Management of Melanoma during Pregnancy: A Case Series of 11 Women Treated at NYU Langone Health

Oncology ◽  
2020 ◽  
Vol 98 (12) ◽  
pp. 847-852
Author(s):  
Amelia E. Sawyers ◽  
Anna C. Pavlick ◽  
Jeffrey S. Weber ◽  
Iman Osman ◽  
Jennifer A. Stein
Keyword(s):  
Early Stage ◽  
Case Series ◽  
Advanced Stage ◽  
Early Stage Disease ◽  
Melanoma Diagnosis ◽  
Stage Disease ◽  
Treatment Plans ◽  
Melanoma Patients ◽  
The Impact

<b><i>Objectives:</i></b> Melanoma is one of the most common malignancies diagnosed during pregnancy. This study examined the impact of pregnancy on management decisions of melanoma patients treated at NYU Langone Health (NYULH). <b><i>Methods:</i></b> We analyzed data for patients who were pregnant at initial or recurrent melanoma diagnosis at NYULH from 2012 to 2019 with prospective protocol-driven follow-up. <b><i>Results:</i></b> Of the 900 female patients accrued during this period, 11 women in the childbearing range were pregnant at melanoma diagnosis. Six patients presented with early (stage 0 or I) disease and five with advanced (stage III or IV) melanoma. Women with early stage disease had normal deliveries and minimal changes to their treatment timeline and regimen. However, patients with more advanced stage disease opted for either termination of the pregnancy or early delivery and altered treatment timelines because of pregnancy. <b><i>Conclusion:</i></b> Both melanoma stage and gestational age at diagnosis contribute to the differences in the therapeutic management of melanoma in pregnant women. Given the complexity and variety of each case of melanoma during pregnancy, informed discussion between patients and physicians allows for individualized treatment plans that address each patient’s unique situation.

scholarly journals A Tertiary Cancer Center Experience of 52 Cases of Primary Ovarian Mucinous Adenocarcinomas

2020 ◽  
Vol 9 (02) ◽  
pp. 090-092
Author(s):  
Gaurav Das ◽  
V. Sridevi ◽  
Mohanaraj Natarajan
Keyword(s):  
Early Stage ◽  
Clinicopathological Characteristics ◽  
Cancer Center ◽  
Advanced Stage ◽  
Ovarian Adenocarcinoma ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Long Term Follow Up ◽  
Tertiary Cancer Center

Abstract Background Primary mucinous epithelial ovarian adenocarcinoma (mEOC) constitutes a small percentage (2–5%) of ovarian cancer. Our aim is to understand the clinicopathological characteristics and survival results of patients with mEOC after a long-term follow-up. Materials and Methods This is a retrospective study of primary mEOC cases treated at a tertiary cancer center in India, from January 1, 2005, to December 31, 2012. Results Out of 958 malignant ovarian tumors, 52 (5.43%) were mucinous adenocarcinoma. Nearly 71.2% of cases were of early-stage disease, and the remaining were of advanced-stage disease. After a follow-up period of 63 months (range: 1–138 months), the 5-year actuarial overall survival for stages I, II, III, and IV was 92.5, 70, 38.5, and 0%, respectively. Among advanced-stage tumors, half of them progressed without undergoing cytoreductive surgery and died. Conclusion Most of the mEOC cases present in early stages and have good clinical outcome. Patients with advanced-stage disease do not respond well to standard chemotherapy regimens in use and have poor survival figures. The use of primary cytoreduction should be considered in the place of interval cytoreduction for advanced mEOC.

scholarly journals Time from Diagnosis to Initiation of Curative Chemotherapy Affects Outcomes in DLBCL - Data from a Large Asian Cohort

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 1871-1871
Author(s):  
Colin Phipps ◽  
Yuh Shan Lee ◽  
Chandramouli Nagarajan ◽  
Yunxin Chen ◽  
Allan ZK Goh ◽  
...  
Keyword(s):  
Cox Regression ◽  
Early Stage ◽  
B Cell Lymphoma ◽  
Continuous Variable ◽  
Disease Stage ◽  
Advanced Stage ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Stage 1 ◽  
The Impact

Abstract Diffuse large B-cell lymphoma (DLBCL) is a high-grade lymphoma that requires treatment. It remains unclear how promptly curative anthracycline-based immunochemotherapy should be started and the prognostic effects time from diagnosis to treatment (TDT) has. We retrospectively analyzed the impact of TDT on progression-free survival (PFS) and overall survival (OS) using patient characteristics available at diagnosis. From the databases of two large lymphoma treatment centers in Singapore, we included 581 DLBCL patients sequentially diagnosed and treated with R-CHOP (or R-EPOCH) between 2002 and 2014. All transformed lymphomas and retroviral positive cases were excluded. Patients with TDT > 7 weeks were also excluded as only a few (N=17) in our dataset were, and in real world practice would be, treated beyond this time. The effect of TDT on PFS and OS was examined in Cox regression models which included other known prognostic variables of age, extranodal (EN) sites, lactate dehydrogenase (LDH), performance status, stage, international prognostic index (IPI) risk and cell-of-origin (COO) based on Hans' algorithm. TDT was treated as a continuous variable in per week time units. As well as in a binary normal vs. high model, LDH was analyzed as a continuous variable and then categorically following the NCCN-IPI concept of a normalized LDH to provide more clinical relevance. The median age was 60 years (range, 15-88) and median follow up in surviving patients 47 months. The number of patients with TDT in week 1 = 97, week 2 = 199, week 3 = 126, week 4 = 81, week 5 = 41, week 6 = 28, week 7 = 9. The median TDT was 14 days (range, 4-49) and was significantly longer in patients with normal LDH level, stage 1-2 disease, EN ≤ 1 site, and low IPI. In univariate analysis, longer TDT was associated with poorer PFS and OS in the high LDH and stage 3-4 groups. Cox regression analysis for PFS showed that poorer performance state of ECOG ≥ 2 (P=0.029), stage 3-4 disease (P<0.001), increased LDH 1-2 fold (P=0.01) and ≥ 2-fold (P <0.001), and longer TDT (P=0.008; HR 1.144, 95% CI 1.036 - 1.263) were predictive. For OS, stage 3-4 disease (P=0.019), increase in LDH 1-2 fold (P=0.005) and ≥ 2-fold (P <0.001), and longer TDT (P=0.01, HR 1.154; 95% CI 1.035 - 1.287) were significantly associated. Considering the statistically significant interactions between LDH and disease stage and TDT, we performed Cox regression separately for patients with high (>normal) and normal LDH, and for advanced stage (3-4) and early stage (1-2) disease. We found that TDT remained a significant predictor of PFS and OS in patients with advanced stage but not early stage disease and in high LDH but not normal level LDH patients. The analysis demonstrated that delays in starting curative immunochemotherapy have detrimental effects on PFS and OS in patients with high LDH and advanced stage disease. The benefit of starting treatment earlier in DLBCL patients with higher tumor bulk, while intuitive, has not been previously demonstrated. Our findings suggest that treatment delays, whenever possible, should be minimized. Disclosures Hwang: Janssen: Honoraria, Other: Travel support; MSD: Honoraria, Other: Travel support; Celgene: Honoraria, Other: Travel support; Roche: Honoraria, Other: Travel support; Sanofi: Honoraria, Other: Travel support; Pfizer: Honoraria, Other: Travel support; BMS: Honoraria, Other: Travel support; Novartis: Honoraria, Other: Travel support.

scholarly journals Collision Tumors of the Cervix – A Case Series: Its Clinical Significance in the Management of an Early Stage Disease

2018 ◽  
Vol 52 (6) ◽  
Author(s):  
Jimmy A. Billod ◽  
Efren J. Domingo
Keyword(s):  
Cervical Cancer ◽  
Recent Literature ◽  
Early Stage ◽  
Case Series ◽  
Response To Treatment ◽  
Clinicopathologic Features ◽  
Early Stage Disease ◽  
Collision Tumors ◽  
Stage Disease ◽  
Histologic Types

Majority of cervical cancer are squamous cell carcinoma and adenocarcinoma. The co-existence of two histologic types is rare. This article presents three cases of collision tumors of the cervix within a 10-year review. All underwent radical hysterectomy for an early stage disease. Likewise, it aims to review clinicopathologic features, management, response to treatment and prognosis of these types of tumor in the light of recent literature.

SO091URINE-TO-PLASMA UREA RATIO, AS SURROGATE MARKER FOR URINE CONCENTRATING CAPACITY, IS ASSOCIATED WITH DISEASE PROGRESSION IN ADPKD

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Judith E Heida ◽  
Ronald Gansevoort ◽  
Lianne Messchendorp ◽  
Esther Meijer ◽  
Niek F Casteleijn ◽  
...  
Keyword(s):  
Disease Progression ◽  
Water Deprivation ◽  
Early Stage ◽  
Early Stage Disease ◽  
Plasma Urea ◽  
Final Model ◽  
Stage Disease ◽  
Observational Cohort ◽  
Egfr Decline

Abstract Introduction Predicting disease progression in autosomal dominant polycystic kidney disease (ADPKD) patients poses a challenge, especially in early stage disease when renal function is not yet affected. The ongoing formation and growth of cysts causes the urine concentrating capacity to decrease from early on in the disease. We therefore hypothesized that the easy and inexpensive to measure urine-to-plasma urea ratio (UPU ratio), which is assumed to be surrogate for maximal urine concentrating capacity, can be used as marker to predict disease progression in ADPKD. Methods The UPU ratio was calculated by dividing urea concentration in a fasting morning spot urine sample by plasma urea concentration adjusted for plasma creatinine concentration. First, we validated the UPU ratio in 30 ADPKD patients who underwent a prolonged water deprivation test to measure the maximal urine concentrating capacity. Thereafter, the association of the UPU ratio with renal outcome was evaluated in 583 ADPKD patients participating in the DIPAK observational cohort (inclusion criteria: age&gt;18 years, eGFR &gt;15 mL/min/1.73m2, no concomitant diseases affecting eGFR, without V2 receptor antagonist prescription). Kidney function was assessed as eGFR by the creatinine based CKD-EPI formula, height adjusted total kidney volume (htTKV) by MRI and copeptin (surrogate for vasopressin) by ELISA. Results In the water deprivation test participants (n=30), the UPU ratio was strongly correlated with maximal urine concentrating capacity (R = 0.67, p&lt;0.001). This association remained significant after correcting for sex, age, htTKV and eGFR (st. β = 0.53, p = 0.007). In these subjects maximal urine concentrating capacity as well as UPU ratio were associated with the rate of eGFR decline during a median follow-up of 6.3 yr (12 eGFR assessments per patient) assessed using linear mixed modeling, also when corrected for sex, baseline age and eGFR (β = 0.009, p = 0.04, and β = 5.56, p&lt;0.001, resp.). We subsequently corroborated in the larger DIPAK observational cohort (n=583, 58% female, mean age 47 yr median eGFR 60 mL/min/1.73m2 and htTKV 898 ml/m), that the UPU ratio was significantly associated with rate of eGFR decline during a median follow-up of 4.0 yr (6 eGFR assessments per patient): β = 0.23, p = 0.005. This association remained significant when corrected for sex, baseline age and eGFR (β = 0.32, p&lt;0.001) and even when additionally corrected for Mayo class, PDK mutation and copeptin (β = 0.40, p &lt;0.001). Stepwise backward multivariate regression analysis resulted in a final model including the UPU ratio, PKD mutation, Mayo Class and copeptin. Cox survival analysis showed that a lower baseline UPU ratio (indicating less urine concentrating capacity) was significantly associated with a higher risk to develop the combined renal endpoint of incidence of start of kidney replacement therapy, eGFR &lt;15 mL/min/1.73m2 or eGFR decrease &gt;40% during follow-up (adjusted Hazard Ratio per SD = 1.39, p = 0.007). Limiting the aforementioned analyses to the subgroup of patients with relative early stage disease (n=122, age &lt;40 yr and eGFR &gt;60 mL/min/1.73m2) rendered essentially similar results, with an adjusted β for UPU ratio in the final model of 0.33 (p = 0.04). In this subgroup with a limited number of events (n=10), Cox survival analysis did not reach formal significance (adjusted HR per SD: 2.67, p = 0.055). Conclusion The UPU ratio, which is calculated from routine laboratory measurements, predicts renal prognosis in ADPKD in addition to other, more laborious to measure and expensive risk markers. Notably, this marker of urine concentrating capacity also shows promise in early-stage disease.

Neuroendocrine carcinoma of the cervix: A single institution’s experience.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15585-e15585
Author(s):  
Megan Preston ◽  
Georgia Anne-Lee McCann ◽  
David M. O'Malley ◽  
Christina Boutsicaris ◽  
Larry J. Copeland ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Metastatic Disease ◽  
Survival Data ◽  
Early Stage ◽  
Stage I ◽  
Stage Ii ◽  
Advanced Stage ◽  
Single Institution ◽  
Early Stage Disease ◽  
Stage Disease

e15585 Background: Neuroendocrine carcinomas (NEC) of the cervix comprise only 2% of all cervical cancers. As a result, prospective data is limited and treatment guidelines rely on literature from lung NEC. The objective of this study was to examine and report on our experience in the management of this rare, aggressive disease. Methods: This was an IRB-approved, single-institution, retrospective review. Study criteria included patients with cervical NEC diagnosed between 1990-2011. Demographic, treatment and survival data was collected. Progression-free survival (PFS) and overall survival (OS) was defined as the time from date of initial treatment until progression or death respectively, or date of last contact. Results: A total of 24 patients met inclusion criteria. The median age at diagnosis was 43. Median PFS was 13.6 months and median OS was 16.4 months. The majority of patients had advanced-stage disease (61% stage II-IV, 39% stage I). Of the 9 patients with stage I disease, 4 were treated with platinum + etoposide-based neoadjuvant chemotherapy and 5 were treated with initial radical surgery. Seven of the 9 patients had post-operative adjuvant therapy consisting of chemotherapy, chemo-radiation or radiation only. Seven of the 9 patients (78%) were alive at last follow-up. Of the two patients who were deceased, one had metastatic disease found at surgery and the other declined adjuvant therapy and died of recurrence. Patients with stage II-IV disease (n=15) had a median PFS and OS of 11.5 and 12.1 months, respectively. Only 2 had no evidence of disease at last encounter. The remainder died without achieving remission. Patients with metastatic disease had significantly worse survival when compared to those with loco-regional disease with a median OS of 8 vs. 28 months (p = .03), respectively. Conclusions: We report one of the largest single-institution experiences of neuroendocrine cervical cancer. Advanced-stage patients had a poor prognosis regardless of therapy. However, multi-modality therapy in early-stage disease resulted in an excellent prognosis (78% survival) for these rare, highly aggressive tumors. These findings support the goal of curative intent for early-stage disease using multi-modality therapy.

scholarly journals Spilled gallstones during laparoscopic cholecystectomy

2014 ◽  
Vol 96 (5) ◽  
pp. e18-e20 ◽  
Author(s):  
J Ahmad ◽  
AIW Mayne ◽  
Y Zen ◽  
MB Loughrey ◽  
P Kelly ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gallbladder Cancer ◽  
Histological Examination ◽  
Early Stage ◽  
Recurrent Pain ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Symptomatic Gallstones ◽  
Incidental Gallbladder Cancer

Introduction Incidental gallbladder cancer is found in 0.6–2.1% of patients undergoing laparoscopic cholecystectomy for symptomatic gallstones. Patients with Tis or T1a tumours generally undergo no further intervention. However, spilled stones during surgery may have catastrophic consequences. We present a case and suggest aggressive management in patients with incidental gallbladder cancer who had spilled gallstones at surgery. Case History A 37-year-old woman underwent a laparoscopic cholecystectomy for symptomatic gallstones, during which some stones were spilled into the peritoneal cavity. Subsequent histological examination confirmed incidental pT1a gallbladder cancer. Hepatopancreatobiliary multidisciplinary team discussion agreed on regular six-monthly follow-up. The patient developed recurrent pain two years after surgery. Computed tomography revealed a lesion in segment 6 of the liver. At laparotomy, multiple tumour embedded gallstones were found on the diaphragm. Histological examination showed features (akin to the original pathology) consistent with a metastatic gallbladder tumour. Conclusions This case highlights the potential for recurrence of early stage disease resulting from implantation of dysplastic or malignant cells carried through spilled gallstones. It is therefore important to know if stones were spilled during original surgery in patients with incidental gallbladder cancer following a laparoscopic cholecystectomy. Aggressive and early surgical management should be considered for these patients.

The relationship between tumor size and stage in early versus advanced ovarian cancer: A retrospective chart review

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5580-5580
Author(s):  
L. E. Horvath ◽  
T. Werner ◽  
K. Jones
Keyword(s):  
Ovarian Cancer ◽  
Chart Review ◽  
Advanced Disease ◽  
Early Stage ◽  
Abdominal Cavity ◽  
Advanced Ovarian Cancer ◽  
Retrospective Chart Review ◽  
Advanced Stage ◽  
Early Stage Disease ◽  
Stage Disease

5580 Background: Ovarian cancer has a different prognosis between early (I and II) and advanced stage (III and IV). The mechanism of disease progression is unknown, but patients with advanced disease may have a higher propensity for seeding of the abdominal cavity early in the disease process than those with early stage. Theoretically if this is so, then patients with advanced stage should have smaller sized tumors than patients with early stage. Methods: This was a retrospective chart review of patients in the tumor registry in 2003 to 2006. Patients had epithelial ovarian cancer, other cell types were excluded. Only cases with documentation of surgical and pathologic staging and measured dimensions on pathologic specimen were included. Patient stage and all available dimensions measured on diseased ovaries were recorded. The dimensions for each patient were averaged into a single dimension for that patient, and then these measurements were totaled and averaged. Results: There were 110 patients analyzed: 85 with advanced disease, 25 with early stage. The average measurement was 4.8 cm in advanced disease, and was 10.7 cm in early stage disease. This difference was statistically significant (p < 0.001). Conclusions: Overall, patients with early stage ovarian cancer have diseased ovaries that are more than twice as large as those found in advanced disease. This finding supports the fact that early versus advanced ovarian cancer are 2 separate disease processes. Early stage grows locally and does not disseminate, and advanced stage disseminates while the tumor is still relatively small. Theoretically there may be a factor that separates these 2 into different diseases, where advanced disease patients have a substance produced by their tumor that allows for early dissemination, and early stage lacks this substance and only grows locally. Basic science research comparing the tissue microarrays of early versus advanced stage disease may be able to identify this difference. If the difference is found, perhaps therapy can be targeted against this difference. No significant financial relationships to disclose.

Frequency of late-stage breast cancer diagnoses despite high mammography screening rates in an HMO

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 1526-1526
Author(s):  
R. Haque ◽  
J. E. Schottinger ◽  
M. H. Kanter ◽  
C. C. Avila ◽  
R. Contreras ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Late Stage ◽  
Mammography Screening ◽  
Early Stage ◽  
Advanced Tumor Stage ◽  
Early Stage Disease ◽  
Advanced Tumor ◽  
Stage Disease ◽  
Late Stage Diagnosis ◽  
The Impact

1526 Background: Kaiser Permanente Southern California (KPSC) led the nation in screening women for breast cancer (BCa) with a mammography rate of nearly 90% in 2007 according to 2008 Healthcare Effectiveness Data and Information Set (HEDIS) measures. Despite successes in improving screening rates in this health plan that serves 3+ million diverse members, the percentage of women diagnosed with late stage BCa (stage III, IV) remained stable, varying from 12.9% (N∼323) in 2003 to 10.8% (N∼270) in 2007. To identify patient and health care factors associated with late stage diagnosis and the impact of its enhanced screening implementation guidelines, KPSC undertook this study. Methods: This cross-sectional study included a cohort of 10,580 BCa patients from 2003–2007. We compared women diagnosed with late stage disease versus those with early stage disease (stages I, II). P values (2-sided) were based on the chi-square distribution. Adjusted odds ratios and 95% confidence intervals were estimated using unconditional logistic regression. Results: Factors that were positively associated with late stage diagnosis in the univariate analyses included age, lack of recent mammography screening, worse tumor features, 80+ years of age, minority race, lower geocoded household income, increased healthcare visits, and use of Pap testing (P < 0.01 for all variables). Factors significantly associated with late stage diagnosis in the multivariate model included only lack of recent mammography screening (OR = 1.35, 95% CI: 1.14–1.58) and worse tumor features including high grade (grade 3, OR = 2.58, 95% CI: 1.96–3.40), positive lymph nodes (OR = 53.49, 95% CI: 39.90–71.72), and HER-2+ tumors (OR = 1.40, 95% CI: 1.13–1.72). Conclusions: Targeting older women, those with lower utilization, and women who did not have a recent mammogram may help further lower the prevalence of late stage diagnoses. However, given the extent of the health plan's previous efforts to enhance BCa screening rates, a ceiling effect may limit additional benefit. Additional efforts to decrease the rate of advanced tumor stage at diagnosis may include improving interpretation of mammograms or earlier detection of aggressive tumors by enhanced BRCA genetic testing. No significant financial relationships to disclose.

Clinical and molecular characteristics of non-small cell lung cancer patients from rural Maine.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18237-e18237
Author(s):  
Antoine Harb ◽  
Adam Curtis ◽  
Laura Skacel ◽  
Michael Babcock ◽  
Marek Skacel
Keyword(s):  
Lung Cancer ◽  
Overall Survival ◽  
Early Stage ◽  
P53 Mutation ◽  
Small Cell ◽  
Small Cell Lung ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Disease Free

e18237 Background: Non-Small Cell Lung Cancer (NSCLC) is the most common malignancy worldwide and the leading cause of malignancy-related mortality in the United States. The state of Maine in particular, has one of the highest rates of lung cancer in the country. Methods: We reviewed all NSCLC patients (adenocarcinoma (AC) and squamous cell (SC) histology) diagnosed between January 2017 and June 2018 at Northern Light Cancer Institute. 261 patients with clinical follow-up were identified. We correlated their clinical characteristics with molecular abnormalities identified by Next Generation Sequencing (NGS) and Fluorescence in situ hybridization, PD-L1 status by immunohistochemistry, disease-free and overall survival. Results: 210 patients had AC and 51 SC. They were evenly split between men and women. The median age at diagnosis was 68 years. 99% of patients were Caucasian. 15 patients were never smokers, the rest were equally divided between active and previous smokers. 44% had early stage disease (I/II) and 56% had late stage disease (III/IV) on presentation. 36.4% had a PD-L1 high status. The frequencies of the molecular aberrations identified in AC and SC are listed in the table below: Treatment differed by stage, including surgery/Radiation +/- adjuvant chemotherapy for early stage disease, definitive chemo-radiation followed by immunotherapy for stage III disease. Stage IV patients were treated with immunotherapy, combination chemo-immunotherapy, targeted therapy, palliative radiation and hospice referral. After a median follow-up of 10.6 months, overall survival (OS) was 66%. Disease free survival (DFS) was 33%. Using univariate (chi-square), multivariate (logistic regression) and Kaplan-Meier (log rank) analyses, we identified that in addition to a high clinical stage, which was associated with shorter OS and DFS, high PD-L1 status, and the presence of p53 mutation, were independent predictors of shorter OS, and p53 mutation of shorter DFS. Conclusions: NGS-based molecular testing deployed in real-time non-academic setting proved to be a valuable tool to identify therapeutic and prognostic targets in NSCLC. Besides those endorsed by the NCCN guidelines, p53 mutation is a common abnormality associated with adverse outcomes. While high PD-L1 expression is a desirable immunotherapy marker, its presence also predicted adverse overall outcomes in our patients.[Table: see text]

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