tbuckley/cabot-search huggingface dataset:
Cross-trial comparison of taxane versus non-taxane combination chemotherapy regimens for advanced penile cancer (APC): A systematic review.
Authors: Esmail Mutahar Al-Ezzi, Jamila Jama Almi Riromar, Eitan Amir, Rouhi Fazelzad, Aaron Richard Hansen
Journal: Journal of Clinical Oncology (2019)

511 Background: Penile cancer is rare and there are scant data on the optimal chemotherapy regimen. The majority of trials are single arm, non-randomized studies. Here we report on a systematic review aiming to compare taxane combination chemotherapy regimens with non-taxane regimens for APC. Methods: A systematic review was conducted in accordance with the PRISMA guidelines. Medline, Embase and Cochrane Central Register of Controlled Trials databases were searched using the following terms: penile cancer, penis, antineoplastic combined chemotherapy, taxane, docetaxel, paclitaxel, platinum, cisplatin, carboplatin. Studies were identified using preplanned eligibility criteria by 2 investigators (EA-E and JR). Data were extracted independently by EA-E and JR. Studies were weighted by study sample size and those comparing taxane-based chemotherapy were compared to non-taxane therapy using the Mann Whitney test. Results: The search identified 1929 publications and 40 were selected for further assessment. Of these, 8 met eligibility criteria (7 prospective and 1 retrospective). Three studies tested taxane combinations (docetaxel, cisplatin and 5FU [DCF] and paclitaxel, ifosfamide and cisplatin [TIP]). A total of 148 men with APC were treated with non-taxane regimens and 98 men received a taxane combination. Patient characteristics (age, ECOG status, stage, number of cycles) were comparable between the two groups. Partial response and overall response rates were significantly higher in the taxane versus the non-taxane group (35.7% vs. 24.2% p = 0.01 and 41.9% vs. 32.5% p = 0.007) respectively. Grade3/4 neutropenia was significantly higher in taxane group than non-taxane group (27.8% vs 19.4% p = 0.02). Median PFS and OS was numerically but not significantly higher in the taxane versus the non-taxane group (5.7 vs. 4.4 months, p = 0.45 and 12.1 vs 10 months, p = 0.48, respectively). Conclusions: Compared to non-taxane-based regimens, taxane combinations have higher response rates and may improve survival in APC. Hematologic toxicities are worse with taxane containing regimens. Taxane combinations should be the preferred regimen for suitable men with APC.
Reporting of surgical response to disasters in low-income and middle-income countries: a literature review
Authors: Luke Caddell, Taylor Wurdeman, Rolvix H Patterson, Jordan Pyda, Rachel Koch, John G Meara, Scott Corlew
Journal: The Lancet Global Health (2019)

BackgroundNatural and man-made disasters can overwhelm the capacity of surgical systems in low-income and middle-income countries (LMICs). Most studies addressing peri-disaster surgical care focus on international relief efforts rather than on how disasters stress local surgical capacity. Our understanding of factors that affect the ability of health systems to absorb increased volume and case-complexity is poor. We conducted a structured literature review to identify whether components of capacity were reported as part of surge response in local surgical care after disasters.MethodsWe searched PubMed and Medline databases for articles published between January, 2008, and August, 2018, using English language search terms for LMICs, surgery, and disasters. We extracted information about the WHO region, disaster classification, and the components of surge capacity using the 4S framework: Staff (human resources), Stuff (equipment/supplies), Space (infrastructure), and Systems (logistics). The 4S components were further classified by data quality into the following categories: quantitative description, qualitative description, or no description.FindingsWe identified 7704 articles but after applying exclusion criteria, including foreign aid response, we selected 84 articles for analysis. Most articles (59/84 [70%]) described earthquakes and 40/84 (48%) reported events in the Western Pacific region. Using the 4S framework, we identified articles that reported quantitative data: 16 (19%) for Staff, 3 (4%) for Stuff, 21 (25%) for Space, and 9 (11%) for Systems. Despite a low threshold for quantitative categorisation, only 1/84 (1%) articles described all four components with quantitative data. By comparison, 51/84 (61%) articles provide no quantitative data on any of the four components.InterpretationThere is no organised framework for evaluation of surgical surge capacity in disasters. Our analysis shows that there are very few descriptions of capacity within disaster literature and a limited understanding of LMIC health system response to surges in surgical volume. Without a structured framework to collect data on health system response, we miss opportunities to identify and strengthen areas of insufficient capacity. We encourage the incorporation of quantitative surgical metrics when reporting outcomes after disaster response, and propose the 4S framework as a conceptual model for reporting such metrics and understanding the surgical system response to disasters.FundingNone.
Results of prognostic analysis of young breast cancer patients (&lt;35 years of age) based on the Breast Cancer Registry of the Japanese Breast Cancer Society.
Authors: Akemi Kataoka, Eriko Tokunaga, Norikazu Masuda, Tadahiko Shien, Mika Miyashita, Kimiko Kawabata, Ai Tomotaki, Hiroaki Miyata, Takayuki Kinoshita, Yutaka Tokuda
Journal: Journal of Clinical Oncology (2015)

e12599 Background: The Japanese Breast Cancer Research Group has published findings on the biological characterization of young breast cancer patients( < 35 years of age) through a national survey of breast cancer patients, the effects of treatment outcome and age at onset on prognosis remain to be elucidated. Methods: Among the 53,670 patients in the Breast Cancer Registry of the Japanese Breast Cancer Society between 2004 and 2006, 25,785 patients who underwent prognostic investigation were analyzed for 5-year disease-free survival (5yDFS) and 5-year overall survival (5yOS), and these parameters were compared between young and non-young breast cancer patients. Results: The 5yDFS according to the Kaplan-Meier survival curve was 78.9% for the young patients and 87.8% for the non-young patients, whereas the 5yOS were 89.9% and 91.9%, respectively. In both cases, the prognosis of the young patients was significantly worse (P < 0.0001). The 5yDFS in the young patients according to stage, lymph node metastasis, and subtype were as follows: stage 0: 95.2%, stage I: 87.0%, stage II: 78.0%, and stage III: 56.7%; n−: 86.7% and n+: 60.7%; and ER+/HER2−: 82.2%, ER+/HER2+: 67.7%, ER−/HER2+: 68.5%, and TN: 68.0%. Similarly, the 5yOS were as follows: stage 0: 100%, stage I: 97.4%, stage II: 90.0%, stage III: 75.2%, and stage IV: 53.7%; n−: 96.3% and n+: 75.4%; and ER+/HER2−: 93.6%, ER+/HER2+: 96.2%, ER−/HER2+: 77.9%, and TN: 77.6%. These results suggest a prognostic difference in the young patients according to stage, lymph node metastasis, and subtype (P < 0.0001). Moreover, logistic regression analysis of stage 0–III breast cancer patients revealed that TNM classification, subtype and age at diagnosis are independent prognostic factors of breast cancer recurrence and overall mortality (OR, 1.52; 95% CI, 1.15–2.00; OR, 1.77; 95% CI, 1.45–2.16). Conclusions: It has been suggested that young breast cancer patients have poorer prognosis because of delayed diagnosis at an advanced stage with the larger tumor, higher incidences of HER2 positivity and TN tumor. However, this study demonstrates that younger age at diagnosis itself is an independent prognostic factor in Japanese patients.
Circulating Tumor DNA Provides a Sneak Peek into Treatment Responses in Non–Small Cell Lung Cancer
Authors: Tao Zou, Matthew Meyerson
Journal: Cancer Research (2019)

Abstract Circulating tumor DNA (ctDNA) holds great promise as a noninvasive diagnostic tool to guide treatment for patients with lung cancer. Two studies by Phallen and colleagues and Anagnostou and colleagues correlated sensitive measures of ctDNA with clinical responses to tyrosine kinase inhibitors (TKI) and immune checkpoint inhibitors, respectively, in patients with non–small cell lung cancer (NSCLC). Together, these studies further highlight the potential clinical utility of serial ctDNA monitoring in patients with NSCLC undergoing treatment with both targeted therapies and immunotherapies. See related articles by Phallen et al., p. 1204, and Anagnostou et al., p. 1214
Comparative analyses of trends and survival in patients with urothelial versus nonurothelial bladder carcinoma: National Cancer Database (NCDB) analysis.
Authors: Jeanny B. Aragon-Ching, Donald L. Trump, Hongkun Wang
Journal: Journal of Clinical Oncology (2019)

402 Background: Bladder cancer is estimated to occur in 81,190 patients in 2018 with estimated death in 17,240. Urothelial cancers make up the majority of cancers but non-urothelial cancers are known to have more aggressive phenotype with worse survival. We have demonstrated previously that non-urothelial histologic subtypes have worse survival outcomes compared to urothelial cancers in a population-based analysis (Aragon-Ching J et al.; J Clin Oncol 36, 2018 (suppl 6S: abstr 425). Methods: The primary objective of this review is to gather data on trends and differences between urothelial versus non-urothelial histologies (squamous, sarcomatoid, small cell or neuroendocrine, adenocarcinoma) and compare the demographics, disease characteristics (incidence of metastases, stage presentation, etc), and survival according to the NCDB. Results: Data from diagnosis in year 2004 – 2013 were extracted from the NCDB. A total of 76,858 and 5560 patients were included for urothelial and non-urothelial, respectively. More men were diagnosed with urothelial carcinoma (75%) and non-urothelial carcinoma (61%) than women. The median age was 71 years and 69 years of age, respectively for urothelial and non-urothelial. Majority were Caucasian at 91% and 86%, respectively though there seemed to be more African-Americans in the non-urothelial (11%) compared to 6% in the urothelial cohorts. More patients were diagnosed with higher stages of III and IV in the non-urothelial group (62%) compared to 36% in the urothelial group, although the sites of metastases in the brain, bone or liver were fairly equivalent for both urothelial and non-urothelial cohorts. Median survival time from diagnosis was better in the urothelial compared to non-urothelial arms [69.91 (69.39 – 70.54) vs 64.53 (61.5 – 67.45 months), p-value &lt; 0.001]. Conclusions: Non-urothelial cancers have distinct demographics different from non-urothelial cancers. Patients often present at a higher stage and survival appears to fare worse than urothelial cancers. Further studies to refine treatment options to optimize treatment outcomes are an area of increased unmet need.
Progressive skin fibrosis is associated with a decline in lung function and worse survival in patients with diffuse cutaneous systemic sclerosis in the European Scleroderma Trials and Research (EUSTAR) cohort
Authors: Wanlong Wu, Suzana Jordan, Nicole Graf, Janethe de Oliveira Pena, John Curram, Yannick Allanore, Marco Matucci-Cerinic, Janet E Pope, Christopher P Denton, Dinesh Khanna, Oliver Distler
Journal: Annals of the Rheumatic Diseases (2019)

To determine whether progressive skin fibrosis is associated with visceral organ progression and mortality during follow-up in patients with diffuse cutaneous systemic sclerosis (dcSSc).We evaluated patients from the European Scleroderma Trials and Research database with dcSSc, baseline modified Rodnan skin score (mRSS) ≥7, valid mRSS at 12±3 months after baseline and ≥1 annual follow-up visit. Progressive skin fibrosis was defined as an increase in mRSS >5 and ≥25% from baseline to 12±3 months. Outcomes were pulmonary, cardiovascular and renal progression, and all-cause death. Associations between skin progression and outcomes were evaluated by Kaplan-Meier survival analysis and multivariable Cox regression.Of 1021 included patients, 78 (7.6%) had progressive skin fibrosis (skin progressors). Median follow-up was 3.4 years. Survival analyses indicated that skin progressors had a significantly higher probability of FVC decline ≥10% (53.6% vs 34.4%; p<0.001) and all-cause death (15.4% vs 7.3%; p=0.003) than non-progressors. These significant associations were also found in subgroup analyses of patients with either low baseline mRSS (≤22/51) or short disease duration (≤15 months). In multivariable analyses, skin progression within 1 year was independently associated with FVC decline ≥10% (HR 1.79, 95% CI 1.20 to 2.65) and all-cause death (HR 2.58, 95% CI 1.31 to 5.09).Progressive skin fibrosis within 1 year is associated with decline in lung function and worse survival in dcSSc during follow-up. These results confirm mRSS as a surrogate marker in dcSSc, which will be helpful for cohort enrichment in future trials and risk stratification in clinical practice.
Abstract P092: Age and Gender-specific Associations of Diet Quality and 4-year Weight Change in Non-obese Adults of the Dutch Lifelines Cohort
Authors: Petra C Vinke, Daan Kromhout, Gerjan Navis, Eva Corpeleijn
Journal: Circulation (2019)

Introduction: Diet is an important lifestyle factor in strategies for overweight prevention, but little is known about its dependency on contextual factors like age and gender. Hypothesis: We assessed the hypothesis that the strength of the association between diet quality and 4-year weight change differed among age categories and between genders. Methods: From the Dutch Lifelines Cohort, 85.618 non-obese, adult participants were included in the study. At baseline, diet was assessed with a 110-item food frequency questionnaire. The Lifelines Diet Score, based on established evidence-based food groups for the prevention of chronic diseases, was calculated to assess diet quality. For analyses, the score was divided in quintiles. Body weight was objectively measured at baseline and after a median follow-up of 44 months (25th-75th percentile: 35-51 months). In between, body weight was self-reported twice. Linear mixed models were used to investigate the association between diet quality and weight change in 6 age categories (18-29 to 70+) and stratified by gender. Results: Mean 4-year weight change decreased over age categories. Confounder adjusted linear mixed model analyses showed that the association between diet quality and weight change was dependent on age, more so in women (p INTERACTION =0.001). Poor diet quality (quintile 1 vs. quintile 5) was most strongly related to 4-year weight gain in young men (estimated mean +1.62 kg) and young women (estimated mean +1.13 kg). In contrast, in women aged 70+, poor diet quality was associated with weight loss (estimated mean -1.80 kg). Conclusions: Poor diet quality was prospectively related to higher weight gain, especially in young adults. Oppositely, among women aged 70+, better diet quality was related to less weight loss. Therefore, a healthful diet is a promising target for unintentional weight changes in both directions.
Therapy-Related Cardiac Risk in Childhood Cancer Survivors: An Analysis of the Childhood Cancer Survivor Study
Authors: James E. Bates, Rebecca M. Howell, Qi Liu, Yutaka Yasui, Daniel A. Mulrooney, Sughosh Dhakal, Susan A. Smith, Wendy M. Leisenring, Daniel J. Indelicato, Todd M. Gibson, Gregory T. Armstrong, Kevin C. Oeffinger, Louis S. Constine
Journal: Journal of Clinical Oncology (2019)

The impacts of radiotherapy dose and exposed cardiac volume, select chemotherapeutic agents, and age at exposure on risk for late-onset cardiac disease in survivors of childhood cancer remain unresolved.We determined the rates of severe to fatal cardiac disease in 24,214 5-year survivors in the Childhood Cancer Survivor Study diagnosed between 1970 and 1999 at a median age of 7.0 years (range, 0 to 20.9 years), with a median attained age of 27.5 years (range, 5.6 to 58.9 years). Using piecewise exponential models, we evaluated the association between cardiac disease rates and demographic and treatment characteristics.The cumulative incidence of cardiac disease 30 years from diagnosis was 4.8% (95% CI, 4.3 to 5.2). Low to moderate radiotherapy doses (5.0 to 19.9 Gy) to large cardiac volumes (≥ 50% of heart) were associated with an increased rate of cardiac disease (relative rate, 1.6; 95% CI, 1.1 to 2.3) compared with survivors without cardiac radiotherapy exposure. Similarly, high doses (≥ 20 Gy) to small cardiac volumes (0.1% to 29.9%) were associated with an elevated rate (relative rate, 2.4; 95% CI, 1.4 to 4.2). A dose-response relationship was observed between anthracycline chemotherapy and heart failure with younger children (age ≤ 13 years) at the greatest risk for heart failure after comparable dosing.These observations support advances in radiation field design and delivery technology to reduce cardiac dose/volume and should guide future treatment protocols. They also inform clinical practice guidelines for post-therapy surveillance and risk-reducing strategies.
Abstract 36: Fitness and Reclassification of Risk for Incidence of Heart Failure: The Veterans Exercise Testing Study
Authors: Jonathan Myers, Peter Kokkinos, Khin Chan, Eshan Dandekar, Bilge Yilmaz, Atul Nagare, Charles Faselis, Muhammad Soofi
Journal: Circulation (2017)

Background: It is well-established that fitness is inversely associated with cardiovascular and all-cause mortality, but little is known regarding the association between cardiorespiratory fitness (CRF) and incidence of heart failure (HF). Methods: CRF was determined in 21,080 US Veterans (mean age 58.3 ± 11) free of HF at baseline from the Veterans Affairs Medical Centers in Washington, DC and Palo Alto, CA, and followed for a mean of 12.3±7.4 years. Subjects were classified by quintiles of fitness based on age-specific peak metabolic equivalents (METs) achieved. Participants were followed for incidence of HF, determined through review of computerized medical records. Multivariable Cox models were used to determine the association between incidence of HF and clinical and exercise test variables. Reclassification characteristics of fitness relative to standard clinical risk factors were determined using the category-free net reclassification improvement index (NRI), and the integrated discrimination improvement. Results: During the follow-up, 1902 subjects (9%) developed HF, with an average annual incidence rate of 7.4 events per 1,000 person-years. When fitness status was considered as a binary variable (Unfit/Fit), low fitness was the strongest predictor of risk for HF among clinical and exercise test variables (HR 1.91, 95% CI 1.74-2.09, p&lt;0.001). In a fully adjusted model with the least fit group as the reference, there was a graded and progressive reduction in risk for HF as fitness level was higher. Risks for developing HF were 36%, 41%, 67%, and 76% lower among increasing quintiles of fitness compared to the least fit subjects (p&lt;0.001) (Figure). Adding CRF to standard risk factors resulted in an NRI of 0.37 (p&lt;0.001). Conclusion: CRF is strongly and inversely associated with future incidence of HF, and significantly reclassifies risk for HF. Reducing the growing burden of HF by improving fitness provides an additional impetus for health care providers to recommend physical activity.
Abstract P120: Feasibility of Cardiac Rehabilitation in Resource Limited Settings
Authors: Gedion T Ngeno, Felix Barasa, Peter S Kussin, Joseph Egger, Jemima Kamano, Charity Wambui, Edith Kwobah, Nathan Thielman, Gerald S Bloomfield
Journal: Circulation (2019)

Background: Heart failure (HF) is a growing driver of morbidity and mortality worldwide. Cardiac rehabilitation in HF improves functional status, quality of life, and depression. Global access to cardiac rehabilitation remains poor, and adherence rates are low. Methods: We implemented and assessed adherence rates associated with two models of cardiac rehabilitation in Western Kenya. One hundred participants with HF were prospectively enrolled. Choice of rehabilitation model was based on participant preference. Twenty-five participants opted to participate in 36 institution-based sessions (IBCR). Thirty-one participants enrolled into home-based sessions (HBCR). HBCR comprised 12 weekly pedometer step targets. Forty-four participants were later enrolled into an observational arm (OA). We hypothesized that participants would adhere to at least 25% of prescribed sessions. We secondarily compared changes in 6-minute walk time distance (6MWTD), depression screening (PHQ9) and quality of life (SF36) scores using a paired t-test. Results: The mean age of participants was 51 years, of whom 73 were female. Rehabilitation participants preferred institution based rehabilitation. Both study arms were adherent to the prescribed protocol as shown in figure 1. All study arms demonstrated significant improvement in 6MWTD, PHQ9 and SF36 scores. Conclusions: IBCR and HBCR, are feasible rehabilitation models for HF in this setting. Adherence rates attained in both models are higher than those seen in many developed countries. Although our results demonstrate feasibility, future research should focus on methods to further improve adherence as well evaluate efficacy of cardiac rehabilitation in this setting.