bluuebunny/crossref_metadata_2025_split huggingface dataset:
An investigation of the relationship between tumor location and survival following colon cancer resection.
Authors: Knight Katrina , Horgan Paul G. , McMillan Donald C. , Park James Hugh , Roxburgh Campbell SD 
Published: February 2020

255 Background: Both tumour location and systemic inflammation (SI) have been related to survival in patients undergoing curative surgery for colon cancer. Recently, right colon cancer (RCC) has been associated with pre-existing cardiovascular disease (CVD). Comorbidity scores such as the Lee Cardiac Risk Index (LCRI) capture symptomatic disease only. Imaging-based assessment of vascular calcification can be used to identify subclinical CVD. We explored the relationship between tumour location, systemic inflammation, cardiac comorbidity and survival in patients undergoing CC resection. Methods: Patients were identified from a prospective cancer database. Clinicopathological characteristics and survival data were abstracted. Aortic calcification (AC) was quantified visually on staging CT images. SI was measured using the modified Glasgow Prognostic Score (mGPS). Results: Of 418 patients, most were female (221, 53%), over 65 (282, 67%), ASA grade II or less (66%) with RCC (230, 55%) and TNM II-III disease (320, 77%). Compared with LCC, RCC was associated with increasing age (59% vs 41%, p = 0.039), greater AC (61% vs 39%, p = 0.013) but not SI (61% vs 39%, p = 0.139). There were no significant differences between LCC with respect to ASA, smoking status or LCRI. Univariate analysis revealed TNM stage (HR 3.55 (95%CI 1.51 - 8.39) p = 0.004) and degree of AC (HR 1.77 (1.04 - 3.00) p = 0.034) were associated with cancer-specific survival (CSS) in RCC while in LCC, only TNM stage was related to CSS (HR 2.30 (0.99 - 5.30) p = 0.05). Multivariate analysis in patients with RCC confirmed AC to be a stage-independent predictor of CSS (HR 1.94 (1.15 – 3.67) p = 0.013). Conclusions: AC is associated with RCC and confers an inferior prognosis, independent of stage. Investigation of underlying mechanisms is required, but impaired perfusion may limit mucosal function, potentiating the effect of carcinogens in the right colon.
Modified Controlling Nutritional Status score: A refined prognostic indicator depending on the stage of gastric cancer.
Authors: Jeon Chul Hyo , Lee Han Hong 
Published: February 2020

294 Background: The role of controlling nutritional status (CONUT) score in predicting cancer survival remains uncertain. This study aimed to investigate the predictive value of the CONUT score and to develop a more appropriate scoring system beyond CONUT for gastric cancer (GC). Methods: We retrospectively reviewed 1307 patients who underwent curative gastrectomy between 2009 and 2015. The CONUT and three modified scores with modified lipid components (L-CONUT: albumin/total lymphocyte count [TLC]/low density lipoprotein, H-CONUT: albumin/TLC/high density lipoprotein, and T-CONUT: albumin/TLC/triglyceride) were calculated. The predictive value of each scoring system on long-term survival was assessed. Results: The values of the four nutritional scores were categorized into three groups (low, medium, and high). The CONUT (P < 0.001), L-CONUT (P < 0.001), H-CONUT (P < 0.001), and T-CONUT (P < 0.001) scores showed significant differences in overall survival in the three groups. Survival analysis according to the pathological stage showed that advanced age, Eastern Cooperative Oncology Group performance status, male sex, and high H-CONUT score (HR, 3.93; 95% CI, 1.81–8.55; P = 0.001) were independent worse prognostic factors for overall survival in the stage I group. In the stage II group, CONUT score (HR, 5.077; 95% CI, 1.65–15.65; P = 0.005) was significantly associated with poor prognosis. In the stage III group, no scoring system showed significant results. Conclusions: In advanced GC (beyond stage II), the prognostic impact of the nutritional scoring system was uncertain. However, the H-CONUT score is a promising indicator of prognosis in stage I GC, and the CONUT score is useful for predicting long-term survival in stage II GC.
Real-world outcomes of first-line U.S. patients with unresectable advanced or metastatic gastroesophageal adenocarcinoma by primary tumor location.
Authors: Shankaran Veena , Xiao Hong , Bertwistle David , Zhang Ying , Abraham Pranav , Chau Ian 
Published: February 2020

304 Background: Gastric cancer clinical trials are inconsistent in their inclusion of esophageal adenocarcinoma (EAC). Thus it is uncertain if outcomes are similar among subgroups of gastroesophageal adenocarcinoma. The aim of this study was to compare baseline characteristics and clinical outcomes of US patients with EAC versus Gastroesophageal Junction Cancer (GEJC) and Gastric Cancer (GC) treated in real world clinical settings. Methods: Adult patients with unresectable, advanced or metastatic GC, GEJC, or EAC diagnosed between January 2011 and November 2018 were identified from the Flatiron Health database. Patients with a positive HER2 test, or who received trastuzumab, were excluded. Overall survival (OS) was defined as time from first-line (1L) treatment initiation to death or loss of follow-up. Survival analyses were conducted using Kaplan-Meier methods with log-rank test and Cox models. Results: A total of 3052 patients (969 EAC and 2083 GEJC/GC) met eligibility criteria. Out of all EAC patients, 90% were males and 76% were white. Within the GEJC/GC patients, 67% were males and 57% were white. Median age was 66 years for both cohorts while proportion with ECOG PS of 0 or 1 was 78% for EAC and 84% for GEJC/GC among patients with ECOG scores. The proportion of patients receiving 1L treatment was comparable (78% for EAC, 76% for GEJC/GC) across groups with FOLFOX being the most frequent treatment (25% for EAC and 29% for GEJC/GC). There was no significant difference in OS between the two groups, with median OS of 9.1 and 9.6 months for EAC and GEJC/GC, respectively (HR 0.957, 95% CI: 0.863 - 1.062, p = 0.41). Conclusions: In this US real-world analysis, OS did not differ significantly between patients with EAC and patients with GEJC/GC who received 1L treatment, suggesting that these two populations may have comparable survival benefit from systemic therapy.
Change in neutrophial-to-lymphocyte ratio (NLR) in response to immune checkpoint inhibitor for advanced gastric cancer.
Authors: Chen Yang , Peng Zhi , Gong Jifang , QI Changsong , Zhang Xiaotian , Li Jian , Shen Lin 
Published: February 2020

306 Background: We intended to evaluate the utility of neutrophil-to-lymphocyte (NLR) in advanced gastric cancer patients treated with immune checkpoint inhibitor (ICI). Methods: We examined NLR at baseline and 6 (±2) weeks later in 139 patients between August 2015 and April 2019. Landmark analysis at 6 weeks was conducted to explore the prognostic value of NLR change on progress-free survival (PFS), overall survival (OS), objective response rate (ORR), and disease control rate (DCR). Cox and logistic regression models were adjusted for tumor differention, Lauren classification, line of therapy, type of anti-PD-1/PD-L1 therapy, and baseline NLR. Results: Median duration on therapy was 6 cycles. Median NLR was 3.33 (IQR: 2.26-4.84) at baseline and 2.93 (IQR: 1.67-4.83) at week 6. Patients with a higher baseline NLR showed a trend toward lower DCR, shorter PFS, and shorter OS. Higher NLR at 6 weeks was significantly associated with inferior PFS [hazard ratios (HRs) 1.03, 95% confidence interval (CI): 1.00-1.06 ] and inferior OS (HR 1.08, 95%CI: 1.03-1.12). Relative NLR decrease by ≥ 25% from baseline to 6 weeks after ICI therapy was an independent prognostic factor for ORR (OR 8.11,95% CI:2.40-27.4), DCR (OR 20.03, 95% CI: 3.32-121), PFS (HR 0.37, 95% CI: 0.20-0.68), and OS (HR 0.26, 95% CI: 0.10-0.65). Conclusions: Early decline of NLR (and NLR at 6 weeks) were associated with improved clinical outcomes in advanced gastric cancer patients treated with ICI. [Table: see text]
Construction and validation of a simple-to-use nomogram incorporating clinicopathological parameters into the TNM staging system to predict prognosis for stage II colorectal cancer.
Authors: Mo Shaobo , Li Yaqi , Peng Junjie , Cai SanJun 
Published: February 2020

31 Background: Survival outcomes are significant different in stage II colorectal cancer (CRC) patients with diverse clinicopathological features. Objective of this study is to establish a credible prognostic nomogram incorporating easily obtained parameters for stage II CRC patients. Methods: A total of 1708 stage II CRC patients at Fudan University Shanghai Cancer Center (FUSCC) during 2008 to 2013 were retrospectively analyzed in this study. Cases were randomly separated into training set (n = 1084) and validation set (n = 624). Univariate and multivariate Cox regression analyses were used to identify independent prognostic factors which were subsequently incorporated into a nomogram. The performance of the nomogram was evaluated by C-index and ROC curve to calculate the area under the curve (AUC). The clinical utility of the nomogram was evaluated using decision curve analysis (DCA). Results: In univariate and multivariate analyses, eight parameters were correlated with disease free survival (DFS), which were subsequently selected to draw prognostic nomogram based on DFS. For DFS predictions, the predicted concordance index (C-index) of the nomogram was 0.842 (95% confidence interval (CI), 0.710-0.980), and 0.701 (95% CI, 0.610-0.770) for training and validation set, respectively. The AUC values of ROC predicted 1, 3 and 5-year survival of nomogram in the training and validation groups were 0.869, 0.858, 0.777 and 0.673, 0.714, 0.706, respectively. The recurrence probability calibration curve showed good consistency between actual observations and nomogram-based predictions. DCA showed better clinical application value for the nomogram compared with TNM staging system. Conclusions: A novel nomogram based on a large population study was established and validated, which is a simple-to-use tool for physicians to facilitate the postoperative personalized prognostic evaluation and determine therapeutic strategies for stage II CRC patients.
Impact of palliative care in patients with metastatic esophageal cancer declining chemotherapy.
Authors: Manguso Nicholas , Kim Sungjin , Guan Michelle , Placencio-Hickok Veronica , Kim Haesoo , Liu Jar-Yee , Hendifar Andrew Eugene , Klempner Samuel J. , Burch Miguel , Gangi Alexandra , Chao Joseph , Kamrava Mitchell , Atkins Katelyn Mae , Gong Jun 
Published: February 2020

315 Background: Palliative care has been associated with improved overall survival (OS), but limited data exist in metastatic esophageal cancer (mEC). We investigated the impact of palliative care in patients with mEC who declined chemotherapy (CTX). Methods: The National Cancer Database was used to identify patients between 2004-2015. Patients with M1 disease who declined CTX and had known palliative care status (surgery, radiotherapy [RT], pain management, or any combination of) were included. Cases with unknown CTX, RT, or nonprimary surgery status were excluded. Kaplan-Meier estimates of OS were calculated. Univariable and multivariable Cox regressions were performed. Results: Among 140,234 EC cases, we identified 1,493 patients who declined CTX and had complete data. Median age was 70 years, most (66.3%) had a Charlson Comorbidity Index (CCI) of 0, and 37.1% were treated at an academic center. Most (72.7%) did not receive palliative care. Median OS was 2.53 months (mos), with no statistically significant difference in median OS between those receiving palliative care (2.83 mos, 95% confidence interval [CI] 2.53-3.12) vs. no palliative care (2.37 mos, 2.2-2.56; p = 0.288). On univariable analysis, treatment at an academic center (hazard ratio [HR] 0.90, 0.80-1.00) and CCI ≥2 (HR 1.20, 1.00-1.42) were predictive of OS (p < 0.05). On multivariable analysis, male sex (HR 1.23, 1.08-1.40), South geographic region (HR 1.23, 1.04-1.46), CCI of 1 (HR 1.17, 1.03-1.32), higher grade (HR 1.21, 1.07-1.38), and higher T stage (HR 1.39, 1.12-1.73) were associated with poor OS (p < 0.05). Conclusions: Palliative care conferred a numerically higher, but not statistically significant difference in OS among patients with mEC declining CTX. Quality of life metrics, inpatient status, and subgroup analyses are important for examining the role of palliative care in mEC and future studies are warranted.
Should adenosquamous esophageal carcinoma be treated like adenocarcinoma or squamous cell carcinoma?
Authors: Gamboa Adriana C. , Meyer Benjamin I , Switchenko Jeffrey M. , Rupji Manali , Lee Rachel M. , Turgeon Michael K. , Russell Maria C. , Cardona Kenneth , Kooby David A. , Maithel Shishir K. , Shah Mihir M. 
Published: February 2020

323 Background: Adenocarcinoma and squamous cell carcinoma of the esophagus have distinct outcomes, treatment strategies, and response profiles to therapy. Adenosquamous carcinoma (ASC) is thought to behave more aggressively than each of its counterparts. Our aim was to determine if ASC is best managed as adenocarcinoma or squamous cell carcinoma. Methods: The National Cancer Database (2004-15) was queried for patients with non-metastatic, esophageal ASC. Analysis was stratified by clinical node negative (cN0) or node positive (cN1-3) according to AJCC 8th edition. Treatment types were categorized into chemoradiation alone, surgery alone, or preoperative chemoradiation followed by surgery. Primary outcome was overall survival (OS). Results: Among 352 pts, median age was 67 yrs, 80% were male (n = 281). Median f/u was 46 mos. 43% were cN0 (n = 151), 57% were cN1-3 (n = 201). 55% had chemoradiation alone (n = 194), 15% had surgery alone (n = 53) and 30% had preoperative chemoradiation (n = 105). Of pts who had preoperative chemoradiation, 20% had pathologic complete response (n = 17). For either cN0 or cN1-3, Charlson-Deyo Comorbidity Index did not differ among the treatment groups (all p > 0.05). On KM analysis for cN0 disease, treatment with surgery alone had a comparable 5-yr OS to preoperative chemoradiation (47 vs 34% p = 0.5) and each had improved 5-yr OS compared to chemoradiation alone (30%; p = 0.02; p = 0.06). On UV analysis for patients with cN0 disease, clinical T-stage was not associated with 5-yr OS. For patients with cN1-3 disease, however, preoperative chemoradiation was associated with improved 5-yr OS when compared to chemoradiation alone or surgery alone (27 vs 19 vs 0% p < 0.001). This persisted even when accounting for age and clinical T-stage (HR 0.45 p < 0.001). Conclusions: Esophageal adenosquamous carcinoma behaves more like adenocarcinoma both in response to chemoradiation and survival outcomes based on the treatment modality. The complete response rate to chemoradiation is only 20% unlike what has been shown for squamous cell carcinoma, where chemoradiation is an acceptable definitive therapy. Esophageal adenosquamous carcinoma should be managed like adenocarcinoma and not squamous cell carcinoma.
Age-related outcomes in patients with esophageal cancer: A propensity score matched analysis.
Authors: Blinn Paige , Maramara Taylor , Shridhar Ravi , Huston Jamie , Meredith Kenneth Lee 
Published: February 2020

326 Background: Esophageal cancer is increasing in incidence worldwide. It is estimated that there will be 17,650 new cases of esophageal cancer diagnosed, with 16,080 dying from the disease in the United States in 2019. There has been an increase in younger patients diagnosed with esophageal cancer. We sought to evaluate the outcomes in younger patients diagnosed with esophageal cancer. Methods: Utilizing the National Cancer Database we identified patients with esophageal cancer. We then stratified by age < 50, 51-60, 61-70, and > 70 years. Baseline univariate comparisons were made for continuous variables using both the Mann-Whitney U and Kruskal Wallis tests as appropriate. Pearson’s Chi-square test was used to compare categorical variables. Unadjusted survival analyses were performed using the Kaplan-Meier method. All statistical tests were two-sided and p < 0.05 was significant. Propensity score matched analysis was performed and only exact matches were allowed. Results: We identified 20,324 patients ( < 50, 2157), (51-60, 5387), (61-70, 7853), and ( > 70, 4927). T-stages and N stages were higher in the younger age groups p < 0.001 and p < 0.001 respectively. Median lymph nodes positive were highest in the < 50 group (2.2 vs 1.8 vs 1.6 vs 1.7) p < 0.001. Additionally, tumor size was largest in this age cohort (3.7 vs 3.5 vs 3.5 vs 3.2) p = 0.002. Neoadjuvant therapy was administered in 69.4% of patients in the < 50, 68.5% (51-60), 65.5% (61-70), and 49.5% > 70 patients, p < 0.001. The < 50 age group was however more likely to receive adjuvant therapy (22.9% vs 20.5% vs 16.9% vs 13.4%) p < 0.001. Median and overall survival was 49.8 mo and 45% ( < 50), 45.4mo and 43% (51-60), 45.4mo and 43% (61-70), and 35.8mo and 39% > 70, p < 0.001. After propensity score matching, multivariate analysis found that age < 50, male gender, GEJ tumor location, grade, Charleson Deyo score, T-stage N stage, margin, facility volume, neoadjuvant and adjuvant therapy were predictors of survival. Conclusions: Although younger patients present with larger tumors, higher T-stages, and N stages, they are more likely to receive neoadjuvant and adjuvant therapies. It is these therapies which are most likely contributing to improved survival compared to their older counterparts.
Self-reported patient experience and quality of care among elderly patients with colon cancer.
Authors: Snyder Rebecca A , Wardrop Rebecca , Mclain Alexander , Parikh Alexander A. , Cass Anna 
Published: February 2020

33 Background: Although studies have identified demographic and clinical factors associated with quality colorectal cancer care, the association between patient-reported experience of care and quality of care is unknown. Our primary aim was to assess the relationship between patient-reported experience of care and receipt of guideline-concordant colon cancer (CC) treatment. Methods: Fee-For-Service Medicare beneficiaries with resected stage I-III CC (2003-2013) were identified in the linked SEER registry and Consumer Assessment of Healthcare Providers and Systems patient experience survey (SEER-CAHPS) dataset. Patient-reported ratings were compared based on receipt of care consistent with recommended treatment guidelines [resection of ≥ 12 lymph nodes (LN) (stage I-III) and receipt of adjuvant chemotherapy (stage III)]. Linear regression was performed to compare mean patient experience scores by receipt of guideline concordant care, adjusting for patient and hospital factors. Results: 1010 patients with stage I-III CC were identified (mean age 76.7, SE 6.9). Of these, 58.4% of stage I (n = 192/329) and 73.4% of stage II (n = 298/406) patients underwent resection of ≥ 12 LN. Among stage III patients, 76.0% (n = 209/275) underwent resection of ≥ 12 LN and 52.4% (n = 144/275) received adjuvant chemotherapy. By multivariable analysis, patient-reported ratings of health care quality, personal and specialty physicians, customer service, physician communication, getting needed care, and getting care quickly were similar among patients who received guideline-concordant treatment compared to those who did not. However, mean ratings of overall health care quality [91.3 (SE 2.0) vs. 82.4 (SE 1.7), p = 0.0004] and getting needed care [92.8 (SE 2.4) vs. 86.8 (SE 2.0), p = 0.047] were higher among stage III patients who received guideline concordant care compared to those who did not. Conclusions: Patient-reported ratings of health care quality and ability to get needed care are associated with guideline concordant cancer care among elderly patients with stage III CC. Further investigation is needed to determine if patient-reported experience correlates with other clinical measures of quality of colorectal cancer care.
Relationship of periodic methylation patterns in the gastric mucosa and periodic stem cell replacement.
Authors: Oh Jung-Hwan , Hong Seung Jin 
Published: February 2020

333 Background: The role of Helicobacter pylori-associated methylation in the inactivation of tumour-suppressor genes has been previously investigated. However, the relationship between H. pylori-associated methylation and gene inactivation is unclear. Stem cells are replaced periodically every 8 years in the gastrointestinal mucosa. Hence, age-related methylation in the gastric mucosa was studied to understand the stabilization of new stem cell phenotypes. Methods: Endoscopic biopsy specimens of the antral mucosa were obtained from 148 H. pylori-negative and 124 H. pylori-positive subjects. The methylation-variable sites of 4 housekeeping genes ( CDH1, ARRDC4, MMP2, and CDKN2A) and 2 stomach-specific genes ( TFF2 and TFF3) were examined using radioisotope-labelled methylation-specific polymerase chain reaction. Age-related methylation was evaluated at an interval of 2 years. Results: The 4 housekeeping genes were more frequently methylated in H. pylori-positive subjects than in H. pylori-negative subjects. Periodic changes in the housekeeping gene methylation were obscure. TFF2, which is highly expressed in the stomach, was periodically methylated to attain peaks at the age of 40–41, 48–49, 56–57, and 64–65 years in both H. pylori-negative and -positive subjects. TFF3, which is weakly expressed in the stomach, was methylated at the age of 46–47, 54–55, 66–67, and 72–73 years in H. pylori-negative subjects. The methylation of stomach-specific genes periodically fluctuated approximately at 8-year intervals in the gastric mucosa. Conclusions: Periodic methylation changes in the gastric mucosa may be used to estimate the replacement of new stem cells.
Early implementation of a postoperative nutrition support pathway for patients undergoing esophagectomy.
Authors: Carr Rebecca , Stella Christina , Glauner Diana , Kenny Erin , Russo Lianne , Garrity Meghan , Bott Matthew , Isbell James M. , Park Bernard , Sihag Smita , Jones David Randolph , Molena Daniela 
Published: February 2020

344 Background: A significant risk of malnutrition burdens patients with esophageal cancer undergoing esophagectomy as tumor-related dysphagia and side effects of chemoradiation impair the patients’ ability to maintain adequate nutrition. Moreover, patients lose 10% or more of their preoperative body weight in the first year following surgery. Implementation of nutrition protocols may reduce postoperative weight loss and enhance recovery in these patients. Methods: This is a retrospective study examining a postoperative nutrition protocol initiated in August of 2017. Patients with esophagogastric cancer who underwent Ivor Lewis esophagectomy from July 2016 to July 2019 were identified from a prospectively collected database. Patients that underwent surgery after implementation of this protocol were compared to those operated prior to it. Results: Patients’ and tumor characteristics were similar between the two groups. The protocol included preoperative evaluation by a dietician, postoperative feeding pathway, and regular post-discharge follow up by phone with a dietician. In the post protocol group, we observed a reduction in time to initiation of diet and decreased weight loss at patient follow up (Table). There was no difference in incidence of postoperative complication, length of stay, 30-day readmission, or in hospital mortality. Conclusions: In conclusion, postoperative nutrition support programs may help reduce postoperative weight loss and may have a role in the prevention of malnutrition in these patients. Initial results suggest that more aggressive nutritional supplement program is feasible and may lead to improved postoperative outcomes in patients undergoing esophagectomy. [Table: see text]