Patient-specific prognostic factors

We cannot discount altogether the patient-specific prognostic factors outhned in the staging systems described in Table 104.1. For reasons that are not completely understood, both the age and sex of the patient at diagnosis influence disease behavior and the outcome of initial therapies. 

Renal dysfunctions can be diagnosed by different methods, depending on the severity of the condition. Examination of urine, which is produced by the kidneys, provides an important indication of renal insufficiency. The urine output, color, odor, acidity, specific gravity, and constituents are important prognostic factors of kidney status. However, in critically ill patients and in acute renal failures induced by several diseases including multiple organ failures and diabetes, urine examination may be impractical and redundant. Such patients require reliable and simple methods to diagnose the onset of renal failure. 

Breast cancer patients with the same stage of disease can have markedly different clinical outcomes. Traditional diagnostic and prognostic factors may stratify patients with molecularly distinct diseases into the same group based on morphological assessments. It remains a critical issue to reliably identify specific breast cancer patients at high risk for recurrent and metastatic disease. Molecular prediction is the future direction of personalized cancer care. 

In both adults and children with ALL, recent studies have identified several risk factors that correlate with prognosis (Table 131-6). As most patients with ALL achieve a CR, these factors correlated with the risk of leukemic relapse rather than the risk of not achieving a CR.. 1 Poor prognostic factors include high WBC count at presentation, very young or old age at presentation, delayed remission induction, and the presence of specific cytogenetic abnormalities. Several specific chromosomal translocations have been iden- tifled and are now being routinely used in risk assessment. 

However, in the absence of known prognostic factors, and with the exception of breast cancer, to date there are very few data to draw firm conclusions regarding the role of microspheres for non-colorectal, nonneuroendocrine cancer-related hepatic metastases. Thus, although it may become a promising component of overall treatment, it cannot be generalized and at present should be individualized based on the patient s clinical course and by the biologic behaviors of the specific malignancy. 

Patients should be categorized into either prognostically mild or severe disease using any one of a number of validated multiple-factor scoring systems (Table 39 ). " Two widely used measures include Ranson s criteria and the Acute Physiology and Chronic Health Evaluation (APACHE II). The APACHE II (>8 points) system is more sensitive and specific than Ranson s criteria (>3 criteria), but it is also more complex. The APACHE II system uses 14 indicators of physiological and biochemical function that can be readily calculated upon admission to an intensive care unit. Ranson s criteria includes 11 variables that must be monitored at the time of admission and during the initial 48 hours of hospitalization. Patients with fewer than three Ranson criteria have a mortality rate of less than 1%, while... 

Laboratory aberrations are nonspecific (2). The erythrocyte sedimentation rate (ESR) is elevated in >60% of patients circulating antinuclear antibodies (ANA) or rheumatoid factor are present in 10% to 26% (2,15). These serological parameters do not correlate with the extent or activity of the disease and have no prognostic value (2,15). Elevations of the glycoprotein KL-6 (19,20) and the lung surfactant proteins (SP) A and D (21) have been noted in serum and bronchoalveolar lavage fluid (BALF) in patients with IPF, and may have prognostic value. These assays are available in only a few research laboratories and additional studies are required to assess their specificity and clinical role. 

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