1
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Abraham A, Barcenas CH, Bleicher RJ, Cohen AL, Javid SH, Levine EG, Lin NU, Moy B, Niland JC, Wolff AC, Hassett MJ, Asad S, Stover DG. Clinicopathologic and sociodemographic factors associated with late relapse triple negative breast cancer in a multivariable logistic model: A multi-institution cohort study. Breast 2023; 67:89-93. [PMID: 36681001 PMCID: PMC9982264 DOI: 10.1016/j.breast.2023.01.004] [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] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Most metastatic recurrences of triple negative breast cancer (TNBC) occur within five years of diagnosis, yet late relapses of TNBC (lrTNBC) do occur. Our objective was to develop a risk prediction model of lrTNBC using readily available clinicopathologic and sociodemographic features. METHODS We included patients diagnosed with stage I-III TNBC between 1998 and 2012 at ten academic cancer centers. lrTNBC was defined as relapse or mortality greater than 5 years from diagnosis. Features associated with lrTNBC were included in a multivariable logistic model using backward elimination with a p < 0.10 criterion, with a final multivariable model applied to training (70%) and independent validation (30%) cohorts. RESULTS A total 2210 TNBC patients with at least five years follow-up and no relapse before 5 years were included. In final multivariable model, lrTNBC was significantly associated with higher stage at diagnosis (adjusted Odds Ratio [aOR] for stage III vs I, 10.9; 95% Confidence Interval [CI], 7.5-15.9; p < 0.0001) and BMI (aOR for obese vs normal weight, 1.4; 95% CI, 1.0-1.8; p = 0.03). Final model performance was consistent between training (70%) and validation (30%) cohorts. CONCLUSIONS A risk prediction model incorporating stage, BMI, and age at diagnosis offers potential utility for identification of patients at risk of development of lrTNBC and warrants further investigation.
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Affiliation(s)
- Adith Abraham
- Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | | | | | | | | | | | - Beverly Moy
- Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | - Sarah Asad
- Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Daniel G. Stover
- Ohio State University Wexner Medical Center, Columbus, OH, USA,Corresponding author. Stefanie Spielman Comprehensive Breast Center, Ohio State University Comprehensive Cancer Center, Biomedical Research Tower, Room 984 Columbus, OH, 43210, USA.
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2
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Gray SW, Ottesen RA, Currey M, Cristea M, Nikowitz J, Shehayeb S, Lozano V, Hom J, Kilburn J, Lopez LN, Wing S, Sosa E, Shen J, Morris M, Dilsizian B, Joseph T, Shen J, Adeimy C, Phillips T, Bahadini B, Niland JC. Leveraging an Informatics Approach to Identify an Unmet Clinical Need for BRCA1/ 2 Testing Among Patients With Ovarian Cancer. JCO Clin Cancer Inform 2022; 6:e2200034. [PMID: 36049148 PMCID: PMC9470148 DOI: 10.1200/cci.22.00034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/31/2022] [Accepted: 07/18/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Although BRCA1/2 testing in ovarian cancer improves outcomes, it is vastly underutilized. Scalable approaches are urgently needed to improve genomically guided care. METHODS We developed a Natural Language Processing (NLP) pipeline to extract electronic medical record information to identify recipients of BRCA testing. We applied the NLP pipeline to assess testing status in 308 patients with ovarian cancer receiving care at a National Cancer Institute Comprehensive Cancer Center (main campus [MC] and five affiliated clinical network sites [CNS]) from 2017 to 2019. We compared characteristics between (1) patients who had/had not received testing and (2) testing utilization by site. RESULTS We found high uptake of BRCA testing (approximately 78%) from 2017 to 2019 with no significant differences between the MC and CNS. We observed an increase in testing over time (67%-85%), higher uptake of testing among younger patients (mean age tested = 61 years v untested = 65 years, P = .01), and higher testing among Hispanic (84%) compared with White, Non-Hispanic (78%), and Asian (75%) patients (P = .006). Documentation of referral for an internal genetics consultation for BRCA pathogenic variant carriers was higher at the MC compared with the CNS (94% v 31%). CONCLUSION We were able to successfully use a novel NLP pipeline to assess use of BRCA testing among patients with ovarian cancer. Despite relatively high levels of BRCA testing at our institution, 22% of patients had no documentation of genetic testing and documentation of referral to genetics among BRCA carriers in the CNS was low. Given success of the NLP pipeline, such an informatics-based approach holds promise as a scalable solution to identify gaps in genetic testing to ensure optimal treatment interventions in a timely manner.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Sam Wing
- Health Economics and Outcomes Research, Intuitive Surgical, Sunnyvale, CA
| | | | - Jenny Shen
- The State University of New York at Stony Brook, Stony Brook, NY
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3
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Hom J, Nikowitz J, Ottesen R, Niland JC. Facilitating clinical research through automation: Combining optical character recognition with natural language processing. Clin Trials 2022; 19:504-511. [PMID: 35608136 DOI: 10.1177/17407745221093621] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/AIMS Performance status is crucial for most clinical research, as an eligibility criterion, a comorbidity covariate, or a trial endpoint. Yet information on performance status often is embedded as free text within a patient's electronic medical record, rather than coded directly, thereby making this concept extremely difficult to extract for research. Furthermore, performance status information frequently resides in outside reports, which are scanned into the electronic medical record along with thousands of clinic notes. The image format of scanned documents also is a major obstacle to the search and retrieval of information, as natural language processing cannot be applied to unstructured text within an image. We, therefore, utilized optical character recognition software to convert images to a searchable format, allowing the application of natural language processing to identify pertinent performance status data elements within scanned electronic medical records. METHODS Our study cohort consisted of 189 subjects diagnosed with diffuse large B-cell lymphoma for whom performance status was a required data element for analysis of prognostic factors related to recurrence and survival. Manual abstraction of performance status was previously conducted by a clinical Subject Matter Expert, serving as the gold standard. Leveraging our data warehouse, we extracted relevant scanned electronic medical record documents and applied optical character recognition to these images using the ABBYY FineReader software. The Linguamatics i2e natural language processing software was then used to run queries for performance status against the corpus of electronic medical record documents. We evaluated our optical character recognition/natural language processing pipeline for accuracy and reduction in data extraction effort. RESULTS We found that there was high accuracy and reduced time for extraction of performance status data by applying our optical character recognition/natural language processing pipeline. The transformed scanned documents from a random sample of patients yielded excellent precision, recall, and F score, with <1% incorrect results. Time savings from a second cohort showed that median time to review documents for patients with performance status data present was reduced by a third. The major time savings was in the review of those documents that in fact did not contain performance status information: median of 18 minutes versus 108 minutes for manual review, an 83% reduction in data abstraction effort. CONCLUSION By applying this optical character recognition/natural language processing pipeline, we achieved significant operational improvement and reduced time for information retrieval to support clinical research. Our study demonstrated that optical character recognition software provides an effective mechanism to transform scanned electronic medical record images to allow the application of natural language processing, yielding highly accurate data abstraction. We conclude that our optical character recognition/natural language processing pipeline can greatly facilitate research data abstraction by providing a highly focused data review, eliminating unnecessary manual review of the entire chart, and thus freeing time for abstracting other data elements requiring more human interpretation.
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Affiliation(s)
- Julie Hom
- Department of Diabetes & Cancer Discovery Science, City of Hope, Duarte, CA, USA
| | - Janet Nikowitz
- Department of Diabetes & Cancer Discovery Science, City of Hope, Duarte, CA, USA
| | - Rebecca Ottesen
- Department of Diabetes & Cancer Discovery Science, City of Hope, Duarte, CA, USA
| | - Joyce C Niland
- Department of Diabetes & Cancer Discovery Science, City of Hope, Duarte, CA, USA
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4
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Olack BJ, Alexander M, Swanson CJ, Kilburn J, Corrales N, Flores A, Heng J, Arulmoli J, Omori K, Chlebeck PJ, Zitur L, Salgado M, Lakey JRT, Niland JC. Optimal Time to Ship Human Islets Post Tissue Culture to Maximize Islet. Cell Transplant 2021; 29:963689720974582. [PMID: 33231091 PMCID: PMC7885128 DOI: 10.1177/0963689720974582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 01/03/2023] Open
Abstract
Access to functional high-quality pancreatic human islets is critical to advance diabetes research. The Integrated Islet Distribution Program (IIDP), a major source for human islet distribution for over 15 years, conducted a study to evaluate the most advantageous times to ship islets postisolation to maximize islet recovery. For the evaluation, three experienced IIDP Islet Isolation Centers each provided samples from five human islet isolations, shipping 10,000 islet equivalents (IEQ) at four different time periods postislet isolation (no 37°C culture and shipped within 0 to 18 hours; or held in 37°C culture for 18 to 42, 48 to 96, or 144 to 192 hours). A central evaluation center compared samples for islet quantity, quality, and viability for each experimental condition preshipment and postshipment, as well as post 37°C culture 18 to 24 hours after shipment receipt. Additional evaluations included measures of functional potency by static glucose-stimulated insulin release (GSIR), represented as a stimulation index. Comparing the results of the four preshipment holding periods, the greatest IEQ loss postshipment occurred with the shortest preshipment times. Similar patterns emerged when comparing preshipment to postculture losses. In vitro islet function (GSIR) was not adversely impacted by increased tissue culture time. These data indicate that allowing time for islet recovery postisolation, prior to shipping, yields less islet loss during shipment without decreasing islet function.
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Affiliation(s)
- Barbara J Olack
- Integrated Islet Distribution Program, Department of Diabetes & Cancer Discovery Science, City of Hope, Duarte, CA, USA
| | - Michael Alexander
- Department of Surgery, University of California Irvine, Orange, CA, USA
| | - Carol J Swanson
- Integrated Islet Distribution Program, Department of Diabetes & Cancer Discovery Science, City of Hope, Duarte, CA, USA
| | - Julie Kilburn
- Integrated Islet Distribution Program, Department of Diabetes & Cancer Discovery Science, City of Hope, Duarte, CA, USA
| | - Nicole Corrales
- Department of Surgery, University of California Irvine, Orange, CA, USA
| | - Antonio Flores
- Department of Surgery, University of California Irvine, Orange, CA, USA
| | - Jennifer Heng
- Department of Surgery, University of California Irvine, Orange, CA, USA
| | | | - Keiko Omori
- Department of Translational Research and Cellular Therapeutics, City of Hope, Duarte, CA, USA
| | - Peter J Chlebeck
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Laura Zitur
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Mayra Salgado
- Department of Translational Research and Cellular Therapeutics, City of Hope, Duarte, CA, USA
| | - Jonathan R T Lakey
- Department of Surgery, University of California Irvine, Orange, CA, USA.,Department of Biomedical Engineering, University of California Irvine, Irvine, CA, USA
| | - Joyce C Niland
- Integrated Islet Distribution Program, Department of Diabetes & Cancer Discovery Science, City of Hope, Duarte, CA, USA
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5
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Scott A, Olack B, Rouch JD, Khalil HA, Kokubun BA, Lei NY, Wang J, Solorzano S, Lewis M, Dunn JCY, Stelzner MG, Niland JC, Martín MG. Comparison of Surgical and Cadaveric Intestine as a Source of Crypt Culture in Humans. Cell Transplant 2021; 29:963689720903709. [PMID: 32907378 PMCID: PMC7784595 DOI: 10.1177/0963689720903709] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Human small intestinal crypts are the source of intestinal stem cells (ISCs) that are capable of undergoing self-renewal and differentiation to an epithelial layer. The development of methods to expand the ISCs has provided opportunities to model human intestinal epithelial disorders. Human crypt samples are usually obtained from either endoscopic or discarded surgical samples, and are thereby exposed to warm ischemia, which may impair their in vitro growth as three-dimensional culture as spheroids or enteroids. In this study we compared duodenal samples obtained from discarded surgical samples to those isolated from whole-body preserved cadaveric donors to generate in vitro cultures. We also examined the effect of storage solution (phosphate-buffered saline or University of Wisconsin [UW] solution) as well as multiple storage times on crypt isolation and growth in culture. We found that intestinal crypts were successfully isolated from cadaveric tissue stored for up to 144 h post-procurement and also were able to generate enteroids and spheroids in certain media conditions. Surgical samples stored in UW after procurement were sufficiently viable up to 24 h and also allowed the generation of enteroids and spheroids. We conclude that surgical samples stored for up to 24 h post-procurement in UW solution allowed for delayed crypt isolation and viable in vitro cultures. Furthermore, in situ, hypothermic preservation in cadaveric duodenal samples permitted crypt/ISC isolation, and successful culture of spheroids and enteroids from tissues held for up to 6 days post-procurement.
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Affiliation(s)
- Andrew Scott
- Department of Surgery, David Geffen School of Medicine, 12222UCLA, Los Angeles, CA, USA
| | - Barbara Olack
- Department of Diabetes and Cancer Discovery Science, 20220City of Hope, Integrated Islet Distribution Program and Intestinal Stem Cell Consortium, Coordinating Center, Duarte, CA, USA
| | - Joshua D Rouch
- Department of Surgery, David Geffen School of Medicine, 12222UCLA, Los Angeles, CA, USA
| | - Hassan A Khalil
- Department of Surgery, David Geffen School of Medicine, 12222UCLA, Los Angeles, CA, USA
| | - Brent A Kokubun
- Department of Surgery, David Geffen School of Medicine, 12222UCLA, Los Angeles, CA, USA
| | - Nan Ye Lei
- Department of Surgery, David Geffen School of Medicine, 12222UCLA, Los Angeles, CA, USA
| | - Jiafang Wang
- Division of Gastroenterology and Nutrition, Department of Pediatrics, Mattel Children's Hospital and the David Geffen School of Medicine, 12222UCLA Los Angeles, CA, USA
| | - Sergio Solorzano
- Division of Gastroenterology and Nutrition, Department of Pediatrics, Mattel Children's Hospital and the David Geffen School of Medicine, 12222UCLA Los Angeles, CA, USA
| | - Michael Lewis
- Department of Pathology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - James C Y Dunn
- Department of Surgery, 6429Stanford University School of Medicine, Stanford, CA, USA
| | - Matthias G Stelzner
- Department of Surgery, David Geffen School of Medicine, 12222UCLA, Los Angeles, CA, USA.,Department of Surgery, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Joyce C Niland
- Department of Diabetes and Cancer Discovery Science, 20220City of Hope, Integrated Islet Distribution Program and Intestinal Stem Cell Consortium, Coordinating Center, Duarte, CA, USA
| | - Martín G Martín
- Division of Gastroenterology and Nutrition, Department of Pediatrics, Mattel Children's Hospital and the David Geffen School of Medicine, 12222UCLA Los Angeles, CA, USA.,Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, 12222UCLA, Los Angeles, CA, USA
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6
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Kaddis JS, Rouse L, Parent AV, Saunders DC, Shalev A, Stabler CL, Stoffers DA, Wagner BK, Niland JC. From type 1 diabetes biology to therapy: The Human Islet Research Network. Mol Metab 2021; 54:101283. [PMID: 34224917 PMCID: PMC8711046 DOI: 10.1016/j.molmet.2021.101283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- John S Kaddis
- Department of Diabetes and Cancer Discovery Science, Arthur Riggs Diabetes and Metabolism Research Institute, Beckman Research Institute, City of Hope, Duarte, CA, USA.
| | - Layla Rouse
- Department of Diabetes and Cancer Discovery Science, Arthur Riggs Diabetes and Metabolism Research Institute, Beckman Research Institute, City of Hope, Duarte, CA, USA
| | - Audrey V Parent
- Diabetes Center, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Diane C Saunders
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anath Shalev
- Comprehensive Diabetes Center, Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cherie L Stabler
- J. Crayton Pruitt Family, Department of Biomedical Engineering, Herbert Wertheim College of Engineering, University of Florida, Gainesville, FL, USA; University of Florida Diabetes Institute, University of Florida, Gainesville, FL, USA
| | - Doris A Stoffers
- Institute for Diabetes, Obesity, and Metabolism and Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Bridget K Wagner
- Chemical Biology and Therapeutics Science Program, Broad Institute, Cambridge, MA, USA
| | - Joyce C Niland
- Department of Diabetes and Cancer Discovery Science, Arthur Riggs Diabetes and Metabolism Research Institute, Beckman Research Institute, City of Hope, Duarte, CA, USA
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7
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Kasendra M, Troutt M, Broda T, Bacon WC, Wang TC, Niland JC, Helmrath MA. Intestinal organoids: roadmap to the clinic. Am J Physiol Gastrointest Liver Physiol 2021; 321:G1-G10. [PMID: 33950707 PMCID: PMC8321798 DOI: 10.1152/ajpgi.00425.2020] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 01/31/2023]
Abstract
Recent advances in intestinal organoid research, along with encouraging preclinical proof-of-concept studies, have revealed significant therapeutic potential for induced pluripotent stem cell (iPSC)-derived organoids in the healing and replacement of severely injured or diseased bowel (Finkbeiner et al. Biol Open 4: 1462-1472, 2015; Kitano et al. Nat Commun 8: 765, 2017; Cruz-Acuna et al. Nat Cell Biol 19: 1326-1335, 2017). To fully realize the tremendous promise of stem cell organoid-based therapies, careful planning aligned with significant resources and efforts must be devoted demonstrating their safety and efficacy to meet critical regulatory requirements. Early recognition of the inherent preclinical and clinical obstacles that occur with the novel use of pluripotent stem cell-derived products will accelerate their bench-to-bedside translation (Neofytou et al. J Clin Invest 125: 2551-2557, 2015; O'Brien et al. Stem Cell Res Ther 6: 146, 2015; Ouseph et al. Cytotherapy 17: 339-343, 2015). To overcome many of these hurdles, a close and effective collaboration is needed between experts from various disciplines, including basic and clinical research, product development and manufacturing, quality assurance and control, and regulatory affairs. Therefore, the purpose of this article is to outline the critical areas and challenges that must be addressed when transitioning laboratory-based discovery, through an investigational new drug (IND) application to first-in-human clinical trial, and to encourage investigators to consider the required regulatory steps from the earliest stage of the translational process. The ultimate goal is to provide readers with a draft roadmap that they could use while navigating this exciting cell therapy space.
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Affiliation(s)
- Magdalena Kasendra
- Center for Stem Cell and Organoid Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Misty Troutt
- Center for Stem Cell and Organoid Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Taylor Broda
- Center for Stem Cell and Organoid Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - W Clark Bacon
- Center for Stem Cell and Organoid Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Timothy C Wang
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York City, New York
| | - Joyce C Niland
- Department of Diabetes and Cancer Discovery Science, City of Hope, Duarte, California
| | - Michael A Helmrath
- Center for Stem Cell and Organoid Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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8
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Song JY, Perry AM, Herrera AF, Chen L, Skrabek P, Nasr MR, Ottesen RA, Nikowitz J, Bedell V, Murata-Collins J, Li Y, McCarthy C, Pillai R, Wang J, Wu X, Zain J, Popplewell L, Kwak LW, Nademanee AP, Niland JC, Scott DW, Gong Q, Chan WC, Weisenburger DD. Double-hit Signature with TP53 Abnormalities Predicts Poor Survival in Patients with Germinal Center Type Diffuse Large B-cell Lymphoma Treated with R-CHOP. Clin Cancer Res 2021; 27:1671-1680. [PMID: 33414134 DOI: 10.1158/1078-0432.ccr-20-2378] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/28/2020] [Accepted: 12/23/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE We performed detailed genomic analysis on 87 cases of de novo diffuse large B-cell lymphoma of germinal center type (GCB DLBCL) to identify characteristics that are associated with survival in those treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). EXPERIMENTAL DESIGN The cases were extensively characterized by combining the results of IHC, cell-of-origin gene expression profiling (GEP; NanoString), double-hit GEP (DLBCL90), FISH cytogenetic analysis for double/triple-hit lymphoma, copy-number analysis, and targeted deep sequencing using a custom mutation panel of 334 genes. RESULTS We identified four distinct biologic subgroups with different survivals, and with similarities to the genomic classifications from two large retrospective studies of DLBCL. Patients with the double-hit signature, but no abnormalities of TP53, and those lacking EZH2 mutation and/or BCL2 translocation, had an excellent prognosis. However, patients with an EZB-like profile had an intermediate prognosis, whereas those with TP53 inactivation combined with the double-hit signature had an extremely poor prognosis. This latter finding was validated using two independent cohorts. CONCLUSIONS We propose a practical schema to use genomic variables to risk-stratify patients with GCB DLBCL. This schema provides a promising new approach to identify high-risk patients for new and innovative therapies.
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Affiliation(s)
- Joo Y Song
- Department of Pathology, City of Hope National Medical Center, Duarte, California. .,Toni Stephenson Lymphoma Center, City of Hope National Medical Center, Duarte, California
| | - Anamarija M Perry
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Alex F Herrera
- Toni Stephenson Lymphoma Center, City of Hope National Medical Center, Duarte, California.,Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Lu Chen
- Toni Stephenson Lymphoma Center, City of Hope National Medical Center, Duarte, California.,Department of Information Sciences, City of Hope National Medical Center, Duarte, California
| | - Pamela Skrabek
- Department of Hematology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Michel R Nasr
- Department of Pathology, SUNY Upstate Medical University, Syracuse, New York
| | - Rebecca A Ottesen
- Department of Diabetes & Cancer Discovery Science, City of Hope National Medical Center, Duarte, California
| | - Janet Nikowitz
- Department of Diabetes & Cancer Discovery Science, City of Hope National Medical Center, Duarte, California
| | - Victoria Bedell
- Department of Pathology, City of Hope National Medical Center, Duarte, California.,Toni Stephenson Lymphoma Center, City of Hope National Medical Center, Duarte, California
| | - Joyce Murata-Collins
- Department of Pathology, City of Hope National Medical Center, Duarte, California
| | - Yuping Li
- Department of Pathology, City of Hope National Medical Center, Duarte, California
| | - Christine McCarthy
- Department of Diabetes & Cancer Discovery Science, City of Hope National Medical Center, Duarte, California
| | - Raju Pillai
- Department of Pathology, City of Hope National Medical Center, Duarte, California.,Toni Stephenson Lymphoma Center, City of Hope National Medical Center, Duarte, California
| | - Jinhui Wang
- Integrative Genomics Core, City of Hope National Medical Center, Duarte, California
| | - Xiwei Wu
- Integrative Genomics Core, City of Hope National Medical Center, Duarte, California
| | - Jasmine Zain
- Toni Stephenson Lymphoma Center, City of Hope National Medical Center, Duarte, California.,Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Leslie Popplewell
- Toni Stephenson Lymphoma Center, City of Hope National Medical Center, Duarte, California.,Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Larry W Kwak
- Toni Stephenson Lymphoma Center, City of Hope National Medical Center, Duarte, California.,Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Auayporn P Nademanee
- Toni Stephenson Lymphoma Center, City of Hope National Medical Center, Duarte, California.,Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Joyce C Niland
- Department of Diabetes & Cancer Discovery Science, City of Hope National Medical Center, Duarte, California
| | - David W Scott
- British Columbia Research Center, Vancouver, British Columbia, Canada
| | - Qiang Gong
- Department of Pathology, City of Hope National Medical Center, Duarte, California
| | - Wing C Chan
- Department of Pathology, City of Hope National Medical Center, Duarte, California.,Toni Stephenson Lymphoma Center, City of Hope National Medical Center, Duarte, California
| | - Dennis D Weisenburger
- Department of Pathology, City of Hope National Medical Center, Duarte, California.,Toni Stephenson Lymphoma Center, City of Hope National Medical Center, Duarte, California
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9
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Yang DD, Buscariollo DL, Cronin AM, Weng S, Hughes ME, Bleicher RJ, Cohen AL, Javid SH, Edge SB, Moy B, Niland JC, Wolff AC, Hassett MJ, Punglia RS. Association between the 21-gene recurrence score and isolated locoregional recurrence in stage I-II, hormone receptor-positive breast cancer. Radiat Oncol 2020; 15:198. [PMID: 32799886 PMCID: PMC7429461 DOI: 10.1186/s13014-020-01640-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/10/2020] [Indexed: 12/26/2022] Open
Abstract
Background Although the 21-gene recurrence score (RS) assay is widely used to predict distant recurrence risk and benefit from adjuvant chemotherapy among women with hormone receptor-positive (HR+) breast cancer, the relationship between the RS and isolated locoregional recurrence (iLRR) remains poorly understood. Therefore, we examined the association between the RS and risk of iLRR for women with stage I-II, HR+ breast cancer. Methods We identified 1758 women captured in the national prospective Breast Cancer-Collaborative Outcomes Research Database who were diagnosed with stage I-II, HR+ breast cancer from 2006 to 2012, treated with mastectomy or breast-conserving surgery, and received RS testing. Women who received neoadjuvant therapy were excluded. The association between the RS and risk of iLRR was examined using competing risks regression. Results Overall, 19% of the cohort (n = 329) had a RS ≥25. At median follow-up of 29 months, only 22 iLRR events were observed. Having a RS ≥25 was not associated with a significantly higher risk of iLRR compared to a RS < 25 (hazard ratio 1.14, 95% confidence interval 0.39–3.36, P = 0.81). When limited to women who received adjuvant endocrine therapy without chemotherapy (n = 1199; 68% of the cohort), having a RS ≥25 (n = 74) was significantly associated with a higher risk of iLRR compared to a RS < 25 (hazard ratio 3.66, 95% confidence interval 1.07–12.5, P = 0.04). In this group, increasing RS was associated with greater risk of iLRR (compared to RS < 18, hazard ratio of 1.66, 3.59, and 7.06, respectively, for RS 18–24, 25–30, and ≥ 31; Ptrend = 0.02). Conclusions The RS was significantly associated with risk of iLRR in patients who did not receive adjuvant chemotherapy. The utility of the RS in identifying patients who have a low risk of iLRR should be further studied.
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Affiliation(s)
- David D Yang
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.,Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, 75 Francis St, Boston, MA, 02115, USA
| | - Daniela L Buscariollo
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.,Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, 75 Francis St, Boston, MA, 02115, USA
| | - Angel M Cronin
- Division of Population Science, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
| | - Shicheng Weng
- Division of Population Science, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
| | - Melissa E Hughes
- Department of Medical Oncology, Dana-Farber/Brigham and Women's Cancer Center, 75 Francis St, Boston, MA, 02115, USA
| | - Richard J Bleicher
- Department of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA
| | - Adam L Cohen
- Department of Medicine, Division of Oncology, Huntsman Cancer Institute, 1950 Circle of Hope Dr, Salt Lake City, UT, 84112, USA
| | - Sara H Javid
- Department of Surgery, University of Washington School of Medicine, Box 356410, Seattle, WA, 98105, USA
| | - Stephen B Edge
- Department of Surgical Oncology, Roswell Park Cancer Institute, 665 Elm St, Buffalo, NY, 14203, USA
| | - Beverly Moy
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.,Department of Medical Oncology, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Joyce C Niland
- Department of Diabetes and Cancer Discovery Science, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Duarte, CA, 91010, USA
| | - Antonio C Wolff
- Department of Oncology, Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, 401 N. Broadway, Weinberg, Baltimore, MD, 21231, USA
| | - Michael J Hassett
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.,Department of Medical Oncology, Dana-Farber/Brigham and Women's Cancer Center, 75 Francis St, Boston, MA, 02115, USA
| | - Rinaa S Punglia
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA. .,Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, 75 Francis St, Boston, MA, 02115, USA.
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10
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Song JY, Egan C, Bouska AC, Zhang W, Gong Q, Venkataraman G, Herrera AF, Chen L, Ottesen R, Niland JC, Bedell V, Valle-Catuna M, Murata-Collins J, Weisenburger DD, Iqbal J, Jaffe ES, Chan WC. Genomic characterization of diffuse large B-cell lymphoma transformation of nodular lymphocyte-predominant Hodgkin lymphoma. Leukemia 2020; 34:2238-2242. [PMID: 32054999 PMCID: PMC8499090 DOI: 10.1038/s41375-020-0739-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/11/2019] [Accepted: 01/30/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Joo Y Song
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA.
| | - Caoimhe Egan
- Hematopathology Section, Laboratory of Pathology, National Cancer Institute, Bethesda, MD, USA
| | - Alyssa C Bouska
- Department of Pathology, University of Nebraska, Omaha, NE, USA
| | - Weiwei Zhang
- Department of Pathology, University of Nebraska, Omaha, NE, USA
| | - Qiang Gong
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | | | - Alex F Herrera
- Department of Hematology & Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA, USA
| | - Lu Chen
- Department of Information Sciences, City of Hope National Medical Center, Duarte, CA, USA
| | - Rebecca Ottesen
- Department of Diabetes and Cancer Discovery Science, City of Hope National Medical Center, Duarte, CA, USA
| | - Joyce C Niland
- Department of Diabetes and Cancer Discovery Science, City of Hope National Medical Center, Duarte, CA, USA
| | - Victoria Bedell
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | - Maria Valle-Catuna
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
| | | | | | - Javeed Iqbal
- Department of Pathology, University of Nebraska, Omaha, NE, USA
| | - Elaine S Jaffe
- Hematopathology Section, Laboratory of Pathology, National Cancer Institute, Bethesda, MD, USA
| | - Wing C Chan
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, USA
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11
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Brissova M, Niland JC, Cravens J, Olack B, Sowinski J, Evans-Molina C. The Integrated Islet Distribution Program answers the call for improved human islet phenotyping and reporting of human islet characteristics in research articles. Diabetologia 2019; 62:1312-1314. [PMID: 31089753 PMCID: PMC7365209 DOI: 10.1007/s00125-019-4876-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/01/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Marcela Brissova
- Department of Medicine, Division of Diabetes, Endocrinology, and Metabolism, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joyce C Niland
- Department of Diabetes and Cancer Discovery Science, Diabetes and Metabolism Research Institute at City of Hope, 1500 E. Duarte Rd, Duarte, CA, 91010, USA.
| | - James Cravens
- Department of Diabetes and Cancer Discovery Science, Diabetes and Metabolism Research Institute at City of Hope, 1500 E. Duarte Rd, Duarte, CA, 91010, USA
| | - Barbara Olack
- Department of Diabetes and Cancer Discovery Science, Diabetes and Metabolism Research Institute at City of Hope, 1500 E. Duarte Rd, Duarte, CA, 91010, USA
| | - Janice Sowinski
- Department of Diabetes and Cancer Discovery Science, Diabetes and Metabolism Research Institute at City of Hope, 1500 E. Duarte Rd, Duarte, CA, 91010, USA
| | - Carmella Evans-Molina
- Department of Medicine, Indiana University School of Medicine, 635 Barnhill Drive, Room 2031, Indianapolis, IN, 46202, USA.
- Roudebush VA Medical Center, Indianapolis, IN, USA.
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12
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Brissova M, Niland JC, Cravens J, Olack B, Sowinski J, Evans-Molina C. The Integrated Islet Distribution Program Answers the Call for Improved Human Islet Phenotyping and Reporting of Human Islet Characteristics in Research Articles. Diabetes 2019; 68:1363-1365. [PMID: 31092479 PMCID: PMC6609985 DOI: 10.2337/dbi19-0019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/05/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Marcela Brissova
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Joyce C Niland
- Department of Diabetes & Cancer Discovery Science, Diabetes & Metabolism Research Institute at City of Hope, Duarte, CA
| | - James Cravens
- Department of Diabetes & Cancer Discovery Science, Diabetes & Metabolism Research Institute at City of Hope, Duarte, CA
| | - Barbara Olack
- Department of Diabetes & Cancer Discovery Science, Diabetes & Metabolism Research Institute at City of Hope, Duarte, CA
| | - Janice Sowinski
- Department of Diabetes & Cancer Discovery Science, Diabetes & Metabolism Research Institute at City of Hope, Duarte, CA
| | - Carmella Evans-Molina
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
- Roudebush VA Medical Center, Indianapolis, IN
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13
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Hassett MJ, Jiang W, Hughes ME, Edge S, Javid SH, Niland JC, Theriault R, Wong YN, Schrag D, Punglia RS. Treating Second Breast Events After Breast-Conserving Surgery for Ductal Carcinoma in Situ. J Natl Compr Canc Netw 2018; 16:387-394. [PMID: 29632058 DOI: 10.6004/jnccn.2018.7003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 01/03/2018] [Indexed: 11/17/2022]
Abstract
Background: Because of screening mammography, the number of ductal carcinoma in situ (DCIS) survivors has increased dramatically. DCIS survivors may face excess risk of second breast events (SBEs). However, little is known about SBE treatment or its relationship to initial DCIS care. Methods: Among a prospective cohort of women who underwent breast-conserving surgery (BCS) for DCIS from 1997 to 2008 at institutions participating in the NCCN Outcomes Database, we identified SBEs, described patterns of care for SBEs, and examined the association between DCIS treatment choice and SBE care. Using multivariable regression, we identified features associated with use of mastectomy, radiation therapy (RT), or antiestrogen therapy (AET) for SBEs. Results: Of 2,939 women who underwent BCS for DCIS, 83% received RT and 40% received AET. During the median follow-up of 4.2 years, 200 women (6.8%) developed an SBE (55% ipsilateral, 45% invasive). SBEs occurred in 6% of women who underwent RT for their initial DCIS versus 11% who did not. Local treatment for these events included BCS (10%), BCS/RT (30%), mastectomy (53%), or none (6%); only 28% of patients received AET. Independent predictors of RT or mastectomy for SBEs included younger age, shorter time to SBE diagnosis, and RT or AET for the initial DCIS. Conclusions: A sizable proportion of patients with SBEs were treated with mastectomy, most especially those who previously received RT for their initial DCIS and those who developed an ipsilateral SBE. Despite the occurrence of an SBE, relatively few patients received AET. Future studies should investigate optimal treatment approaches for SBEs, including the benefit of mastectomy versus lumpectomy for an ipsilateral SBE and the benefit of AET for a hormone-receptor-positive SBE contingent on AET use for the initial DCIS diagnosis.
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MESH Headings
- Adenocarcinoma in Situ/etiology
- Adenocarcinoma in Situ/pathology
- Adenocarcinoma in Situ/therapy
- Adult
- Aged
- Carcinoma, Ductal, Breast/etiology
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Combined Modality Therapy/adverse effects
- Combined Modality Therapy/methods
- Female
- Follow-Up Studies
- Humans
- Mastectomy
- Mastectomy, Segmental
- Middle Aged
- Neoplasm Grading
- Neoplasm Staging
- Neoplasms, Second Primary/etiology
- Neoplasms, Second Primary/pathology
- Neoplasms, Second Primary/therapy
- Risk Factors
- Treatment Outcome
- Tumor Burden
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14
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Meyer LA, Cronin AM, Sun CC, Bixel K, Bookman MA, Cristea MC, Griggs JJ, Levenback CF, Burger RA, Mantia-Smaldone G, Matulonis UA, Niland JC, O'Malley DM, Wright AA. Use and Effectiveness of Neoadjuvant Chemotherapy for Treatment of Ovarian Cancer. J Clin Oncol 2017; 34:3854-3863. [PMID: 27601552 DOI: 10.1200/jco.2016.68.1239] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose In 2010, a randomized clinical trial demonstrated noninferior survival for patients with advanced ovarian cancer who were treated with neoadjuvant chemotherapy (NACT) compared with primary cytoreductive surgery (PCS). We examined the use and effectiveness of NACT in clinical practice. Patients and Methods A multi-institutional observational study of 1,538 women with stages IIIC to IV ovarian cancer who were treated at six National Cancer Institute-designated cancer centers. We examined NACT use in patients who were diagnosed between 2003 and 2012 (N = 1,538) and compared overall survival (OS), morbidity, and postoperative residual disease in a propensity-score matched sample of patients (N = 594). Results NACT use increased from 16% during 2003 to 2010 to 34% during 2011 to 2012 in stage IIIC disease ( Ptrend < .001), and from 41% to 62% in stage IV disease ( Ptrend < .001). Adoption of NACT varied by institution, from 8% to 30% for stage IIIC disease (P < .001) and from 27% to 61% ( P = .007) for stage IV disease during this time period. In the matched sample, NACT was associated with shorter OS in stage IIIC disease (median OS: 33 v 43 months; hazard ratio [HR], 1.40; 95% CI, 1.11 to 1.77) compared with PCS, but not stage IV disease (median OS: 31 v 36 months; HR, 1.16; 95% CI, 0.89 to 1.52). Patients with stages IIIC and IV disease who received NACT were less likely to have ≥ 1 cm postoperative residual disease, an intensive care unit admission, or a rehospitalization (all P ≤ .04) compared with those who received PCS treatment. However, among women with stage IIIC disease who achieved microscopic or ≤ 1 cm postoperative residual disease, NACT was associated with decreased OS (HR, 1.49; 95% CI, 1.01 to 2.18; P = .04). Conclusion Use of NACT increased significantly between 2003 and 2012. In this observational study, PCS was associated with increased survival in stage IIIC, but not stage IV disease. Future studies should prospectively consider the efficacy of NACT by extent of residual disease in unselected patients.
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Affiliation(s)
- Larissa A Meyer
- Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA
| | - Angel M Cronin
- Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA
| | - Charlotte C Sun
- Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA
| | - Kristin Bixel
- Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA
| | - Michael A Bookman
- Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA
| | - Mihaela C Cristea
- Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA
| | - Jennifer J Griggs
- Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA
| | - Charles F Levenback
- Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA
| | - Robert A Burger
- Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA
| | - Gina Mantia-Smaldone
- Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA
| | - Ursula A Matulonis
- Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA
| | - Joyce C Niland
- Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA
| | - David M O'Malley
- Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA
| | - Alexi A Wright
- Larissa A. Meyer, Charlotte C. Sun, and Charles F. Levenback, The University of Texas MD Anderson Cancer Center, Houston, TX; Angel M. Cronin, Ursula A. Matulonis, and Alexi A. Wright, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Kristin Bixel and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Michael A. Bookman, US Oncology Research and Arizona Oncology, Tucson, AZ; Mihaela C. Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; Robert A. Burger, University of Pennsylvania; and Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA
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15
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Yan KS, Gevaert O, Zheng GXY, Anchang B, Probert CS, Larkin KA, Davies PS, Cheng ZF, Kaddis JS, Han A, Roelf K, Calderon RI, Cynn E, Hu X, Mandleywala K, Wilhelmy J, Grimes SM, Corney DC, Boutet SC, Terry JM, Belgrader P, Ziraldo SB, Mikkelsen TS, Wang F, von Furstenberg RJ, Smith NR, Chandrakesan P, May R, Chrissy MAS, Jain R, Cartwright CA, Niland JC, Hong YK, Carrington J, Breault DT, Epstein J, Houchen CW, Lynch JP, Martin MG, Plevritis SK, Curtis C, Ji HP, Li L, Henning SJ, Wong MH, Kuo CJ. Intestinal Enteroendocrine Lineage Cells Possess Homeostatic and Injury-Inducible Stem Cell Activity. Cell Stem Cell 2017; 21:78-90.e6. [PMID: 28686870 PMCID: PMC5642297 DOI: 10.1016/j.stem.2017.06.014] [Citation(s) in RCA: 224] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 04/17/2017] [Accepted: 06/20/2017] [Indexed: 12/22/2022]
Abstract
Several cell populations have been reported to possess intestinal stem cell (ISC) activity during homeostasis and injury-induced regeneration. Here, we explored inter-relationships between putative mouse ISC populations by comparative RNA-sequencing (RNA-seq). The transcriptomes of multiple cycling ISC populations closely resembled Lgr5+ ISCs, the most well-defined ISC pool, but Bmi1-GFP+ cells were distinct and enriched for enteroendocrine (EE) markers, including Prox1. Prox1-GFP+ cells exhibited sustained clonogenic growth in vitro, and lineage-tracing of Prox1+ cells revealed long-lived clones during homeostasis and after radiation-induced injury in vivo. Single-cell mRNA-seq revealed two subsets of Prox1-GFP+ cells, one of which resembled mature EE cells while the other displayed low-level EE gene expression but co-expressed tuft cell markers, Lgr5 and Ascl2, reminiscent of label-retaining secretory progenitors. Our data suggest that the EE lineage, including mature EE cells, comprises a reservoir of homeostatic and injury-inducible ISCs, extending our understanding of cellular plasticity and stemness.
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Affiliation(s)
- Kelley S Yan
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; Columbia Center for Human Development, Columbia Stem Cell Initiative, Department of Medicine, Division of Digestive and Liver Diseases, Department of Genetics and Development, Columbia University Medical Center, New York, NY 10032, USA
| | - Olivier Gevaert
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | | | - Benedict Anchang
- Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Christopher S Probert
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Kathryn A Larkin
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Paige S Davies
- Oregon Health & Science University, Department of Cell, Developmental and Cancer Biology, Portland, OR 97239, USA
| | - Zhuan-Fen Cheng
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - John S Kaddis
- Department of Diabetes and Cancer Discovery Science, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | - Arnold Han
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; Columbia Center for Translational Immunology, Department of Medicine, Division of Digestive and Liver Diseases, Department of Microbiology and Immunology, Columbia University Medical Center, New York, NY 10032, USA
| | - Kelly Roelf
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Ruben I Calderon
- Columbia Center for Human Development, Columbia Stem Cell Initiative, Department of Medicine, Division of Digestive and Liver Diseases, Department of Genetics and Development, Columbia University Medical Center, New York, NY 10032, USA
| | - Esther Cynn
- Columbia Center for Human Development, Columbia Stem Cell Initiative, Department of Medicine, Division of Digestive and Liver Diseases, Department of Genetics and Development, Columbia University Medical Center, New York, NY 10032, USA
| | - Xiaoyi Hu
- Columbia Center for Human Development, Columbia Stem Cell Initiative, Department of Medicine, Division of Digestive and Liver Diseases, Department of Genetics and Development, Columbia University Medical Center, New York, NY 10032, USA
| | - Komal Mandleywala
- Columbia Center for Human Development, Columbia Stem Cell Initiative, Department of Medicine, Division of Digestive and Liver Diseases, Department of Genetics and Development, Columbia University Medical Center, New York, NY 10032, USA
| | - Julie Wilhelmy
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Sue M Grimes
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - David C Corney
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | | | | | | | | | | | - Fengchao Wang
- Stowers Institute for Medical Research, Kansas City, MO 64110, USA
| | | | - Nicholas R Smith
- Oregon Health & Science University, Department of Cell, Developmental and Cancer Biology, Portland, OR 97239, USA
| | - Parthasarathy Chandrakesan
- Department of Internal Medicine, Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Randal May
- Department of Internal Medicine, Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Mary Ann S Chrissy
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Rajan Jain
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | - Joyce C Niland
- Department of Diabetes and Cancer Discovery Science, City of Hope Comprehensive Cancer Center, Duarte, CA 91010, USA
| | - Young-Kwon Hong
- Departments of Surgery and of Biochemistry & Molecular Biology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
| | - Jill Carrington
- National Institutes of Health, Division of Digestive Diseases and Nutrition, NIDDK, Bethesda, MD 20892, USA
| | - David T Breault
- Division of Endocrinology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Jonathan Epstein
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Courtney W Houchen
- Department of Internal Medicine, Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - John P Lynch
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Martin G Martin
- Department of Pediatrics, Division of Gastroenterology and Nutrition, Mattel Children's Hospital and the David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Sylvia K Plevritis
- Department of Radiology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Christina Curtis
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Hanlee P Ji
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Linheng Li
- Stowers Institute for Medical Research, Kansas City, MO 64110, USA
| | - Susan J Henning
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Melissa H Wong
- Oregon Health & Science University, Department of Cell, Developmental and Cancer Biology, Portland, OR 97239, USA
| | - Calvin J Kuo
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
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16
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Esselen KM, Cronin AM, Bixel K, Bookman MA, Burger RA, Cohn DE, Cristea M, Griggs JJ, Levenback CF, Mantia-Smaldone G, Meyer LA, Matulonis UA, Niland JC, Sun C, O'Malley DM, Wright AA. Use of CA-125 Tests and Computed Tomographic Scans for Surveillance in Ovarian Cancer. JAMA Oncol 2017; 2:1427-1433. [PMID: 27442965 DOI: 10.1001/jamaoncol.2016.1842] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance A 2009 randomized clinical trial demonstrated that using cancer antigen 125 (CA-125) tests for routine surveillance in ovarian cancer increases the use of chemotherapy and decreases patients' quality of life without improving survival, compared with clinical observation. The Society of Gynecologic Oncology guidelines categorize CA-125 testing as optional and discourage the use of radiographic imaging for routine surveillance. To date, few studies have examined the use of CA-125 tests in clinical practice. Objectives To examine the use of CA-125 tests and computed tomographic (CT) scans in clinical practice before and after the 2009 randomized clinical trial and to estimate the economic effect of surveillance testing. Design, Setting, and Participants A prospective cohort of 1241 women with ovarian cancer in clinical remission after completion of primary cytoreductive surgery and chemotherapy at 6 National Cancer Institute-designated cancer centers between January 1, 2004, and December 31, 2011, was followed up through December 31, 2012, to study the use of CA-125 tests and CT scans before and after 2009. Data analysis was conducted from April 9, 2014, to March 28, 2016. Main Outcomes and Measures The use of CA-125 tests and CT scans before and after 2009. Secondary outcomes included the time from CA-125 markers doubling to retreatment among women who experienced a rise in CA-125 markers before and after 2009, and the costs associated with surveillance testing using 2015 Medicare reimbursement rates. Results Among 1241 women (mean [SD] age 59 [12] years; 1112 white [89.6%]), the use of CA-125 testing and CT scans was similar during the study period. During 12 months of surveillance, the cumulative incidence of patients undergoing 3 or more CA-125 tests was 86% in 2004-2009 vs 91% in 2010-2012 (P = .95), and the cumulative incidence of patients undergoing more than 1 CT scan was 81% in 2004-2009 vs 78% in 2010-2012 (P = .50). Among women whose CA-125 markers doubled (n = 511), there was no significant difference in the time to retreatment with chemotherapy before and after 2009 (median, 2.8 vs 3.5 months; P = .40). During a 12-month period, there was a mean of 4.6 CA-125 tests and 1.7 CT scans performed per patient, resulting in a US population surveillance cost estimate of $1 999 029 per year for CA-125 tests alone and $16 194 647 per year with CT scans added. Conclusions and Relevance CA-125 tests and CT scans are still routinely used for surveillance testing in patients with ovarian cancer, although their benefit has not been proven and their use may have significant implications for patients' quality of life as well as costs.
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Affiliation(s)
- Katharine M Esselen
- Division of Gynecologic Oncology, Department of Obstetrics/Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Angel M Cronin
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Kristin Bixel
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Comprehensive Cancer Center, Columbus
| | | | - Robert A Burger
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia
| | - David E Cohn
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Comprehensive Cancer Center, Columbus
| | - Mihaela Cristea
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Jennifer J Griggs
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan Comprehensive Cancer Center, Ann Arbor8Division of Hematology and Oncology, Department of Health Management and Policy, University of Michigan Comprehensive Cancer Center, Ann Arbor
| | - Charles F Levenback
- Division of Surgery, Department of Gynecologic and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Gina Mantia-Smaldone
- Division of Gynecologic Oncology, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Larissa A Meyer
- Division of Surgery, Department of Gynecologic and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - Ursula A Matulonis
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
| | - Joyce C Niland
- Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Charlotte Sun
- Division of Surgery, Department of Gynecologic and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston
| | - David M O'Malley
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, The Ohio State University Comprehensive Cancer Center, Columbus
| | - Alexi A Wright
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts
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17
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Partridge AH, Hughes ME, Warner ET, Ottesen RA, Wong YN, Edge SB, Theriault RL, Blayney DW, Niland JC, Winer EP, Weeks JC, Tamimi RM. Subtype-Dependent Relationship Between Young Age at Diagnosis and Breast Cancer Survival. J Clin Oncol 2016; 34:3308-14. [PMID: 27480155 DOI: 10.1200/jco.2015.65.8013] [Citation(s) in RCA: 255] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Young women are at increased risk for developing more aggressive subtypes of breast cancer. Although previous studies have shown a higher risk of breast cancer recurrence and death among young women with early-stage breast cancer, they have not adequately addressed the role of tumor subtype in outcomes. METHODS We examined data from women with newly diagnosed stage I to III breast cancer presenting to one of eight National Comprehensive Cancer Network centers between January 2000 and December 2007. Multivariable Cox proportional hazards models were used to assess the relationship between age and breast cancer-specific survival. RESULTS A total of 17,575 women with stage I to III breast cancer were eligible for analysis, among whom 1,916 were ≤ 40 years of age at diagnosis. Median follow-up time was 6.4 years. In a multivariable Cox proportional hazards model controlling for sociodemographic, disease, and treatment characteristics, women ≤ 40 years of age at diagnosis had greater breast cancer mortality (hazard ratio [HR], 1.4; 95% CI, 1.2 to 1.7). In stratified analyses, age ≤ 40 years was associated with statistically significant increases in risk of breast cancer death among women with luminal A (HR, 2.1; 95% CI, 1.4 to 3.2) and luminal B (HR 1.4; 95% CI, 1.1 to 1.9) tumors, with borderline significance among women with triple-negative tumors (HR, 1.4; 95% CI, 1.0 to 1.8) but not among those with human epidermal growth factor receptor 2 subtypes (HR, 1.2; 95% CI, 0.8 to 1.9). In an additional model controlling for detection method, young age was associated with significantly increased risk of breast cancer death only among women with luminal A tumors. CONCLUSION The effect of age on survival of women with early breast cancer seems to vary by breast cancer subtype. Young age seems to be particularly prognostic in women with luminal breast cancers.
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Affiliation(s)
- Ann H Partridge
- Ann H. Partridge, Melissa E. Hughes, Erica T. Warner, Eric P. Winer, Jane C. Weeks, and Rulla M. Tamimi, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Erica T. Warner, Harvard T.H. Chan School of Public Health, Boston, MA; Rebecca A. Ottesen and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte; and Douglas W. Blayney, Stanford Cancer Institute, Palo Alto, CA; Yu-Ning Wong, Fox Chase Cancer Center, Philadelphia, PA; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Richard L. Theriault, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Melissa E Hughes
- Ann H. Partridge, Melissa E. Hughes, Erica T. Warner, Eric P. Winer, Jane C. Weeks, and Rulla M. Tamimi, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Erica T. Warner, Harvard T.H. Chan School of Public Health, Boston, MA; Rebecca A. Ottesen and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte; and Douglas W. Blayney, Stanford Cancer Institute, Palo Alto, CA; Yu-Ning Wong, Fox Chase Cancer Center, Philadelphia, PA; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Richard L. Theriault, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Erica T Warner
- Ann H. Partridge, Melissa E. Hughes, Erica T. Warner, Eric P. Winer, Jane C. Weeks, and Rulla M. Tamimi, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Erica T. Warner, Harvard T.H. Chan School of Public Health, Boston, MA; Rebecca A. Ottesen and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte; and Douglas W. Blayney, Stanford Cancer Institute, Palo Alto, CA; Yu-Ning Wong, Fox Chase Cancer Center, Philadelphia, PA; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Richard L. Theriault, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rebecca A Ottesen
- Ann H. Partridge, Melissa E. Hughes, Erica T. Warner, Eric P. Winer, Jane C. Weeks, and Rulla M. Tamimi, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Erica T. Warner, Harvard T.H. Chan School of Public Health, Boston, MA; Rebecca A. Ottesen and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte; and Douglas W. Blayney, Stanford Cancer Institute, Palo Alto, CA; Yu-Ning Wong, Fox Chase Cancer Center, Philadelphia, PA; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Richard L. Theriault, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yu-Ning Wong
- Ann H. Partridge, Melissa E. Hughes, Erica T. Warner, Eric P. Winer, Jane C. Weeks, and Rulla M. Tamimi, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Erica T. Warner, Harvard T.H. Chan School of Public Health, Boston, MA; Rebecca A. Ottesen and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte; and Douglas W. Blayney, Stanford Cancer Institute, Palo Alto, CA; Yu-Ning Wong, Fox Chase Cancer Center, Philadelphia, PA; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Richard L. Theriault, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stephen B Edge
- Ann H. Partridge, Melissa E. Hughes, Erica T. Warner, Eric P. Winer, Jane C. Weeks, and Rulla M. Tamimi, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Erica T. Warner, Harvard T.H. Chan School of Public Health, Boston, MA; Rebecca A. Ottesen and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte; and Douglas W. Blayney, Stanford Cancer Institute, Palo Alto, CA; Yu-Ning Wong, Fox Chase Cancer Center, Philadelphia, PA; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Richard L. Theriault, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Richard L Theriault
- Ann H. Partridge, Melissa E. Hughes, Erica T. Warner, Eric P. Winer, Jane C. Weeks, and Rulla M. Tamimi, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Erica T. Warner, Harvard T.H. Chan School of Public Health, Boston, MA; Rebecca A. Ottesen and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte; and Douglas W. Blayney, Stanford Cancer Institute, Palo Alto, CA; Yu-Ning Wong, Fox Chase Cancer Center, Philadelphia, PA; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Richard L. Theriault, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Douglas W Blayney
- Ann H. Partridge, Melissa E. Hughes, Erica T. Warner, Eric P. Winer, Jane C. Weeks, and Rulla M. Tamimi, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Erica T. Warner, Harvard T.H. Chan School of Public Health, Boston, MA; Rebecca A. Ottesen and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte; and Douglas W. Blayney, Stanford Cancer Institute, Palo Alto, CA; Yu-Ning Wong, Fox Chase Cancer Center, Philadelphia, PA; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Richard L. Theriault, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Joyce C Niland
- Ann H. Partridge, Melissa E. Hughes, Erica T. Warner, Eric P. Winer, Jane C. Weeks, and Rulla M. Tamimi, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Erica T. Warner, Harvard T.H. Chan School of Public Health, Boston, MA; Rebecca A. Ottesen and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte; and Douglas W. Blayney, Stanford Cancer Institute, Palo Alto, CA; Yu-Ning Wong, Fox Chase Cancer Center, Philadelphia, PA; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Richard L. Theriault, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eric P Winer
- Ann H. Partridge, Melissa E. Hughes, Erica T. Warner, Eric P. Winer, Jane C. Weeks, and Rulla M. Tamimi, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Erica T. Warner, Harvard T.H. Chan School of Public Health, Boston, MA; Rebecca A. Ottesen and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte; and Douglas W. Blayney, Stanford Cancer Institute, Palo Alto, CA; Yu-Ning Wong, Fox Chase Cancer Center, Philadelphia, PA; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Richard L. Theriault, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jane C Weeks
- Ann H. Partridge, Melissa E. Hughes, Erica T. Warner, Eric P. Winer, Jane C. Weeks, and Rulla M. Tamimi, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Erica T. Warner, Harvard T.H. Chan School of Public Health, Boston, MA; Rebecca A. Ottesen and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte; and Douglas W. Blayney, Stanford Cancer Institute, Palo Alto, CA; Yu-Ning Wong, Fox Chase Cancer Center, Philadelphia, PA; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Richard L. Theriault, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rulla M Tamimi
- Ann H. Partridge, Melissa E. Hughes, Erica T. Warner, Eric P. Winer, Jane C. Weeks, and Rulla M. Tamimi, Dana-Farber Cancer Institute and Brigham and Women's Hospital; Erica T. Warner, Harvard T.H. Chan School of Public Health, Boston, MA; Rebecca A. Ottesen and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte; and Douglas W. Blayney, Stanford Cancer Institute, Palo Alto, CA; Yu-Ning Wong, Fox Chase Cancer Center, Philadelphia, PA; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Richard L. Theriault, The University of Texas MD Anderson Cancer Center, Houston, TX
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18
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Halasz LM, Uno H, Hughes M, D'Amico T, Dexter EU, Edge SB, Hayman JA, Niland JC, Otterson GA, Pisters KMW, Theriault R, Weeks JC, Punglia RS. Comparative effectiveness of stereotactic radiosurgery versus whole-brain radiation therapy for patients with brain metastases from breast or non-small cell lung cancer. Cancer 2016; 122:2091-100. [PMID: 27088755 DOI: 10.1002/cncr.30009] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [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: 10/03/2015] [Revised: 01/28/2016] [Accepted: 02/23/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND The optimal treatment for patients with brain metastases remains controversial as the use of stereotactic radiosurgery (SRS) alone, replacing whole-brain radiation therapy (WBRT), has increased. This study determined the patterns of care at multiple institutions before 2010 and examined whether or not survival was different between patients treated with SRS and patients treated with WBRT. METHODS This study examined the overall survival of patients treated with radiation therapy for brain metastases from non-small cell lung cancer (NSCLC; initially diagnosed in 2007-2009) or breast cancer (initially diagnosed in 1997-2009) at 5 centers. Propensity score analyses were performed to adjust for confounding factors such as the number of metastases, the extent of extracranial metastases, and the treatment center. RESULTS Overall, 27.8% of 400 NSCLC patients and 13.4% of 387 breast cancer patients underwent SRS alone for the treatment of brain metastases. Few patients with more than 3 brain metastases or lesions ≥ 4 cm in size underwent SRS. Patients with fewer than 4 brain metastases less than 4 cm in size (n = 189 for NSCLC and n = 117 for breast cancer) who were treated with SRS had longer survival (adjusted hazard ratio [HR] for NSCLC, 0.58; 95% confidence Interval [CI], 0.38-0.87; P = .01; adjusted HR for breast cancer, 0.54; 95% CI, 0.33-0.91; P = .02) than those treated with WBRT. CONCLUSIONS Patients treated for fewer than 4 brain metastases from NSCLC or breast cancer with SRS alone had longer survival than those treated with WBRT in this multi-institutional, retrospective study, even after adjustments for the propensity to undergo SRS. Cancer 2016;122:2091-100. © 2016 American Cancer Society.
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Affiliation(s)
- Lia M Halasz
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Hajime Uno
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Melissa Hughes
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Thomas D'Amico
- Department of Surgery, Duke Cancer Institute, Durham, North Carolina
| | - Elisabeth U Dexter
- Department of Surgery, Roswell Park Cancer Institute, Buffalo, New York.,University of Buffalo, Buffalo, New York
| | - Stephen B Edge
- Department of Surgery, Roswell Park Cancer Institute, Buffalo, New York.,University of Buffalo, Buffalo, New York
| | | | | | - Gregory A Otterson
- Department of Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Katherine M W Pisters
- Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Richard Theriault
- Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jane C Weeks
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Rinaa S Punglia
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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19
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Valle LF, Jagsi R, Bobiak SN, Zornosa C, D'Amico TA, Pisters KM, Dexter EU, Niland JC, Hayman JA, Kapadia NS. Variation in Definitive Therapy for Localized Non-Small Cell Lung Cancer Among National Comprehensive Cancer Network Institutions. Int J Radiat Oncol Biol Phys 2016; 94:360-7. [DOI: 10.1016/j.ijrobp.2015.10.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/16/2015] [Accepted: 10/20/2015] [Indexed: 11/16/2022]
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20
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Papas KK, Bellin MD, Sutherland DER, Suszynski TM, Kitzmann JP, Avgoustiniatos ES, Gruessner AC, Mueller KR, Beilman GJ, Balamurugan AN, Loganathan G, Colton CK, Koulmanda M, Weir GC, Wilhelm JJ, Qian D, Niland JC, Hering BJ. Islet Oxygen Consumption Rate (OCR) Dose Predicts Insulin Independence in Clinical Islet Autotransplantation. PLoS One 2015; 10:e0134428. [PMID: 26258815 PMCID: PMC4530873 DOI: 10.1371/journal.pone.0134428] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 07/10/2015] [Indexed: 12/05/2022] Open
Abstract
Background Reliable in vitro islet quality assessment assays that can be performed routinely, prospectively, and are able to predict clinical transplant outcomes are needed. In this paper we present data on the utility of an assay based on cellular oxygen consumption rate (OCR) in predicting clinical islet autotransplant (IAT) insulin independence (II). IAT is an attractive model for evaluating characterization assays regarding their utility in predicting II due to an absence of confounding factors such as immune rejection and immunosuppressant toxicity. Methods Membrane integrity staining (FDA/PI), OCR normalized to DNA (OCR/DNA), islet equivalent (IE) and OCR (viable IE) normalized to recipient body weight (IE dose and OCR dose), and OCR/DNA normalized to islet size index (ISI) were used to characterize autoislet preparations (n = 35). Correlation between pre-IAT islet product characteristics and II was determined using receiver operating characteristic analysis. Results Preparations that resulted in II had significantly higher OCR dose and IE dose (p<0.001). These islet characterization methods were highly correlated with II at 6–12 months post-IAT (area-under-the-curve (AUC) = 0.94 for IE dose and 0.96 for OCR dose). FDA/PI (AUC = 0.49) and OCR/DNA (AUC = 0.58) did not correlate with II. OCR/DNA/ISI may have some utility in predicting outcome (AUC = 0.72). Conclusions Commonly used assays to determine whether a clinical islet preparation is of high quality prior to transplantation are greatly lacking in sensitivity and specificity. While IE dose is highly predictive, it does not take into account islet cell quality. OCR dose, which takes into consideration both islet cell quality and quantity, may enable a more accurate and prospective evaluation of clinical islet preparations.
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Affiliation(s)
- Klearchos K. Papas
- Institute for Cellular Transplantation, Department of Surgery, University of Arizona, Tucson, Arizona, United States of America
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States of America
- Schulze Diabetes Institute, Minneapolis, Minnesota, United States of America
- * E-mail:
| | - Melena D. Bellin
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States of America
- Schulze Diabetes Institute, Minneapolis, Minnesota, United States of America
| | - David E. R. Sutherland
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States of America
- Schulze Diabetes Institute, Minneapolis, Minnesota, United States of America
| | - Thomas M. Suszynski
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States of America
- Schulze Diabetes Institute, Minneapolis, Minnesota, United States of America
| | - Jennifer P. Kitzmann
- Institute for Cellular Transplantation, Department of Surgery, University of Arizona, Tucson, Arizona, United States of America
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States of America
- Schulze Diabetes Institute, Minneapolis, Minnesota, United States of America
| | - Efstathios S. Avgoustiniatos
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States of America
- Schulze Diabetes Institute, Minneapolis, Minnesota, United States of America
| | - Angelika C. Gruessner
- Institute for Cellular Transplantation, Department of Surgery, University of Arizona, Tucson, Arizona, United States of America
| | - Kathryn R. Mueller
- Institute for Cellular Transplantation, Department of Surgery, University of Arizona, Tucson, Arizona, United States of America
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States of America
- Schulze Diabetes Institute, Minneapolis, Minnesota, United States of America
| | - Gregory J. Beilman
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Appakalai N. Balamurugan
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States of America
- Schulze Diabetes Institute, Minneapolis, Minnesota, United States of America
| | - Gopalakrishnan Loganathan
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States of America
- Schulze Diabetes Institute, Minneapolis, Minnesota, United States of America
| | - Clark K. Colton
- Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Maria Koulmanda
- The Transplant Institute, Beth Israel Deaconess Medical Center (BIDMC), Harvard Medical School, Boston, Massachusetts, United States of America
| | - Gordon C. Weir
- Joslin Diabetes Center, Boston, Massachusetts, United States of America
| | - Josh J. Wilhelm
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States of America
- Schulze Diabetes Institute, Minneapolis, Minnesota, United States of America
| | - Dajun Qian
- Information Science, City of Hope, Duarte, California, United States of America
| | - Joyce C. Niland
- Information Science, City of Hope, Duarte, California, United States of America
| | - Bernhard J. Hering
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, United States of America
- Schulze Diabetes Institute, Minneapolis, Minnesota, United States of America
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Wright AA, Cronin A, Milne DE, Bookman MA, Burger RA, Cohn DE, Cristea MC, Griggs JJ, Keating NL, Levenback CF, Mantia-Smaldone G, Matulonis UA, Meyer LA, Niland JC, Weeks JC, O'Malley DM. Use and Effectiveness of Intraperitoneal Chemotherapy for Treatment of Ovarian Cancer. J Clin Oncol 2015; 33:2841-7. [PMID: 26240233 DOI: 10.1200/jco.2015.61.4776] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE A 2006 randomized trial demonstrated a 16-month survival benefit with intraperitoneal and intravenous (IP/IV) chemotherapy administered to patients who had ovarian cancer, compared with IV chemotherapy alone, but more treatment-related toxicities. The objective of this study was to examine the use and effectiveness of IP/IV chemotherapy in clinical practice. PATIENTS AND METHODS Prospective cohort study of 823 women with stage III, optimally cytoreduced ovarian cancer diagnosed at six National Comprehensive Cancer Network institutions. We examined IP/IV chemotherapy use in all patients diagnosed between 2003 and 2012 (N = 823), and overall survival and treatment-related toxicities with Cox regression and logistic regression, respectively, in a propensity score-matched sample (n = 402) of patients diagnosed from 2006 to 2012, excluding trial participants, to minimize selection bias. RESULTS Use of IP/IV chemotherapy increased from 0% to 33% between 2003 and 2006, increased to 50% from 2007 to 2008, and plateaued thereafter. Between 2006 and 2012, adoption of IP/IV chemotherapy varied by institution from 4% to 67% (P < .001) and 43% of patients received modified IP/IV regimens at treatment initiation. In the propensity score-matched sample, IP/IV chemotherapy was associated with significantly improved overall survival (3-year overall survival, 81% v 71%; hazard ratio, 0.68; 95% CI, 0.47 to 0.99), compared with IV chemotherapy, but also more frequent alterations in chemotherapy delivery route (adjusted rates discontinuation or change, 20.4% v 10.0%; adjusted odds ratio, 2.83; 95% CI, 1.47 to 5.47). CONCLUSION Although the use of IP/IV chemotherapy increased significantly at National Comprehensive Cancer Network centers between 2003 and 2012, fewer than 50% of eligible patients received it. Increasing IP/IV chemotherapy use in clinical practice may be an important and underused strategy to improve ovarian cancer outcomes.
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Affiliation(s)
- Alexi A Wright
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Angel Cronin
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dana E Milne
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael A Bookman
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Robert A Burger
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David E Cohn
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mihaela C Cristea
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jennifer J Griggs
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nancy L Keating
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charles F Levenback
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gina Mantia-Smaldone
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ursula A Matulonis
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Larissa A Meyer
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Joyce C Niland
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jane C Weeks
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David M O'Malley
- Alexi A. Wright, Angel Cronin, Dana E. Milne, Nancy L. Keating, Ursula A. Matulonis, and Jane C. Weeks, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA; Michael A. Bookman, University of Arizona Cancer Center, Tucson, AZ; Robert A. Burger, University of Pennsylvania; Gina Mantia-Smaldone, Fox Chase Cancer Center, Philadelphia, PA; David E. Cohn and David M. O'Malley, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Mihaela Cristea and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte, CA; Jennifer J. Griggs, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; and Charles F. Levenback and Larissa A. Meyer, The University of Texas MD Anderson Cancer Center, Houston, TX
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22
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Tseng YD, Uno H, Hughes ME, Niland JC, Wong YN, Theriault R, Blitzblau RC, Moy B, Breslin T, Edge SB, Hassett MJ, Punglia RS. Biological Subtype Predicts Risk of Locoregional Recurrence After Mastectomy and Impact of Postmastectomy Radiation in a Large National Database. Int J Radiat Oncol Biol Phys 2015; 93:622-30. [PMID: 26461004 DOI: 10.1016/j.ijrobp.2015.07.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/17/2015] [Accepted: 07/06/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate locoregional recurrence (LRR) after mastectomy and impact of postmastectomy radiation (PMRT) by breast cancer subtype. METHODS AND MATERIALS Between 2000 and 2009, 5673 patients with stage I to III breast carcinoma underwent mastectomy and nodal evaluation; 30% received PMRT. Isolated LRR (iLRR) and LRR were compared across groups defined by biological subtype and receipt of trastuzumab: luminal A (estrogen [ER]/progesterone [PR]+, HER2-, low/intermediate grade), luminal B (ER/PR+, HER2-, high grade), HER2 with trastuzumab, HER2 without trastuzumab, and triple negative (TN; ER-, PR-, HER2-). LRR hazard ratios (HR) were estimated with multivariable Fine and Gray models. The effect of PMRT on LRR was evaluated with Fine and Gray models stratified by propensity for PMRT. RESULTS With a median follow-up time of 50.1 months, there were 19 iLRR and 109 LRR events. HER2 patients with trastuzumab had no iLRR and only a single LRR. Compared with luminal A patients, TN patients had significantly greater adjusted risk of iLRR (HR 14.10; 95% CI 2.97%-66.90%), with a similar trend among luminal B (HR 4.94; 95% CI 0.94%-25.82%) and HER2 patients without trastuzumab (HR 4.41; 95% CI 0.61%-32.11%). Although PMRT reduced LRR, the effect of PMRT varied by subgroup, with the greatest and smallest effects seen among luminal A (HR 0.17; 95% CI 0.05%-0.62%) and TN patients (HR 0.59; 95% CI 0.25%-1.35%), respectively. CONCLUSIONS TN patients had the highest risk of LRR and the least benefit from PMRT; these patients may benefit from alternative treatment strategies. In contrast, in the era of HER2-directed therapy, the role of local therapy may need to be reassessed among HER2 patients.
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Affiliation(s)
- Yolanda D Tseng
- Department of Radiation Oncology, University of Washington, Seattle, Washington.
| | - Hajime Uno
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Melissa E Hughes
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Joyce C Niland
- Department of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Yu-Ning Wong
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Richard Theriault
- Department of General Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rachel C Blitzblau
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Beverly Moy
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Tara Breslin
- Division of Surgical Oncology, Department of Surgery, Northwestern Lake Forest Hospital, Lake Forest, Illinois
| | - Stephen B Edge
- Baptist Cancer Center, Memphis, Tennessee; Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Michael J Hassett
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Rinaa S Punglia
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
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23
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Behrendt CE, Hurria A, Tumyan L, Niland JC, Mortimer JE. Socioeconomic and clinical factors are key to uncovering disparity in accrual onto therapeutic trials for breast cancer. J Natl Compr Canc Netw 2015; 12:1579-85. [PMID: 25361805 DOI: 10.6004/jnccn.2014.0158] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To monitor and address disparity in accrual, patient participation in cancer clinical trials is routinely summarized by race/ethnicity. To investigate whether confounding obscures racial/ethnic disparity in participation, all women with breast cancer treated by medical oncologists at City of Hope Comprehensive Cancer Center from 2004 through 2009 were classified by birthplace and self-reported race/ethnicity, and followed for accrual onto therapeutic trials through 2010. Undetectable on univariate analysis, significantly reduced participation by subjects of African, Asian, Eastern European, Latin American, and Middle Eastern ancestries was revealed after accounting for age, socioeconomic factors, tumor and oncologist characteristics, and intrapractice clustering of patients.
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Affiliation(s)
- Carolyn E Behrendt
- From the Departments of Information Sciences, Medical Oncology, and Diagnostic Radiology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Arti Hurria
- From the Departments of Information Sciences, Medical Oncology, and Diagnostic Radiology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Lusine Tumyan
- From the Departments of Information Sciences, Medical Oncology, and Diagnostic Radiology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Joyce C Niland
- From the Departments of Information Sciences, Medical Oncology, and Diagnostic Radiology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Joanne E Mortimer
- From the Departments of Information Sciences, Medical Oncology, and Diagnostic Radiology, City of Hope Comprehensive Cancer Center, Duarte, California
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24
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Meyer L, Cronin A, Sun CC, Bookman MA, Burger RA, Cristea MC, Griggs JJ, Levenback CF, Mantia-Smaldone G, Matulonis U, Niland JC, O'Malley DM, Wright AA. Use of neoadjuvant chemotherapy in advanced ovarian cancer. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.5563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Larissa Meyer
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Robert Allen Burger
- Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA
| | - Mihaela C. Cristea
- City of Hope, Department of Medical Oncology and Therapeutics Research, Duarte, CA
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25
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Warner ET, Tamimi RM, Hughes ME, Ottesen RA, Wong YN, Edge SB, Theriault RL, Blayney DW, Niland JC, Winer EP, Weeks JC, Partridge AH. Racial and Ethnic Differences in Breast Cancer Survival: Mediating Effect of Tumor Characteristics and Sociodemographic and Treatment Factors. J Clin Oncol 2015; 33:2254-61. [PMID: 25964252 DOI: 10.1200/jco.2014.57.1349] [Citation(s) in RCA: 211] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To evaluate the relationship between race/ethnicity and breast cancer-specific survival according to subtype and explore mediating factors. PATIENTS AND METHODS Participants were women presenting with stage I to III breast cancer between January 2000 and December 2007 at National Comprehensive Cancer Network centers with survival follow-up through December 2009. Cox proportional hazards regression was used to compare breast cancer-specific survival among Asians (n = 533), Hispanics (n = 1,122), and blacks (n = 1,345) with that among whites (n = 14,268), overall and stratified by subtype (luminal A like, luminal B like, human epidermal growth factor receptor 2 type, and triple negative). Model estimates were used to derive mediation proportion and 95% CI for selected risk factors. RESULTS In multivariable adjusted models, overall, blacks had 21% higher risk of breast cancer-specific death (hazard ratio [HR], 1.21; 95% CI, 1.00 to 1.45). For estrogen receptor-positive tumors, black and white survival differences were greatest within 2 years of diagnosis (years 0 to 2: HR, 2.65; 95% CI, 1.34 to 5.24; year 2 to end of follow-up: HR, 1.50; 95% CI, 1.12 to 2.00). Blacks were 76% and 56% more likely to die as a result of luminal A-like and luminal B-like tumors, respectively. No disparities were observed for triple-negative or human epidermal growth factor receptor 2-type tumors. Asians and Hispanics were less likely to die as a result of breast cancer compared with whites (Asians: HR, 0.56; 95% CI, 0.37 to 0.85; Hispanics: HR, 0.74; 95% CI, 0.58 to 0.95). For blacks, tumor characteristics and stage at diagnosis were significant disparity mediators. Body mass index was an important mediator for blacks and Asians. CONCLUSION Racial disparities in breast cancer survival vary by tumor subtype. Interventions are needed to reduce disparities, particularly in the first 2 years after diagnosis among black women with estrogen receptor-positive tumors.
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Affiliation(s)
- Erica T Warner
- Erica T. Warner and Rulla M. Tamimi, Harvard School of Public Health; Erica T. Warner, Rulla M. Tamimi, Melissa E. Hughes, Eric P. Winer, Jane C. Weeks, and Ann H. Partridge, Brigham and Women's Hospital; Melissa E. Hughes, Eric P. Winer, Jane C. Weeks, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Rebecca A. Ottesen and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte; Douglas W. Blayney, Stanford University Cancer Center, Palo Alto, CA; Yu-Ning Wong, Fox Chase Cancer Center, Philadelphia, PA; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Richard L. Theriault, University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Rulla M Tamimi
- Erica T. Warner and Rulla M. Tamimi, Harvard School of Public Health; Erica T. Warner, Rulla M. Tamimi, Melissa E. Hughes, Eric P. Winer, Jane C. Weeks, and Ann H. Partridge, Brigham and Women's Hospital; Melissa E. Hughes, Eric P. Winer, Jane C. Weeks, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Rebecca A. Ottesen and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte; Douglas W. Blayney, Stanford University Cancer Center, Palo Alto, CA; Yu-Ning Wong, Fox Chase Cancer Center, Philadelphia, PA; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Richard L. Theriault, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Melissa E Hughes
- Erica T. Warner and Rulla M. Tamimi, Harvard School of Public Health; Erica T. Warner, Rulla M. Tamimi, Melissa E. Hughes, Eric P. Winer, Jane C. Weeks, and Ann H. Partridge, Brigham and Women's Hospital; Melissa E. Hughes, Eric P. Winer, Jane C. Weeks, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Rebecca A. Ottesen and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte; Douglas W. Blayney, Stanford University Cancer Center, Palo Alto, CA; Yu-Ning Wong, Fox Chase Cancer Center, Philadelphia, PA; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Richard L. Theriault, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rebecca A Ottesen
- Erica T. Warner and Rulla M. Tamimi, Harvard School of Public Health; Erica T. Warner, Rulla M. Tamimi, Melissa E. Hughes, Eric P. Winer, Jane C. Weeks, and Ann H. Partridge, Brigham and Women's Hospital; Melissa E. Hughes, Eric P. Winer, Jane C. Weeks, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Rebecca A. Ottesen and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte; Douglas W. Blayney, Stanford University Cancer Center, Palo Alto, CA; Yu-Ning Wong, Fox Chase Cancer Center, Philadelphia, PA; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Richard L. Theriault, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yu-Ning Wong
- Erica T. Warner and Rulla M. Tamimi, Harvard School of Public Health; Erica T. Warner, Rulla M. Tamimi, Melissa E. Hughes, Eric P. Winer, Jane C. Weeks, and Ann H. Partridge, Brigham and Women's Hospital; Melissa E. Hughes, Eric P. Winer, Jane C. Weeks, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Rebecca A. Ottesen and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte; Douglas W. Blayney, Stanford University Cancer Center, Palo Alto, CA; Yu-Ning Wong, Fox Chase Cancer Center, Philadelphia, PA; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Richard L. Theriault, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stephen B Edge
- Erica T. Warner and Rulla M. Tamimi, Harvard School of Public Health; Erica T. Warner, Rulla M. Tamimi, Melissa E. Hughes, Eric P. Winer, Jane C. Weeks, and Ann H. Partridge, Brigham and Women's Hospital; Melissa E. Hughes, Eric P. Winer, Jane C. Weeks, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Rebecca A. Ottesen and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte; Douglas W. Blayney, Stanford University Cancer Center, Palo Alto, CA; Yu-Ning Wong, Fox Chase Cancer Center, Philadelphia, PA; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Richard L. Theriault, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Richard L Theriault
- Erica T. Warner and Rulla M. Tamimi, Harvard School of Public Health; Erica T. Warner, Rulla M. Tamimi, Melissa E. Hughes, Eric P. Winer, Jane C. Weeks, and Ann H. Partridge, Brigham and Women's Hospital; Melissa E. Hughes, Eric P. Winer, Jane C. Weeks, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Rebecca A. Ottesen and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte; Douglas W. Blayney, Stanford University Cancer Center, Palo Alto, CA; Yu-Ning Wong, Fox Chase Cancer Center, Philadelphia, PA; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Richard L. Theriault, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Douglas W Blayney
- Erica T. Warner and Rulla M. Tamimi, Harvard School of Public Health; Erica T. Warner, Rulla M. Tamimi, Melissa E. Hughes, Eric P. Winer, Jane C. Weeks, and Ann H. Partridge, Brigham and Women's Hospital; Melissa E. Hughes, Eric P. Winer, Jane C. Weeks, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Rebecca A. Ottesen and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte; Douglas W. Blayney, Stanford University Cancer Center, Palo Alto, CA; Yu-Ning Wong, Fox Chase Cancer Center, Philadelphia, PA; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Richard L. Theriault, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Joyce C Niland
- Erica T. Warner and Rulla M. Tamimi, Harvard School of Public Health; Erica T. Warner, Rulla M. Tamimi, Melissa E. Hughes, Eric P. Winer, Jane C. Weeks, and Ann H. Partridge, Brigham and Women's Hospital; Melissa E. Hughes, Eric P. Winer, Jane C. Weeks, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Rebecca A. Ottesen and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte; Douglas W. Blayney, Stanford University Cancer Center, Palo Alto, CA; Yu-Ning Wong, Fox Chase Cancer Center, Philadelphia, PA; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Richard L. Theriault, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eric P Winer
- Erica T. Warner and Rulla M. Tamimi, Harvard School of Public Health; Erica T. Warner, Rulla M. Tamimi, Melissa E. Hughes, Eric P. Winer, Jane C. Weeks, and Ann H. Partridge, Brigham and Women's Hospital; Melissa E. Hughes, Eric P. Winer, Jane C. Weeks, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Rebecca A. Ottesen and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte; Douglas W. Blayney, Stanford University Cancer Center, Palo Alto, CA; Yu-Ning Wong, Fox Chase Cancer Center, Philadelphia, PA; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Richard L. Theriault, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jane C Weeks
- Erica T. Warner and Rulla M. Tamimi, Harvard School of Public Health; Erica T. Warner, Rulla M. Tamimi, Melissa E. Hughes, Eric P. Winer, Jane C. Weeks, and Ann H. Partridge, Brigham and Women's Hospital; Melissa E. Hughes, Eric P. Winer, Jane C. Weeks, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Rebecca A. Ottesen and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte; Douglas W. Blayney, Stanford University Cancer Center, Palo Alto, CA; Yu-Ning Wong, Fox Chase Cancer Center, Philadelphia, PA; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Richard L. Theriault, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ann H Partridge
- Erica T. Warner and Rulla M. Tamimi, Harvard School of Public Health; Erica T. Warner, Rulla M. Tamimi, Melissa E. Hughes, Eric P. Winer, Jane C. Weeks, and Ann H. Partridge, Brigham and Women's Hospital; Melissa E. Hughes, Eric P. Winer, Jane C. Weeks, and Ann H. Partridge, Dana-Farber Cancer Institute, Boston, MA; Rebecca A. Ottesen and Joyce C. Niland, City of Hope Comprehensive Cancer Center, Duarte; Douglas W. Blayney, Stanford University Cancer Center, Palo Alto, CA; Yu-Ning Wong, Fox Chase Cancer Center, Philadelphia, PA; Stephen B. Edge, Baptist Cancer Center, Memphis, TN; and Richard L. Theriault, University of Texas MD Anderson Cancer Center, Houston, TX
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Miller M, Ottesen RA, Niland JC, Kruper L, Chen SL, Vito C. Tumor response ratio predicts overall survival in breast cancer patients treated with neoadjuvant chemotherapy. Ann Surg Oncol 2014; 21:3317-23. [PMID: 25059788 DOI: 10.1245/s10434-014-3922-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) is commonly used to treat locally advanced breast cancer. Pathologic complete response (pCR) predicts improved overall survival (OS); however, prognosis of patients with partial response remains unclear. We evaluated whether tumor response ratio (TRR) is a better predictor of OS than current staging methods. METHODS Using the National Comprehensive Cancer Network Breast Cancer Outcomes Database, we identified patients with stage I-III breast cancer who had NAC and pretreatment imaging at City of Hope (1997-2010). Patient demographics, tumor characteristics, and OS were analyzed. TRR was calculated as residual in-breast disease divided by size on pre-NAC imaging. Four TRR groups were stratified; TRR 0 (pCR), TRR > 0-0.4 (strong partial response, SPR), TRR > 0.4-1.0 (weak partial response, WPR), or TRR > 1.0 (tumor growth, TG). OS was estimated by the Kaplan-Meier method and tested by the log-rank test. Cox regression was performed to evaluate associations between OS and TRR in a multivariable analysis while controlling for potential confounders. RESULTS There were 218 eligible patients identified; 59 (27 %) had pCR, 61 (28 %) SPR, 72 (33 %) WPR, and 26 (12 %) TG. Five-year OS decreased continuously with increasing TRR:pCR (90 %), SPR (79 %), WPR (66 %), and TG (60 %). TRR was the only measure that significantly predicted OS (p = 0.0035); pathologic stage (p = 0.23) and pre-NAC clinical tumor stage (cT) (p = 0.87) were not significant. TRR continued to be statistically significant by multivariable analysis (p = 0.016). CONCLUSIONS TRR takes into account both pretreatment and residual disease and more accurately predicts OS than pathologic stage and pre-NAC cT. TRR may be useful to more accurately assess prognosis and OS in breast cancer patients undergoing NAC.
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Affiliation(s)
- Marian Miller
- Department of Surgical Oncology, City of Hope, Duarte, CA, USA
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McCormick B, Ottesen RA, Hughes ME, Javid SH, Khan SA, Mortimer J, Niland JC, Weeks JC, Edge SB. Impact of guideline changes on use or omission of radiation in the elderly with early breast cancer: practice patterns at National Comprehensive Cancer Network institutions. J Am Coll Surg 2014; 219:796-802. [PMID: 25127504 DOI: 10.1016/j.jamcollsurg.2014.05.013] [Citation(s) in RCA: 37] [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: 03/25/2014] [Revised: 05/22/2014] [Accepted: 05/23/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Breast radiation therapy (RT) is a care standard after breast-conservation surgery that improves local control and survival in women. In 2004, a phase III trial demonstrated radiation after breast-conservation surgery provided no survival and limited local control benefit to women aged 70 years and older with stage I, estrogen receptor-positive cancers who receive endocrine therapy. This led to breast-conservation surgery and endocrine therapy alone being incorporated as a category I option in the National Comprehensive Cancer Network (NCCN) Guidelines for older women in 2004. We examined factors associated with change in radiation use in elderly patients at 13 NCCN centers. STUDY DESIGN We identified women treated at NCCN centers meeting age and stage criteria during 2000 to 2009. Factors considered a priori potentially associated with RT use were evaluated in univariate and multivariable models, including year of diagnosis, tumor and patient characteristics, axillary surgery, and treating institution. Date of diagnosis was classified as 2000 to 2004 vs 2005 to 2009, reflecting when guidelines changed. RESULTS Among 1,292 eligible cases, 78% received RT. In multivariable analysis, diagnosis after 2004 (p = 0.0003), older age (p < 0.0001), higher comorbidity score (p = 0.0006), smaller tumors (p = 0.0146), and omission of axillary surgery (p < 0.0001) predicted RT omission. Ninety-four percent of women aged 70 to 74 years received RT in 2000, compared with 88% in 2009. For the same times and age 80 years and older, RT use was 80% vs 41%. Finally, RT use was associated with treating institution (p < 0.0001). CONCLUSIONS After guideline changes for RT use in older women, NCCN centers demonstrated wide variation in implementing change. This suggests other factors are also influencing guideline uptake.
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Affiliation(s)
| | | | | | - Sara H Javid
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Seema A Khan
- Robert H Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | | | | | | | - Stephen B Edge
- Baptist Cancer Center, Memphis, TN; Vanderbilt University School of Medicine, Nashville, TN
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Wright AA, Cronin A, Milne D, Bookman MA, Burger RA, Cristea MC, Griggs JJ, Levenback C, Niland JC, Weeks JC, O'Malley D. Effect of intraperitoneal chemotherapy on survival for ovarian cancer in clinical practice and frequency of use. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.5576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Angel Cronin
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Dana Milne
- Dana-Farber Cancer Institute, Boston, MA
| | | | | | | | | | | | | | | | - David O'Malley
- Ohio State University Wexner Medical Center, Columbus, OH
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Herrera AF, Crosby-Thompson A, Friedberg JW, Abel GA, Czuczman MS, Gordon LI, Kaminski MS, Millenson MM, Nademanee AP, Niland JC, Rodig SJ, Rodriguez MA, Zelenetz AD, LaCasce AS. Comparison of referring and final pathology for patients with T-cell lymphoma in the National Comprehensive Cancer Network. Cancer 2014; 120:1993-9. [PMID: 24706502 DOI: 10.1002/cncr.28676] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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: 12/23/2013] [Revised: 02/04/2014] [Accepted: 02/20/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND T-cell lymphomas (TCLs) are uncommon in the United States. The accurate diagnosis of TCL is challenging and requires morphologic interpretation, immunophenotyping, and molecular techniques. The authors compared pathologic diagnoses at referring centers with diagnoses from expert hematopathology review to determine concordance rates and to characterize the usefulness of second-opinion pathology review for TCL. METHODS Patients in the National Comprehensive Cancer Network non-Hodgkin lymphoma database with peripheral TCL, not otherwise specified (PTCL-NOS), angioimmunoblastic TCL (AITL), and anaplastic lymphoma kinase (ALK)-positive and ALK-negative anaplastic large cell lymphoma (ALCL) were eligible if they had prior tissue specimens examined at a referring institution. Pathologic concordance was evaluated using available pathology and diagnostic testing reports and provider progress notes. The etiology of discordance and the potential impact on treatment were examined. RESULTS Among 131 eligible patients, 57 (44%) had concordant results, totaling 64% of the 89 patients who were referred with a final diagnosis. Thirty-two patients (24%) had discordant results, representing 36% of those who were referred with a final diagnosis. The rates of discordance among patients with of PTCL-NOS, AITL, ALK-negative ALCL, and ALK-positive ALCL were 19%, 33%, 34%, and 6%, respectively. In 14 patients (44% of discordant results), pathologic reclassification could have resulted in a different therapeutic strategy. Forty-two patients (32%) were referred for classification with a provisional diagnosis. CONCLUSIONS In a large cohort of patients with TCL who were referred to National Comprehensive Cancer Network centers, the likelihood of a concordant final diagnosis at a referring institution was low. As current and future therapies target TCL subsets, these data suggest that patients with suspected TCLs would benefit from evaluation by an expert hematopathologist.
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Affiliation(s)
- Alex F Herrera
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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Magness ST, Puthoff BJ, Crissey MA, Dunn J, Henning SJ, Houchen C, Kaddis JS, Kuo CJ, Li L, Lynch J, Martin MG, May R, Niland JC, Olack B, Qian D, Stelzner M, Swain JR, Wang F, Wang J, Wang X, Yan K, Yu J, Wong MH. A multicenter study to standardize reporting and analyses of fluorescence-activated cell-sorted murine intestinal epithelial cells. Am J Physiol Gastrointest Liver Physiol 2013; 305:G542-51. [PMID: 23928185 PMCID: PMC3798732 DOI: 10.1152/ajpgi.00481.2012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Fluorescence-activated cell sorting (FACS) is an essential tool for studies requiring isolation of distinct intestinal epithelial cell populations. Inconsistent or lack of reporting of the critical parameters associated with FACS methodologies has complicated interpretation, comparison, and reproduction of important findings. To address this problem a comprehensive multicenter study was designed to develop guidelines that limit experimental and data reporting variability and provide a foundation for accurate comparison of data between studies. Common methodologies and data reporting protocols for tissue dissociation, cell yield, cell viability, FACS, and postsort purity were established. Seven centers tested the standardized methods by FACS-isolating a specific crypt-based epithelial population (EpCAM+/CD44+) from murine small intestine. Genetic biomarkers for stem/progenitor (Lgr5 and Atoh 1) and differentiated cell lineages (lysozyme, mucin2, chromogranin A, and sucrase isomaltase) were interrogated in target and control populations to assess intra- and intercenter variability. Wilcoxon's rank sum test on gene expression levels showed limited intracenter variability between biological replicates. Principal component analysis demonstrated significant intercenter reproducibility among four centers. Analysis of data collected by standardized cell isolation methods and data reporting requirements readily identified methodological problems, indicating that standard reporting parameters facilitate post hoc error identification. These results indicate that the complexity of FACS isolation of target intestinal epithelial populations can be highly reproducible between biological replicates and different institutions by adherence to common cell isolation methods and FACS gating strategies. This study can be considered a foundation for continued method development and a starting point for investigators that are developing cell isolation expertise to study physiology and pathophysiology of the intestinal epithelium.
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Affiliation(s)
| | | | | | - James Dunn
- 3University of California Los Angeles, Los Angeles, California;
| | | | | | | | | | - Linheng Li
- 7Stowers Institute for Medical Research, Kansas City, Missouri;
| | - John Lynch
- 2University of Pennsylvania, Philadelphia, Pennsylvania;
| | | | - Randal May
- 4University of Oklahoma, Oklahoma City, Oklahoma;
| | | | | | | | | | - John R. Swain
- 8Oregon Health & Science University, Portland, Oregon; and
| | - Fengchao Wang
- 7Stowers Institute for Medical Research, Kansas City, Missouri;
| | - Jiafang Wang
- 3University of California Los Angeles, Los Angeles, California;
| | - Xinwei Wang
- 9University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kelley Yan
- 6Stanford University, Stanford, California;
| | - Jian Yu
- 9University of Pittsburgh, Pittsburgh, Pennsylvania
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Vandergrift JL, Niland JC, Theriault RL, Edge SB, Wong YN, Loftus LS, Breslin TM, Hudis CA, Javid SH, Rugo HS, Silver SM, Lepisto EM, Weeks JC. Time to adjuvant chemotherapy for breast cancer in National Comprehensive Cancer Network institutions. J Natl Cancer Inst 2012; 105:104-12. [PMID: 23264681 DOI: 10.1093/jnci/djs506] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND High-quality care must be not only appropriate but also timely. We assessed time to initiation of adjuvant chemotherapy for breast cancer as well as factors associated with delay to help identify targets for future efforts to reduce unnecessary delays. METHODS Using data from the National Comprehensive Cancer Network (NCCN) Outcomes Database, we assessed the time from pathological diagnosis to initiation of chemotherapy (TTC) among 6622 women with stage I to stage III breast cancer diagnosed from 2003 through 2009 and treated with adjuvant chemotherapy in nine NCCN centers. Multivariable models were constructed to examine factors associated with TTC. All statistical tests were two-sided. RESULTS Mean TTC was 12.0 weeks overall and increased over the study period. A number of factors were associated with a longer TTC. The largest effects were associated with therapeutic factors, including immediate postmastectomy reconstruction (2.7 weeks; P < .001), re-excision (2.1 weeks; P < .001), and use of the 21-gene reverse-transcription polymerase chain reaction assay (2.2 weeks; P < .001). In comparison with white women, a longer TTC was observed among black (1.5 weeks; P < .001) and Hispanic (0.8 weeks; P < .001) women. For black women, the observed disparity was greater among women who transferred their care to the NCCN center after diagnosis (P (interaction) = .008) and among women with Medicare vs commercial insurance (P (interaction) < .001). CONCLUSIONS Most observed variation in TTC was related to use of appropriate therapeutic interventions. This suggests the importance of targeted efforts to minimize potentially preventable causes of delay, including inefficient transfers in care or prolonged appointment wait times.
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Affiliation(s)
- Jonathan L Vandergrift
- Outcomes Research Group, National Comprehensive Cancer Network, Fort Washington, PA, USA.
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Khrizman P, Niland JC, ter Veer A, Milne D, Bullard Dunn K, Carson WE, Engstrom PF, Shibata S, Skibber JM, Weiser MR, Schrag D, Benson AB. Postoperative adjuvant chemotherapy use in patients with stage II/III rectal cancer treated with neoadjuvant therapy: a national comprehensive cancer network analysis. J Clin Oncol 2012; 31:30-8. [PMID: 23169502 DOI: 10.1200/jco.2011.40.3188] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Practice guidelines recommend that patients who receive neoadjuvant chemotherapy and radiation for locally advanced rectal cancer complete postoperative adjuvant systemic chemotherapy, irrespective of tumor downstaging. PATIENTS AND METHODS The National Comprehensive Cancer Network (NCCN) Colorectal Cancer Database tracks longitudinal care for patients treated at eight specialty cancer centers across the United States and was used to evaluate how frequently patients with rectal cancer who were treated with neoadjuvant chemotherapy also received postoperative systemic chemotherapy. Patient and tumor characteristics were examined in a multivariable logistic regression model. RESULTS Between September 2005 and December 2010, 2,073 patients with stage II/III rectal cancer were enrolled in the database. Of these, 1,193 patients receiving neoadjuvant chemoradiotherapy were in the analysis, including 203 patients not receiving any adjuvant chemotherapy. For those seen by a medical oncologist, the most frequent reason chemotherapy was not recommended was comorbid illness (25 of 50, 50%); the most frequent reason chemotherapy was not received even though it was recommended or discussed was patient refusal (54 of 74, 73%). After controlling for NCCN Cancer Center and clinical TNM stage in a multivariable logistic model, factors significantly associated with not receiving adjuvant chemotherapy were age, Eastern Cooperative Oncology Group performance status ≥ 1, on Medicaid or indigent compared with private insurance, complete pathologic response, presence of re-operation/wound infection, and no closure of ileostomy/colostomy. CONCLUSION Even at specialty cancer centers, a sizeable minority of patients with rectal cancer treated with curative-intent neoadjuvant chemoradiotherapy do not complete postoperative chemotherapy. Strategies to facilitate the ability to complete this third and final component of curative intent treatment are necessary.
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Affiliation(s)
- Polina Khrizman
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL 66011, USA
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Zornosa C, Vandergrift JL, Kalemkerian GP, Ettinger DS, Rabin MS, Reid M, Otterson GA, Koczywas M, D'Amico TA, Niland JC, Mamet R, Pisters KM. First-line systemic therapy practice patterns and concordance with NCCN guidelines for patients diagnosed with metastatic NSCLC treated at NCCN institutions. J Natl Compr Canc Netw 2012; 10:847-56. [PMID: 22773800 DOI: 10.6004/jnccn.2012.0088] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) allow many systemic therapy options for patients with metastatic non-small cell lung cancer (NSCLC). This analysis uses the NCCN NSCLC Outcomes Database to report on first-line therapy practice patterns and concordance with NCCN Guidelines. The analysis was limited to patients diagnosed with metastatic NSCLC between September 2006 and November 2009 at 1 of 8 participating NCCN Member Institutions. Patient characteristics, regimens used, and guidelines concordance were analyzed. Institutional variation and changes in practice over time were also measured. A total of 1717 patients were included in the analysis. Of these, 1375 (80%) were treated with systemic therapy, most often in the form of a carboplatin-based doublet (51%) or carboplatin-based doublet with targeted therapy (17%). Overall, 76% of patients received care that was concordant with NCCN Guidelines. Among patients with good performance status (n = 167), the most common reasons for not receiving first-line therapy were that therapy was not recommended (39%) or death occurred before treatment (33%). The most common reason for receiving nonconcordant drug therapy was the administration of pemetrexed or erlotinib before its incorporation into the NCCN Guidelines for first-line therapy (53%). Most patients in this cohort received care that was concordant with NCCN Guidelines. The NSCLC Outcomes Database is a valuable resource for evaluating practice patterns and concordance with NCCN Guidelines among patients with NSCLC.
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Affiliation(s)
- Carrie Zornosa
- National Comprehensive Cancer Network, Fort Washington, PA 19034, USA.
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Warner ET, Tamimi RM, Hughes ME, Ottesen RA, Wong YN, Edge SB, Theriault RL, Blayney DW, Niland JC, Winer EP, Weeks JC, Partridge AH. Time to diagnosis and breast cancer stage by race/ethnicity. Breast Cancer Res Treat 2012; 136:813-21. [PMID: 23099438 DOI: 10.1007/s10549-012-2304-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 10/13/2012] [Indexed: 01/07/2023]
Abstract
We examined differences in time to diagnosis by race/ethnicity, the relationship between time to diagnosis and stage, and the extent to which it explains differences in stage at diagnosis across racial/ethnic groups. Our analytic sample includes 21,427 non-Hispanic White (White), Hispanic, non-Hispanic Black (Black) and non-Hispanic Asian/Pacific Islander (Asian) women diagnosed with stage I to IV breast cancer between January 1, 2000 and December 31, 2007 at one of eight National Comprehensive Cancer Network centers. We measured time from initial abnormal mammogram or symptom to breast cancer diagnosis. Stage was classified using AJCC criteria. Initial sign of breast cancer modified the association between race/ethnicity and time to diagnosis. Among symptomatic women, median time to diagnosis ranged from 36 days among Whites to 53.6 for Blacks. Among women with abnormal mammograms, median time to diagnosis ranged from 21 days among Whites to 29 for Blacks. Blacks had the highest proportion (26 %) of Stage III or IV tumors. After accounting for time to diagnosis, the observed increased risk of stage III/IV breast cancer was reduced from 40 to 28 % among Hispanics and from 113 to 100 % among Blacks, but estimates remained statistically significant. We were unable to fully account for the higher proportion of late-stage tumors among Blacks. Blacks and Hispanics experienced longer time to diagnosis than Whites, and Blacks were more likely to be diagnosed with late-stage tumors. Longer time to diagnosis did not fully explain differences in stage between racial/ethnicity groups.
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Affiliation(s)
- Erica T Warner
- Department of Epidemiology, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA.
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Vaz-Luis I, Ottesen RA, Hughes ME, Marcom PK, Moy B, Rugo HS, Theriault RL, Wilson J, Niland JC, Weeks JC, Lin NU. Impact of hormone receptor status on patterns of recurrence and clinical outcomes among patients with human epidermal growth factor-2-positive breast cancer in the National Comprehensive Cancer Network: a prospective cohort study. Breast Cancer Res 2012; 14:R129. [PMID: 23025714 PMCID: PMC4053106 DOI: 10.1186/bcr3324] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Accepted: 10/01/2012] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION In gene expression experiments, hormone receptor (HR)-positive/human epidermal growth factor-2 (HER2)-positive tumors generally cluster within the luminal B subset; whereas HR-negative/HER2-positive tumors reside in the HER2-enriched subset. We investigated whether the clinical behavior of HER2-positive tumors differs by HR status. METHODS We evaluated 3,394 patients who presented to National Comprehensive Cancer Network (NCCN) centers with stage I to III HER2-positive breast cancer between 2000 and 2007. Tumors were grouped as HR-positive/HER2-positive (HR+/HER2+) or HR-negative/HER2-positive (HR-/HER2+). Chi-square, logistic regression and Cox hazard proportional regression were used to compare groups. RESULTS Median follow-up was four years. Patients with HR-/HER2+ tumors (n = 1,379, 41% of total) were more likely than those with HR+/HER-2+ disease (n = 2,015, 59% of total) to present with high histologic grade and higher stages (P <0.001). Recurrences were recorded for 458 patients. HR-/HER2+ patients were less likely to experience first recurrence in bone (univariate Odds Ratio (OR) = 0.53, 95% Confidence Interval (CI): 0.34 to 0.82, P = 0.005) and more likely to recur in brain (univariate OR = 1.75, 95% CI: 1.05 to 2.93, P = 0.033). A lower risk of recurrence in bone persisted after adjusting for age, stage and adjuvant trastuzumab therapy (OR = 0.53, 95% CI: 0.34 to 0.83, P = 0.005) and when first and subsequent sites of recurrence were both considered (multivariable OR = 0.55, 95% CI: 0.37 to 0.80, P = 0.002). CONCLUSIONS Presenting features, patterns of recurrence and survival of HER2-positive breast cancer differed by HR status. These differences should be further explored and integrated in the design of clinical trials.
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Warner ET, Tamimi RM, Hughes ME, Ottesen RA, Wong YN, Edge SB, Theriault RL, Blayney DW, Niland JC, Winer EP, Weeks JC, Partridge AH. Abstract PR06: Racial/ethnic differences in breast cancer survival and mediating effects of tumor characteristics, sociodemographic, and treatment factors. Cancer Epidemiol Biomarkers Prev 2012. [DOI: 10.1158/1055-9965.disp12-pr06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose: To evaluate the relationship between race/ethnicity and breast cancer specific survival and to investigate the mediating effects of tumor characteristics, treatment, anthropomorphic and sociodemographic factors on racial/ethnic disparities in survival.
Methods: Analysis included 19,480 women presenting to National Comprehensive Cancer Network centers with stage I-III breast cancer between January 2000 and December 2007 with National Death Index survival follow-up through December 2009. Multiple Cox proportional hazards regression models were used to compare breast cancer specific mortality by Non-Hispanic Asian-Pacific Islanders (Asian, n=634), Hispanics (Hispanic, n=1,291), Non-Hispanic Blacks (Black, n=1,500) as compared to Non-Hispanic Whites (White, n=16,055) respectively. Additionally models were analyzed overall and also stratified by tumor subtypes. Cox models were analyzed with control variables in steps: age adjusted, plus SES factors, plus tumor characteristics, plus treatment variables. Mediation analyses were performed to estimate the proportion of excess breast cancer mortality mediated through exposures.
Results: Median follow-up time was 6.9 years. Due to non-proportional hazards among Blacks, overall and within certain clinical subgroup models, analyses for total breast cancer, estrogen receptor positive and negative (ER+ and ER-) and basal tumors were performed in two time periods (0-3 years and 3 years to end of follow-up (EOF)). In multivariable fully adjusted models, Blacks had higher risk of breast cancer specific death overall (years 0-3: hazard ratio [HR] 1.48, 95% confidence interval [CI] 1.12-1.94; years 3 to EOF: HR 1.34, 95% CI 1.06-1.69), among ER+ tumors (years 0-3: HR 2.85, 95% CI 1.75-4.62; years 3 to EOF: HR 1.49, 95% CI 1.11-2.00), and for luminal B subtypes (HR 1.76, 95% CI 1.30-2.39) as well as for luminal A subtypes (HR 1.66, 95% CI 1.03-2.67) subtypes. After adjustment for age, SES factors, tumor characteristics and treatment variables there were no significant differences between Blacks and Whites for ER-, basal, or Her2 over expressed tumors. In fully adjusted models Asians were at significantly lower risk of death from breast cancer as compared to Whites (all cancers: HR 0.60, 95% CI 0.40-0.90; ER- tumors: HR 0.51, 95% CI 0.27-0.94; luminal A: HR 0.23, 95% CI 0.06-0.93; HER2 over expressed tumors: HR 0.25, 95% CI 0.07-0.92). There were no significant differences in breast cancer mortality between Hispanics and Whites. The estimated proportion of excess breast cancer mortality among Blacks that was mediated by tumor markers (estrogen, progesterone, and her2neu) and grade was 24.8% (p<0.0001). Other mediators included stage at diagnosis (18.2%, p=0.002), comorbidity score (13.8%, p=0.02), body mass index (BMI) (9.8%, p=0.04), and insurance type (9.5%, p=0.04). Among Asians, BMI (13.9%, p=0.06) was an important mediator.
Conclusions: Blacks are at higher risk of breast cancer death as compared to Whites, particularly in the first three years after diagnosis and predominantly among ER+, luminal A and luminal B tumor subtypes. This excess risk is mediated through differences in tumor characteristics, stage at diagnosis, comorbid conditions, BMI, and insurance type. Asian women have better breast cancer survival than Whites somewhat mediated through their lower BMI at diagnosis.
This abstract is also presented as Poster B64.
Citation Format: Erica T. Warner, Rulla M. Tamimi, Melissa E. Hughes, Rebecca A. Ottesen, Yu-Ning Wong, Stephen B. Edge, Richard L. Theriault, Douglas W. Blayney, Joyce C. Niland, Eric P. Winer, Jane C. Weeks, Ann H. Partridge. Racial/ethnic differences in breast cancer survival and mediating effects of tumor characteristics, sociodemographic, and treatment factors. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr PR06.
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Affiliation(s)
| | - Rulla M. Tamimi
- 2Channing Laboratory, Brigham and Women's Hospital, Boston, MA,
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Ferketich AK, Niland JC, Mamet R, Zornosa C, D'Amico TA, Ettinger DS, Kalemkerian GP, Pisters KM, Reid ME, Otterson GA. Smoking status and survival in the national comprehensive cancer network non-small cell lung cancer cohort. Cancer 2012; 119:847-53. [PMID: 23023590 DOI: 10.1002/cncr.27824] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 08/18/2012] [Accepted: 08/20/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND The objectives of this study were to evaluate survival among current smokers, former smokers, and never smokers who are diagnosed with non-small cell lung cancer (NSCLC). METHODS The study included patients who participated in the National Comprehensive Cancer Network's NSCLC Database Project. Current, former, and never smokers were compared with respect to overall survival by fitting Cox regression models. RESULTS Data from 4200 patients were examined, including 618 never smokers, 1483 current smokers, 380 former smokers who quit 1 to 12 months before diagnosis, and 1719 former smokers who quit >12 months before diagnosis. Among patients with stage I, II, and III disease, only never smokers had better survival than current smokers (hazard ratio, 0.47 [95% confidence interval, 0.26-0.85] vs 0.51 [95% confidence interval, 0.38-0.68], respectively). Among patients with stage IV disease, the impact of smoking depended on age: Among younger patients (aged ≤55 years), being a never smoker and a former smoker for ≥12 months increased survival. After age 85 years, smoking status did not have a significant impact on overall survival. CONCLUSIONS Patients who were smoking at the time of diagnosis had worse survival compared with never smokers. Among younger patients with stage IV disease, current smokers also had worse survival compared with former smokers who quit >12 months before diagnosis. It is likely that tumor biology plays a major role in the differences observed; however, to improve survival, it is prudent to encourage all smokers to quit smoking if they are diagnosed with NSCLC.
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Affiliation(s)
- Amy K Ferketich
- The Ohio State University College of Public Health and the Comprehensive Cancer Center, Columbus, Ohio 43210, USA.
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Kaddis JS, Hanson MS, Cravens J, Qian D, Olack B, Antler M, Papas KK, Iglesias I, Barbaro B, Fernandez L, Powers AC, Niland JC. Standardized transportation of human islets: an islet cell resource center study of more than 2,000 shipments. Cell Transplant 2012; 22:1101-11. [PMID: 22889479 DOI: 10.3727/096368912x653219] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Preservation of cell quality during shipment of human pancreatic islets for use in laboratory research is a crucial, but neglected, topic. Mammalian cells, including islets, have been shown to be adversely affected by temperature changes in vitro and in vivo, yet protocols that control for thermal fluctuations during cell transport are lacking. To evaluate an optimal method of shipping human islets, an initial assessment of transportation conditions was conducted using standardized materials and operating procedures in 48 shipments sent to a central location by eight pancreas-processing laboratories using a single commercial airline transporter. Optimization of preliminary conditions was conducted, and human islet quality was then evaluated in 2,338 shipments pre- and postimplementation of a finalized transportation container and standard operating procedures. The initial assessment revealed that the outside temperature ranged from a mean of -4.6 ± 10.3°C to 20.9 ± 4.8°C. Within-container temperature drops to or below 15°C occurred in 16 shipments (36%), while the temperature was found to be stabilized between 15°C and 29°C in 29 shipments (64%). Implementation of an optimized transportation container and operating procedure reduced the number of within-container temperature drops (≤ 15°C) to 13% (n = 37 of 289 winter shipments), improved the number desirably maintained between 15°C and 29°C to 86% (n = 250), but also increased the number reaching or exceeding 29°C to 1% (n = 2; overall p < 0.0001). Additionally, postreceipt quality ratings of excellent to good improved pre- versus postimplantation of the standardized protocol, adjusting for preshipment purity/viability levels (p < 0.0001). Our results show that extreme temperature fluctuations during transport of human islets, occurring when using a commercial airline transporter for long distance shipping, can be controlled using standardized containers, materials, and operating procedures. This cost-effective and pragmatic standardized protocol for the transportation of human islets can potentially be adapted for use with other mammalian cell systems and is available online at http://iidp.coh.org/sops.aspx.
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Affiliation(s)
- John S Kaddis
- Department of Information Sciences, City of Hope, Duarte, CA 91010-3000, USA
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Arvold ND, Punglia RS, Hughes ME, Jiang W, Edge SB, Javid SH, Laronga C, Niland JC, Theriault RL, Weeks JC, Wong YN, Lee SJ, Hassett MJ. Pathologic characteristics of second breast cancers after breast conservation for ductal carcinoma in situ. Cancer 2012; 118:6022-30. [PMID: 22674478 DOI: 10.1002/cncr.27691] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 04/12/2012] [Accepted: 05/04/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND The number of women diagnosed with ductal carcinoma in situ (DCIS) is increasing. Although many eventually develop a second breast cancer (SBC), little is known about the characteristics of SBCs. The authors described the characteristics of SBC and examined associations between the pathologic features of SBC and index DCIS cases. METHODS Women were identified in the National Comprehensive Cancer Network Outcomes Database who were diagnosed with DCIS from 1997 to 2008 and underwent lumpectomy and who subsequently developed SBC (including DCIS or invasive disease that occurred in the ipsilateral or contralateral breast). The Fisher exact test and the Spearman test were used to examine associations between the pathologic characteristics of SBC and index DCIS cases. RESULTS Among 2636 women who underwent lumpectomy for DCIS, 150 (5.7%) experienced an SBC after a median of 55.5 months of follow-up. Of these 150 women, 105 (70%) received adjuvant radiotherapy, and 50 (33.3%) received tamoxifen for their index DCIS. SBCs were ipsilateral in 54.7% of women and invasive in 50.7% of women. Among the index DCIS cases, 60.6% were estrogen receptor (ER)-positive, and 54% were high grade, whereas 77.5% of SBCs were ER-positive, and 48.2% were high grade. Tumor grade (P = .003) and ER status (P = .02) were associated significantly between index DCIS and SBC, whereas tumor size was not (P = .87). CONCLUSIONS After breast conservation for DCIS, SBC in either breast exhibited pathologic characteristics similar to the index DCIS, suggesting that women with DCIS may be at risk for developing subsequent breast cancers of a similar phenotype.
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Affiliation(s)
- Nils D Arvold
- Harvard Radiation Oncology Program, Harvard Medical School, Boston, Massachusetts, USA.
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Jones NB, Ottesen RA, Niland JC, Breslin TM, Weeks JC, Hughes ME, Agnese DM, Edge SB. Overuse of sentinel lymph node biopsy with breast conserving surgery for clinical DCIS. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.1125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1125 Background: The National Comprehensive Cancer Network (NCCN) guidelines recommend against sentinel lymph node biopsy (SLNB) for ductal carcinoma in-situ (DCIS) treated with breast conservation surgery (BCS). SLNB is appropriate with mastectomy because it precludes subsequent SLNB if invasive cancer is identified. However, SLNB is commonly performed with BCS for DCIS. We hypothesize SLNB use in the setting of BCS for DCIS varies and may be over used in some cancer centers. Methods: We examined 6,070 cases with initial biopsy showing DCIS presenting to 13 institutions participating in the NCCN Breast Outcomes Database from 1998-2009. Receipt of SLNB was defined as SLNB performed at any point in primary treatment for those with a final diagnosis of DCIS or at the first surgical procedure for those upstaged to invasive cancer. Characteristics of patients who did and did not have SLNB were compared using Chi-square tests. Logistic models adjusting for clinical and pathologic variables were performed to assess factors associated with use of SLNB. Results: Of 3,725 treated with BCS, 778 (20.9%) had SLNB. Among 2,345 treated with mastectomy, 1,484 (63.3%) had SLNB. Within BCS, patients presenting with clinical symptoms (vs. screening detected) were more likely to have SLNB (p=0.0006, OR: 1.76; 95% CI 1.31-2.36). For both groups, presence of comedo necrosis, year of diagnosis, and treating institution were predictors of SLNB (p<0.0001). 1,171 (19.3%) were upstaged from DCIS at initial biopsy to invasive cancer on final pathology. 212 (18.1% invasive cancer group) had positive nodes. Use of SLNB increased over time from 1998-2009 in mastectomy group. Among BCS group, SNLB use decreased over the first half of the study period and then remained stable at approximately 15% across all centers. Conclusions: Although use of SNLB has decreased over time, a substantial percentage of patients undergoing BCS for DCIS receive SNLB. Practices vary considerably across centers. SLNB can be performed as a second procedure for those treated with BCS and identified with invasive cancer, thereby avoiding unnecessary risk of significant morbidity. Breast programs should review their practices to curtail the use of unnecessary surgery for women with DCIS.
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Affiliation(s)
| | | | | | - Tara M. Breslin
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
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Palomares MR, Banzet M, Lu K, Justus J, Ottesen RA, Niland JC. Breast cancer risk reduction among patients with DCIS. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.1562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1562 Background: The incidence of ductal carcinoma in situ (DCIS) has dramatically increased with widespread mammographic screening. Although risk of recurrence of DCIS is low, it is associated with a higher risk for subsequent contralateral breast cancer (CBC), for which preventive measures are available. We evaluated the uptake of surgical and pharmacologic interventions to reduce CBC risk at our institution and investigated factors that may influence treatment choices for DCIS. Methods: City of Hope (COH) DCIS patients were identified using two sources, the Circulating Breast Tumor Marker (BrTM) Registry and the National Comprehensive Cancer Network (NCCN) database. Datasets were linked together, and treatment variables were cross-tabulated with patient and tumor characteristics. Results: Of 782 patients with breast malignancy diagnosed since 1997, 370 were excluded due to concurrent or prior invasive disease, 8 due to suspected misclassification based on therapies received, and 4 due to treatment on protocol. Of the remaining pure DCIS patients, treatment choices were recorded for 289. Of those, 40 (14%) chose bilateral risk reduction mastectomy (BRRM), 82 (28%) unilateral mastectomy, 165 (57%) lumpectomy, and 2 had no surgery. Hormonal therapy (HT) was recorded for 215 individuals who did not pursue BRRM: 124 (57%) took tamoxifen, 3 of whom switched to raloxifene, 5 (2%) started with raloxifene, and 7 (3%) took an unspecified hormonal agent, for a total HT uptake of 55%. This included 8 of 29 women with ER-negative DCIS who chose HT for CBC risk reduction. Younger age at diagnosis was associated with BRRM (24% of women diagnosed before age 50, 10% of those diagnosed 50-64, and 5% of women 65+ had BRRM, p<0.001) and HT (59% of women <65 chose HT compared to 40% of women 65+, p=0.009). Within ethnic minorities, more Asian women chose BRRM (22% vs 7% of other minorities, p=0.08). Interestingly, fewer high grade DCIS women opted for HT (39% vs 55% for low to intermediate grade, p=0.06). Conclusions: Young women tend to pursue surgical prophylaxis. Among women who keep their breasts, HT uptake was high across all age and ethnic groups, except for those older than 65 at diagnosis. It is unclear if this is due to patient choice or reflects age bias in physician recommendation.
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Affiliation(s)
| | | | | | - Jacob Justus
- California State University, San Bernardino, San Bernardino, CA
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Luu DCN, Mamet R, Zornosa CC, Niland JC, D'Amico TA, Kalemkerian GP, Koczywas M, Pisters K, Rabin MS, Otterson GA. Retrospective analysis of the impact of age on overall survival in patients with non-small cell lung cancer. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e18018] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18018 Background: Clinical trials have failed to demonstrate that age is a significant prognostic indicator among patients treated for non-small cell lung cancer (NSCLC). Clinical trials do not necessarily represent real-world experience, however. We sought to analyze the impact of age on survival in patients in the National Comprehensive Cancer Network (NCCN) NSCLC Outcomes Database. Methods: We performed a retrospective analysis of 6,834 NSCLC patients from the NCCN NSCLC Database representing 8 NCCN institutions. Of this population, 4,943 patients were eligible for our analysis. Exclusion criteria included the following: alive patients with < 180 days of follow-up, patients with incomplete staging, and patients with a prior cancer diagnosis. The study population was separated into five age quintiles with equal number of patients in each group. Variables included institution, smoking status, gender, race, Charlson comorbidity score, ECOG performance status (PS), histology, stage, and receipt of resection, drug and radiation therapy. Multivariable Cox model was performed for the effect of age on survival after adjusting for the above variables. Model assumptions were evaluated via graphs and residual tests. Results: Across the five quintiles (< 54, 54-60, 61-66, 67-72 and ≥ 73) there was a trend towards lower stage and higher Charlson score with increasing quintile. In addition, there was an increased proportion of patients with squamous cancer in the older age group. In the adjusted Cox model, there was a statistically significant longer survival in each of four younger quintiles compared to the reference group of ≥ 73 years of age (p=0.01). The adjusted hazard ratio of death for patients < 54 was .82 (95% CI = .72 to .94), for patients 54-60 was .86 (95% CI = .76 to .97), for patients 61-66 was .84 (95% CI = .74 to .95), and for patients 67-72 was .84 (95% CI = .74 to .95). There were no statistically significant pairwise interactions among age, smoking status and stage. Conclusions: Even after adjusting for institution, comorbidity scores, smoking status, race, gender, ECOG PS, histology, stage and treatment, NSCLC patients who were ≥ 73 years of age had a worse survival when compared to younger age groups.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Gregory Alan Otterson
- Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
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Luis IMVD, Ottesen RA, Hughes ME, Marcom PK, Moy B, Rugo HS, Theriault RL, Wilson J, Niland JC, Weeks JC, Lin NU. Impact of hormone receptor (HR) status on clinicopathological features, patterns of recurrence, and clinical outcomes among patients (pts) with human epidermal growth factor receptor-2 positive (HER2) breast cancer (BC) in the National Comprehensive Cancer Network (NCCN). J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
599 Background: According to gene expression profiling, HER2+ BC is heterogeneous and appears to diverge by HR status. Methods: We evaluated 3394 pts who presented to NCCN centers with stage I-III HER2+ BC between 2000-07. Pts were classified as HR+ (ER+ and/or PR+) and HR- (ER- and PR-). Chi-square, univariate logistic regression, log-rank test, and Cox hazard proportional regression were used for analysis. Results: Median follow-up was 51 months. 59% of patients had HR+ and 41% HR- disease respectively. Pts with HR- BC were more likely to be postmenopausal and to present with higher stage and high grade disease (p<0.001). Most pts received adjuvant or neoadjuvant therapy; 44% received adjuvant trastuzumab. Recurrences were recorded for 458 pts. HR- patients were more likely to recur first in the central nervous system (CNS) (OR: 1.8, 95% CI: 1.1, 2.9; p= 0.03) and less likely to recur in bone (OR: 0.5, 95% CI: 0.3, 0.8; p<0.01). No differences in risk of lung or liver recurrence were observed. Combining first and subsequent sites of recurrence, the difference in CNS involvement was lost (p=0.107) but HR- were more likely to experience lung involvement (OR: 1.5, 95% CI: 1.0, 2.2; p= 0.05). After adjusting for age, year of diagnosis (y), race, stage, and grade, HR- had worse survival after initial BC diagnosis than HR+ pts (Hazard Ratio of death [HRd] 1.4, 95% CI: 1.14, 1.7; p<0.01). However, the risk of death was not proportional over time with HR- having significantly increased hazard in the first five years: HRd 0-2 y 1.9 [1.3, 2.9]; p< 0.01; HRd 2-5y 1.5, [1.2, 2.0]; p<0.01; HRd 5+ y, 0.8, [ 0.6, 1.2], p=0.29. Conclusions: Clinicopathological features, sites of recurrence, and risk of death over time for HER2+ BC differed by HR status. This suggests that HR status in HER2+ BC is clinically relevant. These differences should be further explored from a mechanistic and therapeutic standpoint.
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Affiliation(s)
| | | | | | | | | | - Hope S. Rugo
- University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
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Hassett MJ, Silver SM, Hughes ME, Blayney DW, Edge SB, Herman JG, Hudis CA, Marcom PK, Pettinga JE, Share D, Theriault R, Wong YN, Vandergrift JL, Niland JC, Weeks JC. Adoption of gene expression profile testing and association with use of chemotherapy among women with breast cancer. J Clin Oncol 2012; 30:2218-26. [PMID: 22585699 DOI: 10.1200/jco.2011.38.5740] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Gene expression profile (GEP) testing is a relatively new technology that offers the potential of personalized medicine to patients, yet little is known about its adoption into routine practice. One of the first commercially available GEP tests, a 21-gene profile, was developed to estimate the benefit of adjuvant chemotherapy for hormone receptor-positive breast cancer (HR-positive BC). PATIENTS AND METHODS By using a prospective registry data set outlining the routine care provided to women diagnosed from 2006 to 2008 with HR-positive BC at 17 comprehensive and community-based cancer centers, we assessed GEP test adoption and the association between testing and chemotherapy use. RESULTS Of 7,375 women, 20.4% had GEP testing and 50.2% received chemotherapy. Over time, testing increased (14.7% in 2006 to 27.5% in 2008; P < .01) and use of chemotherapy decreased (53.9% in 2006 to 47.0% in 2008; P < .01). Characteristics independently associated with lower odds of testing included African American versus white race (odds ratio [OR], 0.70; 95% CI, 0.54 to 0.92) and high school or less versus more than high school education (OR, 0.63; 95% CI, 0.52 to 0.76). Overall, testing was associated with lower odds of chemotherapy use (OR, 0.70; 95% CI, 0.62 to 0.80). Stratified analyses demonstrated that for small, node-negative cancers, testing was associated with higher odds of chemotherapy use (OR, 11.13; 95% CI, 5.39 to 22.99), whereas for node-positive and large node-negative cancers, testing was associated with lower odds of chemotherapy use (OR, 0.11; 95% CI, 0.07 to 0.17). CONCLUSION There has been a progressive increase in use of this GEP test and an associated shift in the characteristics of and overall reduction in the proportion of women with HR-positive BC receiving adjuvant chemotherapy.
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Affiliation(s)
- Michael J Hassett
- Center for Outcomes and Policy Research, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, USA.
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Partridge AH, Hughes ME, Ottesen RA, Wong YN, Edge SB, Theriault RL, Blayney DW, Niland JC, Winer EP, Weeks JC, Tamimi RM. The effect of age on delay in diagnosis and stage of breast cancer. Oncologist 2012; 17:775-82. [PMID: 22554997 DOI: 10.1634/theoncologist.2011-0469] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [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: 02/07/2023] Open
Abstract
BACKGROUND Young women with breast cancer are more likely to present with more advanced disease and are more likely to die as a result of breast cancer than their older counterparts. We sought to examine the relationship among young age (≤40 years), the likelihood of a delay in diagnosis, and stage. METHODS We examined data from women with newly diagnosed stage I-IV breast cancer presenting to one of eight National Comprehensive Cancer Network centers in January 2000 to December 2007. Delay in diagnosis was defined as time from initial sign or symptom to breast cancer diagnosis >60 days. RESULTS Among 21,818 women with breast cancer eligible for analysis, 2,445 were aged ≤40 years at diagnosis. Young women were not more likely to have a delay in diagnosis >60 days (odds ratio [OR], 1.08; 95% confidence interval [CI], 0.98-1.19) after adjustment for type of initial sign or symptom. Young women were only modestly more likely to present with higher stage disease after a similar adjustment (OR, 1.18; 95% CI, 1.07-1.31). Women presenting with symptomatic disease, more common in younger women, were more likely to have a delay in diagnosis (OR, 3.31; 95% CI, 3.08-3.56) and higher stage (OR, 4.31; 95% CI 4.05-4.58). CONCLUSION Young age is not an independent predictor of delay in diagnosis of breast cancer and only modestly is associated with higher stage disease. Presenting with symptoms of breast cancer predicts delay and higher stage at diagnosis.
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Affiliation(s)
- Ann H Partridge
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, Massachusetts 02115, USA.
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Lin NU, Vanderplas A, Hughes ME, Theriault RL, Edge SB, Wong YN, Blayney DW, Niland JC, Winer EP, Weeks JC. Clinicopathologic features, patterns of recurrence, and survival among women with triple-negative breast cancer in the National Comprehensive Cancer Network. Cancer 2012; 118:5463-72. [PMID: 22544643 DOI: 10.1002/cncr.27581] [Citation(s) in RCA: 405] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 02/03/2012] [Accepted: 03/02/2012] [Indexed: 12/18/2022]
Abstract
BACKGROUND The objective of this study was to describe clinicopathologic features, patterns of recurrence, and survival according to breast cancer subtype with a focus on triple-negative tumors. METHODS In total, 15,204 women were evaluated who presented to National Comprehensive Cancer Network centers with stage I through III breast cancer between January 2000 and December 2006. Tumors were classified as positive for estrogen receptor (ER) and/or progesterone receptor (PR) (hormone receptor [HR]-positive) and negative for human epidermal growth factor receptor 2 (HER2); positive for HER2 and any ER or PR status (HER2-positive); or negative for ER, PR, and HER2 (triple-negative). RESULTS Subtype distribution was triple-negative in 17% of women (n = 2569), HER2-positive in 17% of women (n = 2602), and HR-positive/HER2-negative in 66% of women (n = 10,033). The triple-negative subtype was more frequent in African Americans compared with Caucasians (adjusted odds ratio, 1.98; P < .0001). Premenopausal women, but not postmenopausal women, with high body mass index had an increased likelihood of having the triple-negative subtype (P = .02). Women with triple-negative cancers were less likely to present on the basis of an abnormal screening mammogram (29% vs 48%; P < .0001) and were more likely to present with higher tumor classification, but they were less likely to have lymph node involvement. Relative to HR-positive/HER2-negative tumors, triple-negative tumors were associated with a greater risk of brain or lung metastases; and women with triple-negative tumors had worse breast cancer-specific and overall survival, even after adjusting for age, disease stage, race, tumor grade, and receipt of adjuvant chemotherapy (overall survival: adjusted hazard ratio, 2.72; 95% confidence interval, 2.39-3.10; P < .0001). The difference in the risk of death by subtype was most dramatic within the first 2 years after diagnosis (overall survival for 0-2 years: OR, 6.10; 95% confidence interval, 4.81-7.74). CONCLUSIONS Triple-negative tumors were associated with unique risk factors and worse outcomes compared with HR-positive/HER2-negative tumors.
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Affiliation(s)
- Nancy U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
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Abel GA, Vanderplas A, Rodriguez MA, Crosby AL, Czuczman MS, Niland JC, Gordon LI, Millenson M, Zelenetz AD, Friedberg JW, LaCasce AS. High rates of surveillance imaging for treated diffuse large B-cell lymphoma: findings from a large national database. Leuk Lymphoma 2012; 53:1113-6. [DOI: 10.3109/10428194.2011.639882] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Gregory A. Abel
- Brigham and Women's Hospital,
Boston, MA, USA
- Dana-Farber Cancer Institute,
Boston, MA, USA
| | | | | | | | | | | | - Leo I. Gordon
- Robert H. Lurie Comprehensive Cancer Center,
Chicago, IL, USA
| | | | | | | | - Ann S. LaCasce
- Brigham and Women's Hospital,
Boston, MA, USA
- Dana-Farber Cancer Institute,
Boston, MA, USA
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Kapadia NS, Mamet R, Zornosa C, Niland JC, D'Amico TA, Hayman JA. Radiation therapy at the end of life in patients with incurable nonsmall cell lung cancer. Cancer 2012; 118:4339-45. [PMID: 22252390 DOI: 10.1002/cncr.27401] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 12/03/2011] [Accepted: 12/09/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Receipt of chemotherapy at the end of life (EOL) is considered an indicator of poor quality of care for medical oncology. The objective of this study was to characterize the use of radiotherapy (RT) in patients with nonsmall cell lung cancer (NSCLC) during the same period. METHODS Treatment characteristics of patients with incurable NSCLC who received RT at the EOL, defined as within 14 days of death, were analyzed from the National Comprehensive Cancer Network NSCLC Outcomes Database. RESULTS Among 1098 patients who died, 10% had received EOL RT. Patients who did and did not receive EOL RT were similar in terms of sex, race, comorbid disease, and Eastern Cooperative Oncology Group performance status. On multivariable logistic regression analysis, independent predictors of receiving EOL RT included stage IV disease (odds ratio [OR], 2.04; 95% confidence interval [CI], 1.09-3.83) or multiorgan involvement (OR, 1.75; 95% CI, 1.08-2.84) at diagnosis, age <65 years at diagnosis (OR, 1.85; 95% CI, 1.21-2.83), and treating institution (OR, 1.24-5.94; P = .02). Nearly 50% of EOL RT recipients did not complete it, most commonly because of death or patient preference. CONCLUSIONS In general, EOL RT was received infrequently, was delivered more commonly to younger patients with more advanced disease, and often was not completed as planned. There also was considerable variation in its use among National Comprehensive Cancer Network institutions. Next steps include expanding this research to other cancers and settings and investigating the clinical benefit of such treatment.
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Affiliation(s)
- Nirav S Kapadia
- Department of Radiation Oncology, University of Michigan Hospital, Ann Arbor, Michigan, USA
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Partridge AH, Hughes ME, Ottesen R, Wong YN, Edge SB, Theriault RL, Blayney DW, Niland JC, Winer EP, Weeks JC, Tamimi RM. P1-08-05: Age and Survival in Women with Early Stage Breast Cancer: An Analysis Controlling for Tumor Subtype. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p1-08-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Previous research has suggested that young age at diagnosis is an independent risk factor for breast cancer recurrence and death in women with early stage breast cancer. However, young women are more likely to have aggressive subtypes of breast cancer. No prior studies have adequately controlled for tumor phenotype, including HER-2/neu (HER2) status, in particular. Recent evidence has suggested that the prognostic effect of young age varies by tumor subtype.
Methods: We examined data from women with newly diagnosed Stage 1–3 breast cancer presenting to one of 8 NCCN centers between January 2000 and December 2007. Multivariate Cox proportional hazards models were used to assess the relationship between age and breast cancer specific survival, controlling for known prognostic factors and treatment. In addition, we conducted stratified analyses by estrogen receptor (ER) and HER2 status.
Results: 19,633 women with Stage 1–3 breast cancer eligible for analysis including 2,177 (11%) who were age 40 years or younger at diagnosis. Younger women were more likely to be non-white or Hispanic, more educated, employed, and to have higher stage, high grade, ER-negative, progesterone receptor (PR) negative, and HER2−positive disease, and treated with chemotherapy and trastuzumab (all variables P< 0.0001 by Chi-Square test). 5-year survival among younger women was 94.1 (95% Confidence Interval [CI] 92.9−95.3) and 96.3 (95% CI 95.9−96.6) for older women. In a multivariate Cox proportional hazards model controlling for sociodemographic, disease, and treatment characteristics, women age < 40 or younger at diagnosis had increased mortality compared to older women (Hazard Ratio [HR] 1.26, 95% CI 1.02−1.56). In stratified analyses, age 40 or less was associated with increased mortality among women with ER-positive disease (HR 1.44, 95% CI 1.01−2.05), but was not among those with ER-negative disease (HR 1.15, 95% CI 0.85−1.55). Younger age was associated with a statistically significant increase in mortality among women with HER2−negative disease (HR 1.29, 95% CI 1.00−1.68), but this difference did not reach statistical significance among those with HER2−positive disease (HR 1.30, 95% CI 0.82−2.09). Conclusions: The effect of age on short-term survival of women with early breast cancer appears to vary by breast cancer subtype, particularly ER status. Further research to elucidate differences in breast cancer biology and efficacy of therapy within tumor types by age is warranted.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-08-05.
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Affiliation(s)
- AH Partridge
- 1Dana-Farber Cancer Institute, Boston, MA; City of Hope, Duarte, CA; Fox Chase Cancer Center, Philadelphia, PA; Roswell Park Cancer Institute, Buffalo, NY; University of Texas MD Anderson Cancer Center, Houston, TX; Stanford Cancer Center, Palo Alto, CA; Brigham and Women's Hospital, Boston, MA
| | - ME Hughes
- 1Dana-Farber Cancer Institute, Boston, MA; City of Hope, Duarte, CA; Fox Chase Cancer Center, Philadelphia, PA; Roswell Park Cancer Institute, Buffalo, NY; University of Texas MD Anderson Cancer Center, Houston, TX; Stanford Cancer Center, Palo Alto, CA; Brigham and Women's Hospital, Boston, MA
| | - R Ottesen
- 1Dana-Farber Cancer Institute, Boston, MA; City of Hope, Duarte, CA; Fox Chase Cancer Center, Philadelphia, PA; Roswell Park Cancer Institute, Buffalo, NY; University of Texas MD Anderson Cancer Center, Houston, TX; Stanford Cancer Center, Palo Alto, CA; Brigham and Women's Hospital, Boston, MA
| | - Y-N Wong
- 1Dana-Farber Cancer Institute, Boston, MA; City of Hope, Duarte, CA; Fox Chase Cancer Center, Philadelphia, PA; Roswell Park Cancer Institute, Buffalo, NY; University of Texas MD Anderson Cancer Center, Houston, TX; Stanford Cancer Center, Palo Alto, CA; Brigham and Women's Hospital, Boston, MA
| | - SB Edge
- 1Dana-Farber Cancer Institute, Boston, MA; City of Hope, Duarte, CA; Fox Chase Cancer Center, Philadelphia, PA; Roswell Park Cancer Institute, Buffalo, NY; University of Texas MD Anderson Cancer Center, Houston, TX; Stanford Cancer Center, Palo Alto, CA; Brigham and Women's Hospital, Boston, MA
| | - RL Theriault
- 1Dana-Farber Cancer Institute, Boston, MA; City of Hope, Duarte, CA; Fox Chase Cancer Center, Philadelphia, PA; Roswell Park Cancer Institute, Buffalo, NY; University of Texas MD Anderson Cancer Center, Houston, TX; Stanford Cancer Center, Palo Alto, CA; Brigham and Women's Hospital, Boston, MA
| | - DW Blayney
- 1Dana-Farber Cancer Institute, Boston, MA; City of Hope, Duarte, CA; Fox Chase Cancer Center, Philadelphia, PA; Roswell Park Cancer Institute, Buffalo, NY; University of Texas MD Anderson Cancer Center, Houston, TX; Stanford Cancer Center, Palo Alto, CA; Brigham and Women's Hospital, Boston, MA
| | - JC Niland
- 1Dana-Farber Cancer Institute, Boston, MA; City of Hope, Duarte, CA; Fox Chase Cancer Center, Philadelphia, PA; Roswell Park Cancer Institute, Buffalo, NY; University of Texas MD Anderson Cancer Center, Houston, TX; Stanford Cancer Center, Palo Alto, CA; Brigham and Women's Hospital, Boston, MA
| | - EP Winer
- 1Dana-Farber Cancer Institute, Boston, MA; City of Hope, Duarte, CA; Fox Chase Cancer Center, Philadelphia, PA; Roswell Park Cancer Institute, Buffalo, NY; University of Texas MD Anderson Cancer Center, Houston, TX; Stanford Cancer Center, Palo Alto, CA; Brigham and Women's Hospital, Boston, MA
| | - JC Weeks
- 1Dana-Farber Cancer Institute, Boston, MA; City of Hope, Duarte, CA; Fox Chase Cancer Center, Philadelphia, PA; Roswell Park Cancer Institute, Buffalo, NY; University of Texas MD Anderson Cancer Center, Houston, TX; Stanford Cancer Center, Palo Alto, CA; Brigham and Women's Hospital, Boston, MA
| | - RM Tamimi
- 1Dana-Farber Cancer Institute, Boston, MA; City of Hope, Duarte, CA; Fox Chase Cancer Center, Philadelphia, PA; Roswell Park Cancer Institute, Buffalo, NY; University of Texas MD Anderson Cancer Center, Houston, TX; Stanford Cancer Center, Palo Alto, CA; Brigham and Women's Hospital, Boston, MA
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Abstract
The identification and grading of adverse events (AEs) during the conduct of clinical trials is a labor-intensive and error-prone process. This paper describes and evaluates a software tool developed by City of Hope to automate complex algorithms to assess laboratory results and identify and grade AEs. We compared AEs identified by the automated system with those previously assessed manually, to evaluate missed/misgraded AEs. We also conducted a prospective paired time assessment of automated versus manual AE assessment. We found a substantial improvement in accuracy/completeness with the automated grading tool, which identified an additional 17% of severe grade 3–4 AEs that had been missed/misgraded manually. The automated system also provided an average time saving of 5.5 min per treatment course. With 400 ongoing treatment trials at City of Hope and an average of 1800 laboratory results requiring assessment per study, the implications of these findings for patient safety are enormous.
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Affiliation(s)
- Joyce C Niland
- Department of Information Sciences, City of Hope National Medical Center, Duarte, California, USA.
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