Gene expression profiling in prognosis of distant recurrence in HR-positive and HER2-negative breast cancer patients.

There had been several studies using gene-expression profiling in predicting distant recurrence in breast cancer. In this study, we developed an 18-gene classifier (18-GC) to predict distant recurrence of breast cancer and compared it with the 21-gene panel (Oncotype DX®, ODx) in performance. Included were 224 breast cancer patients with positive hormonal receptor (HR+) and negative human epidermal growth factor receptor 2 (HER2-). We compared the demographic, clinical, and survival information of the patients, and further compared the prediction of recurrence risk obtained by using the 18-GC with that by ODx. To have the best combined sensitivity and specificity, receiver operating characteristics (ROC) curve analysis was performed to determine the cutoff values for several breakpoint scores. For the new 18-GC, a breakpoint score of 21 was adopted to produce a combined highest sensitivity (95%) and specificity (39%) in detecting distant recurrence. At this breakpoint score, 164 of the 224 patients were classified by the 18-GC in the same risk level as by ODx, giving a concordance rate of 73%. Along with patient age and tumor stage, this 18-GC was found to be an independent significant prognostic factor of distant metastasis of breast cancer. We have thus created a new gene panel assay for prediction of distant recurrence in HR+ and HER2- breast cancer patients. With a high concordance rate with ODx, this new assay may serve as a good tool for individual breast cancer patients to make an informed decision on whether adjuvant chemotherapy should be performed post-surgery.

Survival benefit of surgical approach for advanced oropharyngeal and hypopharyngeal cancer: A retrospective analysis.

BACKGROUND: Head and neck cancer is increasingly being managed through nonsurgical approaches. Evidence comes from studies that have mainly examined patients with laryngeal cancer. Few studies, with limited sample size, have focused on the comparative outcomes of surgical and nonsurgical approaches in patients with advanced oropharyngeal or hypopharyngeal cancer. METHODS: Using a national cancer database, we identified 1603 and 1512 patients with clinical stage III/IVA oropharyngeal and hypopharyngeal cancer, respectively, treated between 2004 and 2009. The study cohort was followed until 2012, and analyzed through Kaplan-Meier survival analysis and Cox regression. RESULTS: Overall, 31.4% of patients with advanced oropharyngeal cancer and 42.2% of patients with hypopharyngeal cancer received surgery as their primary treatment. Receiving primary surgery for advanced oropharyngeal and hypopharyngeal cancer was associated with higher survival rates after controlling for potential confounders. CONCLUSION: We recommend that surgery be considered a first-line treatment for advanced oropharyngeal and hypopharyngeal cancers.

An International Collaborative Standardizing a Comprehensive Patient-Centered Outcomes Measurement Set for Colorectal Cancer.

IMPORTANCE: Global health systems are shifting toward value-based care in an effort to drive better outcomes in the setting of rising health care costs. This shift requires a common definition of value, starting with the outcomes that matter most to patients. OBJECTIVE: The International Consortium for Health Outcomes Measurement (ICHOM), a nonprofit initiative, was formed to define standard sets of outcomes by medical condition. In this article, we report the efforts of ICHOM's working group in colorectal cancer. EVIDENCE REVIEW: The working group was composed of multidisciplinary oncology specialists in medicine, surgery, radiation therapy, palliative care, nursing, and pathology, along with patient representatives. Through a modified Delphi process during 8 months (July 8, 2015 to February 29, 2016), ICHOM led the working group to a consensus on a final recommended standard set. The process was supported by a systematic PubMed literature review (1042 randomized clinical trials and guidelines from June 3, 2005, to June 3, 2015), a patient focus group (11 patients with early and metastatic colorectal cancer convened during a teleconference in August 2015), and a patient validation survey (among 276 patients with and survivors of colorectal cancer between October 15, 2015, and November 4, 2015). FINDINGS: After consolidating findings of the literature review and focus group meeting, a list of 40 outcomes was presented to the WG and underwent voting. The final recommendation includes outcomes in the following categories: survival and disease control, disutility of care, degree of health, and quality of death. Selected case-mix factors were recommended to be collected at baseline to facilitate comparison of results across treatments and health care professionals. CONCLUSIONS: A standardized set of patient-centered outcome measures to inform value-based health care in colorectal cancer was developed. Pilot efforts are under way to measure the standard set among members of the working group.

Better Overall Survival for Breast Cancer Patients by Adding Breast Ultrasound to Follow-Up Examinations for Early Detection of Locoregional Recurrence-A Survival Impact Study.

We retrospectively reviewed patient records to evaluate the effectiveness of our 15 y of ultrasound (US) surveillance of recurrent breast disease in comparison with mammography (MM) and clinical examination. From 4796 stage 0-III breast cancer patients who had received surgical treatment, we identified locoregional recurrence (LRR) in 161 patients. The mean age of the 161 patients was 48 y (27-82 y), and the mean follow-up interval was 77.2 mo (11-167 mo). The methods of LRR detection, sites of LRR and overall survival (OS) were examined. Multivariate Cox survival analysis showed significantly better survival in groups detected by US (hazard ratio = 0.6, p = 0.042). The 10-y LRR OS by detection types for US (n = 69), clinical examination (n = 78) and MM (n = 8) were 58.5%, 33.1% and 100%, respectively (p = 0.0004). US was seen with better OS associated with the effective early detection of non-palpable LRR breast cancer, which is mostly not detectable on MM.