tbuckley/cabot-search huggingface dataset:
Abstract 11093: Layer-specific Quantification of Myocardial Deformation by Strain Echocardiography May Reveal the Mechanism of Preserved Left Ventricular Ejection Fraction in Patients With Hypertrophic Cardiomyopathy
Authors: Jing Ping Sun, Xianda Ni, Tingyan Xu, Min Xu, Xing Sheng Yang, Alex PW Lee, Fang Fang, Cheuk-Man Yu
Journal: Circulation (2015)

Purpose: We aimed to evaluate compensatory mechanisms in hypertrophic cardiomyopathy (HCM) patients (pts) with preserved left-ventricular (LV) ejection fraction (EF). Methods: Speckle-tracking echocardiography (Vivid E9, GE) was performed in 50 HCM with preserved LV EF (38 m; 49± 14 y, all LV EF &gt; 55%) and 50 age, gender matched controls (38 m; 49±12 y). The global and segmental longitudinal (LS), circumferential (CS) and radial strain (RS) strains of endocardia (End), mid-wall and epicardia layers were analyzed using a novel layer-specific TTE. The ratio of End to epicardia strain (End/Epi) was calculated. Results: The LV EF were similar in pts and controls (64±8 vs 64±7 %, p=0.95). The diastolic function was significantly impaired in HCM pts compared with controls (E/E’:18.4±8.4 vs 8.6 ±2.4, p&lt;0.0001). The absolute value of LS and CS was reserved at apical End layers (-34±7 vs -35±6, p=0.44); the remaining segments and LV global LS and CS of three layers were significantly smaller (LS,-16±5 vs -22±3; CS -24±8 vs -33±7; p&lt;0.0001), and LS and CS End/Epi (1.7±0.3 vs 1.3±0.1, 3.4±1.1 vs 1.7±0.2 respectively, P &lt;0.0001) was significantly higher in HCM pts than in controls. The RS and LV twist were preserved in all LV segments (27±10 vs 24±12, p=0.19; 20±8 vs 18±5, p=0.33; respectively). In HCM pts, the LV LS value at basal and middle levels revealed significant negative correlations with LV relative wall thickness (r=–0.65, –0.59 and –0.60, –0.54, respectively , p&lt; 0.0001); and mild negative correlations (r=-0.33,-0.29, p&lt;0.0001). The LV CS value at all levels revealed mild correlations with relative wall thickness (r=-0.22, p&lt;0.05) . The LS were significantly reduced at the hypertrophic segments (Figure). Conclusions: In HCM patients with preserved LVEF, LV GLS was impaired, but apical End LS and basal End CS, LV RS as well as LV twist were maintained as the compensation for reduction LV LS and CS. The Bull’s eye of LS may help us to localize the lesion segments and define the type of HCM.
Effect of clinical outcome-driven reimburesement on cost savings and innovation in multiple myeloma.
Authors: Ohad Oren, Michal Oren
Journal: Journal of Clinical Oncology (2017)

e18344 Background: The cost of cancer care is dissociated from the individual patient’s clinical outcome. A cancer patient treated with a particular drug incurs a fixed expense that is independent of her clinical response. Manufacturers thus have little incentive to design medications more effective than the minimum required for FDA approval. Methods: We propose a model whereby drug manufacturers are rewarded for sustained patient responses. Clinical information flowing to insurance companies dictates patients’ co-payment rates. “Integrated” PFS (iPFS) is defined as the mean of the median PFS of all medications approved for an indication. Patients with objective evidence of disease progression before reaching a given iPFS endure no out-of-pocket expenditure and insurance company deducts a certain percentage from launch price. Patients with durable responses longer than a chosen iPFS threshold pay 20% while the insurance company pays 80% of launch price. For each patient still responding at a specific (high) iPFS, drug company earns extra percentage of launch price via the insurance company (same fraction saved from cases of failure to respond). PFS Kaplan-Meier curves of five common drugs in mm were assessed. Model's impact was calculated. Results: The calculated iPFS was 17 months. iPFS thresholds chosen were 0.7 and 1.2, equaling 11.9 and 20.4 months. For each patient progressing before 11.9 months, the manufacturer were to (randomly) lose 19% of launch price. For each patient with no progression at 20.4 months, it was calculated that manufacturers should earn extra 15% of launch price to achieve overall financial neutrality. Patients had no out-of-pocket expenditure if they had progression earlier than 0.35 iPFS. Approximately 70k patients experienced early progression and were spared cost, with savings amounting 5 m dollars. Amgen and Bristol-Myers generated extra annual revenues amounting 18.4 and 10.6 m dollars for carfilzomib and elotuzumab. Celegne and Takeda experienced annual deductions of 9.9 and 25.9 m dollars for lenalidomide and bortezomib. Conclusions: Our model would spur scientific innovation while generating economic savings for mm patients.
Adjuvant chemotherapy for stage II colon cancer: Practice patterns and effectiveness in the general population.
Authors: Christopher M. Booth, Sulaiman Nanji, Xuejiao Wei, Yingwei Peng, James Joseph Biagi, Timothy P Hanna, Monika K. Krzyzanowska, William J. Mackillop
Journal: Journal of Clinical Oncology (2016)

6569 Background: While guidelines do not recommend adjuvant chemotherapy (ACT) for stage II colon cancer, many state that ACT may be considered in high-risk disease. Here we describe practice patterns and outcomes associated with ACT in the general population. Methods: All cases of colon cancer diagnosed in Ontario 2002-2008 were identified using the Ontario Cancer Registry which was linked to electronic treatment records. Pathology reports were obtained for a 25% random sample of cases. High-risk disease was defined as: T4 tumours, < 12 lymph nodes, poorly differentiated histology, lymphovascular invasion. Modified Poisson regression was used to evaluate factors associated with ACT. Cox proportional hazards model was used to explore the association between ACT and cancer-specific (CSS) and overall (OS) survival. Results: The study population included 2488 patients with stage II colon cancer; 1175 (47%) with high-risk disease. ACT was delivered to 18% of all patients and 24% of patients with high-risk disease. ACT rates were higher among younger patients (51% age 20-49 vs. 16% age 70-79, p < 0.001) and varied considerably across geographic regions (range 10-39%, p < 0.001). Among all patients with stage II colon cancer, ACT was not associated with improved CSS (HR 1.41, 95%CI 1.09-1.82) or OS (HR 1.16, 95%CI 0.94-1.42). Stratified survival analysis for patients with high-risk disease did not show benefit to ACT (CSS HR 1.14, 95%CI 0.84-1.55; OS HR 1.02, 95%CI 0.79-1.31). Conclusions: ACT utilization varies across age groups and geographic regions. ACT is not associated with improved survival among patients with stage II colon cancer including those with high-risk disease.
Less versus more radical surgery in stage IB1 cervical cancer: A population-based study of long-term survival.
Authors: Mario M. Leitao, Yukio Sonoda, Ginger J. Gardner, Oliver Zivanovic, Nadeem Abu-Rustum, Jill Tseng
Journal: Journal of Clinical Oncology (2016)

5525 Background: Our objective was to assess associated factors and disease-specific survival (DSS) of women with stage IB1 cervical cancer treated with less radical surgery (LRS, defined as conization, trachelectomy or simple hysterectomy) compared to those treated with more radical surgery (MRS, defined as modified radical or radical hysterectomy). Methods: We identified women with FIGO stage IB1 cervical cancer from the Surveillance, Epidemiology and End Results (SEER) database. Additional inclusion criteria were age < 45, disease of squamous cell, adenocarcinoma or adenosquamous histology, and diagnosis between 1998 and 2012. Associated factors and outcomes of LRS were compared with those of MRS. Appropriate univariate and multivariate statistical testing was performed. Results: Overall, 1041 women underwent LRS (conization 10%, trachelectomy 9%, simple hysterectomy 81%), and 1797 underwent MRS (modified radical hysterectomy 16%, radical hysterectomy 18%, modified radical/radical hysterectomy 66%). For LRS vs MRS, 27% vs 23% of women were diagnosed with adenocarcinoma (p = .02), 38% vs 45% had tumor size > 2 cm (p < .001), and 78% vs 98% underwent regional lymphadenectomy (p < .001). Median age, race, marital status, and lymph node positivity were similar between the two groups. Those who underwent MRS were more likely to have grade 2 or 3 disease or tumor size > 2 cm than those who underwent LRS (OR 1.48, 95% CI 1.14-1.93; OR 1.90, 95% CI 1.44-2.52; OR 1.22, 95% CI 1.03-1.43). With a median follow-up of 79 months (range, 0-179), 10-year DSS for LRS vs MRS was 92.8% vs 92.3% (SE +/- 0.1, 0.7; p = .80). Adenosquamous histology (HR 2.14, 95% CI 1.42-3.25), grade 3 disease (HR 3.13, 95% CI 1.31-7.49), tumor size > 2 cm (HR 1.96, 95% CI 1.39-2.76), and lymph node positivity (HR 2.32, 95% CI 1.64-3.269) were independently associated with DSS, while LRS vs MRS was not. When stratified by tumor size, DSS for LRS vs MRS was as follows: tumor size < 2 cm, 95.0% vs 95.7% (n = 622, 969; SE +/- 1.1, 0.8; p = .73); and tumor size > 2 cm, 89.1% vs 88.0% (n = 391, 809; SE +/- 1.8, 1.3; p = .96). Conclusions: In young women with stage IB1 cervical cancer, treatment with less radical surgery does not appear to compromise DSS.
TCT-772 Practice-level Variation in Initial Treatment Strategy in Patients With Non-ST Segment Elevation Myocardial Infarction – a Multi-level Methodological Approach
Authors: Yoon Jung Park, Jang Hoon Lee, Bo Eun Park, Hong Nyun Kim, Nam Kyun Kim, Se Yong Jang, Myung Hwan Bae, Dongheon Yang, Hun Sik Park, Yongkeun Cho, Shung Chull Chae, Jang Hoon Lee
Journal: Journal of the American College of Cardiology (2018)
Increase in tumor burden at disease progression as a predictor of survival in advanced NSCLC patients.
Authors: Yuri Kogan, Moran Elishmereni, Eldad Taub, Zvia Agur
Journal: Journal of Clinical Oncology (2018)

e21114 Background: Extending survival in advanced non-small cell lung cancer (NSCLC) is of great importance. Finding survival predictors and assessing the potential for improving patient outcomes through their modification can assist these efforts. Here we tested tumor burden changes at disease progression as survival predictors in NSCLC. Methods: Data were taken from 2 clinical trials in advanced NSCLC patients under 1st line CarboTaxol (projectdatasphere.org). Magnitude and rate of changes in tumor size (sum of longest diameters; SLD) close to progression, and other patient parameters, were evaluated as predictors of post-progression survival (PPS) using univariate/multivariate Cox proportional hazards models. The latter were built by stepwise regression, p = 0.2 being the entrance criterion. Results: In both trials (n = 381 patients with progressive disease (PD) on target lesions), the SLD rise from nadir to progression (dSLD) was significantly correlated with PPS (Table). Patients with lower-than-median dSLD showed longer survival, with a 4.9 and 9.6 month gain in PPS over large-dSLD patients. The impact of dSLD persisted in a multivariate model that included also baseline performance status, gender, appearance of new lesions, and time to progression as significant factors; the additive contribution of dSLD to the multivariate model (Table) was verified by model comparison. Conclusions: Tumor burden increase near first progression was found to be a unique survival predictor for advanced NSCLC. Continuous control of SLD features in NSCLC patients may thus assist in predicting outcomes and suggesting appropriate therapy. We have used these features to develop a new predictive tool that alerts to imminent progression and suggests a treatment switch to limit tumor growth and extend survival. Clinical Study -Identifier Target lesion PD patients (% of all PD patients) Median PPS (months) Median dSLD (cm) Median PPS (months) dSLD Hazard ratio [95% CI], p value > median dSLD < median dSLD Univariate model Multivariate model CA031 -NCT00540514 159 (44%) 7.8 2 4.8 9.7 1.46 [1.22, 1.74], 4.37x10-5 1.26 [1.04, 1.53], 0.01 IPASS -NCT00322452 222 (49%) 12.4 1.5 9.4 19 1.21 [1.12, 1.32], 5.45x10-6 1.18 [1.08, 1.29], 0.0004
FDG-uptake and expression levels of TILs and PD-L1 in primary breast cancer.
Authors: Tomoko Hirakata
Journal: Journal of Clinical Oncology (2018)

12119 Background: 18F-Fluorodeoxyglucose-positron emission tomography (FDG-PET) is used to evaluate the glucose metabolic rates of cancers. Several studies have reported that high FDG uptake is predictive of poor prognosis and aggressive features in patients with breast cancer (BC). However, FDG-uptake is influenced by many factors, including inflammation. In this study, we investigated the relationship between FDG uptake and immunological factors, including degrees of Tumor-infiltrating lymphocytes (TILs), CD8 and programmed cell death ligand 1 (PD-L1), which has been suggested as prognostic factor in BC. Methods: Invasive carcinoma tissues of 97 BC patients who underwent surgery without preoperative therapy were examined. Grade of stromal-TILs was immunohistochemically (IHC) evaluated using the criteria of the International Working Group for TILs in BC: low (10-20%), intermediate (20-40%) and high (50-90%). CD8 positive and PD-L1 positive were evaluated by IHC. The evaluation of PET was determined using standardized uptake value max (SUVmax): low ( < 5) and high (≧5). The relationships between SUVmax and expressions of TILs, CD8 and PD-L1 were investigated. Results: Among the 97 patients, 22 (22.7%) had high SUVmax in the primary tumor. We divided the cases into two groups based on the value of SUVmax, low and high. The analysis revealed that large tumor size (p = 0.004), high nuclear grade (p = 0.019), high degree of TILs (p = 0.004) and positive expression of PD-L1 (p = 0.003) were significantly associated with high SUVmax in the primary tumor. There were associations between SUVmax and degree of TILs, and between SUVmax and the positive expression of PD-L1 (r = 0.428, p < 0.001 and r = 0.413, p < 0.001, respectively). All cases with high degree of TILs showed high expression of CD8. Conclusions: The present study demonstrated that the finding of preoperative FDG uptake in BC may be reflective of the grades of TILs and expression of PD-L1 in the tumor. High TILs is to be better prognostic factor, however, high expression of PD-L1 is to be a poor prognostic factor. In light of our results, FDG uptake may be predictive of immunological features in addition to aggressive features among patients with BC.
Febrile neutropenia-related care and associated costs in elderly cancer patients.
Authors: Shuling Li, Jiannong Liu, Charles Bowers, Tamer Garawin, Christopher Kim, Mark Bensink, David Chandler
Journal: Journal of Clinical Oncology (2018)

e18933 Background: Few population-based studies examine febrile neutropenia (FN)-related care and associated costs in elderly Medicare cancer patients (pts). Methods: Using Medicare 20% sample data, we identified pts aged ≥ 66 years who initiated a first chemotherapy course 1/1/2008-8/31/2015 with high/intermediate-risk regimens to treat breast cancer (BC), lung cancer (LC), or non-Hodgkin lymphoma (NHL), and had ≥ 1 FN episode. We defined each cycle and identified within-cycle FN occurrences based on diagnosis codes for neutropenia, fever, or infection on Part A inpatient (IP) claims, or on Part A outpatient (OP) or Part B claims and, on the same claim, use of IV antimicrobials. An FN episode was defined starting from the first FN claim and ending at the last claim during a cycle. We described the site of FN-related care (IP hospital, OP ER, OP non-ER) and reported the mean cost of FN-related care per episode with the corresponding site of care (adjusted to 2015 US$). Results: We identified 2138, 3521, and 2862 pts with BC, LC, or NHL with ≥1 FN episode (totals, 2407, 3840, and 3587 episodes, respectively). Most FN episodes required IP care (BC, 88%; LC, 93%; NHL, 93%) with mean (SD) length of stay (LOS) in hospital ranging from 6.2 (4.0) days, BC, to 6.8 (4.6) days, NHL. In 20%-30% of hospitalizations, ICU admission was required, with mean (SD) LOS ranging from 4.7 (5.8) days, BC, to 5.5 (6.0) days, NHL. Overall mean cost of FN care was highest for NHL ($15,006) and lowest for BC ($11,959); IP admission was the most costly care component (table). Conclusions: Among elderly pts with BC, LC, or NHL who experienced FN, most FN episodes required costly IP hospital care, highlighting the burden of FN on health care systems and the potential value of FN prophylaxis for elderly cancer pts receiving myelosuppressive chemotherapy. Table. Total FN-related care and cost ($ per episode), overall and by site of care Site of care Breast Cancer Lung Cancer NHL Episodes, n (%) Mean cost ($) Episodes, n (%) Mean cost ($) Episodes, n (%) Mean cost ($) Overall 2407 (100.0) 11,959 3840 (100.0) 14,388 3587 (100.0) 15,006 IP hospital 2121 (88.1) 13,420 3571 (93.0) 15,371 3342 (93.2) 15,963 OP ER 113 (4.7) 1,268 137 (3.6) 1,229 131 (3.7) 1,365 OP non-ER 240 (10.0) 742 219 (5.7) 879 231 (6.4) 1,292
Validity of using cancer registry data for comparative effectiveness research.
Authors: Zachary David Guss, Paige Sheridan, Reith Sarkar, Brent Shane Rose, Ronghui Xu, James Don Murphy
Journal: Journal of Clinical Oncology (2018)

6574 Background: Researchers often use cancer registry data to compare survival for different treatment options in clinical situations where higher level evidence does not exist. However, the retrospective non-randomized approach using cancer registry data for comparative effectiveness research raises important questions about study validity. The purpose of this project was to determine whether retrospective research with cancer registry data produces results concordant with randomized controlled trials (RCTs). Methods: Landmark RCTs involving surgery, systemic therapy or radiation were identified for nine common tumor sites including gastrointestinal, breast, lung, prostate, lymphoma, urinary, gynecologic, head and neck, and central nervous system. We identified experimental and control arms for each trial and recreated these arms using patients from the National Cancer Database (NCDB), matching eligibility criteria from the trial whenever possible. We used multivariable Cox regressions to determine hazard ratios for overall survival for each trial. The multivariable analyses controlled for potential confounders including clinical and tumor variables. We compared hazard ratios from the NCDB analyses with hazard ratios from randomized controlled trials. Results: Eighty-six RCTs were identified and included in this analysis. Overall survival hazard ratios for forty RCTs (45%) were found to be outside the 95% confidence interval reported for the RCTs. Fifty-one (59%) of the RCTs found no significant difference in overall survival between treatment arms, and among these trials 37 (73%) had significant findings showing superiority of one arm within NCDB. Thirty-five (41%) of the RCTs found a significant difference in overall survival between treatment arms, and among these trials 12 (34%) found no significant difference in survival within NCDB. The discordant results between RCTs and NCDB did not differ by disease site or treatment modality. Conclusions: Comparative effectiveness analyses using NCDB frequently produce results discordant from existing RCTs. These results suggest that comparative effectiveness research emanating from cancer registry should be interpreted with caution.
Conditional survival estimates for patients with plasma cell leukemia: An analysis of the SEER database.
Authors: Veena Iyer, Arindam Bagchi, Danae Hamouda, Qiang Nai, Hosam Hakim, Cherian Verghese
Journal: Journal of Clinical Oncology (2017)

e19533 Background: Plasma cell leukemia (PCL) is an aggressive malignancy with poor prognosis. Retrospective studies have suggested improved outcomes with stem cell transplant and use of novel agents. Methods: We used the Surveillance, Epidemiology, and End Results database to identify 480 patients with PCL from 1973 to 2009. Kaplan Meier method was used to calculate 3-year Cancer Specific Survival (CSS) estimates, conditional on 1 to 3 years of survival (CS 3 ). Covariates included age, sex, race and geographic location. The cohort was divided into three time frames, 1973-95, 1996-2005 and 2006-2009, to account for use of transplant from 1995 and novel agents from 2005. Results: 398 patients were selected for analysis from the initial cohort. Median age was 65. 50.75% were female and 65.8% were white. The 3-year CSS for patients with PCL was 19.6% and conditional probability of surviving additional 3 years (CS 3 ) at 1, 2, 3 and 5 years from diagnosis was 36.9%, 51.5%, 58.5% and 71.2% respectively. CSS rates at 3 years during 1973-95, 1995-2005 and 2006-2009 were 14.7%, 12.4% and 32.9% respectively and the CS 3 improved from 37.4% / 27.9% / 44.5% at 1 year to 72.7% / 46.3% / 57.5% at 3 years. 3-year CSS rates of patients aged &lt; 50, 50-59, &gt; 70 years was 19.9%, 19.7% and 18.7% respectively. The CS 3 with each year survived increased for all age groups, with the most dramatic increase for those &gt; 70 years (45.8% at 1 year to 80.5% at 3 years). Hispanics had the lowest 3-year CSS rate (5.5%). Improvement in CS 3 from 1 to 3 years for races was as follows – Whites: 35.8% to 57.9%, Blacks: 41.9% to 50.10%, Asians: 28.6% to 67% and Hispanics: 18.7% to 33.3%. 3-year CSS rate for patients from metropolitan/non-metropolitan areas was 19.5%/18%. CS 3 for metropolitan/non-metropolitan areas increased from 38.2%/27.3% at 1 year to 63%/33.3% at 3 years. Conclusions: The risk profile of patients with PCL changes as they survive past the diagnosis. Improvements in survival are more substantial in older patients and patients from metropolitan areas.
Bone marrow aspiration diagnostic findings in adults at the Lagos University Teaching Hospital: A 10-year review (2005-2014).
Authors: Yusuf Adetomiwa Adelabu, Uche Maureen Amaechi, Sampson Omagbemi Owhin, Folasade Adebisi Adelekan, Oluwole Olugbenga Banjoko, Olufunto Olufela Kalejaiye, Michael Olufemi Kehinde
Journal: Journal of Clinical Oncology (2016)

e18563 Background: There is great need to study the morphologic outcome of bone marrow aspiration done in our center for generation of baseline data and planning. Methods: Record of bone marrow aspiration cytology reported in adults 18 years and above in the Haematology/Oncology unit, Department of Medicine, Lagos University Teaching Hospital between January 2005 and December 2014 were studied. Results: A total of 973 bone marrow aspiration results had complete data for analysis within the study period. 477(49%) were males while 496(51%) were females. Haematologic malignancies accounted for 21% of the pathological outcomes with leukaemias and lymphomas accounting for 15.7% and 2.9% respectively. Conclusions: There is need to expand the scope of laboratory investigations beyond morphology.