tbuckley/cabot-search huggingface dataset:
Comparison of the accuracy of endoscopy ultrasound (EUS) versus positron emission tomography (PET) scan for the staging of the lung carcinoma - A prospective study
Authors: R. M. Reddy, P. Singh, R. A. Erickson, B. Camazine, R. Gupta, Y. Jadhav, C. Jonagadatha, R. S. Shah, P. Mukhopadhyay
Journal: Journal of Clinical Oncology (2005)

7183 Background: PET scan is an established test for the staging of the lung carcinoma. Recent studies have shown high accuracy of EUS guided FNA to detect metastases to the mediastinal lymph nodes and distant regions. Aim: To compare the accuracy of the EUS-FNA and PET scan for the staging of the lung carcinoma. Methods: Prospectively consecutive subjects with CT findings of lung mass that was suspicious for lung carcinoma were enrolled over a time period of 10 months. An attempt was made to perform EUS-FNA prior to the PET scan for the purpose of staging. Primary outcome was to determine the sensitivity and specificity of the EUS-FNA and PET scan for the metastases of the lung cancer to the mediastinum and distant regions (lymph node at celiac axis, adrenal gland and liver). Gold standard for the diagnosis of metastatic lesion was cytology obtained by FNA or surgery. Result: Thirty-five subjects with lung cancer were identified that underwent EUS-FNA and PET scan. EUS-FNA was performed prior to the PET scan in 83% of cases. EUS-FNA cytologically confirmed the metastases to mediastinum, celiac axis, adrenal gland and liver in 45%, 14%, 9%, 6% respectively. PET scan missed metastases (cytologically confirmed) to mediastinum in 2 cases and to celiac axis in 3 cases. PET scan was false positive for metastases to liver in 1 case. EUS missed metastases to mediastinum in 1 case and to distant region in 1 case. Conclusion: EUS is as accurate as PET scan for the detection of the metastases to the mediastinum and distant regions. EUS-FNA offers an additional advantage of confirming the diagnosis cytologically and thus influences the management. No significant financial relationships to disclose.
Response rates to hepatic arterial infusion (HAI) pump therapy in patients with metastatic colorectal cancer liver metastases (mCRC LM) after progression on all standard chemotherapies.
Authors: Andrea Cercek, Ariel Aguilo, Jill Gluskin, Joanne F. Chou, Diane Lauren Reidy, Leonard Saltz, Cara Siegel, Marinela Capanu, William R. Jarnagin, Ronald P. DeMatteo, Peter J. Allen, Peter T. Kingham, Yuman Fong, Michael Ian D'Angelica, Nancy E. Kemeny
Journal: Journal of Clinical Oncology (2014)

597 Background: To evaluate the overall response rate of HAI with floxuridine (FUDR) in the refractory setting in patients with mCRC LM. Methods: After obtaining an IRB waiver a computerized search was performed for patients with mCRC treated with 5FU, oxaliplatin and irinotecan +/- EGFR and VEGF inhibitor from 2003-2012. Charts were reviewed to ensure patients (pts) had received all standard therapies prior to HAI pump placement. All pts received HAI FUDR and no new systemic targeted or cytotoxic therapies were used with HAI pump. Imaging was re-reviewed for confirmation of progression prior to HAI pump placement and for best response using RECIST 1.1 criteria. Results: 75 pts were identified; of these 23 had radiographic disease progression on all standard chemotherapies (5FU, irinotecan and oxaliplatin) prior to having a pump placed. Of the 23 evaluable pts, the median age was 53 (range 37-75). Six pts had low volume extrahepatic metastases at the time of pump placement. The overall response rate (ORR) was 8/23 (35%); 10/23 (43%) pts had stable disease (SD). The median duration of SD was 4 months (range 1-10). Median follow up, measured from the date of HAI initiation, was 24 months and median overall survival (OS) was 22 months (95% CI 13-16). The median hepatic progression free survival (hPFS) was 4.5 months [CI: 3.8-6.7]. Thirteen pts developed extrahepatic disease progression (including 5 pts with preexisting extrahepatic disease). The median overall PFS was 3.9 months [95% CI 2.24-5.33]. Median number of HAI treatments was 4 cycles (range 1-13). Six out of 23 (26%) pts required a 50-75% dose reduction by the second cycle due to elevated liver function tests and 18/23 (78%) required a dose reduction after the 3 rd cycle. No pts required stents or developed long term liver or biliary toxicity. Conclusions: In a cohort of 23 patients with mCRC LM, refractory to all standard agents, treatment with HAI FUDR resulted in an ORR by RECIST 1.1 of 35% and median OS of 22 months. Further studies focusing on locoregional therapy in patients with liver predominant disease are warranted. Studies to molecularly characterize these tumors are ongoing.
Intra and extrahepatic cholangiocarcinoma: An evaluation of adjuvant therapy.
Authors: Jeff Wiisanen, Joleen Marie Hubbard, John Bergquist, Steven R. Alberts, David Nagorney, Mark Joseph Truty
Journal: Journal of Clinical Oncology (2016)

291 Background: Cholangiocarcinoma (CCA) is a rare malignancy with poor survival. The only curative therapy is resection and the role of adjuvant therapy is not well defined. Despite the unproven benefit, adjuvant therapy is used in resected CCA. The aim of this study is to analyze our institution’s outcomes for peri-operative treatment of resected intrahepatic and extrahepatic CCA. Methods: We retrospectively analyzed 145 intrahepatic (iCCA) and 109 extrahepatic (eCCA) CCA patients who underwent resection at the Mayo Clinic, Rochester. The majority of treated patients received adjuvant chemotherapy; however neo-adjuvant and radiation were also included. Results: In stage 1-2 iCCA patients, the HR indicated worse outcomes for time to recurrence and death. For stage 3-4 or node positive disease, outcomes were not significantly different. Those with node unknown/negative disease had significantly worse time to recurrence but not OS. There was a significant difference in stage and treatment modality between these groups (see table). Among eCCA, for any stage and node positive disease, outcomes were not different. In the node unknown/negative group, neither time to recurrence nor OS differed significantly. In controlling for different features in multi-variable analyses, no significant differences were observed (see table). Conclusions: This retrospective study does not show a significant difference in recurrence free or OS for treated patients. The apparent lack of benefit most likely reflects selection bias among treatment groups. Prospective, randomized trials are needed to make sound recommendations in adjuvant treatment for CCA. [Table: see text] [Table: see text]
Incidence and predictors of venous thromboembolism (VTE) among ambulatory patients with lung cancer.
Authors: G. C. Connolly, M. R. Dalal, J. Lin, A. A. Khorana
Journal: Journal of Clinical Oncology (2011)

7066 Background: The incidence of VTE among lung cancer patients reported in hospital-discharge database studies and single-institution studies is 2%-13%. The incidence and economic impact of lung cancer–associated VTE is unknown in the ambulatory setting, where most cancer care occurs. This retrospective cohort analysis examined incidence and risk factors for VTE in ambulatory patients with primary lung tumors who were starting chemotherapy. Methods: Data were extracted from the IMS Patient-Centric database, a large administrative database of US healthcare claims. Demographics/clinical characteristics and healthcare resource utilization of patients with solid tumors, including lung, and patients in a matched control cohort without cancer were evaluated. The incidence of deep vein thrombosis (DVT), pulmonary embolism (PE), and DVT+PE was recorded during 3- to 12-month follow-up after chemotherapy initiation in the lung cancer cohort. Results: Lung cancer (n=6,732) and control (n=17,284) cohorts had 51% women, with a mean age of 64 years. Respective mean Charlson Comorbidity Index (CCI) scores were 6.7 and 0.6. VTE occurred in 13.9% of the lung cancer cohort (odds ratio [OR], 3.15; 95% confidence interval [CI], 2.55, 3.89) and 1.4% of the control cohort (P<0.0001). The incidence of DVT, PE, and DVT+PE was 7.4%, 3.6%, and 2.9%, respectively, in the lung cancer cohort vs 1.0%, 0.2%, and 0.2% in the control cohort (P<0.0001 for all comparisons). The use of erythropoiesis-stimulating agents (ESAs; OR, 1.63; 95% CI, 1.40, 1.89; P<0.0001 vs no ESA), CCI ≥5 (OR, 2.56; 95% CI, 1.02, 6.39; P=0.045 vs CCI <5), and congestive heart failure (CHF; OR, 1.29; 95% CI, 1.01, 1.66; P=0.045 vs no CHF) were associated with VTE. Bleeding occurred in 22.1% of the lung cancer cohort and 7.0% of the control cohort (P<0.0001). Among lung cancer patients, VTE was associated with a 39.5% higher total medical cost than non-VTE (P<0.0001). Conclusions: VTE is highly prevalent among patients with lung cancer receiving chemotherapy and is associated with a significant increase in healthcare resource utilization. Disclosure: Study funding and editorial support provided by sanofi-aventis U.S.
Prognostic role of microRNA-34a expression in colorectal cancer.
Authors: Albert Y. Lin, Natalia B. Kouzminova, Jonathan Pollack, Gerard Nuovo
Journal: Journal of Clinical Oncology (2014)

472 Background: Colorectal Cancer (CRC) is one of the leading causes of death worldwide. MicroRNA-34a (miR-34a), a tumor suppressor gene, is known to be down-regulated in CRC cell lines and recently shown to be a cell-fate determinant in early-stage dividing colon cancer stem cells. However, its prognostic significance is unclear. Methods: MiR-34a detection was performed by in situ hybridization on a CRC tissue microarray (n=127; stage I, 21 patients; II: 42; III: 33; IV: 31). Its expression was graded as negative (no signal), low (expression in 1-19% of cancer cells), moderate (20-49% of cancer cells), and strong (50-100% of cancer cells). The correlations between miR-34a expression and EGFR, osteopontin (OPN), p53, Ki67, LEF1, VEGF, COX2, MMR, stage and grade were evaluated by chi-squared test and Spearman's rank correlation coefficient. Kaplan-Meier survival analysis, log-rank test and Cox regression model were used to assess the association of miR-34a expression with recurrence-free survival (RFS) and disease specific survival (DSS). Results: MiR-34a expression had moderate positive correlation with genes associated with tissue proliferation and invasion, including Ki67 (Spearman's r=0.28, p=0.002), and weak correlation with EGFR (r=0.2, p=0.02) and LEF1 (r=0.18, p=0.039). In the subgroup of patients (n=75; stage II/III) with negative OPN expression (n=25), weak or negative miR-34a expression was associated with worse RFS (HR=4.1; 95%CI=1.1-15.9; p=0.036) and DSS (HR=10.5; 95%CI=1.2-94.5; p=0.036). Conclusions: Our results suggest that down-regulated or absent expression of miR-34a correlates with worse RFS and DSS in stage II - III CRC patients with negative OPN expression. Further investigation of miR34a in prospective randomized studies is warranted to establish its role as a prognostic factor for CRC outcome.
Utilization and relative value of breast cancer adjuvant chemotherapy regimens in the community.
Authors: D. A. Patt, J. L. Espirito, B. Turnwald, J. R. Hoverman, M. A. Neubauer, T. H. Cartwright, B. D. Brooks, L. T. Busby, M. A. Sitarik, M. A. Kolodziej, A. L. Ginsburg, S. Sheth, J. S. Garey, M. Clayton, G. C. Nelson, R. W. Anderson, R. A. Beveridge
Journal: Journal of Clinical Oncology (2011)

e16595 Background: Selection of adjuvant breast cancer (BC) therapy varies based on patient risk factors. Utilization and choice of chemotherapy (CT), schedule, duration, and supportive care affects costs. We aimed to characterize neoadjuvant/adjuvant (N/Ad) CT utilization by tumor type and regimen (R) type, and estimate associated costs. Methods: Using the US Oncology iKnowMed EHR database, we retrospectively identified female BC patients (pts) diagnosed with stage I-III BC, between 7/2006 and 11/2010. Secondary diagnoses were excluded. Pts were characterized by age, ER and HER2 status, tumor size, grade, and nodes. CT utilization was determined by the number of pts assigned an N/Ad line of therapy (LOT) during the study period. Rs were categorized by CT title and drugs. Clinical trial pts were included. Incomplete, changed, and non-standard Rs were categorized as ‘other’. Medicare allowable was used for CT costs (using 70 kg or 1.7m2). Office visit (OV) and lab costs were added to each CT administration excluding trastuzumab maintenance. Results: During the time period, 40,881 BC pts were identified. An N/Ad LOT was documented in 37% of pts. CT utilization was 65% in HER2+ pts, 60% in ER-/HER2- pts, and 29% in ER+/HER2- pts. Other subsets were also characterized. TC (docetaxel/cyclophosphamide) then AC-paclitaxel like regimens were the most used HER2- regimens. TCH (docetaxel/carboplatin/trastuzumab) then AC-TH (paclitaxel/trastuzumab) were the most used HER2+ regimens. The table shows utilization and estimated costs. Conclusions: CT is a driver of cost. Nonanthracycline regimens are highly utilized in the community for N/Ad BC treatment. Use of docetaxel, trastuzumab, and pegfilgrastim increased treatment costs. Utilization and costs of select regimens. Utilization (%) Regimens ER+/HER2- ER-/HER2- Estimated total cost* ($) HER2- AC x 4 6 7 1,153 AC x 4 - docetaxel x 4 2 2 14,328 AC x 4 - paclitaxel weekly x 12 19 27 3,520 CMF x 6 1 1 1,518 FEC x 6 <1 <1 2,219 TC x 4 37 26 10,411 TAC x 6 16 13 31,009 Other 11 16 Clinical trial 8 8 HER2+ Any HER2+ AC x 4 - paclitaxel weekly x 12 + H x 1 yr 14 55,201 TCH x 6 - H x 1 yr 37 67,076 Other 39 Clinical trial 10 * CT Medicare allowable 1Q2011 + level 5 established OV and CBC and CMP per dose. Includes pegfilgrastim.
TRP genes family expression in colorectal cancer and its relationship with prognostic factors.
Authors: Mehmet Emin Kalender, Yilmaz Sozucan, Ibrahim Sari, Ali Suner, Serdar Oztuzcu, Ibrahim Bozgeyik, Beyhan Cengiz, Yusuf Z Igci, Ozan Balakan, Celaletdin Camci
Journal: Journal of Clinical Oncology (2014)

513 Background: Different factors are effective in the development of colorectal cancer (CC). With the discovery of that TRP (transient receptor potential) genes family is an important component of calcium channel, about 30 members of the family of TRP ion channel in mammals have been determined up to the present. TRP channels are associated with many pathological conditions like cancer and cardiovascular diseases as well as the physiological significance of them.. The aim of this study is to investigate TRPM, TRPV and TRPC gene expression levels in tumor tissues of CC patients and to analyze the relationship of expression in tumor tissue of colorectal cancer with other known prognostic factors. Methods: In this study, 93 CC patients whose follow-up and treatment realized in Medical Oncology Department of Gaziantep University Medical Faculty Hospital were analyzed retrospectively. Level of TRP gene expression in paraffin blocks of normal and cancerous colorectal tissue samples of 93 patients were studied at the level of mRNA with real-time PCR. Results: From normal and cancerous colorectal tissues of 37 female and 56 male patients diagnosed with colorectal cancer, expressions of TRPV3, TRPV4, TRPV5, TRPM4, and TRPC6 genes in tumor tissue were detected lower when compared to normal tissue (p &lt; 0.05). When expression levels of other TRP genes in tissues were compared, any significant difference was not found (p &gt; 0.05). There was no meaningful difference between prognostic factors and gene expressions of tumor tissues statistically (p &gt; 0.05). Conclusions: Expression of many proteins in cancer cells compared to normal cells increases or decreases. In CC, TRPV3, TRPV4, TRPV5, TRPM4, and TRPC6 genes of which expression in cancerous tissue decreases may be thought as potential genes contributing to tumorigenesis. To verify this hypothesis, it should be supported with further studies.
Nonseminomatous germ cell tumor of the testis: Prognostic factors for a lethal phenotype.
Authors: Shi-Ming Tu, Mehmet Asim Bilen, Zachary H. Tu, Raphael General, John Francis Ward, Louis L. Pisters, Rosale General, Adrienne H. Chen, Yago Nieto, Lance C. Pagliaro, S. J. Yeung, Christopher Logothetis, Sue-Hwa Lin, Ivan Gorlov
Journal: Journal of Clinical Oncology (2014)

390 Background: Cancer is a heterogeneous disease. Studying cancer heterogeneity may enable us to elucidate the various subtypes of a particular cancer, and improve the diagnosis, prognostication, and therapy of cancer. Nonseminomatous germ cell tumor (NSGCT) is a prime example of a heterogeneous disease. We determined potential lethality of NSGCT by characterizing the histological makeup of primary testicular tumors, the tumor burden, psychosocial issues, and surgical factors. Methods: From November 1997 to October 2012, 142 consecutive patients diagnosed with a NSGCT of the testis were evaluated for this study. The log-rank test was used to identify prognostic factors in univariate Kaplan-Meier analysis. A multivariate Cox regression model was used to evaluate predictive factors for overall survival. Results: Patient and tumor characteristics: median (range) age 25 (12 to 53); pathology – embryonal carcinoma 15%, teratoma 6%, and mixed NSGCT 79%; stage – I 46%, II 32%, and III 21%. Ten (7%) patients died from their NSGCT. Seven (5%) patients had incurable NSGCT. Multivariate analysis showed that presence of seminoma (p=0.007), presence of yolk sac tumor (p=0.019), clinical stage (p=0.027), and psychosocial issues (p=0.04), have unfavorable prognostic significance. Conclusions: Certain subtypes of NSGCT containing yolk sac tumor and seminoma are inherently chemotherapy resistant and potentially lethal. Psychosocial factors can delay the diagnosis and treatment of patients with such tumors and adversely affect their clinical outcome. Results of this study need to be validated in another data base or a prospective clinical trial.
Endoscopic and endosonographic staging in the management of cancer of the stomach and the esophagogastric junction.
Authors: G. Töppler, H. Röper, S. Cameron, L. Füzesi, A. Beham, G. Ramadori
Journal: Journal of Clinical Oncology (2011)

e14592 Background: Staging of the primary tumor in patients with advanced adenocarcinoma of the stomach or the oesophago-gastric junction under chemotherapy is not generally recommended. RECIST criteria do not detect local tumor regression adequately. Standards for endoscopic staging throughout therapy have not yet been established. Methods: We here report on 20 consecutive patients with locally advanced or metastasised esophago- or gastric adenocarcinoma which were treated with EOX or EOF (epirubicin, oxaliplatin, capecitabine or 5-FU) in the neoadjuvant setting and FLOT (5-FU, leucovorine, oxaliplatin, doxetacel) or FLP (5-FU, leucovorine, cisplatin) in the palliative setting between 12/2007 and 10/2010. Therapeutic efficacy was assessed by gastroscopy (EGD), endosonography (EUS), ultrasonography (US) and CT-scan. EGD staging criteria included luminal occlusion, the aboral length of tumor involvement, tumor exulceration, formation of polypoid tissue or superficial ulcers, and gut motility. EUS-staging criteria included uT-staging of the different layers of the esophago-gastric wall as well as of the adjacent lymph-nodes. If possible surgery was performed within 2 to 4 weeks after the end of the third chemotherapy cycle. Results: In all patients, an early response to chemotherapy was observed by EGD and EUS, including regression of tumor size (length and depth), and appearance: former exulcerative tissue became rather polypoid and less vulnerable, and motility was regained in areas were tumor regression was observed. For the assessment of local tumor behaviour under chemotherapy, CT-scan was of limited help, as it was only able to monitor lymphadenopathy. Only in 3/20 cases there was a concordance between the EUS and CT-scan, as verified by histopathological review of the surgical specimen. Endoscopically the primary tumour was stable or even regressed for all patients. Conclusions: EGD and EUS monitor early tumor response of the primary to chemotherapy adequately in all our cases of locally advanced esophago- or gastric adenocarcinoma. Endoscopic measures are helpful for the assessment of early treatment response, and might help to direct therapeutic strategies.
Retroperitoneal sarcoma: A population-based analysis of epidemiology, surgery, and radiotherapy
Authors: G. A. Porter, N. N. Baxter, P. W. T. Pisters
Journal: Journal of Clinical Oncology (2005)

9025 Background: There are no population-based studies of retroperitoneal sarcoma (RPS), and the use and timing of adjuvant radiotherapy (RT) in its treatment is controversial. The goal of our study was to examine the incidence and treatment of RPS, specifically regarding the use of adjuvant RT. Methods: We used the Surveillance, Epidemiology, and End Results (SEER) database to evaluate the incidence of RPS over a 29-year period (1973–2001). We evaluated the rate of surgery as well as the rate and timing of adjuvant RT. We then assessed the influence on treatment of factors including patient age, sex, race, marital status, year of diagnosis, and geographic location. Results: A total of 2348 cases of RPS were identified. The mean annual incidence of RPS was 2.7 cases per 106 persons, and did not change significantly over time (2.6 in 1973 vs. 2.8 in 2001; p=0.92). Most patients (1654; 70.4%) underwent surgical resection. RT was used in 428 patients (25.9%) who underwent surgery; RT was given postoperatively in 366 (85.5%), preoperatively in 20 (4.7%), and intraoperatively or unknown in 42 (9.8%). Patients who received adjuvant RT were on average 5 years younger than those who underwent surgery alone (p<0.0001). RT was more commonly used among whites than African Americans (25.8% vs. 16.7%; p=0.02) and there was significant variation in the use of adjuvant RT by geographic location (p=0.003). No associations were identified between the use of adjuvant RT and sex, marital status, or year of diagnosis. On multivariate analysis using logistic regression, race (p=0.01), age (p<0.0001), and geographic location (p=0.02) were independently associated with the use of adjuvant RT. Conclusions: The incidence of RPS, a rare disease, appears stable. Most patients who undergo surgery do not receive any adjuvant RT, and very few receive preoperative RT. Differences in adjuvant RT use found on the basis of demographic and geographic factors suggest that at least some treatment variations reflect individual and institutional practice patterns. These data, representing current practice, are important in considering how to implement future results of an ongoing randomized trial (ACOSOG 9031) comparing preoperative RT and surgery to surgery alone. No significant financial relationships to disclose.