prognostic subgrouping
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BACKGROUND: Glioblastoma (GBM) is the most aggressive adult primary brain cancer, characterized by significant heterogeneity, posing challenges for patient management, treatment planning, and clinical trial stratification. METHODS: We developed a highly reproducible, personalized prognostication, and clinical subgrouping system using machine learning (ML) on routine clinical data, magnetic resonance imaging (MRI), and molecular measures from 2838 demographically diverse patients across 22 institutions and 3 continents. Patients were stratified into favorable, intermediate, and poor prognostic subgroups (I, II, and III) using Kaplan-Meier analysis (Cox proportional model and hazard ratios [HR]). RESULTS: The ML model stratified patients into distinct prognostic subgroups with HRs between subgroups I-II and I-III of 1.62 (95% CI: 1.43-1.84, P < .001) and 3.48 (95% CI: 2.94-4.11, P < .001), respectively. Analysis of imaging features revealed several tumor properties contributing unique prognostic value, supporting the feasibility of a generalizable prognostic classification system in a diverse cohort. CONCLUSIONS: Our ML model demonstrates extensive reproducibility and online accessibility, utilizing routine imaging data rather than complex imaging protocols. This platform offers a unique approach to personalized patient management and clinical trial stratification in GBM.
- MeSH
- dospělí MeSH
- glioblastom * patologie klasifikace mortalita diagnostické zobrazování MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody MeSH
- míra přežití MeSH
- mladý dospělý MeSH
- nádory mozku * patologie klasifikace mortalita diagnostické zobrazování MeSH
- následné studie MeSH
- prognóza MeSH
- senioři MeSH
- strojové učení * MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
Cíl studie: Poruchy imunitních mechanismů jsou významným faktorem v patogenezi sepse a syndromu systémové zánětlivé odpovědi. Snížená exprese HLA-DR na monocytech a snížená schopnost produkce tumor nekrotizujícího faktoru-α ex vivo jsou parametry charakterizující stav imunoparalýzy. Cílem studie bylo zjistit význama užitečnost stanovení exprese HLA-DR na monocytech a produkce tumor nekrotizujícího faktoru-α ex vivo po stimulaci lipopolysacharidem u pacientů se syndromem systémové zánětlivé odpovědi, sepse a septického šoku. Typ studie: Retrospektivní. Název a sídlo pracoviště: Anesteziologicko-resuscitační oddělení nemocnic v Praze a Mladé Boleslavi. Materiál a metody: Bylo vyšetřeno 67 pacientů anesteziologicko-resuscitačních oddělení splňující kritéria diagnózy syndromu systémové zánětlivé odpovědi (SIRS),sepse, těžké sepse a septického šoku podle konsenzuální konference z roku 1991. Exprese HLA-DR na monocytech byla stanovena s použitím metody průtokové cytometrie, schopnost produkce TNF-α ex vivo z plné krve po stimulaci lipopolysacharidem byla stanovena při použití komerčního kitu Vollblutstimulation Kit fy Millenia a změřením vyprodukovaného TNF-α chemiluminiscenční metodou. Výsledky: Exprese HLA-DR na monocytech a produkce TNF-α byla statisticky významně snížena u pacientů se SIRS, sepsí i septickýmšokemve srovnání s kontrolní skupinou (p < 0,001).Hodnoty expreseHLA-DR na monocytech a TNF-α významně korelovaly s diagnózou (Spearmanův korelační koeficient r = -0,38, resp. r = -0,40, p < 0,0001). Zjistili jsme statisticky významné rozdíly obou parametrů mezi pacienty se SIRS a pacienty se sepsí, stejně jako mezi pacienty se SIRS a pacienty se septickým šokem. Hodnoty exprese HLA-DR korelovaly statisticky významně s hodnotami TNF-α u pacientů se SIRS a pacientů se sepsí (p = 0,0004, resp. p = 0,0003). Exprese HLA-DR na monocytech a produkceTNF-α při posledním vyšetření byla statisticky významně nižší ve skupině zemřelých pacientů ve srovnání se skupinou přeživších (p < 0,001, resp. p < 0,05). Závěr: Exprese HLA-DR na monocytech a produkce TNF-α ex vivo se snižují již v časných fázích SIRS a sepse. Jejich dlouhodobé snížení je přítomno u pacientů s nepříznivým konečným klinickým výsledkem.
Objective: Dysbalance in immune system play an important role in pathogenesis of sepsis and systemic inflammatory response syndrome (SIRS). Lowered expression of HLA-DR on monocytes coupled with decreased production of tumor necrosis factor-α ex vivo after stimulation with lipopolysaccharide are characteristic features of immunoparalysis.Thestudy aimed to determine importance and feasibility of their evaluation in patients with SIRS, sepsis and septic shock. Design: Retrospective, cohort study. Setting: Multidisciplinary intensive care unit. Material and methods: 67 patients meeting the criteria for diagnosis of systemic inflammatory response syndrome (SIRS), sepsis and septic shock according to the Consens Conference in 1991, admitted to the intensive care units were examined. For determination of HLA-DR expression on monocytes flow cytometry was used and production of TNF-α ex vivo from whole blood after lipopolysaccharide stimulation was evaluated by chemiluminiscence method utilising Vollblutstimulation Kit (Millenia). Results: Expression of HLA-DR on monocytes and TNF-α production were significantly decreased in patients with SIRS, sepsis and septic shock compared to the control group (P < 0.001) and correlated significantly with diagnosis (Spearman´s correlation coefficient r = -0.38, resp. r = -0.40, P < 0.0001). We found significant differences of both parameters between subgroups of patients with SIRS and sepsis or SIRS and septic shock. The values of expression of HLA-DR correlated significantly with values of TNF-α in patients with SIRS and sepsis (P = 0.0004, resp. P = 0.0003). Last measured values of HLA-DR expression on monocytes and production of TNF-α were significantly lower in non-survivals compared to survived (P < 0.001, resp. P < 0.05). Conclusion:HLA-DR expression on monocytes and production of TNF-α ex vivo decrease in early phase of SIRS and sepsis. Long lasting duration of their lower values is associated with unfavourable clinical outcome.
Atypical teratoid/rhabdoid tumor (ATRT) is an aggressive central nervous system tumor characterized by loss of SMARCB1/INI1 protein expression and comprises three distinct molecular groups, ATRT-TYR, ATRT-MYC and ATRT-SHH. ATRT-SHH represents the largest molecular group and is heterogeneous with regard to age, tumor location and epigenetic profile. We, therefore, aimed to investigate if heterogeneity within ATRT-SHH might also have biological and clinical importance. Consensus clustering of DNA methylation profiles and confirmatory t-SNE analysis of 65 ATRT-SHH yielded three robust molecular subgroups, i.e., SHH-1A, SHH-1B and SHH-2. These subgroups differed by median age of onset (SHH-1A: 18 months, SHH-1B: 107 months, SHH-2: 13 months) and tumor location (SHH-1A: 88% supratentorial; SHH-1B: 85% supratentorial; SHH-2: 93% infratentorial, often extending to the pineal region). Subgroups showed comparable SMARCB1 mutational profiles, but pathogenic/likely pathogenic SMARCB1 germline variants were over-represented in SHH-2 (63%) as compared to SHH-1A (20%) and SHH-1B (0%). Protein expression of proneural marker ASCL1 (enriched in SHH-1B) and glial markers OLIG2 and GFAP (absent in SHH-2) as well as global mRNA expression patterns differed, but all subgroups were characterized by overexpression of SHH as well as Notch pathway members. In a Drosophila model, knockdown of Snr1 (the fly homologue of SMARCB1) in hedgehog activated cells not only altered hedgehog signaling, but also caused aberrant Notch signaling and formation of tumor-like structures. Finally, on survival analysis, molecular subgroup and age of onset (but not ASCL1 staining status) were independently associated with overall survival, older patients (> 3 years) harboring SHH-1B experiencing relatively favorable outcome. In conclusion, ATRT-SHH comprises three subgroups characterized by SHH and Notch pathway activation, but divergent molecular and clinical features. Our data suggest that molecular subgrouping of ATRT-SHH has prognostic relevance and might aid to stratify patients within future clinical trials.
- MeSH
- gen SMARCB1 genetika metabolismus MeSH
- lidé MeSH
- metylace DNA MeSH
- nádory centrálního nervového systému * genetika MeSH
- neuroepitelové nádory * genetika MeSH
- prognóza MeSH
- proteiny hedgehog genetika metabolismus MeSH
- rhabdoidní nádor * genetika MeSH
- teratom * genetika MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
T-cell prolymphocytic leukemia (T-PLL) is a rare post-thymic T-cell neoplasm with aggressive clinical course and short overall survival. So far, due to the rareness of this disease, genetic data are available only from individual cases or small cohorts. In our study, we aimed at performing a comprehensive cytogenetic and molecular genetic characterization of T-PLL comprising the largest cohort of patients with T-PLL analyzed so far, including correlations between the respective markers and their impact on prognosis. Genetic abnormalities were found in all 51 cases with T-PLL, most frequently involving the TCRA/D locus (86%). Deletions were detected for ATM (69%) and TP53 (31%), whereas i(8)(q10) was observed in 61% of cases. Mutations in ATM, TP53, JAK1, and JAK3 were detected in 73, 14, 6, and 21% of patients, respectively. Additionally, BCOR mutations were observed for the first time in a lymphoid malignancy (8%). Two distinct genetic subgroups of T-PLL were identified: A large subset (86% of patients) showed abnormalities involving the TCRA/D locus activating the proto-oncogenes TCL1 or MTCP1, while the second group was characterized by a high frequency of TP53 mutations (4/7 cases). Further, analyses of overall survival identified JAK3 mutations as important prognostic marker, showing a significant negative impact.
- MeSH
- analýza přežití MeSH
- chromozomální aberace MeSH
- dospělí MeSH
- genetická variace MeSH
- Janus kinasa 3 genetika MeSH
- lidé středního věku MeSH
- lidé MeSH
- mutace * MeSH
- prognóza MeSH
- sekvenční analýza DNA MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- T-buněčná prolymfocytární leukemie genetika patologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Merkel cell polyomavirus (MCPyV), a ubiquitous DNA tumor virus, has been found to be associated with Merkel cell carcinoma and chronic lymphocytic leukemia (CLL). Previous studies have reported conflicting results on the frequency and potential pathogenetic role of MCPyV in CLL. The aim of this study was to evaluate MCPyV's association with CLL and its prognostic significance. PATIENTS AND METHODS: Between 2006 and 2013, DNA samples obtained from CLL patients (n = 119) before treatment were tested for MCPyV using quantitative real-time polymerase chain reaction analysis and verified by gel electrophoresis. Only samples testing positive by both methods were considered valid. RESULTS: We found that 13 (11%) of 119 CLL cases were positive for MCPyV. Between the groups of MCPyV-positive and -negative patients, there was no significant difference in the sex, age, cytogenetics, presence of p53 defect, or immunoglobulin heavy chain (IGHV) mutational status. In the subset of MCPyV-negative patients, advanced Rai stage (III to IV) was found more frequently, and therapy was initiated more often. There was no difference in overall response rate, median progression-free survival, and overall survival between both groups. We did not observe any new positivity after treatment in initially MCPyV-negative patients. CONCLUSION: This study provides the first analysis of the prognostic role of MCPyV in CLL. MCPyV occurrence seems to be a relatively rare event during the course of CLL. MCPyV is also unlikely to influence the outcome of CLL patients.
- MeSH
- chronická lymfatická leukemie diagnóza virologie MeSH
- elektroforéza v polyakrylamidovém gelu MeSH
- infekce onkogenními viry diagnóza virologie MeSH
- kvantitativní polymerázová řetězová reakce MeSH
- lidé středního věku MeSH
- lidé MeSH
- Merkelův polyomavirus patogenita MeSH
- mutace MeSH
- polyomavirové infekce diagnóza virologie MeSH
- prevalence MeSH
- prognóza MeSH
- těžké řetězce imunoglobulinů genetika MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Morphological examination is the routine first step in the diagnosis of hematological malignancies, including chronic lymphocytic leukemia (CLL). Atypical cell morphology according to the FAB criteria is known to herald disease progression. Several years ago, it was proposed that FAB morphology at diagnosis had a considerable prognostic impact. However, this proposal has not been widely adopted in practice. Thus we questioned the prognostic value of the morphological examination, which was performed retrospectively in 88 patients out of our 110 institutional registry patients (70 males and 40 females, median age 57 yrs) with CLL at diagnosis. We related the results to the more modern prognostic markers. Atypical FAB morphology was shown to correlate with IgVH gene mutation status, trisomy of chromosome 12 and deletion of 17p detected either by conventional G-banding or by fluorescence in situ hybridization (FISH) analysis. The correlation of FAB morphology with CD38 antigen expression or with the histopathological pattern of bone marrow infiltration was not significant. Overall survival (OS) data were available for 84 morphologically examined patients. The patients with atypical morphology (64 patients) had a significantly shorter OS (103 months) than the 20 patients presenting with typical CLL morphology (237 months; p=0.03). Only the mutation status of IgVH genes correlated more closely with OS (p=0.002). Of note, there was no leukemia-related death within "unmutated" cases who had typical FAB morphology (p=0.14), and vice versa, the mutation status had a significant prognostic impact within the morphologically atypical cases (p=0.01). Thus FAB morphology and the mutation status may yield complementary prognostic information. OS was affected both by the presence of cytogenetic aberrations (p=0.03) - most adversely by deletions of 17p and 11q, and by CD38 expression (p=0.003). We conclude that careful examination of peripheral blood smears according to FAB is a simple, cheap and valuable tool in the first-line assessment of prognosis of CLL patients and should not be overlooked even in 3rd millennium when more sophisticated prognostic markers are at hand. This ought to be confirmed in larger prospective studies with multivariate analysis of data.
- MeSH
- antigeny CD38 MeSH
- chronická lymfatická leukemie genetika mortalita patologie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mutace * MeSH
- počet leukocytů MeSH
- prognóza MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- těžké řetězce imunoglobulinů * genetika MeSH
- variabilní oblast imunoglobulinu * genetika MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
Cieľ práce: Cieľom práce bolo zhodnotiť antivírusovú liečbu a vplyv vybraných faktorov na jej úspešnosť u pacientov s chronickou hepatitídou C liečených na Klinike infektológie a cestovnej medicíny v Košiciach v rokoch 2003 až 2007. Materiál a metódy. Retrospektívne sme analyzovali súbor 213 pacientov liečených pre chronickú hepatitídu C a v rámci neho prognostické faktory úspešnosti liečby v podskupine 159 pacientov, ktorí ukončili kompletnú liečbu pegylovaným interferónom alfa a ribavirínom. Výsledky: Z celkového súboru sme 193 pacientov liečili kombináciou pegylovaného interferónu a ribavirínu, 5 monoterapiou pegylovaným interferónom a v 15 prípadoch bol použitý konvenčný interferón. Ú 179 hečených (84 %) sa jednalo o prvoliečbu, 34 pacientov bolo liečených opakovane. Genotyp 1 bol zistený u 91,5 % zo 189 vyšetrených. Biopsia pečene bola realizovaná u 143 pacientov, 46,9 % z nich malo mierne histologické zmeny, 38,5 % stredne ťažké, 14,7 % ťažké až cirhózu pečene. Liečba bola predčasne ukončená pre nežiadúce účinky v 12,2 % prípadov. V skupine 159 pacientov s ukončenou liečbou sme trvalú virologickú odpoveď (SVR) zaznamenali V 35,8 % prípadov a ďalších 12,6 % malo virologickú odpoveď na konci Uečby (SVR ešte nehodnotená). Virologický relaps alebo breaktrough malo 26,4 % pacientov, 25,2 % bolo bez odpovede. Pacienti, ktorí dosiahli SVR boh častejšie infikovaní genotypmi 2 alebo 3, mali nižší stupeň fibrózy pečene, nižší priemerný vek a častejšie dosiahli kompletnú skorú virologickú odpoveď. Naopak, v skupine nonrespondérov sme potvrdili vyšší podiel pacientov s redukovanou liečbou pod 80 %. Ostatné pozorované rozdiely ako zastúpenie pohlaví, hmotnosť, podiel pacientov s normálnou aktivitou ALT alebo podiel predtým neliečených pacientov neboli signifikantné. Záver: Úspešnosť liečby v našom súbore bola pri zohľadnení nepriaznivého zastúpenia genotypov a podielu pacientov s opakovanou liečbou porovnateľná s literárnymi údajmi. Medzi priaznivé prognostické faktory liečby pozorované v našom súbore patrili predovšetkým infekcia genotypom vírusu 2 alebo 3, nižší stupeň fibrózy pečene a nižší vek.
Objective: The study aimed at evaluating antiviral therapy and the impact of selected factors on its efficacy in patients with chronic hepatitis C treated at the Department of Infectology and Travel Medicine in Košice, Slovakia, between 2003 and 2007. Material and Methods: A retrospective analysis of a group of 213 patients treated for chronic hepatitis C and of prognostic factors for treatment efficacy in a subgroup of 159 patients who completed theraov with pegilated interferon alpha and ribavirin. Results: From the entire group, 193 patients were treated with a combination of pegylated interferon and ribavirin, 5 received pegylated interferon monotherapy and in 15 cases, conventional interferon was used. A total of 179 patients (84 %) were treated for the first time, the remaining 34 patients were treated repeatedly. Genotype 1 was detected in 91.5 % of 189 studied patients. Liver biopsy was performed in 143 patients, with mild, moderate and severe histological changes or liver cirrhosis being detected in 46.9 %, 38.5 % and 14.7 % of them, respectively. In 12.2 % of cases, treatment was discontinued due to adverse effects. In the group of 159 patients who completed therapy, sustained viral response (SVR) was found in 35.8 %; another 12.6 % had viral response at the end of therapy (SVR has not been assessed as yet). Viral relapse or breakthrough were observed in 26.4 % and 25.2 % showed no response. Patients who achieved SVR were more frequently infected with genotypes 2 and 3, had lower degrees of liver fibrosis, lower mean age and more frequently achieved complete early viral response. By contrast, the group of non-responders was characterized by a higher proportion of patients with reduced therapy below 80 %. The other observed differences such as male/female ratio, weight, proportion of patients with normal ALT activity or proportion of previously untreated patients were not significant. Conclusion: The efficacy of treatment in our group adjusted for the adverse proportion of genotypes and proportion of patients with repeated therapy was comparable with the literature data. The favorable prognostic factors observed in the group included infection with genotypes 2 or 3, lower degree of t liver fibrosis and lowower age.
Aim: We analyzed the mortality risk of myocardial infarction (MI) patients according to renal function, observed during hospitalization. Materials & methods: Patients hospitalized for MI between 2006 and 2018 were followed (n = 5659). We divided the sample into four groups by estimated glomerular filtration (eGFR) [ml/min]: normal functions (lowest eGFR during hospitalization >60); transiently moderate insufficiency (lowest eGFR >30 and ≤60, highest >60); permanently moderate insufficiency (highest eGFR >30 and ≤60); severe insufficiency (highest and lowest eGFR ≤30). Results: Permanently moderate renal insufficiency indicates increased 5-years all-cause mortality (hazard risk ratio: 2.27 [95% CIs: 1.87-2.75], p < 0.0001), but a similar risk was found in patients with the only transient decline of renal functions (hazard risk ratio: 2.08 [95% CIs: 1.70-2.55], p < 0.0001). Both moderate insufficiency subgroups (transient/permanent) did not statistically differ regarding mortality risk. Conclusion: Even just fluctuation of eGFR toward moderate insufficiency during hospitalization represents an important prognostic indicator in MI patients.
The clinical course of chronic lymphocytic leukemia (CLL) is highly variable. Patients with unmutated IGHV (U-CLL) usually progress rapidly, whereas patients with mutated IGHV (M-CLL) have a more indolent disease. The expression of several genes correlates closely with the IGHV mutational status and could be used to assess prognosis in CLL. We analyzed the prognostic relevance of COBLL1, LPL, and ZAP70 gene expression, which correlated with IGHV mutational status (p < 0.0001), in 117 CLL patients and established a prognostic parameter dividing the tested cohort according to the disease aggressiveness. Our prognostic parameter was validated on an independent cohort of 161 CLL patients and achieved a high accuracy (94%). Patients divided according to the prognostic parameter differ in overall survival and time to first treatment (p < 0.0001, HR = 2.300/5.970, 95% CI: 1.587-3.450/4.621-15.86). Our approach provides a reliable alternative method to prognosis assessment via IGHV mutational status analysis.
- MeSH
- analýza přežití MeSH
- chronická lymfatická leukemie diagnóza genetika mortalita MeSH
- dospělí MeSH
- exprese genu MeSH
- lidé středního věku MeSH
- lidé MeSH
- lipoproteinlipasa genetika MeSH
- mutace * MeSH
- nádorové biomarkery MeSH
- prognóza MeSH
- progrese nemoci MeSH
- protein-tyrosinkináza ZAP-70 genetika MeSH
- reprodukovatelnost výsledků MeSH
- ROC křivka MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- těžké řetězce imunoglobulinů genetika MeSH
- transkripční faktory genetika MeSH
- variabilní oblast imunoglobulinu genetika MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Bazocelulárny karcinóm kože (BCC) je v súčasnosti u ľudí najčastejším malígnym nádorovým ochorením s celosvetovo stále stúpajúcou incidenciou. Tento karcinóm v skutočnosti predstavuje spektrum viacerých rozdielnych nádorových podtypov, ktoré sa odlišujú v histomorfologickom obraze aj biologickom správaní. Hoci BCC väčšinou nebýva život ohrozujúci a iba zriedkavo vytvára metastázy, v určitých prípadoch má aj veľmi nepriaznivý klinický priebeh so zlou prognózou. Celková prognóza ochorenia závisí od viacerých klinicko-morfologických parametrov, ku ktorým patrí veľkosť nádoru, jeho histologický variant, lokalizácia na tele, hĺbka infiltrácie, vzhľad makroskopicky viditeľných nádorových okrajov, nález perineurálnej a perivaskulárnej invázie, vznik karcinómu na miestach kože po predchádzajúcom ožarovaní, prítomnosť recidivujúcich nádorov a imunologický stav pacienta. Stratifikácia pacientov na základe uvedených faktorov do prognostických skupín môže zlepšiť individuálny manažment, umožniť výber najoptimálnejšej terapeutickej stratégie a tým redukovať riziko recidívy ochorenia a s ňou súvisiacej morbidity. Dôkladné zhodnotenie obidvoch ukazovateľov – klinických parametrov pacientov aj jednotlivých tumor-špecifických ukazovateľov – sú preto základným kritériom v diagnostickom procese. Informácie o biologickom správaní BCC a zatriedenie pacientov do „nízko-rizikovej“ a „vysoko-rizikovej“ skupiny sú v klinickej praxi dôležité pre stanovenie ďalšieho liečebného plánu a dispenzarizáciu pacienta. V súčasnosti rastú požiadavky na vytváranie klasifikačných systémov, ktoré nebudú založené iba na spektre histomorfologických nálezov karcinómu, ale budú zahrňovať aj jednotlivé prognostické a prediktívne parametre ochorenia.
Basal cell carcinoma of the skin (BCC) is currently the most common cancer in humans, the incidence of which is also continuously rising throughout the world. In fact, this cancer represents a spectrum of several tumour subtypes, which differ in histomorphological picture and biological behaviour. Although BCC is usually not life-threatening and rarely forms metastases, it demonstrates a very adverse clinical outcome with a poor prognosis in certain cases. Overall prognosis of disease depends on several clinico-morphological parameters including tumour size, histological variant, body localisation, depth of infiltration, character of macroscopically visible tumour margins, findings of perineural and perivascular invasion, appearance of carcinoma on skin sites after previous irradiation, presence of recurrent tumours, and immunological status of patient. Based on the present parameters, allocation of patients into the prognostic groups can improve individual management and allow selection of the most appropriate therapeutic strategy to reduce the risk of disease recurrence and its associated morbidity. Therefore, a careful assessment of both individual patient’s factors and certain tumour-specific indicators are key to the diagnostic process. Information about the biological behaviour of BCC and classification of individuals into low-risk and high-risk subgroups is important in clinical practice to set up a further treatment plan. Recently, there have been increasing demands for the creation of classification systems, that would not be based just on the spectrum of histomorphological findings of carcinoma, but that would also constitute individual prognostic and predictive parameters of disease.
