A B S T R A C T PurposeRecent studies have reported increased mortality for right-sided colon cancers but had limited adjustment for patient characteristics and conflicting results by stage. We examined the relationship between colon cancer location (right-v left-side) and 5-year mortality by stage. Patients and MethodsWe identified Medicare beneficiaries from 1992 to 2005 with American Joint Commission on Cancer stages I to III primary adenocarcinoma of the colon who underwent surgery for curative intent through Surveillance, Epidemiology, and End Results (SEER) -Medicare data. Adjusted hazard ratios (HRs) and 95% CIs for predictors of all-cause 5-year mortality were obtained by using Cox proportional hazards regression. ResultsOf 53,801 patients, 67% had right-sided colon cancer. Patients with right-sided cancer were more likely to be older, to be women, to be diagnosed with a more advanced stage, and to have more poorly differentiated tumors. Adjusted Cox regression showed no significant difference in mortality between right-and left-sided cancers for all stages combined (HR, 1.01; 95% CI, 0.98 to 1.04; P ϭ .598) or for stage I cancers (HR, 0.95; 95% CI, 0.88 to 1.03; P ϭ .211). Stage II right-sided cancers had lower mortality than left-sided cancers (HR, 0.92; 95% CI, 0.87 to 0.97; P ϭ .001), and stage III right-sided cancers had higher mortality (HR, 1.12; 95% CI, 1.06 to 1.18; P Ͻ .001). ConclusionWhen analysis was adjusted for multiple patient, disease, comorbidity, and treatment variables, no overall difference in 5-year mortality was seen between right-and left-sided colon cancers. However, within stage II disease, right-sided cancers had lower mortality; within stage III, right-sided cancers had higher mortality.

Purpose Adjuvant chemotherapy is typically considered for patients with stage II colon cancer characterized by poor prognostic features, including obstruction, perforation, emergent admission, T4 stage, resection of fewer than 12 lymph nodes, and poor histology. Despite frequent use, the survival advantage conferred on patients with stage II disease by chemotherapy is yet unproven. We sought to determine the overall survival benefit of chemotherapy among patients with stage II colon cancer having poor prognostic features. Patients and Methods A total of 43,032 Medicare beneficiaries who underwent colectomy for stage II and III primary colon adenocarcinoma diagnosed from 1992 to 2005 were identified from the Surveillance, Epidemiology, and End Results (SEER) –Medicare database. χ2 and two-way analysis of variance were used to assess differences in patient- and disease-related characteristics. Five-year overall survival was examined using Kaplan-Meier survival analysis and Cox proportional hazards regression with propensity score weighting. Results Of the 24,847 patients with stage II cancer, 75% had one or more poor prognostic features. Adjuvant chemotherapy was received by 20% of patients with stage II disease and 57% of patients with stage III disease. After adjustment, 5-year survival benefit from chemotherapy was observed only for patients with stage III disease (hazard ratio[HR], 0.64; 95% CI, 0.60 to 0.67). No survival benefit was observed for patients with stage II cancer with no poor prognostic features (HR, 1.02; 95% CI, 0.84 to 1.25) or stage II cancer with any poor prognostic features (HR, 1.03; 95% CI, 0.94 to 1.13). Conclusion Among Medicare patients identified with stage II colon cancer, either with or without poor prognostic features, adjuvant chemotherapy did not substantially improve overall survival. This lack of benefit must be considered in treatment decisions for similar older adults with colon cancer.

Objectives-Early hospital readmission is a common and costly problem in the Medicare population. In 2009, the Centers for Medicaid and Medicare Services began mandating hospital reporting of disease-specific readmission rates. We sought to determine the rate and predictors of readmission after colectomy for cancer, as well as the association between readmission and mortality.Methods-Medicare beneficiaries who underwent colectomy for stage I-III colon adenocarcinoma from 1992-2002 were identified from the SEER-Medicare database. Multivariate logistic regression identified predictors of early readmission and one-year mortality. Odds ratios were adjusted for multiple factors, including measures of comorbidity, socioeconomic status, and disease severity.Results-Of 42,348 patients who were discharged, 4,662 (11.0%) were readmitted within 30 days. The most common causes of rehospitalization were ileus/obstruction and infection. Significant predictors of readmission included male gender, comorbidity, emergent admission, prolonged hospital stay, blood transfusion, ostomy, and discharge to nursing home. Readmission was inversely associated with hospital procedure volume, but not surgeon volume. After adjusting for potential confounding variables, the predicted probability of one-year mortality was 16% for readmitted patients, compared to 7% for those not readmitted. This difference in mortality was significant for all stages of cancer.Conclusions-Early readmission after colectomy for cancer is common and due in part to modifiable factors. There is a remarkable association between readmission and one-year mortality. Early readmission is therefore an important quality-of-care indicator for colon cancer surgery. These findings may facilitate the development of targeted interventions that will decrease readmissions and improve patient outcomes.

Background Individuals ≥80 years of age represent an increasing proportion of colon cancer diagnoses. Selecting these patients for elective surgery is challenging due to diminished overall health, functional decline, and limited data to guide decisions. The objective was to identify overall health measures that are predictive of poor survival after elective surgery in these oldest-old colon cancer patients. Methods Medicare beneficiaries ≥80 years who underwent elective colectomy for stage I-III colon cancer from 1992-2005 were identified from the Surveillance, Epidemiology and End Results(SEER)-Medicare database. Kaplan-Meier survival analysis determined 90-day and 1-year overall survival. Multivariable logistic regression assessed factors associated with short-term post-operative survival. Results Overall survival for the 12,979 oldest-old patients undergoing elective colectomy for colon cancer was 93.4% and 85.7%, at 90-days and 1-year. Older age, male gender, frailty, increased hospitalizations in prior year, and dementia were most strongly associated with decreased survival. In addition, AJCC stage III (versus stage I) disease and widowed (versus married) were highly associated with decreased survival at 1-year. Although only 4.4% of patients were considered frail, this had the strongest association with mortality, with an odds ratio of 8.4 (95% confidence interval 6.4-11.1). Discussion Although most oldest-old colon cancer patients do well after elective colectomy, a significant proportion (6.6%) dies by post-operative day 90 and frailty is the strongest predictor. The ability to identify frailty through billing claims is intriguing and suggests the potential to prospectively identify, through the electronic medical record, patients at highest risk of decreased survival.

Normal perception depends, in part, on accurate judgments of the temporal relationships between sensory events. Two such relativetiming skills are the ability to detect stimulus asynchrony and to discriminate stimulus order. Here we investigated the neural processes contributing to the performance of auditory asynchrony and order tasks in humans, using a perceptual-learning paradigm. In each of two parallel experiments, we tested listeners on a pretest and a posttest consisting of auditory relative-timing conditions. Between these two tests, we trained a subset of listeners ϳ1 h/d for 6 -8 d on a single relative-timing condition. The trained listeners practiced asynchrony detection in one experiment and order discrimination in the other. Both groups were trained at sound onset with tones at 0.25 and 4.0 kHz. The remaining listeners in each experiment, who served as controls, did not receive multihour training during the 8 -10 d between the pretest and posttest. These controls improved even without intervening training, adding to evidence that a single session of exposure to perceptual tasks can yield learning. Most importantly, each of the two groups of trained listeners learned more on their respective trained conditions than controls, but this learning occurred only on the two trained conditions. Neither group of trained listeners generalized their learning to the other task (order or asynchrony), an untrained temporal position (sound offset), or untrained frequency pairs. Thus, it appears that multihour training on relative-timing skills affects task-specific neural circuits that are tuned to a given temporal position and combination of stimulus components.

Background Age-related disparities in colon cancer treatment exist, with older patients less likely to receive recommended therapy. However, few studies have focused on receipt of surgery. The objective was to describe patterns of surgery in colon cancer patients ≥80 years and examine outcomes with and without colectomy. Methods Medicare beneficiaries ≥80 years with colon cancer diagnosed from 1992–2005 were identified from the Surveillance, Epidemiology and End Results- Medicare database. Multivariable logistic regression analysis was utilized to assess factors associated with non-operative management. Kaplan-Meier survival analysis determined one-year overall and colon cancer-specific survival. Results Of 31,574 patients, 80% underwent colectomy. 46% occurred during an urgent/emergent admission, with decreased 1-year overall survival (70% vs. 86% during an elective admission). Factors most predictive of non-operative management include older age, black race, more hospital admissions, use of home oxygen, use of a wheel chair, being frail and dementia. For both operative and non-operative patients, one-year overall survival was lower than colon cancer-specific survival (colectomy 78% vs. 89%; no colectomy 58% vs. 78%). Conclusions Most older colon cancer patients are receiving surgery, with improved outcomes compared to non-operative management. However, many patients not selected for surgery die of unrelated causes, reflecting good surgical selection. Patients undergoing surgery during an urgent/emergent admission have an increased short-term mortality. As earlier detection of colon cancer may increase the proportion of older patients undergoing elective surgery, these findings have policy implications for colon cancer screening and suggest that age should not be the only factor driving cancer screening recommendations.

The difficulty in finding causative mutations has hampered their use in genomic prediction. Here, we present a methodology to fine-map potentially causal variants genome-wide by integrating the functional, evolutionary and pleiotropic information of variants using GWAS, variant clustering and Bayesian mixture models. Our analysis of 17 million sequence variants in 44,000+ Australian dairy cattle for 34 traits suggests, on average, one pleiotropic QTL existing in each 50 kb chromosome-segment. We selected a set of 80k variants representing potentially causal variants within each chromosome segment to develop a bovine XT-50K genotyping array. The custom array contains many pleiotropic variants with biological functions, including splicing QTLs and variants at conserved sites across 100 vertebrate species. This biology-informed custom array outperformed the standard array in predicting genetic value of multiple traits across populations in independent datasets of 90,000+ dairy cattle from the USA, Australia and New Zealand.

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