bluuebunny/crossref_metadata_2025_split huggingface dataset:
Widening disparity in survival between white and African‐American patients with breast carcinoma treated in the U. S. Department of Defense Healthcare system
Authors: Jatoi Ismail , Becher Heiko , Leake Charles R. 
Published: August 2003

AbstractBACKGROUNDIn the U. S., age‐adjusted breast carcinoma mortality rates among white and African‐American women have been diverging during the last 20 years. Some investigators speculate that the widening disparity is due to inequalities in access to healthcare, with African Americans having less access to necessary healthcare and improved therapies. Others argue that differences in tumor biology or some extrinsic influences on cancer etiology and behavior may account for the widening disparity. To examine this issue further, the authors compared trends in survival among white and African‐American women diagnosed with breast carcinoma in the U. S. Department of Defense (DoD), an equal access healthcare system.METHODSThe medical records of all women diagnosed with primary breast carcinoma between 1980–1999 were retrieved from the U. S. DoD Automated Central Tumor Registry (ACTUR). Variables selected for further analysis were date of diagnosis, date of birth, vital status and date of death if applicable, race (black, white, and others), and stage of tumor. Because the database does not contain causes of death, overall survival was investigated. The effect of year of diagnosis and race on overall survival was analyzed using the Cox proportional hazards model stratified by age at diagnosis (1‐year age groups). Calculations were performed separately by disease stage for all stages combined and stratified by stage. Statistical analyses were performed using the statistical software package SAS.RESULTSAfter deleting observations with missing or implausible information regarding patient age, gender, and follow‐up time, the final dataset was comprised of 23,612 women with primary breast carcinoma. The survival of African‐American women compared with white women demonstrated an increasing ratio with calendar period. Although the hazard ratio was 1.269 for women diagnosed with breast carcinoma during the calendar period 1980–1984, it increased to 1.849 for those diagnosed between 1995–1999, which is a ratio of 1.46. For this period, the interaction between race and period was found to be significant (P = 0.04).CONCLUSIONSThe results of the current study demonstrated that breast carcinoma survival rates among white and African‐American patients, adjusted for age and stage, are diverging in the U. S. DoD healthcare system. Thus, inequalities in access to healthcare most likely are not solely responsible for the widening racial disparities in outcome reported among women diagnosed with breast carcinoma. Cancer 2003;98:894–9. © 2003 American Cancer Society.DOI 10.1002/cncr.11604
Routine mammography is associated with earlier stage disease and greater eligibility for breast conservation in breast carcinoma patients age 40 years and older
Authors: Freedman Gary M. , Anderson Penny R. , Goldstein Lori J. , Hanlon Alexandra L. , Cianfrocca Mary E. , Millenson Michael M. , von Mehren Margaret , Torosian Michael H. , Boraas Marsha C. , Nicolaou Nicos , Patchefsky Arthur S. , Evers Kathryn 
Published: August 2003

AbstractBACKGROUNDReduction in breast carcinoma mortality is a major benefit of screening mammography and has been demonstrated in multiple randomized clinical trials and service screening programs. Another benefit from screening is that it allows the patient a wider choice of treatment options, particularly the possibility of conservation surgery. The current study analyzed the impact of mammography in the staging and treatment of breast carcinoma.METHODSA total of 1591 women aged ≥ 40 years were treated for breast carcinoma between July 1995 and October 2001. Three subgroups were defined and compared. Group 1 had 192 patients with no previous mammography, Group 2 was comprised of 695 patients who underwent mammography on average less often than once yearly, and Group 3 was comprised of 704 patients who on average underwent mammography once yearly or more often.RESULTSThe difference in tumor stage was found to be statistically significant between the groups (P < 0.0001). In Group 1, 15% of the patients had ductal carcinoma in situ (DCIS) compared with 21% of patients in Group 2 and 26% of patients in Group 3. In addition, 32% of patients in Group 1 had T1 tumors, whereas 50% of patients in Group 2 and 56% of patients in Group 3 had T1 tumors. The tumor size was ≤ 1 cm in 8% of the patients in Group 1 compared with 20–23% of patients in Groups 2 and 3 (P = 0.0092). Breast conservation was an option for 41% of the patients in Group 1 but mastectomy was recommended in another 41% of patients. However, in Groups 2 and 3, 61% of patients were offered breast conservation and mastectomy was recommended to 28% (P < 0.0001).CONCLUSIONSIn the current study, women age ≥ 40 years with breast carcinoma who underwent mammography at least once yearly were diagnosed with DCIS more often compared with patients who underwent mammography less frequently or those who had no prior mammography. Women who underwent mammo‐graphic screening were found to have smaller tumors, which resulted in a majority of these patients being able to consider breast conservation as an alternative to mastectomy. Cancer 2003;98:918–25. © 2003 American Cancer Society.DOI 10.1002/cncr.11605
Weekly chemotherapy with cisplatin, vincristine, doxorubicin, and etoposide is an effective treatment for advanced thymic carcinoma
Authors: Yoh Kiyotaka , Goto Koichi , Ishii Gen‐ichiro , Niho Seiji , Ohmatsu Hironobu , Kubota Kaoru , Kakinuma Ryutaro , Nagai Kanji , Suga Moritaka , Nishiwaki Yutaka 
Published: August 2003

AbstractBACKGROUNDThymic carcinoma is a rare neoplasm that often disseminates or metastasizes. The role of chemotherapy in treating this malignancy is unclear. The purpose of the current study was to determine the efficacy and tolerability of a weekly chemotherapy regimen consisting of cisplatin, vincristine, doxorubicin, and etoposide (CODE) for the treatment of advanced thymic carcinoma.METHODSThe authors retrospectively reviewed 18 patients with thymic carcinoma who were treated between 1996 and 2002. Twelve of these patients had unresectable advanced diseases and received weekly chemotherapy according to the CODE regimen. The CODE regimen consisted of cisplatin (25 mg/m2, intravenously [i.v.]; weekly administration), vincristine (1 mg/m2, i.v.; administered during Weeks 1, 2, 4, 6, and 8), doxorubicin (40 mg/m2, i.v.; administered during Weeks 1, 3, 5, 7, and 9), and etoposide (80 mg/m2, i.v.; administered for 3 days during Weeks 1, 3, 5, 7, and 9).RESULTSThe responses of all 12 patients to the CODE regimen were assessed. A partial response was achieved in 5 patients, and the overall response rate was 42%. Only one patient experienced disease progression. The median progression‐free survival period was 5.6 months (range, 2–39 months). The overall survival period ranged from 6 to 79 months, with a median survival period of 46 months. Based on the Kaplan–Meier method, the estimated 1‐year and 2‐year survival rates were 80% and 58%, respectively. The most common side effects were hematologic toxicities, and only mild nonhematologic toxicities were experienced.CONCLUSIONSWeekly chemotherapy treatments according to the CODE regimen were effective and tolerated by patients with advanced thymic carcinoma. Cancer 2003;98:926–31. © 2003 American Cancer Society.DOI 10.1002/cncr.11606
Patients with high‐risk aggressive lymphoma treated with frontline intensive chemotherapy and autografting
Authors: Cuttica Alessandra , Zallio Francesco , Ladetto Marco , Di Nicola Massimo , Caracciolo Daniele , Magni Michele , Marinone Carlo , Dell'Aquila Maria , Rosace Michela , Pileri Alessandro , Boccadoro Mario , Gianni Alessandro M. , Tarella Corrado 
Published: August 2003

AbstractBACKGROUNDThe goal of the current study was to evaluate the impact of presentation with an age‐adjusted International Prognostic Index (aaIPI) score of 2 or 3 on patients with high‐risk aggressive lymphoma who are treated with frontline intensive chemotherapy and autografting.METHODSSixty‐nine consecutive patients (median age, 40 years) with either B‐cell (n= 60) or non–B‐cell (n= 9) aggressive lymphoma were treated with high‐dose sequential (HDS) chemotherapy and peripheral blood progenitor cell (PBPC) autografting. The patients who were examined had poor prognoses, with aaIPI scores of 2 (n= 37) or 3 (n= 32). The original treatment regimen, sequential delivery of cyclophosphamide, methotrexate, and etoposide, followed by PBPC autografting (o‐HDS), was used in the first 32 patients; the program was intensified by the addition of a course of high‐dose cytosine arabinoside (C‐HDS) in the next 37 patients.RESULTSThere were 4 toxicity‐related deaths—2 in each aaIPI subgroup (treatment‐related mortality, 5.8%). The complete remission rate was significantly higher among patients with an aaIPI score of 2 (n= 32 [86%]) compared with those with an aaIPI score of 3 (n= 13 [41%];P< 0.001). Patients with an aaIPI score of 2 had significantly better outcomes than did patients with an aaIPI score of 3 in terms of both overall survival (78% vs. 34% at 8 years;P< 0.001) and event‐free survival (72% vs. 28% at 8 years;P< 0.001). Similar results were observed when the analysis was limited to the 60 patients with B‐cell‐derived lymphoma. No significant differences in outcome between patients receiving o‐HDS and patients receiving C‐HDS were observed. Multivariate analysis demonstrated that an aaIPI score of 3 was the only parameter that was significantly associated with poor overall and event‐free survival.CONCLUSIONSAge‐adjusted International Prognostic Index score is applicable to patients with aggressive lymphoma who are treated with frontline intensive chemotherapy and autografting. In addition, upfront use of HDS chemotherapy appears to be beneficial to patients with an aaIPI score of 2 but not to those with an aaIPI score of 3. Cancer 2003;98:983–92. © 2003 American Cancer Society.DOI 10.1002/cncr.11610
The diagnostic and prognostic relevance of human telomerase reverse transcriptase mRNA expression detected in situ in patients with nonsmall cell lung carcinoma
Authors: Fujita Yuka , Fujikane Toshiaki , Fujiuchi Satoru , Nishigaki Yutaka , Yamazaki Yasuhiro , Nagase Atsushi , Shimizu Tetsuo , Ohsaki Yoshinobu , Kikuchi Kenjiro 
Published: August 2003

AbstractBACKGROUNDThe objectives of this study were to evaluate the diagnostic and prognostic relevance of human telomerase reverse transcriptase (hTERT) detected in situ in patients with nonsmall cell lung carcinoma (NSCLC) and to investigate the possible correlations between hTERT mRNA in NSCLC and the patients' clinicopathologic features, including survival.METHODShTERT mRNA was detected by in situ hybridization in 146 samples from patients with NSCLC. The signal intensity of hTERT mRNA expression was evaluated by two independent observers. The expression level was defined subjectively as strong, moderate, or weak.RESULTShTERT mRNA was detected mainly in the cytoplasm of tumor cells. It was detected in the cytoplasm of 100% of samples from patients with NSCLC but was not detected in normal lung tissue, except in activated lymphocytes. There was a significant correlation between hTERT mRNA expression and pathologic tumor status, pathologic disease stage (pStage), and Ki‐67 labeling index. There was no significant correlation between hTERT mRNA expression and age, gender, pathologic lymph node status (pN), histology, or tumor differentiation. The 5‐year survival rates for patients with strong and moderate hTERT mRNA expression levels were 46.9% and 77.9%, respectively; the difference was statistically significant (P = 0.0001). A multivariate analysis of survival using a stepwise procedure revealed that hTERT mRNA expression, pN status, pStage, and age were statistically significant prognostic factors (P = 0.0029, P = 0.0012, P = 0.0237, and P = 0.0496, respectively).CONCLUSIONSThe findings suggested that hTERT mRNA expression may be useful for the diagnosis of NSCLC and also may be an independent prognostic factor for patients with NSCLC. Cancer 2003;98:1008–13. © 2003 American Cancer Society.DOI 10.1002/cncr.11611
Rasburicase (recombinant urate oxidase) for the management of hyperuricemia in patients with cancer
Authors: Bosly André , Sonet Anne , Pinkerton C. Ross , McCowage Geoffrey , Bron Dominique , Sanz Miguel A. , Van den Berg Hendrik 
Published: August 2003

AbstractBACKGROUNDHyperuricemia and tumor lysis syndrome (TLS) are serious complications that can occur during chemotherapy for hematologic malignancies, even if standard management procedures, including administration of allopurinol, are undertaken. Rasburicase, a recombinant urate oxidase that converts uric acid (UA) into the soluble compound allantoin, has been shown to control hyperuricemia faster and more reliably than allopurinol.1METHODSA compassionate use trial, running from January 1999 to December 2001, provided access to rasburicase for patients in nine countries who were at risk for TLS during the initiation of chemotherapy. Of the 280 patients enrolled in the study, 278 received rasburicase and were included in the analysis. A total of 166 pediatric patients who had leukemia (∼ 74%), lymphoma (∼ 24%), or solid tumors (∼ 3%) were treated with rasburicase. One hundred twelve adults with either leukemia (68%) or lymphoma (30%) also were treated. Rasburicase (0.20 mg/kg) was administered intravenously once a day for 1 to 7 days, at the investigator's discretion. Two doses daily could be administered during the first 3 days. A response was defined as a reduction in UA level or maintenance of a UA level less than 7.5 mg/dL (or less than 6.5 mg/dL, for children age < 13 years).RESULTSUA levels at 24–48 hours after administration of the last dose of rasburicase were available for 122 pediatric patients and 97 adult patients. The mean UA level in 29 hyperuricemic children decreased from 15.1 mg/dL to 0.4 mg/dL, whereas in 27 hyperuricemic adults, the mean level decreased from 14.2 mg/dL to 0.5 mg/dL. Prophylactic administration of rasburicase to prevent TLS during chemotherapy reduced UA levels from a mean of 4.4 mg/dL to 0.8 mg/dL in 93 nonhyperuricemic children and from 4.8 mg/dL to 0.4 mg/dL in 70 nonhyperuricemic adults (for all reductions in UA levels, P < 0.001). The response rate was 100%. Rasburicase was very well tolerated. Serious adverse events related to rasburicase were observed in one patient.CONCLUSIONSThe results of the current study confirm that rasburicase is safe and highly effective in the prevention and treatment of chemotherapy‐induced hyperuricemia in both children and adults. Cancer 2003;98:1048–54. © 2003 American Cancer Society.DOI 10.1002/cncr.11612
Treatment of febrile neutropenic patients with cancer who require hospitalization
Authors: Raad Issam I. , Escalante Carmen , Hachem Ray Y. , Hanna Hend A. , Husni Rola , Afif Claude , Boktour Maha R. , Whimbey Estella E. , Kontoyiannis Dimitrios , Jacobson Kalen , Kantarjian Hagop , Levett L. Martin , Rolston Kenneth V. I. 
Published: August 2003

AbstractBACKGROUNDThe objective of the current study was to compare the efficacy and safety of imipenem and cefepime in the treatment of adult patients with cancer who had fever and neutropenia requiring hospitalization according to Infectious Disease Society of America criteria.METHODSIn the current prospective randomized clinical trial at a university‐affiliated tertiary cancer center, adult patients with cancer who had fever (≥ 38.3 °C or ≥ 38.0 °C for > 2 hours) and neutropenia (≤ 500/mm3 or < 1000/mm3 but declining) requiring hospitalization were randomized to receive either cefepime or imipenem. Vancomycin or amikacin was added on suspicion of gram‐positive or gram‐negative bacterial infection, respectively.RESULTSPatients who received an imipenem regimen or a cefepime regimen were comparable in terms of age, gender, underlying malignancy, prior transplantation, degree and trend of neutropenia, and presence of central venous catheters (P ≥ 0.3). An intent‐to‐treat analysis showed a 68% response rate to the imipenem regimen, compared with a 75% response rate to the cefepime regimen (P = 0.2). The rates of antibiotic‐related adverse events and superinfections also were comparable (P = 0.6). There was no difference in response among patients who received imipenem or cefepime alone compared with patients who also received vancomycin or amikacin (P = 1.0). Leukemia was the only independent risk factor associated with a poor outcome (odds ratio, 4.6; 95% confidence interval, 1.9–10.7; P < 0.0001).CONCLUSIONSImipenem and cefepime had similar efficacy and safety profiles in the treatment of adult cancer patients with fever and neutropenia who required hospitalization. The addition of either vancomycin or amikacin may not be necessary. Cancer 2003;98:1039–47. © 2003 American Cancer Society.DOI 10.1002/cncr.11613
Breast carcinoma in pregnant women
Authors: Middleton Lavinia P. , Amin Mitual , Gwyn Karin , Theriault Richard , Sahin Aysegul 
Published: August 2003

AbstractBACKGROUNDBreast carcinoma is one of the most common carcinomas in pregnant women. The incidence of breast carcinoma may increase in the future because of the trend toward delayed childbearing and increased screening. However, very few contemporary studies have attempted to identify the combined histopathologic and immunohistochemical features of breast carcinoma in these patients.METHODSThe authors evaluated 39 patients with breast carcinoma occurring coincident with pregnancy. This was comprised of a critical histologic review and immunohistochemical evaluation to determine the status of prognostic and predictive markers including estrogen receptor (ER), progesterone receptor (PR), HER‐2/neu, Ki‐67, and p53.RESULTSThe mean age at presentation was 33 years (range, 24–44 years). Densities and/or masses were noted on mammograms in 14 of 16 patients with available radiographic information. The primary tumors were a mean of 4.5 cm in greatest dimension (range, 0.1–13.5 cm). Two of the 39 patients had clinical (American Joint Committee on Cancer) Stage I disease, 19 patients had Stage II disease, 16 had Stage III disease, and 2 patients had Stage IV disease at the time of presentation. Histologically, high‐grade invasive ductal carcinomas were found in 32 of 38 patients. The primary tumor was not available for review in one patient. A predominantly solid pattern of growth was observed in nine patients. Lymphovascular invasion was identified in 61% of cases. Ductal carcinoma in situ was identified in 72% of tumors and was high grade in all cases. Of the 25 patients tested, ER positivity was found in 7 patients, PR positivity was found in 6 patients, HER‐2/neu positivity was found in 7 patients, and p53 positivity was found in 12 patients. The proliferation rate as shown by Ki‐67 staining was high in 60% of the cases. Follow‐up information was available for 35 patients and the mean follow‐up period was 43 months (range, 2–163 months). Distant metastasis occurred in seven patients. The mean time to disease recurrence was 20.4 months (range, 10–33 months). Of 35 patients, 4 have died, 22 were alive with no evidence of disease, and 9 were alive with disease at the last follow‐up. The remaining four patients died of unknown causes.CONCLUSIONSPregnant women with breast carcinomas generally present with advanced‐stage disease and the tumors have poor histologic and prognostic features. The findings from the follow‐up indicated that these tumors do not follow a very aggressive clinical course as was proposed in earlier reports. Breast carcinomas occurring during pregnancy share many histologic and prognostic similarities with breast carcinoma occurring in other young women. Cancer 2003;98:1055–60. © 2003 American Cancer Society.DOI 10.1002/cncr.11614
Once‐weekly dosing of epoetin‐α increases hemoglobin and improves quality of life in anemic cancer patients receiving radiation therapy either concomitantly or sequentially with chemotherapy
Authors: Shasha Daniel , George Martine J. , Harrison Louis B. 
Published: August 2003

AbstractBACKGROUNDThe current study was performed to prospectively evaluate the effectiveness, clinical outcomes, and safety of once‐weekly (QW) recombinant human erythropoietin (r‐HuEPO [epoetin‐α]) in anemic cancer patients with nonmyeloid malignancies who were receiving radiation therapy (RT) concomitantly or sequentially with chemotherapy (CT).METHODSA total of 777 anemic patients (hemoglobin [Hb] ≤ 11 g/dL) were enrolled in this multicenter, open‐label, nonrandomized, 16‐week study. Patients initially received epoetin‐α at a dose of 40,000 units (U) subcutaneously QW, escalating to a dose of 60,000 U QW if the Hb increased to ≤ 1 g/dL after 4 weeks. Endpoints were changes in hematologic and quality of life (QOL) parameters.RESULTSAmong the 442 patients evaluable for hematologic response, the mean increase in Hb from baseline to the time of final evaluation was 1.9 ± 1.8 g/dL (P < 0.05). An increase in Hb of ≥ 2 g/dL, in the absence of blood transfusions, occurred in 68.3% of patients (278 of 407 patients) who were on the study for ≥ 30 days. The overall response rate (Hb increase ≥ 2 g/dL or Hb ≥ 12 g/dL in the absence of blood transfusions) was 74.0% (301 of 407 patients). In 359 patients who were evaluable for QOL assessment, epoetin‐α therapy was found to significantly (P < 0.05) improve mean Linear Analog Scale Assessment (LASA) scores for energy level, ability to perform daily activities, and overall QOL from baseline to the time of final evaluation. QW epoetin‐α therapy was found to be well tolerated.CONCLUSIONSTreatment with QW epoetin‐α was found to increase Hb levels, decrease transfusion requirements, and improve functional status and QOL in anemic patients with nonmyeloid malignancies who were receiving RT concomitantly or sequentially with CT. Clinical benefits and the safety profile of QW epoetin‐α in this setting appear to be similar to those observed in anemic cancer patients receiving CT. Cancer 2003;98:1072–9. © 2003 American Cancer Society.DOI 10.1002/cncr.11616