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Booker BD, Markt SC, Schumacher FR, Rose J, Cooper G, Selfridge JE, Koroukian SM. Variation in KRAS/NRAS/BRAF-Mutation Status by Age, Sex, and Race/Ethnicity Among a Large Cohort of Patients with Metastatic Colorectal Cancer (mCRC). J Gastrointest Cancer 2024; 55:237-246. [PMID: 37355486 DOI: 10.1007/s12029-023-00954-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Racial/ethnic disparities in metastatic colorectal cancer (mCRC) survival are well documented as is the impact that tumor mutation of KRAS and BRAF has on prognosis. It has been suggested that frequency differences of KRAS- and BRAF-mutated tumors may partially explain this disparity. Demographic differences in mutation frequency are not well established nor whether mutation and microsatellite instability (MSI) differentially impact survival among groups. METHODS Using data for 11,117 patients diagnosed with de-novo mCRC from an electronic health record-derived database we estimated adjusted odds ratios (aOR) to characterize the association between demographics and MSI and KRAS/NRAS/BRAF-mutation status. Stratified Cox models were used to identify differences in overall survival (OS), adjusting for treatment and demographics. RESULTS Being female, compared to male, (aORKRAS:1.33 (1.23-1.44); aORBRAF:1.84 (1.56-2.16)), and non-Hispanic Black race (NHB), compared to non-Hispanic White (NHW) (aORKRAS:1.62 (1.42-1.85); aORBRAF: 0.55 (0.38-0.77)) were associated with KRAS- or BRAF-mutant tumors. MSI prevalence was similar across race/ethnicity but higher in women. BRAF-mutant tumors were associated with poorer prognosis overall, especially among non-white patients. Among patients who had KRAS/NRAS/BRAF-WT tumors we observed no difference in OS by race or MSI. Among patients with KRAS-mutant tumors, Hispanic patients had more favorable prognosis adjusted hazards ratio (aHR) = 0.76 (0.65-0.89)) than their NHW counterparts. Among those with BRAF-mutant tumors, NHB patients had poorer prognosis than NHW patients (aHR:1.78 (1.08-2.93)). CONCLUSION MSI and frequency of KRAS and BRAF mutations differed by demographics. Racial/ethnic disparities in OS differed by mutation. Future studies should explore biological and/or social determinants underlying these differences.
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Rajanala SH, Plym A, Vaselkiv JB, Ebot EM, Matsoukas K, Lin Z, Chakraborty G, Markt SC, Penney KL, Lee GSM, Mucci LA, Kantoff PW, Stopsack KH. SLCO1B3 and SLCO2B1 genotypes, androgen deprivation therapy, and prostate cancer outcomes: a prospective cohort study and meta-analysis. Carcinogenesis 2024; 45:35-44. [PMID: 37856781 PMCID: PMC10859730 DOI: 10.1093/carcin/bgad075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/09/2023] [Accepted: 10/18/2023] [Indexed: 10/21/2023] Open
Abstract
Solute carrier organic anion (SLCO) transporters (OATP transporters) are involved in cellular uptake of drugs and hormones. Germline variants in SLCO1B3 and SLCO2B1 have been implicated in prostate cancer progression and therapy response, including to androgen deprivation and statin medications, but results have appeared heterogeneous. We conducted a cohort study of five single-nucleotide polymorphisms (SNPs) in SLCO1B3 and SLCO2B1 with prior evidence among 3208 men with prostate cancer who participated in the Health Professionals Follow-up Study or the Physicians' Health Study, following participants prospectively after diagnosis over 32 years (median, 14 years) for development of metastases and cancer-specific death (lethal disease, 382 events). Results were suggestive of, but not conclusive for, associations between some SNPs and lethal disease and differences by androgen deprivation and statin use. All candidate SNPs were associated with SLCO mRNA expression in tumor-adjacent prostate tissue. We also conducted a systematic review and harmonized estimates for a dose-response meta-analysis of all available data, including 9 further studies, for a total of 5598 patients and 1473 clinical events. The A allele of the exonic SNP rs12422149 (14% prevalence), which leads to lower cellular testosterone precursor uptake via SLCO2B1, was associated with lower rates of prostate cancer progression (hazard ratio per A allele, 0.80; 95% confidence interval, 0.69-0.93), with little heterogeneity between studies (I2, 0.27). Collectively, the totality of evidence suggests a strong association between inherited genetic variation in SLCO2B1 and prostate cancer prognosis, with potential clinical use in risk stratification related to androgen deprivation therapy.
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Chowdhury-Paulino IM, Vaselkiv JB, Cheng I, Schernhammer ES, Lin Z, Haiman CA, Le Marchand L, Valdimarsdóttir U, Wilkens LR, Markt SC, Mucci LA. Adiposity, Weight Change, and Urinary Melatonin Levels among Men in the Multiethnic Cohort. Cancer Epidemiol Biomarkers Prev 2024; 33:136-142. [PMID: 37909946 DOI: 10.1158/1055-9965.epi-23-0860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/12/2023] [Accepted: 10/30/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Low levels of 6-sulfatoxymelatonin, the primary urinary metabolite of melatonin, have been linked to cancer and cardiometabolic outcomes in White and female populations. METHODS We examined the association between adulthood adiposity and 6-sulfatoxymelatonin levels in a racially and ethnically diverse population. Our study included 4,078 men in the Multiethnic Cohort with adiposity measurements at enrollment (1993-1996) and biomarkers measured in urines collected in 1995 and 2005. Multivariable linear regression models were used to estimate the percent change in 6-sulfatoxymelatonin levels and 95% confidence intervals (CI). Associations were examined separately by racial/ethnic group. RESULTS The prevalence of obesity varied by race and ethnicity, from 10% for Japanese American men to 34% for Native Hawaiian men. Compared with men with normal body mass index (BMI), men who were overweight (-7.8%; 95% CI, -11.9 to -3.5%) and obese (-18.1%; 95% CI, -23.2 to -12.6%) had significantly lower 6-sulfatoxymelatonin levels adjusting for potential confounding factors. Increasing weight gain in adulthood was also associated with lower 6-sulfatoxymelatonin (Ptrend < 0.0001). The inverse associations for BMI and weight change were qualitatively similar across racial and ethnic groups. CONCLUSIONS Obesity is inversely associated with melatonin in a racially diverse population. This finding is relevant given higher rates of obesity among Black, Native Hawaiian, and Latino men, as well as potential racial and ethnic differences in circadian function. IMPACT Melatonin may be a relevant biomarker among obesity-associated malignancies and could shed light on a potential mechanism of cancer disparities.
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Chowdhury-Paulino IM, Hart JE, James P, Iyer HS, Wilt GE, Booker BD, Nethery RC, Laden F, Mucci LA, Markt SC. Association between Outdoor Light at Night and Prostate Cancer in the Health Professionals Follow-up Study. Cancer Epidemiol Biomarkers Prev 2023; 32:1444-1450. [PMID: 37462694 PMCID: PMC10592318 DOI: 10.1158/1055-9965.epi-23-0208] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/07/2023] [Accepted: 07/14/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Circadian disruption is a potential risk factor for advanced prostate cancer, and light at night (LAN) exposure may disrupt circadian rhythms. We evaluated whether outdoor LAN increases the risk of prostate cancer. METHODS We prospectively followed 49,148 participants in the Health Professionals Follow-up Study from 1986 through 2016. We estimated baseline and cumulative time-varying outdoor LAN with ∼1 km2 resolution using data from the US Defense Meteorological Satellite Program's Operational Linescan System, which was assigned to participants' geocoded addresses. Participants reside in all 50 U.S. states and reported a work or home address. We used multivariable Cox models to estimate HRs and 95% confidence intervals (CI) for the association between outdoor LAN and risk of overall (7,175 cases) and fatal (915 cases) prostate cancer adjusting for individual and contextual factors. RESULTS There was no association between the interquartile range increase in cumulative LAN and total (HR, 1.02; 95% CI, 0.98-1.06) or fatal (HR, 1.05; 95% CI, 0.96-1.15) prostate cancer in adjusted models. However, there was a positive association between baseline LAN and total prostate cancer among non-movers (HR, 1.06; 95% CI, 1.00-1.14) including among highly screened participants (HR, 1.11; 95% CI, 1.01-1.23). CONCLUSIONS There was a suggestive positive association between baseline outdoor LAN and total prostate cancer. Additional studies with different measures of outdoor LAN and in more diverse populations are necessary. IMPACT To our knowledge, this is the first longitudinal cohort study exploring the relationship between outdoor LAN and prostate cancer.
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Shu TD, Schumacher FR, Conroy B, Ponsky L, Mahran A, Bukavina L, Calaway A, Markt SC. Disparities in cause-specific mortality by race and sex among bladder cancer patients from the SEER database. Cancer Causes Control 2023; 34:521-531. [PMID: 36882598 DOI: 10.1007/s10552-023-01679-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 02/13/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE Previous literature shows that more bladder cancer patients overall die from causes other than the primary malignancy. Given known disparities in bladder cancer outcomes by race and sex, we aimed to characterize differences in cause-specific mortality for bladder cancer patients by these demographics. METHODS We identified 215,252 bladder cancer patients diagnosed with bladder cancer from 2000 to 2017 in the SEER 18 database. We calculated cumulative incidence of death from seven causes (bladder cancer, COPD, diabetes, heart disease, external, other cancer, other) to assess differences in cause-specific mortality between race and sex subgroups. We used multivariable Cox proportional hazards regression and Fine-Gray competing risk models to compare risk of bladder cancer-specific mortality between race and sex subgroups overall and stratified by cancer stage. RESULTS 17% of patients died from bladder cancer (n = 36,923), 30% died from other causes (n = 65,076), and 53% were alive (n = 113,253). Among those who died, the most common cause of death was bladder cancer, followed by other cancer and diseases of the heart. All race-sex subgroups were more likely than white men to die from bladder cancer. Compared to white men, white women (HR: 1.20, 95% CI: 1.17-1.23) and Black women (HR: 1.57, 95% CI: 1.49-1.66) had a higher risk of dying from bladder cancer, overall and stratified by stage. CONCLUSION Among bladder cancer patients, death from other causes especially other cancer and heart disease contributed a large proportion of mortality. We found differences in cause-specific mortality by race-sex subgroups, with Black women having a particularly high risk of dying from bladder cancer.
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Koroukian SM, Booker BD, Vu L, Schumacher FR, Rose J, Cooper GS, Selfridge JE, Markt SC. Receipt of Targeted Therapy and Survival Outcomes in Patients With Metastatic Colorectal Cancer. JAMA Netw Open 2023; 6:e2250030. [PMID: 36656585 PMCID: PMC9857024 DOI: 10.1001/jamanetworkopen.2022.50030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
IMPORTANCE Professional society guidelines recommend treating patients with metastatic colorectal cancer with targeted therapies, including epithelial growth factor receptor (EGFR) inhibitors and vascular endothelial growth factor (VEGF) inhibitors, depending on the presence or absence of certain mutations. Since most studies of first-line targeted therapies have been limited by sample size, there is a need for larger studies using data from routine clinical care. OBJECTIVES To identify factors associated with receipt of first-line targeted therapies among patients with metastatic colorectal cancer for whom RAS or BRAF mutation data in the tumor were available and investigate whether targeted therapy is associated with survival. DESIGN, SETTING, AND PARTICIPANTS This cohort study used deidentified data from an electronic health record-derived database to include patients from 800 sites of patient care across the US who were diagnosed with de novo metastatic colorectal cancer between January 1, 2013, and March 31, 2020 (n = 9134). MAIN OUTCOMES AND MEASURES Receipt of first-line targeted therapy, categorized as ever having received EGFR inhibitors, VEGF inhibitors, or neither. The secondary outcome was overall survival. RESULTS The study population included 9134 patients. The median age at diagnosis was 62 years (IQR, 53-71 years), 5019 (54.9%) were male, and 5692 (62.3%) were White. The median follow-up period was 15 months. Overall, 713 patients (7.8%) received EGFR inhibitors and 5081 patients (55.6%) received VEGF inhibitors as part of their first-line treatment. Among patients with RAS wild-type (RAS-WT) tumors, 625 patients (15.5%) received EGFR inhibitors and 2053 patients (50.9%) received VEGF inhibitors. In patients with RAS mutant (RAS-Mut) tumors, 50 patients (1.1%) received EGFR inhibitors and 2682 patients (59.7%) received VEGF inhibitors; among those with BRAF-mutant (BRAF-Mut) tumors, 38 patients (6.3%) received EGFR inhibitors and 346 patients (57.2%) received VEGF inhibitors. More than one-third of the patients (36.6%) received neither EGFR inhibitors nor VEGF inhibitors. Compared with patients younger than age 40 years, those aged 80 years or older had significantly lower odds to receive targeted therapies (EGFR or VEGF inhibitors in patients with RAS-WT tumors: adjusted odds ratio [aOR], 0.53; 95% CI, 0.36-0.79; and VEGF inhibitors in patients with RAS-Mut tumors: aOR, 0.62; 95% CI, 0.42-0.90). Improved survival was associated with EGFR inhibitor therapy in patients with RAS-WT tumors (adjusted hazard ratio [aHR], 0.85; 95% CI, 0.74-0.98). Unlike in clinical trials, however, no survival benefit was noted with use of VEGF inhibitors among patients with RAS-WT (aHR, 1.00; 95% CI, 0.91-1.11) or RAS-Mut (aHR, 1.01; 95% CI, 0.93-1.10) tumors. CONCLUSIONS AND RELEVANCE The findings of this study showed mixed results on survival benefits associated with targeted therapy. In addition, given that some of the results differed from those of randomized clinical trials, this study highlights the importance of using data originating from routine clinical care.
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Zhou G, Koroukian SM, Navale SM, Schiltz NK, Kim U, Rose J, Cooper GS, Moore SE, Mintz LJ, Avery AK, Mukherjee S, Markt SC. Cancer burden in women with HIV on Medicaid: A nationwide analysis. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231170061. [PMID: 37184054 PMCID: PMC10192809 DOI: 10.1177/17455057231170061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Cancer is the leading cause of death in people living with HIV. In the United States, nearly 1 in 4 people living with HIV are women, more than half of whom rely on Medicaid for healthcare coverage. OBJECTIVE The objective of this study is to evaluate the cancer burden of women living with HIV on Medicaid. DESIGN We conducted a cross-sectional study of women 18-64 years of age enrolled in Medicaid during 2012, using data from Medicaid Analytic eXtract files. METHODS Using International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes, we identified women living with HIV (n = 72,508) and women without HIV (n = 17,353,963), flagging the presence of 15 types of cancer and differentiating between AIDS-defining cancers and non-AIDS-defining cancers. We obtained adjusted prevalence ratios and 95% confidence intervals for each cancer and for all cancers combined, using multivariable log-binomial models, and additionally stratifying by age and race/ethnicity. RESULTS The highest adjusted prevalence ratios were observed for Kaposi's sarcoma (81.79 (95% confidence interval: 57.11-117.22)) and non-Hodgkin's lymphoma (27.69 (21.67-35.39)). The adjusted prevalence ratios for anal and cervical cancer, both of which were human papillomavirus-associated cancers, were 19.31 (17.33-21.51) and 4.20 (3.90-4.52), respectively. Among women living with HIV, the adjusted prevalence ratio for all cancer types combined was about two-fold higher (1.99 (1.86-2.14)) in women 45-64 years of age than in women 18-44 years of age. For non-AIDS-defining cancers but not for AIDS-defining cancers, the adjusted prevalence ratios were higher in older than in younger women. There was no significant difference in the adjusted prevalence ratios for all cancer types combined in the race/ethnicity-stratified analyses of the women living with HIV cohort. However, in cancer type-specific sub-analyses, differences in adjusted prevalence ratios between Hispanic versus non-Hispanic women were observed. For example, the adjusted prevalence ratio for Hispanic women for non-Hodgkin's lymphoma was 2.00 (1.30-3.07) and 0.73 (0.58-0.92), respectively, for breast cancer. CONCLUSION Compared to their counterparts without HIV, women living with HIV on Medicaid have excess prevalence of cervical and anal cancers, both of which are human papillomavirus related, as well as Kaposi's sarcoma and lymphoma. Older age is also associated with increased burden of non-AIDS-defining cancers in women living with HIV. Our findings emphasize the need for not only cancer screening among women living with HIV but also for efforts to increase human papillomavirus vaccination among all eligible individuals.
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Miller DB, Markt SC, Nguyen CT, Coleman OC. Prostate Cancer Screening and Young Black Men: Can Early Communication Avoid Later Health Disparities? JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1460-1465. [PMID: 33689157 PMCID: PMC7943410 DOI: 10.1007/s13187-021-01984-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/26/2021] [Indexed: 05/27/2023]
Abstract
This study aims to determine if younger men, across racial and ethnic groups, discussed the benefits/risks/harms of PSA screening with health care professionals. Publicly available data were obtained from the Health Information National Trends Survey https://hints.cancer.gov/ in March 2019. Cross-sectional analysis of 518 men between the ages of 18 and 49 years from men who completed the survey between October 2011 and February 2012 (HINTS cycle 4) was performed. We used logistic regression to evaluate the association between race/ethnicity and discussions around PSA. Less than 10% of the participants reported a prior PSA; Black and Hispanic men were more likely compared with White men. Compared with White men, Black and other race men reported receiving less communications from some doctors recommending PSA screening (ORblack: 0.16, 95% CIblack: 0.07-0.38; ORother: 0.10, 95% CIother: 0.04-0.25), and that no one is sure PSA testing saves lives (ORblack: 0.49, 95% CIblack: 0.04-6.91; ORother: 0.17, 95% CIother: 0.06-0.48). Minority men, while more likely to have had a PSA, were less likely to be told of the harms and benefits of PSA testing, compared with White men. Increasing communication surrounding screening advantages and disadvantages between providers and patients can increase awareness and knowledge among younger men. In a post-COVID-19 environment, communication regarding the return to preventative screenings within vulnerable populations is an important message to convey. Research shows preventive screenings have dropped across all population groups due to the pandemic yet the decline disproportionately affects Black and other minority men.
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Markt SC, Booker BD, Bensken W, Schiltz NK, Schumacher FR, Rose J, Cooper G, Selfridge JE, Koroukian SM. Sociodemographic and clinical factors associated with receipt of biomarker testing in patients with metastatic colorectal cancer. Cancer Med 2022; 12:1850-1859. [PMID: 35837788 PMCID: PMC9883565 DOI: 10.1002/cam4.4995] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 06/03/2022] [Accepted: 06/19/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Standard clinical practice and national guidelines dictate somatic testing of metastatic colorectal cancer (mCRC) tumors to guide appropriate therapy; however, previous studies suggest that not all patients are tested. The objective of this study was to investigate potential differences in testing for mCRC by demographic and clinical factors. METHODS We performed a retrospective review of de-identified patient data derived from electronic health records (EHRs) of 25,469 patients diagnosed with mCRC between the years 2013 and 2020. Our outcome was a receipt of the following tests: (a) biomarker testing (BRAF, KRAS, NRAS, MMR/MSI) and (b) next-generation sequencing (NGS). We interrogated our data using the machine-learning algorithm Classification and Regression Tree (CART), a unique approach to identifying combinations of, rather than individual demographic and clinical characteristics associated with receipt of testing. RESULTS A total of 25,469 patients were identified with mCRC. Of these, 21,133 (83%) received either biomarker testing only (n = 12,485) or any testing (biomarker + NGS) (n = 8648). The proportion of patients who received any testing increased over calendar time for all age, race, and sex categories. Receipt of any testing was highest (90%) among younger and patients with better performance status, and there was no difference in receipt of any testing by race. The highest percentage of NGS testing was among those with better performance status, <70 years old, commercial or other governmental program payers, and low comorbidity burden; however, those who were Black or Hispanic had a lower prevalence of NGS testing than those who were White. CONCLUSIONS AND RELEVANCE Considerable variations exist in somatic biomarker testing across subgroups of the population. Identification of genomic alterations can aid in determining targeted treatment and improving clinical outcomes; therefore, equitable use of these testing strategies, particularly NGS, is necessary.
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Hue JJ, Katayama ES, Markt SC, Elshami M, Saltzman J, Bajor D, Hosmer A, Mok S, Dumot J, Ammori JB, Rothermel LD, Hardacre JM, Winter JM, Ocuin LM. A nationwide analysis of pancreatic cancer trial enrollment reveals disparities and participation problems. Surgery 2022; 172:257-264. [PMID: 34839935 DOI: 10.1016/j.surg.2021.10.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/22/2021] [Accepted: 10/08/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Our research group recently surveyed the clinical trial landscape in pancreatic adenocarcinoma and identified 430 active trials. These represent an opportunity to expand treatment options for patients with pancreatic adenocarcinoma. Our primary objective was to detail clinical trial participation among patients with pancreatic adenocarcinoma. Our secondary objective was to evaluate survival. METHODS We queried the National Cancer Database (2004-2016) for patients with pancreatic adenocarcinoma. Patients were stratified by trial participation: clinical trial or non-trial. Multivariable logistic regression was used to identify variables associated with trial participation. The Kaplan-Meier method and multivariable Cox hazards regression were used to analyze survival. RESULTS In total, 261,483 patients were included: 1,110 (0.4%) were enrolled in a clinical trial. A total of 57 Black patients participated in a clinical trial (0.19% of Black patients). This was lower compared to White patients (n = 955, 0.49% of White patients, P < .001). After adjusting for demographic and clinical factors, Black patients were less likely to be enrolled in a clinical trial (odds ratio = 0.387, P < .001). Patients treated at nonacademic medical centers were less likely to be in a clinical trial. Trial participation was associated with an increased median survival relative to non-trial patients (stage IV: 9.0 vs 3.8 months, P < .001), and this association remained on multivariable regression (hazard ratio = 0.779, P < .001). CONCLUSION Fewer than 1% of patients with pancreatic adenocarcinoma participated in a clinical trial. There are racial and sociodemographic disparities in clinical trial enrollment. An association was observed between clinical trial participants and prolonged survival.
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Stopsack KH, Rajanala H, Plym A, Vaselkiv JB, Matsoukas K, Ebot EM, Markt SC, Penney KL, Lee GSM, Mucci LA, Kantoff PW. Abstract 1438: Organic anion transporter (SLCO)genotype and prostate cancer progression: Prospective cohort study and meta-analysis. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-1438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Organic anion-transporting polypeptides, encoded by SLCO genes, have multiple substrates, including androgens. Genotype and protein levels moderate the uptake of androgens into prostate cells, a process competitively inhibited in vitro by statin medications. Single-nucleotide polymorphisms (SNPs) in SLCO2B1 influence SLCO1B2 expression and efficacy of androgen uptake in vitro.
Methods: Among men of self-reported European ancestry diagnosed with prostate cancer during prospective follow-up of the Health Professionals Follow-up Study (HPFS, diagnosed 1986-2017) and the Physicians’ Health Study (PHS, 1982-2010) combined, we evaluated four SLCO2B1 SNPs identified in prior studies and time from diagnosis to lethal disease (metastases/prostate cancer-specific death), adjusting for age, calendar year of diagnosis, and principal components of genetic variation to account for local ancestry. We also conducted a systematic review and harmonized allele coding in prior studies for a two-stage dose-response meta-analysis with additive allele coding.
Results: Of the 3208 men in the prospective cohort study, 96% were diagnosed with clinically localized (T1/T2) prostate cancer. Most were treated with radical prostatectomy (47%) or radiation (36%); 33% ever received androgen deprivation therapy (ADT). Over up to 32 years of follow-up (median, 14.4 years), 382 lethal events occurred. The intronic SNP rs1077858 had the strongest association with lethal disease (hazard ratio [HR] per minor allele 1.14, 95% confidence interval [CI] 0.98-1.33). Data were suggestive of potential differences for the four SNPs by use of statins and ADT but were not conclusive. The systematic review identified 2 additional population-based studies of primary disease and 4 hospital-based studies of advanced disease, none of which studied effect modification by statins or ADT. Among these 2377 men, 1088 events of recurrence, metastasis, or prostate cancer death occurred. In a meta-analysis of all 7 studies, the genotype of the exonic SNP rs12422149 (minor allele frequency 15%) that results in lower androgen uptake was associated with better outcomes (HR per minor allele 0.80, 95% CI 0.69-0.93), with little between-study heterogeneity (I2 0.27). For the intronic SNP rs1077858, the genotype with higher SLCO2B1 mRNA expression was associated with worse outcomes (HR per minor allele 1.14, 95% CI 0.99-1.31, 3 studies with I2 0.68).
Conclusion: These results are compatible with the hypothesis that inherited genetic variation in SLCO2B1 influences androgen uptake and prostate cancer prognosis. These and other genetic variants, together with clinical features, may have potential utility as predictive biomarkers for identifying men with prostate cancer who might benefit from early therapy beyond ADT. Whether adjuvant statin therapy could mitigate the inherited risk requires further study.
Citation Format: Konrad H. Stopsack, Harisha Rajanala, Anna Plym, Jane B. Vaselkiv, Konstantina Matsoukas, Ericka M. Ebot, Sarah C. Markt, Kathryn L. Penney, Gwo-Shu M. Lee, Lorelei A. Mucci, Philip W. Kantoff. Organic anion transporter(SLCO)genotype and prostate cancer progression: Prospective cohort study and meta-analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1438.
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Booker BD, Markt SC, Schumacher FR, Rose J, Cooper GS, Selfridge JE, Koroukian SM. Abstract 4126: Treatment and survival of patients with de novo metastatic colorectal cancer (mCRC) rested for KRAS, NRAS or BRAF mutations. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-4126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Study Purpose: Molecular profiling of RAS (KRAS, NRAS) and BRAF mutations in mCRC is recommended by national guidelines to inform targeted treatment. The purpose of this study was to determine whether results of genomic testing are associated with receipt of targeted therapy (i.e. VEGFi and EGFRi), and whether receipt of first-line targeted therapy is associated with survival among patients with mCRC.
Methods: Using the nationwide de-identified electronic health record-derived Flatiron Health database, we included 10,168 patients with de novo mCRC diagnosed between 2013-2020 and tested for at least one of the above biomarkers at any time. We used multivariable Cox proportional hazards regression models, beginning follow-up at date of metastatic diagnosis and continued until death or end of follow-up, adjusted for age, sex, race/ethnicity, mutation status (mutant vs. wild type (WT)), tumor site (colon vs. rectum), mismatch repair (MMR), comorbidities, ECOG status, payer type, and first-line (1L) treatment, to investigate the associations between: 1) mutation status and 1L treatment; and 2) 1L treatment and overall survival.
Results: Overall, 9.5% did not have documented 1L treatment. Among patients with 1L treatment documented (n=9,202), the most common were FOLFOX+VEGFi (36.3%), followed by FOLFOX alone (15.8%), single-agent capecitabine (7.2%), and FOLFIRI+VEGFi (5.0%). After adjusting for treatment, patients with KRAS, NRAS, and BRAF mutant tumors had worse survival than those WT for all three: (HR: 1.32, 95% confidence interval: 1.23-1.42), (HR: 1.23, 95% CI: 1.04-1.47), and (HR: 1.77, 95% CI: 1.57-2.00), respectively. Of patients with RAS mutations, 59.8% received VEGFi, regardless of chemotherapy backbone. Contrary to outcomes reported from clinical trials, we observed similar survival in patients treated with VEGFi, compared to those without (HR: 1.03, (0.95-1.12)). Among patients with RAS WT tumors, 51.6% received VEGFi, but had no survival benefits (HR:1.06 (0.96-1.17)). About 1% of patients RAS mutant and 15.9% of RAS WT tumors received EGFRi regardless of chemotherapy backbone, and experienced better survival than those treated with VEGFi (HR: 0.88 (0.77-1.00). We observed no differences in survival by treatment among those with BRAF mutations.
Conclusions: Treatment with VEGFi was common. However, contrary to survival data from clinical trials, which exclude vulnerable populations, patients treated with VEGFi did not experience survival benefits, highlighting the importance of examining survival outcomes in routine clinical care. In patients with RAS WT tumors, treatment with EGFRi was associated with improved survival compared with those treated with VEGFi. Future studies should incorporate tumor sidedness and contraindications to determine appropriateness of treatment with VEGFi or EGFRi in patients with mCRC.
Citation Format: Ben D. Booker, Sarah C. Markt, Fredrick R. Schumacher, Johnie Rose, Greg S. Cooper, J Eva Selfridge, Siran M. Koroukian. Treatment and survival of patients with de novo metastatic colorectal cancer (mCRC) rested for KRAS, NRAS or BRAF mutations [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 4126.
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Sussman TA, Vu L, Buchbinder EI, Ott PA, Markt SC, Koroukian SM, Hodi FS, Khorana AA. Thromboembolism (TE) and association with survival in patients (pts) with melanoma receiving chemo– or immunotherapy. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.12082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
12082 Background: Emerging reports suggest high rates of venous thromboembolism (VTE) and arterial thromboembolism (ATE) with immune checkpoint inhibitors (ICI) in pts with melanoma, but it is unclear whether these are truly increased compared to older systemic therapy approaches. We assessed the incidence of TE in melanoma pts on ICI, cytokine therapy (CY), and chemotherapy (chemo), and evaluated its impact on survival. Methods: We conducted a cohort study using the SEER-Medicare database to evaluate rates of TE in pts with melanoma treated from 2008-2019 with ICI (ipilimumab, nivolumab, pembrolizumab), CY (IL2, IFN), and/or chemo (antineoplastic agents, BRAF/MEK inhibitors) within two years of treatment initiation. TE including VTE events of deep venous thrombosis, pulmonary embolism, and ATE of MI, ischemic stroke, and transient ischemic attack were identified by at least two outpatient claims or one inpatient claim. Overall survival (OS) from treatment start was analyzed by time-varying Cox analysis. Results: The cohort comprised 13,124 pts with median age 75 (24-101) years and 68% male. Of these, 14.8% received ICI, 48.9% chemo, 1.7% CY, 31.8% chemo+ICI, and 2.8% chemo+CY. At treatment start, comorbidities included 72% of pts with hypertension, 33% cerebrovascular disease, 17% atrial fibrillation, 7.3% history of VTE, and 13.0% history of ATE. Overall, 11.4% were on anticoagulation and 5.2% on antiplatelet agents. Incidence rates of ATE and VTE after treatment start are shown (Table). VTE was highest at 3 months after starting therapy with 19.6 events per 100 person-years in those receiving chemo+ICI, 17.1 events with chemo, 15.4 events with ICI, 10.1 events with chemo+CY, and 7.7 events with CY. In multivariable analysis, VTE and ATE were associated with worse OS compared to patients without (HR 2.77 [95%CI, 2.50-3.08], and HR 2.53 [95%CI, 2.23-2.86], respectively). Conclusions: Systemic therapy with ICI and chemo, especially when exposed to both sequentially or concurrently, demonstrates a high incidence of TE in pts with melanoma. TE is associated with substantial worsening of survival. TE rates are not substantially increased with ICI in comparison to chemo. Further studies are needed to identify benefit of thromboprophylaxis.[Table: see text]
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Hue JJ, Ocuin LM, Kyasaram RK, Shanahan J, Rao G, Rothermel LD, Ammori JB, Hardacre JM, Winter JM, Markt SC. Weight Tracking as a Novel Prognostic Marker After Pancreatectomy. Ann Surg Oncol 2022; 29:3450-3459. [PMID: 35067790 DOI: 10.1245/s10434-022-11325-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/30/2021] [Indexed: 12/17/2023]
Abstract
BACKGROUND Objective measures of post-pancreatectomy weight change for pancreatic ductal adenocarcinoma (PDAC) have not been extensively studied for long-term outcomes. We used weight measurements in our institutional medical record to analyze trends in post-pancreatectomy weight and determine the association with disease status. METHODS Pancreatectomies for PDAC (n = 315) and benign indications (n = 111) were identified. Preoperative baseline, minimum postoperative (Min #1), and subsequent postoperative maximum (Max) weights were abstracted. Multivariable Cox hazards regression was conducted to analyze the association between weight change and survival. RESULTS Median weight loss postoperatively in each group was > 20 lbs. PDAC patients gained 10 lbs after Min #1 compared to 15 lbs in the benign cohort (p < 0.001). Few patients returned to their preoperative weight (29.8% PDAC vs. 40.5% benign, p = 0.04). Patients with early PDAC recurrence (< 13 months) lost more weight (18.0% vs. 13.3% vs. 10.9%, p < 0.001) and gained less weight (2.1% vs. 12.0% vs. 7.9%, p < 0.001) compared with those with late cancer recurrence (≥ 13 months) or no evidence of active disease, respectively. PDAC patients lost 11.2 lbs in the year preceding recurrence diagnosis. Weight loss was not associated with survival; however, weight gain was associated with improved survival. CONCLUSIONS Resections for PDAC are complicated by a similar degree of weight loss as patients with benign disease, and there is no association with survival. However, failure to gain weight is especially ominous. Weight loss after weight recovery foreshadows disease recurrence. These data suggest that rigorous weight tracking is an untapped surveillance strategy in patients with PDAC.
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Basourakos SP, Gulati R, Vince RA, Spratt DE, Lewicki PJ, Hill A, Nyame YA, Cullen J, Markt SC, Barbieri CE, Hu JC, Trapl E, Shoag JE. Harm-to-Benefit of Three Decades of Prostate Cancer Screening in Black Men. NEJM EVIDENCE 2022; 1. [PMID: 35721307 PMCID: PMC9202998 DOI: 10.1056/evidoa2200031] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Prostate-specific antigen screening has profoundly affected the epidemiology of prostate cancer in the United States. Persistent racial disparities in outcomes for Black men warrant re-examination of the harms of screening relative to its cancer-specific mortality benefits in this population. METHODS We estimated overdiagnoses and overtreatment of prostate cancer for men of all races and for Black men 50 to 84 years of age until 2016, the most recent year with treatment data available, using excess incidence relative to 1986 based on the Surveillance, Epidemiology, and End Results registry and U.S. Census data as well as an established microsimulation model of prostate cancer natural history. Combining estimates with plausible mortality benefit, we calculated numbers needed to diagnose (NND) and treat (NNT) to prevent one prostate cancer death. RESULTS For men of all races, we estimated 1.5 to 1.9 million (range between estimation approaches) overdiagnosed and 0.9 to 1.5 million overtreated prostate cancers by 2016. Assuming that half of the 270,000 prostate cancer deaths avoided by 2016 were attributable to screening, the NND and the NNT would be 11 to 14 and 7 to 11 for men of all races and 8 to 12 and 5 to 9 for Black men, respectively. Alternative estimates incorporating a lag between incidence and mortality resulted in a NND and a NNT for Black men that reached well into the low single digits. CONCLUSIONS Complementary approaches to quantifying overdiagnosis indicate a harm-benefit tradeoff of prostate-specific antigen screening that is more favorable for Black men than for men of all races considered together. Our findings highlight the need to account for the increased value of screening in Black men in clinical guidelines. (Funded by the Patient-Centered Outcomes Research Institute, the National Cancer Institute, the Bristol Myers Squibb Foundation, and the Damon Runyon Cancer Research Foundation.).
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Hansen M, Hamieh NM, Markt SC, Vaselkiv JB, Pernar CH, Gonzalez-Feliciano AG, Peisch S, Chowdhury-Paulino IM, Rencsok EM, Rebbeck TR, Platz EA, Giovannucci EL, Wilson KM, Mucci LA. Racial Disparities in Prostate Cancer: Evaluation of Diet, Lifestyle, Family History, and Screening Patterns. Cancer Epidemiol Biomarkers Prev 2022; 31:982-990. [PMID: 35247879 PMCID: PMC9083301 DOI: 10.1158/1055-9965.epi-21-1064] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/09/2021] [Accepted: 02/22/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Racial disparities in prostate cancer incidence and mortality rates are considerable. We previously found in the Health Professionals Follow-up Study (HPFS) that African-American men had an 80% higher prostate cancer risk than White men. With 21 additional years of follow-up and four-fold increase in cases, we undertook a contemporary analysis of racial differences in prostate cancer incidence and mortality in HPFS. METHODS For 47,679 men, we estimated HRs and 95% confidence intervals (CI) for the association between race and risk of prostate cancer through 2016 using Cox proportional hazards regression. Multivariable models (mHR) were adjusted for lifestyle, diet, family history, and PSA screening collected on biennial questionnaires. RESULTS 6,909 prostate cancer cases were diagnosed in White, 89 in African-American, and 90 in Asian-American men. African-Americans had higher prostate cancer incidence (mHR = 1.31; 95% CI, 1.06-1.62) and mortality (mHR = 1.67; 95% CI, 1.00-2.78), and lower PSA screening prevalence than White men. The excess risk was greater in the pre-PSA screening era (HR = 1.68; 95% CI, 1.14-2.48) than the PSA screening era (HR = 1.20; 95% CI, 0.93-1.56). Asian-Americans had lower prostate cancer risk (mHR = 0.74; 95% CI, 0.60-0.92), but similar risk of fatal disease compared with white men. CONCLUSIONS Racial differences in prostate cancer incidence and mortality in HPFS are not fully explained by differences in lifestyle, diet, family history, or PSA screening. IMPACT Additional research is necessary to address the disproportionately higher rates of prostate cancer in African-American men.
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Hue JJ, Markt SC, Sugumar K, Kyasaram RK, Shanahan J, Rothermel LD, Ammori JB, Hardacre JM, Winter JM, Ocuin LM. Weight loss during neoadjuvant therapy for pancreatic cancer does not predict poor outcomes. Am J Surg 2022; 223:927-932. [PMID: 34642044 DOI: 10.1016/j.amjsurg.2021.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 09/18/2021] [Accepted: 10/03/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Weight changes during neoadjuvant chemotherapy (NAC) for pancreatic cancer (PDAC) are not well studied. We hypothesized that weight loss may predict poor outcomes. METHODS Weight change from NAC initiation to pancreatectomy was grouped: gain (≥5%), stable, and loss (≥5%). Pathologic, postoperative, and survival outcomes were compared. RESULTS 95 patients were included: 31.6% lost weight, 58.9% maintained weight, and 9.5% gained weight. There were no differences in chemotherapeutic regimens. Median recurrence-free survival (RFS) and overall survival (OS) were similar between patients with stable weight and those who lost weight (RFS: 9.6vs14.0months; OS: 25.8vs26.7months). Among those who gained weight, RFS (29.5months) and OS (38.4months) were greater relative to the other weight categories. On multivariable regression, weight gain was associated with improved RFS compared to loss (HR = 0.16). CONCLUSION Most patients maintain or lose weight during NAC, and weight loss does not predict poor outcomes. Weight gain may predict improved RFS.
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Koroukian SM, Zhou G, Navale SM, Schiltz NK, Kim U, Rose J, Cooper GS, Moore SE, Mintz LJ, Avery AK, Mukherjee S, Markt SC. Excess cancer prevalence in men with HIV: A nationwide analysis of Medicaid data. Cancer 2022; 128:1987-1995. [PMID: 35285515 DOI: 10.1002/cncr.34166] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 12/08/2021] [Accepted: 12/16/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Cancer is one of the most common comorbidities in men living with HIV (MLWH). However, little is known about the MLWH subgroups with the highest cancer burden to which cancer prevention efforts should be targeted. Because Medicaid is the most important source of insurance for MLWH, we evaluated the excess cancer prevalence in MLWH on Medicaid relative to their non-HIV counterparts. METHODS In this cross-sectional study using 2012 Medicaid Analytic eXtract data nationwide, we flagged the presence of HIV, 13 types of cancer, symptomatic HIV, and viral coinfections using codes from the International Classification of Diseases, Ninth Revision, Clinical Modification. The study population included individuals administratively noted to be of male sex (men), aged 18 to 64 years, with (n = 82,495) or without (n = 7,302,523) HIV. We developed log-binomial models with cancer as the outcome stratified by symptomatic status, age, and race/ethnicity. RESULTS Cancer prevalence was higher in MLWH than in men without HIV (adjusted prevalence ratio [APR], 1.84; 95% confidence interval [CI], 1.78-1.90) and was higher among those with symptomatic HIV (APR, 2.74; 95% CI, 2.52-2.97) than among those with asymptomatic HIV (APR, 1.73; 95% CI, 1.67-1.79). The highest APRs were observed for anal cancer in younger men, both in the symptomatic and asymptomatic groups: APR, 312.97; 95% CI, 210.27-465.84, and APR, 482.26; 95% CI, 390.67-595.32, respectively. In race/ethnicity strata, the highest APRs were among Hispanic men for anal cancer (APR, 198.53; 95% CI, 144.54-272.68) and for lymphoma (APR, 9.10; 95% CI, 7.80-10.63). CONCLUSIONS Given the Medicaid program's role in insuring MLWH, the current findings highlight the importance of the program's efforts to promote healthy behaviors and vaccination against human papillomavirus in all children and adolescents and to provide individualized cancer screening for MLWH.
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Vaselkiv JB, Cheng I, Chowdhury-Paulino IM, Gonzalez-Feliciano AG, Wilkens LR, Hauksdóttir AM, Eiriksdottir G, Le Marchand L, Haiman CA, Valdimarsdóttir U, Mucci LA, Markt SC. Urinary 6-sulfatoxymelatonin Levels and Prostate Cancer Risk among Men in the Multiethnic Cohort. Cancer Epidemiol Biomarkers Prev 2022; 31:688-691. [PMID: 34937795 PMCID: PMC8901549 DOI: 10.1158/1055-9965.epi-21-1041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 11/10/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The circadian hormone melatonin has anticancer properties, and prior studies suggest a positive association between low melatonin and prostate cancer risk. The purpose of this study was to examine urinary melatonin levels and prostate cancer in a racially/ethnically diverse cohort. METHODS We conducted a nested case-control study, including 1,263 prostate cancer cases and 2,346 controls, sampled from participants in the Multiethnic Cohort Study with prediagnostic urine samples assayed for 6-sulfatoxymelatonin, the primary melatonin metabolite. Conditional logistic regression was used to examine the association between melatonin levels and the development of prostate cancer outcomes (all incident cases, advanced, lethal, high-grade, and aggressive), overall and by race/ethnicity. RESULTS Among 1,263 cases, 135 were advanced stage, 101 were lethal cases, and 282 were high-grade disease. Median melatonin levels were similar in controls [17.12 ng/mL; interquartile range (IQR), 19.78] and cases (17.93 ng/mL; IQR, 19.76), and we found no significant association between urinary melatonin levels and prostate cancer risk overall or in any clinical or racial subgroup. CONCLUSIONS In this diverse cohort, there was no significant association between melatonin and any prostate cancer outcome, nor were there any differences by racial/ethnic group. IMPACT These results do not support a strong association between melatonin levels and risk of prostate cancer.
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Bukavina L, Prunty M, Calaway AC, Isali I, Retuerto M, Ghannoum M, Markt SC, Sindhani M, Mishra K, Ponsky LE, Abbosh P. Characterization of fungal mycobiome in bladder cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
542 Background: Bacterial dysbiosis accompanies carcinogenesis in malignancies such as colon, breast and pancreatic cancer. However, the role of fungal mycobiome has not been evaluated in bladder cancer. With the sexual dimorphism that exists within bladder cancer (Bca) prevalence and survival, our study aims to characterize fungal mycobiome composition in Bca. Methods: This is a single site, non-randomized, prospective study of patients with the diagnosis of muscle invasive bladder cancer (MIBC) undergoing cystectomy from September 2020 to May 2021. Stool samples were collected during surgery using aseptic technique. We utilized the ITS1 region from DNA sample extracts, which was amplified in triplicate using primers with high specificity for ascomycete fungi (fluorescently-labeled forward primer ITS1F (CTTGGTCATTTAGAGGAAGTAA) and unlabeled reverse primer ITS2 (GCTGCGTTCTTCATCGATGC). Fungal PCR products were separated on the SCE 9610 capillary DNA sequencer (Spectrumedix LLC, State College, PA) using GenoSpectrum software to convert fluorescent output into electropherograms. Hierarchical clustering by Bray-Curtis distance was performed using hclust2. Mean normalized abundance for each amplicon was calculated from the three PCR replicates of each sample, excluding means below 1%. Results: A total of 29 patients (17 males and 12 females) were enrolled. The median (IQR) age was 74 yo (63-77), males, and 68.5 yo (58-78), females. Per figure 1, Saccharomycecales dominated the fungal community at order level with mean relative abundance of 36.35% females, and 21.20%, males. (Figure 1D) Tremellales was the second most notable order, composing 8.22% and 5.13% of male and female samples. There were no differences seen in alpha and beta diversity (Figure 1C) (Figure 1A, C), notable differences were seen across orders. The greatest difference between sexes in LDA( M:F) were noted in Saccharomycecales (log change -4.686, p=0.001/ padj= 0.01), Tremellales (log change 5.119, p=0.001/padj= 0.01), and Sporidiobolales (log change 4.839, p=0.001 padj= 0.03). (Figure 1B). Female bladder cancer patients demonstrating an increase abundance of Saccharomycecale. When assessing differences in fungal composition in patients with history of neoadjuvant therapy( NAC) (receipt vs none), patients with history of NAC exhibited a 3.48 increase in Saccharomycecale (padj= 0.015 ), 4.81 increase Tremalles (padj= 0.009) and 4.37 increase Pleosporales(padj= 0.009) . Conclusions: Mycobiome is an integral part of gut microbiota, with fungal elements relatively poorly studied. Nevertheless, the association between fungal dysbiosis and carcinogenesis across multiple cancers exists. Our study is the first to characterize fungal profile in bladder cancer patients, stratified by sex and receipt of NAC, with results highlighting key fungal players: Saccharomycecale, Tremallales, Pleosoporales.
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Bukavina L, Calaway AC, Isali I, Prunty M, Ghannoum M, Retuerto M, Mishra K, Sindhani M, Castro Bigalli A, MacLennan G, Ponsky LE, Markt SC, Abbosh P. Characterization and functional analysis of microbiome in bladder cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
541 Background: The role of microbiome in genitourinary cancer is an emerging field, with evidence implicating the important role of microbiome as causative factors or cofactors in tumorigenesis and drug metabolism. Our study aims to characterize healthy and bladder cancer enterotypes in the gut and identify functional alterations through the use of metagenomics data. Methods: After prospective collection of 29 rectal swab samples of bladder cancer (BCa) patients undergoing cystectomy, and 32 healthy volunteers, we perform 16S rRNA amplicon sequencing on 61 samples (29 with bladder cancer, 32 without cancer). Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt) was applied to infer functional categories associated with taxonomic composition. The p values were adjusted using the false discovery rate. The a- and b-diversity analyses were performed using QIIME. The Mann-Whitney U test was employed to evaluate the statistical significance of b-diversity distances within and between groups of interest. Results: Across all the bladder cancer stool samples, estimation of relative abundance revealed of the five most dominant bacterial populations was Bacteroidales ( 46.21%), Clostridiales ( 32.29%), Burkholderiales (9.07%), Erysipelotrichales (3.20%) and Lactobacillales ( 2.20%). In contrast, healthy controls exhibited an increased relative abundance of Enterobacteriales ( 10.75% vs 0.52%) and Pseudomonadales (8.33% vs 0.18%) as compared to tumor samples. The microbial diversity differences between Bca and normal samples showed no differences across alpha diversity metrics (Shannon diversity p>0.05) as compared to normal tissue. However, there was significant difference in clustering of organisms as determined by principal coordinate analysis ( PCoA) ordination of unweighted UniFrac Distances, (p=0.002). Furthermore, upon stratification of patients on smoking status (all healthy=nonsmokers), clustering persisted, albeit non smokers with bladder cancer displayed an intermediate across PCoA. Bca samples exhibited higher LDA score Campylobacterales (log change 8.0, p<0.001, padj <0.001) ,Fusobacteriales (log change 6.11, p<0.001/ padj<0.01), Epysipelotrichales (log 2.55, p<0.001/ padj <0.001 ), Actinomycetales (log change 1.86, p=0.001/ padj<0.001), Verrucomicrobiales (log change 1.78, p=0.017/padj=0.031) and Enterobacteriales (log change -1.54,p=0.017/ padj= 0.132). Conclusions: In conclusion, our study provides preliminary evidence that the GI microbiota is different in bladder cancer patients. Collectively, our study highlights distinct microbial overexpression of Campylobacter and Fusobacterium in Bca cohort not previously reported, both implicated in tumorigenesis, and could serve as a target that could be modulated to enhance treatment response.
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Hue JJ, Ocuin LM, Kyasaram RK, Shanahan J, Rao G, Rothermel LD, Ammori JB, Hardacre JM, Winter JM, Markt SC. ASO Visual Abstract: Weight Tracking as a Novel Prognostic Marker After Pancreatectomy. Ann Surg Oncol 2022. [PMID: 35157190 DOI: 10.1245/s10434-022-11392-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Markt SC, Penney KL, Schumacher FR. Finding a Place for Family History To Inform High-grade Prostate Cancer Risk. Eur Urol 2022; 82:170-171. [PMID: 35105480 DOI: 10.1016/j.eururo.2022.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 01/13/2022] [Indexed: 11/04/2022]
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Hue JJ, Winter JM, Markt SC. ASO Author Reflection: Post-pancreatectomy Weight Trends Predict Recurrence and Survival. Ann Surg Oncol 2022; 29:3460-3461. [DOI: 10.1245/s10434-022-11328-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 01/05/2023]
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Yamoah K, Lee KM, Awasthi S, Alba PR, Perez C, Anglin-Foote TR, Robison B, Gao A, DuVall SL, Katsoulakis E, Wong YN, Markt SC, Rose BS, Burri R, Wang C, Aboiralor O, Fink AK, Nickols NG, Lynch JA, Garraway IP. Racial and Ethnic Disparities in Prostate Cancer Outcomes in the Veterans Affairs Health Care System. JAMA Netw Open 2022; 5:e2144027. [PMID: 35040965 PMCID: PMC8767437 DOI: 10.1001/jamanetworkopen.2021.44027] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/22/2021] [Indexed: 01/05/2023] Open
Abstract
Importance Prostate cancer (PCa) disproportionately affects African American men, but research evaluating the extent of racial and ethnic disparities across the PCa continuum in equal-access settings remains limited at the national level. The US Department of Veterans Affairs (VA) Veterans Hospital Administration health care system offers a setting of relatively equal access to care in which to assess racial and ethnic disparities in self-identified African American (or Black) veterans and White veterans. Objective To determine the extent of racial and ethnic disparities in the incidence of PCa, clinical stage, and outcomes between African American patients and White patients who received a diagnosis or were treated at a VA hospital. Design, Setting, and Participants This retrospective cohort study included 7 889 984 veterans undergoing routine care in VA hospitals nationwide from 2005 through 2019 (incidence cohort). The age-adjusted incidence of localized and de novo metastatic PCa was estimated. Treatment response was evaluated, and PCa-specific outcomes were compared between African American veterans and White veterans. Residual disparity in PCa outcome, defined as the leftover racial and ethnic disparity in the outcomes despite equal response to treatment, was estimated. Exposures Self-identified African American (or Black) and White race and ethnicity. Main Outcomes and Measures Time to distant metastasis following PCa diagnosis was the primary outcome. Descriptive analyses were used to compare baseline demographics and clinic characteristics. Multivariable logistic regression was used to evaluate race and ethnicity association with pretreatment clinical variables. Multivariable Cox regression was used to estimate the risk of metastasis. Results Data from 7 889 984 veterans from the incidence cohort were used to estimate incidence, whereas data from 92 269 veterans with localized PCa were used to assess treatment response. Among 92 269 veterans, African American men (n = 28 802 [31%]) were younger (median [IQR], 63 [58-68] vs 65 [62-71] years) and had higher prostate-specific antigen levels (>20 ng/mL) at the time of diagnosis compared with White men (n = 63 467; [69%]). Consistent with US population-level data, African American veterans displayed a nearly 2-fold greater incidence of localized and de novo metastatic PCa compared with White men across VA centers nationwide. Among veterans screened for PCa, African American men had a 29% increased risk of PCa detection on a diagnostic prostate biopsy compared with White (hazard ratio, 1.29; 95% CI, 1.27-1.31; P < .001). African American men who received definitive primary treatment of PCa experienced a lower risk of metastasis (hazard ratio, 0.89; 95% CI, 0.83-0.95; P < .001). However, African American men who received nondefinitive treatment classified as “other” were more likely to develop metastasis (adjusted hazard ratio, 1.29; 95% CI, 1.17-1.42; P < .001). Using the actual rate of metastasis from veterans who received definitive primary treatment, a persistent residual metastatic burden for African American men was observed across all National Comprehensive Cancer Network risk groups (low risk, 4 vs 2 per 100 000; intermediate risk, 13 vs 6 per 100 000; high risk, 19 vs 9 per 100 000). Conclusions and Relevance This cohort analysis found significant disparities in the incidence of localized and metastatic PCa between African American veterans and White veterans. This increased incidence is a major factor associated with the residual disparity in PCa metastasis observed in African American veterans compared with White veterans despite their nearly equal response to treatment.
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