bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characteristics and treatment (Tx) patterns (TxP) of high-risk biochemically recurrent (HR-BCR) non-metastatic castration-sensitive prostate cancer in the real-world by race, age, and prostate-specific antigen (PSA) doubling time (PSADT).
Authors: Morgans Alicia K. , Mucha Lisa , El-Chaar Nader N. , Elsouda Dina , Ramaswamy Krishnan , Schuler Tammy , Feinberg Bruce A. , Pathak Prathamesh , Asgarisabet Parisa , Gentile Danielle , Freedland Stephen J. 
Published: June 2024

e17071 Background: The optimal approach to manage HR-BCR is undefined. Recent trials examined early intensified androgen-deprivation therapy (ADT), but its alignment with current practice is unclear. We describe real-world characteristics and TxP in patients (pts) with HR-BCR, and how age, race, and PSADT impact them. Methods: This physician-abstracted chart review used de-identified data from the Cardinal Health’s Urology and Oncology Provider Extended Network 2018-2022 in the US. HR-BCR was defined as in EMBARK: PSADT ≤9 months (m) and PSA ≥1 ng/mL for pts with prior radical prostatectomy (RP) or ≥2 ng/mL above nadir PSA for pts with radiotherapy (RT) without prior RP. Data were collected from index date (PSADT ≤9 m observed) until disease progression/last follow-up/death. PSADT was reported by physician (rwPSADT) or calculated (cPSADT) retrospectively. First-line (1L) Tx was that received ≤60 days post-index; no Tx received was defined as observation. Pt characteristics and TxP were analyzed descriptively in the overall cohort and by age ( < 65 or ≥65 years [yrs]), race (White [W]/Black [B]), and PSADT (≤3 m, > 3─9 m). Results: Of 284 pts with HR-BCR (mean [SD] age, 67 [7.5] yrs), most had Gleason ≥8. While one-third received 1L Tx (mainly systemic Tx ± RT [Table]), during a median follow-up of 1193 days, 75% of pts on 1L observation received systemic Tx (median time to Tx, 162 days), mostly ADT alone. Observation was used as 1L more often in the < 65 yrs, W, and PSADT ≤3 m groups, but few pts in these groups, especially in PSADT ≤3 m and < 65 yrs, had rwPSADT. At follow-up, over 70% pts received systemic Tx in all subgroups. Conclusions: During a short follow-up period, most pts with HR-BCR received systemic Tx suggesting that current practice includes Tx with systemic therapy rather than surveillance alone. Notably, pts < 65 yrs and PSADT ≤3 m, those who perhaps stand the most to benefit, had lower rates of 1L systemic Tx, likely because many lacked rwPSADT (i.e., physician didn`t know PSADT). Our data support that lack of knowing PSADT in real-time may be associated with delayed Tx, which may warrant further research. [Table: see text]
Experience with de-intensification of intensified treatment in metastatic castration-sensitive prostate cancer in Venezuela: A pilot study.
Authors: Sucre Carlos Eduardo , Sucre Oscar , Cavaniel Rudy , Sucre Santiago , Borga Guillermo 
Published: June 2024

e17080 Background: Novel therapeutic approaches in recent years have changed the management of metastatic castration-sensitive prostate cancer (mCSPC). Traditionally, an antiandrogenic agent was used for androgen deprivation (AD); currently, the approach is to do treatment intensification with AD plus an additional medication (such as abiraterone, enzalutamide, docetaxel, among others). Historically, intermittent versus sustained AD have been considered as equally effective therapeutic measures. In developing countries, treatment adherence has been limited by access to some of these medications, as well as financial toxicity. Recently a new therapeutic approach has been proposed, one which entails treatment de-intensification in patients with a negative PSA after 1 year of treatment, aiming to decrease adverse events and improve treatment adherence. Methods: We included patients with mCSPC that received treatment intensification with AD plus either abiraterone or enzalutamide. Concurrent use of docetaxel was allowed. After at least twelve months of treatment and with a PSA level under 0.2 ng/mL, we proceeded to suspend intensified therapy, maintaining AD alone (de-intensification). These patients were followed up every 12 weeks, with a clinical evaluation plus PSA measurement. Patients that were deemed to have biochemical progression were excluded from the study, and underwent full imaging evaluation as well as a change in their current therapy on a case-by-case basis. Results: A total of 28 patients with mCSPC are included, with a mean age of 71.71 years. Thirteen patients have synchronic disease (46.42%), and fifteen patients have metachronic disease (53.58%). Of the original 28 patients, 16 patients have low volume disease (57.14%) and 12 have high volume (42.85%). Concurrently, 26 out of the 28 included patients had a negative PSA after six months of follow up (92.85%). To this date, 18 patients have completed twelve months of follow up, out of which 15 patients have maintained a negative PSA (83.3% of total sample). Out of the other 3 that developed biochemical progression, 2 of them had high volume disease and all 3 had a Gleason 8 score. Conclusions: Treatment de-intensification appears to be an acceptable therapeutic approach. This strategy could prove most beneficial in developing countries, where access to some medications is limited, and could improve treatment adherence in the long run. Adverse events associated to medications is also minimized with this approach. It’s also possible that this new therapeutic approach is most beneficial in lower risk patients (Gleason score < 8, low volume metastatic disease). In order to make these results more robust, a larger population sample and longer follow up is required.
Survival outcomes for metastatic castration sensitive prostate cancer: Real world data from a Danish cohort 2016-2022.
Authors: Zedan Ahmed H. , Hansen Torben , Timm Signe 
Published: June 2024

e17088 Background: Metastatic castration sensitive prostate cancer (mCSPC) has the worst prognosis in the whole disease spectrum of prostate cancers. However, the therapeutic armamentarium has dramatically evolved during the last decade leading to a marked improvement in survival outcomes for this population. The main aim of this study is to investigate the impact of treatment options for mCSPC derived from real world data (RWD). Methods: This is a single retrospective observational study performed at Department of Oncology, Vejle Hospital, Denmark. Eligible patients (men aged ≥18 years) had newly diagnosed, histologically confirmed mCSPC, and were treated with androgen deprivation therapy (ADT) plus either docetaxel (DOC) or novel androgen receptor axis-targeted agents (ARATA) such as abiraterone (ABI) or enzalutamide (ENZ). Endpoints included overall survival (OS), both Radiological- and Biochemical progression free survival (rPFS and bPFS) and time to next treatment (TTNT). Subgroup analysis was done for those whose inclusion criteria were matching to those in the randomized controlled trails (RCTs); both CHAARTED and LATITUDE. Results: In total, 259 patients diagnosed with mCSPC from January 2016 until January 2022 have been included in the study. Patients treated with DOC were 224 (87%), while ABI and ENZ were used in 32 (12%), and 3 (1%) patients, respectively. Data analysis was done after a median follow-up of 39.9 months (range 11.4-85.1). Median OS, rPFS and bPFS were not reached during the follow-up period, while median TTNT was 26.7 months (95% CI 23.8-31.2). For the above defined subgroup (233 patients) median TTNT was 26.2 months (95% CI 23.2-29.7). Conclusions: Observations from this study emphasizes the remarkable benefits for treatment intensification for mCSPC population, and inclusion of RWD resulted in outcomes comparable with RCTs.
Chemoresistance in high grade serous ovarian cancer molecular subtypes and the role of NRF2.
Authors: Toma Helen , Al-Odat Omar S. , Hamad Layla , Joshi Hansa , Kelly Rebeca , Katz Chelsea , Shojaei Hadi , Li Yahui , Mitra Ramkrishna , Bendjilali Nasrine , Spitz Francis R. , Chu Christina , Krill Lauren , Pandey Manoj , Wang Yemin , Warshal David Philip , Hamad Samera 
Published: June 2024

e17574 Background: Epithelial ovarian cancer accounts for 90% of ovarian cancer diagnoses, 70% of which are high grade serous subtype (HGSOC). The HGSOC is the most aggressive type of Ovarian Cancer with limited therapeutic options. Studies have shown that several molecular subtypes of HGSOC exist such as immunoreactive, differentiated, proliferative, and mesenchymal, which further complicate the effort of finding therapies for this deadly cancer. Nuclear erythroid-related factor-2 (NRF2) is a transcription factor that is found to be frequently activated in ovarian cancer. NRF2 normally protects cells from oxidative damage by regulating more than 500 genes in human body. Hyperactivation of NRF2 in cancer is found to protect cancer cells from oxidative damage, and thus, promotes tumor growth and metastases. NRF2 is also known as an anti-inflammatory pathway and a master regulator of immune cells differentiation, distribution, and infiltration. Patients with high-NRF2 tumors tend to have significantly lower survival than patients with Low-NRF2 tumors. In this study, we investigate the role of NRF2 in HGSOC subtype evolution and responses to chemotherapies. Methods: Two human HGSOC cell lines, OVCAR8 and PEO1 were used to identify and quantify the NRF2 protein level with its down-stream targets. We also quantified differentiation markers such as Vimentin, P63, PD-L1, that are associated with HGSOC subtypes, using western blotting. These human cell lines were also tested for Carboplatin and Paclitaxel half maximal inhibitory concentration (IC50) using MTT assay. RNA-seq data of human HGSOC from The Cancer Genome Atlas (TCGA) was analyzed to compare our in vitro studies with human tumors. Results: The human OVCAR8 cell line had a 50-fold higher expression of NRF2 and 12-fold higher expression of vimentin when compared to the PEO1 cell line. When treated with Carboplatin, the IC50 for OVCAR8 was 112 ± 3.6 µM vs 67.5 ± 5µM for PEO1. For Paclitaxel, the IC50s for the two cell lines were 5 ± 0.4nM and 4 ± 0.15nM, respectively. Finally, RNA sequencing data from the TCGA showed that the NRF2 activation score in mesenchymal subtype was significantly increased compared to the immunoreactive subtype (p=0.004). Conclusions: Our data show that expression of NRF2 is significantly higher in the mesenchymal (the most chemo-resistant and aggressive) subtype, while the subtypes with lower NRF2 tend to be more responsive to chemotherapies. These findings imply that targeting NRF2 in these subtypes could improve responses to chemotherapies and enhance tumor prognosis in patients with HGSOC.
Demographic factors influencing hysterectomy approaches (with vs. without removal of tubes and/or ovaries): An NCDB review.
Authors: Au Kristine , Voth Caitlyn , Keirns Darby , Silberstein Peter T. 
Published: June 2024

e17578 Background: Endometrial cancer is the most common cancer of the female reproductive organs in the United States, and surgery involving the removal of the uterus, cervix, and ovaries (total hysterectomy) is the most common treatment. However, some women may have their uterus removed with sparing of the ovaries, resulting in the prevention of menopause but an increased incidence of cancer recurrence. Given the pivotal role of surgical outcomes, it is important to examine the variations in treatment approaches – specifically, the choice between total hysterectomy with and without removal of the tubes and/or ovaries – across different demographic groups. Methods: Patients with endometrial cancer were selected from the National Cancer Database (NCDB) and 19,147 patients were identified between 2004 and 2020. We compared the demographic variables of patients who had a total hysterectomy with and without removal of tubes and ovaries. Descriptive statistics, multivariate, and chi-square analyses on SPSS version 28 was used for all analyses; P < 0.05 was considered significant. Results: Black patients with endometrial cancer were 26% less likely to have a total hysterectomy with the removal of tubes and/or ovaries compared to white patients. Conversely, no significant difference was observed in the choice of surgical approach between Hispanic and non-Hispanic patients. A median household income of $74,063 were 97% less likely to have a total hysterectomy with removal of tubes and/ovaries compared to patients with a median household income of less than $46,277. Patients with insurance, including private, Medicaid, Medicare, or other government insurance did not have a significantly different surgical approach than those without insurance. Furthermore, patients living in more educated areas (where <5% of adults lacked a high school degree) were 29% more likely to receive a total hysterectomy with removal of tubes and/or ovaries compared to less educated areas (where >15.3% of adults lacked a high school degree). Conclusions: This study highlights significant determinants that influence the decision to remove the tubes and/or ovaries during a total hysterectomy for endometrial cancer, with emphasis on race, education, and income. Significant implications with removal of ovaries and/or tubes include changes in a woman’s hormonal balance, infertility, and increased risk of further diseases. Understanding and recognizing these determinants within the context of endometrial cancer treatment can contribute to improved patient outcomes, a reduced risk of ovarian cancer and associated complications, and an improvement in overall quality of life. By acknowledging the versatile nature of this decision, healthcare providers can better individualize treatment plans, ultimately striving for favorable long-term health and well-being outcomes for their patients.
Magnetic resonance texture analysis for predicting histologic tumor type in endometrial cancer.
Authors: Lee Seung-Mi , Lee Hyun-Jung , Lee Juhun 
Published: June 2024

e17580 Background: The aim of the present study was to assess the feasibility of texture analysis and histogram on magnetic resonance image for predicting histologic type in patients with endometrial cancer. Methods: A total of 85 patients who underwent surgery and had pathologically confirmed endometrial cancer were included in this study. We investigated the parameters for normalized perfusion map including perfusion ratio and integrated density, defined as the product of area and mean gray value from the normalized perfusion mapping on gadolinum-enhanced T1-weigted pelvic MRI. Apparent Diffusion Coefficient map and texture analysis by gray-level co-occurrence matrix in endometrial cancer, including angular second moment, contrast, correlation, entropy and inverse difference moment. MR parameters were correlated with pathologic feature including tumor type, FIGO staging, tumor invasion and lymph node metastasis. Results: The normalize perfusion map analysis revealed noteworthy distinctions between type 1 and type 2 endometrial cancer. Specifically, we observed significant differences in tumor area (p = 0.014), perfusion ratio (p = 0.001), perimeter (p = 0.002), integrated density (p = 0.042), median (p = 0.001), and roundness (p = 0.018). Entropy form the texture analysis demonstrated associations with integrated density and linear correlation, with notable differences observed between type 1 (R2 = 0.363) and type 2 (R2 = 0.471) endometrial cancer subtypes, displaying statistical significance (p = 0.010). Conclusions: In conclusion, parameters obtained by texture analysis and perfusion map could be useful for predicting the histological type of endometrial cancer.
Demographic factors of malignant endometrioid adenofibroma: An NCDB study.
Authors: Ramos Brianna Eillen , Khatib Rawaan , Tandon Nikhita , Sadighian Assal , Silberstein Peter T. , Heise Craig , Hsia Beau 
Published: June 2024

e17592 Background: Malignant endometrioid adenofibroma (MEA) is a rare subtype of ovarian carcinoma characterized by squamous metaplasia and frequently linked with endometriosis and colorectal cancer. This fibrous tumor with cystic spaces is primarily diagnosed in postmenopausal females who present with abnormal vaginal bleeding. The current recommended treatment option is a laparoscopic resection; however, a hysterectomy may be indicated in more serious cases. Analyzing the trends of MEA may provide significant insights into its epidemiology. An analysis of the National Cancer Database (NCDB) was conducted to identify the demographic factors of patients diagnosed with MEA. Methods: A retrospective cohort analysis utilizing the 2004–2020 National Cancer Database (NCDB) included 193 patients with a histologically-confirmed diagnosis of CA (ICD-O-3 code 8381). Demographic factors (age, sex, race, Hispanic status, insurance status, facility type, distance from facility, and Charlson-Deyo score) were analyzed by descriptive statistics and incidence trends were interpreted in regression analysis. Results: 193 patients diagnosed with MEA were recorded in the database from 2004 to 2019, with a strong declining annual incidence rate (R²=0.7833). Women were much more likely to be diagnosed (99.5%) than men (0.5%), where the average age at diagnosis was 61.40 years (SD= 12.89, Range =30-90). The primary site of diagnosis was the endometrium (54%). Most patients were noted to be non-Hispanic (85%) and White (86%), privately insured (59%), and lived in metropolitan areas with a population greater than 1 million (54%). The majority also had a Charlson-Deyo comorbidity score of 0 (78%). In regard to treatment, patients were seen relatively equally at the comprehensive community cancer program (42%) and academic/research program (32%). 93% of patients received surgery as their primary treatment, 20% received chemotherapy, and 20% received radiation. Conclusions: To the best of our knowledge, this is the first NCDB analysis on malignant endometrioid adenofibroma and thus serves to address prior gaps in the topic’s research. Results were similar to descriptions in earlier case reports, where MEA is notably more common in females who identify as non-Hispanic and White, with a primary site diagnosis at the endometrium. This is the first time the socioeconomic factors of MEA patients have been described in the literature: patients are more likely to live in metropolitan areas, be privately insured, and be treated at similar rates at both academic/research and comprehensive community cancer programs. Further studies are essential in promoting the knowledge of this topic, specifically how demographic/socioeconomic factors influence the diagnosis and treatment options of patients with MEA.
Vaginal lacerations during laparoscopic hysterectomy for endometrial cancer and local recurrence risk.
Authors: Nicolais Olivia , Cummings Mackenzie , Edelson Mitchell , Moukarzel Lea , Cardillo Nicholas , Burton Elizabeth , Buchanan Tommy , Shahin Mark S. 
Published: June 2024

e17596 Background: Laparoscopic surgery offers equivalent oncologic outcomes as compared to open surgery, while causing lesser morbidity and resulting in a faster recovery. However, vaginal extraction of specimens may cause vaginal or perineal lacerations (VL). To date, no studies have specifically reported the impact of vaginal laceration on local recurrence after surgical treatment for endometrial cancer. The objective of this study is to assess local recurrence rates compared between cases with or without vaginal lacerations (NL). Methods: We identified all patients with endometrial cancer who underwent laparoscopic surgical management between 2014 and 2018. We assessed the rate of local recurrence between patients in VL and NL cohorts. The study included all histologic subtypes and stages. Patients with benign final pathology, cases of synchronous primaries or cases that required laparotomy for extraction were excluded. Results: Among the 540 endometrial cancer MIS cases, 338 were evaluable. There were 40 cases of vaginal laceration during specimen extraction. There was no significant difference in age, race, presence of LVSI, stage, grade, histology or use of vaginal brachytherapy between cohorts. Cases with vaginal lacerations were significantly associated with a higher median BMI of 33.6kg/m2 (range 18.9-66) in the VL group as compared to 32.3kg/m2 (range 19.1-66) in the NL group (p=0.03). Uterine size was greater in the laceration group (VL) with a median of 150.5 g (49 - 462g) versus 110g (33 – 573g) in the NL cohort (p <0.01). The VL cohort was more likely to have received adjuvant treatment. Specifically external beam radiation therapy (EBRT) was administered 20% in the VL group versus 8.4% in the NL group (p = 0.02) and chemotherapy was used in 27.5% of the VL group versus 9.7% in the NL group (p < 0.01). In early stage disease, more cases had non-endometrioid histology in the VL group (23% versus 11.5%, p=0.043) and had increased incidence of chemotherapy and radiation use as well (EBRT 5.6% vs 23% and chemotherapy 6.7% versus 23%, both with p= <0.01). There were no cases of isolated vaginal recurrence (0/40) in the VL group as compared to an incidence of 2% (7/298) in the NL group with a relative risk of 0.48 (CI: 0.03-8.36, p=0.62). There were 4 cases of pelvic recurrence (4/40) in the VL group and 2 cases in the NL group (2/298) with a relative risk of 2.13 (CI: 0.46-9.89, p=0.34). Conclusions: In endometrial cancer cases, we did not observe a significantly increased risk of vaginal or pelvic recurrence after a vaginal laceration at the time of specimen removal. This could be attributed to the higher rate of non-endometrioid histology in early stage disease, which resulted in higher rates of adjuvant chemotherapy or radiation treatment.