bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preoperative prognosis predictors for patients with gastric stump cancers.
Authors: Tokunaga Masanori , Sugita Shizuki , Watanabe Masahiro , Kaito Akio , Kinoshita Takahiro 
Published: January 2019

179 Background: The incidence of GSC is expected to increase as the survival outcome following gastrectomy for gastric cancer improves. Considering poor tolerability to postoperative adjuvant chemotherapy after completion of total gastrectomy, neoadjuvant chemotherapy (NAC) is a plausible treatment strategy for GSC, but it is unclear which clinical factors should make patients candidates for NAC, due to the lack of studies investigating the relationship between clinical factors and survival outcome. The aim of this study was to review preoperative prognostic factors and identify suitable candidates for NAC. Methods: A total of 71 patients with GSC who underwent curative completion total gastrectomy between 1998 and 2015 were included. Preoperative clinical factors and survival outcomes were investigated, and independent prognostic factors were analyzed by Cox proportional hazards model. Results: Median age (range) was 68 (42-82) years, and male-female ratio was 6.0:1. Initial surgery was for benign disease in 21 and for malignant disease in 49 patients. Preoperative diagnosis was cT2-4 in 30 (43%), and cN+, which was defined as lymph node ≥10mm in diameter, in 7 patients (10%). The 3-year recurrence free survival (RFS) rate was 79%. Multivariable analysis revealed cT2-4 as an independent prognostic factor (HR, 2.86; 95% C.I., 1.03-8.64), but clinical N+ was not (HR, 0.64; 95% C.I., 0.10-2.31). When survival curves were stratified by cT, 3-year RFS of cT2-4 (60%) was significantly worse than cT1 (92%, p=0.024) Conclusions: Survival outcomes of patients with cT2-4 seem worse enough for them to be selected as candidates for NAC. On the contrary, cN+ was not associated with worse survival outcome. NAC could be a treatment option for cT2-4 GSC patients irrespective of nodal status.
Validation of the 8th AJCC TNM staging system for gastric cancer: Survival analysis with high volume Asian centers and SEER database by comparing with 7th TNM staging system.
Authors: Son Taeil , Sun Jiyu , Kim Hyoung-Il , Cheong Jae-Ho , Choi Seung Ho , Noh Sung Hoon , Woo Yanghee , Fong Yuman , Park Sohee , Hyung Woo Jin 
Published: January 2019

18 Background: Recently, the 8th AJCC TNM staging system for estimating prognosis for patients with gastric cancer was revised with new subgroups. There are little number of studies have shown its validation with other datasets. We aimed to validate the new TNM staging system by using various datasets with large number of gastrectomies. Methods: We retrospectively reviewed data of 17160, 11324 and 1500 patients treated for gastric cancer in Yonsei University Severance Hospital (SH), The Surveillance, Epidemiology, and End Results (SEER) and Gangnam Severance Hospital (GSH), respectively. Survival curves were plotted and the performance of tumor staging defined by the 7th and 8th TNM staging was compared based on the log-rank test, Concordance index (C-index) and Akaike information criterion (AIC). Results: The performance of predicting survival using the 8th TNM staging system is superior to that of the previous version in SH by evaluating log-rank, C-statistics, and AIC (8444.5 vs. 9263.8, 0.796 vs. 0.798, 104152 vs. 103909), respectively. It is also superior in a data with SEER and GSH (log-rank, C-statistics, and AIC; 3342 vs. 3527, 0.7064 vs. 0.709, 100931 vs. 100820 in SEER, 973 vs. 1031, 0.8021 vs. 0.8038, 7173 vs. 7154 in GSH), respectively. In subgroup analysis of each subclassification, IA, IB, IIA, IIB, IIIA, IIIB, IIIC, and IV in SH, the 8th TNM staging system shows similar or more homogenous survival (0.0324 vs. < 0.001 in Stage IIB, 0.020 vs. < 0.0001 in Stage IIIB, 0.0004 vs. < 0.0001 in Stage IIIC, respectively) in each subclassification than that of the 7th TNM staging system by measuring log-rank p values. Conclusions: The 8th TNM staging system provides more accurate prediction of prognosis of gastric cancer patients than the previous one. In addition, each subgroup in the same stage is relatively homogenous with respect to survival than the previous staging system. It is also applicable to Eastern and Western patients with various backgrounds.
The utility of PET-CT after preoperative chemoradiation in predicting treatment outcomes in locally advanced esophageal cancer.
Authors: Lewis Gary , Teh Bin S. , Dalwadi Shraddha , Chiang Stephen , Butler Edward Brian , Farach Andrew M , Bernicker Eric , Kim Min 
Published: January 2019

182 Background: In the treatment of gastroesophageal junction (GEJ) cancer, trimodality treatment with preoperative chemoradiation followed by surgery is the standard of care. However, predicting patient survival outcomes remains difficult. One possible means of predicting outcomes is comparing pre-treatment PET-CT with post-treatment PET-CT to see if a favorable response on imaging correlates with survival outcomes. Methods: We conducted a retrospective chart review of locally advanced GEJ cancer patients who underwent preoperative chemoradiotherapy followed by esophagectomy with negative margins. All patients underwent two PET-CT scans (before and after preoperative chemoradiation). We compared PET-CT imaging results and pathology results with survival outcomes. Values such as pre-treatment max SUV, post-treatment max SUV, change in max SUV, percent residual max SUV, complete response on PET-CT, and pathologic complete response were analyzed for potential impacts on recurrence rates and survival outcomes. Results: Forty patients had sufficient data to be included in our study. The median follow-up was 22.5 months. The majority of patients were male (82.5%), Caucasian (84.2%) and had adenocarcinoma histology (97.5%). Altogether, 75% of patients had stage III disease and 67.5% had locoregional nodal involvement. The majority (90%) of patients received some form of taxane and platinum based chemotherapy. Pre-treatment max SUV, post-treatment max SUV, change in max SUV, percent residual max SUV, and complete response on PET-CT were not associated with local recurrence, regional recurrence, disease-free survival, or overall survival. Pathologic complete response was associated with a decrease in the rate of distant metastasis ( P= 0.021) but not disease-free survival ( P= 0.411) or overall survival ( P= 0.878). Conclusions: Response on PET-CT after preoperative chemoradiation is not a predictive factor for recurrence, disease-free survival, or overall survival. Pathologic complete response predicted for a decrease in the rate of distant metastasis but not disease-free survival or overall survival.
The feasibility and safety of laparoscopy-assisted distal gastrectomy that was performed by trainee supervised by a technically qualified surgeon.
Authors: Yamada Takanobu , Hayashi Tsutomu , Nakazono Masato , Hara Kentaro , Osakabe Hiroaki , Nagasawa Shinsuke , Kumazu Yuta , Ogata Takashi , Yoshikawa Takaki 
Published: January 2019

183 Background: The laparoscopic gastrectomy is becoming widespread. But acquisition of its technique is challenging. We investigated whether supervision by a technically qualified surgeon (QS) affects the feasibility and safety of laparoscopic gastrectomy performed by trainee (TR). Methods: The outcomes of laparoscopy-assisted distal gastrectomy for gastric cancer performed by QS group and TR group between 2013 and 2016 were assessed. A laparoscopic surgeon qualified by the Endoscopic Surgical Skill Qualification System (Japan Society for Endoscopic Surgery) participated in surgeries that ware performed by trainee as the teaching assistant. Results: All patient characteristics were not different between QS group and TR group, except of BMI (median BMI 23.9 vs 22.2, p = 0.01). Although operation time of TR group was longer than that of QS group (median time: 248 min. vs 285 min., p = 0.01), Blood loss and number of harvested lymph nodes were not different. One patient (0.3%) in QS group and two patients (0.4%) in TR group required conversion to open surgery (p = 0.58). Postoperative complication, that was defined by Clavien-Dindo classification grade 3 and more, occurred in four patients (11.4%) in QS group and nine patients (5.4%) in TR group (p = 0.25). Complication in QS group were anastomotic leakage (n = 2) and abdominal abscess (n = 2), whereas that in TR group were anastomotic leakage (n = 3), anastomotic stenosis (n = 2), pancreatic fistula (n = 1), bowel obstruction (n = 1), pneumothorax (n = 1), and cerebral hemorrhage (n = 1). One patient in QS group (2.9%) and four patients in TR group (2.4%) underwent reoperation (p = 1.00). Postoperative mortality occurred in one cases in TR group (0.01%). Conclusions: The laparoscopy-assisted distal gastrectomy of TR group supervised by QS was feasible and safe procedure as well as that of QS group.
Staffing turnover effect of fellowship-trained surgical specialists on oncologic outcomes in community cancer center.
Authors: Franko Jan , Kraemer Soren , Goldman Charles David , Frankova Daniela , Raman Shankar 
Published: January 2019

187 Background: Contemporary health care is delivered in highly interdependent team-based environment. Transitions in surgeon complement may be associated with a disturbance of workflow, especially in smaller-sized community cancer centers. Herein we examined the impact of two surgical oncologists turnover in our cancer center. Methods: Survival outcomes of all cases of esophageal, gastric, rectal and pancreatic adenocarcinoma treated in the index cancer center (n = 1,445) were compared to then-contemporary standard derived from Iowa-SEER registry, 2001-2015 (n = 12,617). Period before and after changeover of surgeons was compared using descriptive statistics and regression model. Results: Substantial reduction of annually referred (101.8±9.2 versus 60.5±0.7 case per year, p = 0.026) and operative cases (37.0±4.5 versus 17.5±3.5 cases per year, p = 0.027) was seen during fully-staffed versus on-boarding periods at the index hospital. At the state level, there was no fluctuation of annually referred cases (898.0±19.8 versus 910.5±35.6 cases per year, p = 0.384) and minimal decrease in operated cases (366.2±18.0 versus 335.0±24.1 cases per year, p = 0.020) in early versus late period. New surgical team was able to improve upon survival of resectable esophageal cancer patients in the index hospital and maintain survival of other complex GI malignancies as compared to geographically relevant standard of Iowa-SEER registry. Survival regression model on all 5,795 non-metastatic cases with available data, adjusted for age, stage and primary disease site, demonstrated that being treated in the index hospital did not result is inferior survival comparing early and late period (HR = 1.060, p = 0.237). Conclusions: Loss of surgical cancer specialists was associated with profound & significant loss of referrals to the index cancer center, and likely outmigration of patients from the community seeking advanced care. Quick restoration of surgical services may reinstate overall efficacy of care for resectable cancer cases without negative survival effect.
Prognostic factors for survival in apatinib-treated gastric cancer: Results from a post-marketing phase IV study (Ahead-G201).
Authors: Qin Shukui , Deng Wenying , Wen Lu , Wang Junsheng , Zhang Guifang , Zhong Haijun , Jia Tongfu , Yang Jianwei , Ba Yi , Bai Yuxian , Lin Xiaoyan , Wang Mei , Wang Lin , Liu Likun , He Yifu , Tao Min , Xie Congying , Ye Feng , Wu Xiang-yuan , Li Jin 
Published: January 2019

19 Background: Easily detectable and reliable prognostic factors for apatinib response in gastric cancer are of great interest. In this study, 42 characteristics were test for their prognostic value. Methods: Data were collected from the ongoing single-arm phase IV trial in patents (pts) with advanced or metastatic adenocarcinoma of the stomach or gastroesophageal junction after failure of ≥2 lines of chemotherapy. Kaplan–Meier and multivariable Cox analysis were conducted. Results: As of 2017/7/10, 1037 pts were enrolled. 820 were evaluable for survival. The median progression free survival (PFS) and overall survival (OS) was 4.60 and 6.57 m. Age, metastatic lesions, region, treatment interruption, leucocyte decrease and adverse events (AEs) occurrence were independent prognostic factors for PFS, while ECOG PS, disease duration, metastatic lesions, region, developed city, initial dose, treatment interruption, BMI, AST abnormal, hand-foot-skin reaction (HFSR), leucocyte decrease and AE occurrence for OS (Table). Conclusions: Multiple demographics, baseline clinical and laboratory indexes, treatment related indicators and occurrence of AEs can predict the efficacy of apatinib in gastric cancer. Updated results will be reported to guide the clinical application of apatinib. Clinical trial information: NCT02426034. [Table: see text]
Targeted next-generation sequencing (NGS) of germline DNA to identify genetic predisposition to gastric cancer (GC) in patients with CDH1-mutation negative early-onset (EO) or familial GC (FGC).
Authors: Ku Geoffrey Yuyat , Mukherjee Semanti , Okoro Chizoba , Sharma Medha , Ravichandran Vignesh , Offit Kenneth , Joseph Vijai , Janjigian Yelena Yuriy , Stadler Zsofia Kinga , Kelsen David Paul 
Published: January 2019

20 Background: While GC arises as part of several hereditary cancer syndromes, a genetic etiology is not identified for most FGC kindreds and EOGC patients. We hypothesize that NGS of germline DNA may reveal previously unsuspected genomic alterations that predispose to EOGC/FGC. Methods: We identified 42 Pts from a prospective GC registry with CDH1-mutation negative EOGC (≤50 years old) and/or with FGC. Germline DNA was analyzed by MSK-IMPACT, a 468-gene targeted NGS panel that includes > 70 genes associated with known cancer predisposition syndromes. GATK HaplotypeCaller (HTC) was used to call SNVs and Indels simultaneously from the sequence read data and joint calling of all samples was used to generate VCF files. We annotated the VCF with public annotators and public allele frequencies from large sequencing studies. Manual variant curation was performed and were classified by ACMG criteria (Genet Med 2015;17:405), with only likely pathogenic and pathogenic variants included. Results: 41 Pts (98%) had early onset and 11 Pts (26%) had FGC (9 had ≥1 1st or 2nd degree relatives with GC). Median age was 40 (range, 18 to 55) and 23 (55%) were men. Ethnicities were 21 (50%) White, 13 (31%) Black, 6 (14%) Asian and 2 (5%) unknown. 40 (95%) had poorly differentiated and/or diffuse histology. Pathogenic mutations were diagnosed in 4 Pts (10%). 1 Pt had a BRCA2 mutation; his father had prostate CA and a paternal aunt had breast CA but he did not meet current NCCN criteria for BRCA testing. Three additional pathogenic mutations were FGFR1, SOX17 and KMT2D; none has previously been described in GC susceptibility but are associated with GC carcinogenesis. All 3 Pts had EOGC. None had FGC but all 3 had ³1 1st-degree relative with CA ( FGFR1: breast, uterine, appendix; SOX17: breast; KMT2D: osteosarcoma). Further functional work of these variants and segregation analysis is on-going. Conclusions: MSK-IMPACT identified germline mutations in 10% of Pts; most are previously not known GC predisposition genes. NGS can be an important clinical tool for screening multiplex families and also a research tool for discovering genes that predispose to GC.
Cabozantinib (C) versus placebo (P) in patients (pts) with advanced hepatocellular carcinoma (HCC) who have received prior sorafenib: Results from the randomized phase III CELESTIAL trial.
Authors: Abou-Alfa Ghassan K. , Meyer Tim , Cheng Ann-Lii , El-Khoueiry Anthony B. , Rimassa Lorenza , Ryoo Baek-Yeol , Cicin Irfan , Merle Philippe , Park Joong-Won , Blanc Jean-Frédéric , Bolondi Luigi , Klümpen Heinz Josef , Chan Stephen Lam , Dadduzio Vincenzo , Hessel Colin , Borgman-Hagey Anne E. , Schwab Gisela , Kelley Robin Kate 
Published: January 2019

207 Background: C, an inhibitor of MET, VEGFR, and AXL, has previously shown clinical activity in pts with advanced HCC. This phase 3 trial (NCT01908426) evaluated C vs P in previously treated pts with advanced HCC. Methods: In this double-blind, global, phase 3 trial, pts were randomized 2:1 to receive C (60 mg qd) or matched P stratified by disease etiology (HBV, HCV, other), geographic region (Asia, other), and presence of extrahepatic spread and/or macrovascular invasion (EHS/MVI). Eligible pts had pathologic diagnosis of HCC, Child-Pugh score A, ECOG PS ≤1, and must have received prior sorafenib. Pts received up to two lines of prior systemic therapy for HCC and must have progressed following at least one. The primary endpoint was overall survival (OS). Secondary endpoints were investigator-assessed progression-free survival (PFS) and objective response rate (ORR) per RECIST 1.1. The study was designed to detect a hazard ratio (HR) for OS of 0.76 (90% power, 2-sided α = 0.05) at the final analysis with two prespecified interim analyses at 50% and 75% of the planned 621 events. Results: As of 1 Jun 2017, 707 pts were randomized, and 484 deaths had occurred (317 out of 470 for C; 167 out of 237 for P). Baseline characteristics were balanced between the two arms: median age was 64 years, 82% were male, 38% had HBV, 24% had HCV, 25% enrolled in Asia, 78% had EHS, 30% had MVI, 85% had EHS/MVI, and 27% had received two prior systemic therapy regimens for advanced HCC. The study met the primary endpoint at the second planned interim analysis with median OS 10.2 mo for C vs 8.0 mo for P (HR 0.76, 95% CI 0.63-0.92; p = 0.0049). Median PFS was 5.2 mo for C vs 1.9 mo for P (HR 0.44, 95% CI 0.36-0.52; p < 0.001), and ORR was 4% vs 0.4% (p = 0.0086). The most common grade 3/4 adverse events (predominantly grade 3) with higher incidence in the C vs P arm included hand-foot skin reaction (17% vs 0%), hypertension (16% vs 2%), increased aspartate aminotransferase (12% vs 7%), fatigue (10% vs 4%), and diarrhea (10% vs 2%). Conclusion: C significantly improved OS and PFS vs P in previously treated pts with advanced HCC. Adverse events were consistent with the known safety profile of C. Clinical trial information: NCT01908426.
Evaluation of systemic inflammation based prognostic scores in patients with advanced oesophageal cancer receiving palliative radiotherapy.
Authors: Dolan Ross , Tilling Elliot , Kong Chia Y , MacLeod Nicholas James , McSorley Stephen Thomas , Park James Hugh , Glen Paul , Horgan Paul G. , Laird Barry , McMillan Donald C 
Published: January 2019

21 Background: The presence of a systemic inflammatory response (SIR) in patients with advanced cancer is an increasingly recognised prognostic domain and is commonly assessed by the Glasgow Prognostic Score (GPS) and modified Glasgow Prognostic Score (mGPS). However, little work has been carried out to evaluate their role in palliative radiotherapy. The aim of the present study was to compare the prognostic value of the GPS/mGPS in patients with advanced oesophageal cancer receiving palliative radiotherapy. Methods: Those patients receiving palliative radiotherapy for oesophageal cancer between 2010 and 2015 were examined (n=194). After exclusions the following demographic data was recorded sex, age, indication for radiotherapy, time from treatment to death/last clinic visit, medical comorbidities, tumour and radiotherapy location/dose, CRP, albumin, and differential blood counts. GPS, mGPS, NLR, PLR and LMR were all calculated and Cox regression analysis carried out in SPSS. Results: Patients who had undergone non-oesophageal/neoadjuvant radiotherapy (n=2) or died within 30 days of treatment administration were excluded (n=22). Of the remaining 170 analysed, 112 (66%) were male and the median age was 72 (Range: 43-91). The most common clinical indications for radiotherapy were dysphagia (n=142), weight loss (n=81) and pain (n=50). Medical comorbidities varied with the most common being hypertension (n=83), ischaemic heart disease (n=46) and COPD (n=42). At the time of analysis, 170 (100%) of the patients were dead with median survival of 6 months (Range: 1-81 month). On univariate six month cancer specific survival analysis, TNM stage (p=0.028), GPS (p<0.001) and mGPS (p<0.001) were significantly associated with poor survival. On multivariate analysis of the significant variables, only mGPS (HR: 2.28, 95%CI 1.29-4.01, p=0.004) and TNM stage (HR: 1.71 95%CI 1.09-2.69, p=0.020) remained independently associated with survival. Conclusions: In the palliative radiotherapy setting, systemic inflammation based scores (GPS/mGPS) had prognostic value and the mGPS had independent prognostic value.
Effect of transarterial chemoembolization plus external beam radiotherapy on survival of patients with hepatocellular carcinoma showing macroscopic vascular invasion compared with sorafenib: A randomized trial.
Authors: Yoon Sang MIN , Lee So Jung , Kim Jong Hoon , Shin Ji Hoon , An Jihyun , Lee Han Chu , Ryoo Baek-Yeol , Lim Young-Suk 
Published: January 2019

210 Background: Sorafenib is the sole treatment option for advanced stage hepatocellular carcinoma (HCC) with macroscopic vascular invasion (MVI) with unsatisfactory response rate and survival benefit. Combined transarterial chemoembolization (TACE) plus external beam radiotherapy (RT) has shown promising results in these patients by observational studies. Here, we report the efficacy and safety of TACE plus RT compared to sorafenib in patients with advanced HCC and MVI. Methods: This study was a randomized, open-label trial at an academic tertiary care center. Between 2013 and 2016, 90 treatment-naive patients with liver-confined HCC showing MVI were randomly assigned to receive sorafenib (400 mg twice-daily; n = 45; sorafenib group) or TACE (every 6 weeks) plus RT (within 3 weeks after the first TACE; n = 45; TACE+RT group). Primary endpoint was 12-week the progression-free survival (PFS) rate by intention-to-treat analysis. Radiologic response was assessed by independent review according to Response Evaluation Criteria in Solid Tumors (version 1.1). Crossover of treatment was permitted after confirming disease progression. Results: All patients had portal vein invasion of HCC and Child-Pugh class A liver function. The median maximal tumor diameter was 9.7 cm. At week 12, the PFS rate was significantly higher in the TACE+RT group than the sorafenib group (77.8% vs. 26.7%; P< 0.001). The TACE+RT group showed significantly higher radiologic response rate (33.3% vs. 2.2% at 24 weeks; P< 0.001), significantly longer median time to disease progression (30 weeks vs. 8 weeks; P< 0.001), and significantly longer overall survival (55 weeks vs. 43 weeks; P= 0.04), compared with the sorafenib group. No patients in the TACE+RT group discontinued treatment due to hepatic decompensation. Conclusions: In patients with advanced HCC showing MVI, first-line treatment with TACE+RT was well-tolerated and provided improved progression-free survival, objective response rate, time to disease progression, and overall survival, compared with sorafenib treatment. Clinical trial information: NCT01901692.