tbuckley/cabot-search huggingface dataset:
Prognostic effect of beta blockers (BB) in triple-negative breast cancer (TNBC) patients.
Authors: Elisabetta Munzone, Edoardo Botteri, Nicole Rotmensz, Carlo Maria Cipolla, Arnaldo Zanelotti, Laura Adamoli, Giuseppe Viale, Aron Goldhirsch, Sara Gandini
Journal: Journal of Clinical Oncology (2013)

1061 Background: BB drugs have been used for decades worldwide, typically to treat hypertension and arrhythmias. Despite its therapeutic indication, evidence from recent epidemiological studies suggested that BB intake can improve prognosis of patients (pts) with cancer. With the present study we aimed at assessing whether BB intake is associated with improved prognosis in postmenopausal pts with TNBC, which represents one of the most aggressive cancers. Methods: We retrospectively identified 659 postmenopausal pts operated between 1997 and 2008 at the European Institute of Oncology, Milan, for a primary TNBC. Pts with advanced disease at diagnosis, presurgical systemic treatment or history of other cancers were excluded. The effect of BB intake on the risk of breast cancer recurrence and death from breast cancer (BC) was evaluated through competing risk survival analyses and multivariable Cox regression models. Results: At the time of cancer diagnosis, 61 pts (9.3%) out of 659 were currently using BB, while 598 (90.7%) were not. Median age was 63 years for the BB users and 60 years for the non-users (p value 0.048). All other characteristics—such as tumor size, lymph-nodal involvement, Ki-67, tumor grade, perivascular invasion, type of surgery and adjuvant therapy—were equally distributed between BB users and non-users. Median follow-up was 6 years for both groups. The 5-year cumulative incidence of BC recurrences was 11.7% and 24.1% for BB users and non-users, respectively (p = 0.030). After adjusting for age, tumor size, lymph nodal involvement, grade, perivascular invasion and use of other antihypertensive drugs, the beneficial impact of BB use remained statistically significant, with an hazard ratio of 0.44 (95% CI 0.21-0.98; p = 0.044). The 5-year cumulative incidence of BC deaths was 8.2% and 12.5% for BB users and non-users, respectively (p = 0.185). Hypertension and antihypertensive drugs other than BB did not have any significant impact on recurrence and survival. Conclusions: In this series of postmenopausal pts with primary TNBC, BB intake was associated with a significantly decreased risk of BC recurrence. Additional studies evaluating the potential benefits of BB on cancer prognosis are warranted.
Effect of increased time from chemoradiation to surgery on the pathologic complete response rate in patients with esophageal cancer.
Authors: Talha Shaikh, Karen Ruth, Walter Joseph Scott, Barbara Burtness, Steven J. Cohen, Andre A. Konski, Harry S Cooper, Igor A. Astsaturov, Joshua E. Meyer
Journal: Journal of Clinical Oncology (2012)

84 Background: Studies have demonstrated that pathologic complete response (pCR) in patients undergoing tri-modality treatment for esophageal cancer predicts for decreased local and distant recurrence, as well as increased survival. Increased time from chemoradiation (CRT) to surgery has been shown to increase pCR rates in rectal cancer. This study assessed the effect of the time between the end of CRT and surgery on pCR rates in esophageal cancer. Methods: Clinical records identified 231 patients with resectable esophageal cancer who were treated with CRT from 2000 to 2011, of which 89 underwent subsequent surgery. The records were analyzed for predictors of pCR. Univariate and multivariable analyses were used to determine the significance of all predictors of pCR. Results: Of 89 patients completing trimodality therapy, 76 were male, and the median age was 61 years (range=36-80). Adenocarcinomas comprised 75 patients, and 14 were squamous cell carcinomas. Nine patients had T1/T2 lesions and 80 patients had T3/T4 lesions; 68 patients had node positive tumors. 72 patients received 5FU-based therapy and 17 patients received carboplatin-based therapy. The median radiation dose was 5040 cGy (720-6000) and median follow-up was 24 months. Overall, pCR was seen in 21 patients (24%). The median time from CRT to surgery for a pCR was 102 days vs. 87 days for less than a pCR (p=0.06). By quartile of time from CRT to surgery, pCRs were 18% for &lt;81 days, 13% for 81-88 days, 18% for 89-102 days, and 45% for 103+ days (p=0.05). Multivariable logistic regression showed a trend towards a difference in pCR rates by interval quartile (p=0.06); OR for the highest vs lowest quartile was 5.3 (95% CI=1.1 to 25.6). T stage, N stage, histology, radiation dose and type of chemotherapy were not predictive of a pCR. Conclusions: In this retrospective study, increased time between CRT and surgery was associated with a trend toward increased pCR rates; patients in the longest interval quartile (103+ days) had more pCRs than patients in the shortest interval quartile (&lt;81 days). These data suggest further evaluation of time from CRT to surgery is warranted.
Racial disparities in the morbidity of radical cystectomy in the United States.
Authors: Tudor Borza, Chen Chen Feng, Jeffrey Leow, Benjamin I. Chung, Steven L. Chang
Journal: Journal of Clinical Oncology (2014)

304 Background: Racial disparities in the management of bladder cancer have been previously reported. However, limited data exists on inequalities in the morbidity of radical cystectomy. We performed a contemporary population-based analysis to examine the association between race and surgical complications among patients undergoing radical cystectomy. Methods: We analyzed the Prospective Rx Comparative Database (Premier, Inc., Charlotte, NC), which collects data from over 600 non-federal hospitals throughout the US. We identified patients who underwent radical cystectomy between 2003 and 2010 based on ICD-9 code (57.71). Primary outcome measure was 90-day major complication rates, defined as Clavien Classification System Grade 3-5, derived from ICD-9 codes. Multivariable logistic regression models were developed adjusting for clustering by hospitals and survey weighting to ensure nationally representative estimates to evaluate 90-day major complication for all patients (Model 1), patients ≥65 years (Model 2), and Medicare only patients (Model 3). Results: Our study cohort included 50,175 patients. The majority of patients were Caucasion (76%), men (83.5%), with Medicare (64.2%). Major complication rates were 16% for Caucasions, 17% for African American, 24% for Hispanics, and 16% for Other. Compared to Caucasians, the odds ratio (OR) of major complications for Hispanics was 1.9 (p=0.03) and 2.6 (p&lt;0.0001) in Models 1 and 2, and 1.7 (p=0.1) for Model 3. None of the other racial groups had significantly different odds of major complications compared with Caucasians. Conclusions: In the United States, Hispanic patients are the least likely to undergo radical cystectomy but have the highest rate of major complication following surgery. Our analysis shows that this disparity is uniquely absent among Hispanic patients with Medicare suggesting that barriers to healthcare may underlie the observed phenomenon. Therefore, the worse outcomes for Hispanic patients with bladder cancer may be secondary to challenges in accessing medical treatment at earlier stages of disease arising from language differences and non-U.S. citizenship status.
Tobacco use and race as copredictors of overall survival in patients with breast cancer.
Authors: Jeremy Clady Wells, Thomas A. Samuel, Kyana Morton, Stephen W. Looney
Journal: Journal of Clinical Oncology (2013)

20 Background: Tobacco use (TOB) has been linked to the development of breast cancer (BCa), but limited data exists linking TOB with overall survival (OS) and the influence of race on this relationship. Our previous research has shown that African-American (AA) patients with BCa have worse OS compared with Caucasian (C) patients. This retrospective study examines the effect of TOB on OS in BCa patients at Georgia Regents University (GRU) and the effect of race in conjunction with TOB on OS. Methods: Data were obtained from the GRU Tumor Registry. Inclusion criteria were all female patients diagnosed with BC between 2002 and 2010. The estimated hazard ratio (HR) from Cox regression was used to measure the association between TOB and OS. Race, age at diagnosis, and stage at diagnosis were considered for inclusion as covariates. A stratified OS analysis was also performed dividing patients by race (C vs. AA). Results: Data were collected on 836 females who met inclusion criteria. TOB was categorized as "none" vs. "any" at time of BCa diagnosis The Cox regression analysis indicated a decreased OS for women with any tobacco use (unadjusted HR, 1.45; p = 0.024). Statistical significance was retained when this HR was adjusted for race (HR, 1.47; p = 0.021) and age at diagnosis (HR, 1.45; p = 0.024), but not for stage at diagnosis (HR, 1.21; p = 0.266). In the stratified analysis, the results for C patients were similar to those obtained in the complete sample (HR, 1.62; p = 0.044). Statistical significance was not retained for AA patients (HR 1.31; p = 0.244). We compared C tobacco users (n = 157) vs. AA tobacco users (n = 127) (HR, 1.10; p = 0.716) and C tobacco non-users (n = 291) vs. AA tobacco non-users (n = 261) (HR, 1.36; p= 0.156) and found no statistical significance. Conclusions: Our analysis shows that patients with history of TOB at BCa diagnosis have a 45% chance of decreased OS compared to non-TOB users. The negative impact of TOB is still noted when adjusted for race and age at diagnosis but not for stage at diagnosis. When stratifying by race, we found that any TOB is a significant risk factor among C patients but not among AA patients. We conclude that any history of TOB at BCa diagnosis is an important negative prognostic factor for OS, and this is particularly true in C patients.
The prognostic value of neuroendocrine differentiation in patients with undifferentiated-type gastric adenocarcinoma.
Authors: Rie Makuuchi, Masanori Tokunaga, Hironobu Goto, Yutaka Tanizawa, Etsuro Bando, Taiichi Kawamura, Takashi Nakajima, Masanori Terashima
Journal: Journal of Clinical Oncology (2013)

20 Background: Neuroendocrine carcinoma (NEC) of the stomach is defined as carcinoma having prominent (&gt;70%) neuroendocrine differentiation (NED), and is well known to be highly malignant tumor with extremely poor overall survival time. However the biological meaning of less NED in gastric adenocarcinoma is still unclear. The aim of this study is to identify the prevalence of NED in undifferentiated type gastric adenocarcinoma (UDGA) and to clarify the prognostic value of NED. Methods: A total of 112 patients with advanced UDGA who underwent curative resection at Shizuoka Cancer Center between January 2004 and December 2006 were included. We performed immunohistochemical analysis for neuroendocrine markers, and classified patients into four groups according to the result of the immunohistochemical study as follows: NEC group (n=6), NED &gt; 70%; MANEC (mixed adenoneuroendocrine carcinoma ) group (n=0), 30-70%; NED+ group (n=46), 1-30%; NED- group (n=60), NED &lt; 1%. In the present study, clinicopathological features were compared between the NED+ and NED- groups and independent prognostic factors were identified. Results: The patients in the NED+ group were significantly younger (61y) than the NED- group (63y, p=0.035). There were no differences in sex, tumor depth, lymph node metastasis, macroscopic type, tumor size, and histological type between the two groups. The five-year survival rates of the NED+ and the NED- groups were 75.7% and 56.5%, respectively. Overall survival was significantly better in the NED+ group than in the NED- group (p=0.030). Cox-proportional hazard model revealed that tumor invasion deeper than T3 (HR, 2.387; 95% CI, 1.114-5.114; p=0.025), lymph node involvement (HR, 3.000; 95% CI, 1.346-9.685; p=0.007) and presence of NED (HR, 0.478; 95% CI, 0.236-0.969; p=0.041) were selected as independent prognostic factors. Conclusions: The frequency of NED in UDGA was 41.1%. The long-term outcome in the NED+ group was better than that in the NED- group. Therefore, UDGA with NED might be clinicopathologically different from the NEC of the stomach and further large scale study should be warranted to determine the biological behavior and to estimate the proper treatment strategy.
Using RFID technology to drive quality improvement.
Authors: Ben de Mendonca, Matthew C. Cheung, Simron Singh, Flay Charbonneau, Kirsty Wield, Philomena de Soudsa
Journal: Journal of Clinical Oncology (2013)

70 Background: The Odette Cancer Centre (OCC) is the sixth largest cancer institution in North America and manages over 24,000 chemotherapy patient visits/year. We initiated an automated system whereby patients can “actively” self-check-in using Radio Frequency Identification (RFID) cards to the chemotherapy unit as part of a quality improvement initiative. Methods: Four self check-in kiosks were implemented into the OCC and all patients received a unique identifiable RFID card. Patients “self-arrived” to the OCC upon entry as well as before the nursing assessment. The technology created an electronic data infrastructure to capture patient experience data for ambulatory chemotherapy. In addition, visual management boards have been implemented that display the patients’ unique identifiers and communicates their process status. This tool also acts as a call-in system wherein the screen flashes and prompts the patient to proceed to the service area. Data was extracted electronically from various information systems, consolidated in excel linking information by the patients hospital file number. Results were analyzed. Results: The mean number of patients treated per day is 85 with a range of 65 to 105 (n=853). Median wait time from arrival to chair placement was 1:52 minutes ranging 0:02 to 6:12. There were 43% of patients that had medication ready within 30 minutes of their appointment time. There was an observed reduction in interruptions to the assessment nurses related to patient status updates (data to be presented). Patient satisfaction was high despite the modest improvement in efficiency. Conclusions: A comprehensive business analysis is being performed on the operations of the OCC with the implementation of this technology. The visual management boards enhance communication to patients while increasing privacy and patient confidentiality. The boards allow for patient mobility in the waiting room and eases anxiety associated with being “lost in the queue”. Next steps for the OCC are to create a data cube linked with other systems to further enrich the data. This technology enabled data analysis, evaluated the impact of change, set baseline targets for performance and built continuous quality improvement.
Cost comparison of robotic, laparoscopic, and open partial nephrectomy.
Authors: Mehrdad Alemozaffar, Steven Lee Chang, Ravi Kacker, Maryellen Sun, William C DeWolf, Andrew Wagner
Journal: Journal of Clinical Oncology (2012)

394 Background: Laparoscopic and robotic partial nephrectomy (LPN and RPN) are increasingly common minimally invasive alternatives to open partial nephrectomy (OPN) for management of renal tumors. The cost discrepancies of these approaches warrants evaluation. We compared hospital costs associated with RPN, LPN, and OPN. Methods: Variable hospital costs including operating room (OR) time, supplies, anesthesia, inpatient care, radiology, pharmacy, and laboratory charges were captured for 25 patients who underwent OPN, LPN, and RPN at our institution between 11/2008 -9/2010. Fixed costs of acquisition of a laparoscopic suite and a robotic system (including maintenance) were amortized over 7 years. We considered alternative scenarios through one-way and multi-way sensitivity analysis. Results: We found similar overall variable costs for OPN, LPN, and RPN. Sensitivity analysis demonstrated that RPN and LPN are more cost effective than OPN (excluding fixed costs) if the average hospital stay is &lt; 2 days, or OR time less is than 204 and 196 mins, respectively. By including fixed costs of equipment, RPN and LPN are always more costly than OPN. Conclusions: There was no difference among variable hospital costs of OPN, LPN, and RPN. Minimizing OR time and hospital stay reduces RPN and LPN costs to levels comparable to OPN. Inclusion of fixed costs makes LPN and RPN more expensive than OPN, but increased utilization and efficiency can decrease cost per case. [Table: see text]
Can pancreaticoduodenectomy performed at a comprehensive community cancer center have comparable results as tertiary centers?
Authors: C. Cheng, D. Duppler, B. Koczon-Jaremko
Journal: Journal of Clinical Oncology (2011)

e14514 Background: We maintained a prospective database covering the time period from 2001 to 2010. We believe that the outcome achieved at a small cancer center can be similar to a tertiary cancer center. Methods: Our study measures the outcome of pancreaticoduodenectomy. Data were compared to the published literature. Results: There are 62 patients who underdone surgery with various histologies. Pylorus was preserved in 59 patients. Three patients had portal venorrhaphy. Forty six patients had malignancy, whereas 16 had a benign histology. One case had dual histology (ductal carcinoma and neuroendocrine). The average age of patients was 63. Mean preoperative CA19-9 for exocrine pancreatic malignancies was 638, whereas for benign lesions and endocrine tumors it was 122. Average operative time was 6 hours 25 minutes for surgeries before 2005 and 5 hrs 48 minutes for surgeries performed after 2005. Blood transfusion was rare with 15 patients receiving blood product. There were two perioperative deaths due to ischemic bowel and severe acidosis. Average length of stay in the hospital was 16.1 days (range 0-87 days). There was no pancreatic leak among any of the patients. Two bile leaks were identified, one controlled with the drainage tube while the other one required repeat surgery. 30 day mortality rate was calculated at 10%. To date, 28 patients have died, including two from causes unrelated to carcinoma. Mean survival during our study period is 30.6 months. In comparison to published literature, the mortality, morbidity, and survival were similar. In the literature five year survival for pancreatic cancer patients treated with pancreaticoduodenectomy ranged from 10% to 29%. Conclusions: In our study 5-yr survival was 47% for pancreatic cancer patients. Despite overall poor outcome for patients with pancreatic and biliary malignancies, surgery can be performed in community hospitals with special interest in treating pancreatic disorders, offering patients prolonged survival and quality of life. Pancreaticoduodenectomy is effective and safe with low hospital mortality and with acceptable complication rates.
An International Assessment of Event-Free Survival at 24 Months (EFS24) and Subsequent Survival in Peripheral T-Cell Lymphoma
Authors: Matthew J Maurer, Fredrik Ellin, Line Srour, Mats Jerkeman, Nabila Nora Bennani, Joseph M. Connors, Karin Ekstrom Smedby, Stephen Ansell, Brian K Link, James R Cerhan, Thomas Relander, Kerry J Savage, Andrew L Feldman
Journal: Blood (2016)
Data-driven quality improvement in an oncology patient-centered medical home.
Authors: John David Sprandio, Maureen Lowry, Brian Flounders, Susan Higman Tofani
Journal: Journal of Clinical Oncology (2016)

54 Background: In a 2012 abstract, Data driven transformation for an Oncology Patient-Centered Medical Home, Consultants in Medical Oncology (CMOH) demonstrated that standardized processes and enhanced IT capabilities (IRIS software app) provided a rapid learning system for the practice. Iris aggregated data became the basis for Quality Improvement Projects (QIPs) allowing CMOH to continue to improve in quality and cost measures. Deviation from performance trend is readily identifiable, providing operational direction. Methods: A review of 2012 data identified an increase in the rate of hospitalizations, initiating a QIP. We identified inconsistent processes in Telephone Triage Symptom Management at one of the three practice locations. It was determined that symptom calls in the early to mid afternoon were being directed to the ER, and a higher percentage of these evaluations resulted in admissions. Steps to restructure roles and internal processes and reinforced training followed, resulting in improvement. Results: After analysis of site specific performance, we centralized Telephone Triage services to reduce variability in execution. We addressed staffing issues, streamlined nursing and physician education around Triage related processes, revised algorithms, and improved education materials to enhance patient engagement. This resulted in resetting our trend in ER utilization and admissions, increasing the number of calls into the telephone triage service, increasing the percentage of symptoms managed at home and decreasing the number of office visits within 24 hours. Conclusions: Aggregated real-time data provides the tools to rapidly identify opportunities for improvement and conduct QIPs to enhance the quality and value of delivered services. Supportive software apps like Iris are foundational for practice transformation to future value-based cancer care models. [Table: see text]
Association of high tumor infiltrating cytotoxic T cells with absence of lymph node involvement in resected colorectal and gastric cancer: Implications for immunosurveillance.
Authors: Tong Dai, Sunnie S. Kim, Prashant Thakkar, Yifang Liu, Bing He, Nicole C. Panarelli, Manish A. Shah
Journal: Journal of Clinical Oncology (2015)

4068 Background: Adaptive immune response can play an important role in restricting tumor growth, and the presence of tumor infiltrating lymphocytes (TIL) is associated with lower cancer stage and improved survival. However, the characterization of TILs with gastrointestinal malignancies, and their clinical implication, remains poorly understood. Methods: To characterize TIL sub-populations in different gastrointestinal cancer types, we performed immunohistochemistry (IHC) staining of CD3, CD8, CD45RO, and CD4/FOXP3 markers for all T cells, cytotoxic, memory, and regulatory T cells, respectively. Tissue microarray(TMA) from 122 colorectal, 37 gastric, and 59 esophageal cancer were included in the study, and IHC staining for each immune marker was scored as low (< 5 cells/hpf), intermediate (5-50 cells/hpf), and high (> 50 cells/hpf). Results: LN- colorectal and gastric cancer was associated with higher CD3+ and CD8+ cell infiltration, when compared with LN+ disease (Table 1). This was not observed in esophageal cancer. Increased memory T cell infiltration is also associated with LN- disease in gastric cancer. In addition, increased FOXP3+ regulatory T cells are associated with LN- disease in colorectal cancer. Conclusions: Across a panel of gastrointestinal malignancies, we found that for both gastric and colorectal cancer, increased infiltration of cytotoxic T cells (CD3+/CD8+) was associated with LN- disease. These findings suggest high cytotoxic T cells may protect from LN metastasis in colorectal and gastric cancer. Regulatory FOXP3+ regulatory T cells may have similar function in colorectal cancer. Understanding the spatial distribution of proteins that regulate the immune response in the tumor microenvironment will have implications for subsequent immunomodulatory treatments. Percentage of tumor with high expression of CD3, CD8, and CD45RO. Cancer Type LN Status CD3+ CD8+ CD45RO+ Colorectal LN+ 22.6% 17.1% 52.6% LN- 37.7% 42.3% 44.0% Gastric LN+ 37.0% 42.8% 43.5% LN- 70.0% 75.0% 80.0% Esophageal LN+ 28.9% 36.4% 52.6% LN- 14.3% 41.2% 40.0%