bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of telehealth based nutrition counselling to improve dietary compliance and nutritional status of cancer patients.
Authors: Jotwani Amit Kumar , NG Krishna Priya , AK Arun , Jain Rashie 
Published: June 2021

e13619 Background: According to published literature, regardless of the cancer type, the overall prevalence of malnutrition in cancer is about 40% (range 30%-70%). Malnutrition is known to adversely affect the treatment compliance, quality of life and survival outcomes for cancer patients. Onco.com provides telehealth based nutrition care support (NCS) as a part of cancer care management program. We sought to evaluate impact of telehealth based nutrition counselling on diet compliance and overall nutritional status of patients. Methods: NCS includes virtual nutrition screening, nutrition diagnosis and nutrition intervention. Virtual nutrition screening was done using modified patient generated subjective global assessment (PG-SGA) tool developed by Ottery. An initial nutrition screening was initially performed for 165 patients. After nutrition screening, patients were divided as malnourished (category 1- 47%), nutritionally at risk (category 2- 34%) and well nourished (category 3- 19%). Patients in category 1 & 2 were analysed for the purpose of study. Diet counselling and customized diet plans were provided to the patients between the age group of 12 to 83 years for a period of 3 months from October to December 2020. On follow up, 24 hour diet recall method and food frequency method were used to assess the compliance to the diet plan. One day prior 24 hour diet recall and food frequency method for two weeks was used to analyse the adherence to the plan. If the patient consumed ≥75% of the recommended diet for a minimum of 5 days in a week, he/she was considered a ‘compliant’, while those who consumed < 75% of the recommended diet were considered to be ‘non-compliant’. Data on body weight and performance status (PS) was documented during follow up to track changes. Results: Of 134 study participants, 35.1% were in the early (I & II) stage, 38.7 % were in the locally advanced (III) stage, 21.2 % were in the metastatic stage, and 4.8 % were in the recurrent stage of disease. After 3 months of initiation of the nutrition counselling, 40% of the patients had gained weight, whereas 38% could maintain the body weight and 22 % had lost weight. Change in physical activity, appetite, management of side effects after diet plan initiation were also assessed during the reassessment calls. Overall, 67% patients showed improvement in diet compliance across all stages of disease. Majority of dietary non-compliance was noted in patients with head and neck, upper GI cancers or those with poor PS. Conclusions: Telehealth based nutritional counselling is an effective tool to help cancer patients achieve better diet compliance and nutrition outcomes across all stages of disease. Dietary non-compliance in head and neck cancers and upper gastrointestinal cancers or poos PS could correlate with difficulty in oral intake. Getting accurate information could be one of the challenges in virtual mode of counselling.
Clinical and immunological allergy assessment in cancer patients.
Authors: Carneiro Bruno Gustavo Muzzi Carvalho , Petroianu Andy , Machado Jose Augusto Nogueira , Anjos Paula Martins Ferreira dos , Silva Fabiana Rocha da , Alberti Luiz Ronaldo , Resende Vivian , Barrientos Sofia Candia 
Published: June 2021

e15021 Background: Cancer is associated with immunodeficiency, while allergies result from immune system hyperactivity mediated by cytokines and immunoglobulins. The purpose of this study was to determine the relationship between immune environment of specific cancers and allergies, emphasizing cytokines related to Th1 and Th2 responses associated with IgE. Methods: 80 adults were distributed into two groups: control (n = 20) and cancer (n = 60), distributed in three subgroups (n = 20), head and neck, stomach, and prostate cancers. This study considered cytokine deviation in Th1 (IL-2) response to Th2 (IL-4), anti-inflammatory, pro-inflammatory, or regulatory profile regarding both IgE levels and reported allergies, by means of clinical manifestations and IgE, IL-1β, IL-2, IL-4, IL-17, and TGF-β serum concentration. Results: Clinically allergies were observed in 50% of the control group and in 20% of the cancer group (p = 0.01). IL-2 cytokine and TGF-β concentrations were higher in the patients with cancer as compared to the control (p < 0.005). However, there were IL-4, IL-17, and IL-1β decreases in the patients with cancer (p < 0.05). No correlation was observed between the cytokines studied and IgE and clinically proven allergies in both investigated groups. Conclusions: There was an inverse association between cancer and clinical allergy manifestations. In head and neck, stomach, and prostate cancers, an immunosuppressive serum tumor environment was predominant. Cytokine deviation in the Th1 response to Th2 in relation to IgE was not identified. No correlation was found between clinically proved allergies and immunity markers related to the same allergens.
Assessment of ethnic difference in the incidence of thrombocytopenia induced by trastuzumab emtansine (T-DM1): A meta-analysis.
Authors: Zhang Jingyi , Yang Yaning , Chen Ru , Chen Shanshan , Wang Jiayu , Luo Yang , Ma Fei , Xu Binghe , Fan Ying 
Published: June 2021

e15096 Background: Trastuzumab emtansine (T-DM1) has been proved its value and efficacy in advanced metastatic cancer disease as well as in the adjuvant setting. However, there is an increasing concern in T-DM1-induced thrombocytopenia (TCP), which also showed difference of incidence in races. This meta-analysis, combining available data from all single-agent T-DM1 studies to date, aimed to evaluate the incidence of treatment-related thrombocytopenia of T-DM1 and the differences between Asian and non-Asian patients. Methods: We conducted a systematic search of the relevant published clinical studies of T-DM1 that reported safety profile including thrombocytopenia, from 1980 to March of 2020 using PubMed, Embase, and the Cochrane database. Screening and data extraction were conducted by two independent reviewers. Pooled-effect estimates calculated with fixed-effects or random-effects model were expressed as incidence with 95% CIs. Results: A total of 29 studies involving 6188 patients were included. The incidence of all-grade thrombocytopenia in Asian patients was 0.39 (95%CI 0.11-0.67) and 0.29 (95%CI 0.23-0.35) in non-Asian patients. And the incidence of the grade 3 or higher thrombocytopenia in Asians was 0.20 (95%CI 0.10-0.29), in non-Asians was 0.02 (95%CI 0.01-0.03). Gastrointestinal cancer type and the dose of 2.4 mg/kg Q3W T-DM1 treatment were both associated with the higher incidence of grade 3 or higher thrombocytopenia. Conclusions: Asian patients have the higher risk of thrombocytopenia induced by T-DM1. Clinicians should have an awareness of careful observation in platelet counts when patients receive T-DM1 therapy.
LincRNA-p21 as predictive response marker for preoperative chemoradiotherapy in rectal cancer.
Authors: Benitez Jose Carlos , Diaz Tania , Ferrer Carme , Acosta Melissa , Monzo Mariano , Cirera Luis , Besse Benjamin , Navarro Alfons , Campayo Marc 
Published: June 2021

e15534 Background: Preoperative chemoradiotherapy (CRT) is a standard treatment for locally advanced rectal cancer (RC) patients (pts). Despite the benefits of CRT, its use in non-responder pts can be associated with increased toxicities and resection delay. The identification of CRT response biomarkers, such as long non-coding RNAs (lncRNA), could improve the management of these pts. LincRNA-p21 is a lncRNA involved in the p53 pathway and angiogenesis regulation that acts as prognostic marker in several tumors. We aim to study lincRNA-p21 expression in pretreatment samples from RC pts treated with CRT to evaluate whether lincRNA-p21 can act as a predictive biomarker for CRT response. Methods: RNA from pretreatment endoscopy biopsies from 58 RC pts treated with preoperative CRT at Mutua Terrassa University Hospital were analyzed. Pathological response was classified according to the tumor regression grade (TRG) Dworak classification. LincRNA-p21 expression was determined by RTqPCR and was correlated with CRT response and, time to relapse (TTR), disease-free survival (DFS) and overall survival (OS). Results: Samples from 58 pts were analyzed. Most of them males (n = 40, 69%). Median age at diagnosis of 67 (44-82) years. Fifty (86.2%) pts reported stage III and, 42 (72.4%) pts assessed TRG 0-3 with a 70.7% of downstaging reported. LincRNA-p21 was upregulated in stage III tumors (p < 0.0001) and also in tumors with worst response to CRT regarding TRG, TGR0-3 (TRG0-3, n = 42 vs TRG4, n = 16, p = 0.019). In this line, the ROC curve analysis showed that lincRNA-p21 expression had capacity to distinguish pts with maximum response (TRG4) from others (AUC:0.7; p = 0.02). The binary logistic regression analysis validated its independence as response biomarker. LincRNA-p21 levels correlated with pts relapse after surgery. When the pts were classified in 3 groups, high, medium and low, according to lincRNA-p21 levels, RC pts with highest lincRNA-p21 expression had the shortest TTR. TTR for pts with high levels was 74.5 months (m) (95% CI:31-117), while it was 114 m (95% CI:95-133) for those with Medium levels and 123 m (95% CI:111-134) for those with low levels (p = 0.047). Conclusions: LincRNA-p21 is a marker of advanced disease and worse response to CRT. LincRNA-p21 may add valuable information for individualizing pre-operative CRT in locally advanced RC pts.
The impact of myosteatosis on outcomes following surgery for gastro-intestinal malignancy: A systematic review and meta-analysis.
Authors: MacCormick Andrew , Puckett Mark , Streeter Adam , Aroori Somaiah 
Published: June 2021

e15540 Background: Recent research has demonstrated the impact that body composition parameters can have on the outcomes following cancer surgery. Adipose tissue deposition in muscle, known as myosteatosis, can be detected on pre-operative imaging. This systematic review aims to analyse the impact of pre-operative myosteatosis on long-term outcomes following surgery for gastro-intestinal malignancy. Methods: Using MeSH terms, a systematic search of the databases PubMed MEDLINE, EMBASE, Cochrane, CINAHL and AMED was performed. Studies were included if they reported hazard ratios (HR) analysing the impact of pre-operatively defined myosteatosis, or similar term, on the long-term outcomes following surgery for gastro-intestinal malignancy. A total of 39 full texts articles were reviewed for inclusion, with 19 being included after the inclusion criteria were applied. A sub-group analysis was performed for those studies reporting outcomes for colorectal cancer patients only. Results: The total number of included patients across all studies was 14,481. Patients with myosteatosis had a significantly poorer overall survival, according to univariate (HR 1.82, 95% CI 1.67 – 1.99) and multivariable (HR 1.66, 95% CI 1.49 – 1.86) analysis. This was also demonstrated with regards to cancer-specific survival (univariate HR 1.62, 95% CI 1.18 – 2.22, multivariable HR 1.73, 95% CI 1.48 – 2.03) and recurrence-free survival (univariate HR 1.28, 95% CI 1.10 – 1.48, multivariable HR 1.38, 95% CI 1.07 – 1.77). Conclusions: This review demonstrates that patients with pre-operative myosteatosis have poorer long-term outcomes following surgery for gastro-intestinal malignancy. Therefore, myosteatosis should be used for pre-operative optimisation and as a prognostic tool before surgery. More standardised definitions of myosteatosis and further cohort studies of patients with non-colorectal malignancies are required.
System inflammation markers of resectable colorectal cancer patients with different mismatch repair gene status.
Authors: Jingjing Li , Zhang Yiwen , Qi Xu , Wei Qing , Ying Jieer , Cong Luo 
Published: June 2021

e15612 Background: Clinical trials suggested that solid tumors with MSI-high or dMMR are associated with responses to programmed cell death 1 inhibitors. Understanding the associations of MMR status with clinicopathological characteristics in CRC patients would help further guide clinical treatment and explore the pathogenetic mechanisms of this disease. Methods: Bioinformatics analysis was used to identify the differential expression genes between CRC patients with different MMR status. 208 resectable colorectal cancer patients, including 104 dMMR patients and 104 matched pMMR patients were retrospectively analyzed. Clinicopathological data, including age, gender, tumor location, histological subtype, tumor grade, tumor stage, regional lymph node (LNs) metastasis, American Joint Committee on Cancer (AJCC) 8th edition stage, perineural invasion, vascular invasion, number of retrieved LNs, number of metastatic LNs, systemic inflammation markers, including C-reactive protein (CRP), lactic dehydrogenase (LDH), albumin, neutrophil, monocyte, lymphocyte, platelet and survival were retrospectively reviewed. Results: Bioinformatics analysis shown chemokine-mediated signalling pathway and inflammatory response were the main differences in gene expression between dMMR and pMMR CRC patients. In all 208 CRC patients, those with dMMR were more frequently located in right side, with more mucinous adenocarcinoma, and with more grade 3 for tumor grade. Patients with dMMR had earlier AJCC stage than pMMR ones. Meanwhile, lymph nodes (LNs) metastasis was more frequently in dMMR patients compared with pMMR patients. Interestingly, CRC patients with dMMR were able to remove more regional lymph nodes during surgery, but with less metastati. Resectable CRC patients with dMMR were more likely to have higher level of neutrophil, monocyte, platelet, NLR, PLR, MLR, CAR, GPS and CRP. In CRC patients with dMMR, the patients with higher level of PLR, MLR, CAR and co-effect present had shorter OS significantly. It was interesting to note that the prognosis of high level of systemic inflammatory markers did not predict long OS in pMMR CRC patients. Conclusions: dMMR CRC has presented a comprehensively distinct systemic inflammatory microenvironment. The systemic inflammatory response can predict oncological outcomes in CRC patients with dMMR.
Phase-II study of toripalimab combined with neoadjuvant chemotherapy for the treatment of resectable esophageal squamous cell carcinoma.
Authors: Liu Delin , Zhang Qin , Zhu Jinghua , Qian Ting , Yin Rong , Fan Zhaohui , Jiang Feng , Li Houhuai , Lu Jianwei , Cao Guochun 
Published: June 2021

e16029 Background: Compared with neoadjuvant chemotherapy alone，Neoadjuvant radiochemotherapy can significantly increase pCR rate in esophageal squamous cell carcinoma and improve patient overall survival. However, the addition of radiotherapy increases the risk of adverse reactions and surgery. Neoadjuvant radiochemotherapy is currently used in < 5% of Chinese patients.The purpose of this phase II study is to assess the efficacy and safety of toripalimab combined with paclitaxel and cisplatin as neoadjuvant treatment for resectable locally advanced esophageal squamous cell carcinoma(clinical trial registration number: ChiCTR1900025318). Methods: Patients 18–75 years old with esophageal squamous cell carcinoma confirmed by endoscopic biopsy, assessed to be locally advanced esophageal squamous cell carcinoma (cT1–cT2, N+; cT3–cT4 a, any N), and expected to be resectable were given toripalimab (240 mg d1 + PTX 175 mg/m2 + PDD 75 mg/m2 q3w) before surgery for two treatment cycles, followed by efficacy assessment. A consultation meeting with thoracic surgeons was held to assess radical surgery for patients with resectable lesions 4–6 weeks after neoadjuvant therapy was completed. pCR and postoperative-stage statistical analysis were conducted based on postoperative pathology test results. These results were used to determine the efficacy and safety of PD-1 monoclonal antibody combined with chemotherapy as neoadjuvant therapy for locally advanced esophageal cancer. Results: By December 2020, 23 subjects were enrolled. Of the subjects, five withdrew without undergoing surgery (three subjects refused surgery and switched to radical radiochemotherapy, one subject progressed to PD after two cycles of neoadjuvant therapy and switched to palliative treatment, and one subject could not undergo surgery after neoadjuvant treatment and gave up the treatment) and 18 evaluable patients underwent surgery. The R0 resection rate was 100%, and T0–Tis 33.3% (6/18) achieved pCR. Among these patients, 61.1% (11/18) achieved T0–T1 after surgery, and 72.2% (13/18) achieved N0. Moreover, stage reduction effects were significant compared with preoperative TN staging. Common side-effects include nausea, vomiting, neutropenia, thrombocytopenia, rash, asthenia, constipation, and muscle soreness. Most adverse events were grades 1–2, and grades 3/4 adverse events include one case of grade 3 neutropenia and one case of grade 3 diarrhea (suspected immune-related colitis), which improved after symptomatic treatment. Conclusions: Toripalimab combined with the TP scheme showed preliminary efficacy and controllable safety in the treatment of resectable locally advanced esophageal squamous cell carcinoma and is worthy of further exploration. Clinical trial information: ChiCTR1900025318.
Risk of hepatocellular carcinoma after spontaneous and nucleos(t)ide analogue induced hepatitis B surface antigen seroclearance.
Authors: Yoo Sunghwan , Lee Hyun Woong 
Published: June 2021

e16162 Background: Despite a favorable clinical course, the risk of hepatocellular carcinoma (HCC) still exists in patients achieving HBsAg seroclearance. Therefore, we investigated the incidence of HCC after spontaneous and nucleos(t)ide analogue (NA) induced HBsAg seroclearance in real-life clinical practice. Methods: A cohort study was conducted using data from Gangnam Severance Hospital. We identified all subjects with positive HBsAg between January 1, 2001 and March 21, 2018. NA use, liver biochemistries, serial HBsAg and anti-HBs results were retrieved. The primary endpoint was the incidence of HCC after naturally and NA induced HBsAg seroclearance. Results: Among the 5,609 HBsAg-positive patients, 83 chronic hepatitis B (CHB) patients achieved HBsAg seroclearance during 19 years. The cumulative incidence of HBsAg seroclearance was 0.024% at 2 years to 32.4% at 19 years. Of the 83 patients with HBsAg seroclearance, 52 patients achieved spontaneous HBsAg seroclearance and 31 patients achieved NA-induced HBsAg seroclearance. Of 52 patients with spontaneous HBsAg seroclearance, only one patient (2%) developed HCC 6 months after HBsAg seroclearance. On the other hands, there was no development of HCC in patients with NA-induced HBsAg seroclearance. No significant difference was observed in the cumulative incidence of HCC between two groups ( P=0.443). All patients had sustained HBsAg seroclearance and there was no HBsAg seroreversion. Conclusions: The incidence of HCC was extremely rare after spontaneous and NA induced HBsAg seroclearance in real-life clinical practice. NA-induced HBsAg seroclearance is also as durable as spontaenous HBsAg seroclearance.
The association between real-world CA19-9 level monitoring patterns and with clinical outcomes among patients with metastatic pancreatic ductal adenocarcinoma (mPDAC) in the second- and third-line of therapy.
Authors: George Ben , Chudnovsky Aleksander , Cockrum Paul , Lamarre Neil , Kent Matthew , Surinach Andy 
Published: June 2021

e16251 Background: Pancreatic cancer has an aggressive disease course, mandating close clinical monitoring while on treatment. Evaluation of treatment response in patients with mPDAC necessitates scheduled clinical and radiographic assessments along with monitoring serum CA 19-9 levels. We investigated the impact of serum CA 19-9 monitoring and its association with clinical outcomes in patients with mPDAC who received second- (2L) and third line (3L) in a population-based setting. Methods: Data were extracted from the nationwide Flatiron Health electronic health record (EHR)-derived de-identified database for patients diagnosed with mPDAC and subsequently treated in the 2L or 3L setting between January 1, 2014 and June 30, 2020. Serum CA 19-9 levels at baseline were extracted – defined as the values obtained ≤ 60 days of treatment initiation and during treatment. CA 19-9 levels > 40 IU/mL were considered elevated. Survival analysis was performed using Kaplan-Meier methods. Categorical measures were compared with a chi-square test and survival outcomes with a log-rank test. Results: There were 2,402 patients who received 2L and 790 patients who received 3L treatment included in the study. Among the 2L cohort, median age at treatment initiation was 67 years (IQR: 60 – 73), 54% were male, 57% had an ECOG score of 0-1, and 82% had a baseline serum CA 19-9 level available. Among the 3L cohort, median age at treatment initiation was 67 years (IQR: 60 – 73), 53% were male, 58% had an ECOG score of 0-1, and 84% had a baseline CA 19-9 level available. Most patients in the 2L and 3L cohorts had an elevated CA 19-9 at baseline, 85.2% and 82.0%, respectively. Among the 2L and 3L cohorts, 38.5% and 31.9% had CA 19-9 levels decrease/remain stable during treatment and 27.6% and 31.4% had levels increase during treatment, respectively. Patients with normal baseline CA 19-9 experienced longer survival than patients with elevated levels [2L: 7.2 months (95% CI: 6.1 – 9.2) vs 5.2 months (4.9 – 5.6), p < 0.001; 3L: 6.1 months (5.4 – 9.1) vs 3.9 months (3.4 – 4.3), p < 0.001]. Similarly, patients with decreasing/stable CA 19-9 during treatment had longer survival than patients who had their CA 19-9 levels increase [2L: 8.2 months (7.7 – 8.5) vs 4.3 months (4.1 – 4.7), p < 0.001; 3L: 7.5 months (6.6 – 9.2) vs 3.7 months (3.4 – 4.3), p < 0.001]. Conclusions: In this large, contemporary, real-world study of patients with mPDAC, CA 19-9 levels at treatment initiation had a prognostic value across later lines of therapy. Routine serial monitoring of CA 19-9 levels during treatment, in addition to clinical and radiographic assessment, may help with timely additional diagnostic testing and treatment intervention. Further validation studies are needed to understand the generalizability of these results.