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Background & Objective: Acute Promyelocytic Leukemia (APL) is a medical emergency with potentially fatal complications. APL primarily results from a chromosomal translocation (t(15;17)(q22;q21)), leading to the formation of the PML-RARA fusion gene with three possible isoforms. This study aims to investigate the characteristics of Iranian APL patients, the distribution of PML-RARA isoforms, and survival analysis. Methods: We included 145 consecutive eligible patients in this study. Data were collected through archived documents and phone inquiries, following consent. Subsequently, we analyzed the data using SPSS software version 26.0. Results: We examined 75 men and 70 women, with a mean age of 34 years (range: 2-78 years). Besides t(15;17) (q22;q21), 45.6% had other chromosomal abnormalities. The prevalence of bcr1 and bcr3 isoforms was 73% and 27%, respectively. bcr3 correlated with higher white blood cell (WBC) counts, additional chromosomal abnormalities, and faster Complete Hematologic Response (CHR). Early death occurred in approximately 36% of all patients. The mean overall survival time was 73.5 months, with 120-month survival rates of 53.8% for all patients and 83.9% for those who achieved CHR. Univariate analysis identified old age, relapse, lower platelet (PLT) counts, higher WBC counts, and leukocytosis as survival risk factors. However, in multivariate analysis, only old age and higher WBC counts were identified as adverse prognostic factors. Conclusion: In Iranian APL patients, bcr1 predominates, while bcr3 correlates with higher WBC counts, high-risk categorization, additional chromosomal abnormalities, and faster CHR. Survival is negatively impacted by old age, relapse, lower PLT counts, higher WBC counts, and leukocytosis.
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BACKGROUND: Today, with the progress of medical sciences, increasing the cure probability and survival time is an important goal of cancer treatment. This study compared long-term disease-free survival (DFS) of non-metastatic breast cancer patients based on different molecular subtypes. METHODS: This retrospective cohort study consisted of 1287 patients diagnosed with breast cancer and treated at Motamed Cancer Institute from 2000 to 2016 and followed up until 2018. Kaplan-Meier curve was fitted to data based on molecular subtypes. Then the semi-parametric mixture cure model was applied to determine the survival and cure probability of molecular subtypes by adjusting clinical and demographic factors. RESULTS: Among 1287 breast cancer patients, 200 (15.5%) cases died. The mean age of patients was 47.00 ± 10.72 years. Women with the HR+/HER2-subtype had the best 5-year survival rate (84.2%), whereas other subtypes had a lower rate as follows: HR+/HER2+ (77.3%), triple-negative (76.5%), and HR-/HER2+ (62.3%). Kaplan-Meier curve calculated a cure rate of about 60% and patients who survived more than 150 months were intuitively considered cured. After adjustment for clinical and demographic variables, the cure probability of HR-/Her2+ patients was substantially lower than HR+/HER2- patients (OR = 0.22), though there were no significant variations in short-term DFS based on molecular subtypes (HR = 0.91). CONCLUSIONS: Our results confirm that the most prevalent breast cancer was HR+/HER2- tumor type which had the best prognosis. It is also concluded that HR-/HER2+ patients had the worst outcomes, with the highest rates of recurrence and metastasis and the lowest overall and disease-free survival rates.
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Breast Neoplasms , Adult , Breast Neoplasms/diagnosis , Disease-Free Survival , Female , Humans , Middle Aged , Prognosis , Retrospective Studies , Survival RateABSTRACT
AIM: This study aims to predict survival rate of gastric cancer patients and identify the effective factors related to it, using artificial neural network model. BACKGROUND: Gastric cancer is the most deadly disease in north and northeast provinces of Iran. A total of 430 patients with gastric cancer who referred to Baghban clinic in Sari, from early November 2006 to late October 2013 were followed. METHODS: A historical cohort of patients who referred to Baghban Clinic, the cancer research center of Mazandaran University of Medical Sciences in Sari, from early November 2006 to late October 2013 was studied. Three groups of variables (demographic, biological and socio-economic) were studied. Survival rate and effective factors on survival time were calculated using Kaplan-Meier methods and artificial neural networks and the best network structure were chosen using the mean square error and ROC curve. All analyses were performed using SPSS v.18.0 and the level of significance was selected α=0.05. RESULTS: In this research, the median survival time was 19±2.04 months. The 1 to 5-year survival rates for patients were 0.64, 0.44, 0.34, 0.24 and 0.19, respectively. The percentage of right predictions of the selected network and the area under the ROC curve were 92% and 94%, respectively. According to the results, the type of treatment, metastasis, stage of disease, histology grade, histology type and the age of diagnosis were effective factors on survival period. CONCLUSION: the 5 years survival rate of gastric cancer patients in Mazandaran is lower than other provinces which could be due to the delay in diagnosis or patient's referral. Therefore, the use of screening methods and early diagnosis could be influential for improving survival rate of these patients.
