scholarly journals Oncotype DX recurrence score implications for disparities in chemotherapy and breast cancer mortality in Georgia

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Lindsay J. Collin ◽  
Ming Yan ◽  
Renjian Jiang ◽  
Kevin C. Ward ◽  
Brittany Crawford ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Racial Disparities ◽  
Breast Cancer Mortality ◽  
Recurrence Score ◽  
Oncotype Dx ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Hazard Ratios ◽  
Cox Proportional Hazard Regression ◽  
To Receive

Abstract Among women diagnosed with stage I–IIIa, node-negative, hormone receptor (HR)-positive breast cancer (BC), Oncotype DX recurrence scores (ODX RS) inform chemotherapy treatment decisions. Differences in recurrence scores or testing may contribute to racial disparities in BC mortality among women with HR+ tumors. We identified 12,081 non-Hispanic White (NHW) and non-Hispanic Black (NHB) BC patients in Georgia (2010–2014), eligible to receive an ODX RS. Logistic regression was used to estimate the odds of chemotherapy receipt by race and ODX RS. Cox proportional hazard regression was used to calculate the hazard ratios (HRs) comparing BC mortality rates by race and recurrence score. Receipt of Oncotype testing was consistent between NHB and NHW women. Receipt of chemotherapy was generally comparable within strata of ODX RS—although NHB women with low scores were slightly more likely to receive chemotherapy (OR = 1.16, 95% CI 0.77, 1.75), and NHB women with high scores less likely to receive chemotherapy (OR = 0.77, 95% CI 0.48, 1.24), than NHW counterparts. NHB women with a low recurrence score had the largest hazard of BC mortality (HR = 2.47 95% CI 1.22, 4.99) compared to NHW women. Our data suggest that additional tumor heterogeneity, or other downstream treatment factors, not captured by ODX, may be drivers of racial disparities in HR+ BC.

scholarly journals Factors Associated With Weight Gain in People Treated With Dolutegravir

2020 ◽  
Vol 7 (6) ◽  
Author(s):  
Lucia Taramasso ◽  
Paolo Bonfanti ◽  
Elena Ricci ◽  
Giancarlo Orofino ◽  
Nicola Squillace ◽  
...  
Keyword(s):  
Weight Gain ◽  
Female Gender ◽  
Proportional Hazard ◽  
Cd4 Counts ◽  
Factors Associated ◽  
Cox Proportional Hazard ◽  
Hazard Ratios ◽  
Tenofovir Alafenamide ◽  
Cox Proportional Hazard Regression

Abstract Background An unexpected excess in weight gain has recently been reported in the course of dolutegravir (DTG) treatment. The aim of the present study was to investigate whether weight gain differs among different DTG-containing regimens. Methods Adult naïve and experienced people with HIV (PWH) initiating DTG-based antiretroviral therapy (ART) between July 2014 and December 2019 in the Surveillance Cohort Long-Term Toxicity Antiretrovirals (SCOLTA) prospective cohort were included. We used an adjusted general linear model to compare weight change among backbone groups and a Cox proportional hazard regression model to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for weight increases >10% from baseline. Results A total of 713 participants, 25.3% women and 91% Caucasian, were included. Of these, 195 (27.4%) started DTG as their first ART regimen, whereas 518 (72.6%) were ART-experienced. DTG was associated with abacavir/lamivudine in 326 participants, tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) in 148, boosted protease inhibitors in 60, rilpivirine in 45, lamivudine in 75, and tenofovir alafenamide (TAF)/FTC in 59. At 6 and 12 months, weight gain was highest among PWH on TDF/FTC+DTG and TAF/FTC+DTG. Baseline CD4 <200 cells/mm3 (HR, 1.84; 95% CI, 1.15 to 2.96), being ART-naïve (HR, 2.24; 95% CI, 1.24 to 4.18), and treatment with TDF/FTC+DTG (HR, 1.92; 95% CI, 1.23 to 2.98) or TAF/FTC+DTG (HR, 3.80; 95% CI, 1.75 to 8.23) were associated with weight gain >10% from baseline. Higher weight (HR, 0.97 by 1 kg; 95% CI, 0.96 to 0.99) and female gender (HR, 0.54; 95% CI, 0.33 to 0.88) were protective against weight gain. Conclusions Naïve PWH with lower CD4 counts and those on TAF/FTC or TDF/FTC backbones were at higher risk of weight increase in the course of DTG-based ART.

scholarly journals Prognostic nomogram for patients with non-metastatic HER2 positive breast cancer in a prospective cohort

2019 ◽  
Vol 34 (1) ◽  
pp. 41-46 ◽  
Author(s):  
Chuanxu Luo ◽  
Xiaorong Zhong ◽  
Zhu Wang ◽  
Yu Wang ◽  
Yanping Wang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Prospective Cohort ◽  
Proportional Hazard ◽  
Her2 Positive ◽  
Her2 Positive Breast Cancer ◽  
Cox Proportional Hazard ◽  
Cox Proportional Hazard Regression ◽  
Positive Breast Cancer

Purpose: A nomogram is a reliable tool to generate individualized risk prediction by combining prognostic factors. We aimed to construct a nomogram for predicting the survival in patients with non-metastatic human epidermal growth factor receptor 2 (HER2) positive breast cancer in a prospective cohort. Methods: We analyzed 1304 consecutive patients who were diagnosed with non-metastatic HER2 positive breast cancer between January 2008 and December 2016 in our institution. Independent prognostic factors were identified to build a nomogram using the COX proportional hazard regression model. The prediction of the nomogram was evaluated by concordance index (C-index), calibration and subgroup analysis. External validation was performed in a cohort of 6379 patients from the Surveillance, Epidemiology, and End Results (SEER) database. Results: Through the COX proportional hazard regression model, five independent prognostic factors were identified. The nomogram predicting overall survival achieved a C-index of 0.78 in the training cohort and 0.74 in the SEER cohort. The calibration plot displayed favorable accordance between the nomogram prediction and the actual observation for 3-year overall survival in both cohorts. The quartiles of the nomogram score classified patients into subgroups with distinct overall survival. Conclusion: We developed and validated a novel nomogram for predicting overall survival in patients with non-metastatic HER2 positive breast cancer, which presented a favorable discrimination ability. This model may assist clinical decision making and patient–clinician communication in clinical practice.

Effect of air pollution on gout development: a nationwide population-based observational study

QJM ◽  
2020 ◽  
Author(s):  
W -S Hu ◽  
C -L Lin
Keyword(s):  
Air Pollution ◽  
Fine Particulate Matter ◽  
Population Based ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Hazard Ratios ◽  
Yearly Average ◽  
Cox Proportional Hazard Regression ◽  
Particulate Matter 2.5 ◽  
Total Hydrocarbons

Summary Objective To investigate the effect of air pollution on gout development. Methods A total of 170318 participants were enrolled. These pollutants were considered: carbon monoxide (CO), fine particulate matter 2.5 (PM2.5), total hydrocarbons (THC) and methane (CH4). The yearly average concentrations were calculated from 2000 to 2011. Univariate and multivariate analyses by Cox proportional hazard regression models were adopted to estimate hazard ratios for gout in the Q2–Q4 concentrations of air pollutants compared with the Q1 concentration. Results In THC, relative to the Q1 concentration, the risk of gout was higher in participants exposed to the Q2–Q4 concentrations [adjusted hazard ratio (aHR), 1.10 with 95% confidence interval (CI), 1.01–1.19 in the Q2 concentration of THC; aHR, 4.20 with 95% CI, 3.93–4.49 in the Q3 concentration of THC; aHR, 5.65 with 95% CI, 5.29–6.04 in the Q4 concentration of THC]. In regard to CH4, when the Q1 concentration was defined as the reference, the risks of gout were increased for participants exposed to the Q2, Q3 and Q4 concentrations (aHR, 1.16 with 95% CI, 1.06–1.26 in the Q2 concentration of CH4; aHR, 2.37 with 95% CI, 2.20–2.55 in the Q3 concentration of CH4; aHR, 8.73 with 95% CI, 8.16–9.34 in the Q4 concentration of CH4). Conclusions Association between air pollution and risk of gout was noted.

scholarly journals Computer-assisted quantification of tumor-associated collagen signatures to improve the prognosis prediction of breast cancer

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Gangqin Xi ◽  
Lida Qiu ◽  
Shuoyu Xu ◽  
Wenhui Guo ◽  
Fangmeng Fu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Regression Analysis ◽  
Cancer Patients ◽  
Validation Cohort ◽  
Proportional Hazard ◽  
Breast Cancer Patients ◽  
Cox Proportional Hazard ◽  
Clinical Center ◽  
Microscopic Features ◽  
Cox Proportional Hazard Regression

Abstract Background Collagen fibers play an important role in tumor initiation, progression, and invasion. Our previous research has already shown that large-scale tumor-associated collagen signatures (TACS) are powerful prognostic biomarkers independent of clinicopathological factors in invasive breast cancer. However, they are observed on a macroscale and are more suitable for identifying high-risk patients. It is necessary to investigate the effect of the corresponding microscopic features of TACS so as to more accurately and comprehensively predict the prognosis of breast cancer patients. Methods In this retrospective and multicenter study, we included 942 invasive breast cancer patients in both a training cohort (n = 355) and an internal validation cohort (n = 334) from one clinical center and in an external validation cohort (n = 253) from a different clinical center. TACS corresponding microscopic features (TCMFs) were firstly extracted from multiphoton images for each patient, and then least absolute shrinkage and selection operator (LASSO) regression was applied to select the most robust features to build a TCMF-score. Finally, the Cox proportional hazard regression analysis was used to evaluate the association of TCMF-score with disease-free survival (DFS). Results TCMF-score is significantly associated with DFS in univariate Cox proportional hazard regression analysis. After adjusting for clinical variables by multivariate Cox regression analysis, the TCMF-score remains an independent prognostic indicator. Remarkably, the TCMF model performs better than the clinical (CLI) model in the three cohorts and is particularly outstanding in the ER-positive and lower-risk subgroups. By contrast, the TACS model is more suitable for the ER-negative and higher-risk subgroups. When the TACS and TCMF are combined, they could complement each other and perform well in all patients. As expected, the full model (CLI+TCMF+TACS) achieves the best performance (AUC 0.905, [0.873–0.938]; 0.896, [0.860–0.931]; 0.882, [0.840–0.925] in the three cohorts). Conclusion These results demonstrate that the TCMF-score is an independent prognostic factor for breast cancer, and the increased prognostic performance (TCMF+TACS-score) may help us develop more appropriate treatment protocols.

scholarly journals Interface of Multiple Sclerosis, Depression, Vascular Disease, and Mortality

Neurology ◽  
2021 ◽  
Vol 97 (13) ◽  
pp. e1322-e1333 ◽  
Author(s):  
Raffaele Palladino ◽  
Jeremy Chataway ◽  
Azeem Majeed ◽  
Ruth Ann Marrie
Keyword(s):  
Multiple Sclerosis ◽  
Vascular Disease ◽  
Population Based ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Hazard Ratios ◽  
Depression Status ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Cox Proportional Hazard Regression

Background and ObjectivesTo assess whether the association among depression, vascular disease, and mortality differs in people with multiple sclerosis (MS) compared with age-, sex-, and general practice–matched controls.MethodsWe conducted a population-based retrospective matched cohort study between January 1, 1987, and September 30, 2018, that included people with MS and matched controls without MS from England, stratified by depression status. We used time-varying Cox proportional hazard regression models to test the association among MS, depression, and time to incident vascular disease and mortality. Analyses were also stratified by sex.ResultsWe identified 12,251 people with MS and 72,572 matched controls. At baseline, 21% of people with MS and 9% of controls had depression. Compared with matched controls without depression, people with MS had an increased risk of incident vascular disease regardless of whether they had comorbid depression. The 10-year hazard of all-cause mortality was 1.75-fold greater in controls with depression (95% confidence interval [CI] 1.59–1.91), 3.88-fold greater in people with MS without depression (95% CI 3.66–4.10), and 5.43-fold greater in people with MS and depression (95% CI 4.88–5.96). Overall, the interaction between MS status and depression was synergistic, with 14% of the observed effect attributable to the interaction. Sex-stratified analyses confirmed differences in hazard ratios.DiscussionDepression is associated with increased risks of incident vascular disease and mortality in people with MS, and the effects of depression and MS on all-cause mortality are synergistic. Further studies should evaluate whether effectively treating depression is associated with a reduced risk of vascular disease and mortality.

Persistence of circulating tumour cells after treatment predicts clinical outcome in breast cancer patients

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 21080-21080
Author(s):  
M. Serrano ◽  
P. Sánchez-Rovira ◽  
M. Campos ◽  
F. Warleta ◽  
J. Ruiz-Mora ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Regression Analysis ◽  
Clinical Outcome ◽  
Cancer Patients ◽  
Tumor Cells ◽  
Circulating Tumor Cells ◽  
Proportional Hazard ◽  
Breast Cancer Patients ◽  
Cox Proportional Hazard ◽  
Cox Proportional Hazard Regression

21080 Background: The hematogenous distant metastasis is the leading cause of cancer death. This process involves the passage through the blood and lymphatic circulation of circulating tumor cells (CTC) with metastatic properties. Thus, the early detection of such cells has important implication for cancer prognosis, monitoring of treatment and to predict clinical outcome. We present the results that showed that CTC are prognostic factor after chemotherapy independently of treatment. Methods: A total of 59 patients with breast cancer were enrolled in this study between April 2000 and December 2002. The median follow-up was 50 months. All patients received chemotherapy as first line treatment. Results of this work included CTC detection one month after of the end of chemotherapy. After informed consent, 10ml of heparinized peripheral blood was collected from patients. For enrichment of CTC we use the Carcinoma Cell Enrichment and Detection kit using MACS technology (Miltenyi Biotec). After enrichment of epithelial tumor cells immunomagnetic labeled with a multi- cytokeratin-specific antibody, the positive cells were detected by immunocytochemical staining with alkaline phosphatase substrate. Results: Analysis of CTC after chemotherapy: Circulating tumor cells were detected in 32 patients (54.23%). A mean number of cells were detected 3.7 (SD 13.9; range 1–105).The number of CTC was correlationed with progression free of disease (PFS) and overall survival (OS). In the univariate Cox proportional hazard regression analysis number cells were significantly associated with OS (p = 0.020) and PFS (p = 0.008). In the multivariate Cox proportional hazard regression analysis, number cells admit borderline statically significance with PFS (p = 0.052) and OS (p = 0.071). Conclusions: Our results suggest that the persistence of CTC after the treatment predicts clinical outcome and therefore the detection of CTC in breast cancer patients might allow monitoring of chemotherapy response. No significant financial relationships to disclose.

scholarly journals Racial Disparities in Breast Cancer Outcomes in the Metropolitan Atlanta Area: New Insights and Approaches for Health Equity

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Lindsay J Collin ◽  
Renjian Jiang ◽  
Kevin C Ward ◽  
Keerthi Gogineni ◽  
Preeti D Subhedar ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Racial Disparities ◽  
Racial Differences ◽  
Triple Negative ◽  
Patient Characteristics ◽  
Tumor Treatment ◽  
Luminal A ◽  
Breast Cancer Outcomes ◽  
Hazard Ratios ◽  
Cox Proportional Hazard Regression

Abstract Background Racial disparities in breast cancer (BC) outcomes persist where non-Hispanic black (NHB) women are more likely to die from BC than non-Hispanic white (NHW) women, and the extent of this disparity varies geographically. We evaluated tumor, treatment, and patient characteristics that contribute to racial differences in BC mortality in Atlanta, Georgia, where the disparity was previously characterized as especially large. Methods We identified 4943 NHW and 3580 NHB women in the Georgia Cancer Registry with stage I–IV BC diagnoses in Atlanta (2010–2014). We used Cox proportional hazard regression to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) comparing NHB vs NHW BC mortality by tumor, treatment, and patient characteristics on the additive and multiplicative scales. We additionally estimated the mediating effects of these characteristics on the association between race and BC mortality. Results At diagnosis, NHB women were younger—with higher stage, node-positive, and triple-negative tumors relative to NHW women. In age-adjusted models, NHB women with luminal A disease had a 2.43 times higher rate of BC mortality compared to their NHW counterparts (95% CI = 1.99 to 2.97). High socioeconomic status (SES) NHB women had more than twice the mortality rates than their white counterparts (HR = 2.67, 95% CI = 1.65 to 4.33). Racial disparities among women without insurance, in the lowest SES index, or diagnosed with triple-negative BC were less pronounced. Conclusions In Atlanta, the largest racial disparities are observed in luminal tumors and most pronounced among women of high SES. More research is needed to understand drivers of disparities within these treatable features.

Androgen-deprivation Therapy and the Risk of newly Developed Fractures in Patients with Prostate Cancer: A Nationwide Cohort Study in Korea

2021 ◽  
Author(s):  
Do Kyung Kim ◽  
Jong Won Kim ◽  
Hye Sun Lee ◽  
Ju-Young Park ◽  
Hyun Kyu Ahn ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Androgen Deprivation Therapy ◽  
Cox Regression ◽  
Androgen Deprivation ◽  
Proportional Hazard ◽  
Cox Regression Analysis ◽  
Cox Proportional Hazard ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Cox Proportional Hazard Regression

Abstract Purpose: We evaluated the risk of osteoporosis and fractures associated with androgen deprivation therapy (ADT) use and duration in men with prostate cancer.Methods: From the nationwide claims database in South Korea, a total of 218,203 men with prostate cancer were identified between 2008 and 2017. To adjust for comorbidities between cohorts, 1:1 propensity score matching was used. Cox proportional hazard regression models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of events associated with ADT. Results: In the matched cohort, there were differences in the incidence of newly developed osteoporosis (8.79% in the ADT group vs. 7.08% in the non-ADT group, p < 0.0001) and fractures (8.12% in the ADT group vs. 5.04% in the non-ADT group, p < 0.0001). Age-adjusted Cox regression analysis revealed that the ADT group had a significantly higher risk of osteoporosis (HR, 1.381; 95% CI, 1.305–1.461; p < 0.0001) and fractures (HR, 1.815; 95% CI; 1.703–1.935; p < 0.0001) compared to the non-ADT group. Furthermore, the risk of osteoporosis and fractures increased as the duration of ADT increased.Conclusions: The ADT was associated with an increased risk of osteoporosis and fractures in prostate cancer patients.

scholarly journals Androgen-deprivation therapy and the risk of newly developed fractures in patients with prostate cancer: a nationwide cohort study in Korea

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Do Kyung Kim ◽  
Hye Sun Lee ◽  
Ju-Young Park ◽  
Jong Won Kim ◽  
Hyun Kyu Ahn ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Androgen Deprivation Therapy ◽  
Cox Regression ◽  
Androgen Deprivation ◽  
Proportional Hazard ◽  
Cox Regression Analysis ◽  
Cox Proportional Hazard ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Cox Proportional Hazard Regression

AbstractWe evaluated the risk of osteoporosis and fractures associated with androgen deprivation therapy (ADT) use and duration in men with prostate cancer. From the nationwide claims database in South Korea, a total of 218,203 men with prostate cancer were identified between 2008 and 2017. After applying the inclusion and exclusion criteria, a total of 144,670 patients were included in the analysis. To adjust for comorbidities between cohorts, 1:1 propensity score matching was used. Cox proportional hazard regression models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of events associated with ADT, after controlling for potential confounding factors. In the matched cohort, there were differences in the incidence of newly developed osteoporosis (8.79% in the ADT group vs. 7.08% in the non-ADT group, p < 0.0001) and fractures (8.12% in the ADT group vs. 5.04% in the non-ADT group, p < 0.0001). Age-adjusted Cox regression analysis revealed that the ADT group had a significantly higher risk of osteoporosis (HR, 1.381; 95% CI, 1.305–1.461; p < 0.0001) and fractures (HR, 1.815; 95% CI, 1.703–1.935; p < 0.0001) compared to the non-ADT group. Furthermore, the risk of osteoporosis and fractures increased as the duration of ADT increased. The ADT was associated with an increased risk of osteoporosis and fractures in prostate cancer patients. Clinicians who administer ADT for patients with prostate cancer should always be mindful of the risk of osteoporosis and fracture, avoid unnecessary ADT, and perform regular bone health check-ups.

scholarly journals Conjugated equine estrogen used in postmenopausal women associated with a higher risk of stroke than estradiol

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Wei-Chuan Chang ◽  
Jen-Hung Wang ◽  
Dah-Ching Ding
Keyword(s):  
Postmenopausal Women ◽  
Population Based ◽  
Research Database ◽  
Proportional Hazard ◽  
Conjugated Equine Estrogen ◽  
Cox Proportional Hazard ◽  
Hazard Ratios ◽  
Taiwanese Women ◽  
Taiwan National Health Insurance ◽  
Cox Proportional Hazard Regression

AbstractThis study aimed to evaluate the risk of ischemic stroke (IS) in hormone therapy (HT) with oral conjugated equine estrogen (CEE) and estradiol (E2) in postmenopausal women in Taiwan. A retrospective cohort study was conducted using the Taiwan National Health Insurance Research Database, a population-based healthcare claims dataset. Eligible women, aged 40–65 years, who received HT with E2 and CEE orally were enrolled. The primary outcome was IS. Propensity score matching with menopausal age and comorbidities was used. Cox proportional hazard regression models were used to calculate the incidence and hazard ratios (HRs) for IS. The mean menopausal ages of the E2 and CEE groups were 50.31 ± 4.99 and 50.45 ± 5.31 years, respectively. After adjusting for age and comorbidities, the incidence of IS was 1.17-fold higher in the women treated with CEE than in those treated with E2 (4.24 vs. 3.61/1000 person-years), with an adjusted HR (aHR) of 1.23 (95% confidence interval [CI] 1.05–1.44). Moreover, HT with CEE initiated within 5 years of menopause had a higher HR than E2 (aHR = 1.20; 95% CI 1.02–1.42). In conclusion, HT with oral CEE might be associated with a higher risk of IS than E2 in postmenopausal Taiwanese women. The use of HT with CEE should be cautioned with the risk of IS.

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