Addition of N-terminal pro-B natriuretic peptide to soluble fms-like tyrosine kinase-1/placental growth factor ratio > 38 improves prediction of pre-eclampsia requiring delivery within 1 week: a longitudinal cohort study.

OBJECTIVE: Short-term prediction of pre-eclampsia (PE) using the soluble fms-like tyrosine kinase-1 (sFlt-1)/placental growth factor (PlGF) ratio is characterized by frequent false-positive results. As such, no treatment can be recommended to test-positive patients and multiple measurements are often required. The aim of this study was to evaluate the effectiveness of N-terminal pro-B natriuretic peptide (NT-proBNP), uric acid and the sFlt-1/PlGF ratio for prediction of delivery with PE within 1 week in singleton pregnancies with suspected PE and sFlt-1/PlGF ratio > 38. METHODS: This was a longitudinal prospective cohort study of singleton pregnancies presenting at 24 + 0 to 36 + 6 weeks of gestation with clinically suspected PE and sFlt-1/PlGF ratio > 38, enrolled between January 2015 and June 2017. Multiple samples per patient were allowed but were restricted to one sample per gestational week. From 495 enrolled patients, 270 blood samples from 134 patients were ultimately analyzed. By using generalized estimating equations (GEE), the best-fit model was selected for prediction of delivery with PE within 1 week. The predictive value of this model was then assessed using area under the paired-ROC curve (AUC) analysis. RESULTS: The best-fit model included the sFlt-1/PlGF ratio, NT-proBNP and the gestational week at the time of the measurement. This combined model was compared with the GEE model based on the sFlt-1/PlGF ratio and the gestational week at the time of the measurement (reduced model). The AUC for the combined model was 0.845 (95% CI, 0.787-0.896), which was significantly greater (P = 0.011) than that of the reduced model (0.786 (95% CI, 0.722-0.844)). CONCLUSION: The addition of NT-proBNP assessment improves the short-term prediction of delivery as a result of PE compared with sFlt-1/PlGF ratio alone, when the sFlt-1/PlGF ratio is > 38. This finding should be considered in future research on the assessment of short-term risk of delivery as a result of PE. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Carcinoma of the parotid gland: developing prognostic indices.

Prognosis for parotid carcinomas is not-well defined. The authors have developed models that could be useful to define subgroups of patients with differential risks. Clinical and pathological variables, and immunohistochemically studied MMP-7, MMP-9, MT1-MMP, and VEGF proteins were analysed in 42 patients with parotid gland cancer, regarding disease-specific survival and loco-regional recurrence. A prognostic index (PI) was calculated by combining age, disease stage, squamous cell carcinoma histology, and vascular endothelial growth factor immunoexpression. Based on the values of this PI, patients were classified into three groups: 1.89-4.18 (SPI1); 4.2-7 (SPI2), and >7 (SPI3). Corresponding 5-year survival rates for these groups of patients were of 89%, 47%, and 21%, respectively. Regarding loco-regional recurrence three different patient groups were calculated combining three factors: T, N and grade. Differences amongst them were statistically significant and the estimated hazard ratios were 6.4 and 24.2 for intermediate and poor prognosis, respectively, taking the good prognostic group as reference. The authors identified several significant prognostic factors and they propose two PIs for disease-specific survival and for loco-regional recurrence. They allow for the calculation of death risk and recurrence for a given patient, providing a practical system for clinical use.

Expression of MMP-7 and MT1-MMP in oral squamous cell carcinoma as predictive indicator for tumor invasion and prognosis.

BACKGROUND: Squamous cell carcinoma of the oral cavity is a highly invasive neoplasm that spreads locally and metastasizes to regional lymph nodes. This process involves multiple proteolytic enzymes including matrilysin (MMP-7) and membrane type I-matrix metalloproteinase (MT1-MMP). This study was designed to explore the association between MMP-7 and MT1-MMP in the invasiveness and prognosis of oral squamous cell carcinoma (OSCC). METHODS: About 4-microM, formalin-fixed, paraffin-embedded tissue sections from 69 patients with OSCC were immunohistochemically studied using specific antibodies against MMP-7 and MT1-MMP proteins. Immunostaining was semiquantitatively scored, and results were correlated with histologic and clinical variables including clinical behavior and survival. RESULTS: MMP-7 was observed only in cancer cells, and MT1-MMP in both tumoral tissue and stroma. MMP-7 expression was significantly correlated with lymph node metastasis (P = 0.03; RR = 3.2). MT1-MMP showed a significant association with TIMP-2 (in N+ cases) and p53 expression (P = 0.01). MMP-7 and MT1-MMP displayed a survival relevance, and in multivariate analysis they were independent prognostic indicators, particularly in neck node-positive cases.