bluuebunny/crossref_metadata_2025_split huggingface dataset:
Solitary large hepatic metastasis in an elderly patient with anaplastic thyroid carcinoma: a case report
Authors: Adamidou Alexandra , Kotsaftis Panagiotis , Vlachou Maria , Haritanti Afroditi , Xanthakis Ioannis , Zantidis Anestis , Ntaios George 
Published: January 2009

Abstract

Background
We present the case of a patient who presented with anaplastic thyroid carcinoma with a solitary large liver metastasis. Hepatic metastases are extremely rare in anaplastic thyroid carcinoma.

Case presentation
We report the case of a 78-year old Greek man who presented with voice hoarseness, dyspnoea and a large mass on the anterior surface of the cervical region (neck), as well as constitutional symptoms such as anorexia, weight loss and malaise. On physical examination, the thyroid was hard and tender on palpation and a liver mass was palpable. Routine biochemistry yielded normal results except increased C-reactive protein, alkaline phosphatase and γ-glutaryl transferase. Other biochemical tests including tumor markers, thyroid hormones, antithyroid antibodies, hepatitis B and hepatitis C antibodies were negative. Imaging methods revealed enlargement of the left thyroid lobe extending to the anterior mediastinum and compressing the trachea, metastatic bilateral pulmonary lesions and a large, nodular, contrast-enhanced mass-occupying lesion in the right hepatic lobe. The findings of fine-needle aspiration biopsy of the thyroid were consistent with anaplastic carcinoma. Liver biopsy showed infiltrations by poorly differentiated anaplastic cells, few of which were slightly positive for thyroglobulin. These findings were suggestive of a hepatic metastasis originating from anaplastic thyroid carcinoma. During his hospitalization, the patient suffered progressive obstruction of the trachea due to rapid increase of the thyroid gland mass. The tumor was considered unresectable due to its advanced stage, as well as the presence of extrathyroid metastatic lesions. The patient was irradiated on cervical region (neck) and upper mediastinum with a daily dose of 300 cGy for 10 days which resulted in mild improvement of obstructive phenomena. However, his clinical condition deteriorated rapidly and he died within a few days.

Conclusion
Solitary, large hepatic metastasis may constitute a rare complication in anaplastic thyroid carcinoma.
Serum concentrations of cortisol, interleukin 6, leptin and adiponectin predict stress induced insulin resistance in acute inflammatory reactions
Authors: Lehrke Michael , Broedl Uli C , Biller-Friedmann Ingeborg M , Vogeser Michael , Henschel Volkmar , Nassau Kirsten , Göke Burkhard , Kilger Erich , Parhofer Klaus G 
Published: January 2009

Abstract
Introduction
Inflammatory stimuli are causative for insulin resistance in obesity as well as in acute inflammatory reactions. Ongoing research has identified a variety of secreted proteins that are released from immune cells and adipocytes as mediators of insulin resistance; however, knowledge about their relevance for acute inflammatory insulin resistance remains limited. In this study we aimed for a clarification of the relevance of different insulin resistance mediating factors in an acute inflammatory situation.

Methods
Insulin resistance was measured in a cohort of 37 non-diabetic patients undergoing cardiac surgery by assessment of insulin requirement to maintain euglycaemia and repeated measurements of an insulin glycaemic index. The kinetics of cortisol, interleukin 6 (IL6), tumour necrosis factor α (TNFα), resistin, leptin and adiponectin were assessed by repeated measurements in a period of 48 h.

Results
Insulin resistance increased during the observation period and peaked 22 h after the beginning of the operation. IL6 and TNFα displayed an early increase with peak concentrations at the 4-h time point. Serum levels of cortisol, resistin and leptin increased more slowly and peaked at the 22-h time point, while adiponectin declined, reaching a base at the 22-h time point. Model assessment identified cortisol as the best predictor of insulin resistance, followed by IL6, leptin and adiponectin. No additional information was gained by modelling for TNFα, resistin, catecholamine infusion rate, sex, age, body mass index (BMI), operation time or medication.

Conclusions
Serum cortisol levels are the best predictor for inflammatory insulin resistance followed by IL6, leptin and adiponectin. TNFα, and resistin have minor relevance as predictors of stress dependent insulin resistance.
Randomized Phase III Study of 1 Month Versus 1 Year of Adjuvant High-Dose Interferon Alfa-2b in Patients With Resected High-Risk Melanoma
Authors: Pectasides Dimitrios , Dafni Urania , Bafaloukos Dimitrios , Skarlos Dimosthenis , Polyzos Aristidis , Tsoutsos Dimosthenis , Kalofonos Haralambos , Fountzilas George , Panagiotou Petros , Kokkalis George , Papadopoulos Othon , Castana Ourania , Papadopoulos Stefanos , Stavrinidis Elias , Vourli Georgia , Ioannovich John , Gogas Helen 
Published: January 2009

Purpose A high-dose interferon alfa (IFN-α) regimen as reported in E1684 was unique for the incorporation of an induction phase of maximally tolerated dosages of intravenous (IV) therapy for the initial 4 weeks. This is the only trial that has shown prolongation of overall survival and relapse-free survival (RFS) in comparison with observation. Analysis of the hazard curves for RFS and overall survival (OS) in E1684 revealed separation of the high-dose and observation arms, suggesting that the induction phase may represent a critical component of this regimen, although this has not been tested prospectively. Patients and Methods We conducted a prospective randomized study of IV induction therapy versus a full year of high-dose IFN, with primary end points of RFS and OS for patients with stage IIB, IIC, and III melanoma, within 56 days of curative surgery. Patients were randomly assigned to receive IFN-α-2b 15 × 106 U/m2 IV × 5/7 days weekly × 4 weeks (arm A) versus the same regimen followed by IFN-α-2b 10 × 106 U (flat dose) administered subcutaneously three times a week for 48 weeks (arm B). Results Between 1998 and 2004, 364 patients were enrolled (353 eligible: arm A, n = 177; arm B, n = 176). At a median follow-up of 63 months (95% CI, 58.1 to 67.7), the median RFS was 24.1 months versus 27.9 months (P = .9) and the median OS was 64.4 months versus 65.3 months (P = .49). Patients in arm B had more grade 1 to 2 hepatotoxicity, nausea/vomiting, alopecia, and neurologic toxicity. Conclusion There were no significant differences in OS and RFS between the regimens of 1 month and 1 year of treatment.
Phase III Comparison of Preoperative Chemotherapy Compared With Chemoradiotherapy in Patients With Locally Advanced Adenocarcinoma of the Esophagogastric Junction
Authors: Stahl Michael , Walz Martin K. , Stuschke Martin , Lehmann Nils , Meyer Hans-Joachim , Riera-Knorrenschild Jorge , Langer Peter , Engenhart-Cabillic Rita , Bitzer Michael , Königsrainer Alfred , Budach Wilfried , Wilke Hansjochen 
Published: January 2009

Purpose Preoperative chemotherapy is an accepted standard in the treatment of localized esophagogastric adenocarcinoma. Adding radiation therapy to preoperative chemotherapy appears promising, but its definitive value remains unknown. Patients and Methods Patients with locally advanced (uT3-4NXM0) adenocarcinoma of the lower esophagus or gastric cardia were randomly allocated to one of two treatment groups: induction chemotherapy (15 weeks) followed by surgery (arm A); or chemotherapy (12 weeks) followed by chemoradiotherapy (3 weeks) followed by surgery (arm B). Primary outcome was overall survival time. A total of 354 patients were needed to detect a 10% increase in 3-year survival from 25% to 35% by addition of radiation therapy. The study was prematurely closed due to low accrual. Results The median observation time was 46 months. A total of 126 patients were randomly assigned and 119 eligible patients were evaluated. The number of patients undergoing complete tumor resection was not different between treatment groups (69.5% v 71.5%). Patients in arm B had a significant higher probability of showing pathologic complete response (15.6% v 2.0%) or tumor-free lymph nodes (64.4% v 37.7%) at resection. Preoperative radiation therapy improved 3-year survival rate from 27.7% to 47.4% (log-rank P = .07, hazard ratio adjusted for randomization strata variables 0.67, 95% CI, 0.41 to 1.07). Postoperative mortality was nonsignificantly increased in the chemoradiotherapy group (10.2% v 3.8%; P = .26). Conclusion Although the study was closed early and statistical significance was not achieved, results point to a survival advantage for preoperative chemoradiotherapy compared with preoperative chemotherapy in adenocarcinomas of the esophagogastric junction.
Physical Activity and Quality of Life in Adult Survivors of Non-Hodgkin's Lymphoma
Authors: Bellizzi Keith M. , Rowland Julia H. , Arora Neeraj K. , Hamilton Ann S. , Miller Melissa Farmer , Aziz Noreen M. 
Published: January 2009

Purpose To examine the prevalence and correlates of physical activity in adult survivors of aggressive non-Hodgkin's Lymphoma (NHL) and to explore the association between physical activity level and health-related quality of life (HRQOL). Patients and Methods Physical activity and HRQOL data from 319 survivors of NHL (mean age, 59.8 years, standard deviation, ±14.8) who were diagnosed in Los Angeles County approximately 2 to 5 years before the study was analyzed. Results One quarter of survivors of NHL met public health guidelines of 150 minutes or more of moderate to vigorous exercise per week. More than half (53%) reported some activity but less than 150 minutes per week, whereas 20% reported no physical activity. Females, those with lower perceived health competence, and individuals with more comorbid limitations were at increased risk for inactivity. Individuals who met public health guidelines reported better HRQOL than those who were sedentary. Interestingly, our findings suggest a significant positive association between HRQOL and those who get at least some exercise. Conclusion The effort to promote physical activity among cancer survivors, who are at risk for poor quality of life as a result of treatment, is of great importance to the health of this growing population. As NHL, similar to other cancers, becomes a disease that people live with as opposed to one that people die as a result of, oncologists and primary care physicians will be increasingly challenged to provide evidence-based guidance for the long-term management of the patient's health. Consideration should be given to how clinicians frame exercise-promoting messages to cancer survivors, especially to those who are sedentary.
Delivery of Survivorship Care by Primary Care Physicians: The Perspective of Breast Cancer Patients
Authors: Mao Jun J. , Bowman Marjorie A. , Stricker Carrie T. , DeMichele Angela , Jacobs Linda , Chan Dingyun , Armstrong Katrina 
Published: January 2009

Purpose Most of the 182,460 women diagnosed with breast cancer in the United States this year will become long-term survivors. Helping these women transition from active treatment to survivorship is a challenge that involves both oncologists and primary care physicians (PCPs). This study aims to describe postmenopausal breast cancer survivors' (BCS) perceptions of PCP-related survivorship care. Patients and Methods We conducted a cross-sectional survey of 300 BCSs seen in an outpatient breast oncology clinic at a large university hospital. The primary outcome measure was a seven-item self-reported measure on perceived survivorship care (Cronbach's α = .89). Multivariate regression analyses were used to identify factors associated with perceived care delivery. Results Overall, BCSs rated PCP-related survivorship care as 65 out of 100 (standard deviation = 17). The areas of PCP-related care most strongly endorsed were general care (78%), psychosocial support (73%), and health promotion (73%). Fewer BCSs perceived their PCPs as knowledgeable about cancer follow-up (50%), late effects of cancer therapies (59%), or treating symptoms related to cancer or cancer therapies (41%). Only 28% felt that their PCPs and oncologists communicated well. In a multivariate regression analysis, nonwhite race and level of trust in the PCP were significantly associated with higher perceived level of PCP-related survivorship care (P = .001 for both). Conclusion Although BCSs perceived high quality of general care provided by their PCPs, they were not as confident with their PCPs' ability to deliver cancer-specific survivorship care. Interventions need to be tested to improve oncology-primary care communication and PCP knowledge of cancer-specific survivorship care.
Prolonged Survival of Dendritic Cell–Vaccinated Melanoma Patients Correlates With Tumor-Specific Delayed Type IV Hypersensitivity Response and Reduction of Tumor Growth Factor β-Expressing T Cells
Authors: López Mercedes N. , Pereda Cristian , Segal Gabriela , Muñoz Leonel , Aguilera Raquel , González Fermín E. , Escobar Alejandro , Ginesta Alexandra , Reyes Diego , González Rodrigo , Mendoza-Naranjo Ariadna , Larrondo Milton , Compán Alvaro , Ferrada Carlos , Salazar-Onfray Flavio 
Published: January 2009

Purpose The aim of this work was to assess immunologic response, disease progression, and post-treatment survival of melanoma patients vaccinated with autologous dendritic cells (DCs) pulsed with a novel allogeneic cell lysate (TRIMEL) derived from three melanoma cell lines. Patients and Methods Forty-three stage IV and seven stage III patients were vaccinated four times with TRIMEL/DC vaccine. Specific delayed type IV hypersensitivity (DTH) reaction, ex vivo cytokine production, and regulatory T-cell populations were determined. Overall survival and disease progression rates were analyzed using Kaplan-Meier curves and compared with historical records. Results The overall survival for stage IV patients was 15 months. More than 60% of patients showed DTH-positive reaction against the TRIMEL. Stage IV/DTH-positive patients displayed a median survival of 33 months compared with 11 months observed for DTH-negative patients (P = .0014). All stage III treated patients were DTH positive and remained alive and tumor free for a median follow-up period of 48 months (range, 33 to 64 months). DTH-positive patients showed a marked reduction in the proportion of CD4+ transforming growth factor (TGF) β+ regulatory T cells compared to DTH-negative patients (1.54% v 5.78%; P < .0001). Conclusion Our findings strongly suggest that TRIMEL-pulsed DCs provide a standardized and widely applicable source of melanoma antigens, very effective in evoking antimelanoma immune response. To our knowledge, this is the first report describing a correlation between vaccine-induced reduction of CD4+TGFβ+ regulatory T cells and in vivo antimelanoma immune response associated to improved patient survival and disease stability.
Gene Expression Profiling Reveals a New Classification of Adrenocortical Tumors and Identifies Molecular Predictors of Malignancy and Survival
Authors: de Reyniès Aurélien , Assié Guillaume , Rickman David S. , Tissier Frédérique , Groussin Lionel , René-Corail Fernande , Dousset Bertrand , Bertagna Xavier , Clauser Eric , Bertherat Jérôme 
Published: January 2009

Purpose Adrenocortical tumors, especially cancers, remain challenging both for their diagnosis and prognosis assessment. The aim of this article is to identify molecular predictors of malignancy and of survival. Patients and Methods One hundred fifty-three unilateral adrenocortical tumors were studied by microarray (n = 92) or reverse transcription quantitative polymerase chain reaction (n = 148). A two-gene predictor of malignancy was built using the disease-free survival as the end point in a training cohort (n = 47), then validated in an independent validation cohort (n = 104). The best candidate genes were selected using Cox models, and the best gene combination was validated using the log-rank test. Similarly, for malignant tumors, a two-gene predictor of survival was built using the overall survival as the end point in a training cohort (n = 23), then tested in an independent validation cohort (n = 35). Results Unsupervised clustering analysis discriminated robustly the malignant and benign tumors, and identified two groups of malignant tumors with very different outcome. The combined expression of DLG7 and PINK1 was the best predictor of disease-free survival (log-rank P ≈ 10−12), could overcome the uncertainties of intermediate pathological Weiss scores, and remained significant after adjustment to the Weiss score (P < 1.3 × 10−2). Among the malignant tumors, the combined expression of BUB1B and PINK1 was the best predictor of overall survival (P < 2 × 10−6), and remained significant after adjusting for MacFarlane staging (P < .005). Conclusion Gene expression analysis unravels two distinct groups of adrenocortical carcinomas. The molecular predictors of malignancy and of survival are reliable and provide valuable independent information in addition to pathology and tumor staging. These original tools should provide important improvements for adrenal tumors management.
Early and Late Mortality After Diagnosis of Wilms Tumor
Authors: Cotton Cecilia A. , Peterson Susan , Norkool Patricia A. , Takashima Janice , Grigoriev Yevgeny , Green Daniel M. , Breslow Norman E. 
Published: January 2009

Purpose To assess rates and causes of mortality in patients with Wilms tumor (WT). Methods Through 2002, 6,185 patients enrolled onto the National Wilms Tumor Study between 1969 and 1995 were actively observed. Deaths were classified on the basis of medical records as the result of original disease, late effects (including second malignant neoplasms [SMNs], cardiac causes, pulmonary disease, and renal failure), or other causes. Standardized mortality ratios (SMRs) and Cox regression were used to assess the effects of sex, age, and calendar period of diagnosis on mortality. Results Within 5 years of WT diagnosis, 819 deaths occurred, and 159 deaths occurred among 4,972 known 5-year survivors. The SMR was 24.3 (95% CI, 22.6 to 26.0) for the first 5 years, was 12.6 (95% CI, 10.0 to 15.7) for the next 5 years, and remained greater than 3.0 thereafter. For deaths in the first 5 years, the mortality risk decreased by 5-year calendar period of diagnosis (rate ratio [RR] = 0.78 per period). No such trend occurred for later deaths. Among 5-year survivors, 62 deaths were attributed to late effects of treatment or disease, including 27 to SMNs. A trend of decreased risk with calendar period of diagnosis was observed for late-effects mortality (RR = 0.86; 95% CI, 0.67 to 1.10) and for SMN mortality (RR = 0.82; 95% CI, 0.55 to 1.21). Conclusion Although the survival outlook for WT patients has improved greatly over time, survivors remain at elevated risk for death many years after their original diagnosis.
Phase II Trial of Bevacizumab in the Treatment of Persistent or Recurrent Squamous Cell Carcinoma of the Cervix: A Gynecologic Oncology Group Study
Authors: Monk Bradley J. , Sill Michael W. , Burger Robert A. , Gray Heidi J. , Buekers Thomas E. , Roman Lynda D. 
Published: January 2009

Purpose Vascular endothelial growth factor is a key promoter of tumor progression in cervical carcinoma. The Gynecologic Oncology Group (GOG) conducted a phase II trial to assess the efficacy and tolerability of bevacizumab, a recombinant humanized anti–vascular endothelial growth factor monoclonal antibody. Patients and Methods Eligible patients had recurrent cervical cancer, measurable disease, and GOG performance status ≤ 2. Treatment consisted of bevacizumab 15 mg/kg intravenously every 21 days until disease progression or prohibitive toxicity. Primary end points were progression-free survival (PFS) at 6 months and toxicity. Results Forty-six patients were enrolled (median age, 46 years); 38 patients (82.6%) received prior radiation as well as either one (n = 34, 73.9%) or two (n = 12, 26.1%) prior cytotoxic regimens for recurrent disease. Grade 3 or 4 adverse events at least possibly related to bevacizumab included hypertension (n = 7), thrombo-embolism (n = 5), GI (n = 4), anemia (n = 2), other cardiovascular (n = 2), vaginal bleeding (n = 1), neutropenia (n = 1), and fistula (n = 1). One grade 5 infection was observed. Eleven patients (23.9%; two-sided 90% CI, 14% to 37%) survived progression free for at least 6 months, and five patients (10.9%; two-sided 90% CI, 4% to 22%) had partial responses. The median response duration was 6.21 months (range, 2.83 to 8.28 months). The median PFS and overall survival times were 3.40 months (95% CI, 2.53 to 4.53 months) and 7.29 months (95% CI, 6.11 to 10.41 months), respectively. This compared favorably with historical phase II GOG trials in this setting. Conclusion Bevacizumab seems to be well tolerated and active in the second- and third-line treatment of patients with recurrent cervical cancer and merits phase III investigation.
Association Between Hyperglycemia and Survival in Patients With Newly Diagnosed Glioblastoma
Authors: Derr Rachel L. , Ye Xiaobu , Islas Melissa U. , Desideri Serena , Saudek Christopher D. , Grossman Stuart A. 
Published: January 2009

PurposeHyperglycemia has been associated with poor outcomes in many disease states. This retrospective study assessed the association between hyperglycemia and survival in patients with newly diagnosed glioblastoma multiforme (GBM).Patients and MethodsBetween 1999 and 2004, before the standard use of temozolomide, 191 patients were accrued onto New Approaches to Brain Tumor Therapy CNS Consortium trials with similar eligibility criteria. Time-weighted mean glucose and mean glucocorticoid dose were calculated for each patient using all values collected regularly in follow-up. The primary outcome was survival.ResultsMean glucose levels ranged between 65 and 459 mg/dL. These were divided into quartiles: quartile one (< 94 mg/dL), quartile two (94 to 109 mg/dL), quartile three (110 to 137 mg/dL), and quartile four (> 137 mg/dL). Median survival times for patients in quartiles one, two, three, and four were 14.5, 11.6, 11.6, and 9.1 months, respectively. The association between higher mean glucose and shorter survival persisted after adjustment for mean daily glucocorticoid dose, age, and baseline Karnofsky performance score (KPS). Compared with patients in the lowest mean glucose quartile, those in quartile two (adjusted hazard ratio [HR], 1.29; 95% CI, 0.85 to 1.96), quartile three (adjusted HR, 1.35; 95% CI, 0.89 to 2.06), and quartile four (adjusted HR, 1.57; 95% CI, 1.02 to 2.40) were at progressively higher risk of dying (P = .041 for trend).ConclusionIn these patients with newly diagnosed GBM and good baseline KPS, hyperglycemia was associated with shorter survival, after controlling for glucocorticoid dose and other confounders. The effect of intensive management of glucocorticoid-related hyperglycemia on survival deserves additional study in patients with GBM.