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Gmunder KN, Ruiz JW, Franceschi D, Suarez MM. Demographics associated with US healthcare disparities are exacerbated by the telemedicine surge during the COVID-19 pandemic. J Telemed Telecare 2024; 30:64-71. [PMID: 34160328 DOI: 10.1177/1357633x211025939] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION As coronavirus disease 2019 (COVID-19) hit the US, there was widespread and urgent implementation of telemedicine programs nationwide without much focus on the impact on patient populations with known existing healthcare disparities. To better understand which populations cannot access telemedicine during the coronavirus disease 2019 pandemic, this study aims to demographically describe and identify the most important demographic predictors of telemedicine visit completion in an urban health system. METHODS Patient de-identified demographics and telemedicine visit data (N = 362,764) between March 1, 2020 and October 31, 2020 were combined with Internal Revenue Service 2018 individual income tax data by postal code. Descriptive statistics and mixed effects logistic regression were used to determine impactful patient predictors of telemedicine completion, while adjusting for clustering at the clinical site level. RESULTS Many patient-specific demographics were found to be significant. Descriptive statistics showed older patients had lower rates of completion (p < 0.001). Also, Hispanic patients had statistically significant lower rates (p < 0.001). Overall, minorities (racial, ethnic, and language) had decreased odds ratios of successful telemedicine completion compared to the reference. DISCUSSION While telemedicine use continues to be critical during the coronavirus disease 2019 pandemic, entire populations struggle with access-possibly widening existing disparities. These results contribute large datasets with significant findings to the limited research on telemedicine access and can help guide us in improving telemedicine disparities across our health systems and on a wider scale.
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Affiliation(s)
| | - Jose W Ruiz
- Department of Otolaryngology, University of Miami Miller School of Medicine, USA
| | - Dido Franceschi
- Department of Surgery, University of Miami Miller School of Medicine, USA
| | - Maritza M Suarez
- Department of Medicine, University of Miami Miller School of Medicine, USA
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Seldon C, Grossman JG, Shrivastava G, Fernandez M, Jin W, Conaway S, Rosenberg A, Livingstone A, Franceschi D, Jonczak E, Trent J, Subhawong T, Studenski MT, Yechieli R. CivaSheet® use for soft tissue sarcoma: A single institution experience. Brachytherapy 2023; 22:649-654. [PMID: 37271655 DOI: 10.1016/j.brachy.2023.03.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 02/28/2023] [Accepted: 03/05/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE CivaSheet is a palladium-103, implantable, intraoperative radiation therapy device which emits unidirectional radiation that enables boost doses in patients who have otherwise received the maximum radiation dose. Here, we present our initial clinical experience with the first 10 cases using this new technology. METHODS AND MATERIALS A retrospective chart review of all patients with STS treated with surgical resection and CivaSheet placement at the University of Miami Hospital, a tertiary care center, from January 2018 to December 2019, was performed. Adjuvant radiation was administered by a palladium-103 implant, which delivered an average of 47 Gy (35-55) to a depth of 5 mm. RESULTS Nine patients underwent CivaSheet placement from January 2018 until December 2019 for a total of 10 CivaSheets placed (1 patient had 2 CivaSheets inserted) and followed for a mean of 27 months (4-45 months). Four tumors were located in the retroperitoneum, two in the chest, two in the groin, and two within the lower extremity. At the time of tumor resection and CivaSheet placement, tumor sizes ranged from 2.5 cm to 13.8 cm with an average of 7.6 cm. Four patients necessitated musculocutaneous tissue flaps for closure and reconstruction. All patients with Grade 4 complications had flap reconstruction and prior radiation. Four patients' tumors recurred locally for a local recurrence rate of 40%. Three patients had modified accordion Grade 4 complications necessitating additional surgery for CivaSheet removal. Extremity tumors unanimously developed modified accordion Grade 4 adverse events. CONCLUSIONS CivaSheet may be an acceptable alternative treatment modality compared to prior brachytherapy methods.
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Affiliation(s)
- Crystal Seldon
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Julie G Grossman
- Department of Surgical Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Gautam Shrivastava
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Melanie Fernandez
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - William Jin
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Sheila Conaway
- Department of Orthopedic Surgery, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Andrew Rosenberg
- Department of Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Alan Livingstone
- Department of Surgical Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Dido Franceschi
- Department of Surgical Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Emily Jonczak
- Department of Hematology Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Jonathan Trent
- Department of Hematology Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Ty Subhawong
- Department of Radiology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Matthew T Studenski
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - Raphael Yechieli
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL.
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Meng J, Tao J, Abu Y, Sussman DA, Girotra M, Franceschi D, Roy S. HIV-Positive Patients on Antiretroviral Therapy Have an Altered Mucosal Intestinal but Not Oral Microbiome. Microbiol Spectr 2023; 11:e0247222. [PMID: 36511710 PMCID: PMC9927552 DOI: 10.1128/spectrum.02472-22] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/27/2022] [Indexed: 12/15/2022] Open
Abstract
This study characterized compositional and functional shifts in the intestinal and oral microbiome in HIV-positive patients on antiretroviral therapy compared to HIV-negative individuals. Seventy-nine specimens were collected from 5 HIV-positive and 12 control subjects from five locations (colon brush, colon wash, terminal ileum [TI] brush, TI wash, and saliva) during colonoscopy and at patient visits. Microbiome composition was characterized using 16S rRNA sequencing, and microbiome function was predicted using bioinformatics tools (PICRUSt and BugBase). Our analysis indicated that the β-diversity of all intestinal samples (colon brush, colon wash, TI brush, and TI wash) from patients with HIV was significantly different from patients without HIV. Specifically, bacteria from genera Prevotella, Fusobacterium, and Megasphaera were more abundant in samples from HIV-positive patients. On the other hand, bacteria from genera Ruminococcus, Blautia, and Clostridium were more abundant in samples from HIV-negative patients. Additionally, HIV-positive patients had higher abundances of biofilm-forming and pathogenic bacteria. Furthermore, pathways related to translation and nucleotide metabolism were elevated in HIV-positive patients, whereas pathways related to lipid and carbohydrate metabolism were positively correlated with samples from HIV-negative patients. Our analyses further showed variations in microbiome composition in HIV-positive and negative patients by sampling site. Samples from colon wash, colon brush, and TI wash were significant between groups, while samples from TI brush and saliva were not significant. Taken together, here, we report altered intestinal microbiome composition and predicted function in patients with HIV compared to uninfected patients, though we found no changes in the oral microbiome. IMPORTANCE Over 37 million people worldwide are living with HIV. Although the availability of antiretroviral therapy has significantly reduced the number of AIDS-related deaths, individuals living with HIV are at increased risk for opportunistic infections. We now know that HIV interacts with the trillions of bacteria, fungi, and viruses in the human body termed the microbiome. Only a limited number of previous studies have compared variations in the oral and gastrointestinal microbiome with HIV infection. Here, we detail how the oral and gastrointestinal microbiome changes with HIV infection, having used 5 different sampling sites to gain a more comprehensive view of these changes by location. Our results show site-specific changes in the intestinal microbiome associated with HIV infection. Additionally, we show that while there were significant changes in the intestinal microbiome, there were no significant changes in the oral microbiome.
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Affiliation(s)
- Jingjing Meng
- Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
| | - Junyi Tao
- Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
| | - Yaa Abu
- Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
| | - Daniel Andrew Sussman
- Department of Gastroenterology, University of Miami Medical Group, Miami, Florida, USA
| | - Mohit Girotra
- Department of Gastroenterology, University of Miami Medical Group, Miami, Florida, USA
| | - Dido Franceschi
- Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
| | - Sabita Roy
- Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
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Burke J, Friedman-Eldar O, Halfteck G, Silva IDC, Baumrucker CC, Reyes FV, Lessard AS, Kassira W, Franceschi D, Kesmodel SB, Avisar E, Goel N, Möller MG. Persistent and interdependent: Racial disparities and their mechanisms in postmastectomy breast reconstruction. Surgery 2022; 172:25-30. [PMID: 35241302 DOI: 10.1016/j.surg.2022.01.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Racial disparities in accessing postmastectomy breast reconstruction persist despite expansion of insurance coverage. An updated examination with a broad assessment of mediating factors in a "majority minority" community is needed. METHODS Data were collected on all patients undergoing mastectomy for breast cancer from 2011 to 2019 in a private academic center and adjacent safety-net hospital. Multivariable logistic regression was used to assess the effect of race on postmastectomy breast reconstruction, controlling for predetermined potentially mediating and confounding variables. RESULTS Of 1,554 patients, 63.8% (n = 203) of non-Hispanic White, 33.4% (n = 102) of Black, and 47.9% (n = 438) of Hispanic patients underwent postmastectomy breast reconstruction. Multivariable logistic regression showed that Black patients (odds ratio [OR] 3.6, 95% confidence internal [CI]: 2.2-5.9; P < .0001) undergo significantly less postmastectomy breast reconstruction than White patients. Age, insurance status, stage, and hospital type mediated this relationship. CONCLUSION Black patients have substantially reduced rates of postmastectomy breast reconstruction compared with White patients, which is mediated by socioeconomic factors.
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Affiliation(s)
- Jonathan Burke
- Department of Surgery, New York University School of Medicine, NY.
| | - Orli Friedman-Eldar
- University of Miami Miller School of Medicine, FL; Jackson Memorial Hospital, Miami, FL
| | - Gili Halfteck
- University of Miami Miller School of Medicine, FL; Jackson Memorial Hospital, Miami, FL
| | | | | | | | - Anne-Sophie Lessard
- Division of Plastic Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, FL
| | - Wrood Kassira
- Division of Plastic Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, FL
| | - Dido Franceschi
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, FL
| | - Susan B Kesmodel
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, FL
| | - Eli Avisar
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, FL
| | - Neha Goel
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, FL
| | - Mecker G Möller
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, FL. https://twitter.com/MeckeritaMoller
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Friedman-Eldar O, Ozmen T, El Haddi SJ, Goel N, Tjendra Y, Kesmodel SB, Moller MG, Franceschi D, Layton C, Avisar E. Axillary Response to Neoadjuvant Therapy in Node-Positive, Estrogen Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Breast Cancer Patients: Predictors and Oncologic Outcomes. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11473-9. [PMID: 35303178 DOI: 10.1245/s10434-022-11473-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/02/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND One potential benefit of neoadjuvant therapy (NAT) in node-positive, estrogen receptor-positive (ER+), human epidermal growth factor receptor 2-negative (HER2-) patients is axillary downstaging to avoid axillary dissection. OBJECTIVE The aim of this study was to evaluate axillary response to NAT with chemotherapy (NCT) or endocrine therapy (NET) and identify potential predictors of response. METHODS A prospectively collected database was queried for node-positive, ER+, HER2- breast cancer patients treated with NAT and surgery from January 2011 to September 2020. Axillary response was categorized into pathologic complete response (pCR) versus no pCR, and was correlated to demographic and clinicopathologic parameters in a logistic regression model. RESULTS A cohort of 176 eligible patients was identified and 178 breast cancers were included in the study. The overall axillary pCR rate was 12.3% (22/178). NCT and NET achieved response rates of 13.9% (19/137) and 7.3% (3/41), respectively (p = 0.232). A significantly higher axillary pCR rate was identified in patients with clinical stage II at diagnosis (12/60, 20%) compared with stage III (10/118, 8.4%; p = 0.03). NET patients with ypN0 were younger and were treated for a longer period of time (>6 months). Completion axillary dissection was omitted in the majority (73.7%) of NCT patients achieving axillary pCR. CONCLUSIONS For patients with node-positive, ER+, HER2- breast cancer, a lower burden of disease at the time of diagnosis (stage II) is associated with a significantly higher axillary pCR, enabling those patients to be spared axillary dissection. Further studies are necessary to define the role of genomic profiling in predicting axillary response.
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Affiliation(s)
- Orli Friedman-Eldar
- Department of Surgical Oncology, Jackson Memorial Hospital, Miami, FL, USA.
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Tolga Ozmen
- Department of Surgical Oncology, Jackson Memorial Hospital, Miami, FL, USA
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Salah James El Haddi
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Neha Goel
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Youley Tjendra
- Division of Surgical Pathology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Susan B Kesmodel
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mecker G Moller
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dido Franceschi
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Christina Layton
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eli Avisar
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Friedman-Eldar O, Ozmen T, Haddi SJE, Goel N, Tjendra Y, Kesmodel SB, Moller MG, Franceschi D, Layton C, Avisar E. ASO Visual Abstract: Axillary Response to Neoadjuvant Therapy in Node-Positive ER+/HER2- Breast Cancer Patients-Predictors and Oncologic Outcomes. Ann Surg Oncol 2022. [PMID: 35286530 DOI: 10.1245/s10434-022-11531-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Orli Friedman-Eldar
- Department of Surgical Oncology, Jackson Memorial Hospital, Miami, FL, USA. .,Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Tolga Ozmen
- Department of Surgical Oncology, Jackson Memorial Hospital, Miami, FL, USA.,Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Salah James El Haddi
- Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Neha Goel
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Youley Tjendra
- Division of Surgical Pathology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Susan B Kesmodel
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mecker G Moller
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dido Franceschi
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Christina Layton
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eli Avisar
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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Suarez M, Botwinick A, Akkiraju R, Pebanco G, Franceschi D, Ruiz J, Reis D, Weiss RE. Automation of mass vaccination against COVID-19 at an academic health center. JAMIA Open 2021; 4:ooab102. [PMID: 34927000 PMCID: PMC8672935 DOI: 10.1093/jamiaopen/ooab102] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/11/2021] [Accepted: 11/09/2021] [Indexed: 11/12/2022] Open
Abstract
As vaccines against COVID-19 became available for distribution, the University of Miami addressed several challenges to facilitate vaccine allocation to the highest risk employees, patients, and students. Advanced use of technology allowed for the automation of key processes in the mass vaccination effort, which expedited vaccine outreach and scheduling, while maintaining routine delivery of healthcare services. The University's employees were initially prioritized for vaccination; employees who opted in were stratified into 5 vaccine administration phases. A similar process was implemented for students. When the state of Florida mandated expansion of vaccine allocation to include individuals aged 65 and older, an algorithm for patients was designed, taking into account age, comorbidities, date of last visit, and presence of an activated patient portal account. Innovative use of technology allowed for 19 000 vaccines to be administered within the first 37 days, which comprised 100% vaccine allotment, without wasting a single vaccine dose.
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Affiliation(s)
- Maritza Suarez
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Avi Botwinick
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ravi Akkiraju
- UHealth Information Technology Department, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Gilbert Pebanco
- UHealth Information Technology Department, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Dido Franceschi
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jose Ruiz
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - David Reis
- UHealth Information Technology Department, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Roy E Weiss
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
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Friedman-Eldar O, Layton C, De Castro Silva I, Moller MG, Allen A, Franceschi D, Isrow D, Samuels S, Takita C, Avisar E. Surgical and Oncologic Outcomes With Intraoperative Radiation Therapy for Early Breast Cancer. Am Surg 2021:31348211047499. [PMID: 34732085 DOI: 10.1177/00031348211047499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND For selected patients with early-stage breast cancer (BC), intraoperative radiation therapy (IORT) has emerged as a convenient alternative to standard whole breast irradiation (WBI). We report a single institution experience with IORT in terms of oncologic outcomes, toxicities, and cosmesis. METHODS Clinicopathological and perioperative outcomes of patients who underwent IORT for early-stage BC at a public hospital from 2017 to 2020 were retrospectively retrieved. Toxicity was categorized to acute or chronic based on 6 months post-IORT cutoff. RESULTS 85 patients underwent IORT and had complete data, aged 49-85 years (mean 62). Intraoperative radiation therapy added 23 minutes on average to the total operative time. Final stage was 0, I, and II in 40%, 58.9%, and 1.1% of patients, respectively. Mean tumor size was 0.8 cm (range .1-2.1), with ductal histology comprising 94% of cases. Surgical margins were positive in 2 patients, and adjuvant WBI was required in 5 patients. After a median follow-up of 17 months (range 3-41), none of the patients had local recurrence and no mortality was recorded. Early wound complications included wound dehiscence (n = 1), seroma/hematoma (n = 15), and re-operation with loss of nipple-areola complex (n = 1). Chronic skin toxicities were reported in 10 (12%) patients and good or excellent cosmetic outcome was reported in 93% of patients. CONCLUSIONS Utilizing IORT among low-risk early BC patients may be a safe and more convenient alternative to traditional WBI, with low toxicity rate, acceptable cosmetic results, and good oncologic outcomes at 17 months. Longer follow-up and further prospective controlled studies are needed to confirm these findings.
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Affiliation(s)
- Orli Friedman-Eldar
- Department of Surgical Oncology, 23215Jackson Memorial Hospital, Miami, FL, USA.,Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, 12235University of Miami Miller School of Medicine, Miami, FL, USA
| | - Christina Layton
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, 12235University of Miami Miller School of Medicine, Miami, FL, USA
| | - Iago De Castro Silva
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, 12235University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mecker G Moller
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, 12235University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ahkeel Allen
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, 12235University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dido Franceschi
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, 12235University of Miami Miller School of Medicine, Miami, FL, USA
| | - Derek Isrow
- Department of Radiation Oncology, 12235University of Miami Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, FL, USA
| | - Stuart Samuels
- Department of Radiation Oncology, 12235University of Miami Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, FL, USA
| | - Cristiane Takita
- Department of Radiation Oncology, 12235University of Miami Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, FL, USA
| | - Eli Avisar
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, 12235University of Miami Miller School of Medicine, Miami, FL, USA
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Collier AL, Kronenfeld J, Franceschi D, Sleeman D, Livingstone AS, Thorson CM. Minimizing Complications with Minimally Invasive Distal Pancreatectomy for Pancreatic Malignancy. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.08.302] [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] [Indexed: 10/20/2022]
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10
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Collier AL, Kronenfeld J, Franceschi D, Livingstone AS, Sleeman D, Thorson CM. Nationwide Outcomes of Pancreaticoduodenectomy for Pancreatic Malignancies: Center Volume Matters. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.07.275] [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] [Indexed: 10/20/2022]
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Kronenfeld JP, Collier AL, Khalafi S, Sleeman D, Franceschi D, Livingstone AS, Thorson CM. Disparities in Insurance Access Affect Outcomes in Pancreaticoduodenectomy: An Analysis of Nationwide Complications and Readmissions. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.07.229] [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] [Indexed: 11/28/2022]
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12
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Gmunder KN, Ruiz JW, Franceschi D, Suarez MM. Factors to Effective Telemedicine Visits During the COVID-19 Pandemic: Cohort Study. JMIR Med Inform 2021; 9:e27977. [PMID: 34254936 PMCID: PMC8404776 DOI: 10.2196/27977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/05/2021] [Accepted: 07/10/2021] [Indexed: 02/01/2023] Open
Abstract
Background With COVID-19 there was a rapid and abrupt rise in telemedicine implementation often without sufficient time for providers or patients to adapt. As telemedicine visits are likely to continue to play an important role in health care, it is crucial to strive for a better understanding of how to ensure completed telemedicine visits in our health system. Awareness of these barriers to effective telemedicine visits is necessary for a proactive approach to addressing issues. Objective The objective of this study was to identify variables that may affect telemedicine visit completion in order to determine actions that can be enacted across the entire health system to benefit all patients. Methods Data were collected from scheduled telemedicine visits (n=362,764) at the University of Miami Health System (UHealth) between March 1, 2020 and October 31, 2020. Descriptive statistics, mixed effects logistic regression, and random forest modeling were used to identify the most important patient-agnostic predictors of telemedicine completion. Results Using descriptive statistics, struggling telemedicine specialties, providers, and clinic locations were identified. Through mixed effects logistic regression (adjusting for clustering at the clinic site level), the most important predictors of completion included previsit phone call/SMS text message reminder status (confirmed vs not answered) (odds ratio [OR] 6.599, 95% CI 6.483-6.717), MyUHealthChart patient portal status (not activated vs activated) (OR 0.315, 95% CI 0.305-0.325), provider’s specialty (primary care vs medical specialty) (OR 1.514, 95% CI 1.472-1.558), new to the UHealth system (yes vs no) (OR 1.285, 95% CI 1.201-1.374), and new to provider (yes vs no) (OR 0.875, 95% CI 0.859-0.891). Random forest modeling results mirrored those from logistic regression. Conclusions The highest association with a completed telemedicine visit was the previsit appointment confirmation by the patient via phone call/SMS text message. An active patient portal account was the second strongest variable associated with completion, which underscored the importance of patients having set up their portal account before the telemedicine visit. Provider’s specialty was the third strongest patient-agnostic characteristic associated with telemedicine completion rate. Telemedicine will likely continue to have an integral role in health care, and these results should be used as an important guide to improvement efforts. As a first step toward increasing completion rates, health care systems should focus on improvement of patient portal usage and use of previsit reminders. Optimization and intervention are necessary for those that are struggling with implementing telemedicine. We advise setting up a standardized workflow for staff.
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Affiliation(s)
| | - Jose W Ruiz
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Dido Franceschi
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Maritza M Suarez
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States
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13
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Baumrucker C, Remer L, Franceschi D, Livingstone AS, Macedo FI. Contemporary trends and survival outcomes of females with esophageal cancer in the United States. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e16100] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16100 Background: Esophageal cancer (EC) is historically a male dominant disease. Current evidence on the impact of gender on clinical presentation and survival outcomes of EC is limited by small sample size or single institution series. Methods: Patients with EC (stage I-III) were identified in the NCDB (2004-2016). Clinicopathologic and treatment characteristics of male and female patients were compared using Chi-square analysis. Kaplan-Meier and Cox multivariable regression were used to estimate overall survival (OS). Results: Of 62,893 patients included, most patients were male (77.7%). Adenocarcinoma was the most common subtype (66.7%). Squamous cell carcinoma was more predominant in females (57.1% vs. 26.5%, p<0.001). Females were older (68.5 vs. 66.1 yrs; p<0.001) and more likely African American (AA, 14% vs. 8.1%; p<0.001). Females presented with more local disease (stage I, 19.6% vs. 18.2%; p<0.001) while males presented with more locoregional disease (LRD, stage II/III, 80.4% vs 81.8%, p<0.001). Of those with LRD, females less frequently received chemotherapy (CT, 75.4% vs. 82.9%, p<0.001), radiation therapy (RT, 78.9% vs. 82.6%, p<0.001), and esophagectomy (EG, 28% vs. 40.5%, p<0.001). White females with LRD received less CT (76.2% vs. 83.9%, p<0.001), RT (79.5% vs. 83.3%, p<0.001), and EG (30.6% vs. 43.5%, p<0.001). AA females with LRD received less CT (71.9% vs. 75.2%, p=0.013) and RT (77.4% vs. 80.5%, p=0.013) but had similar rates of EG as AA males (p=0.476). Females had worse OS than males (18.1 vs. 19.7mo, p=0.001; cI: 23.5 vs. 31.9mo, p<0.001; LRD: 17.2 vs 18.3mo, p=0.473). White females had worse OS than white males (18.6 vs. 20.4mo, p<0.001) while AA females had better OS (13.5 vs. 12.6mo, p=0.001). White females who underwent EG had improved OS over white males (47.6 vs 38mo, p<0.001) while AA males and females who underwent EG had similar OS (p=0.473). Female gender, older age, AA race, high comorbidity score and clinical stage, and lack of access to CT, RT, and EG were independent predictors of mortality (Table 1). Conclusions: Females with EC seem to have less access to CT, RT, and EG with worse OS than males. Healthcare policies should focus on increasing access to standard treatments for female patients with EC.[Table: see text]
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Affiliation(s)
- Camille Baumrucker
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Lindsay Remer
- University of Miami Miller School of Medicine, Miami, FL
| | - Dido Franceschi
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Alan S Livingstone
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Francis Igor Macedo
- North Florida Regional Medical Center, University of Central Florida College of Medicine, Gainesville, FL
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Pace R, Giuliani V, Di Nasso L, Pagavino G, Franceschi D, Franchi L. Regenerative Endodontic Therapy using a New Antibacterial Root Canal Cleanser in necrotic immature permanent teeth: Report of two cases treated in a single appointment. Clin Case Rep 2021; 9:1870-1875. [PMID: 33936606 PMCID: PMC8077429 DOI: 10.1002/ccr3.3696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/06/2020] [Revised: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 12/20/2022] Open
Abstract
A case of regenerative endodontics: (a) before treatment; (b) post-treatment Xray; (c) follow-up at 6 months; (d) follow-up at 12 months.
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Affiliation(s)
- R Pace
- Department of Experimental and Clinical Medicine University of Florence Italy
| | - V Giuliani
- Department of Experimental and Clinical Medicine University of Florence Italy
| | - L Di Nasso
- Department of Experimental and Clinical Medicine University of Florence Italy
| | - G Pagavino
- Department of Experimental and Clinical Medicine University of Florence Italy
| | - D Franceschi
- Department of Experimental and Clinical Medicine University of Florence Italy
| | - L Franchi
- Department of Experimental and Clinical Medicine University of Florence Italy
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15
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Goel N, Yadegarynia S, Rodgers S, Kelly K, Collier A, Franceschi D, Moller M, Avisar E, Kesmodel SB. Axillary response rates to neoadjuvant chemotherapy in breast cancer patients with advanced nodal disease. J Surg Oncol 2021; 124:25-32. [PMID: 33852160 DOI: 10.1002/jso.26480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/08/2021] [Accepted: 03/15/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Utilization of sentinel lymph node biopsy (SLNB) in breast cancer patients with positive nodes after neoadjuvant chemotherapy (NAC) has increased. We examine axillary response rates after NAC in patients with clinical N2-3 disease to determine whether SLNB should be considered. METHODS Breast cancer patients with clinical N2-3 (AJCC 7th Edition) disease who received NAC followed by surgery were selected from our institutional tumor registry (2009-2018). Axillary response rates were assessed. RESULTS Ninety-nine patients with 100 breast cancers were identified: 59 N2 (59.0%) and 41 (41.0%) N3 disease; 82 (82.0%) treated with axillary lymph node dissection (ALND) and 18 (18.0%) SLNB. The majority (99.0%) received multiagent NAC. In patients undergoing ALND, cCR was observed in 20/82 patients (24.4%), pathologic complete response (pCR) in 15 patients (18.3%), and axillary pCR in 17 patients (20.7%). In patients with a cCR, pCR was identified in 60.0% and was most common in HER2+ patients (34.6%). CONCLUSION In this analysis of patients with clinical N2-3 disease receiving NAC, 79.3% of patients had residual nodal disease at surgery. However, 60.0% of patients with a cCR also had a pCR. This provides the foundation to consider evaluating SLNB and less extensive axillary surgery in this select group.
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Affiliation(s)
- Neha Goel
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sina Yadegarynia
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Steve Rodgers
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Kristin Kelly
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Amber Collier
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Dido Franceschi
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mecker Moller
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Eli Avisar
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Susan B Kesmodel
- Division of Surgical Oncology, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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16
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Baumrucker C, Franceschi D, Livingstone AS, Macedo FI. Impact of gender on treatment and survival of patients with esophageal cancer in the United States. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.173] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
173 Background: Esophageal cancer (EC) is historically a male-predominant disease. Current available evidence on the impact of gender on clinical presentation and survival outcomes of EC is limited by small sample size or single institutional series. Methods: Patients with EC (stage I-III) were identified in the National Cancer Data Base (NCDB, 2004-2016). Clinicopathologic and treatment characteristics of male and female patients were compared using Chi-square analysis. Overall survival (OS) was estimated using Kaplan-Meier method and Cox proportional hazards regression. Results: Of 62,893 patients included, male gender was predominant (77.7% vs 22.3%). Adenocarcinoma was the most common subtype (66.7%); however, squamous cell carcinoma was more predominant in females (57.1% vs. 26.5%, p<0.001). Females were significantly older (68.5 vs. 66.1 years; p<0.001) and more likely African American (AA) (14% vs. 8.1%; p<0.001). Females were more likely to present with local disease (stage I, 19.6% vs. 18.2%; p<0.001), while males presented more likely with locoregional disease (LRD, stage II/III, 80.4% vs 81.8%, p<0.001). Females had worse OS compared to males (18.1 vs. 19.7 mo; p=0.001; cI: 23.5 vs. 31.9mo, p<0.001; cII/III: 17.2 vs 18.3mo, p=0.473). White females had worse OS than white males (18.6 vs. 20.4mo, p<0.001), while AA females had better OS (13.5 vs. 12.6mo, p=0.001). Among patients with LRD, females less frequently received chemotherapy (CT, 75.4% vs. 82.9%, p<0.001), radiation therapy (RT, 78.9% vs. 82.6%, p<0.001), and esophagectomy (28% vs. 40.5%, p<0.001). Females who underwent esophagectomy had improved OS over males (40.3 vs. 32.7mo; p<0.001). More specifically, white females who underwent esophagectomy had improved OS over white males (47.6 vs 38mo, p<0.001); however, AA males and females who underwent esophagectomy had similar OS (33.8 vs 32.6mo, p=0.452). Female gender, advanced age, AA race, high comorbidity score and clinical stage, and lack of access to CT, RT, and esophagectomy were independent predictors of mortality (Table). Conclusions: Females with EC seem to have less access to CT, RT and esophagectomy, which is associated with worse OS compared to males. Healthcare policies should be implemented to increase access to standard of care treatment for female patients with EC. [Table: see text]
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Affiliation(s)
- Camille Baumrucker
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Dido Franceschi
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Alan S Livingstone
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Francis Igor Macedo
- North Florida Regional Medical Center, University of Central Florida College of Medicine, Gainesville, FL
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17
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Franceschi D, Suarez MM, Ruiz JW, Seo D, Merchant NB. A Novel Interdisciplinary Iterative Approach for Optimizing the Electronic Health Record to Improve Perioperative Efficiency. Ann Surg 2020; 272:669-675. [PMID: 32932324 DOI: 10.1097/sla.0000000000004347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE We present a holistic perioperative optimization approach led by a CI team with the goal to optimize the workflow within our EHR, improve operative room metrics and user satisfaction. SUMMARY OF BACKGROUND DATA The EHR has become integral to perioperative care. Many approaches are utilized to improve performance including systems-based approaches, process redesign, lean methodology, checklists, root cause analysis, and parallel processing. Although most reports describe strategies improving day or surgery productivity, few include perioperative interventions to improve efficiencies. METHODS An interdisciplinary CI team consisting of clinicians, informatics specialists, and analysts spent 6 weeks assessing users and optimizing all perioperative areas (scheduling, day of surgery, postop discharge/admission). Elbow-to-elbow retraining and simultaneous content development was performed utilizing an Agile workflow process optimization with the Scrum framework. This iterative approach averaged 1 week from build to change implementation. Pre/post optimization surveys were sent. RESULTS Two hundred forty-two perioperative enhancements were completed. While most impacted documentation, all areas were enhanced including billing, reporting, registration, device integration, scheduling, central supply, and so on. FCOTS improved from <70% to >85% and total delay was halved. These parameters were consistently sustained for over 1 year after the 6-week optimization. While only 5% of pre-optimization users agreed to proficiency in the EHR system, this improved to 70% post-optimization. Furthermore, EHR confidence and acceptance improved from 40% to 90%. CONCLUSIONS To improve workflow efficiency, all who contribute to the perioperative process must be assessed. This IT driven initiative resulted in improved FCOTS, perioperative workflows, and user satisfaction.
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Affiliation(s)
- Dido Franceschi
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Maritza M Suarez
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Jose W Ruiz
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida
| | - David Seo
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Nipun B Merchant
- Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
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18
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Baumrucker C, Cohen B, Macedo FI, Franceschi D. The Effect of Hospital Volume on Outcomes of Patients with Occult Breast Cancer. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.027] [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] [Indexed: 11/27/2022]
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19
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Baumrucker CC, Spring SR, Cohen BL, Millen JC, Macedo FI, Franceschi D. The Effect of Hospital Volume on Outcomes of Patients with Occult Breast Cancer. Ann Surg Oncol 2020; 28:2128-2135. [PMID: 32914387 DOI: 10.1245/s10434-020-09103-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/20/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION With limited data in regards to management, occult breast cancer (OBC) poses a challenging surgical scenario. Current surgical management includes axillary lymphadenectomy (ALND) with or without mastectomy. We sought to investigate the impact of hospital volume on surgical approach and survival outcomes of patients with OBC. METHODS Patients with cT0N+ breast cancer were selected from the National Cancer Data Base (NCDB, 2004-2014). Primary outcome was overall survival (OS), calculated using Kaplan-Meier methods compared according to hospital volume: community cancer center (CC), comprehensive community cancer center (COMP), and academic center (AC). Secondary outcome was the rate of modified radical mastectomy (MRM). RESULTS We identified 574 patients with OBC, 11.1% were treated at a CC, 51.8% at a COMP, and 37.0% at an AC. Patients treated at CC had lower socioeconomic status compared with COMP or AC (23.1%, 14.1%, 19.3%; p = 0.005, respectively). There was no difference in access to radiation therapy (p = 0.888) or neoadjuvant chemotherapy (p = 0.221). Patients treated at CC had worse OS compared with COMP or AC (87.04, 105.29, 108.06 mo, p = 0.026, respectively). There was an increased rate of MRM at CC compared with COMP or AC (54.7%, 41.2%, 30.5%, p = 0.003, respectively). CONCLUSIONS A direct association seems to exist between hospital volume and outcomes of patients with OBC. Patients with OBC treated at AC were more likely to undergo breast-conserving approaches and had better survival than those treated at CC.
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Affiliation(s)
- Camille C Baumrucker
- Division of Surgical Oncology, Dewitt-Daughtry Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Samantha R Spring
- Division of Surgical Oncology, Dewitt-Daughtry Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Brianna L Cohen
- Division of Surgical Oncology, Dewitt-Daughtry Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Janelle-Cheri Millen
- Division of Surgical Oncology, Department of Surgery, North Florida Regional Medical Center, University of Central Florida College of Medicine, Gainesville, FL, USA
| | - Francis I Macedo
- Division of Surgical Oncology, Department of Surgery, North Florida Regional Medical Center, University of Central Florida College of Medicine, Gainesville, FL, USA
| | - Dido Franceschi
- Division of Surgical Oncology, Dewitt-Daughtry Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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20
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Azab B, Macedo FI, Chang D, Ripat C, Franceschi D, Livingstone AS, Yakoub D. The Impact of Prolonged Chemotherapy to Surgery Interval and Neoadjuvant Radiotherapy on Pathological Complete Response and Overall Survival in Pancreatic Cancer Patients. Clin Med Insights Oncol 2020; 14:1179554920919402. [PMID: 32669884 PMCID: PMC7336830 DOI: 10.1177/1179554920919402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 03/04/2020] [Indexed: 01/15/2023]
Abstract
Background: We aimed to study the impact of neoadjuvant chemotherapy to surgery (NCT-S)
interval and neoadjuvant radiotherapy (NRT) on pathological complete
response (pCR) and overall survival (OS) in pancreatic cancer (pancreatic
ductal adenocarcinoma [PDAC]). Methods: National Cancer Data Base (NCDB)–pancreatectomy patients who underwent
NCT/NRT were included. The NCT-S interval was divided into time quintiles in
weeks: 8 to 11, 12 to 14, 15 to 19, 20 to 29, and >29 weeks. Results: A total of 2093 patients with NCT were included with median follow-up of
74 months and 71% NRT. The pCR rate was 2.1% with higher median OS compared
with non-pCR (41 vs 19 months, P = .03). The pCR rate
increased with longer NCT-S interval (quintiles: 1%, 1.6%, 1.7%, 3%, and 6%,
P < .001, respectively). In logistic regression, NRT
(odds ratio [OR] = 2.5, 95% confidence interval [CI]: 1.1-6.1,
P = .03) and NCT-S >29 weeks (OR = 6.1, 95%
CI = 2.02-18.50, P < .001) were predictive of increased
pCR. The prolonged NCT-S interval and pCR were independent predictors of OS,
whereas NRT was not. Conclusions: Longer NCT-S interval and pCR were independent predictors of improved OS in
patients with PDAC. The NRT predicted increased pCR but not OS.
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Affiliation(s)
- Basem Azab
- Surgical Oncology, Sentara Healthcare, Sentara CarePlex Hospital, Hampton, VA, USA
| | - Francisco Igor Macedo
- Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David Chang
- Virginia Oncology Associate, Hampton, VA, USA
| | - Caroline Ripat
- Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dido Franceschi
- Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alan S Livingstone
- Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Danny Yakoub
- Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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21
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Azab B, Amundson JR, Cioci A, Stuart H, Yakoub D, Avisar E, Moffat F, Livingstone AS, Franceschi D. The Usefulness of the Pretreatment Neutrophil/Lymphocyte Ratio as a Predictor of the 5-Year Survival in Stage 1-3 Triple Negative Breast Cancer Patients. Breast Care (Basel) 2020; 16:43-49. [PMID: 33716631 DOI: 10.1159/000506463] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/16/2020] [Indexed: 11/19/2022] Open
Abstract
Background We have previously shown that the neutrophil/lymphocyte ratio (NLR) is a predictor of survival among breast cancer patients. The aim of this study was to determine the predictive value of NLR among different nodal and chemotherapy subgroups of triple negative breast cancer (TNBC). Methods Patients with stage 1-3 TNBC who underwent treatment from 2007 to 2014 and had blood counts prior to treatments were included. Patients were categorized into high (≥2) and low (<2) NLR groups. Primary outcomes were overall survival (OS) and disease-free survival (DFS). Results The average follow-up time was 54 months. The high NLR group had worse OS (HR 2.8, CI 1.3-5.9, p < 0.001) and DFS (HR 2.3, CI 1.2-4.2, p < 0.001) than the low NLR group. After adjusting for confounding variables, high NLR was an independent prognostic factor for both OS (HR 5.5, CI 2.2-13.7, p < 0.0001) and DFS (HR 5.2, CI 2.3-11.6, p < 0.0001). Categorization of TNBC patients by NLR (high vs. low) and nodal status (positive vs. negative) resulted in four groups with significantly different OS and DFS (log rank p < 0.0001). Significant improvements in OS (p < 0.001) and DFS (p < 0.001) were observed for patients who received chemotherapy and had high NLR but not for patients with low NLR (p = 0.65 and p = 0.07, respectively). Conclusion High pretreatment NLR is an independent predictor of poor OS and DFS among TNBC patients. Combining NLR and pN provides better risk stratification for TNBC patients. Chemotherapy appears to be beneficial only in patients with high NLR. Larger prospective studies are needed to validate these findings.
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Affiliation(s)
- Basem Azab
- Surgical Oncology, Sentara Healthcare, Hampton, Virginia, USA
| | - Julia R Amundson
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Alessia Cioci
- Department of Surgical Oncology, University of Miami, Miami, Florida, USA
| | - Heather Stuart
- Department of Surgical Oncology, University of British Colombia, Vancouver, British Columbia, Canada
| | - Danny Yakoub
- Department of Surgical Oncology, University of Tennessee, Memphis, Tennessee, USA
| | - Eli Avisar
- Department of Surgical Oncology, University of Miami, Miami, Florida, USA
| | - Fredrick Moffat
- Department of Surgical Oncology, University of Miami, Miami, Florida, USA
| | - Alan S Livingstone
- Department of Surgical Oncology, University of Miami, Miami, Florida, USA
| | - Dido Franceschi
- Department of Surgical Oncology, University of Miami, Miami, Florida, USA
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22
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Cohen BL, Collier AL, Kelly KN, Goel N, Kesmodel SB, Yakoub D, Moller M, Avisar E, Franceschi D, Macedo FI. Surgical Management of the Axilla in Patients with Occult Breast Cancer (cT0 N+) After Neoadjuvant Chemotherapy. Ann Surg Oncol 2020; 27:1830-1841. [PMID: 31989360 DOI: 10.1245/s10434-020-08227-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Occult breast cancer (OBC) is a rare clinical entity. Current surgical management includes axillary lymphadenectomy (ALND) with or without mastectomy. We sought to investigate the role of sentinel lymph node biopsy (SLNB) in patients with OBC treated with neoadjuvant chemotherapy (NAC). METHODS Patients with clinical T0N+ breast cancer were selected from the National Cancer Data Base (NCDB, 2004-2014) and compared according to axillary surgical approach, SLNB (≤ 4 LNs) or ALND (> 4 LNs). Primary outcome was overall survival (OS), calculated using Kaplan-Meier methods. Secondary outcome was complete pathological response (pCR). RESULTS A total of 684 patients with OBC were identified: 470 (68.7%) underwent surgery upfront and 214 (31.3%) received NAC. Of the NAC patients, 34 (15.9%) underwent SLNB and 180 (84.1%) ALND. One hundred and fifty-three (72%) patients received radiotherapy (RT). There was no difference in pCR rates between the ALND and SLNB (34.3% vs 24.5%, respectively p = 0.245). In patients undergoing surgery first, improved OS was observed with ALND compared to SLNB (106.9 vs 85.5 months, p = 0.013); however, no difference in OS was found in patients who received NAC (105.6 vs 111.3 months, p = 0.640). RT improved OS in patients who underwent NAC followed by SLNB (RT, 123 months vs no RT, 64 months, p = 0.034). Of NAC patients who did not undergo RT, ALND had superior survival compared to SLNB (113 vs 64 months, p = 0.013). CONCLUSION This is the first comparative analysis assessing the surgical management of the axilla in patients with OBC who underwent NAC. In this population, there was a decrease in survival in patients who underwent SLNB alone; however, with the addition of RT, there was no difference in OS between SLNB and ALND. SLNB plus RT may be considered as an alternative to ALND in patients with OBC who have a good response to NAC.
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Affiliation(s)
- Brianna L Cohen
- Division of Surgical Oncology, Dewitt-Daughtry Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Amber L Collier
- Division of Surgical Oncology, Dewitt-Daughtry Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kristin N Kelly
- Division of Surgical Oncology, Dewitt-Daughtry Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Neha Goel
- Division of Surgical Oncology, Dewitt-Daughtry Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Susan B Kesmodel
- Division of Surgical Oncology, Dewitt-Daughtry Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Danny Yakoub
- Division of Surgical Oncology, University of Tennessee at Memphis, Memphis, TN, USA
| | - Mecker Moller
- Division of Surgical Oncology, Dewitt-Daughtry Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eli Avisar
- Division of Surgical Oncology, Dewitt-Daughtry Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dido Franceschi
- Division of Surgical Oncology, Dewitt-Daughtry Department of Surgery, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Francis I Macedo
- Department of Surgery, North Florida Regional Medical Center, University of Central Florida College of Medicine, Gainesville, FL, USA.
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Macedo FI, Mesquita-Neto JW, Kelly KN, Azab B, Yakoub D, Merchant NB, Livingstone AS, Franceschi D. Utility of Radiation After Neoadjuvant Chemotherapy for Surgically Resectable Esophageal Cancer. Ann Surg Oncol 2019; 27:662-670. [PMID: 31788752 DOI: 10.1245/s10434-019-07788-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Neoadjuvant chemotherapy (NAC) ± radiation (NRT) is the "gold standard" approach for locally advanced esophageal cancer (EC). However, the benefits of RT on overall survival (OS) in patients with resectable EC undergoing neoadjuvant therapy followed by esophagectomy remain controversial. METHODS The National Cancer Data Base was queried for patients with nonmetastatic EC between 2004 and 2014. Kaplan-Meier, log-rank, and Cox multivariable regression analysis were performed to analyze OS. Logistic regression analyzed factors associated with 90-day mortality, lymph node involvement, and complete pathological response (pCR). RESULTS A total of 12,238 EC patients who underwent neoadjuvant therapy [neoadjuvant chemoradiation (NACR), 92.1% and NAC, 7.9%] followed by esophagectomy were included. OS was similar in patients undergoing NAC ± RT (35.9 vs. 37.6 mo, respectively, p = 0.393). pCR rate was 18.1% (19.2%, NACR vs. 6.3%, NAC, p < 0.001). NRT was an independent predictor for increased pCR (HR 2.593, p < 0.001). Patients with pCR had increased survival compared with those without pCR (62.3 vs. 34.4 mo, p < 0.001); however, no difference was found between NACR and NAC (61.7 mo vs. median not reached, p = 0.745) in pCR patients. In non-pCR patients, NAC had improved OS compared with NACR (37.3 vs. 30.8 mo, p = 0.002). NRT was associated with worse 90-day mortality (8.2% vs. 7.7%, HR1.872, p = 0.036) In Cox regression, NRT was an independent predictor of worse OS (HR 1.561, p < 0.001). CONCLUSIONS Neoadjuvant RT is associated with improved pCR rates; however, it had deleterious effects in short- and long-term survival. Also, patients who did not achieve pCR had worse OS after neoadjuvant RT.
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Affiliation(s)
- Francis I Macedo
- Department of Surgery, North Florida Regional Medical Center, University of Central Florida College of Medicine, Gainesville, FL, USA.
| | | | - Kristin N Kelly
- Division of Surgical Oncology, Dewitt-Daughtry Department of Surgery, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Basem Azab
- Sentara Careplex Hospital, Sentara Healthcare System, Hampton, VA, USA
| | - Danny Yakoub
- Department of Surgery, University of Tennessee School of Medicine, Memphis, TN, USA
| | - Nipun B Merchant
- Division of Surgical Oncology, Dewitt-Daughtry Department of Surgery, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alan S Livingstone
- Division of Surgical Oncology, Dewitt-Daughtry Department of Surgery, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dido Franceschi
- Division of Surgical Oncology, Dewitt-Daughtry Department of Surgery, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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Kelly KN, Ryon E, Allen A, Franceschi D, Moller M, Avisar E, Kobetz EN, Merchant N, Kesmodel SB, Goel N. Overcoming Disparities: Multidisciplinary Breast Cancer Care at a Public Safety-Net Hospital. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.351] [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] [Indexed: 11/16/2022]
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Kelly KN, Ryon E, Macedo FIB, Franceschi D, Moller M, Avisar E, Kobetz EN, Merchant N, Kesmodel SB, Goel N. Comprehensive Analysis of Breast Cancer Survival Outcomes in a Public Safety-Net Hospital Compared with an Adjacent Academic Cancer Center. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.324] [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] [Indexed: 10/25/2022]
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Macedo FI, Picado O, Hosein PJ, Dudeja V, Franceschi D, Mesquita-Neto JW, Yakoub D, Merchant NB. Does Neoadjuvant Chemotherapy Change the Role of Regional Lymphadenectomy in Pancreatic Cancer Survival? Pancreas 2019; 48:823-831. [PMID: 31210664 DOI: 10.1097/mpa.0000000000001339] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The objective of this study was to evaluate the role of lymph node (LN) dissection and staging in outcomes of patients with pancreatic adenocarcinoma (PDAC) who underwent neoadjuvant chemotherapy (NAC). METHODS National Cancer Database was queried for patients with stages I to III PDAC diagnosed between 2004 and 2014. Overall survival (OS) was derived from Kaplan-Meier methods, and Cox-regression model was used to evaluate associations between the number of LN examined, number of positive nodes, and LN ratio with OS. RESULTS A total 35,599 patients were included, 3395 (9%) underwent NAC, 19,865 (56%) received adjuvant chemotherapy (AC), and 12,299 (35%) underwent surgery alone. Cox-regression showed superior OS in NAC compared with AC and surgery alone (26 vs 23 vs 14 months, P < 0.001). Minimum number of LN examined affecting OS was 8 LNs in NAC (23.8 vs 26.6 months, P = 0.029), and 12 LNs in AC group (22 vs 23.1 months, P = 0.028). Lymph node ratio cutoff of greater than 0.2 was associated with decreased OS (19.4 vs 24.4 months, P < 0.001). CONCLUSIONS Neoadjuvant chemotherapy is associated with improved survival in PDAC. Lymph node yield remains a significant prognostic factor after NAC, whereas the minimum number of harvested LNs associated with sufficient staging and survival is decreased.
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Affiliation(s)
| | | | | | | | | | - Jose Wilson Mesquita-Neto
- Department of Surgery, Karmanos Comprehensive Cancer Center, Wayne State University School of Medicine, Detroit, MI
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Azab B, Macedo FI, Picado O, Ripat C, Franceschi D, Livingstone AS, Yakoub D. The value of lymphadenectomy in esophageal cancer after neoadjuvant chemoradiation. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.79] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
79 Background: There are conflicting reports on the value of the extent of post neoadjuvant chemoradiation (NCRT) lymphadenectomy (LND) in locally advanced esophageal adenocarcinoma (E-ADC) and squamous cell carcinoma (E-SCC). We sought to study the impact of LND variables [positive and total lymph node (LN) number and LN ratio (LNR)] on oncological outcomes in these patients. Methods: The National Cancer Data Base 2004-2014 was queried for patients with NCRT followed by esophagectomy. The median examined LN number was used to divide the patients into a higher (> 12) and lower (≤ 12) LND groups. The primary outcome was overall survival (OS) and secondary outcomes were 30- and 90-day postoperative mortality. Results: A total 4708 patients were included. The median of positive, negative LN, and LNR were and (0, 11, 0%). The median and 5-year OS for higher LND group were higher than the lower LND group (39 vs. 32 months, 38% vs. 34%), p < 0.0001. OS was not significantly different among E-SCC subset or among those who achieved pathological complete response (pCR). The higher LND group had better 30- and 90-day postoperative mortality rates (61/2335 = 2.6%, 141/2308 = 6.1%) than lower LND group (86/2262 = 3.8%, 184/2251 = 8.2%), p = 0.01 and 0.001, respectively . In multivariate Cox regression analysis, higher LND group (HR 0.88, 95% CI 0.81-0.96, p = 0.004) and LNR (per 10% increase: 1.11, 95% CI 1.09-1.13, p < 0.0001) were significant predictor of OS. Conclusions: The LND (> 12 examined LN) remains as a crucial treatment goal after NCRT with potential survival benefit, especially among E-ADC and those did not achieve pCR.
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Affiliation(s)
| | | | - Omar Picado
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Caroline Ripat
- University of Miami Miller School of Medicine, Miami, FL
| | - Dido Franceschi
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Alan S Livingstone
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Danny Yakoub
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
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Macedo FI, Azab B, Picado O, Yakoub D, Livingstone AS, Franceschi D, Dudeja V, Merchant NB. Impact of neoadjuvant radiation on survival in patients with pancreatic cancer undergoing neoadjuvant chemotherapy followed by pancreatectomy. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.453] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
453 Background: Pancreatic adenocarcinoma (PDAC) carries a dismal prognosis. Neoadjuvant chemoradiation therapy (NACR) has been introduced to enhance the outcomes of patients with borderline resectable and locally advanced PDAC, however the role of radiation therapy remains largely unknown. Methods: The National Cancer Database (NCDB) was queried for patients with stage I-III PDAC who underwent surgical resection from 2004 to 2014. Patients undergoing NACR were compared to those undergoing neoadjuvant chemotherapy (NAC) alone. The association between clinical characteristics and overall survival (OS) was assessed using the Kaplan-Meier method and multivariable Cox regression model. Results: Of 3,133 patients, 2,351 (75%) patients underwent NACR and 782 (25%), NAC alone. Most patients were Caucasians (84%), treated at academic institutions (67%) and underwent pancreaticoduodenectomy (74%). Median follow-up time was 32 months (IQR, 22-50 months). Median number of lymph nodes examined (LNE) and number of positive nodes (NPN) were significantly decreased in NACR (13 vs. 16, p < 0.001 and 0 vs. 1, p < 0.001, respectively). Rates of margin positivity, median OS and 5-year OS were similar between 2 groups (NACR vs. NAC: 15% vs. 17%, p = 0.545; 25.7 months (95% CI 24.4–26.7) vs. 25.1 months (95% CI: 23.9–27.5), and 20% vs. 22%, p = 0.616, respectively, Figure 1). Subgroup analysis of high-risk features (R1/R2 and N1) also showed no difference in survival outcomes. Neoadjuvant radiation was not an independent predictor associated with OS, whereas advanced age, R1/R2, T3/T4, N1, and poorly differentiated histology were independent negative prognostic factors. Conclusions: NACR is associated with lower rates of lymph node positivity, however this did not translate in survival or margin positivity benefit compared to NAC alone. The role of radiotherapy in PDAC continues to evolve, however no convincing data is currently available to advocate the widespread use of radiotherapy in the neoadjuvant setting. Further evidence with prospective clinical trials is still warranted to confirm these findings.
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Affiliation(s)
- Francis Igor Macedo
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | | | - Omar Picado
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Danny Yakoub
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Alan S Livingstone
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Dido Franceschi
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Vikas Dudeja
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Nipun B. Merchant
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
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Macedo FI, Kelly K, Yakoub D, Franceschi D, Livingstone AS, Merchant NB. Utility of radiation after neoadjuvant chemotherapy for surgically resectable esophageal cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.172] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
172 Background: Neoadjuvant chemotherapy (NAC) is the gold standard approach for locally advanced esophageal cancer (EC), however the addition of radiation remains largely controversial. We sought to investigate the role of neoadjuvant radiation in resectable EC by comparing outcomes of patients who underwent neoadjuvant chemotherapy with (NACR) or without radiation (NAC) using a large nationwide cohort. Methods: National Cancer Data Base (NCDB) was queried for patients with non-metastatic EC between 2010 and 2014. Kaplan-Meier, log-rank and Cox multivariable regression analysis were performed to calculate overall survival (OS). Logistic regression was used to identify factors associated with 90-day mortality and complete pathological response (pCR). Results: A total of 12,546 EC patients who underwent neoadjuvant therapy were included: the majority were males (84%), Caucasians (90.3%), and had adenocarcinoma (81.1%), cT3 (60.6%) and cN1 (49.1%). 11,269 (89.8%) patients had NACR, whereas 969 (7.7%), NAC alone. pCR rate was 14.1% (19.2%, NACR vs. 6.3%, NAC, p < 0.001). Neoadjuvant radiation was an independent predictor for improved pCR [HR 0.305, 95% CI 0.205-0.454, p < 0.001], however OS was similar in patients undergoing NAC with or without radiation (35.9 vs. 37.6 months, respectively, p = 0.393). This persisted regardless of tumor staging. There was a trend towards worse 90-day mortality after radiation (8.2%, NACR vs. 7.7%, NAC; HR 1.410, 95% CI 0.975-2.038, p = 0.068). In Cox regression, controlling for patient and disease-related factors, neoadjuvant radiation was an independent predictor of worse OS (HR 1.322, 965% CI 1.177-1.485, p < 0.001). Conclusions: This is the largest study comparing NACR versus NAC in resected EC. The addition of radiation to neoadjuvant chemotherapy is associated with improved pathological response rates, however it had deleterious effects in long-term and possibly, short-term survival. Our findings suggest that NAC without radiation may be the optimal neoadjuvant therapy in resectable EC, however further evidence with randomized clinical trials is warranted.
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Affiliation(s)
- Francis Igor Macedo
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Kristin Kelly
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Danny Yakoub
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Dido Franceschi
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Alan S Livingstone
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Nipun B. Merchant
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
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Azab B, Macedo FI, Picado O, Franceschi D, Livingstone AS, Yakoub D. The impact of neoadjuvant chemoradiation versus chemotherapy on short and long-term outcomes among gastric carcinoma patients. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.78] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
78 Background: There is little consensus on the use of neoadjuvant chemoradiation (NCRT) versus neoadjuvant chemotherapy (NCT) in gastric carcinoma (GC) patients. We sought to compare the outcomes of these two approaches in a large national data base. Methods: National Cancer Data Base PUF (2004-2014) of GC patients who underwent NCRT/NCT followed by resection were included. Primary outcome was overall survival (OS), secondary outcomes were pathological complete response (pCR), R0 resection and postoperative mortality. Results: A total of 4204 GC patients with NCT were included, 62% of them had additional neoadjuvant radiotherapy (NRT). NCRT had higher pCR and R0 rates [551/2613 (21%), 2314/2561 (90%)] than NCT group [148/1573 (9%), 1242/1543 (80%)], p < 0.0001. Multivariate logistic regression showed similar higher odds of pCR (OR 2.8, 95% CI 1.65-4.60, p < 0.0001) and R0 (OR 1.5, 95% CI 1.14-1.99, p = 0.004) among NCRT versus NCT. There was no significant difference in length of hospital stay, 30-day readmission rate, 30- and 90-day postoperative mortality. Median, 3- and 5-year OS for NCRT versus NCT were: (20.4 months, 24% and 11%) versus (18.3 months, 19% and 6%), p < 0.001. Univariate cox regression analysis showed superior OS with NRT (HR 0.9, 95% CI 0.80-0.91, p < 0.001). After adjusting for confounding variables, pCR (HR 0.2, 95% CI 0.18-0.24, p < 0.001) and R0 (HR 0.7, 95% CI 0.61-0.75, p < 0.001) had better OS, while NRT was not. Conclusions: NRT improved pCR and R0 rates in GC without increase in surgical morbidity/mortality. The long-term OS benefit of NRT is likely secondary to higher pCR and R0 resection.
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Affiliation(s)
| | | | - Omar Picado
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Dido Franceschi
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Alan S Livingstone
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
| | - Danny Yakoub
- Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, FL
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Azab B, Macedo FI, Cass SH, Ripat C, Razi SS, Picado O, Franceschi D, Livingstone AS, Yakoub D. A large national comparative study of clinicopathological features and long-term survivals between esophageal gastrointestinal stromal tumor and leiomyosarcoma. Am J Surg 2018; 218:323-328. [PMID: 30471808 DOI: 10.1016/j.amjsurg.2018.10.046] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 10/25/2018] [Accepted: 10/29/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Esophageal gastrointestinal stromal tumors (E-GIST) and leiomyosarcoma (E-LMS) are rare tumors. Previous studies are limited to small number of patients. We sought to study these two tumors using a large national database. METHODS The National Cancer Data Base 2004-2014 was queried for patients with E-GIST and E-LMS. The primary outcome was overall survival (OS). Univariate and multivariable Cox regression models were used to investigate OS predictors. RESULTS We found 141 E-GIST and 38 E-LMS patients, with esophagectomy and systemic treatment rate of 55% and 49% for E-GIST and 50% and 26% for E-LMS. The 5-year OS of E-GIST and E-LMS were 62% and 23%, respectively, p < 0.001. In multivariable analysis, young age, tumor <10 cm, esophagectomy, and E-GIST were associated with superior OS. There was a higher median and mean OS with neoadjuvant vs. upfront surgery for E-GIST group (98 and 111 vs 79 and 80 months). CONCLUSION E E-GIST has superior OS compared to E-LMS. Esophagectomy is the cornerstone treatment modality. Further studies are needed to evaluate the role of neoadjuvant therapy in E-GIST patients.
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Affiliation(s)
- Basem Azab
- Surgical Oncology, Sentara Careplex Hospital, Sentara Healthcare System, Hampton, VA, USA.
| | - Francisco Igor Macedo
- Surgical Oncology Division, Department of Surgery, University of Miami, Miami, FL, USA
| | - Samuel H Cass
- Surgical Oncology Division, Department of Surgery, University of Miami, Miami, FL, USA
| | - Caroline Ripat
- Surgical Oncology Division, Department of Surgery, University of Miami, Miami, FL, USA
| | - Syed S Razi
- Surgical Oncology Division, Department of Surgery, University of Miami, Miami, FL, USA
| | - Omar Picado
- Surgical Oncology Division, Department of Surgery, University of Miami, Miami, FL, USA
| | - Dido Franceschi
- Surgical Oncology Division, Department of Surgery, University of Miami, Miami, FL, USA
| | - Alan S Livingstone
- Surgical Oncology Division, Department of Surgery, University of Miami, Miami, FL, USA
| | - Danny Yakoub
- Surgical Oncology Division, Department of Surgery, University of Miami, Miami, FL, USA
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Azab B, Amundson JR, Picado O, Ripat C, Macedo FI, Franceschi D, Livingstone AS, Yakoub D. Impact of Chemoradiation-to-Surgery Interval on Pathological Complete Response and Short- and Long-Term Overall Survival in Esophageal Cancer Patients. Ann Surg Oncol 2018; 26:861-868. [DOI: 10.1245/s10434-018-6897-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Indexed: 12/25/2022]
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Picado O, Dygert L, Macedo FI, Franceschi D, Sleeman D, Livingstone AS, Merchant N, Yakoub D. The Role of Surgical Resection for Stage IV Gastric Cancer With Synchronous Hepatic Metastasis. J Surg Res 2018; 232:422-429. [PMID: 30463751 DOI: 10.1016/j.jss.2018.06.067] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/23/2018] [Accepted: 06/20/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND With improved responses to chemotherapy and targeted treatments, the role of surgery in metastatic gastric cancer (MGC) to the liver needs to be revisited. We sought to examine whether surgical resection is associated with improvement of long-term survival. METHODS The National Cancer Database was queried for MGC to the liver (2010-2014). Survival analysis was performed to compare the effect of gastrectomy and perioperative chemotherapy (G-CT) to palliative chemotherapy (PCT) alone. RESULTS We identified 3175 patients with MGC to the liver. Most patients (94%, n = 2979) were treated with PCT, whereas 6% (n = 196 patients) underwent G-CT. Overall survival improved in patients treated with G-CT compared to PCT alone (16 versus 9.7 mo, P < 0.001). In patients undergoing G-CT, neoadjuvant chemotherapy was associated with increased overall survival compared to adjuvant chemotherapy (18.9 versus 14.8 mo, P = 0.011). Hazards of death significantly decreased with gastrectomy (hazard ratio [HR]: 0.53, 95% confidence interval [CI]: 0.44-0.63, P < 0.001). Negative prognostic factors included advanced age (HR: 1.10, 95% CI: 1.06-1.14, P < 0.001), treatment at nonacademic institution (HR: 1.23, 95% CI: 1.13-1.33, P < 0.001), and poorly differentiated grade (HR: 1.54, 95% CI: 1.17-2.03, P < 0.001). CONCLUSIONS G-CT is associated with improved survival in patients with gastric cancer and synchronous liver metastasis. Further experience with well-designed prospective trials may be warranted to confirm these findings.
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Affiliation(s)
- Omar Picado
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Levi Dygert
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Francisco Igor Macedo
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Dido Franceschi
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Danny Sleeman
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Alan S Livingstone
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Nipun Merchant
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida
| | - Danny Yakoub
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida.
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Azab B, Picado O, Ripat C, Macedo FI, Livingstone AS, Franceschi D, Yakoub D. The impact of the chemoradiation to surgery interval on pathological complete response: Short and long-term overall survival in esophageal cancer patients. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2 Background: The association of the interval between neoadjuvant chemo-radiation and surgery (CRT-S), and cancer outcomes in patients with esophageal cancer is not clear. We aimed to determine the relationship between CRT-S interval and pathological complete response rate (pCR), short and long overall survival (OS). Methods: Patients listed on the National Cancer Data Base from 2004 to 2013 were studied. We included patients with CRT followed by surgery in 15-90 days. All patients had reported pT, pN cancer stages and survival status. CRT-S interval was studied as continuous (weeks) and categorical variables (quintiles). Results: A total of 5181 patients were included; 81% were adenocarcinomas, 84% were males and mean age was 62 years. They were divided into CRT-S interval quintiles (15 to 37, 38 to 45, 46 to 53, 54 to 64 and 65 to 90 days) (n = 1016, 1063, 1081, 1083 and 938 patients), respectively. There was a significant increase of pCR rate across the CRT-S quintiles (18%, 21%, 24%, 25% and 29%, p < 0.001). This advantage persisted when CRT-S was measured as continuous variable in weeks (OR: 1.11, 95% CI = 1.078-1.143, p < 0.001). However, 90-day mortality significantly increased as CRT-S increased across quintiles (5.7%, 6.2%, 6.8%, 8.5% and 8.2%, p = 0.02) and through weeks (OR = 1.05, 95%CI = 1.005-1.106, p = 0.03). Mean OS across CRT-S quintiles was 59.2, 58.8, 55.4, 56.6 and 51.5 months, respectively. Multivariate Cox regression showed significantly worse OS per week increase in CRT-S interval (HR 1.02, 95% 1.003-1.037, p = 0.02), especially among the last quintile (CRT-S = 65-90 days: HR 1.2, 95% CI 1.04-1.32, p = 0.009). Those with no-pCR had worse OS as time to surgery increased (p < 0.001), while pCR group had similar OS across CTR-S intervals. Conclusions: Despite higher pCR rate as CRT-S interval increasing, surgery is preferred to be done in less than 65 days after CRT to avoid worse 90-day mortality and achieve better OS. Further randomized studies are needed to consolidate our findings.
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Affiliation(s)
| | - Omar Picado
- University of Miami Miller School of Medicine, Miami, FL
| | - Caroline Ripat
- University of Miami Miller School of Medicine, Miami, FL
| | | | | | - Dido Franceschi
- University of Miami Sylvester Comprehensive Cancer Center, Miami, FL
| | - Danny Yakoub
- University of Miami Sylvester Comprehensive Cancer Center/ Jackson Memorial Hospital, Miami, FL
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Klingbeil KD, Polcari AM, Azab B, Franceschi D. Large, extra-abdominal leiomyoma of the round ligament with carneous degeneration. BMJ Case Rep 2017; 2017:bcr-2017-222454. [PMID: 29170184 DOI: 10.1136/bcr-2017-222454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Round ligament tumours represent a rare entity that can present similarly to an incarcerated hernia. Basic understanding and appropriate preoperative management is imperative in order to differentiate between the two diagnoses. Leiomyoma is the most common type of round ligament tumour. It is associated with oestrogen exposure and is more common in the presence of uterine leiomyomas. Here we discuss a 68-year-old woman who presented with a palpable left inguinal mass that progressively grew in size, associated with pelvic pressure and discomfort. On surgical resection, the mass was found to be derived from the round ligament at the entrance of the external inguinal ring. Pathology confirmed a round ligament leiomyoma, measuring 25×9×8.5 cm. This case is the largest round ligament leiomyoma recorded to date and the first to exhibit carneous degeneration. A review of the current literature is also provided.
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Affiliation(s)
- Kyle D Klingbeil
- Department of Surgical Oncology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Ann M Polcari
- Department of Surgical Oncology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Basem Azab
- Department of Surgical Oncology, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Dido Franceschi
- Department of Surgical Oncology, Miller School of Medicine, University of Miami, Miami, Florida, USA
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Picado O, Brosch JR, Rubio GA, Yakoub D, Franceschi D, Sleeman D, Livingstone AS, Merchant NB, Dudeja V. Impact of Intraperitoneal Drain on Postoperative Morbidity after Pancreatic Resection: An American College of Surgeons NSQIP Analysis. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.611] [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] [Indexed: 10/18/2022]
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Picado O, Brosch JR, Rubio GA, Yakoub D, Franceschi D, Sleeman D, Livingstone AS, Merchant NB, Dudeja V. Effect of Neoadjuvant Chemotherapy on Postoperative Morbidity after Pancreatic Resection for Pancreatic Adenocarcinoma: An American College of Surgeons NSQIP Analysis. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.642] [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] [Indexed: 11/28/2022]
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Tiesi G, Park W, Gunder M, Rubio G, Berger M, Ardalan B, Livingstone A, Franceschi D. Long-term survival based on pathologic response to neoadjuvant therapy in esophageal cancer. J Surg Res 2017; 216:65-72. [PMID: 28807215 DOI: 10.1016/j.jss.2017.03.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 03/06/2017] [Accepted: 03/23/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Neoadjuvant treatment is standard for locally advanced esophageal cancer. However, whether the addition of radiation to neoadjuvant regimen improves survival remains unclear. The aim of this study was to compare survival in locally advanced esophageal cancer treated with neoadjuvant chemotherapy versus chemoradiation. MATERIALS AND METHODS A prospectively maintained database of esophagectomies (1999-2012) was analyzed. We identified 297 patients with locally advanced esophageal cancer that underwent either neoadjuvant chemotherapy (n = 231) or chemoradiation (n = 66) followed by esophagectomy. Pretreatment and pathologic staging were compared to assess response. Overall survival was recorded. RESULTS Most patients in the chemotherapy and chemoradiation groups had pretreatment stage III disease (66.7% versus 65.2%; P = 0.44). Median follow-up was 79.3 and 64.9 mo for chemotherapy and chemoradiation cohorts, respectively. Complete response rate was higher in chemoradiation than chemotherapy groups (30.3% versus 13.8%; P < 0.001). Overall survival was similar between complete responders in both groups (median not reached versus 121.1 mo; chemotherapy versus chemoradiation). However, partial responders in the chemotherapy cohort had improved median survival (147.2 mo) versus those in the chemoradiation cohort (83.7 mo, P < 0.03). Within the chemotherapy-only group, partial responders had improved survival compared with nonresponders (P = 0.041); however, there was no difference in survival between partial and complete responders (P = 0.36). CONCLUSIONS In patients undergoing esophagectomy for locally advanced esophageal cancer, neoadjuvant chemotherapy was associated with an equivalent overall survival, when compared with neoadjuvant chemoradiotherapy. Adding neoadjuvant radiation may enhance complete response rates but does not appear to be associated with improved survival.
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Affiliation(s)
- Gregory Tiesi
- Division of Surgical Oncology, Department of General Surgery, University of Miami, Miller School of Medicine, Jackson Memorial Hospital, Sylvester Comprehensive Cancer Center, University of Miami Hospital, Miami, Florida.
| | - Wungki Park
- Division of Hematology-Oncology, Department of Medicine, University of Miami, Miller School of Medicine, Jackson Memorial Hospital, Sylvester Comprehensive Cancer Center, University of Miami Hospital, Miami, Florida
| | - Meredith Gunder
- Division of Surgical Oncology, Department of General Surgery, University of Miami, Miller School of Medicine, Jackson Memorial Hospital, Sylvester Comprehensive Cancer Center, University of Miami Hospital, Miami, Florida
| | - Gustavo Rubio
- Division of Surgical Oncology, Department of General Surgery, University of Miami, Miller School of Medicine, Jackson Memorial Hospital, Sylvester Comprehensive Cancer Center, University of Miami Hospital, Miami, Florida
| | - Michael Berger
- Division of Surgical Oncology, Department of General Surgery, University of Miami, Miller School of Medicine, Jackson Memorial Hospital, Sylvester Comprehensive Cancer Center, University of Miami Hospital, Miami, Florida
| | - Bach Ardalan
- Division of Hematology-Oncology, Department of Medicine, University of Miami, Miller School of Medicine, Jackson Memorial Hospital, Sylvester Comprehensive Cancer Center, University of Miami Hospital, Miami, Florida
| | - Alan Livingstone
- Division of Surgical Oncology, Department of General Surgery, University of Miami, Miller School of Medicine, Jackson Memorial Hospital, Sylvester Comprehensive Cancer Center, University of Miami Hospital, Miami, Florida
| | - Dido Franceschi
- Division of Surgical Oncology, Department of General Surgery, University of Miami, Miller School of Medicine, Jackson Memorial Hospital, Sylvester Comprehensive Cancer Center, University of Miami Hospital, Miami, Florida
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Stuart H, Ripat C, Azab B, Yakoub D, Franceschi D, Livingstone AS, Dudeja V, Merchant NB. Significant upstaging of patients with stage I pancreatic cancer from clinical to pathologic staging. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
349 Background: Clinical staging of patients with pancreatic cancer is essential to determine if neo-adjuvant treatment, surgery or palliative treatment is required. Patients with early stage disease often receive upfront surgery, where as patients with more advanced disease often receive neo-adjuvant therapy. Therefore the accuracy of clinical staging significantly influences management decisions. This study investigates the correlation between clinical and pathologic staging for patients with stage I pancreatic cancer. Methods: A retrospective review of patients with pancreatic cancer in National Cancer Data Base from 1998-2006 was preformed. The clinical stage of patients with presumed stage I disease was compared to the postoperative pathologic stage. Cox proportional hazard ratio model and regression analysis were used to determine factors associated with mortality and upstaging, respectively. Results: 1697 patients with clinical stage I pancreatic cancer were divided into two groups. Group 1 was comprised of patients who were stage I postoperatively and Group 2 was comprised of patients that were upstaged to either stage II, III or IV postoperatively. There were 704 (41%) in group 1 and 993 (59%) in group 2. Within group 2, 595 (60%) were stage II, 321 (32%) were stage III and 77 (8%) were stage IV. Patients that were upstaged after surgery had an increased risk of mortality (HR 1.414, p < 0.001), whereas patients that received adjuvant chemotherapy had a decreased risk of mortality (HR 0.799, p < 0.001). Compared to Grade 1 tumors, Grade 2 and 3 tumors on biopsy were most likely to be upstaged on final pathology (p < 0.001). Conclusions: Patients with stage I pancreatic cancer are often candidates for upfront surgery, however this study demonstrates that a large number are upstaged on postoperative staging. Recognizing this may lead clinicians to administer neo-adjuvant treatment in a greater number of patients with early stage disease in order to optimize survival.
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Affiliation(s)
| | - Caroline Ripat
- University of Miami Miller School of Medicine, Miami, FL
| | | | - Danny Yakoub
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL
| | - Dido Franceschi
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Alan S Livingstone
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
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Ardalan B, Gombosh M, Franceschi D, Avisar E, Yakoub D, Ribeiro A, Garrido J, Merchant N, Livingstone AS. Neoadjuvant and adjuvant, floxuridine, leucovorin, oxaliplatin, and docetaxel (FLOD) in patients with locally advanced operable gastroesophageal adenocarcinoma: A phase II study with pathologic responses and long term follow-up. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.124] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
124 Background: A complete pathological response to neoadjuvant chemotherapy without the use of radiation has infrequently been reported in operable chemo-naïve stage III gastro esophageal adenocarcinoma patients. Methods: Twenty-nine patients were enrolled in this study. Neoadjuvant therapy consisted of Floxuridine, Leucovorin, Oxaliplatin, and Docetaxel and was administered in 2, four week cycles. Chemotherapy consisted on day one and day fifteen; Oxaliplatin, Docetaxel, FUDR, and Leucovorin. The latter two drugs were given concurrently over twenty four hours. On day eight, chemotherapy consisted of Docetaxel, FUDR, and Leucovorin. Following therapy, patients underwent surgical resection. Those patients having residual disease were offered adjuvant chemotherapy. Patients having a complete pathological response were not offered any further therapy. Results: Twenty-four out of twenty-nine patients completed neoadjuvant therapy and underwent esophagectomy. Two were declared inoperable after treatment. Three patients died prior to surgery. The median follow-up of all patients is now sixty months. The median overall survival has not been reached at sixty months. Five yr actual OS is 51%. Clinical response to neoadjuvant therapy was seen in (72.4%) patients. Complete pathological response to neoadjuvant therapy was seen in (16.7%) who are disease free at sixty month follow-ups. Seven out of twenty-four patients achieved partial pathological response (29.1%) and received adjuvant chemotherapy. They are all alive (100%). Eight patients achieved less than partial pathological response and received adjuvant chemotherapy, four out of eight are alive at sixty months (50%). Grade three and four toxicities were seen in sixteen out of twenty nine patients during neoadjuvant therapy. Grade three and four toxicities were seen in six out of fourteen patients during adjuvant therapy. Conclusions: Our chemotherapy regimen of Floxuridine, Leucovorin, Oxaliplatin and Docetaxel (FLOD) has resulted in long term survival in patients with adenocarcinoma of the esophagus. Clinical trial information: NCT00448760.
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Affiliation(s)
| | | | - Dido Franceschi
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Eli Avisar
- University of Miami Miller School of Medicine, Miami, FL
| | - Danny Yakoub
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL
| | | | | | - Nipun Merchant
- University of Miami Miller School of Medicine, Miami, FL
| | - Alan S Livingstone
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
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Yoon H, Kim S, Yang J, Chen H, Hu I, Kim B, Bilfinger T, Matthews R, Franceschi D, Moore W, Stessin A, Ryu S. Prognostic Factors and Outcome After SBRT for Stage I Non-Small Cell Lung Cancer (NSCLC) Using Different Fractionation Regimens From 2007 to 2013. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1616] [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] [Indexed: 10/22/2022]
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Gadde R, Tamariz L, Hanna M, Avisar E, Livingstone A, Franceschi D, Yakoub D. Metastatic gastric cancer (MGC) patients: Can we improve survival by metastasectomy? A systematic review and meta-analysis. J Surg Oncol 2015; 112:38-45. [PMID: 26074130 DOI: 10.1002/jso.23945] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 05/18/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Prognosis with current management strategies continues to be dismal in metastatic gastric cancer (MGC) patients. We aimed to evaluate the role of metastasectomy in improving survival. METHODS A comprehensive search of MEDLINE, EMBASE, SCOPUS, and Cochrane central databases (1965 to present) was performed. All comparative studies measuring survival in MGC patients undergoing metastasectomy versus other therapies were included. Pooled risk ratios with corresponding 95% confidence intervals (CI) were calculated for survival at 1, 3, and 5 years. RESULTS Sixteen studies with 1712 patients (378 patients in metastasectomy, 1334 patients in other therapies) were eligible for the final meta-analysis. Median age was 63 years. For patients undergoing metastasectomy, a significant survival advantage was observed at 1 year (RR 0.52, CI 0.43-0.62), 3 year (RR 0.75 CI 0.67-0.83), and 5 year (RR 0.82, CI 0.74-0.91); mean increased difference in survival conferred by metastasectomy averaged between 9.3 and 15.7 months; P < 0.001 for all results. Age, ECOG status, and STROBE score did not contribute to differences in survival. CONCLUSION Metastasectomy is associated with increased survival at 1, 3, and 5 years in MGC patients. Large prospective randomized controlled trials are critically needed to evaluate the role of metastasectomy in MGC.
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Affiliation(s)
- Rahul Gadde
- Division of Surgical Oncology at Department of Surgery, University of Miami-Miller School of Medicine, Miami, Florida.,Department of Internal Medicine, University of Miami-Miller School of Medicine, Miami, Florida
| | - Leonardo Tamariz
- Department of Internal Medicine, University of Miami-Miller School of Medicine, Miami, Florida
| | - Mena Hanna
- Division of Surgical Oncology at Department of Surgery, University of Miami-Miller School of Medicine, Miami, Florida
| | - Eli Avisar
- Division of Surgical Oncology at Department of Surgery, University of Miami-Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, University of Miami-Miller School of Medicine, Miami, Florida
| | - Alan Livingstone
- Division of Surgical Oncology at Department of Surgery, University of Miami-Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, University of Miami-Miller School of Medicine, Miami, Florida
| | - Dido Franceschi
- Division of Surgical Oncology at Department of Surgery, University of Miami-Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, University of Miami-Miller School of Medicine, Miami, Florida
| | - Danny Yakoub
- Division of Surgical Oncology at Department of Surgery, University of Miami-Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, University of Miami-Miller School of Medicine, Miami, Florida
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Alghamdi H, Franceschi D, Miao F, Byrne MM, Koru-Sengul T. Detrimental effect of blood-product transfusion on survival for patients with breast cancer in Florida (1996-2007). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.1062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Dido Franceschi
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL
| | - Feng Miao
- Department of Public Health Sciences and Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL
| | - Margaret M Byrne
- Department of Public Health Sciences, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Tulay Koru-Sengul
- Department of Public Health Sciences, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
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Yakoub D, Avisar E, Koru-Sengul T, Miao F, Tannenbaum SL, Byrne MM, Moffat F, Livingstone A, Franceschi D. Factors associated with contralateral preventive mastectomy. Breast Cancer (Dove Med Press) 2015; 7:1-8. [PMID: 25609997 PMCID: PMC4293214 DOI: 10.2147/bctt.s72737] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Contralateral prophylactic mastectomy (CPM) is an option for women who wish to reduce their risk of breast cancer or its local recurrence. There is limited data on demographic differences among patients who choose to undergo this procedure. METHODS The population-based Florida cancer registry, Florida's Agency for Health Care Administration data, and US census data were linked and queried for patients diagnosed with invasive breast cancer from 1996 to 2009. The main outcome variable was the rate of CPM. Primary predictors were race, ethnicity, socioeconomic status (SES), marital status and insurance status. RESULTS Our population was 91.1% White and 7.5% Black; 89.1% non-Hispanic and 10.9% Hispanic. Out of 21,608 patients with a single unilateral invasive breast cancer lesion, 837 (3.9%) underwent CPM. Significantly more White than Black (3.9% vs 2.8%; P<0.001) and more Hispanic than non-Hispanic (4.5% vs 3.8%; P=0.0909) underwent CPM. Those in the highest SES category had higher rates of CPM compared to the lowest SES category (5.3% vs 2.9%; P<0.001). In multivariate analyses, Blacks compared to Whites (OR =0.59, 95% CI =0.42-0.83, P=0.002) and uninsured patients compared to privately insured (OR =0.60, 95% CI =0.36-0.98, P=0.043) had significantly less CPM. CONCLUSION CPM rates were significantly different among patients of different race, socio-economic class, and insurance coverage. This observation is not accounted for by population distribution, incidence or disease stage. More in-depth study of the causes of these disparities in health care choice and delivery is critically needed.
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Affiliation(s)
- Danny Yakoub
- Division of Surgical Oncology at Department of Surgery, University of Miami - Miller School of Medicine, Miami, FL, USA ; Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA
| | - Eli Avisar
- Division of Surgical Oncology at Department of Surgery, University of Miami - Miller School of Medicine, Miami, FL, USA ; Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA
| | - Tulay Koru-Sengul
- Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA ; Department of Public Health Sciences, University of Miami - Miller School of Medicine, Miami, FL, USA
| | - Feng Miao
- Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA
| | - Stacey L Tannenbaum
- Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA
| | - Margaret M Byrne
- Division of Surgical Oncology at Department of Surgery, University of Miami - Miller School of Medicine, Miami, FL, USA ; Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA ; Department of Public Health Sciences, University of Miami - Miller School of Medicine, Miami, FL, USA
| | - Frederick Moffat
- Division of Surgical Oncology at Department of Surgery, University of Miami - Miller School of Medicine, Miami, FL, USA ; Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA
| | - Alan Livingstone
- Division of Surgical Oncology at Department of Surgery, University of Miami - Miller School of Medicine, Miami, FL, USA ; Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA
| | - Dido Franceschi
- Division of Surgical Oncology at Department of Surgery, University of Miami - Miller School of Medicine, Miami, FL, USA ; Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, FL, USA
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Yakoub D, Avisar E, Koru-Sengul T, Miao F, Tannenbaum SL, Byrne MM, Moffat FL, Livingstone AS, Franceschi D. Factors associated with increasing rates of contralateral prophylactic mastectomy. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.26_suppl.57] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
57 Background: Contralateral prophylactic mastectomy (CPM) is an option increasingly used by women who wish to reduce their risk of breast cancer or its local recurrence. There is limited data on demographic differences among patients who choose to undergo this procedure. Methods: The population-based Florida cancer registry, Florida’s Agency for Health Care Administration (AHCA) data, and U.S. census data were linked and queried for patients diagnosed with invasive breast cancer from 1996 to 2009. The main outcome variable was the rate of CPM in those with a single unilateral cancer diagnosis. Primary predictors were race, ethnicity, socioeconomic status (SES), marital status, and insurance status. Results: The rates of CPM rose from 2% in 1996 to 4.8% in 2006 up to 8% in 2009. The population studied was 91.1% white and 7.5% black; 89.1% non-Hispanic and 10.9% Hispanic. Out of 21,608 included patients, 837 (3.9%) underwent CPM. Significantly more white than black (3.9 versus 2.8%; p < 0.001) and more Hispanic than non-Hispanic (4.5 versus 3.8%; p = 0.0909) underwent CPM. Those in the highest SES category had higher rates of CPM compared to the lowest SES category (5.3 versus 2.9%; p < 0.001). In multivariate analyses, Blacks and uninsured patients had significantly less CPM compared to whites and private patients (OR = 0.59, 95% CI 0.42- 0.83, p = 0.002) and (OR = 0.60, 95% CI 0.36- 0.98, p = 0.043), respectively. Conclusions: CPM rates are significantly increasing; these rates were significantly different among patients of different race, socioeconomic class, and insurance coverage. This observation is not accounted for by population distribution, incidence or disease stage. More in-depth study of the causes of this increase and the disparities in healthcare delivery is critically needed.
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Affiliation(s)
- Danny Yakoub
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine and Jackson Memorial Hospital, Miami, FL
| | - Eli Avisar
- University of Miami, Miller School of Medicine, Miami, FL
| | - Tulay Koru-Sengul
- Department of Epidemiology and Public Health and Sylvester Comprehensive Cancer Center of University of Miami Miller School of Medicine, Miami, FL
| | - Feng Miao
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL
| | | | | | | | - Alan S Livingstone
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL
| | - Dido Franceschi
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL
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Wang Z, Da Silva TG, Jin K, Han X, Ranganathan P, Zhu X, Sanchez-Mejias A, Bai F, Li B, Fei DL, Weaver K, Carpio RVD, Moscowitz AE, Koshenkov VP, Sanchez L, Sparling L, Pei XH, Franceschi D, Ribeiro A, Robbins DJ, Livingstone AS, Capobianco AJ. Notch signaling drives stemness and tumorigenicity of esophageal adenocarcinoma. Cancer Res 2014; 74:6364-74. [PMID: 25164006 DOI: 10.1158/0008-5472.can-14-2051] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Esophageal adenocarcinoma ranks sixth in cancer mortality in the world and its incidence has risen dramatically in the Western population over the last decades. Data presented herein strongly suggest that Notch signaling is critical for esophageal adenocarcinoma and underlies resistance to chemotherapy. We present evidence that Notch signaling drives a cancer stem cell phenotype by regulating genes that establish stemness. Using patient-derived xenograft models, we demonstrate that inhibition of Notch by gamma-secretase inhibitors (GSI) is efficacious in downsizing tumor growth. Moreover, we demonstrate that Notch activity in a patient's ultrasound-assisted endoscopic-derived biopsy might predict outcome to chemotherapy. Therefore, this study provides a proof of concept that inhibition of Notch activity will have efficacy in treating esophageal adenocarcinoma, offering a rationale to lay the foundation for a clinical trial to evaluate the efficacy of GSI in esophageal adenocarcinoma treatment.
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Affiliation(s)
- Zhiqiang Wang
- Molecular Oncology Program, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Thiago G Da Silva
- Molecular Oncology Program, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Ke Jin
- Molecular Oncology Program, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Xiaoqing Han
- Molecular Oncology Program, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Prathibha Ranganathan
- Molecular Oncology Program, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Xiaoxia Zhu
- Molecular Oncology Program, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Avencia Sanchez-Mejias
- Molecular Oncology Program, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Feng Bai
- Molecular Oncology Program, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Bin Li
- Molecular Oncology Program, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Dennis Liang Fei
- Molecular Oncology Program, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Kelly Weaver
- Molecular Oncology Program, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Rodrigo Vasquez-Del Carpio
- Molecular Oncology Program, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Anna E Moscowitz
- Molecular Oncology Program, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Vadim P Koshenkov
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Lilly Sanchez
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Lynne Sparling
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Xin-Hai Pei
- Molecular Oncology Program, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida. Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida. Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, Florida
| | - Dido Franceschi
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida. Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, Florida
| | - Afonso Ribeiro
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida. Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, Florida
| | - David J Robbins
- Molecular Oncology Program, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida. Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida. Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, Florida
| | - Alan S Livingstone
- Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida. Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, Florida
| | - Anthony J Capobianco
- Molecular Oncology Program, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida. Division of Surgical Oncology, DeWitt Daughtry Family Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida. Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, Florida.
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Ribeiro A, Bejarano P, Livingstone A, Sparling L, Franceschi D, Ardalan B. Depth of injury caused by liquid nitrogen cryospray: study of human patients undergoing planned esophagectomy. Dig Dis Sci 2014; 59:1296-301. [PMID: 24395381 DOI: 10.1007/s10620-013-2991-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 12/09/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cryotherapy using liquid nitrogen delivered endoscopically has been used for mucosal ablation of esophageal neoplasia. There are no data for the human esophagus on the depth of injury and effects of this technique. AIM Prospective study to examine the effect of treatment and depth of injury to the human esophagus of liquid nitrogen spray cryotherapy for subjects with esophageal neoplasia before planned esophagectomy. METHODS Liquid nitrogen spray cryoablation was performed seven days before scheduled esophagectomy for seven males with esophageal carcinoma. Subjects were assigned to either treatment of four cycles of 10 s each (group 1) or two cycles of 20 s each (group 2) applied to a 2-cm segment of healthy esophagus above the tumor area. Main outcomes measured were: mean depth of injury (mm); surface displaying mucosal ablation, and adverse events. RESULTS Mucosal destruction was similar for both groups (group 1, 95%; group 2, 93%; p = NS). Deeper injury was observed for group 2; mean depth was 5.4 mm compared with 4.0 mm for group 1. Cryonecrosis reached the submucosa for 60% (12/20) of subjects in group 1 versus 93% (14/15) of subjects in group 2 (p = 0.04, two-tailed Fisher's exact test). No serious adverse events occurred. No perforation was seen in the resected esophagus. CONCLUSION Mucosal ablation with liquid nitrogen spray cryotherapy was highly effective in inducing mucosal necrosis; the doses assessed had similar effects. Ablation reached the submucosa more often with longer spray time despite fewer treatment cycles.
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Affiliation(s)
- Afonso Ribeiro
- Division of Gastroenterology, Department of Surgery, University of Miami School of Medicine, Miami, FL, USA,
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48
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Alazhri J, Koru-Sengul T, Miao F, Tannenbaum SL, Byrne MM, Alghamdi H, Franceschi D, Avisar E. Predictors of surgery types after neoadjuvant therapy for advanced stage breast cancer. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.1034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Tulay Koru-Sengul
- Department of Epidemiology and Public Health and Sylvester Comprehensive Cancer Center of University of Miami Miller School of Medicine, Miami, FL
| | - Feng Miao
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL
| | | | | | | | - Dido Franceschi
- Sylvester Comprehensive Cancer Center, University of Miami, Miller School of Medicine, Miami, FL
| | - Eli Avisar
- University of Miami School of Medicine, Miami, FL
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Koshenkov VP, Yakoub D, Livingstone AS, Franceschi D. Tracheobronchial injury in the setting of an esophagectomy for cancer: Postoperative discovery a bad omen. J Surg Oncol 2014; 109:804-7. [DOI: 10.1002/jso.23577] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 01/22/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Vadim P. Koshenkov
- Division of Surgical Oncology; Rutgers Cancer Institute of New Jersey; New Brunswick New Jersey
| | - Danny Yakoub
- DeWitt Daughtry Family Department of Surgery, Division of Surgical Oncology; Miller School of Medicine, University of Miami; Miami Florida
- Sylvester Comprehensive Cancer Center; Miller School of Medicine, University of Miami; Miami Florida
| | - Alan S. Livingstone
- DeWitt Daughtry Family Department of Surgery, Division of Surgical Oncology; Miller School of Medicine, University of Miami; Miami Florida
- Sylvester Comprehensive Cancer Center; Miller School of Medicine, University of Miami; Miami Florida
| | - Dido Franceschi
- DeWitt Daughtry Family Department of Surgery, Division of Surgical Oncology; Miller School of Medicine, University of Miami; Miami Florida
- Sylvester Comprehensive Cancer Center; Miller School of Medicine, University of Miami; Miami Florida
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50
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Gersdorff M, Heylen G, Franceschi D, Gerard JM. [Myringoplasties for anterior tympanic perforations: Our surgical technique]. Rev Laryngol Otol Rhinol (Bord) 2014; 135:219-220. [PMID: 26521373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Anterior tympanic perforations are actually the most difficult to close and a number of different techniques exist. This article represents the author's surgical procedure for type I tympanoplasties (myringoplasties) for this kind of perforation using the tragal cartilage and the perichondrium after preparation (revival, cleaning) of the perforation edge with a laser. This technique does not use a skin incision of external auditory meatus, when this one is large.
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