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Harrison DJ, Qumseya A, Xue W, Arnold M, Lautz TB, Hiniker SM, Thomas SM, Venkatramani R, Weiss AR, Mascarenhas L. Adolescents and young adults with rhabdomyosarcoma: A report from the Soft Tissue Sarcoma Committee of the Children's Oncology Group. Pediatr Blood Cancer 2024; 71:e30847. [PMID: 38282125 DOI: 10.1002/pbc.30847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 12/02/2023] [Accepted: 12/21/2023] [Indexed: 01/30/2024]
Abstract
INTRODUCTION The impact of established prognostic factors on survival outcomes for childhood rhabdomyosarcoma (RMS) have not been well described in the adolescent and young adult (AYA) RMS patient population. METHODS This is a retrospective analysis of patients with newly diagnosed RMS enrolled between 1997 and 2016 on seven previously reported Children's Oncology Group (COG) clinical trials. Demographics, clinical features, treatment details, and outcome data were collected. Five-year event-free survival (EFS) and overall survival (OS) were estimated for patients diagnosed at age 15-39 years and those diagnosed under age 15 years using the Kaplan-Meier method. Log-rank test was used to compare prognostic factors for EFS and OS. Factors significant in the univariable analysis were included in a Cox proportional hazards regression model. Nonsignificant covariates were removed from the multiple regression model. RESULTS Total 2151 patients including 402 AYAs were analyzed. AYAs were more likely to present with primary tumors ≥5 cm in size, metastatic disease, alveolar histology, and have FOXO1 fusions compared to children. Five-year EFS for the AYA cohort was 44.2% versus 67% for children (p < .001), and 5-year OS was 52% for the AYA cohort versus 78% for children (p < .001). Multivariable analysis revealed tumor site, size and invasiveness, clinical group, and histology were prognostic in AYAs. CONCLUSION AYAs with RMS have a poorer prognosis compared to younger children due to multiple factors. Further research focused on AYAs to better understand RMS biology and improve treatments is critical to improve survival.
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Affiliation(s)
| | | | - Wei Xue
- University of Florida, Gainesville, Florida, USA
| | - Michael Arnold
- Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Timothy B Lautz
- Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
| | | | | | - Rajkumar Venkatramani
- Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center, Houston, Texas, USA
| | | | - Leo Mascarenhas
- Children's Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles, California, USA
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Oberoi S, Qumseya A, Xue W, Venkatramani R, Weiss AR. Outcome of patients with relapsed or refractory nonrhabdomyosarcoma soft tissue sarcomas enrolled in phase 2 cooperative group clinical trials: A report from the Children's Oncology Group. Cancer 2024. [PMID: 38470405 DOI: 10.1002/cncr.35276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND The aim of this study was to estimate the event-free survival (EFS) of children and young adults with relapsed or refractory nonrhabdomyosarcoma soft tissue sarcoma (NRSTS) treated in nonrandomized phase 2 studies conducted by the Children's Oncology Group (COG) and predecessor groups to establish a benchmark EFS for future phase 2 NRSTS trials evaluating the activity of novel agents. METHODS A retrospective analysis of patients with recurrent or refractory NRSTS prospectively enrolled in nonrandomized phase 2 COG and predecessor group trials between 1994 and 2015 was conducted. EFS was defined as disease progression/relapse or death and calculated via the Kaplan-Meier method. The log-rank test and relative risk regression were used to compare EFS distribution by age at enrollment, sex, race, NRSTS histology, prior lines of therapy, calendar year of trial, and type of radiographic response. RESULTS In total, 137 patients were enrolled in 13 phase 2 trials. All trials used radiographic response rate as a primary outcome, and none of the agents used were considered active on the basis of trial-specified thresholds. The estimated median EFS and 6-month EFS of the entire study cohort was 1.5 months (95% confidence interval [CI], 1.3-1.8 months) and 19.4% (95% CI, 12.7%-26%), respectively. No difference in EFS was observed by age at enrollment, sex, race, NRSTS histology subtype, prior lines of therapies, and trial initiation year. EFS significantly differed by radiographic response. CONCLUSIONS The EFS for children and young adults with relapsed or refractory NRSTS remains suboptimal. Established EFS can be referenced as a benchmark for future single-agent phase 2 trials incorporating potentially active novel agents in this population.
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Affiliation(s)
- Sapna Oberoi
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatric Hematology-Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Amira Qumseya
- Department of Biostatistics, College of Public Health and Health Professions College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Wei Xue
- Department of Biostatistics, College of Public Health and Health Professions College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Rajkumar Venkatramani
- Division of Hematology/Oncology, Department of Pediatrics, Texas Children's Cancer Center, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Aaron R Weiss
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Maine Medical Center, Portland, Maine, USA
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Schloemer NJ, Xue W, Qumseya A, Luo LY, Hiniker SM, Lautz TB, Rhee DS, Arnold MA, Venkatramani R. Prognosis of children and young adults with newly diagnosed rhabdomyosarcoma metastatic to bone marrow treated on Children's Oncology Group studies. Pediatr Blood Cancer 2023; 70:e30701. [PMID: 37783659 DOI: 10.1002/pbc.30701] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/15/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children. Metastatic disease occurs in 16% of all RMS cases and has a poor prognosis. There are limited studies examining the outcomes specific to patients with RMS metastatic to bone marrow despite an incidence of 6% at diagnosis. Our study aims to document the outcomes, prognostic factors, and clinical courses of children presenting with RMS metastatic to bone marrow treated on Children's Oncology Group (COG) cooperative trials. METHODS We performed a retrospective analysis of the patients diagnosed with RMS metastatic to bone marrow between 1997 and 2013 enrolled on one of four COG RMS clinical trials of D9802, D9803, ARST0431, and ARST08P1. RESULTS We identified 179 cases with RMS metastatic to bone marrow. Patients had a median age of 14.8 years, 58% were male, predominantly alveolar histology (76%), extremity was the most common primary site (32%), and 87% had metastatic disease to additional sites; 83% (n = 149) received radiation as a treatment modality. The 3- and 5-year event-free survival was 9.4% and 8.2%, respectively. The 3- and 5-year overall survival was 26.1% and 12.6%, respectively. Age ≥10 years, alveolar histology, FOXO1 fusion presence, unfavorable primary location, higher Oberlin score, and lack of radiation were identified as poor prognostic/predictive characteristics. CONCLUSIONS This study represents the largest analysis of RMS metastatic to bone marrow, defining the poor prognostic outcome for these patients. These patients may be eligible for therapy deintensification or early pursuit of novel treatments/approaches that are desperately needed.
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Affiliation(s)
- Nathan J Schloemer
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Wei Xue
- Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Amira Qumseya
- Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Leo Y Luo
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Susan M Hiniker
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Timothy B Lautz
- Department of Surgery, Division of Pediatric Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniel S Rhee
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael A Arnold
- Department of Pathology and Laboratory Medicine, Children's Hospital Colorado, Aurora, Colorado, USA
- Department of Pathology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rajkumar Venkatramani
- Texas Children's Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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Lautz TB, Xue W, Luo LY, Fair D, Qumseya A, Gao Z, Dasgupta R, Rodeberg D, Venkatramani R. Management and outcomes of chest wall rhabdomyosarcoma: A report from the Children's Oncology Group Soft Tissue Sarcoma Committee. Pediatr Blood Cancer 2023; 70:e30357. [PMID: 37070563 PMCID: PMC10391743 DOI: 10.1002/pbc.30357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/05/2023] [Accepted: 03/20/2023] [Indexed: 04/19/2023]
Abstract
INTRODUCTION Rhabdomyosarcoma (RMS) of the chest wall presents unique management challenges and local control considerations. The benefit of complete excision is uncertain and must be weighed against potential surgical morbidity. Our aim was to assess factors, including local control modality, associated with clinical outcomes in children with chest wall RMS. METHODS Forty-four children with RMS of the chest wall from low-, intermediate-, and high-risk Children's Oncology Group studies were reviewed. Predictors of local failure-free survival (FFS), event-free survival (EFS), and overall survival (OS) were assessed, including clinical characteristics and staging, primary tumor anatomic locations, and local control modalities. Survival was assessed by Kaplan-Meier analysis and the log-rank test. RESULTS Tumors were localized in 25 (57%) and metastatic in 19 (43%), and they involved the intercostal region (52%) or superficial muscle alone (36%). Clinical group was I (18%), II (14%), III (25%), and IV (43%), and ultimately 19 (43%) patients had surgical resection (upfront or delayed), including 10 R0 resections. Five-year local FFS, EFS, and OS were 72.1%, 49.3%, and 58.5%, respectively. Univariate factors associated with local FFS included age, International Rhabdomyosarcoma Study (IRS) group, extent of surgical excision, tumor size, superficial tumor location, and presence of regional or metastatic disease. Other than tumor size, the same factors were associated with EFS and OS. CONCLUSIONS Chest wall RMS has variable presentation and outcome. Local control is a significant contributor to EFS and OS. Complete surgical excision, whether upfront or after induction chemotherapy, is usually only possible for smaller tumors confined to the superficial musculature but is associated with improved outcomes. While overall outcomes remain poor for patients with initially metastatic tumors, regardless of local control modality, complete excision may be beneficial for patients with localized tumors if it can be achieved without excess morbidity.
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Affiliation(s)
- Timothy B Lautz
- Department of Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, USA
| | - Wei Xue
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Leo Y Luo
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Douglas Fair
- Division of Hematology/Oncology, Department of Pediatrics, University of Utah, Primary Children's Hospital, Huntsman Cancer Institute, Salt Lake City, Utah, USA
| | - Amira Qumseya
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Zhengya Gao
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Roshni Dasgupta
- Division of Pediatric Surgery, Cincinnati Children's Medical Center, Cincinnati, Ohio, USA
| | - Dave Rodeberg
- Division of Pediatric Surgery, Kentucky Children's Hospital, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Rajkumar Venkatramani
- Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, Texas, USA
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Qumseya B, Qumsiyeh Y, Sarheed A, Rosasco R, Qumseya A. Barrett’s Esophagus in Obese Patient Post-Roux-en-Y Gastric Bypass: a Systematic Review. Obes Surg 2022; 32:3513-3522. [DOI: 10.1007/s11695-022-06272-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/05/2022] [Accepted: 09/05/2022] [Indexed: 11/27/2022]
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Crane JN, Xue W, Qumseya A, Gao Z, Arndt CA, Donaldson SS, Harrison DJ, Hawkins DS, Linardic CM, Mascarenhas L, Meyer WH, Rodeberg DA, Rudzinski ER, Shulkin BL, Walterhouse DO, Venkatramani R, Weiss AR. Clinical group and modified TNM stage for rhabdomyosarcoma: A review from the Children's Oncology Group. Pediatr Blood Cancer 2022; 69:e29644. [PMID: 35253352 PMCID: PMC9233945 DOI: 10.1002/pbc.29644] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 12/14/2022]
Abstract
The Children's Oncology Group (COG) uses Clinical Group (CG) and modified Tumor Node Metastasis (TNM) stage to classify rhabdomyosarcoma (RMS). CG is based on surgicopathologic findings and is determined after the completion of initial surgical procedure(s) but prior to chemotherapy and/or radiation therapy. The modified TNM stage is based on clinical and radiographic findings and is assigned prior to any treatment. These systems have evolved over several decades. We review the history, evolution, and rationale behind the current CG and modified TNM classification systems used by COG for RMS. Data from the seven most recently completed and reported frontline COG trials (D9602, D9802, D9803, ARST0331, ARST0431, ARST0531, ARST08P1) were analyzed, and confirm that CG and modified TNM stage remain relevant and useful for predicting prognosis in RMS. We propose updates based on recent data and discuss factors warranting future study to further optimize these classification systems.
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Affiliation(s)
| | - Wei Xue
- Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL
| | - Amira Qumseya
- Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL
| | - Zhengya Gao
- Department of Biostatistics, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL
| | - Carola A.S. Arndt
- Department of Pediatric and Adolescent Medicine, Mayo Clinic and Foundation, Rochester, MN
| | | | - Douglas J. Harrison
- Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX
| | - Douglas S. Hawkins
- Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA
| | | | - Leo Mascarenhas
- Children's Hospital Los Angeles and University of Southern California Keck School of Medicine, Los Angeles, CA
| | - William H. Meyer
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - David A. Rodeberg
- Division of Pediatric Surgery, Department of Surgery, East Carolina University, Greenville, NC
| | - Erin R. Rudzinski
- Department of Laboratories, Seattle Children’s Hospital, Seattle, WA
| | - Barry L. Shulkin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN
| | - David O. Walterhouse
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Aaron R. Weiss
- Department of Pediatrics, Maine Medical Center, Portland, ME
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Qumseya B, Bukannan A, Rosasco R, Liu X, Qumseya A. Surveillance of Barrett's esophagus using wide-area transepithelial sampling: systematic review and meta-analysis. Endosc Int Open 2022; 10:E394-E402. [PMID: 35433217 PMCID: PMC9010089 DOI: 10.1055/a-1783-9015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 11/10/2021] [Indexed: 11/04/2022] Open
Abstract
Background and study aims Wide-area transepithelial sampling (WATS) is an emerging technique that may increase dysplasia detection in Barrett's esophagus (BE). We conducted a systematic review and meta-analysis of patients who underwent surveillance for BE assessing the additional yield of WATS to forceps biopsy (FB). Methods We searched Pubmed, Embase, Web of science, and the Cochrane library, ending in January 2021. The primary outcomes of interest were the relative and absolute increase in dysplasia detection when adding WATS to FB. Heterogeneity was assessed using I 2 and Q statistic. Publication bias was assessed using funnel plots and classic fail-safe test. Results A total of seven studies were included totaling 2,816 patients. FB identified 158 dysplasia cases, whereas WATS resulted in an additional 114 cases. The pooled risk ratio (RR) of all dysplasia detection was 1.7 (1.43-2.03), P < 0.001, I 2 = 0. For high-grade dysplasia (HGD), the pooled RR was 1.88 (1.28-2.77), P = 0.001, I 2 = 33 %. The yield of WATS was dependent on the prevalence of dysplasia in the study population. Among studies with high rates of dysplasia, the absolute increase in dysplasia detection (risk difference, RD) was 13 % (8 %-18 %, P < 0.0001, number needed to treat [NNT] = 8). The pooled RD in HGD was 9 % (2 %-16 %), P < 0.001, NNT = 11. For studies with a low prevalence of dysplasia, RD for all dysplasia was 2 % (1 %-3 %), P = 0.001, NNT = 50. For HGD, the RD was 0.6 % (0.2 %-1.3 %), P = 0.019, NNT = 166. Conclusions In populations with a high prevalence of dysplasia, adding WATS to FB results in a significant increase in dysplasia detection.
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Affiliation(s)
- Bashar Qumseya
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, Florida, United States
| | - Aymen Bukannan
- Archbold Gastroenterology Group, Thomasville, Georgia, United States
| | - Robyn Rosasco
- Florida A & M University, 334 Palmer Ave, Tallahassee, Florida, United States
| | - Xiuli Liu
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, Florida, United States
| | - Amira Qumseya
- Department of Public Health, University of Florida, Gainesville, Florida, United States
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Qumseya B, Goddard A, Qumseya A, Estores D, Draganov PV, Forsmark C. Barriers to Clinical Practice Guideline Implementation Among Physicians: A Physician Survey. Int J Gen Med 2021; 14:7591-7598. [PMID: 34754231 PMCID: PMC8572046 DOI: 10.2147/ijgm.s333501] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/04/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Clinical practice guidelines can help physicians provide evidence-based, standardized clinical decisions. We aimed to assess physician attitudes toward and barriers to guideline adherence. Methods We conducted a single center, cross-sectional, survey-based study. Physicians from many specialties participated in the study. All outcomes were measured using a validated survey tool. The primary outcome of interest was barriers to guideline adherence. Secondary outcomes included general attitudes toward guidelines and factors that could improve adherence to guidelines. Outcomes were measured by the survey tool. All outcomes were reported on a 5-point Likert scale. Results The email survey was received by 1819 physicians with 400 responders (22% response rate). About 50% (n=200) were in practice for >5 years, while 27% (n=107) were still in training. Trainees were less likely to understand the process of guideline development (RR= 0.76 [0.65–0.88], p=0.0017), to have input in guideline development (RR= 0.52 [0.41–0.65], p<0.0001), and to report up-to-date knowledge in practice guidelines (RR=0.53 [0.30–0.73], p=0.0002). Three factors were identified as major barriers to guideline adherence: complexity of guideline documents (61%, n=240), high number of weak or conditional recommendations (62%, n=245), and time constraints due to clinical responsibilities (65%, n=255). Factors that would improve guideline adherence included access to relevant guidelines at the point of care (87%), improved focus on guidelines during training (82%), and transparency on physician commercial affiliation (62%). Conclusion Improved focus on guidelines during training and access to relevant guidelines at the point of care may be important to improve adherence to guidelines.
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Affiliation(s)
- Bashar Qumseya
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL, USA
| | - April Goddard
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL, USA
| | - Amira Qumseya
- College of Public Health & Health Professions, Department of Biostatistics, Children's Oncology Group Statistics & Data Center, University of Florida, Gainesville, FL, USA
| | - David Estores
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL, USA
| | - Peter V Draganov
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL, USA
| | - Christopher Forsmark
- Division of Gastroenterology, Hepatology and Nutrition, University of Florida, Gainesville, FL, USA
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Qumseya BJ, Bartel MJ, Gendy S, Bain P, Qumseya A, Wolfsen H. High rate of over-staging of Barrett's neoplasia with endoscopic ultrasound: Systemic review and meta-analysis. Dig Liver Dis 2018; 50:438-445. [PMID: 29573963 DOI: 10.1016/j.dld.2018.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 12/07/2017] [Accepted: 02/06/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The use of endoscopic ultrasound (EUS) to stage patients with Barrett's esophagus (BE) with suspected neoplasia is controversial due to high rates of over-staging. However, this rate of over-staging has not been adequately investigated or quantified. AIM To determine the rate of over-staging related EUS in this population. METHODS Search included Medline, Embase, Web of Science, and Cochrane Central ending on 9/30/2016. The primary effect-estimate of interest was the false positive rate of advanced disease on EUS at the tumor level (T1a vs. T1b). Secondary outcomes included false detection rate, false negative rate, accuracy, sensitivity, and specificity. Study heterogeneity was assessed using the I2 and Cochrane's Q. RESULTS Of 1872 studies, 11 met our inclusion criteria totaling 895 patients. Based on random effects models, the pooled FPR for advanced disease was 9.1% ([6.5-12.5%], p<0.001). Tests of heterogeneity showed no significant heterogeneity for this outcome. The pooled false negative rate was 9.2% [95%CI: 4.7-17.3%], p<0.01. Overall, the pooled accuracy of EUS results in BE neoplasia patients was low at 74.6% [58.7-85.8%], p=0.004. CONCLUSIONS The use of EUS in BE patients with dysplasia and early neoplasia results in a large proportion of patients falsely over-staged and under-staged.
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Affiliation(s)
- Bashar J Qumseya
- Division of Gastroenterology and Hepatology, Archbold Medical Group/Florida State University, United States.
| | - Michael J Bartel
- Division of Gastroenterology, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Sherif Gendy
- Florida A&M University, Tallahassee, FL, United States
| | - Paul Bain
- Harvard Medical School, Boston, MA, United States
| | - Amira Qumseya
- Evidence-Based Research Institute, Tallahassee, FL, United States
| | - Herbert Wolfsen
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, United States
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Qumseya BJ, Wani S, Desai M, Qumseya A, Bain P, Sharma P, Wolfsen H. Adverse Events After Radiofrequency Ablation in Patients With Barrett's Esophagus: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2016; 14:1086-1095.e6. [PMID: 27068041 DOI: 10.1016/j.cgh.2016.04.001] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 03/29/2016] [Accepted: 04/01/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Radiofrequency ablation (RFA) with or without endoscopic mucosal resection (EMR) is routinely used for treatment of Barrett's esophagus with dysplasia. Despite the relative safety of this method, there have been imprecise estimates of the rate of adverse events. We performed a systematic review and meta-analysis to assess the rate of adverse events associated with RFA with and without EMR. METHODS We searched MEDLINE, Embase, Web of Science, and Cochrane Central through October 22, 2014. The primary outcome of interest was the overall rate of adverse events after RFA with or without EMR. We used forest plots to contrast effect sizes among studies. RESULTS Of 1521 articles assessed, 37 met our inclusion criteria (comprising 9200 patients). The pooled rate of all adverse events from RFA with or without EMR was 8.8% (95% confidence interval [CI], 6.5%-11.9%); 5.6% of patients developed strictures (95% CI, 4.2%-7.4%), 1% had bleeding (95% CI, 0.8%-1.3%), and 0.6% developed a perforation (95% CI, 0.4%-0.9%). In studies that compared RFA with vs without EMR, the relative risk for adverse events was significantly higher for RFA with EMR (4.4) (P = .015). There was a trend toward higher proportions of adverse events in prospective studies compared with retrospective studies (11.3% vs 7.8%, P = .20). Other factors associated with adverse events included Barrett's esophagus and length and baseline histology. CONCLUSIONS In a systematic review and meta-analysis, we found the relative risk for adverse events from RFA to be about 4-fold higher with EMR than without; we identified factors associated with these events. Endoscopists should discuss these risks with patients before endoscopic eradication therapy.
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Affiliation(s)
- Bashar J Qumseya
- Division of Gastroenterology and Hepatology, Archbold Medical Group/Florida State University, Thomasville, Georgia.
| | - Sachin Wani
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Madhav Desai
- Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Kansas
| | - Amira Qumseya
- Department of Biostatistics, Florida State University, Tallahassee, Florida
| | - Paul Bain
- Harvard School of Public Health, Boston, Massachusetts
| | - Prateek Sharma
- Division of Gastroenterology and Hepatology, Veterans Affairs Medical Center and University of Kansas School of Medicine, Kansas City, Kansas
| | - Herbert Wolfsen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida
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