bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification of prognostic variables in advanced ovarian cancer based on real-world patients from big data analytics.
Authors: García-Donas Jesús , Sevillano Elena , Muñoz Sergio , Bote Luis , Yagüe Monica , Lainez Nuria , Guerra Eva Mª , Garrido Maria , Garcia-Donas Teresa , Amarilla Sandra , Navarro Paloma , Ruiz Sergio , Fenor MD , Rodriguez-Moreno Juan Francisco , Rojo Jose Luis
Published: May 2019

e17104

Background: Prognosis of advanced ovarian cancer is dismal with most cases recurring after initial surgery. Current factors able to predict the evolution of the disease are limited to BRCA status and platinum sensitivity. We aim to explore the potential of different clinical variables as prognostic factors using big data analytics in currently available hospitalary departmental information systems. Methods: An observational study with two cohorts (one prospective and one retrospective) was designed. Inclusion criteria were adult patients ( > 18 years old) diagnosed with epithelial ovarian cancer stage IC or superior.Clinical and histological data were recorded by a central data manager to ensure homogeneity in data collection. Big data analytics consisted on building an approximation to the statistical distribution of the tests to distinguish different kinds of features (metric, categorical, free text). Bootstrap resampling allowed to characterize the confidence regions for proportion differences, average differences, and text-profile differences in exitus vs in non-exitus groups. Results: Up to 265 patients in four different hospitals were recruited. Median age was 59 years (range 20-87), stage distribution was 48 (18%) I, 20 (8%) II, 122 (46%) III, 41 (15%) IVand 34 (13%) NA. Histology distribution was 158 (60%) papillary serous, 31 (12%) endometrioid, 18 (7%) clear cell, 11 (4%) mucinous and 47 (18%) NA. 152 (58%) patients underwent upfront surgery, 76 (29%) interval surgery and 10 (4%) no surgical intervention, 27 (10%) NA. 207 (78%) achieved optimal cytoreduction. 232 (88%) received adjuvant chemotherapy, most with carboplatin plus paclitaxel 180 (68%) and 48 (18%) also with bevacizumab. Median follow up was 81.4 months (CI95% 64.1-98.7) The proposed Big Data analytics identified a higher frequency of upfront surgery (vs interval surgery) and bevacizumab administration (vs chemotherapy alone) in the non-exitus group. Conclusions: Our results point to the notion that performance of upfront surgery and bevacizumab administration could have a long term impact in ovarian cancer. Simple Big Data analytics can contribute to identify new prognostic factors and to assess their real impact on patients managed in daily practice.
Patterns of distant metastases in patients with endometrial carcinoma: A SEER population-based analysis.
Authors: Li Jun , Sun Li , Zhang Yuzi , Cai Shangli
Published: May 2019

e17109

Background: Endometrial carcinoma is the most common gynecology malignancies in the worldwide. The clinical outcome of endometrial carcinoma is excellent, with disease specific survival rate over 90% in early stages. However, the prognosis of metastatic endometrial carcinoma is poor and the pattern of distant metastases has not been well characterized. In the present study, we sought to assess the incidence and prognosis of different distant metastatic sites in endometrial carcinoma. Methods: Patients who were diagnosed with endometrial carcinoma between 2010 and 2015 were identified according to the following criteria in the Surveillance, Epidemiology, and End Results (SEER) database: (1) confirmed age and older than 18 years old; (2) enrolled patients should have confirmed distant visceral metastatic status information. Kaplan-Meier analysis and log-rank tests were used to estimate the overall survival (OS) between difference groups. Data were analyzed with GraphPad Prism (version 7.01, GraphPad Software, USA), and R (version 4.3.1, R Development Core Team). Results: A total of 73328 patients with endometrial carcinoma were included. Median age of diagnosis was 62 years and 80.3% of patients were white. 92.8% of patents have received surgery. 4.2% of patients (3053/73328) suffered at least one site of distant metastases. The most common metastasis site was lung (1331/73328, 1.82%), followed by distant lymph nodes (1191/72703, 1.6%), liver (661/73328, 0.9%), bone (475/73328, 0.65%) and brain (133/73328, 0.18%). Median OS was 15 months, 4 months, 7 months, 9 months and 8 months for pure distant lymph node, brain, bone, lung and liver metastases, respectively. Furthermore, metastatic sites showed significant impact on OS in univariate analysis. Multivariate analysis with COX proportional regression model showed that distant metastatic sites were independent prognostic factors of OS. Conclusions: Lung is the most common distant metastatic site of endometrial carcinoma. Patients with pure distant lymph node metastasis exhibited the best overall survival, while patients with brain metastases had worst clinical prognosis compared with other metastatic sites.
Hysterectomy utilization among newly diagnosed endometrial cancer patients by body mass index category: A real-world analysis using a claims and electronic health record database.
Authors: Irwin Debra E. , Thiel Ellen
Published: May 2019

e17112

Background: For endometrial cancer (EC), laparoscopic hysterectomy (LH) is an effective, minimally invasive surgical treatment; however, this approach may not be recommended for obese patients due to increased risk for complications. Methods: This retrospective study utilized insurance claims linked to electronic health record (EHR) data contained in the IBM MarketScan Explorys Claims-EHR Data Set. Newly diagnosed EC patients (1/1/2007 - 6/30/2017) with continuous enrollment during a 12-month baseline and 6-month follow-up period were selected. Patients were stratified into four BMI subgroups based on baseline BMI on the EHR: normal or underweight (BMI < 25), overweight (BMI 25- < 30), obese (BMI 30- < 40), morbidly obese (BMI > 40), and were required to have had a hysterectomy within the follow-up period. Emergency room visits and rehospitalization within 30 days of hysterectomy were measured. Results: A total of 1,090 newly-diagnosed EC patients met the selection criteria, of whom, 16% were normal/underweight, 19% were overweight, 39% were obese, and 26% were morbidly obese. The proportion of patients receiving LH increased as BMI category increased (Table 1). Among those with LH between 6% and 15% had an ER visit or rehospitalization in 30 days, and rates were higher among other hysterectomy modalities. Conclusions: This real-world analysis shows that LH is utilized in a high proportion of morbidly obese EC patients, despite that it is frequently deemed infeasible in this patient population. Although the rate of ER visits and rehospitalization is lower among LH patients than those undergoing traditional hysterectomy across all BMI strata, further research is needed to determine the optimal patient population to receive LH.[Table: see text]
Association betweenBRCA1 and BRCA2 mutations and prognosis in women with endometrial carcinoma.
Authors: Wang Aifen , Holloway Robert W. , Cui Lijuan , Sun Yan , Zhao Zihan
Published: May 2019

e17115

Background: To evaluate the prognosis of BRCA mutation carriers compared to non-carriers and to demonstrate whether BRCA1 and BRCA2 mutation carriers present similar survival patterns among endometrial carcinomas. Methods: This data was from NCI Cancer Genome Atlas endometrial cancer database (TCGA) with pathogenic mutations in BRCA1 (58) or BRCA2 (77) or BRCA1and BRCA2 coexisted mutation (40) and non-mutation (461). We compared clinicopathologic features and prognosis of patients with BRCA1 or BRCA2 or BRCA1and BRCA2 coexisted mutation. Survival time was analyzed for the combined data using Cox proportional hazard models with BRCA1and BRCA2 as time-varying covariates. Results: We found histologic types of patients with BRCA1 or BRCA2 mutation presented more progressive than non-carriers ( p = 0.029, p= 0.029, respectively). BRCA1 or BRCA2 mutations were detected to be associated with younger patients at diagnosis ( p = 0.036, p = 0.001, respectively). BRCA2 mutation carrier was identified more advanced stage than BRCA non-carriers. Compared to patients with BRCA1 mutation, the body mass index is higher in non-carriers. Before around 100 months survival, BRCA2 mutation carriers had the most favorable overall survival (OS). OS rate of all patients with BRCA1 or BRCA2 mutation was higher than non-carriers. BRCA1 and BRCA2 mutation carriers had similar OS. Around 100 months later, BRCA1 carriers had more favorable OS than patients with BRCA2 mutation, BRCA1 / BRCA2 coexisted mutation and non-carriers ( p < 0.001). Patients with BRCA2 mutation had the most favorable progression-free survival (PFS), following by BRCA1 and BRCA2 coexisted mutation and BRCA2 alteration carriers ( p= 0.011). BRCA non-carriers had the worst PFS and OS all the time. Conclusions: BRCA1 or BRCA2 mutation carriers have favorable overall survival and progression-free survival among patients with endometrial carcinoma. [Table: see text]
The influence of obesity on tumor recurrence in vulvar cancer patients.
Authors: Klapdor Rüdiger , Hillemanns Peter , Woelber Linn Lena , Jueckstock Julia Kathrin , Hilpert Felix , de Gregorio Nikolaus , Hasenburg Annette , Sehouli Jalid , Ignatov Atanas , Fuerst Sophie , Strauss Hans-Georg , Baumann Klaus , Thiel Falk , Mustea Alexander , Meier Werner , Harter Philipp , Wimberger Pauline , Hanker Lars Christian , Schmalfeldt Barbara , Mahner Sven
Published: May 2019

e17130

Background: Obesity is associated with worse patients’ survival in several cancer entities. Vulvar cancer as well as obesity show increasing incidence over the last years. The influence of obesity on prognosis of vulvar cancer patients is not clear. However, knowledge about this may have consequences on prevention, treatment, and follow-up. Methods: This is an analysis of the large AGO-CaRE-1 study. Patients suffering from squamous cell vulvar cancer (UICC stage IB and higher), treated in 29 cancer centers between 1998 and 2008, were categorized in a database, in order to analyze treatment patterns and prognostic factors in a retrospective setting. Results: In total, 849 patients with documented height and weight were divided into two groups depending on their body mass index (BMI, < 30 vs. ≥30 kg/m²). There was no difference in the baseline variables (age, tumor diameter, depth of infiltration, tumor stage, nodal invasion, tumor grade) between both groups (p > 0.05). However, we identified differences regarding ECOG status and preexistent comorbidities (cardiovascular, dementia) towards healthier patients with BMI < 30 kg/m². Treatment variables (R0 resection, chemotherapy, radiotherapy, continuation of adjuvant therapy) did not differ (p > 0.05). Patients with BMI ≥30 kg/m² underwent radical vulvectomy more often (61.1 % vs. 51.8%, p = 0.042). During follow-up, there was a higher recurrence rate in the group having a BMI ≥30 kg/m² (43.4%, vs. 28.3%, p < 0.01) due to an increased rate of local recurrences (33.3% vs. 18.5%, p < 0.01). The rate of groin and distant recurrences was similar between both groups (p > 0.05). Noteworthy, we observed a significantly shorter disease free survival (DSF) of the obese patients in univariate analysis (HR 1.362, 95%CI 1.093-1.696, p = 0.006). Even in multivariate Cox-regression analysis including age, ECOG, tumor stage, type of surgery, nodal invasion, tumor grade, and comorbidities patients with BMI ≥30 kg/m² had a significantly shorter DFS (HR 1.811, 95%CI 1.005-3.262, p = 0.048). Conclusions: In this first large study about the association between obesity and prognosis of vulvar cancer patients, we observed that a BMI ≥30kg/m² was associated with shorter DFS, mainly attributed to a higher risk for local recurrence.
Apatinib in treating patients with platinum-resistant or platinum-refractory recurrent or metastatic nasopharyngeal carcinoma.
Authors: Chen Xiaozhong , Tao Changjuan
Published: May 2019

e17502

Background: To evaluate the efficacy and safety of apatinib in treating patients with platinum-resistant or platinum-refractory recurrent or metastatic nasopharyngeal carcinoma. Methods: In this phase 2, single-arm, prospective study, we recruited patients aged 18–65 years with platinum-resistant or platinum-refractory recurrent /metastatic nasopharyngeal carcinoma. Patients were treated with apatinib at an initial dose of 500 mg once daily and continued until disease progression, patient withdrawal, or unacceptable toxic effects. The primary endpoint was clinical benefit rate (CBR) and toxicity. Secondary endpoints included progression-free survival (PFS) at 3 months and overall survival (OS). We used Simon’s two-stage design, and analysed efficacy and toxicity in the intention-to-treat and per-protocol populations. This study is registered with ClinicalTrials.gov, number NCT03213587. Results: Between Aug 5,2017 and Oct 13,2018, we enrolled 16 patients. Until the final follow-up (Jan 14, 2019), the CBR (complete response + partial response+ stable disease) was 69.2% (9/13) in the per-protocol population. Median PFS and 3-month PFS rate were 3.70 (95% CI, 0-8.771) months and 67.1%, respectively. Median OS and 1-year OS rate were 12.9 (95% CI 5.56-20.23) months and 47.9%, respectively. The most common grade 3-4 adverse events were neutropenia (1[6.25%]), hand-foot syndrome (2[12.5%]), albuminuria (2[12.5%]), hypertension (1[6.25%]), hyponatremia (1[6.25%]), artery dissection (1[6.25%]) and nasopharyngeal hemorrhage (2[12.5%]) in the intention-to-treat population. Serious adverse event was reported in one patient who died of nasopharyngeal hemorrhage. Conclusions: Apatinib achieved excellent disease control in platinum-resistant or platinum-refractory recurrent or metastatic nasopharyngeal carcinoma. More attention needs to be paid to toxicity management. Clinical trial information: NCT03213587.
Practice patterns and outcomes following radiation dose de-escalation for oropharyngeal cancer: A National Cancer Database analysis.
Authors: White Richard , Abel Stephen , Hasan Shaakir , Verma Vivek , Greenberg Larisa , Colonias Athanasios , Wegner Rodney E
Published: May 2019

e17508

Background: Numerous trials are evaluating radiotherapy (RT) de-escalation for HPV-mediated (HPV+) oropharyngeal squamous cell carcinoma (OPSCC). Herein, we evaluated the degree to which de-escalated RT is delivered in the United States, as well as, comparative outcomes with full-dose RT, as stratified for HPV status. Methods: We identified patients diagnosed with OPSCC in the National Cancer Database, excluding those with stage I/II disease, unknown HPV status, receiving surgery or not receiving EBRT to the primary site, receipt of radiation doses > 75 or < 54 Gy, radiation treatment course duration < 25 or > 75 days, and unknown or inadequate ( < 2 months) follow-up. Multivariable logistic regression analysis identified variables associated with delivery of de-escalated RT ( < 66 Gy). Overall survival of HPV+ and HPV- disease was compared between full-dose and de-escalated approaches. Results: Altogether, 617 and 551 patients were HPV+ and HPV-, respectively. De-escalated RT was delivered in 16.9% HPV+ and 15.2% of HPV- disease, respectively. Older patients and those not receiving systemic therapy were more likely to receive de-escalated RT. In HPV+ patients, 3- and 5-year survival rates were 83% and 80% in the de-escalated cohort versus 83% and 78% in the full-dose group (p = 0.83). In HPV- patients, corresponding 3- and 5-year survival rates were 29% and 23% versus 61% and 51% (p = 0.001). Conclusions: National utilization of de-escalated RT for OPSCC is low (15-20%), but does not seem to impact overall survival in HPV+ (but not HPV-) patients. The caveats of this heterogeneous, retrospective analysis require corroboration from a number of ongoing randomized trials.
A Nationwide analysis of mortality trends in geriatric and non-geriatric patients with oral cavity tumors.
Authors: Waseem Bushra , Ajebo Germame Hailegiorgis , Krutchik Allan N. , Guddati Achuta Kumar
Published: May 2019

e17510

Background: Squamous cell carcinoma is the most common histological-subtype of oral cavity tumors and no major advances in its treatment have occurred recently. However, p16 positive tumors have been noted to have a better prognosis than p16 negative tumors. Older patients have increasingly been found to have p16 positive oral cavity cancers. This study explores the incidence based mortality of geriatric patients irrespective of p16 status. Methods: Data from Surveillance, Epidemiology, and End Results (SEER) Database was extracted to study the incidence-based mortality for the years 2000 to 2014. Incidence-based mortality for all stages of oral cavity tumors was queried and the results were grouped by age (geriatric vs. non-geriatric) and race (Caucasian/White, African American/Black, American Indian/Alaskan native and Asian/Pacific Islander). All stages and both genders were included in the analysis. T-test was used to determine statistically significant difference between various subgroups. Linear trend lines were used to visualize the mortality trends between various subgroups (Geriatric vs. Non- geriatric and Caucasian vs. African American). Results: Incidence-based mortality for oral cavity tumors has worsened since 2000 to 2014 for geriatric patients (p < 0.05) when compared to non-geriatric patients in both Caucasian/White patients and African American/Black patients. The results are summarized in the table below. Conclusions: The similarity in incidence-based mortality for geriatric patients with oral cavity tumors is high in all races and may imply age as a significant risk factor in these patients. A stage-specific, gender-specific and age-binned analysis may help differentiate these concerning trends. [Table: see text]
Survival estimates for young patients with tongue cancer: An analysis of the SEER database.
Authors: Khullar Pooja , Pendharkar Dinesh , Gupta Sumant , Vatsal Shivam , Dhingra Neeraj
Published: May 2019

e17549

Background: Carcinoma tongue is a common malignancy with increasing trend. Studies have suggested poor outcomes in young patients. To better understand ,we reviewed survival in young patients of tongue cancer from Surveillance and Epidemiologic and End Results (SEER) analysis. Methods: We identified 261 patients, aged 15 to 29 years, with squamous cell carcinoma tongue reported to SEER program between 2004 to 2015. Cases were categorized by age, sex, laterality, stage. Survival rates were compared using SPSS software. Results: The group had male to female ratio of 1.2:1, with a median age of 26 years. According to ICD-03, 85 patients (32.6%) had keratinizing variant of squamous cell carcinoma. About 40 patients (15.2%) had grade I, 161(61.7%) grade II and 46 (17%) – had grade III tumors. Out of 216 patients laterality was not paired in the majority (214-82%), while 24 (9.2%) had left side and 21 (8%) had right side primaries. According to the AJCC staging classification - 90 patients (34.5%) had stage I, 36 (13.6%)- stage II, 50 (18.9%)- stage III, and 83 (30%) as stage IV disease. Surgical procedures included- excisional biopsy in 13 patients (4.9%), 183 (69.3%) had wide local excision, 37 (14%) underwent radical excision of the tumor. Overall 193 patients were alive (73%), 40 patients (15.2%) died of cancer and 20 (7.6%) died of other causes. Average survival was 41 months (range 0-142 months). The median survival did not differ between male and female (35 vs 45, p = NS). Grade of the tumor had no impact on survival (33, 44 and 32 months-well, moderately and poorly differentiated respectively). Similarly keratinizing tumors had equal to other squamous non classified tumors ( 45 vs 31 months). The staging of the tumor was predictive of the survival(p < 0.01) .Median survival as per the stage was 62, 46, 36 and 20 months for stage I,II,III and IV respectively .There was no statistical difference based on laterality of the tumor( left sided 28 months vs right sided 22 months).As per TNM staging small lesions survived better : 60, 45, 17 and 13 months respectively for T1 ,T2 ,T3 and T4 size (p < 0.006). Nodal status was also strong predictor of the survival p < 0.001) , 49,45,31 and 19 months respectively for N0, N1, N2 and N3 tumors. Metastatic disease also shortened survival significantly (p < 0.001) , 42 month with M0, while 3 months only for M1 disease. Conclusions: In young patients with tongue cancer, stage of the disease, size of the tumor, nodal status has significant impact on survival. Other parameters like sex, histological type, grade of the tumor, laterality has no major impact.
The effect of induction chemotherapy on tumor volume changes in patients with locoregionally advanced nasopharyngeal carcinoma.
Authors: Han Guang , Li Ying , Wu Yuan , Bi Jianping , Li Yanping , Zheng Dandan , Xie Conghua , Hu Desheng
Published: May 2019

e17557

Background: The use of induction chemotherapy (IC) in locoregionally advanced nasopharyngeal carcinoma (NPC) for radiotherapy target volume reduction is increasing, however, the number of cycles is still varying. The purpose of this study was to observe changes in the gross tumor volumes of nasopharynx primary lesion (GTV_T), metastatic retropharyngeal lymph node (GTV_RP), and metastatic cervical lymph node (GTV_N) on longitudinal CT images during multi-cycle IC, and identify the optimal number of IC cycles. Methods: Eighteen patients with locoregionally advanced NPC received 3 cycles of platinum-based doublet IC. Each patient underwent an initial CT scan before the first cycle, followed by repeat CT (rCT) scans 14 days after each IC cycle. GTV_T, GTV_RP, and GTV_N were contoured on each CT. Wilcoxon signed-rank test was used for the comparing the longitudinal tumor volume changes. Results: The volume reductions of GTV_T, GTV_RP, and GTV_N following IC were found to have different magnitudes. Compared with GTV_T0 (before IC), the volume changes of GTV_Tn (n = 1, 2, 3) after IC were -3.1±0.7 cm3, -7.0 ±1.9 cm3 and -6.9 ±2.0 cm3, respectively, corresponding to relative reductions of 12.0%, 22.5%, and 20.1%, respectively. The GTV_T volume reduction was significant following the first two cycles of IC ( P< 0.05) but insignificant following the third cycle. Similarly, compared with GTV_RP0, the volume changes of GTV_RPn (n = 1, 2, 3) after IC were -1.4±0.4 cm3, -2.5±0.5 cm3 and -2.4±0.5 cm3, respectively, corresponding to relative reductions of 26.0%, 44.1%, and 42.2%, respectively. Again, the volume significantly decreased following the first two IC cycles ( P< 0.05) but remained unchanged or even slightly increased after the third cycle. In contrast, compared with GTV_N0, the volume changes of GTV_Nn (n = 1, 2, 3) after IC were -7.3±1.7 cm3, -13.5±2.9 cm3 and -17.2±3.4 cm3, respectively, corresponding to relative reductions of 25.3%, 43.2%, and 54.7%, respectively. For GTV_N, significant volume reduction ( P< 0.05) was observed following each of the three IC cycles. All patients experienced grade 1 or 2 adverse events. Conclusions: A two-cycle IC is recommended for patients with large GTV_T and GTV_RP volumes before radiotherapy. However, for patients with a large GTV_N volume, a 3-cycle IC before radiotherapy is recommended.
Retrospective analysis of outcomes of cisplatin (CDDP) versus non cisplatin based treatment regimens for concurrent chemoradiotherapy (CCRT) in locally advanced squamous cell head and neck cancer (LA-SCCHN).
Authors: Ashraf Syed Muhammad Mushtaq , Raufi Ali Mehmood , Barnett William R , Williams James Benjamin , Skeel Roland T.
Published: May 2019

e17564

Background: Different dosing schedules of CDDP are being used as standard of care for CCRT in LA-SCCHN, but there are no adequately powered trials to directly compare other non-CDDP regimens with CDDP to identify the optimal CCRT regimen. Methods: After obtaining IRB approval, we reviewed medical records from hospital tumor registry for consecutive patients with LA-SCCHN to retrieve data regarding demographics, diagnosis and treatment with definitive CCRT between December 2012 and December 2016. All patients had followed up for at least 24 months after completion of treatment. Results: 155 patients were included in the analysis. They fell into 2 groups: 89 (57.4%) had been administered CDDP and 66 (42.6%) received non-CDDP based regimen. In the latter group, 30 (45.5%) received cetuximab, 30 (45.5%) received carboplatin with paclitaxel, 1 (1.5%) received carboplatin with 5-fluorouracil and 5 (7.6%) received carboplatin alone. The majority of patients in both groups had oropharyngeal involvement, approximately 65%. All patients completed treatment with intensity-modulated radiation therapy. Median age was 57 years in CDDP group and 67 years in non-CDDP group. Patients in both groups were predominantly male, Caucasian, with positive smoking history. 67% patients in CDDP & 59% in non-CDDP group were HPV positive. The 2-year overall survival (OS) from initiation of treatment was 73.9% in CDDP and 62.1% in non-CDDP group (hazard ratio = 1.63, 95% CI 0.92 – 2.87, p = 0.092). Comparing non-CDDP regimens with CDDP, cetuximab appeared to confer better 2 year OS in HPV positive patients (HR 0.63, 95% CI 0.40 – 0.98, p = 0.040). Median time-to-treatment failure was 33 months in CDDP group and 24 months in non CDDP group. Conclusions: In this retrospective comparison, there was no significant difference in the 2 year overall survival in patients with locally advanced squamous cell head and neck cancers being treated with cisplatin based concurrent chemoradiotherapy regimen versus a non-cisplatin based regimen.
Does weekly versus daily low-dose of concurrent cisplatin have any effect on compliance and clinical outcomes in cases of locally advanced head and neck cancers?
Authors: Garg Ayush , Kumar Piyush , Chauhan Arvind Kumar , Kumar Pavan
Published: May 2019

e17569

Background: Concurrent Cisplatin with radiotherapy improves outcomes in locally advanced squamous cell carcinomas of the head neck.Cisplatin at 35mg/m2(weekly) raise compliance & hospitalization. There are only few reports on efficacy and toxicity of low dose Cisplatin (6mg/m2). Hence the purpose of this study was to evaluate the compliance and clinical outcomes between two concurrent cisplatin chemotherapy regimens & to see long term effects. Methods: Total 50 patients were included in study from Nov 2015 to Mar 2017 with 25 in each group. Radiotherapy given 70Gy/35# in 7weeks & Cisplatin at 35mg/m2 weekly (Group I) and 6mg/m2 daily (Group II). Assessment of toxicity was done by RTOG scoring criteria. WHO Response criterion was used to assess clinical response. Median follow up was 6 months. Results: Group I(80%) and Group II(84%)patients completed Radiotherapy. In Group I 48% patients received less than 6 cycles and Group II 40% received ≤25 cycles chemotherapy. Median OTT in Group I & II in was 51 & 52days. Neutropenia & Mucositis statistically insignificant between both groups.There was no statistical difference in complete response between the two groups. In Group I 40% patients developed Progressive disease on follow up as compared to 12% in Group II(p-0.02). After 1.5 years of follow up, Group I vs Group II 4 patients had complete response, 6 had recurrence & 11 vs 4 patients expired (p-0.03). At a median follow up of 6 months overall survival in Group I and II was 56% and 44%(p-0.39). While as median disease free survival in Group I & II was 6.6 & 11.9 months(p-0.14). Conclusions: Low dose daily Cisplatin offers ease of administration in the outpatient clinic, better tolerability and better quality of life.Group II patients were more compliant in terms of patients receiving chemotherapy or completing radiotherapy. At median follow up of 6 months there was no statistical difference in terms of overall and disease-free survival. The statistical difference was seen in terms of patients expired in Group I (44%) as compared to Group II (16%). Therefore, we need a larger number of patients for the use of low dose Cisplatin to be evaluated in future clinical trials.
Precision oncology for the treatment of salivary gland tumors.
Authors: Rieke Damian Tobias , Lamping Mario , Leyvraz Serge , Kim Theo Daniel , Brinkmann Lutz , Tessmer Antje , Fischer Lars , Busse Antonia , Horak Peter , Mock Andreas , Tinhofer Inge , Messerschmidt Clemens , Blanc Eric , Beule Dieter , Klauschen Frederick , Klinghammer Konrad Friedrich , Froehling Stefan , Ochsenreither Sebastian , Keilholz Ulrich
Published: May 2019

e17577

Background: Salivary gland tumors (SGT) represent a rare and heterogeneous group of malignancies. No standard treatment exists in the advanced situation and the prognosis is poor. We here report characteristics and clinical outcomes of patients with SGT discussed at the Charité molecular tumor board (MTB). Methods: Patients with advanced cancer and no curative treatment option were discussed at the Charité MTB. Eligible patients underwent fresh tissue sampling and subsequent whole exome (WES) and RNA sequencing (RNA-seq) and immunohistochemical analyses (EGFR, HER2, AR as well as validation tests) or panel sequencing. Results from molecular testing were discussed at the MTB and patients were followed-up after recommendations were made. Results: 24 patients (median age 56 years, 13 male, 11 female) with advanced SGT were presented at the MTB between 2016 and 2019 (9 adenoidcystic carcinomas, 5 adenocarcinomas, 3 mucoepidermoid, 2 carcinosarcoma, 5 miscellaneous). WES/RNA sequencing was performed on tumor tissue from 16 patients. 2 patients were not included in the sequencing program and WES/RNA-Seq was ongoing for another 4 patients at the time of analysis. For another 2 patients, panel sequencing and IHC analysis, respectively was done. Results from analyses were discussed and a median of 2 recommendations, ranked by priority according to prespecified evidence levels, were made for 17 patients, each. Most commonly proposed treatment options by the MTB were FGFR inhibitors in 6 patients, mTOR or PARP inhibitors in 5 each, EGFR, HDAC inhibitors or antiandrogen therapy in 4, each. Treatments following MTB recommendations were initiated in 8 patients, 1 of which received a second recommended therapy after progression (antiandrogen therapy in 4, EGFR inhibitor in 2, a PDGFR, mTOR and PARP inhibitor in 1, each). A clinical benefit (CR = 1; Mixed Response = 1, SD = 3) was achieved in 5 patients, including a complete response in a patient with a metastatic adenocarcinoma of the parotid gland, treated with antiandrogen therapy. Conclusions: Precision oncology represents a feasible treatment strategy in patients with advanced SGT and shows early evidence of activity in a subset of patients. These results suggest further exploration of personalized therapy in these hard-to-treat tumors.
Factors associated with recurrence and death in patients with aggressive hobnail morphology papillary thyroid carcinoma.
Authors: Sharrett Jonathan Matthew , Li Hong , Shah Akeesha , Nasr Christian , Scharpf Joseph , Koyfman Shlomo A. , Joshi Nikhil , Geiger Jessica Lyn
Published: May 2019

e17590

Background: Papillary thyroid carcinoma (PTC) with hobnail morphology (HM) is an aggressive variant associated with poorer outcomes compared to classical PTC, with a little over 100 cases reported in the literature. We aim to identify prognostic factors potentially associated with recurrence and death in the largest single institutional experience of PTC with HM. Methods: From an IRB approved registry, we identified all PTC HM cases with patient, diagnostic and treatment data and outcomes. Hobnail variant (HV) PTC had ≥30% HM; pure hobnail features (PHF) had < 30% HM without tall cell morphology (TCM) & multi variant features (MVF) had both HM & TCM. Demographic and clinical features at time of HM diagnosis that were potentially associated with 3-yr event free (death or recurrence) survival (EFS) were evaluated using Kaplan-Meir method (KM). Results: Forty-five (median age 55 yo, range 19-86 yo; 66.7% female) HM pts (35 HM at initial PTC, 10 at recurrence) were evaluable. Majority were ECOG 0 (84.1%). HM: 44.4% MVF, 37.8% PHF, & 17.8% HV; 68.9% pT3/T4; 64.4% node positive; & 15.6% metastatic. Positive surgical margins (+SM) with HM in 31.8%. RAI at HM given to 73%. Overall EFS was 83.5% at 1-yr & 69.6% at 2-yr. Of 13 events at 3 yrs, 4 were deaths (3 from PTC) & 9 recurrences. All events were in those > 55 yo (p < 0.001) with pT3/T4 disease (p = 0.01). Non-0 ECOG (KM 2-yr EFS: 28.6% vs 77.7%, p = 0.002), cT3/T4 (49.5% vs 85.5%p = 0.004), and +SM (32.1% vs 92.1%, p = 0.001) were also associated with EFS compared to their counterpart. HM grouping, RAI, initial HM vs HM at recurrence, sex, and tumor size were not statistically significant. Conclusions: To our knowledge, this is the largest reported cohort of PTC with HM. We identified several factors potentially associated with recurrence and death. There was no difference in outcomes between HV versus PHF versus MVF, which raises question to validity of 30% cutoff in defining “variant” versus “features of variant”. Age > 55 yo, T3/T4 disease, and +SM exhibited significantly inferior EFS. Further evaluation in a multi-institutional cohort will help in validating these findings and help identify patients who warrant more aggressive initial treatment.
A survey of cancer patients’ rehabilitation therapy needs in Southwest China.
Authors: Jin Zhou , Li Fang , Xiaodong Peng , Jingjing Peng , Shasha Jiang , Lang He , Xiaoshan Wang , Jiang Zhu , Bin Ye , Chi Du , Zhujuan Xiong , Qian Gao
Published: May 2019

e18003

Background: Medical advance in the recent decades has turned cancer into a chronic disease. At the same time, quality of life (LoF) during the treatment period has emerged as a new concern of cancer patients. Rehabilitation therapy, which can help patients conquer fear and be more engaged in the process, has gradually attracted more attentions in China. We designed a survey, for both the cancer patients and their families, to understand their view of the rehabilitation therapy. Methods: We sent paper-based surveys to volunteers consisted of cancer patients and their families. Majority of patients are from 10 cancer centers at the southwest region of China. The main cancer types are lung cancer, breast cancer and colon cancer. The survey questions focus on: patients and their families’ engagement of the treatment, their view on rehabilitation therapy, and their method preference for the rehabilitation therapy. Results: We sent 2,000 copies of the survey and received 1,920 valid inputs. Below are the key findings. 1. Their biggest concern: the outcome of the treatment 55.8%, side effects 19.7%, financial burden 12.8% and mental stress 11.5%. 2. The importance of the rehabilitation therapy as compared to traditional medical treatment, such as surgery and chemotherapy: equally important 67.8%, less important 17.7%, more important 10.1%, no preference 4.4%. 3. The necessity of rehabilitation therapy: very necessary 65.7%, somewhat necessary 22.7%, not necessary 11.6%. 4. The first three reasons for participating rehabilitation therapy: it helped go through the treatment 42.8%, it improved quality of life 31.6% and it helped release their mental stress 22.3%. 5. The best form to conduct rehabilitation therapy: face-to-face communicate with the doctors 60.6%, telecommunication 15.8% and combination of both 22.1%. Conclusions: The results of the survey strongly indicate the demands for rehabilitation therapy. Patients started to understand it – more than half of them think it is as important as the traditional medical treatment. Patients’ quality of life and mental health, which is part of the holistic treatment, are gradually recognized. Next, we plan to group our survey results by types of cancers, patients and their families’ genders and age, as well as the local economics, to better understand the data. We hope this study can serve as a data point to help build China’s rehabilitation therapy infrastructure.
Treatment delays in localized breast cancer: A NCDB analysis.
Authors: Bhandari Shruti , Ngo Phuong , Mudra Sarah , Murray Drew Carl Drennan , Lele Rachana Shirish , Srivastava Sudhir , Wu Xiaoyong , Rai Shesh , Mandadi Mounika , Riley Elizabeth Carloss
Published: May 2019

e18023

Background: Breast cancer remains the second leading cause of cancer death despite continued advances. Delayed treatment results in worse outcomes. Association with treatment location and trend over time are not well described. Methods: National Cancer Database identified 1042844 stage I-III breast cancer patients treated from 2004 - 2014. Multivariable analysis identified clinical and socioeconomic factors associated with delayed treatment and overall survival (OS). Results: Patients had a median age of 61y and a median time to treatment of 25 days. Time to treatment was ≤30d in 50.9%, 31 - 60d in 35.9%, 61 - 90d in 8.7% and > 90d in 4.5% of patients. Percentage of patients with delayed treatment increased from 2004 to 2014 (For 61 - 90d: 6% to 10.6% and > 90d: 3.3% to 5.1%). Multivariable analysis showed younger age, black race, no insurance/Medicaid, a higher comorbidity score, and later stage disease were significantly associated with treatment delay [Table]. OS was significantly worse with delayed treatment (HR: 1.11; 95% CI 1.08 - 1.13; p < 0.001). Treatment at an academic facility was associated with treatment delays, however OS was better compared to community facility (HR: 0.81; 95% CI 0.79 - 0.82; p < 0.001). Conclusions: Treatment delays of > 90 days were rare but associated with worse OS. Despite the small percentages overall, this study shows an increase in treatment delays over the last 10 years. Academic centers were associated with treatment delays, but the OS was improved compared to other locations. Historic risk factors to timely treatment were again identified, despite increased efforts to reduce disparities. Further analysis of practice patterns is needed to better understand the direct clinical impact of these findings, especially in vulnerable populations. [Table: see text]
A new model of care for patients with central nervous system cancers.
Authors: Nevel Kathryn Sara , Konig Franchesca , Skakodub Anna , Davis Mary Elizabeth , Sibilla Maryann , Harrison Mabel , Rawlins-Peters Gayle , Jean-Charles Dominique , Zankowsky Anastasia , Gilman Jody , Kelly Brian , Zavolas Stephanie , Reiner Anne S. , Panageas Katherine , Diamond Eli L. , Carver Alan , DeAngelis Lisa Marie , Barnett Kara , Ruppert Lisa Marie , Pentsova Elena
Published: May 2019

e18029

Background: Patients (pts) with primary or metastatic central nervous system (CNS) cancers often have multiple physical, psychosocial, and spiritual needs. Neurological impairments can transform relationship dynamics as loved ones become caregivers. These issues are difficult to address within a single outpatient oncology clinic. Methods: The Neurological Multidisciplinary Care Clinic (MdCC) at Memorial Sloan Kettering Cancer Center was a pilot study from 08/2017 to 01/2019 to foster a new model of care for complex pts with CNS cancers to identify and address their needs. The MdCC team, comprised of a neurologist, nurse, physiatrist, physical therapist, social worker(SW), case manager(CM), dietitian(RD), and chaplain. During a 3-hour visit, MdCC providers saw each pt/caregiver. Since 11/2017 participants completed validated surveys on unmet needs, financial strain, and home equipment prior to their visit and satisfaction surveys afterward. Descriptive statistics were used to analyze results. Results: Seventy-six pts were seen: 37 were female, median age 60. Of these 76 pts, 63 had primary CNS cancers; glioblastoma (51%) and high-grade glioma (HGG) (29%). Fifty-five were receiving cancer-directed therapy at the time of MdCC. Over 70% had never seen a SW, CM, RD, or physiatrist prior to MdCC. Pts’ most commonly reported need was “not being able to do the things I used to do”; for caregivers it was “I need my partner to have an ongoing CM.” Seventy-four pts (97%) received symptom management recommendations. Prognosis/coping with cancer was discussed with 70 (92%) which increased signed health care proxy forms by 11% and DNR orders by 3%. New/updated physical therapy was ordered for 48 pts (61%), orthotics for 8 (10%), and new equipment for 12 (15%). Five pts were referred to a food assistance program. Forty-five pts completed a satisfaction survey; of these, 96% were highly satisfied, and would recommend MdCC to others. Conclusions: Pts’/caregivers’ unmet needs were effectively identified and addressed in this new model, and an emphasis on supportive and coordinated care contributed to high pt/caregiver satisfaction. We therefore propose to offer this clinic for all pts with HGG to improve pts’ well-being, quality of care, and increase pt/caregiver satisfaction.
AI platform in mammography to screening breast cancer: A sole-center experience.
Authors: Li Jie , Zhang Zhicheng , Chang Jia , Lin Bo , Lv Weiming
Published: May 2019

e18052

{\rtf1\ansi\ansicpg936\cocoartf1347\cocoasubrtf570 {\fonttbl\f0\froman\fcharset0 Times-Roman;\f1\fnil\fcharset0 Calibri;\f2\fswiss\fcharset0 Helvetica; \f3\fnil\fcharset134 STHeitiSC-Light;\f4\froman\fcharset0 TimesNewRomanPSMT;} {\colortbl;\red255\green255\blue255;\red0\green0\blue0;} \paperw11900\paperh16840\margl1440\margr1440\vieww25400\viewh13600\viewkind0 \deftab720 \pard\pardeftab720 \f0\fs24 \cf2 \expnd0\expndtw0\kerning0 \outl0\strokewidth0 \strokec2 AI platform in mammagraphy to screening breast cancer: a sole center experence. \f1\fs21 \cf0 \kerning1\expnd0\expndtw0 \outl0\strokewidth0 \ \pard\pardeftab720\ri714\qj \cf0 Background: The aim of this study was to use deep convolutional neural network (DCNN) to relieve radiologists ' burden and to minimize misses and interpretation errors of suspicious lesions at digital mammography. Methods: We developed and trained the DCNN model on the training set, then validated it in an internal validation set. The labeled data were used for training the DCNN model, and the mass detection, calcification detection and benign and malignant diagnosis were interpreted respectively. After verifying the feasibility of the DCNN model in the diagnosis of breast cancer, we gradually increased the number of cases in the training set and established the verification set to test the training results. The latest training sets include 21100 atlas of our hospital between April 2010 and October 2017, among which the malignant case atlas is 1774. Each atlas contains 2 ipsilateral mammography images. The verification set includes 1307 atlas, among which the malignant case atlas is 248. Results: The DCNN model achieved high performance in identifying breast cancer patients in the validation sets tested, with sensitivity of 98.02%, specificity of 91.86% \f3 \'a3\'ac \f2 and area under the curve values of 0.9813. As for mass detection, we reached a recall rate of 89.6% on the premise of lowing the false positive to 0.168%. For the latest clinical data between October 2018 and November 2018 including 1043 atlas from 576 patients, the sensitivity was 78.6% (95%CI 62.8-89.1) versus 90.5% (95%CI 76.5 \f4 - \f2 96.9; p=0.021) and specificity was 93.4% (95%CI 91.6 \f4 - \f2 94.8) versus 82.7% (95%CI 80.2 \f4 - \f2 85 \f4 . \f2 0; p<0.0001). Conclusions: The DCNN model showed improved specificity in diagnosis breast cancer compared with a group of skilled radiologists. As the number of cases in the training set increases, the capacity of DCNN model will be further improved.
Real-world data (RWD) and patients reported outcomes (PRO) in breast cancer (BC): Physical, emotional side effects (S/E), financial toxicity (FT), and complementary usage (CM) relations.
Authors: Vorobiof Daniel A. , Malki Eliran , Deutsch Irad , Hasid Lior
Published: May 2019

e18060

Background: RWD denotes data accumulated via electronic health records as well as cutting edge technology paired with consumer mobile devices. Artificial intelligence (AI) incorporates the use of algorithms and machine learning (ML) software to analyze complex medical data, improving the knowledge of cancer journeys. PRO on 256 BC patients (pts) survey repliers, users of Belong.life, a worldwide social media application for cancer pts, are presented. Methods: From 11/2018 to 01/2019, 256 pts replied to a 37 questions’ survey which included information regarding clinical and emotional S/E, FT and CM use. Results: 98 pts (38%) were < 50 years of age, 158 (62%) > 50 years. Most of the pts (163, 64%) were diagnosed within 2017-8. Most pts had Stage 1 (83 pts,32%) and 2 (94 pts,37%) and 71 pts (28%) had Stage 3-4. 154 (61%) had neo-adjuvant anthracyclines-based treatments, followed by a taxane (docetaxel/paclitaxel). 149 of 256 pts (58%) reported clinical S/E: nausea and vomiting in 77 pts (52%), fatigue in 63 pts (42%), hair loss in 42 pts (28%) and body pain and neuropathy in 13 pts each (8.8%). 90 pts (35%) described various emotional symptoms: depression in 32 pts (35.6%), anxiety 13 (14.4%), ‘up and down’ feelings in 20 pts (22 %). FT was experienced by 100/208 pts (48%). FT was most prevalent in ages 35-50 (51/85pts, 60%) than in 51-65 (41/100pts, 41%). Main reported causes in both groups were loss or absence from work (33% and 51%) and treatment copayments (40% and 21%). CM use was reported by 42/256 pts (16.4%). Most common CM were nutritional, multivitamins, supplements and CBD oil use. ML documented a strong relationship between BC recurrence in 55/256 pts (21.5%), FT in 25/55 pts (45.5%) and CM use in 9/25 pts (36%) vs no FT in 3/30 pts (10%). Conclusions: 256 BC users of the Belong application reported on clinical and emotional S/E, FT and CM use. The high incidence of emotional S/E stresses the need for individualized attention. FT was most prevalent in the younger age group (35-50yrs) due to work loss and treatment copayments. A significant relationship was determined by ML techniques on those patients experiencing BC recurrence, FT and CM use.