tbuckley/cabot-search huggingface dataset:
Radiomics features of ground glass nodules tailored different pathological grades of lung adenocarcinoma.
Authors: C Zhang, Haoran Zhai, Lan He, Zai-Yi Liu, Yi-Long Wu, Wenzhao Zhong
Journal: Journal of Clinical Oncology (2017)

e23127 Background: Different pathological subtypes as well as different grades of adenocarcinoma based on the IASLC/ATS/ERS classification had been proven to be stage-independent predictor of survival. Radiomics features, as a novel analytic method, has been increasingly applied in variety cancer research and may be a potential predictor for preoperatively differentiating pathological grades of adenocarcinoma. Methods: Patients (pts) with radiological proved as solitary ground glass nodule were eligible in this study. Radiomics features derived from computed tomography (CT) images were extracted by Chinese Academy of Science. All pts will be categorized into three groups with lepidic predominance as low-grade, acinar and papillary predominance as intermediate-grade, micropapillary and solid predominance as high-grade. We used L1 penalized constrained continuation ratio model to select relevant radiomics features, and corresponding radiomics signature was constructed. Association between the radiomics signature and pathological grades of adenocarcinoma was explored using the Kruskal-Wallis test and C-index was performed to test the efficacy of differentiating. Results: 82 pts were included in this study. Low-grade, intermediate-grade and high-grade contained 15 (18.3%), 53 (64.6%), 14 (17.1%) pts respectively. 475 radiomics features were extracted from thin section CT image and 10 of them selected through L1 penalized constrained continuation ratio model composed radiomics signature which significantly associated with pathological grades (P &lt; 0.0001). C-index for radiomics signature were 0.813 (95%CI 0.793-0.833). Since clinical characters including gender, age, smoking status, NSE, CEA and CYFRA21-1 were not associated with different grades of adenocarcinoma, we could not establish nomogram based on the radiomics signature and correlated clinical characters. Conclusions: Radiomics features only can be a potential predictor for preoperatively differentiating pathological grades of adenocarcinoma, which may be a more applicable clinical predictor for patients’ survival. Yet large sample sizes are warranted to confirm the results.
Using health-related quality of life and treatment measures to predict 10-year mortality in older survivors of early stage breast cancer.
Authors: Clark DuMontier, Kerri Clough-Gorr, Rebecca A Silliman, Andreas Stuck, André Moser
Journal: Journal of Clinical Oncology (2017)

e21548 Background: Older women make up the growing majority of breast cancer (BC) survivors. Guideline BC treatments are known contributors to long-term survival, and health-related quality of life (HRQOL) is emerging as not only an important outcome in survivorship care but also as a factor thought to influence mortality. However, prognostic models that include HRQOL alongside BC treatment measures are lacking. We aimed to develop a 10-year mortality risk score based on a priori chosen treatment and HRQOL variables. Methods: We studied 660 women ≥65-years old diagnosed with stage I-IIIA primary breast cancer in years 1997-1999. Data from medical and psychosocial domains were collected over 10 years from interviews, medical records, and death indexes. BC treatment variables included receipt of definitive locoregional surgery +/- radiation, chemotherapy, and tamoxifen. HRQOL variables included physical function [10-item Physical Function Index (PFI-10) from the Medical Outcomes Study Short Form-36 (MOS SF-36)]; mental health [5-item Mental Health Index (MHI-5) from the MOS SF-36]; and social support [8-item modified MOS Social Support Scale (mMOS-SSS)]. We used penalized logistic regression models to develop a 10-year mortality risk score, and investigated its discrimination (c-statistic) and calibration (observed versus predicted mortality using the Hosmer-Lemeshow (HL) test). Results: Mortality though 10-years of follow-up was 34.8% (230 of 660 women). The c-statistic of a risk score using only age, number of comorbidities, stage of BC, and BC treatment was 0.71. The c-statistic increased to 0.74 with the addition of HRQOL measures and showed good calibration (p = 0.72 from HL test). Physical function and mental health had strong independent associations with mortality (women with high PFI-10: OR 0.63, 95% CI 0.43, 0.92; women with high MHI-5: OR 0.57, 95% CI 0.39, 0.85). Conclusions: In older early stage breast cancer survivors, our risk score combining HRQOL with treatment measures showed good discrimination and calibration. HRQOL is independently associated with 10-year mortality and adds predictive ability to age, comorbidity, stage of BC, and BC treatment.
P05.26 Efficacy and tolerability of high dose chemotherapy with autologous stem cell rescue after surgery in patients with congenital brain tumors
Authors: M Guidi, L Giunti, A Buccoliero, B Spacca, M Lucchesi, S Farina, C Fonte, C Moscheo, M Censullo, L Genitori, I Sardi
Journal: Neuro-Oncology (2018)

Congenital malignant brain tumors are extremely rare characterized by a poor prognosis. This could be due to a massive size of these tumors when they are diagnosed, the surgical difficulties and the lack of consolidated therapeutic approaches. Being radiotherapy not recommend for very young patients, the most favorable outcome is correlated to the gross total resection. We evaluated genetic characteristics, response rate, progression-free survival (PFS), and overall survival (OS) of high-dose chemotherapy and autologous stem cell transplant (ASCT) after surgery of infants with congenital brain malignancy. Ten infant aged less than 12 months were included in this study. The median age at diagnosis was 56 days (range: 1–279 days; mean: 80,9 days). All patients were subjected to a regimen of induction chemotherapy, two high-dose chemotherapy courses and autologous stem cell transplant after surgery. Furthermore, we analyzed the Copy Number Variants (CNVs) profile using SNP/CGH array approach in all patients. We also performed a sequence analysis of the coding regions for investigating the clinical relevance of germline INI1 gene mutation in atypical teratoid/rhabdoid tumors (AT/RT) patients. Pathological diagnosis was available in all cases: 4 anaplastic astrocytomas, 2 glioblastoma multiforme, 2 supratentorial primitive neuroectodermal tumors and 2 AT/RT. In our study only two patients were subjected to maximal surgery. A tumor debulking with macroscopic residual was performed in the other patients. At 1–5 years from diagnosis, the PFS was 80% and 58% and the OS was 90%, 69%, respectively. Two germline INI1 mutations were found in both patients with AT/RT. One patients with AT/RT had a c.618G>A (p.Trp206*) mutation in exon 5 of INI1 gene. The genetic analysis of other patient showed c.175C>T mutation in exon 2 of INI1 in heterozygosis in tumor’s DNA. The two patients with AT/RT died early, whereas the other congenital patients showed an 5-years OS of 85%. We found a statistical correlation with OS and PFS with the presence of mutation (p: 0,0009; p: 0,01) and the histology (p:0.007 and p:0.0590). Intensive postoperative chemotherapy and ASCT represents the most effective therapeutic approach for congenital brain tumors with a high response rate. The determination of germline INI1 mutation in AT/RT could be a decisive prognostic marker for the palliative choice.
Pooled Analysis of Defibrotide Studies in the Treatment of Veno-Occlusive Disease/Sinusoidal Obstruction Syndrome (VOD/SOS) after Hematopoietic Stem Cell Transplantation (HSCT) or Chemotherapy without HSCT
Authors: Paul G Richardson, Saurabh Aggarwal, Ozlem Topaloglu, Kathleen Villa, Selim Corbacioglu
Journal: Blood (2017)
Early disease progression in patients (pts) with newly diagnosed localized nasal extranodal NK/T-cell lymphoma, nasal type (ENKL) treated with radiotherapy with dexamethasone, etoposide, ifosfamide, and carboplatin (RT-DeVIC).
Authors: Motoko Yamaguchi, Ritsuro Suzuki, Masahiko Oguchi, Naoko Asano, Kana Miyazaki, Yasuhito Terui, Nobuko Kubota, Takeshi Maeda, Yukio Kobayashi, Jun Amaki, Toshinori Soejima, Bungo Saito, Emiko Shimoda, Noriko Fukuhara, Norifumi Tsukamoto, Kazuyuki Shimada, Ilseung Choi, Takahiko Utsumi, Yasuo Ejima, Naoyuki Katayama
Journal: Journal of Clinical Oncology (2017)

7546 Background: Approximately 25% of all pts with localized nasal ENKL experience disease progression during the first two years (yrs) after diagnosis under new treatments including concurrent chemoradiotherapy. The clinical features of those pts are largely unknown. Methods: The database of our study (NKEA project; UMIN000015491) was used for the present analysis. Data from pts with newly diagnosed localized (stage IE and contiguous IIE) nasal ENKL diagnosed between 2000 and 2013 at 31 institutes in Japan and treated with RT-DeVIC were retrospectively analyzed. Progression of disease within 2 yrs (POD24) (Casulo, JCO 2015) was applied as the definition of early progression. Results: Of 162 pts, 38 were in the POD24 group (23%) and 124 were in the reference group. Treatment yrs and doses of RT and DeVIC were not associated with the incidence of POD24. With a median follow-up of 5.8 yrs, the overall survival (OS) of the POD24 group was inferior to that of the reference group ( P &lt; 0.00001; 2-yr OS, 26% vs. 100%; 5-yr OS, 23% vs. 89%). The POD24 group showed the following features more frequently than the reference group: serum soluble interleukin-2 receptor (sIL-2R) level &gt; upper limit of normal (ULN) (25/33, 76%; P = 0.000012), C-reactive protein (CRP) &gt; ULN (28/37, 76%; P = 0.013), and detectable Epstein-Barr virus (EBV)-DNA in peripheral blood (15/17, 88%; P = 0.033). The positive predictive value and negative predictive value of elevated sIL-2R for POD24 were 42% and 90%, respectively; those of elevated CRP were 31% and 87%, respectively; and those of detectable EBV-DNA were 39% and 90%, respectively. Of the 9 pts who were negative for all three factors, none experienced POD24. A multivariate analysis in the POD24 group identified elevated sIL-2R as an independent predictive factor for worse OS (HR 3.16; 95% CI, 1.07 - 9.32). Conclusions: Pretreatment sIL-2R, CRP, and EBV-DNA were associated with POD24 among pts with localized nasal ENKL treated with RT-DeVIC. The strong association of elevated sIL-2R with early progression and short OS in the POD24 group provides a rationale for targeting strategies.
Atezolizumab (atezo) in special populations: Analyses from an expanded access program (EAP) in platinum-treated locally advanced or metastatic urothelial carcinoma (mUC).
Authors: Jean H. Hoffman-Censits, Sumanta K. Pal, Hanzhe Zheng, Darren Tayama, Joaquim Bellmunt
Journal: Journal of Clinical Oncology (2018)

4529 Background: Prior to FDA approval of atezo (anti–PD-L1) for platinum-treated mUC (and later cisplatin-ineligible mUC), a US EAP granted mUC pts access to atezo. The EAP (Bellmunt ASCO 2017) included special populations previously ineligible for Ph II study IMvigor210 (Rosenberg Lancet 2016). Here, we evaluate outcomes in pts with impaired baseline renal function or variant histology. Methods: This study (NCT02589717) enrolled mUC pts who progressed during or following platinum and had ECOG PS ≤ 2. Pts had predominant TCC histology but no restrictions on CrCl levels. Pts received atezo 1200 mg IV q3w until loss of clinical benefit. ORR (per investigator), DCR (CR+PR+SD) and safety were assessed by CrCl or primary tumor histology. Results: 114 pts were response evaluable; responses occurred in most subgroups (Table). All-grade treatment-related AEs (TRAEs) occurred in 46% of 214 safety-evaluable pts. In renal function subgroups, TRAE rates ranged from 35% (CrCl 30-45 mL/min) to 54% (CrCl 45-60 mL/min); no TRAE rate differences by histology were seen (46% each). Similar trends occurred for AEs of special interest. TRAEs leading to discontinuation were uncommon ( < 3% across subgroups). Two serious TRAEs (15%) occurred in CrCl < 30 mL/min subgroup ( < 8% in other subgroups). Conclusions: Responses or SD with atezo were seen in pts with mixed histology or compromised renal function (notably in pts with CrCl 30-45 mL/min), and safety was comparable across subgroups. These results suggest that atezo provides clinical benefit in a broad range of platinum-treated mUC pts. Clinical trial information: NCT02589717.RECIST v1.1 response by baseline characteristic. n ORR, % 95% CI, % CR, % DCR, % 95% CI, % All 114 15 9, 23 3 49 40, 59 CrCl, < 30 mL/min 6 0 0, 46 0 50 12, 88 30-45 19 21 6, 46 5 63 38, 84 45-60 27 4 0, 19 0 30 14, 50 ≥ 60 62 19 10, 31 3 53 40, 66 TCC histology only 102 13 7, 21 2 48 38, 58 TCC with mixed histologya 12 33 10, 65 8 58 28, 85 Median follow-up (N = 214): 2.3 mo (range 1.6-3.4).a 1 PR was seen among 2 pts with an adenocarcinoma component and 1 CR + 2 PR among 5 pts with “other” subtype. No responses occurred in 1 pt with sarcomatoid or 4 pts with squamous components; 2 pts with squamous histology and 1 with “other” histology had SD.
Real life outcomes of metastatic urothelial carcinoma (mUC) patients treated post first line platinum based systemic therapy: A single centre experience.
Authors: Jamila Jama Almi Rir Omar, Sunita Ghosh, Nazanin Fallah-Rad, Elena Elimova, Aaron Richard Hansen, Srikala S. Sridhar
Journal: Journal of Clinical Oncology (2018)

e16500 Background: First-line, gemcitabine and cisplatin (GC) remains the standard in mUC with a median overall survival (mOS) of 13.8 months. Until recently there were no standard second line options, but the landscape has changed significantly with the use of second line chemotherapy and checkpoint inhibitors. However, it is unclear how this has impacted short and long term outcomes in routine clinical practice. This information will be critical for future clinical trial design in mUC Methods: A retrospective chart review of all mUC patients (pts) treated with first line GC at the Princess Margaret Cancer Center from 2009-2016 was conducted. Patient characteristics including age, sex, primary disease site, and sites of metastasis were collected. Pre-treatment complete blood count, neutrophil to lymphocyte ratio, renal function and hepatic function as well as all prior therapies, lines of chemotherapy, duration of treatment(s), median progression free survival (mPFS), and median overall survival (mOS) were also compiled. Results: From 2009-2016, 62 pts were identified: average age 65.7 (range: 42-87), M:F (47:15), 43 (69%) had a bladder primary, 19 (31%) had an upper tact primary. Of the 62 pts who started first line GC, mPFS was 8.2 mo (95% CI 6.9-9.4) and mOS was 15.9 mo (95% CI 11.3-20.4 mo). Overall 28 (45%) received second line therapy with a mOS of 10.3 mo (95% CI 5.68-15); 14 pts (23%) received third line therapy with a mOS of 9.01 mo (95% CI 4.3-13.9 mo); 3 pts received fourth line with a mOS of 4.17 mo (95% CI 3.9-4.4 mo) and 2 pts received 5th line therapy. Conclusions: In this single center experience, mOS with GC appeared slightly better than historical controls, and almost half of the patients went on to receive two or more lines of therapy, suggesting that novel options beyond second line warrant development. Further studies are also needed to better define the prognostic and predictive factors for patients treated in later lines of treatment.
Liver needle biopsies and prediction of histologic tumor grade for midgut neuroendocrine tumors.
Authors: Robert A. Ramirez, David T Beyer, Yi-Zarn Wang, Thiagarajan Ramcharan, Mary Jennifer Ricks, J Philip Boudreaux, Eugene Woltering
Journal: Journal of Clinical Oncology (2016)

e15664 Background: Our group has previously shown than neuroendocrine tumors (NETs) are heterogeneous neoplasms having histologic and functional differences between their primary tumor, lymph node, and hepatic metastases. Due to the heterogeneity of these malignancies, we hypothesized that there would be discordance between histologic grade of surgical specimen predicted by preoperative needle biopsies. Methods: Twenty consecutive patients diagnosed with NETs of the ileum and hepatic metastasis were included. Ki-67 proliferative index and WHO 2010 histologic grade were recorded for preoperative hepatic needle biopsy and subsequent tissue-matched surgical specimens. Concordance between sample values was determined. Results: Ten males and 10 females were included in this analysis. Five and fifteen patients had fine-needle aspirate (FNA) and core needle biopsies, respectively. Preoperative biopsies predicted the histologic grade of subsequent tissue-matched surgical specimens in only 65% of samples (13/20). Of the 7 values that changed grade (7/20, 35%), 4 went from intermediate (G2) to low (G1) grade [1 FNA and 3 core biopsies] and 3 went from low (G1) to intermediate (G2) grade [1 FNA and 2 core biopsies]. The corresponding inter-rater agreement statistic (K) was 0.251 ± 0.230 (95% CI: -0.199-0.702). Conclusions: Preoperative fine-needle aspirates and core needle biopsies of hepatic metastasis have a 35% error rate in predicting the histologic grade from subsequent tissue-matched surgical NET specimens. Clinicians should be cognizant of this error rate when making decisions on systemic treatment and consider repeat needle biopsy or open biopsy if actual clinical course does not match predicted behavior.
P04.88 Phasic alertness deficits in brain tumor patients
Authors: M de Dreu, I Schouwenaars, N Ramsey, G Rutten, M Jansma
Journal: Neuro-Oncology (2018)

Brain tumor patients often have cognitive deficits, which can greatly affect their socio-professional life. Previous studies have shown that a healthy brain already shows changes in activation before it has to perform a task, so called ‘phasic alertness’. In this study we examined if brain tumor patients show abnormal brain activity associated with deficits in phasic alertness. For this purpose we compared the level as well as the distribution of activation over two brain networks regions that are associated with phasic alertness. 20 healthy controls (HC), 27 meningioma patients (MG), 15 low grade glioma patients (LGG), and 16 high grade glioma patients (HGG), age (SEM) = 36 (2.5), 55 (2.3), 42 (3.4), 49 (3.5) performed a visual perception task with a cue warning the subject when a stimulus would appear. Bilateral ROIs were defined to represent activated regions of the central executive network (CEN) and the default mode network (DMN). Univariate (for average level of activation) and multivariate analysis (for activation pattern) were performed for CEN and DMN separately. Patients were significantly slower than HC (F(3) = 6.9, p < 0.001, MG v HC: t(45) = -5.1, p < 0.000, LGG v HC: t(33) = -2.2, p = 0.04, HGG v HC: t(34) = -2.9, p = 0.006). Univariate analysis showed no significant difference in signal changes in CEN and DMN (F(3) = 1.66, p = 0.18; F(3) = 1.02, p = 0.39). Multivariate analysis did show significant differences in the distribution of signal changes over the CEN and DMN (CEN: F(27,194) = 1.93, p = 0.006; DMN: F(21,200) = 1.91, p = 0.01). Each patient group showed comparable signal distribution changes in CEN (MG v HC: F(9,37) = 3.61, p = 0.003, LGG v HC: F(9,25) = 3.09, p = 0.01, HGG v HC F(9,26) = 2.14, p = 0.06),and in DMN (MG v HC: F(.7,39) = 2.08, p = 0.07, LGG v HC: F(7,27) = 2.38, p = 0.05, HGG v HC: F(7,28) = 2.45, p = 0.04. Our results suggest that meningiomas as well as gliomas, independent of the grade, may disturb normal anticipatory brain activity patterns associated with phasic alertness. These results may reflect a compensatory change in strategy to prepare for a cognitive challenge. Our findings could also play a role in cognitive deficits and mental fatigue as reported by patients with a brain tumor.
Abstract 15118: Different Risks for Hypertension, Diabetes, Dyslipidemia, and Hyperuricemia According to Level of Body Mass Index in American and Japanese Populations
Authors: Masanari Kuwabara, Diana I Jalal, Koichiro Niwa, Gerard Smits, Miguel A Lanaspa, Minoru Ohno, Ichiro Hisatome, Richard J Johnson
Journal: Circulation (2017)

Introduction: An elevated body mass index (BMI) is a recognized risk factor for diabetes mellitus (DM), dyslipidemia, hypertension, and hyperuricemia. However, whether it confers similar or identic...
In embolic stroke of undetermined source, rivaroxaban vs aspirin did not reduce recurrence and increased bleeding
Authors: Richard W. Frieden
Journal: Annals of Internal Medicine (2018)

ACP Journal Club18 September 2018In embolic stroke of undetermined source, rivaroxaban vs aspirin did not reduce recurrence and increased bleedingRichard W. Frieden, MDRichard W. Frieden, MDUpper Peninsula Health System, Marquette General Hospital, Marquette, Michigan, USA (R.W.F.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/ACPJC-2018-169-6-032 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Source CitationHart RG, Sharma M, Mundl H, et al; NAVIGATE ESUS Investigators. Rivaroxaban for stroke prevention after embolic stroke of undetermined source. N Engl J Med. 2018;378:2191-201. https://pubmed.ncbi.nlm.nih.gov/29766772Clinical Impact RatingsNeurology: References1 Powers WJ, Rabinstein AA, Ackerson T, et al; American Heart Association Stroke Council. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49:e46-110. [PMID: 29367334] Google Scholar2 Chimowitz MI, Lynn MJ, Howlett-Smith H, et al; Warfarin–Aspirin Symptomatic Intracranial Disease Trial Investigators. Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med. 2005;352:1305-16. [PMID: 15800226] Google Scholar3 Wang Y, Wang Y, Zhao X, et al; CHANCE Investigators. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med. 2013;369:11-9. [PMID: 23803136] Google Scholar4 Johnston SC, Easton JD, Farrant M, et al; Clinical Research Collaboration, Neurological Emergencies Treatment Trials Network, and the POINT Investigators. Clopidogrel and aspirin in acute ischemic stroke and high-risk TIA. N Engl J Med. 2018;379:215-25. [PMID: 29766750] Google Scholar5 Yao X, Abraham NS, Sangaralingham LR, et al. Effectiveness and safety of dabigatran, rivaroxaban, and apixaban versus warfarin in nonvalvular atrial fibrillation. J Am Heart Assoc. 2016;5(6);pii:e003725. [PMID: 27412905] Google Scholar Author, Article, and Disclosure InformationAffiliations: Upper Peninsula Health System, Marquette General Hospital, Marquette, Michigan, USA (R.W.F.)This article was published at Annals.org on 4 September 2018. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 18 September 2018Volume 169, Issue 6Page: JC32KeywordsAnticoagulantsAntiplatelet therapyAspirinDrugsHemorrhageHemorrhagic strokeIschemic strokeNumber needed to harmSafetyStroke ePublished: 18 September 2018 Issue Published: 18 September 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...