Hispanic Ethnicity and the Risk of Pediatric Leukemia Relapse

2017 ◽  
Vol 57 (6) ◽  
pp. 656-659
Author(s):  
Ernest K. Amankwah ◽  
Greg A. Hale
Keyword(s):  
Cox Regression ◽  
Small Sample Size ◽  
Small Sample ◽  
Single Institution ◽  
Relapse Free Survival ◽  
Pediatric Leukemia ◽  
Free Survival ◽  
Hazard Ratios ◽  
Leukemia Relapse ◽  
Study Participants

Limited knowledge currently exists on the disparity in pediatric leukemia relapse. This study compared the risk of pediatric leukemia relapse between Hispanic and non-Hispanic Whites. Study participants were children (<20 years) diagnosed with leukemia from January 2006 to December 2014 at the Johns Hopkins All Children’s Hospital, St. Petersburg, Florida. Hazard ratios and 95% confidence intervals for relapse-free survival were calculated using adjusted Cox regression. The study included 35 Hispanic and 94 non-Hispanic Whites. Among patients <10 years old, there was a significantly higher risk of relapse in Hispanic compared to non-Hispanic Whites (hazard ratio = 6.19, 95% confidence interval = 1.15-33.27). No association was observed for patients aged ≥10 years nor all participants combined. Although the finding of this study may suggest that ethnic disparity in pediatric leukemia relapse may exist in younger children, our finding is limited by the small sample size from a single institution. Therefore, future larger multiinstitutional studies are warranted.

Outcome of patients with colorectal cancer undergoing lung metastases resection: a single-institution retrospective analysis

2020 ◽  
pp. 030089162093079
Author(s):  
Marco Mammana ◽  
Francesca Bergamo ◽  
Letizia Procaccio ◽  
Marco Schiavon ◽  
Fotios Loupakis ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Cox Regression ◽  
Multivariable Analysis ◽  
Postoperative Chemotherapy ◽  
Single Institution ◽  
Relapse Free Survival ◽  
Free Survival ◽  
Lung Metastasectomy

Introduction: This study was undertaken to review a single-institution cohort of patients with metastatic colorectal cancer undergoing lung resection after a multidisciplinary evaluation and to investigate the main prognostic factors for survival. Methods: Medical records of 129 patients undergoing lung metastasectomy for colorectal cancer with curative intent from 2001 to 2017 were reviewed. Tissue samples from the primary tumor were analyzed with a multiplex genotyping system for the detection of mutations in RAS and BRAF genes. Survival analyses were carried out by the Kaplan-Meier method. Univariate and multivariable analyses were performed using the log-rank test and the Cox regression model. Results: Postoperative morbidity and mortality were 13.2% and 0%, respectively. At a median follow-up time of 62.5 months, median overall survival was 90.5 months and median relapse-free survival was 42.8 months. Multivariable analysis for overall survival identified synchronous versus metachronous metastatic presentation as the only prognostic factor, whereas relapse-free survival was independently associated with synchronous versus metachronous metastatic presentation, number of metastases, and postoperative chemotherapy. Conclusions: This study shows particularly favorable survival outcomes for patients undergoing lung metastasectomy. The validity of some of the main prognostic factors was confirmed and a positive effect of postoperative chemotherapy on relapse-free survival was shown. Contrary to other reports, the presence of KRAS mutations was not associated with significant survival differences. Further studies are needed in order to clarify the interactions between molecular, clinical, and pathologic characteristics and treatment-related factors.

scholarly journals Body Mass Index at Pediatric Leukemia Diagnosis and the Risks of Relapse and Mortality: Findings from a Single Institution and Meta-analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Ashleigh M. Saenz ◽  
Stacie Stapleton ◽  
Raquel G. Hernandez ◽  
Greg A. Hale ◽  
Neil A. Goldenberg ◽  
...  
Keyword(s):  
Small Sample Size ◽  
Meta Analysis ◽  
Small Sample ◽  
Obese Patients ◽  
Single Institution ◽  
Pediatric Leukemia ◽  
Risk Of Mortality ◽  
Obesity Status ◽  
Increased Risk ◽  
Leukemia Diagnosis

High body mass index (BMI) is associated with relapse of certain adult cancers, but limited knowledge exists on its association with pediatric leukemia relapse. We evaluated the association between overweight/obesity (BMI ≥ 85th percentile) at pediatric leukemia diagnosis and relapse or mortality. A meta-analysis combining our findings with those of previous studies was also performed. The study included 181 pediatric leukemia patients. Sporadic missing data were multiply imputed, and hazard ratios (HR) and 95% confidence intervals (95% CI) were calculated using Cox proportional hazard. Age- and sex-adjusted analysis for patients ≥10 years showed a trend towards increased risk of relapse for overweight/obese patients (HR = 2.89, 95% CI = 0.89–9.36, p=0.08) that was not evident among children<10 years (HR = 0.52, 95% CI = 0.08–3.54, p=0.49). We observed a statistically significant association between mortality and obesity status in unadjusted models (imputed: HR = 2.54, 95% CI = 1.15–5.60, p=0.021; complete set: HR = 2.72, 95% CI = 1.26–5.91, p=0.011) that was not statistically significant in both age- and sex-adjusted and multivariable adjusted analyses. The pooled estimate of our finding and previous studies showed an association between overweight/obese and increased risk of mortality for ALL (HR = 1.39, 95% CI = 1.16–1.46) and AML (HR = 1.64, 95% CI = 1.32–2.04). Although our study did not observe statistically significant associations due to a small sample size, the meta-analyses revealed an increased risk of mortality for overweight/obese patients. The findings of our study suggest an association of obesity status with relapse in children ≥10 years. However, our study was based on a small sample size from a single institution, and this association needs to be investigated in larger, multicenter studies.

Is more surgery better for patients with gallbladder cancer? A survival analysis of extended versus simple cholecystectomy.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15615-e15615
Author(s):  
Christos Fountzilas ◽  
Marcela Mazo- Canola ◽  
Brian Hernandez ◽  
Michelle Janania Martinez ◽  
Ruchi Hamal ◽  
...  
Keyword(s):  
Gallbladder Cancer ◽  
Retrospective Analysis ◽  
Small Sample Size ◽  
Small Sample ◽  
Single Institution ◽  
Free Survival ◽  
Entire Cohort ◽  
Simple Cholecystectomy ◽  
Kaplan Meier ◽  
Extended Cholecystectomy

e15615 Background: Gallbladder cancer (GBC) is a rare cancer; the minority of patients have resectable tumor at diagnosis. Based on retrospective, single-institution data, extended cholecystectomy (EXT) has been recommended over simple cholecystectomy (CHOL) in >T1 tumors; however, effect of EXT on survival is unclear. Thus, we evaluated the survival of patients with resectable GBC at our institution. Methods: Retrospective analysis from 1/1/2005 to 1/1/2016 for patients with GBC. Patients with advanced or metastatic disease were excluded. The Recurrence-free survival (RFS) and overall survival (OS) were calculated using the Kaplan-Meier method. Results: 68 patients with GBC; 26 (38%) with early disease. Twelve patients had EXT. Patient/tumor characteristics are shown in Table. Median RFS was 22 months (95% CI: 9-not reached) and OS was 25 months (95% CI: 15-not reached) for the entire cohort. Median RFS was increased in CHOL (30 months) relative to EXT (9 months); p=0.73. OS appeared similar between the two groups (25 vs. 23 months for CHOL and EXT group, respectively). Conclusions: EXT appears to improve RFS with no effect on OS in patients with early GBC. Due to the limitations of small sample size and retrospective analysis, multi-institutional collaborations are necessary to better identify optimal management. [Table: see text]

Aspirin in the prevention of colorectal cancer recurrence.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 578-578
Author(s):  
Nimisha Kumari ◽  
Hiren A. Mandaliya ◽  
Tiffany Evans ◽  
Patrick McElduff ◽  
Christopher Oldmeadow ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Regression Model ◽  
Propensity Scores ◽  
Cox Regression ◽  
Colorectal Adenomas ◽  
Stage Ii ◽  
Single Institution ◽  
Relapse Free Survival ◽  
Free Survival

578 Background: Aspirin use reduces the incidence of colorectal adenomas, and of colorectal cancer (CRC) in patients with hereditary non-polyposis colorectal cancer. There is limited data on the effect of aspirin in the secondary prevention of CRC, currently the subject of multiple prospective randomized trials. We aimed to test the hypothesis that aspirin reduces disease recurrence in patients diagnosed with early CRC at a high volume, single institution. Methods: A retrospective analysis was conducted of all patients (pts) treated with at least one cycle of adjuvant chemotherapy for stage II or III CRC over a 5yr period (2009–13). Patients with synchronous CRC were excluded. Aspirin use at the onset of adjuvant chemotherapy was sourced from the universal electronic recording of concomitant medications. Kaplan-Meier curves and the log-rank test were used to compare crude relapse free survival (RFS) between pts who were using aspirin to those who were not. Propensity score analyses was used to balance the groups according to potentially confounding variables: tumor site (colon vs rectum), tumor stage (II vs III), and adjuvant chemotherapy (oxaliplatin-based vs no oxaliplatin). The propensity scores were estimated through a multivariable logistic regression model, and a Cox proportional hazards model used to assess the effect of aspirin use on RFS in the sample weighted according to the inverse probability of receiving aspirin. Results: A cohort of 231 pts met eligibility criteria; median age 64yr; 50% colon, 50% rectal; 19% stage II, 81% stage III; 35% received oxaliplatin; 13% (n=31) were using aspirin and 26% of pts (n=61) developed CRC recurrence in median follow-up of 2.9yr. Unadjusted RFS was not significantly different for those using aspirin (log rank p value 0.88). There was good overlap in propensity scores for the two groups. The hazard ratio for RFS with aspirin use from the weighted Cox regression model was 1.2 (95% CI 0.62-2.29), indicating no statistically significant effect of aspirin on CRC relapse. Conclusions: In this single institution series, we did not find evidence that aspirin use at onset of chemotherapy had an effect on CRC relapse free survival. These results do not exclude an aspirin effect that is modest or restricted to select CRC subgroups.

scholarly journals CDK4/6 Inhibitors and Arthralgia: A Single Institution Experience

2021 ◽  
Vol 9 (2) ◽  
pp. 42
Author(s):  
Angeliki Andrikopoulou ◽  
Oraianthi Fiste ◽  
Kleoniki Apostolidou ◽  
Efthymia Skafida ◽  
Christos Markellos ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Small Sample Size ◽  
Small Sample ◽  
Musculoskeletal Symptoms ◽  
Hematological Toxicity ◽  
Breast Cancer Patients ◽  
Single Institution ◽  
Duration Of Treatment ◽  
Positive Breast Cancer

Background: Aromatase inhibitors (AIs) are associated with musculoskeletal pain in one third (20–47%) of breast cancer patients. Recently, CDK4/6 inhibitors have emerged as a new therapeutic approach in hormone receptor (HR)-positive breast cancer. While hematological and gastrointestinal toxicities are frequently reported during treatment with CDK4/6 inhibitors, musculoskeletal symptoms are less commonly encountered. Methods: Herein, we present a retrospective study of 47 breast cancer patients who received CDK4/6 inhibitors along with endocrine therapy in our department between 01/01/2018 and 01/09/2020. Results: Median age at diagnosis was 58 years (29–81). Median duration of treatment was 8.76 months (SD: 7.68; 0.47–30.13 months). Median PFS was 24.33 months (95% CI; 1.71–46.96). Overall, toxicity was reported in 61.7% of the cases (29/47). Arthralgia was reported in 6.4% (3/47) of the patients. Hematological toxicity was reported in 51.1% (24/47) of the patients. Neutropenia was the main hematological toxicity observed (86.8%; 22/47) along with anemia (4.3%; 2/47), thrombocytopenia (2.1%; 1/47), and leukopenia (4.2%; 1/24). Conclusions: Though our data reflect a small sample size, we report a reduced arthralgia rate (6.4%) during treatment with CDK4/6 inhibitors compared with that reported in studies of AIs (20–47%).

scholarly journals FMRI-based prediction of naltrexone response in alcohol use disorder: a replication study

2021 ◽  
Author(s):  
Patrick Bach ◽  
Georg Weil ◽  
Enrico Pompili ◽  
Sabine Hoffmann ◽  
Derik Hermann ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Pharmacological Treatment ◽  
Alcohol Use Disorder ◽  
Cox Regression ◽  
Small Sample Size ◽  
Cue Reactivity ◽  
Small Sample ◽  
Hazard Ratio ◽  
Number Needed To Treat ◽  
Significant Interaction Effect

AbstractPharmacological treatment in alcohol use disorder suffers from modest effect sizes. Efforts have been undertaken to identify patient characteristics that help to select individuals that benefit from pharmacological treatment. Previous studies indicated that neural alcohol cue-reactivity (CR) might provide a marker that identifies patients, which benefit from naltrexone treatment.We investigated the reproducibility of the association between ventral striatum (VS) activation and naltrexone (NTX) treatment response by analyzing data from a recent longitudinal clinical trial in N = 44 abstinent treatment-seeking alcohol-dependent patients. A follow-up was conducted over 3 months. We computed the percentage of significant voxels in VS and tested main effects and interactions with NTX treatment on relapse risk using Cox Regression models.We found a significant interaction effect between pre-treatment cue reactivity in the VS and NTX treatment on time to first heavy relapse (Hazard Ratio = 7.406, 95% CI 1.17–46.56, p = 0.033), such that the patient group with high VS activation (defined by a mean split) showed a significant medication effect (Hazard Ratio = 0.140, 95% CI 0.02–0.75, p = 0.022) with a number needed to treat of 3.4 [95% CI 2.413.5], while there was no significant effect in the group with low VS activation (Hazard Ratio = 0.726, p = 0.454).Thus, using an independent sample we replicated the previously described positive association between VS activation and NTX efficacy. Although our results should be considered cautiously in light of the small sample size, our results support the potential of neural alcohol CR as a tool for precision medicine approaches in alcohol dependence.

Bevacizumab (BEV) plus second-line taxane (TAX) or other chemotherapy (CT) for triple-negative breast cancer (TNBC): Subgroup analysis of RIBBON-2.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 290-290
Author(s):  
A. Brufsky ◽  
V. Valero ◽  
B. Tiangco ◽  
S. R. Dakhil ◽  
A. Brize ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Endpoint ◽  
Small Sample Size ◽  
Objective Response ◽  
Metastatic Breast ◽  
Progression Free Survival ◽  
Small Sample ◽  
Second Line ◽  
First Line ◽  
Free Survival

290 Background: In three randomized trials in the first-line metastatic breast cancer (MBC) setting, combining BEV with CT significantly improved progression-free survival (PFS; primary endpoint) and objective response rate (ORR) vs. CT alone. BEV also showed a significant PFS benefit in the second-line MBC setting (RIBBON-2) when combined with TAX or other CT. We analyzed data from the subgroup of patients (pts) with TNBC in RIBBON-2. Methods: Eligible pts had MBC that had progressed on first-line CT without BEV. Second-line CT (TAX, gemcitabine, capecitabine, or vinorelbine) was chosen before 2:1 randomization to CT with either BEV (10 mg/kg q2w or 15 mg/kg q3w) or placebo (PLA). All pts could receive BEV at progression. The primary endpoint was PFS. Results: RIBBON-2 included 684 pts; 159 (23%) had TNBC and of these, 67 (42%) received TAX with BEV/PLA. Baseline characteristics were broadly similar in the two treatment arms. In an exploratory analysis of pts with TNBC, BEV + CT led to significantly improved PFS and ORR vs. CT alone, and a trend toward improved overall survival (OS). The magnitude of the effect was particularly pronounced in pts receiving TAX CT. Conclusions: Pts with TNBC derive significant ORR and PFS benefit from BEV combined with second-line CT. Despite the small sample size, there was a trend (HR 0.624; p = 0.0534) toward OS benefit in pts treated with BEV, especially with TAX CT. [Table: see text]

Clinical activity of enzalutamide pre- and post-docetaxel in patients with metastatic castration-resistant prostate cancer (mCRPC).

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 216-216 ◽  
Author(s):  
Rosa Nadal ◽  
Zhe Zhang ◽  
Hitesh Raheja ◽  
Mario A. Eisenberger ◽  
Emmanuel S. Antonarakis
Keyword(s):  
Cox Regression ◽  
Small Sample Size ◽  
Univariate Analysis ◽  
Progression Free Survival ◽  
Small Sample ◽  
Cross Resistance ◽  
Clinical Activity ◽  
Castration Resistant Prostate Cancer ◽  
Cox Regression Analysis ◽  
Docetaxel Treatment

216 Background: Enzalutamide is an androgen receptor signaling inhibitor that is FDA-approved for post-docetaxel mCRPC patients. Overlapping mechanisms of action and clinical evidence for an interaction between taxanes and androgen-targeted therapies complicates optimal sequencing of taxanes and enzalutamide. We retrospectively evaluated the efficacy of enzalutamide pre- (preD) and post-docetaxel (postD) therapy. Methods: Men with mCRPC who received enzalutamide preD or postD were identified from a single institution database. We investigated factors influencing enzalutamide activity by using univariate and multivariable Cox regression models, with particular attention to whether or not prior docetaxel had been used. Outcome measures of interest were time-to-PSA-progression (TTPP) and progression-free-survival (PFS). Results: A total of 72 patients received enzalutamide at our institution: 22 were preD and 50 were postD. Median duration of enzalutamide therapy was 5.5 mo (range, 0.7–33.6 mo). In univariate Cox regression analysis, the following factors were predictive of TTPP: ECOG status (≥1 vs 0), number of metastases (>5 vs 0-5), hemoglobin and albumin. Prior docetaxel treatment was associated with a trend towards shorter TTPP on enzalutamide (HR 0.54, 95%CI 0.27–1.10, P=0.09). The following factors were predictive of PFS in univariate analysis: ECOG status, number of metastases, hemoglobin and albumin. Prior docetaxel therapy was associated with a trend towards shorter PFS on enzalutamide (HR 0.57, 95%CI 0.29–1.13, P=0.10). Conclusions: These data suggest numerically inferior TTPP and PFS outcomes to enzalutamide in men previously treated with docetaxel compared to men who were docetaxel-naïve, although the small sample size precludes statistically significant results. This potentially supports the hypothesis of cross-resistance between enzalutamide and docetaxel.

scholarly journals Histopathological and Genomic Grading Provide Complementary Prognostic Information in Breast Cancer: A Study on Publicly Available Datasets

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Nilotpal Chowdhury
Keyword(s):  
Breast Cancer ◽  
Cox Regression ◽  
Prognostic Indicator ◽  
Rank Test ◽  
Prognostic Impact ◽  
Prognostic Information ◽  
Free Survival ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Significant Prognostic Indicator

The genomic grade (GG) for breast cancer is thought to be the genomic counterpart of histopathological grade (HG). The motivation behind this study was to see whether HG retains its prognostic impact even when adjusted for GG, or whether it can be replaced by the latter. Four publicly available gene expression datasets were analyzed. Kaplan-Meier curves, log rank test, and Cox regression were used to study recurrence-free survival (RFS) and distant metastasis-free survival (DMFS). HG remained a significant prognostic indicator in low GG tumors (P = 0.003 for DMFS, P< 0.001 for RFS) but not in high GG tumors. HG grade 2 tumors differed significantly from HG grade 1 tumors, underlining the prognostic role of intermediate HG tumors. Additionally, GG could stratify HG 1 as well as HG 2 tumors into distinct prognostic groups. HG and GG add independent prognostic information to each other. However, the prognostic effects of both HG and GG are time varying, with the hazard ratios of high HG and GG tumors being markedly attenuated over time.

scholarly journals What People with Newly Diagnosed MS (and their Families and Friends) Need to Know

2000 ◽  
Vol 2 (3) ◽  
pp. 29-39 ◽  
Author(s):  
Judy Wollin ◽  
Helen Dale ◽  
Nancy Spenser ◽  
Anne Walsh
Keyword(s):  
Multiple Sclerosis ◽  
Small Sample Size ◽  
Cross Sectional Study ◽  
Small Sample ◽  
Newly Diagnosed ◽  
Cross Sectional ◽  
Wide Range ◽  
Study Participants ◽  
To Receive ◽  
Depth Interviews

Abstract The aim of this retrospective study was to determine from people with multiple sclerosis (MS) and their families what information would assist a person with newly diagnosed MS — in which format, when, and from whom it should be delivered. Thirty-four Queensland, Australia, residents with MS and 18 family members and friends participated in the main study. Participants were self-selected for this purposive, statewide, cross-sectional study. Nine of the respondents answered open-ended questions in addition to the standard questionnaires, and seven respondents gave in-depth interviews. The respondents recommended that people with a recent MS diagnosis and their families be given a wide range of information reflective of their personal needs. The information should be provided in person (in both group and individual sessions). They preferred to receive the information from their physicians and the staff of the Multiple Sclerosis Society. Research aimed at cures and therapies, as well as counseling and support services, should be discussed early in the course of the disease. Because of the small sample size and retrospective design, additional studies with larger populations are suggested to confirm these results and their cross-cultural applicability.

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