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Concept: Prognosis

170

Transcatheter arterial chemoembolization (TACE) is the most widely used treatment option for unresectable hepatocellular carcinoma (HCC). Elevated serum YKL-40 level has been shown to predict poor prognosis in HCC patients undergoing resection. This study was designed to validate the prognostic significance of serum YKL-40 in patients with HCC undergoing TACE treatment.

Concepts: Lung cancer, Medical terms, Hepatocellular carcinoma, Hepatology, Radiology, Prognosis, Thought experiment, Transcatheter arterial chemoembolization

168

Spontaneous nystagmus, which has been considered a typical sign of acute vestibulopathy, has recently been reported in benign paroxysmal positional vertigo involving the lateral semicircular canals (LC-BPPV) without unilateral vestibulopathy (pseudo-spontaneous nystagmus, PSN), but research about its clinical application is still limited. Here we investigate the frequency and characteristics of PSN in LC-BPPV patients, and estimate its prognostic value.

Concepts: Medical terms, Semicircular canal, Prognosis, Ear, Canal, Pathologic nystagmus, Benign paroxysmal positional vertigo, Horizontal semicircular canal

168

The aim of this study was to determine the impact of prognostic factors in primary fallopian tube carcinoma (PFTC). All cases of PFTC diagnosed between 1990 and 2010 were retrieved from the files of 6 academic centers. The cases were staged according to a modification of the International Federation of Obstetrics and Gynecology staging system proposed by Alvarado-Cabrero et al (Gynecol Oncol 1999; 72: 367-379). One hundred twenty-seven PFTC cases were identified. The mean age of the patients was 64.2 years. Stage distribution was as follows: 72 (57%), stage I; 19 (15%), stage II; 28 (22%), stage III; and 8 (6.2%), stage IV. Depth of infiltration of the tubal wall was an independent prognostic factor in stage I cases (P < .001). Carcinomas located in the fimbriated end even without invasion had a worse prognosis than did carcinomas involving the tubal portion of the organ. The presence of vascular space invasion correlated with the depth of tubal wall invasion (P = .001) and the presence of lymph node metastases (P = .003). Tumor grade significantly correlated with survival (P < .0001), but histologic type was of marginal significance and only if it was grouped as nonserous/non-clear cell vs serous/clear cell (P = .04). The depth of invasion of the tubal wall and the presence of carcinoma in the fimbriated end even without invasion are important prognostic indicators. The modified International Federation of Obstetrics and Gynecology staging system should be used on a routine basis in all carcinomas of the fallopian tube.

Concepts: Cancer, Lung cancer, Cancer staging, Lymph node, Gynecology, Prognosis, Fallopian tube cancer, Obstetrics and gynaecology

167

BACKGROUND: Elevated Glasgow Prognostic Score (GPS) has been related to poor prognosis in patients with hepatocellular carcinoma (HCC) undergoing surgical resection or receiving sorafenib. The aim of this study was to investigate the prognostic value of GPS in patients with various stages of the disease and with different liver functional status. METHODS: One hundred and fifty patients with newly diagnosed HCC were prospectively evaluated. Patients were divided according to their GPS scores. Univariate and multivariate analyses were performed to identify clinicopathological variables associated with overall survival; the identified variables were then compared with those of other validated staging systems. RESULTS: Elevated GPS were associated with increased asparate aminotransferase ( P<0.0001), total bilirubin ( P<0.0001), decreased albumin (P<0.0001), alpha-fetoprotein ( P=0.008), larger tumor diameter ( P=0.003), tumor number ( P=0.041), vascular invasion ( P=0.0002), extra hepatic metastasis ( P=0.02), higher Child-Pugh scores (P<0.0001), and higher Cancer Liver Italian Program scores (P<0.0001). On multivariate analysis, the elevated GPS was independently associated with worse overall survival. CONCLUSIONS: Our results demonstrate that the GPS can serve as an independent marker of poor prognosis in patients with HCC in various stages of disease and different liver functional status.

Concepts: Cancer, Lung cancer, Cirrhosis, Liver, Multivariate statistics, Bilirubin, Prognosis, Jaundice

154

The anaplastic lymphoma kinase (ALK) gene rearrangement is a driver gene of non-small cell lung cancer (NSCLC). Positive expression of ALK gene rearrangement has been considered a molecular subtype of NSCLC, that there are special pathological characteristics and clinical prognosis. Furthermore, the tyrosine kinase inhibitor has demonstrated high effective in treating ALK positive NSCLC patients. Thus making molecular diagnostic testing for ALK expression is an important step in the process of pathological diagnosis. Currently, many detecting ALK expression assays are available or in development, clinical pathologists focus on how to choose the best method for routine diagnosis of lung cancer. There are many domestic and international authoritative guidelines recommend ALK detecting assays, technological process and relative standard. In the current review, we summarize the diagnostic tests available and the special sample types that could be used to identify patients with ALK-positive NSCLC.

Concepts: Gene expression, Cancer, Lung cancer, Non-small cell lung carcinoma, Pathology, Prognosis, Medical test, Anaplastic large cell lymphoma

138

The pathophysiology of cardiac syndrome X is multifactorial and endothelial dysfunction has been implicated as important contributing factor. Asymmetric dimethylarginine (ADMA), characterized as a circulating endogenous inhibitor of nitric oxide synthase, may have been implicated as an important contributing factor for the development of endothelial dysfunction. In this study, we aim to assess the predictive power of ADMA for long-term prognosis in patients with cardiac syndrome X.

Concepts: Endothelium, Nitric oxide, Prognosis, Asymmetric dimethylarginine, Arginine, Syndrome X, Cardiac syndrome X

116

Soluble mesothelin is beneficial to detect the progression and the treatment response of malignant pleural mesothelioma. However, the prognostic value of soluble mesothelin in malignant pleural mesothelioma remains unclear.

Concepts: Cancer, Prognosis, Effect size, Mesothelioma

62

Intravenous fluid administration is an essential component of sepsis management, but a positive fluid balance has been associated with worse prognosis. We analyzed whether a positive fluid balance and its persistence over time was an independent prognostic factor in septic patients.

Concepts: Medical terms, Intravenous therapy, Prognosis

33

Prognoses will always have inherent uncertainty, which is often difficult for patients, their families, and even physicians to deal with. But there are ways that clinicians can communicate more effectively to help patients and families manage uncertainty.

Concepts: Hospital, Physician, Prognosis

31

The prognosis in lung cancer depends largely on early stage detection, and thus new screening methods are attracting increasing attention. Canine scent detection has shown promising results in lung cancer detection, but there has only been one previous study that reproduces a screening-like situation. Here breath samples were collected from 122 patients at risk for lung cancer (smokers and ex-smokers); 29 of the subjects had confirmed diagnosis of lung cancer but had not yet been treated and 93 subjects had no signs or symptoms of lung cancer at the time of inclusion. The breath samples were presented to a trained sniffer dog squadron in a double-blind manner. A rigid scientific protocol was used with respect to earlier canine scent detection studies, with one difference: instead of offering one in five positive samples to the dogs, we offered a random number of positive samples (zero to five). The final positive and negative predictive values of 30.9% and 84.0%, respectively, were rather low compared to other studies. The results differed from those of previous studies, indicating that canine scent detection might not be as powerful as is looked for in real screening situations. One main reason for the rather poor performance in our setting might be the higher stress from the lack of positive responses for dogs and handlers.

Concepts: Cancer, Metastasis, Lung cancer, Cancer staging, Addition, Prognosis, 0, Medical test