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ABSTRACT: INTRODUCTION: Persistent lymph node-positive disease after preoperative radiotherapy for rectal cancer is associated with adverse outcomes. We quantified mortality risks of persistent pathologic lymph nodes in lymph node-positive rectal cancer patients treated with preoperative versus postoperative chemoradiation. METHODS: This was a retrospective population-based analysis of 2,038 patients with stage III rectal cancer diagnosed 1994-2005 with follow-up through 2007 using data from the California Cancer Registry. Survival estimates were generated using the Kaplan-Meier method. Multivariate cancer-specific and overall mortality analyses were performed using Cox proportional hazard ratios with adjustment for age, gender, race/ethnicity, tumor grade, T stage, N stage, socioeconomic status, and time period (1994-1997, 1998-2001, and 2002-2005). RESULTS: Overall survival was higher among lymph node-positive patients receiving postoperative chemoradiation compared to lymph node-positive patients receiving preoperative chemoradiation (median overall survival = 87 versus 62 months, P = 0.0002). In adjusted analyses, patients with persistent lymph node-positive disease after preoperative chemoradiation treatment had increased overall (HR = 1.69; 95 % CI, 1.42-2.01) and CRC-specific (HR = 1.78; 95 % CI, 1.44-2.19) mortality risk compared to lymph node-positive disease after postoperative chemoradiation treatment. CONCLUSIONS: Stage III rectal cancer patients with persistent pathologic lymph nodes after preoperative chemoradiation represent a high-risk group, with higher mortality than those treated with postoperative chemoradiation.
Journal of Gastrointestinal Surgery 12/2012; · 2.83 Impact Factor
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ABSTRACT: Chemoprevention with the polyamine-inhibitory regimen difluoromethylornithine (DFMO) + sulindac markedly reduces risk of recurrent adenoma in colorectal adenoma patients. Obesity is associated with risk of colorectal adenoma and colorectal cancer. This study investigates how obesity influences risk of recurrent adenoma after prolonged treatment with DFMO + sulindac versus placebo.
Our analysis included subjects enrolled in the phase III colorectal adenoma prevention clinical trial investigating DFMO + sulindac versus placebo. Patients were classified by obesity (body mass index, BMI ≥ 30 kg/m(2)) status at baseline. Pearson χ(2) statistic and Mann-Whitney U test were used to compare baseline characteristics, including rectal tissue polyamine levels. Log-binomial regression analysis was used to determine the risk ratio (RR) of recurrent adenomas, adjusted for covariates and an interaction term for obesity and treatment.
The final analytic cohort was comprised of 267 patients. In separate regression models, the risk of adenoma recurrence after treatment compared to placebo was similar for obese (RR = 0.32, 95 % CI 15-71) and non-obese patients (RR = 0.27, 95 % CI 15-49). No significant interaction was detected between obesity, treatment, and risk of colorectal adenoma in the full regression model (p (interaction) = 0.91).
Obesity does not substantially modify the colorectal adenoma risk reduction ascribed to DFMO + sulindac versus placebo.
Cancer Causes and Control 08/2012; 23(10):1739-44. · 2.88 Impact Factor
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ABSTRACT: To reduce the morbidity and mortality from colorectal cancer (CRC), current clinical practice focuses on screening for early detection and polypectomy as a form of secondary prevention, complemented with surgical interventions when appropriate. No pharmaceutical agent is currently approved for use in clinical practice for the management of patients at risk for CRC. This article will review earlier attempts to develop pharmaceuticals for use in managing patients with a sporadic or genetic risk of CRC. It will also discuss therapeutic end points under evaluation in current efforts to develop drugs for treating CRC risk factors.
Expert review of gastroenterology & hepatology 08/2012; 6(4):507-17.
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ABSTRACT: Information about adenosquamous carcinoma of the colon and rectum is scarce because of its extremely low incidence.
The aim of this study was to examine the prognostic significance of a histological diagnosis of adenosquamous carcinoma in comparison with adenocarcinoma of the colon and rectum.
This study was retrospective in design.
California Cancer Registry data from 1994 through 2004 with follow-up through 2008 were analyzed.
Patients were included whose cancer of the colon and rectum, excluding the anus with a tumor histology of adenocarcinoma and adenosquamous carcinoma, was surgically treated.
The primary outcomes measured were histology-specific survival analyses (with the use of the Kaplan-Meier method), and overall and colorectal-specific mortality (with the use of multivariable Cox proportional hazards regression analyses).
A total of 111,263 adenocarcinoma and adenosquamous carcinoma of colon and rectal cancer cases were identified (adenocarcinoma, 99.91%; adenosquamous carcinoma, 0.09%). There was no significant difference in sex, age, race, and socioeconomic status between the 2 groups. The most common location of adenocarcinoma and adenosquamous carcinoma was the right and transverse colon. The adenosquamous carcinoma group was significantly associated with a higher rate of metastasis at the time of operation (adenosquamous carcinoma, 36.56% vs adenocarcinoma, 13.92%) and with poorly differentiated tumor grade (adenosquamous carcinoma, 65.96% vs adenocarcinoma, 19.74%) in comparison with the adenocarcinoma group. The median overall survival time was significantly greater in the adenocarcinoma group (82.4 months) in comparison with the adenosquamous carcinoma group (35.3 months). With the use of multivariable hazard regression analyses, adenosquamous carcinoma histology was independently associated with increased overall mortality (hazard ratio, 1.67) and colorectal-specific mortality (hazard ratio, 1.69) in comparison with adenocarcinoma.
This is one of the largest studies of adenosquamous carcinoma of the colon and rectum to date. This uncommon colorectal cancer subtype was associated with higher overall and colorectal-specific mortality in comparison with adenocarcinoma. Among colorectal cancer cases, adenosquamous carcinoma histology should be considered a poor prognostic feature.
Diseases of the Colon & Rectum 05/2012; 55(5):509-14. · 3.13 Impact Factor
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ABSTRACT: Chordoma is the most common primary malignant tumor of the spine. It is extremely rare and has been studied primarily in single-institution case series. Using data from a large, population-based cancer registry, we designed the present study to examine the outcome for patients with chordoma and to determine relevant prognostic factors.
A retrospective analysis of the California Cancer Registry database was performed to identify patients with a diagnosis of chordoma in the years 1989 to 2007. Comparisons examined differences in demographics, disease characteristics, treatment, and survival. Survival analyses were performed with use of the Kaplan-Meier method with log-rank tests and Cox proportional hazards models.
Four hundred and nine patients with chordoma were identified; 257 (62.8%) were male and 152 (37.2%) were female. With regard to racial or ethnic distribution, 266 patients (65%) were white; ninety-three (22.7%), Hispanic; forty-three (10.5%), Asian or other; and seven (1.7%), black. The site of presentation was the head in 202 patients (49.4%), spine in 106 patients (25.9%), and pelvis and/or sacrum in 101 patients (24.7%). Hispanic race (p = 0.0002), younger age (less than forty years; p < 0.0001), and female sex (p = 0.009) were associated with cranial presentation, whereas older age (forty years or older; p < 0.0001) was associated with pelvic presentation. After adjustment for clinically relevant factors, a significantly decreased risk of death for chordoma-specific survival was seen for Hispanic race (hazard ratio = 0.51, 95% confidence interval [95% CI], 0.28 to 0.93; p = 0.03), high socioeconomic status (hazard ratio = 0.8, 95% CI, 0.67 to 0.95; p = 0.01), and local excision and/or debulking (hazard ratio = 0.38, 95% CI, 0.18 to 0.81; p = 0.01). Large tumor size was independently associated with an increased risk of death (hazard ratio = 2.05, 95% CI, 1.01 to 4.20; p = 0.048).
In this study, the survival of patients with chordoma was significantly better for those who were Hispanic and had a small tumor, high socioeconomic status, and surgical intervention.
The Journal of Bone and Joint Surgery 02/2012; 94(4):356-63. · 3.27 Impact Factor
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ABSTRACT: Dietary arginine and meat consumption are implicated in colorectal cancer (CRC) progression via polyamine-dependent processes. Polymorphism in the polyamine-regulatory gene, ornithine decarboxylase 1 (Odc1, rs2302615) is prognostic for CRC-specific mortality. Here, we examined joint effects of meat consumption and Odc1 polymorphism on CRC-specific mortality.
The analytic cohort was comprised of 329 incident stage I-III CRC cases diagnosed 1994-1996 with follow- up through March 2008. Odc1 genotyping was conducted using primers that amplify a 172-bp fragment containing the polymorphic base at +316. Dietary questionnaires were administered at cohort entry. Multivariate Cox proportional hazards regression analysis for CRC-specific mortality was stratified by tumor, node, metastasis (TNM) stage, and adjusted for clinically relevant variables, plus meat consumption (as a continuous variable, i.e., the number of medium-sized servings/week), Odc1 genotype, and a term representing the meat consumption and Odc1 genotype interaction. The primary outcome was the interaction of Odc1 and meat intake on CRC-specific mortality, as assessed by departures from multiplicative joint effects.
Odc1 genotype distribution was 51% GG, 49% GA/AA. In the multivariate model, there was a significant interaction between meat consumption and Odc1 genotype, P-int = 0.01. Among Odc1 GA/AA CRC cases in meat consumption Quartiles 1-3, increased mortality risk was observed when compared to GG cases (adjusted hazards ratio (HR) = 7.06 [95% CI 2.34-21.28]) - a difference not found among cases in the highest dietary meat consumption Quartile 4.
Effects of meat consumption on CRC-specific mortality risk differ based on genetic polymorphism at Odc1. These results provide further evidence that polyamine metabolism and its modulation by dietary factors such as meat may have relevance to CRC outcomes.
Journal of Carcinogenesis 01/2012; 11:17.
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ABSTRACT: Lymph node retrieval is an independent prognostic factor for survival in rectal cancer. Preoperative radiotherapy has been shown to impact the number of lymph nodes retrieved.
This study aimed to analyze colorectal cancer-specific mortality and overall mortality associated with the number of lymph nodes retrieved in relation to use and timing of radiotherapy.
This study was designed as a retrospective analysis.
Analysis of the California Cancer Registry was conducted.
Patients with rectal cancer from 1994 to 2006 with a follow-up until January 2008 were included.
The number of lymph nodes (1-3, 4-6, 7-11, ≥ 12) stratified by stage (I, II, and III) was analyzed based on radiotherapy status (no radiotherapy, preoperative radiotherapy, and postoperative radiotherapy). Multivariate colorectal cancer-specific survival and overall mortality analyses were performed using Cox proportional-hazard ratios.
A total of 17,670 incident cases of stage I, II, and III rectal cancer were identified. The number of lymph nodes retrieved in cases receiving preoperative radiotherapy was lower than others. In stage II cases receiving preoperative radiotherapy, retrieval of 7 to 11 lymph nodes (compared with 0 lymph nodes retrieved as a reference) reached the nadir of colorectal cancer-specific mortality benefit (HR = 0.39, 95% CI, 0.28-0.56) and overall mortality (HR = 0.62, 95% CI, 0.48-0.80). In stage II cases with no radiotherapy or postoperative radiotherapy, retrieval of ≥ 12 lymph nodes remained the strongest prognosticator of colorectal cancer-specific mortality (HR = 0.34, 95% CI, 0.25-0.46; HR = 0.36, 95% CI, 0.24-0.53 respectively).
: The California Cancer Registry does not include radiation dose and duration, chemotherapy type and dosage, margin status and surgeon characteristics, and stated reasons for lower number of lymph nodes retrieved or patient-related factors. In addition, no central pathology laboratory was used.
In stage II rectal cancer cases receiving preoperative radiotherapy vs either postoperative or no radiotherapy, a lower threshold of lymph node retrieval may be sufficient to evaluate prognosis and to guide further therapy.
Diseases of the Colon & Rectum 05/2011; 54(5):526-34. · 3.13 Impact Factor
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ABSTRACT: Hormone-receptor (HR) and HER2/neu-receptor (HER2) status of breast tumors are important indicators for targeted therapies. We examine the association of receptor status and risk for a second breast cancer.
We analyzed data on 106,331 women in the California Cancer Registry whose first cancer is locoregional invasive breast disease, diagnosed from 1999 through 2005, yielding 1,613 second primary breast cancers. Standardized incidence ratios (SIR) with 95% confidence intervals (CIs) were used to evaluate risk of second tumors, accounting for age at first diagnosis, duration at risk, and race/ethnicity.
Among non-Hispanic whites, HR-positive first tumors signal a reduction in risk for second breast cancers (SIR = 0.83, 95% CI: 0.77-0.89) whereas HR-negative status signals elevated risk (SIR = 1.48, 95% CI: 1.29-1.70). Asian/Pacific Islanders, African Americans, and Hispanics are at elevated risk of second breast cancers regardless of HR status of the first tumor. Hispanics with HR-negative first tumors are at greater risk than those with HR-positive disease (HR(-): SIR = 3.76, 95% CI: 2.97-4.71; HR(+): SIR = 1.86, 95% CI: 1.56-2.20). HER2 status does not differentiate risk for second tumors in any group examined.
HR status of a first breast cancer is a marker for risk of a second breast cancer. HER2 status does not seem to be a marker of risk for a second breast cancer. Risk differences across race/ethnic groups by HR status suggest heterogeneity of breast cancers across race/ethnicity.
These data suggest that HR status may be helpful in shaping strategies to reduce risk of a second breast cancer, while HER2 status seems uninformative for this purpose.
Cancer Epidemiology Biomarkers & Prevention 03/2011; 20(2):389-96. · 4.12 Impact Factor
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Jason A Zell
Journal of Carcinogenesis 01/2011; 10:8.
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ABSTRACT: Patients with history of colorectal cancer (CRC) are at increased risk for developing a second primary colorectal cancer (SPCRC) as compared to the general population. However, the degree of risk is uncertain. Here, we attempt to quantify the risk, using data from the large population-based California Cancer Registry (CCR).
We analyzed the CCR data for cases with surgically-treated colon and rectal cancer diagnosed during the period 1990-2005 and followed through up to January 2008. We excluded those patients diagnosed with metastatic disease and those in whom SPCRC was diagnosed within 6 months of the diagnosis of the primary CRC. Standardized incidence ratios (SIR) with 95% confidence intervals (CI) were calculated to evaluate risk as compared to the underlying population after taking into account age, sex, ethnicity, and time at risk.
The study cohort consisted of 69809 cases with colon cancer and 34448 with rectal cancer. Among these patients there were 1443 cases of SPCRCs. The SIR for developing SPCRC was higher in colon cancer survivors (SIR=1.4; 95% CI: 1.3 to 1.5) as compared to the underlying population. The incidence of SPCRC was also higher in females (SIR=1.5; 95% CI: 1.3 to 1.6) and Hispanics (SIR=2.0; 95% CI: 1.7 to 2.4) with primary colon cancer. The SIR for developing an SPCRC was higher only among those whose initial tumor was located in the descending colon (SIR=1.6; 95% CI: 1.3 to 2.0) and proximal colon (SIR=1.4; 95% CI: 1.3 to 1.6).
Our results confirm that CRC patients, especially females and Hispanics, are at a higher risk of developing SPCRC than the general population. Differential SPCRC risk by colorectal tumor subsite is dependent on gender and ethnicity, underscoring the heterogeneous nature of CRC.
Journal of Carcinogenesis 01/2011; 10:6.
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ABSTRACT: Pancreatic adenosquamous carcinoma has historically been characterized as having a more aggressive clinical course than ductal adenocarcinoma. The natural history of this disease, however, is essentially unknown.
We evaluated the clinical characteristics of all patients with pancreatic adenosquamous carcinoma recorded in the California Cancer Registry 2000-2007 and compared them to those of patients with ductal adenocarcinoma.
Ninety-five patients with pancreatic adenosquamous carcinoma and 14,746 patients with ductal adenocarcinoma were identified. Demographics were similar between subtypes (p > 0.05). Disease stage at presentation was also similar; over 50% of each diagnostic group presented with metastatic disease (p = 0.62). Surgical resection was more common among patients with locoregional adenosquamous carcinoma than adenocarcinoma (p = 0.0004), but rates of adjuvant therapy administration were similar (p > 0.05). The cohorts' median overall survival durations were similar in a Cox proportional hazards model (p = 0.45); overall survival was also similar when only patients with resected disease were considered (p = 0.65). Early stage, resection and receipt of radiation or chemotherapy were favorable independent prognostic factors among patients with adenosquamous carcinoma. The median overall survival duration of patients with resected adenosquamous carcinoma was 12 months (95% CI, 8-52).
Adenosquamous carcinoma has a natural history similar to that of ductal adenocarcinoma when treated with prevalent clinical patterns of care.
Journal of Gastrointestinal Surgery 11/2010; 15(1):165-74. · 2.83 Impact Factor
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ABSTRACT: The ornithine decarboxylase-1 (ODC1) polymorphism at position +316 affects binding by transcriptional activators and repressors and modulates the risk of metachronous colorectal adenomas, particularly in association with aspirin use. We investigated the effects of ODC1 after treatment with difluoromethylornithine (eflornithine)/sulindac or placebo. Two hundred twenty-eight colorectal adenoma patients in a randomized phase III trial were genotyped for ODC1. We used Wilcoxon rank sums tests on non-normally distributed continuous variables across two genotype groups, χ(2) or Fisher exact test to assess the association between baseline categorical variables and genotype group, and log binomial regression for the primary (adenoma recurrence) and secondary outcomes (tissue polyamine response, cardiovascular toxicity, gastrointestinal toxicity, and ototoxicity). All statistical tests were two-sided. In binomial regression models with variables age, sex, race, aspirin use, treatment, and ODC1 genotype, treatment was the only statistically significant factor associated with differences in adenoma recurrence or tissue polyamine response. A statistically significant interaction was detected between ODC1 genotype and treatment with respect to adenoma recurrence (placebo group: GG, 50%, AA/GA: 34%; treatment group: GG, 11%, AA/GA, 21%; P(interaction) = .038). Excess ototoxicity was observed among ODC1 AA patients receiving treatment, but the interaction of genotype and treatment on ototoxicity was not statistically significant (P = .45).
CancerSpectrum Knowledge Environment 10/2010; 102(19):1513-6. · 14.07 Impact Factor
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ABSTRACT: We investigated the association between hypertension, antihypertensive (AH) medication use, and breast cancer in a large prospective study, the California Teachers Study (CTS).
Information on history of hypertension and lifetime regular use of AH medications was collected from 114,549 women in 1995-1996. Among them, 4,151 invasive breast cancers were diagnosed between 1995 and 2006. Additional information on AH use was collected from 73,742 women in 2000-2001, and 1,714 of these women were subsequently diagnosed with breast cancer. Cox proportional hazards regression was used to estimate relative risks (RR) and 95% confidence intervals (CI) for breast cancer.
Use of AH medication for ≥5 years, when compared with no use, was associated with a modest increased risk of invasive breast cancer (RR = 1.18, 95%CI 1.02-1.36). This increased risk appeared to be confined to estrogen receptor (ER)-positive tumors (RR = 1.21, 95%CI 1.03-1.43) and pre-/peri-menopausal women (RR = 1.58, 95%CI 1.11-2.25).
Increased risk of invasive breast cancer was observed for long-term (≥5 years) AH use, and this appeared to be confined to ER + breast cancer and younger women.
Cancer Causes and Control 10/2010; 21(10):1615-24. · 2.88 Impact Factor
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ABSTRACT: Combination of polyamine and prostaglandin E2 (PGE2)-synthesis inhibitors reduced the risk of colorectal adenoma (CRA) by 70% in patients who received polypectomies. We studied effects of the combination of difluoromethylornithine (DFMO) and sulindac on biomarkers and investigated factors that modify their efficacy.
We analyzed rectal mucosal levels of polyamines (spermidine, spermine, and putrescine) and PGE2, treatment regimens, and risk of CRA in 267 participants of a phase IIb/III chemoprevention trial of DFMO/sulindac.
In the group that received DFMO/sulindac, spermidine-to-spermine ratio (Spd:Spm) in rectal mucosa decreased between baseline and 12- and 36-month follow-up examinations (0.30, 0.23, and 0.24, respectively; P < .001 for both comparisons to baseline). Putrescine levels decreased between baseline and 12 months (0.46 vs 0.15 nmol/mg protein; P < .001) but rebounded between 12 and 36 months (0.15 vs 0.36 nmol/mg protein; P = .001). PGE2 levels did not change, although aspirin use was significantly associated with lower baseline levels of PGE2. No significant associations were observed between changes in biomarker levels and efficacy. However, drug efficacy was greatest in subjects with low Spd:Spm and high PGE2 at baseline; none of these subjects, versus 39% of those given placebo, developed CRA (P < .001). Efficacy was lowest in subjects with high Spd:Spm and low PGE2 at baseline; 28% developed CRA, compared with 36% of patients given placebo (P = .563).
A combination of DFMO and sulindac significantly suppressed production of rectal mucosal polyamines but not PGE2. No relationship was found between changes in biomarker levels and response. However, baseline biomarker levels modified the effect of DFMO/sulindac for CRA prevention.
Gastroenterology 09/2010; 139(3):797-805, 805.e1. · 11.68 Impact Factor
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ABSTRACT: We have previously demonstrated, using a regional California Cancer Registry database, that Asian ethnicity is an independent favorable prognostic factor for overall survival (OS) in non-small cell lung cancer (NSCLC).
Retrospective population-based analysis of Korean and US white patients with NSCLC with known smoking status from Samsung Cancer Center, Seoul, South Korea, and a Southern California Regional Cancer Registry between 1998 and 2005 with follow-up through February 2008 to allow for even case ascertainment periods before and after 2002, when epidermal growth factor receptor tyrosine kinase inhibitors were introduced in Korea and considered as the year of reference.
A total of 4622 Korean and 8846 US white patients were analyzed. Median age of diagnosis was 63 years versus 71 years for Korean and white patients, respectively (P < 0.0001). A total of 34.5% of Korean compared with 8.2% white patients were never-smokers. There was significant OS improvement in never-smokers when compared with ever-smokers among either Korean patients (p < 0.0141) or US white (p < 0.0397), respectively. There was significant improvement in OS among Korean patients from 2002 to 2005 compared with 1998-2001 (p < 0.0001) but not among US white patients (p = 0.5641). Except for stage II patients (p = 0.0723), univariate analysis revealed Korean patients had improved OS compared with US white patients among stages I, III, and IV, respectively (all p < 0.0001). Multivariate analysis revealed Korean ethnicity (versus white; hazard ratio (HR) = 0.869; p < 0.0001) was an independent favorable factor for OS. The adjusted HR for OS Korean ethnicity when compared with white ethnicity improved during 2002-2005 (HR = 0.795; p < 0.0001) compared with 1998-2001 (HR = 0.889; p = 0.0013).
These results suggest that Korean ethnicity compared with US white ethnicity is an independent favorable prognostic factor for OS in NSCLC. In addition, greater survival benefit among Korean patients with NSCLC was noted in the postepidermal growth factor receptor tyrosine kinase inhibitor era (2002 and after) compared with US white ethnicity.
Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 08/2010; 5(8):1185-96. · 4.55 Impact Factor
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ABSTRACT: We previously reported that Asian ethnicity was a favorable prognostic factor for overall survival (OS) in non-small cell lung cancer (NSCLC). In this study, we performed a combined data analysis from a Japanese Cancer Registry and a regional California Cancer Registry to further validate this observation.
Retrospective population-based analysis of Japanese and Caucasian patients with NSCLC with known smoking status from the Japanese National Hospital Organization Study Group for Lung Cancer and a Southern California Regional Cancer Registry between 1991 and 2001.
A total of 15,185 Japanese and 13,332 US Caucasian patients were analyzed. Median age of Japanese patients was 68 years compared with 69 years for Caucasian patients (p < 0.0001). A total of 29.3% of Japanese compared with 7.3% Caucasian patients were never-smokers. Never-smoking status conferred significant improved OS for Japanese (p < 0.0001) and a trend for improved OS for Caucasian patients (p = 0.1282). Univariate analysis revealed Japanese patients with stage III (versus Caucasian; hazard ratio [HR] = 0.830, 95% confidence interval [CI]: 0.789-0.873, p < 0.0001) and IV disease (versus Caucasian; HR = 0.955, 95% CI: 0.915-0.997, p = 0.0369) had improved OS compared with Caucasian patients. Multivariate analysis revealed Japanese ethnicity (versus Caucasian; HR = 0.937, 95% CI: 0.898-0.978, p = 0.0028) and never-smoker status (versus ever-smoker; HR = 0.947, 95% CI: 0.909-0.987, p = 0.0104) to be independent favorable factors for OS in addition to younger age, female gender, early stage, and treatment received (surgery, radiation, and chemotherapy).
Japanese ethnicity when compared with Caucasian ethnicity and never-smoker status are independent favorable prognostic factors for OS in NSCLC.
Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 07/2010; 5(7):1001-10. · 4.55 Impact Factor
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ABSTRACT: A low-meat diet and regular use of nonsteroidal anti-inflammatory drugs (NSAID) have been associated with decreased mortality among colorectal cancer (CRC) patients. Here, we investigated the association between prediagnosis usual meat consumption and CRC-specific mortality, and whether meat consumption modifies the previously noted association between NSAID use and CRC-specific mortality among women in the California Teachers Study cohort. Women joining the California Teachers Study in 1995-1996 without prior CRC diagnosis, diagnosed with incident CRC during follow-up through December 2007, were eligible for inclusion. Meat intake (frequency and serving size) and NSAID use (aspirin or ibuprofen use) were ascertained via self-administered questionnaires before diagnosis. Vital status and cause of death were determined by linkage with mortality files. Multivariable Cox proportional hazards regression models were used to estimate hazard ratios for death and 95% confidence intervals. Prediagnosis meat consumption was not associated with CRC-specific mortality among 704 CRC patients (and 201 CRC-specific deaths), comparing patients in the lowest consumption tertile (0-5.4 medium-sized servings/wk) to those in the higher consumption tertiles. Regular NSAID use (1-3 times/wk, 4-6 times/wk, daily) versus none was associated with decreased CRC-specific mortality among patients in the lowest meat consumption tertile (hazard ratio, 0.22; 95% CI, 0.06-0.82), but not among patients in the higher meat intake tertiles. The previously observed mortality risk reduction among female CRC patients associated with regular NSAID use was restricted to patients who reported low meat intake before diagnosis. These findings have implications for CRC survivorship and tertiary CRC prevention.
Cancer Prevention Research 07/2010; 3(7):865-75. · 4.91 Impact Factor
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ABSTRACT: The presence of signet-ring cell component has been described as a prominent feature of EML4-ALK positive non-small cell lung cancer. We investigated the clinicopathologic features and survival outcome of primary signet-ring carcinoma (SRC) of the lung with comparison to adenocarcinoma of the lung.
Retrospective population-based analysis of histologically diagnosed primary SRC of the lung in the California Cancer Registry between 1989 and 2006 with comparison with adenocarcinoma of the lung.
Two hundred sixty-two histologically diagnosed primary SRC of the lung were compared to 50,089 patients with lung adenocarcinoma. Patients with primary SRC of the lung were significantly younger than patients with adenocarcinoma, with a significantly higher proportion of poorly differentiated tumor and stage IV disease. There was no difference in the distribution of gender and ethnicity among patients with SRC when compared to patients with adenocarcinoma. Subset analysis of patients with available smoking status revealed never smokers comprised a significantly higher proportion of patients with SRC (30.8%) when compared to patients with adenocarcinoma (11.0%; p = 0.0013). Never smokers with SRC tended to be younger with a trend to improved survival (median age = 55 years, median overall survival [OS] = 8 months) than ever smokers with SRC (median age = 59 years, median OS = 4.5 months). Patients with SRC had decreased OS (versus adenocarcinoma; unadjusted hazard ratio = 1.507; 95% confidence interval: 1.326-1.714; p < 0.0001) and was an independent unfavorable prognostic factor by multivariate analysis (versus adenocarcinoma, hazard ratio 1.214, 95% confidence interval: 1.068-1.381; p = 0.0030).
Primary SRC of the lung is a rare subtype of adenocarcinoma, carries a worse prognosis when compared to adenocarcinoma and shares many of the recently identified clinicopathologic characteristics ascribed to EML4-ALK positive non-small cell lung cancer.
Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 04/2010; 5(4):420-7. · 4.55 Impact Factor
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ABSTRACT: Ewing sarcoma is a high-grade malignancy that most often occurs in children. Because its occurrence in adults has been historically low, few studies have been published on the epidemiology of Ewing sarcoma in this group of patients. By using data from a large, population-based cancer registry, the authors designed the present study to examine the outcome of children and adult patients with Ewing sarcoma and relevant prognostic factors.
A retrospective analysis of Ewing sarcoma patient cases in the California Cancer Registry database was performed to identify incident patient cases diagnosed between 1989-2007. Comparisons were made to examine differences in demographics, disease characteristics, treatment, and survival. Survival analyses were performed using Kaplan-Meier method with log-rank tests and Cox proportional hazards models.
Seven hundred and twenty-five incident patient cases of Ewing sarcoma were identified, including 372 (51.3%) children and 353 (48.7%) adults. Hispanic race was associated with young age (P = .001) and lower socioeconomic status (SES; P = .0001). Pelvic involvement was associated with large tumor size (>8 cm; P < .0001), an increased incidence of metastasis (P < .0002), and poorer survival (P < .0001). After adjusting for clinically relevant factors, statistically significant decreased overall survival was seen with adults (hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.35-2.17), Hispanics (HR, 1.33; 95% CI, 1.01-1.75), metastatic disease (HR, 2.74; 95% CI, 2.14-3.49), large tumor size (HR, 1.65; 95% CI, 1.17-2.34), no surgical treatment, and low SES.
The authors determined that adult age, Hispanic race, metastatic disease, large tumor size, and low SES are poor prognostic factors for overall survival among Ewing sarcoma patient cases.
Cancer 02/2010; 116(8):1964-73. · 4.77 Impact Factor
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ABSTRACT: We previously reported that Asian ethnicity is a favorable prognostic factor for overall survival (OS) in non-small cell lung cancer (NSCLC) patients independent of smoking status. However, Asian ethnicity represents a diverse and heterogeneous population. In this report, we compared the clinicopathologic characteristics of Asian American NSCLC patient subgroups by smoking status.
Clinicopathologic characteristics of the five major Asian American NSCLC patient subgroups diagnosed between 1991 and 2005 from three Southern California counties were analyzed. Prognostic factors for OS were evaluated by Cox multivariate analysis.
One thousand one hundred twenty-four NSCLC patients were analyzed: Filipino American (37.0%), Vietnamese American (32.8%), Japanese American (11.8%), Chinese American (11.7%), and Korean American (6.7%). A total of 25.7% of these patients were never smokers. With the exception of Japanese American, most of Asian American were native born. Median age of never smokers was marginally younger than ever smokers (66 years versus 68 years, respectively, p = 0.0507). The proportion of never smokers who were women was 72.7% and ranged from the lowest among Korean American women (66.7%) to the highest among Japanese American women (84.2%). Among female patients, Vietnamese American patients had the highest proportion of being never smokers (65.5%). Significantly more never smokers (60.9%) than ever smokers (47.9%) presented with stage 4 disease. There was no statistical significant difference in OS between never smokers and ever smokers (11 versus 10 months; p = 0.3040). Tumor-related factors (stage and histologic differentiation) and treatment (surgery and chemotherapy) were independent prognostic factors for survival.
We found no statistical significant difference in clinicopathologic features or survival outcome between individual Asian American subgroup when analyzed according to smoking status.
Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 02/2010; 5(2):158-68. · 4.55 Impact Factor
