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N Natarajan

Publications and source records attributed to N Natarajan.

At least 37 records · Page 2Linked to original sources
PubMed1993

Predictive value of serum CA125 following optimal cytoreductive surgery during weekly cisplatin induction therapy for advanced ovarian cancer.

One hundred seventy-one patients with epithelial ovarian cancer were treated on a prospective protocol of weekly cisplatin induction (1 mg/kg weekly for four courses) followed by monthly cisplatin (50 mg/m2), Adriamycin (50 mg/m2), and cyclophosphamide (750 mg/m2). Seventy-five patients with FIGO stage III or IV disease who underwent optimal cytoreductive surgery (<2 cm residual disease) were treated on this protocol and had weekly as well as monthly serum CA125 levels measured. A retrospective analysis was performed in order to determine if a > or = 50% fall in elevated serum CA125 levels during weekly cisplatin induction therapy would be predictive of findings at second look operation, normalization of serum CA125 levels (< 35 u/ml) immediately prior to the third course of multiagent chemotherapy, and to determine the impact of such a decline on median progression-free interval. Positive predictive values for this parameter with respect to findings at second look operation ranged between 38% and 50% (P > 0.05). Positive predictive values for this parameter with respect to normalization of serum CA125 levels immediately prior to the third course of multiagent chemotherapy ranged between 64.2% and 89.6% (P > 0.05). Logistic regression analysis demonstrated that a > or = 50% fall observed in CA125 levels during four weekly courses of chemotherapy served as an independent predictor of normalization of serum CA125 levels (<35 u/ml) following two courses of multiagent chemotherapy (P = 0.009) and improved median progression-free interval (P = 0.04). Eighteen patients demonstrated a rise in serum CA125 levels during weekly induction cisplatin chemotherapy. Only one of these patients (5.5%) demonstrated a surgical complete response at the end of standard therapy.

Adult↗
PubMed1993

Clinical, scholarly & campus information hypertext tools at Columbia-Presbyterian Medical Center.

In conjunction with other researchers at Columbia-Presbyterian Medical Center (CPMC) we have developed a number of hypertext and free text retrieval computer applications aimed at an extremely diverse audience which includes students and faculty in a university setting as well as health care providers and patients in hospital and clinic settings. Hypertext and free text systems offer features which make them ideal for presenting information in a wide variety of contexts; however, they also have several major weaknesses which must be addressed before these applications can be useful tools. We have learned to maximize the strengths and minimize the weaknesses to present material in a manner that is individualized to the needs of each user from the research scientist in the lab to the patient at the bedside.

Academic Medical Centers↗
PubMed1992

Survival in Hodgkin's disease by stage and age.

Patterns of care for Hodgkin's disease in the United States were surveyed through voluntary audits of hospitals with cancer programs nonapproved and approved by the Cancer Commission of the American College of Surgeons. Four hundred and seventy-three hospitals reported 6,345 patients diagnosed immediately preceding December 31, 1975. The survival rates varied with age, being better at younger ages and worse in the elderly. By pathologic stage, the younger patients faired better than the elderly in each stage grouping. Histologic type was not a factor in this poor prognosis. Hodgkin's disease in elderly patients has a different biologic behavior than in younger patients.

Adolescent↗
PubMed1990

Patterns of milk consumption and risk of cancer.

The reported milk consumption habits of 3,334 cancer patients and 1,300 comparable control subjects seen at Roswell Park Memorial Institute were studied. The cancer patient group included persons diagnosed with cancers of the oral cavity, stomach, colon, rectum, lung, breast, uterus, cervix, prostate, or bladder. Data were obtained by means of a standardized admissions questionnaire. As a group, control patients were more likely to report never drinking whole milk; cancer patients more often reported frequent consumption of whole milk. Relative risks of different patterns of milk consumption for specific cancer diagnoses, adjusted for sex, age, smoking history, education, and county of residence, were calculated with multiple logistic regression analysis. Elevated risks for frequent consumption of whole milk relative to not drinking milk were observed for cancers of the oral cavity, stomach, colon, rectum, lung, bladder, breast, and cervix. Reduced risks for frequent consumption of 2% milk relative to not drinking milk were observed for cancers of the oral cavity, stomach, rectum, lung, and cervix. Preference for exclusive consumption of reduced-fat milk was linked to significant risk reduction for oral and cervical cancers, and drinking only whole milk was linked to significant risk increases for cancers of the oral cavity, stomach, rectum, lung, and breast. Some associations were observed for a computed index of milk fat intake, but the overall pattern of effects was not fully explained by variations in fat content. The effects observed for some sites may be confounded by other dietary or nondietary correlates of risk.

Adult↗
PubMed1990

The association of age and familial risk in a case-control study of breast cancer.

To investigate the association of breast cancer risk, age, and family history of breast cancer, 779 breast cancer patients and 1,558 comparably aged control patients without cancer or a history of cancer were studied. All patients were admitted to Roswell Park Memorial Institute, Buffalo, New York between 1982 and 1987. After adjustment for the effects of other major breast cancer risk factors, no overall increase in risk for a history of breast cancer in a first-degree relative was observed among younger women. However, when the age at reported occurrence of breast cancer was considered, increased relative risk (RR) was observed when the affected first-degree relative was diagnosed at a young age (RR = 1.3). In contrast, among older patients, greater risk (RR = 1.9) was associated with diagnosis in a first-degree relative at an older age. Among patients aged 55 years or older, risk for reporting one first-degree relative with breast cancer was significant (RR = 1.8) and was greater when more than one first-degree relative was reported to have breast cancer (RR = 3.3). Bilaterality in an affected first-degree relative was associated with increased risk only among older patients (RR = 2.3). Other studies have observed various age-related effects, but the present research differs in that the authors studied both the age of the patient at risk and the age of the affected relatives across the full range of ages at which breast cancer occurs. These findings may have implications for the identification of populations for earlier initiation of routine screening and for laboratory investigation of the genetic etiology of breast cancer.

Adult↗
PubMed1990

Vasectomy and prostate cancer risk.

To assess the hypothesis that a history of vasectomy is a risk factor in the etiology of prostate cancer, the authors conducted a case-control study at Roswell Park Memorial Institute, Buffalo, NY, between 1982 and 1988. From epidemiologic data routinely collected from entering patients, information on vasectomy history and other data were obtained for 614 patients with prostate cancer and 2,588 comparable control subjects with cancer at another site. Age-specific and age-adjusted relative risks were calculated. Increased risk (relative risk = 1.7, 95% confidence interval 1.1-2.6) was found for reporting vasectomy at any age. Age-adjusted relative risk of 2.2 (95% confidence interval 1.0-4.6) was observed for men who reported vasectomy 13-18 years before diagnosis. A significant trend in the association of years since vasectomy and risk also was observed. Cases and controls were found to be nearly identical with respect to education, income, race, marital history, and number of children. A difference in smoking histories of cases and controls was found not to confound the observed associations. These data may suggest the importance of further epidemiologic and biologic research on vasectomy as a risk factor for prostate cancer.

Aged↗
PubMed1989

Beta-carotene and animal fats and their relationship to prostate cancer risk. A case-control study.

A case-control study of 371 prostate cancer patients and comparable control subjects admitted to Roswell Park Memorial Institute (RPMI), Buffalo, New York, was conducted. Data were obtained from routine epidemiologic questionnaires administered to all patients on admission. An index of beta-carotene intake was computed based on the vitamin A activity of 27 fruits and vegetables included in a food frequency checklist. A similar measure of fat intake from meats was computed based on nine meats included in the checklist. Intake frequencies of common and alcoholic beverages also were studied. A significant age-adjusted and residence-adjusted protective effect for high levels of beta-carotene intake was observed (relative risk [RR], 0.60; 95% confidence interval [CI], 0.37 to 0.99). This effect was evident particularly among men 68 years of age and younger (RR, 0.30; 95% CI, 0.13 to 0.66), but not among subjects older than 68 years of age. A trend toward increased risk for fat intake was not significant. However, the reported usual consumption of high-fat milk was associated with increased risk (RR, 1.92; 95% CI, 1.05 to 3.50). A greater reported frequency of whole milk intake was similarly associated with increased risk. Men who reported drinking three or more glasses of whole milk daily had an RR of 2.49 (95% CI, 1.27 to 4.87), compared with men who reported never drinking whole milk. When these findings are evaluated in the context of other recent studies, the weight of the evidence appears to favor the hypothesis that animal fat intake is related to increased risk of prostate cancer.

Aged↗
PubMed1989

Prostate cancer in blacks: an update from the American College of Surgeons' patterns of care studies.

Data from the American College of Surgeons' prostate cancer surveys covering nearly a decade of experience demonstrate that the problem of prostate cancer is unique among black men in the United States. These data show that the distribution of stage at diagnosis changed across the 10-year interval. The data indicate that there have been improvements in the 5-year survival rates of both black and white patients, but the prostate cancer-specific survival of black patients remains significantly poorer than that of whites.

Black or African American↗
PubMed1989

National survey of patterns of care for brain-tumor patients.

An excellent response by participating institutions was realized in this survey of patterns of care for patients with primary brain tumors. Since the histopathology of the tumor is such a strong predictor of outcome and influences care so greatly, most analyses were performed not only on the overall series of patients but also by World Health Organization histological classification. Several factors that influence outcome were identified: tumor type, patient age, patient Karnofsky rating, tumor location, and therapy. Very few cases were coded as regards the American Joint Committee on Cancer clinical stage, and few potentially eligible cases were placed in investigative protocols. It behooves those centers providing investigative protocol opportunities to develop liaisons with practicing physicians nearby as well as at some distance and to provide an organizational framework that will make participation in these protocols practical for a larger segment of our brain-tumor patient population. Between 1980 and 1985, the increased use of magnetic resonance imaging in neuroradiology is apparent as well as the increased use of stereotactic biopsy and interstitial radiotherapy. Complications of therapy seem acceptably low. Five-year survival for benign brain tumor is high, while that for the most common primary tumor, glioblastoma multiforme, is only 5.5%. Some of the findings in this survey confirm those from the literature while others, particularly the pattern of care, represent new data.

Brain Neoplasms↗
PubMed1989

Rehabilitation of the mastectomy patient: a randomized, blind, prospective study.

After biopsy confirmation of breast carcinoma, women who were scheduled to undergo a modified radical mastectomy had demographic data collected, goniometric measurements of shoulder flexion and abduction, and functional evaluation of the ipsilateral shoulder performed, and upper extremity circumferential measurements at five levels determined. Patients were then randomly assigned either to a group that received immediate postoperative physical therapy or to one that did not. Results represent the combination of data from a pilot study and this subsequent study following appropriate statistical analysis. Sixty-four women in the treatment group showed a statistically significant increase in shoulder range of motion in both abduction and flexion as compared to 51 women who received no physical therapy. The treated group also had fewer problems with five of the six upper extremity functional tasks that were assessed. There were no significant differences between the groups for length of hospital stay, postoperative complications, or upper extremity edema. The authors conclude that early physical therapy intervention makes a significant contribution to return to normal function without increasing the incidence of postoperative complications or prolonging hospital stay.

Activities of Daily Living↗
PubMed1988

Breast cancer survival among Orientals and whites living in the United States.

Data from the 1982 breast cancer survey of the American College of Surgeons were used to study the survival differences between Oriental and white women. Oriental women were significantly younger than white women. Oriental women were reported with a slightly higher percent of localized breast tumors (59.2% vs. 53.8%) and a slightly higher percent with negative nodes (60.3% vs. 56.2%) compared with whites. Oriental women in the United States have a higher 5-year survival rate compared to whites. Multivariate analyses taking into account differences in age, stage of disease, and histology did not alter the finding of a significant difference in survival experiences.

Breast Neoplasms↗
PubMed1987

National survey of patterns of care for testis cancer.

A national survey of testicular cancer documented recent trends in disease characteristics, treatment, and outcome, providing a basis for progress being achieved on a community basis. A long-term study of 3285 patients diagnosed between 1970 and 1975 was compared with a short-term study of 1887 patients diagnosed in 1983. An increase of the symptom of a lump in the testis from 23.1% to 31.2% and a mass as a sign of cancer from 44.5% to 53.8% suggests earlier detection of testis cancer by the patient and physician. Changes in the methods of diagnosis reflect the changing technology of tumor diagnosis. The 10-year survival rates for pathologic Stage I seminoma (82.6% of all seminomas) exceeded 96%. For pathologic Stage I nonseminomatous germ cell tumors (51.7% of all NSGCT), 10-year survival was 87.1%; whereas for Stage III (18.7% of all NSGCT) it was 22.1%. The impact of the important advances in chemotherapy is reflected in the increase of 1-year survival of Stage III NSGCT from 50.5% to 78.4%. Testis cancer can be cured in most patients.

Health Surveys↗
PubMed1987

End results for urologic cancers. Trends and interhospital differences.

Long-term results for treatment of several urologic cancers have improved in recent years. Data from the studies of the American College of Surgeons and from the National Cancer Institute document these trends. For prostate cancer, the 5-year survival rate, for all stages, increased during the 1970s. Although seminomas of the testes have had high survival rates for several years, nonseminomas have had much poorer outcomes. Data from the 1985 survey of the American College of Surgeons indicate that the prognosis for nonseminoma tumors of the testes is now much improved. Analyses have been conducted to assess the influence of patient and tumor characteristics on end results. Age, race, stage and, histologic type continue to be the major determinants of survival. The role of treatment setting also has been studied. The data reveal that outcomes for similar patients differ little among hospitals which meet approval standards for operation of a cancer program. Issues regarding validity of the observations and the influence of "stage migration" on the end results have been examined. The distribution of survival improvements across stages, and, the correlation of changing survival with improved patterns of care may suggest that the improvements in urologic cancer outcomes are more than statistical artifacts.

Actuarial Analysis↗
PubMed1987

Interhospital differences in cancer survival.

We examined variations in cancer survival rates among a large number of hospitals in the United States. Survival rates for breast cancer, prostate cancer, and Hodgkin's disease were calculated from patient care studies of the American College of Surgeons and were linked to data on hospital characteristics from the surveys of the American Hospital Association. When patient, disease, treatment, and institutional characteristics were examined in multivariate analyses, medical school affiliation, residency training, and community size were not related to hospitals' cancer survival experience. Patterns of care involving greater use of staging laparotomy with splenectomy for Hodgkin's diseases, lesser use of mastectomy without axillary dissection for breast cancer and, greater use of bone scanning and lesser use of hormone therapy for prostate cancer all were associated with better survival. The differences between hospitals' survival rates were large but we found that the differences were more a function of patient characteristics, disease stage, and tumor histology than of hospital affiliations, location, size, facilities, or treatment patterns. These findings provide some data upon which future public health interventions to affect cancer mortality may be planned and evaluated.

Breast Neoplasms↗
PubMed1987

Adult soft tissue sarcomas. A pattern of care survey of the American College of Surgeons.

A nationwide survey of the clinical presentation, pathology, and management of soft tissue sarcomas in adults was carried out under the auspices of the Commission on Cancer of the American College of Surgeons. Two separate 2-year periods were used to allow assessment of changes in patterns of care. Data were obtained from 504 hospitals in 1977-1978 (2355 patients) and 645 institutions in 1983-1984 (3457 patients). Pretreatment findings of interest included some evidence of physician delay in diagnosis, overuse of excisional biopsy as opposed to the generally preferred approach of incisional biopsy, a low rate of usage of the American Joint Committee for Cancer Staging (AJCSS) system, and major reliance on CT for pretreatment patient evaluation. Operation was the primary treatment, with or without adjuvant therapies, in approximately three fourths of the patients. The other one fourth were primarily patients with distant metastasis at the time of diagnosis. Some increase in multimodal therapy did occur in the second period but the rate of amputation was low (approximately 10%) in both periods studied. Survival curves support the prognostic validity of the AJCCS system and the value of complete resection of soft tissue sarcomas. Adverse prognostic factors included positive surgical margins, large tumors, retroperitoneal or mediastinal primary sites, some histologic types, and the perceived need for adjuvant therapy. Patients receiving adjuvant radiation or chemotherapy had less favorable survival data than those treated by operation alone due to criteria used for selecting patients for these therapies. Approximately one half of the treatment failures in the 1977-1978 series were locoregional, whereas 18% were limited to lung metastasis. Salvage therapy for these two forms of treatment failure yielded 61% and 21% 5-year survival rates.

Adult↗
PubMed1986

Trends in patterns of care for prostatic cancer, 1974-1983: results of surveys by the American College of Surgeons.

Data from a recent survey of patterns of care for prostatic cancer sponsored by the American College of Surgeons suggest several trends compared to similar data from a decade ago. The observed differences include increased diagnosis of localized cancer, and increased use of acid phosphatase determinations, bone scans, radical retropubic prostatectomy, radiotherapy (particularly interstitial techniques) and orchiectomy. In contrast, use of bone surveys, perineal prostatectomy and hormonal therapy has decreased. Transurethral resection continues to be the most common means to establish the diagnosis of prostatic cancer but the data do suggest that in more patients the tumors are being staged and graded. Five-year survival rates appear to be improving for all stages, and for white and black patients. Survival of black patients continues to lag behind that of white subjects, presumably owing to the more advanced stage of disease at diagnosis observed in these data. These findings may have important implications for understanding trends in survival of patients with this disease.

Acid Phosphatase↗