Philip H. G. Ituarte

Development and Validation of a Prognostic Score for Intrahepatic Cholangiocarcinoma

Importance In patients with intrahepatic cholangiocarcinoma (ICC), the oncologic benefit of surgery and perioperative outcomes for large multifocal tumors or tumors with contiguous organ involvement remain to be defined. Objectives To develop and externally validate a simplified prognostic score for ICC and to determine perioperative outcomes for large multifocal ICCs or tumors with contiguous organ involvement. Design, Setting, and Participants This study of a contemporary cohort merged data from the California Cancer Registry (January 1, 2004, through December 31, 2011) and the Office of Statewide Health Planning and Development inpatient database. Clinicopathologic variables were compared between tumors that were intrahepatic, small (<7 cm), and solitary (ISS) and those that had extrahepatic extension and were large (≥7 cm) and multifocal (ELM). External validation of the prognostic model was performed using an independent data set from the National Cancer Institute’s Surveillance, Epidemiology, and End Results database from January 1, 2004, through December 31, 2013. Main Outcomes and Measures Patient overall survival after hepatectomy. Results A total of 275 patients (123 men [44.7%] and 152 women [55.3%]; median [interquartile range] age, 65 [55-72] years) met the inclusion criteria. No significant differences in overall complication rate (ISS, 48 [34.5%]; ELM, 37 [27.2%]; P = .19) and mortality rate (ISS, 10 [7.2%]; ELM, 6 [4.4%]; P = .32) were found. A multivariate Cox proportional hazards model demonstrated that multifocality, extrahepatic extension, grade, node positivity, and age greater than 60 years are independently associated with worse overall survival. These variables were used to develop the MEGNA prognostic score. The prognostic separation/discrimination index was improved with the MEGNA prognostic score (0.21; 95% CI, 0.11-0.33) compared with the staging systems of the American Joint Committee on Cancer sixth (0.17; 95% CI, 0.09-0.29) and seventh (0.18; 95% CI, 0.08-0.30) editions. Conclusions and Relevance The MEGNA prognostic score allows more accurate and superior estimation of patient survival after hepatectomy compared with current staging systems.

Partners' clinic: an innovative gender strengths‐based intervention for breast cancer patients and their partners immediately prior to initiating care with their treating physician

It is well documented that women with breast cancer report high levels of distress [1]. However, partners of breast cancer patients are often as distressed as patients themselves [2]. A partner is an important component of the patient’s support system during a breast cancer diagnosis and throughout treatment [1]. Women have better psychological adjustment to their illness if their partners are emotionally supportive, but this is often where partners struggle the most [3,4]. Furthermore, positive relationships with many supportive friends do not compensate for a problematic partner relationship [3,5]. Despite this knowledge, there are few successful therapeutic models that foster an environment where women and their partners can identify their unique contributions to coping and make positive emotional connections during times of acute stress. The purpose of this correspondence is to describe a unique gender strengths-based intervention (Partners’ Clinic), report distress screening and satisfaction data for both the patient and their partners, and demonstrate the feasibility of providing a couples intervention early in the treatment continuum. Partners’ Clinic engages women and their partners in a psychoeducational consultation with clinician-educators immediately prior to their initial surgical consultation. Partners’ Clinic was developed using a psychoeducational and gender strengths-based theoretical framework. Educating pairs about their illness, treatment, and coping skills while integrating cognitive-behavioral and supportive therapeutic components can lead to reduced illness related distress [4,6]. The foundation of a gender strength-based approach is based on the belief that positive change occurs in the context of authentic relationships, every person has unique strengths, the importance of valuing differences, and the need to collaborate [6,7]. The goal is to maximize the ability of women and men to increase their emotional connection and problem solving skills despite the challenges of cancer. (See examples in Intervention)

Primary liver sarcomas in the modern era: Resection or transplantation?

Primary liver sarcomas (PLS) are rare. Published series are limited by small numbers of patients.

Oral 3.03. Increasing number of thymectomies performed in the United States

Background Thymoma is a relatively rare disorder, but the true incidence in the United States is unknown because only cases described as “malignant” or “invasive” on final pathology reports are included in cancer registry data. An increasing number of thymomas may be identified incidentally on CT scans done for other purposes. As minimally invasive techniques have become more prevalent, thymectomy may also be offered for more patients. For these reasons, we hypothesized that the use of thymectomy has increased in the U.S. in recent years.