Medullary thyroid carcinoma: multivariate analysis of prognostic factors influencing survival

Background Medullary thyroid carcinoma (MTC) is a rare development of thyroid cancer with a no negligible mortality rate. Our aim was to determine factors that predict outcome in patients with MTC. Methods We reviewed the records of all patients with MTC (n=56) who underwent treatment at our institution between January 1990 and December 2000. Univariate and multivariate analysis of clinicopathologic predictors of MTC outcome were performed to identify subsets of patients with different probabilities in terms of overall survival, local recurrence, and distant metastases. Results Multivariate analysis demonstrated that a statistically significant decrease in overall survival is associated with T4b tumours (p=0.06), the presence of distant metastases at the time of presentation (p=0.033), lymphatic invasion (p=0.099), and postoperative treatment (p=0.045). Conclusions The analysis of survival curves of patients with MTC shows that the occurrence of locoregional and distant metastases occurs preferentially within the first 5 years, which identifies this as a crucial period for follow-up. In this series of patients with MTC, the tumours classified as T4b, metastases at presentation, the presence of lymphovascular invasion, and postoperative treatment were the most important prognostic features. At present, there is no available beneficial adjuvant therapy. However, as the development of molecular therapy progresses, it should be tested in clinical trials with the purpose of achievement of novel targeted therapies for selected MTC patients with risk factors.     

Clinical stage I and II endometrial carcinoma: multivariate analysis of prognostic factors.

In 221 patients with FIGO stage I and II endometrial carcinoma, the impact on survival of age at diagnosis, menopausal status, FIGO stage, myometrial invasion, tumor grade and histology was evaluated by univariate and multivariate analysis. At a median follow-up of 50 months (range 45-210), 42 patients had died, and therefore overall survival was 81% (179/221). Univariate analysis showed that age, menopausal status and histology did not influence survival, whereas FIGO stage, myometrial invasion and tumor grade were important prognostic factors. Multivariate analysis showed that tumor grade had a significant and independent impact on survival and confirmed that FIGO stage is the most important parameter influencing survival.     

AFP-producing gastric carcinoma: multivariate analysis of prognostic factors in 270 patients

Serum alpha-fetoprotein (AFP) is sometimes high in patients with primary gastric carcinoma, and there is no comprehensive study on the clinicopathologic characteristics and prognostic factors of AFP-producing gastric carcinoma (AGC). To clarify the variables associated with the survival after gastrectomy for AGC, we reviewed the data of patients with AGC and examined the independent prognostic factors. We studied 270 cases of AGC reported in the Japanese literature from June 1982 to March 2001, together with 1 patient of our own experience. The clinicopathologic findings, including serum AFP level, operative curability, and stage of the disease were examined, and factors associated with survival were determined by multivariate analysis. There were 15 stage I tumors (6%), 50 stage II tumors (19%), 51 stage III tumors (20%), and 145 stage IV tumors (55%). The tumors were characterized by frequent serosal invasion (75%), lymph node metastasis (83%), liver metastasis (33%), stage III or IV disease (75%), and noncurative operation (48%). The survival was influenced by the serum AFP level, tumor size, serosal invasion, lymph node metastasis, and liver metastasis, but the independent prognostic factors were operative curability (curative vs. noncurative) and stage of the disease (I, II vs. III, IV). Although the 5-year survival rate and median survival period in all patients were 22% and 14 months, respectively, those in patients with curative gastrectomy were 42% and 29 months, respectively. The results indicate that operative curability and stage of the disease are factors associated with the survival of patients with AGC. Although tumors are often advanced and complicated with liver metastases, long-term survival can be achieved when patients with stage I or II tumor undergo curative gastrectomy.     

Prognostic factors of nasopharyngeal carcinoma: a multivariate analysis

Between 1979 and 1985, 561 patients with nasopharyngeal carcinoma were reviewed to determine prognostic factors that may influence survival. Sex (p = 0.294) and histopathology (p = 0.677) had no correlation to the actuarial survival, whereas the site of cervical metastasis (p = 0.001) and the radiation doses to the nasopharynx and regional lymph nodes (p = 0.03) were both significant when one used univariate analyses. Cox's multivariate regression model revealed that the presence rather than the site of distant metastases was the single most important independent factor influencing the treatment outcome (p less than 0.0001). The addition of chemotherapy, on the other hand, did not show a survival benefit even when one took available confounding factors into account. There are, however, survival advantages associated with: (a) young age (less than or equal to 40 years), (b) asymptomatic status, (c) Stage I or II lesions, and (d) biopsy via nasopharynx instead of neck nodes. These favorable prognostic factors may be used for therapeutic guidance and end-result reporting.     

复发性喉癌患者的临床特点和影响预后因素的分析

喉癌复发是影响预后的重要因素,但对复发性喉癌患者的临床特点和影响预后因素的研究较少。本研究的目的是总结分析复发性喉癌患者的临床特点,探讨影响复发性喉癌患者预后的主要因素。     

Medullary thyroid cancer: multivariate analysis of prognostic factors influencing survival.

AIMS: The aims of this study were to assess the long-term results of treatment of medullary thyroid carcinoma (MTC) and to define prognostic factors. METHODS: Retrospective analysis of all patients diagnosed with MTC between 1949 and 1998 and treated in our unit was carried out. RESULTS: One hundred and sixty-two patients (87 females, 75 males) were identified; 52 patients (32%) had familial disease. Median follow-up was 9 years (2-20 years). The majority of patients (90%) presented with a thyroid mass or enlarged neck nodes. Total/subtotal thyroidectomy was performed in 129/18 patients respectively; 45 patients also underwent neck dissection while 52 had simple nodal excision. External beam radiotherapy (RT) was given to 76 patients with advanced disease at presentation. Overall survival was 72% at 5 years and 56% at 10 years; case-specific survival was very similar. In multivariate analysis the factors which were significant predictors of survival were age at diagnosis, extent of nodal disease, extent of surgery and metastases at presentation. RT significantly reduced local relapse in patients with ipsilateral nodal disease. CONCLUSIONS: MTC may be associated with prolonged survival; the best prognosis occurs in young patients undergoing total thyroidectomy and neck dissection. External beam RT significantly reduces local relapse in patients with limited nodal disease.     

Prognostic factors of adult metastatic renal carcinoma: a multivariate analysis

In order to define the prognostic factors for metastatic renal carcinoma, we reviewed 134 patients who were treated from 1971 through 1986. Survival rates were 72, 45, and 25% at 6, 12, and 18 months, respectively. Seventeen variables were tested using the logrank test. Improved survival was correlated with normal performance status, and an absence of fever, weight loss, hepatic metastasis, and lung metastasis (or, if lung metastasis was present, less than 2 cm in diameter and limited to one site), a disease-free interval, sedimentation rate less than 100, and renal surgery. Four variables retained significant value in the multivariate analysis: hepatic metastasis, lung metastasis, disease-free interval, and a variable combining the sedimentation rate and the weight loss (SWRL). Predictive survival rates based on these variables were calculated from the Cox model. Six subgroups of patients were identified. The estimation of survival is clinically of value for future phase II trials of chemotherapy in patients with adult metastatic renal carcinoma.     

Prognostic factors in neuroendocrine small cell cervical carcinoma: a multivariate analysis

BACKGROUND: The purpose of this study was to evaluate the clinical and pathologic factors associated with survival in patients with neuroendocrine (NE) cervical carcinoma. METHODS: All patients with NE cervical carcinoma diagnosed between 1979-2001 were identified from tumor registry databases at two hospitals. Data were collected from hospital charts, office records, and tumor registry files. The impact of clinical and pathologic risk factors on the survival of patients with small cell NE carcinoma of the cervix was evaluated using Kaplan-Meier life table analyses and log-rank tests. The independent prognostic factors found to be predictive of survival in univariate analysis were evaluated using Cox regression. All tests were two-tailed with P values < 0.05 considered significant. RESULTS: Thirty-four patients (median age, 42 years) were diagnosed with neuroendocrine cervical carcinoma, which included 21 with International Federation of Gynecology and Obstetrics (FIGO) Stage I disease, 6 with FIGO Stage II disease, 5 with FIGO Stage III disease, and 2 with FIGO Stage IV disease. Seventeen patients underwent a radical and 6 patients underwent a simple hysterectomy. Fourteen women received adjuvant therapy with pelvic radiation and/or cisplatin-based chemotherapy. Ten women received primary radiotherapy with (n = 5) or without (n = 4) chemotherapy and the remaining patient refused therapy. Women with early-stage (Stage I-IIA) disease had median survival rates of 31 months compared with 10 months in the advanced-stage (Stage IIB-IVB) group (P = 0.002). In univariate analysis, advanced stage (P = 0.002), tumor size >2 cm (P = 0.02), margin involvement (P = 0.016), pure versus a mixed histologic pattern (P = 0.04), margin status (P = 0.016), and smoking (P = 0.04) were considered poor prognostic factors. In multivariate analysis, smoking for early-stage patients and stage of disease in the overall population remained as independent prognostic factors of survival. CONCLUSIONS: Smoking and advanced stage are reported to be poor prognostic factors for survival in patients with NE small cell carcinoma of the cervix. Only those with early lesions amenable to extirpation are cured. The role of primary or postoperative radiation with or without chemotherapy is unclear and yields uniformly poor results, particularly in patients with advanced lesions. Clinical trials are needed.     

Basosquamous carcinoma: analysis of prognostic factors influencing recurrence

BACKGROUND: Basosquamous carcinoma is a rare malignancy, with features of both basal cell carcinoma and squamous cell carcinoma. Some authors believe that basosquamous carcinoma merely is a variant of basal cell carcinoma, whereas others have suggested that basosquamous carcinoma may behave more aggressively. To the authors' knowledge the largest published series to date, comprised of 35 cases, was reported >20 years ago. The authors reviewed their recent experience with basosquamous carcinoma to identify prognostic factors influencing recurrence. METHODS: The medical records of all patients with the diagnosis of basosquamous carcinoma treated at the University of Louisville-affiliated hospitals between 1985-1988 were reviewed by a senior pathologist. Prognostic factors were analyzed using Cox regression analysis and the log rank test. RESULTS: Thirty-one cases of basosquamous carcinoma were identified in 28 patients. The median age at diagnosis was 68 years (range, 10-94 years). The median follow-up was 60 months (range, 12-312 months). Seventy-five percent of cases were located on the face, neck, and scalp. One patient had regional lymph node metastasis synchronous with the primary tumor. Patterns of recurrence were: local recurrence only (five patients), local recurrence plus regional lymph nodes (three patients), and pulmonary plus regional lymph nodes (one patient). One patient died of pulmonary metastasis. Significant factors predictive of recurrence (P<0.01) were male gender, positive surgical resection margin, lymphatic invasion, and perineural invasion. Although tumor size was not a statistically significant factor overall (P = 0.076), the 3 patients with lymph node metastases had large tumors (measuring 2 cm, 5 cm, and 5 cm, respectively). CONCLUSIONS: Basosquamous carcinoma is an aggressive epithelial neoplasm with a propensity for local recurrence and potential for distant metastatic spread. This behavior differs substantially from basal cell carcinoma. Complete resection with negative surgical margins is essential. Long term follow-up for the detection of local recurrence and distant metastatic spread is recommended.     

肝外胆管癌术后预后的多因素回归分析

目的:探讨影响肝外胆管癌术后生存的预后因素。方法:采用Cox比例风险模型,选择临床因素及E 钙粘附素(E cd)及基质金属蛋白酶(MMP 9),进行多因素回归分析。结果:全组 1年生存率为 44. 2%, 3年生存率为 23. 1%, 5年生存率为 9. 6%;单因素分析显示:肿块大小、TNM分期、浸润转移、手术方式、E cd、MMP 9与肝外胆管癌术后预后显著相关(P<0. 01) ;Cox多因素回归分析显示:E cd和MMP 9的表达是影响胆管癌术后预后的重要因素,可作为判断预后的独立指标(P<0. 05)。结论:E cd和MMP 9的表达是影响胆管癌术后预后的独立因素。     

Inflammatory breast cancer. Determination of prognostic factors by univariate and multivariate analysis

Between January 1977 and June 1983, 64 consecutive patients were treated for unilateral inflammatory nonmetastatic breast cancer. Our protocol included three or four courses of induction chemotherapy, then locoregional irradiation therapy with Co-60, followed by maintenance chemotherapy only if induction chemotherapy had proven effective. Eight patients with a residual tumor after radiotherapy underwent a modified radical mastectomy. Actuarial 3-year overall survival for the whole group was 38%, and the median disease-free survival time was 19 months. The effect of 17 factors on overall survival or disease-free survival was analyzed. With univariate analysis, eight factors were found to affect overall survival or disease-free survival: extent of initial erythema, size of initial edema, lymph node involvement, erythema present at the end of initial chemotherapy, erythema present at the end of radiotherapy, tumor size at the end of induction chemotherapy, residual breast tumor at the end of maintenance chemotherapy, and performance of a radical mastectomy. Age at diagnosis, menopausal status, type of chemotherapy, and date of appearance of inflammatory signs did not influence prognosis. Multivariate analysis using the Cox proportional hazard model isolated three bad prognosis factors: erythema involving the whole breast at initial diagnosis, erythema present at the end of initial chemotherapy, and lymph node involvement.     

Lymphnode metastasis in head and neck squamous cells carcinoma: multivariate analysis of prognostic variables.

Cervical lymphnodes metastatization by the squamous cell carcinoma of the head and neck is well known as a prognostic negative factor as far as survival is concerned. Multivariate analysis has been used on 207 cases of head and neck squamous cell carcinomas (HNSCC) in order to identify the possible prognostic significance of a group of clinical and histopathological characteristics, aiming to find a correlation with the possible occurrence of cervical lymphnodes. Two hundred and seven patients (168 males and 39 females, mean age: 62 years) with SCCHN were studied. They underwent surgery alone and radiotherapeutic associated treatment. Variables regarding the patient, carcinoma and histology were analysed: age, sex, smoking and alcohol consumption, performance status, concomitant internal pathologies (cardiopathies, hepatopathies, broncho-pneumopathies, metabolic disorders), site and size of primary tumor (T stage), number and size of laterocervical lymph node localization (clinical N stage), grading, vascular permeation, perineural infiltration. Multivariate analysis of prognostic factors was performed using BMDP's PLR programme. Some variables showed a great risk of lymphnode metastasis; among sites: supraglottic larynx (p = 0.05), base of the tongue (p = 0.04), hypopharynx (p = 0.05); some histological parameters as lower degree of histological differentiation (p = 0.02), the presence of vascular permeation (p = 0.06) and perineural invasion (p = 0.07) appear to represent predisposing factors for the onset of adenopathies. By considering prognostic factors as shown, it is possible to better identify metastasis risk cases, that leads to improved therapeutical strategies.     

Prostatic carcinoma: histoprognosis, prognostic value of Gleason's index

This paper recalls the definition of the Gleason index and describes the five architectural types that enable a calculation of the index. The conditions of the practical application of the index are defined, with a discussion of reproducibility of results based on current literature and the author's experience. The index allows appreciation of the developmental potential of prostatic cancer and distinguishes between patients with a high risk of metastases and death from the cancer and those with low potential development. While the Gleason index cannot predict the course of the tumour in any given patient, it can be considered a useful element among the clinical and biological factors assessed in the prognosis of prostatic carcinoma.     

Gallbladder carcinoma: analysis of prognostic factors in 132 cases

Objective: To evaluate the prognostic factors of gallbladder carcinoma. Methods: Presentation, operativedata, complications, and survival outcome were examined for 132 gallbladder carcinoma patients who underwentgallbladder surgery in our unit during 2002-2007, and follow-up results were obtained from every patient forunivariate and multivariate survival analysis. Results: The univariate analysis showed that gallbladder lesionhistory, tumor cell differentiation, Nevin staging, preoperative lymph node metastasis and the surgical approachsignificantly correlated with the prognosis of the patients (p <0.05). The results of the multivariate analysis (Coxregression) showed that gallbladder lesion history, Nevin staging and the surgical approach were independentpredicators with relative risks of 6.9, 4.4, 2.8, respectively (p=0.002, 0.003, 0.008). Conclusion: Gallbladder lesionhistory, Nevin staging and the surgical approach are independent prognostic factors for gallbladder carcinoma,a rapidly fatal disease. Therefore, early diagnosis, anti-infective therapy and radical surgery are greatly neededto improve the prognosis of gallbladder carcinoma.     

A multivariate analysis of prognostic factors in early stage Hodgkin's disease

A multivariate analysis of the prognostic factors was carried out with a Cox model on 1,139 patients with clinical Stage I + II Hodgkin's disease included in three controlled clinical trials. The following indicators had been prospectively registered: age, sex, systemic symptoms, erythrocyte sedimentation rate (ESR), number and sites of involved lymph node areas, histologic type, clinical stage, pattern of presentation, results of staging laparotomy when performed, as well as the date and type of treatment. A linear logistic analysis showed that most of the indicators are interrelated. This emphasizes the necessity of a multivariate analysis in order to assess the independent influence of each of them. The two main prognostic indicators for relapse-free survival are systemic symptoms and/or ESR and number of involved areas. The only significant factor for survival after relapse is age. Sex has a small but significant influence on relapse-free survival. The relative influence of each indicator varies with the type of treatment and these variations may help in understanding the biologic significance of the indicators.     

子宫内膜癌的预后影响因素分析

背景与目的:子宫内膜癌的预后影响因素较多,但其中仅有少数因素对预后构成独立影响。本研究的目的在于探讨子宫内膜癌的独立预后影响因素。方法:对我院1990年1月至2000年12月间初治时行手术治疗的265例子宫内膜癌患者的临床资料进行回顾性研究,预后相关因素采用单因素分析及多因素相关回归分析,并进行逐步筛查。结果:本组病例的5年无瘤生存率及总生存率分别为83.3%和84.3%。单因素分析显示:临床分期、手术-病理分期、病理分级、组织学类型、肌层浸润深度、宫颈受累、淋巴结转移、腹腔液性质、脉管瘤栓及附件转移与5年无瘤生存率及总生存率有显著性相关(P<0.05),年龄、合并症因素与预后无显著性相关(P>0.05)。经多因素分析后得出,手术-病理分期、病理分级、肌层浸润深度及宫颈受累4个因素对子宫内膜癌患者的5年无瘤生存率及总生存率均产生显著性影响(P<0.05),临床分期仅对5年无瘤生存率有显著性影响(P<0.001),而对总生存率无显著性影响(P=0.074)。肌层浸润>50%者远处转移率(12.9%)明显高于≤50%者(0.6%)(P<0.001)。宫颈受累者的淋巴结转移率(21.1%)明显高于宫颈未受累者(3.6%)(P<0.001)。结论:FIGO分期、病理分级、肌层浸润深度及宫颈受累是子宫内膜癌独立的预后影响因素。在估计预后方面,手术-病理分期     

Synovial sarcoma: a multivariate analysis of prognostic factors in 112 patients with primary localized tumors of the extremity.

PURPOSE: Synovial sarcoma is a high-grade tumor that is associated with poor prognosis. Previous studies analyzing prognostic factors are limited because of inclusion of heterogeneous cohorts of patients with nonextremity and recurrent tumors. The objective of this study was to determine independent prognostic factors of primary synovial sarcoma localized to the extremity. PATIENTS AND METHODS: Between July 1, 1982, and June 30, 1996, 112 patients underwent surgical resection for cure at our institution and then were followed-up prospectively. Clinical and pathologic factors examined for prognostic value included age, sex, tumor site and location, depth, size, microscopic status of surgical margins, invasion of bone or neurovascular structures, and monophasic or biphasic histology. The end points analyzed were the time to first local recurrence that was not preceded by a distant recurrence, time to any distant recurrence, and time to disease-related mortality. These end points were modeled using the method of Kaplan and Meier and analyzed by the log-rank test and Cox regression. RESULTS: The median duration of follow-up among survivors in this cohort of 112 patients was 72 months. The 5-year local-recurrence, distant-recurrence, and mortality rates were 12%, 39%, and 25%, respectively. Tumor size > or = 5 cm (P =.001; relative risk [RR] = 2. 7; 95% confidence interval [CI], 1.5 to 5.2) and the presence of bone or neurovascular invasion (P =.04; RR = 2.3; 95% CI, 1.0 to 5. 3) were independent adverse predictors of distant recurrence. Tumor size > or= 5 cm (P =.003; RR = 2.3; 95% CI, 1.4 to 6.3) and the presence of bone or neurovascular invasion (P =.03; RR = 2.7; 95% CI, 1.0 to 6.5) were also independent adverse predictors of mortality. CONCLUSION: The natural history of primary synovial sarcoma of the extremity is related to tumor size and invasion of bone and neurovascular structures.     

Preoperative values of CA 15-3 and CEA as prognostic factors in breast cancer: a multivariate analysis.

The role of circulating tumor markers in providing prognostic information has not been widely studied. In the current study, serum levels of the carbohydrate antigen 15-3 (CA 15-3) and carcinoembryonic antigen (CEA) were determined preoperatively in 364 breast cancer patients with no clinical signs of metastasis. The prognostic relevance of these markers for recurrence (175/364) and death of disease (104/175) was determined by Cox multivariate analysis, including the comparison with classical prognostic factors. High levels of both tumor markers were associated with aneuploid tumors with high S-phase fraction and high ornithine decarboxylase activity. CA 15-3 was highly associated with the number of positive lymph nodes and peritumoral lymphatic or blood vessel invasion. No significant associations were found between CEA or CA 15-3 levels and histologic grade, necrosis and steroid receptor status. In univariate analysis, preoperative values, using optimum cutoff values of CA 15-3 (40 U/ml) and CEA (6 ng/ml), were statistically significant for relapse-free survival and overall survival. In multivariate analysis, only node status, DNA ploidy and ornithine decarboxylase activity were independent predictors for relapse-free survival; the estrogen receptor status was a predictor of overall survival. In node-negative patients, ornithine decarboxylase activity was the only factor selected for relapse-free survival. In node-positive patients, the number of lymph nodes and DNA ploidy were the only variables selected for relapse-free survival or overall survival. Estrogen receptor and ornithine decarboxylase activity were excluded for relapse-free survival, but were significant prognostic factors for overall survival.