatocellular carcinomas (HCC). We studied the expression of the following three factors, Fas and Fas L expression in carcinoma cells and Fas L expression in stromal mononuclear cells (defined as stromal Fas L index). Fas expression in HCC cells was significantly decreased in cases with poor differentiation (P < 0.0001) and of larger size (P = 0.0058). Fas L expression in carcinoma cells was observed exclusively in moderately or poorly differentiated cases. Furthermore, each factor had prognostic significance for disease-free survival (DFS) (P< 0.0001, P = 0.0222 and 0.0027 respectively). We then scored the results of each factor and defined the total score as 'Fas-Fas L risk score'. The P-value of the score for DFS was even lower than that of the clinical stage by multivariate analysis. These results suggest that the evaluation of Fas and Fas ligand expression potentially has a significant prognostic value for DFS of HCC patients, in addition to the clinical stage, and can be regarded as a new prognostic marker.

Aged↗
PubMed2001

Aspects in mammographic screening. Detection, prediction, recurrence and prognosis.

Screening mammograms comprising of 32 first round, 10 interval and 32 second round detected cancers and 46 normal were examined by an expert screener, a screening radiologist, a clinical radiologist and a computer-assisted diagnosis (CAD) system. The expert screener, screening radiologist, clinical radiologist and the CAD detected 44, 41, 34 and 37 cancers, respectively, while their respective specificities were 80%, 83%, 100% and 22%. Later, with CAD prompting, the screening and the clinical radiologist detected 1 and 3 additional cancers each with unchanged specificities. Screening mammograms comprising 35 first round, 12 interval and 14 second round detected cancers and 89 normal findings were examined without and with previous mammograms by experienced screeners. Without previous mammograms, the screeners detected 40.3 cancers with a specificity of 87%. With previous mammograms, 37.7 cancers were detected with a 96% specificity. The decrease in sensitivity was not significant but the screeners showed significant increase in specificity. Local recurrences in 303 nonpalpable breast cancers with preoperative localizations and breast conservation therapy were evaluated for needle-caused implant metastasis. A total of 214 percutaneous biopsies were performed. There were 33 local recurrences. Needle-caused seeding or implantation as based on the location of the recurrence in comparison to the needle path in the mammograms was suspected in 3/44 (7%) invasive cancers without radiotherapy. The mammographic characteristics of 317 nonpalpable breast cancers were categorized. Logistic regression showed that the risk ratios for a spiculated mass without calcifications and calcifications alone were 12 and 19 for invasive cancer and ductal cancer in situ (DCIS), respectively. Invasive ductal grade 1, ductal grade 2, lobular and ductal grade 3, had a risk ratio (RR) of 28, 17, 11 and 4.6, respectively, for a spiculated mass without calcifications. DCIS nuclear grade 3 and invasive ductal grade 3 had an RR of 17 and 9.7, respectively, for sole casting calcifications. The eight-year survival of 96 1-9-mm invasive breast cancers were investigated in relation to their mammographic appearance, node status and histologic grade. After a median follow-up of 7 years, 6/96 died from breast cancer: 3/14 had calcifications alone, 2/56 had spiculated masses, 1/12 had rounded mass, 5/78 were node-negative and 1/4 was node-positive. The survival rate was 93%: 77% for the calcifications alone, 95% for spiculated masses, 91% for rounded masses, 92% for node-negative and 75% for node-positive. Calcifications alone and node positivity, each, carried a significantly higher risk of death.

Academic Dissertations as Topic↗