Recent Publications by CFE Educators
Recent Published articles, books, and other scholarship by Academy members, CFE Education Scientists, and CFE Faculty.
The impact of histologic subtype on primary site surgery in the management of metastatic lobular versus ductal breast cancer: a population based study from the National Cancer Database.
2023
Authors: Rothschild HT, Clelland EN, Abel MK, Chien AJ, Shui AM, Esserman L, Khan SA, Mukhtar RA
PURPOSE
Primary site surgery for metastatic breast cancer improves local control but does not impact overall survival. Whether histologic subtype influences patient selection for surgery is unknown. Given differences in surgical management between early-stage lobular versus ductal disease, we evaluated the impact of histology on primary site surgery in patients with metastatic breast cancer.
METHODS
The National Cancer Database (NCDB, 2010-2016) was queried for patients with stage IV HR-positive, HER2-negative invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC). We compared clinicopathologic features, primary site surgery rates, and outcomes by histologic subtype. Multivariable Cox proportional hazard models with and without propensity score matching were used for overall survival (OS) analyses.
RESULTS
In 25,294 patients, primary site surgery was slightly but significantly less common in the 6,123 patients with ILC compared to the 19,171 patients with IDC (26.9% versus 28.8%, = 0.004). Those with ILC were less likely to receive chemotherapy (41.3% versus 47.4%, 0.0001) or radiotherapy (29.1% versus 37.9%, 0.0001), and had shorter OS. While mastectomy rates were similar, those with ILC had more positive margins (10.6% versus 8.3%, = 0.005). In both groups, the odds of undergoing surgery decreased over time, and were higher in younger patients with T2/T3 tumors and higher nodal burden.
CONCLUSION
Lobular histology is associated with less primary site surgery, higher positive margin rates, less radiotherapy and chemotherapy, and shorter OS compared to those with HR-positive HER2-negative IDC. These findings support the need for ILC-specific data and treatment approaches in the setting of metastatic disease.
View on PubMedEvaluation of a Radiation Oncology Microclerkship as a Component of Medical Student Education.
2023
Authors: Subramanian S, Parikh P, Kra JA, Maldjian PD, Walther S, Kim S, DeNunzio NJ, Abrams MJ, Braunstein SE, Gunther JR, Mattes MD
Predictors of Early Versus Late Recurrence in Invasive Lobular Carcinoma of the Breast: Impact of Local and Systemic Therapy.
2023
Authors: Rothschild HT, Clelland EN, Mujir F, Record H, Wong J, Esserman LJ, Alvarado M, Ewing C, Mukhtar RA
BACKGROUND
Invasive lobular carcinoma (ILC) of the breast is known for high risk of late recurrence, yet some patients still recur within 5 years of diagnosis. Determining factors associated with early/late recurrence could help tailor treatment and surveillance strategies.
METHODS
Using an institutional database, we evaluated patients with ILC and ≥ 5 years of follow-up or recurrence within 5 years. We used multivariate logistic regression and the Kaplan-Meier method to evaluate which clinicopathologic features and treatment strategies were associated with recurrence 5 years since diagnosis versus recurrence ≥ 5 years since diagnosis. Additionally, we explored the association between Clinical Treatment Score 5 (CTS5) with early versus late recurrence.
RESULTS
Among 513 cases of stage I-III ILC, there were 75 early and 54 late recurrences during a median follow-up period of 9.4 years. Early recurrence was associated with larger tumors (mean 4.2 cm vs. 2.9 cm, p 0.0001), higher incidence of > 3 positive nodes (32.4% vs. 9.11%, p > 0.0001), and more aggressive tumor biology (low/negative progesterone receptor expression, higher grade, and higher Ki67). Late recurrence was associated with younger age (mean 55.6 vs. 59.2 years, p = 0.037) and elevated body mass index (BMI > 25 kg/m in 60.1.0% vs. 45.4%, p = 0.021). Omission of adjuvant endocrine therapy or radiotherapy after lumpectomy conferred increased risk of early rather than late recurrence.
CONCLUSION
Factors related to tumor aggressiveness and treatment were associated with early recurrence, whereas patient related factors were related to late recurrence. These data may help guide treatment strategies and surveillance approaches for patients with ILC.
View on PubMedEditorial: Contrast mammography-a promising tool for the pre-operative evaluation of lobular breast cancer.
2023
Authors: Jochelson MS, Mukhtar RA
ASO Author Reflections: Patient, Tumor, and Treatment Characteristics Predict Early Versus Late Recurrence in Patients with Invasive Lobular Carcinoma of the Breast.
2023
Authors: Rothschild HT, Mukhtar RA
The Brescia Internationally Validated European Guidelines on Minimally Invasive Pancreatic Surgery (EGUMIPS).
2023
Authors: Abu Hilal M, van Ramshorst TME, Boggi U, Dokmak S, Edwin B, Keck T, Khatkov I, Ahmad J, Al Saati H, Alseidi A, Azagra JS, Björnsson B, Can FM, D'Hondt M, Efanov M, Alvarez FE, Esposito A, Ferrari G, Koerkamp BG, Gumbs AA, Hogg ME, Huscher CGS, Ielpo B, Ivanecz A, Jang JY, Liu R, Luyer MDP, Menon K, Nakamura M, Piardi T, Saint-Marc O, White S, Yoon YS, Zerbi A, Bassi C, Berrevoet F, Chan C, Coimbra FJ, Conlon KCP, Cook A, Dervenis C, Falconi M, Ferrari C, Frigerio I, Fusai GK, De Oliveira ML, Pinna AD, Primrose JN, Sauvanet A, Serrablo A, Smadi S, Badran A, Baychorov M, Bannone E, van Bodegraven EA, Emmen AMLH, Giani A, de Graaf N, van Hilst J, Jones LR, Sandri GBL, Pulvirenti A, Ramera M, Rashidian N, Sahakyan MA, Uijterwijk BA, Zampedri P, Zwart MJW, Alfieri S, Berti S, Butturini G, Di Benedetto F, Ettorre GM, Giuliante F, Jovine E, Memeo R, Portolani N, Ruzzenente A, Salvia R, Siriwardena AK, Besselink MG, Asbun HJ, Collaborators
Experience matters for robotic assistance: an analysis of case data.
2023
Authors: Brian R, Oh D, Ifuku KA, Sarin A, O'Sullivan P, Chern H
Competency Assessment of General Surgery Trainees: A Perspective From the Global South, in a CBME-Naive Context.
2023
Authors: Nel D, McNamee L, Wright M, Alseidi AA, Cairncross L, Jonas E, Burch V
Perception of Quiet Students in Emergency Medicine: An Exploration of Narratives in the Standardized Letter of Evaluation.
2023
Authors: Quinn JK, Mongelluzzo J, Nip A, Graterol J, Chen EH
Strategies to Promote High-Value, Evidence-Based Pharmaceuticals.
2023
Authors: Hauser J, Redberg RF
