bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical prognostic factors associated with survival after definitive chemoradiotherapy in advanced squamous cell carcinoma of esophagus.
Authors: Shim Hyun-Jeong , Choi Won-young , Kim Dae-Eun , Hwang Jun-Eul , Bae Woo Kyun , Cho Sang-Hee , Chung Ik-Joo 
Published: March 2020

e15121 Background: Definitive chemoradiotherapy (dCRT) has been used as a standard care for treating and palliating of symptoms in advanced esophageal cancer patients even if they have metastatic disease. The purpose of this study is to identify the treatment outcomes and prognostic factors for survival in squamous cell type of esophagus. Methods: We retrospectively studied the patients who treated with dCRT using 5-FU and cisplatin, and histologically proven squamous cell esophageal carcinoma of stage III and IV between January 2004 and December 2010. Results: In total 110 patients were enrolled in analysis of whom 64 patients were stage III and Iva (localized advanced) and 46 patients were stage IVb. The ratio of male/female was 109/1 and the median age was 65 years. T-stage was cT2=8%, cT3=75, cT4=17% and N-stage was cN0=5%, cN1=95%. The most common metastatic site was distant LN (60%). The median dose of radiation was 5400 cGy (range, 4400-6600). The median OS for locally advanced and metastatic disease group was 19.0 and 12.8 months, respectively (p=0.032). The median PFS for these groups was 8.3 and 6.9 months, respectively (p=0.208). The most common pattern of failure was locoregional area. In univariate analysis, cell type (poorly differentiation), dysphagia score, PS (ECOG 1-2 vs. 0), PFS (<5months) and CRP were significantly associated with OS and cell type, PS, PFS were shown significantly poor prognostic factors for OS in multivariate analysis. Among the patients who had locally advanced disease, maintenance chemotherapy after dCRT did not influence the OS. However, “good risk” patients who had less than 2 risk factors receiving maintenance chemotherapy showed better OS than those with no maintenance chemotherapy (40.9 vs. 12.3 months; p=0.011). Conclusions: dCRT has a major role in improving survival and palliation of dysphagia in inoperable advanced esophageal cancer even in metastatic stage. Cell type and PS have been still important prognostic factors in survival. In addition, maintenance chemotherapy after dCRT may be helpful for prolongation survival in good risk patients.
The role of VEGFR-2 expression in outcomes and survival of patients with peritoneal carcinomatosis from appendiceal cancer.
Authors: Sardi Armando , Jimenez William Andres , Francis Jennifer , Macdonald Ryan , Studeman Kimberly , Nieroda Carol Ann , Falla Juan Camilo 
Published: March 2020

e15123 Background: Vascular endothelial growth factor receptor 2 (VEGFR-2) is considered a prognostic factor and treatment target for metastatic colorectal and ovarian cancer. Peritoneal Carcinomatosis (PC) from appendiceal cancer is a rare malignancy, treated with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), for which tumor histology, completeness of cytoreduction (CC), and lymph node (LN) status are predictors of survival. We hypothesize that high VEGFR-2 expression is a negative prognostic factor for survival in patients with PC from appendiceal cancer. Methods: A retrospective study of a prospective database was conducted in 127 patients with PC from appendiceal cancer who underwent CRS/HIPEC. Surgical specimens from a total of 59 patients were tested to identify “high” vs. “low” VEGFR-2 expression. Patients were divided into 2 groups: high VEGFR-2 expressers and low VEGFR-2 expressers. Patients’ outcomes and survival were analyzed. Results: There were 26 males and 33 females. Mean age was 51 years. Mean follow up of high and low expressers was 25.1 and 26.6, respectively (p = 0.806). At follow up, 33 (70%) of high expressers were alive and 14 (30%) deceased, while 11 (92%) of low expressers were alive and 1 (8%) deceased. Overall recurrence, use of bevacizumab, CC score, PCI, and LN status showed no differences between high and low expressers and did not correlate with survival or outcome. OS for high expressers was 90.5%, 59.8, and 47.1% at 1-, 3-, 5-years (p = 0.133) respectively, while OS for low expressers was 91.7% at 1-, 3-, and 5-years. Conclusions: There is a trend toward better outcomes and survival in patients with PC from appendiceal cancer who have low expression of VEGFR-2 compared to high expression. However, follow up is short and a larger number of patients is needed to confirm this trend and possibly correlate a high expression of VEGFR-2 to poorer outcomes and decreased survival in PC of appendiceal origin.
Effect of adjuvant chemoradiotherapy on survival in primary small cell carcinoma of esophagus (SCCE) patients: An analysis of multicenter clinical outcomes.
Authors: Zou Bingwen , Tao Li , Qiang Zhou , Yuan Ma Dai , Chen Yongshun , Xie Conghua , Li Wenhui , Lu You , Xu Yong 
Published: March 2020

e15125 Background: To retrospectively evaluate the therapy pattern and survival in patients with dissection of primary SCCE. Methods: This study included 119 patients from seven centers in Middle and Western China who underwent radical section of SCCE. Forty six of them were treated with postoperative chemoradiotherapy (POCRT), and 73 of them with postoperative chemotherapy (POCT) alone. The median radiation dose to clinical target volume (CTV) was 50 Gy (varying between 44 and 52 Gy), while the cycles of platinum-based chemotherapy ranged from two to eight with a median of four. Results: The 5-year OS and DFS were 14.5% and 11.7% of all patients, respectively. The median OS and DFS of all patients were 17.0(95%CI: 13.2-20.8) and 10.0(95%CI: 7.3-12.3) months, respectively. The 5-year OS and DFS were 22.0% and 20.0%, respectively, in the POCRT group, and 9.3% and 6.4%, respectively, in the POCT group (P=0.003 for OS and P=0.007 for DFS). There was significant difference in LRFS, favoring the POCRT group (5-year LRFS 74.3% vs. 42.0%, P=0.010), while the 5-year DRFS was 34.1% for the POCRT group comparing to 15.5% for the POCT group (P=0.039).In a multivariate analysis, treatment with more than four cycles of chemotherapy was associated with significantly better OS (HR=0.553, 95% CI, 0.347 to 0.881, P=0.0128) and DFS (HR=0.594, 95% CI, 0.386 to 0.914, P=0.0177). Tumor size less than 3cm was a poor prognostic factor for both overall survival and disease-free survival. Conclusions: Compared with chemotherapy alone, adjuvant treatment with both radiotherapy and chemotherapy improves survival in patients with completely resected SCCE. Future study of treatment modality with radiotherapy and chemotherapy is warranted.
Phase I dose-escalation study of pasireotide LAR in patients with advanced neuroendocrine tumors.
Authors: Phan Alexandria T. , Wolin Edward M. , Chan Jennifer A. , Huang Jerry M. , Hudson Michelle , Hughes Gareth , Shen Guoxiang , Strosberg Jonathan R. 
Published: March 2020

e15126 Background: Somastatin analogs (SSA), including octreotide and lanreotide, bind predominantly to somatostatin receptor (SSTR) 2 and form the foundation of treatment for symptomatic neuroendocrine tumors (NET). Pasireotide, a novel SSA with a broad binding affinity (SSTR 1-3 and 5), is being explored for treatment of NET. A phase 1 dose-escalation study (NCT01364415) of pasireotide long-acting release (LAR; starting dose of 80 mg) was designed to determine the maximum tolerated dose (MTD) or recommended phase 2 dose (RP2D) and to characterize safety, tolerability, pharmacokinetics, and efficacy in pts with advanced NET. Methods: Pts with advanced, well- or moderately differentiated NET received pasireotide LAR beginning at a dose of 80 mg q28d. Successive cohorts will receive doses (up to 220 mg) guided by a Bayesian logistic regression model until MTD/RP2D is reached. Results: To date, 15 pts have been treated at 80 mg (n=6) and 120 mg (n=9). Median age is 59 (44-76) years. Primary tumor sites include small intestine (40%), pancreas (20%), and lung (13.3%). All pts received prior antineoplastic therapy; 93% received prior SSA. Median number of cycles of pasireotide was 6.68 (2-14) (1 cycle=28 days). 10 (67%) pts remain on treatment: 3 on 80 mg and 7 on 120 mg. 5 (33%) have discontinued (disease progression, 2 pts; withdrew consent, 2 pts; adverse event [AE], 1 pt). Median plasma concentrations of pasireotide increased with dose. No dose-limiting toxicities have been reported. Most frequent AEs were similar in both dose groups and included hyperglycemia (87%), diarrhea (53%), abdominal pain (47%), nausea (40%), anemia (33%), and fatigue (33%). Most AEs were mild/moderate. 2 pts (1 in each group) had grade 3 hyperglycemia. 4 (27%) and 2 (13%) pts had HbA1C increase from <6.5% at baseline to 6.5-<8% and ≥8%, respectively. 13 (87%) pts had radiographically stable disease as best response. More pts at 120 mg (50%) vs 80 mg (33%) achieved ≥50% reduction in chromogranin A. Conclusions: Pasireotide LAR up to 120 mg appears to be well tolerated in patients with advanced NET. The study is ongoing. Pasireotide represents a promising therapy for pts with NET. Clinical trial information: NCT01364415.
A prospective study on the incidence of postoperative venous thromboembolism in Korean gastric cancer patients: An inquiry into the application of western guidelines to Asian cancer patients.
Authors: Lee Keun Wook , Kim Jin Won , Chun Eun Ju , Choi Sang Il , Park Do Joong , Bang Soo-Mee , Lee Jeong-Ok , Kim Yu Jung , Kim Jee Hyun , Lee Jong-Seok , Kim Hyung-Ho 
Published: March 2020

e15129 Background: Several Western guidelines recommend the routine use of pharmacologic thromboprophylaxis for cancer surgery patients to prevent venous thromboembolism (VTE). However, the necessity of routine pharmacologic perioperative thromboprophylaxis in Asian gastric cancer (GC) patients has not been clearly determined. Methods: To determine the necessity of routine perioperative pharmacologic thromboprophylaxis in Korean gastric cancer patients, the incidence of postoperative VTE was prospectively evaluated in gastric cancer patients receiving surgery. Among 610 GC patients who had received surgery, 375 patents prospectively underwent routine duplex Doppler ultrasonography (DUS) on days 5-12 following surgery to detect VTE and then VTE-related symptoms and signs were checked at 4 weeks after surgery (cohort A). The 235 patients that declined DUS were registered to cohort B and the occurrence of postoperative VTE was retrospectively analyzed. Results: In cohort A, symptomatic or asymptomatic VTE until 4 weeks after surgery was detected in 9 patients [2.4%; 95% confidence interval (CI); 0.9-3.9]. Tumor stage was a significant factor related to VTE development [stage I, 1.4%; stage II/III, 2.4%; stage IV, 9.7% (P = 0.008)]. In multivariate analysis, patients with stage IV had a higher postoperative VTE development [odds ratio, 8.18 (95% CI, 1.54-43.42)] than those with stage I. In cohort B, a low incidence of postoperative VTE was reaffirmed; only one postoperative VTE case (0.4%) was observed. Conclusions: The incidence of postoperative VTE in Korean GC patients was only 2.4%. Risk-stratified applications of perioperative pharmacologic thromboprophylaxis are thought to be more appropriate than the routine pharmacologic thromboprophylaxis in Korean GC patients receiving surgery.
Effect of the 92-gene molecular classifier on therapeutic decision-making in cancers of uncertain primary.
Authors: Schroeder Brock , Schnabel Catherine A. , Erlander Mark G. , Kim Benjamin 
Published: March 2020

e15130 Background: Patients with metastatic cancer of uncertain primary site are at risk of suboptimal therapy if tumor type and subtype cannot be determined. Gene expression-based assays for tumor classification are utilized to complement clinicopathologic evaluation in cases with unknown primary sites of tumor origin or differential diagnoses; however, few studies have evaluated their clinical utility and effectiveness in real-world practice. The objective of this study was to evaluate the influence of a 92-gene molecular classification assay on clinical diagnosis and therapeutic decision-making. Methods: Medical oncologists who ordered the 92-gene assay as part of clinical care were invited to participate in a retrospective, questionnaire-based study. To minimize selection and recall biases, recruitment was based on consecutive cases: participating physicians were instructed to review the medical record of the first patient they ordered the 92-gene assay after a specified date and subsequently complete a 61-question survey. Results: Of 1,105 physicians invited, 103 (9.4%) completed the study (82% community practice; median practice time: 10 years). The majority of respondents had not initiated oncologic treatment before ordering the 92-gene assay: 31% had begun treatment, 24% had a specific regimen chosen but were waiting to begin treatment and 45% had not begun treatment or chosen a specific regimen. The 92-gene assay prediction was concordant with the final clinical diagnosis in 84% of cases; in one-third of these, the molecular diagnosis had not been clinically considered prior to molecular testing. Eighty-one percent of study participants reported that the 92-gene assay helped with therapeutic decision-making. Of these, the assay guided initial treatment choice in 52%, changed a considered treatment in 10%, excluded a potential treatment in 6%, and confirmed a previously determined treatment in 29% of cases. Conclusions: The results of this retrospective study demonstrate the clinical utility of molecular cancer classification: the molecular diagnoses provided by the 92-gene assay influenced therapeutic decision-making in the majority of cases.
Clinical outcomes with yttrium-90 resin microsphere radioembolization for hepatocellular carcinoma in a multiethnic southeast Asian population.
Authors: Khor Andrew Yu Keat , Toh Ying , Allen John Carson , Ng David Chee Eng , Zhu Guili , Choo SuPin , Lo Richard H. G. , Tay Kiang Hiong , Goh Anthony , Chow Pierce K. H. 
Published: March 2020

e15137 Background: Treatment options for unresectable hepatocellular carcinoma (HCC) are limited. Intra-arterial yttrium-90 (90Y) microsphere radioembolization is an emerging treatment option with good outcomes among Caucasian patients. We report clinical outcomes in a multi-ethnic south-east Asian population treated with 90Y microspheres. Methods: A single-centre, retrospective, observational cohort study was conducted on patients who received 90Y microsphere radioembolization at Singapore General Hospital between January 2008 and June 2012. Patients were followed from the date of treatment until January 30, 2013, or until the date of death. Disease was staged by Barcelona Clinic Liver Cancer (BCLC) and Child-Pugh class. Patient survival was estimated using the Kaplan-Meier method. Response rate was determined by RECIST criteria. Prognostic factors for survival were identified using Cox proportional hazards regression. Results: 103 patients comprising 40.8% Chinese, 30.1% Myanmar, 14.6% Indonesian, 6.8% Indochinese and 7.7% others were treated with 90Y microspheres. Hepatitis B or C was recorded as the etiology in 47.6% and 23.3% of patients, respectively. The median overall survival (OS) was 14.4 months [95% CI 11.3-22.2 months] (BCLC B, 23.8 months ; BCLC C, 13.6 months; P = 0.048); (Child-Pugh A, 21.7 months; Child-Pugh B, 10.1 months; P < 0.0001). Median OS in patients with portal vein thrombosis (PVT) was poorer than those without PVT (PVT, 11.0 months; No PVT, 18.1 months; P = 0.024). Overall disease control rate by RECIST was 64.7%, while target lesions response rate was 98.3%. Progression of disease was mainly due to new lesions (69.2%). Significant prognostic factors for survival were serum albumin levels, presence of ascites and PVT. Conclusions: Survival outcomes in south-east Asian patients treated with 90Y microsphere radioembolization for HCC are comparable to Western populations in spite of the different etiologies. While target lesions response was good, new lesions are common and suggest that concomitant systemic therapy may have a role in disease control.
Clinicopathologic significance of HER2 expression in gastric cancer: A retrospective study in Indian population.
Authors: Kataru Sudheer Reddy , Vankamamidi Venkata Sampath , Chowhan Amit Kumar , Manickavasagam Meenakshisundaram , Radhakrishna Khajjayam , Raghuvamsi Nadiminty , Bhargavi Dandugundu , Andra Vindhya Vasini 
Published: March 2020

e15143 Background: Gastric cancer is the second most common cause of cancer related death worldwide. HER2 expression is an important biomarker for identifying patients who could respond to targeted therapy. The purpose of this study was to evaluate the frequency of HER2 expression and its clinicopathological significance in Indian population with gastric cancer. Methods: In this retrospective study, clinicopathological details and formalin fixed embedded tissue from patients with gastric and gastro-esophageal junction Adenocarcinoma of all stages from August 2009 to January 2012 were collected. HER2 status in the tissue was evaluated by the validated methods. IHC (Immunohistochemistry) scores of 3+ were considered positive, 2+ equivocal, 1+ and 0 negative for HER2. Equivocal staining was further evaluated with FISH (Fluorescence In-situ Hybridization) testing. The significance of HER2 expression was correlated with epidemiological, clinical, pathological and biochemical parameters using Pearson’s test. Progression free survivals (PFS) were compared using Log Rank test (Mantel-Cox). Kaplan-Meier curves were determined for PFS. SPSS version 17.0 was used for statistical analysis. Results: We studied 135 patients, of which IHC for HER2 was 3+ in 8.8%, 2+ in 10.4%, 1+ in 8.9% and zero in 71.9%. Among HER2 equivocal samples (n=14), FISH showed HER2 gene amplification in 14.2%. HER2 status was negative in 89.6% and positive in 10.4%.HER2 status significantly correlated with stage (p=0.03), smoking status (p=0.022) and not correlated with Age, Gender, Site, Lauren’s classification, Albumin, Hemoglobin. HER2 negative patients have better PFS (13.1 versus 7.1 months; p=0.005) and the levels of HER2 expression significantly influenced the PFS (p=0.006).Median PFS in patients with 3+, 2+, 1+ and zero IHC scores were 8.2, 8.8, 9.3, and 14.2 months respectively. Conclusions: The frequency of HER2 expression in gastric cancer in Indian population is comparable to the published data. HER2 in Gastric cancer serves as a prognostic marker.
The effect of delay of adjuvant chemotherapy on survival in patients with resected stage II and III gastric cancer.
Authors: Jung Minkyu , Park Hyoung Soon , Park Han Na , Lim Seungtaek , Park Ji Soo , Chon Hong Jae , Kim Hyoung-Il , Ahn Ji Yeong , Cheong Jae-Ho , Hyung Woo Jin , Noh Sung Hoon , Kim Hye Ryun , Kim Hyo Song , Rha Sun Young , Chung Hyun Cheol 
Published: March 2020

e15144 Background: Adjuvant chemotherapy improved survival in patients with gastric cancer. However, the association between the timing of adjuvant chemotherapy and survival has not been investigated. Methods: Patients with stage II and III gastric cancer who received adjuvant chemotherapy at Yonsei University Health System were included in this study. Time to adjuvant chemotherapy, relapse free survival (RFS), and overall survival (OS) were calculated from the day of surgery. RFS and OS were compared using log-rank test and multivariate analysis by the Cox proportional hazards model. Results: Among 675 patients, 226 patients (33.5%) began adjuvant chemotherapy within 1 month, 421 patients (60.1%) began adjuvant chemotherapy in 1 to 2 months, and 28 patients (4.1%) began adjuvant chemotherapy > 2 months after surgery. Intervals > 2 months between chemotherapy and surgery was associated with worse RFS and OS in both univariate analysis (RFS, p=0.039; OS, p=0.022, respectively) and a Cox proportional hazards model (RFS, hazard ratio [HR] =1.81, 95% confidential interval [CI] =1.05-3.12; OS, HR=1.96, 95% CI=1.11-3.47, respectively). Conclusions: Only 4.1% of patients initiated adjuvant chemotherapy >2 months after the date of curative surgery. Adjuvant chemotherapy delay > 2 months after surgical resection is associated with worse survival among patients with resected stage II and III gastric cancer.
The use of AFP and DCP as serum biomarkers to differentiate between hepatocellular carcinoma and intrahepatic cholangiocarcinoma in non-cirrhotic livers.
Authors: Nathavitharana Ravindhi Lakmalee , Teng Mabel Joey , Johnson Philip James , Berhane Sarah , Skowronska Anna , Morse Janet 
Published: March 2020

e15162 Background: Differential diagnosis of hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) can be challenging in patients without evidence of liver cirrhosis. Definitive diagnosis is based on tissue biopsy. We investigated if the use of serum biomarkers could help differentiate between these two types of malignancies, thereby avoiding the risks associated with biopsy. Methods: Patients with cholangiocarcinoma and HCC were recruited from Queen Elizabeth Hospital, Birmingham, UK; blood samples were collected at time of diagnosis. Two biomarkers, alpha-fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP) were measured in the serum samples from 56 patients with cholangiocarcinoma and 35 patients with HCC without evidence of liver cirrhosis. Of the 56 patients with cholangiocarcinoma, 17 were intrahepatic and 39 were extrahepatic. Results: 17 ICC and 35 HCC were included in the analysis. The levels of AFP and DCP were much higher in HCC as compared to ICC. The median AFP was 64.6 (IQR 10.9, 3564.2) in HCC as compared to 3 (IQR 2.4, 3.9) in ICC. Similarly, the median DCP was 215.41 (IQR 22.46, 692.53) in HCC as compared to 0.33 (IQR 0.16, 1.08) in ICC. Stepwise logistic regression was performed using both biomarkers. Log- DCP remained significant at 95% level in predicting HCC from ICC, giving an AUC of 0.96. Conclusions: In patients with a non-cirrhotic liver and radiological evidence of cancer, measurement of serum AFP and DCP level may help differentiate between HCC and ICC. In this study, DCP is the most useful discriminator between HCC and ICC. Further prospective studies should be done with larger sample sizes to validate the use of AFP and DCP as diagnostic biomarkers in this clinical setting.