Change in model for end-stage liver disease score on the transplant waiting list predicts survival in patients undergoing liver transplantation

Allocation of donor livers through the model for end-stage liver disease (MELD) score has resulted in a fall in waiting list deaths in the United States. Change in MELD score (DeltaMELD) whilst awaiting transplant has been suggested as a method of refining organ allocation. Our aims were to analyse the effect of DeltaMELD between listing and transplant, and examine its impact on patient survival, intensive care stay and hospital stay in 402 patients transplanted for chronic liver disease at a single centre. Patients who had a DeltaMELD score of >+1 point were more likely to die in hospital following transplant (P < 0.05) and had a significantly worse 12- and 36-month survival post transplant (P < 0.0001) when compared with patients with DeltaMELD 相似文献   

Predictors of survival in surgically treated patients of spinal metastasis

Background:

The spinal metastasis occurs in up to 40% of cancer patient. We compared the Tokuhashi and Tomita scoring systems, two commonly used scoring systems for prognosis in spinal metastases. We also assessed the different variables separately with respect to their value in predicting postsurgical life expectancy. Finally, we suggest criteria for selecting patients for surgery based on the postoperative survival pattern.

Materials and Methods:

We retrospectively analyzed 102 patients who had been operated for metastatic disease of the spine. Predictive scoring was done according to the scoring systems proposed by Tokuhashi and Tomita. Overall survival was assessed using Kaplan–Meier survival analysis. Using the log rank test and Cox regression model we assessed the value of the individual components of each scoring system for predicting survival in these patients.

Result:

The factors that were most significantly associated with survival were the general condition score (Karnofsky Performance Scale) (P=.000, log rank test), metastasis to internal organs (P=.0002 log rank test), and number of extraspinal bone metastases (P=.0058). Type of primary tumor was not found to be significantly associated with survival according to the revised Tokuhashi scoring system (P=.9131, log rank test). Stepwise logistic regression revealed that the Tomita score correlated more closely with survival than the Tokuhashi score.

Conclusion:

The patient''s performance status, extent of visceral metastasis, and extent of bone metastases are significant predictors of survival in patients with metastatic disease. Both revised Tokuhashi and Tomita scores were significantly correlated with survival. A revised Tokuhashi score of 7 or more and a Tomita score of 6 or less indicated >50% chance of surviving 6 months postoperatively. We recommend that the Tomita score be used for prognostication in patients who are contemplating surgery, as it is simpler to score and has a higher strength of correlation with survival than the Tokuhashi score.     

Surgical volume influences survival in patients undergoing resections for stage II colon cancers

BACKGROUND: There is current interest in the correlation between surgical volume and outcomes. Survival in patients with rectal cancer appears to improve when carried out by surgeons who do high volumes of procedures. A similar correlation for patients with colon cancer has never been clearly established. The aim of this study was to determine whether surgical volume was an independent predictor for survival in patients undergoing surgery for stage II colon cancer. METHODS: Population-based findings were collected from all patients diagnosed with stage II colon cancer in Western Australia between 1993 and 2003. The Kaplan-Meier product limit estimate of survival was used to calculate overall and cancer-specific survival. The Cox proportional hazards model was used to define the correlation between a number of covariates and survival. The results are recorded as hazard ratio (HR) with 95% confidence intervals (CI). RESULTS: From 1993 to 2003, 1467 patients underwent resections for stage II colon cancers. Significant independent predictors for overall survival were surgeon carrying out more than 25 procedures (P = 0.0001, HR 0.657, 95%CI 0.532-0.811), surgery in a private hospital (P = 0.0001, HR 0.487, 95%CI 0.400-0.594), use of chemotherapy (P = 0.001, HR 0.664, 95%CI 0.496-0.837), age at diagnosis (P = 0.0001, HR 1.014, 95%CI 1.027-1.044) and T staging and vascular invasion (T4 and vascular positive P = 0.001, HR 1.850, 95%CI 1.294-2.645). CONCLUSIONS: Surgical volume was a significant independent predictor for survival in patients undergoing resections for stage II colon cancers. Surgeons carrying out only 25 procedures over a 10-year period outperformed surgeons doing fewer cases.     

Tumour location is a prognostic factor for survival in colonic cancer patients

Objective To evaluate survival and prognostic factors in a consecutive series of colon cancer patients from a defined city population in Norway. Method All patients with adenocarcinoma of the colon diagnosed between 1993 and 2000 were registered prospectively. Five‐year actuarial survival and 5‐year relative survival rates were calculated. Cox regression analyses were used to study the effect of prognostic factors on survival. Results In the study period 627 patients were admitted. Overall 5‐year relative survival was 50% in females and 52% in males. Five‐year relative survival in 410 (65%) patients operated with curative intent, was 74% for females and 79% for males. Tumour location in the transverse colon, splenic flexure and descending colon (OR = 1.8), emergency operation (OR = 1.7), TNM stage (OR = 1.8–2.9), blood transfusion of more than two units (OR = 1.8) and age (OR = 4.0–7.1) were independent negative prognostic factors. Conclusion Colon cancer located in the transverse and descending colon is associated with poor prognosis. Comparison of results from different centres is difficult due to selection and classification differences, and different methods used for calculation of survival.     

Less-invasive surgery for gastric cancer prolongs survival in patients over 80 years of age

This study was undertaken to determine the most appropriate form of surgery for elderly patients with gastric cancer in relation to postoperative complications and long-term survival. A total of 72 consecutive patients over 80 years of age who underwent partial or total gastrectomy were evaluated using an E-PASS scoring system. This system is comprised of a preoperative risk score (PRS), a surgical stress score (SSS), and a comprehensive risk score (CRS) determined by both the PRS and SSS. Patients with a CRS≥0.5 had significantly higher rates of morbidity and mortality at 45.0% and 20.0%, respectively, than those with CRS≤0.5, at 17.0% and 2.1%, respectively. A Cox regression analysis of long-term survival, including death from other causes, identified five significant prognostic factors, namely: stage, curability, SSS, CRS, and allogeneic blood transfusion. Among the patients without any apparent residual cancer, a significantly better survival was seen in those who underwent less invasive surgery (SSS<0.25), those with a CRS≤0.5, and those who had not been given a blood transfusion. These results suggest that less invasive surgery not requiring a blood transfusion is advisable for patients over 80 years of age with gastric cancer. Furthermore, gastrectomy with a CRS≥0.5 may have a poor therapeutic effect on both early and long-term outcome.     

Prediction of overall survival following colorectal cancer surgery in elderly patients

BACKGROUND With advanced age and chronic illness,the life expectancy of a patient with colorectal cancer(CRC) becomes less dependent on the malignant disease and more on their pre-morbid condition.Justifying major surgery for these elderly patients can be challenging.An accurate tool demonstrating post-operative survival probability would be useful for surgeons and their patients.AIM To integrate clinically significant prognostic factors relevant to elective colorectal surgery in the elderly into a validated pre-operative scoring system.METHODS In this retrospective cohort study,patients aged 70 and above who underwent surgery for CRC at Singapore General Hospital between 1 January 2005 and 31 December 2012 were identified from a prospectively maintained database.Patients with evidence of metastatic disease,and those who underwent emergency surgery or had surgery for benign colorectal conditions wereexcluded from the analysis.The primary outcome was overall 3-year overall survival(OS) following surgery.A multivariate model predicting survival was derived and validated against an equivalent external surgical cohort from Kyungpook National University Chilgok Hospital,South Korea.Statistical analyses were performed using Stata/MP Version 15.1.RESULTS A total of 1267 patients were identified for analysis.The median post-operative length of stay was 8 [interquartile range(IQR) 6-12] d and median follow-up duration was 47(IQR 19-75) mo.Median OS was 78(IQR 65-85) mo.Following multivariate analysis,the factors significant for predicting overall mortality were serum albumin 35 g/dL,serum carcinoembryonic antigen ≥ 20 μg/L,T stage 3 or 4,moderate tumor cell differentiation or worse,mucinous histology,rectal tumors,and pre-existing chronic obstructive lung disease.Advanced age alone was not found to be significant.The Korean cohort consisted of 910 patients.The Singapore cohort exhibited a poorer OS,likely due to a higher proportion of advanced cancers.Despite the clinicopathologic differences,there was successful validation of the model following recalibration.An interactive online calculator was designed to facilitate post-operative survival prediction,available at http://bit.ly/sgh_crc.The main limitation of the study was selection bias,as patients who had undergone surgery would have tended to be physiologically fitter.CONCLUSION This novel scoring system generates an individualized survival probability following colorectal resection and can assist in the decision-making process.Validation with an external population strengthens the generalizability of this model.     

Glycated albumin levels predict long-term survival in diabetic patients undergoing haemodialysis

Aim: Glycated albumin (GA) is recognized as a reliable marker for monitoring glycemic control particularly in patients with end‐stage renal disease (ESRD). Here, we investigated the impact of GA levels on long‐term survival in diabetic patients with ESRD. Methods: We enrolled ESRD patients with diabetic nephropathy into our single‐centre prospective follow‐up study (n = 98, 66 men and 32 women; age 68.2 12.3 years) with a mean follow‐up period of 47.7 months. All patients had started haemodialysis between December 1992 and November 2003. They were categorized into two groups according to their GA levels at the initiation of haemodialysis; GA < 29% (low‐GA group; n = 54) and GA 29% (high‐GA group; n = 44). Results: Between low‐GA and high‐GA groups, there were no significant differences in various clinical parameters except GA and HbA1c levels. The cumulative survival rate of low‐GA group was significantly higher than that of high‐GA group (P = 0.034, log–rank test). After adjustment for age, sex, total cholesterol, C‐reactive protein and albumin, high‐GA was a significant predictor of survival (hazard ratio 1.042 per 1.0% increment of GA, 95% CI 1.014–1.070, P < 0.05), but not in the case with HbA1c. Cox proportional hazard model demonstrated that high‐GA group was a significant predictor for cardiovascular death (hazard ratio 2.971 (1.064–8.298), P = 0.038). Conclusion: We conclude that poor glycemic control (GA 29%) before starting haemodialysis is associated with increased cardiovascular morbidity and shortened survival in diabetic patients with ESRD.     

Prediction of survival in patients with head and neck cancer

BACKGROUND: In patients with head and neck squamous cell carcinoma (HNSCC) the estimated prognosis is usually based on the TNM classification. The relative weight of the three contributing parameters is often not completely clear. Moreover, the impact of other important clinical variables such as age, gender, prior malignancies, etc is very difficult to substantiate in daily clinical practice. The Cox-regression model allows us to estimate the effect of different variables simultaneously. The purpose of this study was to design a model for application in new HNSCC patients. In our historical data-base of patients with HNSCC, patient, treatment, and follow-up data are stored by trained oncological data managers. With these hospital-based data, we developed a statistical model for risk assessment and prediction of overall survival. This model serves in clinical decision making and appropriate counseling of patients with HNSCC. PATIENTS AND METHODS: All patients with HNSCC of the oral cavity, the pharynx, and the larynx diagnosed in our hospital between 1981 and 1998 were included. In these 1396 patients, the prognostic value of site of the primary tumor, age at diagnosis, gender, T-, N-, and M-stage, and prior malignancies were studied univariately by Kaplan-Meier curves and the log-rank test. The Cox-regression model was used to investigate the effect of these variables simultaneously on overall survival and to develop a prediction model for individual patients. RESULTS: In the univariate analyses, all variables except gender contributed significantly to overall survival. Their contribution remained significant in the multivariate Cox model. Based on the relative risks and the baseline survival curve, the expected survival for a new HNSCC patient can be calculated. CONCLUSIONS: It is possible to predict survival probabilities in a new patient with HNSCC based on historical results from a data-set analyzed with the Cox-regression model. The model is supplied with hospital-based data. Our model can be extended by other prognostic factors such as co-morbidity, histological data, molecular biology markers, etc. The results of the Cox-regression may be used in patient counseling, clinical decision making, and quality maintenance.     

Validation of a postoperative prognostic model consisting of tumor microvascular invasion, size, and grade to predict disease-free and cancer-specific survival of patients with surgically resected renal cell carcinoma

Objectives:   To determine the value of microvascular invasion, tumor size, and Fuhrman grade to predict the survival of patients with surgically resected renal cell carcinoma (RCC).
Methods:   A total of 771 consecutive patients (T1–4, Nx, M0) were retrospectively reviewed. For each patient with RCC, the prognostic Sao Paulo score (SPS) was calculated using the following variables: tumor size (>7 cm vs ≤7 cm), nuclear grading, and microvascular invasion. On the basis of SPS, patients were subdivided into low-risk (LR), intermediate-risk (IR), and high-risk (HR) groups. Disease-free survival (DFS) and cancer-specific survival (CSS) were estimated using the Kaplan–Meier method. Median follow-up was 80 months.
Results:   Median follow-up was 80 months. DFS rates after 5 years were 91.2%, 61.3%, and 51.9% in the original SPS LR, IR, and HR groups, respectively. CSS rates after 5 years were 94.3%, 79.8%, and 58.7%, respectively ( P  < 0.001). Each original SPS constituent revealed a significant influence on DFS and CSS in the multivariate analysis. By modification of the cut-off value of the maximum tumor size from 7 to 5 cm the predictive value of the SPS sum score was marginally enhanced. Using a cut-off value of 5 cm also resulted in a relatively better discrimination between the IR and the HR group regarding DFS and CSS.
Conclusions:   Stratifying RCC patients by SPS into LR, IR, and HR groups provides a clinically useful tool for outcome analysis and risk assessment. However, the prognostic value of the SPS could be enhanced by including a maximum tumor size with a cut-off at 5 cm into the sum score.     

Serum creatinine and albumin predict sarcoma‐specific survival in patients with myofibroblastic and fibroblastic sarcomas

Recent evidence suggests that common prognostic factors predicting disease progression and survival in soft tissue sarcomas (STS) are not applicable to all STS entities, indicating the need for histotype specific evaluation of new prognosticators. This study aimed at evaluating preoperative serum creatinine, albumin, and the albumin‐creatinine ratio (ACR) as markers for survival in patients with malignant fibroblastic and myofibroblastic sarcomas. One hundred and thirty‐two patients who underwent sarcoma resection have been included. Statistical analysis comprised uni‐ and multivariable Cox proportional hazard models, competing risk analysis and Kaplan–Meier estimates. The 5‐year overall survival (OS) was estimated at 64.1% (95%CI: 53.7–72.8) and the 5‐year sarcoma‐specific mortality was 19.9% (95%CI: 12.8–28.1). Elevated serum creatinine levels were significantly associated with an impaired sarcoma‐specific survival (SSS) adjusted for tumor stage (subdistribution hazard ratio (SHR) per 1 mg/dl increase: 3.27; 95%CI: 1.87–5.73; p < 0.0001). Low serum albumin levels were associated with a shorter recurrence‐free survival (RFS) experience (HR per 10 g/L increase: 0.62; 95%CI: 0.41–0.94; p = 0.024). The ACR emerged as an AJCC‐stage‐independent prognosticator of SSS (SHR per 1 unit increase: 0.94; 95%CI: 0.90–0.98; p = 0.003). In conclusion, serum albumin and creatinine have been confirmed as predictive biomarkers for disease‐specific outcomes in myofibroblastic and fibroblastic sarcomas. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2815–2824, 2017.

     

Predictors of disease‐free survival in rectal cancer patients undergoing curative proctectomy

Objective To identify the factors that affect the disease‐free survival (DFS) of rectal cancer patients. Method Patients from an IRB approved rectal cancer database were reviewed (1990–2000). All patients underwent either abdominoperineal resection or low anterior resection using total mesorectal excision with curative intent. Univariate and multivariate analyses were performed to analyse the factors that influenced DFS. Results A total of 304 patients were reviewed (mean age 64, 52% male). Seventy‐seven per cent of patients received neoadjuvant therapy (28.6% short‐course radiation therapy (RT), 35.5% long‐course RT, 12.5% chemo‐RT). The radial margin was involved with tumour in 5.2% of patients (final pathology). The overall survival rate was 85.2% with a mean follow‐up time of 33 ± 26 months. The mean time to death was 34.8 ± 26.8 months. Local recurrence (± distant recurrence) occurred in 4%. Anastomotic leaks occurred in 3.6% of patients. Overall pathologic stage, pathologic T stage, nodal status, the use of adjuvant chemotherapy, tumour fixation, involvement of the radial margin, the presence of mucin, and lymphatic and perineural invasion (PNI) were predictors of DFS by univariate analysis. Of note, anastomotic leaks and obstructing cancers did not influence DFS. Using multivariate analysis with backward elimination, overall pathologic stage, radial margin status, adjuvant chemotherapy, and PNI predicted the DFS. Conclusion Major predictors of DFS in rectal cancer are the overall pathologic stage, adjuvant chemotherapy, radial margin status and PNI. Radial margin status may be a marker of tumour aggressiveness and should be considered in deciding on adjuvant chemotherapy.