Parathyroid adenoma in a cancer center patient population

Abstract Abstract 1370 Background: Though the cancer immune surveillance hypothesis was first proposed a century ago, there has been limited evidence to support the role of antigen presentation in the detection or suppression of CLL. In this study we evaluated the frequencies of HLA haplotype and homozygosity and subsequent impact on clinical outcome in CLL patients with advanced disease. Methods: We performed a retrospective chart review of 249 CLL patients who were referred for allogeneic stem cell transplant at MD Anderson Cancer Center. We compared HLA allele frequencies of the patient population with those of local, race-matched controls and identified specific HLA alleles which were more frequent in the patient population. We also compared HLA homozygosity between the patient and control population. The Kaplan-Meier method was then used to determine the prognostic significance of the identified HLA alleles and homozygosity on clinical outcome within our patient population. Progression-free survival (PFS) was calculated from the time of first treatment to the time of progression or death. Results: CLL patients with advanced disease were significantly more likely to express HLA-A1 (OR=1.49, 95% CI 1.15–1.94, p=0.0003) or HLA- C7 (OR 1.24, 95% CI 1.00–1.53, p=0.05). In addition, these patients were more likely to be homozygous at any HLA locus than were controls (OR=1.20, 95% CI 0.97–1.48, p=0.04), particularly at HLA-C (OR=1.62, 95% CI 1.13–2.33, p=0.002) and at multiple HLA loci (OR=1.69, 95% CI 1.06–2.70, p=0.006). CLL patients who were HLA-A1+, HLA-A1/C7+ or homozygous at any allele demonstrated worse PFS in comparison with CLL patients without any of these HLA allelic characteristics. Median survival was 23.9 months for HLA-A1+ patients, 13.9 months for HLA-A1/C7+ patients and 25.7 months for patients with homozygosity, in comparison to 31.8 months for the population without any detrimental alleles or homozygosity (p=0.02, p=0.0008, and p=0.007 respectively, Figure 1: A, B, C). Analysis of patients possessing only HLA-C7 as a risk factor demonstrated a trend toward decreased PFS but was not quite statistically significant (p=0.07, data not shown). Conclusions: Patients with advanced CLL appear to express certain HLA alleles and exhibit HLA homozygosity more frequently than normal controls. In addition, these HLA characteristics may predispose CLL patients to a worse outcome. Because HLA allelic variation determines the specificity of antigens presented to the immune system, the data suggest that immune surveillance may play a physiologic role in the control of leukemic disease and provide a theoretical framework for the identification of CLL antigens which could eventually serve as targets for immunotherapy. A. Negative effects of HLA-A1 allele on overall survival of patients with advanced CLL are B. synergistically worsened by the presence of the HLA-C7 allele. C. Homozygosity at any HLA allele also imparted a negative impact upon overall survival. Disclosures: O'Brien: Novartis: Research Funding; BMS: Research Funding.

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Treating nonagenarians with cancer

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.8542 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 8542-8542

Author(s):

E. J. Crane ◽

M. Extermann

Keyword(s):

General Anesthesia ◽

Cancer Patients ◽

Patient Population ◽

Treatment Plan ◽

Performance Status ◽

Cancer Center ◽

Preliminary Evaluation ◽

Ecog Performance Status ◽

Patients Âgés ◽

One Year

8542 Background: In the U.S., the number of cancer patients who are greater than age 85 is expected to quadruple in the next 50 years. Barriers exist to treating this patient population because of concerns of frailty, lack of inclusion in clinical trials, and unknown outcomes when treating this patient population. This single institution retrospective evaluation provides data regarding treatment outcomes for cancer patients ages 90 or older at the time of their treatment at this cancer center. Methods: The charts of all patients registered at the Moffitt Cancer Center who were age 90 or older at during their treatment/evaluation were eligible to be reviewed. The total number of charts eligible was 643. Included patients: 1) had a diagnosis of cancer, 2) had a clear treatment plan with at least two follow-up visits over a one month time period, 3) patients with only one evaluation would be eligible if a clear treatment plan was outlined and their death occurred within 6 months of their evaluation at this cancer center. To date, 329 charts have been reviewed which has yielded 121 patients who meet the inclusion criteria. Results: Preliminary evaluation of reveals that the most common diagnoses are breast cancer (14%), malignant melanoma (11%), head and neck cancer (9%), SCC of the skin (9%), and prostate cancer (8%). Treatment plans included surgery for 45% of the patients with 36% of the patients undergoing general anesthesia. Chemotherapy was administered to 6.8% of the patients, and hospice was recommended to 7.8%. One year after evaluation at this cancer center 54% of the patients were alive, and 42% were alive at 2 years. The average number of medications that these patients used was 5.5 and greater than 95% of the patients had an ECOG performance status of 1. Conclusions: These preliminary results indicate that the nonagenarian cancer patients are probably healthy given the low number of medications taken, indicating fewer comorbid conditions. These patients do have months to years of survival after their therapies which included surgery under general anesthesia and chemotherapy. Although the nonagenarian cancer patient population found at a referral center is likely to be healthier than that found in the community, these findings indicate that nonagenarians with few comorbidities and a good performance status can be successfully treated for their cancer. No significant financial relationships to disclose.

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Improving Wait Time for Chemotherapy in an Outpatient Clinic at a Comprehensive Cancer Center

Journal of Oncology Practice ◽

10.1200/jop.2011.000281 ◽

2012 ◽

Vol 8 (1) ◽

pp. e1-e7 ◽

Cited By ~ 56

Author(s):

Michael A. Kallen ◽

James A. Terrell ◽

Paula Lewis-Patterson ◽

Jessica P. Hwang

Keyword(s):

Outpatient Clinic ◽

Delay Time ◽

Patient Population ◽

Primary Source ◽

Wait Time ◽

Medical Patient ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Patient Appointment ◽

Appointment Delay

Excessive appointment delay time has been identified as a primary source of overall patient appointment dissatisfaction among the general medical patient population as well as oncology patients.

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Prognostic factors (PF) in advanced hepatocellular carcinoma (AHCC): Multivariate analysis and comparison between staging systems (SS) in patients (pts) treated at Memorial Sloan-Kettering Cancer Center (MSKCC)

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.4601 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 4601-4601 ◽

Cited By ~ 1

Author(s):

F. D. Huitzil ◽

M. Capanu ◽

G. Jacobs ◽

W. Smith ◽

E. O’Reilly ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Multivariate Analysis ◽

Patient Population ◽

Cox Regression ◽

Prognostic Index ◽

Locoregional Therapy ◽

Rank Test ◽

Cancer Center ◽

Advanced Hepatocellular Carcinoma ◽

Staging Systems

4601 Background: Several SS have been proposed in hepatocellular carcinoma. These include TNM, Okuda, Cancer of the Liver Italian Program (CLIP), Chinese University Prognostic Index (CUPI), and Barcelona Clinic Liver Cancer (BCLC). There is no consensus as to what constitutes the best SS for use by oncologists for pts with AHCC with no locoregional therapy options. We propose to define the PF and compare SS in this patient population. SS may help select pts for systemic therapy, predict outcome, and help in clinical trial design for AHCC. Methods: We retrospectively identified pts with AHCC treated at MSKCC between 2001 and 2006. Clinical, laboratory, tumor characteristics and all four SS were recorded. Survival (S) was measured from the date of development of AHCC to the date of death. S was estimated using Kaplan-Meier’s method, differences in S were tested using the log rank test. A Cox regression model was used for the multivariate analysis. A second Cox regression was done to compare SS and was expressed using the Akaike information (AI) criterion. AI helps determine which SS is the most informative of S. A low AI is favorable. Results: We identified 280 pts. Data on the first 101 pts analyzed are presented. Median age 61 years; 71% males, 29% females; 60% Caucasians, 9% Black, 24% Asians and 5% Hispanics. Etiologies included HCV 24%, HBV 38%, and alcohol 22%. Child Pugh score: A in 65% and B in 29% of pts. Multivariate analysis independent PF for S were albumin (p=0.0358), alkaline phosphatase (ALP) (p=0.001), identified etiology (p=0.008), abdominal pain (p=0.001) and liver tumor extent (more or less than 50% of the liver) (p=0.0043). AI ranked SS as follows: TNM 6th (588.991), TNM 5th (591.373), BCLC (541.095), Okuda (540.490), CLIP (537.8), and CUPI (526.483). CUPI S was 19.47 months (m) for low, 5.89 m for medium, and 1.36 m for high risk pts. Conclusions: Pts with AHCC who are treated by oncologists in this US-based population have distinct PF. CUPI provided the best prognostic information for our patient population. CUPI may be suggested as the SS to use clinically for AHCC. These results need prospective validation. No significant financial relationships to disclose.

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Pancreatic adenocarcinoma (PAC) in a younger patient population: 10-year experience at Memorial Sloan-Kettering Cancer Center (MSKCC)

Journal of Clinical Oncology ◽

10.1200/jco.2008.26.15_suppl.4623 ◽

2008 ◽

Vol 26 (15_suppl) ◽

pp. 4623-4623

Author(s):

A. Duffy ◽

M. Capanu ◽

P. Allen ◽

R. Kurtz ◽

E. Ludwig ◽

...

Keyword(s):

Pancreatic Adenocarcinoma ◽

Patient Population ◽

Cancer Center ◽

Younger Patient

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Predictors for thromboembolism in patients with cholangiocarcinoma

Journal of Cancer Research and Clinical Oncology ◽

10.1007/s00432-021-03794-1 ◽

2021 ◽

Author(s):

Christian Pfrepper ◽

Maren Knödler ◽

Ruth Maria Schorling ◽

Daniel Seehofer ◽

Sirak Petros ◽

...

Keyword(s):

Patient Population ◽

Multivariable Analysis ◽

Stage Iv ◽

Cancer Center ◽

First Year ◽

Thromboembolic Events ◽

Rare Type ◽

Increased Risk ◽

Stage Iv Disease ◽

Portal Venous Thrombosis

Abstract Background Patients with cancer are at increased risk of thromboembolic events contributing significantly to cancer-related morbidity and mortality. Because cholangiocarcinoma is a rare type of cancer, the incidence of thromboembolism in this patient population is not well defined. Methods Patients with cholangiocarcinoma treated at the University Cancer Center Leipzig between January 2014 and December 2018 were analyzed retrospectively regarding the incidence of arterial and venous thromboembolism. Results A total of 133 newly and consecutively diagnosed patients were included, of whom 22% had stage IV disease. Thromboembolism was diagnosed in 39 (29.3%), with 48% of the events occurring between 60 days prior and 30 days after the initial diagnosis. Arterial thrombosis accounted for 19% and portal venous thrombosis for 33% of the events, while the rest of events occurred in the non-portal venous system. In multivariable analysis, an ONKOTEV score ≥ 2 was the only independent predictor for thromboembolism. Serum CA 19-9 was available in 87 patients (65.4%). In this subgroup, CA 19-9 above the median of 97.7 U/ml and vascular or lymphatic compression were independent predictors for thromboembolism in the first year and CA 19-9 alone remained a significant predictor over the whole observation period. An ONKOTEV score ≥ 2 and increasing age were predictors of survival. Conclusions A very high thromboembolic risk was observed in cholangiocarcinoma, comparable to the risk situation in pancreatic and gastric cancer. The ONKOTEV score and serum CA 19-9 are independent predictors of thromboembolic events. Prospective validation of our observations in this patient population is warranted.

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Tolerance of bevacizumab in an older patient population: The Memorial Sloan-Kettering Cancer Center (MSKCC) experience

Journal of Clinical Oncology ◽

10.1200/jco.2008.26.15_suppl.9569 ◽

2008 ◽

Vol 26 (15_suppl) ◽

pp. 9569-9569 ◽

Cited By ~ 2

Author(s):

S. Richardson ◽

M. N. Dickler ◽

C. T. Dang ◽

C. A. Hudis ◽

T. A. Traina

Keyword(s):

Patient Population ◽

Cancer Center ◽

Older Patient

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Compliance with established pneumonia core measures at MD Anderson Cancer Center in the emergency center.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.34_suppl.189 ◽

2012 ◽

Vol 30 (34_suppl) ◽

pp. 189-189

Author(s):

Carmen E. Gonzalez ◽

Tami N. Johnson ◽

Lisa M. Kidin ◽

Scott Evans ◽

Yvette DeJesus ◽

...

Keyword(s):

Cause Of Death ◽

Patient Population ◽

Clinical Pathways ◽

Quality Care ◽

The United States ◽

Cancer Center ◽

Emergency Center ◽

Md Anderson ◽

Core Measures ◽

Order Set

189 Background: Pneumonia is the major cause of death due to infectious diseases in the United States. In the cancer patient, pneumonia is the overall leading infectious cause of death. Pneumonia Core Measures (PCM) and Clinical Pathways are frequently used by healthcare organizations to ensure the delivery of high-quality care and pathogen-directed therapy. A multidisciplinary team was organized at the University of Texas MD Anderson Cancer Center (MDACC) Emergency Center (EC) into a Pneumonia Team to optimize care and to enhance compliance with current PCM. Methods: A retrospective review of EC patients during pneumonia season was completed. Results: Three areas for improvement in the EC were identified. The areas include lack of EC staff’s knowledge on PCM, lack of standardized order-sets for pathogen-directed treatment, and cancer patients presenting with pneumonia syndromes that fall outside established Community-Acquired Pneumonia (CAP) guidelines. The identified problems were addressed through three strategies: Intense EC staff education initially and yearly prior to pneumonia season (September-March). Microbiologic analysis of the pathogens responsible for the pneumonias in our unique cancer population at MDACC. Development and implementation of an institutional pneumonia algorithm and an order-set. The Pneumonia Team also identified a gap between our patient population and the current PCM. Pneumonia patients at MDACC EC are divided into two distinct groups, solid tumor and hematologic cancers. The microbiology analyzed in both groups is consistent with Healthcare-Associated Pneumonia (HCAP) and not CAP. Microbiology analysis identified gram positive, gram negative, fungal, viral and multi-drug resistant organisms. The initial analysis demonstrated that 87% of our patients met criteria for HCAP and only 12% met CAP. Based on this percentage, antibiotic selection for our CAP patients comprises a small portion of our total population. Conclusions: Our current algorithm and order-set optimize care and minimize variation to match our patient population. These findings provide important considerations for policy makers in regard to pneumonia measurements in a cancer setting.

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