tbuckley/cabot-search huggingface dataset:
Papillary thyroid microcarcinoma: Analysis of outcomes and features predicting risk of recurrence.
Authors: Chandra Shekhar Dravid, Priya Sr, P. S. Pai, D. Chaukar
Journal: Journal of Clinical Oncology (2020)

e18569 Background: Papillary thyroid microcarcinoma (PTMC) is an enigmatic entity - diverse opinions exist on its clinical course and management. We aimed to analyse disease outcomes and to identify high-risk factors in PTMCs. Methods: This is a retrospective analysis of patients of PTMC treated in our hospital between 2000 and 2014. Clinico-radiological features, treatment details, long term outcomes and recurrence patterns were noted; these were analysed statistically. Results: 160 patients were studied; 61% were females; 86% were aged 55 years or below; 95% cases presented with an enlarged neck node or thyroid nodule or distant metastasis while 5% were incidentalomas. Total thyroidectomy with radioiodine ablation was done in 77% while hemithyroidectomy was done in 23% patients. Follow up ranged between 2 and 238 months. There were 11 (7%) disease related events (nodal or distant metastases or death due to persistent disease). 4 (2.5%) patients died of disease. On univariate analysis, a larger thyroid primary (p 0.001), pre-operatively radiologically identifiable disease in the thyroid (p 0.02) and the lesion not being an incidentaloma (p 0.01) were associated with development of adverse events. Multivariate analysis confirmed the latter two factors as high risk (p 0.05 and 0.00). Nodal metastasis increased with a larger primary (p 0.001), which was multifocal (p 0.00), bilateral (p 0.01) and showed extrathyroid extension (p 0.00). Distant metastases were related with advanced age (p 0.02), presence of involved nodes (p 0.04), larger primary tumour (p 0.15), multifocal tumour (p 0.17), bilateral foci (p 0.02) and extrathyroidal extension (p 0.06). Correspondingly, Kaplan Meier curves showed a better overall survival (OS) and disease free survival (DFS) with incidentalomas as compared to cases presenting with symptoms (Median OS 84 months vs 78 months; Median DFS 79 months vs 77 months) and cases where the lesion was not seen on radiology (Median OS 80 months vs 76 months; Median DFS 80 months vs 75 months). However neither was significant statistically. Addition of Radioiodine ablation did not confer survival advantage (p 0.6). Conclusions: PTMCs are associated with adverse events despite the size of the primary lesion. Stratification as per the above risk factors can improve event free survival. Conversely, aggressive treatment may be deferred in cases of lesions discovered incidentally or on routine screening.
First‐ and third‐generation epidermal growth factor receptor inhibitors mediate distinct phosphoprotein signalling networks: implications for adverse dermatological reactions
Authors: C. Vasavda, B.K. Ho, D.Y. Zhang, K.A. Williams, B.H. Kaffenberger, S.G. Kwatra, M.M. Kwatra
Journal: British Journal of Dermatology (2020)
Clinical analyses of letrozole treatment in stimulating ovulation for anovulatory infertile women
Authors: Kunling Song
Journal: BMJ (2015)

A total of 130 anvolatory infertile outpatients were divided randomly into 4 groups of LE1 (letrozole 2.5 mg, n=45), LE2 (letrozole 5 mg, n=30), CC1 (clomiphene citrate 50 mg, n=35) and CC2 (clomiphene citrate 100 mg, n=20). The treatments started at day 5 of menstruation and lasted for 5 days. The size and number of ovarian follicles and thickness of endometrium of all 4 groups were measured starting from day 10 of menstruation.8 000-10 000 units of human chorionic gonadotropin (hCG) was injected when ovary follicles were mature. And blood estradiol (E2 ) was measured at the same day. Ovulation, pregnancy and adverse reaction were also monitored. The pregnancy rate was 33% (n=15) in group LE1 and 14% (n=5) in group CC1 with significant statistical difference (χ2=4.00, P<0.05). And there were 43 successful ovulation periods in 55 periods with an ovulation rate of 78% in group LE1; 28 successful ovulation periods in 52 periods with an ovulation rate of 54% in group CC with significant statistical difference (χ2=4.60, P<0.05). E2 level (pmol/L) in the day of hCG injection in group LE1 was (774.2±126.0) pmol/L and in group CC1 (963.7±108.3) pmol/L, t=3.98 with significant difference (P<0.01). The number of follicle in group LE1 was 1.20±0.38; CC1 2.28±0.88, t=4.76 with significant difference (P<0.01). The thickness of endometrium in the day of hCG in LE1 was (9.6±1.3) mm; CC1 (5.9±1.1) mm, t=6.20 with significant difference (P<0.01). No significant statistical differences existed between LE1 and LE2, CC1 and CC2 in pregnancy rate, successful ovulation, number of mature follicles, E2 level and thickness of endometrium at the day of hCG injection. The outcomes of 36 pregnancies were 32 full-term deliveries with neonatal health, 2 early abortions and 2 prematures. Mild ovarian hyperstimulation syndrome (OHSS) had a low occurrence rate.

Key words: 
Infertility, female; Ovulation induction
Longitudinal investigation of Distress Thermometer scores in patients with cancer.
Authors: Fauzia Ullah, Emily Brugioni, Matthew M Gannon, Hayden L Smith, Joshua Cole Lukenbill
Journal: Journal of Clinical Oncology (2020)

e24200 Background: The Distress Thermometer (DT) is a tool used to evaluate distress among cancer patients. The DT can provide information for intervention recommendations such as social work, psychological, and other ancillary services. The National Comprehensive Cancer Network (NCCN) recommends recurrent use of the tool. The DT is widely used as a standard of care for an initial screening of cancer patients, but data on subsequent use is lacking. The aim of this research was to evaluate repeat DT scores in a heterogeneous cancer patient population. Methods: Clinical investigators conducted a longitudinal study of DT ratings for cancer patients receiving outpatient care at a community-based oncology subspecialty practice in a mid-sized city from 2018 to 2019. Study objectives included reviewing referrals and evaluating the relationship between the initial screening and the screening at the 6-month checkup. The Distress Thermometer was used (i.e., 0-10; zero is “no distress” and ten “extreme distress”) with scores of four or greater regarded as a signal of greater risk for patient distress. Results: The study sample included 79 patients with an average score of 4.3 and 4.0 at baseline and the 6-month screening, respectively. Patient referrals included physical and emotional therapy (n=1) or social/psychosocial worker assessment (n=26). Patients with a documented referral had a crude 1.7 (95% CI: 0.6, 3.3) greater point decrease in scores compared to patients not offered a service referral. When adjusting for baseline scores and the time between scores, referral accounted for 1% (95% CI: 0%, 14%) of variability in score changes, while baseline scores accounted for 40% (95% CI: 22%, 52%) and time accounted for 3% (95% CI: 0%, 14%). Conclusions: Study results reveal a possible decrease in higher scores from the initial screening to the 6-month check-up. Patients with a referral did not have their service utilization confirmed and this study failed to show an additional decrease in scores based on referrals when controlling for baseline score and time. Most previous research has focused on one specific cancer type. This study revealed the possible importance in understanding DT scores in a heterogenous cancer patient population. Furthermore, large scale research is needed to confirm preliminary data and further expound on distress at initial and subsequent screenings after interventions. A better understanding of this content area may function to improve future care and patient well-being.
Quantification of inequities in breast cancer incidence in New Mexico through Bayesian disease mapping.
Authors: David Zahrieh, Michael A Golafshar, Samir H Patel, Todd A DeWees
Journal: Journal of Clinical Oncology (2020)

e13617 Background: Breast cancer (BC) is the most prevalent cancer of women in the United States (US). The incidence rates for BC among American Indian and Alaska Native (AI/AN) women vary across the US. A novel application of Bayesian disease mapping was applied to quantify potential inequities in 10-year BC incidence in New Mexico (NM) in order to better inform health equity initiatives within the AI/AN at-risk population. Methods: Surveillance, Epidemiology, and End Results Program (SEER) data from 2005 to 2014 were used to identify new cases of BC within the 33 counties in NM. Initially, a Poisson-gamma model was applied to quantify the reduction in risk of BC within the at-risk AI/AN population compared with the general at-risk population. To account for spatial variation and to address the small area estimation problem inherent in these data by borrowing strength globally and locally in NM, we applied Bayesian disease mapping to the counts of county-level BC cases. We quantified the disparity effect, as measured by the rate ratio (95% credible interval [CI]), comparing the incidence of BC between at-risk AI/AN and non-AI/AN women, and assessed if the rate ratio differed between counties. Markov chain Monte Carlo sampling was used to estimate posterior quantities and the deviance information criterion was used for model selection. Results: In 2010, 1,041,758 women were at-risk for BC of which 107,656 (10.3%) were AI/AN women. During the 10-year study period, 12,974 new BC cases were recorded in the general at-risk population. In the at-risk AI/AN population, the expected number of new cases during the 10-year study period, therefore, was 1,340.74; however, 597 incidence cases of BC were diagnosed in the at-risk AI/AN population resulting in a posterior mean for the true relative risk of 0.445 (95% CI: 0.410, 0.482). Based on the selected model that accounted for over dispersion and spatial correlation among the 33 counties, the posterior mean of the overall adjusted rate ratio was 0.405 (95% CI: 0.336, 0.478). The adjusted rate of BC in AI/AN women was 0.40 times the corresponding adjusted rate for women who were non-AI/AN. Further, the adjusted rate ratios were similar for each county. Conclusions: The novel application of Bayesian disease mapping to these data provided substantial evidence of a significant overall disparity effect in BC incidence within NM between at-risk AI/AN and non-AI/AN women, which was more marked than previous reports. Targeted state-wide health equity initiatives may lead to reducing disparities in BC incidence in AI/AN at-risk women.
Rare triple-negative breast cancers (TNBC): An NCDB analysis.
Authors: Elizabeth Blessing Elimimian, Thomas A. Samuel, Hong Liang, Nadeem Bilani, Leah Elson, Zeina A. Nahleh
Journal: Journal of Clinical Oncology (2020)

e19253 Background: The literature on rare triple negative breast cancer (TNBC) histology types is sparse; herein we present the clinical demographic and treatment patterns as well as overall survival (OS) for rare (&lt; 10%) types of breast cancers that typically present as TNBCs: Medullary carcinoma (MedC), Adenoid cystic carcinoma (ACC), and Metaplastic breast cancer (MetC). Methods: Records of patients with a confirmed diagnosis of MedC, ACC, and MetC between 2010 and 2016 in the National Cancer Database (NCDB) were analyzed. Patients with an unknown stage were excluded. Univariate analyses and multivariable Cox-regression models were performed in SAS v. 9.4. Results: A total of 8,479 records were analyzed. MetC was the most commonly diagnosed histologic type in our cohort with 6,867 (81%) patients versus 255 (3.0%) MedC patients and 1,357 (16%) ACC patients. MedC presented earlier in life, with a median age of 53 years versus 62 years for ACC patients, and 63 years for MetC patients. The proportion of TNBC varied by histology type for MedC (70.4%), ACC (77.0%), and MetC (79.0 %). Patients with ACC were less likely to receive radiotherapy (52.4%) and chemotherapy (12.9%) compared to MedC (61.2%, 74.5%) and MetC (49.7%, 68.6%) respectively. On Cox multivariate regression, age ≥60 (HR 4.7), stage ≥3 [compared to patients with stage 0&amp;1] (HR 5.7), and not receiving radiotherapy (HR 2.0) or chemotherapy (HR 1.25) conferred worse overall survival for MedC. Similarly, among patients with ACC, age ≥60 (HR 3.5), stage ≥3 (HR 5.3), and lymph node involvement (HR 4.8) were adverse prognostic indicators as well as not receiving radiation therapy (HR 1.47). Among MetC, lung metastasis (HR 2.6), stage ≥3 (HR 4.5), but also not receiving chemotherapy (HR 1.8) or radiation therapy (HR 1.47) was associated with worse survival outcomes. All p-values for cox regression is &lt;0.0001. The 5-year OS was 92.6% for patients with MedC, 92.0% for ACC patients, 69.3% for MetC patients; all p-values &lt;0.0001. Conclusions: This analysis describes rare types of TNBCs: MedC (most common), ACC, and MetC. We noted heterogeneity among these 3 rare types of TNBC, with the worst 5-year OS noted for MetC. Poor prognostic factors for MetC include advanced stage, lung metastasis, older age, and not receiving chemotherapy or radiation therapy. Future research focusing on rare subtypes of breast cancer is desirable and would potentially inform the optimal management of these breast carcinomas.
Implementation of cardiac rehabilitation for patients with acute coronary syndrome in community hospital
Authors: Lina Sun, Ling Yang, Xueping Du
Journal: BMJ (2019)

Acute coronary syndrome (ACS) is a serious type of coronary disease with high morbidity and mortality rates, being one of leading causes of death in both developed and developing countries. Studies abroad have shown that, the cardiac rehabilitation in community hospitals carried out by general practitioners with the guidance of cardiac specialists and the establishment of a continuous, long-term exercise rehabilitation and drug therapy can effectively reduce the mortality of ACS patients. In order to complete the health care chain from prevention, treatment to rehabilitation for ACS patients in China, it is imperative for community hospitals to provide cardiac rehabilitation service.


Key words: 
Acute coronary syndrome; Community health centers; Cardiac rehabilitation
Follicular lymphoma Grade 1 of the minor duodenal papilla successfully diagnosed by endoscopic papillectomy
Authors: Takashi Abe, Kosuke Kodama, Takayuki Nagai, Koki Yamanaka, Masato Hanzawa, Takafumi Yano, Kazunari Murakami
Journal: Endoscopy (2020)

A 70-year-old asymptomatic woman underwent screening esophagogastroduodenoscopy, which revealed a bulging minor duodenal papilla with redness and rough surface ([Fig. 1 a – c]). Biopsy was suggestive of adenocarcinoma. Laboratory data included normal blood counts and standard serum biochemical tests. Abdominal computed tomography (CT) showed a slightly contrast-enhanced duodenal tumor, approximately 1 cm in size without regional lymphadenitis in the second part of the duodenum; however, choledocholith was also noted incidentally ([Fig. 2 a]). Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) showed a normal pancreatic duct ([Fig. 2 b, c]) and choledocholith.
Randomized phase III study of high-dose methotrexate and whole brain radiotherapy with or without concomitant and adjuvant temozolomide in patients with newly diagnosed primary central nervous system lymphoma: JCOG1114C.
Authors: Kazuhiko Mishima, Ryo Nishikawa, Yoshitaka Narita, Junki Mizusawa, Minako Sumi, Manabu Kinoshita, Motoo Nagane, Yoshiki Arakawa, Koji Yoshimoto, Ichiyo Shibahara, Naoki Shinojima, Kenichiro Asano, Takao Tsurubuchi, Hikaru Sasaki, Akio Asai, Takashi Sasayama, Yasutomo Momii, Atsushi Sasaki, Hiroshi Katayama, Haruhiko Fukuda
Journal: Journal of Clinical Oncology (2020)

2500 Background: Temozolomide (TMZ) is an oral alkylating agent that penetrates the blood-brain barrier with moderate toxicity, and has shown anti-tumor activity in primary central nervous system lymphoma (PCNSL) in single arm studies. Our goal was to determine whether the addition of concomitant and adjuvant TMZ chemotherapy to standard treatment of high-dose methotrexate (HD-MTX) and whole brain radiotherapy (WBRT) for PCNSL improves survival in a randomized controlled trial. Methods: We did an open-label, randomized phase III trial at 30 hospitals in Japan enrolling immunocompetent patients (pts) aged 20-70 years with histologically confirmed newly diagnosed PCNSL. Pts enrolled at step 1 registration received HD-MTX (MTX; 3.5 g/m 2 at day 1, 15, 29). Pts who received at least 1 cycle of HD-MTX were randomly assigned (1:1) at step 2 registration to receive WBRT (30 Gy) ± 10 Gy boost (control arm: A) or WBRT ± boost with concomitant TMZ (75 mg/m 2 daily) and adjuvant TMZ (150-200 mg/m 2 daily for 5 days every 28 days) for two years after initiation of HD-MTX or until tumor progression (experimental arm: B). Randomization was adjusted by institution, PS (0-1 / 2-3), age (≤60/≥61 years), presence or absence of intraparenchymal tumor after HD-MTX. The primary endpoint was overall survival (OS). The planned sample size was 130 pts in total, to provide an 80% power to detect a 0.52 hazard ratio (65% vs 80% in 2y-OS) for arm B to A and a one-sided alpha of 5%. Results: Between September 29, 2014 and October 15, 2018, 134 pts were enrolled, of whom 122 were randomly assigned and analyzed; 62 to arm A and 60 to arm B. At the planned interim analysis, the 2-y OS was 86.8% (95% CI: 72.5-94.0) in arm A and 71.4% (56.0-82.2) in arm B. The hazard ratio was 2.18 (95% CI: 0.95 to 4.98) with predictive probability for showing the superiority of arm B at the final analysis was calculated to be 1.3%. The study was terminated due to futility. The 2-y progression-free survival was 60.6% (43.6-73.8) in arm A and 49.9% (34.4-63.5) in arm B with a hazard ratio of 1.54 (0.88 to 2.70). The most common grade 3 and 4 toxicities were lymphopenia, observed in 7 (11.5%) pts during WBRT in arm A, 18 (30%) pts during WBRT + concomitant TMZ and 18 (37.5%) pts during adjuvant TMZ in arm B. Conclusions: This study failed to demonstrate the benefit of the addition of TMZ to WBRT and adjuvant TMZ in newly diagnosed PCNSL. Possible biomarkers including methylation status of the MGMT promoter in the tumors will be analyzed. Clinical trial information: jRCTs031180207 .
Patient-reported outcomes (PROs) from the phase III IMspire150 trial of atezolizumab (A) + cobimetinib (C) + vemurafenib (V) in patients (pts) with <i>BRAF</i><sup>V600+</sup>melanoma.
Authors: Karl D. Lewis, Caroline Robert, Paolo Antonio Ascierto, Daniil Stroyakovskiy, Helen Gogas, Svetlana Protsenko, Rodrigo Perez Pereira, Thomas K. Eigentler, Piotr Rutkowski, Lev V. Demidov, Georgy Moiseevich Manikhas, Sara Tadesse-Bell, Kuan-Chieh Huang, V. McNally, Sohail Mulla, Grant A. McArthur, Ralf Gutzmer
Journal: Journal of Clinical Oncology (2020)

10073 Background: In IMspire150, A+C+V significantly improved investigator-assessed progression-free survival vs placebo (Pbo)+C+V in previously untreated pts with unresectable stage IIIc/IV BRAF V600+ melanoma. PRO data from this trial are now reported. Methods: 514pts were randomized 1:1 to 28-day cycles of A+C+V or Pbo+C+V. Pts received C+V in cycle 1; A or Pbo was added on days 1 and 15 from cycle 2 onward. Pts completed the EORTC QLQ-C30 questionnaire on day 1 of cycle 1 (baseline), days 1 and 15 of cycle 2 and cycle 3, day 1 from cycle 4 onward, within 28-d of treatment discontinuation, and ≤6 months post-treatment. Prespecified secondary PRO endpoints were time to confirmed deterioration (TTCD; defined as time from randomization to first ≥10-point decrease from baseline held for 2 consecutive assessments, or 1 assessment followed by death on treatment) in quality of life (QoL) and physical functioning (PF). Prespecified exploratory endpoints were TTCD in role functioning (RF); mean change from baseline and percentage of pts with a clinically meaningful change (≥10 points from baseline) in QoL, PF, and RF. Results: Questionnaire completion rates were &gt; 80% for most of the treatment period. At baseline, mean QoL, PF, and RF scores were moderate to high (Table). At week 6 (cycle 2), following initiation of A, QoL, PF, and RF scores declined, but returned to near-baseline levels at week 10 (cycle 3) and were largely maintained until week 36 (cycle 10), when &lt; 50% of pts contributed data. In this time, ≥56% pts in both arms did not experience a clinically meaningful deterioration in QoL, PF, and RF. TTCD on QoL (hazard ratio [HR] 1.23; 95% CI 0.90-1.67), PF (HR 1.27; 95% CI 0.93-1.74), and RF (HR 1.15; 95% CI 0.86-1.55) favored Pbo, but only one-third of pts overall experienced a confirmed deterioration. Conclusions: PRO data showed that A+C+V did not worsen QoL, PF, and RF in pts with advanced BRAF V600+ melanoma, thus supporting its use as a treatment option. Clinical trial information: NCT02908672. [Table: see text]
MYC Drives Temporal Evolution of Small Cell Lung Cancer Subtypes by Reprogramming Neuroendocrine Fate
Authors: Abbie S. Ireland, Alexi M. Micinski, David W. Kastner, Bingqian Guo, Sarah J. Wait, Kyle B. Spainhower, Christopher C. Conley, Opal S. Chen, Matthew R. Guthrie, Danny Soltero, Yi Qiao, Xiaomeng Huang, Szabolcs Tarapcsák, Siddhartha Devarakonda, Milind D. Chalishazar, Jason Gertz, Justin C. Moser, Gabor Marth, Sonam Puri, Benjamin L. Witt, Benjamin T. Spike, Trudy G. Oliver
Journal: Cancer Cell (2020)
Effect of anti-allergic drug combined with deanxit on emotional symptoms and quality of life in elderly patients with allergic rhinitis
Authors: Juebo Yu, Haizhou Zheng, Yuanling Zhuang, Min Wang, Junfeng Wang
Journal: BMJ (2020)

Sixty-three elderly patients with allergic rhinitis and symptoms of anxiety and depression attending in the Affiliated Hospital of Yangzhou University from August 2016 to August 2018 were randomly divided into two groups: 30 patients received deanxit combined with anti-allergic drugs for treatment (study group) and another 30 patients received anti-allergic drugs treatment alone (control group). Subjective nasal obstruction was evaluated by Visual Analogue Scale (VAS), and the quality of life of patients was assessed by Rhinoconjunetivitis Quality of Life Questionnaire (RQLQ).The anxiety and depression mood changes were assessed by Self-rating Anxiety Scale (SAS) sand Self-rating Depression Scale (SDS).The scores of symptoms and mood were compared after 4 weeks and 8 weeks of treatment. The clinical nasal symptoms VAS score, the total RQLQ scores and its 7 domains scores, SDS and SAS scores of patients in two groups were significantly reduced compared to those before treatment (P<0.05). The VAS score, the total of RQLQ scores and its 7 domains scores, SDS and SAS scores were significantly lower in the study group than those in the control group after 4 weeks and 8 weeks of treatment.The total effective rate of study group was significantly higher than those of the control group (χ2=6.922, P=0.031; χ2=11.544, P=0.003). Deanxit combined with anti-allergic drugs shows significant clinical efficacy, it also can improve the symptoms of anxiety and depression, and the quality of life for elderly patients with allergic rhinitis.


Key words: 
Rhinitis, allergic; Aged; Quality of life; Depression; Anxiety