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PubMed1980

Relationship of presence of progesterone receptors to prognosis in early breast cancer.

The presence of progesterone receptors was found to be associated with a favorable prognosis in 98 patients with primary breast cancer. The occurrence of metastases was 3.6 times less probable in patients with progesterone receptor-positive tumors than in patients with progesterone receptor-negative tumors. There was also an inverse relationship between the concentration of progesterone receptor and the frequency of metastases. However, there was no statistical correlation between frequency of local recurrences and progesterone receptor content of the tumor. In patients displaying clinical or histological criteria of gravity, the presence of progesterone receptors allowed us to define subgroups with good prognosis. Thus, in women with progesterone receptor-positive cancers, metastases had occurred at 18 months, in only 5% of the 39 Grade III cancers and in none of the 25 cases with invaded axillary nodes. Measurement of estradiol receptor (105 patients including the previous 98 patients) was found to be less effective for guiding the prognosis of early breast cancer. Combined evaluation of estradiol and progesterone receptors did not provide any more information than did the determination of progesterone receptor alone.

Adult↗
PubMed1995

Poor prognosis in multiple myeloma is associated only with partial or complete deletions of chromosome 13 or abnormalities involving 11q and not with other karyotype abnormalities.

Chromosomal abnormalities have major biologic and prognostic implications in leukemias. Cytogenetic information in typically hypoproliferative multiple myeloma (MM) is limited because of difficulties in obtaining analyzable metaphases. In this study, karyotypes and other known prognostic factors were analyzed in 155 newly diagnosed MM patients, entered on an intensive treatment program with two autotransplants. Complete remission (CR), event-free (EFS) and overall survival (OS) were analyzed using standard statistical methods. Abnormal cytogenetics were found in 39% of patients and were associated with a significantly lower CR rate (27% v 48%; P = .008). EFS and OS were inferior in patients with either partial or complete deletion of chromosome 13 or 11q abnormalities ("unfavorable" karyotype) when compared with the remaining patients (P < .001) who, as a group, had a similar prognosis irrespective of cytogenetic findings, ie, inevaluable, normal, or abnormal but without an "unfavorable" karyotype. The patients with abnormalities of both chromosomes 11 and 13 had a dismal prognosis with median EFS and OS of only 11 and 12 months, respectively. Significant associations were noted between an "unfavorable" karyotype and IgA isotype, elevated levels of beta-2 microglobulin (B2M, > or = 3 mg/L) and age > 60 years. On multivariate regression analysis, the absence of an "unfavorable" karyotype was the most significant variable associated with prolonged EFS and OS (P = .0001 and .0002, respectively). Other independent favorable variables were age less than 60 years, C-reactive protein (CRP) < or = 0.4 mg/dL and bone marrow plasmacytosis < or = 50% before treatment. On a multivariate analysis without cytogenetics, these same three standard parameters were identified as the only favorable variables. Patients not having all three standard favorable variables had a significantly lower CR rate (P = .03), EFS (P = .0001), and OS (P = .002) if an unfavorable karyotype was detected. We conclude that, in this program of uniformly treated MM patients, a poor prognosis was associated predominantly with abnormalities of chromosomes 11 and 13.

Chromosome Aberrations↗
PubMed1995

Endoscopic therapy for early gastric cancer. Utility of endosonography and evaluation of prognosis.

We analyzed 30 endoscopically treated patients with early gastric cancer in terms of the utility of endoscopic ultrasonography (EUS) and the evaluation of prognosis. Endoscopic therapy for early gastric cancer included strip biopsy, laser irradiation, and OK-432 injection. Examination of the depth of cancer invasion in the strip biopsy specimens showed that the diagnostic accuracy of EUS was 85.7%. Complete resection rate in strip biopsy was 82.8%, and the patients with incompletely resected cancer were successfully treated with laser irradiation and/or OK432 injection. The prognosis of the patients treated with strip biopsy was good. Three patients died of causes other than gastric cancer. Local recurrence and a heterochronous new lesion developed in six patients, but all of these cases were successfully treated with additional strip biopsy. All but one patient treated with laser irradiation and/or OK 432 injection survived during the study period. These results suggest that EUS is useful in determining the indication of endoscopic therapies and that prognosis is good in patients with early gastric cancer treated endoscopically.

Aged↗
PubMed1995

[Prognosis and outcome of rheumatoid arthritis--10 to 16 years of anti-rheumatic therapy].

One hundred twenty-eight rheumatoid arthritis (RA) patients were followed up over a long period of time (mean, 13.3 years; range, 10-16 years) in order to determine the role of pharmacotherapy in RA. Patients were aged 48.2 years on the average (23-79 years) and the mean RA duration was 7.8 years (0-58 years) upon initial visit to this unit. Although pharmacotherapy was effective in improving Lansbury's activity index and ESR, articular bone and cartilage destruction and functional impairment progressed gradually, resulting in the need for total hip, knee or ankle arthroplasty in 46 (96 joints) of the 128 patients. This finding indicates that current pharmacotherapy for RA has limitations in that it cannot completely prevent joint destruction and resulting functional impairment. This suggests that new therapeutic modalities, including new drugs, are necessary. Efforts were also made to determine factors which affect the prognosis of RA. The prognosis seemed pessimistic in RA patients with high activity and rheumatoid factor (RAPA) levels, long duration of illness, high Larsen scores and advanced functional impairment at the time of initial active therapy. It appeared necessary to maintain Lansbury's activity index at 30% or below in order to obtain a good prognosis.

Adult↗
PubMed1995

[Preliminary analysis of relationship between immunological changes and syndrome differentiation-typing in traditional Chinese medicine and prognosis with chronic idiopathic thrombocytopenic purpura].

In order to study the relationship between the basement immunological changes, TCM Syndrome Differentiation and prognosis, alkaline phosphates antialkaline phosphatase (APAAP) and ELISA assay were used to determine the T lymphocyte subsets, the platelet associated antibody (PAIgG, PAIgA, PAIgM) and plasma antiplatelet-autoantibodies (GP II b, GP III a, GP I b) in 55 chronic idiopathic thrombocytopenic purpura (ITP) and 53 healthy subjects as control. The results indicated that the immunological changes was closely related to the prognosis, while the TCM Syndrome Differentiation was also related to it, which denoted that it is significant to investigate both factors in guiding treatment and assessing the prognosis.

Adolescent↗
PubMed1995

[Can the prognosis of early rheumatoid arthritis be predicted?].

Rheumatoid arthritis is a frequently and potentially severe disease which causes a functional handicap in nearly half the patients 10 years after the identification of the first clinical manifestations. Some patients develop very severe forms with joint destruction and multiple organ involvement while in others the disease remains benign, even after a long clinical course of several years. Theoretically, the future intensity of rheumatoid arthritis in a given patient cannot be predicted at the time of early diagnosis. No prognosis factor has been identified and universally accepted and validated. A marker of prognosis would be highly appreciated by clinicians who could then more closely adapt their management decisions to the disease potential. Clinical and biological data collected to date have provided a limited amount of prognostic information but recent progress in molecular biology suggests that genetic markers could be correlated with disease severity. Several HLA-DRB1 alleles including DR1*0401, DRB1*0404, DRB1*0101 and sometimes DRB1/1001 and DRB1/1402 are potential markers. In France 85% of the patients with rheumatoid arthritis have one of these genes compared with 25% in the general population. In patients with a "high risk" alleles, the second haplotype could also have prognostic value. It would appear possible to distinguish immunogenetically homogeneous subpopulations corresponding to the more severe forms of the disease. It is still too early to propose therapeutic strategies based on current prognosis markers, but a combination of the most pertinent markers should be already used to select homogeneous subsets of patients in fundamental research and clinical trials.

Arthritis, Rheumatoid↗
PubMed1993

Autologous and allogeneic bone marrow transplantation for poor prognosis patients with B-cell chronic lymphocytic leukemia.

Twenty patients with poor prognosis B-cell chronic lymphocytic leukemia (B-CLL) underwent uniform high-dose chemoradiotherapy followed by rescue with multiple monoclonal antibody-purged autologous bone marrow (BM) (12 patients) or T-cell-depleted allogeneic BM from HLA-identical siblings (8 patients) in a pilot study to assess the feasibility of BM transplantation (BMT) in this disease. All had poor prognosis disease by either staging, BM pattern, tumor doubling time criteria, or cytogenetics. All patients achieved remission criteria (defined as < or = 2 adenopathy, absence of splenomegaly, < or = 20% of the intertrabecular space involved on BM biopsy) before BMT. Despite the use of fludarabine, a median of three treatment regimens were required to achieve BMT eligibility. After BMT, all patients achieved complete hematologic engraftment. Toxicities were not significantly different between autologous versus allogeneic BMT. Two toxic deaths were observed. Of 19 evaluable patients, 17 clinical complete clinical remissions (89%) were observed, with 2 patients (1 allogeneic and 1 autologous) exhibiting persistent BM disease. Complete clinical remissions were documented at the phenotypic and molecular level for the majority of patients in whom dual fluorescence for CD5 and CD20 (15 of 15; 100%) and Ig gene rearrangements (11 of 14; 79%) were performed. Although long-term follow-up is needed to assess any potential impact on the disease-free and overall survival of these patients, this study shows the feasibility of using high-dose chemoradiotherapy and BMT in patients with poor prognosis B-CLL.

Adult↗
PubMed1995

DNA ploidy, proliferative index, and epidermal growth factor receptor: expression and prognosis in patients with gastric cancers.

BACKGROUND: The 5-year survival rate of patients with stomach cancer is usually around 20%. The clinico-pathological features that are presently used to assess patient prognosis are not sufficient to define gastric tumor behavior. Therefore, an accurate analysis of different biological characteristics of gastric cancer cells could allow the course of disease to be predicted and may help to improve treatment strategies. EXPERIMENTAL DESIGN: The prognostic values of DNA ploidy, proliferative activity and epidermal growth factor receptor (EGF-R) expression were studied in gastric tumors from a series of 63 patients. DNA ploidy and proliferative activity, evaluated in terms of DNA index (DI) and proliferative index (PI), respectively, were determined by flow cytometry on paraffin-embedded tumor tissues. EGF-R expression was detected by immunohistochemistry on paraffin-embedded tumor sections of the same specimens. The clinico-pathological and the biological parameters were then correlated, and the patients overall survival was calculated using a chi-square test and the Kaplan-Meier method. RESULTS: DNA ploidy abnormal cell clones were found in 44% of cases (median DI = 1.4, range 1.04-2.5). Aneuploid tumors showed high PI more frequently than diploids (71% versus 36%, p = 0.01). The analysis of the expression of EGF-R revealed that 88% of aneuploid tumors were positive for receptor expression. On the contrary, diploid tumors showed the presence of EGF-R only in 56% of cases (p = 0.01). DI, PI, and EGF-R expression were not related to histological grade. Conversely, the three biological parameters were significantly correlated to clinical stage and tumor invasion. The Kaplan-Meier survival curves showed a 73% 5-year survival rate in patients with diploid tumors whereas only 33% of patients with aneuploid lesions had a good prognosis (p = 0.001). CONCLUSIONS: We demonstrate that DNA ploidy, PI, and EGF-R expression are closely related to some pathological and clinical characteristics in gastric cancer. The close relationship between aneuploidy, EGF-R positive expression, node involvement, and tumor invasion suggests that these parameters may be indicators of high malignancy. Finally, the results also show that aneuploidy and EGF-R-positive expression are indicative of a worse prognosis in gastric cancer patients. The study of these parameters might allow a more accurate stratification of patients, so that a targeted therapeutic protocol may be defined.

Aged↗
PubMed1995

[Long-term prognosis of pulmonary sarcoidosis. 2. Cardiac sarcoidosis and other extrapulmonary manifestations].

Frequency and prognostic importance of extrapulmonary manifestations have been examined in 254 patients with intrathoracic sarcoidosis. A follow-up was carried out after a median of 27 years from diagnosis. All patients could be traced. Extrapulmonary manifestations were found in 119 patients (47%), mostly occurring within the first years after diagnosis of intrathoracic sarcoidosis; skin manifestations were most frequently seen. ECG-abnormalities were found in 35 patients (14%); in 17 cases in the form of sinus tachycardia. No excess mortality was found (80 deaths observed versus 66 expected). The causes of death were related to sarcoidosis in 41%. Only tachycardia was associated with an unfavourable prognosis and this association vanished after adjusting for decreased lung function. None of the other extrapulmonary manifestations were associated with an unfavourable vital prognosis. Erythema nodosum was of no prognostic significance concerning survival. In conclusion, extrapulmonary manifestations are frequent in patients with intrathoracic sarcoidosis but do not influence vital prognosis.

Aged↗
PubMed1994

[Prognosis of idiopathic interstitial pneumonia].

Idiopathic interstitial pneumonia (IIP) is characterized by chronic inflammation and fibrosis of the lung. It carries a poor prognosis and the treatment for IIP has not yet been established. We evaluated 116 cases of IIP retrospectively, and analyzed possible prognostic factors, such as the mode of detection, clinical symptoms, chest X-ray findings, pulmonary function tests, blood chemistry, bronchoalveolar lavage (BAL), and treatments. The 5-year survival rate from the onset was 39.5% and the 10-year survival rate was only 12.7%. The 5-year survival rate from the appearance of dyspnea on exertion was 23.2% and 10-year survival rate was 9.0%. According to the results of the Kaplan-Meier analysis, patients with low% FVC (< 70%), those with high values of ESR, those with high values of CRP, and those with advanced chest X-ray shadows did not survive as long as other patients. Multivariate analysis with a proportional hazards model revealed that a high percentage of eosinophils in BALF was associated with a poor prognosis. Analysis with a logistic model revealed that being male having a low %DLCO were associated with a poor prognosis.

Female↗
PubMed1994

[Improved prognosis of breast cancer].

The trend in the prognosis of female patients with breast cancer has been investigated by comparing Kaplan-Meier survival curves of different patient cohorts diagnosed during the period 1948-87. The study is based on 71,448 patients from the Danish Cancer Registry. The cohorts were defined by age at diagnosis, year of diagnosis and residential area. The survival time from diagnosis to death nearly doubled from 1948-57 to 1978-87 with the most important improvement taking place after 1978. Patients diagnosed in 1948-77 in the Copenhagen area had a far better prognosis than patients during this period in the rest of the country. For patients diagnosed in 1978-87 the prognosis, however, reached an equal level in all parts of the country. Thus, it is reasonable to assume that the national programme introduced in 1977 by the Danish Breast Cancer Cooperative Group (DBCG) has played an important role in these improvements.

Adult↗
PubMed1994

[The relation between prognosis and amplification of the c-erB-2 (HER-2/neu) proto-oncogene in ovarian carcinomas].

C-erbB-2 (HER-2/neu) proto-oncogene is mainly expressed in epithelial tissue and activated due to its amplification. Amplification of the C-erbB-2 proto-oncogene is associated with poor prognosis in human ovarian cancer. We examined whether amplification of C-erbB-2 is common in ovarian carcinoma or is associated with poor prognosis. The DNA of ovarian carcinoma was extracted and consequently digested with restriction endonuclease EcoRI, electrophoresed in 0.8% agarose gels and blotted onto nitrocellulose filter with Southern transfering method. It was hybridized with a 32p-labelled C-erbB-2 probe and subsequently underwent autoradiography. It was shown that the C-erbB-2 (HER-2/neu) gene was amplified in 8 of 26 human ovarian carcinomas (30.8%). Clinically the 8 patients with the amplified C-erbB-2 were in their advanced stage (III-IV). Five of the patients died from 2 to 4 months after operation. These findings suggest that amplification of the C-erbB-2 gene may play a role in the pathogenesis of ovarian carcinoma, it is frequently observed in advanced ovarian carcinoma and associated with poor prognosis for these patients.

DNA, Neoplasm↗
PubMedDate not supplied

Determinants of prognosis in patients with heart failure.

Heart failure is now the single most common inpatient diagnosis for patients 65 years of age and older and is growing. As decisions regarding heart transplantation are contemplated in an era of fixed resources, determination of prognosis becomes a critically important process. No single factor can be used to predict survival in this complex clinical syndrome, but a number of factors, which are highly interactive, can be deduced from laboratory studies. Left ventricular ejection fraction, exercise tolerance, and heart size are the most consistent and reliable measures of prognosis, but other variables are also useful. Despite the availability of numerous high technology measurements, determination of prognosis remains largely an art form.

Aged↗
PubMed1994

[The prognosis of patients with posterior urethral valves according to the initial treatment and their urodynamic behavior].

Long-term outcome of 35 boys with severe posterior urethral valves is reviewed, with intention to know if the course of renal function depended on initial treatment and bladder dysfunction. Diagnosis was established during the first month in 15 patients, before one year in 16 and later in 4. Surgical management was initially, upper urinary tract diversion (pyeloureterostomy) in 19 patients (group A) and valve ablation in 15 (group B). The average age for closure of temporary urinary diversion was 17 months. Follow-up ranged from 4-19 years (mean 8.3 years). Twenty one patients had a urodynamic study years after initial treatment and this study showed 8 normal bladder, 7 unstable and 6 non-compliant. In group A, at the end of study, 13 patients (70%) have a glomerular filtration of more than 80 ml/min/1.72 m2 while in group B only 6 (37.5%) and average height after treatment was higher in patients of group A. Noncompliant bladders had worst prognosis (66% renal failure) than unstable bladders (25%) and the prognosis was improved in these types of bladders when initial treatment was upper tract diversion. The results of our study suggest that in patients with severe posterior urethral valves, the renal function improved with early diversion (pyeloureterostomy) and irreversible bladder dysfunction worsen the prognosis in these patients.

Follow-Up Studies↗
PubMed1994

Long-term prognosis of patients presenting to the emergency room with decompensated congestive heart failure.

OBJECTIVES: This observational study was done to describe the long term prognosis of patients presenting to an emergency room with decompensated heart failure and to determine the factors that influence their survival. DESIGN: The routine clinical and laboratory characteristics of consecutive patients presenting to an emergency room with decompensated heart failure were documented and the patients followed for an average of 44 months (range 41 to 47). SETTING: One teaching hospital and one community-based hospital in Montreal, Quebec. PATIENTS: A prospective cohort of 153 consecutive patients presenting to the emergency room with decompensated heart failure. OUTCOME MEASURES: Total mortality was the main outcome. Survival status was validated by the government health insurance board. RESULTS: Survival was poor, with 61% dying within the 47-month follow-up. Univariate analysis revealed the following variables to be associated with decreased survival; low sodium (P < 0.001), decreased renal function (P < 0.001), prior hospitalization for decompensated heart failure (P < 0.001), intraventricular conduction defect (P < 0.002), failure despite prior use of angiotensin-converting enzyme (ACE) inhibitors (P < 0.005) and increased cardiac dimensions as determined by increased left ventricular end systolic diameter (P < 0.04). The multivariate analysis using the Cox proportional hazards model showed a prior admission for heart failure (relative risk [RR] 1.9 [P = 0.005], 95% confidence interval [CI] 1.2 to 2.9), hyponatremia (RR 2.1 [P = 0.005], 95% CI 1.2 to 3.5), presence of an intraventricular conduction delay (RR 1.9 [P = 0.003], 95% CI 1.2 to 2.9), and the cumulative required dose of intravenous furosemide (RR 1.7 [P = 0.03], 95% CI 1.1 to 2.8) to be associated with increased mortality. Patients with hyponatremia despite the use of ACE inhibitors were at greatest risk (RR 11.5 [P < 0.001], 95% CI 5.3 to 24.9). CONCLUSIONS: This prospective observational study confirms that the long term prognosis of patients needing hospitalization for congestive heart failure remains poor. Readily available acute-phase clinical variables may assist in predicting prognosis.

Aged↗
PubMed1994

The prognosis of extrapulmonary sarcoidosis.

The frequency and functional prognosis of some major extrapulmonary manifestations (EPM) are reviewed using the literature and our own data. The influence of EPM on the vital prognosis is studied. Our knowledge of functional and vital prognosis in EPM is scanty.

Eye Diseases↗
PubMed1994

Soft tissue sarcoma. Epidemiology and prognosis in 508 patients.

We have evaluated epidemiology, prognosis and the association between metastases and local recurrence in a series of adult patients with soft tissue sarcoma (STS) of the extremity and trunk wall. 508 patients were diagnosed in the Southern Swedish Health Care Region from 1964 through 1989. The series was population-based, i.e., all patients within a defined area were included, irrespective of where treated, thereby avoiding selection bias in referral and follow-up. Epidemiology. The annual incidence was 18 per million. The median age was 64 years. One third of the tumors were subcutaneous, and these were smaller than the deep-seated tumors. Malignant fibrous histiocytoma and grade IV were the commonest. Differences were noted in clinicopathologic features among histotypes. The 5-year metastasis-free survival rate (MFSR) was 0.6. The crude local recurrence rate was 0.3. The majority of metastases and local recurrences occurred within 3 years. The referral pattern to the tumor center has become more favorable over time; in the last 5 years half of the subcutaneous and four fifths of the deep-seated tumors were referred before surgery. Prognostic factors. Tumor size, tumor necrosis, and vascular invasion were strong and independent prognostic factors for metastasis in a histologically mixed series. In MFH, storiform and pleomorphic subtype, tumor necrosis and tumor size were associated with a poor prognosis. Tumor necrosis and vascular invasion independently worsened the prognosis in leiomyosarcoma. In liposarcoma, tumor necrosis and in synovial sarcoma, tumor size were the only important prognostic factors. Tumor size, tumor necrosis, and vascular invasion were used in a prognostic system which identified two thirds of all patients with a 5-year MFSR of 0.8 and one third of the patients with a 5-year MFSR of 0.3. Metastasis and local recurrence. The causal association proposed for local recurrence and metastasis should be interpreted with caution. We suggest that highly malignant tumors combine local and distant aggressiveness, and that local recurrence is a marker of risk, and not necessarily a cause of, metastasis. Conclusions. 1. Population-based series are preferable when studying epidemiology in soft tissue sarcoma. 2. We propose that tumor size, tumor necrosis, and vascular invasion are strong and reliable factors that can be used to improve prognostic accuracy. 3. There is a growing body of evidence against a causal relationship between local recurrence and metastasis.

Adolescent↗
PubMed1993

The aetiology, pattern and prognosis of fractures of the spine in Dar es Salaam, Tanzania.

To determine the aetiology, pattern and prognosis of fractures of the spine in Dar es Salaam, Tanzania we studied a total of 54 patients who had sustained fractures of the spine and were managed by the Orthopaedic/Trauma Department of Muhimbili Medical Centre from January to December 1992. Of these patients 50 were males and four females. Their ages ranged between 12 and 69 years with a mean of 35.5 years. The 21-30 year age group formed the majority of the patients (48.2 pc). Common causes for fractures of the spine observed were motor traffic accidents (MTA) accounting for 38.9 pc of the fractures, falls from heights (46.3 pc) and injuries from falling objects (11.1 pc). The vertebra in the C3-C5 and T11-L3 regions were most frequently fractured. Neurological deficits were observed in 33 patients (61.1 pc) with paraplegia and quadriplegia dominating the neurological pathology. Full recovery of the neurological deficit was observed in five patients (15.2 pc) and partial recovery in 10 (30.3 pc). The overall case fatality rate was 29.6 pc all of whom had neurological deficit. Cervical spine fractures had the worst prognosis accounting for 43.8 pc of the mortality. All patients except two were treated conservatively. There is a need to disseminate knowledge on the initial care for spinal injury patients so as to improve the prognosis of such patients.

Accidental Falls↗