tbuckley/cabot-search huggingface dataset:
Biological and clinical features of early triple-negative invasive lobular carcinomas of the breast.
Authors: Fabio Conforti, Laura Pala, Elena Guerini Rocco, Eleonora Pagan, Vincenzo Bagnardi, Emilia Montagna, Giulia Peruzzotti, Tommaso Martino De Pas, Caterina Fumagalli, Silvana Pileggi, Chiara Pesenti, Sergio Marchini, Caterina Marchiò, Anna Sapino, Richard D. Gelber, Giuseppe Viale, Marco Colleoni, Aron Goldhirsch
Journal: Journal of Clinical Oncology (2020)

e12570 Background: Hormone receptors and HER2 negative (triple negative, TN) invasive lobular carcinomas (ILCs) are very rare, accounting for 1-2% of all TN breast cancers (BCs). Methods: We extracted data from our prospectively collected institutional database on all consecutive patients (pts) with early stage TN ILC operated at the European Institute of Oncology (IEO) between June 1994 and December 2012. Invasive disease-free survival (iDFS) and cumulative incidence of distant metastases (CI-DM) were calculated. Biological features of these tumors, including molecular intrinsic subtypes based on PAM50 assay, expression of androgen receptor (AR) and mutational status of c-erbB2 gene were also evaluated. Additionally, NGS data of 45 TN ILCs were obtained from 3 large public databases, to confirm mutations in c-erbB2 gene and to identify other recurrently mutated genes. Results: Among 2952 ILCs treated at IEO, 44 (1.5%) were TN and were included in the analysis. All pts received adjuvant chemotherapy. The iDFS rates at 5 and 10 years of follow-up were 47.4% (95% CI, 31.1-62.0) and 29.5% (95% CI, 14.8-45.8), respectively. The corresponding CI-DM percentages were 17.6% (95% CI, 7.6-31.2) and 20.8% (95% CI, 9.5-35.1). The molecular intrinsic subtype was defined through PAM50 for 31 out of 44 TN ILCs: 48% were classified as luminal A, 3% luminal B, 32% HER2-enriched, and only 16% basal-like. The group of pts with luminal A or B tumors had a significantly better CI-DM as compared with pts with non-luminal tumors (i.e. HER2-enriched and basal-like; p=0.003). Luminal tumors expressed AR more frequently than non-luminal tumors (AR≥1% in 96% of luminal tumors versus 53% in non-luminal tumors; p=0.001), and at significantly higher levels (median percentage of AR-positive cells was 80% in luminal tumors versus 15% in non-luminal tumors; p=0.01). Higher AR expression was associated with significantly better iDFS in the whole cohort of TN ILCs (p=0.01), as well as in the group of luminal tumors (p=0.05). 27 TN ILCs of the IEO cohort were analyzed for mutations in c-erbB2 gene, and 9 (33%) harbored mutations. Analysis of the 3 public databases, confirmed c-erbB2 mutations in 9 out of 45 (20%) TN ILCs. All the c-erbB2 mutations found were previously reported to be pathogenetic in BCs and to predict response to neratinib. ErbB signaling and DNA damage response were among the top 10 pathways significantly enriched for mutated genes in TN ILCs. Conclusions: TN ILCs are rare tumors with dire prognosis. Their specific biological features require newly defined targeted therapeutic strategies.
Molecular profiles and treatment recommendations for invasive lobular carcinoma in a real-world prospective breast cancer registry.
Authors: Beth-Ann Lesnikoski, Jennifer A. Crozier, Gordan Srkalovic, Patricia A. Robinson, Clodia Osipo, Kalyan Banda, Heather M. Kling, Erin Yoder, William Audeh
Journal: Journal of Clinical Oncology (2020)

e19291 Background: Invasive lobular carcinoma (ILC), the second most common histological breast cancer type, comprises 10-15% of breast tumors. Although ILC is thought to have a low risk of relapse, patient survival data vary. ILC treatment guidelines mirror those for invasive ductal carcinoma (IDC); however, these were extrapolated from trials that included predominantly IDC. The FLEX Registry captures data from real-world breast cancer patients; the current sub-study evaluated molecular profiles and treatment recommendations in ILC. Methods: The FLEX Registry (NCT03053193) includes stage I-III primary invasive breast cancer patients who receive 70-gene signature (70-GS)/80-gene signature (80-GS) testing and consent to full transcriptome and clinical data collection. This sub-analysis includes 335 ILC patients and 2,179 IDC patients enrolled from 2017 to present. 70-GS stratified tumors by risk of distant metastasis [High (HR), Low (LR), Ultralow (UL) Risk], and 80-GS classified tumors by molecular subtype (Luminal, HER2, or Basal type). Genomic and clinical data were compared for ILC and IDC using chi-square or Fisher’s exact test. Results: ILC represented 13% of FLEX cases (n = 335/2752); 81% were lymph node-negative, 99% ER-positive, and 94% HER2-negative. Clinical risk assessment (MINDACT criteria) classified 61% of ILC and 53% of IDC as low risk (p = 0.03). 70-GS risk distribution in ILC (18% UL, 51% LR, 31% HR) differed from IDC (13% UL, 34% LR, 53% HR; p &lt; 0.01). Discordance between 70-GS and clinical risk was greater in ILC (43%) than IDC (30%, p &lt; 0.01). 80-GS results also differed between ILC (98% Luminal, 1.6% HER2, 0.3% Basal) and IDC (85% Luminal, 3% HER2, 11% Basal; p &lt; 0.01). Inclusion of chemotherapy (CT) in treatment plans was associated with 70-GS risk (p &lt; 0.01); treatment plans that disagreed with 70-GS results were associated with discordant clinical risk (p &lt; 0.05). Treatment plans disagreed with 70-GS in 15% of ILC and 12% of IDC total cases (p = 0.08), and more frequently in HR cases (25% in ILC, 14% in IDC; p &lt; 0.01). Conclusions: The FLEX Registry includes patients with ILC consistent with real-world breast cancer frequencies. ILC demonstrated genomic risk and subtype profiles distinct from IDC. Treatment plans largely agreed with 70-GS results; however, discordance was more frequent in HR ILC than IDC. Future studies will evaluate clinical outcomes; however, these results demonstrate the added value of molecular profiling in ILC and the utility of real-world registry data in evaluating uncommon breast tumor types. Clinical trial information: NCT03053193 .
Survival outcomes of metastatic renal cell carcinoma (RCC) patients with pancreatic metastases (PM): Pooled analysis from a large clinical trials database.
Authors: Justin Shaya, Xun Lin, Angelo Cabal, Justine Panian, Nicole Weise, Rana R. McKay
Journal: Journal of Clinical Oncology (2020)

e17072 Background: Pancreatic metastases are a rare site of metastasis for RCC. It has been suggested that patients with metastases to the pancreas have a more indolent disease course, however long term survival outcomes with systemic therapy are not well defined. Methods: We conducted a pooled analysis of metastatic RCC patients treated in phase II/III clinical trials. The primary objective was to evaluate overall survival in patients with PM compared to those without PM. Secondary objectives included progression-free survival (PFS) and objective response rate. Outcome measures were evaluated in the overall cohort and stratified by line and type of therapy and IMDC risk group. Statistical analyses were performed using Cox regression and Kaplan-Meier analysis. Results: We identified 4736 patients treated with either vascular endothelial growth factor (VEGF) targeted (n=3511), mammalian target of rapamycin (mTOR) targeted (n=665), or cytokine therapy (n=560), of which 5.0% (n=235) had PM at initiation of therapy. Median OS (mOS) in patients with PM was significantly prolonged compared to those without PM (Table). In a multivariate Cox regression model, this improvement in mOS remained statistically significant when adjusting for concurrent metastases to the lung, bone, or liver, line and type of therapy, and IMDC risk group. In further subgroup analysis, among patients with PM, superior mOS was noted in patients with favorable or intermediate IMDC risk, treatment naive patients, and treatment with VEGF inhibitors or cytokine therapy (Table). For the overall cohort, PFS was 10.9 vs 6.9 months for patients with and without PM (HR 0.72, 95% CI: 0.60, 0.86). Objective responses were higher in patients with PM vs those without PM (37% vs 24%, p&lt;0.01). Conclusions: The presence of PM in advanced RCC is an independent positive predictor for survival. This effect is pronounced in patients treated with VEGF inhibitors and IMDC favorable and intermediate risk disease. Unraveling the molecular determinates of pancreatic tropism in RCC will be important for personalizing therapy for patients. [Table: see text]
Survey on consultation length and waiting time of community general practice clinics
Authors: Haiyan Yu, Yun Wei, Guanghui Jin, Yali Zhao
Journal: BMJ (2019)

Objective
To survey the consultation length and waiting time of general practice clinics in community health service centers(CHSC).


Methods
Three CHSCs were selected from urban areas,urban-rural junction and rural areas Beijing Chaoyang District. The length of consultation,waiting time and the satisfaction of patients were surveyed by self-designed questionnaires among 373 patients visiting these three CHSCs between July to August 2018.


Results
In 364 patients who completed the questionnaire 69.0%(251/364) had a consultation length between 5 to 10 min, and the proportion of consultation length 30 min. The proportion of patients with waiting<5 min was the lowest (20.7%) in urban area. The distribution of consultion length was different among groups of the reason of consultion, frequently seen doctor and the familarity with the doctor(P<0.05). Most patients were satisfied with the length of consultation (85.4%) and waiting time (74.5%). The satisfaction of patients in urban areas with the consultation length (75.2%) and waiting time (49.6%) was lower than that in urban-rural junction and rural areas.


Conclusion
The consultation length in general practice clinics of CHSC is relatively short, but patients are basically satisfied with the current status of consultation length and waiting time.However, consultation length and wating time should be regularly monitared,to promote the quality of care in general practice clinics.


Key words: 
Community health service; General practice; Consultation length; Waiting time
氟比洛芬酯致抽搐和过敏性休克一例
Authors: 康新, 纪春阳, 韩莹旻, 路小光
Journal: BMJ (2011)

氟比洛芬酯(凯纷)可以选择性地聚集在手术切口、血管和炎症损伤部位,通过抑制前列腺素的合成发挥靶向镇痛效应,具有起效快,镇痛效果明显、持久,胃肠道不良反应少等优点[1].我院一例输尿管结石患者在使用氟比洛芬酯镇痛时引起过敏性休克伴抽搐。
Association between serum uric acid and blood pressure in patients aged over 80
Authors: Han Wang, Hui Jiang, Chenli Fang, Yingying Cai
Journal: BMJ (2014)

Three hundred and eighty two patients aged over 80, who visited outpatient clinic from 2009 to 2011, were enrolled in the study. Serum uric acid levels and blood pressure were measured. Spearman's correlation and logistic regression model were used for data analysis. Compared to patients with normal blood pressure, hypertensive patients had high levels of triglyceride (P=0.027). There were not significant differences in serum uric acid levels among patients with different levels of blood pressure (P=0.223; P=0.420; P=0.088). Serum uric acid was not correlated with systolic/diastolic blood pressure (r 0.005).


Key words: 
Aged, 80 and over; Uric acid; Blood pressure
Diagnosis of vestibular diseases
Authors: Shusheng Gong
Journal: BMJ (2018)

眩晕是前庭性疾病的主要症状。除眩晕外，前庭症状还包括头晕、前庭视觉症状、姿势症状。2015年国际眩晕疾病分类(ICVD)将前庭性疾病分为急性前庭综合征、发作性前庭综合征及慢性前庭综合征，临床诊断可以根据此分类的思路进行初步排查。临床医生需先了解各综合征包含的各种疾病的特征，即可进行综合征分类后，再进一步初步诊断。其中，急性前庭综合征需引起重视的是要首先排查急性脑血管病；发作性前庭综合征的重点是各种常见眩晕病的鉴别。
结核病的临床诊断
Authors: 肖和平
Journal: BMJ (2006)

结核病在我国仍属于常见性疾病,疫情的严重程度仅次于印度,位居世界第二,被我国以及世界卫生组织列为重点控制疾病之一.据估计,我国约有活动性肺结核病患者477万,其中涂片阳性159万,菌阳208万[1].我国有5.5亿人口感染了结核菌,明显高出全球1/3人口感染的水平,因此在结核病的临床诊断中肺结核的早期发现尤为重要。
First-line fluoropyrimidine and oxaliplatin chemotherapy in gastro-entero-pancreatic grade III well-differentiated neuroendocrine tumors (NET G3).
Authors: Giuseppe Lamberti, Sara Pusceddu, Toni Ibrahim, Alberto Bongiovanni, Natalie Prinzi, Ilaria Maggio, Davide Campana
Journal: Journal of Clinical Oncology (2020)

e16709 Background: The 2019 World Health Organization (WHO) classification of neuroendocrine neoplasia (NEN) introduced the new category of well-differentiated NEN with Ki67 proliferation index ≥20% (NET G3). Fluoropyrimidine-based regimens with oxaliplatin (FOLFOX/XELOX) were a treatment option in neuroendocrine carcinomas with low Ki67. However, FOLFOX/XELOX efficacy in this newly defined NET G3 category is unknown. Objective of this study was to describe FOLFOX/XELOX efficacy in NET G3 and identify factors associated with outcome. Methods: We retrospectively collected all metastatic gastro-entero-pancreatic NET G3 patients who received a fluoropyrimidine-based regimen with oxaliplatin (FOLFOX/XELOX) as first-line treatment at 4 NEN-dedicated Italian Centers. Concomitant somatostatin analog (SSA) treatment was allowed and recorded. Objective response rate (ORR) was defined according to RECIST criteria v1.1. Factors associated with progression-free survival (PFS), overall survival (OS), and ORR were analyzed. Results: Twenty-nine NET G3 patients (median age 57 years, range 18-79) matching inclusion criteria were identified. Twenty patients (69%) were of pancreatic origin, while 9 (31%) had gastrointestinal primary. Median Ki67 was 30% (range 21-50). Treatment was FOLFOX in 14 (48%) and XELOX in 15 patients (52%), while 12 (44%) received also concomitant SSA. After a median follow-up of 44.1 months, median PFS was 7.9 months (95%CI 6.2 -11.4) and median OS was 44.8 months (95%CI 37.1 - NA). The 12 patients whose tumor responded to treatment (44% [95%CI 26-65]) had longer PFS (26.5 vs 5.0 months; p = 0.004) and OS (194.0 vs 38.0 months; p = 0.04) compared to those who did not respond. Progressive disease was the best disease response in 7 patients (24%). Objective response was associated with a reduced risk for progression (HR: 0.22 [95%CI: 0.07-0.62]; p = 0.007) while higher Ki67 was associated with an increased risk for progression (HR: 1.11 [95%CI: 1.04-1.19]; p = 0.002) and for death (HR: 1.09 [95%CI: 1.01-1.17]; p = 0.017). After correcting for confounding factor, ORR (HR: 0.26 [95%CI: 0.08-0.83]; p = 0.023) and Ki67 (HR: 1.09 [95%CI: 1.02-1.16]; p = 0.009) retained their association with the risk for progression, but not with the risk for death. Conclusions: Fluoropyrimidine-based regimens with oxaliplatin (FOLFOX/XELOX) may be active and effective in NET G3 of gastroenteropancreatic origin.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): a review
Authors: Wei Feng, Wei Zong, Feng Wang, Shaoqing Ju
Journal: Molecular Cancer (2020)

Abstract In recent years, the prevalence and spread of coronavirus has had a huge impact on global public health. Due to the incomplete understanding of the pathogenic mechanism of the virus, it is difficult for humans to fight against the virus quickly and effectively once the outbreak occurs. In early 2020, a novel coronavirus was discovered in Wuhan, China. Soon after, similar cases were found in other countries around the world, and the number of infected people increased rapidly. So far, the global cumulative number of infected people has exceeded 3 million, and more than 200,000 people have died, which has had a huge impact on global human health and economic development. Every outbreak of disease makes a deep impression on mankind. Herein, we summarize the virology, epidemiology, clinical manifestations, diagnosis, treatment and prevention of SARS-CoV-2, and hope that countries can control the outbreak as soon as possible to minimize the loss.
Design and implementation of a core tool for quality evaluation of cancer care in 10 oncology institutions in Colombia.
Authors: Luis Eduardo Pino, Ivan Camilo Triana, Diana Potes, Henry JULIAN Cortes, Alejandra Alcantara, Angela Cuervo, Paola Vargas
Journal: Journal of Clinical Oncology (2020)

e19166 Background: Measuring quality in cancer care is a complex process due to the heterogeneity of the medical information and the biological complexity of the disease. There are different tools designed for this purpose, including the ASCO QOPI scale that includes core and specific dimensions for some types of cancer. In Colombia there is no specific quality tools in cancer for the evaluation of providers. Methods: This is an observational study. We designed and applied an oncology quality evaluation tool based in the SCO QOPI scale, but adapted to regional language and available technologies. This tool was based on six dimensions, each one weighted according to its relevance in the quality of cancer care (percentage in parentheses): Patient identification (5), oncologic history (25), physical exam (5), diagnostic tests (20), treatment plan (40) and readability (5).The tool was applied to four diseases: Breast cancer, colon cancer, non-small cell lung cancer (NSCLC) and multiple myeloma. 706 clinical cases were evaluated from 10 hospitals, both general and oncological. After evaluating each case, 171 met with the criteria, however, only 110 had complete clinical records. Four auditor physicians were trained by a clinical expert for each disease. Results: The distribution of cases by disease was: Breast cancer 51%, colon cancer 17%, multiple myeloma 22% and NSCLC 10%. Overall result of quality was 51% (maximum score: 100%) which was considered deficient according to the parameters of the tool. The best performance was obtained for cancer hospitals in Medellín (61%) and for a general hospital in Bogotá (56%). The best disease results were obtained in NSCLC (62,4%) and the worst in breast cancer (47%). These results, according to the dimension evaluated were: 33,6% Patient identification, 44,3% oncologic history, 58,2% physical exam, 71,7% diagnostic tests, 33,8% treatment plan and 98,2% readability. Conclusions: Although Medellin and Bogota had the highest comparative performance in this study, the overall results were low. Oncologic history and treatment plan showed deficiencies in their performance, which should be highlighted due to important items such as evaluation of functional scales (ECOG) and intentionality of interventions were considered within adequate decision making. This quality tool is a contribution to the specific evaluation of quality in oncology for countries like Colombia.
Pembrolizumab plus axitinib versus sunitinib as first-line therapy for advanced renal cell carcinoma (RCC): Updated analysis of KEYNOTE-426.
Authors: Elizabeth R. Plimack, Brian I. Rini, Viktor Stus, Rustem Gafanov, Tom Waddell, Dmitry Nosov, Frédéric Pouliot, Denis Soulieres, Bohuslav Melichar, Ihor Vynnychenko, Sergio Jobim Azevedo, Delphine Borchiellini, Raymond S. McDermott, Jens Bedke, Satoshi Tamada, Lina Yin, Mei Chen, L. Rhoda Molife, Michael B. Atkins, Thomas Powles
Journal: Journal of Clinical Oncology (2020)

5001 Background: The randomized, open-label, phase 3 KEYNOTE-426 study (NCT02853331) demonstrated that pembrolizumab (pembro) + axitinib (axi) significantly improved OS, PFS, and ORR vs sunitinib as first-line therapy for advanced RCC (aRCC) at the first pre-planned interim analysis (minimum study follow-up of 7 mo). Updated analyses are presented here. Methods: Treatment-naive patients (pts) with clear cell aRCC, KPS ≥70%, and measurable disease (RECIST v1.1) were randomly assigned 1:1 to receive pembro 200 mg IV Q3W for up to 35 doses + axi 5 mg orally BID or sunitinib 50 mg orally QD on a 4-wk on/2-wk off schedule until progression, toxicity, or withdrawal. Randomization was stratified by IMDC risk (favorable vs intermediate vs poor) and geographic region (North America vs Western Europe vs rest of world). Primary end points were OS and PFS. Secondary end points were ORR, DOR, and safety. All P values are nominal. A post-hoc exploratory analysis was done to evaluate association of depth of response (maximum reduction from baseline in sum of diameters of target lesions) and OS using landmark analysis up to 6 mo after randomization. Results: 861 pts were randomly assigned (pembro + axi, n = 432; sunitinib, n = 429). Median (range) duration of follow-up for all pts was 27.0 mo (0.1-38.4). Pembro + axi improved OS (HR, 0.68 [95% CI, 0.55-0.85]; P &lt; 0.001; 24-mo OS rate, 74% vs 66%) vs sunitinib. Median (95% CI) OS was not reached with pembro + axi and was 35.7 mo (33.3-NR) with sunitinib. Pembro + axi improved PFS (HR, 0.71 [95% CI, 0.60-0.84]; P &lt; 0.001; 24-mo PFS rate, 38% vs 27%) vs sunitinib. For pembro +axi vs sunitinib respectively, median (95% CI) PFS was 15.4 (12.7-18.9) vs 11.1 mo (9.1-12.5); ORR was 60% vs 40% ( P &lt; 0.0001); CR rate was 9% vs 3%; and median DOR was 23.5 mo (range 1.4+ to 34.5+) vs 15.9 mo (range 2.3-31.8+). In general, the pembro + axi benefit was observed in all subgroups tested, including IMDC risk and PD-L1 expression subgroups. Post-hoc landmark analysis at 6-mo showed that pts on pembro + axi with ≥80% target lesion reduction had OS similar to that of pts with CR per RECIST v1.1 based on Kaplan-Meier curves and HR [95% CI] estimates (0.20 [0.05-0.84] vs. 0.10 [0.01-0.76], respectively) vs pts with 0-30% target lesion reduction. No new safety signals were observed. Conclusions: Pembro + axi continued to demonstrate superior and durable antitumor activity vs sunitinib in pts with first-line aRCC with a 27-mo median follow up; no new safety signals were observed. Clinical trial information: NCT02853331 .
Real-world observation of the efficacy and prognostic factors analysis of apatinib for patients with advanced gastric cancer.
Authors: Qiwen Shen, Mingyun WANG, Xiaobao Peng, Siyi Tan, Jiaqi Xie, Juan Du, Qin Liu, Jia Wei, Baorui Liu, Yang Yang
Journal: Journal of Clinical Oncology (2020)

e15508 Background: Apatinib is the first oral anti-angiogenic agent approved for the treatment of advanced gastric cancer in China. With the development of marketing promotion, the real world observation of the efficacy and prognostic factors analysis of apatinib become the urgent need for clinical decision. The aim of this study is to evaluate the efficacy and safety of apatinib in patients with advanced gastric cancer, and the association between some prognostic factors and clinical outcomes. Methods: We collected the data of 153 patients with advanced gastric cancer, who were treated with apatinib after failure of at least one regimen chemotherapy from December 2014 to June 2019. Treatment response, progression-free survival(PFS), overall survival(OS) and treatment-related adverse events were evaluated. Results: The median PFS for 153 patients was 3.1m (95% confidence interval, CI 2.863-3.337). The median OS was 6.0m (95% CI 4.392-7.608). Adverse events of grade 3 or above happened in 47.6 percent of patients and 61.7 percent of whom stopped treatment. Multivariate analysis showed that the number of metastatic sites was the independent factor simultaneously predicting DCR (disease control rate, P = 0.008) and OS (P = 0.007). Patients spending more than one year from diagnosis to treatment with apatinib had better DCR (P = 0.032) and longer PFS (P = 0.015). Liver metastasis (P = 0.007) and combined systemic therapy (P = 0.036) were significantly associated with DCR, but not associated with PFS or OS. Conclusions: Some patients with advanced gastric cancer can benefit from apatinib. This study help us to identify patients who has potential benefit from apatinib.