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Senguttuvan RN, Cohen JG. Combining the prognostic role of age with molecular advances in the understanding of endometrial cancer. Lancet Oncol 2024:S1470-2045(24)00193-1. [PMID: 38701814 DOI: 10.1016/s1470-2045(24)00193-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 04/02/2024] [Indexed: 05/05/2024]
Affiliation(s)
- Rosemary N Senguttuvan
- Department of Surgery, Division of Gynecologic Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA
| | - Joshua G Cohen
- Department of Surgery, Division of Gynecologic Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA.
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Arend RC, Monk BJ, Shapira-Frommer R, Haggerty AF, Alvarez EA, Amit A, Alvarez Secord A, Muller C, Casado Herraez A, Herzog TJ, Tewari KS, Cohen JG, Huang M, Yachnin A, Holeman LL, Ledermann JA, Rachmilewitz Minei T, Buyse M, Fain Shmueli S, Lavi M, Harats D, Penson RT. Ofranergene Obadenovec (Ofra-Vec, VB-111) With Weekly Paclitaxel for Platinum-Resistant Ovarian Cancer: Randomized Controlled Phase III Trial (OVAL Study/GOG 3018). J Clin Oncol 2024; 42:170-179. [PMID: 37906726 DOI: 10.1200/jco.22.02915] [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: 12/28/2022] [Revised: 06/10/2023] [Accepted: 08/26/2023] [Indexed: 11/02/2023] Open
Abstract
PURPOSE To evaluate the addition of ofranergene obadenovec (ofra-vec, VB-111), a novel gene-based anticancer targeted therapy, to once a week paclitaxel in patients with recurrent platinum-resistant ovarian cancer (PROC). METHODS This placebo-controlled, double-blind, phase III trial (ClinicalTrials.gov identifier: NCT03398655) randomly assigned patients with PROC 1:1 to receive intravenous ofra-vec every 8 weeks with once a week IV paclitaxel or placebo with paclitaxel until disease progression. The dual primary end points were overall survival (OS) and progression-free survival (PFS) as assessed by Blinded Independent Central Review. RESULTS Between December 2017 and March 2022, 409 patients were randomly assigned. The median PFS was 5.29 months in the ofra-vec arm and 5.36 months in the control arm, hazard ratio (HR) 1.03 (CI, 0.83 to 1.29; P = .7823). The median OS with ofra-vec was 13.37 months versus 13.14 months, HR 0.97 (CI, 0.75 to 1.27; P = .8440). Objective response rates (ORRs) per RECIST 1.1 were similar in both arms: 28.9% with ofra-vec versus 29.6% with control. In both treatment arms, response to CA-125 was a substantial prognostic factor for both PFS and OS. In the ofra-vec arm, the HR in CA-125 responders compared with that in nonresponders for PFS was 0.2428 (CI, 0.1642 to 0.3588), and for OS, the HR was 0.3343 (CI, 0.2134 to 0.5238). Safety profile was characterized by common transient flu-like symptoms such as fever and chills. CONCLUSION The addition of ofra-vec to paclitaxel did not improve PFS or OS. The PFS and ORR in the control arm exceeded the results that were anticipated on the basis of the AURELIA chemotherapy control arm. CA-125 response was a substantial prognostic biomarker for PFS and OS in patients with PROC treated with paclitaxel.
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Affiliation(s)
- Rebecca C Arend
- University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - Bradley J Monk
- HonorHealth Research Institute, University of Arizona College of Medicine, Creighton University School of Medicine, Phoenix, AZ
| | | | | | | | - Amnon Amit
- Rambam Health Care Campus, Haifa, Israel
| | | | | | | | - Thomas J Herzog
- University of Cincinnati Cancer Center, University of Cincinnati, Cincinnati, OH
| | | | | | - Marilyn Huang
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | | | - Laura L Holeman
- Stephenson Cancer Center at the University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | | | | | - Marc Buyse
- International Drug Development Institute, Louvain-la-Neuve, Belgium
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Cotangco K, Pineda E, Hingarh V, Nyakudarika NC, Cohen JG, Holschneider CH. Integrating social care into gynecologic oncology: Identifying and addressing patient's social needs. Gynecol Oncol 2023; 179:138-144. [PMID: 37980768 DOI: 10.1016/j.ygyno.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/26/2023] [Accepted: 11/02/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE We aimed to identify social needs of gynecologic oncology patients using a self-administered social needs assessment tool (SNAT), compare the SNAT to a formal social work assessment performed by cancer care navigators (CCN), and provide SNAT-informed community resources. METHODS We analyzed prospectively collected data from a performance improvement initiative in a safety-net gynecologic oncology clinic between October 2021 and July 2022. We screened for eight social needs domains, health literacy, desire for social work, and presence of urgent needs. Clinicodemographic data were abstracted from the electronic medical record. Univariate descriptive statistics were used. Inter-rater reliability for social needs domains was assessed using percent agreement. RESULTS 1010 unique patients were seen over this study period. 488 (48%) patients completed the SNAT, of which 265 (54%) screened positive for ≥1 social need. 83 (31%) patients were actively receiving cancer treatment, 140 (53%) were in post-treatment surveillance, and 42 (16%) had benign gynecologic diagnoses. Transportation (19% vs 25%), housing insecurity (18% vs 19%), and desire to speak with a social worker (16% vs 27%) were the 3 most common needs in both the entire cohort and among patients actively receiving cancer treatment. 78% patients in active treatment were seen by a CCN and received SNAT informed community resources. The percent agreement between the SNAT and formal CCN assessment ranged from 72%-94%. CONCLUSIONS The self-administered SNAT identified many unmet social needs among gynecologic oncology patients, corresponded well with the formal social work CCN assessment, and informed the provision of community resources.
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Affiliation(s)
- Katherine Cotangco
- Department of Obstetrics and Gynecology, Olive View-UCLA Medical Center, Sylmar, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Veda Hingarh
- Department of Obstetrics and Gynecology, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - Natsai C Nyakudarika
- Department of Obstetrics and Gynecology, Harbor UCLA Medical Center, Torrance, CA, USA
| | - Joshua G Cohen
- Division of Gynecologic Oncology, City of Hope Orange County, Irvine, CA, USA
| | - Christine H Holschneider
- Department of Obstetrics and Gynecology, Olive View-UCLA Medical Center, Sylmar, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Chaudhari SR, Lai TS, Zakhour M, Myung Shin S, Baltayan A, Tan H, Cohen JG. Comparison of Mirena and Liletta levonorgestrel intrauterine devices for the treatment of endometrial intraepithelial neoplasia and grade 1 endometrioid endometrial cancer. Gynecol Oncol Rep 2023; 49:101257. [PMID: 37691755 PMCID: PMC10485590 DOI: 10.1016/j.gore.2023.101257] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 09/12/2023] Open
Abstract
Objective Current standard nonsurgical management of endometrial intraepithelial neoplasia (EIN) and grade 1 endometrioid endometrial cancer (g1EEC) is the Mirena levonorgestrel intrauterine device (M-IUD). This retrospective study was designed primarily to determine noninferiority of the Liletta IUD (L-IUD) for pathologic regression of EIN and g1EEC compared to the M-IUD at 6 months of continuous use. Secondary objectives include to determine noninferiority as above at 3, 9, and 12 months of continuous use and to identify factors including DNA mismatch repair (MMR) status associated with pathologic regression after LNG-IUD use. Methods A retrospective observational study was performed with patients treated for EIN or g1EEC and managed continuously with M- or L-IUD. Patients with recent (within 6 months) or concurrent progesterone use were excluded. For the EIN group, the noninferiority margin of odds ratio was predetermined to be 0.58, and for the g1EEC group it was 0.64. Results 62 patients from an academic center and a safety-net hospital were identified with continuous M-IUD (n = 44) or L-IUD (n = 18) use for EIN or g1EEC. 85% of patients treated with L-IUD were from a safety-net hospital, which had 63% with public insurance. At 3/6/9 months, 54/71/73% of patients with M-IUD and 80/83/100% with L-IUD had pathologic regression of EIN (95% confidence interval of estimated odds ratio 1.00-2.07/0.84-2.03/0.69-2.10). Lifetime smoking status, not MMR status, was significantly associated with pathologic regression. Conclusions L-IUD is an effective fertility-sparing treatment for EIN. L-IUD is noninferior to M-IUD for pathologic regression of EIN after 3,6, and 9 months. Further larger studies are warranted to validate findings in EIN and g1EEC.
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Affiliation(s)
- Sonal R. Chaudhari
- University of California, Los Angeles, Division of Gynecologic Oncology, Department of Surgery, USA
- Olive View-UCLA Medical Center, Division of Gynecologic Oncology, Department of Surgery, USA
| | - Tiffany S. Lai
- University of California, Los Angeles, Division of Gynecologic Oncology, Department of Surgery, USA
- Olive View-UCLA Medical Center, Division of Gynecologic Oncology, Department of Surgery, USA
| | - Mae Zakhour
- Corewell Health Gynecology Oncology, Division of Gynecologic Oncology, Department of Surgery, USA
| | - Sim Myung Shin
- University of California, Los Angeles, Division of Gynecologic Oncology, Department of Surgery, USA
| | - Armine Baltayan
- Olive View-UCLA Medical Center, Division of Gynecologic Oncology, Department of Surgery, USA
| | - Hongying Tan
- Olive View-UCLA Medical Center, Division of Gynecologic Oncology, Department of Surgery, USA
| | - Joshua G. Cohen
- City of Hope, Division of Gynecologic Oncology, Department of Surgery, USA
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Abstract
PURPOSE OF REVIEW To summarize the most recent publications highlighting the trends and disparities among patients diagnosed with high-risk endometrial cancer. RECENT FINDINGS Endometrial cancer mortality continues to rise, driven by the increasing incidence of high-risk histologic subtypes that accounts for a disproportionate number of endometrial cancer deaths. The lack of progress made in endometrial cancer treatment, particularly of high-risk histologic subtypes, disproportionately affects black women who are more likely to be diagnosed with these aggressive tumor types. Even when accounting for high-risk histology, various factors across the spectrum of care may influence the survival disparities between black and white women, including timely access to guideline-concordant care, clinical trial enrollment, and systemic racism that impacts cancer outcomes. SUMMARY In this review, we highlight the disproportionate impact of worsening endometrial cancer mortality and healthcare inequalities contributing to the endometrial cancer survival disparity between black and white women.
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Affiliation(s)
- Cortney M Eakin
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Los Angeles, CA 90095
| | - Tiffany Lai
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Los Angeles, CA 90095
| | - Joshua G Cohen
- Division of Gynecologic Oncology, Department of Surgery, City of Hope, Irvine, CA 92618
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Armstrong A, Kroener L, Cohen JG, Han CS, Nitti VW, Rible R, Brennan K. Faculty and applicant perceptions of virtual interviews on subspecialty fellowship match in obstetrics and gynecology. Med Educ Online 2022; 27:2068993. [PMID: 35473575 PMCID: PMC9067945 DOI: 10.1080/10872981.2022.2068993] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/23/2022] [Accepted: 04/19/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND In response to COVID-19, the AAMC recommended that hospitals conduct interviews in a virtual setting. OBJECTIVE To evaluate whether fellowship video conference interviews (VCIs) are an acceptable alternative to in-person interviews from both the applicant and program perspectives. METHODS Applicants and faculty from a single academic institution with five OBGYN subspecialty fellowship programs were invited to complete surveys regarding their experience using VCIs during the 2020 interview season. Survey responses used a 5-point Likert scale (strongly disagree to strongly agree). Comparative analyses between faculty and applicants responses to survey questions were performed with two-tailed Student's t-tests. RESULTS 45 faculty members and 131 applicants received the survey. Response rate for faculty members and applicants was 95.6% (n = 43) and 46.6% (n = 61), respectively. Faculty and applicants agreed that the VCIs allowed them to accurately represent themselves (83.7% vs. 88.6%, p = 0.48). Most applicants (62.3%, n = 38) reported a fundamental understanding of the fellowship's culture. The majority of applicants (77.1%, n = 47) and faculty (72.1%, n = 31) agreed that they were able to develop connections during the virtual interview (p = 0.77). Faculty and applicants stated that VCIs assisted them in determining whether the candidate or program, respectively, was a good fit (83.7% vs. 67.2%, p = 0.98). CONCLUSIONS The VCI fellowship recruitment process allowed OBGYN fellowship applicants and programs to accurately represent themselves compared to in-person interviews. Most applicants and faculty were able to develop relationships over the virtual platform. Although not explicitly assessed, it is possible that the virtual interviews can achieve a suitable match between applicant and program across all OBGYN subspecialty fellowships. The VCI process may be a long-term resolution to minimize both the financial burden and time commitment presented by traditional in-person interviews. Follow-up studies should assess the performance of the virtually selected fellows compared to those selected in previous years using traditional in-person interviews.
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Affiliation(s)
- Abigail Armstrong
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California, USA
| | - Lindsay Kroener
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California, USA
| | - Joshua G. Cohen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California, USA
| | - Christina S. Han
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California, USA
| | - Victor W. Nitti
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California, USA
| | - Radhika Rible
- Division of Family Planning, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California, USA
| | - Kathleen Brennan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of California at Los Angeles, Los Angeles, California, USA
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Francoeur AA, Liao CI, Caesar MA, Chan A, Kapp DS, Cohen JG, Salani R, Chan JK. The increasing incidence of stage IV cervical cancer in the USA: what factors are related? Int J Gynecol Cancer 2022; 32:ijgc-2022-003728. [PMID: 35981903 DOI: 10.1136/ijgc-2022-003728] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [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: 01/06/2023] Open
Abstract
OBJECTIVE Cervical cancer (International Federation of Gynecology and Obstetrics (FIGO)) stage IVA-B (distant stage) is a rare diagnosis with an approximate 5 year survival rate of 17% and with limited treatment options. The objective of this study was to determine the trends in distant stage cervical cancer in the USA and identify possible factors related to these trends. METHODS Data were obtained from the United States Cancer Statistics program from 2001 to 2018. Rates of cervical cancer screening and vaccination were evaluated using the Behavioral Risk Factor Surveillance System and TeenVaxView. SEER*Stat 8.3.8.9.2 and Joinpoint regression program 4.9.0.0 were used to calculate incidence trends. RESULTS Over the last 18 years, 29 715 women were diagnosed with distant stage cervical carcinoma. Black women have disproportionately higher rates at 1.55/100 000 versus 0.92/100 000 in White women (p<0.001). When examining the trends over time, there has been an annual increase in distant stage cervical cancer at a rate of 1.3% per year (p<0.001). The largest increase is seen in cervical adenocarcinoma with an average annual percent change of 2.9% (p<0.001). When performing an intersection analysis of race, region and age, White women in the South aged 40-44 have the highest rise in distant cervical cancer at a rate of 4.5% annually (p<0.001). Using the Behavioral Risk Factor Surveillance System and TeenVax data, compared with Black women, we found that White women have a nearly two-fold higher rate of missed or lack of guideline screening, 26.6% vs 13.8%. White teenagers (13-17 years) have the lowest human papillomavirus vaccination rate at 66.1% compared with others at 75.3%. CONCLUSIONS Black women have a higher incidence of distant stage disease compared with White women. However, White women have a greater annual increase, particularly in adenocarcinomas. Compared with Black women, White women also have lower rates of guideline screening and vaccination.
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Affiliation(s)
- Alex Andrea Francoeur
- Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, California, USA
| | - Cheng-I Liao
- Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Michelle Ann Caesar
- Department of Pediatrics, University of California San Diego, San Diego, California, USA
| | - Ava Chan
- Department of Obstetrics and Gynecology, California Pacific Medical Center Research Institute, San Francisco, California, USA
| | - Daniel S Kapp
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Joshua G Cohen
- Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, California, USA
| | - Ritu Salani
- Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, California, USA
| | - John K Chan
- California Pacific Palo Alto Medical Foundation; Sutter Cancer Research Institute, San Francisco, California, USA
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Nakhla M, Eakin CM, Mandelbaum A, Karlan B, Benharash P, Salani R, Cohen JG. Frailty is independently associated with worse outcomes and increased resource utilization following endometrial cancer surgery. Int J Gynecol Cancer 2022; 32:ijgc-2022-003484. [PMID: 35725031 PMCID: PMC9763544 DOI: 10.1136/ijgc-2022-003484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Frailty has been associated with poorer surgical outcomes and is a critical factor in procedural risk assessment. The objective of this study is to assess the impact of frailty on surgical outcomes in patients with endometrial cancer. METHODS Patients undergoing inpatient gynecologic surgery for endometrial cancer were identified using the 2005-2017 Nationwide Inpatient Sample database. The Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator was used to designate frailty. Multivariate regression models were used to assess the association of frailty with postoperative outcomes and resource use. RESULTS Of 339 846 patients, 2.9% (9868) were considered frail. After adjusting for patient and hospital characteristics, frailty was associated with a four-fold increase in inpatient mortality (adjusted OR (aOR) 4.1; p<0.001), non-home discharge (aOR 5.2; p<0.001), as well as increased respiratory (aOR 2.6; p<0.001), neurologic (aOR 3.3; p<0.001), renal (aOR 2.0; p<0.001), and infectious (aOR 3.2; p<0.001) complications. While frail patients exhibited increased mortality with age, the rate of mortality in this cohort decreased significantly over time. Compared with non-frail counterparts, frail patients had longer lengths of stay (7.6 vs 3.4 days; p<0.001) and increased hospitalization costs with surgical admission ($25 093 vs $13 405; p<0.001). CONCLUSIONS Frailty is independently associated with worse surgical outcomes, including increased mortality and resource use, in women undergoing surgery for endometrial cancer. Though in recent years there have been improvements in mortality in the frail population, further efforts to mitigate the impact of frailty should be explored.
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Affiliation(s)
- Morcos Nakhla
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Cortney M Eakin
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Ava Mandelbaum
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Beth Karlan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Ritu Salani
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Joshua G Cohen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
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Ng AP, Sanaiha Y, Verma A, Lee C, Akhavan A, Cohen JG, Benharash P. Insurance-based disparities and risk of financial toxicity among patients undergoing gynecologic cancer operations. Gynecol Oncol 2022; 166:200-206. [PMID: 35660294 DOI: 10.1016/j.ygyno.2022.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/18/2022] [Accepted: 05/22/2022] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the risk of financial toxicity (FT) among inpatients undergoing gynecologic cancer resections and the association of insurance status with clinical and financial outcomes. METHODS Using the 2008-2019 National Inpatient Sample, we identified adult hospitalizations for hysterectomy or oophorectomy with a diagnosis of cancer. Hospitalization costs, length of stay (LOS), mortality, and complications were assessed by insurance status. Risk of FT was defined as health expenditure exceeding 40% of post-subsistence income. Multivariable regressions were used to analyze costs and factors associated with FT risk. RESULTS Of 462,529 patients, 49.4% had government-funded insurance, 44.3% private, and 3.2% were uninsured. Compared to insured, uninsured patients were more commonly Black and Hispanic, admitted emergently, and underwent open operations. Uninsured patients experienced similar mortality but greater rates of complications, LOS, and costs. Overall, ovarian cancer resections had the highest median costs of $17,258 (interquartile range: 12,187-25,491) compared to cervical and uterine. Approximately 52.8% of uninsured and 15.4% of insured patients were at risk of FT. As costs increased across both cohorts over the 12-year study period, the disparity in FT risk by payer status broadened. After risk adjustment, perioperative complications were associated with nearly 2-fold increased risk of FT among uninsured (adjusted odds ratio 1.75, 95% confidence interval 1.46-2.09, p < 0.001). Among the insured, Black and Hispanic race, public insurance, and open operative approach exhibited greater odds of FT. CONCLUSION Patients undergoing gynecologic cancer operations are at substantial risk of FT, particularly those uninsured. Targeted cost-mitigation strategies are warranted to minimize financial burden.
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Affiliation(s)
- Ayesha P Ng
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Arjun Verma
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Cory Lee
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Aaron Akhavan
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Joshua G Cohen
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America.
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Porter A, Barcelon JM, Budker RL, Marsh L, Moriarty JM, Aguiar X, Rao J, Ghorani E, Kaur B, Maher G, Seckl MJ, Konecny GE, Cohen JG. Treatment of metastatic placental site trophoblastic tumor with surgery, chemotherapy, immunotherapy and coil embolization of multiple pulmonary arteriovenous fistulate. Gynecol Oncol Rep 2021; 36:100782. [PMID: 34036138 PMCID: PMC8134973 DOI: 10.1016/j.gore.2021.100782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/25/2021] [Accepted: 04/30/2021] [Indexed: 11/28/2022] Open
Abstract
Placental site trophoblastic tumor can be resistant to chemotherapy. Multidisciplinary care is required for management of advanced disease. Increased PD-L1 expression can help guide use of immunotherapies. Complete responses are possible with aggressive multidisciplinary management.
Placental Site Trophoblastic Tumor (PSTT) is a rare malignancy that often presents with extensive disease and can be resistant to traditional treatments. We present the case of a woman with stage IV PSTT who was initially managed with neoadjuvant chemotherapy followed by tumor debulking. Adjuvant therapy was guided by further pathologic analysis that revealed high levels of staining for PD-L1 as well as the presence of tumor infiltrating lymphocytes (TILs). Subsequently, the patient was treated with traditional chemotherapy with the EP/EMA regimen with the addition of pembrolizumab. The patient’s treatment course was complicated by the development of pulmonary arteriovenous malformations, autoimmune thyroiditis thought to be secondary to immunotherapy, and significant tinnitus secondary to platinum agents. Currently the patient is in follow up and remains in a complete remission.
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Affiliation(s)
- A Porter
- University of California Los Angeles, Division of Hematology Oncology, Los Angeles, CA, USA
| | - J M Barcelon
- University of California Los Angeles, Division of Gynecologic Oncology, Los Angeles, CA, USA
| | - R L Budker
- University of California Los Angeles, Division of Gynecologic Oncology, Los Angeles, CA, USA
| | - L Marsh
- University of California Los Angeles, Division of Gynecologic Oncology, Los Angeles, CA, USA
| | - J M Moriarty
- University of California Los Angeles, Division of Interventional Radiology, Los Angeles, CA, USA
| | - X Aguiar
- California Los Angeles, Department of Pathology, Los Angeles, CA, USA
| | - J Rao
- California Los Angeles, Department of Pathology, Los Angeles, CA, USA
| | - E Ghorani
- Gestational Trophoblastic Disease Centre, Charing Cross Hospital Campus of Imperial College London, United Kingdom
| | - B Kaur
- Gestational Trophoblastic Disease Centre, Charing Cross Hospital Campus of Imperial College London, United Kingdom
| | - G Maher
- Gestational Trophoblastic Disease Centre, Charing Cross Hospital Campus of Imperial College London, United Kingdom
| | - M J Seckl
- Gestational Trophoblastic Disease Centre, Charing Cross Hospital Campus of Imperial College London, United Kingdom
| | - G E Konecny
- University of California Los Angeles, Division of Hematology Oncology, Los Angeles, CA, USA
| | - J G Cohen
- University of California Los Angeles, Division of Gynecologic Oncology, Los Angeles, CA, USA
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Milki AA, Cohen JG, Mann AK, Kapp DS, Chan JK. Progress and trends in publication of oral and video presentations at the society of gynecologic oncology annual meeting from 2006 to 2016. Gynecol Oncol Rep 2021; 36:100758. [PMID: 33948477 PMCID: PMC8080448 DOI: 10.1016/j.gore.2021.100758] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/08/2021] [Accepted: 03/22/2021] [Indexed: 11/18/2022] Open
Abstract
Over 11 years of SGO annual meetings, chemotherapy clinical trials and palliative care publications increased. Translational research and surgery publications decreased over time. The interval from presentation at the SGO annual meeting to publication in peer-reviewed journals decreased over time.
Previous research has identified factors associated with publication of plenary presentations at the Society of Gynecologic Oncology annual meeting. However, there are no detailed comprehensive trends analyses on the publications of these oral and video presentations over time. In this analysis of 11 annual meetings, we found an increase in clinical rather than translational science publications over time. There was a greater focus on chemotherapy clinical studies and palliative care medicine, with a corresponding decline in publications on surgery. Furthermore, the time interval from presentation to publication shortened over our study period. The evaluation of trends in research publications can inform clinicians and researchers about the quality, competitiveness, and neglected areas of study from national meeting presentations.
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Affiliation(s)
- Anthony A. Milki
- The George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Joshua G. Cohen
- Department of Obstetrics and Gynecology, UCLA Medical Center, Los Angeles, CA, United States
| | - Amandeep Kaur Mann
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States
| | - Daniel S. Kapp
- Stanford University School of Medicine, Stanford, CA, United States
| | - John K. Chan
- California Pacific Medical Center, San Francisco, CA, United States
- Corresponding author at: Gynecologic Oncology, Denise & Prentis Cobb Hale Endowed Chair, California Pacific Medical Center, Palo Alto Medical Foundation, Sutter Cancer Research Consortium, 1100 Van Ness Ave. 4th floor, San Francisco, CA 94109, United States.
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12
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Cohen JG, Chang AJ. Use of stereotactic body radiotherapy in gynecologic cancers: Local control with systemic treatment implications. Gynecol Oncol 2021; 159:599-600. [PMID: 33279016 DOI: 10.1016/j.ygyno.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Joshua G Cohen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Albert J Chang
- Division of Brachytherapy, Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA.
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13
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Boitano TKL, Smith HJ, Cohen JG, Rossi EC, Kim KH. Implementation and evaluation of a novel subspecialty society fellows robotic surgical course: the SGO minimally invasive academy surgical curriculum. J Gynecol Oncol 2021; 32:e26. [PMID: 33470068 PMCID: PMC7930459 DOI: 10.3802/jgo.2021.32.e26] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/18/2020] [Accepted: 12/05/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the utility of a society-based robotic surgery training program for fellows in gynecologic oncology. METHODS All participants underwent a 2-day robotic surgery training course between 2015-2017. The course included interactive didactic sessions with video, dry labs, and robotic cadaver labs. The labs encompassed a wide range of subject matter including troubleshooting, instrument variation, radical hysterectomies, and lymph node dissections. Participants completed a pre- and post-course survey using a 5-point Likert scale ranging from "not confident" to "extremely confident" on various measures. Statistical analysis was performed using SPSS Statistics v. 24. RESULTS The response rate was high with 86% of the 70 participants completing the survey. Sixteen (26.7%) of these individuals were attending physicians and 44 (73.3%) were fellows. In general, there was a significant increase in confidence in more complex procedures and concepts such as radical hysterectomy (p=0.01), lymph node dissection (p=0.01), troubleshooting (p=0.001), and managing complications (p=0.004). Faculty comfort and practice patterns were cited as the primary reason (58.9%) for limitations during robotic procedures followed secondarily by surgical resources (34.0%). CONCLUSION In both gynecologic oncology fellows and attendings, this educational theory-based curriculum significantly improved confidence in the majority of procedures and concepts taught, emphasizing the value of hands-on skill labs.
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Affiliation(s)
- Teresa K L Boitano
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Haller J Smith
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joshua G Cohen
- Division of Gynecologic Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Emma C Rossi
- Division of Gynecologic Oncology, University of North Carolina, Chapel Hill, NC, USA
| | - Kenneth H Kim
- Division of Gynecologic Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
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Cinar P, Bold R, Bosslet BA, Bota DA, Burgess D, Chew HK, Cohen JG, Elquza E, Gold KA, Kamiya E, Karlan BY, McKay RR, Patel SP, Ternavan K, Welborn J, Yamamoto M, Rugo HS. Planning for post-pandemic cancer care delivery: Recovery or opportunity for redesign? CA Cancer J Clin 2021; 71:34-46. [PMID: 32997807 PMCID: PMC7537198 DOI: 10.3322/caac.21644] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 01/02/2023] Open
Abstract
The delivery of cancer care has never changed as rapidly and dramatically as we have seen with the coronavirus disease 2019 (COVID-19) pandemic. During the early phase of the pandemic, recommendations for the management of oncology patients issued by various professional societies and government agencies did not recognize the significant regional differences in the impact of the pandemic. California initially experienced lower than expected numbers of cases, and the health care system did not experience the same degree of the burden that had been the case in other parts of the country. In light of promising trends in COVID-19 infections and mortality in California, by late April 2020, discussions were initiated for a phased recovery of full-scale cancer services. However, by July 2020, a surge of cases was reported across the nation, including in California. In this review, the authors share the response and recovery planning experience of the University of California (UC) Cancer Consortium in an effort to provide guidance to oncology practices. The UC Cancer Consortium was established in 2017 to bring together 5 UC Comprehensive Cancer Centers: UC Davis Comprehensive Cancer Center, UC Los Angeles Jonsson Comprehensive Cancer Center, UC Irvine Chao Family Comprehensive Cancer Center, UC San Diego Moores Cancer Center, and the UC San Francisco Helen Diller Family Comprehensive Cancer Center. The interventions implemented in each of these cancer centers are highlighted, with a focus on opportunities for a redesign in care delivery models. The authors propose that their experiences gained during this pandemic will enhance pre-pandemic cancer care delivery.
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Affiliation(s)
- Pelin Cinar
- Division of Medical OncologyDepartment of MedicineUniversity of California San FranciscoSan FranciscoCalifornia
- University of California San Francisco Helen Diller Family Comprehensive Cancer CenterSan FranciscoCalifornia
| | - Richard Bold
- University of California Davis Comprehensive Cancer CenterSacramentoCalifornia
| | - Bryn A. Bosslet
- Division of Infectious DiseasesDepartment of MedicineUniversity of California San FranciscoSan FranciscoCalifornia
| | - Daniela A. Bota
- University of California Irvine Chao Family Comprehensive Cancer CenterOrangeCalifornia
| | - Debra Burgess
- University of California Davis Comprehensive Cancer CenterSacramentoCalifornia
| | - Helen K. Chew
- University of California Davis Comprehensive Cancer CenterSacramentoCalifornia
| | - Joshua G. Cohen
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyUniversity of California Los AngelesLos AngelesCalifornia
- University of California Los Angeles Jonsson Comprehensive Cancer CenterLos AngelesCalifornia
| | - Emad Elquza
- University of California Irvine Chao Family Comprehensive Cancer CenterOrangeCalifornia
| | - Kathryn A. Gold
- University of California San Diego Moores Cancer CenterSan DiegoCalifornia
| | - Emi Kamiya
- University of California HealthLos AngelesCalifornia
| | - Beth Y. Karlan
- Division of Gynecologic OncologyDepartment of Obstetrics and GynecologyUniversity of California Los AngelesLos AngelesCalifornia
- University of California Los Angeles Jonsson Comprehensive Cancer CenterLos AngelesCalifornia
| | - Rana R. McKay
- University of California San Diego Moores Cancer CenterSan DiegoCalifornia
| | - Sandip P. Patel
- University of California San Diego Moores Cancer CenterSan DiegoCalifornia
| | | | - Jeanna Welborn
- University of California Davis Comprehensive Cancer CenterSacramentoCalifornia
| | - Maki Yamamoto
- University of California Irvine Chao Family Comprehensive Cancer CenterOrangeCalifornia
| | - Hope S. Rugo
- Division of Medical OncologyDepartment of MedicineUniversity of California San FranciscoSan FranciscoCalifornia
- University of California San Francisco Helen Diller Family Comprehensive Cancer CenterSan FranciscoCalifornia
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Milki AA, Cohen JG, Kaur Mann A, Kapp DS, Chan JK. Publication of oral and video presentations from the Society of Gynecologic Oncology annual meeting over 11 years - What characteristics were important? Gynecol Oncol Rep 2020; 35:100688. [PMID: 33385054 PMCID: PMC7771100 DOI: 10.1016/j.gore.2020.100688] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/09/2020] [Accepted: 12/13/2020] [Indexed: 11/17/2022] Open
Abstract
From 2006 to 2016, over 85% of SGO annual meeting oral plenaries were published. Surgical videos had a publication rate of only 41%. Multicenter, international and cohort studies were predictive of publication. Among published content, cancer genetics was the most commonly covered topic. Gynecologic Oncology was the most frequent publisher of conference research.
The goal of this study was to determine the characteristics associated with publication of oral and video presentations presented at the Society of Gynecologic Oncology annual meetings. Abstracts were reviewed using publication booklets from 2006 to 2016. PubMed and internet searches were used to determine publication status. Chi-squared test, Fisher's exact test, and logistic regression were used for statistical analyses. Of 585 oral plenary sessions, 502 (85.8%) led to publications in peer-reviewed journals. The majority (75.7%) of presentations were clinical rather than translational (24.3%). Compared to single institution studies, multicenter presentations led to a higher publication rate (89.9% 80.5%; p = 0.001). Randomized controlled trials and cohort studies had publication rates of over 90%, while chart reviews and translational research were published at a rate of 87.1% and 80%, respectively (p = 0.004). 41.4% of all publications were in the specialty journal Gynecologic Oncology. Of 56 surgical videos, 23 (41.1%) advanced to publication in either peer-reviewed journals or as online videos: 32.1% were in print media, 5.4% were posted as accessible online videos (YouTube, Google Video, university websites). On multivariate analysis of oral presentations, multicenter studies (OR: 1.95; 95% CI: 1.15–3.31; p = 0.01), cohort studies (OR: 3.13; 95% CI: 1.30–7.58; p = 0.01), and international studies (OR: 4.02; 95% CI: 1.20–13.40; p = 0.02) were most likely to be published. Over 11 Society of Gynecologic Oncology annual meetings, >85% of oral plenary sessions led to peer-reviewed publication and 41% of surgical videos were published or accessible online. Multicenter, international, and cohort studies were more likely to be published.
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Affiliation(s)
- Anthony A. Milki
- The George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Joshua G. Cohen
- Department of Obstetrics and Gynecology, UCLA Medical Center, Los Angeles, CA, United States
| | - Amandeep Kaur Mann
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, United States
| | - Daniel S. Kapp
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, United States
| | - John K. Chan
- California Pacific Medical Center, San Francisco, CA, United States
- Corresponding author: John K. Chan, M.D.Director, Gynecologic Oncology, Denise & Prentis Cobb Hale Endowed Chair, California Pacific Medical Center, Palo Alto Medical Foundation, Sutter Cancer Research Consortium, 1100 Van Ness Ave. 4th floor, San Francisco, CA 94109, United States. Phone: (415) 600-0930.
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16
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Manrriquez E, Mandelbaum A, Aguayo E, Zakhour M, Karlan B, Benharash P, Cohen JG. Factors associated with high-cost hospitalizations in elderly ovarian cancer patients. Gynecol Oncol 2020; 159:767-772. [PMID: 32980126 PMCID: PMC7771656 DOI: 10.1016/j.ygyno.2020.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/13/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To characterize factors associated with high-cost inpatient admissions for ovarian cancer. METHODS Operative hospitalizations for ovarian cancer patients ≥65 years of age were identified using the 2010-2017 National Inpatient Sample. Admissions with high-cost were defined as those incurring ≥90th percentile of hospitalization costs each year, while the remainder were considered low-cost. Multivariable logistic regression models were developed to assess independent predictors of being in the high-cost cohort. RESULTS During the study period, an estimated 58,454 patients met inclusion criteria. 5827 patient admissions (9.98%) were classified as high-cost. Median hospitalization cost for this high-cost group was $55,447 (interquartile range (IQR) $46,744-$74,015) compared to $16,464 (IQR $11,845-$23,286, p < 0.001) for the low-cost group. Patients with high-cost admissions were more likely to have received open (adjusted odds ratio (AOR) 2.23, 1.31-3.79) or extended (AOR 5.64, 4.79-6.66) procedures and be admitted non-electively (AOR 3.32, 2.74-4.02). Being in the top income quartile (AOR 1.77, 1.39-2.27) was also associated with high-cost. Age and hospital factors, including bed size and volume of gynecologic oncology surgery, did not affect cost group. CONCLUSION High-cost ovarian cancer admissions were three times more expensive than low-cost admissions. Fewer open and extended procedures with subsequently shorter lengths of stay may have contributed to decreasing inpatient costs over the study period. In this cohort of patients largely covered by Medicare, clinical factors outweigh socioeconomic factors as cost drivers. Understanding the relationship of disease-specific and social factors to cost will be important in informing future value-based quality improvement efforts in gynecologic cancer care.
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Affiliation(s)
- Erica Manrriquez
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, United States of America
| | - Ava Mandelbaum
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, United States of America
| | - Esteban Aguayo
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, United States of America
| | - Mae Zakhour
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, United States of America
| | - Beth Karlan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, United States of America
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, United States of America
| | - Joshua G Cohen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, United States of America.
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Kang Y, Kim TH, Gjertson DW, Cohen JG, Memarzadeh S, Moatamed NA. The uterine pathological features associated with sentinel lymph node metastasis in endometrial carcinomas. PLoS One 2020; 15:e0242772. [PMID: 33232380 PMCID: PMC7685478 DOI: 10.1371/journal.pone.0242772] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 11/09/2020] [Indexed: 11/19/2022] Open
Abstract
Background In recent years, sentinel lymph node excision and ultrastaging have been performed in endometrial carcinomas to obtain information about lymph node status, avoiding unnecessary complete pelvic and paraaortic lymphadenectomy. The purpose of this retrospective study was to provide a comprehensive evaluation of the pathological features of endometrial carcinomas and their significance in association with sentinel lymph node involvement. Methods Patients with endometrial carcinomas, preceded by sentinel lymph node mapping, were classified into Group-I and Group-II with negative and positive involvement, respectively. The pathological features, associated with sentinel lymph node involvement, were statistically analyzed, including determination of test performance parameters. Results Among 70 patients who had undergone hysterectomy and sentinel lymph node excision, 61 had carcinoma and 9 had atypical hyperplasia. There were 50 patients in Group-I and 10 in Group-II. In Group-II, the significant pathological features were: 1) lower uterine segment involvement (100%), 2) an average tumor size of ≥5 CM, 3) lymphovascular invasion (50%), 4) cervical stromal invasion (40%), and 5) depth of myometrial invasion of ≥50% (50%). The incidences of these pathological features were significantly less in Group-I. Statistical analyses singled out “lower uterine segment involvement” as the most important feature. Conclusions We have identified five pathological features which are associated with sentinel lymph node involvement. Since lower uterine segment involvement has occurred in all cases of the Group-II cohort, we recommend FIGO and other organizations that determine staging rules should consider whether tumors that involve the lower uterine segment should be staged as higher than “1a”, if the findings in this small series are confirmed by other studies. The results of this study may guide pathologists and oncologists in the diagnostic and therapeutic approaches to management of endometrial carcinomas.
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Affiliation(s)
- Yuna Kang
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Teresa H. Kim
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - David W. Gjertson
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
- Department of Biostatistics, Fielding School of Public Health at UCLA, Los Angeles, California, United States of America
| | - Joshua G. Cohen
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Sanaz Memarzadeh
- Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
| | - Neda A. Moatamed
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States of America
- * E-mail:
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Wong DH, Manrriquez EN, Aryasomayajula C, Cohen JG. Feasibility of incorporating a mobile application into clinical care for patients with ovarian cancer. Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.07.092] [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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Mardock AL, Rudasill SE, Lai TS, Sanaiha Y, Wong DH, Sinno AK, Benharash P, Cohen JG. Readmissions after ovarian cancer cytoreduction surgery: The first 30 days and beyond. J Surg Oncol 2020; 122:1199-1206. [PMID: 32700323 DOI: 10.1002/jso.26137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/13/2020] [Accepted: 07/13/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Postoperative readmissions are often used to assess quality of surgical care. This study compared 30-day vs 31- to 90-day readmission following surgery for ovarian, fallopian tube, or primary peritoneal cancer. METHODS This retrospective study of the 2010-2015 Nationwide Readmissions Database characterized 90-day readmissions following cytoreductive surgery for these cancers. Each patient's first postoperative hospitalization was included. Univariate analysis compared patient demographics and reasons for readmission. Multivariable regression identified independent predictors of readmission. RESULTS Of an estimated 76 652 patients, 10 264 (13.4%) were readmitted within 30 days, and 6942 (9.1%) between 31 and 90 days. The 30-day readmissions were more frequently associated with postoperative infection, while 31- to 90-day readmissions were more frequently associated with renal or hematologic diagnoses. Predictors of any 90-day readmission included index hospitalization longer than 7 days (adjusted odds ratio (AOR) 1.61 [1.48-1.75], P < .001), extended surgical procedure (AOR 1.41 [1.30-1.53], P < .001), pulmonary circulation disorder (AOR = 1.34 [1.13-1.60], P = .001), and diabetes mellitus (AOR = 1.12 [1.02-1.24], P = .020). CONCLUSIONS Readmission rates remain high during the 31- to 90-day postoperative period in ovarian cancer patients, although these readmissions are less frequently related to postoperative complications. Prospective study is merited to optimize surveillance beyond the initial 30 days after ovarian cancer surgery.
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Affiliation(s)
- Alexandra L Mardock
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, Division of Cardiac Surgery, University of California, Los Angeles, California
| | - Sarah E Rudasill
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, Division of Cardiac Surgery, University of California, Los Angeles, California
| | - Tiffany S Lai
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of California, Los Angeles, California
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, Division of Cardiac Surgery, University of California, Los Angeles, California
| | - Deanna H Wong
- David Geffen School of Medicine, University of California, Los Angeles, California
| | - Abdulrahman K Sinno
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Miami, Miami, Florida
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, Division of Cardiac Surgery, University of California, Los Angeles, California
| | - Joshua G Cohen
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of California, Los Angeles, California
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Chung SH, Woldenberg N, Roth AR, Masamed R, Conlon W, Cohen JG, Joines MM, Patel MK. BRCA and Beyond: Comprehensive Image-rich Review of Hereditary Breast and Gynecologic Cancer Syndromes. Radiographics 2020; 40:306-325. [DOI: 10.1148/rg.2020190084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Stephanie Histed Chung
- From the Departments of Radiology (S.H.C., R.M., M.M.J., M.K.P.), Clinical Genetics (W.C.), and Obstetrics and Gynecology (J.G.C.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, Calif; Hoag Hospital, Newport Harbor Radiology Associates, Newport Beach, Calif (N.W.); and Department of Radiology, Olive View–UCLA Medical Center, Sylmar, Calif (A.R.R.)
| | - Nina Woldenberg
- From the Departments of Radiology (S.H.C., R.M., M.M.J., M.K.P.), Clinical Genetics (W.C.), and Obstetrics and Gynecology (J.G.C.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, Calif; Hoag Hospital, Newport Harbor Radiology Associates, Newport Beach, Calif (N.W.); and Department of Radiology, Olive View–UCLA Medical Center, Sylmar, Calif (A.R.R.)
| | - Antoinette R. Roth
- From the Departments of Radiology (S.H.C., R.M., M.M.J., M.K.P.), Clinical Genetics (W.C.), and Obstetrics and Gynecology (J.G.C.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, Calif; Hoag Hospital, Newport Harbor Radiology Associates, Newport Beach, Calif (N.W.); and Department of Radiology, Olive View–UCLA Medical Center, Sylmar, Calif (A.R.R.)
| | - Rinat Masamed
- From the Departments of Radiology (S.H.C., R.M., M.M.J., M.K.P.), Clinical Genetics (W.C.), and Obstetrics and Gynecology (J.G.C.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, Calif; Hoag Hospital, Newport Harbor Radiology Associates, Newport Beach, Calif (N.W.); and Department of Radiology, Olive View–UCLA Medical Center, Sylmar, Calif (A.R.R.)
| | - Wendy Conlon
- From the Departments of Radiology (S.H.C., R.M., M.M.J., M.K.P.), Clinical Genetics (W.C.), and Obstetrics and Gynecology (J.G.C.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, Calif; Hoag Hospital, Newport Harbor Radiology Associates, Newport Beach, Calif (N.W.); and Department of Radiology, Olive View–UCLA Medical Center, Sylmar, Calif (A.R.R.)
| | - Joshua G. Cohen
- From the Departments of Radiology (S.H.C., R.M., M.M.J., M.K.P.), Clinical Genetics (W.C.), and Obstetrics and Gynecology (J.G.C.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, Calif; Hoag Hospital, Newport Harbor Radiology Associates, Newport Beach, Calif (N.W.); and Department of Radiology, Olive View–UCLA Medical Center, Sylmar, Calif (A.R.R.)
| | - Melissa M. Joines
- From the Departments of Radiology (S.H.C., R.M., M.M.J., M.K.P.), Clinical Genetics (W.C.), and Obstetrics and Gynecology (J.G.C.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, Calif; Hoag Hospital, Newport Harbor Radiology Associates, Newport Beach, Calif (N.W.); and Department of Radiology, Olive View–UCLA Medical Center, Sylmar, Calif (A.R.R.)
| | - Maitraya K. Patel
- From the Departments of Radiology (S.H.C., R.M., M.M.J., M.K.P.), Clinical Genetics (W.C.), and Obstetrics and Gynecology (J.G.C.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, Calif; Hoag Hospital, Newport Harbor Radiology Associates, Newport Beach, Calif (N.W.); and Department of Radiology, Olive View–UCLA Medical Center, Sylmar, Calif (A.R.R.)
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Kim JS, Liang MI, Prendergast EN, Alldredge J, Datta A, Hurteau JA, Kirschner CV, Rodriguez G, Vogel TJ, Brooks RA, Cass I, Cohen JG, Penner KR, Wang CE, Diaz Moore ES. Clinical outcomes in ovarian cancer patients receiving three versus more cycles of chemotherapy after neoadjuvant treatment and interval cytoreductive surgery. Int J Gynecol Cancer 2019; 29:1156-1163. [PMID: 31352365 DOI: 10.1136/ijgc-2019-000374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES To compare clinical outcomes for stage IIIC and IV ovarian cancer patients receiving neoadjuvant chemotherapy and interval cytoreductive surgery followed by up to three versus more cycles of post-operative chemotherapy. METHODS We conducted a multi-institution retrospective cohort study of patients treated from January 2005 to February 2016 with neoadjuvant platinum-based therapy followed by interval surgery and post-operative chemotherapy. The following were exclusion criteria: more than four cycles of neoadjuvant chemotherapy, bevacizumab with neoadjuvant chemotherapy, non-platinum therapy, prior chemotherapy, and elevated CA125 values after three post-operative chemotherapy cycles. Progression-free and overall survival and toxicity profiles were compared between groups receiving up to three cycles versus more that three cycles post-operatively. RESULTS A total of 100 patients met inclusion criteria: 41 received up to three cycles and 59 received more than three cycles. The groups were similar in terms of age, body mass index, performance status, tumor histology, optimal cytoreduction rates, and median number of neoadjuvant chemotherapy cycles. Median progression-free survival was 14 vs 16.6 months in those receiving up to three cycles versus more than three cycles, respectively (HR 0.99, 95% CI 0.58 to 1.68, p=0.97). Similarly, median overall survival was not different at 47.1 vs 69.4 months, respectively (HR 1.96, 95% CI 0.87 to 4.42, p=0.10). There were no differences in grade 2 or higher chemotherapy-related toxicities. CONCLUSIONS Extending post-operative chemotherapy beyond three cycles in patients receiving neoadjuvant chemotherapy and interval cytoreductive surgery with normalization of CA125 levels was not associated with improved survival or greater toxicity. Future study in a larger cohort is warranted to define optimal length of cytotoxic treatment.
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Affiliation(s)
- Josephine S Kim
- Section of Gynecologic Oncology, University of Chicago Medicine, Chicago, Illinois, USA .,Division of Gynecologic Oncology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Margaret I Liang
- Division of Gynecologic Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Division of Gynecologic Oncology, University of California Los Angeles, Los Angeles, California, USA
| | - Emily N Prendergast
- Division of Gynecologic Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA.,Division of Gynecologic Oncology, University of California Los Angeles, Los Angeles, California, USA
| | - Jill Alldredge
- Division of Gynecologic Oncology, University of California Irvine, Orange, California, USA
| | - Avisek Datta
- Department of Biostatistics and Research Informatics, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Jean A Hurteau
- Division of Gynecologic Oncology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Carolyn V Kirschner
- Division of Gynecologic Oncology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Gustavo Rodriguez
- Division of Gynecologic Oncology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Tilley J Vogel
- Division of Gynecologic Oncology, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Rebecca A Brooks
- Section of Gynecologic Oncology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Ilana Cass
- Division of Gynecologic Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Joshua G Cohen
- Division of Gynecologic Oncology, University of California Los Angeles, Los Angeles, California, USA
| | - Kristine R Penner
- Division of Gynecologic Oncology, University of California Irvine, Orange, California, USA
| | - Chi E Wang
- Department of Biostatistics and Research Informatics, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Elena S Diaz Moore
- Division of Gynecologic Oncology, NorthShore University HealthSystem, Evanston, Illinois, USA
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22
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Liang MI, Prendergast EN, Staples JN, Holschneider CH, Cohen JG, Cass I. Prognostic role of pathologic response and cytoreductive status at interval debulking surgery after neoadjuvant chemotherapy for advanced epithelial ovarian cancer. J Surg Oncol 2019; 120:779-785. [PMID: 31283034 DOI: 10.1002/jso.25612] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 06/16/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND We sought to determine if complete pathologic response (cPR) and cytoreductive status at interval debulking surgery (IDS) after neoadjuvant chemotherapy (NACT) are associated with improved clinical outcomes in ovarian cancer. METHODS We evaluated 91 patients with advanced ovarian cancer who underwent NACT and IDS. Pathologic response, cytoreductive status, and outcomes were determined. Descriptive statistics, bivariate analysis, and Kaplan-Meier survival probabilities were calculated. RESULTS cPR occurred in 9 (10%), microscopic pathologic response (microPR) in 18 (20%), and macroscopic pathologic response (macroPR) in 64 (70%) patients. Median progression-free survival (PFS) for patients with cPR was significantly improved compared with patients with any pathologic residual disease (microPR/macroPR; undefined vs 10.9 months, P = .01); whereas, microPR was not associated with significantly improved PFS compared with macroPR (16.3 months vs 10 months, P = .08). Cytoreduction to no gross residual disease was associated with improved PFS (undefined vs 7.5 months vs 5.5 months, P < .01) and overall survival (undefined vs 38.7 months vs 12 months, P < .01) compared with visible residual disease less than or equal to 1 cm or suboptimal. CONCLUSIONS cPR is uncommon (10%) after NACT for advanced ovarian cancer. Better pathologic response and cytoreductive status are associated with improved PFS, emphasizing the importance of both chemotherapy response and surgical effort.
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Affiliation(s)
- Margaret I Liang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California.,Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California Los Angeles Medical Center, Los Angeles, California.,Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Olive View Hospital-University of California Los Angeles Medical Center, Sylmar, California
| | - Emily N Prendergast
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California.,Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California Los Angeles Medical Center, Los Angeles, California.,Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Olive View Hospital-University of California Los Angeles Medical Center, Sylmar, California
| | - Jeanine N Staples
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Christine H Holschneider
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Olive View Hospital-University of California Los Angeles Medical Center, Sylmar, California
| | - Joshua G Cohen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California Los Angeles Medical Center, Los Angeles, California
| | - Ilana Cass
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California
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23
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Kaufman M, Cruz A, Thompson J, Reddy S, Bansal N, Cohen JG, Wu Y, Vadgama J, Farias-Eisner R. A review of the effects of healthcare disparities on the experience and survival of ovarian cancer patients of different racial and ethnic backgrounds. ACTA ACUST UNITED AC 2019; 5. [PMID: 31236478 PMCID: PMC6590085 DOI: 10.20517/2394-4722.2018.25] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Ovarian cancer (OC) is a serious condition that often presents at advanced stages and has high mortality rates, with the current mode of early-stage screening lacking sensitivity and specificity. OC often presents asymptomatically, which renders early diagnosis difficult. Furthermore, many patients lack significant risk factors or family history of the disease. Five-year survival rates differ between patients with OC among racial, ethnic, and social groups as a result of different social barriers. This review article aims to present the currently existing data regarding health care disparities among OC patients of different ethnic, demographic, and socioeconomic backgrounds, and what next steps should be taken to better understand and eventually eliminate these potentially devastating health care disparities. Increasing data support the notion that a combination of genomic, socioeconomic status, social factors, and cultural differences lead to differential treatments and therefore health care disparities. While genomic and biological factors are important, language barriers, geographic and travel barriers, differences in comorbidity likelihood between populations, and different treatment plans seem to have a greater impact on 5-year survival rates of patients from diverse backgrounds. Language barriers limit a shared-decision model of care. Transportation limitations and geographic differences can lead to limited follow-up and insufficient care in resource and equipment restrictive settings. Patients with these barriers also tend to have a higher incidence of comorbidities that raise the mortality rate of OC. Further research needs to explore effective solutions to bridge health care disparities and understand why they occur.
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Affiliation(s)
- Matthew Kaufman
- Obstetrics and Gynecology, University of California, Los Angeles, CA 90024, USA
| | - Ana Cruz
- Obstetrics and Gynecology, University of California, Los Angeles, CA 90024, USA
| | - Janese Thompson
- School of Medicine, Meharry Medical College, Nashville, TN 37208, USA
| | - Srinivasa Reddy
- Obstetrics and Gynecology, University of California, Los Angeles, CA 90024, USA
| | - Nisha Bansal
- Obstetrics and Gynecology, University of California, Los Angeles, CA 90024, USA
| | - Joshua G Cohen
- Obstetrics and Gynecology, University of California, Los Angeles, CA 90024, USA
| | - Yanyuan Wu
- Internal Medicine, Charles Drew University, Los Angeles, CA 90059, USA
| | - Jay Vadgama
- Internal Medicine, Charles Drew University, Los Angeles, CA 90059, USA
| | - Robin Farias-Eisner
- Obstetrics and Gynecology, University of California, Los Angeles, CA 90024, USA
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24
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Cohen JG, Reymond E, Medici M, Lederlin M, Lantuejoul S, Laurent F, Toffart AC, Moreau-Gaudry A, Jankowski A, Ferretti GR. CT-texture analysis of subsolid nodules for differentiating invasive from in-situ and minimally invasive lung adenocarcinoma subtypes. Diagn Interv Imaging 2018; 99:291-299. [PMID: 29477490 DOI: 10.1016/j.diii.2017.12.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 12/11/2017] [Accepted: 12/21/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the usefulness of computed tomography-texture analysis (CTTA) in differentiating between in-situ and minimally-invasive from invasive adenocarcinomas in subsolid lung nodules (SSLNs). MATERIAL AND METHODS Two radiologists retrospectively reviewed 49 SSLNs in 44 patients. There were 27 men and 17 women with a mean age of 63±7 (SD) years (range: 47-78years). For each SSLN, type (pure ground-glass or part-solid) was assessed by consensus and CTTA was conducted independently by each observer using a filtration-histogram technique. Different filters were used before histogram quantification: no filtration, fine, medium and coarse, followed by histogram quantification using mean intensity, standard deviation (SD), entropy, mean positive pixels (MPP), skewness and kurtosis. RESULTS We analyzed 13 pure ground-glass and 36 part-solid nodules corresponding to 16 adenocarcinomas in-situ (AIS), 5 minimally invasive adenocarcinomas (MIA) and 28 invasive adenocarcinomas (IVA). At uni- and multivariate analysis CTTA allowed discriminating between IVAs and AIS/MIA (P<0.05 and P=0.025, respectively) with the following histogram parameters: skewness using fine textures and kurtosis using coarse filtration for pure ground-glass nodules, and SD without filtration for part-solid nodules. CONCLUSION CTTA has the potential to differentiate AIS and MIA from IVA among SSLNs. However, our results require further validation on a larger cohort.
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Affiliation(s)
- J G Cohen
- Radiology department, Grenoble Alpes University Teaching Hospital, CS 10217, 38043 Grenoble cedex 9, France.
| | - E Reymond
- Radiology department, Grenoble Alpes University Teaching Hospital, CS 10217, 38043 Grenoble cedex 9, France
| | - M Medici
- Clinical Investigation Center for Innovative Technology (CICIT), Grenoble Alpes University Teaching Hospital, CS 10217, 38043 Grenoble cedex 9, France
| | - M Lederlin
- Department of Medical Imaging, Haut-Lévêque Teaching Hospital, 33000 Bordeaux, France
| | - S Lantuejoul
- Pathology department, Grenoble Alpes University Teaching Hospital, CS 10217, 38043 Grenoble cedex 9, France; INSERM research unit 823, Albert Bonniot Institute, 38700 La Tronche, France
| | - F Laurent
- Department of Medical Imaging, Haut-Lévêque Teaching Hospital, 33000 Bordeaux, France
| | - A C Toffart
- INSERM research unit 823, Albert Bonniot Institute, 38700 La Tronche, France; Pneumology department, Grenoble Alpes University Teaching Hospital, CS 10217, 38043 Grenoble cedex 9, France
| | - A Moreau-Gaudry
- Clinical Investigation Center for Innovative Technology (CICIT), Grenoble Alpes University Teaching Hospital, CS 10217, 38043 Grenoble cedex 9, France
| | - A Jankowski
- Radiology department, Grenoble Alpes University Teaching Hospital, CS 10217, 38043 Grenoble cedex 9, France
| | - G R Ferretti
- Radiology department, Grenoble Alpes University Teaching Hospital, CS 10217, 38043 Grenoble cedex 9, France; Pneumology department, Grenoble Alpes University Teaching Hospital, CS 10217, 38043 Grenoble cedex 9, France
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25
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Rouch JD, Li A, Cohen JG, Kazanjian KK, Festekjian JH. Re-exploration of vertical rectus abdominis myocutaneous flap for vaginal reconstruction: Case report and review of the literature. JPRAS Open 2017; 15:32-35. [PMID: 32158795 PMCID: PMC7061550 DOI: 10.1016/j.jpra.2017.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 08/23/2017] [Indexed: 10/28/2022] Open
Abstract
The vertical rectus abdominis myocutaneous (VRAM) flap is a versatile and well-established reconstructive technique for many defects created as a result of colorectal and gynecologic extirpation. However, major re-operation in the pelvis following a VRAM flap reconstruction several months later is uncommon, and the safety and integrity of the VRAM flap in this setting has not been described. This case examines VRAM flap preservation during repeat exploratory laparotomy, and a unique view of the VRAM flap during interval exploration. We demonstrate an intact flap after lysis of adhesions with an audible Doppler signal, and maintenance of flap integrity in the postoperative period. This further substantiates its use as a durable rotational flap for perineal tissue defects.
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Affiliation(s)
- Joshua D Rouch
- Division of Plastic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
| | - Andrew Li
- Division of Plastic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
| | - Joshua G Cohen
- Division of Gynecological Oncology, Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Kevork K Kazanjian
- Division of Colon and Rectal Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Jaco H Festekjian
- Division of Plastic Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
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26
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Liang MI, Wong DH, Walsh CS, Farias-Eisner R, Cohen JG. Cancer Genetic Counseling and Testing: Perspectives of Epithelial Ovarian Cancer Patients and Gynecologic Oncology Healthcare Providers. J Genet Couns 2017; 27:177-186. [PMID: 28785836 DOI: 10.1007/s10897-017-0135-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 07/18/2017] [Indexed: 01/07/2023]
Abstract
Multi-gene panel testing has expanded the genetic information available to cancer patients. The objective was to assess provider behaviors and attitudes and patient knowledge and attitudes towards genetic counseling and testing. An online survey was distributed to Society of Gynecologic Oncology members and a written questionnaire was administered to patients diagnosed with epithelial ovarian cancer at a tertiary care referral center. Most of the 233 (18% response rate) provider respondents were gynecologic oncologists. Access to a genetic counselor was reported by 87% of providers and 55% deferred all testing to genetic counselors. Of 53 ovarian cancer patient respondents, two-thirds had previously seen a genetic counselor or undergone testing. Patients' attitudes about genetic counseling and/or testing were favorable with respect to themselves (70-81%) and their family members (94%). Less than 25% of patients indicated worrying about health care discrimination, lack of privacy, or high cost. Seventy-seven percent of patients demonstrated a desire to obtain genetic information even if the results were not currently actionable, and 20% of providers stated they test for only those genes with guideline-supported actionable results. Provider practice differences were identified in screening and prevention strategies for patients with deleterious non-BRCA mutations and variants of uncertain significance. The variation in clinical interpretation of results associated with poorly defined cancer risks signals a need for more comprehensive training and guidelines to ensure access to evidence-based care.
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Affiliation(s)
- Margaret I Liang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California Los Angeles, 10833 Le Conte Avenue, CHS Room 27-139, Los Angeles, CA, 90095, USA.,Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Deanna H Wong
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California Los Angeles, 10833 Le Conte Avenue, CHS Room 27-139, Los Angeles, CA, 90095, USA
| | - Christine S Walsh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Robin Farias-Eisner
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California Los Angeles, 10833 Le Conte Avenue, CHS Room 27-139, Los Angeles, CA, 90095, USA
| | - Joshua G Cohen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California Los Angeles, 10833 Le Conte Avenue, CHS Room 27-139, Los Angeles, CA, 90095, USA.
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27
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Cohen JG, Prendergast E, Geddings JE, Walts AE, Agadjanian H, Hisada Y, Karlan BY, Mackman N, Walsh CS. Evaluation of venous thrombosis and tissue factor in epithelial ovarian cancer. Gynecol Oncol 2017; 146:146-152. [PMID: 28501328 DOI: 10.1016/j.ygyno.2017.04.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [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: 01/17/2017] [Revised: 04/25/2017] [Accepted: 04/27/2017] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Ovarian clear cell carcinoma (OCCC) and high grade serous ovarian cancer (HGSOC) are associated with the highest risk of VTE among patients with epithelial ovarian cancer (EOC). Tissue factor (TF) is a transmembrane glycoprotein which can trigger thrombosis. We sought to evaluate if there is an association between VTE and tumor expression of tissue factor (TF), plasma TF, and microvesicle TF (MV TF) activity in this high-risk population. METHODS We performed a case-control study of OCCC and HGSOC patients with and without VTE. 105 patients who underwent surgery at a tertiary care center between January 1995 and October 2013 were included. Plasma TF was measured with an enzyme-linked immunosorbent assay. A TF-dependent Factor Xa generation assay was used to measure MV TF activity. Immunohistochemical (IHC) analysis was performed to evaluate tumor expression of TF. RESULTS 35 women with OCCC or HGSOC diagnosed with VTE within 9months of surgery were included in the case group. Those with VTE had a worse OS, p<0.0001, with a greater than three-fold increase in risk of death, HR 3.33 (CI 1.75-6.35). There was no significant difference in median plasma TF level or MV TF activity level between patients with and without VTE. OCCC patients had greater expression of TF in their tumors than patients with HGSOC, p<0.0001. CONCLUSIONS TFMV activity and plasma TF level were not predictive of VTE in this patient population. Given the extensive expression of TF in OCCC tumors, it is unlikely IHC expression will be useful in risk stratification for VTE in this population.
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Affiliation(s)
- Joshua G Cohen
- Division of Gynecologic Oncology, University of California, Los Angeles, 200 Medical Plaza, Suite 220, Los Angeles, CA 90095, USA
| | - Emily Prendergast
- Division of Gynecologic Oncology, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 280W, Los Angeles, CA 90048, USA
| | - Julia E Geddings
- Division of Hematology/Oncology, University of North Carolina, Chapel Hill, 2312 MBRB, 111 Mason Farm Rd, CB#7126, Chapel Hill, NC 27599, USA
| | - Ann E Walts
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA
| | - Hasmik Agadjanian
- Division of Gynecologic Oncology, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 280W, Los Angeles, CA 90048, USA
| | - Yohei Hisada
- Division of Hematology/Oncology, University of North Carolina, Chapel Hill, 2312 MBRB, 111 Mason Farm Rd, CB#7126, Chapel Hill, NC 27599, USA; K.G. Jebsen TREC, The Faculty of Health Sciences, UiT- The Arctic University of Tromsø, 9037 Tromsø, Norway
| | - Beth Y Karlan
- Division of Gynecologic Oncology, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 280W, Los Angeles, CA 90048, USA
| | - Nigel Mackman
- Division of Hematology/Oncology, University of North Carolina, Chapel Hill, 2312 MBRB, 111 Mason Farm Rd, CB#7126, Chapel Hill, NC 27599, USA; K.G. Jebsen TREC, The Faculty of Health Sciences, UiT- The Arctic University of Tromsø, 9037 Tromsø, Norway
| | - Christine S Walsh
- Division of Gynecologic Oncology, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 280W, Los Angeles, CA 90048, USA.
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28
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Zakhour M, Cohen JG, Gibson A, Walts AE, Karimian B, Baltayan A, Aoyama C, Garcia L, Dhaliwal SK, Elashoff D, Amneus M, Walsh C. Abnormal mismatch repair and other clinicopathologic predictors of poor response to progestin treatment in young women with endometrial complex atypical hyperplasia and well-differentiated endometrial adenocarcinoma: a consecutive case series. BJOG 2017; 124:1576-1583. [PMID: 28128512 DOI: 10.1111/1471-0528.14491] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To report the response to progestin therapy in young women with endometrial complex atypical hyperplasia (CAH) or FIGO grade 1 endometrial adenocarcinoma (FIGO 1 EAC) based on clinicopathologic features, including abnormal DNA mismatch repair (MMR) by immunohistochemistry (IHC). DESIGN Consecutive case series. SETTING Olive View-UCLA Medical Center in Sylmar, CA, USA, and Cedars-Sinai Medical Center in Los Angeles, CA, USA. POPULATION Women ≤55 years old with CAH or FIGO 1 EAC. METHODS Response to progestin therapy in 84 consecutive patients was assessed based on clinicopathologic factors, including age, body mass index (BMI), initial histology, and IHC staining for MMR proteins. MAIN OUTCOME MEASURES Rates of abnormal MMR protein expression and response to progestin therapy were determined. RESULTS Six (7%) patients had abnormal IHC staining, of whom five (83%) had FIGO 1 EAC at initial diagnosis. Following progestin treatment, none of the endometrial lesions in patients with abnormal IHC for MMR proteins had resolution of hyperplasia or malignancy, in contrast to 41 (53%) with normal staining (P = 0.028). Age ≤40 years and initial lesion (CAH versus FIGO 1 EAC) were predictors of response to progestin; BMI was not. CONCLUSIONS In this cohort, 7% of women ≤55 years of age with CAH or FIGO 1 EAC had loss of MMR proteins by IHC. These patients had a higher incidence of invasive cancer and a lower incidence of resolution with progestin therapy. TWEETABLE ABSTRACT Abnormal MMR protein expression predicts poor response to progestins in young women with CAH or FIGO 1 EAC.
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Affiliation(s)
- M Zakhour
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of California Los Angeles Medical Center, Los Angeles, CA, USA.,Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - J G Cohen
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | - A Gibson
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | - A E Walts
- Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - B Karimian
- Department of Pathology & Laboratory Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - A Baltayan
- Department of Pathology & Laboratory Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - C Aoyama
- Department of Pathology & Laboratory Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - L Garcia
- Department of Obstetrics & Gynecology, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - S K Dhaliwal
- Department of Medicine Statistics Core, University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | - D Elashoff
- Department of Medicine Statistics Core, University of California Los Angeles Medical Center, Los Angeles, CA, USA
| | - M Amneus
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - C Walsh
- Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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29
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Cohen JG, Reymond E, Jankowski A, Brambilla E, Arbib F, Lantuejoul S, Ferretti GR. Lung adenocarcinomas: correlation of computed tomography and pathology findings. Diagn Interv Imaging 2016; 97:955-963. [PMID: 27639313 DOI: 10.1016/j.diii.2016.06.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/29/2016] [Accepted: 06/30/2016] [Indexed: 12/13/2022]
Abstract
Adenocarcinoma is the most common histologic type of lung cancer. Recent lung adenocarcinoma classifications from the International Association for the Study of Lung cancer, the American Thoracic Society and the European Respiratory Society (IASLC/ETS/ERS, 2011) and World Health Organization (WHO, 2015) define a wide range of adenocarcinoma types and subtypes featuring different prognosis and management. This spectrum of lesions translates into various CT presentations and features, which generally show good correlation with histopathology, stressing the key role of the radiologist in the diagnosis and management of those patients. This review aims at helping radiologists to understand the basics of the up-to-date adenocarcinoma pathological classifications, radio-pathological correlations and how to use them in the clinical setting, as well as other imaging-related correlations (radiogenomics, quantitative analysis, PET-CT).
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Affiliation(s)
- J G Cohen
- Clinique universitaire de radiologie et imagerie médicale (CURIM), CHU A.-Michallon, BP 217, 38043 Grenoble cedex 9, France; Université Grenoble-Alpes, 38000 Grenoble, France.
| | - E Reymond
- Clinique universitaire de radiologie et imagerie médicale (CURIM), CHU A.-Michallon, BP 217, 38043 Grenoble cedex 9, France.
| | - A Jankowski
- Clinique universitaire de radiologie et imagerie médicale (CURIM), CHU A.-Michallon, BP 217, 38043 Grenoble cedex 9, France.
| | - E Brambilla
- Université Grenoble-Alpes, 38000 Grenoble, France; Département d'anatomo-cytologie pathologie (DACP), CHU A.-Michallon, 38043 Grenoble, France; Inserm U 823, institut A.-Bonniot, 38000 Grenoble, France.
| | - F Arbib
- Clinique universitaire de pneumologie, pôle d'oncologie, CHU A.-Michallon, 38043 Grenoble, France.
| | - S Lantuejoul
- Université Grenoble-Alpes, 38000 Grenoble, France; Département d'anatomo-cytologie pathologie (DACP), CHU A.-Michallon, 38043 Grenoble, France; Inserm U 823, institut A.-Bonniot, 38000 Grenoble, France.
| | - G R Ferretti
- Clinique universitaire de radiologie et imagerie médicale (CURIM), CHU A.-Michallon, BP 217, 38043 Grenoble cedex 9, France; Université Grenoble-Alpes, 38000 Grenoble, France; Département d'anatomo-cytologie pathologie (DACP), CHU A.-Michallon, 38043 Grenoble, France.
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Hodeib M, Cohen JG, Mehta S, Rimel B, Walsh CS, Li AJ, Karlan BY, Cass I. Recurrence and risk of progression to lower genital tract malignancy in women with high grade VAIN. Gynecol Oncol 2016; 141:507-510. [DOI: 10.1016/j.ygyno.2016.03.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 03/21/2016] [Accepted: 03/23/2016] [Indexed: 10/22/2022]
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Tran AQ, Cohen JG, Li AJ. Impact of obesity on secondary cytoreductive surgery and overall survival in women with recurrent ovarian cancer. Gynecol Oncol 2015; 138:263-6. [PMID: 26037901 DOI: 10.1016/j.ygyno.2015.05.035] [Citation(s) in RCA: 9] [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] [Received: 02/18/2015] [Revised: 05/27/2015] [Accepted: 05/28/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Obesity may negatively influence tumor biology in women with epithelial ovarian cancers. To date, only body mass indices (BMI) determined at the time of diagnosis have correlated with clinical outcome. We hypothesized that obesity negatively affects survival throughout the disease course, and sought to determine the prognostic role of BMI at the time of secondary cytoreductive surgery (SCS) for recurrent ovarian cancer. METHODS We performed a review of patients undergoing SCS for recurrent epithelial ovarian or peritoneal cancer between 1997 and 2012. We retrospectively reviewed data which were analyzed using Fisher's exact test, Kaplan-Meier survival, and Cox regression analysis. BMI was defined according to the National Institutes of Health's categorizations. RESULTS We identified 104 patients; 2 were underweight, 46 were of ideal body weight, 32 were overweight, and 24 were obese. Overall, 90 patients underwent optimal resection and BMI did not correlate with ability to perform optimal SCS (p=0.25). When examining BMI strata (underweight, ideal, overweight, and obese), we observed a statistical trend between increasing BMI and poor outcome; median survival was undetermined (greater than 50 months), 46 months, 38 months, and 34 months, respectively (p=0.04). In a multivariate analysis, BMI was an independent predictor of survival (p=0.02). CONCLUSIONS In this cohort of women undergoing SCS for recurrent ovarian cancer, BMI significantly and independently correlated with overall survival. This observation suggests an effect of excess weight on tumor biology and/or response to treatment that is prevalent throughout the disease course.
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Affiliation(s)
- Arthur-Quan Tran
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 280W, Los Angeles, CA 90048, USA
| | - Joshua G Cohen
- Division of Gynecologic Oncology, Women's Cancer Program, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 280W, Los Angeles, CA 90048, USA
| | - Andrew J Li
- Division of Gynecologic Oncology, Women's Cancer Program, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 280W, Los Angeles, CA 90048, USA.
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Chung CJ, Cohen JG, Zakhour M, Margulies D, Cass I. Post-Cesarean Delivery Necrotizing Fasciitis: Examination of the Uterus and Hysterotomy Site. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2014.0028] [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: 11/13/2022] Open
Affiliation(s)
- Connie J. Chung
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cedars–Sinai Medical Center, Los Angeles, CA
| | - Joshua G. Cohen
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cedars–Sinai Medical Center, Los Angeles, CA
| | - Mae Zakhour
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cedars–Sinai Medical Center, Los Angeles, CA
| | - Daniel Margulies
- Department of Surgery, Trauma Program, Cedars–Sinai Medical Center, Los Angeles, CA
| | - Ilana Cass
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cedars–Sinai Medical Center, Los Angeles, CA
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Cohen JG, White M, Cruz A, Farias-Eisner R. In 2014, can we do better than CA125 in the early detection of ovarian cancer? World J Biol Chem 2014; 5:286-300. [PMID: 25225597 PMCID: PMC4160523 DOI: 10.4331/wjbc.v5.i3.286] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 03/12/2014] [Accepted: 05/14/2014] [Indexed: 02/05/2023] Open
Abstract
Ovarian cancer is a lethal gynecologic malignancy with greater than 70% of women presenting with advanced stage disease. Despite new treatments, long term outcomes have not significantly changed in the past 30 years with the five-year overall survival remaining between 20% and 40% for stage III and IV disease. In contrast patients with stage I disease have a greater than 90% five-year overall survival. Detection of ovarian cancer at an early stage would likely have significant impact on mortality rate. Screening biomarkers discovered at the bench have not translated to success in clinical trials. Existing screening modalities have not demonstrated survival benefit in completed prospective trials. Advances in high throughput screening are making it possible to evaluate the development of ovarian cancer in ways never before imagined. Data in the form of human “-omes” including the proteome, genome, metabolome, and transcriptome are now available in various packaged forms. With the correct pooling of resources including prospective collection of patient specimens, integration of high throughput screening, and use of molecular heterogeneity in biomarker discovery, we are poised to make progress in ovarian cancer screening. This review will summarize current biomarkers, imaging, and multimodality screening strategies in the context of emerging technologies.
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Cohen JG, Tran AQ, Rimel BJ, Cass I, Walsh CS, Karlan BY, Li AJ. Thrombocytosis at secondary cytoreduction for recurrent ovarian cancer predicts suboptimal resection and poor survival. Gynecol Oncol 2014; 132:556-9. [PMID: 24423879 DOI: 10.1016/j.ygyno.2014.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 01/03/2014] [Accepted: 01/04/2014] [Indexed: 01/28/2023]
Abstract
OBJECTIVES A growing body of evidence supports a role for thrombocytosis in the promotion of epithelial ovarian cancer biology. However, studies have only linked preoperative platelet count at time of initial cytoreductive surgery to clinical outcome. Here, we sought to determine the impact of elevated platelet count at time of secondary cytoreductive surgery (SCS) for recurrent disease. METHODS Under an IRB-approved protocol, we identified 107 women with invasive epithelial ovarian cancer who underwent SCS between January 1997 and June 2012. We reviewed clinical, laboratory, and pathologic records from this retrospective cohort. The data was analyzed using the chi-squared, Fisher's exact, Cox proportional hazards, and Kaplan-Meier tests. We defined thrombocytosis as a platelet count ≥ 350 × 10(9)/L and optimal resection at SCS as microscopic residual disease. RESULTS Thirteen of 107 women (12%) with recurrent ovarian cancer had thrombocytosis prior to SCS. Preoperative thrombocytosis at SCS was associated with failure to undergo optimal resection (p=0.0001). Women with preoperative thrombocytosis at time of SCS demonstrated shorter overall survival (33 months) compared to those with normal platelet counts (46 months, p=0.004). On multivariate analysis, only preoperative platelet count retained significance as an independent prognostic factor (p=0.025) after controlling for age at SCS (p=0.90), disease free interval from primary treatment (0.06), and initial stage of disease (0.66). CONCLUSIONS Elevated platelet count at time of SCS is associated with suboptimal resection and shortened overall survival. These data provide further evidence supporting a plausible role for thrombocytosis in aggressive ovarian tumor biology.
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Affiliation(s)
- Joshua G Cohen
- Division of Gynecologic Oncology, Women's Cancer Program, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 280W, Los Angeles, CA 90048, USA
| | - Arthur-Quan Tran
- Division of Gynecologic Oncology, Women's Cancer Program, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 280W, Los Angeles, CA 90048, USA
| | - B J Rimel
- Division of Gynecologic Oncology, Women's Cancer Program, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 280W, Los Angeles, CA 90048, USA
| | - Ilana Cass
- Division of Gynecologic Oncology, Women's Cancer Program, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 280W, Los Angeles, CA 90048, USA
| | - Christine S Walsh
- Division of Gynecologic Oncology, Women's Cancer Program, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 280W, Los Angeles, CA 90048, USA
| | - Beth Y Karlan
- Division of Gynecologic Oncology, Women's Cancer Program, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 280W, Los Angeles, CA 90048, USA
| | - Andrew J Li
- Division of Gynecologic Oncology, Women's Cancer Program, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 280W, Los Angeles, CA 90048, USA.
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Cohen JG, Kiet T, Shin JY, Sherman AE, Hamilton CA, Brooks RA, Ueda SM, Chen LM, Kapp DS, Chan JK. Factors associated with publication of plenary presentations at the Society of Gynecologic Oncologists annual meeting. Gynecol Oncol 2012; 128:128-131. [PMID: 22892364 DOI: 10.1016/j.ygyno.2012.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 08/02/2012] [Accepted: 08/05/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the rate and factors associated with publication of plenary abstract presentations from the Society of Gynecologic Oncologists annual meeting. METHODS Plenary presentations were reviewed from 2000 to 2005. A PubMed search was performed to identify subsequent peer-reviewed publication of these presentations. Chi-squared test and logistic regression were used for statistical analyses. RESULTS Of 378 main, focused or express plenary presentations, 173 (45.8%) involved multiple and 205 (54.2%) single institutions. The types of study include: chart review (29.4%), cohort study (28.0%), translational (23.5%), and randomized clinical trial (6.9%). 309 (81.7%) of presentations were subsequently published. The median time from presentation to publication was 14months (range: 1-85). Studies from multiple vs. single institutions were more likely to be published (87.9% vs. 76.6%; p=0.005). In addition, randomized controlled trials were more likely to be published compared with chart review, cohort, and translation research (92.3% vs. 83.8%, 77.4%, and 74.2%; p<0.01). On multivariate analysis, multi-institutional studies (OR=2.28, 95% CI=1.28-4.04; p=0.005) and type of study (OR=1.64, 95% CI=1.19-2.26; p=0.002) were independent factors associated with publication. In addition, multi-institutional studies had longer times from presentation to publication compared with their counterparts. CONCLUSIONS A high percentage of plenary presentations at the Society of Gynecologic Oncologists annual meeting resulted in subsequent publication. Multi-institutional studies and randomized clinical trials were more likely to be published.
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Affiliation(s)
- Joshua G Cohen
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, & Reproductive Sciences, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 1600 Divisadero Street, San Francisco, CA 94143-1702, USA
| | - Tuyen Kiet
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, & Reproductive Sciences, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 1600 Divisadero Street, San Francisco, CA 94143-1702, USA
| | - Jacob Y Shin
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, & Reproductive Sciences, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 1600 Divisadero Street, San Francisco, CA 94143-1702, USA
| | - Alexander E Sherman
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, & Reproductive Sciences, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 1600 Divisadero Street, San Francisco, CA 94143-1702, USA
| | - Chad A Hamilton
- Gynecologic Oncology Service, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889-5600, USA
| | - Rebecca A Brooks
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, & Reproductive Sciences, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 1600 Divisadero Street, San Francisco, CA 94143-1702, USA
| | - Stefanie M Ueda
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, & Reproductive Sciences, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 1600 Divisadero Street, San Francisco, CA 94143-1702, USA
| | - Lee-May Chen
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, & Reproductive Sciences, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 1600 Divisadero Street, San Francisco, CA 94143-1702, USA
| | - Daniel S Kapp
- Department of Radiation Oncology, Stanford Cancer Center, Stanford University, 875 Blake Wilbur Drive, Stanford, CA 94305, USA
| | - John K Chan
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, & Reproductive Sciences, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 1600 Divisadero Street, San Francisco, CA 94143-1702, USA.
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Cohen JG, Sherman AE, Kiet TK, Kapp DS, Osann K, Chen LM, O'Sullivan PS, Chan JK. Characteristics of success in mentoring and research productivity - a case-control study of academic centers. Gynecol Oncol 2012; 125:8-13. [PMID: 22252098 DOI: 10.1016/j.ygyno.2012.01.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 12/08/2011] [Accepted: 01/08/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVES While mentoring has been associated with research productivity, the specific characteristics of successful mentoring have not been well studied. Thus, we performed a case-control study to identify characteristics of successful mentoring programs. METHODS Institutions were divided based on number of plenary research presentations at an annual society meeting over 6years. Case institutions (Group A) had more presentations vs. controls (Group B). A survey of professors and research fellows assessed characteristics of their mentoring program. Chi-square and logistic regression analyses were performed. RESULTS Of 159 surveyed, response rates were 46% for professors and 51% for fellows. Compared to Group B, Group A was more likely to have: an additional year of protected fellowship research training (62% vs. 24%; p=0.003), an established program to connect a mentor and mentee with similar research interests (52% vs. 27%; p=0.049), methods to provide feedback to mentors (62% vs. 29%; p=0.01), require mentee research progress reports (45% vs. 21%; p=0.047), and report ease of identifying a mentor (90% vs. 69%; p=0.046). On multivariate analyses, the additional year of research training (OR=7.53, 95% CI: 2.10-27.09; p=0.002) and ease at identifying a research mentor (OR=7.45, 95% CI: 1.44-38.6; p=0.017) remained as independent factors associated with higher research productivity. CONCLUSIONS Our data suggest that programs can enhance research productivity with the incorporation of accountability features including formalized reports of progress and mentorship feedback in fellowship training. Facilitating the identification of a mentor and providing an additional year of research may be independent factors associated with research productivity.
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Affiliation(s)
- Joshua G Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA 94143-1702, USA
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Cohen JG, Kapp DS, Shin JY, Urban R, Sherman AE, Chen LM, Osann K, Chan JK. Small cell carcinoma of the cervix: treatment and survival outcomes of 188 patients. Am J Obstet Gynecol 2010; 203:347.e1-6. [PMID: 20579961 DOI: 10.1016/j.ajog.2010.04.019] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 01/27/2010] [Accepted: 04/12/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine the clinicopathologic factors associated with survival in neuroendocrine small cell cervical cancer patients. STUDY DESIGN Patients were identified from a review of literature with an additional 52 patients from four hospitals. Kaplan-Meier and Cox regression methods were used for analyses. RESULTS Of 188 patients, 135 had stages I-IIA, 45 stages IIB-IVA, and 8 stage IVB disease. A total of 55.3% underwent surgery, 16.0% had chemoradiation, 12.8% radiation, and 3.2% chemotherapy alone. The 5-year disease-specific survival in stage I-IIA, IIB-IVA, and IVB disease was 36.8%, 9.8%, and 0%, respectively (P < .001). Adjuvant chemotherapy or chemoradiation was associated with improved survival in patients with stages IIB-IVA disease compared with those who did not receive chemotherapy (17.8% vs 6.0%; P = .04). On multivariable analysis, early-stage disease and use of chemotherapy or chemoradiation were independent prognostic factors for improved survival. CONCLUSION Use of adjuvant chemotherapy or chemoradiation was associated with higher survival in small cell cervical cancer patients.
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Worden B, Yang XP, Lee TL, Bagain L, Yeh NT, Cohen JG, Van Waes C, Chen Z. Hepatocyte growth factor/scatter factor differentially regulates expression of proangiogenic factors through Egr-1 in head and neck squamous cell carcinoma. Cancer Res 2005; 65:7071-80. [PMID: 16103054 DOI: 10.1158/0008-5472.can-04-0989] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hepatocyte growth factor/scatter factor (HGF) and the angiogenesis factors platelet-derived growth factors (PDGF), vascular endothelial growth factor (VEGF), and interleukin-8 (IL-8) are found in elevated concentrations in serum or tumor tissue of patients with head and neck squamous cell carcinomas (HNSCC), suggesting these factors may be coregulated. A cDNA microarray analysis for HGF-inducible genes revealed that HGF also modulates PDGFA expression, a gene recently shown to be inducible by the transcription factor, early growth response-1 (Egr-1). In the present study, we investigated the potential role of HGF-induced Egr-1 in expression of PDGF, VEGF, and IL-8. HGF induced expression of all three factors and Egr-1 expression and DNA-binding activity. The analysis of promoter sequences showed putative Egr-1 binding sites in the PDGFA or VEGF but not in the IL-8 promoter, and HGF-induced Egr-1-binding activity was confirmed by chromatin immunoprecipitation (ChIP) assay. The maximal basal and HGF-induced promoter activity for the PDGFA gene existed within -630 bp of the promoter region, and overexpression of Egr-1 significantly increased such activity. Consistent with this, expression of PDGFA and VEGF but not IL-8 showed corresponding differences with Egr-1 expression in HNSCC tumor specimens and were strongly suppressed by transfection of Egr-1-antisense or small interference RNA (siRNA) oligonucleotides. HGF-induced expression of Egr-1, PDGFA, and VEGF was suppressed by pharmacologic and siRNA inhibitors of mitogen-activated protein kinase kinase 1/2 (MEK1/2) and protein kinase C (PKC) pathways. We conclude that the HGF-induced activation of transcription factor Egr-1 by MEK1/2- and PKC-dependent mechanisms differentially contributes to expression of PDGF and VEGF, which are important angiogenesis factors and targets for HNSCC therapy.
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Affiliation(s)
- Brian Worden
- Tumor Biology Section, Head and Neck Surgery Branch, National Institute on Deafness and Other Communication Disorders, NIH, Bethesda, Maryland 20892-1419, USA
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Martin P, Choi DJ, Jinn TH, Cohen JG, John EO, Moorehead MT, Kaura CS, Kaura SH, Jung TTK. Effect of nitric oxide on mucin production in experimental otitis media. Otolaryngol Head Neck Surg 2004; 130:249-54. [PMID: 14990923 DOI: 10.1016/j.otohns.2003.09.019] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the role of nitric oxide (NO) in the pathogenesis of mucoid otitis media (OM) in lipopolysaccharide (LPS)-induced OM. METHODS OM was induced in chinchillas by injecting S-nitroso-N-acetylpenicillamine (SNAP), LPS, and LPS + SNAP into the superior bullae. Auditory brainstem response thresholds were measured every 24 hours. Samples of middle ear fluid were collected and analyzed for mucin by the periodic acid-Schiff method. At the end of each experiment, temporal bones were harvested for histopathologic study. RESULTS Mucin concentration was greatest in the LPS + the SNAP group and least in the SNAP-alone group. Auditory brainstem response threshold was highest in the LPS group and lowest in the SNAP group, although not significantly. Histopathology showed the greatest mucosal thickening and inflammation in the LPS + SNAP group. CONCLUSION The addition of NO in LPS-induced OM increased the mucin concentration in middle ear fluid and increased mucosal thickness and inflammation in middle ear mucosa. SIGNIFICANCE In the OM disease process, NO may contribute to the pathogenesis of mucoid OM.
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Affiliation(s)
- Paul Martin
- Division of Otolaryngology-Head adn Neck Surgery, Loma Linda University School of Medicine, Loma Linda, California, 92354, USA.
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Abstract
BACKGROUND Genetic testing for inherited predisposition to diverse cancers has recently become available as a clinical service. We conducted a follow-up study of the initial series of US families who underwent RB1 genetic testing to evaluate long-term effects of the service. PROCEDURE We enrolled 52 of 71 eligible families who responded to a follow-up study questionnaire administered 3-10 years after receipt of their RB1 results. Each family had one proband with unilateral, non-familial retinoblastoma, which is associated with a 12% pre-test probability of hereditary retinoblastoma. RB1 testing identified germline RB1 mutations in five patients, lowered the carrier probability to 2% in 21 patients, and did not substantially modify the carrier probability in the remaining 26. RESULTS Diverse medical specialists offered and arranged for RB1 testing, and their recommendation was the most influential factor in the decision to be tested. Pre-test counseling was provided by ophthalmologists (30), oncologists (11), and geneticists and genetic counselors (11). Most respondents, regardless of test result, were satisfied and perceived gains from their genetic testing. Based on small numbers, families with reduced likelihood of hereditary retinoblastoma reported more positive outcomes. Parents of RB1 carriers were more likely to seek medical services, worry, and decide against having more children. CONCLUSIONS This study demonstrates the feasibility of follow-up studies of families who had genetic testing. Results from our small series suggest that genetic information and counseling are important components of RB1 clinical genetic testing, and long-term adverse effects of testing are uncommon.
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Affiliation(s)
- J G Cohen
- Dana Farber Cancer Institute, Smith 201, 44 Binney Street, Boston, MA 02115, USA
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Carlberg RG, Cohen JG, Patton DR, Blandford R, Hogg DW, Yee HK, Morris SL, Lin H, Hall PB, Sawicki M, Wirth GD, Cowie LL, Hu E, Songaila A. Caltech Faint Galaxy Redshift Survey. XI. The Merger Rate to Redshift 1 from Kinematic Pairs. Astrophys J 2000; 532:L1-L4. [PMID: 10702118 DOI: 10.1086/312560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The rate of mass accumulation due to galaxy merging depends on the mass, density, and velocity distribution of galaxies in the near neighborhood of a host galaxy. The fractional luminosity in kinematic pairs combines all of these effects in a single estimator that is relatively insensitive to population evolution. Here we use a k-corrected and evolution-compensated volume-limited sample having an R-band absolute magnitude of Mk,eR</=-19.8+5logh mag drawing about 300 redshifts from the Caltech Faint Galaxy Redshift Survey and 3000 from the Canadian Network for Observational Cosmology field galaxy survey to measure the rate and redshift evolution of merging. The combined sample has an approximately constant comoving number and luminosity density from redshift 0.1 to 1.1 (OmegaM=0.2, OmegaLambda=0.8); hence, any merger evolution will be dominated by correlation and velocity evolution, not density evolution. We identify kinematic pairs with projected separations less than either 50 or 100 h-1 kpc and rest-frame velocity differences of less than 1000 km s-1. The fractional luminosity in pairs is modeled as fL&parl0;Deltav,rp,Mk,er&parr0;&parl0;1+z&parr0;mL, where &sqbl0;fL,mL&sqbr0; are &sqbl0;0.14+/-0.07,0+/-1.4&sqbr0; and &sqbl0;0.37+/-0.7,0.1+/-0.5&sqbr0; for rp</=50 and 100 h-1 kpc, respectively (OmegaM=0.2, OmegaLambda=0.8). The value of mL is about 0.6 larger if Lambda=0. To convert these redshift-space statistics to a merger rate, we use the data to derive a conversion factor to a physical space pair density, a merger probability, and a mean in-spiral time. The resulting mass accretion rate per galaxy (M1,M2>/=0.2M*) is 0.02+/-0.01&parl0;1+z&parr0;0.1+/-0.5M* Gyr-1. Present-day high-luminosity galaxies therefore have accreted approximately 0.15M* of their mass over the approximately 7 Gyr to redshift 1. Since merging is likely only weakly dependent on the host mass, the fractional effect, deltaM&solm0;M approximately 0.15M*&solm0;M, is dramatic for lower mass galaxies but is, on the average, effectively perturbative for galaxies above 1M*.
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Behr BB, Cohen JG, McCarthy JK. Rotations and Abundances of Blue Horizontal-Branch Stars in Globular Cluster M15. Astrophys J 2000; 531:L37-L40. [PMID: 10673409 DOI: 10.1086/312524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
High-resolution optical spectra of 18 blue horizontal-branch stars in the globular cluster M15 indicate that their stellar rotation rates and photospheric compositions vary strongly as a function of effective temperature. Among the cooler stars in the sample, at Teff approximately 8500 K, metal abundances are in rough agreement with the canonical cluster metallicity, and the vsini rotations appear to have a bimodal distribution, with eight stars at vsini<15 km s-1 and two stars at vsini approximately 35 km s-1. Most of the stars at Teff>/=10,000 K, however, are slowly rotating, vsini<7 km s-1, and their iron and titanium are enhanced by a factor of 300 to solar abundance levels. Magnesium maintains a nearly constant abundance over the entire range of Teff, and helium is depleted by factors of 10-30 in three of the hotter stars. Diffusion effects in the stellar atmospheres are the most likely explanation for these large differences in composition. Our results are qualitatively very similar to those previously reported for M13 and NGC 6752, but with even larger enhancement amplitudes, presumably due to the increased efficiency of radiative levitation at lower intrinsic [Fe/H]. We also see evidence for faster stellar rotation explicitly preventing the onset of the diffusion mechanisms among a subset of the hotter stars.
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Cohen JG. Star Systems: Stellar Populations. Science 1987; 237:1626. [PMID: 17834454 DOI: 10.1126/science.237.4822.1626] [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: 11/02/2022]
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Morales ES, Krumperman LW, Cohen JG. Bronchoscopy under diazepam anesthesia. Anesth Analg 1973; 52:414-21. [PMID: 4513358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Jeffries CD, Cohen JG, Hall MR. Inhibition of Proteus swarming by nucleic acid products. Appl Microbiol 1968; 16:1431-3. [PMID: 5676412 PMCID: PMC547674 DOI: 10.1128/am.16.9.1431-1433.1968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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