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Prognostic Factors and Decision Tree for Long-Term Survival in Metastatic Uveal Melanoma
Daniel Lorenzo,María Ochoa,Josep Maria Piulats,Cristina Gutiérrez,Luis Arias,Jaume Català,María Grau,Judith Peñafiel,Estefanía Cobos,Pere Garcia-Bru,Marcos Javier Rubio,Noel Padrón-Pérez,Bruno Dias,Jo 대한암학회 2018 Cancer Research and Treatment Vol.50 No.4
Purpose The purpose of this study was to demonstrate the existence of a bimodal survival pattern in metastatic uveal melanoma. Secondary aims were to identify the characteristics and prognostic factors associated with long-term survival and to develop a clinical decision tree. Materials and Methods The medical records of 99 metastatic uveal melanoma patients were retrospectively reviewed. Patients were classified as either short ( 12 months) or long-term survivors (> 12 months) based on a graphical interpretation of the survival curve after diagnosis of the first metastatic lesion. Ophthalmic and oncological characteristics were assessed in both groups. Results Of the 99 patients, 62 (62.6%) were classified as short-term survivors, and 37 (37.4%) as long-term survivors. The multivariate analysis identified the following predictors of long-term survival: age 65 years (p=0.012) and unaltered serum lactate dehydrogenase levels (p=0.018); additionally, the size (smaller vs. larger) of the largest liver metastasis showed a trend towards significance (p=0.063). Based on the variables significantly associated with long-term survival, we developed a decision tree to facilitate clinical decision-making. Conclusion The findings of this study demonstrate the existence of a bimodal survival pattern in patients with metastatic uveal melanoma. The presence of certain clinical characteristics at diagnosis of distant disease is associated with long-term survival. A decision tree was developed to facilitate clinical decision-making and to counsel patients about the expected course of disease.
Salvador Israel Macías-Hernández,Juan Daniel Morones-Alba,Irene Tapia-Ferrusco,Oscar Benjamín Vélez-Gutiérrez,Cristina Hernández-Diaz,Tania Inés Nava-Bringas,Eva Cruz-Medina,Lya Contreras-del Toro,Ma. 대한구강악안면외과학회 2022 대한구강악안면외과학회지 Vol.48 No.1
Objectives: Osteoarthritis (OA) is the most prevalent and disabling joint disease in the world. Temporomandibular joint (TMJ) exercise is a widely used treatment and could be a beneficial and long-term tool for treating TMJ OA. The present study aims to evaluate the effects of therapeutic exercise in the conservative treatment of TMJ OA. Materials and Methods: A single-group experimental pre-post test was performed. We included patients who met the diagnostic criteria for TMJ OA. Outcome variables were pain intensity (visual analogue scale), functionality (Helkimo index), and structural changes (ultrasound). Follow-up peri-ods were at months 1, 3, and 6. The intervention included a home-based program with thermotherapy, manual therapy, and therapeutic exercise during the entire follow-up period. Results: We included 15 patients and 26 joints, all women with a median age of 57 years (range, 49-62 years). Median change in pain intensity on joint palpation, mouth opening, and at rest at the first month was 47.5 mm, 51 mm, and 60 mm, respectively, and 48 mm, 49.5 mm, and 42.5 mm, at six months (P=0.001). The Helkimo index showed significant improvement in medians from baseline severe dysfunction (17 points) to minimal dys-function at three and six months (2 points) (P=0.001). Ultrasound showed improved disc position. Conclusion: This study demonstrated significant improvements in pain, function, and joint disc position and represents a valuable tool for the long-term treatment of patients with TMJ OA.