tbuckley/cabot-search huggingface dataset:
The impact of new-onset atrial fibrillation on short- and long-term outcomes after esophagectomy for esophageal cancer.
Authors: Eisuke Booka, Hiroya Takeuchi, Kazumasa Fukuda, Koichi Suda, Rieko Nakamura, Norihito Wada, Hirofumi Kawakubo, Yuko Kitagawa
Journal: Journal of Clinical Oncology (2017)

183 Background: AF is common after thoracic and esophageal surgical procedures. The full spectrum of risk factors, associations, and implications are unclear. Objective:The aim of this study was to assess the impact of new-onset atrial fibrillation (AF) after esophagectomy on short- and long-term outcome. Methods: A retrospective analysis was performed on patients with esophageal cancer who underwent esophagectomy with thoracotomy and laparotomy, with R0 or R1 resection between January 1997 and December 2012. For the 402 patients included in this study, we analyzed the stage of disease, neoadjuvant therapies, surgical approaches, surgical complications, postoperative medical complications, and overall and relapse-free survivals using medical records. Results: The median age was 62 (range 34-82). Most patients were male (90.0%) and had squamous cell carcinoma (90.3%). Pathological staging of the esophageal cancers according to UICC 7th TNM classification system was categorized as follows: 17 (4.2%), 96 (23.9%), 16 (4.0%), 43 (10.7%), 57 (14.2%), 78 (19.4%), 39 (9.7%), 37 (9.2%), and 19 (4.7%) patients were designated as stage 0, ⅠA, ⅠB, ⅡA, ⅡB, ⅢA, ⅢB, ⅢC and Ⅳ respectively. Of the 402 patients studied, 42 (10.6%) had AF, 87 (21.6%) had pneumonia, 80 (20.0%) had anastomotic leakage, and 69 (17.2%) had recurrent laryngeal nerve paralysis. At a median follow-up of 133 months, the median survival was 49 months, and 5-year survival was 48% in the AF group, compared with 138 months and 60% in the non-AF group (p = 0.212). AF was significantly associated with recurrent laryngeal nerve paralysis (p = 0.001), but not with pneumonia or anastomotic leakage. Conclusions: New-onset AF is common, mostly associated with recurrent laryngeal nerve paralysis, but not with pneumonia or anastomotic leakage. AF has no impact on oncologic outcomes.
Accuracy of EUS-FNA for distant regional lymph nodes in the initial staging of esophageal cancer (EC).
Authors: Yusuke Shimodaira, Elena Elimova, Hironori Shiozaki, Roopma Wadhwa, Nikolaos Charalampakis, Venkatram Planjery, Mariela A. Blum, Quynh Nguyen, Heath Devin Skinner, Rebecca Slack, Dipen M. Maru, Wayne Lewis Hofstetter, Brian Weston, Manoop S. Bhutani, Jeffrey H. Lee, Jaffer A. Ajani
Journal: Journal of Clinical Oncology (2015)

4064 Background: Accurate clinical staging is essential for making immediate treatment decisions. The role of endoscopic ultrasound (EUS) and fine needle aspiration (FNA) in altering treatment has been debated in patients diagnosed with cStage II or III EC. The purpose of this study was to assess the yield of EUS-FNA for paratracheal and subcarinal lymph nodes in distal ECs. Methods: We analyzed278 EC patients who had baseline EUS-FNA between 2010 and 2014. A subgroup of 85 patients with Seiwert’s type I or II EC had FNAs of the paratracheal or subcarinal nodes (far away from the primary EC) were carefully reviewed. The accuracy of EUS, PET, EUS+PET, and FNA were compared using FNA as the gold standard. A McNemar’s test was used to determine whether EUS+PET or FNA performed differently in identifying positive nodes. Results: In the subgroup of 85 patients, FNA was positive for malignancy in 27 (32%) leading to modifications of the radiation field in upper thorax. Moreover, EUS, PET, and EUS+PET had an accuracy of 83.0% (EUS), 87.1% (PET), and 93.0% (EUS+PET), respectively. Comparing FNA to EUS+PET, FNA was positive whenever EUS or PET was positive. In 6 patients, PET-negative nodes were malignant by EUS-FNA (p = 0.03). Of 58 cases with negative initial FNA, only one was malignant, on follow-up, when surgically removed. Conclusions: Our data show that in distal ECs with suspicious paratracheal or subcarinal lymph node(s), EUS-FNA is a highly effective tool to help with appropriate treatment decisions. An extremely low false negative rate (1/58) suggests that EUS/FNA is highly complimentary to PET and can also identify malignant nodes that are not FDG-avid. From U. T. M. D. Anderson Cancer Center (UTMDACC), Houston, Texas, USA. (Supported in part by UTMDACC, and CA 138671 and CA172741 from the NCI).
Did patients (pts) in OPTiM, a trial of unresectable melanoma, have truly unresectable disease?: Results from an independent review.
Authors: Mark B. Faries, Mark Shilkrut, Eduard Gasal, Vernon K. Sondak
Journal: Journal of Clinical Oncology (2015)

e20109 Background: Unresectability is a frequent inclusion criterion for clinical trials in metastatic melanoma. However, no consensus definition of unresectability exists. In OPTiM, a phase 3 trial in 436 pts with stage IIIB-IV melanoma, intralesional talimogene laherparepvec (T-VEC) improved the primary endpoint of durable response rate (continuous PR/CR ≥ 6 months) vs GM-CSF. Here we report the results of an independent review to determine the interpretation of unresectability as an inclusion criterion by OPTiM investigators. Methods: Two independent surgical oncologists retrospectively reviewed clinical and radiological data of 50 randomly selected pts (52% IIIB/C, 48% IVM1a) from 249 OPTiM pts with stage IIIB/C/IVM1a melanoma (assumed to be potentially resectable) and categorized them based on 19 predefined factors impacting resectability (eg, lesion location, distribution). Pts were categorized as potentially resectable or unresectable. Unresectable pts were subcategorized as technically unresectable or futile resection (technically resectable but unlikely to benefit due to prohibitive risk of rapid recurrence). Results: Of 50 pts evaluated, 39 (78%) were agreed to be unresectable by both reviewers, 7 were deemed potentially resectable, 1 was disputed, and 3 were found to be unevaluable due to insufficient information provided. Among the unresectable pts, 29 (74%) were agreed upon as technically unresectable, 4 (10%) were agreed upon as futile, and 6 (15%) were found by one reviewer to be technically unresectable and futile by the other. The disputed resectability pt was found to be futile by one reviewer and potentially resectable by the other. Among pts deemed unresectable, a median of 5 adverse resectability factors were identified with 36 (92%) pts having ≥ 2 factors impacting resection. Conclusions: This post-hoc review of randomly selected OPTiM pts confirmed that the majority were demonstrably unresectable. Although the retrospective nature of this analysis prevented definitive determination in some cases, high concordance between reviewers suggests that objective criteria may be feasible for future melanoma trials. Clinical trial information: NCT00769704.
Practice parameters for the diagnosis and treatment of asthma
Authors: E. Bardana, I. L. Bernstein, J. Blessing-Moore, W. W. Busse, J. A. Chapman, J. J. Condemi, P. S. Creticos, N. P. Cummings-Beim, S. R. Findlay, S. M. Fineman, P. Godley, R. L. Green, P. A. Greenberger, G. N. Gross, P. J. Hannaway, L. Hendeles, J. P. Kemp, P. Korenblatt, R. E. Lee
Journal: Journal of Allergy and Clinical Immunology (1995)
Frequency of occult findings in contralateral prophylactic mastectomy as it relates to preoperative MRI or BRCA testing.
Authors: Lillian M. Erdahl, Judy Caroline Boughey, Tanya L. Hoskin, Amy C. Degnim, Tina J. Hieken
Journal: Journal of Clinical Oncology (2014)

1520 Background: Contralateral prophylactic mastectomy (CPM) rates in patients with unilateral breast cancer are increasing in the U.S. Preoperative MRI screening and genetic testing may influence surgical planning for patients undergoing CPM. The aim of our study was to determine the impact of breast MRI and BRCA mutation status on the rate of finding an occult high risk lesion (HRL) or occult malignancy (OM) in a CPM. Methods: We identified 740 women with unilateral breast cancer undergoing concurrent therapeutic mastectomy and CPM from 10/2008 to 6/2013 with no history of cancer in the CPM breast. We reviewed medical records for use of preoperative bilateral breast MRI and genetic testing for a BRCA 1 or 2 mutation. Likelihood ratio chi-square tests and multivariate logistic regression were used to assess potential impact of MRI and genetic testing on the likelihood of occult findings in the CPM breast. Results: Of 740 patients, 494 (67%) had a preoperative breast MRI and 244 (33%) had BRCA testing [197 (80.7%) BRCA 1/2 negative, 38 (15.6%) positive for BRCA 1/2 deleterious mutation, and 9 (3.7%) variant of unknown significance (VUS)]. Both MRI and BRCA testing were more likely to be performed in younger patients (p<0.0001). A clinically occult HRL or OM was identified in 108 (14.6%) CPM breasts: 78 (10.5%) HRL and 30 (4.1%) OM. There was no difference in the rate of occult lesions by use of MRI (14.2% MRI vs 15.5% no MRI, p = 0.63). BRCA 1 or 2 mutation was not associated with a higher rate of occult findings: 10.5% for BRCA 1/2 positive, 11.1% for VUS, 11.2% for BRCA 1/2 negative, and 16.4% for not tested (p = 0.28). A multivariate model adjusted for age, index breast cancer characteristics, and neoadjuvant chemotherapy, showed that neither preoperative breast MRI or BRCA 1/2 mutation was associated with occult findings on CPM. Conclusions: Patients not undergoing preoperative MRI were not more likely to have an occult malignancy or HRL identified in the CPM. The presence of a deleterious mutation in BRCA 1 or 2 is not associated with a higher rate of occult finding on CPM. Factors other than preoperative MRI or mutation status should be used to guide operative management of patients electing CPM.
Impact of timing of adjuvant chemotherapy initiation on survival in pancreatic adenocarcinoma.
Authors: Sofia Palacio, Caroline Ripat, Heather Stuart, Danny Yakoub, Nipun B. Merchant
Journal: Journal of Clinical Oncology (2017)

355 Background: Pancreatic adenocarcinoma (PDAC) is now the third leading cause of cancer death. Surgical resection followed by adjuvant chemotherapy has been the standard of care. Due to the significant risk of morbidity following pancreatic surgery, initiation of adjuvant chemotherapy is often delayed. Prior prospective adjuvant trials have suggested that adjuvant therapy can be initiated as late as 12 weeks without detriment, but data regarding the effectiveness of beginning adjuvant therapy beyond that time remains unknown. Methods: We retrospectivelyreviewed data from the National Cancer Data Base (2004-2014) and included adult patients (pts) with PDAC with pathologic stage I-IIB who underwent surgical resection with curative intent. The primary outcome was overall survival (OS) based on time to adjuvant chemotherapy post-surgery as defined by postoperative weeks. Data were analyzed using Cox proportional hazard model and Kaplan-Meier survival curves. Results: 5279 pts. had surgery alone and 4,537 pts. received adjuvant chemotherapy. The median age was 64 years. 52% were male, 88% were white, 46% were treated at comprehensive community cancer centers. The primary surgical approach was whipple procedure in 61% of pts. 63% pts. received single agent chemotherapy and the mean time from surgery to chemotherapy was 61 days. Adjuvant chemotherapy was associated with improved OS irrespective of disease stage compared to those undergoing surgery alone (median OS for surgery alone 14 months vs adjuvant chemotherapy 21 months, p &lt; 0.001). Cox proportional hazard model controlling for stage, surgical technique, lymph node dissection and margin status revealed improved OS in pts. receiving adjuvant chemotherapy. No significant differences in OS were seen for pts. starting adjuvant chemotherapy at 3, 6, 9, 12, 16, 20 or 24 weeks after surgical resection. Conclusions: Current guidelines recommend initiation of adjuvant chemotherapy prior to 12 weeks after pancreatic resection. Initiating adjuvant chemotherapy even up to six months post-operatively improves OS compared to those undergoing surgery alone. Our data supports the use of adjuvant chemotherapy if indicated regardless of time of surgery.
Difference in toxicity reporting between patients and clinicians during systemic chemotherapy for urothelial carcinoma.
Authors: Shingo Hatakeyama, Takahiro Yoneyama, Yasuhiro Hashimoto, Takuya Koie, Chikara Ohyama
Journal: Journal of Clinical Oncology (2017)

347 Background: Symptomatic toxicities associated with anticancer treatments are at high risk of under-reporting by clinicians. However, insufficient evidence is available for urothelial carcinoma. To compare toxicity reporting by patients and clinicians in urothelial carcinoma patients who received systemic chemotherapy. Methods: Between June 2013 and March 2016, 100 urothelial carcinoma patients who received two courses of chemotherapy of gemcitabine plus cisplatin (GCis) or gemcitabine plus carboplatin (GCb) were included in this study. Outcome Measurements and Statistical Analysis: During chemotherapy, patients answered QLQ-C30 quality of life (QOL) questionnaires, which included questions on four toxicity-related symptoms (appetite loss, nausea, constipation, and diarrhea). Clinicians evaluated adverse events using CTCAE v4.0. Differences in toxicity reporting were retrospectively compared between patients and clinicians. Logistic regression analyses were performed to investigate potential factors for under-reporting by clinicians. Results: Toxicity under-reporting was most frequent in diarrhea (44%), followed by appetite loss (39%), constipation (33%), and nausea (22%). In total, toxicity under-reporting was observed in 72% patients. Background-adjusted logistic regression analyses showed that pretreatment QOL items, such as global and symptomatic scores, were selected as potential predictors for toxicity under-reporting by clinicians. Limitations of our study included its retrospective nature and small sample size. Conclusions: Toxicity under-reporting by clinicians is frequent in urothelial carcinoma patients who received systemic chemotherapy. Pretreatment QOL evaluation is essential to identify potential individuals at risk for toxicity under-reporting. Clinical trial information: UMIN000020784.
Young age, disparities, and survival in gastric adenocarcinoma: Implications for screening strategies.
Authors: Shrawan G Gaitonde, Trevan D Fischer, Maris S Jones, Bradley Bandera, Stacey Stern, Melanie Goldfarb
Journal: Journal of Clinical Oncology (2017)

17 Background: Recent foreign publications have demonstrated increasing frequencies of gastric cancer in younger patients with differing biology and outcomes. This study will be the largest of gastric adenocarcinoma (GA) in young adults and aims to examine disparities and the impact of age on overall survival (OS). Methods: All patients diagnosed with primary GA from 2004-2013 in the National Cancer Data Base (NCDB) were reviewed for patient demographics, tumor characteristics, and treatment. Patients were grouped by age (AYA &lt; 40, adult ≥ 40) and appropriate statistical analyses performed. Results: Of 49,278 patients, 1517 (3%) were &lt; 40 years old. Compared to older adults, AYAs were more commonly female, represented an ethnic minority, and had more markers of socioeconomic disadvantage (SES) (all p &lt; 0.001). They presented with higher grade tumors, higher tumor and nodal staging, and more metastatic disease at diagnosis (all p &lt; 0.001). AYAs also more commonly received adjuvant radiation and/or chemotherapy (all p &lt; 0.001). Five-year OS in AYAs was 32.9% vs 29.4% for older adults (p &lt; 0.001). After controlling for competing factors, higher tumor grade (HR 1.61, CI 1.32-1.97), distant metastases (HR 2.22, CI 1.84-2.68), and increasing tumor (HR 2.69-5.44) and nodal stage (HR 1.84-2.35) independently decreased OS in AYAs whereas Hispanic (HR 0.78, CI 0.65-0.93) or Asian ethnicity (HR 0.72, CI 0.56-0.93) and receipt of adjuvant chemotherapy improved OS (HR 0.62, CI 0.52-0.75). Similar results were seen in older adults except that all markers of low SES decreased OS also. Age &lt; 40 had an independent effect on OS only for early stage (stage I/II) disease, resulting in a 19% survival advantage compared to older adults (HR 0.81, CI 0.71-0.93). Conclusions: Young patients with GA are more ethnically diverse and SES disadvantaged compared to older adults, with disparities effecting OS more in older patients. When diagnosed at an early stage, young age independently improves OS, emphasizing the importance of early diagnosis especially in this age group. Further research is needed to address whether national screening strategies could improve survival for selected young patients.
Focal therapy for prostate cancer: Attitude and practice patterns.
Authors: Amit L Jain, Abhinav Sidana, Mahir Maruf, Dordaneh Sugano, Brian P. Calio, Bradford J. Wood, Peter A. Pinto
Journal: Journal of Clinical Oncology (2017)

e541 Background: Focal therapy (FT) for localized prostate cancer (PCa) has been shown to have encouraging short term oncological outcomes, excellent preservation of functional outcomes and is increasing in popularity in Urologic community. We aim to evaluate the preferences and practice trends among urologists regarding this upcoming treatment strategy. Methods: An anonymous online questionnaire was designed to collect information on urologists’ views and use of focal therapy. The survey was sent to members of the Endourological Society (ES) and American Urological Association (AUA). Multivariate logistic regression analysis was done to determine predictors for utilization of FT for localized prostate cancer. Results: A total of 383 responses were received [AUA: 342, ES: 41]. Mean age of respondents was 43(±11.2) years. Although about half of the respondents (51.4%) believed FT to be moderate to extremely beneficial in the treatment of PCa, only 23% (89) of the respondents currently utilize FT in their practice. While the most common setting for utilization of FT was in patients with unilateral intermediate risk (75.2%) PCa, a small percentage of respondents also used FT for patients with bilateral intermediate risk and unilateral high risk PCa (9% and 7% respectively). The most common FT modality was Cryoablation in 62% followed by High Intensity Focused Ultrasound in 44%. Most common reasons for not using focal therapy were the lack of belief in ‘index lesion theory’ (186) (63.2%) followed by the lack of experience (121) (41.1%). About 58.2% respondents would use FT often in an office or outpatient setting if they had access to reliable and cost effective options. Surgeon’s experience (practice for more than 15 years) (p = 0.035) was the only independent predictor for utilizing FT in localized PCa. Conclusions: Only a quarter of our respondents utilize FT in their practice with surgeon’s experience being the only independent predictor for utilizing FT. Majority of respondents though consider FT to be beneficial in prostate cancer management would use it more often if they provided more reliable and cost effective options. Over time experience and accessibility to reliable methods to perform FT may lead to further use of this novel treatment.
A phase II trial of lenvatinib in patients with advanced or recurrent endometrial cancer: Angiopoietin-2 as a predictive marker for clinical outcomes.
Authors: Ignace Vergote, Michael Teneriello, Matthew A. Powell, David S. Miller, Agustin A. Garcia, Olga N. Mikheeva, Tamas Pinter, Mariusz Bidzinski, Cristina Ligia Cebotaru, Jean Fan, Min Ren, Nicole Meneses, Yasuhiro Funahashi, Tadashi Kadowaki, James P. O'Brien, Richard T. Penson
Journal: Journal of Clinical Oncology (2013)

5520 Background: Lenvatinib is an oral receptor tyrosine kinase inhibitor targeting VEGFR1-3, FGFR1-4, RET, KIT, and PDGFRβ. The importance of angiogenesis in endometrial cancer (EC) highlights the need to understand clinical mechanisms of escape (eg, angiopoietin-2 [Ang-2]) from antiangiogenic therapy. Methods: Patients (pts) had metastatic/unresectable EC after 1 or 2 prior platinum-based treatments (Tx), ≤2 prior chemotherapies, and ECOG PS ≤2. Pts received lenvatinib 24 mg once daily until disease progression or development of unmanageable toxicities. Primary endpoint was objective response rate (ORR: complete + partial response [CR+PR]) by RECIST 1.1. Archival tumor tissue and baseline (BL) and post-Tx plasma samples were collected for molecular analyses (reported elsewhere). Results: 133 pts were treated (median age: 62 y) and evaluated for safety, efficacy, and molecular correlative analysis. Dose reduction (31%) or Tx discontinuation (31%) occurred for toxicity. Median Tx duration was 112 days. The most common adverse events were hypertension 55% (Gr 3/4: 33%), fatigue 42% (Gr 3: 12.8%), diarrhea 35% (Gr 3: 5.3%), decreased appetite 35% (Gr 3: 2.3%), and nausea 32% (Gr 3: 3%); 1 pt had Gr 5 asthenia. Bowel obstruction, fistula formation, and perforation occurred in 3.8%, 2.3%, and 1.5%, respectively. Confirmed CR+PRs were observed in 19 pts (14.3%) by independent review (IRR) and 29 pts (21.8%) by investigator assessment (Inv). mPFS was 5.4 mos and mOS was 10.6 mos. Among 50 serum factors tested, only BL plasma Ang-2 correlated with maximal tumor shrinkage, R = 0.36 (Spearman), p &lt; 0.001; ORR; PFS; and OS. The 24 pts with low BL Ang-2 plasma levels (cut-off value &lt;2082 pg/mL) were compared with the 98 pts with high BL Ang-2 (&gt;2082 pg/mL) and improved ORR (61% vs 18%), mPFS (9.5 vs 3.7 mos), and mOS (23 vs 8.9 mos) were observed. Conclusions: Lenvatinib in this population was tolerable and resulted in a 14.3% (IRR) and 21.8% (Inv) ORR and mOS of 10.6 mos.Low BL Ang-2 level appears to predict clinical benefit in a subset of pts with advanced EC who may achieve high response rates and prolonged overall survival. Further assessment is warranted. Clinical trial information: NCT01111461.
Efficacy of rechallenge chemotherapy in patients with sensitive relapsed small cell lung cancer.
Authors: Kazushige Wakuda, Hirotsugu Kenmotsu, Tateaki Naito, Hiroaki Akamatsu, Akira Ono, Takehito Shukuya, Yukiko Nakamura, Asuka Tsuya, Haruyasu Murakami, Toshiaki Takahashi, Masahiro Endo, Takashi Nakajima, Nobuyuki Yamamoto
Journal: Journal of Clinical Oncology (2012)

7088 Background: Treatment efficacy of rechallenge chemotherapy recommended for patients with sensitive-relapse small cell lung cancer (SCLC) has not been fully clarified. Methods: We defined sensitive relapse as treatment-free interval (TFI) ≥ 90 days. Sixty-five sensitive-relapse SCLC patients who received second-line chemotherapy at the Shizuoka Cancer Center between September 2002 and May 2011 were separated into those treated with rechallenge chemotherapy (rechallenge group) and those treated with other regimens (other group) for comparison and analysis of treatment efficacy. Results: No significant differences in age, gender, ECOG performance status at relapse, disease extent at diagnosis, or response to first-line treatment were found between the two groups, but TFI was significantly longer in the rechallenge group, which included 19 sensitive-relapse patients. The other group included 46 sensitive-relapse patients, 21 of whom received amrubicin. There was no significant difference in overall survival (OS) between the two groups (median survival time (MST): rechallenge group 14.4 months, other group 13.1 months, p = 0.51). In the patients treated with amrubicin, MST was 12.6 months. Comparing the rechallenge group with the patients treated with amrubicin, there was also no significant difference in OS (p = 0.38). Both the rechallenge and other group included 11 patients with ex-sensitive relapse (TFI ≥ 180 days). There was no significant difference in OS between the two groups (MST 15.7 vs. 26.9 months, p = 0.46). Conclusions: Rechallenge chemotherapy did not prove superior to other chemotherapies, suggesting that monotherapy, such as amrubicin, might be reasonable as second-line chemotherapy for sensitive-relapse SCLC patients.