Incorporation of molecular data into the Revised International Prognostic Scoring System in treated patients with myelodysplastic syndromes.

The Revised International Prognostic Scoring System (IPSS-R) was developed for untreated myelodysplastic syndrome (MDS) patients based on clinical data. We created and validated a new model that incorporates mutational data to improve the predictive capacity of the IPSS-R in treated MDS patients. Clinical and mutational data from treated MDS patients diagnosed between January 2000 and January 2012 were used to develop the new prognostic system. A total of 508 patients were divided into training (n=333) and validation (n=175) cohorts. Independent significant prognostic factors for survival included age, IPSS-R, EZH2, SF3B1 and TP53. Weighted coefficients for each factor were used to build the new linear predictive model, which produced four prognostic groups: low, intermediate-1, intermediate-2 and high with a median overall survival of 37.4, 23.2, 19.9 and 12.2 months, respectively, P<0.001. Significant improvement in the C-index of the new model (0.73) was observed compared with the IPSS-R (0.69). The new model predicted outcome both in a separate validation cohort and in another cohort of patients with paired samples at different time points during their disease course. The addition of mutational data to the IPSS-R makes it dynamic and enhances its predictive ability in treated MDS patients regardless of their initial or subsequent therapies.

Clinical outcome of stereotactic radiosurgery for central nervous system metastases from renal cell carcinoma.

BACKGROUND: Current treatment modalities for central nervous system (CNS) metastases from renal cell cancer (RCC) include surgical resection, stereotactic radiosurgery (SRS), and whole-brain radiotherapy. Existing studies describing treatment outcomes for CNS metastases include multiple tumor types and thus provide little insight into how RCC CNS metastases respond to these modalities. MATERIALS AND METHODS: RCC patients with brain metastases treated with SRS at the Cleveland Clinic between 1996 and 2010 were retrospectively identified. Radiosurgery and systemic therapy characteristics were recorded. Patients were followed up radiographically at 1 to 2 months after radiosurgery and every 3 to 6 months thereafter with magnetic resonance imaging scans. RESULTS: Of the 166 patients identified, local control was obtained in 90% of patients. In 38% of patients there were additional distant CNS metastases at a median of 12.8 months (95% CI, 8.5-21.1) after SRS. The median time to progression (either local or distant) was estimated to be 9.9 months (95% CI, 5.9-12.9). Higher (> 2.5) RCC-specific graded prognostic assessment (GPA) score was the only factor examined that was found to be a significant prognostic factor for improved outcome (P = .02); however, there was some suggestion that a single target lesion (P = .07) and age ≥ 60 years (P = .07) may also be associated with better CNS control. CONCLUSION: Stereotactic radiosurgery for a limited number of CNS metastases from RCC is associated with excellent local control and is an effective if not preferred treatment modality.

Cloning and characterization of a Dictyostelium discoideum cDNA encoding a protein related to the medium chain subunit of clathrin-associated adaptor complexes.

We describe the cloning and characterization of a cDNA, DdApm1, encoding a putative medium chain subunit of a clathrin-associated protein (adaptor or assembly protein [AP]) complex in Dictyostelium discoideum. The DdApm1 clone is predicted to encode a polypeptide of 439 amino acids (aa) with a molecular mass of 49.9 kDa. The predicted translation product (DdApm1p) shares at least 51.7% identity and 76.3% similarity with the medium chain subunits of plasma membrane (mb)-associated clathrin AP complexes from rat and Caenorhabditis elegans. The deduced aa sequence also demonstrates significant but lesser homology to a number of medium chain subunits of Golgi-associated clathrin AP complexes. Since DdApm1p demonstrates significantly greater homology to plasma mb-associated clathrin AP complex medium chains than to their Golgi-associated counterparts, we suggest that DdApm1p may be a medium chain subunit of an AP complex involved in clathrin function at the plasma mb of D. discoideum. Southern blot analysis indicated that DdApm1 gene defines a single copy gene in the D. discoideum genome. Northern blot analysis of RNA purified at different times during growth and development demonstrated that the DdApm1 gene is expressed at relatively constant levels throughout the life cycle of the organism. DdApm1 is the first reported full-length cDNA encoding a subunit of an AP complex in D. discoideum, and thus provides the first evidence for the existence of AP complexes in this organism.