26
|
Gutierrez JC, Cheung MC, Zhuge Y, Koniaris LG, Sola JE. Does Children's Oncology Group hospital membership improve survival for patients with neuroblastoma or Wilms tumor? Pediatr Blood Cancer 2010; 55:621-8. [PMID: 20806361 DOI: 10.1002/pbc.22631] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
PURPOSE To determine prognostic significance of hospital surgical volume and Children's Oncology Group (COG) membership on neuroblastoma (NBL) and Wilms tumor (WT) survival. METHODS The Florida Cancer Data System was queried from 1981 to 2004. RESULTS Of 869 NBL patients, 463 were treated at COG/HVC, 246 at COG/LVC, and 160 at non-COG/LVC. COG hospitals treated a larger proportion of patients <1 year of age (P = 0.002) and relatively more patients with adrenal and mediastinal tumors (P = 0.005). COG centers more frequently administered chemotherapy (72% vs. 51%, P < 0.001). Five- and 10-year survival rates were higher at COG/HVC (70.6%, 67.7%) and COG/LVC (75.8%, 72.6%) than non-COG/LVC (59.5%, 54.4%, P < 0.05). Of 790 WT patients, 395 were treated at COG/HVC, 210 at COG/LVC, and 185 at non-COG/LVC. COG hospitals treated younger patients and lower staged tumors (P < 0.05). COG centers more frequently administered chemotherapy (88% vs. 59%, P < 0.001). Five- and 10-year survival rates were higher at COG/HVC (91.3%, 89.9%) and COG/LVC (96.7%, 94.7%) than non-COG/LVC (82.4%, 81.7%, P < 0.05). Multivariate analysis demonstrated WT patients treated at non-COG hospitals, but not NBL patients, had worse survival (HR 3.107, P = 0.01). CONCLUSION Children treated at COG hospitals had higher overall use of chemotherapy. This translated into a significantly improved survival benefit for WT.
Collapse
|
27
|
Cheung MC, Koniaris LG, Yang R, Zhuge Y, Mackinnon JA, Byrne MM, Franceschi D. Do all patients with carcinoma of the esophagus benefit from treatment at teaching facilities? J Surg Oncol 2010; 102:18-26. [PMID: 20213687 DOI: 10.1002/jso.21509] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND We sought to determine whether patients with esophageal carcinoma benefit from regionalization of care. METHODS The Florida Cancer Data System (FCDS) and the Agency for Health Care Administration data sets (1998-2002) were merged and queried. RESULTS A total of 5,041 patients (87.6% Caucasian vs. 11.1% African American (AA)) demonstrated a median survival time of 9.8 months overall and 23.4 months following surgical resection (P < 0.001). Adenocarcinoma arose predominantly in Caucasian patients (98.1%). Patients with adenocarcinoma (n = 2,248) derived a treatment benefit at a TF (HR = 1.35, P = 0.003), including an improved 90-day mortality following surgery (2.1% vs. 4.0%, P < 0.001). Squamous cell carcinoma (SCC) arose predominantly in AA patients (91.6%). No overall survival benefit at TF was observed (HR = 1.01, P = 0.915), however a trend for reduced 90-day surgical mortality was observed at TF (1.9% vs. 5.2%, P = 0.062). Multivariate analysis for adenocarcinoma demonstrates that poverty, lack of chemotherapy or surgery, and failure to provide treatment at a TF are independent predictors of worse survival. For SCC patients, AA race was a significant predictor of poorer survival while TF and poverty level were not. CONCLUSIONS These data suggest no benefit from potential regionalized care for patients with squamous histology, which disproportionately affects AA.
Collapse
|
28
|
Sola JE, Bronson SN, Cheung MC, Ordonez B, Neville HL, Koniaris LG. Survival disparities in newborns with congenital diaphragmatic hernia: a national perspective. J Pediatr Surg 2010; 45:1336-42. [PMID: 20620341 DOI: 10.1016/j.jpedsurg.2010.02.105] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Accepted: 02/23/2010] [Indexed: 12/11/2022]
Abstract
PURPOSE The aim of the study was to examine national outcomes for congenital diaphragmatic hernia (CDH). METHODS We analyzed the Kids' Inpatient Database for patients admitted at less than 8 days of age. RESULTS Overall, 2774 hospitalizations were identified. Most patients were white and had private insurance. Most patients were treated at urban (96%), teaching (75%), and not identified as children's hospital (NIACH) (50%). Birth was the most common admission source at NIACH (91%) and children's unit in general hospital (CUGH) (59%), compared to hospital transfer at children's general hospital (CGH) (81%). Most CDH were repaired through the abdomen (81%), and 25% required extracorporeal membrane oxygenation (ECMO). Most NIACH patients were transferred to another hospital, whereas most at CGH and CUGH were discharged home. Survival to discharge was 66% after excluding hospital transfers. Univariate analysis revealed higher survival for males, birth weight (BW) of 3 kg or more, whites, patients with private insurance, and those in the highest median household income quartile. Survival was 86% after CDH repair but 46% for ECMO. Multivariate analysis identified black race (hazard ratio [HR], 1.536; P = .03) and other race (HR, 1.515; P = .03) as independent predictors of mortality. CONCLUSIONS Hospital survival for CDH is related to sex, BW, race, and socioeconomic status. Blacks and other non-Hispanic minorities have higher mortality rates.
Collapse
|
29
|
Jawad MU, Cheung MC, Clarke J, Koniaris LG, Scully SP. Osteosarcoma: improvement in survival limited to high-grade patients only. J Cancer Res Clin Oncol 2010; 137:597-607. [PMID: 20514491 DOI: 10.1007/s00432-010-0923-7] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Accepted: 05/19/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND We sought to identify the significant prognostic parameters of patients with osteosarcoma over the past three decades using a population-based registry. METHODS A total of 3765 patients with osteosarcoma were identified in the SEER database. Information regarding patient demographics, clinical and treatment characteristics, cause of death and survival were extracted. Kaplan-Meier, Log-Rank, and Cox regression were used for analysis. RESULTS On multivariate analysis only age group '<25 years', 'local' stage and 'low' grade, 'appendicular skeleton' and employment of 'surgical resection' showed a disease-specific survival benefit with a P value < 0.001. The long-term survival improved in the interval from 1973 to 1985 from approximately 55 to 65% but subsequent improvement has been limited only to patients with high-grade disease. CONCLUSION When comparing survival rates by decade of diagnosis, it appears that improvement in survival since 1985 is limited to patients with high-grade disease only. LEVEL OF EVIDENCE The level of evidence for this article is 2.
Collapse
|
30
|
Yang R, Cheung MC, Zhuge Y, Armstrong C, Koniaris LG, Sola JE. Primary Solid Tumors of the Colon and Rectum in the Pediatric Patient: A Review of 270 Cases. J Surg Res 2010; 161:209-16. [DOI: 10.1016/j.jss.2008.12.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Revised: 11/14/2008] [Accepted: 12/02/2008] [Indexed: 11/25/2022]
|
31
|
Yang R, Cheung MC, Byrne MM, Huang Y, Nguyen D, Lally BE, Koniaris LG. Do racial or socioeconomic disparities exist in lung cancer treatment? Cancer 2010; 116:2437-47. [PMID: 20209616 DOI: 10.1002/cncr.24986] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Determine the effects of race, socioeconomic status, and treatment on outcomes for patients diagnosed with lung cancer. METHODS The Florida cancer registry and inpatient and ambulatory data were queried for patients diagnosed from 1998-2002. RESULTS A total 76,086 of lung cancer patients were identified. Overall, 55.6% were male and 44.4% were female. The demographic distribution of patients was 92.7% Caucasian, 6.7% African American, and 5.7% Hispanic. The mean age of diagnosis was 70 years old. African American patients presented at a younger age, with more advanced disease, and were less likely to undergo surgical therapy than their Caucasian counterparts. Median survival time (MST) for the entire cohort was 8.7 months, while MST for African American patients was 7.5 months. Patients who received surgery, chemotherapy, or radiation therapy demonstrated significantly improved outcomes. Stepwise multivariate analysis revealed that African American race was no longer a statistically significant predictor of worse outcomes once corrections were made for demographics and comorbid conditions, suggesting that the originally reported disparities in lung cancer outcomes and race may be in part because of poor pretreatment performance status. In contrast, patients of the lowest socioeconomic status continue to have a slightly worse overall prognosis than their affluent counterparts (hazard ratio = 1.05, P = .001). CONCLUSIONS Lung cancer continues to carry a poor prognosis for all patients. Once comorbidities are corrected for, African American patients carry equivalently poor outcomes. Nonetheless, emphasis must be placed on improving pretreatment performance status among African American patients and efforts for earlier diagnosis among the impoverished patients must be made.
Collapse
|
32
|
Cheung MC, Zhuge Y, Yang R, Ogilvie MP, Koniaris LG, Rodríguez MM, Sola JE. Incidence and outcomes of extremity soft-tissue sarcomas in children. J Surg Res 2010; 163:282-9. [PMID: 20638678 DOI: 10.1016/j.jss.2010.04.033] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 04/05/2010] [Accepted: 04/19/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND We studied the outcomes of pediatric extremity tumors on a population scale. METHODS The Surveillance, Epidemiology, and End Results database (1973-2006) was queried for all patients under 20 y of age. RESULTS Overall, 1175 patients were identified. The median age at diagnosis was 12 y, but most patients were ≥10 y of age (72%, n = 842). Most tumors were non-rhabdomyosarcoma soft tissue sarcomas (NRSTS) (79%, n = 879). The most common tissue of origin was muscle (43%, n = 474). Most rhabdomyosarcoma (RMS) (n = 220) were alveolar type (n = 140). Most patients presented with local disease (64%, n = 699), and underwent surgical intervention (88%, n = 1027), but did not have radiotherapy (62%, n = 710). RMS was more likely to present in younger children (P < 0.001) and with distant disease (P < 0.001). Older patients were more likely to receive radiotherapy than infants (P < 0.001). Overall 5-y survival was 79%. RMS had significantly worse 5-y survival (56% versus 85% for NRSTS, P < 0.001). Surgical intervention was associated with higher 5-y survival (84% versus 48%, P < 0.001). Radiotherapy was associated with worse 5-y survival (74% versus 83%, P = 0.002). Multivariate analysis identified RMS (HR 2.20, P < 0.001), nerve and muscle (not synovial sarcoma) tissue of origin (HR 2.26, P = 0.002, and HR 1.59, P = 0.036), regional or distant disease (HR 1.65, P = 0.011, and HR 5.96, P < 0.001, respectively), and lack of surgical intervention (HR 2.20, P < 0.001) as independent predictors of poor outcome. CONCLUSIONS Extremity sarcomas are most common in older children. RMS is more common in younger children, but is associated with lower survival, and is an independent prognostic indicator of mortality.
Collapse
|
33
|
Zhuge Y, Cheung MC, Yang R, Perez EA, Koniaris LG, Sola JE. Pediatric non-Wilms renal tumors: subtypes, survival, and prognostic indicators. J Surg Res 2010; 163:257-63. [PMID: 20538287 DOI: 10.1016/j.jss.2010.03.061] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Revised: 03/07/2010] [Accepted: 03/26/2010] [Indexed: 11/15/2022]
Abstract
BACKGROUND To determine the outcomes and predictors of survival for pediatric non-Wilms renal tumors (NWRT). METHODS The SEER database (1973-2005) was queried for all patients < 20 y of age. RESULTS Overall, 349 cases of NWRT were identified. The major histologic groups included renal cell carcinoma (RCC) (44%), clear cell sarcoma of the kidney (CCSK) (17%), and malignant rhabdoid tumor (MRT) (12%). A bimodal age distribution was observed, with tumors commonly presenting in patients ≤4 y of age and ≥15 y of age. More than 50% of RCC presented at ≥15 y of age, whereas ≥80% of CCSK or MRT patients were ≤4 y of age. Most RCC (57%) and CCSK (53%) were locally staged while most MRT presented with distant disease (51%, P < 0.001). Overall 10-y survival was 63% with improved survival observed in patients with CCSK (79%) and RCC (70%) versus MRT (29%, P < 0.001). By univariate analysis, surgical resection was associated with improved overall 10-y survival (68% versus 30%, P < 0.001), while no benefit was observed for radiotherapy (60% versus 63%, P = 0.8). By multivariate analysis, worse overall survival was observed for patients ≥ 10 y old (HR 4.01, P = 0.013) and those with advanced disease (HR = 12.78, P < 0.001). Patients with MRT (HR = 11.61, P < 0.001) and CCSK (HR = 3.68, P = 0.038) had significantly worse prognosis compared with those with RCC. Surgical resection improved overall survival (HR = 0.36, P = 0.001). CONCLUSION For pediatric NWRT, younger patients and those with RCC have improved survival, while a diagnosis of MRT portends a worse prognosis. Surgical extirpation significantly improves survival for all patients.
Collapse
|
34
|
Koniaris LG, Cheung MC, Garrison G, Awad WM, Zimmers TA. Perspective: PhD scientists completing medical school in two years: looking at the Miami PhD-to-MD program alumni twenty years later. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2010; 85:687-691. [PMID: 20354390 DOI: 10.1097/acm.0b013e3181d296da] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Producing and retaining physician-scientists remains a major challenge in advancing innovation, knowledge, and patient care across all medical disciplines. Various programs during medical school, including MD-PhD programs, have been instituted to address the need for continued production of physician-scientists. From 1971 through 1989, 508 students with a prior PhD in the sciences, mathematics, or engineering graduated in two years from an accelerated MD program at the University of Miami School of Medicine. The program, designed to address potential clinical physician shortages rather than physician-scientist shortages, quickly attracted many top-notch scientists to medicine. Many program graduates went to top-tier residencies, pursued research careers in academic medicine, and became academic leaders in their respective fields. A retrospective examination of graduates conducted in 2008-2009 demonstrated that approximately 59% took positions in academic university medical departments, 3% worked for governmental agencies, 5% entered industry as researchers or executives, and 33% opted for private practice. Graduates' positions included 85 full professors, 11 university directors or division heads, 14 academic chairs, 2 medical school deans, and 1 astronaut. Overall, 30% of graduates had obtained National Institutes of Health funding after completing the program. These results suggest that accelerated medical training for accomplished scientists can produce a large number of successful physician-scientists and other leaders in medicine. Furthermore, these results suggest that shortening the medical portion of combined MD-PhD programs might also be considered.
Collapse
|
35
|
Cheung MC, Yang R, Byrne MM, Solorzano CC, Nakeeb A, Koniaris LG. Are patients of low socioeconomic status receiving suboptimal management for pancreatic adenocarcinoma? Cancer 2010; 116:723-33. [PMID: 19998350 DOI: 10.1002/cncr.24758] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The objective of this study was to define the effects of socioeconomic status (SES) and other demographic variables on outcomes for patients with pancreatic adenocarcinoma. METHODS Florida cancer registry and inpatient hospital data were queried for pancreatic adenocarcinoma diagnosed from 1998 to 2002. RESULTS In total, 16,104 patients were identified. Low SES (LSES) patients were younger at diagnosis (P < .001) but presented with similar disease stage and tumor grade. LSES patients were less likely to receive surgical extirpation (16.5% vs 19.8%; P < .001), chemotherapy (30.7% vs 36.4%; P < .001), or radiotherapy (14.3% vs 16.9%; P = .003). Among surgical patients, 30-day mortality was significantly higher (5.1% vs 3.7%; P < .001) and overall median survival was significantly worse (5.0 months vs 6.2 months; P < .001) in the LSES cohorts. Although surgical patients who were treated at teaching facilities (TF) did significantly better; an increased 30-day surgical mortality (2.2% vs 1.3%; P < .001) and decreased median survival (5 months for poverty level >15% vs 6.2 months for poverty level <5%; P < .001) also were observed for patients of LSES. In a multivariate analysis that corrected for patient comorbidities, significant independent predictors of a poorer prognosis included LSES (hazard ratio [HR], 1.09); treatment at a non-TF (HR, 1.09); and failure to receive surgical extirpation (HR, 1.92), chemotherapy (HR 1.41), or radiation (HR 1.25). CONCLUSIONS Patients of LSES were less likely to receive surgical extirpation, chemotherapy, or radiation and had significantly higher perioperative and long-term mortality rates. A greater understanding of the barriers to providing optimal care and identifying means for improving successful delivery of therapies to the poor with pancreatic cancer are needed.
Collapse
|
36
|
Jawad MU, Schneiderbauer MM, Min ES, Cheung MC, Koniaris LG, Scully SP. Primary lymphoma of bone in adult patients. Cancer 2010; 116:871-9. [PMID: 20043324 DOI: 10.1002/cncr.24828] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
37
|
Cheung MC, Franzmann E, Sola JE, Pincus DJ, Koniaris LG. A comprehensive analysis of parotid and salivary gland cancer: worse outcomes for male gender. J Surg Res 2010; 171:151-8. [PMID: 20189602 DOI: 10.1016/j.jss.2009.11.721] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2009] [Revised: 11/05/2009] [Accepted: 11/19/2009] [Indexed: 12/20/2022]
Abstract
BACKGROUND To determine the effects of patient demographics, socioeconomic status (SES) and clinical variables on outcomes for patients with salivary and parotid gland tumors. METHODS Florida cancer registry and inpatient hospital data were queried for cancer of the salivary glands diagnosed between 1998-2002. RESULTS A total of 1573 patients were identified. Women were diagnosed at a younger age (median age (years): women 60.8 versus men 64.3, P=0.003). Men were more often diagnosed with high grade tumors (65.1% versus 41.9% for women, P<0.001) and advanced disease stage (>stage III: 60.2 versus 49.4%, P<0.001), but underwent surgical extirpation and received radiation at equal rates compared with women. Overall 5-year survival rates was superior in women (67.4% versus 55.6%, P=0.001). By multivariate analysis, adjusted for patient comorbidities, age over 65 (HR 3.43 P=0.008), advanced disease stage (HR 8.05 P<0.001), and high tumor grade (HR 2.33, P<0.001) were independent predictors of worse prognosis. Improved outcomes were observed for female gender (HR 0.68, P=0.011). Tumors located in the parotid gland (HR 0.631 P=0.003) and receiving both surgical extirpation and radiation were predictors of improved survival. CONCLUSION Salivary gland tumors carry a worse prognosis than tumors of the parotid. Male patients have worse outcomes.
Collapse
|
38
|
Yang R, Cheung MC, Byrne MM, Jin X, Montero AJ, Jones C, Koniaris LG. Survival Effects of Adjuvant Chemoradiotherapy After Resection for Pancreatic Carcinoma. ACTA ACUST UNITED AC 2010; 145:49-56. [DOI: 10.1001/archsurg.2009.244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
39
|
Ting W, Cheung MC, Ng SP, Wan SY, Chan WM. Phy03 Effects of an Integrated Activity Programme for Demented Elders Living in Private Residential Care Homes. Hong Kong J Occup Ther 2009. [DOI: 10.1016/s1569-1861(10)70015-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
40
|
Neville HL, Hogan AR, Zhuge Y, Perez EA, Cheung MC, Koniaris LG, Thompson WR, Sola JE. Incidence and Outcomes of Malignant Pediatric Lung Neoplasms. J Surg Res 2009; 156:224-30. [DOI: 10.1016/j.jss.2009.03.100] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 02/24/2009] [Accepted: 03/26/2009] [Indexed: 11/28/2022]
|
41
|
Solomon NL, Cheung MC, Byrne MM, Zhuge Y, Franceschi D, Livingstone AS, Koniaris LG. Does chemoradiotherapy improve outcomes for surgically resected adenocarcinoma of the stomach or esophagus? Ann Surg Oncol 2009; 17:98-108. [PMID: 19777191 DOI: 10.1245/s10434-009-0679-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Accepted: 08/04/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND To use a population-based registry to evaluate the effect of chemotherapy or radiation on survival for patients undergoing curative-intent surgery for adenocarcinoma of the esophagus or stomach. METHODS A linked data set between the Florida Cancer Data System and the Florida Agency for Health Care Administration from 1998 to 2003 was queried. RESULTS Overall, 3,378 patients underwent surgical extirpation with curative intent, 636 patients had esophageal adenocarcinoma (EAC), and 2,742 patients had gastric adenocarcinoma (GAC). Outcomes were adjusted for patient comorbidities and hospital teaching status. Overall, no benefit was observed for adjuvant therapies for EAC patients. A small improvement in survival was observed with adjuvant therapies for GAC. For localized EAC or GAC there was no additional survival benefit associated with adjuvant therapies. For patients with regional EAC, chemotherapy (20.0 vs. 13.0 months, P < .001) and radiation (18.6 vs. 13.5 months, P = .007) were associated with a statistically significant survival benefit. In multivariate analysis, independent predictors of improved survival for regional EAC include chemotherapy (hazard ratio [HR] .535, P < .001) and radiotherapy (HR .656, P = .01). For GAC, patients with regional disease showed an improved median survival with chemotherapy (21.1 vs. 11.2 months, P < .001) and radiotherapy (22.6 vs. 12.3 months, P < .001). In multivariate analysis, independent predictors of improved survival for regional GAC include chemotherapy (HR .629, P < .001) and radiation (HR .603, P < .001). CONCLUSIONS Patients with regional adenocarcinoma of the esophagus or stomach, but not those with localized disease, derive a statistically significant survival benefit from the addition of chemotherapy and radiation to surgical resection.
Collapse
|
42
|
Brookfield KF, Cheung MC, Gomez C, Yang R, Nieder AM, Lee DJ, Koniaris LG. Survival disparities among African American women with invasive bladder cancer in Florida. Cancer 2009; 115:4196-209. [DOI: 10.1002/cncr.24497] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
43
|
Jawad MU, Cheung MC, Min ES, Schneiderbauer MM, Koniaris LG, Scully SP. Ewing sarcoma demonstrates racial disparities in incidence-related and sex-related differences in outcome: an analysis of 1631 cases from the SEER database, 1973-2005. Cancer 2009; 115:3526-36. [PMID: 19548262 DOI: 10.1002/cncr.24388] [Citation(s) in RCA: 187] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Previous reports of Ewing sarcoma cohorts suggested that there is a difference in incidence according to racial origin. However, to the authors' knowledge, this finding has never been tested in a population-based database, and the impact of race on clinical outcome and the significance of known risk factors stratified to racial groups have not been reported. METHODS Patients who had Ewing sarcoma diagnosed between 1973 and 2005 were identified in the Surveillance, Epidemiology, and End Results database. Patient demographic and clinical characteristics; incidence; year of diagnosis; tumor location, tumor size, and disease stage at diagnosis; treatment(s); cause of death; and survival were extracted. Kaplan-Meier, log-rank, and Cox regressions were used to analyze the significance of prognostic factors. RESULTS Race-specific incidence indicated that Caucasians have the highest incidence (0.155), followed by Asians/Pacific Islanders (0.082), and African Americans (0.017). The difference in incidence between Caucasians and African Americans was 9-fold and significant (P<.001). The incidence of Ewing sarcoma increased over the past 3 decades among Caucasians (P<.05). Survival was not impacted by race. Local disease stage, primary tumor location in the appendicular skeleton, and tumor size<or=8 cm conferred a significant survival benefit. Women demonstrated improved survival among the Caucasian patients (P<.03). CONCLUSIONS To the authors' knowledge, this is the first report focusing on racial disparity in incidence of Ewing sarcoma. Caucasians were affected more frequently, although outcomes were similar between races. It is noteworthy that being a woman constituted a survival benefit only among the Caucasian patients. Further studies will need to clarify the reasons for racial disparities in incidence and for sex differences in survival.
Collapse
|
44
|
Cheung MC, Zhuge Y, Yang R, Koniaris LG. Disappearance of Racial Disparities in Gastrointestinal Stromal Tumor Outcomes. J Am Coll Surg 2009; 209:7-16. [DOI: 10.1016/j.jamcollsurg.2009.03.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 03/13/2009] [Accepted: 03/18/2009] [Indexed: 10/20/2022]
|
45
|
Cheung MC, Housri N, Ogilvie MP, Sola JE, Koniaris LG. Surgery does not adversely affect survival in primary gastrointestinal lymphoma. J Surg Oncol 2009; 100:59-64. [PMID: 19399785 DOI: 10.1002/jso.21298] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the impact of surgery on gastrointestinal lymphoma. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was queried from 1973 to 2005. RESULTS A total of 17,222 cases of PGIL were identified. The overall incidence of PGIL was approximately 1.505 cases per 100,000. A significantly increasing incidence for PGIL was observed (APC = +4.67, P < 0.05). In the cases for which treatment data was available, resection occurred in roughly half of the patients. In univariate analysis, surgical extirpation did not improve survival (47 months vs. 76 months, P < 0.001), while radiation treatment improved median survival (77 months vs. 59 months, P < 0.001). Multivariate analysis revealed increasing age and male gender as independent predictors of decreased overall survival. Tumor location also was a significant predictor of outcome. Large B-cell lymphoma type PGIL had a poorer prognosis than marginal zone B-cell lymphoma. By multivariate analysis, surgery was not found to increase the risk of death (HR = 0.99). CONCLUSIONS No associated survival benefit for surgery in the treatment in gastrointestinal lymphoma was observed. Determination of lymphoma should preclude surgical resection. Nonetheless, inadvertent extirpative surgery or in association with perforation does not appear to increase mortality.
Collapse
|
46
|
Rodríguez D, Cheung MC, Housri N, Quinones-Hinojosa A, Camphausen K, Koniaris LG. Outcomes of malignant CNS ependymomas: an examination of 2408 cases through the Surveillance, Epidemiology, and End Results (SEER) database (1973-2005). J Surg Res 2009; 156:340-51. [PMID: 19577759 DOI: 10.1016/j.jss.2009.04.024] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 02/02/2009] [Accepted: 04/09/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Determine the role of surgery and radiation therapy for patients with malignant CNS ependymomas. METHODS The Surveillance, Epidemiology, and End Results (SEER) database (1973-2005) was queried. RESULTS Overall, a total of 2408 cases of malignant ependymomas were identified. Of these, 2132 cases (88.5%) were identified as WHO grade II ependymomas and 276 cases (11.5%) as WHO grade III (anaplastic) ependymomas. The annual incidence of ependymomas was approximately 1.97 cases per million in 2005. Overall median survival for all patients was 230 mo, with a significant difference between women and men (262 mo versus196 mo, respectively) (P=0.004). Median age at diagnosis was 37 y among females and 34 y in males. Patients who successfully underwent surgical resection had a considerably longer median survival (237 mo versus 215 mo, P<0.001) as well as a significantly improved five-year survival (72.4% versus 52.6%, P<0.001). Univariate analysis demonstrated that age, gender, ethnicity, primary tumor site, WHO grade and surgical resection were significant predictors of improved survival for ependymoma patients. Multivariate analysis identified that a WHO grade III tumor, male gender, patient age, intracranial tumor locations and failure to undergo surgical resection were independent predictors of poorer outcomes. Multivariate analysis of partially resection cases revealed that lack of radiation was a sign of poor prognosis (HR 1.748, P=0.024). CONCLUSION Surgical extirpation of ependymomas is associated with significantly improved patient survival. For partially resected tumors, radiation therapy provides significant survival benefit.
Collapse
|
47
|
Sola JE, Cheung MC, Yang R, Koslow S, Lanuti E, Seaver C, Neville HL, Schulman CI. Pediatric FAST and elevated liver transaminases: An effective screening tool in blunt abdominal trauma. J Surg Res 2009; 157:103-7. [PMID: 19592033 DOI: 10.1016/j.jss.2009.03.058] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 02/17/2009] [Accepted: 03/22/2009] [Indexed: 12/26/2022]
Abstract
BACKGROUND The current standard for the evaluation of children with blunt abdominal trauma (BAT) consists of physical examination, screening lab values, and computed tomography (CT) scan. We sought to determine if the focused assessment with sonography for trauma (FAST) combined with elevated liver transaminases (AST/ALT) could be used as a screening tool for intra-abdominal injury (IAI) in pediatric patients with BAT. METHODS Registry data at a level 1 trauma center was retrospectively reviewed from 1991-2007. Data collected on BAT patients under the age of 16 y included demographics, injury mechanism, ISS, GCS, imaging studies, serum ALT and AST levels, and disposition. AST and ALT were considered positive if either one was >100 IU/L. RESULTS Overall, 3171 cases were identified. A total of 1008 (31.8%) patients received CT scan, 1148 (36.2%) had FAST, and 497 (15.7%) patients received both. Of the 497 patients, 400 (87.1%) also had AST and ALT measured. FAST was 50% sensitive, 91% specific, with a positive predictive value (PPV) of 68%, negative predictive value (NPV) of 83%, and accuracy of 80%. Combining FAST with elevated AST or ALT resulted in a statistically significant increase in all measures (sensitivity 88%, specificity 98%, PPV 94%, NPV 96%, accuracy 96%). CONCLUSIONS FAST combined with AST or ALT > 100 IU/L is an effective screening tool for IAI in children following BAT. Pediatric patients with a negative FAST and liver transaminases < 100 IU/L should be observed rather than subjected to the radiation risk of CT.
Collapse
|
48
|
Zhuge Y, Hogan AR, Cheung MC, Neville HL, Thompson WR, Birusingh R, Sola JE. Thrombotic cutaneous gangrene with autoamputation of the penis: a rare extracolonic manifestation of ulcerative colitis in a child. J Pediatr Surg 2009; 44:e1-4. [PMID: 19302836 DOI: 10.1016/j.jpedsurg.2008.11.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Accepted: 11/25/2008] [Indexed: 01/15/2023]
Abstract
We present a pediatric patient with ulcerative colitis who developed thrombotic cutaneous gangrene involving skin of the lower chest, abdomen, back, bilateral buttocks, bilateral thighs, perineum, and genitalia, ultimately resulting in autoamputation of the glans penis. After an extensive review of the literature, we describe the diagnosis and management of this devastating condition.
Collapse
|
49
|
Cheung MC, Bailey D, Pennell N, Imrie KR, Berinstein NL, Amato D, Ghorab Z. In situ localization of follicular lymphoma: evidence for subclinical systemic disease with detection of an identical BCL-2/IGH fusion gene in blood and lymph node. Leukemia 2009; 23:1176-9. [DOI: 10.1038/leu.2009.9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
50
|
Yang R, Cheung MC, Franceschi D, Hurley J, Huang Y, Livingstone AS, Koniaris LG. African-American and low-socioeconomic status patients have a worse prognosis for invasive ductal and lobular breast carcinoma: do screening criteria need to change? J Am Coll Surg 2009; 208:853-68; discussion 869-70. [PMID: 19476849 DOI: 10.1016/j.jamcollsurg.2008.10.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2008] [Accepted: 10/07/2008] [Indexed: 12/15/2022]
Abstract
BACKGROUND Determine the effect of race, socioeconomic status (SES) and other demographic variables on outcomes of patients with invasive ductal and lobular breast cancer. STUDY DESIGN Florida cancer registry and inpatient hospital data were queried for patients diagnosed with invasive breast cancer from 1998 to 2002. RESULTS A total of 63,472 patients with breast cancer were identified. Overall, 90.5% of patients were Caucasian, 7.6% African American, and 8.7% Hispanic. African-American patients presented at a younger age and with more-advanced disease, 10.5% presented with breast cancer before the age of 40 years, and 22.4% before 45 years of age. African-American patients were less likely to undergo operations. Similarly, low-SES patients were less likely to have operations and presented more often with larger tumors. Stepwise multivariate analysis revealed a substantial drop in the hazard ratio for African-American patients once correction for stage of presentation was made, suggesting that disparities in breast cancer outcomes are, in part, a result of advanced stage at presentation. Race and low SES were independent predictors of worse prognosis when controlling for patient comorbidities and treatment. CONCLUSIONS Dramatic disparities by patient race and SES exist in breast cancer. Our study integrates previous smaller studies, providing comprehensive insight into African-American patients and their outcomes for breast cancer. Earlier screening programs and greater access to cancer care for the poor and African Americans are needed. Successful institution of such programs will not completely erase disparities in outcomes for breast cancer in African-American patients.
Collapse
MESH Headings
- Adult
- Black or African American/statistics & numerical data
- Aged
- Aged, 80 and over
- Breast Neoplasms/epidemiology
- Breast Neoplasms/ethnology
- Breast Neoplasms/mortality
- Breast Neoplasms/prevention & control
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/ethnology
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/prevention & control
- Carcinoma, Lobular/epidemiology
- Carcinoma, Lobular/ethnology
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/prevention & control
- Female
- Hispanic or Latino/statistics & numerical data
- Humans
- Male
- Mass Screening
- Middle Aged
- Multivariate Analysis
- Prognosis
- Social Class
- Survival Analysis
- White People/statistics & numerical data
- Young Adult
Collapse
|