bluuebunny/crossref_metadata_2025_split huggingface dataset:
Synchronous pulmonary and esophageal cancers: Is combined esophagectomy and anatomic lung resection appropriate?
Authors: Zhao Hedi , Misariu Ana-Maria , Ramirez-Garcia Luna Jose , Hofstetter Wayne Lewis , Molena Daniela , Katz Amit , Nobel Tamar B. , Mueller Carmen L. , Cools-Lartigue Jonathan , Spicer Jonathan , Mulder David S. , Ferri Lorenzo 
Published: February 2020

341 Background: Resection is the best treatment for both esophagus and lung cancer, however, concerns that a combined resection of synchronous lung/esophagus tumors might be associated with higher morbidity may preclude surgical therapy. We sought to review a multi-institutional experience on combined esophagus/lung cancer resections. Methods: Patients undergoing esophagectomy and those with concurrent anatomic resection for bronchogenic carcinoma between 1997-2018 at three high-volume North American centers were identified from prospectively collected databases. Combined resection cases (E+L) were matched in a 1:3 ratio to patients who underwent esophagectomy alone (E), based on age, sex, stage, neoadjuvant therapy, procedure (2/3hole), and approach (MIE/open). Patient demographics, tumour characteristics, and post-operative outcomes were compared. Statistical analysis was performed using unpaired t-test or Wilcoxon sum-rank test for continuous variables and Fisher’s exact test for categorical data. Statistical significance was defined as p < 0.05. Results: Of over 2500 patients undergoing esophagectomy, synchronous anatomic lung resection was performed in 20; 4 were excluded due to incomplete data (n = 16). Matching yielded 48 patients and 4 duplicates were removed (n = 44); there were no significant differences in patient demographics, neoadjuvant therapy, clinical stage, or procedure. Anatomic resection consisted of lobectomy (16/20), segmentectomy (3/20) and pneumonectomy (1/20), combined with 2-hole (14/20), 3-hole (4/20), or left thoraco-abdominal (2/20) esophagectomy. The proportion of patients with any complication in E+L was 50%, and 66% in E (p = 0.42). Pulmonary complications were 19% and 27% in the respective groups (p = 0.74). Mortality did not differ (E+L = 0/16:E = 1/44)NS. The median length of stay for both groups was similar (E+L = 10.5 days(IQR 5.7): E = 10.0 days (IQR 8.7))NS. Conclusions: Patients with synchronous localized lung and esophageal cancer, although rare, should not be biased towards non-surgery therapy, as the morbidity associated with combined esophagectomy and anatomic lung resection does not differ significantly from esophagectomy alone.
Variation in treatment patterns and outcomes for resected esophageal cancer at designated thoracic surgery centers.
Authors: Gupta Vaibhav , Levy Jordan , Kidane Biniam , Mahar Alyson , Ringash Jolie , Sutradhar Rinku , Darling Gail Elizabeth , Coburn Natalie ,   PRESTO Research Group
Published: February 2020

343 Background: Ontario regionalized thoracic surgery to designated centers to provide high-volume care for patients undergoing esophageal cancer resection. The objective of this study was to assess variation in treatment patterns and outcomes across thoracic centers, and to compare their performance to non-thoracic centers. Methods: A retrospective, population-based cohort study (2002-2014) was conducted in Ontario, Canada (population 13.6 million). Adults with resected esophageal cancer were identified through the PRESTO database. Case mix, use of neoadjuvant therapy, surgical outcomes (lymph node yield and margin rates) and survival were described across thoracic centers. Multivariable regression was used to estimate the effect of having surgery at a regionalized thoracic surgery center on perioperative (in-hospital & 90-day post-discharge) mortality and long-term survival, adjusting for case mix. Results: Of 3,880 patients meeting study criteria, 2,213 had pathology data available and were included in the analysis. Average age was 64 years, 85.7% had adenocarcinoma, 50.2% were pT3, and 38.4% were pN0. Most (82.6%) had surgery at one of 15 thoracic centers. Across thoracic centers, rates of neoadjuvant therapy varied 16.4-81.6%, positive margin rates varied 8.2-29.6%, median lymph node harvest varied from 7-20 nodes, perioperative mortality varied 2.6-20.5%, and 2-year survival varied from 48-80%. There was a trend toward reduced perioperative mortality, but no difference in long-term survival, with having surgery at a thoracic center. Conclusions: Even at designated thoracic centers, there is significant variability in treatment patterns, surgical outcomes, and survival. Looking beyond center volume, and translating best practices from high-performing hospitals to other hospitals, may improve patient outcomes.
Impact of inaccurate clinical staging for gastric cancer on patient survival outcomes.
Authors: Ju Michelle , Porembka Matthew R. 
Published: February 2020

345 Background: Accurate clinical staging (CS) in gastric cancer is critical for appropriate treatment selection and prognostication, but CS remains highly ineffective. Our study aims to evaluate the factors associated with inaccurate CS, the impact of inaccurate CS on patient outcomes, and effect of adjuvant therapy in patients with inaccurate CS. Methods: We conducted a retrospective review of the NCDB of patients diagnosed with clinical early-stage gastric adenocarcinoma based on AJCC 8th edition (cT1-2, N0, M0) between 2004-2016. Those who did not undergo upfront surgery or had missing pathologic staging data were excluded. Patients were classified into 3 groups: accurately staged (AS) if pathologic staging confirmed early-stage cancer, inaccurately staged with receipt of adjuvant therapy (IS+), and inaccurately staged with no receipt of adjuvant therapy (IS-). Logistic regression using stepwise selection was utilized to assess the impact of factors on CS accuracy and receipt of adjuvant therapies. Kaplan-Meier and Cox Proportional Hazard methods were used to compare survival outcomes. Results: Approximately 39% of patients (2841/7199) were understaged. T2 tumors, non-well differentiated tumors, and diffuse type histology were associated with increased likelihood of inaccurate CS. Age >60, female sex, Asian/Black race, and non-cardia tumor location were associated with decreased likelihood of inaccurate CS. Only 44% of patients who were inaccurately staged received adjuvant chemotherapy/radiation. Age >75 and fundus/body tumor location were associated with decreased likelihood of receiving adjuvant therapies, while more advanced pT and pN stage were associated with increased likelihood. Treatment facility type (community vs. academic) had no impact on likelihood of accurate CS or receipt of adjuvant treatment after inaccurate CS. 5-year overall survival was significantly different between groups (71.7% AS, 48.3% IS+, 51.1% AS-; p<0.001). Conclusions: CS is inadequate, and understaging has detrimental effects on patient survival outcomes. Novel strategies for improved CS are needed to improve patient care.
Feasibility and pathological response of TAS-118 + oxaliplatin as perioperative chemotherapy for patients with locally advanced gastric cancer (APOLLO-11).
Authors: Takahari Daisuke , Takashima Atsuo , Nakajima Takako Eguchi , Ishizuka Naoki , Ohashi Manabu , Katai Hitoshi , Mikami Shinya , Chin Keisho , Nunobe Souya , Ito Miki , Wada Takeyuki , Ogura Takashi , Sano Takeshi , Boku Narikazu , Yamaguchi Kensei 
Published: February 2020

351 Background: TAS-118 is a novel oral agent, containing S-1 and leucovorin. In the SOLAR study (NCT02322593), TAS-118 + oxaliplatin (OHP) significantly improved overall survival compared to S-1 + cisplatin for patients (pts) with advanced gastric cancer (GC). We conducted this open-label study to assess feasibility of perioperative adjuvant chemotherapy with TAS-118 + OHP in pts with locally advanced resectable GC with lymph node metastasis. (Clinical trial information: UMIN000024688). Methods: Eligible pts who had histopathologically confirmed GC with clinical T3-4N1-3M0 on image findings (14th Japanese classification of gastric carcinoma), age 20 to 79 years, were enrolled in this study. The protocol treatment consisted of preoperative 4 courses of TAS-118 (80-120 mg/body, days 1-7) + OHP (85 mg/m2, day 1) every 2 weeks, and gastrectomy with D2 lymphadenectomy, followed by postoperative 12 courses of TAS-118 alone (step1) or 8 cycles of TAS-118 + OHP (step2). The primary endpoints were tolerability of preoperative chemotherapy, gastrectomy and postoperative chemotherapy with TAS-118 plus OHP. Here, we report the feasibility of preoperative chemotherapy and gastrectomy, and pathological response. Results: Between December 2016 and April 2018, 45 pts with a median age of 61 years were enrolled. The numbers of pts with T stage (cT3/4a) and those with N stage (cN1/2/3) were 13/32 and 25/17/3, respectively. The completion rate of preoperative chemotherapy and gastrectomy was 88.9% ( 95% CI 78.0-95.5) and 95.6% (95% CI 86.7-99.2). The relative dose intensity of TAS-118 and OHP was 86.0% and 90.6%. During the 4 cycles of preoperative TAS-118 + OHP, 2 pts discontinued the treatment due to adverse event (AE). Major grade 3-4 AEs were diarrhea (17.8%) and neutropenia (8.9%). R0 resection rate was as high as 95.6%. One pts experienced grade 4 postoperative bleeding, but no treatment-related death was reported. pCR was achieved in 6/45 pts (13.3%) and other 7 pts (28.9%) showed near complete regression (<10 % residual tumor cells). Conclusions: Preoperative TAS-118 + OHP followed by D2 gastorectomy was well tolerated and showed promising efficacy. Clinical trial information: 000024688.
A phase II trial of cytoreduction, gastrectomy, and hyperthermic intraperitoneal perfusion with chemotherapy for patients with gastric cancer and stage IV peritoneal disease.
Authors: Badgwell Brian D. , Ikoma Naruhiko , Blum Murphy Mariela A. , Wang Xuemei , Estrella Jeannelyn , Roy-Chowdhuri Sinchita , Das Prajnan , Minsky Bruce D. , Mansfield Paul F. , Ajani Jaffer A. 
Published: February 2020

361 Background: Current national guidelines do not include hyperthermic intraperitoneal chemoperfusion (HIPEC) as treatment for gastric cancer, and there are no completed clinical trials of cytoreduction, gastrectomy, and HIPEC from the U.S. However, recent international studies report long-term survival rates of approximately 20% with cytoreduction/gastrectomy/HIPEC. Methods: Patients with gastric adenocarcinoma and positive peritoneal cytology or carcinomatosis who had completed systemic chemotherapy and laparoscopic HIPEC underwent cytoreduction, gastrectomy, and HIPEC with 30 mg mitomycin C and 200 mg cisplatin. The primary end point was overall survival (OS), with secondary end points of safety and postoperative complications. Results: We enrolled 20 patients from 9/2016 to 3/2019, with a median age of 58 years (range, 20-75 years). Six patients had positive cytology only at diagnosis of stage IV disease, whereas 14 had carcinomatosis. All patients were treated with systemic chemotherapy with a median of 8 cycles (range, 5-11 cycles) and at least one laparoscopic HIPEC. The median peritoneal carcinomatosis index at cytoreduction/gastrectomy/HIPEC was 2 (range, 0-13). After surgery, the 90-day morbidity and mortality rates were 70% and 0%, respectively. Median length of hospital stay was 13 days (range, 7-23 days). Median follow-up was 1.8 years. Median OS from the date of diagnosis of metastatic disease was 2.1 years. Median OS from the date of cytoreduction, gastrectomy, and HIPEC was 1.4 years. One, 2, and 3-year OS rates from the diagnosis of metastatic disease are 90%, 54%, and 29%. Conclusions: Survival rates for patients with gastric adenocarcinoma and peritoneal disease treated with cytoreduction, gastrectomy, and HIPEC are encouraging; our early results are similar to those of recent prospective registry studies. Cooperative group trials should be supported and will be required to confirm survival and safety outcomes. Clinical trial information: NCT02891447.
The real-world practiсe of surgery in patients with metastatic gastric cancer (mGC).
Authors: Obarevich Ekaterina , Besova Natalia , Titova Tatiana , Trusilova Elena , Davydov Mikhail , Nered Sergey , Stilidi Ivan , Artamonova Elena 
Published: February 2020

363 Background: According to recent studies the results of treatment patients with initially mGC are still not sufficient: median overall survival varies between 6.1 and 12.4 months. The triplet-chemotherapy regimens demonstrate high efficacy and allow to downstage the disease and perform surgical treatment. Conversion treatment in stage IV GC is a modern trend and still an area of ongoing research. Methods: We analyzed the efficacy of first line chemotherapy (6-9 courses) for patients with mGC (n = 55) including the following regimens: 1) mFOLFIRINOX; 2) douplet: oxaliplatin/irinotecan + fluoropyrimidine; 3) triplet variations: docetaxel, platinum and fluoropyrimidine. 27/55 patients had > 2 metastatic sites, 2/55 patient - 5 metastatic sites. The most common localizations of metastases were peritoneum (n = 34) and retroperitoneal lymph nodes (n = 11). Unlike in REGATTA trial all patients underwent surgical treatment with curative intent followed by complete response of distant metastases after chemotherapy. For patients with ovarian metastases ovariectomy was also perfomed. Results: Median progression-free survival and median overall survival were 18.5 and 33.27 months, respectively and the 3-year survival rate was 43.5%. Multivariate analysis showed that clinically determined ascites (p = 0.023), linitis plastica (p = 0.022), tumor grade 3 (p = 0.014), present of lymphovascular invasion (p = 0.037), absence of grade III-IV pathomorphosis (p = 0.037) and treatment free interval before surgery < 3.4 month (p = 0.046) were poor independent prognostic factors. Conclusions: Surgery after effective combination chemotherapy may have significant clinical efficacy for selected patients with initially unresectable gastric cancer. According to our data the optimal time for surgery is a 3.4 and more months treatment-free interval in the absence of disease progression.
A phase II study of neoadjuvant chemotherapy with DCS for resectable advanced esophageal cancer.
Authors: Kitadani Junya , Nakamura Masaki , Ojima Toshiyasu , Katsuda Masahiro , Hayata Keiji , Yamaue Hiroki 
Published: February 2020

366 Background: The current standard treatment for clinical stage II/III esophageal cancer is neoadjuvant chemotherapy (NAC) with CDDP/5-FU (CF) regimen followed by surgery. However, to improve the survival of patients with advanced ESCC, more effective regimens are urgently needed. Triplet regimens containing docetaxel have been one of next candidates for advanced ESCC. Methods: The DCS regimen (Docetaxel 40mg/m2/day Day 1 div, CDDP 60mg/m2/day Day 1 div, S-1 80mg/m2/day Day 1~14 civ) was repeated every 4weeks until toxicity became unacceptable, the patient refused treatment, or disease progression was observed to a maximum of 3cycles. In this phase II trial of DCS, the primary endpoint was pathological response rate. Results: 40 patients were enrolled in this study and finally 39 patients underwent surgery and one patient performed chemoradiotherapy because of patient refusal. cT3 was 85%, cStage III and IV were 90%. Far advanced cases were in this study. Surgical complication was not increased compared to the historical data. R0 resection rate was achieved in 85%. The clinical response rate was 76%. Pathological response rate was 33%, which was the primary endpoint. 2-year recurrence-free survival rate was 56% and 2-year overall survival rate was 71%. The rate of Grade 3 or 4 Neutropenia was 69%, and FN was 18%. NAC-DCS was high toxic regimen, but manageable regimen. The median time of onset with Grade 3/4 neutropenia was day 11 from start of each cycle. Conclusions: NAC with DCS regimen was feasible and good response for advanced ESCC and became to a promising candidate. Further, the survival benefit of triplet regimen including S-1 should be verified by the randomized controlled trial. Clinical trial information: UMIN000017153.
Apatinib combined with SOX neoadjuvant therapy for locally advanced gastric cancer: A multicenter, single-armed, prospective study.
Authors: Lin Jian-Xian , Huang Changming 
Published: February 2020

367 Background: Molecular targeted therapy has made great progress in the treatment of gastric cancer. In some previous studies, apatinib, an oral small molecular of VEGFR-2 TKI, had been confirmed can improve OS and PFS with an acceptable safety profile in patients with advanced gastric cancer refractory to two or more lines of prior chemotherapy. However, there is limited evidence about the safety and feasibility of apatinib combined with SOX regimen as neoadjuvant therapy for locally advanced gastric cancer (AGC). Methods: This is a multicenter, single-armed, prospective study. Patients with AGC (cT2-4N+M0) without prior anti-cancer strategies were included. Patients were received 2 to 5 cycles (21 days a cycle) of neoadjuvant therapy using S-1 (po, 40-60 mg bid, day1-day14), oxaliplatin (iv, 130 mg/m2, day1), and apatinib (po, 500 mg qd). Apatinib was prohibited in the last cycle. The operation should be performed 2 to 4 weeks later of the neoadjuvant therapy. The primary endpoint was R0 resection rate. The secondary endpoint included safety, ORR, and DCR. Results: A total of 56 patients from 10 centers in China were recruited. There were 43 males and 13 females. The median age was 63.04 years (range 41-75 years). There were 43 patients with tumor response evaluation, 29 patients (67.4%) had partial response (PR), 12 patients (27.9%) had stable disease (SD), and 2 patient (4.6%) had progressive disease (PD). The ORR and DCR were 67.4% (29/43) and 95.3% (41/43), respectively. 36 patients received gastric surgery, the R0 resection rate was 97.2%, 3 patients had postoperative complication: one had intestinal obstruction and 2 had pneumonia (all Clavien-Dindo classification less than grade II). 46 patients were included for safety analysis. The incidence of adverse events (AEs) and grade 3/4 AEs were 84.8% (39/46) and 17.4% (8/46), respectively. The most common AEs were neutropenia (40%), low platelet count (40%), leucopenia (32.6%), vomit (13%). Conclusions: This prospective study shows that neoadjuvant therapy using apatinib plus SOX brings clinical benefit to AGC with a high disease control rate and tolerable adverse reactions. Clinical trial information: NCT 03192735.
Short- and long-term outcomes following laparoscopic gastrectomy for advanced gastric cancer compared with open gastrectomy.
Authors: Shibuya Kazuaki , Kawamura Hideki , Ohno Yosuke , Ichikawa Nobuki , Yoshida Tadashi , Homma Shigenori , Taketomi Akinobu 
Published: February 2020

369 Background: To investigate the oncological feasibility and technical safety of laparoscopic gastrectomy with D2 lymphadenectomy for advanced gastric cancer. Methods: 186 advanced gastric cancer patients treated by gastrectomy with D2 lymphadenectomy were eligible for inclusion including those with invasion into the muscularis propria, subserosa, and serosa without involvement of other organs, and stages N0–2 and M0. We retrospectively compared the short- and-long term outcomes between laparoscopic gastrectomy and open gastrectomy. Results: We analyzed short-term outcomes by comparing distal- with total gastrectomy results. We found no significant difference for distal gastrectomy for postoperative morbidity (laparoscopic vs. open: n = 4 (4.6%) vs. n = 1 (3.6%); p= 1.00). We also found no significant difference in postoperative morbidity for total gastrectomy (laparoscopic vs. open: n = 2 (4.0%) vs. n = 1 (4.0%); p= 1.00). No deaths occurred in any group. The entire cohort analysis revealed no statistically significant differences in overall- or recurrence-free survival between the laparoscopic and open groups. For overall survival, there were no significant differences between open and laparoscopic groups for clinical stage II or III ( p= 0.29 and 0.27, respectively), and for pathological stage II or III ( p= 0.88 and 0.86, respectively). For recurrence-free survival, there were no significant differences between open and laparoscopic groups for clinical stage II or III ( p= 0.63 and 0.60, respectively), and for pathological stage II or III (p = 0.98 and 0.72, respectively). Conclusions: Laparscopic gastrectomy for advanced gastric cancer compared favorably with open gastrectomy regarding short- and long-term outcomes. Clinical trial information: 160907.
A novel preoperative risk score to optimize patient selection for performing concomitant liver resection with cytoreductive surgery/HIPEC.
Authors: Lee Rachel M. , Gamboa Adriana C. , Turgeon Michael K. , Grotz Travis Edward , Fournier Keith F. , Dineen Sean Patrick , Veerapong Jula , Clarke Callisia , Patel Sameer H. , Henrix Ryan James , Lambert Laura A. , Abbott Daniel Erik , Raoof Mustafa , Johnston Fabian McCartney , Staley Charles A. , Cloyd Jordan , Maithel Shishir K. , Russell Maria C. 
Published: February 2020

37 Background: While parenchymal hepatic metastases were previously considered a contraindication to cytoreductive surgery(CRS) and heated intraperitoneal chemotherapy(HIPEC), liver resection(LR) is increasingly performed concomitantly with CRS/HIPEC. As this practice continues to expand, identification of preoperative factors associated with poor outcomes is paramount. Methods: Patients from the US HIPEC Collaborative(2000-2017) with invasive appendiceal or colorectal adenocarcinoma undergoing primary, curative intent CRS/HIPEC with CC0-1 resection were included. LR was defined as a formal parenchymal resection. Primary endpoints were postoperative complications and overall survival(OS). Results: 658 patients were included. Average age was 54 years and 45% were male; 83 (15%) underwent liver resection of colorectal (58%) or invasive appendiceal (42%) metastases. Liver resection patients had more complications (81 vs 60%; p = 0.001), greater number of complications (2.3 vs 1.5; p < 0.001), and required more reoperations (22 vs 11%; p = 0.007) and readmissions (39 vs 25%; p = 0.014) than non-liver resection patients. Liver resection patients had decreased OS (2-year OS 62% vs 79%, p < 0.001), which persisted on multivariable Cox regression when accounting for PCI and histology type. Preoperative factors associated with decreased OS on multivariable analysis in patients undergoing liver resection included age < 60 years (HR:3.61), colorectal histology (HR:3.84), and multiple liver tumors (HR:3.45) (all p < 0.05). When assigning one point for each factor, there was an incremental decrease in 2-yr survival as the risk score increased from 0 to 3 (0: 100%; 1: 91%; 2: 58%; 3: 0%; p < 0.001). Conclusions: As concurrent liver resection with CRS/HIPEC has become more common, we created a simple risk score to stratify patients considered for CRS/HIPEC with liver resection. These data aid in striking the balance between an increased perioperative complication profile with the potential for improvement in overall survival.