***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE To define outcome data and prognostic criteria for patients with metastatic renal cell carcinoma ( RCC ) treated with interferon-alfa as initial systemic therapy . The data can be applied to design and interpretation of clinical trials of new agents and treatment programs against this refractory malignancy . PATIENTS AND METHODS Four hundred sixty-three patients with advanced RCC administered interferon-alpha as first-line systemic therapy on six prospect i ve clinical trials were the subjects of this retrospective analysis . Three risk categories for predicting survival were identified on the basis of five pretreatment clinical features by a stratified Cox proportional hazards model . RESULTS The median overall survival time was 13 months . The median time to progression was 4.7 months . Five variables were used as risk factors for short survival : low Karnofsky performance status , high lactate dehydrogenase , low serum hemoglobin , high corrected serum calcium , and time from initial RCC diagnosis to start of interferon-alpha therapy of less than one year . Each patient was assigned to one of three risk groups : those with zero risk factors ( favorable risk ) , those with one or two ( intermediate risk ) , and those with three or more ( poor risk ) . The median time to death of patients deemed favorable risk was 30 months . Median survival time in the intermediate-risk group was 14 months . In contrast , the poor-risk group had a median survival time of 5 months . CONCLUSION Progression-free and overall survival with interferon-alpha treatment can be compared with new therapies in phase II and III clinical investigations . The prognostic model is suitable for risk stratification of phase III trials using interferon-alpha as the comparative treatment arm Background : The neutrophil-to-lymphocyte ratio ( NLR ) and platelet-to-lymphocyte ratio ( PLR ) are prognostic factors for various types of cancer . In this study , we assessed the association of NLR and PLR with the prognosis of small-cell lung cancer ( SCLC ) in patients who received the st and ard treatment . Methods : We retrospectively review ed patients who were diagnosed with SCLC and treated with platinum-based chemotherapy between July 2006 and October 2013 in Gyeongsang National University Hospital Regional Cancer Center and Changwon Samsung Hospital . Results : In total , 187 patients were evaluated . Compared with low NLR ( < 4 ) , high NLR ( ⩾4 ) at diagnosis was associated with poor performance status , advanced stage , and lower response rate . Median overall survival ( OS ) and progression-free survival ( PFS ) were worse in the high-NLR group ( high vs low , 11.17 vs 9.20 months , P=0.019 and 6.90 vs 5.49 months , P=0.005 , respectively ) . In contrast , PLR at diagnosis was not associated with OS or PFS ( P=0.467 and P=0.205 , respectively ) . In multivariate analysis , stage , lactate dehydrogenase , and NLR at diagnosis were independent prognostic factors for OS and PFS . Conclusions : NLR is easily measurable and reflects the SCLC prognosis . A future prospect i ve study is warranted to confirm our results OBJECTIVE We investigated the impact of S-1 on the prognosis of patients with gemcitabine-refractory pancreatic cancer . METHODS A total of 108 patients with gemcitabine-refractory pancreatic cancer were divided by the time of S-1 introduction in our institution : 47 patients who experienced progressive disease before February 2005 ( pre-S-1 group ) and 61 patients showed progressive disease after February 2005 ( post-S-1 group ) . Introduction rates of second-line chemotherapy and survival were compared . Prognostic factors for residual survival were analyzed using the Cox proportional hazards model . RESULTS Introduction rates of second-line chemotherapy were 12.8 % in the pre-S-1 group and 45.9 % in the post-S-1 group . Second-line chemotherapy was administered to 34 patients : 29 using S-1 , 4 using 5-fluorouracil-based chemoradiation and 1 using 5-fluorouracil . The objective response rate , progression-free survival and overall survival for second-line chemotherapy with S-1 were 17.2 % , 2.5 and 7.7 months , respectively . By the introduction of S-1 in our institution , residual survival was prolonged from 3.1 months in the pre-S-1 group to 6.7 months in the post-S-1 group ( P < 0.001 ) . Overall survival from the initiation of gemcitabine was 8.8 months in the pre-S-1 group and 11.3 months in the post-S-1 group ( P = 0.013 ) . Multivariate analysis identified the post-S-1 group ( hazard ratio , 0.43 ; P = 0.001 ) , gender , performance status , liver metastasis , and lactate dehydrogenase and C-reactive protein levels at progressive disease for gemcitabine to be prognostic factors for residual survival . CONCLUSIONS The introduction of S-1 might improve the prognosis of patients with gemcitabine-refractory pancreatic cancer BACKGROUND Intermediate or surrogate endpoints for survival can shorten time lines for drug approval . We aim ed to assess circulating tumour cell ( CTC ) count as a prognostic factor for survival in patients with progressive , metastatic , castration-resistant prostate cancer receiving first-line chemotherapy . METHODS We identified patients with progressive metastatic castration-resistant prostate cancer starting first-line chemotherapy in the IMMC38 trial .  CTCs were isolated by immunomagnetic capture from blood sample s at baseline and after treatment . Baseline variables , including CTC count , titre of prostate-specific antigen ( PSA ) , and concentration of lactate dehydrogenase ( LDH ) , and post-treatment variables ( change in CTCs and PSA ) were tested for association with survival with Cox proportional hazards models . Concordance probability estimates were used to gauge discriminatory strength of the informative factors in identifying patients at low-risk and high-risk of survival . FINDINGS Variables associated with high risk of death were high LDH concentration ( hazard ratio 6.44 , 95 % CI 4.24 - 9.79 ) , high CTC count ( 1.58 , 1.41 - 1.77 ) , and high PSA titre ( 1.26 , 1.10 - 1.45 ) , low albumin ( 0.10 , 0.03 - 0.39 ) , and low haemoglobin ( 0.72 , 0.64 - 0.81 ) at baseline . At 4 weeks , 8 weeks , and 12 weeks after treatment , changes in CTC number were strongly associated with risk , whereas changes in PSA titre were weakly or not associated ( p>0.04 ) . The most predictive factors for survival were LDH concentration and CTC counts ( concordance probability estimate 0.72 - 0.75 ) . INTERPRETATION CTC number , analysed as a continuous variable , can be used to monitor disease status and might be useful as an intermediate endpoint of survival in clinical trials . Prospect i ve recording of CTC number as an intermediate endpoint of survival in r and omised clinical trials is warranted Background We aim ed to vali date prognostic scores for survival in patients undergoing chemotherapy for advanced or metastatic cancer after first-line treatment . Methods We previously described two models with good prognostic value based on a combination of Performance Status ( PS ) and either lactate dehydrogenase ( LDH ) level or lymphocyte count . These factors were evaluated for their ability to predict overall survival ( OS ) in a prospect i ve cohort of 299 patients .  Clinical and blood parameters were prospect ively recorded . C and i date prognostic factors for OS with 0.05 significance level in univariate analysis were included in a multivariate Cox model . Results Median age was 59 years ( range : 26 - 85 ) . Primary tumor sites were breast ( 45 % ) , lung ( 15 % ) , ovaries ( 11 % ) and others ( 29 % ) . The number of metastatic sites was 1 ( 29 % ) , 2 ( 48 % ) , > 2 ( 23 % ) . Median follow-up and median OS were 12 and 6 months , respectively . Multiple regression analysis confirmed that PS > 1 , lymphocyte count ≤700/μL and LDH > 600 UI/L were independent predictors of short OS , as well as interleukin 6 ( IL-6 ) level , serum albumin concentration and platelet count . Conclusions Prognostic scores using PS plus LDH level or PS plus lymphocyte count were vali date d for predicting survival in metastatic cancer patients in relapse beyond first-line treatment . A score combining PS , LDH , lymphocyte and platelet count , serum albumin and IL-6 level was superior in determining patients ' prognosis Abstract The aim of this study was to evaluate the long-term survival outcomes in patients with advanced thymic carcinoma and identify prognostic factors influencing the survival . We retrospectively analyzed 90 consecutive patients with pathologically confirmed advanced thymic carcinoma ( Masaoka III and IV ) in our institute , from December 2000 to 2012 . Age , sex , clinical characteristics , laboratory findings , Masaoka and tumor node metastasis staging , pathologic grade , and treatment modalities were analyzed to identify prognostic factors associated with the progress-free survival ( PFS ) and the overall survival ( OS ) rates . Statistical analysis was conducted using SPSS , version 19.0 ( SPSS , Inc , Chicago , IL).A total of 73 ( 81.1 % ) male and 17 ( 18.9 % ) female patients participated in the study . The median follow-up time was 75 months ( range , 20–158 months ) . The 5-year PFS and OS rates were 23.6 % ( 95 % confidence interval [ CI ] , 14.6%–33.8 % ) and 35.7 % ( 95 % CI , 25.1%–46.4 % ) , respectively . The multivariate Cox regression model analysis showed that factors improving the PFS were the normal lactate dehydrogenase ( LDH ) level ( P < 0.001 ) , Masaoka III stage ( P = 0.028 ) , and  radiotherapy  ( RT ) ( P < 0.001 ) . The LDH ( P < 0.001 ) , T stage ( P < 0.001 ) , and the pathologic grade ( P = 0.047 ) were independently prognostic of OS.Long-term follow-up of the advanced thymic carcinoma showed poor outcomes of PFS and OS . LDH , Masaoka stage , and RT affected the PFS , and LDH , T stage , and pathologic grade seemed to affect the OS . Establishing a better staging system for predicting outcomes would be warranted Purpose The purpose of this study was to clarify the safety and efficacy of combination chemotherapy of uracil-tegafur ( UFT ) and doxorubicin ( UFD regimen ) , and to identify the prognostic factors in patients with unresectable advanced biliary tract cancer who received systemic chemotherapy .  Methods Patients with histologically or cytologically confirmed , measurable biliary tract cancer , including intrahepatic or extrahepatic cholangiocarcinoma , gallbladder cancer , and ampullary cancer , who were not suitable c and i date s for surgery , were eligible for the study . Patients received oral UFT at 300 mg/m2 per day divided into two doses on days 1–14 and intravenous doxorubicin at 30 mg/m2 on day 1 . This cycle was repeated every 21 days . The relationship between the patient characteristics and the prognosis was examined . Univariate and multivariate analyses were conducted to identify the prognostic factors associated with survival . Results Sixty-one patients from 12 institutions were enrolled in the late phase II study between April 2005 and March 2006 . Of the 61 patients , 4 patients had partial responses , for an objective response rate of 6.6 % ( 95 % CI : 1.8–15.9 % ) ; 28 patients had stable disease , 27 had progressive diseases , and 2 patients were not evaluated . The median progression-free survival was 1.6 months , and the overall median survival time was 6.5 months . In the 85 patients who received this UFD chemotherapy in previous and late phase II studies , multivariate analysis revealed the ECOG performance status 1 ( P = 0.001 ) , gallbladder as the primary cancer site ( P = 0.014 ) , T-factor 4 of the TNM classification ( P = 0.035 ) , and elevated serum lactate dehydrogenase levels ( P = 0.043 ) as being associated with a significantly shorter survival . Conclusions Combination chemotherapy of UFT and doxorubicin  had minimum activity against advanced biliary tract cancer . Performance status was identified as the most important prognostic factor in patients who received systemic chemotherapy AIMS To identify independent prognostic factors in patients with cancer of unknown primary site ( CUP ) who do not belong to prognostically favourable subsets , and to develop a prognostic index for predicting survival in these patients . MATERIAL S AND METHODS In this prospect i ve study , univari 
    Output:
    
A high serum LDH level is associated with a poor survival in solid tumors , in particular melanoma , prostate and renal cell carcinomas , and can be used as a useful and inexpensive prognostic biomarker in metastatic carcinomas