bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of surgical staging in grade 1 endometrioid corpus cancer
Authors: Chan J. K. , Guo H. , Cheung M. K. , Osann K. , Husain A. , Teng N. N. , Berek J. S. , Kapp D. S. 
Published: March 2020

5009 Background: To evaluate the role of surgical staging of patients with grade 1 endometrioid uterine cancer. Methods: Data including stage, histology, grade, lymph nodes involvement and disease-specific survival were extracted from Surveillance, Epidemiology, and End Results Program from 1988 to 2001. Kaplan-Meier and Cox proportional hazards analyses were used to determine the predictors for survival. Results: 12,712 women were diagnosed with endometrioid carcinoma which included 3,867 (30.4%) with grade 1, 5,285 (41.6%) with grade 2, and 3,560 (28%) with grade 3 disease. The 5-year disease specific survival of patients with grade 1, 2, and 3 disease was 97.78% ± 0.29, 92.14% ± 0.45, and 78.04% ± 0.82, respectively. Of all the patients with nodal involvement, 10% had grade 1, 39% had grade 2 and 51% had grade 3 disease (p < 0.001). Positive nodes were found in 3% of grade 1, 9% of grade 2 and 18% in grade 3 tumors (p < 0.001). Of the 3,867 patients with grade 1 disease, 3,281 (84.9%) had stage I, 317 (8.2%) had stage II, 166 (4.3%) had stage III, and 103 (2.7%) had stage IV disease. Fifteen percent of the patients with grade 1 disease had extra-uterine spread, including 8% to the cervix, 4% to the pelvis and 3% to the upper abdomen or distant metastases. Conclusions: Grade 1 uterine cancers have a risk of extra-uterine spread. Given that the information obtained from a thorough staging procedure clearly influences adjuvant treatment decisions, complete surgical staging is recommended. No significant financial relationships to disclose.
Screen-and-treat colposcopy as public health strategy for cervical cancer early detection in high-risk population: The experience of the Centro de Estudios y Prevencion del Cancer (CEPREC) in indigenous population of Southern Mexico
Authors: Marcial-Toledo S. , Cortes-Guzman J. , Chavez L. , Guzman-Patraca C. , Terrazas-Espitia S. , Sanchez-Ruiz J. , Perez-Romero J. , Torres R. , Ramirez M. , Gutierrez-Delgado F. 
Published: March 2020

5012 Background: The incidence of cervical cancer in Mexico remains high, due to ineffective Papanicolau smear screening, social, educational, cultural and financial issues. Southern Mexico is a region with a high incidence of cervical cancer. CEPREC has designed educational, preventive and early cancer detection programs in that population (Onkologie 27:211). We propose screen-and-treat colposcopy for cervical cancer prevention as public health strategy in selected high-risk population. This study evaluates the feasibility and acceptability of this approach through an educational program. Methods: From 12/2002 to 12/2005, women living in Southern Mexico were educated about cervical cancer and its prevention and were offered colposcopy either in CEPREC facilities or in ambulatory clinics. Colposcopy diagnosis and cervical cytology were established according to the 1990 IFCPC criteria and the 2001 Bethesda System, respectively. A cone biopsy was indicated in patients diagnosed as having human papilloma virus (HPV), cervical intraepithelial neoplasia (CIN 1, CIN 2, CIN 3), or carcinoma. Patients diagnosed as having HPV, CIN 2 and CIN 3 were treated by large loop excision of the transformation zone under local anesthesia. Results: 8281 women (median age 39 years, range: 14–87) were evaluated. 5645 (68%) of them underwent colposcopy in ambulatory clinics. 1171 (14%) women were illiterates and the highest education level was 9 years in 4881 (59%). Median age at first intercourse and first Papanicolau smear were 19 and 29 years, respectively. 4251 (51%) women had vaginal symptoms before colposcopy. Abnormal colposcopy (HPV, CIN 1, CIN 2 or CIN 3), was diagnosed in 1073 (13%) patients and 9 (<1%) had carcinoma. 238 (22%) of them were treated on site. Low-Grade (n = 190) (80%), and high-grade squamous intraepithelial lesions (n = 48) (20%), were diagnosed in those patients. Conclusions: Screen-and-treat colposcopy is a feasible public health strategy with high acceptability in selected high-risk population and could be an alternative to cytology-based screening programs. No significant financial relationships to disclose.
The number of lymph nodes with metastatic disease portends for a poorer prognosis in women with stage IIIC-IV endometrioid uterine cancer
Authors: Chan J. K. , Cheung M. K. , Osann K. , Husain A. , Teng N. N. , Berek J. S. , Kapp D. S. 
Published: March 2020

5039 Background: To determine the prognosis of women with IIIC-IV endometrioid uterine cancer based on the number lymph nodes with metastatic disease Methods: Demographic and clinico-pathologic information were obtained from the Surveillance, Epidemiology and End Results Program from 1988–2001 and analyzed using Kaplan-Meier methods and Cox proportional hazards regression. Results: Of the 1,222 women diagnosed with stage IIIC-IV endometrioid uterine cancer with nodal disease, the median age was 64 (range: 28–93). All patients underwent surgical staging including a lymph node assessment and were found to have nodal metastases. 639 (52.3%) had stage IIIC, 24 (2.0%) IVA, and 559 (45.7%) IVB disease. The study cohort was divided in three subgroups based on the number of positive nodal metastases: 1, 2–5, and >5. The 5-year overall disease-specific survivals of women with 1, 2–5, and >5 positive nodes were 68.1%, 55.1% and 46.4%, respectively (p < 0.0001). The increasing number of positive nodes was associated with a worsening survival in stage IIIC (77.1%, 60.9%, 69.1%; p = 0.003) and stage IV (50.9%, 49.8%, 38.9%; p = 0.09) diseases. It appears that the extent of benign nodal resection attenuates the increase in the mortality associated with a higher number of positive nodes (see table ). Women with higher number of positive nodes received significantly less adjuvant radiotherapy at 76.8%, 59.5%, and 56.7% respectively. On multivariate analysis, age, stage, grade, number of positive lymph nodes and extent of lymph node resection were significant independent prognostic factors for survival. However, adjuvant radiation was not an important independent prognostic factor in multivariate analysis. Conclusion: Women with node positive endometrioid uterine cancers have a decreased survival associated with increasing number of positive nodes. Our data suggests that the extent of lymph node resection improves the survival of patients with node-positive uterine cancer. [Table: see text] No significant financial relationships to disclose.
Development of invasive disease in 433 women treated for vulvar, vaginal or perianal intraepithelial neoplasia
Authors: Fehr M. K. , Dedes K. J. , Heinzl S. , Mueller M. D. , Baumann M. , Fink D. 
Published: March 2020

5043 Background: The incidence of intraepithelial neoplasia (IN) of the lower anogenital tract is increasing. Due to small case-series, the malignant potential of treated high-grade IN is not well defined and risk factors for progression are not established. Methods: Patients with IN of the vulva (VIN), vagina (VAIN) and perianal skin (PAIN) were identified in the electronic databases of three university colposcopy clinics. Inclusion criteria were biopsy proven IN grade 2–3 (high-grade) and no history of vaginal, vulvar or anorectal cancer. Excluded were patients with the diagnosis of invasive disease within one year from initial diagnosis of IN. Results: 442 patients were identified from 1977 to 2005 with a mean follow up of 69.9 ± 56.1 months. Initial diagnosis was VIN III in 75.3%, VIN II in 17.2%, VAIN II in 4.3%, VAIN III in 2%, and PAIN II/III in 1.1% of patients. Mean age at initial diagnosis was 47.1 ± 14.1 (range, 18–102). Initial treatment was biopsy and laser evaporation in 61.5%, surgical excision in 32.8%, and other locally destructive methods in 3.1% of patients. 9 patients refused any treatment (2.0%). In the 433 treated patients, recurrent disease (e.g. diagnosed >1 year after initial diagnosis) occurred in 32.2%. In patients with a follow up longer than 5 years, 14.4 % were still experiencing recurrences. In multivariate analysis, immunosuppression (OR: 2.33, 95% CI 1.06–5.06, p = 0.035) was associated with recurrence but not smoking, age or histological grade. Progression to invasive disease occurred in 3.8% of treated patients within a mean time of 7.9 ± 6.8 years (range, 1.3–24.5). In multivariate analysis, immunosuppression (OR:3.31, 95% CI 1.01–10.93, p = 0.049) and smoking (OR:3.12, 95% CI 1.07–9.08, p = 0.037) were independent risk factors for progression. Conclusions: Anogenital IN is a chronic disease in a substantial proportion of patients. The malignant potential is remarkably high despite repeated treatments. Therefore, long lasting surveillance is mandatory, especially in immunosuppressed or smoking patients. No significant financial relationships to disclose.
Short-term survival of ovarian cancer patients waiting more than six weeks after surgery before chemotherapy is given
Authors: Paulsen T. , Kærn J. , Kjærheim K. , Haldorsen T. , Tropé C. 
Published: March 2020

5070 Background: To investigate the impact on short-term survival of time between surgery and start of first chemotherapy cycle in patients with advanced ovarian cancer. Methods: This prospective, population-based study comprised 371 patients with epithelial ovarian, tubal or peritoneal cancer diagnosed in 2002–2003. All patients underwent primary surgery, followed at different intervals by chemotherapy. The data were derived from notifications to the Norwegian Cancer Registry and included medical, surgical and histopathological records. Kaplan-Meier plots were used to show differences in survival, and Cox regression analysis was used to show the effect of prognostic factors on survival, expressed as hazard ratios (HRs). Results: No difference in survival between patient groups was seen when time between surgery and start of chemotherapy was divided into quartiles. The group of patients with interval between surgery and chemotherapy less than six weeks had inferior survival if they had residual disease after surgery. Adjusted HR = 2.36 (95% CI, 1.22–4.57). However, in the patient groups with interval more than six weeks, there was no significant difference in survival between patients without and with residual disease. Adjusted HR = 1.35 (0.51–3.56) versus HR = 1.64 (0.76–3.57). Conclusions: The interval between surgery and start of chemotherapy had no major impact on short-term survival after ovarian cancer. Patients might be included in chemotherapy trials when interval between surgery and start of chemotherapy is more than six weeks. [Table: see text] No significant financial relationships to disclose.
Phase I trial of liposomal doxorubicin and ZD 1839 in patients with refractory gynecological malignancies or metastatic breast cancer
Authors: Campos S. M. , Parker L. , Chen W. , Bunnell C. A. , Atkinson T. , Lee J. , Matulonis U. A. , Harris L. N. , Krasner C. N. 
Published: March 2020

5085 Background: Liposomal Doxorubicin has activity in both breast and ovarian cancer. Preclinical data reported by several investigators have suggested that ZD1839 acts synergistically with chemotherapy in ovarian cancer cells expressing high levels of EGFR. Given the lack of cross resistance and the different targets for these agents a Phase I trial was initiated examining the safety and the efficacy of the combination of Liposomal Doxorubicin and ZD1839. Methods: Dose limiting toxicity was defined within the first two cycles of treatment. The dose escalation schema was described as such: Results: As of January 2006, 23 patients have been enrolled in this study (GYN = 6; Breast 17). Six patients were enrolled in dose level 1 and no DLTs were observed. Dose level 2 enrolled six patients. One DLT was observed (febrile neutropenia). As defined by protocol an additional 6 patients were accrued to dose level 2. Accrual to dose level 3 began on 11/2005. One patient has completed 2 cycles and no additional DLTs have been noted. MTD has not yet been reached. SAEs have included mental status changes, and two CNS bleeds (believed most likely to be unrelated to study drug combination). Toxicities noted in cycle 3 and above have been mild with the exception of 2 grade 3 and 2 grade 4 toxicities related to skin and GI toxicity. No cardiac toxicity was observed. Doxil dose modifications (cycle 3 +) occurred in 7 patients. Best response to therapy has included 2 PRs and 10 patients with SD. Eleven patients to date have had progressive disease. The trial continues to accrue. Correlative studies including EGFR expression and CECs and PKs (at MTD) are planned. Conclusion: Liposomal Doxorubicin in conjunction with ZD1839 is tolerable regimen in patients with advanced breast and ovarian cancer. To date MTD has not been reached. [Table: see text] [Table: see text]
A phase I study of a hypomethylating agent azacitidine in combination with carboplatin in patients with platinum resistant epithelial ovarian cancer
Authors: Fu S. 
Published: March 2020

5087 Background: Hypermethylation is a common event associated with inactivation of a variety of genes and pathways involved in tumorigenesis and progression as well as drug resistance. Previous evidence displayed that hypomethylating agents could resensitize epithelial ovarian cancer cells to platinum treatment through reexpression of platinum sensitivity-related genes. Therefore, it is of great interest to use a hypomethylating agent to resensitize platinum resistant epithelial ovarian cancer cells to platinum treatment. Methods: This proof-of-concept study used a modified dose-escalation schema (3+3 design). All patients, who have progressed within the 6 months after a platinum-based regimen, are eligible if they have a pathologically confirmed epithelial ovarian cancer. All patients receive subcutaneous injection of azacitidine 75 mg/m2/day for 5 days on days 1–5 and intravenous infusion of carboplatin once on day 2 of each treatment cycle (28 days). Azacitidine is maintained at the same dosage during dose-escalation of carboplatin from AUC4 to AUC5. Results: Six patients have received a total of 16 cycles of treatment. There was no grade 2 or higher toxicity observed. Three patients were evaluable for response: 1 patient, who received 6 cycles of treatment, achieved complete response by CA125 criteria and stable disease by imaging criteria; 1 patient, who received 5 cycles of treatment, displayed stable disease; and the 3rd patient, who received 2 cycles of treatment, showed mixed response by imaging criteria. Conclusions: Preliminary data showed that a regimen of azacitidine 75 mg/m2/day for 5 days plus carboplatin AUC 5 on day 2 was well tolerated in patients with extensive prior treatment. No significant financial relationships to disclose.
Study participants’ perceptions of the process and impact of receiving results of N9831
Authors: Partridge A. H. , Wolff A. C. , Marcom P. K. , Kaufman P. A. , Moore C. , Lake D. , Fleming G. , Rugo H. S. , Collyar D. , Winer E. P. 
Published: March 2020

518 Background: There has been growing interest in providing clinical trial participants with study results. We sought to evaluate the process of sharing results from a large cooperative group trial in an effort to guide clinicians and clinical investigators. Methods: We mailed surveys to a subset of women who participated in NCCTG 9831, Phase III Trial of Adjuvant Chemotherapy with or without Trastuzumab for Women with HER2+ Breast Cancer, after the preliminary study results were mailed to participants. Surveys were sent to all trial participants enrolled through 9 CALGB/ECOG institutions. Results: Of 228 surveys sent, 160 (70%) have been returned. Average age of respondents was 51 years (range 26–76); 84% were white; 61% were college graduates; 4% reported recurrent disease. Women reported receiving results by mail (84%), from a health care provider in person or by phone (43%), and/or from the media (47%); 2% reported that they were not informed of the results. 29% heard the results first from the media; 27% first heard by mail. 35% of women might have preferred to be offered results, with the option of not receiving them, but only 4% of women indicated that they would have declined results had they been offered first. 89% of women found the results information easy to understand; 69% correctly interpreted the results of the study; 31% either had an incorrect interpretation or were unsure of the findings. 81% of women were satisfied with how results were shared; 63% of women felt that learning results had an impact on their lives, 24% were more anxious after learning the results; 36% were less anxious. Multivariable analyses evaluating factors associated with greater satisfaction and increased anxiety will be presented. Conclusions: Sharing results is met with overwhelmingly favorable responses from patients, although a substantial proportion of patients may not initially understand the findings. Some patients desire to be offered results first, but few would decline them. The potential for increased anxiety should be considered, and psychosocial support may be required by some. A plan to share results should be routinely and prospectively included in the design of clinical trials. (Supported in part by an ASCO Career Development Award (AHP) No significant financial relationships to disclose.
Congestive heart failure (CHF) in older women treated with anthracycline (A) chemotherapy (C)
Authors: Giordano S. H. , Pinder M. , Duan Z. , Hortobagyi G. , Goodwin J. 
Published: March 2020

521 Background: There are little available data on the long-term cardiac safety of anthracycline chemotherapy in women over age 65, so we evaluated rates and predictors of CHF in this population of older women. Methods: We used data from the Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) database and included women aged 66–90 years who were diagnosed with breast cancer from 1992–1999, had no other cancers, and no history of CHF. Multivariable Cox regression analysis was used to estimate the 5- and 10-year cumulative rates of CHF and to determine the factors independently associated with the development of CHF. Results: A total of 34,621 women were included in this observational study: 28,640 who received no C, 3253 who received non-A C, and 2728 who received A C. Women who received A tended to be younger, have lower comorbidity scores, and have more advanced disease than women treated with non-A chemo or women who did not receive chemotherapy (p<0.001 for each). By multivariable Cox regression analysis, the 5- and 10-year rates of CHF in women aged 66–70 years were 19% and 47% for the A C cohort, 14% and 33% for the non-A C cohort, and 12% and 28% for the no C cohort. The adjusted hazard ratio was 1.45 (95% CI 1.19–1.76) for A C versus other C and was 0.97 (95% CI 0.82–1.14) for no C versus other C. The rates of CHF were not statistically different among women in the older age cohorts, although selection biases were likely stronger. Other significant predictors of CHF included black race (HR 1.28, 1.17–1.40), increasing comorbidity, and preceding diagnosis of hypertension (HR 1.40, 1.34–1.47), diabetes (HR 1.23, 1.16–1.30), and peripheral vascular disease (HR 1.26, 1.19–1.34). Conclusions: Although women ages 66–70 treated with A tended to be healthier than women treated with other types of chemotherapy, the rates of CHF among women treated with A were significantly higher. The difference in rates of CHF continued to increase through 10 years of follow-up. No significant financial relationships to disclose.
Proteomic profiling of breast cancer serum via two-dimensional liquid-chromatography—tandem mass spectrometry
Authors: Ru Q. C. , Zhu L. A. , Silberman J. , Mural R. , Shriver C. D. 
Published: March 2020

542 Background: Discovering biomarkers for early cancer detection is a major goal of translational research. We have applied modern proteomic technology, two-dimensional liquid-chromatography-tandem mass spectrometry (2-D LC-MS/MS), to large-scale breast cancer serum profiling. Methods: 189 human sera from breast disease or cancer patients (14 atypical hyperplasia, 63 benign, 29 DCIS, and 83 invasive CA) were analyzed via 2-D LC-MS/MS method. Patient ages ranged from 19 to 97 years, with a mean of 55. Ethnicities included African American, Asian, Hispanic, Native American, and Caucasian. This methodology utilizes only 10 μL of human serum per specimen. Every sample was run three times to ensure reproducibility and to maximize identification. The protein identification was conducted using the Bioworks Browser 3.1 and the IPI_human protein database (version 6.23.04) and filtered via HUPO criteria to ensure confidence. Results: 230 high-confidence proteins were identified from analyses of 189 sera. 26 common serum proteins were detected in all samples and 17 were found in two- or three- diagnostic stages. 83 proteins such as insulin receptor substrate 4, serine/threonine-protein kinase WNK4, DNA mismatch repair protein MSH6, and signal recognition particle 72 kDa protein were detected only in invasive sera. 30 proteins including breast carcinoma amplified sequence 3, uncharacterized bone marrow protein BM032, fibroblast growth factor receptor 2, and tumor necrosis factor receptor superfamily member 4 were detected only in DCIS sera. The 15 proteins detected only in atypical hyperplasia sera included cholecystokinin type A receptor and cell division cycle 2-related protein kinase 7. 59 proteins including serine/threonine protein phosphatase 6, probable transcription factor CST, insulin-like growth factor IA, and connective tissue growth factor were found in benign samples. Conclusions: Identification of signaling pathway/transcriptions proteins and cell cycle related proteins in breast cancer sera, and identification of breast cancer amplified sequence 3 proteins in the DCIS sera, suggest that high-throughput proteomic technologies like 2-D LC - MS/MS may facilitate the discovery of diagnostically useful breast cancer biomarkers. No significant financial relationships to disclose.