Benjamin Powers

Examining rectal carcinoids in the era of screening colonoscopy: a surveillance, epidemiology, and end results analysis.

BACKGROUND: Little is known about the epidemiology of rectal carcinoids in the United States since the implementation of screening colonoscopy. OBJECTIVE: The goal of this study was to identify epidemiological differences between rectal and small intestinal carcinoids. DESIGN: This study was retrospective in design. SETTING: Surveillance, Epidemiology and End Results registry data from 1992 to 2008 were examined. PATIENTS: Patients with rectal carcinoids included those with carcinoid tumors of the rectum. Patients with small intestinal carcinoids included those with carcinoids in the duodenum, jejunum, or ileum. MAIN OUTCOME MEASURE: Epidemiological characteristics of rectal carcinoids were identified and compared with small intestinal carcinoids using multiple variable logistic regression. RESULTS: Patients with rectal carcinoids were more likely to be women (OR, 1.196 (95% CI, 1.090–1.311); p < 0.001). Rectal carcinoids were more common among all minorities, including Asians (OR, 10.063 (95% CI, 8.330–12.157); p < 0.001), blacks (OR, 1.994 (95% CI, 1.770–2.246); p < 0.001), and Hispanics (OR, 2.682 (95% CI, 2.291–3.141), p < 0.001). Patients in the 50- to 59-year age group (OR, 0.752 (95% CI, 0.599–0.944); p = 0.014) were more likely to be diagnosed with rectal carcinoids than those in the 60- to 69-year (OR, 0.481 (95% CI, 0.383–0.605); p < 0.001) and ≥70-year age groups (OR, 0.220 (95% CI, 0.175–0.277); p < 0.001). Rectal carcinoids were more likely to be diagnosed in the screening colonoscopy era among the 50- to 59-year age group (OR, 1.432 (95% CI, 1.082–1.895); p = 0.012). Since the implementation of screening colonoscopy in 2000, the proportion of patients diagnosed with rectal carcinoids has been greater than the proportion diagnosed with small intestinal carcinoids in every year except 2001, and the proportion of patients diagnosed with rectal carcinoids after 2000 has been greater than the proportion diagnosed with small intestinal carcinoids in 12 of 13 Surveillance, Epidemiology, and End Results registry reporting agencies. CONCLUSIONS: Rectal carcinoids and small intestinal carcinoids are epidemiologically distinct tumors with unique presentations. In the era of screening colonoscopy, rectal carcinoids are the more common tumor.

Challenges in the treatment of angiosarcoma: a single institution experience

BACKGROUND Angiosarcomas are rare tumors that carry poor prognosis. Because of insidious growth rate, the diagnosis is often difficult and delayed. METHODS Between 1990 and 2011, 72 (41 female, 31 male) patients were treated at our institution. Pathologic confirmation was obtained and multiple prognostic factors were evaluated for survival. RESULTS Forty-four cases were sporadic and 28 cases were secondary. In the sporadic group, 16 (36%) patients had increased sun exposure, while in the secondary group, the majority (n = 23, 82%) of patients had prior exposure to radiation. The latent period between radiation exposure and diagnosis was predictive of survival (P = .037). Presentation was delayed by more than 3 months in 41% of patients. The majority of men developed head and neck angiosarcomas (n = 15, 48.5%), while women developed breast angiosarcomas (n = 21, 51%). Median survival was prolonged in patients treated initially with surgery. CONCLUSIONS A delay in the diagnosis of angiosarcoma can affect survival. Clinical suspicion and prompt diagnosis are essential for successful multimodal therapy. Initial surgical resection with adjuvant chemotherapy provides survival advantage.

The impact of race on gastric cancer outcomes in the United States.

83 Background: Disparities in gastric cancer outcomes are well-documented. We evaluate the association of race with gastric cancer outcomes using a diverse database of patients in the U.S. Methods: SEER was queried for gastric adenocarcinoma cases from 2004-2008, excluding cardia. Logistic (LR) and Cox regressions were used for analyses. Results: 9,440 cases were analyzed: 4,134 (43.8%) Whites (W), 2,015 (21.3%) Asian-American Pacific Islanders (AP), 1,826 (19.3%) Hispanics (H), and 1,465 (15.5%) Blacks (B). Presentation: Average age was 70.1. B, H, and AP were more likely than W to present younger. AP were more likely and H less likely than W to present at a lower stage. B were more likely to have a lower grade. No differences in gender were seen. Treatment: Compared to W, AP were more likely to have surgery. AP, H, and B were more likely to receive radiation (XRT). AP and H had increased odds of ≥15 lymph nodes examined (LNE). Survival: AP and H had improved but B had worse survival compared to W when s...

Predictors of quality radiation therapy completion after breast-conserving surgery.

210 Background: Quality radiation therapy completion (QRTC) is critical to quality breast conserving treatment (BCT). Our aim was to identify predictors of QRTC after BCT in an urban setting. METHODS Hospital Tumor Registry Data was collected for female BCT patients Stage I and II. Radiation therapy completion (RTC) was defined as 35 days or more of breast radiation. QRTC was defined as RTC of 35-49 days. Statistical analyses were performed with SPSS. RESULTS 346 patients were analyzed. Demographic data: Ethnicity: Black n=230 (66.5%), White n=63 (18.2%), Hispanic n=53 (15.3%); Age: < 50 years n=74 (21.4%), 50 - 64 years n=152 (43.9%), > 64 years n=120 (34.7%); Insurance: Medicare n=131 (37.9%), Private n=94 (27.2%), Medicaid n=121 (35.0%). Hispanics (60.4%) were more likely to have Medicaid versus blacks (33%) and whites (20.6%), p<0.001. Majority (52%) of patients live within 3 miles of treatment. More blacks (66.5%) live <3.0 miles than whites (7.9%) or Hispanics (41.5%), p<0.001. There was no significant difference in mean days of RTC by ethnicity (black 46.8, white 46.4, and Hispanic 48.1 days; p=0.75) or total RTC % (black 88.2%, white 97.9%, Hispanic 93.3%; p=0.09). However, a substantial difference was seen in QRTC % by ethnicity (black 51.8%, white 79.2%, Hispanic 57.8%; p=0.03) Multivariate logistic regression of failure to achieve QRTC found associations with black race (OR=2.67), Medicare (OR= 3.46), Medicaid (OR=2.19), and age <50 years (OR=4.13). CONCLUSIONS This study demonstrates high overall % RTC; however, it identifies significant disparities in successful QRTC. Those at greatest risk of unsuccessful QRTC were younger, Medicare or Medicaid insured, and black ethnicity. Distance was not a significant factor in this urban population. Further studies should investigate the specific barriers that may contribute to disparities in QRCT among those at risk groups. [Table: see text].

Abstract 1697: Gadd45A expression is high in luminal A and her2 human breast cancers, but frequently absent in triple negative breast cancers

Proceedings: AACR 103rd Annual Meeting 2012‐‐ Mar 31‐Apr 4, 2012; Chicago, IL Gadd45a is a stress sensor, playing an important role in tumorigenesis. Generation and side by side analysis of breast cancer prone MMTV-myc and MMTV-ras mice highlight a unique role for Gadd45a as either a suppressor or promoter of breast cancer development, employing distinct signaling pathways in response to distinct oncogenic stress stimuli. Thus, it appears that gadd45a can function to either promote or suppress breast tumor development in mice via engagement of different signaling pathways depending on the molecular nature of the activated oncogene. Extending the work to human breast cancer has provided initial, novel data, showing that Gadd45a, which is not expressed in normal breast tissue, is expressed at high levels in less aggressive breast cancers and is low or absent in more aggressive subtypes. Notably, Gadd45a is expressed at very high levels in luminal A and her2 positive breast cancers, but frequently is absent in triple negative breast cancers. Experiments are currently underway to elucidate the functional role of Gadd45a in human breast cancer. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 1697. doi:1538-7445.AM2012-1697