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JCO Oncology Practice Jun 2021Cancer patients' belief about prognosis can heavily influence medical decision making and goals of care. It is known that parents of children with cancer tend to be...
PURPOSE
Cancer patients' belief about prognosis can heavily influence medical decision making and goals of care. It is known that parents of children with cancer tend to be optimistic regarding their child's prognosis; however, little is known about pediatric patients' prognostic beliefs, how physicians' prognostic communication is perceived, and how these perceptions are compared with actual prognoses.
PATIENTS AND METHODS
An original survey was administered to 100 pediatric oncology patients, age 10-18 years, and their parents from 2013 to 2015, at St Jude Children's Research Hospital. Patients were eligible for inclusion if they had an oncologic diagnosis, were between 1 month and 1 year from diagnosis, and were English speaking. Survey responses regarding perceived prognosis were compared with actual prognoses as determined from the medical record review and published literature. Analysis included descriptive statistics and association tests.
RESULTS
Nearly half of participants (patients = 48.9%, parents = 50.5%) displayed prognostic optimism as compared with the determined objective estimate of curative potential. The majority of both patients (78%) and parents (85%) reported belief in a very high chance of cure, although fewer reported that their physician communicated a very high chance for cure (patients = 57%, parents = 70%), and only 43% were determined to have a very high probability of cure. Significant differences were noted in prognostic optimism by cancer type ( < .0001); patients with solid tumor were more often optimistic (n = 25, 83.3% optimistic; n = 5, 16.7% accurate), and patients with lymphoma were most often accurate (n = 2, 8.7% optimistic; n = 21, 91.3% accurate).
CONCLUSION
Pediatric oncology patients and parents tend to be optimistic about their chance of cure, as compared to both perceived prognostic communication from physicians and objective estimated prognosis. Understanding the nature of prognostic optimism among patients with cancer and caregivers may empower clinicians to guide realistic decision making while supporting hope.
Topics: Adolescent; Child; Humans; Medical Oncology; Neoplasms; Parents; Perception; Prognosis
PubMed: 33661701
DOI: 10.1200/OP.20.00762 -
Journal of Cancer Research and Clinical... Sep 2023We aimed to study the role of anoikis-related genes (ARGs) in colorectal cancer (CRC) using bioinformatics.
PURPOSE
We aimed to study the role of anoikis-related genes (ARGs) in colorectal cancer (CRC) using bioinformatics.
METHODS
GSE39582 and GSE39084, which collectively contain 363 CRC samples, were downloaded from the NCBI Gene Expression Omnibus (GEO) database as a test set. TCGA-COADREAD, with 376 CRC samples, was downloaded from the UCSC database as a validation set. Univariate Cox regression analysis was used to screen for ARGs that were significantly associated with prognosis. The top 10 ARGs were used to classify the samples into different subtypes based on unsupervised cluster analysis. The immune environments of the different subtypes were analyzed. ARGs that were significantly associated with CRC prognosis were used to construct a risk model. Univariate and multivariate Cox regression analyses were used to screen independent prognostic factors and construct a nomogram.
RESULTS
Four anoikis-related subtypes (ARSs) with differential prognoses and immune microenvironments were identified. KRAS and epithelial-mesenchymal transition pathways were enriched in subtype B, which had the worst prognosis. Three ARGs (DLG1, AKT3, and LPAR1) were used to construct the risk model. Both the test and validation sets showed worse outcomes for patients in the high-risk group than those in the low-risk group. Risk score was found to be an independent prognostic factor for CRC. Moreover, there was a difference in drug sensitivity between the high- and low-risk groups.
CONCLUSION
The identified ARGs and risk scores were associated with CRC prognosis and could predict the responses of patients with CRC to immunotherapy strategies.
Topics: Humans; Anoikis; Prognosis; Nomograms; Immunotherapy; Colorectal Neoplasms; Tumor Microenvironment
PubMed: 37318595
DOI: 10.1007/s00432-023-04945-2 -
Epigenetics Dec 2023Patients with acute myeloid leukaemia (AML) have poor prognoses and low overall survival (OS) rates owing to its heterogeneity and the complexity of its tumour...
Patients with acute myeloid leukaemia (AML) have poor prognoses and low overall survival (OS) rates owing to its heterogeneity and the complexity of its tumour microenvironment (TME). N6-methyladenosine (mA) modification plays a key role in the initiation and progression of haematopoietic malignancies. However, the underlying function of mA regulators in AML remains elusive. This study thoroughly analysed the mA modification features of 177 AML patients based on 22 mA regulators. Utilizing unsupervised clustering, we determined three distinct mA modification patterns related to different biological functions, TME cell-infiltrating characteristics and clinical outcomes. Additionally, a risk score was constructed based on six mA regulators-associated prognostic signatures and was validated as an independent and valuable prognostic factor for AML. Patients with a low-risk score exhibited better survival than those with a high-risk score. Many mA regulators were aberrantly expressed in AML, among which and were observed to be associated with the OS of AML. In addition, these four mA regulators were found to be noticeably related to the immune checkpoint inhibitor (ICI) treatments. Finally, we verified the expression levels of these four mA regulators in AML and healthy samples and three groups of AML patients with different risk categories. Collectively, our study indicates that the mA modification pattern is involved in TME immune-infiltrating characteristics and prognosis in AML. A better understanding of the mA modification pattern will help enhance our knowledge of the molecular mechanisms of AML and develop potential prognosis prediction indicators and more effective immunotherapeutic strategies.
Topics: Humans; Tumor Microenvironment; DNA Methylation; Prognosis; Leukemia, Myeloid, Acute; RNA
PubMed: 36567510
DOI: 10.1080/15592294.2022.2160134 -
Technology in Cancer Research &... 2022This study aimed to establish a nomogram to predict overall survival in lung squamous cell carcinoma patients with metastasis for clinical decision-making. We...
This study aimed to establish a nomogram to predict overall survival in lung squamous cell carcinoma patients with metastasis for clinical decision-making. We investigated lung squamous cell carcinoma patients diagnosed with stage M1 in the Surveillance, Epidemiology, and Final Results database between 2010 and 2015. They were divided into training cohort and validation cohort. In the training cohort, statistically significant prognostic factors were identified using univariate and multivariate Cox regression analysis, and an individualized nomogram model was developed. The model was evaluated by C-index, area under the curve, calibration plot, decision curve analysis, and risk group stratification. In total, 9910 patients were included in our study, including 6937 in the training cohort and 2937 in the validation cohort. Factors containing age, T stage, N stage, bone metastasis, brain metastasis, liver metastasis, surgery, chemotherapy, and radiotherapy were independent prognostic factors for overall survival and were used in the construction of the nomogram. The C-index in the training cohort and validation cohort were 0.711 (95% confidenc interval: 0.705-0.717) and 0.707 (95% confidenc interval: 0.697-0.717), respectively. The time-dependent area under the curve of both groups was higher than 0.7 within 5 years. Calibration plots indicated that the nomogram-predicted survival was consistent with the recorded 6-month, 1-year, and 2-year prognoses. Furthermore, decision curve analysis revealed that the nomogram was clinically useful and had a better discriminative ability to recognize patients at high risk than the TNM criteria-based tumor staging. And then we developed an overall survival risk classification system based on the nomogram total points for each patient, which divided all patients into a high-risk group and a low-risk group. Finally, we implemented this nomogram in a free online tool. We constructed a nomogram and a corresponding risk classification system predicting the overall survival of lung squamous cell carcinoma patients with metastasis. These tools can assist in patients' counseling and guide treatment decision-making.
Topics: Carcinoma, Non-Small-Cell Lung; Carcinoma, Squamous Cell; Humans; Lung; Lung Neoplasms; Neoplasm Staging; Nomograms; Prognosis; SEER Program
PubMed: 36217877
DOI: 10.1177/15330338221132035 -
The Oncologist Jun 2019Young survivors of gastric cancer (GC) have better prognoses than elderly patients, yet their disease-specific survival (DSS) has received little attention.
BACKGROUND
Young survivors of gastric cancer (GC) have better prognoses than elderly patients, yet their disease-specific survival (DSS) has received little attention.
PATIENTS AND METHODS
Data on young patients (aged ≤40 years) with GC undergoing resections at three Chinese institutions ( = 542) and from the SEER database ( = 533) were retrospectively analyzed. Three-year conditional disease-specific survival (CS3) was assessed. The effects of well-known prognostic factors over time were analyzed by time-dependent Cox regression.
RESULTS
Overall, young Chinese patients with GC had a better 5-year DSS than U.S. patients (62.8% vs. 54.1%; < .05). The disease-specific mortality likelihood of the entire cohort was not constant over time, with most deaths occurring during the first 3 years after surgery but peaking at 1 and 2 years in China and the U.S., respectively. Based on 5-year survivorship, the CS3 rates of both groups were similar (90.9% [U.S.] vs. 91.5% [China]; > .05). Cox regression showed that for Chinese patients, site, size, T stage, and N stage were independent prognostic factors at baseline ( < .05). For U.S. patients, grade, T stage. and N stage significantly affected DSS at baseline ( < .05). In both groups, only T stage continuously affected DSS within 3 years after gastrectomy. However, for both groups, the initial well-known prognostic factors lost prognostic significance after 5 years of survival (all > .05). Although the 5-year DSS rates of young Chinese patients with T3 and T4a disease were significantly better than those of young U.S. patients, in each T stage, the CS3 of both regions trended toward consistency over time.
CONCLUSION
For young patients with GC, the factors that predict survival at baseline vary over time. Although the initial 5-year DSS is heterogeneous, insight into conditional survival will help clinicians evaluate the long-term prognoses of survivors while ignoring population differences.
IMPLICATIONS FOR PRACTICE
With the increasing number of young survivors of gastric cancer (GC), it is essential for clinicians to understand the dynamic prognosis of these patients. Based on large data sets from China and the U.S., this study found that the prognostic factors that predict survival for young patients with GC at baseline vary over time. Although the initial 5-year disease-specific survival is heterogeneous, insight into conditional survival will help clinicians evaluate the long-term prognoses of survivors while ignoring population differences. This knowledge may be more effective in helping young patients with GC to manage future uncertainties, especially when they need to make important life plans.
Topics: Adult; Cancer Survivors; Cause of Death; Chemotherapy, Adjuvant; China; Cross-Cultural Comparison; Female; Follow-Up Studies; Gastrectomy; Humans; Kaplan-Meier Estimate; Male; Neoplasm Grading; Neoplasm Staging; Prognosis; Retrospective Studies; SEER Program; Stomach; Stomach Neoplasms; Time Factors; United States
PubMed: 30470692
DOI: 10.1634/theoncologist.2018-0220 -
Haematologica Jun 1998This is an invited review of a condition that is likely to become increasingly frequent in coming years. The objective is to define the varying prognoses of the... (Review)
Review
This is an invited review of a condition that is likely to become increasingly frequent in coming years. The objective is to define the varying prognoses of the condition and to discuss treatment options for patients with better and worse prognoses. The source of the data is the literature. Of particular note are the paper by Greenberg et al. describing the International Prognostic Scoring System for MDS and that by Estey et al. describing the similar response of AML, RAEB-t, and RAEB to AML-type chemotherapy. The state of the art is that no satisfactory therapeutic options exist; consequently, the majority of patients with secondary MDS should participate in clinical trials.
Topics: Antineoplastic Combined Chemotherapy Protocols; Humans; Myelodysplastic Syndromes; Prognosis; Radiotherapy
PubMed: 9676028
DOI: No ID Found -
Acute Medicine 2021This systematic review investigates whether infrared thermography (IRT) can measure systemic vasoconstriction and addresses the value of IRT in assessing circulatory...
PURPOSE
This systematic review investigates whether infrared thermography (IRT) can measure systemic vasoconstriction and addresses the value of IRT in assessing circulatory deficiency and prognoses.
METHODS
Design was based on the PRISMA criteria and a systematic search of 6 databases was performed.
RESULTS
Of 3,198 records, five articles were included. Three clinical studies were identified; two found significant correlations between IRT obtained temperatures and mortality. An experimental study found an association between peripheral temperature and stroke volume. An animal study found that central-peripheral temperature differences correlated with shock index, mean arterial pressure, and disease progression.
CONCLUSIONS
Data from the most valid study suggests that central-peripheral temperature differences should be investigated further, both on its own, and integrated with other variables.
Topics: Animals; Body Temperature; Humans; Infrared Rays; Prognosis; Thermography; Vasoconstriction
PubMed: 34190740
DOI: No ID Found -
American Journal of Perinatology Oct 1987In order to assess the prognosis of hypertension first documented during labor, an inception cohort of all women with hypertension complicating pregnancy was assembled.... (Comparative Study)
Comparative Study
In order to assess the prognosis of hypertension first documented during labor, an inception cohort of all women with hypertension complicating pregnancy was assembled. In this cohort, even extreme elevations of blood pressure, regardless of the degree of proteinuria, were not associated with either maternal or fetal adverse outcomes. Therefore, some degree of hypertension during labor may be physiologic. Matched pairs analysis demonstrated that intravenous (IV) magnesium sulfate, administered to prevent seizures, was associated with an excess number of primary cesarean sections. Given the excellent prognoses in patients with good antepartum care in whom hypertension is first documented during labor, the need for any preventive measures, or for antihypertensive or anticonvulsant treatment, should be reconsidered.
Topics: Blood Pressure; Cesarean Section; Delivery, Obstetric; Female; Humans; Hypertension; Labor, Obstetric; Magnesium Sulfate; Obstetric Labor Complications; Pregnancy; Pregnancy Outcome; Prognosis
PubMed: 3651190
DOI: 10.1055/s-2007-999799 -
Leukemia Research May 1998Recent efforts have been directed at improving the methodology for predicting clinical outcomes in patients with myelodysplastic syndromes (MDS). This review focuses on... (Comparative Study)
Comparative Study Review
Recent efforts have been directed at improving the methodology for predicting clinical outcomes in patients with myelodysplastic syndromes (MDS). This review focuses on the development of a consensual, prognostic, risk-based analysis system generated by the International MDS Risk Analysis Workshop. In the workshop, cytogenetic, morphological, and clinical data were combined and collated from a relatively large group of patients with primary MDS. Critical prognostic variables were evaluated using the data set. Based on these findings, the International Prognostic Scoring System (IPSS) was developed, compared with other systems, and shown to provide more accurate prognoses regarding survival and evolution to acute myeloid leukemia in MDS patients. The improvement was due to several features of the workshop model: more refined cytogenetic categorization, inclusion of cytopenias, improved subdivision of marrow blast percentages, four subgroups defining outcome, and separate stratification for age. The IPSS should result in better-defined clinical outcomes in MDS and provide a framework for future studies determining the possible role of molecular determinants (e.g. oncogenes, tumor suppressor genes, cytokine expression and responsiveness) for evaluating prognoses. The IPSS will likely prove useful in the design and analysis of therapeutic trials in MDS as well as in patient management.
Topics: Humans; Karyotyping; Multivariate Analysis; Myelodysplastic Syndromes; Prognosis
PubMed: 9734692
DOI: 10.1016/s0145-2126(98)00040-x -
Clinical Oncology (Royal College of... Oct 2023Perineural invasion (PNI) is a special type of metastasis of several cancers and has been reported as being a factor for poor prognosis in colorectal carcinoma. However,... (Meta-Analysis)
Meta-Analysis
AIMS
Perineural invasion (PNI) is a special type of metastasis of several cancers and has been reported as being a factor for poor prognosis in colorectal carcinoma. However, investigations of PNI in only rectal cancer and a comprehensive analysis combining meta-analyses with real-world case studies remain lacking.
MATERIALS AND METHODS
First, articles from 2000 to 2020 concerning the relationship between PNI and rectal cancer prognoses and clinical features were meta-analysed. Subsequently, we carried out a retrospective analysis of 312 rectal cancer cases that underwent radical surgery in the real world. The incidence of PNI and the relationship between PNI and prognosis, as well as clinicopathological factors, were investigated.
RESULTS
The incidence of PNI was 23.09% and 33.01% in the meta-analysis and clinical cases, respectively. PNI occurred as early as stage I (2.94%). Moreover, neoadjuvant therapy significantly reduced the PNI-positive rate (20.34% versus 26.54%). Both meta-analysis and real-world clinical case studies suggested that PNI-positive patients had poorer prognoses than PNI-negative patients. We established an effective risk model consisting of T stage, differentiation and lymphovascular invasion to predict PNI in rectal cancer.
CONCLUSION
PNI is a poor prognostic factor for rectal cancer and could occur even in stage I. Additionally, neoadjuvant therapy could sufficiently reduce the PNI-positive rate. T stage, lymphovascular invasion and differentiation grade were independent risk factors for PNI and the risk model that included these factors could predict the probability of PNI.
Topics: Humans; Retrospective Studies; Incidence; Neoplasm Invasiveness; Prognosis; Rectal Neoplasms; Carcinoma; Neoplasm Staging
PubMed: 37263883
DOI: 10.1016/j.clon.2023.05.008