bluuebunny/crossref_metadata_2025_split huggingface dataset:
Proliferative activity in primary breast carcinomas is a salient prognostic factor
Authors: Michels Jean‐Jacques , Marnay Jacques , Delozier Thierry , Denoux Yves , Chasle Jacques 
Published: January 2004

AbstractBACKGROUNDThe goal of the current study was to investigate the prognostic impact of proliferative activity, together with the other classic clinicopathologic prognostic factors (tumor size, tumor grade, receptor status, ploidy, and lymph node status), in breast carcinoma by counting mitoses and evaluating S phase fraction (SPF) in fresh and frozen tumor samples.METHODSFrom March 1, 1990, to July 1, 1999, a total of 1984 previously untreated invasive breast carcinoma samples were snap‐frozen for flow cytometry.RESULTSAfter multivariate analysis incorporating all classic prognostic factors, SPF combined with mitotic activity (i.e., proliferative activity) remained the sole prognostic factor in the lymph node–negative group; proliferative activity was accompanied by tumor size as a prognostic factor in patients with lymph node–positive disease and by lymph node status, lymphatic invasion, and receptor status in the overall population. The predictive value of proliferative activity was superior to that of the reference standards (classic prognostic predictors according to the guidelines of our institution [common oncology practice] and the St. Gallen classification). A review of the literature, focusing on series in which fresh material was used, allowed us to demonstrate that there is widespread agreement regarding the correlation between SPF and prognosis, even after multivariate analysis.CONCLUSIONSS phase fraction is a valuable predictor of survival and can confidently be assessed in approximately 80% of cases. In conjunction with mitotic activity, SPF should become a prognostic factor that is used in daily practice by oncologists for the management of breast carcinoma. Cancer 2004. © 2003 American Cancer Society.
A retrospective analysis of health care costs for bone fractures in women with early‐stage breast carcinoma
Authors: Zhou Zhiyuang , Redaelli Alberto , Johnell Olof , Willke Richard J. , Massimini Giorgio 
Published: January 2004

AbstractBACKGROUNDIn this retrospective data base study, the authors sought to estimate direct costs for bone fractures in women age ≥ 65 years with early‐stage breast carcinoma and to compare those costs with treatment costs for bone fractures in older women without early‐stage breast carcinoma.METHODSDirect costs for bone fractures in patients with early‐stage breast carcinoma, which consist of excess treatment costs for bone fracture and excess costs of long‐term care for bone fracture, were evaluated by using the 1997–1998 Standard Analytical File. The statistical significance of the difference in inpatient costs, medical treatment costs, and long‐term care admission rates were determined with the t test and the Fisher chi‐square test, respectively.RESULTSFor older women with early‐stage breast carcinoma, the direct costs for bone fracture were estimated at $45,579, and 57% of those costs came from treating the bone fracture (32% came from inpatient hospital costs, and 25% came from noninpatient hospital costs), 25% came from other excess treatment costs, and 18% came from excess long‐term care costs. The women who had early‐stage breast carcinoma and sustained bone fracture did not differ significantly from the women without early‐stage breast carcinoma who sustained a bone fracture.CONCLUSIONSBone fracture was associated with high direct costs in older women with early‐stage breast carcinoma. Additional research should include appropriate, incidence‐based studies to investigate the potential benefit of an intervention for preventing bone fracture in this increasingly large patient population. Cancer 2004. © 2003 American Cancer Society.
Should decisions on internal mammary lymph node irradiation be based on current lymphoscintigraphy techniques for sentinel lymph node identification?
Authors: Benda Rashmi K. , Cendan Juan C. , Copeland Edward M. , Feezor Robert J. , Lind D. Scott , Morris Christopher G. , Mendenhall Nancy Price 
Published: January 2004

AbstractBACKGROUNDTreatment of internal mammary lymph node (IMN) metastases remains controversial because of the difficulty in predicting involvement, potential treatment‐related morbidity, and questionable efficacy. Lymphoscintigraphy with sentinel lymph node biopsy offers a means to identify occult involvement of IMN, allowing appropriate patient selection for IMN treatment.METHODSThe authors retrospectively reviewed 262 lymphoscintigraphies (LS) of 248 patients treated at the University of Florida (Gainesville, FL) between 1998 and 2002. Tumor characteristics were assessed for their value in predicting IMN drainage and their association with IMN radiation.RESULTSLymph flow to the IMN was documented with LS in 23 of 262 tumor specimens (9%). Flow to the IMN was not correlated with any of the five factors: tumor location, tumor size, lymphovascular invasion, pathologic lymph node status, and laterality of the involved breast (right vs. left breast). Identification of IMN flow increased from 5.7% to 10.1% with the use of a deep injection technique. IMN radiotherapy was used more frequently in patients with larger tumors (15 of 188 in Tis/T1 vs. 31 of 70 in T2–T4; P < 0.0001) and positive lymph nodes (17 of 91 in lymph node–negative patients vs. 28 of 66 in lymph node–positive patients; P < 0.0001). In patients with T2N0 tumors (n = 32), IMN radiotherapy was used more frequently with medial tumors (5 of 11 [45%]) than with lateral tumors (4 of 21 [19%]).CONCLUSIONSThe incidence of flow to the IMN documented with the current LS technique was low compared with other LS and extended radical mastectomy series. Histopathologic information was obtained for the sentinel IMN when IMN flow was identified on the LS. In the absence of histopathologic information, treatment decisions should continue to be based on clinical factors known to be correlated with occult IMN involvement. Cancer 2004. © 2003 American Cancer Society.
Treatment of advanced colorectal carcinoma with oxaliplatin and capecitabine
Authors: Shields Anthony F. , Zalupski Mark M. , Marshall John L. , Meropol Neal J. 
Published: January 2004

AbstractBACKGROUNDThe current study was designed to evaluate the antitumor activity and toxicity of capecitabine and oxaliplatin in previously untreated patients with advanced colorectal carcinoma. The primary endpoint of the study was to determine the objective response rate, and a secondary endpoint was to measure the time to disease progression.METHODSA 2‐stage trial was planned with an accrual goal of 35 patients. The treatment included oxaliplatin given at a dose of 130 mg/m2 on Day 1 of each 3‐week cycle. Initially, capecitabine at a dose of 2000 mg/m2/day in 2 divided doses was given on Days 1–14 of each cycle, but this was reduced to a dose of 1500 mg/m2/day because of toxicity. Patients were followed by computed tomography scans every two cycles to evaluate treatment response, and toxicity was monitored.RESULTSThe first 13 patients on the trial received the higher dose of capecitabine. Although 5 responses (38.5%) were noted, 5 patients were hospitalized with diarrhea and dehydration. This toxicity led to a decrease in the dose of capecitabine to 1500 mg/m2/day and an additional 35 patients were treated. At the lower dose, the partial response rate was 37.1% (95% confidence interval [95% CI], 21.5–55.1%). The estimated median progression‐free survival was 6.9 months (95% CI, 4.4–8.2 months). At the lower dose, four patients were hospitalized with diarrhea/dehydration (with one death reported), one with febrile neutropenia, and one with ventricular fibrillation. Overall, Grade (according to version 2.0 of the National Cancer Institute Common Toxicity Criteria) 3‐4 diarrhea was reported to develop in 20% of those patients treated at the capecitabine dose of 1500 mg/m2/day compared with 62% of patients treated at the dose of 2000 mg/m2/day.CONCLUSIONSThe combination of oxaliplatin and capecitabine is an active and convenient regimen for the treatment of patients with advanced colorectal carcinoma and should be compared with other front‐line regimens as therapy for disease. Cancer 2004. © 2003 American Cancer Society.
Restaging of recurrent cervical carcinoma with dual‐phase [18F]fluoro‐2‐deoxy‐D‐glucose positron emission tomography
Authors: Lai Chyong‐Huey , Huang Kuan‐Gen , See Lai‐Chu , Yen Tzu‐Chen , Tsai Chien‐Sheng , Chang Ting‐Chang , Chou Hung‐Hsueh , Ng Koon‐Kwan , Hsueh Swei , Hong Ji‐Hong 
Published: January 2004

AbstractBACKGROUNDThe clinical value of positron emission tomography (PET) with [18F]fluoro‐2‐deoxy‐D‐glucose (FDG) for primary staging in cervical carcinoma appears to be promising. The authors sought to evaluate the diagnostic efficacy and benefit of PET in restaging cervical carcinoma at the time of first recurrence.METHODSForty patients with cervical carcinoma who experienced confirmed treatment failure but who were feasible candidates for curative salvage therapy were enrolled prospectively in the current study. Restaging was performed with PET and with computed tomography and/or magnetic resonance imaging (CT/MRI). Dual‐phase PET was performed by adding 3‐hour‐delayed images to the 40‐minute scans. The results of the PET and CT/MRI scans were compared. Lesion status was determined by pathologic findings or by clinical follow‐up. The receiver operating characteristic curve method with calculation of area under the curve (AUC) was used to evaluate diagnostic efficacy. The primary endpoint was percent improvement in restaging (with improvement indicated by treatment modification) after PET. The secondary endpoint was 2‐year overall survival among study participants compared with comparable previously treated patients who did not undergo disease restaging with PET.RESULTSTwenty‐two patients (55%) had their treatment modified due to PET findings. PET was significantly superior to CT/MRI (sensitivity: 92% vs. 60%; AUC: 0.962 vs. 0.771;P< 0.0001) in identifying metastatic lesions. For individuals receiving primary surgery, a significantly better 2‐year overall survival rate was observed among study participants compared with patients who underwent disease restaging without PET (HR, 0.21 [95% confidence interval, 0.05–0.83];P= 0.020).CONCLUSIONSDual‐phase FDG‐PET is superior to CT/MRI in the restaging of recurrent cervical carcinoma. Restaging with PET provides benefit by allowing the physician to offer optimal management of recurrent cervical carcinoma. Cancer 2004. © 2003 American Cancer Society.
Intravenous itraconazole for prophylaxis of systemic fungal infections in patients with acute myelogenous leukemia and high‐risk myelodysplastic syndrome undergoing induction chemotherapy
Authors: Mattiuzzi Gloria N. , Kantarjian Hagop , O'Brien Susan , Kontoyiannis Dimitrios P. , Giles Francis , Zhou Xian , Lim JoAnn , Bekele B. Nebiyou , Faderl Stefan , Cortes Jorge , Pierce Sherry , Leitz Gerhard J. , Raad Issam , Estey Elihu 
Published: January 2004

AbstractBACKGROUNDSystemic fungal infections remain the leading cause of mortality in patients with newly diagnosed acute myelogenous leukemia (AML) and high‐risk myelodysplastic syndrome (MDS). The objective of the current study was to determine whether intravenous itraconazole (I.V. ITRA) reduced the incidence of probable/proven fungal infections in this group of patients, and compare the results with those of a historic control group treated with fluconazole plus itraconazole capsules (F+I).METHODSPatients with AML and high‐risk MDS who underwent induction chemotherapy received 200 mg of i.v. itraconazole over 60 minutes every 12 hours during the first 2 days followed by 200 mg given i.v. once daily.RESULTSOne hundred patients were enrolled, 96 of whom were evaluable. Approximately 48% of the patients in the group of patients treated with IV ITRA as well as in the F+I group completed prophylaxis. Nine patients (9%) in the study group developed either proven/probable fungal infections (Candida glabrata in 5 patients, C. tropicalis in 1 patient, C krusei in 1 patient, and Fusarium in 2 patients) compared with 3 patients (4%) with proven fungal infection in the historic control group (C. tropicalis in 1 patient and Aspergillus in 2 patients). There were no significant differences noted between the two groups with regard to the percentage of patients who developed proven/probable or possible fungal infection as well as with regard to survival. These results also were obtained after adjusting for relevant prognostic factors (creatinine and bilirubin). The most common toxicity encountered with the use of IV ITRA was NCI Grade 3‐4 hyperbilirubinemia (6%).CONCLUSIONSDespite its theoretic advantages, the authors found no evidence that IV ITRA is superior to itraconazole capsules, at least when the latter is combined with fluconazole. Cancer 2004. © 2003 American Cancer Society.
New agents in acute myeloid leukemia and other myeloid disorders
Authors: Ravandi Farhad , Kantarjian Hagop , Giles Francis , Cortes Jorge 
Published: January 2004

AbstractOver the past several decades, improvements in chemotherapeutic agents and supportive care have resulted in significant progress in treating patients with acute myeloid leukemia (AML). More recently, advances in understanding the biology of AML have resulted in the identification of new therapeutic targets. The success of all‐trans‐retinoic acid in acute promyelocytic leukemia and of imatinib mesylate in chronic myeloid leukemia have demonstrated that targeted therapy may be more effective and less toxic when well defined targets are available. At the same time, understanding mechanisms of drug resistance and means to overcome them has led to modification of some of the existing cytotoxic agents. Rational design and conduct of clinical trials is necessary to ensure that the full potential of these new agents is realized. Cancer 2004. © 2003 American Cancer Society.
Amphotericin B lipid complex as prophylaxis of invasive fungal infections in patients with acute myelogenous leukemia and myelodysplastic syndrome undergoing induction chemotherapy
Authors: Mattiuzzi Gloria N. , Kantarjian Hagop , Faderl Stefan , Lim JoAnn , Kontoyiannis Dimitrios , Thomas Deborah , Wierda William , Raad Isaam , Garcia‐Manero Guillermo , Zhou Xian , Ferrajoli Alexandra , Bekele Nebiyou , Estey Elihu 
Published: January 2004

AbstractBACKGROUNDThe optimal antifungal prophylactic regimen for patients with acute myelogenous leukemia (AML) or high‐risk myelodysplastic syndrome (MDS) undergoing induction chemotherapy has yet to be identified. A prospective historical control study evaluated the efficacy and safety of amphotericin B lipid complex (ABLC) in this patient population.METHODSNewly diagnosed patients with AML or high‐risk MDS who were undergoing induction chemotherapy received prophylactic ABLC 2.5 mg/kg intravenously 3 times weekly. This treatment group was compared with a historical control group that had similar baseline characteristics and received prophylactic liposomal amphotericin B (L‐AmB) 3 mg/kg 3 times weekly. The primary endpoint was the incidence of documented or suspected fungal infections during and up to 4 weeks after cessation of prophylaxis. Reported adverse events were used to assess tolerability.RESULTSThe overall efficacy of antifungal prophylaxis was similar in patients who received ABLC and patients who received L‐AmB (P = 0.95). Among 131 ABLC‐treated patients and 70 L‐AmB‐treated patients who ere assessed for efficacy and safety, 49% of patients in each group completed therapy without developing a documented or suspected fungal infection. Documented fungal infections occurred in 5% of ABLC‐treated patients and in 4% of L‐AmB‐treated patients. Alternative antifungal strategies were required because of persistent fever or pneumonia of unknown pathogen in 28% and 32% of ABLC‐treated and L‐AmB‐treated patients, respectively. Grade 3 and 4 adverse events, therapy discontinuations due to adverse events, and survival rates also were similar between treatment groups.CONCLUSIONSABLC and L‐AmB appeared to have similar efficacy and were tolerated well as antifungal prophylaxis in patients with AML and high‐risk MDS who were undergoing induction chemotherapy. Cancer 2004. © 2003 American Cancer Society.
Noninflammatory breast carcinoma with skin involvement
Authors: Güth Uwe , Moch Holger , Herberich Linda , Holzgreve Wolfgang 
Published: January 2004

AbstractBACKGROUNDAccording to the TNM Supplement, only breast carcinoma with macroscopic ‘classic’ skin changes (e.g., edema, peau d'orange, ulceration) should be placed in the T4 category; the classification of tumors with histologically proven skin involvement but no clinical skin changes or only discreet changes should be based on the size of the tumor (T1–3). To the authors' knowledge, no data supporting these recommendations have been reported to date.METHODSSeventy‐six patients with noninflammatory breast carcinoma and histologically proven skin involvement were classified based on the degree of their skin involvement. Fifty patients (66%) presented with clinically obvious skin involvement (Group A), and 26 patients (34%) had breast carcinoma with histologically proven skin involvement but without clinical skin changes (Group B). Reclassification was undertaken to assess the malignant potential of tumors independent of the morphologic parameter ‘skin involvement’.RESULTSPatients in Group A presented significantly more frequently with extensive disease at regional or distant sites (Stages IIIC and IV; P = 0.009). The clinical outcome of patients in Group B was significantly more favorable (P = 0.0003). The adjusted 3‐year survival rates in Group A and Group B were 46.7% and 92.3%, respectively, and the 5‐year rates were 38.1% and 83.7%, respectively. Patients in Group B were found to have significantly better (P = 0.036) distant recurrence–free survival (DRFS) rates. The DRFS rate at 3 years was 63.6% in Group A, compared with 91.7% in Group B, and the DRFS rate at 5 years was 56.9% in Group A, compared with 82.0% in Group B. Using a cutoff point of tumor size = 3 cm, similar findings were made.CONCLUSIONSBoth study groups exhibited distinct clinical entities with significant differences in clinical course and prognosis. Cases with histologic skin involvement, relative to those with classic skin involvement, were found to have much less malignant potential. This corroborates the recommendation that cases with only histologic skin involvement should not be placed in the T4 category of the TNM classification. Cancer 2004. © 2003 American Cancer Society.
Prognostic significance of phosphorylated P38 mitogen‐activated protein kinase and HER‐2 expression in lymph node‐positive breast carcinoma
Authors: Esteva Francisco J. , Sahin Aysegul A. , Smith Terry L. , Yang Ying , Pusztai Lajos , Nahta Rita , Buchholz Thomas A. , Buzdar Aman U. , Hortobagyi Gabriel N. , Bacus Sarah S. 
Published: January 2004

AbstractBACKGROUNDChemotherapy‐induced p38 mitogen‐activated protein kinase (MAPK) phosphorylation reportedly leads to increased apoptosis in breast carcinoma cells. The goals of the current study were to assess the incidence of activated phosphorylated p38 MAPK (P‐p38) expression in invasive breast carcinoma, correlate expression of P‐p38 MAPK with HER‐2, and estimate the prognostic value of this marker in patients with lymph node‐positive breast carcinoma treated with adjuvant chemotherapy.METHODSP‐p38, HER‐2, and Ki‐67 were measured using immunohistochemistry (peroxidase method) in 96 patients with lymph node‐positive breast carcinoma treated with adjuvant fluorouracil, doxorubicin, and cyclophosphamide chemotherapy. All markers were measured in the primary tumors, before the initiation of adjuvant chemotherapy. The median follow‐up period was 11 years after initial cancer surgery. P‐p38 MAPK expression was scored visually and quantified using an image analyzer.RESULTSThe rate of P‐p38 MAPK expression ranged from 19–24%, depending on the scoring system used. There was a trend toward shorter progression‐free survival (PFS) for patients whose tumors expressed high levels of P‐p38 MAPK, although the difference was not statistically significant (P = 0.39). PFS was shorter in patients whose tumors overexpressed P‐p38 MAPK and had a high level of Ki‐67 (P = 0.04). In HER‐2–negative patients, P‐p38 MAPK overexpression was associated with a shorter PFS (P = 0.05).CONCLUSIONSP38 MAPK phosphorylation occurred in 20% of primary breast carcinomas and may be associated with poor outcome in patients with lymph node‐positive breast carcinoma. Further studies are needed to define the interaction between P‐p38 MAPK and HER‐2 expression in breast carcinoma. Cancer 2004. © 2003 American Cancer Society.
A potential role for perioperative hepatic arterial infusion chemotherapy?
Authors: Espat N. Joseph 
Published: January 2004

The liver is the most common site of distant failure and cause of disease‐related mortality in patients with advanced colon carcinoma. In the study by Sadahiro et al., a randomized controlled study evaluated the effects of prophylactic hepatic arterial infusion chemotherapy for the prevention of liver metastasis in patients with TNM Stage II or Stage III colon carcinoma.See also pages 590–7.
Survival experience of black patients and white patients with bladder carcinoma
Authors: Prout George R. , Wesley Margaret N. , McCarron Peter G. , Chen Vivien W. , Greenberg Raymond S. , Mayberry Robert M. , Edwards Brenda K. 
Published: January 2004

AbstractBACKGROUNDBlacks are less likely than whites to develop bladder carcinoma. However, once they are diagnosed, black patients experience poorer survival. The authors investigated which factors were related to survival differences in black patients and white patients with bladder carcinoma stratified by extent of disease.METHODSA population‐based cohort of black patients with bladder carcinoma and a random sample of frequency‐matched white patients with bladder carcinoma, stratified by age and gender, were identified through cancer registry systems in Atlanta, New Orleans, and San Francisco/Oakland. Patients had no previous cancer history and were ages 20–79 years at the time they were diagnosed with bladder carcinoma in 1985–1987. Medical records were reviewed at initial diagnosis, and 77% of patients were interviewed. Tumor grade, T classification, and other variables, including age, socioeconomic position, symptom duration, smoking history, and comorbidities, were recorded. Survival of black patients and white patients by extent of disease was modeled using Cox regression analysis.RESULTSA greater proportion of black patients had histologic types of tumors that were associated with poorer survival. Among those with pure urothelial carcinoma, black patients had greater extent of disease at the time of diagnosis. Within specific extent‐of‐disease categories, there was some evidence of poorer survival for black patients with T2 tumors and strong evidence of poorer survival among those with T3 tumors compared with white patients. Black patients with muscle‐invasive carcinoma who died within 6 months of diagnosis tended to present with life‐threatening symptoms. Black patients and white patients did not differ with respect to diagnostic tests performed or therapy given.CONCLUSIONSBlack patients with bladder carcinoma had poorer survival due to greater extent of disease at diagnosis and a higher proportion of more aggressive histologies compared with white patients. Within urothelial carcinomas, by extent of disease (clinical/pathologic stage) these black/white survival differences were limited to patients with muscle invasion (T2 and T3 tumors). Cancer 2004. Published 2003 by the American Cancer Society.