Early-Onset Colorectal Cancer Is Associated with a Lower Risk of Metachronous Advanced Neoplasia than Traditional-Onset Colorectal Cancer.

BACKGROUND: Colorectal cancer (CRC) incidence in the USA has increased in adults under age 50. Current CRC surveillance guidelines do not consider age at diagnosis, and there are limited data available on outcomes from surveillance colonoscopies in early-onset CRC (EO-CRC) to guide recommendations on surveillance intervals. AIMS: To compare surveillance outcomes between EO-CRC and traditional-onset colorectal cancer (TO-CRC). METHODS: In a retrospective cohort study in a large tertiary care academic medical center, we collected data on patients with a diagnosis of CRC between 2000 and 2014 who received surgery with curative intent. We used log-rank test and inverse probability of treatment weighted Cox regression analysis to compare the development of metachronous advanced neoplasia (MAN) in patients with EO-CRC (diagnosed ages 18-49) and TO-CRC (diagnosed ages 50-75). RESULTS: Patients with EO-CRC (n = 107) were more likely to present with advanced-stage disease (62% versus 35%, p < 0.0001), rectal tumors (45% versus 27%, p < 0.01), and a family history of CRC (30% versus 16%, p = 0.02) compared to those with TO-CRC (n = 139). Patients with EO-CRC had lower risk of MAN (adjusted HR 0.44, 95% CI 0.22-0.88) than TO-CRC patients. The 5-year event rate for MAN was lower for patients with EO-CRC compared to patients with TO-CRC (5.8% vs. 16.1%, p = 0.07). The presence of synchronous neoplasia or history of diabetes was also predictive of MAN. CONCLUSIONS: EO-CRC was independently associated with a lower risk of developing MAN compared to TO-CRC. Shorter surveillance intervals may not be warranted in EO-CRC; however, large prospective studies are needed.

Integrating Tobacco Dependence Treatment into Hospital Practice Using the Rochester Model.

Purpose: Delivering evidence-based tobacco dependence treatments to hospital patients in real-world settings continues to be a challenge. To achieve long-term abstinence, a program should provide both bedside counseling and post-discharge contacts. These program features are necessary but difficult to implement due to lack of training, time and low administrative support. The Rochester Model is a tobacco treatment program using existing staff and medical students to reduce the barriers for treating hospitalized smokers. Patients and Methods: Any smoking patient admitted to a participating hospital unit can participate. Staff nurses, mid-level providers and physicians deliver the counseling steps during the admission. Nurses hold two bedside counseling sessions, while providers give quitting advice and encourage pharmacotherapy. Nurses also contribute as unit champions and post-discharge call counselors. New York State quit line counselors combined with a University of Rochester call team fulfill the post-discharge calls. The latter call team is composed of staff nurses, respiratory therapists and medical students. Results: The number of smoking patients screened was 2610 while 385 enrolled after a proof-of-concept period. The 7-day point prevalence quit rates using the as treated (patients contacted) analysis is 50% at 4 weeks, 42% at 3 months and 38% at 6 months. The 7-day point prevalence quit rates using the intent-to-treat (all patients) analysis is 23% at 4 weeks, 16% at 3 months and 14% at 6 months. Conclusion: Preliminary data on the Rochester Model is showing an effective yet affordable tobacco treatment program using hospital staff and medical students. Nurses serve as bedside counselors, unit champions and post-discharge call counselors. Hospitals, even with limited resources, can implement tobacco treatment programs using existing staff.

Ten-year Thyroid Cancer Incidence in an Integrated Healthcare Delivery System.

INTRODUCTION: The incidence of papillary thyroid cancer (PTC) has increased in recent decades, but data from community-based settings are limited. This study characterizes PTC trends in a large, integrated healthcare system over 10 years. METHODS: The annual incidence of PTC (2006-2015) was examined among Kaiser Permanente Northern California adults aged 21 to 84 years using Cancer Registry data, including tumor size and stage. Incidence estimates were age-adjusted using the 2010 US Census. RESULTS: Of 2990 individuals newly diagnosed with PTC (76.8% female, 52.7% non-Hispanic White), 38.5% and 61.5% were aged < 45 and < 55 years, respectively. At diagnosis, 60.9% had PTC tumors ≤ 2 cm, 9.2% had tumors > 4 cm, and 66.1% had Stage I disease. The annual age-adjusted incidence of PTC increased from 9.4 (95% confidence interval [CI] = 8.1-10.7) to 14.5 (95% CI = 13.1-16.0) per 100,000 person-years and was higher for female patients than for male patients. Incidence tended to be higher in Asian/Pacific Islanders and lower in Black individuals. Increasing incidence was notable for Stage I disease (especially 2006-2012) and evident across a range of tumor sizes (3.0-4.6 for ≤ 1 cm, 2.5-3.5 for 1-2 cm, and 2.4-4.7 for 2-4 cm) but was modest for large tumors (0.9-1.5 for > 4 cm) per 100,000 person-years. DISCUSSION: Increasing PTC incidence over 10 years was most evident for tumors ≤ 4 cm and Stage I disease. Although these findings may be attributable to greater PTC detection, the increase across a range of tumor sizes suggests that PTC burden might also have increased.

Risk of Mortality between Untreated and Treated Papillary Thyroid Cancer: A Matched Cohort Analysis.

OBJECTIVES: To examine the association between treatment status and mortality risk among patients with papillary thyroid cancer (PTC). METHODS: We identified 3,679 adults with PTC. Thirty-one untreated patients were matched to 155 treated patients. Hazards ratios (HR) and 95% confidence intervals (CIs) were calculated to estimate all-cause and disease-specific mortality. A low-risk subgroup was analyzed for differences in all-cause mortality. RESULTS: The adjusted HRs (95% CIs) for all-cause mortality at 5 and 10 years were 4.2 (1.7-10.3) and 4.1 (1.9-9.4) and for disease- specific mortality were 14.1 (3.4-59.3) and 10.2 (2.9-36.4), respectively, for untreated versus treated patients. The adjusted HRs (95% CIs) for all- cause mortality was 0.7 (0.1-6.4) for low-risk untreated versus matched treated patients. CONCLUSIONS: Compared to treated patients, untreated PTC patients were at higher risk of death while low-risk untreated PTC patients had comparable rate of metastasis and no increased risk of all-cause mortality. Level of evidence: 3.

Understanding the natural history of papillary thyroid cancer: Case series.

BACKGROUND: Papillary thyroid cancer (PTC) incidence continues to rise. We describe the natural history of untreated PTC patients. METHODS: Retrospective case series of 31 untreated PTC patients. RESULTS: We identified 31 untreated patients from the Kaiser Permanente Cancer Registry with PTC from 1973 to 2010. Patients were categorized as low risk (n = 16), high risk (n = 12), or low risk but medically contraindicated for surgery (n = 3). At diagnosis, 7 (58.3%) in the high-risk group had cervical lymph node metastases and 5 (41.7%) had distant metastases, compared to none in the low-risk group. Among the latter, three (18.8%) patients developed tumor growth >3 mm and one (6.3%) developed regional lymph node metastases without distant metastases. The 10-year overall survival was 71% and 35% for the low-risk and high-risk groups, respectively. CONCLUSIONS: Patients with low-risk untreated PTC were less likely to develop new regional or distant metastases and had better overall survival than patients with high-risk untreated PTC. LEVEL OF EVIDENCE: 4.

Sinonasal Ewing Sarcoma: A Case Report and Literature Review.

INTRODUCTION: Ewing sarcoma (ES) of the sinonasal tract and associated primitive neuroectodermal tumors are rare. To our knowledge, only 10 case reports of sinonasal ES of the nose or paranasal sinuses have been reported. Furthermore, there has been only 1 case of sinonasal ES arising from the middle turbinate. Recommended management of sinonasal ES stems from the management of its osseous counterpart, ES, but treatment with surgery, radiotherapy, and chemotherapy is varied. Five-year survival rates vary from 21% to 70%, with the lower rates representing patients presenting with metastatic disease. CASE PRESENTATION: A 26-year-old man presented with persistent left-sided nasal obstruction. Endoscopy demonstrated a friable mass in the left nasal cavity originating from the middle turbinate with extension into the nasopharynx, confirmed with computed tomography and magnetic resonance imaging. There was no evidence of metastatic disease on positron emission tomography-computed tomography. Histopathologic results were consistent with sinonasal ES. The result of fluorescent in situ hybridization was positive for the EWS gene translocation. A multidisciplinary tumor board evaluated the patient. The patient then underwent neoadjuvant chemotherapy, followed by definitive endoscopic surgical resection and postoperative radiotherapy. DISCUSSION: Our literature review found more involvement of the maxillary and ethmoid sinuses compared with the nasal cavity, and that the role of radiation and surgical approach was varied. ES of the sinonasal tract is a rare entity with high mortality, but few standardized treatment protocols exist. Further study and evidence-based treatment protocols are needed. This article outlines the role of relevant imaging, a multidisciplinary team approach, and the optimal timing of surgery, chemotherapy, and radiation.

Analyzing nasal septal deviations to develop a new classification system: a computed tomography study using MATLAB and OsiriX.

IMPORTANCE Accurately characterizing nasal septal deviations is valuable for surgical planning, classifying nasal septal deviations, providing a means to accurately perform outcomes research, and understanding the causes of chronic conditions. OBJECTIVE To determine and quantify regions of septal deformity that can be used to develop a comprehensive classification system. DESIGN, SETTING, AND PARTICIPANTS A retrospective case series study was conducted at an academic tertiary care hospital. Sixty-four participants were selected based on a convenience sample of computed tomography (CT) scans of the paranasal sinuses and midface available between June 29, 2011, and August 16, 2012. Exclusion criteria consisted of incomplete or inadequate CT series. The most recent CT scans were chosen for analyses regardless of the indication for imaging. Digital Imaging and Communications in Medicine format bitmap file­formatted data were obtained and analyzed using MATLAB and OsiriX. The line to curve ratio, deviation area, and root mean square (RMS) values of the septal contour vs the ideal straight septum fit were calculated. Analysis was performed to detect significant differences (P < .05) using the 3 measures.MAIN OUTCOMES AND MEASURES Quantitative analysis of nasal septal deviation.RESULTS The population consisted of 50 male and 14 female patients aged 3 to 83 years(mean, 42 years). Mean line to curve ratios, areas, and RMS values were highest in contours that intersected the perpendicular plate­vomer junction, with a mean line to curve ratio of1.04 and mean deviated area of 627.16 arbitrary units (P = .02). Maximal deviation areas were also seen midway from the perpendicular plate­vomer junction to the nasal spine with a mean area of 577.31 arbitrary units (P = .01). The RMS values were significantly elevated along the crista galli and perpendicular plate­vomer junction (P < .05).CONCLUSIONS AND RELEVANCE Maximum septal deviation is seen at the perpendicular plate­vomer junction and in the regions near the crista galli and anterior nasal spine.Deviation area and RMS values are important measures to characterize septal deviations.Understanding septal deviations can aid in developing a functional classification system of nasal septal deviations for clinical use and a means to better record and compare surgical outcomes.

Expansion and redifferentiation of chondrocytes from osteoarthritic cartilage: cells for human cartilage tissue engineering.

OBJECTIVE: To determine if selected culture conditions enhance the expansion and redifferentiation of chondrocytes isolated from human osteoarthritic cartilage with yields appropriate for creation of constructs for treatment of joint-scale cartilage defects, damage, or osteoarthritis. METHODS: Chondrocytes isolated from osteoarthritic cartilage were analyzed to determine the effects of medium supplement on cell expansion in monolayer and then cell redifferentiation in alginate beads. Expansion was assessed as cell number estimated from DNA, growth rate, and day of maximal growth. Redifferentiation was evaluated quantitatively from proteoglycan and collagen type II content, and qualitatively by histology and immunohistochemistry. RESULTS: Using either serum or a growth factor cocktail (TFP: transforming growth factor beta1, fibroblast growth factor 2, and platelet-derived growth factor type bb), cell growth rate in monolayer was increased to 5.5x that of corresponding conditions without TFP, and cell number increased 100-fold within 17 days. In subsequent alginate bead culture with human serum or transforming growth factor beta1 and insulin-transferrin-selenium-linoleic acid-bovine serum albumin, redifferentiation was enhanced with increased proteoglycan and collagen type II production. Effects of human serum were dose dependent, and 5% or higher induced formation of chondron-like structures with abundant proteoglycan-rich matrix. CONCLUSION: Chondrocytes from osteoarthritic cartilage can be stimulated to undergo 100-fold expansion and then redifferentiation, suggesting that they may be useful as a cell source for joint-scale cartilage tissue engineering.