bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinicopathological description of a subset of schistosoma mansoni associated colorectal cancer patients in an endemic area in Brazil.
Authors: Almeida Gustavo Fernandes Godoy , Freitas Mauricio Assuero Lima de , Lira Mariana M M , Domingues Ana Lucia Coutinho , Neares Lais , Silva Lauro Vinicius Machado da , Moura Maxwell , Maior Marcelo , Mattos Luiz Alberto Reis ,   ASQO - Advanced Support for Quality-of-life in Oncology
Published: May 2019

e15154 Background: Schistosoma have been implicated in colorectal carcinogenesis. We aim to describe clinicopathological description of a subset of Schistosoma mansoni-associated colorectal cancer patients in an endemic area in Brazil. Methods: We have performed a survey at cancer registry and identified those colorectal cancer patients who underwent biopsy and/or surgery in our institution in the last 10 years. We performed a comparison between Schistosoma- and non-Schistosoma colorectal cancer patients. T-test were performed to compare clinico-pathological features. Results: 300 hundred patients were identified. From this population, 83 patients had encounters at gastroenterology unit, where schistosoma patients (among those with other diseases) are treated. Among them, 7 patients presented both conditions (colorectal cancer and schistosomiasis), corresponding to 8.4% of these selected population. We identified diferences among Schistosoma- and non-Schistosoma colorectal patients neither in age of cancer diagnosis nor in terms of laterality. We did not find diferences in terms of metastatic disease rate between both populations, however, we have observed a higher incidence of limph node metastasis among Schistosoma colorectal patients. Conclusions: Schistosoma colorectal patients present similarity in terms of age of cancer diagnosis and laterality when compared to non-Schistosoma colorectal patients, however, lymph node metastasis are increased in this population. Next publications from our group will provide information about survival curves and genetic profile.
Reirradiation and/or surgery for locoregionally recurrent rectal cancer: A systemic review and meta-analyses.
Authors: Rim Chai Hong , Lee Jeongshim 
Published: May 2019

e15159 Background: Locoregional recurrence of rectal cancer (LRRC) might be occurred even after combination treatments including surgery and pelvic radiotherapy. Re-irradiation might provide the control of recurrence and/or symptomatic palliation, but possible complications are fearful hindrances. This study is to integrate information from various clinical studies, regarding re-irradiation and/or surgery of LRRC, and to provide practical information for clinical decision making. Methods: We searched four databases including pubmed, MEDLINE, Cochrane library, and Embase. The primary endpoint was overall survival (OS), and secondary endpoints were complications of grade ≥3, local control rate (LC), and symptomatic palliation rate. Results: A total of 17 studies, involving 18 cohorts and 744 patients with LRRC were included. Median OS among included studies ranged from 10 to 45 months (median: 24.5 months). Pooled 1-, 2-, and 3- year OS rates for all LRRC patients were 76.1% [95% confidence interval (CI): 61.7-86.3], 49.1% (38.5-59.7), and 38.3% (30.2-47.2), respectively. For patients who underwent re-irradiation and surgery (OP group), pooled 1-, 2-, and 3- year OS rates were 85.9% (95% CI: 74.0-92.9), 71.8% (54.6-84.4), and 51.7% (39.4-63.8). For patients who underwent re-irradiation but not surgery (non-OP group), pooled 1-, 2-, and 3-year OS rates were 63.5% (95% CI: 51.1-74.4), 34.2% (20.4-51.2), and 23.8% (15.4-34.8). The difference between two subgroups were significant for all 3 years analyses. Pooled 1-, 2-, and 3- year LC rates for OP group were 84.4% (95% CI: 75.5-90.4), 63.8% (55.2-71.5), and 46.9% (39.6-54.4), and for non-OP group were 72.0% (95% CI: 48.8-87.4), 54.8% (28.6-78.5), and 44.6% (16.6-76.5). The difference between subgroups were not statistically significant for all 3 years analyses. Pooled overall grade ≥3 acute complication rate was 11.7% (95% CI: 6.7-19.5), and for late complication was 25.5% (95% CI: 16.7-40.0). Patients who underwent surgery had a higher risk of grade ≥3 late complications (OR: 6.39, 95% CI: 3.2-12.7). Pooled symptomatic palliation rate was 75.2% (95% CI: 67.3-81.8). Conclusions: Re-irradiation and/or surgery might be an option with oncologic and palliative efficacies, where combined surgery provided more favorable survival outcome. However, late complication should be carefully considered especially when combined with surgery.
Prognostic impact of SOX9 in stage II colon cancer: Results from a large nationwide cohort.
Authors: Hansen Torben , Kjær-Frifeldt Sanne , Eriksen Ann Christina , Lindebjerg Jan , Jensen Lars Henrik , Jakobsen Anders Kristian Moeller , Sørensen Flemming Brandt 
Published: May 2019

e15165 Background: Up-regulation of the transcription factor SOX9 has been described in colon cancer, and it has been argued that differences in the expression levels dictates cell proliferation. The aim of the present study was to analyze the prognostic impact of SOX9 in stage II colon cancer. Methods: Individual patient data and formalin fixed paraffin embedded tumor tissue were collected from a large unbiased, population-based cohort, representing all patients operated for stage II colon cancer in Denmark in 2002 and 2003. The SOX9 expression was evaluated by immunohistochemistry on whole tumor sections. Patients were classified into three groups dependent on the SOX9 expression gradient in the tumor: luminal, peripheral, and uniform for comparison with the clinical data. The endpoint was disease free survival (DFS). Results: A total of 1,153 patients were included. We detected an expression-dependent relationship between SOX9 and prognoses. Patients with tumors exhibiting a luminal expression pattern (N = 267, increasing SOX9 expression towards the luminal compartment of the tumor) were characterized by a significantly better DFS compared to the uniform (N = 846) and peripheral (N = 40) patterns, p = 0.0070. The five-year DFS rates were 74%, 67%, and 56%, respectively. Multiple Cox regression analysis, adjusted for all standard high risk factors, confirmed an independent prognostic advantage of the luminal SOX9 expression pattern, as compared to the uniform pattern, hazard ratio (HR) 0.7211 (95% confidence interval (CI) 0.5561-0.9351), p = 0.0137, whereas the possible disadvantage of the periphery pattern could not be verified, HR 1.4393 (95% CI 0.8869-2.3660), p = 0.1405. Conclusions: The present results support a prognostic impact of SOX9 in stage II colon cancer. The consequence of an altered SOX9 expression seems to differ between intra-tumoral compartments, and we propose that a gradient-dependent evaluation should be applied to provide the most clinically relevant information about this transcription factor.
Incidence and severity of postoperative complications following neoadjuvant therapy and full-thickness local excision for moderately advanced rectal cancer.
Authors: Abdalla Ahmed , Aref Amr , Alame Amer , Barawi Mohammed , Hawasl Abdelkader , Yakan Adli 
Published: May 2019

e15167 Background: Trans-anal full-thickness local excision (LE) for patients with moderately advanced rectal cancer (MARC) whose tumors respond well to neoadjuvant therapy, is one approach for organ preservation. Some authors call for abandoning this procedure because it causes frequent and severe complications. We aim to report our post-operative complications rate and severity following this procedure. Methods: This is a retrospective review of the complications observed in 10 patients who underwent LE at our center between May 2017-January 2019. Primary outcomes were the presence and nature of complications associated with the treatment course. Results: Five patients were treated according to Phase II trial and received three months of FOLFOX chemotherapy followed by concurrent chemo-RT. Five additional patients received only concurrent chemo-radiotherapy as they were treated off protocol. Radiation therapy (RT) dose ranged between 45-54 Gy and the interval between completion of RT and LE ranged between 6-15 weeks; median 11.5 weeks. Gross residual disease was resected with no margin in nine patients. The size of removed specimens ranged between 6.8-1.4cm; median 2.2 cm with a depth of resection of 1.5-0.4 cm; median .6 cm. Two patients had a very low residual gross abnormality and the surgical resection extended to the dentate line. Both patients experienced grade III complications of severe pain, infection and fistula formation. Of the remaining 8 patients with tumors located between 3-8 cm from the anal verge, two patients developed grade II complications requiring a short course of antibiotics and symptomatic treatment. In both cases, symptoms resolved within one week. Conclusions: Post-operative complications in this setting are not prohibitive if LE doesn’t extend to the dentate line and the resection is limited to only residual abnormality with no mucosal margin. A complete pathological response, confirmed by LE after neoadjuvant therapy provides valuable prognostic information and can influence the intensity and burden of future follow up. The risk of surgical complications is acceptable in view of these advantages. LE remains a viable option in pursuing organ preservation for MARC when complete remission is achieved by neoadjuvant therapy.
Current treatment strategies and patterns of recurrence in locally advanced colon cancer.
Authors: Huynh Caroline , Minkova Stephanie , Kim Diane , Stuart Heather , Hamilton Trevor D 
Published: May 2019

e15171 Background: Locally advanced colon cancer (LACC) is a frequent presentation and has a high rate of recurrence. The aim of this study was to evaluate current population-based strategies in LACC patients, and to analyze patterns of recurrence. Methods: We conducted a retrospective review of all patients treated at a regional cancer agency with a diagnosis of LACC between 2005 and 2015 treated with curative intent resection. Inclusion criteria were adults with T4 colon cancer, 16 cm above the anal verge, with no evidence of distant metastases. Descriptive statistics were used to define the study population. Kaplan-Meier and Cox-proportional hazards modeling were used for survival analysis. Results: 1394 patients with LACC were reviewed. Median age was 69 [IQR 60-77] and 49.3% were female. Primary tumor location was right-sided in 57.1% of cases. Most tumors were T4a (69.4%) and 39.4% were node positive. A total of 35.4% had urgent/emergent surgery, 46.4% were at least partially obstructed, 22.0% were perforated and 1.9% had a diverting ostomy as an initial operation. En-bloc multi-visceral resection occurred in 23.5% of cases. Positive margins were present in 14.3%. Only 1.6% had neoadjuvant chemotherapy and 0.8% had neoadjuvant chemoradiation. Adjuvant chemotherapy was delivered in 59.8% and adjuvant chemoradiation in 2.8%. Median follow up was 37 months. During follow up 681 (48.9%) patients died and 584 (41.9%) patients developed recurrence. In the entire cohort, rates of recurrences were local-regional (14.7%) and distant metastatic (35.1%). Overall survival for the entire cohort was 63 months [95% CI 55.7-70.3] and recurrence-free survival was 61 months [95% CI 38.8-83.2]. Multivariate analysis identified age (HR 1.03, 95% CI [1.02-1.05] p < 0.001), node negative status (HR 0.62, 95% CI [0.45-0.84] p = 0.002) and positive margin (HR 1.79, 95% CI [1.24-2.57] p = 0.002) as predictive of overall survival after adjusting for confounding factors. Predictive factors for recurrence-free survival were node negative status (HR 0.55, 95% CI [0.39-0.77] p < 0.001) and positive margin (HR 1.51, 95% CI [1.02-2.23] p = 0.038). Conclusions: Recurrence after curative intent treatment for LACC is common. Recurrence and survival patterns are significantly influenced by tumor nodal status and margin positivity.
LONG TERM opioid use in RURAL NON-metastatic colon cancer patients.
Authors: Araujo-Mino Emilio Paul , Bulbul Ajaz , Minhas Hamza , Bautista Adriana , Lentkowski Lisa , Khorsand-Sahbaie Masoud 
Published: May 2019

e15174 Background: Cancer related pain and subsequent long-term opioid (LTO) use worsens the opioid epidemic and facilitates abuse. Non-metastatic colon cancer (CC) is a potentially curable malignancy and prescription opioid (PO) may increase risks of adverse events when CC has been eradicated. Methods: A retrospective study evaluated stage I-III CC patients between January 2013 and January 2018 across rural cancer clinics in New Mexico who received PO during their cancer diagnosis and treatment. It excluded patients with stage IV CC, concurrent malignancies and non-cancer pain. Descriptive statistics, Chi-square and logistic regression were performed to identify correlation and predictors of LTO use. Results: Among 197 patients identified, opioids were prescribed in 24% (48/197); 22 patients met inclusion criteria. Mean age was 65.1±9.8 years; 68% male; Stage I (4.5%), II (36.3%), III (59.1%). Adjuvant chemotherapy was given in 91% (20/22). Oxaliplatin regimen was used in 63.6% (14/22). One year after therapy, 27.3% (6/22) still had neuropathy. The rate of opioid use was 72.7% (16/22) at 3 months, 54.5% (12/22) at 6 months and 41% (9/22) at 12 months; 56.2% (9/16) of opioid users at 3 months were also using opioids at 12 months from initial prescription (X2 5.71 p = 0.046). Also, 75% (9/12) of opioid users at 6 months, continued using opioids at 12 months (X2 12.7 p = 0.0001). Patients with smoking history, unemployed and PO from a surgeon, were more likely to be LTO users at 12 months; however, it was not statistically significant. Conclusions: Non-metastatic CC patients who continue to use opioids at 3 months are at a significantly higher risk of LTO use at one year. Biological and social factors in rural communities can be important determinants of this use pattern. The challenges surrounding opioid use and the need for safe and effective alternative analgesics require urgent attention and regulatory discourse.
Liver findings and risk of recurrence in locally-advanced rectal cancer (LARC): An Italian retrospective cohort study.
Authors: Damato Angela , Besutti Giulia , Bonelli Candida , Venturelli Francesco , Giorgi Rossi Paolo , Vicentini Massimo , Pattacini Pierpaolo , Pinto Carmine 
Published: May 2019

e15175 Background: Despite the combination of fluoropyrimidine chemotherapy and long course radiotherapy (50.4 Gy) followed by TME, LARC still results in 30% distant recurrence within 2-3 years after surgery. One of the most affected organs is the liver. We aimed to analyze if basal liver pathological alterations and drug-induced liver damages influence the liver recurrence. Methods: 50 patients (pts) with LARC treated with neoadjuvant chemoradiotherapy (NACRT) between June 2010 and June 2017 in a single center were included. Liver function tests (LFTs) including AST, ALT and GGT at baseline and after NACRT were evaluated. The first staging CT scan and, when available, post-NACRT CT scan were reviewed to assess steatosis (unenhanced liver density < 48 HU or liver-to-spleen ratio < 1.1), and liver volume. Associations of baseline LFTs and CT liver alterations and changes after NACRT with liver metastasis (LM) during follow-up were evaluated with Hazard Ratio (HR) and respective 95%CI calculated with Cox analysis. Results: The characteristics of pts were: 68% males, median age 60.4 ys (range 34-84), cTN stage II (32%) and stage III (64%). During a follow-up ranging from 1.5 to 7 ys, 17(34%) pts developed distant recurrence and 7(14%) LM. At baseline, 2 pts had GGT > 73 U/l and 11(22%) had steatosis. After NACRT, 4(9%) pts had AST > 40 U/I and/or ALT > 49 U/l with > 2-folds increase, 6 (40%) of the 15 pts with available unenhanced post-NACRT CT had steatosis development, or increase (≥10 HU density decrease), and 9 (27%) of 33 pts with available post-NACRT CT had a > 10% increase in liver volume. LM was associated with female sex (p = 0.016). Baseline steatosis, post-NACRT steatosis development or increase, > 10% liver volume and transaminase increase were associated with LM (HR = 3.36, 95%CI = 0.75-15.1; HR = 3.67, 95%CI = 0.33-40.7; HR = 2.91, 95%CI = 0.59-14.5; HR = 3.05, 95%CI = 0.33-27.72, respectively). All the reported associations almost disappeared, when considering all-sites of distant recurrence. Conclusions: Even if small numbers cannot exclude that associations are due to chance, baseline liver steatosis and post-NACRT liver damage may be involved in LM during follow-up of LARC.
Prognostic factors for severe diarrhea in patients with locally advanced rectal carcinoma treated with neoadjuvant chemoradiation with capecitabine: A single-center cohort study.
Authors: Hartman Wesley , De Hoop Esther Oomen , Verhoef Cornelis , Nuyttens Joost , van Meerten Esther 
Published: May 2019

e15176 Background: Chemoradiation with concomitant capecitabine (CRT) followed by total mesorectal excision is the standard of care for locally advanced rectal carcinoma (LARC). Grade ≥ 3 diarrhea is considered a dose-limiting toxicity of adding capecitabine to radiotherapy. The aim of this study is to describe the risk factors of grade ≥ 3 diarrhea in patients with LARC during CRT. Methods: A single centre retrospective cohort study was conducted in our tertiary center. All patients with LARC treated with CRT from 2009 to 2015 were included. Patients with local recurrence who received CRT for the first time were also included. Univariate logistic regression analyses were used, followed by a multivariate analysis of the significant factors with backward selection at p < 0.05. Results: A total of 738 patients were included: 67% male, median age 64 years (range 17-88), 95% primary presentation. DPYD-testing was not performed upfront. In this cohort 69 patients (9%) developed ≥3 grade diarrhea. In the univariate analysis, factors significantly associated with ≥3 grade diarrhea were; female gender, age ≥65 years, body weight and decreased renal function (defined as MDRD GFR < 60 ml/min/1,73 m2). The following factors remained significantly associated with ≥3 grade diarrhea in the multivariate analysis; female gender (odds ratio (OR) 2.77, 95% confidence interval (CI) 1.54-4.99, p 0.001), age ≥65 years (OR 2.85, 95% CI 1.63-4.98, p < 0.001) and a lower bodyweight (OR 0.98, 95% CI 0.96-1.00, p 0.015). Conclusions: Female gender and age ≥65 years significantly increase the risk of grade ≥ 3 diarrhea caused by neoadjuvant CRT for LARC. So, older female patient must be closely watched during this treatment to intervene on time. The difference in toxicity between females and males might be explained by the pelvic anatomical differences between men and women. The found prognostic factors will be validated in a second cohort of patients with LARC treated with CRT. Besides, sarcopenia will be tested as a prognostic factor as well.
Neoadjuvant treatment of adenocarcinoma of the rectum: Historical analysis and correlation between pathological regression rate and the outcomes.
Authors: Basso Jeziel , Azevedo Sergio Jobim , Nassif Pereira Lima Marta , Damin Daniel C. , Liedke Pedro Emanuel Rubini , Moreira Luis Fernando , de Souza Pereira Fernando , Pereira Rodrigo Perez 
Published: May 2019

e15177 Background: Treatment of locally advanced rectal cancer is based on chemoradiation associated with surgery. This treatment has high potential for curability. Tumor regression grade appears to be a prognostic factor and be influenced by the timing of surgery. Methods: A retrospective database was formed. We included patients submitted to neoadjuvant chemoradiotherapy and rectal surgery, treated at the Hospital de Clínicas, Porto Alegre. We analyzed outcomes, pathologic and treatment toxicity data. TRG was mensurated by the modified Ryan method, as the AJCC. We sought to analyze the better timing for surgery after chemotherapy, comparing the weeks after surgery with the rate of pCR. Statistical analysis was done with Kaplan Meier, Pearson's Chi-square and the Cox regression method. Results: We accrued 156 patients between 2006 and 2018. The rate of PFS at 3 and 5 years were 75% and 70%, respectively. The 5-year overall survival was 91%. The rate of pCR was 12.8%. TRG was an important prognostic factor. The absence of a pathological response (TRG 3) was associated with an increase in mortality, HR 3,148 (95% CI 1.6-12.2 P 0.003) and a decrease in PFS, HR 3,148 (95% CI 1, 7-5.8 P 0.0001). The 5-years PFS with TRG 0,1, 2 and 3 were 95%, 87%, 73.3% and 48%, respectively. Comparing the time between neoadjuvant treatment and surgery of less than 8 weeks versus 8 and 12 weeks versus above 12 weeks, the rates of pCR were 4.3%, 18.6% and 7.1% and the rates of TRG 3 were 32,6%, 18,6% and 57,1% (P 0.016). The chemotherapy regimens included 5FU bolus (75.1%) and capecitabine (19.1%). Doses of radiotherapy above 45 Gy were received by 80.5% of patients. Adjuvant treatment was not performed in 30.6% and 16.6% of these cases had positive pathological lymph nodes. The grade 3/4 adverse event rate was 21.6%. Conclusions: The outcomes found are favorable. The pathological tumor regression grade is an important prognostic factor. New strategies such as total neoadjuvant may play a role considering the rate of patients who cannot perform adjuvant chemotherapy. The time after neoadjuvant treatment seems to influence the tumor regression rate, especially between 8 and 12 weeks.
Investigating the effect of chemotherapy combined with ketogenic diet on stage IV colon cancer.
Authors: Furukawa Kenji , Shigematsu Kyousuke , Katsuragawa Hideo , Tezuka Toru , Hataji Kenichiro 
Published: May 2019

e15182 Background: The effectiveness of carbohydrate restriction to limiting cancer growth has often been observed in in vitro and in vivo experiments; however, few cases of clinical efficacy have been reported. We examined the clinical effectiveness of chemotherapy with ketogenic diet for advanced cancer treatment. Methods: We administered chemotherapy with a modified medium-chain triglyceride (MCT) ketogenic diet at a ratio of 1.4:1 in 10 patients with stage IV recurrent colon cancer for one year and performed a conversion surgery in five of the cases. We followed-up for the next 3 years, compared the overall survival (OS) of the chemotherapy-only group of the stage IV colon cancer patients, and investigated the factors contributing to an improved OS. Results: Evaluations in the first year revealed a response rate of 21% and disease control rate of 64% for patients in the chemotherapy-only group. Patients in the ketogenic diet-chemotherapy combination group exhibited a response rate of 60%, disease control rate of 70%, and complete response rate of 50% for the five conversion surgeries. The time to conversion surgery was 4.0±0.9 months and the time to postoperative recurrence was 6.2±2.6 months. Regarding the duration of overall survival, there was no significant difference ( p value = 0.98) upon comparing the ketogenic diet group with the chemotherapy-only group (32.5 months and 37.9 months, respectively). However, overall survivals were 50 months, 23.0 months, and 32.5 months for the ketogenic diet-chemotherapy combination response group, ketogenic diet-chemotherapy combination non-response group, and chemotherapy-only group, respectively ( p value = 0.07). The ketogenic diet-chemotherapy combination response group tended to have a longer OS than the chemotherapy-only group. In addition, in the ketogenic diet-chemotherapy combination response group, introduction time was earlier than the ketogenic diet-chemotherapy combination non-response group for 5.7 months, with high serum ketone body levels and low blood sugar levels. Conclusions: Chemotherapy with ketogenic diet resulted in higher response and disease control rates than chemotherapy alone. Additionally, the conversion surgery rate was high and an improved OS could be expected. Therefore, ketogenic diet may be a supportive therapy to chemotherapy. Clinical trial information: 000029527.