Relationship between lung immune prognostic and the prognosis of locally advanced non-small cell lung cancer treated with radiochemotherapy / 中华放射医学与防护杂志

Objective:To investigate the relationship between lung immune prognostic index (LIPI) and the prognosis of locally advanced non-small cell lung cancer (LA-NSCLC) treated with radiochemotherapy.Methods:A retrospective analysis was conducted for the clinical data of LA-NSCLC patients who received radiochemotherapy in the Affiliated Cancer Hospital of Zhengzhou University from 2013 to 2019. According to the hematologic test result of the derived neutrophil-to-lymphocyte ratio (dNLR) and the lactate dehydrogenase (LDH), the patients were divided into three groups according to their LIPI scores, namely the good-LIPI group with dNLR ≤ 3 and LDH ≤ upper limit of normal (ULN), moderate-LIPI group with dNLR >3 or LDH > ULN, and poor-LIPI group with dNLR >3 and LDH > ULN. Moreover, the overall survival (OS) and the progression-free survival (PFS) were calculated using the Kaplan-Meier method, the Log-rank test, and the Cox regression model.Results:A total of 238 patients were enrolled, and their median follow-up time was 37.1 months, median PFS 16.1 months, and median OS 30.6 months. The OS and PFS of the poor-LIPI group were significantly worse than those of the good- and moderate-LIPI groups ( χ2= 9.04, 2.88, P<0.05). The univariate analysis showed that the factors influencing OS included gender, pathological type, epidermal growth factor receptor (EGFR) mutations, and LIPI ( χ2=6.10, 13.66, 10.58, 9.04, P<0.05), and the PFS was only affected by the LIPI ( χ2=2.88, P = 0.03). Multivariate analysis suggested that EGFR mutations and LIPI were independent prognostic markers for OS ( HR = 1.31, 1.36; 95% CI: 1.03-1.67, 1.05-1.76; P<0.05). Conclusions:The LIPI is a potential prognostic indicator of radiochemotherapy in LA-NSCLC, and this result should be further confirmed by prospective studies.

Índice pronóstico de bajo peso al nacer / Prognostic index of low weight at birth

RESUMEN Introducción: diversos son los factores mancomunados a un mayor riesgo de recién nacidos con bajo peso al nacer en gestantes. Objetivos: aplicar y validar un índice pronóstico para la estratificación de riesgo de recién nacidos con bajo peso al nacer. Material y métodos: se realizó un estudio observacional de corte longitudinal, prospectivo o de cohortes en gestantes atendidas en el área de salud del municipio de Guanabacoa, en el período comprendido desde el 1º de enero de 2016 hasta el 31 de diciembre del 2019, para aplicar un índice pronóstico de bajo peso al nacer, con elementos clínicos. Mediante la función de regresión logística apreciada se calcularon las probabilidades de bajo peso al nacer en la muestra de estimación, y esa distribución empírica fue fragmentada en terciles para escrutar zonas que permitieran clasificar a las gestantes como de bajo, mediano y alto riesgo de bajo peso. Resultados: el (85,7 %) de las gestantes poseían baja probabilidad de bajo peso al nacer. El 60,4 % de las gestantes estuvieron clasificadas como pacientes con una alta probabilidad de bajo peso al nacer, y la mayoría de los pacientes clasificados de riesgo medio con bajo peso al nacer; 11 pacientes no fueron clasificados adecuadamente por el Índice pronostico. Conclusiones: el índice construido mostró eficacia y robustez adecuadas, siendo útil para realizar pronóstico de bajo peso al nacer en gestantes del área de salud (AU).

SUMMARY Introduction: there are many factors associated to a bigger risk for newborns with low weight at birth. Objective: to apply and to validate a prognostic index for the risk stratification in newborns with low weight at birth. Materials and methods: a cohort or prospective, longitudinal, observational study was carried out in pregnant women attending the health area of Guanabacoa municipality in the period from January 1st 2016 until December 31st 2019 to apply a prognostic index of low weight at birth, with clinical elements. Through the appreciated logistic regression function the possibilities of low weight at birth were calculated in the estimation sample, and that empiric distribution was fragmented in tertils to scrutinize zones allowing classifying pregnant women as low, medium and high risk of low weight births. Results: 85.7% of the pregnant women showed low probability of low birth weight. 60.4% of them was classified as patient with a high probability of low birth weight, and most of the patients classified as of medium risk of low birth weight; 11 patients were not adequately classified by the prognostic index. Conclusions: the conformed index showed suitable efficacy and reliability, being useful to carry out prognosis of low weight at birth in pregnant women of the health area (AU).

Utilidad de los índices neutrófilo/linfocito, monocito/linfocito y linfocito/plaqueta para el pronóstico de complicaciones asociadas a COVID-19 / Usefulness of the neutrophil-to-lymphocyte, monocyte-to-lymphocyte and lymphocyte-to-platelet ratios for the prognosis of COVID-19-associated complications

Resumen Introducción: Diversos biomarcadores basados en conteos sanguíneos han sido de utilidad para el pronóstico de los pacientes en estado crítico por COVID-19. Objetivo: Describir la utilidad de los índices neutrófilo/linfocito (INL), monocito/linfocito (IML) y linfocito/plaqueta (IPL) para el pronóstico de la mortalidad y necesidad de soporte ventilatorio por COVID-19. Método: Cohorte retrospectiva de registros clínicos de pacientes con COVID-19 que requirieron atención hospitalaria. Resultados: Se analizaron 125 casos, la edad media fue de 51 años y 60 %, del sexo masculino; 21.6 % padecía diabetes mellitus tipo 2 y 18.4 %, hipertensión. La media de leucocitos fue 9.5 × 103/mL y la de neutrófilos, de 8.0 × 103/mL. La media del INL fue de 12.01; del IML, de 0.442 y del IPL, de 373.07. Respecto al área bajo la curva se registraron los siguientes valores en cuanto a mortalidad: INL, 0.594; IML, 0.628 e ILP, 0.505; en cuanto a ventilación mecánica: INL, 0.581; IML, 0.619 e ILP, 0.547. En el análisis univariado, INL > 13 (RM = 2.750, p = 0.001) e IML > 0.5 (RM = 2.069, p = 0.047) se asociaron a mortalidad; ILP no mostró impacto en la mortalidad ni en el soporte respiratorio. Conclusión: INL e IML son de utilidad para predecir la mortalidad en pacientes con COVID-19.

Abstract Introduction: Various biomarkers based on blood counts have been useful for the prognosis of patients critically ill with COVID-19. Objective: To describe the usefulness of the neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR) and lymphocyte-to-platelet ([LPR) ratios for the prognosis of mortality and ventilatory support requirement for COVID-19. Method: Retrospective cohort of clinical records of patients with COVID-19 who required hospital care. Results: One-hundred and twenty-five cases were analyzed; mean age was 51 years, and 60 % were of the male gender; 21.6 % had type 2 diabetes mellitus, and 18.4 % had hypertension. Mean leukocyte count was 9.5 × 103/mL, with a neutrophil mean of 8.0 × 103/mL. Mean NLR was 12.01, while for MLR it was 0.442, and for LPR, 373.07. Regarding the area under the curve, the following values were recorded for mortality: 0.594 for NLR, 0.628 for MLR and 0.505 for LPR; as for mechanical ventilation, the values were 0.581 for NLR, 0.619 for MLR and 0.547 for LPR. In the univariate analysis, an NLR value > 13 (OR: 2.750, p = 0.001) and an MLR of > 0.5 (OR: 2.069, p = 0.047) were associated with mortality. LPR showed no impact on mortality or respiratory support. Conclusion: NLR and MLR are useful for predicting mortality in patients with COVID-19.

Expressions of tissue factor and vascular endothelial growth factor in diffuse large B-cell lymphoma and their clinical significances / 白血病·淋巴瘤

Objective@#To investigate the expressions of tissue factor (TF) and vascular endothelial growth factor (VEGF) in diffuse large B-cell lymphoma (DLBCL) and their clinical significances.@*Methods@#The clinical data of 80 cases of DLBCL diagnosed at the Second People's Hospital of Lianyungang from January 2010 to December 2017 were collected, and 30 cases of reactive hyperplasia of lymph node (RLN) were selected as the controls. The expressions of TF and VEGF in the two groups were detected by using immunohistochemical staining.@*Results@#The positive rate of TF and VEGF in the DLBCL group was higher than that in the RLN group [TF: 86.3% (69/80) vs. 50.0% (15/30) ; VEGF: 90.0% (72/80) vs. 53.3% (16/30) ; both P < 0.01]. And there was a positive correlation between the expression of TF and VEGF (r = 0.704, P < 0.05). There was no significant difference in the positive rates of TF and VEGF among the patients with different gender, age and Hans subtypes in DLBCL group (all P > 0.05). The positive rate of TF in DLBCL patients with B symptom, increased LDH, physical status grade ≥2, and extranodal lesion number >1 was higher (all P < 0.05). The positive rate of VEGF in patients with Ann Arbor stage Ⅲ-Ⅳ, B symptom, increased LDH, and extranodal lesion number >1 was higher (all P < 0.05). The positive rate of TF in international prognostic index (IPI) high-risk group was higher than that in low-risk group (P < 0.01); the positive rate of VEGF in IPI high-risk group and middle-high-risk group was higher than that in low-risk group (all P < 0.01). The expressions of TF (r = 0.491, P < 0.01) and VEGF (r = 0.529, P < 0.01) were positively correlated with IPI. The overall survival rates of TF and VEGF low-expression group were higher than those of TF and VEGF high-expression group (both P < 0.05).@*Conclusion@#The expressions of TF and VEGF are highly expressed in DLBCL, which is associated with the IPI. It can provide a reference value in evaluating prognosis of DLBCL.

Predictive value of preoperative albumin-to-fibrinogen ratio for postoperative survival of esophageal squamous cell carcinoma after radical esophagectomy / 中华消化外科杂志

Objective To investigate the predictive value of preoperative albumin-to-fibrinogen ratio (A/F) for postoperative survival of esophageal squamous cell carcinoma after radical esophagectomy.Methods The retrospective cohort study was conducted.The clinicopathological data of 559 patients with esophageal squainous cell carcinoma who underwent radical resection in the Sun Yat-sen University Cancer Center from January 2009 and January 2012 were collected.There were 443 males and 116 females,aged from 53 to 66 years,with an average age of 59 years.Of 559 patients,394 with A/F ＞ 11.14 were in high A/F group,and 165 with A/F ≤ 11.14 were in low A/F group.Levels of plasma albumin and fibrinogen were measured at two weeks before surgery,and patients underwent radical esophagectomy.Observation indicators:(1) clinicopathological characteristics of patients;(2) survival of patients;(3) risk factors analysis of prognosis of patients.Follow-up was conducted by outpatient examination and telephone interview to detect postoperative survival of patients up to November 2018.The overall survival time was from surgery date to date of endpoint events including death or the last follow-up,and the overall disease-free survival time was from surgery date to date of endpoint events including tumor recurrence,tumor-falted death,or the last follow-up.Measurement data with skewed distribution were expressed by M (range).Count data were described as percentage,and comparison between groups was analyzed using chi-square test or Fisher exact probability.Comparison of ordinal data was analyzed by Mann-Whitney U nonparametric test.The survival rate and curve were calculated and drawn by Kaplan-Meier method and the Log-rank test was used for survival analysis.The univariate and multivariate analyses were done using COX proportional hazard model.Results (1) Clinicopathological characteristics of patients:of 559 patients,cases with age ≤ 60 years and ＞ 60 years,cases in T1 stage,T2 stage,T3 stage(depth of tumor invasion)were 246,148,60,79,255 in the high A/F group,and 79,86,5,32,128 in the low A/F group,there were statistically significant differences in the age and depth of tumor invasion between the two groups (x2 =10.127,Z=-3.468,P＜0.05).(2) Survival of patients:559 patients were followed up for 97 months (range,91-103 months).The 5-year overall survival rate and 5-year disease-free survival rate were 55.8％ and 48.7％ in the high A/F group,and 38.8％ and 35.8％ in the low A/F group,respectively,with statistically significant differences between the two groups (x2 =16.501,11.679,P＜0.05).(3) Risk factors analysis of prognosis of patients:results of univariate analysis showed that sex,age,preoperative fibrinogen level,preoperative A/F level,surgical method,depth of tumor invasion,tumor pathological N staging,and postoperative adjuvant therapy were associated with 5-year overall survival rate of esophageal squamous cell carcinoma after radical esophagectomy [hazard ratio (HR) =1.362,1.358,1.421,0.617,0.772,1.490,1.732,1.436,95％ confidence interval (CI):1.010-1.835,1.084-1.700,1.114-1.814,0.487-0.781,0.612-0.973,1.239-1.792,1.552-1.934,1.128-1.829,P＜ 0.05];age,preoperative fibrinogen level,preoperative A/F level,surgical method,depth of tumor invasion,tumor pathological N staging,postoperative adjuvant therapy were associated with 5-year disease-free survival rate of esophageal squamous cell carcinoma after radical esophagectomy (HR=1.248,1.371,0.675,0.740,1.427,1.665,1.606,95％CI:1.006-1.547,1.086-1.732,0.538-0.847,0.592-0.924,1.202-1.695,1.498-1.851,1.275-2.022,P＜ 0.05).Results of multivariate analysis showed that age,preoperative A/F level,surgical method,depth of tumor invasion,and tumor pathological N staging were independent factors for 5-year overall survival rate and 5-year disease-free survival rate of esophageal squamous cell carcinoma after radical esophagectomy (HR=1.491,0.699,0.741,1.353,1.761,95％CI:1.184-1.877,0.550-0.888,0.587-0.935,1.120-1.634,1.573-1.971,P＜0.05;HR=1.372,0.760,0.703,1.281,1.692,95％CI:1.100-1.711,0.603-0.957,0.562-0.880,1.074-1.527,1.518-1.887,P＜0.05).Conclusion Preoperative A/F level has a good predictive value for survival of esophageal squamous cell carcinoma after radical esophagectomy,and preoperative A/F level ≤ 11.14 is a independent risk factor for 5-year overall survival rate and 5-year disease-free survival rate of esophageal squamous cell carcinoma after radical esophagectomy.

Exercise Training Improves Heart Rate Recovery after Exercise in Hypertension

Abstract Aim: This study tested the hypothesis that: 1- the exercise training would improve the heart rate recovery (HRR) decline after maximal exercise test in hypertensive patients and; 2- the exercise training would normalize HRR decline when compared to normotensive individuals. Methods: Sixteen hypertensive patients were consecutively allocated into two groups: Exercise-trained (n = 9, 47±2 years) and untrained (n = 7, 42±3 years). An exercise-trained normotensive group (n = 11, 41±2 years) was also studied. Heart rate was evaluated by electrocardiogram. The autonomic function was evaluated based on heart rate changes on the first and the second min of recovery after the maximal exercise test. Exercise training consisted of three 60-minute exercise sessions/week for 4 months. Results: In hypertensive patients, exercise training significantly increased the HRR decline in the first (-19±2 vs. -34±3 bpm, P = 0.001) and second (-33±3 vs. -49±2 bpm, P = 0.006) minutes after the maximal exercise test. In addition, after exercise training, the initial differences in the HRR decline after exercise between hypertensive patients and normotensive individuals were no longer observed (first minute: -34±3 vs. -29±3 bpm, P = 0.52, and second minute: -49±2 vs. -47±4 bpm, P = 0.99). Conclusion: Hypertension causes a delay in HRR after the maximal exercise test yet the exercise training normalizes HRR during the post-exercise period in hypertensive patients.

Immunohistochemical evaluation of lymphovascular invasion in carcinoma breast with CD34 and D2-40 and its correlation with other prognostic markers

Background: Carcinoma breast is ever-evolving and becoming increasingly prevalent in India. Numerous prognostic factors based on morphology and immunohistochemistry (IHC) have been established which need to be interconnected to give patients best possible treatment. Aims: This study aims to confirm and analyze lymphovascular invasion (LVI) detected by hematoxylin and eosin (H and E) using IHC with CD34 and D2-40 and its correlation with other biologic and morphologic prognostic markers. Settings and Design: This was a prospective study. Materials and Methods: Fifty mastectomy specimens diagnosed as infiltrating ductal carcinoma breast on histopathology selected for the study. Evaluation of formalin-fixed paraffin-embedded sections was done using H and E and IHC for estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 HER2/neu receptors, CD34, and D2-40 endothelial markers. Correlation of LVI done with prognostic markers of Carcinoma Breast, namely, age of the patient, tumor size, Nottingham grade, lymph node ratio (LNR), Nottingham prognostic index (NPI), ER/PR status, and HER2/neu status. CD34 and D2-40 utilized to distinguish blood vessel, lymph vessel, and retraction artifacts and to calculate lymphatic microvessel density (LMVD) and blood microvessel density (BMVD). Statistical Analysis Used: SPSS Software Package. Results: LVI was associated with younger age (P = 0.001), greater tumor size (P = 0.007), higher Nottingham grade (P = 0.001), higher LNR (P = 0.001), higher NPI (P = 0.001), Negative ER Status (P = 0.001), Negative PR Status (P = 0.002), Positive HER2/neu status (P = 0.021), Higher Intratumoral BMVD (P = 0.016), Peritumoral BMVD (P = 0.001), and Intratumoral LMVD (P = 0.009). Blood vessels more commonly invaded than lymph vessels. Retraction artifacts can be mistaken for LVI without IHC. Conclusions: D2-40 is a promising marker for lymphatic endothelium. LVI is a poor prognostic marker hence should be evaluated imperatively in all cases of carcinoma breast.

A novel prognostic index for oral cancer in Fujian province / 中华流行病学杂志

Objective To explore the survival factors and construct a prognostic index (PI) for oral squamous cell carcinoma (OSCC).Methods From January 2004 to June 2016,a total of 634 patients with pathologically confirmed OSCC were recruited in a hospital of Fujian.The clinical and follow-up data of all the patients with pathologically confirmed OSCC were collected to identify the factors influencing the prognosis of OSCC.All the patients were randomly divided into two groups:modeling group (modeling dataset,n =318) and validation group (validation dataset,n =316).Randomization was carried out by using computer-generated random numbers.In the modeling dataset,survival rates were calculated using Kaplan-Meier method and compared using the log-rank test.Cox regression model was used to estimate the hazard ratio (HRs) and 95％ confidence intervals (CIs) of prognosis factors.An PI for OSCC patients prognostic prediction model was developed based onβ value of each significant variable obtained from the multivariate Cox regression model.Using the tertile analysis,patients were divided into high-risk group,moderate-risk group,and low-risk group according to the PI,the Akaike information criterion (AIC) and Harrell's c-statistic (C index) were used to evaluated the model's predictability.Results Results from the multivariate Cox regression model indicated that aged ≥55 years (HR=2.22,95％ CI:1.45-3.39),poor oral hygiene (HR=2.12,95％ CI:1.27-3.54),first diagnosis of lymph node metastasis (HR=5.78,95％CI:3.60-9.27),TNM stage Ⅲ-Ⅳ (stage Ⅰ as reference) (HR=2.43,95％CI:1.10-5.37) and poor differentiation (well differentiation as reference) (HR=2.53,95％CI:1.60-4.01) were the risk factors influencing the prognosis of OSCC.The PI model had a high predictability in modeling group and validation group (AIC and C index were 1 205.80,0.700 2 and 1 150.47,0.737 3).Conclusion Age,poor oral hygiene,first diagnosis of lymph node metastasis,TNM stage and histological grade were factors associated with the prognosis of OSCC,and the PI model has a certain significance in the clinical treatment of OSCC.

The prognostic value of the international prognostic index, the national comprehensive cancer network IPI and the age-adjusted IPI in diffuse large B cell lymphoma / 中华血液学杂志

Objective@#To explore the prognostic value of the international prognostic index (IPI), the national comprehensive cancer network IPI(NCCN-IPI)and the age-adjusted IPI (aa-IPI) in diffuse large B cell lymphoma.@*Methods@#A total of 311 patients with de novo diffuse large B-cell lymphoma (DLBCL) diagnosed from 2003 to 2012 in Nanfang hospital were included. All patients were divided into CHOP (cyclophosphamide, vincristine, doxorubicin, and prednisone) and R-CHOP (rituximab, CHOP) groups. Survival analysis was compared among IPI, NCCN-IPI and aa-IPI models. Discrimination of three different prognostic models was assessed using the Harrell’s C statistic.@*Results@#A total of 311 patients were analyzed. Among them, 128 patients were treated with CHOP regimen and other 183 patients were treated with R-CHOP regimen. In CHOP groups, both NCCN-IPI (5-year OS: 59.7% vs 26.8%, P<0.001) and aa-IPI (5-year OS: 71.0% vs 25.0%, P<0.001) showed better risk stratification for low-intermediate and high-intermediate group than the IPI (5-year OS: 47.6% vs 36.6%, P=0.003). However, in the patients treated with R-CHOP, NCCN-IPI showed better risk stratification in low, low-intermediate, high-intermediate groups (5-year OS: 96.0% vs 83.0% vs 66.5%, P=0.009). According to the Harrell’s C statistic, C-index of IPI, NCCN-IPI and aa-IPI for overall survival (OS) were 0.546, 0.667, 0.698 in CHOP group and 0.611,0.654, 0.695 in R-CHOP group respectively. In patients younger than 60 years old, C-index of IPI, NCCN-IPI and aa-IPI for OS were 0.534, 0.675, 0.698 in CHOP group and 0.584, 0.648, 0.695 in R-CHOP respectively.@*Conclusion@#The NCCN-IPI is more powerful than IPI and aa-IPI in DLBCL patients receiving R-CHOP. aa-IPI is a preferable model in predicting prognosis than IPI and NCCN-IPI in anthracycline-based chemotherapy without rituximab.

A novel prognostic index for oral cancer in Fujian province / 中华流行病学杂志

Objective To explore the survival factors and construct a prognostic index (PI) for oral squamous cell carcinoma (OSCC).Methods From January 2004 to June 2016,a total of 634 patients with pathologically confirmed OSCC were recruited in a hospital of Fujian.The clinical and follow-up data of all the patients with pathologically confirmed OSCC were collected to identify the factors influencing the prognosis of OSCC.All the patients were randomly divided into two groups:modeling group (modeling dataset,n =318) and validation group (validation dataset,n =316).Randomization was carried out by using computer-generated random numbers.In the modeling dataset,survival rates were calculated using Kaplan-Meier method and compared using the log-rank test.Cox regression model was used to estimate the hazard ratio (HRs) and 95％ confidence intervals (CIs) of prognosis factors.An PI for OSCC patients prognostic prediction model was developed based onβ value of each significant variable obtained from the multivariate Cox regression model.Using the tertile analysis,patients were divided into high-risk group,moderate-risk group,and low-risk group according to the PI,the Akaike information criterion (AIC) and Harrell's c-statistic (C index) were used to evaluated the model's predictability.Results Results from the multivariate Cox regression model indicated that aged ≥55 years (HR=2.22,95％ CI:1.45-3.39),poor oral hygiene (HR=2.12,95％ CI:1.27-3.54),first diagnosis of lymph node metastasis (HR=5.78,95％CI:3.60-9.27),TNM stage Ⅲ-Ⅳ (stage Ⅰ as reference) (HR=2.43,95％CI:1.10-5.37) and poor differentiation (well differentiation as reference) (HR=2.53,95％CI:1.60-4.01) were the risk factors influencing the prognosis of OSCC.The PI model had a high predictability in modeling group and validation group (AIC and C index were 1 205.80,0.700 2 and 1 150.47,0.737 3).Conclusion Age,poor oral hygiene,first diagnosis of lymph node metastasis,TNM stage and histological grade were factors associated with the prognosis of OSCC,and the PI model has a certain significance in the clinical treatment of OSCC.

Relationship Between Dual Time Point FDG PET/CTand Clinical Prognostic Indexes in Patients with High Grade Lymphoma: a Pilot Study / 대한핵의학회잡지

PURPOSE: This study investigated the correlative relationship between metabolic parameters estimated from dual time point 2-deoxy-2-[¹⁸F] fluoro-D-glucose (¹⁸F-FDG) positron emission tomography/computerized tomography (PET/CT) and the clinical tools predicting the outcome of a lymphoma. We also measured metabolic and volumetric alterations between early and delayed ¹⁸F-FDG PET/CT in patients with high grade lymphoma (HGL).METHODS: The samples were 122 lymph nodes and extralymphatic lesions from 26 patients diagnosed with HGL. All patients were applied to the International Prognostic Index (IPI), Ann Arbor stage, and revised IPI as clinical prognostic parameters. ¹⁸F-FDG dual time point PET/ CT (DTPFP) consisted of an early scan 1 h after ¹⁸F-FDG injection and a delayed scan 2 h after the early scan. Based on an analysis of DTPFP, we estimated the standardized uptake value (SUV) of tumors from the early and delayed scans, retention index (RI) representing the percentage change between early and delayed SUV, and metabolic volume different index (MVDI) calculated using metabolic tumor volumes (MTV).RESULTS: RI(max) showed a multiple positive correlative relationship with stage and IPI in lesion-by-lesion analysis (p < 0.01). In the case of IPI, the high risk group exhibited higher RI(max) than the low risk group (p = 0.004). In the case of revised IPI, the RI(max) of the low risk group were significantly lower than the intermediate and high risk groups, respectively (p < 0.01). The MVDIs of the best outcome group were decreased in comparison to the moderate outcome group (p = 0.029). There was a significant negative correlative relationship between RI(max) and MVDI, and the inclinations for decreased MVDIs were slightly associated with increased RIs.CONCLUSIONS: RI(max) extracted from DTPFP had a significant relationship to extranodal involvement, staging, IPI, and revised IPI. MVDI showed significant negative correlation with RI(max). Further large scale studies are warranted to support and extend these preliminary results.

Prognostic significance of NCCN-International Prognostic Index (NCCN-IPI) for patients with peripheral T-cell lymphoma treated with CHOP-based chemotherapy / 中华血液学杂志

Objective@#To validate the prognostic value of NCCN-International Prognostic Index (NCCN-IPI) for patients with peripheral T-cell lymphoma (PTCL) treated with CHOP-based chemotherapy.@*Methods@#A retrospective analysis in 162 PTCL patients who were initially diagnosed and treated in Rui Jin Hospital from January 2003 to May 2013 was conducted. Baseline characteristics were collected, and survival analysis was performed according to the IPI and NCCN-IPI model.@*Results@#The estimated 5-year overall survival (OS) rate and progression free survival (PFS) rate were 33% and 20%, with median OS and PFS of 17.0 months and 9.2 months, respectively. Multivariate analysis indicated ECOG score (PFS: HR=2.418, 95%CI 1.535-3.809, P<0.001; OS: HR=2.347, 95%CI 1.435-3.839, P= 0.001) , specific extra-nodal sites (PFS: HR=1.800, 95%CI 1.216-2.665, P=0.003; OS: HR=1.608, 95% CI 1.054-2.454, P=0.027) and pathology type (PFS: HR=0.424, 95% CI 0.184-0.975, P=0.043; OS: HR=0.276, 95% CI 0.087-0.877, P=0.029) were independent prognostic factors of OS and PFS for the patients with PTCL. The survival rates of low risk patients based on NCCI-IPI were remarkably higher than the counterparts based on IPI (5-year OS 74% vs 54%, χ2=5.041, P=0.025, 5-year PFS 50% vs 38%, χ2= 5.295, P=0.021) . NCCN-IPI was outstanding to identify the subgroup of low risk patients with PTCL, who may benefit from conventional chemotherapy such as CHOP or CHOP-like regimen.@*Conclusion@#NCCN-IPI is more powerful for low risk PTCL patients and a strong supplement for IPI.

Correlation of serum β2-microglobulin expression with the clinical characteristics and prognosis of mantle-cell lymphoma / 肿瘤

Objective: To investigate the correlation of serum β2-microglobulin (β2-MG) with overall survival and mantle-cell lymphoma international prognostic index (MIPI) of patients with mantle-cell lymphoma (MCL). Methods: The clinical data of 61 MCL patients admitted in Tianjin Medical University Cancer Institute and Hospital were retrospectively analyzed. Fisher's exact test was used to analyze the relationship between serum β2-MG level and the clinical features of MCL patients. COX proportional hazards model was used to analyze the influencing factors of prognosis in MCL patients. Results: In total of 61 MCL patients, 35 (57.4%) had abnormal elevation of serum β2-MG. The level of serum β2-MG was significantly associated with clinical stage (P = 0.011), B symptom (P = 0.032), bone marrow (P 2.5 mg/L have a poor overall survival as compared with the pateints with serum β2-MG ≤2.5 mg/L.

A Study on the Usefulness of Prognostic Prediction by Palliative Prognostic Index for Medical Oncology Patients

<p>Object: We validated the adequacy of using Palliative Prognostic Index (PPI) as a prognostic method for medical oncology patients. Method: PPI was measured for patients with advanced cancer admitted to our department from May 2015 to June 2016.Result: There were 45 patients analyzed. When classified into three groups according to the score of PPI, there was a tendency for survival curves to separate according to risk. Especially, there was a statistical difference in survival time between the high-risk group (PPI: ≥6.5) and the low-risk group (PPI: ≤4.0) (median survival time: 11 days vs 39 days, p=0.0048, HR: 2.75, 95%CI: 1.32-5.84). Prognostic accuracy of the PPI≥6.5 is similar to other reports. There is no difference in the accuracy of the prognostic prediction depending on the period from drug therapy to PPI evaluation. It was suggested that the influence of drug therapy on PPI evaluation is small. Discussion: We showed that it is appropriate to use PPI for the prognostic prediction of medical oncology patients.</p>

Development of Biological Prognostic Score Versions 2 and 3 for Advanced Cancer Patients and a Prospective Study on the Prediction Accuracy: Comparison with the Palliative Prognostic Index

<p>Objectives: We developed versions 2 and 3 of the Biological Prognostic Score (BPS) for advanced cancer patients and confirmed the prediction accuracy. Methods: We conducted a parametric survival analysis using blood test data, performance status (PS), clinical symptoms, age, sex, and cancer type as variables for advanced cancer patients who completed or suspended cancer treatment, in the development of BPS2 and BPS3. We then prospectively compared the accuracy between BPS2/BPS3 and the Palliative Prognostic Index (PPI). Results: We developed the BPS2 and BPS3 based on the data from 589 patients in a development cohort. While the former version was calculated based on the cholinesterase, blood urea nitrogen, and white blood cell counts, the latter was calculated based on the BPS2, ECOG PS and edema. For 206 patients in a validation cohort, the overall accuracy in prediction of survival for 3 and 6 weeks using the BPS2 and BPS3 were significantly higher than those for the PPI. Conclusion: The usefulness of BPS2 and BPS3 was suggested.</p>

Relevance of prognostic index with β2-microglobulin for patients with diffuse large B-cell lymphoma in the rituximab era

BACKGROUND: The International Prognostic Index (IPI) has been a useful tool for predicting the prognosis of aggressive non-Hodgkin lymphoma in the last 20 years. Herein, we aimed to develop a new prognostic model for diffuse large B-cell lymphoma (DLBCL) in the rituximab era. METHODS: Between March 2004 and June 2012, patients with DLBCL treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone chemotherapy regimen were identified in the database of the Asan Medical Center (AMC) Lymphoma Registry. The primary and secondary endpoints were a new prognostic index for DLBCL and validation of the National Comprehensive Cancer Network-International Prognostic Index in our cohort, respectively. RESULTS: The AMC cohort comprised 621 patients. The median follow-up duration was 43.3 months (range, 6.2–122.5 mo). Univariate analysis revealed that age (≤60 vs. >60 yr), lactate dehydrogenase (LDH; within normal vs. increased), Eastern Cooperative Oncology Group performance status (ECOG PS; 0 or 1 vs. ≥2), advanced stage (Ann Arbor stage I/II vs. III/IV), extra-nodal involvement (≤1 vs. >1), B symptoms (no vs. yes), and beta-2 microglobulin (β2MG, ≤2.5 vs. >2.5) can be used to predict overall survival (OS). In multivariate analysis, only age, LDH, ECOG performance status, and β2MG were significantly associated with OS, and we developed a new prognostic model with these 4 factors. The new prognostic model showed better discriminative power compared with the classic IPI. CONCLUSION: Our new prognostic index model for DLBCL in the rituximab era has good discriminative power and is convenient to use.

Aplicación de un índice pronóstico de mortalidad en pacientes con insuficiencia cardiaca aguda / Application of a Prognostic Index of Mortality in Patients with Acute Heart Failure

Introducción: muchos son los factores asociados a un mayor riesgo de morir en los pacientes con insuficiencia cardiaca aguda. Objetivos: aplicar y validar un índice pronóstico para la estratificación de riesgo en pacientes con insuficiencia cardiaca aguda. Métodos: se realizó un estudio de cohorte en pacientes atendidos con el diagnóstico de insuficiencia cardiaca aguda en la Unidad de Cuidados Intermedios del Hospital Universitario Miguel Enríquez, para aplicar un índice pronóstico de mortalidad basado, fundamentalmente, en elementos clínicos. Mediante la función de regresión logística estimada se calcularon las probabilidades de morir en la muestra de la estimación, y esa distribución empírica fue dividida en terciles para buscar zonas que permitieran clasificar a los pacientes como de bajo, mediano y alto riesgo de fallecer (índice pronóstico). Resultados: el 58,3 por ciento de los egresados vivos fueron clasificados como de bajo riesgo, y 52,5 por ciento de los fallecidos fueron adecuadamente clasificados como de elevado riesgo; solo el 7,5 por ciento de los pacientes de este grupo fueron mal clasificados por el modelo pronóstico. Conclusiones: el índice construido mostró validez y consistencia adecuadas, es útil para realizar predicción del pronóstico de mortalidad en pacientes con insuficiencia cardiaca aguda(AU)

Introduction: Many factors are associated with the increased risk of dying in patients with acute heart failure. Objectives: Apply and validate a prognostic index for risk stratification in patients with acute heart failure. Methods: A cohort study was performed in patients treated with the diagnosis of acute heart failure in the Intermediate Care Unit at Miguel Enríquez University Hospital, in order to apply a prognostic index of mortality based, mainly, on clinical elements. The estimated logistic regression function calculated the probabilities of dying in the sample of the estimate, and that empirical distribution was divided into tertiles to search for areas that could be classified as low, medium and high risk of dying (prognostic index). Results: 58.3 percent of the patiets who were alive at discharge were classified as low risk, and 52.5 percent of the deceased were adequately classified as high risk; the prognostic model poorly classified only 7.5 percent of the patients in this group. Conclusions: The produced index showed adequate validity and consistency, it is useful to predict the prognosis of mortality in patients with acute heart failure(AU)

Diseño y validación de un índice pronóstico de muerte de la neumonía adquirida en la comunidad / Design and validation of death prognosis rate of community-acquired pneumonia

Introducción: la neumonía adquirida en la comunidad constituye un motivo frecuente de consulta médica y es causa de elevadas morbilidad y mortalidad en el adulto, pero la decisión de ingresar a un paciente se basa en el empleo de escalas pronósticas que no siempre se ajustan a un contexto geográfico en particular. Objetivo: diseñar y validar un índice, basado en factores pronósticos que permita predecir el riesgo de morir en adultos mayores de 18 años con diagnóstico de neumonía adquirida en la comunidad. Métodos: se realizó el diseño y la validación de un índice pronóstico de muerte de la neumonía adquirida en la comunidad, mediante un estudio de cohorte, para determinar el riesgo de morir en pacientes que ingresaron en los servicios de Medicina Interna y Unidades de Cuidados Intensivos del Hospital General Carlos Manuel de Céspedes, de Bayamo, Granma, desde el 1 de febrero de 2012 hasta el 31 de julio de 2015. Resultados : el factor pronóstico de mayor relevancia fue el estado de choque seguido del derrame pleural, la proteína C reactiva y la neumonía multilobar, todos de forma significativa (p= 0,000). La capacidad de discriminación (área bajo la curva ROC de 0,956) y de calibración del índice (0,493) fueron adecuadas. La validez de construcción, de criterio y confiabilidad y la consistencia interna del índice fueron adecuadas. Discusión: este índice se distingue por su simplicidad y fácil aplicación, incluye solo 8 parámetros clínicos y complementarios que suelen estar a disposición en las unidades asistenciales del país. Los componentes del índice se obtienen a partir de un estudio de cohorte realizado a priori por lo que es posible su aplicación clínica incluso al nivel primario. Conclusión: el índice creado y validado a partir de los factores de riesgo más importantes, permite pronosticar el riesgo de morir a los enfermos con neumonía adquirida en la comunidad, con una confiabilidad adecuada(AU)

Introduction: community-acquired pneumonia is a common reason for medical consultation and causes high morbidity and mortality in adults, but the decision to admit a patient is based on the use of scales prognoses which do not always fit a geographical context in particular. Objective: design and validate an index, based on prognostic factors for predicting the risk of death in adults older than 18 years diagnosed with community-acquired pneumonia. Methods: the design and validation was made for death prognostic index of community-acquired pneumonia, by a cohort study to determine the risk of death in patients admitted to the Internal Medicine and Intensive Care Units of Carlos Manuel de Céspedes General hospital, Bayamo, Granma, from February 1, 2012 to July 31, 2015. Results: the most important prognostic factor was the shock followed by pleural effusion, C-reactive protein and multilobar pneumonia, all significantly (p = 0.000). The ability of discrimination (area under ROC curve 0.956) and calibration index (0.493) were adequate. The validity of construct, criterion, and reliability were adequate as well as the internal consistency index. Discussion: this index is distinguished by its simplicity and easy application; it includes only 8 clinical parameters and complementary studies which are often available in Cuban health care units. The index components are took from a priori cohort study so its clinical application is possible even at the primary level. Conclusion: the index created and validated from the most important risk factors can fairly predict the dying risk of patients with community-acquired pneumonia(AU)

The prognostic signiifcance of peripheral blood ALC/AMC in follicular lymphoma patients treated with R-CHOP-like chemotherapy / 中国癌症杂志

Background and purpose:The prognostic capability of traditional prognostic index like follicular lymphoma international prognostic index (FLIPI) is limited in the rituximab era. This study was to investigate the prognostic significance of peripheral blood absolute lymphocyte count/absolute monocyte count (ALC/AMC) in Chinese patients with follicular lymphoma (FL).Methods:This study retrospectively analyzed 136 newly diagnosed FL patients who received rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP)-like chemotherapy in Department of Hematology, Ruijin Hospital from Jan. 2003 to Dec. 2013, and further classified these patients according to FLIPI scoring system.Results:According to FLIPI, 61 patients (44.9%) were stratified into the low-risk (0-1 points) group, 42 cases (30.9%) into the intermediate-risk (2 points) group, and 33 cases (24.2%) into the high-risk (3-5 points) group. The overall response rate and 2-year progression-free survival (PFS) of the 3 risk groups were 88.5%, 95.2%, and 78.8% (P=0.090), and 91.4%, 74.6%, and 47.8% (log-rank=23.3,P<0.001), respectively. The overall response rate and 2-year PFS for patients with ALC/AMC≥4.7 and <4.7 were 91.9%, 68.6% (P=0.005) and 96.0%, 69.7% (log-rank=13.0,P<0.001), respectively. In the multivariate study, ALC/AMC≥4.7 was independent of FLIPI and was able to distinguish the FLIPI low-risk and intermediate-risk patients (log-rank=7.535,P=0.006).Conclusion:For FL patients treated with R-CHOP-like regimens, ALC/AMC is a simple and effective biomarker reflecting tumor microenvironment and human immunity, and could be considered for prognosis evaluation.

Correlation of various histopathologic prognostic factors with Nottingham prognostic index and microvessel density in invasive breast carcinoma: A study of 100 cases.

BACKGROUND: Nottingham prognostic index (NPI) is a widely used integrated prognostic variable in patients with breast cancer. NPI has been correlated with tumor size, grade, lymph node stage and patient survival. The present study aimed at evaluating and correlating the various clinical and pathologic features of breast carcinoma with NPI. METHODS: This study included 100 consecutive cases of primary breast carcinoma over a period of 2 years. Demographic data was noted and histomorphological features like tumor size, grade, lymph node involvement, necrosis, vascular invasion etc., were assessed. NPI was calculated as reported in the literature. Immunohistochemical staining for hormone receptors and CD34 (to calculate microvessel density [MVD]) was performed. Statistical analysis was used for correlation. RESULTS: Of the 100 cases, 54% of the tumors were in T2 tumor size category (2‑5 cm) and lymph node metastasis in 48% of the cases. NPI ranged from 2.3 to 7.3 with 54% of the cases in the intermediate NPI group (3.41‑5.4). The mean MVD was 160.93 (±69.4/mm2). On statistical analysis, tumor size and grade, lymph node stage, mitotic rate, nuclear pleomorphism, necrosis and MVD showed a correlation with NPI (P < 0.05). CONCLUSION: NPI is an important and useful prognostic indicator for breast cancer patients, which shows the correlation with other histomorphological prognostic features as well.