Immunopathological prognostic and predictive factors in prostate cancer

Prostate cancer is the leading male malignancy in the Western world. Patients with prostate cancer have an unpredictable clinical course, as three biologically different types of tumor exist. This review summarises some of the recent progress made in understanding the biology of prostate cancer with special reference to the prognostic and predictive role of immunohistochemical markers. The prognostic value of established prognostic variables is also discussed.     

Potential predictive factors of osteoporosis in HIV-positive subjects

Recent reports showed a high frequency of osteopenia/osteoporosis in HIV-infected subjects. Mechanism on the basis of this alteration is still unclear, as the direct effect of virus or of antiretroviral drugs. One hundred sixty-one consecutive HIV-infected outpatients aged 30–50 years, both naive and HAART-treated for >1 year, were included. An interview questionnaire was performed to establish prior pathological, toxic, epidemiological histories, medications intake, physical activity and eating habits. Blood and urinary tests were checked to exclude concomitant diseases, as were markers of bone metabolism and vitamin D3-metabolites. Each subject underwent to a lumbar spine and left hipbone mineral density by DEXA, using WHO criteria for diagnosis of osteopenia/osteoporosis. Radiologist was unaware if the subject was receiving HAART or not. For groups' homogeneity Chi-square, Fisher's exact and Student's t tests were used. Logistic regression analysis was used to find predictors of osteopenia/osteoporosis and linear regression model to find differences in bone mass density. The demographic characteristics of the 48 naive subjects and the 113 on HAART were comparable. Eighty subjects (49.7%) showed osteopenia/osteoporosis: 22 (45.8%) naive and 58 (51.3%) on HAART (P = 0.46). Independent predictors of osteopenia/osteoporosis were female gender (OR: 3.02, 95% CI: 1.26–7.25, P = 0.01 vs. male), older age (OR: 1.10, 95% CI: 1.01–1.20, P = 0.03, for each additional year), low body mass index (OR: 0.78, 95% CI: 0.68–0.91, P = 0.001 for each additional unit) and higher HIV-RNA levels at DEXA (OR: 1.97, 95% CI: 1.16–3.34, P = 0.01 for each additional Log₁₀), whereas the use of HAART (OR: 2.61, 95% CI: 0.66–10.27, P = 0.17 vs. naive) and the alterations of markers of bone metabolism were not significantly related to osteopenia/osteoporosis. Similar findings were obtained using linear regression model analysis. HIV-infected subjects have a high frequency of osteopenia/osteoporosis. Traditional risk factors are predictive of osteopenia/osteoporosis also in HIV-subjects; the association with higher HIV-RNA levels can suggest a direct role of HIV itself in the occurrence of bone disease.     

Prognostic and predictive factors revisited

Standard prognostic factors include clinical and pathological staging, especially lymph node status and tumor size. Tumor grade and estimates of lymphatic invasion appear to be moderately strong predictive factors, but reproducibility is poor, especially for grade 2 tumors. Standard predictive factors include hormone receptor status and HER-2 amplification and/or over-expression for selection of endocrine therapy and, at least for clinical trials and in the metastatic setting, of trastuzumab, respectively. Three new markers appear particularly promising: detection of bone marrow metastases, either at baseline or after 2-4 years of follow-up; expression of UPA/PAI-1 by the primary cancer; and recognition of simultaneous multiple gene expression patterns, or "signatures." Important caveats exist for each of these. Although new technologies offer exciting and promising new approaches to determining a patient's prognosis and whether she will or will not benefit from specific therapies, few have been validated in well-designed, Level of Evidence I studies. In particular, available data are often confounded by patient selection and the effects of systemic therapy, which are often not determined prospectively, not included in analyses, and not reported adequately.     

Restricted structure predictive optimal control

The design of low‐order predictive optimal controllers, that involve a multi‐step cost index and future setpoint knowledge, is considered. The usual predictive controller is of high order and the aim is to develop simpler structures, suitable for applications where PID controllers might be employed. The system is assumed to be represented by a discrete‐time state‐space model, which is very general, and the quadratic cost‐function may include dynamic cost weighting terms. Using this approach, it is straightforward to generate a much lower‐order predictive controller and thereby simplify implementation. Even with a continuing improvement in computational power there are many good reasons why low‐order simple controllers have advantages in real applications. Copyright © 2004 John Wiley & Sons, Ltd.     

Hyperbilirubinemia as a predictive factor in acute appendicitis

Purpose

Our aim was to establish the role of hyperbilirubinemia as a predictive parameter for the prediction of either acute, or gangrenous/perforated appendicitis as well as to compare other parameters in a similar role.

Methods

Medical files of the patients who underwent appendectomies between September 2013 and September 2014 were evaluated. Age, gender, preoperative white blood cell count (WBC), neutrophil count (NEU), neutrophil percentage (NEU%), C-reactive protein (CRP), total/direct/indirect bilirubin levels, and the postoperative histopathological findings were recorded. The Fisher’s exact, Pearson’s χ ², ANOVA, and Kruskal–Wallis tests while logistic regression for multivariate analysis was performed. p < 0.05 was accepted as statistically significant.

Results

The study group of 162 patients consisted of 97 (60 %) men and 65 (40 %) women with a median age of 36 (18–90). Histopathological examinations revealed normal appendix in 21 (13 %) patients, non-complicated acute appendicitis in 100 (62 %), and appendiceal gangrene/perforation in 41 (25 %) patients. WBC, NEU, NEU%, and CRP levels were significantly higher in cases of acute and gangrenous/perforated appendicitis (p < 0.01). Total and direct bilirubin levels were also significantly elevated in patients with acute and gangrenous/perforated appendicitis (p < 0.01). According to multivariate analysis, elevated CRP levels were associated with 14 times, elevated total bilirubin levels were associated with five times, and elevated direct bilirubin levels were associated with 36 times greater risk for appendiceal gangrene/perforation (p < 0.01, p < 0.05, p < 0.01, respectively).

Conclusions

Hyperbilirubinemia, especially with elevated direct bilirubin levels, may be considered as an important marker for the prediction of appendiceal gangrene/perforation.

     

Factors predictive of mortality in pediatric extremity rhabdomyosarcoma

In order to examine factors predictive of fatal outcome in children presenting with histologically confirmed extremity rhabdomyosarcoma, we performed a retrospective analysis of our institutional experience from 1970 to 1985. Thirty-five patients were identified and staged according to international criteria (TNM). Variables evaluated for their predictive effect on fatal outcome included (1) tumor invasiveness, (2) tumor size, (3) anatomic location of the primary, (4) regional lymph node involvement, (5) distant metastases at presentation, (6) complete surgical resection, (7) use of amputation, and (8) alveolar histologic subtype. Significant predictors of mortality included (1) tumor invasiveness (P less than or equal to .0001), (2) regional node involvement (P less than or equal to .0002), (3) distant metastases at the time of presentation (P less than or equal to .001), (4) alveolar histology (P less than or equal to .001), (5) size of primary (P less than or equal to .007), and (6) completeness of surgical resection (P less than or equal to .05). In multivariate analysis, local tumor invasiveness was the most important predictor of fatal outcome with an associated relative risk of 18. We conclude that local tumor invasiveness is the most important determinant of clinical stage.     

Factors predictive of venous thromboembolism in bariatric surgery

Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in bariatric surgery. The aim of this study was to evaluate the effect of patient characteristics, payer type, comorbidities, and surgical techniques on development of VTE in bariatric surgery. Using the National Inpatient Sample (NIS) database from 2006 to 2008, clinical data of 304,515 morbidly obese patients who underwent bariatric surgery were examined. Multiple regression analysis was performed to identify factors predictive of VTE. The overall rate of in-hospital VTE was 0.17 per cent, with the highest rate of VTE observed in open gastric bypass (0.45%). The VTE rate was significantly lower in laparoscopic compared with open gastric bypass (0.13% vs 0.45%, respectively, P < 0.01) and in nongastric bypass compared with gastric bypass procedures (0.06% vs 0.21%, respectively, P < 0.01). Alcohol abuse [odds ratio (OR): 8.7], open operation (OR: 2.5), gastric bypass procedures (OR: 2.4), renal failure (OR: 2.3), congestive heart failure (OR: 2.0), male gender (OR: 1.5), and chronic lung disease (OR: 1.4) were associated with a higher rate of VTE. This study identified several significant risk factors for development of VTE in bariatric surgery. To minimize the risk of VTE, surgeons may consider these factors in selection of appropriate prophylaxis and bariatric surgical options.     

Factors predictive of survival in ampullary carcinoma.

OBJECTIVE: To review the recent Memorial Sloan-Kettering Cancer Center experience with adenocarcinoma of the ampulla of Vater and to identify clinicopathologic factors that have an impact on patient survival. SUMMARY BACKGROUND DATA: The prognosis for patients with tumors of the ampulla of Vater is improved relative to other periampullary neoplasms. Identification of independent prognostic factors in ampullary tumors has been limited by small numbers of tumors and a lack of pathologic review. METHODS: Data were collected prospectively for patients presenting with periampullary carcinomas to the Memorial Sloan-Kettering Cancer Center between October 15, 1983 and June 30, 1995. The correlation between clinicopathologic variables and survival of ampullary carcinoma was tested by the Kaplan-Meier method and log-rank test, and Cox proportional hazards regression. Survival of patients with periampullary adenocarcinomas was compared by the Kaplan-Meier method. RESULTS: In 123 patients presenting with ampullary carcinoma, 101 tumors (82.1%) were resected. Factors significantly correlated with improved survival were resection (p < 0.01), and in resected tumors, negative nodes (p = 0.04) and margins (p = 0.02) independently predicted for improved survival. In periampullary tumors, the highest rates of resection and overall survival (median, 43.6 months) were found in ampullary carcinomas. CONCLUSIONS: Factors predictive of improved survival in ampullary carcinoma include resection, negative margins, and negative nodes. Improved overall survival in ampullary relative to periampullary adenocarcinoma is due in part to a significantly higher rate of resection.     

The predictive value of microalbuminuria

An elevated urinary albumin excretion (termed microalbuminuria) has been proposed as a predictor for later development of clinical diabetic nephropathy (hypertension, falling glomerular filtration rate [GFR], and urinary albumin excretion greater than 300 mg/24 h). However, review of the original reports on the predictability of microalbuminuria revealed a concomitant presence of elevated BP and a propensity to falling GFR. Thus, the predictability of microalbuminuria rests on the added evaluation of BP and GFR. Additional investigation is needed to address the possibility that microalbuminuria and either a rising BP or a falling GFR or both indicates established diabetic nephropathy rather than predicting its development.     

腹腔镜预测指数与晚期卵巢癌患者一期切除结果的一致性及预测价值

目的:分析腹腔镜预测指数值(PIV)与晚期卵巢癌患者一期切除结果的一致性及预测价值。方法:选取2016年6月至2019年2月诊断并治疗的98例晚期卵巢癌患者作为研究对象,患者均行腹腔镜检查,并计算PIV,如果PIV<8分,则行初始肿瘤减灭术;如PIV≥8分,则行新辅助化疗。对比腹腔镜PIV与晚期卵巢癌初期肿瘤减灭术PIV结果的一致性,分析腹腔镜PIV对R0/R1切除状态的预测价值,并应用Logistic回归分析影响腹腔镜PIV预测符合率的独立危险因素。结果:腹腔镜PIV与晚期卵巢癌初期肿瘤减灭术PIV具有较好的一致性(Kappa=0.898);腹腔镜PIV<8分对初次肿瘤减灭术R0切除状态具有预测价值;单因素Logistic回归分析显示,肠系膜回缩(OR=6.630,P=0.003)、大网膜饼侵犯胃大弯(OR=5.719,P=0.007)、肠道浸润(OR=4.880,P=0.016)为影响腹腔镜PIV预测符合率的相关因素,而膈肌转移、肝脏转移、腹膜转移无明显相关性;多因素Logistic回归分析结果显示,肠系膜回缩(OR=4.907,P=0.020)、大网膜饼侵犯胃大弯(OR=4.553,P=0.030)、肠道浸润(OR=4.901,P=0.023)是影响腹腔镜PIV预测符合率的独立危险因素(P<0.05)。结论:腹腔镜PIV与晚期卵巢癌患者一期切除的结果具有一致性,且对初次肿瘤减灭术切除状态具有预测价值。     

Use of nomograms as predictive tools in bladder cancer

Bladder cancer is a common genitourinary malignancy that demonstrates a great variation in risk of tumor recurrence and progression following treatment. The dramatic differences in clinical behavior dictate vastly differing treatments, which may range from simple surveillance to combination radical surgery with systemic chemotherapy. For non-muscle invasive bladder cancer prediction of the risk of recurrence and progression is necessary to assess the need for intravesical therapy and possible early cystectomy. In contrast, prediction of advanced disease response to primary treatment such as cystectomy and the response to systemic chemotherapy plays an important role in treatment assignment for patients with muscle invasive disease. To estimate these risk traditional risk grouping schemes such as the present TNM staging system has been used to guide patient treatment. More recently, improved prognostic tools such as nomograms have been developed to provide a more accurate assessment of outomes. Clinicians are enthusiastically working to utilize these statistical methods in bladder cancer. We summarize the current status of outcome predictive models for bladder cancer; and focus particularly on the ability of nomograms to predict disease recurrence, progression, and patient survival.     

Sensitivity and predictive value of ultrasound in pediatric cholecystitis

Background

Ultrasonography has a high sensitivity and positive predictive value (PPV) for diagnosing cholecystitis in adults. The objective of this study was to determine the sensitivity and PPV of ultrasonography in the diagnosis of pediatric cholecystitis.

Methods

We performed a single-institution retrospective review of the records of all patients undergoing cholecystectomy with a preoperative ultrasound during 2005–2010. We calculated sensitivity, specificity, and PPV using pathologic findings as the standard for the diagnosis of cholecystitis.

Results

In the 223 included patients, the median (interquartile range) age was 14 y (11–16 y); and 64% were female. Preoperative symptoms of abdominal pain were reported in 98% of patients. A diagnosis of cholecystitis was reported in 10% (23 of 223) of ultrasound readings. Pathologic diagnosis of cholecystitis was present in 80% (179 of 223) of cholecystectomy specimens, with 8% (15 of 179) having acute cholecystitis, 83% (148 of 179) chronic cholecystitis, and 9% (16 of 179) both. Sensitivity of ultrasound findings ranged from 6% for Murphy's sign to 66% for cholelithiasis. Positive predictive values ranged from 67% for Murphy's sign to 87% for gallbladder sludge. Presence of any one ultrasound sign had a sensitivity of 82% and PPV of 80%.

Conclusions

Ultrasound findings in pediatric cholecystitis have lower sensitivities and PPVs than reported in adults. These differences may be explained by the higher prevalence of chronic cholecystitis in children, which suggests that children may have milder episodes of self-limited gallbladder inflammation compared with adults, which may lead to a delay in treatment.     

Bed-wetting in Chinese children: epidemiology and predictive factors

AIMS: To estimate the prevalence and severity of bed-wetting in 1-18-year-old Chinese children. MATERIALS AND METHODS: A cross-sectional study of bed-wetting was performed by using 13,515 self-administered questionnaires distributed to the parents of 1-18-year-old Chinese children in Henan province. The prevalence of bed-wetting was determined. The relationship of wetting to age, gender, community characteristics (rural or urban), arousal dysfunction, associated day-time symptoms (frequency, urgency, and incontinence), and family history were analyzed. RESULTS: There was a response rate of 87% (5,978 boys and 5,786 girls). The overall prevalence of bed-wetting was 23.03% in those aged 1-4, 5.66% in those 5-12, and 1.37% in those 13-18. When a logistic regression analysis was applied to determine risk factors for the bed-wetting, a positive relationship was seen with male gender and living in rural areas. Further, living in rural areas, arousal dysfunction, and associated day symptoms were significantly related to more severe bed-wetting. Only 3.64% of the children had undergone professional evaluation. CONCLUSION: The prevalence of bed-wetting is significant in Chinese children, but lower than in most western countries, which is likely due to cultural differences. Living in rural areas, having arousal dysfunction, and having associated day-time symptoms may be predicative factors for marked bed-wetting.     

A predictive model of early mortality in trauma patients

Background

Rapid thrombelastography (rTEG) is a real-time whole-blood viscoelastic coagulation assay. We hypothesized that admission rTEG and clinical data are independent predictors of trauma-related mortality.

Methods

Prospective observational data (patient demographics, admission vital signs, laboratory studies, and injury characteristics) from trauma patients enrolled within 6 hours of injury were collected. Mann–Whitney U test and analysis of variance test assessed significance (P ≤ .05). Logistic regression analyses determined the association of the studied variables with 24-hour mortality.

Results

Seven hundred ninety-five trauma patients were enrolled, of which 55 died within 24 hours of admission. Admission variables which independently predicted 24-hour mortality were as follows: Glasgow Coma Scale ≤8, hemoglobin <11 g/dL, international normalized ratio >1.5, Ly30 >8%, and penetrating injury (P < .05). This 5-variable model's area under the receiver operator characteristic curve was .88. The Hosmer–Lemeshow goodness-of-fit test was .90.

Conclusions

This 5-variable model provides a rapid prediction of 24-hour mortality. The inclusion of rTEG Ly30 demonstrates the association of fibrinolysis with outcome and may support the early use of antifibrinolytic therapies.