scholarly journals The Will Rogers phenomenon, Breast Cancer and Race

2020 ◽  
Author(s):  
Mary Roselin Nittala ◽  
Eswar K Mundra ◽  
Satyaseelan Packianathan ◽  
Divyang Mehta ◽  
Maria L Smith ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Racial Differences ◽  
Cox Regression ◽  
Academic Medical Center ◽  
Disease Free Survival ◽  
Staging Systems ◽  
Will Rogers ◽  
The Will ◽  
Will Rogers Phenomenon ◽  
8Th Edition

Abstract Background: The Will Rogers phenomenon [WRP] describes an apparent improvement in outcome for patients’ group due to tumor grade reclassification. Staging of cancers is important to select appropriate treatment and to estimate prognosis. The WRP has been described as one of the most important biases limiting the use of historical cohorts when comparing survival or treatment. The main purpose of this study is to assess whether the WRP exists with the move from the AJCC 7th to AJCC 8th edition in breast cancer [BC] staging, and if racial differences are manifested in the expression of the WRP.Methods: This is a retrospective analysis of 300 BC women (2007- 2017) at an academic medical center. Overall survival [OS] and disease-free survival [DFS], estimated by Kaplan-Meier analysis. Bi and multi-variate Cox regression analyses, used to identify racial factors associated with outcomes.Results: Our patient cohort included 30.3% Caucasians [C] and 69.7% African-Americans [AA]. Stages I, II, III, and IV were 46.2%, 26.3%, 23.1%, and 4.4% of C; 28.7%, 43.1%, 24.4%, and 3.8% of AA respectively, in anatomic staging (p=0.043). In prognostic staging, 52.8%, 18.7%, 23%, and 5.5% were C while 35%, 17.2%, 43.5%, and 4.3% were AA, respectively (p=0.011). A total of C (45.05% vs. 47.85%) AA, upstaged. C (16.49% vs. 14.35%) AA, down-staged. Remaining, 38.46% and 37.79% patients had their stages unchanged.With a median follow-up of 54 months, the AA patients showed better stage-by-stage 5-year OS rates using 8th edition compared to the 7th edition (p=0.000). Among the C, those who were stage IIIA in the 7th but became stage IB in the 8th had a better prognosis than stages IIA and IIB in the 8th (p=0.000). The 8th showed complex results (p=0.176) compared to DFS estimated using the 7th’s (p=0.004).Conclusion: The WRP exists with significant variability in the move from the AJCC 7th to the 8th edition in BC staging (both C and AA patients). We suggest that caution needs to be exercised when results are compared across staging systems to account for the WRP in the interpretation of the data.

scholarly journals The Will Rogers phenomenon, breast cancer and race

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mary R. Nittala ◽  
Eswar K. Mundra ◽  
S. Packianathan ◽  
Divyang Mehta ◽  
Maria L. Smith ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Racial Differences ◽  
Academic Medical Center ◽  
7Th Edition ◽  
Black Patients ◽  
Staging Systems ◽  
Will Rogers ◽  
The Will ◽  
Will Rogers Phenomenon ◽  
8Th Edition

Abstract Background The Will Rogers phenomenon [WRP] describes an apparent improvement in outcome for patients’ group due to tumor grade reclassification. Staging of cancers is important to select appropriate treatment and to estimate prognosis. The WRP has been described as one of the most important biases limiting the use of historical cohorts when comparing survival or treatment. The main purpose of this study is to assess whether the WRP exists with the move from the AJCC 7th to AJCC 8th edition in breast cancer [BC] staging, and if racial differences are manifested in the expression of the WRP. Methods This is a retrospective analysis of 300 BC women (2007–2017) at an academic medical center. Overall survival [OS] and disease-free survival [DFS] was estimated by Kaplan-Meier analysis. Bi and multi-variate Cox regression analyses was used to identify racial factors associated with outcomes. Results Our patient cohort included 30.3% Caucasians [Whites] and 69.7% African-Americans [Blacks]. Stages I, II, III, and IV were 46.2, 26.3, 23.1, and 4.4% of Whites; 28.7, 43.1, 24.4, and 3.8% of Blacks respectively, in anatomic staging (p = 0.043). In prognostic staging, 52.8, 18.7, 23, and 5.5% were Whites while 35, 17.2, 43.5, and 4.3% were Blacks, respectively (p = 0.011). A total of Whites (45.05% vs. 47.85%) Blacks, upstaged. Whites (16.49% vs. 14.35%) Blacks, downstaged. The remaining, 38.46 and 37.79% patients had their stages unchanged. With a median follow-up of 54 months, the Black patients showed better stage-by-stage 5-year OS rates using 8th edition compared to the 7th edition (p = 0.000). Among the Whites, those who were stage IIIA in the 7th but became stage IB in the 8th had a better prognosis than stages IIA and IIB in the 8th (p = 0.000). The 8th showed complex results (p = 0.176) compared to DFS estimated using the 7th edition (p = 0.004). Conclusion The WRP exists with significant variability in the move from the AJCC 7th to the 8th edition in BC staging (both White and Black patients). We suggest that caution needs to be exercised when results are compared across staging systems to account for the WRP in the interpretation of the data.

The Will Rogers phenomenon in the staging of breast cancer – Does it matter?

2015 ◽  
Vol 39 (1) ◽  
pp. 115-117 ◽  
Author(s):  
G.H. Tan ◽  
N. Bhoo-Pathy ◽  
N.A. Taib ◽  
M.H. See ◽  
S. Jamaris ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Will Rogers ◽  
The Will ◽  
Will Rogers Phenomenon

scholarly journals The Will Rogers Phenomenon, Breast Cancer and Race

2020 ◽  
Author(s):  
Mary Roselin Nittala ◽  
Eswar Mundra ◽  
S. Packianathan ◽  
Divyang Mehta ◽  
Maria L. Smith ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Will Rogers ◽  
The Will ◽  
Will Rogers Phenomenon

Chemotherapy-related outcomes in triple-negative breast cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e12049-e12049
Author(s):  
Rebecca M. Wellmann ◽  
Sanaz N. Ghafouri ◽  
Nicholas Patrick McAndrew ◽  
Sara A. Hurvitz
Keyword(s):  
Breast Cancer ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
Cox Regression ◽  
Medical Center ◽  
Academic Medical Center ◽  
Disease Free Survival ◽  
Free Survival ◽  
Node Positive ◽  
Increased Risk

e12049 Background: Triple-negative breast cancer (TNBC) is associated with a poor prognosis when compared to hormone receptor positive breast cancers. Anthracycline-based regimens (ABRs) are mainstays of treatment for non-metastatic TNBC. However, anthracyclines are associated with an increased risk of potentially life-threatening adverse effects. We sought to compare survival outcomes in patients with early TNBC treated with ABRs versus those treated with anthracycline-sparing regimens (ASRs). Methods: All patients treated for stage I-III TNBC who had undergone curative-intent surgery at a large academic medical center between January 2013-May 2018 were included in the study. Event-free survival (EFS) and disease-free survival (DFS) were the primary endpoints, with overall survival (OS) as a secondary endpoint and were defined as per standardized STEEP criteria. Kaplan-Meier, multivariable Cox regression, and log-rank tests were used to define key survival and treatment related differences between subjects treated with ABRs vs ASRs. Results: 137 patients met inclusion criteria with a median follow-up of 39 months. 21 patients (15%) recurred and 16 (12%) died. Patients treated with ABRs (n = 26, 19%) compared with ASRs (n = 111, 81%) had significantly shorter median EFS (38 months vs not-yet-reached, NYR, p < 0.001), DFS (37 months vs NYR, p < 0.001), and OS (50 months vs NYR, p < 0.001). Though patients in the ABR vs the ASR group were more likely to be node-positive (Odds Radio 3.46, p = 0.006), shorter survival estimates in the ABR group were observed after adjusting for nodal status. 27% of patients (7/26) had an anthracycline added after suboptimal response to an ASR. After adjusting for these patients, the survival findings were similar. 43 patients (31%) received a platinum containing ASR. In the platinum subgroup, ASRs were associated with longer EFS and DFS compared to ABRs, but this effect was not statistically significant in the node-positive group. No cardiac or secondary leukemic events were observed in either group. Conclusions: ABRs were associated with shorter EFS, DFS and OS, even after adjusting for certain high-risk clinical features. Larger studies are needed to identify the role of platinum containing ASRs in patients with early TNBC.

scholarly journals Prognostic value of metabolic activity of the psoas muscle evaluated by preoperative 18F-FDG PET-CT in breast cancer: a retrospective cross-sectional study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Keunyoung Kim ◽  
In-Joo Kim ◽  
Kyoungjune Pak ◽  
Taewoo Kang ◽  
Young Mi Seol ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Metabolic Activity ◽  
Cox Regression ◽  
Surrogate Marker ◽  
Disease Free Survival ◽  
Psoas Muscle ◽  
Cox Regression Analysis ◽  
Standardized Uptake Values ◽  
The Mean ◽  
Receptor Negativity

Abstract Background This study aimed to evaluate the potential of metabolic activity of the psoas muscle measured by 18F-fluorodeoxyglucose positron emission tomography-computed tomography to predict treatment outcomes in patients with resectable breast cancer. Methods The medical records of 288 patients who had undergone surgical resection for stages I–III invasive ductal carcinoma of the breast between January 2014 and December 2014 in Pusan National University Hospital were reviewed. The standardized uptake values (SUVs) of the bilateral psoas muscle were normalized using the mean SUV of the liver. SUVRmax was calculated as the ratio of the maximum SUV of the average bilateral psoas muscle to the mean SUV of the liver. SUVRmean was calculated as the ratio of the mean SUV of the bilateral psoas muscle to the mean SUV of the liver. Results Univariate analyses identified a higher T stage, higher N stage, estrogen receptor negativity, progesterone receptor negativity, human epidermal growth factor receptor 2 positivity, triple-negative breast cancer, mastectomy (rather than breast-conserving surgery), SUVRmean > 0.464, and SUVRmax > 0.565 as significant adverse factors for disease-free survival (DFS). Multivariate Cox regression analysis revealed that N3 stage (hazard ratio [HR] = 5.347, P = 0.031) was an independent factor for recurrence. An SUVRmax > 0.565 (HR = 4.987, P = 0.050) seemed to have a correlation with shorter DFS. Conclusions A higher SUVRmax of the psoas muscle, which could be a surrogate marker of insulin resistance, showed strong potential as an independent prognostic factor for recurrence in patients with resectable breast cancer.

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as predictors of outcomes in inflammatory breast cancer

2021 ◽  
Author(s):  
Ouissam Al Jarroudi ◽  
Khalid El Bairi ◽  
Naima Abda ◽  
Adil Zaimi ◽  
Laila Jaouani ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Receiver Operating Characteristic ◽  
Inflammatory Breast Cancer ◽  
Operating Characteristic ◽  
Cox Regression ◽  
Menopausal Status ◽  
Pathologic Complete Response ◽  
Disease Free Survival ◽  
Prognostic Impact ◽  
Receiver Operating

Background: Inflammatory breast cancer (IBC) is uncommon, aggressive and associated with poor survival outcomes. The lack of prognostic biomarkers and therapeutic targets specific to IBC is an added challenge for clinical practice and research. Inflammatory biomarkers such as neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios (NLR and PLR) demonstrated independent prognostic impact for survival in breast cancer. In our study, these biomarkers were investigated in a cohort of patients with nonmetastatic IBC. Methods: A retrospective cohort of 102 IBC patients with nonmetastatic disease was conducted at the Mohammed VI University Hospital (Oujda, Morocco) between January 2010 and December 2014. NLR and PLR were obtained from blood cell count at baseline before neoadjuvant chemotherapy (NACT) from patients’ medical records. The receiver operating characteristic was used to find the optimal cut-off. Correlation between these blood-based biomarkers and response to NACT was analyzed by Chi-squared and Fisher's exact test. Their prognostic value for predicting disease-free survival (DFS) and overall survival (OS) was performed based on Cox regression models. Results: Totally, 102 patients with IBC were included in the analysis. Pathologic complete response (pCR) after NACT, defined by the absence of an invasive tumor in the breast tissues and nodes after surgery (ypT0 ypN0), was observed in eight patients (7.8%). NACT response was found to be associated with menopausal status (p = 0.039) and nodal status (p < 0.001). Patients with a low NLR had a higher pCR rate as compared with the high-NLR group (p = 0.043). However, the pCR rate was not significantly associated with age (p = 0.122), tumor side (p = 0.403), BMI (p = 0.615), histological grade (p = 0.059), hormone receptors status (p = 0.206), human epidermal growth factor receptor 2 (p = 0.491) and PLR (p = 0.096). Pre-treatment blood-based NLR of 2.28 was used as the cut-off value to discriminate between high and low NLR according to the receiver operating characteristic curves. Similarly, a value of 178 was used as the cut off for PLR. Patients with low-NLR had a significantly better 5-year DFS (p < 0.001) and OS (p < 0.001) than the high-NLR group. Moreover, low-PLR was significantly associated with higher DFS (p = 0.001) and OS (p = 0.003). The NLR showed a significant prognostic impact for DFS (HR: 2.57; 95% CI: 1.43–4.61; p = 0.01) and for OS (HR: 2.92; 95% CI: 1.70–5.02; p < 0.001). Similarly, a meaningful association between PLR and 5-year DFS (HR: 1.95; 95% CI: 1.10–3.46; p = 0.021) and OS (HR: 1.82; 95% CI: 1.06–3.14; p = 0.03) was noticed. Conclusions: High NLR and PLR were found associated with reduced DFS and OS in nonmetastatic IBC. Further studies are awaited to confirm these findings.

scholarly journals Exploratory Analysis of Single-Gene Predictive Biomarkers in HERA DASL Cohort Reveals That C8A mRNA Expression Is Prognostic of Outcome and Predictive of Benefit of Trastuzumab

2018 ◽  
pp. 1-12 ◽  
Author(s):  
Scooter Willis ◽  
Varvara Polydoropoulou ◽  
Yuliang Sun ◽  
Brandon Young ◽  
Zoi Tsourti ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Mrna Expression ◽  
Cox Regression ◽  
Single Gene ◽  
Disease Free Survival ◽  
Predictive Biomarkers ◽  
Exploratory Analysis ◽  
Treatment Benefit ◽  
Significant Treatment ◽  
Her2 Breast Cancer

Purpose The Herceptin Adjuvant study is an international multicenter randomized trial that compared 1 or 2 years of trastuzumab given every 3 weeks with observation in women with human epidermal growth factor 2–positive (HER2+) breast cancer after chemotherapy. Identification of biomarkers predictive of a benefit from trastuzumab will minimize overtreatment and lower health care costs. Methods To identify possible single-gene biomarkers, an exploratory analysis of 3,669 gene probes not expected to be expressed in normal breast tissue was conducted. Disease-free survival (DFS) was used as the end point in a Cox regression model, with the interaction term between C8A mRNA and treatment as a categorical variable split on the cohort mean. Results A significant interaction between C8A mRNA and treatment was detected ( P < .001), indicating a predictive response to trastuzumab treatment. For the C8A-low subgroup (mRNA expression lower than the cohort mean), no significant treatment benefit was observed ( P = .73). In the C8A-high subgroup, patients receiving trastuzumab experienced a lower hazard of a DFS event by approximately 75% compared with those in the observation arm (hazard ratio [HR], 0.25; P < .001). A significant prognostic effect of C8A mRNA also was seen ( P < .001) in the observation arm, where the C8A-high group hazard of a DFS event was three times the respective hazard of the C8A-low group (HR, 3.27; P < .001). C8A mRNA is highly prognostic in the Hungarian Academy of Science HER2+ gastric cancer cohort (HR, 1.72; P < .001). Conclusion C8A as a single-gene biomarker prognostic of DFS and predictive of a benefit from trastuzumab has the potential to improve the standard of care in HER2+ breast cancer if validated by additional studies. Understanding the advantage of overexpression of C8A related to the innate immune response can give insight into the mechanisms that drive cancer.

Targeted biopsy of the prostate: does this result in improvement in detection of high-grade cancer or the occurrence of the Will Rogers phenomenon?

2019 ◽  
Vol 124 (4) ◽  
pp. 643-648 ◽  
Author(s):  
Edward J. Bass ◽  
Clement Orczyk ◽  
Alistair Grey ◽  
Alex Freeman ◽  
Charles Jameson ◽  
...  
Keyword(s):  
High Grade ◽  
Targeted Biopsy ◽  
Will Rogers ◽  
The Will ◽  
Will Rogers Phenomenon
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