tbuckley/cabot-search huggingface dataset:
Prognostic role of cell cycle–related biomarkers in clear cell renal cell carcinoma.
Authors: Bishoy A. Gayed, Ramy F. Youssef, Aditya Bagrodia, Payal Kapur, Arthur I. Sagalowsky, Yair Lotan, Vitaly Margulis
Journal: Journal of Clinical Oncology (2013)

404 Background: Cell cycle regulatory molecules are implicated in various stages of carcinogenesis. In this study we systematically evaluate the impact of aberrant expression of cell cycle regulators on oncological outcomes in clear cell renal carcinoma (ccRCC). Methods: After obtaining IRB approval, immunohistochemistry for Cyclin D, Cyclin E, p16, p21, p27, p53, p57, and Ki-67 was performed on tissue microarray constructs of patients treated with radical or partial nephrectomy for ccRCC between 1997-2010. Comprehensive clinical and pathologic data elements were collected. A prognostic marker score (MS) was defined as favorable if ≤4 biomarkers were altered; unfavorable if &gt;4 biomarkers were altered. The relationship between MS and aggressive pathological features and oncological outcomes was evaluated. Results: The study included 452 patients, 277 males (61%). Median age was of 57 years (range, 17-85) and median follow up of 20 months (range, 0-150). The tumors demonstrated extrarenal extension (pT3-T4) in 120 (27%) patients and advanced grade (G 3/4) in 169 (37%). Regional nodal involvement and systemic metastases at the time of nephrectomy was present in 22 (5%) and 51(11%) patients, respectively. Unfavorable MS was found in 80 (18%) patients and was associated with distant and nodal metastasis, advanced T stage, advanced grade, tumor necrosis, sarcomatoid differentiation, lymphovascular invasion, fat invasion, adrenal involvement, and presence of venous thrombus (p &lt; .05). A statistically significant correlation between unfavorable MS and disease recurrence (HR 6.5 and p = 0.01) and a correlation approaching significance with cancer specific mortality (HR 3.4 and p = 0.06) was demonstrated in Kaplan Meier survival analysis. In a multivariate Cox regression analysis, unfavorable MS was an independent predictor of disease recurrence (HR 2.268, CI 1.00-5.12 p = 0.049). Conclusions: The cumulative number of aberrantly expressed cell cycle biomarkers correlates with aggressive pathological features and inferior oncologic outcomes. Our findings support prospective pathway-based exploration of biomarkers to augment current clinico-pathologic predictors of oncologic outcomes in ccRCC.
A novel preoperative inflammatory marker prognostic score in patients with clear cell and non-clear cell renal cell carcinoma.
Authors: Rishi Robert Sekar, Dattatraya Patil, Jeff Pearl, Yoram Baum, Omer Kucuk, Wayne B. Harris, Bradley Carthon, Mehrdad Alemozaffar, Christopher Paul Filson, Kenneth Ogan, Viraj A. Master
Journal: Journal of Clinical Oncology (2016)

530 Background: Several inflammatory markers have been studied as potential biomarkers in clear cell renal cell carcinoma (RCC), however few reports have analyzed their prognostic value in aggregate and in non-clear cell histologies. We hypothesize that a combination of preoperative C-Reactive Protein (CRP), albumin, Erythrocyte Sedimentation Rate (ESR), corrected calcium, and AST/ALT ratio into a RCC Inflammatory Score (RISC) could serve as a rigorous prognostic indicator in patients with clear cell and non-clear cell RCC. Methods: Patients that underwent nephrectomy for localized RCC were queried from our nephrectomy database. The optimal threshold for individual biomarkers was determined using grid search methodology, receiver operating characteristic (ROC) analysis, and sensitivity-specificity trade-off analysis. The final score, RISC, was the sum of points accrued from each biomarker (Table). ROC and chi-square analysis was performed to compare the prognostic ability of RISC to SSIGN and UISS. Impact on overall survival was analyzed with multivariate logistic regression analysis. Results: 391 patients were included in the study. Area under the curve (AUC) for RISC, SSIGN, and UISS was 0.78, 0.78, and 0.81, respectively. Chi-square analysis of AUCs revealed no statistically significant difference between RISC, SSIGN, and UISS (p= 0.820, and p =0.317, respectively). On multivariate analysis, after adjusting for confounding variables, each unit increase in RISC was associated with a 32% increase in mortality (HR=1.32, 95%CI 1.17-1.49, p&lt;0.001). Conclusions: RISC is an independent and significant predictor of overall survival in clear cell and non-clear cell RCC with accuracy at least as good as other established prognostic tools. Notably, RISC is composed of standardized preoperative laboratory markers, allowing crucial prognostic information to be integrated into medical decision making prior to surgery. [Table: see text]
Perioperative calculator to predict complications for patients with hepatocellular carcinoma resection.
Authors: Katherine Ostapoff, Kristopher Attwood, Sergei Kurenov, Boris W. Kuvshinoff, Steven N. Hochwald, Moshim Kukar, Steven J. Nurkin
Journal: Journal of Clinical Oncology (2016)

446 Background: Hepatocellular carcinoma (HCC) is a common cancer worldwide, but few patients are optimal surgical candidates due to liver disease. Current prediction models (Childs-Pugh and MELD) poorly estimate serious morbidity risks for those patients considering resection. Methods: Using ACS-NSQIP database, patients with HCC were selected from 2006-2013. Patients included had a curative resection (partial hepatectomy or formal lobectomy) and were excluded if they had emergency surgery or disseminated cancer. Outcomes included 30 day morbidity and serious morbidity. Data was randomly divided into testing (n=1764) and validation (n=441) cohorts. Regression analyses of the testing cohorts were used to construct prediction models, then optimized using the validation cohort. Results: We identified 2,205 patients. Major morbidity or serious morbidity occurred in 34% (n=745) and 21% (n=456). Patient demographics are shown in Table 1. Factors significant for morbidity include age, surgical procedure, BMI, ASA class, hypertension, alkaline phosphatase (AP), bilirubin (Bili), BUN, AST, albumin and MELD score. Factors included in risk score for morbidity included MELD, ASA class, surgical procedure, platelet count, smoking and AP. The model predicts morbidity AUC 0.616 vs 0.597 for model and validation cohort respectively. Factors significant for serious morbidity included age, race, procedure, BMI, diabetes, ASA class, hypertension, AP, Bili, AST and albumin. Serious morbidity score included MELD, surgical procedure, platelet count, diabetes and AST. The model predicts serious morbidity AUC 0.566 vs 0.592 for model and validation cohort respectively. Conclusions: Our calculator predicts morbidity based on surgical procedure for patients undergoing HCC curative intent surgery. Risk prediction can assist in appropriately selecting patients for surgical vs medial therapy. [Table: see text]
Angiosarcomas: Natural history and prognostic factors from 161 cases in three French institutions
Authors: J. Fayette, E. Martin, S. Piperno-Neumann, A. Le Cesne, C. Robert, S. Bonvalot, D. Ranchère, P. Pouillart, J.-M. Coindre, J.-Y. Blay
Journal: Journal of Clinical Oncology (2005)

9024 Background: Angiosarcoma is a heterogeneous group of rare sarcoma types. Its natural history and outcome remains poorly understood. In order to enhance our knowledge and to determine prognostic factors, a retrospective study of angiosarcomas was planned. Methods: Descriptive data of patients with angiosarcomas treated in three institutions between 1980/01/01 and 2004/04/30 were obtained retrospectively. The overall survival and prognostic factors were estimated using the Kaplan-Meier method and Cox’s proportional-hazards models. Hazard ratios (HR) are given with their confidence intervals (CI) at 95%. Results: Median age at the diagnosis was 52 on 161 patients, 35% males and 65% females. Angiosarcomas occurred most frequently in the breast (37.8%), skin (21.2%) and superficial soft tissues (13.2%). Grade 1, 2, and 3 tumors represented 20, 38.9 and 41.1% of documented cases respectively. Tumors were metastatic at the diagnosis in 26,9% of the cases, mostly in lung (25.5%) and 67.3% were multifocal. Surgery was used as first treatment in 80%, chemotherapy and radiotherapy were used in 38.5 and 30% of these patients. With a median follow up of 1.8 years, 56% of patients relapsed, mostly locally and 47.2% died. The median survival was 3.4 years (CI95% 2.4 - 5.8). The overall survival is significantly different according whether patients have or not metastasis at the diagnosis (p=0.0001), their 5-year survival is respectively 23% and 48%, and according to their grade (p=0.03). HR calculated for each angiosarcoma’s localisation (ever/never), after adjusting on age, initial metastatic status and grade, showed that bone (HR 8.7 CI95% 1.6 - 48.3), heart (HR 2.9 CI95% 0.9 - 9.7), and liver (HR 10.8 CI95% 2.7 - 43.4) localisations are bad prognostic factors. Conclusions: Angiosarcomas have a specific pattern of occurrence and relapse, a high risk of relapse and a better prognostic than usually admitted mostly in the metastatic situation. Significant adverse prognostic factors are bone and liver localizations, metastases and histological grade 3. No significant financial relationships to disclose.
The impact of lymph node ratio (LNR) on survival in patients with stage IV colon cancer: A Veteran’s Affairs Central Cancer Registry analysis.
Authors: M. Abu Hazeem, J. Wolpert, T. Tashi, W. Gonsalves, J. Krishnamurthy, R. Thota, A. R. Sama, I. T. Aldoss, I. AL-Howaidi, P. Townley, P. T. Silberstein, S. Subbiah
Journal: Journal of Clinical Oncology (2011)

e14092 Background: Lymph node ratio (LNR) is the quota between the number of lymph node metastasis and assessed lymph nodes. It is prognostically significant in stage III colon cancer but is less described in metastatic disease since surgical resection is not standard therapy. However, palliation, bleeding or obstruction may demand surgical resection of the colon tumor despite distant metastases. We evaluated LNR as a prognostic marker in such pts with stage IV colon cancer. Methods: Retrospective analysis of stage IV colon cancer pts who underwent surgical resection of the primary tumor from 1995-2008 was done via the Veteran's Affairs Central Cancer Registry. Age at diagnosis, Charlson co-morbidity index (CCI) score, extent of metastases, sex, no of nodes examined, LNR, type of surgery, use of chemo, primary tumor site and grade were studied with respect to overall survival by using log-rank and Kaplan-Meier analysis. Multivariate analysis was performed using Cox proportions hazards model to assess significance of prognostic factors. Results: There were 2,625 pts with stage IV colon cancer who had primary tumor resection. Age at diagnosis, CCI, LNR and the use of chemotherapy were found to be independent predictors of survival by multivariate analysis. Median survival based on LNR was: 1) 0 - 0.24 = 18.7 mos, 2) 0.25 – 0.49 = 15.2 mos, 3) 0.50 – 0.74 = 12.8 mos and 4) 0.75 – 1.00 = 7.0 mos; p < 0.001 (Table). Conclusions: Higher LNR appears to be a poor prognostic marker for survival in metastatic colon cancer who undergo primary tumor resection. This possibly highlights a role for node assessment in metastatic colon cancer pts that have resection of their primary tumor. Characteristic No Median survival (mos) Multivariate analysis HR (95% CI); p value LNR 0- 0.24 1,207 18.7 1.00 0.25–0.49 543 15.2 1.426 (1.273–1.596); p <0.001 0.50–0.74 409 12.8 1.682 (1.486–1.904); p < 0.001 0.75–1.00 466 7.0 2.205 (1.956–2.487); p < 0/001 Chemo Yes 1,402 21.0 1.00 No 1,196 8.1 1.792 (1.639-1.959); p < 0.001 Age at Dx <65 1,069 18.3 1.00 65-79 1234 13.7 1.186 (1.079-1.303); p < 0.001 80+ 295 8.6 1.489 (1.286-1.724); p < 0.001 CCI 0 853 17.7 1.00 1-2 442 17.0 1.032 (0.902-1.180); p = 0.647 3+ 45 12.6 1.445 (1.031-2.025); p <0.001
A systematic approach to adaptation of clinical practice guidelines (CPGs)
Authors: B. Fervers, J. Latreille, M. Haugh, L. Paquet, J. Burgers, M. Coulombe, M. Poirier, N. Mlika-Cabanne, B. Burnand
Journal: Journal of Clinical Oncology (2005)

6094 Background: The number of evidence-based guidelines (CPGs) is increasing, with many developed on the same topic. Development of high-quality CPGs requires substantial resources. Unnecessary duplication of effort could be avoided by adapting existing CPGs. However to date there is no validated process for a systematic approach to the adaptation of guidelines produced in a distinct cultural and organisational setting, i.e. trans-contextual adaptation. Methods: We developed a systematised process based on the results of a literature review and the experience of an international group of guidelines researchers. The pivotal steps of the process (assessment of CPG quality and content) were pilot tested by two multidisciplinary expert groups in Quebec (16 experts) using two French cancer guidelines (treatment of ovarian cancer and metastatic colon cancer (www.fnclcc.fr)). Results: The developed adaptation process involves: 1) search and selection of CPGs corresponding to the clinical question(s); 2) evaluation of selected guidelines: assessment of quality, internal validity and applicability to the context of use; 3) adaptation of the recommendations from one or more CPGs using standard guideline methodology; 4) adoption and implementation. All the experts found the steps assessed useful, complete and easy to use. Most (15/16) said that the explicit evaluation process is a guarantee of the validity and credibility of the adapted guideline. 13/16 felt that they would have as much confidence in a guideline adapted by this process as in a de novo guideline. Conclusions: This is the first systematic approach to trans-contextual guideline adaptation. The preliminary results confirm the need for an explicit assessment of all aspects of guideline quality. The amount of adaptation and time needed is dependent on the differences in the cultural and organisational context, and the number and quality of the sources guidelines. Further assessment will enable us to determine if our approach reduces duplication of effort and will foster uptake by end-users. No significant financial relationships to disclose.
Systematic identification of metastatic population subsets for advance care planning (ACP) discussions: A scalable approach using electronic health record (EHR) technology.
Authors: Cynthia Taniguchi, Kevin Donald Olson, Deb Harrison, J. Russell Hoverman, Aimee Ginsburg Arlen, Sabrina Q. Mikan, Susan Ash-Lee
Journal: Journal of Clinical Oncology (2013)

243 Background: Comprehensive cancer care embraces the concept of having timely discussions with patients about end of life care preferences regarding treatment interventions. Physicians and healthcare teams are frequently challenged with identifying patients who are clinically appropriate for these discussions and subsequent management of ACP work within the context of clinic resource capacity. A data extraction process is needed to systematically identify cancer population subsets for ACP based on clinical data elements maintained within an EHR database. Methods: Seven cancer center sites of service participated in a 90-day pilot study for delivering ACP services to discrete patient populations who it was believed would most benefit from ACP. Electronic methodology was developed and tested through the pilot process to systematically identify those patients having documented evidence of designated clinical criteria, including metastatic disease status. Metastatic status was determined using five clinical data elements. EHR technology enabled further targeting by cancer diagnoses and allowed this program to be scalable to individual practice capacity. Additional filtering capability was incorporated to exclude non-applicable patient records. Results: On a weekly basis, each pilot site received a report of eligible patients based on clinical criteria and practice-specific diagnoses. During the 90-day pilot period, sites collectively identified an average of 871 patients per week who met clinically-based selection criteria. Once a patient was identified, physicians were able to determine if the patient was appropriate for ACP introduction. The systematic patient identification process allowed ACP to be easily integrated into mainstream practice workflow. Conclusions: EHR technology is invaluable for strategically identifying cancer patient population subsets for clinically appropriate delivery of ACP services. Automated notification of eligible patients and the ability to filter the population enabled practices to engage the ACP process wholly within the scope of comprehensive cancer care delivery.
Efficacy of screening and treatment of breast cancer patients reporting high level of distress.
Authors: Ryan West, John W Thomas, Elaine Smith, Navneet Dhillon, Haritha Pabbathi, John Edward McKnight, Anita Johnson, Ricardo H. Alvarez
Journal: Journal of Clinical Oncology (2015)

101 Background: Cancer patients (pts) are burdened by symptoms related to the disease itself or to the toxicities of treatment. The ASCO clinical oncology guideline adaptation recommends all health care providers routinely screen for the presence of emotional distress and specifically symptoms of anxiety from the point of diagnosis onward [Andersen BL, 2014].At Cancer Treatment Centers of America (CTCA) we perform screening assessments using a Symptom Inventory Tool (SIT) composed of 27 questions. Pts with moderate and severe levels of anxiety are evaluated by the Integrative Resource Assessment Program (IRAP) and subsequently referred to integrative oncology consultation. Methods: The SIT is an assessment tool that captures pts’ perceived symptom burden for real-time clinical intervention, taken at the point of no intervention (baseline) and every 21 days or greater. The SIT is comprised of 27 questions utilizing the M.D. Anderson Symptom Inventory tool (MDASI) and validated assessment instrument with 8 questions and a free text box added by CTCA. Symptoms were rated “at the worst” on an 11-point numeric scale ranging from 0 (“no present”) to 10 (“as bad as you can imagine”) in the previous 24 hours. Results: Between 9/1/2014 and 2/27/2015, 842 pts with multiple types of cancer were screened for distress and 435 (51.6%) scored 5 or greater, of which 212 completed a second screening assessment.58 breast cancer pts provided SIT distress scores at baseline and then again at least 23 days after the initial assessment. The average reduction in the distress scores for breast cancer patients was 2 (1 st SIT mean = 6.2, 2 nd SIT mean = 4.2) with 40 pts (69%) reporting a decrease, 7 pts (12%) having no change, and 11 pts (19%) reporting an increase in distress. The 4 interventions most frequently referred and completed by the pts were mind body therapy (100%), rehabilitation (66%), acupuncture (50%), and massage therapy (45%). Conclusions: Distress is a relevant symptom reported by cancer pts. This study demonstrates that early intervention in breast cancer pts using integrative oncology approaches will reduce the distress in 69% of cases.
Evaluation of combined argon plasma coagulation and savary bougienage for the relief of dysphagia of esophageal squamous cancer patients in the end of life.
Authors: Ruinuo Jia, Caihong Dong, Tanyou Shan, Xiaozhi Yuan, Shuoguo Li, Xuezhen Ding, Shegan Gao
Journal: Journal of Clinical Oncology (2016)

214 Background: To relieve the dysphagia is a critical treatment for advanced esophageal cancer patients’ palliative care in their end-of-life. The ideal way is to satisfy both the patient’s nutrition supplement and self-taste. Although several endoscopic dilation techniques have been reported, the high incidence of dysphagia quickly relapsing remains. The aim of this study was to compare the effect of Argon Plasma Coagulation (APC) combined with Savary bougienage (SB) and SB alone for the relief of dysphagia of esophageal squamous cancer in the end-of-life. Methods: Patients with dysphagia for local advanced esophageal squamous cell carcinoma or local tumor recurrence and no any radiotherapy or surgery chance were randomly assigned to undergo APC combined with SB or SB alone. Primary endpoints were the dysphagia-free survival (DFS, be defined as the time from first dilation of effectively relieved dysphagia to dysphagia relapse, days) after 3 months followed up. Results: A total of 60 patients from Cancer Institute, First Affiliated Hospital of Henan University of Science and Technology were included in the study (SB group, n = 30, Combination group [APC combined with SB], n = 30), 2011. October 1-31, 2015. Primary endpoints: 3 months after treatment, DFS of Combination group (30.63 days; 95% CI, 20.31-36.95) was significantly longer than the SB alone group (5.3 days; 95% CI, 3.01-8.84, P = 0.000). No severe complications occurred within both of two groups. Conclusions: APC combined with SB was a safe and well-tolerated method for relieving dysphagia of advanced esophageal squamous cell cancer patients in the end-of-life, more investigation should pay on if this dilation method could obviously improve the life quality of patients and family by questionnaire as well. Clinical trial information: ChiCTR-TRC-13003757.
Small cell carcinoma of the bladder: Comparison of survival in various treatment modalities at Fox Chase Cancer Center (FCCC) from 1995 to 2015.
Authors: Pooja Ghatalia, Kyungsuk Jung, Samuel Litwin, Marijo Bilusic
Journal: Journal of Clinical Oncology (2016)

465 Background: Small cell carcinoma of the bladder (SCBC) is a rare but aggressive neuroendocrine neoplasm. It accounts for only 0.35-0.70% of all bladder tumors. Because of its low incidence, there has been no consensus on the standard treatment of SCBC. We hypothesized that patients (pts) treated over the past 10 years would have better outcomes than those treated earlier, given recent treatment advances in oncology. Methods: We performed retrospective analysis of pts treated at FCCC with confirmed pathologic diagnosis of either SCBC or mixed urothelial and SCBC from 1995 to 2015. Kaplan-Meier estimates were made of the median times and log rank tests were used to compare OS and PFS. Results: We identified 38 pts, 10 women and 28 men who met inclusion criteria. The mean age at diagnosis was 68.2 years, all were Caucasians and 26 pts were smokers. Three pts (8%) had Stage I, 22 (58%) had Stage II, 6 (16%) had Stage III and 7 pts (18%) had Stage IV disease. Radical cystectomy was performed in 26 pts, 3 pts underwent surgery followed by radiation therapy, and 5 pts received primary radiation therapy alone. All but 1 pt received chemotherapy: 32 pts received neoadjuvant chemotherapy, 3 pts received adjuvant chemotherapy and 2 pts received both adjuvant and neoadjuvant chemotherapy. The number of prior lines of therapy, including perioperative chemotherapy as a line, was 1 in 25 pts, 2 in 7, 3 in 2 and 4 in 3 pts. Sixteen pts progressed after the primary treatment with the median time to progression of 7.7 months. The median OS was 397 days (95% CI: (309,633)), and median PFS was 332 days (95% CI: (427,608)). OS estimates are based on all 38 pts; PFS are based on 21 pts. There was no difference in OS (p = 0.752) in 19 pts who were treated before 12/31/2010 vs 19 pts treated after 12/31/2010. No difference was detected in PFS (p = 0.37) based on the earliest 10 (up to February 2010) vs final 11 pts (after February 2010) for whom data was available. Conclusions: No significant improvement in the treatment of SCBC or pt outcomes over the past 10 years was observed. Further data analysis will be aimed at comparing different treatment modalities and pt outcomes.