bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of myeloma cast nephropathy in the era of anti-CD38 monoclonal antibody-based frontline therapy: A retrospective cohort study.
Authors: Hughes Michael Sang , Balev Metodi , Radhakrishnan Jai , Bhutani Divaya , Mapara Markus Y. , Eisenberger Andrew , Lentzsch Suzanne , Chakraborty Rajshekhar 
Published: June 2024

7555 Background: Myeloma cast nephropathy (MCN) has been a well-known negative predictive marker in newly diagnosed multiple myeloma (NDMM). Anti-CD38+ monoclonal antibodies (mAb) have improved outcomes, but little is known about their impact in patients with MCN. We performed a retrospective cohort study to investigate the outcomes of patients with MCN in the era of anti-CD38+ mAb-based frontline therapy. Methods: 115 NDDM patients received frontline anti-CD38+ mAb from 11/15/18 to 1/24/23. MCN was defined as evidence of light chain casts on biopsy, serum creatinine of >2mg/dL, or 2021 CKD-EPI eGFR of <40mL/min/1.73m2; ≥1g/d proteinuria; and involved FLC ≥50mg/dL. 23 had MCN; 92 were contemporary controls. We obtained data regarding clinical course. Results: 6 MCN patients needed hemodialysis (HD) at diagnosis. MCN patients had similar R2-ISS to controls. Median proteinuria in MCN patients was 5.7g/d more than in controls; serum creatinine (Cr) was 3.2mg/dL higher; and median hemoglobin was 1.5g/dL less. More MCN patients received quadruplet regimens (86.9% vs 62.0%, p = 0.010); similar proportions were transplanted. At 1, 3, and 6 months, serum Cr was higher in MCN patients (p < 0.001, p = 0.002, p = 0.002). Urine protein:creatinine ratios trended toward difference at 1 month (2.04 vs 0.15g/g MCN vs controls, p = 0.061) but were similar at 3 and 6 months. Response rates at 6 months did not differ. 4 MCN patients still required HD after 6 months. Median follow-up was 23.0-23.5 months. 4 MCN patients died, 1 due to progressive disease. No significant difference in disease-free survival (DFS; HR = 0.58, 95% CI 0.20-1.64, p = 0.295), time to next treatment (TTNT; HR = 0.53, 95% CI 0.20-1.39, p = 0.191), or overall survival (OS; HR 0.610, 95% CI 0.19-1.98, p = 0.406) was seen at any point between MCN and control cohorts. 1 year DFS, TTNT, and OS were: 87.0% MCN, 94.5% control; 77.2% MCN, 91.7% control; 87.9% MCN, 96.1% control. By statistical equivalence testing, MCN DFS and TTNT were within 6 months of control DFS and TTNT (p = 0.038, p = 0.032); MCN OS was within 5 months of control OS (p = 0.034). Conclusions: Patients with NDMM and MCN who receive upfront anti-CD38+ mAb therapy experience prolonged survival compared to prior findings. Anti-CD38+ mAb may substantially reduce, though not fully eliminate, the negative survival impact of MCN. Multiple mechanisms, including time to proteinuria resolution, may be involved. Further study is warranted. [Table: see text]
Long term follow up of monoclonal gammopathy of undetermined significance (MGUS) in US Veterans: Racial differences and associations with other malignancies.
Authors: Ma Helen , Gupta Pankaj 
Published: June 2024

7573 Background: Monoclonal gammopathy of undetermined significance (MGUS) is associated with lymphoid malignancies such as lymphoma and myeloma, but the association with other malignancies has not been described in the US veteran population. Methods: Veterans diagnosed with MGUS from 1991-2023 were identified from the US Veteran Affairs Central Cancer Registry (VACCR). Age at the diagnosis of MGUS was divided into four categories of <60, 60-69, 70-79, 80+. Variables collected included demographic factors and the diagnosis of other cancers. Differences were analyzed using the Chi Square test. Results: There were 3975 veterans who met the criteria. Most patients were male (96.7%) with a median age at diagnosis of MGUS of 70.5 (IQR 65.4-76.0). Almost 1/3 of patients were Black and were diagnosed with MGUS at a younger age compared to White veterans (Table, p<0.0001). Over the 32-year period included in this study, 2/3 of patients remained with a diagnosis of MGUS (62.3%) alone whereas 29.4% had 1 additional malignancy diagnosed and 8.3% had 2 or more additional malignancies. Black veterans with MGUS were more likely to have additional malignancies than white patients (41.4% vs 35.9%, p=0.016). MGUS was diagnosed prior to other cancers in 52% of patients and afterward in 48%. The most common cancers diagnosed in patients with MGUS were prostate (31%), lymphomas (13%), GI (12.5%), lung (12.0%), and skin (6.8%). CLL (3.4%), LPL (3.0%). Among lymphomas, CLL (3.4%) and LPL (3.0%) were most common. Of note, multiple myeloma or plasmacytoma was diagnosed in 6.5% of patients. The proportion of patients with MGUS and additional malignancies was comparable in the 4 age cohorts (p=0.072), indicating that younger patients with MGUS were as likely to be diagnosed with additional malignancies as older patients. Conclusions: In US veterans, nearly 1/3 of those diagnosed with MGUS were Black. These patients were younger when diagnosed with MGUS and were more likely to develop additional malignancies compared to White veterans. Over the 32 years of this study, a considerable proportion of veterans with MGUS developed various solid tumors. Further investigation is warranted to understand the racial, genetic, and other factors that may be contributing to the development of cancers in patients with MGUS. [Table: see text]
Real-world effectiveness and safety of PD-1 inhibitors combined with recombinant human endostatin and chemotherapy in refractory, recurrent/metastatic nasopharyngeal carcinoma.
Authors: Huang Shuang , Cao Caineng , Qiang Mengyun , Hua Yonghong , Jin Qifeng , Jin Ting , Chen Xiaozhong 
Published: June 2024

e18007 Background: Nasopharyngeal carcinoma(NPC) is one of the most common head and neck malignancies with a high overall survival rate. However, the treatment of refractory, recurrent or metastatic NPC is complicated. This study aimed to evaluate the safety and effectiveness of GEP (Gemcitabine combined with recombinant human endostatin (Rh-endostatin) and anti-PD-1 antibody) in patients with refractory, recurrent or metastatic NPC that cannot be treated locally in the real-world setting. Methods: Patients with refractory, recurrent or metastatic NPC (Refractory patients were defined as those unsuitable for local treatment due to extensive tumor recurrence/metastasis or necrosis of ulcers) treated in our hospital from December 2022 to October 2023 were retrospectively reviewed and analyzed. with the GEP regimen. Patients received 1-6 cycles of GEP therapy, including Gemcitabine (1.0 g /m2 ond1 and d8) combined with Rh-endostatin (180-210 mg/continuous intravenous pump 72-120h) and PD-1 antibody, Objective response rate (ORR) and disease control rate (DCR) were determined by Clopper-Pearson's method. The incidence of adverse events (AES). Results: A total of 25 patients who completed ≥ 2 cycles of treatment and at least one efficacy assessment were included in the efficacy analysis. The median age was 59 years (range: 33-75 years), 36% of patients ≥ 65 years. There was significant liquefaction necrosis in 17 cases (68%). 68% of the patients were treated with second-line or above GEP. 32% (8/25) of patients had tumor progression after anti-vascular therapy, and 44% (11/25) had disease progression after immunotherapy. Based on RECIST 1.1, the ORR was 44.00% (95%CI: 26.67%, 62.93%), and DCR was 92.00% (95%CI: 70.04%, 95.83%). The history of immunotherapy was a significant influence factor on ORR. 30 patients who received at least one course of GEP therapy were included in the safety analysis. Grade 3 AEs were observed in 7 patients (20%), with hematological toxicity (6/7) and hypertension (1/7). Other AEs with more than 20% incidence were hematological toxicity (93.0%), weight loss (67.0%), abdominal distension and constipation (47.0%), hypertension (47%), infection (33.0%), liver dysfunction (27.0%), nausea and vomiting (23.0%), and infusion reaction (20.0%). The recurrent lesions of 15 patients with recurrent NPC were accompanied by significant liquefaction necrosis and ulcers. The ORR was 46.7%, and DCR was 100%. Among them, 5 patients had grade 1 nosebleed, and the other grade 2 or above AEs were hematological toxicity, and there were no grade 4 treatment-related AEs. Conclusions: Real-world data demonstrated that GEP was well-tolerated, safe and effective in patients with refractory, recurrent or metastatic NPC.
Clinical prognostic factors to guide treatment strategy for HPV-positive oropharyngeal cancer from treatment outcomes of induction chemotherapy: A real-world experience.
Authors: Bang Hyun Jin , Kim Hyeon-Jong , Lee Seung Hyuk , Shim Hyun Jeong , Hwang Jun Eul , Bae Woo Kyun , Chung Ik-Joo , Cho Sang Hee 
Published: June 2024

e18014 Background: The role of induction chemotherapy (IC) in locally advanced oropharyngeal cancer (OPC) remains a topic of debate and suitable candidates for de-escalation treatment in these patients have not been fully identified. This study aimed to identify high-risk groups for HPV-positive OPC by analyzing patients who underwent IC followed by chemoradiotherapy (CRT) to guide optimal treatment strategies. Methods: Between 2004 and 2020, we reviewed patients with OPC diagnosed with stage III-IVA who underwent a treatment regimen comprising a minimum of two cycles of IC followed by CRT.In this study, all patients were re-staged according to the American Joint Committee on Cancer (AJCC) 8th edition, and we analyzed the overall response rate and survival outcomes associated with clinical factors based on HPV status by utilizing univariate and multivariate analyses. Results: This study analyzed 105 patients with a median age of 60 years (range: 40–76 years). Among 105 patients, 40 (38.1%) were HPV-negative, and 65 (61.9%) were HPV-positive. Through a median follow-up of 60.0 months (range, 5–60 months), no significant differences in progression-free survival (PFS) (p = 0.172) and overall survival (OS) (p = 0.064) were observed based on HPV status, regardless of no differences in relative dose intensity of IC and cumulative dose of radiation and cisplatin in CRT. In all patients, survival outcomes were notably poorer in patients aged ≥ 60 years ( p = 0.006) and those who did not achieve complete response (non-CR) post-CRT ( p < 0.001), irrespective of HPV status. All have received sufficient IC with a median RDI of 80% or more in both age < 60 years and age ≥ 60 years. Unlike HPV-negative OPC, where age and T stage showed no significant correlation, in HPV-positive OPC, age ≥ 60 years ( p = 0.011) and T4 stage ( p = 0.019) emerged as substantial poor prognostic factors for survival outcomes despite IC and CRT. Utilizing these results, we categorized HPV-positive OPC patients into three groups based on the number of clinical risk factors at diagnosis (age, T4 stage), the PFS and OS showed significant stratification across each group as the number of clinical risk factors increased. Conclusions: This study revealed that age and T stage significantly influenced on prognosis in HPV-positive OPC but not in HPV-negative OPC. Considering our result, HPV-positive OPC exhibiting these risk factors requires a careful treatment strategy, and combined treatments, including immunotherapy, may be considered to enhance treatment outcomes for these patients.
Primary tracheal cancer: Demographics, histology, and treatment outcomes in the United States from 2000-2018.
Authors: Armel Kristen , Stamey Taylor , Ju Andrew W. , Speicher James E. , Burke Aidan Michael , Navaid Musharraf , Larkins Michael Casmer , Bhatt Arjun 
Published: June 2024

e18060 Background: Primary tracheal cancers (PTC) account for 0.2% of all respiratory malignancies and have an estimated incidence of 2.6 new cases per one million people in the US. Given the rarity of these cancers and paucity of data in the literature, we sought to determine the demographic and treatment patterns of PTC in the US. Methods: A retrospective cohort study utilizing the Surveillance, Epidemiology, and End Results (SEER) database sponsored by the National Cancer Institute (NCI) was conducted for patients with a diagnosis of PTC between 2000 and 2018. Univariate, multivariate, and survival analyses were performed using 95% confidence intervals [CI] and a p-value < 0.05 indicating significance. Results: 689 patients with PTC were identified, with 53% of these cases being squamous cell carcinoma (SCC) and 17% being adenoid cystic carcinoma (ACC). Comparison of five-year overall survival (OS) stratified by treatment modality, disease stage, and histology can be found in the table. Multi-factor analysis demonstrated significance with only disease histology (p=0.005). Asian patients with SCC had decreased five-year OS compared to White or Black patients (n=12; hazard ratio (HR)=0.19 and 0.20, and p=0.003 and 0.006, respectively). Patient age < 65 years was associated with increased survival (hazard ratio (HR)=0.48; p<0.001); no difference in survival based on sex or marital status was seen (sex: HR=1.03; p=0.733, marital status: HR=1.07; p=0.568). Conclusions: Patients with tracheal ACC had greater five-year OS compared to patients with tracheal SCC. Those with local or regional SCC that received surgery or RT saw survival benefit; patients with regional SCC had survival benefit with chemotherapy. Patients with ACC had no survival benefit from any treatment modality regardless of stage. Patients aged < 65 years had increased survival and Asian patients with SCC had decreased survival. Further investigation into the potential differences in survival among various chemotherapeutic regimens and socioeconomic factors is warranted.[Table: see text]
Utilizing stereotactic body radiation therapy in combination with tyrosine kinase inhibitors for therapeutic benefit in thyroid cancer.
Authors: Kaur Sundeep , Gui Bin , Ghaly Maged , Seetharamu Nagashree 
Published: June 2024

e18065 Background: Tyrosine kinase inhibitors improve overall survival (OS) and progression free survival (PFS) in metastatic thyroid cancer. Additionally, studies have shown success of hypo-fractionated radiotherapy in controlling local disease not responsive to systemic therapies. However, there is limited data assessing the combined benefits of radiation therapy (RT) and systemic therapy. This study aimed to determine the effects of adding radiation to tyrosine kinase inhibitors (TKIs) for symptomatic locoregional/metastatic iodine-refractory thyroid cancer. Methods: 21 patients with metastatic/loco-regionally advanced thyroid cancer were treated with radiation to areas of symptomatic disease alone or along with continuation of oral TKIs between March 2016 and December 2023. 18 were treated with RT + TKIs, while 3 were treated with RT only. Response to treatment was assessed 3 months post- RT treatment via imaging and clinical examination. The primary endpoint was assessing overall response rate as per RECIST 1.1. Secondary endpoints included local control, adverse effects, progression-free survival, and overall survival. Results: Median age of patients was 70. 12 patients were male, 14 patients had distant metastases. Histologic types include 12 papillary thyroid cancers, 4 anaplastic, and 5 others. 18 patients (85.7%) received treatment to thyroid mass, others were treated for nodal, soft tissue, and/or bone metastases. Most patients (90.5%) received stereotactic body radiation therapy (SBRT), while 2 patients received intensity-modulated radiation therapy (IMRT) due to insurance denial. The regimen that was frequently used (52.4%) was SBRT 800cGy in 5 fractions. 5 patients were treated with lenvatinib, 5 with dabrafenib/trametinib, and 4 with cabozantinib. 4 patients developed severe AEs requiring discontinuation or change in treatment plan. 74% of patients had documented response at 3 months post-treatment. 19 patients had additional follow up imaging and at median follow up of 16 months, 14 patients had continued clinical response with 9 complete responses (47.4%) and 5 partial responses (26.3%). The median duration of disease control at the site of RT was 23.4 months. Treatment was well-tolerated in general. 13/20 (65%) patients completed treatment without any interruptions or delays. Conclusions: SBRT can be effectively and safely administered to achieve durable disease control in patients with aggressive thyroid cancer histology when combined with tyrosine kinase inhibitors. This strategy warrants evaluation in prospective clinical trials.
Epidemiological analysis and overall survival of thyroid cancer in a developing Middle Eastern Country over 18 years.
Authors: Abdulelah Zaid A. , Abdulelah Ahmed A. , Alhajahjeh Abdulrahman Ahmad , Al-Dqour Mohammad , Saadeh Aseel , Abdel-Razeq Hikmat 
Published: June 2024

e18071 Background: The significance of thyroid cancer lies not only in the resulting morbidity and mortality, but in its prevalence as the most commonly encountered endocrine malignancy in the Middle East and globally. Given that thyroid cancer epidemiology in the Middle East is not sufficiently evaluated, the establishment of epidemiological characteristics of thyroid cancer in the Middle Eastern population is of substantial importance for the introduction of effective interventions, especially in scarcely resourced countries and populations. Methods: Comprehensive data on 4,362 patients of various nationalities residing in Jordan diagnosed with thyroid cancer during the period 2000-2018 were retrieved from the Jordan Cancer Registry, the official institutionalized reporting body for cancer epidemiology in Jordan. Epidemiological analysis including Kaplan-Meier analysis and regression models was performed to establish the epidemiological features of thyroid cancer in a Middle Eastern population. Results: A total of 4,362 patients with a mean age of 43.5 ± 29.6 years old and a significant female predominance of 74.9% were included in the analysis. 7.97% of the enrolled patients were smokers at the time of diagnosis. Thyroid carcinoma was found in the right and left thyroid lobes almost equally the same, with only 1.28% having involvement in both lobes. Localized thyroid carcinoma was encountered in 28.8% of the sample, while 6.65% had systemic involvement and distant metastasis. The observed overall survival rate was determined to be 94.7%, 94.7%, 94.1%, 88.2%, and 86.6% at 1-year, 2-year, 3-year, 4-year, and 5-year interval, respectively. There is a statistically significant incline in the crude incidence of thyroid cancer in Jordan over the 18 years with a crude incidence estimated effect of 0.19 (P-value<0.001). Conclusions: Over 18 years, thyroid cancer in Jordan has been progressively increasing in incidence with a worrisome uptrend that carries significant socioeconomic and health burden. Ensuring preventative measures such as reduced exposure to radiation and early detection of thyroid nodules are warranted to achieve better outcomes.
Imaging and clinical characteristics of incidental abnormal thyroid uptake on PSMA PET/CT.
Authors: Yilmaz Burcak , Trone Kristin , Chalker Cameron , Sun John , Lim James Y , Sokolova Alexandra , Mallak Nadine 
Published: June 2024

e18077 Background: To investigate the incidence, features, and clinical characteristics of unexpected prostate-specific membrane antigen (PSMA) uptake within the thyroid gland of patients with prostate cancer (PCa) who underwent F-18 DCFPyL PSMA PET/CT. Methods: We retrospectively reviewed a cohort of 1148 PCa patients who underwent PSMA PET/CT at our institution between 11/2021 - 09/2023. Scans with abnormal thyroid uptake were identified. Clinical data included patient demographics, PCa history, Gleason score, prostate specific antigen (PSA), ultrasonography (US), fine needle aspirate (FNA) / thyroidectomy, histopathology, and history of neck radiation or prior malignancy. Each scan was further analyzed with lesion-specific iso-contour method (42% cutoff) to obtain PET parameters (most prominent nodule SUVmax, SUVmean, PSMA volume, tumor lesion PSMA, contralateral gland SUVmax, SUVmax-nodule / SUVmax-contralateral gland ratio, most prominent PCa lesion SUVmax), PCa tumor distribution, and tumor volume. CT-related variables (nodule number, dominant nodule size, short/long axis ratio, CT-HU, integral total value) were also collected. Pearson's chi-square testing and Kruskal-Wallis testing was performed for categorical and nonparametric data respectively. Receiver operating characteristic (ROC) curves with area under curve (AUC) value were determined using IBM SPSS (version 29.0). Results: Of the 1148 PSMA PET/CTs, 60 (5.2%) had abnormal thyroid uptake (nodular: 58, diffuse: 2). Diffuse uptake was found to represent thyroiditis in both patients. 43 (56.7%) had an US, 20 (33%) were biopsied (11 benign, 5 indeterminate, 4 malignant), and 5 (8.3%) pursued thyroidectomy (3 malignant, 2 benign). 22 patients (36.7%) had histopathology data and 5 malignancies (2 PCa, 1 CLL, 2 primary thyroid) were identified. Nodule size was larger in those who had an US relative to those who did not. Among those with US data, no significant differences in clinical or histopathological parameters were seen. SUVmax (p: 0.01; AUC: 0.876, 95%CI: 0.731-1.0) and SUVmean (p:0.01; AUC: 0.871, 95%CI: 0.722-1.0) were higher in the malignant group. Nodule SUVmax/contralateral gland SUVmax ratio showed borderline significance (p = 0.05). Conclusions: Incidental PSMA PET uptake in the thyroid gland is seen in approximately 5% of patients. Focal uptake should prompt consideration of US and FNA due to the possibility of prostate cancer metastasis and thyroid cancer. SUVmax/mean is higher in malignant lesions.