bluuebunny/crossref_metadata_2025_split huggingface dataset:
40 INTRODUCING AN INTERACTIVE ONLINE-REPORT FROM THE SWEDISH NATIONAL QUALITY REGISTER FOR ESOPHAGEAL AND GASTRIC CANCER—OPEN NREV
Authors: Linder G , Lindblad M , Johansson J , Lindberg F , Smedh U , Moritz E , Hedberg J 
Published: September 2020

Abstract

The Swedish National Quality Register for Esophageal and Gastric Cancer (NREV) was introduced in 2007 and is the sole quality registry in Sweden for patients with esophageal and gastric cancer. Previously, selected variables from the registry was made available to both caregivers and the public through a downloadable annual report.
We aimed to make quality indicators readily available to all interested parties; caregivers, patient groups, hospital staff, researchers, administrators and health-political decision-makers.

Methods
A database was compiled with registry data presented for all years since 2007 and updated every six months. Several graphical and numeric presentations were implemented. Both medical expertise and a patient representative were involved in choosing relevant quality indicator variables as well as designing the web interface.

Results
Registry Coverage, Quality indicators/lead times, Treatment and Outcomes were the four main focus areas. All areas contained selectable sub-variables and the user was given the choice to present data on a national or regional level. Alterations in chosen variables or selection-base resulted in real time changes in the online report. Thus, a variable national or regional report could be tailored to the users’ needs. All data could be presented as comparative diagrams, crude tables or as time-trend analysis, as exemplified by figure 1.

Conclusion
An interactive online platform to display population based results and time-trends for important quality indicators in the diagnosis and treatment of esophageal and gastric cancer is now available for all. The main purpose, to make anonymized data available, was achieved by OPEN-NREV. We propose that presenting data in this manner is of interest to patients, caregivers, scientists and decision makers.
415 OCCUPATIONAL PHYSICAL ACTIVITY AND THE RISK OF GORD, BARRETT’S OESOPHAGUS AND OESOPHAGEAL ADENOCARCINOMA A PROSPECTIVE COHORT STUDY IN UK BIOBANK
Authors: Lam S , Savva G , Alexandre L , Kumar B , Hart A 
Published: September 2020

Abstract

Recreational physical activity has been shown to protect against the development of oesophageal adenocarcinoma as well as gastroesophageal reflux disease (GORD), but such effects have not been demonstrated for non-recreational activity. We examined whether high levels of occupational physical activity (heavy manual labour or physical work) were associated with the risk of oesophageal adenocarcinoma as well as its sequential precursor diseases; gastroesophageal reflux disease (GORD), reflux oesophagitis and Barrett’s oesophagus.

Methods
In this population-based prospective cohort study, participants aged between 37 to 73 years were recruited from 22 regions across the United Kingdom. Baseline occupational information of job type and levels of heavy manual activity was assessed using both questionnaires and verbal interviews. Incident cases were identified by linkage with routinely collected hospital inpatient and cancer registry data for England, Scotland and Wales. Primary clinical outcomes were GORD without oesophagitis, GORD with oesophagitis (reflux oesophagitis), Barrett’s oesophagus and oesophageal adenocarcinoma. The effects of heavy manual activity on disease risk were estimated using Cox proportional hazard regression.

Results
Between 2006 and 2010, 502 524 men and women were enrolled. Main analyses were limited to the working population with a full set of variables of interest (n = 266 453). Compared to jobs with low levels of heavy manual activity, high level jobs had increased hazard ratios (HRs) for GORD (1.20, 95% CI 1.11–1.30), reflux oesophagitis (1.17, 95% CI 1.04–1.31) and Barrett’s oesophagus (1.13, 95% CI 0.98–1.32), but not oesophageal adenocarcinoma (0.91 95% CI 0.54–1.56).

Conclusion
High levels of occupational heavy manual activity could be used as a risk factor for GORD and reflux oesophagitis, the precursor diseases of Barrett’s oesophagus and oesophageal adenocarcinoma.
442 HAS HOSPITAL VARIATION IN THE PROBABILITY OF RECEIVING TREATMENT WITH CURATIVE INTENT FOR ESOPHAGEAL AND GASTRIC CANCER DECREASED OVER TIME?
Authors: Luijten J , Vissers P , Lingsma H , van Leeuwen N , Rozema T , Siersema P , Rosman C , van Laarhoven H , Lemmens V , Nieuwenhuijzen G , Verhoeven R 
Published: September 2020

Abstract

Geographical variation in cancer care has been observed between and within countries. Variation in treatment may occur at any point along the cancer care continuum attributing to potentially avoidable disparities in patient outcomes such as survival. Other studies have shown a large variation in the proportion of patients undergoing treatment with curative intent for esophageal(EC) and gastric cancer(GC). Due to these studies and thus an increased awareness, we hypothesize that variation has decreased over time.

Methods
Patients with potentially curable EC (n = 10,115) or GC (n = 3,983) diagnosed between 2012-2017 were selected from the Netherlands Cancer Registry. Multilevel multivariable logistic regression was used to examine the differences in the probability of treatment with curative intent between hospitals of diagnosis, comparing 2012-2014 with 2015-2017. We compared relative survival (RS) and relative excess risk of death (RER) between hospitals with different probabilities of treatment with curative intent.

Results
The range of proportions of patients undergoing treatment with curative intent per hospital of diagnosis was 45-95% in 2012-2014 and 54-89% in 2015-2017 for EC, and 52-100% and 45-100% for GC. The adjusted variation declined for EC with Odds Ratios (ORs) ranging from 0.50 to 1.72 between hospitals in the first period to 0.70–1.44 in the second period (p &lt; 0.001) and did not change for GC (ORs ranging from 0.78–1.23 to 0.82–1.23, p = 1.00). A higher probability of receiving treatment with curative intent was associated with better RS and reduced RER for both types of cancer.

Conclusion
Although substantial variation between hospitals of diagnosis in the probability in receiving treatment with curative intent still exists for both malignancies, it has decreased for EC, but did not change for GC. A low probability of receiving curative treatment was associated with a worse survival. Further research is needed to elucidate the factors associated with the observed variability.
448 SYSTEMATIC IMPLEMENTATION OF A REGIONAL MULTIDISCIPLINARY TEAM MEETING IMPROVES PROGNOSIS FOR ESOPHAGEAL CANCER PATIENTS.
Authors: Luijten J , Haagsman V , Luyer M , Heesakkers F , Schrauwen R , Jürgens M , Buster E , Vincent J , Kneppelhout J , Verhoeven R , Nieuwenhuijzen G 
Published: September 2020

Abstract

Surgery for esophageal cancer (EC) has been centralized in the Netherlands. However, patients are still diagnosed in referral centers and not all patients are discussed with a resection center. The aim of this study was to examine the impact of the implementation of the regional Upper-GI video multidisciplinary team meeting (MDT) in the Eindhoven region in which all regional patients should be discussed, on the decision-making process, treatment, and survival of patients with EC.

Methods
All patients diagnosed between 2012 and 2018 with EC, in hospitals currently working together with the Catharina hospital, were selected from the Netherlands Cancer Registry (n = 1119). The regional MDT was implemented in 2 hospitals in May 2014 and the other hospitals gradually joined. The primary outcome of this study was the proportion of patients discussed in any MDT. Secondary outcomes were involvement of a resection center in MDT, treatment and survival. Outcomes were described prior to and after participation in the regional MDT and analyzed by chi-square tests. Kaplan–Meier curves and log-rank tests were used to compare overall survival.

Results
Since participation in the regional MDT more patients were discussed in any MDT (80%-89%, p &lt; 0.0001) and involvement of a resection center during the MDT almost doubled (43%-82%, p &lt; 0.0001). The proportion of patient who underwent treatment with a curative intent remained the same (75%). However, esophagectomy (41%-43%) and endoscopic resections (2%-6%) were performed more often and the use of definitive chemoradiation therapy decreased (31%-25%)(p = 0.049). The use of palliative systemic therapy increased (39%-52%, p &lt; 0.001). Three-year overall survival for all EC patients increased significantly (24%-32%, p &lt; 0.02)(Figure). A non-significant increase in 3-year survival in potentially curable patients (38%-48%, p = 0.09) and 1-year survival in palliative patients (18%-26%, p = 0.13) was observed.

Conclusion
After implementation of the regional MDT more EC patients were discussed during a MDT and also more often with the involvement of a resection center. This is the first study showing an association of the implementation of a regional MDT with an improved survival. Hypothetically, the implementation of the regional tumor specific video MDT could have had a positive effect on the quality and effectiveness of decision making in patients diagnosed with EC.
449 MANAGEMENT OF LATE PRESENTATION OF ESOPHAGEAL CANCER
Authors: Lim K 
Published: September 2020

Abstract

The incidence of esophageal carcinoma (EC) in Singapore is declining since 1970s. However, the age-incidence curve in 2010s shows a steep rise after age 40-50s. The majority of EC patients presented with locally advanced or metastatic disease. The 2 common risk factors are cigarette smoking and disease progression from acid reflux-related intestinal metaplasia.

Methods
Consecutive cases of esophageal malignancy (n = 62) including gastro-esophageal junction carcinoma were identified from the hospital electronic medical records between August 2015 to February 2020 for data analysis. True gastric cardia tumors not invading above squamo-columnar junction were excluded.

Results
The mean age was 65 years (range 40–90), predominantly male (n = 51) and 50% were smokers. The histological types were adenocarcinoma (n = 33), squamous cell carcinoma (n = 25), undifferentiated carcinoma (n = 3) and adenosquamous carcinoma (n = 1). Staging CT scan showed M1 disease in 42% of cases whilst 62% received palliative therapy including stent insertion (n = 4). Only a handful of cases received curative-intent treatment such as EMR (n = 2), ESD (n = 1), extended total gastrectomy (n = 2) and 2-staged esophagectomy (n = 2). From the time of EC diagnosis was made, the survival cases at Year 1, 2, 3, and 4 follow up were 30, 8, 5 and 1 respectively.

Conclusion
EC is a dismal disease to manage in this population group due to advanced disease at the time of presentation. The majority had Stage IV disease and was given palliative treatment. Primary and secondary preventative healthcare against development of EC should be targeted to reduce the risk factors such as cigarette smoking and chronic acid reflux.
504 THE USE OF ENDOSCOPIC VACUUM THERAPY (EVT) AS COMPARED TO ENDOSCOPIC STENTING (ES) FOR LEAKAGES AFTER FOREGUT SURGERY
Authors: Chan S , Yip H , Teoh A , Chiu P , Ng E 
Published: September 2020

Abstract

Anastomotic leakage after foregut surgeries are often difficult to manage. The conventional way of endoscopic treatment is ES. However, it carries a risk of stent migration and erosion. EVT is a novel way of treating these leaks.

Methods
This was a retrospective cohort study including all patients with anastomotic leak after foregut surgery and were treated with ES or EVT between July 2008 and July 2019. Patients’ demographics, type of surgery, size of anastomotic defect, success rate, complications, number of procedures were recorded and compared.

Results
There were 17 patients treated with ES and 7 patients treated with EVT. The success rate of both therapies are similar. (11/17(64.7%) in the ES group vs 5/7(71.4%) in the EVT group; p = 0.751). However, there was a trend to less complications in the EVT group (9/17 (52.9%) in ES group vs. 1/7(14.2%) in EVT group; p = 0.135). On the other hand, the EVT group has a trend to requiring more endoscopic procedures (median (range) 3 (7) procedures in the ES group vs 6(11) in the EVT group; p 0.435).

Conclusion
The use of EVT is feasible and safe in treating anastomotic leaks after foregut surgeries. Although more procedures are required, it achieved similar success rate while having a trend to less complications.
507 NEOADJUVANT AND ADJUVANT CHEMOTHERAPIES FOR PATIENTS WHO UNDERWENT RESECTION FOR SQUAMOUS CELL CARCINOMA CF THE THORACIC ESOPHAGUS
Authors: Liu J , Wang Y 
Published: September 2020

Abstract

The efficacy of neo-adjuvant chenmotherapy (NCT) and adjuvant chemotherapy (ACT) for squamous cell carcinoma (SCC) of the esophagus has not been fully expounded. This study analyzed the prognostic factors of patients who underwent esophagectomy for SCC of the thoracic esophagus, specially focused on NCT and ACT.

Methods
From January 2008 to January 2016, 1075 consecutive patients underwent esophgagectomy for stage T3-T4 SCC of the thoracic esophagus. Propensity-score matching (PSM) analyses were conducted in patients who underwent NCT, surgery alone (SA) and ACT. After PSM, there were 83 patients in NCT, 249 patients in SA and 249 patients in ACT group. Postoperative outcomes and prognostic factors of patients in the three groups were analyzed. Univariate analysis was performed using the Kaplan–Meier method and multivariate analysis using the Cox proportional hazard model. Differences were considered to be statistically significant when P &lt; 0.05.

Results
The incidence of main postoperative complications was 9.6% (8/83) in NCT group compared to 6.8% (34/498) in SA and ACT groups (P = 0.834). In NCT group, 20 patients (24.1%) were downstaged by NCT and 63 patients (75.9%) remained stable. The 3-year survival rate of the entire group was 51.0%, and the 5-year survival rate was 33.4%. The 5-year survival rate was 32.2% in NCT group, 50.9% in ACT, and 19.5% in SA patients. In univariate analysis, both NCT and ACT were associated with long-term survival. In multivariate analysis, however, ACT rather than NCT was independent prognostic factor.

Conclusion
This study supports the use of postoperative ACT for patients with stage T3 or T4 SCC of the thoracic esophagus, but the effect of NCT needs further study.
510 IMPACT OF TUMOR REGRESSION ON PROGNOSIS AFTER NEOADJUVANT CHEMORADIOTHERAPY IN MINIMALLY INVASIVE ESOPHAGECTOMY TREATED ESOPHAGEAL ADENOCARCINOMA
Authors: Crull D , Hogenes M , van Det M , Kouwenhoven E 
Published: September 2020

Abstract

Multimodal therapy is the standard of care in curative esophageal cancer. However, tumor characteristics such as differentiation, subtype of adenocarcinoma and tumor regression grade (TRG) are not incorporated in the 8th AJCC-staging or used for prognosis. The aim of this study is to determine the impact of these tumor characteristics on overall survival (OS) and disease free survival (DFS) and explore the prognostic value when TRG is combined with the AJCC-staging.

Methods
Between 2011 and 2018, 316 patients underwent a minimally invasive esphagectomy (MIE) in a single, high volume center. 228 patients were selected based on having an adenocarcinoma treated with neoadjuvant chemo-radiotherapy, a radical resection and a pM0 stage. TRG was determined using Mandard Tumor Regression (MTR). Subtype of adenocarcinoma was confirmed using either the pre-operative biopsy or the residual tumor tissue after surgery. Differentiation grade was determined on resected tumor tissue. MTR was modified from a 5-tier to a 3-tier classification. MTR 1 and 2 were classified in one group of “major response”, MTR 4 and 5 as “minimal response”.

Results
Median follow up was 2.1 years. MTR was a strong predictor for OS and DFS in univariate analysis. MTR combined with AJCC-staging did not improve the prognostic value of the AJCC-staging for the prediction of OS. However, in DFS the prognostic value of AJCC-staging is improved by adding MTR (Hazard Ratio of 1.78 (CI 1.008–3.131)). DG or subtype neither correlated with OS or DFS and did not improve the prognostic value of the AJCC-staging.

Conclusion
The prognostic value of AJCC-staging on OS is not improved by either MTR, DG or subtype. However, the 8th AJCC-staging combined with a 3-tier MTR provides a better prognostic tool for DFS in esophageal adenocarcinoma treated with MIE after neoadjuvant chemo-radiotherapy.
514 CANCER CELLS PERSIST AFTER COMPLETE PATHOLOGICAL RESPONSE IN ESOPHAGEAL ADENOCARCINOMA
Authors: Walker R , Harrington J , Grace B , Sharpe B , Breininger S , Izadi F , Kelly J , Byrne J , Noble F , Rose-Zerilli M , Underwood T 
Published: September 2020

Abstract

In esophageal adenocarcinoma (EAC) with apparent pathological complete response (pCR) to neoadjuvant therapy (NAT) debate remains as to whether esophagectomy is required. Recurrence after pCR is not limited to distant metastases outside radiation or resection fields. It is unknown if cancer persists below the lower detection limit of current diagnostic technology. Trials randomising patients with apparent pCR to esophagectomy or active surveillance are currently recruiting in an attempt to spare patients the morbidity of esophagectomy.

Methods
Single cell (scRNAseq) was performed on fresh tissue taken at surgical resection to determine the transcriptomic profiles of cell populations in 24 EAC tumours and matched normal samples. Five tumour-normal pairs were also analysed using bulk RNA sequencing and high-precision mass spectrometry proteomics. Immunohistochemistry (IHC) was used to confirm pCR. Paired scRNAseq analysis of pre-and post-treatment specimens from three patients was used to compare transcriptomic profiles before and after NAT. Cancer cells were assigned a cancer stem cell module score curated from published gene sets.

Results
We analysed a total of 22,738 single cells forming 29 different cell states. In two samples with pCR, we repeated the pathological analysis and performed IHC using antibodies to known cancer proteins and identified no residual cancer cells (figure 1A). Bulk tissue RNA (figure 1B) and proteomic analysis did not detect cancer genes or proteins in the pCR samples. ScRNAseq, conversely, revealed small populations of persistent cancer cells in both complete responders (12/978 and 45/774) (figure 1C). Transcriptomic analysis of these residual cells identified upregulation of stem cell markers and high cancer stem cell scores in these remaining cells (figure 1D).

Conclusion
We have determined the cell states present across multiple different EAC and normal esophageal samples. We have shown cancer cells persisting after NAT, in patients with apparent pCR, beneath the lower detection limit of standard diagnostic approaches. These cells express gene programs consistent with cancer stem cells. Cancer stem cells are a critical subpopulation that drive tumour initiation, growth, and resistance to therapy. Esophagus sparing approaches in pCR may subject patients to risk of progression.
519 PERIOPERATIVE FLUID MANAGEMENT IN ESOPHAGECTOMY FOR CANCER AND ITS RELATION TO POSTOPERATIVE RESPIRATORY COMPLICATIONS
Authors: Van Dessel E , Moons J , Nafteux P , Van Veer H , Depypere L , Coosemans W , Coppens S , Neyrinck A 
Published: September 2020

Abstract

The optimal perioperative fluid management during esophagectomy is still not clear. Liberal regimens have been associated with higher morbidity and respiratory complications. Restrictive regimens might raise concerns for kidney function and increase the need to associate vasopressors. Recently, perioperative care is changing towards goal-directed fluid regimens as part of early recovery programs. The aim of this study was to investigate retrospectively the perioperative fluid administration during esophagectomy and to correlate this with postoperative respiratory outcome.

Methods
All patients who underwent esophagectomy between January–December 2016 were retrospectively analyzed. Patient characteristics, type of surgery and postoperative course were reviewed. Fluid administration and vasopressor use were calculated intra-operatively and during the postoperative stay at the recovery room. Fluid overload was defined as a positive fluid balance of more than 125 mL/m2/h during the first 24 hours. Patients were divided in 3 groups: GRP0 (no fluid overload/no vasopressors); GRP1 (need for vasopressors); GRP2 (fluid overload with/without vasopressors). Postoperative complications were prospectively recorded according to Esophagectomy Complications Consensus Group criteria. Multivariable analysis (binary logistic regression) for “any respiratory complication” was performed.

Results
103 patients were analyzed: 35 (34%) GRP0, 50 (49%) GRP1 and 18 (17%) GRP2. No significant differences were found for age, treatment (neoadjuvant vs. primary), type of surgery (Open/MIE), histology and comorbidities.
There were significant (p ≤ 0.001) differences in fluid balance/m2/h (75 ± 21 mL; 86 ± 22 mL and 144 ± 20 mL) across GRP0, GRP1 and GRP2 respectively.
We found differences in respiratory complications GRP0 (20%) versus GRP1 (42%;p = 0.034) and GRP0 (20%) versus GRP2 (61%;p = 0.002)) and “Comprehensive Complications Index” GRP0 (20.5) versus GRP1 (34.6;p = 0.015) and GRP0 (20.5) versus GRP2 (35.1;p = 0.009). Multivariable analysis for any respiratory complication is presented in FIGURE 1.

Conclusion
Among patients undergoing esophagectomy, there is a wide variety in the administration of fluid during the first 24 hours. There was a higher incidence of respiratory complications if patients received higher amounts of fluid or if vasopressors were used. Type of surgery (open versus MIE) did not impact respiratory outcome. We believe that a personalized and protocolized fluid administration algorithm should be implemented and that individual risk factors for patients at risk should be identified.