Epidemiological trends in metastatic renal cell carcinoma in the era of targeted therapies: An analysis of the SEER registry.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 516-516
Author(s):  
Arpit Rao ◽  
Charles Wiggins ◽  
Richard C. Lauer
Keyword(s):  
Kinase Inhibitors ◽  
Age Groups ◽  
Rank Test ◽  
Kaplan Meier ◽  
Time Period ◽  
Long Term Impact ◽  
Epidemiological Trends ◽  
Improvement In Survival ◽  
The Impact ◽  
Cause Specific Survival

516 Background: Clear cell RCC (ccRCC) accounts for 70-75% of all kidney and renal pelvis cancers with approximately 16% of patients presenting with distant (metastatic) disease. Five year overall survival (OS) remains dismal at 11.2% for patients with distant disease. Several tyrosine kinase inhibitors (TKI) were approved by US Food and Drug Administration for use in metastatic RCC between 2005 and 2012. While these therapies have been shown to improve outcomes in metastatic ccRCC, the long term impact remains unknown. Methods: The Surveillance, Epidemiology and End-Results (SEER) database was queried for patients aged 18 years and older diagnosed with distant stage (metastatic) ccRCC between 2001 and 2012 in the nine core SEER registries. Analyses were restricted to histologically confirmed cases. Study period was divided into 3-year intervals: 2001-03 (pre-TKI era); 2004-06 (TKI trials era); 2007-09 (early TKI era); and 2010-12 (sequential TKI era). Patients were stratified by age at diagnosis: 18-60 years, 60-69 years, and 70+ years. One, two, and three year, and median cause-specific survival were calculated by Kaplan-Meier method. Differences in cause-specific survival by time period were assessed with the Log-Rank test. Results: A total of 3,747 eligible patients were included in the analysis. For all ages combined, cause-specific survival at three years post-diagnosis was 18.8% for those diagnosed during the period 2001-03 (median 8 months), 22.7% in 2004-06 (median 10 months), 23.2% in 2007-09 (median 9 months), and 28.9% in 2010-12 (median 11.0 months) (p= 0.0004). No statistically significant improvement in survival was observed in patients aged 70 years and above (p= 0.1302). Conclusions: Our analysis quantifies the improvement in survival outcomes in metastatic ccRCC that correlate with TKI use in this setting. While there is evidence that all age groups may have benefitted from these therapies, the impact is least pronounced in patients aged 70 years and above. A SEER-Medicare analysis is planned to evaluate disparities in TKI use in this age group.

The Efficacy of Etoposide-Based Therapy in Adult Secondary Hemophagocytic Lymphohistiocytosis

2021 ◽  
pp. 1-9
Author(s):  
Leonard Naymagon ◽  
Douglas Tremblay ◽  
John Mascarenhas
Keyword(s):  
Hemophagocytic Lymphohistiocytosis ◽  
Proportional Hazards ◽  
Multivariable Analysis ◽  
Cox Proportional Hazards ◽  
Rank Test ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Significant Difference ◽  
The Impact

Data supporting the use of etoposide-based therapy in hemophagocytic lymphohistiocytosis (HLH) arise largely from pediatric studies. There is a lack of comparable data among adult patients with secondary HLH. We conducted a retrospective study to assess the impact of etoposide-based therapy on outcomes in adult secondary HLH. The primary outcome was overall survival. The log-rank test was used to compare Kaplan-Meier distributions of time-to-event outcomes. Multivariable Cox proportional hazards modeling was used to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs). Ninety adults with secondary HLH seen between January 1, 2009, and January 6, 2020, were included. Forty-two patients (47%) received etoposide-based therapy, while 48 (53%) received treatment only for their inciting proinflammatory condition. Thirty-three patients in the etoposide group (72%) and 32 in the no-etoposide group (67%) died during follow-up. Median survival in the etoposide and no-etoposide groups was 1.04 and 1.39 months, respectively. There was no significant difference in survival between the etoposide and no-etoposide groups (log-rank <i>p</i> = 0.4146). On multivariable analysis, there was no association between treatment with etoposide and survival (HR for death with etoposide = 1.067, 95% CI: 0.633–1.799, <i>p</i> = 0.8084). Use of etoposide-based therapy was not associated with improvement in outcomes in this large cohort of adult secondary HLH patients.

scholarly journals The Effects of Mood, Language, and Order of Songs on Writing Productivity

2021 ◽  
Vol 13 (1) ◽  
pp. 12
Author(s):  
Ke Nicole Hu
Keyword(s):  
Age Groups ◽  
Cognitive Tasks ◽  
Modern Life ◽  
Academic Literature ◽  
Test Taking ◽  
Popular Songs ◽  
Induced Mood ◽  
Time Period ◽  
The Impact ◽  
Sad Music

With music consumption being increasingly prominent in everyday modern life, it has become critical to examine the impact of music on the performance of cognitive tasks. Despite preexisting academic literature on the correlation between music and memorization, test-taking ability, and executive planning, conclusions from past studies regarding these cognitive tasks may not be directly applicable to writing, leaving the effects of music on writing tasks a relatively unexplored territory. Given the prevalence of music in the 21st century among all age groups, the current study explores the effects of induced mood (happy versus sad) and language (native versus foreign) of popular songs on writing productivity, measured by number of words written in a set time period. Participants in the experiment were randomly separated into four conditions based on the language and mood of songs, and each given two argumentative writing prompts to complete while listening to the songs assigned to them. Results revealed that the induced mood of the songs significantly affected the writing productivity, with participants listening to sad music producing word counts that are significantly higher than those given happy songs. No effects, however, were found for the language of the music&rsquo;s lyrical content, suggesting that the language of a song has no significant impact on writing productivity.

Improvement in survival in younger patients with acute lymphoblastic leukemia from the 1980s to the early 21st century

Blood ◽  
2009 ◽  
Vol 113 (7) ◽  
pp. 1408-1411 ◽  
Author(s):  
Dianne Pulte ◽  
Adam Gondos ◽  
Hermann Brenner
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Age Groups ◽  
Relative Survival ◽  
The United States ◽  
Period Analysis ◽  
Early 21St Century ◽  
Time Period ◽  
Improvement In Survival ◽  
Difficult Issue

Abstract Acute lymphoblastic leukemia (ALL) is an uncommon but highly fatal disease in adults. We used period analysis to data from the Surveillance, Epidemiology, and End Results (SEER) database to disclose changes in outcomes for patients diagnosed with ALL in the United States in the 2 decades between 1980–1984 and 2000–2004. Major improvement in survival was observed for patients less than 60 years of age. Improvement in survival was greater for women than for men, but was significant for both genders. The greatest improvement was seen in patients aged 15 to 19, in whom 5-year relative survival improved from 41.0% to 61.1%, and 10-year survival improved from 33.0% to 60.4%. Lesser but significant improvements were seen for age groups 20–29, 30–44, and 45–59. Survival for patients aged 60 and over remained essentially unchanged at levels around or below 10%, respectively. Survival has improved for patients with ALL over the time period studied, but treatment of older patients remains a difficult issue.

Comparative study of six cycles versus twelve cycles of adjuvant temozolomide post concurrent chemoradiation in newly diagnosed glioblastoma.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e13034-e13034
Author(s):  
Menal Bhandari ◽  
Ajeet K Gandhi ◽  
Pramod Kumar Julka ◽  
Chitra Sarkar ◽  
Dayanand Sharma ◽  
...  
Keyword(s):  
Univariate Analysis ◽  
Progression Free Survival ◽  
Extent Of Resection ◽  
Rank Test ◽  
Karnofsky Performance Score ◽  
Free Survival ◽  
Kaplan Meier ◽  
The Impact ◽  
Mib 1

e13034 Background: This study assesses the impact of 6 cycles of adjuvant TMZ (conventional arm) versus 12 cycles (Extended arm) on Progression free survival (PFS), evaluate the toxicity and correlate the outcome with EGFR, P53 and MIB I labelling Index. Methods: Between December 2010 to October 2012, 36 post operative patients of Glioblastoma between age 18-65 years and Karnofsky Performance Score (KPS) ≥ 70 were included. Patients were randomized to receive Radiation with a dose of 60 Gray in 30 fractions over 6 weeks at 2 gray/fraction with concomitant TMZ (75 mg/m2/day) and Adjuvant therapy with either 6 or 12 cycles of TMZ(150 mg/m2 for 5 days, 28 days cycle). Patients were then assessed monthly clinically and imaged with MRI/CT every 3 monthly or when symptomatic. Toxicity was assessed using CTCAE version 3.0. Statistical Analysis was done using SPSS version 17.0.Kaplan Meier method was used for analysis of survival and log rank test was used for assessing the impact of variables on survival. Results: Of 36 patients, 18 patients were treated in each arm. Median age and KPS in both the arms was 47 years and 80 respectively. 44 % patients in the conventional arm and 50% patients in the Extended arm underwent complete surgical resection. 22% patients in the conventional arm and 28% in the extended arm did not complete their intended treatment. Grade ¾ Thrombocytopenia was seen in 16% in the extended arm and 0% in the conventional arm.EGFR, P 53 and MIB 1 >20% was seen in 26%, 45% and 20% patients respectively, overall. Median follow up was 18 months for both the arms (Range 10-23 months).At last follow up,8 patients in each arm had progression. Median PFS was 10 months vs.18.4 months (p 0.47) in conventional and extended arm respectively. On Univariate analysis, patients with KPS ≤ 80 had poorer survival than those >80 (Median PFS 9.5 Months vs. 16.9 Months; p 0.02).Age, extent of resection, EGFR, P53, MIB 1 did not significantly alter survival in the two treatment groups. Conclusions: Our study showed that schedule of extended Temozolomide is well tolerated by patients and tend to have better progression free survival. Further prospective randomized studies are needed to validate the findings of our study.

Sorafenib in hepatocellular carcinoma (HCC): Is there a role for starting patients on a total daily dose of 400mg daily?

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 364-364
Author(s):  
Olugbenga Olanrele Olowokure ◽  
Brian Singeltary ◽  
Abhimanyu Ghose, ◽  
Michelle Lynn Mierzwa ◽  
Tahir Latif ◽  
...  
Keyword(s):  
Asia Pacific ◽  
Locoregional Therapy ◽  
Total Daily Dose ◽  
Rank Test ◽  
Loss To Follow Up ◽  
Kaplan Meier ◽  
Daily Dose ◽  
Ecog Ps ◽  
The Impact

364 Background: S at a starting daily dose of 400mg twice daily (800mg) is considered the standard systemic therapy for HCC, in pts with well preserved liver function and advanced stage HCC, based largely on data reported by the SHARP and Asia-pacific trials. Due to complaints regarding SE and reluctance to start at full dose, we decide to retrospectively look at our HCC data base. This single institution retrospective review, evaluated the impact of starting S at a 400mg daily (200mg twice daily). Methods: From 06/01/09-09/01/13, using ICD code 155, newly registered advanced HCC pts, ECOG PS 2, Childs Pugh (CP) class A or B who were started on S 400mg daily were identified : CT scans and AFP levels were followed. PFS was estimated from the date of commencing therapy to date of progression or death if this occurred first and OS was estimated from date of commencing therapy until date of death or loss to follow up. Kaplan Meier survival estimates were obtained with 95% (CI). Log rank test was used to compare the PFS according to CP class. Results: 33 pts (M:F, 21:12), mean age of 59.8y (SD: 12.40) met inclusion criteria, the median duration (MD) of follow up was 8.7 m ( 1.07-27.43). 23(69.7%) pts were CP-A. 70% had abnormal AFP and this decreased > 50% from baseline in 8 (35%). 96% of the pts received prior locoregional therapy in CP-A and 50% in CP-B. Initial dose tolerance was observed in 23 (69.7%) pts. 16 pts (48.5%) needed dose reduction (CP-A: 56.5%, CP-B: 30%) while 19 (57.6%) pts were able to escalate their dose at some point (CP-A: 60.9%, CP-B: 50%). MD of (400mg/d) was 3m prior to any adjustment (CP-A: 3, CP-B: 2). Mean duration of S use was 8.88m (A-10.04, B-6.2). During follow up, 26 pts had POD and 24 pts died. There was no difference in PFS between CP-A and B and following POD 10/19 evaluable pts continued S. OS was 79 % (95%CI: 61-89%) at 3m, 67% (95%CI: 48-80%) at 6m, 50% (95%CI: 32-66%) at 9m, and 40% (95%CI: 23-57%) at 12m. The most common reported toxicities were fatigue 87.5%, diarrhea 53.1% and HFS/rash 43.8% Conclusions: In this cohort of pts S started at 400mg/d did not seem to result in worse outcomes compared to historic controls possibly due to the ability to tolerate therapy for a longer period of time.

Can sidedness predict for survival in primary locoregional colon cancers?

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 584-584
Author(s):  
Weining Wang ◽  
Chin Jin Seo ◽  
Grace Hwei Ching Tan ◽  
Claramae Shulyn Chia ◽  
Khee Chee Soo ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Multivariate Analysis ◽  
Proportional Hazards ◽  
Cox Regression ◽  
Rank Test ◽  
Rectosigmoid Junction ◽  
Colon Cancers ◽  
Kaplan Meier ◽  
Significant Difference ◽  
The Impact

584 Background: Right and left-sided colon cancers are embryonically distinct and present differently. Recently, there has been growing belief that sidedness could be independently associated with survival outcomes. This has important clinical implications regarding the prognostication, management and surveillance of colon cancer patients. Hence, we aim to investigate the impact of sidedness on survival in our patient population in this study. Methods: Patients who had primary treatment naïve colon cancer who underwent curative surgical resection in our institution from September 2002 to December 2010 were included in this study. Demographic and clinicopathological data was collected from electronic records and clinical charts. Tumours arising from the cecum, ascending colon, hepatic flexure and transverse colon were considered right-sided, while those arising from splenic flexure and descending colon were considered left-sided. Cancers of the rectosigmoid junction and rectum were excluded. Kaplan-Meier curves and log-rank test were used to compare overall, locoregional recurrence-free and distant recurrence-free survivals (OS, LRFS, DRFS respectively) between both groups. Multivariate analysis was performed using Cox regression proportional hazards. Results: 389 patients were included in this study. 238 had left-sided tumours while the remaining 151 had right-sided tumours. In our cohort, right-sided tumours were associated with older age and mucinous histology. Kaplan-Meier curves plotted showed improved LRFS in left-sided tumours (p = 0.04, median survival not reached) but no significant difference in OS and DRFS. On multivariate analysis, sidedness was also found to be an independent prognostic factor for LRFS but not OS and DRFS despite factoring in age, size of tumour, pT, pN and histology. Conclusions: Our study suggests that left-sided tumours in primary colon cancer are independently prognostic for improved locoregional survival as compared to the right-sided tumours, even after taking into account other known factors such as age, staging and histology.

A process mining approach to real-world advanced melanoma treatments.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e22040-e22040
Author(s):  
Camille Lea Gerard ◽  
Erica Tavazzi ◽  
Roberto Gatta ◽  
Julie Delyon ◽  
Michel A Cuendet ◽  
...  
Keyword(s):  
Real World ◽  
Kinase Inhibitors ◽  
Process Mining ◽  
Advanced Melanoma ◽  
Rank Test ◽  
Personalized Care ◽  
Clinical Events ◽  
Kaplan Meier ◽  
Medical Guidelines ◽  
Treatment Sequences

e22040 Background: Process Mining (PM) is an emerging discipline with promising potential in oncology, which offers a time-oriented perspective on the clinical events that define the patient’s (pts) path of care, from diagnosis to follow-up. PM enables us to 1) build unsupervised models that automatically discover frequent patterns and detect unexpected behaviors, and 2) show the pts flow through predefined models, allowing quantitative assessments of conformance/divergence between reality and expected behaviors or medical guidelines. Methods: We explored the potential of PM to analyze treatments in a real-world melanoma cohort of 212 advanced melanoma pts treated with tyrosine kinase inhibitors (TKI), chemotherapy, or immunotherapy (IO) since 2010. 44% of pts are BRAF mutated, 24% NRAS mutated, and 16% WT. Using PM, we characterize the sequences of treatment according to type of drugs, order and timing of consecutive lines. We use kernel density estimations, Fisher or Wilcoxon tests to assess differences between groups. As main endpoint we assess the overall survival (OS) with respect to specific patterns of care followed by the pts using Kaplan-Meier analysis with log-rank test. Results: This approach provides important self-consistency checks for data and reveals the most frequent treatment sequences, and the associated outcome. The 324 administered treatments, characterized in terms of type and occurrence, are: TKI (23%), antiCTLA4 + antiPD1 (22%), antiPD1 (21%), and antiCTLA4 (20%). The overall 3-year OS is 56.9% (95% CI: 49.2 – 65.8). We identified 50 distinct patterns, which can be further aggregated into relevant cohorts to provide real-world answers to medical questions. Among others, we probed the influence of treatment order: IO single (any BRAF status), IO → TKI, TKI → IO (see table). Preliminary results suggest that pts treated with TKI → IO had shorter OS despite balance prognostic factors to IO → TKI group. IO → TKI provides short-term benefits with 1.5-year OS similar to IO alone, but degraded 3-year OS. Conclusions: The PM approach enables fast and efficient visual inspection of the data, emphasizing treatment sequences over time and allowing stratification at different levels. More population attributes and outcomes will be included to further characterize treatment sequences and provide real-world insights into future personalized care options. [Table: see text]

SURVIVAL TRENDS IN CHILDHOOD HEMATOLOGICAL MALIGNANCIES

2012 ◽  
Vol 05 (06) ◽  
pp. 1250053
Author(s):  
STEPHANIE RICH ◽  
SHIHAB ALI ◽  
GEOFFREY W. CALKINS ◽  
JAMES S. MICHAELSON
Keyword(s):  
Hodgkin’S Lymphoma ◽  
Hematological Malignancies ◽  
Lymphoblastic Leukemia ◽  
Hodgkin's Lymphoma ◽  
Medical Progress ◽  
Risk Of Death ◽  
The Past ◽  
Kaplan Meier ◽  
Time Period ◽  
Cause Specific Survival

Survival of patients with childhood hematological malignancies has increased markedly in the past decades. To examine the fine-scale details of how this progress has occurred, we carried out Kaplan–Meier cause-specific survival analysis using the Surveillance Epidemiology and End Results (SEER) dataset for patients with childhood hematological malignancies — Hodgkin's Lymphoma, Non-Hodgkin's Lymphoma, Lymphoblastic Leukemia and Myeloid Leukemia — diagnosed in five eras: 1983–1987; 1988–1992; 1993–1997; 1998–2002 and 2003–2007. We generated Kaplan–Meier estimates of survival for each of the first 24 years after diagnosis. These figures agree with previously reported five- and ten-year values and attest to the remarkable increase in survival that has occurred over the past three decades of medical progress. The trend towards progressively increasing survival shows no sign of slowing, suggesting that we may expect further increases in survival in the years ahead. Most of the increase in survival for childhood hematological malignancies has occurred by reducing the risk of death in the first two years after diagnosis. This may be largely explained by the fact that this is the time period when patients are at highest risk of death.

Impact of target location on the response of trigeminal neuralgia to stereotactic radiosurgery

2014 ◽  
Vol 120 (3) ◽  
pp. 716-724 ◽  
Author(s):  
Zhiyuan Xu ◽  
David Schlesinger ◽  
Krisztina Moldovan ◽  
Colin Przybylowski ◽  
Xingwen Sun ◽  
...  
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Stereotactic Radiosurgery ◽  
Target Location ◽  
Rank Test ◽  
Root Entry Zone ◽  
Kaplan Meier ◽  
Increased Risk ◽  
Facial Numbness ◽  
The Impact

Object The authors evaluate the impact of target location on the rate of pain relief (PR) in patients with intractable trigeminal neuralgia (TN) undergoing stereotactic radiosurgery (SRS). Methods The authors conducted a retrospective review of 99 patients with idiopathic TN who were identified from a prospectively maintained database and were treated with SRS targeting the dorsal root entry zone with a maximum dose of 80 Gy. Targeting of the more proximal portion of a trigeminal nerve with the 50% isodose line overlapping the brainstem was performed in 36 patients (proximal group). In a matched group, 63 patients received SRS targeting the 20% isodose line tangential to the emergence of the brainstem (distal group). The median follow-up time was 33 months (range 6–124 months). Results The actuarial rate of maintenance of Barrow Neurological Institute (BNI) Pain Score I–IIIa was attained in 89% of patients at 1 year, 81% at 2 years, and 69% at 4 years, respectively, after SRS. Kaplan-Meier analysis revealed that durability of PR was only associated with the proximal location of the radiosurgical target (log-rank test, p = 0.018). Radiosurgery-induced facial numbness (BNI Score II or III) developed in 35 patients, which was significantly more frequent in the proximal group (19 patients [53%] compared with 16 [25%] in the distal group [p = 0.015]). Conclusions The radiosurgical target appears to affect the duration of pain relief in patients with idiopathic trigeminal neuralgia with the target closer to the brainstem affording extended pain relief. However, the proximal SRS target was also associated with an increased risk of mild to moderate facial numbness.

scholarly journals BOND FAILURE RATE OF AMORPHOUS CALCIUM PHOSPHATE CONTAINING (AEGIS ORTHO) AND FLUORIDE RELEASING (TRANSBOND PLUS COLOUR CHANGE) ORTHODONTIC ADHESIVES-A RANDOMIZED CLINICAL TRIAL

2019 ◽  
Author(s):  
Shyamala Naidu ◽  
Anand Suresh
Keyword(s):  
Calcium Phosphate ◽  
Failure Rate ◽  
Amorphous Calcium Phosphate ◽  
Age Groups ◽  
Colour Change ◽  
White Spot ◽  
Rank Test ◽  
White Spot Lesions ◽  
Bond Failure ◽  
Kaplan Meier

Background: The aim of the study was to compare the survival rate of brackets bonded with amorphous calcium phosphate containing adhesive and fluoride releasing orthodontic adhesive over 6 months period. White spot lesions were also evaluated prior to bonding, 3 months and 6 months from the date of bonding. Methods: Thirty six orthodontic patients were randomly divided into two equal groups using split mouth design. 592 brackets were bonded up to the premolars with either Aegis Ortho or Transbond Colour Change(TPCCA). Bracket failure rate and survival distribution were evaluated and compared using Kaplan- meier analysis and Log rank test with respect to adhesives, dental arches, segments , tooth types, gender and age groups. White spot lesion was assessed using WSL index. Results: There was no significant difference between the failure rate of Aegis Ortho(3.0%) and TPCCA(1.4%). Kaplan Meier analysis, Log rank test showed that the difference in the overall failure rate and survival time between the arches, gender, and different age groups were not statistically significant. Both adhesives had a high bond failure rate in the posterior segment especially in the premolar region. Three patients had white spot lesions in the upper premolar region bonded with Aegis ortho. Conclusion: Both Aegis ortho and Transbond plus colour change adhesive with a low bond failure rate can be used as an alternative orthodontic adhesive. Key words : bond failure, amorphous calcium phosphate, transbond colour change adhesive, white spot lesions.

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