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PubMed1986

[Prognostic significance of pathology in 3, 147 cases of colorectal cancer. National Cooperative Group on Pathology and Prognosis of Colorectal Cancer].

This paper analyses the pathological features and prognosis in 3,147 cases of colorectal carcinoma collected from thirteen colleges, institutes and hospitals. The results reveal: The mean 5 year survival rate of 3,147 cases of colorectal carcinoma is 50.21%. The age of patient, tumor location, size, gross typing, histologic classification, growth pattern, the depth of infiltration, the metastasis into lymph nodes, the lymphocyte infiltration and fibrous proliferation surrounding the cancer are all prognostic. The depth of infiltration and metastasis into lymph nodes are the chief determinant of prognosis. The prognosis is much better in cases without penetrating the musculature or prognosis. The prognosis is much better in cases without penetrating the musculature or metastasis into lymph nodes than otherwise. It is better in those with metastases into 1-2 2 lymph nodes than with 3 or more. The histological types reflect the biologic nature of the cancer, exercising the most decisive influence upon the prognosis. The various pathologic changes are all closely associated with it. There is much difference in prognosis among well, moderately and poorly differentiated adenocarcinomas (70.3%, 49.6% and 26.6%) whereas almost no difference exists among the different histologic types with the same degree of differentiation. This indicates that it is the cancer differentiation which plays the important role in the prognosis. 4. The immune response in the regional lymph nodes, the lymphocyte infiltration and fibrous proliferation surrounding the cancer reflect the immune status of the organism against the cancer and favorably affect the prognosis.

Adenocarcinoma, Mucinous↗
PubMed1993

Predictable factors for estimating prognosis of patients after resection of hepatocellular carcinoma.

BACKGROUND: Although many studies have been concerned with a clarification of the relation between various clinicopathologic factors and the prognosis of operated hepatocellular carcinoma (HCC), few studies have focused on the prognostic predictability of mitotic index and anti-hepatitis C virus (anti-HCV). METHODS: One hundred forty cases of HCC with hepatic resection were observed from 1 to 11 years, and the relationship among various clinicopathologic factors, including the mitotic index and anti-HCV, and prognosis was evaluated. RESULTS: Age at the time of operation, positive results for hepatitis B surface antigen or anti-HCV, accompanying cirrhosis, and the degree of tumor necrosis due to transarterial embolization did not influence the prognosis significantly. Patients with hepatitis C virus-related cases had a better prognosis than patients with hepatitis B-related cases. Patients with a single and small carcinoma smaller than 2 cm had a significantly better prognosis than those who had larger and/or multiple tumors. A better prognosis also was observed in the carcinomas with no histologic invasion into portal vein branches, low Edmondson grades, and low mitotic activities when compared with the counterpart of each group. Among these factors, the mitotic index was correlated best with prognosis in the current study. CONCLUSIONS: The examination of mitotic index was quite simple, and the index was a helpful factor in predicting prognosis.

Age Factors↗
PubMed1995

Staging, scoring and grading of medulloblastoma. A postoperative prognosis predicting system based on the cases of a single institute.

Although recently survival of some medulloblastoma patients increased remarkably, it remains a serious diagnosis in others. In order to predict the postoperative prognosis in patients treated for medulloblastoma, a new staging, scoring and grading system was developed. Sixty-six patients operated on microsurgically between 1975 and 1990 at a single neurosurgical center were fully followed-up. No patient was excluded due to a poor postoperative course. Completion of commonly used radiotherapy protocols was attempted in all patients. Survival of patients was evaluated by the Kaplan-Meier method. The following 5 parameters were selected to define subgroups: patients' age, tumour location and histology, degree of resection and presence or absence of metastases. Patients older than 10 years had a better prognosis than individuals aged 10 or less (p < 0.01), patients with lateral tumours had a better prognosis than patients with midline tumours with brain stem infiltration (p < 0.05), patients with complete tumour resection had a more favourable prognosis than individuals with subtotal (p < 0.01) or partial resection (p < 0.001), patients without metastases at the time of diagnosis had a better prognosis than individuals without such evidence (p < 0.001), patients with the desmoplastic tumour variant had a better prognosis than patients with classical tumour histology (p < 0.01). According to the prognosis of a distinct subgroup, scoring points were distributed which correlated with the degree of inter-subgroup significances. The sum of a single patient's scoring points was called the total score. Based on this score, three groups of prognosis were distinguished.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2005

Ganirelix acetate use in normal- and poor-prognosis patients and the impact of estradiol patterns.

OBJECTIVE: To evaluate cycle outcomes in patients with either poor or normal prognosis undergoing IVF treatment with a GnRH antagonist (ganirelix acetate) for LH suppression. DESIGN: Nonrandomized, noncontrolled, retrospective review. PATIENT(S): 204 patients, aged 23-41 years, undergoing IVF. INTERVENTION(S): Patients completed 225 consecutive cycles of IVF with a GnRH antagonist (Antagon; Organon, Roseland, NJ) for LH surge prevention. Sixty cycles were conducted in patients with a known poor prognosis, whereas 165 were conducted in patients with a normal IVF prognosis. MAIN OUTCOME MEASURE(S): Pregnancy rate (PR), for the series as a whole and according to prognosis, and serum E2 patterns. RESULT(S): The PR per initiated cycle for the series as a whole was 33.3%. The pregnancy rate was 42.1% per ET for the entire series, with a cycle cancellation rate of 21%. When evaluated by prognosis, the poor-prognosis patients had PRs of 8.3% per attempt and 15% per transfer, whereas the normal-prognosis patients had PRs of 40% per attempt and 45% per transfer. Pregnancy rate did not vary by E2 pattern (drop, plateau, or rise). Oral contraceptive pretreatment was noted to be associated with high cancellation rates in the group of known poor responders, whereas for the group as a whole, cycle outcome was unaffected by the use of oral contraceptives. CONCLUSION(S): Use of GnRH antagonists in patients with an a priori poor IVF prognosis results in predictably poor outcomes. Patients without factors predicting poor outcome have acceptable PRs. The pattern of E2 rise immediately after initiation of GnRH antagonists does not predict cycle outcome. Oral contraceptives can be successfully used to schedule antagonist-based IVF cycles but might increase the risk of cycle cancellation in some patient populations.

Adult↗
PubMed2003

Preliminary evidence of striatal D2 receptor density as a possible biological marker of prognosis in naive schizophrenic patients.

UNLABELLED: With the aim of investigating a possible biological marker of prognosis in schizophrenia, the relationship between striatal dopaminergic D2 receptor (D2R) density and clinical prognostic factors was studied in an initial sample of nine neuroleptic-naive schizophrenic patients. Previous psychosocial adaptation was evaluated by means of the Premorbid Adjustment Scale (PAS). Based on the four DSM-IV criteria in schizophreniform disorder for good prognosis, patients were divided in two groups: good prognosis if > or =2 criteria were met (n=5) and poor prognosis if <2 criteria were met (n=4). D2R density was assessed by means of 123I-IBZM single photon emission computed tomography (SPECT) and striatum/occipital uptake ratios (S/O). S/O ratios previously obtained from a control group of nine age- and sex-matched healthy volunteers were used for comparison. RESULTS: Patients with poor prognosis showed a higher S/O ratio (mean=1.94, range=1.93-1.98) than patients with good prognosis (mean=1.64, range=1.52-1.79) and the control group (mean=1.69, range=1.51-1.85) [analysis of variance (ANOVA) F=10.628, df=2, P=.001, post hoc Scheffé P<.005]. PAS scores were significantly different between patients with good and poor prognosis (40+/-9.39 vs. 84.25+/-26, Mann-Whitney U-test P=.014). A direct correlation of S/O ratios with PAS scores was found (Spearman r=.72, P=.028). CONCLUSIONS: Striatal D2R density in naive schizophrenic patients may be related to DSM-IV prognostic factors and premorbid adjustment criteria (PAS). If these preliminary results are confirmed, striatal D2R density might predict premorbid and clinical features associated with poor prognosis in neuroleptic-naive patients.

Adolescent↗
PubMed1995

Long-term prognosis of different forms of coronary heart disease: the Reykjavik Study.

BACKGROUND: While coronary heart disease (CHD) is a serious and often fatal disease the prognosis is variable and major effort has been invested in risk stratification. The purpose of this study was to examine the relation between long-term prognosis and risk factors in different clinical categories of CHD. METHODS: A general population sample of 9141 men, aged 34-79 at entry into the study was divided into six groups with respect to manifestations of CHD at entry: I. Symptomatic infarction. II. Silent or unrecognized infarction. III. Angina pectoris with ischaemic changes on ECG. IV. Angina without ischaemic changes. V. Angina by Rose questionnaire but not confirmed by a physician. VI. No manifestations of CHD. RESULTS: The risk factor profile varied considerably between the different categories and by life-table analysis marked differences in survival were demonstrated between the groups. The risk factors maintained their detrimental effects on prognosis in the presence of CHD. Thus, age, serum total cholesterol, impaired glucose tolerance and smoking were found by Cox's regression to be statistically significant independent risk factors of CHD mortality among men having manifestations of CHD (groups I-V). Furthermore, the composite risk score, a measure of the overall risk factor exposures had marked effect on the prognosis of the various CHD groups. When the comprehensive risk factor score for both CHD mortality and all-cause mortality was accounted for marked differences persisted in the long-term prognosis. Compared to those without CHD the infarct groups had about a 7.6- and 3.7-fold risk of dying from CHD and all causes respectively. Those with angina had from 2.5- to 3.2-fold risk of CHD mortality and 1.7- to 2.2-fold risk of all-cause mortality depending on the subgroup of angina, again compared to those without manifestations of CHD. CONCLUSION: Different categories of CHD had different risk factor profiles and the long-term prognosis resulted from a complex interplay between those factors and the diagnostic category of CHD. The risk factors maintained their detrimental effects on prognosis in the presence of CHD and after accounting for the comprehensive risk factor score marked differences persisted in the long-term prognosis, being worst for those having suffered a myocardial infarction, either symptomatic or silent.

Adult↗
PubMed2005

A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis.

STUDY DESIGN: A semi-prospective clinical study was conducted. OBJECTIVES: To evaluate the accuracy of a revised scoring system predicting metastatic spinal tumor prognosis and the suitability of the subsequent treatment strategy. SUMMARY OF THE BACKGROUND DATA: We used a scoring system for the preoperative evaluation of the prognosis of metastatic spinal tumors and selected treatment methods for the predicted prognosis. In the previous version of our scoring system, the reliability of the predicting prognosis was 63.3% in 128 patients with metastatic spinal tumors. METHODS: The study participants were 164 patients who died after surgery and 82 who died after conservative treatment. Six parameters were used in the revised scoring system. Each parameter ranged from 0 to 5 points, and the total score was 15 points. In principle, conservative treatment or palliative procedures were indicated in patients with a total score of 8 or less (predicted survival period, less than 6 months) or those with multiple vertebral metastases, while excisional procedures were performed in patients with a total score of 12 or more (predicted survival period, 1 year or more) or those with a total score of 9 to 11 (predicted survival period, 6 months or more) and with metastasis in a single vertebra. The selection of treatment modality was followed faithfully according to the criteria of the revised scoring system after 1998. The prognosis predicted by the revised scoring system and the actual survival period after treatment were compared, and the reliability of the prognostic criteria was analyzed for the group subjected to it prospectively after 1998 (n = 118) and for all 246 patients it was applied to retrospectively. RESULTS: The total score for each patient could be correlated with the survival period. This correlation was also observed in each treatment group. The consistency rate between the predicted prognosis from the criteria of the total scores and the actual survival period was high in patients within each score range (0-8, 9-11, or 12-15), 86.4% in the 118 patients evaluated prospectively after 1998, and 82.5% in the 246 patients evaluated retrospectively. Furthermore, a similar result was also observed in both the surgical procedure group and conservative treatment group. The rate of consistency between the predicted prognosis and the actual survival period in each local extension of the lesion was 75% or more in all types, excluding Type 6 in the surgical classification of Tomita et al. CONCLUSION: The prognostic criteria using the total scores from our revised scoring system were useful for the pretreatment evaluation of metastatic spinal tumor prognosis irrespective of treatment modality or local extension of the lesion.

Adolescent↗
PubMedDate not supplied

Immunoreactive MUC1 expression at the deepest invasive portion correlates with prognosis of colorectal cancer.

This study sought to examine the relationship between MUC1 expression at the deepest invasive portion, invasive/metastatic potential, and prognosis of colorectal cancer in relation to cellular proliferation. MUC1 expression was detected immunohistochemically using KL-6 antibody (anti-MUC1 monoclonal antibody) in 100 surgically resected specimens of advanced colorectal cancer. Distinct staining of the luminal surfaces, defined as positive immunoreactive (IR)-MUC1 expression, was seen in more than 30% of the tumor cells at the deepest invasive portion. The proliferating cell nuclear antigen labeling index (PCNA-LI) was also examined in the same areas. IR-MUC1 expression was detected in 71 (71%) of 100 lesions. Lesions with lymphatic or venous invasion showed a significantly higher incidence of IR-MUC1 expression than those without lymphatic or venous invasion (80 vs. 42% and 82 vs. 61%, respectively). Lesions with lymph node metastasis showed a significantly higher incidence of IR-MUC1 expression than those without lymph node metastasis (88 vs. 53%). Lesions with liver metastasis showed a significantly higher incidence of IR-MUC1 expression than those without liver metastasis (92 vs. 59%). Dukes' stage was also significantly correlated with IR-MUC1 expression. The incidence of IR-MUC1 expression did not significantly differ with regard to histologic subclassification and depth of invasion. There was no significant correlation between IR-MUC1 expression and the PCNA-LI. IR-MUC1 expression at the deepest invasive portion revealed a significant correlation with prognosis; furthermore, in patients with better differentiated lesions, in those with lesions confined to muscularis propria or subserosa (subadventitial) invasion, in those with Dukes' B and C, or in those undergoing curative resection, IR-MUC1 expression significantly correlated with prognosis. Patients with high PCNA-LI lesions showed a significantly poorer prognosis than those with low PCNA-LI lesions. Only in patients undergoing curative resection, patients with IR-MUC1-positive and high PCNA-LI lesions showed a significantly poorer prognosis than those with IR-MUC1-negative and low PCNA-LI lesions. The significant risk factors in the order of poorer prognosis in patients undergoing curative resection by the multivariate analysis were the histologic grade (moderately-poorly, poorly or mucinous adenocarcinomas), IR-MUC1 expression, and lymph node metastasis. These results indicate that IR-MUC1 expression is an important predictor of the metastatic potential and the prognosis of colorectal cancer, independent of histologic grade, depth of invasion or cellular proliferative activity. Combined analysis of IR-MUC1 and histologic grade, and combined expression of IR-MUC1 and PCNA at the deepest invasive portion are especially useful in predicting colorectal cancer prognosis.

Aged↗
PubMed1975

[Some observations on prognosis in congenital hydrocephalus (first report)--with reference to the preoperative evaluation of the hydrocephalic infants (author's transl)].

Recently, the prognosis of congenital hydrocephalus has improved by shunting operation. There are some cases, however, showing poor prognosis even when this procedure has been performed. Thus, postoperative courses of hydrocephalus are variable, and do not always produce the same results. From the clinical viewpoint, we have studied preoperative signs and symptoms, and tried to find some factors which influence the prognosis. This report consists of 41 cases of congenital hydrocephalus and 7 cases of hydroencephalodysplasia over the past six years. For the purpose of observations before and after operation, we adopted some neurological symptoms, head circumference, thickness of cerebral mantle in pneumoventriculogram, intraventricular pressure and others. The average period of follow up of all the cases was two years and six months. Of the 41 patients of congenital hydrocephalus, 24 survived and 14 died. Of the 7 patients of hydroencephalodysplasia, 5 survived and 2 died. As to the age of the patients on admission, 57% of all the cases were infants from 2 months to 4 months old. The patients who had such neurological signs already on admission as motor disability, opisthotonic posture and severe optic nerve atrophy, had a tendency to show poor prognosis in general and to result in a higher mortality. The convulsion and so-called setting sun sign had no significant correlation to poor prognosis. From the morphological evaluation, we have examined increase of circumference and enlargement rate of the head. In the death group, abnormal increase of head circumference was recognized within the first three months of life. When the enlargement was higher than Nellhaus's standard rate within four months after birth, over half of the cases died. In the survival cases, the cerebral mantle thickness was found to be variable while a remarkable decrease was often noted in the death cases. If the mantle is less than 14 mm within three months after birth, prognosis of these cases was generally poor. In the evaluation of intraventricular pressure under endotracheal anesthesia, we found little difference between the survival cases and death cases. However, the death cases exhibited slightly higher average intraventricular pressure. In hydroencephalodysplasia, the cases with abnormal enlarged head marked dysplasia of cerebral hemisphere and thin cerebral cortex showed a tendency toward death, however, the cases with localized partial brain or a lobe dysplasia survived. In some cases by using the ventriculoscope, we could see directly the defect of the brain and obtain beneficial information on diagnosis. Due to the influence of various factors, it is impossible to predict or decide exactly the prognosis of congenital hydrocephalus before operation, but it is of critical necessity to anticipate the postoperative prognosis from preoperative synthetic information.

Cerebral Cortex↗
PubMedDate not supplied

[Non-valvular atrial fibrillation and completed stroke: factors determining mortality, recurrence and prognosis after a first event in the Mexican population].

AIMS: Non-valvular atrial fibrillation (NVAF) accounts for 25% of completed strokes (CS) of a cardioembolic origin in patients over 60 years old. Our aim was to define the predictors of a good and poor prognosis after a CS secondary to an NVAF in our milieu. PATIENTS AND METHODS: We evaluated the risk factors (RF) and severity of CS in relation to death, functionality and recurrence at 5 years. 81 patients between the ages of 49 and 88 were followed up consecutively for 1 to 90 months; 38 (46.9%) of them were males. Multivariate analysis was performed with the following independent variables: age, gender, smoking, hypertension, heart disease, diabetes mellitus and characteristics of the stroke. The severity of the CS was assessed by means of the modified Rankin scale, which was dichotomised into a good prognosis (0-2) and a poor prognosis (> or = 3), both basal and at the end of the clinical control. We also evaluated the secondary preventive treatment used and its relation with recurrence, prognosis, death and complications. RESULTS: No RF was linked to a poor prognosis or recurrence; 88% had a poor prognosis. Antiplatelet drugs were used in 42% of cases and 39% received anticoagulants. A good final progression was observed in 9.5% of the patients treated with antiplatelet drugs versus 35% of those receiving anticoagulation therapy (p = 0.004). Severity of the CS on admission was worse in the aspirin group, with no differences in recurrence and mortality. A better prognosis was observed in patients from urban areas. CONCLUSIONS: Use of antiplatelet drugs, living in a rural area and a Rankin score of > or = 3 on admission are factors suggesting a poor prognosis in the clinical control at 5 years.

Aged↗
PubMed2005

[A single factor analysis of the prognosis of 301 hepatitis failure cases and a study of a scoring system on their prognostic assessment].

OBJECTIVES: To analyze the factors related to prognosis of hepatitis failure and to determine the factors which significantly affect it, and to build a scoring system for assessment of the prognosis of hepatitis failure and also to examine its efficacy for clinical use. METHODS: Clinical data from 301 patients were analyzed retrospectively. The correlated degree between those single factors and prognosis of hepatitis failure was explored by logistic regression analysis. Independent risk factors of prognosis and those correlated coefficients, which were from logistic regression analysis, were used to build a scoring system. This system was used in analyzing the clinical data of 275 patients to examine its efficacy of the prognostic assessment. RESULTS: The factors that significantly affected the prognosis of hepatitis failure included age, clinical typing, hepatic coma, total bilirubin, and others (P < 0.01). Some factors, including PTA, blood urea, sodium and hepatic coma, were independent risk factors of prognosis. The scoring system built gave different scores between the effective treatment group and ineffective treatment group with statistical significance (P < 0.01). When the score was less than 40, the probability of a recovery was 76.9%; when the score was 40 to 80, the probability of a recovery was only 12.5%. When the score was more than 80, the probability of a recovery dropped to 0%. CONCLUSIONS: The factors, including PTA, blood urea and sodium and hepatic coma, are important in building a scoring system to assess the prognosis of hepatitis failure. The scoring system we built is very effective in evaluating the prognosis of hepatitis failure.

Adolescent↗
PubMed1989

[Prediction of prognosis in sudden deafness].

Factors influencing the prognosis of sudden deafness were studied in 70 cases. Clinical data were analyzed and three important factors have been found: 1. Among various factors concerning the prognosis, the most important one was the presence of 8 kHz hearing. If hearing in the 8 kHz level could be obtained, prognosis would be better; 2. The time between the onset of deafness and the initial examination was found to be in close relationship with the prognosis, i.e. the sooner the patient seeks for treatment, the better would be the result; 3. The rapidity of the development of deafness was closely related to the prognosis. The faster the development of deafness, the worse would be the prognosis. An optimal regression equation for predicting prognosis has been established. According to this equation, otologists would be able to estimate the prognosis of the patients suffering from sudden deafness.

Auditory Threshold↗
PubMed1997

[Proximal femoral fractures in patients over 75 years. Vital and functional prognosis of a cohort of 78 patients followed during 2.5 years].

PURPOSE OF THE STUDY: The purpose of this study was to highlight factors influencing vital and functional prognosis at 2.5 years of elderly people being treated for a proximal femoral fracture. MATERIAL: The study was based on 78 patients more than 75 years old admitted to the orthopedic department for emergency treatment. After post-operative care, patients were transferred to a geriatric readaptation unit. The average patient age at the time of surgery was 85 years. METHODS: This was a retrospective study. Survival graphs were established for the entire population as well as for the sub-populations characterized by a studied parameter. Mortality factors were compared via a univariable analysis. A multivariable logistical regression analysis isolated the factors explaining mortality at 12, 18, and 30 months and survival at 30 months, as well as factors explaining functional prognosis at 1 year. RESULTS: The overall mortality rate was 41 per cent, 48.5 per cent of deaths occur within the first year. Factors which are harmful for vital prognosis are the following: high degree of dependence before the fracture, the existence of a neuropsychiatric pathology, and age factor (more than 85 years). 61.5 per cent of surviving patients were independent for daily activities. 77 per cent of surviving patients lived in their usual place of residence. Factors which were harmful for functional prognosis were the following: type of the fall, symptomatic of an underlying pathological state, and existence of a neuropsychiatric pathology. Nutrition was also a predictive factor concerning the patient's out come. DISCUSSION: The average age of the studied population was higher than in most studies in literature. The treatment is mainly based on hip arthroplasty. The group of patients of over 85 have the highest mortality rate. However, a better survival rate at 18 months has been observed for patients older than 90 years. The delay before surgical care was significantly negative if longer than 6 days. However, a delay of 3 to 6 days was not significantly harmful for survival. Within the studied population, the maximum autonomy gain was observed during the first 6 months. The type of non-accidental fall, symptomatic of an associated pathology, was a factor for functional prognosis which has not been often mentioned. So was the biological deficit of nutrition. Social status acted as an indicator of functional status evolution. CONCLUSION: Therapeutic choices can only be guided by assessments of patients' vital and functional prognosis. A sophisticated or even expensive device should be demanded for patients with favorable prognosis. For patients with precarious functional and vital prognosis, priority should be given to less invasive techniques with immediate walking. The cost of the device should be correlated with patient's functional investment.

Age Factors↗
PubMed2006

Does it hurt to know the worst?--psychological morbidity, information preferences and understanding of prognosis in patients with advanced cancer.

BACKGROUND AND METHOD: Many doctors, while offering open discussion of diagnosis and treatment to cancer patients, still express concern about the psychological impact of discussing a poor prognosis. In this study, 106 advanced cancer patients were interviewed at home. The interview included open discussion and structured questionnaires: the Hospital Anxiety Depression Scale and Rotterdam Symptom Checklist. Participants were asked about information preferences, worries and unanswered questions. The interviewer (M.B.) rated "Understanding of diagnosis and of prognosis". RESULTS: A majority of participants (78%) demonstrated a good understanding of their diagnosis and were consistent with their information preference. On prognosis, 54% of those desiring information (49% of overall group) were fully aware; a further 22% were aware but unrealistic about time-scale. Although most were satisfied with their level of knowledge, 28% had further questions, particularly concerning "mode of disease progression" (n=25), "mode of death" (n=13) and prognosis (n=18). When understanding of prognosis was compared with psychological distress, a significant difference was observed between those with realistic versus unrealistic time-scales. However, this could be explained by increasing physical symptoms. CONCLUSIONS: Patients with advanced cancer have a good understanding of their diagnosis but many do not fully understand their prognosis. Although patients with deteriorating health are more likely to be psychologically distressed, awareness of prognosis does not itself cause depression. Doctors should be aware of patients' ongoing but often unvoiced concerns and prepared to explore these with them.

Adult↗
PubMed2004

Preoperative evaluation of prognosis in breast cancer patients by [(18)F]2-Deoxy-2-fluoro-D-glucose-positron emission tomography.

PURPOSE: [18F]2-Deoxy-2-fluoro-D-glucose (FDG)-positron emission tomography (PET) was applied to breast cancer patients for the purpose of preoperative evaluation of patient prognosis with more accuracy than conventional TNM staging. METHODS: FDG-PET was performed preoperatively in 81 patients with breast cancer, and the maximum standardized uptake value (SUVmax) of tumors as well as the focal accumulation of FDG in the axillary region (PET-N status) were investigated in their association with patient prognosis. RESULTS: The SUVmax high group (n=40) showed a significantly (P=0.011) poorer prognosis than the SUVmax low group (n=41) (5-year disease-free survival (DFS) rates; 75.0% vs 95.1%). FDG-PET was more accurate in the diagnosis of axillary lymph node status than physical examination, i.e., diagnostic accuracy was 80% and 70% for FDG-PET and physical examination, respectively. The combination of high SUVmax and positive PET-N (+) was shown to be a highly significant risk factor being independent of the clinical T and N factors, i.e., patients with high SUVmax and positive PET-N (+) showed a significantly (P<0.001) poorer prognosis than the other patients (5-year DFS rates; 44.4% vs 96.8%). CONCLUSIONS: These results suggest that FDG-PET is useful in the preoperative evaluation of prognosis in breast cancer patients with more accuracy than conventional TNM staging. It is expected that the indication of neoadjuvant chemotherapy can be decided more precisely by the preoperative evaluation of patient prognosis with FDG-PET due to a possible elimination of overtreatment for those who have good prognosis and, thus, need not to be treated with chemotherapy.

Adult↗
PubMed2001

Documentation of discussions about prognosis with terminally ill patients.

PURPOSE: Previous studies have suggested the importance of communicating with patients about prognosis at the end of life, yet the prevalence, content, and consequences of such communication have not been fully investigated. The purposes of this study were to estimate the proportion of terminally ill inpatients with documented discussions about prognosis, describe the nature and correlates of such discussions, and assess the association between documented discussions about prognosis and subsequent advance care planning. SUBJECTS AND METHODS: Inpatients (n = 232) at least 65 years old who had brain, pancreas, liver, gall bladder, or inoperable lung cancer were randomly selected from six randomly chosen community hospitals in Connecticut. The presence and content of discussions about prognosis, advanced care planning efforts, and sociodemographic and clinical factors were ascertained by comprehensive review of medical records using a standardized abstraction form. RESULTS: Discussions about prognosis were documented in the medical records of 89 (38%) patients. Physicians and patients were both present during the discussion in 46 (52%) of these cases. Time until expected death was infrequently documented. Having a documented discussion about prognosis was associated with documented discussions of life-sustaining treatments (adjusted odds ratio [OR] = 5.8; 95% confidence interval [CI]: 2.8 to 12.0) and having a do-not-resuscitate order (adjusted OR = 2.2; 95% CI: 1.1 to 4.2). CONCLUSIONS: Among terminally ill patients with cancer, discussions about prognosis as documented in medical charts are infrequent and limited in scope. In some cases, such documented discussions may be important catalysts for subsequent discussions of patient and family preferences regarding treatment and future care.

Advance Directives↗
PubMed1993

The long-term prognosis of AA and AL renal amyloidosis and the pathogenesis of chronic renal failure in renal amyloidosis.

Investigation of the long-term prognosis and pathogenesis of chronic renal failure in 225 cases of AA and AL renal amyloidosis (perireticular and perireticular + pericollagenous amyloidosis) yielded the following results: 1) The prognosis of both AA and AL amyloidosis is poor, and is worse than all other types of glomerulopathy with the exception of rapidly progressive glomerulonephritis. 2) The probability of maintaining renal function in AL amyloidosis is no lower than that in AA amyloidosis. 3) The prognosis of both AA and AL amyloidosis is significantly worse in cases in which the renal cortical interstitium exhibits fibrosis at the time of the biopsy than in those in which it is normal. 4) In AA and AL amyloidosis, as in various types of inflammatory glomerulopathy, the relative area of the renal cortical interstitium shows a significant positive correlation with the serum creatinine concentration and a significant negative correlation with the creatinine clearance. However, the extent of interstitial amyloid deposition does not correlate with the serum creatinine concentration. Deposition of amyloid in the renal cortical interstitium has no effect on renal excretory function. 5) The long-term prognosis of renal amyloidosis is related to the severity of the glomerular amyloidosis in as much as it is generally worse in Grades III to V than in Grades I and II. However, it must be borne in mind that the incidence of interstitial fibrosis, which is decisive for the long-term prognosis, increases with the severity of glomerular changes. 6) The long-term prognosis of renal amyloidosis is worse if acute renal failure or interstitial fibrosis is present at the time of the biopsy. Patients with both acute renal failure and interstitial fibrosis have the worst prognosis. 7) Isolated glomerular amyloidosis, even if there is severe vascular amyloidosis (vas afferns), does not lead to renal insufficiency or even to a rise in serum creatinine concentration. 8) The number of T lymphocytes in the tubular epithelium in AA and AL amyloidosis is significantly greater than normal, and the number of T lymphocytes, macrophages/monocytes, and fibroblasts/fibrocytes per unit area of interstitium is also significantly increased. 9) As far as the pathogenesis of renal cortical interstitial fibrosis in renal amyloidosis is concerned, it is proposed that, in some cases, this develops from the interstitial edema that is seen in biopsy specimens of patients with renal amyloidosis and acute renal failure.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1994

Prognosis based on primary breast carcinoma instead of pathological nodal status.

In breast cancer patients, prognostic information required to plan post-surgical therapy is obtained mainly through axillary dissection. This study was designed to establish a new prognostic score based solely on parameters of the primary tumour as an alternative to axillary surgery in assessing prognosis. Eight different prognostic factors, including menopausal status, tumour size, grading, lymphatic invasion, desmoplasia, necrosis, c-erbB-2 and laminin receptor expression, were evaluated retrospectively on a large series of primary breast carcinoma patients. From multivariate analysis, four independent parameters were selected and examined, alone and in combination, for their prognostic potential. These parameters were used to generate a prognostic score that was analysed retrospectively in 467 N0-N1a patients to determine its predictive value for survival. The score, which includes variables such as tumour size, grading, laminin receptor and c-erbB-2 overexpression, was established based on the number of negative prognostic factors: score 1 refers to cases in which all four parameters reflect a good prognosis, scores 2 and 3 refer to tumours in which, respectively, one or two of the four parameters reflect a poor prognosis, whereas score 4 refers to tumours with three or four poor prognosis factors. Analysis of the overall survival of the four score groups shows that patients with score 1 tumours (22% of the total) had the best prognosis with a 15 year survival of 82%, patients with score 2 and 3 had an intermediate prognosis, whereas score 4 patients had the poorest prognosis with a 15 year survival of only 38%. Moreover, survival in the N+ score 1 cases was found to be longer than that in the total N- patients. Our data suggest that the primary tumour score provides more reliable prognostic information than pathological nodal status, and that axillary dissection can be avoided in a large number of patients.

Breast Neoplasms↗