bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pathological examination of CT findings of tumor infiltration to the periarterial plexus in pancreatic cancer.
Authors: Miyamoto Takashi , Yamamoto Yusuke , Sugiura Teiichi , Okamura Yukiyasu , Ito Takaaki , Ashida Ryo , Ohgi Katsuhisa , Uesaka Katsuhiko 
Published: February 2020

644 Background: The radiographic diagnosis of tumor infiltration into the periarterial plexus in pancreatic cancer is important because it is related to the classification, however, it is difficult to distinguish the abnormal shadow along the artery caused by inflammation or cancer infiltration. The aim of this study is to investigate CT values of the abnormal shadow along artery could distinguish between inflammation and tumor invasion. Methods: Study 1: Of 26 patients who underwent DP-CAR between 2009 and 2018, we analyzed 19 patients who had dynamic CT and obtained sagittal slice taken 120 seconds after injection with less than 2.5 mm slice thickness. At first, we measured CT values at upper and lower point of CeA and CHA each sagittal slice using CT. Next, we evaluated tumor invasion at the upper and lower plexus of CeA and CHA in each section of the pathological specimen, and evaluated the relationship between the tumor invasion and the CT value. Study 2: Using these 19 patients and 40 patients who underwent DP for PDAC between 2010 and 2014, we analyzed the relation between CT value and long-term states. Results: Study 1: CT value was totally measured at the 606 points using 19 patients who underwent DP-CAR. At the 490 points, we did not observe cancer infiltration and fibrosis. At the 70 points, we observed fibrosis without cancer cells. At the 46 points, we observed cancer infiltration. CT value was significantly higher in the tumor infiltration group than that in the without cancer infiltration and fibrosis group (P < 0.01). Study 2: The best cut-off of CT value of the presence of cancer infiltration was 44.9 HU using ROC curve (AUC = 0.861). The median survival time of patients who had the points of CT value > 44.9 HU around arteries was significantly shorter than that of patients who did not have the points of CT value > 44.9 HU (2.17 vs. 4.55 years, p = 0.03). Conclusions: The CT value around the arteries was significantly higher in the points of pathological tumor infiltration than that in the points of fibrosis without cancer cells. The best cut-off CT value of the presence of cancer infiltration around arteries was 44.9 HU, and the presence of the point of CT value > 44.9 HU around arteries was associated with poor survival.
Efficacy of chemotherapy for patients with unresectable or recurrent pancreatic adenosquamous carcinoma: A multicenter retrospective analysis.
Authors: Yoshida Yukio , Fukutomi Akira , Ueno Makoto , Mori Keita , Watanabe Kazuo , Ohba Akihiro , Kobayashi Satoshi , Furuta Mitsuhiro , Tsujimoto Akiko , Osaka Masato , Okano Naohiro , Yane Kei , Umemoto Kumiko , Kawamoto Yasuyuki , Terashima Takeshi , Tsumura Hidetaka , Doi Keitaro , Shioji Kazuhiko , Asagi Akinori , Furuse Junji 
Published: February 2020

647 Background: Pancreatic adenosquamous carcinoma (PASC) is a rare variant of pancreatic ductal adenocarcinoma (PDAC). Although unresectable or recurrent PASC is usually treated by systemic chemotherapy, there are few reports which show the efficacy of chemotherapy. The aim of this study was to evaluate the efficacy of chemotherapy for patients (pts) with unresectable or recurrent PASC. Methods: We collected data retrospectively from 24 Japanese institutions. The selection criteria were as follows: 1) histologically or cytologically proven PASC (non-surgical specimens were eligible if squamous cell carcinoma (SCC) was detected), 2) unresectable or recurrent disease treated with 1st line chemotherapy between April 2001 and December 2017. Results: This study included 138 pts with median age of 66 years (range: 36-85). About 60% of pts were diagnosed with biopsy and only SCC was detected in 13.0% of pts. Median overall survival (mOS) was 6.7 months (M), median progression free survival (mPFS) was 2.8 M, and the 1-year survival rate (1YSR) was 26.7%. For the 102 metastatic or distal recurrent pts with PS of 0-1, patient characteristics were as follows: ≥76 years old, 9 (8.8%); PS of 0, 39 (38.2%); number of metastatic sites ≥2, 25 (24.5%). The treatment efficacies (The objective response rates(%)/mPFS(M)/mOS(M)/1YSR(%)) of the 5 major regimens were Gemcitabine(GEM) (n=45, 4.4%/2.2M/4.8M/28.1%), GEM+nab-PTX (n=24, 29.2%/2.9M/7.6M/23.1%), GEM+S-1 (n=9, 11.1%/5.1M/9.9M/25.4%), FOLFIRINOX (n=7, 14.3%/2.5M/7.5M/14.3%), and S-1 (n=7; 28.6%/2.6M/5.0M/28.6%), respectively. One patient with liver metastasis underwent conversion surgery after GEM+nab-PTX and achieved long survival. CRP ≥3.0mg/dl, CA19-9 ≥1000 U/ml, residual primary site, and monotherapy had a significant correlation with poor survival in multivariate analysis. Conclusions: Although combination chemotherapy regimens such as FOLFIRINOX and GEM+nab-PTX are now available, the prognosis of metastatic PASC remains poor. Development of more effective treatment options is required.
Scoring model with serum albumin and CA19-9 in advanced pancreatic cancer in second-line treatment: Results from the NAPOLEON study.
Authors: Komori Azusa , Otsu Satoshi , Shimokawa Mototsugu , Otsuka Taiga , Koga Futa , Ueda Yujiro , Nakazawa Junichi , Arima Shiho , Fukahori Masaru , Okabe Yoshinobu , Makiyama Akitaka , Taguchi Hiroki , Honda Takuya , Shibuki Taro , Nio Kenta , Ide Yasushi , Ureshino Norio , Shirakawa Tsuyoshi , Mitsugi Kenji 
Published: February 2020

649 Background: Patients with metastatic pancreatic cancer refractory to first-line chemotherapy (CTx) have limited treatment options. Moreover, it is unclear what kind of patients could be brought about survival benefit by 2nd-line CTx after refractory to gemcitabine+ nab-PTX (GnP) or FOLFIRINOX. Methods: This analysis was performed as part of a multicenter retrospective study of GnP or FOLFIRINOX in patients with unresectable pancreatic cancer (NAPOLEON study) conducted by 14 centers in Japan. From December 2013 to March 2017, 255 patients with advanced or recurrent pancreatic cancer received GnP or FOLFIRINOX as 1st-line CTx. Excluding censored cases in first-line treatment, 156 and 77 patientsreceived 2nd-line CTx and best supportive care (BSC), respectively. Variables at the refractory or intolerant to the 1st-line treatment were used to investigate correlation with prognosis by Cox regression model. Then, we made scoring system using the prognostic factors to reveal the benefit of 2nd-line CTx. Results: Median post-progression survivals (PPSs) were 5.2 months in 2nd-line CTx group and 2.7 months in BSC group, respectively (hazard ratio [HR]; 0.42, 95% confidence interval [CI]; 0.31-0.57, p<0.01). According to the Cox regression model, serum Alb level of less than 3.5 g/dL (HR; 1.98, 95% CI; 1.33–2.96, p<0.01) and CA19-9 level of greater than 1,000 U/mL (HR; 1.87, 95% CI; 1.25–2.80, p<0.01) were independent predictive factors. The scoring system for PPS was designed using these factors, which was obtained by summing up serum Alb (≥ and < 3.5 g/dL allocated to scores 0 and 1) and CA19-9 (< and ≥ 1,000 U/mL allocated to scores 0 and 1) at disease progression in patients with 2nd-line CTx group. Patients with score 0 and 1 displayed significantly favorable PPSs in comparison with BSC group; however, there was no significant difference in PPS between patients with score 2 and BSC group (Table). Conclusions: Survival benefit of 2nd-line CTx was observed in patients with the score 0 and 1, but not in the score 2. [Table: see text]
Prognostic factors associated with short-term survival (STS) in advanced pancreatic cancer (APC): A multicenter analysis from the CHORD consortium.
Authors: Mehta Sakshi , Cardoso Miguel , Kim Christina , Armstrong Dawn Elizabeth , Ramjeesingh Ravi , Renouf Daniel John , Ahmed Shahid , Ko Yoo-Joung , Harb Mohammed , Kong Shiying , Cheung Winson Y. , Meyers Brandon M. 
Published: February 2020

650 Background: The survival of patients (pts) with APC (locally advanced/metastatic) is slowly improving; however, in some pts it remains extremely short. Few studies have evaluated the clinical, pathologic and treatment characteristics associated with STS in APC. Methods: Pts with APC (between 2011-2017) were included in the analysis. Descriptive analyses were conducted for demographic, tumor and treatment characteristics between pts who survived ≤ and > 90 days using Wilcoxon rank-sum test and Chi-square test for continuous and categorical variables respectively. Multivariable logistic regression was performed to identify association between pts’ characteristics and STS. Results: A total of 580 pts were included in the analysis: median age 68, 53% male, 92% metastatic and 53% ECOG 0/1. STS ≤90 days occurred in 152 pts (26.2%), with 65.1% not receiving any chemotherapy. Median overall survival for STS was 49 days vs. 276 for non-STS. At least 1 cycle of chemotherapy was administered to 358 pts; mean duration of first-line chemotherapy for pts with STS ≤90 was 1.5(SD 2.5) cycles (N=53), compared to 7.6(SD 11.1) cycles (N=305) for pts surviving > 90 days. Prognostic factors associated with STS <90 days were neutrophil:lymphocyte ratio, LDH, metastatic disease, ECOG and not receiving chemotherapy (Table). Other clinical factors (BMI, smoking history, diabetes) and laboratory values (platelet, baseline CA19-9, estimated GFR) were not prognostic. Conclusions: In a multicenter database of Canadian academic centers, <2/3 of pts received at least 1 cycle of chemotherapy. Prognostic factors associated with STS include routine laboratory values, not receiving chemotherapy, ECOG and the presence of metastatic disease. Further evaluation of factors related to not receiving chemotherapy, and why chemotherapy is discontinued could improve the outcomes of pts with STS. [Table: see text]
Clinical outcomes of FOLFIRINOX and gemcitabine-nab-paclitaxel for metastatic pancreatic cancer in the real-world setting.
Authors: Franco Fabio , Martin Valades Jose Ignacio , Marrupe David , Camara Juan Carlos , Gutierrez Abad David , Lopez-Alfonso Ana , Martinez-Amores Brezo , Leon Ana , Perez Mar , Juez Ignacio , Hurtado Alicia , Ruiz-Casado Ana 
Published: February 2020

656 Background: Randomized clinical trials have established new chemotherapeutic standards of care for metastatic pancreatic cancer, namely FOLFIRINOX (FFX) and gemcitabine + nab-paclitaxel (GNP) after demonstrating a significant and relevant increase of overall survival. However, there are some important uncertainties regarding how many patients are candidate to each of the two new regimens in the real life and how is the pattern of use in the elderly population. Methods: This is a retrospective study. Departments of Pharmacy of 7 Spanish hospitals generated the listings of patients (pts) treated in first line with these new regimens (FFX or GNP). Non-metastatic patients were excluded. An exploratory analysis was performed in the elderly population. Results: From Jan 2012 to Dec 2017, a total of 119 pts (M/F 58/42 %) were treated. Med age 63 y (38-83 y), 99% adenocarcinoma. 40% located in the head of pancreas. ECOG 87% 0-1. 89% had liver mets. In the 1st line 49.6% were treated with FFX and 50.4% with GNP. 53% of the pts could receive a 2nd line (82% after FFX 75% after GNP). The median OS was 12 months with no statistically significant differences between both regimens (12,7m for FFX vs 10,2 m for GNP). Elevated Ca 19.9 levels and Neutrophil-Lymphocyte ratio (NLR) increased the risk of death. Patients who received both regimens in first/second line had a median OS longer than 15 months whichever the sequence. 32 patients (27%) were older than 70 yo. 13 (41%) were treated with FFX and 19 (59%) with GNP. The median OS for patients older than 70 was 9.5m versus 12.3m for patients younger than 70. Conclusions: In our setting the use of FFX and GNP for treating metastatic pancreatic cancer is quite similar. Superiority could not be demonstrated for any of the schemes in first-line. Overall survival was determined by basal Ca 19.9 and NLR. Patients receiving both regimens (FFX or GNP) in first/second line whichever the sequence, exhibited the best survival rates. In our series elderly patients had poor survival rates.
Efficacy of second-line chemotherapy after standard combination chemotherapy in patients with metastatic pancreatic cancer: The results from the NAPOLEON study.
Authors: Fukahori Masaru , Okabe Yoshinobu , Shimokawa Mototsugu , Otsuka Taiga , Koga Futa , Ueda Yujiro , Nakazawa Junichi , Komori Azusa , Arima Shiho , Makiyama Akitaka , Taguchi Hiroki , Honda Takuya , Ushijima Tomoyuki , Miwa Keisuke , Shibuki Taro , Nio Kenta , Ide Yasushi , Ureshino Norio , Mitsugi Kenji , Shirakawa Tsuyoshi 
Published: February 2020

661 Background: Gemcitabine plus nab-paclitaxel (GnP) and FOLFIRINOX (FFX) have been established as standard first-line combination chemotherapy (CTx) for patients with metastatic pancreatic cancer (MPC). However, the efficacy of second-line CTx and the significance of combination CTx in clinical practice are unclear. We therefore investigated the efficacy of second-line CTx in patients with MPC. Methods: Data were collected from CTx-naive MPC patients treated with first-line combination CTx at 14 hospitals in the Kyushu area of Japan from December 2013 to June 2018. The median overall survival (mOS) from second-line treatment was compared between patients who received second-line CTx (CT group) and those who received best supportive care (BSC group). Furthermore, in the CT group, the mOS was compared between the patients who received combination CTx and those who received mono-CTx. To control potential bias in the selection of second-line treatment, we also conducted a propensity score-adjusted analysis. Results: A total of 255 patients received GnP or FFX as first-line CTx. Of these, there were 156 (61%) in the CT group and 77 (30%) in the BSC group. The number of patients who received FFX/GnP as first-line CTx was 79 (51%)/77 (49%) in the CT group and 15 (20%)/62 (80%) in the BSC group, respectively (P < 0.01). The mOS in the CT group was significantly longer than that in the BSC group (5.2 vs. 2.7 months; hazard ratio [HR] 0.42; 95% confidence interval [CI] 0.31-0.57; p < 0.01 and 5.2 vs. 2.6 months; adjusted HR 0.39; 95% CI 0.28-0.55; p < 0.01). In the CT group, 89 (57%) patients received combination CTx, and 67 (43%) received mono-CTx. There was no significant difference in the mOS between the combination CTx and mono-CTx patients (5.5 vs. 4.4 months; HR 0.88; 95% CI 0.62-1.26; p = 0.88 and 5.6 vs. 4.4 months; adjusted HR 0.85; 95% CI 0.56-1.30; p = 0.47). Conclusions: Among patients with MPC receiving second-line treatment, the CT group had a significantly longer mOS than the BSC group, but combination CTx conferred no improvement in the survival duration compared with mono-CTx.
A real-world evidence analysis of periampullary cancers in an academic hospital in Chile.
Authors: Villanueva Luis , Navarrete Gonzalo , Gallegos Ivan , Castillo Valentina , Dodds Francisco , Gonzalez Jaime , Barajas Olga , Vasquez Rodrigo , Nuñez Barbara , Ahumada Monica 
Published: February 2020

663 Background: Periampullary cancers can originate in the pancreas, duodenum, bile duct or structures of the ampullary complex. The treatment of choice in early stages is pancreatoduodenectomy. The management post-surgery can depend on the histology pattern, and the overall survival can vary in different subgroups. Methods: A retrospective cohort study. We examined patients (pts) with invasive periampullary cancer undergoing pancreatoduodenectomy at the Hospital Clinico Universidad de Chile between 2002 to 2018. We analyzed epidemiological, clinical, surgical, and histological data. OS and the hazard ratio (HR) were established by GraphPad Prism 8.0. Results: Thirty-seven cases were registered. Twenty-two (59%) pts were men. The mean age was 62.5 (43-83 years). The histological subtypes were: 15 pts (40.5%) intestinal group (IN), 20 pts (54%) pancreatobiliary group (PB), 1 pt (2.7%) mixed and 1 pt (2.7%) signet ring cell type. A full concordance between histology and immunohistochemistry (CK20, CK7, CDX2, MUC1, and MUC2) patterns was 66% of the PB group, and 0% of the IN group. The stage IB was most frequent in all of the group (36,4%). The most frequent stages were IB (66,6%) in the IN type and IIIA (46%) in the PB type. The level of Ca19-9 was higher the PB group than IN group (629.7 versus 41.5 U/ml, respectively). Seven pts received postoperative adjuvant treatment such as FOLFOX, capecitabine, and gemcitabine. The median OS was 133,5 months (mo) in the intestinal group and 32,6 mo in PB group (P-value = 0.021). The HR was 0.38 (95% CI of ratio 0.1332 to 1.084). The 5-year OS was 75,2% and 45,7% in the IN and PB group, respectively. Conclusions: Periampullary cancer remains very challenging because it is a rare malignancy and present diverse histological pattern. These factors influence the behavior and OS of the disease. Our results showed clinically and statistically relevant differences in the staging, levels of Ca19-9, and OS of the IN and PB subtypes. Our patients received few post-operatory therapies such as chemotherapy; this factor could influence the OS in the high-risk group. According to our data, a personalized treatment by histological type should consider in this disease.
Long-term outcome after combined carbon-ion radiotherapy and chemotherapy for locally advanced pancreatic cancer.
Authors: Shinoto Makoto , Hirata Hidenari , Suefuji Hiroaki , Toyama Shingo , Ueda Minoru 
Published: February 2020

671 Background: Carbon-ion radiotherapy (C-ion RT) has the potential advantages in terms of improved dose localization and enhanced biological effectiveness compared to conventional radiotherapy or proton therapy. C-ion RT is expected to contribute to the prolongation of survival in patients with pancreatic ductal adenocarcinoma (PDAC). We started C-ion RT for pancreatic cancer at SAGA HIMAT since April 2014. The aim of this study is to evaluate the long-term clinical results of C-ion RT for locally advanced PDAC. Methods: From April 2014 to March 2018, 144 patients with pancreatic cancer were treated with definitive C-ion RT. 80 patients who were confirmed as unresectable locally advanced PDAC were included in this retrospective analysis. C-ion RT was performed with 55.2 Gy (RBE) at 12 fractions in 3 weeks. Overall survival (OS) and prognostic factors were analyzed. Toxicities were evaluated using the CTCAE ver. 5.0. Results: The median follow-up period for survivors was 38 (range 13-59) months from the initiation of C-ion RT. In all patients, planned C-ion RT was completed. Induction chemotherapy was performed in 64 patients (80%) and the median duration time was 3 (range 1-19) months. Seventy patients (86%) underwent concurrent chemotherapy with gemcitabine or S-1. 2y-, 3y-, and 4y-OS from C-ion RT were 47% (95%CI, 37-59%), 25% (95%CI,16-37%), and 18% (95%CI, 10-30%), respectively. 2y-, 3y-, and 4y-OS from initial treatment were 55% (95%CI, 45-66%), 33% (95%CI, 24-45%), and 20% (95%CI, 12-32%). Multivariate analysis showed that PS 1-2, CA19-9 ≥350, and the absence of concurrent chemotherapy were independent prognostic factors on OS. Only seven patients (9%) experienced grade 3 toxicities that were gastrointestinal ulcer/bleeding (n = 4), anorexia (n = 1), leukopenia (n = 1), and neutropenia (n = 1). There was no grade 4 or 5 toxicity. Conclusions: C-ion RT for locally advanced PDAC was effective and well-tolerated.
Over-detection of colonic abnormalities on CTAP and a decrease with experience: A simulation of machine learning.
Authors: Chang John , Brooks Ryan , Gibson Zachary , Koo∗∗ Phillip , Dragovich Tomislav , Kundranda Madappa N. 
Published: February 2020

68 Background: Artificial intelligence (AI) can potentially improve patient care by assisting physicians as demonstrated with the recent approvals for technologies that detect intracranial hemorrhage on CT exams of the head. AI also has potential for assisting early detection of colorectal cancer (CRC) on routine CT abdomen and pelvis (CTAP). We assessed the difference in detection of abnormal colonic findings between an expert reader (JC) and amateur readers (ARs). Methods: ARs consisting of two third year medical students (RB - AR1, ZG - AR2) studied 20 CTAP for tracing the colon and identifying pathology. Their search pattern and assessment of the colon was then evaluated by an expert radiologist (JC). They then spent two hours reviewing abnormalities in 10 scans with JC, who highlighted suspicious neoplastic findings such as colonic wall thickening, fat stranding, edema, masses, and abnormal lymph nodes. The ARs then individually read 203 CTAP scans to assess for these suspicious findings. The studies were from a single institution and were reported in a prior study in 2019 GI-ASCO. The findings of the ARs were then compared to those of the expert reader and the initial reader for each study. Data was analyzed using t-test with 2 tails. Results: The incidence of suspicious neoplastic findings was 87% and 81% for AR1 and AR2, respectively, compared to 18% in the initial reads and 33% for expert reader (p=0.01). Greatest discordance were 94% and 87% between AR1 and AR2 to the initial reads. Additionally, the incidence of suspicious findings between the first and last 20 cases (p=0.03 and 0.17) examined by ARs declined from 79 to 40% for AR1 and 69 to 55% for AR2. Conclusions: ARs are capable of detecting CRC features on CTAP from ED, but with higher false-positive (FP) rate than trained experts. The FP rate decreases with increasing experience. ARs learning course simulates AI which will likely yield high FP rate with initial training, but with improving FP with deep training, especially with larger volume of normal variants.
Survival and quality of life after isolated upper abdominal perfusion with chemofiltration (UAP-F) for stage III and IV pancreatic cancer.
Authors: Aigner Karl R , Gailhofer Sabine , Selak Emir , Aigner Kornelia 
Published: February 2020

681 Background: In order to increase response and survival rates of advanced pancreatic cancer at good quality of life, UAP-F was clinically tested. We report on feasibility, safety, overall survival and quality of life of 79 patients in stage III and 142 patients in stage IV submitted to UAP with subsequent chemofiltration for lowering of systemic drug exposure. Methods: This technique is achieved with stop-flow balloon catheters introduced via the femoral artery and vein. The arterial balloon is placed below the celiac axis and proceeded beneath the diaphragm after injection of a three-drug combination consisting of cisplatin (CDDP), adriamycin (ADM) and mitomycin (MMC). Because of tenfold increased cytotoxicity of ADM and MMC, the perfusion is performed under hypoxic condition. Perfusion time is 15 minutes followed by 30 – 45 minutes of chemofiltration. Results: Median survival was 12.1 months and 8.7 months in stage III and IV respectively. One-year survival was 49.4 % and 37 % for stage III and IV, and 3-years survival 21.7 % and 7.7 % for stage III and IV respectively. Cisplatin levels in the arterial circuit amounted to 60.000 ng/ml and 6.000 ng/ml in the venous line. Resolution of ascites was achieved within two therapies in 33/36 cases with UAP-F. Toxicity was generally mild, not exceeding WHO grade II and amounted to grade III or IV only in patients after prior severe systemic chemotherapy. Conclusions: Upper abdominal perfusion with chemofiltration is a safe technique for advanced cancers of the pancreas, increasing survival time and maintaining quality of life.