Costs and outcomes associated with febrile neutropenia-related hospitalizations across patients with varying cancer types: A retrospective analysis

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20560-e20560
Author(s):  
M. B. Schilling ◽  
C. Parks ◽  
R. G. Deeter
Keyword(s):  
Febrile Neutropenia ◽  
Healthcare Cost ◽  
Opportunistic Infections ◽  
Metastatic Breast ◽  
Clinical Impact ◽  
Cancer Type ◽  
Tumor Type ◽  
Healthcare Database ◽  
Hospitalization Costs ◽  
Cancer Types

e20560 Background: Neutropenia, the major dose-limiting toxicity of chemotherapy, is a frequent, often serious, and sometimes fatal complication of myelosuppressive chemotherapy. Its economic and clinical impact is often under-appreciated, and thus this study evaluates the contribution of febrile neutropenia (FN) by tumor type as related to healthcare cost and mortality. Methods: FN patients in this study were identified as having cancer (ICD-9-CM: 140.xx - 208.xx), neutropenia (288.0x) and either opportunistic infections (110 total codes) or fever of unknown origin (780.6) who were hospitalized between 1/05 and 6/08 in a retrospective cohort study from the Aspen US healthcare database (∼11 million pts, >342 inpatient facilities, and >300 million charge-detail records). Unadjusted mean healthcare cost of hospitalization, length of hospital stay (LOS), and mortality rates were calculated, stratifying by cancer type (breast, metastatic breast, and lung cancers, non-Hodgkin lymphoma (NHL), or other hematologic tumors). Results: Among 598 hospitalized patients (mean age 63 years; 53% female) with cancer experiencing FN, the mean cost of hospitalization, LOS and mortality varied significantly by tumor type ( Table ). Conclusions: FN hospitalizations are costly and may be associated with significant mortality. Considerable variations exist across cancer types for hospitalization costs, LOS and mortality. The tumor type is important in assessing the economic and clinical impact of FN hospitalizations. [Table: see text] [Table: see text]

NGS testing patterns in advanced non-small cell lung cancer (aNSCLC) and metastatic breast cancer (mBC): OneOncology (OO) sites compared to Flatiron Health Nationwide (NAT).

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 288-288
Author(s):  
Ari M. Vanderwalde ◽  
Esprit Ma ◽  
Elaine Yu ◽  
Tania Szado ◽  
Richard Price ◽  
...  
Keyword(s):  
Advanced Disease ◽  
Metastatic Breast ◽  
Precision Oncology ◽  
Cancer Type ◽  
Tumor Type ◽  
Future Studies ◽  
Testing Rate ◽  
Testing Patterns ◽  
Test Result ◽  
Over Time

288 Background: Personalized treatment (tx) decisions can be improved through diagnostic tests with NGS by detecting different actionable mutations. OO, a research-focused network of community practices, has a network-wide precision oncology initiative and has advocated for NGS testing in advanced cancers since 2019. This study evaluated NGS testing patterns in aNSCLC and mBC populations descriptively in OO community sites and Flatiron Health NAT. Methods: This study used the Flatiron Health EHR derived de-identified database from [1] four OO sites, and [2] NAT. Patients (pts) diagnosed (Dx) with aNSCLC (stage ≥ IIIb) or mBC from 1/1/2015 to 5/31/2020, aged ≥ 18 years, had ≥ 1 visit ≤ 90 days (d) of advanced or metastatic Dx, and had ≥ 1 biomarker test were included. NAT NGS was confirmed via abstraction from patient records. Descriptive analyses were conducted to assess NGS testing patterns and pts characteristics by tumor type. Results: Of biomarker tested pts at OO vs. NAT (community:academic: 90%:10% aNSCLC; 93%:7% mBC), 2,029 of 3,152 (64%) OO vs. 13,681 of 29,572 (46%) NAT in aNSCLC and 514 of 1,282 (40%) OO vs. 2,458 of 12,175 (20%) NAT in mBC received NGS ± other tests. Testing rate of all 5 aNSCLC biomarkers (ALK, BRAF, EGFR, ROS-1, and KRAS) was higher with NGS vs. other tests for OO (87% vs. 6%) and NAT (87% vs. 11%). In mBC, a higher testing rate of BRCA with NGS vs. other tests (OO: 68% vs. 26%, NAT: 71% vs. 28%) and similar testing rate on HER2 (OO: 98% vs. 98%, NAT: 100% vs. 99%). Median time from Dx to NGS test result at OO vs. NAT was 33 d vs. 32 d in aNSCLC and 70 d vs. 188 d in mBC. NGS testing rates increased over time, with higher rates at OO vs. NAT [Table]. Pts with NGS vs. other tests were slightly younger in aNSCLC (OO: 68 y vs. 70 y, p = 0.001; NAT: 69 y vs. 70 yr, p < 0.001) and mBC (OO: 61 y vs. 67 y, p < 0.001; NAT: 61 y vs. 66 y, p < 0.001), and slightly more commercially insured in aNSCLC (OO: 48% vs. 45%, p = 0.3; NAT: 37% vs. 33%, p < 0.001) and mBC (OO: 54% vs. 48% OO, p = 0.053; NAT: 42 % vs. 36 %, p < 0.001). Conclusions: The adoption of NGS differed by cancer type and NGS testing rates have increased over time in aNSCLC and mBC. While some pts may have received testing outside of the Flatiron network, OO had a higher NGS uptake than NAT, and had a shorter time to testing in mBC that was possibly related to a network wide strategy recommending testing at Dx of advanced disease. Future studies on tx pattern after NGS testing are warranted to improve the actionability of NGS to foster personalized tx. [Table: see text]

Macrophage Flipping from Foe to Friend: A Matter of Interest in Breast Carcinoma Heterogeneity Driving Drug Resistance

2019 ◽  
Vol 19 (3) ◽  
pp. 189-198 ◽  
Author(s):  
Ishita Tandon ◽  
Nilesh Kumar Sharma
Keyword(s):  
Drug Resistance ◽  
Breast Carcinoma ◽  
Tumor Heterogeneity ◽  
Cellular Heterogeneity ◽  
Cancer Type ◽  
Tumor Type ◽  
Cancer Types ◽  
Clinical Drugs ◽  
Molecular Aspects ◽  
Cancer Immunotherapeutic

Tumor heterogeneity within various cancer types including breast carcinoma is pivotal in the manifestations of tumor hallmarks. Tumor heterogeneity is seen as a common landscape where intra-tumoral components including cellular and non-cellular factors create an interface with outside environment that leads to the unique identity of a specific cancer type. Among various contributors to tumor heterogeneity, cellular heterogeneity immensely plays a role in drug resistance and relapse of cancer. Within cellular heterogeneity of tumor, tumor-associated macrophages (TAMs) are the pro-tumor type of immune cells that promote growth, metastasis and drug resistance in breast carcinoma and other cancer types. Revealing the molecular aspects of TAMs can provide a breakthrough to remove therapeutics blockade to existing drugs and this understanding in future will pave the way for a new class of cancer immunotherapeutic. This review addresses current understanding of the role of TAMs in breast carcinoma hallmarks and clarifies the current scenario of pre-clinical drugs directed to tame pro-cancer TAMs.

Comprehensive analysis of advanced-stage solid tumors from TCGA reveal widespread variation of genomics evidence levels across cancer types.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e13547-e13547
Author(s):  
Dilhan Weeraratne ◽  
Elisa Napolitano Ferreira ◽  
Miguel Mitne Neto ◽  
Hu Huang ◽  
David Brotman ◽  
...  
Keyword(s):  
Clinical Evidence ◽  
The Cancer Genome Atlas ◽  
Braf V600e ◽  
Precision Oncology ◽  
Cancer Type ◽  
Tumor Type ◽  
Advanced Stage ◽  
Level Of Evidence ◽  
Cancer Types ◽  
Level 1

e13547 Background: Improved scalability and affordability of next generation sequencing (NGS) has pivoted cancer care toward genomics-driven treatment decisions. Particularly in advanced-stage or refractory cancer, clinical insights gleaned from NGS have become an integral option as these patients have typically exhausted all lines of available therapy. As precision oncology evolves, NGS is expected to have a differential impact based on the cancer type. In this study, a comprehensive NGS panel was used to determine the strength of clinical evidence in various advanced stage tumor samples from The Cancer Genome Atlas (TCGA). Methods: A hybrid capture panel, Oncofoco, was developed to evaluate SNVs, INDELs, CNVs and TMB in 366 genes. The panel’s utility was validated by interrogating a broader cohort of 2847 TCGA samples (advanced tumors with T3 or T4; or N > = 1; or M > = 1). Watsonä for Genomics, an artificial intelligence offering, was used for variant interpretation and annotation of the 366 genes. A clinical evidence classification system that evaluated the strength of biomarker/drug response associations was used for annotation with level 1/R1 strongest and level 4 weakest from clinical literature, FDA drug labels and guidelines (PMID:28890946). Results: The highest level of evidence for the top nine frequently occurring advanced stage cancers in TCGA is shown in Table. Conclusions: Thyroid cancer and cutaneous melanoma have emerged as the cancer types with the most level 1 evidence (FDA approved drugs) owing to BRAF V600E mutations. Kidney and prostate cancers show no cases with level 1 evidence and also had the largest fraction of unactionable tumors. Over half of colorectal cancer cases had level R1 resistance evidence attributed to KRAS and NRAS mutations. The clinical utility of NGS in late-stage refractory cancer varies widely by tumor type. The presence of level 3 and level 4 evidence in all cancer types bodes well for the development of new targeted drugs. [Table: see text]

First Cycle Risk of Severe and Febrile Neutropenia in Cancer Patients Receiving Systemic Chemotherapy: Results from a Prospective Nationwide Study.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 2210-2210 ◽  
Author(s):  
Jeffrey Crawford ◽  
Debra A. Wolff ◽  
Eva Culakova ◽  
Marek S. Poniewierski ◽  
Caleb Selby ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Primary Outcome ◽  
Chemotherapy Regimen ◽  
Severe Neutropenia ◽  
Tumor Type ◽  
Risk Models ◽  
Total N ◽  
Nationwide Study ◽  
Cancer Types ◽  
Dose Limiting Toxicity

Abstract Introduction: Myelosuppression represents the major dose-limiting toxicity of cancer chemotherapy. This prospective, nationwide study was undertaken to better define risk of neutropenia and its complications and to develop risk models for selecting patients for appropriate supportive care. Methods: More than 3,500 patients initiating a new chemotherapy regimen have been prospectively registered at 137 randomly selected practice sites. Major disease sites include breast, lung, colorectal, ovary and lymphoma. Primary outcomes include severe neutropenia (SN; absolute neutrophil count nadir <500) and febrile neutropenia (FN) (fever/infection and nadir <1000) by cycle of treatment and overall. Results: This analysis is based on the first 2,361 patients treated to date including 924 (39%) age ≥65. Severe neutropenia was documented in 28% and FN in 16% across all cancer categories. The proportion of patients with ANC <500 over the first four cycles of treatment include: colorectal (8%); lung (18%); ovary (23%); lymphoma (27%) and breast (37%). Likewise, the proportion of patients with FN during the first four cycles include: colorectal (7%); lung (11%); ovary (13%); lymphoma (18%) and breast (20%). As shown in the table, approximately half of the initial episodes of ANC <500 and FN over four cycles of treatment occurred in cycle 1. Neutropenic Events By Cycle (% Patients) Primary Outcome Cycle 1 (N=2361) Cycle 2 (N=2032) Cycle 3 (N=1724) Cycle 4 (N=1246) Total (N=2361) Any SN 16 11 10 11 48 1st Cycle SN 16 6 4 2 28 Any FN 8 6 5 1 20 1st Cycle FN 8 4 3 1 16 The proportion of initial episodes of severe neutropenia that occur in cycle 1 include: colorectal (67%); lung (59%); ovary (44%); lymphoma (62%) and breast (70%). Likewise, the proportion of initial episodes of FN occurring in cycle 1 include: colorectal (53%); lung (60%); ovary (57%); lymphoma (56%) and breast (58%). Conclusions: Rates of severe and febrile neutropenia vary with tumor type. The initial episode of severe or febrile neutropenia is most likely to occur during the first cycle of chemotherapy across all major cancer types.

scholarly journals RADT-21. NATIONAL PRACTICE PATTERNS AND OUTCOMES OF STEREOTACTIC BODY RADIOTHERAPY VS. CONVENTIONAL EXTERNAL BEAM RADIOTHERAPY FOR SPINAL METASTASES

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii186-ii186
Author(s):  
Asad Lak ◽  
Nayan Lamba ◽  
Timothy Smith ◽  
Bryan Iorgulescu
Keyword(s):  
Stereotactic Body Radiotherapy ◽  
Practice Patterns ◽  
External Beam Radiotherapy ◽  
Spinal Metastases ◽  
Cancer Type ◽  
External Beam ◽  
Tumor Type ◽  
Single Fraction ◽  
Cancer Types ◽  
National Practice

Abstract INTRODUCTION Up to 10% of cancer patients experience spinal cord compression from metastatic disease. Palliation and local control were traditionally pursued with conventional external beam radiotherapy (cEBRT), but advancements in image-guidance and intensity-modulation for stereotactic body radiotherapy (SBRT) have dramatically changed the management of these lesions. Herein we evaluate the national practice patterns and outcomes associated with cEBRT vs. SBRT. METHODS U.S. patients newly diagnosed with metastatic cancer necessitating RT to the spine were identified from the National Cancer Database (2004-2016), stratified by RT modality and cancer type, and evaluated using multivariable logistic regression and Cox proportional hazards. RESULTS 34,759 U.S. patients required spinal RT within 3 months of initial stage 4 cancer presentation, primarily for lung adenocarcinoma (25%), lung small cell carcinoma (14%), and prostatic (12%) metastases. Patients overwhelming received cEBRT (30Gy/10; 50%), followed by hypo-fractionated SBRT (15-30Gy/2-6; 11%) and single-fraction SBRT (i.e. stereotactic radiosurgery, SRS; 15-24Gy/1; 0.9%); whereas 38% received another regimen (e.g. 30-37.5Gy/12-15 or 40Gy/20). From 2004→2016, the rates of single-fraction SRS (0.4→1.9%) and hypo-fractionated SBRT (13.1→23.6%) increased, whereas cEBRT (86.5→74.4%) decreased. SBRT was significantly more likely to be utilized at academic hospitals as compared to cEBRT (OR 0.57; 95% CI: 0.49-0.66; p&lt; 0.01). SBRT was more likely utilized for elderly or high comorbidity patients and varied across cancer types. Survival analysis indicated that across all cancer types, single-fraction SRS, was independently associated with improved overall survival compared to cEBRT (HR 1.51; 95%CI: 1.31-1.74; p&lt; 0.01) after adjusting for patient characteristics, care setting, tumor type and systemic treatment. CONCLUSIONS Through analysis of cancer registry data, we found that practice patterns of RT for spinal metastases have been evolving nationally, with an increase in the use of SBRT. Single-fraction SBRT was associated with improved adjusted OS. Notably, we found that utilization of SBRT lags in the community setting.

scholarly journals A Pan-Cancer Study of KMT2 Family as Therapeutic Targets in Cancer

2022 ◽  
Vol 2022 ◽  
pp. 1-10
Author(s):  
Jiamin Zhu ◽  
Zhili Liu ◽  
Xiao Liang ◽  
Lu Wang ◽  
Dan Wu ◽  
...  
Keyword(s):  
Overall Survival ◽  
Tumor Microenvironment ◽  
Patient Survival ◽  
Expression Patterns ◽  
Family Members ◽  
Cancer Type ◽  
Tumor Type ◽  
Histone Lysine ◽  
Cancer Types ◽  
Pan Cancer

Objective. Exome sequencing studies have shown that the histone-lysine N-methyltransferase 2 (KMT2) gene is one of the most commonly mutated genes in a range of human malignancies and is linked to some of the most common and deadly solid tumors. However, the connection between this gene family’s function and tumor type, immunological subtype, and molecular subtype dependency is still unknown. Methods. We examine the expression patterns of the histone-lysine N-methyltransferase 2 (KMT2) gene, as well as their relationship to patient survival. We also used a pan-cancer analysis to link their function to immunological subtypes, the tumor microenvironment, and treatment sensitivity. Results. Using the TCGA pan-cancer data, researchers looked at and examined KMT2 expression patterns and their links to patient survival and the tumor microenvironment in 33 cancer types. The expression of the KMT2 family changes significantly across and within cancer types, indicating significant inter- and intracancer heterogeneity. Patients’ overall survival was often linked to the expression of KMT2 family members. However, the direction of the link differed depending on the KMT2 isoform and cancer type studied. Notably, in all cancer types examined, nearly all KMT2 family members were substantially linked with overall survival in patients with renal clear cell carcinoma (KIRC). Furthermore, all KMT2 genes have a strong relationship with immune infiltrate subtypes, as well as varying degrees of stromal cell infiltration and tumor cell stemness. Finally, we discovered that higher expression of KMT2s, particularly KMT2F and KMT2G, was linked to greater chemotherapeutic sensitivity in several cell lines. Conclusions. The necessity to investigate each KMT2 member as a distinct entity inside each particular cancer type is highlighted by our comprehensive investigation of KMT2 gene expression and its relationship with immune infiltrates, tumor microenvironment, and cancer patient outcomes. Our research also confirmed the identification of KMT2 as a potential therapeutic target in cancer, but further laboratory testing is required.

Treatment and outcomes for patients (pts) with selected advanced/metastatic cancers by place of care.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e20717-e20717
Author(s):  
Yihua Xu ◽  
Lisa M. Hess ◽  
Cliff Molife ◽  
Gebra Cuyun Carter ◽  
Yajun Emily Zhu ◽  
...  
Keyword(s):  
Treatment Duration ◽  
Metastatic Breast ◽  
Cancer Type ◽  
Policy Makers ◽  
Community Oncology ◽  
Significant Difference ◽  
Advanced Stages ◽  
Cancer Types ◽  
Baseline Characteristics ◽  
Care Outcome

e20717 Background: Place of care may be an important factor affecting treatment & economic outcomes for pts in advanced stages of cancer. This retrospective observational study compared treatment patterns, healthcare resource use & costs, and overall survival (OS) for pts treated for selected cancers in the hospital outpatient department (HO) vs community oncology practices (CP) including physician offices & freestanding ambulatory centers. Methods: Claims data from a large national health plan were used to identify adult pts with newly diagnosed advanced/metastatic non small cell lung cancer (aNSCLC), metastatic breast (mBC) or metastatic colorectal cancer (mCRC) between 07/2012 & 12/2016, who initiated anticancer therapy in HO or CP settings. Pts enrolled in Medicare Advantage Prescription Drug (MAPD) or commercial plans for ≥ 6 months prior & ≥ 30 days after start of first line (1L) (index date) were included. OS was evaluated among pts enrolled in MAPD and costs were evaluated among pts enrolled ≥ 6 months pre- & post-index, by cancer type & by place of care. Outcome analyses were adjusted using multivariable models. Results: Among 8,333 eligible pts, there were 4,618, 2,304 & 1,411 pts with aNSCLC, mCRC & mBC, respectively and each cohort was evenly split by place of care. No notable differences in baseline characteristics or the most commonly used 1L, 2L or 3L regimens were observed by place of care for the 3 cancers. For aNSCLC pts, mean 1L treatment duration was shorter (96 v 102 days, P = 0.02) and time between 1L & 2L was longer (125 v 106 days, P = 0.04) in the HO than the CP setting, respectively. For mBC, mean 1L treatment duration was longer in the HO setting (156 v 190 days, P < 0.01). Adjusted total all cause healthcare costs were higher in HO than CP for mBC ( P < 0.01) & mCRC ( P < 0.01), but no significant difference in median OS was observed between HO & CP settings for the 3 cancer types. Conclusions: This study showed no major differences between HO & CP settings in baseline characteristics, the first 3 lines of therapy, or adjusted median OS for aNSCLC, mCRC, or mBC cohorts. However, total costs were higher in the HO setting for mCRC & mBC pts. These findings may be useful for healthcare decision & policy makers but warrant further evaluation.

scholarly journals Cancer Vaccines: Promising Therapeutics or an Unattainable Dream

Vaccines ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 668
Author(s):  
Howard Donninger ◽  
Chi Li ◽  
John W. Eaton ◽  
Kavitha Yaddanapudi
Keyword(s):  
Stem Cell ◽  
Immune System ◽  
Tumor Immunity ◽  
Cancer Vaccines ◽  
Tumor Antigens ◽  
Host Immune System ◽  
Tumor Type ◽  
Therapeutic Vaccines ◽  
Cancer Types ◽  
Prophylactic Vaccines

The advent of cancer immunotherapy has revolutionized the field of cancer treatment and offers cancer patients new hope. Although this therapy has proved highly successful for some patients, its efficacy is not all encompassing and several cancer types do not respond. Cancer vaccines offer an alternate approach to promote anti-tumor immunity that differ in their mode of action from antibody-based therapies. Cancer vaccines serve to balance the equilibrium of the crosstalk between the tumor cells and the host immune system. Recent advances in understanding the nature of tumor-mediated tolerogenicity and antigen presentation has aided in the identification of tumor antigens that have the potential to enhance anti-tumor immunity. Cancer vaccines can either be prophylactic (preventative) or therapeutic (curative). An exciting option for therapeutic vaccines is the emergence of personalized vaccines, which are tailor-made and specific for tumor type and individual patient. This review summarizes the current standing of the most promising vaccine strategies with respect to their development and clinical efficacy. We also discuss prospects for future development of stem cell-based prophylactic vaccines.

scholarly journals Proportion of children with cancer that have an indication for genetic counseling and testing based on the cancer type irrespective of other features

2021 ◽  
Author(s):  
Thi Minh Kha Nguyen ◽  
Astrid Behnert ◽  
Torsten Pietsch ◽  
Christian Vokuhl ◽  
Christian Peter Kratz
Keyword(s):  
Childhood Cancer ◽  
Rhabdoid Tumor ◽  
Juvenile Myelomonocytic Leukemia ◽  
Cancer Type ◽  
Nerve Sheath Tumor ◽  
Children With Cancer ◽  
Pediatric Pathology ◽  
Cancer Trial ◽  
Cancer Predisposition Syndrome ◽  
Cancer Types

Abstract In children with cancer, specific clinical features such as physical anomalies, occurrence of cancer in young relatives, specific cancer histologies, and unique mutation/methylation signatures may indicate the presence of an underlying cancer predisposition syndrome (CPS). The proportion of children with a cancer type suggesting a CPS among all children with cancer is unknown. To determine the proportion of children with cancer types suggesting an underlying CPS among children with cancer. We evaluated the number of children with cancer types strongly associated with CPS diagnosed in Germany between 2007 and 2016. Data were obtained from various sources including two national pediatric pathology reference laboratories for brain and solid tumors, respectively, various childhood cancer trial offices as well as the German Childhood Cancer Registry. Among 21,127 children diagnosed with cancer between 2007 and 2016, 2554 (12.1%) had a cancer type strongly associated with a CPS. The most common diagnoses were myelodysplastic syndrome and juvenile myelomonocytic leukemia, retinoblastoma, malignant peripheral nerve sheath tumor, infantile myofibromatosis, medulloblastomaSHH, rhabdoid tumor as well as atypical teratoid/rhabdoid tumor. Based on cancer type only, 12.1% of all children with cancer have an indication for a genetic evaluation. Pediatric oncology patients require access to genetic counselling and testing.

scholarly journals Estimating the predictive power of silent mutations on cancer classification and prognosis

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Tal Gutman ◽  
Guy Goren ◽  
Omri Efroni ◽  
Tamir Tuller
Keyword(s):  
Gene Expression ◽  
Predictive Power ◽  
Predictive Ability ◽  
Cancer Classification ◽  
Silent Mutation ◽  
Cancer Type ◽  
Coding Region ◽  
Probability Of Survival ◽  
Diagnosis And Prognosis ◽  
Cancer Types

AbstractIn recent years it has been shown that silent mutations, in and out of the coding region, can affect gene expression and may be related to tumorigenesis and cancer cell fitness. However, the predictive ability of these mutations for cancer type diagnosis and prognosis has not been evaluated yet. In the current study, based on the analysis of 9,915 cancer genomes and approximately three million mutations, we provide a comprehensive quantitative evaluation of the predictive power of various types of silent and non-silent mutations over cancer classification and prognosis. The results indicate that silent-mutation models outperform the equivalent null models in classifying all examined cancer types and in estimating the probability of survival 10 years after the initial diagnosis. Additionally, combining both non-silent and silent mutations achieved the best classification results for 68% of the cancer types and the best survival estimation results for up to nine years after the diagnosis. Thus, silent mutations hold considerable predictive power over both cancer classification and prognosis, most likely due to their effect on gene expression. It is highly advised that silent mutations are integrated in cancer research in order to unravel the full genomic landscape of cancer and its ramifications on cancer fitness.

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