bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preoperative muscle strength as a predictor of complications after esophagectomy.
Authors: Colcord Madison , Watson Michael D , Gower Nicole Lee , Benbow Jennifer H , Trufan Sally Jeanne , Hill Joshua , Salo Jonathan C. 
Published: February 2020

454 Background: Sarcopenia has been associated with post-operative complications and length of stay (LOS) in patients undergoing esophagectomy. A variety of methods exist to measure muscle mass and strength, with few comparisons between methods. We compared hand-grip strength (HGS), muscle mass and intramuscular adipose tissue as predictors of post-operative outcomes. Methods: Patients with esophageal cancer undergoing esophagectomy were identified between January 2015 – June 2019 at Levine Cancer Institute. Skeletal muscle index (SMI) and skeletal muscle density (SMD), a measure of intramuscular adipose tissue, were derived from CT. HGS was measured using a dynamometer. Uni- and multivariable GLM analyses were performed. Results: 115 patients (100 male, 15 female) underwent esophagectomy with an average age of 64.3 +/- 9.8. The analysis was stratified by sex due to significant differences in HGS, SMI, and SMD. Among men, univariable analysis revealed a significant association between pre-operative HGS <25 kg and increased risk of post-operative pneumonia ( p=0.02), ventilation >48hrs ( p=0.02), LOS ( p=0.002), discharge to home ( p=0.001), and one-year mortality ( p=0.005). All associations except discharge home remained significant in multivariable analyses (Table). Among women, no factors analyzed were significantly associated with postoperative outcomes. Conclusions: HGS is a more powerful predictor of postoperative complications and LOS than either muscle mass or intramuscular adipose tissue among men undergoing esophagectomy. HGS is cost-effective and easily incorporated into routine clinical care, allowing for preoperative intervention to optimize patients for esophagectomy. To better understand the implications in women, additional research with a larger cohort is needed. [Table: see text]
Effect of age on swallowing dysfunction after esophagectomy.
Authors: Mann Della , Raj Vishwa , Colcord Madison , Watson Michael D , Trufan Sally Jeanne , Benbow Jennifer H , Gower Nicole Lee , Hill Joshua , Salo Jonathan C. 
Published: February 2020

455 Background: Patients undergoing esophagectomy frequently experience malnutrition, which in combination with the catabolic effects of surgery can result in loss of muscle mass and function. Safe swallowing requires the preservation of muscle mass. Modified barium swallow (MBS) enables assessment of postoperative swallowing impairments. We assessed the incidence and risk factors of swallowing dysfunction post-esophagectomy. Methods: Patients with a MBS post-esophagectomy were identified between January 2015-June 2019 at Levine Cancer Institute at Carolinas Medical Center. Swallowing was evaluated with the Penetration Aspiration Scale. Muscle loss was evaluated with pre-operative hand-grip strength (HGS) and skeletal muscle index (SMI) and skeletal muscle density (SMD) from axial CT images. Uni- and multivariable GLM analyses were performed. Results: 91 patients (79 men, 12 women) underwent esophagectomy with an average age of 64.0 + 10.1. Pre-operative HGS, SMI, and SMD all decreased with age. Significant differences existed between sexes in HGS, SMI, and SMD, so the cohort was stratified by sex for analysis. Univariate analysis of male patients revealed older age, lower body mass index (BMI), smoking history, prior feeding tube, and lower pre-operative HGS and SMI were associated with aspiration or penetration on MBS. Among women, no factors analyzed were significantly associated with swallowing dysfunction. Conclusions: Swallowing dysfunction after esophagectomy is correlated with increased age and lower BMI. The role of muscle loss in the risk of aspiration after esophagectomy is not clear. Further research is needed to determine the relationship between these factors with the goal of enabling preoperative physiologic optimization and patient selection. [Table: see text]
A prediction model for pathological findings after neoadjuvant chemoradiotherapy for resectable locally advanced esophageal cancer based on PET images using radiomics and machine-learning.
Authors: Murakami Yuji , Nagata Yasushi , Kawahara Daisuke 
Published: February 2020

456 Background: The pathologic complete response (PCR) rate by neoadjuvant chemoradiotherapy (NCRT) for resectable locally advanced esophageal squamous cell carcinoma (ESCC) is about 40%. If we could predict a PCR from pre-treatment image data, it might be possible to select patients who can be cured by organ-preserving CRT. The purpose of this study is to construct a predictive model for PCR by NCRT in patients with locally advanced ESCC using radiomics and machine-learning. Methods: We used data of 98 ESCC patients who underwent NCRT and surgery from 2003 to 2016. Firstly, we fused the radiotherapy treatment planning CT images and PET images scanned before treatment. Then using target delineations on planning CT images, we created eight kinds of target regions on PET images. Secondly, we generated a total of 6968 features per patient using the PET image data within these target regions that were preprocessed by radiomics technique. Among them, we extracted the optimal features for machine-learning using the least absolute shrinkage and selection operator (LASSO) logistic regression. Thirdly, artificial neural networks were used as a machine-learning method to create a predictive model. The extracted radiomics features were used as input values, and the information of ‘PCR’ or ‘not PCR’ was used as output values. We used data of randomly selected 58 patients for training and constructed a predictive model. Then we used data of 15 patients to validate the models and created the optimal model. Finally, we evaluated the predictive model using the test data of 25 patients. Results: By the LASSO analysis, 32 radiomics features were extracted for machine-learning classification. This predictive model predicted pathological findings after NCRT in 24 of 25 test data. The accuracy, specificity and sensitivity in the prediction of PCR after NCRT by this predictive model were 96.0%, 93.8%, and 100%, respectively. Conclusions: A prediction model based on PET images using radiomics and machine-learning could predict pathological findings after NCRT for resectable locally advanced ESCC.
Effect of baseline medications on response to immunotherapy in hepatocellular carcinoma.
Authors: Jun Tomi , Dharmapuri Sirish , Marron Thomas Urban , Sung Max W. , Ang Celina 
Published: February 2020

484 Background: Immunotherapy (IO) response rates in advanced hepatocellular carcinoma (HCC) are less than 20%. The microbiome has been shown to mediate IO response in experimental models, and clinical studies have observed that antibiotics, especially prior to IO initiation, are associated with reduced IO response. We reasoned that commonly prescribed antacid medications, such as proton pump inhibitors (PPIs) and histamine receptor antagonists (H2RAs), which are known to influence the microbiome, may also influence IO response. Methods: This is a retrospective chart review-based study of 95 patients with advanced HCC treated with IO at a single academic medical center. The primary outcome was overall survival (OS). The secondary outcome was overall response rate (ORR). The primary predictors were antibiotic or antacid exposure in the 60 days prior to IO. A secondary predictor was antibiotic or antacid exposure in the 30 days prior to IO. Results: The cohort was predominantly male (84%), was racially diverse (31% White, 23% Black, 23% Asian, 13% Hispanic), and had a median age of 65 years. There were 49 deaths with a median follow up of 0.96 years. The most common underlying liver diseases were HCV (49%), HBV (31%), and NASH (11%). The majority of patients had cirrhosis (80%), with a median Child Pugh score of 6. Within 60 days before IO, 25 patients received antibiotics, 40 received PPIs and 5 received H2RAs. Most patients receiving antibiotics also received a PPI (92%). The median duration of antibiotics was 5 days. Neither antibiotic nor antacid exposure within 60 or 30 days prior to IO was significantly correlated with OS in univariate or multivariate analyses, nor were they correlated with ORR. Conclusions: No significant associations between baseline exposure to antibiotics and antibiotics and OS or ORR were identified in this single-institution study. Larger observational studies or mechanistic studies are needed to clarify interactions between medications, the microbiome, and IO response. [Table: see text]
IGF-1 Child-Turcotte-Pugh score as a predictor of overall survival to therapy in CTP-A, BCLC stage C patients with advanced hepatocellular carcinoma.
Authors: Abugabal Yehia I. , Qayyum Aliya , Hassan Manal , Xiao Lianchun , Duda Dan G. , Hatia Rikita , Lee Sunyoung S. , Wolff Robert A. , Pestana Roberto , Morris Jeffrey , Yao James C. , Amin Hesham M. , Kaseb Ahmed Omar 
Published: February 2020

488 Background: Child-Turcotte-Pugh (CTP) A is the standard population for active HCC therapy. The IGF-CTP score, comprises levels of type 1 insulin-like growth factor (IGF-1), bilirubin, INR, and albumin, significantly improved the prediction of overall survival (OS) in recently published studies. Our current study aimed to investigate the accuracy of the IGF-CTP score in predicting OS in HCC Child-Pugh A patients (pts) treated with local and/or systemic therapies (tx). The overall hypothesis is that the IGF-CTP score can further distinguish CP-A pts in terms of overall survival, PFS. Methods: Between 2014 and 2018, a total of 274 pts with new advanced HCC BCLC stage who had available baseline plasma IGF-1 level were retrospectively enrolled. Clinicopathologic features and treatment history were collected. We calculated IGF-CTP scores, used Kaplan-Meier method and log rank test to estimate and compare time to event outcomes between subgroups of patients. Results: 198 pts were CTP Class A, 209 patient underwent systemic tx, 65 underwent local tx [see table]; 161 were re-classified as IGF-CTP-A with a median OS of 16.09 months (95% CI = 13.06 to 23.29 months) (p <0.0001), whereas 37 patients were reclassified as intermediate risk (IGF-CTP-B) and had significantly shorter OS of 10.66 months (95% CI = 5.49 to 26.51) (p <0.0001). Conclusions: The results of this study support our biologically-driven hypothesis that IGF-CTP score is predictive of overall survival to therapy in advanced HCC treated with local and/or systemic therapy. Among HCC pts with CTP-A class, some are reclassified as IGF-CP-B/C and were found to have significantly poorer prognosis in terms of shorter OS. Future validation of the predictive ability of our IGF-1 score may lead to adopting it as a stratification tool in clinical trials as well as to predict HCC outcome and guide therapy decision in routine practice. [Table: see text]
Impact of population center (PC) size on access to care in advanced hepatocellular carcinoma (HCC).
Authors: Yu Irene S. , Liu Shiru Lucy , Zaborska Valeriya O. , Raycraft Tyler , Davies Janine Marie 
Published: February 2020

489 Background: To evaluate access to subspecialists, local therapies, treatment at a specialized HCC center, and survival in advanced HCC patients (pts) based on geographical distribution. Methods: Retrospective chart review was performed on HCC pts who received sorafenib in British Columbia from 2008 to 2016. Pts were stratified by Statistics Canada PC size criteria: large urban PC (LUPC), medium urban PC (MUPC), and small urban PC (SUPC). Chi-square tests and Kaplan Meier were used to analyze the groups. Results: Of 288 pts, geographical distribution was: LUPC 75%, MUPC 16%, SUPC 8%, and rural 0.3%. Age, gender, and ECOG performance status were similar; a higher proportion of Asians (50 vs 9 vs 4%), Child Pugh A (93 vs 83 vs 83%), and hepatitis B (37 vs 15 vs 4%) was observed in LUPC vs MUPC and SUPC, respectively. SUPC pts were less likely to see a hepatologist (p=0.04, Table); access to other subspecialists was similar. Pts from LUPC were more likely to have transarterial chemoembolization compared to MUPC and SUPC (38 vs 20 vs 21%; p=0.04); receipt of other local therapies was similar. Sixty percent were treated at a specialized HCC center and were more likely to see a hepatologist (83 vs 19%), hepatobiliary surgeon (57 vs 42%), and/or interventional radiologist (32 vs 13%) (all p<0.01). Median OS was higher for pts treated at a HCC center (24.7 vs 13.2 mo, p<0.01), but similar when stratified by PC size (overall mOS 19.3 mo, p=0.59). Conclusions: Geography did not significantly impact access to care or survival, but pts treated at a specialized HCC center have improved survival. Further research is needed to better understand social and clinical factors that influence these findings. [Table: see text]
Efficacy and safety of lenvatinib (LEN) in Korean patients (pts) with advanced hepatocellular carcinoma (aHCC): Multicenter retrospective analysis.
Authors: Cheon Jaekyung , Yoo Changhoon , Bang Yeonghak , Chon Hong Jae , Ryoo Baek-Yeol 
Published: February 2020

490 Background: LEN has demonstrated the efficacy and safety in pts with aHCC as first-line treatment in the pivotal REFLECT trial. Further evaluation in real-world setting is necessary to measure the clinical outcomes of LEN in daily practice. Methods: This is a multicenter retrospective analysis from 3 Korean referral cancer institutions. Between September 2018 and August 2019, a total of 74 pts received LEN for the management of BCLC B or C aHCC, and 66 pts who had at least one follow-up visit after the start of LEN were included in this analysis. Results: Median age was 58 years (range, 19-81), and 46 pts (69.7%) were male. Baseline characteristics were as follows; Child-Pugh class A/B/C in 46 (69.7%)/14 (21.2%)/6 (9.1%), BCLC B/C/D in 1 (1.5%)/63 (95.5%)/2 (3.0%), prior systemic therapy in 25 (37.9%) including 14 (21.2%) with prior immune checkpoint inhibitors (ICIs). LEN was used as first/second/third to fourth lines of therapy in 41 (62.1%)/13 (19.7%)/12 (18.2%) pts, and 27 (40.9%) had extensive disease extent excluded in the REFLECT trial. With a median follow-up duration of 4.8 months (95% CI, 3.4–6.1), the median PFS and OS were 4.6 (95% CI, 3.2-6.0) and 7.5 months (mo) (95% CI, 3.7–11.2), respectively, in overall pts: first-line setting, 4.2 (95% CI, 3.2-5.2) and 6.5 mo (95% CI, 5.0-8.1), respectively; ≥ second-line setting, 6.1 mo (95% CI, 3.6–8.5) and not reached, respectively. In pts with prior ICIs, median PFS was 6.1 mo (95% CI, 1.8-8.4) and median OS was not reached. According to the RECIST v 1.1, response rates and disease control rate were 12.1% and 71.2%, respectively, in overall pts. The most common grade 3-4 toxicities were hyperbilirubinemia (n=9, 13.6%), AST elevation (n=5, 7.6%), diarrhea (n=4, 6.1%) and fatigue (n=4, 6.1%). Conclusions: LEN was effective and well tolerated in pts with aHCC in Korean real-life setting.
The impact of skeletal muscle loss for hepatocellular carcinoma treated with lenvatinib.
Authors: Okada Mao , Nakanishi Hiroyuki , Kurosaki Masayuki , Inada Kento , Kirino Sakura , Yamashita Koji , Sekiguchi Shuhei , Hayakawa Yuka , Osawa Leona , Wang Wan , Higuchi Mayu , Takaura Kenta , Maeyashiki Chiaki , Kaneko Shun , Tamaki Nobuharu , Yasui Yutaka , Tsuchiya Kaoru , Itakura Jun , Takahashi Yuka , Izumi Namiki 
Published: February 2020

493 Background: Many previous reports have shown that skeletal muscle loss (SML) is one of the prognostic factors for hepatocellular carcinoma (HCC) patients treated with sorafenib. However, there are few reports about the impact of SML for the HCC patients treated with lenvatinib. Therefore, we evaluated the relation between SML and overall survival (OS) of HCC patients treated with lenvatinib (LEN). Methods: We retrospectively analyzed 50 HCC patients treated with LEN from April 2018 to February 2019. We included 36 patients who continued LEN more than 8 weeks and evaluated CT scans before treatment and after 8 weeks. Skeletal muscle area was measured on axial image at the level of the third lumber vertebra (L3) using sliceOmatic. Skeletal Mass Index (SMI) was calculated by dividing the muscle area (㎠) with square of height (㎡). The definition of myopenia is based on the guideline described by the Japan Society of Hepatology (42㎠/㎡ in men and 38 ㎠/㎡ in women). ΔSMI is a chronological change of SMI for 8 weeks. We calculated decreasing rate of ΔSMI. We evaluated the relation between chronological change of SMI and OS. Results: The patients with myopenia at baseline were 12 (33.3 %). The decreasing rate of ΔSMI at 8 weeks was -2.57 % [-5.9, 0.2]. SMI had decreased in 27 patients (75 %) for 8 weeks. There was no significant difference between OS and baseline myopenia (p = 0.2), ALBI grade (p = 0.2), BCLC stage (p = 0.5), up to 7 in or out (p = 0.35), previous TKI treatment (p = 0.15), metastasis (p = 0.91), or vascular invasion (p = 0.12). However, the patients who had decreased SMI had significantly poor prognosis (p = 0.028). In backgrounds, there was no significant difference between patients with or without decreasing of ΔSMI, such as baseline myopenia (p = 0.7), ALBI grade (p = 0.4), BCLC stage (p = 1.0), Child Pugh score (p = 0.8), age (p = 0.6), sex (p = 0.3), up to7 in or out (p = 1.0), previous TKI treatment (p = 0.3), and relative dose intensity at 4 weeks (p = 0.9). Conclusions: There was no significant correlation between baseline myopenia and OS. However, chronological decreasing of SMI for 8 weeks was a prognostic factor of HCC patients treated with LEN. Therefore, monitoring and preventing of decreasing of skeletal muscle mass may be important.
Clinical outcome associated with neoadjuvant chemoradiation and orthotopic liver transplantation versus definitive chemoradiation in 49 patients with unresectable, hilar, or extrahepatic cholangiocarcinoma.
Authors: Laughlin Brady S. , Petersen Molly M. , Ashman Jonathan Ben , Rule William G. , Borad Mitesh J. , Aqel Bashar A. , Sonbol Mohamad Bassam , Bekaii-Saab Tanios S. , Ahn Daniel H. , Yu Nathan Y. , DeWees Todd , Sio Terence Tai Weng 
Published: February 2020

494 Background: Our aim was to compare survival between patients receiving neoadjuvant chemoradiation and orthotopic liver transplantation (OLT group) versus definitive chemoradiation (CRT group) for extrahepatic or hilar cholangiocarcinoma. Methods: 49 patients (20 in OLT group vs. 29 in CRT group) with unresectable hilar/extrahepatic cholangiocarcinoma were treated at Mayo Clinic Arizona between Feb. 1998–Sep. 2019. Treatment included external beam radiation therapy (median 4500cGy) and boost (median 900cGy) with either continuous 5-flurouracil (dose range 180–225 mg/m2) or capecitabine (dose range 825–1000 mg/m2 BID) prior to or without OLT. Radiation boosts were delivered with EBRT or bile duct brachytherapy. Patients were between 27.9–84.3 years (median 64.3) at diagnosis. 18 patients had previous diagnosis of PSC. Results: Between Feb. 1998–Sep. 2019, 31(63%) of 49 patients died by the end of follow-up. Of patients treated with neoadjuvant therapy and OLT, 7(35%) of 20 patients died. 24(86%) of 28 patients treated with definitive therapy died. The OLT cohort were younger (mean age 56.5 vs. 69.0 years), more likely to have PSC and UC (65% vs. 17%), and had a lower CA 19-9 (median 43 vs. 535)(P < 0.003). From the end date of radiation, median overall survival was 76.8 months vs. 15.6 months for the OLT and CRT groups, respectively. Survival rates at 3 and 5 years were 78% and 69% in the OLT group compared to 19% and 6% in the CRT group (HR 7.73; 3.04-19.65:(P < 0.0001)). Progression-free survival (89% vs. 30% at 3 years), and distant metastasis-free survival (88% vs. 66% at 3 years) favored OLT versus CRT alone (HR 5.74;1.12-29.34:(P < 0.02)). Univariate analysis demonstrated that the method of treatment (OLT vs. CRT) was the only variable associated with better clinical outcomes. Conclusions: In patients with unresectable extrahepatic/hilar cholangiocarcinoma, survival was higher in those who underwent chemoradiation and OLT. Patients who received definitive chemoradiation in the absence of OLT were expected to have worse overall, progression-free, and metastasis-free survival.
Variations in surgical treatment of stage I gallbladder carcinoma impacts survival.
Authors: Scholer Anthony Joseph , Garland-Kledzik Mary , Wang Mansen , Khader Adam , Santamaria-Barria Juan , Jutric Zeljka , Wolf Ronald , Goldfarb Melanie 
Published: February 2020

495 Background: Variations in surgical care for stage I gallbladder carcinoma (GBC) may be associated with inferior outcomes. The aim of this study was to identify the variations in surgical treatment of GBC. Methods: All patients diagnosed with stage I GBC by AJCC 8 criteria from 2004-2013 were identified in the NCDB. Surgical treatment was categorized as cholecystectomy (C), cholecystectomy with lymph node dissection (C+LND), or radical cholecystectomy (RC). Independent predictors of improved overall survival (OS) and extent of surgery were identified by multinomial regression analyses. Results: Of 1756 patients with stage I GBC, 26% were T1a, 56% T1b, and 18.5% T1NOS. The majority were White non-Hispanic (61.8%) and female (68.5%), with 55.1% > 70 years of age. Two-thirds of T1a tumors were treated with more aggressive surgery (28% C+LND, 4.2% RC), which did not differ by age. However, only 44.4% of patients with T1b tumors had more aggressive surgery, which was significantly less likely in patients > 70 years, even after controlling for other factors (C+LND (OR:0.60; CI:0.44-0.81), RC (OR:0.52; CI:0.29-0.91)). Five-year OS was 54.34% for T1a and 43.05% for T1b (p = 0.02). After controlling for other factors, both C+LND (HR:0.46, CI:0.26-0.81) and RC (HR:0.31, CI:0.16-0.62) significantly improved 5-year OS for T1b tumors, whereas RC also improved 5-year OS for all patients > 70 years old (p = 0.04). Conclusions: A majority of patients with T1b GBC had less than adequate surgery by the current AJCC staging, which significantly decreased survival in all patients. This was especially evident in older patients who were also the least likely to receive more aggressive surgery.