tbuckley/cabot-search huggingface dataset:
Prognostic impact of lymph node retrieval and ratio in gastric cancer: A single-center U.S. experience.
Authors: Joyce Wong, Shams Rahman, Nadia Saeed, Hui-Yi Lin, Khaldoun Almhanna, Ravi Shridhar, Sarah Hoffe, Kenneth Meredith
Journal: Journal of Clinical Oncology (2013)

17 Background: Recommendations for extended lymphadenectomy in gastric cancer is thought to be associated with improved overall survival (OS), although defining adequate lymphadenectomy remains controversial. Methods: A single-institution, prospectively-maintained database of patients referred for surgical care of gastric cancer was reviewed. Patients were stratified by number of examined lymph nodes (eLN): &lt;5, 6-10, 11-15, and &gt;15 and positive LNs (LN+) stratified by 0, 1-2, 3-6, 7-15, and &gt;15. Lymph node ratio (LN+:eLN) was evaluated, stratified by 0, 0.01-0.2, 0.21-0.5, and &gt;0.5. Disease-free-survival (DFS) and OS were the primary endpoints, determined by Kaplan-Meier analyses. Results: From 1997-2012, 222 patients were included; most were male (N=122, 55%) with median age 67 (range 17-92) years. Of 220 (99%) patients surgically explored, 164 (74%) ultimately underwent resection. Median OS of the entire cohort was 22 months. Gender, ethnicity, and smoking status did not impact OS. Pathologic factors such as perineural invasion, lymphovascular invasion, and poor differentiation adversely affected OS, P&lt;0.05. A median 14 lymph nodes (LN) were retrieved (range 0-45), with a median of one positive LN (range 0-31). No OS or disease-free survival (DFS) difference was observed when comparing &lt;5, 6-10, 11-15, and &gt;15 eLN, P=0.30. LN+ affected both OS and DFS: median OS was 52 months for 0 LN+ and decreased to 21 months with 1-2 LN+, 34 months 3-6 LN+, 25 months 7-15 LN+, and 11.5 months with &gt;15 LN+. Similarly, median DFS decreased from 35 months with 0 LN+ to 19 months with 1-2 LN+, 9 months with 3-6 LN+, 13.5 months with 7-15 LN+, and 7.5 months with &gt;15 LN+. Lymph node ratio demonstrated worse median OS with increasing ratio: 49 months for ratio of 0, 37 months for 0.01-0.2, 27 months for 0.21-0.5, and 12 months for &gt;0.5, P&lt;0.0001. DFS was similar: 35months for ratio of 0, 22 months for 0.01-0.2, 13 months for 0.21-0.5, and 7 months for &gt;0.5, P&lt;0.0001. Conclusions: Extent of lymphadenectomy does not impact OS or DFS. Presence of LN+ adversely impacts OS and DFS. Lymph node ratio may be a better prognostic indicator than number of eLN or LN+ in gastric cancer.
Developing symptom management quality improvement reports with data from a registry-based patient reported outcomes (PRO) collection method.
Authors: Tenbroeck Smith, Kathleen Castro, Alyssa Troeschel, Neeraj K. Arora, Kevin Stein, Steven Clauser, Kenneth M. Portier, Elizabeth M. Ward, Ryan M McCabe
Journal: Journal of Clinical Oncology (2014)

180 Background: Symptom management is critical to quality cancer care, affecting treatment completion, functioning and quality of life. We describe the use of the Commission on Cancer’s Rapid Quality Reporting System (RQRS) to ascertain cases for PRO collection, identify key PRO quality indicators, and provide actionable symptom management quality improvement (QI) reports to community cancer centers (CCC). Methods: The Patient Reported Outcomes Symptoms &amp; Side Effects Study used RQRS to sample patients (pt) 4-12 months from diagnosis with locoregional breast/colon from 17 National Cancer Institute Community Cancer Centers Program centers. Surveys were mailed with web option. Pts were asked if they talked to a health professional about pain (Talk about) and, separately, if the health professional gave advice about what to do if pain started, got worse, or came back (Advice). Similar questions were asked about fatigue and emotional distress (ED). QI reports were designed with CCC staff feedback and produced for each CCC providing crude and case-mix adjusted CCC-specific rates, and study-wide rates. Direct standardization methods were used to adjust CCC-specific rates for cancer type and education. Results: 2,487 eligible participants responded (RR=61%). This table shows overall study-wide estimates and the range of adjusted CCC-specific estimates for six key indicators. (See Table.) Conclusions: This pilot study shows the registry-based method for PRO collection was successful and has potential for wider dissemination. Study-wide, 20-45% of pts did not report discussing or getting advice about three common symptoms from their healthcare team. CCCs varied significantly on these indicators, suggesting room for improvement. Quality reports were well received by hospital staff, who report sharing them with clinicians, navigators and cancer committees. CCC-specific reports may promote efforts to improve care through professional/patient education and applying standards of care. [Table: see text]
A multifaceted educational intervention shortened time to antibiotic administration in children with severe sepsis and septic shock: ABISS Edusepsis pediatric study
Authors: Elisabeth Esteban, Sylvia Belda, Patricia García-Soler, Antonio Rodríguez-Núñez, Cristina Calvo, Javier Gil-Anton, Amaya Bustinza, María-Isabel Iglesias-Bouzas, Montserrat Pujol-Jove, Juan Carlos deCarlos, Juan-Pablo García-Iñiguez, Antonio Pérez-Iranzo, Cinta Téllez, Irene Ortiz, Rosalía Pérez, Vanesa Bonil, Sonia Brió, Andrés Concha, José-Domingo López, Vega Murga, Jose-Carlos Flores, Alberto Trujillo, Aida Felipe, Clara Abadesso, María Pino, José León, María-Carmen Martínez, Fernando Gómez, Rut Pérez-Montejano, Rocío Tapia, Iolanda Jordan, Ricard Ferrer
Journal: Intensive Care Medicine (2017)
Surrogacy of progression-free survival (PFS) for overall survival (OS) in rectal cancer trials with preoperative therapy: Literature-based meta-analysis.
Authors: Junki Mizusawa, Kenichi Nakamura, Kozo Kataoka, Junko Eba, Hiroshi Katayama, Taro Shibata, Haruhiko Fukuda
Journal: Journal of Clinical Oncology (2015)

734 Background: Disease-free survival (DFS) after adjuvant chemotherapy in colon cancer has been validated as a surrogate endpoint for OS. An analysis of individual patient data from two randomized controlled trials evaluating preoperative chemoradiotherapy for rectal cancer has already shown that PFS might be a surrogate endpoint for OS (Eur J Cancer, 2012). However, since the report was derived from only two trials, the further evaluation of surrogacy with a larger number of trials is desirable. This study was conducted to explore the trial level correlations between PFS and OS in resectable rectal cancer with preoperative therapy. Methods: A systematic literature search of randomized trials of preoperative chemoradiotherapy, radiotherapy or chemotherapy for rectal cancer reported from January 1990 to September 2014 was conducted using PubMed and the Cochrane library. Weighted linear regression using sample size of each trial as a weight was used to estimate coefficient of determination (R 2 ) within PFS and OS. 95% confidence interval of R 2 was estimated by bootstrap method. The primary analysis included trials in which the HR of PFS and OS were reported. A sensitivity analysis included the trials in which either HR or 5 years point estimates of PFS and OS was reported. In the sensitivity analysis, HR was estimated from the point estimates of PFS and OS assuming exponential distribution. Results: Of 1,048 articles, 14 trials (7,233 patients) were selected for the primary analysis and 18 (8,020) for the sensitivity analysis. Median numbers of enrolled patients were 332 (range 113-1,805) in primary analysis, and 296 (113-1,805) in sensitivity analysis. The primary analysis did not show the correlation between treatment effects on PFS and OS(R 2 0.408; 95% CI [0.133-0.845]). The sensitivity analysis showed modest correlation between PFS and OS (R 2 0.603; 95% CI [0.296-0.871]). Conclusions: The primary analysis showed that PFS was not suitable as a surrogate endpoint, which is contradictory to the previous report. Based on our results, OS is still preferable as the primary endpoint in the trials of preoperative therapy for resectable rectal cancer.
Evaluating oncology pharmacist safety reporting in an outpatient cancer center.
Authors: Gayle C. Blouin, Christine Chio, E. Bridget Kim, Conor McGladrigan, Nie Bohlen, Katie Lafleur
Journal: Journal of Clinical Oncology (2014)

238 Background: Safety reporting is imperative because it provides an opportunity to identify and address preventable errors to enhance patient safety. Pharmacists at the Massachusetts General Hospital cancer center have historically submitted the highest number of safety reports compared to clinicians/nursing. This past year, however, there was a decline in the number of reports submitted. Because pharmacists are in a key position to monitor patient safety, this study was conducted to characterize safety reports submitted by pharmacists and describe subsequent action plans. Additionally, pharmacists’ attitudes towards safety reporting were assessed and obstacles identified. Methods: A retrospective analysis of medication safety reports submitted by outpatient staff over the past 4 years was conducted. Data were obtained from institutional safety reporting system. Pharmacy procedures and education materials were compared against safety reports. Pharmacists’ attitudes were assessed using online survey adapted from the AHRQ. Results: Pharmacists consistently submitted more safety reports compared to other disciplines. However, safety reporting declined from a mean of 61 reports annually to 40 in 2013. The majority of reported events involved prescribing errors, followed by orders submitted to pharmacy without meeting treatment criteria. Actions plans included: protocol checklists, staff education and updating order sets. The majority of pharmacists surveyed agreed/strongly agreed that the practice is actively doing things to improve patient safety and mistakes have led to positive changes. When an event is reported, almost 50% of pharmacists indicated infusion unit staff perceive the person is being written up, not the problem. Common barriers to reporting were time constraints, nurses taking reports personally and not knowing which events warrant reporting. Conclusions: Pharmacists at our institution play an integral role in safety reporting which is essential to provide quality patient care and enhance patient safety. Obstacles identified in this study may have contributed to the recent decline in reporting. Opportunities exist to reinforce non-punitive nature of safety reporting.
Phase I study of intravenous TZT-1027 (T) and carboplatin (C), administered on Day 1 (T and C) and Day 8 (T) every three weeks in patients (pts) with advanced solid tumors
Authors: S. Blagden, A. Thomas, J. S. De-Bono, S. Ahmed, A. Greystoke, G. Attard, A. Jenner, P. Fong, W. P. Steward
Journal: Journal of Clinical Oncology (2005)

3141 Abstract: T is a tubulin-binding drug and a synthetic derivative of dolastatin 10 with cytotoxic and antivascular activity in vitro, and in vivo. Clinical studies have demonstrated antitumor activity in several tumor types including NSCLC. Methods: T was administered as a 1 h IV infusion on d1 and 8 of a 21-day cycle, using a starting dose of 1.6mg/m2. On d1 of each cycle, C was given as a 30 min IV infusion prior to T. Both drugs were given 3 weekly. T was increased by increments of 0.4mg/m2/d and C at AUC 4 or 5 in subsequent cohorts. Results: To date, 13 pts (median age: 59 years, 9 males) have received 42 cycles (median 3, range 1–8) at 3 dose levels: 3 pts at 1.6mg/m2 T and C AUC4 (cohort 1); 9 pts at 1.6mg/m2 T and C AUC5 (cohort 2); 1 pt at 2mg/m2 T and C AUC5 (cohort 3). No DLTs were observed in cohort 1. In cohort 2, 1 pt experienced DLT (neutropenia) so the cohort was expanded to 6 pts, with 2 further DLTs: fatigue (pt was grade 1 at baseline) and diarrhea (antibiotic related, not optimally treated). As causality of DLTs was not fully established, 3 further minimally pre-treated pts were recruited to this cohort, with 1 DLT observed (grade 4 neutropenia <5d). Grade 4 neuropathy was observed in 1 pt in cohort 3 after 4 courses, the pt having had previous platinum exposure. Overall, the most frequent toxicities were neutropenia 50% (19% grade 3, 17% grade 4), fatigue 36%, nausea and vomiting 38% (2% grade 3) and anemia 21% (5% grade 3). Peripheral neuropathy was reported in 12% of pts. Tumor assessment: 1 PR (pancreatic adenocarcinoma- 3 months duration), 7 SD, 4 PD. PK was evaluated. T has a mean clearance of 8 L/h (SD 4.1), mean VD 41 L (SD 31.6); mean elimination T ½ 6.1 h (SD 1.4); and no interaction between T and C. Conclusion: The recommended Phase II dose of T is 1.6mg/m2 and C AUC5. Further clinical studies using DCE-MRI to investigate the antivascular properties of T are ongoing. No significant financial relationships to disclose.
Perioperative outcomes of open and minimally invasive nephroureterectomy and pre-operative predictors of complications: An analysis using the National Surgical Quality Improvement Program database.
Authors: Nachiketh Soodana-Prakash, Nicola Pavan, Raymond R Balise, Bruno Nahar, Samarpit Rai, Chad Ritch, Sanoj Punnen, Ramgopal Satyanarayana, Dipen Parekh, Mark L. Gonzalgo
Journal: Journal of Clinical Oncology (2016)

408 Background: Minimally invasive nephroureterectomy (MINU) is an alternative approach to open nephroureterectomy for management of upper tract urothelial carcinoma (UTUC). Oncological outcomes between the two methods has been shown to be similar. We analyzed the NSQIP database to determine if there was a significant difference in perioperative complications between MINU and open nephroureterectomy. Methods: Between 2005 and 2013, a total of 1,027 patients were identified in the National Surgical Quality Improvement Program Database (NSQIP) that underwent nephrouretectomy for UTUC. Pre−operative covariates were analyzed to predict the rates of severe (Clavien−Dindo grade ≥ 3) perioperative complications. Univariate and multivariate logistic regression models (controlling for demographic and comorbid conditions) were built to predict severe complications and exploratory analyses were done to predict 18 common complications. Results: A total of 669 (65%) and 359 (35%) patients underwent MINU and open nephroureterectomy, respectively. Open nephroureterectomy was associated with a higher rate of severe complications (OR 1.87, CI 1.02−3.4, p = 0.04). Post−operative occurrence of pneumonia (OR 4.5, CI 1.7−3.4, p &lt; 0.001) and transfusions (OR 2.5, CI 1.7−3.6, p &lt; 0.0001) were lower for MINU compared to open nephroureterectomy. There were no significant differences between the two surgical methods with respect to incidence of other complications. MINU took longer on average than open nephroureterectomy (median 219 mins vs. 200 mins, p &lt; 0.001). Time to discharge was longer for open nephroureterectomy compared to MINU (median 6.25 days vs. 5 days, p &lt; 0.0001). Conclusions: Post−operative pneumonia and occurrence of severe complications (Clavien−Dindo grade ≥ 3) were higher for the open nephroureterectomy group compared to MINU. These data suggest that MINU is an acceptable surgical approach for management of UTUC that is associated with lower morbidity compared to open nephroureterectomy.
Tumor angiogenesis as predictive factor for site of relapse in patients with gastric cancer: Biological and clinical implications.
Authors: R. Giampieri, M. Scartozzi, C. Loretelli, E. Galizia, M. Pistelli, A. Bittoni, M. Del Prete, A. Mandolesi, W. Siquini, R. Berardi, C. Trana, C. Marmorale, A. Fianchini, I. Bearzi, S. Cascinu
Journal: Journal of Clinical Oncology (2011)

e21119 Background: Tumor integrins are relevant for gastric cancer diffusion. Preclinical studies suggested that angiogenesis is also crucial for metastatic spread. We investigated the role of VEGF and VEGF-R genotyping and integrin polymorphisms in determining either peritoneal or hematogenous metastases in radically resected gastric cancer. Methods: Genotyping for VEGF-A, VEGF-C and VEGFR-1,2,3 and for tumor integrins was carried out on pT3, peritoneal washing negative, radically resected gastric cancer patients recurring with either peritoneal-only or hematogenous metastases. Results: 101 patients were analyzed: 57 with peritoneal carcinomatosis only and 44 with hematogenous spread only. The following VEGF polymorphisms were associated with hematogenous metastases at the univariate analysis: the AA genotype of rs1570360 (VEGF-A) (p=0.0282), the AC genotype of rs699947 (VEGF-A) (p=0.006) and the GG genotype of rs7993418 (VEGFR-1) (p=0.0259). The following tumoral integrin polymorphisms were associated with hematogenous metastases at univariate analysis: the GG genotype of rs2269772 (ITGA3) (p=0.0002) and the GG genotype of rs11902171 (ITGV) (p=0.029). An increased rate of peritoneal carcinomatosis was found with the AA genotype of ITGA3 (p=0.014) and the CC genotype of ITGV (p=0.016). Variables with a statistically significant odds ratio for peritoneal carcinomatosis at the multivariate analyisis were diffuse tumoral histology (OR: 43,35, 95% CI: 9.07-207.9, p<0.0001) and the AA genotype of ITGA3 (OR: 5.69, 95% CI: 1.1-29.9, p=0.04). At the multivariate analysis the AC genotype of VEGF-A (OR: 8.08, 95% CI: 1.7-37.5, p=0.008) and intestinal histology (OR: 4.2, 95% CI: 1.8-9.9, p=0.0008) were independently associated with hematogenous metastases Conclusions: Tumor histology still represents a crucial factor for site of relapse. Furthermore a specific integrin polymorphism (AA genotype of ITGA3) and a specific VEGF-A polymorphism (AC genotype of VEGF-A) may represent a further asset in the definition of high-risk patients for respectively peritoneal carcinomatosis or hematogenous relapse.
Protein Expression and Methylation Status of the CKI p21, p15 and p16 in Adult Acute Lymphoblastic Leukemia (ALL) Patients: Prognostic Implications.
Authors: Chiara Gregorj, Fabiana De Cave, Maria Teresa Petrucci, Maria R. Ricciardi, Maria C. Scerpa, Sara Santinelli, Vincenzo Liso, Rosario Giustolisi, Andrea Camera, Eugenio Gallo, Felicetto Ferrara, Francesco Nobile, Nicola Cascavilla, Francesco Fabbiano, Giuseppe Leone, Omar Perbellini, Patrizio Mazza, Luciana Annino, Piero Galieni, Eustachio Miraglia, Massimo Martelli, Giuseppe Torelli, Nicola Cantore, Antonio Peta, Alfonso M. D’Arco, Alessandra Tedeschi, Giuseppe Fioritoni, Antonio Cuneo, Maura Brugiatelli, Gianluca Gaidano, Giuseppe Visani, Ignazio Majolino, Rosa Nieddu, Mario Boccadoro, Ernesto Capussela, Antonella Vitale, Giovanna Meloni, Paola Fazzi, Marco Vignetti, Robert Foa, Agostino Tafuri
Journal: Blood (2006)
The prognostic impact of hypoxia-inducible factor-1α and p-Akt expressions in gastric adenocarcinoma
Authors: R. Xu, M. Qiu, B. Han
Journal: Journal of Clinical Oncology (2008)

4560 Background: We investigated the impact of expression of hypoxia inducible factor (HIF)-1α and phosphorylated Akt (p-Akt) on prognosis of gastric adenocarcinoma patients. Methods: Expressions of HIF-1α protein and p-Akt were studied by immunohistochemistry in 188 gastric adenocarcinoma patients. We investigated the impact of HIF-1α and p-Akt on survival. Furthermore we analyzed the correlation of expression of HIF-1α and p-Akt to clinicopathologic features. Results: Among 188 gastric adenocarcinoma patients, 158 (84%) and 148 (78.7%) were positive for HIF-1α and p-Akt. HIF-1α protein expression showed an impact on survival of gastric adenocarcinoma patients by both univariate and multivariate factors analysis. The median survival was significantly different between HIF-1α negative and positive patients (not reached vs 30.9 months, p=0.039, log rank test). High expressions of HIF-1α and p-Akt were significantly correlated with pTNM stage (p=0.004 for HIF-1α and p=0.031 for p-Akt), depth of invasion (p<0.001 for both HIF-1α and p-Akt), lymph node metastasis (p<0.001 for both HIF-1α and p-Akt) and differentiated levels (p<0.001 for HIF-1α and p<0.012 for p-Akt). In addition, there was a significant correlation of HIF-1α protein expression and p-Akt (p<0.001). Conclusions: Our results showed that expression of HIF-1α protein was an independent factor on survival of gastric adenocarcinoma patients. The median survival was significant longer in patients with HIF-1α negative than positive. High expression of HIF-1α and p-Akt were significantly correlated with poor clinicopathologic features. No significant financial relationships to disclose.
Reducing inappropriate PSA-based prostate cancer screening in men age 75 or older with a highly specific computerized clinical decision support tool.
Authors: Jeremy B. Shelton, Lee Ochotorena, Carol J. Bennett, Paul Shekelle, Caroline Goldzweig
Journal: Journal of Clinical Oncology (2013)

233 Background: The value of PSA-based screening for prostate cancer is a topic of intense debate, however the Veterans Health Administration's (VHA) national clinical policy is to use age as a proxy for life expectancy and avoid screening in men ≥ age 75. To facilitate this we developed and implemented a highly specific computerized clinical decision support (CCDS) reminder to remind providers of current guidelines, at the moment of entering an inappropriate PSA order. Methods: We defined screening PSA as: any PSA ordered on men excluding those a) with a diagnosis of existing malignant prostate disease or “elevated prostate specific antigen”, b) who are using either enhancers or suppressors of testosterone, or d) who had a PSA of 2.5ng/ml or greater on either of the two most recent PSA tests. We measured PSA-based prostate cancer screening rates using this definition and on a monthly basis from 07/2011 to 07/2013. Using an interrupted time-series design, we turned the reminder on from 6/2012-8/2012 and then again from 1/2013-4/2013. Results: There were a total of 24,705 men eligible for screening during the two year period of analysis and 1,524 men who were screened. The mean screening rate during the 12 months prior to the study period was 7.8% among men, and during the 12 months of the intervention period it was 4.3%. During the 12 month baseline period the screening rate declined by 29.3%. During the two periods when the CCDS tool was turned on the screening rate feel by 59.7% and 29.8%, whereas during the two periods when it was off, it rose by 84.3% and 18.4%. Conclusions: The overall reduction in screening rate before and after the intervention period is likely substantially confounded by the secular event of the May, 2012 release of the USPSTF grade D recommendation against all PSA-based screening and its substantial media coverage. Despite this, the striking correlation between rate of change in screening rate and the turning on and off of the CCDS tool, suggests that this highly specific CCDS tool was able to reduce inappropriate PSA-based screening, even in an era of significant public discussion of the merits of PSA-based prostate cancer screening.