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Moten AS. Fibrosis following neoadjuvant treatment of PDAC: Less is not always more. Am J Surg 2024; 232:8. [PMID: 38092641 DOI: 10.1016/j.amjsurg.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 05/15/2024]
Affiliation(s)
- Ambria S Moten
- Surgical Oncology, Complex Upper GI/HPB Surgery, Packnett Family Cancer Institute, Parkview Health, 11050 Parkview Circle, Fort Wayne, IN, USA.
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Moten AS, Grande P, Hendrix A, Fleming MD. Early-stage breast cancer treatment disparities in the Midsouth: Has anything changed? Am J Surg 2023; 226:447-454. [PMID: 37438176 DOI: 10.1016/j.amjsurg.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND We sought to determine if racial disparities in treatment and survival persist among patients with breast cancer in the Midsouth. METHODS Patients with early-stage breast cancer were identified in the tumor registry of a large healthcare system in the Midsouth. Regression analyses were performed to determine how race was associated with receipt of treatment and mortality. RESULTS Among 4605 patients, 38.8% were Black. Black patients were less likely to undergo surgery (OR = 0.71; 95%CI 0.53-0.97) and receive hormone therapy (OR = 0.81; 95%CI 0.69-0.95) than White patients, but more likely to receive radiation (OR = 1.20; 95%CI 1.08-1.40) and chemotherapy (OR = 1.36; 95%CI 1.16-1.61). Among Black patients, the risk of mortality was lower among those who underwent partial (OR = 0.25; 95%CI 0.12-0.51) or total (OR = 0.35; 95%CI 0.16-0.76) mastectomy and among those who received hormone therapy (OR = 0.62; 95%CI 0.40-0.97). CONCLUSION There remains room for improvement in providing treatments that optimize survival among this patient population.
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Affiliation(s)
- Ambria S Moten
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Payton Grande
- The University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA
| | - Ashley Hendrix
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Martin D Fleming
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA.
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Moten AS, Dickson PV, Deneve JL, Shibata D, Stanfill AG, Glazer ES. Impact of Social Determinants of Health on Outcomes Following Resection for Hepatocellular Carcinoma. Ann Surg Oncol 2023; 30:738-747. [PMID: 36319871 DOI: 10.1245/s10434-022-12735-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 10/10/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND We sought to determine the impact of social determinants of health (SDoH) on outcomes of patients undergoing resection for hepatocellular carcinoma (HCC). PATIENTS AND METHODS Patients with HCC in the National Cancer Database who underwent resection from 2009 to 2018 were identified. SDoH associated with length of stay (LOS), 30-day readmission, and 30-day mortality were analyzed using regression analyses adjusted for confounding variables. RESULTS Among 9235 patients, the median age (range) was 65.0 (18-90) years, 72.1% were male, and 57.9% were White. A total of 3% were uninsured, 11.1% had Medicaid, 21% resided in regions with a median household income within the lowest quartile of the US population, and 27.0% resided in regions within the lowest quartile of education level. The odds for having longer LOS were lower among patients with the highest regional education level compared with those with the lowest level [odds ratio (OR) 0.86, 95% confidence interval (CI) 0.77-0.97]. The risk of readmission was lower among patients with Medicare (OR 0.52; 95% CI 0.33-0.81), Medicaid (OR 0.52; 95% CI 0.31-0.87), or private insurance (OR 0.56; 95% CI 0.35-0.88) compared with uninsured patients. Thirty-day overall mortality was less likely among patients with Medicare (OR 0.45; 95% CI 0.27-0.75), Medicaid (OR 0.53; 95% CI 0.30-0.93), or private insurance (OR 0.40; 95% CI 0.24-0.66), and among patients with high regional income (OR 0.58; 95% CI 0.44-0.77). CONCLUSIONS Adjusted regression analyses identified SDoH that were associated with HCC outcomes. Increased awareness of how SDoH relate to outcomes may inform strategies that attempt to account for these associations and improve patient outcomes.
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Affiliation(s)
- Ambria S Moten
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Paxton V Dickson
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jeremiah L Deneve
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - David Shibata
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA.,Center for Cancer Research, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ansley G Stanfill
- Department of Acute and Tertiary Care, College of Nursing, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Evan S Glazer
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA. .,Center for Cancer Research, College of Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA.
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Moten AS, Dickson PV, Deneve JL, Shibata D, Stanfill AG, Glazer ES. ASO Visual Abstract: The Impact of Social Determinants of Health on Outcomes After Resection for Hepatocellular Carcinoma. Ann Surg Oncol 2023; 30:748-749. [PMID: 36418797 DOI: 10.1245/s10434-022-12841-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ambria S Moten
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Paxton V Dickson
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jeremiah L Deneve
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - David Shibata
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
- Center for Cancer Research, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ansley G Stanfill
- Department of Acute and Tertiary Care, College of Nursing, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Evan S Glazer
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
- Center for Cancer Research, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
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Moten AS, Lau KN. Pancreatic Adenocarcinoma Treatment and Outcomes At An Urban Academic Center. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.07.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Moten AS, Fagenson AM, Pitt HA, Lau KN. Recent Improvements in Racial Disparity in the Treatment of Hepatocellular Carcinoma: How Times Have Changed. J Gastrointest Surg 2021; 25:2535-2544. [PMID: 33547582 DOI: 10.1007/s11605-021-04912-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/10/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Race has been shown to impact receipt of and outcomes following hepatobiliary surgery. We sought to determine if racial disparities in the management of hepatocellular carcinoma persist. METHODS Information on patients with hepatocellular carcinoma diagnosed between 2012 and 2016 was obtained from the Surveillance, Epidemiology, and End Results database. The sample was stratified by race/ethnicity, and associations between tumor characteristics, treatment, and survival were assessed. RESULTS Of 33,672 patients, the mean age was 65 years, and 77% were male. By race, 17,150 (51%) were white, 4755 (14%) black, 6850 (20%) Hispanic, and 4917 (15%) Asian. When assessing the likelihood of treatment versus no treatment for tumors less than 5 cm, no difference was observed between whites and blacks in any year, but Hispanics were less likely than whites to receive treatment in most years. Asians were more likely to receive treatment every year. When assessing the likelihood of transplant versus surgical resection, blacks were less likely than whites to undergo transplant in all years except 2016. Hispanics were equally likely, while Asians were less likely to undergo transplant in all years. For years 2012 to 2016 collectively, Asians had better 5-year survival rates than other races after undergoing ablation and resection. No difference in the risk of death was observed among blacks, whites, or Hispanics after undergoing ablation, resection, or transplant. CONCLUSION Racial disparities for blacks and Hispanics have improved. Although Asians were less likely to undergo transplant, they had better survival after undergoing resection or ablation.
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Affiliation(s)
- Ambria S Moten
- Department of Surgery, Temple University Hospital, 3401 N Broad St, Philadelphia, PA, 19140, USA
| | - Alexander M Fagenson
- Department of Surgery, Temple University Hospital, 3401 N Broad St, Philadelphia, PA, 19140, USA
| | - Henry A Pitt
- Department of Surgery, Rutgers-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ, 08901, USA
| | - Kwan N Lau
- Department of Surgery, Temple University Hospital, 3401 N Broad St, Philadelphia, PA, 19140, USA.
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Fagenson AM, Pitt HA, Moten AS, Karhadkar SS, Di Carlo A, Lau KN. Fatty liver: The metabolic syndrome increases major hepatectomy mortality. Surgery 2020; 169:1054-1060. [PMID: 33358472 DOI: 10.1016/j.surg.2020.11.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 11/01/2020] [Accepted: 11/17/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND As the obesity epidemic worsens, the prevalence of fatty liver disease has increased. However, minimal data exist on the impact of combined fatty liver and metabolic syndrome on hepatectomy outcomes. Therefore, the aim of this analysis is to measure the outcomes of patients who do and do not have a fatty liver undergoing hepatectomy in the presence and absence of the metabolic syndrome. METHODS Patients with fatty and normal livers undergoing major hepatectomy (≥3 segments) were identified in the 2014 to 2018 American College of Surgeon National Surgical Quality Improvement Program database. Patients undergoing partial hepatectomy and those with missing liver texture data were excluded. Propensity matching was used and adjusted for multiple variables. A subgroup analysis stratified by the metabolic syndrome (body mass index ≥30 kg/m2, hypertension and diabetes) was performed. Demographics and outcomes were compared by χ2 and Mann-Whitney tests. RESULTS Of 2,927 hepatectomies, 30% of patients (N = 863) had a fatty liver. The median body mass index was 28.6, and the metabolic syndrome was present in 6.3% of patients (N = 184). After propensity matching, 863 patients with fatty and 863 with normal livers were compared. Multiple outcomes were significantly worse in patients with fatty livers (P <.05), including serious morbidity (32% vs 24%), postoperative invasive biliary procedures (15% vs 10%), organ space infections (11% vs 7.8%), and pulmonary complications. Patients with fatty livers and the metabolic syndrome had significantly increased postoperative cardiac arrests, pulmonary embolisms, and mortality (P < .05). CONCLUSION Fatty liver disease is associated with significantly worse outcomes after major hepatectomy. The metabolic syndrome confers an increased risk of postoperative mortality.
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Affiliation(s)
| | - Henry A Pitt
- Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Ambria S Moten
- Department of Surgery, Temple University Hospital, Philadelphia, PA
| | | | - Antonio Di Carlo
- Department of Surgery, Temple University Hospital, Philadelphia, PA
| | - Kwan N Lau
- Department of Surgery, Temple University Hospital, Philadelphia, PA.
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Moten AS, von Mehren M, Reddy S, Howell K, Handorf E, Farma JM. Treatment Patterns and Distance to Treatment Facility for Soft Tissue Sarcoma of the Extremity. J Surg Res 2020; 256:492-501. [PMID: 32798997 PMCID: PMC10034971 DOI: 10.1016/j.jss.2020.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/14/2020] [Accepted: 07/11/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The impact that distance traveled to receive treatment has on treatments and outcomes among patients with soft tissue sarcoma (STS) of the extremity has yet to be thoroughly investigated. METHODS Information on patients treated for STS of the extremity between 2006 and 2015 was obtained from the National Cancer Database. Patients were stratified into two groups based on median distance traveled to receive treatment. Chi-square tests assessed associations between categorical variables and distance to treatment. Kaplan-Meier survival estimates and Cox regression were used to estimate survival. RESULTS The sample included 21,763 patients. The mean age was 59.3 y, 54.6% were men, and 83.2% were white. The median distance traveled to the treating facility was 15.6 miles. Compared with patients who traveled <15 miles, those who traveled ≥15 miles were more likely to have undifferentiated rather than well-differentiated tumors (odds ratio [OR], 1.23; 95% confidence interval [95% CI], 1.10-1.37), and stage II rather than stage I disease (OR, 1.14; 95% CI, 1.04-1.24). They were also more likely to undergo limb-sparing resection (OR, 1.58; 95% CI, 1.39-1.79) or amputation (OR, 1.72; 95% CI, 1.44-2.07) rather than no surgery and less likely to have positive margins (OR, 0.86; 95% CI, 0.79-0.93). There was no difference in the risk of death between patients who traveled ≥15 miles and those who did not (hazard ratio, 1.00; 95% CI, 0.94-1.07). CONCLUSIONS Although clinical characteristics and treatments may differ based on distance traveled, survival appears equivalent. Further research into reasons why greater distance traveled is associated with more advanced disease, but comparable survival is warranted.
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Affiliation(s)
- Ambria S Moten
- Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania.
| | - Margaret von Mehren
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Sanjay Reddy
- Department of Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Krisha Howell
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Elizabeth Handorf
- Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jeffrey M Farma
- Department of Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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Moten AS, Ouyang W, Hava S, Zhao H, Caroline D, Abbas A, Dass C. In vivo measurement of esophageal hiatus surface area using MDCT: description of the methodology and clinical validation. Abdom Radiol (NY) 2020; 45:2656-2662. [PMID: 31667547 DOI: 10.1007/s00261-019-02279-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE Accurate estimation of esophageal hiatus surface area (HSA) prior to surgical repair of hiatal hernia is difficult. The ability to do so may assist with following progression of hiatal hernias, choosing the optimal surgical approach and post-surgical evaluation. We developed a method for measurement of HSA using multi-planar reconstruction (MPR) of multi-detector computed tomography (MDCT) scans and sought to validate our method using intra-operative HSA measurements. METHODS Patients with thoracic or abdominal CT scans who were scheduled to undergo hiatal hernia repair were identified. A radiologist performed MPR of each MDCT scan to obtain the measured HSA (mHSA). Estimated HSA (eHSA) was obtained using intra-operative measurements of crura length and distance between crural edges. The association between eHSA and the corresponding mHSA was assessed using Pearson correlation. The intra-class correlation coefficient was calculated to assess both intra-observer and inter-observer agreement for the MDCT-MPR technique. RESULTS Of 30 subjects included, 16 (53.3%) were female and the median age was 68.5 years. All patients underwent robotic-assisted laparoscopic hiatal hernia repair. The median HSA was 8.1 cm2 based on intra-operative measurements and 9.9 cm2 based on CT measurements. The correlation coefficient for eHSA and corresponding mHSA was 0.83 (p < 0.001). The intra-class correlation coefficient was 0.97 (p < 0.001) for intra-observer agreement and 0.97 (p < 0.001) for inter-observer agreement. CONCLUSION We developed a MDCT-MPR technique that measures HSA in vivo. This technique is reproducible and can be used for pre-operative planning and post-operative follow-up of patients with symptomatic hiatal hernia.
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Moten AS, Abbas AE. Pneumonectomy is necessary following delayed detection of pulmonary artery compromise. Interact Cardiovasc Thorac Surg 2020; 30:154-155. [PMID: 31535125 DOI: 10.1093/icvts/ivz225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/15/2019] [Accepted: 08/20/2019] [Indexed: 11/12/2022] Open
Abstract
It has been previously suggested that lung tissue remains viable without blood supply from the pulmonary artery (PA). However, our experience demonstrates otherwise. We present 2 cases of accidental left lower lobe PA occlusion during upper lobectomy causing ischaemic changes to the remaining lung tissue. Both patients became septic secondary to necrosis of infarcted lung and required completion pneumonectomy. Development of collateral circulation to bypass the occluded PA may occur but is often insufficient to support the affected lung tissue. Unless the patient is medically unfit, resection of the ischaemic lung should be undertaken.
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Affiliation(s)
- Ambria S Moten
- Department of Surgery, Temple University Hospital, Philadelphia, PA, USA
| | - Abbas E Abbas
- Department of Thoracic Medicine and Surgery, Temple University School of Medicine, Philadelphia, PA, USA
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Moten AS, Zhao H, Intenzo CM, Willis AI. Disparity in the use of adjuvant radioactive iodine ablation among high-risk papillary thyroid cancer patients. Eur J Surg Oncol 2019; 45:2090-2095. [DOI: 10.1016/j.ejso.2019.06.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/20/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022] Open
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Lou J, Moten AS, Reddy SS, Howell KJ, Movva S, von Mehren M, Farma JM. Retroperitoneal Sarcomas: Does Laterality Matter? J Surg Res 2019; 244:34-41. [PMID: 31279261 DOI: 10.1016/j.jss.2019.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 04/17/2019] [Accepted: 05/08/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Sarcomas are malignant tumors of connective tissue that can vary widely in etiology. Parameters such as grade, extent of resection, and tumor integrity have been shown to affect prognosis. Our principal aim was to examine associations between the laterality of retroperitoneal sarcomas and tumor characteristics, treatment, and patient outcomes. MATERIALS AND METHODS We performed a retrospective study of patients treated at our tertiary referral center with a diagnosis of primary retroperitoneal sarcoma who underwent tumor resection. Categorical variables were compared using the chi-square test, whereas continuous variables were compared using one-way analysis of variance. Cox regression was used to estimate the risk of death. RESULTS Data from 106 patients were analyzed. A greater proportion of bilateral or midline tumors were leiomyosarcomas (P = 0.02), whereas right-sided tumors were more likely to be liposarcoma (P = 0.02). There was no significant relationship between laterality and tumor grade or stage. Two-thirds of patients had at least one contiguous organ resected (n = 68, 65.4%). Patients with nephrectomy during sarcoma resection were more likely to have right-sided disease (P = 0.02). Splenectomy and pancreatectomy were associated with left-sided disease (P < 0.01; P < 0.01), and pancreaticoduodenectomies with bilateral or midline disease (P < 0.001). Adjusting for age, sex, race, grade, stage, histology, and treatment, there was no increased risk of death or recurrence based on laterality. CONCLUSIONS Although laterality did not seem to have a measurable relationship with patient outcomes or survival, there was a significant association between laterality, tumor histology, and resection of contiguous organs. These preliminary findings warrant further investigation.
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Affiliation(s)
- Johanna Lou
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Ambria S Moten
- Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - Sanjay S Reddy
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Krisha J Howell
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Sujana Movva
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Margaret von Mehren
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jeffrey M Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
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Moten AS, Zhao H, Howell K, Nadler A, Reddy SS, von Mehren M, Movva S, Farma JM. Soft tissue sarcoma of the extremity: Characterizing symptom duration and outcomes. Surg Oncol 2019; 29:190-195. [PMID: 31196487 DOI: 10.1016/j.suronc.2019.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 05/12/2019] [Accepted: 05/18/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND We sought to investigate how the interval between symptom onset and diagnosis of soft tissue sarcoma (STS) of the extremity was associated with survival. METHODS Patients treated for extremity STS years 2006-2015 were stratified by symptom duration: at least two, six or twelve months between symptom onset and diagnosis. Chi-square tests compared patient and tumor-related characteristics based on symptom duration. Survival analysis included Cox regression and Kaplan-Meier estimates. RESULTS Of 113 patients included, mean age was 56.7 years, 52.2% were male, and 75.2% were white. Median tumor size was 75 mm, 48.7% were grade 3, and 38.1% were stage I. With symptom duration of either at least 6 or 12 months, a greater proportion of patients who experienced the specified symptom duration had lower grade tumors (p < 0.01 and p = 0.01, respectively) and lower stage disease (p < 0.01 and p = 0.02, respectively) than those who did not. Among all patients, survival estimates were similar between those who experienced a symptom duration of 2 (p = 0.12), 6 (p = 0.18) or 12 (p = 0.61) months and those who did not. CONCLUSION Patients with extremity STS who tolerated a longer symptom duration had less advanced disease. Reasons for prolonged symptom duration and methods to address these factors warrant further investigation.
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Affiliation(s)
- Ambria S Moten
- Temple University Hospital, Department of Surgery, 3401 N Broad St, Philadelphia, PA, 19140, United States.
| | - Huaqing Zhao
- Lewis Katz School of Medicine at Temple University, Department of Clinical Sciences, 3500 N Broad St, Philadelphia, PA, 19140, United States
| | - Krisha Howell
- Fox Chase Cancer Center, Department of Radiation Oncology, 333 Cottman Ave, Philadelphia, PA, 19111, United States
| | - Ashlie Nadler
- Fox Chase Cancer Center, Department of Surgery, 333 Cottman Ave, Philadelphia, PA, 19111, United States
| | - Sanjay S Reddy
- Fox Chase Cancer Center, Department of Surgery, 333 Cottman Ave, Philadelphia, PA, 19111, United States
| | - Margaret von Mehren
- Fox Chase Cancer Center, Department of Hematology/Oncology, 333 Cottman Ave, Philadelphia, PA, 19111, United States
| | - Sujana Movva
- Fox Chase Cancer Center, Department of Hematology/Oncology, 333 Cottman Ave, Philadelphia, PA, 19111, United States
| | - Jeffrey M Farma
- Fox Chase Cancer Center, Department of Surgery, 333 Cottman Ave, Philadelphia, PA, 19111, United States
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Moten AS, Goldberg AJ. Malignant Phyllodes Tumors of the Breast: Association Between Race, Clinical Features, and Outcomes. J Surg Res 2019; 239:278-283. [PMID: 30897515 DOI: 10.1016/j.jss.2019.01.054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 11/05/2018] [Accepted: 01/24/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND We sought to investigate associations between race, clinical characteristics, and outcomes among patients with malignant phyllodes of the breast. METHODS Malignant phyllodes cases were identified using Surveillance Epidemiology and End Results database. We used chi-square tests to compare characteristics between racial groups and multinomial logistic regression to calculate relative risk ratios (RRR) and 95% confidence intervals (CI) comparing the likelihood of having particular characteristics by race. Survival analyses included Cox regression and Kaplan-Meier functions. RESULTS Among 1202 patients included, mean age was 51.7 y and 55.2% were white. Compared to whites, blacks were younger (mean age 45.7 versus 55.1 y; P < 0.001), and more likely to have tumors 51-100 mm (RRR = 1.91; 95% CI: 1.20-3.05) and tumors > 100 mm (RRR = 2.52; 95% CI: 1.56-4.05) than tumors ≤ 50 mm in size. Compared to whites, Hispanics were younger (mean age 46.7 versus 55.1 y; P < 0.001), and more likely to have tumors 51-100 mm (RRR = 1.46; 95% CI: 1.01-2.11) than tumors ≤ 50 mm in size. Asians were more likely to have tumors 51-100 mm (RRR = 1.52; 95% CI: 1.01-2.30) and tumors > 100 mm (RRR = 1.61; 95% CI: 1.03-2.52) than tumors ≤ 50 mm in size, and more likely to have tumors that extended beyond the breast tissue (RRR = 1.87; 95% CI: 1.05-3.31), compared to whites. Survival was similar for blacks (HR = 1.48; 95% CI: 0.80-2.76), Hispanics (HR = 1.02; 95% CI: 0.54-1.93), and Asians (HR = 1.13; 95% CI: 0.63-2.01) compared to whites. CONCLUSIONS Further research into factors contributing to extensive disease at presentation among minorities is warranted.
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Affiliation(s)
- Ambria S Moten
- Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - Amy J Goldberg
- Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.
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Moten AS, Zhao H, Wu H, Farma JM. Malignant granular cell tumor: Clinical features and long-term survival. J Surg Oncol 2018; 118:891-897. [PMID: 30196562 DOI: 10.1002/jso.25227] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 08/13/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Malignant granular cell tumor GCT (mGCT) has not been well described. We sought to investigate associations between tumor characteristics, treatments and survival. METHODS Patients diagnosed with mGCT years 1995-2014 were identified using the Surveillance, Epidemiology and End Results database. Descriptive statistics regarding tumor and treatment characteristics were calculated. Chi-square tests determined associations between tumor location and features. Survival analyses included Kaplan-Meier functions and Cox proportional hazard ratios (HR). RESULTS Of 113 patients included, median age was 54 years and 77.0% were female. Frequent tumor sites included soft tissues (36.3%), ovary/testis (16.8%), and skin (11.5%). Median tumor size was 4.0 cm. Metastases to regional lymph nodes (12.5%) and distant sites (11.4%) occurred. Treatments included surgery (85.0%), radiotherapy (12.4%) and chemotherapy (8.9%). Overall five and 10-year cause-specific survival was 74.3% and 65.2%, respectively. Survival was worse for patients with tumors >5 cm compared to those with tumors ≤5 cm (HR = 34.03; 95% confidence interval [CI]: 2.57-450.17), and patients with metastasis (HR = 15.25; 95% CI: 1.19-195.72) compared with those without metastasis. Patients who underwent surgery had superior survival than those who did not (HR = 0.13; 95% CI: 0.05-0.34). CONCLUSIONS Particular tumor features and treatments are associated with superior survival. This information may be used to more accurately estimate prognosis.
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Affiliation(s)
- Ambria S Moten
- Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - Huaqing Zhao
- Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Hong Wu
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jeffrey M Farma
- Department of Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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Moten AS, Movva S, von Mehren M, Wu H, Esnaola NF, Reddy SS, Farma JM. Granular cell tumor experience at a comprehensive cancer center. J Surg Res 2018; 226:1-7. [DOI: 10.1016/j.jss.2018.01.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 12/10/2017] [Accepted: 01/17/2018] [Indexed: 12/20/2022]
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17
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Moten AS, Jayarajan SN, Willis AI. Spindle cell carcinoma of the breast: a comprehensive analysis. Am J Surg 2016; 211:716-21. [PMID: 26830716 DOI: 10.1016/j.amjsurg.2015.11.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 11/12/2015] [Accepted: 11/13/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Breast spindle cell malignancies are rare. No standard treatment exists. METHODS The Surveillance, Epidemiology, and End Results database was used to identify patients with breast spindle cell malignancies, 1992 to 2011. Descriptive statistical analysis and survival analysis were performed. RESULTS A total of 286 patients were identified (98.6% female). Approximately, 15% had estrogen receptor-positive tumors and 12.5% had progesterone receptor-positive tumors. Nearly 38% underwent partial mastectomy, whereas 55.5% underwent mastectomy. The frequency of partial mastectomy has increased in more recent years. One-third received radiation. Lymph node metastases were infrequent (9.3%) and distant metastases were uncommon (6.1%). Ten-year survival rates for patients with early-stage (I and II) disease were 83.9% after partial mastectomy, 86.7% after partial mastectomy plus radiation, and 71.6% after complete mastectomy. Three-year survival rates for patients with late-stage (III and IV) disease were low with 40.0% after complete mastectomy and 0% after complete mastectomy plus radiation. CONCLUSIONS This nationally representative analysis demonstrates that early-stage spindle cell carcinoma of the breast is adequately treated by partial mastectomy. Radiation may be considered for small, potentially early survival benefit. For late stage disease, complete mastectomy is appropriate; however, survival is poor, and radiation contributes no significant additional benefit.
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Affiliation(s)
- Ambria S Moten
- Department of Surgery, Temple University School of Medicine, Philadelphia, PA, USA
| | - Senthil N Jayarajan
- Department of Surgery, Temple University School of Medicine, Philadelphia, PA, USA
| | - Alliric I Willis
- Department of Surgery, Temple University School of Medicine, Philadelphia, PA, USA.
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Moten AS, Thibault DP, Willis AW, Willis AI. Demographics, disparities, and outcomes in substernal goiters in the United States. Am J Surg 2016; 211:703-9. [PMID: 26813846 DOI: 10.1016/j.amjsurg.2015.11.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 11/12/2015] [Accepted: 11/23/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Disparities distinguishing patients with substernal goiters from nonsubsternal goiters have not been thoroughly described. METHODS The National Inpatient Sample database was used to compare patients who underwent substernal thyroidectomy years 2000 to 2010 with those who underwent thyroidectomy for nonsubsternal goiter. RESULTS A total of 110,889 patients underwent thyroidectomy for goiter (5,525 substernal and 105,364 nonsubsternal). Substernal thyroidectomy patients were older, more likely to be Black or Hispanic and to have Medicare insurance. They had a higher comorbidity index, were more likely to be admitted emergently and to have postoperative complications such as hemorrhage/hematoma, pneumothorax, pulmonary embolism, and hypocalcemia/hypoparathyroidism. Furthermore, substernal thyroidectomy patients had 73% increased odds of death during admission than nonsubsternal thyroidectomy patients. CONCLUSIONS Substernal goiters present a distinct type of goiter with identifiable patient-level characteristics and an increased risk of postoperative complications and death. Earlier identification and treatment of goiters may allow earlier interventions at a stage when risks are reduced.
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Affiliation(s)
- Ambria S Moten
- Department of Surgery, Temple University School of Medicine, Philadelphia, PA, USA
| | - Dylan P Thibault
- University of Pennsylvania Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA, USA
| | - Allison W Willis
- University of Pennsylvania Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA, USA
| | - Alliric I Willis
- Thyroid and Parathyroid Surgery Program, Department of Surgery, Thomas Jefferson University, 1100 Walnut St., Suite 500, Philadelphia, PA, USA.
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