Prognostic factor

The presence of acute inflammatory manifestations (i.e., erythema nodosum, polyarthritis, and fever), termed Lofgren s syndrome, portends an excellent prognosis, with high rates ( 85%) of SRs (9,14,33,37,38). Conversely, the following factors were associated with a worse prognosis in sarcoidosis age onset 40 years (9,36), hypercalcemia (9), extrathoracic disease (9,20), lupus pernio (9), splenomegaly (36), pulmonary infiltrates on chest radiograph (9,36), chronic uveitis, cystic bone lesions, nasal mucosal sarcoidosis (9), and lower annual family income (14). 

Ethnic, geographic, and genetic factors influence prognosis (36,39,40). Lofgren s syndrome is three to six times more common in women (7,38). Black race is associated with a higher rate of chronic progressive disease, worse 

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Ziedonis DM, Kosten TR Depression as a prognostic factor for pharmacological treatment of cocaine dependence. Psychopharmacol Bull 27 337-343, 1991... 

Uhl E, Kreth EW, Elias B, Goldammer A, Hempelmann RG, Liefner M, Nowak G, Oertel M, Schmieder K, Schneider GH. Outcome and prognostic factors of hemicraniectomy for space occup3nng cerebral infarction. J Neurol Neurosurg Psychiatry 2004 75(2) 270-274. 

Asthma results from a complex interaction of genetic and environmental factors however, the underlying cause is not well understood. There appears to be an inheritable component, as the presence of asthma in a parent is a strong risk factor for the development of asthma in a child. This risk increases when a family history of atopy is also present.13 Approximately 50% of asthma can be attributed to atopy, and atopic asthma is more common in children than adults.3 Furthermore, atopy in childhood asthma is the strongest prognostic factor for continued asthma as an adult.1,3... 

The two variables most strongly associated with the occurrence of breast cancer are gender and age. Although one commonly thinks of breast cancer as a disease confined to women, about 1,720 cases of male breast cancer were projected to be diagnosed in the United States in 2006.1 When stage and other known prognostic factors are controlled for, men do not fare any differently from their female counterparts and receive similar treatment regimens. 

The pathologic evaluation of breast lesions serves to establish the histologic diagnosis and to confirm the presence or absence of other factors believed to influence prognosis. These prognostic factors include the presence of necrosis, lymphatic or vascular invasion, nuclear grade, hormone receptor status, proliferative index, amount of aneuploidy, and HER-2/neu expression. 

A number of potential prognostic factors have been identified for breast cancer. Prognostic factors are measurements available at diagnosis or time of surgery that in the absence of adjuvant therapy are associated with recurrence rate, death rate, or other clinical outcome. 

The stage of colorectal cancer is determined by the TNM staging system and is the most important prognostic factor for patient survival. Stage I to III disease is curable, whereas patients with stage IV disease are treated with the goal of palliation. 

TABLE 90-2. Negative Prognostic Factors for Hodgkin s Lymphoma and Non-Hodgkin s Lymphoma... 

P2-microglobulin concentration have been correlated with survival. The International Index is a predictive model for aggressive NHL to be treated with doxorubicin-containing chemotherapy regimens.11 This index is used as a tool for selecting therapy for patients who may warrant a more intense treatment regimen based on known poor prognostic factors. 

The histology of the disease is a prognostic factor. For instance, clear-cell and undifferentiated tumors do not respond as well to chemotherapy.2 The extent of residual disease and tumor grade are also predictive of response to chemotherapy and overall survival.2 There are other prognostic factors that may predict how well a patient will respond to adjuvant chemotherapy. 

Identify the prognostic factors for acute lymphocytic leukemia (ALL). 

TABLE 92-5. Prognostic Factors in Acute Lymphocytic Leukemia... 

The major prognostic factors in newly diagnosed AML are age, sub-type (FAB M2), and chromosome status. Older adults with AML (greater than 60 years), in comparison with younger patients with the same disease, have a dismal prognosis and represent a distinct population in terms of disease biology, treatment-related complications, and overall survival. These older patients have a higher incidence of unfavorable chromosomal abnormalities, such as aberrations of chromosomes 5,7, or 8, and fewer abnormalities that are associated with a more favorable outcome, such as t(8 21) or inv(16) (see Table 92—6).9... 

The proportion of ALL in patients older than age 60 years constitutes between 16% and 31% of all adult leukemias. Treatment of adults largely has followed the conventional chemotherapeutic regimes used in childhood ALL. However, the intensification regimens common in childhood are not suitable for this population because of their associated toxic-ities in older patients. The adverse prognostic factor, the Philadelphia chromosome, occurs in 15% to 30% of adults and thus is more common in the over 60 age group.17 Based on the experience achieved in CML, the use of imatinib, a potent inhibitor of the Ph+-associated BCR-ABL tyrosine kinase, is becoming a common practice for these older adults. Results show that the combination of imatinib with conventional chemotherapy has improved remission rates compared with the use of conventional chemotherapy alone,... 

Poor Prognostic Factors (Sokal Risk Model)6... 

Other findings Bone lesions, fractures, osteoporosis Poor Prognostic Factors... 

Determination of lymph node status is important in melanoma staging because it is an independent prognostic factor, and it provides the oncologist with guidance for therapy decisions. 

Since patients with spinal metastases generally are incurable, the primary goal of treatment of spinal cord compression is palliation. The most important prognostic factor for patients presenting with spinal cord compression is the underlying neurologic status. 

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