Abstract:
:There is increasing regulatory pressure for cost containment in neuro-oncology, and rationalization of the observed regional disparities. We investigated the presence of such disparities in New York State and examined the impact of risk adjustment on the magnitude of this variation. We performed a cohort study involving patients with brain tumors (gliomas, metastases, or meningiomas), who underwent craniotomy for resection from 2009 to 2013, and were registered in the Statewide Planning and Research Cooperative System (SPARCS) database. A linear regression model was utilized for risk-adjustment of inpatient charges using socioeconomic factors and comorbidities. Hospitals with fewer than 20 craniotomies were excluded. 13,535 patients underwent treatment, including 5032 (37.2 %) gliomas, 4858 (35.9 %) metastases, and 3645 (26.9 %) meningiomas. Unadjusted median hospitalization charges ranged from $22,954 to $177,398 at the hospital level, and $30,086 to $159,281 at the county level. Despite extensive risk-adjustment we observed persistent disparities with median hospitalization charges ranging from $40,455 to $124,691 at the hospital level, and $53,999 to $94,844 at the county level. Analysis of variance (ANOVA) demonstrated that these disparities were significant at the facility and the county level (P < 0.0001). Increased charges were not associated with shorter LOS (r = 0.10, P = 0.41), or lower rates of death (r = 0.09, P = 0.46), and unfavorable discharge (r = 0.24, P = 0.06). Using a comprehensive all-payer cohort of patients with brain tumors in New York State we identified wide disparities at the hospital and the county level despite comprehensive risk-adjustment. Increased charges were not associated with shorter LOS, or lower rates of death and unfavorable discharge.
journal_name
J Neurooncoljournal_title
Journal of neuro-oncologyauthors
Missios S,Bekelis Kdoi
10.1007/s11060-016-2122-0subject
Has Abstractpub_date
2016-06-01 00:00:00pages
365-71issue
2eissn
0167-594Xissn
1573-7373pii
10.1007/s11060-016-2122-0journal_volume
128pub_type
杂志文章abstract::A case of a functioning invasive pituitary oncocytoma in a 50-year-old man is reported. The serum prolactin was increased and immunocytochemical staining was positive for prolactin. In addition to numerous mitochondria within the neoplastic cells, structurally abnormal mitochondria with crystalline inclusions were als...
journal_title:Journal of neuro-oncology
pub_type: 杂志文章
doi:10.1007/BF00165379
更新日期:1986-01-01 00:00:00
abstract::The aim of the present study was to evaluate the spectrum of late effects in a large cohort of pediatric patients with low-grade gliomas (WHO grade I and II) during an observation period of 20 years. Eighty-seven patients with low-grade gliomas grouped according to tumor location (cerebellum: n=28; cerebral hemisphere...
journal_title:Journal of neuro-oncology
pub_type: 杂志文章
doi:10.1007/s11060-005-9091-z
更新日期:2006-06-01 00:00:00
abstract::Medulloblastomas (MB) are the most common central nervous system malignancies in children. Numerous publications describe certain efforts to identify predictive value of various patterns of MB pathology and immunohistochemistry but received data appear to be controversial. In the present study, the apoptotic index (AI...
journal_title:Journal of neuro-oncology
pub_type: 杂志文章
doi:10.1023/a:1016226319068
更新日期:2002-07-01 00:00:00
abstract::Developing and conducting gene therapy clinical trials poses unique challenges which must be addressed to satisfy regulatory requirements and, most importantly, to protect human subjects. Experimental products used for gene transfer studies, such as viral vectors, are often complex and cannot be sterilized or complete...
journal_title:Journal of neuro-oncology
pub_type: 杂志文章,评审
doi:10.1023/b:neon.0000003659.04633.6e
更新日期:2003-12-01 00:00:00
abstract::High expression of ERBB2 has been reported in medulloblastoma and ependymoma; EGFR is amplified and over-expressed in brainstem glioma suggesting these proteins as potential therapeutic targets. We conducted a molecular biology (MB) and phase II study to estimate inhibition of tumor ERBB signaling and sustained respon...
journal_title:Journal of neuro-oncology
pub_type: 杂志文章,随机对照试验
doi:10.1007/s11060-013-1166-7
更新日期:2013-09-01 00:00:00
abstract:BACKGROUND:The role of immunotherapy for metastatic melanoma has expanded over the past decade triggering questions regarding the combination and timing of immunotherapy and radiation for brain metastases. We used the National Cancer Database (NCDB) to see if the time from radiation to immunotherapy in patients with me...
journal_title:Journal of neuro-oncology
pub_type: 杂志文章
doi:10.1007/s11060-020-03663-w
更新日期:2021-01-11 00:00:00
abstract:INTRODUCTION:Clinical trials directed at mechanistic target of rapamycin (mTOR) inhibition have yielded disappointing results in glioblastoma (GBM). A major mechanism of resistance involves the activation of a salvage pathway stimulating internal ribosome entry site (IRES)-mediated protein synthesis. PRMT5 activity has...
journal_title:Journal of neuro-oncology
pub_type: 杂志文章
doi:10.1007/s11060-019-03274-0
更新日期:2019-10-01 00:00:00
abstract::Ewing's sarcoma/primitive neuroectodermal tumor (EWS/PNET) has a characteristic chimeric oncogene EWS-FLI1, which results from chromosomal translocation t (11; 22), that is believed to initiate tumorigenesis of EWS/PNET. However, the specific details of EWS/PNET oncogenesis and exact role of EWS-FLI1 remain largely un...
journal_title:Journal of neuro-oncology
pub_type: 杂志文章
doi:10.1007/s11060-008-9646-x
更新日期:2008-11-01 00:00:00
abstract::We examined the mechanism of action of nitrosoureas as represented by 1-(4-amino-2-methyl-5-pyrimidinyl) methyl-3-(2-chloroethyl)-3-nitrosourea (ACNU) with respect to p53 and the G2M cell cycle checkpoint using two glioblastoma cell lines: U251MG and U373MG, with mutated p53. At log-phase cell growth, fresh medium con...
journal_title:Journal of neuro-oncology
pub_type: 杂志文章
doi:10.1023/a:1016342013616
更新日期:2002-08-01 00:00:00
abstract::Signal transducers and activators of transcription 3 (STAT3) are activated by various cytokines and oncogenes; however, the activity and pathogenesis of STAT3 in diffuse large B cell lymphoma of the central nervous system have not been thoroughly elucidated. We investigated the phosphorylation levels of STAT3 in 40 sp...
journal_title:Journal of neuro-oncology
pub_type: 杂志文章
doi:10.1007/s11060-015-1843-9
更新日期:2015-09-01 00:00:00
abstract::To characterize a population of pediatric high-grade astrocytoma (HGA) patients by confirming the proportion with a correct diagnosis, and determine prognostic factors for survival in a subset diagnosed with uniform pathologic criteria. Sixty-three children diagnosed with HGA were treated at the Johns Hopkins Hospital...
journal_title:Journal of neuro-oncology
pub_type: 杂志文章
doi:10.1007/s11060-009-0102-3
更新日期:2010-08-01 00:00:00
abstract:INTRODUCTION:Recurrent intracranial epidermoid cysts may be difficult to address surgically given their proximity to critical neurovascular structures of the skull base. There are emerging reports of using radiotherapy (RT) for the treatment of recurrent epidermoid cysts. Here, we report a case series of adjuvant fract...
journal_title:Journal of neuro-oncology
pub_type: 临床试验,杂志文章
doi:10.1007/s11060-019-03202-2
更新日期:2019-08-01 00:00:00
abstract::Children with recurrent high grade gliomas (HGG) have a dismal outcome with a median progression free survival (PFS) of 12 weeks. Adults with recurrent HGG treated with irinotecan and bevacizumab reportedly have a 63% response rate and a median PFS of 23 weeks. There is a paucity of corresponding published pediatric d...
journal_title:Journal of neuro-oncology
pub_type: 杂志文章
doi:10.1007/s11060-010-0444-x
更新日期:2011-07-01 00:00:00
abstract::Leptomeningeal disease (LMD) is a highly aggressive and usually rapidly fatal condition. The purpose of this study is to identify clinical factors that can serve to predict for LMD at the time of stereotactic radiosurgery (SRS) for brain metastases from breast carcinoma. We conducted a retrospective review of patients...
journal_title:Journal of neuro-oncology
pub_type: 杂志文章
doi:10.1007/s11060-015-1854-6
更新日期:2015-09-01 00:00:00
abstract::In the following study, we present our experience in the treatment of PCNSL patients using a multi-step schedule combining chemotherapy and deferred radiotherapy. Patients were treated with two modified M-BACOD cycles and then differently according to radiological response For PR, SD and PD patients, chemotherapy was ...
journal_title:Journal of neuro-oncology
pub_type: 杂志文章
doi:10.1007/s11060-006-9276-0
更新日期:2007-05-01 00:00:00
abstract::Gender-specific incidence patterns and the presence of hormonal receptors on tumor cells suggest that sex hormones may play a role in the onset of primary brain tumors. However, epidemiological studies on the relation of hormonal risk factors to the risk of brain tumors have been inconsistent. We examined the role of ...
journal_title:Journal of neuro-oncology
pub_type: 杂志文章
doi:10.1007/s11060-014-1427-0
更新日期:2014-06-01 00:00:00
abstract::Sixteen immunocompetent patients, 10 of whom were previously reported, with primary non-Hodgkins lymphoma of the central nervous system (PCNSL) were treated and followed longitudinally by the Neuro-oncology Service at the University of California, San Francisco (UCSF) and the University of California, San Diego (UCSD)...
journal_title:Journal of neuro-oncology
pub_type: 杂志文章
doi:10.1007/BF00172603
更新日期:1992-11-01 00:00:00
abstract:BACKGROUND:Prior studies have highlighted infratentorial tumor location as a prognostic factor for solitary fibrous tumor (SFT) and hemangiopericytoma (HPC) of the central nervous system (CNS), and spinal location is considered a positive prognostic factor for other tumors of the CNS. While SFT/HPC of the CNS is known ...
journal_title:Journal of neuro-oncology
pub_type: 杂志文章
doi:10.1007/s11060-019-03177-0
更新日期:2019-07-01 00:00:00
abstract:INTRODUCTION:Patterns of failure in patients with olfactory neuroblastoma (ONB) according to two surgical approaches, craniofacial resection (CFR) and endoscopic surgery (ENDO), have yet to be analyzed. METHODS:We retrospectively reviewed 28 patients with surgically treated ONB between January 1995 and October 2017. F...
journal_title:Journal of neuro-oncology
pub_type: 杂志文章
doi:10.1007/s11060-018-03056-0
更新日期:2019-01-01 00:00:00
abstract::Brain metastasis often has a poor prognosis in patients with advanced non-small cell lung cancer (NSCLC). Therefore, it is urgent to identify factors associated with lung cancer brain metastasis. Metastasis associated lung adenocarcinoma transcript 1 (MALAT1) also known as noncoding nuclear-enriched abundant transcrip...
journal_title:Journal of neuro-oncology
pub_type: 杂志文章
doi:10.1007/s11060-014-1613-0
更新日期:2015-01-01 00:00:00
abstract::Glioblastoma (GBM) is the most common and deadly form of primary brain tumor with a median survival of eleven months, despite use of extensive chemotherapy, radiotherapy and surgery. We have previously shown that nuclear factor-kappa B (NF-κB) is aberrantly expressed in GBM tumors and primary cell lines derived from t...
journal_title:Journal of neuro-oncology
pub_type: 杂志文章
doi:10.1007/s11060-010-0261-2
更新日期:2011-01-01 00:00:00
abstract::Proliferative activities were determined in 72 human brain tumors, including 20 metastatic carcinomas, 41 gliomas, 8 meningiomas and 3 hematological tumors. Immunocytochemical techniques included labeling with monoclonal antibody (mAb) to bromodeoxyuridine (BrdU) which identifies S phase cells after previous in vitro ...
journal_title:Journal of neuro-oncology
pub_type: 杂志文章
doi:10.1007/BF00151242
更新日期:1991-02-01 00:00:00
abstract::Neurological complications may occur in the course of Waldenström's macroglobulinemia (Wm). These complications affect both the central and peripheral nervous system. Pathogenesis is debated and several mechanisms have been suggested. Direct malignant lymphoid infiltration (MLI) is very rare and has only been reported...
journal_title:Journal of neuro-oncology
pub_type: 杂志文章
doi:10.1023/a:1023393532546
更新日期:2003-05-01 00:00:00
abstract::The aim of this study was to test by means of a voxel-based approach the hypothesis that there is a different spatial distribution of brain metastases (BM) and white matter hyperintensities (WMH) and that the presence of WMH affects the location of BM in lung and non-lung cancer patients. Two-hundred consecutive cance...
journal_title:Journal of neuro-oncology
pub_type: 杂志文章
doi:10.1007/s11060-014-1554-7
更新日期:2014-11-01 00:00:00
abstract::While the 5-year overall survival is better in pediatric than in adult patients diagnosed with glioblastoma (GBM), outcomes in children remain very poor. Understanding the mechanisms of tumorigenesis and tumor propagation can identify therapeutic targets to improve these outcomes. Human cytomegalovirus (CMV) proteins ...
journal_title:Journal of neuro-oncology
pub_type: 杂志文章
doi:10.1007/s11060-015-1905-z
更新日期:2015-11-01 00:00:00
abstract::The effect of methionine enkephalin on the growth of human brain tumor cells was investigated. The results show that this endogenous opioid has dual effects on tumor cell growth. This peptide exerted an inhibitory effect in SK-N-MC human neuroblastoma cell line; in contrast, in U-373 MG human astrocytoma cell line, th...
journal_title:Journal of neuro-oncology
pub_type: 杂志文章
doi:10.1007/BF01051044
更新日期:1994-01-01 00:00:00
abstract:PURPOSE:To analyze the surgical outcome of a consecutive and single center series of medulla oblongata (MO) and spinal cord hemangioblastomas (HB). PATIENT AND METHODS:We retrospectively reviewed the medical charts of all MO and spinal HB patients operated on in our institution between 1985 and 2002. All patients had ...
journal_title:Journal of neuro-oncology
pub_type: 杂志文章
doi:10.1007/s11060-009-9861-0
更新日期:2009-05-01 00:00:00
abstract::Two distinct mechanisms, vasculogenesis and angiogenesis implement the formation of the vascular network in the embryo. Vasculogenesis gives rise to the heart and the first primitive vascular plexus inside the embryo and in its surrounding membranes, as the yolk sac circulation. Angiogenesis is responsible for the rem...
journal_title:Journal of neuro-oncology
pub_type: 杂志文章,评审
doi:10.1023/a:1006493130855
更新日期:2000-10-01 00:00:00
abstract::The insular cortex is located deep within the Sylvian fissure between multi-functional and structurally-compressed cerebral structures, and has been suggested to play an important role in both basic sensorimotor and complex social-emotional functions. Such structural and functional complexity presents a challenge for ...
journal_title:Journal of neuro-oncology
pub_type: 杂志文章
doi:10.1007/s11060-014-1380-y
更新日期:2014-04-01 00:00:00
abstract::Glioblastomas (GBM) may originate de novo (primary), or following transformation from a lower grade glioma (secondary), and it has been postulated that these tumors may have different biological behaviors. We performed a correlative analysis involving 204 patients with glioma treated prospectively on NCCTG clinical tr...
journal_title:Journal of neuro-oncology
pub_type: 杂志文章
doi:10.1007/s11060-010-0476-2
更新日期:2011-08-01 00:00:00