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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.
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Yu Ling Lee-Tsai,Rodrigo Luna-Santiago,Roberta Demichelis-Gómez,Alfredo Ponce-de-León,Eric Ochoa-Hein,Karla María Tamez-Torres,María T Bourlon,Christianne Bourlon 대한혈액학회 2019 Blood Research Vol.54 No.2
BackgroundClostridium difficile infection (CDI) is a nosocomial condition prevalent in patients with hematological disorders. We aimed to identify the risk factors associated with the devel-opment of CDI and assess the mortality rate at 15 and 30 days among hematologic patients admitted to a tertiary care center.MethodsWe conducted a retrospective case-control study from January 2010 to December 2015. Forty-two patients with hematologic malignancy and CDI, and 84 with hematologic dis-ease and without history of CDI were included in the case and control groups, respectively.ResultsUnivariate analysis revealed that episodes of febrile neutropenia [odds ratio (OR), 5.5; 95% confidence interval (CI), 2.3‒12.9; P<0.001], admission to intensive care unit (OR, 3.8; 95% CI, 1.4‒10.2; P=0.009), gastrointestinal surgery (OR, 1.2; 95% CI, 1.1‒1.4; P<0.001), use of therapeutic (OR, 6.4; 95% CI, 2.5‒15.9; P<0.001) and prophylactic antibiotics (OR, 4.2; 95% CI, 1.6‒10.7; P=0.003) in the last 3 months, and >1 hospital-ization (OR, 5.6; 95% CI, 2.5‒12.6; P<0.001) were significant risk factors. Multivariate analysis showed that use of therapeutic antibiotics in the last 3 months (OR, 6.3; 95% CI, 2.1‒18.8; P=0.001) and >1 hospitalization (OR, 4.3; 95% CI, 1.7‒11.0; P=0.002) were independent risk factors. Three (7.1%) and 6 (14.2%) case patients died at 15 and 30 days, respectively.ConclusionThe risk factors for developing CDI were exposure to therapeutic antibiotics and previous hospitalization. Hematological patients who developed CDI had higher early mortality rates, suggesting that new approaches for prevention and treatment are needed.
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