bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety of double and a half-layered esophagojejunal anastomosis in total gastrectomy with gastric cancer.
Authors: Ma Pengfei , Zhao Yuzhou , Zhang Xijie 
Published: May 2020

e16563 Background: Esophageal jejunal anastomotic fistula is still one of the serious postoperative complications of gastric cancer, the incidence was 1% ~ 16.5%. The aim of this study was to evaluate the safety of double and a half layered esophagojejunal anastomosis in total gastrectomy. Methods: The new method was called double and a half layered esophagojejunal anastomosis: esophagojejunal anastomosis was performed with a tubular stapler, then the anastomosis was reinforced by absorbable suture (Full-layer continuous suture, slurry muscularis embedding). The new method was used in observation group (n = 295). In the control group(n = 469),the esophagojejunal anastomosis was performed with a tubular stapler, then reinforced by intermittent suture with absorbable sutures. Data analysis including operating time, blood loss, anastomosis time, types and cases of postoperative complications, and postoperative hospitalization time. Results: The data of 764 patients who performed radical gastrectomy between May 2015 and May 2019 were analyzed retrospectively. 1.Surgery situations: The operating time (140.66±26.96 min vs 139.61±22.75min, t= 0.581, P> 0.05) blood loss (200.61±111.03ml vs214.45±114.09ml, t= -1.481, P> 0.05), anastomosis time (20.44±4.31min vs19.92±4.58min, t= 1.573, P> 0.05), postoperative hospitalization time (15.35±6.46 d vs15.89±5.58d, t= -1.229, P> 0.05) .2. Postoperative situations: the rates of anastomotic complications in observation group was 1.69% (5/295) and 4.69% (22/469) in control group, with a statistically significant difference between two groups( χ2 = 4.768, P< 0.05). The rates of anastomotic leakage in observation group was lower than that in the control group 1.02% (3/295) vs 3.41% (16/469) ( χ2 = 4.282, P< 0.05) . The severity of anastomotic leakage, anastomotic stenosis, anastomotic bleeding were no statistically significant differences between two groups( χ 2= 2.030,1.261,0.075, P> 0.05). Total postoperative complications: 101 cases (34.24%) in the observation group, 14 cases (4.75%) with severe complications, and 1 case death. 151 cases (32.2%) in the control group, 34 cases (7.25%) with serious complications, and 2 cases death ( χ2 = 0.838, Z = -1.465, P > 0.05). Conclusions: Double and a half layered esophagojejunal anastomosis is safe and feasible in total gastrectomy, which can reduce the incidence of anastomosis complications.
Survival benefit of oophorectomy in stage IV gastric cancer patients with Krukenberg tumors.
Authors: Abdelhakeem Ahmed , Badgwell Brian D. , Ikoma Naruhiko , Meyer Larissa , Zhao Meina , Ta Anh , Das Prajnan , Sagebiel Tara L. , Waters Rebecca E , Estrella Jeannelyn , Ajani Jaffer A. , Blum-Murphy Mariela A. 
Published: May 2020

e16566 Background: The management of Krukenberg tumors from primary gastric cancer remains unclear and it is unknown if oophorectomy improves survival. The purpose of this study was to compare the overall survival (OS) of patients with ovarian metastases from gastric cancer treated with standard chemotherapy to chemotherapy and oophorectomy. Methods: Between January 2008 and August 2019, we retrospectively analyzed the clinicopathological features and treatment data of 97 patients with stage IV gastric cancer patients with ovarian metastases. Patients were categorized into two groups: Oophorectomy plus standard chemotherapy treatment vs. standard chemotherapy only (non-oophorectomy). The primary objective was to assess OS. Results: A total of 97 patients were identified. 37 (38.1%) patients had oophorectomy and 60 (61.9%) patients did not have oophorectomy. OS was better in the oophorectomy group relative to the non-oophorectomy group (37 months vs. 20 months; P= 0.0554). Survival from the time of diagnosis of ovarian metastases was significantly better in oophorectomy group relative to the non-oophorectomy group (26 months vs. 12 months; P= 0.0006). Conclusions: Our results showed that Oophorectomy in addition to systemic chemotherapy in this unique population seems to confer survival advantage in this retrospective analysis. Prospective evaluation is warranted.
Totally laparoscopic plus one transthoracic port esophagogastrectomy for Siewert-type Ⅱ adenocarcinoma of esophagogastric junction.
Authors: Wang Wei , Xiong Wenjun , Xue Yuling , Li Jin , Huang Haipeng , Zheng Yansheng , Luo Lijie , Wan Jin 
Published: May 2020

e16568 Background: The incidence of Siewert type Ⅱ adenocarcinoma of esophagogastric junction (AEG) is increasing, especially in Asia, but laparoscopic surgery for type Ⅱ AEG is not widely accepted due to the technical challenges and unknown prognosis. To address this problem, we developed a novel technique of totally laparoscopic plus one transthoracic port esophagogastrectomy. Methods: From May 2017 to December 2019, 24 patients with advanced Siewert type Ⅱ AEG underwent the procedure. The surgical technique is that after completely abdominal lymphadenectomy and mobilization of the stomach laparoscopically, the left diaphragm was incised 5 to 7 cm, followed by one transthoracic port was inserted into the thoracic cavity through the left axillary frontline at the sixth to eighth intercostal spaces. Then lower mediastinal lymphadenectomy and transection of the lower esophagus were completed through the transthoracic supplementary port. An intrathoracic Roux-en-Y esophagojejunostomy was performed also through this port, which was finally used for thoracic drainage. Results: All procedures containing 5 proximal gastrectomies and 19 total gastrectomies were completed successfully without surgical morbidity and mortality. The median operative time was 344 (205 to 540) min. The time for reconstruction was 38 (25 to 60) min. The median blood loss was 100 (20 to 300) ml. The median tumor diameter was 3.8 (1.5 to 6.7) cm with a median esophagus invasion of 2.5 (0.6 to 4.5) cm. The median number of lymph nodes harvest was 37 (18 to 60). The median number of lower mediastinal lymph nodes was 5 (1 to 13) and its metastasis rate was 33.3%(8/24). The median time of first flatus was 4 (2 to 7) days. The median hospital stay was 11 (7 to 45) days. One patient developed a thoracic infection and one esophagojejunostomy leakage, both cured with thoracic drainage and antibiotic treatment. The median follow-up was 22(1-32). The DFS was 83.3% and OS was 91.7%. Conclusions: Our initial result suggested that this novel technique was safe and feasible for Siewert type Ⅱ AEG, associated with the advantages of complete lower mediastinal lymphadenectomy and easy intrathoracic Roux-en-Y esophagojejunostomy by using the transthoracic assisted port.
Gastric juice piR-1245: A promising prognostic biomarker for gastric cancer.
Authors: Peng Wei , Liu Jianhong , Zhou Xiaorong , Fan Hong , Lu Jianwei , Chen Senqing , Feng Jifeng 
Published: May 2020

e16574 Background: Emerging reports demonstrated that PIWI-interacting RNAs (piRNAs) played an indispensable role in tumorigenesis. However, it still remains elusive whether piR-1245 in gastric juice specific in stomach could be employed as a biomarker for gastric cancer (GC). The present work is aiming at exploring the possibility of piR-1245 in gastric juice as a potential marker to judge for diagnosis and prognosis of gastric cancer. Methods: Gastric juice was collected from 66 GC patients and 66 healthy individuals. Quantitative real-time reverse transcriptase polymerase chain reaction (qRT-PCR) was employed to measure the levels of piR-1245 expression. Then, the pattern of piR-1245 expression in gastric juice was determined between GC patients and healthy individuals. A receiver operating characteristic (ROC) curve was constructed for distinguishing GC from healthy individuals. Results: Gastric juice piR-1245 levels in GC were higher than those of controls (P < 0.0001). The value of area under ROC (AUC) was 0.885 (sensitivity, 90.9%; specificity, 74.2%; 95% confidence interval, 0.8286 to 0.9414). High gastric juice piR-1245 expression was signally correlated with tumor size (P = 0.013) and TNM stage (P = 0.001). GC patients with high piR-1245 expression in gastric juice exerted a poorer overall survival (OS) (P = 0.0152) and progression-free survival (PFS) (P = 0.013). COX regression analysis verified that gastric juice piR-1245 expression was an independent prognostic risk variable for OS (P < 0.05). Conclusions: The current study suggested that piR-1245 in gastric juice had the potential to be a useful biomarker for GC detection and prognosis prediction.
Clinicopathological features and treatment outcomes of young patients with gastric and esophageal cancers.
Authors: Beck Lauren Amanda , Ma Lucy Xiaolu , Espin-Garcia Osvaldo , Suzuki Chihiro , Jiang Di Maria , Liu Geoffrey , Chen Eric Xueyu , Knox Jennifer J. , Wong Rebecca , Brar Savtaj Singh , Swallow Carol Jane , Yeung Jonathan , Darling Gail Elizabeth , Conner James , Elimova Elena , Jang Raymond Woo-Jun 
Published: May 2020

e16577 Background: Gastric and esophageal (GE) cancers most commonly occur in older adults in their 60’s.However, there are inconsistent reports about prognosis in adolescent and young adult (AYA) pts, and treatment patterns and outcomes in this population have not been well characterized. Methods: A retrospective analysis was performed for AYA (age 18-40 years) pts with histologic diagnosis of GE cancers who presented to Princess Margaret Cancer Centre from 2008 to 2016. The Kaplan-Meier method was used to analyze progression free (PFS) and overall survival (OS). Results: We identified 57 AYA GE cancer pts (30 gastric, 27 esophageal). Baseline features included: median age 35 years, 51% female (70% in gastric, 30% in esophageal), 82% with Eastern Cooperative Oncology Group performance status 0-1, 82% Charlson Comorbidity Index 0, 54% stage IV. For gastric pts, 53% had diffuse subtype and 47% had signet ring adenocarcinoma. Most had negative family history (77%). Curative intent and palliative treatment was used in 23 (40%) and 34 pts (60%) respectively. In curative pts, 48% had neoadjuvant therapy, 52% had upfront surgery. Of pts who underwent curative resection, 62% had pT3/T4 and 38% had pN2/N3 disease; 5-year OS rate was 37% (95% CI 20-67). Of the palliative pts, 91% received systemic therapy. First-line regimen included triplet (81%) and doublet chemotherapy (13%), administered for a median of 6 cycles. Median PFS was 7.4 months. Second- and third-line treatments were administered in 14 and 3 pts respectively, 1 pt was treated beyond third-line. Median OS in palliative pts was 12.1 months (95% CI 8-21.3). Conclusions: Our gastric AYA pts had increased female predominance and diffuse histology. Many AYA pts had advanced GE cancer at diagnosis, with over half of pts presenting with metastatic disease. In both the curative and palliative setting, AYA pts did not appear to have better survival outcomes despite having few comorbidities, suggesting they may have more aggressive biology.
Deep learning-based unsupervised morphological subtyping in histopathology images of gastric cancer.
Authors: Jung Kyu-Hwan , Park Jeonghyuk , Kim Kyungdoc , Kim Yeong Won , Park Hyunho , Kook Myeong-Cherl , Kim Dong-Il 
Published: May 2020

e16580 Background: Gastric cancer subtyping system such as Lauren classification is widely used in clinical practice since it is an independent prognostic factor, and also provides the basis for individualized treatment. However, Lauren classification showed low reproducibility because it is based on qualitative method. Thus, a more reproducible system has been required. In this study, we explore the concordance between a cancer detection model (CDM)-based unsupervised subtyping and a current classification system. Methods: We focused on Lauren classification since it has relatively simple major subtypes: intestinal and diffuse types. 88 resection cases of gastric cancer are collected. Two experienced gastrointestinal pathologists evaluated each case independently by Lauren’s criteria. 200 cancer region image patches per case and its features extracted by the CDM were clustered into five groups via k-means clustering. We then defined the ratio of the number of patches in each cluster group as the case-level feature. Cases are clustered into two groups via k-means clustering using the features. We named this case-level clustering result as a deep learning-based subtyping (DLS), hereafter. Results: DLS showed a high correlation with Lauren classification: intestinal and diffuse subtype. The kappa scores between the pathologists and algorithm (0.765 and 0.796) were higher than between pathologists (0.700). The cluster centers corresponding to intestinal and diffuse types were [44.6, 21.5, 47.5, 63.7, 22.7] and [35.5, 148.2, 4.0, 9.0, 2.3], respectively. Further review of the patches contributing to the second feature (21.5 and 148.2) confirmed that they demonstrate typical morphological characteristics of diffuse type. Conclusions: Our analysis showed that the morphological characteristics of Lauren classification were inherent in gastric cancer detection task and WSIs can be subtyped by the data-driven, and unsupervised manner. Furthermore, DLS was more reliable than human from the concordance results. This suggests that the DLS can supplement current classification systems or be a new subtyping system. [Table: see text]
Chemoradiation versus chemotherapy after D2 gastrectomy: A meta-analysis including randomized and real-world trials.
Authors: Rim Chai Hong , Shin In-soo , Lee Hye yoon , Park Sunmin 
Published: May 2020

e16590 Background: The ARTIST trial failed to achieve positive result regarding benefit of chemoradiation (CRT) after D2 gastrectomy. In most of clinical guidelines and practices, postoperative CRT has been recommended only for those with R1 resection or lesser extent surgery than D2. Our study is to evaluate oncologic benefit of CRT after D2 gastrectomy, integrating data from randomized clinical trials (RCTs) and real-world studies so far. Methods: Systematic searches for Medline and Embase were performed for controlled trials comparing CRT and chemotherapy (CT) arms after D2 gastrectomy with R0 resection, for gastric cancer. Subgroup analyses were performed including RCTs, and balanced studies without significant difference regarding major clinical indicators. Primary endpoint was disease free survival (DFS), and secondary endpoints included overall survival (OS), locoregional recurrence rate (LRR), distant recurrence rate (DRR), and grade ≥3 complications. Results: A total of 13 studies, comprised of 6 RCTs and 7 non-RCTs, involving 2,603 patients were included. DFS benefit was found in overall pooled analysis [odds ratio (OR): 1.264, p = 0.053, I2= 37.5%], and more evident in subgroup analyses using RCTs (OR: 1.440, p = 0.006, I2= ~0%) and balanced studies (OR: 1.417, p < 0.001, I2= ~0%). OS benefit was not significant. LRR reduction was noted in overall pooled analysis (OR: 0.559, p = 0.012, I2 = 46.1%), and clearer in the subgroup analyses with RCTs (OR: 0.495, p < 0.001, I2= ~0%) and balanced studies (OR 0.472, p < 0.001, I2= 9.2%). Pooled LRR rates were 11.3% (95% confidence interval: 7.5-16.8) and 18.1% (13.1-24.4) in CRT and CT arms. DRR was lower in CRT arms (OR: 0.768, p = 0.023, I2= ~0.0%), but the difference was less significant in subgroup analyses. A grade 5 complication was found in each of the two arms among all studies. Comparison of complications varies and will be shown descriptively in the manuscript. Conclusions: Benefit of DFS and LRR with CRT after D2 gastrectomy was well shown in the present study. Identifying subgroup population mostly benefitable from CRT might yield positive results regarding OS and DRR in future studies.
The prognostic significance of the advanced lung cancer inflammation index(ALI) in patients with advanced biliary tract cancer: A retrospective study.
Authors: Kim Jung Hoon , Oh Sung Yong , Kang Jung Hun , Kang Myoung-Hee , Jeong Chi-Young , Ji Jun Ho 
Published: May 2020

e16613 Background: Intrahepatic cholangiocarcinoma is the second most common primary cancer, but the prognosis is poor and aggressive therapies provide only limited benefit when it is in advanced stage. Many studies were conducted to find significant prognostic factors to predict clinical outcomes, but there is no definitive parameter or scoring model yet in this disease. This study is a retrospective analysis to test various kinds of prognostic scoring systems including the advanced lung cancer inflammation (ALI) index, a new prognostic model, for patients treated for advanced intrahepatic cholangiocarcinoma. Methods: We retrospectively searched medical records of patients who were diagnosed with advanced intrahepatic cholangiocarcinoma between January 2012 and December 2017 and actively treated at a single tertiary regional cancer center. Patients who received only supportive care, or had active infection concomitantly were excluded. 60 patients were identified, and we reviewed and analyzed their baseline characteristics and clinical outcomes. Various types of inflammation or nutritional scoring systems, neutrophil to lymphocyte ratio (NLR), Onodera’s prognostic nutritional index (OPNI), the advanced lung cancer inflammation (ALI) index were concurrently calculated and significance for patients’ survival was evaluated. Results: In 50 patients with metastatic stage and 10 patients with locally advanced disease, the median overall survival was 13.97 months (95% confidence interval (CI) 7.99 – 19.95). ALI of 28.5 was determined as the optimal cut-off value for prediction of 1-year survival by receiver operating characteristics (ROC) curve with an AUC value of 0.671 (sensitivity and specificity were 77.8% and 60.6%, respectively). 26 patients with ALI > 28.5 had significantly better overall survival compared with 34 patients with ALI≤28.5 (19.2 months vs. 8.73 months, p= .007). NLR above 2.8 only showed mildly significant difference for overall survival (OS), and the OPNI failed to predict prognosis of these patients. In multivariate analysis, there was no independent prognostic factor observed to have association with overall survival. Conclusions: The advanced lung cancer inflammation (ALI) index showed a potential to be a new prognostic model for advanced intrahepatic cholangiocarcinoma. Further cohort studies to expand population size may be worth.
Characterization of advanced hepatocellular carcinoma patients via a multi-omic cancer registry.
Authors: Ryan Joseph S , Xu Xiaojun , Tamayo Pablo , Burgoyne Adam 
Published: May 2020

e16617 Background: Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver and has significant cancer-related mortality worldwide. Molecularly matched therapy has an emerging role in HCC treatment; however, HCC poses a unique challenge as patients are frequently diagnosed radiographically rather than by tissue biopsy, limiting our ability to utilize tumor tissue data for therapy selection. The purpose of this study is to establish a multi-omic database with matched demographic and clinical data to identify patterns of shared molecular aberrations in HCC tumors. Methods: An institutional HCC cancer registry was created, and a retrospective review was performed using data from 2017-2020 at a tertiary cancer center. 56 patients with advanced HCC were identified, and tissue samples were analyzed with multi-omic profiling assays (next generation DNA sequencing, RNA sequencing, protein expression via immunohistochemistry) versus ctDNA from peripheral blood. Results: Next generation sequencing was obtained for 38 (76%) patients using either tissue or ctDNA. While the results were similar, a higher number of total mutations were identified using tumor tissues rather than ctDNA. The average variant allele fraction for tumor tissues was approximately 10x higher than the variant allele fractions identified by ctDNA. However, ctDNA sequencing identified a higher number of potentially actionable mutations, on average, than did tissue testing. The most commonly mutated genes included TERT (42% of patients), TP53 (47%), CTNNB1 (34%), ARID1A (18%), CCND1 (16%), and NEF2L2 (13%). Several patients had serial ctDNA sequencing, which showed an increase in actionable and total mutations over time as well as changes in variant allele fractions in response to therapy. Conclusions: Next generation sequencing of ctDNA can be used in lieu of tumor tissue in patients diagnosed with HCC radiographically to identify actionable mutations, but it may underestimate the mutational burden of HCC tumors. Serial analyses with cell free DNA may be useful to monitor clonal evolution in response to targeted treatment and may identify new actionable mutations as patients progress on systemic therapies. [Table: see text]
TP53 R249G/S mutation as an independent prognosis indicator in hepatocellular carcinoma.
Authors: Zhou Ledu , Xu Ying , Wang Dong , Ye Ke , Xiao Liang , Long Guo , Chen Rongrong , Xia Xuefeng 
Published: May 2020

e16622 Background: Many cancers could be driven by some specially mutations exampled as EGFR in lung cancer, influenced prognosis prominently. However, there were few related studies in liver cancer, although primary liver cancer was a common malignant tumor causing high morbidity and mortality. Methods: 97 patients diagnosed with primary hepatocellular carcinoma were enrolled in this study. Operative tissue samples were collected and analyzed using hybridization capture based NGS ERSeq method from all patients. Results: 1088 somatic mutations were identified in tissue samples. Targeted-capture sequencing of 1,021 genes that are frequently mutated in solid tumors revealed that the most frequently mutated genes were TP53 (59%), TERT (32%) and AXIN1 (19%). By using the least absolute shrinkage and selection operator (LASSO), the recurrence risks were constructed on the basis of five-gene mutations, AXIN1, CTNNB1, LRP1B, PDGFRA and TP53. The ROC curve was 0.813 and 0.882 in training and validation cohorts, respectively. TP53 R249G/S point mutation was predicted prognostic independently. Up to 60% TP53 R249S mutated patients occurred recurrence, while less than 30% TP53 R249 wildtype patients occurred recurrence ( P = 0.0002). Patients with R249G/S point mutation showed a worse prognosis. The median disease-free survival time was 8.0 VS 45.0 months in R249G/S mutated group (n = 79) and R249- wildtype (n = 18) group, respectively (Log-rank test, P = 0.0364). Conclusions: In various cancer types, TP53 has a broad-spectrum mutation, but only in hepatocellular carcinoma, TP53 mutations are highly concentrated at the R249 point, which was considered to be related to aflatoxin infection, and mutations at this site can significantly affect the prognosis of patients. The discovery of this target also provide clue for subsequent targeted treatment of liver cancer.