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PubMed1986

Prognostic indicators in diffuse large-cell (histiocytic) lymphoma.

Identification of prognostic groups among patients with diffuse large-cell (histiocytic) lymphoma (DHL) would help to select specific therapy for individual patients and allow comparisons among combination chemotherapy clinical trials. The Ann Arbor staging system is of limited value in predicting outcome in diffuse histiocytic lymphoma. Prognostic factors have been examined by various groups without a consensus of reliable prognostic indicators. This study was undertaken to examine the validity of a predictive model for response to treatment and survival in DHL. Eighty-six patients with the diagnosis of DHL treated with combination chemotherapy between the years 1976 and 1982 were examined for prognostic variables influencing response to treatment and survival. The variables examined included: age, sex, presence or absence of systemic symptoms, serum lactic dehydrogenase (LDH), sites of disease involvement, bulk of disease, prior therapy, stage of disease, according to the Ann Arbor classification, and pathological criteria, according to the Lukes Collins classification. Factors achieving a p-value in the 0 to 0.05 range with univariate analysis for predicting response were age and systemic symptoms. Factors significant for overall survival were age and bone marrow involvement. These factors have been found to influence survival in previous studies, but there has not been a consistency regarding the importance of these factors. Large numbers of patients must be examined for various factors in order to allow identification of prognostic groups among patients with DHL.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1996

Shoulder disorders in general practice: prognostic indicators of outcome.

BACKGROUND: Shoulder pain is common in primary health care. Nevertheless, information on the outcome of shoulder disorders is scarce, especially for patients encountered in general practice. AIM: To study the course of shoulder disorders in general practice and to determine prognostic indicators of outcome. METHOD: For this prospective follow-up study, 11 Dutch general practitioners recruited 349 patients with new episodes of shoulder pain. The participants filled out a questionnaire at presentation and further ones after 1, 3, 6 and 12 months; these contained questions on the nature, severity and course of the shoulder complaints. The association between potential prognostic indicators and the status of shoulder complaints (absence or presence of symptoms) was evaluated after one and 12 months of follow-up. RESULTS: After one month, 23% of all patients showed complete recovery; this figure increased to 59% after one year. A speedy recovery seemed to be related to preceding overuse or slight trauma and early presentation. A high risk of persistent or recurrent complaints was found for patients with concomitant neck pain and severe pain during the day at presentation. CONCLUSION: A considerable number of patients (41%) showed persistent symptoms after 12 months. It may be possible to distinguish patients who will show a speedy recovery from those with a high risk of long-standing complaints by determining whether there is a history of slight trauma or overuse, an early presentation or an absence of concomitant neck pain.

Family Practice↗
PubMed2004

Prognostic indicators for early discontinuation of risperidone long-acting injection.

Although efficacy trials have been conducted on risperidone long-acting injection (RLAI), its most appropriate utilization in clinical practice remains unclear. This 6-month, follow-up study investigated prognostic indicators for early discontinuation of RLAI. Consecutive sampling was conducted for adult patients with a psychotic disorder commenced on RLAI, whose injection was dispensed by one of three South London psychiatric hospital pharmacies. Prescription data were collected prospectively and clinical data retrospectively. Eightly-one out of 88 (92.0%) eligible patients were included, of whom 29 (35.8%) had treatment refractoriness and 30 (37.0%) discontinued within 6 months. Patients with a preceding oral antipsychotic were more likely to discontinue RLAI than those with a preceding depot; treatment refractoriness weakly confounded this relationship [summary adjusted odds ratio (OR) 2.68, 95% confidence interval (CI) 0.95-7.53, P=0.061]. After adjusting for preceding antipsychotic type, patients with treatment refractoriness were no more likely to discontinue than those without (summary adjusted OR 1.55, 95% CI 0.59-4.11, P=0.376). Sociodemographic factors and other clinical factors were non-predictive of discontinuation. For this first wave of patients commenced on RLAI, many had treatment refractoriness. RLAI discontinuation is high early on but subsequently tapers off. Preceding antipsychotic type (depot versus oral) is a stronger prognostic indicator than treatment refractoriness for RLAI discontinuation.

Administration, Oral↗
PubMed1996

Des-gamma-carboxy prothrombin and alpha-fetoprotein positive status as a new prognostic indicator after hepatic resection for hepatocellular carcinoma.

BACKGROUND: The aim of this study was to elucidate the usefulness of measuring the positive status of both des-gamma-carboxy prothrombin (DCP) and alpha-fetoprotein (AFP) preoperatively as a new prognostic indicator of hepatocellular carcinoma (HCC). METHODS: One hundred forty-seven patients who underwent curative hepatic resection for primary HCC were studied. The definitions of DCP and AFP positivity were: positive DCP > 0.1 AU/ml, and positive AFP > 50 ng/ml. The patients were classified into four groups according to their levels of positivity for DCP and/or AFP: Group 1 (n = 59), negative levels of both DCP and AFP; Group 2 (n = 28), negative DCP and positive AFP levels; Group 3 (n = 31), positive DCP and negative AFP levels; and Group 4 (n = 29), positive levels of both DCP and AFP. RESULTS: Patient survival and disease free survival in Group 4 were the worst among the four groups. By multivariate analysis, using Cox proportional hazards model, both the DCP- and AFP-positive status (in combination) and poorly differentiated histology were independent factors of poor prognosis for patient survival; and DCP- and AFP-positive status (in combination), poorly differentiated histology, positive intrahepatic metastasis, and tumor diameter over 5 cm were independent factors of poor prognosis for disease free survival. CONCLUSIONS: The combination of DCP- and AFP-positive status is a new prognostic indicator for patients with HCC after hepatic resection.

Adult↗
PubMed1999

Lobular involvement: prognostic indicator for invasive ductal carcinoma of the breast.

One of the striking microscopic appearances of breast carcinoma is malignant transformation of the epithelium of an entire lobule, although the lobular architecture is still preserved. We termed this pathological feature 'lobular involvement'. An investigation was carried out to determine whether lobular involvement would be a useful prognostic indicator for invasive ductal carcinoma. One hundred and fifty cases of invasive ductal carcinoma were included in this study. The lobular involvement, as well as the conventional prognostic factors, was evaluated to find out the correlation with the overall and relapse-free survivals by univariate and multivariate analyses. The lobular involvement was identified in 31 of 150 patients (20.6%). Of the patients with lobular involvement, two had experienced recurrence (6.5%) and one had died (3.2%). The lobular involvement and lymph node metastases were significantly and independently correlated with the overall and relapse-free survivals. The presence of lobular involvement was statistically correlated with the favorable outcome. Lobular involvement can be assumed as a new prognostic indicator for invasive ductal carcinoma.

Adult↗
PubMed2000

DNA content of nasopharyngeal carcinoma: an independent prognostic indicator.

The purpose of this study was to examine whether tumor DNA content correlated with prognosis in nasopharyngeal carcinoma (NPC). DNA flow-cytometric analysis in fresh specimens of nasopharyngeal biopsy from 123 patients with clinical suspicion of NPC was collected initially. Histopathologic study and successful flow-cytometric analysis had 28 lymphoid hyperplasias and 87 NPCs. Seventeen NPC patients were treated elsewhere and were excluded. A total of 98 patients, including 28 lymphoid hyperplasias and 70 NPCs, formed the materials of this study. There were 34 (49%) diploid and 36 (51%) aneuploid in NPC patients. No lymphoid hyperplasias were aneuploid. The mean of S-phase fraction was higher in NPC than in lymphoid hyperplasia (P < .001), indicating higher cellular activity in NPC. DNA content failed to associate with age, gender, pathology, distant metastasis, and stage, indicating that DNA content was an independent prognostic indicator and possibly a clinical parameter. The log-rank test of overall survival curves was significant for stage (P = .002) and DNA ploidy (P = .042); it was almost significant for S-phase fraction (P = .057). Because the follow-up duration was not long enough, univariate and multivariate analysis were not significant for stage, ploidy, and S-phase fraction, except for distant metastasis. It is also most likely colinearity of clinical stage and distant metastasis that explained why clinical stage could not show significance in prognosis. Interestingly, the DNA content appeared to be a potential prognostic parameter in overall survival, although it was not statistically significant (P = .052). Our data suggested that NPC patients with aneuploid DNA and high S-phase fraction tend to have poor prognosis and should be treated more aggressively, even in the early stage of the disease.

Adult↗
PubMedDate not supplied

Evaluation of the prognostic indices in Legg-Calvé-Perthes disease: statistical analysis of 116 hips.

The records of 100 patients (116 hips) with Legg-Calvé-Perthes' (LCP) disease, with a minimum follow-up of 4 years and treated at the University Hospital, Pellenberg, were reviewed. Sex, Salter's, and Catterall's classifications and lateral subluxation were found to be important prognostic indices. Older children tended to do worse than younger children, but statistical significance could not be established. "Head at risk" factors other than lateral subluxation were found to be unimportant as prognostic indices. Salter's classification was found to be simple, accurate, and significant, and could be made quite early. In the future, this should be an important consideration when making decisions on the management of LCP.

Age Factors↗
PubMed1981

Prognostic indicators in hemiparetic cerebral palsy.

In an attempt to define prognostic indicators of intelligence and seizures in the hemiparetic cerebral palsy population, birth histories, electroencephalograms, and computerized tomographic (CT) scans were reviewed in 52 children with hemiparetic cerebral palsy. Cases were excluded when the hemiparesis might have been related to events beyond the neonatal period, such as meningitis, trauma, focal seizures, tumor, or vascular insults. Detailed neurological histories and examinations were done in all patients. Intellectual evaluations, electroencephalograms, and CT scans were obtained. There was no significant relationship of birth history to subsequent seizure development or mental retardation. In contrast, findings in electroencephalograms and CT scans correlated well with the development of seizures and abnormal intelligence. Children who shared anatomical abnormalities of commissural pathways, association pathways, or cerebral cortex were found to have a much higher incidence of seizures and abnormal intelligence.

Cerebral Palsy↗
PubMed1991

Acute renal failure prognostic indices in hospital inpatients referred for haemodialysis.

Forty-eight patients with acute renal failure (ARF) who were referred to the Department of Renal Medicine, Singapore General Hospital for acute dialysis between August 1985 and August 1989 were studied retrospectively to identify risk factors associated with ARF that serve as prognostic indicators. There was no difference in the mean age of survivors and non-survivors (49.5 +/- 17.5 years vs 53.5 +/- 18 years, p greater than 0.05). The overall mortality rate was 52%. ARF as a result of surgical complication had a higher mortality rate in comparison to ARF from medical complications (66% vs 50%, p greater than 0.05). Septicaemia was the most common cause of ARF requiring dialysis. Hepatobiliary sepsis was the most frequent cause of septicaemia. Pre-dialysis serum urea and creatinine levels, and the number of dialysis treatments did not affect the outcome. Poor prognostic indicators included oliguria or anuria, fluid overload and coma. Patients tended to have a worse outcome if they had more than three risk factors taken from the following list:-decreased renal perfusion, assisted ventilation, coma, gastrointestinal dysfunction, recent surgery, sepsis, congestive heart failure, hepatobiliary dysfunction, malignancy, diabetes mellitus, chronic renal insufficiency and poor nutritional status. Early referral of patients with septicaemia due in particular to hepatobiliary infection may improve the prognosis.

Acute Kidney Injury↗
PubMed2003

Prognostic indicators for gastrointestinal stromal tumours: a clinicopathological and immunohistochemical study of 108 resected cases of the stomach.

AIMS: Whether immunohistochemical markers increase accuracy in predicting prognosis for gastrointestinal stromal tumours (GISTs) remains uncertain. However, past studies have used only small, heterogeneous patient groups. Our aim was to test previously studied and more novel morphological features as well as four immunohistochemical markers as prognostic indicators amongst a large cohort of surgically resected, gastric GISTs. METHODS AND RESULTS: Tissues from 127 gastric mesenchymal tumours were collected retrospectively and subjected to repeat histological assessment and immunophenotyping. Further immunohistochemistry was performed for Ki67, p53, Bcl-2 and cyclin D1. Complete follow-up data were collected for 108 patients with immunophenotyped diagnoses of GIST (i.e. c-kit+ tumours). At the census point, 52 patients were alive, 24 had died from their GISTs and the remainder of other causes. Univariate analysis showed the following predicted for shorter disease-specific survival: size > or =50 mm; necrosis, no intratumoral lymphocytes; mitotic count > or =5/50 high power fields; Ki67 labelling index > or =5%; p53 immunopositivity. Of these variables, multivariate analyses showed only mitotic count and, to a lesser extent, Ki67 labelling to be independent prognostic indicators. CONCLUSIONS: Mitotic count remains the best predictor of outcome following surgical resection of gastric GISTs. Ki67 immunohistochemistry does not provide better prognostication and p53, Bcl-2 and cyclin D1 immunohistochemistry provide no additional prognostication.

Adult↗
PubMed1986

Flow cytometric analysis of DNA content as a prognostic indicator in squamous cell carcinoma of the tongue.

The mortality of squamous cell carcinoma of the tongue has not significantly improved in decades. Much of the information that has been gathered to date has been based on retrospective analyses. There is little consensus on treatment of the disease. In an attempt to define an objective prognostic indicator of aggressiveness of these tumors, a retrospective analysis of 15 paraffin-embedded specimens using flow cytometry was performed. Ten patients (67 percent) had aneuploid tumors and had a 5 year disease-free survival rate of 33 percent, whereas patients with diploid tumors (33 percent) had a 5 year disease-free survival rate of 80 percent. Although the number of patients was small, it appears that flow cytometry may be an objective prognostic indicator in patients with squamous cell carcinoma of the tongue. Larger series of archival paraffin-embedded flow cytometry analyses are recommended, as well as examination of variables other than the disease-free survival rate.

Adult↗
PubMed1993

Relationships between c-Ki-ras mutations, HPV types, and prognostic indicators in invasive endocervical adenocarcinomas.

OBJECTIVE: Ras gene mutations have been identified in squamous cell carcinomas of the cervix and are associated with advanced-stage tumors. The current study was designed to determine the prevalence of c-Ki-ras mutations in invasive endocervical adenocarcinomas and associations between mutations, HPV status, and known prognostic indicators. METHODS: Paraffin-embedded tissue samples from 32 cases of invasive adenocarcinoma of the endocervix were analyzed for the presence of c-Ki-ras mutations by amplification of DNA extracted from paraffin blocks using the polymerase chain reaction (PCR) and subsequent restriction enzyme digestion of the amplimers. This method allows detection of aspartic acid mutations of the c-Ki-ras gene at codons 12 and 13. Samples were also analyzed for the presence of HPV DNA using PCR and either "consensus sequence" primers or "type-specific" primers for HPVs 16 and 18. Patients' charts were reviewed for clinical information and correlations between clinical outcome and known prognostic indicators and the presence of c-Ki-ras mutations was assessed. RESULTS: c-Ki-ras codon 12 mutations were detected in only 4 of the 32 cases (12.5%) of invasive endocervical adenocarcinomas examined. No codon 13 mutations were detected. Fifty-nine percent of the cases were HPV 16 or HPV 18 DNA positive and only 1 of the 4 cases with a codon 12 mutation was associated with HPV 16 or HPV 18. There were no significant associations between stage or grade of tumor or outcome and the presence of codon 12 mutations. However, using the observed survival as computed by the Berkson Gage Method at 12 months, the estimated median survival for patients with c-Ki-ras codon 12 mutations is 29 months compared to 68 months for patients lacking codon 12 mutations. CONCLUSIONS: These results indicate that c-Ki-ras codons 12 and 13 mutations are uncommon in invasive endocervical adenocarcinomas.

Adenocarcinoma↗
PubMed1998

Ki-67 immunolabelling index is a prognostic indicator in childhood posterior fossa ependymomas.

Conventional histological evaluation and subclassification of childhood ependymomas poorly predict their biological behaviour. The Ki-67 labelling index (Ki-67 LI), a measure of growth fraction, correlates with the biological behaviour of several neoplasms, and this retrospective study tested the hypothesis that Ki-67 LI is a prognostic indicator in childhood posterior fossa ependymomas. Immunocytochemistry using an antibody to Ki-67 was undertaken on 5 microns sections of formalin-fixed, paraffin-embedded tissue from 74 cases of childhood (age < 16 years.) posterior fossa ependymoma. A Ki-67 LI was established by counting the proportion of labelled nuclei in more than 1000 cells from several histological fields. Several clinical and histological variables (including Ki-67 LI) potentially associated with survival were entered into univariate and multivariate analyses using a Cox proportional hazards model. Variables that showed a significant and independent association with survival were Ki-67 LI (P < 0.002), whether total surgical resection had been achieved according to operation records (P < 0.03), and whether no adjuvant therapy had been given (P < 0.01). Age, sex, and the presence of necrosis or microvascular proliferation did not correlate with survival. In our defined population of patients with ependymomas, Ki-67 LI is a strong prognostic indicator. We recommend that Ki-67 LI is used in the histological evaluation of childhood posterior fossa ependymomas during trials of novel adjunctive therapies.

Adolescent↗
PubMed1996

[Expression of glutathione S-transferase pi and numerical aberration of chromosome 11 in human ovarian cancer as a prognostic indicator].

In 33 patients with primary ovarian cancer who had not received any chemotherapy before surgery, expression of glutathione S-transferase pi (GST-pi) was studied immunohistochemically in relation to the response to chemotherapy with CDDP, and furthermore it was examined whether numerical aberration of chromosome 11 was available as a prognostic indicator. The obtained results were as follows: 1. Of 33 ovarian cancer tissue samples, 19 (57.6%) showed positive staining and 14 (42.4%) negative staining for GST-pi. 2. The 5 year survival rate of the patients with GST-pi positive tumors was significantly lower than that of those with GST-pi negative tumors (p < 0.01). 3. The frequency of detection of cells showing numerical aberration of chromosome 11 in tissues was significantly higher in ovarian cancers than in benign ovarian tumors and normal ovaries. 4. The 5 year survival rate of the patients with ovarian cancer in which the cells showing numerical aberration of chromosome 11 at 20% or more was significantly lower than that of those in which such cells were under 20% (p < 0.02). These results show that expression of GST-pi and numerical aberration of chromosome 11 in the tissues of human ovarian cancers are useful as prognostic indicators.

Chromosome Aberrations↗
PubMed2002

Influence of delay to diagnosis on prognostic indicators of screen-detected breast carcinoma.

BACKGROUND: Although delay to diagnosis after a breast screening abnormality causes anxiety, its effect on prognosis is unknown. METHODS: Using pooled data from five Canadian organized breast cancer screening programs, the authors used unconditional logistic regression to evaluate the effect of delay to diagnosis on prognostic indicators among 4465 women with invasive breast carcinoma diagnosed in the ipsilateral breast within 3 years of an abnormal screen performed during 1990-1996. RESULTS: Women with high-suspicion screens (n = 1569) compared with those without (n = 2896) were more promptly investigated (median days from screen to diagnosis, 31 vs. 47; P < or = 0.0001), had larger tumors (79.4% vs. 55.9% > 10 mm; P < or = 0.0001), and were more likely to be lymph node positive (33.9% vs. 17.3%; P < or = 0.0001). For delays beyond > 12 to < or = 20 weeks, a linear trend of increased tumor size and lymph node positivity began to emerge. Controlling for suspicion, the authors found that odds ratios for tumor size greater than 10 mm were 0.9 (95% CI, 0.66-1.17), 1.2 (95% confidence interval [CI], 0.88-1.56), 1.5 (95% CI, 1.05-2.16), and 2.1 (95% CI, 1.15-3.86) for delays of > 12 to < or = 20, > 20 to < or = 52, > 52 to < or = 104, and > 104 < or = 156 weeks, respectively (p(trend) < or = 0.0001), compared with delays of > 4 to < or = 12 weeks. Similarly, odds ratios for lymph node metastasis were 1.0 (95% CI, 0.67-1.42), 1.2 (95% CI, 0.84-1.69), 2.2 (95% CI, 1.48-3.15), and 3.2 (95% CI, 1.84-5.55) for the same time intervals (p(trend) = 0.0033). CONCLUSIONS: The authors' findings suggest that delays to diagnosis of asymptomatic breast carcinoma of 6 to 12 months are associated with progression of breast carcinoma as measured by increasing risk of lymph node metastases and larger tumor size. A policy of early recall rather than biopsy for low suspicion mammographic abnormalities may introduce delays of this magnitude. The tendency to more expediently investigate women with high-suspicion, worse prognosis screens (suspicion bias) obscures whether delays shorter than 20 weeks also worsen prognostic indicators. Suspicion bias should be considered when interpreting the effect of delay on prognosis.

Aged↗
PubMed2006

Evaluation of deletions in 7q11.2 and 8p12-p21 as prognostic indicators of tumour development following molar pregnancy.

OBJECTIVES: Previous studies have identified loss of chromosomal regions 7p12-q11.2 and 8p12-p21 in choriocarcinoma suggesting that suppressor genes involved in tumour development may be located within these regions. Our objectives were to refine the regions of loss and evaluate these deletions as prognostic indicators of trophoblastic tumour development following molar pregnancy. METHODS: Fluorescent microsatellite genotyping was used to perform deletion mapping in a series of thirty-nine gestational trophoblastic tumours (GTT) including both choriocarcinoma and placental site trophoblastic tumours. RESULTS: Significant loss of heterozygosity (LOH) was found for both regions in GTT that originated in non-molar pregnancies. Although no common interval of loss was found in those GTT with LOH for the 7q11.2 region, for the 8p12-p21 locus, markers D8S1731 and NEFL defined a minimal region of loss in all tumours showing LOH. However, complete LOH of either region occurred in only a minority of tumours (20%; chromosome 7: 24%; chromosome 8) suggesting that loss of neither region is likely to be a primary event in the development of GTT. This was further supported by the observation that no deletions were found in either region for the fourteen GTT that followed complete molar pregnancies. CONCLUSIONS: While we have defined a minimal interval in 8p12-p21 in which tumour suppressor genes involved in GTT are likely to be located, the data suggest that deletions in 7q11.2 or 8p12-p21 are unlikely to be useful prognostic indicators in the management of patients with molar pregnancies.

Adult↗
PubMed1997

P-glycoprotein as a prognostic indicator in pre- and postchemotherapy ovarian adenocarcinoma.

P-glycoprotein (P-gp) is a plasma membrane efflux transporter that maintains the intracellular concentration of chemotherapeutic agents at low levels. Since the clinical outcome of ovarian adenocarcinoma depends largely on its response to chemotherapy, an objective assessment of P-gp expression could serve as a prognostic indicator. Eighty-five patients were studied. Available tissue sections from the primary tumor (n = 75) and persistent or recurrent lesions (n = 19) were tested with anti-P-gp (JSB-1) monoclonal IgG. Multivariate survival analysis using Cox regression was performed controlling for fixed covariates (age, surgical stage, and presence of residual tumor) and included occurrence of postchemotherapy tumors and P-gp positivity in postchemotherapy neoplasms as time-dependent variables. P-gp was expressed in 49 prechemotherapy (65.3%) and 14 postchemotherapy (73.7%) tumors. After controlling for potentially confounding factors, patients with P-gp-positive postchemotherapy neoplasms were at three times greater risk of dying within 2 years than their counterparts with P-gp-negative tumors (hazard ratio = 3.1: 95% confidence interval = 1.2, 9.1; p < 0.05). Detection of P-gp-expressive subclones can serve as an independent poor prognostic indicator for patients with postchemotherapy tumors.

ATP Binding Cassette Transporter, Subfamily B, Mem↗
PubMed1982

The anion gap as a prognostic indicator in horses with abdominal pain.

The anion gap was calculated for each of 90 horses with signs of abdominal pain, using laboratory data obtained shortly after admission. The anion gap was defined as the difference between the sodium concentration (mEq/L) and the sum of the chloride and bicarbonate concentrations. To evaluate the use of the anion gap as a prognostic indicator, the survival rates were calculated for horses whose anion gap concentrations were within various ranges. It was found that the probability of survival decreased as the anion gap progressively increased about 20 mEq/L. The survival rates for increasing ranges of anion gap were as follows: less than 20 mEq/L, 81% survival; 20 to 24.9 mEq/L, 47%; greater than or equal to 25 mEq/L, 0%. Though not of diagnostic significance as to the source of abdominal pain, the anion gap is a suitable prognostic indicator.

Abdomen↗