tbuckley/cabot-search huggingface dataset:
Abstract 18234: Patient Participation in Cardiac Rehabilitation and Long-term Cardiovascular Events: A Population-based study
Authors: Jose R Medina-Inojosa, Virend Somers, Miguel Gomez Ibarra, Nathalie Jean, Randal Thomas, Leth Shawn, Stephanie Daniels, Francisco Lopez-Jimenez
Journal: Circulation (2015)

Introduction: Cardiac rehabilitation (CR) is recommended for secondary prevention following a coronary artery disease (CAD) event. The association between CR attendance and long-term major cardiovascular events (MACE)in the community has not been previously reported . Hypothesis: We tested the hypothesis that higher CR participation would be related to a lower risk of MACE,in residents of Olmsted county, Minnesota. Methods: We performed a community-based retrospective longitudinal study on patients referred to CR for CAD events or procedures between the years 2002 and 2012. Follow-up was performed using a record linkage system from the Rochester Epidemiology Project. CR participation was assessed as the number of CR sessions attended, and was analyzed as a continuous variable, as quintiles and also as a binomial variable using 12 sessions as the cutoff. The composite outcome MACE was defined as having an acute coronary syndrome (myocardial infarction (MI) or unstable angina), revascularization (CABG or PCI), ventricular arrhythmias requiring hospitalization, stroke or death from any cause. Multivariate models were adjusted for age and gender and also for factors associated with MACE in the univariate analysis. Results: Our cohort included 2273 patients, 69% males, mean age (SEM) 64 (0.26) years. After a mean follow-up of 6 (0.07) years, 827 patients had an event: MI (73), unstable angina (113), CABG(53), PCI (260), ventricular arrhythmia (13), stroke (72) and death (243). Participation in 12 or more sessions (vs &lt;12 sessions) had a lower rate of MACE (HR 0.81, 95% CI 0.70-0.93, p=0.003, see Figure1 . After adjusting for smoking, hypertension, diabetes and history of MI the association remained significant HR 0.85, 95% CI 0.74-0.98, p=0.03. Conclusions: A higher participation in CR was associated with a lower risk of MACE. These results provide additional evidence of important CR health advantages and expand on previous evidence of a dose-response benefit of CR.
Clinical and epidemiological features in 495 gastroenteropancreatic neuroendocrine patients in Mexico.
Authors: Rafael Medrano Guzman
Journal: Journal of Clinical Oncology (2017)

e15687 Background: Data, incidence and/or prevalence about gastroenteropancreatic neuroendocrine tumors remains unknown in Mexico. Also there is no evidence about any Mexican multicenter study reporting information such as clinical presentation, diagnostic approach and treatment. The biggest problem is the lack of clinical and therapeutic management results so physicians can validate the proper patient protocols. Methods: To know the clinical, epidemiological and therapeutic characteristics of NET-GEP patients treated at the 5 biggest Concentration Mexican Medical Institutions.This paper was developed with the support of 5 Public Medical Institutions: Mexican Social Security Institute (IMSS), Institute for Social Security and Services for State Workers (ISSSTE), Secretary of the Mexican Navy, Petroleos Mexicanos (PEMEX), Ministry of Public Health 495 Patients from 6 hospitals where included: Oncology Hospital, CMN XXI Century, Hospital No. 25 25, Monterrey IMSS, National Cancer Institute (INCAN), National Medical Center November 20, Naval General Hospital of High Specialty and Private Institutions. This was a observational and retrospective academic paper . Results: :Of 495 patients, 59.7% (296) were women and 40.32% (200) were men, 26% of them had around 50 years old. Diagnosis symptoms included: abdominal pain 47.27% (234), gastrointestinal bleeding 18.58% (92) no-predominant symptoms 28.88% (143). Around 32.25% (160) had Carcinoid syndrome and 67.74% (336) were nonfunctioning. The predominant location was pancreas 33.27% (165) and stomach 28.02% (139). 36% resulted circumscribed neoplasia (179), features polypoid 26% (129) and infiltrative 15% (73). The size was &gt; 2cm in 49% (242) &gt; 1-2cm: 36% (180) 0.5 to 1 cm 9% (45) &lt; 0.5 cm 6% (29). Grade: GI 64% (316), GII 13% (66), GIII 23% (114). Metastasis positive ganglioanres (6%) (31), negative (94%) (465). Only seven cases extra nodal metastases (liver (3), lung (2), spleen (2)) Conclusions:This is the first multi-center study in Mexico. Which reflects the clinical characteristics of the NET_GET. The results differ in their epidemiology from that reported in other countries. However, the clinical and therapeutic results are very similar.
Differences in density of tumor infiltrating immune cells and its prognostic role in five different malignancies.
Authors: Carlos Castaneda Altamirano, Miluska Castillo Garcia, Luis A. Bernabe, Joselyn Sanchez, Carlos Chavez, Henry Guerra, Jose M. Cotrina, Edgar Amorin, Henry Leonidas Gomez, Iván Chávez
Journal: Journal of Clinical Oncology (2018)

e24139 Background: Growth pattern, replication rates of cancer cells and metastasis location differs by malignancy. And it is reflected in prognosis and response to immune modulators differences by malignancy. We evaluated differences in distribution and density of Tumor Infiltrating immune cell among malignancies, and their influence over prognosis. Methods: Paraffin samples of 165 malignant tumors that were resected at INEN (2007-2013). Glioblastoma (GB, n = 41), melanoma (MLN, n = 43), gastric cancer (GC, n = 42) and cervical cancer (CC, n = 39) samples were organized in tissue microarrays and stained for CD3, CD4, CD8, CD20, CD68 and CD163. Slides were scanned and automatized counts were performed by BX63 Olympus in 5 HPF. Results: Median age was 52.43 years and 43.64% were male; most tumors were HG-3 (51.85%) (except for GB y MLN) and clinical stage I and III (33.06% in both cases) (except for GB). Median CD3, CD4, CD8, CD20, CD68 and CD163 immune cell counts were 8.82%, 1.57%, 6.16%, 0.91%, 10.31% and 6.22%, respectively. Median CD8/CD3 ratio was 0.67. MLN (median = 19.31%) and GC (12.01%) had the highest median CD3 (p < 0.001). MLN (7.83%) and GC (1.56%) had the highest median CD4 (p < 0.001). MLN (median = 8.69%) and GC (7.97%) had the highest median CD8 (p < 0.001). MLN (median = 3.04%) and GC (1.35%) had the highest median CD20 (p < 0.001). MLN (median = 16.63%) and GC (12.35%) had the highest median CD68 (p < 0.001). MLN (median = 19.2%) and GC (8.39%) had the highest median CD163 (p < 0.001). CC (median = 0.817) and GB (0.65) had the highest CD8/CD3 ratio (p = 0.299) Clinicopathological features associated to overall survival was Tumor Size (p < 0.001), primary location (p < 0.001), Gender (p = 0.0001), Clinical Stage (p < 0.001), Metastasis (p < 0.001), Histologic Subtype (p < 0.001) and HG (p = 0.0023). CD4 (p = 0.02), CD20 (p = 0.0195) and CD68 (p = 0.008) were associated with survival. CD8/CD3 ratio was not associated with survival (p = 0.95). Conclusions: Density of tumor infiltrating immune cells differs by malignancy primary, however MLN were the most enriched tumor. CD4, CD20 and CD68 were consistently associated with longer survival. This study was supported by Innovate Peru (contract#317-PNICP-EC-2014).
Docetaxol, bevacizumab, gemcitabine “TAG” chemotherapy for high risk and relapsed adolescent and young adult (AYA) sarcoma patients.
Authors: Chris Kuo, Antonio D Logan, Richard A Jacobson, Paul Kent
Journal: Journal of Clinical Oncology (2016)

10518 Background: Adolescent and young adult (AYA) patients with high-risk recurrent / metastatic sarcomas have very poor prognosis, with few living 2 years. There are currently no standard treatments for these patients. Docetaxol (T), Bevacizumab (A), and Gemcitabine (G) have activity in sarcomas. One study of 3 children using “TAG” yielded a partial response in 2 patients, and stable disease in one (JPHO 2012 34:524-7). We report our preliminary experience with this novel combination for 22 high-risk sarcoma AYA patients. Methods: From 2000-2011, three week cycles of TAG (T = 100m/m2 Day 8, A = 15mg/m2 Day 1, G = 1000 mg/m2 days 1 and 8) was given to 22 AYAs with relapsed sarcomas (5 had Ewings Sarcoma, 8 Osteosarcoma, and 9 other) for up to 11 cycles. The median age was 26 (2-51), 14 were male, 11 had multiple relapses. Nineteen (86%) had failed multiple chemotherapy regimens, 17 with multiple surgeries, and 9 with radiation. Results: Median overall and progression free survival were 18.5 and 6 months respectively. Seven of 22 (32%) patients achieved clinical remission (CR), with 3 having sustained remission. 6 had partial responses (PR) (30% reduction by RECIST), while 5 had progressive disease and 4 had stable disease. Overall Response (CR + PR) was = 59%. Side effects include: mucositis, nasolacrimal duct obliteration, septal perforation, infection and thrombosis. 111 cycles of TAG were given with no toxic deaths, organ failure or need to stop prescribed therapy. Conclusions: In our uncontrolled study, the combination of Taxotere, Avastin and Gemcitabine, “TAG” showed response in 59% of relapsed, pretreated, or very high risk young sarcoma patients. TAG’s toxicities were manageable. TAG may offer a choice to prolong life in highly treated, relapsed, high risk AYA sarcoma patients.
Impact of FDA approval of lenalidomide maintenance therapy in the first-line treatment of multiple myeloma after autologous stem cell transplant on total healthcare costs.
Authors: Jipan Xie, Kejal Parikh, Christina Chen, Chelsey Yang, Adina Farrukh, Paul Cockrum, Amit Balkrishna Agarwal, Safiya Abouzaid
Journal: Journal of Clinical Oncology (2017)

e19509 Background: Lenalidomide maintenance therapy after autologous stem cell transplant (ASCT) in the first-line treatment has been shown to improve progression-free survival (PFS) and overall survival (OS) in multiple myeloma (MM) patients (pts). This study assessed the impact of FDA approval of lenalidomide maintenance therapy on total healthcare costs of a US health plan. Methods: A model was developed to estimate the incremental (additional) total plan costs (in 2016 USD) for maintenance therapy in each year for the first 3 years after lenalidomide monotherapy (R) maintenance therapy approval. The number of post-ASCT adult MM pts eligible for initiating maintenance therapy was estimated from published epidemiological data and an analysis of Connect MM Registry data. Clinical endpoints for R-maintenance, including time on treatment, PFS and OS, were obtained from a meta-analysis of published clinical trials (CALGB, IFM, and GIMEMA). The use of common off-label maintenance therapies was considered. Types of costs included in the model were drug, drug administration, adverse events (AE), AE monitoring, one-time progression and terminal care costs. Results: In a hypothetical health plan with 1 million members, the number of adult MM pts eligible to initiate post-ASCT maintenance therapy was estimated to be 28. Among them, 14.8 pts initiated R-maintenance in Year 1, 15.2 in Year 2, and 15.3 in Year 3, representing an incremental increase of 2.9%, 4.2% and 4.4% after R-maintenance therapy approval, respectively. After considering additional costs of maintenance, as well as potential offsets resulting from delayed progression the incremental total healthcare costs by year are listed in the table. Conclusions: Approval of lenalidomide monotherapy for maintenance after ASCT in the first-line treatment of MM has minimal impact on total plan costs, primarily due to the small incident population and the already common use of lenalidomide in post-ASCT maintenance. [Table: see text]
Improved access to Children's Oncology Group (COG) clinical trials for under-represented minorities and adolescents and young adults (AYAs) through a novel tri-institutional program: addressing cancer disparities.
Authors: Mario F Martinez, Reynaldo Sanchez, Nupur Mittal, Paul Kent, Cathleen Kiely, Kathleen Breen, Jonathan Davidson, Nitin Sane, Ashish Thakkar, Michael Buraglio, Karen Tamulonis, Dipti Dighe, Lisa Giordano, Daniel K. Choi, Jeff Ording, Philomina Thomas, John G Quigley, Rosalind Catchatourian, Steven Gitelis, Mary Lou Schmidt
Journal: Journal of Clinical Oncology (2016)

e18000 Background: Access to COG clinical trials has led to significant improvements in overall survival rates; however, disparities persist, particularly among Black and Hispanic patients, AYAs, and the inadequately insured. (Bhatia, PBC, 2011) In 2008, to improve access to this largely underserved population, two COG institutions (University of Illinois at Chicago (UIC) and Rush University) and a non-member hospital (John H Stroger Hospital formerly Cook County Hospital) created a unified COG program utilizing one lead IRB and one research team. This study assesses the impact that the UIC/Rush/Stroger COG program had on minority and AYA clinical trial enrollment. Methods: Comparative analyses of COG enrollment data from 2002-2008 and 2008-2014 (pre vs. post-merger) including enrollments by race/ethnicity, age at diagnosis, gender, insurance status, clinical trial type (biology, registry, therapeutic, epidemiology), diagnosis, and outcome was completed.Results: Enrollments onto COG clinical trials increased by 248% (2002-08: n = 160, 2008-14: n = 556). Of the post-merger enrollments, 68% were minority (non-white) patients and 50% were AYAs (ages 15-39), a 16% increase in representation for both populations. There was a 96% increase in enrollments for uninsured patients and 71 enrollments occurred at Stroger, a non-member site prior to the merger. Enrollments increased for all diagnoses by at least 100% and the maximum increases were seen in diagnoses that carry a worse prognosis in children and AYAs [Brain tumors by 15x, AML by 30x, Non-Hodgkin Lymphoma by 20x]. (SEER, 1975-2004) Although follow-up time was shorter for post-merger patients, overall survival improved by 50%. Conclusions: Significant increases in COG protocol enrollments, especially for under-represented minorities and AYAs, were a direct result of the creation of this tri-institutional COG research program. Improving access to clinical trials is essential to addressing current disparities in cancer and the UIC/Rush/Stroger COG Program serves as a model to increase enrollment opportunities for minority and AYA patients.
Clinical benefit for minority patients (pts) with advanced refractory cancer versus non Hispanic whites (NHW) when enrolled on early phase (I) clinical trials.
Authors: Audrey E. Kam, Mohammad Haroon Ghalib, Imran Chaudhary, Sridhar Mani, Sanjay Goel
Journal: Journal of Clinical Oncology (2018)

e18634 Background: Minority pts have poor representation in clinical trial participation, and little data exists specifically about phase I trials. These represent a valuable option for pts with advanced cancers who progress on standard therapy. Herein, we report the clinical outcome and prognosis of minority pts treated at our institution. Methods: Records of pts on phase I trials at our institution from January 1999 to December 2016 were reviewed. Treatment-related response, toxicity, and deaths were recorded. Prognostic factors for overall survival (OS) were calculated using univariate (UVA) and multivariable Cox proportional hazards analysis (MVA). Results: Overall, 737 pts – NHW-38.3%, non Hispanic black (NHB) - 32.3%, and Hispanic (26.6%) enrolled on 64 phase I trials [50.5% cytotoxic, 33.5% biologic, 16.0% combined therapy]. Median age was 60 years (range 29-93). Primary cancer diagnoses: colorectal (25.3%), ovarian (19.1%), lung (2.9%), uterine (6.6%), and breast (5.6%). Median number of prior therapies: 3 (range 0-13). In all, 585 pts were evaluable for response. Clinical benefit rate (stable disease+response) was 49.1% and ORR was 7.5%. Grade 3/4 non-hematological and hematological toxicity were seen in 25.8% and 19.0% of pts, respectively. Treatment-related mortality was 0.9%. Median progression free survival was 8 wks and OS was 31.5 wks. Median OS by race was NHW (35wks); NHB (27.4wks, p = 0.92), and Hispanic (35.1wks, p = 0.71). In MVA, age > 60 (HR 1.25, p = 0.025), PS ≥2 (HR 1.77, p = 0.016), metastatic sites > 2 (HR 1.23, p = 0.043), LDH G1 (HR 1.28, p = 0.025), LDH G2 (HR 1.74, p = 0.0004), albumin > G1 (HR 2.46, p < 0.001), total bilirubin ≥ G1 (HR 1.82, p = 0.019), AST ≥ G1 (HR 1.54, p < 0.01), and hemoglobin ≥ G2 (HR 1.40, p = 0.028) were negative prognostic factors for OS. Conclusions: These data represent the first effort to document outcomes on phase I trials among minorities. NHB, and Hispanics derive similar benefit as NHW. Offering minorities the option of enrolment to novel trials is encouraged. Negative prognostic factors for OS were: age > 60, PS > 2, metastatic sites > 2, LDH (G1, G2), albumin > G1, total bilirubin > G1, AST ≥G1, and hemoglobin > G2.
TCT-827 Septal Alcohol Ablation Versus Myectomy for Symptomatic Hypertrophic Obstructive Cardiomyopathy: An Updated Meta-analysis for Long Term Outcomes
Authors: Mohammed Osman, Babikir Kheiri, Mahmoud Barbarawi, None Khansa Osman, Fahad Alqahtani, Mohamad Adnan Alkhouli
Journal: Journal of the American College of Cardiology (2018)
Identification for metastasis lymph node in magnetic resonance imaging with faster region-based convolutional neural network.
Authors: Yun Lu, Qiyue Yu, Yuanxiang Gao, Yunpeng Zhou, Guangwei Liu, Qian Dong, Zhuoli Zhang, Hongwei Yao, Gang Xiao, Guiying Wang, Weitang Yuan, Dianliang Zhang, Wenjian Xu, Jianli Zhang, Dongsheng Wang, Xianxiang Zhang
Journal: Journal of Clinical Oncology (2018)

e15500 Background: The TNM staging of rectal cancer is crucial to select treatment programs for patients, and MRI is the gold standard to confirm the diagnosis of pelvic lymph node metastasis. MRI image features of regional lymph nodes were analyzed to make diagnostic decisions in traditional method, and thus diagnosis lacks objectivity and accuracy. For resolving these problems, a deep neural network named Faster R-CNN was trained and allowed Faster R-CNN to read these images and make diagnosis as imaging experts. Methods: A MRI big database was established. The data includes 28080 lymph node metastasis MRI images and annotations from September 2011 to October 2017 in the Affiliated Hospital of Qingdao University. MRI images in the database were input into Faster R-CNN, and 80,000 times of four-step iteration training were carried out. 414 cases of rectal cancer patients from 6 Chinese medical centers were used to validate Faster R-CNN’s auxiliary effectiveness on MRI imaging diagnosis of lymph nodes. The diagnosis results were then compared with those of specialists to analyze sensitivity, specificity and accuracy of Faster R-CNN in diagnosing metastatic lymph nodes, so ROC curve was attained. The AUC is calculated by trapezoidal method.Results: A Faster R-CNN was trained for identification of lymph node metastasis in MRI images. According to result of evaluation, Faster R-CNN has achieved 100% accuracy. In clinical verification, the results showed that the area under ROC of the Faster R-CNN is 0.912, so the diagnosis of Faster R-CNN is more effective and objective. At the same time, the diagnosis time of the Faster R-CNN is 20s/case, which is more efficient than the average time (600s/case) of imaging experts. Conclusions: The result showed that the AUC value of Faster R-CNN is 0.912, which equals to the level of senior imaging experts whose diagnosis time is 20s/person. Therefore, the Faster R-CNN is of good clinical use feasibility and is more accurate and efficient than the traditional diagnosis method.
Post-operative radiation therapy (PORT) in resected non-small cell lung cancer (NSCLC): An updated population based analysis.
Authors: Stephen Shamp, Tithi Biswas
Journal: Journal of Clinical Oncology (2018)

8522 Background: Post-operative radiation therapy (PORT) in resected NSCLC remains controversial. A previous Surveillance, Epidemiology, and End Results (SEER) analysis showed improved overall survival (OS) in subset with N2 disease, and detriment in N0-N1 (JCO, 2006). Reanalysis of the ANITA trial demonstrated overall detriment of PORT on OS, but improved OS in subset with N2 disease or N1 disease who did not receive chemotherapy (CT). Since SEER recently introduced chemotherapy information, we aim to analyze outcomes of PORT in conjunction with CT in these patient populations Methods: Patients with AJCC 6th stage II-III NSCLC diagnosed between 2004-2014 who underwent lobectomy or pneumonectomy were identified using the SEER 18 database. Patients who survived less than 4 months were excluded to account for perioperative mortality. Neoadjuvant RT was excluded. 15,644 patients met the criteria and were included, with a median followup of 31 months (range 5-120). Survival outcome was calculated using Kaplan-Meier analysis, with log-rank comparison. Multivariable analysis (MVA) was calculated using cox proportional hazard ratio Results: On Kaplan-Meier survival analysis, PORT was associated with inferior OS (p < 0.0001, 5-yr OS 40% vs 50%) whereas CT was associated with improved OS (p < 0.0001, 5-yr OS 46% vs 41%). Subset analysis demonstrated that PORT was associated with worse OS for patient with N0 and N1 disease both with and without CT, as well as N2 disease without CT (p < 0.001 for all). OS was similar with or without PORT for patients with N2 disease who received CT (p = 0.41). On MVA, receipt of PORT was associated with younger age, not receiving CT, advanced T and N stage, male sex, and receiving lobectomy. On MVA, improved OS was associated with younger age, receipt of CT, less advanced T and N stage, female sex, not receiving PORT, Asian race, and receiving lobectomy Conclusions: In a population based cohort, PORT use is associated with reduced OS, and CT is associated with improved OS. Subset analysis shows OS was similar with or without PORT for patients with N2 disease who received CT, but was associated with reduced OS in N2 without CT, as well as N0 and N1. Pneumonectomy was associated with reduced OS