bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in the proportion of patients presenting with early stage colon cancer over time among Medicaid expansion and nonexpansion states.
Authors: Hao Scarlett , Snyder Rebecca A , Irish William , Parikh Alexander A. 
Published: February 2020

251 Background: In 2010, the Affordable Care Act required insurance plans to cover preventative screening, and the Medicaid expansion provision enabled participating states to increase Medicaid coverage of uninsured individuals. The aim of this study was to determine whether the proportion of patients diagnosed with early vs. late stage colon cancer (CC) at Commission on Cancer (CoC) facilities differed over time within states that expanded Medicaid in January 2014 (MES) vs. non-Medicaid expansion states (NMES). Methods: A hospital-based cohort study of patients diagnosed with CC from 2006-2016 was performed using the National Cancer Database. Uninsured and Medicaid-insured patients in MES were compared with patients in NMES. Patients with Medicare, private, or government insurance were excluded. The observed proportions of patients with early (AJCC I-II) vs late (III-IV) stage within each cohort were compared over time. Propensity score adjusted probability of early stage at presentation was determined among patients residing in MES and NMES. Results: The study cohort included 10,289 patients in MES and 15,173 patients in NMES. Compared to MES, a greater proportion of patients in NMES were black (33.4% vs 24.0%), had a median income < $38,000 (39.7% vs 28.2%), and resided in a state with ≥21% of the population without a high school degree (37.4% vs 28.1%). The proportions of early stage CC in both cohorts in 2006 were similar. In NMES, this proportion remained constant over time until 2014 and declined by 0.8% per year after 2014. Within MES, the proportion of early stage CC increased by 0.6% per year until 2014 and 0.9% per year after 2014. By 2016, the absolute difference in the propensity adjusted proportion of early stage CC between cohorts was 8.8% (39.7% vs 30.9%, p < 0.001). Conclusions: Following Medicaid expansion in 2014, the proportion of patients presenting to a CoC facility with early stage CC increased over time within MES and declined in NMES. Further investigation, including population-based research, is warranted to determine if enrollment in Medicaid improves access to colorectal cancer screening and leads to earlier stage at diagnosis.
Bowel anastomosis before or after HIPEC: A prospective comparative study in patients undergoing CRS+HIPEC for peritoneal surface malignancy at a tertiary care cancer center in India.
Authors: Somashekhar S.P. , C. Rohit Kumar , Rajgopal Ashwin K. , Zaveri Shabber , Yethadka Ramya , Rauthan Amit 
Published: February 2020

254 Background: To do bowel anastomosis before or after HIPEC has been debated since the time heat is being used for intraperitoneal chemotherapy after cytoreductive surgery. We report our experience of impact of heat on anastomosis and leak rates. Methods: All patients diagnosed with peritoneal surface malignancy eligible for CRS+ HIPEC as per institution protocol had bowel restoration being performed with stapler & second layer taken. Our institution has two teams, of which one performs anastomosis before and one after HIPEC. All the data was entered prospectively in the HIPEC registry and is being analyzed to see the effect of heat on anastomosis. Results: 220 patients underwent CRS+ HIPEC of which organ of origin was colorectal 39%, stomach 20%, mesothelioma 11%, ovary 20% and others 10%. Upfront cases were 12%, interval 58% & recurrent 30%. Prior surgical score was 0 (62%), 1 (11%), 2 (23%), 3 (4%). 100 patients were in group that had anastomosis before HIPEC and 120 patients in other. Mean PCI 13.4±4.5, blood loss 1250±553.9 ml, duration of surgery 9.5±2.4 hrs, duration of hospital stay 9±3.5 days. Overall 57.05% had bowel resections, of which large bowel was 47.8%, small bowel 17.7%, stomach 6.13%. 19.6% required multivisceral resection & stoma rate was 11.1% for whole group. Both the group had almost same number of total (55.4 %vs 58.6%), small (15.3%vs16.5%) & large bowel resections (44.3%vs 49.5%). We had 4 (1.84%) leak overall, of which 2 were in either groups. Overall G3-4 morbidity was 28.4%, surgical G3-4 was 12.5%, perforation 3.6%, obstruction 1.84%, re exploration was 9.2%. 30-day mortality was 4.9%. Conclusions: We conclude that anastomotic integrity, leak rates & complications related to small or large bowel restoration is same either before or after HIPEC as we observed no difference in our study. However, since this is not a randomized study a well-designed multi-institutional randomized study needs to be planned for stronger evidence of the same.
Results of the JAVELIN Gastric 100 phase 3 trial: avelumab maintenance following first-line (1L) chemotherapy (CTx) vs continuation of CTx for HER2− advanced gastric or gastroesophageal junction cancer (GC/GEJC).
Authors: Moehler Markus H. , Dvorkin Mikhail , Ozguroglu Mustafa , Ryu Min-hee , Muntean Alina Simona , Lonardi Sara , Nechaeva Marina , Campos Bragagnoli Arinilda Silva , Coskun Hasan Senol , Cubillo Gracián Antonio , Takano Toshimi , Wong Rachel , Safran Howard , Vaccaro Gina M. , Boku Narikazu , Conti Ilaria , Hong Janet , Xiong Huiling , Taieb Julien , Bang Yung-Jue 
Published: February 2020

278 Background: We report the primary analysis of JAVELIN Gastric 100, which compared avelumab (anti–PD-L1) maintenance after 1L CTx vs continued CTx in patients (pts) with GC/GEJC. Methods: In this global, open-label, phase 3 trial (NCT02625610), eligible pts had previously untreated, unresectable, locally advanced/metastatic (LA/M) HER2− GC/GEJC. Pts without progressive disease (PD) after 12 weeks of 1L oxaliplatin/fluoropyrimidine induction were randomized 1:1 to avelumab 10 mg/kg Q2W switch maintenance or continued CTx, stratified by region (Asia vs non-Asia). Primary endpoint was overall survival (OS) post induction in all randomized or PD-L1+ (≥1% of tumor cells, 73-10 assay) pts. Results: 805 pts received induction CTx and 499 pts were randomized (avelumab, n = 249; CTx, n = 250). At data cutoff (Sep 13, 2019), minimum follow-up was 18 months. In the avelumab and CTx arms, median OS post induction/randomization was 10.4 months (95% CI 9.1-12.0) vs 10.9 months (95% CI 9.6-12.4), hazard ratio (HR) 0.91 (95% CI 0.74-1.11; p = 0.1779); 24-month OS rates were 22.1% (95% CI 16.8-28.0) vs 15.5% (95% CI 10.8-20.9), respectively. The HR for OS in PD-L1+ pts (n = 54) was 1.13 (95% CI 0.57-2.23). No OS trend was seen in Asian pts (n = 114; HR 0.90 [95% CI 0.59-1.36]) or other subgroups, except for a potential benefit with avelumab in pts with no metastatic sites at randomization (n = 60; HR 0.52 [95% CI 0.28-0.98]). Progression-free survival was similar between arms (HR 1.04 [95% CI 0.85-1.28]). In the avelumab vs CTx arms, objective response rates (post randomization only) were 13.3% (95% CI 9.3-18.1) vs 14.4% (95% CI 10.3-19.4), and 12-month rates for duration of response were 62.3% (95% CI 40.9-77.9) vs 28.4% (95% CI 13.2-45.7), respectively. Treatment-related adverse event rates (all grades/grade ≥3) were 61.3%/12.8% with avelumab and 77.3%/32.8% with CTx. Conclusions: Avelumab maintenance showed clinical activity and favorable safety vs continued CTx in pts with LA/M GE/GEJC; however, JAVELIN Gastric 100 did not meet its primary objective of demonstrating superior OS in the randomized or PD-L1+ population. Clinical trial information: NCT02625610.
Hyperthermic intraperitoneal chemotherapy post cytoreductive surgery in management of peritoneal carcinomatosis of colorectal primaries: Tertiary center experience.
Authors: Sobh Ahmed Badran , Al-Wusaibie Ahmed , Elshenawy Mahmoud Abdelsatar , Abdelgawad Marwa Ismail , Hakeam Hakeam , Azzam Ayman , AbdelRehem Rania Naguib , Al-Yahya Zyad , Amin Tarek 
Published: February 2020

28 Background: Hyperthermic intraperitoneal chemotherapy (HIPEC) in addition to Cytoreductive surgery (CRS) has survival benefit observed in management of Peritoneal Carcinomatosis (PC) from Colo-rectal cancer (CRC)origin. We report the outcomes and prognostic factors of patients with CRC, who presented with PC and underwent CRS and HIPEC at King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia. Methods: Patients presented with PC from CRC origin and underwent CRS and HIPEC; from February 2009 to September 2015 were recruited. Results: 52 patients identified. A total of 55 CRS procedures were performed, where 3 patients underwent repeated CRS and HIPEC for tumor recurrence. All except 3 used mitomycin-C for HIPEC, the remaining received either melphalan (2 patients) or cisplatin plus mitomycin-C regimen (1 patient). Melphalan used for patients who underwent repeated HIPEC as 2nd line chemotherapeutic agent. Intraoperative Radiation therapy performed in 5 patients with tumor invading the surrounding structures, where performing a safe or complete resection was either technically difficult or carried high risk. Complication assessment by Clavien-Dindo score, 62 % grade (I-II), while 31% had grade (3–4). Two patients (3.6%) died postoperatively; both from sepsis. Respiratory complications were the most commonly encountered morbidities. The 5-year overall survival(OS) was 50% with disease free survival (DFS) 29.5%. Univariate analysis showed poor OS and DFS encountered in; Signet-ring tumors (p < 0.0001) for both, peritoneal cancer index (PCI) ≥ 6 (p < 0.0009) for both, completeness of cytoreduction(CC) score >1 (p < 0.0001) for both, and high 3-month postoperative carcinoembryonic antigen value (p <0.0001) for both. In multivariate analysis; DFS was significant for (PCI) ≥ 6 (p < 0.0131) and (CC) score >1 (p < 0.0031) while PCI > 6 was the only significant factor (p < 0.0030) for OS. Conclusions: Addition of HIPEC to CRS was safe, and improved survival in patient with peritoneal Carcinomatosis of colo-rectal origin. PCI and CC score are prognostic factors of survival, signet-ring subtype may not benefit of this procedure.
Early results of the randomized, multicenter, controlled evaluation of S-1 and oxaliplatin as neoadjuvant chemotherapy for Chinese advanced gastric cancer patients (RESONANCE Trial).
Authors: Wang Xinxin , Li Shuo , Xie Tianyu , Lu Yixun , Guo Xin , Lin Chen 
Published: February 2020

280 Background: Perioperative chemotherapy brings potential benefits to growing patients with gastric cancer based on several clinical trials including MAGIC, ACTS-GC, CLASSIC and INT-0116. However, the effect of neoadjuvant therapy before D2 gastrectomy remains pending. According to phase II clinical trials, SOX regimen as neoadjuvant chemotherapy is associated with increased rate of D2 lymph nodes dissection and R0 resection. We hypothesize that SOX regimen can improve survival of patients with gastric cancer. Methods: Through CT, EUS and laparoscopic exploration, patients with gastric cancer on the stage IIA-IIIC were included in the study and divided into 2 groups randomly. Patients in neoadjuvant group received 2-4 cycles of SOX before surgery and 4-6 cycles after surgery, while patients in no neoadjuvant group received 8 cycles after surgery. The primary endpoint was 3-y DFS and the secondary endpoint were 5-y OS, ORR, D2/R0 resection rate and side effect. Results: A total of 772 patients were enrolled in the study between September 2012 and July 2019. After neoadjuvant therapy, the downstaging was found in neoadjuvant group (261/386, 67.6%). The pathological efficiency rate and pCR rate of neoadjuvant group were 67.8% and 23.6% respectively. The R0 resection rate in neoadjuvant group was significantly higher than that in adjuvant group(73.1% vs 58.1%, p < 0.05). There was no difference in terms of surgical time, blood loss, postoperative complications and hospital stay. Conclusions: SOX makes increased rate of R0 resection, acceptable adverse effect and no impression on surgeries, which suggest that perioperative chemotherapy using SOX can prolong median survival time, DFS and OS. Clinical trial information: NCT01583361.
Access to care and outcomes for noncurative esophagogastric cancer: A population-based geographic study.
Authors: Yee Elliott Kenneth , Coburn Natalie , Zuk Victoria , Davis Laura E , Mahar Alyson , Liu Ying , Gupta Vaibhav , Darling Gail Elizabeth , Hallet Julie 
Published: February 2020

284 Background: Esophagogastric cancer (EGC) carries a heavy mortality burden owing largely to high rates of unresectable disease at diagnosis. Among patients not undergoing curative-intent therapy, access to care may vary. We examined the geographic distribution of care delivery and survival across a jurisdiction, and its relationship with distance to cancer centres (CCs), for non-curative EGC. Methods: We conducted a population-based analysis of adults with non-curative EGC from 2005-2017 using linked administrative healthcare datasets in Ontario, Canada. Outcomes were medical oncology consultation, receipt of chemotherapy, and overall survival (OS). We used geographic information system analysis to map locations of CCs and outcomes across census divisions. Regions of discordance between care use and OS were identified with bivariate choropleth maps. Multivariable modified Poisson models assessed the relationship between distance to the nearest CC and outcomes, adjusting for demographic, clinical, and socioeconomic factors. Results: Of 10,228 patients surviving a median of 5.1 months (IQR: 2.0-12.0), 68.6% had medical oncology consultation and 32.2% received chemotherapy. Regions of comparable OS and care delivery were clustered throughout the province. CCs were distributed unevenly, with higher levels in Southern Ontario. Higher-level CCs clustered in regions with higher rates of consultation, chemotherapy use, and OS. Each increment in distance from location of residence to the nearest CC (11-50, 51-100, and ≥101 km) was associated with lower likelihood of seeing medical oncology and receiving chemotherapy, and inferior OS, compared to ≤10 km. Conclusions: A third of patients with non-curative EGC did not see medical oncology, and the majority did not receive chemotherapy. Care delivery and OS exhibited high geographic variability. Location of residence influenced access to care and OS, with inferior outcomes for those living further from a CC. These findings are important for designing interventions and policies to reduce disparities in access to care and outcomes for non-curative EGC.
Prognostic value of circulating tumor DNA (ctDNA) detection during adjuvant chemotherapy in patients with stage III colorectal cancer: The interim report of a prospective, observational study.
Authors: Peng Junjie , Li Yaqi , Mo Shaobo , Ma Xiaoji , Hu Xiang , Zhang Long , Huang Dan , Cai Sanjun 
Published: February 2020

29 Background: Adjuvant chemotherapy (ACT) is the standard treatment for stage III colorectal cancers (CRC). However, optimal biomarker were still needed for individualized adjuvant strategies. Here, we conducted a prospective study in patients with stage III CRCs with combined ACT, to explore the prognostic effect of circulating tumor DNA (ctDNA) before and after ACT. Methods: The study enrolled 130 patients with stage III colon and rectal cancer (≥10cm from anal) who received curative resection without neoadjuvant therapy at Fudan University Shanghai Cancer Center. All patients received 3 or 6 months of ACT. The Roche AVENIO Surveillance Kit was used to assess somatic mutations by next-generation sequencing (NGS) in tissue, pre- and post-chemo plasma samples. The plasmas were collected 3-5 weeks after surgery and after last cycle of ACT, respectively. Patients were classified as ctDNA (+) or (-) based on the detection of SNVs identified in tumor tissue at an AF of at least 5%. Results: In the interim analysis, 116 tissues, 123 pre-chemo and 98 post-chemo plasmas were prospectively collected and detected, and a total of 86 matched samples were analyzed with a median follow-up of 12.0 months. ctDNA was detectable in 14 of 86 patients (16.3%) before ACT, and in 10 (11.6%) patients after ACT. After 1-year follow-up, longitudinal ctDNA analysis identified 6 of 12 early relapses (50.0%), while 6 in 69 patients (8.7%) who were both ctDNA (-) in pre- and post-chemo samples had early relapse. Before ACT, ctDNA(+) patients were 7 times more likely to relapse early than ctDNA(-) patients (HR, 7.372; 95% CI, 1.543-35.22; P = 0.012). Similarly, after ACT, ctDNA(+) patients were 13 times (HR, 13.37; 95% CI, 2.026-88.23; P = 0.007) more likely to relapse. Monitoring after ACT indicated that 7 of the 14 ctDNA(+) patients (50.0%) were cleared, and the early relapse rate decreased from 43.9% (3/7) to 28.6% (2/7) if ctDNA turned negative. Conclusions: ctDNA analysis can potentially change the postoperative management and surveillance strategies for stage III CRC by enabling risk stratification, monitoring ACT efficacy, and detecting early relapse. Clinical trial information: ChiCTR1800018754.
Is preoperative screening colonoscopy useful in patients with gastric cancer?
Authors: Koseki Yusuke , Hikage Makoto , Ikegame Ko , Itamoto Kouta , Isobe Yujiro , Yagi Taisuke , Nagata Masato , Waki Yuhei , Nakamura Kenichi , Kenichiro Furukawa , Fujiya Keiichi , Kamiya Satoshi , Tanizawa Yutaka , Bando Etsuro , Terashima Masanori 
Published: February 2020

290 Background: In patients with gastric cancer (GC), the most common double cancer is colorectal cancer (CRC). However, the meaning of screening colonoscopy has not been established. The aim of this retrospective study was to evaluate the useful of screening colonoscopy in preoperative patients with GC. Methods: This study included 689 patients who received screening colonoscopy before gastric surgery between 2012 and 2016. Multivariate analysis using logistic regression model was conducted to elucidate independent risk factors of CRC. Then, we investigated the clinicopathological factors for CRC. Results: Colorectal adenomas and CRC were observed in 315 patients (46%) and 37 patients (5.4%), respectively. The clinical T classification of the CRC were as follows; Tis: 24 patients (65%), T1: 8 patients (21%), T2: 2 patients (6%), and T3: 3 patients (8%). In multivariate analysis, male (OR 5.04, 95% C.I. 1.29-19.6, p = 0.020) was revealed as risk factor for affecting CRC. The treatments for CRC were as follows; EMR was performed in 27 patients, simultaneous resection with GC was performed in 9 patients, resection after gastrectomy was performed in 1 patient, respectively. Pathological stage of CRC was as follows; Stage 0: 24 patients, Stage I: 10 patients, and Stage IIA: 3 patients, respectively. As for the patients who underwent surgery for CRC, all of them received radical colectomy. No patient died for CRC who received colonoscopy before gastric surgery. Conclusions: Screening colonoscopy is useful for GC patients. Because most of the synchronous CRC were found early stage and curatively treated.
Conditional survival of patients with rectal cancer undergoing Watch and Wait: The risk of recurrence over time.
Authors: Fernandez Laura Melina , Figueiredo Nuno , Beets Geerard , Valk Maxime Van Der , Bahadoer Renu , Hilling Denise , Renehan Andrew , Van De Velde Cornelis J. H. , Habr-Gama Angelita , Perez Rodrigo O ,   International Watch & Wait Database (IWWD)
Published: February 2020

30 Background: Patients with rectal cancer and complete clinical response (cCR) after neoadjuvant chemoradiation (nCRT) have been offered non-operative management (W&W). Risk factors for local regrowth (RG) include baseline cT and type of nCRT. However, the influence of risk factors for RG over time and the extent in time that patients need to be followed with the rectum in situ after a cCR are unknown. Objective: Analyze the risk of recurrence over time through conditional survival (cDFS/cLRFS) estimates for rectal cancer patients under W&W. Methods: Retrospective analysis of all patients from the largest multicenter database of patients managed non-operatively (International Watch and Wait Database–IWWD). Only patients with cCR after nCRT and W&W with a median of >3 years of follow-up were included. cDFS was used to investigate the evolution of recurrence-odds, as patients remain disease-free after nCRT. 2-year cDFS was estimated at “x” years after nCRT based on the formula cDFS2=DFS(x+2)/DFS(x). Results: 768 patients treated between 1991-2015 were included. Using cDFSestimates, the probability of remaining disease-free for 2 additional years once cCR was achieved and sustained for 1, 3, and 5 years, were 85%, 97%, and 95%, respectively. These contrast with the actuarial DFS for similar intervals of 70%, 68% and 65% respectively. Baseline cT was associated with the risk of RG at 1 year after a cCR (cT2 aLRFS 89% vs. cT3 82%; p=0.004). However, after sustaining a cCR for 1 year, baseline cT becomes irrelevant at 2 years (cLRFS; 94% vs. 90%; |d| 0.14). Also, total dose of RT (≤50 vs >50Gy) was associated with the risk of RG (aLRFS 76% vs 85%; p=0.03) at 1 year. Dose of RT becomes irrelevant (at 2 years; cLRFS 93% vs. 90%; |d| 0.10) once patients sustained a cCR for 1 year. Conclusions: Conditional survival estimates suggests that patients have significantly lower risks (≤5%) of developing late RG (at 5 years) after sustaining cCR for 3 years. A sustained cCR over time may be more relevant for long-term risk of RG than cT-stage or RT dose. The present data can have significant consequences for the recommendation of intensive surveillance after sustaining 3ys of cCR.
Treatment burden following standard of care open versus robotic D2 gastrectomy plus neoadjuvant chemotherapy (NAC) for locally advanced gastric cancer (LAGC).
Authors: Rodriguez Mariana Juanita , Ore Ana Sofia , Schawkat Khoschy , Kennedy Kevin F. , Bullock Andrea J. , Critchlow Jonathan F. , Moser James 
Published: February 2020

303 Background: Phase III trials demonstrate improved short-term outcomes after laparoscopic gastrectomy for LAGC compared to open. We hypothesized that robotic D2 gastrectomy after NAC (NAC/RG) yields benefits across multiple outcome domains vs standard of care treatment for LAGC. Methods: Single institution, interrupted time series comparing SOC plus open gastrectomy (OG,2008-2013) for LAGC (T2-4Nany/TanyN+) vs universal neoadjuvant plus RG (2013-2018). Treatment burden was a composite of adverse events affecting: efficiency (postoperative length of stay, reoperation or 90 d readmission), oncology (positive margins, < 16 resected nodes), cumulative major morbidity (90 d comprehensive complication index) and pain (narcotic consumption). Predictors were evaluated via multivariate modeling, and 2-year overall survival was estimated by Kaplan-Meier/log-rank tests. Results: After exclusions, 87 subjects underwent surgical resection (55 OG; 32 RG) with equivalent baseline characteristics: demographics, BMI, comorbidity (Charlson), tumor size, and clinical AJCC staging; male sex was more likely in RG (69% vs. 44%, p = 0.02). NAC administration increased from 35% in SOC/OG cohort to 100% in NAC/RG. All four domains of efficiency, oncologic efficacy, morbidity, and pain (narcotic use) improved. Treatment burden declined from 86% in OG to 56% after RG (p = 0.003). Multivariable modeling demonstrated OR 0.23 for treatment burden in RG compared to OG (95% CI 0.07-0.72, p = 0.012), whereas sex, extent of resection (total vs subtotal), tumor size, and T stage had no effect. These differences persisted in NAC subgroup (n = 51) comparisons between RG and OG treatment burden, as well as pathologic T stage, tumor size, and AJCC stage. No detriment in 2-year overall survival was observed after adoption of NAC/RG (80% RG vs. SOC 60%, p = 0.048). Conclusions: After NAC, robot-assisted D2 gastrectomy was associated with decreased treatment burden relative to OG. Frequencies of unfavorable hospitalization, adverse oncological outcomes, major morbidity, and narcotic consumption all improved after RG in this interrupted time series. Prospective trials are needed.