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Schab M, Skoczen S. Nutritional status, body composition and diet quality in children with cancer. Front Oncol 2024; 14:1389657. [PMID: 38706604 PMCID: PMC11066172 DOI: 10.3389/fonc.2024.1389657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
During cancer treatment, nutritional status disorders such as malnutrition or obesity affect the tolerance of cancer treatment, quality of life, but also the pharmacokinetics of drugs. It is hypothesized that changes in fat and lean body mass can modify chemotherapy volume distribution, metabolism and clearance. In children with cancer, lean body mass decreases or remains low during treatment and fat mass increases. Body composition is influenced by the cancer itself, aggressive multimodal-therapies, changes in metabolism, unbalanced diet and reduced physical activity. Due to the side effects of treatment, including changes in the sense of taste and smell, nausea, vomiting, diarrhea, and stress, eating according to recommendation for macronutrients and micronutrients is difficult. Research indicates that throughout cancer treatment, the consumption of fruits, vegetables, and dairy products tends to be insufficient, whereas there is an elevated intake of sugar and unhealthy snacks. Children exhibit a preference for high-carbohydrate, salty, and strongly flavored products. This review revealed the importance of body composition and its changes during cancer treatment in children, as well as eating habits and diet quality.
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Affiliation(s)
- Magdalena Schab
- Doctoral School of Medical and Health Science, Jagiellonian University Medical College, Krakow, Poland
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Szymon Skoczen
- Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
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Li Y, Lu Z, Ma A, Yao W, Dong R, Li K, Wu M, Dong K, Qian T. Nutritional status associated with clinical outcomes in children with solid tumors: A retrospective cohort study from China. Cancer Med 2024; 13:e6798. [PMID: 38111308 PMCID: PMC10807599 DOI: 10.1002/cam4.6798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/12/2023] [Accepted: 11/27/2023] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE To investigate the long-term changes in nutritional status in children with solid tumors during treatment and the relationship between nutritional status and clinical outcomes. METHODS This study was a retrospective medical records review of data from children who were diagnosed with solid tumors and followed up for more than 3 months from January 2016 to December 2021 in China. Patient demographics and clinical information, including nutritional status, parenteral nutrition use, intensive care unit (ICU) transfers, infection during hospitalization, hospitalization frequency, length of stay, hospitalization costs and antibiotic costs, were collected to analyze the nutritional status of children with different types of solid tumors, the dynamic changes in nutritional status during treatment, and the relationship between nutritional status and clinical outcomes. RESULTS Among the 764 patients (383 males (50.1%); 381 females (49.9%); mean age: 2.58 years), 41.6% of the solid tumors were neuroblastomas, 17.1% were hepatoblastomas, and Wilms tumors as the third most common solid tumors (8.9%). The median follow-up duration was 6 months (range: 3-40 months). At diagnosis, the proportion of children who were undernourished (underweight and wasting) versus overweight or obese were 26.71% versus 5.21% (25.86% vs. 2.89% in the third month; 29.77% vs. 2.28% in the sixth month; 24.77% vs. 3.27% in the 12th month). The body mass index Z scores decreased from the initial values after the first month (-0.56 (-1.47, 0.23) vs. -0.44 (-1.29, 0.41)) but improved later and decreased again at 6 months. The children in the undernutrition group had longer hospital stays (p < 0.001), higher hospitalization costs (p < 0.001), higher antibiotic costs (p < 0.001), a higher risk of neutropenia (OR = 4.781 (95% CI: 1.571-14.553), p = 0.006), and a higher risk of ICU transfers (OR = 1.498 (95% CI: 1.010-2.224), p = 0.044). No significant differences in those associations by malnutrition and infection, ICU duration, or length of parenteral nutrition were observed. CONCLUSION There is a considerable prevalence of malnutrition in children with solid tumors. Malnutrition is related to adverse clinical outcomes and increases in total hospital expenses and antibiotic costs.
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Affiliation(s)
- Yongzhen Li
- Clinical nutrition DepartmentChildren's Hospital of Fudan UniversityShanghaiChina
- Child Health Management CentreStarkids Children's HospitalShanghaiChina
| | - Zhongying Lu
- Clinical nutrition DepartmentChildren's Hospital of Fudan UniversityShanghaiChina
| | - Ao Ma
- Pediatric Clinical Research Unit, Department of Research ManagementChildren's Hospital of Fudan UniversityShanghaiChina
| | - Wei Yao
- Department of OncologyChildren's Hospital of Fudan UniversityShanghaiChina
| | - Rui Dong
- Department of OncologyChildren's Hospital of Fudan UniversityShanghaiChina
| | - Kai Li
- Department of OncologyChildren's Hospital of Fudan UniversityShanghaiChina
| | - Min Wu
- Department of OncologyChildren's Hospital of Fudan UniversityShanghaiChina
| | - Kuiran Dong
- Department of OncologyChildren's Hospital of Fudan UniversityShanghaiChina
| | - Tian Qian
- Clinical nutrition DepartmentChildren's Hospital of Fudan UniversityShanghaiChina
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Dos Santos ICL, da Silva Vargas Silva G, Murad LB, Murad LD. Nutritional status and inflammatory markers as survival predictors in pediatric central nervous system tumors. Clin Nutr ESPEN 2023; 57:89-95. [PMID: 37739738 DOI: 10.1016/j.clnesp.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 05/22/2023] [Accepted: 06/22/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND & AIMS Central nervous system tumors (CNS) are the second most common malignancies in childhood. Inflammation and changes in nutritional status play an important role and can be used as prognostic markers. Thus, this study aimed to evaluate the predictive ability of nutritional status and inflammatory markers on overall survival (OS) of pediatric patients with CNS. METHODS In this retrospective cohort study, 103 patients were followed for 5 years. Clinical, anthropometric, and hematological data were collected. Body mass index for age (BMI/A), neutrophil-to-lymphocyte ratio (NLR) and systemic inflammation response index (SIRI) were calculated. OS curves were calculated using the Kaplan Meier method and evaluated using the Log-Rank test. The Cox proportional hazards model was performed to identify independent variables associated with prognostic factors, generating hazard ratios (HR) and 95% confidence intervals (CI). RESULTS Nutritional status did not significantly affect OS. However, patients with NLR ≥2.18 and SIRI ≥1249.18 had significantly lower OS in 5 years. Only treatment and high NLR were identified as independent prognostic factors for worse OS. Treatment with exclusive radiotherapy or chemotherapy (HR: 16.22, 95% CI: 2.19-120.07) and NLR (HR: 1.94, 95% CI: 1.02-3.69) were identified as independent prognostic factors for worse OS at 5 years. CONCLUSION High pretreatment NLR was shown to be an independent prognostic factor for OS in pediatric patients with CNS.
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Affiliation(s)
- Isabelle Cristine Lôpo Dos Santos
- Nutrition and Dietetics Section, Brazilian National Cancer Institute Jose Alencar Gomes da Silva (INCA), Rio de Janeiro, RJ, Brazil.
| | - Gabrielle da Silva Vargas Silva
- Nutrition and Dietetics Section, Brazilian National Cancer Institute Jose Alencar Gomes da Silva (INCA), Rio de Janeiro, RJ, Brazil.
| | - Leonardo Borges Murad
- Nutrition and Dietetics Section, Brazilian National Cancer Institute Jose Alencar Gomes da Silva (INCA), Rio de Janeiro, RJ, Brazil.
| | - Luana Dalbem Murad
- Nutrition and Dietetics Section, Brazilian National Cancer Institute Jose Alencar Gomes da Silva (INCA), Rio de Janeiro, RJ, Brazil.
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Yu L, Zhou Y, Zhang W, Wu Q, Chu X, Zhang Y, Lv D, Shen Z. Body Mass Index Affects Delayed Chemotherapy-induced Vomiting in Pediatric Malignancy Patients. J Pediatr Hematol Oncol 2023; 45:398-403. [PMID: 37677942 DOI: 10.1097/mph.0000000000002736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 06/09/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Delayed chemotherapy-induced vomiting (DCIV) is a problem for children undergoing chemotherapy for malignant tumors. The aim of this study was to investigate the association between body mass index (BMI) and DCIV in children. PATIENTS AND METHODS Clinical data were collected from patients with malignancies who underwent chemotherapy at our center. Independent risk factors for DCIV derived by logistic regression. The Youden Index, which calculates BMI, divides patients into a high-risk group and a low-risk group, and the difference in DCIV between the two groups was analyzed. The relationship between BMI and DCIV was assessed by calculating the frequency of vomiting episodes and the severity of vomiting. RESULTS A total of 283 patients were included in this cohort study. BMI (odds ratio [OR]: 0.811; 95% CI: 0.699-0.941), age (OR: 1.014; 95% CI: 1.006-1.021), and emetogenic grade (OR: 2.858, 95% CI: 1.749-4.671) were independent risk factors for the development of DCIV in children. Patients in the high-risk group experienced vomiting more frequently and with greater severity than those in the low-risk group ( P < 0.05). CONCLUSIONS BMI in children with malignancy is associated with DCIV, and the incidence of DCIV decreases as BMI increases. Physicians may be able to arrange a more elaborate antiemetic prevention regimen based on the patient's BMI.
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Affiliation(s)
| | | | - Wenbo Zhang
- Department of Neurosurgery, The Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | | | | | | | | | - Zhipeng Shen
- Department of Neurosurgery, The Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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Karalexi MA, Markozannes G, Tagkas CF, Katsimpris A, Tseretopoulou X, Tsilidis KK, Spector LG, Schüz J, Siahanidou T, Petridou ET, Ntzani EE. Nutritional Status at Diagnosis as Predictor of Survival from Childhood Cancer: A Review of the Literature. Diagnostics (Basel) 2022; 12:2357. [PMID: 36292046 PMCID: PMC9600212 DOI: 10.3390/diagnostics12102357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/22/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
Few studies so far have examined the impact of nutritional status on the survival of children with cancer, with the majority of them focusing on hematological malignancies. We summarized published evidence reporting the association of nutritional status at diagnosis with overall survival (OS), event-free survival (EFS), relapse, and treatment-related toxicity (TRT) in children with cancer. Published studies on children with leukemia, lymphoma, and other solid tumors have shown that both under-nourished and over-nourished children at cancer diagnosis had worse OS and EFS. Particularly, the risk of death and relapse increased by 30-50% among children with leukemia with increased body mass index at diagnosis. Likewise, the risk of TRT was higher among malnourished children with osteosarcoma and Ewing sarcoma. Nutritional status seems to play a crucial role in clinical outcomes of children with cancer, thus providing a significant modifiable prognostic tool in childhood cancer management. Future studies with adequate power and longitudinal design are needed to further evaluate the association of nutritional status with childhood cancer outcomes using a more standardized definition to measure nutritional status in this population. The use of new technologies is expected to shed further light on this understudied area and give room to person-targeted intervention strategies.
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Affiliation(s)
- Maria A. Karalexi
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, 45110 Ioannina, Greece
- Hellenic Society for Social Pediatrics and Health Promotion, 11527 Athens, Greece
| | - Georgios Markozannes
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, 45110 Ioannina, Greece
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London SW7 2BX, UK
| | - Christos F. Tagkas
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, 45110 Ioannina, Greece
| | - Andreas Katsimpris
- Hellenic Society for Social Pediatrics and Health Promotion, 11527 Athens, Greece
| | - Xanthippi Tseretopoulou
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, 45110 Ioannina, Greece
- Department of Pediatric Endocrinology, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
| | - Konstantinos K. Tsilidis
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, 45110 Ioannina, Greece
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London SW7 2BX, UK
| | - Logan G. Spector
- Department of Pediatrics, Division of Epidemiology & Clinical Research, University of Minnesota, Minneapolis, MN 55455, USA
| | - Joachim Schüz
- Section of Environment and Radiation, International Agency for Research on Cancer (IARC), 69372 Lyon, France
| | - Tania Siahanidou
- First Department of Pediatrics, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Eleni Th. Petridou
- Hellenic Society for Social Pediatrics and Health Promotion, 11527 Athens, Greece
- Department of Hygiene, Epidemiology, and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Evangelia E. Ntzani
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, 45110 Ioannina, Greece
- Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI 02903, USA
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Lazow MA, Salloum R, Pressey JG. Comorbidity Burden in a Cohort of Adolescent and Young Adult Patients Diagnosed with Central Nervous System Tumors and Sarcomas. J Adolesc Young Adult Oncol 2022; 12:215-223. [PMID: 35675692 DOI: 10.1089/jayao.2022.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Adolescent and young adult (AYA) oncology patients experience unique biological, behavioral, and socioeconomic challenges, for which provision of care must be tailored. AYAs with central nervous system (CNS) tumors and sarcomas represent a vulnerable population with worse outcomes and potential for serious sequelae from intense multimodal therapy. Comorbidity burden impacts treatment tolerance, adherence, and efficacy, yet has been understudied among these high-risk AYA patients. Methods: Utilizing a validated AYA oncology comorbidity index, we (1) measured comorbid conditions present at diagnosis in AYA-aged patients with CNS tumors and sarcomas and (2) compared baseline comorbidity burden across ascending AYA age groups (15-19, 20-29, and 30-39 years) and with pediatric patients (10-14 years). Results: The cohort included 131 AYAs and 50 pediatric patients. Mean comorbidity score significantly differed between pediatric (0.8) and AYA (1.7) patients, and across ascending age subgroups (0.8 [10-14] < 1.2 [15-19] < 1.7 [20-29] < 2.5 [30-39]). AYAs were significantly more likely than pediatric patients to have ≥2 or ≥3 comorbidities (47% vs. 18%, 24% vs. 6%), with increasing prevalence across ascending age subgroups. Frequency of overweight/obese status, smoking/substance use, obstetric/gynecologic conditions, and cardiovascular comorbidities increased with age. In multivariate analyses adjusting for sex, tumor type, and race, age remained a significant predictor of comorbidity score. Conclusions: AYAs with CNS tumors or sarcomas have a high burden of baseline comorbidities, which increase with age at diagnosis, conferring susceptibility to treatment-related toxicity and mortality. Improving the prognosis for AYAs requires appropriate identification of pre-existing comorbidities and tailoring therapeutic and supportive care accordingly.
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Affiliation(s)
- Margot A Lazow
- Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Pediatric Neuro-Oncology Program, Division of Hematology, Oncology, and BMT, Nationwide Children's Hospital, Columbus, Ohio, USA.,The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Ralph Salloum
- Pediatric Neuro-Oncology Program, Division of Hematology, Oncology, and BMT, Nationwide Children's Hospital, Columbus, Ohio, USA.,The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Joseph G Pressey
- Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Schab M, Skoczen S. The Role of Nutritional Status, Gastrointestinal Peptides, and Endocannabinoids in the Prognosis and Treatment of Children with Cancer. Int J Mol Sci 2022; 23:5159. [PMID: 35563548 PMCID: PMC9106013 DOI: 10.3390/ijms23095159] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/29/2022] [Accepted: 04/29/2022] [Indexed: 12/26/2022] Open
Abstract
Neoplastic diseases in children are the second most frequent cause of death among the young. It is estimated that 400,000 children worldwide will be diagnosed with cancer each year. The nutritional status at diagnosis is a prognostic indicator and influences the treatment tolerance. Both malnutrition and obesity increase the risk of mortality and complications during treatment. It is necessary to constantly search for new factors that impair the nutritional status. The endocannabinoid system (ECS) is a signaling system whose best-known function is regulating energy balance and food intake, but it also plays a role in pain control, embryogenesis, neurogenesis, learning, and the regulation of lipid and glucose metabolism. Its action is multidirectional, and its role is being discovered in an increasing number of diseases. In adults, cannabinoids have been shown to have anti-cancer properties against breast and pancreatic cancer, melanoma, lymphoma, and brain tumors. Data on the importance of both the endocannabinoid system and synthetic cannabinoids are lacking in children with cancer. This review highlights the role of nutritional status in the oncological treatment process, and describes the role of ECS and gastrointestinal peptides in regulating appetite. We also point to the need for research to evaluate the role of the endocannabinoid system in children with cancer, together with a prospective assessment of nutritional status during oncological treatment.
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Affiliation(s)
- Magdalena Schab
- Department of Pediatric Oncology and Hematology, University Children’s Hospital of Krakow, 30-663 Krakow, Poland;
| | - Szymon Skoczen
- Department of Pediatric Oncology and Hematology, University Children’s Hospital of Krakow, 30-663 Krakow, Poland;
- Department of Pediatric Oncology and Hematology, Faculty of Medicine, Jagiellonian University Medical College, 30-663 Krakow, Poland
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Rhaponticin suppresses osteosarcoma through the inhibition of PI3K-Akt-mTOR pathway. Saudi J Biol Sci 2021; 28:3641-3649. [PMID: 34220214 PMCID: PMC8241634 DOI: 10.1016/j.sjbs.2021.05.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/01/2021] [Accepted: 05/02/2021] [Indexed: 02/04/2023] Open
Abstract
Osteosarcoma is the frequent pediatric bone cancer where pediatric osteosarcoma incidences are more than 10% within the population. Most of the patients with osteosarcoma fall within the age of 15-30 years. Therefore, in this research, we examined the anticancer effect of Rhaponticin against the human osteosarcoma (MG-63) cells. The cytotoxicity of Rhaponticin on the MC3T3-E1 and MG-63 cells was examined through the MTT assay. The intracellular ROS accumulation, cell nuclear morphological alterations, apoptotic cell death and nuclear damages, and MMP status of Rhaponticin administered MG-63 cells were inspected by fluorescent staining techniques. The cell migration was assessed through scratch assay. The mRNA expressions of PI3K-Akt-mTOR signaling proteins were studied by RT-PCR analysis. Rhaponticin showed potent cytotoxicity, substantially inhibited the MG-63 cell growth, and displayed morphological alterations. However, rhaponticin did not affect the MC3T3-E1 cell viability. Rhaponticin administered MG-63 cells demonstrated augmented intracellular ROS accretion, weakened MMP, increased nuclear damages, and increased apoptosis. Rhaponticin effectively down-regulated the PI3K-Akt-mTOR signaling cascade in the MG-63 cells. These outcomes proved that the Rhaponticin can be a hopeful chemotherapeutic agent in the future to treat human osteosarcoma.
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Bhandari R, Scott E, Yeh MY, Wong K, Rushing T, Huh W, Orgel E. Association of body mass index with toxicity and survival in pediatric patients treated with cisplatin-containing regimens. Pediatr Hematol Oncol 2021; 38:239-250. [PMID: 33170064 PMCID: PMC8439118 DOI: 10.1080/08880018.2020.1842952] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/25/2020] [Accepted: 10/18/2020] [Indexed: 10/23/2022]
Abstract
Malnutrition is associated with treatment-related toxicities (TRT) in adults with solid tumors and in children with leukemia. Few studies have assessed whether malnutrition in pediatric patients treated for solid tumors impacts risk for TRT, relapse, and/or survival. To address this knowledge gap, this retrospective study evaluated the association between body mass index (BMI) at diagnosis, and imputed BMI during therapy, on the prevalence of TRT, specific toxicities, relapse, and survival in pediatric patients with solid tumors treated with cisplatin-containing regimens. Kaplan-Meier curves and regression models evaluated the association between patient-specific characteristics (including BMI) and TRT, relapse, and survival. The cohort included 221 patients, of whom 22% were malnourished at diagnosis (10% were underweight and 12% were obese). Most patients (60%) experienced at least one severe TRT, and 30% developed more than one severe TRT. Most patients with obesity at diagnosis remained obese during therapy (62%). In multivariable analysis, obesity at diagnosis was significantly associated with a more than threefold greater risk for developing severe TRT (p = 0.037), specifically for acute or chronic kidney injury (p = 0.014). Obesity at diagnosis and adolescent and young adult age (≥15 years at diagnosis) were associated with worse event-free survival (hazard ratio [HR] 2.32, p = 0.024 and HR 2.28, p = 0.010, respectively) and overall survival (HR 3.69, p = 0.006 and HR 2.6, p = 0.012, respectively). Obese and older patients therefore constitute populations at risk for poorer outcomes. Prospective studies are warranted to gain further insight into the mechanism and role of obesity and adolescence in developing TRT and/or treatment failure.
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Affiliation(s)
- Rusha Bhandari
- Cancer and Blood Disease Institute, Children’s
Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine of University of Southern
California, Los Angeles, California
- Currently at City of Hope National Medical Center
| | - Elizabeth Scott
- Keck School of Medicine of University of Southern
California, Los Angeles, California
| | - Mei Yu Yeh
- Department of Biostatistics, Epidemiology, and Research
Design, Children’s Hospital Los Angeles, Los Angeles, California
| | - Kenneth Wong
- Cancer and Blood Disease Institute, Children’s
Hospital Los Angeles, Los Angeles, California
- Department of Radiation Oncology, Keck School of Medicine,
University of Southern California, Los Angeles, California
- Radiation Oncology Program, Children’s Hospital Los,
Angeles, Los Angeles, California
| | - Teresa Rushing
- Department of Pharmacy, Children’s Hospital of Los
Angeles, Los Angeles, California
| | - Winston Huh
- Cancer and Blood Disease Institute, Children’s
Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine of University of Southern
California, Los Angeles, California
| | - Etan Orgel
- Cancer and Blood Disease Institute, Children’s
Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine of University of Southern
California, Los Angeles, California
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Diakatou V, Vassilakou T. Nutritional Status of Pediatric Cancer Patients at Diagnosis and Correlations with Treatment, Clinical Outcome and the Long-Term Growth and Health of Survivors. CHILDREN-BASEL 2020; 7:children7110218. [PMID: 33171756 PMCID: PMC7694979 DOI: 10.3390/children7110218] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/26/2020] [Accepted: 11/05/2020] [Indexed: 11/16/2022]
Abstract
Malnutrition is caused either by cancer itself or by its treatment, and affects the clinical outcome, the quality of life (QOL), and the overall survival (OS) of the patient. However, malnutrition in children with cancer should not be accepted or tolerated as an inevitable procedure at any stage of the disease. A review of the international literature from 2014 to 2019 was performed. Despite the difficulty of accurately assessing the prevalence of malnutrition, poor nutritional status has adverse effects from diagnosis to subsequent survival. Nutritional status (NS) at diagnosis relates to undernutrition, while correlations with clinical outcome are still unclear. Malnutrition adversely affects health-related quality of life (HRQOL) in children with cancer and collective evidence constantly shows poor nutritional quality in childhood cancer survivors (CCSs). Nutritional assessment and early intervention in pediatric cancer patients could minimize the side effects of treatment, improve their survival, and reduce the risk of nutritional morbidity with a positive impact on QOL, in view of the potentially manageable nature of this risk factor.
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Affiliation(s)
- Vassiliki Diakatou
- Children’s & Adolescents’ Oncology Radiotherapy Department, Athens General Children’s Hospital “Pan. & Aglaia Kyriakou”, GR-11527 Athens, Greece;
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens University Campus, 196 Alexandras Avenue, GR-11521 Athens, Greece
| | - Tonia Vassilakou
- Department of Public Health Policy, School of Public Health, University of West Attica, Athens University Campus, 196 Alexandras Avenue, GR-11521 Athens, Greece
- Correspondence: ; Tel.: +30-213-2010-283
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Šalaševičius L, Vaitkevičienė GE, Pasaulienė R, Kiudelienė R, Ivanauskaitė-Didžiokienė E, Vajauskas D, Jurkienė N, Rascon J. Early Radiation-Induced Sarcoma in an Adolescent Treated for Relapsed Hodgkin Lymphoma with Nivolumab. MEDICINA-LITHUANIA 2020; 56:medicina56040155. [PMID: 32244416 PMCID: PMC7230437 DOI: 10.3390/medicina56040155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/04/2020] [Accepted: 03/25/2020] [Indexed: 11/17/2022]
Abstract
Radiation-induced sarcoma (RIS) has been reported as a late secondary malignancy following radiotherapy for various types of cancer with a median latency of 10 years. We describe an early RIS that developed in an adolescent within three years of treatment (including PD-L1 check-point inhibitor Nivolumab) of a relapsed classic Hodgkin lymphoma (HL) and was diagnosed post-mortem. The patient died of the progressive RIS that was misleadingly assumed to be a resistant HL based on the positive PET/CT scan. Repetitive tumor biopsies are warranted in cases of aggressive and multi-drug resistant HL to validate imaging findings, ensure correct diagnosis and avoid overtreatment.
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Affiliation(s)
- Lukas Šalaševičius
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (L.Š.); (G.E.V.)
| | - Goda Elizabeta Vaitkevičienė
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (L.Š.); (G.E.V.)
- Center for Pediatric Oncology and Hematology, Vilnius University, 08406 Vilnius, Lithuania;
| | - Ramunė Pasaulienė
- Center for Pediatric Oncology and Hematology, Vilnius University, 08406 Vilnius, Lithuania;
| | - Rosita Kiudelienė
- Center of Pediatric Oncology and Hematology at Pediatric Department and Hospital of Kauno Klinikos, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
| | | | - Donatas Vajauskas
- Institute of Biomedical Sciences, Department of Radiology, Nuclear Medicine and Medical Physics, Vilnius University, 03101 Vilnius, Lithuanian;
- Radiology and Nuclear Medicine Center, Department of Nuclear Medicine, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania
| | - Nemira Jurkienė
- Radiology Clinic, Nuclear Medicine Department of Kauno Klinikos, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
| | - Jelena Rascon
- Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (L.Š.); (G.E.V.)
- Center for Pediatric Oncology and Hematology, Vilnius University, 08406 Vilnius, Lithuania;
- Correspondence:
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Lulloff AJ, Vessey JA, Bashore L, Gregas M. Nutrition-Related Clinical Decision Making of Pediatric Oncology Nurses. J Pediatr Oncol Nurs 2019; 36:352-360. [PMID: 31027451 DOI: 10.1177/1043454219844233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Children with a cancer diagnosis have risk factors leading to unique nutritional challenges. Malnutrition in this population is correlated with worse patient outcomes. Nurses are responsible for providing holistic care to their patients; however, the quality of nutritional assessments by pediatric oncology nurses is unknown. The purpose of this study was to investigate staff nurses' clinical decision making regarding nutritional assessment of children with cancer. A web-based survey composed of a demographic form, vignettes of patients with diverse nutritional status and the New General Self-Efficacy Scale, was distributed to members of the Association of Pediatric Hematology Oncology Nurses. Participants were also asked to rate their confidence in responses as well as select key nutritional cues. Nurses were significantly more likely to under-rate the nutritional status and select far fewer cues than the experts. Further research regarding nutritional assessment is warranted. Evidenced-based guidelines for nutritional assessment of children with cancer should be developed to ensure the highest quality of care is provided to this patient population.
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Affiliation(s)
| | - Judith A Vessey
- 2 Boston College, Chestnut Hill, MA, USA.,3 Boston Children's Hospital, Chestnut Hill, MA, USA
| | - Lisa Bashore
- 4 Texas Christian University, Fort Worth, TX, USA.,5 Cook Children's Health Care System, Fort Worth, TX, USA
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13
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Joffe L, Dwyer S, Glade Bender JL, Frazier AL, Ladas EJ. Nutritional status and clinical outcomes in pediatric patients with solid tumors : A systematic review of the literature. Semin Oncol 2018; 46:48-56. [PMID: 30655021 DOI: 10.1053/j.seminoncol.2018.11.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 11/21/2018] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Nutritional status (NS), defined by undernutrition (body mass index [BMI] <5th percentile) or overnutrition (BMI ≥ 85th percentile), is a poor prognostic indicator in pediatric oncology patients. The impact of NS has been primarily studied in hematologic malignancies. This review is intended to summarize literature reporting on the association of NS and treatment-related outcomes in pediatric solid tumors. METHODS We searched four electronic databases from inception through August 2018 without language restriction, and included studies of children with cancers arising from renal, bone, liver, eye, muscle, vascular, germ cell, and neural crest tissues, reporting on NS as a predictor for toxicity, survival or relapse. Due to data heterogeneity and limited availability of studies, formal statistical analysis was not achievable. Descriptive statistics were summarized in table format. RESULTS Of 8,991 reports identified, 75 full-text articles were evaluated, 10 of which met inclusion criteria. Up to 62% of patients were over- or undernourished at diagnosis. Abnormal BMI was associated with worse overall survival in Ewing sarcoma (hazard ratio (HR): 3.46, P = .022), osteosarcoma (HR: 1.6, P < .005), and a trend toward poorer overall survival in rhabdomyosarcoma (HR: 1.70, P = .0596). High BMI in osteosarcoma was associated with increased nephrotoxicity (odds ratio: 2.8, P = .01) and postoperative complications. NS was not a significant predictor of outcomes in other included disease categories. CONCLUSIONS Existing literature supports the prognostic significance of NS in pediatric solid tumor patients and underscores the need for prospective studies to better elucidate underlying physiological changes in this population.
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Affiliation(s)
- Lenat Joffe
- Department of Pediatric Hematology, Oncology and Stem Cell Transplant, Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York
| | - Sarah Dwyer
- Institute of Human Nutrition, Columbia University Medical Center, New York, New York
| | - Julia L Glade Bender
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - A Lindsay Frazier
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Elena J Ladas
- Department of Pediatric Hematology, Oncology and Stem Cell Transplant, Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York.
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14
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Montgomery C, Harris J, Siegel E, Suva L, Wilson M, Morell S, Nicholas R. Obesity is associated with larger soft-tissue sarcomas, more surgical complications, and more complex wound closures (obesity leads to larger soft-tissue sarcomas). J Surg Oncol 2018; 118:184-191. [PMID: 29878365 DOI: 10.1002/jso.25119] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 05/07/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Does a link exist between obesity and soft-tissue sarcoma outcomes? We hypothesized that soft-tissue sarcomas in patients with obesity may lead to larger tumors at detection, with an increased risk for a more complex surgical excision, wound healing-related complications, higher stage at presentation, and decreased survival. METHODS One hundred thirty-nine and patients with soft-tissue sarcoma were retrospectively evaluated over 10 years. Patients were divided into 2 cohorts based on the World Health Organization body mass index (BMI) obesity grouping. A BMI ≥ 30 kg/m2 was classified as obese and a BMI < 30 kg/m2 was classified as nonobese. RESULTS Eighty-five nonobese and 54 obese individuals were evaluated. The median tumor diameter was 50% larger (P = .024) and the overall complication rate was 1.7-fold higher in patients with obesity (P = .0032). Patients with obesity also had a statistically significantly higher rate of complex wound closures. In multivariable logistic regression, obesity remained a highly significant factor favoring complications after the surgical treatment of soft-tissue sarcoma (odds ratio = 3.66, 95% confidence interval = 1.54-8.71; P = .0033). No statistically significant differences were noted on comparing groups for the incidence of metastatic spread or survival. CONCLUSIONS These findings suggest that obesity is associated with larger tumors, a higher incidence of wound complications, and greater use of complex wound-closure methods.
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Affiliation(s)
- Corey Montgomery
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - John Harris
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Eric Siegel
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Larry Suva
- Department of Veterinary Physiology and Pharmacology, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Margaret Wilson
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Sean Morell
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Richard Nicholas
- Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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15
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Abstract
Osteosarcoma is the most common primary bone malignancy in children and adolescents. Because the incidence of osteosarcoma is low and the disease occurs in physically active patients, it may be misdiagnosed as a more benign condition, thus leading to late diagnosis. This article describes the disease's most frequent presenting complaints and initial radiographic findings, as well as its risk factors and common misdiagnoses. Clinicians should consider osteosarcoma in young patients with persistent bone pain, especially pain with weight-bearing.
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Affiliation(s)
- Chelsea Hiller
- Chelsea Hiller practices family medicine at the Scripps Clinic in San Diego, Calif. Jennifer L. Wegler is a clinical instructor of family medicine in the PA program at the University of Southern California in Alhambra, Calif., and practices orthopedics at Kaiser-Permanente in Baldwin Park, Calif. Christopher P. Forest is an assistant professor of clinical family medicine and director of research at the University of Southern California's Keck School of Medicine and practices urgent care and family medicine in Los Angeles, Calif. The authors have disclosed no potential conflicts of interest, financial or otherwise
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16
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Li Z, Dong H, Li M, Wu Y, Liu Y, Zhao Y, Chen X, Ma M. Honokiol induces autophagy and apoptosis of osteosarcoma through PI3K/Akt/mTOR signaling pathway. Mol Med Rep 2017; 17:2719-2723. [PMID: 29207060 DOI: 10.3892/mmr.2017.8123] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 06/08/2017] [Indexed: 11/05/2022] Open
Abstract
Honokiol is the main active constituent of Magnolia officinalis. With effective and long‑term pharmacological functions of being antibacterial, anti‑oxidative, anti‑inflammatory, antitumor, anti‑spasmic, anti‑anxiety and anti‑viral, Honokiol is clinically used in the treatment of acute enteritis and chronic gastritis. The aim of the present study was to observe the possible anti‑effects of honokiol on autophagy and apoptosis of osteosarcoma, and to investigate the role of the PI3K/Akt/mTOR signaling pathway in its anticancer effects. MTT assay was used to evaluate cell proliferation and Annexin V‑fluorescein isothiocyanate/propidium iodide staining flow cytometry was used to analyze the apoptotic rate. The authors identified that honokiol could inhibit cell proliferation and induce the apoptotic rate of osteosarcoma cells. The expression level of Bcl‑2‑like protein 4, caspase‑3 and p53 protein expression were induced and cyclin D1 protein expression was suppressed in osteosarcoma cells by honokiol. Autophagy‑associated LC3II protein expression level was promoted, and PI3K, p‑Akt and p‑mTOR protein expression level was suppressed in osteosarcoma cells by honokiol. The present study demonstrated, to the best of the authors' knowledge, for the first time that honokiol induces autophagy and apoptosis of osteosarcoma cells through the PI3K/Akt/mTOR signaling pathway.
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Affiliation(s)
- Zhiquan Li
- PLA Institute of Orthopedics and Traumatology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Hui Dong
- Department of Orthopedics, The 474th Hospital of PLA, Urumqi, Xinjiang 830013, P.R. China
| | - Mo Li
- PLA Institute of Orthopedics and Traumatology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Yaoping Wu
- PLA Institute of Orthopedics and Traumatology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Yanwu Liu
- PLA Institute of Orthopedics and Traumatology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Yinan Zhao
- PLA Institute of Orthopedics and Traumatology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Xiaochao Chen
- PLA Institute of Orthopedics and Traumatology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Minliang Ma
- PLA Institute of Orthopedics and Traumatology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
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17
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Buchta CM, Boi SK, Miller BJ, Milhem MM, Norian LA. Obesity Does Not Exacerbate the Protumorigenic Systemic Environment in Sarcoma Subjects. Immunohorizons 2017; 1:20-28. [PMID: 29202127 PMCID: PMC5711445 DOI: 10.4049/immunohorizons.1700001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Sarcomas are a rare but fatal tumor type that accounts for <1% of adult solid malignancies and ~15% of childhood malignancies. Although the use of immunotherapy is being actively investigated for other solid tumors, advances in immunotherapy for sarcoma patients are lacking. To better understand the systemic immune environment in sarcoma patients, we performed a detailed multiplex analysis of serum cytokines, chemokines, and protumorigenic factors from treatment-naive subjects with localized, high-grade sarcoma. Because obesity is a major healthcare issue in the United States, we additionally examined the effects of obesity on serum protein profiles in our sarcoma subject cohort. We found that the systemic host environment is profoundly altered to favor tumor progression, with epidermal growth factor, angiopoietin-2, vascular endothelial growth factor A, IL-6, IL-8, and MIP-1β all increased relative to tumor-free controls (all p < 0.05). Surprisingly, we found that obesity did not exacerbate this protumorigenic profile, as epidermal growth factor and IL-8 decreased with increasing subject body mass index (both p < 0.05 versus normal or overweight subjects). The Th2-related cytokines IL-4, IL-5, and IL-13 were also decreased in the presence of obesity. Thus, although the systemic environment in sarcoma subjects favors tumor progression, obesity does not further aggravate the production of protumorigenic factors.
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Affiliation(s)
- Claire M Buchta
- Department of Urology, University of Iowa, Iowa City, IA 52242
| | - Shannon K Boi
- Graduate Biomedical Sciences, Immunology Theme, University of Alabama at Birmingham, Birmingham, AL 35233
| | - Benjamin J Miller
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA 52242
| | - Mohammed M Milhem
- Department of Internal Medicine, University of Iowa, Iowa City, IA 52242.,Division of Hematology and Oncology, University of Iowa, Iowa City, IA 52242
| | - Lyse A Norian
- Department of Urology, University of Iowa, Iowa City, IA 52242.,Department of Nutrition Sciences, Nutrition Obesity Research Center, and Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35233
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18
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Dietrich CG, Rau M, Jahn D, Geier A. Changes in drug transport and metabolism and their clinical implications in non-alcoholic fatty liver disease. Expert Opin Drug Metab Toxicol 2017; 13:625-640. [PMID: 28359183 DOI: 10.1080/17425255.2017.1314461] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The incidence of non-alcoholic fatty liver disease (NAFLD) is rising, especially in Western countries. Drug treatment in patients with NAFLD is common since it is linked to other conditions like diabetes, obesity, and cardiovascular disease. Consequently, changes in drug metabolism may have serious clinical implications. Areas covered: A literature search for studies in animal models or patients with obesity, fatty liver, non-alcoholic steatohepatitis (NASH) or NASH cirrhosis published before November 2016 was performed. After discussing epidemiology and animal models for NAFLD, we summarized both basic as well as clinical studies investigating changes in drug transport and metabolism in NAFLD. Important drug groups were assessed separately with emphasis on clinical implications for drug treatment in patients with NAFLD. Expert opinion: Given the frequency of NAFLD even today, a high degree of drug treatment in NAFLD patients appears safe and well-tolerated despite considerable changes in hepatic uptake, distribution, metabolism and transport of drugs in these patients. NASH causes changes in biliary excretion, systemic concentrations, and renal handling of drugs leading to alterations in drug efficacy or toxicity under specific circumstances. Future clinical drug studies should focus on this special patient population in order to avoid serious adverse events in NAFLD patients.
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Affiliation(s)
- Christoph G Dietrich
- a Bethlehem Center of Health , Department of Medicine , Stolberg/Rhineland , Germany
| | - Monika Rau
- b Division of Hepatology, Department of Medicine II , University of Würzburg , Würzburg , Germany
| | - Daniel Jahn
- b Division of Hepatology, Department of Medicine II , University of Würzburg , Würzburg , Germany
| | - Andreas Geier
- b Division of Hepatology, Department of Medicine II , University of Würzburg , Würzburg , Germany
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19
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van As JW, van den Berg H, van Dalen EC. Platinum-induced hearing loss after treatment for childhood cancer. Cochrane Database Syst Rev 2016; 2016:CD010181. [PMID: 27486906 PMCID: PMC6466671 DOI: 10.1002/14651858.cd010181.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Platinum-based therapy, including cisplatin, carboplatin, oxaliplatin or a combination of these, is used to treat a variety of paediatric malignancies. Unfortunately, one of the most important adverse effects is the occurrence of hearing loss or ototoxicity. There is a wide variation in the reported prevalence of platinum-induced ototoxicity and the associated risk factors. More insight into the prevalence of and risk factors for platinum-induced hearing loss is essential in order to develop less ototoxic treatment protocols for the future treatment of children with cancer and to develop adequate follow-up protocols for childhood cancer survivors treated with platinum-based therapy. OBJECTIVES To evaluate the existing evidence on the association between childhood cancer treatment including platinum analogues and the occurrence of hearing loss. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 8), MEDLINE (PubMed) (1945 to 23 September 2015) and EMBASE (Ovid) (1980 to 23 September 2015). In addition, we searched reference lists of relevant articles and the conference proceedings of the International Society for Paediatric Oncology (2008 to 2014), the American Society of Pediatric Hematology/Oncology (2008 to 2015) and the International Conference on Long-Term Complications of Treatment of Children and Adolescents for Cancer (2010 to 2015). Experts in the field provided information on additional studies. SELECTION CRITERIA All study designs, except case reports, case series (i.e. a description of non-consecutive participants) and studies including fewer than 100 participants treated with platinum-based therapy who had an ototoxicity assessment, examining the association between childhood cancer treatment including platinum analogues and the occurrence of hearing loss. DATA COLLECTION AND ANALYSIS Two review authors independently performed the study selection. One review author performed data extraction and risk of bias assessment, which was checked by another review author. MAIN RESULTS We identified 13 eligible cohort studies including 2837 participants with a hearing test after treatment with a platinum analogue for different types of childhood cancers. All studies had methodological limitations, with regard to both internal (risk of bias) and external validity. Participants were treated with cisplatin, carboplatin or both, in varying doses. The reported prevalence of hearing loss varied considerably between 0% and 90.1%; none of the studies provided data on tinnitus. Three studies reported a prevalence of 0%, but none of these studies provided a definition for hearing loss and there might be substantial or even complete overlap in included participants between these three studies. When only studies that did provide a definition for hearing loss were included, the prevalence of hearing loss still varied widely between 1.7% and 90.1%. All studies were very heterogeneous with regard to, for example, definitions of hearing loss, used diagnostic tests, participant characteristics, (prior) anti-tumour treatment, other ototoxic drugs and length of follow-up. Therefore, pooling of results was not possible.Only two studies included a control group of people who had not received platinum treatment. In one study, the prevalence of hearing loss was 67.1% (95% confidence interval (CI) 59.3% to 74.1%) in platinum-treated participants, while in the control participants it was 7.4% (95% CI 6.2% to 8.8%). However, hearing loss was detected by screening in survivors treated with platinum analogues and by clinical presentation in control participants. It is uncertain what the effect of this difference in follow-up/diagnostic testing was. In the other study, the prevalence of hearing loss was 20.1% (95% CI 17.4% to 23.2%) in platinum-treated participants and 0.4% (95% CI 0.12% to 1.6%) in control participants. As neither study was a randomized controlled trial or controlled clinical trial, the calculation of a risk ratio was not feasible as it is very likely that both groups differed more than only the platinum treatment.Only two studies evaluated possible risk factors using multivariable analysis. One study identified a significantly higher risk of hearing loss in people treated with cisplatin 400 mg/m(2) plus carboplatin 1700 mg/m(2) as compared to treatment with cisplatin 400 mg/m(2) or less, irrespective of the definition of hearing loss. They also identified a significantly higher risk of hearing loss in people treated with non-anthracycline aminoglycosides antibiotics (using a surrogate marker) as compared to people not treated with them, for three out of four definitions of hearing loss. The other study reported that age at treatment (odds ratio less than 1 for each single-unit increase) and single maximum cisplatin dose (odds ratio greater than 1 for each single-unit increase) were significant predictors for hearing loss, while gender was not. AUTHORS' CONCLUSIONS This systematic review shows that children treated with platinum analogues are at risk for developing hearing loss, but the exact prevalence and risk factors remain unclear. There were no data available for tinnitus. Based on the currently available evidence we can only advise that children treated with platinum analogues are screened for ototoxicity in order to make it possible to diagnose hearing loss early and to take appropriate measures. However, we are unable to give recommendations for specific follow-up protocols including frequency of testing. Counselling regarding the prevention of noise pollution can be considered, such as the use of noise-limiting equipment, avoiding careers with excess noise and ototoxic medication. Before definitive conclusions on the prevalence and associated risk factors of platinum-induced ototoxicity can be made, more high-quality research is needed. Accurate and transparent reporting of findings will make it possible for readers to appraise the results of these studies critically.
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Affiliation(s)
- Jorrit W van As
- Princess Máxima Center for Pediatric Oncologyc/o Cochrane Childhood CancerHeidelberglaan 25UtrechtNetherlands3584 CS
| | - Henk van den Berg
- Emma Children's Hospital, Amsterdam UMC, University of AmsterdamDepartment of Paediatric OncologyPO Box 22660AmsterdamNetherlands1100 DD
| | - Elvira C van Dalen
- Princess Máxima Center for Pediatric OncologyHeidelberglaan 25UtrechtNetherlands3584 CS
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20
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Romano F, Heinze C, Barber L, Mason J, Freeman L. Association between Body Condition Score and Cancer Prognosis in Dogs with Lymphoma and Osteosarcoma. J Vet Intern Med 2016; 30:1179-86. [PMID: 27279003 PMCID: PMC5153966 DOI: 10.1111/jvim.13965] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 03/03/2016] [Accepted: 04/21/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In humans and rodents obesity appears to promote some cancers by increasing incidence, tumor aggressiveness, recurrence, and fatality. However, the relationship between obesity and cancer in dogs has not been thoroughly evaluated. HYPOTHESIS/OBJECTIVES Whether body condition score (BCS) at the time of lymphoma (LSA) or osteosarcoma (OSA) diagnosis in dogs is predictive of survival time (ST) or progression-free interval (PFI). We hypothesized that an overweight body state at the time of cancer diagnosis would be associated with negative outcomes. ANIMALS Dogs with LSA (n = 270) and OSA (n = 54) diagnosed and treated between 2000 and 2010. METHODS Retrospective case review. Signalment, body weight, BCS, cancer diagnosis and treatment, relevant clinicopathologic values, and survival data were collected. Dogs were grouped by BCS (underweight, ideal, and overweight) and ST and PFI were compared. RESULTS Overall, 5.5% of dogs were underweight, 54.0% were ideal weight, and 40.4% were overweight at diagnosis. Underweight dogs with LSA had shorter ST (P = .017) than ideal or overweight dogs. BCS was not associated with ST for OSA (P = .474). Progression-free interval did not differ among BCS categories for either cancer. CONCLUSIONS AND CLINICAL IMPORTANCE Obesity was not associated with adverse outcomes among dogs with LSA or OSA in this retrospective study; however, being underweight at the time of diagnosis of LSA was associated with shorter survival. More research is needed to elucidate the relationship between excessive body weight and cancer development and progression in dogs.
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Affiliation(s)
- F.R. Romano
- Department of Clinical SciencesCummings School of Veterinary MedicineTufts UniversityNorth GraftonMA
| | - C.R. Heinze
- Department of Clinical SciencesCummings School of Veterinary MedicineTufts UniversityNorth GraftonMA
| | - L.G. Barber
- Department of Clinical SciencesCummings School of Veterinary MedicineTufts UniversityNorth GraftonMA
| | - J.B. Mason
- Jean Mayer USDA Human Nutrition Research Center at Tufts UniversityBostonMA
| | - L.M. Freeman
- Department of Clinical SciencesCummings School of Veterinary MedicineTufts UniversityNorth GraftonMA
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21
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Interiano RB, Malkan AD, Loh AHP, Hinkle N, Wahid FN, Bahrami A, Mao S, Wu J, Bishop MW, Neel MD, Gold RE, Rao BN, Davidoff AM, Fernandez-Pineda I. Initial diagnostic management of pediatric bone tumors. J Pediatr Surg 2016; 51:981-5. [PMID: 26995522 PMCID: PMC5154299 DOI: 10.1016/j.jpedsurg.2016.02.068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 02/26/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Osteosarcoma (OS) and the Ewing sarcoma family of tumors (ESFT) are the most common primary pediatric bone malignancies. We sought to assess the diagnostic accuracy of initial tumor biopsies in patients with OS or ESFT at a pediatric cancer center. METHODS All biopsies performed at initial presentation of patients with OS or ESFT at our institution from 2003 to 2012 were retrospectively reviewed. Diagnostic accuracy and incidence of complications were correlated with study variables using logistic regression analysis. RESULTS One hundred forty-two biopsies were performed in 105 patients (median age 13.4years, range: 1.8-23.0), 104 (73.2%) OS and 38 (27.8%) ESFT. Thirty-one (21.8%) were performed on metastatic sites. Eighty-five (76.6%) of 111 primary site biopsies were open procedures, and 26 were percutaneous (23.4%). Primary site biopsies were successful in 94.1% of open and 73.1% of percutaneous procedures. Odds of obtaining a successful diagnostic specimen were 7.8 times higher with open approach (CI: 1.6-36.8). Metastatic site biopsies were successful in 66.7% of percutaneous and 100% of open and thoracoscopic procedures. CONCLUSION Biopsy of metastatic sites was equal to primary site in obtaining diagnostic material with the added benefit of accurate staging, with few adverse events and high diagnostic yield.
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Affiliation(s)
- Rodrigo B Interiano
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Alpin D Malkan
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Amos H P Loh
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore
| | - Nathan Hinkle
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Fazal N Wahid
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Armita Bahrami
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Shenghua Mao
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jianrong Wu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Michael W Bishop
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Michael D Neel
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Robert E Gold
- Department of Radiological Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Bhaskar N Rao
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Israel Fernandez-Pineda
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA; Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
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22
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Gerrand C, Athanasou N, Brennan B, Grimer R, Judson I, Morland B, Peake D, Seddon B, Whelan J. UK guidelines for the management of bone sarcomas. Clin Sarcoma Res 2016; 6:7. [PMID: 27148438 PMCID: PMC4855334 DOI: 10.1186/s13569-016-0047-1] [Citation(s) in RCA: 140] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/09/2016] [Indexed: 01/02/2023] Open
Abstract
This document is an update of the British Sarcoma Group guidelines published in 2010. The aim is to provide a reference standard for the clinical care of patients in the UK with bone sarcomas. Recent recommendations by the European Society of Medical Oncology, The National Comprehensive Cancer Network and The National Institute for Health and Care Excellence have been incorporated, and the literature since 2010 reviewed. The standards represent a consensus amongst British Sarcoma Group members in 2015. It is acknowledged that these guidelines will need further updates as care evolves. The key recommendations are that bone pain or a palpable mass should always lead to further investigation and that patients with clinico-radiological findings suggestive of a primary bone tumour at any site in the skeleton should be referred to a specialist centre and managed by a fully accredited bone sarcoma multidisciplinary team. Treatment recommendations are provided for the major tumour types and for localised, metastatic and recurrent disease. Follow up schedules are suggested.
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Affiliation(s)
- Craig Gerrand
- />Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, NE7 7DN UK
| | | | | | - Robert Grimer
- />Royal Orthopaedic Hospital, Birmingham, B31 2AP UK
| | | | - Bruce Morland
- />Birmingham Children’s Hospital, Birmingham, B4 6NH UK
| | - David Peake
- />Queen Elizabeth Hospital, Birmingham, B15 2TH UK
| | | | | | - On behalf of the British Sarcoma Group
- />Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, NE7 7DN UK
- />Nuffield Orthopaedic Centre, Oxford, OX3 7LD UK
- />Royal Manchester Children’s Hospital, Manchester, M13 9WL UK
- />Royal Orthopaedic Hospital, Birmingham, B31 2AP UK
- />The Royal Marsden, Sutton, SM2 5PT UK
- />Birmingham Children’s Hospital, Birmingham, B4 6NH UK
- />Queen Elizabeth Hospital, Birmingham, B15 2TH UK
- />University College Hospital, London, NW1 2PG UK
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23
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Wu XC, Prasad PK, Landry I, Harlan LC, Parsons HM, Lynch CF, Smith AW, Hamilton AS, Keegan THM. Impact of the AYA HOPE Comorbidity Index on Assessing Health Care Service Needs and Health Status among Adolescents and Young Adults with Cancer. Cancer Epidemiol Biomarkers Prev 2015; 24:1844-9. [PMID: 26420768 PMCID: PMC4670595 DOI: 10.1158/1055-9965.epi-15-0401] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/22/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Existing comorbidity indices were not developed for adolescent and young adults (AYA) 15 to 39 years of age. The aim of this study was to assess impact of comorbidities on health care service needs and health status among AYA cancer survivors using the newly developed AYA HOPE comorbidity index in comparison with the existing indices. METHODS Data on comorbid conditions were obtained from medical records and service needs and health status were from a survey of AYA cancer survivors. Prevalence of comorbidities was based on the AYA HOPE index. Charlson and NCI indices were compared. Multivariable logistic regression was used. RESULTS Of the 485 patients, 14.6% had ≥2 comorbidities based on the AYA HOPE Index. Prevalence of mental illness and obesity/overweight, which were not included in existing indices, were 8.2% and 5.8%, respectively. Prevalence of cardiovascular, endocrine, gastrointestinal, and neurologic conditions were higher with the AYA HOPE Index than the other two indices. Forty percent of AYA patients reported service needs, particularly for mental health services (25.2%) and support groups (17.7%). Having ≥2 comorbidities on the AYA index was associated with higher mental health service needs [OR, 2.05; 95% confidence interval (CI), 1.10-3.82] adjusting for demographic and clinical factors. Comorbidities were associated with fair/poor self-reported health status. CONCLUSION The AYA HOPE Index is a more comprehensive comorbidity index for AYA cancer patients than existing indices, and the number of comorbidities is associated with service needs and health status. IMPACT The AYA HOPE index could identify patients' additional service needs early in therapy.
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Affiliation(s)
- Xiao-Cheng Wu
- Department of Epidemiology, LSUHSC, New Orleans, Louisiana.
| | - Pinki K Prasad
- Department of Pediatric Hematology/Oncology, LSUSHC/Children's Hospital of New Orleans, New Orleans, Louisiana
| | - Ian Landry
- Department of Epidemiology, LSUHSC, New Orleans, Louisiana
| | - Linda C Harlan
- Applied Research Program, National Cancer Institute, Bethesda, Maryland
| | - Helen M Parsons
- University of Texas Health Science Center, San Antonio, Texas
| | - Charles F Lynch
- Department of Epidemiology, University of Iowa, Iowa City, Iowa
| | - Ashley W Smith
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Ann S Hamilton
- Preventive Medicine, University of Southern California Norris Cancer Center, Los Angeles, California
| | - Theresa H M Keegan
- Department of Internal Medicine, Division of Hematology and Oncology, University of California, Davis, California
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24
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Goldstein G, Shemesh E, Frenkel T, Jacobson JM, Toren A. Abnormal body mass index at diagnosis in patients with Ewing sarcoma is associated with inferior tumor necrosis. Pediatr Blood Cancer 2015; 62:1892-6. [PMID: 26053354 DOI: 10.1002/pbc.25589] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 04/16/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Abnormal body mass index (BMI) in cancer patients at diagnosis has been associated with lower survival rates. The degree of tumor necrosis after induction chemotherapy in Ewing sarcoma (EWS) is highly associated with treatment failure. We analyzed the effect of BMI on tumor necrosis in children and young adults undergoing induction treatment for EWS. PROCEDURE Retrospective review of BMI and tumor necrosis in children and young adults with EWS. Patients were grouped into normal and abnormal BMI groups. Multivariate logistic regression and multivariate Cox regression were used to evaluate the impact of BMI on tumor necrosis, recurrence of disease, and survival. RESULTS Fifty patients who underwent resection of the tumor were eligible. Of them, 32 (64%) and 18 (36%) had normal and abnormal BMI, respectively. Poor histologic response (PR), defined as tumor necrosis of less than 90%, was achieved in 35 (70%) patients. When comparing abnormal to normal BMI, there were more cases of PR [9 (50%) vs. 6 (19%) (P = 0.025)], more relapses [8 (44%) vs. 8 (25%) (P = 0.164)], and more deaths [10 (57%) vs. 7 (22%) (P = 0.040)], respectively. Abnormal BMI was independently associated with PR (OR 4.33, 95% CI 1.12-19.14 P = 0.034) and worse overall survival (HR 2.76, 95% CI 1.19-9.99 P = 0.022), while it had no impact on event free survival. CONCLUSIONS The association between abnormal BMI and lower survival in EWS is presumed to be due to PR to chemotherapy. These findings stress the significance of BMI on treatment response in malignant diseases.
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Affiliation(s)
- Gal Goldstein
- Pediatric Hemato-Oncology and Bone Marrow Transplantation, The Edmond and Lily Safra Children Hospital, Sheba Medical Center, Tel-Hashomer and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Erez Shemesh
- Pediatric Hemato-Oncology and Bone Marrow Transplantation, The Edmond and Lily Safra Children Hospital, Sheba Medical Center, Tel-Hashomer and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tal Frenkel
- Pediatric Hemato-Oncology and Bone Marrow Transplantation, The Edmond and Lily Safra Children Hospital, Sheba Medical Center, Tel-Hashomer and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jeffrey M Jacobson
- Pediatric Radiology, The Edmond and Lily Safra Children Hospital, Sheba Medical Center, Tel-Hashomer and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amos Toren
- Pediatric Hemato-Oncology and Bone Marrow Transplantation, The Edmond and Lily Safra Children Hospital, Sheba Medical Center, Tel-Hashomer and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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25
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Liang S, Ren Z, Han X, Yang J, Shan L, Li L, Wang B, Zhang Q, Mu T, Chen K, Xiong S, Wang G. PLA2G16 Expression in Human Osteosarcoma Is Associated with Pulmonary Metastasis and Poor Prognosis. PLoS One 2015; 10:e0127236. [PMID: 25993412 PMCID: PMC4436297 DOI: 10.1371/journal.pone.0127236] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 04/12/2015] [Indexed: 11/18/2022] Open
Abstract
Background Osteosarcoma is the most frequent type of malignant bone tumor in children and adolescents and is associated with a high propensity for lung metastasis. Recent experiments have indicated that PLA2G16 contributes to osteosarcoma progression and metastasis in both mouse and human osteosarcoma cell lines. The aim of this study was to compare the expression of PLA2G16 in non-metastatic and metastatic osteosarcomas to determine whether PLA2G16 expression can serve as a biomarker of osteosarcoma prognosis and metastasis. Methods Quantitative real-time PCR was used to examine PLA2G16 mRNA in primary osteosarcoma patients (18 patients without metastases and 17 patients with metastases), and immunohistochemistry (IHC) staining of PLA2G16 was performed on tissue microarrays from 119 osteosarcoma patients. Tumor metastatic behavior and survival of the patients were followed up for a minimum of 36 months and a maximum of 171 months. The prognostic value of PLA2G16 expression was evaluated by the Kaplan–Meier method and a log-rank test. Multivariate Cox regression analysis was used to identify significant independent prognostic factors. Results Osteosarcoma patients with metastasis showed a higher expression of PLA2G16 at both the mRNA and protein levels (both at P values< 0.05) than did patients without metastasis. Osteosarcoma patients with positive IHC staining of PLA2G16 expression at primary sites had shorter overall survival and metastasis-free survival (both at P values <0.02). Moreover, multivariate Cox analysis identified PLA2G16 expression as an independent prognostic factor to predict poor overall survival and metastasis-free survival (both P values < 0.03). Conclusions This study indicated that PLA2G16 expression is a significant prognostic factor in primary osteosarcoma patients for predicting the development of metastases and poor survival.
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Affiliation(s)
- Shoulei Liang
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Zhiwu Ren
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Xiuxin Han
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Jilong Yang
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Luling Shan
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Lin Li
- Institute of Cancer Stem Cell, Dalian Medical University Cancer Center, Dalian, China
| | - Binying Wang
- School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou, China
| | - Qianyi Zhang
- Institute of Cancer Stem Cell, Dalian Medical University Cancer Center, Dalian, China
| | - Tianyang Mu
- Institute of Cancer Stem Cell, Dalian Medical University Cancer Center, Dalian, China
| | - Kexin Chen
- Department of Epidemiology and Biostatistics, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Shunbin Xiong
- Department of Genetics, The University of Texas, M.D. Anderson Cancer Center, Houston, Texas, United States of America
- * E-mail: (SX); (GW)
| | - Guowen Wang
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
- * E-mail: (SX); (GW)
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26
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Clarke JD, Cherrington NJ. Nonalcoholic steatohepatitis in precision medicine: Unraveling the factors that contribute to individual variability. Pharmacol Ther 2015; 151:99-106. [PMID: 25805597 DOI: 10.1016/j.pharmthera.2015.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/17/2015] [Indexed: 01/14/2023]
Abstract
There are numerous factors in individual variability that make the development and implementation of precision medicine a challenge in the clinic. One of the main goals of precision medicine is to identify the correct dose for each individual in order to maximize therapeutic effect and minimize the occurrence of adverse drug reactions. Many promising advances have been made in identifying and understanding how factors such as genetic polymorphisms can influence drug pharmacokinetics (PK) and contribute to variable drug response (VDR), but it is clear that there remain many unidentified variables. Underlying liver diseases such as nonalcoholic steatohepatitis (NASH) alter absorption, distribution, metabolism, and excretion (ADME) processes and must be considered in the implementation of precision medicine. There is still a profound need for clinical investigation into how NASH-associated changes in ADME mediators, such as metabolism enzymes and transporters, affect the pharmacokinetics of individual drugs known to rely on these pathways for elimination. This review summarizes the key PK factors in individual variability and VDR and highlights NASH as an essential underlying factor that must be considered as the development of precision medicine advances. A multifactorial approach to precision medicine that considers the combination of two or more risk factors (e.g. genetics and NASH) will be required in our effort to provide a new era of benefit for patients.
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Affiliation(s)
- John D Clarke
- Department of Pharmacology and Toxicology, University of Arizona, Tucson, AZ 85721, United States
| | - Nathan J Cherrington
- Department of Pharmacology and Toxicology, University of Arizona, Tucson, AZ 85721, United States.
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27
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Glover J, Krailo M, Tello T, Marina N, Janeway K, Barkauskas D, Fan TM, Gorlick R, Khanna C. A summary of the osteosarcoma banking efforts: a report from the Children's Oncology Group and the QuadW Foundation. Pediatr Blood Cancer 2015; 62:450-5. [PMID: 25611047 PMCID: PMC4304398 DOI: 10.1002/pbc.25346] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 10/08/2014] [Indexed: 01/15/2023]
Abstract
BACKGROUND Survival rates of patients with osteosarcoma have remained stagnant over the last thirty years. Better understanding of biology, new therapeutics, and improved biomarkers are needed. The Children's Oncology Group (COG) addressed this need by developing one of the largest osteosarcoma biorepositories ever, containing over 15,000 tumor and tissue samples from over 1,500 patients. PROCEDURE The biology study P9851 and the banking study AOST06B1 has enrolled 1,787 patients (as of September, 2013). Clinical information was lacking on 510 patients on P9851, who were not enrolled on a concurrent therapeutic trial. The value of these specimens was diminished. The lack of statistical support available for biology projects slowed the analysis of several critical studies. The QuadW Foundation, CureSearch, and the COG formed the Childhood Sarcoma Biostatistics and Annotation Office (CSBAO) to provide the infrastructure and address these needs by linking clinically annotated patient data to archived tissue samples and to develop biostatistical support for childhood sarcoma research. RESULTS Originally 5.3% of samples from the 510 patients on P9851 not enrolled on a therapeutic study had full clinical annotation. The efforts of the CSBAO have linked clinical annotation to 90.8% of those specimens and provided statistical analyses to several studies that had used COG samples. As a result, 24 biology studies in osteosarcoma have been completed and published in peer-reviewed journals. CONCLUSIONS These samples and in-silico data are available to the research community for basic and translational science projects to improve the biological understanding and treatment of patients affected by osteosarcoma.
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Affiliation(s)
- Jason Glover
- Children’s Cancer and Blood Disorders Program, Randall Children’s Hospital, Portland OR USA
| | - Mark Krailo
- Children’s Oncology Group, Monrovia, CA, USA
| | - Tanya Tello
- Children’s Oncology Group, Monrovia, CA, USA
| | - Neyssa Marina
- Department of Pediatric Hematology/Oncology, Stanford University, Palo Alto, CA, USA
| | - Katherine Janeway
- Department of Pediatric Oncology, Dana Farber / Boston Children’s Cancer and Blood Disorders Center, Boston, MA, USA
| | - Don Barkauskas
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Timothy M. Fan
- Department of Veterinary Clinical Medicine, University of Illinois, Urbana IL USA
| | - Richard Gorlick
- Division of Pediatric Hematology and Oncology, The Children’s Hospital at Montefiore, Bronx, New York, USA
| | - Chand Khanna
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda MD, USA
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28
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Bielack S, Kevric M. High BMI at diagnosis is not associated with inferior survival in patients with osteosarcoma. A report from the Cooperative Osteosarcoma Study Group. Pediatr Blood Cancer 2014; 61:952. [PMID: 24127430 DOI: 10.1002/pbc.24817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 09/12/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Stefan Bielack
- Pediatrics 5 (Oncology, Hematology, Immunology; Gastroenterology, Rheumatology, General Pediatrics), Klinikum Stuttgart, Olgahospital, Stuttgart, Germany; Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster, Germany
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