Gustavo Figueiredo Marcondes Westin

Characteristics and long-term outcomes of head and neck squamous cell carcinoma after solid organ transplantation

INTRODUCTION Immunosuppression after solid organ transplant prevents graft rejection, but leads to increased incidence of various malignancies including head and neck squamous cell carcinoma (HNSCC). Outcomes of patients with post-transplant HNSCC are unknown. MATERIALS AND METHODS We retrospectively identified patients who developed HNSCC after solid organ transplant between 1995 and 2010. Adults with pathology-proven HNSCC and adequate follow up were included. Median overall survival and progression free survival were analyzed using the Kaplan-Meier method. The prognostic effect of variables was studied with Cox proportional hazards models. RESULTS Thirty-three patients met study inclusion criteria. The median time to diagnosis of HNSCC after transplant was 5.9years. The primary site was oral cavity in 15 patients, oropharynx in 10, larynx in 3, hypopharynx in 2, parotid in 2 and unknown in 1 patient. Eighty-eight percent underwent upfront surgical resection. Of those, sixty-six percent received adjuvant therapy. Six percent of patients had definitive chemoradiation. Treatment was well tolerated and did not lead to graft rejection. The 5-year overall survival rate was 45% and 37% for localized and locally advanced disease respectively. Seventy-five percent of patients with oropharyngeal tumors were HPV-positive and they had better outcomes (5-year overall survival rate of 67%). In multivariate analysis, age ≥60years was a negative predictor of survival (HR 2.7; 95% CI, 1.1-6.5; P=0.03). CONCLUSIONS Patients with post-transplant HNSCC have relatively poor survival and high risk of locoregional and distant recurrence. HPV- positive oropharyngeal tumors continue to have better outcomes in this population.

Helicobacter Pylori Infection in Texas Hispanic and Non-Hispanic White Men: Implications for Gastric Cancer Risk Disparities

Chronic Helicobacter pylori (H. pylori) infection is a major gastric adenocarcinoma (GA) risk factor. GA disproportionately affects U.S. Hispanics compared with non-Hispanic Whites (NHWs). Since H. pylori infection studies in Hispanics are few, infection rates in Hispanic and NHW men in Bexar County were compared, and relationships with ethnicity and obesity examined. Age- and zip code-matched participants from a community-dwelling cohort were randomly selected. Sera from 284 men were analyzed by enzyme immunoassay for H. pylori antibodies. Adjusted risk ratio estimation for matched data was conducted to identify differences. Hispanics had a markedly higher prevalence of infection (30.3%) than NHWs (9.2%). Matched risk ratio (mRR) analyses revealed a strong association between H. pylori seropositivity and Hispanic ethnicity (mRR = 3.31; 95% CI [1.91, 5.73], adjusted by BMI, smoking status, and family history of cancer (mRR range = 3.28-3.89). BMI mRRs (range = 1.19-1.22) were significant in all models. In this cohort, Hispanic men had higher H. pylori infection rates than NHWs, and parallel the disproportionately higher rates of GA; obesity contributes to this higher prevalence. Future studies should address country of origin, acculturation, and other factors influencing obesity to further elucidate risk of GA in Hispanic populations.

Abstract B13: Gastric cancer disparities in Latino populations in Texas, South Texas, and United States

Gastric cancer (GC) is the second-leading cause of cancer-related deaths in most Western countries. US Hispanics have higher rates of GC compared to the general population. The purpose of this study was to comprehensively compare Latinos to non-Hispanic white (NHW) for all primary gastric malignant tumor incidence and trends from 1995 to 2010, in the US, TX and STX. This includes incidence rates for all GC, Gastric Adenocarcinomas (GCA) by anatomic location and morphologic type, and Gastric Non-Epithelial Tumors (GNET). This analysis will provide a population comparison for incidences of gastric malignancies at regional, state and national levels among Latinos and NHW, yielding a clear snapshot of existing GC disparities which can be used to generate novel interventions and programs. Methods: Data were collected from SEER and the Texas Cancer Registry. SEER*Stat software v 8.1.5 (SEER*Stat, 2014, National Cancer Institute) generated 1995-2010 average annual age-specific, age-adjusted, and three-year moving averages of GC, GCA, and GNET incidence rates, rate ratios (RR), annual percent changes (APCs) and 95% confidence intervals (CI) for Latino and NHW populations in the SEER, TX and STX datasets. APCs were derived using weighted least squares point-estimation; trends were tested for statistical significance using SEER*Stat. Results: Incidence rates of GC were higher in Latino than NHW men in all three geographic populations analyzed. Latinas likewise showed higher rates than NHW women. Rates were similar for both genders across all Latino populations. The male-to-female ratio was approximately 2.1 for Latinos and 1.7 for NHW, and was similar in all populations. In terms of rate ratios (RR), TX and STX displayed the greatest ethnic disparities. The largest RR for GC was in STX, comparing Latino vs. NHW men (2.31; 95% CI=2.17-2.46; p Because GCA accounts for the majority of GC, GCA incidence rates and RR were analyzed in more detail by stomach site and histology type. Intestinal was the most common type at both cardia and non-cardia sites (63%), followed by diffuse (22%) and other epithelial (OET) carcinomas (14 %). Type distributions were similar in all populations. Cardia GCA incidence rates were higher in NHW, particularly for intestinal type. In contrast, Latinos had higher incidence rates at non-cardia sites in all populations. Antrum/pylorus site had the highest rates of non-cardia GCA for intestinal and diffuse types. In this location, the most significant disparities were seen in intestinal type in TX (RR 4.28; 95% CI: 3.74-4.89) and STX (4.38; 95% CI: 3.25-5.98). The greatest disparity in the curvature site was the diffuse type in TX for both men (5.51; 95% CI: 4.04 – 7.55; p Conclusions: Our study provided a comprehensive overview of the ethnic differential distribution of gastric epithelial and non-epithelial tumors in US, TX and STX populations, as well as a detailed evaluation of GCA by histology type and stomach site. GC disparities between Latinos and NHW are more prominent in TX and STX. Latinos are at higher risk of developing GCA and GNET. Additional research is needed to further explore different contributors to these disparities. Citation Format: Edgar Munoz, Gustavo Figueiredo Westin, Dorothy Long-Parma, Lucina Suarez, Amelie G. Ramirez. Gastric cancer disparities in Latino populations in Texas, South Texas, and United States. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B13.

Clinicopathologic features and outcomes of gastrointestinal stromal tumors arising from the esophagus and gastroesophageal junction

Background Our aim was to characterize the clinicopathological features and outcomes of gastrointestinal stromal tumors (GISTs) arising from the esophagus and gastroesophageal junction (GEJ) and describe the survival of patients treated at our institution as well as from a national hospital-based registry. Methods Twenty-eight cases were identified using the Mayo Clinic Cancer Registry from 1997 to 2016, and 1,010 cases from the National Cancer Database (NCDB) between 2004 and 2014, with analysis of TNM staging, histopathological features, mitotic index, immunohistochemical studies, and KIT mutational analysis. Results At Mayo Clinic, the tumors ranged in size from 0.3-13 cm (mean 5.40 cm). IHC results were: CD117 (KIT) in 100% (23/23 cases) and DOG1 in 100% (6/6), followed by CD34 (85.7%, 12/14), smooth muscle actin (27.8%, 5/18), desmin (18.2%, 2/11), and S-100 protein (13.3%, 2/15). Mutational analysis (performed in 10 cases) showed KIT exon 11 mutations in 8 cases; KIT mutation was not identified in 2 cases (presumed wild-type). Two-thirds of patients underwent surgery, of which 70% had an esophagectomy. Fourteen patients received adjuvant imatinib mesylate. Five patients had liver metastases at the time of diagnosis; none had lymph node metastases. A total of 38.9% of cases had recurrent or metastatic disease. Complete clinical follow-up was available for 10 patients (median follow-up duration 31.5 months; range, 10-145 months): one (male) had a local recurrence at the anastomotic site and one (female) suffered a liver metastasis; the others were either disease-free or had stable disease at the time of last follow-up. There was a significant association seen among metastatic disease and mitotic count >5/50 high-powered field (HPF) (P=0.016), with median mitotic rate 90/50 HPF (range, 7-500) for metastatic tumors versus 6/50 HPF (range, 0-100) for non-metastatic tumors. For metastatic disease, median tumor size was 7.3 cm (range, 1-66 cm) compared to 4.8 cm (range, 0.02-71 cm) for non-metastatic disease, which was also statistically significant (P≤0.0001). Two hundred and fifty-eight NCDB cases were risk stratified using the Joensuu criteria. Among 89 low risk category tumors, only 2 (2.2%) were ultimately metastatic. A total of 10.9% (15/138) of high risk category tumors were metastatic. The median overall survival (OS) from the time of diagnosis for the Mayo Clinic cohort was 129.5 months (95% CI, 55.7-not reached), with 5-year OS 85.7%. Median OS for the NCDB cohort was 135.95 months (95% CI, 104.08-not reached) with 5-year OS 68.2%. Superior OS was seen in females (HR 0.67, 95% CI, 0.49-0.89, P=0.006). Conclusions Among esophageal and GEJ GISTs, metastatic disease was associated with increased mitotic count and increased tumor size. Men were found to have inferior OS. The Joensuu risk criteria were validated for risk stratification of esophageal and GEJ GISTs.

Presentation, Treatment, and Outcomes of Haitian Women With Breast Cancer in Miami and Haiti: Disparities in Breast Cancer—A Retrospective Cohort Study

Purpose We compared a cohort of Haitian immigrants with residents in Haiti with breast cancer (BC) to evaluate the effects of location on presentation, treatment, and outcomes. Patients and Methods Participants were Haitian women with BC living in Miami who presented to the University of Miami/Jackson Memorial Hospital and women with BC living in Haiti who presented to the Innovating Health International Women’s Cancer Center. The primary outcome was the relationship between location, cancer characteristics, and survival. The secondary objective was to compare our results with data extracted from the SEER database. Cox regression was used to compare survival. Results One hundred two patients from University of Miami/Jackson Memorial Hospital and 94 patients from Innovating Health International were included. The patients in Haiti, compared with the patients in Miami, were younger (mean age, 50.2 v 53.7 years, respectively; P = .042), presented after a longer duration of symptoms (median, 20 v 3 months, respectively; P < .001), had more advanced stage (44.7% v 25.5% with stage III and 27.6% v 18.6% with stage IV BC, respectively), and had more estrogen receptor (ER) –negative tumors (44.9% v 26.5%, respectively; P = .024). The percentage of women who died was 31.9% in Haiti died compared with 17.6% in Miami. Median survival time was 53.7 months for women in Haiti and was not reached in Miami. The risk of death was higher for women in Haiti versus women in Miami (adjusted hazard ratio, 3.09; P = .0024). Conclusion Women with BC in Haiti experience a significantly worse outcome than immigrants in Miami, which seems to be related to a more advanced stage and younger age at diagnosis, more ER-negative tumors, and lack of timely effective treatments. The differences in age and ER status are not a result of access to care and are unexplained.

Abstract C55: Presentation, treatment, and outcomes of Haitian women with breast cancer in Miami and Haiti: Disparities in breast cancer. A retrospective cohort study

Breast cancer diagnosis and death has risen in low to middle income countries (LMIC) in the past 20 years. Early detection, diagnosis and treatment in the LMIC setting are thought to impact morbidity and survivorship. The population of South Florida is composed of a significant portion of Afro-Caribbean immigrants from LMICs. We compared a cohort of recent Haitian immigrants with residents in Haiti who had a diagnosis of breast cancer to evaluate the effects of geographical location on presentation, treatment and outcomes. Methods: Retrospective cohort study. Participants were Haitian females with breast cancer that were living in Miami and presented to the University of Miami/Jackson Memorial Hospital (UM/JMH) between 2008 and 2014 and patients living in Haiti and presented to the Breast Cancer Treatment program at the Hospital Bernard Mevs Project Medishare (HBMPM) from 2013 to 2015 with a new diagnosis or who had been diagnosed as far back as 2008 and were presenting for continuation of care. The main outcome was the relationship between cohort location and breast cancer characteristics and cancer–specific survival by log-rank. Cox proportional hazards regression was used to compare breast cancer–specific survival overall and analyzed by stage and other significant explanatory factors. Results: 102 patients from UM/JMH and 94 patients from HBMPM were included in the analysis. The cohort in Haiti presented after longer median duration of symptoms (20 vs 3 months, p Conclusion: Haitian women diagnosed with breast cancer in Haiti experience a significantly worse outcome than Haitians living in Miami that appears to be related to a more advanced stage, younger age, more ER negative tumors and lack of timely effective treatments including restricted access to trastuzumab and radiation. In addition there is a difference in the age of breast cancer onset (Caucasian 62, African American 58, Haitian American 55, Haitian 50) and ER positivity (Caucasian 70%, African American 48%, Haitian American 74%, Haitian 55%) depending on race and ethnic group that raises the question of whether there are disparities within subgroups of women of African origin who have breast cancer. Confounding epigenetic-related variables may impact survival and they need further exploration in these populations. Citation Format: Alexandra Gomez, Vincent DeGennaro, Jr., Sophia George, Estefania Santamaria, Gustavo Westin, Gabriel Dieudina, Judith Hurley. Presentation, treatment, and outcomes of Haitian women with breast cancer in Miami and Haiti: Disparities in breast cancer. A retrospective cohort study. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C55.