bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence of early-onset gastric and esophagus cancers has changed over time with disproportionate impact on Black and Hispanic patients.
Authors: Torrejon Nataly Valeria , Kamath Suneel Deepak , Wei Wei , Tullio Katherine , Khorana Alok A. 
Published: January 2021

171 Background: The increased incidence of gastro-esophageal junction adenocarcinoma has been well-described, but how the proportion of early versus older onset cancer has changed over time remains incompletely understood. This study characterized the socioeconomic and pathologic characteristics of early-onset gastro-esophageal malignancies. Methods: All patients with gastric cancer (GC) and esophageal cancer (EC) from 2004-2015 in the National Cancer Database were included and categorized by age under or over 60 years. Differences in demographics, disease stage, treatment characteristics and socioeconomic factors between young and older patients were assessed by Chi-square test. The effect of age, race, insurance status, community median income and community educational attainment on overall survival (OS) were assessed using uni- and multivariable Cox models with Bonferonni correction when indicated. Results: The study population comprised 158,599 patients with GC and 139,210 patients with EC. For GC, 43,146 patients (27.2%) were under age 60. The proportion of patients diagnosed under 60 increased over time: 26.7% in 2004-2006, 26.9% in 2007-2009, 27.6% in 2010-2012 and 27.5% in 2013-2015. Compared to older patients, young patients were more likely to be Black (16.7% vs. 13.2%), Asian (7.6% vs. 6.1%) or Hispanic (15.5% vs. 7.7%), diagnosed with stage 4 disease (43.5% vs. 31.3%) and to have poorly differentiated grade (61% vs. 51.7%), p value < 0.0001 for all. For EC, 38,801 patients (27.8%) were under age 60. The proportion of patients diagnosed under 60, decreased over time: 29.6% in 2004-2006, 28.3% in 2007-2009, 27.6% in 2010-2012 and 26.2 % in 2013-2015. Compared to older patients, young patients were more likely to be Black (12.6% vs. 8.2%) or Hispanic (4.2% vs. 3.1%), diagnosed with stage 4 disease (34.3% vs. 26.1%), p value < 0.0001 for all. There was no difference in histologic grade between younger and older patients (41.1% vs. 40.3%, p = 0.85). Age < 60 years was associated with improved OS in both GC and EC. After adjusting for other demographic, socioeconomic, disease stage and treatment-related factors, Black patients had the worst median OS compared to other races in both malignancies as shown in the Table. Conclusions: Early-onset GC has increased over time while early-onset EC has decreased. Patients with early-onset gastric and esophageal cancer are more likely to be Black or Hispanic and to present with stage 4 cancer. Younger patients with GC are also more likely to have poorly differentiated histology. Most concerning, Black patients have the worst OS compared to other races for both GC and EC. [Table: see text]
Impact of gender on treatment and survival of patients with esophageal cancer in the United States.
Authors: Baumrucker Camille , Franceschi Dido , Livingstone Alan S , Macedo Francis Igor 
Published: January 2021

173 Background: Esophageal cancer (EC) is historically a male-predominant disease. Current available evidence on the impact of gender on clinical presentation and survival outcomes of EC is limited by small sample size or single institutional series. Methods: Patients with EC (stage I-III) were identified in the National Cancer Data Base (NCDB, 2004-2016). Clinicopathologic and treatment characteristics of male and female patients were compared using Chi-square analysis. Overall survival (OS) was estimated using Kaplan-Meier method and Cox proportional hazards regression. Results: Of 62,893 patients included, male gender was predominant (77.7% vs 22.3%). Adenocarcinoma was the most common subtype (66.7%); however, squamous cell carcinoma was more predominant in females (57.1% vs. 26.5%, p<0.001). Females were significantly older (68.5 vs. 66.1 years; p<0.001) and more likely African American (AA) (14% vs. 8.1%; p<0.001). Females were more likely to present with local disease (stage I, 19.6% vs. 18.2%; p<0.001), while males presented more likely with locoregional disease (LRD, stage II/III, 80.4% vs 81.8%, p<0.001). Females had worse OS compared to males (18.1 vs. 19.7 mo; p=0.001; cI: 23.5 vs. 31.9mo, p<0.001; cII/III: 17.2 vs 18.3mo, p=0.473). White females had worse OS than white males (18.6 vs. 20.4mo, p<0.001), while AA females had better OS (13.5 vs. 12.6mo, p=0.001). Among patients with LRD, females less frequently received chemotherapy (CT, 75.4% vs. 82.9%, p<0.001), radiation therapy (RT, 78.9% vs. 82.6%, p<0.001), and esophagectomy (28% vs. 40.5%, p<0.001). Females who underwent esophagectomy had improved OS over males (40.3 vs. 32.7mo; p<0.001). More specifically, white females who underwent esophagectomy had improved OS over white males (47.6 vs 38mo, p<0.001); however, AA males and females who underwent esophagectomy had similar OS (33.8 vs 32.6mo, p=0.452). Female gender, advanced age, AA race, high comorbidity score and clinical stage, and lack of access to CT, RT, and esophagectomy were independent predictors of mortality (Table). Conclusions: Females with EC seem to have less access to CT, RT and esophagectomy, which is associated with worse OS compared to males. Healthcare policies should be implemented to increase access to standard of care treatment for female patients with EC. [Table: see text]
Localized diffuse-type gastric adenocarcinoma: Influence of baseline positron emission tomography on survival and therapy response.
Authors: Abdelhakeem Ahmed , Wang Xuemei , Waters Rebecca E , Patnana Madhavi , Estrella Jeannelyn , Blum-Murphy Mariela A. , Trail Allison , Lu Yang , Devine Catherine E , Ikoma Naruhiko , Badgwell Brian D. , Rogers Jane Elizabeth , Ajani Jaffer A. 
Published: January 2021

176 Background: Diffuse type of gastric adenocarcinoma (dGAC) confers a poor but variable prognosis compared to intestinal type of GAC. The value of baseline uptake of FDG-PET in localized dGAC is unclear and ~40% are not FDG-PET avid. We analyzed outcomes based on the avidity (high with SUV > 3.5 or low with SUV ≤3.5) of the primary on baseline FDG-PET. Methods: We retrospectively selected 111 localized dGAC cases who had baseline FDG-PET for staging. We compared the FDG-PET avidity with overall survival (OS) and response to preoperative therapy. Standard statistical methods were utilized. Results: The mean age was 59.4 years and with many female patients (47.7%). All patients had dGAC. The high-SUV group (58 [52.3%] patients) and the low-SUV group (53 [47.7%] patients) were equally divided. While the median OS for all patients was 49.5 months (95% CI: 38.5 – 98.8 months), it was 98.0 months for the low-SUV group and 36.0 months for the high-SUV ( p value = 0.003). While the median PFS for all patients was 38.2 months (95%CI: 27.7 – 97.6 months), it was 98.0 months for the low-SUV group was and 27.0 months for the high-SUV group ( p value = 0.005). Clinical responses before surgery were more common in the low-SUV group but there were only 4 patients with pathologic complete response in the entire cohort. Conclusions: Our unique data suggest that localized dGAC patients with low SUV fare better than those with high SUV meaning highly metabolic GACs consuming glucose confer poor prognosis and overall all dGACs seem resistant to therapy.
A retrospective multicenter study: Clinicopathological factors affecting recurrence-free survival in operable gastric cancer patients.
Authors: Yekeduz Emre , Dogan İzzet , Akbulut Hakan , Karabulut Senem , Utkan Gungor , Urun Yuksel 
Published: January 2021

185 Background:Gastric cancer is one of the most common cancers in Asian countries, particularly. However, according to the American Cancer Society, 27,600 new gastric cancer cases and 11,010 deaths due to gastric cancer will be observed in the US in 2020. The rates of 5-year overall survival (OS) are 69.5% and 32% in the localized and regional diseases. Despite surgery and adjuvant treatment, gastric cancer’s recurrence rate is still not reasonable. In this multicenter study, we aimed to identify the clinicopathological factors that affect gastric cancer recurrence. Methods: Clinical and pathological data of the patients performed surgery between the 2009-2018 in the two university hospitals in Turkey was collected retrospectively. Recurrence-free survival (RFS) was estimated using Kaplan-Meier and categorical variables were compared using a log-rank test. After identifying clinicopathological factors affecting RFS, a multivariate analysis was performed using Cox regression analysis. All statistical analyses were performed using IBM SPSS Statistics software, version 27 (IBM Corp. Released 2020. IBM SPSS Statistics for Windows, Version 27 Armonk, NY: IBM Corp.). Results: Three hundred fifty-four patients were included in this study. Two out of three of all patients were male and the median age at diagnosis was 56 years old (Interquartile Range (IQR):48-64). The median follow-up was 25 months (IQR:15-50). The median RFS was 53.2 months (95% Confidence Interval (CI) could not calculated). 5-year survival rate was 64% and the median overall survival (OS) was 136 months (95% CI: 98-173). According to results of multivariate analysis, there was an increased risk for recurrence in patients with preoperative hypoalbuminemia (albumin < 3.5 gr/dl) [Hazard Ratio (HR): 5.3 (95% CI: 1.2-23.4]; p=0.005), and performed R1 resection [HR:5.7 (95% CI:1.2-25.3), p=0.02]. Additionally, patients administered chemoradiotherapy (CRT) had a lower risk for recurrence compared to those administered chemotherapy (CT) alone [HR:0.15 (95% CI:0.04-0.57), p=0.005]. Conclusions: Hypoalbuminemia in the preoperative setting and R1 resection were independent factors that affected gastric cancer recurrence. However, postoperative CRT decreased the recurrence rate of gastric cancer compared to CT alone. Low albumin level is an indicator of a systemic inflammatory response and according to previous studies, hypoalbuminemia was a poor prognostic factor in gastric cancer patients. Although CT alone is considered efficient for patients undergone D2 lymph node dissection, our study showed that CRT decreased the recurrence rates compared to CT alone. This result might be related to the higher number of patients undergone D1 dissection in our study.
Risk factors for gastric cancers in the United States: Variation by anatomic site and race/ethnicity.
Authors: In Haejin , Friedmann Patricia , Sarkar Srawani , Rapkin Bruce , Castle Philip E. , Epplein Meira 
Published: January 2021

189 Background: Gastric cancer (GC) is a high mortality cancer in the US. Differences in risk factors by anatomic location and race/ethnicity have been suggested but remain understudied in the US population. Methods: The Multiethnic Cohort (MEC) is a prospective cohort study that collected data on 5 racial/ethnic groups [Whites (W), Blacks (B), Latino (L), Japanese-American (JA), and Hawaiian (HA)] from Hawaii and Los Angeles in 1993-1996. Participants completed a detailed baseline survey and were followed for development of incident cancer. Cox regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) to identify GC risk factors by anatomic location (cardia, non-cardia) and by race/ethnicity. Results: Data from 192,626 participants was available. The cohort was 25% W, 17% B, 23% L, 28% JA, and 7% HA. During a median follow up of 20.3 years, 1,109 non-cardia and 201 cardia incident GCs were diagnosed. Older age (per year, non-cardia HR 1.08, 95% CI 1.07-1.92; cardia HR 1.06, 95% CI 1.05-1.09), male sex (non-cardia HR 1.6, 95% CI 1.4-1.8; cardia HR 3.0, 95% CI 2.1-4.4), and current (non-cardia HR 1.7, 95% CI 1.5-2.2, cardia HR 3.4, 95% CI 2.2-5.3) or former (non-cardia HR 1.3, 95% CI 1.1-1.5; cardia HR 2.0, 95% CI 1.3-2.9) smoking were associated with both cancer types. Notably, race/ethnicity (ref W: B HR 3.0, 95% CI 2.2-4.0; L HR 2.5, 95% CI 1.8-3.3; JA HR 3.9, 95% CI 3.0-5.1; HA HR 3.9, 95% CI 2.8-5.5), foreign-born (ref: self & parents US born: HR 1.3 95% CI 1.1-1.7), and family history of GC (OR 1.9, 95% CI 1.5-2.3) were associated with non-cardia GC. BMI ≥30 (HR 1.6, 95% CI 1.1-2.3), having ≥1 drink/week (HR 1.6, 95% CI 1.1-2.3), and being JA (ref W: HR 1.9, 95% CI 1.2-2.9) were associated with cardia GC. Risk factors other than age differed by race/ethnicity for non-cardia GC. Male sex was a risk factor for B, L and JA only. Having less than a high school education was a risk factor for B and JA only, smoking a risk factor for L and JA only, and having diabetes a risk factor for B only. Being in the highest sodium intake quartile was a risk factor among W and HA. A family history of GC was a risk factor for W, L, and JA. Having foreign-born parents was a risk factor for W and being foreign-born was a risk factor for JA. Conclusions: GC risk factors differ between subtypes and, for non-cardia, between race/ethnic groups. These differences provide an insight into the etiology of GC and the disproportionate incidence rates in high-risk groups, potentially aiding in the design of targeted intervention strategies.
Is shift-work associated with increased risk of esophageal cancer for males? A meta-analysis.
Authors: Sun Chenyu , Cheng Ce 
Published: January 2021

190 Background: Globally, more than 570,000 people are diagnosed of esophageal cancer each year. Shift-work involving circadian disruption was designated as a probable cause of cancer by The International Agency for Research on Cancer. Previous studies investigating the relationship between shift-work and esophageal cancer among showed controversial results. Thus, this meta-analysis was conducted. Methods: A comprehensive literature search on PubMed was conducted to identify all relevant studies published prior to September 2020 according to the established inclusion criteria. The quality assessment was performed by the Newcastle-Ottawa Scale (NOS). The pooled odds risk (OR) and 95% confidence intervals (CI) were calculated to estimate the association between the shift-work and esophageal cancer risk. Random-effect or fixed-effect model was used to calculate the pooled OR, based on heterogeneity significance. Subgroup analyses were conducted based on night-shift versus rotating-shift. Sensitivity analysis and publication bias detection were also performed. All statistical analyses were performed using RevMan software (version 5.3; Cochrane library) and STATA 12.0 statistical software (Stata Corp., College Station, TX), and all P values were two-tailed, the test level was 0.05. Results: 21 articles were obtained from database searching, and 9 articles were obtained from other sources. 3 articles involving 52,098 participants were included. All studies were considered moderate to high quality. All included studies investigated only males on the association between shift-work and esophageal cancer risk. A statistically significant association between shift-work and increased esophageal cancer risk among males was found (OR 2.09, 95%CI: 1.48, 2.94, P< 0.0001, I 2= 29%). In subgroup analyses, night-shift work was associated with a non-statistically significant increased risk of esophageal cancer (OR 1.56, 95%CI: 0.96, 2.53, P= 0.07, I 2= 0%). In contrast, Rotating-shift was associated with increased esophageal cancer risk (OR 2.80, 95%CI: 1.72, 4.57, P < 0.0001, I 2= 0%). Sensitivity analysis confirmed the stability of the result. Funnel plot, Egger's test, and Begg's test found no publication bias of analysis (P = 0.572). Conclusions: The current meta-analysis demonstrates that shift-work is associated with increased esophageal cancer risk for males. However, no association between night-shift work and esophageal cancer risk was found. In contrast, association between rotating-shift work and increased esophageal cancer risk was found. Original studies on females regarding shift-work and esophageal cancer risk are lacking. More original studies on this topic for both male and female are needed to further explore shift-work impacts on esophageal cancer risk.
Evaluating the clinical impact of a shortened infusion duration for ramucirumab: A population pharmacokinetic model-based approach.
Authors: Abada Paolo , Lau Yiu-Keung , Wei Ran , O’Brien Lisa , Long Amanda , Piao Yongzhe , Gao Ling 
Published: January 2021

191 Background: Ramucirumab is a human recombinant immunoglobin G1 monoclonal antibody (mAb) antagonist of vascular endothelial growth factor receptor-2. Ramucirumab dosed at 8 mg/kg every 2 weeks or 10 mg/kg every 3 weeks, either as monotherapy or in combination with chemotherapy, was initially studied with as an intravenous infusion over 60 minutes following premedication with a histamine-1 receptor antagonist. Lengthy intravenous infusions are inconvenient for patients and increase the workloads of nursing and administrative staff. Shortening the infusion duration of ramucirumab could therefore benefit both patients and healthcare professionals. The current analysis determined the impact such a change could have on the pharmacokinetic (PK) profile of ramucirumab. Additionally, the relationship between infusion rate and incidence of immediate infusion-related reactions (IRRs; occurring on the day of administration), common adverse events associated with mAb infusions, was assessed. Methods: A population pharmacokinetic model was established using concentration–time data collected from 2522 patients who received one of five different ramucirumab regimens involving an intravenous infusion over ~60 minutes in 17 clinical studies. The final PK model was used to simulate concentration–time profiles and exposure parameters following ramucirumab infusion durations of 30 vs 60 min. Phase II/III clinical study data from patients receiving ramucirumab were pooled to assess the association between ramucirumab infusion rate and incidence of immediate IRRs using multivariate logistic regression analysis. Results: Ramucirumab infusions of 30- and 60-min durations resulted in equivalent concentration–time profiles and, hence, equivalent systemic exposure to ramucirumab. Among 3216 patients receiving ramucirumab in phase II/III studies, 254 (7.9%) had at least one immediate any-grade IRR; 17 (0.5%) experienced grade ≥3 immediate IRRs. The incidence of immediate IRRs (any grade or grade ≥3) was similar across infusion rate quartiles. Under multivariate logistic analysis, infusion rate was not significantly associated with an increased risk of an immediate IRR (odds ratio per 1 mg/min increase 1.014, 95% confidence interval 0.999, 1.030; p=0.071). Conclusions: Administering ramucirumab using different infusion durations (30 vs 60 min) did not affect ramucirumab exposure. Analysis of clinical study data showed a faster infusion rate was not associated with an increased risk of immediate IRRs. It is considered unlikely that shortening the infusion duration of ramucirumab will impact its clinical efficacy or overall safety profile, and is now an option for administration in the U.S.
Lymph node mapping in gastric cancer: A pilot study in Western patients.
Authors: Watanabe Akie , Hamilton Trevor D 
Published: January 2021

192 Background: Adequate surgical lymphadenectomy is integral to the staging and treatment of gastric cancer. A number of Asian studies have explored the utility of lymph node (LN) mapping in gastric cancer but this in not commonly performed in Western countries. We sought to evaluate the utility and safety of LN mapping in Western patients. Methods: We conducted a pilot study of 13 patients with histologically proven non-metastatic gastric adenocarcinoma that received endoscopic peri-tumoral indocyanine green fluorescence (ICG) injections immediately prior to surgical resection to facilitate LN mapping. Illumination with ICG around the primary tumor, in lymphatic basins, tracts, and lymph nodes were confirmed by the PINPOINT system on recorded videos. Descriptive statistical analysis was performed. Results: Among the 13 patients enrolled, median age was 75 years and 7 were men. On pathologic review, 15% were T1, 54% were T2, and 69% had were node negative. Tumours were located in the proximal third in 1 patient, middle third in 2 patients and distal third in 10 patients. All patients had a laparoscopic subtotal gastrectomy and 10 patients had a D2 lymphadenectomy. 5 patients received preoperative and 7 received postoperative chemotherapy. The median number of LNs harvested was 26 [IQR 24-34]. Video confirmation of ICG mapping of the primary tumor, lymphatic basins, tracts, and LNs were obtained in all patients. All LNs identified with ICG uptake were removed with surgical lymphadenectomy. ICG mapped LNs fell outside the D1 distribution in 100% and outside the D1-plus distribution in 54% of cases. ICG mapped LNs were within the D2 distribution in all cases. No ICG related allergic reactions or procedural complications were observed. Postoperative complications included 2 grade A pancreatic fistulas, 1 gastrointestinal bleed, and 1 NSTEMI. Peri-operative morality was zero. Conclusions: We demonstrate ICG lymph node mapping as a safe and useful technique for identifying regional draining lymph nodes and for primary tumor localization in Western patients. The majority of cases found LNs draining outside the D1 and D1+ distributions, highlighting the importance of appropriate lymphadenectomies in gastric cancer.
Impact of age on outcomes and symptoms in patients with advanced gastroesophageal cancer (GEC).
Authors: Almugbel Fahad , Al-Showbaki Laith , Alqaisi Husam , Suzuki Chihiro , Espin-Garcia Osvaldo , Honório Marta , Jang Raymond Woo-Jun , Alibhai Shabbir M.H. , Elimova Elena 
Published: January 2021

193 Background: Although age is a non-modifiable risk factor for most cancers, alone it is not very helpful in deciding on the best treatment for patients. Insufficient data exist in the oldest old ( > 75 years) compared to young-old (65-75 years) and to younger ( < 65 years) patients with de novo metastatic GEC regarding which factors influence response and outcomes. Methods: We retrospectively assessed all patients with de novo metastatic GEC seen from 2006-2015 at the Princess Margaret Cancer Center in Toronto-Ontario, Canada. We used Kaplan-Meier plots and Cox proportional hazards analyses to examine factors associated with progression-free survival (PFS) and overall survival (OS). To examine patient-reported outcomes we used the Edmonton Symptom Assessment System (ESAS) in the first six months of therapy using cross-sectional and longitudinal analyses. Results: A total of 580 de novo metastatic GEC patients were seen between 2006 and 2015. Of these (14%) were oldest old, (31%) were young-old (age 65-75) and 54% were younger ( < 65 years). Most patients (67-80%) were male. Median OS for the entire cohort was 9.1 mo. (95% confidence interval (CI) 8.0 – 10.1); the shortest OS was in the oldest old group at 4.5 mo. compared to 8.7 mo. in young-old and 9.8 mo. in younger group, p < 0.001. PFS was also significantly different among the age groups (4.4 mo., 6.1 mo., and 6.5 mo., respectively), p = 0.0145. In a multivariate model predictors for OS were age (young-old group), number of metastasis, and Eastern Cooperative Oncology Group (ECOG) performance scale (PS). Similar predictors were found for PFS; however, age was not a significant factor. Of the 55 patients who provided ESAS data, 58% were < 65 and 42% were age≥ 65. The most common symptoms at presentation were fatigue, appetite, and well-being. There were no differences by age group (all p > 0.05). Conclusions: Patients age > 75 have poorer OS compared to younger age groups but PFS does not differ, suggesting similar benefits with treatment in appropriately selected older adults with advanced GEC. Symptom profiles were similar with age. Further comprehensive care is needed for older patients with advanced GEC to improve their survival.