tbuckley/cabot-search huggingface dataset:
Association of Low Socioeconomic Status With Premature Coronary Heart Disease in US Adults
Authors: Rita Hamad, Joanne Penko, Dhruv S. Kazi, Pamela Coxson, David Guzman, Pengxiao C. Wei, Antoinette Mason, Emily A. Wang, Lee Goldman, Kevin Fiscella, Kirsten Bibbins-Domingo
Journal: JAMA Cardiology (2020)

Individuals with low socioeconomic status (SES) bear a disproportionate share of the coronary heart disease (CHD) burden, and CHD remains the leading cause of mortality in low-income US counties.To estimate the excess CHD burden among individuals in the United States with low SES and the proportions attributable to traditional risk factors and to other factors associated with low SES.This computer simulation study used the Cardiovascular Disease Policy Model, a model of CHD and stroke incidence, prevalence, and mortality among adults in the United States, to project the excess burden of early CHD. The proportion of this excess burden attributable to traditional CHD risk factors (smoking, high blood pressure, high low-density lipoprotein cholesterol, low high-density lipoprotein cholesterol, type 2 diabetes, and high body mass index) compared with the proportion attributable to other risk factors associated with low SES was estimated. Model inputs were derived from nationally representative US data and cohort studies of incident CHD. All US adults aged 35 to 64 years, stratified by SES, were included in the simulations.Low SES was defined as income below 150% of the federal poverty level or educational level less than a high school diploma.Premature (before age 65 years) myocardial infarction (MI) rates and CHD deaths.Approximately 31.2 million US adults aged 35 to 64 years had low SES, of whom approximately 16 million (51.3%) were women. Compared with individuals with higher SES, both men and women in the low-SES group had double the rate of MIs (men: 34.8 [95% uncertainty interval (UI), 31.0-38.8] vs 17.6 [95% UI, 16.0-18.6]; women: 15.1 [95% UI, 13.4-16.9] vs 6.8 [95% UI, 6.3-7.4]) and CHD deaths (men: 14.3 [95% UI, 13.0-15.7] vs 7.6 [95% UI, 7.3-7.9]; women: 5.6 [95% UI, 5.0-6.2] vs 2.5 [95% UI, 2.3-2.6]) per 10 000 person-years. A higher burden of traditional CHD risk factors in adults with low SES explained 40% of these excess events; the remaining 60% of these events were attributable to other factors associated with low SES. Among a simulated cohort of 1.3 million adults with low SES who were 35 years old in 2015, the model projected that 250 000 individuals (19%) will develop CHD by age 65 years, with 119 000 (48%) of these CHD cases occurring in excess of those expected for individuals with higher SES.This study suggested that, for approximately one-quarter of US adults aged 35 to 64 years, low SES was substantially associated with early CHD burden. Although biomedical interventions to modify traditional risk factors may decrease the disease burden, disparities by SES may remain without addressing SES itself.
Analysis of chronic myeloid leukaemia during deep molecular response by genomic PCR: a traffic light stratification model with impact on treatment-free remission
Authors: Katerina Machova Polakova, Hana Zizkova, Jan Zuna, Eliska Motlova, Lenka Hovorkova, Andrea Gottschalk, Ingmar Glauche, Jitka Koblihova, Pavla Pecherkova, Hana Klamova, Marketa Stastna Markova, Dana Srbova, Adela Benesova, Vaclava Polivkova, Tomas Jurcek, Daniela Zackova, Jiri Mayer, Thomas Ernst, Francois X. Mahon, Susanne Saussele, Ingo Roeder, Nicholas C. P. Cross, Andreas Hochhaus
Journal: Leukemia (2020)
A novel and feasible technique for diagnosis and treatment of small subepithelial tumors
Authors: Epifânio Silvino do Monte Junior, Dalton Marques Chaves, Christiano Makoto Sakai, Gustavo de Oliveira Luz, Igor Braga Ribeiro, Vitor Massaro Takamatsu Sagae, Eduardo Guimarães Hourneaux de Moura
Journal: Endoscopy (2020)

Subepithelial tumors are commonly encountered during routine endoscopy, but their exact prevalence is uncertain. Their management and treatment stand in striking contrast to those of mucosal lesions: techniques are still early in evolution, numbers are small, and robust outcome data are sparse [1]. Using endoscopic ultrasonography (EUS), it has become possible to diagnose subepithelial lesions by evaluating the originating layer, echo level, and internal echo pattern of the lesion [2] [3]. Lipomas, lymphangiomas, and fibromas originate from the third layer and leiomyomas and schwannomas from the fourth layer [4].
Ranking of therapeutic regimens for hormone receptor-positive, HER2-negative, metastatic breast cancer (MBC) using information theoretic network meta-analysis.
Authors: Xuanyi Li, Hossein Tavana, Suresh Bhavnani, Jeremy Lyle Warner
Journal: Journal of Clinical Oncology (2020)

2050 Background: Hormone receptor-positive (HR+), HER2-negative (HER2-) metastatic breast cancer (MBC) is treated with targeted therapy, hormone therapy, chemotherapy, or combinations of these modalities. Evaluating the increasing number of treatment options is challenging, especially since few regimens have been compared head-to-head in randomized clinical trials (RCTs). Potential solutions include expert-driven guidelines (e.g. NCCN guidelines), algorithmic scales (e.g. the ASCO and ESMO Value Frameworks), traditional Bayesian network meta-analysis (NMA), and information theoretic (IT) NMA, a graph theory-based approach that also enables dynamic ranking of regimens over time. Methods: We used IT-NMA to rank regimens for HR+/HER2- MBC. The analysis includes RCTs of regimens identified from HemOnc.org and a recent large traditional NMA (Giuliano et al. 2019). Variables used in ranking include primary endpoints, no. of patients enrolled, p-value, hazard ratio for time-based outcomes (e.g. overall survival) or odds ratio for fixed endpoints (e.g. response rate), and year of publication. Results: The analysis included 238 RCTs enrolling 92,971 patients published between 1974-2019. There were 277 unique regimens, taking into account variations in dosage, frequency, and no. of cycles. As of 2019, out of 85 ranks, combinations of targeted therapy and hormone therapy (e.g. letrozole &amp; palbociclib) are ranked the highest (Table). Over time, we observe that novel treatments tested in escalation trials tend to rise to the top of the rankings (e.g. paclitaxel &amp; bevacizumab in 2007, driven by ECOG E2100), and monotherapy approaches tend to fall to the bottom. Conclusions: In 2019, the combinations of hormone or chemotherapy and targeted therapy are ranked higher than hormone therapy or chemotherapy alone. Our ranking result is similar to previous studies with a notably larger number of comparisons (Giuliano et al. is the largest published study, with 131 regimens/50,029 pts analyzed). Informatic theoretic NMA is a promising method of indirect rankings of treatment that also enables dynamic regimen ranking over time. [Table: see text]
Patient-reported outcomes among patients with resected high-risk melanoma (AJCC7 IIIB, IIIC, M1a, M1b) randomized to low- or high-dose adjuvant Ipilimumab (ipi) versus high-dose interferon alfa-2b (HDI): Health-related quality of life (HRQL) analysis of ECOG-ACRIN E1609.
Authors: Ahmad A. Tarhini, Yue Zheng, Sandra J. Lee, F. Stephen Hodi, Uma Rao, Gary Irvin Cohen, Vernon K. Sondak, John M. Kirkwood, Lynne I. Wagner
Journal: Journal of Clinical Oncology (2020)

e22078 Background: The primary objective of the patient-reported outcomes (PRO) study of E1609 patients (pts) was to compare overall HRQL among pts receiving ipi (ipi10, ipi3) or HDI. We hypothesized that ipi would be superior to HDI in HRQL. Secondary analyses compared HRQL and GI distress between ipi10 and ipi3. Methods: PROs were administered among pts enrolled from NCI Community Oncology Research Program (NCORP) sites at baseline, every 12 weeks (wks) during treatment, and every 24 wks off-treatment for one year. Differences between ipi arms and HDI in overall HRQL at 12 wks (completion of ipi induction) was defined a priori as the primary outcome. HRQL was assessed using the 27-item Functional Assessment of Cancer Therapy –General (FACT-G) total score. GI toxicity was a secondary outcome measured by the 11-item FACIT-Diarrhea (FACIT-D) scale. Two sample t-test was used to compare scores between arms. Results: 548 pts completed PROs at baseline and 334 at 12 wks. Among 322 (59%) pts with PRO data at both time points, mean FACT-G total change scores from baseline to 12 wks were significantly lower (indicating less decline in HRQL) among pts randomized to ipi10 (-4.9,SD:14.1) or ipi3 (-3.4 points,SD:13.2) vs. HDI (-12.9, SD:14.1), p &lt; 0.05 for both ipi10 vs. HDI and ipi3 vs. HDI. Mean FACIT-D change scores indicated higher GI distress from baseline to 12 wks among pts randomized to ipi10 (-3.7, SD:6.9) or ipi3 (-2.2, SD:5.1) vs HDI (-0.7, SD:2.7), p &lt; 0.05 for both comparisons. In comparing ipi10 to ipi3, FACT-G total and FACIT-D total change scores from baseline to wk 12 were comparable. Conclusions: Overall decline in HRQL from baseline to completion of ipi induction was less among pts receiving ipi compared to HDI. Pts randomized to ipi reported a greater increase in diarrhea compared to HDI. HRQL and diarrhea were comparable between ipi3 and ipi10. Our findings are based on PRO data, thus increase our confidence in capturing pts’ experience with treatment from the pt’s perspective. Clinical trial information: NCT01274338. [Table: see text]
Brentuximab vedotin with chemotherapy for advanced stage untreated classic Hodgkin’s lymphoma in a real-world setting.
Authors: Raphael Steiner, Frederick M Cramer, Prachee Singh, Melody Becnel, Pedro E Alcedo, Collin K Chin, Branko Cuglievan, Paolo Strati, Sairah Ahmed, Felipe Samaniego, Ranjit Nair, Jillian Rebecca Gunther, Chelsea Camille Pinnix, Penny Fang, Bouthaina Shbib Dabaja, Lei Feng, Hun Ju Lee
Journal: Journal of Clinical Oncology (2020)

e20020 Background: In the pivotal phase III study ECHELON-1, Brentuximab Vedotin (BV), doxorubicin, vinblastine, and dacarbazine (A+AVD) demonstrated superior efficacy but more hematological and neurological toxicity than bleomycin+AVD (ABVD) as therapy of advanced-stage untreated classic Hodgkin’s lymphoma (ucHL) (Straus et al Blood 2020). It is unknown if A+AVD in a real world setting shows the same efficacy and safety profile. Methods: After obtaining institutional research approval, we retrospectively reviewed the characteristics and outcomes of 41 stage III and IV ucHL patients treated per physician preference with A+AVD as standard of care between 3/2010 and 12/2019. Treatment consisted of 1.2 mg/kg of BV and standard dose AVD, intravenously on days 1 and 15 of each 28-day cycle for up to 6 cycles. All patients received support with granulocyte colony stimulating factor. Results: At time of treatment with A+AVD, median age was 38 (range 18-54 years) and IPS was 0-3 in 56% of patients. Overall, 95.1% of patients received 6 cycles of A+AVD, with a range of 3-6 cycles. During therapy, 19.5% of patients developed febrile neutropenia, 68.3% had at least one emergency department visit (median 2 visits, range 1-7), and 58.5% were hospitalized at least once (median hospital stay of 3 days, range 1-23). Furthermore, 4.9% of patients presented with grade ≥3 elevation of lipase, 4.9% grade ≥3 elevation of alanine aminotransferase, 9.8% deep vein thrombosis and 7.3% pulmonary embolism. Peripheral neuropathy (PN) occurred in 78% of patients, including grade ≥3 in 12.2%. Due to various toxicities, 22% of patients required at least one dose reduction of BV (median 5 reductions, range 2-7) and 46.3% had a least one dose omission of BV (median 4 omissions, range 1-10). At a median follow-up (FU) of 12.65 months (range: 5.91-85.97), 87.5% of patients had partial or complete improvement of their PN. The median delay of completion of 6 cycles of A+AVD was 8 days (range -1 to 35). The end-of-therapy PET/CT showed Deauville score of 1-3 in 85.3% of patients, 4 in 2.4% and 5 in 12.2%. However, only one patient relapsed 5 months after completion of 4 cycles of A+AVD and another relapsed 6 months after completion of 6 cycles. Both patients were still alive at last FU. The median PFS was not reached and 12-months PFS was 96.0% (95% confidence interval [CI], 88.6-100). Conclusions: In real-world experience, A+AVD is a highly effective treatment strategy for patients with advanced-stage ucHL. In light of its toxicity profile, strategies aimed at improving its safety are needed.
Male breast cancer: Epidemiological evaluation and clinical outcomes.
Authors: Edla Renata Cavalcante, Katia Regina Marchetti, Jamile Almeida Silva, Laura Testa
Journal: Journal of Clinical Oncology (2020)

e13619 Background: Male breast cancer (BC) is a rare neoplasia, with a risk of 1:1.000 in USA. Data from Sao Paulo Cancer Registry has shown that BC adjusted incidence rates is about 1.21 per 100,000 at the period from 2001 to 2005, but there is no incidence data for the whole country. Methods: We conducted a unicentric retrospective cohort, with histologically proven male BC patients whose first appointment was between 2008 and 2018 at Instituto do Câncer do Estado de São Paulo in Brazil. The primary endpoint was OS according to metastatic status and initial staging. OS and RFS were analyzed by Kaplan–Meier method and the difference calculated by log-rank test; reported hazard ratios by univariate Cox Models and P-values by score test. Multivariate analysis was calculated through COX regression. Results: 89 male BC patients were accessed, average age at diagnosis was 63.3 yeas-old. 84.2% had carcinoma of no special type (88,7% estrogen positive receptor, 84,2% progesterone positive receptor). When Charlson Comorbidity Index (CCI) was calculated, most (23.5%) were ≥ 7 (10-year survival: 0%), being 17.9% stage IV. Mastectomy was performed at 73% patients, 38.2% received adjuvant chemotherapy; 44.9% received adjuvant radiotherapy and 64% received adjuvant endocrine therapy (94.7% tamoxifen). For metastatic disease, endocrine therapy was the first option in 52%. Median OS was 75 months (95% CI, 39.2-110.7) in M0 and 39 months (95% CI, 25,2–52,8) in M1 ( p = 0.001). CCI showed be an independent death factor (HR 0.37, 95% CI, 0.17-0.8, p = 0.011). Median RFS was 97 months [95% CI, 47.3–146.7]. When BMI was evaluated for patients with obesity (&gt; 30) there was no difference in disease relapse ( p = 0.29). Conclusions: Our results are consistent with those from previous literature, regarding histology, biomarkers and later stage at diagnosis. A quarter of our patients had high CCI and this could had impacted on best treatment option choices. Treatment approaches use to be similar from those of female population. However, as disease biology and hormonal physiology are different between gender, there is a lack of specific protocols and trials in male population.
Development and allocation of regional elderly care resources based on the service needs
Authors: Shanshan Zhao, Ji Gu, Minjie Jin, Ping Lu, Bo Gao, Yuanyuan Ge
Journal: BMJ (2019)

Objective
To develop and allocate regional elderly care resources based on local service needs.


Methods
From February 2016 to May 2016, a face-to-face questionnaire survey was conducted to measure the elderly care service needs among residents over 60 years of age in Malu Township of Shanghai Jiading District. A telephone survey on the old-age care resources in Malu Township was carried out in November 2016. The demarcation of the aged care service needs was considered according to the resource classification from supplier side and the needs scores from the demander side. Kappa consistency test was used to compare the current care setting and the care setting matched to the real needs on the basis of the demarcation criteria.


Results
The results of the demarcation showed that 8 old-aged with score ≥ 44.5 in the survey (0.2%) should have the skilled nursing facility-based care; 218 with the score of 24.1 to 44.4 (5.1%) should have the welfare institution-based care; 60 with score of 23.2 to 24.0 (1.4%) should have elderly home-based care; 72 with scores of 22.1 to 23.1 (1.7%) should have the community-based care; 3 954 with score ≤ 22.0 (91.6%) should have home-based care. The consistency between the status of current care setting and the care setting matched to the real needs based on the demarcation criteria was poor (Kappa=0.092, P<0.01).


Conclusions
This study sets a grading criterion for the service objects of the various aged care services in Malu Township, and provides a basis for the orderly, rational and fair distribution of the regional old-age care service resources. However, the current resource allocation in the region is not accurately matched to the real needs, the problem should be solved with the application of the demarcation criterion.


Key words: 
Service for the aged; Need; Resource; Demarcation standard
急诊心肺复苏患者氧利用率的变化初探
Authors: 霍开秀, 王晓川, 李复雄, 涂昌弟, 谢建雄, 周秀红
Journal: BMJ (2004)

将71例危重患者分为急诊心肺复苏组、非心肺复苏危重患者组,并设正常对照组(30例).于急诊入院抢救时和住院后第1、2、3、5、7、10天分别抽动、静脉血各1次做血气分析,并计算氧利用率(O2UC).结果显示急诊心肺复苏后患者早期O2UC常升高,而中晚期则常明显下降,且病情严重、预后差.提示O2UC可作为判断急诊心肺复苏患者组织缺氧、病情严重程度和评估预后的有效指标。
The long-lasting anti-tumor activity of cisplatin affecting the sustainable systemic immune alteration may improve distant-disease free survival of triple-negative breast cancer in patients with a substantial residual tumor following preoperative chemotherapy: A retrospective analysis with translational research.
Authors: Ayane Yamaguchi, Kosuke Kawaguchi, Hiroshi Ishiguro, Tatsuki R Kataoka, Masae Torii, Chenfeng He, Nobuko Kawaguchi-Sakita, Masahiro Kawashima, Masahiro Takada, Eiji Suzuki, Masakazu Toi
Journal: Journal of Clinical Oncology (2020)

e12631 Background: Residual disease after preoperative chemotherapy is known to be a poor prognostic factor in triple-negative breast cancer (TNBC). Perioperative use of cisplatin (CDDP) is a well-known, standard treatment for most tumors except breast cancer. In this study, we explore the long-lasting anti-tumor activity of CDDP for TNBC patients. Methods: This research was based on consecutive study of seventy-nine previously untreated stage I–III TNBC patients treated with or without CDDP-based preoperative chemotherapy from 2007 to 2018 at the Kyoto University Hospital. We calculated the residual cancer burden (RCB) using the RCB calculator. All patients were sorted according to their RCB class: the pathological complete response (pCR), and RCB class I (minimal), II (moderate) or III (extensive). Distant disease-free survival (DDFS) was analyzed using the Kaplan-Meier method. Using mass spectrometry, we measured platinum concentrations in serum and normal breast tissue removed during surgery from patients treated with any platinum agents. We examined multiplex cytokine assays from serum sequentially, comparing CDDP and non-CDDP groups. Results: Forty-seven cases were treated with CDDP, and thirty-two did not have CDDP. The pCR rate was 53.2% for the CDDP group and 21.9% without CDDP. Patients with pCR and RCB class I were all distant disease-free. There was no significant difference between each RCB class using CDDP. However, patients belonging to RCB classes II and III with CDDP showed a better prognosis than the same RCB classes without CDDP (hazard ratio = 0.12). Platinum concentrations in serum were correlated with the time from the last dose of platinum agents, but platinum was even detected in serum two years after CDDP. No significant difference was found in the platinum concentrations of serum or normal breast tissue in the pCR and non-pCR groups. We also found that there were significant cytokine expression alteration related to T-cell infiltration only in the CDDP group one year after operation. It is suggested that CDDP may even affect the systemic immune alteration one year after operation. Conclusions: Our data shows that CDDP- based chemotherapy improves DDFS in patients with a substantial residual tumor. CDDP seems to sustain anti-tumor activity for a number of years and interaction with the systemic immune alteration.
Influence of BRCA pathogenic variants in the benefit of secondary cytoreductive surgery.
Authors: Felipe Leonardo Estati, Viviane Alencar, Rafaela Pirolli, Adriana Regina Goncalves Ribeiro, Giovana Tardin Torrezan, Dirce Maria Carraro, Maria Nirvana Formiga, Andrea Paiva Guimaraes, Glauco Baiocchi, Alexandre Andre B. A. Da Costa
Journal: Journal of Clinical Oncology (2020)

6076 Background: Germline BRCA pathogenic variants are present in 15% to 25% of ovarian carcinoma patients. These tumors are more sensitive to platinum and PARP inhibitor therapy and have a better prognosis. Two retrospective studies with limited number of patients have shown conflicting results regarding the benefit of secondary cytoreductive surgery (SCS) in patients with BRCA mutations. Our aim was to evaluate the impact of SCS in recurrent ovarian cancer according to BRCA status. Methods: All patients with ovarian carcinoma with recurrent disease and who were tested for BRCA pathogenic variants treated at a tertiary Cancer Center in Brazil were included. Patients characteristics were compared between patients treated with SCS and not treated with SCS. Cox regression analysis was used to evaluate the impact of SCS on progression free survival (PFS) and the influence of BRCA pathogenic variants on the effect of SCS. Results: One hundred and forty patients were included, 49.6% were treated with SCS and chemotherapy and 50.4% treated with chemotherapy only. Patients treated with SCS were younger, presented better performance status, lower CA 125 and longer platinum free interval. After adjusting for relevant covariables SCS was associated with longer PFS (HR 0.53, 95%CI 0.29-0.97, p = 0.039). Germline BRCA pathogenic variants were found in 37 patients (26.4%). No patient was treated with PARP inhibitors. Among non-carriers of pathogenic variants in BRCA, SCS lead to a longer PFS (HR 0.48, 95%CI 0.28-0.81, p = 0.006) but among carriers there was no benefit of SCS (HR 0.84, 95%CI 0.30-2.34, p = 0.735). Test for interaction was not statistically significant (p = 0.359). Conclusions: Our study is the second to demonstrate no benefit of SCS among patients with BRCA pathogenic variants and not treated with PARP inhibitor. The only other study to show a benefit of SCS in this group of patients included a limited number of patients and all of them were treated with PARP inhibitors. BRCA germline status might influence the efficacy of SCS, and should be evaluated as a potential biomarker to be assessed together with clinical factors to better select patients for SCS.