Background
Pathologic complete response (pCR) after neoadjuvant chemotherapy (NACT) is a surrogate for outcome, but not necessarily conversion to BCT eligibility. We sought to examine the impact of ...NACT on surgical decision making among HR+ patients.
Methods
Our IRB‐approved breast cancer database was queried for patients who underwent NACT, including the clinicopathologic data and surgeon's pre‐ and post‐NACT assessment. Surgical conversion rate (SCR) was defined as patients ineligible for BCT prior to NACT, who were given the choice following NACT.
Results
Among 289 patients, pCR rates were highest among patients with HER2‐enriched subtype (60%) and lowest in patients with luminal A disease (4%). Overall, the BCT rate was 41%, while 28% opted for bilateral mastectomy across subtypes. Despite a low pCR, the SCR was still high (54%) among patients with the luminal A subtype.
Conclusion
Despite poor pCR rates, NACT still has potential to improve surgical outcomes among hormone receptor positive patients. The surgical conversion rate is a superior measure of the impact of NACT on surgical decision making than examining BCT rates.
Purpose
The incidence of oropharyngeal squamous cell carcinoma continues to rise with the majority of patients receiving definitive or adjunctive radiation. For patients with locoregional recurrence ...after radiation, optimal treatment involves salvage surgery. The aim of this study is to identify factors that predict survival to ultimately improve patient selection for salvage surgery.
Methods
Retrospective cohort study at an NCI-designated cancer center. We analyzed patients with a history of head and neck radiation who presented with persistent/recurrent or second primary disease requiring salvage oropharyngeal resection from 1998–2017 (
n
= 120). Patients were stratified into three classes based on time to recurrence and presence of laryngopharyngeal dysfunction. Primary outcomes were 5-year overall survival (OS) and disease specific survival (DSS).
Results
Median OS was 27 months (median follow-up 20 months). Five-year OS was 47% for class I (recurrence > 2 years), 26% for class II (recurrence ≤ 2 years), and 0% for class III (recurrence ≤ 2 years and laryngopharyngeal dysfunction), (
p
< 0.0001). Five-year DSS showed significant differences between classes (
p
< 0.0001). On multivariate analysis, class remained predictive of OS (
p
= 0.04– < 0.001) and DSS (
p
= 0.04–0.001). Adjuvant radiation after salvage surgery with negative margins showed superior OS (71% vs. 28%,
p
= 0.01) and DSS (83% vs 37%,
p
= 0.02) compared to surgery alone and was a significant predictor of improved survival on multivariate analysis (HR 0.1,
p
= 0.04).
Conclusion
This study identified a subset of patients with oropharyngeal cancer recurrence within two years of initial treatment and with laryngopharyngeal dysfunction who have poor outcomes for salvage surgery.
Abstract
The validity of hemoglobin
A
1c (
HgbA1c
) is undergoing increasing scrutiny in the advanced
CKD
/
ESRD
(chronic kidney disease/end‐stage renal disease) population, where it appears to be ...discordant from other glycemic indices. In the Glycemic Indices in Dialysis Evaluation (
GIDE
) Study, we sought to assess correlation of
HgbA1c
with casual glucose, glycated albumin, and serum fructosamine in a large group of diabetic patients on dialysis. From 26 dialysis facilities in the
U
nited
S
tates, 1758 diabetic patients (hemodialysis = 1476, peritoneal dialysis = 282) were enrolled in the first quarter of 2013. The distributions of
HgbA1c
and the other glycemic indices were analyzed. Intra‐patient coefficients of variation and correlations among the four glycemic indices were determined. Patients with low
HgbA1c
values were both on higher erythropoietin (
ESA
) doses and more anemic. Serum glucose exhibited the highest intra‐patient variability over a 3‐month period; variability was modest among the other glycemic indices, and least with
HgbA1c
. Statistical analyses inclusive of all glycemic markers indicated modest to strong correlations.
HgbA1c
was more likely to be in the target range than glycated albumin or serum fructosamine, suggesting factors which may or may not be directly related to glycemic control, including anemia,
ESA
management, and iron administration, in interpreting
HgbA1c
values. These initial results from the
GIDE
Study clarify laboratory correlations among glycemic indices and add to concerns about reliance on
HgbA1c
in patients with diabetes and advanced kidney disease.
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