Tumors arising within the parotid encompass a heterogeneous mix of benign and malignant neoplasms and other tissue growths. The purpose of this study was to determine the association between the ...location of intraparotid masses and the risk of malignancy. A retrospective cohort study was performed of patients diagnosed with parotid tumors following open tumor excision. The primary predictor variable was the location of the epicenter of the tumor in three-dimensional space, as determined from preoperative imaging. Other variables were patient demographics and clinical parameters. The primary outcome variable was the final histopathologic diagnosis of a benign or malignant process. A χ2 analysis was performed to test for any significant associations between demographic, clinical, and radiographic factors in relation to the outcome, and backwards stepwise logistic regression analysis was used to control for variables. Both increasing age (P = 0.002) and the presence of local pain (P = 0.020) were associated with malignancy. Tumors located anterior to the posterior border of the retromandibular vein had 2.18 times higher odds of malignancy (95% confidence interval 1.13–4.21; P = 0.020). Multivariate regression analysis suggested that patient age, the presence of pain, and tumor location anterosuperiorly and superoinferiorly could all assist in determining the odds of malignancy.
Abstract
Background
The amyloid imaging agent, 124I-AT-01 (124I-p5+14), is being developed for the diagnosis and monitoring of amyloidosis, of any type, by PET/CT imaging (1,2). PET/CT is an ...intrinsically quantitative imaging modality, and this reagent could provide a facile, first-line method for the diagnosis of amyloidosis as well as permit quantitative longitudinal imaging for monitoring progression or regression of disease, notably in the heart, of all amyloid patients. Here we describe an interim analysis of a case series of AL and ATTR patients who have been imaged at least twice with 124I-AT-01 with a minimum of 12 months between imaging (NCT designation pending). Radiotracer uptake has been quantified for the heart, liver, spleen and kidneys and changes in uptake reported.
Purpose
The goal was to quantitatively assess changes in organ-specific radiotracer uptake in AL and ATTR patients with previous cardiac uptake using manual region-of-interest methods.
Methods
The study will enroll patients with AL (n=10) and ATTR (n=10) who were previously imaged more than 12 months prior and who had positive uptake of 124I-AT-01 in the heart. To date, six patients have been imaged twice and one has had three evaluations since 2019. Patients received 37 or 74 MBq 124I-AT-01 and PET/CT imaging was performed at ∼5 h post injection. A fully manual 2D region of interest analysis was performed on three representative image views of the heart in the transaxial plane as well as the liver, spleen and kidneys. The blood pool was used as a reference tissue to determine standard uptake value ratios (SUVRmean). Changes in cardiac uptake of radiotracer were compared with contemporaneous NTproBNP measurements.
Results
The PET images were of high quality and readily interpretable and quantifiable (Figure 1A). In this early analysis of the data, both AL (n=2) and ATTR (n=4) have been evaluated. The mean time between first and second imaging was 30.3 ± 8.9 months. In the patients with ATTR amyloidosis, there was an average of a 7.9 ± 10% decrease in cardiac uptake of 124I-AT-01 after an average of 32.5 months from the first scan, in patients on silencers or stabilizers. In the AL patients, one had a 10% decrease and the other a 12% decrease in heart uptake. In some, these changes correlated with serum NTproBNP levels. A notable decrease in 124I-AT-01 binding in both AL patients was observed in the liver (45% and 59%) and spleen (75% and 73%) with one example shown in Figure 1B. No cases of increased radiotracer uptake were observed in the heart, consistent with these patients being stabilised with standard of care therapy.
Conclusion
Changes in cardiac amyloid load, based on differential uptake of radiotracer, can be seen by longitudinal imaging and quantified using 124I-AT-01 PET/CT imaging. This technique may play a valuable role not only in the early and accurate diagnosis of amyloidosis but also for monitoring changes in organ-specific amyloid load.
A multimodality approach to enhance recovery after bowel surgery is demonstrated to reduce complications and decrease patient length of stay (LOS). This study evaluates the factors that influence ...patient LOS within a formal enhanced recovery protocol. From January 2014 to December 2016, all consecutive patients admitted to one ward, who had undergone bowel resection and were enrolled in an enhanced recovery protocol, were evaluated prospectively. We entered every patient's data into the American College of Surgeons Risk Calculator (ACSRC) to compare predicted versus actual outcomes. Statistical analysis of clinical factors, patient participation, and outcomes compared with the overall LOS was performed. Of 670 bowel resections performed during the study period, a total of 127 (19%) patients met the criteria and were analyzed for comorbidities, type of surgery, complications, and participation in recovery protocols. The median length of stay (mLOS) for all patients was 4.0 days (1.8–24.6 days). Factors influencing mLOS included laparoscopic versus open surgery (P = 0.006), COPD (P = 0.003), missing 24 hours of ambulation (P < 0.001), use of patient-controlled analgesia (P = 0.011), and diagnosis of insulin-dependent diabetes mellitus (P = 0.041). Increasing the use of morphine equivalents (MEs) increased mLOS beyond the ACSRC estimate (P = 0.003). Developing a major complication increased mLOS by 8.5 times the ACSRC estimate. Conclusion: A multimodality approach to enhance surgical recovery after bowel surgery decreases the LOS. The surgical approach, participation in ambulation, insulin-dependent diabetes mellitus, and COPD influenced the overall LOS. Increasing use of morphine equivalents and developing a complication increased mLOS beyond the ACSRC preoperative risk estimates.
Abstract
Breast cancer treatments (Rx) are becoming more individualized; however, there remain patients (pts) who refuse recommended standard Rx. There is paucity of data defining the characteristics ...of these pts. Our study objective was to identify socioeconomic characteristics of pts who refuse recommended Rx and analyze their outcome.
Female pts diagnosed with IBC from 2004-2014 were selected from the NCDB. Socioeconomic characteristics and overall survival (OS) of pts who refused standard Rx (surgery, chemotherapy, anti-estrogen therapy, or radiation) were compared with an exact number of randomly matched patients who received recommended Rx. Frequency statistics, Mann-Whitney U test and logistic regression were used in statistical analyses.
There were 1772260 IBC pts; 11164 (0.6%) refused surgery; 108,486 (6.1%) refused chemotherapy; 68,995 (3.9%) refused anti-estrogen; 52,081 (2.9%) refused radiation. Pts who refused recommended Rx were significantly more likely to die, to be older, non-Caucasian race, lower income, and surprisingly higher education than pts who received recommended Rx (p<0.05).
Results reveal that older age, non-Caucasian race, and lower income were correlated with refusal of recommended Rx for IBC and consequently significantly worse OS compared to matched pts that received recommended Rx. When putting this into national perspective, this data reveals that almost 10% (˜25,000/yr) of newly diagnosed pts with IBC may choose to refuse one or more of recommended standard Rx. Further study is necessary to identify reasons for refusal and ways to minimize these events.
Surgery NOSurgery YESChemoRx NOChemoRx YESAnti-estrogen Rx NO†Anti-estrogen Rx YES†# pts11164Random 11164 / 1630429108486Random 108486 /73550168995Random 68995 / 1039320N %OSDead6004 60.91639 16.320339 21.717159 17.512445 20.58726 14.2Alive3855 398393 83.773362 78.380710 82.548254 79.552534 85.8Odds ratio for death (95%CI)7.9 (7.4-8.5)*1.3 (1.2-1.3)*1.5 (1.5-1.6)*Survival months (mean)60.87452.86053.359.1Age≤40225 2727 6.52602 2.411911 113210 4.73583 5.241-693507 31.4*7330 65.760764 56*84835 78.236477 52.9**46575 67.570+7432 66.6*3107 27.845120 41.6*11740 10.829308 42.5**18837 27.3RaceWhite8439 75.69414 84.392013 84.887256 80.459542 86.359448 86.2Black2162 19.4*1215 10.911190 10.3**15188 146408 9.3 NS6259 9.1Other408 3.7*423 3.84323 4**4953 4.62369 3.4**2639 3.8Unknown155 1.4112 1960 0.91089 1676 1649 0.9Income≤38K2239 20.31652 14.916393 15.217146 169282 13.69645 14.138K-479992580 23.4**2359 21.324195 22.5*23071 21.514594 21.3*14473 21.248K-629992845 25.8**2991 2729646 27.5*28524 26.619335 28.2*18504 2763K+3378 30.6**4067 36.737489 34.8 NS38678 3625282 36.9 NS25798 37.7% with NO high school diploma21+1834 16.61578 14.314619 13.617427 16.2809111.89354 13.713-20.92937 26.62668 24.126426 24.5*26095 24.315697 22.9*15756 237-12.93686 33.4**3695 33.437084 34.4*35198 32.823997 35*23260 34<72588 23.4**3131 28.329641 27.5*28738 26.720728 30.3*20080 29.3p<.05 *higher or **lower likelihood to refuse Rx (logistic regression, 1st category=referent) NS=Not significant; †Radiation Rx data not shown, similar trends to anti-estrogen Rx
Citation Format: Orucevic A, Heidel RE, Bell JL. Outcomes of patients with invasive breast cancer (IBC) refusing standard cancer treatments: 10-year analysis of the National cancer data base (NCDB) abstract. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-08-19.
Introduction
The microbial epidemiology differs between infective endocarditis (IE) patients with and without a history of injection drug use. We set out to determine the prevalence and microbial ...epidemiology of infective endocarditis in our region, the Southeastern USA, to determine if any changes need to be made in empiric antimicrobial treatment.
Methods
The electronic medical record was reviewed for patients with IE between January 2013 and July 2017, which revealed 299 cases. The cases were then sorted between patients with and without a history of injection drug use. The growth of their initial set of blood cultures and side of cardiac involvement were then recorded. Statistical analyses were run on the data sets.
Results
There were statistically significant effects associated with both methicillin-resistant
Staphylococcus aureus
(MRSA) and
Pseudomonas
species infections occurring more often in individuals with active injection drug use, while streptococcus and enterococcus infections were more likely to occur in the population of individuals who do not inject drugs.
Conclusion
In IE patients who use or are suspected of injection drug use, first-line broad-spectrum antibiotics with excellent MRSA and
Pseudomonas
coverage are essential.
Abstract
Oncotype DX (ODX) is a commercially available 21-gene recurrence score (RS) assay for breast cancer (BC), which has both prognostic and predictive recurrence value for estrogen ...receptor-positive (ER+)/HER2-negative (HER2-)/lymph node-negative (LN-) BC. ODX is currently endorsed for us by ASCO, the NCCN, and others for routine guideline application. The RS predicts benefit of adding adjuvant chemotherapy to hormonal manipulation. ODX is costly, a factor which contributes to the test being performed in only ∼1/3 of ER+BC in the USA. Disparities of its use in the US and other developed countries were recently published by us and others. The need for finding an accurate widely applicable, readily available surrogate for ODX is apparent. This study serves to develop and validate nomograms which can be used in place of ODX.
National Cancer Data Base (NCDB) analysis from 2010-2012 of ODX tested ER+/HER2-/LN- patients (pts) with 6-50mm tumor size was used to create nomograms for predicting a high or low ODX RS test results. Analysis of NCDB ODX tested pts in 2013 was used for external validation. Age, tumor size, grade, progesterone receptor (PR) status, lymph-vascular invasion (LVI), and the four most frequent BC histologic types were chosen as variables for creating nomograms based on the published methods (JCO, 26(8):1364-70, 2008). Logistic regression was used to generate the scores and predicted probabilities. The predictive accuracy of the regression model was yielded using a Receiver Operator Characteristic (ROC) analysis and model fit was analyzed by plotting the predicted probabilities against the actual probabilities.
Nomograms predicting a high- or low-risk ODX RS test results were created based on results from 27,719 ODX tested pts (2012-2012) and were validated on 12,763 ODX tested pts (2013) (table1).
Table 1.Points assigned for original cohort nomogram (2010-2012; N=27,719)Points assigned for external validation cohort nomogram (2013; N=12,763)Clinicopathologic CharacteristicsHigh-risk ODX RSLow-risk ODX RSHigh-risk ODX RSLow-risk ODX RSAge0.1/yr0.1/yrTumor size0.8/1mm0.9/1mmGrade 101000100Grade 240403737Grade 310001000PR Positive ≥1%076075PR Negative <1%760750LVI Yes0.5020LVI No00.502Invasive ductal carcinoma036032Invasive lobular carcinoma360320Invasive ductal and lobular317302Invasive ductal mixed with other types731230Maximum points214210C-index.89.89p value<.001<.00195%CI.88-.89.88-.90Note: actual nomogram to be published in manuscript
Grade and PR status were shown to be the highest predictors for a low- or high-risk ODX RS. The ROC curves for the probabilities of a low- or high-risk RS showed excellent agreement between the nomogram prediction and actual observation with high, acceptable C-indexes-.89 for both internal and external validation cohorts.
We created and validated nomograms that accurately predict for a high- and low-risk ODX score based on the large, National Cancer Data Base which is comprised of >1500 Commission on Cancer accredited facilities. These nomograms may serve to select pts for which further ODX testing is not necessary and may be an excellent surrogate for BC pts for which ODX testing is not available.
Citation Format: Orucevic A, Bell JL, Heidel RE. A novel nomogram model can predict oncotype DX results thus reducing healthcare expenditures abstract. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr PD7-04.
Abstract
Background
Adenosquamous carcinomas (ASQ) of the breast is rare, with a reported incidence of <1%. This tumor is considered to belong to the metaplastic breast carcinoma category and is ...commonly low grade. It has a distinct adenocarcinomatous component comprised of infiltrating small glands with varying degrees of squamous differentiation. The significance of ASQ differentiation and its impact on diagnosis, treatment and prognosis is based primarily on results from small retrospective case series reports. The objective of our study is to define prevalence, clinicopathologic characteristics, treatment patterns and prognosis of ASQ and compare these to the most frequent invasive breast carcinoma (BC), ductal (IDC), through analysis of the National Cancer Data Base (NCDB).
Methods
A retrospective observational study of NCDB patients (pts) compared all ASQ pts to the same number of randomly selected IDC pts (ICD-O-3 diagnosis codes 8560 and 8500, respectively) using SPSS software. Patients' clinicopathologic characteristics, treatment, and overall survival (OS) were analyzed using frequency statistics, t-tests, Mann-Whitney U tests, chi-square, Kaplan-Meier and logistic regression.
Results
From 1,932,688 female pts with invasive BC, 1,421,250 had IDC (73.5%); 453 had ASQ (0.0002%). ASQ pts were significantly (p<0.05) more likely to be: older, have grade 1 tumors, negative lymph nodes, ER, PR, and HER2-negative tumors when compared to IDC. No significant difference was found in tumor size, TNM stage, or treatment. ASQ pts had significantly worse 5-year OS than IDC pts (p<0.025; 73% vs 82% at 60 months, respectively).
Conclusion
Our study is the largest study to date on ASQ revealing that this unique disease is an aggressive carcinoma and carries a significantly worse prognosis than IDC. Since prospective randomized clinical trial(s) are unlikely, further studies on the genomic make-up of ASQ are needed in order to understand biology and personalize treatment of pts with this uncommon BC.
Clinicopathologic characteristics of pts with ASQ & IDC - NCDB analysis (2004-2015)DemographicsASQIDC (random sample)Adjusted Odds Ratio95% CI Lower95% CI Upper N=453N=453 N%N% Age Average63.50*60.62 Tumor Size (mm) Median18.018.0 Interquartile Range2419 Grade 1202*88Referent 44.619.4 271*185.17.12.24 15.740.8 3136*147.40.29.57 3032.5 Unknown4433 9.77.3 # of node(s) positive 0296*267Referent 65.358.9 1 to 350*72.63.42.93 11.015.9 4 to 914*31.41.21.78 3.16.8 >10910.81.332.02 2.02.2 Unknown8473 18.516.1 TNM Stage I227223Referent 50.250.2 II1461301.1.821.49 32.329.3 III3855.68.431.07 8.412.4 IV1622.71.371.40 3.55.0 Unknown2514 5.53.2 ER (+)135*359 31.481 (-)295*849.36.812.8 68.619 PR (+)61*313 14.371.1 (-)367*12714.810.520.8 85.728.9 HER2 (+)8*44 3.218 (-)240*2016.63.014.3 96.882 Surgery Yes427424 94.794.2 No2426.92.521.62 5.35.8 Chemotherapy No199206 51.751.8 Yes1861921.00.761.33 48.348.2 Hormone Therapy No308131 76.832.7 Yes93270.15.11.2 23.267.3 Radiation No210200 46.944.3 Yes238251.90.71.17 53.155.7 5-year Overall Survival Alive137*165.65.43.98 64.974 Dead74*58 35.126 *Significant (p<.05)
Citation Format: Cochrane K, Heidel RE, Bell JL, Orucevic A. Adenosquamous carcinoma of the breast, an uncommon diagnosis with poor prognosis – Lessons learned from analysis of the National Cancer Data Base 2004-2015 abstract. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-22.
Abstract
Primary neuroendocrine carcinomas of the breast (NECB) is rare (a reported incidence <5%). The significance of neuroendocrine differentiation and its impact on diagnosis, treatment and ...prognosis of NECB is controversial and based primarily on results from small retrospective case series reports. Our study objective is to define incidence, clinicopathologic characteristics, treatment patterns and prognosis of NECB and compare these to the most common invasive breast carcinoma (BC)-ductal (IDC).
A retrospective observational comparison study of NCDB patients (pts) from 2004 to 2014 compared all NECB pts with ICD-O-3 diagnosis codes 8246/3, 8041/3 and 8574/3 (well-differentiated neuroendocrine tumor, poorly differentiated/small cell carcinoma and invasive BC with neuroendocrine differentiation, respectively) to the same number of randomly selected IDC (8500/3) pts. Patients' clinicopathologic characteristics, treatment, and overall survival (OS) were analyzed using frequency statistics, chi-square, Kaplan-Meier and logistic regression.
1,790,023 pts had BC; 1,316,696=IDC (73.6%); 957=NECB (.0005%). NECB pts were significantly (p<.05) more likely to be: older, have larger tumors, grade 3 tumors, positive lymph nodes, ER, PR, HER2-negative tumors and higher TNM stage when compared to IDC. NECB pts were less likely to undergo surgery, radiation and anti-estrogen therapy. NECB pts had significantly worse 10-year OS than IDC pts (p<.001), with NECB pts being 3.4 times more likely to die in 10-years (95%CI 2.7-4.3).
Our study is the largest study to date on NECB (incidence 0.0005%) showing that NECB is aggressive and carries a significantly worse prognosis than IDC. Prospective randomized clinical trial(s) are unlikely, yet needed in order to conquer the current challenges of patients with NECB.
DemographicsNECBIDC (random sample)Adjusted Odds Ratio *=p<.0595%CI95%CI N=957N=957 LowerUpper N % Age ≤4047 4.970 7.3R 41-69564 58.9616 64.4NS ≥70346 36.2271 28.31.9*1.32.8Race White809 84.5804 84R Black118 12.3105 11NS Other21 2.239 4.1NS Unknown9 .99 .9 Tumor size mm ≤543 4.588 9.4R (tumor ≤10mm) 6-1096 10.1172 18.3R (tumor ≤10mm) 11-20196 20.6339 36.1NS 21-50382 40.2264 28.13.1*2.44.1≥51160 16.851 5.46.7*4.69.9Unknown68 7.222 2.3 Grade 193 9.7181 18.9R 2208 21.7372 38.9NS 3480 50.2360 37.62.6*1.93.5Unkown176 18.444 4.6 # of node(s) positive 0372 38.9577 60.3R 1 to 3194 20.3193 20.21.5*1.21.94 to 947 4.955 5.7NS ≥10328 34.3121 12.64.2*3.35.4Unknown16 1.711 1.1 TNM stage I245 25.6502 52.5R II334 34.9293 30.62.3*1.92.9III121 12.692 9.62.7*1.93.7IV166 17.335 3.79.7*6.514.4Unknown89 9.326 2.7 ER (+)540 62.6730 78.2R (-)322 37.4203 21.8.5*.4.6PR (+)474 55.8636 68.2R (-)375 44.2296 31.8.6*.5.7HER2 (+)15 3.474 15.4R (-)428 96.6402 84.5.2*.1.3Surgery Yes724 79.4900 95.8R No188 20.639 4.2.17*.1.2Chemotherapy No335 35409 42.7R Yes622 65548 57.31.4*1.21.7Anti-estrogen tx No460 54.6292 34.2R Yes382 45.4562 65.8.4*.4.5Radiation No444 46.4398 41.6R Yes513 53.6559 58.4.8*.6.910-year overall survival Odds ratio Dead350 40.5141 16.63.4*2.74.3Alive515 59.5710 83.4 R = Referent NS = Not significant
Citation Format: Rose CE, Heidel RE, Bell JL, Orucevic A. Primary neuroendocrine carcinoma of the breast – lessons learned from a ten year analysis of the National cancer data base (NCDB) abstract. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-08-02.
PDF
