tbuckley/cabot-search huggingface dataset:
The prevalence of fibroadenoma-like areas in malignant phyllodes tumors of the breast: A retrospective analysis from a referral center.
Authors: Carmine Valenza, Edoardo Olmeda, Francesca Maria Porta, Tommaso Martino De Pas, Aurora Gaeta, Grazia Castellano, Celeste Santoro, Elena Battaiotto, Giulia Chiappini, Dario Trapani, Sara Coppola, Fabio Conforti, Denise Mattar, Sara Gandini, Paolo Veronesi, Elena Guerini Rocco, Elisabetta Pennacchioli, Giuseppe Curigliano
Journal: Journal of Clinical Oncology (2024)

e23522 Background: Malignant phyllodes tumors of the breast (B-MPT) are supposed to arise de novo or to derive from a fibroadenoma/benign phyllodes tumor ("secondary"), through a MED12-dependent pathway. Secondary B-MPTs may be associated to better outcomes: both the history of previous fibroadenomas and the presence of MED12 mutations were demonstrated to be associated to improved recurrence-free survival, in small case series. We assessed the prevalence and the prognostic value of fibroadenoma-like areas (FLA) in the context of B-MPTs, which were described as potentially associated with MED12 mutations (Pareja, 2017). Methods: Single-center, retrospective, translational study conducted at European Institute of Oncology. Consecutive patients aged 18 years old or more, with non-metastatic B-MPT, who underwent surgery from Jan 2000 to Dec 2021, were included. FLA were defined as intracanalicular, pericanalicular or myxoid areas of low stromal cellularity, lacking cytologic atypia and mitotic activity. All specimens were reviewed by three pathologists. The endpoints were the cumulative incidences of distant and local recurrences. Results: 89 patients were included (Table). After a median follow-up of 6.4 years, 18 and 14 local and distant recurrences were registered, respectively. The cumulative incidences at 5-years of local and distant recurrences were 19% (95% Confidence Interval [CI], 11–28%) and 11% (95%CI, 5–18%). 47% of tumors had FLA, which were associated with lower ( &lt; 15/10HPF) mitoses (p = 0.05). No pathologic feature was associated with distant or local relapse. The presence of FLA areas was associated with fewer local recurrences, without reaching the statistical significance (p = 0.14); no difference in terms of distant recurrences emerged (p = 0.61). Conclusions: 47% of B-MPTs are characterized by FLAs, which are associated with a lower mitotic count. The association between FLAs and fewer local recurrences did not reach the threshold for statistical significance, probably due to the small number of events. The prognostic role of FLAs needs to be assessed in a larger cohort and may potentially enhance the selection of patients deserving postoperative treatment intensification. [Table: see text]
Atrial flutter in a patient population with cancer: Comparison of incidence, mortality, and readmission rates.
Authors: Muhammad Sohaib Afzal, Faryal Farooq, Manoj Kumar, Muhammad Sultan, Bilal Nasir, Vishal Devarkonda, Laxman Yashwant Byreddi, Sundeep Atluri, Shafaqat Ali
Journal: Journal of Clinical Oncology (2024)

e23079 Background: Cardiac tachyarrhythmias are common in cancer patients. Much has been studied regarding atrial fibrillation, but the impact of atrial flutter (AFL) in different malignancies is under-studied. We aim to compare the occurrence of atrial flutter (AFL), its mortality, and readmission rates in cancer patients stratified by different types. Methods: The National Readmission Database (2016-2020) was queried to identify all-cause admissions for patients with active malignancy of any origin. The study population was divided into six subgroups based on the type of cancer (colorectal, renal, lung, breast, prostate, and hematological). Multivariate regression analysis was utilized for adjusted odds of mortality. A propensity score matching (PSM) model matched malignancy of interest with other malignancies to obtain incidence rates. Results: Among 10.6 million all-cause cancer-related hospitalizations, about 0.4% developed AFL. After propensity matching, when compared to other malignancies, AFL had the highest incidence in hospitalizations associated with lung malignancies (0.75%), followed by hematological (0.66%), prostrate (0.57%), renal (0.49%), colorectal (0.38%) and breast (0.31%) malignancies [p &lt; 0.05]. Moreover, cancer hospitalizations complicated by AFL were associated with higher mortality. AFL was associated with the highest odds of mortality in colorectal malignancies (aOR:2.80), followed by hematological (aOR:2.67), renal (aOR:2.66), lung (aOR:2.22), breast (aOR:2.12), &amp; prostate (aOR:1.76) malignancies [p &lt; 0.001]. AFL was also associated with frequent readmissions in cancer patients. The rates of 30-day AFL-related recurrent admission were highest in lung malignancies (18.3%), followed by hematological (18%), renal (16.6%), prostate (15.1%), colorectal (14.7%) &amp; breast (14.2%) malignancies [p &lt; 0.05]. Conclusions: The incidence of AFL in nationwide hospitalizations among cancer patients was ~ 0.4%. AFL was found to have the highest incidence and readmission rates in lung malignancies, while AFL-related mortality was highest in colorectal malignancies.
Mental health prevalence in Brazil: Understanding anxiety and depression in southern Capixaba region.
Authors: Sabina B. Aleixo, Jose Zago Pulido, Narelle Parmanhane, Ana Arlete Sartoli, Ana Paula Siller
Journal: Journal of Clinical Oncology (2024)

e23295 Background: The rising significance of mental health issues and psychological distress among cancer patients has prompted an in-depth investigation. In the brazilian context, this crucial aspect remains largely unexplored, with limited available data and insufficient investment in understanding the psychosocial dimensions of cancer care. This study aims to generate brazilian-specific data to facilitate the development and implementation of targeted psychosocial interventions within cancer care. Methods: From August 1, 2023, to December 31, 2023, a random selection of 263 patients at a brazilian cancer center underwent assessment for signs and symptoms of anxiety and depression using the Anxiety and Depression Assessment Scale – HAD. This validated screening scale, comprising 14 Likert-type questions, features two subscales with seven items each to track anxiety and depression symptoms. Severity scores for each subscale range from zero to 21, with higher scores indicating increased anxiety and depression levels. In this study, interviewers assessed the severity of symptoms, employing scales ranging from 0 to 21. Three score levels were identified: mild (0-7), moderate (8-11), and high (12-21). Inclusion criteria encompassed age over 18, residency in the southern region of the State of Espírito Santo, a cancer diagnosis, and active treatment. Exclusion criteria included non-residency in th southern region of th state, lack of cancer diagnosis, and oncohematological treatments. Of the 263 eligible participants, 21 were excluded for not meeting inclusion criteria, and 16 declined to participate, resulting in a final sample of 226 patients. Results: The sample comprised 160 women, with 64.90% diagnosed with breast cancer and 35.10% with other neoplasms. Among the 66 men, 41% had prostate cancer and 59% had other neoplasms. Anxiety levels in women were mild (28%), moderate (24%), and high (48%), while in men, levels were mild (39%), moderate (21%), and high (53%). Depression levels in women were mild (42%), moderate (19%), and high (39%). Notably, six suicide attempts occurred among women before cancer diagnosis, and one occurred after diagnosis. Among men, depression levels were mild (47%), moderate (22%), and high (31%). With no history of attempts of suicide in the men population. Conclusions: The study's robust dataset provides compelling and valid information, unveiling a substantial prevalence of mental disorders within the analyzed populations. It emphatically underscores the critical need for tailored supportive care in addressing the unique psychosocial challenges faced by this demographic. Furthermore, the findings advocate for the urgent implementation of targeted psychosocial support interventions to enhance the overall well-being of individuals navigating the complex terrain of cancer and its associated mental health implications.
Adult genitourinary sarcomas: A single-centre experience over 25 years.
Authors: Abdul Baseet Arham, Michael A. O'Donnell, Sarah L. Mott
Journal: Journal of Clinical Oncology (2024)

e23532 Background: Genitourinary sarcomas are a rare entity. This study is a retrospective review of the patient characteristics, types of adult GU sarcomas, treatments and outcomes in a single institution over the past 25 years. Methods: Survival probabilities were estimated and plotted using the Kaplan-Meier method. Estimates along with 95% pointwise confidence intervals were reported. Recurrence-free survival (RFS) is defined as time from when the patient was disease-free to recurrence. Otherwise, patients were censored at last disease evaluation. OS was defined as time from when the patient was disease-free to death due to any cause. Patients still alive were censored at last known alive. Results: 29 patients presented with various types of GU sarcomas, with the majority being paratesticular tumors (n = 22, 75.9%). Others included bladder leiomyosarcomas (n = 5), prostatic leiomyosarcoma (n = 1), renal leiomyosarcoma (n = 1). Median age for diagnosis was 51 years (range: 21-79) for leiomyosarcoma vs 61 (range: 36-89) for liposarcoma. Among the paratesticular tumors majority were (n = 16) were liposarcoma, remaining 5 being leiomyosarcoma and 1 being rhabdomyosarcoma. Majority tumors were stage III and above (n = 16, 55.17%), high and intermediate grade (65.51%). All tumors were resected ± adjuvant therapy (n = 4). Leiomyosarcomas had a higher stage (66%) and grade (83%) at diagnosis, recurrence rate was also higher at 37.5% (vs 6.6% for liposarcoma) along with a higher mortality (41.6%). Commonest site of recurrence for leiomyosarcoma was the lungs (n = 3, 100%). Treatment for recurrence commonly involved radiotherapy, pembrolizumab etc. Paratesticular liposarcomas were found to be associated with a lipomatosis syndrome with n = 5 (31.25%) having lipomas elsewhere in the body and n = 2 (12.5%) patients having had previously resected spermatic cord lipoma. Paratesticular sarcomas often required (n = 15, 68%) revision surgery due to being initially diagnosed as a hernia, cord lipoma or hydrocele and requiring high ligation of the cord with hemiscrotectomy and radical orchiectomy ± LND on revision surgery, which often demonstrated a focus of residual tumor in liposarcomas (n = 5, 31%). N = 4 patients (25%) had positive margins in spite of revision surgery. Majority of these were MDM2+ positive on FISH (n = 9, 56%). Overall, GU sarcomas had an RFS of 63% (53-94%) and OS of 82% (53-94%) at 36 months since NED was achieved. The median length of follow-up was 19.9 months for leiomyosarcoma, 33.8 months for liposarcoma. Conclusions: Leiomyosarcomas in adults have worse outcomes compared to other GU sarcomas especially if it originates in the bladder. [Table: see text]
Trainee-led quality improvement (QI) project examining PCP prophylaxis in patients on chronic, high-dose corticosteroids.
Authors: Ian Schonman, Cole Harris Sterling, Kayla Garzio Baran, Kara M. Schenk, H. Catherine Wilbur, Yanka Campbell, Allen Ray Sing Chen, Kristen A. Marrone, S. M. Qasim Hussaini, Govind Warrier
Journal: Journal of Clinical Oncology (2024)

e23211 Background: Patients with cancer who develop Pneumocystis pneumonia (PCP) have 30-day mortality rates estimated to be &gt; 50%. Despite consensus guidelines from the American Society of Clinical Oncology (ASCO) and Infectious Diseases Society of America (IDSA), appropriate PCP prophylaxis is reported as low as 3.9% for patients with solid malignancies on chronic, high-dose corticosteroids. In this trainee-led QI initiative, we investigated rates of appropriate PCP prophylaxis at a tertiary care cancer center and surveyed clinicians regarding barriers to prescribing prophylaxis. Methods: An interprofessional, multidisciplinary team consisting of hematology-oncology fellows and cancer-center level QI staff was established. This analysis combined a retrospective chart review and survey at a tertiary care center. Retrospective chart review examined PCP prophylaxis rates among patients with solid malignancies prescribed high dose/duration corticosteroids per ASCO/IDSA guidelines (≥20mg prednisone equivalents daily for ≥1 month) between May 1, 2022 and May 31, 2023. The survey, conducted between December 2022 and May 2023, assessed prescriber knowledge of, and attitudes towards, appropriate PCP prophylaxis prescription. The survey was open to clinicians across oncology specialties. Results: Over the study period, 297 patients met inclusion criteria for PCP prophylaxis (median age 62, 178 (60%) were male, 212 (71%) were White, and 55 (18%) were Black). Fewer than half of eligible patients were prescribed prophylactic antibiotics (n = 140, 47%). There were no sociodemographic differences between patients prescribed prophylaxis and those not prescribed prophylaxis. Survey responses (n = 71) included 33 (46%) attending physicians, 21 (30%) advanced practice providers, 8 (11%) residents/fellows, and 9 (13%) unknown. Thirty participants (42%) had cared for a patient who developed PCP while on corticosteroids. While 62 participants (87%) had experience prescribing PCP prophylaxis, only 18 (25%) accurately identified the dose and duration of corticosteroids at which prophylaxis is needed. Lack of guideline knowledge/education was the most commonly cited barrier to prophylaxis (Table). Conclusions: Our study shows strikingly fewer than half of eligible patients on chronic, high-dose steroids were prescribed PCP prophylaxis. Lack of provider knowledge and systems-related obstacles were noted as primary barriers. Based on these findings, an urgent QI intervention is underway to address each barrier, increase rates of PCP prophylaxis, and reduce rates of PCP incidence towards the broader goal of improving outcomes in this at-risk patient population. [Table: see text]
Characterizing TP53 mutations in bone and soft tissue sarcoma.
Authors: Olayode Babatunde, Ryan Quin Notti, William D. Tap
Journal: Journal of Clinical Oncology (2024)

e23521 Background: Tumor protein P53 (TP53) is the most frequently mutated gene in cancer and most mutations inactivate wild type TP53 activity through heterogenous mechanisms. Whether different variants of mutant TP53 have different biologic potencies or clinical outcomes remain unclear. This ongoing study aims to characterize the spectrum of TP53 mutations in patients with bone and soft tissue sarcoma. Methods: We retrospectively identified and analyzed patients with bone and soft tissue sarcoma who underwent MSK-IMPACT (Memorial Sloan Kettering Cancer Center - Integrated Mutation Profiling of Actionable Cancer Targets) next-generation sequencing panel and had at least one mutation in the TP53 gene at Memorial Sloan Kettering Cancer Center. Mutations in the TP53 gene were categorized into the following sub-types: fusion, missense, splice site, or protein-truncating. Hotspots were defined as variants with frequency of 10 or greater. We queried the missense variants for the 800 most frequent variants recorded in the International Agency for Research on Cancer R20 (IARC), which were structurally characterized based on their impact on TP53 protein and rescue potencies with arsenic trioxide (ATO) in vitro (Song et al. Sci Transl Med. 2023). Results: We identified a total of 1257 patients with bone and soft tissue sarcoma who had at least one mutation in TP53. 92.5% of patients had only 1 mutation in TP53. In total, 1363 mutations were detected with 541 variants identified across all sarcoma subtypes. Most TP53 mutations were identified in soft tissue leiomyosarcoma (18.05%), uterine leiomyosarcoma (12.84%), sarcoma not otherwise specified (15.62%), undifferentiated pleomorphic sarcoma (12.11%), and osteosarcoma (7.78%). Of the 541 variants identified, the most frequent alterations were intragenic fusion (6.23%), R175H missense (2.93%), R248Q missense (2.27%), R273H missense (2.13%), and R213* protein-truncating (2.05%) mutations. Of the 800 most frequent missense variants in IARC R20 database, 233 missense variants were detected representing 52% of all mutations detected. Structural or likely structural mutations represented most of the identified missense mutations (77.46%). These mutations were clustered in the following hotspots: R175H, Y220C, R282W, H179Y, and C135Y. DNA-contact mutations were clustered in the following hotspots: R248Q, R273H, R273C, and R248W. Conclusions: This analysis highlights the heterogenous landscape of TP53 mutations in bone and soft tissue sarcomas. Structural variants are prevalent in sarcoma and occur at hotspots that may represent novel drug targets in the future.
Epithelioid hemangioendothelioma: Real-world data about a rare entity in a Portuguese tertiary cancer center.
Authors: Sara Cabral, Rita Freitas, Inês Dunões, Miguel Santos, Carolina Pereira, Patricia M. Pereira, Emanuel Jose Gouveia, Margarida Ferreira, Fatima H Vaz
Journal: Journal of Clinical Oncology (2024)

e23525 Background: Epithelioid hemangioendothelioma (EHE) is a rare entity of vascular origin, whose malignant potential is uncertain. It can develop in different locations, most commonly bone, liver and lungs. Since there are no specific associated symptoms, the diagnosis is often incidental. Due to its rarity there is no standard treatment. Our aim was to evaluate the demographic characteristics, course of disease and treatment effectivity in EHE patients in our institution in the last 25 years. Methods: We performed a retrospective study of all patients with EHE treated at our institution between January/1997 and September/2023. Statistical analysis was performed using SPSS. Normal distribution was checked using Shapiro-Wilk test. Results: From the 23 patients diagnosed with hemangioendothelioma, 20 were epithelioid (EHE) and 3 were other type. Of note, all the biopsies were centrally reviewed and since 2022 the diagnosis were confirmed with WWTR1 rearrange (3 out of 5 patients were positive). From the total number of EHE, the majority were women (n = 13, 65%). The mean age at diagnosis was 46 ± 22 years-old. Seven (35%) were asymptomatic and 13 (65%) had metastatic disease at diagnosis, all of them with lung metastasis, 2 (10%) with hepatic metastasis and 2 (10%) with bone metastasis. The most frequent primary locations were lungs (n = 5, 25%); soft tissue (n = 5, 25%), and liver (n = 4, 20%), followed by bone (n = 2,10%), stomach (n = 1, 5%), parotid gland (n = 1, 5%), superior vena cava (n = 1, 5%) and one case of unknown primary EHE. The majority of tumors were multifocal (12, 60%). Eight (40%) patients were under active surveillance, 4 (20%) underwent surgery with or without adjuvant radiotherapy, 2 (10%) underwent systemic treatment with tyrosine kinase inhibitor (pazopanib) and 2 (10%) chemotherapy (paclitaxel, doxorubicin). Two (10%) patients received a liver transplant and 2 (10%) patients underwent multiple treatment modalities. With a median follow-up of 30.89 months (3-253), 6 (30%) patients were dead at the time of analysis and mean overall survival was 142.3 months. Patients with an angiosarcoma differentiation had significantly worse mean survival outcomes (p &lt; 0.001), 7.9 ± 4.5 months vs. 158.9 ± 37.2 months. Conclusions: The biological behavior of these tumors remains uncertain. In our cohort, the majority of patients presented with distant metastasis, but the course of the disease was very heterogeneous, regardless of the primary or metastatic site or the treatment modality. Our data emphasizes that this disease should be managed on a case-by-case basis, with a multidisciplinary approach and tailored treatment and surveillance.
Factors predicting surgical receipt in extracranial rhabdoid tumors.
Authors: Marlaena Nicole Nooney, Jasleen Kaur Chaddha, Peter T. Silberstein
Journal: Journal of Clinical Oncology (2024)

e23541 Background: Extracranial rhabdoid tumors (ERTs) are a very rare and aggressive carcinoma that grow in a wide range of tissues, including but not limited to the lungs, kidneys, muscles, skin, and other soft tissues. These tumors most commonly present in infants between 11-18 months old, with an estimated annual incidence of less than 1 per million in the United States. Metastasis is common, and average survival time after diagnosis is approximately 5 years. Though most patients appear to undergo tumor resection at the primary site, a standardized treatment protocol for ERTs has not yet been developed. This study aimed to analyze the factors predicting receipt of this surgery. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with SEF from 2004 to 2020 using histology code 8963 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA Chi-Square, and Logistic Regression tests were performed, and data were analyzed using SPSS version 29. Statistical significance was set at α = 0.05. Results: 208 patients with extracranial rhabdoid tumors formed the initial sample. Of these patients, 128 patients (61.5%) received surgery at the primary site. 80 patients (38.5%) did not have tumor resection. Median overall survival of surgical patients was significantly higher than nonsurgical patients ( 91.6 months vs. 32.1 months, p &lt; 0.001). Head, neck, and face, were the most common primary tumor sites (25.4%). Wider surgical margins were associated with improved outcomes ( p &lt; 0.05). On nominal regression, stage I, II, and III disease, grade 1 and 2, and younger age were associated with increased likelihood of receiving surgery ( p &lt; 0.05). Metastasis to distant sites was associated with decreased likelihood of receiving surgery ( p &lt; 0.05). Treatment at an academic facility, income status, tumor size, insurance status, and race were not significant predictors of receiving surgery. 77 patients (37%) received adjuvant chemotherapy, 1 patient received adjuvant radiation, and 4 patients received adjuvant chemoradiation. 121 patients (58.2%) did not receive adjuvant therapy. Conclusions: Resection of the primary tumor in ERT is associated with improved overall survival. Younger age, stage I, II, or III disease, and grade 1 or 2 disease are factors predicting a higher likelihood of receiving surgery. Improved outcomes of tumor resection are associated with wider surgical margins. The presence of metastasis decreased likelihood of undergoing surgery. Treatment location, insurance, status, race, income, and tumor size did not affect surgery receipt. Interestingly, the majority of patients sampled did not receive any adjuvant therapies, such as chemotherapy or radiation. Future research should continue delineating what factors predict both receipt of surgery and improved surgical outcomes, as well as better understand what the role of adjuvant therapies is in managing ERT.