bluuebunny/crossref_metadata_2025_split huggingface dataset:
Retrospective analysis of resected primary colorectal cancer revealed
Authors: Khan K. H. 
Published: August 2020

e15137 Background: Lymphadenectomy in colorectal cancer is believed to be a critical component concerning prognosis and survival of patients.. The aim of this study was to analyze the relationship between the number of lymph nodes harvested (LNH) and the number of lymph nodes involved (LNI), at the histological examination of the specimens of resected primary colorectal cancer (CRC) at our unit. Results: Over the five-year study period, 142 resections for primary CRC were performed on 141 patients (one metachronous). Mean number of resections per annum was 28. There were 86 (60.5%) colonic and 56 (39.5%) rectal cancers (Fig 1). There were 70 (49.3%) anterior resections (Fig 2). M:F ratio was 0.97:1. Median age was 71years for colonic and 69.5years for rectal cancers. Eighty eight percent of resections were elective (OR=2.2 RR=1.14 p=0.003 compared to the national audit)1. Adenocarcinoma NOS constituted 94% of all histology results (5% mucinous and 1% signet ring). Median CRM was 7.5mm (mean=8.8mm) (fig 3). The CRM involvement was 12.7% for all CRC and 16% for rectal cancers. The LRM involvement was 1.5%. Median overall LNH was 12, (mean=13 p=0.08 when compared to the recommended LNH of 12) (Fig 5). Median LNH for rectal cancers=11 and for colonic cancer=13. There were 11 (14%) APRs compared to 70 (86%) sphincter-saving operations from a total of 83 rectal resections. 84%of resections were R0. The 30-day all-cause mortality was 4.3%. Actuarial survival curve demonstrated 17.6% chance of metastasis at presentation, all-stage 3-year disease-free survival (DFS) of 67% and of 82% for stages I-III (Tany Nany M0). CEA relapse as a marker of disease recurrence (available for n=125) revealed 3-year DFS=71%.When correlation was determined between LNH and lymph node involvement, it revealed a low correlation (r=0.159 p=0.06) which was statistically insignificant. When the national audit calculated the same relationship among its much larger sample the results were the same (r=0.152 p=0.001)3 and had achieved statistical significance. Conclusions: LNI as a function of tumour and host behaviour is of prognostic significance whereas LNH may be a marker of ‘pathologist's diligence’ at the histological examination and therefore a quality assurance (QA) tool. No significant financial relationships to disclose.
DWIBS (diffusion weighted whole body imaging with background signal suppression) scan for colorectal cancer and its evaluation: Comparison with CT or PET scans
Authors: Sasatomi T. , Ogata Y. 
Published: August 2020

e15140 Background: The most important clinical point for the colorectal cancer patients after surgery is to find out local recurrence and distant metastasis to liver or lungs in early state. Recently, DWIBS (diffusion weighted whole body imaging with background body signal suppression) scan, one of the diffusion weighted MRI imaging methods, was developed, and it has been become used for diagnosis of lung cancer and bladder cancer instead of PET scan. In this report, we examined whether it was more useful method for the diagnosis of recurrence or distant metastasis of the colorectal cancer after surgery than PET/CT scan or not. Methods: All the 12 primary colorectal carcinomas were resected at the surgical division, Kumamoto Central Hospital, Fukuoka Saisekai Ohmuta Hospital and Kurume University Medical Center from 2000 to 2008. (Table 1) After surgery, 14 recurrent regions (seven liver metastasis, two lung metastasis and five local recurrence) were diagnosed by CT and MRI scans. Then all the cases were performed by DWIBS scan. And also the seven out of 12 cases (three liver metastasis, two lung metastasis and four local recurrence) were performed by PET scan. Conditions set before DWIBS scan were six hours of fasting with no restriction on drinking water and normal oral administration of regularly used drugs. No bowel preparation was carried out in any of the patients. Informed consent was obtained from each patient before DWIBS scan. Results: All the 14 metastatic and recurrent regions (seven liver metastasis, two lung metastasis and five local recurrence ) of 12 recurrent patients were performed by DWIBS, MRI and CT scans. Within the seven out of 12 recurrent patients (three liver metastasis, two lung metastasis and five local recurrence), performed by PET scan, all the liver and lung metastatic regions were detected, on the other hand, three out of four local recurrent regions were diagnosed but the other one was not diagnosed by PET scan. Conclusions: DWIBS is not only useful diagnostic method for local recurrence of colorectal cancer after surgery, but also less invasive method than PET scan. No significant financial relationships to disclose.
Efficacy of FOLFOX4 in patients with hypoalbuminemia or immune impairment
Authors: Shibata M. , Yumiko N. , Hirano T. , Matsuo S. , Abe H. , Yajima Y. 
Published: August 2020

e15141 Background: The effects of chemotherapeutic agents are understood to be regulated by many factors including tumor factors such as sensitivity to drugs and host factors. Among these host factors, nutritional conditions and immune function of cancer-bearing host has been told to relate the effects of chemotherapy, however, it has not been clarified yet. Methods: We have analysed the relationships between the effects of FOLFOX4 and nutritional markers such as serum albumin concentrations and immunology markers including counts of lymphocytes and neutrophils, the ratios of these counts G/L: granulocytes/lymphocytes) and serum concentrations of immunosuppressive acidic protein (IAP) in the patients with disseminated colorectal cancer who have received FOLFOX4. All these blood examinations were performed before the first administration of FOLFOX4 as a first line chemotherapy in 18 patients with disseminated colorectal cancer. Results: Firstly serum albumin levels have shown significant correlation to lymphocyte counts and did inverse correlation to neutrophil counts and G/L ratios. The albumin levels in the patients with PD of FOLFOX outcome was significantly lower than in the patients with PR(p<0.05) and SD (p<0.05). The lymphocytes counts in the patients with PD were significantly lower than in those with PR (p<0.05) and SD (p<0.05). Neutrophil counts, on the other hand, was significantly higher in the patients with PD than in those with PR (p<0.01) and SD (p<0.05). IAP, have been recognized as a marker of immune-suppression in patients with cancer was higher in the patients with PD. Conclusions: Thus the nutritional status is closely related to the immune status in patients with cancer, and the markers of these conditions may present important informations in prediction of results of cancer chemotherapy. No significant financial relationships to disclose.
A qualitative analysis of a focus group discussion on patient decision making in cancer care
Authors: Srinivasaiah N. , Joseph B. , Gunn J. , Hartley J. , Monson J. 
Published: August 2020

e15145 Background: Patient preferences should play an important role when decision making in cancer care. Literature is increasingly demonstrating that surgeons and physicians have divergent preferences for treatment options compared with their patients and with each other. Cancer psychology is an important aspect of cancer care. Qualitative research is a gateway to explore this. We aim to explore opinions and thoughts among surgical colleagues about “patient decision making in cancer care”. Methods: A pilot focus group discussion among members of the academic surgical unit involving 4 consultants, 3 registrars and 3 research fellows. The discussion was audio-taped and transcribed. Qualitative methodology was adopted for analysis. Thematic analysis using framework approach was done thereby identifying Themes & Outcomes. Results: Themes that emerged are Evidence based clinical practice, Knowledge, Decision making, Patient Information, Risk, Communication, Consent, Socioeconomic factors and Patient empowerment, Outcomes derived are to increase the evidence base, Increase the clinician and patient knowledge, provide adequate information, Decisions to be based on patients best interest, Communicate risk in a understandable manner, Take patients views, knowledge and demands into consideration, Conclusions: Patient decision making in cancer care is slowly evolving, where decisions are not only made taking into account patients views, knowledge and demand but are also driven by them in a minority. Time is a factor and in years to come the patients will play an increased role in their treatments taking into account tradeoffs and risks between survival and quality of life. No significant financial relationships to disclose.
Capecitabine combined with oxaliplatin (XELOX) as first-line chemotherapy in colorectal cancer with liver metastases
Authors: Mahfouf H. , Djeddi H. , Belhadef S. , Bouzid K. , Bentabak K. 
Published: August 2020

e15146 Background: The combination of 5-fluorouracil (5-FU), leucovorin (LV), and oxaliplatin (I-OHP) was shown to be both more active against metastatic colorectal carcinoma and better tolerated. Methods: Chemotherapy-naive patients confirmed histologic colorectal cancer with liver metastases, adequate born morrow, renal and hepatic function, measurable diseases were considered eligible for the study. Treatment: Six cycles of oxaliplatin 85 mg/m2 day1 plus capecitabine 1250 mg/m2 twice daily days 1–14 every 21 days Results: Twenty six patients were evaluated for safety and efficacy (male/female, 12/14). Median age was 53 years (range 32–75 years). A total of 142 cycles have been administered: median per patient 4 (range 3–6 courses). In an intent-to-treat efficacy analysis, One complete and ten partial responses were achieved [overall objective response rate (ORR): 42, 3%; whereas 7 patients had stable disease and eight patients had progressive disease. Seven patients from 11 with objective response underwent major liver resection: 2 bisegmentectomy, 1 left lobectomy, 4 segmentectomy, and receive the same regimen of chemotherapy (Six cycles) as an adjuvant treatment and still alive without recurrence. The overall survival (OS) was 19, 2 months. The median response duration was 7 months. The median time to progression (TTP) was 8 months. The grade 3 toxicities were diarrhea (7%), fatigue (4%), neurotoxicity (2%), neutropenia (2%), and thrombocytopenia 4%). Conclusions: The combination of oxaliplatin and capecitabine is safe and has a promising activity in patients with liver metastatic colorectal carcinoma. No significant financial relationships to disclose.
Usefulness and faults of the sentinel lymph node biopsy using dye technique in distal gastrectomy for gastric cancer
Authors: Rino Y. , Yukawa N. , Murakami H. , Masuda M. , Oshima T. , Sato T. , Yamamoto N. , Imada T. 
Published: August 2020

e15509 Background: We apply sentinel node biopsy (SNB) in distal gastrectomy to perform it as safe limited surgery. Limited surgery is a procedure in which the extent of lesion resection and lymph node dissection is reduced. We assessed usefulness and faults of intraoperative diagnosis of lymph node metastasis in this regard. Methods: Surgical procedures: Patent blue (1%) is injected submucosally into 4 to 5 different sites at 1 mL per site around the primary tumor. If blue nodes are found, biopsy and diagnosis of metastasis are performed at this point. Subjects and methods: The study was conducted in 96 gastric cancer patients with a preoperative diagnosis of T1 or mp invasion. Informed consent was obtained from the all patients. There were 65 males and 31 females with a mean age of 64.2 years. Tumor invasion of m, sm, mp, ss, and se was identified in 44, 38, 8, 2, and 4 patients, respectively. All patients underwent open distal gastrectomy (DG) (n=31) or laparoscopy-assisted distal gastrectomy (LADG) (n=65) and Billroth-I reconstruction. Results: The mean number of BNs dissected was 4.5 and 3.7 in DG and LADG cases, respectively. Intraoperative identification and biopsy of BNs could be performed in 34 of 35 DG patients and in 58 of 61 LADG patients. Of the 34 patients in whom BNs were identified, 5 had metastases in BNs confirmed by intraoperative frozen section diagnosis in DG cases. On the other hand, of the 58 LADG patients in whom BNs were identified, 5 had metastases in BNs confirmed by intraoperative frozen section diagnosis in LADG case. False-negative rate was 1.9%. Conclusions: SNB can be performed in LADG as well as in DG. For the case that shows infiltration up to MP, the possibility of lymph node metastasis for other lymph node is considered to be negligible. In obese cases we had some cases of no BNs and false-negative. In consequence, as long as the infiltration is lower than MP, and confirmed that metastasis was not found by blue node biopsy, distal gastrectomy using limited surgery would be thought to be done safely. No significant financial relationships to disclose.
Plasma IL-6 level and survival of pancreatic cancer patients treated with a VEGFR inhibitor, vatalanib (PTK/ZK)
Authors: Baker A. F. , Dragovich T. , Cui A. , Laheru D. , Campen C. , Von Hoff D. D. , Hidalgo M. 
Published: August 2020

e15514 Background: Use of anti-angiogenesis drugs in pancreatic cancer has not yet resulted in significant clinical improvements and it is unknown if there are subsets of patients with pancreatic cancer that may benefit from this therapeutic approach. We have reported on a phase II trial of PTK/ZK (VEGFR inhibitor) in patients (n=65) who have failed or progressed on gemcitabine. The 6- month OS met the primary endpoint of 29 % and there were 2 partial responses. We investigated some of the plasma proteins relevant for angiogenesis in correlation with clinical outcomes on this trial. Methods: Plasma samples were obtained prior to and after 4 weeks of therapy with PTK/ZK, aliquoted and frozen until assayed. Patient plasma was assayed for: VEGFA, VEGFC, VEGFR1, VEGFR2, FGFb, PDGFBB, OPN, ANG2, IL-6, and sIL-6R (SearchLight, Pierce Biotechnology Multiplex ELISA and IL-6 and sIL-6R using R&D Systems).The Spearmen correlation was utilized to look for correlations and changes from baseline compared to post-treatment levels. The correlation of baseline levels with survival were analyzed using the Cox proportional hazard model. Results: Thirty eight paired patient samples were assayed. A significant correlation of baseline values was found between VEGF-C and VEGFR1 (p=0.0496), VEGF-C and VEGF (0.0092), PDGFB and ANG2 (p=0.0003), IL-6 and ANG2 (p=0.0089), and FGFb and OPN (p=0.0281). A correlation in post-treatment change was observed between VEGF-C and PDGFB (p=0.0008), FGFb and OPN (p=0.0374), PDGFB and ANG2 (p=0.0005), IL-6 and ANG-2 (p=0.0464), and VEGF and IL-6 (p=0.0546). Lower baseline IL-6 levels correlated with longer survival (p=0.0227). A post-treatment decrease in plasma IL-6 levels was significantly associated with improvement in survival (p=0.0457). IL-6 mediates multiple effects including angiogenic and pro-survival signaling and has been proposed as a potential prognostic factor in different malignancies. Conclusions: Of all angiogenesis markers analyzed only a post-treatment decrease in plasma IL-6 correlated with improved survival on study. IL-6 warrants further investigation as a potential marker of sensitivity to anti-angiogenesis therapy, especially in patients with pancreatic cancer. Supported by: 1P50 CA95060; 1PO1CA109552–01A1 [Table: see text]
Gender disparities in hepatocellular cancer survival
Authors: Hendifar A. E. , Yang D. , Iqbal S. , Lenz H. , El-Khoueiry A. 
Published: August 2020

e15517 Background: Recent reports suggest that estrogen mediated inhibition of IL-6 protects against the development of HCC and may explain the decreased risk of liver cancer in women. We investigated the relation-hip between gender, age, and survival for patients with localized HCC. Methods: We identified 11,097 patients with localized, histologically defined HCC, from 1988- 2003, using the Surveillance, Epidemiology, and End Results (SEER) registry. Age at diagnosis, sex, ethnicity, and overall survival were evaluated using Cox proportional hazards model. The models were adjusted for treatment modality, tumor differentiation, tumor size, lymph node involvement, and number of lesions; they were stratified by year of diagnosis and SEER registry site. Results: 8,111 (73%) patients were men and 2,986 (27%) were women. In univariate and multivariate analyses, female gender, young age (< 55 yo), and Asian ethnicity were all associated with improved overall survival (p<0.001). In patients less than 55 yo, women had a superior OS and cancer specific survival (CSS) when compared to men (OS: 18 months vs. 9, CSS: 31 months vs. 14, p<0.001). Conversely, in patients older than 55, there were no gender differences (OS: 8 months vs. 8, CSS 13 months vs. 11, p = 0.08). Local therapies, including, ablation (HR = 0.47 [0.43–0.53]), hepatectomy (HR = 0.40 [0.36–0.44]), radiation (HR = 0.67 [0.57–0.78]) and transplantation (HR = 0.17 [0.15–0.20]) were also associated with improved survival. There were no interactions identified between gender and treatment use. Conclusions: To our knowledge, this is the first report to highlight the superior outcome of premenopausal women with HCC compared to men. We postulate a potential role for estrogen in influencing the biology of HCC and the response to treatment. These observations are consistent with ones made in other gastrointestinal cancers and with reported preclinical data suggesting a protective role for estrogen. Further studies that confirm these observations and elucidate the biology of estrogen's influence on HCC are needed. [Table: see text] No significant financial relationships to disclose.
Prognostic significance of endoluminal ultrasound defined tumor volume (EDTV) in patients diagnosed with esophageal cancer
Authors: Escofet X. , Twine C. , Roberts A. , Dave B. , Rawlinson C. , Chan D. , Crosby T. , Robinson M. , Lewis W. 
Published: August 2020

e15519 Background: The aim of this study was to assess the prognostic significance of endoluminal ultrasound defined tumour volume (EDTV) in patients diagnosed with esophageal cancer. The hypothesis was that tumour volume is a better predictor of outcome than tumour length. Methods: One hundred and seventy-four consecutive patients (median age 64y, 128 m) underwent both CT and specialist EUS, and the maximum potential tumour cylinder volume (EDTV) was calculated using the formula πr2L (cylinder volume), where r = tumour thickness (cm) and L = total length of disease, including the position and level of both the primary tumour and proximal and distal lymph nodes (cm). All patients received stage directed multidisciplinary treatment [surgery 104 patients (80 neoadjuvant chemotherapy), definitive chemoradiotherapy 54 patients, and palliative therapy alone 16 patients]. The primary measure of outcome was survival. Results: Survival was related to EUS T (p=0.013), EUS N (p=0.001), EUS M1a stage (p=0.004), EUS disease length (p=0.001), and EDTV (all patients <25cm3, p=0.001, surgical patients <40cm3, p=0.036). Forward conditional multivariate analysis revealed 3 factors to be associated with survival; EUS N stage (HR= 1.646, 95% CI 1.041 to 2.602, p=0.033), EUS M1a stage (HR= 2.702, 95% CI 1.069 to 6.830, p=0.036), and EDTV (HR= 2.702, 95% CI 1.069 to 6.830, p=0.025). Conclusions: EDTV emerged as a new and important prognostic indicator for patients diagnosed with esophageal cancer. No significant financial relationships to disclose.
Clinical outcome of sequential chemotherapy in metastatic and/or recurrent gastric cancer
Authors: Moon Y. , Rha S. , Jeung H. , Shin S. , Yoo N. , Roh J. , Noh S. , Chung H. 
Published: August 2020

e15521 Background: Little is known about data on subsequent chemotherapy (CTx) following 1st-line CTx in stage IV gastric cancer. The purpose of this study was to analyze the natural history of stage IV gastric cancer with sequential CTx Methods: A total of 532 patients (pts) with unresectable gastric adenocarcinoma were studied. They were managed with a strategy of maximal administration of CTx only if pts’ general conditions were allowed. Response evaluation was performed by RECIST every 2 cycles. Response of unmeasurable lesions was dichotomized only into stable disease or progressive disease. Results: When pts were divided into CTx group (460 of 532, 87%) and best supportive care group (BSC; 72 of 532, 13%) resulting from poor performance/pt's refusal/comorbidity (31/23/18), the former had younger age (p = 0.046), better performance (p < 0.001), and less advanced metastatic sites (p = 0.001) than the latter. Median overall survivals from diagnosis of unresectable cancer were 12.0/13.3/2.5 months for overall/CTx/BSC, respectively. 87%/47%/23% of the whole pts received 1st/2nd/3rd-line CTx, respectively. Median number of regimens delivered was 2. Maximally 5th-line CTx was given to 15 pts (3%). Response and disease control rates were 21.7%/12.5%/11.8% and 79.4%/56.3%/49.4% for 1st/2nd/3rd lines, respectively. Median progression-free and overall survivals from CTx were 5.5/3.4/2.5 months and 12.1/7.9/5.5 months for 1st/2nd/3rd lines, respectively. The most common cause of discontinuation of CTx was disease progression (68%/74%/70%) followed by pt's refusal (22%/13%/12%) for 1st/2nd/3rd lines, respectively. Prognosticators were performance status, histology, metastatic site, and CTx before 1st or 2nd line. Conclusions: When pts with unresectable gastric cancer were managed with a strategy of maximal administration of CTx, a considerable number of pts could receive 2nd or 3rd line CTx, showing modest activity. Performance status and metastatic site were consistent prognosticators even if lines changed. Our data on the natural history of stage IV gastric cancer with sequential CTx may suggest that clinical trials can be performed in a 2nd or 3rd line setting as well. No significant financial relationships to disclose.
A phase II trial of oral S-1 combined with gemcitabine in patients with unresectable biliary tract cancer
Authors: Nakamura K. , Yamaguchi T. , Sudo K. , Hara T. , Denda T. , Azemoto R. , Ishihara T. , Tsuyuguchi T. 
Published: August 2020

e15527 Background: Optimal chemotherapy for unresectable biliary tract cancer is yet to be defined. We have conducted the phase II trial of Gemcitabine (GEM) with S-1, oral fluorouracil prodrug tegafur combined with two modulators, 5-chloro-2, 4-dihydropridine and potassium oxonate to evaluate the activity and toxicity of such combination in patients with unresectable biliary tract cancer. Methods: Eligibility criteria were pathologically-proven biliary tract cancer, appropriate performance status 0 to 2, age 20 to 79 years, adequate hematological, renal and liver functions, no prior chemotherapy, and written informed consent. S-1 was given orally (30mg/m2) bid for 14 consecutive days and GEM (1000mg/m2) was given on day 8 and 15. Cycle was repeated every 21 days. Results: 30 patients with unresectable biliary tract cancer (Gall-bladder: intrahepatic bile ducts: extrahepatic bile ducts=7:16:7) were enrolled from March 2007 to December 2008. Patients characteristics were: median age; 67 (46–79), male/female; 20/10, PS 0/1/2; 16/13/1. Median number of cycles was 8 (range 1 to 14). Out of total 26 evaluable patients, objective responses were observed in 9 patients (30%); 16 patients achieved stable disease and 1 patients showed disease progression. Median survival was 390 days (95% c.i.: 290 - 490 days). The grade 3–4 toxicities observed were leucopenia (20%), neutropenia (40%), anemia (17%), thrombocytopenia (37%), anorexia (7%), fever (10%), rash (7%) and interstitial pneumonia (7%). Conclusions: The combination chemotherapy with GEM and S-1 was well tolerated and high response rate has been observed. This result is very promising but survival benefit against GEM monotherapy should be demonstrated in future phase 3 studies. No significant financial relationships to disclose.