“A molecular test can pinpoint which patients will have a very low risk of death from breast cancer even 20 years after diagnosis and tumor removal, according to a new clinical study led by UC San Francisco in collaboration with colleagues in Sweden. As a result, ‘ultralow’ risk patients could be treated less aggressively and overtreatment avoided, leading to fewer toxic effects.
” ‘This is an important step forward for personalizing care for women with breast cancer,’ said lead author Laura J. Esserman, MD, MBA, a breast cancer specialist and surgeon with UC Health. ‘We can now test small node-negative breast cancers, and if they are in the ultralow risk category, we can tell women that they are highly unlikely to die of their cancers and do not need aggressive treatment, including radiation after lumpectomy.’ ”
“Prostate cancer (PC) is the second leading cause of male cancer death in the United States with an estimated 26,000 deaths in 2016. Two-thirds of all PC deaths observed in the US are men with localized disease who developed metastasis. Several markers for dying from prostate cancer exist, but whether these are markers for telling who is likely to die early from any cause, and how their performance compares, is unknown. Identifying such a marker is important because we can then identify which men may benefit from new, more aggressive treatments for prostate cancer.”
“People with limited education and low income have higher odds of death within 30 days after undergoing an operation for lung cancer than those who are more educated and financially better off, according to new research published as an article in press on the website of the Journal of the American College of Surgeons in advance of print publication later this year.
” ‘In order to get uniform superior outcomes for our patients, we need to identify the patients who are at risk for worse outcomes,’ said study co-author Felix G. Fernandez, MD, FACS, a lung surgeon and an assistant professor of surgery at Emory University School of Medicine. Atlanta. ‘This is the first step in describing where those disparities exist.’ ”
“For the study, Dr. Fernandez and his colleagues sought to determine the specific clinical and socioeconomic factors that lead to disparities in 30-day survival for patients undergoing operations for lung cancer.
“They analyzed data from over 215,000 lung cancer operation admissions entered into the National Cancer Data Base (NCDB) between 2003 and 2011. This cancer registry is a joint program of the America College of Surgeons and American Cancer Society and is the largest cancer database in the U.S., providing patient demographic data, insurance status, diagnosis, treatment and how long patients live after treatment. NCDB captures an estimated 70 percent of newly diagnosed cancer cases in the United States from approximately 1,500 cancer programs accredited by the Commission on Cancer of the American College of Surgeons.”
“A new study indicated that the measurement of levels of C-reactive protein (CRP) in the blood has been found to be an independent prognostic marker for survival in patients with melanoma. Patients with the most markedly increased levels of CRP were found to be at high risk for melanoma recurrence and death.
“ ‘We believe it is reasonable to include measurement of CRP in prospective investigations of outcomes of patients with melanoma, including in trials of systemic therapy,’ wrote Shenying Fang, MD, PhD, of the University of Texas MD Anderson Cancer Center, and colleagues in the Journal of Clinical Oncology. ‘Furthermore, although these data cannot determine whether interventions to reduce inflammation and/or CRP could benefit selected patients with melanoma, they do suggest that preclinical investigation of such interventions is justified.’
“This study is not the first to show a link between levels of CRP and cancer. Prior research has shown an association between CRP and lung and colorectal cancer, and a small study indicated that the marker may be prognostic in patients with early-stage melanoma.”
The gist: Men who are newly diagnosed with non-metastatic prostate cancer might increase their risk of death if they take selenium supplements. That was the conclusion of a recents study of 4,459 patients.
“Selenium supplementation of 140 μg/d or more after diagnosis of nonmetastatic prostate cancer may increase risk of prostate cancer mortality, according to a prospective study following 4,459 men initially diagnosed with nonmetastatic prostate cancer in the Health Professionals Follow-up Study from 1988 through 2010. ‘Caution is warranted regarding usage of such supplements among men with prostate cancer,’ Kenfield et al advised in the Journal of the National Cancer Institute…
“The Health Professionals Follow-up Study is a prospective cohort study of 51,529 U.S. male health professionals who were between age 40 and 75 years at the time of enrollment in 1986. Participants completed a baseline questionnaire that included extensive data, including medical history and lifestyle factors such as diet and supplement use, and completed detailed information on the use and dose of supplements every 2 years.
“ ‘Total selenium supplement intake was calculated as the sum from multivitamins and selenium supplements,’ the investigators explained. Total selenium supplement dosage was divided into four categories: nonuser, 1 to 24 μg/d, 25 to 139 μg/d, and ≥ 140 μg/d. ‘We also calculated total duration of use to assess whether the association between selenium supplement use and prostate cancer morality differed by duration,’ the authors noted.”
“Patients with intestinal polyps have a lower risk of dying from cancer than previously thought, according to Norwegian researchers.
“This group of patients may therefore need less frequent colonoscopic surveillance than what is common today. As a potential concequence, the researchers argue, health service resources may be diverted to other, patient groups.
“The findings were released today in The New England Journal of Medicine (NEJM).”
“Nonsentinel lymph node (NSLN) status in patients who underwent complete lymph node dissection after positive sentinel lymph node biopsy (SLNB) had independent prognostic value in patients with two to three positive lymph nodes, according to the results of a study published recently in the Journal of Clinical Oncology.
“Furthermore, researchers led by Sandro Pasquali, MD, of the University of Padova, Italy, found that patients who had metastatic disease in their NSLN had their risk for melanoma death increased by more than one-third.”
Editor’s note: Sentinel lymph nodes (those closest to the tumor) can be examined to predict whether a patient will survive melanoma. This study shows that nonsentinel lymph nodes could potentially be used for survival predictions. We covered a similar story last July.
“Measuring circulating tumor cells — the cells that spread cancer through the body — may be a better predictor of patient survival than the prostate-specific antigen, new research indicates.
“The research was published March 10, 2014 in the Journal of Clinical Oncology by a team led by Amir Goldkorn, M.D., assistant professor of medicine at USC Norris, part of Keck Medicine of USC. Goldkorn’s team discovered that elevated CTC counts after chemotherapy indicated as much as a five-fold higher risk of death, and for patients whose CTCs dropped by 50 percent or more, the risk of death was cut in half. The study demonstrates CTCs are an important biomarker for cancer research and treatment.”
Yu O, Eberg M, Benayoun S, Aprikian A, et al. Journal of Clinical Oncology. Nov 4, 2013.
“Purpose: To determine whether the use of statins after prostate cancer diagnosis is associated with a decreased risk of cancer-related mortality and all-cause mortality and to assess whether this association is modified by prediagnostic use of statins. Patients and Methods: A cohort of 11,772 men newly diagnosed with nonmetastatic prostate cancer between April 1, 1998, and December 31, 2009, followed until October 1, 2012, was identified using a large population-based electronic database from the United Kingdom. Time-dependent Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) with 95% CIs of mortality outcomes associated with postdiagnostic use of statins, lagged by 1 year to account for latency considerations and to minimize reverse causality, and considering effect modification by prediagnostic use of statins. Results: During a mean follow-up time of 4.4 years (standard deviation, 2.9 years), 3,499 deaths occurred, including 1,791 from prostate cancer. Postdiagnostic use of statins was associated with a decreased risk of prostate cancer mortality (HR, 0.76; 95% CI, 0.66 to 0.88) and all-cause mortality (HR, 0.86; 95% CI, 0.78 to 0.95). These decreased risks of prostate cancer mortality and all-cause mortality were more pronounced in patients who also used statins before diagnosis (HR, 0.55; 95% CI, 0.41 to 0.74; and HR, 0.66; 95% CI, 0.53 to 0.81, respectively), with weaker effects in patients who initiated the treatment only after diagnosis (HR, 0.82; 95% CI, 0.71 to 0.96; and HR, 0.91; 95% CI, 0.82 to 1.01, respectively). Conclusion: Overall, the use of statins after diagnosis was associated with a decreased risk in prostate cancer mortality. However, this effect was stronger in patients who also used statins before diagnosis.”