Nadine Housri

Outcomes of Malignant CNS Ependymomas: An Examination of 2408 Cases Through the Surveillance, Epidemiology, and End Results (SEER) Database (1973–2005)

BACKGROUND Determine the role of surgery and radiation therapy for patients with malignant CNS ependymomas. METHODS The Surveillance, Epidemiology, and End Results (SEER) database (1973-2005) was queried. RESULTS Overall, a total of 2408 cases of malignant ependymomas were identified. Of these, 2132 cases (88.5%) were identified as WHO grade II ependymomas and 276 cases (11.5%) as WHO grade III (anaplastic) ependymomas. The annual incidence of ependymomas was approximately 1.97 cases per million in 2005. Overall median survival for all patients was 230 mo, with a significant difference between women and men (262 mo versus196 mo, respectively) (P=0.004). Median age at diagnosis was 37 y among females and 34 y in males. Patients who successfully underwent surgical resection had a considerably longer median survival (237 mo versus 215 mo, P<0.001) as well as a significantly improved five-year survival (72.4% versus 52.6%, P<0.001). Univariate analysis demonstrated that age, gender, ethnicity, primary tumor site, WHO grade and surgical resection were significant predictors of improved survival for ependymoma patients. Multivariate analysis identified that a WHO grade III tumor, male gender, patient age, intracranial tumor locations and failure to undergo surgical resection were independent predictors of poorer outcomes. Multivariate analysis of partially resection cases revealed that lack of radiation was a sign of poor prognosis (HR 1.748, P=0.024). CONCLUSION Surgical extirpation of ependymomas is associated with significantly improved patient survival. For partially resected tumors, radiation therapy provides significant survival benefit.

Malignant breast cancer in children: a review of 75 patients.

OBJECTIVE To determine incidence trends and outcomes for pediatric patients with malignant breast disease. METHODS The Surveillance, Epidemiology, and End Results registry was examined for all females 19 years of age and younger diagnosed with a malignant breast tumor between 1973 and 2004. RESULTS A total of 75 patients with malignant breast tumors were identified. Overall, 14.5% of patients had in situ tumors, and 85.5% had invasive disease. Tumors were classified as being either carcinomas (n = 41, 54.7%) or sarcomas (n = 34, 45.3%). The majority of sarcomatous lesions were phyllodes tumors (n = 29, 85.5%), whereas most carcinomas were of a ductal etiology (n = 19, 46.3%). The age-adjusted incidence of all malignant pediatric breast tumors in 2003 was 0.08 cases per 100,000 people (0.03 carcinoma and 0.06 sarcoma cases per 100,000 people). In the carcinoma group, regionally advanced disease was present in 11 patients (26.8%), whereas only 3 patients (7.3%) presented with metastatic disease. All patients with sarcomatous tumors presented with localized disease. Adjuvant radiation therapy was administered in only 9.8% of carcinomas and 8.8% of sarcomas, and 85.4% of carcinoma patients and 97.1% of sarcoma patients underwent surgical resection for their primary disease. Subgroup analysis revealed 5- and 10-year survival rates of 89.6% for patients with sarcomatous tumors and 63.1% and 54.3% for carcinomas. CONCLUSIONS Malignant pediatric breast malignancies remain relatively rare. The two most common histologies of breast neoplasms in children are malignant carcinomas followed by sarcomas. Although uncommon, malignant disease must be considered in the differential diagnosis of the pediatric patient with a breast mass.

Malignant abdominal mesothelioma: defining the role of surgery.

Determine the role of surgery for patients with malignant abdominal mesotheliomas (MAMs).

Are many community hospitals undertreating breast cancer?: lessons from 24,834 patients.

Objective:To compare treatment patterns and long-term outcomes between teaching and community hospitals treating patients with infiltrating ductal carcinoma (IDC). Methods:All IDCs from the Florida Cancer Data System from 1994 to 2000 were examined. Results:Overall, 24,834 operative cases of IDC were identified. Teaching hospitals treated 11.3% of patients with a larger proportion of stage III and IV disease (39.8% vs. 33.0%). Five- and 10-year overall survival rates at teaching hospitals were 84% and 72%, compared with 81% and 69% at high-volume community hospitals and 77% and 63% at low-volume hospitals (P < 0.001). The greatest differences on survival were observed in patients with advanced IDC. Examination of practice patterns demonstrated that multimodality therapy was most frequently administered in teaching hospitals. Breast-conserving surgery was more frequently performed at teaching hospitals (41.5% vs. 38.9% P = 0.008). On multivariate analysis, it was found that treatment at a teaching hospital was a significant independent predictor of improved survival (hazard ratio = 0.763, P < 0.001). This survival benefit was greater and independent of high-volume center status (hazard ratio = 0.903, P < 0.02). Conclusions:Patients with IDC treated at teaching hospitals have significantly better survival than those treated at high-volume centers or community hospitals, particularly in the setting of advanced disease. Poorer long-term outcomes for IDC at community hospitals seem to be, at least in part, because of decreased use of proven life-extending adjuvant therapies. These results should encourage community hospitals to institute changes in treatment approaches to invasive breast cancer to optimize patient outcomes.

Scientific Impact of Women in Academic Surgery

OBJECTIVE To evaluate the scientific impact of women in the surgical literature. METHODS Gender of the principal investigator of every abstract presented at the 2002, 2003, and 2004 annual meetings of the Association for Academic Surgery and Society of University Surgeons was identified by internet search. Resulting publications were identified using PubMed. Journal impact factor and number of article citations were determined using ISI Web of Knowledge. RESULTS The principal investigators gender was identified for 649 (98.8%) of the 657 abstracts presented at the 2002--2004 AAS meetings. Women authored 9.1% of abstracts and 11.8% of total resulting publications. The publication rate of abstracts by women was significantly higher than that of men (69.5% versus 52.4%, P = 0.0132). There was a trend toward higher average impact factors of journals in which female authors published (3.265 versus 2.673, P = 0.0626). There was no significant difference in mean number of citations per publication. The principal investigators gender was identified for all 337 (100%) abstracts presented at the 2002--2004 SUS meetings. Women authored 11.0% of abstracts and 11.2% of resulting publications. Publication rates and average citation numbers were similar for female and male authors. The average impact factors of journals in which women published were significantly higher (4.741 versus 3.348, P = 0.0082). CONCLUSIONS Although women comprise a small proportion of principal investigators on abstracts presented at these conferences, the quality of their presented work is equal to or better than those of their male counterparts.

Surgery does not adversely affect survival in primary gastrointestinal lymphoma

To evaluate the impact of surgery on gastrointestinal lymphoma.

Should informed consent for cancer treatment include a discussion about hospital outcome disparities

Background to the debate: Several studies have found disparities in the outcome of medical procedures across different hospitals—better outcomes have been associated with higher procedure volume. An Institute of Medicine workshop found such a “volume–outcome relationship” for two types of cancer surgery: resection of the pancreas and esophagus (http://www.iom.edu/?id=31508). This debate examines whether physicians have an ethical obligation to inform patients of hospital outcome disparities for these cancers.

SUS/AAS abstracts: what is the scientific impact?

AIM To evaluate the scientific impact of presentations at the annual meetings of the Society of University Surgeons (SUS) and the Association for Academic Surgery (AAS). METHODS All Abstracts presented at the 2002-2004 annual conferences were examined for publication rate (PR), publication citation (PC) and journal impact factor (IF). RESULTS Overall, 1200 abstracts from the SUS (n = 543,45%) and AAS (n = 657,55%) were reviewed. One way ANOVA analysis of SUS results across session types demonstrated significant differences in PR (89% plenary, 81% parallel, 100% basic science, 47% resident conference, poster 76%, p < 0.0001), but no difference in PC (12.96 plenary, 9.66 parallel, 7.77 basic science, 8.23 resident conference, 8.21 poster, p = 0.25561) or IF (4.17 plenary, 3.50 parallel, 2.66 basic science, 3.12 resident conference 3.13 poster, p = 0.3947). AAS results demonstrated significant differences for PR (81% plenary, 62% parallel and 43% poster, p < 0.0001), CR (8.33 plenary, 4.81 parallel, and 4.78 poster, p = 0.006) and IF (3.75 plenary, 2.64 parallel, and 2.73 poster, p = 0.0124). Comparison of abstracts between meetings demonstrated a higher overall PR, CR and IF for SUS publications (p < 0.0001). CONCLUSION These data suggest that SUS and AAS presentations constitute high-quality research, Trends towards higher PR, PC and IF for plenary sessions indicate that the review process properly stratifies research. Statistically higher impact measures for SUS presentations are consistent with the more mature research careers of SUS members.

Review ArticleElectronic Medical Record: A Balancing Act of Patient Safety Privacy Health Care Delivery

Abstract:With almost

Ethics and the Law: Is There Common Ground on Informed Consent for Disparities in Hospital Outcomes?

35 billion appropriated in government incentives and additional funds spent in development by institutions, the concept of an electronic patient record (EPR) within integrated health information technology (HIT) systems has taken the United States by storm. However, the United Kingdoms expensive struggle to implement a seamless EPR highlights the variety of pitfalls and unforeseen complications ranging from recognizing the importance of accurately assessing EPR-related patient risks to understanding the difficulties in the exchange of information across a gradient of distinct interfaces. Furthermore, the tenuous relationship between HIT implementation and patient outcomes in the short-term draws into question the value of EPR construction costs along with the ethical and privacy issues they create. Nonetheless, experts agree that with future software advances and physician familiarization, a robust HIT will be an important asset to patient autonomy, epidemiologic and clinical research, evidence-based error reduction and the potential for cost reduction. This article seeks to review the current status of this initiative and potential pitfalls that remain.