Primary liver angiosarcoma and factors associated with improved outcomes: An analysis of the National Cancer Database.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 498-498
Author(s):  
Prantesh Jain ◽  
Gino Cioffi ◽  
Nirav Patil ◽  
Aman Opneja ◽  
Asrar Alahmadi ◽  
...  
Keyword(s):  
Median Survival ◽  
Statistical Significance ◽  
Rank Test ◽  
National Cancer Database ◽  
Factors Associated ◽  
Academic Center ◽  
Risk Of Mortality ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

498 Background: Primary liver angiosarcoma (LAS) is a rare and aggressive tumor of the liver. In this analysis of the national cancer database (NCDB) we sought the risk of mortality and factors associated with survival amongst patient diagnosed with LAS. Methods: Patients diagnosed with hepatocellular carcinoma (HCC) or LAS from 2004 – 2014 were identified in the NCDB. The Kaplan-Meier method with the log-rank test was used to calculate survival for HCC and LAS patients. Additional analyses were performed on the cohort with LAS to assess the impact of surgery, chemotherapy, radiation therapy (RT) and facility type on overall survival (OS). Multivariable analyses using cox proportional methods, adjusted for age, sex, Charlson/Deyo score, race, ethnicity, insurance status, facility location and type, surgery status, and chemotherapy status were performed to obtain adjusted hazard ratio (aHR). Results: Total of 118,066 patients with HCC and 346 patients with LAS were identified in the database. Median survival for HCC patients was 11.9 months (95% CI: 11.7-12.2) and 2.0 months for LAS patients (95% CI: 1.8 – 2.4). Risk of mortality was higher for patients with LAS compared to those with HCC (aHR (95% CI): 2.23 (1.97 - 2.53), p < .0001). Among the LAS patients, those who received surgery had a median survival of 8.6 months (95% CI: 5.6 - 17.3), and 1.8 months for those who did not (95% CI: 1.48 - 1.94). Risk of mortality was lower in patients who received surgery compared to those who did not (aHR (95% CI): 0.23 (0.15 - 0.37), p < .0001). Patients treated at and academic center had a higher median survival (3.3 months, 95% CI: 2.2 - 4.1) then those treated at a non-academic center (1.5 months, 95% CI: 1.2 - 1.8). Though, there was no significant difference in OS (aHR (95% CI): 0.48 (0.21 - 1.10), p = 0.082). A very small number of patients received chemotherapy or RT to conduct a meaningful analysis. Conclusions: Patients diagnosed with primary LAS have a worse OS compared to those with HCC. Amongst patients with primary LAS, surgical resection is associated with best survival outcomes. Treatment at an academic center is associated with better median survival, although OS did not reach statistical significance in our analysis.

The IC50 Assay Is Predictive of Molecular Response, and Indicative of Optimal Dose in De-Novo CML Patients.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1109-1109
Author(s):  
Deborah L White ◽  
Verity A Saunders ◽  
Thea Kalebic ◽  
Timothy P Hughes
Keyword(s):  
De Novo ◽  
Statistical Significance ◽  
Continuous Variable ◽  
Rank Test ◽  
P Value ◽  
Molecular Response ◽  
Optimization Strategy ◽  
Log Reduction ◽  
Significant Difference ◽  
The Impact

Abstract We have previously demonstrated significant interpatient variability in the IC50imatinib, a measure of the intrinsic sensitivity of a patient to imatinib induced kinase inhibition. Furthermore, this measure is predictive of the achievement of major molecular response (MMR &gt; 3 log reduction in BCR-ABL) in de-novo CML patients treated with imatinib (n=60)1. In an expanded patient pool (n=116) we now perform an evaluation of the IC50 as a predictor of response, and address the IC50imatinib as a guide to dose selection. Samples were obtained with informed consent from de novo CML patients enrolled to either the TIDEL (600mg imatinib) or TOPS (randomised 400mg vs 800mg imatinib) trials. Blood was collected pre therapy, and the IC50 was performed as previously1. Outcome data was assessed using Kaplan Meier Analysis and the log rank test was used to assess statistical significance. In our previous analysis the IC50imatinib was divided about the median value for the cohort (0.6μM) into low and high IC50, with a significantly greater proportion of patients with low IC50imatinib achieving MMR by 12 months. In this expanded patient pool, we confirm this finding (&lt;median of 0.7μM for this patient group) (low IC50 65% of patients achieve MMR by 12 mo vs high IC50 39% of patients p=0.014) Dividing the IC50’s into quartiles we now demonstrate that the IC50imatinib is a continuous variable with a greater proportion of patients in the lower quartile achieving MMR than those in the higher (Table 1 Total). Addressing the issue of dose we demonstrate that no patients with IC50&gt;0.95uM achieve MMR on 400mg, and that this is statistically significantly when compared to all other groups. At 600mg while there is no overall significant difference there is a statistically relevant difference between groups 1, 2 and 4 as indicated. In contrast, at 800 mg the effect of IC50imatinib is overcome. MMR by 12 months Total 400mg 600mg 800mg p value Group1 &lt;0.5μM 67% (27) 83% (12)* 50% (8)* 86% (7) 0.470 Group 2 &gt;0.5&lt;0.7μM 63% (30) 67% (6)* 53% (17)* 71% (7) 0.337 Group 3 &gt;0.7&lt;0.95μM 45% (31) 40%(5)* 30% (10) 56% (16) 0.139 Group 4&gt;0.95μM 32% (28) 0% (7)* 22% (9)* 58% (12) 0.016 P value 0.042 0.018 0.108 0.778 Table 1: Dividing the patients into quartile based on the IC50 imatinib and assessing the Impact of dose on the achievement of MMR by 12 month. *p value &lt;0.05 between groups (n). The failure to achieve a Complete Cytogenetic Response by 12 months is considered a suboptimal response. Assessing the molecular equivalent (≥2 log reduction in BCR-ABL) we demonstrate that a significantly greater proportion of patients with IC50imatinib&gt;0.7μM fail to achieve a 2 log reduction when treated with 400mg (IC50 &lt;0.7μM 11%: &gt;0.7μM 33% p=0.034), and 600mg (IC50 &lt;0.7μM 12%: &gt;0.7μM 22% p=0.036). However, there is no significant difference in the 800mg patient cohort (IC50 &lt;0.7μM 7%: &gt;0.7μM 14% p=0.79). This analysis confirms that the IC50imatinib, is predictive of imatinib response. Patients with an IC50imatinib &lt;0.7μM are likely to respond well to doses of 400mg imatinib, as suggested by evaluation of statistically relevant outcome benefit. In contrast patients with higher IC50imatinib (&gt;0.7μM) may benefit from higher dosing regimens (p=0.012). Thus, the accurate assessment of IC50imatinib could support dose optimization strategy for patients with a suboptimal response.

scholarly journals Pancreatic Cancer Stem Cells May Define Tumor Stroma Characteristics and Recurrence Patterns in Pancreatic Ductal Adenocarcinoma

2020 ◽  
Author(s):  
Gokce Askan ◽  
Ibrahim Halil Sahin ◽  
Joanne F. Chou ◽  
Aslihan Yavas ◽  
Marinela Capanu ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Statistical Significance ◽  
Specific Antigen ◽  
Tumor Stroma ◽  
Ductal Adenocarcinoma ◽  
Rank Test ◽  
Stem Cell Markers ◽  
Significant Difference ◽  
The Impact

Abstract Background: Herein, we investigate the relationship between pancreatic stem cell markers (PCSC markers), CD44, and epithelial-specific antigen (ESA), tumor stroma, and the impact on recurrence outcomes in pancreatic ductal adenocarcinoma (PDAC) patients.Methods: PDAC patients who underwent surgical resection between 01/2012 -06/2014 were identified. CD44 and ESA expression was assessed by immunohistochemistry. Stroma was classified as loose, moderate, and dense based on fibroblast content. Overall survival (OS) and relapse-free survival (RFS) were estimated using the Kaplan-Meier method and compared between subgroups by log-rank test. The association between PCSC markers and stroma type was assessed by Fisher`s exact test. Results: N= 93 PDAC patients were identified. The number of PDAC patients with dense, moderate density, and loose stroma was 11 (12%), 51 (54%), and 31 (33%) respectively. PDAC with CD44+/ESA- had highest rate of loose stroma (63%) followed by PDAC CD44+/ESA+ (50%), PDAC CD44-/ESA+ (35%), CD44-/ESA- (9%) (p=0.0033). No local recurrence was observed in patients with dense stroma and 9 had distant recurrence. The highest rate of cumulative local recurrence observed in patients with loose stroma. No statistically significant difference in RFS and OS were observed among subgroups (P=0.089). Conclusions: These data indicate PCSCs may have an important role in stroma differentiation in PDAC. Although not reaching statistical significance, we observed more local recurrences in patients with loose stroma, and no local recurrence was seen in patients with dense stroma suggesting tumor stroma may influence the recurrence pattern in PDAC patients.

Predictors of long-term survival with metastatic pancreatic cancer (mPC) in the gemcitabine era: The Fox Chase Cancer Center experience.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 253-253
Author(s):  
Namrata Vijayvergia ◽  
Efrat Dotan ◽  
Karthik Devarajan ◽  
Bianca Lewis ◽  
Steven J. Cohen
Keyword(s):  
Serum Albumin ◽  
Median Survival ◽  
Lung Metastases ◽  
Statistical Significance ◽  
Rank Test ◽  
Type I ◽  
Term Survival ◽  
Metastatic Setting ◽  
Significant Difference

253 Background: Although median survival (OS) for patients (pts) with mPC was ~6 months (m) in the gem era, a subset of pts lived significantly longer as long term survivors (LTS). We compared the patterns of care and outcomes of pts living < 12 m (Gp 1) and ≥ 12 m (Gp 2) to identify predictors for LTS. Methods: With IRB approval, we retrospectively analyzed medical charts of mPC pts treated at our center between 2000 and 2010. Gp 1 and Gp 2 were compared with respect to pt, tumor and treatment characteristics. Fisher’s exact and Mann-Whitney tests were used, respectively, to compare categorical and continuous variables, and the log-rank test to compare OS. All tests were two-sided and a Type I Error of 5% was used to determine statistical significance. Results: 579 mPC pts (median age 64 y, 56% males) were identified, 476 pts in Gp1 and 103 in Gp 2 (OS 4m vs 18 m, respectively). There was no significant difference in the age, site of pancreatic primary, comorbidities, tobacco use or stage at diagnosis between the two. 341 (72%) pts in Gp1 and 86 (83%) in Gp 2 had an initial PS <2 (p 0.06). Alcohol use was more prevalent in LTS [170 (36%) in Gp1 vs 50 (49%) in Gp2 (OR 1.8, p 0.008)]. 170 (36%) pts in Gp 1 and 55 (52%) in Gp 2 had serum albumin (alb) > 3.5 gm/dl (p< 0.001) and this predicted survival (OS 4m if Alb < 3.5 and 7m if Alb > 3.5, p <0.001). Use of chemotherapy in the metastatic setting (66% in Gp1 vs 93% in Gp 2) and number of agents used also predicted survival with 202 (42%) pts in Gp 1 and 79 (87%) in Gp 2 having received > one agent in the metastatic setting (p < 0.001). Liver metastases were more common as an initial site in Gp1 vs Gp2 [329 (70%) vs 48 (47%) respectively, p < 0.001]. In contrast, lung metastases were more common in Gp 2 [42 (9%) Gp 1 vs 20 (19%) in Gp 2, p< 0.001]. The median survival for pts with liver as initial metastatic site was worse than those with lung metastases (5m vs 7m, p < 0.001). Conclusions: Use of chemotherapy and increasing number of agents are associated with better survival in mPC, in line with the current practice of using combination chemotherapy. The site of initial metastasis and serum albumin also predict for survival. Clinical trial designs should consider the latter as stratification factors.

scholarly journals Applying ENL Risk Stratification Schema on a Local Acute Myeloid Leukemia Cohort in Kuwait

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 38-39
Author(s):  
Mazyad Jamal Almazyad ◽  
Ramesh Pandita ◽  
Mohan Ram ◽  
Salem Alshemmari
Keyword(s):  
Retrospective Study ◽  
Risk Stratification ◽  
Median Survival ◽  
Negative Impact ◽  
Risk Group ◽  
Statistical Significance ◽  
World Health ◽  
Rank Test ◽  
Mutational Status ◽  
The Impact

Introduction: AML is a malignant clonal disease that affects mainly the elderly [1]. Data on younger populations, particularly from the Middle East is scarce. The aim of this retrospective study is to investigate the risk factors that are associated with lower survival, particularly when applying the European Leukemia Network (ELN) prognostic scheme [2].Methods: Overall survival (OS) was calculated from the date of diagnosis until the date of death from any cause. Kaplan-Meier curves were plotted to evaluate OS [3]. Log Rank test was used to assess the statistical significance of our findings. Results: This study included 231 AML cases, with a median age of 47 years, ranging from 16 to 96 years of age. The majority of the cases are young (20-39: 35.1%; 40-59: 37.7%). Females accounted for 48.5% of all cases (table 1). Cases were assigned to a risk group based on the ELN risk stratification scheme (table 1). Accordingly, 86 (37.2%) cases were assigned to the favorable group, 104 (45.0%) patients were in the intermediate group, and 41 (17.8%) enrollees were in the adverse group. Among the 154 cases with a normal cytogenetic profile, 32 cases were FLT3 positive/dominant, 19 patients tested positive for NPM1 only, and 103 enrollees were negative for both mutations. Figure 1 shows the negative impact of a positive/dominant FLT3 mutational status on OS, with a median survival time of 10 months (95% CI: 1.44 - 18.56). The other groups have not reached their median survival. Figure 2 illustrates that those who are among the ELN adverse group fared the worst in terms of OS, with a median survival of 11 months (95% CI: 0.00-22.31). Additionally, the median survival of the intermediate risk groups is 30 months (95% CI: 14.61 - 45.39). The favorable risk group has not reached its median survival. Conclusion: This retrospective study confirms the impact of the ELN risk categories, and the detrimental effects of FLT3 mutation on OS among AML cases. Currently, FLT3 inhibitors have been shown to improve leukemia free survival in those who are mutated at presentation, as well as at the time of relapse [4, 5]. Alternative strategies that are less toxic but more effective are needed to improve the survival of older patients. ELN risk-grouping is robust in our cohort of younger cases , and can be used to guide the choice of intensive treatment, particularly for bone marrow transplantation or enrollment into clinical trials. References 1. Arber, D.A., et al.,The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia.Blood, 2016.127(20): p. 2391-405. 2. Döhner, H., et al.,Diagnosis and management of AML in adults: 2017 ELN recommendations from an international expert panel.Blood, 2017.129(4): p. 424-447. 3. Altman, D.G. and J.M. Bland,Time to event (survival) data.Bmj, 1998.317(7156): p. 468-469. 4. Perl, A.E., et al.,Gilteritinib or chemotherapy for relapsed or refractory FLT3-mutated AML.New England Journal of Medicine, 2019.381(18): p. 1728-1740. 5. Levis, M.,Midostaurin approved for FLT3-mutated AML.Blood, The Journal of the American Society of Hematology, 2017.129(26): p. 3403-3406. Disclosures Pandita: Novartis:Honoraria;Pfizer:Honoraria;Amgen:Honoraria;AstraZeneca:Honoraria;Takeda:Honoraria;Jansen:Honoraria;Cilag:Honoraria.

Improving the Quality of Cancer Registry Data on Adult Haematopoietic Neoplasms: Impact of Engaging Clinicians.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3129-3129
Author(s):  
Karen Phekoo ◽  
Henrik Moller2 ◽  
Mike Richards ◽  
David Bevan3 ◽  
Don Gillett4 ◽  
...  
Keyword(s):  
Cancer Registry ◽  
Statistical Significance ◽  
Adult Population ◽  
Cancer Registries ◽  
Rank Test ◽  
Quality Of Data ◽  
Significant Difference ◽  
The Impact ◽  
North And South

Abstract Haematological malignancies (HM) accounts for 7% of all cancers in England (DoH, 2003). However, concerns have been expressed regarding the quality of information from cancer registries (DoH, 2000, Haward, 2003) which sheds doubt on the validity of the data. Several initiatives have been undertaken to improve the quality of data (Cartwright et al., 1990, 1997, Clough et al., 1996, Taylor et al., 1998, Maynadie et al., 1996, Ong et al., 1997). These initiatives have been restricted in the range of diagnoses or have operated independently of national cancer registries (Phekoo et al., 2002). No studies have assessed the impact of incidence on survival rates. We present results of a collaboration designed to improve the quality of data and assess the impact on incidence and survival. A consensus dataset and database of HM was developed between the Thames Cancer Registry (TCR) and clinicians between 1999 and 2000 in South Thames (adult population 5.4 million). Clinicians identified and confirmed the diagnosis of patients whilst diagnostic data were collected by a dedicated team of data collectors. Clinicians validated their cases bi-annually. Incidence and survival of the study population for the period 1999–2000 following the collaboration were compared with the same population over the period 1994–1996 prior to the collaboration and with a control population (North Thames area, adult population 5.5 million), where TCR collected data but without any clinical collaboration, for the period 1999–2000. Statistical analyses: the statistical significance of the standardized rate ratio (SRR) was evaluated using the method of Jensen et al., (1991). The Kaplan-Meier survival curves were compared using the log-rank test. For the period 1994–1996 there were no differences in the SRR or survival estimates in any disorders between North and South Thames. A 43% increase in incidence occurred between 1994–1996 and 1999–2000 in South Thames compared to only 5% in North Thames over the same periods, mainly for CLL, MDS, PV, PT, IMF, MGUS and WM. Table I shows a statistically significant difference in the SRR between the North and South Thames during the period 1999–2000 for five conditions: CLL, MDS, PV, PT and WM. Three year survival for patients diagnosed between 1999 and 2000 were higher in South Thames than North Thames in four conditions: CLL (71% vs. 49%, p = 0.001), CML (50% vs. 30%, p = 0.001), MDS (45% vs. 27%, p &lt;0.001) and MM (39% vs. 28%, p &lt;0.001). No significant difference in incidence or survival were seen for acute leukaemia, NHL or HD. Table 1: Comparison of the age standardized rate between 1994–1996 and 1999–2000 in patients aged 16–85+ years 1994–1996 1999–2000 North Thames South Thames Comparison North Thames South Thames Comparison Subtypes ASR ASR SRR (95% CI) ASR ASR SRR (95% CI) CLL 4.28 4.76 0.89 (0.89–1.07) 3.78 6.58 0.57 (0.48–0.67) MDS 2.33 2.15 1.08 (0.80–1.46) 3.48 5.80 0.60 (0.50–0.71) PT 0.69 0.91 0.75 (0.50–1.13) 0.48 2.57 0.18 (0.13–0.26) PV 1.05 1.06 0.99 (0.69–1.41) 0.72 1.60 0.45 (0.31–0.63) WM 0.37 0.37 1.00 ( 0– 0) 0.33 0.98 0.33 (0.21–0.53) This study has shown that engaging clinicians have improved case ascertainment and that changes in incidence alone may affect outcome without significant differences in treatment. This study provides a benchmark of incidence and survival in the UK and a model for future collaborations.

Frequency and prognostic utility of MSI and TILs in advanced noncolorectal GI malignancies.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 313-313
Author(s):  
Uqba Khan ◽  
Ameer Hamza ◽  
Muhammad S Khurram ◽  
Renny Abraham ◽  
Paul Mazzara ◽  
...  
Keyword(s):  
Median Survival ◽  
Checkpoint Inhibitors ◽  
Medical Center ◽  
Adoptive T Cell Therapy ◽  
Mismatch Repair Gene ◽  
Repair Gene ◽  
T Cell Therapy ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

313 Background: Mismatch repair gene mutation status not only has a role in pathogenesis but also has significant clinical implications with respect to treatment with checkpoint inhibitors. Additionally tumor infiltrating lymphocytes (TILs) are also emerging prognostic biomarker and are utilized in adoptive T-cell therapy as well. Methods: This is a retrospective cohort study of patients who were diagnosed with advanced unresectable non-colorectal GI (NCGI) cancers. Biopsy specimens of patients diagnosed between 2009 and 2015 at St. John Hospital and Medical Center were analyzed. Immunohistochemistry panels were performed on a representative tissue sections for microsatellite instability (MSI) testing. TILs were assessed on the hematoxylin and Eosin stained slide of the same tissue section. MSI was interpreted as stable or high and TILs were categorized as ≤5 and > 5 per high power field. Descriptive statistics were generated using frequency distributions, medians and means. Kaplan-Meier analysis was performed to determine the impact of TILs and MSI on survival; differences by factor were assessed with the Log_Rank test. Results: We analyzed 114 patients; the mean age at diagnosis was 66.8 ± 10.7 years, 61.4% were male. All samples were MSI stable. The percentage of patients with TILs ≤ 5 was 46.5. When stratified by tumor stage, overall median survival by TILs level did not differ significantly. When stratified by type of tumor, overall median survival by TILs level was significantly different only for hepatocellular cancers (HCC) (≤ 5 TILs, 86 days vs. > 5 TILs 312 days, p = 0.031) only, (see table). Conclusions: Our study shows that MSI-H tumors are very rare in advanced NCGI malignancies. TILs are definitely present in tumor microenvironment of NCGI malignancies. Though the number of patients of our study was small, there was a statistically significant difference in median overall survival of patients with HCC when stratified by TILs status.[Table: see text]

scholarly journals The Ongoing Impact of COVID-19 on US Dermatology Practices

2021 ◽  
Vol 5 (1) ◽  
pp. 29-33
Author(s):  
Graham Litchman ◽  
Justin Marson ◽  
Darrell Rigel
Keyword(s):  
Outpatient Care ◽  
Negative Impact ◽  
Statistical Significance ◽  
Healthcare Delivery ◽  
Statistical Testing ◽  
Large Sample Size ◽  
Patient Volume ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

Background: COVID-19 is significantly impacting healthcare delivery worldwide. Chen et al anecdotally reported the impact on dermatology outpatient care at the outbreak epicenter in Wuhan, China, but nothing has yet been assessed for the US. The purpose of this study was to determine the magnitude of the ongoing impact of COVID-19 on US dermatology outpatient care.  Methods: After pre-validation, 2 surveys comparing outpatient volumes and scheduling issues for the weeks of February 17th versus the week of March 16th, 2020 (Survey 1) and April 13th, 2020 (Survey 2) and for estimation of trends in the next several weeks was emailed to 9,891 US Dermatologists on 3/21(Survey 1) and 4/18(Survey 2)(Tables S1a & S1b). Because of the importance of this information and the need for rapid dissemination, only data from the first 1,000 respondents (collected in the initial 36 hours) were included in each survey. In Survey 1, 30 responses were removed due to ineligible geography or errors in survey entry, leaving 970 for the analysis. Survey 2 consisted of 1,000 eligible respondents. Demographics (Table 1) representativeness with AAD membership was confirmed (Table S2). Statistical significance was calculated using chi-square, difference-of-proportions, and two-tailed independent t-tests. Results: COVID-19 impact was material (Table 2). From the 3rd week in February to the 3rd week in March to the 3rd week in April, the average number of patients seen fell from 149.4 to 63.4 to 28.2(p<0.0001), practice days from 4.2 to 3.1 and then rose to 3.5(p<0.0001) and biopsies from 19.8 to 7.7 to 3.5(p<0.0001). Although by 3/16 there were only 24.5k cases nationally, the early-phase decrease in patient volume and office days suggests the magnitude of disease concern impact was greater than actual prevalence. Postponement of non-essential appointments increased from 35.5% to 79.4% to 95.6%(p<0.00001). In Survey 1, 66.3% of respondents estimated a >50% decrease in patient volume in the coming 2 weeks (18.9% completely closing practices) and, disturbingly, 47.2% of respondents in the 2nd survey estimated an additional 50%+ decrease in patient volume in the next 2 weeks. 54.6% (Survey 1) of postponed appointments were for >4 weeks with an additional 25.4% not rescheduled. Discussion: A greater negative impact was found in US “hotspot” regions (36% (Survey 1) and 34% (Survey 2) of respondents-Figure S1) for week 3/16-20 for practice days (3.0 hotspots vs. 3.3 non-hotspots) and patients seen (56.2 in hotspots vs. 70.0 in non-hotspots); and for week 4/13-18 (3.4 in hotspots vs 3.5 in non-hotspots) and patients seen (25.3 in hotspots vs 29.7 in non-hotspots). No significant differing telemedicine usage (39.5% hotspots vs 37.2% non-hotspots) or practice closure (21.0% hotspots vs 17.6% non-hotspots) was found in Survey 1 (March); however, a significant difference in telemedicine usage (54.5% hotspots vs 45.5% non-hotspots) and practice closure (25.4% hotspots vs 16.4% non-hotspots, when compared to a typical April week) was found in Survey 2 (April). Mean estimated telemedicine visits overall for the next 2 weeks was 37.8% (Survey 1) and 45.9% (Survey 2). Academic/University/Institutional dermatologists were significantly more likely to use telemedicine (Survey 1=57.1%, Survey 2=68.6%) than private practitioners (Survey 1=35.5%, Survey 2=46.2%). Telemedicine usage was less likely for dermatologists with >30 practice years (>30=32.4% vs 40.0%) and this trend continued in April with only 37.2% of more experienced dermatologists using telemendine. However, telemedicine usage does not have an impact on the deferred/postponed biopsies that had already occurred during the March (mean=10.7) or April (mean=7.9) weeks as well as those predicted to be subsequently postponed. Limitations include that this study reflects a “snapshot” which could materially change given the dynamically evolving situation. Estimations could have led to recall bias and the 10.1% response rate could have introduced sampling and non-response bias. Those with lower work volumes could have been more likely to have time to respond, but this bias was minimized by weekend-only data collection. However, the large sample size and representative distribution mitigate selection bias and standard statistical testing demonstrated significance. Conclusion: Our findings demonstrate the significant early impact of COVID-19 on US dermatologic care and can help better understand national trends. With an estimated 49.9 million annual US dermatology office visits, the 50%+ decrease in predicted visits could be devastating. Beyond telemedicine, other innovative approaches will need to be developed and implemented to help delivery of essential dermatology care during this crisis.

Tumor genomics and response to CDK 4/6 inhibitors for patients with hormone receptor-positive (HR+) metastatic breast cancer (MBC).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 1046-1046 ◽  
Author(s):  
Laura Spring ◽  
Andrzej Niemierko ◽  
Dejan Juric ◽  
Mark Zangardi ◽  
Elizabeth Abraham ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Multivariable Analysis ◽  
Metastatic Breast ◽  
Predictive Biomarkers ◽  
Driver Mutations ◽  
Rank Test ◽  
Second Line ◽  
Significant Difference ◽  
The Impact ◽  
Tumor Genotyping

1046 Background: The combination of endocrine therapy with a cyclin-dependent kinase (CDK) 4/6 inhibitor, such as palbociclib, has changed the treatment paradigm of HR+ MBC, particularly as 1stline therapy. However, there are no predictive biomarkers at present, and little is known about the impact of tumor genomics on outcomes. For example, mutations in TP53 could impact the ability of p53 to negatively regulate p21, thereby promoting cell cycle progression despite CDK 4/6 inhibition. The aim of this study was to evaluate the association between tumor genomics, particularly PIK3CA and TP53 mutations, and response to CDK 4/6 inhibitors in HR+ MBC. Methods: All HR+/HER2- MBC patients at our institution receiving a CDK 4/6 inhibitor in the second line or beyond were identified. Tumor genomics were analyzed utilizing the institutional tumor genotyping next generation sequencing (NGS) assay known as “Snapshot-NGS assay” on DNA isolated from the tumor, covering key oncogenic driver mutations and tumor suppressor genes. The log-rank test was used for statistical analysis. Results: A total of 83 patients with HR+/HER2- MBC were identified, of which 61 had available tumor genotyping results available (52 metastatic specimens). The median line of therapy was three. Median progression-free survival (PFS) on CDK 4/6 inhibitor-based therapy, as second line or beyond, was 9.2 months (mo) overall. No significant difference in PFS was seen among patients with PIK3CA (n = 31) mutations (7.1 vs. 9.7 mo; p = 0.28) or with any alteration in the PI3K/Akt/mTOR (n = 36) pathway (8.2 vs. 9.3 mo; p = 0.40). The presence of a p53 mutation (n = 9) or complex tumor genomics (n = 14) demonstrated a trend towards shorter PFS (5.5 vs. 9.2 mo; 5.5 vs. 9.5 mo, respectively), although statistical significance was not reached due to small numbers (p = 0.76; p = 0.31). In a multivariable analysis adjusting for age and prior lines of therapy, similar results were observed. Conclusions: This study suggests patients with HR+ MBC harboring p53 mutations or complex tumor genomics may experience shorter PFS on CDK 4/6 inhibitor-based therapy in the second line and beyond, and these novel findings require validation in additional studies.

scholarly journals Does Social Support Affect the Health of the Elderly in Rural China? A Meta-Analysis Approach

2019 ◽  
Vol 16 (18) ◽  
pp. 3471 ◽  
Author(s):  
Natuya Zhuori ◽  
Yu Cai ◽  
Yan Yan ◽  
Yu Cui ◽  
Minjuan Zhao
Keyword(s):  
Social Support ◽  
Rural Areas ◽  
Rural China ◽  
Statistical Significance ◽  
Empirical Studies ◽  
Relevant Literature ◽  
The Elderly ◽  
Significant Difference ◽  
Meta Regression ◽  
The Impact

As the trend of aging in rural China has intensified, research on the factors affecting the health of the elderly in rural areas has become a hot issue. However, the conclusions of existing studies are inconsistent and even contradictory, making it difficult to form constructive policies with practical value. To explore the reasons for the inconsistent conclusions drawn by relevant research, in this paper we constructed a meta-regression database based on 65 pieces of relevant literature published in the past 25 years. For more valid samples to reduce publication bias, we also set the statistical significance of social support to the health of the elderly in rural areas as a dependent variable. Finally, combined with multi-dimensional social support and its implications for the health of the elderly, meta-regression analysis was carried out on the results of 171 empirical studies. The results show that (1) subjective support rather than objective support can have a significant impact on the health of the elderly in rural areas, and there is no significant difference between other dimensions of social support and objective support; (2) the health status of the elderly in rural areas in samples involving western regions is more sensitive to social support than that in samples not involving the western regions; (3) among the elderly in rural areas, social support for the older male elderly is more likely to improve their health than that for the younger female elderly; and (4) besides this, both data sources and econometric models greatly affect the heterogeneity of the effect of social support on the health of the elderly in rural areas, but neither the published year nor the journal is significant. Finally, relevant policies and follow-up studies on the impact of social support on the health of the elderly in rural areas are discussed.

scholarly journals 288. Follow-Up Blood Cultures in Gram-Negative Bacteremia: How Do They Impact Outcomes

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S144-S144
Author(s):  
Azza Elamin ◽  
Faisal Khan ◽  
Ali Abunayla ◽  
Rajasekhar Jagarlamudi ◽  
aditee Dash
Keyword(s):  
Clinical Outcomes ◽  
Antibiotic Treatment ◽  
Readmission Rate ◽  
Blood Cultures ◽  
Categorical Variables ◽  
Gram Negative ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

Abstract Background As opposed to Staphylococcus. aureus bacteremia, there are no guidelines to recommend repeating blood cultures in Gram-negative bacilli bacteremia (GNB). Several studies have questioned the utility of follow-up blood cultures (FUBCs) in GNB, but the impact of this practice on clinical outcomes is not fully understood. Our aim was to study the practice of obtaining FUBCs in GNB at our institution and to assess it’s impact on clinical outcomes. Methods We conducted a retrospective, single-center study of adult patients, ≥ 18 years of age admitted with GNB between January 2017 and December 2018. We aimed to compare clinical outcomes in those with and without FUBCs. Data collected included demographics, comorbidities, presumed source of bacteremia and need for intensive care unit (ICU) admission. Presence of fever, hypotension /shock and white blood cell (WBC) count on the day of FUBC was recorded. The primary objective was to compare 30-day mortality between the two groups. Secondary objectives were to compare differences in 30-day readmission rate, hospital length of stay (LOS) and duration of antibiotic treatment. Mean and standard deviation were used for continuous variables, frequency and proportion were used for categorical variables. P-value &lt; 0.05 was defined as statistically significant. Results 482 patients were included, and of these, 321 (67%) had FUBCs. 96% of FUBCs were negative and 2.8% had persistent bacteremia. There was no significant difference in 30-day mortality between those with and without FUBCs (2.9% and 2.7% respectively), or in 30-day readmission rate (21.4% and 23.4% respectively). In patients with FUBCs compared to those without FUBCs, hospital LOS was longer (7 days vs 5 days, P &lt; 0.001), and mean duration of antibiotic treatment was longer (14 days vs 11 days, P &lt; 0.001). A higher number of patients with FUBCs needed ICU care compared to those without FUBCs (41.4% and 25.5% respectively, P &lt; 0.001) Microbiology of index blood culture in those with and without FUBCs Outcomes in those with and without FUBCs FUBCs characteristics Conclusion Obtaining FUBCs in GNB had no impact on 30-day mortality or 30-day readmission rate. It was associated with longer LOS and antibiotic duration. Our findings suggest that FUBCs in GNB are low yield and may not be recommended in all patients. Prospective studies are needed to further examine the utility of this practice in GNB. Disclosures All Authors: No reported disclosures

Sign in / Sign up

Export Citation Format

Share Document