tbuckley/cabot-search huggingface dataset:
Clinicopathologic features and prognostic analysis of stage IB-IIA cervical adenosquamous carcinoma and adenocarcinoma
Authors: Wanli Wu
Journal: BMJ (2016)

Objective
To analyze the clinicopathologic features and prognosis of early stage cervical adenosquamous carcinoma and adenocarcinoma. 


Methods
Clinical data of 62 patients with cervical adenosquamous carcinoma, 149 patients with adenocarcinoma and 2 687 patients with squamous carcinoma of stage ⅠB-ⅡA, who received surgical treatment and adjuvant radiotherapy from June 2006 to February 2012 were retrospectively analyzed. The Chi-square test, Kaplan-Meier method, log-rank test and logistic regression were used for statistical analysis. 


Results
In patients with adenosquamous carcinoma, adenocarcinoma and squamous carcinoma, the rates of lymph node metastasis were 33.6% (50/149), 29.0% (18/62) and 22.0% (591/2 687), deep stromal invasion were 64.4% (96/149), 75.8%(47/62) and 55.3% (1 486/2 687) and corpus invasion were 26.2%(39/149), 25.8%(16/62) and 6.7%(181/2 687), respectively. Those pathological parameters in adenosquamous carcinoma and adenocarcinoma were higher than those in squamous carcinoma (χ2=12.170, P=0.002; χ2=14.660, P=0.001; χ2=97.732, P=0.000). There were no difference between adenocarcinoma and adenosquamous carcinoma in proportion of massive tumor (≥4 cm)[38.9%(58/149) vs. 35.5(22/62), χ2=0.220, P=0.639], lymph node metastasis (χ2=0.410, P=0.522), corpus invasion (χ2=0.003, P=0.956), deep stromal invasion (χ2=2.595, P=0.107) and low differentiation[38.9%(58/149) vs. 48.4%(30/62), χ2=1.612, P=0.204]. The median follow-up period was 45 (3-92) months. Multivariate analysis showed that corpus invasion (P=0.014, RR=3.393, 95%CI: 1.280-8.991), age (P=0.000, RR=1.077, 95%CI: 1.037-1.117) and stage (P=0.007, RR=0.275, 95%CI: 0.108-0.699) were prognostic factors of adenosquamous carcinoma. Age (P=0.006, RR=1.025, 95%CI: 1.007-1.043) and lymph node metastasis (P=0.000, RR=2.525, 95%CI: 1.547-4.120) affected the prognosis of adenocarcinoma. The median survival times for adenocarcinoma, adenosquamous carcinoma and squamous carcinoma were 45, 46 and 56 months (adenosquamous carcinoma vs. squamous carcinoma: χ2=1.347, P=0.246; adenosquamous carcinoma vs. adenocarcinoma: χ2 =1.808, P=0.179). There were no difference in recurrence rates between adenosquamous carcinoma and squamous carcinoma[14.0%(7/50) vs. 7.6%(175/2 298), χ2=1.968, P=0.161], and between adenosquamous carcinoma and adenocarcinoma[14.0%(7/50) vs. 22.1%(27/122), χ2=1.478, P=0.224]. 


Conclusions
Clinicopathologic features are similar between stage ⅠB-ⅡA cervical adenosquamous carcinoma and adenocarcinoma. Corpus invasion, age and stage are the leading indicators affecting the prognosis of adenosquamous carcinoma. Age and lymph node metastasis are the factors affecting the prognosis of adenocarcinoma. There are no difference in survival and prognosis between adenosquamous carcinoma and adenocarcinoma.


Key words: 
Uterine cervical neoplasms; Adenocarcinoma; Adenosquamous carcinoma; Pathological conditions, signs and symptoms; Prognosis
Pegfilgrastim versus filgrastim in the supportive care of heavily pretreated multiple myeloma in treatment with pomalidomide-dexamethasone.
Authors: Claudio Cerchione, Giovanni Martinelli, Davide Nappi, Anna Emanuele Pareto, Gerardo Musuraca, Alessandro Lucchesi, Fabrizio Pane, Lucio Catalano
Journal: Journal of Clinical Oncology (2020)

e20514 Background: Pegfilgrastim is a pegylated long-acting recombinant form of G-CSF that extends the half-life and allows for once-per-cycle dosing, requiring less frequent dosing than nonpegylated G-CSF. The objective of this study was to compare the efficacy and safety of pegfilgrastim in patients affected by heavily pretreated MM, treated with pomalidomide-dexamethasone, in order to determine whether a single subcutaneous injection of pegfilgrastim is as effective as daily injections of standard filgrastim, in terms of haematological toxicity, febrile neutropenic episodes, antibiotic usage and hospedalization duration. Methods: We enrolled 57 patients (31 M, 26 F) median age at diagnosis 69 years (r. 52-84), and median age at start of treatment 76 years (r.56-90) treated with several lines of treatments (median 7, r. 2-12), every refractory to all the drugs previously received, received Pomalidomide-Dexamethasone (P 4 mg for 21 days, D 40 mg days 1,8,15,22, pegfilgrastim day +8) every 28 days, until progression. Results: Since first course, received in domestic setting, with a very good compliance, patients performed blood counts once weekly and received, day +8 to day +19, prophylactic oral chinolonic antibiotics and anti-fungal drugs. During neutropenia after first cycle, Filgrastim (5 μgr/kg/day for 3 d) was given if neutrophils count was &lt; 1500 x 10^9 cells/L. Median number of filgrastim administrations was 4.6 (r. 3-6); nadir neutropenia was registered after a median of 10.4 days (r. 7-14); median of nadir neutrophil count was 1.13 x 10^9 cells/L (r.0.3–1.5), with maximum duration of 14 days. From the second course, all patients switched to pegfilgrastim (6 mg), injected subcutaneously with a single administration on day +3 independently from the neutrophil count at that time. During pegfilgrastim, neutropenia was never longer than 8 days, with a consequent reduction of neutropenia-related infections. Median nadir neutrophil count, evaluated for every patients for at least three courses of therapy (r. 3-6) registered at day +11, was 1.28 (r.0.9-2.2). Only 4 patients needed a supplement of 3 administrations of filgrastim. Pegfilgrastim was well tolerated in all patients: main side effects were mild fever and bone pain (21.2%). Conclusions: In conclusions, in patients affected by heavily pretreated MM treated with pomalidomide-dexamethasone, pegfilgrastim seems to reduce the incidence of severe neutropenia and infections and may increase the possibility to maintain the scheduled time of treatment.
A phase II trial of the Wee1 inhibitor adavosertib (AZD1775) in recurrent uterine serous carcinoma.
Authors: Joyce F. Liu, Niya Xiong, Susana M. Campos, Alexi A. Wright, Carolyn N. Krasner, Susan T. Schumer, Neil S. Horowitz, Jennifer Taylor Veneris, Nabihah Tayob, Stephanie Morrissey, Gabriela West, Roxanne Quinn, Ursula A. Matulonis, Panagiotis A. Konstantinopoulos
Journal: Journal of Clinical Oncology (2020)

6009 Background: Uterine serous carcinoma (USC) is an aggressive subtype of endometrial carcinoma characterized by TP53 mutations ( &gt; 90%), often concomitantly with oncogenic mutations or amplifications that can increase replication stress. As such, USC may therefore be uniquely sensitive to further interference of cell cycle regulation by Wee1 inhibition. This two-stage single arm Phase 2 study was conducted to assess the activity of the Wee1 inhibitor adavosertib as monotherapy in recurrent USC. Methods: Women with recurrent USC (defined as non-carcinosarcoma uterine cancers with any serous component) were eligible. Patients (pts) were required to have had at least one prior platinum-based chemotherapy regimen; those with known MSI-H/MMRd disease were required to have received prior PD1/PDL1 therapy or to be ineligible for such therapy. There was no upper limit on the number of prior lines pts could have received. All pts were required to have RECIST measurable disease. Pts received adavosertib 300mg daily on days 1 through 5 and 8 through 12 of a 21-day cycle. Coprimary endpoints were objective response and progression-free survival at 6 months (PFS6). Results: Between OCT-11-2018 and SEP-30-2019, 35 pts enrolled on study. Median follow-up is 4.6 months. The median number of prior lines was 3 (range 1-8). 34 pts were considered evaluable for response. In these pts, 9 confirmed and 1 unconfirmed responses were observed, for an ORR of 29.4% (95% CI 15.1-47.5%). The PFS at 6 months was 58.7% (95% CI: 39.5-73.7%). The median PFS is 6.1 months and the median duration of response is 9.0 months. Frequently observed Grade 3 or higher related adverse events included neutropenia (32.3%), anemia (20.6%), and fatigue (23.5%). Immunohistochemistry and targeted next-generation sequencing were performed to investigate potential biomarkers of response. Conclusions: Adavosertib monotherapy demonstrates promising clinical activity in women with USC. The observed monotherapy activity is higher than in other diseases, and additional exploration of the biology of Wee1 inhibition in USC is needed. Further studies of adavosertib in this patient population are planned. Clinical trial information: NCT03668340.
Prognostic value of circulating nucleosomes in primary breast cancer.
Authors: Michal Mego, Katarina Kalavska, Marian Karaba, Gabriel Minarik, Juraj Benca, Tatiana Sedlackova, Denisa Manasova, Daniel Pindak, Jozef Mardiak, Peter Celec
Journal: Journal of Clinical Oncology (2020)

e12553 Background: Nucleosomes are composed of DNA wound around histone proteins and represent the basic structural unit of chromatin in the nucleus. When cells die, nucleosomes get out of the cell and end eventually in the circulation. Plasma nucleosomes might serve as a non-specific biomarker of cell death, which might be of particular interest for non-invasive tumor monitoring. The aim of this study was to assess the prognostic value of circulating nucleosomes in primary breast cancer. Methods: This study included 92 primary breast cancer patients treated with surgery from March 2012 to February 2015, for whom plasma isolated on the day before surgery was available in the biobank. Plasma nucleosomes were detected using Cell Death Detection ELISA kit with anti-histone and anti-DNA antibodies. Results: Circulating nucleosomes were associated with the systemic inflammatory index (0.17 vs. 0.27, P = 0.02) and with aldehyde-dehydrogenase expression (0.22 vs. 0.15, P = 0.03). Patients with lower than mean nucleosomes had significantly better disease-free survival (HR = 0.46, P = 0.05). The prognostic value was most pronounced in lymph node positive disease with high proliferation rate and in patients with detectable circulating tumor cells with epithelial-to-mesenchymal transition, but negative for epithelial circulating tumor cells. In a multivariate analysis, nucleosomes, hormone receptor status, HER2 status, lymph node involvement and tumor grade were independent predictors of disease-free survival. Conclusions: Our data suggest prognostic value of plasma nucleosomes in primary breast cancer and their association with metastatic ability and stem-cell ness characteristics. Their quantification could be added to the established prognostic markers.
Impact of empirically eliminating 5-fluorouracil (5-FU) bolus and leucovorin (LV) in patients with metastatic colorectal cancer (mCRC) receiving first-line treatment with mFOLFOX6.
Authors: Alexa Basilio, Anand Shah, Katelyn Sommerer, Sarah Chehab, Salvatore Michael Bottiglieri, Iman Imanirad
Journal: Journal of Clinical Oncology (2020)

4022 Background: Systemic chemotherapy with a 5-FU-based regimen, such as mFOLFOX6, is the preferred first line treatment option for mCRC. Due to hematologic toxicities associated with the 5-FU bolus component, providers may choose to eliminate it empirically in patients receiving palliative therapy. This study aimed to assess the impact of empirically eliminating the 5-FU bolus and LV from first line treatment with mFOLFOX6 in mCRC. Methods: This was a retrospective chart review of patients ≥ 18 years old with mCRC receiving palliative first line mFOLFOX6 chemotherapy with (bolus) or without (non-bolus) the 5-FU bolus and LV components from January 1, 2015 through August 31, 2019 at Moffitt Cancer Center. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS), disease control rate (DCR) defined as partial response and stable disease at first scan, utilization of growth factor support and safety. Results: Data analysis cutoff was December 31, 2019, with 61 patients included in the bolus arm and 72 in the non-bolus arm. Median follow-up time was 21.8 months. No difference was found in median PFS (8.12 vs. 6.64 months, p=0.787) or OS (29.36 vs. 21.6 months, p=0.395) between the bolus and non-bolus arms, respectively. Observed DCR at first scan was similar between both arms (47.3% vs. 52.7%, p=0.44). Utilization of growth factor support was significantly higher in the bolus arm (73.7% vs. 26.3%, p=0.012). Fewer grade ≥ 3 treatment-related hematologic adverse events (AE) were seen in the non-bolus arm (37.7% vs. 22.2%, p=0.058) (table). Conclusions: This is the only study to date that analyzed the impact of empirically eliminating 5-FU bolus and LV from first line palliative therapy with mFOLFOX6 in mCRC. Results showed no significant difference in median PFS or OS. Despite reduced growth factor utilization, the non-bolus arm demonstrated a favorable safety profile with less treatment-related hematologic grade ≥ 3 AE. The results of this study warrant consideration of empirically eliminating 5-FU bolus and LV from the mFOLFOX6 regimen to avoid additive toxicities without negatively impacting efficacy. [Table: see text]
A retrospective chart review evaluating the relationship between cancer diagnosis and drinking water source on the Lower Eastern Shore of Maryland.
Authors: Angela Marie DeRidder, Sowjanya Kalluri, Veera Holdai
Journal: Journal of Clinical Oncology (2020)

e13587 Background: The lower Eastern Shore of Maryland is an agricultural and rural region with high cancer rates. The purpose of this retrospective study was to determine if cancer patients on the lower Eastern Shore utilize higher rates of well water compared to individuals in the general county population. Methods: A retrospective chart review of all cases of colon, lung, melanoma and breast cancer diagnosed at Peninsula Regional Medical Center in 2017 was completed. Demographic and clinical information including family, smoking and prior cancer history, as well as residential water source were recorded. Individuals with residential addresses outside of Wicomico, Worcester and Somerset counties were excluded. Overall well water use for each county was determined using U.S. 2010 census data. Fisher’s exact test was used to compare well water utilization rates in cancer patients and the overall county population. Results: 631 patient cases were reviewed and 384 patients were identified for data analysis. The majority of patients were white (81%), diagnosed with breast cancer (41%), and used well water (52%, n = 209). Cancer patients in the three counties combined were significantly more likely to use well water than individuals in the general county population (OR = 2.5, 95% CI 2.11, 3.16). In Wicomico county, 61% of cancer patients used well water (n = 140). Wicomico cancer patients were more likely to use well water than individuals in the general Wicomico county population (OR = 4.4, 95% CI 3.41, 5.78). No significant findings were observed for patients living in Worcester and Somerset counties. No differences in family, smoking or prior cancer history in patients using well water versus municipal water were identified. Conclusions: Cancer patients on the lower Eastern Shore of Maryland used well water more than municipal water. Cancer patients also utilized higher rates of well water compared to individuals in the general county population. Interpretation is limited by small sample size and lack of causality, however the results signal a need for additional studies evaluating well water use and cancer risk in this region.
枣仁安神液能治疗所有失眠吗
Authors: 郝伟欣
Journal: BMJ (2010)

工作的繁忙、生活节奏的加快、竞争的激烈加重了人们的心理负担,使许多现代人患上了失眠症.失眠会导致心情压抑、情绪低落、郁闷沮丧、悲观失望、反应迟缓、头痛、记忆力下降,其最大的影响在精神层面,严重者会产生抑郁、焦虑、恐惧、敏感多疑和精神障碍,令人痛苦不堪。
Stereotactic body radiotherapy for early-stage non-small cell lung cancer in patients with subclinical interstitial lung disease.
Authors: Min Hu, Xiaojiang Sun, Yuanjun Liu, Yaoyao Zhu, Qinghua Xu, Fangjuan Li, Hui Liu, Yaping Xu, Denghu Weng, Qingren Lin
Journal: Journal of Clinical Oncology (2020)

e21050 Background: Stereotactic body radiotherapy (SBRT) is a highly focused radiation treatment, which is now recommended to treat non-small cell lung cancer (NSCLC) patients with early stage disease. The purpose of this study is to evaluate the efficacy and toxicity of SBRT for early stage NSCLC patients with subclinical interstitial lung disease (ILD). Methods: One hundred and nine patients with early stage NSCLC were treated with SBRT between December 2011 and August 2016 in our institution; patients with subclinical (untreated and oxygen-free) ILD were treated with SBRT, while those with clinical ILD (post- or under treatment) were not. The median SBRT dose was 50 Gy in 5 fractions and the median biologically effective dose (BED; α/β = 10) was 100 Gy (range:72-119 Gy). The presence of subclinical ILD in the pre-SBRT CT findings was reviewed by two chest radiologists. The relationships among the efficacy, radiation pneumonitis (RP) and clinical factors were investigated. Results: Subclinical ILD was recognized in 38 (35%) of 109 patients. Grade 2–4 RP was recognized in 48 (44%) of 109 patients, no Grade 5 RP was happened. Grade 2–4 RP was observed in 17 (45%) of 38 patients with subclinical ILD. Subclinical ILD was not found to be a significant factor influencing Grade 2–4 RP; however, extensive RP beyond the irradiated field, including the contralateral lung, was recognized in only two patients who were both suffering from subclinical ILD, and the rate of extensive RP was significantly high in the patients with subclinical ILD. Dosimetric factors of the lungs (V5, V10, V20, MLD, V12.5, V13.5) were significantly associated with Grade 2–4 RP. The three-year overall survival and progression-free survival rates of all patients were 82.8% and 62.5%, respectively. No significant differences were seen in either overall survival or progression-free survival rates among the patients with ILD and those without ILD, or with RP and those without RP. Conclusions: Subclinical ILD was not found to be a significant factor for Grade 2–5 RP or clinical outcomes in early stage NSCLC treated with SBRT; however, uncommon extensive RP can occur in patients with subclinical ILD.
阻塞性睡眠呼吸暂停低通气综合征的临床表现
Authors: 张立强
Journal: BMJ (2005)

阻塞性睡眠呼吸暂停低通气综合征(OSAHS)是以睡眠时反复上气道塌陷导致打鼾、频繁呼吸暂停及呼吸浅慢、低氧血症、睡眠中断、白天嗜睡为主要表现的临床综合征.OSAHS对机体的损害复杂而广泛,可导致多器官、多系统受损,因此其临床表现既包括OSAHS本身的症状、体征,也包括其合并症的表现。
Patient-reported use of marijuana and cannabinoid (CBD) oil in patients with renal cell carcinoma undergoing systemic therapy.
Authors: Dena Battle, Cristiane Decat Bergerot, Pavlos Msaouel, Tian Zhang, Daniel J. George, Michael D. Staehler
Journal: Journal of Clinical Oncology (2020)

5084 Background: The use of cannabis and cannabinoid related products has become increasingly common among cancer patients. We sought to gather independent data from online kidney cancer patient communities to assess frequency of use of marijuana and CBD-oil and estimate influence on treatment duration and side-effects. Methods: The KCCure online survey was performed between August 1, and September 30, 2019. Descriptive statistics were used to characterize patients who self-report using marijuana, their systemic treatments, and interactions with their oncologists. Results: Out of 1,136 patients responding, 411 patients were on systemic therapy with a median age of 57 years (28-86). Of the 441 patients with systemic therapy, 223 patients (54%) were male. There was no difference in gender distribution or race among patients who reported using or not using marijuana and or CBD oil. 93 patients (21%) reported using marijuana or CBD oil and 35 patients (8.5%) reported using both. Patients using marijuana and/or CBD oil had a median age of 55.7 +/- 1.1 years compared with patients not using (65.1 +/- 6.9 years). The median treatment duration was 23.9+/-2.4 months for patients using marijuana and/or CBD oil versus 26.4+/- 1.9 months for patients not using these supplements (p=0.437). Patients using marijuana and/or CBD oil were more likely to have bothersome side effects from therapy (p=0.001) and were less likely to talk to their doctor about their situation (p=0.044). The median NCCN distress score in patients using marijuana and/or CBD oil was 49.5+/-25.7 versus 51.4+/-24.0 (p n.s.). No correlation was seen with the use of steroids, anti-diarrhea drugs, anti-nausea-drugs, hormone substitution or other drugs used to manage side effects. Conclusions: Marijuana and/or CBD oil are used by a significant number of patients. No benefit/harm on treatment duration and use of concomitant drugs to control side effects and severity was seen. Patients using marijuana and/or CBD oil were more likely to report bothersome treatment related side effects and were more willing to report their side effects to their provider. As cannabinoids become more mainstream and legal in a number of states, more research is needed to better understand the impact these supplements may have on patients.
Has Medicaid expansion improved access to care among socioeconomically disadvantaged breast cancer patients? An NCDB analysis.
Authors: Leah Elson, Nadeem Bilani, Elizabeth Blessing Elimimian, Zeina A. Nahleh
Journal: Journal of Clinical Oncology (2020)

e19003 Background: For socioeconomically disadvantaged individuals without insurance, expenses related to diagnosis and management of chronic conditions, such as cancer, may be too costly to afford. This contributes to diagnoses made at later stages of disease, and inadequate treatment compliance. These factors are reported to lead to unfavorable clinical outcomes and higher mortality risk, historically making uninsured/Medicaid-ineligible patients an especially vulnerable group. With recent Affordable Care Act-related Medicaid expansion, state adoption allows new access to coverage for individuals with income &lt;138% of the federal poverty limit. Therefore, we sought to understand how Medicaid expansion has affected demographic coverage and access to care among socioeconomically disadvantaged breast cancer patients. Methods: The data presented herein was extrapolated from a 2004-2016 NCDB breast cancer population. Sociodemographic and clinical data was evaluated for a sample of Medicaid-enrolled patients, diagnosed during pre- and post-expansion years. Results: In Medicaid-expanded states, there was a significantly increased utilization of Medicaid insurance (24.3% vs. 13.2%; p&lt;0.001), and a significant trend towards an increased proportion of Hispanic enrollment in Medicaid (21.1% vs. 11.8%; p&lt;0.001) than in non-expanded states. In non-expanded states, there was a larger proportion of black patients (p&lt;0.001), and patients who live further from diagnostic centers (p&lt;0.001), in more rural areas (p&lt;0.001), with lower education levels (p&lt;0.001). The total study population of Medicaid-enrolled patients was n=42,217; the total comparative uninsured population was n=13,133. Medicaid-enrolled patients were observed to have more timeliness to systemic treatment following diagnosis (85.6 vs. 87.6 days; p=0.021), and were 40% less likely to be diagnosed with late-stage disease (p&lt;0.001) than uninsured patients. Conclusions: Medicaid expansion may be associated with a less diagnosis at late stages, more timeliness to treatment, and more Hispanic coverage, which may prove to be a positive paradigm shift in cancer outcomes for underserved and underinsured groups. Several socioeconomic factors already identified as being independently associated with poor outcomes are more prevalent in the non-expanded state populations compared to the expanded states. Therefore, while benefits have been noted in patients of expanded states, many breast cancer populations still remain vulnerable in the post-expansion era.