tbuckley/cabot-search huggingface dataset:
Value of peritoneal drain placement after total gastrectomy for gastric adenocarcinoma: A multi-institutional analysis from the U.S. Gastric Cancer Collaborative.
Authors: Gregory C. Dann, Malcolm Hart Squires, Lauren McLendon Postlewait, David A. Kooby, George A. Poultsides, Sharon M. Weber, Mark Bloomston, Ryan C. Fields, Timothy M. Pawlik, Konstantinos Ioannis Votanopoulos, Carl Richard Schmidt, Neil Saunders, Clifford Suhyun Cho, Emily Winslow, Maria C. Russell, Charles A. Staley, Shishir Kumar Maithel, Kenneth Cardona
Journal: Journal of Clinical Oncology (2015)

131 Background: A recent randomized trial of peritoneal drain (PD) placement after pancreaticoduodenectomy concluded that placement of PDs decreased the frequency and severity of complications. The role of PD placement after total gastrectomy for gastric adenocarcinoma (GAC) is not well-established. Methods: Patients who underwent total gastrectomy for GAC at 7 institutions from the U.S. Gastric Cancer Collaborative from 2000-2012 were identified. Univariate and multivariate analyses were performed to evaluate the association of PD placement with postoperative outcomes. Results: 344 patients were identified and anastomotic leak rate was 9%.253 (74%) patients received a PD. Those with PD placed had similar ASA class, tumor size, TNM stage, and need for additional organ resection when compared to their counterparts with no PD. No difference was observed in the rate of any complication (54% vs. 48%;p=0.45), major complication (25% vs. 24%;p=0.90), or 30-day mortality (7% vs. 4%;p=0.51) between the two groups. In addition, no difference in anastomotic leak (9% vs. 10%;p=0.90), need for secondary drainage (10% vs. 9%;p=0.92), or reoperation (13% vs. 8%;p=0.28) was identified. On multivariate analysis, PD placement was not associated with a decrease in frequency or severity of postoperative complications. Subset analysis of patients stratified by whether they underwent concomitant pancreatectomy similarly demonstrated no association of PD placement with reduced complications or mortality. In patients who experienced an anastomotic leak (n=31), placement of PD was similarly not associated with a decrease in complications, need for secondary drainage, or mortality. Conclusions: Peritoneal drain placement after total gastrectomy for adenocarcinoma, regardless of concomitant pancreatectomy, is not associated with a decrease in the frequency and severity of adverse postoperative outcomes, including anastomotic leak and mortality, or decrease in the need for secondary drainage procedures or reoperation. Routine use of peritoneal drains is not warranted.
Patient-reported outcomes in patients enrolled at Pain Control Center Hospice of Solofra (Italy): A management model.
Authors: Geppino Genua, Mela Fasano, Luisa M Rizzo, Lucia Genua, Vincenzo Landolfi, AnnaMaria Strollo, Elena De Vinco, P. Lino Fina, Sergio Canzanella, Mario Nicola Vittorio Ferrante, Giuseppe Servillo
Journal: Journal of Clinical Oncology (2016)

e266 Background: The Pain Control Center of Solofra (Italy) is managed with a mixed public / private using the funds provided by Law 39/1999 of the Italian Republic for the establishment of the hospice. The daily rate for each resident is € 281.09 and is paid entirely by the national health system. We have evaluated the treatment procedures and the clinical outcome on 282 consecutive patients enrolled from December 2012 to May 2015 at “Pain Control Center” of the Hospice. Methods: The following characteristics have been evaluated: patient gender, mean hospitalization time, differentiation between patients (pts) with and without cancer , tumor type, medical weapon use, venous access type, parenteral feeding, transfer in intensive care units, pain killer use. Results: 282/164 pt males 282/118 females, mean age 72.04 yr (range 18-92 yr, mean hospitalization time 38 days), 205/282 pt (72.69%) had tumor diseases and 77/282 pt (27.31%) non cancer diseases. % Types of cancer: lung 20, colorectal 13.6, breast 7.7, ovarian 3.1, bladder 4, gastric 6.8, prostate 4.5, hepatocellular and biliary tract 7.7, pancreas 2, head and neck 8.6, kidney 2.7, other tumors 19. The central venous accesses were already present at the time of hospitalization in 77/282 pt (27.30%); the central venous access were made on 65/282 (29.44%). 131/282 pt received either parenteral feeding while 39/282 pt enteral feeding. 11/282 pt were transferred to ICU and 189/273 pt (69.23%) deceased at hospice. Analgesic therapy with opiates was administered at 216/282 pt (76.59%). The most intensively treated pt were those with tracheostomy(4.96%) and followed by uretero and colostomy(11.34%). About 30% of pt required central venous access procedures. Conclusions: The present study shows the underestimation of the parenteral feeding and analgesic requirements by pts with chronic diseases. The results lead us to continue the experience of public / private collaboration to achieve greater effectiveness of care and improve the overall management of patients so peculiar.
A novel molecular tool for lymph node upstaging in colon cancer patients: Results of a prospective European, multicenter study.
Authors: Markus Zuber, Carol-Immanuel Geppert, Franz Bader, Ulrich Nitsche, Robert Rosenberg, Andreas Zettl, Jordi Tarragona, Xavier Matias-Guiu, Roland Croner
Journal: Journal of Clinical Oncology (2013)

464^ Background: A new diagnostic semi-automated system, One Step Nucleic Acid Amplification (OSNA), was designed for the detection of cytokeratin 19 (CK 19) mRNA in lymph node (LN) metastases of colon cancer (CC) patients (Güller U et al. CANCER 2012: DOI 10.1002/cncr.27667). Recently it has been shown that occult metastases detected in pN0 patients have an adverse effect on survival based on stage migration. In this study we investigated whether pN0 patients diagnosed by standard histopathology can be upstaged by OSNA analysis to stage III. Methods: In this international, multicenter (4 institutions: CH, G [2], E) study 103 patients-originally diagnosed as pN0 by the standard use of 1 single section haematoxylin &amp; eosin (H&amp;E)-were subjected to OSNA analysis. LN were isolated from fresh tissue, homogenised, and directly subjected to OSNA without prior isolation of mRNA. OSNA results were provided in qualitative categories (- / + / ++), along with the exact CK19 mRNA copy number (+: 250-5000 copies, ++: &gt;5000 copies). Results: In total, 1,594 LN from 103 CC patients (median 14 LN / patient, range 1-46) were analyzed with OSNA. From the 103 histology pN0 patients 26 were positive with OSNA, resulting in an upstaging rate of 25.2%. Sixteen patients had 1 OSNA positive LN, three had 2, three had 3, and one had 4 positive LNs, resulting in a total of 35 positive LN. Patients with pT1, pT2, and pT4 tumors only had 1 positive LN, while all patients with multiple positive LN were from the pT3 group which also contained 9/10 patients with a (++) OSNA result. Concerning stage categories, 6/37 (16.2%) CC patients with stage I were upstaged and 20/66 (30.3%) patients with stage II. Conclusions: OSNA is a novel molecular tool for LN upstaging in CC patients with similar performance as very intensive histological investigation (Güller U et al. CANCER: 2012 DOI 10.1002/cncr.27667). The present study confirms that OSNA improves staging in CC patients and provides a standardized, observer-independent technique for a more accurate staging than the standard histopathology.
Clinicopathologic features and treatment outcomes of patients (pts) with HER2-positive (pos) adenocarcinomas (ACA) of the esophagus (E) and gastroesophageal junction (GEJ).
Authors: B. E. Phillips, R. R. Tubbs, T. W. Rice, L. A. Rybicki, T. Plesec, C. P. Rodriguez, G. M. Videtic, J. P. Saxton, D. I. Ives, D. J. Adelstein
Journal: Journal of Clinical Oncology (2011)

71 Background: HER2 is overexpressed in 21% of gastric and 33% of GEJ ACA, and pts with advanced HER2pos disease survive longer after chemotherapy and trastuzumab than after chemotherapy alone. This retrospective analysis was undertaken to better define the clinicopathologic features and treatment outcomes in pts with HER2pos ACA of the E and GEJ. Methods: Between 11/99 and 7/06, 156 pts with T3 or N1 or M1a ACA of the E or GEJ were entered on one of two Cleveland Clinic trials. Induction chemoradiation, with 96 hour infusions of cisplatin (20 mg/m 2 /d) and fluorouracil (1,000 mg/m 2 /d) beginning on day 1 of radiation (30 Gy at 1.5 Gy bid), was followed by surgery and identical post-operative chemoradiation. 76 pts also received 2 years of oral gefitinib. Pathology was tested for HER2 by immunohistochemistry using PATHWAY anti-HER-2/neu 4B5 rabbit monoclonal primary antibody (Ventana, Tucson AZ) and in situ hybridization with the inform HER2 dual ISH DNA probe cocktail assay (Ventana, Tucson AZ). Baseline characteristics and outcomes after treatment of the HER2pos and negative (neg) pts were compared. Results: Of the 156 pts, 136 pts had either initial biopsy or resection specimen available. HER2 was deemed pos if either was pos. Discordance between biopsy and resection was found in only 6/65 pts (9%). 32 pts (24%) were HER2pos; 27% of 82 pts with GEJ, and 19% of 54 pts with E tumors (p=0.31). There was no statistical difference between HER2pos and neg pts in age, gender, race, stage, or pathological response. The only difference was that HER2neg tumors were more likely poorly differentiated (p&lt;0.001). Locoregional control, distant metastatic control, freedom from recurrence and overall survival were statistically the same in both the entire cohort, and in the gefitinib-treated subset. Conclusions: Except for tumor differentiation, HER2pos and neg pts with ACA of the E and GEJ do not differ in clinicopathologic characteristics and treatment outcomes. Given the demonstrated benefit of trastuzumab in HER2pos gastric cancer and the similar incidence of HER2 overexpression in the E and GEJ, further evaluation of HER2 directed therapy in this disease seems indicated. No significant financial relationships to disclose.
Benefit of adjuvant chemotherapy in patients with T4, UICC II colon cancer.
Authors: Andreas Teufel, Michael Gerken, Janine Hartl, Timo Itzel, Stefan Fichtner-Feigl, Christian Stroszczynski, Hans J. Schlitt, Ferdinand Hofstaedter, Monika Klinkhammer-Schalke
Journal: Journal of Clinical Oncology (2015)

700 Background: Colorectal cancer is the third most common cancer and a major cause of morbidity and mortality worldwide. Adjuvant chemotherapy is considered standard of care in patients with UICC stage III colon cancer after R0-resection. For patients with UICC stage II colon cancer, a benefit of adjuvant therapy was not demonstrated. However, there is an ongoing discussion whether adjuvant chemotherapy may be beneficial for a subgroup of UICC II patients with "high-risk situation" (e.g., T4 situation). Methods: We investigated our Bavarian, population based (2.1 million inhabitants) cohort of 1,937 patients with UICC II CRC for a benefit of adjuvant chemotherapy in patients with larger (T4) tumors. Patients over 80 years were excluded. Of these patients, 240 patients had a T4 tumor (12%). 77 of all T4 patients received postoperative chemotherapy (33%). Survival analyses were performed using Kaplan Meier analysis and Cox regression models. Results: Patients with a T4 tumor who received postoperative chemotherapy had a highly significant survival benefit with respect to overall survival (p&lt;0.001) and recurrence free survival (p=0.008). However, no difference was seen between oxaliplatin containing or non-oxaliplatin containing treatment regimens. Finally, G2 and G3 tumors were demonstrated to particularly benefit from adjuvant treatment. Chemotherapy, age at diagnosis and tumor grading remained independent risk factors in multivariable cox regression analysis. Conclusions: Overall, our retrospective study demonstrated a significant benefit of an adjuvant chemotherapy in the T4 UICC II subgroup of patients with colon cancer. Based on our data adjuvant chemotherapy should strongly be considered in these patients.
Comorbidity and outcomes after surgery among women with breast cancer: Analysis of national in-patient sample database.
Authors: Ahmed Dehal, Ali Abbas, Samir Johna
Journal: Journal of Clinical Oncology (2012)

83 Background: Evidence is scarce about the influence of comorbidity on short-term outcomes of patients with breast cancer after surgery. The objective of this study was to examine the effect of comorbidity on risk of postoperative complications, prolonged hospitalization (defined as above median length of stay), and in-patient death among women with breast cancer. Methods: National inpatient sample is a nationwide clinical and administrative database. Patient discharges with primary diagnosis code of breast cancer and coincident procedure code for breast surgery from 2005 to 2009 were identified using International Disease Codes 9th edition (ICD-9). Information about demographics, hospital characteristics, comorbidities, stage, surgical treatment, postoperative complications, length of hospital stay, and in-patient deaths was obtained. Comorbidities were identified using ICD-9 codes and used to calculate modified Charlson comorbidity index (CCI) score. We divided patients based on these scores into 4 groups: 0, 1, 2, and 3 or more. Multivariate logistic regression analyses were used to examine risk adjusted association between CCI score and the aforementioned outcomes. Results: We identified 75,100 patient discharges with a mean age of 61 years. Compared to patients with a CCI score of 0, as a reference group, CCI scores of 1, 2, and 3 or more increased the risk of post-operative complications by 1.7 fold, 2.6 fold, and 4.6 fold, respectively (p &lt;0.001). Compared to patients with a CCI score of 0, CCI scores of 1, 2, and 3 or more increased the risk of prolonged hospitalization by 1.2 fold, 1.6 fold, and 2.3 fold, respectively (p &lt;0.001). Similarly, Compared to patients with a CCI score of 0, CCI scores of 1, 2, and 3 or more increased the risk of in-patient death by 3.1 fold, 5.4 fold, and 15.8 fold, respectively (p &lt;0.001). Conclusions: After controlling for potential confounders, we found a strong and statistically significant association between comorbidity and outcomes of patients with breast cancer after surgery. Effective control of comorbidity in breast cancer patients may reduce post-operative morbidity and mortality.
Prognostic Factors in Follicular Lymphoma Patients in Japan: Application of Follicular Lymphoma International Prognostic Index.
Authors: Chizuko Hashimoto, Heiwa Kanamori, Naoto Tomita, Shin Fujisawa, Etsuko Yamazaki, Koji Ogawa, Michiko Hattori, Hiroyuki Fujita, Shigeki Motomura, Fumio Kodama, Yoshiaki Ishigatsubo
Journal: Blood (2005)
Association of Gleason 9-10 prostate cancer with worse outcomes compared to Gleason 8 disease.
Authors: Che-Kai Tsao, Kathryn P. Gray, Mari Nakabayashi, Caroline Evan, Matt D. Galsky, Philip W. Kantoff, William K. Oh, Mark Pomerantz
Journal: Journal of Clinical Oncology (2013)

e16032 Background: Use of pathological Gleason score for risk stratification of localized prostate cancer is widely accepted. However, data are lacking regarding differences in presentation and outcome among those with Gleason 8-10 disease. Methods: Using the Dana-Farber Cancer Institute Prostate Clinical Research Information Systems database, we identified a cohort of patients with biopsy Gleason 8-10 disease who received definitive radical prostatectomy (RP) or radiation therapy (RT) (external beam or brachytherapy) for curative intent. The study endpoints, time to biochemical recurrence (BCR), time to metastatic disease (MD), and overall survival (OS) were estimated using the Kaplan-Meier method. Cox proportional hazards model was used to investigate the association of the study endpoints and Gleason score groups (8 vs. 9 and 10) adjusted for clinical and pathological factors including age, PSA at diagnosis, type of local therapy, and tumor stage. Results: We identified 848 patients who received either local definitive RT (n=411) or RP (n=437). Median follow-up from diagnosis was 5.3 years. Patient characteristics at diagnosis (race, age, and clinical stage) were similar between the two groups (Gleason 8 vs. Gleason 9-10). Patients with Gleason 9-10 disease were more likely to receive radiotherapy as primary local therapy (58% vs. 46%, p=0.001), and to receive hormonal therapy as a part of their definitive treatment course (64% vs. 48%, p&lt;0.001). Patients with Gleason 9-10 disease had shorter time to BCR, time to MD, and a trend towards worse OS using multivariate analysis adjusted for significant clinical and pathological factors (detailed in the Table below). Conclusions: In our study, we found that patients with localized Gleason 9-10 disease who were treated with definitive therapy with curative intent had worse outcomes compared to patients with Gleason 8 disease. More aggressive, multimodality treatments may be indicated for men diagnosed with the highest Gleason grades. [Table: see text]
The impact of patient navigation on receipt of quality breast cancer treatment in the national patient navigation research program.
Authors: Naomi Ko, Tracy Ann Battaglia, Julie Darnell, Elizabeth Calhoun, Frederick Snyder, Electra D. Paskett, Elizabeth Whitley, Kristen J. Wells, Heather A. Young, Anand B. Karnad, Jennifer J. Griggs, Victoria Warren-Mears
Journal: Journal of Clinical Oncology (2012)

72 Background: The discrepancy in breast cancer outcomes for underserved populations has been linked to lack of receipt of quality treatment. Patient navigation programs are being rapidly adopted as a model to improve cancer outcomes for these vulnerable populations, yet the effect of navigation on their quality of cancer care is unknown. Methods: We conducted a secondary analysis of the National Patient Navigation Research Program (PNRP) data to assess the impact of navigation on receipt of quality care among women diagnosed with breast cancer. Data pooled from 7 PRNP sites were used to determine the proportion of newly diagnosed cancer patients whose care met National Comprehensive Cancer Network (NCCN) quality metrics: 1) hormonal therapy for HR+ patients 2) post-lumpectomy radiation therapy; and 3) chemotherapy for hormone negative, &gt;1cm tumors, in patients &lt;70 years of age. Chi-square tests were performed to compare probability of receiving recommended care among navigated and control patients. Results: A total of 1,006 breast cancer patients eligible for treatment were enrolled across all sites: 491 (49%) in the intervention arm, 515 (51%) in the control arm (mean age: 56 years; 38% African American, 23% Hispanic; 13% uninsured and 38% Medicaid). Among those eligible for hormone therapy, 283/357 (79%) navigated patients received hormonal therapy compared to 237/371 (64%) of controls (p &lt; 0.001). Among those eligible for radiation therapy post lumpectomy, 235/277 (85%) of navigated patients received radiation compared to 270/324 (83%) of controls (p=0.62). Among those eligible for chemotherapy, 79/122 (65%) of navigated patients received chemotherapy compared to 81/100 (81%) of controls (p &lt; 0.007). Logistic regression models to determine the odds of receiving recommended care for navigated and non-navigated patients, adjusting for patient demographics, will be conducted. Conclusions: Navigation had a positive effect for receipt of hormonal therapy, but not for radiation therapy and chemotherapy. Future studies are needed to assess the role navigation may play in ensuring quality care for the most vulnerable.
Mapping prostate cancer (CaP) recurrence after prostatectomy with c-11 choline PET/CT and 3T pelvic MRI in the contemporary era.
Authors: Ilya Sobol, Rimki Haloi, Sean Sunghun Park, Boyd Viers, Brian Davis, Lance A Mynderse, Stephen A. Boorjian, Robert Houston Thompson, Matthew K. Tollefson, Matthew Gettman, Fernando Quevedo, Adam Froemming, Val J. Lowe, Igor Frank, R. Jeffrey Karnes, Eugene D. Kwon
Journal: Journal of Clinical Oncology (2016)

255 Background: The purpose of this study was to identify site-specific recurrence patterns for patients (pts) with biochemical recurrence (BCR) after prostatectomy (RP) using C-11 Choline PET/CT (C11Ch) and 3T pelvic MRI with endorectal coil (pMRI). Methods: Between 2008 and 2006, 2,466 men underwent C11Ch and pMRI for BCR after RP. From this cohort, we identified 261 pts who received no adjuvant or salvage therapy (androgen deprivation or radiation). Suspected radiographic relapse was confirmed by biopsy (46%) or progression/response to treatment in concordance with subsequent rise/decline in PSA (54%). Results: Of the 261 men evaluated, 202 (75%) had positive pMRI, C11Ch or both. Seventy nine (39%), 105 (52%) and 18 (9%) pts had high, intermediate, and low risk CaP, respectively at RP. Median PSA at the time of positive scan was 2.3 ng/mL, with a median time from BCR to radiographic disease identification of 15 months. Of these 202 men, 67 (33%) harbored prostate fossa recurrence only, 44 (22%) had a combination of local and metastatic disease and 91 (45%) had metastatic disease without local recurrence. Forty (20%) pts had pelvic nodal recurrence only and 18 (9%) had perirectal nodal involvement. Median PSA for pts with local only recurrence, distant metastases only, and local + distant disease was 2.3, 2.7 and 2.2 ng/mL, respectively, with a median interval from BCR to positive scan of 16.7, 7.9 and 11 months. Imaging revealed that 33% to 66% of our cohort would have all sites of disease treated by salvage RT depending on the extent of the treatment field Conclusions: C11Ch and pMRI were used to identify recurrence patterns in pts with BCR after RP only. At median PSA of 2.3 ng/ml, our study demonstrates a low rate of local-only recurrence, higher than anticipated frequency of metastatic recurrence with peak frequency within the pelvic lymph nodes, and substantial perirectal recurrences. Despite the high rates of distant recurrences, 2/3 of our cohort had their disease limited to the pelvis and could be potential candidates for local therapies, including salvage radiation.