Journal articles on the topic 'Stage II patients'
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Warde, P., M. Gospodarowicz, T. Panzarella, C. Catton, J. Sturgeon, M. Moore, and M. Jewett. "Management of stage II seminoma." Journal of Clinical Oncology 16, no. 1 (January 1998): 290–94. http://dx.doi.org/10.1200/jco.1998.16.1.290.
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PURPOSE To assess the results of treatment, patterns of failure, and prognostic factors for relapse in a contemporary cohort of patients with stage II seminoma. MATERIALS AND METHODS From January 1981 and December 1993, 99 patients (median age, 35 years) with stage II seminoma (IIA, 41; IIB, 28; IIC, 24; IID, six) were managed at our institution. Eighty were treated with radiation therapy (RT) and 19 with chemotherapy (ChT). RESULTS With a median follow-up of 6.7 years, the five-year overall actuarial survival was 94%, the 5-year cause-specific survival was 94%, and the 5-year relapse-free rate was 83%. Sixteen (20%) of the 80 patients treated with RT relapsed (median time to relapse, 9 months). Relapse occurred outside the irradiated area in all but two patients. Distant relapse sites included the supraclavicular fossa, bone (four patients, three with spinal cord compression), and lung/mediastinum. All 19 patients treated primarily with ChT achieved disease control and none has relapsed. The relapse rate at 5 years for patients with stage IIA to IIB was 11% (seven of 64), and 56% (nine of 16) for those with stage IIC to IID disease (P < .0001). No patient with IIC or IID disease treated with ChT relapsed as compared with 56% of patients treated with RT (0 of 14 v nine of 16, P = .002). CONCLUSION Radiation therapy is highly effective in patients with stage IIA or IIB seminoma (89% were relapse free). In stage IIC or IID disease, although local control with RT is excellent, a 50% risk of distant relapse is unacceptable, and not all patients who relapse can be salvaged. Chemotherapy should clearly be the primary treatment in patients with stage IIC or IID seminoma.
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Karsten, Imke E., Gabriele Reinartz, Michaela Pixberg, Kai Kröger, Michael Oertel, Birte Friedrichs, Georg Lenz, and Hans Theodor Eich. "Radiotherapy in Follicular Lymphoma Staged by 18F-FDG-PET/CT: A German Monocenter Study." Biomedicines 9, no. 5 (May 17, 2021): 561. http://dx.doi.org/10.3390/biomedicines9050561.
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This retrospective study examined the role of 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) in stage-related therapy of follicular lymphomas (FL). Twelve patients each in stages I and II, 13 in stage III and 11 in stage IV were treated in the Department of Radiation Oncology, University Hospital of Muenster, Germany from 2004 to 2016. Radiotherapy (RT), as well as additional chemoimmunotherapy were analyzed with a median follow-up of 87.6 months. Ultrasound (US), CT and 18F-FDG-PET/CT were used to determine progression-free survival (PFS), overall survival (OS) and lymphoma-specific survival (LSS) over 5- and 10- years. 23 of 24 patients with stage I/II (95.8%) had complete remissions (CR) and 17 of 24 patients with stages III/IV FL showed CR (70.8%). 5- and 10-year PFS in stages I/II was 90.0%/78.1% vs. 44.3%/28.5% in stages III/IV. 5- and 10-year OS rates in stages I/II was 100%/93.3% vs. 53.7%/48.4% in stages III/IV. 5- and 10-year LSS of stages I/II was 100%/93.8% vs. 69.2%/62.3% in stages III/IV. FL of stages I/II, staged by 18F-FDG-PET/CT, revealed better survival rates and lower risk of recurrence compared to studies without PET/CT-staging. Especially, patients with PET/CT proven stage I disease showed significantly better survival and lower relapses rates after RT.
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Liu, Zeming, Xiaopei Shen, Rengyun Liu, Guangwu Zhu, Tao Huang, and Mingzhao Xing. "Stage II Differentiated Thyroid Cancer Is a High-Risk Disease in Patients <45/55 Years Old." Journal of Clinical Endocrinology & Metabolism 104, no. 11 (May 22, 2019): 4941–48. http://dx.doi.org/10.1210/jc.2018-02809.
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Abstract Purpose The mortality risk of stage II differentiated thyroid cancer (DTC) based on the American Joint Committee on Cancer (AJCC) staging system requires further investigation. Methods Retrospective study of DTC in the US Surveillance, Epidemiology, and End Results program for disease-specific mortality risk in various AJCC stages, with patient age stratification of stage II disease. Results Using AJCC staging system 6.0, hazard ratios (HRs) of mortality for stage II DTC in patients <45 yo and patients ≥45 yo and stages III, IVA, IVB, and IVC compared with stage I were 46.95, 4.95, 9.82, 57.37, 222.10, and 468.68, respectively, showing a robustly higher mortality risk in stage II disease in patients <45 yo than in older patients (P < 0.001), comparable with stage IVA (P = 0.482). Similar results were obtained with AJCC 7.0. With AJCC 8.0, HRs of mortality for stage II in patients <55 yo and patients ≥55 yo and stages III, IVA, and IVB compared with stage I were 75.16, 11.23, 69.45, 134.94, and 235.70, respectively, showing a robustly higher risk in stage II disease in patients <55 yo than in older patients (P < 0.001), comparable with stage III (P = 0.57). Kaplan-Meier survival curves displayed a sharp decline with stage II disease in patients <45/55 yo compared with older patients. Conclusions The mortality risk of stage II DTC was sharply differentiated at patient age 45/55 years, being robustly high in younger patients and comparable with stage III/IVA. This emphasizes the importance of considering age when managing stage II DTC and not treating it as a uniformly low-risk disease.
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Deng, Shengming, Bin Zhang, Yeye Zhou, Xin Xu, Jihui Li, Shibiao Sang, and Wei Zhang. "The Role of18F-FDG PET/CT in Multiple Myeloma Staging according to IMPeTUs: Comparison of the Durie–Salmon Plus and Other Staging Systems." Contrast Media & Molecular Imaging 2018 (July 30, 2018): 1–9. http://dx.doi.org/10.1155/2018/4198673.
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We aimed at comparing the Durie–Salmon Plus (DS Plus) staging system based on Italian Myeloma criteria for PET USe (IMPeTUs) with other two staging systems in predicting prognosis of patients with all stages of newly diagnosed multiple myeloma (MM). A total of 33 MM patients were enrolled in this retrospective study. The variation between the DS Plus classification and Durie–Salmon staging system (DSS) or Revised International Staging System (RISS) classification was assessed. When staged by the DSS, patients in stage I and stage II did not reach the median overall survival (OS), and the median OS was 33 months for stage III (p=0.3621). When staged by the DS Plus, patients in stage I did not reach the median OS of stage I, and the median OS for stages II and III was 38 and nine months, respectively (p=0.0064). When staged by the RISS, patients in stage I did not reach the median OS, and the median OS was 33 and 16 months for stage II and stage III, respectively (p=0.0319). The concordances between two staging systems were 0.07 (DS Plus versus DSS) and 0.37 (DS Plus versus RISS), respectively. Multivariate analysis revealed that DS Plus stage III (HR: 11.539,p=0.021) and the Deauville score of bone marrow ≥4 (HR: 3.487,p=0.031) were independent prognostic factors associated with OS. Both the DS Plus based on IMPeTUs and RISS possessed a better potential in characterizing and stratifying MM patients compared with the DSS. Moreover, DS Plus stage III and the Deauville score of bone marrow ≥4 were reliable prognostic factors in newly diagnosed MM patients.
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Tataryn, Bohdan, Anna Kryzhanivska, Iryna Dyakiv, and Alina Andriiv. "SURVIVAL OF PATIENTS WITH RECTAL CANCER." Wiadomości Lekarskie 74, no. 9 (2021): 2044–51. http://dx.doi.org/10.36740/wlek202109104.
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The aim: To evaluate the early and late results of treatment of rectal cancer patients after special treatment methods with a view to indentifying optimal method of treatment in correlation with the stage of the disease. Materials and methods: The study is based on the results of observation of 779 patients with stage II, III and IV rectal cancer (RC) who were divided into groups according to the treatment (surgery, surgery + chemotherapy, chemotherapy, surgery + chemotherapy + radiation therapy, radiation therapy + surgery, radiation therapy). Results: According to the results obtained, the overall survival of patients correlates with the stage of rectal cancer: we see the highest percentage of patients’ survival in stage II and, accordingly, the lowest – in stage IV in each of the studied time intervals. Conclusions: The use of combined and integrated treatment in patients with stages II and stage III and the use of chemotherapy in stage IV RC gives a higher rate of cumulative survival of patients at each of the studied intervals
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Reinhardt, Zdenka, Joseph De Giovanni, John Stickley, Vinay K. Bhole, Benjamin Anderson, Bari Murtuza, Chetan Mehta, Paul Miller, Rami Dhillon, and Oliver Stumper. "Catheter interventions in the staged management of hypoplastic left heart syndrome." Cardiology in the Young 24, no. 2 (February 8, 2013): 212–19. http://dx.doi.org/10.1017/s1047951113000024.
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AbstractAimTo analyse the current practice and contribution of catheter interventions in the staged management of patients with hypoplastic left heart syndrome.MethodsThis study is a retrospective case note review of 527 patients undergoing staged Norwood/Fontan palliation at a single centre between 1993 and 2010. Indications and type of catheter interventions were reviewed over a median follow-up period of 7.5 years.ResultsA staged Norwood/Fontan palliation for hypoplastic left heart syndrome was performed in 527 patients. The 30-day survival rate after individual stages was 76.5% at Stage I, 96.3% at Stage II, and 99.4% at Stage III. A total of 348 interventions were performed in 189 out of 527 patients. Freedom from catheter intervention in survivors was 58.2% before Stage II and 46.7% before Stage III. Kaplan–Meier freedom from intervention post Fontan completion was 55% at 10.8 years of follow-up. Post-stage I interventions were mostly directed to relieve aortic arch obstruction – 84 balloon angioplasties – and augment pulmonary blood flow – 15 right ventricle-to-pulmonary conduit interventions; post-Stage II interventions centred on augmenting size of the left pulmonary artery – 73 procedures and abolishing systemic venous collaterals – 32 procedures. After Stage III, the focus was on manipulating the size of the fenestration – 42 interventions – and the left pulmonary artery −31 procedures.ConclusionInterventional cardiac catheterisation constitutes an integral part in the staged palliative management of patients with hypoplastic left heart syndrome. Over one-third (37%) of patients undergoing staged palliation required catheter intervention over the follow-up period.
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Novikova, I. A., and O. I. Kit. "Expression of epithelial-mesenchymal transition markers E-cadherin and ZEB1 in colorectal cancer." Research and Practical Medicine Journal 8, no. 2 (June 23, 2021): 23–33. http://dx.doi.org/10.17709/2410-1893-2021-8-2-2.
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Purpose of the study. Evaluation of expression of the epithelial-mesenchymal transition markers E-cadherin and ZEB1 in patients with stage II-IV colorectal cancer (CRC).Materials and methods. The study included operational material obtained from 299 patients aged 42–86 years (mean age 64.2±1.7 years) with stage II-IV CRC treated at National Medical Research Centre for Oncology in 2013-2017. Stage II CRC (T3-4 N0 M0 ) was diagnosed in 110 patients, stage III (T1-4 N1-2 M0 ) – in 88 patients, stage IV (T1-4 N0-2 M1 ) – in 101 patients. Polyclonal rabbit antibodies to ZEB1 (Biorbyt Ltd., UK) and mouse monoclonal antibodies to E-cadherin (Diagnostic BioSystems, USA) were used for an IHC analysis. The intensity and degree of tumor cell staining, percentage of stained tumor cells in the sample and the number of patients with positive and negative marker expression were determined. Groups were compared using the Mann–Whitney U test and the Pearson's chi-square test.Results. Positive expression of E-cadherin was found in 64.5 % (193 of 299 patients), ZEB1 – in 80.6 % (241 of 299 patients). The number of patients with E-cadherin-positive tumors statistically significantly decreased (χ2 =15.888 at p<0.001) from stage II to stage IV, while for ZEB1, on the contrary, it statistically significantly increased (χ2 =43.912 at p><0.001) from stage II to stage IV. The mean values of expression in positively stained cells were: in stage II – E-cadherin 55.3±6.8 %, ZEB1 43.0±5.9 %; in stage III – E-cadherin 38.4±5.8 %, ZEB1 77.0±5.5 %; in stage IV – E-cadherin 14.7±4.7 %, ZEB1 76.9±3.5 %. Significant differences were observed between the mean values of ZEB1 expression in stages III and IV compared to stage II, as well as between the mean values of E-cadherin expression in stages II and III compared to stage IV (p><0.05). No significant differences were found in the mean values of ZEB1 and E-cadherin expression in stages III and IV, II and III respectively.Conclusions. The study demonstrated statistically significant relationship between tumor stages and expression of E-cadherin and ZEB1 in the epithelial-mesenchymal transition. The loss of the E-cadherin expression in tumor cells of patients from stage II to stage IV and increased expression of ZEB1 in the studied groups were statistically significant (p<0.05).
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Chen, Y., W. Xu, S. Zheng, and S. Zhang. "Molecular staging with CM10 ProteinChip and SELDI-MS-TOF for colorectal cancer patients before surgery." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 3612. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.3612.
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3612 Background: The objectives of this are to detect the serum proteomic patterns by using SELDI-TOF-MS technology and CM10 ProteinChip in colorectal cancer (CRC) patients, and to evaluate the significance of the proteomic patterns in the tumor staging of colorectal cancer. Methods: SELDI-TOF-MS and CM10 ProteinChip were used to detect the serum proteomic patterns of 76 colorectal cancer patients which including 10 Stage I, 19 Stage II, 16 Stage III and 31 Stage IV patients. Models for various stages were developed and validated by using Support Vector Machine, Discriminant Analysis and time-series analysis methods. Results: The first model, formed by 6 protein peaks (M/Z: 2759.58, 2964.66, 2048.01, 4795.90, 4139.77 and 37761.60 Da), could be used to distinguish local CRC patients (StageIand Stage II) from regional CRC patients (Stage III) with an accuracy of 86.67% (39/45). The second model, formed by 3 protein peaks (M/Z: 6885.30, 2058.32 and 8567.75 Da), could be used to distinguish locoregional CRC patients (Stage I,Stage II and Stage III) from systematic CRC patients (Stage IV) with an accuracy of 75.00% (57/76). The third model could distinguish Stage I from Stage II with an accuracy of 86.21% (25/29). The fourth model could distinguish Stage I from Stage III with an accuracy of 84.62% (22/26). The fifth model could distinguish Stage II from Stage III with an accuracy of 85.71% (30/35). The sixth model could distinguish Stage II from Stage IV with an accuracy of 80.00% (40/50). The seventh model could distinguish Stage III from Stage IV with an accuracy of 78.72% (37/47). All four stages could be distinguished by using a two-dimensional scattered spots figure. Conclusion: We conclude that this method is promising in the staging of colorectal cancer patients before surgery. No significant financial relationships to disclose.
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Bertelsen, K., B. HØLund, J. E. Andersen, K. Nielsen, I. StrØYer, and P. Ladehoff. "Prognostic factors and adjuvant treatment in early epithelial ovarian cancer." International Journal of Gynecologic Cancer 3, no. 4 (1993): 211–18. http://dx.doi.org/10.1046/j.1525-1438.1993.03040211.x.
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Four hundred and ten patients with epithelial ovarian cancer FIGO stages I and II were registered by a Danish multicenter study group (The Danish Ovarian Cancer Group - DACOVA). Two-thirds were stage I, the most frequent substage was Iai which was the classification in 27%. Five-year survival for stage I was 72%, and 38% for stage II. Multivariate analysis showed that age, stage, residual tumor, histologic grade and adjuvant treatment had prognostic value. For stage, three significantly different groups could be identified: (1) stage Iai, (2) stage Iaii-Ic, and (3) stage II. Histologic grade showed a significant survival difference between all grades. Adjuvant treatment had a moderate but significant impact on survival. Patients in stage Iai had a good survival with surgery alone and will probably not benefit from adjuvant therapy. Adjuvant treatment improved survival for the remaining patients in stages I and II without residual tumor. A difference between treatment modalities was not observed. However, the data need to be confirmed by a randomized trial. Patients in stage II with residual tumor should be treated as stage III.
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Connors, Joseph M., Randy D. Gascoyne, Paul Hoskins, James Morris, Tom Pickles, Laurie Sehn, Tamara Shenkier, Richard Klasa, Nicholas Voss, and Kerry Joanne Savage. "Hodgkin Lymphoma Patients with Stage II B or Stage II Bulky Disease Have Advanced Disease and Should Not Be Included In Limited Stage Trials." Blood 116, no. 21 (November 19, 2010): 417. http://dx.doi.org/10.1182/blood.v116.21.417.417.
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Abstract Abstract 417 Background: Trials enrolling patients with limited stage Hodgkin lymphoma conducted by European cooperative groups including EORTC, GELA and the GHSG frequently include patients with stage II B or stage II bulky (≥ 10 cm) disease in either “favorable” or “unfavorable” subgroups. Similar patients are usually excluded from North American trials of limited stage disease and rather are included in trials of advanced stage lymphoma. We sought to clarify the appropriateness of these approaches. Methods: All adult (age > 15 but < 66 y) HIV antibody negative patients with stage II A bulky, II B non-bulky or II B bulky Hodgkin lymphoma treated in British Columbia since 1981, when ABVD-type chemotherapy became standard, were identified using the BC Cancer Agency Lymphoid Cancer Database. Characteristics: n=416; male 54%; age range 16–64 y (median = 30); histologic subtype nodular sclerosis 86%, mixed cellularity 5%, not subclassifiable 6%, other 3%; subdiaphragmatic 3%; stage II A bulky 32%, II B non-bulky 32%, II B bulky 36%; localized extranodal extension (E lesion) 35%; largest mass diameter non-bulky range 1–9 cm (median 6 cm), bulky range 10–25 cm (median 12 cm); IPFP prognostic score 0, 9%; 1, 33%; 2, 32%; 3, 19%; 4, 6%; 5, 1% (data missing 36%). Results: Planned treatment consisted of 6–8 cycles of ABVD-type chemotherapy followed by radiation for a persistent residual mass (only if PET positive since 2005). 50% of patients received radiation (extended field 24%, involved field 76%). Thus, patients were treated with the same approach that is used for stage III or IV. Patients with bulky disease were much more likely to receive radiation: II A bulky 72%; II B non-bulky 11%; II B bulky 65%. For all 416 patients, with a median follow-up of 8 y, 5 and 10 y progression free survivals (PFS) were 81% and 76%; time-to-progression (TTP) estimates 83% and 81% (Fig. 1); and overall survivals (OS) were 94% and 90%. Although there is some variation, survivals were very similar across the three stage groups. This experience is instructive and indicates that when patients with stage II B bulky or non-bulky or stage II A bulky Hodgkin lymphoma are treated with the same approach as is used for advanced stage disease at least 20% of patients relapse. Conclusion: It is inappropriate to include patients with stage II B or stage II A bulky Hodgkin lymphoma on trials designed for limited stage disease. With an estimated relapse rate of at least 20% inclusion of these patients can grossly distort outcomes and compromise interpretation of the results of the trial since the expectation for the rest of the patients (stage I A and II A, low bulk) is that no more than 5% of patients will relapse. Patients with stage II B or stage II A bulky Hodgkin lymphoma should be included in trials for patients with advanced stage disease. Disclosures: Klasa: Seattle Genetics, Inc.: Research Funding.
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Eriksson, Hanna, Deborah Utjés, Roger Olofsson Bagge, Peter Gillgren, Karolin Isaksson, Jan Lapins, Inkeri Leonardsson Schultz, Johan Lyth, and Therese M. L. Andersson. "The Proportion Cured of Patients with Resected Stage II–III Cutaneous Melanoma in Sweden." Cancers 13, no. 10 (May 18, 2021): 2456. http://dx.doi.org/10.3390/cancers13102456.
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Background: Cure proportion represents the proportion of patients who experience the same mortality rate as the general population and can be estimated together with the survival of the proportion experiencing excess mortality (the uncured). The aim was to estimate the cure proportions and survival among uncured stage II–III cutaneous melanoma (CM) patients. Methods: 1- and 5-year relative survival ratios, cure proportions and the median survival times of uncured stage II–III CM patients in Sweden (n = 6466) were calculated based on data from the nationwide population-based Swedish Melanoma Register 2005–2013 with a follow-up through 2018. Results: Stages IIB and IIC showed significant differences in standardized cure proportions vs. stage IIA CM (0.80 (95% CI 0.77–0.83) stage IIA; 0.62 (95% CI 0.59–0.66) stage IIB; 0.42 (95% CI 0.37–0.46) for stage IIC). Significant differences in standardized cure proportions were found for stages IIIB and IIIC-D CM vs. stage IIIA (0.76 (95% CI 0.68–0.84) stage IIIA; 0.52 (95% CI 0.45–0.59) stage IIIB; 0.35 (95% CI 0.30–0.39) for stage IIIC–D). Conclusions: The results are emphasizing the poor prognosis with low proportions cured by surgery only for sub-groups of stage II–III CM, specifically within stages IIB–C CM.
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Gamerman, Victoria, Giorgos Constantine Karakousis, DuPont Guerry, and Phyllis A. Gimotty. "Conditional survival (CS) in patients with stage II melanoma." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): e19054-e19054. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e19054.
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e19054 Background: While sentinel lymph node biopsy is recommended for those presenting with clinical stage II melanoma, it is not always performed. Future survival beyond the time already survived is captured by CS and is relevant to patient counseling and guiding follow up. We sought to investigate patterns of CS in patients with clinical (no nodal biopsy) or pathological stage II melanomas controlling for ulceration. Methods: The study included 5,370 patients diagnosed with primary cutaneous melanoma in 2004-2008 from the Surveillance, Epidemiology, and End Results (SEER) data. Three-year CS probabilities were estimated from the Kaplan-Meier survival curves (time to melanoma-specific death) at 6, 12, and 18 months from diagnosis. Newly developed biostatistical methods were used to evaluate the statistical significance of changes in CS as the time survived increased for four groups of patients: those clinically and pathologically staged with and without ulceration. Results: With increasing time survived up to 18 months, there was no significant change in the 3-year CS estimates for the cohort of pathologically-staged patients with non-ulcerated lesions (n=1702). For pathologically-staged patients with ulcerated lesions (n=1915), 3-year CS increased significantly only after having survived 1 year (86% to 87% p=0.001). A similar pattern was seen for the cohort of clinically-staged patients with non-ulcerated lesions (n=801), (85% to 87% p<0.001). For clinically-staged patients with ulcerated lesions (n=952), the 3-year CS estimates for those who had survived 6, 12, or 18 months were 74%, 78%, and 82%. After the initial 6 months of survival, there was a significant change in 3-year CS having survived 6 versus 12 months (p=0.002), as well as having survived 12 versus 18 months (p<0.001). Among patients with ulcerated lesions, CS for those clinically staged begins to change after 6 months whereas for those pathologically staged change occurs only after a year. Conclusions: CS provides up-to-date prognostic information to patients, their physicians and clinical trialists. Formal statistical methods, as illustrated here, identify when clinically meaningful CS estimates change in statistically significant ways.
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Taieb, J., M. Karoui, and D. Basile. "How I treat stage II colon cancer patients." ESMO Open 6, no. 4 (August 2021): 100184. http://dx.doi.org/10.1016/j.esmoop.2021.100184.
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Sidorova, Yuliya Igorevna, and Marina Petrovna Biletskaya. "Psychological features of patients with GB II stage." Pediatrician (St. Petersburg) 4, no. 1 (January 15, 2013): 86–88. http://dx.doi.org/10.17816/ped4186-88.
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In the work of the Yu. I. Sidorova and M. P. Biletskaya with the aim of studying the psychological features of patients with GB of stage II has been investigated 90 people: 45 people with essential hypertension II stage of the age from 30 to 40 years; 45 people (30–40 years) without chronic somatic For patients GB is characterized by a broad range of emotional experience with a predominance of negative emotions. Installed gender differences in the expression of ways of expression of aggression. Fears of patients GB are polymorphic in nature, linked to non-adaptive protective-сoping behavior, the leading role of which belongs to the fear of death. For patients GB have such personal qualities as: a tendency to depressive feelings, dominance, self-criticism, incredulity.
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Perez, Carlos A., Katherine K. Matthay, James B. Atkinson, Robert C. Seeger, Hiroyuki Shimada, Gerald M. Haase, Daniel O. Stram, Robert B. Gerbing, and John N. Lukens. "Biologic Variables in the Outcome of Stages I and II Neuroblastoma Treated With Surgery as Primary Therapy: A Children’s Cancer Group Study." Journal of Clinical Oncology 18, no. 1 (January 1, 2000): 18. http://dx.doi.org/10.1200/jco.2000.18.1.18.
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PURPOSE: To determine prospectively whether surgery alone is sufficient therapy for Evans stages I and II neuroblastoma and to define biologic and clinical features having prognostic potential for this group. PATIENTS AND METHODS: Between June 1989 and August 1995, 374 eligible children (age range, 0 to 18 years) with newly diagnosed stage I (n = 141) and stage II (n = 233) neuroblastoma were registered onto Children’s Cancer Group trial 3881. Surgical resection was the only primary therapy except in cases with spinal cord compression, where radiation therapy was allowed. Event-free survival (EFS) and overall survival (OS) were analyzed by life-table methods according to clinical and biologic features. RESULTS: EFS and OS (mean ± SE) for all stage I patients were 93% ± 3.0% and 99% ± 1.0%, respectively, compared with 81% ± 4.0% and 98% ± 2.0%, respectively, for stage II patients. The significantly higher recurrence rate among stage II patients was managed successfully in 38 of 43 children with either surgery or multimodality treatment. There was one death among stage I patients and six among stage II. For stage II patients tumor MYCN gene amplication, unfavorable histopathology, an age greater than 2 years, and positive lymph nodes predicted a lower OS (P < .05). CONCLUSION: Children with stages I and II neuroblastoma have 98% survival with surgery alone as primary therapy. Supplemental treatment was necessary in only 10% of stage I patients and 20% of stage II patients. In children with localized neuroblastoma, a subset of patients that are at higher risk for death can be defined as those with stage II disease who have tumor MYCN amplification or who are ≥ 2 years of age with either unfavorable histopathology or positive lymph nodes.
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Gerald, Thomas, Vitaly Margulis, Xiaosong Meng, Suzanne Cole, Qian Qin, Greg Call, Elizabeth Mauer, Yair Lotan, and Solomon L. Woldu. "Actionable genomic landscapes from a real-world cohort of localized urothelial carcinoma patients." Journal of Clinical Oncology 40, no. 6_suppl (February 20, 2022): 525. http://dx.doi.org/10.1200/jco.2022.40.6_suppl.525.
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525 Background: Recent targeted therapies for advanced and metastatic urothelial cancer have generated enthusiasm, but the actionable genomic landscape of early-stage disease remains largely unknown. Here, we used real-world evidence to investigate differences between somatic and germline mutations in localized, early-stage urothelial cancers and advanced urothelial cancers. Methods: We retrospectively analyzed de-identified NGS data from 1,146 bladder cancer patients (stages I-IV) with formalin-fixed, paraffin-embedded tumor biopsies sequenced using the Tempus|xT solid tumor assay (DNA-seq of 595-648 genes at 500x coverage; whole-exome capture RNA-seq). For the subset of patients with tumor-normal match sequencing (n=758), additional incidental germline alterations in 46 different genes were assessed. Results: A total of 1,146 bladder cancer tumors were investigated: stage I-II (n=124), stage III (n=159), and stage IV (n=863)—summarized in Table. Tumor mutational burden (TMB) was calculated for 1,126 tumors, and TMB-high (TMB-H; ≥10 mutations per megabase) was similar across tumor stages. PD-L1 immunohistochemical staining was performed on 698 tumors, and no significant differences were observed. Microsatellite instability high (MSI-H) status was detected in only 2 (1.6%) stage I-II tumors and 8 (0.9%) stage IV tumors. Alterations—single nucleotide variants, insertions/deletions, and copy number variants—in FGFR2/3, homologous recombination repair genes (18 genes including BRCA1/2 and ATM), additional DNA repair gene mutations ( ERCC2, RB1, FANCC) and NTRK fusions were detected at similar frequencies across disease stages. In 758 patients with tumor/normal matched sequencing, we identified a low rate of incidental germline mutations in MUTYH (stage III, 1%; stage IV, 1.9%), BRCA2 (stages I-II, 1.2%; stage III, 1%; stage IV, 0.5%), BRIP1 (stages I-II, 1.2%), ATM (stage III, 1%; stage IV, 0.7%), MSH6 (stage III, 1%; stage IV, 0.2%), and TP53 (stage III, 1%; stage IV, 0.2%). Conclusions: Patients with bladder cancer have similar rates of potentially actionable mutations and genomic landscapes regardless of clinical disease stage. These findings provide a rationale for further investigating targeted therapies among early-stage bladder cancer patients.[Table: see text]
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Matsuo, Mioko, Fumihide Rikimaru, Satoshi Tou, Yuuichirou Higaki, and Kichinobu Tomita. "The Causes of Deaths Occurred in Patients of Early Stage Laryngeal Cancer (Stage I, Stage II)." Koutou (THE LARYNX JAPAN) 17, no. 1 (2005): 11–16. http://dx.doi.org/10.5426/larynx1989.17.1_11.
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VanderWalde, Noam Avraham, Ramzi George Salloum, Tsai-Ling Liu, Mark Christopher Hornbrook, Maureen Cecelia O'Keeffe-Rosetti, Debra Pearson Ritzwoller, Paul Arthur Fishman, Jennifer Elston Lafata, Amir H. Khandani, and Bhishamjit S. Chera. "Positron emission tomography and stage migration for head and neck cancer." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): 6018. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.6018.
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6018 Background: Positron emission tomography (PET) is often used for the staging of head and neck cancer (HNC). The purpose of this study is to explore the association between the increased utilization of PET and stage/survival in the managed care environment. Methods: Adult patients diagnosed with HNC (n=958) between 2000-2008, at 4 integrated health systems (Group Health Cooperative, Seattle; Health Alliance Plan/Henry Ford Health System, Detroit; Kaiser Permanente Colorado and Northwest, Portland) were identified via tumor registries linked to claims data. We compared AJCC stage distribution, patient/treatment characteristics, and survival between pre-PET era (2000-2004) vs. PET era (2005-2008), and those with PET vs. those without, during the PET era. AJCC stage was grouped into stage I/II (localized), stage III/IVa/IVb (locally advanced), and stage IVc (metastatic). Ordered logistic regression estimated the effects of PET utilization on upstaging. Kaplan-Meier estimates described overall survival (OS) differences between PET users and nonusers in the PET era. Cox proportional hazards regression evaluated the effect of PET use on survival. Results: There was a non-significant increase in stage III/IVa/IVb (40% to 44%) with a decrease in stage I/II (58% to 52%) between pre-PET era and PET era (p=0.11). During the PET era, patients with PET were more likely stage III/IVa/IVb and less likely stage I/II compared to patients without PET (III/IVa/IVb: 62% vs. 29%, I/II: 35% vs. 68%). On multivariate analysis those who were staged with PET were twice as likely to have locally advanced disease (OR 2.091; p=0.006). There was no difference in stage IVc. Patients with PET scans were more likely to receive chemotherapy with radiation and less likely to receive no treatment. 3-year actuarial OS for patients (all stages) with and without PET was 81% vs. 77% (p=0.261). 3-year actuarial OS for patients staged III/IVa/IVb with and without PET was 58% vs. 41% (p= 0.001). Conclusions: HNC patients were more likely to be upstaged with the use of PET. There was an improvement in survival in stage III/IVa/IVb patients, but no difference in survival across all stages. This likely reflects selection bias and stage migration rather than improved outcomes among individual patients.
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Kamthan, A. G., J. C. Morris, J. Dalton, J. P. Mandeli, M. R. Chesser, D. Leben, A. Cooperman, and H. W. Bruckner. "Combined modality therapy for stage II and stage III pancreatic carcinoma." Journal of Clinical Oncology 15, no. 8 (August 1997): 2920–27. http://dx.doi.org/10.1200/jco.1997.15.8.2920.
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PURPOSE To study the outcome achieved with three-drug chemotherapy and split-course external-beam radiotherapy as a treatment for unresectable stage II and III pancreatic carcinoma. PATIENTS AND METHODS Radiotherapy was given in three cycles of 2 Gy/d on days 1 to 5 and 8 to 12 (total dose, 54 Gy) concurrently with fluorouracil (FU) 1,000 mg/m2/d by continuous infusion for 4.5 days, streptozocin (STZ) 300 mg/m2 on days 1, 2, and 3 and cisplatin (P) 100 mg/m2 on day 3 of each every-28-day cycle. Subsequent treatment consisted of leucovorin (LV) 200 mg/m2 and FU 600 to 1,000 mg/m2 every 14 days. RESULTS The median survival time for the 35 patients was 15 months and 26% of patients were alive at 24 months. Fifteen patients (42.8%) had objective responses to therapy. Six (17%) had a complete response (CR). Three of nine patients with partial responses (PRs) achieved a radiographic CR within the next 3 months. Nine patients underwent attempts at surgical resection: five were resected (median survival time, 31 months; range, 12.8 to 44.7+), two had no residual disease found at complete resection, and three others also had a complete resection. Of four others who could not be resected, three underwent intraoperative radiotherapy and one had occult metastatic disease. Of primary tumors, 91% did not produce either back pain or local gastrointestinal complications for 2 years. The rates of severe side effects were stomatitis 15%, anemia 14%, granulocytopenia 6%, and thrombocytopenia 6%. CONCLUSION Palliation and survival compare favorably with other series, including many surgical series. The response findings encourage studies of both unresectable and (as neoadjuvant therapy) resectable tumors.
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Yang, Kailin, Matthew C. Ward, Chandana A. Reddy, Brian B. Burkey, David J. Adelstein, and Shlomo A. Koyfman. "Nationwide treatment patterns of oropharyngeal cancer in the human papillomavirus era." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e17521-e17521. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e17521.
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e17521 Background: Human papillomavirus-mediated (HPV+) oropharyngeal cancer is now defined as a clinically distinct entity from HPV-unrelated (HPV-) disease in the 8th edition AJCC staging system, which more accurately informs prognosis for HPV+ patients. Treatment decisions are currently made according to the AJCC 7th ed staging. HPV+ patients are associated with favorable outcome. This study aims to analyze the national pattern of practice for HPV+ disease. Methods: Patients with oropharyngeal squamous cell carcinoma (OPSCC) diagnosed from 2010-2012 were identified from the National Cancer Database (NCDB). Patients were staged using the AJCC 7th system. Chemotherapy, radiotherapy and surgery were counted as treatment modalities. Fisher’s exact test and chi-squared test were used to assess treatment patterns over time. Overall survival (OS) was compared with Cox proportional hazards model. Results: 5,928 HPV+ OPSCC patients were identified. Single modality (surgery or radiation) was the most common treatment choice, used in 53.6% of stage I and 48.8% of stage II patients. For stage I, the use of dual modality therapy (70.8% received surgery with radiation) decreased from 36% in 2010 to 19% in 2012 (p = 0.05), though no significant difference in OS was seen between dual modality and single modality. Dual modality with chemoradiation was the main approach for stage III (58.6%) and stage IVA (67.5%) disease. Use of trimodality decreased from 2010 to 2012 in both stage III (p = 0.03) and stage IVA (p < 0.01). Conclusions: Using a national cohort of HPV+ patients from the NCDB, we showed that single modality was the most common for stages I/II and dual modality was the mainstay for stages III/IVA. Usage of aggressive approaches (dual modality for stages I/II and trimodality for stages III/IVA) decreased over time. Prospective studies would be needed to determine the optimized therapeutic choice for HPV+ patients given favorable outcome.
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Anklesaria, Pervin N., Suresh H. Advani, and Avinash N. Bhisey. "Studies on Granulocyte Functions in Patients with Chronic Myeloid Leukemia." Tumori Journal 71, no. 4 (August 1985): 317–23. http://dx.doi.org/10.1177/030089168507100401.
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Granulcoyte functions, viz. endocytosis, NADPH oxidase activity and iodination by leukocytes, were studied in granulocytes isolated from 17 chronic myeloid leukemia (CIVIL) patients at initial diagnosis (stage I), from 10 patients in relapse (stage II), and 10 patients in acute blastic crisis (stage III). The mean phagocytic index of granulocytes from CML patients was similar to the normal value. NADPH activity decreased as the disease progressed. Thus, the amount of formazan produced was lower in granulocytes from patients in stage II (P < 0.05) and stage III (P < 0.01) than that produced by normal granulocytes. H2O2-Myeloperoxidase-dependent iodination was found to be significantly reduced in granulocytes from all stages of the disease compared to that of normal, stage I (P < 0.01), stage II (P < 0.05) and stage III (P < 0.01). It thus seems that granulocyte function becomes less efficient as the disease progresses towards acute blastic crisis. Immature cells from the same patients carried out these functions at a more reduced level than did their mature counterparts.
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Yamamoto, Akitaka, Hideo Wada, Yuhuko Ichikawa, Hikaru Mizuno, Masaki Tomida, Jun Masuda, Katsutoshi Makino, et al. "Evaluation of Biomarkers of Severity in Patients with COVID-19 Infection." Journal of Clinical Medicine 10, no. 17 (August 24, 2021): 3775. http://dx.doi.org/10.3390/jcm10173775.
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Object: Although many Japanese patients infected with coronavirus disease 2019 (COVID-19) only experience mild symptoms, in some cases a patient’s condition deteriorates, resulting in a poor outcome. This study examines the behavior of biomarkers in patients with mild to severe COVID-19. Methods: The disease severity of 152 COVID-19 patients was classified into mild, moderate I, moderate II, and severe, and the behavior of laboratory biomarkers was examined across these four disease stages. Results: The median age and male/female ratio increased with severity. The mortality rate was 12.5% in both moderate II and severe stages. Underlying diseases, which were not observed in 45% of mild stage patients, increased with severity. An ROC analysis showed that C-reactive protein (CRP), ferritin, procalcitonin (PCT), hemoglobin (Hb) A1c, albumin, and lactate dehydrogenase (LDH) levels were significantly useful for the differential diagnosis of mild/moderate I stage and moderate II/severe stage. In the severe stage, Hb levels, coagulation time, total protein, and albumin were significantly different on the day of worsening from those observed on the day of admission. The frequency of hemostatic biomarker abnormalities was high in the severe disease stage. Conclusion: The evaluation of severity is valuable, as the mortality rate was high in the moderate II and severe stages. The levels of CRP, ferritin, PCT, albumin, and LDH were useful markers of severity, and hemostatic abnormalities were frequently observed in patients in the severe disease stage.
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Stahl, Kelly A., Elizabeth J. Olecki, Matthew E. Dixon, June S. Peng, Madeline B. Torres, Niraj J. Gusani, and Chan Shen. "Gastric Cancer Treatments and Survival Trends in the United States." Current Oncology 28, no. 1 (December 24, 2020): 138–51. http://dx.doi.org/10.3390/curroncol28010017.
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Gastric cancer is the third most common cause of cancer deaths worldwide. Despite evidence-based recommendation for treatment, the current treatment patterns for all stages of gastric cancer remain largely unexplored. This study investigates trends in the treatments and survival of gastric cancer. The National Cancer Database was used to identify gastric adenocarcinoma patients from 2004–2016. Chi-square tests were used to examine subgroup differences between disease stages: Stage I, II/III and IV. Multivariate analyses identified factors associated with the receipt of guideline concordant care. The Kaplan–Meier method was used to assess three-year overall survival. The final cohort included 108,150 patients: 23,584 Stage I, 40,216 Stage II/III, and 44,350 Stage IV. Stage specific guideline concordant care was received in only 73% of patients with Stage I disease and 51% of patients with Stage II/III disease. Patients who received guideline consistent care had significantly improved survival compared to those who did not. Overall, we found only moderate improvement in guideline adherence and three-year overall survival during the 13-year study time period. This study showed underutilization of stage specific guideline concordant care for stage I and II/III disease.
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Johannet, Paul, Min Jae Kim, Melissa Call, Nicholas Gulati, Judy Zhong, Janice M. Mehnert, and Iman Osman. "The risk and tropism of central nervous system metastases (CNS) in patients with stage II cutaneous melanoma." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): 9551. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.9551.
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9551 Background: Recent data suggest that patients with stage III melanoma are at high enough risk for developing CNS metastases to consider routine surveillance neuroimaging (Journal of Clinical Oncology; PMID: 31990608). Given that a subset of stage II patients have a worse prognosis than stage III patients, we investigated the risk of developing brain metastases in stage II disease and compared it to the risk in stage III disease. Methods: We studied a cohort of prospectively enrolled melanoma patients who had protocol driven follow-up at New York University (NYU) Langone Health. We investigated both the incidence and time to development of CNS metastases, and explored whether the frequency of CNS metastases as a first isolated site of distant disease varies among the different stages. Results: The study cohort included a total of 1,102 patients (stage II: n = 619 with median follow-up 56.5 months; stage III: n = 483 with median follow-up 40.9 months). 85/619 (14%) stage II and 91/483 (19%) stage III patients developed CNS metastases (p = 0.03). The estimated 5-year cumulative incidence was 9% in stage IIA, 14% in stage IIB, and 29% in stage IIC patients (p = 0.0001). It was 10% in stage IIIA, 32% in stage IIIB, 23% in stage IIIC, and 49% in stage IIID (p = 0.0001). The CNS was the site of first metastasis for 32/154 (21%) stage II patients who developed distant disease compared to 28/214 (13%) stage III patients (p = 0.06). Conclusions: A subset of stage II patients are at an elevated risk for developing CNS metastases within 5 years of their initial diagnosis, which is comparable to that seen in stage III patients. The frequency of the CNS as a first site of metastasis in stage II melanoma suggests a propensity for brain tropism that cannot only be explained by a generalized pro-metastatic phenotype. Surveillance strategies that incorporate serial neuroimaging should be considered for these individuals.
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Zivanovic, Oliver, Mario M. Leitao, Alexia Iasonos, Lindsay M. Jacks, Qin Zhou, Nadeem R. Abu-Rustum, Robert A. Soslow, et al. "Stage-Specific Outcomes of Patients With Uterine Leiomyosarcoma: A Comparison of the International Federation of Gynecology and Obstetrics and American Joint Committee on Cancer Staging Systems." Journal of Clinical Oncology 27, no. 12 (April 20, 2009): 2066–72. http://dx.doi.org/10.1200/jco.2008.19.8366.
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Purpose Uterine leiomyosarcoma (LMS) is staged by the modified International Federation of Gynecology and Obstetrics (FIGO) staging system for uterine cancer. We aimed to determine whether the American Joint Committee on Cancer (AJCC) soft tissue sarcoma (STS) staging system is more accurate in predicting progression-free survival (PFS) and overall survival (OS). Patients and Methods Patients with uterine LMS who presented at our institution from 1982 to 2005 were staged retrospectively according to a modified FIGO staging system and the AJCC STS staging system. The predictive accuracy of the two staging systems was compared using concordance estimation. Results Two hundred nineteen patients had sufficient clinical and pathologic information to be staged under both systems; 132 patients were upstaged using the AJCC staging system, whereas only four were downstaged. Stage-specific PFS and OS rates for stages I, II, and III differed substantially between the two staging systems. In both systems, there was prognostic overlap between stages II and III. Thus, despite the marked stage-specific differences in 5-year PFS and OS rates for stages I, II, and III, both systems had similar concordance indices. Conclusion Estimates of stage-specific PFS and OS for uterine LMS were altered substantially when using the AJCC versus FIGO staging system. Adjuvant treatment strategies should be tested in patients at substantial risk for disease progression and death. Neither the FIGO nor AJCC staging system is ideal for identifying such patients, suggesting a need for a uterine LMS-specific staging system to better target patients for trials of adjuvant therapies.
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Rogers, Paul C., Thomas A. Olson, John W. Cullen, Deborah F. Billmire, Neyssa Marina, Frederick Rescorla, Mary M. Davis, et al. "Treatment of Children and Adolescents With Stage II Testicular and Stages I and II Ovarian Malignant Germ Cell Tumors: A Pediatric Intergroup Study—Pediatric Oncology Group 9048 and Children's Cancer Group 8891." Journal of Clinical Oncology 22, no. 17 (September 1, 2004): 3563–69. http://dx.doi.org/10.1200/jco.2004.01.006.
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Purpose To determine whether children with localized gonadal malignant germ cell tumors (MGCT) stage II testicular and stages I and II ovarian treated with four cycles of standard-dose cisplatin combined with etoposide and low-dose bleomycin (PEB) have an event-free survival (EFS) of at least 85% without significant toxicity. Patients and Methods Between May 1990 and July 1995, eligible pediatric patients with stage II or recurrent from stage I (as a stage II) testicular MGCT and stages I and II ovarian MGCT were enrolled onto this Pediatric Oncology Group and Children's Cancer Group study. PEB chemotherapy consisted of bleomycin 15 U/m2 on day 1, cisplatin 20 mg/m2/d on days 1 to 5, and etoposide 100 mg/m2/d on days 1 to 5. Patients received four cycles of therapy at 21-day intervals. Results Seventy-four patients with a median age of 10.5 years (range, 8.7 months to 16.7 years) were enrolled. Primary sites included: stage II testicular (n = 17), stage I ovarian (n = 41), and stage II ovarian MGCT (n = 16). Treatment with standard PEB resulted in 6-year EFS of 95% and overall survival (OS) of 95.7%. EFS and OS by primary site were as follows: stage II testicular, 100% and 100%; stage I ovarian, 95.1% and 95.1%; and stage II ovarian, 87.5% and 93.8%, respectively. Two patients died from recurrent disease, and one patient died of secondary acute myelocytic leukemia. Infrequent grade 3 to 4 hematologic toxicity was reported. No grade 3 to 4 renal, pulmonary, or ototoxicity was observed. Conclusion Combination chemotherapy with PEB results in excellent EFS and OS with minimal toxicity in children and adolescents with localized gonadal MGCT.
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Hong, Jin-Liern, Victoria Crossland, Aaron Galaznik, and Paul Dolin. "Dynamic Changes in International Staging System As a Predictor of Survival Outcome in Patients with Advanced Multiple Myeloma." Blood 132, Supplement 1 (November 29, 2018): 4438. http://dx.doi.org/10.1182/blood-2018-99-112134.
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Abstract Background: The International Staging System (ISS) based on serum beta-2 microglobulin and serum albumin is a useful tool for risk stratification in patients with multiple myeloma. ISS is usually assessed at the time of diagnosis. Recent studies have suggested that risk stratification should be considered dynamic over the disease course. Our study aimed to describe dynamic changes in ISS over time and their impacts on mortality in patients with advanced multiple myeloma. Methods: This study included 417 patients with multiple myeloma from the Flatiron medical records database (Jan 2011- May 2018) who have received at least two lines of therapy and had data on ISS at the time of diagnosis (TDX) and at the time of initiating the second line of therapy (T2L). ISS stage was either abstracted from medical records or derived from the results of laboratory tests of serum beta-2 microglobulin and serum albumin. Patients were followed up from T2L until the earliest event of the last activity in database or death. We calculated mortality rates by TDX and T2L ISS stages, and generated Cox proportional hazard models to estimate the impact of TDX and T2L ISS stages on mortality. Additionally, in the subgroup of patients in ISS stage III at TDX, we used univariate logistic models to identify the predictors for downward shift to ISS stage I or II at T2L. Results: The study cohort had a median age of 70 (interquartile range: 61 to 77), and 59% were male. Based on ISS at TDX, 30%, 37%, and 33% of the study cohort were classified as stage I, II, and III with the mortality rate of 12, 11, and 24 deaths per 100 person-years, respectively. The hazard ratios were 0.95 (95% confidence interval (CI): 0.57-1.61) for patients in stage II and 1.96 (95% CI: 1.22-3.16) for patients in stage III, compared with patients in stage I. Based on ISS at T2L, 47%, 34%, and 20% were classified as stage I, II, and III, with the mortality rate of 7, 19, and 39 deaths per 100 person-years, respectively. The hazard ratios were 2.62 (95% CI: 1.61-4.25) for patients in stage II and 5.18 (95% CI: 3.10-8.64) for patients in stage III, compared with patients in stage I. Dynamic changes in ISS stages over time and mortality rates were depicted in the Table. Among patients in ISS stage I at TDX, about 25% shifted to higher stages at T2L, and had a higher mortality rate (26 per 100 person-years) than did patients remaining in stage I (8 per 100 person-years). For patients in ISS stage II at TDX, 43% stayed in Stage II at T2L, and 46% moved down to Stage I, with a mortality rate of 20 and 5 per 100 person-years, respectively. Among patients in ISS stage III at TDX, 58% moved down to lower stages at T2L. The mortality rate was 10, 21, and 40 per 100 person-years for patients moving down to Stage I and II at T2L and those remaining in Stage III, respectively. In the subgroup of patients in ISS stage III at TDX, strong predictors for shifting down to lower stages were younger age (odds ratio: 2.65; 95% CI:1.20-5.87 for age <65 vs ≥65 years) and serum creatinine ≤ 2 mg/dL at TDX (odds ratio: 2.26; 95% CI:1.03-4.92 for serum creatinine ≤ 2 vs >2 mg/dL), but not gender, race, or cytogenetic abnormality of del17p, t(4;14), and t(14;16). Conclusion: Large changes in ISS stages were observed in multiple myeloma patients when advancing the line of therapy. Changes in ISS stage were also associated with survival outcome. A downward shift to stage I was associated with substantially improved overall survival; in contrast, patients moving up to or remaining in higher stages had poor outcomes, especially for those remaining in ISS stage III. Our results suggest that re-evaluating ISS stage at the time of change in line of therapy can improve prediction of survival outcomes. Disclosures Hong: Takeda Pharmaceuticals International Co.: Employment. Crossland:Takeda Pharmaceuticals International Co.: Employment. Galaznik:Takeda Pharmaceuticals International Co.: Employment. Dolin:Shire: Other: PD holds shares in Shire ; GSK: Other: PD holds shares in GSK; Takeda Pharmaceuticals International Co.: Employment.
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Tchero, Huidi, Christian Herlin, Farid Bekara, Sergiu Fluieraru, and Luc Teot. "Two-stage surgical repair in 31 patients with stage II-III hidradenitis suppurativa." International Journal of Dermatology 57, no. 6 (March 26, 2018): 745–47. http://dx.doi.org/10.1111/ijd.13969.
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Ono, Masamichi, Benedikt Mayr, Melchior Burri, Nicole Piber, Christoph Röhlig, Martina Strbad, Julie Cleuziou, Alfred Hager, Jürgen Hörer, and Rüdiger Lange. "Tricuspid valve repair in children with hypoplastic left heart syndrome: impact of timing and mechanism on outcome." European Journal of Cardio-Thoracic Surgery 57, no. 6 (February 7, 2020): 1083–90. http://dx.doi.org/10.1093/ejcts/ezaa004.
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Abstract OBJECTIVES Our aim was to evaluate the results of tricuspid valve repair (TVr) in patients with hypoplastic left heart syndrome during staged reconstruction, focussing on the timing of the repair and the mechanisms of tricuspid regurgitation (TR). METHODS Records of 44 children with hypoplastic left heart syndrome who underwent a total of 62 tricuspid valve (TV) procedures during staged reconstruction were retrospectively analysed. RESULTS TVr was performed before stage II in 4 (9%) patients, at stage II in 23 (52%) patients, between stages II and III in 3 (7%) patients and at stage III in 14 (32%) patients. The median age at the first TV procedure was 5 months. At surgery, TR emanated commonly from the anteroseptal commissure in 21 (48%) patients. Anterior leaflet prolapse was observed most frequently (n = 23; 52%), followed by septal leaflet restriction (n = 22; 50%), dilated annulus (n = 21; 48%) and cleft anterior leaflet (n = 9; 21%). Surgical techniques included commissuroplasty in 27 (61.4%) patients, leaflet adaptation in 20 (44%) patients, partial annuloplasty in 11 (25%) patients, chordal reconstruction in 10 (23%) patients and cleft closure in 10 (23%) patients. Among all 44 patients, 27 (61%) patients had preoperative grade III TR and 17 (39%) patients had grade IV; postoperatively, there were no patients with grade IV, 25 patients with grade III (57%), 10 patients with grade II (23%) and 6 patients with grade I (14%). Fifteen patients required redo TV surgeries. Reoperation-free survival was 52% at 5 years. Lower weight at initial TVr predicted mortality [hazard ratio (HR) 0.7, P = 0.044] and reoperation (HR 0.8, P = 0.015). TVr before stage II was a risk for both reoperation (HR 5.5, P = 0.042) and TV replacement (HR 36.9, P = 0.013). Among morphological factors, septal leaflet restriction was a risk for reoperation (HR 4.7, P = 0.017) and anterior (HR 4.7, P = 0.037) and posterior (HR 7.3, P = 0.015) leaflet chordal anomaly for TV replacement. CONCLUSIONS Anterior leaflet prolapse and septal leaflet restriction are the main mechanisms of TR in hypoplastic left heart syndrome. Early-onset TR before stage II predicts worse outcome. Refinements to repair techniques in early infancy, especially for septal leaflet restrictions and chordal anomalies, are mandatory to improve outcomes.
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Momin, Sehrish Nizar Ali, M. A. Rehman Siddiqui, Shiraz Hashmi, Abdul Sami Memon, and Haroon Tayyab. "Post-operative visual outcomes based on morphological staging of idiopathic epiretinal membranes on OCT." International Journal of Ophthalmology 15, no. 12 (December 18, 2022): 1966–70. http://dx.doi.org/10.18240/ijo.2022.12.11.
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AIM: To evaluate the recently described optical coherence tomography (OCT) based classification of epiretinal membrane (ERM) and its usefulness in predicting the functional outcome. METHODS: A retrospective observational review of OCT scans of patients with the diagnosis of idiopathic ERM was carried out from January 2016 to June 2021. All consecutive images diagnosed with any stage of idiopathic ERM and fulfilled the eligibility criteria were included in the analysis. ERM was identified on OCT scans as a thin hyperreflective layer over the inner layers of retina. OCT scans of patients with ERM who underwent vitrectomy, were independently staged as per the new classification by two independent retinal surgeons to form a consensus on stage. Best corrected visual acuity (BCVA) in logMAR scale and central subfield thickness (CST) on pre- and post-operative spectral domain OCT scans were the variables noted for all patients at the time of diagnosis and at 6 and 12mo follow up visit after undergoing intervention. Partial correlation coefficient was computed between BCVA (logMAR) and CST by ERM stage adjusting by baseline measures. RESULTS: Clinical charts of 74 patients with idiopathic ERM were assessed. Clinically significant improvement in BCVA overtime was observed with significant difference in median visual acuity of patients with Stage II-IV ERM with P<0.001. The median CST of all patients with stage II-IV ERM showed similar consistent improvement with P<0.001 from baseline to 12th month. Our results showed not only gain in visual acuity but also shift from baseline to anatomical normalization of CST in stage II. We found a decrease in CST with difference of 166 μm and 151 μm in stage III and stage IV respectively. Our results remained consistent with the hypothesis of improved visual outcomes with all stages of ERM with adjusted moderate linear correlation between visual acuity and CST in stage II-IV (r>0.3). CONCLUSION: Equally significant visual outcomes of patients with ERM staged II-IV and therefore can be counselled for improved visual acuity after surgical removal of ERM with improvement up to 5 lines on Snellen’s chart from the baseline.
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Murashka, D. I., A. D. Tahanovich, M. M. Kauhanka, V. I. Prokhorova, and O. V. Gotko. "Diagnostic efficiency of determining CXCR1, CXCR2 and hyaluronic acid blood level in non-small cell lung cancer patients." Biomeditsinskaya Khimiya 67, no. 5 (2021): 434–42. http://dx.doi.org/10.18097/pbmc20216705434.
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In the structure of lung cancer incidence most cases belong to non-small cell lung cancer (NSCLC) which is subdivided into two histological subtypes: adenocarcinoma (AC) and squamous cell carcinoma (SCC). A five-year survival rate of patients with stage I NSCLC is two times higher than in patients with stage II and more than five times higher than in stages III-IV. Currently, there are no informative blood biomarkers to diagnose early stages of NSCLC. The aim of the study was to evaluate complex determination of hyaluronic acid (HA), CXCR2 and CXCR1 levels blood of patients with AC and SCC. Blood samples from of 107 patients with SCC, 90 patients with AC, and 40 healthy people were used in this study. Concentration of HA in blood serum was determined by enzyme linked immunoassay. The level of CXCR2 and CXCR1 was determined by flow cytometry. Diagnostic parameters were determined by constructing mathematical models in the form of regression equations using the method of stepwise inclusion of predictors and subsequent ROC-analysis. Results of the study indicate that MFI CXCR1 in granulocytes, proportion of lymphocytes containing CXCR2 and concentration of HA in blood serum in stage I AC and SCC are significantly higher than in healthy people. The level of these parameter significantly increases at stage II of the disease compared to stage I and demonstrates further growth at its later stages. Based on the obtained results, regression equations were created: (i) including MFI CXCR1 in granulocytes, proportion of lymphocytes supplied with CXCR2 and HA concentration in the serum to detect stages I-II SCC (diagnostic sensitivity — 95.7%, specificity — 93.7%, threshold value — 0.59) and stages III-IV SCC (diagnostic sensitivity — 93.1%, specificity — 93.3%, threshold value — 0.64); (ii) including the proportion of lymphocytes supplied with CXCR2 MFI CXCR1 in granulocytes and CYFRA 21-1 blood level, which allows the detection of I-II stages of AC (sensitivity — 91.3%, specificity — 94.7%, threshold value — 0.61); (iii) including the proportion of lymphocytes supplied with CXCR2 and CYFRA 21-1 blood level, which allows the detection of AC stages III-IV (sensitivity — 94.6%, specificity — 91.3%, threshold value — 0.15); (iv) including the proportion of lymphocytes supplied with CXCR2 and HA level in the serum to differentiate stage II SCC from stage I (sensitivity — 94.4%, specificity — 87.5%, threshold value — 0.44) and II stage AC from stage I (sensitivity — 88.5%, specificity — 91.2%, threshold value — 0.46).
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KIMURA, Tomoki, Yutaka HIROKAWA, Minoru FUJITA, Yuji MURAKAMI, Masahiro KENJO, Yuko KANEYASU, and Katsuhide ITO. "BRACHYTHERAPY FOR ELDERLY PATIENTS WITH STAGE II TONGUE CANCER." Japanese jornal of Head and Neck Cancer 29, no. 4 (2003): 575–80. http://dx.doi.org/10.5981/jjhnc1974.29.575.
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Boland, C. Richard, and Ajay Goel. "Prognostic Subgroups among Patients with Stage II Colon Cancer." New England Journal of Medicine 374, no. 3 (January 21, 2016): 277–78. http://dx.doi.org/10.1056/nejme1514353.
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Amri, Ramzi, Jonathan England, Liliana G. Bordeianou, and David L. Berger. "Risk Stratification in Patients with Stage II Colon Cancer." Annals of Surgical Oncology 23, no. 12 (July 5, 2016): 3907–14. http://dx.doi.org/10.1245/s10434-016-5387-9.
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Tuma, Rabiya S. "Identification of High-Risk Stage II Colorectal Cancer Patients." Oncology Times 29, no. 23 (December 2007): 30–31. http://dx.doi.org/10.1097/01.cot.0000310383.80623.e1.
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Ciatto, Stefano. "Follow-up of breast cancer patients stage I–II." European Journal of Cancer 29, no. 7 (January 1993): 1072. http://dx.doi.org/10.1016/s0959-8049(05)80233-3.
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Kim, Hyung Jin. "Adjuvant chemotherapy in patients with stage II colon cancer." Korean Journal of Clinical Oncology 14, no. 2 (December 31, 2018): 67–68. http://dx.doi.org/10.14216/kjco.18012.
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Nunziata, C., E. Pagani, M. Tricarico, F. Concolino, L. Nardini, G. Sonego, F. Carlesimo, et al. "Adjuvant chemo-immunotherapy of melanoma patients (stage II, III)." Melanoma Research 7, Supplement 1 (June 1997): S112. http://dx.doi.org/10.1097/00008390-199706001-00391.
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Ercan, Metin, Erdal B. Bostanci, Tebessum Cakir, Kerem Karaman, Ilter Ozer, Murat Ulas, Tahsin Dalgic, Yusuf Ozogul, Erol Aksoy, and Musa Akoglu. "The Rationality of Resectional Surgery and Palliative Interventions in the Management of Patients with Gallbladder Cancer." American Surgeon 81, no. 6 (June 2015): 591–99. http://dx.doi.org/10.1177/000313481508100623.
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The aim of the present study was to evaluate in a retrospective manner, the survival period and survival rate according to stages and groups after R0, R1, R2 resections and palliative interventions. Between 2003 and 2012, 67 patients diagnosed with gallbladder carcinoma were retrospectively analyzed. Patient demographics, the survival period, and survival rate according to stages and groups after R0, R1, R2 resections and palliative interventions were retrospectively analyzed. Sixty-seven patients were diagnosed with gallbladder carcinoma. Thirty-eight patients (56.7%) were female and 29 patients (43.3%) were male. The median survival period was significantly longer in stage II and III diseases than in stage IV disease ( P < 0.001). The R0, R1, and R2 resection rates in patients who underwent surgery with curative intent were 67.7, 19.4, and 12.9 per cent, respectively. The R0 resection rate according to the tumor stages was 100 per cent for stage I, 87.5 per cent for stage II, 66.7 per cent for stage III, and 42.8 per cent for stage IV disease. The median follow-up period was six months (eight days to 36 months). During this follow-up period, 53 patients (79.1%) died. In conclusion, R0 resection rate decreases when tumor stage increases. The highest survival rates after R0 resection are achieved in patients with stage I, II, and III diseases. Radical surgery has no benefit over palliative surgery for stage IV disease in terms of survival.
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Bohanes, Pierre Oliver, Dongyun Yang, Fotios Loupakis, Melissa Janae Labonte, Armin Gerger, Yan Ning, Takeru Wakatsuki, et al. "Integrin genetic variants and stage-specific tumor recurrence in patients with stage II and III colon cancer." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): 3604. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.3604.
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3604 Background: Integrins are key elements in cancer biology regulating tumor growth, angiogenesis and lymphangiogenesis through interactions of the tumor cells with the microenvironment. Recent evidence showing that integrins are critical in cancer dormancy suggests that their differential expression or activity may be responsible for tumor recurrence. Moving from the hypothesis that integrins could have different effects in stage II and III colon cancer, we tested as a primary endpoint whether a comprehensive panel of germline single nucleotide polymorphisms (SNPs) in integrin genes could predict stage-specific time to tumor recurrence (TTR) in stage II and III colon cancer patients. Methods: A total of 234 patients, 105 high-risk stage II and 129 stage III, treated with 5-fluorouracil-based chemotherapy at the University of Southern California were included in this study. The median follow-up time was 4.4 years. Whole blood samples were analyzed for 22 germline SNPs in integrin genes using PCR-RFLP or direct DNA-sequencing. Results: In the multivariate analysis,stage II colon cancer patients with at least one G allele for ITGB3 rs4642 had higher risk of recurrence (HR=4.027, 95%CI 1.556-10.421, p=0.004). This association was also significant in the combined stage II-III cohort (HR=1.975, HR 95%CI 1.194-3.269, p=0.008). The predominant role of ITGB3 rs4642 in stage II diseases was confirmed using recursive partitioning, showing that ITGB3 rs4642 was the most important factor in stage II diseases. In contrast, in stage III diseases, both ITGB1 rs2298141 (HR=1.909, 95%CI 1.054-3.459, p=0.033) and ITGA4 rs7562325 (HR=0.227, 95%CI 0.064-0.804, p=0.022) were associated with TTR. The latter showed a significant interaction between stages (p=0.048). Conclusions: This study identifies germline polymorphisms in integrin genes as independent stage-specific prognostic markers for stage II and III colon cancer. These data strengthen the role of tumor dormancy in early colon cancer and may help to select subgroups of patients who may benefit from integrin-targeted treatments.
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Nepomnyashchaya, Evgeniya M., Elena P. Ulianova, Inna A. Novikova, Aleksandr B. Sagakyants, Maksim N. Chernyak, M. A. Gappoeva, and Maria O. Ezhova. "ZEB1 expression in different stages of colorectal cancer." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): e15526-e15526. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.e15526.
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e15526 Background: Colorectal cancer (CRC) is among the most common cancers. The leading cause of high mortality is tumor progression developed due to the epithelial to mesenchymal transition (EMT). The ZEB1 protein is one of the critical regulators of this process. In this regard, our study aimed to assess the ZEB1 expression in different stages of colorectal cancer. Methods: This study included samples of 206 patients with stage II-IV CRC aged 42 to 86 years (mean age 64.2±1.7). All patients were divided into three groups: group 1 - patients with T3-4 N0 M0 (stage II) with high-risk factors for recurrence, n = 6; group 2 - patients with T1-4 N1-2 M0 (stage III), n = 88; group 3 - patients with T1-4 N0-2 M1 (stage IV), n = 58. IHC study was performed using polyclonal rabbit antibodies to ZEB1 (Biorbyt Ltd.) diluted 1:200 and a Reveal Polyvalent HRP-DAB Detection System. The staining percentage and intensity were assessed: 0, 1+ weak, 2+ moderate, 3+ strong. The nuclear reaction of the ZEB1 protein was considered positive when staining was detected in more than 10% (cut-off) of tumor cells with intensities of 2+ and 3+. Statistical analysis of the results was carried out using the STATISTICA 13.0 software (StatSoft Inc., USA). Results: A positive nuclear reaction for ZEB1 was detected in 80.6% (166 of 206 patients), while negative in 19.4% (40 of 206 patients). The maximal percentage of patients with positive staining for ZEB1 was among those with stage IV (94.8%), the minimal percentage - stage II (60%). The prevalence of ZEB1+ in patients with stages III and IV significantly increased the risk of tumor progression by 3.5 (95% CI 1.8-8.4) and 12.2 (95% CI 3.4-43.6) times, respectively, compared with stage II patients. No statistical significance was observed in the comparison between patients with stages III and IV (95% CI 0.9-11.7). The percentage of ZEB1+ samples increased in more advanced tumors. The ratio of ZEB1+/ZEB1- tumors in stage II was 1.5, in stage III - 5.8, in stage IV - 18.3 (p < 0.05). Conclusions: The immunohistochemical study revealed the features of ZEB1 expression in different stages of colorectal cancer, which can serve as prognostic factors that determine the disease progression.
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Hosoya, Tokuko, Goshi Oda, Tsuyoshi Nakagawa, Iichiroh Onishi, Tadashi Hosoya, Megumi Ishiguro, Toshiaki Ishikawa, and Hiroyuki Uetake. "Plasma Levels of Decorin Increased in Patients during the Progression of Breast Cancer." Journal of Clinical Medicine 10, no. 23 (November 26, 2021): 5530. http://dx.doi.org/10.3390/jcm10235530.
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Decorin (DCN), an extracellular matrix proteoglycan found in tumor surrounding tissues, is a natural inhibitor of tumor cell proliferation and invasion. We conducted a cross-sectional observation study to evaluate the association of the pathological stage with the levels of DCN in plasma or tumor surrounding tissue. Among 118 patients who underwent breast surgery, 35 were designated as carcinoma in situ (Stage 0), 39 were Stage I, and 44 were Stage II or III. The stromal expression of DCN was quantified using a semiquantitative digital image analysis after immunohistochemical staining. The concentration of DCN was evaluated with a specific ELISA. As we have previously shown, stromal DCN expression was attenuated in the patients with Stage I, whereas stromal and plasma DCN was elevated paradoxically in those with Stage II/III. The elevated plasma DCN is an independent predictive factor of Stage II/III by the multivariate logistic regression analysis. The plasma level of DCN was negatively correlated with stromal DCN expression only in patients with advanced disease (Stage II/III). The plasma level of DCN could become a useful biomarker for patients in the advanced stages. Extensive studies and further assessments are warranted for evaluating the prognostic significance and tumor characteristics to understand the clinical significances of stromal and systemic DCN.
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deLeon, Maria, Lingeng Lu, Pei Hui, Alessandro Santin, Thomas J. Rutherford, Dan Arin-Silasi, Masoud Azodi, Elena Ratner, and Peter E. Schwartz. "Prognostic factors and treatment-related outcomes in patients with uterine serous cancer (USC)." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): 5099. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.5099.
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5099 Background: USC an uncommon (10%) but aggressive form of uterine cancer, causes 50% of uterine cancer deaths. The purpose of this study is to report a large single-institution experience with USC investigating the effects of clinicopathological parameters and treatment on overall (OS) and disease-free survival (DFS). Methods: Records from our institution were reviewed from 1987-2009. All 334 USC patients (pts) identified were surgically staged. Postoperative treatments used were: (1) observation (OBS, n=33); (2) platinum-based chemotherapy (PCH, n=78); (3) whole pelvis radiation therapy (WPRT, n=16); (4) PCH and vaginal apex brachytherapy (PCHR, n=165); (5) vaginal apex brachytherapy (VAB, n=35). The cancer stages were 121 pts IA (36.2%), 36 IB (10.8%), 27 II (8.1%), 39 IIIA (11.7%), 2 IIIB (0.6%), 32 IIIC1 (9.6%), 9 IIIC2 (2.7%), 28 IVA (8.4%) and 40 IVB (12%). Results: The 5-year OS for stage IA/IB, II, IIIA/IIIB, IIIC1/IIIC2, IVA/IVB were 82%, 70%, 64%, 36%, and 9%, respectively. The 5-year DFS for stage IA/IB, II, IIIA/IIIB, IIIC1/IIIC2, IVA/IVB were 82%, 68%, 56%, 24%, 6%, respectively. Advanced stage was associated with significantly shorter OS and DFS (p <0.01). The 5-year OS for stage IA/IB disease was 94% for pts who received PCHR, 90% for OBS, 75% for PCH, 65% for VAB and 0% for WPRT. The 5-year DFS for PCHR, OBS, PCH, VAB and WPRT for Stage IA/IB were 89%, 82%, 86%, 72% and 0% respectively. For stage II-IVB pts, the 5-year OS was 51% for PCHR, 0% for OBS, 23% for PCH and 20% for WPRT. The 5-year DFS for stage II-IVB with PCHR, OBS, PCH and WPRT were 42%, 0%, 17% and 13% respectively. Older age pts had worse survival, (p<0.01). Race and BMI did not impact survival. Incomplete surgical debulking (p<0.01), depth of myometrial invasion >50% (p<0.01) and lymph node metastasis (p<0.01) were all associated with worse prognosis. Conclusions: PCHR overall exhibited better OS and DFS regardless of disease stage. Age, incomplete surgical debulking, depth of myometrial invasion and lymph node involvement were independent prognostic factors in USC patients in this study.
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Ozaki, Shuji, Takayuki Saitoh, Hiroshi Handa, Hirokazu Murakami, Kenshi Suzuki, Naoki Takezako, Jun Konishi, et al. "A Revised International Staging System of Multiple Myeloma in the Era of Novel Agents and Autologous Stem Cell Transplantation in Japan: A Multicenter Retrospective Collaborative Study of the Japanese Society of Myeloma." Blood 126, no. 23 (December 3, 2015): 4199. http://dx.doi.org/10.1182/blood.v126.23.4199.4199.
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Abstract Survival outcomes of patients with multiple myeloma (MM) vary considerably depending on the presence or absence of disease-related risk factors [i.e., advanced ISS (International Staging System) stage, CAs (cytogenetic abnormalities), etc.], patient-related risk factors, and/or treatment-related risk factors. ISS, developed in 2006 by the IMWG (International Myeloma Working Group), has been considered an important disease-related baseline prognostication model and has been used in routine clinical practice worldwide. However, it is solely determined by the serum biochemistry data without taking account of CAs which are currently identified as the most powerful prognostic indicator for MM. Recently, a Revised ISS (R-ISS) scoring system which is accounting the presence or absence of serum LDH abnormality as well as CAs such as t(4;14), t(14;16), or del(17p) in addition to the ISS stage has been proposed (Oliva S, et al. EHA 2014, #S1289). In the present study, we applied the R-ISS to the Japanese MM patients diagnosed between 2001 and 2012 and compared the clinical relevance of the R-ISS with that of the original ISS in the era of novel agents and autologous stem cell transplantation (ASCT). Clinical data of 3,270 patients were collected from 38 centers; however, ISS and R-ISS were only applicable to 2,998 and 788 patients, respectively. Patient characteristics including age, gender, type of M protein, Durie and Salmon stage, ISS stage, and chromosomal abnormalities were not significantly different between the patients to which ISS and R-ISS were applied. In the 788 patients evaluable for the R-ISS analysis, distribution of the patients according to the ISS stages I, II, and III were 31.4%, 35.8%, and 32.8%, respectively, whereas that of the R-ISS stages were 22.2%, 67.6%, and 10.2%, respectively. Median overall survival (OS) for the ISS stages I, II, and III were 100.7, 65.2, and 50.9 months, respectively, and that of R-ISS stages I, II, and III were 152.8, 62.4, and 40.5 months, respectively. Accordingly, the difference of survival time between the stages seemed more distinct in R-ISS compared with the performance of the original ISS. According to the analysis by the ISS, there were no significant difference in the median OS between the patients whether initially treated with novel agents or with conventional chemotherapy (stage I, 91.2 vs 84.6 months, p=0.054; stage II, 64.1 vs 62.5 months, p=0.18; and stage III, 41.2 vs 37.2 months, p=0.24). In contrast, the analysis by the R-ISS disclosed a beneficial effect of novel therapy than with conventional chemotherapy, particularly in patients with stage I disease (stage I, not reached vs 87.6 months, p=0.018; stage II, 78.8 vs 61.7 months, p=0.075; and stage III, 37.5 vs 45.3 months, p=0.87). As for ASCT, both ISS and R-ISS stages showed a significant difference in the median OS between the patients treated with ASCT and those without ASCT (ISS stages: stage I, 101.3 vs 78.8 months, p=0.40; stage II, 83.8 vs 52.4 months, p=0.0002; stage III, 67.5 vs 31.7 months, p=0.0004; and R-ISS stages: stage I, not reached vs 90.7 months, p=0.21; stage II, 74.2 vs 56.5 months, p<0.00001; stage III, 73.8 vs 37.5 months, p=0.11). Thus, our results have demonstrated that R-ISS is a useful model for the risk assessment of Japanese patients with MM. Notably, the outcome of MM patients with R-ISS stage I showed a dramatic improvement by the initial treatment with novel agents and ASCT. However, the survival benefit remained unmet in patients with advanced stages of R-ISS even in the era of novel agents and ASCT, and further development of therapeutic strategies is needed in high-risk patients with MM. Disclosures Sunami: Takeda pharmaceutical Compani Limited: Research Funding; ONO PHAMACEUTICAL CO.,LTD: Research Funding.
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Alese, Olatunji B., Wei Zhou, Renjian Jiang, Katerina Mary Zakka, Walid Labib Shaib, Christina Wu, Maria Diab, Mehmet Akce, and Bassel F. El-Rayes. "Impact of primary tumor size/horizontal extent on survival in colorectal cancer." Journal of Clinical Oncology 39, no. 3_suppl (January 20, 2021): 125. http://dx.doi.org/10.1200/jco.2021.39.3_suppl.125.
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125 Background: Pathologic staging in colorectal cancer (CRC) is crucial in patient management. Data regarding the impact of size/horizontal tumor extent is limited, contradictory and currently excluded from the American Joint Committee on Cancer (AJCC) staging model. However, a previously published SEER analysis showed that AJCC stages I and IIIA have similar 2- and 5- year survival rates, and worse rates for stage II. Using the largest cohort to date, we report the impact of primary tumor size on CRC survival. Methods: Data were obtained from all US hospitals that contributed to the National Cancer Database (NCDB) between 2010 and 2015. Univariate and multivariate analyses were performed to identify factors associated with patient outcome. Kaplan-Meier analysis and Cox proportional hazards models were used to assess the association between tumor/patient characteristics and overall survival (OS). Results: A total of 61,145 patients were identified with a similar gender distribution (M/F:50.9%/49.1%). The mean age was 62.7years (SD+/-14.1) and 82% were non-Hispanic Whites. Majority had colon primary (82.7%) and 82.4% had microsatellite stable (MSS) disease. Distribution across stages I-IV was 20.1%, 32.1%, 34.7% and 13.2% respectively. Among the total study population, AJCC stage correlated closely with OS on multivariate analysis (HR 1.49, 2.29, 8.38 for stages II to IV compared to stage I), while the distinguishing power for tumor size was relatively mild (HR 1.19 and 1.33 for 5-10 cm and >5cm compared to <5cm). Among patients with stage II disease, tumors >10cm were associated with worse survival compared to those <5cm (HR 1.2; 1.03-1.39; p=0.22). Stage III disease also had differential survival rates; patients with tumors 5-10cm (HR 1.21; 1.14-1.28; p<0.001) and >10cm (HR 1.57; 1.37-1.80; p<0.001) had worse survival than those <5cm. Patients with stage II who did not receive adjuvant chemotherapy (CTX) had worse survival outcomes (HR 1.29; 1.08-1.55; p=0.005) compared to stage III disease who did. Accounting for tumor size, there was no statistically significant survival differences between stage I patients and stages II and III patients who received adjuvant chemotherapy. Conclusions: Tumors larger than 10cm have inferior outcomes among patients in the same AJCC stages. Stage II patients without adjuvant CTX did worse than stage III with CTX. Further studies are needed to clarify the role of tumor size in staging models. [Table: see text]
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Sanal, S. M., F. W. Flickinger, M. J. Caudell, and R. M. Sherry. "Detection of bone marrow involvement in breast cancer with magnetic resonance imaging." Journal of Clinical Oncology 12, no. 7 (July 1994): 1415–21. http://dx.doi.org/10.1200/jco.1994.12.7.1415.
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PURPOSE To evaluate the value of magnetic resonance imaging (MRI) in detecting bone marrow metastases in patients with breast cancer. PATIENTS AND METHODS Twenty-three patients with breast cancer in various stages (stage IV, 11; stage III, five; stage II, seven) were evaluated for bone marrow involvement. MRIs of marrow from lumbar spine, pelvis, and proximal femora were obtained with a 1.5-Tesla unit. All patients underwent bilateral bone marrow aspirations and biopsies for histologic evaluation and immunostaining with monoclonal antibody (MoAB) against low-molecular weight cytokeratin (CAM 5.2). Marrow MRI findings were compared with technetium 99m bone scans. Patients with stage II or III disease were monitored for clinical outcome. Possible correlation of MRI findings with serum alkaline phosphatase level was explored. RESULTS Fourteen of 23 patients showed MRI abnormalities suggestive of metastatic marrow disease (stage IV, nine; stage III, two; stage II, three). In six patients with abnormal MRIs, histology and MoAB immunostaining confirmed marrow involvement (stage IV, five; stage III, zero; stage II, one). In the other eight patients with MRI abnormalities, neither of these methods confirmed the presence of marrow metastasis. Four of five operable breast cancer (stage II-III) patients with an abnormal initial MRI showed additional abnormalities on follow-up examination and developed metastatic disease within 5 to 18 months demonstrable by conventional clinical methods. Conversely, none of the operable patients with negative MRIs developed recurrent disease at 3 to 16 months (Student's t test, P = .01). Nine patients with a normal MRI had no evidence of marrow involvement with histologic or MoAB immunostaining (stage IV, two; stage III, two; stage II, five). Of 14 patients with abnormal MRIs, bone scans were normal in seven and failed to show corresponding abnormalities in six. Elevated serum alkaline phosphatase levels showed a direct relationship with abnormal bone scans indicating extensive bony involvement, but failed to correlate with positive marrow MRIs. CONCLUSION MRI is a promising new technique to detect occult marrow involvement in breast cancer patients. There is a good correlation between abnormal marrow MRI and early development of clinical metastatic disease in patients with stage II to III disease.
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Chagpar, Ryaz, Yan Xing, Yi-Ju Chiang, Barry W. Feig, George J. Chang, Y. Nancy You, and Janice N. Cormier. "Adherence to Stage-Specific Treatment Guidelines for Patients With Colon Cancer." Journal of Clinical Oncology 30, no. 9 (March 20, 2012): 972–79. http://dx.doi.org/10.1200/jco.2011.39.6937.
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Purpose Adherence to evidence-based treatment guidelines has been proposed as a measure of cancer care quality. We sought to determine rates of and factors associated with adherence to the National Comprehensive Cancer Network (NCCN) treatment guidelines for colon cancer. Patients and Methods Patients within the National Cancer Data Base treated for colon adenocarcinoma (2003 to 2007) were identified. Adherence to stage-specific NCCN guidelines was determined based on disease stage. Hierarchical regression analyses were performed to identify factors predictive of adherence, overtreatment, and undertreatment. Results A total of 173,243 patients were included in the final cohort, 123,953 (71%) of whom were treated according to NCCN guidelines. Patients with stage I disease were more likely to receive guideline-based treatment (96%) than patients with stage II (low risk, 66%; high risk, 36%), III (71%), or IV (73%) disease (P < .001). Adherence to consensus-based guidelines increased over time. Factors associated with adherence across all stages included age, Charlson-Deyo comorbidity index score, later year of diagnosis, and insurance status. Among patients with high-risk stage II or stage III disease, older patients with pre-existing comorbidities and patients with lower socioeconomic status were less likely to be offered adjuvant chemotherapy. Among patients with stage I and II disease, young, healthy patients were more likely to be recommended chemotherapy, in discordance with NCCN guidelines. Conclusion Significant variation exists in the treatment of colon cancer, particularly in treatment of high-risk stage II and stage III disease. The impact of nonadherence to guidelines on patient outcomes needs to be further elucidated.
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Burlaka, Yu, N. Gryn, O. Goloborodko, and S. Verevka. "Investigation of erythrocyte aggregation in patients with laryngeal cancer." Bulletin of Taras Shevchenko National University of Kyiv. Series: Problems of Physiological Functions Regulation 20, no. 1 (2016): 34–38. http://dx.doi.org/10.17721/2616_6410.2016.20.34-38.
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It was compared evaluation of results of erythrocytes aggregation parameters in patients with laryngeal cancer compared to the healthy persons. It was found that in patients with laryngeal cancer II-d and III-d stage of the tumor process against the background of increasing the degree of aggregation and the time relative to the corresponding reference data, there is a simultaneous decrease in its speed of aggregation. In addition, the study has shown increase in average weight molecules and fibrinogen levels in the blood plasma of patients with laryngeal cancer, to a lesser extent – with the II-d stage of the disease, and their more significant violations were observed in the III-d stage of the cancer process. Sialic acid content was increased at II and III-d stages of cancer of the larynx in the same degree compared to the healthy persons. It was established opposite changes of basic parameters of erythrocytes aggregation. The most significant violations of aggregation degree were observed in the II-d stage of the cancer process. Growing of levels of the average weight molecules, fibrinogen and sialic acid in the blood plasma of patients with laryngeal cancer indicates the presence of metabolic intoxication and the acute phase of inflammation, the severity of which to a certain extent depends on the stage of the disease.
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Gandham, Goutham, Hridya Jayamohanan, Bharadwaj Ponnada, Anil Kumar, Sudhindran S, and Pavithran Keechilat. "Correlation of serum PIVKA-II and AFP level with portal vein tumor thrombus and BCLC stage in newly diagnosed hepatocellular carcinoma patients." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e16608-e16608. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e16608.
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e16608 Background: Protein Induced by Vitamin K Absence-II (PIVKA-II) is a tumor marker specific for hepatocellular carcinoma (HCC). PIVKA-II levels correspond with HCC oncogenesis and disease progression. Portal vein tumor thrombus (PVTT) in patients with HCC is a significant factor that affect treatment and prognosis. In this study we assessed the predictive value of PIVKA-II and AFP for vascular invasion and BCLC stage in newly diagnosed HCC patients. Methods: We retrospectively reviewed records of newly diagnosed HCC patients at a tertiary hospital in India between January 2019 to December 2019. Clinical details, BCLC stage, radiological imaging records, serum levels of PIVKA-II and AFP at the time of diagnosis were obtained from medical records. Diagnostic accuracy and cut-off value of PIVKA-II in patients with portal invasion were calculated using receiver operator curve (ROC) analysis. Multiple pairwise comparisions between BCLC stage with PIVKA-II and AFP levels were analysed using Kruskal-Wallis test. Results: Out of 162 newly diagnosed HCC patients 42(25.9%) were detected with PVTT on imaging such as contrast-enhanced computed tomography or magnetic resonance imaging at the time of diagnosis.120(74.1%) patients without PVTT were taken as controls for the analysis. Serum level of PIVKA-II in HCC patients with PVTT was significantly higher than in HCC patients without PVTT (1152.57 mAU/ml vs 146.39 mAU/ml; p = 0.001). AUROC of PIVKA-II was 0.796 (95%CI 0.70-0.892, p = 0.000).The optimal cut-off value of PIVKA-II was 271.81 mAU/ml with a sensitivity of 78.6% and specificity of 52.4%, and the diagnostic accuracy was 59.98%. AUROC of AFP was 0.619 (95%CI 0.59-0.72, p = 0.001). Median PIVKA-II value increased from BCLC stage A to D. Kruskal-Wallis test showed a significant difference of PIVKA-II levels between all stages except stage A and B (p values for stage A-B (0.297), A-C (0.000), A-D(0.000),whereas for AFP results were significant only between stages A and C (p values for stage A-B (0.348), A-C (0.003), A-D(0.206). Conclusions: Serum PIVKA-II level appears as a good predictive marker for PVTT and BCLC stage when compared to AFP which may guide therapeutic strategy and assessment of prognosis in newly diagnosed HCC patients.
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Yu, Yang, Siquan Liang, Yue Wang, Yanan Zhao, Jiaojiao Zhao, Haitao Li, Jingchao Wu, Yuanyuan Cheng, Fan Wu, and Jialing Wu. "Quantitative Analysis of Postural Instability in Patients with Parkinson’s Disease." Parkinson's Disease 2021 (April 13, 2021): 1–7. http://dx.doi.org/10.1155/2021/5681870.
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Introduction. Postural instability is commonly observed in Parkinson’s disease, leading to an increasing risk of falling and worsening as the disease progresses. We found that limit of stability can be applied to reflect the dynamic evolution of postural instability in patients with Parkinson's disease. Methods. Forty-three patients (9 of Hoehn and Yahr stage I, 12 of stage II, 14 of stage III, and 8 of stage IV) met the criteria for the diagnosis of idiopathic Parkinson’s disease and could stand independently for at least 10 minutes. Twelve healthy controls with no sign of parkinsonism were also recruited. Postural instability was assessed by posturography in different directions (forward, backward, right, left, forward-right, forward-left, backward-right, and backward-left). This study trial was registered with the Chinese Clinical Trial Registry (no. ChiCTR1900022715). Results. All participants were able to complete the limit of stability tasks without any complications. Patients in stages II to IV exhibited smaller end point excursion and slower time to complete than controls, suggesting an impaired limit of stability. The patients in stage II exhibited a remarkable decline in most directions compared to controls, except for right and left, and forward and backward decline occurred the earliest. For patients in stage III, right was the only direction with no significant difference from controls. In stage IV patients, the limit of stability declined significantly in all directions ( p < 0.05 ). Conclusions. The postural abnormalities of Parkinson’s disease can occur at early stages, and the pattern of decline is more severe in the forward-backward direction. This trial is registered with ChiCTR1900022715.