tbuckley/cabot-search huggingface dataset:
Comparative study comparing robotic thyroidectomy plus central neck dissection using the axillo-bilateral-breast approach and open conventional thyroidectomy for papillary thyroid microcarcinoma.
Authors: QingQing He
Journal: Journal of Clinical Oncology (2015)

e17031 Background: Robotic surgical techniques using da Vinci Si Surgical Robot System have developed rapidly in response to patient concerns regarding cosmesis and the need of surgeons for 3D magnified fields of view . The aim of this study is to evaluate surgical outcomes and the feasibility of robotic thyroidectomy plus CND. Methods: Total thyroidectomy (or lobectomy /isthmusectomy) plus CND was underwent for 80 patients for papillary thyroid microcarcinoma. Either an open total thyroidectomy (or lobectomy /isthmusectomy) plus CND (n = 40) using the Harmonic Focus or a robotic total thyroidectomy (or lobectomy /isthmusectomy) plus CND (n = 40) using the axillo-bilateral-breast approach (ABBA) is performed. Dissected tissues in robotic thyroidectomy group using a specimen pouch. Vacuum-assisted closure was placed and then suture incision was made. Compare the total operative time, intraoperative estimated blood loss, postoperative hospital stay, numberoflymph nodesremoved, visual analogue scale, complication rate, and cosmetic effect. Results: The robotic total thyroidectomy (or lobectomy /isthmusectomy) plus CND in 40 patients was successfully performed by da Vinci Si surgical system. No operation related complications and conversions to open or endoscopic surgery. The mean duration for the robotic thyroidectomy group was longer than those of the open procedure group[(129.8±12.4)min vs (97.7±11.2)min , P <0.05].The study showed statistical significant difference between the two groups regarding the visual analog scale pain assessment[(1.9±0.9)vs(3.9±1.1),P <0.05]. The difference of the two groups in the intraoperative estimated blood loss, the postoperative hospital stay, thenumberoflymph nodes removed, and the complication rate were not meaningful(P＞0.05). Postoperative cosmetic result was very satisfactory, with minimal numbness and tingling in the robotic thyroidectomy group. Conclusions: The robotic thyroidectomy using ABBA is a good alternative surgical modality for patients with papillary thyroid microcarcinoma who wish to avoid neck scars.
Third of patients with lower GI cancers face delays
Authors: Harriet Pike
Journal: BMJ (2019)

A third of patients in England with lower gastrointestinal cancers are facing delayed treatment, while figures show that NHS performance against treatment time targets has fallen to an all time low.

Data for January released by NHS England show that 66.1% of people with lower gastrointestinal cancers received treatment within two months of being urgently referred by their GP, against the 85% target set for the NHS in England.1 It is the worst performance for any of the five main cancer types where the target is measured.

The target was also missed for urological cancers (68.8% of patients were treated within two months) and lung cancers (69%) but was met for breast and skin cancers (88.6% and 93.2%, respectively).

The latest figures also show worsening waits for emergency and routine care when compared with the …
The transition of adjuvant chemotherapy for stage III colorectal cancer: A single institute experience in Japan.
Authors: Hiroki Osumi, Eiji Shinozaki, Mitsukuni Suenaga, Satoshi Matsusaka, Mariko Ogura, Masato Ozaka, Yosuke Kumekawa, Keisho Chin, Yoshiya Fujimoto, Masashi Ueno, Nobuyuki Mizunuma
Journal: Journal of Clinical Oncology (2015)

e14528 Background: As for the contribution to clinical outcomes of L-OHP in adjuvant setting of colon cancer, although there is robust data that supports them in European and US trials, on the other hand there is no clinical evidence in Japan. The result of ACTS-CC trial; S-1 vs UFT/LV, the 3 years DFS using S-1 monotherapy for stage III colon cancer was 75.5% which seems to be comparable to the outcomes of L-OHP incluiding trials in Europe and US. So it is unclear exactly and there is a controversy whether adding L-OHP as adjuvant chemotherapy for all stage III CRC in Japanese patients yields a better clinical outcomes or not. The aim of this study is to review the transition of adjuvant chemotherapy for stage III colorectal cancer in our hospital and to evaluate additional effects of L-OHP for stage III CRC in Japanese situations. Methods: A total of 642 patients with histopathologically confirmed stage III CRC patients who performed curative operation and 509 patients received adjuvant chemotherapy were enrolled from March 2005 to December 2010. According to the transition of adjuvant chemotherapy, we divided it into two groups after the generation when use frequency of L-OHP was increasing. OS and DFS were evaluated using the Kaplan–Meier method and compared using the log-rank test. Results: The frequency of adding L-OHP as adjuvant chemotherapy was increased after 2008. So we divided it into the period of 2005-2007 and 2008-2010. 189 patients received adjuvant chemotherapy in the period of 2005 to 2007; on the other hand 320 patients received adjuvant chemotherapy in the period of 2008 to 2010. (Stage IIIA / IIIB / IIIC; 21.6% / 53.2% / 25.2%). Median follow up period was 55 months. The 4-year OS rate was 86.6% and 91.5%, and the 3-year DFS rate was 69.2% and 76.6%, respectively (OS p = 0.007, DFS p = 0.023). The stratified hazard ratio (HR) for OS treated with the adding L-OHP and fluoropirimidine monotherapy was 0.79 and the DFS was 0.73 (95% confidence interval: 0.50–1.22, p = 0.29, 0.37-1.45, p = 0.38), respectively. Conclusions: Our analysis suggested that adding L-OHP to fluoropyrimidine might also improve the outcomes and yield similar risk reduction on the adjuvant treatment of stage Ⅲ colorectal cancer in Japanese patients.
EphB4-EphrinB2 receptor-ligand pair as a novel target in prostate cancer (PC).
Authors: Sarmad Sadeghi, Grace Li, Imran Siddiqi, Akash Sali, Gangning Liang, Inderbir Gill, Jacek K. Pinski, David I. Quinn, Parkash S. Gill
Journal: Journal of Clinical Oncology (2019)

275 Background: Studies have shown that EphB4 (B4), a receptor kinase, is upregulated in PC. The ligand for B4, EphrinB2 (B2) has not been studied in PC thus far. In our PTEN null mouse PC model, B4 and B2 are both upregulated in PC, but not in normal prostate. Furthermore, Soluble B4-albumin (sB4) decoy receptor blocks B4-B2 bidirectional signaling, inhibits PI3K/AKT signaling and is currently in phase II clinical trials in multiple tumor types. We thus studied B2 expression in human PCs and normal tissues. Methods: B2 levels were studied in 180 clinically localized human PCs and normal prostates. Tissue staining was performed with specific monoclonal antibody, using LEICA platform. B2 expressions in tumor vessel, tumor cell and stromal cells were scored by a pathologist. In addition, a CRPC patient was treated with sB4 under an IND approved by the FDA and IRB. The patient’s prostate cancer was diagnosed in 2014, Gleason’s score 4+3, treated with radical prostatectomy (pT3bN0) with subsequent metastases bone/bone marrow and progression on sipuleucel T, enzalutamide, abiraterone, docetaxel, cabazitaxel, and carboplatin. Tumor and blood samples were obtained and analyzed after informed consent. Results: B2 was not expressed in any of the 40 normal prostate gland or normal vessels in bladder, pancreas, small intestine, liver, adrenal glands, skeletal muscle, and bone marrow tissues. B2 was expressed 50% of the human prostate cancer tissues, being positive in tumor cells and negative in vascular and stromal cells. Expression was correlated with Gleason score (p = 0.003). B2 was also upregulated in PC cell lines that are characterized for genomic, and epigenomic alterations to study mechanisms of B2 induction. Metastatic tumor tissue from the CRPC patient showed high elevation of B2. After a 4-week course of sB4, PSA level declined by 45% (from 2284 to 1257). PI3K and AR levels in tumor tissue declined compared to baseline. PI3K/AKT/pS6 and AR levels in tumor tissue ex-vivo studies were also reduced with sB4 exposure. Conclusions: B2 is expressed in half of PCs and our experiments suggest a significant role for the EphB4-EphrinB2 pair through regulation of PI3K and AR signaling. Given the central role of AR in PC, sB4 may offer a novel approach to targeting AR.
Utility of surveillance following curative intent resection of metastases.
Authors: Richard M. Lee-Ying, Daniel John Renouf, Howard John Lim, Hagen F. Kennecke, Sharlene Gill, Caroline Speers, Winson Y. Cheung
Journal: Journal of Clinical Oncology (2015)

6562 Background: Surveillance is frequently conducted after the completion of curative treatment in early stage cancers to detect resectable recurrences. As more stage IV patients undergo curative resection of metastases (CRM), surveillance of such cases is increasingly performed, but its utility is unclear. Using a cohort of metastatic colorectal cancer (mCRC) patients, we aimed to 1) characterize surveillance patterns in a population-based setting and 2) examine if surveillance contributed to improved outcomes. Methods: Patients diagnosed with mCRC from 1995 to 2010 and referred to any 1 of 5 cancer centers in British Columbia were reviewed. Using Cox regression models that adjusted for confounders, we identified predictors of overall survival (OS) in patients who underwent CRM. Recurrences were categorized into those detected by surveillance vs symptoms and whether further attempts at CRM were feasible. Results: We identified 2082 mCRC patients of whom 254 proceeded to CRM. Median age was 63, 52% were men, 44% had de novo stage IV disease, 56% received perioperative chemotherapy, and 17%/66% had lung/liver metastases, respectively. Surveillance practices after CRM varied widely, but included clinical examination (85%), CEA (86%), imaging (89%) and endoscopy (28%) in the first 5 years. The median OS of CRM cases was 40.9 months, including 191 (75%) recurrences. The median time to recurrence was 10.2 months. Recurrences were detected by surveillance in 152 (80%) cases, and proceeded to a second CRM in 41 (21%). Compared to recurrences detected by symptoms, those based on surveillance were more likely to proceed to another CRM (25% vs. 11%, p < 0.001). Adjusting for confounders, surveillance (HR 0.61 95% CI 0.39-0.94, p = 0.026) and a second CRM (HR 0.53, 95% CI 0.34-0.82, p = 0.004) were independently correlated with improved OS. Conclusions: In this population-based cohort of mCRC patients, the majority recurred after the initial CRM, but recurrences detected by surveillance were more amenable to a subsequent CRM. While surveillance was performed in most cases, significant variations in practice were observed, underscoring the need for wider dissemination of evidence-based guidelines for the surveillance of selected metastatic disease.
What are the differences between young (≤25 years) and adults (&gt;25 years) colorectal cancer (CRC)? An Anatolian Society of Medical Oncology Study.
Authors: Muhammet Ali Kaplan, Zuhat Urakci, Mahmut Gumus, Ülkü Yalçintas Arslan, Caglayan Geredeli, Nuriye Ozdemir, Dogan Koca, Zeynep Oruc, Mukremin Uysal, Faysal Dane, Alper Sevinc, Mehmet Metin Seker, Asude Aksoy, Mehmet Kucukoner, Kezban Nur Pilanci, Turkan Ozturk Topcu, Mustafa Karaagac, Ramazan Yildiz, Abdurrahman Isikdogan
Journal: Journal of Clinical Oncology (2015)

e14657 Background: CRC is one of the most common tumors in adults, also can occur rarely in children and young adults. Although we know there are some differences between young and adults CRC patients, there is no study demonstrating these differences by comparative studies. The aim of the study to determine these differences by comparing young and adult patients. Methods: Between 2003 to 2014, 119 young CRC patients ( ≤ 25 years) were included in the study from referral center. As a control group, 135 adult patients ( > 25 years) were included in the study from Dicle University medical records. The medical records studied to analyze age, sex, presenting symptoms, presentation, family history, presence of polyps, histological features, localization, stage, and survival outcomes. Results: Median age for young and adult CRC group was 23 (10-25) and 52 (26-94), respectively. There were no statistical differences between two groups in terms of gender (male gender was 51.3% vs. 54.8%, p = 0.571), family history (24.2% vs. 24.6%, p = 0.517), presence of polyps (6.6% vs. 12.1%, p = 0.152), and acute presentation (20.7% vs. 18.8%, p = 0.707). While abdominal pain more common in adult group (55.3% vs. 72.0%, p = 0.008), rectal bleeding (35.9% vs. 37.1%, p = 0.850), change in bowel habit (34.0% vs. 24.2%, p = 0.101), nausea/vomiting (13.6% vs. 7.6%, p = 0.131), and weight loss (17.5% vs. 18.2%, p = 0.889) were similar between two groups. Mucinous histology (44.8% vs. 5.9%, p < 0.001), poorly differentiated tumor (34.7% vs. 10.5%, p < 0.001), rectal localization (40.2% vs. 25.4%, p = 0.021), and presence of metastasis at the time of diagnosis (25.4% vs. 10.4%, p = 0.002) were more common in young group than adults. In adult patients, overall survival was longer (numerically but not statistically) compared with young patients (67.7 months vs. 57.8 months, p = 0.141). Conclusions: This study supports our previous knowledge about differences between young and adult CRC patients.
Survival outcomes for adjuvant or salvage radiation in men with pN+M0 prostate cancer.
Authors: Jonathan David Tward, Brock O'Neil, Robert A Stephenson, Neeraj Agarwal, Tyler Farr, Rachel Petragallo, William Thomas Lowrance
Journal: Journal of Clinical Oncology (2019)

276 Background: The benefit of adjuvant or salvage radiation in pN+ men following radical prostatectomy (RP) is debated. Prior outcome studies are hampered either by missing prognostic variables or poor statistical analysis. We performed a rigorous outcome analysis in completely pathologically staged pN+ men treated with radical prostatectomy at the Univ. of Utah between the years 1998 and 2018. Methods: Men who were cN0M0 prior to surgery found with pN+ disease after RP were identified in our combined prospectively and retrospectively gathered institutional database. Those with metastasis found within 3 months of RP were excluded. The pathologic T and N stage, margin status, # of nodes resected, # of nodes positive, age, and NCI comorbidity scores were known for all subjects. Propensity weighted adjustment for the aforementioned covariates was performed to balance prognostic covariates in those who received EBRT + ADT (RT) versus those who didn’t (No-RT). Cox proportional hazards and KM analysis in the propensity-adjusted and original populations were used to evaluate metastasis free and overall survival. Results: Median follow-up time was 3.7 years. There were 129 men in the No-RT cohort and 72 in the RT cohort. Those in the No-RT group were twice as likely to develop metastasis (p &lt; 0.05 in all statistical models) and 2-3 times as likely to die of any cause (p 0.03 to 0.12 depending on model) than those receiving RT at any time after surgery. The median time to metastasis in the No RT cohort was 7.3 years and was not-reached in the RT cohort. The median time to death was 11.9 years in the No-RT cohort and was not reached in the RT cohort. Conclusions: The addition of adjuvant or salvage pelvic nodal radiation with limited duration ADT results in clinically and statistically significant reduction in metastasis and death following RP. A nomogram has been created which can be used to predict metastasis and mortality for individual subjects based on pathologic findings after RP.
Pulmonary rehabilitation, physical activity, respiratory failure and palliative respiratory care
Authors: Martijn A Spruit, Carolyn L Rochester, Fabio Pitta, Klaus Kenn, Annemie M W J Schols, Nicholas Hart, Emiel F M Wouters, Stefano Nava, Michael Dreher, Daisy J A Janssen, Miriam J Johnson, Randall J Curtis, Manuel Sastry, Frits M E Franssen
Journal: Thorax (2019)

The CIRO Academy in Horn (the Netherlands) organised a 2-day meeting to present and discuss the studies published in 2017 pertaining to key priority areas of respiratory and critical care medicine. This review summarises studies focussing on pulmonary rehabilitation and exercise training, physical activity, chronic respiratory failure and palliative respiratory care published in 2017.
The association of anxiety and depression with mortality risk among patients with clear cell renal cell carcinoma undergoing nephrectomy.
Authors: Vignesh T. Packiam, Matvey Tsivian, Mark D. Tyson, Christine M. Lohse, John C. Cheville, Stephen A. Boorjian, Bradley C. Leibovich, Robert Houston Thompson
Journal: Journal of Clinical Oncology (2019)

617 Background: Anxiety and depression are psychosocial factors which have been demonstrated to have mixed interactions with mortality across various malignancies. While these variables have been associated with poor overall survival for patients with metastatic RCC, the influence on outcomes for localized RCC has been poorly studied. We evaluated the association of anxiety or depression with survival in patients with surgically treated localized clear cell RCC (ccRCC). Methods: We performed retrospective review of our institutional nephrectomy registry to identify 1,990 patients who underwent radical or partial nephrectomy for unilateral, sporadic, non-metastatic ccRCC between 1995- 2011. Baseline anxiety and depression were identified using ICD-9 codes. Associations of anxiety or depression with outcomes of interest were evaluated using Cox proportional hazards models. Two propensity score (PS) techniques were used: adjusting for PS quintile and re-weighting by stabilized inverse probability weights. Results: A total of 197 (10%) patients had diagnoses of anxiety or depression (57 had anxiety alone, 107 had depression alone, and 33 had both anxiety and depression). Median follow-up among survivors was 10.0 (IQR 7.3-13.6) years, during which time 864 died, including 363 from RCC. Patients with anxiety or depression were younger (mean age 59 vs 62 years, p &lt; 0.001) and had more recent operations (75% vs 47% in 2005-2011, p &lt; 0.001) compared to those with neither diagnosis. After PS adjustment, all clinical and pathologic features were well balanced between groups. After PS adjustment, there were no significant differences in time to local ipsilateral recurrence, distant metastases, and death from RCC between groups. We did note a trend to poorer overall survival in patients with anxiety or depression (HR 1.29, 95%CI = 0.98-1.69, p = 0.065). Conclusions: Our results suggest that neither anxiety nor depression is significantly associated with oncologic outcomes among patients with localized surgically treated ccRCC. The trend toward worse overall survival among patients with anxiety or depression warrants further investigation.
Abstract 045: The Dose-Response Effect of a Mediterranean Style Diet With Lean Beef on Lipids and Lipoproteins
Authors: Jennifer Fleming, Penny Kris-Etherton, Kristina Petersen, David Baer
Journal: Circulation (2019)

A Mediterranean dietary pattern is widely recommended because of an extensive evidence base showing beneficial effects on cardiovascular disease (CVD) risk and mortality. The reduction in cardiovascular mortality is due, in part, to the improvements in lipids and lipoproteins versus a Western dietary pattern. Plant-based diets such as a Mediterranean diet are recommended for CVD risk reduction. However, adherence to plant-based diets is often hampered by the limited or restricted intake of red meat, a staple of the American diet. We conducted a multicenter, 4-period controlled feeding, randomized crossover study at Penn State University and USDA-Beltsville to evaluate the effects of a Mediterranean diet (CHO 42%, PRO 17%, FAT 41%, SFA 8%, MUFA 26%, PUFA 8%) with different quantities of lean beef (0.5, 2.5 and 5.5 oz/day) compared to an Average American diet (AAD; CHO 52%, PRO 15%, FAT 33%, SFA 12%, MUFA 13%, PUFA 8%) on CVD risk factors. We tested the hypothesis that including 0.5, 2.5 or 5.5 oz/d (based on 2100 kcals) of lean beef in a healthy Mediterranean style diet will confer similar cardioprotective benefits, and be superior to an AAD. Each Mediterranean diet included 7oz. equivalents of protein, of which 0.5, 2.5 or 5.5 oz. came from beef and the remainder from fish, poultry, pork, nuts, eggs, and legumes. The quantities of beef reflect amounts consumed in a traditional Mediterranean diet (0.5 oz.), current consumption in the U.S. (2.5 oz.), and an amount that represents all animal protein equivalents (5.5 oz.). Participants (n=60; 30 per site) included generally healthy normal to overweight/obese males and females (BMI= 20-38 kg/m 2 ) 30 to 60 years. Participants were randomized to each of the 4 diets for 4 weeks with an approximate 2-week break between treatments. Fasting blood samples were collected on two consecutive days at baseline (start of study) and at the end of each 4-week period. All three Mediterranean diets elicited similar lowering of total cholesterol (TC; p&lt;0.0001), LDL-C (p&lt;0.001), non-HDL-C (p&lt;0.0001) and apolipoprotein B (apoB) (p&lt;0.0001) that was greater than the AAD. All diets (AAD, MED0.5, MED2.5 and MED5.5) decreased HDL-C (-3.46 ± 1.11, -4.93 ± 1.14, -4.44 ± 0.93, and -3.31 ± 1.20 mg/dl, respectively; p&lt;0.01) and apolipoprotein A1 (apoA1) (-8.63 ± 1.77, -11.45 ± 1.72, -11.21 ± 1.71, and -7.97 ± 1.90 mg/dl, respectively; p&lt;0.0001). The MED5.5 attenuated the reduction in apoA1 versus the other two MED diets (p&lt;0.05). In conclusion, a healthy Mediterranean Style diet containing 0.5 to 5.5 oz/day of lean beef improves multiple CVD risk factors compared to a current American dietary pattern.
Abstract P206: Multiple Sclerosis Risk Factors Improved With Residential Lifestyle Intervention
Authors: Francisco E Ramirez, Neil Nedley, Amy Krueger
Journal: Circulation (2019)

Rationale: Previous research suggest that lipids, which are important elements in healthy myelin sheaths, could play a role in multiple sclerosis (MS). This study evaluate the effect on lipids of a medical 18-day lifestyle program. Methods: The program is summarized in the word NEWSTART acronym of (N)utrition (vegan diet), (E)xercise, (W)ater, (S)unshine (proper exposure), (T)emperance (proper use of good things and avoiding harmful things), (A)ir (breathing exercises), (R)est, (T)rust in rational, spiritual, and psychological aspects. Patients were seen by certified physicians, nutritionists, and chaplaincy. They received physician consultations, plant-based diet, massage, hydrotherapy and exercise therapy among other modalities. Results: Out of 2081 patients that completed the program in an 11 year period, n=10 had a diagnosis of MS. Only n=9 of the n=10 patients had complete laboratories. Average age of MS patients was 51 (SD 15), 89% were female. At baseline, the average of cholesterol, triglycerides, HDL, and LDL (listed in the same order) was 196, 141, 59, and 100, with an SD of 47.7, 84.3, 10.1, 35.6, minimum of 126, 68, 50, 75, maximum 276, 304, 70, 141 and median 203, 100, 58, 85. On completion of the 18-day program, the average of cholesterol, triglycerides, HDL, and LDL was 174, 129, 49, and 99, SD was 27.4, 64.3, 18.0, 30.1, minimum 139, 64, 28, 69, maximum 214, 270, 87, 147, median 175, 115, 47, 88, t-test values 2.6, 1.2, -.2, 2.9, significant change? ( Yes(p&lt;.02), Yes(p&lt;.2), No(p&lt;.8), Yes(p&lt;0.1). Conclusions: The program is effective in improving lipids of MS patients. The risk factors cholesterol, triglycerides and LDL responded very well to the intervention. HDL decreased a few point but the change was not significant. Patients seem to benefit from the intervention.
Interleukin-6 Adversely Impacts Genomic Stability Via Targeting Multiple Pathways in Multiple Myeloma
Authors: Chaitanya Yenumula, Srikanth Talluri, Tommaso Perini, Subodh Kumar, Jialan Shi, Rao Prabhala, Masood A. Shammas, Nikhil Munshi
Journal: Blood (2018)