rubrica

Registri di patologia

  • Emanuele Crocetti1

  1. 1. UO Epidemiologia clinica e descrittiva, ISPO Firenze
Emanuele Crocetti -

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Ricerca bibliografica periodo dal 16 ottobre 2011 al 1 gennaio 2012

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Stringa: (("registries"[MeSH Terms] OR "registries"[All Fields] OR "registry"[All Fields]) OR ("registries"[MeSH Terms] OR "registries"[All Fields])) AND (("italy"[MeSH Terms] OR "italy"[All Fields]) OR italian[All Fields]) AND "humans"[MeSH Terms] AND ("2011/10/16"[PDat] : "2012/01/01"[PDat])
1. Pacini D, Tsagakis K, Jakob H, Mestres CA, Armaro A, Weiss G, Grabenwoger M, Borger MA, Mohr FW, Bonser RS, Di Bartolomeo R. The frozen elephant trunk for the treatment of chronic dissection of the thoracic aorta: a multicenter experience. Ann Thorac Surg. 2011 Nov;92(5):1663-70; discussion 1670. Epub 2011 Oct 31.
Department of Cardiac Surgery, Sant'Orsola-Malpighi Hospital, Bologna, Italy. dpacini@hotmail.com
Comment in "Ann Thorac Surg. 2011 Nov;92(5):1557-8"

Abstract
BACKGROUND: Because of the extensive involvement of the aorta, surgical treatment of its chronic dissection continues to represent a surgical challenge. We conducted a study of a multicenter experience to describe a multicenter experience in the treatment of this complex pathology, using the frozen elephant trunk (FET) technique.
METHODS: Between January 2005 and May 2010, 240 patients underwent treatment with the FET technique and had their clinical data collected in the International E-vita Open Registry. Ninety of the patients, who were the population in the present study, underwent operations for chronic dissection of the aorta (type A, 77%). The mean age of these 90 patients was 57 ± 12 years, and 72 (80%) of the patients were male. Sixty-two patients (69%) had undergone a previous aortic operation. All of the procedures in the study were performed with the aid of antegrade selective cerebral perfusion.
RESULTS: Total replacement of the aortic arch was done in 84 patients (93%). Cardiopulmonary bypass, myocardial ischemia, cerebral perfusion, and visceral ischemia times were 243 ± 65, 145 ± 48, 86 ± 24, and 75 ± 22 minutes, respectively. In-hospital mortality was 12% (11 patients). One patient died from a stroke and 8 patients (9%) died from ischemic spinal cord injury. The false lumen (FL) in the patients' aortae was evaluated with computed tomography after operation and during follow up. The rates of complete thrombosis of the FL around the elephant trunk were 69% and 79% at the first and last postoperative examinations, respectively. The rates of 4-year survival and freedom from aortic reoperation were 78% ± 5% and 96% ± 3%, respectively.
CONCLUSIONS: The treatment of chronic aortic dissection (AD) with the FET technique is feasible, with respectable results. The rate of aortic reoperation with the use of this technique appears to be lower than that with a conventional approach to the repair of chronic AD. Ischemic spinal cord injury represents a concerning complication of the FET technique but seems to be unrelated to thrombosis of the FL.

2. D'Angelo S, Palazzi C, Cantini F, Lubrano E, Marchesoni A, Mathieu A, Salvarani C, Scarpa R, Spadaro A, Olivieri I. Etanercept in spondyloarthopathies. Part II: safety and pharmacoeconomic issues. Clin Exp Rheumatol. 2011 Sep-Oct;29(5):865-70. Epub 2011 Oct 31.
Rheumatology Department of Lucania, San Carlo Hospital of Potenza, Italy. saldangelo@katamail.com

Abstract
Etanercept (ETN) and other anti-TNF-a agents have revolutionised the management of spondyloarthropathies (SpA). With the increasingly widespread and prolonged use of these drugs an assessment of their long-term safety is extremely important. An additional concern regarding biological agents is their higher costs compared with conventional drugs. We examined safety data regarding ETN from clinical reports, clinical trials, review articles, databases and registries. In addition, evidence was reviewed about the cost effectiveness of ETN in the treatment of patients with SpA. Our review suggests that ETN is well tolerated as long-term, continuous treatment of SpA with a favourable risk-benefit ratio maintained from 4 to 5 years. Diversity in structure and mode of action could explain some differences in the safety profile of ETN with respect to the other anti-TNF agents. In particular, ETN is less immunogenic and is less likely to induce tuberculosis re-activation than the other TNF-a antagonists. Although ETN is considerably more expensive than conventional therapy, it reduces direct and indirect costs associated to SpA by improving disease activity and quality of life. Recent pharmacoeconomic studies have demonstrated its cost-effectiveness in the treatment of SpA.

3. Gatta G, van der Zwan JM, Casali PG, Siesling S, Dei Tos AP, Kunkler I, Otter R, Licitra L, Mallone S, Tavilla A, Trama A, Capocaccia R; RARECARE working group Rare cancers are not so rare: the rare cancer burden in Europe. Eur J Cancer. 2011 Nov;47(17):2493-511. Epub 2011 Oct 25. .
Collaborators: Hackl M, Van Eycken E, Schrijvers D, Sundseth H, Geissler J, Marreaud S, Audisio R, Mägi M, Hedelin G, Velten M, Launoy G, Guizard AV, Bouvier AM, Maynadié M, Mercier M, Buemi A, Tretarre B, Colonna M, Molinié F, Lacour B, Schvartz C, Ganry O, Grosclaude P, Benhamou E, Grossgoupil M, Coquard IR, Droz JP, Baconnier S, Holleczek B, Wartenberg M, Hehlmann R, Tryggvadottir L, Deady S, Bellù F, Ferretti S, Serraino D, Vercelli M, Vitarelli S, Cirilli C, Fusco M, Traina A, Michiara M, Giacomin A, Pastore G, Tumino R, Mangone L, Falcini F, Senatore G, Budroni M, Piffer S, Crocetti E, La Rosa F, Contiero P, Zambon P, Berrino F, Casali PG, Gatta G, Gronchi A, Licitra L, Sowe S, Trama A, Capocaccia R, De Angelis R, Tavilla A, Dei Tos AP, Brandes AA, England K, Langmark F, Rachtan J, Mezyk R, Zwierko M, Bielska-Lasota M, Slowinski J, Miranda A, Safaei Diba Ch, Primic-Zakelj M, Mateos A, Izarzugaza I, Marcos R, Sánchez MJ, Ardanaz E, Galceran J, Virizuela-Echaburu JA, Martinez-Garcia C, Melchor JM, Cervantes A, Adolfsson J, Lambe M, Möller TR, Ringborg U, Jundt G, Usel M, Frick H, Ess SM, Bordoni A, Konzelmann I, Dehler S, Lutz JM, Visser O, Otter R, Siesling S, van der Zwan JM, Coebergh JW, Schouten H, Greenberg DC, Wilkinson J, Roche M, Verne J, Meechan D, Lawrence G, Coleman MP, Mackay J, Gavin A, Brewster DH, Kunkler I, Steward J.

Department of Preventive and Predictive Medicine, Fondazione IRCSS, Istituto Nazionale dei Tumori, Via Venezian 1, Milan, Italy. gemma.gatta@istitutotumori.mi.it

Abstract
PURPOSE: Epidemiologic information on rare cancers is scarce. The project Surveillance of Rare Cancers in Europe (RARECARE) provides estimates of the incidence, prevalence and survival of rare cancers in Europe based on a new and comprehensive list of these diseases.
MATERIALS AND METHODS: RARECARE analysed population-based cancer registry (CR) data on European patients diagnosed from 1988 to 2002, with vital status information available up to 31st December 2003 (latest date for which most CRs had verified data). The mean population covered was about 162,000,000. Cancer incidence and survival rates for 1995-2002 and prevalence at 1st January 2003 were estimated.
RESULTS: Based on the RARECARE definition (incidence <6/100,000/year), the estimated annual incidence rate of all rare cancers in Europe was about 108 per 100,000, corresponding to 541,000 new diagnoses annually or 22% of all cancer diagnoses. Five-year relative survival was on average worse for rare cancers (47%) than common cancers (65%). About 4,300,000 patients are living today in the European Union with a diagnosis of a rare cancer, 24% of the total cancer prevalence.
CONCLUSION: Our estimates of the rare cancer burden in Europe provide the first indication of the size of the public health problem due to these diseases and constitute a useful base for further research. Centres of excellence for rare cancers or groups of rare cancers could provide the necessary organisational structure and critical mass for carrying out clinical trials and developing alternative approaches to clinical experimentation for these cancers.

Commento a cura di E. Crocetti
Si tratta di un grande studio descrittivo che ha l’obiettivo di valutare i principali indicatori epidemiologici, incidenza, sopravvivenza e prevalenza, dei tumori rari in Europa sulla base dei dati dei registri tumori di popolazione. Il primo problema che è stato affrontato è stato quello della loro definizione per la quale è stato scelto un approccio quantitativo, ovvero un numero di diagnosi, un’incidenza <6 casi /100.000 persone-anno. Sulla base di questo cut-off è stata stilata una lista di entità topo-morfologiche che è disponibile, assieme ad altro materiale, nel sito del progetto (www.rarecare.eu). La disaggregazione in sede e morfologia fa sì che molti tumori possano essere definiti rari, ovvero non raggiungano la soglia minima d’incidenza, tanto che un quinto del totale dei tumori stimati in Europa risultano rari. Sebbene i tumori rari se considerati nel loro complesso sono tutt’altro che rari, questo non riduce né modifica la problematica della singola patologia oncologica rara che per la sua specifica infrequenza presenta difficoltà sia in fase diagnostiche che di trattamento. Singole tipologie di tumore raro devono essere diagnosticate e trattate in centri di alta specialità dove ci possa essere assieme ad una concentrazione quantitativa della casistica lo sviluppo proporzionale della competenza sanitaria per una adeguata gestione clinica.

4. Cei M, Mumoli N. Areas of uncertainty in prophylaxis of venous thromboembolism in unselected subjects. South Med J. 2011 Nov;104(11):770-5.
Department of Internal Medicine, Livorno Hospital, Livorno, Italy. marcocei59@gmail.com

Abstract
In the last decade, parenteral anticoagulants have proven to be effective in the prevention of venous thromboembolism (VTE) in patients admitted to hospitals. Despite this, some registry studies have shown that pharmacological prophylaxis is still widely underused. We performed a literature search to identify important knowledge gaps in the use of VTE prophylaxis that were not addressed by previous published reports. MEDLINE and HighWire databases covering the years 1999-2009 were searched; only clinical trials of unselected adult subjects were included. Two reviewers independently selected studies and extracted data on inclusion and exclusion criteria, age, weight, comorbidities, study designs, and endpoints. Five of 113 relevant studies were identified from the literature search. Knowledge gaps were disclosed in subject inclusion, exclusion, and stratification regarding young age, under- and overweight, comorbidities, and the selection of clinically significant endpoints. Uncertainties in the dosage, risk stratification of subjects, and effect on hard endpoints as prevention of pulmonary embolism or reduction of mortality reduce the impact of VTE prevention clinical trials.

5. Beghi E, Pupillo E, Messina P, Giussani G, Chiò A, Zoccolella S, Moglia C, Corbo M, Logroscino G; EURALS Group. Coffee and amyotrophic lateral sclerosis: a possible preventive role. Am J Epidemiol. 2011 Nov 1;174(9):1002-8. Epub 2011 Sep 26.
Laboratory of Neurological Disorders, ‘‘Mario Negri’’ Institute, Via G. la Masa 19, 20156 Milano, Italy. ettore.beghi@marionegri.it

Abstract
The relation between coffee intake and risk of amyotrophic lateral sclerosis (ALS) was investigated in 377 newly diagnosed ALS patients from 4 Italian population-based registries in the European ALS Consortium (EURALS Group) (2007-2010). For each patient, 2 age- and sex-matched hospital controls were selected, one from a neurology department and one from a nonneurologic department. Two additional healthy control groups were identified from local general practitioners' (GPs') lists (n = 99) and residents of the same area as a cancer cohort (n = 7,057). Coffee intake was defined in terms of status (ever consuming coffee daily for =6 months vs. never), duration, and history (never, former, or current). Ever coffee drinkers comprised 74.7% of ALS patients, 80.4% of neurologic controls, 85.6% of nonneurologic controls (P = 0.0004), 88.9% of GP controls (P = 0.0038), and 86.0% of cancer cohort controls (P<0.0001). Current coffee drinkers comprised 60.2% of ALS patients, 70.2% of neurologic controls (P = 0.0294), 76.4% of nonneurologic controls (P < 0.0001), and 82.3% of GP controls (P = 0.0002); duration of intake was =30 years for 62.3%, 67.7%, 74.7%, and 72.6%. ALS patients had lower lifetime coffee exposure: Odds ratios were 0.7 (95% confidence interval (CI): 0.5, 1.1), 0.6 (95% CI: 0.4, 0.8), and 0.4 (95% CI: 0.2, 0.9) in comparison with neurologic, nonneurologic, and GP controls, respectively. In current (vs. never) coffee drinkers, odds ratios were 0.7 (95% CI: 0.5, 1.0), 0.5 (95% CI: 0.3, 0.7), and 0.4 (95% CI: 0.2, 0.8), respectively. These findings provide epidemiologic evidence of an inverse correlation between coffee intake and ALS risk.

6. Dorigo W, Pulli R, Castelli P, Dorrucci V, Ferilli F, De Blasis G, Monaca V, Vecchiati E, Pratesi C; Propaten Italian Registry Group. A multicenter comparison between autologous saphenous vein and heparin-bonded expanded polytetrafluoroethylene (ePTFE) graft in the treatment of critical limb ischemia in diabetics. J Vasc Surg. 2011 Nov;54(5):1332-8. Epub 2011 Aug 15.
Department of Vascular Surgery, University of Florence, Florence, Italy. dorigow@unifi.it

Abstract
OBJECTIVES: The aim of this study was to evaluate early and follow-up results of below-knee bypasses performed using a bioactive heparin-treated expanded polytetrafluoroethylene (ePTFE) graft in diabetic patients with critical limb ischemia (CLI) in a multicenter retrospective registry involving seven Italian vascular centers and to compare them with those obtained in patients operated on with autologous saphenous vein (ASV) in the same centers in the same period of time.
METHODS: Over an 8-year period, ending in 2009, a heparin-bonded prosthetic graft (Propaten Gore-Tex; W. L. Gore & Associates Inc, Flagstaff, Ariz) was implanted in 180 diabetic patients undergoing below-knee revascularization for CLI in seven Italian hospitals (group 1). In the same period in these seven centers, 133 below-knee bypasses with ipsilateral ASV in diabetics with CLI were performed (group 2). Data concerning these interventions were retrospectively collected in a multicenter registry with a dedicated database. Early (<30 days) results were analyzed in terms of graft patency, major amputation rates, and mortality. Follow-up results were analyzed in terms of primary and secondary graft patency, limb salvage, and survival.
RESULTS: The interventions consisted of below-knee bypasses in 132 cases in group 1 (73%) and in 45 cases in group 2 (33%; P < .001); 48 patients in group 1 (27%) and 88 patients in group 2 (67%; P < .001) had distal tibial anastomosis. Patients in group 1 had more frequently adjunctive procedures performed at distal anastomotic sites to improve run-off status. Postoperative and long-term medical treatment consisted of single antiplatelet therapy in 93 cases (52%) in group 1 and in 64 cases (48%, P = ns) in group 2, of double antiplatelet therapy in 18 cases (10%) in group 1 and in four cases (3%; P = .05) in group 2 and of oral anticoagulants in 69 patients in group 1 (38%) and in 65 (49%; P = .02) in group 2. Mean duration of follow-up was 28.3 ± 21.4 months; 308 patients (98%) had at least one postoperative clinical and ultrasonographic examination and 228 (72%) reached at least a 1-year follow-up. Estimated 48-month survival rates were 76.6% in group 1 and 72.7% in group 2 (P = > .9, log-rank 0.08). Primary patency rate at 48 months was significantly better in group 2 (63.5%) than in group 1 (46.3%; P = .03, log-rank 4.1). Assisted primary patency rates at 48 months were 47.3% (SE 0.05) in group 1 and 69% (SE 0.05) in group 2 (P = .01, log-rank 6.3). The rates of secondary patency at 48 months were 57.5% in group 1 and 69.6% in group 2 (P = .1, log-rank 2.3); the corresponding values in terms of limb salvage and amputation free-survival rates were 75.4% and 82.4% (P = .3, log-rank 1), and 59.9% and 64.4% (P = .3, log-rank 0.9), respectively.
CONCLUSIONS: Data from this large, retrospective registry confirmed that the indexed heparin-bonded ePTFE graft provides satisfactory early and midterm results in diabetic patients undergoing surgical treatment of CLI. While autologous saphenous vein maintains its superiority in terms of primary patency, secondary patency rates are not statistically different, even in the presence of a trend for improved secondary patency with vein graft; and also limb salvage rates are comparable.

7. Di Bartolomeo S, Ventura C, Marino M, Chieregato A, Gambale G, Fabbri A, Volpi A, De Palma R. Is the TMPM-ICD9 revolution in trauma risk-adjustment compatible with imperfect administrative coding? Accid Anal Prev. 2011 Nov;43(6):1955-9. Epub 2011 Jun 8.
Anaesthesia and ICU S.M.M. Hospital, Udine/Regional Health Agency of Emilia-Romagna, Viale Aldo Moro 21, 40127 Bologna, Italy. stefano.dibartolomeo@uniud.it

Abstract
BACKGROUND: TMPM-ICD9 is the latest injury-severity measure based on empirical estimation from ICD-9-CM codes. It is candidate to replace expert-based AIS measures worldwide because of easier accessibility and better predictive performances. In Italy and other countries administrative ICD coding is generally less complete than dedicated AIS coding. We attempted to ascertain how this affects TMPM performances.
METHODS: Discrimination (c statistics) and calibration (calibration curves, Akaike's criterion) of hierarchical logistic regression models for hospital mortality comprising TMPM or ISS were compared using trauma-registry data on 3570 patients of years 2007-2009. The completeness of AIS vs. ICD-9-CM coding was also investigated through the ratio of the respective numbers of codes per patient. Model discrimination was further analyzed after stratification according to the above ratio (>1 and = 1).
RESULTS: The models with TMPM showed worse performances. The differences, concerned calibration (graphical evidence) in univariate models and discrimination (-1.2% of area under the ROC curve, p<0.05) in models completed with age, gender, mechanism of injury, motor GCS and systolic pressure. In parallel, ICD coding was less complete than AIS, as expected: 68% of patients had a ratio >1. The discrimination of TMPM vs. ISS models improved when the ratio changed from >1 to = 1.
CONCLUSIONS: The predictive performances of TMPM-ICD9 vs. ISS were lower than in the previous studies; the sub-optimal quality of ICD coding was a main cause. Imperfect administrative coding may hence hamper the TMPM-ICD9 revolution, although in our setting the negligible differences and the ready availability of administrative data may still give reason for adopting TMPM-ICD9.

8. Mani K, Lees T, Beiles B, Jensen LP, Venermo M, Simo G, Palombo D, Halbakken E, Troëng T, Wigger P, Björck M.. Treatment of abdominal aortic aneurysm in nine countries 2005-2009: a vascunet report. Eur J Vasc Endovasc Surg. 2011 Nov;42(5):598-607. Epub 2011 Jul 19
Department of Vascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK. kevin.mani@surgsci.uu.se

Abstract
OBJECTIVES: To study contemporary treatment and outcome of abdominal aortic aneurysm (AAA) repair in nine countries.
DESIGN AND METHODS: Data on primary AAA repairs 2005-2009 were amalgamated from national and regional vascular registries in Australia, Denmark, Finland, Hungary, Italy, Norway, Sweden, Switzerland and the UK. Primary outcome was in-hospital or 30-day mortality. Multivariate logistic regression was used to assess case-mix.
RESULTS: 31,427 intact AAA repairs were identified, mean age 72.6 years (95% CI 72.5-72.7). The rate of octogenarians and use of endovascular repair (EVAR) increased over time (p < 0.001). EVAR varied between countries from 14.7% (Finland) to 56.0% (Australia). Overall perioperative mortality after intact AAA repair was 2.8% (2.6-3.0) and was stable over time. The perioperative mortality rate varied from 1.6% (1.3-1.8) in Italy to 4.1% (2.4-7.0) in Finland. Increasing age, open repair and presence of comorbidities were associated with outcome. 7040 ruptured AAA repairs were identified, mean age 73.8 (73.6-74.0). The overall perioperative mortality was 31.6% (30.6-32.8), and decreased over time (p = 0.004).
CONCLUSIONS: The rate of AAA repair in octogenarians as well as EVAR increased over time. Perioperative outcome after intact AAA repair was stable over time, but improved after ruptured repair. Geographical differences in treatment of AAA remain.

9. Gugliotta L, Tieghi A, Tortorella G, Scalzulli PR, Ciancia R, Lunghi M, Cacciola E, Cacciola R, Candoni A, Crugnola M, Codeluppi K, Usala E, Specchia G, Martinelli V, Palmieri F, Pierri I, Liberati AM, Iurlo A, Grossi A, Vannucchi AM, Vianelli N, Mazzucconi MG. Low impact of cardiovascular adverse events on anagrelide treatment discontinuation in a cohort of 232 patients with essential thrombocythemia. Leuk Res. 2011 Dec;35(12):1557-63. Epub 2011 Jul 20.
Hematology Institute L e A Seragnoli, University Hospital, Bologna, Italy. luigi.gugliotta@unibo.it

Comment in Leuk Res. 2011 Dec;35(12):1543-4.

Abstract
This retrospective study of the thrombocythemia Italian registry (RIT) documented that 71 (30.6%) out of 232 ET patients experienced 88 cardiovascular adverse events (CV-AEs) during anagrelide treatment (522 pt-y). The rate of CV-AEs was: 24.1% for palpitations, 4.3% for angina, 3.5% for arterial hypertension, 3.0% for congestive heart failure, 1.8% for arrhythmia, 0.9% for AMI, 0.4% for pericardial effusion. CV-AEs led to treatment discontinuation in nine (3.9%) patients, while in the remaining cases they were managed by pharmacological intervention and/or patient life style improvement. CV-AEs had no relationship with patient characteristics (including older age). A significant relationship was found only with a higher anagrelide induction dose. In the absence of any agreed protocol, a cardiovascular instrumental evaluation (CV-IE) was performed in 102 (44%) patients before commencement of anagrelide (with higher rate after the anagrelide/Xagrid EMA approval of 2004), and in 84 (36%) patients during treatment. Patients with and without CV-IEs, who resulted completely balanced for all their characteristics, did not significantly differ in the occurrence of CV-AEs. In conclusion, this study on ET patients treated with anagrelide shows that CV-AEs, equally distributed in younger and older subjects, were mostly mild and easily manageable, allowing safe treatment continuation in the majority of cases. Moreover, routinely performing a CV-IE did not appear to anticipate the occurrence of CV-AEs.

10. Falco P, Levis A, Stacchini A, Ciriello MM, Geuna M, Notari P, Omedè P, Pautasso M, Prato G, Strola G, Gioia D, Bonferroni M, Cametti G, Ferrero D, Freilone R, Gaidano G, Marinone C, Marmont F, Pollio B, Salvi F, Saglio G, Girotto M; Piedmont MDS Registry--Italy. Prognostic relevance of cytometric quantitative assessment in patients with myelodysplastic syndromes. Eur J Haematol. 2011 Nov;87(5):409-18. doi: 10.1111/j.1600-0609.2011.01676.x. Epub 2011 Aug 11.
Collaborators: Darbesio A, Giobatta C, Mezzabotta M, Montalenti P, Monferrato C, Paccagnino L, Pagetto A, Salomone A, Tonso A.

Division of Hematology and Transfusional Medicine ASLTO4, Via Marchesi della Rocca 30, Ciriè, Turin. pfalco@aslto4.piemonte.it

Abstract
OBJECTIVES: Morphology and cytogenetics are currently used to define prognosis in myelodysplastic syndromes (MDS). However, these parameters have some limits. Flow cytometry has been recently included in the diagnostic panel for MDS, and its prognostic significance is under evaluation.
METHODS: Marrow aspirates from 424 MDS patients were analyzed by flow cytometry to evaluate the impact of bone marrow cell immunophenotype on overall survival (OS) and leukemia-free survival (LFS). The immature compartment of myeloblasts was analyzed by the quantitative expression of CD34 (<3% vs. =3%), CD117, and CD11b(-) /CD66b(-) (<5% vs. =5%); myeloid maturation was analyzed by the expression of CD11b(+) /CD66b(++) (<15% vs. =15%) and CD11b(+) /CD66b(+) (<25% vs. =25%).
RESULTS: In univariate analysis, the expression of immaturity markers (CD34(+) , CD117(+) , and CD11b(-) /CD66b(-) ) was associated with shorter LFS and OS (P < 0.0001); higher expression of differentiation markers (CD11b(+) /CD66b(++) and CD11b(+) /CD66b(+) ) was associated with longer LFS (P < 0.0001 and P = 0.0002, respectively) and OS (P < 0.0001). In multivariate analysis, expression of CD34(+) (P = 0.007), CD117(+) (P = 0.013), and CD11b(+) /CD66b(++) (P = 0.023) retained independent prognostic value for OS, while only the expression of CD34(+) was a prognostic factor for LFS (P = 0.0003). Two different risk groups were defined according to the presence of 0-1 or =2 of these factors with significant different LFS and OS (P < 0.0001). This score showed prognostic value in predicting survival even in subanalysis according to IPSS and WHO subgroups.
CONCLUSIONS: Flow cytometric analysis in MDS may provide meaningful prognostic information. Blast percentage expressed as CD117(+) or CD34(+) cells and the quantitative assessment of myeloid maturation showed prognostic value for survival.

11. Motta M, del Vecchio A, Attuati L, Picozzi P, Perna L, Franzin A, Bolognesi A, Cozzarini C, Calandrino R, Mortini P, di Muzio N. Gamma knife radiosurgery for treatment of cerebral metastases from non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2011 Nov 15;81(4):e463-8. Epub 2011 Apr 27.
Radiotherapy Department, San Raffaele Scientific Institute, Milan, Italy. mail: motta.micaela@hsr.it

Abstract
PURPOSE: To evaluate clinical and physico-dosimetric variables affecting clinical outcome of patients treated with Gamma Knife radiosurgery (GKRS) for brain metastases from non-small cell lung cancer (NSCLC).
METHODS AND MATERIALS: Between 2001 and 2006, 373 patients (298 men and 75 women, median age 65 years) with brain metastases from NSCLC underwent GKRS. All of them had KPS = 60%, eight or fewer brain metastases, confirmed histopathological diagnosis and recent work-up (<3 months). Thirty-five patients belonged to recursive partitioning analysis (RPA) Class I, 307 patients were in RPA Class II, 7 patients were in RPA Class III. Median tumor volume was 3.6 cm(3). Median marginal dose was 22.5 Gy at 50% isodose.; median 10 Gy and 12 Gy isodose volumes were 30.8 cm(3) and 15.8 cm(3), respectively. Follow-up with MRI was performed every 3 months. Overall survival data were collected from internal database, telephone interviews, and identifying registries.
RESULTS: Mean follow-up after GKRS was 51 months (range, 6 to 96 months); mean overall survival was 14.2 months. Of 373 patients, 29 were alive at time of writing, 104 had died of cerebral progression, and 176 had died of systemic progression. In 64 cases it was not possible to ascertain the cause. Univariate and multivariate analysis were adjusted for the following: RPA class, surgery, WBRT, age, gender, number of lesions, median tumor volume, median peripheral dose, and 10 Gy and 12 Gy volumes. Identified RPA class and overall tumor volume >5 cc were the only two covariates independently predictive of overall survival in patients who died of cerebral progression.
CONCLUSIONS: Global volume of brain disease should be the main parameter to consider for performing GKRS, which is a first-line therapy for patient in good general condition and controlled systemic disease.

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