Faculty of Medicine
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Item type:Publication, INFLUENCE OF PROGNOSTIC FACTORS ON OVERALL SURVIVAL IN MYELODYSPLASTIC SYNDROMES(Turkish Society of Hematology, 2015); ; ; ; Background: Accurate prediction of a patient’s prognosis is useful to define the risk posed by the disease. Age, gender, peripheral blood cytopenias, proportion of bone marrow (BM) blasts, performance status, comorbidities, transfusion dependence, specific karyotype abnormalities and molecular biomarkers can refine the prediction of prognosis in MDS. Aim: to assess the influence of the some prognostic factors like age, gender, cytopenias, BM blast percentage, transfusion dependence, ferritin, hemoglobin (Hb), lactate dehydrogenase (LDH), albumin and specific karyotype abnormalities in myelodysplastic syndromes on overall survival (OS). Patients and Methods: we retrospectively analyzed the cohort of 108 patients diagnosed between 1.1.2011 and 31.12.2013 at the University Clinic of Hematology, Ss Cyril and Methodius University, Skopje, Macedonia. They were evaluated for clinical and hematologic features at diagnosis and at leukemic transformation. Results: in the study group 62 were man and 46 women. Male to female ratio was 1.35 to 1. The differences in OS between men and women were significant (p =.03015). The mean age at diagnosis was 66,6 years. According to the age OS was 16,4 months. FAB subtypes influenced OS significantly (p =.03015). OS inversely correlated with BM blast percentage (p=.02327). Cytopenias had no impact on OS (p=.33755). Hb as a whole and groups with different levels of Hb had no influence on OS (p =.12142) and (p=.07535), respectively. The group with ferritin <500 μg/L had better OS (p=.04720). Transfusion dependence, LDH and albumin had no impact on OS. Leukemic transformation was noticed in 10 (9,3%) patients. Mortality was 36,1%. Conclusion: gender, FAB subtypes, BM blast percentage and the serum levels of ferritin had an influence on OS, while age, hemoglobin level, transfusion dependence, LDH and albumin had no impact on OS. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Association of prognostic fa ctors with overall survival in myelodysplastic syndromes: a cohort study(SHMSHM - AAMD, 2015); ; ; ; Background: Myelodysplastic syndromes (MDS) are heterogeneous disorders in terms of clinical presentation, laboratory findings and life expectancies. A lot of studies have been conducted to determine factors that can refine the prediction of prognosis in MDS. Aim: Our aim was to evaluate which prognostic factors had an impact on overall survival (OS) in MDS. Methods: we conducted retrospective cohort study of 154 adult patients (81 male, 73 female) with MDS who presented to the University Clinic of Hematology, Ss Cyril and Methodius University, Skopje, Macedonia, from January 2011 to June 2014. Data on demographics, FAB classification, treatment and outcome were collected. Results: Age and gender had no influence on OS (p=.80847 and p=.974895, respectfully). Different FAB subtypes had an impact on OS (p = .00757). Bone marrow (BM) blast percentage correlated significantly with OS (p= .028026). Hemoglobin, platelet count and absolute neutrophil count (ANC) did not influence OS (p=. 179970, p= .386355 and p= .972602, respectfully). Transfusion did not influence OS (p= .445856). Albumins had no impact on OS (p=.559900). Lactate dehydrogenase (LDH) and comorbidities influenced OS (p= .018895 and p= .02278, respectfully). Leukemic transformation was noticed in 7 (4.5%) patients. Mortality was 35.1%. Conclusions: FAB subtypes, BM blast percentage, LDH and comorbidities are independent predictors on OS and should be considered for future revisions of International Prognostic Scoring System in order to refine the prediction of prognosis in MDS. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Impact of age and comorbodity as prognostic factors on overall survival in patients with multiple myeloma(Macedonian Association of Anatomists and Morphologists, 2015); ; ; Background: Multiple myeloma is a heterogeneous disease with variable disease course, a wide range of clinical presentation and many subtypes, variable response to therapy and survival outcome that ranges from less than one year in patients with aggressive disease to more than ten years in patients with indolent disease presentation. It is very important to clearly define the risk profile of each patient during establishing the diagnosis, and to predict the eventual type of therapeutic approach, its depth, quality and length. The age >75 and presence of comorbidities at the start of therapy are risk factors which impact on the quality of life, therapy response and overall survival (OS) in patients with multiple myeloma (MM). Aim: The aim of this study was to assess the influence of the two most important risk factors in myeloma patients, ageism and comorbidities, that complicate the management of MM and at the same time OS. Patients and methods: We retrospectively analyzed a total of 296 myeloma patients (150 male and 146 female) with average age of 62 ±10.3 years. The most affected age group (58.1%) comprised patients at the age ranging between 60 and 88 years, diagnosed at the University Clinic of Hematology, Ss Cyril and Methodius University, Skopje, Macedonia in the period 2005-2015. The follow-up period was 24 months. We evaluated some parameters that could influence OS: age and comorbidity that could influence the overall clinical condition of the patient during his therapy and his eventual future disease behavior. OS was estimated on monthly basis including the period from the date of diagnosis to the time of death / time of last visit. Results: In the study group 26% of patients ≥ 65 years have survived more than 60 months, and 40% younger than 65 years have survived more than 60 months. Survival time in group ≥65 years is 18.3 months, and in group <65 years is 43.4 months. It is evident that age had a significant effect on OS in myeloma patients, and 49% of patients with no registered comorbodity preceding the diagnostic procedures had survived more than 60 months, but only 16% of patients with registered comorbidity survived more than 60 months. Survival time in patients with registered comorbodity preceding the diagnostic procedures was 59.3 months and survival time in patients with registered comorbodity before the diagnostic procedures is 10.7 months. Conclusions: The age-related changes in physiology combined with comorbid conditions, disability or frailty have important implications in the treatment of myeloma patients. Based on these risk factors our recommendation is tailored treatment for each MM patient. Key words: multiple myeloma, prognostic factors, overall survival - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Predictive value of estrogen receptors evaluated by immunocytochemical analysis in breast cancer patients(Gustav Fischer, 1997-09); Zografski, GeorgeBACKGROUND: The determination of estrogen receptor (ER)status is valuable in selecting the appropriate therapy and predicting prognosis for patients with invasive breast carcinoma. OBJECTIVE: The aim of our study was to assess the predictive value of ER status evaluated preoperatively by immunocytochemical analysis and compared with recurrence rate, clinical and histopathological features in 52 patients with breast carcinoma. MATERIALS AND METHODS: Fifty-two aspirates obtained by fine-needle-aspiration biopsy (FNAB) were prepared as cytospin samples for ER-immunocytochemical analysis (ER-1CA). Cytospin slides were stained using a standard procedure with horseradish peroxidase-antiperoxidase (PAP) method, utilising monoclonal antibody to ER (H222SP, ER-ICA kit, Abbott Laboratories, USA). The assessment of staining was scored in a semiquantitative fashion incorporating the intensity and the distribution of stained cells and the values were designated as IS-CYTOSCORE. All the patients underwent radical mastectomy with axillar lymphadenectomy during the period from September 1990 to March 1992 and were staged according to the postoperative pTNM classification of UICC (1987) guidelines. During the follow-up period (range, 2-75 months, mean 32) recurrences were observed in 25 (48%) patients.ER status was correlated to recurrence rate, age of the patients, type of the breast carcinoma, tumor size, grade of histologic differentiation, desmoplastic reaction, elastosis, necrosis and calcifications. The comparison was made by cross-classification and statistical significance determined by χ2 and Fisher's exact test. RESULTS: ER status was positively detected in 28 (53.8%) patients. There is significant association between ER status and age of the patients (p = 0.02), the type of the breast carcinoma (p = 0.018), and the recurrence rate (p = 0.012). Eighteen out of 26 (70%) patients 50 years or older, were positively related to ER status. In 22 (42.3%) lobular carcinomas, ER status was positive in 16 (73%) patients, compared with 30 (57.7%) ductal carcinomas, with ER status positive for 12 (40%) patients, only. Recurrences were observed in 16 (64%) patients with ER- breast carcinomas and 9 (36%) patients with ER+ breast carcinomas. Less important histopathological features as elastosis and calcifications, demonstrated statistically significant positive relation with ER status (p = 0.004 and p = 0.005, respectively). No significant association was found between the ER status and other histopathological characteristics. CONCLUSION: Our results suggest that recurrences, age of the patients and the lobular type of breast carcinoma are positively correlated with ER status. These data are consistent with the results of other similar studies. On the other hand, the stage of the disease as well as the grade of histologic differentiation and lymph node involvement, demonstrated no significant association with ER status as expected. A small number of cases studied and the heterogeneous stages included, could explain some of the differences between our data and the results from other studies. Semiquantitative ER-1CA, as fast and simple method, is especially useful in determination of ER status in recurrent, metastatic and small-sized breast carcinomas. The great advantage of ER-ICA is in a possibility of ER status preoperative determination, and repeating the procedure, if necessary. Despite the good performances, some inherent difficulties must be noted: subjectivity in scoring and detection by antigenicity of ER. Therefore, ER status quantitative assessment by using Cell-Analysing-System (CAS) and concomitant quantitative measurements of progesterone receptor status, should be of additional benefit. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Human papilloma virus DNA presence in early stage cervical carcinomas: Correlation with other prognostic factors and recurrence rate(Gustav Fischer, 1997-09); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Postoperative TNM classification of cervical cancer (1989-1995)(University of Niš Faculty of Medicine and the Department of the Serbian Medical Society Niš, 1996-06)The aim of this study is to present and analyze the results of the application of postoperative TNM classification of cervical cancer. For this purpose we have reviewed the clinical and histopathological data of 464 patients with cervical intraepithelial (74) and invasive cancer (390) who underwent abdominal hysterectomy or radical hysterectomy with regional lymphadenectomy from March 1989 to December 1995. There were 74 (16.0%) cases of Stage 0, 211 (45.5%) of Stage I, 88 (18.9%) of Stage II, 84 (18.1%) of Stage III and 7 (1.5) cases of Stage IV. In our case series (399) we have found significant rate of discordance between clinical FIGO and postoperative stadium. The incidence of error increases progressively as the stage grows more advanced, with prevalent understaging. Cross relationships of tumor extent, incidence of lymph node metastasis, grade of tumor differentiation, histological type, and age of the patients were also studied and are discussed. These data indicate that postoperative TNM classification staging system should be applied regularly, systematically and universally. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Prognostic significance of the human papillomavirus DNA presence in early stage cervical carcinoma(1996-05); Stavrik, GeorgeAlthough the role of human papillomavirus in cervical carcinogenesis is reasonably well established, the attempts to determine the prognostic value of presence or absence of detectable human papillomavirus DNA and HPV type in cervical carcinoma have yielded conflicting results. The objective of our study was to assess the prognostic significance of the presence of HPV DNA in a fairly homogenous population of patients with early stage cervical carcinomas who underwent abdominal hysterectomy with pelvic lymphadenectomy as primary therapy. In this report the preliminary results of this larger study are presented by exploring the relationship of HPV presence to the recurrence rate and clinical and histopathologic features of 44 patients with cervical carcinoma. Routinely processed formalin-fixed paraffin-embedded cervical carcinoma surgical specimens were examined for the presence of HPV DNA by in situ hybridization technique using mixed biotinylated probes to identify HPV types 6/11, 16/18 and 31/33/51. Clinical and histopathologic data of these patients was analyzed retrospectively to determine their relation to presence or absence of HPV DNA. All the patients were staged according to the postoperative TNM classification of UICC (1987) guidelines. In our case series the tumor was limited to cervix in 24 (54.6%) patients, while local extension to vagina and parametrial tissues was found in 6 (13.6%) and 14 (31.8%) patients, respectively. Pelvic lymph node involvement was found in 15 (34%) patients. During the follow up period (range, 2-72, mean, 39 months), recurrences were observed in 6 patients. HPV DNA was detected in 20 (45%) cervical carcinoma specimens. The prevalence rate of different HPV types was 34% (18) for HPV 16/18, 9% (4) for HPV 31/33/5, while HPV type 6/11 was detected only in one case of verrucous carcinoma. Recurrence rate in relation to the presence of HPV DNA exhibited a trend but was not statistically significant. Among the HPV DNA positive patients with cervical carcinoma the recurrence rate was 5% (1 case), compared to 21% (5 cases) for the HPV DNA negative group. Various clinical and histopathologic features of the patients with cervical carcinomas (tumor extent, grade, presence of regional lymph nodal metastases, histologic subtype, maximum depth of cervical stromal invasion, longitudinal tumor diameter, tumor-cervix area quotient, parametrial involvement, vaginal invasion, lymph-vascular space invasion, peri- and intra-tumoral lymphocytic infiltration, age) were also correlated with the presence of HPV. None of these factors was found to have statistically significant relationship to the presence of HPV DNA. The preliminary results of our study are consistent the observations reported by several other authors. The presence of HPV DNA appeared to be unrelated to recurrence rate and various histopathologic characteristics of well-known prognostic significance. However, having in mind the limited number of cases studied, as well as a lower sensitivity of in situ hybridization technique, an analysis of larger series, as well as introducing a more sensitive technique like PCR assay, will be necessary to determine whether the presence of HPV DNA and HPV type should be considered when developing treatment strategies and assessing prognosis in patients with early stage cervical carcinomas. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Axillary lymph node metastases in early (pT1) breast carcinomas: Most of the common prognostic factors lack predictive value.(University of Ioannina, 2003-09); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, HER2/neu expression in correlation with p53 and Ki-67 immunoreactivity and clinicopathological parameters in breast cancer patients.(Blackwell Publishing, 2002-10); - Some of the metrics are blocked by yourconsent settings
Item type:Publication, Association between Her2/neu expression and hormon receptor status in breast cancer patients.(2002-06);