Comparative analysis of primary repair vs resection and anastomosis, with laparostomy, in management of typhoid intestinal perforation: results of a rural hospital in northwestern Benin
The objective is to compare primary repair vs intestinal resection in cases of intestinal typhoid perforations. In addition, we hypothesised the usefulness of laparostomy for the early diagnosis and treatment of complications.
Factors associated with developing esophageal adenocarcinoma in Barett's esop...Dr Sayan Das
Based on the study “Rates and predictors of progression to esophageal carcinoma in a large population-based Barrett’s esophagus cohort” by Krishnamoorthi R et al published in “HHS Public Access” on 2016 July
This document summarizes two recent studies on prognostic biomarkers for hepatocellular carcinoma (HCC). The first study found that high levels of C-reactive protein (CRP), an inflammatory marker, predicts poor long-term survival for patients with HCC undergoing nonsurgical treatments. The second study found that low levels of CD4+ cytotoxic T lymphocytes (CTLs), part of the immune system, predicts poor outcomes and high recurrence rates for HCC patients. Both inflammatory and immunological markers may provide prognostic information to supplement current clinical staging systems for HCC. However, more research is still needed to validate the prognostic value of these biomarkers.
This document describes a student research project using pathway analysis to analyze results from a genome-wide association study of pancreatic cancer survival data. The student aims to identify pathways associated with disease progression and locate genetic mutations influencing patient prognosis. Two software programs, GSA-SNP and ICSNPathway, are used to analyze GWAS data from 252 pancreatic cancer patients based on predefined gene sets and pathways. The goal is to gain insight into pancreatic cancer mechanisms and their relationship to candidate pathways identified.
Introduction: Biochemical recurrence after radical prostatectomy has been associated with Gleason pattern 5(GP5) and Prostatic
Specifi c Antigen (PSA) is a sensitive marker of relapse. Was analyzed the correlation between the Gleason score 7(group 2 e 3), pattern Gleason 5, biochemical recurrence and its correlation with other adverse histological findings. Material and Methods: Historic cohort comprising 219 patients, subjected to score 7 radical prostatectomy with acinar adenocarcinoma. and GP5 represents 5% or less of tumor size. Recurrence was determined as postoperative PSA less or equal 0.2/ ml in the second postprostatectomy assessment. Were considered as signifi cant value of p < or equal to 0,005. All statistical analysis were conducted using the SPSS (SPSS Inc: released 2009, version 18.0, Chicago, IL, USA).
Computational challenges in precision medicine and genomicsGary Bader
Genomics is mapping complex data about human biology and promises major medical advances. In particular, genomics is enabling precision medicine, the use of a patient's genome and physiological state to improve therapeutic efficacy and outcome. However, routine use of genomics data in medical research is in its infancy, due mainly to the challenges of working with "Big data". These data are so complex and large that typical researchers are not able to cope with them. Collectively, these data require an understanding of many aspects of experimental biology and medicine to correctly process and interpret. Data size is also an issue, as individual researchers may need to handle tens of terabytes (genomes from a few hundred patients), which is challenging to download and store on typical workstations. To effectively support precision medicine, scientists from a wide range of disciplines, including computer science, must develop algorithms to improve precision medicine (e.g. diagnostics and prognostics), genome interpretation, raw data processing and secure high performance computing.
Optimal schedule of Bacillus Calmette-Guerin for non-muscle-invasive bladder ...Enrique Moreno Gonzalez
To explore the necessity of maintenance, efficacy of low-dose and superiority of various combination therapies of Bacillus Calmette-Guérin (BCG) in treatment of superficial bladder cancer (BCa).
Cost-effectiveness of MRI for breast cancer screening in BRCA1/2 mutation car...Enrique Moreno Gonzalez
Women with mutations in BRCA1 or BRCA2 are at high risk of developing breast cancer and, in British Columbia, Canada, are offered screening with both magnetic resonance imaging (MRI) and mammography to facilitate early detection. MRI is more sensitive than mammography but is more costly and produces more false positive results. The purpose of this study was to calculate the cost-effectiveness of MRI screening for breast cancer in BRCA1/2 mutation carriers in a Canadian setting.
Post-diagnosis hemoglobin change associates with overall survival of multiple...Enrique Moreno Gonzalez
Anemia refers to low hemoglobin (Hb) level and is a risk factor of cancer patient survival. The National Comprehensive Cancer Network recently suggested that post-diagnosis Hb change, regardless of baseline Hb level, indicates the potential presence of anemia. However, there is no epidemiological study evaluating whether Hb change has direct prognostic values for cancer patients at the population level.
Factors associated with developing esophageal adenocarcinoma in Barett's esop...Dr Sayan Das
Based on the study “Rates and predictors of progression to esophageal carcinoma in a large population-based Barrett’s esophagus cohort” by Krishnamoorthi R et al published in “HHS Public Access” on 2016 July
This document summarizes two recent studies on prognostic biomarkers for hepatocellular carcinoma (HCC). The first study found that high levels of C-reactive protein (CRP), an inflammatory marker, predicts poor long-term survival for patients with HCC undergoing nonsurgical treatments. The second study found that low levels of CD4+ cytotoxic T lymphocytes (CTLs), part of the immune system, predicts poor outcomes and high recurrence rates for HCC patients. Both inflammatory and immunological markers may provide prognostic information to supplement current clinical staging systems for HCC. However, more research is still needed to validate the prognostic value of these biomarkers.
This document describes a student research project using pathway analysis to analyze results from a genome-wide association study of pancreatic cancer survival data. The student aims to identify pathways associated with disease progression and locate genetic mutations influencing patient prognosis. Two software programs, GSA-SNP and ICSNPathway, are used to analyze GWAS data from 252 pancreatic cancer patients based on predefined gene sets and pathways. The goal is to gain insight into pancreatic cancer mechanisms and their relationship to candidate pathways identified.
Introduction: Biochemical recurrence after radical prostatectomy has been associated with Gleason pattern 5(GP5) and Prostatic
Specifi c Antigen (PSA) is a sensitive marker of relapse. Was analyzed the correlation between the Gleason score 7(group 2 e 3), pattern Gleason 5, biochemical recurrence and its correlation with other adverse histological findings. Material and Methods: Historic cohort comprising 219 patients, subjected to score 7 radical prostatectomy with acinar adenocarcinoma. and GP5 represents 5% or less of tumor size. Recurrence was determined as postoperative PSA less or equal 0.2/ ml in the second postprostatectomy assessment. Were considered as signifi cant value of p < or equal to 0,005. All statistical analysis were conducted using the SPSS (SPSS Inc: released 2009, version 18.0, Chicago, IL, USA).
Computational challenges in precision medicine and genomicsGary Bader
Genomics is mapping complex data about human biology and promises major medical advances. In particular, genomics is enabling precision medicine, the use of a patient's genome and physiological state to improve therapeutic efficacy and outcome. However, routine use of genomics data in medical research is in its infancy, due mainly to the challenges of working with "Big data". These data are so complex and large that typical researchers are not able to cope with them. Collectively, these data require an understanding of many aspects of experimental biology and medicine to correctly process and interpret. Data size is also an issue, as individual researchers may need to handle tens of terabytes (genomes from a few hundred patients), which is challenging to download and store on typical workstations. To effectively support precision medicine, scientists from a wide range of disciplines, including computer science, must develop algorithms to improve precision medicine (e.g. diagnostics and prognostics), genome interpretation, raw data processing and secure high performance computing.
Optimal schedule of Bacillus Calmette-Guerin for non-muscle-invasive bladder ...Enrique Moreno Gonzalez
To explore the necessity of maintenance, efficacy of low-dose and superiority of various combination therapies of Bacillus Calmette-Guérin (BCG) in treatment of superficial bladder cancer (BCa).
Cost-effectiveness of MRI for breast cancer screening in BRCA1/2 mutation car...Enrique Moreno Gonzalez
Women with mutations in BRCA1 or BRCA2 are at high risk of developing breast cancer and, in British Columbia, Canada, are offered screening with both magnetic resonance imaging (MRI) and mammography to facilitate early detection. MRI is more sensitive than mammography but is more costly and produces more false positive results. The purpose of this study was to calculate the cost-effectiveness of MRI screening for breast cancer in BRCA1/2 mutation carriers in a Canadian setting.
Post-diagnosis hemoglobin change associates with overall survival of multiple...Enrique Moreno Gonzalez
Anemia refers to low hemoglobin (Hb) level and is a risk factor of cancer patient survival. The National Comprehensive Cancer Network recently suggested that post-diagnosis Hb change, regardless of baseline Hb level, indicates the potential presence of anemia. However, there is no epidemiological study evaluating whether Hb change has direct prognostic values for cancer patients at the population level.
This document summarizes the current state of evidence on prostate cancer screening using PSA tests. Two major randomized trials, ERSPC and PLCO, showed mixed results on the efficacy of PSA screening, with ERSPC finding a small reduction in prostate cancer mortality but PLCO finding no reduction. Several organizations now recommend against routine PSA screening or recommend shared decision making. While screening may reduce prostate cancer deaths by around 1 per 1000 men screened, it also leads to many false positives and overdiagnosis of indolent cancers, with significant harms from treatment. The benefits of screening remain small compared to the harms. Rates of PSA screening in the US have declined since 2012 guidelines, providing a natural experiment
- The Personalized OncoGenomics (POG) program at the British Columbia Cancer Agency conducted whole-genome analysis on tumors from 100 patients with advanced or incurable cancers to inform treatment decisions.
- Fresh tumor and blood samples were obtained from patients and underwent whole-genome and RNA sequencing. Computational analysis identified potential driver mutations, genes and pathways.
- A multidisciplinary team discussed genomic findings weekly and established guidelines for interpreting and communicating results to integrate them into patient care. Genomic findings were considered actionable in 55 of 78 cases that underwent whole-genome analysis, and motivated treatment changes in 23 cases.
- The experience demonstrated that a multidisciplinary team can implement an approach where whole-genome
Update on Systemic Therapy for Metastatic Pancreas AdenocarcinomaOSUCCC - James
The document discusses treatment options for metastatic pancreatic cancer. For first-line therapy, FOLFIRINOX is an option but is reserved for younger, healthier patients due to toxicity. Gemcitabine plus nab-paclitaxel is a preferred first-line option. For second-line therapy after progression on gemcitabine, nanoliposomal irinotecan plus 5-FU/LV has shown a survival benefit compared to 5-FU/LV alone. Molecular profiling of pancreatic tumors has identified subtypes that could help guide targeted therapies, and immune-based approaches also offer promise. The James Cancer Hospital is conducting clinical trials evaluating novel combinations for both first-line and second-line metastatic pancreatic cancer
BRAF mand CDKN2A deletion define a clinically distinct subgroup of childhood ...Joshua Mangerel
This study analyzed the genomic alterations in 26 cases of pediatric secondary high-grade glioma (sHGG) that developed from an initial diagnosis of pediatric low-grade glioma (PLGG). Whole-exome sequencing of 7 sHGG cases found a high mutation burden and alterations in chromatin-modifying genes. The most recurrent genetic alterations were BRAF V600E mutations, present in 39% of sHGGs, and CDKN2A deletions, present in 57% of sHGGs. Importantly, the BRAF and CDKN2A alterations could be traced back to the original PLGG in most cases. Patients with BRAF-mutant PLGG had a significantly longer
Сравнение эффективности препаратов Карбоплатин (Carboplatin) и Паклитаксел (P...oncoportal.net
Сравнение эффективности препаратов Карбоплатин (Carboplatin) и Паклитаксел (Paclitaxel) при добавлении препарата Бевацизумаб (Bevacizumab) и без него для лечения одной их форм рака легкого у пациентов старше 65 лет
in Older Patients With Advanced Non–Small Cell Lung Cancer
Precision Medicine in Oncology InformaticsWarren Kibbe
Precision medicine in oncology aims to provide targeted cancer treatments based on a patient's individual tumor characteristics. The presentation discusses precision oncology initiatives including NCI-MATCH clinical trials which assign cancer therapies based on a tumor's molecular abnormalities rather than location. It outlines plans to expand genomically-based cancer trials, understand and overcome treatment resistance through molecular analysis, and establish a national cancer database integrating genomic and clinical data to accelerate cancer research. Cloud computing platforms are being developed to provide researchers access to large cancer genomic and clinical datasets. The goal is to advance precision cancer treatment by incorporating individual patient genetics and biomarkers into therapeutic decision making.
Ohio States 2016 ASH Review Blood and Marrow TransplantationOSUCCC - James
Ohio State’s 2016 ASH Review
Blood and Marrow Transplantation
Basem M. William, MD, MRCP(UK), FACP
Assistant Professor of Internal Medicine
Blood and Marrow Transplant Program
Development and internal validation of a multivariable prediction model for b...Max Peters
This document describes the development and internal validation of a prediction model for biochemical failure (BF) after salvage iodine-125 brachytherapy for recurrent prostate cancer. 62 patients who underwent salvage brachytherapy between 1993-2010 were studied. Multivariable analysis identified disease-free survival interval after primary therapy and pre-salvage prostate-specific antigen doubling time as predictors of BF, with higher intervals and doubling times associated with lower risk. The model had moderate discriminatory ability (optimism-adjusted C-statistic 0.70) and accurate calibration up to 36 months. Patients with doubling time >30 months and interval >60 months had >75% 3-year biochemical disease-free survival.
Usefulness of Serum Carcinoembryonic Antigen (CEA) in evaluating response to ...Enrique Moreno Gonzalez
High serum carcinoembryonic antigen (CEA) levels are an independent prognostic factor for recurrence and survival in patients with non-small cell lung cancer (NSCLC). Its role as a predictive marker of treatment response has not been widely characterized.
This document provides information about various research projects and areas of expertise at the UVM Medical Center. It describes projects related to osteoporosis, inter-hospital transfers, chronic kidney disease, asthma, vaccinations, liver disease, critical care, and more. Contact information is provided for principal investigators studying topics like statin use in chronic kidney disease, acute kidney injury following cardiopulmonary bypass, and physiological phenotyping of asthma.
This study aims to assess the immune competence of ovarian cancer patients after chemotherapy treatment by vaccinating them against hepatitis B virus (HBV) and measuring the antibody response. Patients who completed chemotherapy 3-12 months prior will be divided into two groups based on time since chemotherapy. All patients will receive the HBV vaccine and have antibody levels measured over time. The study will investigate if antibody responses differ between the two groups and correlate levels of the immune checkpoint proteins PD-L1 and PD-1 with clinical outcomes. Results so far show higher antibody responses in patients vaccinated sooner after chemotherapy. Continued recruitment is planned along with additional immune analyses.
Association between genomic recurrence risk and well-being among breast cance...Enrique Moreno Gonzalez
Gene expression profiling (GEP) is increasingly used in the rapidly evolving field of personalized medicine. We sought to evaluate the association between GEP-assessed of breast cancer recurrence risk and patients’ well-being.
Chapter 15 precision medicine in oncologyNilesh Kucha
This document discusses precision medicine in oncology and molecular monitoring of cancer patients. It describes how molecular characterization of tumors can guide treatment decisions and help develop targeted therapies. Next-generation DNA sequencing is allowing large amounts of tumor DNA to be analyzed to identify molecular targets and guide clinical trials matching treatments to tumor mutations. Challenges include limiting sequencing to known targets, accounting for germline variants, incidental findings, and integrating sequencing results into clinical decision making. Repeated biopsies during treatment can provide insights into drug sensitivity and resistance mechanisms in individual patients.
SILS 2015 - Connecting Precision Medicine to Precision Wellness Sherbrooke Innopole
By: Joel Dudley, Mount Sinai School of Medicine
At Sherbrooke International Life Sciences Summit - 2nd edition | September 28/29/30 2015
www.sils-sherbrooke.com
Personalized Medicine in Diagnosis and Treatment of Cancer Maryam Rafati
The document discusses next generation sequencing (NGS) and its applications in personalized medicine for cancer diagnosis and treatment. It provides examples of several families with hereditary cancer syndromes who were analyzed using NGS to identify pathogenic variants. The results demonstrated higher response rates and prolonged progression-free and overall survival for cancer patients receiving personalized treatments based on biomarkers identified by NGS, compared to non-personalized treatments. NGS can detect somatic and germline mutations to classify cancers at a molecular level and guide precision oncology.
Preoperative Factors Predict Perioperative Morbidity
and Mortality After PancreaticoduodenectomyDavid Yu Greenblatt, MD, MSPH, Kaitlyn J. Kelly, MD, Victoria Rajamanickam, MS, Yin Wan, MS,
Todd Hanson, BS, Robert Rettammel, MA, Emily R. Winslow, MD, Clifford S. Cho, MD, FACS,
and Sharon M. Weber, MD, FACS
Department of Surgery, University of Wisconsin, Madison, WI.
Original article:
New research studies presented at the 2011 Annual Meeting of the American Urological Association examine promising biomarkers and genetic tests for bladder and prostate cancers. Certain genetic variants on chromosomes 8q24 and 19q13 were found to be associated with higher rates of prostate cancer aggressiveness. Combining measurements of the PCA3 and TMPRSS2:ERG tests improved the sensitivity and accuracy of prostate cancer diagnosis compared to the PCA3 test alone. Additionally, a urine assay measuring TMPRSS2:ERG gene fusion levels correlated with higher pathologic stage, Gleason score, and Gleason upgrading in prostate cancer patients. The studies suggest newer diagnostic tests may help distinguish between indolent and aggressive forms of prostate and bladder cancers.
New research studies presented at the 2011 Annual Meeting of the American Urological Association examine promising biomarkers and genetic tests for bladder and prostate cancers. Certain genetic variants on chromosomes 8q24 and 19q13 were found to be associated with higher rates of prostate cancer aggressiveness. Combining measurements of the PCA3 and TMPRSS2:ERG tests improved the sensitivity and accuracy of prostate cancer diagnosis compared to the PCA3 test alone. Additionally, a urine assay measuring TMPRSS2:ERG gene fusion levels correlated with higher pathologic stage, Gleason score, and Gleason upgrading in prostate cancer patients. The studies suggest newer diagnostic tests may help distinguish between indolent and aggressive forms of prostate and bladder cancers.
This document discusses management strategies for localized prostate cancer, including active surveillance and radical prostatectomy. It notes that active surveillance involves delayed treatment if cancer progresses, allowing patients to avoid or delay unnecessary treatment. However, criteria for patient selection and treatment triggers require further definition and validation. Radical prostatectomy remains the gold standard for treating localized prostate cancer as it offers the possibility of cure while minimizing damage to surrounding tissues when performed skillfully. Innovations have led to improved preservation of urinary continence and erectile function with this procedure.
This document summarizes the current state of evidence on prostate cancer screening using PSA tests. Two major randomized trials, ERSPC and PLCO, showed mixed results on the efficacy of PSA screening, with ERSPC finding a small reduction in prostate cancer mortality but PLCO finding no reduction. Several organizations now recommend against routine PSA screening or recommend shared decision making. While screening may reduce prostate cancer deaths by around 1 per 1000 men screened, it also leads to many false positives and overdiagnosis of indolent cancers, with significant harms from treatment. The benefits of screening remain small compared to the harms. Rates of PSA screening in the US have declined since 2012 guidelines, providing a natural experiment
- The Personalized OncoGenomics (POG) program at the British Columbia Cancer Agency conducted whole-genome analysis on tumors from 100 patients with advanced or incurable cancers to inform treatment decisions.
- Fresh tumor and blood samples were obtained from patients and underwent whole-genome and RNA sequencing. Computational analysis identified potential driver mutations, genes and pathways.
- A multidisciplinary team discussed genomic findings weekly and established guidelines for interpreting and communicating results to integrate them into patient care. Genomic findings were considered actionable in 55 of 78 cases that underwent whole-genome analysis, and motivated treatment changes in 23 cases.
- The experience demonstrated that a multidisciplinary team can implement an approach where whole-genome
Update on Systemic Therapy for Metastatic Pancreas AdenocarcinomaOSUCCC - James
The document discusses treatment options for metastatic pancreatic cancer. For first-line therapy, FOLFIRINOX is an option but is reserved for younger, healthier patients due to toxicity. Gemcitabine plus nab-paclitaxel is a preferred first-line option. For second-line therapy after progression on gemcitabine, nanoliposomal irinotecan plus 5-FU/LV has shown a survival benefit compared to 5-FU/LV alone. Molecular profiling of pancreatic tumors has identified subtypes that could help guide targeted therapies, and immune-based approaches also offer promise. The James Cancer Hospital is conducting clinical trials evaluating novel combinations for both first-line and second-line metastatic pancreatic cancer
BRAF mand CDKN2A deletion define a clinically distinct subgroup of childhood ...Joshua Mangerel
This study analyzed the genomic alterations in 26 cases of pediatric secondary high-grade glioma (sHGG) that developed from an initial diagnosis of pediatric low-grade glioma (PLGG). Whole-exome sequencing of 7 sHGG cases found a high mutation burden and alterations in chromatin-modifying genes. The most recurrent genetic alterations were BRAF V600E mutations, present in 39% of sHGGs, and CDKN2A deletions, present in 57% of sHGGs. Importantly, the BRAF and CDKN2A alterations could be traced back to the original PLGG in most cases. Patients with BRAF-mutant PLGG had a significantly longer
Сравнение эффективности препаратов Карбоплатин (Carboplatin) и Паклитаксел (P...oncoportal.net
Сравнение эффективности препаратов Карбоплатин (Carboplatin) и Паклитаксел (Paclitaxel) при добавлении препарата Бевацизумаб (Bevacizumab) и без него для лечения одной их форм рака легкого у пациентов старше 65 лет
in Older Patients With Advanced Non–Small Cell Lung Cancer
Precision Medicine in Oncology InformaticsWarren Kibbe
Precision medicine in oncology aims to provide targeted cancer treatments based on a patient's individual tumor characteristics. The presentation discusses precision oncology initiatives including NCI-MATCH clinical trials which assign cancer therapies based on a tumor's molecular abnormalities rather than location. It outlines plans to expand genomically-based cancer trials, understand and overcome treatment resistance through molecular analysis, and establish a national cancer database integrating genomic and clinical data to accelerate cancer research. Cloud computing platforms are being developed to provide researchers access to large cancer genomic and clinical datasets. The goal is to advance precision cancer treatment by incorporating individual patient genetics and biomarkers into therapeutic decision making.
Ohio States 2016 ASH Review Blood and Marrow TransplantationOSUCCC - James
Ohio State’s 2016 ASH Review
Blood and Marrow Transplantation
Basem M. William, MD, MRCP(UK), FACP
Assistant Professor of Internal Medicine
Blood and Marrow Transplant Program
Development and internal validation of a multivariable prediction model for b...Max Peters
This document describes the development and internal validation of a prediction model for biochemical failure (BF) after salvage iodine-125 brachytherapy for recurrent prostate cancer. 62 patients who underwent salvage brachytherapy between 1993-2010 were studied. Multivariable analysis identified disease-free survival interval after primary therapy and pre-salvage prostate-specific antigen doubling time as predictors of BF, with higher intervals and doubling times associated with lower risk. The model had moderate discriminatory ability (optimism-adjusted C-statistic 0.70) and accurate calibration up to 36 months. Patients with doubling time >30 months and interval >60 months had >75% 3-year biochemical disease-free survival.
Usefulness of Serum Carcinoembryonic Antigen (CEA) in evaluating response to ...Enrique Moreno Gonzalez
High serum carcinoembryonic antigen (CEA) levels are an independent prognostic factor for recurrence and survival in patients with non-small cell lung cancer (NSCLC). Its role as a predictive marker of treatment response has not been widely characterized.
This document provides information about various research projects and areas of expertise at the UVM Medical Center. It describes projects related to osteoporosis, inter-hospital transfers, chronic kidney disease, asthma, vaccinations, liver disease, critical care, and more. Contact information is provided for principal investigators studying topics like statin use in chronic kidney disease, acute kidney injury following cardiopulmonary bypass, and physiological phenotyping of asthma.
This study aims to assess the immune competence of ovarian cancer patients after chemotherapy treatment by vaccinating them against hepatitis B virus (HBV) and measuring the antibody response. Patients who completed chemotherapy 3-12 months prior will be divided into two groups based on time since chemotherapy. All patients will receive the HBV vaccine and have antibody levels measured over time. The study will investigate if antibody responses differ between the two groups and correlate levels of the immune checkpoint proteins PD-L1 and PD-1 with clinical outcomes. Results so far show higher antibody responses in patients vaccinated sooner after chemotherapy. Continued recruitment is planned along with additional immune analyses.
Association between genomic recurrence risk and well-being among breast cance...Enrique Moreno Gonzalez
Gene expression profiling (GEP) is increasingly used in the rapidly evolving field of personalized medicine. We sought to evaluate the association between GEP-assessed of breast cancer recurrence risk and patients’ well-being.
Chapter 15 precision medicine in oncologyNilesh Kucha
This document discusses precision medicine in oncology and molecular monitoring of cancer patients. It describes how molecular characterization of tumors can guide treatment decisions and help develop targeted therapies. Next-generation DNA sequencing is allowing large amounts of tumor DNA to be analyzed to identify molecular targets and guide clinical trials matching treatments to tumor mutations. Challenges include limiting sequencing to known targets, accounting for germline variants, incidental findings, and integrating sequencing results into clinical decision making. Repeated biopsies during treatment can provide insights into drug sensitivity and resistance mechanisms in individual patients.
SILS 2015 - Connecting Precision Medicine to Precision Wellness Sherbrooke Innopole
By: Joel Dudley, Mount Sinai School of Medicine
At Sherbrooke International Life Sciences Summit - 2nd edition | September 28/29/30 2015
www.sils-sherbrooke.com
Personalized Medicine in Diagnosis and Treatment of Cancer Maryam Rafati
The document discusses next generation sequencing (NGS) and its applications in personalized medicine for cancer diagnosis and treatment. It provides examples of several families with hereditary cancer syndromes who were analyzed using NGS to identify pathogenic variants. The results demonstrated higher response rates and prolonged progression-free and overall survival for cancer patients receiving personalized treatments based on biomarkers identified by NGS, compared to non-personalized treatments. NGS can detect somatic and germline mutations to classify cancers at a molecular level and guide precision oncology.
Preoperative Factors Predict Perioperative Morbidity
and Mortality After PancreaticoduodenectomyDavid Yu Greenblatt, MD, MSPH, Kaitlyn J. Kelly, MD, Victoria Rajamanickam, MS, Yin Wan, MS,
Todd Hanson, BS, Robert Rettammel, MA, Emily R. Winslow, MD, Clifford S. Cho, MD, FACS,
and Sharon M. Weber, MD, FACS
Department of Surgery, University of Wisconsin, Madison, WI.
Original article:
Similar to Comparative analysis of primary repair vs resection and anastomosis, with laparostomy, in management of typhoid intestinal perforation: results of a rural hospital in northwestern Benin
New research studies presented at the 2011 Annual Meeting of the American Urological Association examine promising biomarkers and genetic tests for bladder and prostate cancers. Certain genetic variants on chromosomes 8q24 and 19q13 were found to be associated with higher rates of prostate cancer aggressiveness. Combining measurements of the PCA3 and TMPRSS2:ERG tests improved the sensitivity and accuracy of prostate cancer diagnosis compared to the PCA3 test alone. Additionally, a urine assay measuring TMPRSS2:ERG gene fusion levels correlated with higher pathologic stage, Gleason score, and Gleason upgrading in prostate cancer patients. The studies suggest newer diagnostic tests may help distinguish between indolent and aggressive forms of prostate and bladder cancers.
New research studies presented at the 2011 Annual Meeting of the American Urological Association examine promising biomarkers and genetic tests for bladder and prostate cancers. Certain genetic variants on chromosomes 8q24 and 19q13 were found to be associated with higher rates of prostate cancer aggressiveness. Combining measurements of the PCA3 and TMPRSS2:ERG tests improved the sensitivity and accuracy of prostate cancer diagnosis compared to the PCA3 test alone. Additionally, a urine assay measuring TMPRSS2:ERG gene fusion levels correlated with higher pathologic stage, Gleason score, and Gleason upgrading in prostate cancer patients. The studies suggest newer diagnostic tests may help distinguish between indolent and aggressive forms of prostate and bladder cancers.
This document discusses management strategies for localized prostate cancer, including active surveillance and radical prostatectomy. It notes that active surveillance involves delayed treatment if cancer progresses, allowing patients to avoid or delay unnecessary treatment. However, criteria for patient selection and treatment triggers require further definition and validation. Radical prostatectomy remains the gold standard for treating localized prostate cancer as it offers the possibility of cure while minimizing damage to surrounding tissues when performed skillfully. Innovations have led to improved preservation of urinary continence and erectile function with this procedure.
This document summarizes a study that developed an approach to extend cancer pathways based on biological network topology analysis. The approach calculates correlation values between genes in a pathway and the overall pathway to identify new candidate genes for inclusion. It was tested on the prostate cancer pathway, identifying top candidate genes with strong literature support for involvement in prostate cancer. The results demonstrate that the pathway extension approach can accurately predict new genes highly relevant to the cancer, improving understanding and prognosis potential.
The study found that a cell cycle progression (CCP) gene expression signature can differentiate indolent from aggressive prostate cancer and provide prognostic information beyond standard clinical parameters. Specifically:
1) Higher CCP scores, indicating more actively dividing cells, were associated with increased risk of biochemical recurrence after prostatectomy and death from prostate cancer in a conservatively managed cohort.
2) The CCP score was a strong univariate predictor of outcome and added significant prognostic information when combined with clinical factors like PSA and Gleason score in multivariate analyses.
3) The CCP score was robust across different patient populations and clinical settings and may help physicians select optimal treatment strategies at diagnosis.
This study examined the association between statin and beta-blocker (BB) use and outcomes in 130 patients diagnosed with both head and neck cancer and diabetes mellitus. The results showed that use of lipophilic statins and selective BBs was associated with improved overall survival and disease-free survival. However, the small sample sizes of patients using hydrophilic statins and non-selective BBs may have biased these results. The study was limited by its inability to determine medication duration but suggests longer use prior to cancer diagnosis.
This document discusses several predictive models and nomograms for prostate cancer outcomes:
- The CAPRA nomogram predicts outcomes after radical prostatectomy using clinical factors.
- The J-CAPRA nomogram was designed for patients receiving primary androgen deprivation therapy and predicts cancer progression and mortality.
- Nomograms have been developed to predict survival for patients with metastatic castration-resistant prostate cancer using PSA kinetics and other clinical variables.
- Additional nomograms aim to predict outcomes after specific therapies like docetaxel or abiraterone. Prospective validation of these tools is still needed to help guide treatment decisions.
This document discusses principles of cancer screening and summarizes a proposed cancer screening program called CitiScreen. It begins by outlining the Wilson-Jungner criteria for cancer screening approved by the WHO. It then discusses updated screening criteria and reviews the scientific basis for cancer screening through randomized controlled trials and other methods. The document summarizes CitiScreen's goal of comprehensive cancer screening through a combination of technologies and outlines screening patterns for specific cancers like breast, ovarian, lung, and colorectal cancer.
Understanding Uterine Cancer Treatment Optionsbkling
Join Dr. Bhavana Pothuri, gynecologic oncologist at NYU Langone Medical Center, as she breaks down the different types of uterine cancer treatments available to patients based on their particular diagnosis. Learn about new research and treatment updates, options for when cancer recurs, side effects, and more.
Interrogating differences in expression of targeted gene sets to predict brea...Enrique Moreno Gonzalez
Genomics provides opportunities to develop precise tests for diagnostics, therapy selection and monitoring. From analyses of our studies and those of published results, 32 candidate genes were identified, whose expression appears related to clinical outcome of breast cancer. Expression of these genes was validated by qPCR and correlated with clinical follow-up to identify a gene subset for development of a prognostic test.
Prostate Cancer - Current Approach and Future Perspective in Castration-Resis...KCR
Prostate carcinoma is one of the most commonly diagnosed solid tumours in males worldwide. Selection of the treatment method is strictly dependent upon disease stage and the patient’s age. Availability of diagnostic tests is constantly increasing in clinical practice, allowing early diagnosis and better chances for complete and permanent recovery. In the case of locally advanced prostate carcinoma, radical surgery or radiotherapy is considered as the most effective therapeutic approach, whereas in metastatic prostate carcinoma, hormone therapy or androgen deprivation therapy (ADT) is the primary therapeutic option. Moreover, increased use of chemotherapy with docetaxel and cabazitaxel in clinical practice has resulted in better prognosis for patients in this advanced stage of the disease.
The biggest challenge for doctors and patients remains the treatment of hormone-resistant carcinoma (which very often is also metastatic). Concerns of today’s medicine regarding effective therapies for this type of disease have recently led to a significant increase in the number of papers/studies on new-generation biological treatments.
Benefit of Serum-Thymidine Kinase 1 Concentration for Risk Assessment from Ga...eshaasini
This meta-analysis examined 27 studies to determine if serum thymidine kinase 1 concentration (STK1p) can provide benefit for risk assessment of gastric neoplasm progression to gastric carcinoma (GC) and for evaluating GC treatment effects. The studies included 1,909 GC patients, 1,229 gastric neoplasm patients, and 2,260 tumor-free individuals. The results showed that STK1p levels increased significantly from tumor-free to superficial gastritis to chronic gastritis to atrophic gastritis to gastric ulcer to GC. STK1p levels in 251 GC patients declined significantly by 66% one month after surgery compared to pre-surgery levels. This suggests that STK1p has
Benefit of Serum-Thymidine Kinase 1 Concentration for Risk Assessment from Ga...semualkaira
Human Thymidine kinase 1 (hTK1), a key enzyme involved in the DNA synthesis during S-phase of the cell cycle and upregulation of cell proliferation, thus it is reliable tumor proliferating biomarker for assessment of tumor proliferation rate in serum and in tissue in oncology. This meta-analysis is investigation whether the serum TK1 concentration(STK1p)based on hTK1-IgY-polyclonal-antibody can provide a benefit for risk assessment from gastric neoplasm progression to gastric carcinoma (GC) as well as for evaluation of treatment effect in GC.
Benefit of Serum-Thymidine Kinase 1 Concentration for Risk Assessment from Ga...semualkaira
Human Thymidine kinase 1 (hTK1), a key enzyme involved in the DNA synthesis during S-phase of the cell cycle and upregulation of cell proliferation, thus it is reliable tumor proliferating biomarker for assessment of tumor proliferation rate in serum and in tissue in oncology. This meta-analysis is investigation whether the serum TK1 concentration(STK1p)based on hTK1-IgY-polyclonal-antibody can provide a benefit for risk assessment from gastric neoplasm progression to gastric carcinoma (GC) as well as for evaluation of treatment effect in GC.
Similar to Comparative analysis of primary repair vs resection and anastomosis, with laparostomy, in management of typhoid intestinal perforation: results of a rural hospital in northwestern Benin (20)
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Comparative analysis of primary repair vs resection and anastomosis, with laparostomy, in management of typhoid intestinal perforation: results of a rural hospital in northwestern Benin
2. The modified Glasgow prognostic score in prostate
cancer: results from a retrospective clinical series of
744 patients
Kashif Shafique1,2,*
Email: k.shafique.1@research.gla.ac.uk
Michael J Proctor3
Email: Michael.j.proctor@gmail.com
Donald C McMillan3
Email: Donald.McMillan@glasgow.ac.uk
Hing Leung4,5
Email: h.leung@beatson.gla.ac.uk
Karen Smith6
Email: Karen.smith2@ggc.scot.nhs.uk
Billy Sloan7
Email: Billy.sloan@glasgow.ac.uk
David S Morrison1,7
Email: David.morrison@glasgow.ac.uk
1
Institute of Health & Wellbeing, Public Health, University of Glasgow, 1
Lilybank Gardens, Glasgow G12 8RZ, UK
2
Department of Community Medicine, Dow Medical College, Dow University of
Health Sciences, Karachi, Pakistan
3
University Department of Surgery, Faculty of Medicine, University of Glasgow,
Royal Infirmary, Glasgow G31 2ER, UK
4
Urology Department, Gartnavel General Hospital, 1053 Great Western Road,
Glasgow G12 0YN, UK
5
Beatson Institute for Cancer Research, Garscube Estate Switchback Road
Bearsden, Glasgow G61 1BD, UK
6
Department of Clinical Biochemistry, Royal Infirmary, Glasgow G4 0SF, UK
7
West of Scotland Cancer Surveillance Unit, University of Glasgow, 1 Lilybank
Gardens, Glasgow G12 8RZ, UK
*
Corresponding author. Institute of Health & Wellbeing, Public Health,
University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ, UK
3. Abstract
Background
As the incidence of prostate cancer continues to rise steeply, there is an increasing need to
identify more accurate prognostic markers for the disease. There is some evidence that a
higher modified Glasgow Prognostic Score (mGPS) may be associated with poorer survival
in patients with prostate cancer but it is not known whether this is independent of other
established prognostic factors. Therefore the aim of this study was to describe the relationship
between mGPS and survival in patients with prostate cancer after adjustment for other
prognostic factors.
Methods
Retrospective clinical series on patients in Glasgow, Scotland, for whom data from the
Scottish Cancer Registry, including Gleason score, Prostate Specific Antigen (PSA), C-
reactive protein (CRP) and albumin, six months prior to or following the diagnosis, were
included in this study.
The mGPS was constructed by combining CRP and albumin. Five-year and ten-year relative
survival and relative excess risk of death were estimated by mGPS categories after adjusting
for age, socioeconomic circumstances, Gleason score, PSA and previous in-patient bed days.
Results
Seven hundred and forty four prostate cancer patients were identified; of these, 497 (66.8%)
died during a maximum follow up of 11.9 years. Patients with mGPS of 2 had poorest 5-year
and 10-year relative survival, of 32.6% and 18.8%, respectively. Raised mGPS also had a
significant association with excess risk of death at five years (mGPS 2: Relative Excess Risk
= 3.57, 95% CI 2.31-5.52) and ten years (mGPS 2: Relative Excess Risk = 3.42, 95% CI
2.25-5.21) after adjusting for age, socioeconomic circumstances, Gleason score, PSA and
previous in-patient bed days.
Conclusions
The mGPS is an independent and objective prognostic indicator for survival of patients with
prostate cancer. It may be useful in determining the clinical management of patients with
prostate cancer in addition to established prognostic markers.
Keywords
mGPS, Prostate cancer, Prognosis, PSA
4. Background
Survival in patients with prostate cancer has improved in recent years but prognosis remains
poorly understood. It is often difficult to differentiate high risk patients who require
potentially curative treatment from low risk patients for whom watchful waiting is sufficient.
There is also increasing evidence that radical prostatectomy, with its high iatrogenic
morbidity, confers no appreciable survival benefit to watchful waiting in localized disease
[1]. Considerable effort has gone into identifying novel genetic and immunological
biomarkers for prostate cancer outcomes. However, these remain time consuming and not
validated within routine clinical practice [2,3]. Currently, imprecise clinical prognostication
is based on readily available tumour related factors, including Prostate Specific Antigen
(PSA) levels, Gleason score, surgical margins and pathological stage [4].
There is increasing recognition that systemic inflammation is associated with progression and
reduced survival of prostate cancer patients [5,6]. In particular, the systemic inflammatory
response, as evidenced by an elevated C-reactive protein (CRP), has been shown to be
independently associated with poor prognosis in localised and metastatic prostate cancer [7].
For example, in a retrospective study of 160 patients from the ASCENT (Androgen-
Independent Prostate Cancer Study of Calcitriol Enhancing Taxotere) trial, CRP levels
appeared to be a predictor of poorer survival [8]. This finding was also shown in another
independent dataset of 119 patients with castration-resistant prostate cancer (of whom 57
received docetaxel) enrolled in six phase II clinical trials [9]. These initial findings are
limited, however, by the relatively small number of cases and prognostic factors that were
considered and adjusted for in the multivariate analysis. Earlier studies on systemic
inflammation and prostate cancer survival had smaller sample sizes and follow-up was also
limited from 12 to 24 months following diagnosis. In a recent review it has been concluded
that CRP might serve as a useful biomarker for urological cancers and that it satisfies the
2001 NIH criteria to be used as a biomarker [10].
More recently, systemic inflammation based prognostic scores such as the modified Glasgow
Prognostic Score (mGPS, a combination of C-reactive protein and albumin), have been
developed [7] and found to have significant prognostic value in one-year and five-year
survival from prostate cancer [11]. However, thes findings from the Glasgow Inflammation
Outcome Study (GIOS), failed to account for PSA and comorbidities that would be known to
clinicians at the time of diagnosis. Furthermore, earlier study could not examine the
relationship between mGPS and long term survival. Therefore the aim of this study was to
examine in greater detail the associations between the mGPS and survival in a large mature
cohort of patients with prostate cancer and to establish whether it had prognostic significance
independent of PSA and comorbidities.
Methods
Data of prostate cancer patients diagnosed between 2000 and 2006, from the Scottish Cancer
Registry, (Scottish Morbidity Record number six (SMR06)) were obtained. Prostate cancer
was defined as International Classification of Diseases (ICD), revision 10 code C61. We
identified prostate cancer patients in the North Glasgow biochemistry database by extracting
records of all patients for whom PSA had been requested. We linked Cancer Registry records
to routine biochemistry laboratory records using an indexing method that ensured that patient
identifiers and clinical information were never transferred in the same dataset. The linkage
5. was carried out by exact matching of patients’ forename, surname and date of birth, followed
by a Soundex phonetic matching algorithm if initial exact matching was unsuccessful. Only
data for those patients who had a blood sample taken within a period of six months before or
six months after the diagnosis of prostate cancer were included. Out of 8,483 prostate cancer
patients diagnosed in the West of Scotland region from 1st January 2000 to 31st December
2006, PSA data were available for 1,861 patients in Glasgow. Of these, patients whose data
for C-reactive protein and albumin were available were included in this study. If more than
one record was available for a patient within a six month period (before or after diagnosis)
then only the record close to the date of diagnosis was used.
The Gleason grading system is known to be associated with prostatic cancer prognosis [12]
and was used to describe tumour morphology. Gleason score was extracted from the Scottish
Cancer Registry, where available. The information on Gleason score was obtained through
prostatic biopsy. The number of hospital in-patient bed days in the period of 10 years up to 1
year preceding diagnosis of prostate cancer were also obtained and used as a crude measure
of general pre-existing co-morbidity. In-patient bed days have been previously used as
measure of co-morbidity in patients with breast and colorectal cancer in Scotland [13]. Date
and cause of death was extracted through cancer registration patient based linkage with
National Records of Scotland death records.
Socio-economic status of individuals was assigned by matching their postcode of residence at
diagnosis to the Scottish Index of Multiple Deprivation (SIMD) 2006 score. SIMD is an area-
based measure of socio-economic circumstances that ranks small geographic areas of
Scotland (datazones) from 1 (most deprived) to 6505 (least deprived) using 31 indicators that
cover current income, employment, health, education, housing and access [14]. The
datazones are further grouped into national quintiles that range from least deprived to the
most deprived. The modified Glasgow Prognostic score was constructed as described in
Table 1 [15]. This study was approved by the West of Scotland Research Ethics Service
(WoSRES reference number 11/AL0249).
Table 1 The modified Glasgow prognostic score
Prognostic score Score
The modified Glasgow prognostic score
C-reactive protein ≤ 10 mg/l 0
C-reactive protein > 10 mg/l and albumin ≥ 35 g/l 1
C-reactive protein > 10 mg/l and albumin < 35 g/l 2
Statistical analysis
Follow up was from date of incidence of cancer to the date of death or censor date (31st
December 2011), whichever came first. Relative survival was used as a measure of cancer
patients’ survival. Relative survival has a key advantage over the cause specific survival as it
does not rely on the accurate classification of cause of death; instead it provides a measure of
total prostate cancer associated excess mortality.
Five and ten year relative survival estimates were made by using age and deprivation specific
life tables provided by National Records of Scotland (formerly the General Register Office).
These were available until 2009 so for the purposes of this study, the 2009 mortality rates
were used for both 2010 and 2011. Relative survival estimates were made by age,
6. deprivation, Gleason score and mGPS, PSA and previous in-patient bed days using the
complete and hybrid approach (by STREL and STRS commands in STATA) [16]. The STRS
command in STATA implements the Ederer II method by default for the estimation of
relative survival; however, we repeated the analyses using both the Ederer I and Hakulinen
approaches. All three methods provided identical results, so the results presented in this study
are based on the Ederer II Method. Using Poisson regression modelling, the relative excess
risk was estimated after adjusting for age, deprivation and Gleason score, PSA and previous
in-patient bed days [16]. The lowest category was used as referent for the mGPS and all other
categorical covariates. All analyses were conducted using STATA version 11 (StataCorp,
College Station, TX, USA). Adherence to the proportional hazards assumption was
investigated by plotting smoothed Schoenfeld residuals against time; no violations of the
assumption were identified. All statistical tests were two tailed and statistical significance
was taken as p < 0.05.
Results
A total of 744 patients who had a diagnosis of prostate cancer, and had biochemistry data
within six months before or after diagnosis, were included in this study. The majority of
patients, 578 (78%), were aged 65 or over. Thirty five percent of patients (n = 262) had high
Gleason score (Gleason 8–10), 21.9% had Gleason score missing (n = 163) and nearly half of
the cohort (n = 362, 49%) had PSA greater than 20ug/l. More than a third of patients (n =
272, 37%) lived in the most socio-economically deprived areas while only 18% lived in the
most affluent areas. The median follow-up from the cancer diagnosis was 4.11 years, and
maximum 11.9 years.
Patients with an elevated mGPS (mGPS 1 and 2) were significantly more likely to be 75
years or older (p = 0.014) and have either high Gleason score disease (Gleason 8–10) or
unknown Gleason (p < 0.001) but there was no association with socioeconomic
circumstances based on SIMD (p = 0.219) – Table 2. Patients with an elevated mGPS were
significantly more likely to have raised PSA (PSA > 20 ug/l) and less likely to have higher
previous inpatients bed days (p-value 0.022).
8. Increasing age, Gleason score, PSA and previous inpatient bed days were associated with
poorer 5 and 10 year relative survival (Table 3). Decreasing deprivation was associated with
better 5 and 10 year relative survival. On multivariate analysis, increasing age, Gleason score,
PSA > 20ug/l, previous inpatients bed days >28 and mGPS were the major predictors of
relative excess risk of death at 5 and 10 years (Table 3). Compared with patients with an
mGPS of 0, patients with an mGPS of 1 and 2 had higher risks of death in the five years
following diagnosis (RER 1.84, 95% CI 1.33-2.55, p <0.001 and RER 3.57, 2.31-5.25, p <
0.001, respectively) which was independent of age, Gleason score, SIMD, PSA and previous
inpatient bed days. Similarly, 10 year mortality was raised in patients with mGPS of 1 and 2
(RER 1.87. 95% 1.37-2.55, p <0.001 and RER 3.42, 95% 2.25-5.21, p < 0.001, respectively)
after adjusting for other factors (Table 3).
9. Table 3 The relationship between patient characteristics and five and ten year relative survival and relative excess risk of death of
patients with prostate cancer
Five year survival and excess risk of death
P-value
Ten year survival and excess risk of death
P-value
5-year relative survival Relative excess risk (95% CI) * 10-year relative survival Relative excess risk (95% CI)*
Modified Glasgow prognostic score
0 74.8 (67.9-81.3) 1 51.4 (42.8-60.1) 1
1 48.3 (41.1-55.1) 1.84 (1.33-2.55) <0.001 22.4 (16.6-29.1) 1.87 (1.37-2.55) <0.001
2 32.6 (19.8-47.3) 3.57 (2.31-5.52) <0.001 18.8 (7.6-36.1) 3.42 (2.25-5.21) <0.001
Age at incidence (years)
Age < 65 73.3 (65.1-80.2) 1 47.4 (37.6-56.9) 1
Age 65-74 58.4 (50.9-65.6) 1.69 (1.15-2.49) 0.008 36.1 (28.3-44.3) 1.49 (1.05-2.12) 0.026
Age ≥ 75 51.6 (43.2-60.3) 1.92 (1.31-2.80) 0.001 24.4 (16.8-33.7) 1.69 (1.20-2.40) 0.003
Gleason score
Gleason < 7 96.6 (87.6-100) 1 68.9 (56.1-81.1) 1
Gleason = 7 77.0 (66.4-86.2) 2.96 (1.19-7.37) 0.020 44.3 (32.5-56.5) 2.74 (1.28-5.86) 0.010
Gleason 8-10 50.0 (42.2-58.0) 7.18 (3.12-16.50) <0.001 25.1 (17.9-33.3) 5.55 (2.75-11.20) <0.001
Unknown Gleason 16.3 (10.4-23.7) 16.27 (7.09-37.34) <0.001 7.5 (3.2-14.7) 12.44 (6.12-25.29) <0.001
SIMD 2006, Quintiles
1 (most deprived) 49.9 (42.8-56.9) 1 27.8 (20.9-35.5) 1
2 51.0 (40.9-61.1) 1.24 (0.88-1.73) 0.221 25.4 (16.5-36.0) 1.28 (0.92-1.78) 0.146
3 70.4 (56.6-82.9) 0.80 (0.49-1.30) 0.364 35.2 (22.4-49.9) 0.91 (0.58-1.42) 0.682
4 74.4 (59.2-87.9) 0.81 (0.48-1.36) 0.419 49.0 (32.1-67.3) 0.93 (0.58-1.49) 0.761
5 (least deprived) 71.9 (59.4-83.6) 0.80 (0.51-1.24) 0.312 58.7 (42.2-76.2) 0.81 (0.53-1.23) 0.319
Prostate specific antigen (ug/l)
PSA < 10 78.0 (70.4-84.8) 1 58.2 (48.4-67.9) 1
PSA 10-20 73.1 (60.6-84.2) 0.78 (0.44-1.38) 0.396 45.4 (31.4-60.3) 0.78 (0.44-1.39) 0.409
PSA > 20 40.4 (34.0-47.0) 1.47 (1.01-2.14) 0.041 15.4 (10.7-21.2) 1.82 (1.26-2.63) 0.002
Previous inpatient bed days
0 60.8 (54.5-66.9) 1 36.7 (30.3-44.0)
1-7 70.0 (59.2-79.9) 0.78 (0.53-1.15) 0.205 41.5 (29.7-54.2) 0.75 (0.51-1.09) 0.141
8-28 52.7 (41.3-64.0) 1.07 (0.74-1.55) 0.708 26.3 (16.2-38.7) 1.12 (0.79-1.59) 0.530
29+ 33.7 (19.7-49.5) 1.65 (1.09-2.51) 0.018 19.2 (7.1-38.6) 1.64 (1.08-2.47) 0.019
*Multivariate model included all the co-variates presented in the table.
10. When the analysis was stratified based on Gleason score and PSA level, we observed a
significant association between mGPS and risk of death within ten years of diagnosis with
PSA < 10ug/l group (RER 9.65, 95% CI 3.13-29.75, p for trend <0.001), PSA 10-20ug/l
category (RER 2.50, 95% CI 0.20-31.07, p for trend 0.088) and those with PSA > 20ug/l
(RER 5.01, 95% CI 3.05-8.22, p for trend 0.001) after adjustment for age, socioeconomic
circumstances and previous inpatient bed days (Table 4). In grade-specific analysis, we
observed a significant association between the mGPS and risk of death within 10 years at all
grades of disease: low grade (RER 20.46, 95% CI 3.43-121.97, p for trend <0.001),
intermediate grade (RER 2.25, 95% CI 0.31-16.08, p for trend 0.003), high grade (RER 1.88,
95% CI0.98-3.61, p for trend 0.035) and unknown grade (RER 1.97, 95% CI 1.03-3.73) after
adjustment for other factors (Table 4).
12. After excluding deaths in first 12 months following diagnosis (n = 149) to minimise the
effects of “reverse causality”, elevated mGPS showed an increased risk of death at five (RER
2.43, 95% CI 1.23-4.79, p-value 0.011) and ten years (RER 2.42, 95% CI 1.29-4.58, p-value
0.006) after adjusting for age, Gleason score, socioeconomic circumstances, PSA and
inpatient bed days (Table 5).
Table 5 Five and ten year conditional relative survival and relative excess risk of death
of prostate cancer patients
Five year survival and excess risk of death
P-value
Ten year survival and excess risk of death
P-value
5-year relative survival Relative excess risk (95% CI) 10-year relative survival Relative excess risk (95% CI)
Modified Glasgow
prognostic score
00 83.0 (75.8-89.5) 1 81.7 (65.6-94.2) 1
11 64.1 (55.7-72.0) 1.66 (1.12-2.46) 0.012 43.2 (32.0-55.5) 1.75 (1.21-2.53) 0.003
22 56.9 (35.6-77.3) 2.43 (1.23-4.79) 0.011 38.8 (16.6-67.0) 2.42 (1.29-4.58) 0.006
Estimates adjusted for age, Gleason score, socioeconomic circumstances, PSA and inpatient bed days. Survival and risk estimates taken after
excluding the deaths in first 12 months following the diagnosis.
Figure 1 shows the age-specific relative survival of prostate cancer patients based on the
mGPS categories. Raised level of mGPS (1 and 2), showed significantly poorer survival in all
age groups with particularly worse survival in the oldest group (age ≥ 75). There was no
convincing difference in mortality between patients with mGPS scores of 1 and 2 in patients
under 75 years of age.
Figure 1 The modified Glasgow prognostic score and survival based on age categorie.
Discussion
The results of the present study indicate that a raised level of mGPS is associated with poorer
short and long term survival in men with prostate cancer. This relationship was independent
of age at diagnosis, socio-economic circumstances, Gleason score, PSA level and previous
in-patient bed days. These findings are consistent with earlier observations from the Glasgow
Inflammation Outcome Study, where the mGPS was compared with Neutrophil Lymphocyte
Ratio and demonstrated significant prognostic value [11]. The prognostic value of mGPS
remained consistent even after excluding deaths in the first 12 months after diagnosis, which
suggest that disease stage is unlikely to explain the survival differences between mGPS
categories.
We observed 40% and 22% lower 5-year and 10-year relative survival respectively, among
those with raised modified Glasgow Prognostic Score (mGPS = 2) compared to the normal
(mGPS = 0) following diagnosis of prostate cancer. In the present study, patients with raised
mGPS were significantly more likely to have unknown Gleason score and less likely to have
low grade disease compared with the mGPS of 0. Similarly, patients with raised mGPS
(mGPS = 2) were significantly more likely to have PSA > 20ug/l. In Gleason score specific
analysis, a raised mGPS had significant associations with excess risk of death among patients
regardless of disease grading. The largest effect of mGPS was seen in patients with low grade
prostate cancer (Gleason < 7), i.e. men with raised mGPS (mGPS = 2) were 46 and 20 times
more likely to die in the first five and ten years following diagnosis compared to patients with
a mGPS of 0. The large effect and wide confidence interval in this category may be due to the
small number of cases with low Gleason score and raised mGPS (n = 15), of whom 11 died
during ten years follow up.
13. In PSA specific analysis, patients with raised mGPS were significantly more likely to die in
five and ten years in both, PSA < 10ug/l and PSA > 20ug/l categories. Although there was no
significant association between mGPS and survival in the intermediate PSA category (PSA
10-20ug/l), this could have been due to the small number of cases in intermediate PSA
category with raised mGPS (n = 4).
In the present study, patients with raised mGPS had poorer five and ten year survival even
when the deaths in the first 12 months were excluded from the analysis. This was based on
the assumption that patients with metastatic disease may have raised level of inflammatory
markers and the overall effect of mGPS may be driven by the advance stage disease among
men with the raised mGPS. Exclusion of early deaths from analysis did not change the
prognostic value of the mGPS, this suggest that differential distribution of metastatic disease
between mGPS categories is unlikely to explain the prognostic significance of mGPS.
Furthermore, previous studies have shown systemic inflammation to be associated with
survival, independent of disease stage, for gastroesophageal, colorectal (including those with
liver metastases), renal, breast and prostate cancers [17-19] however, the findings of earlier
prostate cancer study are based on smaller sample (n = 62) [17].
Additionally, the raised mGPS (1 and 2) has shown poorer survival in all age groups. This is
of particular interest in the younger age group (<65 years) where most uncertainty lies about
the management of disease and treatment decisions are made on the basis of individual’s age,
fitness, comorbidity, PSA, Gleason score and disease stage. Novel genetic and
immunological biomarkers have been identified but these, to date, have not been incorporated
into routine clinical practice [2,3]. The results of the present study further strengthen the
earlier observations that systemic inflammation is of clinical importance and suggest the
routine use of the mGPS may be a cost effective, readily available tool for risk stratification
in patients with prostate cancer.
Strengths of our study include its large sample size, inclusion of information on PSA and
Gleason score and a fairly long follow-up to determine the effect of systemic inflammation
on short and long term survival. However, our study has limitations. First, patients were
selected on the basis of availability of PSA, C-reactive protein and albumin, therefore this
cohort of patients might not be representative of all the prostate cancer patients diagnosed and
treated in the area. Second, the reason why these patients were tested for C-reactive protein
remains unclear and there is a possibility that they might have had concurrent morbidity for
which they were clinically investigated. However, this is unlikely to have had a major effect
on our results, as we adjusted for background mortality as well as the previous inpatient bed
days from ten years to one year prior to the diagnosis of prostate cancer. The value of mGPS
between different treatment groups need to be evalued in future work and further work is also
required to investigate this relationship in a larger, representative sample of prostate cancer
patients including information on disease stage.
Conclusion
The mGPS is an objective prognostic marker for survival in prostate cancer patients and has
additional value to other conventional, routinely available information. Prospective studies
are required to validate our results and to test the clinical utility of mGPS in the clinical
management of prostate cancer.
14. Competing interests
All authors declare that they have no competing of interest.
Authors’ contributions
KS (Kashif Shafique) and DSM designed the study. KS (Kashif Shafique) carried out
statistical analyses. KS (Karen Smith) and BS carried out data extraction and linkage. All
authors contributed to interpreting the results; KS (Kashif Shafique) wrote the initial draft.
KS, DCM and DSM revised and finalised the manuscript; all authors saw and approved the
final manuscript.
Acknowledgement
We appreciate the support of Colin Fletcher in extracting this data from biochemistry
department. We are also grateful for Paul Dickman (Associate Professor of Biostatistics in
Karolinska Institute) for his support during regarding relative estimation and modelling.
Funding and role of sponsor
No external funding for this study, all authors are paid by their employers.
References
1. Wilt TJ: Radical prostatectomy versus observation for localized prostate cancer.
NEJM 2012, 367:203–213.
2. Castelli T, Cimino S, Magno C, Morgia G: Molecular markers for prostatic cancer.
Front Biosci 2010, 2:641–656.
3. Huang HC, Zheng S, VanBuren V, Zhao Z: Discovering disease-specific biomarker
genes for cancer diagnosis and prognosis. Technol Cancer Res Treat 2010, 9:219–230.
4. Verhagen PC, Tilanus MG, de Weger RA, van Moorselaar RJ, van den Tweel JG, Boon
TA: Prognostic factors in localised prostate cancer with emphasis on the application of
molecular techniques. Eur Urol 2002, 41:363–371.
5. Elsberger B, Lankston L, McMillan DC, Underwood MA, Edwards J: Presence of
tumoural C-reactive protein correlates with progressive prostate cancer. Prostate
Cancer Prostatic Dis 2011, 14:122–128.
6. Vasto S, Carruba G, Candore G, Italiano E, Di BD, Caruso C: Inflammation and prostate
cancer. Future Oncol 2008, 4:637–645.
7. McMillan DC, McMillan DC: The systemic inflammation-based Glasgow prognostic
score: a decade of experience in patients with cancer. Cancer Treat Rev 2012.
doi:10.1016/j.ctrv.2012.08.003. Epub- Ahead of Print.
15. 8. Beer TM, Lalani AS, Lee S, Mori M, Eilers KM, Curd JG, et al: C-reactive protein as a
prognostic marker for men with androgen-independent prostate cancer: results from
the ASCENT trial. Cancer 2008, 112:2377–2383.
9. Prins RC, Rademacher BL, Mongoue-Tchokote S, Alumkal JJ, Graff JN, Eilers KM, et al:
C-reactive protein as an adverse prognostic marker for men with castration-resistant
prostate cancer (CRPC): confirmatory results. Urol Oncol 2012, 30:33–37.
10. Saito K, Kihara K, Saito K, Kihara K: Role of C-reactive protein in urological cancers:
a useful biomarker for predicting outcomes. Int J Urol 2012. doi:10.1111/j.1442-
2042.2012.03121.x. Epub- Ahead of Print.
11. Shafique K, Proctor MJ, McMillan DC, Qureshi K, Leung H, Morrison DS: Systemic
inflammation and survival of patients with prostate cancer: evidence from the Glasgow
inflammation outcome study. Prostate Cancer Prostatic Dis 2012, 15:195–201.
12. Sogani PC, Israel A, Lieberman PH, Lesser ML, Whitmore WF Jr: Gleason grading of
prostate cancer: a predictor of survival. Urology 1985, 25:223–227.
13. Brewster DH, Clark DI, Stockton DL, Munro AJ, Steele RJ: Characteristics of patients
dying within 30 days of diagnosis of breast or colorectal cancer in Scotland, 2003–2007.
Br J Cancer 2011, 104:60–67.
14. The Scottish Government: Using the Scottish index of multiple deprivation 2004:
guidance. Scottish Government; 2006.
http://www.scotland.gov.uk/Publications/2005/01/20458/49127.
15. Proctor MJ, Talwar D, Balmar SM, O’Reilly DS, Foulis AK, Horgan PG, et al: The
relationship between the presence and site of cancer, an inflammation-based prognostic
score and biochemical parameters. Initial results of the Glasgow inflammation outcome
study. Br J Cancer 2010, 103:870–876.
16. Dickman PW, Coviello E, Hills M: Estimating and modelling relative survival. The
Stata Journal 2008.
17. McArdle PA, Mir K, Almushatat AS, Wallace AM, Underwood MA, McMillan DC:
Systemic inflammatory response, prostate-specific antigen and survival in patients with
metastatic prostate cancer. Urol Int 2006, 77:127–129.
18. Pierce BL, Ballard-Barbash R, Bernstein L, Baumgartner RN, Neuhouser ML, Wener
MH, et al: Elevated biomarkers of inflammation are associated with reduced survival
among breast cancer patients. J Clinl Oncol 2009, 27:3437–3444.
19. Roxburgh CS, McMillan DC: Role of systemic inflammatory response in predicting
survival in patients with primary operable cancer. Future Oncol 2010, 6:149–163.
16. 0102030405060708090100
Relativesurvival,%
0 1 2 3 4 5
Years since diagnosis
mGPS = 0 mGPS = 1 mGPS = 2
0102030405060708090100
Relativesurvival,%
0 1 2 3 4 5
Years since diagnosis
mGPS = 0 mGPS = 1 mGPS = 2
0102030405060708090100
Relativesurvival,%
0 1 2 3 4 5
Years since diagnosis
mGPS = 0 mGPS = 1 mGPS = 2
Age < 65 Age 65-74
Age œ 75
Figure 1