bluuebunny/crossref_metadata_2025_split huggingface dataset:
Introduction of #PancChat: A novel Twitter platform to inform and engage the pancreatic cancer community.
Authors: Ocean Allyson J. , Gusani Niraj Jaysukh , Beg Muhammad Shaalan , Maitra Anirban , Viana Julissa , Rosenzweig Allison , Zelada-Arenas Fatima , Whiteley Andrew , Huneke Cassie , Gavin Cindy Price , Randel Susan , Frame Lisa M 
Published: January 2019

242 Background: Twitter provides a platform for health care stakeholders to disseminate information about diseases to patients, caregivers, and doctors. Chats are especially effective because participants can interact directly with experts. Pancreatic cancer (PC) conversations on Twitter previously were sporadic and inconsistent. The authors report the creation of #PancChat, a first-of-its-kind Tweet Chat developed to provide relevant, credible, and timely information to the PC community. A collaboration between leading PC organizations, a pharmaceutical company, and an academic oncologist, PancChat is an example of successful outreach using an accessible communications tool. Methods: Launched in April 2016, the hour-long monthly chat is a live event publicized and promoted through multiple social media channels and major news outlets. It is moderated and focused around a pre-selected topic. The hashtag #PancChat is used to filter specific chatter into a single conversation. Participants include patients, caregivers, physicians, researchers, top ASCO social media influencers, AACR members, and advocacy organizations. Moderators and participants are drawn from 23 academic institutions. The PancChat team corresponds with participants and replies to tweets that are not addressed during the chat. Results: Since its inception, PancChat has had a total of 28 million impressions (the total number of times each tweet is seen) from 16 chats, averaging 1.75 million per chat. Popular topics include clinical trials (1.4 million), familial/hereditary PC (2.9 million), and early detection (2.2 million). The average engagement rate is 72% which measures how much people interact with a tweet by clicking or sharing links. From April 2016-August 2017 there were 8,502 tweets using #PancChat. Conclusions: Impression and engagement numbers show that this novel PancChat platform fulfills a need for the PC community. The narrow focus of each chat provides an opportunity to learn about the disease, research, and clinical trials. Participants return knowing that they will interact with PC experts. The popularity of PancChat among patients and doctors confirms the power of social media to reach a specific community.
Skeletal metastases in advanced pancreatic ductal adenocarcinoma (PDAC): A retrospective analysis.
Authors: Puri Akshjot , Chang John , Dragovich Tomislav , Lucente Patricia , Kundranda Madappa N. 
Published: January 2019

245 Background: Skeletal metastasis (SM) in advanced PDAC is an infrequent occurrence and has been previously reported to be < 2.5%. However; pathological fractures in these patients can result in intractable pain, immobilization and a significant deterioration in quality of life. Methods: A retrospective analysis was conducted of patients (pts) with advanced PDAC receiving palliative chemotherapy. Data collection included age, gender, ECOG, sites of disease, and overall survival (OS). Statistical analysis included Kaplan Meier survival analysis. Results: The 135 pts included had a median age of 65.8 years (range: 53.7–91.3); 5 (31.2%) were women and 11 (68.7%) had an ECOG performance status of 0 or 1. A majority of patients received combination therapy that was either gemcitabine or 5-flurouracil based. Sixteen pts (11.8%) had skeletal metastasis with the primary tumor located in the pancreatic body/tail (11 pts - 68.7%).The sites of SM included thoracic vertebrae (8), lumbar vertebrae (5), pelvis (5), ribs (4), sacrum (4), scapula (3), acetabulum (2), cervical vertebrae (2), femoral head (2), sternum (1) and humerus head (1). A majority of the lesions were osteolytic (62.5%) with a median time of diagnosis of SM from initial diagnosis being 1.25 months (range 0-33). Bone pain was observed as the initial symptom in 5 pts (32%), 1 pt (6.2%) had a pathological fracture. The mOS for patients with SM was 6.5 months (range 0-38) when compared to 8 months (range 0-147) without SM.The mOS for pts treated with gemcitabine based regimen was 5.75 months (range 2.5-14), and patients who received multiple lines of therapy including gemcitabine and 5-FU based regimens was 15 months (range 5-38). Survival from onset of skeletal metastases ranged from 0-14 months (mOS: 4 months). Conclusions: More effective systemic therapies which improve mOS are likely to result in increased incidence of SM. The most common sites observed were the thoracic and lumbar vertebrae and pathological fractures in these sites can be catastrophic. Therefore careful evaluation of skeletal signs and symptoms, early detection and intervention will be important to prevent morbidity and mortality from pathological fractures.
Relationship between ethnicity and overall survival (OS) in patients with advanced hepatocellular carcinoma (HCC) treated with sorafenib (S).
Authors: Meyers Daniel E. , Lee-Ying Richard M. , Alghamdi Mohammed Abdullah , Cheung Winson Y. , Samawi Haider , Tam Vincent C. 
Published: January 2019

248 Background: The SHARP and Asia Pacific (AP) trials showed that S improves OS compared to placebo in advanced HCC. However, OS was worse in the AP trial which included predominantly Asian patients. It is unclear if ethnicity, or perhaps Hepatitis B (HBV) infection, is a poor prognostic factor for these patients. The purpose of this study was to determine whether ethnicity affects OS in patients with advanced HCC being treated with S. Methods: All patients treated with S for HCC in Alberta, Canada from 01/2008 to 07/2016 were included. Patient demographics and clinical/pathological variables were retrospectively collected. Patients were dichotomized by ethnicity as either East Asian or not according to a validated list of surnames. Survival outcomes were assessed with Kaplan-Meier curves and compared with the log-rank test. A Cox-proportional hazard model was constructed with ethnicity and relevant clinical/pathological characteristics to assess their impact on survival. Results: A total of 175 patients were included. Mean age was 64 years. 78% were men, 28% were East Asian, and 79% were Child-Pugh A at initiation of S. The most common etiologies of underlying liver disease were Hepatitis C (HCV) (31%), HBV (29%) and alcohol (21%). 42% had distant metastatic disease. The majority of patients had an ECOG performance status of 0 (26%) or 1 (64%). Median OS was 9.0 months in Asians and 9.5 months in non-Asians (p = 0.68). On multivariate analysis, ethnicity (HR 0.76, 95% CI 0.39 – 1.32, p = 0.33) was not a significant prognostic factor for OS. However, lack of distant metastases (HR 0.57 95% CI 0.40 - 0.82, p < 0.01), initial AFP < 400 (HR 0.54 95%CI 0.38 - 0.78, p < 0.01) and 3+ localized treatments (HR 0.60 95% CI 0.39 - 0.92, p = 0.02) were associated with better OS. Further, HBV was associated with inferior OS when compared to HCV (HR 2.12, 95% CI 1.08 - 4.17, p = 0.03). Conclusions: When treated with S in one Canadian province, ethnicity does not appear to be a prognostic factor for OS. However, HCV infection, lack of distant metastases, initial AFP < 400, and 3+ previous localized treatments were significant prognosticators of OS. We are validating these findings in a larger multi-centre Canadian dataset.
Gauging public awareness and interest related to pancreatic cancer: An analysis of Google search volumes.
Authors: Mukhija Dhruvika , Khorana Alok A. , Sohal Davendra 
Published: January 2019

250 Background: Over the last 2 decades, the internet has become a major source of medical information. Infoveillance, i.e., public health surveillance using online content analysis has become a powerful tool and internet search activity has been used as a surrogate to gauge public awareness and interest for particular diseases. We aimed to evaluate the search volume for pancreatic cancer (PC), using colon cancer (CC), as a comparator, using data from a popular search engine. Methods: Using Google Trends, a public web facility of Google Inc., based on Google Search, we compared the relative frequency of search terms ‘pancreatic cancer’ and ‘colon cancer’ between 1st January 2004 and 31st August 2017 (n = 164 months). The program assigns a reference value of 100 for the point of maximum popularity from among all the search terms during the search period and provides comparative monthly scores, which we termed relative interest scores (RIS). The RIS for each cancer was then adjusted for incidence (i.e., 53,070 for PC and 95,270 for CC, based on 2016 data), calculated per 10,000 patients and termed ‘i-RIS’. A p-value of < 0.05 was considered significant. Results: For the entire duration, the maximum popularity (RIS = 100) corresponded to a point in March 2008 for PC, likely related to the diagnosis of a famous celebrity during that month. Similar but smaller surges in RIS were observed for other significant news events related to PC during other months (January 2009, October 2009 and October 2011). Overall, the mean (±S.D) RIS for PC and CC were 32.52±8.98 and 50.18±6.44, respectively (p < 0.001). However, the i-RIS was somewhat higher for PC (6.12±1.69) as compared with CC (5.26±0.67) (p < 0.001). Conclusions: Internet search data can provide estimates of public awareness and interest related to cancer. For PC, incidence-adjusted search volumes show spikes in search volumes related to major news events, providing internal validation of these results. Generating news items and promotion by celebrities may play a significant role in the success of cancer awareness campaigns.
Prognostic value of neutrophil-lymphocyte ratio during palliative chemotherapy in patients with unresectable gallbladder adenocarcinoma.
Authors: Lee Jae Woo , Lee Sang Hyub , Son Jun Hyuk , Kang Jinwoo , Paik Woo Hyun , Ryu Ji Kon , Kim Yong-Tae 
Published: January 2019

253 Background: Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) is a valuable prognostic marker in several kinds of solid tumors. This study aimed to evaluate the NLR, PLR and change of NLR and PLR over time as a prognostic marker in unresectable gallbladder cancer (GBC) which is treated with palliative chemotherapy. Methods: A total of 163 patients with pathologically confirmed unresectable GBC were enrolled. Baseline and post 1-cycle chemotherapy NLR and PLR were used in analysis. The changes in NLR and PLR were defined as the ratio of post chemotherapy value to baseline value. The relation between survival time and NLR and PLR changes were analyzed. Results: NLR and PLR had AUC value of 0.679, 0.660 in predicting 1-year overall survival (OS) and NLR 1.96 and PLR 111 were the optimal cutoff value with the highest sum of sensitivity and specificity. NLR change and PLR change had AUC value of 0.517, 0.519 in predicting 1-year OS and NLR change 0.4, PLR change 0.6 were the optimal cutoff value. Patients with NLR lower than 1.96 had better OS (16.1 months vs. 9.5 months, p < 0.001) and similarly patients with PLR lower than 111 had better OS (17.3 months vs. 9.5 months, p < 0.001). However, NLR change lower than 0.4 didn’t show better OS (9.2 months vs. 11.6 months, p = 0.178), and the same with PLR change lower than 0.6 (8.5 months vs. 11.3 months, p = 0.138). Conclusions: Baseline NLR and PLR is a valuable predictor of overall survival in unresectable GBC undergoing palliative chemotherapy, whereas NLR and PLR change over time is not.
Effect of surgical resection on survival following neoadjuvant chemotherapy in patients with stage I-II pancreatic adenocarcinoma.
Authors: Henrix Ryan James , Rouanet Eva , Schultz Kurt , Ali Tasneem , Switzer Bradley Alan , Bathini Venu Gopal , Whalen Giles Francis , Lafemina Jennifer 
Published: January 2019

255 Background: Pancreatic adenocarcinoma (PDAC) is a lethal malignancy, representing the 4th leading cause of cancer deaths. Our 2011 institutional protocol guides that patients with Stage I/II PDAC receive neoadjuvant chemotherapy (FOLFIRINOX or gemcitabine- nab-paclitaxel); a similar protocol is followed with patients with Stage III disease. The aim of the study is to determine if potentially curative surgery provides added survival benefit, compared to neoadjuvant chemotherapy alone. Methods: Patients who received neoadjuvant chemotherapy and who were diagnosed with stage I-III PDAC from 2011-2017 at a tertiary medical center were included in this prospectively-collected, retrospective analysis. The primary endpoint was overall survival (OS). Kaplan-Meier curves are compared using Log-rank. Cox proportional hazards were used to adjust for confounders. Results: 105 patients met inclusion criteria: 38 (36%) had Stage I disease (n = 18 had neoadjuvant chemotherapy and surgery [N+S], n = 20 had neoadjuvant chemotherapy [N] alone), 44 (42%) had stage II (N+S n = 20, N n = 24), 23 (22%) had stage III (N+S n = 4, N n = 19). There was no difference in 5-year OS regardless of treatment regimen in patients with Stage I (median OS N+S 22.5 mo vs N 27.9 mo; p = 0.99, HR 1.00, 95%CI 0.74-1.35) or Stage II disease (median OS N+S 28.7 mo vs N 27.6 mo; p = 0.69; HR 1.06, 95%CI 0.79-1.41). There is a trend towards improved OS with N+S in those with Stage III disease (median OS N+S 46.0 mo vs N 14.5 mo, p = 0.08), but the number who underwent resection is low (17%), limiting this analysis. Conclusions: In patients with Stage I-II PDAC, potentially curative surgery may not provide additional survival benefit beyond that afforded by modern day neoadjuvant chemotherapy. Stage III outcomes are limited by small numbers, and the impact of surgery is unclear. It may be possible that the locally unresectable tumor that is rendered resectable with neoadjuvant chemotherapy may be associated with a more favorable biology, such that surgery offers added survival benefit. Additional large-scale trials are needed to confirm whether newer therapies may obviate the need for resection in select patients.
Protease/protease inhibitor balance in blood plasma to predict postoperative complications in operated patients with pancreatic head cancer.
Authors: Kit Oleg Ivanovich , Frantsiyants Elena , Kozlova Larisa S. , Bandovkina Valeria A. , Kolesnikov Evgeniy N. , Kozhushko Mikhail Anatolievich , Kazieva Tanzila Beksultanovna , Averkin Michail , Trifanov Vladimir 
Published: January 2019

258 Background: Our purpose was to study the protease/protease inhibitor (P/PI) balance in the blood plasma of patients with cancer of the head of the pancreas before and after pancreatoduodenal resection (PDR) with postoperative complications. Methods: The study was performed using clinical observation, biochemical examinations and statistical analysis in Microsoft Office Excel 2010. The blood plasma of 92 patients with pancreatic head cancer (53 men and 39 women aged 45-76 years, Т2-4N0M0) was studied before the surgery (b/s) and on days 1, 7, 14 and 17 after PDR. The patients were divided into two groups: g1 – 69 patients without postoperative (p/o) complications and g2 – 23 patients with p/o complications: generalization – 7, thrombosis - 8, acute postoperative pancreatitis - 2, gastrostasis - 2, anastomotic leakage - 4 patients. Kinetics of trypsin-like proteases (TLP) and α-1-proteinase inhibitor (α1PI) was studied by spectrophotometry. The data were compared with the blood plasma of 39 healthy donors (N). Results: TLP activity b/s exceeded N in g1 and g2 by 4.1 and 10.6 times; TLP in g2 was 2.6 times higher than in g1. The α1PI activity b/s was higher than N by 1.2 times (p < 0.05) in g1 and lower than N by 2.0 times in g2; α1PI in g2 was 2.4 times lower than in g1. After PDR, activity of TLP increased in all patients on day 1 but decreased on days 7-14 in g1 remaining 2.7 times higher than N by the discharge. The TLP activity in g2 by the discharge was similar to levels b/s and exceeded g1 by 4.4 and N by 12.1 times. The α1PI activity after PDR increased in all patients on days 1-17, but in g1 by the discharge it was similar to N and in g2 it was 1.5 times lower than N. The TLP/α1PI ratio was higher in g2 than in g1 at all times. Conclusions: A high TLP activity and a low α1PI activity, compared to N, were maintained in the blood plasma of all patients with p/o complications, despite their types. The P/PI balance in g2 was shifted to the left being 5.5-9.0 times higher than in g1 at all times which allowed the prognosis of postoperative complications before the surgery, perioperatively or on day 1 after the surgery.
Effect of outside referrals to a tertiary care liver tumor board on diagnostic testing and initial curative therapy.
Authors: Zhang Yapei , Arango Jennifer , Weinreb Jeffrey , Taddei Tamar Hamosh 
Published: January 2019

259 Background: Hepatocellular carcinoma (HCC) is a complex and unique cancer. Arriving at the optimal treatment plan is best accomplished by a multidisciplinary tumor board (MDTB). We hypothesized that patients referred from outside institutions to our tertiary care center for MDTB review may face disparities in diagnosis and treatment. Methods: We performed chart review of incident HCC cases presented from 2/1/13-2/1/16 at an American College of Surgeons accredited MDTB that convenes weekly at a tertiary care, university-affiliated hospital. We examined variables such as demographics, originating institution, liver disease etiology, location of index imaging, date of first tumor board presentation, diagnostic method (imaging, biopsy, tumor board consensus), BCLC stage at diagnosis, initial treatment, and time to treatment. Results: 167 cases of HCC were referred from 37 outside institutions (outside cases); 127 cases originated from our institution (internal cases). The two groups were comparable in gender distribution, liver disease etiology, and BCLC stage at tumor board presentation. Compared to internal cases, outside cases were diagnosed less often by imaging (47% vs. 77%, p < 0.000001) and more often by biopsy (38% vs. 17%, p < 0.001) or MDTB consensus (16% vs. 6%, p < 0.05). When stratified by BCLC stage, this difference in diagnostic method persisted in early and mid-staged patients (Stages 0, A, B), but not in advanced staged patients. Outside cases were also more likely to receive tumor biopsy (33% vs. 9%, p < 0.05) and less likely to receive initial curative therapy (resection, ablation, transplantation) (22% vs. 32%, p < 0.05). There was no significant difference in time to treatment. Conclusions: Despite similar demographics and disease profiles compared to patients from our tertiary care center, patients referred from outside facilities for MDTB review more often required biopsies or MDTB consensus to diagnose HCC, and were less likely to receive curative therapy. Differences in HCC diagnostic imaging protocols across institutions may help explain these results. Further study will help identify disparities in receipt of curative therapy.
Defining the number of lymph nodes needed to accurately stage small bowel neuroendocrine tumors: An 8-institution study from the US neuroendocrine tumor study group.
Authors: Zaidi Mohammad , Lopez-Aguiar Alexandra G , Dillhoff Mary , Beal Eliza W , Poultsides George A. , Makris Eleftherios , Rocha Flavio G. , Crown Angelena , Idrees Kamran , Marincola Smith Paula , Nathan Hari , Beems Megan , Abbott Daniel , Barrett James , Fields Ryan C , Davidson Jesse T , Cardona Kenneth , Maithel Shishir 
Published: January 2019

265 Background: Small bowel neuroendocrine tumors (SB-NETs) frequently involve regional lymph nodes (LNs). The prognostic value of LN positivity on recurrence of disease is not well defined. The number of LNs needed to accurately stage patients is unknown. Methods: All patients with primary SB-NETs who underwent curative-intent resection at 8 institutions in the US Neuroendocrine Tumor Study Group between 2000 and 2016 were identified. Patients with distant metastatic disease were excluded. The association of LN positivity with recurrence of disease and the extent of lymphadenectomy required were analyzed. Results: Of 2182 patients with resected NETs, 203 had SB-NETs. Median age was 60 yrs, 56% were male, and median follow-up was 39 months. 83.5% of patients (n = 157) had LN positive disease. There was no difference in 3-year recurrence free survival (3-yr RFS) among patients with 1 or 2 positive LNs compared to patients with negative LNs (p = 0.63). Patients who had 3 or more positive LNs had a worse 3-yr RFS compared to those with 0, 1, or 2 positive LNs (n = 92 vs n = 73; 3-yr RFS 82% vs 92%; p < 0.001). Retrieval of 8 or more LNs was associated with a higher positive LN count compared to less than 8 LNs (4.6 vs. 1.6; p = 0.002). However, an increasing LN ratio was not associated with 3-yr RFS. When examining patients who had less than 8 lymph nodes retrieved, there was no difference in 3-yr RFS in those patients with 3 or more positive LNs compared to those with 0, 1, or 2 positive LNs (3-yr RFS: 100% vs 91%; p = 0.37). Retrieval of more than 8 lymph nodes, however, accurately discriminated patients with 3 or more positive LNs compared to those with 0, 1, or 2 positive LNs (3-yr RFS: 79.7% vs 93.5%; p = 0.005). Conclusions: For patients undergoing curative-intent resection of small bowel NETs, accurate lymph node staging requires a minimum of 8 lymph nodes for examination. 3 or more positive LNs is associated with decreased 3-yr RFS compared to 0, 1, or 2 positive lymph nodes. A thorough regional lymphadenectomy is critical for accurate staging and management of patients with small bowel neuroendocrine tumors.
Utility of comprehensive genomic profiling (CGP) to distinguish neoplasms pathologically diagnosed as PanNETs and PanNECs and identify potentially actionable genomic alterations (GA).
Authors: Singhi Aatur D. , Stephens Philip J. , Ross Jeffrey S. , Miller Vincent A. , Ali Siraj Mahamed , Schrock Alexa Betzig 
Published: January 2019

274 Background: The majority of pancreatic neuroendocrine neoplasms are classified as pancreatic neuroendocrine tumors (PanNETs) or carcinomas (PanNECs). These are distinct entities with respect to clinical presentation, prognosis and treatment; however, locally advanced/metastatic cases may exhibit overlapping histopathologic features and, thus are challenging to differentiate and may result in inappropriate management. Recent sequencing studies have identified key differences between PanNETs and PanNECs. PanNECs often harbor recurrent GA in RB1, and members of the RAS/MAPK and TGF-β pathways. In contrast, PanNETs frequently exhibit GA in chromatin remodeling genes (e.g., MEN1, DAXX and ATRX). The purpose of this study was to evaluate the utility of CGP in the pathologic assessment of locally advanced/metastatic pancreatic neuroendocrine neoplasms. Methods: Hybrid-capture based CGP was performed for up to 315 cancer-related genes and intronic regions of up to 28 genes rearranged in cancer on 318 locally advanced/metastatic pancreatic neuroendocrine neoplasms. Results were correlated with submitting histopathologic diagnoses. Results: Among 50 pathologically-classified PanNETs, 41 (82%) and 9 (18%) cases harbored GA consistent with a PanNET and PanNEC, respectively. In comparison, among 268 pathologically-classified PanNECs, 209 (78%) and 59 (22%) cases had GA compatible with a PanNET and PanNEC, respectively. Commonly altered genes in CGP-classified PanNETs include: MEN1 (37%), DAXX (21%), CDKN2A/B (20%), ATRX (11%), TSC2 (10%), TP53 (8%), PTEN (8%), ARID1A (7%) and SETD2 (5%). Defects in the BRCA pathway were seen in 10% of PanNETs. Conversely, CGP-classified PanNECs had GA in TP53 (54%), RB1 (49%), KRAS (46%), CDKN2A/B (21%), GNAS (10%), PTEN (9%), SMAD4 (7%), MYC (7%) and ARID1A (6%). Conclusions: Pathologic discrimination between PanNETs and PanNECs can be difficult, but incorporating CGP improves the classification of these neoplasms. Further, the identification of recurrent GA in members of the BRCA family highlights a potential therapeutic target for locally advanced/metastatic PanNETs.