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Predicting survival of patients with hypocellular myelodysplastic syndrome: development of a disease-specific prognostic score system.

ABSTRACT: Although most patients with myelodysplastic syndrome (MDS) exhibit bone marrow hypercellularity, a subset of them present with a hypocellular bone marrow. Specific factors associated with poor prognosis have not been investigated in patients with hypocellular MDS.The authors studied a cohort of 253 patients with hypocellular MDS diagnosed at The University of Texas MD Anderson Cancer Center between 1993 and 2007 and a cohort of 1725 patients with hyper-/normocellular MDS diagnosed during the same time period.Patients with hypocellular MDS presented more frequently with thrombocytopenia (P < .019), neutropenia (P < .001), low serum ?-2 microglobulin (P < .001), increased transfusion dependency (P < .001), and intermediate-2/high-risk disease (57% vs 42%, P = .02) compared with patients with hyper-/normocellular MDS. However, no difference in overall survival was observed between the 2 groups (P = .28). Multivariate analysis identified poor performance status (Eastern Cooperative Oncology Group ?2), low hemoglobin (<10 g/dL), unfavorable cytogenetics (-7/7q or complex), increased bone marrow blasts (?5%), and high serum lactate dehydrogenase (>600 IU/L) as adverse independent factors for survival.A new prognostic model based on these factors was built that segregated patients into 3 distinct risk categories independent of International Prognostic Scoring System (IPSS) score. This model is independent from the IPSS, further refines IPSS-based prognostication, and may be used to develop of risk-adapted therapeutic approaches for patients with hypocellular MDS.

SUBMITTER: Tong WG

PROVIDER: S-EPMC3913560 | biostudies-literature | 2012 Sep

REPOSITORIES: biostudies-literature

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Predicting survival of patients with hypocellular myelodysplastic syndrome: development of a disease-specific prognostic score system.

Tong Wei-Gang WG Quintás-Cardama Alfonso A Kadia Tapan T Borthakur Gautam G Jabbour Elias E Ravandi Farhad F Faderl Stefan S Wierda William W Pierce Sherry S Shan Jianqin J Bueso-Ramos Carlos C Kantarjian Hagop H Garcia-Manero Guillermo G

Cancer 20120117 18

<h4>Background</h4>Although most patients with myelodysplastic syndrome (MDS) exhibit bone marrow hypercellularity, a subset of them present with a hypocellular bone marrow. Specific factors associated with poor prognosis have not been investigated in patients with hypocellular MDS.<h4>Methods</h4>The authors studied a cohort of 253 patients with hypocellular MDS diagnosed at The University of Texas MD Anderson Cancer Center between 1993 and 2007 and a cohort of 1725 patients with hyper-/normoce ...[more]

PMID: 22252728

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Project description:BackgroundNaples prognostic score (NPS) serves as a new prognostic index based on nutritional and inflammatory status in recent years. The aim of the current study was to explore the prognostic effect of NPS and to develop and validate a reliable nomogram based on NPS for individual cancer-specific survival (CSS) prediction in patients with resected ESCC without neoadjuvant therapy.MethodsThe clinical data for 287 (Jan. 2010 to Jun. 2012, Training sets) and 118 (Jan. 2015 to Dec 2015, Validation sets) consecutive resected ESCC cases were retrospectively analyzed. Two NPS models based on the different cut-off values of parameters were compared. Cut-off values in model 1 were derived from previous published studies, while cut-off values in model 2 were obtained in this study based on receiver operating characteristic (ROC) curves. The relationships between NPS and clinical characteristics and CSS were analyzed. The prediction model of nomogram was developed with independent prognostic factors in the training sets and was validated in the validation sets.ResultsThe 5-year CSS for NPS 0, 1 and 2 were 61.9%, 34.6% and 13.4% in model 1 and 75.0%, 42.4% and 13.0% in model 2, respectively (P<0.001). Subgroup analyses revealed that NPS was also significantly associated with CSS in both model 1 and model 2 in different TNM stages. Multivariate analyses revealed that NPS was an independent prognostic marker regarding CSS in patients with resected ESCC (P<0.001). A predictive nomogram based on NPS was established and validated. The C-indexes of the nomogram in the training sets and validation sets were 0.68 and 0.72 in model 1 and 0.69 and 0.73 in model 2, respectively. These results confirmed that NPS-based nomogram was a more accurate and effective tool for predicting CSS in patients with resected ESCC.ConclusionThe current study confirmed that NPS was still a useful independent prognostic score in patients with resected ESCC. The NPS-based nomogram was successfully developed and validated, which may contribute to individual CSS prediction for resected ESCC patients.

Project description:BackgroundCurrently, the prognosis of kidney cancer depends mainly on the pathological grade or tumor stage. Clinicians have few effective tools that can personalize and adequately evaluate the prognosis of kidney cancer patients.MethodsA total of 70 481 kidney cancer patients were selected from the Surveillance, Epidemiology, and End Results database, among which patients diagnosed in 2005-2011 (n = 42 890) were used to establish nomograms for overall survival (OS) and cancer-specific survival (CSS), and those diagnosed in 2012-2015 (n = 24 591) were used for external validation. Univariate and multivariate Cox analyses were used to determine independent prognostic factors. Concordance index (C-index), receiver operating characteristic curve, and calibration curve were used to evaluate the predictive capacity of the nomograms. We further reduced subgroup classification and used propensity score matching to balance clinical informations, and analyzed the effect of other variables on survival. We established a new kidney cancer prognostic score system based on the effect of all available variables on survival. Cox proportional hazard model and Kaplan-Meier curves were used for survival comparison.ResultsAge, gender, marital status, surgery, grade, T stage, and M stage were included as independent risk factors in the nomograms. The favorable area under the curve (AUC) value (for OS, AUC = 0.812-0.858; and for CSS, AUC = 0.890-0.921), internal (for OS, C-index = 0.776; and for CSS, C-index = 0.856), and external (for OS, C-index = 0.814-0.841; and for CSS, C-index = 0.894-0.904) validation indicated that the proposed nomograms could accurately predict 1-, 3-, and 5-year OS and CSS of kidney cancer patients. The Aggtrmmns prognostic scoring system based on age, gender, race, marital status, grade, TNM stage, and surgery of kidney cancer patients could stage patients more explicitly than the AJCC staging system.ConclusionThe nomogram and Aggtrmmns scoring system can predict OS and CSS in kidney cancer patients effectively, which may help clinicians personalize prognostic assessments and clinical decisions.

Dataset Information

Predicting survival of patients with hypocellular myelodysplastic syndrome: development of a disease-specific prognostic score system.

Publications

Predicting survival of patients with hypocellular myelodysplastic syndrome: development of a disease-specific prognostic score system.

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