Aggressive 비호즈킨 림프종의 예후인자 분석과 고위험군 환자 선별을 위한 International Prognostic Index Model

김경태(Kyung Tae Kim),김태유(Tae You Kim),임영혁(Young Hyuck Im),강윤구(Yoon Koo Kang),이창희(Chang Hee Lee),곽영임(Young Im Kwak),류백렬(Baek Yeol Ryoo),성주병(Ju Byeung Sung),이영우(Young Wo Lee),장은정(Eun Jung Jang),김재학(Jae Ha 대한내과학회 1997 대한내과학회지 Vol.53 No.3

N/A Objective: Although the therapeutic outcome of aggressive non-Hodgkin's lymphoma (NHL) has been considerably improved by the introduction of combination chemotherapy, many patients still fail to achieve complete response(CR) and/or long-term survival. Because the outcome appears to depend on certain prognostic factors, long term prognosis can be predicted by identification of risk group. And also, the patients in high risk group may benefit from new therapeutic modality. In 1993, the international prognostic index model for aggressive NHL as developed far the purpose of predicting outcome and designing of therapeutic trial. Thus, analysis of prognostic factors was performed to identify independent factors for the end points of CR, overall survival, and disease-free survival. Methods : From 1989 to 1994, total 340 patients were treated with combination chemotherapy and/or radiotherapy for NHL in Korea Cancer Center Hospital. Among 340, informations on eleven prognostic factors(sex, age, performance status, Ann Arbor stage, serum LDH level, tumor size, number of extranodal disease sites, bone marrow involvement, presence of B symptom, sex, time to CR, and histologic grade) were avaliable for 273 patients. Among these, 221 patients with aggressive NHL(NCI clinical schema) were eligible for the prognostic factor analysis for the response and survival. Also, 186 patients were eligible to determine whether International Prognostic Index Model could be applicable for Korean NHL. Results: One hundred fifty patients(68%, 95% CI 62-74%) achieved a complete remission, 43 patients (20%) a partial remission. With a median follow-up of 3,5 years, overall 3 year survival rate was 6396, and 3 year DFS for the 150 CRs was 72%. In a univariate analysis for the CR and survival, Ann Arbor stage, number of extranadal disease, performance status, presence of B symptoms, presence of BM involvement, serum LDH level and histologic grade were found to be statistically significant prognostic factors. Among them, by multivariate analysis, number of extranodal disease(RR 0.2, 95% CI 0.1-0.7), B Symptoms (RR 0.4, 95% CI 0.2-0.9), and histologic grade(RR 0.2, 95% CI 0.08-0.7) showed to be independent adverse prognostic factors for CR. For disease-free survival, Ann Arbor stage(RR 2.6, 95% CI 1.1-6.4) was independent risk factor. For overall survival, number of extranodal involvement(RR 2, 95% CI 1.3-4) and histologic grade(RR 2, 95% CI 1.2-3.7) were independently significant prognostic factors. With these 2 independent prognostic factors for survival, we could establish a prognastic index model which could separate the high risk patients. However, the usefulness of this model should be confirmed in a larger patient population. The dose intensity of cyclophosphamide, during initial 3 months of treatment, was significantly associated with CR rate and overall survival(p=0.01 & 0.03, respectively). When International Prognostic Index Model was applied to our patients, patients in the lower risk groups had significantly better outcome than patients in the higher risk groups(3 year survival and RR: 77% & 1 for low risk group, 61% & 1.9 for low-intermediate risk group, 50% & 2.2 for high-intermediate risk group, and 25% & 6 for high risk group). Conclusion: In this study, we confirmed that features other than the Ann Arbor stage were independently associated with CR and survival, and the International Prognostic Index Model would be an useful tool for the selection of high-risk patients who could be benefited from more aggressive chemotherapy.

Multivariate survival analysis of the patients with recurrent endometrial cancer

Tetsuji Odagiri,Hidemichi Watari,Masayoshi Hosaka,Takashi Mitamura,Yousuke Konno,Tatsuya Kato,Noriko Kobayashi,Satoko Sudo,Mahito Takeda,Masanori Kaneuchi,Noriaki Sakuragi 대한부인종양학회 2011 Journal of Gynecologic Oncology Vol.22 No.1

Objective: Few studies on the prognosticators of the patients with recurrent endometrial cancer after relapse have been reported in the literature. The aim of this study was to determine the prognosticators after relapse in patients with recurrent endometrial cancer who underwent primary complete cytoreductive surgery and adjuvant chemotherapy. Methods: Thirty-five patients with recurrent endometrial cancer were included in this retrospective analysis. The prognostic significance of several clinicopathological factors including histologic type, risk for recurrence, time to relapse after primary surgery, number of relapse sites, site of relapse, treatment modality, and complete resection of recurrent tumors were evaluated. Survival analyses were performed by Kaplan-Meier curves and the log-rank test. Independent prognostic factors were determined by multivariate Cox regression analysis. Results: Among the clinicopathological factors analyzed, histologic type (p=0.04), time to relapse after primary surgery (p=0.03), and the number of relapse sites (p=0.03) were significantly related to survival after relapse. Multivariate analysis revealed that time to relapse after primary surgery (hazard ratio, 6.8; p=0.004) and the number of relapse sites (hazard ratio, 11.1; p=0.002) were independent prognostic factors for survival after relapse. Survival after relapse could be stratified into three groups by the combination of two independent prognostic factors. Conclusion: We conclude that time to relapse after primary surgery, and the number of relapse sites were independent prognostic factors for survival after relapse in patients with recurrent endometrial cancer. Objective: Few studies on the prognosticators of the patients with recurrent endometrial cancer after relapse have been reported in the literature. The aim of this study was to determine the prognosticators after relapse in patients with recurrent endometrial cancer who underwent primary complete cytoreductive surgery and adjuvant chemotherapy. Methods: Thirty-five patients with recurrent endometrial cancer were included in this retrospective analysis. The prognostic significance of several clinicopathological factors including histologic type, risk for recurrence, time to relapse after primary surgery, number of relapse sites, site of relapse, treatment modality, and complete resection of recurrent tumors were evaluated. Survival analyses were performed by Kaplan-Meier curves and the log-rank test. Independent prognostic factors were determined by multivariate Cox regression analysis. Results: Among the clinicopathological factors analyzed, histologic type (p=0.04), time to relapse after primary surgery (p=0.03), and the number of relapse sites (p=0.03) were significantly related to survival after relapse. Multivariate analysis revealed that time to relapse after primary surgery (hazard ratio, 6.8; p=0.004) and the number of relapse sites (hazard ratio, 11.1; p=0.002) were independent prognostic factors for survival after relapse. Survival after relapse could be stratified into three groups by the combination of two independent prognostic factors. Conclusion: We conclude that time to relapse after primary surgery, and the number of relapse sites were independent prognostic factors for survival after relapse in patients with recurrent endometrial cancer.

Is Diabetes Mellitus a Prognostic Factor for Survival in Patients with Small Cell Lung Cancer?

Inal, Ali,Kaplan, M. Ali,Kucukoner, Mehmet,Urakci, Zuhat,Karakus, Abdullah,Nas, Necip,Guven, Mehmet,Isikdogan, Abdurrahman Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.4

Background: Previous studies have pointed to many different prognostic factors for small cell lung cancer (SCLC) but diabetes mellitus (DM) has not been clearly or consistently identified as of prognostic value. The aim of this study was to investigate the prognostic significance of the characteristics of patients and clinical laboratory tests in SCLC. Specifically, we investigated that the impact of DM for survival in the patients receiving first-line etoposide plus cisplatin (EP) chemotherapy. Methods: We retrospectively reviewed 161 patients with SCLC with a focus on DM and other potential prognostic variables were chosen for univariate and multivariate analyses with respect to survival. Result: Among the sixteen variables of univariate analysis, five were identified to have prognostic significance: performance status (PS) (p<0.001), stage (p=0.001), DM (p=0.005), serum albumin (p<0.001) and hemoglobin levels (p=0.03). Multivariate analysis showed PS, stage and serum albumin level to be independent prognostic factors for survival (p=0.02, p=0.02 and p=0.009 respectively), but DM was not an independnet factor. Conclusion: In conclusion, PS, stage and serum albumin level were identified as important prognostic factors, while DM at the time of diagnosis of SCLC did not have prognostic importance for survival.

Treatment Outcome and Prognostic Factors for Malignant Skin Melanoma Treated with Radical Surgery

Majewski, Wojciech,Stanienda, Karolina,Wicherska, Katarzyna,Ulczok, Rafal,Wydmanski, Jerzy Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.14

Aim: To assess the treatment outcome in patients with malignant skin melanoma and prognostic factors for distant metastases (DM), disease-free survival (DFS) and overall survival (OS). Materials and Methods: A retrospective analysis was conducted on 113 patients with malignant skin melanoma (60 females, 53 males, average age-55 years) who were treated surgically. Primary treatment consisted of local excision. In 12 cases, it was accompanied by lymph node excision. In 93 (82%) cases, radicalization was necessary, which was either local only (19 cases) or accompanied by lymph node surgery/biopsy (74 cases). Possible prognostic factors such as Clark's stage and Breslow's depth of invasion, ulceration, average tumor dimensions, lymph nodes metastases (pN+), gender, tumor location and primary excision margins were considered. Results: In 51 (45%) cases, treatment failure occurred. The 5-year DM rate was 47%, the 5-year DFS was 38%, and the 5-year OS was 56%. In the univariate analysis, the important factors with respect to at least one endpoint included Clark's stage, Breslow's depth of invasion, ulceration, average tumor dimensions, lymph nodes metastases, gender and primary tumor localization. The presence of metastasic nodes was the most important prognostic factor, with a 5-year DM rates of 30% for pN(-) and 76% for pN(+) and a 5-year DFS and OS of 56% and 76% for pN(-) and 13% and 24% for pN(+), respectively. The average tumor dimension was independently significant for DFS and OS, with 5-year rates of 69% and 80% for ${\leq}1cm$, 28% and 53% for 1-2 cm, and 18% and 30% for >2 cm, respectively. Tumor location was also significant for DM and OS, with 5-year rates of 69% vs 33% and 41% vs 66% for trunk vs other locations, respectively. Conclusions: The natural course of a malignant skin melanoma treated radically is disadvantageous, with unsuccessful outcome in nearly half of the cases. Common clinical factors, such as Clark's tumor stage, Breslow's depth of invasion and the presence of metastatic nodes, have high prognostic significance. The size and location of the primary lesion may be considered independent prognostic factors. The most important negative prognostic factor is the presence of metastatic regional lymph nodes. Only one quarter of patients with metastases in lymph nodes survive 5 years from primary surgery.

Prognostic significance of interventricular septal thickness in patients with AL amyloidosis

Cho, Hyunsoo,Kim, Soo-Jeong,Shim, Chi Young,Hong, Geu-Ru,Ha, Jong-Won,Kim, Yu Ri,Yang, Woo Ick,Chung, Haerim,Jang, Ji Eun,Cheong, June-Won,Min, Yoo Hong,Kim, Jin Seok Elsevier 2017 Leukemia research Vol.60 No.-

<P><B>Abstract</B></P> <P>The major prognostic determinant of immunoglobulin light chain (AL) amyloidosis is cardiac involvement. However, the role of interventricular septal thickness (IVST), which reflects the extent of cardiac involvement, remains unclear. Therefore, we analyzed 77 patients with newly diagnosed AL amyloidosis and evaluated the prognostic role of IVST. Fifty patients (64.9%) had cardiac involvement and 17 patients (22.1%) showed IVST >15mm. Among all patients, the revised Mayo Clinic Stage III–IV and IVST >15mm were independently associated with inferior overall survival (OS) in a multivariable analysis. IVST >15mm was also adversely prognostic for OS in a subgroup of advanced-stage (revised Mayo Clinic stage III–IV) patients in a multivariable analysis (<I>P</I> <0.001). Furthermore, advanced-stage patients with IVST >15mm did not show survival benefit from treatment with bortezomib-based regimens and/or autologous stem-cell transplantation (ASCT). Our study demonstrated that IVST >15mm is adversely prognostic independent of the revised Mayo Clinic staging system in patients with AL amyloidosis. In addition, the degree of IVST might be used as a useful prognostic indicator that can guide the management of patients with AL amyloidosis especially at an advanced stage.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Cardiac involvement is the major prognostic determinant of AL amyloidosis. </LI> <LI> Interventricular septal thickness (IVST) >15mm was an important prognostic factor. </LI> <LI> IVST >15mm was also adversely prognostic in advanced stage patients. </LI> <LI> IVST might be used as a useful prognostic indicator in AL amyloidosis. </LI> </UL> </P> <P><B>Graphical abstract</B></P> <P>Differences in overall survival (OS) according to the interventricular septal thickness (IVST) and the new four-factor model, incorporating IVST into the revised Mayo Clinic staging system; patients are grouped by the presence of 0–1 (low-risk), 2–3 (intermediate-risk), or 4 (high-risk) of the following risk factors: IVST >15mm, troponin-T≥0.025ng/mL, N-terminal pro-brain natriuretic peptide ≥1800pg/mL, and difference between involved and uninvolved free light chains≥18mg/dL.</P> <P>[DISPLAY OMISSION]</P>

Prognostic Factors on Overall Survival in Lymph Node Negative Gastric Cancer Patients Who Underwent Curative Resection

정지윤,권성준,김민규,하태경 대한위암학회 2012 Journal of gastric cancer Vol.12 No.4

Purpose: To assess independent prognostic factors for lymph node-negative metastatic gastric cancer patients following curative resection is valuable for more effective follow-up strategies. Materials and Methods: Among 1,874 gastric cancer patients who received curative resection, 967 patients were lymph node-negative. Independent prognostic factors for overall survival in lymph node-negative gastric cancer patients grouped by tumor invasion depth (early gastric cancer versus advanced gastric cancer) were explored with univariate and multivariate analyses. Results: There was a significant difference in the distribution of recurrence pattern between lymph node-negative and lymph nodepositive group. In the lymph node-negative group, the recurrence pattern differed by the depth of tumor invasion. In univariate analysis for overall survival of the early gastric cancer group, age, macroscopic appearance, histologic type, venous invasion, lymphatic invasion,and carcinoembryonic antigen level were significant prognostic factors. Multivariate analysis for these factors showed that venous invasion (hazard ratio, 6.695), age (≥59, hazard ratio, 2.882), and carcinoembryonic antigen level (≥5 ng/dl, hazard ratio, 3.938) were significant prognostic factors. Multivariate analysis of advanced gastric cancer group showed that depth of tumor invasion (T2 versus T3,hazard ratio, 2.809), and age (hazard ratio, 2.319) were prognostic factors on overall survival. Conclusions: Based on our results, independent prognostic factors such as venous permeation, carcinoembryonic antigen level, and age, depth of tumor invasion on overall survival were different between early gastric cancer and advanced gastric cancer group in lymph node-negative gastric cancer patients. Therefore, we are confident that our results will contribute to planning follow-up strategies.

자궁경부암 환자에서 수술 후 림프절 전이가 확인된 경우 생존율에 영향을 미치는 예휴인자에 관한 연구

성정희(Jeong Hee Sung),김병섭(Byoung Sub Kim),이은희(Eun Hee Lee),윤창범(Chang Beom Yun),유상영(Sang Young Ryu),김종훈(Jong Hoon Kim),김병기(Byoung Gie Kim),박상윤(Sang Yoon Park),이의돈(Eui Don Lee),이경희(Kyung Hee Lee) 대한산부인과학회 1998 Obstetrics & Gynecology Science Vol.41 No.11

N/A The presence of metastatic lymph nodes in cervical carcinoma is one of the most important prognostic factors to survival. In general, the characteristics of metastatic lymph nodes such as number, site, and bilaterality etc. can modify the survival of patients with lymph node metastasis. This nonrandomized retrospective study was performed to identify prognostic factors for survival in patients with FIGO stage IA2, I B and IIA, IIB carcinoma of the cervix with nodal metastases. From January 1, 1993, to December 31, 1995, 86 patients with FIGO stage I A, I B and IIA, IIB carcinoma of the cervix were found to have nodal metastasis at the time of radical hysterectomy and pelvic lymphadenectomy at the Department of Obstetrics and Gynecology, Korea Cancer Center Hospital. The prognostic significance of number of metastatic lymph nodes, site(s) of lymph node metastases, cervical lesion size, age, FIGO stage have been evaluated. In this study, the 3-year disease free survival rate (DFSR) and clinical characteristics were compared with the prognostic factors. Univariate analysis revealed significant that number of metastatic lymph nodes (p=0.0008) and tumor size (p=0.0490) were significant prognostic factor, but there were no significant differences in 3-year DFSR according to age (p=0.1257), FIGO stage (0.4687), site(s) of lymph node metastases (p=0.5552). However, by multivariate analysis only number of metastatic lymph nodes (p=0.0248) was noted to be a significant prognostic factor determining survival of the patient. A risk of recurrence increased continuously in accordance with increased of the number of metastatic lymph nodes. In particular the 3-year DFSR fell markedly from 85.3% in patient with less than four metastatic lymph node to 25.9% in those with five or more metastatic lymph node (p=0.0008). These results demonstrated that the number of metastatic lymph nodes was the most important and independent prognostic factor in patients with cervical cancer showing lymph node metastasis.

비부비동에 발생한 NK/T 세포 림프종의 예후인자 분석

김동현,윤주헌,강성욱,박정섭,홍성표,강희선,김현준 대한이비인후과학회 2007 대한이비인후과학회지 두경부외과학 Vol.50 No.1

Background and Objectives:Nasal natural killer T (NK/T) cell lymphomas are relatively comon in Asia, but the prognostic factors are not wel known. The purpose of this research was therefore to evaluate those prognostic factors. Subjects and Method:We reviewed and analyzed the medical records of 68 patients diagnosed as nasal NK/T cell lymphomas between 1984 lactate dehydrogenase (LDH) levels, Eastern cooperative oncology group (ECOG) performance status, international prognostic indices (IPI), treatment modality, and Ann Arbor tumor stages were analyzed using the methods of univariate and multivariate statistics. Results:The five-year overall survival rate was 43%. By univariate analysis, we found ECOG performance status, Ann Arbor tumor stages, B symptoms, and IPI to be significant prognostic factors of nasal NK/T cell lymphoma. The multivariate Conclusion:ECOG performance status, Ann Arbor tumor stages, B symptoms, and IPI could all be prognostic factors of the nasal NK/T cell lymphoma. Among these factors, ECOG performance status and B symptoms may be regarded more useful in diagnosis of the disease than others. (Korean J Otolaryngol 2007 ;50 :37-42)

Prognostic Factors for Overall Survival in Patients With Metastatic Colorectal Carcinoma Treated With Vascular Endothelial Growth Factor-Targeting Agents

Cetin, Bulent,Kaplan, Mehmet Ali,Berk, Veli,Ozturk, Selcuk Cemil,Benekli, Mustafa,Isikdogan, Abdurrahman,Ozkan, Metin,Coskun, Ugur,Buyukberber, Suleyman Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.3

Objective: Angiogenesis represents a key element in the pathogenesis of malignancy. There are no robust data on prognostic factors for overall survival (OS) in patients with metastatic colorectal cancer treated with vascular endothelial growth factor (VEGF)-targeted therapy. The present study was conducted to establish a prognostic model for patients using an oxaliplatin-based or irinotecan-based chemotherapy plus bevacizumab in metastatic colorectal cancer. Methods: Baseline characteristics and outcomes on 170 patients treated with FOLFIRI or XELOX plus anti-VEGF therapy-naive metastatic colorectal cancer were collected from three Turkey cancer centers. Cox proportional hazards regression was used to identify independent prognostic factors for OS. Results: The median OS for the whole cohort was 19 months (95% CI, 14.3 to 23.6 months). Three of the seven adverse prognostic factors according to the Anatolian Society of Medical Oncology (ASMO) were independent predictors of short survival: serum lactate dehydrogenase (LDH) greater than the upper limit of normal (ULN; p<0.001); neutrophils greater than the ULN (p<0.0014); and progression free survival (PFS) less than 6 months (p =0.001). Conclusion: Serum LDH and neutrophil levels were the main prognostic factors in predicting survival, followed by PFS. This model validates incorporation of components of the ASMO model into patient care and clinical trials that use VEGF-targeting agents.

Prognostic factors in adult granulosa cell tumors of the ovary: a retrospective analysis of 80 cases

Ali Ayhan,Mehmet Coskun Salman,Melih Velipasaoglu,Mehmet Sakinci,Kunter Yuce 대한부인종양학회 2009 Journal of Gynecologic Oncology Vol.20 No.3

Objective: Ovarian granulosa cell tumors are rare malignancies with a relatively favorable prognosis. However, patients still suffer from disease-related mortality. Therefore, the prognostic factors should be clarified. The purpose of this study was to investigate the clinical and pathologic characteristics related with disease recurrence and mortality in adult type ovarian granulosa cell tumors. Methods: Eighty surgically staged patients with granulosa cell ovarian tumor treated at the Hacettepe University Hospital between 1982 and 2006 were retrospectively reviewed. Clinical and pathological characteristics were analyzed. Results: Granulosa cell ovarian tumors accounted for 4.3% of malignant ovarian neoplasms. Mean age was 47.6 years. The most common presenting symptom was abnormal uterine bleeding (53.7%). Endometrial pathology was detected in 51.2% of patients preoperatively. Seventy percent of patients were diagnosed at stage I, and 53.8% of patients received adjuvant treatment. Mean follow-up was 67.5 months. Overall 5-year and 10-year survival was 91% and 86%, respectively. Mean survival was 147.1 months. Recurrence rate was 11.2%. In univariate analysis, advanced stage, advanced age, residual disease after surgery, and need for adjuvant treatment were associated with disease-related mortality and advanced stage disease and absence of initial staging surgery were associated with disease recurrence. However, in multivariate analysis, only initial stage was found to be a significant prognostic factor. Conclusion: Initial stage seems to be the single most important prognostic factor in ovarian granulosa cell tumors. Therefore, a comprehensive staging surgery should be attempted to document the real extent of disease and to estimate the oncologic outcome more accurately. Objective: Ovarian granulosa cell tumors are rare malignancies with a relatively favorable prognosis. However, patients still suffer from disease-related mortality. Therefore, the prognostic factors should be clarified. The purpose of this study was to investigate the clinical and pathologic characteristics related with disease recurrence and mortality in adult type ovarian granulosa cell tumors. Methods: Eighty surgically staged patients with granulosa cell ovarian tumor treated at the Hacettepe University Hospital between 1982 and 2006 were retrospectively reviewed. Clinical and pathological characteristics were analyzed. Results: Granulosa cell ovarian tumors accounted for 4.3% of malignant ovarian neoplasms. Mean age was 47.6 years. The most common presenting symptom was abnormal uterine bleeding (53.7%). Endometrial pathology was detected in 51.2% of patients preoperatively. Seventy percent of patients were diagnosed at stage I, and 53.8% of patients received adjuvant treatment. Mean follow-up was 67.5 months. Overall 5-year and 10-year survival was 91% and 86%, respectively. Mean survival was 147.1 months. Recurrence rate was 11.2%. In univariate analysis, advanced stage, advanced age, residual disease after surgery, and need for adjuvant treatment were associated with disease-related mortality and advanced stage disease and absence of initial staging surgery were associated with disease recurrence. However, in multivariate analysis, only initial stage was found to be a significant prognostic factor. Conclusion: Initial stage seems to be the single most important prognostic factor in ovarian granulosa cell tumors. Therefore, a comprehensive staging surgery should be attempted to document the real extent of disease and to estimate the oncologic outcome more accurately.