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  • Effect of Axillary Dissection vs No Axillary Dissection on 10-Year Overall Survival Among Women With Invasive Breast Cancer and Sentinel Node Metastasis: The ACOSOG Z0011 (Alliance) Randomized Clinical Trial

    Abstract Full Text
    JAMA. 2017; 318(10):918-926. doi: 10.1001/jama.2017.11470

    This noninferiority trial compares 10-year overall survival of women with invasive breast cancer and sentinel lymph node metastases treated with breast-conserving therapy and sentinel lymph node dissection alone vs axillary dissection.

  • JAMA July 11, 2017

    Figure: Overall Survival Among Patients With Metastatic Cancer Assigned to Electronic Patient-Reported Symptom Monitoring During Routine Chemotherapy vs Usual Care

    Crosses indicate censored observations. Enrollment in the patient-reported symptom monitoring group was enriched for a preplanned subgroup with low baseline computer experience as part of a feasibility substudy with a 2:1 randomization ratio in that subgroup (N = 227) and a 1:1 ratio in the computer-experienced subgroup (N = 539), yielding 441 participants in the patient-reported symptom monitoring group, and 325 in the usual care group. With a minimum follow-up of 5.4 years, median follow-up was 6.9 years (interquartile range, 6.5-7.7) for the electronic patient-reported symptom monitoring group and 7 years (interquartile range, 6.6-8.1) for the usual care group.
  • New Insights on How Immune Cells Breach Blood Vessel Walls

    Abstract Full Text
    JAMA. 2017; 317(9):899-899. doi: 10.1001/jama.2017.1067
  • Implantable Device Attracts and Captures Early Metastatic Cells

    Abstract Full Text
    JAMA. 2015; 314(17):1788-1788. doi: 10.1001/jama.2015.13931
  • JAMA October 6, 2015

    Figure: Flow of Patients Through the ACOSOG Z6051 Randomized Clinical Trial

    Data on assessment of eligibility were not collected. Of the 486 patients randomized, 5 patients’ data could not be used in any analysis (including demographics). Of these 5 patients 1 was allocated to receive the laparoscopic-assisted resection and 4 were allocated to receive the open rectal resection. The patient allocated to the laparoscopic-assisted resection refused to participate after randomization and refused to have any data used. This patient did not receive surgery. The 4 patients allocated to open rectal resection did not receive proper consent; hence, no data could be used. Of those 4 patients, 3 went on to receive the allocated intervention per protocol.aPatients found to be ineligible after randomization (n = 10): Pregnancy test not conducted before neoadjuvant therapy (n = 3), no transrectal ultrasound/magnetic resonance imaging (TRUS/MRI) conducted before the start of neoadjuvant therapy (n = 2), no computed tomography (CT) scan of the abdomen and pelvis before neoadjuvant therapy (n = 1), liver metastasis (n = 1), liver metastasis and stage I (n = 2), and lower lobe metastasis (n = 1). bOne patient from the laparoscopic arm and 4 patients from the open resection arm are not shown in Table 1 because of patient refusal or improper consent.cPatients found to be ineligible after randomization (n = 18): Consent after registration (n = 2), consent after registration and CT scan of the abdomen and pelvis after neoadjuvant therapy and TRUS/MRI not conducted (n = 1), consent after registration and stage I (n = 1), CT scan of the abdomen and pelvis after neoadjuvant therapy (n = 2), metastatic adenocarcinoma (n = 1), pregnancy test not conducted (n = 3), pregnancy test not conducted and body mass index higher than 34 (n = 1), severe dysplasia (n = 1), stage I (n = 1), TRUS/MRI not conducted (n = 4), and TRUS/MRI not conducted and stage I (n = 1).
  • JAMA September 1, 2015

    Figure 1: Overview of the Peds-MiOncoSeq Clinical Study

    aOne patient declined participation because the patient did not have available tissue, so the family declined research biopsy. The second patient’s cancer was in remission at the time of screening, so the family chose not to pursue the study using archived tissue. bOne patient had both his primary and metastatic tumor site samples sequenced.cOne patient’s sample was sequenced twice using frozen tissue.dOne patient with leukemia had both bone marrow and malignant pleural fluid sequenced.
  • JAMA November 5, 2014

    Figure 3: Subgroup Analyses for Overall Survival and Progression-Free Survival in the Intent-to-Treat Patient Population

    A, Shows subgroup analyses of overall survival among subgroups of patients as defined by baseline characteristics (age, sex, Eastern Cooperative Oncology Group [ECOG] performance status, lactate dehydrogenase [LDH]) and stratification factors (prior therapy and metastasis [M] stage classified according to the TNM categorization for melanoma of the American Joint Committee on Cancer [AJCC]). There was a differential treatment effect on overall survival by sex. Although men treated with ipilimumab plus sargramostim had better overall survival, women treated with ipilimumab alone had better overall survival. This trend needs to be interpreted with caution because the sample size and number of deaths in subgroups by sex were relatively small. Size of data markers are inversely proportional to SE of hazard ratios (HRs). Bars represent 2-sided 95% CIs. The stratified HR for overall survival was 0.64 with 1-sided 90% RCI (not applicable-0.90). HRs and the 95% CIs were calculated using univariate Cox models for each category. Overall HR was estimated from the Cox model stratified by AJCC stage and prior therapy.
  • Effect of PET Before Liver Resection on Surgical Management for Colorectal Adenocarcinoma Metastases: A Randomized Clinical Trial

    Abstract Full Text
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    JAMA. 2014; 311(18):1863-1869. doi: 10.1001/jama.2014.3740

    Moulton and coauthors report results from a randomized clinical trial on the effect of positron emission tomography (PET) before liver resection on surgical management for colorectal adenocarcinoma metastases.

  • Axillary Node Interventions in Breast Cancer: A Systematic Review

    Abstract Full Text
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    JAMA. 2013; 310(13):1385-1394. doi: 10.1001/jama.2013.277804

    Rao and coauthors conducted a review of the literature to summarize evidence regarding the role of axillary interventions (surgical and nonsurgical) in breast cancer treatment and to review the association of these axillary interventions with recurrence of axillary node metastases, mortality, and morbidity outcomes in patients with breast cancer.

  • Patient Requests for Nonbeneficial Care

    Abstract Full Text
    JAMA. 2012; 307(17):1797-1798. doi: 10.1001/jama.307.17.1797-b
  • Antitumor Activity in Metastatic Disease Does Not Predict Efficacy in the Adjuvant Setting

    Abstract Full Text
    JAMA. 2012; 307(13):1431-1432. doi: 10.1001/jama.2012.410
  • Association of Occult Metastases in Sentinel Lymph Nodes and Bone Marrow With Survival Among Women With Early-Stage Invasive Breast Cancer

    Abstract Full Text
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    JAMA. 2011; 306(4):385-393. doi: 10.1001/jama.2011.1034
  • JAMA July 27, 2011

    Figure 1: Flowchart of the Z0010 Trial

    The trial was designed to evaluate the prevalence and prognostic significance of occult metastases in sentinel lymph nodes and bone marrow.aOf the 578 excluded, 334 bone marrow specimens tested negative and 5 tested positive. ICC indicates immunocytochemistry; IHC, immunohistochemistry; and SLN, sentinel lymph node.
  • JAMA July 27, 2011

    Figure 3: Bone Marrow Specimen Results and Cumulative Incidence of Death

    A, Patients whose bone marrow specimens were negative or positive for occult metastases by immunocytochemistry. B, Cumulative incidence of recurrence or death for patients whose bone marrow specimens were negative or positive for occult metastases by immunocytochemistry. The numbers at risk include 339 women of 578 whose sentinel lymph node specimens were not analyzed by immunohistochemistry.
  • Physician Stewardship of Health Care in an Era of Finite Resources

    Abstract Full Text
    JAMA. 2011; 306(4):430-431. doi: 10.1001/jama.2011.999
  • JAMA March 23, 2011

    Figure: Researchers Discover New Biomarker That May Improve Cancer Care Strategies

    Researchers found in a small preliminary study that varying levels of a novel biomarker, an N-terminal truncated protein variant of carboxypeptidase E (CPE-ΔN), may be predictive of metastasis in certain cancers.
  • Axillary Dissection vs No Axillary Dissection in Women With Invasive Breast Cancer and Sentinel Node Metastasis: A Randomized Clinical Trial

    Abstract Full Text
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    JAMA. 2011; 305(6):569-575. doi: 10.1001/jama.2011.90
  • JAMA November 24, 2010

    Figure: Enrollment and Randomization of Study Patients

    N2/N3 indicates patients with locally advanced disease due to malignant unilateral (N2) or contralateral (N3) mediastinal lymph nodes. T4 indicates patients with locally advanced disease based on direct mediastinal tumor invasion. The patients with T4 because of multiple nodules in the same lobe are not shown here. In the patients without locally advanced disease, there was no evidence of either mediastinal nodal invasion or mediastinal tumor invasion. For 11 patients, there was no verification of the mediastinal nodal status (8 patients in the surgical staging group and 3 in the endosonography group). Nine of these patients did not have a thoracotomy. Two patients had a thoracotomy, but no nodal biopsies were taken. For 3 patients, there was evidence of presence of metastatic nodules in a different ipsilateral lobe (pM1) during thoracotomy (see Table 3). One of these patients also had unforeseen mediastinal nodal metastasis (pN2). Two patients underwent thoracotomy outside protocol after proven nodal invasion found by mediastinoscopy. In 1 of these patients, a bleeding complication occurred during mediastinoscopy, requiring the surgeon to convert to thoracotomy. For 1 patient in the endosonography group, the preoperative staging with endosonography and mediastinoscopy did not show locally advanced disease, but a second video bronchoscopy revealed invasion in the main carina (endoscopic T4), implying irresectability.
  • Mediastinoscopy vs Endosonography for Mediastinal Nodal Staging of Lung Cancer: A Randomized Trial

    Abstract Full Text
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    JAMA. 2010; 304(20):2245-2252. doi: 10.1001/jama.2010.1705
  • Medical Leadership in an Increasingly Complex World

    Abstract Full Text
    JAMA. 2010; 304(4):465-466. doi: 10.1001/jama.2010.1049