bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identification of prognostic variables in advanced ovarian cancer based on real-world patients from big data analytics.
Authors: García-Donas Jesús , Sevillano Elena , Muñoz Sergio , Bote Luis , Yagüe Monica , Lainez Nuria , Guerra Eva Mª , Garrido Maria , Garcia-Donas Teresa , Amarilla Sandra , Navarro Paloma , Ruiz Sergio , Fenor MD , Rodriguez-Moreno Juan Francisco , Rojo Jose Luis 
Published: May 2019

e17104 Background: Prognosis of advanced ovarian cancer is dismal with most cases recurring after initial surgery. Current factors able to predict the evolution of the disease are limited to BRCA status and platinum sensitivity. We aim to explore the potential of different clinical variables as prognostic factors using big data analytics in currently available hospitalary departmental information systems. Methods: An observational study with two cohorts (one prospective and one retrospective) was designed. Inclusion criteria were adult patients ( > 18 years old) diagnosed with epithelial ovarian cancer stage IC or superior.Clinical and histological data were recorded by a central data manager to ensure homogeneity in data collection. Big data analytics consisted on building an approximation to the statistical distribution of the tests to distinguish different kinds of features (metric, categorical, free text). Bootstrap resampling allowed to characterize the confidence regions for proportion differences, average differences, and text-profile differences in exitus vs in non-exitus groups. Results: Up to 265 patients in four different hospitals were recruited. Median age was 59 years (range 20-87), stage distribution was 48 (18%) I, 20 (8%) II, 122 (46%) III, 41 (15%) IVand 34 (13%) NA. Histology distribution was 158 (60%) papillary serous, 31 (12%) endometrioid, 18 (7%) clear cell, 11 (4%) mucinous and 47 (18%) NA. 152 (58%) patients underwent upfront surgery, 76 (29%) interval surgery and 10 (4%) no surgical intervention, 27 (10%) NA. 207 (78%) achieved optimal cytoreduction. 232 (88%) received adjuvant chemotherapy, most with carboplatin plus paclitaxel 180 (68%) and 48 (18%) also with bevacizumab. Median follow up was 81.4 months (CI95% 64.1-98.7) The proposed Big Data analytics identified a higher frequency of upfront surgery (vs interval surgery) and bevacizumab administration (vs chemotherapy alone) in the non-exitus group. Conclusions: Our results point to the notion that performance of upfront surgery and bevacizumab administration could have a long term impact in ovarian cancer. Simple Big Data analytics can contribute to identify new prognostic factors and to assess their real impact on patients managed in daily practice.
Patterns of distant metastases in patients with endometrial carcinoma: A SEER population-based analysis.
Authors: Li Jun , Sun Li , Zhang Yuzi , Cai Shangli 
Published: May 2019

e17109 Background: Endometrial carcinoma is the most common gynecology malignancies in the worldwide. The clinical outcome of endometrial carcinoma is excellent, with disease specific survival rate over 90% in early stages. However, the prognosis of metastatic endometrial carcinoma is poor and the pattern of distant metastases has not been well characterized. In the present study, we sought to assess the incidence and prognosis of different distant metastatic sites in endometrial carcinoma. Methods: Patients who were diagnosed with endometrial carcinoma between 2010 and 2015 were identified according to the following criteria in the Surveillance, Epidemiology, and End Results (SEER) database: (1) confirmed age and older than 18 years old; (2) enrolled patients should have confirmed distant visceral metastatic status information. Kaplan-Meier analysis and log-rank tests were used to estimate the overall survival (OS) between difference groups. Data were analyzed with GraphPad Prism (version 7.01, GraphPad Software, USA), and R (version 4.3.1, R Development Core Team). Results: A total of 73328 patients with endometrial carcinoma were included. Median age of diagnosis was 62 years and 80.3% of patients were white. 92.8% of patents have received surgery. 4.2% of patients (3053/73328) suffered at least one site of distant metastases. The most common metastasis site was lung (1331/73328, 1.82%), followed by distant lymph nodes (1191/72703, 1.6%), liver (661/73328, 0.9%), bone (475/73328, 0.65%) and brain (133/73328, 0.18%). Median OS was 15 months, 4 months, 7 months, 9 months and 8 months for pure distant lymph node, brain, bone, lung and liver metastases, respectively. Furthermore, metastatic sites showed significant impact on OS in univariate analysis. Multivariate analysis with COX proportional regression model showed that distant metastatic sites were independent prognostic factors of OS. Conclusions: Lung is the most common distant metastatic site of endometrial carcinoma. Patients with pure distant lymph node metastasis exhibited the best overall survival, while patients with brain metastases had worst clinical prognosis compared with other metastatic sites.
Hysterectomy utilization among newly diagnosed endometrial cancer patients by body mass index category: A real-world analysis using a claims and electronic health record database.
Authors: Irwin Debra E. , Thiel Ellen 
Published: May 2019

e17112 Background: For endometrial cancer (EC), laparoscopic hysterectomy (LH) is an effective, minimally invasive surgical treatment; however, this approach may not be recommended for obese patients due to increased risk for complications. Methods: This retrospective study utilized insurance claims linked to electronic health record (EHR) data contained in the IBM MarketScan Explorys Claims-EHR Data Set. Newly diagnosed EC patients (1/1/2007 - 6/30/2017) with continuous enrollment during a 12-month baseline and 6-month follow-up period were selected. Patients were stratified into four BMI subgroups based on baseline BMI on the EHR: normal or underweight (BMI < 25), overweight (BMI 25- < 30), obese (BMI 30- < 40), morbidly obese (BMI > 40), and were required to have had a hysterectomy within the follow-up period. Emergency room visits and rehospitalization within 30 days of hysterectomy were measured. Results: A total of 1,090 newly-diagnosed EC patients met the selection criteria, of whom, 16% were normal/underweight, 19% were overweight, 39% were obese, and 26% were morbidly obese. The proportion of patients receiving LH increased as BMI category increased (Table 1). Among those with LH between 6% and 15% had an ER visit or rehospitalization in 30 days, and rates were higher among other hysterectomy modalities. Conclusions: This real-world analysis shows that LH is utilized in a high proportion of morbidly obese EC patients, despite that it is frequently deemed infeasible in this patient population. Although the rate of ER visits and rehospitalization is lower among LH patients than those undergoing traditional hysterectomy across all BMI strata, further research is needed to determine the optimal patient population to receive LH.[Table: see text]
Association betweenBRCA1 and BRCA2 mutations and prognosis in women with endometrial carcinoma.
Authors: Wang Aifen , Holloway Robert W. , Cui Lijuan , Sun Yan , Zhao Zihan 
Published: May 2019

e17115 Background: To evaluate the prognosis of BRCA mutation carriers compared to non-carriers and to demonstrate whether BRCA1 and BRCA2 mutation carriers present similar survival patterns among endometrial carcinomas. Methods: This data was from NCI Cancer Genome Atlas endometrial cancer database (TCGA) with pathogenic mutations in BRCA1 (58) or BRCA2 (77) or BRCA1and BRCA2 coexisted mutation (40) and non-mutation (461). We compared clinicopathologic features and prognosis of patients with BRCA1 or BRCA2 or BRCA1and BRCA2 coexisted mutation. Survival time was analyzed for the combined data using Cox proportional hazard models with BRCA1and BRCA2 as time-varying covariates. Results: We found histologic types of patients with BRCA1 or BRCA2 mutation presented more progressive than non-carriers ( p = 0.029, p= 0.029, respectively). BRCA1 or BRCA2 mutations were detected to be associated with younger patients at diagnosis ( p = 0.036, p = 0.001, respectively). BRCA2 mutation carrier was identified more advanced stage than BRCA non-carriers. Compared to patients with BRCA1 mutation, the body mass index is higher in non-carriers. Before around 100 months survival, BRCA2 mutation carriers had the most favorable overall survival (OS). OS rate of all patients with BRCA1 or BRCA2 mutation was higher than non-carriers. BRCA1 and BRCA2 mutation carriers had similar OS. Around 100 months later, BRCA1 carriers had more favorable OS than patients with BRCA2 mutation, BRCA1 / BRCA2 coexisted mutation and non-carriers ( p < 0.001). Patients with BRCA2 mutation had the most favorable progression-free survival (PFS), following by BRCA1 and BRCA2 coexisted mutation and BRCA2 alteration carriers ( p= 0.011). BRCA non-carriers had the worst PFS and OS all the time. Conclusions: BRCA1 or BRCA2 mutation carriers have favorable overall survival and progression-free survival among patients with endometrial carcinoma. [Table: see text]
The influence of obesity on tumor recurrence in vulvar cancer patients.
Authors: Klapdor Rüdiger , Hillemanns Peter , Woelber Linn Lena , Jueckstock Julia Kathrin , Hilpert Felix , de Gregorio Nikolaus , Hasenburg Annette , Sehouli Jalid , Ignatov Atanas , Fuerst Sophie , Strauss Hans-Georg , Baumann Klaus , Thiel Falk , Mustea Alexander , Meier Werner , Harter Philipp , Wimberger Pauline , Hanker Lars Christian , Schmalfeldt Barbara , Mahner Sven 
Published: May 2019

e17130 Background: Obesity is associated with worse patients’ survival in several cancer entities. Vulvar cancer as well as obesity show increasing incidence over the last years. The influence of obesity on prognosis of vulvar cancer patients is not clear. However, knowledge about this may have consequences on prevention, treatment, and follow-up. Methods: This is an analysis of the large AGO-CaRE-1 study. Patients suffering from squamous cell vulvar cancer (UICC stage IB and higher), treated in 29 cancer centers between 1998 and 2008, were categorized in a database, in order to analyze treatment patterns and prognostic factors in a retrospective setting. Results: In total, 849 patients with documented height and weight were divided into two groups depending on their body mass index (BMI, < 30 vs. ≥30 kg/m²). There was no difference in the baseline variables (age, tumor diameter, depth of infiltration, tumor stage, nodal invasion, tumor grade) between both groups (p > 0.05). However, we identified differences regarding ECOG status and preexistent comorbidities (cardiovascular, dementia) towards healthier patients with BMI < 30 kg/m². Treatment variables (R0 resection, chemotherapy, radiotherapy, continuation of adjuvant therapy) did not differ (p > 0.05). Patients with BMI ≥30 kg/m² underwent radical vulvectomy more often (61.1 % vs. 51.8%, p = 0.042). During follow-up, there was a higher recurrence rate in the group having a BMI ≥30 kg/m² (43.4%, vs. 28.3%, p < 0.01) due to an increased rate of local recurrences (33.3% vs. 18.5%, p < 0.01). The rate of groin and distant recurrences was similar between both groups (p > 0.05). Noteworthy, we observed a significantly shorter disease free survival (DSF) of the obese patients in univariate analysis (HR 1.362, 95%CI 1.093-1.696, p = 0.006). Even in multivariate Cox-regression analysis including age, ECOG, tumor stage, type of surgery, nodal invasion, tumor grade, and comorbidities patients with BMI ≥30 kg/m² had a significantly shorter DFS (HR 1.811, 95%CI 1.005-3.262, p = 0.048). Conclusions: In this first large study about the association between obesity and prognosis of vulvar cancer patients, we observed that a BMI ≥30kg/m² was associated with shorter DFS, mainly attributed to a higher risk for local recurrence.
Apatinib in treating patients with platinum-resistant or platinum-refractory recurrent or metastatic nasopharyngeal carcinoma.
Authors: Chen Xiaozhong , Tao Changjuan 
Published: May 2019

e17502 Background: To evaluate the efficacy and safety of apatinib in treating patients with platinum-resistant or platinum-refractory recurrent or metastatic nasopharyngeal carcinoma. Methods: In this phase 2, single-arm, prospective study, we recruited patients aged 18–65 years with platinum-resistant or platinum-refractory recurrent /metastatic nasopharyngeal carcinoma. Patients were treated with apatinib at an initial dose of 500 mg once daily and continued until disease progression, patient withdrawal, or unacceptable toxic effects. The primary endpoint was clinical benefit rate (CBR) and toxicity. Secondary endpoints included progression-free survival (PFS) at 3 months and overall survival (OS). We used Simon’s two-stage design, and analysed efficacy and toxicity in the intention-to-treat and per-protocol populations. This study is registered with ClinicalTrials.gov, number NCT03213587. Results: Between Aug 5,2017 and Oct 13,2018, we enrolled 16 patients. Until the final follow-up (Jan 14, 2019), the CBR (complete response + partial response+ stable disease) was 69.2% (9/13) in the per-protocol population. Median PFS and 3-month PFS rate were 3.70 (95% CI, 0-8.771) months and 67.1%, respectively. Median OS and 1-year OS rate were 12.9 (95% CI 5.56-20.23) months and 47.9%, respectively. The most common grade 3-4 adverse events were neutropenia (1[6.25%]), hand-foot syndrome (2[12.5%]), albuminuria (2[12.5%]), hypertension (1[6.25%]), hyponatremia (1[6.25%]), artery dissection (1[6.25%]) and nasopharyngeal hemorrhage (2[12.5%]) in the intention-to-treat population. Serious adverse event was reported in one patient who died of nasopharyngeal hemorrhage. Conclusions: Apatinib achieved excellent disease control in platinum-resistant or platinum-refractory recurrent or metastatic nasopharyngeal carcinoma. More attention needs to be paid to toxicity management. Clinical trial information: NCT03213587.
Practice patterns and outcomes following radiation dose de-escalation for oropharyngeal cancer: A National Cancer Database analysis.
Authors: White Richard , Abel Stephen , Hasan Shaakir , Verma Vivek , Greenberg Larisa , Colonias Athanasios , Wegner Rodney E 
Published: May 2019

e17508 Background: Numerous trials are evaluating radiotherapy (RT) de-escalation for HPV-mediated (HPV+) oropharyngeal squamous cell carcinoma (OPSCC). Herein, we evaluated the degree to which de-escalated RT is delivered in the United States, as well as, comparative outcomes with full-dose RT, as stratified for HPV status. Methods: We identified patients diagnosed with OPSCC in the National Cancer Database, excluding those with stage I/II disease, unknown HPV status, receiving surgery or not receiving EBRT to the primary site, receipt of radiation doses > 75 or < 54 Gy, radiation treatment course duration < 25 or > 75 days, and unknown or inadequate ( < 2 months) follow-up. Multivariable logistic regression analysis identified variables associated with delivery of de-escalated RT ( < 66 Gy). Overall survival of HPV+ and HPV- disease was compared between full-dose and de-escalated approaches. Results: Altogether, 617 and 551 patients were HPV+ and HPV-, respectively. De-escalated RT was delivered in 16.9% HPV+ and 15.2% of HPV- disease, respectively. Older patients and those not receiving systemic therapy were more likely to receive de-escalated RT. In HPV+ patients, 3- and 5-year survival rates were 83% and 80% in the de-escalated cohort versus 83% and 78% in the full-dose group (p = 0.83). In HPV- patients, corresponding 3- and 5-year survival rates were 29% and 23% versus 61% and 51% (p = 0.001). Conclusions: National utilization of de-escalated RT for OPSCC is low (15-20%), but does not seem to impact overall survival in HPV+ (but not HPV-) patients. The caveats of this heterogeneous, retrospective analysis require corroboration from a number of ongoing randomized trials.
A Nationwide analysis of mortality trends in geriatric and non-geriatric patients with oral cavity tumors.
Authors: Waseem Bushra , Ajebo Germame Hailegiorgis , Krutchik Allan N. , Guddati Achuta Kumar 
Published: May 2019

e17510 Background: Squamous cell carcinoma is the most common histological-subtype of oral cavity tumors and no major advances in its treatment have occurred recently. However, p16 positive tumors have been noted to have a better prognosis than p16 negative tumors. Older patients have increasingly been found to have p16 positive oral cavity cancers. This study explores the incidence based mortality of geriatric patients irrespective of p16 status. Methods: Data from Surveillance, Epidemiology, and End Results (SEER) Database was extracted to study the incidence-based mortality for the years 2000 to 2014. Incidence-based mortality for all stages of oral cavity tumors was queried and the results were grouped by age (geriatric vs. non-geriatric) and race (Caucasian/White, African American/Black, American Indian/Alaskan native and Asian/Pacific Islander). All stages and both genders were included in the analysis. T-test was used to determine statistically significant difference between various subgroups. Linear trend lines were used to visualize the mortality trends between various subgroups (Geriatric vs. Non- geriatric and Caucasian vs. African American). Results: Incidence-based mortality for oral cavity tumors has worsened since 2000 to 2014 for geriatric patients (p < 0.05) when compared to non-geriatric patients in both Caucasian/White patients and African American/Black patients. The results are summarized in the table below. Conclusions: The similarity in incidence-based mortality for geriatric patients with oral cavity tumors is high in all races and may imply age as a significant risk factor in these patients. A stage-specific, gender-specific and age-binned analysis may help differentiate these concerning trends. [Table: see text]
Survival estimates for young patients with tongue cancer: An analysis of the SEER database.
Authors: Khullar Pooja , Pendharkar Dinesh , Gupta Sumant , Vatsal Shivam , Dhingra Neeraj 
Published: May 2019

e17549 Background: Carcinoma tongue is a common malignancy with increasing trend. Studies have suggested poor outcomes in young patients. To better understand ,we reviewed survival in young patients of tongue cancer from Surveillance and Epidemiologic and End Results (SEER) analysis. Methods: We identified 261 patients, aged 15 to 29 years, with squamous cell carcinoma tongue reported to SEER program between 2004 to 2015. Cases were categorized by age, sex, laterality, stage. Survival rates were compared using SPSS software. Results: The group had male to female ratio of 1.2:1, with a median age of 26 years. According to ICD-03, 85 patients (32.6%) had keratinizing variant of squamous cell carcinoma. About 40 patients (15.2%) had grade I, 161(61.7%) grade II and 46 (17%) – had grade III tumors. Out of 216 patients laterality was not paired in the majority (214-82%), while 24 (9.2%) had left side and 21 (8%) had right side primaries. According to the AJCC staging classification - 90 patients (34.5%) had stage I, 36 (13.6%)- stage II, 50 (18.9%)- stage III, and 83 (30%) as stage IV disease. Surgical procedures included- excisional biopsy in 13 patients (4.9%), 183 (69.3%) had wide local excision, 37 (14%) underwent radical excision of the tumor. Overall 193 patients were alive (73%), 40 patients (15.2%) died of cancer and 20 (7.6%) died of other causes. Average survival was 41 months (range 0-142 months). The median survival did not differ between male and female (35 vs 45, p = NS). Grade of the tumor had no impact on survival (33, 44 and 32 months-well, moderately and poorly differentiated respectively). Similarly keratinizing tumors had equal to other squamous non classified tumors ( 45 vs 31 months). The staging of the tumor was predictive of the survival(p < 0.01) .Median survival as per the stage was 62, 46, 36 and 20 months for stage I,II,III and IV respectively .There was no statistical difference based on laterality of the tumor( left sided 28 months vs right sided 22 months).As per TNM staging small lesions survived better : 60, 45, 17 and 13 months respectively for T1 ,T2 ,T3 and T4 size (p < 0.006). Nodal status was also strong predictor of the survival p < 0.001) , 49,45,31 and 19 months respectively for N0, N1, N2 and N3 tumors. Metastatic disease also shortened survival significantly (p < 0.001) , 42 month with M0, while 3 months only for M1 disease. Conclusions: In young patients with tongue cancer, stage of the disease, size of the tumor, nodal status has significant impact on survival. Other parameters like sex, histological type, grade of the tumor, laterality has no major impact.
The effect of induction chemotherapy on tumor volume changes in patients with locoregionally advanced nasopharyngeal carcinoma.
Authors: Han Guang , Li Ying , Wu Yuan , Bi Jianping , Li Yanping , Zheng Dandan , Xie Conghua , Hu Desheng 
Published: May 2019

e17557 Background: The use of induction chemotherapy (IC) in locoregionally advanced nasopharyngeal carcinoma (NPC) for radiotherapy target volume reduction is increasing, however, the number of cycles is still varying. The purpose of this study was to observe changes in the gross tumor volumes of nasopharynx primary lesion (GTV_T), metastatic retropharyngeal lymph node (GTV_RP), and metastatic cervical lymph node (GTV_N) on longitudinal CT images during multi-cycle IC, and identify the optimal number of IC cycles. Methods: Eighteen patients with locoregionally advanced NPC received 3 cycles of platinum-based doublet IC. Each patient underwent an initial CT scan before the first cycle, followed by repeat CT (rCT) scans 14 days after each IC cycle. GTV_T, GTV_RP, and GTV_N were contoured on each CT. Wilcoxon signed-rank test was used for the comparing the longitudinal tumor volume changes. Results: The volume reductions of GTV_T, GTV_RP, and GTV_N following IC were found to have different magnitudes. Compared with GTV_T0 (before IC), the volume changes of GTV_Tn (n = 1, 2, 3) after IC were -3.1±0.7 cm3, -7.0 ±1.9 cm3 and -6.9 ±2.0 cm3, respectively, corresponding to relative reductions of 12.0%, 22.5%, and 20.1%, respectively. The GTV_T volume reduction was significant following the first two cycles of IC ( P< 0.05) but insignificant following the third cycle. Similarly, compared with GTV_RP0, the volume changes of GTV_RPn (n = 1, 2, 3) after IC were -1.4±0.4 cm3, -2.5±0.5 cm3 and -2.4±0.5 cm3, respectively, corresponding to relative reductions of 26.0%, 44.1%, and 42.2%, respectively. Again, the volume significantly decreased following the first two IC cycles ( P< 0.05) but remained unchanged or even slightly increased after the third cycle. In contrast, compared with GTV_N0, the volume changes of GTV_Nn (n = 1, 2, 3) after IC were -7.3±1.7 cm3, -13.5±2.9 cm3 and -17.2±3.4 cm3, respectively, corresponding to relative reductions of 25.3%, 43.2%, and 54.7%, respectively. For GTV_N, significant volume reduction ( P< 0.05) was observed following each of the three IC cycles. All patients experienced grade 1 or 2 adverse events. Conclusions: A two-cycle IC is recommended for patients with large GTV_T and GTV_RP volumes before radiotherapy. However, for patients with a large GTV_N volume, a 3-cycle IC before radiotherapy is recommended.