bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends of survival based on race and ethnicity in gastrointestinal tract neuroendocrine tumor.
Authors: Goksu Suleyman Yasin , Beg Muhammad Shaalan , Sanford Nina Niu , Fangman Benjamin David , Herrman Sarah , Bacik Goksu Busra , Verma Udit , Sanjeevaiah Aravind , Jones Amy Little , Kainthla Radhika , Kazmi Syed Mohammad Ali 
Published: February 2020

607 Background: There is paucity of data about racial/ethnic disparities in gastrointestinal tract neuroendocrine tumors (GiNET). We aimed to study the race/ethnic differences in disease characteristics and survival in GiNET. Methods: We analyzed the SEER database to identify cases with non-pancreatic GiNET between 2004 and 2015. We evaluated trends in incidence and outcomes between Hispanic, non-Hispanic/non-Black (NH/NB) and non-Hispanic Black (NHB). Kaplan-Meier method and cox regression model were performed for overall survival (OS) after adjusting for stage, grade, gender, race/ethnicity, and surgery. Results: 25,826 cases were included, 12.7% were Hispanic, 18.5% NHB and 68.8% NH/NB; males comprised 46.8%, 50.5%, 41.9%, respectively (p < 0.001). The overall incidence of GiNET increased two-folds in the ten years. The highest increase in incidence was observed in appendiceal NET followed by small intestine NET, and this increase was observed mostly among Hispanic population. NH/NB cases were older ( > 65 years) (31.3% vs. 23.3% vs. 23.5%; p < 0.001) and presented with metastatic disease (17.8% vs. 12.7%, 12.0%; p < 0.001). On multivariate analysis Hispanic population had significantly better OS than NH/NB and NHB (HR: 1.25 95% CI: 1.14-1.37 and HR: 1.15 95% CI: 1.033-1.28, respectively). For stage-4 low- and intermediate-grade GiNET, OS was better if surgery was performed (p < 0.001), and this trend was most pronounced among Hispanic as compared to NH/NB (HR 1.35, 95% CI 1.07-7.71). Conclusions: The incidence of GiNET had increased two-fold in the last ten years with the highest increase in Hispanic. However, Hispanic had significantly better overall survival than NH/NB and NHB population.[Table: see text]
A real-world observational study of somatostatin analogue use and costs in Canada.
Authors: Cheung Winson Y. , Feuilly Marion , Laforty Callahan , Liovas Anna , McKechnie Heather , Loree Jonathan M. 
Published: February 2020

608 Background: Somatostatin analogue (SSA) use is indicated in acromegaly and neuroendocrine tumours for symptomatic relief and tumour control. Two long-acting SSAs (lanreotide and octreotide) are currently available, but comparative real-world data on their use are limited. This study evaluated SSA use and costs in Canada. Methods: Claims data from the IQVIA Private Drug Plan (PDP), Ontario Drug Benefit (ODB) program and Régie de l’assurance-maladie du Québec (RAMQ) were compiled. Injection burden, rescue medication use and costs were compared (using unpaired t-test or Wilcoxon test) over a 12-month period from first SSA prescription. Patients (pts) were eligible if the first prescription was dispensed Sept. 2015–Jun. 2018. Results: 908 pts were included: lanreotide 120 mg, N=375; octreotide long-acting release (LAR) 30 mg, N=533. Lanreotide treatment was associated with a lower weighted average injection burden for 12 months when compared to octreotide (12.54 vs 13.44 injections/pt, respectively; p<0.0001). Pts receiving lanreotide also had lower mean use of rescue medications than those treated with octreotide (0.01 vs 0.05 claims/pt/year), although this difference was greatest during the first month of treatment (mean difference: 0.19; p<0.0001), after which differences in rescue medication use were only significant (p<0.05) at Months 5 and 6. Mean total annual costs (rescue medication + LAR) were lower for lanreotide than octreotide ($27,829.35/pt [N=373] vs $31,255.49/pt [N=530], respectively, p<0.0001). Conclusions: In the absence of clinical trials directly comparing the SSAs, factors driving treatment selection are unclear. Findings from our real-world observational study suggest treatment with lanreotide to be less burdensome and costly than octreotide and may inform treatment discussions with pts. References1. Ipsen Biopharmaceuticals. Somatuline Autogel Product Monograph. 2018. Available at: https://cnetscanada.org/wp-content/uploads/2018/06/Somatuline-Product-Monograph.pdf; 2. Novartis Pharmaceuticals Canada Inc. Sandostatin LAR Product Monograph. 2018. Available at: http://www.ask.novartispharma.ca/download.htm?res=sandostatin_scrip_e.pdf&resTitleId=789.
Implications of neuroendocrine tumor and diabetes mellitus on patient outcomes and care: A matched case control study.
Authors: Karlin Nina J. , Kosiorek Heidi E. , Buras Matthew , Rone Kelley , Verona Patricia M. , Coppola Kyle , Cook Curtiss B. 
Published: February 2020

612 Background: The aim of this study was to examine the impact of diabetes mellitus (DM) on survival in neuroendocrine tumor and the impact of neuroendocrine tumor on glycemic control in DM. Methods: Patients with newly diagnosed neuroendocrine tumor with and without DM were matched 1:1 according to age, gender, and year of cancer diagnosis (2005-2017). The file was linked to the electronic medical record to obtain information on DM and neuroendocrine tumor therapies and laboratory results. There were 59 matched pairs (total 118 patients) included in the analysis. We compared characteristics between cases and controls and assessed survival with the Kaplan-Meier method and Cox proportional hazards model. Mixed models compared hemoglobin A1c and glucose levels over time. Results: Median age of patients at diagnosis was 67 (40-86); 41% had stage IV disease. Women constituted 49% of the study population; 22% had pancreatic neuroendocrine tumor and 45% had another GI primary neuroendocrine tumor. No differences in race/ethnicity, marital status, alcohol or tobacco use were detected between cancer patients with and without DM. Mean BMI was significantly different between DM and non-DM patients (31.0 [7.90] versus 26.4 [5.27]); p = 0.011. Among those with DM, mean HbA1c during the year following cancer diagnosis was 7.3%. Mean glucose was significantly different between DM (159.1 [43.5] versus non-DM pts 117 [31.5]); p < 0.001. Median follow-up time was 32.8 (2.4-165.4) months in alive patients. Three year survival was estimated at 72% (95% CI: 60-86%) for DM patients versus 80% (95% CI: 70-92%) in non-DM patients by Kaplan Meier method (p = 0.82 log rank test). Hazard ratio (stratification for matched pairs) = 1.33 (95% CI: 0.56 – 3.16; p = 0.51). Conclusions: DM did not adversely impact survival in patients with neuroendocrine tumor. Neuroendocrine tumor and its treatment did not affect glycemic control. This should be reassuring to oncologists and endocrinologists who treat patients with neuroendocrine tumors and diabetes.
Outcomes after high-dose radiation in management of neuroendocrine neoplasms.
Authors: Chen Katherine , Whitman Julia , Paciorek Alan , Nakakura Eric K. , Fidelman Nicholas , Feng Mary Uan-Sian , Bergsland Emily K. , Anwar Mekhail 
Published: February 2020

616 Background: In this study, we analyze outcomes after the use of high-dose radiation therapy (RT) in management of neuroendocrine neoplasms (NENs) at a high-volume center. Methods: We performed a retrospective review of patients who received high-dose RT (defined as biologically effective dose (BED) >40, α/β = 10) for their NEN. Patients with small cell lung cancer and Merkel cell carcinoma were excluded, given their unique treatment paradigms. Results: 61 patients completed a radiation course with BED >40 for their NEN (median BED 70, range 44-180). Most tumors were gastroenteropancreatic in origin (n = 20); additional primary sites included lung (n = 11), head and neck (n = 10), cervix (n = 6), other (n = 9) and unknown (n = 5). 56% (n = 34) had well-differentiated (WD) neuroendocrine tumors, and 44% (n = 27) had poorly-differentiated (PD) neuroendocrine carcinomas. Disease stage at the time of RT was localized/locally advanced (LLA, n = 27), or metastatic/recurrent (MR, n = 34). The intent of RT was definitive (n = 18), post-operative (n = 10), for oligoprogression (n = 18), or purely palliative (n = 15). 48 patients had follow-up imaging at a median follow-up of 20 months after radiation. Outcomes were grouped by differentiation and stage, with median time to progression (mTTP) in months (Table). 8% of patients had local progression, while 44% developed new metastases, including 38% of WD-LLA, 47% of PD-LLA, 37% of WD-MR, and 67% of PD-MR disease with progressively shorter median time to progression (26, 10, 8, and 3 months, respectively). Conclusions: These data suggest that focal, high-dose radiation has a role in the management of NENs. Local failure is rare in patients with both WD-LLA and PD-LLA disease. The predominant pattern of failure is development of new metastases, which appear to occur sooner and more frequently in patients with PD and MR disease. [Table: see text]
Efficacy of somatostatin analog (SSA) monotherapy for well-differentiated grade 3 (G3) gastroenteropancreatic neuroendocrine tumors (NETs).
Authors: McGarrah Patrick Walsh , Hobday Timothy J. , Starr Jason Scott , Kendi Ayse T. , Graham Rondell P. , Sonbol Mohamad Bassam , Halfdanarson Thorvardur Ragnar 
Published: February 2020

617 Background: Currently, there is no published data on the efficacy of SSAs for well-differentiated G3 NETs. Randomized trials have demonstrated a progression-free survival (PFS) benefit and limited tumor response for lower grade 1-2 NETs, but the optimal systemic therapy for metastatic/unresectable G3 NETs is unknown. We sought to evaluate the efficacy of SSAs in G3 NETs. Methods: We performed a retrospective analysis of Mayo Clinic patients treated with SSAs for metastatic/unresectable G3 NETs, querying data from 1992 - present. Inclusion criteria were: centrally reviewed pathology confirming well-differentiated morphology, G3 based on WHO classification, SSA monotherapy, and radiological data available to assess response. Patients who had prior lines of treatment were included as long they subsequently were treated with single-agent SSA. Poorly-differentiated tumors were excluded. The primary endpoint was PFS. Best overall response was determined by radiographic regression, stabilization, or progression of tumor size. Results: Ninety patient records were reviewed, with 14 meeting inclusion criteria (diagnosed 2014 – 2018). Median Ki-67 proliferative index was 25%. Two patients (14%) had a partial response to SSA therapy, five (36%) had stable disease, and seven (50%) had progressive disease. The estimated median PFS was 4.4 months (95% CI 2.9 – 24). Of the 7 patients with stable disease or partial response, the median time to progression was 8.7 months. Three patients had stable disease for greater than 9 months (24, 29 and 42 months, respectively). Overall survival was not estimable. There was no association of Ki-67 index with PFS based on a proportional hazards model. Conclusions: This is the first report on the efficacy of SSAs for G3 NETs. Although half of the patients in our series had at least stable disease, the PFS was modest at only 4.4 months. Given their favorable side-effect profile compared to cytotoxic chemotherapy, SSAs may present an attractive option to be further explored in a prospective fashion. We are presently updating this data by reassessing response using RECIST criteria.
A phase II trial of atezolizumab and bevacizumab in patients with advanced, progressive neuroendocrine tumors (NETs).
Authors: Halperin Daniel M. , Liu Suyu , Dasari Arvind , Fogelman David R. , Bhosale Priya , Mahvash Armeen , Dervin Shannon , Estrella Jeannelyn , Cortazar Patricia , Maru Dipen M. , Mckenna Edward Francis , Wistuba Ignacio Ivan , Schulze Katja , Futreal Phillip Andrew , Darbonne Walter C. , Yun Cindy , Hwu Patrick , Yao James C. 
Published: February 2020

619 Background: Neuroendocrine tumors (NETs) are relatively rare and heterogeneous tumors arising throughout the aerodigestive tract, which are incurable and life-limiting when metastatic. Prior studies of checkpoint inhibitors in NET patients have yielded minimal evidence of efficacy. Historically, effective therapies for advanced, progressive NET yield response rates less than 10% and progression-free survival (PFS) durations of approximately 11 months, as compared to approximately 4.5 months with placebo. Methods: We undertook a phase II basket study of atezolizumab in combination with bevacizumab in patients with rare cancers, and present here the data from the pancreatic NET (pNET) cohort and extrapancreatic NET (epNET) cohort, each of which included 20 patients with grade 1-2 NET that was progressive under any prior therapy. Patients received 1200mg of atezolizumab and 15mg/kg of bevacizumab IV q 21 days. The primary endpoint was confirmed objective response by RECIST 1.1. Results: The confirmed objective response rate with this combination was 20% (95% CI 6-44%) in the pNET cohort and 15% (95% CI 3-38%) in the epNET cohort. The median PFS in the pNET cohort is 19.6 months (95% CI 10.6-NR), while it was 14.9 months (95% CI 6.1-NR) in the epNET cohort, 1-year PFS was 75% and 52%, respectively. The combination was well-tolerated in this patient population, with the most common related treatment-emergent adverse events being hypertension (47.5%), proteinuria (37.5%), and fatigue (35%). The most common related grade 3/4 adverse events were hypertension (20%) and proteinuria (7.5%). Conclusions: The combination of atezolizumab and bevacizumab demonstrated moderate clinical activity in patients with advanced NETs. As pre-treatment and on-treatment biopsies were obtained for all patients, correlations with immune infiltration, mutations, and transcriptome alterations should provide additional insight into the mechanisms of response and resistance. Clinical trial information: NCT03074513.
Impact of race on incidence and survival from colorectal cancer in young adults in the United States.
Authors: Mukhija Dhruvika , Nagpal Sajan 
Published: February 2020

62 Background: Multiple studies have reported an increasing incidence of colorectal cancer (CRC) in young( < 45 years)adults.However, the impact of race on the incidence, tumor location and survival in adults < 45 years with CRC has not been explored. Methods: Using Surveillance,Epidemiology and End Results database,we identified patients with CRC and abstracted data on patient demographics,tumor location and survival between 1973-2014, and compared these variables in patients 18-44 years with those > 45 years. Cases where CRC was not the first/only malignancy were excluded.Categorical variables were compared using the Chi-square test and overall survival was analyzed using Kaplan-Meier method. Results: Overall, 453,019 patients were included (27, 352 < 45,and 425,667 >45 years). 81.7% among those > 45 years were caucasian, as compared to 74.3% < 45 years of age. Among those < 45, 14.3% were black, 10.3% were Asian/Pacific Islander (API) and 1.1% were American Indian/Alaska Native (compared to 10.1%, 7.5% and 0.6% respective in adults > 45) (p < 0.0001*) (Table). 73.1% of those < 45 had left sided disease (descending, sigmoid colon and rectum) as compared to 60.1% in those > 45 (p < 0.0001*).Survival was poorer for non-white patients (black, API and AI) (94 months, 95%CI 90-100) as compared to white patients (153 months, 95%CI 145-161) overall, and individually for the < 45 and >45 years subgroups as well. Conclusions: Racial distribution in patients with CRC differs significantly among patients < 45 as compared to older adults,with incidence in young American Indian/Alaska Natives approaching 2 times that of older adults,and 1.5 times in young Blacks and Asian/Pacific Islanders.Non-white races have poorer survival across all age groups.With rates of CRC rising sharply in young adults, underlying reasons for these differences require further investigation to better channelize efforts for education and screening. [Table: see text]
Weight loss as an untapped early detection marker in pancreatic cancer.
Authors: Hue Jonathan J. , Markt Sarah C. , Kyasaram Ravi Kumar , Shanahan John , Rao Goutham , Winter Jordan Michael 
Published: February 2020

643 Background: Pancreatic cancer has the worst survival of common cancers and there are no reliable early detection tests. While prior reports link unintentional weight loss (>5% decrease from baseline) to pancreatic cancer, there has never been a study documenting the frequency of this presenting sign using raw patient weight data. Methods: Patients at our institution with a pancreatic neoplasm (n=288) were queried using ICD-9 code 157.9 and ICD-10 code C25.9. Retrospective review identified 95 patients with pancreatic ductal adenocarcinoma and two or more prediagnosis weights (>7 days apart). Date of diagnosis was defined by the date of positive biopsy or encounter with surgical or medical oncology. Standard statistical analysis was performed. Results: Among the 95 patients, there was a slight preponderance of female (65.3%) and Caucasian (54.7%) patients. The median age at diagnosis was 71 (range: 41-90) and the median BMI was 25.6 kg/m2 (range: 15.4-49.5). 9.5% presented with clinical stage I disease, 27.3% with stage II, 9.5% with stage III, and 53.7% with stage IV. Within 1 year of diagnosis (range: 9-365 days), median weight loss was 7.1% of body weight (range: 0.2-34.5%). In this period, 71.6% of patients lost greater than 5% body weight and 32.6% lost over 10% (Table). In the 6 months before diagnosis (range: 9-180 days), median weight loss was 6.4% (range: 0.2-24.2%). A subgroup analysis of early (I, II) and late stage (III, IV) patients showed that those with late stage at presentation lost significantly more prediagnosis weight compared to the early stage patients (median 8.2% vs 5.6%, p=0.02) in a median of 175 days. Prior to diagnosis of late stage patients, 80.0% lost over 5% body weight and 38.3% lost over 10%. Conclusions: Diagnosis of pancreatic cancer is preceded by weight loss in the majority of cases, even at an early stage. Monitoring unintentional weight loss in otherwise asymptomatic patients may be an inexpensive and practical way to detect pancreatic cancer. [Table: see text]
Improved surgical margins with neoadjuvant versus adjuvant chemotherapy in clinical stage I resectable pancreatic adenocarcinoma: A National Cancer Database study.
Authors: Bellini Geoffrey , Datta Samit Kumar , Sich Nicholas , Singh Maharaj , Weese James Leighton , Sanchez Federico Augusto , Guda Nalini , Papenfuss Wesley Allan , Chevinsky Aaron 
Published: February 2020

651 Background: A strengthening consensus exists for neoadjuvant therapy (NAT) in borderline resectable pancreatic adenocarcinoma (PA), but the utilization of NAT in resectable stage I PA remains controversial. Many cancer centers are using NAT for these patients (pts), but others continue to offer upfront surgery and adjuvant therapy (AT). We hypothesized that NAT would improve margin negative resection in clinical stage I resectable PA. Methods: We utilized the IRB approved 2016 national cancer database for pancreas to establish a cohort of stage I PA pts. We divided this subset into pts who underwent NAT vs AT. We compared demographics. Primary endpoint was surgical margins. Results: 10,453pts from 2004 to 2016 had clinical stage I resectable PA: 8483pts (81.1%) AT and 1970pts (18.9%) total or partial NAT. There was a statistical difference in age (64.9 ± 9.9years NAT and 66.2 ± 9.9years AT, p<0.001), but no difference in Charlson comorbidity score (p=0.1693). NAT pts had significantly higher margin negative resection rates (84.5%) than AT pts (79.4%) (p<0.0001). Final pathologic staging was available for 10,237 pts: 8369 (81.8%) AT and 1868 (18.2%) NAT. Significantly fewer pts were upstaged on final pathology to stage II or greater (73.5%) in the NAT group than the AT group (84.1%) (p<0.001). Conclusions: NAT leads to significantly higher margin negative rates for resectable clinical stage I PA than surgery followed by AT. The majority of pts for both groups were upstaged suggesting that we continue to clinically understage the majority of pts. Overall, total or partial NAT for clinical stage I resectable PA provides a better chance for margin negative resection. Further study in the form of a randomized control trial is necessary. [Table: see text]
An institutional series of early-onset pancreatic cancer (EOPC): Clinical outcomes and genetic and supportive care referral patterns.
Authors: Kadakia Kunal C. , Trufan Sally Jeanne , Jagosky Megan , Worrilow William Mills , Harrison Bradley W. , Broyhill Katherine , Gower Nicole Lee , Coley Harris , Hwang Jimmy J. , Musselwhite Laura W. , Nazemzadeh Reza , Chai Seungjean , Salmon John Stuart , Kim Edward S. , Salem Mohamed E. 
Published: February 2020

652 Background: The incidence of EOPC is rising and is associated with substantial implications for affected individuals and their families. Little is known about the extent of physician referrals of these patients (pts) to genetic, supportive care, and hospice services. Methods: Pts with EOPC (≤50 years) were identified using the institutional tumor registry for years 2011-2018 and retrospectively reviewed. Clinical data and rates of referral to supportive, genetic and hospice services were retrieved. Descriptive analyses were performed with 25-75% interquartile ranges (IQR) where appropriate. Overall survival (OS) was assessed using Kaplan-Meier curves and Cox Proportional Hazards modeling. Results: In total, 113 pts with EOPC and a median age of 47 years (range, 28-50) were analyzed. Of these 113 pts, 43% were female, 27% were black, and 45% had metastatic disease at initial presentation. The most commonly administered first line chemotherapy was FOLFIRINOX, with gemcitabine/nab-paclitaxel reserved for the second line. The median OS of pts with metastatic disease was 5.8 compared to 15.8 months for those without metastases. Only 28% of pts were referred to genetic services, and 72% of these underwent genetic testing. Out of the genetically tested pts, pathogenic germline mutations were confirmed for 33%. Of the original 113 pts, 41% received concurrent palliative care, which was provided at a median of 2.4 mos. (IQR, 0.7-6.8) preceding death. The median time between last chemotherapy administered and death was 2 mos. (IQR, 1-4.4), with 23% receiving treatment within the last month of life. Only 55% used hospice services prior to death for a median duration of 0.5 mos. (IQR, 0.2-1.4). Conclusions: Our study suggests that there is a tendency for late utilization of supportive and hospice care in pts with EOPC, possibly due to the desire of both pts and physicians to be more aggressive given the young age. Larger studies are warranted to elucidate barriers to concurrent supportive care, and whether formation of specialized young patient supportive care clinics would aid this situation and to avoid the use of unnecessary chemotherapy near the end of life.