tbuckley/cabot-search huggingface dataset:
Clinical impact of preoperative albumin to globulin ratio in gastric cancer patients with curative intent.
Authors: Yuji Toiyama, Masato Okigami, Hiromi Yasuda, Masaki Ohi, Koji Tanaka, Yasuhiro Inoue, Yasuhiko Mohri, Masato Kusunoki
Journal: Journal of Clinical Oncology (2016)

13 Background: Albumin to globulin ratio (AGR) has mainly been used as a clinical indicator for multiple myeloma or other immunoproliferative diseases. Recently, AGR has been reported to predict long term mortality in patients with nasopharyngeal carcinoma, colorectal cancer, lung cancer and breast cancer. However, clinical impact of preoperative AGR in gastric cancer (GC) has not yet been addressed. Therefore, we, for the first time, investigated the association between AGR and clinico-pathological findings including overall survival (OS) and disease free survival (DFS) in GC patients with curative intent. Methods: Clinicopathological findings including preoperative laboratory data (carcinoembryonic antigen [CEA], carbohydrate antigen [CA] 19-9 and AGR) from 384 curative GC patients were assessed as indicators of early recurrence and poor prognosis in this retrospective study. AGR was calculated as [AGR = albumin/ (total protein - albumin)]. The cut-off value of AGR was 1.4 in current study. Results: Several pathological categories related with tumor progression such as lymph node metastasis, tumor serosal invasion, large tumor size, venous invasion were significantly associated with lower AGR levels. In addition, significant negative correlation between AGR and age was found. Among preoperative serum markers, AGR was an independent predictor of early recurrence in curative GC patients after adjusted by age and sex. On the other hand, 2 pathological factors such as lymph node metastasis and serosal invasion were independent factors to identify early recurrence in curative GC patients among postoperative categories. Furthermore, sub analysis revealed that GC patients with AGR &lt; 1.4 showed significant poorer DFS in both lymph node metastasis and serosal invasion group, respectively. Conclusions: Preoperative AGR may represent a simple, potentially useful predictive biomarker for selecting GC patients who might need neoadjuvant chemotherapy. Furthermore, AGR may select candidates who are better to introduce more intensive adjuvant chemotherapy after curative operation in stage II-III GC.
Liver transplantation (Ltx) in patients with nonresectable liver metastases from colorectal carcinoma.
Authors: Svein Dueland, Morten Hagness, Pal-Dag Line, Tim Scholz, P. Jorgensen, Bjarte Fosby, Ostein Mathisen, Ivar Gladhaug, Aksel Foss
Journal: Journal of Clinical Oncology (2012)

577 Background: Liver resection is considered the only curative treatment of liver metastases (mets) from colo-rectal (CRC) tumors. Ltx is standard of care in selected patients with hepatocellular carcinoma, cholangiocarcinoma and neuroendocrine tumors. Patients with non-resectable liver metastases (mets) from colo-rectal cancer (CRC) receiving palliative chemotherapy have a median survival of about 2 and 1 year from start of 1. and 2. line chemotherapy, respectively. Overall 5 years survival in CRC patients after start of palliative chemotherapy is about 5-10%. In this study we examined overall survival after Ltx in selected CRC patients. The primary endpoint of the study was overall survival at 2 years after Ltx Methods: Major inclusion criteria were: non-resectable liver mets, no extra hepatic disease or local relapse determined by PET/CT scan, CT- or MRI scan and colonoscopy. No mets. on frozen section biopsies at time of surgery, ECOG 0-1, at least one line of chemotherapy for metastatic disease. Postoperative immunosuppresion: mTOR inhibitor (Rapamune), mycofpenolmofetil and tapering doses of prednisolon. Quality of life questionnaire (EORTC-C30) pre Ltx, 3, 6 and 12 months post Ltx. Results: Thirteen men and 8 women with non-resectable liver only CRC liver mets received Ltx in the period of Nov 2006 to March 2011. Median age was 56 years (range 45-65 years). Thirteen patients had colon cancer and 8 patients had rectal cancer. The T-stage of the primary tumor was T2,T3 and T4 in 2, 16 and 3 patients, respectively. N status of the primary tumor was: pN0, pN1 and pN2 all 7 patients. Nine patients had received 1.line chemotherapy and 12 patients had received 2. or 3.line therapy. The median number of liver mets was 8 (range 2-40) and the median size of the largest lesion was 4.5cm (range 2.8-13cm). The patients had good, stabile or increased Global Health Score and Physical Function at all time points after Ltx. Fifteen patients with follow-up of 2 years or more or death within 2 years of Ltx had 2 years overall survival of 87%. Conclusions: Long term survival is obtained after Ltx in selected patients with non-resectable liver mets from CRC. The patients reported good quality of life and physical function after Ltx.
Neoadjuvant single and dual HER2 blockade among patients with localized HER2-positive breast cancer.
Authors: Kerry Lynn Reynolds, XingXing Cheng, Ashmeet Bhatia, Michelle Connolly Specht, Barbara Lynn Smith, Beverly Moy, Aditya Bardia
Journal: Journal of Clinical Oncology (2013)

147 Background: Dual neoadjuvant HER2 directed therapy is offered only in a clinical trial setting and is not standard of care, but emerging data suggests targeting multiple mechanisms may be more effective. We conducted a comprehensive systematic review and meta-analysis to evaluate the impact of neoadjuvant dual and single agent HER2 blockade on breast conserving surgery (BCS), and on pathological complete response (pCR) for estrogen receptor (ER)+ and ER- tumors, as well as the impact of pCR on disease-free survival (DFS) and overall survival (OS) for HER2+ breast cancer. Methods: MEDLINE, EMBASE, and Cochrane Controlled Clinical Trials Register databases were queried to identify eligible trials. Inclusion criteria were prospective, neoadjuvant trials that had at least one arm with HER2 directed therapy, and reported pCR. Pooled relative risk ratios (RRs) and p values were estimated for endpoints using the random effects statistical model. Results: We identified 36 trials (N = 4130). High pCR rates (&gt; 40%) were seen with anthracycline-based chemotherapy and trastuzumab alone, and non-anthracycline based dual HER2 blockade. The addition of trastuzumab to chemotherapy did not improve BCS rate (RR 1.40, p = 0.15), but significantly increased rates of pCR (RR 1.91, p = 0.0001). Similarly, dual HER2 blockade compared to trastuzumab alone did not improve BCS rate (RR 1.03, p = 0.84), but significantly increased rates of pCR overall (RR 1.39, p &lt; 0.00001), in both ER+ (RR 1.72, p = 0.01) and ER- subsets (RR 1.91, p = 0.0001), with no increase in grade 3/4 toxicity (RR:1.13, p = 0.16). Dual HER-2 blockade without chemotherapy was associated with pCR in a subset (11.2% - 27%) with minimal toxicity (incidence of grade 3/4 toxicity:1-5%). Higher pCR was associated with improved DFS (RR 2.29, p = 0.006) and OS (RR 4.61, p = 0.009). Conclusions: Neither the addition of trastuzumab to chemotherapy, nor the dual-HER2 blockade compared to trastuzumab, improves rates of BCS. However,both significantly improve rates of pCR, which is associated with improved DFS and OS. Dual HER2 blockade,with endocrine therapy for ER+, could potentially lessen or even obviate the use of chemotherapy.
Sipuleucel-T in metastatic castration-resistant prostate cancer (mCRPC) patients ≥80 years-old: Data from PROCEED.
Authors: Chadi Nabhan, A. Oliver Sartor, Matthew R. Cooperberg, Andrew J. Armstrong, Jeffrey L. Vacirca, Raoul S. Concepcion, William R. Berry, Manish Dhawan, Ronald Tutrone, Andrew Sandler, Candice McCoy, James Boyd Whitmore, Robert Claude Tyler, Celestia S. Higano
Journal: Journal of Clinical Oncology (2014)

64 Background: Sipuleucel-T is an autologous cellular immunotherapy indicated for asymptomatic or minimally symptomatic mCRPC based on data from the pivotal phase 3 IMPACT trial that demonstrated a 22% reduction in the risk of death. Given the high prevalence of older men in the mCRPC patient (pt) population, we sought to understand disease characteristics and sipuleucel-T product parameters in pts ≥80 years (yrs). Methods: PROCEED is an ongoing phase 4 registry enrolling pts treated with sipuleucel-T within ≤6 months. Baseline pt demographics and disease characteristics were collected. Sipuleucel-T product parameters that were assessed included: total nucleated cell (TNC) count, antigen presenting cell (APC) count (large CD54 + cells), and APC activation (upregulation of CD54; a measure of product potency). Results: As of May 2013, 1254 subjects were enrolled and have completed treatment. Of these, 278 (20%) pts were ≥80 yrs-old. Disease and infused product characteristics in pts ≥80 yrs vs. &lt;80 yrs are detailed in the table below. Product parameters appear similar between groups. Conclusions: In this large cohort of elderly pts ≥80 yrs treated prospectively with sipuleucel-T immunotherapy, we demonstrate that product parameters were similar to their younger counterparts (&lt;80 years). This implies adequate immune up-regulation in elderly pts. Additional follow-up is needed to explore correlations between OS and various immune parameters in both groups. Clinical trial information: NCT01306890. [Table: see text]
Oncologic and functional hazards of obesity among patients with locally advanced rectal cancer.
Authors: I. J. Park, C. Hu, M. A. Rodriguez-Bigas, Y. N. You, J. M. Skibber, C. Eng, R. A. Wolff, P. Das, C. H. Crane, G. J. Chang
Journal: Journal of Clinical Oncology (2011)

3553 Background: Obesity is a prevalent health problem. Association of obesity with tumor response and sphincter preservation after neoadjuvant chemoradiotherapy (CXRT) for rectal cancer has not been well studied. The purpose was to evaluate the impact of obesity on tumor response and sphincter preservation after CXRT for rectal cancer. Methods: We performed a retrospective cohort study of patients diagnosed 1993-2010 with cT3-4 or cN+ (by EUS, CT, or MRI) rectal carcinoma and treated with preoperative CXRT and resection. Patients were classified according to body mass index (BMI) as obese (BMI≥30) or nonobese (BMI<30). Results: 758 patients met criteria and 28.6% patients were obese. Both the proportion of obese patients (p=.02) and sphincter preservation (p=.01) increased over time. Obesity was associated with a lower rate of pCR (12.4 % vs 19.6 % in non-obese) and among patients with mid to low rectal cancers, a lower rate of sphincter preservation (64.5% vs 71.6% in non-obese). In multivariate analysis, obesity remained associated with lower pCR (OR =.57; 95% CI, .36 to .90, p=.017) and lower rate of sphincter preservation (OR=.66; 95% CI, .46 to .95, p=.027). See Table. Conclusions: Following neoadjuvant chemoradiotherapy for rectal cancer, obesity was associated with a lower rate of complete remission and also with a lower rate of sphincter preservation among patients with mid and low rectal cancer. Obesity could be a modifiable factor to improve response and sphincter preservation after neoadjuvant chemoradiotherapy for rectal cancer. Variables Odds ratio 95% confidence interval P pCR (n=758) * Obesity (No, BMI < 30) Yes, BMI ≥ 30 0.57 0.36-0.90 0.02 cT stage (cT2 + cT3) cT4 0.38 0.14-0.99 0.05 Sphincter preservation (mid-distal rectal cancer subcohort) (n=705) ** Obesity (No, BMI < 30) Yes, BMI ≥ 30 0.66 0.46-0.95 0.03 ypT (T0) ypT1 ypT2 ypT3 ypT4 1.14 0.63 0.70 0.04 0.56-2.34 0.37-1.05 0.43-1.15 0.01-0.13 < 0.001 0.71 0.08 0.16 < 0.001 Age (< 50) 50-75 > 75 1.17 0.53 0.80-1.71 0.26-1.06 0.06 0.42 0.07 Period (1993-2001) 2002-2010 1.81 1.29-2.55 0.001 * Also adjusted for sex, tumor grade, location within rectum, cN stage, year of diagnosis (not significant). ** Also adjusted for sex and tumor grade (not significant).
A longitudinal study of alterations in cognitive function and brain metabolites among women receiving chemotherapy for primary breast cancer.
Authors: S. Kohli, J. C. Buckner, J. H. Cerhan, K. Kantarci, D. L. Barton, J. A. Sloan, P. J. Novotny
Journal: Journal of Clinical Oncology (2011)

TPS240 Background: Cancer patients treated with chemotherapy frequently complain of cognitive deficits during treatment and often for some years thereafter. Many cytotoxic drugs commonly used in chemotherapy result in cognitive deficits via direct neurotoxicity to the cerebral parenchyma, neuronal axons, microglia, and/or oligodendrocytes. This chemotherapy-induced neurotoxicity may lead to changes in the levels of various brain metabolites. Previous studies using Magnetic Resonance Spectroscopy (MRS) suggest that cognitive impairment is accompanied by changes in specific brain metabolites such as N-acetyl aspartate (NAA), creatine, choline, and myo-inositol (Jung RE et al; 1999, Ross AJ et al; 2004). Because metabolic changes are likely to precede clinically detectable cognitive dysfunction, MRS may allow early identification of patients who will develop cognitive dysfunction associated with cancer treatments. Methods: The aims of this study are 1. to evaluate cognitive function using neuropsychological testing, 2. to collect MRS data from left thalamus, hippocampus, frontal and parietal lobes, 3. to characterize the temporal relationship between brain metabolite concentrations and cognitive functioning. Fifty newly diagnosed breast cancer patients, who are to receive adjuvant chemotherapy are evaluated with a battery of neuropsychological tests and MRS at three time points: before receiving chemotherapy (baseline), 4-8 weeks after completing their final treatment, and one year later. Patients also complete self-report questionnaires at all three time points. Exclusion criteria include CNS metastasis and depression. Neuropsychological tests are scored by standard procedures with adjustments for age, gender and education, and converted to Z-scores. Concentrations of NAA, creatine, choline, and myo-inositol are calculated from the MRS data for all time points by standard methods, with correction for the cerebrospinal fluid fraction in the voxel. Results of this study could lead to greater understanding of chemotherapy-induced cognitive impairment and improved prevention/treatment strategies in this population of cancer survivors.
Transurethral (TURP) biopsy of suspected anterior prostate cancers identified by MRI: Pilot study of a novel technique.
Authors: Shawn Dason, Christopher Brian Allard, Keith Barrett, Ian Wright, Bobby Shayegan
Journal: Journal of Clinical Oncology (2014)

230 Background: Prostatic MRI allows for identification of cancerous lesions in patients with a prior negative TRUS biopsy. Although in-gantry and MR-ultrasound fusion technologies have been reported, access to these technologies is limited. Here we present a novel technique to sample anterior lesions suspicious for prostate cancer (PCa) identified by MRI with transurethral (TURP) biopsy. Methods: MRI studies ordered by a single uro-oncologist at a tertiary center from 2007 to 2013 were reviewed. Patients were included if their studies met the following criteria: prostate MRI (n=148), indication for MRI was prior negative TRUS biopsy (n=48), PCa considered likely by reading radiologist (n=25) and anterior tumor location (n=7). Anterior tumors were those 17mm or more from the posterior prostate margin. Medical records were thoroughly reviewed. Additionally, regional medical databases were searched for 30 day readmission, emergency room (ER) visit, or positive bacterial culture result. Biopsy patients were treated with the standard monopolar TURP clinical pathway at our center. TURP sampling was directed by pre-procedural review of MRI images and report by the surgeon. MRI imaging was read by a single radiologist and obtained with a 3-T MRI with no endorectal coil employing T1, T2, DWI, and DCE sequences. Results: All seven patients identified with anterior tumors received TURP biopsy. Patients had a mean age of 63.6, Prostate-specific antigen of 13.3 ng/mL and a mean of 2.3 prior negative TRUS biopsies. There were no immediate complications reported. In 30 day follow-up data, no patients had a postoperative infection, although one patient was assessed in the ER for self-resolving hematuria and one patient was admitted for hematuria. Mean specimen weight was 4g and all but one patient had Gleason 7 or higher PCa on biopsy. This study demonstrated that MRI followed by TURP biopsy for anterior PCa had an 85.7% cancer detection rate for clinically significant anterior cancers. Conclusions: This pilot study demonstrates that cognitively directed TURP biopsy for MRI-identified anterior prostate lesions is feasible, has an excellent pickup rate for clinically significant cancer, and does not require access to limited technology.
Dutch observational study on anemia management with epoetin alfa.
Authors: A. De Boer, J. Van Den Bosch, L. Kerkhofs, F. Valster, N. Schlosser, R. Lunde, J. Aerts, R. Brok, M. Lahaye, M. Franken
Journal: Journal of Clinical Oncology (2011)

e19525 Background: The medical practice with epoetin alfa (Eprex) treatment (ET) for chemotherapy-induced anaemia (CIA) in the Netherlands was evaluated with regards to safety and efficacy in this observational study enrolling 1927 patients (pts) from 2005 to 2009. Methods: Eligible pts were ≥18 years and diagnosed with a solid tumour, multiple myeloma or (non-)Hodgkin’s disease for which chemotherapy (CT) was initiated. Data on haemoglobin level (Hb), blood transfusions (BT), CT, ET, iron supplementation and treatment-emergent adverse events (TEAE) were collected. Hb response to ET, not influenced by a transfusion within 28 days prior to reaching response, was defined in the protocol as ≥1 g/dl Hb rise within first 4 weeks ET or ≥2 g/dl Hb-rise from baseline or Hb within range 11–13 g/dl after 4 weeks of ET until end of study. Results: Average age was 63.2 years, 46.9% were male. Median mode dose was 40.000 IU/week. Most pts had lung (48.9%), breast (13.0%) or gastro-intestinal (9.9%) tumours. Majority of pts had metastatic disease (61.2%) and received platinum-containing CT (66.6%). ET generally started during the first 3 cycles of CT (79.1%). During CT, iron supplementation occurred in 23.8% of pts (mostly oral iron). Median ET duration was 10 weeks (95% CI: 11.38-12.09 weeks). ET response was reached in 61.9% of pts. ET started at an Hb of 10.52±1.11 g/dl (n=1182) and resulted in a transfusion-independent Hb-rise of 0.48±1.72 g/dl after 4 weeks (28–35 days) (n=891, p<0.0001) and 1.31±2.05 g/dl after 8 weeks (56–63 days) (n=623, p<0.0001). In 18.8% of pts, a BT was given beyond the first 4 weeks of ET. TEAEs were reported in 77.2% of patients; 1.5% of events were related to ET upon investigator assessment. Thrombovascular TEAE’s (TVE) occurred in 152 pts (7.9%); 35 events were assed as having a causal relation to ET. During study 207 pts died, the majority (n=143) due to disease progression. Six pts died due to a TVE: cerebrovascular accident (3), myocardial infarction (1) and pulmonary embolism (2); none assessed to be related to ET. Conclusions: Results of this Dutch study show that ET generally started according to published guidelines for the treatment of CIA. ET significantly increased Hb in pts with CIA and TEAEs seem in line with current label for epoetin alfa.
Rapid screening of SNPs in metastatic colorectal cancer (mCRC) utilizing multiplex sequencing technology (Sequenom).
Authors: Radhashree Maitra, Jay B. Nayak, Atrayee Basu-Mallick, Arjun Sood, Titto A Augustine, John Mariadason, David M Reynolds, Sanjay Goel
Journal: Journal of Clinical Oncology (2012)

418 Background: Accurate and fast screening of mutations is essential for designing individualized therapy necessary and critical for efficient disease management and better patient outcome in mCRC. Detection of hotspots by gold standard direct sequencing (DS) is time consuming and cost ineffective. Pyrosequencing (PS) technique is rapid and precisely committed towards SNP detection. Recent introduction of high throughput multiplex PCR based extension on microarray (Sequenom, SEQ) offers a robust platform capable of detecting multiple SNPs simultaneously in a rapid and cost effective manner. The current study analyzes the concordance and efficacy of the cutting edge SEQ technique to the well established DS and PS methods. Methods: DNA isolated from 122 specimens from 76 mCRC patients were sequenced by all three methods. DS and PS were performed on 4 genes at 10 hotspots. SEQ multiplexing was performed on 31 hotspots in 19 genes by 4 multiplex reactions. Results: We were able to make "calls" for all samples by DS and PS. With the multiplex system, the “calls” rate was 97.8% of successful reactions. Using PS data as our standard in the assay we calculated the percent concordance of DS and SEQ. Futhermore SEQ offered a more accurate identification of the substituted nucleotide in Kras codon 12 as compared to PS. Conclusions: The multiplexing of PCR reactions offers an excellent advantage of high throughput with strong feasibility of analyzing several samples for multiple SNPs simultaneously. The concordance rate of &gt; 90% when compared to PS along with the ability to analyze multiple samples/ hotspots plexed together in a time effective rapid mode provided a trifold advantage of the sequenom technology. It is therefore the next generation technology for rapid genetic evaluation of cancer patients. [Table: see text]
Long-term incidence of microvascular disease after bariatric surgery or usual care in patients with obesity, stratified by baseline glycaemic status: a post-hoc analysis of participants from the Swedish Obese Subjects study
Authors: Lena M S Carlsson, Kajsa Sjöholm, Cecilia Karlsson, Peter Jacobson, Johanna C Andersson-Assarsson, Per-Arne Svensson, Ingrid Larsson, Stephan Hjorth, Martin Neovius, Magdalena Taube, Björn Carlsson, Markku Peltonen
Journal: The Lancet Diabetes & Endocrinology (2017)
Integrating a palliative care longitudinal track into a family medicine residency program.
Authors: Nelson E. Dalla Tor
Journal: Journal of Clinical Oncology (2016)

156 Background: Palliative care and Palliative care skills are being instituted in many hospitals and clinics as they have been shown to improve health care outcomes and decrease costs. While health care organizations are adopting these coordinated care programs, finding competent physicians to work effectively in these programs is difficult. Methods: PIH Health Hospital Whittier Family Medicine Residency Program developed a longitdudinal Palliative Care and Chronic Disease track to generate a transformed workforce of future family physicians that can deliver innovative, empathetic and effective care for seriously ill patients who are at risk due to health disparities, advanced multiple chronic conditions, or frailty. We applied for and obtained a Unihealth grant to fund the track development as well as funding through our sponsoring hospital. The Palliative Care track has its own NRMP residency Match number, differentiating it from the categorical residency program. Each year we accept two residents to enter our track. Using a multidisciplinary approach and faculty, the track meets every two weeks in seminar sessions to train residents in the broad scope of Palliative Care. As part of the track, residents then rotate two months in their senior years in our hospital's palliative care service. Results: An exhaustive medical literature review has shown that our program is unique in its scope and breadth. We have accepted our fifth class of residents that will be entering the track this July, 2016. Conclusions: PIH Health Hospital Whittier Family Medicine Residency Program has created an unique and academically sound program to train Family Medicine residents in Palliative Care.