bluuebunny/crossref_metadata_2025_split huggingface dataset:
Racial and ethnic disparities in clinical presentation and prognosis of conjunctival cancer.
Authors: Zhang Yang , Aurit Sarah J , Kosoko-Lasaki Omofolasade 
Published: May 2019

e13086 Background: To investigate racial and epidemiological disparities in presentation and prognosis of conjunctival cancer in a retrospective population-based study. Methods: Non-Hispanic white (NHW) and African American patients with squamous cell carcinoma or melanoma of the conjunctiva or cornea with known age, insurance, gender, zip code-level income and education, and tumor size were selected from the National Cancer Database (NCDB). Patients were stratified based on race and ethnicity into two mutually exclusive groups, and unadjusted comparisons were made with the Chi-square or Mann-Whitney tests. Survival was examined with the Kaplan-Meier method and a Cox regression model was employed after checking that the proportional hazards assumption was met for all pertinent variables. SAS version 9.4 was used for all analyses and p< 0.05 was considered significant. Results: Of the 2,192 identified patients from 2004 to 2014, 104 were African American. Unadjusted differences were found between groups in regard to age, histology, insurance, income, and education. African American patients in comparison to NHW were younger (median age: 61 years vs. 71 years; p< 0.001), had a higher proportion of Medicaid (10.6% vs. 3.4%) or no insurance (11.5% vs. 2.7%), and resided in areas with lower levels of education (36.5% of African American patients vs. 17.0% of NHW patients were from areas with greater than 21% of the population with no high school degree). It was also found that African Americans had higher proportion of squamous cell carcinoma than NHW (69.9% vs. 81.7%; p= 0.007). In general, risk of death was higher for older African American males with no private insurance, and for those from areas of lowest level of income. Conclusions: Disparities in socioeconomic factors were observed in the African American population. In addition, the overall incidence of conjunctival and corneal cancer occurs at a younger age in African Americans, who also face poorer prognoses. This association between social inequality and poor outcome warrant further investigation.
Angiotensin converting enzyme inhibitors use and development of lung cancer: A systematic review and meta-analysis.
Authors: Bahaj Waled , Albawaliz Anas , Qureini Aref , Abughanimeh Omar Khaled Mahmoud , Younis Moustafa , Tahboub Mohammad , Noman Anas , Bin Abdulhak Aref A 
Published: May 2019

e13093 Background: Angiotensin-converting enzyme inhibitors (ACEIs) are commonly prescribed medications for hypertension and heart failure. Generally, ACEIs are well-tolerated medications with reasonable safety profile making them a favorable choice by many clinicians. However, several studies with conflicting results have signaled an association between ACEIs use and the development of lung cancer. We sought to systematically review the literature and perform the first meta-analysis to study the risk of lung cancer among ACEI users. Methods: We performed a literature review by searching multiple databases. A random effect meta-analysis approach was used to pool the data and relative risk was used to calculate the overall effect estimate. Results: A total of 423 articles were identified but only 6 observational studies were included with a total of 872,220 patients (634,672. ACEIs users). The relative risk of lung cancer development among ACEIs users was 1.02 (CI 0.89-1.16) compared to non-ACEIs users. Conclusions: Current systematic review and meta-analysis show no significant association between ACEIs use and the development of lung cancer. The result of our meta-analysis provides further assurance to the health care providers regarding ACEIs use.
Association of atrial fibrillation with colorectal and breast cancer: A systematic review and meta-analysis.
Authors: Farooq Muhammad Zain , Mukthinuthalapati V V Pavan Kedar , Lateef Noman , Siddiqi Tariq Jamal , Asmi Nisar , Malik Saad , Patlolla Sri Harsha , Riaz Irbaz Bin , Murad M. Hassan , Babiker Hani M. 
Published: May 2019

e13096 Background: Several studies have reported the association between atrial fibrillation (AF) and malignant cancer. Recently, results from a large cohort within the Women’s Health Study showed increased incident risk of breast, colon and lung cancer in patients with AF. Therefore, we performed a systematic review to assess the available evidence and a meta-analysis to define the strength of this association. Methods: MEDLINE, Cochrane and Scopus databases were searched for all prospective studies that reported the association between AF and presence of cancer. The HR for incident risk of common cancers was recorded (Breast, Lung, Colorectal) in patients with and without AF. Lung cancer was excluded because the data required for the analysis was not consistently reported. The DerSimonian-Laird random effects meta-analysis was performed to derive pooled Hazard Ratio (HR) estimates for incident risk of colorectal and breast cancer in patients with AF. Q-test was used to assess between-study heterogeneity; I2 statistic was computed to expresses the percentage of the total observed variability due to study heterogeneity. Results: A total of 390,479 participants in 3 prospective studies were included in the analysis. Mean age of participants was 66.3 ± 6.5 with mean follow up for 12.6 years. Patients with atrial fibrillation had 27% more risk of developing colorectal cancer [HR 1.27 (1.07-1.51) p < 0.005, I2= 73%] and 14% more risk of developing breast cancer [HR 1.14 (1.03-1.26) p = 0.01, I2= 37%] as compared to those without atrial fibrillation. Applying these hazard ratios to age adjusted yearly incidence ratios from 2000-2015, one in 5824 new onset AF cases will develop CRC and one in 7474 new onset AF cases will develop breast cancer. Conclusions: There is small but statistically significant increase in risk of subsequent diagnosis of colorectal or breast cancer diagnosis in patients with AF. Shared risk factors such as old age or systemic disease processes may explain this association. While the results of this analysis raise interesting questions for future search, these results should not be used as basis to initiate cancer screening for an occult cancer in a patient with AF.
Time to cancer diagnosis in young women presenting to surgeons with breast-related symptoms: A population-based cohort study.
Authors: Menes Tehillah S , Sella Tal , Chodick Gabriel 
Published: May 2019

e13099 Background: Reports on delay to diagnosis of cancer in young women are based on retrospective studies and conflicting. The purpose of this study was to investigate time to cancer diagnosis in women presenting to a surgeon with breast-related complaints; and particularly, the role of age. Methods: A population-based cohort study including all women aged 18 to 44 presenting to a surgeon with a breast-related complaint between 2005 and 2015 in a large Israeli healthcare plan (N = 157,264). We collected data including demographics, diagnosis codes, breast imaging and biopsies. Breast cancer diagnosis within one year of the visit was ascertained from the national cancer registry. Time to breast imaging and biopsy was compared between the different age groups. Logistic regression analysis was used to determine the association between age and delay to biopsy while adjusting for possible confounders. Results: During the first year after the visit, 45,434 (29%) women had a breast imaging study; 5,767 (3.7%) women had a breast biopsy; and 676 (0.43%) were diagnosed with breast cancer. Overall, time to first breast imaging (mean, 53 days) and biopsy (mean, 68 days) did not differ significantly between the age groups. Non-specific visit codes (other than breast mass) were associated with delays to imaging and biopsy. This was more pronounced in the women ultimately diagnosed with breast cancer. Among women diagnosed with breast cancer, age under 40 (OR 2.3, 95% CI 1.4; 3.9), being post-partum (OR 2.6, 95% CI 1.1; 5.9) and a non-specific visit code (OR-8.3, 95% CI 4.9; 14.2) were associated with delay to biopsy. Conclusions: Symptomatic women with lower a-priori likelihood of breast malignancy (younger age, post-partum, or non-specific visit code) are at a significantly greater risk of delayed diagnosis of cancer. Physicians should be aware of the challenging diagnosis in young women with non-specific symptoms.
Global burden of HPV-related cancers in men: A systematic literature review.
Authors: Varga Stefan , Wang Xuan , Luttropp Karin , Morais Edith , Walia Anuj , Pimpin Laura , Eriksson Jennifer , Kothari Smita 
Published: May 2019

e13108 Background: Human papillomavirus (HPV) causes about 5% of all cancer cases worldwide. Global male-specific incidence of HPV-related cancers, including anal (AC), penile (PC) and head and neck (HNC) cancer, is largely unknown. This study aims to summarize global incidence and HPV prevalence of these cancers in men. Methods: The systematic literature review was conducted following PRISMA guidelines. MEDLINE and EMBASE were searched for studies published in English between Jan 2008-Mar 2018 containing male-specific AC/PC/HNC incidence data, or HPV prevalence in AC/PC/HNC adult patients. Results: Fifty-six studies reported AC incidence in men between 1962-2014. The rate ranged between 0-1.5/100,000 persons in the general population. Globally, AC incidence increased over time. In the US, AC incidence in HIV-positive men increased from 10.5 to 20.7/100,000 person-years (PYs) from 1980-1989 to 1990-1995, and from 47 to 270/100,000 PYs between 1984 and 2013 in HIV-positive men who have sex with men (MSM). Prevalence of any HPV among men with AC ranged between 20-96%, HPV-16 and -18 being the most prevalent (14-100% vs 8-24%). PC incidence among men was reported in 14 studies between 1962-2015. The rate ranged between 0-10.2/100,000 persons (0-12.8/100,000 PY), with higher incidence rates in older men. Prevalence of any HPV among men with PC ranged between 6.3-100%, HPV-11 and -16 being the most prevalent (0.7-80% vs 18.1-79.2%). HNC incidence among men was reported in 66 studies between 1973-2014. Global cancer registry data reported a range of HNC incidence from 1.4-42.2/100,000, declining over time depending on the geographical location. The corresponding incidence range for oropharyngeal cancer (OPC) was 0.4-17.8/100,000, with higher incidence rates for men aged 55 and above and a rapid increase during the past decade in well-developed regions. Prevalence of any HPV ranged between 0-93.8%, HPV-16 and -18 being the most prevalent (1.2-86% vs 2.5-46.9%). Conclusions: This review demonstrates the existing burden of HPV-related cancers globally. Overall, the incidence of HPV-related AC and OPC appears to have increased among men between 1962 and 2015, highlighting a growing unmet medical need and the importance of preventing HPV infection.
Influenza and mortality for non-small cell lung cancer.
Authors: Kinslow Connor J , Wang Yuankun , Liu Yi , Zuev Konstantin M. , Wang Tony J. C. , Donalek Ciro M. , Amori Michael , Cheng Simon 
Published: May 2019

e13114 Background: Lung cancer is the leading cause of cancer deaths in the United States and worldwide. While influenza illness is known to be particularly dangerous for frail and elderly patients, the relationship between influenza illness and outcomes in cancer patients remains largely unknown. Methods: Monthly mortality rates for all patients at risk, as well as newly diagnosed patients, with non-small cell lung cancer (NSCLC) diagnosed between 2009 and 2015 were compared during high and low flu months using data from the Surveillance, Epidemiology, and End Results (SEER) Program and the Center for Disease Control and Prevention (CDC) website. Influenza severity was determined by the percentage of outpatient visits to healthcare providers for influenza-like illness (ILI). CDC ILI activity levels were matched with SEER data by month and state. State-months with an ILI activity level of 8 or higher were considered to be high flu months, as defined by the CDC. Results: 195,038 patients with NSCLC from 13 states were included in the analysis. 52 out of 1,081 state-months (5.1%) had high flu activity. Monthly mortality rates for low and high flu months were 4.9 and 5.7%, respectively (p = .001). The monthly mortality rate for newly diagnosed patients was also significantly higher during high flu months (9.4 vs. 10.2%, p = .01). When the analysis was limited to winter months only, monthly mortality rates for low and high flu months were 4.7 and 5.3%, respectively (p = .02). The relationship between flu severity and mortality was also observed at the individual state level. Conclusions: Increased influenza severity is associated with higher mortality rates for NSCLC patients. Future research should elucidate the relationship between vaccination and survival in lung cancer patients.
Analysis of nationwide lung, breast, and prostate cancer incidence in relation to provider availability and training programs in oncology.
Authors: Mehta Smit , Krikorian Armand A 
Published: May 2019

e13116 Background: Lung, Breast, and Prostate cancer are the leading causes of cancer incidences and mortality across all ages, races, and genders. These accumulate to 1.2 million deaths from 2011-2015. We hypothesize that the regional provider availability should match the local patterns of cancer incidences due to resource scarcity. This analysis examines the nationwide incidence of the most common cancers in relation to provider availability and conducts a further analysis of the location of training programs in relation to cancer incidence. Methods: Lung, Breast, and Prostate cancer incidences in the U.S. between ages 19-85 was assessed using data from the CDC and NCI. Oncology fellowships were found through the ERAS portal and the databases of the AMA. Oncologists’ practicing locations were found using Doximity data. These datasets were mapped using Google Maps software and a gap analysis was conducted. Results: In 2015, approximately 6.2% of the population were diagnosed with lung cancer, 12.4% of women with breast cancer, and 11.2% of men with prostate cancer. The highest incidences were seen in Kentucky, Connecticut, and New Jersey. Above average incidences were seen in New Hampshire, West Virginia, Mississippi, Louisiana, and Massachusetts. Roughly 25% of the 16,215 registered oncologists were concentrated in Florida, Texas, and California. A total of 132 oncology fellowships were identified, with only eight located within a 50-mile radius of the areas of most need. Conclusions: We found a significant disparity in the distribution of cancer incidences versus location in oncologists and fellowship programs. This data, along with data from the 2018 National Oncologists Workforce suggests that Florida, California, Michigan, Illinois, and New York have the highest percentage of oncologists near or above retirement age; indicating that the gap is likely to widen. It also showed a 12-fold variation in oncologist retention compared to where they completed their fellowship, with metropolitan areas in California rounding out the top 10 highest percentages of trained oncologists1. This highlights the need to match the workforce with areas of highest need, such as the Appalachian states; which have some of the highest cancer incidences and largest discrepancies of training programs and oncologists.
Vitamin D deficiency in patients with newly diagnosed cancer.
Authors: Shaikh Hira , Bakalov Veli , Mao Shifeng 
Published: May 2019

e13117 Background: Vitamin D deficiency (VDD) is pandemic in modern society. There has been increasing interest in vitamin D and its impact on cancer. A number of studies have been published on a possible link between VDD and cancer. However, because of inconsistent results, controversy remains in various aspects of vitamin D. In this study, we assessed the association of VDD with various cancers. Methods: A retrospective study was conducted in a tertiary care hospital network in western Pennsylvania. Electronic health record database was used to extract the data from patients seen in outpatient office with newly diagnosed cancer who had a measured 25-hydroxy vitamin D level at diagnosis between 02/2016 and 02/2018. VDD was defined as level less than 30 ng/dl. Patient demographics, smoking, and vitamin D status were used for multivariate logistic regression analysis in order to determine odds ratio (OR) of certain cancer type in our cohort. We used SPSS version 23 for statistical analysis. Results: A total of 934 patients (59.2% female) with cancer were included. Most patients, 86.4%, were Caucasian, and 10.8% African American (AA). VDD was found in 433 patients (46.4%) and more prevalent in men (n = 203, 53.3%), and AA (n = 65, 64.4%) in our cohort. The most common cancer type was breast cancer (30.9%), followed by prostate cancer (11.3%), lymphoma (11.1%), and lung cancer (7.8%). After adjusting to demographic characteristics and smoking status, VDD was significantly associated with pancreatic cancer (OR = 2.28, p = 0.02), and reversely associated with breast cancer (OR = 0.56, p = 0.001). VDD was also prevalent in colorectal cancer, but not statistically significant, (OR = 1.71, p = 0.064). Conclusions: Our study demonstrated that VDD is prevalent among cancer patients, especially in men and AA patients. There is a strong association between VDD and the malignancies of digestive system, particularly pancreatic cancer. Further studies are needed to assess the effect of VDD on disease-specific risk and cancer mortality as well as the impact of vitamin D supplement.
Determination of plasma EGFR mutations from non-small cell lung cancer patients at Bach Mai Hospital.
Authors: Pham Cam Phuong , Mai Khoa Trong , Loi Nguyen Thuan , Hien NGO Thi Thu , Vo Quynh Thi Thuy , Tran Ha Dinh 
Published: May 2019

e13121 Background: Lung cancer patients with mutations in the epidermal growth factor receptor (EGFR) are primary candidates for EGFR-targeted therapy. Reliable analyses of such mutations have previously been possible only in tumor tissue. Here, we demonstrate that mutations can be detected in plasma samples of non-small cell lung cancer patients at Bach Mai Hospital and relation of different variables to the frequency of EGFR mutations. Methods: 193 patients with non-small cell lung cancer were identified with EGFR mutation by cobas EGFR Mutation Test v2 kit (Roche Diagnostics, USA), evaluating the EGFR mutation status with different variables. Results: The EGFR mutation rate was 43%, common in patients with adenocarcinoma, female, non-smoking, late stage disease. The rate of EGFR T790M mutation was 36.1%. Among 78 patients who was previous treated TKIs, EGFR mutation rate was 73.1% and the rate of EGFR T790M mutation was 50.8% at the time of progression. The concordance of EGFR mutation from plasma sample with tissue sample was 81%. Conclusions: EGFR mutation in plasma sample results was not different from those in tissue samples and similar with result of studies in Vietnam and worldwide.
Molecular characterization of NSCLC-like and SCLC-like subsets in Chinese pulmonary large cell neuroendocrine carcinoma (LCNEC).
Authors: Wu Lin , Cao Liming , Chen Likun , Zhu Bo , HU Xiaohua , Gen Lin , Lin Yingcheng , Zhang Sheng , Huang Cheng , Peng Wenying , Jiang Meilin , Mao Xinru , Zhang Tengfei , Ye Junyi , Zhang Lu 
Published: May 2019

e13125 Background: LCNEC is an aggressive, biologically heterogenous carcinoma which can be molecularly characterized as SCLC-like and NSCLC-like. Accurate distinction of molecular subset is of major clinical relevance since it may guide treatment choices in LCNEC. Here we determined the genomic characteristics of the two LCNEC subsets in a Chinese cohort to clarify their correlations with traditional lung cancer histologies. Methods: FFPE samples from 31 LCNECs were sequenced using a 520-cancer-related gene panel, with an average sequencing depth of 1353X. Comparative mutational analysis was conducted between NSCLC-like LCNECs from our cohort and adenocarcinomas from TCGA dataset. Results: Despite similar clinical features in terms of stage and age at diagnosis, NSCLC-like (42%, 13/31) and SCLC-like (32%, 10/31) subsets from LCNEC displayed distinct molecular characteristics. NSCLC-like subset harbored significant higher mutation frequencies of STK11, KEAP1 and FAT3 (53.8%, 38.5% and 38.5%, p = .007, .046 and .046), while SCLC-like subset was characterized by highly mutated RB1 (100%, p < .001) and PTEN (50%, p = .007). Compared with TCGA adenocarcinomas, NSCLC-like LCNEC displayed more frequent mutations in TP53, STK11, APC, KMT2D and SMARCA4 (76.9%, 53.8%, 30.8%, 30.8% and 23.1%; p = .043, .004, .045, .005 and .049). In addition, potential targetable alterations were present in 46.2% (6/13) pts of NSCLC-like subset. For those advanced stage pts, 2/5 NSCLC-like and 5/5 SCLC-like pts received relevant chemotherapy according to their molecular characteristics. The clinical outcomes of these pts are still under follow-up. Conclusions: This study demonstrates the distinct molecular features between NSCLC-like and SCLC-like subsets, and highlights the predominant genomic similarity and separate entities between NSCLC-like LCNEC with adenocarcinoma. Given the evidence that genomic profiling may aid in informing treatment decisions for pts with LCNEC, our study indicates that, based on accurate molecular typing, 46.2% NSCLC-like pts may benefit from potential targeted therapy and the rest of them may be more suitable to receive NSCLC-chemotherapy.
Clinical significance of pathogenic variants in germline BRCA wild type patients at risk for hereditary breast cancer.
Authors: Kuang Xiaying , Lin Ying , Shao Nan , Yu Liang , Shan Zhen , Chen Shuyin , Shi Xinyi , Liu Hao , Liu Jing 
Published: May 2019

e13127 Background: Approximately, 10% of breast cancer (BC) are related to inherited germline mutations. BRCA1/2, the most recognized and tested genes, are responsible for 50% of hereditary BC. Genetic testing for hereditary BC has changed significantly. Increasing evidence suggests parallel multigene testing. Methods: NGS-based germline BRCA status assessment was performed on 209 high risk BC patients with at least one of the following risk factors: triple negative BC, early onset ( < -45), with a family history of BC, bilateral BC and male BC. Multigene-panel testing was subsequently offered to patients with at least 2 of the risk factors and WT germline BRCA. Capture-base targeted sequencing was performed on white blood cells using a panel consisting of 53 hereditary cancer-related genes, spanning 229kb of human genome. Results: Among the 209 patients screened, only 12 patients had pathogenic BRCA1/2 mutation. Next, we investigated the prevalence of non- BRCA pathogenic germline pathogenic mutations in patients with at least 2 risk factors. Thirty-seven patients met the criteria and only 23 patients had sufficient WBC DNA for sequencing. This cohort had a median age of 42, with a majority carrying infiltrating ductal carcinoma. Except for one bilateral BC patient who had stage IV disease, all other patients had early stage disease. We identified 5 pathogenic mutations from 5 patients spanning 4 genes: PALB2, PTEN, ATM and WRN, resulting in a prevalence rate of 20% for pathogenic germline mutations in high risk germline BRCA WT BC patients. Two patients carried mutations in PALB2, one with a frameshift and another with a splice mutation. Mutation types for PTEN, ATM and WRN were splice mutation, stop gain mutation and frameshift mutation, respectively. All 5 patients were diagnosed with BC before the age of 40. Three of them had bilateral BC; one had triple negative BC and another patient had a family history of BC. Conclusions: Our study confirms the clinical significance of testing non- BRCA genes, and suggests multigene panel testing for patients at risk for hereditary BC. Such approach increases the identification of hereditary BC, thus impacting clinical decision-making.