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Biomedical subjects

Frederick L Greene

Publications and source records attributed to Frederick L Greene.

At least 19 recordsLinked to original sources
PubMed2005

Adjuvant chemotherapy for stage III colon cancer: implications of race/ethnicity, age, and differentiation.

CONTEXT: A 1990 National Institutes of Health Consensus Conference recommended that patients with stage III colon cancer receive adjuvant chemotherapy because survival was improved in clinical trials in patients who received a 5-fluorouracil-based regimen. OBJECTIVE: To determine whether adjuvant chemotherapy is used in the community as a standard of practice that improves outcome and whether it failed to benefit any specific sets of patients. DESIGN, SETTING, AND PARTICIPANTS: Prospective data from 85 934 patients with stage III colon cancer from 560 hospital cancer registries were entered into the National Cancer Data Base between 1990 and 2002 and included standard clinical, pathological, and first course of treatment variables. MAIN OUTCOME MEASURES: Prevalence of adjuvant chemotherapy usage and 5-year survival in patients treated in US hospitals. RESULTS: Adjuvant chemotherapy use increased from 39% in 1991 to 64% in 2002 but was lower in black, female, and elderly patients. It improved 5-year survival from almost 8% in 1991 to more than 16% in 1997 compared with surgery alone. Adjuvant chemotherapy increases survival in elderly patients as much as it does in younger patients. However, the benefit of adjuvant chemotherapy in blacks and those with high-grade cancers is not as great. CONCLUSIONS: Adjuvant chemotherapy use has increased from 1990 to 2002 for patients with stage III colon cancer with an associated increase in 5-year survival of 16%. The benefit of adjuvant chemotherapy seems to be lower in black patients and high-grade cancers. Women have the same benefit but are less often treated. Elderly patients have the same benefit as younger patients but are less frequently treated. New options for adjuvant therapy in 2004-2005 may further improve the outcome of patients with stage III colon cancer.

Adjuvants, Immunologic↗
PubMed2005

Controversies in staging of hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is the most common primary cancer of the liver. As the natural history of HCC is better delineated, treatment strategies are in constant evolution. Classic staging systems based on histopathology following resection are often inadequate because the majority of patients present with advanced disease. The dissatisfaction with anatomic staging systems has resulted in the emergence of several new clinical staging systems, which attempt to integrate tumor biology and the underlying function of the nondiseased liver. Tragically, the byproduct of multiple staging strategies is confusion for physicians, patients, and clinical researchers; this undermines the principles on which staging systems are created. To address this issue, a consensus conference was organized in 2002 to identify the best staging strategy for HCC. The purpose of this article is to review the current clinical and pathologic staging strategies and to highlight the recommendations from the consensus conference.

Carcinoma, Hepatocellular↗
PubMed2004

New tumor-node-metastasis staging strategy for node-positive (stage III) rectal cancer: an analysis.

PURPOSE: The tumor-node-metastasis system for staging rectal cancer is based on invasion, number of involved nodes, and metastasis. Nodes are classified as N1 or N2 according to the number involved with metastases. Nodal positivity defines stage III regardless of depth of invasion or number of positive nodes. Our purpose was to analyze overall survival when node-positive patients were stratified into three new subsets. METHODS: We analyzed data entered into the National Cancer Data Base for 5,987 stage III patients with rectal cancer between 1991 and 1993. Survival was calculated using three new subgroups (IIIA: T1/2, N1; IIIB: T3/4, N1; IIIC: any T, N2). Survival following surgery and adjuvant therapy was assessed. The observed survival rates were calculated and compared using the log-rank method. The Cox regression model assessed subgroup differences. RESULTS: Five-year observed survival rates for stage III subcategories were 55.1% in IIIA; 35.3% in IIIB; and 24.5% in IIIC. Stratifying for treatment outcome, stage IIIA patients having surgery alone (n = 278) had poorer observed 5-year survival (39%) than patients treated with surgery and adjuvant chemotherapy or radiation therapy (chemo/XRT; n = 765; 60%). Similar outcomes occurred in IIIB (surgery-alone [n = 726; 21.7%] and chemo/XRT [n = 2,130; 40.9%] groups) and in IIIC (surgery-alone [n = 467; 12.2%] and chemo/XRT [n = 1,621; 28.9%] groups). Differences were significant (P <.0001) in all stages. CONCLUSION: The traditional stage III designation of rectal cancer fails to account for invasion (T1-4) and number of involved nodes (N1, N2). The stratification of stage III patients into three subsets should be used in future analyses of rectal cancer. The effect of postoperative adjuvant therapy was beneficial in all subsets.

Aged↗
PubMed2004

The process for continuous improvement of the TNM classification.

The TNM classification is a worldwide benchmark for reporting the extent of malignant disease and is a major prognostic factor in predicting the outcome of patients with cancer. The objectives for cancer staging were defined by the International Union Against Cancer (UICC) TNM Committee almost 50 years ago and are still broadly applicable today. To keep pace with the modern demands of evidence-based practice, the UICC introduced a structured process for introducing changes to the TNM classification. The elements of the TNM process were determined to include the development of unambiguous criteria for the information and documentation required to consider changes in the classification, establishment of a well-defined process for the annual review of relevant literature, formation of site-specific expert panels, and the participation of experts from all over the world in the TNM review process. Communication between the oncology community and those involved in the TNM classification was established as being essential to the success of the process. The process, which was introduced in 2002, will be tested over the next 3-4 years and evaluated. In addition to the formal process, individual initiative, involvement by the national staging committees, and group consensus are required. Furthermore, increased involvement by the experts should improve the understanding and dissemination of the TNM classification.

Communication↗
PubMed2003

TNM staging for malignancies of the digestive tract: 2003 changes and beyond.

In preparation for the 6th edition of the UICC and AJCC publications on TNM staging, all data regarding sites of the digestive system (gastrointestinal and hepatobiliary) were reviewed by expert site teams. Although the information for several sites (esophagus, small bowel, and anal canal) required no change from the 5th editions, significant changes were recommended for the pancreas, liver, extrahepatic biliary system, colon, and rectum. Minor but important changes were made regarding gastric and peri-ampullary malignancies. The changes were made based on new prognostic information and analysis of available data sets. The importance of large national registries, such as the National Cancer Data Base (NCDB; American College of Surgeons Commission on Cancer), is stressed.

Digestive System Neoplasms↗
PubMed2003

Revision of breast cancer staging: the 6th edition of the TNM Classification.

A Breast Task Force comprised of nationally known experts in the field of breast cancer treatment was charged with recommending additions and changes for the 6th edition of the TNM Classification that were based on published evidence and/or were consistent with widespread clinical consensus. Additions made to the staging system were designed to facilitate the uniform collection of clinically relevant information about new techniques for the detection of metastatic cells. These additions include quantitative criteria to distinguish micrometastases from isolated tumor cells, and specific identifiers to record the use of sentinel lymph node biopsy, immunohistochemical (IHC) staining, and molecular biology techniques. Revisions of the previous staging system are related to the number of affected axillary lymph nodes and to the classification of level III axillary lymph nodes and lymph nodes outside of the axilla.

Breast Neoplasms↗
PubMed2003

Staging system for breast cancer: revisions for the 6th edition of the AJCC Cancer Staging Manual.

Since its inception, the AJCC staging system for breast cancer has been in an almost constant state of evolution, striving with each revision to reflect the most up-to-date clinical research as well as the widespread consensus among physicians about appropriate diagnostic and treatment standards. To date, these revisions have essentially represented a "fine-tuning" of the initial judgment that tumor size, lymph node status, and presence of distant metastases are the most significant prognostic factors for breast cancer. With the problems of standardization and reproducibility being resolved, it is likely that histologic grade will join this group of independent markers and be incorporated into the AJCC staging system in the near future. Over the last 15 years. considerable attention has been focused on the discovery of new markers visualized with immunohistochemistry and RT-PCR that may be validated as independent prognostic indicators (reviewed by Mirza et al). To date, the usefulness of many of these markers has been limited by lack of standardization in measurement techniques, but several show great promise for the future. By increasing the number of prognostic markers that can give independent information about patient outcome, physicians will be better able to determine optimal treatment approaches for individual patients.

Advisory Committees↗