bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic factor Ki67 for breast cancer patients in each subgroup.
Authors: Niikura Naoki , Masuda Shinobu , Terada Mizuho , Terao Mayako , Kumaki Nobue , Oshitanai Risa , Morioka Toru , Tuda Banri , Okamura Takuho , Saito Yuki , Suzuki Yasuhiro , Tokuda Yutaka 
Published: March 2020

565 Background: Immunohistochemical (IHC) Ki67 has described it as a prognostic and predictive marker for breast cancer. The St. Gallen Consensus Meeting determined that Ki67 labeling index is chiefly important for distinguishing between “Luminal A” and “Luminal B (HER2 negative)” subtypes and is a predictive marker for chemotherapeutic efficacy. However, the high and low cutoff points remain controversial. Our objective is to compare survival in patients with low, intermediate, and high Ki67 levels in each subgroup. Methods: We retrospectively identified all the patients in the Tokai University breast cancer database for whom IHC Ki67 data were available between January 1, 2000, and December 31, 2010. Ki67 was defined as low if <10% Ki67 was detected, as Intermediate if 10–20% Ki67 was detected, and as high if >20% Ki67 was detected. To assess Ki67 levels and survival outcomes, survival curves were calculated using the Kaplan–Meier method and compared using the log-rank test. Results: We identified 1331 primary breast cancer patients without metastasis, of whom 686 received neoadjuvant or adjuvant chemotherapy. Patients with high Ki67 had poorer relapse-free survival (RFS) than patients with intermediate (p = 0.009) and low Ki67 (p < 0.001). Patients with intermediate Ki67 had poorer RFS than patients with low Ki67 (p < 0.001). In ER-positive cases (n = 1059), patients with high and intermediate Ki67 had poorer RFS than patients with low Ki67 (p < 0.001 and p = 0.002, respectively). In HER2-positive and ER-negative cases (n = 103), patients with high Ki67 had poorer RFS than patients with low Ki67 (p = 0.002). In triple-negative cases (n = 164), patients with high Ki67 tended to have poorer RFS than patients with low Ki67 (p = 0.064). Conclusions: Our data demonstrated that low, intermediate, and high Ki67 levels may be used to differentiate prognosis in ER-positive cancer patients as well as HER2-positive and triple-negative cancer patients.
Prospective study of the impact of using the 21-gene recurrence score assay on clinical decision making in women with estrogen receptor-positive, HER2-negative, early-stage breast cancer in France.
Authors: Gligorov Joseph , Pivot Xavier B. , Naman Herve L. , Jacot William , Spaeth Dominique , Misset Jean-Louis , Largillier Remy , Sautiere Jean-Loup , de Roquancourt Anne , Pomel Christophe , Rouanet Philippe , Rouzier Roman , Penault-Llorca Frederique Madeleine ,   Francilian Breast Intergroup
Published: March 2020

568^ Background: The 21-gene Oncotype DX Recurrence Score (RS) is a validated assay to help inform the appropriate treatment of estrogen receptor-positive (ER+), early stage breast cancer in the adjuvant setting. Treatment traditions regarding choice of adjuvant treatment vary significantly in different countries. This prospective multicenter study is the first to assess the impact of using the Oncotype DX assay in the French clinical setting. Methods: A total of 100 consecutive patients with ER+, HER2-negative, node negative or pN1 (mi) breast cancer were enrolled. Overall treatment recommendation change, change from chemoendocrine to endocrine alone and change from endocrine alone to chemoendocrine treatment were recorded. Medical oncologists completed questionnaires regarding their confidence in their recommendation before and after knowing the patient’s RS. A preliminary analysis was conducted on the first 92 evaluable patients with data available at the time of abstract submission. Final data will be presented at the meeting. Results: Prior to Oncotype DX 49% of patients were recommended chemoendocrine treatment and 51% endocrine treatment alone. After having the RS, 26% were recommended chemoendocrine treatment and 74% endocrine treatment alone. The overall reduction in chemotherapy recommendation from 49% to 26% was significant (p<0.001). Of patients originally recommended chemoendocrine treatment, 58% were changed to endocrine treatment alone after having the RS. Of patients originally recommended endocrine treatment, 11% were changed to chemoendocrine treatment after receiving the RS. There was a significant improvement in physician confidence in treatment recommendations (p=0.002) when using Oncotype DX. Conclusions: These are the first prospective data regarding the impact of using Oncotype DX in France. Using Oncotype DX was associated with a significant change in treatment decisions and an overall reduction in chemotherapy use. The data are consistent with those presented from Germany, Spain, the UK and the US.
Breast cancer in Sub-Saharan Africa: 1,000 patients with primary breast cancer in Addis Ababa followed for up to 5 years.
Authors: Kantelhardt Eva Johanna , Zerche Peter , Trocchi Pietro , Mathios Assefa , Reeler Anne , Tufa Gemechu , Yonas Bekuretsion , Stang Andreas , Thomssen Christoph , Bogale Solomon Desalegne 
Published: March 2020

580 Background: There is little information on breast cancer (BC) patients (pts) receiving standardized treatment in Sub-Saharan Africa. This study evaluates pts presenting 2005-10 at the University Radiotherapy Center in Addis Ababa, the only institution in the country offering standardized radiotherapy, systemic therapy and free endocrine treatment (ET) during that time. Methods: All pts with histologically verified BC were included. Ethical approval was obtained. Axios/AstraZenaca provided free ET. Therefore, the majority of pts underwent regular follow-up (FUP). We analyzed survival at 18 months by means of Kaplan-Meier survival analysis. We assumed right-censoring to be unrelated to the risk of metastasis. In a worst case sensitivity analysis, we considered all censored pts developing metastasis. Results: Pts with primary diagnosis between July 1st, 2005 and December 31st, 2010 were included (n=1303). The majority of pts were female (95.2%), most (52.3%) postmenopausal. Mean age was 44.1yrs (20-88yrs). Stages 1-4 presented in 3/19/53/25% respectively (36% unknown). Grade 2 tumors were seen in 434 out of 574 pts (58%). Estrogen receptor was pos. in 251 out of 381 pts (66%). Most M0-pts (n=942) underwent surgery (84%), received chemotherapy (59%), and received ET (63%). Median FUP was 18.4 months, 186 events (metastases) occurred. Metastasis-free survival (MFS) was 86%. Worst case analysis on censored observations revealed that MFS declined down to 52%. Pts with early stage 1/2 showed a better MFS than pts with stage 3 disease (93 to 77%). Surgery (no surgery 78% vs surgery 87%) and ET (79% vs 89%) improved MFS. The 5-year MFS for stage 1/2 was 78% and stage 3 was 38%. Conclusions: To our knowledge this is the first presentation of clinical features in 1300 pts with BC in Sub-Saharan Africa. Most pts in Addis Ababa (AA) are <45yrs and present at stage 3/4. Differences to 5-year MFS from Europe stage 1/2 around 90% (AA 78%) and stage 3 around 70% (AA 38%) are smaller in pts treated with surgery and ET. This data is consistent with overall survival in a treated pt cohort from Uganda stage 1/2: 74% and stage 3/4: 39% (n=285) (Gakwaya Brit J Cancer 2008). Policies should focus on earlier presentation and access to care.
Comorbidity, chemotherapy toxicity, and outcomes among older women receiving adjuvant chemotherapy for breast cancer (BC).
Authors: Klepin Heidi D. , Pitcher Brandy , Ballman Karla V. , Kimmick Gretchen Genevieve , Kornblith Alice B. , Cohen Harvey Jay , Hurria Arti , Winer Eric P. , Hudis Clifford , Muss Hyman Bernard 
Published: March 2020

6015 Background: Comorbidity increases with age. We evaluated how comorbidity was associated with toxicity and clinical outcomes among older women with BC who received adjuvant chemotherapy. Methods: Cancer and Leukemia Group B (CALGB 49907) enrolled 633 women ≥65 years with early stage BC and randomized them to standard adjuvant chemotherapy (AC or CMF) or capecitabine (N Eng J Med 360:2055, 2009). 329 women on the Quality of Life companion study completed a pre-treatment health survey (Older American Resources and Services Questionnaire, physical health subscale). The survey evaluates 14 conditions and the degree to which each interferes with daily activities (rated from 1 “not at all” to 3 “a great deal”). Comorbidity was analyzed as follows: 1) total number 2) comorbidity burden score (summed conditions multiplied by interference rating); and 3) individual diseases. Primary outcomes were: 1) grade 3-5 toxicity (incident and cumulative); 2) time to relapse (TTR), and 3) overall survival (OS). Contingency table methods were used to evaluate the association between comorbidity and toxicity. Cox proportional hazards models were used to evaluate TTR and survival outcomes. Results: Among 329 women [median age 71 years (range 65-89), 86% white, 98% ECOG performance score 0-1, 75% stage 1-2] the median number of comorbidities was 2 (0-10), median comorbidity burden score was 3 (0-25), and most common conditions were arthritis (58%) and hypertension (54%). Few patients had diabetes (17%), heart disease (16%), and pulmonary disease (9%). No comorbidity measure was associated with toxicity or TTR. With a median follow-up of 5.4 years, increasing comorbidity was associated with shorter OS. For each additional comorbid condition the hazard of death increased by 18% (HR 1.18 [95% CI; 1.06-1.33]) after adjusting for age, tumor size, treatment, node status and receptor status. Comorbidity burden score was similarly associated with OS (HR 1.08 [95% CI; 1.03-1.14]), while no specific condition was independently associated. Conclusions: Among older women with good functional status, comorbidity was not associated with toxicity or BC relapse. However, comorbidity burden was associated with shorter OS.
A critical evaluation of oncology clinical practice guidelines.
Authors: Reames Bradley Norman , Krell Robert Wallace , Ponto Sarah Nicks , Wong Sandra L. 
Published: March 2020

6020 Background: Clinical Practice Guidelines (CPGs) play an essential role in cancer care today, but there are significant concerns regarding their content and reliability. In 2011, the Institute of Medicine (IOM) report “Clinical Practice Guidelines We Can Trust” created standards for developing trustworthy CPGs. Using these standards as a benchmark, we sought to evaluate recent oncology guidelines. Methods: CPGs and consensus statements addressing the screening, evaluation or management of the four leading causes of cancer-related mortality in the US (non-small cell lung, breast, prostate and colorectal cancers) published between January 2005 and December 2010 were identified using MEDLINE. A standardized scoring system based on the eight standards set forth by the IOM was devised, and the methodology, content and disclosure policies of CPGs were critically evaluated by four independent reviewers. All CPGs were given two scores; points were awarded out of a possible 8 major criteria and 20 sub-criteria. Results: We identified 168 CPGs for inclusion in the study; 45% were from US groups. None of the CPGs fully met all the IOM standards. On average, CPGs only met 2.8 of 8 standards set forth by the IOM (mean 2.8 points out of 8, SD 1.7; 8.3 out of 20, SD 4.3). Less than half of CPGs were based on a systematic review. Only half of CPG panels addressed conflicts of interest. Overall, the CPGs were most consistent with IOM standards for transparency regarding the development process, articulation of recommendations, and use of external review. Most did not comply with standards for inclusion of patient and public involvement in the development or review process, nor did they specify their process for updating. CPGs from the US had higher overall scores than CPGs from international groups. CPGs addressing non-small cell lung cancer had higher overall scores (mean 3.9) than those for other cancers. Conclusions: The vast majority of oncology CPGs fails to meet the IOM standards for trustworthy guidelines. Notably, most CPGs are not based on systematic reviews, lack full disclosure, and do not include all relevant stakeholders in the guideline process. This highlights the need for improved CPG development processes.
Trade-offs associated with axillary lymph node dissection: Implications of the eligibility versus enrollment in ACOSOG Z0011.
Authors: Krishnan Monica Shalini , Recht Abram , Bellon Jennifer Ruth , Punglia Rinaa S. 
Published: March 2020

6022 Background: Results from ACOSOG Z0011 suggest axillary lymph node dissection (ALND) may not be necessary for patients following positive sentinel lymph node biopsy (SLNB). Concerns have been raised regarding generalizability of this trial, given the low-risk patient population. It is uncertain whether a subgroup who would have been eligible for ACOSOG Z0011 but were not adequately represented in the study may still benefit from ALND. Methods: We constructed a decision analysis using a Monte Carlo model to simulate axillary recurrence risk, lymphedema, and quality of life of women aged 45, 55 and 75 y/o with Stage II cancers following breast conserving surgery (BCS) with positive SLNB who were then treated with ALND and whole-breast radiation (BRT) or BRT alone. Women were divided into two risk groups based on the Memorial Sloan-Kettering Cancer Center non-sentinel lymph node (NSLN) nomogram: those with risk of residual nodal involvement of 30-60% (high risk); and those with risk less than 30% (low risk, similar to the Z0011 patients). Probabilities and utilities for health states were derived from prior studies. Results: BRT alone resulted in improved quality-adjusted life expectancy (QALE) in the low-risk group, while ALND with BRT resulted in improved QALE in the high-risk group. Overall survival (OS) was similar at 5 years with both treatment strategies in both groups but was superior with ALND at 20 years in the high risk group (Table). Differences in outcomes decreased with increasing age. In the low-risk group, sensitivity analysis showed BRT alone is preferred unless the axillary recurrence risk with BRT is greater than 1.6% or the lymphedema risk with ALND is less than 10%. In the high-risk group, ALND with BRT is the preferred strategy unless the axillary recurrence risk with BRT is less than 2.3%. Conclusions: Patients who would have been eligible for ACOSOG Z0011 but are at higher risk of having residual nodal disease following BCS and positive SLNB may benefit from ALND plus BRT rather than BRT alone. [Table: see text]
Patterns of diagnostic imaging and cumulative radiation exposure among long-term young adult cancer survivors.
Authors: Daly Corinne , Urbach David , Stukel Therese A. , Deitel Wayne , Nathan Paul C. , Paszat Lawrence Frank , Baxter Nancy N. 
Published: March 2020

6027 Background: Young adults surviving a diagnosis of malignancy have a considerable life expectancy, however, little is known about radiation exposure from diagnostic imaging in these patients. This study aims to describe patterns of imaging and radiation exposure in young adult cancer survivors (YAS) and cancer-free controls in Ontario, Canada. Methods: We conducted a population-based retrospective study. Young adults aged 20-44 diagnosed with an invasive malignancy between 1992 and 1999 who lived at least 5 years without recurrent disease were identified in the Ontario Cancer Registry. YAS were matched 1:5 to randomly selected cancer-free controls on calendar year of birth, sex, and geographic location. Radiological procedures were identified through Ontario Health Insurance Plan administrative data. The rate at which individuals underwent diagnostic procedures after surviving 5-years was compared between survivors and controls using Poisson regression. Cumulative radiation exposure due to computed tomography (CT) and standard x-ray were calculated. Results: 20,911 YAS and 104,524 controls had a median of 13.5 years observation time after cancer diagnosis/referent date. The rate of CT scanning after 5 year survival was higher in YAS (rate ratio= 3.59, 95% CI: 3.46 – 3.73) and varied according to malignancy type (Table). Over the course of diagnosis, treatment and surveillance to 10 years, the average YAS was exposed to 33.8 mSv of radiation, 4.4 times the radiation exposure an individual in the general population received. 47% of YAS cumulative dose was attributed to exposure 5 years or more after diagnosis. Conclusions: YAS undergo imaging and are exposed to diagnostic irradiation at a significantly higher rate than controls even after 5 years of recurrence free survival. Alternative imaging techniques not associated with exposure to radiation should be considered for these patients. [Table: see text]
How do elderly cancer survivors fare? A comparison of characteristics, health status, health behaviors, and spending between Medicare beneficiaries with and without a cancer history.
Authors: Ke Xuehua , Zuckerman Ilene H. , Pandya Naimish B. , Shaffer Thomas , Snyder Claire Frances , Stuart Bruce C. , Davidoff Amy J. 
Published: March 2020

6028 Background: Prior research on cancer (Ca) survivors has been limited to small cohorts or claims data with limited measures. In this study we used population-based survey data to characterize multiple dimensions of the survivor experience including socioceonomic status, health status and behaviors, and healthcare spending, comparing survivors to beneficiaries w/o a Ca history. Methods: Data were pooled from the 1997-2007 Medicare Current Beneficiary Survey (MCBS) including linked claims (3 yrs prior to MCBS enrollment to concurrent). Ca survivors were identified from ICD-9-CM codes on claims or self report of a prior Ca dx, survived 2+ yrs from observed Ca dx, and had no active treatment, hospice enrollment or death in the selected survivorship yr. Beneficiary characteristics and healthcare use were based on self report augmented by claims-based measures. Bivariate and multivariate analyses were used to compare survivors’ characteristics and spending to controls. Results: The study included 3,921 survivors and 7,056 subjects w/o Ca. Among survivors, breast (21%), prostate (21%), and colorectal (16%) were most common Ca sites. Compared to controls without (w/o) Ca, survivors had higher income and assets, were more likely to have supplemental medical and prescription drug coverage (74% vs. 70%), had more comorbid conditions as measured by Charlson Comorbidity Index score >=2 (18% vs. 15%), and a smoking history (60% vs. 53%); survivors were less likely to avoid visiting doctors (22% vs. 30%), and more satisfied with the quality of medical care received (96% vs. 92%). Survivors had higher annual healthcare spending (mean $12,095 vs. $8,928) and outpatient drug spending ($2,205 vs. $1,898). All differences in healthcare use and spending remained significant after adjusting for socioeconomic status, health conditions, and behaviors. Conclusions: Elderly Ca survivorshad more supplemental insurance coverage, stronger preferences for medical care, used more preventive services, and had higher spending compared to beneficiaries w/o Ca. These patterns may reflect the effects of survivorship on need for healthcare and care seeking behaviors.
Longitudinal changes in health care utilization by adult survivors of childhood cancer in the Childhood Cancer Survivor Study (CCSS).
Authors: Casillas Jacqueline N. , Liu Qi , Hudson Melissa M. , Greenberg Mark , Yeazel Mark W. , Ness Kirsten K. , Robison Leslie L. , Armstrong Gregory T. , Leisenring Wendy M. , Yasui Yutaka , Oeffinger Kevin C. , Nathan Paul C. 
Published: March 2020

6030 Background: The incidence of late effects increases as childhood cancer survivors age. Survivors require lifelong care focused on the risks arising from prior cancer therapy (survivor-focused care). Methods: We assessed longitudinal changes in health care utilization in adult survivors of childhood cancer participating in the CCSS. Utilization at baseline and most recent follow-up was classified into one of three mutually exclusive hierarchical categories: no health care, general medical care, or survivor-focused care. Relative risk (RR) and 95% confidence intervals (CI) were calculated for predictors of reduction in care over time from survivor-focused to general or no care. Multivariable models, adjusted for key treatment exposures, were created to assess the risk factors for reductions in level of care over time. Results: Among 8591 eligible survivors, mean age at last follow-up was 35.1 years (SD=7.8) with a mean of 11.6 years (SD=2.2) since baseline. Of 3993 (46%) survivors who reported survivor-focused care at baseline, 2383 (59.7%) reported a lower level of care at follow-up. Among 4598 (54%) not receiving survivor-focused care at baseline, 915 (20%) reported survivor-focused care at follow-up. Baseline predictors of a decreased level of care were no health insurance (RR=1.5, 95% CI 1.2-1.9), male sex (RR=1.4, 95% CI 1.2-1.6), being 10-19 years from diagnosis compared with 20+ years (RR=1.4, 95% CI 1.1-1.7). In contrast, factors associated with a maintenance in survivor-focused care were Canadian residency compared to U.S. residency with insurance (RR=0.7, 95% CI 0.6-0.9), unemployment (RR=0.8, 95% CI 0.7-0.9), physical limitations (RR=0.7, 95% CI 0.6-0.9), cancer-related pain (RR=0.7, 95% CI 0.5-0.8), poor emotional health (RR=0.7, 95% CI 0.5-0.9), having mild-moderate (RR=0.5, 95% CI 0.4-0.6) or severe-disabling chronic health condition (RR=0.6, 95% CI 0.5-0.7). Conclusions: Less than a third of adult survivors of childhood cancer report survivor-focused care. Rates decrease over time. Targeted interventions to maximize survivor-focused care in at-risk survivors should be tested so preventive and risk-reducing opportunities are not lost.
Life expectancy (LE) and the receipt of conservative versus active treatment in men with prostate cancer (CaP): A population-based study.
Authors: Royce Trevor Joseph , Todd Jonathan , Stokes William A. , Allen Ian M. , Chen Ronald C. 
Published: March 2020

6032 Background: Prostate-specific antigen (PSA) screening increases the diagnosis of low-risk and potentially clinically insignificant CaP, which raises concern for possible overtreatment. The National Comprehensive Cancer Network (NCCN) guidelines recommend surveillance (conservative management) for patients with less than 10 years LE diagnosed with low-risk cancer. In contrast, NCCN recommends active treatment for high-risk CaP, the most aggressive form of this disease, irrespective of LE. We examine patterns of care in CaP patients in the Surveillance, Epidemiology and End Results (SEER) registry by LE. Methods: 152,578 men with non-metastatic CaP diagnosed from 2004-8 were included. Gleason, PSA, and clinical stage were used for risk-categorization per D’Amico criteria. The sample was dichotomized into men 76 years and younger (who have an average LE of 10 years or more based on the US Social Security Administration actuarial period life tables) vs. 77 years and older (less than 10 years average LE). Logistic regression models examined factors associated with each treatment modality. Results: 56% of patients age 77 and older with low-risk CaP received conservative management, and 44% active treatment (Table). However, conservative management was just as common in older patients with high-risk cancer (62%); 21% of younger patients with high-risk CaP also received conservative management. Multivariable analysis showed decreased use of conservative management over time in older patients (OR 0.78 for 2008 vs. 2004, 95%CI 0.71-.86, p<.001). African American race, being unmarried, and older age were also significantly associated with conservative management. Conclusions: There may be overtreatment of low-risk CaP patients age 77 and older, which is worsening in recent years. Correspondingly, there appears to be undertreatment of elderly patients with high-risk CaP, the most aggressive form of this disease. [Table: see text]