• The clinically based NCCN-IPI is a robust prognostic tool for the rituximab era that better discriminates low-and high-risk DLBCL patients compared with the IPI.• The NCCN-IPI outperforms the IPI by refined categorization of age and LDH, and the identification of disease involvement at specific extranodal sites. : 96% vs 33%) than the IPI (5 year OS: 90% vs 54%), respectively. When validated using an independent cohort from the British Columbia Cancer Agency (n 5 1138), it also demonstrated enhanced discrimination for both low-and high-risk patients. The NCCN-IPI is easy to apply and more powerful than the IPI for predicting survival in the rituximab era. (Blood. 2014;123(6):837-842)

Background We aimed to describe clinicopathological features, patterns of recurrence, and survival according to breast cancer subtype, with a focus on triple-negative tumors. Methods We evaluated 15,204 women presenting to NCCN centers with stage I-III breast cancer between January 2000 and December 2006. Tumors were classified as hormone receptor positive [HR+]/HER2− (ER+ and/or PR+, and HER2−), HER2+ (HER2+, any ER or PR), or triple-negative (ER−, PR−, and HER2−). Results Subtype distribution was: triple-negative 17% (n=2,569), HER2+ 17% (n=2,602), HR+/HER2− 66% (n=10,033). Triple-negative subtype was more frequent in African-Americans, compared with Caucasians (adjusted odds ratio [OR] 1.98; p<0.0001). Premenopausal, but not postmenopausal, women with high body mass index had an increased likelihood of triple negative subtype (p=0.02). Women with triple-negative cancers were less likely to present on the basis of an abnormal screening mammogram (29% vs. 48%, p<0.0001), more likely to present with higher T stage, but less likely to have nodal involvement. Relative to HR+/HER2− tumors, triple-negative tumors were associated with a higher risk of brain or lung metastases, and had worse breast cancer-specific and overall survival, even after adjusting for age, stage, race, grade, and receipt of adjuvant chemotherapy (adjusted hazard ratio [HR] for overall survival 2.72, 95% CI 2.39–3.10, p<0.0001). The difference in risk of death by subtype was most dramatic within the first two years after diagnosis (HR for OS for 0 to 2 yrs 6.10 [95% CI 4.81, 7.74]). Conclusions Triple-negative tumors are associated with unique risk factors and worse outcomes compared to HR+/HER2− tumors.

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OBJECTIVE -The objective of this study was to characterize health care costs associated with diabetic lower-extremity ulcers.RESEARCH DESIGN AND METHODS -Adult patients with diabetes who had a lower-extremity ulcer episode during 2000 and 2001 were identified using claims data. Ulcerrelated direct health care costs were computed for each episode. Episodes were stratified according to severity level based on the Wagner classification.RESULTS -A total of 2,253 patients were identified. The mean age was 68.9 years, and 59% of the patients were male. The average episode duration was 87.3 Ϯ 82.8 days. Total ulcerrelated costs averaged $13,179 per episode and increased with severity level, ranging from $1,892 (level 1) to $27,721 (level 4/5). Inpatient hospital charges accounted for 77% ($10,188) of the overall cost, indicating that hospitalization was a major cost driver. Total ulcer-related costs were significantly higher for patients Ͻ65 years of age compared with those of older patients ($16,390 vs. $11,925, P ϭ 0.02) and for patients with inadequate vascular status compared with patients with adequate vascular status ($23,372 vs. $5,218, P Ͻ 0.0001). Patients who progressed to a higher severity level also had significantly higher ulcer-related costs compared with patients who did not progress ($20,136 vs. $3,063, P Ͻ 0.0001).CONCLUSIONS -The high costs of treating diabetic lower-extremity ulcers emphasize the value of intensive outpatient interventions designed to prevent ulcer progression. Diabetes Care 27:2129 -2134, 2004L ower-extremity ulcers present a significant burden to patients with diabetes and to the health care system. Of persons with diabetes, 2-3% develop a foot ulcer annually, while the lifetime incidence rate is 15% (1,2). Approximately 3% of hospitalizations among patients with diabetes are attributed to lowerextremity ulcers (2). In patients with diabetes, the length of hospitalization among patients with a lower-extremity ulcer can be Ͼ50% longer than that of patients who do not have an ulcer (1).Diabetic lower-extremity ulcers are responsible for 92,000 amputations annually (3). The 10-year cumulative incidence of lower-extremity amputation is ϳ5% in younger-onset diabetes (diagnosis before 30 years of age) and 7% in older-onset diabetes (diagnosis at age 30 or older) (4). Within 5 years after their first amputation, 28 -51% of patients with diabetes require a second leg amputation (1). Survival after amputation is bleak. The 5-year survival rate after amputation is only 27%, translating to a fourfold increase compared with an age-and sexmatched population (5).In addition, lower-extremity ulcers are costly to manage. In 1991 and 1992, costs of diabetic lower-extremity ulcers averaged $2,687 per patient per year among a population of patients Ͻ65 years of age with private employer-sponsored insurance (6). In an analysis of the 1995 Medicare population, the average cost of treatment for a Medicare patient with a diabetic lower-extremity ulcer was approximately $3,600 per year (7). A cost analy...

SummaryHistological transformation (HT) is a major cause of morbidity and mortality in patients with indolent non-Hodgkin lymphoma (NHL). The multicentre National Cancer Comprehensive Network database for NHL provides a unique opportunity to investigate the natural history of HT in the rituximab era. 118 patients with biopsy-confirmed indolent lymphoma and subsequent biopsy-confirmed HT were identified. Treatments for HT included autologous stem-cell transplant (auto-SCT) (n = 50), allogeneic SCT (allo-SCT) (n = 18), and treatment without transplant (n = 50). The 2-year overall survival (OS) for the entire cohort was 68%. For auto-SCT patients aged ≤60 years (n = 24), the 2-year OS was 74%. For nontransplanted patients aged ≤60 years (n = 19), the 2-year OS was 59%. The 2-year OS of patients na€ ıve to chemotherapy prior to HT was superior to patients who were exposed to chemotherapy prior to HT (100% vs. 35%, P = 0Á03). In this largest prospective cohort of patients of strictly defined HT in the rituximab era, the natural history of HT appears more favourable than historical studies. Younger patients who were not exposed to chemotherapy prior to HT experienced a prolonged survival even without transplantation. This study serves as a benchmark for future trials of novel approaches for HT in the Rituximab era.