1
|
Luo AC, Sydnor VJ, Pines A, Larsen B, Alexander-Bloch AF, Cieslak M, Covitz S, Chen AA, Esper NB, Feczko E, Franco AR, Gur RE, Gur RC, Houghton A, Hu F, Keller AS, Kiar G, Mehta K, Salum GA, Tapera T, Xu T, Zhao C, Salo T, Fair DA, Shinohara RT, Milham MP, Satterthwaite TD. Functional connectivity development along the sensorimotor-association axis enhances the cortical hierarchy. Nat Commun 2024; 15:3511. [PMID: 38664387 PMCID: PMC11045762 DOI: 10.1038/s41467-024-47748-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Human cortical maturation has been posited to be organized along the sensorimotor-association axis, a hierarchical axis of brain organization that spans from unimodal sensorimotor cortices to transmodal association cortices. Here, we investigate the hypothesis that the development of functional connectivity during childhood through adolescence conforms to the cortical hierarchy defined by the sensorimotor-association axis. We tested this pre-registered hypothesis in four large-scale, independent datasets (total n = 3355; ages 5-23 years): the Philadelphia Neurodevelopmental Cohort (n = 1207), Nathan Kline Institute-Rockland Sample (n = 397), Human Connectome Project: Development (n = 625), and Healthy Brain Network (n = 1126). Across datasets, the development of functional connectivity systematically varied along the sensorimotor-association axis. Connectivity in sensorimotor regions increased, whereas connectivity in association cortices declined, refining and reinforcing the cortical hierarchy. These consistent and generalizable results establish that the sensorimotor-association axis of cortical organization encodes the dominant pattern of functional connectivity development.
Collapse
Affiliation(s)
- Audrey C Luo
- Penn Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Valerie J Sydnor
- Penn Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Adam Pines
- Penn Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Bart Larsen
- Penn Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, 55455, USA
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, 55455, USA
| | - Aaron F Alexander-Bloch
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Child and Adolescent Psychiatry and Behavioral Science, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Matthew Cieslak
- Penn Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Sydney Covitz
- Penn Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Andrew A Chen
- Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| | | | - Eric Feczko
- Center for the Developing Brain, Child Mind Institute, New York, NY, 10022, USA
| | - Alexandre R Franco
- Center for the Developing Brain, Child Mind Institute, New York, NY, 10022, USA
- Center for Biomedical Imaging and Neuromodulation, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, 10962, USA
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Raquel E Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Child and Adolescent Psychiatry and Behavioral Science, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Ruben C Gur
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Audrey Houghton
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Fengling Hu
- Penn Statistics in Imaging and Visualization Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Arielle S Keller
- Penn Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Gregory Kiar
- Center for the Developing Brain, Child Mind Institute, New York, NY, 10022, USA
| | - Kahini Mehta
- Penn Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Giovanni A Salum
- Center for the Developing Brain, Child Mind Institute, New York, NY, 10022, USA
- Section on Negative Affect and Social Processes, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Tinashe Tapera
- Penn Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Khoury College of Computer Sciences, Northeastern University, Boston, MA, 02115, USA
| | - Ting Xu
- Center for the Developing Brain, Child Mind Institute, New York, NY, 10022, USA
| | - Chenying Zhao
- Penn Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Taylor Salo
- Penn Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Damien A Fair
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, 55455, USA
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, 55455, USA
- Institute of Child Development, College of Education and Human Development, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Russell T Shinohara
- Penn Statistics in Imaging and Visualization Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Michael P Milham
- Center for the Developing Brain, Child Mind Institute, New York, NY, 10022, USA
- Center for Biomedical Imaging and Neuromodulation, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, 10962, USA
| | - Theodore D Satterthwaite
- Penn Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, PA, 19104, USA.
| |
Collapse
|
2
|
Kang K, Seidlitz J, Bethlehem RA, Xiong J, Jones MT, Mehta K, Keller AS, Tao R, Randolph A, Larsen B, Tervo-Clemmens B, Feczko E, Dominguez OM, Nelson S, Schildcrout J, Fair D, Satterthwaite TD, Alexander-Bloch A, Vandekar S. Study design features that improve effect sizes in cross-sectional and longitudinal brain-wide association studies. bioRxiv 2024:2023.05.29.542742. [PMID: 37398345 PMCID: PMC10312450 DOI: 10.1101/2023.05.29.542742] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Brain-wide association studies (BWAS) are a fundamental tool in discovering brain-behavior associations. Several recent studies showed that thousands of study participants are required to improve the replicability of BWAS because actual effect sizes are much smaller than those reported in smaller studies. Here, we perform analyses and meta-analyses of a robust effect size index (RESI) using 63 longitudinal and cross-sectional magnetic resonance imaging studies from the Lifespan Brain Chart Consortium (77,695 total scans) to demonstrate that optimizing study design is critical for improving standardized effect sizes and replicability in BWAS. A meta-analysis of brain volume associations with age indicates that BWAS with larger covariate variance have larger effect size estimates and that the longitudinal studies we examined have systematically larger standardized effect sizes than cross-sectional studies. We propose a cross-sectional RESI to adjust for the systematic difference in effect sizes between cross-sectional and longitudinal studies that allows investigators to quantify the benefit of conducting their study longitudinally. Analyzing age effects on global and regional brain measures from the United Kingdom Biobank and the Alzheimer's Disease Neuroimaging Initiative, we show that modifying longitudinal study design through sampling schemes to increase between-subject variability and adding a single additional longitudinal measurement per subject can improve effect sizes. However, evaluating these longitudinal sampling schemes on cognitive, psychopathology, and demographic associations with structural and functional brain outcome measures in the Adolescent Brain and Cognitive Development dataset shows that commonly used longitudinal models can, counterintuitively, reduce effect sizes. We demonstrate that the benefit of conducting longitudinal studies depends on the strengths of the between- and within-subject associations of the brain and non-brain measures. Explicitly modeling between- and within-subject effects avoids conflating the effects and allows optimizing effect sizes for them separately. These findings underscore the importance of considering study design features to improve the replicability of BWAS.
Collapse
Affiliation(s)
- Kaidi Kang
- Department of Biostatistics, Vanderbilt University Medical Center
| | - Jakob Seidlitz
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children’s Hospital of Philadelphia
- Department of Psychiatry, University of Pennsylvania
- Lifespan Brain Institute of The Children’s Hospital of Philadelphia and Penn Medicine
| | | | - Jiangmei Xiong
- Department of Biostatistics, Vanderbilt University Medical Center
| | - Megan T. Jones
- Department of Biostatistics, Vanderbilt University Medical Center
| | - Kahini Mehta
- Department of Psychiatry, University of Pennsylvania
- Lifespan Brain Institute of The Children’s Hospital of Philadelphia and Penn Medicine
- Penn Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania
| | - Arielle S. Keller
- Department of Psychiatry, University of Pennsylvania
- Lifespan Brain Institute of The Children’s Hospital of Philadelphia and Penn Medicine
- Penn Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania
| | - Ran Tao
- Department of Biostatistics, Vanderbilt University Medical Center
| | - Anita Randolph
- Department of Pediatrics, University of Minnesota Medical School
| | - Bart Larsen
- Department of Pediatrics, University of Minnesota Medical School
| | - Brenden Tervo-Clemmens
- Department of Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School
| | - Eric Feczko
- Department of Pediatrics, University of Minnesota Medical School
| | | | - Steve Nelson
- Department of Pediatrics, University of Minnesota Medical School
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Damien Fair
- Department of Pediatrics, University of Minnesota Medical School
| | - Theodore D. Satterthwaite
- Department of Psychiatry, University of Pennsylvania
- Lifespan Brain Institute of The Children’s Hospital of Philadelphia and Penn Medicine
- Penn Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania
| | - Aaron Alexander-Bloch
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children’s Hospital of Philadelphia
- Department of Psychiatry, University of Pennsylvania
- Lifespan Brain Institute of The Children’s Hospital of Philadelphia and Penn Medicine
| | - Simon Vandekar
- Department of Biostatistics, Vanderbilt University Medical Center
| |
Collapse
|
3
|
Shafiei G, Keller AS, Bertolero M, Shanmugan S, Bassett DS, Chen AA, Covitz S, Houghton A, Luo A, Mehta K, Salo T, Shinohara RT, Fair D, Hallquist MN, Satterthwaite TD. Generalizable Links Between Borderline Personality Traits and Functional Connectivity. Biol Psychiatry 2024:S0006-3223(24)01140-5. [PMID: 38460580 DOI: 10.1016/j.biopsych.2024.02.1016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 02/02/2024] [Accepted: 02/29/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Symptoms of borderline personality disorder (BPD) often manifest during adolescence, but the underlying relationship between these debilitating symptoms and the development of functional brain networks is not well understood. Here, we aimed to investigate how multivariate patterns of functional connectivity are associated with borderline personality traits in large samples of young adults and adolescents. METHODS We used functional magnetic resonance imaging data from young adults and adolescents from the HCP-YA (Human Connectome Project Young Adult) (n = 870, ages 22-37 years, 457 female) and the HCP-D (Human Connectome Project Development) (n = 223, ages 16-21 years, 121 female). A previously validated BPD proxy score was derived from the NEO Five-Factor Inventory. A ridge regression model with cross-validation and nested hyperparameter tuning was trained and tested in HCP-YA to predict BPD scores in unseen data from regional functional connectivity. The trained model was further tested on data from HCP-D without further tuning. Finally, we tested how the connectivity patterns associated with BPD aligned with age-related changes in connectivity. RESULTS Multivariate functional connectivity patterns significantly predicted out-of-sample BPD scores in unseen data in young adults (HCP-YA ppermuted = .001) and older adolescents (HCP-D ppermuted = .001). Regional predictive capacity was heterogeneous; the most predictive regions were found in functional systems relevant for emotion regulation and executive function, including the ventral attention network. Finally, regional functional connectivity patterns that predicted BPD scores aligned with those associated with development in youth. CONCLUSIONS Individual differences in functional connectivity in developmentally sensitive regions are associated with borderline personality traits.
Collapse
Affiliation(s)
- Golia Shafiei
- Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Lifespan Brain Institute of Perelman School of Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Arielle S Keller
- Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Lifespan Brain Institute of Perelman School of Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Maxwell Bertolero
- Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Lifespan Brain Institute of Perelman School of Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sheila Shanmugan
- Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Lifespan Brain Institute of Perelman School of Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dani S Bassett
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Physics & Astronomy, College of Arts and Sciences, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Electrical & Systems Engineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania; Santa Fe Institute, Santa Fe, New Mexico
| | - Andrew A Chen
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sydney Covitz
- Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Lifespan Brain Institute of Perelman School of Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Audrey Houghton
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, Minnesota
| | - Audrey Luo
- Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Lifespan Brain Institute of Perelman School of Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kahini Mehta
- Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Lifespan Brain Institute of Perelman School of Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Taylor Salo
- Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Lifespan Brain Institute of Perelman School of Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Russell T Shinohara
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Damien Fair
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, Minnesota; Institute of Child Development, College of Education and Human Development, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Michael N Hallquist
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Theodore D Satterthwaite
- Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Lifespan Brain Institute of Perelman School of Medicine and Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
4
|
Mehta K, Salo T, Madison T, Adebimpe A, Bassett DS, Bertolero M, Cieslak M, Covitz S, Houghton A, Keller AS, Luo A, Miranda-Dominguez O, Nelson SM, Shafiei G, Shanmugan S, Shinohara RT, Sydnor VJ, Feczko E, Fair DA, Satterthwaite TD. XCP-D: A Robust Pipeline for the post-processing of fMRI data. bioRxiv 2023:2023.11.20.567926. [PMID: 38045258 PMCID: PMC10690221 DOI: 10.1101/2023.11.20.567926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Functional neuroimaging is an essential tool for neuroscience research. Pre-processing pipelines produce standardized, minimally pre-processed data to support a range of potential analyses. However, post-processing is not similarly standardized. While several options for post-processing exist, they tend not to support output from disparate pre-processing pipelines, may have limited documentation, and may not follow BIDS best practices. Here we present XCP-D, which presents a solution to these issues. XCP-D is a collaborative effort between PennLINC at the University of Pennsylvania and the DCAN lab at the University at Minnesota. XCP-D uses an open development model on GitHub and incorporates continuous integration testing; it is distributed as a Docker container or Singularity image. XCP-D generates denoised BOLD images and functional derivatives from resting-state data in either NifTI or CIFTI files, following pre-processing with fMRIPrep, HCP, and ABCD-BIDS pipelines. Even prior to its official release, XCP-D has been downloaded >3,000 times from DockerHub. Together, XCP-D facilitates robust, scalable, and reproducible post-processing of fMRI data.
Collapse
Affiliation(s)
- Kahini Mehta
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Taylor Salo
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Thomas Madison
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, 55454, USA
| | - Azeez Adebimpe
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Danielle S Bassett
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, PA 19104, USA
- Department of Electrical & Systems Engineering, University of Pennsylvania, PA 19104, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Physics & Astronomy, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Santa Fe Institute, Santa Fe, NM, 87051, USA
| | - Max Bertolero
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Matthew Cieslak
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sydney Covitz
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Audrey Houghton
- Masonic Institute for the Developing Brain, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Arielle S Keller
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Audrey Luo
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Oscar Miranda-Dominguez
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, 55454, USA
- Masonic Institute for the Developing Brain, University of Minnesota Medical School, Minneapolis, MN, USA
- Institute of Child Development, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Steve M Nelson
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, 55454, USA
| | - Golia Shafiei
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sheila Shanmugan
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Russell T Shinohara
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Biomedical Image Computing and Analytics, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Valerie J Sydnor
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Eric Feczko
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, 55454, USA
| | - Damien A Fair
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, 55454, USA
- Masonic Institute for the Developing Brain, University of Minnesota Medical School, Minneapolis, MN, USA
- Institute of Child Development, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Theodore D Satterthwaite
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Biomedical Image Computing and Analytics, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
5
|
Shafiei G, Keller AS, Bertolero M, Shanmugan S, Bassett DS, Chen AA, Covitz S, Houghton A, Luo A, Mehta K, Salo T, Shinohara RT, Fair D, Hallquist MN, Satterthwaite TD. Generalizable links between symptoms of borderline personality disorder and functional connectivity. bioRxiv 2023:2023.08.03.551534. [PMID: 37662311 PMCID: PMC10473667 DOI: 10.1101/2023.08.03.551534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Background | Symptoms of borderline personality disorder (BPD) often manifest in adolescence, yet the underlying relationship between these debilitating symptoms and the development of functional brain networks is not well understood. Here we aimed to investigate how multivariate patterns of functional connectivity are associated with symptoms of BPD in a large sample of young adults and adolescents. Methods | We used high-quality functional Magnetic Resonance Imaging (fMRI) data from young adults from the Human Connectome Project: Young Adults (HCP-YA; N = 870, ages 22-37 years, 457 female) and youth from the Human Connectome Project: Development (HCP-D; N = 223, age range 16-21 years, 121 female). A previously validated BPD proxy score was derived from the NEO Five Factor Inventory (NEO-FFI). A ridge regression model with 10-fold cross-validation and nested hyperparameter tuning was trained and tested in HCP-YA to predict BPD scores in unseen data from regional functional connectivity, while controlling for in-scanner motion, age, and sex. The trained model was further tested on data from HCP-D without further tuning. Finally, we tested how the connectivity patterns associated with BPD aligned with age-related changes in connectivity. Results | Multivariate functional connectivity patterns significantly predicted out-of-sample BPD proxy scores in unseen data in both young adults (HCP-YA; pperm = 0.001) and older adolescents (HCP-D; pperm = 0.001). Predictive capacity of regions was heterogeneous; the most predictive regions were found in functional systems relevant for emotion regulation and executive function, including the ventral attention network. Finally, regional functional connectivity patterns that predicted BPD proxy scores aligned with those associated with development in youth. Conclusion | Individual differences in functional connectivity in developmentally-sensitive regions are associated with the symptoms of BPD.
Collapse
Affiliation(s)
- Golia Shafiei
- Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Arielle S. Keller
- Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Maxwell Bertolero
- Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Sheila Shanmugan
- Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Dani S. Bassett
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
- Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, PA 19104
- Department of Physics & Astronomy, College of Arts and Sciences, University of Pennsylvania, Philadelphia, PA 19104
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
- Department of Electrical & Systems Engineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, PA 19104
- Santa Fe Institute, Santa Fe, NM 87501
| | - Andrew A. Chen
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics,Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Sydney Covitz
- Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Audrey Houghton
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN 55414, USA
| | - Audrey Luo
- Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Kahini Mehta
- Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Taylor Salo
- Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Russell T. Shinohara
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics,Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Damien Fair
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN 55414, USA
- Institute of Child Development, College of Education and Human Development, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN 55414, USA
| | - Michael N. Hallquist
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Theodore D. Satterthwaite
- Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| |
Collapse
|
6
|
Zhao C, Jarecka D, Covitz S, Chen Y, Eickhoff SB, Fair DA, Franco AR, Halchenko YO, Hendrickson TJ, Hoffstaedter F, Houghton A, Kiar G, Macdonald A, Mehta K, Milham MP, Salo T, Hanke M, Ghosh SS, Cieslak M, Satterthwaite TD. A reproducible and generalizable software workflow for analysis of large-scale neuroimaging data collections using BIDS Apps. bioRxiv 2023:2023.08.16.552472. [PMID: 37645999 PMCID: PMC10461987 DOI: 10.1101/2023.08.16.552472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Neuroimaging research faces a crisis of reproducibility. With massive sample sizes and greater data complexity, this problem becomes more acute. Software that operates on imaging data defined using the Brain Imaging Data Structure (BIDS) - BIDS Apps - have provided a substantial advance. However, even using BIDS Apps, a full audit trail of data processing is a necessary prerequisite for fully reproducible research. Obtaining a faithful record of the audit trail is challenging - especially for large datasets. Recently, the FAIRly big framework was introduced as a way to facilitate reproducible processing of large-scale data by leveraging DataLad - a version control system for data management. However, the current implementation of this framework was more of a proof of concept, and could not be immediately reused by other investigators for different use cases. Here we introduce the BIDS App Bootstrap (BABS), a user-friendly and generalizable Python package for reproducible image processing at scale. BABS facilitates the reproducible application of BIDS Apps to large-scale datasets. Leveraging DataLad and the FAIRly big framework, BABS tracks the full audit trail of data processing in a scalable way by automatically preparing all scripts necessary for data processing and version tracking on high performance computing (HPC) systems. Currently, BABS supports jobs submissions and audits on Sun Grid Engine (SGE) and Slurm HPCs with a parsimonious set of programs. To demonstrate its scalability, we applied BABS to data from the Healthy Brain Network (HBN; n=2,565). Taken together, BABS allows reproducible and scalable image processing and is broadly extensible via an open-source development model.
Collapse
Affiliation(s)
- Chenying Zhao
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children’s Hospital of Philadelphia Research Institute, Philadelphia, PA, USA
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dorota Jarecka
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Sydney Covitz
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children’s Hospital of Philadelphia Research Institute, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yibei Chen
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Simon B. Eickhoff
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Center Jülich, Jülich, Germany
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Damien A. Fair
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
- Institute of Child Development, College of Education and Human Development, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Alexandre R. Franco
- Child Mind Institute, New York, NY, USA
- Center for Biomedical Imaging and Neuromodulation, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | | | - Timothy J. Hendrickson
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
- Minnesota Supercomputing Institute, University of Minnesota, Minneapolis, MN, USA
| | - Felix Hoffstaedter
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Center Jülich, Jülich, Germany
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Audrey Houghton
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | | | - Austin Macdonald
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Kahini Mehta
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children’s Hospital of Philadelphia Research Institute, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael P. Milham
- Child Mind Institute, New York, NY, USA
- Center for Biomedical Imaging and Neuromodulation, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Taylor Salo
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children’s Hospital of Philadelphia Research Institute, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Hanke
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Center Jülich, Jülich, Germany
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Satrajit S. Ghosh
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, USA
- Department of Otolaryngology, Harvard Medical School, Boston, MA, USA
| | - Matthew Cieslak
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children’s Hospital of Philadelphia Research Institute, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Theodore D. Satterthwaite
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children’s Hospital of Philadelphia Research Institute, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Biomedical Image Computation and Analytics, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
7
|
Mehta K, Pines A, Adebimpe A, Larsen B, Bassett DS, Calkins ME, Baller EB, Gell M, Patrick LM, Shafiei G, Gur RE, Gur RC, Roalf DR, Romer D, Wolf DH, Kable JW, Satterthwaite TD. Individual differences in delay discounting are associated with dorsal prefrontal cortex connectivity in children, adolescents, and adults. Dev Cogn Neurosci 2023; 62:101265. [PMID: 37327696 PMCID: PMC10285090 DOI: 10.1016/j.dcn.2023.101265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/24/2023] [Accepted: 06/11/2023] [Indexed: 06/18/2023] Open
Abstract
Delay discounting is a measure of impulsive choice relevant in adolescence as it predicts many real-life outcomes, including obesity and academic achievement. However, resting-state functional networks underlying individual differences in delay discounting during youth remain incompletely described. Here we investigate the association between multivariate patterns of functional connectivity and individual differences in impulsive choice in a large sample of children, adolescents, and adults. A total of 293 participants (9-23 years) completed a delay discounting task and underwent 3T resting-state fMRI. A connectome-wide analysis using multivariate distance-based matrix regression was used to examine whole-brain relationships between delay discounting and functional connectivity. These analyses revealed that individual differences in delay discounting were associated with patterns of connectivity emanating from the left dorsal prefrontal cortex, a default mode network hub. Greater delay discounting was associated with greater functional connectivity between the dorsal prefrontal cortex and other default mode network regions, but reduced connectivity with regions in the dorsal and ventral attention networks. These results suggest delay discounting in children, adolescents, and adults is associated with individual differences in relationships both within the default mode network and between the default mode and networks involved in attentional and cognitive control.
Collapse
Affiliation(s)
- Kahini Mehta
- Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Adam Pines
- Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Azeez Adebimpe
- Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Bart Larsen
- Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Danielle S Bassett
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, PA 19104, USA; Department of Electrical & Systems Engineering, University of Pennsylvania, PA 19104, USA; Department of Neurology, University of Pennsylvania, Philadelphia, PA, 19104, USA; Department of Physics & Astronomy, University of Pennsylvania, Philadelphia, PA, 19104, USA; Santa Fe Institute, Santa Fe, NM, 87051, USA
| | - Monica E Calkins
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Erica B Baller
- Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Martin Gell
- Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany; Institute of Neuroscience and Medicine (INM-7: Brain & Behaviour), Research Centre Jülich, Jülich, Germany
| | - Lauren M Patrick
- Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Golia Shafiei
- Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA; Penn/CHOP Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Neurology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ruben C Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA; Penn/CHOP Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Neurology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - David R Roalf
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Daniel Romer
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Daniel H Wolf
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Joseph W Kable
- Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Theodore D Satterthwaite
- Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA; Penn/CHOP Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA 19104, USA.
| |
Collapse
|
8
|
Zhao C, Tapera TM, Bagautdinova J, Bourque J, Covitz S, Gur RE, Gur RC, Larsen B, Mehta K, Meisler SL, Murtha K, Muschelli J, Roalf DR, Sydnor VJ, Valcarcel AM, Shinohara RT, Cieslak M, Satterthwaite TD. ModelArray: An R package for statistical analysis of fixel-wise data. Neuroimage 2023; 271:120037. [PMID: 36931330 PMCID: PMC10119782 DOI: 10.1016/j.neuroimage.2023.120037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 03/17/2023] Open
Abstract
Diffusion MRI is the dominant non-invasive imaging method used to characterize white matter organization in health and disease. Increasingly, fiber-specific properties within a voxel are analyzed using fixels. While tools for conducting statistical analyses of fixel-wise data exist, currently available tools support only a limited number of statistical models. Here we introduce ModelArray, an R package for mass-univariate statistical analysis of fixel-wise data. At present, ModelArray supports linear models as well as generalized additive models (GAMs), which are particularly useful for studying nonlinear effects in lifespan data. In addition, ModelArray also aims for scalable analysis. With only several lines of code, even large fixel-wise datasets can be analyzed using a standard personal computer. Detailed memory profiling revealed that ModelArray required only limited memory even for large datasets. As an example, we applied ModelArray to fixel-wise data derived from diffusion images acquired as part of the Philadelphia Neurodevelopmental Cohort (n = 938). ModelArray revealed anticipated nonlinear developmental effects in white matter. Moving forward, ModelArray is supported by an open-source software development model that can incorporate additional statistical models and other imaging data types. Taken together, ModelArray provides a flexible and efficient platform for statistical analysis of fixel-wise data.
Collapse
Affiliation(s)
- Chenying Zhao
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA; Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA; Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Tinashe M Tapera
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA; Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Joëlle Bagautdinova
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA; Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Josiane Bourque
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA; Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sydney Covitz
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA; Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Raquel E Gur
- Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ruben C Gur
- Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Bart Larsen
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA; Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kahini Mehta
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA; Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Steven L Meisler
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Cambridge, MA 02139, USA
| | - Kristin Murtha
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA; Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - John Muschelli
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - David R Roalf
- Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Valerie J Sydnor
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA; Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Alessandra M Valcarcel
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Russell T Shinohara
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Biomedical Image Computation and Analytics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Matthew Cieslak
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA; Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Theodore D Satterthwaite
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA; Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Biomedical Image Computation and Analytics, University of Pennsylvania, Philadelphia, PA 19104, USA.
| |
Collapse
|
9
|
Mehta K, Pines A, Adebimpe A, Larsen B, Bassett DS, Calkins ME, Baller E, Gell M, Patrick LM, Gur RE, Gur RC, Roalf DR, Romer D, Wolf DH, Kable JW, Satterthwaite TD. Individual Differences in Delay Discounting are Associated with Dorsal Prefrontal Cortex Connectivity in Youth. bioRxiv 2023:2023.01.25.525577. [PMID: 36747838 PMCID: PMC9900814 DOI: 10.1101/2023.01.25.525577] [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] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Delay discounting is a measure of impulsive choice relevant in adolescence as it predicts many real-life outcomes, including substance use disorders, obesity, and academic achievement. However, the functional networks underlying individual differences in delay discounting during youth remain incompletely described. Here we investigate the association between multivariate patterns of functional connectivity and individual differences in impulsive choice in a large sample of youth. A total of 293 youth (9-23 years) completed a delay discounting task and underwent resting-state fMRI at 3T. A connectome-wide analysis using multivariate distance-based matrix regression was used to examine whole-brain relationships between delay discounting and functional connectivity was then performed. These analyses revealed that individual differences in delay discounting were associated with patterns of connectivity emanating from the left dorsal prefrontal cortex, a hub of the default mode network. Delay discounting was associated with greater functional connectivity between the dorsal prefrontal cortex and other parts of the default mode network, and reduced connectivity with regions in the dorsal and ventral attention networks. These results suggest that delay discounting in youth is associated with individual differences in relationships both within the default mode network and between the default mode and networks involved in attentional and cognitive control.
Collapse
Affiliation(s)
- Kahini Mehta
- Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA,Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Adam Pines
- Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA,Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Azeez Adebimpe
- Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA,Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Bart Larsen
- Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA,Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Dani S. Bassett
- Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, PA 19104, USA,Department of Electrical & Systems Engineering, University of Pennsylvania, PA 19104, USA,Department of Neurology, University of Pennsylvania, Philadelphia, PA, 19104, USA,Department of Physics & Astronomy, University of Pennsylvania, Philadelphia, PA, 19104, USA,Santa Fe Institute, Santa Fe, NM, 87051, USA
| | - Monica E. Calkins
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Erica Baller
- Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA,Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Martin Gell
- Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA,Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, RWTH Aachen University, Aachen, Germany,Institute of Neuroscience and Medicine (INM-7: Brain & Behaviour), Research Centre Jülich, Jülich, Germany
| | - Lauren M. Patrick
- Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Raquel E. Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA,Penn/CHOP Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA 19104, USA,Department of Neurology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ruben C. Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA,Penn/CHOP Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA 19104, USA,Department of Neurology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - David R. Roalf
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Daniel Romer
- Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Daniel H. Wolf
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Joseph W. Kable
- Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Theodore D. Satterthwaite
- Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA,Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA,Penn/CHOP Lifespan Brain Institute, University of Pennsylvania, Philadelphia, PA 19104, USA
| |
Collapse
|
10
|
Covitz S, Tapera TM, Adebimpe A, Alexander-Bloch AF, Bertolero MA, Feczko E, Franco AR, Gur RE, Gur RC, Hendrickson T, Houghton A, Mehta K, Murtha K, Perrone AJ, Robert-Fitzgerald T, Schabdach JM, Shinohara RT, Vogel JW, Zhao C, Fair DA, Milham MP, Cieslak M, Satterthwaite TD. Curation of BIDS (CuBIDS): A workflow and software package for streamlining reproducible curation of large BIDS datasets. Neuroimage 2022; 263:119609. [PMID: 36064140 PMCID: PMC9981813 DOI: 10.1016/j.neuroimage.2022.119609] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/19/2022] [Accepted: 09/02/2022] [Indexed: 11/21/2022] Open
Abstract
The Brain Imaging Data Structure (BIDS) is a specification accompanied by a software ecosystem that was designed to create reproducible and automated workflows for processing neuroimaging data. BIDS Apps flexibly build workflows based on the metadata detected in a dataset. However, even BIDS valid metadata can include incorrect values or omissions that result in inconsistent processing across sessions. Additionally, in large-scale, heterogeneous neuroimaging datasets, hidden variability in metadata is difficult to detect and classify. To address these challenges, we created a Python-based software package titled "Curation of BIDS" (CuBIDS), which provides an intuitive workflow that helps users validate and manage the curation of their neuroimaging datasets. CuBIDS includes a robust implementation of BIDS validation that scales to large samples and incorporates DataLad--a version control software package for data--as an optional dependency to ensure reproducibility and provenance tracking throughout the entire curation process. CuBIDS provides tools to help users perform quality control on their images' metadata and identify unique combinations of imaging parameters. Users can then execute BIDS Apps on a subset of participants that represent the full range of acquisition parameters that are present, accelerating pipeline testing on large datasets.
Collapse
Affiliation(s)
- Sydney Covitz
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Tinashe M Tapera
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Azeez Adebimpe
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Aaron F Alexander-Bloch
- Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Maxwell A Bertolero
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Eric Feczko
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, United States
| | - Alexandre R Franco
- Child Mind Institute, 101 E 56th St, New York, NY 10022,; Center for Biomedical Imaging and Neuromodulation, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY 10962, USA; Department of Psychiatry, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Raquel E Gur
- Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ruben C Gur
- Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Timothy Hendrickson
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, United States; University of Minnesota Informatics Institute, University of Minnesota, Minneapolis, MN, United States
| | - Audrey Houghton
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, United States
| | - Kahini Mehta
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kristin Murtha
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Anders J Perrone
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, United States
| | - Tim Robert-Fitzgerald
- Center for Biomedical Image Computation and Analytics, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jenna M Schabdach
- Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Russell T Shinohara
- Center for Biomedical Image Computation and Analytics, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jacob W Vogel
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Chenying Zhao
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA; Department of Bioengineering, School of Engineering and Applied Science, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Damien A Fair
- Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, United States
| | | | - Matthew Cieslak
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Theodore D Satterthwaite
- Lifespan Informatics and Neuroimaging Center (PennLINC), Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Penn/CHOP Lifespan Brain Institute, Perelman School of Medicine, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Biomedical Image Computation and Analytics, University of Pennsylvania, Philadelphia, PA 19104, USA.
| |
Collapse
|
11
|
Mehta K, Panse C. Effect of Covid-19 pandemic: tourism and hospitality industry. CM 2022. [DOI: 10.18137/cardiometry.2022.22.406414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The coronavirus, which causes COVID-19 disease, has unimaginably affected every industry. Among all industries, the tourism and hospitality industry is considered the worst-hit industry, contributing 9% of India’s total GDP; this paper presents an overview of the Indian tourism and hospitality industry before COVID-19. While sending out survey forms, we included general questions like gender, occupation, age, level of education, yearly income, what used to be their choice of location for a holiday before COVID-19, how much they yearly spent on holiday, how they plan their holiday trip, to understand the basic details and reliability of participants, also we did not ask the name of a participant to maintain the anonymity and privacy of a participant, which helped us to get an accurate data. How customers’ changed mindsets different priorities forced the tourism and hospitality industry to change the way of providing service also how the changed time has forced businesses to look for other opportunities to survive in the industry, Moreover here we have test different Sanitization and safety measurements using Friedman test to understand what are the factors that can affect the business of tourism and hospitality industry after the COVID-19 pandemic, as observed by Assaf & Scuderi.
Collapse
|
12
|
Moss K, Russell L, Mehta K, Faisal M, Armstrong D, Verdu E, Dowhaniuk J, Pinto-Sanchez MI. A194 THE ADDITION OF DEAMIDATED GLIADIN PEPTIDE TO TISSUE TRANSGLUTAMINASE ANTIBODIES DOES NOT INCREASE THE ODDS OF CELIAC DISEASE DIAGNOSIS IN AN IGA SUFFICIENT POPULATION. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859345 DOI: 10.1093/jcag/gwab049.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Previous studies proposed that the combination of IgA anti-tissue transglutaminase 2 IgA (TTG) and IgG deamidated gliadin peptide IgG (DGP) antibodies increases celiac disease (CeD) detection rates. However, this remains controversial.
Aims
To evaluate the performance of adding DGP to TTG antibodies, for the diagnosis of celiac disease (CeD) in the immunoglobulin A (IgA)-sufficient population.
Methods
We included consecutive patients with suspected CeD who had both TTG and DGP serology performed simultaneously from 2017–2020 in Hamilton, Canada. Chart review was performed by 3 reviewers to extract data on biopsies, diagnosis of CeD and genetic HLA-DQ2/DQ8. CeD was defined as positive serology (either TTG and/or DGP) and villous atrophy in duodenal biopsies (≥Marsh-3a). A case was defined as an instance of TTG and DGP performed at a single timepoint. A single patient could have represented multiple cases if TTG and DGP were measured at multiple time points. Sensitivity, specificity, negative and positive predictive values were calculated, and ROC curves were generated. Diagnostic odds ratios (DOR) assessed the performance of each serological strategy compared to duodenal biopsies.
Results
There were 580 patients constituting 823 cases that met inclusion criteria, of whom 441 had CeD. IgA-deficient patients (n=100) were excluded. Of the 723 cases remaining, 337 (214 adult;123 pediatric) had serology performed at the time of CeD diagnosis. TTG increased the odds of CeD diagnosis compared with DGP, Diagnostic Odds Ratio (DOR)=53.22 (95% CI 22.63–119.80) vs DOR=21.28 (95% CI 10.67–42.46). The addition of DGP to TTG did not increase the odds of CeD diagnosis [DGP+TTG DOR=51.39 (95% CI 19.36–135.61) vs TTG alone DOR=53.22 (95% CI 22.63–119.80)]. There were 37 discordant cases where only one of either TTG or DGP was positive. HLA-DQ2/DQ8 were absent in 2/9 cases with isolated increased DGP. Among the discordant cases, TTG outperformed DGP (DOR TTG= 4.29; 95% CI 1.09–16.83 vs DOR DGP=0.23; 95% CI 0.06–0.92).
Conclusions
In the IgA-sufficient population, the addition of DGP to TTG testing does not increase the diagnostic accuracy of CeD serologic screening. This has implications in health-care costs as false positive results prompt further investigations. Given these findings, larger prospective studies should be completed prior to adding DGP antibodies to routine TTG serology.
Funding Agencies
None
Collapse
Affiliation(s)
- K Moss
- McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - L Russell
- McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - K Mehta
- McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - M Faisal
- McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - D Armstrong
- McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - E Verdu
- McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - J Dowhaniuk
- McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - M I Pinto-Sanchez
- McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| |
Collapse
|
13
|
Mehta K, Kaur B, Pandey KK, Dhar P, Kaler S. Resveratrol protects against inorganic arsenic-induced oxidative damage and cytoarchitectural alterations in female mouse hippocampus. Acta Histochem 2021; 123:151792. [PMID: 34634674 DOI: 10.1016/j.acthis.2021.151792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 01/04/2023]
Abstract
Prolonged inorganic arsenic (iAs) exposure is widely associated with brain damage particularly in the hippocampus via oxidative and apoptotic pathways. Resveratrol (RES) has gained considerable attention because of its benefits to human health. However, its neuroprotective potential against iAs-induced toxicity in CA1 region of hippocampus remains unexplored. Therefore, we investigated the neuroprotective efficacy of RES against arsenic trioxide (As2O3)-induced adverse effects on neuronal morphology, apoptotic markers and oxidative stress parameters in mouse CA1 region (hippocampus). Adult female Swiss albino mice of reproductive maturity were orally exposed to either As2O3 (2 and 4 mg/kg bw) alone or in combination with RES (40 mg/kg bw) for a period of 45 days. After animal sacrifice on day 46, the perfusion fixed brain samples were used for the observation of neuronal morphology and studying the morphometric features. While the freshly dissected hippocampi were processed for biochemical estimation of oxidative stress markers and western blotting of apoptosis-associated proteins. Chronic iAs exposure led to significant decrease in Stratum Pyramidale layer thickness along with reduction in cell density and area of Pyramidal neurons in contrast to the controls. Biochemical analysis showed reduced hippocampal GSH content but no change in total nitrite (NO) levels following iAs exposure. Western blotting showed apparent changes in the expression levels of Bax and Bcl-2 proteins following iAs exposure, however the change was statistically insignificant. Contrastingly, iAs +RES co-treatment exhibited substantial reversal in morphological and biochemical observations. Together, these findings provide preliminary evidence of neuroprotective role of RES on structural and biochemical alterations pertaining to mouse hippocampus following chronic iAs exposure.
Collapse
Affiliation(s)
- K Mehta
- Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - B Kaur
- Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - K K Pandey
- Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - P Dhar
- Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - S Kaler
- Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
| |
Collapse
|
14
|
Mehta K, Hoadley A, Ray LA, Kiluk BD, Carroll KM, Magill M. Cognitive-Behavioral Interventions Targeting Alcohol or Other Drug Use and Co-Occurring Mental Health Disorders: A Meta-Analysis. Alcohol Alcohol 2021; 56:535-544. [PMID: 33778869 PMCID: PMC8406071 DOI: 10.1093/alcalc/agab016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/19/2021] [Accepted: 02/20/2021] [Indexed: 01/10/2023] Open
Abstract
AIMS This meta-analysis reviewed 15 clinical trials (18 study sites/arms), examining the efficacy of an integrated cognitive-behavioral intervention (CBI) delivered to individuals with an alcohol or other drug use disorder and a co-occurring mental health disorder (AOD/MHD). Outcomes were alcohol or other drug use and mental health symptoms at post-treatment through follow-up. METHODS The inverse-variance weighted effect size was calculated for each study and pooled under random effects assumptions. RESULTS Integrated CBI showed a small effect size for AOD (g = 0.188, P = 0.061; I2 = 86%, τ2 = 0.126, k = 18) and MHD (g = 0.169, P = 0.024; I2 = 58%, τ2 = 0.052, k = 18) outcomes, although only MHD outcomes were statistically significant. Analysis by subgroup suggested that effect magnitude varied by type of contrast condition (integrated CBI + usual care vs. usual care only; integrated CBI vs. a single-disorder intervention), follow-up time point (post-treatment vs. 3-6 months) and primary AOD/MHD diagnosis, although these sub-groups often contained significant residual heterogeneity. In a series of mixed effects, meta-regression models, demographic factors were non-significant predictors of between-study heterogeneity. For AOD outcomes, greater effects were observed in higher quality studies, but study quality was not related to effect size variability for MHD outcomes. CONCLUSIONS The current meta-analysis shows a small and variable effect for integrated CBI with the most promising effect sizes observed for integrated CBI compared with a single disorder intervention (typically an AOD-only intervention) for follow-up outcomes, and for interventions targeting alcohol use and/or post-traumatic stress disorder. Given the clinical and methodological variability within the sample, results should be considered a preliminary, but important step forward in our understanding of treatment for co-occurring AOD/MHD.
Collapse
Affiliation(s)
- Kahini Mehta
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912, USA
| | - Ariel Hoadley
- College of Public Health, Temple University, Philadelphia, PA 19122, USA
| | - Lara A Ray
- Department of Clinical Psychology, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Brian D Kiluk
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06520, USA
| | - Kathleen M Carroll
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06520, USA
| | - Molly Magill
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912, USA
| |
Collapse
|
15
|
Mehta K, Hoadley A, Ray LA, Kiluk BD, Carroll KM, Magill M. Erratum to: Cognitive-Behavioral Interventions Targeting Alcohol or Other Drug Use and Co-Occurring Mental Health Disorders: A Meta-Analysis. Alcohol Alcohol 2021; 56:632. [PMID: 33876816 DOI: 10.1093/alcalc/agab035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 02/19/2021] [Accepted: 02/20/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kahini Mehta
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912, USA
| | - Ariel Hoadley
- College of Public Health, Temple University, Philadelphia, PA 19122, USA
| | - Lara A Ray
- Department of Clinical Psychology, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Brian D Kiluk
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06520, USA
| | - Kathleen M Carroll
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06520, USA
| | - Molly Magill
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI 02912, USA
| |
Collapse
|
16
|
AHMAD S, Bhasin N, Sinha S, Sayed S, Bansode J, Swami R, Mehta K. POS-467 RENAL AND HEPATIC OUTCOMES AFTER REMDESIVIR THERAPY IN COVID-19 POSITIVE PATIENTS WITH RENAL DYSFUNCTION AT BASELINE OR AFTER STARTING THERAPY. Kidney Int Rep 2021. [PMCID: PMC8049664 DOI: 10.1016/j.ekir.2021.03.494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
17
|
Abstract
As the demographic characteristics of the US population have changed over the past decade, the characteristics of different homeless populations have changed as well. This study tracked changes in demographic characteristics of homeless adult, veteran, and healthcare service user populations against general adult and veteran populations from 2007-2017. The results showed that changing demographics of homeless populations largely reflected broader trends in the general population, and attention is needed on the clinical needs of aging homeless populations. There may be some unique changes in the demography of some homeless populations, such as younger homeless veterans seeking healthcare services.
Collapse
Affiliation(s)
- J Tsai
- U.S. Department of Veterans Affairs, National Center on Homelessness Among Veterans, Tampa, FL, USA
- Department of Psychiatry, Yale University School of Medicine, VACT, 950 Campbell Ave., 151D, West Haven, New Haven, CT 06516, USA
| | - K Mehta
- U.S. Department of Veterans Affairs, National Center on Homelessness among Veterans, Tampa, FL, USA
| | - AE Mongtomery
- U.S. Department of Veterans Affairs, National Center on Homelessness among Veterans, Tampa, FL, USA
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - E Elbogen
- U.S. Department of Veterans Affairs, National Center on Homelessness among Veterans, Tampa, FL, USA
- Department of Psychiatry, Duke University School of Medicine, Durham, NC, USA
| | - D Hooshyar
- U.S. Department of Veterans Affairs, National Center on Homelessness among Veterans, Tampa, FL, USA
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| |
Collapse
|
18
|
Martín M, Loibl S, Hyslop T, De la Haba-Rodríguez J, Aktas B, Cirrincione CT, Mehta K, Barry WT, Morales S, Carey LA, Garcia-Saenz JA, Partridge A, Martinez-Jañez N, Hahn O, Winer E, Guerrero-Zotano A, Hudis C, Casas M, Rodriguez-Martin C, Furlanetto J, Carrasco E, Dickler MN. Evaluating the addition of bevacizumab to endocrine therapy as first-line treatment for hormone receptor-positive metastatic breast cancer: a pooled analysis from the LEA (GEICAM/2006-11_GBG51) and CALGB 40503 (Alliance) trials. Eur J Cancer 2019; 117:91-98. [PMID: 31276981 DOI: 10.1016/j.ejca.2019.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/20/2019] [Accepted: 06/02/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Randomised trials comparing the efficacy of standard endocrine therapy (ET) versus experimental ET + bevacizumab (Bev) in 1st line hormone receptor-positive patients with metastatic breast cancer have thus far shown conflicting results. PATIENTS AND METHODS We pooled data from two similar phase III randomised trials of ET ± Bev (LEA and Cancer and Leukemia Group B 40503) to increase precision in estimating treatment effect. Primary end-point was progression-free survival (PFS). Secondary end-points were overall survival (OS), objective response rate (ORR), clinical benefit rate (CBR) and safety. Exploratory analyses were performed within subgroups defined by patients with recurrent disease, de novo disease, prior endocrine sensitivity or resistance and reported grades III-IV hypertension and proteinuria. RESULTS The pooled sample consisted of 749 patients randomised to ET or ET + Bev. Median PFS was 14.3 months for ET versus 19 months for ET + Bev (unadjusted hazard ratio [HR] 0.77; 95% confidence interval [CI] 0.66-0.91; p < 0.01). ORR and CBR with ET and ET + Bev were 40 versus 61% (p < 0.01) and 64 versus 77% (p < 0.01), respectively. There was no difference in OS (HR 0.96; 95% CI 0.77-1.18; p = 0.68). PFS was superior for ET + Bev for endocrine-sensitive patients (HR 0.68; 95% CI 0.53-0.89; p = 0.004). Grade III-IV hypertension (2.2 versus 20.1%), proteinuria (0 versus 9.3%), cardiovascular (0.5 versus 4.2%) and liver events (0 versus 2.9%) were significantly higher for ET + Bev (all p < 0.01). Hypertension and proteinuria were not predictors of efficacy (interaction test p = 0.33). CONCLUSION The addition of Bev to ET increased PFS overall and in endocrine-sensitive patients but not OS at the expense of significant additional toxicity. TRIALS REGISTRATION ClinicalTrial.Gov NCT00545077 and NCT00601900.
Collapse
Affiliation(s)
- M Martín
- Medical Oncology, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense Madrid, Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, GEICAM Spanish Breast Cancer Group, Spain.
| | - S Loibl
- GBG (German Breast Group), Neu-Isenburg, Germany
| | - T Hyslop
- Alliance Statistics and Data Center, Duke University, Durham, NC, USA
| | - J De la Haba-Rodríguez
- Oncology Department and Research Unit, Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Reina Sofía, Universidad de Córdoba Spain. Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, GEICAM Spanish Breast Cancer Group, Spain
| | - B Aktas
- University Women's Hospital Leipzig, Leipzig, Germany
| | - C T Cirrincione
- Alliance Statistics and Data Center, Duke University, Durham, NC, USA
| | - K Mehta
- GBG (German Breast Group), Neu-Isenburg, Germany
| | - W T Barry
- Alliance Statistics and Data Center, Dana-Farber/Partners Cancer Care, Boston, MA, USA
| | - S Morales
- Medical Oncology, Hospital Arnau de Vilanova de Lérida, GEICAM Spanish Breast Cancer Group, Spain
| | - L A Carey
- University of North Carolina, Chapel Hill, NC, USA
| | - J A Garcia-Saenz
- Medical Oncology, Instituto de Investigación Sanitaria del Hospital Clinico San Carlos (IdISSC) Madrid, Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, GEICAM Spanish Breast Cancer Group, Spain
| | - A Partridge
- Dana-Farber/Partners CancerCare, Boston, MA, USA
| | - N Martinez-Jañez
- Medical Oncology. Universitary Hospital Ramon y Cajal. GEICAM, Spanish Breast Cancer Group; Madrid, Spain
| | - O Hahn
- Alliance Protocol Operations Office, University of Chicago, Chicago, IL, USA
| | - E Winer
- Dana-Farber/Partners CancerCare, Boston, MA, USA
| | - A Guerrero-Zotano
- Medical Oncology. Valencian Institute of Oncology. GEICAM Spanish Breast Cancer Group, Valencia, Spain
| | - C Hudis
- American Society of Clinical Oncology (ASCO), Alexandria, VA, USA
| | - M Casas
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | | | - J Furlanetto
- GBG (German Breast Group), Neu-Isenburg, Germany
| | - E Carrasco
- GEICAM Spanish Breast Cancer Group, Madrid, Spain
| | | | | | | | | |
Collapse
|
19
|
Flühmann C, Nguyen TL, Marinelli M, Negnevitsky V, Mehta K, Home JP. Encoding a qubit in a trapped-ion mechanical oscillator. Nature 2019; 566:513-517. [DOI: 10.1038/s41586-019-0960-6] [Citation(s) in RCA: 152] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 01/04/2019] [Indexed: 11/09/2022]
|
20
|
Huober J, Schneeweiss A, Blohmer JU, Denkert C, Tesch H, Hanusch CA, Salat C, Rhiem K, Rezai M, Solbach C, Fasching PA, Jackisch C, Mehta K, Nekljudova V, Seither F, von Minckwitz G, Loibl S, Untch M. Abstract P2-08-01: Factors predicting relapse in early breast cancer patients with a pathological complete response after neoadjuvant therapy – Results of a pooled analysis based on the GBG meta-database. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-08-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Even though patients with a pCR following neoadjuvant chemotherapy have an excellent prognosis still some of these patients will eventually relapse. A better identification of pts with an increased risk of relapse despite a pCR would be helpful to select these patients for additional post-neoadjuvant treatment strategies. Thus, the rationale of this retrospective analysis was to identify factors predicting relapse despite a pCR.
Methods
This pooled retrospective analysis based on the GBG meta-database includes the neoadjuvant trials GeparTrio, GeparQuattro, GeparQuinto, GeparSixto and GeparSepto. In these trials 2188 (27%) of 7933 pts had a pCR according to ypT0/ypTis ypN0 Definition and were included. The primary endpoint was disease-free survival (DFS), secondary endpoints were distant DFS (DDFS) and overall survival (OS). A multivariate Cox proportional hazards model was used to report hazard ratios with 95% confidence interval (CI). The two-sided significance level was set to α=0.05. Endpoints were analysed for all pts and in subgroups defined by intrinsic subtypes. The potential risk factors intrinsic subtype (HER2 negative/hormone receptor (HR) positive, triple negative, HER2 positive/HR positive, HER2 positive/HR negative), histological tumor type (lobular vs other), grade (G1/G2 vs G3), KI67 (≤20% vs higher), initial cT and cN stadium (cT1 vs cT2 vs cT3/4; cN0 vs cN+), age (≤40 vs 41-59 vs ≥60), BMI (< 25 vs 25-29 vs ≥ 30), planned number of cycles of chemotherapy (≤6 vs > 6), menopausal status (pre- vs postmenopausal) and clinical response after 2-4 cycles (SD vs PR vs CR vs PD) were included as covariates in multivariate Cox regression models as well as study identification.
Results
From 2188 evaluable patients DFS, DDFS and OS events were observed in 290/197/130 pts respectively; the median follow-up over all studies was 59 months. In multivariate analysis including study and all potential risk factors DFS was significantly different with regard to the initial cN status (cN+ vs cN0, hazard ratio (HR) 1.70; 95% CI [1.2, 2.4], p=0.002). Of borderline significance was histological type (non-lobular vs lobular, HR 0.52 95% CI [0.3, 1.1]; p=0.076) and initial tumor stage (cT3/4 vs cT1, HR 1.61 95% CI [1.0, 2.7]; p=0.064). In terms of DDFS significant differences were seen for the initial cN status (cN+ vs cN0, HR 2.34; 95% CI [1.5, 3.6], p<0.001) and initial tumor stage (cT3/4 vs cT1, HR 1.83 95% CI [1.0, 3.3]; p=0.044); histological type was again close to significance (non-lobular vs lobular, HR 0.46 95% CI [0.2, 1.1]; p=0.067). Multivariate analysis showed significantly worse OS with initial cT3/4 tumors (cT3/4 vs cT1, HR 2.48 95%CI [1.1, 5.7]; p=0.030), and the lobular type (non-lobular vs lobular, HR 0.35 95% CI [0.1, 0.9]; p=0.026) and a trend for worse OS in pts with cN+ (cN+ vs cN0, HR 1.67 95% CI [1.0, 2.9]; p=0.067).
Conclusions
Initial tumor load before start of neoadjuvant chemotherapy (tumor stage and nodal status) and lobular subtype were predictors of long term outcome after a pCR following neoadjuvant chemotherapy. Intrinsic subtype, KI67, grade and planned number of cycles were not predictive for a relapse.
Citation Format: Huober J, Schneeweiss A, Blohmer J-U, Denkert C, Tesch H, Hanusch CA, Salat C, Rhiem K, Rezai M, Solbach C, Fasching PA, Jackisch C, Mehta K, Nekljudova V, Seither F, von Minckwitz G, Loibl S, Untch M. Factors predicting relapse in early breast cancer patients with a pathological complete response after neoadjuvant therapy – Results of a pooled analysis based on the GBG meta-database [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-08-01.
Collapse
Affiliation(s)
- J Huober
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - A Schneeweiss
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - J-U Blohmer
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - C Denkert
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - H Tesch
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - CA Hanusch
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - C Salat
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - K Rhiem
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - M Rezai
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - C Solbach
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - PA Fasching
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - C Jackisch
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - K Mehta
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - V Nekljudova
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - F Seither
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - G von Minckwitz
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - S Loibl
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - M Untch
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| |
Collapse
|
21
|
Goneau LW, Mehta K, Wong J, L'Huillier AG, Gubbay JB. Zoonotic Influenza and Human Health-Part 1: Virology and Epidemiology of Zoonotic Influenzas. Curr Infect Dis Rep 2018; 20:37. [PMID: 30069735 DOI: 10.1007/s11908-018-0642-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Zoonotic influenza viruses are those that cross the animal-human barrier and can cause disease in humans, manifesting from minor respiratory illnesses to multiorgan dysfunction. They have also been implicated in the causation of deadly pandemics in recent history. The increasing incidence of infections caused by these viruses worldwide has necessitated focused attention to improve both diagnostic as well as treatment modalities. In this first part of a two-part review, we describe the structure of zoonotic influenza viruses, the relationship between mutation and pandemic capacity, pathogenesis of infection, and also discuss history and epidemiology. RECENT FINDINGS We are currently witnessing the fifth and the largest wave of the avian influenza A(H7N9) epidemic. Also in circulation are a number of other zoonotic influenza viruses, including avian influenza A(H5N1) and A(H5N6); avian influenza A(H7N2); and swine influenza A(H1N1)v, A(H1N2)v, and A(H3N2)v viruses. Most recently, the first human case of avian influenza A(H7N4) infection has been documented. By understanding the virology and epidemiology of emerging zoonotic influenzas, we are better prepared to face a new pandemic. However, continued effort is warranted to build on this knowledge in order to efficiently combat the constant threat posed by the zoonotic influenza viruses.
Collapse
Affiliation(s)
- L W Goneau
- Public Health Ontario Laboratory, 661 University Avenue, Suite 1701, Toronto, ON, M5G 1M1, Canada.,University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada
| | - K Mehta
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - J Wong
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada.,Department of Paediatrics, North York General Hospital, Toronto, ON, Canada
| | - A G L'Huillier
- Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - J B Gubbay
- Public Health Ontario Laboratory, 661 University Avenue, Suite 1701, Toronto, ON, M5G 1M1, Canada. .,University of Toronto, 27 King's College Circle, Toronto, ON, M5S 1A1, Canada. .,Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada.
| |
Collapse
|
22
|
Mehta T, Desai N, Mehta K, Parikh R, Male S, Hussain M, Ollenschleger M, Spiegel G, Grande A, Ezzeddine M, Jagadeesan B, Tummala R, McCullough L. Outcomes of early carotid stenting and angioplasty in large-vessel anterior circulation strokes treated with mechanical thrombectomy and intravenous thrombolytics. Interv Neuroradiol 2018; 24:392-397. [PMID: 29697301 DOI: 10.1177/1591019918768574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction Proximal cervical internal carotid artery stenosis greater than 50% merits revascularization to mitigate the risk of stroke recurrence among large-vessel anterior circulation strokes undergoing mechanical thrombectomy. Carotid artery stenting necessitates the use of antiplatelets, and there is a theoretical increased risk of hemorrhagic transformation given that such patients may already have received intravenous thrombolytics and have a significant infarct burden. We investigate the outcomes of large-vessel anterior circulation stroke patients treated with intravenous thrombolytics receiving same-day carotid stenting or selective angioplasty compared to no carotid intervention. Materials and methods The study cohort was obtained from the National (Nationwide) Inpatient Sample database between 2006 and 2014, using International Statistical Classification of Diseases, ninth revision discharge diagnosis and procedure codes. A total of 11,825 patients with large-vessel anterior circulation stroke treated with intravenous thrombolytic and mechanical thrombectomy on the same day were identified. The study population was subdivided into three subgroups: no carotid intervention, same-day carotid angioplasty without carotid stenting, and same-day carotid stenting. Outcomes were assessed with respect to mortality, significant disability at discharge, hemorrhagic transformation, and requirement of percutaneous endoscopic gastronomy tube placement, prolonged mechanical ventilation, or craniotomy. Results This study found no statistically significant difference in patient outcomes in those treated with concurrent carotid stenting compared to no carotid intervention in terms of morbidity or mortality. Conclusions If indicated, it is reasonable to consider concurrent carotid stenting and/or angioplasty for large-vessel anterior circulation stroke patients treated with mechanical thrombectomy who also receive intravenous thrombolytics.
Collapse
Affiliation(s)
- T Mehta
- 1 Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - N Desai
- 2 Department of Neurology, Hartford Hospital, Hartford, CT, USA
| | - K Mehta
- 3 Department of Hematology-Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - R Parikh
- 4 Department of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - S Male
- 1 Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - M Hussain
- 5 Department of Interventional Neuroradiology, Hartford Hospital, Hartford, CT, USA
| | - M Ollenschleger
- 5 Department of Interventional Neuroradiology, Hartford Hospital, Hartford, CT, USA
| | - G Spiegel
- 6 Department of Neuroradiology, University of Texas Health Sciences Center, Houston, TX, USA
| | - A Grande
- 7 Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - M Ezzeddine
- 1 Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - B Jagadeesan
- 8 Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - R Tummala
- 7 Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - L McCullough
- 9 Department of Neurology, University of Texas Health Sciences Center, Houston, TX, USA
| |
Collapse
|
23
|
Mehta K, Pajai A, Bhurke S, Shirkande A, Bhadade R, D'Souza R. Acute Kidney Injury of Infectious Etiology in Monsoon Season: A Prospective Study Using Acute Kidney Injury Network Criteria. Indian J Nephrol 2018; 28:143-152. [PMID: 29861565 PMCID: PMC5952453 DOI: 10.4103/ijn.ijn_355_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The epidemiological pattern of acute kidney injury (AKI) in tropical countries during monsoon reflects infectious disease as the most important cause. AKI is a confounding factor and may be overlooked by primary health-care providers and underreported in health statistics. The present study prospectively helps estimate the burden of disease and analyze etiology, clinical profile, and outcome in a tertiary care hospital of a metropolitan city in a tropical country. The study period included monsoon season of 2012 and 2013, a total of 8 months. AKI staging was done as per the AKI Network (AKIN) criteria. Patients were treated for primary disease. Renal replacement therapy (RRT) was given as required. Patients were followed up during hospitalization till recovery/death. Out of a total of 9930 admissions during this period, 1740 (17.52%) were for infections and 230 (2.31%) had AKI secondary to infectious diseases during monsoon. The incidence of AKI (230/1740) in infectious diseases during monsoon was 13.21%. The study population (n = 230) comprised 79.5% of males and the mean age was 40.95 ± 16.55 years. Severe AKI: AKIN Stage III was seen in 48.26% of patients and AKIN Stage I in 41.74%. The most common etiology of AKI was malaria (28.3%) followed by acute gastroenteritis (23%), dengue (16.5%), leptospirosis (13%), undifferentiated fever (10.4%), more than one etiology (5.4%), and enteric fever (3.5%). RRT was required in 44.78% of patients. Requirement for RRT was maximum in patients with more than one etiology followed by leptospirosis, malaria, dengue, and least in typhoid. The overall mortality was 12.17%. In multivariate analysis, vasopressor support and assisted ventilation were risk factors for mortality.
Collapse
Affiliation(s)
- K. Mehta
- Department of Nephrology, Topiwala National Medical College and B. Y. L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - A. Pajai
- Department of Nephrology, Topiwala National Medical College and B. Y. L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - S. Bhurke
- Department of Nephrology, Topiwala National Medical College and B. Y. L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - A. Shirkande
- Department of Nephrology, Topiwala National Medical College and B. Y. L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - R. Bhadade
- Department of Medicine, Topiwala National Medical College and B. Y. L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - R. D'Souza
- Department of Medicine, Topiwala National Medical College and B. Y. L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
24
|
Villegas SL, Darb-Esfahani S, von Minckwitz G, Huober J, Weber K, Marmé F, Furlanetto J, Schem C, Pfitzner BM, Lederer B, Engels K, Kümmel S, Müller V, Mehta K, Denkert C, Loibl S. Expression of Cyclin D1 protein in residual tumor after neoadjuvant chemotherapy for breast cancer. Breast Cancer Res Treat 2017; 168:179-187. [PMID: 29177689 DOI: 10.1007/s10549-017-4581-1] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/15/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Hormone receptor (HR)-positive breast cancer (BC) shows a poor response to neoadjuvant chemotherapy (NACT). New treatment targets like the Cyclin D1-CDK4/CDK6 complex are promising adjuvant/post-neoadjuvant therapeutic strategies. Evaluating Cyclin D1 overexpression in residual tumor could recognize those patients that benefit most from such post-neoadjuvant treatment. In this study, we determined Cyclin D1 expression in residual BC after NACT. Secondary aims were to correlate Cyclin D1 expression levels with clinicopathological parameters and to assess its prognostic value after NACT. METHODS We retrospectively assessed the nuclear expression of Cyclin D1 on tissue microarrays with residual tumor from 284 patients treated in the neoadjuvant GeparTrio (n = 186) and GeparQuattro (n = 98) trials. Evaluation was performed with a standardized immunoreactive score (IRS) after selecting a cut-off value. RESULTS A high expression level (IRS ≥ 6) of Cyclin D1 was found in 37.3% of the assessed specimens. An increased Cyclin D1 expression was observed in HR-positive tumors, compared to HR-negative tumors (p = 0.02). Low Cyclin D1 levels correlated with clinical tumor stage 1-3 (p = 0.03). Among patients with HR-positive/Her2-negative tumors and high Cyclin D1 expression, a better disease-free survival (DFS) was graphically suggested, but not significant (p = 0.21). CONCLUSION Our study demonstrates a measurable nuclear expression of Cyclin D1 in post-neoadjuvant residual tumor tissue of HR-positive BC. Cyclin D1 expression was not prognostic for DFS after NACT. Our results and defined cut-off suggest that the marker can be used to stratify tumors according to protein expression levels. Based on this, a prospective evaluation is currently performed in the ongoing Penelope-B trial.
Collapse
Affiliation(s)
- S L Villegas
- Institute of Pathology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - S Darb-Esfahani
- Institute of Pathology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Institute of Pathology Spandau, Evangelisches Waldkrankenhaus, Stadtrandstr. 555, 13589, Berlin, Germany
| | - G von Minckwitz
- German Breast Group (GBG Forschungs GmbH), Martin-Behaim-Str. 12, 63263, Neu-Isenburg, Germany
| | - J Huober
- Department of Obstetrics and Gynecology, Ulm University, Ulm, Germany
| | - K Weber
- German Breast Group (GBG Forschungs GmbH), Martin-Behaim-Str. 12, 63263, Neu-Isenburg, Germany
| | - F Marmé
- National Center for Tumor Diseases, University-Hospital Heidelberg, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
| | - J Furlanetto
- German Breast Group (GBG Forschungs GmbH), Martin-Behaim-Str. 12, 63263, Neu-Isenburg, Germany
| | - C Schem
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Hostein, Kiel, Germany
| | - B M Pfitzner
- Institute of Pathology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - B Lederer
- German Breast Group (GBG Forschungs GmbH), Martin-Behaim-Str. 12, 63263, Neu-Isenburg, Germany
| | - K Engels
- Zentrum für Pathologie, Zytologie und Molekularpathologie Neuss, Neuss, Germany
| | - S Kümmel
- Breast Unit Kliniken Essen-Mitte, Essen, Germany
| | - V Müller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - K Mehta
- German Breast Group (GBG Forschungs GmbH), Martin-Behaim-Str. 12, 63263, Neu-Isenburg, Germany
| | - C Denkert
- Institute of Pathology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. .,German Cancer Consortium (DKTK), Partner Site Charité, Berlin, Germany.
| | - S Loibl
- German Breast Group (GBG Forschungs GmbH), Martin-Behaim-Str. 12, 63263, Neu-Isenburg, Germany
| |
Collapse
|
25
|
Yeo G, Hikoyeda N, McBride M, Tzuang M, Grudzen M, Mehta K. FACULTY DEVELOPMENT IN ETHNOGERIATRICS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- G. Yeo
- Stanford University, Stanford, California,
| | | | | | - M. Tzuang
- Stanford University, Stanford, California,
- Johns Hopkins University, Baltimore, Maryland
| | | | - K. Mehta
- Stanford University, Stanford, California,
- University of California, San Francisco, San Francisco, California,
| |
Collapse
|
26
|
Miller E, Viswanathan S, Li S, Mehta K, Smith H, Smotkin D, Kuo D, Goldberg G, Einstein M, Frimer M. Adjuvant pelvic radiation sandwiched between paclitaxel/carboplatin chemotherapy in women with completely resected uterine serous carcinoma (USC): A prospective phase II trial update. Gynecol Oncol 2017. [DOI: 10.1016/j.ygyno.2017.03.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
27
|
Lindauer A, Valiathan CR, Mehta K, Sriram V, de Greef R, Elassaiss-Schaap J, de Alwis DP. Translational Pharmacokinetic/Pharmacodynamic Modeling of Tumor Growth Inhibition Supports Dose-Range Selection of the Anti-PD-1 Antibody Pembrolizumab. CPT Pharmacometrics Syst Pharmacol 2016; 6:11-20. [PMID: 27863176 PMCID: PMC5270293 DOI: 10.1002/psp4.12130] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 08/29/2016] [Indexed: 12/30/2022]
Abstract
Pembrolizumab, a humanized monoclonal antibody against programmed death 1 (PD‐1), has a manageable safety profile and robust clinical activity against advanced malignancies. The lowest effective dose for evaluation in further dose‐ranging studies was identified by developing a translational model from preclinical mouse experiments. A compartmental pharmacokinetic model was combined with a published physiologically based tissue compartment, linked to receptor occupancy as the driver of observed tumor growth inhibition. Human simulations were performed using clinical pharmacokinetic data, literature values, and in vitro parameters for drug distribution and binding. Biological and mathematical uncertainties were included in simulations to generate expectations for dose response. The results demonstrated a minimal increase in efficacy for doses higher than 2 mg/kg. The findings of the translational model were successfully applied to select 2 mg/kg as the lowest dose for dose‐ranging evaluations.
Collapse
Affiliation(s)
- A Lindauer
- Merck & Co., Inc., Rahway, New Jersey, USA
| | | | - K Mehta
- Merck & Co., Inc., Rahway, New Jersey, USA
| | - V Sriram
- Merck & Co., Inc., Rahway, New Jersey, USA
| | - R de Greef
- Merck & Co., Inc., Rahway, New Jersey, USA
| | | | | |
Collapse
|
28
|
Dadayal G, Weston M, Young A, Graham J, Mehta K, Wilkinson N, Spencer J. Transvaginal ultrasound (TVUS)-guided biopsy is safe and effective in diagnosing peritoneal carcinomatosis and recurrent pelvic malignancy. Clin Radiol 2016; 71:1184-92. [DOI: 10.1016/j.crad.2016.06.119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 05/08/2016] [Accepted: 06/23/2016] [Indexed: 11/29/2022]
|
29
|
Jindal RM, Soni R, Mehta K, Patel TG. Incidence of diabetes and hypertension in indigenous Amerindian village in Guyana, South America. Indian J Nephrol 2016; 26:389-390. [PMID: 27795642 PMCID: PMC5015526 DOI: 10.4103/0971-4065.181471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- R M Jindal
- Department of Surgery and Preventative Medicine and Biostatistics, Uniformed Services University of the Health Sciences and Walter Reed NNMC, Bethesda, MD, USA
| | - R Soni
- Department of Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA
| | - K Mehta
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - T G Patel
- Department of Medicine, Uniformed Service University, Bethesda, MD, USA
| |
Collapse
|
30
|
von Minckwitz G, Rezai M, Tesch H, Huober J, Gerber B, Zahm D, Hilfrich J, Costa S, Dubsky P, Blohmer J, Denkert C, Hanusch C, Jackisch C, Kümmel S, Fasching P, Schneeweiss A, Paepke S, Untch M, Burchardi N, Mehta K, Loibl S. Zoledronate for patients with invasive residual disease after anthracyclines-taxane-based chemotherapy for early breast cancer – The Phase III NeoAdjuvant Trial Add-oN (NaTaN) study (GBG 36/ABCSG 29). Eur J Cancer 2016; 64:12-21. [DOI: 10.1016/j.ejca.2016.05.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/27/2016] [Accepted: 05/14/2016] [Indexed: 11/25/2022]
|
31
|
Jindal RM, Mehta K, Soni R, Doyle A, Patel TG. Diabetes, hypertension, sanitation, and health education by high school students in Guyana, South America. Indian J Nephrol 2016; 26:192-8. [PMID: 27194834 PMCID: PMC4862265 DOI: 10.4103/0971-4065.161522] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We initiated a program for early detection of diabetes and hypertension, the main causes of kidney failure in Guyana, South America. We trained local high school students with the goal that these students would stay in the villages for long-term, become health advocates and shift the reliance away from physicians. This project involved 7 high school students who were taught to monitor the health of one village of 1000–1500 population each. The program will be implemented for 3 years in which the entire population of seven villages (approximately 10,000 people) will be covered. This represents 1.3% population in Guyana. We present data from the pilot study from the sample of 619 people. The prevalence of diabetes mellitus was 13.9%. Among diabetics, 33.7% were using insulin and 86% oral hypoglycemic agents. Prevalence of hypertension was 29.4%, 63.2% were overweight and 17% were obese. About 9.9% patients were unaware about the existence of hypertension. We have shown in our study that high school students can be used to collect health data and monitor diabetes and hypertension. There was also a significant incidence of undetected diabetes and hypertension.
Collapse
Affiliation(s)
- R M Jindal
- Department of Surgery, Division of Global Health, Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Medicine and Surgery, The George Washington University, Washington, DC, USA
| | - K Mehta
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - R Soni
- Department of Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA
| | - A Doyle
- Department of Medicine, Drexel University School of Medicine, Philadelphia, PA, USA
| | - T G Patel
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| |
Collapse
|
32
|
Mehta K, Narreddy S, Rao S N. Congenital Syphilis: Complicating an already complex adoption process. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
33
|
Denkert C, Budczies J, Regan M, Loibl S, Dell'Orto P, von Minckwitz G, Mastropasqua M, Mehta K, Müller V, Kammler R, Pfitzner BM, Fasching PA, Viale G. Abstract P5-07-02: Systematic analysis and modulation of Ki67 interobserver variance in 9069 patients from three clinical trials – How much pathologist concordance is needed for meaningful biomarker results? Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p5-07-02] [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: Ki67 has been suggested as a marker for diagnosis of luminal A and B breast carcinomas. Interestingly, on one hand a multitude of studies have described significant results for Ki67 as a prognostic marker, while on the other hand the analytical validation and standardization of this marker has been a challenge. The best parameter for Ki67 interobserver performance is the interclass correlation coefficient (ICC). ICC values between 0.59 and 0.92 have been reported. Recently a minimum ICC of 0.8 has been suggested as a goal for the international ring trial and as a prerequisite for introduction of Ki67 into clinical practice. However, this suggested ICC is not derived from analysis of data, and the amount of pathologist variance that is allowed for meaningful biomarker results is still not defined.
Methods: This study is based on a total of 9069 tumor samples from three large clinical cohorts (IBCSG VIII+IX, BIG1-98, and GeparTrio). In a systematic modeling approach, we introduced different amounts of variance to previously generated central pathology Ki67 datasets by simulation of a total of 1800 different pathologist evaluations for each study cohort. These evaluations were grouped into groups with defined ICCs, ranging from very good concordance (ICC=0.9) to extremely poor concordance (ICC=0.1). For each of the simulated pathologist evaluations, all possible Ki67 cutoffs were systematically evaluated using the web-based software Cutoff Finder (http://molpath.charite.de/cutoff/). As endpoints, we used DFS for all three study cohorts as well as pCR for the neoadjuvant cohort.
Results: For the neoadjuvant GeparTrio study, the different groups with ICCs of 0.8, 0.6 and 0.4 showed a very similar performance resulting in significant analyses for prediction of pCR across a wide range of cutoffs. The odd ratios for pCR were slightly lower with lower ICC. Even with an extremely low ICC of 0.2, 99% of the analyses had one or more significant cutpoints.
The survival endpoint DFS was shown to be very stable despite increased interpathologist variance in all three clinical cohorts. Even with a poor ICC of 0.4, the majority of cutpoints were significant for DFS. For IBCSG VIII+IX 85% of the analyses with an ICC of 0.4 had one or more significant cutpoints for Ki67. In the large BIG 1-98 dataset (n=6090) even an ICC of 0.2 resulted in one or more significant DFS cutpoints in 100% of the analyses. Comparable results were obtained if the analysis was restricted to luminal tumors.
Conclusion: Our results suggest that Ki67 is extremely robust to pathologist variation. Even if less than 40% of the variance is attributable to true Ki67-based proliferation (ICC<0.4), this percentage of information is sufficient to obtain statistically significant differences. This stable performance of Ki67 might provide an explanation for the observation that many Ki67 studies achieve significant results despite the interobserver variance and heterogeneity issues. It might also suggest a relevant clinical utility for Ki67 despite considerable variation introduced in the evaluation. Ongoing efforts to further reduce interobserver variability, however, should be continued.
Citation Format: Denkert C, Budczies J, Regan M, Loibl S, Dell'Orto P, von Minckwitz G, Mastropasqua M, Mehta K, Müller V, Kammler R, Pfitzner BM, Fasching PA, Viale G. Systematic analysis and modulation of Ki67 interobserver variance in 9069 patients from three clinical trials – How much pathologist concordance is needed for meaningful biomarker results?. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-07-02.
Collapse
Affiliation(s)
- C Denkert
- Charité University Hospital - Institute of Pathology, Berlin, Germany; Dana-Farber Cancer Institute, Boston; German Breast Group, Neu-Isenburg, Germany; Istituto Europeo di Oncologia, Milano, Italy; Universitätsklinikum Eppendorf, Hamburg, Germany; IBCSG Coordinating Center, Bern, Switzerland; University of Erlangen, Erlangen, Germany
| | - J Budczies
- Charité University Hospital - Institute of Pathology, Berlin, Germany; Dana-Farber Cancer Institute, Boston; German Breast Group, Neu-Isenburg, Germany; Istituto Europeo di Oncologia, Milano, Italy; Universitätsklinikum Eppendorf, Hamburg, Germany; IBCSG Coordinating Center, Bern, Switzerland; University of Erlangen, Erlangen, Germany
| | - M Regan
- Charité University Hospital - Institute of Pathology, Berlin, Germany; Dana-Farber Cancer Institute, Boston; German Breast Group, Neu-Isenburg, Germany; Istituto Europeo di Oncologia, Milano, Italy; Universitätsklinikum Eppendorf, Hamburg, Germany; IBCSG Coordinating Center, Bern, Switzerland; University of Erlangen, Erlangen, Germany
| | - S Loibl
- Charité University Hospital - Institute of Pathology, Berlin, Germany; Dana-Farber Cancer Institute, Boston; German Breast Group, Neu-Isenburg, Germany; Istituto Europeo di Oncologia, Milano, Italy; Universitätsklinikum Eppendorf, Hamburg, Germany; IBCSG Coordinating Center, Bern, Switzerland; University of Erlangen, Erlangen, Germany
| | - P Dell'Orto
- Charité University Hospital - Institute of Pathology, Berlin, Germany; Dana-Farber Cancer Institute, Boston; German Breast Group, Neu-Isenburg, Germany; Istituto Europeo di Oncologia, Milano, Italy; Universitätsklinikum Eppendorf, Hamburg, Germany; IBCSG Coordinating Center, Bern, Switzerland; University of Erlangen, Erlangen, Germany
| | - G von Minckwitz
- Charité University Hospital - Institute of Pathology, Berlin, Germany; Dana-Farber Cancer Institute, Boston; German Breast Group, Neu-Isenburg, Germany; Istituto Europeo di Oncologia, Milano, Italy; Universitätsklinikum Eppendorf, Hamburg, Germany; IBCSG Coordinating Center, Bern, Switzerland; University of Erlangen, Erlangen, Germany
| | - M Mastropasqua
- Charité University Hospital - Institute of Pathology, Berlin, Germany; Dana-Farber Cancer Institute, Boston; German Breast Group, Neu-Isenburg, Germany; Istituto Europeo di Oncologia, Milano, Italy; Universitätsklinikum Eppendorf, Hamburg, Germany; IBCSG Coordinating Center, Bern, Switzerland; University of Erlangen, Erlangen, Germany
| | - K Mehta
- Charité University Hospital - Institute of Pathology, Berlin, Germany; Dana-Farber Cancer Institute, Boston; German Breast Group, Neu-Isenburg, Germany; Istituto Europeo di Oncologia, Milano, Italy; Universitätsklinikum Eppendorf, Hamburg, Germany; IBCSG Coordinating Center, Bern, Switzerland; University of Erlangen, Erlangen, Germany
| | - V Müller
- Charité University Hospital - Institute of Pathology, Berlin, Germany; Dana-Farber Cancer Institute, Boston; German Breast Group, Neu-Isenburg, Germany; Istituto Europeo di Oncologia, Milano, Italy; Universitätsklinikum Eppendorf, Hamburg, Germany; IBCSG Coordinating Center, Bern, Switzerland; University of Erlangen, Erlangen, Germany
| | - R Kammler
- Charité University Hospital - Institute of Pathology, Berlin, Germany; Dana-Farber Cancer Institute, Boston; German Breast Group, Neu-Isenburg, Germany; Istituto Europeo di Oncologia, Milano, Italy; Universitätsklinikum Eppendorf, Hamburg, Germany; IBCSG Coordinating Center, Bern, Switzerland; University of Erlangen, Erlangen, Germany
| | - BM Pfitzner
- Charité University Hospital - Institute of Pathology, Berlin, Germany; Dana-Farber Cancer Institute, Boston; German Breast Group, Neu-Isenburg, Germany; Istituto Europeo di Oncologia, Milano, Italy; Universitätsklinikum Eppendorf, Hamburg, Germany; IBCSG Coordinating Center, Bern, Switzerland; University of Erlangen, Erlangen, Germany
| | - PA Fasching
- Charité University Hospital - Institute of Pathology, Berlin, Germany; Dana-Farber Cancer Institute, Boston; German Breast Group, Neu-Isenburg, Germany; Istituto Europeo di Oncologia, Milano, Italy; Universitätsklinikum Eppendorf, Hamburg, Germany; IBCSG Coordinating Center, Bern, Switzerland; University of Erlangen, Erlangen, Germany
| | - G Viale
- Charité University Hospital - Institute of Pathology, Berlin, Germany; Dana-Farber Cancer Institute, Boston; German Breast Group, Neu-Isenburg, Germany; Istituto Europeo di Oncologia, Milano, Italy; Universitätsklinikum Eppendorf, Hamburg, Germany; IBCSG Coordinating Center, Bern, Switzerland; University of Erlangen, Erlangen, Germany
| |
Collapse
|
34
|
|
35
|
Singh S, Pokharel P, Raut P, Mehta K. Study of the effects of pesticide exposure among the workers of tea
estates. Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.1026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
36
|
Hong M, Bendavid E, Mehta K. HealthTrax: A new tool to identify and navigate dirt roads for health
outreach work in Southern Zambia. Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
37
|
Kuo H, Tome W, FOX J, Hong L, Yaparpalvi R, Mehta K, Huang Y, Bodner W, Kalnicki S. TU-F-18C-09: Mammogram Surveillance Using Texture Analysis for Breast Cancer Patients After Radiation Therapy. Med Phys 2014. [DOI: 10.1118/1.4889354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|
38
|
Abstract
The findings of the 4 preceding country studies are examined here from a comparative perspective identifying some of the similarities and differences that underlie living arrangements of the elderly. More specifically, we compare the normative basis underlying living arrangements, mechanisms that help perpetuate co-residence, strains inherent to co-residence, preferences for co-residents, alternative forms of living arrangements, and views of social changes in relation to living arrangements. Overall, the focus group data on which the studies are based highlight the importance of culture in influencing the living arrangements of elderly people in Asia. The results suggest that at least for the next generation, co-residential living by elderly with children will continue to be a viable option, although the extent to which it persists is likely to vary among the 4 countries studied.
Collapse
Affiliation(s)
- M M Asis
- Department of Sociology, University of the Philippines, Dilman, 1101, Quexon City, Philippines
| | | | | | | |
Collapse
|
39
|
Cortazar P, Zhang L, Untch M, Mehta K, Constantino J, Wolmark N, Bonnefoi H, Piccart M, Gianni L, Valagussa P, Zujewski JA, Justice R, Loibl S, Swain SM, Bogaerts J, Baselga J, Prowell TM, Rastogi P, Sridhara R, Tang S, Pazdur R, Mamounas E, von Minckwitz G. Abstract P5-17-01: A definition of a high-risk early-breast cancer population based on data from the collaborative trials in neoadjuvant breast cancer (CTNeoBC) meta-analysis. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p5-17-01] [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: Pathological complete response (pCR) is a proposed surrogate endpoint for predicting long-term clinical benefit on endpoints such as event-free survival (EFS) or overall survival (OS). The CTNeoBC meta-analysis did not validate the surrogacy of pCR for EFS or OS, and there is no precedent for its use as a regulatory endpoint in oncology. Use of the accelerated approval pathway has been proposed for neoadjuvant therapies that substantially improve pCR as a means to expedite widespread access to highly effective therapies for high-risk, early breast cancer. Potential risks of this approach include approving an agent that ultimately does not demonstrate clinical benefit and, in the interim, exposing curable patients to the toxicity of therapy without certainty of benefit. To mitigate the risks of this pathway, enrollment to neoadjuvant trials intended to support accelerated approval should be restricted to patients presenting with high-risk early-stage breast cancer. The 5-year EFS rate by breast cancer subtype in the CTNeoBC meta-analysis population is presented. Methods: We identified 12 neoadjuvant randomized trials (N = 12,993) with pCR clearly defined and long-term follow-up available for EFS and OS. Trials included AGO 1 (n = 668), ECTO (n = 1355), EORTC 10994/BIG 1-00 (n = 1856), GeparDuo (n = 907), GeparQuattro (n = 1495), GeparTrio (n = 2072), GeparTrio-Pilot (n = 285), NOAH (n = 234), NSABP B18 (n = 760), NSABP B27 (n = 2411), PREPARE (n = 733), and TECHNO (n = 217). The key objective of this analysis was to establish a definition of “high-risk” based on the Kaplan-Meier estimates of the 5-year EFS rate in the different clinical breast cancer subtypes (hormone receptor-positive, HER2-positive and triple-negative) analyzed by tumor stage and tumor grade at presentation. Results: The 5-year EFS rate was less than 65% in all the breast cancer subtypes with stage III disease. For patients with stage II disease, the impact of tumor grade varied by hormone receptor status. Patients with hormone receptor-negative breast cancer, regardless of HER2 status had a poor prognosis that was independent of tumor grade. For patients with hormone receptor-positive tumors, regardless of HER2 status, high grade histology was associated with an increased risk of recurrence.
5-year Event-Free Survival Rate (EFS) 5-year EFS Rate Estimate (95% confidence interval)TNMStage IIStage III Grade IIGrade IIIGrade IIGrade IIIHormone Receptor + HER2-83% (80%, 85%)71% (65%, 77%)63% (58%, 69%)51% (42%, 59%)HER2+ HR+81% (75%, 86%)69% (60%, 76%)50% (41%, 59%)48% (37%, 59%)HER2+ HR-61% (51%, 70%)66% (57%, 73%)58% (46%, 69%)46% (36%, 55%)Triple Negative66% (58%, 72%)72% (67%, 76%)38% (27%, 48%)37% (29%, 45%)
Conclusions: This analysis estimated the 5-year EFS rate in the breast cancer subtypes from the CTNeoBC meta-analysis population. The HER2-positive population in the meta-analysis was at particularly high risk because most of the patients had locally advanced breast cancer and only 39% of these patients received trastuzumab therapy. We propose defining less than 75% 5-year EFS rate as “high-risk” for the purposes of designing neoadjuvant trials that intend to use pCR to support accelerated approval.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-17-01.
Collapse
Affiliation(s)
- P Cortazar
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - L Zhang
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - M Untch
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - K Mehta
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - J Constantino
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - N Wolmark
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - H Bonnefoi
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - M Piccart
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - L Gianni
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - P Valagussa
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - JA Zujewski
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - R Justice
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - S Loibl
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - SM Swain
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - J Bogaerts
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - J Baselga
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - TM Prowell
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - P Rastogi
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - R Sridhara
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - S Tang
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - R Pazdur
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - E Mamounas
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| | - G von Minckwitz
- FDA; HELIOS Klinikum Berlin-Buch, Berlin, Germany, D-13125; GBG Forschungs GmbH, Germany; NSABP, Pittsburgh, PA; Institut Bergonié, INSERM U916; Jules Bordet Institute, Brussels, Belgium; San Raffaele Scientific Insitute, Milan, Italy; Fondazione Michelangelo, Milan, Italy; Cancer Therapy Evaluation Program, NCI, Bethesda, MD; Medstar Washington Hospital Center, Washington, DC; EORTC Headquarters, Brussels, Belgium; Memorial Sloan-Kettering Cancer Center, New York; Orlando Health MD Anderson Cancer Center
| |
Collapse
|
40
|
von Minckwitz G, Rezai M, Eidtmann H, Tesch H, Huober J, Gerber B, Zahn DM, Costa S, Gnant M, Blohmer JU, Denkert C, Hanusch C, Jackisch C, Kümmel S, Fasching PA, Schneeweiss A, Paepke S, Untch M, Nekljudova V, Mehta K, Loibl S. Abstract S5-05: Postneoadjuvant treatment with zoledronate in patients with tumor residuals after anthracyclines-taxane-based chemotherapy for primary breast cancer – The phase III NATAN study (GBG 36/ABCSG XX). Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-s5-05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Patients with residual disease after neoadjuvant chemotherapy (NACT) are considered to have chemoresistant breast cancer. Adjuvant treatment with bisphosphonates is considered to reduce the relapse risk predominantly in estrogen-deprivated patients.
Methods: Patients who had invasive tumor residuals (ypT1-4 or ypN+) after a minimum of 4 cycles of anthracycline-taxane-containing NACT were eligible to the NATAN study. Patients were randomized within 3 years after surgery to receive zoledronate 4 mg i.v. (plus 1000 mg Ca2+ and 880 I.U. vitamin D daily) for 5 years vs. observation. Zoledronate was given q 4 weeks for the first 6 months, q 3 months the following 2 years, and q 6 months for the last 2.5 years. Patients with hormone receptor (HR)-positive disease received letrozole for 5 years if postmenopausal, or tamoxifen, if premenopausal. Adjuvant trastuzumab for HER2-positive disease was allowed since an amendment in 2007. Stratification factors were HR, time since surgery, age, and center. Primary objective was event-free survival (EFS). 654 patients and 316 events were required to observe an increase of 5yr EFS from 58% to 67.2% (hazard ratio 0.73). Secondary objectives were to determine overall survival, EFS with respect to the interval between surgery and randomization, bone-metastasis-free-survival, toxicity of and compliance to zoledronate, the predictive value of breast tumor response to NACT on the effect of postoperative treatment and the prognostic impact of chemotherapy induced amenorrhea in premenopausal patients. An interim analysis for high efficacy at 158 observed events was planned in the protocol; in agreement with study IDMC a Bayesian analysis for futility with futility boundary of 15% will be performed at the same time.
Results: Between 2/2005 and 5/2009 693 patients were enrolled. Time between surgery and randomization was <4 months in 48.4%, 4-12 months in 34.5%, and 13-36 months in 17.1% of patients. The median age was 50.9 yrs (range 33.7-88.2), 72.3% of patients were postmenopausal. 82% had HR-positive and 19% HER2-positive disease. During a median follow up of 48 months 154 events were observed so far.
Conclusion: This is the first post-neoadjuvant phase III study. Analysis of the primary endpoint will be presented in case the IDMC will release of the results of the futility analysis.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr S5-05.
Collapse
Affiliation(s)
- G von Minckwitz
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - M Rezai
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - H Eidtmann
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - H Tesch
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - J Huober
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - B Gerber
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - DM Zahn
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - S Costa
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - M Gnant
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - JU Blohmer
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - C Denkert
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - C Hanusch
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - C Jackisch
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - S Kümmel
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - PA Fasching
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - A Schneeweiss
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - S Paepke
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - M Untch
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - V Nekljudova
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - K Mehta
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| | - S Loibl
- German Breast Group, Neu-Isenburg, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitäts Frauenklinik Kiel, Germany; Onkologische Gemeinschaftspraxis, Frankfurt, Germany; Frauenklinik Ulm, Germany; Universitäts-Frauenklinik Rostock, Germany; SRH Wald Klinikum Gera, Germany; Universitätsklinikum Magdeburg, Germany; Medical University of Vienna, Austria; Sankt Gertrauden Krankenhaus, Berlin, Germany; Charité University, Berlin, Germany; Rotkruezklinikum München, Germany; Klinikum Offenbach, Germany; Kliniken Essen Mitte, Germany; University Erlangen, Germany; University Heidelberg; Klinikum Rechts der Isar der TU München, Germany; Helios Kliniken Berlin, Germany; Frauenklinik Frankfurt, Germany
| |
Collapse
|
41
|
von Minckwitz G, Rezai M, Fasching PA, Huober J, Tesch H, Bauerfeind I, Hilfrich J, Eidtmann H, Gerber B, Hanusch C, Blohmer JU, Costa SD, Jackisch C, Paepke S, Schneeweiss A, Kümmel S, Denkert C, Mehta K, Loibl S, Untch M. Survival after adding capecitabine and trastuzumab to neoadjuvant anthracycline-taxane-based chemotherapy for primary breast cancer (GBG 40--GeparQuattro). Ann Oncol 2013; 25:81-9. [PMID: 24273046 DOI: 10.1093/annonc/mdt410] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The GeparQuattro study showed that adding capecitabine or prolonging the duration of anthracycline-taxane-based neoadjuvant chemotherapy from 24 to 36 weeks did not increase pathological complete response (pCR) rates. Trastuzumab-treated patients with HER2-positive disease showed a higher pCR rate than patients with HER2-negative disease treated with chemotherapy alone. We here present disease-free (DFS) and overall survival (OS) analyses. PATIENTS AND METHODS Patients (n = 1495) with cT ≥ 3 tumors, or negative hormone-receptor status, or positive hormone-receptor and clinically node-positive disease received four times epirubicin/cyclophosphamide and were thereafter randomly assigned to four times docetaxel (Taxotere), or four times docetaxel/capecitabine over 24 weeks, or four times docetaxel followed by capecitabine over 36 weeks. Patients with HER2-positive tumors received 1 year of trastuzumab, starting with the first chemotherapy cycle. Follow-up was available for a median of 5.4 years. RESULTS Outcome was not improved for patients receiving capecitabine (HR 0.92; P = 0.463 for DFS and HR 93; P = 0.618 for OS) as well as for patients receiving 36 weeks of chemotherapy (HR 0.97; P = 0.818 for DFS and HR 0.97; P = 0.825 for OS). Trastuzumab-treated patients with HER2-positive disease showed similar DFS (P = 0.305) but a significantly better adjusted OS (P = 0.040) when compared with patients with HER2-negative disease treated with chemotherapy alone. Recorded long-term cardiac toxicity was low. CONCLUSIONS Long-term results, similar to the results of pCR, do not support the use of capecitabine in the neoadjuvant setting in addition to an anthracycline-taxane-based chemotherapy. However, the results support previous data showing a benefit of trastuzumab as predicted by higher pCR rates.
Collapse
|
42
|
Baliga S, Mehta K, Goldberg G, Kalnicki S. Stereotactic Body Radiation Therapy in Oligo-Metastatic Recurrent Ovarian Cancer. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.1119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
43
|
Pahlajani D, Kaul U, Mishra A, Mullasari A, Sawhney J, Dargad R, Mehta K, Sinha N. Prospective pre-test and clinical scoring in subjects with suspected coronary disease estimates the probability of coronary artery disease: the Prospective Stable Angina Observational registry, India. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
44
|
Sinn BV, von Minckwitz G, Denkert C, Eidtmann H, Darb-Esfahani S, Tesch H, Kronenwett R, Hoffmann G, Belau A, Thommsen C, Holzhausen HJ, Grasshoff ST, Baumann K, Mehta K, Dietel M, Loibl S. Evaluation of Mucin-1 protein and mRNA expression as prognostic and predictive markers after neoadjuvant chemotherapy for breast cancer. Ann Oncol 2013; 24:2316-24. [PMID: 23661292 DOI: 10.1093/annonc/mdt162] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Mucin-1 (MUC1) is a promising antigen for the development of tumor vaccines. We evaluated the frequency of MUC1 expression and its impact on therapy response and survival after neoadjuvant chemotherapy for breast cancer. PATIENTS AND METHODS Pre-treatment core biopsies of patients from the GeparTrio neoadjuvant trial (NCT 00544765) were evaluated for MUC1 by immunohistochemistry (IHC; N = 691) and quantitative RT-PCR (qRT-PCR; N = 286) from formalin-fixed paraffin-embedded (FFPE) samples. RESULTS MUC1 protein and mRNA was detectable in the majority of cases and was associated with hormone-receptor-positive status (P < 0.001). High MUC1 protein and mRNA expression were associated with lower probability of pathologic complete response (P = 0.017 and P < 0.001) and with longer patient survival (P = 0.03 and P < 0.001). In multivariable analysis, MUC1 protein and mRNA expression were independently predictive (P = 0.001 and P < 0.001). MUC1 protein and mRNA expression were independently prognostic for overall survival (P = 0.029 and P = 0.015). CONCLUSIONS MUC1 is frequently expressed in breast cancer and detectable on mRNA and protein level from FFPE tissue. It provides independent predictive information for therapy response and survival after neoadjuvant chemotherapy. In clinical immunotherapy trials, MUC1 expression may serve as a predictive marker.
Collapse
Affiliation(s)
- B V Sinn
- Department of Pathology, Charité-Universitätsmedizin Berlin, Berlin.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Mansor L, Mehta K, L Page L, Carr C, Clarke K, Heather L. 234 IMPAIRED METABOLIC AND FUNCTIONAL ADAPTATION TO HYPOXIA IN THE TYPE 2 DIABETIC HEART. Heart 2013. [DOI: 10.1136/heartjnl-2013-304019.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
46
|
Bernstein M, Yaparpalvi R, Kuo H, Kalnicki S, Mehta K. CT-Guidance Allows Interstitial Implantation in an Outpatient Setting for Cervical Cancer Patients. Pract Radiat Oncol 2013; 3:S1. [PMID: 24674470 DOI: 10.1016/j.prro.2013.01.007] [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: 11/17/2022]
Affiliation(s)
| | | | - H Kuo
- Montefiore Medical Center, Bronx, NY
| | | | - K Mehta
- Montefiore Medical Center, Bronx, NY
| |
Collapse
|
47
|
Glanzman J, Weiss P, Mehta K, Bodner W, Kalnicki S, Garg M. PO-0986: Surgical resection followed by HDR brachytherapy for management of keloids at high risk for recurrence. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33292-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
48
|
von Minckwitz G, Rezai M, Loibl S, Fasching PA, Huober J, Tesch H, Bauerfeind I, Hilfrich J, Eidtmann H, Gerber B, Hanusch C, Blohmer JU, Costa SD, Jackisch C, Paepke S, Schneeweiss A, Kuemmel S, Denkert C, Mehta K, Untch M. Abstract P1-14-01: Adding capecitabine and trastuzumab to neoadjuvant breast cancer chemotherapy - first survival analysis of the GBG/AGO intergroup-study GeparQuattro. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p1-14-01] [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: 11/16/2022]
Abstract
Abstract
Background: Previous results of the GeparQuattro study demonstrated that adding capecitabine either simultaneously or sequentially to EC-Docetaxel (D) neoadjuvant chemotherapy could not increase pathological complete response rates (pCR) (von Minckwitz G, JCO 2010). However, patients with HER2-positive disease treated simultaneously with trastuzumab showed a significant higher pCR rate than patients with HER2-negative disease treated with chemotherapy alone (Untch M, JCO 2010). We here report survival after a median follow up of 58 months including 279 relapses and 191 deaths.
Patients and methods: Patients with either large operable (cT3) and locally advanced (cT4) tumors, or hormone-receptor (HR)-negative receptor status, or HR-positive tumors but clinically node-positive disease were recruited to receive 4 cycles of EC (90mg/m2/600mg/m2) and randomized to either 4 cycles of D (100mg/m2) or 4 cycles of DX (75mg/m2/1800mg/m2) or 4 cycles of D (75mg/m2) followed by 4 cycles of X (1800mg/m2) (D→X). Patients with HER-2 positive tumors received 1 year of trastuzumab, the first part concurrent to all chemotherapy cycles. All patients with HR+ tumors received endocrine therapy according to current standard. The intent-to-treat survival analysis included 1421 patients for the chemotherapy question and 1495 patients for the trastuzumab question. Analyses were adjusted by age, stage, size, nodal status, histologic type, grade, hormone-receptor (HR) and HER2-status at baseline (if applicable).
Results: No difference in DFS and OS was seen for patients receiving D, DX or D-X overall (hazard ratio 0.978, p = 0.984 and hazard ratio 0.986, p = 0.684, respectively) as well as by phenotype defined according to St. Gallen (all P>0.354).
Patients with HER2-positive disease treated additionally with trastuzumab showed significantly better OS (p = 0.015) compared to patients with HER2-negative disease treated with chemotherapy alone. DFS was significantly better for trastuzumab-treated patients with HR-negative tumors (p = 0.046), but not with HR-positive tumors (p = 0.790). OS after first relapse was significantly better in trastuzumab-retreated patients with HER2-positive tumors (p = 0.032) compared to relapsed patients with HER2-negative tumors.
Patients with an early response after 4 cycles, with a clinical response at surgery and with a pCR showed a significantly better DFS and OS compared to patients without pCR (p = 0.022, P < 0.0001, P < 0.0001). This benefit was most prominent in patients with triple-negative tumors.
Conclusions: Survival analysis of the GeparQuattro study confirmed the results of the primary endpoint analysis on pCR. Capecitabine could not improve outcome when added to anthracycline-taxane-based chemotherapy. As suggested by a recent integrated multi-level meta-analysis (von Minckwitz, BCRT 2011) effect of capecitabine could not be properly assessed in this study as planned docetaxel doses in arms DX and D®X were lower than in arm D. Survival of HER-2 positive patients surmounts that of HER2-negative patients if trastuzumab is used in the neoadjuvant as well as in the metastatic setting.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-14-01.
Collapse
Affiliation(s)
- G von Minckwitz
- German Breast Group, Neu-Isenburg; Louisenkrankenhaus Düsseldorf; University Erlangen; University Duesseldorf; Bethanien-Kankenhaus Frankfurt; Klinikum Landshut; Eilenriedeklinik Duesseldorf; University Kiel; University Rostock; Roteskreuzklinikum Muenchen; Sankt Gertrauden Berlin; University Magdeburg; Klinikum Offenbach; Frauenklinik München; University Heidelberg; Kliniken Essen Mitte; Charite Berlin; Helios Kliniken Berlin
| | - M Rezai
- German Breast Group, Neu-Isenburg; Louisenkrankenhaus Düsseldorf; University Erlangen; University Duesseldorf; Bethanien-Kankenhaus Frankfurt; Klinikum Landshut; Eilenriedeklinik Duesseldorf; University Kiel; University Rostock; Roteskreuzklinikum Muenchen; Sankt Gertrauden Berlin; University Magdeburg; Klinikum Offenbach; Frauenklinik München; University Heidelberg; Kliniken Essen Mitte; Charite Berlin; Helios Kliniken Berlin
| | - S Loibl
- German Breast Group, Neu-Isenburg; Louisenkrankenhaus Düsseldorf; University Erlangen; University Duesseldorf; Bethanien-Kankenhaus Frankfurt; Klinikum Landshut; Eilenriedeklinik Duesseldorf; University Kiel; University Rostock; Roteskreuzklinikum Muenchen; Sankt Gertrauden Berlin; University Magdeburg; Klinikum Offenbach; Frauenklinik München; University Heidelberg; Kliniken Essen Mitte; Charite Berlin; Helios Kliniken Berlin
| | - PA Fasching
- German Breast Group, Neu-Isenburg; Louisenkrankenhaus Düsseldorf; University Erlangen; University Duesseldorf; Bethanien-Kankenhaus Frankfurt; Klinikum Landshut; Eilenriedeklinik Duesseldorf; University Kiel; University Rostock; Roteskreuzklinikum Muenchen; Sankt Gertrauden Berlin; University Magdeburg; Klinikum Offenbach; Frauenklinik München; University Heidelberg; Kliniken Essen Mitte; Charite Berlin; Helios Kliniken Berlin
| | - J Huober
- German Breast Group, Neu-Isenburg; Louisenkrankenhaus Düsseldorf; University Erlangen; University Duesseldorf; Bethanien-Kankenhaus Frankfurt; Klinikum Landshut; Eilenriedeklinik Duesseldorf; University Kiel; University Rostock; Roteskreuzklinikum Muenchen; Sankt Gertrauden Berlin; University Magdeburg; Klinikum Offenbach; Frauenklinik München; University Heidelberg; Kliniken Essen Mitte; Charite Berlin; Helios Kliniken Berlin
| | - H Tesch
- German Breast Group, Neu-Isenburg; Louisenkrankenhaus Düsseldorf; University Erlangen; University Duesseldorf; Bethanien-Kankenhaus Frankfurt; Klinikum Landshut; Eilenriedeklinik Duesseldorf; University Kiel; University Rostock; Roteskreuzklinikum Muenchen; Sankt Gertrauden Berlin; University Magdeburg; Klinikum Offenbach; Frauenklinik München; University Heidelberg; Kliniken Essen Mitte; Charite Berlin; Helios Kliniken Berlin
| | - I Bauerfeind
- German Breast Group, Neu-Isenburg; Louisenkrankenhaus Düsseldorf; University Erlangen; University Duesseldorf; Bethanien-Kankenhaus Frankfurt; Klinikum Landshut; Eilenriedeklinik Duesseldorf; University Kiel; University Rostock; Roteskreuzklinikum Muenchen; Sankt Gertrauden Berlin; University Magdeburg; Klinikum Offenbach; Frauenklinik München; University Heidelberg; Kliniken Essen Mitte; Charite Berlin; Helios Kliniken Berlin
| | - J Hilfrich
- German Breast Group, Neu-Isenburg; Louisenkrankenhaus Düsseldorf; University Erlangen; University Duesseldorf; Bethanien-Kankenhaus Frankfurt; Klinikum Landshut; Eilenriedeklinik Duesseldorf; University Kiel; University Rostock; Roteskreuzklinikum Muenchen; Sankt Gertrauden Berlin; University Magdeburg; Klinikum Offenbach; Frauenklinik München; University Heidelberg; Kliniken Essen Mitte; Charite Berlin; Helios Kliniken Berlin
| | - H Eidtmann
- German Breast Group, Neu-Isenburg; Louisenkrankenhaus Düsseldorf; University Erlangen; University Duesseldorf; Bethanien-Kankenhaus Frankfurt; Klinikum Landshut; Eilenriedeklinik Duesseldorf; University Kiel; University Rostock; Roteskreuzklinikum Muenchen; Sankt Gertrauden Berlin; University Magdeburg; Klinikum Offenbach; Frauenklinik München; University Heidelberg; Kliniken Essen Mitte; Charite Berlin; Helios Kliniken Berlin
| | - B Gerber
- German Breast Group, Neu-Isenburg; Louisenkrankenhaus Düsseldorf; University Erlangen; University Duesseldorf; Bethanien-Kankenhaus Frankfurt; Klinikum Landshut; Eilenriedeklinik Duesseldorf; University Kiel; University Rostock; Roteskreuzklinikum Muenchen; Sankt Gertrauden Berlin; University Magdeburg; Klinikum Offenbach; Frauenklinik München; University Heidelberg; Kliniken Essen Mitte; Charite Berlin; Helios Kliniken Berlin
| | - C Hanusch
- German Breast Group, Neu-Isenburg; Louisenkrankenhaus Düsseldorf; University Erlangen; University Duesseldorf; Bethanien-Kankenhaus Frankfurt; Klinikum Landshut; Eilenriedeklinik Duesseldorf; University Kiel; University Rostock; Roteskreuzklinikum Muenchen; Sankt Gertrauden Berlin; University Magdeburg; Klinikum Offenbach; Frauenklinik München; University Heidelberg; Kliniken Essen Mitte; Charite Berlin; Helios Kliniken Berlin
| | - J-U Blohmer
- German Breast Group, Neu-Isenburg; Louisenkrankenhaus Düsseldorf; University Erlangen; University Duesseldorf; Bethanien-Kankenhaus Frankfurt; Klinikum Landshut; Eilenriedeklinik Duesseldorf; University Kiel; University Rostock; Roteskreuzklinikum Muenchen; Sankt Gertrauden Berlin; University Magdeburg; Klinikum Offenbach; Frauenklinik München; University Heidelberg; Kliniken Essen Mitte; Charite Berlin; Helios Kliniken Berlin
| | - S-D Costa
- German Breast Group, Neu-Isenburg; Louisenkrankenhaus Düsseldorf; University Erlangen; University Duesseldorf; Bethanien-Kankenhaus Frankfurt; Klinikum Landshut; Eilenriedeklinik Duesseldorf; University Kiel; University Rostock; Roteskreuzklinikum Muenchen; Sankt Gertrauden Berlin; University Magdeburg; Klinikum Offenbach; Frauenklinik München; University Heidelberg; Kliniken Essen Mitte; Charite Berlin; Helios Kliniken Berlin
| | - C Jackisch
- German Breast Group, Neu-Isenburg; Louisenkrankenhaus Düsseldorf; University Erlangen; University Duesseldorf; Bethanien-Kankenhaus Frankfurt; Klinikum Landshut; Eilenriedeklinik Duesseldorf; University Kiel; University Rostock; Roteskreuzklinikum Muenchen; Sankt Gertrauden Berlin; University Magdeburg; Klinikum Offenbach; Frauenklinik München; University Heidelberg; Kliniken Essen Mitte; Charite Berlin; Helios Kliniken Berlin
| | - S Paepke
- German Breast Group, Neu-Isenburg; Louisenkrankenhaus Düsseldorf; University Erlangen; University Duesseldorf; Bethanien-Kankenhaus Frankfurt; Klinikum Landshut; Eilenriedeklinik Duesseldorf; University Kiel; University Rostock; Roteskreuzklinikum Muenchen; Sankt Gertrauden Berlin; University Magdeburg; Klinikum Offenbach; Frauenklinik München; University Heidelberg; Kliniken Essen Mitte; Charite Berlin; Helios Kliniken Berlin
| | - A Schneeweiss
- German Breast Group, Neu-Isenburg; Louisenkrankenhaus Düsseldorf; University Erlangen; University Duesseldorf; Bethanien-Kankenhaus Frankfurt; Klinikum Landshut; Eilenriedeklinik Duesseldorf; University Kiel; University Rostock; Roteskreuzklinikum Muenchen; Sankt Gertrauden Berlin; University Magdeburg; Klinikum Offenbach; Frauenklinik München; University Heidelberg; Kliniken Essen Mitte; Charite Berlin; Helios Kliniken Berlin
| | - S Kuemmel
- German Breast Group, Neu-Isenburg; Louisenkrankenhaus Düsseldorf; University Erlangen; University Duesseldorf; Bethanien-Kankenhaus Frankfurt; Klinikum Landshut; Eilenriedeklinik Duesseldorf; University Kiel; University Rostock; Roteskreuzklinikum Muenchen; Sankt Gertrauden Berlin; University Magdeburg; Klinikum Offenbach; Frauenklinik München; University Heidelberg; Kliniken Essen Mitte; Charite Berlin; Helios Kliniken Berlin
| | - C Denkert
- German Breast Group, Neu-Isenburg; Louisenkrankenhaus Düsseldorf; University Erlangen; University Duesseldorf; Bethanien-Kankenhaus Frankfurt; Klinikum Landshut; Eilenriedeklinik Duesseldorf; University Kiel; University Rostock; Roteskreuzklinikum Muenchen; Sankt Gertrauden Berlin; University Magdeburg; Klinikum Offenbach; Frauenklinik München; University Heidelberg; Kliniken Essen Mitte; Charite Berlin; Helios Kliniken Berlin
| | - K Mehta
- German Breast Group, Neu-Isenburg; Louisenkrankenhaus Düsseldorf; University Erlangen; University Duesseldorf; Bethanien-Kankenhaus Frankfurt; Klinikum Landshut; Eilenriedeklinik Duesseldorf; University Kiel; University Rostock; Roteskreuzklinikum Muenchen; Sankt Gertrauden Berlin; University Magdeburg; Klinikum Offenbach; Frauenklinik München; University Heidelberg; Kliniken Essen Mitte; Charite Berlin; Helios Kliniken Berlin
| | - M Untch
- German Breast Group, Neu-Isenburg; Louisenkrankenhaus Düsseldorf; University Erlangen; University Duesseldorf; Bethanien-Kankenhaus Frankfurt; Klinikum Landshut; Eilenriedeklinik Duesseldorf; University Kiel; University Rostock; Roteskreuzklinikum Muenchen; Sankt Gertrauden Berlin; University Magdeburg; Klinikum Offenbach; Frauenklinik München; University Heidelberg; Kliniken Essen Mitte; Charite Berlin; Helios Kliniken Berlin
| |
Collapse
|
49
|
Loibl S, La De Haba J, von Minckwitz G, Morales S, Crespo C, Antón A, Carrasco E, Aktas B, Mehta K, Martin M. Phase III Trial Evaluating the Addition of Bevacizumab to Endocrine Therapy as First-Line Treatment for Advanced Breast Cancer: The GEICAM/GBG Lea Study. Safety Analysis. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)32942-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
50
|
Otiv AS, Mehta K, Ali U, Nadkarni M. Sonographic measurement of renal size in normal indian children. Indian Pediatr 2012; 49:533-6. [DOI: 10.1007/s13312-012-0120-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 10/05/2011] [Indexed: 10/28/2022]
|