tbuckley/cabot-search huggingface dataset:
Body mass index (BMI) and prognosis in women with metastatic breast cancer (MBC).
Authors: A. Gennari, M. Puntoni, O. Nanni, P. F. Conte, D. Amadori, V. Lorusso, A. De Censi, M. Sormani, V. Guarneri, M. D'Amico, A. Gozza, P. Bruzzi
Journal: Journal of Clinical Oncology (2011)

566 Background: Obesity is an acknowledged risk factor for the development of breast cancer and an adverse prognostic factor in those women who have already been diagnosed with breast cancer. However, the effect of obesity on the prognosis of MBC women has not been explored so far. With these premises, the aim of this study was to evaluate the influence of BMI on the prognosis of MBC patients receiving first line chemotherapy. Methods: The relationship between BMI (kg/m2), progression free (PFS) and overall survival (OS) was assessed on 698 MBC patients enrolled into 3 clinical trials (2 phase III and 1 phase II) of first-line chemotherapy. WHO BMI definitions were used: normal 18.5-24.9 kg/m2, overweight 25-30 kg/m2, obese >30 kg/m2. PFS and OS were calculated by Kaplan-Meier estimation; multivariate Cox analysis was performed adjusting for age, menopausal status, PS and study. Results: Information on BMI at the time of study entry, was available on 489 women. All patients received first line chemotherapy regimens including anthracyclines and taxanes, either in sequence or combination. Median follow up was 18 months (range 0.4 to 88.3). Overall, 40.3% of the patients were normal, 38.2% were overweight and 21.5% were obese. Median age was 57 years (range 25 to 73); PS was 0 in 93% of the patients. A non significant trend toward improved PFS was found in overweight women: median PFS was 13.1 months (95% CI 11.0-15.2) in BMI 25-30 versus 10.8 months (8.9-12.6) in BMI < 25 and 12.2 (95% CI 10.4-14.0) in BMI > 30, p=0.2. Median OS was 32.0 months (95% CI 24.9-39.1) in BMI < 25 versus 32.9 (95% CI 27.7-38.1) in BMI 25-30 and 30.7 (95% CI 24.3-37.0) in BMI >30, p=0.8. By multivariate analysis, none of the considered variables was significantly associated with differences in PFS and/or OS. Conclusions: In this study BMI at baseline was not significantly associated with the outcome of MBC patients treated with first line chemotherapy; however, a non significant trend for an improved PFS was observed in overweight women as compared to normal weight and obese patients. These data suggest that overweight should not be regarded as an adverse prognostic factor at least in MBC patients, already burdened by a diagnosis of advanced disease.
Efficacy of adjuvant chemotherapy with S-1 in patients with positive peritoneal cytology (CY1) who underwent R1 surgery.
Authors: M. Terashima, E. Bando, M. Tokunaga, Y. Tanizawa, T. Kawamura, J. Kondo, Y. Kinugasa, H. Kanemoto, K. Uesaka
Journal: Journal of Clinical Oncology (2011)

84 Background: In recent TNM classification, positive peritoneal cytology (CY1) is regarded as M1 disease and classified into stage IV. However, the prognosis of the CY1 patients underwent R1 surgery (microscopic residual tumor) is considered to be relatively better than those underwent R2 surgery (macroscopic residual tumor). Adjuvant chemotherapy with S-1 had demonstrated significant survival benefit in stage II and III gastric cancer in Japan. However, the efficacy of adjuvant S-1 in patients with relatively more advanced stage had not been investigated. Therefore, we investigated the efficacy of adjuvant chemotherapy with S-1 in CY1 patients underwent R1 surgery. Methods: Among the 2,202 patients with gastric cancer treated at our department between September 2002 and July 2009, a total of 105 patients with CY1 and underwent R1 surgery were included in this study. Clinocopathological features and survival were retrospectively analyzed using prospectively registered data base system. Results: There were 64 male and 41 female patients. The median age was 61 years old. Eighty-five patients had T4a or T4b tumor and 96 patients had lymph node metastasis. Seventy-eight patients had undifferentiated type of tumor. In 83 patients, adjuvant chemotherapy with S-1 had been performed. In the uni-variate analysis, only the extent of lymph node dissection (D2) and the adjuvant chemotherapy with S-1 demonstrated significant survival benefit. In multi-variable analysis using Cox proportional hazarded model, N-factor, extent of lymph node dissection (D2 vs D1), and adjuvant chemotherapy with S-1 were selected as independent prognostic factors. The median survival time and 5-year survival rate in patients underwent R1 resection with D2 lymphadenectomy and adjuvant S-1 treatment were 42 months and 46%, respectively. Conclusions: In patients with CY1 and underwent R1 surgery, adjuvant chemotherapy with S-1 demonstrated significant survival benefit. In patients with positive peritoneal cytology without other non-curative factors, D2 lymph node dissection and adjuvant chemotherapy using S-1 is recommended. No significant financial relationships to disclose.
Cancer stem cells profile and clinical outcome in stage III colon cancer patients receiving adjuvant oxaliplatin-based chemotherapy.
Authors: Riccardo Giampieri, Mario Scartozzi, Cristian Loretelli, Michela Del Prete, Luca Faloppi, Maristella Bianconi, Alessandro Bittoni, Alessandra Mandolesi, Italo Bearzi, Stefano Cascinu
Journal: Journal of Clinical Oncology (2014)

474 Background: Although an oxaliplatin-based adjuvant treatment is a widely accepted option for radically resected stage III colorectal cancer patients, it is not uncommon to observe an heterogeneous clinical outcome independently from stage. Cancer stem cells (CSC) profile has been suggested to regulate key steps leading to progression, relapse and metastasis and therefore may be responsible for this otherwise unpredictable heterogeneity. ALCAM, CD133, CD24, LRG5, SOX2, ALDH1A1 have been reported as potential markers for CSC, particularly in digestive system cancer. Aim of our study was to assess the role of these markers in determining clinical outcome for stage III colon cancer patients receiving adjuvant chemotherapy. Methods: Patients undergoing radical surgical resection for stage III colon cancer and receiving adjuvant oxaliplatin in combination with either 5FU or capecitabine were eligible for our analysis. CSC profile (ALCAM, CD133, CD24, LGR5, SOX2, ALDH1A1) was analysed by RT-PCR in primary tumour samples. The multivariate analysis also included adjustments for other variables such as T and N stage, sex, age and tumour location. Results: Seventy-eight patients were eligible for analysis. Only high ALCAM expression was associated with clinical outcome. In particular in colon tumours overexpressing ALCAM we observed a significant interaction for a higher risk of relapse (p = 0.04) and a reduced time to relapse (not reached vs. 33.24 months, HR:0.46, 95%CI:0.23-0.89, p = 0.02). There were no significant differences according to main stratification factors between the high ALCAM group vs. low ALCAM group. In our series N stage (N1 vs. N2-3) resulted also relevant for clinical outcome. Conclusions: Our analysis supports the hypothesis that ALCAM expression may represent a crucial marker for a better risk stratification in stage III colon cancer patients receiving adjuvant chemotherapy. According to our data we also suggest that other potential markers of CSC are probably ineffective for patients stratification. Patients expressing high ALCAM levels may be optimal candidates for therapy intensification and possibly different treatment options.
Relationship between plasma pazopanib concentration and incidence of adverse events in renal cell carcinoma.
Authors: Y. Lin, H. A. Ball, B. Suttle, F. Mehmud, R. G. Amado, T. E. Hutson, L. N. Pandite
Journal: Journal of Clinical Oncology (2011)

345 Background: Pazopanib (P), an oral angiogenesis inhibitor targeting VEGFR, PDGFR, and c-Kit, is approved by the US FDA for the treatment of advanced renal cell cancer (mRCC). Exploratory analyses of data from a Ph II mRCC study (Hutson T, J Clin Oncol. 27, 2009:1) indicated that 70% of patients (pt) receiving 800mg once daily had a week (wk) 4 plasma P trough (Cmin) &gt;20.6μ g/mL that is associated with improved efficacy (Suttle B, J Clin Oncol. 28, 2010:S3048). In this further analysis of the dataset, we investigated the relation between plasma P concentrations at wk 4 and clinically important adverse events (AE) reported within the first 12 wks of treatment. Methods: The % of patients with hypertension (defined as ≥ 15mmHg - baseline on 3 occasions)- a recognized PD marker for this class of agents- or other AEs (CTC grades), occurring during the first 12 wks of treatment were calculated by wk4 Cmin quartiles (Q1-Q4: median and range). Results: P concentrations at 4 wks and AE data were available for 205 out of 225 pts. The incidence of hypertension was 58% in Q1, increasing with concentration to 78% at Q4. The incidence of diarrhea, hair color change, ALT increase, HFS (marked increase), and stomatitis were concentration-dependent, with ≥ 2 fold increase from Q1 to Q4. The incidence of nausea, fatigue, vomiting, dysgeusia, and rash were variable or displayed a flat relationship with Cmin. Conclusions: The incidence of some AEs, such as diarrhea, ALT, HFS (marked relation), and stomatitis increased with plasma Cmin while others did not. We suggest that concentration-dependent AEs are more likely to respond to P dose reduction and as such, provides support for development of a dose optimization strategy. [Table: see text] [Table: see text]
Quality Oncology Practice Initiative (QOPI) participation as a means to physician engagement, performance improvement, and delivery of safe and high-quality cancer care.
Authors: Gurkamal S. Chatta, David Michael Aboulafia, Amy Brockmeyer, Molly Bumpus, Irina Dimitrova, Cathy Goetsch, Andrew Jacobs, Bruce S. Lin, Thomas William Malpass, Craig R. Nichols, Vincent J. Picozzi, Nanette Robinson, Prakash Vishnu, Joseph Grant F. Rosales
Journal: Journal of Clinical Oncology (2014)

80 Background: High quality and safe medical care has been a consistent goal of the medical community at Virginia Mason Medical Center (VMMC). The Am Soc of Clinical Oncology (ASCO) has set out a list of criteria as part of Its Quality Oncology Practice Initiative (QOPI), which are increasingly being adopted as standards for quality measurement in the Oncology community. Our practice at VMMC participated in the QOPI quality metric survey, with the intent of measuring and enhancing cancer care delivery. Methods: We participated in the web-based QOPI quality metric during the September, 2013 and April, 2014 sessions. Chart abstraction was shared by the providers. Following the Sept session, our performance was analyzed, and targeted areas of improvement were collectively identified by all providers. Following the April session, the clinical note format was changed to incorporate a standard template, addressing areas of underperformance. Results: In the September 2013 session, the primary areas of underperformance were assessment of: a) pain, b) emotional distress, c) performance status (PFS), and d) documentation of staging. Following the April 2014 session, we noted improved performance in all these assessments. Thus, pain reporting rates improved from 40.6 to 61.2%; emotional distress screening from 37.3% to 42.8%; PFS documentation from 42.6 to 53.7%; and staging at initial diagnosis from 74.6% to 80.9%. However our areas of underperformance continued to lag 10 to 30% behind QOPI aggregate reporting rates. With the introduction of a structured note in the electronic medical record (EMR), further improvements are expected the results of which will be reported at the time of the meeting. On the positive side, chemotherapy education and discussion of risk/benefit were consistently areas of superior performance in our practice with our reporting rates being 10 to 40% higher than the QOPI aggregate. Conclusions: QOPI participation is a useful tool for improving and sustaining a high level of practice performance in oncology. Structured notes in the EMR maybe indispensable for maintaining a high level of compliance with performance measures.
Incidence, timing, and risk factors for infection after radical cystectomy: Results from the National Surgical Quality Improvement Program.
Authors: William P. Parker, Matthew K. Tollefson, Courtney N. Heins, Elizabeth B. Habermann, Harras B. Zaid, Igor Frank, Robert Houston Thompson, Stephen A. Boorjian
Journal: Journal of Clinical Oncology (2016)

445 Background: Radical cystectomy (RC) is the gold standard treatment for muscle-invasive and high-risk non-muscle invasive bladder cancer. However, the procedure has been associated with a high complication rate, including perioperative infection. In addition to resulting in patient morbidity, infections have been suggested as a quality metric. We sought to evaluate the incidence, risk factors, and timing of infection following RC. Methods: The National Surgical Quality Improvement Program (NSQIP) database was queried to identify patients undergoing RC for bladder cancer from 2005-2013 using CPT procedure and ICD-9 diagnosis codes. Infections (urinary tract infection (UTI), surgical site infection (SSI), and sepsis) within 30 days of RC were recorded. Characteristics including age, gender, ethnicity, body-mass index, diabetes, smoking status, renal function, steroid usage, albumin, receipt of perioperative transfusion, and operative time were abstracted, and relative risk of infection was assessed in univariate chi-squared analysis. Results: A total of 3,187 patients were identified, of whom 2604 (81.8%) were male, with a median age of 68.8 years (IQR 62, 77). Postoperative infection was diagnosed in 766 (24%) patients, at a median of 13 days (IQR 8, 19) after RC, with 44.4% occurring prior to hospital discharge. The most common type of infection was SSI (404; 12.7%), followed by sepsis (315; 9.9%), and UTI (309; 9.7%). Factors associated with increased overall infection risk were obesity (RR 1.32; 1.20-1.46; p &lt; 0.001), receipt of a blood transfusion (RR 1.20; 1.10-1.31; p &lt; 0.001), and increased operative time (RR for &gt; 450 min 1.46; 1.26-1.70; p &lt; 0.001). Risk factors for UTI in particular included obesity (RR 1.28; 1.11-1.47; p &lt; 0.001), diabetes (RR 1.38; 1.09-1.75; p = 0.009), and increased operative time (RR for &gt; 450 min 1.45; 1.18-1.78; p &lt; 0.001). Conclusions: Approximately 25% of patients undergoing RC experience an infection within 30 days of surgery, most commonly SSI. Several modifiable risk factors were identified, including blood transfusion and prolonged operative time, that represent potential targets for care improvement.
Malignant ovarian germ cell tumors: Long-term outcome—A single-institution experience.
Authors: S. Talukdar, R. Hariprasad, A. Gupta, A. Mookerjee, S. Kumar, N. Bhatla, S. Mathur, L. Kumar
Journal: Journal of Clinical Oncology (2011)

e15537 Background: Limited information is available from developing countries on long term outcome of patients with malignant ovarian germ cell tumors (MOGCT). Methods: Between 1988 and 2009, 211 Pts (median age 20 yrs, range 6-54) were diagnosed to have MOGCT. 114 (54%) pts had stage I-II and 89 (42.2%) had stage III-IV dis. Dysgerminoma was the most common subtype (n = 84), followed by endodermal sinus tumor, EST (n=44), immature teratoma, IT (n=40), mixed GCT (n=34), embryonal carcinoma (n=3) and choriocarcinoma (n=2). 191 Pts underwent upfront surgery and 20 received neoadjuvant chemotherapy (CT).Pts in the adjuvant Gr (nil residual dis.) received 3 cycles of CT while those in advanced dis. Gr (residual dis. +ve) or recurrent dis. Gr received 4 cycles and/or 2 cycles after documentation of CR. Adjuvant Gr (n=108): 78 pts received CT: BEP (n=75), PVB (n =3); 21 pts were kept only on surveillance, in view of stage IA dysgerminoma (n=18), & stage IA, grade-I IT (n=3); 6 refused further treatment and 2 were lost to FU. Advanced Dis. Gr (n=69): 68 pts received CT: BEP (n=58), PVB (n=10). 2 pts, one in each group received radiotherapy (RT) for dysgerminoma. Recurrent Dis. Gr: 26 (12.3%) pts had recurrence and were treated with salvage CT; 2 of them also received RT. Results: Adjuvant Gr: 101/108 (93.5%) are in continuous CR; 1 died of CT toxicity, 1 died of unrelated cause and 1 with EST relapsed 15 months after CT and died of Prog. dis.and in 4 pts dis. status is unknown.Advanced Dis. Gr: 53/69 (76.8%) responded; CR-40 and PR-13;10 died of Prog. dis., 1 died of CT toxicity and 5 were lost to FU. Currently, 42/53 (79.2%) are alive and dis. free. Recurrent Gr: 18/26 (69.2%) responded; CR- 16 and PR-2; 5 died of Prog. dis. and 3 were lost to FU. At present, 16/18 responders are alive and dis. free. 119/130 eligible pts resumed menstruation and of married women, 30 have conceived. Currently, 163 of 211 pts (77.2%) are alive and dis. free at a mean FU of 106.5 months (range: 12-160 months). The probability of overall survival for all pts is 87% at 120 months. Outcome was superior for “Nil residual” (p=0.0001) and stage I and II dis. (p=0.0001) while EST carried a poor outcome (p <0.05). Conclusions: MOGCT has excellent survival and reproductive outcome with conservative surgery and platinum-based chemotherapy.
Health professional awareness of treatment-related bone loss in prostate cancer.
Authors: S. Burbridge, K. Thillai, C. Tang, A. Garcia-Imhof, L. Drudge-Coates, S. M. Rudman, J. Kinsella, D. Cahill, G. Kooiman, S. Hughes, P. Harper, S. Chowdhury
Journal: Journal of Clinical Oncology (2011)

e15099 Background: Prostate cancer is the most common male cancer. Androgen deprivation therapy (ADT) is the mainstay of treatment for metastatic disease, and is increasingly used in radical therapy. Treatment with ADT causes bone mineral density (BMD) loss, and is a significant contributor to fracture risk. Therapy with bisphosphonates, raloxifen or denosumab can impact on BMD loss. Imaging with dual energy X-ray absorptiometry (DEXA) scanning is the gold standard for the quantification of BMD. Despite the growing body of evidence supporting BMD loss secondary to ADT a screening and management consensus has not been reached in the United Kingdom. Methods: A questionnaire based study was undertaken. The aims were to investigate current practice around bone health among health professionals treating men with ADT for prostate cancer. Results: Responses from 76 urologists, 49 clinical nurse specialists (CNS) and 48 medical oncologists (of which only 12 regularly treat prostate cancer) have been evaluated to date. Of all 137 treating clinicians 127 (93%) are treating at least 20% of their patients with ADT. In total 114 (83%) do not have local guidelines for the screening and management of BMD loss. Whilst 115 (84%) do have access to DEXA scanning, 95 (69%) have not ordered a DEXA scan in the past 6 months, and 95 (69%) are ‘not confident at all’ of interpreting DEXA scan results. When asked if responders would repeat an abnormal DEXA scan at a later date only 45 (33%) responded yes, 86 (63%) did not know. Understanding of the role of lifestyle advice and therapeutic intervention was poor. When asked whether national guidelines would benefit practice 119 (87%) responded yes. Conclusions: This study shows that understanding of the importance of screening for, and management of BMD loss was poor. Further education about this important complication of treatment is required.
Is pelvic lymphadencetomy unnecessary in patients with clinically localized prostate cancer and a lower PSA (<10 NG/ML)?
Authors: M. Ohori, K. Kuroiwa
Journal: Journal of Clinical Oncology (2005)

4620 Purpose: It has been said that pelvic lymphadenectomy may not be necessary for patients with low level of serum PSA and/or low biopsy Gleason sum when perineal prostatectomy or other local therapy are considered. We questioned that its concept is still true in 2005. Materials and Methods: We retrospectively studied e studied 2,735 patients with clinical stage T1a-T3 prostate cancer treated with radical prostatectomy at two institutions from 1983 to 2004. A whole-mount step section was reviewed by one pathologist at each institution to assess pathologic stage, Gleason score, and tumor volume in the peripheral and transition zone. Results: Overall, 130 (4.7%) patients had positive lymph nodes, and their median PSA was 9.44 ng/ml (1.27–115) compared to 5.84 ng/ml (0.17–108) of 2618 patients with no lymph node metastasis. Incidence of lymph node metastasis in 1983–94, 95–99 and 2000–04 were 9% (62/680), 2.5% (16/627) and 3.6%(52/1441), respectively, and median PSA in each period was 12.9 ng/ml (1.8–74), 8.0 ng/ml (2.5–97) and 7.4 ng/ml (3.8–84), respectively. Also, the incidence of positive lymph node in patients with biopsy Gleason sum 8–10 in each period was 33% (16/48), 11%(4/36) and 24% (16/68), respectively, compared to 7% (46/632), 2%(12/591) and 2.6% (36/1373) in patients with biopsy Gleason sum <=7. Of 52 patients with positive lymph nodes in 2000–04, 31 (60%) had PSA 4–10 ng/ml and of these 31, 22 (71%) had biopsy Gleason sum 6 or 7. Conclusion: The meaning of lymphadenectomy as a treatment is unknown and the incidence of positive lymph node is low, 2–3%, at present so that a local therapy with no lymphadenectomy may be justified in patients with low PSA and low grade tumor. However, some patients with recurrence after such treatments may be explained by the presence of positive lymph node even with a lower PSA. The lymphadenectomy at radical retropubic prostatectomy in patients with low PSA such as <10 ng/ml is not necessary to be avoid since roughly 60% of patients with positive lymph nodes might be missed.
Improving advance care planning for UICC Oncology patients.
Authors: Gowri Ramadas, Janet Golick, Polina Gorodinsky, Udai Jayakumar, Neriza Dumayas, Greg Branen, Lydia Quinones, Hope Engeseth, Neeta K. Venepalli
Journal: Journal of Clinical Oncology (2014)

234 Background: Advance care planning (ACP) in the ambulatory setting is underutilized and poorly documented at the University of Illinois Cancer Center (UICC). A baseline 8 week review noted 8.8% of metastatic solid tumor patients had ACP documentation in the electronic medical record (EMR) by the third visit and 23% in the previous two visits. Our aim was to increase ACP documentation to 75% of UICC metastatic solid tumor patient charts by the third visit through development of a standardized process for ACP discussion and documentation. Methods: A multidisciplinary team of oncology physicians, nurses, social workers (SW), and palliative care created a process map of ACP discussion. A new process for SW consults was piloted over 6 weeks. Additionally, all clinic staff participated in a standardized curriculum for ACP discussions. Post intervention data was prospectively collected over six weeks. Results: Total 94 encounters occurred during the pilot evaluating ACP in metastatic solid tumor patients of which 37/55 (39.4%) had documented ACP discussion. SW consults occurred in 18/94 (19.1%), leading to 18/18 (100%) with Power of Attorney (POA) forms in EMR. Evaluation by tumor subtypes showed 14/21 (66.7%) of gastrointestinal patients had ACP documentation with 9/21 (42.9%) with SW consults leading to 11/21 (52.4%) with POA forms in EMR. Of 39 total thoracic patients, 19/39 (48.7%) had ACP documentation of which 9/39 (23%) with SW consults and 7/39 (17.9%) with POA forms in EMR. Conclusions: UICC successfully piloted the creation and implementation of a process for ACP consults and standardization of ACP discussion and EMR documentation. While our initial aim of 75% a chart was not reached, the piloted process increased SW consults and completion of POA forms, as well as greater multidisciplinary effort and patient engagement. Compared to the pilot period, a multidisciplinary approach and use of the new process did improve ACP documentation. We plan to expand to all metastatic patients. [Table: see text]