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Cioffi G, Waite KA, Price M, Neff C, Kruchko C, Ostrom QT, Barnholtz-Sloan JS. The impact of COVID-19 on 2020 monthly incidence trends of primary brain and other CNS tumors. Neuro Oncol 2024; 26:764-774. [PMID: 38167948 PMCID: PMC10995517 DOI: 10.1093/neuonc/noad235] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND To mitigate disease spread, restrictions implemented in the United States surrounding the COVID-19 pandemic created an environment that led to delays in cancer diagnosis. The data needed to accurately analyze the impact of the pandemic on brain and CNS tumor incidence has not been available until now. Utilizing incidence data from the Central Brain Tumor Registry of the United States (CBTRUS) we analyzed the impact of the COVID-19 pandemic on primary brain and other CNS tumor incidence for the first year of the pandemic. METHODS Monthly age-adjusted incidence rates and incidence trends for 2019 and 2020 were determined for age at diagnosis, sex, race, ethnicity, diagnostic confirmation, behavior, tumor histopathology, and county-level urbanization. Monthly incidence rate ratios comparing 2020 and 2019 were evaluated for the same factors. RESULTS Overall, there was a notable decrease in incidence rates in March-May 2020 when compared to 2019. These decreases were driven by nonmalignant tumors, with a 50% incidence decrease between March 2020 and 2019. Individuals who were Black had a larger incidence decrease in early 2020 than individuals who were White. Radiographically confirmed tumors saw larger incidence decreases than histologically confirmed tumors. There were no changes in monthly incidence of glioblastoma in 2020 compared to 2019. CONCLUSIONS These data provide evidence that disruptions in medical care, such as governmental and health care mandates, in response to the COVID-19 pandemic resulted in an overall decreased incidence of primary brain tumors in early 2020.
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Affiliation(s)
- Gino Cioffi
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Kristin A Waite
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Mackenzie Price
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Corey Neff
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Quinn T Ostrom
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jill S Barnholtz-Sloan
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Bethesda, Maryland, USA
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Dmukauskas M, Cioffi G, Waite KA, Sloan AE, Neff C, Price M, Ostrom QT, Barnholtz-Sloan JS. Sex differences in adverse events in Medicare individuals ≥ 66 years of age post glioblastoma treatment. J Neurooncol 2024:10.1007/s11060-024-04652-z. [PMID: 38563855 DOI: 10.1007/s11060-024-04652-z] [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: 02/16/2024] [Accepted: 03/16/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Glioblastoma (GB) is the most common primary malignant brain tumor with the highest incidence occurring in older adults with a median age at diagnosis of 64 years old. While treatment often improves survival it brings toxicities and adverse events (AE). Here we identify sex differences in treatment patterns and AE in individuals ≥ 66 years at diagnosis with GB. METHODS Using the SEER-Medicare dataset sex differences in adverse events were assessed using multivariable logistic regression performed to calculate the male/female odds ratio (M/F OR) and 95% confidence intervals [95% CI] of experiencing an AE adjusted for demographic variables and Elixhauser comorbidity score. RESULTS Males with GB were more likely to receive standard of care (SOC; Surgery with concurrent radio-chemotherapy) [20%] compared to females [17%], whereas females were more likely to receive no treatment [26%] compared to males [21%]. Females with GB receiving SOC were more likely to develop gastrointestinal disorders (M/F OR = 0.76; 95% CI,0.64-0.91, p = 0.002) or blood and lymphatic system disorders (M/F OR = 0.79; 95% CI,0.66-0.95, p = 0.012). Males with GB receiving SOC were more likely to develop cardiac disorders (M/F OR = 1.21; 95% CI,1.02-1.44, p = 0.029) and renal disorders (M/F OR = 1.65; 95% CI,1.37-2.01, p < 0.001). CONCLUSIONS Sex differences for individuals, 66 years and older, diagnosed with GB exist in treatment received and adverse events developed across different treatment modalities.
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Affiliation(s)
- Mantas Dmukauskas
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Gino Cioffi
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Kristin A Waite
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Andrew E Sloan
- Neuroscience Service Line and Piedmont Brain Tumor Center, Piedmont Health, Atlanta, GA, USA
| | - Corey Neff
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
| | - Mackenzie Price
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
| | - Quinn T Ostrom
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA
| | - Jill S Barnholtz-Sloan
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA.
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Shady Grove Campus 9609 Medical Center Dr, 20850, Rockville, MD, USA.
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Neff C, Price M, Cioffi G, Waite KA, Kruchko C, Iorgulescu JB, Barnholtz-Sloan JS, Ostrom QT. The impact of the COVID-19 pandemic on treatment patterns in glioblastoma. Neuro Oncol 2024; 26:581-583. [PMID: 38159269 PMCID: PMC10912000 DOI: 10.1093/neuonc/noad234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Affiliation(s)
- Corey Neff
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mackenzie Price
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Gino Cioffi
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Trans-Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, Maryland, USA
| | - Kristin A Waite
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Trans-Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, Maryland, USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - J Bryan Iorgulescu
- Molecular Diagnostics Laboratory, Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jill S Barnholtz-Sloan
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Trans-Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, Maryland, USA
- Center for Biomedical Informatics & Information Technology (CBIIT), National Cancer Institute, Bethesda, Maryland, USA
| | - Quinn T Ostrom
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, North Carolina, USA
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Bihn JR, Cioffi G, Waite KA, Kruchko C, Neff C, Price M, Ostrom QT, Swinnerton KN, Elbers DC, Mooney MA, Rachlin J, Stein TD, Brophy MT, Do NV, Ferguson RE, Priemer DS, Perl DP, Hickman RA, Nabors B, Rusiecki J, Barnholtz-Sloan JS, Fillmore NR. Brain tumors in United States military veterans. Neuro Oncol 2024; 26:387-396. [PMID: 37738677 PMCID: PMC10836768 DOI: 10.1093/neuonc/noad182] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND Comprehensive analysis of brain tumor incidence and survival in the Veteran population has been lacking. METHODS Veteran data were obtained from the Veterans Health Administration (VHA) Medical Centers via VHA Corporate Data Warehouse. Brain tumor statistics on the overall US population were generated from the Central Brain Tumor Registry of the US data. Cases were individuals (≥18 years) with a primary brain tumor, diagnosed between 2004 and 2018. The average annual age-adjusted incidence rates (AAIR) and 95% confidence intervals were estimated per 100 000 population and Kaplan-Meier survival curves evaluated overall survival outcomes among Veterans. RESULTS The Veteran population was primarily white (78%), male (93%), and between 60 and 64 years old (18%). Individuals with a primary brain tumor in the general US population were mainly female (59%) and between 18 and 49 years old (28%). The overall AAIR of primary brain tumors from 2004 to 2018 within the Veterans Affairs cancer registry was 11.6. Nonmalignant tumors were more common than malignant tumors (AAIR:7.19 vs 4.42). The most diagnosed tumors in Veterans were nonmalignant pituitary tumors (AAIR:2.96), nonmalignant meningioma (AAIR:2.62), and glioblastoma (AAIR:1.96). In the Veteran population, survival outcomes became worse with age and were lowest among individuals diagnosed with glioblastoma. CONCLUSIONS Differences between Veteran and US populations can be broadly attributed to demographic composition differences of these groups. Prior to this, there have been no reports on national-level incidence rates and survival outcomes for Veterans. These data provide vital information that can drive efforts to understand disease burden and improve outcomes for individuals with primary brain tumors.
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Affiliation(s)
- John R Bihn
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Gino Cioffi
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Kristin A Waite
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Corey Neff
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mackenzie Price
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Quinn T Ostrom
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Danne C Elbers
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Michael A Mooney
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jacob Rachlin
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Thor D Stein
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University, Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Mary T Brophy
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University, Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Nhan V Do
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University, Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Ryan E Ferguson
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University, Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - David S Priemer
- Department of Pathology, Uniformed Services University School of Medicine, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for The Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Daniel P Perl
- Department of Pathology, Uniformed Services University School of Medicine, Bethesda, Maryland, USA
| | - Richard A Hickman
- Henry M. Jackson Foundation for The Advancement of Military Medicine, Bethesda, Maryland, USA
- Human Oncology and Pathogenesis Program, Sloan Kettering Institute, New York, New York, USA
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Burt Nabors
- Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jennifer Rusiecki
- Department of Preventive Medicine and Biostatistics, Uniformed Services University School of Medicine, Bethesda, Maryland, USA
| | - Jill S Barnholtz-Sloan
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Bethesda, Maryland, USA
| | - Nathanael R Fillmore
- VA Boston Healthcare System, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Price M, Ryan K, Shoaf ML, Neff C, Iorgulescu JB, Landi DB, Cioffi G, Waite KA, Kruchko C, Barnholtz-Sloan JS, Ostrom QT. Childhood, adolescent, and adult primary brain and central nervous system tumor statistics for practicing healthcare providers in neuro-oncology, CBTRUS 2015-2019. Neurooncol Pract 2024; 11:5-25. [PMID: 38222052 PMCID: PMC10785588 DOI: 10.1093/nop/npad061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Background The Central Brain Tumor Registry of the United States (CBTRUS), in collaboration with the Centers for Disease Control and Prevention (CDC) and National Cancer Institute (NCI), is the largest aggregation of histopathology-specific population-based data for primary brain and other central nervous system (CNS) in the US. CBTRUS publishes an annual statistical report which provides critical reference data for the broad neuro-oncology community. Here, we summarize the key findings from the 2022 CBTRUS annual statistical report for healthcare providers. Methods Incidence data were obtained from the CDC's National Program of Cancer Registries (NPCR) and NCI's Surveillance, Epidemiology, and End Results Program for 52 central cancer registries (CCRs). Survival data were obtained from 42 NPCR CCRs. All rates are per 100 000 and age-adjusted using the 2000 US standard population. Overall median survival was estimated using Kaplan-Meier models. Survival data for selected molecularly defined histopathologies are from the National Cancer Database. Mortality data are from the National Vital Statistics System. Results The average annual age-adjusted incidence rate of all primary brain and other CNS tumors was 24.25/100 000. Incidence was higher in females and non-Hispanics. The most commonly occurring malignant and predominately non-malignant tumors was glioblastoma (14% of all primary brain tumors) and meningioma (39% of all primary brain tumors), respectively. Mortality rates and overall median survival varied by age, sex, and histopathology. Conclusions This summary describes the most up-to-date population-based incidence, mortality, and survival, of primary brain and other CNS tumors in the US and aims to serve as a concise resource for neuro-oncology providers.
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Affiliation(s)
- Mackenzie Price
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
| | - Katherine Ryan
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA
| | - Madison L Shoaf
- Department of Neurology, Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Corey Neff
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
| | - J Bryan Iorgulescu
- Molecular Diagnostics Laboratory, Department of Hematopathology, Division of Pathology and Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Daniel B Landi
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Gino Cioffi
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
- Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, MD, USA
| | - Kristin A Waite
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
- Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, MD, USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
| | - Jill S Barnholtz-Sloan
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
- Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, MD, USA
- Center for Biomedical Informatics & Information Technology (CBIIT), National Cancer Institute, Bethesda, MD, USA
| | - Quinn T Ostrom
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
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Sperber J, Owolo E, Abu-Bonsrah N, Neff C, Baeta C, Sun C, Dalton T, Sykes D, Bishop BL, Kruchko C, Barnholtz-Sloan JS, Walsh KM, Larry Lo SF, Sciubba D, Ostrom QT, Goodwin CR. Association Between Urbanicity and Outcomes Among Patients with Spinal Cord Ependymomas in the United States. World Neurosurg 2024; 181:e107-e116. [PMID: 37619838 PMCID: PMC10872827 DOI: 10.1016/j.wneu.2023.08.062] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Spinal cord ependymomas (SCEs) represent the most common intramedullary spinal cord tumors among adults. Research shows that access to neurosurgical care and patient outcomes can be greatly influenced by patient location. This study investigates the association between the outcomes of patients with SCE in metropolitan and nonmetropolitan areas. METHODS Cases of SCE between 2004 and 2019 were identified within the Central Brain Tumor Registry of the United States, a combined dataset including the Centers for Disease Control and Prevention's National Program of Cancer Registries and National Cancer Institute's Surveillance, Epidemiology, and End Results Program data. Multivariable logistic regression models were constructed to evaluate the association between urbanicity and SCE treatment, adjusted for age at diagnosis, sex, race and ethnicity. Survival data was available from 42 National Program of Cancer Registries (excluding Kansas and Minnesota, for which county data are unavailable), and Cox proportional hazard models were used to understand the effect of surgical treatment, county urbanicity, age at diagnosis, and the interaction effect between age at diagnosis and surgery, on the survival time of patients. RESULTS Overall, 7577 patients were identified, with 6454 (85%) residing in metropolitan and 1223 (15%) in nonmetropolitan counties. Metropolitan and nonmetropolitan counties had different age, sex, and race/ethnicity compositions; however, demographics were not associated with differences in the type of surgery received when stratified by urbanicity. Irrespective of metropolitan status, individuals who were American Indian/Alaska Native non-Hispanic and Hispanic (all races) were associated with reduced odds of receiving surgery. Individuals who were Black non-Hispanic and Hispanic were associated with increased odds of receiving comprehensive treatment. Diagnosis of SCE at later ages was linked with elevated mortality (hazard ratio = 4.85, P < 0.001). Gross total resection was associated with reduced risk of death (hazard ratio = 0.37, P = 0.004), and age did not interact with gross total resection to influence risk of death. CONCLUSIONS The relationship between patients' residential location and access to neurosurgical care is critical to ensuring equitable distribution of care. This study represents an important step in delineating areas of existing disparities.
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Affiliation(s)
- Jacob Sperber
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Edwin Owolo
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nancy Abu-Bonsrah
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon, Africa
| | - Corey Neff
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA; Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA; Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Cesar Baeta
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Chuxuan Sun
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA; Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Tara Dalton
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - David Sykes
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Brandon L Bishop
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Jill S Barnholtz-Sloan
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA; Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, Maryland, USA; Center for Biomedical Informatics & Information Technology (CBIIT), National Cancer Institute, Bethesda, Maryland, USA
| | - Kyle M Walsh
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA; The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, North Carolina, USA; Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Sheng-Fu Larry Lo
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, New York, New York, USA
| | - Daniel Sciubba
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, New York, New York, USA
| | - Quinn T Ostrom
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA; Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA; The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, North Carolina, USA; Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - C Rory Goodwin
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA; Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA.
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Price M, Neff C, Kruchko C, Barnholtz-Sloan JS, Cordeiro BB, Penas-Prado M, Ozer BH, Cimino PJ, Gilbert MR, Armstrong TS, Ostrom QT. Capturing evolving definitions of 12 select rare CNS tumors: a timely report from CBTRUS and NCI-CONNECT. J Neurooncol 2023; 165:279-290. [PMID: 37980692 DOI: 10.1007/s11060-023-04480-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/11/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE Incidence, prevalence, and survival are population-based statistics describing cancer burden. The National Cancer Institute's (NCI) Comprehensive Oncology Network Evaluating Rare CNS Tumors (NCI-CONNECT) specializes in tumor biology and outcomes for 12 rare CNS tumor types selected for their importance in adults, research interest, or potential for targeted treatment. The aim of this study was to update incidence, prevalence, and survival statistics for these tumors. METHODS The Central Brain Tumor Registry of the United States (CBTRUS) database, a combined dataset of Centers for Disease Control and Prevention's (CDC) National Program of Cancer Registries (NPCR) and NCI's Surveillance, Epidemiology and End Results (SEER) data, was used to calculate average annual age-adjusted incidence rates (AAAIR) per 100,000 population overall and by sex, race-ethnicity, and age for diagnosis years 2008-2019. Incidence time trends were calculated for diagnosis years 2004-2019. NPCR data were used to calculate relative survival rates. Point prevalence on December 31, 2019 was estimated using annual age-specific incidence and survival. RESULTS AAAIR was 1.47 per 100,000 for these tumors combined, with highest incidence in ependymomas (AAAIR = 0.41/100,000). Most tumor types were more common in males, adults (ages 40 + years) or children (ages < 15 years), and non-Hispanic White individuals. Ependymomas were the most prevalent tumor type (19,320 cases) followed by oligodendrogliomas (14,900 cases). Ependymomas had the highest five-year survival (90.6%) and primary CNS sarcomas the lowest (7.7%). CONCLUSIONS These data provide means to measure the impact of clinical care and evaluate new therapies and the evolving histopathology definitions in rare CNS tumor types.
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Affiliation(s)
- Mackenzie Price
- Central Brain Tumor Registry of the United States (CBTRUS), Hinsdale, IL, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
| | - Corey Neff
- Central Brain Tumor Registry of the United States (CBTRUS), Hinsdale, IL, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States (CBTRUS), Hinsdale, IL, USA
| | - Jill S Barnholtz-Sloan
- Central Brain Tumor Registry of the United States (CBTRUS), Hinsdale, IL, USA
- Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute (NCI), Bethesda, MD, USA
- Center for Biomedical Informatics & Information Technology (CBIIT), National Cancer Institute (NCI), Bethesda, MD, USA
| | - Brittany B Cordeiro
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Byram H Ozer
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Patrick J Cimino
- NIH National Institute of Neurological Disorders and Stroke, Surgical Neurology Branch, Neuropathology Unit, Bethesda, MD, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA.
| | - Quinn T Ostrom
- Central Brain Tumor Registry of the United States (CBTRUS), Hinsdale, IL, USA.
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA.
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA.
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Ostrom QT, Price M, Neff C, Cioffi G, Waite KA, Kruchko C, Barnholtz-Sloan JS. CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2016-2020. Neuro Oncol 2023; 25:iv1-iv99. [PMID: 37793125 PMCID: PMC10550277 DOI: 10.1093/neuonc/noad149] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
The Central Brain Tumor Registry of the United States (CBTRUS), in collaboration with the Centers for Disease Control and Prevention and the National Cancer Institute, is the largest population-based registry focused exclusively on primary brain and other central nervous system (CNS) tumors in the United States (US) and represents the entire US population. This report contains the most up-to-date population-based data on primary brain tumors available and supersedes all previous CBTRUS reports in terms of completeness and accuracy. All rates are age-adjusted using the 2000 US standard population and presented per 100,000 population. The average annual age-adjusted incidence rate (AAAIR) of all malignant and non-malignant brain and other CNS tumors was 24.83 per 100,000 population (malignant AAAIR=6.94 and non-malignant AAAIR=17.88). This overall rate was higher in females compared to males (27.85 versus 21.62 per 100,000) and non-Hispanic persons compared to Hispanic persons (25.24 versus 22.61 per 100,000). Gliomas accounted for 26.3% of all tumors. The most commonly occurring malignant brain and other CNS histopathology was glioblastoma (14.2% of all tumors and 50.9% of all malignant tumors), and the most common predominantly non-malignant histopathology was meningioma (40.8% of all tumors and 56.2% of all non-malignant tumors). Glioblastomas were more common in males, and meningiomas were more common in females. In children and adolescents (ages 0-19 years), the incidence rate of all primary brain and other CNS tumors was 6.13 per 100,000 population. There were 86,030 deaths attributed to malignant brain and other CNS tumors between 2016 and 2020. This represents an average annual mortality rate of 4.42 per 100,000 population and an average of 17,206 deaths per year. The five-year relative survival rate following diagnosis of a malignant brain and other CNS tumor was 35.7%, for a non-malignant brain and other CNS tumor the five-year relative survival rate was 91.8%.
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Affiliation(s)
- Quinn T Ostrom
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA
| | - Mackenzie Price
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
| | - Corey Neff
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
| | - Gino Cioffi
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
- Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, MD, USA
| | - Kristin A Waite
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
- Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, MD, USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
| | - Jill S Barnholtz-Sloan
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
- Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, MD, USA
- Center for Biomedical Informatics & Information Technology (CBIIT), National Cancer Institute, Bethesda, MD, USA
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Barnes JM, Neff C, Han X, Kruchko C, Barnholtz-Sloan JS, Ostrom QT, Johnson KJ. The association of Medicaid expansion and pediatric cancer overall survival. J Natl Cancer Inst 2023; 115:749-752. [PMID: 36782354 PMCID: PMC10248835 DOI: 10.1093/jnci/djad024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 01/04/2023] [Accepted: 01/28/2023] [Indexed: 02/15/2023] Open
Abstract
Medicaid eligibility expansion, though not directly applicable to children, has been associated with improved access to care in children with cancer, but associations with overall survival are unknown. Data for children ages 0 to 14 years diagnosed with cancer from 2011 to 2018 were queried from central cancer registries data covering cancer diagnoses from 40 states as part of the Centers for Disease Control and Prevention's National Program of Cancer Registries. Difference-in-differences analyses were used to compare changes in 2-year survival from 2011-2013 to 2015-2018 in Medicaid expansion relative to nonexpansion states. In adjusted analyses, there was a 1.50 percentage point (95% confidence interval = 0.37 to 2.64) increase in 2-year overall survival after 2014 in expansion relative to nonexpansion states, particularly for those living in the lowest county income quartile (difference-in-differences = 5.12 percentage point, 95% confidence interval = 2.59 to 7.65). Medicaid expansion may improve cancer outcomes for children with cancer.
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Affiliation(s)
- Justin M Barnes
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Corey Neff
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
| | - Xuesong Han
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
| | - Jill S Barnholtz-Sloan
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
- Center for Biomedical Informatics & Information Technology and Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Quinn T Ostrom
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
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Neff C, Price M, Cioffi G, Kruchko C, Waite KA, Barnholtz-Sloan JS, Ostrom QT. Complete prevalence of primary malignant and non-malignant brain tumors in comparison to other cancers in the United States. Cancer 2023. [PMID: 37199898 DOI: 10.1002/cncr.34837] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Primary brain tumors (BTs) are rare, but cause morbidity and mortality disproportionately to their incidence. Prevalence estimates population-level cancer burdens at a specified time. This study estimates the prevalence of malignant and non-malignant BTs in comparison to other cancers. METHODS Incidence data were obtained from the Central Brain Tumor Registry of the United States (2000-2019, varying), a combined data set including the Center for Disease Control and Prevention's National Program of Cancer Registries and National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program. Incidence of non-BT cancers were obtained from the United States Cancer Statistics (2001-2019). Incidence and survival estimates for all cancers were obtained from SEER (1975-2018). Complete prevalence as of December 31, 2019, was estimated using prevEst. Estimates were generated overall for non-BT cancers, by BT histopathology, age groups at prevalence (0-14, 15-39, 40-64, 65+ years), and sex. RESULTS We estimated 1,323,121 individuals with a diagnosis of BTs at the date of prevalence. The majority of BT cases had non-malignant tumors (85.3%). Among all cancers, BTs were the most prevalent cancer type among those ages 15 to 39 years, second among those ages 0 to 14 years, and in the top five among those ages 40 to 64 years. The plurality of prevalent cases (43.5%) occurred among those ages 65+ years. Overall, females had a higher prevalence of BTs than males, with an overall female:male prevalence ratio of 1.68. CONCLUSIONS BTs contribute significantly to the cancer burden in the United States, particularly among those younger than age 65 years. Understanding complete prevalence is crucial for monitoring cancer burden to inform clinical research and public policy. We include a comparison of prevalence estimates for all primary brain tumors to other common cancers by age group in the United States. We also provide a description of the complete prevalence of primary malignant and non-malignant brain and other central nervous system tumors in the United States for 2019, an update to a previous study.
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Affiliation(s)
- Corey Neff
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mackenzie Price
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Gino Cioffi
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Trans-Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, Maryland, USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Kristin A Waite
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Trans-Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, Maryland, USA
| | - Jill S Barnholtz-Sloan
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Trans-Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, Maryland, USA
- Center for Biomedical Informatics & Information Technology (CBIIT), National Cancer Institute, Bethesda, Maryland, USA
| | - Quinn T Ostrom
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
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Walsh KM, Price M, Neff C, Komisarow JM, Wimberly CE, Kruchko C, Barnholtz-Sloan JS, Ostrom QT. The joint impacts of sex and race/ethnicity on incidence of grade 1 versus grades 2-3 meningioma across the lifespan. Neurooncol Adv 2023; 5:i5-i12. [PMID: 37287573 PMCID: PMC10243865 DOI: 10.1093/noajnl/vdad020] [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] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
Background Previous research has identified older age, African-American race, and female sex as meningioma risk factors, but there is limited information on their joint effects, or on how these demographic factors vary across strata of tumor grade. Methods The Central Brain Tumor Registry of the United States (CBTRUS) is a population-based registry combining data from the CDC's National Program of Cancer Registries and NCI's Surveillance, Epidemiology and End Results Program which covers ~100% of the U.S. population and aggregates incidence data on all primary malignant and nonmalignant brain tumors. These data were used to explore the joint impacts of sex and race/ethnicity on average annual age-adjusted incidence rates of meningioma. We calculated meningioma incidence rate ratios (IRRs) by sex and race/ethnicity, across strata of age and tumor grade. Results Compared to individuals who are non-Hispanic White, individuals who are non-Hispanic Black had significantly higher risk of grade 1 (IRR = 1.23; 95% CI: 1.21-1.24) and grade 2-3 meningioma (IRR = 1.42; 95% CI: 1.37-1.47). The female-to-male IRR peaked in the fifth decade of life across all racial/ethnic groups and tumor grades, but was 3.59 (95% CI: 3.51-3.67) for WHO grade 1 meningioma and 1.74 (95% CI: 1.63-1.87) for WHO grade 2-3 meningioma. Conclusions This study reveals the joint effects of sex and race/ethnicity on meningioma incidence throughout the lifespan and across strata of tumor grade, highlighting incidence disparities among females and African-Americans that may inform future strategies for tumor interception.
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Affiliation(s)
| | | | - Corey Neff
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Jordan M Komisarow
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Courtney E Wimberly
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Jill S Barnholtz-Sloan
- Center for Biomedical Informatics & Information Technology (CBIIT) and Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute (NCI), Bethesda, Maryland, USA
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Quinn T Ostrom
- Corresponding Author: Quinn T. Ostrom, PhD, DUMC Box 3050, Durham, NC 27710, USA ()
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Dmukauskas M, Cioffi G, Neff C, Price M, Waite KA, Kruchko C, Barnes JM, Ostrom QT, Barnholtz-Sloan JS. Medicaid Expansion Is Associated with Increased One-year Survival for Primary Malignant Brain Tumors. Neurooncol Adv 2023; 5:vdad022. [PMID: 37051332 PMCID: PMC10084498 DOI: 10.1093/noajnl/vdad022] [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] [Indexed: 03/09/2023] Open
Abstract
Abstract
The affordable care act provision to expand access to Medicaid (Medicaid Expansion, or ME) increased insurance coverage among individuals with cancer. Increasing evidence suggests ME impacts cancer outcomes, yet the implication of ME on primary malignant brain tumor (PMBTs) outcomes remains unknown. This study suggests ME may result in an increase in 1-year predictive overall survival (1YPS) among PMBT patients.
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Affiliation(s)
- Mantas Dmukauskas
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute , Bethesda, MD
| | - Gino Cioffi
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute , Bethesda, MD
- Central Brain Tumor Registry of the United States , Hinsdale, IL
| | - Corey Neff
- Central Brain Tumor Registry of the United States , Hinsdale, IL
- Department of Neurosurgery, Duke University School of Medicine , Durham, NC
| | - Mackenzie Price
- Central Brain Tumor Registry of the United States , Hinsdale, IL
- Department of Neurosurgery, Duke University School of Medicine , Durham, NC
| | - Kristin A Waite
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute , Bethesda, MD
- Central Brain Tumor Registry of the United States , Hinsdale, IL
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States , Hinsdale, IL
| | - Justin M Barnes
- Department of Radiation Oncology, Washington University School of Medicine in St. Louis , St. Louis, MO
| | - Quinn T Ostrom
- Central Brain Tumor Registry of the United States , Hinsdale, IL
- Department of Neurosurgery, Duke University School of Medicine , Durham, NC
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine , Durham, NC
- Duke Cancer Institute, Duke University Medical Center , Durham, NC
| | - Jill S Barnholtz-Sloan
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute , Bethesda, MD
- Central Brain Tumor Registry of the United States , Hinsdale, IL
- Center for Biomedical Informatics and Information Technology, National Cancer Institute , Bethesda, MD
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13
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Neff C, Cioffi G, Waite K, Kruchko C, Barnholtz-Sloan JS, Ostrom QT, Iorgulescu JB. Molecular marker testing and reporting completeness for adult-type diffuse gliomas in the United States. Neurooncol Pract 2023; 10:24-33. [PMID: 36659967 PMCID: PMC9837780 DOI: 10.1093/nop/npac079] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background A newly developed brain molecular marker (BMM) data item was implemented by US cancer registries for individuals diagnosed with brain tumors in 2018-including IDH and 1p/19q-co-deletion statuses for adult-type diffuse gliomas. We thus investigated the testing/reporting completeness of BMM in the United States. Methods Cases of histopathologically confirmed glioblastoma, astrocytoma, and oligodendroglioma diagnosed in 2018 were identified in the National Cancer Database. Adjusted odds ratios (ORadj) and 95% confidence intervals (CI) of BMM testing/reporting were evaluated for association with the selected patient, treatment, and facility-level characteristics using multivariable logistic regression. As a secondary analysis, predictors of MGMT promoter methylation testing/reporting among IDH-wildtype glioblastoma individuals were assessed. Key limitations of the BMM data item were that it did not include any details regarding testing technique or assay type and could not distinguish between a lack of testing and a lack of cancer registry reporting of testing results. Results Among 8306 histopathologically diagnosed adult-type diffuse gliomas nationally, overall BMM testing/reporting completeness was 81.1%. Compared to biopsy-only cases, odds of testing/reporting increased for subtotal (ORadj= 1.38 [95% CI: 1.20-1.59], P < .001) and gross total resection (ORadj=1.50 [95% CI: 1.31-1.72], P < .001). Furthermore, the odds were lowest at community centers (hospitals (67.3%; ORadj=0.35 [95% CI: 0.26-0.46], P < .001) and highest at academic/NCI-designated comprehensive cancer centers (85.4%; referent). By geographical location, BMM testing/reporting completeness ranged from a high of 86.8% at New England (referent) to a low of 76.0 % in the West South Central region (ORadj=0.57 [95% CI: 0.42-0.78]; P < .001). Extent of resection, Commission-on-Cancer facility type, and facility location were additionally significant predictors of MGMT testing/reporting among IDH-wildtype glioblastoma cases. Conclusions Initial BMM testing/reporting completeness for individuals with adult-type diffuse gliomas in the United States was promising, although patterns varied by hospital attributes and extent of resection.
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Affiliation(s)
- Corey Neff
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
| | - Gino Cioffi
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Kristin Waite
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
| | - Jill S Barnholtz-Sloan
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
- Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Bethesda, MD, USA
| | - Quinn T Ostrom
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - J Bryan Iorgulescu
- Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Division of Pathology and Laboratory Medicine, MD Anderson Cancer Center, Houston, TX, USA
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Iorgulescu JB, Sun C, Neff C, Cioffi G, Gutierrez C, Kruchko C, Ruhl J, Waite K, Negoita S, Hofferkamp J, Tihan T, McLendon R, Brat DJ, Ostrom QT, Barnholtz-Sloan JS. Corrigendum to: Molecular biomarker-defined brain tumors: Epidemiology, validity, and completeness in the United States. Neuro Oncol 2022; 25:424-429. [PMID: 36534983 PMCID: PMC9925701 DOI: 10.1093/neuonc/noac270] [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: 12/24/2022] Open
Affiliation(s)
- J Bryan Iorgulescu
- Corresponding Authors: Quinn T. Ostrom, PhD, MPH, Department of Neurosurgery, Duke University School of Medicine, 571 Research Drive, MSRB-1, Rm 442, Durham, NC 27710, USA (); J. Bryan Iorgulescu, MD, FCAP, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, 450 Brookline Avenue, Dana-RM518, Boston, MA 02215-5450, USA ()
| | | | - Corey Neff
- Central Brain Tumor Registry of the United States,Department of Neurosurgery, Duke University School of Medicine
| | - Gino Cioffi
- Central Brain Tumor Registry of the United States,Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute
| | - Catherine Gutierrez
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School,Department of Medical Oncology, Dana-Farber Cancer Institute
| | | | - Jennifer Ruhl
- Surveillance, Epidemiology, and End Results program, National Cancer Institute
| | - Kristin Waite
- Central Brain Tumor Registry of the United States,Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute
| | - Serban Negoita
- Surveillance, Epidemiology, and End Results program, National Cancer Institute
| | | | - Tarik Tihan
- Division of Neuropathology, Department of Pathology, University of California San Francisco
| | - Roger McLendon
- Department of Pathology, Duke University School of Medicine,The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine,Duke Cancer Institute, Duke University Medical Center
| | - Daniel J Brat
- Department of Pathology, Northwestern University Feinberg School of Medicine
| | - Quinn T Ostrom
- Corresponding Authors: Quinn T. Ostrom, PhD, MPH, Department of Neurosurgery, Duke University School of Medicine, 571 Research Drive, MSRB-1, Rm 442, Durham, NC 27710, USA (); J. Bryan Iorgulescu, MD, FCAP, Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, 450 Brookline Avenue, Dana-RM518, Boston, MA 02215-5450, USA ()
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Neff C, Cioffi G, Waite K, Kruchko C, Barnholtz-Sloan J, Ostrom Q, Iorgulescu B. BIOM-23. MOLECULAR MARKER TESTING AND REPORTING COMPLETENESS FOR ADULT-TYPE DIFFUSE GLIOMAS IN THE UNITED STATES. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.033] [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] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
A newly developed brain molecular marker (BMM) data item was implemented by U.S. cancer registries for individuals diagnosed with brain tumors in 2018—including IDH and 1p/19q-codeletion statuses for adult-type diffuse gliomas. We thus investigated the testing/reporting completeness of BMM in the U.S.
METHODS
Cases of histopathologically-confirmed glioblastoma, astrocytoma, and oligodendroglioma diagnosed in 2018 were identified in the National Cancer Database. Adjusted odds ratios (ORadj) and 95% confidence intervals (95CI) of BMM testing/reporting were evaluated for association with selected patient, treatment, and facility-level characteristics using multivariable logistic regression. As a secondary analysis, predictors of MGMT promoter methylation testing/reporting among IDH-wildtype glioblastoma individuals was assessed.
RESULTS
Among 7,370 histopathologically-diagnosed adult-type diffuse gliomas nationally, the overall BMM testing/reporting completeness was 81%. Compared to biopsy-only cases, the odds of testing/reporting increased for increased for subtotal (ORadj= 1.38 [95CI: 1.19-1.61], p< 0.001) and gross total resection (ORadj=1.53 [95CI: 1.33-1.77], p< 0.001). Furthermore, the odds of testing/reporting completeness were lowest at community centers (hospitals (65.8%; ORadj=0.33 [95CI: 0.24-0.44], p< 0.001) and highest at academic/NCI-designated comprehensive cancer centers (85.3%; referent). By geographical location, BMM testing/reporting completeness ranged from a high of 86.9% at New England (referent) to a low of 75.2% in the West South Central region (ORadj=0.55 [95CI: 0.39-0.76]; p< 0.001). Extent of resection, facility type, and facility location were additionally significant predictors of MGMT testing/reporting among IDH-wildtype glioblastoma cases.
CONCLUSION
Initial BMM testing/reporting completeness for individuals with adult-type diffuse gliomas in the U.S. were favorable, although patterns varied by hospital attributes and extent of resection.
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Affiliation(s)
- Corey Neff
- Department of Neurosurgery, Duke University School of Medicine , Durham, NC , USA
| | - Gino Cioffi
- Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute , Bethesda, MD , USA
| | - Kristin Waite
- Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute , Bethesda, MD , USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States , Hinsdale, IL , USA
| | - Jill Barnholtz-Sloan
- Center for Biomedical Informatics and Information Technology and Division of Cancer Epidemiology and Genetics, National Cancer Institute , Bethesda, MD , USA
| | - Quinn Ostrom
- Department of Neurosurgery, Duke University School of Medicine , Durham, NC , USA
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Neff C, Chavez G, Proescholdt C, Kruchko C, Cioffi G, Waite K, Barnholtz-Sloan J, Ostrom Q. EPID-06. IMPROVEMENTS IN SURVIVAL FOR GLIOBLASTOMA IN THE POST-STUPP PROTOCOL ERA. Neuro Oncol 2022. [PMCID: PMC9660495 DOI: 10.1093/neuonc/noac209.416] [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] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
Introduction of the Stupp protocol for glioblastoma treatment in 2005 led to a significant increase in overall survival in glioblastoma. Prior analyses identified additional survival gains in glioblastoma since this time, though the source of these gains is unknown. In this analysis, we leveraged commercial claims and population-based datasets to better understand potential treatment factors associated with improved survival for glioblastoma.
METHODS
Provider-side commercial claims data were obtained from IQVIA for adults (18+) diagnosed with malignant brain tumor (ICD-9 codes: 191.0-191.9 or ICD-10 codes: C71.0-C71.9) from 2013-2021. Glioblastoma patients were identified as those who received biopsy/resection, radiation and temozolomide within 60 days of their brain tumor diagnosis. Treatment patterns were determined using ICD-9/ICD-10 procedure codes and HCPCS/CPT codes. Date of death was determined by a claim containing the CPT codes 99238 or 99239 or date of last claim followed by at least 30 days of no additional claims. Population-based survival data for microscopically-confirmed adult glioblastoma cases receiving radiation treatment from the National Program of Cancer Registries (NPCR) from 2004-2018 were used as a comparison group. Median survival was estimated using Kaplan-Meier regression, overall in IQVIA and by two-year periods in NPCR.
RESULTS
In the IQVIA cohort, 9,368 individuals (2.5%) were identified as glioblastoma based on treatment criteria. Median survival in the IQVIA cohort 16.6 months (15.2-17.0), and 12 months (95%CI:12-12) in NPCR. Median survival in NPCR increased from 11 months in 2004-2006, to 12 months in 2006-2009, and then 13 months in 2010-2018. Within the IQVIA cohort, 27% had ≥ 1 claim for Bevacizumab and 15% had ≥ 1 claim for tumor treating fields.
CONCLUSIONS
Survival in glioblastoma continues to improve over time, which may be due to developments of new therapeutic approaches. Assessment of population-level survival patterns is essential for understanding the impact of treatment advancements in the general population.
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Affiliation(s)
- Corey Neff
- Department of Neurosurgery, Duke University School of Medicine , Durham, NC , USA
| | | | | | - Carol Kruchko
- Central Brain Tumor Registry of the United States (CBTRUS) , Hinsdale, IL , USA
| | - Gino Cioffi
- Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute , Bethesda, MD , USA
| | - Kristin Waite
- Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute , Bethesda, MD , USA
| | - Jill Barnholtz-Sloan
- Center for Biomedical Informatics and Information Technology and Division of Cancer Epidemiology and Genetics, National Cancer Institute , Bethesda, MD , USA
| | - Quinn Ostrom
- Department of Neurosurgery, Duke University School of Medicine , Durham, NC , USA
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Iorgulescu B, Sun C, Cioffi G, Neff C, Shoaf M, Waite K, Kruchko C, Wen PY, Brat D, Ostrom Q, Barnholtz-Sloan J. EPID-11. NATIONAL EPIDEMIOLOGY AND SURVIVAL OF ADULT-TYPE DIFFUSE GLIOMAS IN THE UNITED STATES BY IDH, 1P/19Q, MGMT, AND WHO CNS GRADE. Neuro Oncol 2022. [PMCID: PMC9660491 DOI: 10.1093/neuonc/noac209.421] [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] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
Histomolecularly-defined adult-type diffuse gliomas—including IDH-wildtype glioblastoma, IDH-mutant astrocytoma, and IDH-mutant 1p/19q-codeleted oligodendroglioma—were incorporated into U.S. cancer registry reporting for individuals with brain tumors beginning in 2018. We therefore assessed their epidemiology and overall survival (OS) patterns.
METHODS
Individuals histopathologically diagnosed with diffuse gliomas in 2018 and had brain molecular marker data were identified within the National Cancer Database; Surveillance, Epidemiology, and End Results Incidence; and Central Brain Tumor Registry of the United States databases. Age-adjusted incidence rates per 100,000 population with 95% confidence intervals (95CI) were estimated. OS was estimated using Kaplan Meier methods and stratified by WHO CNS grade, age, sex, tumor size, treatment, extent of resection, and MGMT promoter methylation. WHO CNS grade was additionally examined among individuals with IDH-wildtype diffuse astrocytic gliomas.
RESULTS
IDH-wildtype glioblastomas’ incidence rate was 1.74 (95CI = 1.69-1.78); as compared to 0.14 (95CI = 0.12-0.15), 0.15 (95CI = 0.14-0.16), and 0.07 (95CI: 0.06-0.08) WHO grade 2, 3, and 4 IDH-mutant astrocytomas. Irrespective of grade, IDH mutation prevalence was highest in adolescents & young adults, and IDH-mutant astrocytomas were more frequently MGMT promoter methylated. For OS analysis, 8,651 individuals were identified: one-year OS was 53.7% for WHO grade 4 IDH-wildtype glioblastomas (95CI = 52.5-54.9); 98.0% (95CI = 96.1-99.0), 92.4% (95CI = 89.6-94.5), and 76.3% (95CI = 70.1-81.3) for grade 2, 3, and 4 IDH-mutant astrocytomas; 97.9% (95CI = 95.9-98.9) and 94.4% (95CI = 90.9-96.6) for grade 2 and 3 IDH-mutant 1p/19q-codeleted oligodendrogliomas. Among IDH-wildtype glioblastomas, median OS was 17.1 months (95CI = 16.1-18.6) and 12.4 months (95CI = 12.0-12.9) for methylated and unmethylated MGMT promoters. IDH-wildtype diffuse astrocytic gliomas reported as WHO grade 2 or 3 demonstrated longer adjusted OS compared to grade 4 tumors (both p < 0.001). A significant association was not observed between chemotherapy and OS (HRadjusted 0.95, 95CI = 0.41-2.22, p = 0.91) for radiotherapy-treated grade 3 IDH-wildtype diffuse astrocytic gliomas.
CONCLUSIONS
Our findings provide the initial U.S. epidemiological estimates for histomolecularly-defined adult-type diffuse gliomas.
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Affiliation(s)
| | | | - Gino Cioffi
- National Cancer Institute , Lakewood, OH , USA
| | - Corey Neff
- Department of Neurosurgery, Duke University School of Medicine , Durham, NC , USA
| | | | | | - Carol Kruchko
- Central Brain Tumor Registry of the United States (CBTRUS) , Hinsdale, IL , USA
| | | | - Daniel Brat
- Department of Pathology, Northwestern University , Chicago, IL , USA
| | - Quinn Ostrom
- Department of Neurosurgery, Duke University School of Medicine , Durham, NC , USA
| | - Jill Barnholtz-Sloan
- Center for Biomedical Informatics and Information Technology and Division of Cancer Epidemiology and Genetics, National Cancer Institute , Bethesda, MD , USA
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Ostrom QT, Price M, Neff C, Cioffi G, Waite KA, Kruchko C, Barnholtz-Sloan J. CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2015-2019. Neuro Oncol 2022; 24:v1-v95. [PMID: 36196752 PMCID: PMC9533228 DOI: 10.1093/neuonc/noac202] [Citation(s) in RCA: 364] [Impact Index Per Article: 182.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Central Brain Tumor Registry of the United States (CBTRUS), in collaboration with the Centers for Disease Control and Prevention and the National Cancer Institute, is the largest population-based registry focused exclusively on primary brain and other central nervous system (CNS) tumors in the United States (US) and represents the entire US population. This report contains the most up-to-date population-based data on primary brain tumors available and supersedes all previous reports in terms of completeness and accuracy. All rates are age-adjusted using the 2000 US standard population and presented per 100,000 population. The average annual age-adjusted incidence rate (AAAIR) of all malignant and non-malignant brain and other CNS tumors was 24.71 per 100,000 population (malignant AAAIR=7.02 and non-malignant AAAIR=17.69). This overall rate was higher in females compared to males (27.62 versus 21.60 per 100,000) and non-Hispanic persons compared to Hispanic persons (25.09 versus 22.95 per 100,000). The most commonly occurring malignant brain and other CNS histopathology was glioblastoma (14.2% of all tumors and 50.1% of all malignant tumors), and the most common non-malignant histopathology was meningioma (39.7% of all tumors and 55.4% of all non-malignant tumors). Glioblastoma was more common in males, and meningiomas were more common in females. In children and adolescents (ages 0-19 years), the incidence rate of all primary brain and other CNS tumors was 6.20 per 100,000 population. An estimated 93,470 new cases of malignant and non-malignant brain and other CNS tumors are expected to be diagnosed in the US population in 2022 (26,670 malignant and 66,806 non-malignant). There were 84,264 deaths attributed to malignant brain and other CNS tumors between 2015 and 2019. This represents an average annual mortality rate of 4.41 per 100,000 population and an average of 16,853 deaths per year. The five-year relative survival rate following diagnosis of a malignant brain and other CNS tumor was 35.7%, while for non-malignant brain and other CNS tumors the five-year relative survival rate was 91.8%.
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Affiliation(s)
- Quinn T Ostrom
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mackenzie Price
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Corey Neff
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Gino Cioffi
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, Maryland, USA
| | - Kristin A Waite
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, Maryland, USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Jill S Barnholtz-Sloan
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, Maryland, USA
- Center for Biomedical Informatics & Information Technology (CBIIT), National Cancer Institute, Bethesda, Maryland, USA
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Ostrom QT, Price M, Ryan K, Edelson J, Neff C, Cioffi G, Waite KA, Kruchko C, Barnholtz-Sloan JS. CBTRUS Statistical Report: Pediatric Brain Tumor Foundation Childhood and Adolescent Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2014-2018. Neuro Oncol 2022; 24:iii1-iii38. [PMID: 36066969 PMCID: PMC9447434 DOI: 10.1093/neuonc/noac161] [Citation(s) in RCA: 78] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The CBTRUS Statistical Report: Pediatric Brain Tumor Foundation Childhood and Adolescent Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2014-2018 comprehensively describes the current population-based incidence of primary malignant and non-malignant brain and other CNS tumors in children and adolescents ages 0-19 years, collected and reported by central cancer registries covering approximately 100% of the United States population. Overall, brain and other CNS tumors are the most common solid tumor, the most common cancer, and the most common cause of cancer death in children and adolescents ages 0-19 years. This report aims to serve as a useful resource for researchers, clinicians, patients, and families.
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Affiliation(s)
- Quinn T Ostrom
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mackenzie Price
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Katherine Ryan
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jacob Edelson
- Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, Maryland, USA
| | - Corey Neff
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Gino Cioffi
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, Maryland, USA
| | - Kristin A Waite
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, Maryland, USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Jill S Barnholtz-Sloan
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, Maryland, USA
- Center for Biomedical Informatics & Information Technology (CBIIT), National Cancer Institute, Bethesda, USA
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Walsh KM, Neff C, Bondy ML, Kruchko C, Huse JT, Amos CI, Barnholtz-Sloan JS, Ostrom QT. Influence of county-level geographic/ancestral origin on glioma incidence and outcomes in US Hispanics. Neuro Oncol 2022; 25:398-406. [PMID: 35868246 PMCID: PMC9925707 DOI: 10.1093/neuonc/noac175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/22/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Glioma incidence is 25% lower in Hispanics than White non-Hispanics. The US Hispanic population is diverse, and registry-based analyses may mask incidence differences associated with geographic/ancestral origins. METHODS County-level glioma incidence data in Hispanics were retrieved from the Central Brain Tumor Registry of the United States. American Community Survey data were used to determine the county-level proportion of the Hispanic population of Mexican/Central American and Caribbean origins. Age-adjusted incidence rate ratios and incidence rate ratios (IRRs) quantified the glioma incidence differences across groups. State-level estimates of admixture in Hispanics were obtained from published 23andMe data. RESULTS Compared to predominantly Caribbean-origin counties, predominantly Mexican/Central American-origin counties had lower age-adjusted risks of glioma (IRR = 0.83; P < 0.0001), glioblastoma (IRR = 0.86; P < 0.0001), diffuse/anaplastic astrocytoma (IRR = 0.78; P < 0.0001), oligodendroglioma (IRR = 0.82; P < 0.0001), ependymoma (IRR = 0.88; P = 0.012), and pilocytic astrocytoma (IRR = 0.76; P < 0.0001). Associations were consistent in children and adults and using more granular geographic regions. Despite having lower glioma incidence, Hispanic glioblastoma patients from predominantly Mexican/Central American-origin counties had poorer survival than Hispanics living in predominantly Caribbean-origin counties. Incidence and survival differences could be partially explained by state-level estimates of European admixture in Hispanics with European admixture associated with higher incidence and improved survival. CONCLUSIONS Glioma incidence and outcomes differ in association with the geographic origins of Hispanic communities, with counties of predominantly Mexican/Central American origin at significantly reduced risk and those of Caribbean origin at comparatively greater risk. Although typically classified as a single ethnic group, appreciating the cultural, socioeconomic, and genetic diversity of Hispanics can advance cancer disparities research.
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Affiliation(s)
- Kyle M Walsh
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA,The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC,Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Corey Neff
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA,Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Melissa L Bondy
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Jason T Huse
- Department of Translational Molecular Pathology and Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Christopher I Amos
- Department of Medicine, Section of Epidemiology and Population Sciences, and Institute for Clinical and Translational Research, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Jill S Barnholtz-Sloan
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA,Center for Biomedical Informatics & Information Technology and Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA
| | - Quinn T Ostrom
- Corresponding Author: Quinn T. Ostrom, PhD, MPH, Department of Neurosurgery, Duke University School of Medicine, Box 3050, Durham, NC 27710 ()
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Walsh KM, Neff C, Bondy ML, Kruchko C, Huse JT, Amos CI, Barnholtz-Sloan JS, Ostrom QT. Abstract 26: Influence of geographic/ancestral origin on glioma incidence and outcomes in US Hispanics. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-26] [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] [Indexed: 11/16/2022]
Abstract
Abstract
PURPOSE: Glioma is the most common type of primary malignant brain tumor, and incidence is 25% lower in U.S. Hispanics than White non-Hispanics. Though often pooled in epidemiological analyses, the U.S. Hispanic population is very diverse, and registry-based analyses may mask incidence and survival differences associated with geographic/ancestral origins.
METHODS: County-level glioma incidence data in U.S. Hispanics from 2000-2017 were retrieved from the Central Brain Tumor Registry of the United States, and survival data from the CDC’s National Program of Cancer Registries was obtained for 2001-2017. American Community Survey data were used to determine county-level proportion of the Hispanic population of Mexican/Central-American origin and of Caribbean origin (Puerto Rican, Cuban, Dominican). State-level estimates of European and African admixture in Hispanics were obtained from published 23andMe data. Incidence rate ratios (IRRs) quantified the glioma incidence differences across groups. County-level incidence was modeled using linear regression to control for potential confounding factors (e.g., county size, median socioeconomic status), and Cox proportional hazards models were used to assess associations between individual-level survival, county-level origin percentages, and state-level admixture.
RESULTS: Compared to Hispanics living in predominantly Caribbean-origin counties, Hispanics from predominantly Mexican/Central-American-origin counties had lower age-adjusted risks of glioma (IRR=0.83; P<0.0001), glioblastoma (IRR=0.86; P<0.0001), diffuse/anaplastic astrocytoma (IRR=0.78; P<0.0001), oligodendroglioma (IRR=0.82; P<0.0001), ependymoma (IRR=0.88; P=0.012), and pilocytic astrocytoma (IRR=0.76; P<0.0001). Associations were consistent in children and adults, and using more granular geographic regions. Despite having lower glioma incidence, Hispanic glioblastoma patients from predominantly Mexican/Central-American-origin counties had poorer survival than Hispanics living in predominantly Caribbean-origin counties. Incidence and survival differences could be partially explained by state-level estimates of European and African admixture in Hispanics, with European admixture associated with higher incidence and African admixture associated with improved survival.
CONCLUSIONS: Glioma incidence and outcomes differ in association with the geographic origins of the Hispanic community, with residents of predominantly Mexican/Central-American-origin counties at significantly reduced risk and those of Caribbean-origin counties at comparatively greater risk. Although typically classified as a single ethnic group in registry data, appreciating the cultural, socioeconomic, and genetic diversity of U.S. Hispanics will help advance cancer disparities research.
Citation Format: Kyle M. Walsh, Corey Neff, Melissa L. Bondy, Carol Kruchko, Jason T. Huse, Christopher I. Amos, Jill S. Barnholtz-Sloan, Quinn T. Ostrom. Influence of geographic/ancestral origin on glioma incidence and outcomes in US Hispanics [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 26.
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Affiliation(s)
| | - Corey Neff
- 1Duke University School of Medicine, Durham, NC
| | | | - Carol Kruchko
- 3Central Brain Tumor Registry of the United States, Hinsdale, IL
| | - Jason T. Huse
- 4The University of Texas MD Anderson Cancer Center, Houston, TX
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Barnes JM, Neff C, Kruchko C, Barnholtz-Sloan J, Ostrom QT, Johnson KJ. Association of Medicaid expansion under the Affordable Care Act and overall survival among children with cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.6507] [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] [Indexed: 11/20/2022] Open
Abstract
6507 Background: State Medicaid expansions under the Affordable Care Act are associated with increased Medicaid coverage among children, including those with cancer. Since the expansions did not directly affect Medicaid eligibility criteria for children, these changes suggest “welcome mat” effects, where previously uninsured children become enrolled in Medicaid after their parents gain coverage. Insurance improvements from the expansions have been associated with improved cancer outcomes for non-elderly adults. However, it is unclear whether the expansions also impacted childhood cancer outcomes. Methods: Data for children ages 0-14 years diagnosed with cancer from 2011-2017 were queried from central cancer registries covering cancer diagnoses from 43 states as part of the Centers for Disease Control’s National Program of Cancer Registries. The primary outcome was 2-year overall survival. We utilized difference-in-differences analyses to compare changes in 2-year survival from 2011-2013 to 2014-2017 between children who resided in states expanding Medicaid by 2014 vs. states not expanding Medicaid within the study period. Analyses were adjusted for covariates including age, race/ethnicity, sex, metropolitan residence, cancer type, and stage at diagnosis. Results: A total of 42,970 children with cancer were included. Overall, there were increases in 2-year survival among children in expansion states (90.5% in 2011-2013 to 91.4% in 2014-2017) but no change among children in non-expansion states (90.0% in 2011-2013 to 90.0% in 2014-2017). In adjusted difference-in-differences analyses, there was no significant change in survival after Medicaid expansion for children in expansion vs. non-expansion states (1.01 percentage points, 95% CI = -0.23 to 2.25, p = 0.11). In difference-in-differences analyses by race/ethnicity, there was a significant expansion-associated improvement in survival in Black children (3.97 percentage points, 95% CI = 0.02 to 7.93, p = 0.049) but not in White children (0.4 percentage points, 95% CI = -1.07 to 2.04, p = 0.54). There were also expansion-associated improvements in survival among children residing in counties with the lowest quartile of county income (5.88 percentage points, 95% CI = 0.38 to 11.38, p = 0.036) but not for those in higher income counties (1.15, 1.23, and 0.12 percentage points for 2nd, 3rd, and 4th quartiles, respectively). Conclusions: Medicaid expansion, through presumed increases in Medicaid coverage via welcome mat effects, was associated with increased 2-year survival for Black children and children residing in low-income counties. However, the concentration of Black children in states that have not expanded Medicaid highlights the need for further advocacy to more fully achieve improved outcomes. Future data are needed to clarify potential long-term impacts of Medicaid expansion on childhood cancer outcomes.
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Affiliation(s)
| | | | - Carol Kruchko
- Central Brain Tumor Registry of the United States (CBTRUS), Hinsdale, IL
| | - Jill Barnholtz-Sloan
- Case Comprehensive Cancer Center and Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Quinn T Ostrom
- Department of Epidemiology and Population Science, Houston, TX
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Iorgulescu JB, Sun C, Neff C, Cioffi G, Gutierrez C, Kruchko C, Ruhl J, Waite K, Negoita S, Hofferkamp J, Tihan T, McLendon R, Brat DJ, Ostrom QT, Barnholtz-Sloan JS. Molecular Biomarker-Defined Brain Tumors: Epidemiology, Validity, and Completeness in the United States. Neuro Oncol 2022; 24:1989-2000. [PMID: 35460555 PMCID: PMC9629432 DOI: 10.1093/neuonc/noac113] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Selected molecular biomarkers were incorporated into U.S. cancer registry reporting for patients with brain tumors beginning in 2018. We investigated the completeness and validity of these variables, and described the epidemiology of molecularly-defined brain tumor types. METHODS Brain tumor patients with histopathologically-confirmed diagnosis in 2018 were identified within the Central Brain Tumor Registry of the United States and NCI's Surveillance, Epidemiology, and End Results Incidence databases. The brain molecular markers (BMM) site-specific data item was assessed for coding completeness and validity. 1p/19q status, MGMT promoter methylation, and WHO grade data items, and new ICD-O-3 codes were additionally evaluated. These data were used to profile the characteristics and age-adjusted incidence rates per 100,000 population of molecularly-defined brain tumors with 95% confidence intervals (95%CI). RESULTS BMM completeness across the applicable tumor types was 75-92% and demonstrated favorable coding validity. IDH-wildtype glioblastomas' incidence rate was 1.74 (95%CI: 1.69-1.78), as compared to 0.14 for WHO grade 2 (95%CI: 0.12-0.15), 0.15 for grade 3 (95%CI: 0.14-0.16), and 0.07 for grade 4 (95%CI: 0.06-0.08) IDH-mutant astrocytomas. Irrespective of WHO grade, IDH mutation prevalence was highest in adolescent & young adult patients and IDH-mutant astrocytomas were more frequently MGMT promoter methylated. Among pediatric-type tumors, the incidence rate was 0.06 for H3K27M-mutant diffuse midline gliomas (95%CI: 0.05-0.07), 0.03 for SHH-activated/TP53-wildtype medulloblastomas (95%CI: 0.02-0.03), and <0.01 for both C19MC-altered ETMRs and RELA-fusion ependymomas. CONCLUSIONS Our findings illustrate the success of developing a dedicated, integrated-diagnosis variable, which provides critical molecular information about brain tumors related to accurate diagnosis.
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Affiliation(s)
- J Bryan Iorgulescu
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School.,Department of Medical Oncology, Dana-Farber Cancer Institute
| | - Chuxuan Sun
- Department of Biostatistics, Duke University School of Medicine
| | - Corey Neff
- Central Brain Tumor Registry of the United States.,Department of Neurosurgery, Duke University School of Medicine
| | - Gino Cioffi
- Central Brain Tumor Registry of the United States.,Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute
| | - Catherine Gutierrez
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School.,Department of Medical Oncology, Dana-Farber Cancer Institute
| | | | - Jennifer Ruhl
- Surveillance, Epidemiology, and End Results program, National Cancer Institute
| | - Kristin Waite
- Central Brain Tumor Registry of the United States.,Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute
| | - Serban Negoita
- Surveillance, Epidemiology, and End Results program, National Cancer Institute
| | | | - Tarik Tihan
- Division of Neuropathology, Department of Pathology, University of California San Francisco
| | - Roger McLendon
- Department of Pathology, Duke University School of Medicine.,The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine.,Duke Cancer Institute, Duke University Medical Center
| | - Daniel J Brat
- Department of Pathology, Northwestern University Feinberg School of Medicine
| | - Quinn T Ostrom
- Central Brain Tumor Registry of the United States.,Department of Neurosurgery, Duke University School of Medicine.,The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine.,Duke Cancer Institute, Duke University Medical Center
| | - Jill S Barnholtz-Sloan
- Central Brain Tumor Registry of the United States.,Trans Divisional Research Program, Division of Cancer Epidemiology and Genetics, National Cancer Institute.,Center for Biomedical Informatics & Information Technology, National Cancer Institute
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24
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Low JT, Ostrom QT, Cioffi G, Neff C, Waite KA, Kruchko C, Barnholtz-Sloan JS. Primary brain and other central nervous system tumors in the United States (2014-2018): A summary of the CBTRUS statistical report for clinicians. Neurooncol Pract 2022; 9:165-182. [PMID: 35601966 PMCID: PMC9113389 DOI: 10.1093/nop/npac015] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The Central Brain Tumor Registry of the United States (CBTRUS) contains information on all primary brain and other central nervous system (CNS) tumors diagnosed in the United States (US). Here we summarize the 2021 CBTRUS annual statistical report for clinicians. Methods Incidence survival data are obtained from the Centers for Disease Control's National Program of Cancer Registries (NPCR) and National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. Survival data are obtained from NPCR. Mortality data are obtained from the National Vital Statistics System. Incidence and mortality rates are age-adjusted using the 2000 US population and presented per 100,000 population. Results An annual average of 86,355 cases of primary malignant and nonmalignant CNS tumors were diagnosed over the period 2014-2018, corresponding to an average annual age-adjusted incidence rate of 24.25. The most commonly occurring malignant tumor was glioblastoma (14.3%), and the most common predominately nonmalignant tumor was meningioma (39%). Over the 2014-2018 period, there were 16,606 annual average deaths due to malignant primary CNS tumors, corresponding to an average annual age-adjusted mortality rate of 4.43. In this report we detail key incidence, survival, and mortality statistics for major primary CNS tumor histologies, highlighting relevant differences by age, sex, and race. Conclusions This summary describes the most up to date population-based incidence of primary malignant and nonmalignant brain and other CNS tumors in the US, and mortality and survival for primary malignant tumors and aims to serve as a useful resource for clinicians.
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Affiliation(s)
- Justin T Low
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, North Carolina, USA,Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Quinn T Ostrom
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, North Carolina, USA,Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA,Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA,Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Gino Cioffi
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA,Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, Maryland, USA
| | - Corey Neff
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA,Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Kristin A Waite
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA,Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, Maryland, USA
| | - Carol Kruchko
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jill S Barnholtz-Sloan
- Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA,Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, Maryland, USA,Center for Biomedical Informatics & Information Technology (CBIIT), National Cancer Institute, Bethesda, Maryland,USA,Corresponding Author: Jill S. Barnholtz-Sloan, PhD, National Cancer Institute, Shady Grove Campus, 9609 Medical Center Dr, Rockville, MD 20850, USA ()
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Ostrom Q, Kruchko C, Neff C, Firth A, Sherman R. The Central Brain Tumor Registry of the United States Histopathological Grouping Scheme Provides Clinically Relevant Brain and Other Central Nervous System Categories for Cancer Registry Data. J Registry Manag 2022; 49:139-152. [PMID: 37260822 PMCID: PMC10229189] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Background Brain and other central nervous system (CNS) tumors are a heterogenous collection of tumors, but they are generally reported in local and national cancer statistics as a single, large category. Although the collection of non-malignant brain and other CNS tumors has been mandated since diagnosis year 2004, these tumors are often excluded from standard statistical reports on cancer despite their burden on populations in the United States and Canada. The Central Brain Tumor Registry of the United States (CBTRUS) historical and current histopathological grouping schemes have been developed in collaboration with neuropathologists to capture the diversity of these tumors in clinically relevant categories. The goal of this analysis was to test a new recode variable based on the CBTRUS histopathology grouping prior to releasing the variable for use in the North American Association of Central Cancer Registries (NAACCR) Cancer in North American (CiNA) data sets and by individual cancer registries. Methods The CBTRUS histopathology grouping scheme variable was created and implemented in an evaluation CiNA data set. The accuracy of the variable's categories was evaluated. Counts and incidence rates were calculated using SEER*Stat. Results Overall, 481,650 cases of brain and other CNS tumors meeting the CBTRUS definition were identified for diagnosis years 2015-2019 in the CiNA data set for the US and Canada, making these the sixth-most-common tumor as a group. Of the brain and other CNS tumor cases, approximately 29% were malignant (behavior code /3 in the International Classification of Diseases for Oncology, 3rd edition [ICD-O-3]) while about 71% were nonmalignant (ICD-O-3 behavior code /0 or /1). The overall age-adjusted annual incidence rate (AAAIR) of brain and other CNS tumors was 24.44 per 100,000 (95% CI, 24.37-24.51). The most common histopathologies were meningioma, of which approximately 99% were nonmalignant (AAAIR, 9.09 per 100,000; 95% CI, 9.05-9.13); tumors of the pituitary, of which about 99% were nonmalignant (AAAIR, 4.28 per 100,000; 95% CI, 4.25-4.31); and glioblastoma, of which 100% were malignant behavior (AAAIR, 3.20 per 100,000; 95% CI, 3.18-3.22). Conclusion Brain and other CNS tumors make up an extremely diverse category that contributes substantially to the cancer burden in North America. The CBTRUS histopathology grouping variable provides clinically relevant groupings for analysis of these tumors in the NAACCR CiNA as well as by individual central cancer registry groups. We encourage the use of this variable to support more detailed analysis of this important group of tumors.
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Affiliation(s)
- Quinn Ostrom
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois
- Duke University School of Medicine, Durham, North Carolina
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois
| | - Corey Neff
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois
- Duke University School of Medicine, Durham, North Carolina
| | - Albert Firth
- Information Management Systems, Inc, Rockville, Maryland
| | - Recinda Sherman
- North American Association of Central Cancer Registries, Inc, Springfield, Illinois
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Hansen J, Ring K, Hu W, Dood R, Wang Y, Baggerly K, Gallagher S, Tshiaba P, Neff C, Timms K, Mangala L, Westin S, Broaddus R, Lopez-Berestein G, Lu K, Coleman R, Maxwell G, Sood A. Homologous recombination deficiency score testing in endometrial cancer. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Diossy M, Reiniger L, Sztupinszki Z, Krzystanek M, Timms KM, Neff C, Solimeno C, Pruss D, Eklund AC, Tóth E, Kiss O, Rusz O, Cserni G, Zombori T, Székely B, Kulka J, Tímár J, Csabai I, Szallasi Z. Breast cancer brain metastases show increased levels of genomic aberration-based homologous recombination deficiency scores relative to their corresponding primary tumors. Ann Oncol 2019; 29:1948-1954. [PMID: 29917049 PMCID: PMC6158763 DOI: 10.1093/annonc/mdy216] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Based on its mechanism of action, PARP inhibitor therapy is expected to benefit mainly tumor cases with homologous recombination deficiency (HRD). Therefore, identification of tumor types with increased HRD is important for the optimal use of this class of therapeutic agents. HRD levels can be estimated using various mutational signatures from next generation sequencing data and we used this approach to determine whether breast cancer brain metastases show altered levels of HRD scores relative to their corresponding primary tumor. Patients and methods We used a previously published next generation sequencing dataset of 21 matched primary breast cancer/brain metastasis pairs to derive the various mutational signatures/HRD scores strongly associated with HRD. We also carried out the myChoice HRD analysis on an independent cohort of 17 breast cancer patients with matched primary/brain metastasis pairs. Results All of the mutational signatures indicative of HRD showed a significant increase in the brain metastases relative to their matched primary tumor in the previously published whole exome sequencing dataset. In the independent validation cohort, the myChoice HRD assay showed an increased level in 87.5% of the brain metastases relative to the primary tumor, with 56% of brain metastases being HRD positive according to the myChoice criteria. Conclusions The consistent observation that brain metastases of breast cancer tend to have higher HRD measures may raise the possibility that brain metastases may be more sensitive to PARP inhibitor treatment. This observation warrants further investigation to assess whether this increase is common to other metastatic sites as well, and whether clinical trials should adjust their strategy in the application of HRD measures for the prioritization of patients for PARP inhibitor therapy.
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Affiliation(s)
- M Diossy
- Department of Bio and Health Informatics, Technical University of Denmark, Lyngby, Denmark
| | - L Reiniger
- 1st Department of Pathology and Experimental Research, Semmelweis University, Budapest; 2nd Department of Pathology, MTA-SE NAP, Brain Metastasis Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest
| | - Z Sztupinszki
- Department of Bio and Health Informatics, Technical University of Denmark, Lyngby, Denmark; 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - M Krzystanek
- Department of Bio and Health Informatics, Technical University of Denmark, Lyngby, Denmark
| | - K M Timms
- Myriad Genetics Inc, Salt Lake City, USA
| | - C Neff
- Myriad Genetics Inc, Salt Lake City, USA
| | - C Solimeno
- Myriad Genetics Inc, Salt Lake City, USA
| | - D Pruss
- Myriad Genetics Inc, Salt Lake City, USA
| | - A C Eklund
- Department of Bio and Health Informatics, Technical University of Denmark, Lyngby, Denmark
| | - E Tóth
- Department of Pathology, National Institute of Oncology, Budapest
| | - O Kiss
- Department of Pathology, National Institute of Oncology, Budapest
| | - O Rusz
- Department of Oncotherapy, University of Szeged, Szeged
| | - G Cserni
- Department of Oncotherapy, University of Szeged, Szeged; Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét
| | - T Zombori
- Department of Oncotherapy, University of Szeged, Szeged
| | - B Székely
- 2nd Department of Pathology, Semmelweis University, Budapest; Department of Oncological Internal Medicine and Clinical Pharmacology "B", National Institute of Oncology, Budapest
| | - J Kulka
- 2nd Department of Pathology, Semmelweis University, Budapest
| | - J Tímár
- 2nd Department of Pathology, Semmelweis University, Budapest
| | - I Csabai
- Department of Physics of Complex Systems, Eötvös Loránd University, Budapest, Hungary
| | - Z Szallasi
- Department of Bio and Health Informatics, Technical University of Denmark, Lyngby, Denmark; 2nd Department of Pathology, MTA-SE NAP, Brain Metastasis Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest; Computational Health Informatics Program, Boston Children's Hospital, Harvard Medical School, Boston, USA.
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Diossy M, Reiniger L, Sztupinszki Z, Krzystanek M, Timms KM, Neff C, Solimeno C, Pruss D, Eklund AC, Tóth E, Kiss O, Rusz O, Cserni G, Zombori T, Székely B, Kulka J, Tímár J, Csabai I, Szallasi Z. Corrigendum to: Breast cancer brain metastases show increased levels of genomic aberration-based homologous recombination deficiency scores relative to their corresponding primary tumors. Ann Oncol 2019; 30:1406. [PMID: 30929001 PMCID: PMC6683852 DOI: 10.1093/annonc/mdz081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Neff C, Totten C, Plymale M, Oyler DR, Davenport D, Roth JS. Associations between anxiolytic medications and ventral hernia repair. Hernia 2018; 22:753-757. [PMID: 29594842 DOI: 10.1007/s10029-018-1766-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 11/06/2017] [Accepted: 03/23/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE This study examines the relationship between anxiolytic medications (AXM) on outcomes following ventral hernia repair. METHODS A single-center review of prospectively obtained perioperative and 30-day outcome data, including AXM use at admission, as part of the National Surgery Quality Improvement Program. RESULTS Sixty-three of the 393 patients who presented for ventral hernia repair were taking an AXM (15.6%). AXM users were more likely to have a higher ASA class, dyspnea, and treated hypertension (p < 0.05). AXM use was associated with increased operative duration, hernia size, increased estimated blood loss, and need for component separation. After adjusting for medical comorbidities, AXM users were not found to have greater 30-day morbidity or mortality. Patients taking AXM were found to have greater length of stay and increased hospital readmissions. CONCLUSIONS Patients taking anxiolytic medications undergoing ventral hernia repairs have higher ASA scores, more complex hernia characteristics, and require more concurrent procedures. They were found to have longer operative times, increased blood loss, greater duration of hospital stay, and increased readmissions that were associated with the increased perioperative risk factors. Further studies are required to determine causal links.
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Affiliation(s)
- C Neff
- Division of General Surgery, University of Kentucky College of Medicine, C 225, 800 Rose Street, Lexington, KY, 40536, USA
| | - C Totten
- Division of General Surgery, University of Kentucky College of Medicine, C 225, 800 Rose Street, Lexington, KY, 40536, USA
| | - M Plymale
- Division of General Surgery, University of Kentucky College of Medicine, C 225, 800 Rose Street, Lexington, KY, 40536, USA.
| | - D R Oyler
- Department of Pharmacy, University of Kentucky HealthCare, 800 Rose Street, Lexington, KY, 40536, USA
| | - D Davenport
- Department of Surgery, University of Kentucky College of Medicine, C 225, 800 Rose Street, Lexington, KY, 40536, USA
| | - J S Roth
- Division of General Surgery, University of Kentucky College of Medicine, C 225, 800 Rose Street, Lexington, KY, 40536, USA
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Timms K, Cuzick J, Neff C, Reid J, Solimeno C, Sangale Z, Pruss D, Gutin A, Lanchbury J, Stone S. The molecular landscape of genome instability in prostate cancer (PC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw363.63] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Timms K, Neff C, Morris B, Hodgson D, Orr M, Zhongwu L, Fielding A, Dougherty B, Spencer S, Robertson J, Barrett C, Gutin A, Lanchbury J. 466 Next generation sequencing of BRCA1 and BRCA2 genes in ovarian tumors captures all germline mutations and expands the potential treatment group for the PARP inhibitor olaparib. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30300-8] [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: 10/22/2022]
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Haluska P, Timms K, AlHilli M, Wang Y, Hartman A, Jones J, Gutin A, Sangale Z, Neff C, Lynchbury J, Rudolph-Owen L, Becker M, Agarwal S, Wilcoxen K. 214 Homologous recombination deficiency (HRD) score and niraparib efficacy in high grade ovarian cancer. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70340-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Yates M, Timms K, Daniels M, Batte B, Ring K, Neff C, Potter J, Chau S, Chen J, Williams D, Perry M, Morris B, Gutin A, Amin Y, Munsell M, Schmeler K, Lanchbury J, Lu K. Next Generation Sequencing of Brca1/2 in High Grade Ovarian Tumors Expands Brca Defects Beyond Germline Mutations. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu338.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lowery MA, Timms K, Abkevich V, Neff C, Gutin A, Lanchbury JS, Tang LH, O'Reilly EM. Molecular features of BRCA1/2 and PALB2 mutation associated pancreatic cancer (PAC). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.3_suppl.206] [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] [Indexed: 11/20/2022] Open
Abstract
206 Background: Several clinical reports have indicated increased sensitivity to DNA damaging agents and PARP inhibitors in patients with PAC arising on a background of known BRCA1/2 or PALB2 germline mutation. While the mechanism of tumorigenesis in these cancer remains unclear, it appears likely that BRCA1/2germline mutations can predispose to PAC via 2 mechanisms, only one of which requires loss of the second allele. Determination as to whether biallelic inactivation of these genes is present in the tumor may have important therapeutic implications in predicting sensitivity to PARP inhibitors and other strategies targeting DNA repair. Methods: Following approval by the IRB and human bio specimen utilization committee at MSKCC, full exon sequencing of coding regions of 28 genes including BRCA1, 2 and PALB2 using exon capture by hybridization and next generation sequencing was performed on DNA extracted from 135 PAC samples. In addition, samples were analyzed for the presence of BRCA1 promotor methylation, KRAS hotspot mutations, and genome wide loss of heterozygosity (LOH) as an exploratory assessment of number and length of LOH as a marker of homologous repair deficiency / genomic instability. All patients underwent surgery for PAC at MSKCC after year 2000. Patients were selected on the basis of survival and included if they suffered a cancer-specific death within 1 year of resection or survived at least 30 months. Results: 7 tumors had mutations in BRCA2, 1 in BRCA1 and 1 in PALB2. Of 4 BRCA2 mutated samples evaluated for LOH at the BRCA2 locus, 2 demonstrated LOH while 2 did not. There was no LOH at PALB2 in the sample where a mutation was identified. Activating KRAS mutations were identified in BRCA2 mutated tumors with and without LOH. Methylation of the BRCA1promotor regions was not identified. Conclusions: The frequency of BRCA1/2 mutation carriers was as anticipated in this population. Biallelic loss of BRCA2 or PALB2 are not required for pancreatic tumorigenesis. The benefit of PARP inhibitors in BRCA1 / 2 mutated PAC may be limited to tumors with LOH of these genes. Inactivation of BRCA1 through promoter methylation is not identified in sporadic PAC.
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Affiliation(s)
| | | | | | - C Neff
- Myriad Genetics, Inc., Salt Lake City, UT
| | | | | | - Laura H. Tang
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY
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Timms KM, Abkevich V, Neff C, Morris B, Potter J, Tran TV, Chen J, Sangale Z, Tikishvili E, Zharkikh A, Perry M, Gutin A, Lanchbury JS. Abstract P6-05-10: Association between BRCA1/2 status and DNA-based assays for homologous recombination deficiency in breast cancer. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p6-05-10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Homologous recombination (HR) repair defects are of potential therapeutic relevance in a variety of different cancers. Numerous studies have investigated the rate of BRCA1/2 mutations in triple negative breast cancer, and current clinical studies are investigating the efficacy of agents targeting HR deficiency in this breast cancer subtype. A more comprehensive assay for HR defects might expand the number of patients likely to benefit from these therapies, and may expand their utility to other breast cancer subtypes.
Recently three DNA-based measures of HR deficiency (HRD) have been developed based on whole genome tumor LOH profiles, telomeric allelic imbalance, or large-scale state transitions. These will be referred herein as HRD-LOH, HRD-TAI and HRD-LST respectively. All 3 scores are highly correlated with defects in BRCA1/2 and other pathway genes in breast or ovarian cancer, and are associated with sensitivity to platinum agents.
213 invasive breast tumor samples and matched normal tissue blocks were obtained from 3 commercial vendors. The samples were selected to contain approximately equal numbers of all subtypes of breast cancer as defined by IHC analysis of ER, PR, and HER2. BRCA1/2 mutation screening and BRCA1 promoter methylation analysis was performed, and genome wide SNP profiles were generated. These data were used to calculate HRD-LOH, HRD-TAI, and HRD-LST scores.
Somatic and germline BRCA1/2 mutations were detected in all subtypes of breast cancer at significant levels with the total mutation frequency ranging from 7.8 – 16.4% depending on subtype. In contrast BRCA1 promoter methylation was confined almost exclusively to triple negative tumors (19.7%). Overall BRCA1/2 deficiency ranged from approximately 10% in ER+/Her2- tumors up to approximately 36% in triple negative tumors.
HRD-LOH, HRD-TAI, and HRD- LST scores have previously been shown to be highly significantly associated with BRCA1/2 status in both breast and ovarian cancer. In this dataset all 3 scores showed significant association with BRCA1/2 status for the entire dataset, in addition significant association was observed between the scores and BRCA1/2 status in each of the individual tumor subtypes. The 3 scores were found to be highly correlated with one another, but all 3 were still significant in multivariate analysis. This dataset is not of sufficient size to determine which of these scores is best able to identify BRCA1/2 deficient tumors. It is likely that a combination of the 3 scores will prove to be the most robust predictor of HR deficiency.
This study has demonstrated significant levels of BRCA1/2 deficiency across all subtypes of breast cancer. All 3 HR deficiency assays showed significant association with BRCA1/2 deficiency regardless of breast cancer subtype. The 3 scores are highly correlated, but also additive and a combination of all 3 is likely to provide the best predictor of HR deficiency.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-05-10.
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Affiliation(s)
- KM Timms
- Myriad Genetics, Inc., Salt Lake City, UT
| | - V Abkevich
- Myriad Genetics, Inc., Salt Lake City, UT
| | - C Neff
- Myriad Genetics, Inc., Salt Lake City, UT
| | - B Morris
- Myriad Genetics, Inc., Salt Lake City, UT
| | - J Potter
- Myriad Genetics, Inc., Salt Lake City, UT
| | - TV Tran
- Myriad Genetics, Inc., Salt Lake City, UT
| | - J Chen
- Myriad Genetics, Inc., Salt Lake City, UT
| | - Z Sangale
- Myriad Genetics, Inc., Salt Lake City, UT
| | | | - A Zharkikh
- Myriad Genetics, Inc., Salt Lake City, UT
| | - M Perry
- Myriad Genetics, Inc., Salt Lake City, UT
| | - A Gutin
- Myriad Genetics, Inc., Salt Lake City, UT
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Neff C, Sudler C, Hoop RK. Characterization of western European field isolates and vaccine strains of avian infectious laryngotracheitis virus by restriction fragment length polymorphism and sequence analysis. Avian Dis 2008; 52:278-83. [PMID: 18646457 DOI: 10.1637/8168-110107-reg.1] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Infectious laryngotracheitis is a dramatic disease of the upper respiratory tract in poultry caused by a herpesvirus. In this study we investigated the characteristics of western European field isolates of infectious laryngotracheitis virus (ILTV) to gain more information on their diversity. The examined 104 isolates, collected from acute outbreaks during the last 35 years, originated from eight different countries: Switzerland (48), Germany (21), Sweden (14), the United Kingdom (9), Italy (5), Belgium (4), Austria (2), and Norway (1). Two vaccines, a chicken embryo origin product and a tissue culture origin product, were included in the survey. Polymerase chain reaction (PCR) was performed to amplify a 2.1-kb DNA fragment of ILTV using primers generated for the thymidine kinase (TK) gene. After digestion of the resulting PCR products by restriction endonuclease HaeIII, restriction fragment length polymorphism analysis was carried out. PCR amplicons of three field isolates and both vaccine strains were selected for sequencing. Here 98 field isolates showed the same cleavage pattern and were identical to both vaccine strains (clone 1). They differed from five Swiss isolates with identical cleavage pattern (clone 2) and one Swedish isolate (clone 3). The present study demonstrated that at least three clones of ILTV have been circulating in western Europe during the last 35 years. The 104 isolates analyzed showed a high genetic similarity regarding the TK gene, and a large majority of the field isolates (98/104) were genetically related to the vaccine strains.
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Affiliation(s)
- C Neff
- Institute of Veterinary Bacteriology, National Reference Center for Poultry and Rabbit Diseases, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 270, 8057 Zurich, Switzerland.
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Schwab A, Rossmann H, Klein M, Dieterich P, Gassner B, Neff C, Stock C, Seidler U. Functional role of Na+-HCO3- cotransport in migration of transformed renal epithelial cells. J Physiol 2005; 568:445-58. [PMID: 16037087 PMCID: PMC1474735 DOI: 10.1113/jphysiol.2005.092957] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/19/2005] [Accepted: 07/19/2005] [Indexed: 11/08/2022] Open
Abstract
Cell migration is crucial for immune defence, wound healing or formation of tumour metastases. It has been shown that the activity of the Na(+)-H(+) exchanger (NHE1) plays an important role in cell migration. However, so far it is unknown whether Na(+)- HCO(3)(-) cotransport (NBC), which has similar functions in the regulation of intracellular pH (pH(i)) as NHE1, is also involved in cell migration. We therefore isolated NHE-deficient Madin-Darby canine kidney (MDCK-F) cells and tested whether NBC compensates for NHE in pH(i) and cell volume regulation as well as in migration. Intracellular pH was measured with the fluorescent pH indicator 2'7'-bis(carboxyethyl)-5-carboxyfluorescein (BCECF). The expression of NBC isoforms was determined with semiquantitative PCR. Migration was monitored with time-lapse video microscopy and quantified as the displacement of the cell centre. We found that MDCK-F cells express the isoform NBC1 (SLCA4A gene product) at a much higher level than the isoform kNBC3 (SLCA4A8 gene product). This difference is even more pronounced in NHE-deficient cells so that NBC1 is likely to be the major acid extruder in these cells and the major mediator of propionate-induced cell volume increase. NHE-deficient MDCK-F cells migrate more slowly than normal MDCK-F cells. NBC activity promotes migration during an acute intracellular acid load and increases migratory speed and displacement on a short timescale (< 30 min) whereas it has no effect on the long-term behaviour of migrating MDCK-F cells. Taken together, our results show that NBC actvity, despite many functional similarities, does not have the same importance for cell migration as NHE1 activity.
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Affiliation(s)
- A Schwab
- Institute of Physiology II, Münster, Germany.
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Hays R, Buchanan KT, Neff C, Orenic TV. Patterning of Drosophila leg sensory organs through combinatorial signaling by hedgehog, decapentaplegic and wingless. Development 1999; 126:2891-9. [PMID: 10357933 DOI: 10.1242/dev.126.13.2891] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
During development, global patterning events initiate signal transduction cascades which gradually establish an array of individual cell fates. Many of the genes which pattern Drosophila are expressed throughout development and specify diverse cell types by creating unique local environments which establish the expression of locally acting genes. This process is exemplified by the patterning of leg microchaete rows. hairy (h) is expressed in a spatially restricted manner in the leg imaginal disc and functions to position adult leg bristle rows by negatively regulating the proneural gene achaete, which specifies sensory cell fates. While much is known about the events that partition the leg imaginal disc and about sensory cell differentiation, the mechanisms that refine early patterning events to the level of individual cell fate specification are not well understood. We have investigated the regulation of h expression along the dorsal/ventral (D/V) axis of the leg adjacent to the anterior/posterior (A/P) compartment boundary and have found that it requires input from both D/V and A/P patterning mechanisms. Expression of the D/V axis h stripe (D/V-h) is controlled by dorsal- and ventral-specific enhancer elements which are targets of Decapentaplegic (Dpp) and Wingless (Wg) signaling, respectively, but which are also dependent on Hedgehog (Hh) signaling for activation. D/V-h expression is lost in smoothened mutant clones and is specifically activated by exogenously supplied Cubitus interruptus (Ci). D/V-h expression is also lost in clones deficient for Dpp and Wg signaling, but ectopic activation of D/V-h by Dpp and Wg is limited to the A/P compartment boundary where endogenous levels of full-length Ci are high. We propose that D/V-h expression is regulated in a non-linear pathway in which Ci plays a dual role. In addition to serving as an upstream activator of Dpp and Wg, Ci acts combinatorially with them to activate D/V-h expression.
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Affiliation(s)
- R Hays
- Department of Biochemistry, Molecular Biology, and Cell Biology, Northwestern University, Evanston, IL 60208, USA
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Lenzenweger MF, Loranger AW, Korfine L, Neff C. Detecting personality disorders in a nonclinical population. Application of a 2-stage procedure for case identification. Arch Gen Psychiatry 1997; 54:345-51. [PMID: 9107151 DOI: 10.1001/archpsyc.1997.01830160073010] [Citation(s) in RCA: 181] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND There is no epidemiology of personality disorders (PDs) comparable with that currently available for most other mental disorders. One reason for this is that an Axis II diagnosis usually requires considerable clinical sophistication and it is expensive to deploy clinicians rather than trained laypersons to examine large community samples. This study explores the feasibility of using a 2-stage method in which only subjects who were screened as positive for PD would be interviewed by clinicians. METHODS University students were screened with a self-administered Axis II inventory and subsequently interviewed by clinicians with the use of the International Personality Disorder Examination. RESULTS The screen detected all individuals who subsequently received a definite diagnosis on the interview, and a specificity rate of detection was 61%. The point-prevalence estimate for diagnosable PD in this nonclinical population was 11.01% (95% confidence interval, 7.57%-14.52%). CONCLUSION If these results can be replicated in a more representative community sample, this 2-stage method might substantially reduce the number of persons who needed to be interviewed in a major epidemiological study of PDs, with little or no loss in diagnostic accuracy, while presumably lowering the cost of such an investigation.
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Affiliation(s)
- M F Lenzenweger
- Laboratory of Experimental Psychopathology, Cornell University, Ithaca, NY, USA
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Cook WR, Neff C. Attitudes of physicians in northern Ontario to medical malpractice litigation. Can Fam Physician 1994; 40:689-98. [PMID: 8199521 PMCID: PMC2380112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To survey medical practitioners' experience with and attitudes toward litigation alleging medical malpractice. DESIGN A survey using a questionnaire. SETTING The Sudbury and Manitoulin Health District of Northern Ontario. PARTICIPANTS Medical practitioners in the area. RESULTS Physicians are sometimes negligent; malpractice is not simply created by entrepreneurial lawyers and patients with unrealistic expectations. At present malpractice is restrained by both the threat of civil litigation and the disciplinary committee of the Ontario College of Physicians and Surgeons. CONCLUSION We must address the fear of malpractice suits if the North is to attract and retain the physicians it needs to provide modern standards of medical care.
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Affiliation(s)
- W R Cook
- Department of Economics, Laurentian University, Sudbury, Ont
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Bhat S, Neff C, Fisher M, Trebbin W. Sonographic pseudokidney after nephrectomy. Urol Radiol 1990; 12:94-5. [PMID: 2238291 DOI: 10.1007/bf02923977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
When interpreting renal sonograms, one should be aware of the possibility of mistaking fat and scarring in the renal fossa for a normal kidney in a patient with a history of prior nephrectomy. When in doubt, the ultrasound findings should be confirmed with a CT scan.
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Affiliation(s)
- S Bhat
- Department of Medicine, Salem Hospital, Massachusetts 01970
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Neff C. Use of fentanyl and diazepam for special procedures. Radiology 1988; 166:581. [PMID: 3336746 DOI: 10.1148/radiology.166.2.3336746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Neff C, Neff R. Problems and progress in Honduras. Int Nurs Rev 1975; 22:43-5. [PMID: 1040621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Schimmler W, Neff C, Schimert G. [Risk factors and myocardial infarction. A retrospective study]. Munch Med Wochenschr 1968; 110:1585-94. [PMID: 5756284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Schimmler W, Schimert G, Neff C. [Smoking habits and elasticity of the aorta. (Measuring of the pulse wave velocity in male cigarette smokers, ex-smokers and non-smokers). Preliminary report]. Z Kreislaufforsch 1967; 56:1121-7. [PMID: 5599046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Schimmler W, Neff C. [On elastic properties of the aorta following healed-up myocardial infarct. Report on 435 male infarct patients]. Klin Wochenschr 1966; 44:683-7. [PMID: 5992202 DOI: 10.1007/bf01790791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Schimmler W, Neff C. [Smoking habits and myocardial infarct. Socio-epidemiological studies of 473 male and 77 female patients]. Munch Med Wochenschr 1966; 108:903-15. [PMID: 6014231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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