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Vrenken H, Battaglini M, de Vos ML, Nagtegaal GJ, Teixeira BCA, Seitzinger A, Jack D, Sormani MP, Uitdehaag BMJ, Versteeg A, Comi G, Kappos L, De Stefano N, Barkhof F. Temporal evolution of new T1-weighted hypo-intense lesions and central brain atrophy in patients with a first clinical demyelinating event treated with subcutaneous interferon β-1a. J Neurol 2023; 270:2271-2282. [PMID: 36723685 PMCID: PMC10025187 DOI: 10.1007/s00415-022-11554-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Evaluate the effect of subcutaneous interferon β-1a (sc IFN β-1a) versus placebo on the evolution of T1-weighted MRI lesions and central brain atrophy in in patients with a first clinical demyelinating event (FCDE). METHODS Post hoc analysis of baseline-to-24 month MRI data from patients with an FCDE who received sc IFN β-1a 44 μg once- (qw) or three-times-weekly (tiw), or placebo, in REFLEX. Patients were grouped according to treatment regimen or conversion to clinically definite MS (CDMS) status. The intensity of new lesions on unenhanced T1-weighted images was classified as T1 iso- or hypo-intense (black holes) and percentage ventricular volume change (PVVC) was assessed throughout the study. RESULTS In patients not converting to CDMS, sc IFN β-1a tiw or qw, versus placebo, reduced the overall number of new lesions (P < 0.001 and P = 0.005) and new T1 iso-intense lesions (P < 0.001 and P = 0.002) after 24 months; only sc IFN β-1a tiw was associated with fewer T1 hypo-intense lesions versus placebo (P < 0.001). PVVC findings in patients treated with sc IFN β-1a suggested pseudo-atrophy that was ~ fivefold greater versus placebo in the first year of treatment (placebo 1.11%; qw 4.28%; tiw 6.76%; P < 001); similar findings were apparent for non-converting patients. CONCLUSIONS In patients with an FCDE, treatment with sc IFN β-1a tiw for 24 months reduced the number of new lesions evolving into black holes.
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Affiliation(s)
- H Vrenken
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands.
| | - M Battaglini
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - M L de Vos
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - G J Nagtegaal
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - B C A Teixeira
- Department of Radiology, Federal University of Paraná, Curitiba, Paraná, Brazil
- Neuroradiology Department, Neurological Institute of Curitiba (INC/CETAC), Curitiba, Paraná, Brazil
| | - A Seitzinger
- Global Biostatistics, Merck Healthcare KGaA, Darmstadt, Germany
| | - D Jack
- Global Medical Affairs, Merck Serono Ltd, (an affiliate of Merck KGaA), Feltham, UK
| | - M P Sormani
- Department of Health Sciences, University of Genoa and Ospedale Policlinico San Martino IRCCS, Genoa, Italy
| | - B M J Uitdehaag
- Department of Neurology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - A Versteeg
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Biomedical Imaging Group Rotterdam, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - G Comi
- Università Vita-Salute San Raffaele, Casa di Cura Privata del Policlinico, Milan, Italy
| | - L Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB) and Neurology Departments of Head, Spine and Neuromedicine, Biomedical Engineering and Clinical Research, University Hospital, University of Basel, Basel, Switzerland
| | - N De Stefano
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - F Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
- UCL Institutes of Neurology and Healthcare Engineering, London, UK
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Pravatà E, Roccatagliata L, Sormani MP, Carmisciano L, Lienerth C, Sacco R, Kaelin-Lang A, Cianfoni A, Zecca C, Gobbi C. Dedicated 3D-T2-STIR-ZOOMit Imaging Improves Demyelinating Lesion Detection in the Anterior Visual Pathways of Patients with Multiple Sclerosis. AJNR Am J Neuroradiol 2021; 42:1061-1068. [PMID: 33766824 DOI: 10.3174/ajnr.a7082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/20/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Demyelinating lesions in the anterior visual pathways represent an underestimated marker of disease dissemination in patients with MS. We prospectively investigated whether a dedicated high-resolution MR imaging technique, the 3D-T2-STIR-ZOOMit, improves demyelinating lesion detection compared with the current clinical standard sequence, the 2D-T2-STIR. MATERIALS AND METHODS 3T MR imaging of the anterior visual pathways (optic nerves, chiasm, and tracts) was performed using 3D-T2-STIR-ZOOMit and 2D-T2-STIR, in patients with MS and healthy controls. Two experienced neuroradiologists assessed, independently, demyelinating lesions using both sequences separately. 3D-T2-STIR-ZOOMit scan-rescan reproducibility was tested in 12 patients. The Cohen κ was used for interrater agreement, and the intraclass correlation coefficient for reproducibility. Between-sequence detection differences and the effects of location and previous acute optic neuritis were assessed using a binomial mixed-effects model. RESULTS Forty-eight patients with MS with (n = 19) or without (n = 29) past optic neuritis and 19 healthy controls were evaluated. Readers' agreement was strong (3D-T2-STIR-ZOOMit: 0.85; 2D-T2-STIR: 0.90). The 3D-T2-STIR-ZOOMit scan-rescan intraclass correlation coefficient was 0.97 (95% CI, 0.96-0.98; P < .001), indicating excellent reproducibility. Overall, 3D-T2-STIR-ZOOMit detected more than twice the demyelinating lesions (n = 89) than 2D-T2-STIR (n = 43) (OR = 2.7; 95% CI, 1.7-4.1; P < .001). In the intracranial anterior visual pathway segments, 33 of the 36 demyelinating lesions (91.7%) detected by 3D-T2-STIR-ZOOMit were not disclosed by 2D-T2-STIR. 3D-T2-STIR-ZOOMit increased detection of demyelinating lesion probability by 1.8-fold in patients with past optic neuritis (OR = 1.8; 95% CI, 1.2-3.1; P = .01) and 5.9-fold in patients without past optic neuritis (OR = 5.9; 95% CI, 2.5-13.8; P < .001). No false-positive demyelinating lesions were detected in healthy controls. CONCLUSIONS Dedicated 3D-T2-STIR-ZOOMit images improved substantially the detection of MS disease dissemination in the anterior visual pathways, particularly in the intracranial segments and in patients without past optic neuritis.
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Affiliation(s)
- E Pravatà
- From the Department of Neuroradiology (E.P., A.C.), Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - L Roccatagliata
- Department of Health Sciences (L.R., M.P.S., L.C.), University of Genova, Genova, Italy.,Dipartimento di Scienze della Salute - DISSAL (L.R., M.P.S.), Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genoa, Italy
| | - M P Sormani
- Department of Health Sciences (L.R., M.P.S., L.C.), University of Genova, Genova, Italy.,Dipartimento di Scienze della Salute - DISSAL (L.R., M.P.S.), Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Policlinico San Martino, Genoa, Italy
| | - L Carmisciano
- Department of Health Sciences (L.R., M.P.S., L.C.), University of Genova, Genova, Italy
| | - C Lienerth
- Bayer Vital GmbH (C.L.), Leverkusen, Germany
| | - R Sacco
- Department of Neurology (R.S., A.K.-L., C.Z., C.G.), Neurocenter of Southern Switzerland, Lugano, Switzerland
| | - A Kaelin-Lang
- Department of Neurology (R.S., A.K.-L., C.Z., C.G.), Neurocenter of Southern Switzerland, Lugano, Switzerland.,Faculty of Biomedical Sciences (A.K.-L., A.C., C.Z., C.G.), Università della Svizzera Italiana, Lugano, Switzerland
| | - A Cianfoni
- From the Department of Neuroradiology (E.P., A.C.), Neurocenter of Southern Switzerland, Lugano, Switzerland.,Faculty of Biomedical Sciences (A.K.-L., A.C., C.Z., C.G.), Università della Svizzera Italiana, Lugano, Switzerland
| | - C Zecca
- Department of Neurology (R.S., A.K.-L., C.Z., C.G.), Neurocenter of Southern Switzerland, Lugano, Switzerland.,Faculty of Biomedical Sciences (A.K.-L., A.C., C.Z., C.G.), Università della Svizzera Italiana, Lugano, Switzerland
| | - C Gobbi
- Department of Neurology (R.S., A.K.-L., C.Z., C.G.), Neurocenter of Southern Switzerland, Lugano, Switzerland.,Faculty of Biomedical Sciences (A.K.-L., A.C., C.Z., C.G.), Università della Svizzera Italiana, Lugano, Switzerland
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Carmisciano L, Signori A, Pardini M, Novi G, Lapucci C, Nesi L, Gallo E, Laroni A, Cellerino M, Meli R, Sbragia E, Filippi L, Uccelli A, Inglese M, Sormani MP. Assessing upper limb function in multiple sclerosis using an engineered glove. Eur J Neurol 2020; 27:2561-2567. [PMID: 32805743 DOI: 10.1111/ene.14482] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 08/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The importance of upper limb function in multiple sclerosis (MS) is increasingly recognized, especially for the evaluation of patients with progressive MS with reduced mobility. Two sensor-engineered gloves, able to measure quantitatively the timing of finger opposition movements, were previously used to assess upper limb disability in MS. The aims of the present study were: (1) to confirm the association between glove-derived variables and standard measures of MS disability in a larger cohort; (2) to assess the correlation with quantitative magnetic resonance imaging (MRI) and quality of life (QoL) measures; and (3) to determine if the glove-derived variables offer advantages over the standard measure for assessing upper limb function in MS, namely, the Nine-Hole Peg Test (9HPT). METHODS Sixty-five patients with MS, stable on disease-modifying treatment, were evaluated at baseline using the glove, and through clinical examination (Expanded Disability Status Scale, Symbol Digit Modalities Test, Timed 25-Foot Walk Test and 9HPT), MRI evaluation and QoL questionnaires. Correlations between the glove-derived variables and clinical, MRI and QoL variables were assessed using Spearman's rank correlation coefficient analysis. RESULTS Glove-derived variables significantly differed between patients with relapsing-remitting and those with progressive MS, with similar or slightly higher correlations of the 9HPT with clinical variables. We found greater correlations of the QoL physical component with glove-derived variables than with the 9HPT, and a significant correlation of its mental component with the glove-derived variables but not with the 9HPT. CONCLUSION The study results, confirming previous findings and showing advantages over the 9HPT, encourage the investigation of sensitivity to change in glove-derived variables in a longitudinal setting.
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Affiliation(s)
- L Carmisciano
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - A Signori
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - M Pardini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - G Novi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - C Lapucci
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - L Nesi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - E Gallo
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Department of Neuroscience Rita Levi Montalcini, University of Turin, Turin, Italy
| | - A Laroni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - M Cellerino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - R Meli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - E Sbragia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - L Filippi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - A Uccelli
- Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - M Inglese
- Ospedale Policlinico San Martino-IRCCS, Genoa, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - M P Sormani
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
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Palladino R, Brescia Morra V, Lanzillo R, Giordana R, Fumo MG, Montuori P, Sormani MP, Triassi M, Moccia M. Prevalence of multiple sclerosis in the South of Italy based on healthcare administrative data. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Multiple sclerosis (MS) is an heterogenous disease whose prevalence varies in Europe. Hereby, we aimed to estimate prevalence of MS in the Campania Region of Italy.
Methods
To identify individuals with MS living in the Campania Region of Italy, we extracted data from the following healthcare administrative databases: hospital discharge records, regional drug registry, and specialist outpatient visits from Jan-2015 to 3Dec-2017. Individuals alive on the 1-Jan-2018 were included to capture prevalence on this date. Age-sex standardised prevalence rates were calculated using the direct standardisation method; the European population in 2018 was considered as reference population. To assess differences in the prevalence ratios across the five provinces of the region, standardised morbility ratios (SMR) were calculated. To calculate 95% confidence intervals (95%CI) for the standardised rates, the Byar’s approximation method based on the Poisson distribution was used.
Results
We identified 5,361 individuals with MS (females 64.5%, age 45.6±12.7 years). Standardised prevalence rate per 100,000 people was 90.0 cases (95%CI=87.60, 92.40) (112.07 for females [95%CI=108.36, 115.88] and 66.20 for males [95%CI=63.26, 69.25]). The SMR in the province of Naples, the most densely populated, was 0.90 (95%CI=0.86, 0.96), whereas the highest SMR was found in the province of Salerno (SMR=1.30; 95%CI=1.23, 1.38), and the lowest in the province of Caserta (SMR=0.89; 95%CI=0.82-0.96).
Conclusions
Prevalence of MS in the Campania Region is lower than previous estimates from smaller areas in the North of Italy, suggesting a longitudinal gradient. Differences within the Region could be explained by genetic/environmental background and healthcare organization (e.g., missing diagnoses). In the future, healthcare administrative databases could be used to monitor MS prevalence/incidence and to plan healthcare resource utilization.
Key messages
Prevalence of MS in the Campania Region is 90 cases per 100,000 people. It is lower than previous estimates from smaller areas in the North of Italy, suggesting a longitudinal gradient. Differences within the Region could be explained by genetic/environmental background and healthcare organization (e.g., missing diagnoses).
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Affiliation(s)
- R Palladino
- Department of Public Health, University, Naples, Italy
- Department of Primary Care and Public Health, Imperial College, London, UK
| | - V Brescia Morra
- Multiple Sclerosis Clinical Care and Research Centre, University, Naples, Italy
| | - R Lanzillo
- Multiple Sclerosis Clinical Care and Research Centre, University, Naples, Italy
| | - R Giordana
- Campania Region Healthcare System Commissioner Office, Regional Office, Naples, Italy
| | - M G Fumo
- Regional Healthcare Society, Regional Office, Naples, Italy
| | - P Montuori
- Department of Public Health, University, Naples, Italy
| | - M P Sormani
- Biostatistic Unit, University of Genoa, Genoa, Italy
| | - M Triassi
- Department of Public Health, University, Naples, Italy
| | - M Moccia
- Multiple Sclerosis Clinical Care and Research Centre, University, Naples, Italy
- Queen Square MS Centre, University College London, London, UK
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5
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Bonzano L, Bove M, Sormani MP, Stromillo ML, Giorgio A, Amato MP, Tacchino A, Mancardi GL, De Stefano N. Subclinical motor impairment assessed with an engineered glove correlates with magnetic resonance imaging tissue damage in radiologically isolated syndrome. Eur J Neurol 2018; 26:162-167. [PMID: 30133054 DOI: 10.1111/ene.13789] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 08/17/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND An engineered glove measuring finger motor performance previously showed ability to discriminate early-stage multiple sclerosis (MS) patients from healthy controls (HCs). Radiologically isolated syndrome (RIS) classifies asymptomatic subjects with brain magnetic resonance imaging (MRI) abnormalities suggestive of multiple sclerosis. METHODS Seventeen asymptomatic subjects with RIS and 17 HCs were assessed. They performed finger-to-thumb opposition sequences at their maximal velocity, metronome-paced bimanual movements and conventional and diffusion tensor MRI. RESULTS Subjects with RIS showed lower (P = 0.005) maximal velocity and higher (P = 0.006) bimanual coordination impairment than HCs. In RIS, bimanual coordination correlated with T2-lesion volume, fractional anisotropy and radial diffusivity in the white matter. CONCLUSIONS These findings point out the relevance of fine hand measures as a robust marker of subclinical disability.
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Affiliation(s)
- L Bonzano
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - M Bove
- Section of Human Physiology, Department of Experimental Medicine, University of Genoa, Genoa, Italy
| | - M P Sormani
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy
| | - M L Stromillo
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - A Giorgio
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - M P Amato
- Neuroscience Division, Department of NEUROFARBA, University of Florence, Florence, Italy
| | - A Tacchino
- Section of Human Physiology, Department of Experimental Medicine, University of Genoa, Genoa, Italy
| | - G L Mancardi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - N De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
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Uher T, Vaneckova M, Sormani MP, Krasensky J, Sobisek L, Dusankova JB, Seidl Z, Havrdova E, Kalincik T, Benedict RHB, Horakova D. Identification of multiple sclerosis patients at highest risk of cognitive impairment using an integrated brain magnetic resonance imaging assessment approach. Eur J Neurol 2016; 24:292-301. [PMID: 27873386 DOI: 10.1111/ene.13200] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 09/25/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE While impaired cognitive performance is common in multiple sclerosis (MS), it has been largely underdiagnosed. Here a magnetic resonance imaging (MRI) screening algorithm is proposed to identify patients at highest risk of cognitive impairment. The objective was to examine whether assessment of lesion burden together with whole brain atrophy on MRI improves our ability to identify cognitively impaired MS patients. METHODS Of the 1253 patients enrolled in the study, 1052 patients with all cognitive, volumetric MRI and clinical data available were included in the analysis. Brain MRI and neuropsychological assessment with the Brief International Cognitive Assessment for Multiple Sclerosis were performed. Multivariable logistic regression and individual prediction analysis were used to investigate the associations between MRI markers and cognitive impairment. The results of the primary analysis were validated at two subsequent time points (months 12 and 24). RESULTS The prevalence of cognitive impairment was greater in patients with low brain parenchymal fraction (BPF) (<0.85) and high T2 lesion volume (T2-LV) (>3.5 ml) than in patients with high BPF (>0.85) and low T2-LV (<3.5 ml), with an odds ratio (OR) of 6.5 (95% CI 4.4-9.5). Low BPF together with high T2-LV identified in 270 (25.7%) patients predicted cognitive impairment with 83% specificity, 82% negative predictive value, 51% sensitivity and 75% overall accuracy. The risk of confirmed cognitive decline over the follow-up was greater in patients with high T2-LV (OR 2.1; 95% CI 1.1-3.8) and low BPF (OR 2.6; 95% CI 1.4-4.7). CONCLUSIONS The integrated MRI assessment of lesion burden and brain atrophy may improve the stratification of MS patients who may benefit from cognitive assessment.
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Affiliation(s)
- T Uher
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - M Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - M P Sormani
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - J Krasensky
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - L Sobisek
- Department of Statistics and Probability, University of Economics in Prague, Prague, Czech Republic
| | - J Blahova Dusankova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Z Seidl
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - E Havrdova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - T Kalincik
- Department of Medicine, University of Melbourne, Melbourne, Vic., Australia.,Department of Neurology, Royal Melbourne Hospital, Melbourne, Vic., Australia
| | - R H B Benedict
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - D Horakova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
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Mercuri E, Pane M, Palermo C, D'amico A, Messina S, Battini R, Bruno C, Mongini T, Pegoraro E, D'Angelo G, Pini A, Gorni K, Baranello G, Bertini E, Sormani M. The 24-month performance of upper limb (PUL) scale: Changes and steroids correlation in DMD. Neuromuscul Disord 2016. [DOI: 10.1016/j.nmd.2016.06.362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
We investigated the distribution of the magnetic resonance imaging (MRI)-measured response to glatiramer acetate (GA) treatment in multiple sclerosis (MS) using data from a clinical trial of relapsing=remitting (RR) MS. A fixed and a random effects model were used to quantify the between-patient heterogeneity in treatment response, expressed as new enhancing lesion percentage reduction. In 95% of the patients, lesion reduction due to treatment was estimated to range between -20% and -54%, indicating a rather homogeneous effect of GA on MRI-measured disease activity in RRMS.
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Affiliation(s)
- M P Sormani
- Neuroimaging Research Unit, Scientific Institute and University Ospedale San Raffaele, 20132 Milan, Italy
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9
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Zecca C, Disanto G, Sormani MP, Riccitelli GC, Cianfoni A, Del Grande F, Pravatà E, Gobbi C. Relevance of asymptomatic spinal MRI lesions in patients with multiple sclerosis. Mult Scler 2015; 22:782-91. [PMID: 26459149 DOI: 10.1177/1352458515599246] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 07/09/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The impact of new asymptomatic spinal cord lesions (a-SL) in multiple sclerosis (MS) course is poorly characterized. OBJECTIVE The objective of this research paper is to assess the prognostic value of a-SL in predicting MS course. METHODS Relapsing-remitting MS patients who received serial MRI (brain and spinal) at baseline (t1) and within 12 to 36 months (t2) during clinical stability, and had a follow-up (t2-t3) ⩾24 months were included. Relapses and disability progression were evaluated between t2 and t3. RESULTS Of 413 consecutive screened MS patients, 103 patients (65 females, median age 43 years) were included. After a median t1-t2 interval of 17 (IQR 13-26) months, 25.2% and 43.7% patients had ⩾1 new a-SL (a-SL+) and asymptomatic brain lesions (a-BL+), respectively. Relapse risk between t2 and t3 (median interval: 42 (IQR 32-57.5) months) was significantly increased in a-SL+ and/or a-BL+ vs a-BL- and a-SL- (HR = 2.31, 95% CI = 1.13-4.72, p = 0.02). No differences in the risk of disability progression were found in a-SL+ and/or a-BL+ vs a-SL- and a-BL-. CONCLUSION a-SL occur in one-quarter of clinically stable RRMS, and combined with a-BL contribute significantly in predicting future disease course.
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Affiliation(s)
- C Zecca
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Switzerland
| | - G Disanto
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Switzerland
| | - M P Sormani
- Biostatistics Unit, Department of Health Sciences (DISSAL), University of Genova, Italy
| | - G C Riccitelli
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Switzerland/Neuroimaging Research Unit, Institute of Experimental Neurology, Vita-Salute San Raffaele University, Italy
| | - A Cianfoni
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Switzerland
| | - F Del Grande
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Switzerland
| | - E Pravatà
- Department of Neuroradiology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Switzerland
| | - C Gobbi
- Multiple Sclerosis Center, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Switzerland
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Sormani MP, De Stefano N, Francis G, Sprenger T, Chin P, Radue EW, Kappos L. Fingolimod effect on brain volume loss independently contributes to its effect on disability. Mult Scler 2015; 21:916-24. [DOI: 10.1177/1352458515569099] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 12/24/2014] [Indexed: 11/17/2022]
Abstract
Background: Brain volume loss occurs in patients with relapsing–remitting MS. Fingolimod reduced brain volume loss in three phase 3 studies. Objective: To evaluate whether the effect of fingolimod on disability progression was mediated by its effects on MRI lesions, relapses or brain volume loss, and the extent of this effect. Methods: Patients (992/1272; 78%) from the FTY720 Research Evaluating Effects of Daily Oral Therapy in Multiple Sclerosis (FREEDOMS) study were analyzed. Month-24 percentage brain volume change, month-12 MRI-active lesions and relapse were assessed. The Prentice criteria were used to test surrogate marker validity. The proportion of treatment effect on disability progression explained by each marker was calculated. Results: Two-year disability progression was associated with active T2 lesions (OR = 1.24; p = 0.001) and more relapses during year 1 (OR = 2.90; p < 0.001) and lower percentage brain volume change over two years (OR = 0.78; p < 0.001). Treatment effect on active T2 lesions, relapses and percentage brain volume change explained 46%, 60% and 23% of the fingolimod effect on disability. Multivariate analysis showed the number of relapses during year 1 (OR = 2.62; p < 0.001) and yearly percentage brain volume change over two years (OR = 0.85; p = 0.009) were independent predictors of disability progression, together explaining 73% of fingolimod effect on disability. Conclusions: The treatment effect on relapses and, to a lesser extent, brain volume loss were both predictors of treatment effect on disability; combining these predictors better explained the effect on disability than either factor alone.
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Affiliation(s)
- MP Sormani
- Biostatistics Unit, University of Genoa, Italy
| | - N De Stefano
- Department of Medicine Surgery and Neuroscience, University of Siena, Italy
| | - G Francis
- Novartis Pharmaceuticals Corporation, New Jersey, USA
| | - T Sprenger
- Department of Neurology, University Hospital Basel, Switzerland/Medical Image Analysis Center, University Hospital Basel, Switzerland
| | - P Chin
- Novartis Pharmaceuticals Corporation, New Jersey, USA
| | - EW Radue
- Medical Image Analysis Center, University Hospital Basel, Switzerland
| | - L Kappos
- Department of Neurology, University Hospital Basel, Switzerland
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Federici S, Dolezalova P, Cantarini L, Papadopoulou-Alataki E, Alessio M, Herlin T, Gueli I, Modesto C, Fabio G, Maggio MC, Elorduy MJR, Garibotto F, Insalaco A, Kozlova A, Anton J, Brik R, Frenkel J, Hoppenreijs E, Sormani MP, Martini A, Gattorno M. Perspective validation of the eurofever classification criteria for monogenic periodic fevers. Pediatr Rheumatol Online J 2014. [PMCID: PMC4184335 DOI: 10.1186/1546-0096-12-s1-p82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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12
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Newbould RD, Nicholas R, Thomas CL, Quest R, Lee JSZ, Honeyfield L, Colasanti A, Malik O, Mattoscio M, Matthews PM, Sormani MP, Waldman AD, Muraro PA. Age independently affects myelin integrity as detected by magnetization transfer magnetic resonance imaging in multiple sclerosis. Neuroimage Clin 2014; 4:641-8. [PMID: 24936415 PMCID: PMC4053639 DOI: 10.1016/j.nicl.2014.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 01/23/2014] [Accepted: 02/14/2014] [Indexed: 11/25/2022]
Abstract
Background Multiple sclerosis (MS) is a heterogeneous disorder with a progressive course that is difficult to predict on a case-by-case basis. Natural history studies of MS have demonstrated that age influences clinical progression independent of disease duration. Objective To determine whether age would be associated with greater CNS injury as detected by magnetization transfer MRI. Materials and methods Forty MS patients were recruited from out-patient clinics into two groups stratified by age but with similar clinical disease duration as well as thirteen controls age-matched to the older MS group. Images were segmented by automated programs and blinded readers into normal appearing white matter (NAWM), normal appearing gray matter (NAGM), and white matter lesions (WMLs) and gray matter lesions (GMLs) in the MS groups. WML and GML were delineated on T2-weighted 3D fluid-attenuated inversion recovery (FLAIR) and T1 weighted MRI volumes. Mean magnetization transfer ratio (MTR), region volume, as well as MTR histogram skew and kurtosis were calculated for each region. Results All MTR measures in NAGM and MTR histogram metrics in NAWM differed between MS subjects and controls, as expected and previously reported by several studies, but not between MS groups. However, MTR measures in the WML did significantly differ between the MS groups, in spite of no significant differences in lesion counts and volumes. Conclusions Despite matching for clinical disease duration and recording no significant WML volume difference, we demonstrated strong MTR differences in WMLs between younger and older MS patients. These data suggest that aging-related processes modify the tissue response to inflammatory injury and its clinical outcome correlates in MS. Magnetization transfer MRI was used in a cohort of 40 MS subjects differing by age. MTR metrics were different between MS groups and controls, as expected. MTR in normal appearing tissue did not differ between age-stratified MS groups. MTR in white matter lesions was strongly different between age-stratified MS groups. Results imply an age-related effect in tissue integrity in MR-visible lesions.
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Affiliation(s)
- R D Newbould
- Imanova Centre for Imaging Sciences, London, UK ; Division of Experimental Medicine, Imperial College London, UK
| | - R Nicholas
- Division of Brain Sciences, Imperial College London, UK
| | - C L Thomas
- Division of Brain Sciences, Imperial College London, UK
| | - R Quest
- Department of Imaging, Imperial College Healthcare NHS Trust, UK
| | - J S Z Lee
- Division of Brain Sciences, Imperial College London, UK
| | - L Honeyfield
- Department of Imaging, Imperial College Healthcare NHS Trust, UK
| | - A Colasanti
- Imanova Centre for Imaging Sciences, London, UK ; Division of Brain Sciences, Imperial College London, UK
| | - O Malik
- Division of Brain Sciences, Imperial College London, UK
| | - M Mattoscio
- Division of Brain Sciences, Imperial College London, UK
| | - P M Matthews
- Division of Brain Sciences, Imperial College London, UK ; Neurosciences, GlaxoSmithKline Research and Development, UK
| | - M P Sormani
- Department of Health Sciences (DISSAL), University of Genoa, Italy
| | - A D Waldman
- Division of Brain Sciences, Imperial College London, UK ; Department of Imaging, Imperial College Healthcare NHS Trust, UK
| | - P A Muraro
- Division of Brain Sciences, Imperial College London, UK ; Department of Clinical Neurosciences, Imperial College Healthcare NHS Trust, UK
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13
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Gennari A, Costa M, Paleari L, Puntoni M, Sormani MP, Decensi A, Bruzzi P. Abstract S5-08: Breast cancer incidence after hormonal infertility treatments: Systematic review and meta-analysis of population based studies. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-s5-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: With the increasing practice of hormonal infertility treatments in infertile women, both for ovulation induction in anovulatory women and for ovarian hyperstimulation in assisted reproductive technologies, concerns have been raised about the long-term effects of such practice on the subsequent risk of breast cancer. Sterility itself is an independent risk factor, though its effect is not yet clear. In the past years, a number of population-based studies has addressed the possible association between breast cancer incidence and infertility treatments, with inconsistent results. With these premises, we performed a systematic review and pooled analysis of the association between infertility treatments by any kind of hormonal manipulation and breast cancer incidence, based on published data.
Methods: Population cohort studies, evaluating the association between BC incidence and hormonal infertility treatments were identified by literature search. Standardised Incidence Ratios (SIRs) were pooled across the studies by inverse variance weighting. Subgroup analyses were performed according to the following covariates: length of follow up (< 10 yrs vs > 10 yrs), type of hormonal therapy (clomiphene vs gonadotropins) and type of control group (population based on internal control, ie infertile women). All statistical tests were two-sided.
Results: Seventeen eligible studies were identified and retrieved. Data on breast cancer incidence and type of fertility treatments were available for all studies. Overall hormonal infertility treatments were associated with a 11% increase in BC incidence as compared with untreated women (SIR SIR 1.11, 95%CI 0,91-1,30). BC risk was slightly higher in clomiphene treated women (SIR 1.04; 95%CI 0.76-1.32) than in gonadotropins users (SIR 0.83; 95%CI 0.60-1.07), p for interaction < 0.0001. The increase in BC incidence seems to be dependent on follow up duration (SIR 0.94; 95%CI 0.8-1.08 for <10 yrs vs 1.23; 95%CI 0.86-1.6 for > 10yrs, p for interaction < 0.0001). In the subset of cohort studies using population based estimates as controls, hormonal infertility treatment was associated with an increase in breast cancer risk (SIR 1.13, 95% CI 0.86-1.41); in studies with internal controls, i.e. cohorts of untreated infertile women, a similar breast cancer risk was observed (SIR 1.00; 95%CI 0.73-1.26; p for interaction <0.001).
Conclusions: Overall hormonal infertility treatments do not appear to be consistently associated with a significant increase in breast cancer incidence. Subset analyses suggest a possible increase in BC incidence with longer FU (>10 yrs) whereas the use of gonadotropins might exert a protective effect.
Finally, subset analyses according to type of controls suggest that the observed increased risk reported by several studies may be attributable to the infertility condition itself.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr S5-08.
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Affiliation(s)
- A Gennari
- Galliera Hospital, Genoa, Italy; Evangelico Hospital, Genoa, Italy; AOU San Martino-IST, Genoa, Italy; University of Genoa, Genoa, Italy
| | - M Costa
- Galliera Hospital, Genoa, Italy; Evangelico Hospital, Genoa, Italy; AOU San Martino-IST, Genoa, Italy; University of Genoa, Genoa, Italy
| | - L Paleari
- Galliera Hospital, Genoa, Italy; Evangelico Hospital, Genoa, Italy; AOU San Martino-IST, Genoa, Italy; University of Genoa, Genoa, Italy
| | - M Puntoni
- Galliera Hospital, Genoa, Italy; Evangelico Hospital, Genoa, Italy; AOU San Martino-IST, Genoa, Italy; University of Genoa, Genoa, Italy
| | - MP Sormani
- Galliera Hospital, Genoa, Italy; Evangelico Hospital, Genoa, Italy; AOU San Martino-IST, Genoa, Italy; University of Genoa, Genoa, Italy
| | - A Decensi
- Galliera Hospital, Genoa, Italy; Evangelico Hospital, Genoa, Italy; AOU San Martino-IST, Genoa, Italy; University of Genoa, Genoa, Italy
| | - P Bruzzi
- Galliera Hospital, Genoa, Italy; Evangelico Hospital, Genoa, Italy; AOU San Martino-IST, Genoa, Italy; University of Genoa, Genoa, Italy
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14
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Amoroso V, Berruti A, Gallo F, Bertaglia V, Paloja E, Simoncini EL, Generali D, Bottini A, Bruzzi P, Sormani MP. Abstract P3-14-03: Pathological complete response after primary chemotherapy as a surrogate end point of treatment efficacy in breast cancer patients: A trial-based meta-analysis. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p3-14-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The relationship between pathological complete response (pCR) and improved long-term prognosis was first reported in the landmark NSABP B-18 and B-27 trials and then validated in large cohort studies and in meta-analyses. Whether pCR, as surrogate end point, should capture the full effect of neoadjuvant chemotherapy on survival is still unproven. To assess the role of pCR as surrogate of disease-free survival (DFS) and overall survival (OS) at a trial level, we performed a trial-based meta-regression of randomized studies comparing different neoadjuvant therapies with data on both pCR rates and outcome end points.
Methods: The systematic search included electronic databases and proceeding of international meetings. No restriction regarding treatment types was set up except for endocrine therapy trials that were excluded. We did not include studies comparing neoadjuvant versus adjuvant chemotherapy. Relevant data were extracted from each selected trial: patients randomly assigned to treatment and analyzed per arm, tumor stage, type of chemotherapy and targeted therapy, cycles number, additional post-surgical treatments, number of patients achieving pCR and number of outcome events per arm. For each trial, the experimental and the control arm were defined. Treatment effects on DFS and OS were expressed as hazard ratios (HRs) and on pCR as odd ratios (ORs). A weighted regression analysis was performed on log-transformed treatment effect estimates to test the association between the treatment effects on the surrogate outcome and the treatment effects on the clinical outcome.
Results: A final set of 28 trials, 57 arms and 29 contrasts for a total of 13,738 patients was included in the analysis. As one trial had 3 arms, it contributed two contrasts to the analysis. The regression of the logHR for DFS on the logOR for pCR, using the complete set of data, demonstrated a weak but significant association between the two effects (R2 = 0.16, p-value = 0.03). Sixteen% of the variability among the effects on DFS can be explained by the observed effects on pCR. The regression of the logHR for OS on the logOR for pCR demonstrated a weak association between the two effects (R2 = 0.15, p-value = 0.04).
Conclusions: This trial-based meta-regression showed a possible role of pCR as surrogate end point for DFS and OS in breast cancer patients treated with neoadjuvant chemotherapy. The surrogacy of pCR warrants to be further evaluated in more homogeneous subsets of clinical trials in the neoadjuvant chemotherapy-based setting.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-14-03.
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Affiliation(s)
- V Amoroso
- University of Brescia and Spedali Civili of Brescia, Brescia, Italy; University of Genoa, Genoa, Italy; University of Turin, San Luigi Hospital, Orbassano, Italy; Istituti Ospitalieri of Cremona, Cremona, Italy
| | - A Berruti
- University of Brescia and Spedali Civili of Brescia, Brescia, Italy; University of Genoa, Genoa, Italy; University of Turin, San Luigi Hospital, Orbassano, Italy; Istituti Ospitalieri of Cremona, Cremona, Italy
| | - F Gallo
- University of Brescia and Spedali Civili of Brescia, Brescia, Italy; University of Genoa, Genoa, Italy; University of Turin, San Luigi Hospital, Orbassano, Italy; Istituti Ospitalieri of Cremona, Cremona, Italy
| | - V Bertaglia
- University of Brescia and Spedali Civili of Brescia, Brescia, Italy; University of Genoa, Genoa, Italy; University of Turin, San Luigi Hospital, Orbassano, Italy; Istituti Ospitalieri of Cremona, Cremona, Italy
| | - E Paloja
- University of Brescia and Spedali Civili of Brescia, Brescia, Italy; University of Genoa, Genoa, Italy; University of Turin, San Luigi Hospital, Orbassano, Italy; Istituti Ospitalieri of Cremona, Cremona, Italy
| | - EL Simoncini
- University of Brescia and Spedali Civili of Brescia, Brescia, Italy; University of Genoa, Genoa, Italy; University of Turin, San Luigi Hospital, Orbassano, Italy; Istituti Ospitalieri of Cremona, Cremona, Italy
| | - D Generali
- University of Brescia and Spedali Civili of Brescia, Brescia, Italy; University of Genoa, Genoa, Italy; University of Turin, San Luigi Hospital, Orbassano, Italy; Istituti Ospitalieri of Cremona, Cremona, Italy
| | - A Bottini
- University of Brescia and Spedali Civili of Brescia, Brescia, Italy; University of Genoa, Genoa, Italy; University of Turin, San Luigi Hospital, Orbassano, Italy; Istituti Ospitalieri of Cremona, Cremona, Italy
| | - P Bruzzi
- University of Brescia and Spedali Civili of Brescia, Brescia, Italy; University of Genoa, Genoa, Italy; University of Turin, San Luigi Hospital, Orbassano, Italy; Istituti Ospitalieri of Cremona, Cremona, Italy
| | - MP Sormani
- University of Brescia and Spedali Civili of Brescia, Brescia, Italy; University of Genoa, Genoa, Italy; University of Turin, San Luigi Hospital, Orbassano, Italy; Istituti Ospitalieri of Cremona, Cremona, Italy
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15
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Federici S, Ozen S, Koné-Paut I, Lachmann H, Woo P, Cantarini L, Amaryan G, Insalaco A, Kuemmerle-Deschner J, Neven B, Dewarrat N, Uziel Y, Rigante D, Herlin T, Martino S, Simon A, Stojanov S, Ozdogan H, Frenkel J, Ruperto N, Martini A, Sormani M, Hofer M, Gattorno M. OR13-004 – Evidence-based clinical classification criteria for periodic fevers. Pediatr Rheumatol Online J 2013. [PMCID: PMC3953158 DOI: 10.1186/1546-0096-11-s1-a266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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16
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Comi G, Battaglia MA, Bertolotto A, Del Sette M, Ghezzi A, Malferrari G, Salvetti M, Sormani MP, Tesio L, Stolz E, Zaratin P, Mancardi G. Observational case-control study of the prevalence of chronic cerebrospinal venous insufficiency in multiple sclerosis: results from the CoSMo study. Mult Scler 2013; 19:1508-17. [PMID: 24014572 DOI: 10.1177/1352458513501231] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Chronic cerebrospinal venous insufficiency (CCSVI) has been proposed as a possible cause of multiple sclerosis (MS). OBJECTIVES The CoSMo study evaluated the association between CCSVI and MS. METHODS The primary end-point of this multicentric, case-control study was to compare the prevalence of CCSVI between patients with MS, patients with other neurodegenerative diseases (ONDs) and healthy controls (HCs). Color-coded duplex sonography was performed by a sonologist and the images were sent to one of three central sonologists for a second reading. Agreement between local and central sonologists or, in case of disagreement, the predominant judgment among the three central readers, was required for a diagnosis of CCSVI. All readings, data collection and analysis were blinded. RESULTS The study involved 35 MS centers across Italy and included 1874 subjects aged 18-55. 1767 (94%) were evaluable: 1165 MS patients, 226 patients with ONDs and 376 HCs. CCSVI prevalence was 3.26%, 3.10% and 2.13% for the MS, OND and HC groups, respectively. No significant difference in CCSVI prevalence was found amongst the three cohorts (MS versus HC, OR = 1.55, 95%CI = 0.72-3.36, p = 0.30; OND versus HC, OR = 1.47, 95%CI = 0.53-4.11, p = 0.46; MS versus OND, OR = 1.05, 95%CI = 0.47-2.39, p = 0.99). High negative and low positive agreement was found between the local and centralized readers. CONCLUSIONS CCSVI is not associated with MS.
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Affiliation(s)
- G Comi
- Department of Neurology, Università Vita Salute San Raffaele, Milan, Italy
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Mazzone E, Bianco F, Main M, van den Hauwe M, Ash M, de Vries R, Fagoaga Mata J, Stein S, De Sanctis R, D'Amico A, Palermo C, Fanelli L, Scoto MC, Mayhew A, Eagle M, Vigo M, Febrer A, Korinthenberg R, de Visser M, Bushby K, Muntoni F, Goemans N, Sormani MP, Bertini E, Pane M, Mercuri E. Six minute walk test in type III spinal muscular atrophy: a 12month longitudinal study. Neuromuscul Disord 2013; 23:624-8. [PMID: 23809874 DOI: 10.1016/j.nmd.2013.06.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/28/2013] [Accepted: 06/06/2013] [Indexed: 10/26/2022]
Abstract
The aim of our longitudinal multicentric study was to establish the changes on the 6min walk test (6MWT) in ambulant SMA type III children and adults over a 12month period. Thirty-eight ambulant type III patients performed the 6MWT at baseline and 12months after baseline. The distance covered in 6min ranged between 75 and 510m (mean 294.91, SD 127) at baseline and between 50 and 611m (mean 293.41m, SD 141) at 12months. The mean change in distance between baseline and 12months was -1.46 (SD 50.1; range: -183 to 131.8m). The changes were not correlated with age or baseline values (p>.05) even though younger patients reaching puberty, had a relatively higher risk of showing deterioration of more than 30m compared to older patients. Our findings provide the first longitudinal data using the 6MWT in ambulant SMA patients.
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Affiliation(s)
- E Mazzone
- Department of Paediatric Neurology, Catholic University, Rome, Italy
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18
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Affiliation(s)
- MP Sormani
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Italy
| | - A Signori
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Italy
| | - ML Stromillo
- Department of Neurological and Behavioral Sciences, University of Siena, Italy
| | - N De Stefano
- Department of Neurological and Behavioral Sciences, University of Siena, Italy
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19
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Sormani MP, Rio J, Tintorè M, Signori A, Li D, Cornelisse P, Stubinski B, Stromillo ML, Montalban X, De Stefano N. Scoring treatment response in patients with relapsing multiple sclerosis. Mult Scler 2012; 19:605-12. [PMID: 23012253 DOI: 10.1177/1352458512460605] [Citation(s) in RCA: 192] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND We employed clinical and magnetic resonance imaging (MRI) measures in combination, to assess patient responses to interferon in multiple sclerosis. OBJECTIVE To optimize and validate a scoring system able to discriminate responses to interferon treatment in patients with relapsing-remitting multiple sclerosis (RRMS). METHODS Our analysis included two large, independent datasets of RRMS patients who were treated with interferons that included 4-year follow-up data. The first dataset ("training set") comprised of 373 RRMS patients from a randomized clinical trial of subcutaneous interferon beta-1a. The second ("validation set") included an observational cohort of 222 RRMS patients treated with different interferons. The new scoring system, a modified version of that previously proposed by Rio et al., was first tested on the training set, then validated using the validation set. The association between disability progression and risk group, as defined by the score, was evaluated by Kaplan Meier survival curves and Cox regression, and quantified by hazard ratios (HRs). RESULTS The score (0-3) was based on the number of new T2 lesions (>5) and clinical relapses (0,1 or 2) during the first year of therapy. The risk of disability progression increased with higher scores. In the validation set, patients with score of 0 showed a 3-year progression probability of 24%, while those with a score of 1 increased to 33% (HR = 1.56; p = 0.13), and those with score greater than or equal to 2 increased to 65% (HR = 4.60; p < 0.001). CONCLUSIONS We report development of a simple, quantitative and complementary tool for predicting responses in interferon-treated patients that could help clinicians make treatment decisions.
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Affiliation(s)
- M P Sormani
- Department of Health Sciences, University of Genoa, Italy.
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Abstract
Background: The increasing number of effective therapies to treat multiple sclerosis (MS) raises ethical concerns for the use of placebo in clinical trials, suggesting that new clinical trial design strategies are needed. Objectives: To evaluate time to first relapse as an endpoint for MS clinical trials. Methods: A recently-developed model fitting the distribution of time to first relapse in MS was used for simulations estimating the sample sizes of trials using this as an outcome, and for comparison with the size of trials using the annualized relapse rate (ARR) as the primary outcome. Results: Trials based on time to first relapse were feasible, requiring sample sizes that were similar or even smaller than if the study was based on ARR instead. In the case of low ARR (0.4 relapses/year), as is expected in future trials, the 1-year trials designed to detect a treatment effect of 30%, with 90% power, require fewer patients when based on time to first relapse (470 patients/arm) than if based on ARR (540 patients/arm). Conclusions: Our simulations show that time to first relapse is not less powerful than ARR in MS trials; thus, this measure would be a potentially useful primary outcome offering the advantage of an ethically sound design, as the patients randomized to placebo can then switch to the active drug, once they relapse. A potential drawback is the loss of information for other endpoints collected at fixed time points.
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Affiliation(s)
- MP Sormani
- Department of Health Sciences, University of Genova, Italy
| | - A Signori
- Department of Health Sciences, University of Genova, Italy
| | - P Siri
- Department of Mathematical Sciences, Politecnico di Torino, Italy
| | - N De Stefano
- Department of Neurological and Behavioral Sciences, University of Siena, Italy
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Riva MA, Madotto F, Conti S, Fornari C, Patronella G, Sormani M, D'Orso MI, De Vito G, Latocca R, Cesana G. [Hepatitis B vaccination coverage and booster dose: results from a survey on healthcare students]. G Ital Med Lav Ergon 2012; 34:283-285. [PMID: 23405643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This study assessed the immunisation status against hepatitis B in healthcare students and residents, before their hospital internship, as suggested by the "National Immunization Prevention Plan 2012-2014". The concentration of antibodies against hepatitis B was measured in 2,491 subjects (70.90% women), born between 1980 and 1993 and visited between January 1st 2000 and July 15th 2012. Personal and serologic data were collected for each subjects. Individuals with antibody less than 10 mIU/mL (327, 13.3%) were given a booster dose and re-tested 2 months later. The multivariate logistic regression evidenced that immunization is influenced by the gender, the age at first vaccination, the time elapsed between first vaccination and antibody measurement. This study confirms the importance of measuring the concentration of antibodies against hepatitis B among healthcare students, even if they have previously been vaccinated, according to the "National Immunization Prevention Plan 2012-2014".
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Affiliation(s)
- M A Riva
- Unità Medicina Occupazionale ed Ambientale, Azienda Ospedaliera San Gerardo di Monza via Pergolesi 33, 20900 Monza, Italy.
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22
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Laroni A, Giacomazzi CG, Grimaldi L, Gallo P, Sormani MP, Bertolotto A, McDermott JL, Gandoglia I, Martini I, Vitello G, Rinaldi F, Barzon L, Militello V, Pizzorno M, Bandini F, Capello E, Palù G, Uccelli A, Mancardi GL, Varnier OE. Urinary JCV-DNA testing during natalizumab treatment may increase accuracy of PML risk stratification. J Neuroimmune Pharmacol 2012; 7:665-72. [PMID: 22585413 DOI: 10.1007/s11481-012-9366-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 04/03/2012] [Indexed: 12/01/2022]
Abstract
The risk of progressive multifocal leukoencephalopathy (PML) in patients treated with natalizumab for multiple sclerosis (MS) is a serious concern. The presence of anti-JC virus antibodies is a risk factor for PML development, but 2.5 % of the patients result falsely-negative, while the prognostic relevance of testing JCV-DNA in biological fluids of treated patients is debated. Aim of this work was to evaluate the utility of testing JCV-DNA, together with anti-JCV antibodies, in biological samples of treated patients as a tool for PML risk stratification. 126 subjects from 5 MS Centers in Italy were included in the study. We performed a cross-sectional study in 63 patients testing JCV-DNA in blood, peripheral blood cells and urine. We longitudinally assessed the presence of JCV-DNA in a cohort of 33 subjects, one of which developed PML. We could test retrospectively serum samples from another PML case occurred during natalizumab therapy. Anti-JCV antibodies and urinary JCV-DNA were both tested in 73 patients. No changes in JCV-DNA status occurred during natalizumab treatment. The subject who developed PML in the longitudinal cohort had detectable JCV-DNA in urine at all time-points while serum or blood from both PML patients were always negative before the onset of disease and, in one case, after. Four subjects with JCV-DNA in urine and undetectable anti-JCV antibodies were retested for anti-JCV antibodies and three out of four resulted positive. In conclusion, testing JCV-DNA in urine is complementary to testing anti-JCV antibodies in identifying patients at risk of PML.
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Affiliation(s)
- A Laroni
- Department of Neuroscience, Ophthalmology and Genetics, University of Genova, Via De Toni 5, 16132, Genoa, Italy
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Signori A, Crocchiolo R, Oneto R, Sacchi N, Sormani MP, Fagioli F, Rambaldi A, Ciceri F, Bacigalupo A. Chronic GVHD is associated with lower relapse risk irrespective of stem cell source among patients receiving transplantation from unrelated donors. Bone Marrow Transplant 2012; 47:1474-8. [PMID: 22465976 DOI: 10.1038/bmt.2012.58] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Chronic GVHD (cGVHD) has been associated with reduced risk of relapse after allo-SCT for onco-hematological disease due to a graft-vs-malignancy effect. Here we retrospectively analyzed a series of 802 adult patients transplanted from unrelated donors and found that cGVHD was associated with significantly lower relapse and that the limited form was associated with a survival advantage: hazard ratio for OS=0.63 (0.46-0.87); P=0.004; this was due to combination of relapse reduction and similar non-relapse mortality with respect to patients without cGVHD. Importantly, the graft-vs-malignancy effect observed here did not differ when PBSC or BM were used as stem cell source, thus suggesting that the protective effect of limited cGVHD is similar after PBSC- or BM-based transplantation. These findings could have practical implications and suggest no qualitative difference between cGVHD occurring after transplantation performed with different stem cell sources.
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Affiliation(s)
- A Signori
- Department of Health Sciences (DISSAL), Section of Biostatistic, University of Genoa, Genova, Italy.
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Saccardi R, Freedman MS, Sormani MP, Atkins H, Farge D, Griffith LM, Kraft G, Mancardi GL, Nash R, Pasquini M, Martin R, Muraro PA. A prospective, randomized, controlled trial of autologous haematopoietic stem cell transplantation for aggressive multiple sclerosis: a position paper. Mult Scler 2012; 18:825-34. [PMID: 22383228 PMCID: PMC3389500 DOI: 10.1177/1352458512438454] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Haematopoietic stem cell transplantation (HSCT) has been tried in the last 15 years as a therapeutic option in patients with poor-prognosis autoimmune disease who do not respond to conventional treatments. Worldwide, more than 600 patients with multiple sclerosis (MS) have been treated with HSCT, most of them having been recruited in small, single-centre, phase 1–2 uncontrolled trials. Clinical and magnetic resonance imaging outcomes from case series reports or Registry-based analyses suggest that a major response is achieved in most patients; quality and duration of response are better in patients transplanted during the relapsing–remitting phase than in those in the secondary progressive stage. Objectives: An interdisciplinary group of neurologists and haematologists has been formed, following two international meetings supported by the European and American Blood and Marrow Transplantation Societies, for the purpose of discussing a controlled clinical trial, to be designed within the new scenarios of evolving MS treatments. Conclusions: Objectives of the trial, patient selection, transplant technology and outcome assessment were extensively discussed. The outcome of this process is summarized in the present paper, with the goal of establishing the background and advancing the development of a prospective, randomized, controlled multicentre trial to assess the clinical efficacy of HSCT for the treatment of highly active MS.
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Affiliation(s)
- R Saccardi
- Hematology Department, Careggi University Hospital, Florence, Italy.
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Mancardi GL, Sormani MP, Di Gioia M, Vuolo L, Gualandi F, Amato MP, Capello E, Currò D, Uccelli A, Bertolotto A, Gasperini C, Lugaresi A, Merelli E, Meucci G, Motti L, Tola MR, Scarpini E, Repice AM, Massacesi L, Saccardi R, Bosi A, Guidi S, Bagigalupo A, Bonzano L, Bruzzi P, Roccatagliata L, Antenucci R, Granella F, Martino G, Rottoli M, Solaro C, Salvi F, Barilaro A, Capobianco M. Autologous haematopoietic stem cell transplantation with an intermediate intensity conditioning regimen in multiple sclerosis: the Italian multi-centre experience. Mult Scler 2011; 18:835-42. [PMID: 22127896 DOI: 10.1177/1352458511429320] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Over recent years numerous patients with severe forms of multiple sclerosis (MS) refractory to conventional therapies have been treated with intense immunosuppression followed by autologous haematopoietic stem cell transplantation (AHSCT). The clinical outcome and the toxicity of AHSCT can be diverse, depending on the various types of conditioning protocols and on the disease phase. OBJECTIVES To report the Italian experience on all the consecutive patients with MS treated with AHSCT with an intermediate intensity conditioning regimen, named BEAM/ATG, in the period from 1996 to 2008. METHODS Clinical and magnetic resonance imaging outcomes of 74 patients were collected after a median follow-up period of 48.3 (range = 0.8-126) months. RESULTS Two patients (2.7%) died from transplant-related causes. After 5 years, 66% of patients remained stable or improved. Among patients with a follow-up longer than 1 year, eight out of 25 subjects with a relapsing-remitting course (31%) had a 6-12 months confirmed Expanded Disability Status Scale improvement > 1 point after AHSCT as compared with one out of 36 (3%) patients with a secondary progressive disease course (p = 0.009). Among the 18 cases with a follow-up longer than 7 years, eight (44%) remained stable or had a sustained improvement while 10 (56%), after an initial period of stabilization or improvement with median duration of 3.5 years, showed a slow disability progression. CONCLUSIONS This study shows that AHSCT with a BEAM/ATG conditioning regimen has a sustained effect in suppressing disease progression in aggressive MS cases unresponsive to conventional therapies. It can also cause a sustained clinical improvement, especially if treated subjects are still in the relapsing-remitting phase of the disease.
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Affiliation(s)
- G L Mancardi
- Department of Neuroscience, Ophthalmology and Genetics, University of Genoa, Genoa, Italy
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Sormani MP, Li DK, Bruzzi P, Stubinski B, Cornelisse P, Rocak S, De Stefano N. Combined MRI lesions and relapses as a surrogate for disability in multiple sclerosis. Neurology 2011; 77:1684-90. [PMID: 21975200 DOI: 10.1212/wnl.0b013e31823648b9] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE In multiple sclerosis (MS), the aim of therapies is to prevent the accumulation of irreversible disability. This is difficult to assess given the short time course of clinical trials. MRI markers and relapses are often used as surrogate of disability in MS studies, but their validity remains controversial. We sought to validate, at the individual patient level, MRI lesions and relapses as surrogates for disability progression over the course of MS trials. METHODS Individual patient data from a large, placebo-controlled trial of interferon β-1a in relapsing-remitting MS (RRMS) were analyzed. The Prentice criteria were applied to evaluate surrogacy of 1-year MRI active lesions and relapses for disability worsening (Expanded Disability Status Scale [EDSS]) over the 2-year follow-up. RESULTS All Prentice criteria were satisfied. Treatment reduced by 31% the odds of having EDSS worsening over 2 years, reducing the mean number of MRI lesions by 61% and the mean number of relapses by 36% over 1 year. Both 1-year MRI lesion activity and relapses, when considered independently, accounted for more than 60% of the treatment effect on 2-year EDSS worsening. A combination of 1-year MRI lesion activity and relapses explained 100% of the treatment effect on EDSS worsening over 2 years. CONCLUSIONS A combined measure of 1-year changes in MRI lesions and relapses after interferon therapy fully estimated the corresponding effect on 2-year EDSS worsening. This short-term combined measure appears to be a surrogate for disability progression over a longer term when evaluating the effect of interferon in RRMS.
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Affiliation(s)
- M P Sormani
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy.
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Sbardella E, Tomassini V, Stromillo ML, Filippini N, Battaglini M, Ruggieri S, Ausili Cefaro L, Raz E, Gasperini C, Sormani MP, Pantano P, Pozzilli C, De Stefano N. Pronounced focal and diffuse brain damage predicts short-term disease evolution in patients with clinically isolated syndrome suggestive of multiple sclerosis. Mult Scler 2011; 17:1432-40. [DOI: 10.1177/1352458511414602] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: In clinically isolated syndrome (CIS), the role of quantitative magnetic resonance imaging (MRI) in detecting prognostic markers is still debated. Objective: To evaluate measures of diffuse brain damage (such as brain atrophy and the ratio of N-acetylaspartate to creatine (NAA/Cr)) in patients with CIS, in addition to focal lesions, as predictors of 1-year disease evolution. Methods: 49 patients with CIS underwent MRI scans to quantify T2-lesions (T2-L) and gadolinium-enhanced lesion (GEL) number at baseline and after 1 year. Along with 25 healthy volunteers, they also underwent combined MRI/magnetic resonance spectroscopy examination to measure normalized brain volumes (NBVs) and NAA/Cr. Occurrence of relapses and new T2-L was recorded over 1 year to assess disease evolution. Results: Occurrence of relapses and/or new T2-L over 1 year divided patients with CIS into ‘active’ and ‘stable’ groups. Active patients had lower baseline NAA/Cr and NBV. Baseline T2-L number, GEL, NAA/Cr and NBV predicted subsequent disease activity. Multivariable logistic regression models showed that both ‘focal damage’ (based on T2-L number and GEL) and ‘diffuse damage’ (based on NBV and NAA/Cr) models predicted disease activity at 1 year with great sensitivity, specificity and accuracy. This was best when the four MRI measures were combined (80% sensitivity, 89% specificity, 83% accuracy). Conclusions: Quantitative MRI measures of diffuse tissue damage such as brain atrophy and NAA/Cr, in addition to measures of focal demyelinating lesions, may predict short-term disease evolution in patients with CIS, particularly when used in combination. If confirmed in larger studies, these findings may have important clinical and therapeutic implications.
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Affiliation(s)
- E Sbardella
- Department of Neurology and Psychiatry, “Sapienza” University of Rome, Italy
- Department of Psychology, “Sapienza” University of Rome, Italy
| | - V Tomassini
- Department of Neurology and Psychiatry, “Sapienza” University of Rome, Italy
- Oxford University Centre for Functional MRI of the Brain, John Radcliffe Hospital, Oxford, UK
| | - ML Stromillo
- Quantitative Neuroimaging Laboratory, Department of Neurological and Behavioral Sciences, University of Siena, Italy
| | - N Filippini
- Oxford University Centre for Functional MRI of the Brain, John Radcliffe Hospital, Oxford, UK
- Department of Psychiatry, University of Oxford, UK
- Laboratory of Epidemiology, Neuroimaging and Telemedicine, IRCCS S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - M Battaglini
- Quantitative Neuroimaging Laboratory, Department of Neurological and Behavioral Sciences, University of Siena, Italy
| | - S Ruggieri
- Department of Neurology and Psychiatry, “Sapienza” University of Rome, Italy
| | | | - E Raz
- Department of Neurology and Psychiatry, “Sapienza” University of Rome, Italy
| | | | - MP Sormani
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Italy
| | - P Pantano
- Department of Neurology and Psychiatry, “Sapienza” University of Rome, Italy
| | - C Pozzilli
- S. Andrea Hospital, “Sapienza” University of Rome, Italy
| | - N De Stefano
- Quantitative Neuroimaging Laboratory, Department of Neurological and Behavioral Sciences, University of Siena, Italy
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Mesaros S, Rocca MA, Pagani E, Sormani MP, Petrolini M, Comi G, Filippi M. Thalamic damage predicts the evolution of primary-progressive multiple sclerosis at 5 years. AJNR Am J Neuroradiol 2011; 32:1016-20. [PMID: 21393412 DOI: 10.3174/ajnr.a2430] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Reliable markers to monitor PPMS are still needed. We investigated whether conventional and DTI measures of thalamic damage are predictive of long-term disability accumulation in PPMS. MATERIALS AND METHODS Brain conventional and DTI scans were obtained at baseline and after a mean follow-up of 15 months in 54 patients with PPMS and 8 healthy controls. Patients were reassessed clinically after 5 years. At baseline and follow-up, measures of lesion load, brain atrophy, and NTV were obtained. MD and FA histograms of the NAWM, the whole GM without the thalami, and the thalami were obtained. A multivariate analysis evaluated the predictors of long-term neurologic deterioration. RESULTS At follow-up, 35 patients showed disability worsening. At baseline, compared with healthy controls, patients with PPMS had lower NTV (P < .001) and thalamic FA (P = .002) and higher thalamic (P = .002) and whole GM without the thalami (P = .005) MD. During follow-up, the change of thalamic FA was higher in PPMS versus healthy controls (P = .01). Baseline NTV and thalamic DTI quantities differed significantly between patients with PPMS with and without thalamic lesions. Baseline thalamic quantities were significantly correlated with the extent of brain T2 lesions and the severity of NAWM damage. The multivariate model included average NAWM MD (OR = 1.46, P = .005) and FA thalamic change (OR = 0.84, P = .02) as independent predictors of EDSS score deterioration (Nagelkerke R(2) = 0.55). CONCLUSIONS Short-term accrual of thalamic damage and the severity of NAWM involvement predict the long-term accumulation of disability in PPMS.
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Affiliation(s)
- S Mesaros
- Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental Neurology, University Ospedale San Raffaele, Milan, Italy
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Pelagatti MA, Meini A, Caorsi R, Cattalini M, Federici S, Zulian F, Calcagno G, Tommasini A, Bossi G, Sormani MP, Caroli F, Plebani A, Ceccherini I, Martini A, Gattorno M. Long-term clinical profile of children with the low-penetrance R92Q mutation of the TNFRSF1A gene. ACTA ACUST UNITED AC 2011; 63:1141-50. [PMID: 21225694 PMCID: PMC3112258 DOI: 10.1002/art.30237] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective To analyze the long-term impact of the R92Q mutation of TNFRSF1A in children with periodic fever, in comparison with children with tumor necrosis factor receptor–associated periodic syndrome (TRAPS) with TNFRSF1A structural mutations and children with periodic fever of unknown origin fulfilling the criteria for periodic fever, aphthosis, pharyngitis, and adenitis syndrome (PFAPA). Methods The extracellular region of TNFRSF1A was analyzed in 720 consecutive children with periodic fever, using denaturing high-performance liquid chromatography and DNA sequencing. Followup data on 11 pediatric patients with TNFRSF1A structural mutations (cysteine or T50M), 23 pediatric patients with an R92Q substitution, and 64 pediatric patients with PFAPA were collected during routine clinic visits. The 50-item Child Health Questionnaire was used to assess health-related quality of life (HRQOL). Results The frequency of typical TRAPS-related clinical manifestations was significantly lower and the impact of the disease on HRQOL was significantly reduced in patients with the R92Q mutation compared with TRAPS patients carrying structural mutations of TNFRSF1A. Followup data on 11 TRAPS patients with TNFRSF1A structural mutations (mean followup 7.9 years), 16 patients with theR92Q substitution (mean followup 7.3 years), and 64 patients with PFAPA (mean followup 5.2 years) were available. Patients with R92Q mutations and patients with PFAPA displayed a higher rate of self-resolution or amelioration of the fever episodes than did TRAPS patients with structural mutations. Conclusion Although some cases may progress to a more chronic disease course, the majority of children with an R92Q mutation of the TNFRSFA1 gene show a milder disease course than that in children with TNFRSFA1 structural mutations and have a high rate of spontaneous resolution and amelioration of the recurrent fever episodes.
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Gennari A, Puntoni M, Nanni O, Conte PF, Amadori D, Lorusso V, De Censi A, Sormani M, Guarneri V, D'Amico M, Gozza A, Bruzzi P. Body mass index (BMI) and prognosis in women with metastatic breast cancer (MBC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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31
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Sormani MP, Bonzano L, Roccatagliata L, De Stefano N. Magnetic resonance imaging as surrogate for clinical endpoints in multiple sclerosis: data on novel oral drugs. Mult Scler 2010; 17:630-3. [PMID: 21177320 DOI: 10.1177/1352458510393770] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recent studies have provided evidence for using magnetic resonance imaging (MRI) active lesions as surrogate for relapses and disability progression in multiple sclerosis (MS). However, the validity of MRI metrics as surrogate endpoints in MS is controversial. Furthermore, the extrapolation of previous results to novel therapies is not warranted. We tested here the validity of MRI surrogacy in MS studies on recently published trials of oral drugs. The 92% of observed effects of oral drugs on clinical outcomes resulted close to those predicted by MRI active lesions. This further validates MRI surrogacy in MS, with important implications for future trials planning.
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Affiliation(s)
- M P Sormani
- Biostatistics Unit, Department of Health Sciences, University of Genoa, Italy.
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Conteduca G, Ferrera F, Pastorino L, Fenoglio D, Negrini S, Sormani MP, Indiveri F, Scarrà GB, Filaci G. The role of AIRE polymorphisms in melanoma. Clin Immunol 2010; 136:96-104. [PMID: 20363194 DOI: 10.1016/j.clim.2010.03.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 02/10/2010] [Accepted: 03/05/2010] [Indexed: 11/20/2022]
Abstract
Polymorphisms of AIRE, a transcription factor that up-regulates intrathymic expression of tissue-specific antigens including melanoma-associated antigens (MAAs), may variably affect the selection of MAAs-specific thymocytes, generating T-cell repertoires protecting or predisposing individuals to melanoma. We found that AIRE single nucleotide polymorphisms (SNPs) rs1055311, rs1800520 and rs1800522 were significantly more frequent in healthy subjects than in melanoma patients, independently from sex, age and stages of melanoma. The presence of these SNPs was associated with increased frequency of two T-cell clonotypes specific for MAGE-1 linking their protective effect to selection/expansion of MAA-specific T cells. Interestingly, mRNA transcribed on the rs1800520 SNP showed increased free energy than the wild type suggesting that its reduced stability may be responsible for the different activity of the polymorphic AIRE molecule. This finding may contribute at identifying subjects with increased risk of developing melanoma or patients with melanoma that may take benefit from immunotherapy.
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Affiliation(s)
- G Conteduca
- Center of Excellence for Biomedical Research, University of Genoa, Italy
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Sormani MP, Bonzano L, Roccatagliata L, Mancardi GL, Uccelli A, Bruzzi P. Surrogate endpoints for EDSS worsening in multiple sclerosis. A meta-analytic approach. Neurology 2010; 75:302-9. [PMID: 20574036 DOI: 10.1212/wnl.0b013e3181ea15aa] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate whether the effects on potential surrogate endpoints, such as MRI markers and relapses, observed in trials of experimental treatments are able to predict the effects of these treatments on disability progression as defined in relapsing-remitting multiple sclerosis (RRMS) trials. METHODS We used a pooled analysis of all the published randomized controlled clinical trials in RRMS reporting data on Expanded Disability Status Scale (EDSS) worsening and relapses or MRI lesions or both. We extracted data on relapses, MRI lesions, and the proportion of progressing patients. A regression analysis weighted on trial size and duration was performed to study the relationship between the treatment effect observed in each trial on relapses and MRI lesions and the observed treatment effect on EDSS worsening. RESULTS A set of 19 randomized double-blind controlled trials in RRMS were identified, for a total of 44 arms, 25 contrasts, and 10,009 patients. A significant correlation was found between the effect of treatments on relapses and the effect of treatments on EDSS worsening: the adjusted R(2) value of the weighted regression was 0.71. The correlation between the treatment effect on MRI lesions and EDSS worsening was slightly weaker (R(2) = 0.57) but significant. CONCLUSIONS These findings support the use of commonly used surrogate markers of EDSS worsening as endpoints in multiple sclerosis clinical trials. Further research is warranted to validate surrogate endpoints at the individual level rather than at the trial level, to draw important conclusions in the management of the individual patient.
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Affiliation(s)
- M P Sormani
- Department of Health Sciences, Via Pastore 1, Genoa, Italy.
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Gennari A, Sormani M, Nanni O, Stockler M, Wilcken N, Puntoni M, Amadori D, De Censi A, Bruzzi P. Impact of first-line chemotherapy duration in metastatic breast cancer: A systematic review. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.1023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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35
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Gennari A, Sormani M, Decensi A, Decensi A, Pronzato P, Mirisola V, Puntoni M, Roncella M, Ghilli M, Bruzzi P, Pfeffer U. Identification of a Prognostic Signature Based on the Expression of Insulin-Related Genes in Early Breast Cancer. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: A substantial body of evidence indicate that the insulin pathway plays a key role in breast cancer development and progression and may represent a therapeutic target, especially in those patients exposed to high plasmatic level of insulin. However, the potential prognostic role of genes related to the insulin-pathway in breast cancer cells has not been explored. With these premises, we evaluated the prognostic role of the expression of genes related to the insulin pathway in early breast cancer. Methods: Candidate genes were selected from published literature, genomic databases, and gene expression profiling experiments performed in insulin resistant subjects, yielding 143 genes that were used to develop a molecular classifier. We used three publicly available breast cancer datasets, GSE1456, GSE3494 and GSE2990 that include gene expression data on a total of 502 cases with clinical follow up. The insulin gene signature was developed on GSE1456, containing microarray data from 159 early breast cancer patients. This dataset was split by a random procedure into a training set and a validation set. Univariate non-parametric Mann-Whitney U test was used to identify genes differentially expressed. Expression of genes significantly correlated with relapse was combined in a linear score. Patients were classified as low or high risk with respect to the median score. External validation was performed on GSE3494 and GSE2990. Results: On the training set, 15 genes resulted differentially expressed in relapsed and non relapsed patients: the 8-year disease free survival (DFS) was 91% (SE =4%) and 51% (SE = 8%) in the high and low risk group (p< 0.001); HR = 10.6 (95% CI 3.2-35.5, p<0.00001). In the validation set, the 8-year RFS was 97% (SE = 3%) and 54% (SE = 10%), respectively (p = 0.009); HR = 4.6 (95% CI 1.01 to 20.7, p 0.04). External validation was performed on two independent datasets, GSE3494 and GSE 2990 including 350 early breast cancer patients. In GSE3494 the 8-year DFS was 72% (SE = 5%) and 61% (SE = 4%) in the high and low risk group (p = 0.03), respectively. In GSE 2990 the 8-year DFS was 74% (SE = 7%) and 55% (SE = 8%), respectively, (p = 0.03). By multivariate analysis, the insulin signature resulted significantly associated with DFS, independently of age, tumor size, ER status, nodal status and grade. Conclusions: Our findings indicate that the insulin pathway is involved in breast cancer prognosis at a genomic level and might provide a better way to individualize therapeutic interventions targeting insulin signaling.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 108.
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Affiliation(s)
- A. Gennari
- 1National Cancer Research Institute, Italy
| | | | - A. Decensi
- 3Medical Oncology, Galliera Hospital, Italy
| | | | | | | | - M. Puntoni
- 3Medical Oncology, Galliera Hospital, Italy
| | | | - M. Ghilli
- 5Santa Chiara University Hospital, Italy
| | - P. Bruzzi
- 1National Cancer Research Institute, Italy
| | - U. Pfeffer
- 1National Cancer Research Institute, Italy
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Bacigalupo A, Lamparelli T, Milone G, Sormani MP, Ciceri F, Peccatori J, Locasciulli A, Majolino I, Di Bartolomeo P, Mazza F, Sacchi N, Pollicheni S, Pinto V. Pre-emptive treatment of acute GVHD: a randomized multicenter trial of rabbit anti-thymocyte globulin, given on day+7 after alternative donor transplants. Bone Marrow Transplant 2009; 45:385-91. [DOI: 10.1038/bmt.2009.151] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Bonzano L, Roccatagliata L, Mancardi GL, Sormani MP. Gadolinium-enhancing or active T2 magnetic resonance imaging lesions in multiple sclerosis clinical trials? Mult Scler 2009; 15:1043-7. [PMID: 19570818 DOI: 10.1177/1352458509106610] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The treatment effects in multiple sclerosis (MS) clinical trials are often estimated by monitoring disease activity by the count of "active" plaques on T2-weighted or gadolinium (Gd)-enhanced T1-weighted magnetic resonance imaging (MRI). OBJECTIVE To evaluate the relationship between the treatment effects estimated on T2-weighted or Gd-enhanced T1-weighted MRI. METHODS Data were extracted from published randomized clinical trials in relapsing-remitting MS with frequent MRI, reporting both active T2 and Gd-enhancing lesions. A regression analysis was performed between the treatment effects estimated on the two different MRI endpoints. RESULTS A strong association was found between the treatment effect on Gd-enhancing lesions and on active T2 lesions (R(2) = 0.93), and the treatment effect estimates were almost the same (slope = 0.96). CONCLUSION Defining either active T2 or Gd-enhancing lesions as MRI endpoint seems to be not crucial for monitoring MRI activity in MS clinical trials. The choice of the best MRI endpoint should be based on different considerations (e.g., sensitivity, reproducibility, time for assessment, safety, and patients' comfort). Further monitoring active T2 lesions could allow less expensive trials, without requiring injection of Gd-based contrast agents.
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Affiliation(s)
- L Bonzano
- Department of Neurosciences, Ophthalmology and Genetics, University of Genoa, Genoa, Italy; Magnetic Resonance Research Centre on Nervous System Diseases, University of Genoa, Genoa, Italy
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Gennari A, Sormani M, Varesco L, Pronzato P, Viassolo V, Mirisola V, Pfeffer U, Bruzzi P. Prognostic significance of BRCA1, PARP1, and PARP2 in sporadic breast cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e22114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e22114 Background: Breast cancer susceptibility gene (BRCA1) is a tumor suppressor gene whose mutation is associated with the development of hereditary breast cancer. In sporadic tumors, loss of BRCA1, resulting from reduced expression or incorrect subcellular localization, has been suggested to be associated with prognosis. Cells with BRCA1 loss of function are deficient in DNA double strand break repair thus activating poly(ADP-ribose) polymerases (PARPs) whose catalytic activity is immediately stimulated by DNA strand-breaks. The aim of this study was to evaluate the prognostic value of BRCA1 and PARPs (PARP1 and 2) in sporadic breast cancer. Methods: We merged two previously published Affymetrix gene expression datasets: GSE 1456 (159 patients, median follow up 7 years) and GSE 2494 (249 patients, median follow up 10 years). Microarray data preprocessing was carried out using Bioconductor software (gcrma procedure). Expression of BRCA1, PARP1 and PARP2 mRNA were evaluated as continuous variables. Kaplan Meier survival curves and Cox regression analysis (stratified by database) were used to assess the prognostic capability of the identified biomarkers. Results: High mRNA expression of BRCA1, PARP1 and PARP2 was correlated with an adverse prognosis. Relapse Free Survival (RFS) Hazard Ratio was 1.6 (95% CI, 1.2 to 2.1) for BRCA1 (p = 0.002), 1.7 (95% CI, 1.2 to 2.4) for PARP1 (p = 0.002) and 1.7 (95% CI, 1.3 to 2.3) for PARP2 (p = 0.001). By multivariate analysis all 3 genes resulted independently correlated with RFS. When interaction with systemic adjuvant therapy (107 patients treated) was tested, BRCA1 mRNA expression was strongly associated with treatment: HR 2.3 (95% CI, 1.4 to 3.7, p 0.001); p for interaction = 0.06. Conclusions: This study shows that BRCA1, PARP1 and PARP2 are all significantly associated with prognosis in sporadic breast cancer. No significant financial relationships to disclose.
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Affiliation(s)
- A. Gennari
- National Cancer Research Institute, Genoa, Italy; University of Genoa, Genoa, Italy
| | - M. Sormani
- National Cancer Research Institute, Genoa, Italy; University of Genoa, Genoa, Italy
| | - L. Varesco
- National Cancer Research Institute, Genoa, Italy; University of Genoa, Genoa, Italy
| | - P. Pronzato
- National Cancer Research Institute, Genoa, Italy; University of Genoa, Genoa, Italy
| | - V. Viassolo
- National Cancer Research Institute, Genoa, Italy; University of Genoa, Genoa, Italy
| | - V. Mirisola
- National Cancer Research Institute, Genoa, Italy; University of Genoa, Genoa, Italy
| | - U. Pfeffer
- National Cancer Research Institute, Genoa, Italy; University of Genoa, Genoa, Italy
| | - P. Bruzzi
- National Cancer Research Institute, Genoa, Italy; University of Genoa, Genoa, Italy
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Benedetti L, Briani C, Franciotta D, Carpo M, Padua L, Zara G, Zambello R, Sormani MP, Mancardi GL, Nobile-Orazio E, Schenone A. Long-term effect of rituximab in anti-mag polyneuropathy. Neurology 2008; 71:1742-4. [PMID: 19015493 DOI: 10.1212/01.wnl.0000335268.70325.33] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- L Benedetti
- Department of Neurosciences, Ophthalmology and Genetics, University of Genova, Genova, Italy.
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Sanguineti G, Califano J, Zhou J, Stafford E, Koch W, Tufano R, Gourin C, Sormani M, Marur S, Forastiere A. Defining the Risk of Involvement for each Neck Nodal Level in Patients with Early T-stage/Node-positive Oropharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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41
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Federici S, Caroli F, Sormani MP, Meini A, Caorsi R, Martini G, Simonini G, Consolini R, Plebani S, Baldi M, Ceccherini I, Martini A, Gattorno M. Prospective validation of the diagnostic score for molecular analysis of hereditary autoinflammatory syndromes in Italian children with periodic fever. Pediatr Rheumatol Online J 2008. [PMCID: PMC3333979 DOI: 10.1186/1546-0096-6-s1-p178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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42
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Caorsi R, Meini A, Sormani MP, Cattalini M, Pelagatti MA, Zulian F, Cortis E, Calcagno G, Tommasini A, Traverso F, Federici S, Frenkel J, Plebani S, Martini A, Gattorno M. Evidences for the need of new Diagnostic Criteria for PFAPA syndrome. Pediatr Rheumatol Online J 2008. [PMCID: PMC3333983 DOI: 10.1186/1546-0096-6-s1-p181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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43
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Ciprandi G, Fenoglio D, Di Gioacchino M, Ferrera A, Ferrera F, Sormani MP, Marseglia GL. Sublingual immunotherapy provides an early increase of interferon-gamma production. J BIOL REG HOMEOS AG 2008; 22:169-173. [PMID: 18842170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Allergic rhinitis (AR) is characterized by Th2 polarized immune response. Allergen-specific subcutaneous immunotherapy may restore a physiologic Th1 profile. However, there are few studies investigating the immunological effects of sublingual immunotherapy (SLIT). The aim of this study is to investigate whether a pre-seasonal SLIT course could affect IFN-gamma production. Forty-four AR patients with pollen allergy assumed pre-seasonal SLIT for 3 months. IFN-gamma-specific producing cells were assessed by cytokine ELISPOT before and 3 months after the beginning of SLIT. Visual analogue scale (VAS) for symptoms and medication score was also evaluated. The frequency of IFN-gamma-specific producing cells significantly increased after SLIT (p<0.01), and this increase was significantly associated with improvement of both symptoms (p<0.001) and medication use (p<0.01). In conclusion, these results may be considered clinically relevant as SLIT treatment may induce a quick IFN- gamma response that is related to clinical improvement.
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Affiliation(s)
- G Ciprandi
- Azienda Ospedaliera Universitaria San Martino and DIMI-CEBR, University of Genoa, Genoa, Italy.
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44
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Gennari A, Sormani M, Bruzzi P, Wilcken N, Nanni O, Fornier M, Stockler MR. A meta-analysis of chemotherapy duration in metastatic breast cancer (MBC). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.1067] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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45
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Parodi RC, Levrero F, Sormani MP, Pilot A, Mancardi GL, Aliprandi A, Sardanelli F. Supervised automatic procedure to identify new lesions in brain MR longitudinal studies of patients with multiple sclerosis. Radiol Med 2008; 113:300-6. [PMID: 18386130 DOI: 10.1007/s11547-008-0251-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Accepted: 10/18/2006] [Indexed: 11/26/2022]
Abstract
PURPOSE Identification of new enhancing lesions is a major endpoint of longitudinal brain magnetic resonance (MR) studies of multiple sclerosis (MS). To date, this is a visual, time-consuming procedure. We present here a supervised automated procedure (SAP) aimed at reducing the time needed to identify new MS enhancing lesions. MATERIALS AND METHODS The SAP uses an algorithm including Cartesian coordinates of the lesions to be compared, their area and a constant (k). The procedure was validated for enhancing lesions on T1-weighted spin-echo images after intravenous administration of 0.1 mmol/kg of paramagnetic contrast agent, randomly selected from a dataset of a longitudinal MR study on ten relapsing-remitting MS patients followed for 2-5 years. During the validation session, two readers decided by consensus whether two lesions, present on the same slice of two examinations performed on subsequent dates, were the same or not. In this way, k was calibrated to obtain the same result from both visual inspection and automatic algorithm output. RESULTS After evaluating of 25+/-5 (mean+/-standard deviation) lesions in each of ten different sessions with correction of k value, the k value became a stable value (0.45+/-0.05). CONCLUSIONS Once the suitable value of k was found, SAP was able to identify new enhancing lesions, avoiding visual inspection, which is usually a lengthy procedure.
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Affiliation(s)
- R C Parodi
- Department of Neuroradiology, Ospedale di Imperia, ASL 1 Imperiese, Via Sant'Agata 57, Imperia, Italy.
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46
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Sanguineti G, Sormani M, Eugene E, Little M, Chen G, Berilgen J, Parker B. Dosimetric Predictors of Diarrhea During Radiotherapy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.1430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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47
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Rocca MA, Mondria T, Valsasina P, Sormani MP, Flach ZH, Te Boekhorst PA, Comi G, Hintzen RQ, Filippi M. A three-year study of brain atrophy after autologous hematopoietic stem cell transplantation in rapidly evolving secondary progressive multiple sclerosis. AJNR Am J Neuroradiol 2007; 28:1659-61. [PMID: 17885242 PMCID: PMC8134216 DOI: 10.3174/ajnr.a0644] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In multiple sclerosis (MS), autologous hematopoietic stem cell transplantation (AHSCT) induces a profound suppression of clinical activity and MR imaging-detectable inflammation, but it may be associated with a rapid brain volume loss in the months subsequent to treatment. The aim of this study was to assess how AHSCT affects medium-term evolution of brain atrophy in MS. MATERIALS AND METHODS MR imaging scans of the brain from 14 patients with rapidly evolving secondary-progressive MS obtained 3 months before and every year after AHSCT for 3 years were analyzed. Baseline normalized brain volumes and longitudinal percentage of brain volume changes (PBVCs) were assessed using the Structural Image Evaluation of Normalized Atrophy software. RESULTS The median decrease of brain volume was 1.92% over the first year after AHSCT and then declined to 1.35% at the second year and to 0.69% at the third year. The number of enhancing lesions seen on the pretreatment scans was significantly correlated with the PBVCs between baseline and month 12 (r = -0.62; P = .02); no correlation was found with the PBVCs measured over the second and third years. CONCLUSIONS After AHSCT, the rate of brain tissue loss in patients with MS declines dramatically after the first 2 years. The initial rapid development of brain atrophy may be a late consequence of the pretransplant disease activity and/or a transient result of the intense immunoablative conditioning procedure.
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Affiliation(s)
- M A Rocca
- Neuroimaging Research Unit, Scientific Institute and University San Raffaele, Milan, Italy
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48
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Agosta F, Absinta M, Sormani MP, Ghezzi A, Bertolotto A, Montanari E, Comi G, Filippi M. In vivo assessment of cervical cord damage in MS patients: a longitudinal diffusion tensor MRI study. Brain 2007; 130:2211-9. [PMID: 17535835 DOI: 10.1093/brain/awm110] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Cervical cord damage is likely to contribute to the accumulation of disability in multiple sclerosis (MS) and can be quantified in vivo using MRI. We used conventional and diffusion tensor (DT) MRI to: (a) define the temporal evolution of intrinsic tissue injury and atrophy in the cervical cord from MS patients, (b) investigate how these two aspects of cord damage are interrelated and (c) assess the correlation of cord MRI metrics with concomitant brain damage and disability. Conventional and DT MRI of the brain and cervical cord were obtained from 42 MS patients and 9 healthy controls at baseline and after a mean follow-up of 2.4 years. At each time-point, we measured: cervical cord lesion number, cross-sectional area, mean diffusivity (MD) and fractional anisotropy (FA). Brain T2 lesion volume, grey matter MD, normal appearing white matter (NAWM) MD and FA, as well as longitudinal normalized percentage brain volume changes were also measured. In MS patients, cervical cord cross-sectional area (P < 0.001) and FA (P = 0.01) decreased, and cervical cord MD increased (P < 0.001) during follow-up. Cord FA decrease, but not cord cross-sectional area and MD, was significantly higher (P = 0.05) in primary progressive MS patients than in those with either relapsing-remitting or secondary progressive MS. At baseline and follow-up, moderate correlations were found between intrinsic cord diffusivity abnormalities and cord cross-sectional area (r values ranging from 0.34 to 0.58), but not between their changes over time. No cross-sectional and longitudinal correlations were found between these MRI metrics and the number of cord T2-visible lesions. Brain NAWM MD (P = 0.03) and brain volume (P < 0.001) also changed in patients. There was no significant correlation between cord and brain MRI metrics at both time-points, as well as between their changes occurred over the follow-up. Baseline cord cross-sectional area (r = -0.40, P = 0.01) and FA (r = -0.40, P = 0.03) correlated with increase in disability at follow-up. This study shows that both progressive tissue loss and injury to the remaining tissue occur in the cervical cord of MS patients, and that these two components of cord damage are not strictly interrelated, thus suggesting that a multiparametric MRI approach is needed to achieve more accurate estimates of such a damage. MS cord pathology also seems to be independent of concomitant brain changes, to develop at different rates according to disease phenotype, and to be associated to medium-term disability accrual.
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Affiliation(s)
- F Agosta
- Neuroimaging Research Unit, Department of Neurology, Scientific Institute and University Ospedale San Raffaele, Milan, Italy
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49
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Gennari A, Sormani M, Pronzato P, Bruzzi P, Ferrannini E, Iozzo P, Roncella M, Ghilli M, Mirisola V, Pfeffer U. Association between expression of insulin resistance (IR) related genes and breast cancer outcome. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.10597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10597 Background: IR is associated with adverse outcome in breast cancer. IR may affect patient outcome via the insulin and the IGF axis, acting through the tyrosine kinase signaling in enhancing cell proliferation. To date, no study explored the role of insulin- related gene expression in breast cancer progression. The aim of this study was to evaluate the prognostic value of a set of insulin-related genes using published microarray datasets. Methods: IR genes were sorted according to the “insulin sensitivity gene set” previously defined in peripheral tissues of healthy subjects screened for IR by the euglycaemic insulin clamp technique. One-hundred-forty- three genes were used to develop an outcome predictor on a training set of 102 primary breast tumors, randomly selected from 159 patients in the GEO database ( GSE1456 ). The outcome predictor was validated on the remaining 57 patients. Primary outcome measure was relapse free survival (RFS). Univariate non-parametric Mann-Whitney U test was used to identify genes differentially expressed. Expression of genes significantly correlated with relapse was combined in a linear score. Patients were classified as low or high risk with respect to the median score. Kaplan-Meier curves were used to evaluate the discriminating power of the score. Results: Fourteen genes resulted differentially expressed in the training set: the 8-year RFS was 91% (SE =4%) and 51% (SE = 8%) in the low risk and high risk group, respectively (p < .001). In the validation set, the 8-year RFS was 97% (SE = 3%) and 54% (SE = 10%), respectively (p = .009), supporting the discriminating ability of the score. By multivariate Cox analysis, the prognostic ability of the score was independent of subtype and grade (p < .001). Conclusions: Our data provide the first evidence that expression of insulin related genes can predict outcome, and indicate that the insulin pathway is involved in breast cancer progression. This is particularly important since IR is responsive to lifestyle interventions. We are currently validating the insulin-related score on independent breast cancer microarray datasets. No significant financial relationships to disclose.
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Affiliation(s)
- A. Gennari
- University of Genoa, Genoa, Italy; Metabolism Unit, Pisa, Italy; Institute of Clinical Physiology, Pisa, Italy; Senology Unit, Pisa, Italy; National Cancer Research Institute, Genoa, Italy
| | - M. Sormani
- University of Genoa, Genoa, Italy; Metabolism Unit, Pisa, Italy; Institute of Clinical Physiology, Pisa, Italy; Senology Unit, Pisa, Italy; National Cancer Research Institute, Genoa, Italy
| | - P. Pronzato
- University of Genoa, Genoa, Italy; Metabolism Unit, Pisa, Italy; Institute of Clinical Physiology, Pisa, Italy; Senology Unit, Pisa, Italy; National Cancer Research Institute, Genoa, Italy
| | - P. Bruzzi
- University of Genoa, Genoa, Italy; Metabolism Unit, Pisa, Italy; Institute of Clinical Physiology, Pisa, Italy; Senology Unit, Pisa, Italy; National Cancer Research Institute, Genoa, Italy
| | - E. Ferrannini
- University of Genoa, Genoa, Italy; Metabolism Unit, Pisa, Italy; Institute of Clinical Physiology, Pisa, Italy; Senology Unit, Pisa, Italy; National Cancer Research Institute, Genoa, Italy
| | - P. Iozzo
- University of Genoa, Genoa, Italy; Metabolism Unit, Pisa, Italy; Institute of Clinical Physiology, Pisa, Italy; Senology Unit, Pisa, Italy; National Cancer Research Institute, Genoa, Italy
| | - M. Roncella
- University of Genoa, Genoa, Italy; Metabolism Unit, Pisa, Italy; Institute of Clinical Physiology, Pisa, Italy; Senology Unit, Pisa, Italy; National Cancer Research Institute, Genoa, Italy
| | - M. Ghilli
- University of Genoa, Genoa, Italy; Metabolism Unit, Pisa, Italy; Institute of Clinical Physiology, Pisa, Italy; Senology Unit, Pisa, Italy; National Cancer Research Institute, Genoa, Italy
| | - V. Mirisola
- University of Genoa, Genoa, Italy; Metabolism Unit, Pisa, Italy; Institute of Clinical Physiology, Pisa, Italy; Senology Unit, Pisa, Italy; National Cancer Research Institute, Genoa, Italy
| | - U. Pfeffer
- University of Genoa, Genoa, Italy; Metabolism Unit, Pisa, Italy; Institute of Clinical Physiology, Pisa, Italy; Senology Unit, Pisa, Italy; National Cancer Research Institute, Genoa, Italy
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Bruzzi P, Sormani M, Tiseo M, Boni L, Rosell R, Ardizzoni A. Tumor response to chemotherapy as a surrogate endpoint of survival in advanced non-small cell lung cancer (NSCLC): Results of an individual patients data meta-analysis. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.7548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7548 Background: In order to assess the validity of objective response to chemotherapy (CT) as a surrogate endpoint of survival in advanced non-small cell lung cancer (NSCLC), we applied the four Prentice criteria to the data collected in the CISCA meta-analysis, comparing the efficacy of carboplatin and cisplatin in the first-line treatment of advanced NSCLC. Methods: Nine trials including 2,968 patients (pts) were analyzed in the CISCA meta-analysis. The prognostic effect of tumor response on survival was analyzed setting a landmark at two months after randomization (time of response recording), in order to eliminate early death from the analysis. After this landmark correction, pts included in the validation analysis were 2,525 with complete data on tumor response and survival. Results: Cisplatin-based CT was associated with a significantly higher tumor response rate compared with carboplatin-based CT (OR = 1.39; 95% CI: 1.18–1.64; p < 0.001). Carboplatin regimens also led to a numerically higher risk of death as compared to cisplatin (HR = 1.06; 95% CI: 0.98–1.16; p = 0.15). Tumor response was a highly significant predictor of survival (HR = 0.50; 95% CI: 0.46–0.55; p < 0.001). When tumor response was introduced in the Cox model (as a four level variable), the hazard ratio in favour of cisplatin treatment changed from 1.06 to 1.004 (95% CI: 0.922–1.093; p = 0.94), indicating that no residual effect of the cisplatin treatment on survival was present once tumor response was adjusted for. This suggests that the overall survival benefit of cisplatin CT was a result of the increase in response rate. The median survival time of patients with complete and partial response was 19.5 months (95% CI: 11.5–27.5 months) and 14.0 months (95% CI: 13.1–14.9 months), respectively; whereas, the median survival time of patients with no response was 7.8 months (95% CI: 7.5–8.1 months). Conclusions: These results support the hypothesis that the achievement of an objective response to CT in advanced NSCLC is associated with a survival benefit. The potential role of objective response as a surrogate endpoint for survival in CT trials of advanced NSCLC warrants further investigation. No significant financial relationships to disclose.
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Affiliation(s)
- P. Bruzzi
- Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy; Università degli Studi di Genova, Genova, Italy; Azienda Ospedaliero-Universitaria, Parma, Italy; Hospital Germans Trias I Pujol, Barcelona, Spain
| | - M. Sormani
- Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy; Università degli Studi di Genova, Genova, Italy; Azienda Ospedaliero-Universitaria, Parma, Italy; Hospital Germans Trias I Pujol, Barcelona, Spain
| | - M. Tiseo
- Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy; Università degli Studi di Genova, Genova, Italy; Azienda Ospedaliero-Universitaria, Parma, Italy; Hospital Germans Trias I Pujol, Barcelona, Spain
| | - L. Boni
- Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy; Università degli Studi di Genova, Genova, Italy; Azienda Ospedaliero-Universitaria, Parma, Italy; Hospital Germans Trias I Pujol, Barcelona, Spain
| | - R. Rosell
- Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy; Università degli Studi di Genova, Genova, Italy; Azienda Ospedaliero-Universitaria, Parma, Italy; Hospital Germans Trias I Pujol, Barcelona, Spain
| | - A. Ardizzoni
- Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy; Università degli Studi di Genova, Genova, Italy; Azienda Ospedaliero-Universitaria, Parma, Italy; Hospital Germans Trias I Pujol, Barcelona, Spain
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