bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of bimodality versus trimodality therapy for esophageal or gastroesophageal junction (GEJ) cancer: Experience from the Princess Margaret Cancer Centre.
Authors: Natori Akina , Sim Hao-Wen , Chan Bryan Anthony , Sun Peiran , Moignard Stephanie , Yokom Daniel , Lim Charles Henry , Jiang Maria , Ma Lucy Xiaolu , Chen Eric Xueyu , Liu Geoffrey , Knox Jennifer J. , Darling Gail Elizabeth , Yeung Johnathan Chi-Wai , Wong Rebecca , Hafezi-Bakhtiari Sara , Conner James , Rogalla Patrik , Jang Raymond Woo-Jun , Elimova Elena 
Published: January 2019

122 Background: There are no phase 3 trials comparing definitive chemoradiation (bimodality) versus. perioperative chemoradiation (trimodality) for locoregional esophageal/GEJ cancer. Methods: A retrospective analysis (2011-2015) compared bimodality and trimodality therapy in patients (pts) with locoregional esophageal/GEJ cancer treated with curative intent. Overall survival (OS) and disease-free survival (DFS) were calculated from the date of diagnosis. Uni- and multivariable Cox proportional hazards regression adjusted for patient and disease factors. Results: Of 108 patients, 82 (76%) were male. Mean ages were 69.5 ± 11.0 years (bimodality; N = 41) and 60.5 ± 11.1 years (trimodality; N = 67). For bimodality pts, 37% had adenocarcinoma and 63% had squamous cell carcinoma (SCC). For trimodality pts, 79% had adenocarcinoma and 21% had SCC (p < 0.0001). Bimodality pts received a higher radiation dose compared to trimodality pts (50.1 ± 6.7 vs. 45.2 ± 6.4 Gy). Median follow-up was 49.3 months. We found no significant OS difference between bimodality (27.0 months) and trimodality therapy (29.8 months) in the overall cohort (p = 0.57) (4 year OS rate: 42% vs. 38%). In the subgroup with adenocarcinoma histology, trimodality therapy significantly improved OS and DFS compared to bimodality (OS: 31.8 vs. 10.4 months, hazard ratio (HR) 0.34, 95% confidence interval (CI) 0.18-0.66, p = 0.001; DFS: 15.0 vs. 6.7 months; HR 0.39, 95%CI 0.21-0.73, p = 0.003). In the SCC subgroup, median OS and DFS were similar (OS: not reached vs. 29.2 months, p = 0.48; DFS: 27.0 vs. 24.0, p = 0.96). Using multivariable regression with AIC backward selection, the only retained prognostic factors were treatment modality (p = 0.06) and histology (p = 0.01). Conclusions: Our findings support preferential use of trimodality therapy for pts with adenocarcinoma histology given superior OS and DFS, whereas bimodality and trimodality therapy appeared comparable in pts with SCC histology. Pending confirmation in a larger series with longer follow-up, these findings suggest differential treatment algorithms for locoregional esophageal and GEJ cancer based on tumor histology.
Updated results of MSCMCC gastric cancer cohort: Indirect comparison between adjuvant chemoradiation and perioperative chemotherapy in gastric cancer patients.
Authors: Mydlowska Magdalena , Rybski Sebastian , Guzel Zuzanna , Kokoszyńska Katarzyna , Wyrwicz Lucjan 
Published: January 2019

123 Background: In the western world gastric cancer patients are either treated with peri-operative chemotherapy or adjuvant chemoradiation and no direct comparisons of these two treatment strategies are available. In our referral gastric cancer center (MSCMCC) we have changed in January 2013 the treatment protocol from adjuvant chemoradiation (like in INT-0116 study) to peri-operative chemotherapy (ECF or CF regimen). Here we report the updated results of single institution indirect comparison of two treatment strategies in the treatment of gastric cancer patients. Methods: 139 consecutive pts who underwent gastrectomy between 2009-2015 treated at MSCMCC were identified in a cohort manner (2009-2012 radiochemotherapy: 60 pts; 2013-2015- peri-operative chemotherapy: 79 pts). The patients’ clinical characteristics were collected from medical records. All patients were followed for relapse and survival with median observation time of 57 and 17 months for chemoradiation and peri-operative chemotherapy respectively. Results: The patients’ characteristics were similar in two groups including, age, sex, ECOG status and Lauren-classification types. DFS was similar in both arms with 47% of patients in radiochemotherapy and 63% of peri-operative chemotherapy patients without relapse at 2 years cut-off (p=0.17). OS was not significantly different between the groups (p=0.783). The toxicity profile was similar in two cohorts, with only leukopenia reported more often in the chemoradiation group (grade 3-4: 43.3% vs 12.3%. p<0.001) and low platelet count (grade 3-4: 6.7% vs 3.7%; p=0.19).There was a trend for excessive mucositis (p=0.067) and diarrhea (p=0.051) in the chemoradiation group. Vomiting more often observed in the peri-operative chemotherapy group (grade 3-4: 29.6% vs 13.3%, p=0.032). Notable, no differences were reported for neutropenia, fatigue and weigth loss. Conclusions: This indirect comparison suggests that results of two modalities are similar in terms of RFS. Further follow up is needed to assess the impact on survival. The toxicity profile favours the peri-operative chemotherapy.
Safety and efficacy of apatinib in elderly patients with advanced or metastatic gastric cancer in the post-marketing phase IV study: Subgroup analysis by age (Ahead-G201).
Authors: Wen Lu , Qin Shukui , Li Jin , Deng Wenying , Wang Junsheng , Zhang Guifang , Zhong Haijun , Jia Tongfu , Ba Yi , Bai Yuxian , Lin Xiaoyan , Wang Mei , Wang Lin , Liu Likun , He Yifu , Tao Min , Xie Congying , Ye Feng , Wu Xiang-yuan , Yang Jianwei 
Published: January 2019

126 Background: Old age is a potential negative predictor, and thus is of interest. Data from the ongoing post-marketing Phase IV trial were collected to assess the effect of age on apatinib treatment in 2000+ patients (pts) with chemotherapy-refractory advanced or metastatic gastric cancer. Methods: This subgroup analysis was stratified by age (<65 or ≥65 yrs). Both incidence of adverse events (AEs) and clinical outcomes were compared. Results: 725 pts <65 yrs and 312 pts ≥65 yrs were enrolled (data cut-off 2017/7/10). Differences in gender, ECOG PS, BMI, disease duration and metastatic sites were observed. 68.6% and 39.7% of pts aged ≥65 yrs experienced AEs of any grade and grade ≥3, which were not different with 70.2% and 40.0% of pts aged <65 yrs. The common AE profile was similar, but elderly pts had a higher incidence of hypertension, diarrhea and bilirubin increase (Table). Pts ≥65 yrs showed a higher objective response rate (12.2% vs. 9.9%) and longer overall survival (7.82 vs. 6.05 mos); however, there was no statistical difference. The disease control rate (79.6% vs. 65.4%; p=0.002) and progression free survival (PFS) (5.71 vs. 3.22 mos; p<0.001) of pts ≥65 yrs were significantly superior to pts <65 yrs. Multivariate Cox regression model confirmed that age ≥65 yr was a positive prognostic factor for PFS independent of baseline and treatment characteristics (HR: 0.67 [95%CI, 0.50–0.88]). Conclusions: Pts ≥65 yr is not at increased risk of overall AEs, but hypertension, diarrhea and bilirubin increase should be closely monitored. The PFS benefit in elderly pts will be validated. Clinical trial information: NCT02426034. [Table: see text]
Metabolic activity to predict clinical response and prognosis in esophageal adenocarcinoma patients treated with bimodality.
Authors: Harada Kazuto , Wu Carol C , Wang Xuemei , Mizrak Kaya Dilsa , Ghazanfari Amlashi Fatemeh , Lin Quan , Blum Murphy Mariela A. , Maru Dipen M. , Weston Brian , Lee Jeffrey H , Bhutani Manoop S. , Hofstetter Wayne Lewis , Nguyen Quynh , Ajani Jaffer A. 
Published: January 2019

127 Background: Patients with localized esophageal adenocarcinoma (L-EAC) who are not suitable for surgery receive definitive chemoradiation. However, there are no biomarkers or imaging variables to predict clinical complete response (cCR; negative bx and physiologic PET post chemoradiation) or prognosticate favorable overall survival (OS). We analyzed tumor metabolic activity by standardized uptake value (SUV) or total lesion glycolysis (TLG). Methods: 266 patients with L-EAC, who declined or were unsuitable for surgery, were analyzed. Cox proportional hazards regression model for OS was analyzed using categorized SUV (low; < 6.5, moderate; 6.5-12.9, or high; ≥12.9) or TLG (low; < 24.2, moderate; 24.2-82.6, or high; ≥82.6). Logistic regression model for cCR was analyzed using categorized SUV (low; < 5.4 or high; ≥5.4) or TLG (low; < 27.0 or high; ≥27.0). Results: Mean SUV and TLG were 12.8 ± 10.7 and 209 ± 376.8, respectively. Both SUV and TLG were significantly associated with the length of the tumor (p < 0.0001) and clinical stage (p < 0.0001). Higher SUV and TLG were significantly associated with shorter OS than low SUV and TLG (moderate SUV; HR 1.79, CI 1.19-2.69, high SUV; HR 2.82, 1.90-4.18, moderate TLG; HR 1.82, 1.14-2.90, high TLG; 3.16, 2.11-4.74). 68 patients (28%) achieved cCR and remained free of recurrence. In the multivariate logistic regression model, low SUV and low TLG highly predicted cCR without recurrence (low SUV; OR 3.15, 1.38–7.19, low TLG; OR 4.79, 2.28-10.08). Conclusions: Tumor metabolic activity is highly associated with prognosis and response to chemoradiation in patients with L-EAC not undergoing surgery. Further refinements (addition of biomarkers) could allow personalized care of these patients.
Survival impact of post-progression chemotherapy (post-Cx) in advanced gastric cancer (AGC): Systematic review and meta-analysis.
Authors: Iizumi Sakura , Takashima Atsuo , Sakamaki Kentaro , Morita Satoshi , Boku Narikazu 
Published: January 2019

130 Background: We conducted a systematic review and meta-analysis to assess the survival impact of post-Cx after first-line chemotherapy (1st-line Cx) and second-line chemotherapy (2nd-line Cx) for AGC. Methods: Phase III trials published in English between 2005 and 2015 or presented at annual meetings of ASCO or ESMO between 2013 and 2015 were searched. No. of patients, types of chemotherapy, and patient characteristics, proportion of post-Cx use (post-Cx%), median progression free survival (mPFS), and median overall survival (mOS) of each treatment arm were surveyed; trials not reporting these were excluded from the study. Median post-progression survival (mPPS) was calculated as difference between mOS and mPFS. Weighted Spearman's correlation coefficients between post-Cx% and survival outcomes (mOS and mPPS) were calculated. The effect of post-Cx% on survival outcomes adjusted for the types of chemotherapy and patient characteristics was evaluated by meta-regressions. Results: Overall, 25 trials were selected: 15 with 31 arms for 1st-line Cx, and 10 with 16 arms for 2nd-line Cx. Weighted Spearman's correlation coefficients between post-Cx% and mOS/mPPS were 0.520/0.739 for 1st-line Cx, and 0.767/0.823 for 2nd-line Cx, respectively. Meta-regression analysis adjusting for types of chemotherapy, age and PS, showed that 10% increase in post-Cx% was associated with prolongation of mOS by 1.033 months for 1st-line Cx and 0.34 months for 2nd-line Cx. Conclusions: Post-Cx% after 2nd-line Cx are correlated with mPPS and mOS as well as 1st-line Cx, suggesting a survival benefit of 3rd-line Cx. [Table: see text]
Redefining the learning curve for robotic esophagectomy.
Authors: Meredith Ken Lee , Huston Jamie , Briceno Pedro , Shridhar Ravi 
Published: January 2019

132 Background: Minimally invasive esophagectomy(MIE) has demonstrated superior outcomes compared to open approaches. The myriad of techniques has precluded the recommendation of a standard approach. The robotic approach has increased steadily. We have previously published our series defining the learning curve for this approach. The purpose of this study is to redefine the learning curve for robotic-assisted esophagogastrectomy with respect to operative time, conversion rates, and patient safety. Methods: We have prospectively followed all patients undergoing robotic-assisted esophagogastrectomy and compared operations performed at our institutions by a single surgeon in successive cohorts. Our measures of proficiency included: operative times, conversion rates, and complications. Statistical analyses were undertaken utilizing Spearman regression analysis and Mann-Whitney U test. Significance was accepted with 95 % confidence. Results: We identified 203 patients (166 [81.8%] male: 37 [18.2%] female) of median age of 67.2 (30-90) years who underwent robotic-assisted esophagogastrectomies for malignant esophageal disease. One-hundred sixty six were adenocarcinoma, 26 were squamous cell carcinoma and 11 were other. R0 resections was performed in 202 (99.5%) of patients. The median lymph node harvest was 18 (6-63). Neoadjuvant chemoradiation was administered to 157 (77.4%) patients. A significant reduction in operative times (p <0.005) following completion of 20 procedures was identified (514 ± 106 min vs. 415± 91 min compared to subsequent 80 cases and further reduced with the subsequent 100 cases 397 ± 71.9 min) p<0.001. Complications decreased after the initial learning curve of 29 cases, p=0.04. However there was an increase in complications after 90 cases in which there was an increase in the Charleson morbidity index, p<0.01 indicating higher risk patients which tapered after case 115. Conclusions: For surgeons proficient in performing minimally-invasive esophagogastrectomies, the learning curve for a robotic-assisted procedure appears to begin near proficiency after 20 cases however as more complex cases are undertake there appears to be an additional learning curve which is surpassed after 90 cases.
Clinical characters and prognostic factors of young female patients (pts) with metastatic gastric adenocarcinoma (GC).
Authors: Cao Yanshuo , Zhang Xiaotian , Li Jian , Gong Jifang , Lu Ming , Lu Zhihao , Wang Xicheng , Zhou Jun , Li Jie , Li Yan , Shen Lin 
Published: January 2019

133 Background: GC is one of the most common cancers worldwide, and has an even higher incidence rate in China. The incidence rate of GC is rising in young pts (≤ 40 years). Previous studies suggested that the percentage of female pts was higher in young pts than that in older pts. The clinical characters and potential prognostic factors have not been well described for young female pts with metastatic GC. Methods: A retrospective chart review was conducted for all GC pts treated at our institution from 1995 to 2012. Pt demographics, clinical characters, treatment related information and survival data were collected. Kaplan-Meier test was used for the survival analysis. Cox regression was conducted for uni- and multi-variate analysis. Results: In total, 1,862 pts with histologically confirmed GC were identified. Among these pts, 11.3% were young pts when first diagnosed. The male to female ratio was 2.76:1 for the whole group and 1:1.02 for young pts. Ninety-eight female pts were ≤ 40 years when diagnosed of metastatic GC. For this group, median age was 35 years (range: 19-40 years). Seventy-one (72.4%) had > 1 metastatic sites, and 85 (86.7%) received palliative chemotherapy. The median overall survival (OS) was 14.9 months (95% confidence interval [CI] 11.8-18.0 months). Seventy-six (77.6%) pts had intact primary tumor when diagnosed of metastatic disease. Compared to 22 pts who relapsed after radical surgery, OS was similar for pts presented with de novo metastatic disease (Hazard Ratio (HR) 1.03, 95% CI: 0.55 to 1.92, P= 0.9). Of these 76 pts, 36 underwent palliative gastric resection, which was associated with improved OS (15.3 vs. 9.0 months; HR 0.37, 95% CI: 0.19 to 0.74, P = 0.003). Forty-six (46.9%) pts had ovarian metastasis, and 20 had oophorectomy. Palliative oophorectomy was associated with significantly improved OS (36.6 vs. 12.4 months, HR 0.34, 95% CI: 0.14 to 0.80, P = 0.013). Conclusions: There was an increased ratio of females in young GC pts. In young female pts with metastatic GC, palliative resection of gastric primary and ovarian metastasis were associated with significantly improved OS, and should be considered in appropriate pts.
Long-term survival of gastric cancer patients with positive immunocytochemistry peritoneal washings.
Authors: Marcisz-Grzanka Katarzyna , Wieszczy Paulina , Malinowska Malgorzata , Wyrwicz Lucjan , Olesiński Tomasz 
Published: January 2019

134 Background: The prognosis in gastric cancer is highly dependent on tumor stage at presentation. Surgery still remains the main therapeutic option in gastric cancer patients. However, the efficacy of this treatment may be substantially limited by the risk of peritoneal dissemination. The introduction of intraperitoneal chemotherapy (HIPEC) may affect the long-term outcomes in this group of patients, but high morbidity associated with such treatment provides the rational to identify the correct population of patients for HIPEC. Methods: This is the long-term effect analysis of prospectively observed cohort of patients assessed with immunocytochemistry peritoneal lavage in the single reffereal center. Between January 2002 and November 2004, the total of 140 patients with histologically confirmed gastric cancer were enrolled to the study. Laparotomy and intraoperative peritoneal lavage for immunocytochemistry examination were performed prior to gastrectomy. The fluid recovered was centrifuged and the sediment was fixed in 10% buffered formalin for 24 h, embedded in paraffin and cut into 4 µm-thick sections. Microscopic slides were also stained against cytokeratin 19 (CK-19), cytokeratin AE1/AE3 (CK-AE1/AE3) and mesothelioma marker. All patients were followed up with endpoints of cancer recurrence and mortality. Results: Median overall survival (OS) in patients with immunocytochemical evidence of free cancer cells in peritoneal washes was significantly shorter than in those without (11 [range: 2-55] vs. 45 [range: 1-164] months). The two groups differed significantly in long-term survival (5-year OS rate: 0.0% [0/17] vs. 43.1% [53/123]; 10-year OS rate: 0.0% [0/17] vs. 29.3% [36/123]) (p < 0.001). Positive peritoneal washing immunocytochemistry was an independent poor outcome prognostic factor after correction for all major prognostic factors. Conclusions: Positive peritoneal washing immunocytochemistry correlated with clinical staging of gastric cancer and was associated with poor overall survival (OS). With all patients dying in 5 years, this subgroup of patients defines a clear population for early salvage HIPEC for prospective verification.
Is there a role for histology based treatment choice in advanced gastric cancer (GC)?
Authors: Barile Rosalba , Squadroni Michela , Brena Federica , Cerchiaro Eleonora , Zurlo Valeria , Beretta Giordano D. 
Published: January 2019

135 Background: Medical management of advanced GC is mostly dependent on prognostic assessment based on tumor stage (TNM) and clinical patients (pts)’ characteristics, other than HER2 expression. Prognostic and predictive factors are clearly needed, and histotype could be proposed as a surrogate marker of disease biology. Methods: We retrospectively analyzed pts with advanced GC treated with first line chemotherapy (CT) at Oncology Unit of Humanitas Gavazzeni (Bergamo) and Policlinico Gemelli (Roma). Pts were divided in three subgroups according to histological diagnosis: diffuse type carcinoma, intestinal type carcinoma and signet ring cell carcinoma. HER2 positive tumors were excluded from the analysis. The aim of our analysis was to compare clinical outcomes of metastatic GC pts receiving first line CT according to histological classification (overall survival: OS and Progression Free Survival: PFS). Results: We analyzed 170 pts. Histological diagnosis was as follows: 24.1% (n=41) signet ring cell, 54.4% (n=92) diffuse type, 21.1%(n=37) intestinal type. Pts received a fluoropyrimidine-based doublet containing cisplatin, oxaliplatin or irinotecan; in three drugs regimen anthracycline was added. In diffuse type subgroup OS was: 11.3 months with oxaliplatin based CT, 7.3 months in cisplatin and 6.2 months in irinotecan (p=0.0054); PFS was 5.2, 3.5 and 4.4 months for oxaliplatin, cisplatin and irinotecan based CT respectively (p=0.0036). In signet ring cell carcinomas OS was 12.1 months with oxaliplatin 13.9 with irinotecan, and 5.6 months with cisplatin (p=0.04), and PFS was 6.5, 8.5 and 2.9 months in pts treated with oxaliplatin, cisplatin and irinotecan respectively (p=0.0008). Among pts with intestinal type we did not detect any significant difference in term of OS and PFS comparing first line schedules. Conclusions: Based on our results, histology may be used as a simple, costless and easy tool in advanced gastric cancer treatment management. Clinical use of biomarkers (with the exception for HER2) which are being evaluated as prognostic or predictive factors in GC, is still controversial. In this scenario, the prognostic / predictive value of histology could play a significant role in treatment decision making.
Validation of the postneoadjuvant therapy pathological stage of the American Joint Committee on Cancer (AJCC) 8th Edition for predicting outcomes of esophageal squamous cell carcinoma (ESCC) patients receiving neoadjuvant chemoradiotherapy (CRT) followed by esophagectomy.
Authors: Liu Tsung-hao , Kuo Hung-Yang , Guo Jhe-Cyuan , Lin Chia-Chi , Huang Ta-Chen , Hsieh Min-Shu , Lee Jang-Ming , Hsu Chih-Hung 
Published: January 2019

138 Background: The AJCC 8th edition staging system introduces a new postneoadjuvant therapy staging category (ypTNM-8th) for ESCC patients receiving neoadjuvant treatment followed by esophagectomy. Whether this new staging category has better prognostic prediction than the pathological staging category of AJCC 7th edition (ypTNM-7th) needs validation. Methods: We enrolled ESCC patients receiving neoadjuvant paclitaxel/cisplatin-based CRT (RT = 40Gy) followed by esophagectomy from three phase II trials conducted in the National Taiwan University Hospital. The prognostic prediction abilities of the ypTNM-8th and the ypTNM-7th on patients’ survivals were compared using Cox regression, concordance index (C-index), R-square, and Akaike information criteria (AIC). Results: A total 135 patients (M:F = 127: 8, median age:53.0 years) were enrolled. With a median follow-up of 31.3 months, the median PFS and OS of all patients were 24.4 months (95% CI: 15.4-33.5) and 33.9 months (95% CI: 22.6-45.1), respectively. In univariate analysis, both ypTNM-8th and ypTNM-7th had statistically significant prognostic effects for PFS and OS. In multivariate analysis on OS, the ypTNM-8th demonstrated a statistically significant predicting effect (P = 0.015) while the ypTNM-7th did not (P = 0.051). Although there is no statistically different between ypTNM-8th and ypTNM-7th by R-square analysis, the ypTNM-8th had lower AIC and C-index for both PFS and OS, meaning an better efficiency of predicting survivals, than ypTNM-7th. Conclusions: The new ypTNM-8th may have better prognostic prediction for OS of locally advanced ESCC patients receiving neoadjuvant CRT than the ypTNM-7th. (Granted by 106-HCH029)