tbuckley/cabot-search huggingface dataset:
Optimizing treatment strategy for advanced rectal cancer in the West and Japan: International multicenter cohort study.
Authors: Akira Ouchi, Naruhiko Ikoma, Y. Nancy You, Koji Komori, Dai Shida, Brian K. Bednarski, Takashi Kinoshita, Shunsuke Tsukamoto, Miguel A. Rodriguez-Bigas, Taihei Oshiro, John Michael Skibber, Hiroki Ochiai, Yasuhiro Shimizu, Yukihide Kanemitsu, George J. Chang
Journal: Journal of Clinical Oncology (2018)

3524 Background: The treatment strategies for locally advanced rectal cancer in the West and Japan have evolved through divergent philosophies - preoperative chemoradiation (CRT) and total mesenteric excision (TME) in the West and upfront TME with lateral pelvic node dissection (LPND) in Japan. The purpose of this study was to compare these approaches. Methods: Consecutive patients with ≥cT3 rectal cancer located ≤12 cm from the anal verge and diagnosed between 1998 and 2013 at 3 tertiary cancer centers (1 US and 2 Japan) were identified. Only patients who received preoperative CRT+TME in the US and those who underwent TME+/-LPND based on tumor location in Japan were included. The primary outcome was cumulative rate of local recurrence (LR) and secondary outcomes included relapse free survival (RFS). Results: A total of 1597 patients (836 US and 761 Japan) met study criteria and were analyzed. Adjuvant chemotherapy was given to 88.4% in the US and 24.4% in Japan. Five-year cumulative risk for LR was 4.6% in the US and 6.7% in Japan (HRadjusted 0.58 [95% CI 0.30-1.13]). Overall RFS was longer in the US on univariate analysis (HR 2.09 [1.64-2.66], p < 0.001), but after adjustment for (y)p stage and relevant covariates, did not differ from Japan (HRadjusted 0.89 [0.66-1.19]). Following CRT and TME in the US or TME+/-LPND in Japan, 63.4% and 21.2% of stage cIII patients were downstaged, respectively. On stage stratified adjusted analysis, there were no differences in RFS for stage cII and (y)pII subgroups; meanwhile RFS in stage cIII subgroup was significantly longer in the US, but did not differ for stage (y)pIII subgroup (Table). Conclusions: This is the first comparison of a large cohort of patients treated by CRT+TME, and TME+/-LPND within dedicated cancer centers in the US and Japan. Overall the rates of local recurrence were lower than historically reported. These results suggest good outcomes can be achieved without CRT for some stage cII patients but that neoadjuvant CRT is associated with improve survival for stage cIII patients who are downstaged. RFS HRadjusted [95% CI] p Stage cII 1.40 [0.73-2.68] 0.30 Stage (y)pII 1.28 [0.53-3.11] 0.57 Stage cIII 2.54 [1.79-3.61] < 0.001 Stage (y)pIII 0.86 [0.61-1.21] 0.41
Effect of very small tumor size on cancer-specific mortality in node-positive melanoma.
Authors: Xinyang Liu, Zhichao Wang, Qingfeng Li
Journal: Journal of Clinical Oncology (2017)

e21059 Background: Traditionally, larger tumor size and lymph node (LN) involvement have been considered independent predictors of mortality in melanoma. We aimed to characterize the interaction between tumor size and LN involvement in melanoma specific mortality. In particular, we evaluated whether very small tumor size represented a particularly aggressive disease variant compared with larger LN-positive melanoma. Methods: Using Surveillance, Epidemiology and End Results registry data, we identified 57,223 patients (aged 18-85 years) diagnosed between 1998 and 2012 with histologically confirmed nonmetastatic melanoma treated with surgery. Primary study variables were tumor size, LN involvement, and their corresponding interaction term. Kaplan-Meier methods, adjusted Cox proportional hazards models with interaction terms were performed. Potential confounders included age, sex, year of diagnosis, marital status and number of LN dissected. Results: Median follow-up was 48 months. In multivariable analysis, there was significant interaction between tumor size and LN involvement ( P &lt; 0.0001) using the likelihood ratio test and Wald test. In the absence of LN involvement (n = 54,922), the hazard ratio (HR) increased monotonically with increasing tumor size. Among patients with LN involvement (n = 2,301), using the smallest tumors as the reference group, hazard ratio of cancer specific mortality decreased unexpectedly in 0.01-1.00mm tumors (HR 0.61, p = 0.022) and 1.01-2.00mm tumors (HR 0.58, p = 0.007), and reached to a similar level in tumors sized 2.01-4.00mm (HR 0.81, p = 0.280), and subsequently increased in tumors sized larger than 4.00mm (HR 1.57, p = 0.016). Conclusions: In LN positive melanoma, very small tumors may predict for higher mortality compared with larger tumors. These results should be validated in future database studies. Table. Effect of tumor size in LN positive and LN negative melanoma. [Table: see text]
Satisfaction among lung cancer (LCa) patients (pts) in multidisciplinary (MDC) vs. serial care (SC) settings.
Authors: Kenneth Daniel Ward, Nana Boateng, Fedoria Elaine Rugless Stewart, Matthew Smeltzer, Bianca Jackson, Courtney Foust, Nicholas Ryan Faris, Meredith Ray, Raymond U. Osarogiagbon
Journal: Journal of Clinical Oncology (2017)

e18254 Background: Coordinated MDC, in which all key specialists concurrently provide early input, develop and execute a consensus plan of care in collaboration with pts and their caregivers, may improve satisfaction with care. We rigorously evaluated this premise. Methods: Prospective clinical cohort study comparing newly-diagnosed LCa pts receiving MDC (n=156) or SC (n=307) in the same healthcare system. Pts were enrolled before treatment onset. At baseline (study entry) and 3 months later, pts and caregivers completed treatment-related measures from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, including perceptions of quality of care, satisfaction with care, and extent of involvement in decision making. Satisfaction indices at 3 months will be compared in multiple linear regression models, adjusting for baseline scores and demographic and treatment-related characteristics. Results: Pt characteristics were similar, except for age and stage (Table). At baseline, MDC pts rated their care more positively than SC pts, but satisfaction with provider communication was similar. Three month data are currently being analyzed. Conclusions: MDC provided greater pt satisfaction in the diagnostic phase of LCa care. Further prospective analyses will test the hypothesis that MDC pts experience greater satisfaction with quality of care and provider communication compared to SC pts. Clinical trial information: NCT02123797. [Table: see text]
Treatment approaches and outcomes in extramedullary plasmacytomas.
Authors: Gaurav Goyal, Adam C. Bartley, Wilson I. Gonsalves, Shaji Kumar
Journal: Journal of Clinical Oncology (2017)

8050 Background: There is a lack of contemporary studies analyzing the optimum radiation dose and prognostic factors for outcomes of extramedullary plasmacytomas. In this study, we aim to answer these questions by utilizing the National Cancer Data Base (NCDB). Methods: This is a retrospective study of patients with histologically confirmed diagnosis of plasmacytoma from 2000-2011 using NCDB. Patients who had bone marrow involvement were excluded from the analysis. Hazard ratios were calculated using the Cox-proportional hazard method. In addition, we utilized survival trees as a novel tool for assessing prognostic effect of factors among four age quartiles (Q): Q1: 18-52, Q2:52-62, Q3:62-72, and Q4: ≥72 years. Results: A total of 5,056 patients were included in the study (median age 62 years; range, 52-72 years). Of these, 63% were males. Radiation therapy was received by 3,905 patients, with a median radiation dose of 45 Gy. A radiation dose of ≥40 Gy was associated with improved overall survival (OS) as compared to &lt;40 Gy. Factors associated with worse OS included older age (≥65 years) and bone disease (Table). In survival tree analysis, radiation dose ≥44.5 Gy was associated with better OS in Q1 as compared to lower dose. For Q2 and Q3, disease location played a major role, with improved survival seen in upper aero-digestive and lymph node disease as compared to bone and soft tissue. In Q3, among the bone and soft tissue disease, radiation dose ≥ 43.5 Gy was associated with the better survival as compared to ≤43.5 Gy. In Q4, soft tissue and upper aerodigestive plasmacytomas had better outcomes as compared to bone and lymph node disease. Among the latter group, a radiation dose ≥30.3 Gy was associated with improved OS as compared to lower dose. Conclusions: This is the largest study of extramedullary plasmacytomas in the United States. This study shows that dose of radiation has a significant impact on outcomes, in addition to disease location and age. [Table: see text]
Bevacizumab-induced bleeding in colorectal and noncolorectal cancer patients in a community oncology setting: An Abington Memorial Hospital experience.
Authors: Naveed Ali, Faizan Malik, Mary Naglak, Syed Imran Mustafa Jafri, Christian Fidler, Mark S. Shahin, Michael J. Seidman, Steven J. Cohen
Journal: Journal of Clinical Oncology (2017)

e18250 Background: Bevacizumab (Bev) can be associated with clinically significant bleeding. Patients (pts) in community practice have increased comorbidities, leading to some reluctance to use Bev with anticoagulation (AC) or antiplatelet therapy (APT). This study was conducted to determine the incidence of Bev induced bleeding in colorectal (CRC) and non-colorectal (non-CRC) cancer pts in a real-world setting. Methods: In this retrospective analysis, pts with Bev treated CRC and non-CRC from Jan 2010 to Jan 2017 at our hospital were identified. Bleeding was graded according to CTCAE v4.0. Chi-Square and ANOVA were used to calculate associations. Overall survival (OS) and progression free survival (PFS) were calculated using Kaplan-Meier and log rank methods. Results: 241 pts were evaluated (mean age = 63; 54% females), 112 with CRC and 129 with non-CRC (lung = 27%; gynecologic = 14%; CNS = 7%; other = 5%). Median duration of Bev therapy was 21 weeks. Overall bleeding was 22% (mucocutaneous = 14%; hematochezia = 4.5%; hematemesis = 1%; hematuria 2.5%; cerebral hemorrhage = 1%). Grade 3 bleeding occurred in 8 pts (epistaxis = 1; hematemesis = 2; hematochezia = 1; hematuria = 4), of whom 1 was on AC. There were no grade &gt; 3 events. Concomitant AC (n = 35) increased bleeding risk ( p = 0.01) whereas APT (n = 43) did not ( p = 0.4). There was no association of bleeding and Bev dose ( p = 0.1); however, longer duration of therapy increased bleeding risk ( p = 0.01). In CRC pts, concomitant chemotherapy (oxaliplatin vs irinotecan), bleeding history, intact tumors and tumor side were not associated with increased risk ( p &gt; 0.05). In CRC, pts with bleeding had longer estimated median OS (52 [95%CI, 35-66] vs 35 [95%CI, 22-48] months; p= 0.079) and PFS (80 [95%CI, 59-101] vs 72 [95%CI, 49-95] months; p= 0.048). Conclusions: We demonstrated in a modern community hospital practice that there is a 22% incidence of bleeding with Bev, although mostly mild even with concurrent AC, and only 3% grade 3. Concurrent AC but not APT was associated with increased bleeding risk and warrants careful discussion with pts. The observation of longer OS and PFS in pts with Bev induced bleeding warrants further investigation.
Prognostic value of neutrophil- (NLR) and platelet-lymphocyte ratio (PLR) in patients with metastatic colorectal cancer (mCRC) with KRAS, BRAF: A Peruvian point of view.
Authors: Fernando Namuche, Claudio J. Flores, Jorge Leon, Alfredo Aguilar
Journal: Journal of Clinical Oncology (2018)

e15550 Background: High circulating neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) appears to be prognostic in metastatic colorectal cancer (mCRC), they have been suggested as important inflammatory markers and potential predictors of long-term outcomes in patient with colorectal cancer (CRC). Along with another biomarkers, such as RAS and BRAF can facilitate the treatment decision making and follow up in these pts. The incidence of CRC in Peru has been increasing, and there is a lack of data, especially on molecular features due to its cost that makes it prohibitive for many health care systems. Methods: We retrospectively reviewed the electronic medical files of 59 patient with mCRC for whom RAS and BRAF panels were available. Patients were diagnosed and treated at a specialized cancer center between 2014 and 2017. We divided the population according to NLR cut-off (low≤3.8, high > 3.8) and PLR (low≤172, high > 172), the number of patients were similar in each group. Between-group comparison was performed using a stratified Cox’s proportional hazard model for OS and PFS. Chi square was used to evaluate association between NLR/PLR cut-offs and RAS status. Results: A total of 59 mCRC with RAS and BRAF panel pts were included. Independent prognostic factors for poor OS were high PLR and no surgery (p˂ 0.05). The median OS [95 % CI] was statistically significantly higher in the low vs. high PLR subgroup (17.4 ±20.3 vs 10±12.5mo). High PLR ( > 172) was an independent risk factor predicting poor OS. In the Cox regression for PFS: PLR (HR:7.9, 95% CI 1.23 -101.63), histologic grade (HR:9.9, 95% CI 1.99 -49.27), KRAS (HR:5.3, 95% CI 1.3 -41,42) were statistically significant. Independent prognostic factor for poor PFS were: high PLR, mutated KRAS and high histologic grade. We found an association between high NLR and KRAS status (p:0.048). Conclusions: High Platelet-neutrophil ratio, mutated KRAS and high histological grade may indicate a subpopulation of pts with poor PFS. High NLR may be associated with mKRAS, this could be useful in patients that can’t get the RAS panel.
Impact of marital status on colorectal cancer (CRC) disease-specific survival in New York state.
Authors: Carla Francesca Justiniano, Zhaomin Xu, Adan Z Becerra, Christopher Thomas Aquina, Francis P. Boscoe, Maria J. Schymura, Larissa K. F. Temple, Gary R. Morrow, Fergal J. Fleming
Journal: Journal of Clinical Oncology (2017)

e18084 Background: CRC is the second leading cause of cancer death in the US. Social support and financial resources vary by marital status. This study analyzes the impact of marital status by sex on survival after resection for CRC. Methods: The New York State Cancer Registry and Statewide Planning and Research Cooperative System were queried for 2004-2013 colectomy or proctectomy Stage I-III CRC patients and categorized by marital status: single/never married (single), married/domestic partner (married), and widowed/separated/divorced (previously married). Competing risk analysis of 5-year mortality was executed adjusting for patient (age at diagnosis, sex, race, Medicaid, income, marital status, smoking history, comorbidities, year of diagnosis, and stage), treatment (scheduled surgery and complications, chemotherapy, radiation), surgeon (colorectal board, volume), and hospital factors (volume, academic, rural). Results: 38,020 (colon 32,451, rectal 5,569) met inclusion criteria, of which 28% died within 5 years. Single patients were more likely than married to be current smokers (17 vs 12%), be on Medicaid (42 vs 27%) and present emergently (38 vs 25%), and less likely to be treated by high volume surgeons (32 vs 40%). Married patients had decreased risk of 5-year CRC-specific mortality (hazard ratio [HR] 0.86, confidence interval [CI] 0.80-0.94) vs single. When stratified by sex, married males had a decreased risk of death but married females did not and this persists if stratified by colon vs rectum (Table). Income was not significantly associated with survival and previously married patients did not significantly differ from single. Conclusions: Marital status impacts CRC-specific survival in males and females differently. Married men have a protective effect from marriage, whereas married females do not and may benefit from additional support throughout their cancer care. [Table: see text]
Simulation order for patients undergoing SBRT: Identifying predictors of lengthier insurance authorization.
Authors: Seth Blacksburg, Awais Mirza, Gizem Demircioglu, Todd Carpenter, Matthew Witten, Jason Morgenstern, David Ebling, Donna Catell, Elaine Castellano, Diane Accordino, Maria Giambona, Susan Lowery, Jonathan A. Haas
Journal: Journal of Clinical Oncology (2018)

e18581 Background: Delivering Stereotactic Body Radiation Therapy (SBRT) requires first obtaining insurance authorization to mitigate against patient financial hardship. This study explores factors that influence time from simulation order to insurance authorization at a busy hospital practice. Methods: We conducted a retrospective review of simulation order requests for patients undergoing SBRT during the year 2017. We queried data fields that included insurance type, treatment site, and fractionation request. These fields were cross referenced with relevant time stamps. Results: 583 consecutive simulations were ordered for SBRT. Patient insurance included Medicare (36.7%); Medicaid (0.1%); and Commercial (60.9%). The most common treatment sites were prostate (60.9%), lung (10.1%), and brain (10.1%). Mean time to insurance authorization was 10 days (0-105). 13.4% of cases took > 20 days for insurance authorization. Commercial insurance carrier predicted for longer mean authorization time compared to Medicare or Medicaid insurance (13.5d vs. 4.1d and 4.0d, p < .0001). Insurance approval for robotic-SBRT was shorter for cases involving brain, lung, and spine sites than for prostate (3.8d, 3.4d, 4.0d vs. 12.0d, p < .0001). Single fraction cases were approved more expeditiously than cases involving 2-5 or > 5 fraction sizes (3.8d vs. 10.2d and 16.8d, p = .03). Predictors of time > 5days for authorization included Commercial vs. Medicare insurance (56.3% vs. 13.1%, p < .0001), prostate vs. lung and brain cases (45.1% vs. 18.6% and 27.1%, p < .0001), and 5 fraction vs. 1 fraction cases (66.7% vs. 20.7%, p = .005). On multivariate analysis, predictors of longer insurance authorization included non-Medicare insurance (OR 10.2, CI 2.7-40.0, p = .001) and treatment with ≥5 fractions (OR 3.8, CI 1.2-11.9, p = .02). Conclusions: Most patients attain insurance authorization for SBRT within 2 weeks’ time from simulation order. Factors contributing to delay to insurance authorization include non-Medicare carriers as well as ≥5 fraction size. Further study is warranted to prospectively assess whether incorporating this information into dynamic workflow can improve clinical efficiency.
Comparison of surgeries plus perioperative and postoperative chemotherapies in Chinese pN2 patients with non-small cell lung cancer: A real-world observational study.
Authors: Jinbo Zhao, Yin Li, Zhenliang Shi, Deruo Liu, Xiangning Fu, Lin Xu, Jian Hu, Heng Zhao, Yang Liu, Lunxu Liu, Haiying Yang, Xiaofei Li
Journal: Journal of Clinical Oncology (2018)

e20535 Background: Postoperative or perioperative systematic chemotherapies (CTs) in patients with non-small cell lung cancer (NSCLC) have been widely accepted due to providing significant clinical benefits of patient survivals compared to the patients with surgical resections alone. In the pN2 NSCLC patients, the superiority of perioperative CTs to postoperative CTs remains controversial. The study was designed to compare treatment outcomes of the perioperative and postoperative CTs in the target population. Methods: The study data on the pN2 NSCLC patients who received curative radical resection from 2014 to 2017 were collected from the LinkDoc database to compare patient prognoses. The OS were measured by the Kaplan-Meier method and the Log-Rank test. Propensity score matching (PSM) method was implemented to reduce selection bias. Results: Of all the enrolled 766 patients, 688 (89.8%) patients were administered with postoperative CTs, and 78 (10.2%) patients with perioperative CTs. The medians of the follow-up durations in the patients with postoperative and perioperative chemotherapies plus surgeries were 12 months and 14 months, respectively. No significant OS difference in the patients with surgeries plus postoperative or perioperative chemotherapies was observed regardless of PSM within such short follow-up durations. In the subgroup with postoperative CTs, OS of the patients with adenocarcinoma was superior to that of the patients with squamous cell carcinomas (HR = 0.60, p < 0.01); the three-year OS of the patients with adenocarcinoma was found to be remarkably different from that of the patients with squamous cell carcinoma (68.9% vs 48.8%, P < 0.05). The most common complications were pleural effusion, pneumonia, and pneumothorax in the patients with postoperative CTs (5.8%,5.5%,4.2%) and perioperative CTs (6.4%,6.4%,3.8%). Conclusions: Our preliminary analyses showed that there was no significant OS difference in the pN2 NSCLC patients with perioperative and postoperative CTs plus surgeries due to the short follow-up duration. The patients will be followed up for observation of long-term patient survivals. Clinical trial information: ChiCTR1800014702.
Should radiotherapy be succeed tumorectomy in patients with low risk ductal carcinoma in situ (DCIS) when using Van Nuys Prognostic Index based treatment?
Authors: Anna Niwinska, Jacek Galecki, Agnieszka Irena Jagiello-Gruszfeld
Journal: Journal of Clinical Oncology (2018)

e12561 Background: Selecting patients with low risk DCIS in whom radiotherapy could be safely omitted is still debatable. The Van Nuys Prognostic Index (VNPI) which analyses 4 prognostic factors helps in choosing such subgroup (VNPI score 4-6), neverthless its value is questionable. The aim of study: assess the role of radiotherapy after tumorectomy in patients with low risk DCIS based on VNPI. Methods: 737 consecutive breast DCIS patients were treated at a Cancer Center during 1999-2011 where tumorectomy (T), tumorectomy and radiotherapy (BCT) and mastectomy (M) were respectively performed in 21%, 32% and 47%. The competing risk of recurrence (RR) was investigated in each of these groups. The VNPI scores were then counted retrospectively. In the low risk group of patients with VNPI scores of 4-6, the RR was compared between those treated only with tumorectomy and with BCT. Cox multivariate analysis assessed the effect of radiotherapy on RR. Results: The 10-year RR of T, BCT and M treated patients were respectively 25%, 12% and 2.5% whereas after 15 years it respectively became 28%, 24% and 3%. In patients with VNPI scores of 4,5 and 6 treated with T and BCT, the competing RR at 10 years was respectively 22% and 2%. Cox multivariate analysis confirmed that radiotherapy decreased the local RR by a factor of 3 in patients with DCIS (HR 0.311). Conclusions: Patients scoring 4-6 VNPI points treated only with T showed a high risk of recurrence which constantly grew during 15 years of observation. Radiotherapy decreases the risk of RR even in this low risk group. Such patients should be informed about the local RR and should take part in radiotherapy treatment decision -making. New biological markers are thus needed to more precisely assess RR in DCIS patients.