16 results on '"Arati S. Desai"'
Search Results
2. Clinical measures, radiomics, and genomics offer synergistic value in AI-based prediction of overall survival in patients with glioblastoma
- Author
-
Anahita Fathi Kazerooni, Sanjay Saxena, Erik Toorens, Danni Tu, Vishnu Bashyam, Hamed Akbari, Elizabeth Mamourian, Chiharu Sako, Costas Koumenis, Ioannis Verginadis, Ragini Verma, Russell T. Shinohara, Arati S. Desai, Robert A. Lustig, Steven Brem, Suyash Mohan, Stephen J. Bagley, Tapan Ganguly, Donald M. O’Rourke, Spyridon Bakas, MacLean P. Nasrallah, and Christos Davatzikos
- Subjects
Medicine ,Science - Abstract
Abstract Multi-omic data, i.e., clinical measures, radiomic, and genetic data, capture multi-faceted tumor characteristics, contributing to a comprehensive patient risk assessment. Here, we investigate the additive value and independent reproducibility of integrated diagnostics in prediction of overall survival (OS) in isocitrate dehydrogenase (IDH)-wildtype GBM patients, by combining conventional and deep learning methods. Conventional radiomics and deep learning features were extracted from pre-operative multi-parametric MRI of 516 GBM patients. Support vector machine (SVM) classifiers were trained on the radiomic features in the discovery cohort (n = 404) to categorize patient groups of high-risk (OS
- Published
- 2022
- Full Text
- View/download PDF
3. Quantification of tumor microenvironment acidity in glioblastoma using principal component analysis of dynamic susceptibility contrast enhanced MR imaging
- Author
-
Hamed Akbari, Anahita Fathi Kazerooni, Jeffrey B. Ware, Elizabeth Mamourian, Hannah Anderson, Samantha Guiry, Chiharu Sako, Catalina Raymond, Jingwen Yao, Steven Brem, Donald M. O’Rourke, Arati S. Desai, Stephen J. Bagley, Benjamin M. Ellingson, Christos Davatzikos, and Ali Nabavizadeh
- Subjects
Medicine ,Science - Abstract
Abstract Glioblastoma (GBM) has high metabolic demands, which can lead to acidification of the tumor microenvironment. We hypothesize that a machine learning model built on temporal principal component analysis (PCA) of dynamic susceptibility contrast-enhanced (DSC) perfusion MRI can be used to estimate tumor acidity in GBM, as estimated by pH-sensitive amine chemical exchange saturation transfer echo-planar imaging (CEST-EPI). We analyzed 78 MRI scans in 32 treatment naïve and post-treatment GBM patients. All patients were imaged with DSC-MRI, and pH-weighting that was quantified from CEST-EPI estimation of the magnetization transfer ratio asymmetry (MTRasym) at 3 ppm. Enhancing tumor (ET), non-enhancing core (NC), and peritumoral T2 hyperintensity (namely, edema, ED) were used to extract principal components (PCs) and to build support vector machines regression (SVR) models to predict MTRasym values using PCs. Our predicted map correlated with MTRasym values with Spearman’s r equal to 0.66, 0.47, 0.67, 0.71, in NC, ET, ED, and overall, respectively (p
- Published
- 2021
- Full Text
- View/download PDF
4. Case Report: Prolonged Survival Following EGFRvIII CAR T Cell Treatment for Recurrent Glioblastoma
- Author
-
Joseph S. Durgin, Fraser Henderson, MacLean P. Nasrallah, Suyash Mohan, Sumei Wang, Simon F. Lacey, Jan Joseph Melenhorst, Arati S. Desai, John Y. K. Lee, Marcela V. Maus, Carl H. June, Steven Brem, Roddy S. O’Connor, Zev Binder, and Donald M. O’Rourke
- Subjects
CAR T cell therapy ,glioblastoma ,EGFRvIII ,recurrent glioblastoma (rGBM) ,CAR (chimeric antigen receptor) ,perfusion imaging ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Autologous chimeric antigen receptor (CAR) T cells targeted to epidermal growth factor receptor variant III (CAR T-EGFRvIII) have been developed and administered experimentally to treat patients with IDH1 wildtype recurrent glioblastoma (rGBM) (NCT02209376). We report the case of a 59-year-old patient who received a single peripheral infusion of CAR T-EGFRvIII cells and survived 36 months after disease recurrence, exceeding expected survival for recurrent glioblastoma. Post-infusion histopathologic analysis of tissue obtained during a second stage surgical resection revealed immunosuppressive adaptive changes in the tumor tissue as well as reduced EGFRvIII expression. Serial brain imaging demonstrated a significant reduction in relative cerebral blood volume (rCBV), a measure strongly associated with tumor proliferative activity, at early time points following CAR T treatment. Notably, CAR T-EGFRvIII cells persisted in her peripheral circulation during 29 months of follow-up, the longest period of CAR T persistence reported in GBM trials to date. These findings in a long-term survivor show that peripherally administered CAR T-EGFRvIII cells can persist for years in the circulation and suggest that this cell therapy approach could be optimized to achieve broader efficacy in recurrent GBM patients.
- Published
- 2021
- Full Text
- View/download PDF
5. 2137 Percentage of viable tumor Versus radiation treatment effect in surgical specimens is not associated with outcomes in recurrent glioblastoma
- Author
-
Robert D. Schwab, Stephen Bagley, Zev Binder, Robert Lustig, Donald O’Rourke, Steven Brem, Arati S. Desai, and MacLean Nasrallah
- Subjects
Medicine - Abstract
OBJECTIVES/SPECIFIC AIMS: In patients with recurrent glioblastoma (GBM) who undergo a second surgery following standard chemoradiotherapy, histopathologic examination of the resected tissue often reveals a combination of viable tumor and treatment-related inflammatory changes. However, it remains unclear whether the degree of viable tumor Versus “treatment effect” in these specimens impacts prognosis. We sought to determine whether the percentage of viable tumor Versus “treatment effect” in recurrent GBM surgical samples, as assessed by a trained neuropathologist and quantified on a continuous scale, is associated with overall survival. METHODS/STUDY POPULATION: We reviewed the records of 47 patients with histopathologically confirmed GBM who underwent surgical resection as the first therapeutic modality for suspected radiographic progression following standard radiation therapy and temozolomide. The percentage of viable tumor Versus “treatment effect” in each specimen was estimated by one neuropathologist who was blinded to patient outcomes. RESULTS/ANTICIPATED RESULTS: After adjusting for other known prognostic factors in a multivariate Cox proportional hazards model, there was no association between the degree of viable tumor and overall survival (HR 0.83; 95% CI, 0.20–3.4; p=0.20). DISCUSSION/SIGNIFICANCE OF IMPACT: These results suggest that, in patients who undergo resection for recurrent GBM following standard first-line chemoradiotherapy, histopathologic quantification of the degree of viable tumor Versus “treatment effect” present in the surgical specimen has limited prognostic influence and clinical utility.
- Published
- 2018
- Full Text
- View/download PDF
6. Clinical activity of the EGFR tyrosine kinase inhibitor osimertinib in EGFR-mutant glioblastoma
- Author
-
Igor Makhlin, Ryan D Salinas, Daniel Zhang, Fadi Jacob, Gou-li Ming, Hongjun Song, Deeksha Saxena, Jay F Dorsey, MacLean P Nasrallah, Jennifer JD Morrissette, Zev A Binder, Donald M O'Rourke, Arati S Desai, Steven Brem, and Stephen J Bagley
- Subjects
EGFR ,GBM ,glioblastoma ,osimertinib ,precision oncology ,tyrosine kinase inhibitor ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Glioblastoma (GBM) is the most common primary malignant brain tumor in adults and carries a dismal prognosis. The EGFR gene is among the most commonly deranged genes in GBM and thus an important therapeutic target. We report the case of a young female with heavily pretreated EGFR-mutated GBM, for whom we initiated osimertinib, an oral, third-generation tyrosine kinase inhibitor that irreversibly inhibits EGFR and has significant brain penetration. We then review some of the main challenges in targeting EGFR, including lack of central nervous system penetration with most tyrosine kinase inhibitors, molecular heterogeneity of GBM and the need for enhanced specificity for the EGFR mutations relevant in GBM.
- Published
- 2019
- Full Text
- View/download PDF
7. Risk of intracranial hemorrhage with direct oral anticoagulants vs low molecular weight heparin in glioblastoma: A retrospective cohort study
- Author
-
Lauren Reed-Guy, Arati S Desai, Richard E Phillips, Desiree Croteau, Karen Albright, Meghan O’Neill, Steven Brem, Donald M O’Rourke, Nduka M Amankulor, and Stephen J Bagley
- Subjects
Cohort Studies ,Cancer Research ,Oncology ,Clinical Investigations ,Humans ,Anticoagulants ,Venous Thromboembolism ,Neurology (clinical) ,Heparin, Low-Molecular-Weight ,Glioblastoma ,Intracranial Hemorrhages ,Retrospective Studies - Abstract
Background Glioblastoma (GBM) is associated with a high incidence of venous thromboembolism (VTE), but there are little data to guide anticoagulation in patients with GBM, in whom the risks of VTE must be balanced against the risk of intracranial hemorrhage (ICH). Methods We performed a single-institution retrospective cohort study of patients with GBM diagnosed with VTE from 2014 to 2021 who were treated with low molecular weight heparin (LMWH) or a direct oral anticoagulant (DOAC). The incidence of ICH was compared between the LMWH and DOAC groups. The primary outcome was clinically relevant ICH within the first 30 days of anticoagulation, defined as any ICH that was fatal, symptomatic, required surgical intervention, and/or led to cessation of anticoagulation. Secondary outcomes included clinically relevant ICH within 6 months, fatal ICH within 30 days and 6 months, and any bleeding within 30 days and 6 months. Results One hundred twenty-one patients were identified in the cohort for 30-day outcome analyses (DOAC, n = 33; LMWH, n = 88). For 6-month outcome analyses, the cohort included only patients who were maintained on their initial anticoagulant (DOAC, n = 32; LMWH, n = 75). The incidence of clinically relevant ICH at 30 days was 0% in the DOAC group and 9% in the LMWH group (P = .11). The cumulative incidence of clinically relevant ICH at 6 months was 0% in the DOAC group and 24% in the LMWH group (P = .001), with 4 fatal ICHs in the LMWH group. Conclusions DOACs are associated with a lower incidence of clinically relevant ICH in patients with GBM-associated VTE compared to LMWH.
- Published
- 2022
8. Table S2 from Clinical Utility of Plasma Cell-Free DNA in Adult Patients with Newly Diagnosed Glioblastoma: A Pilot Prospective Study
- Author
-
Erica L. Carpenter, Arati S. Desai, Steven Brem, Andrew J. Cucchiara, Donald M. O'Rourke, Zev A. Binder, Jennifer J.D. Morrissette, MacLean P. Nasrallah, Stephanie S. Yee, Theresa Christensen, Samantha Guiry, Timothy Prior, Jasmin Hussain, Whitney Sarchiapone, Scott Levy, Jeffrey B. Ware, Jacob E. Till, Jazmine J. Mays, S. Ali Nabavizadeh, and Stephen J. Bagley
- Abstract
Tissue fusion transcript panel gene coverage (55 genes)
- Published
- 2023
9. Data from Clinical Utility of Plasma Cell-Free DNA in Adult Patients with Newly Diagnosed Glioblastoma: A Pilot Prospective Study
- Author
-
Erica L. Carpenter, Arati S. Desai, Steven Brem, Andrew J. Cucchiara, Donald M. O'Rourke, Zev A. Binder, Jennifer J.D. Morrissette, MacLean P. Nasrallah, Stephanie S. Yee, Theresa Christensen, Samantha Guiry, Timothy Prior, Jasmin Hussain, Whitney Sarchiapone, Scott Levy, Jeffrey B. Ware, Jacob E. Till, Jazmine J. Mays, S. Ali Nabavizadeh, and Stephen J. Bagley
- Abstract
Purpose:The clinical utility of plasma cell-free DNA (cfDNA) has not been assessed prospectively in patients with glioblastoma (GBM). We aimed to determine the prognostic impact of plasma cfDNA in GBM, as well as its role as a surrogate of tumor burden and substrate for next-generation sequencing (NGS).Experimental Design:We conducted a prospective cohort study of 42 patients with newly diagnosed GBM. Plasma cfDNA was quantified at baseline prior to initial tumor resection and longitudinally during chemoradiotherapy. Plasma cfDNA was assessed for its association with progression-free survival (PFS) and overall survival (OS), correlated with radiographic tumor burden, and subjected to a targeted NGS panel.Results:Prior to initial surgery, GBM patients had higher plasma cfDNA concentration than age-matched healthy controls (mean 13.4 vs. 6.7 ng/mL, P < 0.001). Plasma cfDNA concentration was correlated with radiographic tumor burden on patients' first post-radiation magnetic resonance imaging scan (ρ = 0.77, P = 0.003) and tended to rise prior to or concurrently with radiographic tumor progression. Preoperative plasma cfDNA concentration above the mean (>13.4 ng/mL) was associated with inferior PFS (median 4.9 vs. 9.5 months, P = 0.038). Detection of ≥1 somatic mutation in plasma cfDNA occurred in 55% of patients and was associated with nonstatistically significant decreases in PFS (median 6.0 vs. 8.7 months, P = 0.093) and OS (median 5.5 vs. 9.2 months, P = 0.053).Conclusions:Plasma cfDNA may be an effective prognostic tool and surrogate of tumor burden in newly diagnosed GBM. Detection of somatic alterations in plasma is feasible when samples are obtained prior to initial surgical resection.
- Published
- 2023
10. Figure S1 from Clinical Utility of Plasma Cell-Free DNA in Adult Patients with Newly Diagnosed Glioblastoma: A Pilot Prospective Study
- Author
-
Erica L. Carpenter, Arati S. Desai, Steven Brem, Andrew J. Cucchiara, Donald M. O'Rourke, Zev A. Binder, Jennifer J.D. Morrissette, MacLean P. Nasrallah, Stephanie S. Yee, Theresa Christensen, Samantha Guiry, Timothy Prior, Jasmin Hussain, Whitney Sarchiapone, Scott Levy, Jeffrey B. Ware, Jacob E. Till, Jazmine J. Mays, S. Ali Nabavizadeh, and Stephen J. Bagley
- Abstract
Plasma cell-free DNA (cfDNA) concentration (ng/mL) is correlated with (A), total radiographic tumor burden (contrast-enhancing tumor + T2/FLAIR non-enhancing tumor) and (B), contrast-enhancing tumor burden at the first post-radiation MRI scan in patients with newly diagnosed glioblastoma
- Published
- 2023
11. Phase I study of repeated peripheral infusions of anti-EGFRvIII CAR T cells in combination with pembrolizumab in patients with newly diagnosed, MGMT-unmethylated glioblastoma
- Author
-
Stephen J. Bagley, Zev A. Binder, Arati S. Desai, Maclean P. Nasrallah, Eileen Maloney, Steven Brem, Robert Lustig, Goldie Kurtz, Michelle Alonso-Basanta, Suyash Mohan, Wei-Ting Hwang, Oliver Y. Tang, Meghan Logun, Meghna Bhattacharyya, Kelly Markowitz, Devora Delman, Amy Marshall, Cecile Alanio, Gregory L. Beatty, Jennifer L. Brogdon, Elizabeth Hexner, and Donald M. O'Rourke
- Abstract
Treatment efficacy with chimeric antigen receptor (CAR) T cell therapy in glioblastoma (GBM) is undermined by an immunosuppressive tumor microenvironment (TME). We previously showed that CAR T cell therapy targeting epidermal growth factor receptor variant III (EGFRvIII) produces anti-tumor activity against recurrent GBM and causes upregulation of programmed death-ligand 1 (PD-L1) in the TME. Here, we conducted a phase I trial to study the impact of CART-EGFRvIII cells administered concomitantly with the PD-1 inhibitor pembrolizumab in patients (n = 7) with newly diagnosed, EGFRvIII + GBM. Treatment was well tolerated without incidence of dose-limiting toxicity. However, no signal of efficacy was detected with a median progression-free survival of 5.2 months (90% CI, 2.9–6.0 months) and median overall survival of 11.8 months (90% CI, 9.2–14.2 months). In addition, PD-1 expression in the CART-EGFRvIII infusion product did not correlate with outcomes, and peripheral CAR T cell engraftment was relatively short-lived. Together, these findings show the safety of combining CAR T cells and PD-1 inhibition in GBM but given the lack of efficacy, also indicate a need to consider alternative combinatorial strategies. ClinicalTrials.gov registration: NCT03726515.
- Published
- 2023
12. Quantification of Tumor Micro-Environment Acidity in Glioblastoma Using Principal Component Analysis of Dynamic Susceptibility Contrast-Enhanced MR Imaging and Machine Learning
- Author
-
Hamed Akbari, Anahita Kazerooni, Jeffery B. Ware, Elizabeth Mamourian, Hannah Anderson, Samantha Guiry, Chiharu Sako, Catalina Raymond, Jingwen Yao, Steven Brem, Donald M O'Rourke, Arati S Desai, Stephen J Bagley, Benjamin M . Ellingson, Christos Davatzikos, and Ali Nabavizadeh
- Abstract
Glioblastoma (GBM) has high metabolic demands, which can lead to acidification of the tumor microenvironment. We hypothesize that a machine learning model built on temporal principal component analysis (PCA) of dynamic susceptibility contrast-enhanced (DSC) perfusion MRI can be used to estimate tumor acidity in GBM, as estimated by pH-sensitive amine chemical exchange saturation transfer echo-planar imaging (CEST-EPI). We analyzed 78 MRI scans in 32 treatment naïve and post-treatment GBM patients. All patients were imaged with DSC-MRI, and pH-weighting that was quantified from CEST-EPI estimation of the magnetization transfer ratio asymmetry (MTRasym) at 3 ppm. Enhancing tumor (ET), non-enhancing core (NC), and peritumoral T2 hyperintensity (namely, edema, ED) were used to extract principal components (PCs) and to build support vector machines regression (SVR) models to predict MTRasym values using PCs. Our predicted map correlated with MTRasym values with Spearman’s r equal to 0.66, 0.47, 0.67, 0.71, in NC, ET, ED, and overall, respectively (p). The results of this study demonstrates that PCA analysis of DSC imaging data can provide information about tumor pH in GBM patients, with the strongest association within the peritumoral regions.
- Published
- 2021
13. Histopathologic quantification of viable tumor versus treatment effect in surgically resected recurrent glioblastoma
- Author
-
Stephen J, Bagley, Robert D, Schwab, Ernest, Nelson, Angela N, Viaene, Zev A, Binder, Robert A, Lustig, Donald M, O'Rourke, Steven, Brem, Arati S, Desai, and MacLean P, Nasrallah
- Subjects
Aged, 80 and over ,Male ,Brain Neoplasms ,Kaplan-Meier Estimate ,DNA Methylation ,Middle Aged ,Treatment Outcome ,Biomarkers, Tumor ,Disease Progression ,Humans ,Female ,Neoplasm Recurrence, Local ,Glioblastoma ,Aged ,Retrospective Studies - Abstract
The prognostic impact of the histopathologic features of recurrent glioblastoma surgical specimens is unknown. We sought to determine whether key histopathologic characteristics in glioblastoma tumors resected after chemoradiotherapy are associated with overall survival (OS).The following characteristics were quantified in recurrent glioblastoma specimens at our institution: extent of viable tumor (accounting for % of specimen comprised of tumor and tumor cellularity), mitoses per 10 high-power fields (0, 1-10, 10), Ki-67 proliferative index (0-100%), hyalinization (0-6; none to extensive), rarefaction (0-6), hemosiderin (0-6), and % of specimen comprised of geographic necrosis (0-100%; converted to 0-6 scale). Variables associated with OS in univariate analysis, as well as age, eastern cooperative oncology group performance status (ECOG PS), extent of repeat resection, time from initial diagnosis to repeat surgery, and O37 specimens were assessed. In a multivariate model, high Ki-67 proliferative index was the only histopathologic characteristic associated with worse OS following repeat surgery for glioblastoma (hazard ratio (HR) 1.3, 95% CI 1.1-1.5, p = 0.003). Shorter time interval from initial diagnosis to repeat surgery (HR 1.11, 95% CI 1.02-1.21, p = 0.016) and ECOG PS ≥ 2 (HR 4.19, 95% CI 1.72-10.21, p = 0.002) were also independently associated with inferior OS.In patients with glioblastoma undergoing repeat resection following chemoradiotherapy, high Ki-67 index in the recurrent specimen, short time to recurrence, and poor PS are independently associated with worse OS. Histopathologic quantification of viable tumor versus therapy-related changes has limited prognostic influence.
- Published
- 2018
14. Repeatability of
- Author
-
Martin A, Lodge, Matthias, Holdhoff, Jeffrey P, Leal, Asim K, Bag, L Burt, Nabors, Akiva, Mintz, Glenn J, Lesser, David A, Mankoff, Arati S, Desai, James M, Mountz, Frank S, Lieberman, Joy D, Fisher, Serena, Desideri, Xiaobu, Ye, Stuart A, Grossman, David, Schiff, and Richard L, Wahl
- Subjects
Adult ,Male ,Observer Variation ,Brain Neoplasms ,Reproducibility of Results ,Glioma ,Middle Aged ,Sensitivity and Specificity ,Dideoxynucleosides ,United States ,Oncology ,Positron-Emission Tomography ,Image Interpretation, Computer-Assisted ,Humans ,Female ,Neoplasm Grading ,Radiopharmaceuticals - Abstract
Quantitative 3′-deoxy-3′-18F-fluorothymidine (18F-FLT) PET has potential as a noninvasive tumor biomarker for the objective assessment of response to treatment. To guide interpretation of these quantitative data, we evaluated the repeatability of 18F-FLT PET as part of a multicenter trial involving patients with high-grade glioma. Methods: 18F-FLT PET was performed on 10 patients with recurrent high-grade glioma at 5 different institutions within the Adult Brain Tumor Consortium trial ABTC1101. Data were acquired according to a double baseline protocol in which PET examinations were repeated within 2 d of each other with no intervening treatment. On each of the 2 imaging days, dedicated brain PET was performed at 2 time points, 1 and 3 h after 18F-FLT administration. Tumor SUVs and related parameters were measured at a central laboratory using various volumes of interest: isocontour at 30% of the maximum pixel (SUVmean_30%), gradient-based segmentation (SUVmean_gradient), the maximum pixel (SUVmax), and a 1-mL sphere at the region of highest uptake (SUVpeak). Repeatability coefficients (RCs) were calculated from the relative differences between corresponding SUV measurements obtained on the 2 d. Results: RCs for tumor SUVs were 22.5% (SUVmean_30%), 23.8% (SUVmean_gradient), 23.2% (SUVmax), and 18.5% (SUVpeak) at 1 h after injection. Corresponding data at 3 h were 22.4%, 25.0%, 27.3%, and 23.6%. Normalizing the tumor SUV data with reference to a background region improved repeatability, and the most stable parameter was the tumor-to-background ratio derived using SUVpeak (RC, 16.5%). Conclusion: SUV quantification of 18F-FLT uptake in glioma had an RC in the range of 18%–24% when imaging began 1 h after 18F-FLT administration. The volume-of-interest methodology had a small but not negligible influence on repeatability, with the best performance obtained using SUVpeak. Although changes in 18F-FLT SUV after treatment cannot be directly interpreted as a change in tumor proliferation, we have established ranges beyond which SUV differences are likely due to legitimate biologic effects.
- Published
- 2016
15. Obesity, Mammography Use and Accuracy, and Advanced Breast Cancer Risk
- Author
-
Diana S. M. Buist, Rod L. Walker, Diana L. Miglioretti, Arati S. Desai, Rachel Ballard-Barbash, and Karla Kerlikowske
- Subjects
Adult ,Cancer Research ,medicine.medical_specialty ,Breast Neoplasms ,Overweight ,Sensitivity and Specificity ,Severity of Illness Index ,Body Mass Index ,Breast cancer ,Confidence Intervals ,Odds Ratio ,medicine ,Humans ,Mammography ,Obesity ,Prospective Studies ,Risk factor ,Prospective cohort study ,Aged ,Neoplasm Staging ,Gynecology ,medicine.diagnostic_test ,Obstetrics ,business.industry ,nutritional and metabolic diseases ,Articles ,Middle Aged ,medicine.disease ,United States ,Postmenopause ,Logistic Models ,Oncology ,Female ,Breast disease ,medicine.symptom ,business ,Body mass index - Abstract
Being overweight or obese is associated with increased breast cancer risk and disease severity among postmenopausal women, but whether extent of mammography use and accuracy modify this association and further contribute to increases in disease severity at diagnosis among overweight and obese women is unclear.We prospectively collected data during 1996-2005 on 287,115 postmenopausal women not using hormone therapy (HT) who underwent 614,562 mammography examinations; 4,446 women were diagnosed with breast cancer within 12 months of a mammography examination. We calculated rates per 1,000 mammography examinations of large (15 mm), advanced-stage (IIb, III, or IV), high-grade (3 or 4), estrogen receptor (ER)-positive and -negative, and screen-detected and non-screen-detected breast cancer across body mass index (BMI, kg/m(2)) groups defined as normal (18.5-24.9), overweight (25.0-29.9), obese class I (30.0-34.9), and obese class II/III (or =35.0), adjusting for age, race/ethnicity, and mammography registry and use. All statistical tests were two-sided.Adjusted rates per 1000 mammography examinations of overall breast cancer increased across BMI groups (6.6 normal, 7.4 overweight, 7.9 obese I, 8.5 obese II/III; P(trend).001), as did rates of advanced disease, including large invasive (2.3 normal, 2.6 overweight, 2.9 obese I, 3.2 obese II/III; P(trend).001), advanced-stage (0.8 normal, 0.9 overweight, 1.3 obese I, 1.5 obese II/III; P(trend).001), and high nuclear grade (1.5 normal, 1.7 overweight, 1.7 obese I, 1.9 obese II/III; P(trend) = .10) tumors. Rates of ER-positive tumors increased across BMI groups (P(trend).001); rates of ER-negative tumors did not. Rates of screen-detected cancers were higher among overweight and obese women than normal and underweight women, but rates of non-screen-detected (false-negative) cancers were similar. Rates of advanced breast cancer increased across BMI groups regardless of extent of mammography use.Patterns of mammography use and mammography accuracy are not the primary reasons for higher rates of advanced breast cancer among overweight and obese postmenopausal women not using HT; thus, biologic differences in breast tumor development and/or progression may be important.
- Published
- 2008
16. Association between anaemia and N-terminal pro-B-type natriuretic peptide (NT-proBNP): Findings from the Heart and Soul Study
- Author
-
Arati S. Desai, Kirsten Bibbins-Domingo, Alan H.B. Wu, Mary A. Whooley, Sadia Ali, and Michael G. Shlipak
- Subjects
Male ,medicine.medical_specialty ,Anemia ,medicine.drug_class ,Renal function ,Coronary Disease ,Inflammation ,Hemoglobins ,Risk Factors ,Internal medicine ,Natriuretic Peptide, Brain ,Natriuretic peptide ,Humans ,Medicine ,Prospective Studies ,cardiovascular diseases ,Aged ,Aged, 80 and over ,business.industry ,Middle Aged ,medicine.disease ,Peptide Fragments ,Cross-Sectional Studies ,Endocrinology ,Quartile ,Heart failure ,Ambulatory ,Cardiology ,Female ,Kidney Diseases ,N terminal pro b type natriuretic peptide ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Anaemia is associated with elevated levels of natriuretic peptides. Whether the association of anaemia with natriuretic peptides is independent of other cardiovascular risk factors is unclear. Methods This was a cross-sectional study of 809 ambulatory patients with coronary heart disease (CHD) and no history of heart failure (HF). We evaluated the extent to which the relationship between haemoglobin and N-terminal pro-B-type natriuretic peptide (NT-proBNP) was explained by differences in cardiovascular risk factors, inflammation, and kidney dysfunction. Results Of the 809 participants, 189 (23%) had anaemia (haemoglobin
- Published
- 2007
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.