tbuckley/cabot-search huggingface dataset:
The impact of hepatic fiblosis on the incidence of liver metastasis from colorectal cancer.
Authors: Takayuki Kondo, Koji Okabayashi, Hirotoshi Hasegawa, Masashi Tsuruta, Ryo Seishima, Shimpei Matsui, Toru Yamada, Hidena Takahashi, Takehiro Shimada, Mutsuhito Matsuda, Masashi Yahagi, Yusuke Yoshikawa, Yusuke Asada, Kiyoaki Sugiura, Yoshiyuki Suzuki, Yuki Tajima, Junpei Nakadai, Yuko Kitagawa
Journal: Journal of Clinical Oncology (2015)

529 Background: Non-alcoholic steatohepatitis (NASH) is closely associated with hepatic fibrosis (HF). The number of patients who have NASH is increasing by eating high-calorie diet. It remains unclear how much impact such NASH and HF on the development of liver metastasis by colorectal cancer (CRC). The objectives of this study is to clarify the influence of HF on metachronous liver-specific recurrence in colorectal cancer patients who underwent colorectal surgery with curative intent. Methods: Between 2000 and 2010, patients who underwent a curative surgical resection for CRC were included in this study. We evaluated the progression of HF by using non-alcoholic fatty liver disease fibrosis score (NFS) based on preoperative blood test result, age, BMI and DM. The patients with NFS higher than 0.676 were objectively defined as HF. The influence of HF on hepatic recurrence was assessed by survival analyses. Results: A total of 953 CRC patients were enrolled, comprised of 293 in stage I, 327 in stage II and 333 in stage III. The mean of NFS was 1.32±1.55, where the included patients were categorized into 77 HF and 876 non-HF. 5-year liver-specific disease-free survival rate in HF was significantly poorer than non-HF (HS 87.0% vs. non-HF 94.5%, log-rank p=0.009). Multivariate analysis demonstrated that HF significantly promoted liver-specific recurrence compared to non-HF (HR=2.16, 95% CI, 1.00 to 4.64; p=0.049). Conclusions: Hepatic fibrosis had a great impact on hepatic recurrence after curative surgical resection of CRCs. These findings indicated that HF might be a favorable microenvironment in developing colorectal liver metastasis. The evaluation of the degree of HF can be useful in selection of adjuvant chemotherapy and postoperative surveillance.
Survival following resection of pancreatic cancers may not be affected by length of hospital stay or delay to initiating adjuvant chemoradiation (CRT)
Authors: A. Morgans, D. Moghanaki, R. Mick, E. E. Furth, P. Salmon, A. Behbehani, J. Drebin, E. F. Rosato, R. Whittington, B. J. Giantonio
Journal: Journal of Clinical Oncology (2008)

4639 Background: Following resection pancreatic cancer, patients (pts) may benefit from adjuvant CRT. However, postoperative morbidity can extend hospital stay and delay adjuvant CRT, and the effect of such delays on outcomes is unknown. Methods: We identified 117 pts with localized pancreatic cancers (92 pancreatic, 20 ampullary, 5 duodenal) who completed adjuvant 5FU-based CRT at our institution between 1981–2005, and data were collected retrospectively. Hospital stay was measured from date of surgery (DOS) to discharge, and delay was measured from DOS to initiation of CRT. Overall survival (OS) from start of CRT was analyzed by the Kaplan-Meier method, and prognostic variables analyzed by univariate and multivariate analysis with the Cox proportional-hazards model. Results: Mean age was 60 yrs, 62% were males, and 50% had pN0 disease. Median and 3-yr OS were 27.1 months and 38.8% (SE + 5%), respectively. The table below summarizes data regarding hospital stay and delay. Neither length of hospital stay nor time from surgery to initiation of adjuvant CRT was associated with survival by unadjusted or adjusted analysis. Conclusion: OS did not appear to be affected by duration of hospital stay or delay to initiation of adjuvant CRT in this limited retrospective study. These findings warrant further evaluation with larger datasets as greater flexibility in the initiation of adjuvant CRT may be feasible. # Pts 3-yr OS rate + SE HR 95% CI P Adjusted P * Duration of Hospital Stay, n=84 < 10 days 27 56.1% + 10.0% 1.0 0.63 0.59 11–19 days 39 22.9% + 7.9% 1.4 0.7 - 2.7 > 20 days 18 38.9% + 11.5% 1.2 0.5 - 2.5 Delay from DOS to CRT, n=117 < 45 days 33 41.4% + 9.3% 1.0 0.90 0.73 46 - 79 days 40 35.5% + 8.0% 1.1 0.6 - 1.9 > 80 days 44 40.2% + 8.1% 1.0 0.6 - 1.7 * adjusted for N stage and age by Cox proportional- hazards model No significant financial relationships to disclose.
Diagnostic, prognostic, and treatment monitoring value of plasma X in patients with metastatic breast cancer.
Authors: Cike Peng, Rongxi Yang, Dharanija Madhavan, Markus Wallwiener, Anja Rudolph, Jenny Chang-Claude, Barbara Burwinkel
Journal: Journal of Clinical Oncology (2014)

37 Background: Metastasis is the main course of death in breast cancer (BC) patients. Reliable prognostic markers are very much appreciated to evaluate possible outcome of patients. Circulating tumor cells (CTC) is a circulating prognostic tumor marker of metastatic breast cancer patients. Despite the big technical challenges in CTC detection, the reliability of CTC enumeration for the prognosis of BC is still on debate. Some studies have proved that the plasma level of X, a major component in extracellular matrix, was increased in patients with metastatic breast cancer. However, the association between the plasma X level and the prognosis of metastatic breast cancer is still unknown. Methods: Plasma X was measured by ELISA in 60 healthy controls, 48 primary breast cancer (PBC) patients, and 212 metastatic breast cancer (MBC) patients. Progression free survival (PFS) and overall survival (OS) were analyzed. An independent cohort with 210 primary and 69 patients with metastatic breast cancer were further investigated to validate our findings. Results: A 2-fold elevation was presented in MBC patients when compared with PBC patients and controls, regardless of their CTC status. A multivariate Cox regression demonstrated that lower X level at base line was associated with longer PFS (HR: 2.50, 95% CI: 1.72–3.63, p = 1.607 × 10 -6 ), as well as longer OS (HR: 3.74, 95% CI: 1.65 – 8.51, p = 0.002). After 1 st cycle of chemotherapy, plasma X level was still prognostic and was dramatically decreased in patients who had responded to the treatment (54%, IQR: 36%–64%). In the independent validation round, a 2-fold increase of plasma X was observed again in MBC patients, compared with PBC patients. The prognostic value was also validated for PFS (HR: 2.12, 95% CI: 1.43– 3.84, p = 0.001) and OS (HR: 2.91, 95% CI: 1.73–7.65, p = 0.002) in MBC patients. Conclusions: Plasma X could be used as a diagnostic and prognostic marker for metastatic breast cancer. Its reduction after 1 st cycle of chemotherapy could be an indicator of treatment efficacy. This finding may further prevent unnecessary systemic therapy by facilitating personalized medicine in the treatment of metastatic breast cancer.
Dose-escalation study of chemoradiotherapy of three-dimensional conformal radiotherapy (3D-CRT) with accelerated hyperfractionation (AHF) and concurrent chemotherapy (cisplatin and vinorelbine) for unresectable stage III non-small cell lung cancer (NSCLC).
Authors: N. Yoshimura, S. Kudoh, H. Tanaka, N. Sizumira, T. Kimura, S. Mitsuoka, T. Tada, M. H. Hosono, K. Hirata
Journal: Journal of Clinical Oncology (2011)

e17518 Background: To determine a recommended dose (RD) of radiotherapy using AHF for unresectable NSCLC. Methods: Eligible patients had unresectable stage III NSCLC, age of less than 75 years, PS: 0 or 1, V20 of 35% or less. PET was used for staging. Cisplatin (80mg/m2) was administered on day 1 and vinorelbine (20mg/m2) was administered on days 1 and 8 for first cycle. Twice-daily 3D-CRT (1.5 Gy per fraction) without elective nodal irradiation started on day 1. Total doses were 60 Gy in 40 fractions and 66 Gy in 44 fractions at levels 1 and 2 respectively. After concurrent chemoradiotherapy, consolidation chemotherapy regimen was cisplatin (80mg/m2) on day 1 and vinorelbine (20mg/m2) on days 1 and 8 every 4 week for three cycles. The dose-limiting toxicity (DLT) was defined as grade ≥a3 esophagitis, grade 3 neutropenic fever, grade ≥a3 other non-hematologic toxicities and interruption of irradiation for more than 2 weeks. DLT was monitored for 90 days. Results: A total of 12 patients were enrolled (n=6,4 in the levels 1,2). DLTs were noted in 2 patients at Level 1,which were grade 3 esophagitis and the other grade 3 febrile neutropenia. Radiation dose was escalated up to 66 Gy in 44 fractions (Level 2), and there was no DLT in level 2. In principle, Sixty-six Gy in 44 fractions (Level 2) should be the RD. Major toxicities were leucopenia, neutropenia, and anemia. The response rate (RR) and 1-year survival rate was 83.3% and 91.7%, respectively. The progression free survival time was 11.3 months. Conclusions: The RD was 66 Gy in 44 fractions (Level 2). The toxicity of this chemoradiothrapy regimen was managiable and efficacy is promissing. Phase II study is warranted.
Serum CA 19–9 level as a surrogate marker for prognosis in locally advanced pancreatic cancer (LAPC)
Authors: D. R. Fogelman, P. Pathak, W. Qiao, R. Chadha, J. Jhamb, D. Melisi, R. A. Wolff, J. L. Abbruzzese, M. M. Javle
Journal: Journal of Clinical Oncology (2008)

15514 Background: Assessing the efficacy of treatment for locally advanced pancreatic cancer (LAPC) via CT is inadequate; radiologic responses are uncommon. We hypothesized that serum CA 19–9 level may serve as an alternative surrogate marker for treatment efficacy in LAPC. Methods: We conducted an analysis of 143 patients with LAPC treated at MDACC. Baseline, final, nadir and change in CA 19–9 levels were correlated with overall survival (OS). Factors included in our model were treatment regimen, grade, age, race and sex. Analysis was conducted using Kaplan-Meier product-limit survival probability estimates and log-rank tests. For the final multivariate Cox regression related to OS, non-significant variables were eliminated using a step-down fashion. Results: The median age was 62.4 years; 50.3% were male. 98 pts were treated on investigational protocols while 45 received non-protocol therapy. Treatments included induction chemotherapy (n=96), concurrent chemoradiation (n=116), and maintenance chemotherapy after chemoradiation (n=29). OS was 13.2 months (95% CI= 11.2, 17.6). On univariate analysis, age (p=0.02) and elevated final CA 19–9 (p<0.0001) correlated with worsened OS while decreased CA 19–9 (p<0.0001) and delivery of second line chemotherapy (p=0.02) correlated with improved OS. On multivariate analysis, the use of second-line chemotherapy correlated with an improved OS (HR 0.61, CI 0.38–0.98, p=.04) while an elevated post-treatment CA 19–9 correlated with worsened OS (HR 1.12, CI 1.05–1.19, p=.0004). In a Kaplan-Meier analysis patients with CA 19–9 improvement (n=90), a 50% decline correlated with improved OS (p=0.01). A Cox hazard ratio (univariate) for this group was 0.46 (CI 0.25, 0.85 p=.01). Conclusion: LAPC patients with elevated CA 19–9 levels after treatment have a poor prognosis; therefore, these patients should be considered for second-line chemotherapy. CA 19–9 decline by 50% or more is associated with an improved outcome. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration Genentech™ BioOncology, Merck, sanofi-aventis
PET-guided treatment in locally advanced adenocarcinoma of the esophagogastric junction (AEG): The MUNICON-II study.
Authors: F. Lordick, C. Meyer Zum Bueschenfelde, K. Herrmann, H. Geinitz, T. Schuster, H. Friess, M. Molls, M. Schwaiger, C. Peschel, B. Krause
Journal: Journal of Clinical Oncology (2011)

3 Background: Previous studies demonstrated that fluorodeoxyglucose (FDG)-PET can help to detect response early during neoadjuvant chemotherapy. The prognosis of metabolic non-responders is poor. Therefore, we initiated the prospective MUNICON-II study to determine the value of salvage neoadjuvant chemoradiation in early PET nonresponders. Methods: 56 patients (pts) with locally advanced AEG type I and II (cT3/4 Nx M0) were included. Tumor glucose uptake was assessed by FDG-PET before and 14 days after initiation of chemotherapy. PET nonresponse was defined as a decrease of the tumor FDG standard uptake value &lt; 35%. Nonresponders received salvage preoperative chemoradiation consisting of external beam radiation 32 Gy (1.6 Gy/fr x 2/day) plus daily cisplatin 6mg/m 2 and then proceeded to surgery. Metabolic responders continued with chemotherapy (platin/5-FU-based) for 3 months. Results: 33 pts had a PET response, 23 had a PET nonresponse. Resection was performed on 54 pts. R0 was achieved in 27 (82%) PET responders versus 16 (70%) nonresponders (p = 0.51). Major histologic remissions (&lt; 10% residual tumor) were observed in 12 PET responders (36%) and 6 PET non responders (26%). After a median follow-up time of 38.0 mon, the median event-free survival (EFS) and the median overall survival (OS) were not yet reached in the PET responders, while EFS was 15.4 mon and OS was 18.3 mon in nonresponders. Conclusions: This study confirms the prognostic value of early metabolic response evaluation during neoadjuvant chemotherapy. Histopathologic responses were observed after salvage chemoradiation, but the clinical outcome of early PET non-responders to chemotherapy remains poor, indicating a dismal tumor biology in this group of pts. No significant financial relationships to disclose.
Results of the Initial Treatment Phase of a Study of Three Alternative Dosing Schedules of Azacitidine (Vidaza®) in Patients with Myelodysplastic Syndromes (MDS).
Authors: Roger M. Lyons, Thomas Cosgriff, Sanjiv Modi, Heidi McIntyre, Indra Fernando, Jay Backstrom, C.L. Beach
Journal: Blood (2007)
Prognostic significance of perineural invasion in localized prostate cancer.
Authors: Louis Lu, Udit Singhal, Ted A. Skolarus, Ganesh S. Palapattu, Jeffrey Scott Montgomery, Alon Z. Weizer, Brent K. Hollenbeck, David Christopher Miller, Alyssa McNamara, Rohit Mehra, Scott A. Tomlins, Daniel A. Hamstra, Todd Matthew Morgan, Felix Yi-Chung Feng
Journal: Journal of Clinical Oncology (2015)

30 Background: While perineural invasion (PNI) has been associated with poorer clinical outcomes in prostate cancer patients, it is not well defined as a predictor of long-term endpoints in newly diagnosed prostate cancer. Therefore, we evaluated the role of PNI as a prognostic marker in patients with localized prostate cancer who underwent surgery or radiation. Methods: We analyzed a prospectively collected cohort of 5,034 consecutive patients with localized prostate cancer treated with surgery (n = 4,207) or radiation (n = 827) at University of Michigan from 1994-2013. The primary outcome measured was metastasis-free survival, with secondary outcomes of PSA-recurrence free survival and overall survival (OS). Covariates included age, treatment year, race, comorbidity index, pre-treatment PSA, Gleason score, and T-stage. Survival analysis was estimated using the Kaplan-Meir method, and multivariable analysis was performed using a Cox proportional hazards model. Results: 22.6% of surgery patients and 37.5% of radiation patients had PNI. 169 patients developed metastasis a median of 44 months (IQR 21-83 months) after primary therapy. In the combined cohort, PNI was a predictor of metastasis and PSA recurrence, but not OS (Table 1). For surgery, PNI was a predictor of metastasis, PSA recurrence, and OS. For radiation, PNI was a predictor of metastasis and PSA recurrence, but not OS. Conclusions: PNI is an independent predictor of long-term outcomes in newly diagnosed prostate cancer patients regardless of subsequent therapy. These data support the importance of PNI as a key factor denoting potentially aggressive prostate cancer and importing a significant increase in the likelihood of eventual metastatic progression. [Table: see text]
Work satisfaction at a multidisciplinary gastrointestinal oncology fast-track outpatient clinic.
Authors: Yara Basta, Jantien A. Vogel, J. Molenaar, Kristien M. A. J. Tytgat, Jean H. G. Klinkenbijl
Journal: Journal of Clinical Oncology (2014)

605 Background: Physician and nurse satisfaction is positively correlated with patient satisfaction. In our university centre we have established the Gastrointestinal Oncology Clinic Amsterdam (GIOCA), a patient centred multidisciplinary one day diagnostics and fast track treatment planning outpatient clinic for gastrointestinal malignancies. The GIOCA team consists of dedicated surgeons, gastroenterologists, medical oncologists, radiation oncologists, radiologists, nuclear radiologists, pathologists, and specialized nurses. We have measured a high patient satisfaction. However to our knowledge there are no studies that focus on the satisfaction of physicians and nurses working within a multidisciplinary team. Our aim was to evaluate the experience and work satisfaction of the physicians and nurses at GIOCA. Methods: A qualitative observational study was performed to compose a questionnaire. This questionnaire was then sent to every physician (specialist, fellow, and resident) and nurse (n=77) working at the outpatient clinic. Answers were given on a 5-point Likert scale. Data were analysed using non-parametric tests. Results: The questionnaire was answered by 73 respondents, of whom 8.2% were nurses and 91.8% were physicians (95% overall response rate). Overall satisfaction with the fast track outpatient clinic was high for all groups (4; 3-5). The workload was experienced as average by physicians and high by nurses (p&lt;0.001). The highest emotional strain was reported by nurses and residents. The emotional strain reported by residents was significantly higher compared to the level of emotional strain reported by specialists (p=0.034). The quality of the multidisciplinary meeting was rated high by both physicians and nurses. The importance of a multidisciplinary one day diagnostics outpatient clinic was invariably rated high to very high by all physicians and nurses. Conclusions: The overall work satisfaction at GIOCA is high. A patient centred one day diagnostics and fast track treatment outpatient clinic for gastrointestinal malignancies is indispensible according to the physicians and nurses. This may have contributed to a high patient satisfaction and a high overall work satisfaction.
Increasing on-treatment visit compliance for radiation therapy cancer patients.
Authors: Voichita Bar-Ad, Kathleen W. Wilson, Susan Munro, Amy Harrison, Harriet Eldredge, Joshua Siglin, Laura Doyle, Anne Lowther, Daniel Clancy, Mark Hurwitz
Journal: Journal of Clinical Oncology (2013)

175 Background: Weekly on-treatment-visits (OTVs) represent standard care in radiation oncology and have significant impact on the quality of patient care. Ensuring that OTVs are completed might decrease the severity of acute treatment-related side effects by facilitating timely treatment of symptoms. This study evaluates factors contributing to missed OTVs and formulates a plan to mitigate this problem. Methods: A multidisciplinary team of radiation oncology staff members reviewed clinical work flow data to determine the number of patients missing their weekly OTVs. These numbers generated benchmarks for the QIP. The team used 30 patient questionnaires and 291 electronic medical records to identify the causative factors for missing the OTVs. After analyzing these results the team generated an action plan for multiple interventions and future audit protocols. Results: On average, 5% of patients miss their weekly OTVs during radiotherapy course. The identified reasons which affected patient compliance with OTVs include: patient inconvenience waiting for the MD, parking concerns, difficulty navigating the clinic to find the exam room, failure of therapist to send the patient for OTVs, changes in MD’s schedule, lack of patient awareness about expected treatment related side effects and importance of immediate treatment of their symptoms. We developed a multidisciplinary plan to minimize patients missing OTVs which includes electronic medical record alerts, communication cues, physical triggers and improved patient education. Additionally, electronic data collection has been implemented for OTV performance metrics and auditing. Conclusions: Patients missing their weekly OTVs during radiotherapy course might be at risk for more severe treatment-related side effects. The details of this multidisciplinary QIP implementation and its impact on quality of care will be presented at the meeting.
Bone Marrow Niche Attenuation by Non-Steroidal Anti-Inflammatory Drugs Mobilizes Hematopoietic Stem and Progenitor Cells by Differing Mechanisms
Authors: Jonathan Hoggatt, Khalid S Mohammad, Brahmananda Reddy Chitteti, Pratibha Singh, Jennifer M Speth, Peirong Hu, Bradley Poteat, Edward Srour, Theresa Guise, Louis M. Pelus
Journal: Blood (2011)
Goals of care discussions and subsequent health care utilization among adults hospitalized for advanced incurable malignancy.
Authors: Laurie Buchanan, Janet Tooze, Heidi Klepin, Nathan Paul Streer
Journal: Journal of Clinical Oncology (2015)

46 Background: Patients with advanced cancer are at risk for repeated hospitalizations and aggressive therapy near the end of life. For these patients, an unscheduled hospitalization predicts survival of &lt; 6 months and represents an opportunity to discuss goals of care which may decrease subsequent health care utilization. Our objective was to describe healthcare utilization for inpatients with advanced malignancies and investigate the association between goals-of-care discussion and subsequent healthcare utilization. Methods: We conducted a chart review of 100 patients with end-stage malignancies consecutively admitted to an academic medical center’s Oncology services beginning January 2013. Eligible patients had advanced incurable malignancy and an unscheduled admission. Exclusion criteria included hematologic malignancies, and hormone therapy responsive breast and prostate cancer. Descriptive statistics were used to characterize the population; variables were compared by code status using chi-square for categorical variables and t-tests for continuous variables. Results: Among 100 patients, the mean age was 62 (range 19-86), and 61% were male. Common cancer types were GI (32%) and lung (31%). Average # of lines of prior chemotherapy was 1.3 (SD 1.5), and 48% had received chemotherapy within 4 weeks of admission. Common reasons for admission were infection (25%), neurologic (13%), and pulmonary complaints (10%). During the hospitalization, 21% required an ICU setting; in-hospital mortality was 1%. Following discharge, 54% were readmitted to the hospital, and, of those patients, 56% spent time in an ICU. On the index admission, only 51% of patients had resuscitation preference documented which increased to 65% by discharge. The patients who had a discussion of code status while inpatient were more likely to be enrolled in hospice at discharge (40% vs. 0%, p &lt; 0.0001) and had fewer readmissions following discharge (1.1 vs. 2.0 readmissions, p = 0.05). Conclusions: Patients with end-stage malignancies have high rates of healthcare utilization. Enhancing goals of care discussions during hospitalization may have a positive impact on readmissions and hospice enrollment.