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Kazemain E, Figueiredo J, Skarbinski J, McBride R, Simon V, Karger AB, Lee FEH, Hirsch FR, Cox A, Klein S, Fan R, Halene S, Zidar DA, Crawford JM, Thyagarajan B, Gleason C, Mathson A, Srivastava K, Moshele P, Amoss T, Runnstrom M, Linderman S, Rodilla AM, Mack PC, Shyr Y, Yin A, Shea P, VanOudenhove J, Siddiqui H, Wilson BM, Elkin EP, Hsiao CA, Ziemba Y, Schleicher CB, Fox S, Kushi LH, Reckamp K, Merchant A, Merin N. Abstract 798: SeroNet Pooling Project of immunocompromised populations. Cancer Res 2023. [DOI: 10.1158/1538-7445.am2023-798] [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: 04/07/2023]
Abstract
Abstract
Introduction: COVID-19 vaccination substantially reduces morbidity and mortality associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and severe illness. However, despite effective COVID-19 vaccines many questions remain about the efficacy of vaccines and the durability and robustness of immune responses, especially in immunocompromised persons. The NCI-funded Serological Sciences Network (SeroNet) is a coordinated effort including 11 sites to advance research on the immune response to SARS-CoV-2 infection and COVID-19 vaccination among diverse and vulnerable populations. The goals of the Pooling Project are: (1) to conduct real-world data (RWD) analyses using electronic medical records (EMR) data from four health care systems (Kaiser Permanente Northern California, Northwell Health, Veterans Affairs-Case Western, and Cedars-Sinai) to determine vaccine effectiveness in (a) cancer patients; (b) autoimmune diseases and (c) solid organ transplant recipients (SOTR); (2) to conduct meta-analyses of prospective cohort studies from eight SeroNet institutions (Cedars-Sinai, Johns Hopkins, Northwell Health, Emory University, University of Minnesota, Mount Sinai, Yale University) to determine post-vaccine immune responses in (a) lung cancer patients; (b) hematologic cancers/hematopoietic stem cell transplant (HSCT) recipients; (c) SOTR; (d) lupus.
Methods: For our RWD analyses, data is extracted from EMR using standardized algorithms using ICD-10 codes to identify immunocompromised persons (hematologic and solid organ malignancy; SOTR; autoimmune disease, including inflammatory bowel disease, rheumatoid arthritis, and SLE). We use common case definitions to extract data on demographic, laboratory values, clinical co-morbidity, COVID-19 vaccination, SARS-CoV-2 infection and severe COVID-19, and disease-specific variables. In addition, we pool individual-level data from prospective cohorts enrolling patients with cancer and other immunosuppressed conditions from across network. Surveys and biospecimens from serology and immune profiling are collected at pre-specified timepoints across longitudinal cohorts.
Results: Currently, we have EMR data extracted from 4 health systems including >715,000 cancer patients, >9,500 SOTR and >180,000 with autoimmune conditions. Prospective cohorts across the network have longitudinal data on >450 patients with lung cancer, >1,200 patients with hematologic malignancies, >400 SOTR and >400 patients with lupus. We will report results examining vaccine effectiveness for prevention of SARS-CoV-2 infection, severe COVID-19 and post-acute sequelae of COVID-19 (PAS-C or long COVID) in cancer patients compared to other immunocompromised conditions.
Conclusion: Our goal is to inform public health guidelines on COVID-19 vaccine and boosters to reduce SARS-CoV-2 infection and severe illness in immunocompromised populations.
Citation Format: Elham Kazemain, Jane Figueiredo, Jacek Skarbinski, Russell McBride, Viviana Simon, Amy B. Karger, F. Eun-Hyung Lee, Fred R. Hirsch, Andrea Cox, Sabra Klein, Rong Fan, Stephanie Halene, David A. Zidar, James M. Crawford, Bharat Thyagarajan, Charles Gleason, Alex Mathson, Komal Srivastava, Puleng Moshele, Toby Amoss, Martin Runnstrom, Susanne Linderman, Ananda M. Rodilla, Philip C. Mack, Yu Shyr, Anna Yin, Patrick Shea, Jennifer VanOudenhove, Hinnah Siddiqui, Brigid M. Wilson, Eric P. Elkin, Crystal A. Hsiao, Yonah Ziemba, Cheryl B. Schleicher, Sharon Fox, Lawrence H. Kushi, Karen Reckamp, Akil Merchant, Noah Merin. SeroNet Pooling Project of immunocompromised populations [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 798.
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Affiliation(s)
| | | | | | | | - Viviana Simon
- 3Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | | | - Andrea Cox
- 6John Hopkins University School of Medicine, Baltimore, MD
| | - Sabra Klein
- 7Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Rong Fan
- 8Yale School of Medicine, New Haven, CT
| | | | - David A. Zidar
- 9Case Western Reserve University School of Medicine, Cleveland, OH
| | - James M. Crawford
- 10Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, Hempstead, NY
| | | | | | | | | | | | | | | | | | | | | | - Yu Shyr
- 14Vanderbilt University, Nashville, TN
| | - Anna Yin
- 6John Hopkins University School of Medicine, Baltimore, MD
| | - Patrick Shea
- 6John Hopkins University School of Medicine, Baltimore, MD
| | | | - Hinnah Siddiqui
- 16Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH
| | - Brigid M. Wilson
- 16Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH
| | | | | | - Yonah Ziemba
- 10Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, Hempstead, NY
| | - Cheryl B. Schleicher
- 10Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, Hempstead, NY
| | - Sharon Fox
- 10Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, Hempstead, NY
| | | | | | | | - Noah Merin
- 1Cedars-Sinai Medical Center, Los Angeles, CA
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2
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Figueiredo JC, Hirsch FR, Kushi LH, Nembhard WN, Crawford JM, Mantis N, Finster L, Merin NM, Merchant A, Reckamp KL, Melmed GY, Braun J, McGovern D, Parekh S, Corley DA, Zohoori N, Amick BC, Du R, Gregersen PK, Diamond B, Taioli E, Sariol C, Espino A, Weiskopf D, Gifoni A, Brien J, Hanege W, Lipsitch M, Zidar DA, McAlearney AS, Wajnberg A, LaBaer J, Lewis EY, Binder RA, Moormann AM, Forconi C, Forrester S, Batista J, Schieffelin J, Kim D, Biancon G, VanOudenhove J, Halene S, Fan R, Barouch DH, Alter G, Pinninti S, Boppana SB, Pati SK, Latting M, Karaba AH, Roback J, Sekaly R, Neish A, Brincks AM, Granger DA, Karger AB, Thyagarajan B, Thomas SN, Klein SL, Cox AL, Lucas T, Furr-Holden D, Key K, Jones N, Wrammerr J, Suthar M, Yu Wong S, Bowman NM, Simon V, Richardson LD, McBride R, Krammer F, Rana M, Kennedy J, Boehme K, Forrest C, Granger SW, Heaney CD, Knight Lapinski M, Wallet S, Baric RS, Schifanella L, Lopez M, Fernández S, Kenah E, Panchal AR, Britt WJ, Sanz I, Dhodapkar M, Ahmed R, Bartelt LA, Markmann AJ, Lin JT, Hagan RS, Wolfgang MC, Skarbinski J. Mission, Organization and Future Direction of the Serological Sciences Network for COVID-19 (SeroNet) Epidemiologic Cohort Studies. Open Forum Infect Dis 2022; 9:ofac171. [PMID: 35765315 PMCID: PMC9129196 DOI: 10.1093/ofid/ofac171] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/22/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Global efforts are needed to elucidate the epidemiology of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the underlying cause of coronavirus disease 2019 (COVID-19) including seroprevalence, risk factors and long-term sequelae, as well as immune responses following vaccination across populations and the social dimensions of prevention and treatment strategies. In the U.S., the National Cancer Institute in partnership with the National Institute of Allergy and Infectious Diseases, established the SARS-CoV-2 Serological Sciences Network (SeroNet) as the nation’s largest coordinated effort to study COVID-19. The network is comprised of multidisciplinary researchers bridging gaps and fostering collaborations between immunologists, epidemiologists, virologists, clinicians and clinical laboratories, social and behavioral scientists, policy makers, data scientists, and community members. In total, 49 institutions form the SeroNet consortium to study individuals with cancer, autoimmune disease, inflammatory bowel diseases, cardiovascular diseases, HIV, transplant recipients, as well as otherwise healthy pregnant women, children, college students, and high-risk occupational workers (including health care workers and first responders). Several studies focus on underrepresented populations, including ethnic minorities and rural communities. To support integrative data analyses across SeroNet studies, efforts are underway to define common data elements for standardized serology measurements, cellular and molecular assays, self-reported data, treatment, and clinical outcomes. In this paper, we discuss the overarching framework for SeroNet epidemiology studies, critical research questions under investigation, and data accessibility for the worldwide scientific community. Lessons learned will help inform preparedness and responsiveness to future emerging diseases.
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Affiliation(s)
- Jane C Figueiredo
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Fred R Hirsch
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Wendy N Nembhard
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - James M Crawford
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Nicholas Mantis
- Division of Infectious Diseases Wadsworth Center, New York State Department of Health, New York, NY, USA
| | - Laurel Finster
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Noah M Merin
- Division of Hematology and Cellular Therapy, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Akil Merchant
- Division of Hematology and Cellular Therapy, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Karen L Reckamp
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Gil Y Melmed
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Los Angeles, CA, USA
| | - Jonathan Braun
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Los Angeles, CA, USA
| | - Dermot McGovern
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Los Angeles, CA, USA
| | - Samir Parekh
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Douglas A Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Namvar Zohoori
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Benjamin C Amick
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ruofei Du
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Peter K Gregersen
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Betty Diamond
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Emanuela Taioli
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carlos Sariol
- Unit of Comparative Medicine, University of Puerto Rico, Medical Sciences, San Juan, PR
| | - Ana Espino
- Unit of Comparative Medicine, University of Puerto Rico, Medical Sciences, San Juan, PR
| | | | - Alba Gifoni
- La Jolla Institute of Immunology, La Jolla CA, USA
| | - James Brien
- Department of Molecular Microbiology & Immunology, Saint Louis University, St. Louis MI, USA
| | - William Hanege
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, Bethesda, MD, USA
| | - Marc Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, Bethesda, MD, USA
| | - David A Zidar
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ann Scheck McAlearney
- Department of Family and Community Medicine, Ohio State University College of Medicine, Columbus, OH, USA
| | - Ania Wajnberg
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua LaBaer
- Biodesign Virginia G. Piper Center for Personalized Diagnostics, Arizona State University, Tempe AZ, USA
| | - E Yvonne Lewis
- Department of Public Health, Michigan State University, Flint, MI, USA
| | - Raquel A Binder
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Ann M Moormann
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Catherine Forconi
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Sarah Forrester
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jennifer Batista
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - John Schieffelin
- Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA, USA
| | - Dongjoo Kim
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Giulia Biancon
- Section of Hematology, Department of Internal Medicine and Yale Cancer Center, Yale University School of Medicine, New Haven, CT, USA
| | - Jennifer VanOudenhove
- Section of Hematology, Department of Internal Medicine and Yale Cancer Center, Yale University School of Medicine, New Haven, CT, USA
| | - Stephanie Halene
- Section of Hematology, Department of Internal Medicine and Yale Cancer Center, Yale University School of Medicine, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Rong Fan
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Dan H Barouch
- The Center for Virology and Vaccine Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Galit Alter
- Ragon Institute, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Swetha Pinninti
- Department of Pediatrics, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Suresh B Boppana
- Department of Pediatrics, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sunil K Pati
- Department of Pediatrics, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Misty Latting
- Department of Pediatrics, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrew H Karaba
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
| | - John Roback
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Rafick Sekaly
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Andrew Neish
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Ahnalee M Brincks
- Department of Human Development and Family Studies, College of Social Science, Michigan State University, East Lansing, MI, USA
| | - Douglas A Granger
- Institute for Interdisciplinary Salivary Bioscience Research, University of California at Irvine; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy B Karger
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Bharat Thyagarajan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Stefani N Thomas
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Sabra L Klein
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Andrea L Cox
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD, USA
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Todd Lucas
- Division of Public Health, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Debra Furr-Holden
- Division of Public Health, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Kent Key
- Division of Public Health, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Nicole Jones
- Division of Public Health, College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Jens Wrammerr
- Department of Pediatrics, Division of Infectious Disease, Emory University, Atlanta, GA, USA
| | - Mehul Suthar
- Department of Pediatrics, Division of Infectious Disease, Emory University, Atlanta, GA, USA
| | - Serre Yu Wong
- The Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Natalie M Bowman
- University of North Carolina School of Medicine, Division of Infectious Diseases, Chapel Hill, NC, USA
| | - Viviana Simon
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lynne D Richardson
- Institute for Health Equity Research and Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Russell McBride
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Florian Krammer
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Meenakshi Rana
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua Kennedy
- Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Karl Boehme
- Department of Microbiology and Immunology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Craig Forrest
- Department of Microbiology and Immunology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | | | - Christopher D Heaney
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Maria Knight Lapinski
- Department of Communication, Michigan AgBio Research, Michigan State University, East Lansing, MI, USA
| | - Shannon Wallet
- School of Dentistry, Department of Oral and Craniofacial Health Sciences, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Ralph S Baric
- Gillings School of Global Public Health, Department of Epidemiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Luca Schifanella
- Division of Surgical Outcomes and Precision Medicine Research, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Marcos Lopez
- Puerto Rico Public Health Trust, Puerto Rico Science, Technology and Research Trust and University of Puerto Rico at Humacao, Medical Sciences, San Juan, PR, USA
| | - Soledad Fernández
- Department of Biomedical Informatics, Center for Biostatistics, Ohio State University College of Medicine, Columbus, OH, USA
| | - Eben Kenah
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Ashish R Panchal
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - William J Britt
- Department of Immunology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Iñaki Sanz
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Madhav Dhodapkar
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Rafi Ahmed
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA
| | - Luther A Bartelt
- Department of Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Alena J Markmann
- Department of Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Jessica T Lin
- Department of Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Robert S Hagan
- Department of Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Matthew C Wolfgang
- Marsico Lung Institute and Department of Microbiology and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Jacek Skarbinski
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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Dullea J, Rutland J, Gill CM, Ranti D, Arrighi-Allisan AE, Kinoshita Y, McBride R, Bederson JB, Donovan M, Sebra R, Fowkes M, Umphlett M, Shrivastava RK. 821 Association Between Tumor Mutations and Meningioma Recurrence in Grade I/II Disease. Neurosurgery 2022. [DOI: 10.1227/neu.0000000000001880_821] [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: 11/19/2022] Open
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Allen N, McBride R, Lindsay R, Wallace W. 30 Novel Technique of Gastrojejunostomy Tube Insertion to Control Retracted Proximal Stoma. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.002] [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: 11/15/2022]
Abstract
Abstract
Introduction
Extensive small bowel resection for ischaemia can require formation of a proximal jejunostomy. Depending on length of remaining jejunum, a major potential complication is stoma retraction with resultant peritonitis, intra-abdominal sepsis and enterocutaneous fistula formation.
We describe a case using a novel technique of inserting a retrograde gastrojejunostomy tube to gain control of an acutely retracted stoma in a 61-year-old patient who developed an enterocutaneous fistula shortly after major resection due to ischaemia.
Method
Under fluoroscopic guidance, the retracted proximal limb of the jejunostomy was cannulated antegradely by guide wire. A gastro-jejunostomy tube was inserted retrograde over the guide wire and the tip placed within the stomach. The proximal tube fenestrations were sited within the duodenum and the balloon was inflated to limit enteric content spilling into the peritoneal cavity.
Conclusions
This technique enabled drainage of gastroduodenal fluid, minimised spillage into the peritoneal cavity, reduced fistula output and controlled sepsis. This allowed time for nutritional optimisation, better glycaemic control, and endovascular revascularisation in preparation for restoration of intestinal continuity at an appropriate time.
This method offered a useful alternative to surgery, in a patient for whom emergency re-exploration of the abdomen would carry significant risk of morbidity or mortality.
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Affiliation(s)
- N Allen
- Belfast City Hospital, Belfast, United Kingdom
| | - R McBride
- Belfast City Hospital, Belfast, United Kingdom
| | - R Lindsay
- Belfast City Hospital, Belfast, United Kingdom
| | - W Wallace
- Belfast City Hospital, Belfast, United Kingdom
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Gil CM, Loewenstern J, Rutland J, Arib H, Pain M, Umphlett M, Kinoshita Y, McBride R, Bederson JB, Donovan M, Sebra R, Fowkes M, Shrivastava RK. SWI/SNF Chromatin Remodeling Complex Alterations in Meningioma. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Gill CM, Loewenstern J, Rutland J, Arib H, Pain M, Umphlett M, Kinoshita Y, McBride R, Bederson JB, Donovan M, Sebra R, Fowkes M, Shrivastava RK. Peritumoral Edema Correlates with Mutational Burden in Meningiomas. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_797] [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: 11/14/2022] Open
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Pujadas E, Chaudhry F, McBride R, Richter F, Zhao S, Wajnberg A, Nadkarni G, Glicksberg BS, Houldsworth J, Cordon-Cardo C. SARS-CoV-2 viral load predicts COVID-19 mortality. Lancet Respir Med 2020; 8:e70. [PMID: 32771081 PMCID: PMC7836878 DOI: 10.1016/s2213-2600(20)30354-4] [Citation(s) in RCA: 342] [Impact Index Per Article: 85.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/16/2020] [Accepted: 07/29/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Elisabet Pujadas
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Fayzan Chaudhry
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Russell McBride
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Felix Richter
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Shan Zhao
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ania Wajnberg
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Girish Nadkarni
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | | | - Jane Houldsworth
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Green B, Wong E, Andrews S, Hampshire-Jones K, McKinnon S, Brooks C, McAdam R, Gray S, Vickers C, Blake Y, Sekhon G, Merrick S, Faerber J, Mather P, Gilbert E, McBride R, Coombes A, Walker M, Owen A, Davies J, Richardson S, Carr S, Mapson R, Spivey J, Draper S, Kendall F, Hubbard G, Stratton R. Increased protein intake is associated with improved hand grip strength and quality of life in home enterally tube fed adults using a high-energy, high-protein feed. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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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Shen L, Margolies LR, Rothstein JH, Fluder E, McBride R, Sieh W. Deep Learning to Improve Breast Cancer Detection on Screening Mammography. Sci Rep 2019; 9:12495. [PMID: 31467326 PMCID: PMC6715802 DOI: 10.1038/s41598-019-48995-4] [Citation(s) in RCA: 243] [Impact Index Per Article: 48.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/07/2019] [Indexed: 02/06/2023] Open
Abstract
The rapid development of deep learning, a family of machine learning techniques, has spurred much interest in its application to medical imaging problems. Here, we develop a deep learning algorithm that can accurately detect breast cancer on screening mammograms using an "end-to-end" training approach that efficiently leverages training datasets with either complete clinical annotation or only the cancer status (label) of the whole image. In this approach, lesion annotations are required only in the initial training stage, and subsequent stages require only image-level labels, eliminating the reliance on rarely available lesion annotations. Our all convolutional network method for classifying screening mammograms attained excellent performance in comparison with previous methods. On an independent test set of digitized film mammograms from the Digital Database for Screening Mammography (CBIS-DDSM), the best single model achieved a per-image AUC of 0.88, and four-model averaging improved the AUC to 0.91 (sensitivity: 86.1%, specificity: 80.1%). On an independent test set of full-field digital mammography (FFDM) images from the INbreast database, the best single model achieved a per-image AUC of 0.95, and four-model averaging improved the AUC to 0.98 (sensitivity: 86.7%, specificity: 96.1%). We also demonstrate that a whole image classifier trained using our end-to-end approach on the CBIS-DDSM digitized film mammograms can be transferred to INbreast FFDM images using only a subset of the INbreast data for fine-tuning and without further reliance on the availability of lesion annotations. These findings show that automatic deep learning methods can be readily trained to attain high accuracy on heterogeneous mammography platforms, and hold tremendous promise for improving clinical tools to reduce false positive and false negative screening mammography results. Code and model available at: https://github.com/lishen/end2end-all-conv .
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Affiliation(s)
- Li Shen
- Icahn School of Medicine at Mount Sinai (ISMMS), Department of Neuroscience, New York, 10029, USA.
| | - Laurie R Margolies
- ISMMS, Department of Diagnostic, Molecular, and Interventional Radiology, New York, 10029, USA
| | - Joseph H Rothstein
- ISMMS, Department of Population Health Science and Policy and Department of Genetics and Genomic Sciences, New York, 10029, USA
| | - Eugene Fluder
- ISMMS, Department of Scientific Computing, New York, 10029, USA
| | | | - Weiva Sieh
- ISMMS, Department of Population Health Science and Policy and Department of Genetics and Genomic Sciences, New York, 10029, USA
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10
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Alexeeff SE, Odo NU, McBride R, McGuire V, Achacoso N, Rothstein JH, Lipson JA, Liang RY, Acton L, Yaffe MJ, Whittemore AS, Rubin DL, Sieh W, Habel LA. Reproductive Factors and Mammographic Density: Associations Among 24,840 Women and Comparison of Studies Using Digitized Film-Screen Mammography and Full-Field Digital Mammography. Am J Epidemiol 2019; 188:1144-1154. [PMID: 30865217 DOI: 10.1093/aje/kwz033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 08/01/2018] [Revised: 01/29/2019] [Accepted: 02/04/2019] [Indexed: 11/14/2022] Open
Abstract
Breast density is a modifiable factor that is strongly associated with breast cancer risk. We sought to understand the influence of newer technologies of full-field digital mammography (FFDM) on breast density research and to determine whether results are comparable across studies using FFDM and previous studies using traditional film-screen mammography. We studied 24,840 screening-age (40-74 years) non-Hispanic white women who were participants in the Research Program on Genes, Environment and Health of Kaiser Permanente Northern California and underwent screening mammography with either Hologic (Hologic, Inc., Marlborough, Massachusetts) or General Electric (General Electric Company, Boston, Massachusetts) FFDM machines between 2003 and 2013. We estimated the associations of parity, age at first birth, age at menarche, and menopausal status with percent density and dense area as measured by a single radiological technologist using Cumulus software (Canto Software, Inc., San Francisco, California). We found that associations between reproductive factors and mammographic density measured using processed FFDM images were generally similar in magnitude and direction to those from prior studies using film mammography. Estimated associations for both types of FFDM machines were in the same direction. There was some evidence of heterogeneity in the magnitude of the effect sizes by machine type, which we accounted for using random-effects meta-analysis when combining results. Our findings demonstrate the robustness of quantitative mammographic density measurements across FFDM and film mammography platforms.
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Affiliation(s)
- Stacey E Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | | | - Russell McBride
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Valerie McGuire
- Department of Health Research and Policy, Division of Epidemiology, School of Medicine, Stanford University, Stanford, California
| | - Ninah Achacoso
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Joseph H Rothstein
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jafi A Lipson
- Department of Radiology, School of Medicine, Stanford University, Stanford, California
| | - Rhea Y Liang
- Department of Radiology, School of Medicine, Stanford University, Stanford, California
| | - Luana Acton
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Martin J Yaffe
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Alice S Whittemore
- Department of Health Research and Policy, Division of Epidemiology, School of Medicine, Stanford University, Stanford, California
- Department of Biomedical Data Science, School of Medicine, Stanford University, Stanford, California
| | - Daniel L Rubin
- Department of Radiology, School of Medicine, Stanford University, Stanford, California
- Department of Biomedical Data Science, School of Medicine, Stanford University, Stanford, California
| | - Weiva Sieh
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Laurel A Habel
- Division of Research, Kaiser Permanente Northern California, Oakland, California
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11
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Loewenstern J, Rutland J, Gill C, Arib H, Pain M, Umphlett M, Kinoshita Y, McBride R, Donovan M, Sebra R, Bederson J, Fowkes M, Shrivastava R. Comparative genomic analysis of driver mutations in matched primary and recurrent meningiomas. Oncotarget 2019; 10:3506-3517. [PMID: 31191822 PMCID: PMC6544407 DOI: 10.18632/oncotarget.26941] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 02/09/2019] [Accepted: 04/21/2019] [Indexed: 11/25/2022] Open
Abstract
A significant proportion of low-grade WHO grade I and higher-grade WHO grade II or III meningiomas are at risk to develop post-resection recurrence. Though recent studies investigated genomic alterations within histological subtypes of meningiomas, few have compared genomic profiles of primary meningiomas matched to their recurrences. The present study aimed to identify oncogenic driver mutations that may indicate risk of meningioma recurrence and aggressive clinical course. Seventeen patients treated for low-grade (n = 8) or high-grade (n = 9) meningioma and underwent both primary and recurrent resection between 2007-2017 were reviewed. Tumor specimens (n = 38) underwent genomic sequencing of known oncogenic driver mutations. Primary and recurrent tumors were compared using matched-pair analyses for mutational associations with clinical outcomes including functional status, progression-free survival (PFS) and overall survival (OS). Most common driver mutations included POLE and NF2. There was no enrichment for any driver mutation from primary to recurrent tumor specimen. NF2 mutant meningiomas were associated with larger tumor size (8-fold increase), presence of vasogenic edema, and higher mitotic proliferation on univariate and independently on multivariate regression (p's < 0.05) after controlling for preoperative and tumor features. Tumors with POLE driver mutations were associated with decreased functional status at last postoperative follow-up (p = 0.022) relative to presentation. Mutation status was not associated with PFS or OS on multivariate Cox regression, but rather with grade of resection (p = 0.046) for PFS. While primary and recurrent tumors exhibited similar driver mutations within patients, the identification of driver mutations associated with clinical outcomes is crucial for guiding potential targeted treatments in recurrent meningiomas.
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Affiliation(s)
- Joshua Loewenstern
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - John Rutland
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Corey Gill
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Hanane Arib
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Margaret Pain
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Melissa Umphlett
- Department of Pathology, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Yayoi Kinoshita
- Department of Pathology, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Russell McBride
- Department of Pathology, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Michael Donovan
- Department of Pathology, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Robert Sebra
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Joshua Bederson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Mary Fowkes
- Department of Pathology, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Raj Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, NY, New York, USA
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12
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Dunne P, Loughrey MB, Coleman HG, McBride R, Campbell J, Alderdice M, Redmond KL, McArt DG, Isella C, Leedham S, Maughan T, Lawler M, consortium S. Abstract 5175: Advancing the molecular understanding of stage I colorectal cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-5175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: There are ~1.4 million cases of colorectal cancer (CRC) annually worldwide. Bowel cancer screening (BCS) detects cancers and high-risk adenomas earlier; previously stage I accounted for 12% of CRC, but 42% of screen-detected cancers are now stage I. This study is based on the hypothesis that within the early lesions detected by BCS there are "hopeful monsters"; a term used to describe highly aggressive tumours that are simply being caught earlier while they are still potentially curable. Colorectal tumour evolution models have proposed the “Big Bang” of tumour growth, where a single expansion in adenoma development dictates disease outcome. In line with the “hopeful monsters” theory, this model reason that some tumours are “born-to-be-bad” from the earliest point in CRC tumour evolution.
Aims: This proposal aims to develop a molecular stratifier of lethal vs non-lethal early-invasive disease based on comprehensive molecular pathological profiling, improved biological understanding and multiple tiers of validation to inform the management of CRC disease at the earliest stage. Methods: In contrast to stage II-IV CRC, there are limited stage I molecular studies, reducing opportunities to identify lethal early-disseminating tumours in patients who account for ~50% of screen-detected cancers. This study is undertaking collection and molecular profiling of a cohort of retrospective stage I tissue (n=200), enriched for patients that experienced relapsed, to identify factors associated with early-dissemination.
Results: Pathological characterisation of the stage I cohort indicated that histological factors such as fibroblast content or depth of invasive front are not associated with eventual metastatic relapse. Unsupervised analysis highlighted a detectable shift in transcriptional signalling between recurrent and non-recurrent samples. Further supervised analysis indicates that intrinsic “stem-like” factors may be more prognostic than extrinsic factors in stage I.
Conclusions: In order to find any effective treatment you have to first understand the biology underpinning disease. Given the increasing numbers of early stage patients being diagnosed as a result of BCS, and the paucity of tissue cohorts and focussed molecular studies of stage I CRC, this study aims to increase our understanding of specific factors underpinning prognosis at this early stage.
Citation Format: Philip Dunne, M B. Loughrey, H G. Coleman, R McBride, J Campbell, M Alderdice, K L. Redmond, D G. McArt, C Isella, S Leedham, T Maughan, M Lawler, S:CORT consortium. Advancing the molecular understanding of stage I colorectal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5175.
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Affiliation(s)
| | | | | | - R McBride
- 2Queen's Univ. Belfast, Belfast, United Kingdom
| | - J Campbell
- 2Queen's Univ. Belfast, Belfast, United Kingdom
| | - M Alderdice
- 2Queen's Univ. Belfast, Belfast, United Kingdom
| | | | - D G. McArt
- 2Queen's Univ. Belfast, Belfast, United Kingdom
| | | | - S Leedham
- 4University of Oxford, United Kingdom
| | - T Maughan
- 4University of Oxford, United Kingdom
| | - M Lawler
- 2Queen's Univ. Belfast, Belfast, United Kingdom
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13
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Atkins E, Mayes A, McBride R. Quantifying Potential Radiation Exposure in Real Life Endovascular Cases – Implications for Practice. Eur J Vasc Endovasc Surg 2017. [DOI: 10.1016/j.ejvs.2017.08.023] [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: 11/17/2022]
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14
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Jazayeri SB, Kwon YS, McBride R, Leapman M, Collingwood S, Hobbs A, Samadi DB. The Modulating Effects of Benign Prostate Enlargement Medications on Upgrading Predictors in Patients with Gleason 6 at Biopsy. Curr Urol 2017; 10:97-104. [PMID: 28785195 DOI: 10.1159/000447159] [Citation(s) in RCA: 2] [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: 08/18/2016] [Accepted: 12/15/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Upgrading following prostate biopsy is very common in clinical practice. This study investigated whether the use of 5-alpha reductase inhibitors (ARI) and alpha blockers affect known clinical predictors of Gleason score upgrading or not. MATERIALS AND METHODS A retrospective study on 998 patients treated with robotic assisted laparoscopic prostatectomy for clinically localized biopsy Gleason score 6 prostate cancer were studied. The logarithm of prostate specific antigen concentration, prostate size and tumor volume were compared on the basis of the medication history of 5-ARIs and alpha blockers in the cohort of biopsy Gleason 6 patients with benign prostatic hyperplasia history, and patients whose prostate sizes fall in the top quartile. We compared known clinical and pathologic characteristics associated with upgrading in regression models with and without the addition of medications. RESULTS Alpha blockers, but not 5-ARI were associated with a bigger prostate. Upgrading was associated with older age (OR 1.03, 95% CI 1.01-1.06), higher BMI (OR 1.00 CI 1.01-1.08), higher log prostate specific antigen (OR 7.32, CI 3.546-15.52), smaller prostate size (OR 0.97, CI 0.96-0.98), fewer biopsy cores (OR 0.96 CI 0.92-0.99), more positive cores (OR 1.20, CI 1.08-1.34), and higher percentage of tumor at biopsy (OR 1.02, CI 1.01-1.03). Neither of the two medication classes were a significant predictor of upgrading. Medications made minimal changes in the multivariate predictive models. CONCLUSION Although, alpha blockers were associate with bigger prostate size, the modulating effects of alpha blockers and 5-ARIs on common predictors of Gleason score upgrading was not significant.
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Affiliation(s)
| | - Young S Kwon
- Department of Urology, Mercer University School of Medicine, Macon, Ga., USA
| | - Russell McBride
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, N.Y, USA
| | - Michael Leapman
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, N.Y, USA
| | - Shemille Collingwood
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, N.Y, USA
| | - Adele Hobbs
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, Calif., USA
| | - David B Samadi
- Department of Urology, Lenox Hill Hospital, New York, N.Y, USA
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15
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Hu J, Ye F, Cui M, Lee P, Wei C, Hao Y, Wang X, Wang Y, Lu Z, Galsky M, McBride R, Wang L, Wang D, Cordon-Cardo C, Wang C, Zhang DY. Protein Profiling of Bladder Urothelial Cell Carcinoma. PLoS One 2016; 11:e0161922. [PMID: 27626805 PMCID: PMC5023150 DOI: 10.1371/journal.pone.0161922] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 08/15/2016] [Indexed: 12/16/2022] Open
Abstract
This study aimed to detect protein changes that can assist to understand the underlying biology of bladder cancer. The data showed forty five proteins were found to be differentially expressed comparing tumors vs non-tumor tissues, of which EGFR and cdc2p34 were correlated with muscle invasion and histological grade. Ten proteins (ß-catenin, HSP70, autotaxin, Notch4, PSTPIP1, DPYD, ODC, cyclinB1, calretinin and EPO) were able to classify muscle invasive BCa (MIBC) into 2 distinct groups, with group 2 associated with poorer survival. Finally, 3 proteins (P2X7, cdc25B and TFIIH p89) were independent factors for favorable overall survival.
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Affiliation(s)
- Jinghai Hu
- Department of Urology, The First Hospital, Jilin University, Changchun, Jilin, 130021, China
| | - Fei Ye
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, United States of America
| | - Miao Cui
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, United States of America
| | - Peng Lee
- Departments of Pathology, New York University, School of Medicine, New York, NY, 10010, United States of America
| | - Chengguo Wei
- Division of Nephrology, Department of Medicine, Mount Sinai School of Medicine, New York, NY, 10029, United States of America
| | - Yuanyuan Hao
- Department of Urology, The First Hospital, Jilin University, Changchun, Jilin, 130021, China
| | - Xiaoqing Wang
- Department of Urology, The First Hospital, Jilin University, Changchun, Jilin, 130021, China
| | - Yanbo Wang
- Department of Urology, The First Hospital, Jilin University, Changchun, Jilin, 130021, China
| | - Zhihua Lu
- Department of Urology, The First Hospital, Jilin University, Changchun, Jilin, 130021, China
| | - Matthew Galsky
- Division of Hematology and Oncology, Department of Medicine, Mount Sinai School of Medicine, New York, NY, 10029, United States of America
| | - Russell McBride
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, United States of America
| | - Li Wang
- Departments of Genetics and Genomic Sciences, Mount Sinai School of Medicine, New York, NY, 10029, United States of America
| | - Dongwen Wang
- Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, 030002, China
| | - Carlos Cordon-Cardo
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, United States of America
| | - Chunxi Wang
- Department of Urology, The First Hospital, Jilin University, Changchun, Jilin, 130021, China
- * E-mail: (DYZ); (CXW)
| | - David Y. Zhang
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, United States of America
- * E-mail: (DYZ); (CXW)
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16
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Ye F, Wang L, Castillo-Martin M, McBride R, Galsky MD, Zhu J, Boffetta P, Zhang DY, Cordon-Cardo C. Biomarkers for bladder cancer management: present and future. Am J Clin Exp Urol 2014; 2:1-14. [PMID: 25374904 PMCID: PMC4219291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 03/26/2014] [Indexed: 06/04/2023]
Abstract
Accurate and sensitive detection of bladder cancer is critical to diagnose this deadly disease at an early stage, estimate prognosis, predict response to treatment, and monitor recurrence. In past years, laboratory diagnosis and surveillance of urinary bladder cancer have improved significantly. Although urine cytology remains the gold standard test, many new urinary biomarkers have been identified. Furthermore, recent advances in genomic studies of bladder cancer have helped to refine our understanding of the pathogenesis of the disease, the biological basis for outcome disparities, and to inform more efficient treatment and surveillance strategies. In this article, the established diagnostic tests, newly identified biomarkers and genomic landscape of bladder cancer will be reviewed.
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Affiliation(s)
- Fei Ye
- Department of Pathology, Icahn School of Medicine at Mount SinaiNew York City, New York
| | - Li Wang
- Department of Genetics and Genomics, Icahn School of Medicine at Mount SinaiNew York City, New York
| | | | - Russell McBride
- Department of Pathology, Icahn School of Medicine at Mount SinaiNew York City, New York
- The Institute for Translational E pidemiology, Icahn School of Medicine at Mount SinaiNew York City, New York
| | - Matthew D Galsky
- Division of Oncology, Icahn School of Medicine at Mount SinaiNew York City, New York
| | - Jun Zhu
- Department of Genetics and Genomics, Icahn School of Medicine at Mount SinaiNew York City, New York
| | - Paolo Boffetta
- The Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiNew York City, New York
| | - David Y Zhang
- Department of Pathology, Icahn School of Medicine at Mount SinaiNew York City, New York
| | - Carlos Cordon-Cardo
- Department of Pathology, Icahn School of Medicine at Mount SinaiNew York City, New York
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17
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Stensland KD, McBride R, Wisnivesky JP, Latif A, Hendricks R, Roper N, Boffetta P, Hall SJ, Oh WK, Galsky MD. Premature termination of genitourinary cancer clinical trials. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.4_suppl.288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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
288 Background: The GU oncology literature is inundated with clinical trials that terminated prematurely, particularly in bladder cancer. Such trials require substantial resource expenditure and entail the time, trust, and commitment of patients, yet contribute minimally to the scientific knowledgebase and divert resources from answering critical questions. We sought to determine the scope of this problem within the clinical trials enterprise. Methods: ClinicalTrials.gov was queried to identify all phase II-III interventional adult cancer clinical trials registered between 9/11/05 and 11/11/11. Prematurely terminated trials were “stopped early” as defined by the registry. Kaplan-Meier methods and Cox regression were used to determine risk of premature trial termination. Results: We identified 7,776 trials, including 491 prostate (PCa), 142 kidney, 75 bladder, and 34 testis cancer trials. The risk of premature termination due to any cause for all cancers was 25% (95% CI 19-31%) and the risk due to poor accrual was 10% (95% CI 9-12%). Poor accrual was the most common reason for premature termination (Table). Risk was not significantly different for kidney, bladder or testis cancers compared to other cancer types with the exception of PCa (HR 1.35 [1.03-1.78]). Industry-funded trials were more likely to terminate prematurely (HR 2.26 [1.83-2.80]). Trials with sites outside of the USA (HR 0.63 [0.54-0.74]) or both within and outside of the USA (HR 0.68 [0.54-0.74]) were less likely to terminate prematurely as were trials with multiple sites (HR 0.56 [0.48-0.64]). Conclusions: In this large cohort of clinical trials, ~1 in 4 trials terminated prematurely (1 in 10 due to poor accrual). GU cancer trials were at similar risk of termination compared to other cancer clinical trials with the exception of PCa. Novel approaches are needed to improve the efficiency of the clinical cancer research enterprise. [Table: see text]
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Affiliation(s)
| | - Russell McBride
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Juan P. Wisnivesky
- Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine, Mount Sinai School of Medicine, New York, NY
| | - Asma Latif
- Division of Hematology and Medical Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ryan Hendricks
- Division of Hematology and Medical Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nitin Roper
- Division of Hematology and Medical Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Paolo Boffetta
- Ichan School of Medicine at Mount Sinai, NY, NY and International Prevention Research Institute, Lyon, France, New York, NY
| | - Simon J Hall
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - William K. Oh
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Matt D. Galsky
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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18
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Galsky MD, Latif A, Stensland KD, Moshier EL, McBride R, Hendricks R, Sonpavde G, Godbold JH, Hall SJ, Oh WK, Wisnivesky JP. Distribution and geographic accessibility of prostate cancer clinical trials in the United States. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.4_suppl.59] [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
59 Background: An extremely small proportion of patients with cancer in the United States (US) enroll in clinical trials. While several barriers to trial accrual have been described, the geographic distribution and accessibility of clinical trial sites has not been comprehensively explored. Methods: ClinicalTrials.gov was queried to identify all active US clinical trials exploring first-line therapies for metastatic prostate cancer (PCa) on 9/16/2012. We evaluated the geographic distribution of trial sites and determined the relationship between the number of sites and the number of patients with advanced PCa per county and evaluated heterogeneity using Lorenz curves. We also estimated the minimum driving distance required to access a clinical trial site from each ZIP code in the continguous US; a distance >30 miles was defined as high travel burden consistent with prior studies. Results: We identified 958 sites associated with 42 PCa clinical trials (Table). The geographic distribution of clinical trial sites was very inhomogeneous with several states having only 1-2 trial sites. Among 3185 US counties, 2,669 (83.8%) had no clinical trials available for first-line treatment of metastatic PCa. Counties with larger populations of patients with advanced PCa had significantly higher numbers of clinical trial sites. For every 100 additional patients with advanced PCa per county, the number of available trial sites increased by 21.0% (95% CI: 16.5-25.7%). However, Lorenz curves indicated a high degree of inequality in trial accessibility (Gini index 0.71). Approximately 31% of the US population resided >30 miles from a PCa trial site. Conclusions: Clinical trials sites are poorly accessible, geographically, to a large subset of US PCa patients, a finding that likely contributes to dismal accrual. Innovative solutions are required to address geographic barriers to access. [Table: see text]
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Affiliation(s)
- Matt D. Galsky
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Asma Latif
- Division of Hematology and Medical Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Erin L. Moshier
- Department of Preventive Medicine, Mount Sinai School of Medicine, New York, NY
| | - Russell McBride
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ryan Hendricks
- Division of Hematology and Medical Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - James H. Godbold
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Simon J Hall
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - William K. Oh
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Juan P. Wisnivesky
- Divisions of General Internal Medicine and Pulmonary and Critical Care Medicine, Mount Sinai School of Medicine, New York, NY
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Stensland KD, Latif A, Hendricks R, Roper N, McBride R, Hall SJ, Oh WK, Galsky MD. Prevalence and characteristics of prematurely terminated cancer clinical trials. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.6613] [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
6613 Background: Cancer clinical trials require a substantial investment of patient and financial resources. Trials that are terminated prematurely contribute little to the scientific knowledge base and divert resources from answering other critical questions. To our knowledge, the prevalence of prematurely terminated trials, and reasons for termination, has not been comprehensively assessed. Methods: The ClinicalTrials.gov database was queried to identify all phase II and phase III interventional trials for any neoplasm registered between 9/2005 and 11/2012. The disease type, enrollment status, phase, funding source, and number of study sites were collected for each trial. A ”prematurely terminated” trial was any trial with a status of “terminated,” “withdrawn,” or “suspended.” The reason for termination was collected for each prematurely terminated trial. Results: We identified 11,483 interventional cancer trials, of which 1,326 (11.5%) were terminated prematurely. The reasons for termination are shown in the Table. The proportion of cancelled trials was similar among the various disease types, but was slightly higher in lung cancer (14.4% vs. 11.2%, p = 0.001), and slightly lower in skin cancer (8.2% vs. 11.7%, p = 0.022). The most common reason for premature termination was poor accrual (33.1%) though no reason was provided for 23% of trials. Trials sponsored by industry were more likely to be canceled than those with NIH or “other” sponsorship (13.4% vs. 9.9%, p = 0.001). Single center trials were more likely to be canceled than trials with multiple sites (13.6% vs. 9.4%, p < 0.001). Conclusions: More than one in ten cancer clinical trials is terminated prematurely. Full reporting of the reasons for premature termination is necessary for further evaluation of the cancer clinical trial enterprise and identification of predictors of study early closure. [Table: see text]
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Affiliation(s)
| | - Asma Latif
- Division of Hematology and Medical Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ryan Hendricks
- Division of Hematology and Medical Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nitin Roper
- Division of Hematology and Medical Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Russell McBride
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - William K. Oh
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Matt D. Galsky
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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Amin S, McBride R, Kline J, Mitchel EB, Lucas AL, Neugut AI, Frucht H. Incidence of subsequent pancreatic adenocarcinoma in patients with a history of nonpancreatic primary cancers. Cancer 2012; 118:1244-51. [PMID: 21887676 PMCID: PMC3677019 DOI: 10.1002/cncr.26414] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Revised: 05/31/2011] [Accepted: 06/06/2011] [Indexed: 12/19/2022]
Abstract
BACKGROUND Several environmental risk factors are known to predispose individuals to pancreatic cancer, and up to 15% of pancreatic cancers have an inherited component. Understanding metachronous cancer associations can modify pancreas cancer risk. The objective of this study was to investigate the association of nonpancreatic cancers with subsequent pancreatic adenocarcinoma. METHODS The authors used data from the US Surveillance, Epidemiology, and End Results (SEER) registries to identify 1,618,834 individuals who had a primary malignancy and subsequent pancreatic adenocarcinoma (n = 4013). Standardized incidence ratios were calculated as an approximation of relative risk (RR) for the occurrence of pancreatic adenocarcinoma after another primary malignancy. RESULTS Among patients who were diagnosed with a first primary malignancy at ages 20 to 49 years, the risk of subsequent pancreatic adenocarcinoma was increased among patients who had cancers of the ascending colon (relative risk [RR], 4.62; 95% confidence interval [CI], 1.86-9.52), hepatic flexure (RR, 5.42; 95% CI, 1.12-15.84), biliary system (RR, 13.14; 95% CI, 4.27-30.66), breast (RR, 1.32; 95% CI, 1.09-1.59), uterine cervix (RR, 1.61; 95% CI, 1.02-2.41), testes (RR, 2.78; 95% CI, 1.83-4.05), and hematopoietic system (RR, 1.83; 95% CI, 1.28-2.53). Among patients who had a first malignancy at ages 50 to 64 years, the risk was increased after cancers of the stomach (RR, 1.88; 95% CI, 1.13-2.93), hepatic flexure (RR, 2.25; 95% CI, 1.08-4.13), lung and bronchus (RR, 1.46; 95% CI, 1.16-1.82), pharynx (RR, 2.26; 95% CI, 1.13-4.04), and bladder (RR, 1.24; 95% CI, 1.03-1.48). Among patients who had a primary cancer after age 65 years, the risk was increased after cancers of the stomach (RR, 1.79; 95% CI, 1.23-2.53), hepatic flexure (RR, 1.76; 95% CI, 1.06-2.75), biliary system (RR, 2.35; 95% CI, 1.17-4.20), and uterus (RR, 1.23; 95% CI, 1.03-1.47). CONCLUSIONS The results from the current population-based data set suggested that pancreatic adenocarcinoma is associated with certain primary cancers. Genetic predisposition and common environmental and behavioral risk factors all may contribute to this observation. Specific tumor associations will guide future risk-stratification efforts.
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Affiliation(s)
- Sunil Amin
- College of Physicians and Surgeons, Columbia University, New York, NY and New York Presbyterian Hospital, New York, NY
- Muzzi Mirza Pancreatic Cancer Prevention & Genetics Program, Columbia University, New York, NY and New York Presbyterian Hospital, New York, NY
| | - Russell McBride
- Department of Epidemiology, Mailman School of Public Health
- Herbert Irving Comprehensive Cancer Center
| | - Jennie Kline
- Sergievsky Center, Columbia University, New York, NY and the New York State Psychiatric Institute, New York, NY
- Department of Epidemiology, Mailman School of Public Health
| | - Elana B. Mitchel
- College of Physicians and Surgeons, Columbia University, New York, NY and New York Presbyterian Hospital, New York, NY
- Muzzi Mirza Pancreatic Cancer Prevention & Genetics Program, Columbia University, New York, NY and New York Presbyterian Hospital, New York, NY
| | - Aimee L. Lucas
- Muzzi Mirza Pancreatic Cancer Prevention & Genetics Program, Columbia University, New York, NY and New York Presbyterian Hospital, New York, NY
- Division of Digestive and Liver Diseases, Columbia University, New York, NY and New York Presbyterian Hospital, New York, NY
- Department of Medicine, Columbia University, New York, NY and New York Presbyterian Hospital, New York, NY
| | - Alfred I. Neugut
- Department of Medicine, Columbia University, New York, NY and New York Presbyterian Hospital, New York, NY
- Herbert Irving Comprehensive Cancer Center
| | - Harold Frucht
- Muzzi Mirza Pancreatic Cancer Prevention & Genetics Program, Columbia University, New York, NY and New York Presbyterian Hospital, New York, NY
- Division of Digestive and Liver Diseases, Columbia University, New York, NY and New York Presbyterian Hospital, New York, NY
- Department of Medicine, Columbia University, New York, NY and New York Presbyterian Hospital, New York, NY
- Herbert Irving Comprehensive Cancer Center
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Forde N, Carter F, Spencer T, Bazer F, Sandra O, Mansouri-Attia N, Okumu L, McGettigan P, Mehta J, McBride R, O'Gaora P, Roche J, Lonergan P. Conceptus-Induced Changes in the Endometrial Transcriptome: How Soon Does the Cow Know She Is Pregnant?1. Biol Reprod 2011; 85:144-56. [DOI: 10.1095/biolreprod.110.090019] [Citation(s) in RCA: 184] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Onorato DP, Criffield M, Lotz M, Cunningham M, McBride R, Leone EH, Bass OL, Hellgren EC. Habitat selection by critically endangered Florida panthers across the diel period: implications for land management and conservation. Anim Conserv 2010. [DOI: 10.1111/j.1469-1795.2010.00415.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [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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Hershman DL, Buono DL, Malin J, McBride R, Tsai WY, Neugut AI. Patterns of use and risks associated with erythropoiesis-stimulating agents among Medicare patients with cancer. J Natl Cancer Inst 2009; 101:1633-41. [PMID: 19903808 DOI: 10.1093/jnci/djp387] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Erythropoiesis-stimulating agents (erythropoietin and darbepoietin) have been approved to reduce the number of blood transfusions required during chemotherapy; however, concerns about the risks of venous thromboembolism and mortality exist. METHODS We identified patients who were aged 65 years or older in the Surveillance, Epidemiology, and End Results-Medicare database; who were diagnosed with colon, non-small cell lung, or breast cancer or with diffuse large B-cell lymphoma from January 1, 1991, through December 31, 2002; and who received chemotherapy. The main outcome measures were claims for use of an erythropoiesis-stimulating agent, blood transfusion, venous thromboembolism (ie, deep vein thrombosis or pulmonary embolism), and overall survival. We used multivariable logistic regression models to analyze the association of erythropoiesis-stimulating agent use with clinical and demographic variables. We used time-dependent Cox proportional hazards models to analyze the association of time to receipt of first erythropoiesis-stimulating agent with venous thromboembolism and overall survival. All statistical tests were two-sided. RESULTS Among 56,210 patients treated with chemotherapy from 1991 through 2002, 15,346 (27%) received an erythropoiesis-stimulating agent. The proportion of patients receiving erythropoiesis-stimulating agents increased from 4.8% in 1991 to 45.9% in 2002 (P < .001). Use was associated with more recent diagnosis, younger age, urban residence, comorbidities, receipt of radiation therapy, female sex, and metastatic or recurrent cancer. The rate of blood transfusion per year during 1991-2002 remained constant at 22%. Venous thromboembolism developed in 1796 (14.3%) of the 12,522 patients who received erythropoiesis-stimulating agent and 3400 (9.8%) of the 34,820 patients who did not (hazard ratio = 1.93, 95% confidence interval = 1.79 to 2.07). Overall survival was similar in both groups. CONCLUSION Use of erythropoiesis-stimulating agent increased rapidly after its approval in 1991, but the blood transfusion rate did not change. Use of erythropoiesis-stimulating agents was associated with an increased risk of venous thromboembolism but not of mortality.
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Affiliation(s)
- Dawn L Hershman
- Columbia University Medical Center, 161 Fort Washington Ave, 10-1068, New York, NY 10032, USA.
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24
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Forde N, Carter F, Fair T, Crowe M, Evans A, Spencer T, Bazer F, McBride R, Boland M, O'Gaora P, Lonergan P, Roche J. Progesterone-Regulated Changes in Endometrial Gene Expression Contribute to Advanced Conceptus Development in Cattle1. Biol Reprod 2009; 81:784-94. [DOI: 10.1095/biolreprod.108.074336] [Citation(s) in RCA: 232] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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25
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Strauss J, Hershman DL, Buono D, McBride R, Clark-Garvey S, Woodhouse SA, Abrams JA, Neugut AI. Use of adjuvant 5-fluorouracil and radiation therapy after gastric cancer resection among the elderly and impact on survival. Int J Radiat Oncol Biol Phys 2009; 76:1404-12. [PMID: 19540074 DOI: 10.1016/j.ijrobp.2009.03.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 03/15/2009] [Accepted: 03/19/2009] [Indexed: 12/27/2022]
Abstract
PURPOSE In randomized trials patients with resected nonmetastatic gastric cancer who received adjuvant chemotherapy and radiotherapy (chemoRT) had better survival than those who did not. We investigated the effectiveness of adjuvant chemoRT after gastric cancer resection in an elderly general population and its effects by stage. METHODS AND MATERIALS We identified individuals in the Surveillance, Epidemiology, and End Results-Medicare database aged 65 years or older with Stage IB through Stage IV (M0) gastric cancer, from 1991 to 2002, who underwent gastric resection, using multivariate modeling to analyze predictors of chemoRT use and survival. RESULTS Among 1,993 patients who received combined chemoRT or no adjuvant therapy after resection, having a later year of diagnosis, having a more advanced stage, being younger, being white, being married, and having fewer comorbidities were associated with combined treatment. Among 1,476 patients aged less than 85 years who survived more than 4 months, the 313 who received combined treatment had a lower mortality rate (hazard ratio, 0.83; 95% confidence interval, 0.71-0.98) than the 1,163 who received surgery alone. Adjuvant therapy significantly reduced the mortality rate for Stages III and IV (M0), trended toward improved survival for Stage II, and showed no benefit for Stage IB. We observed trends toward improved survival in all age categories except 80 to 85 years. CONCLUSIONS The association of combined adjuvant chemoRT with improved survival in an overall analysis of Stage IB through Stage IV (M0) resected gastric cancer is consistent with clinical trial results and suggests that, in an elderly population, adjuvant chemoradiotherapy is effective. However, our observational data suggest that adjuvant treatment may not be effective for Stage IB cancer, is possibly appropriate for Stage II, and shows significant survival benefits for Stages III and IV (M0) for those aged less than 80 years.
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Affiliation(s)
- Joshua Strauss
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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26
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Adams PC, Skinner JS, Cohen M, McBride R, Fuster V. Acute coronary syndromes in the United States and United Kingdom: a comparison of approaches. The Antithrombotic Therapy in Acute Coronary Syndromes Research Group. Clin Cardiol 2009; 21:348-52. [PMID: 9595218 PMCID: PMC6656248 DOI: 10.1002/clc.4960210510] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Patients with coronary artery disease are managed differently in different countries. HYPOTHESIS These variations in patient management may affect clinical outcome, a possibility that should be taken into consideration in multicenter studies. METHODS In a binational, 3 months study of antithrombotic treatment of patients with unstable angina and non-Q-wave infarction (ATACS), we compared the experience in the four enrollment centers in the United States (US) with the three centers in the United Kingdom (UK). The 59 US patients and the 299 UK patients were similar with regard to age, rates of prior revascularization, prior positive exercise tests, medication use, and aspirin use. RESULTS US patients were more commonly women (45 vs. 28%), diabetic (30 vs. 4%), or hypertensive (52 vs. 31%), and had a prior coronary angiogram (30 vs. 18%). After enrollment, coronary angiography was performed more frequently in the US than in the UK (61 vs. 22%). Although the distribution of coronary disease was similar, revascularization without recurrent angina (19 vs. 4%, p < 0.001), or following recurrent angina (8 vs. 3%), was significantly more frequent in the US. Combined primary end points (recurrent angina, myocardial infarction, or death) did not differ between US (29%) and UK (25%) patients. CONCLUSION Therefore, international studies of acute coronary disease need to account for different treatments in different countries. These differences, in the small ATACS study, did not have a major impact on the composite primary outcome variables.
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Affiliation(s)
- P C Adams
- Department of Cardiology, Royal Victoria Infirmary, Newcastle-Upon-Tyne, U.K
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Abstract
PURPOSE Several case reports and European studies have suggested an association between sarcoidosis and celiac disease; however, they have been inconsistent. We therefore analyzed a large cohort of celiac-disease patients to assess this association. METHODS An anonymized database of patients with celiac disease was reviewed to determine the number of patients with sarcoidosis. Age- and gender-adjusted standardized morbidity ratios with corresponding 95% confidence intervals (CI) were calculated by comparing results to US-population-derived prevalence data. RESULTS Ten patients were found to have a comorbid diagnosis of sarcoidosis, representing an age- and gender-adjusted standardized morbidity ratio of 36.8 (95% CI 26.7-50.9). CONCLUSIONS In this cohort of patients with celiac disease, there was a significantly increased risk of sarcoidosis when compared with the American white population. This further strengthens prior associations that have been made suggesting a shared mechanism behind the etiologies of celiac disease and sarcoidosis.
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Affiliation(s)
- Elizabeth Hwang
- Department of Medicine, Columbia University Medical Center, 180 Fort Washington Avenue, Room 956, New York, NY 10032, USA
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Wright J, Doan T, McBride R, Jacobson J, Hershman D. Variability in chemotherapy delivery for elderly women with advanced stage ovarian cancer and its impact on survival. Br J Cancer 2008; 98:1197-203. [PMID: 18349836 PMCID: PMC2359630 DOI: 10.1038/sj.bjc.6604298] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Given the survival benefits of adjuvant chemotherapy for advanced ovarian cancer (OC), we examined the associations of survival with the time interval from debulking surgery to initiation of chemotherapy and with the duration of chemotherapy. Among patients > or =65 years with stages III/IV OC diagnosed between 1991 and 2002 in the Surveillance, Epidemiology, and End Results-Medicare database, we developed regression models of predictors of the time interval from surgery to initiation of chemotherapy and of the total duration of chemotherapy. Survival was examined with Cox proportional hazards models. Among 2558 patients, 1712 (67%) initiated chemotherapy within 6 weeks of debulking surgery, while 846 (33%) began treatment >6 weeks. Older age, black race, being unmarried, and increased comorbidities were associated with delayed initiation of chemotherapy. Delay of chemotherapy was associated with an increase in mortality (hazard ratio (HR)=1.11; 95% CI, 1.0-1.2). Among 1932 patients in the duration of treatment analysis, the 1218 (63%) treated for 3-7 months had better survival than the 714 (37%) treated for < or =3 months (HR=0.84; 95% CI, 0.75-0.94). This analysis represents one of the few studies describing treatment delivery and outcome in women with advanced OC. Delayed initiation and early discontinuation of chemotherapy were common and associated with increased mortality.
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Affiliation(s)
- Jd Wright
- Department of Obstetrics and Gynecology, Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, New York, NY 10032, USA
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McBride R, Hershman D, Tsai WY, Jacobson JS, Grann V, Neugut AI. Within-stage racial differences in tumor size and number of positive lymph nodes in women with breast cancer. Cancer 2007; 110:1201-8. [PMID: 17701948 DOI: 10.1002/cncr.22884] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Black women have higher breast cancer mortality rates, are more likely to be diagnosed at an advanced stage of disease, and have worse stage-for-stage survival than white women. It was hypothesized that differences in the tumor size and number of positive lymph nodes within each disease stage contribute to the survival disparity. METHODS In the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database, black and white women diagnosed with a first primary tumor (TNM stage I-IIIA breast cancer) between 1988 and 2003 were identified. The demographic and clinical characteristics were compared by race. Logistic regression models of the association between race and tumor size and lymph node status were developed. Cox proportional hazards models of the association between mortality and race, tumor size, lymph node status, and other covariates were also examined. RESULTS Among 256,174 SEER cases (21,861 black and 234,313 white women), more black than white women with lymph node-negative breast cancer had tumors measuring >or=2.0 cm. Adjusted for tumor size, more black than white women had >or=1 positive lymph nodes (odds ratio [OR], 1.24; 95% confidence interval [95% CI], 1.20-1.28). The age-adjusted and TNM stage-adjusted mortality rate ratio for blacks versus whites was 1.56 (95% CI, 1.51-1.61). Adjustment for within-stage differences in tumor size and lymph node involvement were found to have a negligible effect. With adjustment for additional covariates, the rate ratio was 1.39 (95% CI, 1.35-1.44). In addition, the rate ratio reflecting racial disparity increased as the stage of disease increased. CONCLUSIONS.: Adjusting for within-stage differences in tumor size and lymph node status did not appear to reduce the racial disparity. The finding that disparities increased with higher stage of disease suggests that interventions aimed at reducing these differences should target women with more advanced disease.
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Affiliation(s)
- Russell McBride
- Department of Epidemiology, Mailman School of Public Health, New York, New York, USA
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Hershman DL, Eisenberger A, Wang J, Jacobson J, Grann V, McBride R, Tsai W, Neugut A. Doxorubicin, cardiac risk factors and cardiac toxicity in elderly patients with diffuse b-cell non-Hodgkin's lymphoma. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.9050] [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
9050 Background: Anthracyclines are known to cause acute and chronic cardiotoxicity. In a population-based sample of elderly patients with diffuse large B-cell lymphoma (DLBCL), we studied the cardiac effects of doxorubicin (DOX)-containing regimens and of pre-existing diabetes (DM), hypertension (HTN), and heart disease (HD). Methods: Patients aged =65 years diagnosed with DLBCL 1/1/1992–12/31/2000 in the SEER/Medicare database were grouped by treatment: no chemotherapy, doxorubicin-based chemotherapy, or other chemotherapy. We developed multivariable logistic regression models of the associations of DOX-based chemotherapy with demographic and clinical variables and pre-diagnosis DM, HTN, and HD. We then developed Cox proportional hazards regression models of the association between treatment and subsequent congestive heart failure (CHF) taking the predictors of treatment into account. Results: Of 6,413 patients with DLBCL, 2,536 (39%) received doxorubicin-based chemotherapy. DOX use was associated with later year of diagnosis, female gender, younger age, and being married. Black race (HR 0.50, 95% CI 0.33–0.75), comorbidities, preexisting CHF, HD, and DM (HR 0.73, 95% CI 0.62–0.86) were associated with decreased DOX use. The post-treatment HR for CHF following DOX treatment vs. no chemotherapy was 1.39 (95% CI 1.15–1.67); CHF risk increased with duration of DOX use. It was also associated with increasing age, comorbidities, black race, DM, HTN, and HD. There was a significant interaction between race and DOX (P=0.01); For black patients treated with DOX the HR for CHF was 3.4, as compared to a HR of 1.3 for white patients. Conclusions: Among patients with DLBCL, black race, CRFs and pre-existing HD are all associated with both a reduced likelihood of receiving anthracyclines, and an increased risk of CHF. We have previously found a powerful effect of DOX on survival in this patient population; thus, for most patients, the benefits of treatment would appear to outweigh the risks of cardiac toxicity. However, as the number of long-term survivors grows, the need for research on the side effects of treatment, on host factors that may increase the risk of adverse effects, and on ways to minimize such risks will also grow. No significant financial relationships to disclose.
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Affiliation(s)
- D. L. Hershman
- Columbia University Medical Center, New York, NY; Columbia University, New York, NY
| | - A. Eisenberger
- Columbia University Medical Center, New York, NY; Columbia University, New York, NY
| | - J. Wang
- Columbia University Medical Center, New York, NY; Columbia University, New York, NY
| | - J. Jacobson
- Columbia University Medical Center, New York, NY; Columbia University, New York, NY
| | - V. Grann
- Columbia University Medical Center, New York, NY; Columbia University, New York, NY
| | - R. McBride
- Columbia University Medical Center, New York, NY; Columbia University, New York, NY
| | - W. Tsai
- Columbia University Medical Center, New York, NY; Columbia University, New York, NY
| | - A. Neugut
- Columbia University Medical Center, New York, NY; Columbia University, New York, NY
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Hershman D, Neugut AI, Jacobson JS, Wang J, Tsai WY, McBride R, Bennett CL, Grann VR. Acute myeloid leukemia or myelodysplastic syndrome following use of granulocyte colony-stimulating factors during breast cancer adjuvant chemotherapy. J Natl Cancer Inst 2007; 99:196-205. [PMID: 17284714 DOI: 10.1093/jnci/djk028] [Citation(s) in RCA: 225] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recently, increasing numbers of women receiving adjuvant chemotherapy for breast cancer have also received granulocyte colony-stimulating factors (G-CSFs) or granulocyte-macrophage colony-stimulating factors (GM-CSFs). Although these growth factors support chemotherapy, their long-term safety has not been evaluated. We studied the association between G-CSF use and incidence of leukemia in a population-based sample of breast cancer patients. METHODS Among women aged 65 years or older in the Surveillance, Epidemiology, and End Results-Medicare database who were diagnosed with stages I-III breast cancer from January 1, 1991, to December 31, 1999, we identified those who received G-CSF or GM-CSF concurrently with chemotherapy. We used Cox proportional hazards models to estimate hazard ratios for the association of treatment with G-CSF or GM-CSF and subsequent (through December 31, 2003) diagnosis of acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS). All statistical tests were two-sided. RESULTS Of 5510 women treated with chemotherapy, 906 (16%) received G-CSF or GM-CSF therapy, and 64 (1.16%) were subsequently diagnosed with either MDS or AML before a cancer recurrence. Use of G-CSF and GM-CSF was associated with more recent diagnosis, younger age, urban residence, fewer comorbidities, receipt of radiation therapy, positive lymph nodes, and cyclophosphamide treatment. Of the 906 patients who were treated with G-CSF, 16 (1.77%) developed AML or MDS; of the 4604 patients not treated with G-CSF, 48 (1.04%) developed AML or MDS. The hazard rate ratio for AML or MDS among those treated with G-CSF or GM-CSF compared with those who were not was 2.14 (95% confidence interval [CI] = 1.12 to 4.08). AML or MDS developed within 48 months of breast cancer diagnosis in 1.8% of patients who received G-CSF or GM-CSF but only in 0.7% of patients who did not (hazard ratio = 2.59, 95% CI = 1.30 to 5.15). CONCLUSIONS The use of G-CSF was associated with a doubling in the risk of subsequent AML or MDS among the population that we studied, although the absolute risk remained low. Even if this association is confirmed, the benefits of G-CSF may still outweigh the risks. Meanwhile, however, G-CSF use should not be assumed to be risk free.
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Affiliation(s)
- Dawn Hershman
- Department of Medicine and Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
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Doyle JJ, Neugut AI, Jacobson JS, Wang J, McBride R, Grann A, Grann VR, Hershman D. Radiation therapy, cardiac risk factors, and cardiac toxicity in early-stage breast cancer patients. Int J Radiat Oncol Biol Phys 2007; 68:82-93. [PMID: 17336464 DOI: 10.1016/j.ijrobp.2006.12.019] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Revised: 11/13/2006] [Accepted: 12/06/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE The benefits of adjuvant radiation therapy (RT) for breast cancer may be counterbalanced by the risk of cardiac toxicity. We studied the cardiac effects of RT and the impact of pre-existing cardiac risk factors (CRFs) in a population-based sample of older patients with breast cancer. METHODS AND MATERIALS In the Surveillance, Epidemiology and End-Results (SEER)-Medicare database of women > or = 65 years diagnosed with Stages I to III breast cancer from January 1, 1992 to December 31, 2000, we used multivariable logistic regression to model the associations of demographic and clinical variables with postmastectomy and postlumpectomy RT. Using Cox proportional hazards regression, we then modeled the association between treatment and myocardial infarction (MI) and ischemia in the 10 or more years after diagnosis, taking the predictors of treatment into account. RESULTS Among 48,353 women with breast cancer; 19,897 (42%) were treated with lumpectomy and 26,534 (55%) with mastectomy; the remainder had unknown surgery type (3%). Receipt of RT was associated with later year of diagnosis, younger age, fewer comorbidities, nonrural residence, and chemotherapy. Postlumpectomy RT was also associated with white ethnicity and no prior history of heart disease (HD). The RT did not increase the risk of MI. Presence of MI was associated with age, African American ethnicity, advanced stage, nonrural residence, more than one comorbid condition, a hormone receptor-negative tumor, CRFs and HD. Among patients who received RT, tumor laterality was not associated with MI outcome. The effect of RT on the heart was not influenced by HD or CRFs. CONCLUSION It appears unlikely that RT would increase the risk of MI in elderly women with breast cancer, regardless of type of surgery, tumor laterality, or history of CRFs or HD, for at least 10 years.
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Affiliation(s)
- John J Doyle
- Department of Epidemiology, Mailman School of Public, College of Physicians and Surgeons, Columbia University, New York Presbyterian Hospital, New York, NY, USA
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Hershman D, Hall MJ, Wang X, Jacobson JS, McBride R, Grann VR, Neugut AI. Timing of adjuvant chemotherapy initiation after surgery for stage III colon cancer. Cancer 2006; 107:2581-8. [PMID: 17078055 DOI: 10.1002/cncr.22316] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND An important advance in medical oncology has been the use of adjuvant chemotherapy for lymph node-positive colon cancer. However, to the authors' knowledge, the effect of the interval between surgery and the initiation of chemotherapy on survival has not been investigated. METHODS The authors analyzed predictors and outcomes of time intervals to treatment after surgery among patients older than 65 years who were diagnosed with stage III colon cancer between 1992 and 1999 using Surveillance, Epidemiology, and End Results (SEER)-Medicare data. Linear and logistic regression analyses were used to model predictors of delay, and Cox proportional hazards models were used to analyze the impact of treatment timing on survival. RESULTS Among 4382 patients with colon cancer, 1122 patients (26%) began adjuvant chemotherapy within 1 month, 2391 patients (55%) began adjuvant chemotherapy in 1 to 2 months, 454 patients (10%) began adjuvant chemotherapy in 2 to 3 months, and 415 patients (9%) began adjuvant chemotherapy >/=3 months after surgery. Intervals of >/=3 months (delay) were associated with older age, increased comorbid conditions, well/moderately differentiated grade, and being unmarried. Colon cancer-specific mortality was associated with a delay in the initiation of chemotherapy (hazards ratio [HR], 1.48; 95% confidence interval [95% CI], 1.15-1.92), advanced age, increased comorbidity, poorly differentiated tumor grade, the presence of >/=4 positive lymph nodes, and undergoing surgery in a nonteaching hospital. All-cause mortality was associated with intervals >2 months between surgery and chemotherapy (2 to 3 months: HR, 1.41; 95% CI, 1.15-1.74; >/=3 months: HR, 1.62; 95% CI, 1.31-1.99) compared with <1 month. CONCLUSIONS In the older population that was studied, only 9% of patients initiated adjuvant chemotherapy >3 months after the date of curative surgery. However, delay in initiation was associated with both cancer-specific and all-cause mortality. Determining whether these results were because of chemotherapy timing or other associated factors will require further study.
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Affiliation(s)
- Dawn Hershman
- Department of Medicine, Mailman School of Public Health, Columbia University, New York, New York, USA.
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Kent L, McBride R, McConnell R, Neugut AI, Bhagat G, Green PHR. Increased risk of papillary thyroid cancer in celiac disease. Dig Dis Sci 2006; 51:1875-7. [PMID: 16957996 DOI: 10.1007/s10620-006-9240-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Accepted: 01/30/2006] [Indexed: 01/14/2023]
Abstract
Patients with celiac disease have an increased rate of malignancies that are not limited to lymphomas. Thyroid carcinoma has not previously been associated with celiac disease. However, among a cohort of patients with celiac disease, we identified an increased risk of papillary carcinoma of the thyroid, standard morbidity ratio of 22.52 (95% confidence interval 14.90-34.04; P < .001), compared to United States national surveillance data. These patients were on a gluten-free diet. Only 1 had Hashimoto's thyroiditis, suggesting that mechanisms apart from autoimmune thyroiditis contribute to the increased risk of carcinoma of the thyroid in celiac disease.
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Affiliation(s)
- Laura Kent
- Department of Medicine, Columbia University College of Physicians and Surgeons, 161 Fort Washington Ave, Room 645, New York, 10032 New York, USA
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Hershman DL, Wang X, McBride R, Jacobson JS, Grann VR, Neugut AI. Delay in initiating adjuvant radiotherapy following breast conservation surgery and its impact on survival. Int J Radiat Oncol Biol Phys 2006; 65:1353-60. [PMID: 16765531 DOI: 10.1016/j.ijrobp.2006.03.048] [Citation(s) in RCA: 132] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Revised: 03/12/2006] [Accepted: 03/14/2006] [Indexed: 11/22/2022]
Abstract
PURPOSE Delays in the diagnosis of breast cancer are associated with advanced stage and poor survival, but the importance of the time interval between lumpectomy and initiation of radiation therapy (RT) has not been well studied. We investigated factors that influence the time interval between lumpectomy and RT, and the association between that interval and survival. PATIENTS AND METHODS We used data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database on women aged 65 years and older, diagnosed with Stages I-II breast cancer, between 1991 and 1999. Among patients who did not receive chemotherapy, we studied factors associated with the time interval between lumpectomy and the initiation of RT, and the association of delay with survival, using linear regression and Cox proportional hazards modeling. RESULTS Among 24,833 women with who underwent lumpectomy, 13,907 (56%) underwent RT. Among those receiving RT, 97% started treatment within 3 months; older age, black race, advanced stage, more comorbidities, and being unmarried were associated with longer time intervals between surgery and RT. There was no benefit to earlier initiation of RT; however, delays >3 months were associated with higher overall mortality (hazard ratio, 1.92; 95% confidence interval, 1.64-2.24) and cancer-specific mortality (hazard ratio, 3.84; 95% confidence interval 3.01-4.91). CONCLUSIONS Reassuringly, early initiation of RT was not associated with survival. Although delays of >3 months are uncommon, they are associated with poor survival. Whether this association is causal or due to confounding factors, such as poor health behaviors, is unknown; until it is better understood, efforts should be made to initiate RT in a timely fashion.
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Affiliation(s)
- Dawn L Hershman
- Department of Medicine and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, New York, NY 10032, USA.
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Siegel AB, McBride R, Hershman D, Brown RS, Emond J, Neugut AI. Current treatments, determinants of use, and survival for patients with hepatoma in the United States from 1998–2002. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.4138] [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
4138 Background: Multiple case series have described the use of current therapies for hepatocellular carcinoma (HCC), but recent estimates of treatment utilization in the general population and the impact of various treatments on survival are not known. Methods: We first identified 2898 adults diagnosed with HCC with known tumor size and stage in the Surveillance, Epidemiology, and End-Results Program (SEER), from 1998–2002. Treatment was categorized as transplant, resection, ablation, or none of these. We created a second data set of 1856 HCC patients who were potentially operable, as defined by SEER. We used these patients to construct Kaplan-Meier survival curves and adjusted Cox proportional hazards models. Results: The median age of the larger cohort at HCC diagnosis was 62 (range:18–96). Approximately 42% were white, 32% Asian, 16% Hispanic, and 10% African American. Overall, 10% received a transplant, 18% resection, 8% ablation, and 65% none of these. Only 5% of African Americans with HCC received a transplant, versus 12% of whites, 10% of Hispanics, and 8% of Asians. Asians were most likely to receive resection (24%) and ablation (9%), and least likely to have non-surgical treatment (60%). Using the restricted cohort, improved survival in the multivariate analysis was seen with later year of diagnosis, younger age, female sex, Asian race, smaller tumor size, lower tumor grade, and localized disease. Treatment was highly correlated with survival. This was greatest in the transplanted group (1, 3, and 5-year survivals 93%, 79%, and 71%), followed by resection (70%, 45%, and 29%), and ablation (71%, 33%, and 18%). The non-surgical group had poor survival (33%, 9%, and 0%). Conclusions: Transplantation yields excellent survival on a population scale, similar to reported series, and resection gives relatively good outcomes as well. Asians are more likely to be resected and ablated than other groups. They also had better survival than other groups, perhaps due to underlying etiology of HCC (hepatitis B) and better preserved liver function. No significant financial relationships to disclose.
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Affiliation(s)
| | | | | | | | - J. Emond
- Columbia University, New York, NY
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Neugut AI, Matasar M, Wang X, McBride R, Jacobson JS, Tsai WY, Grann VR, Hershman DL. Duration of adjuvant chemotherapy for colon cancer and survival among the elderly. J Clin Oncol 2006; 24:2368-75. [PMID: 16618946 DOI: 10.1200/jco.2005.04.5005] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
PURPOSE In randomized trials, patients with stage III colon cancer who received 6 months of fluorouracil (FU)-based adjuvant chemotherapy had better survival than patients who did not. However, little is known about the predictors of, or the survival associated with, duration of chemotherapy in the community. PATIENTS AND METHODS The linked Surveillance, Epidemiology, and End Results-Medicare database was used to identify individuals > or = 65 years of age diagnosed with stage III colon cancer between 1995 and 1999. We used logistic and Cox proportional hazards regression models to analyze factors associated with early discontinuation of FU-based chemotherapy among these elderly colon cancer patients. RESULTS Among 1,722 patients who received 1 to 7 months of FU-based chemotherapy, older age, being unmarried, and having comorbid conditions were associated with receiving less than 5 months of treatment. Among the 1,579 patients who survived > or = 8 months, the 1,091 (69.1%) who received 5 to 7 months of treatment had lower overall (hazard ratio [HR], 0.59; 95%, CI 0.49 to 0.71) and colon cancer-specific (HR, 0.53; 95% CI, 0.43 to 0.66) mortality than the 488 (30.9%) who received 1 to 4 months of treatment. CONCLUSION More than 30% of elderly patients who initiated FU-based chemotherapy for stage III colon cancer and survived for at least 8 months discontinued treatment early. Mortality rates among such patients were nearly twice as high as among patients who completed 5 to 7 months of treatment. If the association we observed between duration of treatment and survival is confirmed, additional investigation is warranted to determine whether dose-intensity, cumulative dose, or other factors related to receipt of full adjuvant treatment are responsible.
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Affiliation(s)
- Alfred I Neugut
- Department of Medicine and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, New York, NY 10032, USA.
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Hershman DL, Wang X, McBride R, Jacobson JS, Grann VR, Neugut AI. Delay of adjuvant chemotherapy initiation following breast cancer surgery among elderly women. Breast Cancer Res Treat 2006; 99:313-21. [PMID: 16583264 DOI: 10.1007/s10549-006-9206-z] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2006] [Accepted: 02/16/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Delay in the diagnosis of breast cancer is associated with worse stage distribution at diagnosis and decreased survival. However, the occurrence of delay in the delivery of adjuvant therapy and its impact on prognosis is not well understood. METHODS To investigate the timeliness of initiation of adjuvant chemotherapy following surgery for breast cancer, we used data from the Surveillance, Epidemiology, and End-Results (SEER)-Medicare database. Among women > or = 65 years diagnosed between 1992 and 1999 with stages I-II breast cancer, we used linear regression and Cox proportional hazards models to investigate the time intervals between surgery and initiation of adjuvant chemotherapy, factors associated with delay, and the effect of delay on survival. RESULTS Our sample consisted of 5003 women who received adjuvant chemotherapy. Of these, 47% initiated chemotherapy within 1 month, 37% between 1 and 2 months, 6% between 2 and 3 months and 10% >3 months (delay) following surgery. Delay was associated with increasing age, residing in a rural location, being unmarried, earlier tumor stage, hormone receptor positivity, mastectomy, and non-receipt of radiation therapy. Survival did not differ among patients who initiated chemotherapy within 1, 2, or 3 months after surgery. Delay beyond 3 months was, however, associated with increased disease-specific mortality (HR 1.69; 95% CI 1.31-2.19) and overall mortality (HR 1.46; 95% CI 1.21-1.75). CONCLUSIONS Among older patients, moderate delays in the receipt of adjuvant chemotherapy occur frequently, but long delays (>3 months) are uncommon. While early initiation of therapy is no benefit, significant delays are associated with increased mortality. Whether this reflects the medical impact of the delay of chemotherapy or factors associated with delay is unclear, but until this is clarified, patients should be encouraged to initiate treatment without significant delay.
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Affiliation(s)
- Dawn L Hershman
- Department of Medicine and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons Columbia University, 161 Ft Washington Room 1068, New York, NY 10032, USA
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Grann VR, Hershman D, Jacobson JS, Tsai WY, Wang J, McBride R, Mitra N, Grossbard ML, Neugut AI. Outcomes and diffusion of doxorubicin-based chemotherapy among elderly patients with aggressive non-Hodgkin lymphoma. Cancer 2006; 107:1530-41. [PMID: 16933332 DOI: 10.1002/cncr.22188] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND In the past 25 years, clinical trials have demonstrated the benefits of chemotherapy for patients with aggressive non-Hodgkin lymphoma. The authors analyzed the predictors and outcomes of chemotherapy among elderly patients with lymphoma. METHODS Patients age >/=65 years who were diagnosed with Stage III and IV diffuse large B-cell lymphoma [according to the SEER Summary Staging Manual, 2000] between 1991 and 1999 in the Surveillance, Epidemiology, and End Results-Medicare data base were categorized by treatment: no chemotherapy, a doxorubicin-containing regimen, a regimen without doxorubicin, or chemotherapy not otherwise specified. Among the patients who survived for >6 weeks after diagnosis and who had a chemotherapy regimen specified, logistic regression analysis was used to identify predictors of doxorubicin-based treatment, and Cox proportional-hazards regression was used to analyze outcomes. RESULTS Less than 66% of patients received any chemotherapy in the 6 months after diagnosis, and 42% of untreated patients died within 6 weeks. Older age, congestive heart failure, and other comorbidities were strong predictors of treatment without doxorubicin. From 1991 to 1999, the proportion of patients who received doxorubicin increased from <20% to >50%. Patients who received doxorubicin survived more than twice as long (24.4 months) as patients who did not receive doxorubicin (11.2 months). Survival was no better among patients who received chemotherapy without doxorubicin than among patients who received no chemotherapy. CONCLUSIONS By 1999, doxorubicin-based chemotherapy had gained general acceptance for use among the elderly, although nearly 50% of elderly patients still were not receiving it. Given the clinical trial-based evidence of its benefits, in the absence of specific contraindications, most patients, including the elderly, should be treated with regimens that include doxorubicin.
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Affiliation(s)
- Victor R Grann
- Department of Medicine and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, New York, USA.
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El-Serag HB, Siegel AB, Davila JA, Shaib YH, Cayton-Woody M, McBride R, McGlynn KA. Treatment and outcomes of treating of hepatocellular carcinoma among Medicare recipients in the United States: a population-based study. J Hepatol 2006; 44:158-66. [PMID: 16290309 DOI: 10.1016/j.jhep.2005.10.002] [Citation(s) in RCA: 180] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2005] [Revised: 09/27/2005] [Accepted: 10/11/2005] [Indexed: 12/14/2022]
Abstract
BACKGROUND/AIMS There are several treatment alternatives available for patients diagnosed with hepatocellular carcinoma (HCC). Yet, neither the extent to which potentially curative or palliative therapy is used to treat HCC, nor the determinants of using such therapies are known. Further, it is unclear how effective different modalities are for treating HCC. METHODS We used the linked SEER-Medicare dataset to identify patients diagnosed with HCC between 1992 and 1999. We identified 2963 patients with continuous Medicare enrollment who were not enrolled in a Medicare-HMO. HCC treatments were categorized as potentially curative therapy (resection, transplant, local ablation), or palliative (trans-arterial chemoembolization (TACE), chemotherapy), and no therapy. Demographic (age, sex, race, geographic region), clinical (comorbidity, risk factors and severity of liver disease) and tumor factors (tumor size, extent of disease) were examined as potential determinants of therapy, as well as survival in univariate and multivariable analyses. Survival curves were also generated and compared among the different treatment modalities. RESULTS The median age at diagnosis was 74 years (range: 32-105), and most patients (91%) were older than 65 years. Approximately 68% were White, 10% Black, 4% Hispanic, 8% Asian, and 9% were of other race. Thirteen percent of the patients received potentially curative therapy (transplant 0.9%, resection 8.2%, local ablation 4.1%), 4% received TACE, 57% received other palliative therapy, and 26% received no specific therapy. Only 34% of 513 patients with single lesions, and 34% of 143 patients with lesions <3.0 cm received potentially curative therapy. However, 19.2% of patients with unfavorable tumor features (lesion >10.0 cm) received such therapy. Among patients who received potentially curative therapy (n=392), resection was the most common procedure (n=243, 62%) followed by local ablation (n=122, 31%) and finally transplantation (n=27, 7%). In regression analyses, geographic variations in the extent and type of curative therapy persisted after adjusting for demographic, clinical, and tumor features. Median overall survival was 104 days following HCC diagnosis with the longest survival in the transplant group (852 days) and the shortest survival in the group with no treatment (58 days). In the survival analysis, transplantation led to the longest survival, followed by resection. Neither ablation nor TACE yielded prolonged survival (3 year survival was less than 10%). CONCLUSIONS In this predominantly 65 years and older Medicare population, there are marked geographic variations in the management of HCC that seem to be at least as important as clinical and tumor-related features in determining the extent and type of HCC therapy. There is underutilization of potentially curative therapy, even among those with favorable tumor features.
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Affiliation(s)
- Hashem B El-Serag
- Section of Health Services Research, Houston Veterans Affairs Medical Center, Baylor College of Medicine, 2002 Holcombe Boulevard (152), Houston, TX 77030, USA.
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Hershman D, McBride R, Jacobson JS, Lamerato L, Roberts K, Grann VR, Neugut AI. Racial Disparities in Treatment and Survival Among Women With Early-Stage Breast Cancer. J Clin Oncol 2005; 23:6639-46. [PMID: 16170171 DOI: 10.1200/jco.2005.12.633] [Citation(s) in RCA: 248] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Black women with breast cancer are known to have poorer survival than white women. Suboptimal treatment may compromise the survival benefits of adjuvant chemotherapy. We analyzed the association of race and survival with duration of treatment and number of treatment cycles among women receiving chemotherapy for early-stage breast cancer. Patients and Methods Patients were women in the Henry Ford Health System tumor registry who were diagnosed with stage I/II breast cancer between January 1, 1996, and December 31, 2001, who received adjuvant chemotherapy. We calculated an observed/expected ratio of treatment duration and of completed chemotherapy cycles for each patient. Using Cox proportional hazards models, we analyzed the association of early treatment termination and treatment duration with all-cause mortality, controlling for age, race, stage, hormone receptor status, grade, comorbidity score, and doxorubicin use. Results Of 472 eligible patients, 28% (31% black, 23% white; P = .03) received fewer cycles of treatment than expected. Black race, receipt of ≤ 75% of the expected number of cycles, increasing age, hormone receptor negativity, and a comorbidity score of more than 1 were associated with poorer survival. Among the 344 patients receiving the expected number of cycles, 60% experienced delays. These delays did not reduce survival. Conclusion This study is the first to find that a substantial fraction of women with early-stage breast cancer terminated their chemotherapy prematurely and that early termination was associated with both black race and poorer survival. A better understanding of the determinants of suboptimal treatment may lead to interventions that can reduce racial disparities and improve breast cancer outcomes for all women.
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Affiliation(s)
- Dawn Hershman
- Department of Medicine and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, New York, NY, USA.
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Hershman D, Jacobson JS, McBride R, Mitra N, Sundararajan V, Grann VR, Neugut AI. Effectiveness of platinum-based chemotherapy among elderly patients with advanced ovarian cancer. Gynecol Oncol 2004; 94:540-9. [PMID: 15297201 DOI: 10.1016/j.ygyno.2004.04.022] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2004] [Indexed: 11/30/2022]
Abstract
BACKGROUND Platinum-based chemotherapy is the standard of care for women with advanced ovarian cancer based on the results of randomized trials. We previously showed that only about half of women over the age of 65 years with this disease received platinum-based chemotherapy, and that the likelihood of receiving it decreases with age. METHODS We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify women diagnosed from 1/1/92 to 12/31/96 with stage III or IV ovarian cancer who survived > or =120 days beyond diagnosis, and were > or =65 years of age. Cox proportional hazards models and propensity scores were used to control for known predictors of receiving treatment and to estimate the relative effectiveness of different platinum-based regimens. RESULTS Of the 1759 patients in the sample who met our eligibility criteria, 53% received platinum-based therapy. For this sample, the Cox proportional hazard ratio was 0.72 (95% CI, 0.62-0.91) for mortality associated with the use of any platinum-based therapy, and 0.59 (95% CI, 0.45-0.76) for combination platinum/paclitaxel therapy. Similar results were obtained using propensity score modeling. CONCLUSIONS In this population-based study, we found that only about half of women with advanced ovarian cancer over age 65 were treated with platinum-based chemotherapy; however, survival improved by 38% in treated women, similar to the benefits described in randomized controlled trials among younger patients, and were greatest when platinum was combined with paclitaxel. An effort to increase the utilization of platinum combination therapy among older patients with advanced ovarian cancer is justified.
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Affiliation(s)
- Dawn Hershman
- Department of Medicine and the Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, 161 Fort Washington, New York, NY 10032, USA.
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Abstract
PURPOSE In early breast cancer the knowledge of the risk of axillary node involvement is important in determining local as well as systemic therapy. Because of the increased acceptance of mammography, there has been an increase in the diagnosis of small, mammographically detected tumors. The objective of this study is to determine whether mammographically detected breast cancers have a lower risk of axillary node involvement compared to those detected clinically. PATIENTS AND METHODS From our patient database of stage I and II breast cancer we identified 980 patients with tumors < or = 2 cm whom had axillary node dissection. Four hundred thirty-five (44%) patients presented with abnormal mammograms without clinically palpable tumors; 545 (56%) patients had clinically detected tumors. The median size of the mammographically detected tumors is 1.0 cm, and the median size of the clinically detected tumors is 1.5 cm. The median age of the patients with mammographically detected tumors is 61 (range: 29-87) compared to 53 (range: 27-88) in those with palpable tumors. RESULTS Fourteen percent of the patients with mammographically detected tumors had positive axillary nodes compared to 26% of those with clinically detected tumors. Eight percent of patients with mammographically detected tumors had a single positive, while the clinically detected tumors 11% had a single positive node. Thirteen percent of patients with < or = 1 cm tumors and 25% with tumors 1.1 cm to 2 cm had positive axillary nodes. Because the smaller size of the mammographically detected tumors could explain the lower proportion of positive axillary nodes, we analyzed separately the < or = 1 cm tumors. In the group of < or = 1 cm tumors, 9% had positive axillary nodes iftheywere mammographically detected compared to 19% if clinically detected. Four percent had a single positive node while 5% had multiple positive nodes. If the tumors were palpable and < or = 1 cm 9% had a single positive node and 10% had multiple positive nodes. Mammo-graphicallydetected tumors < or = 1 cm had similargrade to clinically detected tumors. In multivariate analysis, method of detection remains a significant variable impacting on the risk of axillary node involvement even in tumors < or = 1 cm. DISCUSSION The risk of axillary node involvement is lower in mammographically detected tumors compared to clinically detected tumors independent of tumor size or grade. Mammography detects tumors early in their metastatic progression. The majority of the axillary node-positive patients who are mammographically detected have a single positive axillary node. Method of detection may need to be considered when assessing the risk of axillary node involvement and incorporated in the staging.
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Affiliation(s)
- Ruth Heimann
- Department of Radiation and Cellular Oncology, The Pritzker School of Medicine, and The University of Chicago, Illinois 60637, USA
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Sachdev PS, McBride R, Loo CK, Mitchell PB, Malhi GS, Croker VM. Right versus left prefrontal transcranial magnetic stimulation for obsessive-compulsive disorder: a preliminary investigation. J Clin Psychiatry 2001; 62:981-4. [PMID: 11780880 DOI: 10.4088/jcp.v62n1211] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is preliminary evidence that repetitive transcranial magnetic stimulation (rTMS) may be useful for the treatment of obsessive-compulsive disorder (OCD), but no definitive study has been published, and the effect of laterality of stimulation is uncertain. METHOD Subjects (N = 12) with resistant OCD were allocated randomly to either right or left prefrontal rTMS daily for 2 weeks and were assessed by an independent rater at 1 and 2 weeks and 1 month later. RESULTS Subjects had an overall significant improvement in the obsessions (p < .01), compulsions (p < .01), and total (p < .01) scores on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) after 2 weeks and at 1-month follow-up. This improvement was significant for obsessions (p < .05) and tended to significance for total Y-BOCS scores (p = .06) after correction for changes in depression scores on the Montgomery-Asberg Depression Rating Scale. There was no significant difference between right- and left-sided rTMS on any of the parameters examined. Two subjects (33%) in each group showed a clinically significant improvement that persisted at I month but with relapse later in I subject. CONCLUSION A proportion (about one quarter) of patients with resistant OCD appear to respond to rTMS to either prefrontal lobe, although in the absence of a sham treatment group in this study, we cannot rule out the possibility of this being a placebo response. This treatment warrants further investigation to better establish its efficacy and examine the best parameters for response.
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Affiliation(s)
- P S Sachdev
- School of Psychiatry, University of New South Wales, Sydney, Australia.
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Mundt AJ, McBride R, Rotmensch J, Waggoner SE, Yamada SD, Connell PP. Significant pelvic recurrence in high-risk pathologic stage I--IV endometrial carcinoma patients after adjuvant chemotherapy alone: implications for adjuvant radiation therapy. Int J Radiat Oncol Biol Phys 2001; 50:1145-53. [PMID: 11483323 DOI: 10.1016/s0360-3016(01)01566-8] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.6] [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: 12/17/2022]
Abstract
OBJECTIVE To evaluate the risk of pelvic recurrence (PVR) in high-risk pathologic Stage I--IV endometrial carcinoma patients after adjuvant chemotherapy alone. METHODS Between 1992 and 1998, 43 high-risk endometrial cancer patients received adjuvant chemotherapy. All patients underwent primary surgery consisting of total abdominal hysterectomy and bilateral salpingo-oophorectomy. No patients received preoperative radiation therapy (RT). Regional lymph nodes and peritoneal cytology were sampled in 62.8% and 83.7% of cases, respectively. Most patients had Stage III--IV disease (83.7%) or unfavorable histology tumors (74.4%). None had evidence of extra-abdominal disease. All patients received 4-6 cycles of chemotherapy as the sole adjuvant therapy, consisting primarily of cisplatin and doxorubicin. Recurrent disease sites were divided into pelvic (vaginal, nonvaginal) and extrapelvic (para-aortic, upper abdomen, liver, and extra-abdominal). Median follow-up was 27 months (range, 2--96 months). RESULTS Twenty-nine women (67.4%) relapsed. Seventeen (39.5%) recurred in the pelvis and 23 (55.5%) in extrapelvic sites. The 3-year actuarial PVR rate was 46.5%. The most significant factors correlated with PVR were cervical involvement (CI) (p = 0.01) and adnexal (p = 0.05) involvement. Of the 17 women who developed a PVR, 8 relapsed in the vagina, 3 in the nonvaginal pelvis, and 6 in both. The 3-year vaginal and nonvaginal PVR rates were 37.8% and 26%, respectively. The most significant factor correlated with vaginal PVR was CI (p = 0.0007). Deep myometrial invasion (p = 0.02) and lymph nodal involvement (p = 0.03) were both correlated with nonvaginal PVR. Nine of the 29 relapsed patients (31%) developed PVR as their only (6) or first site (3) of recurrence. Factors associated with a higher rate of PVR (as the first or only site) were CI and Stage I--II disease. CONCLUSIONS PVR is common in high-risk pathologic Stage I-IV endometrial cancer patients after adjuvant chemotherapy alone. These results support the continued use of locoregional RT in patients undergoing adjuvant chemotherapy. Further studies are needed to test the addition of chemotherapy to locoregional RT.
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MESH Headings
- Adenocarcinoma/epidemiology
- Adenocarcinoma/prevention & control
- Adenocarcinoma/secondary
- Adenocarcinoma/therapy
- Adenocarcinoma, Clear Cell/epidemiology
- Adenocarcinoma, Clear Cell/prevention & control
- Adenocarcinoma, Clear Cell/secondary
- Adenocarcinoma, Clear Cell/therapy
- Adult
- Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carcinoma, Adenosquamous/epidemiology
- Carcinoma, Adenosquamous/prevention & control
- Carcinoma, Adenosquamous/secondary
- Carcinoma, Adenosquamous/therapy
- Chemotherapy, Adjuvant
- Chicago/epidemiology
- Cisplatin/administration & dosage
- Combined Modality Therapy
- Cystadenocarcinoma, Papillary/epidemiology
- Cystadenocarcinoma, Papillary/prevention & control
- Cystadenocarcinoma, Papillary/secondary
- Cystadenocarcinoma, Papillary/therapy
- Doxorubicin/administration & dosage
- Endometrial Neoplasms/drug therapy
- Endometrial Neoplasms/pathology
- Endometrial Neoplasms/therapy
- Female
- Follow-Up Studies
- Humans
- Hysterectomy
- Life Tables
- Lymphatic Metastasis
- Middle Aged
- Neoplasm Invasiveness
- Neoplasm Staging
- Ovariectomy
- Pelvic Neoplasms/epidemiology
- Pelvic Neoplasms/prevention & control
- Pelvic Neoplasms/secondary
- Radiotherapy, Adjuvant
- Retrospective Studies
- Risk
- Treatment Outcome
- Vaginal Neoplasms/epidemiology
- Vaginal Neoplasms/prevention & control
- Vaginal Neoplasms/secondary
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Affiliation(s)
- A J Mundt
- Department of Radiation and Cellular Oncology, Section of Gynecologic Oncology, University of Chicago Hospitals, Chicago, IL 60637, USA.
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Andras SC, Hartman TP, Alexander J, McBride R, Marshall JA, Power JB, Cocking EC, Davey MR. Combined PI-DAPI staining (CPD) reveals NOR asymmetry and facilitates karyotyping of plant chromosomes. Chromosome Res 2001; 8:387-91. [PMID: 10997779 DOI: 10.1023/a:1009258719052] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [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: 11/12/2022]
Abstract
This paper presents a preparative and staining procedure for plant mitotic chromosomes that uses a combination of PI (propidium iodide) and DAPI (4',6-diamidino-2-phenylindol) and which reveals a pattern of high-affinity regions for these fluorochromes. Nucleolar organiser regions (NORs), telomeres and centromeric regions exhibit high PI affinity (red), whereas other chromosomal regions exhibit high affinity for either PI (red) or DAPI (blue). NOR-bearing and other chromosomes are readily distinguished, facilitating karyotyping. The dual staining pattern was observed in all the plants tested. Aspects of NOR size, number and occurrence are discussed. A karyotype of rice metaphase chromosomes is presented, based on their fluorescent banding patterns.
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Affiliation(s)
- S C Andras
- The Ecology Genetics Department, Faculty of Biology-Geology, University Babes-Bolyai, Cluj-Napoca, Romania
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Abstract
Although primary prevention studies are important tools in helping the healthy elderly stay healthy, recruiting from a community-based cohort of healthy elderly individuals for a primary prevention study involves numerous barriers. To better identify and understand these barriers, we conducted and evaluated a comprehensive recruitment strategy for a primary prevention study testing aspirin in an HMO population. In the recruitment phase, we identified healthy individuals (65 years of age or older) who were members of a large, group-model HMO in Oregon and Washington, and used computerized medical database screening, statistical sampling, health plan mailings, e-mail communication with primary care providers, and the experience of a well-established research clinic in an effort to enroll health elderly in this primary prevention trial. Among a random sample of 47,453 eligible patients over the age of 65, 44% responded to recruitment efforts, but only 3% were enrolled--an overall yield of slightly less than 2%. To evaluate these results, we then conducted focus groups with 225 randomly selected "eligible refusers." We determined that healthy elders were hesitant to give up their choice to use aspirin, unwilling to travel to the research center, and reluctant to risk their tenuous hold on good health to participate in a study of primary prevention. Awareness of these attitudes is an indispensable step toward designing effective recruitment strategies for primary prevention studies involving the healthy elderly.
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Affiliation(s)
- M Boles
- Center for Health Research, Kaiser Permanente Northwest Division, Portland, OR 97227, USA
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Nephew KP, Choi CM, Polek TC, McBride R, Bigsby RM, Khan SA, Husseinzadeh N. Expression of fos and jun proto-oncogenes in benign versus malignant human uterine tissue. Gynecol Oncol 2000; 76:388-96. [PMID: 10684716 DOI: 10.1006/gyno.1999.5696] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [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: 01/13/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate expression of fos and jun proto-oncogenes in benign human uterine tissue compared with malignant uterine tissue. METHODS Forty-two endometrial tissue specimens were obtained at the time of hysterectomy. Tissue samples from different phases of the menstrual cycle and from postmenopausal patients were stained using immunohistochemical methods to detect Fos and Jun proteins, estrogen and progesterone receptor status, and Ki67 (detects a nuclear antigen associated with proliferating cells). Tissue was examined microscopically for nuclear staining in endometrial epithelium and stroma. The endometrium was based on the patient's last menstrual period, pathologic dating, and proliferative versus nonproliferative status as determined by Ki67. Benign and malignant specimens were subjected to Northern blot analysis to evaluate levels of expression of c-fos, c-jun, and jun-B mRNA. The pattern of c-fos mRNA expression in malignant samples was further evaluated using in situ hybridization. RESULTS In proliferative, secretory, postmenopausal, and progesterone-influenced, uterine specimens immunohistochemically stained and examined, the endometrial and stromal nuclei stained for both Fos and Jun in varying intensities. However, no pattern was found in the variation of intensity according to the phase of the endometrium. Similarly, in malignant and benign endometrial tissue examined by Northern blot and in situ hybridization analyses, expression of proto-oncogene mRNAs was readily detectable, but no statistical correlation between type of tissue examined, grade of adenocarcinoma, and stage of endometrial cancer was found in this study. CONCLUSIONS In rodent models, control of uterine cell proliferation is related to change in expression of fos and jun proto-oncogenes. Our results indicate that hormonal control is likely to be different in human endometrium and probably involves genes other than the proto-oncogenes under study. Expression of Fos and Jun do not correlate with endometrial cancer stage and grade.
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Affiliation(s)
- K P Nephew
- Division of Gynecologic Oncology, Department of Anatomy and Cell Biology, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267, USA
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Hart RG, Halperin JL, McBride R, Benavente O, Man-Son-Hing M, Kronmal RA. Aspirin for the primary prevention of stroke and other major vascular events: meta-analysis and hypotheses. Arch Neurol 2000; 57:326-32. [PMID: 10714657 DOI: 10.1001/archneur.57.3.326] [Citation(s) in RCA: 114] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Aspirin therapy reduces stroke by about 25% for persons with atherosclerotic vascular disease, but the effect in those without clinically apparent vascular disease is distinctly different. OBJECTIVE To define the effect of aspirin use on stroke and other major vascular events when given for primary prevention to persons without clinically recognized vascular disease. DATA SOURCES AND EXTRACTION Systematic review of randomized clinical trials and large prospective observational cohort studies examining the relation between aspirin use and stroke in persons at low intrinsic risk. Studies were identified by a computerized search of the English-language literature. DATA SYNTHESIS Five randomized trials of primary prevention included 52 251 participants randomized to aspirin doses ranging from 75 to 650 mg/d; the mean overall stroke rate was 0.3% per year during an average follow-up of 4.6 years. Meta-analysis revealed no significant effect on stroke (relative risk = 1.08; 95% confidence interval, 0.95-1.24) contrasting with a decrease in myocardial infarction (relative risk = 0.74; 95% confidence interval, 0.68-0.82). The lack of reduction of stroke by aspirin for primary prevention was incompatible with its protective effect against stroke in patients with manifest vascular disease (P = .001). Intracranial hemorrhage was increased by the regular use of aspirin (relative risk = 1.35; P = .03), similarly for both primary and secondary prevention. In 4 large observational studies, self-selected use of aspirin was consistently associated with higher rates of stroke. CONCLUSIONS The effect of aspirin therapy on stroke differs between individuals based on the presence or absence of overt vascular disease, in contrast with the consistent reduction in myocardial infarction by aspirin therapy observed in all populations. We hypothesize that the effect of aspirin therapy on stroke for persons with major risk factors for vascular disease may be intermediate between a substantial decrease for those with manifest vascular disease and a possible small increase for healthy persons due to accentuated intracranial hemorrhage. When aspirin is given for primary prevention of vascular events, available data support using 75 to 81 mg/d.
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Affiliation(s)
- R G Hart
- Department of Medicine (Neurology), University of Texas Health Science Center, San Antonio 78284, USA.
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Cohen M, Dawson MS, Kopistansky C, McBride R. Sex and other predictors of intra-aortic balloon counterpulsation-related complications: prospective study of 1119 consecutive patients. Am Heart J 2000; 139:282-7. [PMID: 10650301 DOI: 10.1067/mhj.2000.101489] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Intra-aortic balloon counterpulsation (IABC) complication rates remain significant despite technical advances that have simplified and expanded its use. Previous reports implicated patient height, diabetes, or peripheral vascular disease as risk factors. However, these studies were small and not prospective. Therefore a prospective study at one high-volume center was conducted examining the complications associated with IABC and the role of sex and other risk factors in the current era. METHODS The study prospectively evaluated 1174 consecutive percutaneous IAB insertions in 1119 patients between 1993 and 1997. Major complications were defined as embolism or limb ischemia requiring surgery; bleeding requiring transfusion or surgery; systemic infection; balloon rupture; or death from one of these causes. Minor complications were defined as limb ischemia or pulse loss resolving without surgery or after IAB removal or bleeding not requiring transfusion or surgical intervention. All variables were analyzed with univariate and stepwise multivariate analysis. RESULTS Data were collected on 1119 patients (727 men and 392 women) with a mean age of 65 +/- 11 years. The prevalence of diabetes, hypertension, and peripheral vascular disease was 27%, 52%, and 8%, respectively. Complications occurred in 166 patients (15%) and a major complication occurred in 126 (11%) of the 1119 patients. Multivariate logistic regression analysis was done with demographic, clinical, and procedural variables in a cohort of 1106 patients. The analysis identified peripheral vascular disease (relative risk [RR] 4.1), female sex (RR 2.3), and body surface area (RR 0.26 per m(2)) as independent predictors of a major complication. In addition, cardiac index (RR 0.7) was also identified as an independent predictor of any or major complications in a subset of 915 patients. In 754 high-risk patients (women or patients with peripheral vascular disease, diabetes, cardiac index <2.2 L/min/m(2), or body surface area <1.8 m(2)), 114 major complications occurred (15%) compared with 8 (3%) among 278 non-high-risk patients (P <.0001). CONCLUSIONS The current complication rate associated with IABC remains significant. Advances in IAB technology need to focus on the high-risk subset of patients that includes women, smaller patients, and those with peripheral vascular disease.
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Affiliation(s)
- M Cohen
- Division of Cardiology, Department of Medicine, MCP Hahnemann University, Philadelphia, PA19102-1192, USA
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