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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Standring O, Benitez Sanchez S, Pasha S, Demyan L, Lad N, Ruff SM, Anantha S, Karpeh M, Newman E, Nealon W, Talamini M, Coppa G, Deutsch G, Weiss M, DePeralta DK. Potential Role for Observation in Small Solid Pseudopapillary Neoplasm (SPN). Ann Surg Oncol 2023; 30:5105-5112. [PMID: 37233954 DOI: 10.1245/s10434-023-13496-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 03/28/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Solid pseudopapillary neoplasms (SPN) are rare tumors of the pancreas, typically affecting young women. Resection is the mainstay of treatment but is associated with significant morbidity and potential mortality. We explore the idea that small, localized SPN could be safely observed. METHODS This retrospective review of the Pancreas National Cancer Database from 2004 to 2018 identified SPN via histology code 8452. RESULTS A total of 994 SPNs were identified. Mean age was 36.8 ± 0.5 years, 84.9% (n = 844) were female, and most had a Charlson-Deyo Comorbidity Coefficient (CDCC) of 0-1 (96.6%, n = 960). Patients were most often staged clinically as cT2 (69.5%, n = 457) followed by cT3 (17.6%, n = 116), cT1 (11.2%, n = 74), and cT4 (1.7%, n = 11). Clinical lymph node and distant metastasis rates were 3.0 and 4.0%, respectively. Surgical resection was performed in 96.6% of patients (n = 960), most commonly partial pancreatectomy (44.3%) followed by pancreatoduodenectomy (31.3%) and total pancreatectomy (8.1%). In patients clinically staged as node (N0) and distant metastasis (M0) negative, occult pathologic lymph node involvement was found in 0% (n = 28) of patients with stage cT1 and 0.5% (n = 185) of patients with cT2 disease. The risk of occult nodal metastasis significantly increased to 8.9% (n = 61) for patients with cT3 disease. The risk further increased to 50% (n = 2) in patients with cT4 disease. CONCLUSIONS Herein, the specificity of excluding nodal involvement clinically is 99.5% in tumors ≤ 4 cm and 100% in tumors ≤ 2 cm. Therefore, there may be a role for close observation in patients with cT1N0 lesions to mitigate morbidity from major pancreatic resection.
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Affiliation(s)
- Oliver Standring
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
| | | | - Shamsher Pasha
- Northwell Health Cancer Institute, Lake Success, NY, USA
| | - Lyudmyla Demyan
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
| | - Neha Lad
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
- Northwell Health Cancer Institute, Lake Success, NY, USA
| | - Samantha M Ruff
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
| | - Sandeep Anantha
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Martin Karpeh
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Surgical Oncology, Northwell Health, Huntington Hospital, Huntington, NY, USA
| | - Elliot Newman
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Surgical Oncology, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - William Nealon
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Mark Talamini
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Gene Coppa
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Gary Deutsch
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Matthew Weiss
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Danielle K DePeralta
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA.
- Northwell Health Cancer Institute, Lake Success, NY, USA.
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
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Standring O, Sanchez SB, Pasha S, Demyan L, Lad N, Ruff SM, Anantha S, Karpeh M, Newman E, Nealon W, Talamini M, Coppa G, Deutsch G, Weiss M, DePeralta DK. ASO Visual Abstract: Potential Role for Observation in Small Solid Pseudopapillary Neoplasm (SPN). Ann Surg Oncol 2023; 30:5113-5114. [PMID: 37225833 DOI: 10.1245/s10434-023-13602-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Oliver Standring
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
| | | | - Shamsher Pasha
- Northwell Health Cancer Institute, Lake Success, NY, USA
| | - Lyudmyla Demyan
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
| | - Neha Lad
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
- Northwell Health Cancer Institute, Lake Success, NY, USA
| | - Samantha M Ruff
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
| | - Sandeep Anantha
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Martin Karpeh
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Surgical Oncology, Northwell Health, Huntington Hospital, Huntington, NY, USA
| | - Elliot Newman
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Surgical Oncology, Northwell Health, Lenox Hill Hospital, New York, NY, USA
| | - William Nealon
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Mark Talamini
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Gene Coppa
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Gary Deutsch
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Matthew Weiss
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA
- Northwell Health Cancer Institute, Lake Success, NY, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Danielle K DePeralta
- Northwell Health, North Shore/Long Island Jewish General Surgery, Manhasset, NY, USA.
- Northwell Health Cancer Institute, Lake Success, NY, USA.
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
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Behera S, Belyeu JR, Chen X, Paulin LF, Nguyen NQH, Newman E, Mahmoud M, Menon VK, Qi Q, Joshi P, Marcovina S, Rossi M, Roller E, Han J, Onuchic V, Avery CL, Ballantyne CM, Rodriguez CJ, Kaplan RC, Muzny DM, Metcalf GA, Gibbs R, Yu B, Boerwinkle E, Eberle MA, Sedlazeck FJ. Identification of allele-specific KIV-2 repeats and impact on Lp(a) measurements for cardiovascular disease risk. bioRxiv 2023:2023.04.24.538128. [PMID: 37163057 PMCID: PMC10168217 DOI: 10.1101/2023.04.24.538128] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The abundance of Lp(a) protein holds significant implications for the risk of cardiovascular disease (CVD), which is directly impacted by the copy number (CN) of KIV-2, a 5.5 kbp sub-region. KIV-2 is highly polymorphic in the population and accurate analysis is challenging. In this study, we present the DRAGEN KIV-2 CN caller, which utilizes short reads. Data across 166 WGS show that the caller has high accuracy, compared to optical mapping and can further phase ~50% of the samples. We compared KIV-2 CN numbers to 24 previously postulated KIV-2 relevant SNVs, revealing that many are ineffective predictors of KIV-2 copy number. Population studies, including USA-based cohorts, showed distinct KIV-2 CN, distributions for European-, African-, and Hispanic-American populations and further underscored the limitations of SNV predictors. We demonstrate that the CN estimates correlate significantly with the available Lp(a) protein levels and that phasing is highly important.
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Affiliation(s)
- S Behera
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | | | - X Chen
- Illumina Inc., San Diego, CA, USA
| | - L F Paulin
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - N Q H Nguyen
- School of Public Health, University of Texas Health Science Center at Houston, TX, USA
| | - E Newman
- Illumina Inc., San Diego, CA, USA
| | - M Mahmoud
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - V K Menon
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Q Qi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - P Joshi
- Medpace Reference Laboratories, Cincinnati, OH, USA
| | - S Marcovina
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - M Rossi
- Illumina Inc., San Diego, CA, USA
| | - E Roller
- Illumina Inc., San Diego, CA, USA
| | - J Han
- Illumina Inc., San Diego, CA, USA
| | | | - C L Avery
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - C M Ballantyne
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - C J Rodriguez
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - R C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Fred Hutchinson Cancer Center, Public Health Sciences Division, Seattle WA 98109
| | - D M Muzny
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - G A Metcalf
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - R Gibbs
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - B Yu
- School of Public Health, University of Texas Health Science Center at Houston, TX, USA
| | - E Boerwinkle
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
- School of Public Health, University of Texas Health Science Center at Houston, TX, USA
| | | | - F J Sedlazeck
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
- Department of Computer Science, Rice University, 6100 Main Street, Houston, TX, USA
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Covas P, Liu B, Swamy S, Bourne M, Alafarj M, Cantlay C, Newman E, Sidahmed A, Bradley A, Choi B, Lichtenberger J, Zeman R, Katz R, Earls J, Choi A. 415 Canary In A Coal Mine In NSTEMI? AI-QCT Evaluation Of Atherosclerosis And 2-year Outcomes After CCTA. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.020] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mörtzell Henriksson M, Weiner M, Sperker W, Berlin G, Segelmark M, Javier Martinez A, Audzijoniene J, Griskevicius A, Newman E, Blaha M, Vrielink H, Witt V, Stegmayr B. Analyses of registry data of patients with anti-GBM and antineutrophil cytoplasmatic antibody-associated (ANCA) vasculitis treated with or without therapeutic apheresis. Transfus Apher Sci 2021; 60:103227. [PMID: 34384719 DOI: 10.1016/j.transci.2021.103227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/29/2021] [Accepted: 07/29/2021] [Indexed: 11/26/2022]
Abstract
Therapeutic apheresis (TA) as a treatment for antibody-associated vasculitis (AAV) was questioned by the PEXIVAS although the MEPEX study favored TA. The aim of this study was to evaluate the efficacy of TA to improve renal function in patients consecutively included in the WAA-apheresis registry versus patients not treated with TA. MATERIALS AND METHODS Included were 192 patients that suffered from anti-glomerular basement membrane disease (anti-GBM, n = 28) and antineutrophil cytoplasmic antibody-associated vasculitis of MPO or PR3 origin. Of these 119 had performed TA and the other 73 had not performed TA for theses diagnoses (CTRL). RESULTS Elderly had an increased risk to die within 12 months (p = 0.002). All 28 anti-GBM had renal involvement, 21 dialysis dependent. At 3 month nine (36 %) did not need dialysis. Baseline data regarding renal function of AAV patients, subtype MPO and PR3, were worse in the TA groups than in CTRL. Recovery out of dialysis was better for the PR3-TA group compared with 1) the controls of MEPEX (RR 0.59, CI 0.43-0.80) and 2) the MPO-TA patients (RR 0.28, CI 0.12-0.68). The MPO-TA recovered similarly as the MEPEX-CTRL. Renal function improved most for TA-patients from baseline during the first 3 months (MPO-TA and PR3-TA) and stabilized thereafter and less for MPO-CTRL and PR3-CTRL. CONCLUSION PR3-TA patients seem to have best chances to get out of dialysis. PR3-TA and MPO-TA improved residual renal function better than CTRL. The present study recommends reconsiderations to use TA for AAV especially those with PR3-vasculitis with severe renal vasculitis.
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Affiliation(s)
| | - M Weiner
- Department of Nephrology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | | | - G Berlin
- Department of Clinical Immunology and Transfusion Medicine, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - M Segelmark
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | | | | | | | - E Newman
- Concord Hospital, Sydney, Australia
| | - M Blaha
- Kralove University, Kralove, Czech Republic
| | | | - V Witt
- St Anna Kinderspital, Vienna, Austria
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Ruff SM, Standring O, Wu G, Levy A, Anantha S, Newman E, Karpeh MS, Nealon W, Deutsch GB, Weiss MJ, DePeralta DK. Ampullary Neuroendocrine Tumors: Insight into a Rare Histology. Ann Surg Oncol 2021; 28:8318-8328. [PMID: 34312800 DOI: 10.1245/s10434-021-10371-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/11/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Ampullary neuroendocrine tumors (NETs) make up < 1% of all gastroenteropancreatic NETs, and information is limited to case series. This study compares patients with ampullary, duodenal, and pancreatic head NETs. METHODS The National Cancer Database (2004-2016) was queried for patients with ampullary, duodenal, and pancreatic head NETs. Survival was evaluated using Kaplan-Meier analysis and Cox regression. RESULTS Overall, 872, 9692, and 6561 patients were identified with ampullary, duodenal, and pancreatic head NETs, respectively. Patients with ampullary NETs had more grade 3 tumors (n = 149, 17%) than patients with duodenal (n = 197, 2%) or pancreatic head (n = 740, 11%) NETs. Patients with ampullary NETs had more positive lymph nodes (n = 297, 34%) than patients with duodenal (n = 950, 10%) or pancreatic head (n = 1513, 23%) NETs. On multivariable analysis for patients with ampullary NETs, age (hazard ratio [HR] 1.03, p < 0.0001), Charlson-Deyo score of 2 (HR 2.3, p = 0.001) or ≥3 (HR 2.9, p = 0.013), grade 2 (HR 1.9, p = 0.007) or grade 3 tumors (HR 4.0, p < 0.0001), and metastatic disease (HR 2.0, p = 0.001) were associated with decreased survival. At 5 years, the overall survival (OS) for patients with ampullary, duodenal, and pancreatic head NETs was 59%, 71%, and 50%, respectively (p < 0.0001), whereas the 5-year OS for patients with ampullary, duodenal, and pancreatic head NETs who underwent surgery was 62%, 78%, and 76%, respectively (p < 0.0001). CONCLUSIONS Ampullary NETs were more likely to present with high-grade tumors and lymph node metastases. Based on the clinicopathologic and survival data, ampullary NETs have a unique underlying biology compared with duodenal and pancreatic head NETs.
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Affiliation(s)
- Samantha M Ruff
- Department of General Surgery, Northwell Health, Queens, NY, USA
| | - Oliver Standring
- Department of General Surgery, Northwell Health, Queens, NY, USA
| | - Grace Wu
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Anna Levy
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Monter Cancer Center, North New Hyde Park, NY, USA
| | - Sandeep Anantha
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Monter Cancer Center, North New Hyde Park, NY, USA
| | - Elliot Newman
- Lenox Hill Hospital Surgical Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health Cancer Institute, New York, NY, USA
| | - Martin S Karpeh
- Department of Surgical Oncology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Huntington Hospital, Huntington, NY, USA
| | - William Nealon
- Department of General Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Queens, NY, USA
| | - Gary B Deutsch
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Monter Cancer Center, North New Hyde Park, NY, USA
| | - Matthew J Weiss
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Monter Cancer Center, North New Hyde Park, NY, USA
| | - Danielle K DePeralta
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Monter Cancer Center, North New Hyde Park, NY, USA.
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Ruff SM, Standring O, Wu G, Levy A, Anantha S, Newman E, Karpeh MS, Nealon W, Deutsch GB, Weiss MJ, DePeralta DK. ASO Visual Abstract: Ampullary Neuroendocrine Tumors-Insight into a Rare Histology. Ann Surg Oncol 2021. [PMID: 34263373 DOI: 10.1245/s10434-021-10416-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Ampullary neuroendocrine tumors (NETs) make up < 1% of all gastroenteropancreatic NETs. \Our study uses a national database to evaluate clinicopathologic factors and overall survival of this rare tumor ( https://doi.org/10.1245/s10434-021-10371-w ). It demonstrates that ampullary NETs likely have a different underlying biology than duodenal and pancreatic head NETs.
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Affiliation(s)
- Samantha M Ruff
- Department of General Surgery, Northwell Health, Queens, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Oliver Standring
- Department of General Surgery, Northwell Health, Queens, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Grace Wu
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Anna Levy
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Monter Cancer Center, Northwell Health, North New Hyde Park, NY, USA
| | - Sandeep Anantha
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Monter Cancer Center, Northwell Health, North New Hyde Park, NY, USA
| | - Elliot Newman
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Lenox Hill Hospital Surgical Oncology, Northwell Health Cancer Institute, New York, NY, USA
| | - Martin S Karpeh
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Department of Surgical Oncology, Northwell Health, Huntington Hospital, Huntington, NY, USA
| | - William Nealon
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Department of General Surgery, Northwell Health, Queens, NY, USA
| | - Gary B Deutsch
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Monter Cancer Center, Northwell Health, North New Hyde Park, NY, USA
| | - Matthew J Weiss
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Monter Cancer Center, Northwell Health, North New Hyde Park, NY, USA
| | - Danielle K DePeralta
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA. .,Monter Cancer Center, Northwell Health, North New Hyde Park, NY, USA.
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Covas P, Liu B, Newman E, Jennings R, Crabtree T, Min J, Krepp J, Choi B, Lewis J, Reiner J, Katz R, Earls J, Choi A. Artificial Intelligence Guided Evaluation Of Atherosclerosis And Vessel Morphology In Non-ST Elevation Myocardial Infarction From Cardiac Computed Tomography (AI NSTEMI-CCTA). J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.165] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Newman E, Covas P, Liu B, Sidhamed A, Mazhari R, Lichtenberger J, Zeman R, Earls J, Choi A. Low Rate Of Acute Kidney Injury After Coronary Computed Tomography Angiography And Invasive Angiography In Low-intermediate Risk Acute Coronary Syndrome. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.190] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Goyal SP, Vojnic M, Yang JI, Jose J, Newman E, Saif MW. Neoadjuvant Therapy (NAT) in Localized Pancreatic Cancer: Should We Do It and What Should We Do? J Cell Signal 2021; 2:80-84. [PMID: 34355216 PMCID: PMC8336067 DOI: 10.33696/signaling.2.037] [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] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Morana Vojnic
- Northwell Health Cancer Institute, Lake Success, NY 11042, USA
| | - Jung-In Yang
- Northwell Health Cancer Institute, Lake Success, NY 11042, USA
| | - Jyothi Jose
- Northwell Health Cancer Institute, Lake Success, NY 11042, USA
| | - Elliot Newman
- Northwell Health Cancer Institute, Lake Success, NY 11042, USA
| | - M Wasif Saif
- Northwell Health Cancer Institute, Lake Success, NY 11042, USA
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T, Nigo Samuel L, Otuneme C, Prosper N, Umenze F, Boutros M, Caminsky N, Dumitra S, Garfinkle R, Morency D, Salama E, Banks A, Ferri L, He H, Katz A, Liberman AS, Meterissian S, Pang A, Parvez E, Agarwal A, Dare A, Hameed U, Osman F, Sequeira S, Coburn N, Dare A, Jaffer A, Karanicolas P, Mosseler M, Musselman R, Liu X, Yip CW, Garces-Otero JS, Guzman C, Sierra S, Uribe Valencia A, Cabrera Rivera PA, Camelo S, Gonzalez A, González-Orozco A, Mosquera Paz MS, Perez Rivera CJ, Gonzalez F, Isaza-Restrepo A, Nino- Torres L, Arias Madrid N, Mendoza Arango MC, Sierra S, Bake J, Tsandiraki J, Jemendžic D, Kocman B, Šuman O, Canic R, Jurišic D, Karakas I, Krizanovic Rupcic A, Pitlovic V, Samardžic J, Kopljar M, Bacic I, Domini E, Karlo R, Mihanovic J, Miljanic D, Simic A, Ahmed M, Al Nassrallah M, Altaf R, Amjad T, Eltoum R, Haidar H, Hassan A, Khalil O, Qasem M, Ramesh R, Sajith G, Wisal M, Žatecký J, Bujda M, Jirankova K, Paclik A, Abdallah A, Abdulgawad Almogy M, Ayman El-sawy E, ElFayoumy AM, Elghareeb N, Esmat NA, Fadel A, Habater A, Hamdy H, Hefni A, Kamal M, Mohamed Abobakr N, Sayed A, Shaker N, Taha E, Tharwat H, Zakaria O, Abdelmotaleb I, Al-Dhufri A, Al-Himyari HS, El sheikh E, Eldmaty A, Elkhalawy A, M.Elkhashen A, Magdy K, Mostafa S, Sadia HD, Saleh MM, Samir D, Yahia Mohamed Ali M, A. Nassar M, Abdelhady S, Abdelrazek A, Abdelsalam I, El-Sawy A, Essam E, Gadelkarim M, Ghaly K, Hassabalnaby M, Masarani R, Mohamed Shaaban N, Sabry A, Salem M, Soliman NA, Zahran D, Abou El.soud MR, Badr ET, Borham H, Elmeslemany N, Elsayed M, Elsherif F, Eslam S, Gaber G, Ibrahim S, Kamh Y, Mahmoud A, Mohamed SG, Morshedy E, Omar C, Salem Soliman F, Abdelkawy S, Abdelmohsen N, Abdelshakour M, Dahy A, Gamal N, Gamal M, Hasan A, Hetta H, Mousa N, Omar M, Rabie S, Saad M, Saleh B, Sayed Mohamed M, Shawqi M, Abdelhady Mousa H, Alnoury M, Elbealawy M, Elshafey A, Essam Ibrahim El Desouki Muhammad Ahmed M, Ghonaim M, Hgag F, Ibrahim M, Morsy M, Reda Loaloa M, Refaat A, Samir H, Shahien F, Sobhy M, Sroor F, Abdellatif E, Adel M, Afifi AA, Afifi E, Antaky M, Dawoud A, El Zoghby N, El-remaily A, Elzanfaly AA, Gadallah A, Gamal FA, Hashem O, Medhat Youssef S, Muhammad Attyah A, Munir M, Shazly O, Taha E, Wilson K, Adel S, Ali A, Eid E, Elhelow E, Elmahdy M, Elshatby B, Hossam el-din Zakaria A, 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Ashour F, Elgammudi M, Omar F. 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M, Koco H, Lawani S, Kassa MW, Santos Bezerra T, Gribnev P, Dimitrov D, Krastev P, Oum S, Bonghaseh DT, Al Farsi M, Alsharqawi N, Agarwal A, Acevedo V, Castillo Barbosa AC, Giron F, Leon Rodriguez JP, Kucan D, Rosko D, Barsic N, Župan D, Hegazi A, Truncíková V, Fryba V, Mohamed M, Sultan A, Nagi A, Rashad Temerik A, Elshawy ME, Mahmoud MI, Omar S, Anwar M, Rageh T, Elmokadem A, Gaballa K, Teppo S, Turunen A, Pengermä P, Ballouhey Q, Bergeat D, Weyl A, Hain E, Gyedu A, Yenli E, Osei-Poku D, Rompou VA, Zoikas A, Gaitanidis A, Koukis G, Perivoliotis K, Tavlas P, Galanos-Demiris K, Zografos G, Karavokyros I, Xanthopoulou G, Iordanidou E, Ayau F, Garcia A, Damján P, Wason D, B L A, Rangganata E, Kamath P, O'Connor DB, Pinto M, Perrone F, Tropeano FP, Troilo F, Bossi D, Scala D, Pulitanò L, Carella M, Pietrabissa A, Gori A, Giraudo G, De Simone V, Russo AA, Braccio B, Al-Taher R, Athamneh S, Parker A, Sawiee A, Kattia A, Salem M, Tababa O, Shaeeb Z, Syminas V, Jurgaitis J, Damuleviciene G, Svagzdys S, Poskus T, Razafimanjato NNM, Chieng Loo L, Tiong IC, Wan Muhmad WF, Vijeyan H, Li Ying T, Grech G, Arrangoiz R, Jimenez Ley VB, Arizpe D, Jimenez Ley VB, Lagunes Lara E, Castro López EV, Eaazim J, Gordinou de Gouberville M, Bastiaenen V, Rottier S, Nahab F, Ji MY, Seyoji M, Nwachukwu C, Emeghara O, Muhammed SE, Idowu A, Sowemimo O, Ogundoyin O, Akande O, Lott A, Nadeem M, Laghari AA, Loya A, Mushtaq H, Abdullah MT, Abuhilal B, Atawneh M, Hamdan H, Alhabil B, Srour A, Mousa I, Da Silva Medina L, Sacdalan MD, Lapitan MC, Sacdalan MD, Sacdalan MD, Bartosiak K, Ferreira P, Francisco V, Lemos R, Frutuoso L, Fernandes S, Fonseca T, Pereira J, Rachadell J, Torre A, Madeira Martins F, Carvalho AC, Rodrigues Ferreira J, Ribeiro da Silva B, Devesa H, Vieira A, Mónica I, Amaro M, Sousa D, Reia M, Louro J, Martins A, Dominguez J, Santos I, Freitas Oliveira NM, Pereira JC, Silva-Vaz P, Freire L, Escrevente R, Negoita VM, Shakhmatov D, Nezerwa Y, Radulovic R, Moore R, Obery G, Viljoen F, Mendes T, Suarez A, Moncada E, Fernandez-Hevia M, Curtis Martínez C, Gil Garcia JM, González Zunzarren M, Idris T, Eklöv K, Grahn O, Amin L, Blomqvist M, Ajani C, Kraus R, Seeger N, Willemin M, Rayya F, Ayash M, Msouti R, Kannas I, Abazid E, Esper A, Slim S, Kavcar AS, Aytac E, Dural AC, Ilker A, Eray IC, Kurnaz E, Altiner S, Tepe MD, Sahin C, Savli E, Innocent A, Babirye L, Diachenko A, Hordoskiy V, Curry H, Chau CYC, Robertson H, Mahmoud A, Lennon H, Loi L, Kirkham E, McCann C, Watts D, Gurung B, Wilson M, Tribedi T, Garofalo E, Zahra B, MacDonald S, Daniels I, Ng N, Khosla S, Olivier J, Yue SYP, Suresh G, Wellington J, Lorejo E, Mossaad M, Tryliskyy Y, Crutcher M, Alimi M, Baiu I, Abdou H, Conway A, Peck C, Wagner G, Perdomo Perez MA, Trostchansky I, Zulu S, Nakazwe M, Knight SR, Drake TM, Nepogodiev D, Fitzgerald JE, Ademuyiwa A, Alexander P, Ingabire JA, Al-Saqqa SW, Biccard BM, Borda-Luque G, Borowski DW, Burger S, Chu K, Clarke D, Costas-Chavarri A, Davies J, Donaldson R, Ede C, Garden OJ, Ghosh D, Glasbey J, Kingham TP, Salem HK, Anyomih TTK, Koto MZ, Lapitan MC, Lawani I, Lesetedi C, Aguilera-Arevalo ML, Mabedi C, Maimbo M, Magill L, Makinde Alakaloko F, Makupe A, Martin J, Ramos-De la Medina A, Monahan M, Moore R, Msosa V, Mulira S, Mutabazi AZ, Muller E, Musowoyo J, Adisa AO, Olory-Togbe JL, Pius R, Qureshi AU, Rayne S, Roberts T, Sacdalan MD, Shaw CA, Smart N, Smith M, Spence R, Van Straten S, Tabiri S, Tayler V, Weiser TG, Windsor J, Yorke J, Yepez R, Lilford R, Morton D, Bhangu A, Sundar S, Harrison EM, Runigamugabo E, Verjee A, Chen J, Daya L, El Aroussi N, Farina V, Gnintedeme Olivier T, Gonzales Nacarino M, Hammani A, Honjo S, Jacobs R, Kimura H, Litvin A, Nkoronko M, Nour I, Oscullo Yepez JJ, Pagano G, Pata F, Pin Hung W, Raj A, Romani Pozo A, Rommaneh M, Sassamela Fabiano SC, Shiroma Gago CM, Shu Yip S, Srinivas A, Sung CY, Tai A, Valle Aranda YC, Venturini S, Vervoort D, Wilguens Lartigue J. Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries. Lancet 2021; 397:387-397. [PMID: 33485461 PMCID: PMC7846817 DOI: 10.1016/s0140-6736(21)00001-5] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/02/2020] [Accepted: 12/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. METHODS This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. FINDINGS Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70-8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39-8·80) and upper-middle-income countries (2·06, 1·11-3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26-11·59) and upper-middle-income countries (3·89, 2·08-7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. INTERPRETATION Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. FUNDING National Institute for Health Research Global Health Research Unit.
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Magistri P, Boggi U, Esposito A, Carrano FM, Pesi B, Ballarin R, De Pastena M, Menonna F, Moraldi L, Melis M, Coratti A, Newman E, Napoli N, Ramera M, Di Benedetto F. Robotic vs open distal pancreatectomy: A multi-institutional matched comparison analysis. J Hepatobiliary Pancreat Sci 2020; 28:1098-1106. [PMID: 33314791 DOI: 10.1002/jhbp.881] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pancreatic surgery is still a challenge even in high-volume centers. Clinically relevant postoperative pancreatic fistula (CR-POPF) represents the greatest contributor to major morbidity and mortality, especially following pancreatic distal resection. In this study, we compared robotic distal pancreatectomy (RDP) to open distal pancreatectomy (ODP) in terms of CR-POPF development and analyzed oncologic efficacy of RDP in the subgroup of patients with pancreatic ductal adenocarcinoma (PDAC). METHODS We collected data from five high-volume centers for pancreatic surgery and performed a matched comparison analysis to compare short and long-term outcomes after ODP or RDP. Patients were matched with a 2:1 ratio according to age, ASA (American Society of Anesthesiologists) score, body mass index (BMI), final pathology, and TNM (Tumour, Node, Metastasis) staging system VIII ed. RESULTS Two hundred and forty-six patients who underwent 82 RDPs and 164 ODPs were included. No differences were found in the incidence of CR-POPF. In the PDAC group, median DFS and OS were 10.8 months and 14.8 months in the ODP group and 10.4 months and 15 months in the RDP group, respectively. CONCLUSIONS Robotic distal pancreatectomy is a safe surgical strategy for PDAC and incidence of CR-POPF is equivalent between RDP and ODP. RDP should be considered equivalent to ODP in terms of oncological efficacy when performed in high-volume and proficient centers.
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Affiliation(s)
- Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Ugo Boggi
- Division of General and Transplant Surgery, Pisa University Hospital, Pisa, Italy
| | - Alessandro Esposito
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Francesco Maria Carrano
- Department of Surgery, NYU School of Medicine, New York, NY, USA.,Department of General, Emergency and Transplant Surgery, Ospedale di Circolo e "Fondazione Macchi,", ASST Sette Laghi, University of Insubria, Varese, Italy
| | - Benedetta Pesi
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Roberto Ballarin
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Matteo De Pastena
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Francesca Menonna
- Division of General and Transplant Surgery, Pisa University Hospital, Pisa, Italy
| | - Luca Moraldi
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | | | - Andrea Coratti
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Elliot Newman
- Department of Surgery, NYU School of Medicine, New York, NY, USA
| | - Niccolò Napoli
- Division of General and Transplant Surgery, Pisa University Hospital, Pisa, Italy
| | - Marco Ramera
- Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
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Daley D, Zambirinis CP, Seifert L, Akkad N, Mohan N, Werba G, Barilla R, Torres-Hernandez A, Hundeyin M, Kumar Mani VR, Avanzi A, Tippens D, Narayanan R, Jang JE, Newman E, Pillarisetty VG, Dustin ML, Bar-Sagi D, Hajdu C, Miller G. γδ T Cells Support Pancreatic Oncogenesis by Restraining αβ T Cell Activation. Cell 2020; 183:1134-1136. [PMID: 33186522 DOI: 10.1016/j.cell.2020.10.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Hakim N, Chi J, Rehman H, Nealon W, Deutsch GB, Newman E, Anantha S, Coppa G, Deperalta D, Rishi A, Maloney A, Moriarty L, Smith MH, Jose J, Saif WM. Safety and efficacy of biweekly gemcitabine in combination with capecitabine (GemCap) in elderly and frail patients (pts) with resected pancreatic cancer (PC). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.4628] [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
4628 Background: ESPAC-4 study showed that GemCap conferred a survival benefit over gemcitabine monotherapy in resected PC patients. ESPAC-4 included patients with median age of 65 years (37-81) and ECOG performance status (PS) of 0 (43%), 1 (54%) and 2 (2%) who received a median cumulative dose of gemcitabine of 15,000 mg/m2, capecitabine. Here we present our experience with an adopted biweekly regimen of GemCap in patients who were ≥ 75 years and those who were deemed not suitable for ESPAC-4 regimen. Methods: Patients ≥ 75 years with resected PC, ECOG PS of 0-2 and no prior treatments were included. Patients were treated with a modified regimen of gemcitabine (1000-2000 mg/m2) every 2 weeks and capecitabine (800-1000 mg/m2) day 1-7 every 2 weeks. Patients were evaluated for progression-free survival (PFS), overall survival (OS) and sites of recurrence. Toxicities were graded according to NCI CTCAE v5.0. Results: Thirty-five (22M, 13F) patients, ≥ 75 (median age 79) treated with biweekly Gem-Cap adjuvant treatment. 7 (28%) patients had ECOG PS of 1 and 28 (72%) had ECOG PS of 2. There were 5, 7 and 16 patients with stage I, II and III disease. Nine patients (25%) had R1 and 26 (75%) had R0 resection. The median PFS and OS were 8.0 months and 22.0 months. Nine (25%) had local recurrence, 21 (60%) had metastatic disease and 3 (8.6%) had NED. Two patients were lost to follow-up. The most frequent toxicities were grades 1-2 anemia (20%), thrombocytopenia (8%) and hand-foot syndrome (HFS) (10%). Grade ≥3 included diarrhea (4%) and HFS (1%) with no treatment-related discontinuations. Treatment compliance was 100%. Delays were necessary in 7% of cases and dose reduction was required in 4% of cases. There was no treatment related death. Conclusions: This schedule of biweekly GemCap regimen suggests an acceptable option in for elderly, frail patients with PC and warrants further exploration in patients not suitable for FOLFIRINOX, full dose GemCap or a clinical trial. This regimen required fewer dose reduction, omission or delays and allowed to administer pegylated-filgrastim. Previous studies have also shown decreased toxicity and equal efficacy of 7/7 schedule of capecitabine. Moreover, fewer visits to oncology and related expense do favor towards benefit. Additionally, this tolerable regimen is ideal to be combined with immunotherapy in clinical trials for this patient population.
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Affiliation(s)
| | - Jeffrey Chi
- Northwell Health Cancer Institute, Lake Success, NY
| | - Hasan Rehman
- Northwell Health Cancer Institute, Lake Success, NY
| | | | | | | | | | | | | | | | | | | | | | - Jyothi Jose
- Northwell Health Cancer Institute, Lake Success, NY
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Newman E, Dutmer C. M277 INFLAMMATORY RESPONSE TO NOCARDIA IN A PATIENT WITH CHRONIC GRANULOMATOUS DISEASE RESULTING IN AIRWAY OBSTRUCTION. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.382] [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: 12/01/2022]
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18
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Carrano FM, Wang B, Sherman SE, Makarov DV, Berman RS, Newman E, Pachter HL, Melis M. Artificial Intelligence Outperforms Clinical Judgment in Triage for Postoperative ICU Care: Prospective Preliminary Results. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.312] [Citation(s) in RCA: 1] [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: 11/26/2022]
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Wei AC, Ou FS, Shi Q, Carrero X, O'Reilly EM, Meyerhardt J, Wolff RA, Kindler HL, Evans DB, Deshpande V, Misdraji J, Tamm E, Sahani D, Moore M, Newman E, Merchant N, Berlin J, Goff LW, Pisters P, Posner MC. Perioperative Gemcitabine + Erlotinib Plus Pancreaticoduodenectomy for Resectable Pancreatic Adenocarcinoma: ACOSOG Z5041 (Alliance) Phase II Trial. Ann Surg Oncol 2019; 26:4489-4497. [PMID: 31418130 DOI: 10.1245/s10434-019-07685-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND There is considerable interest in a neoadjuvant approach for resectable pancreatic ductal adenocarcinoma (PDAC). This study evaluated perioperative gemcitabine + erlotinib (G+E) for resectable PDAC. METHODS A multicenter, cooperative group, single-arm, phase II trial was conducted between April 2009 and November 2013 (ACOSOG Z5041). Patients with biopsy-confirmed PDAC in the pancreatic head without evidence of involvement of major mesenteric vessels (resectable) were eligible. Patients (n = 123) received an 8-week cycle of G+E before and after surgery. The primary endpoint was 2-year overall survival (OS), and secondary endpoints included toxicity, response, resection rate, and time to progression. Resectability was assessed retrospectively by central review. The study closed early due to slow accrual, and no formal hypothesis testing was performed. RESULTS Overall, 114 patients were eligible, consented, and initiated protocol treatment. By central radiologic review, 97 (85%) of the 114 patients met the protocol-defined resectability criteria. Grade 3+ toxicity was reported in 60% and 79% of patients during the neoadjuvant phase and overall, respectively. Twenty-two of 114 (19%) patients did not proceed to surgery; 83 patients (73%) were successfully resected. R0 and R1 margins were obtained in 67 (81%) and 16 (19%) resected patients, respectively, and 54 patients completed postoperative G+E (65%). The 2-year OS rate for the entire cohort (n = 114) was 40% (95% confidence interval [CI] 31-50), with a median OS of 21.3 months (95% CI 17.2-25.9). The 2-year OS rate for resected patients (n = 83) was 52% (95% CI 41-63), with a median OS of 25.4 months (95% CI 21.8-29.6). CONCLUSIONS For resectable PDAC, perioperative G+E is feasible. Further evaluation of neoadjuvant strategies in resectable PDAC is warranted with more active systemic regimens.
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Affiliation(s)
- Alice C Wei
- University Health Network-Princess Margaret Hospital, Toronto, ON, Canada. .,Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Fang-Shu Ou
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Qian Shi
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Xiomara Carrero
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Hedy L Kindler
- University of Chicago Comprehensive Cancer Center, Chicago, IL, USA
| | | | | | - Joseph Misdraji
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Eric Tamm
- MD Anderson Cancer Center, Houston, TX, USA
| | - Dushyant Sahani
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Malcolm Moore
- University Health Network-Princess Margaret Hospital, Toronto, ON, Canada
| | - Elliot Newman
- New York University Langone Medical Center, New York, NY, USA
| | - Nipun Merchant
- University of Miami Miller School of Medicine-Sylvester Cancer Center, Miami, FL, USA
| | - Jordan Berlin
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Laura W Goff
- Vanderbilt University Medical Center, Nashville, TN, USA
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Hanada Y, Choi AY, Hwang JH, Draganov PV, Khanna L, Sethi A, Bartel MJ, Goel N, Abe S, De Latour RA, Park K, Melis M, Newman E, Hatzaras I, Reddy SS, Farma JM, Liu X, Schlachterman A, Kresak J, Trapp G, Ansari N, Schrope B, Lee JY, Dhall D, Lo S, Jamil LH, Burch M, Gaddam S, Gong Y, Del Portillo A, Tomizawa Y, Truong CD, Brewer Gutierrez OI, Montgomery E, Johnston FM, Duncan M, Canto M, Ahuja N, Lennon AM, Ngamruengphong S. Low Frequency of Lymph Node Metastases in Patients in the United States With Early-stage Gastric Cancers That Fulfill Japanese Endoscopic Resection Criteria. Clin Gastroenterol Hepatol 2019; 17:1763-1769. [PMID: 30471457 DOI: 10.1016/j.cgh.2018.11.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 11/01/2018] [Accepted: 11/02/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS In the West, early gastric cancer is increasingly managed with endoscopic resection (ER). This is, however, based on the assumption that the low prevalence and risk of lymph node metastases observed in Asian patients is applicable to patients in the United States. We sought to evaluate the frequency of and factors associated with metastasis of early gastric cancers to lymph nodes, and whether the Japanese ER criteria are applicable to patients in the US. METHODS We performed a retrospective study of 176 patients (mean age 68.5 years; 59.1% male; 58.5% white) who underwent surgical resection with lymph node dissection of T1 and Tis gastric adenocarcinomas, staged by pathologists, at 7 tertiary care centers in the US from January 1, 1999, through December 31, 2016. The frequency of lymph node metastases and associated risk factors were determined. RESULTS The mean size of gastric adenocarcinomas was 23.0 ± 16.6 mm-most were located in the lower-third of the stomach (67.0%), invading the submucosa (55.1%), and moderately differentiated (31.3%). Lymphovascular invasion was observed in 18.2% of lesions. Overall, 20.5% of patients had lymph node metastases. Submucosal invasion (odds ratio, 3.9; 95% CI, 1.4-10.7) and lymphovascular invasion (odds ratio, 4.6; 95% CI, 1.8-12.0) were independently associated with increased risk of metastasis to lymph nodes. The frequency of lymph node metastases among patients fulfilling standard and expanded Japanese criteria for ER were 0 and 7.5%, respectively. CONCLUSIONS The frequency of lymph node metastases among patients with early gastric cancer in a US population is higher than that of published Asian series. However, early gastric cancer lesions that meet the Japanese standard criteria for ER are associated with negligible risk of metastasis to lymph nodes, so ER can be recommended for definitive therapy. Expanded criteria cancers appear to have a higher risk of metastasis to lymph nodes, so ER may be considered for select cases.
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Affiliation(s)
- Yuri Hanada
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Alyssa Y Choi
- Department of Medicine, University of Washington, Seattle, Washington
| | - Joo Ha Hwang
- Division of Gastroenterology and Hepatology, Stanford University, Stanford, California
| | - Peter V Draganov
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida
| | - Lauren Khanna
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Amrita Sethi
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York
| | - Michael J Bartel
- Section of Gastroenterology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Neha Goel
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Seiichiro Abe
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Rabia A De Latour
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Kenneth Park
- Department of Medicine, New York University School of Medicine, New York, New York
| | - Marcovalerio Melis
- Department of Surgery, New York University School of Medicine, New York, New York
| | - Elliot Newman
- Department of Surgery, New York University School of Medicine, New York, New York
| | - Ioannis Hatzaras
- Department of Surgery, New York University School of Medicine, New York, New York
| | - Sanjay S Reddy
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jeffrey M Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Xiuli Liu
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida
| | - Alexander Schlachterman
- Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jesse Kresak
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida
| | - Garrick Trapp
- Department of Surgery, Columbia University Medical Center, New York, New York
| | - Nadia Ansari
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York
| | - Beth Schrope
- Department of Surgery, Columbia University Medical Center, New York, New York
| | - Jong Yeul Lee
- Digestive Diseases Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Deepti Dhall
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Simon Lo
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Laith H Jamil
- Digestive Diseases Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Miguel Burch
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Srinivas Gaddam
- Digestive Diseases Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Yulan Gong
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Armando Del Portillo
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
| | - Yutaka Tomizawa
- Division of Gastroenterology, University of Washington, Seattle, Washington
| | - Camtu D Truong
- Department of Pathology, University of Washington, Seattle, Washington
| | | | | | | | - Mark Duncan
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Marcia Canto
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Nita Ahuja
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Anne Marie Lennon
- Division of Gastroenterology, Johns Hopkins Hospital, Baltimore, Maryland
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Punekar SR, Masri-Lavine L, Hajdu C, Newman E, Becker DJ. Characterization of a novel entity of high-grade well-differentiated colorectal neuroendocrine tumors. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e15696] [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
e15696 Background: Small studies suggest that a new pathologic entity of high-grade (by Ki-67 or mitotic index) well-differentiated (by histologic features) neuroendocrine tumors (NETs) exist throughout the GI tract, but the prognosis and characteristics of affected patients are unknown. We sought to further characterize the prognosis and demographics of patients with high-grade (HG) well-differentiated (WD) colorectal NET. Materials and Methods: We used the Surveillance Epidemiology and End Results (SEER) database to study patients with NETs of the colon and rectum diagnosed from 2000 to 2015. We identified patient demographics, clinical and tumor characteristics, and studied associations with tumor grade. We compared overall survival (OS) between patients with low-grade (LG)(grade 1-2) well-differentiated (ICD-0-3 = carcinoid), high-grade (grade 3-4) well-differentiated, and high-grade poorly-differentiated NETs (ICD-0-3 = small cell neuroendocrine). We used logistic regression to detect associations with grade and Cox proportional hazards models to examine predictors of survival. Results: We identified 5,894 cases with colorectal carcinoid tumor (5780 [98.1%] LG and 114 [1.9%] HG); the cohort was 68% white, 48% male, and had a median age of 54. Patients diagnosed with HG carcinoid tumors were more likely to be of older age (OR 2.23; 95% CI 1.19-4.19 for age 60-69 vs < 50) and unmarried (OR 1.56; 95% CI 1.02-2.38), and less likely to be diagnosed after 2010 (OR 0.09; 95% CI 0.06-0.15). OS for patients with HG carcinoids (median 36 m; 95% CI 13-92) fell in between OS for those with HG small cell NETs (median 7 m; 95% CI 6-8), and LG carcinoid tumor (median not reached, > 120 m). Among patients with carcinoid tumors, black patients (HR 1.31; 95% CI 1.03-1.67, older patients (HR 3.60; 95% CI 2.50-5.19 for age 60-69 vs < 50), unmarried patients (HR 1.52; 95% CI 1.24-1.87), and those with HG features (HR 3.85; 95% CI 2.88-5.15) had worse survival. Conclusions: We defined a subset of high-grade well-differentiated NETs, more commonly diagnosed in older, unmarried patients, with a prognosis between that of high grade small cell NETs and low grade carcinoid tumors. Our analysis adds the first national registry study to the literature in support of a new classification of non-pancreatic high-grade well differentiated NETs.
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Affiliation(s)
| | - Lena Masri-Lavine
- Columbia University College of Physicians and Surgeons, New York, NY
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22
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Wang D, Carrano FM, Fisichella PM, Desiato V, Newman E, Berman R, Pachter HL, Melis M. A Quest for Optimization of Postoperative Triage After Major Surgery. J Laparoendosc Adv Surg Tech A 2018; 29:203-205. [PMID: 30412455 DOI: 10.1089/lap.2018.0238] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Innovative strategies to reduce costs while maintaining patient satisfaction and improving delivery of care are greatly needed in the setting of rapidly rising health care expenditure. Intensive care units (ICUs) represent a significant proportion of health care costs due to their high resources utilization. Currently, the decision to admit a patient to the ICU lacks standardization because of the lack of evidence-based admission criteria. The objective of our research is to develop a prediction model that can help the physician in the clinical decision-making of postoperative triage. MATERIALS AND METHODS Our group identified a list of index events that commonly grants admission to the ICU independently of the hospital system. We analyzed correlation among 200 quantitative and semiquantitative variables for each patient in the study using a decision tree modeling (DTM). In addition, we validated the DTM against explanatory models, such as bivariate analysis, multiple logistic regression, and least absolute shrinkage and selection operator. RESULTS Unlike explanatory modeling, DTM has several unique strengths: tree models are easy to interpret, the analysis can examine hundreds of variables at once, and offer insight into variable relative importance. In a retrospective analysis, we found that DTM was more accurate at predicting need for intensive care compared with current clinical practice. DISCUSSION DTM and predictive modeling may enhance postoperative triage decision-making. Future areas of research include larger retrospective analyses and prospective observational studies that can lead to an improved clinical practice and better resources utilization.
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Affiliation(s)
- David Wang
- 1 Department of Surgery, New York University School of Medicine , NYU Langone Medical Center, New York, New York.,2 Department of Surgery, New York Harbor Healthcare System VAMC , New York, New York
| | - Francesco M Carrano
- 1 Department of Surgery, New York University School of Medicine , NYU Langone Medical Center, New York, New York.,2 Department of Surgery, New York Harbor Healthcare System VAMC , New York, New York
| | - P Marco Fisichella
- 3 Department of Surgery, Boston VA Healthcare System, Harvard Medical School , Boston, Massachusetts
| | - Vincenzo Desiato
- 1 Department of Surgery, New York University School of Medicine , NYU Langone Medical Center, New York, New York.,2 Department of Surgery, New York Harbor Healthcare System VAMC , New York, New York
| | - Elliot Newman
- 1 Department of Surgery, New York University School of Medicine , NYU Langone Medical Center, New York, New York.,2 Department of Surgery, New York Harbor Healthcare System VAMC , New York, New York
| | - Russell Berman
- 1 Department of Surgery, New York University School of Medicine , NYU Langone Medical Center, New York, New York
| | - H Leon Pachter
- 1 Department of Surgery, New York University School of Medicine , NYU Langone Medical Center, New York, New York
| | - Marcovalerio Melis
- 1 Department of Surgery, New York University School of Medicine , NYU Langone Medical Center, New York, New York.,2 Department of Surgery, New York Harbor Healthcare System VAMC , New York, New York
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Newman E, Venter C, Bauer M. ANAPHYLAXIS SECONDARY TO AN EMULSIFIER IN ALMOND YOGURT IN A CASHEW/PISTACHIO SENSITIZED PATIENT. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.383] [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: 10/27/2022]
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Amodeo S, Masi A, Melis M, Ryan T, Hochster HS, Cohen DJ, Chandra A, Pachter HL, Newman E. Can we downstage locally advanced pancreatic cancer to resectable? A phase I/II study of induction oxaliplatin and 5-FU chemoradiation. J Gastrointest Oncol 2018; 9:922-935. [PMID: 30505595 PMCID: PMC6219979 DOI: 10.21037/jgo.2017.10.04] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 09/22/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Half of patients with pancreatic adenocarcinoma (PC) present with regionally advanced disease. This includes borderline resectable and locally advanced unresectable tumors as defined by current NCCN guidelines for resectability. Chemoradiation (CH-RT) is used in this setting in attempt to control local disease, and possibly downstage to resectable disease. We report a phase I/II trial of a combination of 5FU/Oxaliplatin with concurrent radiation in patients presenting with borderline resectable and locally advanced unresectable pancreatic cancer. METHODS Patients with biopsy-proven borderline resectable or locally advanced unresectable PC were eligible. Chemotherapy included continuous infusion 5FU (200 mg/m2) daily and oxaliplatin weekly for 5 weeks in dose escalation cohorts, ranging from 30 to 60 mg/m2. Concurrent radiation therapy consisted of 4,500 cGy in 25 fractions (180 cGy/fx/d) followed by a comedown to the tumor and margins for an additional 540 cGy ×3 (total dose 5,040 cGy in 28 fractions). Following completion of CH-RT, patients deemed resectable underwent surgery; those who remained unresectable for cure but did not progress (SD, stable disease) received mFOLFOX6 ×6 cycles. Survival was calculated using Kaplan-Meier analysis. End-points of the phase II portion were resectability and overall survival. RESULTS Overall, 24 subjects (15 men and 9 women, mean age 64.5 years) were enrolled between June 2004 and December 2009 and received CH-RT. Seventeen patients were enrolled in the Phase I component of the study, fifteen of whom completed neoadjuvant therapy. Reasons for not completing treatment included grade 3 toxicities (1 patient) and withdrawal of consent (1 patient). The highest dose of oxaliplatin (60 mg/m2) was well tolerated and it was used as the recommended phase II dose. An additional 7 patients were treated in the phase II portion, 5 of whom completed CH-RT; the remaining 2 patients did not complete treatment because of grade 3 toxicities. Overall, 4/24 did not complete CH-RT. Grade 4 toxicities related to initial CH-RT were observed during phase I (n=2, pulmonary embolism and lymphopenia) and phase II (n=3, fatigue, leukopenia and thrombocytopenia). Following restaging after completion of CH-RT, 4 patients had progressed (PD); 9 patients had SD and received additional chemotherapy with mFOLFOX6 (one of them had a dramatic response after two cycles and underwent curative resection); the remaining 7 patients (29.2%) were noted to have a response and were explored: 2 had PD, 4 had SD, still unresectable, and 1 patient was resected for cure with negative margins. Overall 2 patients (8.3%) in the study received curative resection following neoadjuvant therapy. Median overall survival for the entire study population was 11.4 months. Overall survival for the two resected patients was 41.7 and 21.6 months. CONCLUSIONS Combined modality treatment for borderline resectable and locally advanced unresectable pancreatic cancer with oxaliplatin, 5FU and radiation was reasonably well tolerated. The majority of patients remained unresectable. Survival data with this regimen were comparable to others for locally advanced pancreas cancer, suggesting the need for more novel approaches.
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Affiliation(s)
- Salvatore Amodeo
- Department of Surgery, NYU School of Medicine, New York, NY, USA
| | - Antonio Masi
- Department of Surgery, NYU School of Medicine, New York, NY, USA
- Department of Surgery, New York Harbor Healthcare System VAMC, New York, NY, USA
| | - Marcovalerio Melis
- Department of Surgery, NYU School of Medicine, New York, NY, USA
- Department of Surgery, New York Harbor Healthcare System VAMC, New York, NY, USA
| | - Theresa Ryan
- Division of Hematology and Medical Oncology, NYU School of Medicine, New York, NY, USA
| | - Howard S. Hochster
- Division of Hematology and Medical Oncology, NYU School of Medicine, New York, NY, USA
| | - Deirdre J. Cohen
- Division of Hematology and Medical Oncology, NYU School of Medicine, New York, NY, USA
| | - Anurag Chandra
- Division of Hematology and Medical Oncology, NYU School of Medicine, New York, NY, USA
| | - H. Leon Pachter
- Department of Surgery, NYU School of Medicine, New York, NY, USA
| | - Elliot Newman
- Department of Surgery, NYU School of Medicine, New York, NY, USA
- Department of Surgery, New York Harbor Healthcare System VAMC, New York, NY, USA
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Wei ACC, Ou FS, Shi Q, O'Reilly EM, Meyerhardt JA, Wolff RA, Kindler HL, Evans DB, Deshpande V, Misdraji J, Tamm EP, Sahani D, Moore MJ, Newman E, Merchant NB, Berlin J, Goff LW, Pisters PWT, Posner MC. A phase II study of pre- and post-operative gemcitabine and erlotinib plus pancreaticoduodenectomy (PD) for patients with resectable pancreatic ductal adenocarcinoma (PDAC): ACOSOG Z5041 trial (Alliance). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.4112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | - Robert A. Wolff
- Department of GI Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Joseph Misdraji
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Eric P. Tamm
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | - Jordan Berlin
- Vanderbilt University Ingram Cancer Center, Nashville, TN
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Gu P, Park J, Zhong J, Guo S, Hickey R, Aaltonen E, Horn J, Du KL, Shanbhogue K, Megibow A, Xu R, Kyritsis I, Cohen DJ, Newman E, Miller G, Welling T. Initial experience of combination nivolumab and local-regional treatment in patients with advanced hepatocellular carcinoma (HCC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e16149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ping Gu
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, NY
| | | | - Judy Zhong
- Department of Population Health, New York University School of Medicine, New York, NY
| | | | | | | | | | - Kevin Lee Du
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, NY
| | | | | | - Ruliang Xu
- New York University Langone Medical Center, New York, NY
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Megibow AJ, Baker ME, Morgan DE, Kamel IR, Sahani DV, Newman E, Brugge WR, Berland LL, Pandharipande PV. Author's Reply. J Am Coll Radiol 2018; 15:591-593. [PMID: 29483047 DOI: 10.1016/j.jacr.2018.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 01/16/2018] [Indexed: 01/07/2023]
Affiliation(s)
- Alec J Megibow
- NYU-Langone Medical Center, Department of Radiology, NYU Radiology Associates, 530 1st Avenue, New York, NY 10016.
| | - Mark E Baker
- Department of Radiology, Cleveland Clinic, Cleveland, Ohio
| | - Desiree E Morgan
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ihab R Kamel
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Dushyant V Sahani
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Elliot Newman
- Department of Surgery, NYU-Langone Medical Center, New York, New York
| | - William R Brugge
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Gastroenterology, Mount Auburn Hospital, Cambridge, Massachusetts
| | - Lincoln L Berland
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Pari V Pandharipande
- Department of Radiology and Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts
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28
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Sadeghi S, Groshen S, Parikh R, Mortazavi A, Dorff T, Hoimes C, Doyle L, Quinn D, Newman E, Lara P. Phase II California cancer consortium trial of gemcitabine-eribulin combination (ge) in cisplatin ineligible patients (pts) with metastatic urothelial carcinoma (mUC): Efficacy report (NCI-9653; 1UM1CA186717, NO1-CM-2011-00038). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx371.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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29
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Megibow AJ, Baker ME, Morgan DE, Kamel IR, Sahani DV, Newman E, Brugge WR, Berland LL, Pandharipande PV. Management of Incidental Pancreatic Cysts: A White Paper of the ACR Incidental Findings Committee. J Am Coll Radiol 2017; 14:911-923. [PMID: 28533111 DOI: 10.1016/j.jacr.2017.03.010] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [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: 02/27/2017] [Revised: 02/27/2017] [Accepted: 03/13/2017] [Indexed: 12/12/2022]
Abstract
The ACR Incidental Findings Committee (IFC) presents recommendations for managing pancreatic cysts that are incidentally detected on CT or MRI. These recommendations represent an update from the pancreatic component of the JACR 2010 white paper on managing incidental findings in the adrenal glands, kidneys, liver, and pancreas. The Pancreas Subcommittee-which included abdominal radiologists, a gastroenterologist, and a pancreatic surgeon-developed this algorithm. The recommendations draw from published evidence and expert opinion, and were finalized by informal iterative consensus. Algorithm branches successively categorize pancreatic cysts based on patient characteristics and imaging features. They terminate with an ascertainment of benignity and/or indolence (sufficient to discontinue follow-up), or a management recommendation. The algorithm addresses most, but not all, pathologies and clinical scenarios. Our goal is to improve quality of care by providing guidance on how to manage incidentally detected pancreatic cysts.
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Affiliation(s)
- Alec J Megibow
- Department of Radiology, NYU-Langone Medical Center, New York, New York.
| | - Mark E Baker
- Department of Radiology, Cleveland Clinic, Cleveland, Ohio
| | - Desiree E Morgan
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ihab R Kamel
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Dushyant V Sahani
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Elliot Newman
- Department of Surgery, NYU-Langone Medical Center, New York, New York
| | - William R Brugge
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Lincoln L Berland
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Pari V Pandharipande
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Institute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts
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Dickens JK, Morgan GL, Chapman GT, Love TA, Newman E, Perey FG. Cross Sections for Gamma-Ray Production by Fast Neutrons for 22 Elements BetweenZ= 3 andZ= 82. NUCL SCI ENG 2017. [DOI: 10.13182/nse77-a26989] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- J. K. Dickens
- Oak Ridge National Laboratory, P. O. Box X, Oak Ridge, Tennessee 37830
| | - G. L. Morgan
- Oak Ridge National Laboratory, P. O. Box X, Oak Ridge, Tennessee 37830
| | - G. T. Chapman
- Oak Ridge National Laboratory, P. O. Box X, Oak Ridge, Tennessee 37830
| | - T. A. Love
- Oak Ridge National Laboratory, P. O. Box X, Oak Ridge, Tennessee 37830
| | - E. Newman
- Oak Ridge National Laboratory, P. O. Box X, Oak Ridge, Tennessee 37830
| | - F. G. Perey
- Oak Ridge National Laboratory, P. O. Box X, Oak Ridge, Tennessee 37830
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Sadeghi S, Groshen S, Parikh R, Mortazavi A, Dorff T, Hoimes C, Pal S, Levine E, Doyle L, Quinn D, Newman E, Lara P. Phase II California Cancer Consortium trial of gemcitabine–eribulin combination (GE) in cisplatin ineligible patients (pts) with metastatic urothelial carcinoma (mUC): tolerability and toxicity report (NCI-9653; 1UM1CA186717-01, NO1-CM-2011-00038). Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30706-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Vitiello GA, Cavnar MJ, Hajdu C, Khaykis I, Newman E, Melis M, Pachter HL, Cohen SM. Minimally Invasive Management of Ectopic Pancreas. J Laparoendosc Adv Surg Tech A 2017; 27:277-282. [PMID: 28121494 DOI: 10.1089/lap.2016.0562] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The management of ectopic pancreas is not well defined. This study aims to determine the prevalence of symptomatic ectopic pancreas and identify those who may benefit from treatment, with a particular focus on robotically assisted surgical management. METHODS Our institutional pathology database was queried to identify a cohort of ectopic pancreas specimens. Additional clinical data regarding clinical symptomatology, diagnostic studies, and treatment were obtained through chart review. RESULTS Nineteen cases of ectopic pancreas were found incidentally during surgery for another condition or found incidentally in a pathologic specimen (65.5%). Eleven patients (37.9%) reported prior symptoms, notably abdominal pain and/or gastrointestinal bleeding. The most common locations for ectopic pancreas were the duodenum and small bowel (31% and 27.6%, respectively). Three out of 29 cases (10.3%) had no symptoms, but had evidence of preneoplastic changes on pathology, while one harbored pancreatic cancer. Over the years, treatment of ectopic pancreas has shifted from open to laparoscopic and more recently to robotic surgery. CONCLUSIONS Our experience is in line with existing evidence supporting surgical treatment of symptomatic or complicated ectopic pancreas. In the current era, minimally invasive and robotic surgery can be used safely and successfully for treatment of ectopic pancreas.
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Affiliation(s)
- Gerardo A Vitiello
- 1 Department of Surgery, New York University Langone Medical Center , New York, New York
| | - Michael J Cavnar
- 1 Department of Surgery, New York University Langone Medical Center , New York, New York
| | - Cristina Hajdu
- 2 Department of Pathology, New York University Langone Medical Center , New York, New York
| | - Inessa Khaykis
- 3 Department of Gastroenterology, New York University Langone Medical Center , New York, New York
| | - Elliot Newman
- 1 Department of Surgery, New York University Langone Medical Center , New York, New York
| | - Marcovalerio Melis
- 1 Department of Surgery, New York University Langone Medical Center , New York, New York
| | - H Leon Pachter
- 1 Department of Surgery, New York University Langone Medical Center , New York, New York
| | - Steven M Cohen
- 1 Department of Surgery, New York University Langone Medical Center , New York, New York
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Desiato V, Rosman AS, Newman E, Berman RS, Pachter HL, Melis M. Changes in apparent diffusion coefficient evaluated with diffusion-weighted MRI to predict complete pathologic response after neoadjuvant therapy for rectal cancer: Literature review and meta-analysis. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.503] [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
503 Background: A complete pathological response (pCR) is observed in 9-38% of all patients undergoing neo-adjuvant chemo-radiation therapy (CRT) for locally advanced rectal cancer (ARC). Imaging techniques that can reliably assess CRT results may enhance identification of those pCR patients for which surgery may potentially be avoided. Recently, several studies have suggested that diffusion-weighted magnetic resonance imaging (DW-MRI) may predict pathologic response by measuring tumor apparent diffusion coefficient (ADC). ADC can be measured before (pre-ADC) and/or after CRT (post-ADC). Both pre- and post-ADC, as well as the variation between pre- and post-ADC (Δ-ADC) can be used to assess pCR. We aimed to assess the reliability of ADC at predicting pCR in ARC patients treated with CRT. To determine the most effective ADC timing to evaluate pCR. Methods: A systematic review of available literature was conducted to compare all the studies of DW-MRI for identification of pCR after CRT for ARC. For each parameter (pre-ADC, post-ADC and D-ADC) we pooled sensitivity and specificity and calculated the area (AUC) under the summary receiver operating characteristics (sROC) curve. Results: We found 10 prospective and 8 retrospective studies examining correlation of ADC and CRT results. Overall, pCR rate was 25%. Pooled sensitivity, specificity, and AUC were: 0.743, 0.755, and 0.841 for pre-ADC; 0.745, 0.706, and 0.782 for post-ADC; and 0.832, 0.806, and 0.895 for D-ADC. Conclusions: Our meta-analysis confirms that at least 25% of patients with ARC experiences pCR after CRT. DW-MRI is a promising technique for assessment of CRT results and D-ADC appears to be the most effective parameter for prediction of pCR.
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Affiliation(s)
| | - Alan S Rosman
- Section of Gastroenterology and Medicine Program, Mount Sinai School of Medicine and Bronx VA Medical Center, New York, NY
| | - Elliot Newman
- New York University School of Medicine, New York, NY
| | - Russell S. Berman
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
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Winer A, Rosen Y, Lu F, Berman RS, Melis M, Miller G, Pachter HL, Newman E, Hatzaras I. Comparative effectiveness of combination TACE/ablation vs. monotherapy in hepatocellular carcinoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.350] [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
350 Background: Hepatocellular Carcinoma (HCC) is a leading cause of cancer-related death worldwide. Loco-regional treatment modalities for HCC include Trans-Arterial Chemoembolization (TACE) and Radiofrequency/Microwave Ablation (RFA/MWA). Studies have shown that dual therapy with both TACE and ablation is beneficial, though data is limited. We retrospectively studied all HCC patients treated with either TACE, ablation, or dual therapy at a tertiary referral public hospital to determine differences in survival. Methods: Following IRB approval, all patients diagnosed with HCC (1998-2013) at our institution were retrospectively analyzed for date of diagnosis, treatment-type, length of follow-up, and survival. Patients were excluded if they did not undergo TACE or RFA/MWA, or underwent other treatments, such as surgery. The primary outcome was all-cause mortality 5 years after diagnosis. Kaplan Meier curves were created and statistics with Log-rank testing and hazard ratios (HR) were performed. Results: Of 509 patients diagnosed with HCC, 109 (21.4%) met inclusion criteria. 60 were treated with TACE alone, 30 with ablation alone, and 19 were treated with both, either concomitantly or in sequence. Median follow-up and overall median survival was 15.5, 19, and 52 months for TACE, ablation, and dual therapy, respectively. Survival at 5 years was 11.9%, 13.3% and 42.1% for TACE, ablation, and combination groups respectively. Kaplan Meier analysis revealed a significant increase in survival in the combination therapy group vs. RFA or TACE alone at 5 years (p = 0.0006). However, there was no significant difference in survival when comparing TACE vs. RFA/MWA at 5 years (HR = 1.18, p = 0.48). Conclusions: Our study suggests a greater survival benefit for patients treated with TACE and RFA/MWA versus either modality alone.
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Affiliation(s)
| | | | | | - Russell S. Berman
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
| | | | - George Miller
- New York University School of Medicine, Englewood, NJ
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Mörtzell Henriksson M, Newman E, Witt V, Derfler K, Leitner G, Eloot S, Dhondt A, Deeren D, Rock G, Ptak J, Blaha M, Lanska M, Gasova Z, Hrdlickova R, Ramlow W, Prophet H, Liumbruno G, Mori E, Griskevicius A, Audzijoniene J, Vrielink H, Rombout S, Aandahl A, Sikole A, Tomaz J, Lalic K, Mazic S, Strineholm V, Brink B, Berlin G, Dykes J, Toss F, Axelsson CG, Stegmayr B, Nilsson T, Norda R, Knutson F, Ramsauer B, Wahlström A. Adverse events in apheresis: An update of the WAA registry data. Transfus Apher Sci 2016; 54:2-15. [PMID: 26776481 DOI: 10.1016/j.transci.2016.01.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [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: 12/18/2022]
Abstract
Apheresis with different procedures and devices are used for a variety of indications that may have different adverse events (AEs). The aim of this study was to clarify the extent and possible reasons of various side effects based on data from a multinational registry. The WAA-apheresis registry data focus on adverse events in a total of 50846 procedures in 7142 patients (42% women). AEs were graded as mild, moderate (need for medication), severe (interruption due to the AE) or death (due to AE). More AEs occurred during the first procedures versus subsequent (8.4 and 5.5%, respectively). AEs were mild in 2.4% (due to access 54%, device 7%, hypotension 15%, tingling 8%), moderate in 3% (tingling 58%, urticaria 15%, hypotension 10%, nausea 3%), and severe in 0.4% of procedures (syncope/hypotension 32%, urticaria 17%, chills/fever 8%, arrhythmia/asystole 4.5%, nausea/vomiting 4%). Hypotension was most common if albumin was used as the replacement fluid, and urticaria when plasma was used. Arrhythmia occurred to similar extents when using plasma or albumin as replacement. In 64% of procedures with bronchospasm, plasma was part of the replacement fluid used. Severe AEs are rare. Although most reactions are mild and moderate, several side effects may be critical for the patient. We present side effects in relation to the procedures and suggest that safety is increased by regular vital sign measurements, cardiac monitoring and by having emergency equipment nearby.
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Affiliation(s)
| | - E Newman
- Bone Marrow Transplant & Apheresis, New South Wales, Australia
| | - V Witt
- St. Anna, Vienna, Austria
| | | | | | | | | | | | | | - J Ptak
- Frydek-Mistek, Czech Republic
| | - M Blaha
- Hradec Kralove, Czech Republic
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Abstract
Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms of fibroblastic origin. Most commonly they affect the pleura but they been described in other viscera. SFT of the pancreas is extremely rare, and only eight cases have been reported to date. We perform a literature review and report a ninth case. The patient is a 54-year-old African-American female who presented with several months of abdominal pain. Abdominal radiography demonstrated a lesion in the head of the pancreas, and she underwent a Whipple operation. Pathology demonstrated SFT of the pancreas. She is alive and well 1 year post-operatively. SFT of the pancreas predominately affects middle-aged women. These tumors are difficult to distinguish radiologically from neuroendocrine tumors. While SFT of the pancreas tend to have an indolent course, there is the potential for malignancy. We recommend complete surgical excision.
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Affiliation(s)
- Andrew R Baxter
- Department of Surgery, New York University Langone Medical Center, New York, NY, USA
| | - Elliot Newman
- Department of Surgery, New York University Langone Medical Center, New York, NY, USA
| | - Cristina H Hajdu
- Department of Pathology, New York University Langone Medical Center, New York, NY, USA
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Zeng J, Zhou F, Alexander M, Hajdu C, Cohen S, Newman E, Simsir A, Oweity T, Melis M. A Case of a Peripancreatic Paraganglioma: A Diagnostic Challenge on Fine Needle Aspiration. Am J Clin Pathol 2015. [DOI: 10.1093/ajcp/144.suppl2.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Melis M, Masi A, Pinna A, Cohen S, Hatzaras I, Berman R, Pachter LH, Newman E. Does lymph node ratio affect prognosis in gastroesophageal cancer? Am J Surg 2015; 210:443-50. [DOI: 10.1016/j.amjsurg.2014.12.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 11/03/2014] [Accepted: 12/29/2014] [Indexed: 12/19/2022]
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Lin IH, Wu J, Cohen SM, Chen C, Bryk D, Marr M, Melis M, Newman E, Pachter HL, Alekseyenko AV, Hayes RB, Ahn J. Abstract 101: Pilot study of oral microbiome and risk of pancreatic cancer. Epidemiology 2014. [DOI: 10.1158/1538-7445.am2013-101] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Hatzaras I, Masi A, Melis M, Berman RS, Pachter LH, Cohen SM, Newman E. Neutrophil to Lymphocyte Ratio Predicts Biologic Behavior in Patients Undergoing Curative Resection for Gastroesophageal Cancer. J Am Coll Surg 2014. [DOI: 10.1016/j.jamcollsurg.2014.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Atkinson J, Braddick O, Wattam-Bell J, Akshoomoff N, Newman E, Girard H, Dale A, Jernigan T. GLOBAL MOTION, MATHEMATICS AND MOVEMENT: DORSAL STREAM SENSITIVITY RELATES TO CHILDREN'S INDIVIDUAL DIFFERENCES IN COGNITIVE ABILITIES AND REGIONAL BRAIN DEVELOPMENT. J Vis 2014. [DOI: 10.1167/14.10.1324] [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: 11/24/2022] Open
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Fromm P, Anguille S, Papadimitrious M, Bryant C, Kupresanin F, Clark G, Newman E, Bradstock K, Berneman Z, Hart D. Anti-cancer vaccination using mRNA-loaded CMRF-56 immunoselected blood dendritic cells. Cytotherapy 2014. [DOI: 10.1016/j.jcyt.2014.01.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wright C, Zarkos K, Brown R, Larsen S, Anwar Z, Newman E, Trotman J, Gibson J. Post thaw viability of cryopreserved HPC with increased nucleated cell concentration. Cytotherapy 2014. [DOI: 10.1016/j.jcyt.2014.01.195] [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: 10/25/2022]
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Gaston L, Bashllari D, Lu F, Opipari A, Castle V, Newman E. Hypoxia Induces DNA Ligase III Expression in Neuroblastoma Cells. J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.964] [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: 10/25/2022]
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Stegmayr B, Ptak J, Nilsson T, Berlin G, Mirea V, Axelsson CG, Griskevicius A, Centoni P, Liumbruno G, Audzijoniene J, Mokvist K, Lassen E, Knutson F, Norda R, Mörtzell M, Prophet H, Ramlow W, Blaha M, Witt V, Efvergren M, Tomaz J, Newman E, Eloot S, Dhondt A, Lalic K, Sikole A, Derfler K, Hrdlickova R, Tomsova H, Gasova Z, Bhuiyan-Ludvikova Z, Ramsauer B, Vrielink H. Panorama of adverse events during cytapheresis. Transfus Apher Sci 2013; 48:155-6. [PMID: 23809812 DOI: 10.1016/j.transci.2013.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Melis M, Pinna A, Marcon F, Miller G, Cohen S, Pachter H, Newman E. Lymph Node Ratio and Survival After Resection of Pancreatic Adenocarcinoma. J Surg Res 2013. [DOI: 10.1016/j.jss.2012.10.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sarpel U, Melis M, Newman E, Pachter HL, Berman RS. The development of a peritoneal surface malignancy program: a tale of three hospitals. J Cancer Educ 2012; 27:670-675. [PMID: 22477235 DOI: 10.1007/s13187-012-0352-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
An increasing amount of evidence supports the use of cytoreductive surgery and heated intraperitoneal chemotherapy (HIPEC) for the treatment of select patients with carcinomatosis. The care of such patients is optimal at centers where physicians with expertise in the recognition, treatment, and follow-up of carcinomatosis collaborate to manage issues particular to patients undergoing HIPEC. New Peritoneal Surface Malignancy Programs should be introduced to meet the growing interest in this field; however, there are few guidelines available on how to propose, develop, and safely implement them across different hospital models. A new Peritoneal Surface Malignancy Program was initiated at a large academic medical center affiliated with three hospital systems serving distinct patient populations: a private hospital, a public hospital, and a Veterans Affairs hospital. Ten groups were identified as playing key roles in program implementation. Program approval was successfully obtained at all three hospitals. The initial two-year experience included a total of 20 cases across the three sites. Six of these cases were aborted due to high tumor volume, most of which (4/6) were at the public hospital. No 30-day mortalities occurred. Hospitals vary significantly in their approval process and timeline for new Peritoneal Surface Malignancy Program development. Patient populations differ in their awareness of HIPEC as a therapeutic modality. Public hospitals may serve patient populations with more advanced disease presentations. Careful coordination by the surgical oncologist with ten key groups allows for the safe introduction of a complex procedure within varied hospital models.
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Affiliation(s)
- Umut Sarpel
- Department of Surgery, New York University Langone Medical Center, New York, NY 10016, USA.
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Sarpel U, Ayo DM, Newman E. Choice of device for parenchymal transection in laparoscopic hepatectomy. Surg Technol Int 2012; 22:33-38. [PMID: 23023571] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Laparoscopic hepatic surgery has only recently become an established field. Technological limitations in devices used to transect the liver parenchyma and control hemostasis have been a rate limiting step. However, as a result of advances in products specifically tailored to liver surgery, there has been steady progress in the complexity of laparoscopic hepatectomies performed, from the minimally invasive fenestration of liver cysts, to peripheral wedge resections, major hepatectomy, and recently donor hepatectomy. Herein, we discuss the role of several laparoscopic devices which include the endoscopic stapler, pre-coagulators, ultrasonic dissector, ultrasonic shears, and vessel sealing devices. CONCLUSION Laparoscopic liver surgery introduces new challenges to even the experienced surgeon. It is important to have a solid understanding of the advantages and limitations of available instruments in order to safely and effectively expand the use of laparoscopy in hepatic surgery.
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Affiliation(s)
- Umut Sarpel
- Mount Sinai School of Medicine, New York, NY, USA
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Abstract
BACKGROUND A subset of patients with hepatocellular carcinoma (HCC) present with massive tumours. It is unknown why certain patients develop these massive tumours, and whether this presentation is specific to the underlying viral aetiology or patient demographics such as gender, race and age. METHODS All patients with HCC at Bellevue Hospital Center, New York from 1998 to 2012 were identified and relevant demographic and clinical information was collected. Computed tomography/magnetic resonance imaging (CT/MRI) images were reviewed and the maximal tumour diameter on axial sections was recorded. Cirrhosis was defined histologically or by radiographical criteria. The two cohorts of massive and non-massive HCC were compared. RESULTS A total of 361 patients with HCC were identified, of which 58 were categorized as having a massive HCC using a 13 cm size cut-off. Univariate and multivariate analysis demonstrated a significant association of massive HCC with age <40 years; hepatitis B or Asian ethnicity; and a lack of cirrhosis or platelet count >100. DISCUSSION Massive HCC represents a tumour subtype that is associated with young, chronic hepatitis B carriers with non-cirrhotic livers. The clinical implications of this finding are that patients with massive HCC are typically excellent resection candidates barring the presence of gross vascular invasion or distant metastases.
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Affiliation(s)
- Umut Sarpel
- Department of Surgery, Mount Sinai School of MedicineNew York, NY, USA
| | - Diego Ayo
- Department of SurgeryNew York, NY, USA
| | - Iryna Lobach
- Department of Population HealthNew York, NY, USA
| | - Ruliang Xu
- Department of Pathology, New York University School of MedicineNew York, NY, USA
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