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Albain KS, Gray RJ, Makower DF, Faghih A, Hayes DF, Geyer CE, Dees EC, Goetz MP, Olson JA, Lively T, Badve SS, Saphner TJ, Wagner LI, Whelan TJ, Ellis MJ, Wood WC, Keane MM, Gomez HL, Reddy PS, Goggins TF, Mayer IA, Brufsky AM, Toppmeyer DL, Kaklamani VG, Berenberg JL, Abrams J, Sledge GW, Sparano JA. Race, Ethnicity, and Clinical Outcomes in Hormone Receptor-Positive, HER2-Negative, Node-Negative Breast Cancer in the Randomized TAILORx Trial. J Natl Cancer Inst 2021; 113:390-399. [PMID: 32986828 PMCID: PMC8599918 DOI: 10.1093/jnci/djaa148] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/22/2020] [Accepted: 09/09/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Black race is associated with worse outcomes in early breast cancer. We evaluated clinicopathologic characteristics, the 21-gene recurrence score (RS), treatment delivered, and clinical outcomes by race and ethnicity among women who participated in the Trial Assigning Individualized Options for Treatment. METHODS The association between clinical outcomes and race (White, Black, Asian, other or unknown) and ethnicity (Hispanic vs non-Hispanic) was examined using proportional hazards models. All P values are 2-sided. RESULTS Of 9719 eligible women with hormone receptor-positive, HER2-negative, node-negative breast cancer, there were 8189 (84.3%) Whites, 693 (7.1%) Blacks, 405 (4.2%) Asians, and 432 (4.4%) with other or unknown race. Regarding ethnicity, 889 (9.1%) were Hispanic. There were no substantial differences in RS or ESR1, PGR, or HER2 RNA expression by race or ethnicity. After adjustment for other covariates, compared with White race, Black race was associated with higher distant recurrence rates (hazard ratio [HR] = 1.60, 95% confidence intervals [CI] = 1.07 to 2.41) and worse overall survival in the RS 11-25 cohort (HR = 1.51, 95% CI = 1.06 to 2.15) and entire population (HR = 1.41, 95% CI = 1.05 to 1.90). Hispanic ethnicity and Asian race were associated with better outcomes. There was no evidence of chemotherapy benefit for any racial or ethnic group in those with a RS of 11-25. CONCLUSIONS Black women had worse clinical outcomes despite similar 21-gene assay RS results and comparable systemic therapy in the Trial Assigning Individualized Options for Treatment. Similar to Whites, Black women did not benefit from adjuvant chemotherapy if the 21-gene RS was 11-25. Further research is required to elucidate the basis for this racial disparity in prognosis.
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Affiliation(s)
- Kathy S Albain
- Loyola University Chicago Stritch School of Medicine, Cardinal Bernadin Cancer Center, Loyola University Medical Center, Maywood, IL, USA
| | | | - Della F Makower
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Amir Faghih
- Thunder Bay Regional Health Science Centre, Thunder Bay, Ontario, Canada
| | | | | | | | | | - John A Olson
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tracy Lively
- National Institutes of Health, National Cancer Institute, Bethesda, MD, USA
| | - Sunil S Badve
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Lynne I Wagner
- Wake Forest University Health Service, Winston Salem, NC, USA
| | | | | | | | | | - Henry L Gomez
- Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | | | | | | | | | | | | | | | - Jeffrey Abrams
- National Institutes of Health, National Cancer Institute, Bethesda, MD, USA
| | | | - Joseph A Sparano
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Zheng-Pywell R, Fang A, AlKashash A, Awad S, Reddy S, Vickers S, Heslin M, Dudeja V, Chen H, Rose JB. Prognostic Impact of Tumor Size on Pancreatic Neuroendocrine Tumor Recurrence May Have Racial Variance. Pancreas 2021; 50:347-352. [PMID: 33835965 PMCID: PMC8041062 DOI: 10.1097/mpa.0000000000001776] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The incidence of pancreatic neuroendocrine tumors (PNETs) has increased over the last decade. Black patients have worse survival outcomes. This study investigates whether oncologic outcomes are racially disparate at a single institution. METHODS Retrospective analysis was performed on 151 patients with resected PNETs between 2010 and 2019. RESULTS More White males and Black females presented with PNETs (P = 0.02). White patients were older (65 years vs 60 years; P = 0.03), more likely to be married (P < 0.01), and had higher median estimated yearly incomes ($28,973 vs $17,767; P < 0.01) than Black patients. Overall and disease-free survival were not different. Black patients had larger median tumor sizes (30 mm vs 23 mm; P = 0.02). Tumor size was predictive of recurrence only for White patients (hazard ratio, 1.02; P = 0.01). Collectively, tumors greater than 20 mm in size were more likely to have recurrence (P = 0.048), but this cutoff was not predictive in either racial cohort independently. CONCLUSIONS Black patients undergoing curative resection of PNETs at our institution presented with larger tumors, but that increased size is not predictive of disease-free survival in this population.
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Affiliation(s)
- Rui Zheng-Pywell
- From the Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
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3
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Shi R, Lu T, Ku G, Ding H, Saito T, Gibiansky L, Agarwal P, Li X, Jin JY, Girish S, Miles D, Li C, Lu D. Asian race and origin have no clinically meaningful effects on polatuzumab vedotin pharmacokinetics in patients with relapsed/refractory B-cell non-Hodgkin lymphoma. Cancer Chemother Pharmacol 2020; 86:347-359. [PMID: 32770353 PMCID: PMC7478950 DOI: 10.1007/s00280-020-04119-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/19/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE The CD79b-targeted antibody-drug conjugate polatuzumab vedotin (pola), alone and with chemoimmunotherapy, has clinical efficacy and a tolerable safety profile in B-cell non-Hodgkin lymphoma (B-NHL). We assessed (a) whether exposure from global studies of pola is comparable to Asian patients, and (b) if the recommended pola dose is appropriate in Asian patients based on exposure. METHODS The pharmacokinetics (PK) of pola in Asian and global populations was characterized for three analytes (antibody-conjugated monomethyl auristatin E (MMAE) [acMMAE], total antibody, and unconjugated MMAE) in five phase 1b/2 single-agent and combination studies in B-NHL patients (JO29138 [JAPICCTI-142580], DCS4968g [NCT01290549], GO27834 [NCT01691898], GO29044 [NCT01992653], and GO29365 [NCT02257567]). PK data were compared between Japanese phase 1 JO29138 (JAPICCTI-142580) and global phase 1 DCS4968g (NCT01290549) studies and between Asian and non-Asian patients in the randomized relapsed/refractory B-NHL cohorts of the phase 1b/2 study GO29365 (NCT02257567). A population PK (popPK) model was used to assess the effects of Asian race and region on acMMAE and unconjugated MMAE exposure. RESULTS PK non-compartmental analysis (NCA) parameters for the key analyte acMMAE in the Japanese JO29138 (JAPICCTI-142580) and global phase 1 DCS4968g (NCT01290549) studies were similar. In GO29365 (NCT02257567), the phase 1b/2 combination study, mean exposure to the analytes was generally lower in Asian patients (by ~ 9.9 to 17.5%), but not to a clinically meaningful extent. Overall, the popPK model further suggested comparable PK in Asian patients with B-NHL (race or region) versus non-Asian patients. CONCLUSION Race has no clinically meaningful effect on pola PK. These results (and observations from efficacy/safety exposure-response analyses) support no pola dose adjustments are warranted for Asian patients with DLBCL.
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MESH Headings
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/pharmacokinetics
- Asian People/statistics & numerical data
- CD79 Antigens/immunology
- Drug Resistance, Neoplasm
- Follow-Up Studies
- Humans
- Immunoconjugates/administration & dosage
- Immunoconjugates/pharmacokinetics
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/ethnology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/ethnology
- Neoplasm Recurrence, Local/pathology
- Prognosis
- Salvage Therapy
- Survival Rate
- Treatment Outcome
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Affiliation(s)
- Rong Shi
- Genentech Inc., South San Francisco, CA, USA.
| | - Tong Lu
- Genentech Inc., South San Francisco, CA, USA
| | - Grace Ku
- Genentech Inc., South San Francisco, CA, USA
| | - Hao Ding
- Genentech Inc., South San Francisco, CA, USA
| | | | | | | | - Xiaobin Li
- Genentech Inc., South San Francisco, CA, USA
| | - Jin Yan Jin
- Genentech Inc., South San Francisco, CA, USA
| | | | - Dale Miles
- Genentech Inc., South San Francisco, CA, USA
| | - Chunze Li
- Genentech Inc., South San Francisco, CA, USA
| | - Dan Lu
- Genentech Inc., South San Francisco, CA, USA.
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Rivin Del Campo E, Matzinger O, Haustermans K, Peiffert D, Glynne-Jones R, Winter KA, Konski AA, Ajani JA, Bosset JF, Hannoun-Levi JM, Puyraveau M, Chakravarthy AB, Meadows H, Northover J, Collette L, Christiaens M, Maingon P. Pooled Analysis of external-beam RADiotherapy parameters in phase II and phase III trials in radiochemotherapy in Anal Cancer (PARADAC). Eur J Cancer 2019; 121:130-143. [PMID: 31574418 PMCID: PMC6924923 DOI: 10.1016/j.ejca.2019.08.022] [Citation(s) in RCA: 5] [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: 05/20/2019] [Revised: 08/16/2019] [Accepted: 08/24/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Concomitant external-beam radiochemotherapy (5-fluorouracil-mitomycin C) has become the standard of care in anal cancer since the '90s. A pooled analysis of individual patient data from 7 major trials was performed quantifying the effect of radiation therapy (RT)-related parameters on the outcome of patients with anal cancer. MATERIALS AND METHODS Pooling databases from combined modality trials, the impact of RT parameters (total dose, gap duration, OTT: overall treatment time) on outcome including locoregional failure (LRF), 5-year progression free survival (PFS) and toxicities were investigated. Individual patient data were received for 10/13 identified published studies conducted from 1987 to 2008 (n = 3031). A Cox regression model was used (landmark = 3 months after RT for first follow-up). RESULTS After data inspection indicating severe heterogeneity between trials, only 1343 patients from 7/10 studies received were analysed (the most recent ones, since 1994; median follow-up = 4.1 years). A higher overall 5-year LRF rate [22.8% (95% confidence interval [CI] 22.3-27.3%)] significantly correlated with longer OTT (p = 0.03), larger tumour size (p < 0.001) and male gender (p = 0.045). Although significant differences were not observed, subset analyses for LRF (dose range: 50.4-59 Gy) seemed to favour lower doses (p = 0.412), and when comparing a 2-week gap versus 3 (dose: 59.4 Gy), results suggested 3 weeks might be detrimental (p = 0.245). For a 2-week gap versus none (dose range: 55-59.4 Gy), no difference was observed (p = 0.89). Five-year PFS was 65.7% (95% CI: 62.8-68.5%). Higher PFS rates were observed in women (p < 0.001), smaller tumour sizes (p < 0.001) and shorter OTT (p = 0.025). Five-year overall survival [76.7% (95% CI: 73.9%-79.3%)] correlated positively with female gender (p < 0.001), small tumour size (p = 0.027) and short OTT (p = 0.026). Descriptive toxicity data are presented. CONCLUSION For patients receiving concurrent external-beam doublet chemoradiation, a longer OTT seems detrimental to outcome. Further trials involving modern techniques may better define optimal OTT and total dose.
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Affiliation(s)
- Eleonor Rivin Del Campo
- Department of Radiation Oncology, Tenon University Hospital, Sorbonne University, Paris, France.
| | - Oscar Matzinger
- Department of Radiation Oncology, Genolier Clinic, Genolier, Switzerland
| | - Karin Haustermans
- Department of Radiation Oncology, UZ Leuven University Hospital, Leuven, Belgium
| | - Didier Peiffert
- Department of Radiation Oncology, Institut de Cancérologie de Lorraine, Nancy, France
| | - Robert Glynne-Jones
- Department of Radiation Oncology, Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Kathryn A Winter
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA, USA
| | - Andre A Konski
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Leonard Davis Institute of Health Economics, West Chester, PA, USA; Department of Radiation Oncology, The Chester County Hospital, West Chester, PA, USA
| | - Jaffer A Ajani
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Jean-François Bosset
- Department of Radiation Oncology, Jean Minjoz University Hospital, Besançon, France
| | | | - Marc Puyraveau
- Department of Statistics, Jean Minjoz University Hospital, Besançon, France
| | - A Bapsi Chakravarthy
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Helen Meadows
- Cancer Research UK & UCL Cancer Trials Centre, London, United Kingdom
| | - John Northover
- Department of Surgery, The London Clinic and St Marks Hospital, London, United Kingdom
| | | | - Melissa Christiaens
- Department of Radiation Oncology, UZ Leuven University Hospital, Leuven, Belgium
| | - Philippe Maingon
- Department of Radiation Oncology, La Pitié Salpêtrière - Charles Foix University Hospital, Sorbonne University, Paris, France
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Pastoriza JM, Karagiannis GS, Lin J, Lanjewar S, Entenberg D, Condeelis JS, Sparano JA, Xue X, Rohan TE, Oktay MH. Black race and distant recurrence after neoadjuvant or adjuvant chemotherapy in breast cancer. Clin Exp Metastasis 2018; 35:613-623. [PMID: 30136072 DOI: 10.1007/s10585-018-9932-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 08/16/2018] [Indexed: 11/25/2022]
Abstract
Black race compared to white race is associated with more advanced stage and biologically aggressive breast cancer. Consequently, black patients are more frequently treated with neoadjuvant chemotherapy (NAC) than white patients. However, it is unclear how distant recurrence-free survival (DRFS) of black patients treated with NAC, compares to DRFS of black patients treated with adjuvant chemotherapy (AC). We evaluated the association between race, distant recurrence, and type of chemotherapy (AC or NAC) in localized or locally advanced breast cancer. We evaluated DRFS in 807 patients, including 473 black, 252 white, 56 Hispanic, and 26 women of other or mixed race. The association between AC or NAC and DRFS was examined using multivariate Cox proportional hazard models that included race, age, stage, estrogen receptor (ER) and triple negative (TN) status. When the black and white subjects were pooled for the analysis the features associated with worse DRFS included stage III disease and age < 50 years, but not ER-negative disease, TN disease, the use of NAC, or black race. However, in the analysis stratified by race NAC was associated with worse DRFS compared to AC in black (HR 2.70; 95% CI 1.73-4.22; p < 0.0001), but not in white women (HR 1.29, 95% CI 0.56-2.95; p = 0.36). Black patients treated with NAC had worse DRFS than black patients treated with AC, or white patients treated with either NAC or AC. These findings need to be validated in a large-scale observational study and the effect of NAC on the breast cancer microenvironment in black women needs to be further evaluated.
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Affiliation(s)
- Jessica M Pastoriza
- Department of Surgery, Montefiore Medical Center, Bronx, NY, USA
- Gruss-Lipper Biophotonics Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Integrated Imaging Program, Albert Einstein College of Medicine, Bronx, NY, USA
| | - George S Karagiannis
- Gruss-Lipper Biophotonics Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY, USA
- Integrated Imaging Program, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Juan Lin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sonali Lanjewar
- Department of Pathology, Montefiore Medical Center, Bronx, NY, USA
| | - David Entenberg
- Gruss-Lipper Biophotonics Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY, USA
- Integrated Imaging Program, Albert Einstein College of Medicine, Bronx, NY, USA
| | - John S Condeelis
- Gruss-Lipper Biophotonics Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY, USA
- Integrated Imaging Program, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Joseph A Sparano
- Department of Oncology, Montefiore Medical Center, Bronx, NY, USA
| | - Xiaonan Xue
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Thomas E Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Maja H Oktay
- Gruss-Lipper Biophotonics Center, Albert Einstein College of Medicine, Bronx, NY, USA.
- Department of Anatomy and Structural Biology, Albert Einstein College of Medicine, Bronx, NY, USA.
- Integrated Imaging Program, Albert Einstein College of Medicine, Bronx, NY, USA.
- Department of Pathology, Montefiore Medical Center, Bronx, NY, USA.
- Department of Pathology, Anatomy and Structural Biology, Albert Einstein College of Medicine/Montefiore Medical Center, 1301 Morris Park Ave, Price Center, Bronx, NY, 10461, USA.
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6
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Lamb EP, Pritchard FE, Nouer SS, Tolley EA, Boyd BS, Davidson JT, Munene G, Fleming MD. Understanding Disparities in Breast Cancer Care in Memphis, Tennessee. Am Surg 2018; 84:620-627. [PMID: 29966559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Although significant progress has been made in improving breast cancer survival, disparities among racial, ethnic, and underserved groups still exist. The goal of this investigation is to quantify racial disparities in the context of breast cancer care, examining the outcomes of recurrence and mortality in the city of Memphis. Patients with a biopsy-proven diagnosis of breast cancer from January 1, 2002, through December 31, 2012, were obtained from the tumor registry. Black patients were more likely to have advanced (II, III, or IV) clinical stage of breast cancer at diagnosis versus white patients. Black breast cancer patients had a two times higher odds of recurrence (95% confidence interval: 1.4, 3.0) after adjusting for race and clinical stage. Black breast cancer patients were 1.5 times more likely to die (95% confidence interval: 1.2, 1.8), after adjusting for race; age at diagnosis; clinical stage; ER, PR, HER2 status; and recurrence. Black women with stages 0, I, II, and III breast cancer all had a statistically significant longer median time from diagnosis to surgery than white women. Black patients were more likely to have advanced clinical stages of breast cancer at diagnosis versus white patients on a citywide level in Memphis. Black breast cancer patients have higher odds of recurrence and mortality when compared with white breast cancer patients, after adjusting for appropriate demographic and clinical attributes. More work is needed to develop, evaluate, and disseminate interventions to decrease inequities in timeliness of care for breast cancer patients.
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MESH Headings
- Adolescent
- Adult
- Black or African American
- Aged
- Aged, 80 and over
- Breast Carcinoma In Situ/diagnosis
- Breast Carcinoma In Situ/ethnology
- Breast Carcinoma In Situ/mortality
- Breast Carcinoma In Situ/surgery
- Breast Neoplasms/diagnosis
- Breast Neoplasms/ethnology
- Breast Neoplasms/mortality
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/ethnology
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/ethnology
- Carcinoma, Intraductal, Noninfiltrating/mortality
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Lobular/diagnosis
- Carcinoma, Lobular/ethnology
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/surgery
- Female
- Follow-Up Studies
- Health Services Accessibility
- Health Status Disparities
- Healthcare Disparities/ethnology
- Humans
- Logistic Models
- Middle Aged
- Neoplasm Recurrence, Local/ethnology
- Neoplasm Recurrence, Local/mortality
- Registries
- Retrospective Studies
- Tennessee
- White People
- Young Adult
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Affiliation(s)
- Elena P Lamb
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
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Cullen J, Young D, Chen Y, Degon M, Farrell J, Sedarsky J, Baptiste W, Rosen P, Tolstikov V, Kiebish M, Kagan J, Srivastava S, Kuo HC, Moncur JT, Rosner IL, Narain N, Akmaev V, Petrovics G, Dobi A, McLeod DG, Srivastava S, Sesterhenn IA. Predicting Prostate Cancer Progression as a Function of ETS-related Gene Status, Race, and Obesity in a Longitudinal Patient Cohort. Eur Urol Focus 2017; 4:818-824. [PMID: 28753864 DOI: 10.1016/j.euf.2017.02.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 11/16/2016] [Revised: 02/14/2017] [Accepted: 02/24/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND ETS-related gene (ERG) oncogenic activation is the most common genomic alteration in prostate cancer (CaP) although it occurs less frequently in African American (AA) versus Caucasian (CA) patients, and the potential role of ERG as a prognostic marker has not been confirmed. OBJECTIVE This study was conducted to confirm strong racial variation in the prevalence of ERG oncoprotein expression and to examine ERG oncoprotein expression, race, and body mass index as independent and joint predictors of CaP biochemical recurrence (BCR) following radical prostatectomy (RP). DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study of CA and AA CaP patients enrolled at Walter Reed National Military Medical Center, who donated clinically annotated, whole-mounted, prostatectomy specimens between 1994 and 2014 following RP, was conducted. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Kaplan-Meier (KM) estimation curves and multivariable Cox proportional hazards models were used to examine time to BCR as a function of ERG status, patient race, and obesity. RESULTS AND LIMITATIONS Among 930 eligible patients (36.1% AA and 63.9% CA), with 155 (16.7%) BCR events and a median follow-up time of 5.1 yr, ERG oncoprotein expression was significantly less prevalent in index tumors of AA versus CA patients (23.2% vs 49.3%; p<0.0001). KM curves showed significantly poorer BCR-free survival for CA patients with ERG-negative index tumors but not for AA patients. Race-stratified multivariable analyses revealed a significant association between ERG-negative index tumors and poorer BCR-free survival among CA patients (hazards ratio=1.67, confidence interval=1.07, 2.61; p=0.024). Less heterogeneity in ERG expression among AA patients may reduce the ability to show its association with BCR. CONCLUSIONS Striking racial variation in ERG oncoprotein expression was confirmed. A novel observation was the importance of index tumor ERG-negative status in predicting CaP progression for CA patients. PATIENT SUMMARY ETS-related gene (ERG) typing of tumors may be useful in prognosticating prostate cancer aggressiveness.
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Affiliation(s)
- Jennifer Cullen
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | - Denise Young
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Yongmei Chen
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Michael Degon
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Walter Reed National Military Medical Center, Urology Service, Bethesda, MD, USA
| | - James Farrell
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Walter Reed National Military Medical Center, Urology Service, Bethesda, MD, USA
| | - Jason Sedarsky
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Walter Reed National Military Medical Center, Urology Service, Bethesda, MD, USA
| | - Wagner Baptiste
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Walter Reed National Military Medical Center, Urology Service, Bethesda, MD, USA
| | - Philip Rosen
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Walter Reed National Military Medical Center, Urology Service, Bethesda, MD, USA
| | | | | | - Jacob Kagan
- Cancer Biomarkers Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Sudhir Srivastava
- Cancer Biomarkers Research Group, Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA
| | - Huai-Ching Kuo
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Joel T Moncur
- Walter Reed National Military Medical Center, Urology Service, Bethesda, MD, USA
| | - Inger L Rosner
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Walter Reed National Military Medical Center, Urology Service, Bethesda, MD, USA
| | | | | | - Gyorgy Petrovics
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Albert Dobi
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - David G McLeod
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Walter Reed National Military Medical Center, Urology Service, Bethesda, MD, USA
| | - Shiv Srivastava
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Isabell A Sesterhenn
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Joint Pathology Center, Silver Spring, MD, USA
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Wright N, Xia J, Cantuaria G, Klimov S, Jones M, Neema P, Il’yasova D, Krishnamurti U, Li X, Reid MD, Gupta M, Rida PCG, Osan R, Aneja R. Distinctions in Breast Tumor Recurrence Patterns Post-Therapy among Racially Distinct Populations. PLoS One 2017; 12:e0170095. [PMID: 28085947 PMCID: PMC5234824 DOI: 10.1371/journal.pone.0170095] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 12/28/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Clinical studies have revealed a higher risk of breast tumor recurrence in African-American (AA) patients compared to European-American (EA) patients, contributing to the alarming inequality in clinical outcomes among the ethnic groups. However, distinctions in recurrence patterns upon receiving hormone, radiation, and/or chemotherapy between the races remain poorly characterized. METHODS We compared patterns and rates (per 1000 cancer patients per 1 year) of recurrence following each form of treatment between AA (n = 1850) and EA breast cancer patients (n = 7931) from a cohort of patients (n = 10504) treated between 2005-2015 at Northside Hospital in Atlanta, GA. RESULTS Among patients who received any combination of adjuvant therapy, AA displayed higher overall rates of recurrence than EA (p = 0.015; HR: 1.699; CI: 1.108-2.606). Furthermore, recurrence rates were higher in AA than EA among stage I (p = 0.031; HR: 1.736; CI: 1.052-2.864) and T1 classified patients (p = 0.003; HR: 2.009; CI: 1.263-3.197). Interestingly, among patients who received neoadjuvant chemotherapy, AA displayed higher rates of local recurrence than EA (p = 0.024; HR: 7.134; CI: 1.295-39.313). CONCLUSION Our analysis revealed higher incidence rates of recurrence in AA compared to EA among patients that received any combination of adjuvant therapy. Moreover, our data demonstrates an increased risk of tumor recurrence in AA than EA among patients diagnosed with minimally invasive disease. This is the first clinical study to suggest that neoadjuvant chemotherapy improves breast cancer recurrence rates and patterns in AA.
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Affiliation(s)
- Nikita Wright
- Department of Biology, Georgia State University, Atlanta, Georgia, United States of America
| | - Jun Xia
- Department of Mathematics and Statistics, Georgia State University, Atlanta, Georgia, United States of America
| | - Guilherme Cantuaria
- Department of Gynecologic Oncology, Northside Hospital Cancer Institute, Atlanta, Georgia, United States of America
| | - Sergey Klimov
- Department of Biology, Georgia State University, Atlanta, Georgia, United States of America
| | - Mildred Jones
- Department of Pathology Oncology Analytics, Northside Hospital Cancer Institute, Atlanta, GA, United States of America
| | - Pranay Neema
- Department of Biology, Georgia State University, Atlanta, Georgia, United States of America
| | - Dora Il’yasova
- School of Public Health, Georgia State University, Atlanta, Georgia, United States of America
| | - Uma Krishnamurti
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Xiaoxian Li
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Michelle D. Reid
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Meenakshi Gupta
- Clinical Pathology and Anatomic Pathology, West Georgia Hospitals, LaGrange, Georgia, United States of America
| | - Padmashree C. G. Rida
- Department of Biology, Georgia State University, Atlanta, Georgia, United States of America
| | - Remus Osan
- Department of Mathematics and Statistics, Georgia State University, Atlanta, Georgia, United States of America
- * E-mail: (RO); (RA)
| | - Ritu Aneja
- Department of Biology, Georgia State University, Atlanta, Georgia, United States of America
- * E-mail: (RO); (RA)
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Moore SP, Soerjomataram I, Green AC, Garvey G, Martin J, Valery PC. Breast cancer diagnosis, patterns of care and burden of disease in Queensland, Australia (1998-2004): does being Indigenous make a difference? Int J Public Health 2016; 61:435-42. [PMID: 26427859 DOI: 10.1007/s00038-015-0739-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 09/01/2015] [Accepted: 09/09/2015] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES We compared patterns of care, comorbidity, disability-adjusted life-years (DALYs) and survival in Indigenous and non-Indigenous women with breast cancer in Queensland, Australia (1998-2004). METHODS A cohort study of Indigenous (n = 110) and non-Indigenous women (n = 105), frequency matched on age and remoteness. We used Pearson's Chi-squared analysis to compare proportions, hazard models to assess survival differences and calculated disability-adjusted life years (DALYs). RESULTS Indigenous women were more likely to be socially disadvantaged (43 vs. 20 %, p < 0.01) have comorbidity (42 vs. 18 % p < 0.01), and have regional spread or distant metastasis (metastasis, 51 vs. 36 %, p = 0.02) than non-Indigenous women; there was no difference in treatment patterns. More Indigenous women died in the follow-up period (p = 0.01). DALY's were 469 and 665 per 100,000 for Indigenous and non-Indigenous women, respectively, with a larger proportion of the burden attributed to premature death among the former (63 vs. 59 %). CONCLUSIONS Indigenous women with breast cancer received comparable treatment to their non-Indigenous counterparts. The higher proportion of DALYs related to early death in Indigenous women suggests higher fatality with breast cancer in this group. Later stage at diagnosis and higher comorbidity presence among Indigenous women reinforce the need for early detection and improved management of co-existing disease.
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Affiliation(s)
- Suzanne P Moore
- Division of Epidemiology and Health Systems, Menzies School of Health Research, Charles Darwin University, Level 1/147 Wharf Street, Brisbane Adelaide Street, Spring Hill, PO Box 10639, Brisbane, QLD, 4000, Australia.
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Adèle C Green
- Cancer and Population Studies Group, QIMR Berghofer of Medical Research Institute, Brisbane, Queensland, Australia
- CRUK Manchester Institute and University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Gail Garvey
- Division of Epidemiology and Health Systems, Menzies School of Health Research, Charles Darwin University, Level 1/147 Wharf Street, Brisbane Adelaide Street, Spring Hill, PO Box 10639, Brisbane, QLD, 4000, Australia
| | - Jennifer Martin
- School of Medicine, University of Queensland and Princess Alexandra Hospital, Brisbane, Queensland, Australia
- School of Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Patricia C Valery
- Division of Epidemiology and Health Systems, Menzies School of Health Research, Charles Darwin University, Level 1/147 Wharf Street, Brisbane Adelaide Street, Spring Hill, PO Box 10639, Brisbane, QLD, 4000, Australia
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
- Cancer and Population Studies Group, QIMR Berghofer of Medical Research Institute, Brisbane, Queensland, Australia
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Ozen A, Falchook AD, Varia MA, Gehrig P, Jones EL. Effect of race and histology on patterns of failure in women with early stage endometrial cancer treated with high dose rate brachytherapy. Gynecol Oncol 2015; 138:429-33. [PMID: 26024766 DOI: 10.1016/j.ygyno.2015.05.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 04/22/2015] [Revised: 05/19/2015] [Accepted: 05/23/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Clinical trials have helped refine management of early stage endometrial cancer (EC). For patients with intermediate risk features, adjuvant radiation is considered, primarily vaginal cuff brachytherapy. For higher risk patients, there may be a role for chemotherapy and radiation. The purpose of this study is to examine patterns of failure for early stage EC patients treated with postoperative high dose rate brachytherapy. METHODS In this single institution retrospective cohort study, 208 women with early stage endometrial cancer who received definitive therapy between January 1, 2000 and January 1, 2013 were identified. RESULTS Median follow-up was 46.4 (range, 6.2-137.3) months. Thirteen (6.3%) patients developed with locoregional recurrent disease and 15 (7.2%) patients developed distant metastasis. Freedom from recurrence at 5 years was 88.6% for white patients and 60.5% for black patients (p=0.0093). Five year recurrence free survival (RFS) for white vs. black patients was 82.9% vs. 48.9% (p=0.0007). Five year overall survival (OS) was 86.8% for white patients and 59.5% for black patients (p=0.0023). Black patients with unfavorable histology treated with chemotherapy and vaginal brachytherapy had a 15% locoregional recurrence rate, more than double the rate of local recurrence compared to AA patients with endometrioid histology and white patients with any histology (6% locoregional recurrence rate). CONCLUSIONS Black women with unfavorable histology early stage EC experience increased rates of recurrence and worse survival compared to white patients. Patterns of failure in this group also indicate a high locoregional failure rate for the black patients with unfavorable histology (type II).
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Affiliation(s)
- Alaattin Ozen
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Radiation Oncology, Eskisehir Osmangazi University Hospital, Eskisehir, Turkey
| | - Aaron D Falchook
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mahesh A Varia
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paola Gehrig
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ellen L Jones
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Zhou X, Zhang G, Tian Y. p53 Status correlates with the risk of recurrence in non-muscle invasive bladder cancers treated with Bacillus Calmette-Guérin: a meta-analysis. PLoS One 2015; 10:e0119476. [PMID: 25742650 PMCID: PMC4351250 DOI: 10.1371/journal.pone.0119476] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 01/13/2015] [Indexed: 01/26/2023] Open
Abstract
Objective Published studies have yielded inconsistent results on the relationship between p53 status and the prognosis of non-muscle invasive bladder cancer (NMIBC) treated with Bacillus Calmette–Guérin (BCG) intravesical therapy. Therefore, we performed a meta-analysis to evaluate the prognostic value of p53 in NMIBC treated with BCG. Methods We systematically searched for relevant literature in PubMed, EMBASE, CNKI, and Chinese Wanfang databases. Hazard ratios (HRs) with 95% confidence intervals (CIs) were combined as the effect size (ES) across studies for recurrence-free survival (RFS) and progression-free survival (PFS). Results A total of 11 studies, consisting of 1,049 participants, met the criteria. Overall, there was no clear relationship between p53 status and RFS or PFS for NMIBC patients treated with BCG (HR: 1.40, 95% CI: 0.91-2.16; HR: 1.37, 95% CI: 0.90-2.09, respectively). Obvious heterogeneity was observed across the studies (I2 = 69.5%, P = 0.001; I2 = 44.7%, P = 0.081, respectively). In stratified analysis by region, p53 overexpression was a predictor of poor RFS in Asian populations (HR: 1.57, 95% CI: 1.08-2.27). In addition, after excluding the studies that possibly contributed to the heterogeneity by the Galbraith plot, the overall association for RFS became statistically significant (HR: 1.38 95% CI: 1.08-1.77) without evidence of heterogeneity (I2 = 0.0%, P = 0.499). Conclusion This meta-analysis suggests that p53 overexpression in NMIBC patients treated with BCG may be associated with RFS, especially in Asian populations. Because of the heterogeneity and other limitations, further studies with rigid criteria and large populations are still warranted to confirm our findings.
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Affiliation(s)
- Xiaofeng Zhou
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Yongan Road 95, Beijing 100050, China
| | - Guan Zhang
- Department of Urology, China-Japan Friendship Hospital, Yinghua East Road 2, Beijing 100029, China
| | - Ye Tian
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Yongan Road 95, Beijing 100050, China
- * E-mail:
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12
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Gibson LM, Thomas S, Parker V, Mayo R, Wetsel MA. Breast cancer fear in African American breast cancer survivors. J Cult Divers 2014; 21:135-144. [PMID: 25898498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The purpose of this study was to describe breast cancer fear according to phase of survivorship, determine whether breast cancer fear levels differed among survivorship phases, and determine the relationship between fear and age in African-American breast cancer survivors. The study utilized secondary data analysis from the study, Inner Resources as Predictors of Psychological Well-Being in AABCS. A new subscale entitled, "Breast Cancer Fear" was adapted from the Psychological Well Being Subscale by Ferrell and Grant. There was no significant difference between fear and phase of survivorship. There was a significant positive relationship between age and fear.
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Hsieh MC, Chiu YW, Velasco C, Wu XC, O'Flarity MB, Chen VW. Impact of race/ethnicity and socioeconomic status on adjuvant chemotherapy use among elderly patients with stage III colon cancer. J Registry Manag 2013; 40:180-187. [PMID: 24625772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND It is well recognized that stage III colon cancer patients who received chemotherapy postoperatively can have a reduced risk of recurrence and an improved survival rate. This study examined the impact of race/ethnicity and socioeconomic status (SES) on receipt of chemotherapy within 4 months after resection among stage III colon cancer patients enrolling in Medicare Parts A and B and trends of utilizing adjuvant chemotherapy. METHODS Stage III colon cancer patients diagnosed between 2000 and 2007 were obtained from the Surveillance, Epidemiology, and End Results-Medicare data. Multilevel logistic regression was used to estimate the association between predictor variables and adjuvant chemotherapy, and the Cochran-Armitage test was used to assess for linear trends. RESULTS Of 13,608 stage III colon cancer patients aged 66 and older, 56 percent received adjuvant chemotherapy within 4 months of surgical resection. Blacks or patients residing in the least affluent areas were less likely to receive the adjuvant chemotherapy within 4 months after resection, both before and after adjusting for race/ethnicity and other independent variables. A significantly decreasing trend was observed, from 58 percent in 2000 to 53 percent in 2007, for all patients combined. Trends of receiving chemotherapy within 4 months after resection were varied more in racial/ethnic groups than in SES groups. CONCLUSIONS After adjusting for demographic and clinical factors, there are persistent racial/ethnic and SES disparities in the use of adjuvant chemotherapy among Medicare-insured elderly patients with stage III colon cancer. The shortage of chemotherapy drugs and the change of Medicare drug administration reimbursement could be attributive factors in the decline of using adjuvant chemotherapy within 4 months of surgical resection.
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Dias SJ, Zhou X, Ivanovic M, Gailey MP, Dhar S, Zhang L, He Z, Penman AD, Vijayakumar S, Levenson AS. Nuclear MTA1 overexpression is associated with aggressive prostate cancer, recurrence and metastasis in African Americans. Sci Rep 2013; 3:2331. [PMID: 23900262 PMCID: PMC3728596 DOI: 10.1038/srep02331] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 07/16/2013] [Indexed: 01/28/2023] Open
Abstract
Metastasis-associated protein 1 (MTA1), a negative epigenetic modifier, plays a critical role in prostate cancer (PCa) progression. We hypothesized that MTA1 overexpression in primary tumor tissues can predict PCa aggressiveness and metastasis. Immunohistochemical staining of MTA1 was done on archival PCa specimens from University of Mississippi Medical Center and University of Iowa. We found that nuclear MTA1 overexpression was positively correlated with the severity of disease progression reaching its highest levels in metastatic PCa. Nuclear MTA1 overexpression was significantly associated with Gleason > 7 tumors in African Americans but not in Caucasians. It was also a predictor of recurrent disease. We concluded that MTA1 nuclear overexpression may be a prognostic indicator and a future therapeutic target for aggressive PCa in African American men. Our findings may be useful for categorizing African American patients with a higher probability of recurrent disease and metastasis from those who are likely to remain metastasis-free.
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Affiliation(s)
- Steven J. Dias
- Cancer Institute, University of Mississippi Medical Center, Jackson, MS, USA
- These authors contributed equally to this work
| | - Xinchun Zhou
- Department of Pathology, University of Mississippi Medical Center, Jackson, MS, USA
- These authors contributed equally to this work
| | - Marina Ivanovic
- Department of Pathology, University of Iowa, Iowa City, IA, USA
| | | | - Swati Dhar
- Cancer Institute, University of Mississippi Medical Center, Jackson, MS, USA
| | - Liangfen Zhang
- Cancer Institute, University of Mississippi Medical Center, Jackson, MS, USA
| | - Zhi He
- Department of Pathology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Alan D. Penman
- Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Srinivasan Vijayakumar
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Anait S. Levenson
- Cancer Institute, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Pathology, University of Mississippi Medical Center, Jackson, MS, USA
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Abstract
STUDY TYPE Therapy (case series). LEVEL OF EVIDENCE 4 OBJECTIVE To examine the interaction of body mass index (BMI) and race in predicting biochemical failure (BCF) after radical prostatectomy (RP). The relative contribution of BMI and race to BCF after RP has not been well characterized. PATIENTS AND METHODS From 1988 to 2008, 969 white and black men underwent RP and BMI data were available. In all, 168 (17.3%) were black and 801 (82.7%) were white men. BCF was defined as a post-surgery PSA level≥0.2 ng/mL on ≥2 measurements. Cox regression methods were used to model the relationship between race, BMI and BCF. RESULTS The 969 men had a mean age of 59.8±7.2 years. There was no significant difference in BMI between black and white men (P=0.32). The 5-year disease-free survival for black obese men was the lowest at 48%, compared with non-obese black (73%), obese white (82%) and non-obese white men (83%, P<0.001). BMI did not have a significant impact on BCF. In a multivariate analysis, black race remained an independent predictor of BCF [hazard ratio (HR)=1.76, P=0.01]. BMI does not affect the risk of BCF in black men differently than white men (P value for interaction 0.93). CONCLUSIONS Black race is an independent predictor of biochemical failure after adjusting for pathological factors. The impact of BMI on BCF did not vary among different races. These findings suggest that elevated BMI does not affect the BCF rates of black men more than in other races, and that other factors may influence the racial variability in disease-free survival and BCF risk.
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Affiliation(s)
- Daniel J Lee
- Department of Urology, Columbia University Medical Center, Columbia University Mailman School of Public Health, New York, NY 10032, USA.
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Thompson HS, Edwards T, Erwin DO, Lee SH, Bovbjerg D, Jandorf L, Littles M, Valdimarsdottir HB, Lewis T, Karsif K, Petersen B, Romero J. Training lay health workers to promote post-treatment breast cancer surveillance in African American breast cancer survivors: development and implementation of a curriculum. J Cancer Educ 2009; 24:267-274. [PMID: 19838883 DOI: 10.1080/08858190902973085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND African American breast cancer survivors are less adherent to guidelines for post-treatment breast cancer surveillance compared to White survivors. Survivors in Spirit (SIS) is an intervention that addresses this problem through lay health workers (LHWs). METHODS African American women were trained as LHWs using a structured curriculum. Trainees' intervention knowledge was assessed before and after training. RESULTS There was a substantial increase in the mean percentage of correct items from pre- to post-test for the trainees as a group. CONCLUSIONS LHWs can be effectively prepared to conduct interventions focusing on the complexities of breast cancer recurrence and surveillance.
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Morikawa A, Varma V, Gillespie TW, Lyles RH, Goodman M, Bostick RM, Mandel JS, Zhou W. Counting alleles in single lesions of prostate tumors from ethnically diverse patients. Prostate 2008; 68:231-40. [PMID: 18092351 DOI: 10.1002/pros.20693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The presence of racial disparities in incidence and mortality rates are well-documented for prostate cancer. Nevertheless, it is unclear whether such disparities are due to genetic alterations that are involved in prostate cancer initiation. Here, we evaluated chromosome 8p allelic loss in a racially diverse cohort. METHODS Laser-capture microdissection was used to isolate tumors cells from individual lesions in 153 prostate cancer patients, and 8p allelic status was determined by "counting alleles." Statistical analyses examined the association between pathologic predictors and biochemical recurrence. RESULTS AND CONCLUSIONS Thirty percent of prostate lesions were missing an 8p allele at tumor initiation, while 51% of lesions lost an 8p allele during tumor progression. Biochemical recurrence after radical prostatectomy could be reliably predicted by surgical margin status only in lesions with extensive 8p allelic loss. There was, however, no racial disparity in 8p allelic loss at tumor initiation or during tumor progression, suggesting that the molecular event involved was similar between Caucasians and Africa Americans (CA and AA). Nonetheless, racial differences were present in values of prognostic factors for recurrence. Gleason score was the most important predictor of recurrence (HR=3.1, 95% CI=1.1, 9.2) in AA, while among CA, pathologic stage (HR=3.3, 95% CI=1.5, 7.6) and surgical margin (HR=4.7, 95% CI=1.8, 12.6) were the most important. Therefore, racial disparity in prostate cancer may be due to other factors that are involved in prostate cancer development.
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Affiliation(s)
- Aki Morikawa
- Emory University School of Medicine, Winship Cancer Institute, Atlanta, Georgia 30322, USA
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Thompson HS, Littles M, Jacob S, Coker C. Posttreatment breast cancer surveillance and follow-up care experiences of breast cancer survivors of African descent: an exploratory qualitative study. Cancer Nurs 2006; 29:478-87. [PMID: 17135822 DOI: 10.1097/00002820-200611000-00009] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Breast cancer survivors are at considerable risk for breast cancer recurrence and at higher risk of developing a new breast cancer compared with women never diagnosed. It is recommended that survivors undergo careful breast cancer surveillance as cancers detected early are more treatable. However, data indicate that surveillance among African American survivors, particularly mammography, is lower than that of white survivors. There is little published work focusing on general experiences of posttreatment breast cancer surveillance among survivors of African descent. In the current qualitative pilot study, key informant interviews were conducted in order to explore the following: (1) the extent of posttreatment surveillance information provided to or obtained by survivors of African descent; (2) the actual follow-up care received by survivors in the past year; and (3) factors that are either motivators of or barriers to care. Participants were 10 African American and African Caribbean breast cancer survivors. Survivors reported a number of factors that motivated them in obtaining follow-up care: a desire to maintain good health, concern about recurrence, support from healthcare providers, familial relationships, relationships with other survivors, and religious/spiritual faith. Survivors also reported barriers to care: fear of recurrence, low support from family and friends, lack of information about posttreatment follow-up care, and medical care costs. These results represent formative work that may inform similar studies examining factors in breast cancer surveillance and follow-up care in larger samples of survivors of African descent.
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Affiliation(s)
- Hayley S Thompson
- Department of Oncological Sciences, Division of Cancer Prevention and Control, Mount Sinai School of Medicine, One Gustave Levy Place, Box 1130, New York, NY 10029, USA.
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Maxwell GL, Tian C, Risinger J, Brown CL, Rose GS, Thigpen JT, Fleming GF, Gallion HH, Brewster WR. Racial disparity in survival among patients with advanced/recurrent endometrial adenocarcinoma: a Gynecologic Oncology Group study. Cancer 2006; 107:2197-205. [PMID: 17001661 DOI: 10.1002/cncr.22232] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Previous studies have reported shorter survival of black women compared with white women who had advanced/recurrent endometrial cancer. It has been suggested that this may reflect racially based differences in treatment. METHODS The authors retrospectively reviewed data from 169 black women and 982 white women with International Federation of Gynecologic Oncology (FIGO) Stage III, Stage IV, or recurrent endometrial carcinoma who were participants in 1 of 4 Gynecologic Oncology Group randomized treatment trials of doxorubicin alone or combined with paclitaxel and/or cisplatin. Demographic, histologic, treatment, and outcome data were analyzed to estimate survival, and between-group comparisons were performed. RESULTS The pooled data revealed that black women were more likely to have papillary serous histology (P < .001), Stage IV disease (P < .001), and higher tumor grade (P < .001) compared with white women, and survival was worse among black women than among white women (median survival, 10.6 months vs. 12.2 months, respectively; P < .001). A Cox proportional hazards regression analysis that was adjusted for performance status, disease stage, tumor histology, tumor grade, and treatment demonstrated worse survival for black women (hazards ratio, 1.26, 95% confidence interval, 1.06-1.51; P = .010). CONCLUSIONS The data from a large group of women with advanced/recurrent endometrial cancer suggested that a racial disparity in survival persists, despite the finding that black women and white women received similar treatment. Although the causes of racial disparity in endometrial cancer remain to be elucidated, socioeconomic, biologic, and cultural factors should be investigated to identify the etiologic origins of this multifactorial healthcare problem.
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Affiliation(s)
- G Larry Maxwell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and the U.S. Military Cancer Institute, Walter Reed Army Medical Center, Washington, DC, USA
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Abstract
BACKGROUND Most published series of basal cell carcinomas (BCCs) are based on Caucasian populations. Very little is known about the characteristics of incompletely excised BCCs in Asians. OBJECTIVES This study examines the characteristics of BCCs in Asian residents in Singapore, and compares incompletely with completely excised tumors after conventional surgical excision. PATIENTS AND METHODS A retrospective study was conducted using the case records of patients who had a primary BCC excised at the National Skin Centre between 1991 and 1995. RESULTS A total of 185 histologically confirmed BCCs were recorded in 166 patients (male to female ratio, 0.95; mean age, 70.9 years). The highest proportion (27.1%) was in the 81-90-year age group. Compared with census data, a significantly higher proportion of patients with BCCs were Chinese (P < 0.001). The tumors averaged 12.0 mm in diameter and the majority (84.3%) were located on the head and neck. In 28 lesions (15.1%), the tumors were incompletely excised, with those on the nose and nasolabial folds being most frequent. Incompletely excised BCCs were more likely than completely excised lesions to be located on the mid-face and trunk (P = 0.003), but there was no significant correlation with tumor size, tumor duration, or patient age, race, and gender. The overall recurrence rate was 1.6% over a mean follow-up time of 74 months. CONCLUSIONS BCCs are more common amongst Chinese in Singapore and occur chiefly in the elderly. Conventional surgical excision with margin control achieves a satisfactory tumor clearance rate of 84.9%. Incomplete excision is associated with tumor location on the mid-face and trunk rather than tumor size or duration.
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Affiliation(s)
- Boon Kee Goh
- National Skin Centre and Clinical Trials and Epidemiology Research Unit, Singapore.
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Eguchi S, Ijtsma AJC, Slooff MJH, Porte RJ, de Jong KP, Peeters PMJG, Gouw ASH, Kanematsu T. Outcome and pattern of recurrence after curative resection for hepatocellular carcinoma in patients with a normal liver compared to patients with a diseased liver. Hepatogastroenterology 2006; 53:592-6. [PMID: 16995469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND/AIMS The purpose of this study was to investigate whether differences existed in demography and outcome after resection for hepatocellular carcinoma (HCC) in patients with a normal liver compared to patients with a diseased liver. METHODOLOGY Twenty-seven Caucasian patients with HCC in a histologically proven normal liver (NL group) in the Netherlands and 141 Asian patients with HCC in a diseased liver (DL group) in Japan underwent a curative liver resection. Patient and tumor characteristics, post-resectional disease-free, overall survival rates and pattern of recurrence were investigated. RESULTS HCC's in the NL group were found to be larger, in a more advanced stage and needed more extended resections compared to HCC's in the DL group. Microvascular invasion was similar in both groups, while capsule formation was observed less in the NL group. Overall survival and disease-free survival after curative resection were not statistically different between both groups. Also even after stratification for T-stage, there was no difference in survival. Although the rate of recurrence was similar in both groups, a significantly higher number of extrahepatic metastases was observed in the NL group. CONCLUSIONS Distinct demographic differences existed between patients with HCC in the NL group compared to patients in the DL group. Extrahepatic recurrences were more frequent after curative resection for HCC in a normal liver. No difference in survival was demonstrated between both groups.
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Affiliation(s)
- Susumu Eguchi
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery , University Medical Center Groningen, The Netherlands.
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Tam KF, Chan YM, Ng TY, Wong LC, Ngan HYS. Ethnicity is a factor to be considered before dose planning in ovarian cancer patients to be treated with topotecan. Int J Gynecol Cancer 2006; 16:135-9. [PMID: 16445623 DOI: 10.1111/j.1525-1438.2006.00295.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The objective of this study was to determine the efficacy and toxicity of topotecan in Chinese patients with ovarian cancer. A retrospective analysis on recurrent ovarian cancer patients receiving topotecan 1.25 mg/m(2) daily for 5 consecutive days on a 21-day cycle from 1997 to 2002 was conducted. The patients included were all treated with at least two cycles of topotecan. The patient characteristics were compared in relation to their toxicity profile and their response to treatment. Response was evaluated by physical findings, imaging techniques, and serum CA125 level. A total of 60 patients were included in the study. All patients were evaluable for response and toxicities. A total of 361 cycles were given (median, 5 per patient; range 2-15). The major toxicity was neutropenia, which was grade 4 in 45.0% of the patients and 10.2% of the cycles. Age was the only covariate predicting the occurrence of grade 4 neutropenia (logistic regression P= 0.046, CI 1.01-1.12). Neutropenic fever occurred in 8.3% of the patients. Eighteen (30%) patients were required to delay their chemotherapy and 11 (18.3%) required dose reduction. Nonhematologic toxicities were mild. The overall response rate was 21.6%, with eight (13.3%) complete responses and five (8.3%) partial responses. The median duration of response and median time to progression were 11 and 5 months, respectively. The median survival was 14 months. Topotecan 1.25 mg/m(2) in a five-times-daily schedule was well tolerated in a cohort of Chinese patients. Myelotoxicity was the most important side effect in our study, but the incidence is much lower than that reported in other studies. Age was an independent factor predicting the occurrence of grade 4 neutropenia.
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Affiliation(s)
- K F Tam
- Department of Obstetrics & Gynaecology, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong.
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Gebhart F. Racial gap remains in prostate CA recurrence. RN 2006; 69:5-6. [PMID: 16722263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
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Stackhouse BL, Williams H, Berry P, Russell G, Thompson P, Winter JL, Kute T. Measurement of glut-1 expression using tissue microarrays to determine a race specific prognostic marker for breast cancer. Breast Cancer Res Treat 2005; 93:247-53. [PMID: 16228617 DOI: 10.1007/s10549-005-5158-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND African-American women (AAW) have more adverse tumor characteristics than non-African American women (non-AAW) and there is a need for a specific predictive marker for AAW recurrence. Tumors with higher grade and proliferative activity are associated with overexpression of the glucose transporter (Glut-1). An examination of Glut-1 expression relative to recurrence and no recurrence was conducted on both groups to determine if it predicts prognosis and could predict a race specific prognosis. METHODS A breast cancer data set containing clinical information including race and biological characteristics was generated between 1991 and 1996. Tissue samples were selected from this group with similar characteristics in both racial groups for a retrospective analysis of Glut-1 expression using tissue microarrays (TMAs). Mean Glut-1 expression for intensity and percent of tumor cells staining was determined using standard immunohistochemistry. RESULTS Clinical and biological differences were noted in the original data set between AAW and non-AAW. No significant difference between races was noted in mean Glut-1 values using a subset which had similar characteristics. The mean Glut-1 did not predict recurrence but a rounded score did indicate that higher levels of Glut-1 expression was indicative of a lower disease free survival (p = 0.063). The actual average mean for AAW with no recurrence was significantly lower than any other group (p = 0.04). Conclusions. TMA analysis for Glut-1 expression may be useful to predict disease free survival but it does not predict race specific recurrence.
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Gill KM, Mishel M, Belyea M, Germino B, Germino LS, Porter L, LaNey IC, Stewart J. Triggers of uncertainty about recurrence and long-term treatment side effects in older African American and Caucasian breast cancer survivors. Oncol Nurs Forum 2005; 31:633-9. [PMID: 15146229 DOI: 10.1188/04.onf.633-639] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine the sources of uncertainty in older African American and Caucasian long-term breast cancer survivors by focusing on frequency of triggers of uncertainty about cancer recurrence and physical symptoms linked to long-term treatment side effects. DESIGN In the context of a larger randomized, controlled treatment-outcome study, data were gathered from 10 monthly follow-up telephone calls by nurses. SETTING Rural and urban regions of North Carolina. SAMPLE 244 older women (mean age = 64 years); 73 African American women and 171 Caucasian women who were five to nine years after breast cancer diagnosis. FINDINGS The most frequent triggers were hearing about someone else's cancer and new aches and pains. The most frequent symptoms were fatigue, joint stiffness, and pain. Although no ethnic differences occurred in the experience of symptoms, Caucasian women were more likely than African American women to report that their fears of recurrence were triggered by hearing about someone else's cancer, environmental triggers, and information or controversy about breast cancer discussed in the media. CONCLUSIONS Illness uncertainty persisted long after cancer diagnosis and treatment, with most women experiencing multiple triggers of uncertainty about recurrence and a range of symptoms and treatment side effects. IMPLICATIONS FOR NURSING Nurses can help cancer survivors to identify, monitor, and manage illness uncertainty and emotional distress.
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Affiliation(s)
- Karen M Gill
- School of Nursing, University of North Carolina, Chapel Hill, NC, USA.
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Tewari A, Horninger W, Badani KK, Hasan M, Coon S, Crawford ED, Gamito EJ, Wei J, Taub D, Montie J, Porter C, Divine GW, Bartsch G, Menon M. Racial differences in serum prostate-specific antigen (PSA) doubling time, histopathological variables and long-term PSA recurrence between African-American and white American men undergoing radical prostatectomy for clinically localized prostate cancer. BJU Int 2005; 96:29-33. [PMID: 15963115 DOI: 10.1111/j.1464-410x.2005.05561.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To determine if there are significant differences in biochemical characteristics, biopsy variables, histopathological data, and rates of prostate-specific antigen (PSA) recurrence between African-American (AA) and white American (WA) men undergoing radical prostatectomy (RP), as AA men are twice as likely to die from prostate cancer than their white counterparts. PATIENTS AND METHODS We established a cohort of 1058 patients (402 AA, 646 WA) who had RP and were followed for PSA recurrence. Age, race, serum PSA, biopsy Gleason score, clinical stage, pathological stage, and PSA recurrence data were available for the cohort. The chi-square test of proportions and t-tests were used to assess basic associations with race, and log-rank tests and Cox regression models for time to PSA recurrence. Forward stepwise variable selection was used to assess the effect on the risk of PSA recurrence for race, adjusted by the other variables added one at a time. RESULTS The AA men had higher baseline PSA levels, more high-grade prostatic intraepithelial neoplasia (HGPIN) in the biopsy, and more HGPIN in the pathology specimen than WA men. The AA men also had a shorter mean (sd) PSA doubling time before RP, at 4.2 (4.7) vs 5.2 (5.9) years. However, race was not an independent predictor of PSA recurrence (P = 0.225). Important predictors for PSA recurrence in a multivariable model were biopsy HGPIN (P < 0.014), unilateral vs bilateral cancer (P < 0.006), pathology Gleason score and positive margin status (both P < 0.001). CONCLUSIONS This study indicates that while there are racial differences in baseline serum PSA and incidence of HGPIN, race is not an independent risk factor for PSA recurrence. Rather, other variables such as pathology Gleason score, bilateral cancers, HGPIN and margin positivity are independently associated with PSA recurrence. The PSA doubling time after recurrence may also be important, leading to the increased mortality of AA men with prostate cancer.
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Affiliation(s)
- Ashutosh Tewari
- Josephine Ford Cancer Center and Vattikuti Urology Institute, Henry Ford Health, System, Detroit, MI, USA
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Kanemori M, Prygrocki M. Results of breast conservation therapy from a single-institution community hospital in Hawaii with a predominantly Japanese population. Int J Radiat Oncol Biol Phys 2005; 62:193-7. [PMID: 15850921 DOI: 10.1016/j.ijrobp.2004.08.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2004] [Revised: 08/18/2004] [Accepted: 08/26/2004] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the outcome data from breast conservation therapy performed at the Kuakini Medical Center in Honolulu, Hawaii. The remarkably low rates of recurrence found in this study prompted a review of the literature and evaluation of the prognostic factors that may explain these results. METHODS AND MATERIALS The data from patients with Tis, T1 or T2 breast tumors, treated with lumpectomy and radiotherapy during the 12-year period between January 1990 and December 2001 were retrospectively reviewed and compared to results found in national publications. RESULTS Current follow-up data was available in 97.1% of patients who met these criteria, identifying a total of 896 patients who were analyzed in this study. With a median follow-up exceeding 6 years, the local in-breast failure rate was 0.67%. Survival data was superior to the National Cancer Data Base for each stage of disease. CONCLUSION This low rate of local relapse is extraordinary and unmatched by the published results generally cited in the literature. The findings are consistent with other studies reporting unusually low rates of breast cancer recurrence in patients of Japanese ancestry.
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Affiliation(s)
- Mark Kanemori
- Department of Radiation Oncology, Kuakini Medical Center, Honolulu, HI 96817, USA.
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Wilson DB, Porter JS, Parker G, Kilpatrick J. Anthropometric changes using a walking intervention in African American breast cancer survivors: a pilot study. Prev Chronic Dis 2005; 2:A16. [PMID: 15888227 PMCID: PMC1327710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION African American women exhibit a higher mortality rate from breast cancer than do white women. African American women are more likely to gain weight at diagnosis, which may increase their risk of cancer recurrence and comorbidities. Physical activity has been shown to decrease body mass index and improve quality of life in cancer survivors. This study was designed to evaluate the feasibility and impact of a community-based exercise intervention in African American breast cancer survivors. METHODS A theory-based eight-week community intervention using pedometers with scheduling, goal setting, and self-assessment was tested in a convenience sample of African American breast cancer survivors (n = 24). Data were collected at three time points to examine changes in steps walked per day, body mass index, and other anthropometric measures, attitudes, and demographic variables. RESULTS Statistically significant increases in steps walked per day and attitude toward exercise as well as significant decreases in body mass index, body weight, percentage of body fat, and waist, hip, and forearm circumferences, as well as blood pressure, were reported from baseline to immediate post-intervention. Positive changes were retained or improved further at three-month follow-up except for attitude toward exercise. Participant retention rate during eight-week intervention was 92%. CONCLUSION Increasing walking for exercise, without making other changes, can improve body mass index, anthropometric measures, and attitudes, which are associated with improved quality of life and reduced risk of cancer recurrence. The high participant retention rate, along with significant study outcomes, demonstrate that among this sample of African American breast cancer survivors, participants were motivated to improve their exercise habits.
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Affiliation(s)
- Diane B Wilson
- Department of Internal Medicine and Massey Cancer Center, Virginia Commonwealth University, School of Medicine, PO Box 980306, Richmond, VA 23298-0306, USA.
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Amling CL, Riffenburgh RH, Sun L, Moul JW, Lance RS, Kusuda L, Sexton WJ, Soderdahl DW, Donahue TF, Foley JP, Chung AK, McLeod DG. Pathologic Variables and Recurrence Rates As Related to Obesity and Race in Men With Prostate Cancer Undergoing Radical Prostatectomy. J Clin Oncol 2004; 22:439-45. [PMID: 14691120 DOI: 10.1200/jco.2004.03.132] [Citation(s) in RCA: 295] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Purpose To determine if obesity is associated with higher prostate specific antigen recurrence rates after radical prostatectomy (RP), and to explore racial differences in body mass index (BMI) as a potential explanation for the disparity in outcome between black and white men. Patients and Methods A retrospective, multi-institutional pooled analysis of 3,162 men undergoing RP was conducted at nine US military medical centers between 1987 and 2002. Patients were initially categorized as obese (BMI ≥ 30 kg/m2), overweight (BMI 25 to 30 kg/m2), or normal (BMI ≤ 25 kg/m2). For analysis, normal and overweight groups were combined (BMI < 30 kg/m2) and compared with the obese group (BMI ≥ 30 kg/m2) with regard to biochemical recurrence (prostate-specific antigen ≥ 0.2 ng/mL) after RP. Results Of 3,162 patients, 600 (19.0%) were obese and 2,562 (81%) were not obese. BMI was an independent predictor of higher Gleason grade cancer (P < .001) and was associated with a higher risk of biochemical recurrence (P = .027). Blacks had higher BMI (P < .001) and higher recurrence rates (P = .003) than whites. Both BMI (P = .028) and black race (P = .002) predicted higher prostate specific antigen recurrence rates. In multivariate analysis of race, BMI, and pathologic factors, black race (P = .021) remained a significant independent predictor of recurrence. Conclusion Obesity is associated with higher grade cancer and higher recurrence rates after RP. Black men have higher recurrence rates and greater BMI than white men. These findings support the hypothesis that obesity is associated with progression of latent to clinically significant prostate cancer (PC) and suggest that BMI may account, in part, for the racial variability in PC risk.
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Affiliation(s)
- Christopher L Amling
- Department of Urology, Naval Medical Center, 34800 Bob Wilson Drive, San Diego, CA 92134-5000, USA.
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Freedland SJ, Aronson WJ, Kane CJ, Presti JC, Amling CL, Elashoff D, Terris MK. Impact of Obesity on Biochemical Control After Radical Prostatectomy for Clinically Localized Prostate Cancer: A Report by the Shared Equal Access Regional Cancer Hospital Database Study Group. J Clin Oncol 2004; 22:446-53. [PMID: 14691122 DOI: 10.1200/jco.2004.04.181] [Citation(s) in RCA: 319] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Purpose Given the limited information regarding the impact of obesity on treatment outcomes for prostate cancer, we sought to examine the relationship between body mass index (BMI) and cancer control after radical prostatectomy (RP). Patients and Methods We compared clinicopathologic and biochemical outcome information across BMI groups from 1,106 men treated with RP between 1988 and 2002. Multivariate analysis was used to determine if BMI significantly predicted adverse pathology or biochemical recurrence. Results Obesity was related to year of surgery (P < .001) and race (P < .001), with black men having the highest obesity rates. Obese patients had higher biopsy and pathologic grade tumors (P < .001). On multivariate analysis, BMI ≥ 35 kg/m2 was associated with a trend for higher rates of positive surgical margins (P = .008). Overweight patients (BMI, 25 to 30 kg/m2) had a significantly decreased risk of seminal vesicle invasion (P = .039). After controlling for all preoperative clinical variables including year of surgery, BMI ≥ 35 kg/m2 significantly predicted biochemical failure after RP (P = .002). After controlling for surgical margin status, BMI ≥ 35 kg/m2 remained a significant predictor of biochemical failure (P = .012). There was a trend for BMI ≥ 35 kg/m2 to be associated with higher failure rates than BMI between 30 and 35 kg/m2 (P = .053). Conclusion The percentage of obese men undergoing RP in our data set doubled in the last 10 years. Obesity was associated with higher-grade tumors, a trend toward increased risk of positive surgical margins, and higher biochemical failure rates among men treated with RP. A BMI ≥ 35 kg/m2 was associated with a higher risk of failure than a BMI between 30 and 35 kg/m2.
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Affiliation(s)
- Stephen J Freedland
- Department of Urology, The Johns Hopkins School of Medicine, 600 N Wolfe Street, Baltimore, MD 21287-2101, USA.
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Abstract
PURPOSE The influence of family history on outcome after definitive therapy for prostate cancer has been disputed. One series reported increased relapse rates in men with a positive family history of prostate cancer treated with radical prostatectomy or radiation therapy, whereas others have reported no difference in outcome. We examined our series of patients treated with definitive external beam radiation therapy to determine if a positive family history for prostate cancer is associated with better or worse outcome. METHODS AND MATERIALS Family history information was available for 538 patients treated with radiation therapy for prostate cancer between 1983 and 2001. Prostate cancer in one or more first-degree relatives (father, brother, or son) was considered a positive family history. The endpoint of interest was time to prostate-specific antigen failure or initiation of hormonal therapy after radiation therapy. RESULTS Ninety-seven of 538 patients (18%) had a positive family history. There were no significant differences between the positive and negative family history groups. Family history had no effect on relapse-free survival rates in the entire cohort (p = 0.94) or in any subgroup. African American patients with a positive family history had significantly worse 5-year relapse-free survival rates, although there were few patients in this subgroup. Neither family history nor race was a statistically significant predictor of relapse in multivariate analysis; however, combined African American race and positive family history was associated with worse relapse-free survival rates. CONCLUSIONS In this large study of patients receiving definitive radiation therapy for localized prostate cancer, no relationship was found between positive first-degree family history of prostate cancer and relapse. The influence of family history on clinical outcome may be more understandable once the gene or genes responsible for hereditary prostate cancer are identified.
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Affiliation(s)
- Michael E Ray
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, MI, USA.
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Bianco FJ, Kattan MW, Scardino PT, Powell IJ, Pontes JE, Wood DP. Radical prostatectomy nomograms in black American men: accuracy and applicability. J Urol 2003; 170:73-6; discussion 76-7. [PMID: 12796648 DOI: 10.1097/01.ju.0000068037.57553.54] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE Nomograms have been developed to allow the prediction of disease recurrence based on clinical and pathological parameters in patients with clinically localized prostate cancer. However, they have been constructed using predominantly white American male (CAM) cohorts. We have previously shown that black American males (AAMs) have worse disease-free survival after radical prostatectomy after controlling for known prognostic factors. We tested the accuracy of prognostic nomograms in a population of AAMs with prostate cancer treated with radical prostatectomy. MATERIALS AND METHODS We tested the performance of published preoperative and postoperative prognostic nomograms in a cohort of patients treated with radical prostatectomy as monotherapy for localized prostate cancer at Wayne State University in the prostate specific antigen era. Predictions made with the nomogram were stratified by race and compared with actual outcomes. The summary statistic used to evaluate the nomogram was the concordance index. A value of 0.5 indicates no predictive discrimination, whereas a value of 1.0 indicates perfect discrimination. RESULTS A total of 1,043 patients, including 331 AAMs (32%) and 712 CAMs (68%), comprised the study cohort. Treatment failure was defined as increasing prostate specific antigen, which occurred in 193 patients (18.5%). The preoperative concordance index for CAMs and AAMs was 0.78 and 0.74, respectively (p = 0.8). The postoperative index was 0.85 and 0.83, respectively (p = 0.9). CONCLUSIONS Preoperative and postoperative nomograms can be applied accurately to an individual regardless of race.
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Affiliation(s)
- Fernando J Bianco
- Department of Urology, Wayne State University, 4160 John R., Suite 1017, Detroit, MI 48201, USA
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Schorge JO, Lea JS, Garner EO, Duska LR, Miller DS, Coleman RL. Cervical adenocarcinoma survival among Hispanic and white women: a multicenter cohort study. Am J Obstet Gynecol 2003; 188:640-4. [PMID: 12634634 DOI: 10.1067/mob.2003.96] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We compared the clinical outcome of cervical adenocarcinoma in Hispanic and white women to determine whether race was an independent predictor of survival. STUDY DESIGN All women who were diagnosed with cervical adenocarcinoma at three institutions between 1982 and 2000 were identified. Medical records were reviewed retrospectively. Hispanic and white cohorts were matched 1:2 for age, stage of disease, date of diagnosis, tumor size, histologic subtype, grade, and invasive depth. RESULTS The 65 Hispanic patients were more likely to be treated at the public hospital (71% vs 14%; P <.001) than the 122 matched white patients. Most Hispanic patients (72%) and white patients (76%) presented with early (stage IA-IIA), not advanced (IIB-IVB), disease. Early (81% vs 81%, P =.65), advanced (37% vs 26%, P =.21), and overall 5-year survival rates (67% vs 68%, P =.57) were similar among Hispanic and white patients, respectively. The relative risk of race on recurrence was 1.22 (95% CI, 0.56-2.42) and on survival was 0.72 (95% CI, 0.36-1.44). CONCLUSION Hispanic race is not an independent predictor of survival in cervical adenocarcinoma.
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Affiliation(s)
- John O Schorge
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas 75390, USA.
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Shin JH, Ku JL, Shin KH, Shin YK, Kang SB, Park JG. Glutathione S-transferase M1 associated with cancer occurrence in Korean HNPCC families carrying the hMLH1/hMSH2 mutation. Oncol Rep 2003; 10:483-6. [PMID: 12579293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
Hereditary non-polyposis colorectal cancer (HNPCC), an inherited cancer predisposition syndrome, has been associated with germline mutations in DNA mismatch repair (MMR) genes. However, because all mutation carriers of hMLH1/hMSH2 do not account for CRC susceptibility, modifying genes may play a role in the variation of disease expression. In this study, we determined the GSTM1 and GSTT1 genotypes in 104 family members representing 19 Korean HNPCCs carrying hMLH1/hMSH2 mutation, and investigated the influence of GSTM1 and GSTT1 geno-/phenotype status on both age at diagnosis of CRC and cancer occurrence. The overall frequency of the GSTM1 and GSTT1 geno-/phenotype in 55 non-carriers, compared with that in mutation carriers (n=49), was not significantly different, and no significant correlation was found between mean age at diagnosis and the allelomorphs encoding the GSTM1 or GSTT1 enzymes. However, a comparison of the allele frequencies of GSTM1 in affected (n=30) and unaffected (n=19) mutation carriers revealed a significant difference, as the null allele was more prevalent in individuals with cancer (p=0.03; odds ratio, 3.7; 95% confidence interval, 1.1-12.7). Our results suggest that the genotypes of GSTM1 are associated with cancer occurrence in Korean HNPCC family members carrying the hMLH1/hMSH2 mutation. However, a bias due to the small sample size of this study cannot be rule out. Although evidence that GST genotypes are associated with increased cancer risk has often been controversial, the genotyping of GSTM1 could have implications for genetic counseling and the management of MMR gene mutation carriers.
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Affiliation(s)
- Joo-Ho Shin
- Laboratory of Cell Biology, Cancer Research Center and Cancer Research Institute, Seoul National University College of Medicine, Seoul 110-744, Korea
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Grossfeld GD, Latini DM, Downs T, Lubeck DP, Mehta SS, Carroll PR. Is ethnicity an independent predictor of prostate cancer recurrence after radical prostatectomy? J Urol 2002; 168:2510-5. [PMID: 12441951 DOI: 10.1097/01.ju.0000036493.19691.e0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Prostate cancer incidence and mortality are higher in black than in white American men. We determined whether ethnicity is an independent predictor of disease recurrence in men undergoing radical prostatectomy. MATERIALS AND METHODS We studied 1,468 patients who underwent radical prostatectomy at the University of California, San Francisco or as part of the Cancer of the Prostate Strategic Urological Research Endeavor database, a longitudinal disease registry of patients with prostate cancer. Preoperative characteristics, including age, race, prostate specific antigen (PSA) at diagnosis, clinical T stage, biopsy Gleason score and percent positive prostate biopsies at diagnosis were determined in each patient. Disease recurrence was defined as PSA 0.2 ng./ml. or greater on 2 consecutive occasions after radical prostatectomy or second cancer treatment at least 6 months after surgery. Cox proportional hazards analysis was performed to determine independent predictors of time to disease recurrence. To control for pretreatment disease characteristics simultaneously patients were assigned to previously described risk groups based on clinical tumor stage, PSA at diagnosis and biopsy Gleason score. The likelihood of disease recurrence per risk group stratified according to ethnicity was determined using the Kaplan-Meier method and compared using the log rank test. Additional multivariate analysis was performed in the subset of patients enrolled in Cancer of the Prostate Strategic Urological Research Endeavor on whom education and income information was available. RESULTS Disease recurred in 304 of the 1,468 patients (21%). Black ethnicity, serum PSA at diagnosis, biopsy Gleason score and percent positive prostate biopsies were independent predictors of recurrence on multivariate analysis. Black ethnicity remained an independent predictor of disease recurrence in the multivariate model after stratifying patients into risk groups (p = 0.0007). Ethnicity was most important in patients at high risk, in whom estimated 5-year disease-free survival was 65% and 28% in white and black men, respectively. Education, income and ethnicity correlated highly. When education and income were entered into the multivariate model, ethnicity was no longer an independent predictor of outcome after prostatectomy. CONCLUSIONS Ethnicity appears to be an independent predictor of disease recurrence after adjusting for pretreatment measures of disease extent in patients undergoing radical prostatectomy. It appears to be particularly important in those with high risk disease characteristics. However, black ethnicity, education and income are highly correlated variables, suggesting that sociodemographic factors may contribute to the poorer outcomes in black patients even after adjusting for differences in pretreatment disease characteristics.
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Affiliation(s)
- Gary D Grossfeld
- Department of Urology, Program in Urologic Oncology, Urology Outcomes Research Group, University of California-San Francisco, USA
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Tuomaala S, Eskelin S, Tarkkanen A, Kivelä T. Population-based assessment of clinical characteristics predicting outcome of conjunctival melanoma in whites. Invest Ophthalmol Vis Sci 2002; 43:3399-408. [PMID: 12407149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
Abstract
PURPOSE To identify the clinical determinants of prognosis and the incidence of malignant conjunctival melanoma in whites. METHODS A nationwide search identified 85 patients in whom primary conjunctival melanoma was diagnosed in Finland between 1967 and 2000, all of whom were enrolled. Data were collected from the Finnish Cancer and Population Registries and from patients' charts in all involved hospitals. The age-specific and age-adjusted incidences were calculated. Clinical characteristics of the tumors were recorded and time to local recurrence and melanoma-specific survival were analyzed by Kaplan-Meier analysis and univariate and multivariate extended Cox regression. RESULTS The annual crude incidence of conjunctival melanoma in Finland was 0.51 per million inhabitants, and the age-adjusted incidence (mean, 0.54) increased from 0.4 to 0.8 during the 34-year study period. The median age at diagnosis was 60 years (range, 20-90). Clinically detectable primary acquired melanosis preceded or accompanied the primary tumor in 61% of patients. The 5-year cumulative proportion of cases with local recurrence was 0.36 (95% confidence interval [CI], 0.25-0.48). The melanoma-specific 5-and 10-year mortalities were 0.20 (95% CI, 0.12-0.32) and 0.38 (95% CI, 0.26-0.53), respectively. By multiple-event Cox regression, nonlimbal location of the primary tumor predicted a short time to local recurrence (hazard ratio [HR] 1.81, P = 0.024). Nonlimbal location of the primary tumor (HR 4.08, P = 0.023) and increasing tumor thickness (HR 1.19 for each millimeter change, P=0.063) were associated with increased mortality. Local recurrence, analyzed as a time-dependent covariate, also increased mortality (HR 1.39 for each recurrence, P = 0.014). CONCLUSIONS The incidence of conjunctival melanoma in the white population of Finland increased analogous to cutaneous melanoma. Nonlimbal tumors recur more often and are associated with decreased survival, independent of their greater thickness. Local recurrence contributes to mortality, whereas primary acquired melanosis was not associated with either outcome.
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Affiliation(s)
- Seppo Tuomaala
- Ocular Oncology Service, Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland.
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Abstract
Target populations for chemoprevention trials should include those at higher than average risk for the development of prostate cancer as defined by explicit epidemiologic and genetic criteria. Such populations include a "primary prevention" group without histologic or clinical evidence of cancer, and several clinical models of "secondary prevention," including those with clinically evident disease prior to definitive therapy and those at high risk of recurrence after therapy based on histological or biochemical status. Each risk group and clinical model has potential advantages and disadvantages, and the mechanisms that underlie disease development and progression in each group may be unique. These observations give rise to many potential clinical trials of specific agents. These trials should also include collection of data on potentially confounding influences on disease development and progression.
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Affiliation(s)
- E A Klein
- Section of Urologic Oncology, Department of Urology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Abstract
BACKGROUND African-American women have a lower survival rate than white women following a diagnosis of invasive breast cancer. Limited information is available regarding the impact of race on results of breast conservation therapy (BCT). METHODS Local recurrence rates were compared in 71 African-American patients (73 breasts) and 204 white patients (208 breasts) with stage I and II breast cancer treated with BCT. RESULTS Overall 5-year actuarial recurrence rates were 13% in African-Americans and 4% in whites (P = 0.075). These rates were 9% and 4%, respectively, if patients with local skin/soft tissue recurrences were excluded (P = 0.587). Exclusion of these skin/soft tissue failures eliminated any significant difference seen in recurrence between stage II African-American and white patients (P = 0.163). African-American women had less favorable recurrences, including tumor in more than one quadrant or local skin/ soft tissue involvement (P = 0.001). CONCLUSIONS Overall actuarial recurrence rates were slightly higher, but not significantly different, in African-American and white women following BCT. A much less favorable pattern of local recurrence was seen in the African-American patients (P = 0.001), which may represent the presence of more biologically aggressive tumors in these women.
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Affiliation(s)
- C S Connor
- Department of Surgery, University of Kansas Medical Center, Kansas City 66160-7308, USA
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Tay SK, Thilagam MD. Single agent paclitaxel in resistant and relapsed epithelial ovarian cancer after first-line platinum-based chemotherapy--experience in an Asian population. Ann Acad Med Singap 1998; 27:645-9. [PMID: 9919333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
The efficacy and toxicity profile of paclitaxel (Taxol) was studied in 33 Singaporean women with epithelial ovarian carcinoma who had either failed to respond or relapsed after an initial response to first-line chemotherapy with combined platinum and cyclophosphamide. Paclitaxel was given intravenously as a single agent at a dose of 200 mg/m2 over 3 hours, with standard pre-medication, at 4 weekly intervals. A total of 102 cycles were administered. The median number of cycles was 3 (range 1 to 8) per patient. Twenty-six patients were eligible for response evaluation. Six (23.2%) patients showed a complete response and 4 (15.4%) showed a partial response. Two (7.7%) patients had stable disease and 14 (53.8%) patients had progressive disease. The response rate was 22.2% (2 of 9 patients) for patients with progressive disease while on the first-line platinum-based chemotherapy, 37.5% (3 of 8 patients) for patients with response-relapse interval of less than 6 months, 40.0% (2 of 5 patients) for patients with response-relapse interval of 6 to 12 months, and 75% (3 of 4 patients) for patients with response-relapse interval of more than 12 months. The median duration of survival was 10 months for the entire cohort of patients, but all complete responders and 75% of partial responders survived the duration of the study period of 24 months, compared to 50% of patients with stable disease and 7% of patients with progressive disease. Toxicity of paclitaxel treatment was evaluated in 102 cycles. Grade 3 or 4 alopecia, grade 1 or 2 sensory peripheral neuropathy and mild facial flush occurred in all patients. Haematological toxicity was mild, with 9.8% of the cycles complicated by grade 3 or 4 neutropenia. Bone marrow suppression was of short duration. No treatment delay or dose modification was needed. It is concluded that the effectiveness of paclitaxel for salvage treatment of patients with resistant or relapsed epithelial ovarian carcinoma after first-line platinum-based chemotherapy among Asian patients is comparable to that reported in Western populations. The treatment was well tolerated by our patients. It should be considered the chemotherapy of choice for patients with relapsed ovarian cancer after prior platinum-based chemotherapy.
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Affiliation(s)
- S K Tay
- Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
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Abstract
BACKGROUND Incidence reports of nonmelanoma skin cancer (NMSC) in Japanese persons are limited. Most studies have relied primarily on hospital records or voluntary reporting systems. OBJECTIVE Our purpose was to determine the incidence of basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and Bowen's disease (BD) in a defined Japanese population. METHODS A prospective 5-year population-based incidence study was conducted on the island of Kauai, Hawaii from 1983 through 1987. RESULTS Thirty Japanese Kauai residents, 12 men and 18 women, developed BCC during the 5-year study period. At the same time, 24 Japanese, 6 men and 18 women, were identified with SCC, and 11 had BD, three men and eight women. When standardized to the Japanese population in Japan, the annual BCC incidence rate was 30 per 100,000 Japanese Kauai residents with an average patient age of 75 years. More than 80% of these BCCs were localized to the head and neck. New BCCs developed in four patients with BCC, but none was a recurrence of a previously treated lesion. Five patients with BCC had SCC or BD concurrently or at other times. The SCC incidence was 23 per 100,000 Japanese Kauai residents with an average patient age of 80 years. The head and neck were again the most common anatomic sites. New SCCs subsequently occurred in two patients, in one of whom a localized recurrence also developed. Five patients with SCC had BCC simultaneously or at other times. The incidence of BD was 13 per 100,000 Japanese Kauai residents with an average patient age of 74 years. The extremities were the most common anatomic sites. One patient later had a new BD lesion and a recurrent BD lesion. Two patients had BCC or SCC at other times. CONCLUSION We report incidence rates of BCC, SCC, and BD at least 45 times higher in the Japanese population in Kauai, Hawaii than rates for the Japanese population in Japan. Kauai's intense UV radiation and emphasis on outdoor activities may contribute. More Japanese women had NMSC than men, a sex difference not observed in Japan.
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Affiliation(s)
- T Y Chuang
- Department of Dermatology, Wright State University, Dayton, Ohio, USA
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Barshteĭn IA, Vovk AD, Antoniak SM, Shcherbyns'ka AM. [A case of Kaposi's sarcoma of the eye in an AIDS patient]. Lik Sprava 1995:172-4. [PMID: 8819959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Phillips DL, Okamura D, Tokumine T. Ethnic differences in the recurrence of adenomatous polyps after colonoscopic polypectomy. Hawaii Med J 1994; 53:16-22. [PMID: 8144349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A retrospective study was done of polyp recurrence rates following an initial clearing colonoscopy for adenomatous polyps. The intent of the study was to identify risk factors that would predict a greater risk for recurrence in Hawaii's ethnically diverse population. When the initial exam detected multiple polyps, a higher recurrence rate was found in Caucasian patients.
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