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Dose-escalation study of tabalumab with bortezomib and dexamethasone in Japanese patients with multiple myeloma
Today, 28 Ιουνίου 2016, 44 minutes ago
Abstract
B-cell activating factor (BAFF) promotes the survival and adhesion of multiple myeloma (MM) cells. Tabalumab (LY2127399) is an anti-BAFF monoclonal antibody. This phase 1, multicenter, open-label, nonrandomized, dose-escalation study evaluated the safety, tolerability, pharmacokinetics, pharmacodynamics, and efficacy of tabalumab in combination with bortezomib and dexamethasone in Japanese patients with relapsed or refractory MM (RRMM). Sixteen patients received intravenous (IV) tabalumab 100 mg (Cohort 1, n=4) or IV tabalumab 300 mg (Cohort 2, n=12) in combination with oral dexamethasone 20 mg/day and IV or subcutaneous (SC) bortezomib 1.3 mg/m2. All patients had treatment-emergent adverse events (TEAEs) possibly related to study treatment; the most common TEAEs were thrombocytopenia (81.3%), lymphopenia (43.8%), and increased alanine aminotransferase (43.8%). Two (20.0%) dose-limiting toxicities were observed, both in Cohort 2 (tabalumab 300 mg), which was below the predefined cutoff for tolerability (< 33%). The pharmacokinetics of tabalumab were similar when bortezomib was coadministered IV vs SC. The overall response rate was 56.3%, suggesting that the combined treatment was effective. In conclusion, combined treatment with these 3 agents was well tolerated in this population of Japanese patients with RRMM. The study was registered at http://ift.tt/PmpYKN (NCT01556438).
This article is protected by copyright. All rights reserved.
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Couple Functioning after Pediatric Cancer Diagnosis: A Systematic Review
Today, 28 Ιουνίου 2016, 1 hour ago
Abstract
Objectives
A systematic review was conducted to: 1) investigate couple functioning after a pediatric cancer diagnosis, and 2) examine theoretical and methodological tendencies and issues in this literature.
Methods
Searches of Web of Science, Pubmed, Cochrane, PsycInfo and Embase resulted in inclusion of 32 qualitative, quantitative or mixed method papers. Findings of these papers were extracted for summary.
Results
Most couples adapt well to the crisis of a pediatric cancer diagnosis in domains such as emotional closeness, support, marital satisfaction and general marital adjustment. However, most experience difficulties in the domain of sexual intimacy and reports on conflict are mixed across qualitative and quantitative studies.
Conclusions
This review illustrates the need for future research with a greater focus on the impact of a pediatric cancer diagnosis on the couple’s functioning, conducted with use of appropriate theoretical frameworks and based on both partners’ reports. Improvements in research are needed to best inform couple-based interventions.
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Physical and Psychological Correlates of High Somatic Symptom Severity in Chinese Breast Cancer Patients
Today, 28 Ιουνίου 2016, 1 hour ago
Abstract
Objective
We researched associations between somatic symptom severity (SSS), physical and psychological factors in Chinese breast cancer patients.
Methods
This multicenter cross-sectional study enrolled 255 Chinese breast cancer patients of different stages and treatment phases. They answered standard instruments assessing SSS (PHQ-15), depression (PHQ-9), anxiety (GAD-7), health anxiety (WI-7), illness perception (Brief-IPQ), illness attribution (IPQ-R) and sense of coherence (SOC-9). Logistic regression was applied to identify the strongest correlates with SSS.
Results
Our sample of high (PHQ-15 ≥ 10) and low SSS differed significantly in the following physical and psychological variables: symptom duration (r = .339, p < .001), symptom-related disability (Karnofsky index) (r = .182, p < .001); depression (r = .556, p < .001), anxiety (r = .433, p < .001), health anxiety (r = .400, p < .001), illness perception (r = .349, p < .001), psychological illness attributions (r = .217, p < .01) and sense of coherence (r = -.254, p < .001). In an adjusted stepwise multiple binary logistic regression analysis higher health anxiety (WI-7, B = 0.388, p = .002), higher depression (PHQ-9, B = 0.158, p < .001), younger age (B = -0.042, p = .048), higher impairment in daily life (B = 1.098, p = .010) and longer symptom duration (Wald = 18.487, p = .001) showed a significant association with high SSS; the model explained 55.1% of the variance.
Conclusions
High somatic symptom burden in breast cancer is associated with physical and psychosocial features. The results are a basis for further research to evaluate the new DSM-5 SSD concept in cancer patients and to better operationalize psychobehavioural factors in this patient group.
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Couple Functioning after Pediatric Cancer Diagnosis: A Systematic Review
Today, 28 Ιουνίου 2016, 1 hour ago
Couple Functioning after Pediatric Cancer Diagnosis: A Systematic Review: Abstract
Objectives
A systematic review was conducted to: 1) investigate couple functioning after a pediatric cancer diagnosis, and 2) examine theoretical and methodological tendencies and issues in this literature.
Methods
Searches of Web of Science, Pubmed, Cochrane, PsycInfo and Embase resulted in inclusion of 32 qualitative, quantitative or mixed method papers. Findings of these papers were extracted for summary.
Results
Most couples adapt well to the crisis of a pediatric cancer diagnosis in domains such as emotional closeness, support, marital satisfaction and general marital adjustment. However, most experience difficulties in the domain of sexual intimacy and reports on conflict are mixed across qualitative and quantitative studies.
Conclusions
This review illustrates the need for future research with a greater focus on the impact of a pediatric cancer diagnosis on the couple’s functioning, conducted with use of appropriate theoretical frameworks and based on both partners’ reports. Improvements in research are needed to best inform couple-based interventions.
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Objectives
A systematic review was conducted to: 1) investigate couple functioning after a pediatric cancer diagnosis, and 2) examine theoretical and methodological tendencies and issues in this literature.
Methods
Searches of Web of Science, Pubmed, Cochrane, PsycInfo and Embase resulted in inclusion of 32 qualitative, quantitative or mixed method papers. Findings of these papers were extracted for summary.
Results
Most couples adapt well to the crisis of a pediatric cancer diagnosis in domains such as emotional closeness, support, marital satisfaction and general marital adjustment. However, most experience difficulties in the domain of sexual intimacy and reports on conflict are mixed across qualitative and quantitative studies.
Conclusions
This review illustrates the need for future research with a greater focus on the impact of a pediatric cancer diagnosis on the couple’s functioning, conducted with use of appropriate theoretical frameworks and based on both partners’ reports. Improvements in research are needed to best inform couple-based interventions.
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Physical and Psychological Correlates of High Somatic Symptom Severity in Chinese Breast Cancer Patients
Today, 28 Ιουνίου 2016, 1 hour ago
Physical and Psychological Correlates of High Somatic Symptom Severity in Chinese Breast Cancer Patients: Abstract
Objective
We researched associations between somatic symptom severity (SSS), physical and psychological factors in Chinese breast cancer patients.
Methods
This multicenter cross-sectional study enrolled 255 Chinese breast cancer patients of different stages and treatment phases. They answered standard instruments assessing SSS (PHQ-15), depression (PHQ-9), anxiety (GAD-7), health anxiety (WI-7), illness perception (Brief-IPQ), illness attribution (IPQ-R) and sense of coherence (SOC-9). Logistic regression was applied to identify the strongest correlates with SSS.
Results
Our sample of high (PHQ-15 ≥ 10) and low SSS differed significantly in the following physical and psychological variables: symptom duration (r = .339, p
Conclusions
High somatic symptom burden in breast cancer is associated with physical and psychosocial features. The results are a basis for further research to evaluate the new DSM-5 SSD concept in cancer patients and to better operationalize psychobehavioural factors in this patient group.
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Objective
We researched associations between somatic symptom severity (SSS), physical and psychological factors in Chinese breast cancer patients.
Methods
This multicenter cross-sectional study enrolled 255 Chinese breast cancer patients of different stages and treatment phases. They answered standard instruments assessing SSS (PHQ-15), depression (PHQ-9), anxiety (GAD-7), health anxiety (WI-7), illness perception (Brief-IPQ), illness attribution (IPQ-R) and sense of coherence (SOC-9). Logistic regression was applied to identify the strongest correlates with SSS.
Results
Our sample of high (PHQ-15 ≥ 10) and low SSS differed significantly in the following physical and psychological variables: symptom duration (r = .339, p
Conclusions
High somatic symptom burden in breast cancer is associated with physical and psychosocial features. The results are a basis for further research to evaluate the new DSM-5 SSD concept in cancer patients and to better operationalize psychobehavioural factors in this patient group.
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Prognosis Discussions Improve Understanding of Illness for Patients with Terminal Cancer
Today, 28 Ιουνίου 2016, 2 hours ago
New study results show that many patients with advanced, incurable cancer have a poor understanding of their prognosis or life expectancy. Fewer than one in four patients in the study reported having a recent discussion about prognosis with their oncologist, although those who did were more likely to understand the serious nature of their illness, the study showed.
“To our knowledge, our study is the first to directly address and demonstrate these associations between the timing of patient-reported prognostic discussions and improvements in illness understanding by patients,” the study authors wrote in a paper published May 23 in the Journal of Clinical Oncology.
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“To our knowledge, our study is the first to directly address and demonstrate these associations between the timing of patient-reported prognostic discussions and improvements in illness understanding by patients,” the study authors wrote in a paper published May 23 in the Journal of Clinical Oncology.
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Prognosis Discussions Improve Understanding of Illness for Patients with Terminal Cancer
Today, 28 Ιουνίου 2016, 3 hours ago
Prognosis Discussions Improve Understanding of Illness for Patients with Terminal Cancer: New study results show that many patients with advanced, incurable cancer have a poor understanding of their prognosis or life expectancy. Fewer than one in four patients in the study reported having a recent discussion about prognosis with their oncologist, although those who did were more likely to understand the serious nature of their illness, the study showed.
“To our knowledge, our study is the first to directly address and demonstrate these associations between the timing of patient-reported prognostic discussions and improvements in illness understanding by patients,” the study authors wrote in a paper published May 23 in the Journal of Clinical Oncology.
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“To our knowledge, our study is the first to directly address and demonstrate these associations between the timing of patient-reported prognostic discussions and improvements in illness understanding by patients,” the study authors wrote in a paper published May 23 in the Journal of Clinical Oncology.
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Amount of stroma is associated with mammographic density and stromal expression of oestrogen receptor in normal breast tissues
Today, 28 Ιουνίου 2016, 3 hours ago
Abstract
Following female sex and age, mammographic density is considered one of the strongest risk factors for breast cancer. Despite the association between mammographic density and breast cancer risk, little is known about the underlying histology and biological basis of breast density. To better understand the mechanisms behind mammographic density we assessed morphology, proliferation and hormone receptor status in relation to mammographic density in breast tissues from healthy women. Tissues were obtained from 2012–2013 by ultrasound-guided core needle biopsy from 160 women as part of the Karma (Karolinska mammography project for risk prediction for breast cancer) project. Mammograms were collected through routine mammography screening and mammographic density was calculated using STRATUS. The histological composition, epithelial and stromal proliferation status and hormone receptor status were assessed through immunohistochemical staining. Higher mammographic density was significantly associated with a greater proportion of stromal and epithelial tissue and a lower proportion of adipose tissue. Epithelial expression levels of Ki-67, oestrogen receptor (ER) and progesterone receptor (PR) were not associated with mammographic density. Epithelial Ki-67 was associated with a greater proportion of epithelial tissue, and epithelial PR was associated with a greater proportion of stromal and a lower proportion of adipose tissue. Epithelial ER was not associated with any tissues. In contrast, expression of ER in the stroma was significantly associated with a greater proportion of stroma, and negatively associated with the amount of adipose tissue. High mammographic density is associated with higher amount of stroma and epithelium and less amount of fat, but is not associated with a change in epithelial proliferation or receptor status. Increased expressions of both epithelial PR and stromal ER are associated with a greater proportion of stroma, suggesting hormonal involvement in regulating breast tissue composition.from Cancer via xlomafota13 on Inoreader http://ift.tt/296He8e
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Comparison between completely and traditionally retroperitoneoscopic nephroureterectomy for upper tract urothelial cancer
Today, 28 Ιουνίου 2016, 3 hours ago
Comparison between completely and traditionally retroperitoneoscopic nephroureterectomy for upper tract urothelial cancer: Abstract
Background
To evaluate the safety and efficacy of the completely retroperitoneoscopic nephroureterectomy (CRNU), a retrospectively comparative study between completely and traditionally retroperitoneoscopic nephroureterectomy (TRNU) was done in a single center.
Methods
From January 2014 to December 2014, 107 patients with upper tract urothelial cancer (UTUC) underwent CRNU. The kidney was retroperitoneoscopically dissected and the bladder cuff was cut by endoscopic gastrointestinal automatic stapler, and the specimen was removed from a 6-cm incision by posterior axillary line. Demographic, perioperative, and follow-up data were collected and compared retrospectively with 110 patients undergoing TRNU.
Results
The patients’ characteristics between the two groups were not statistically different (p > 0.05), and all patients successfully received the procedure. The mean operative time (106 ± 37.9 versus 199 ± 69.1 min, p
Conclusions
The CRNU using an endoscopic gastrointestinal automatic stapler to manage the bladder cuff is feasible and advantageous in decreasing the operative time, the blood loss, and the hospital stay. However, a larger sample and longer follow-up time will be still required.
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Background
To evaluate the safety and efficacy of the completely retroperitoneoscopic nephroureterectomy (CRNU), a retrospectively comparative study between completely and traditionally retroperitoneoscopic nephroureterectomy (TRNU) was done in a single center.
Methods
From January 2014 to December 2014, 107 patients with upper tract urothelial cancer (UTUC) underwent CRNU. The kidney was retroperitoneoscopically dissected and the bladder cuff was cut by endoscopic gastrointestinal automatic stapler, and the specimen was removed from a 6-cm incision by posterior axillary line. Demographic, perioperative, and follow-up data were collected and compared retrospectively with 110 patients undergoing TRNU.
Results
The patients’ characteristics between the two groups were not statistically different (p > 0.05), and all patients successfully received the procedure. The mean operative time (106 ± 37.9 versus 199 ± 69.1 min, p
Conclusions
The CRNU using an endoscopic gastrointestinal automatic stapler to manage the bladder cuff is feasible and advantageous in decreasing the operative time, the blood loss, and the hospital stay. However, a larger sample and longer follow-up time will be still required.
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Comparison between completely and traditionally retroperitoneoscopic nephroureterectomy for upper tract urothelial cancer
Today, 28 Ιουνίου 2016, 4 hours ago
Abstract
Background
To evaluate the safety and efficacy of the completely retroperitoneoscopic nephroureterectomy (CRNU), a retrospectively comparative study between completely and traditionally retroperitoneoscopic nephroureterectomy (TRNU) was done in a single center.Methods
From January 2014 to December 2014, 107 patients with upper tract urothelial cancer (UTUC) underwent CRNU. The kidney was retroperitoneoscopically dissected and the bladder cuff was cut by endoscopic gastrointestinal automatic stapler, and the specimen was removed from a 6-cm incision by posterior axillary line. Demographic, perioperative, and follow-up data were collected and compared retrospectively with 110 patients undergoing TRNU.Results
The patients’ characteristics between the two groups were not statistically different (p > 0.05), and all patients successfully received the procedure. The mean operative time (106 ± 37.9 versus 199 ± 69.1 min, p < 0.0001), the mean estimated blood loss (47.2 ± 82.4 versus 166.9 ± 250.9 ml, p = 0.002), and the mean hospital stay (6.1 ± 3.5 versus 8.1 ± 3.3 days, p = 0.03) of the CRNU group decreased significantly compared to the traditional group. The operative time was not affected by gender. No open conversion and major complications occurred. The surgical margin of the ureter was all negative. The mean follow-up time was 13.4 months for the CRNU group and 37.5 months for the TRNU group. All follow-up patients in the CRNU group were alive without local recurrence. No cases of port site metastasis and local recurrence were observed in both groups. Bladder tumor recurrence occurred in 4 patients of the CRNU group and 21 patients of the TRNU group.Conclusions
The CRNU using an endoscopic gastrointestinal automatic stapler to manage the bladder cuff is feasible and advantageous in decreasing the operative time, the blood loss, and the hospital stay. However, a larger sample and longer follow-up time will be still required.from Cancer via xlomafota13 on Inoreader http://ift.tt/28Yt4kQ
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Preoperative neutrophil-to-lymphocyte ratio plus platelet-to-lymphocyte ratio in predicting survival for patients with stage I–II gastric cancer
Today, 28 Ιουνίου 2016, 6 hours ago
The preoperative neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) are associated with poor prognosis of gastric cancer. We aimed to determine whether the combination of NLR and P…
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Preoperative neutrophil-to-lymphocyte ratio plus platelet-to-lymphocyte ratio in predicting survival for patients with stage I–II gastric cancer
Today, 28 Ιουνίου 2016, 6 hours ago
Preoperative neutrophil-to-lymphocyte ratio plus platelet-to-lymphocyte ratio in predicting survival for patients with stage I–II gastric cancer: The preoperative neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) are associated with poor prognosis of gastric cancer. We aimed to determine whether the combination of NLR and P…
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Critical care of patients with cancer
Today, 28 Ιουνίου 2016, 6 hours ago
ABSTRACT
The increasing prevalence of patients living with cancer in conjunction with the rapid progress in cancer therapy will lead to a growing number of patients with cancer who will require intensive care treatment. Fortunately, the development of more effective oncologic therapies, advances in critical care, and improvements in patient selection have led to an increased survival of critically ill patients with cancer. As a consequence, critical care has become an important cornerstone in the continuum of modern cancer care. Although, in many aspects, critical care for patients with cancer does not differ from intensive care for other seriously ill patients, there are several challenging issues that are unique to this patient population and require special knowledge and skills. The optimal management of critically ill patients with cancer necessitates expertise in oncology, critical care, and palliative medicine. Cancer specialists therefore have to be familiar with key principles of intensive care for critically ill patients with cancer. This review provides an overview of the state-of-the-art in the individualized management of critically ill patients with cancer. CA Cancer J Clin 2016. © 2016 American Cancer Society.
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Impact of Afirma gene expression classifier on cytopathology diagnosis and rate of thyroidectomy
Today, 28 Ιουνίου 2016, 8 hours ago
Impact of Afirma gene expression classifier on cytopathology diagnosis and rate of thyroidectomy: BACKGROUND
The Afirma gene expression classifier (GEC) assesses malignancy risk in patients with indeterminate thyroid nodules. Afirma putatively reduces costs by classifying certain nodules as benign and thereby avoiding unnecessary surgery. Prior studies have evaluated its impact exclusively on GEC-tested nodules. The objective of the current study was to analyze the effect of Afirma on 1) cytopathology diagnosis, 2) the rate of surgery, and 3) the rate of malignancy on all indeterminate nodules at a high-volume thyroid center.
METHODS
A retrospective cohort analysis of indeterminate (Bethesda III/IV) thyroid nodules from 2012 through 2014 was performed. Cases were evaluated from January 2012 to July 2013 (pre-Afirma), and from July 2013 to December 2014 (post-Afirma).
RESULTS
Of 4292 fine-needle aspirations (FNAs) performed, 13.2% were classified as indeterminate. The GEC was used in 45.3% of post-Afirma cases, with the GEC-Benign call rate at 37.1%. In comparing pre-Afirma and post-Afirma cohorts, a significant increase in Bethesda III (10.7% vs 13.4%; P<.005 and bethesda iv vs p rates were observed. conversely the incidence of ii was found to be significantly decreased rate surgery did not change between pre-afirma post-afirma cohorts nor malignancy>
CONCLUSIONS
The incidence of indeterminate FNA diagnoses significantly increased after Afirma became routinely available, whereas the incidence of benign diagnoses significantly decreased. These data suggest that Afirma may shift FNA interpretation toward Bethesda III/IV, in which molecular testing is used. Moreover, the institutional rates of surgery and malignancy did not appear to change, raising uncertainty regarding the benefits of molecular assay risk stratification. Afirma may produce unintended collateral effects, increasing the number of indeterminate FNA diagnoses while not affecting the institutional thyroidectomy rate or malignancy yield. Cancer Cytopathol 2016. © 2016 American Cancer Society.
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The Afirma gene expression classifier (GEC) assesses malignancy risk in patients with indeterminate thyroid nodules. Afirma putatively reduces costs by classifying certain nodules as benign and thereby avoiding unnecessary surgery. Prior studies have evaluated its impact exclusively on GEC-tested nodules. The objective of the current study was to analyze the effect of Afirma on 1) cytopathology diagnosis, 2) the rate of surgery, and 3) the rate of malignancy on all indeterminate nodules at a high-volume thyroid center.
METHODS
A retrospective cohort analysis of indeterminate (Bethesda III/IV) thyroid nodules from 2012 through 2014 was performed. Cases were evaluated from January 2012 to July 2013 (pre-Afirma), and from July 2013 to December 2014 (post-Afirma).
RESULTS
Of 4292 fine-needle aspirations (FNAs) performed, 13.2% were classified as indeterminate. The GEC was used in 45.3% of post-Afirma cases, with the GEC-Benign call rate at 37.1%. In comparing pre-Afirma and post-Afirma cohorts, a significant increase in Bethesda III (10.7% vs 13.4%; P<.005 and bethesda iv vs p rates were observed. conversely the incidence of ii was found to be significantly decreased rate surgery did not change between pre-afirma post-afirma cohorts nor malignancy>
CONCLUSIONS
The incidence of indeterminate FNA diagnoses significantly increased after Afirma became routinely available, whereas the incidence of benign diagnoses significantly decreased. These data suggest that Afirma may shift FNA interpretation toward Bethesda III/IV, in which molecular testing is used. Moreover, the institutional rates of surgery and malignancy did not appear to change, raising uncertainty regarding the benefits of molecular assay risk stratification. Afirma may produce unintended collateral effects, increasing the number of indeterminate FNA diagnoses while not affecting the institutional thyroidectomy rate or malignancy yield. Cancer Cytopathol 2016. © 2016 American Cancer Society.
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Variations in cancer centers’ use of cytology for the diagnosis of unresectable pancreatic cancer in the National Cancer Data Base
Today, 28 Ιουνίου 2016, 8 hours ago
Variations in cancer centers’ use of cytology for the diagnosis of unresectable pancreatic cancer in the National Cancer Data Base: BACKGROUND
Cytology is an accurate, safe, cost-effective, and guideline-recommended method for pancreatic cancer diagnosis, particularly for unresectable disease. However, to the authors’ knowledge, the frequency and determinants of its use have not been described to date. The current study examined patterns of cytological diagnosis among patients with unresectable pancreatic cancer by treatment facility type and by patient characteristics.
METHODS
The prevalence of definitive cytological diagnosis (cytology only, without confirmatory histology) versus histological diagnosis (with or without accompanying cytology) was examined in National Cancer Data Base records of 13,657 patients diagnosed with unresectable (American Joint Committee on Cancer stages III and IV) pancreatic cancer in 2011 and 2012 who did not undergo surgical treatment (mode of diagnosis could not be ascertained for surgical patients). Associations between definitive cytological diagnosis and patient and facility characteristics were assessed using multivariable marginal logistic regression models and expressed as odds ratios (OR) and 95% confidence intervals (95% CIs).
RESULTS
Overall, 26.8% of unresectable pancreatic cancer cases were definitively diagnosed with cytology. The prevalence of cytological diagnosis ranged from 16.5% in community cancer programs and 22.6% in comprehensive community cancer programs to 31.3% in academic/teaching/research cancer programs and 43.2% in National Cancer Institute-designated cancer programs (P<.001 compared with patients diagnosed in national cancer institute-designated programs those from community ci comprehensive and academic had lower odds of being cytology.>
CONCLUSIONS
Greater than 25% of unresectable pancreatic cancers were diagnosed definitively with cytology, with wide variation in its use by facility type, suggesting opportunities for quality improvement interventions that increase the use of cytology. Cancer Cytopathol 2016. © 2016 American Cancer Society.
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Cytology is an accurate, safe, cost-effective, and guideline-recommended method for pancreatic cancer diagnosis, particularly for unresectable disease. However, to the authors’ knowledge, the frequency and determinants of its use have not been described to date. The current study examined patterns of cytological diagnosis among patients with unresectable pancreatic cancer by treatment facility type and by patient characteristics.
METHODS
The prevalence of definitive cytological diagnosis (cytology only, without confirmatory histology) versus histological diagnosis (with or without accompanying cytology) was examined in National Cancer Data Base records of 13,657 patients diagnosed with unresectable (American Joint Committee on Cancer stages III and IV) pancreatic cancer in 2011 and 2012 who did not undergo surgical treatment (mode of diagnosis could not be ascertained for surgical patients). Associations between definitive cytological diagnosis and patient and facility characteristics were assessed using multivariable marginal logistic regression models and expressed as odds ratios (OR) and 95% confidence intervals (95% CIs).
RESULTS
Overall, 26.8% of unresectable pancreatic cancer cases were definitively diagnosed with cytology. The prevalence of cytological diagnosis ranged from 16.5% in community cancer programs and 22.6% in comprehensive community cancer programs to 31.3% in academic/teaching/research cancer programs and 43.2% in National Cancer Institute-designated cancer programs (P<.001 compared with patients diagnosed in national cancer institute-designated programs those from community ci comprehensive and academic had lower odds of being cytology.>
CONCLUSIONS
Greater than 25% of unresectable pancreatic cancers were diagnosed definitively with cytology, with wide variation in its use by facility type, suggesting opportunities for quality improvement interventions that increase the use of cytology. Cancer Cytopathol 2016. © 2016 American Cancer Society.
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Unspoken Ink: A Structured, Creative Writing Workshop for Adolescents and Young Adult Cancer Patients as a Psychosocial Intervention
Today, 28 Ιουνίου 2016, 8 hours ago
Unspoken Ink: A Structured, Creative Writing Workshop for Adolescents and Young Adult Cancer Patients as a Psychosocial Intervention: Journal of Adolescent and Young Adult Oncology , Vol. 0, No. 0.
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Targeting microRNAs as key modulators of tumor immune response
Today, 28 Ιουνίου 2016, 8 hours ago
Targeting microRNAs as key modulators of tumor immune response: The role of immune response is emerging as a key factor in the complex multistep process of cancer. Tumor microenvironment contains different types of immune cells, which contribute to regulate the fine balanc…
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Erratum to: Elevated MTSS1 expression associated with metastasis and poor prognosis of residual hepatitis B-related hepatocellular carcinoma
Today, 28 Ιουνίου 2016, 8 hours ago
Erratum to: Elevated MTSS1 expression associated with metastasis and poor prognosis of residual hepatitis B-related hepatocellular carcinoma: from Cancer via ola Kala on Inoreader
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miRNA-106a directly targeting RARB associates with the expression of Na+/I− symporter in thyroid cancer by regulating MAPK signaling pathway
Today, 28 Ιουνίου 2016, 8 hours ago
miRNA-106a directly targeting RARB associates with the expression of Na+/I− symporter in thyroid cancer by regulating MAPK signaling pathway: Serum miRNAs profiles between papillary thyroid carcinoma (PTC) patients with non-131I and 131I-avid lung metastases are differentially expressed. These miRNAs have to be further validated and the role of these m…
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Impact of Afirma gene expression classifier on cytopathology diagnosis and rate of thyroidectomy
Today, 28 Ιουνίου 2016, 8 hours ago
BACKGROUND
The Afirma gene expression classifier (GEC) assesses malignancy risk in patients with indeterminate thyroid nodules. Afirma putatively reduces costs by classifying certain nodules as benign and thereby avoiding unnecessary surgery. Prior studies have evaluated its impact exclusively on GEC-tested nodules. The objective of the current study was to analyze the effect of Afirma on 1) cytopathology diagnosis, 2) the rate of surgery, and 3) the rate of malignancy on all indeterminate nodules at a high-volume thyroid center.
METHODS
A retrospective cohort analysis of indeterminate (Bethesda III/IV) thyroid nodules from 2012 through 2014 was performed. Cases were evaluated from January 2012 to July 2013 (pre-Afirma), and from July 2013 to December 2014 (post-Afirma).
RESULTS
Of 4292 fine-needle aspirations (FNAs) performed, 13.2% were classified as indeterminate. The GEC was used in 45.3% of post-Afirma cases, with the GEC-Benign call rate at 37.1%. In comparing pre-Afirma and post-Afirma cohorts, a significant increase in Bethesda III (10.7% vs 13.4%; P<.005) and Bethesda IV (1.8% vs 2.9%; P<.01) rates were observed. Conversely, the incidence of Bethesda II was found to be significantly decreased (74.6% vs 68.8%; P<.001). The rate of surgery did not change significantly between pre-Afirma and post-Afirma cohorts (37.7% vs 45.1%; P = .11), nor did the malignancy rate (25.3% vs 36.0%; P = .12).
CONCLUSIONS
The incidence of indeterminate FNA diagnoses significantly increased after Afirma became routinely available, whereas the incidence of benign diagnoses significantly decreased. These data suggest that Afirma may shift FNA interpretation toward Bethesda III/IV, in which molecular testing is used. Moreover, the institutional rates of surgery and malignancy did not appear to change, raising uncertainty regarding the benefits of molecular assay risk stratification. Afirma may produce unintended collateral effects, increasing the number of indeterminate FNA diagnoses while not affecting the institutional thyroidectomy rate or malignancy yield. Cancer Cytopathol 2016. © 2016 American Cancer Society.
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