bluuebunny/crossref_metadata_2025_split huggingface dataset:
Peritoneal carcinomatosis (PC) in well-differentiated (WD) small-intestinal neuroendocrine tumor (SI-NET) patients (Pts) with mesenteric tumor deposits (MTDs).
Authors: Das Satya , Shi Chanjuan , Koyama Tatsuki , Huang Yi , Gonzalez Raul S. , Idrees Kamran , Bailey Christina Edwards , Berlin Jordan 
Published: January 2019

194 Background: Although WD SI-NETs are typically biologically indolent, they tend to metastasize. PC is a dreaded regional metastatic complication in pts with SI-NETs and contributes to significant morbidity and mortality. Risk factors for PC development in these pts are not well studied, however one factor may be MTD presence. Our analysis is the first to suggest an association between MTD presence and PC in this pt subgroup. Methods: We performed a retrospective analysis on 191 WD SI-NET samples from Vanderbilt University Medical Center with mesenteric masses identified on gross pathology or radiographic review. Of 138 samples with suspected MTDs, 79 were confirmed definitively by detailed pathologic review and 59 were considered likely based on descriptions from surgical pathology reports. We assessed whether pts in our cohort with MTDs had greater rates of PC compared to those without MTDs. We also assessed what other patient determinants were associated with PC and the prognostic role of these determinants. Results: Pts with suspected MTDs had an odds ratio (OR) of 3.9 for PC compared to pts without MTDs. Rates of PC in pts with definitive MTDs and those with likely MTDs were not significantly different (OR 1, p = 1.00). Although suspected MTD presence was not associated with poorer OS (p = 0.97), pts with confirmed MTDs had a trend toward poorer overall survival (OS) than pts with likely MTDs (p = 0.05). PC was a negative prognostic factor in all pts with regards to OS (p = 0.044). Conclusions: SI-NET pts with MTDs appear to have significantly increased rates of PC compared to those without mesenteric deposits. We believe this observation merits prospective evaluation given its potential therapeutic implications. If confirmed prospectively, pts with MTDs could benefit from earlier use of cytoreductive therapies to hinder development of PC. [Table: see text]
Predictive factors for major complications after pancreaticoduodenectomy in patients aged 80 years or older.
Authors: Takeda Naoya , Sawada Shigeaki , Yoshioka Isaku , Shibuya Kazuto , Tazawa Kenichi , Fukuda Takuma , Mori Kosuke , Hirano Katsuhisa , Okumura Tomoyuki , Nagata Takuya , Yamagishi Fuminori , Fujii Tsutomu 
Published: January 2019

199 Background: As the population ages, elderly patients are being diagnosed with periampullary tumors, and hence, it has been suggested that surgeons should consider the indications for pancreaticoduodenectomy (PD) in elderly patients. The aim of this study is to reveal risks and benefits of PD, and is to identify prognostic inflammatory biomarkers for major complications after PD in patients aged 80 years or older. Methods: We retrospectively analyzed the cases of 161 consecutive patients who underwent PD between January 2000 and December 2015, and compared the patients aged ≥ 80 years (n = 22) with those aged < 80 years (n = 139). Postoperative results and preoperative conditions such as nutrition status using controlling nutritional status (CONUT) score, hemoglobin level and comorbidity were assessed. Correlations were evaluated between major postoperative complications (Clavien-Dindo grade III or higher) and 6 systemic inflammation–based prognostic score such as Glasgow prognostic score (GPS), modified-GPS, High sensitive-mGPS, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio (PLR), and prognostic nutritional index in elderly patients. Results: There was no operative mortality. In elderly patients, preoperative hemoglobin level was lower and CONUT score was higher than in younger patients. The complication rates and the disease-specific survival did not differ significantly between the two groups. Ten patients (45%) experienced major complications in the elderly group. Among 6 systemic inflammation–based prognostic score, only PLR was revealed as predictor of major complications (p = 0.012) and optimal cutoff value was determined to be 145.3 (sensitivity = 33%, specificity = 100%, AUC = 0.842). Conclusions: PD could be performed safely in patients aged 80 years or older. The preoperative PLR was a simple and useful predictor of major complications after PD in elderly patients.
Incidence of metachronous gastric neoplasia after endoscopic submucosal dissection for gastric dysplasia.
Authors: Kim Jae Gyu , Park Jae Yong , Kim Young-Il 
Published: January 2019

20 Background: Endoscopic submucosal dissection (ESD) has been usually performed to treat gastric high-grade dysplasia (HGD) and selected lesions of low-grade dysplasia (LGD). However, HGD was classified into the same category of non-invasive carcinoma which were different from LGD in the Vienna classification of gastrointestinal epithelial neoplasia. We investigated whether the incidence of metachonous gastric neoplasia after ESD for gastric dysplasia is different between patients with LGD and HGD. Methods: Between March 2011 and December 2016, 508 patients underwent ESD for 545 gastric dysplasias or cancers at the Chung-Ang University Hospital. Of them, 198 patients with LGD (LGD group) and 46 with HGD (HGD group) who had been followed up for at least one year were included. The primary outcome was the incidence of gastric neoplasia occurred at 1-year follow-up or later after ESD. The secondary outcome was the composite incidence of metachronous HGD and gastric cancers. Results: During a median follow-up of 2.5 years, overall cumulative incidence of metachronous gastric neoplasm was 33.2 cases/1000 person-years. The metachronous neoplasms developed in 17 patients (8.6%; 11 LGD, 2 HGD and 4 gastric cancers) in the LGD group and in 6 patients (13.0%; 3 LGD, 1 HGD and 3 gastric cancers) in the HGD group. The incidence of metachronous gastric neoplasia in LGD group was not significantly different from that in HGD group (hazard ratio [HR] in the LGD group, 0.56; 95% confidence interval [CI], 0.22-1.43; P = 0.229). The composite incidences of metachronous HGD and gastric cancers were not also different between the two groups (HR for the composite incidences in the LGD group, 0.42; 95% CI, 0.10-1.68; P = 0.218). Conclusions: After ESD for gastric LGD, the incidence of metachronous gastric neoplasia was not different from that after ESD for HGD. Thus, similar surveillance strategies are needed for patients who underwent ESD for LGD and HGD.
Role of central hypovascularity in the hepatic arterial phase of dynamic CT on mass-forming intrahepatic cholangiocarcinoma.
Authors: Shimada Mitsuo , Teraoku Hiroki , Morine Yuji , Imura Satoru , Ikemoto Tetsuya , Iwahashi Shuichi , Saito Yu , Takasu Chie , Yamada Shinichiro 
Published: January 2019

205 Background: Intrahepatic cholangiocarcinoma (IHCC) is known as one of most malignant cancers. Recently, the vascularity in the hepatic arterial phase (HAP) of dynamic CT has been reported as a possible prognostic marker in IHCC. The aim of this study is to elucidate the role of central hypovascularity in the HAP on mass-forming IHCC. Methods: Forty patients who underwent initially hepatic resection for mass-forming IHCC were enrolled. The HAP was scanned 40 seconds after the injection of contrast agent. Vascular pattern was classified into three groups; hypervascularity (Hyper) group (n = 8), rim-enhancement (Rim) group (n = 7) and hypovascularity (Hypo) group (n = 25) by a radiologist in reference to Fujita, et al (Eur Radiol 2017). Hypoxia-inducible factor-1 (HIF-1) expression in the surgical specimen was evaluated by immunohistochemistry. The clinicopathological findings were compared among the groups. Results: The advanced stage tended to be more frequent in Hypo group, however, no difference of tumor location (hilar or peripheral) was observed. Overall survival (OS) in Hypo group was worse than that in Hyper group. The OS in Rim+Hypo group, that means central hypovascularity in the tumor, was worse than that in Hyper group. Furthermore, Rim+Hypo group was an independent prognostic factor in OS (HR: 5.44). Regarding the HIF-1 expression, high HIF-1 expression in the central part of the tumor correlated with central hypovascularity in the HAP (25% in Hyper-group and 72% in Rim+Hypo group, respectively). Conclusions: The central hypovascularity (Rim+Hypo group) was an independent prognostic factor, furthermore, high malignant potential of the tumor with central hypovascularity might be related to HIF-1 upregulation.
Investigating disparities: The effect of social environment on pancreatic cancer survival.
Authors: Madnick David , Sorice Kristen , Yin Yinuo , Handorf Elizabeth A. , Nagappan Lavanya , Moccia Matthew , Cheema Khadija , Vijayvergia Namrata , Dotan Efrat , Lynch Shannon M. 
Published: January 2019

208 Background: Incidence rates of pancreatic adenocarcinoma (PAC) are higher in Black compared to White patients (pts). Beyond race, exposure to poor neighborhoods or social environments also contribute to cancer disparities. However, social environmental effects on PAC are not well-studied. Social environment is defined as: 1) a neighborhood’s socioeconomic conditions (SES; i.e. a combination of education, income, poverty and employment levels); 2) racial segregation (RS) or the degree of isolation/separation of race/ethnic groups in a neighborhood. The goal of our study is to investigate whether poor social environments impact survival in a clinic population with metastatic PAC. Methods: Neighborhood SES and RS measures were derived from US census data (2011-2015) at the census tract level, which is a smaller geographic area than a county. Patient (pt) addresses were used to generate a geocode that identifies the census tract or neighborhood in which a pt lives. We joined medical records of PAC pts (n = 374; diagnosed 2010-2016 at Fox Chase Cancer Center) to neighborhood measures via the geocode. Pt variables included in the analysis were: age, sex, race, marital status, treatment, PAC family history, stage, Jewish ancestry, tobacco use and Charlson comorbidity index. Multivariable cox proportional hazards models with cluster adjustments were used and variables with p-values < 0.05 were considered significant. Results: 342 PAC deaths occurred and median survival was 12m. 81% of pts were White; < 40% resided in poor social environments (i.e. low SES or high RS). In multivariable analyses stratified by RS, median survival was lower in pts from high RS (11m) vs low RS areas (13m); however, this difference was not significant (p = 0.27). Variable effects differed by high/low RS. In high RS areas, sex, surgery, chemo, diabetes and neighborhood SES were significant predictors of survival; in low RS areas, surgery, chemo, radiation, PAC family history, tobacco use, Jewish ancestry and race were significant. Conclusions: While social environment did not appear to significantly affect survival time in metastatic pts, its potential moderating (interaction) effects on variable associations with PAC warrant further investigation.
Measurement of urinary kininogen (KNG) fragments as a noninvasive tool for early diagnosis of pancreatic cancer (PaCa).
Authors: Ohno Izumi , Mitsunaga Shuichi , Kan Motoyasu , Ikeda Masafumi , Tsubouchi Hironobu , Yanagi Shigehisa , Matsumoto Nobuhiro , Okumura Nobuaki , Takao Toshifumi , Nakazato Masamitsu 
Published: January 2019

209 Background: There is a clear need to identify a non-invasive biomarker for early diagnosis of PaCa, in order to improve the overall survival of PaCa patients. Secretion of large amounts of proteases is a hallmark of PaCa, which results in an abundance of protease-induced cleavage products being excreted in the urine. This has led to speculation that measurement of PaCa-specific fragments in the urine might be useful as a tool for discrimination between PaCa patients and healthy controls. Herein, we introduce urinary KNG fragments as a promising biomarker for early diagnosis of PaCa. Methods: Urine samples were collected from PaCa patients and healthy volunteers, with the written informed consent, from January 2014 to July 2016. Urinary protein tryptic fragments derived from protein C-termini were measured using isobaric tags (iTRAQ) for their relative quantitation, and the diagnostic ability of the urinary levels of these fragments was evaluated by receiver operating characteristic (ROC) curve analysis. The fragments which showed an area-under-the-curve (AUC) of over 0.8 were selected as candidate fragments for further validation by the multiple-reaction-monitoring technique (MRM) combined with high-speed liquid chromatography. The urinary level of each candidate fragment was quantified by MRM, and the diagnostic capability of each for discriminating PaCa patients from healthy controls was evaluated by ROC curve analysis. Results: Urine samples of 39 PaCa patients (7 resectable, 32 unresectable) and 42 healthy controls were examined by iTRAQ to find 12,783 fragments. ROC curve analysis was carried out to select two candidate fragments (fragments A, B), both of which turned out to be KNG cleavage products. The urinary levels of the two fragments were measured in 23 resectable PaCa, 118 unresectable PaCa patients, and 42 healthy volunteers using high-speed-LC-/MRM. The AUCs of serum CA19-9 and urinary levels of fragments A and B for discriminating patients of PaCa from healthy controls were 0.89, 0.81 and 0.70, respectively. Conclusions: Urinary KNG fragments showed favorable diagnostic capability and were considered as promising, noninvasively measurable biomarkers of PaCa.
The impact of primary tumor site on outcomes of treatment with etoposide and cisplatin in grade 3 gastroenteropancreatic neuroendocrine carcinoma.
Authors: Yoon Sang Eun , Kim Jung Hoon , Hur Joon Young , Lee Su Jin , Lee Jeeyun , Park Se Hoon , Park Joon Oh , Lim Ho Yeong , Kang Won Ki , Kim Seung Tae 
Published: January 2019

213 Background: Gastroenteropancreatic neuroendocrine carcinoma (GEP-NEC) is a heterogeneous disease in terms of embryonic origin, aggressiveness, prognosis, and genomic profiling. Data regarding the efficacy of etoposide and cisplatin (EP) as a standard treatment of the primary tumor site in GEP-NEC are limited. Methods: We analyzed 64 patients with histopathologically confirmed metastatic GEP-NEC who received EP at Samsung Medical Center, Seoul, Korea, between January 2010 and January 2018. Based on primary tumor site, outcome of treatment with EP was evaluated. Results: Primary sites included 22 foregut-derived GEP-NECs (stomach, n = 6; duodenum, n = 4; pancreas, n = 12), 4 midgut-derived GEP-NECs, 5 hindgut-derived GEP-NECs of the rectum, 25 GEP-NECs originating from the hepatobiliary (HB) tract, and 12 GEP-NECs involving only intra-abdominal lymph nodes. No patient had a complete response (CR) and 17 had a partial response (PR), resulting in a 27.9% response rate (RR). When evaluating the efficacy of EP based on primary tumor site, the RR was most favorable in GEP-NECs involving only intra-abdominal lymph nodes, followed by GEP-NECs originating from foregut, midgut, HB, and hindgut. However, no statistically significant difference was observed for RR based on primary tumor site (p = 0.821). Similarly, no significant differences were found for progression-free survival (PFS) among patients with GEP-NECs arising from various primary tumor sites. Conclusions: Results from this study showed thatRR and PFS associated with EP treatment were not different based on the primary tumor site in patients with advanced or metastatic GEP-NEC.
Early detection of pancreatic ductal adenocarcinoma using abnormal urinary fragmentation ratio of a liver-originated protein.
Authors: Kan Motoyasu , Mitsunaga Shuichi , Ikeda Masafumi , Ohno Izumi , Tsubouchi Hironobu , Yanagi Shigehisa , Matsumoto Nobuhiro , Okumura Nobuaki , Takao Toshifumi , Nakazato Masamitsu 
Published: January 2019

214 Background: Non PDAC tissue-originated proteins are cleaved by proteases derived from PDAC, which can result in abnormal cleavage patterns in the urine of PDAC patients. Urinary proteomic analysis for quantifying the ratios of the abnormal protein fragments to the non-fragmented protein levels in the urine may be useful to distinguish early PDAC from healthy controls. This proof-of-concept study was planned to determine the usefulness of measuring the protein fragments from non PDAC tissue-originated proteins in the urine using the multiple-reaction-monitoring technique (MRM) for discriminating resectable PDAC from healthy controls. Methods: Urinary proteins were digested with trypsin, and resultant peptides were measured by MRM analysis and the ratio of the level of each fragment to the non-fragmented protein level (fragmentation ratio) was calculated. Fragments for which the fragmentation ratios were higher in the PDAC group than those in the healthy group were defined as abnormal protein fragments. The diagnostic capability of each abnormal protein fragment for discriminating cases of PDAC from healthy controls was evaluated by receiver operating characteristic (ROC) curve analysis. Results: A total of 21 patients with resectable PDAC and 30 healthy control subjects were enrolled in this study. All the PDAC patients were treated by pancreatic resection. Urine samples for this study were collected prior to the surgery from the PDAC patients. The non PDAC tissue-originated protein was determined as a liver-originated protein. The fragmentation ratios for six fragments were found to be higher in the PDAC group as compared to those in the healthy control group, and these fragments were determined as abnormal protein fragments. ROC curve analysis was performed for each of the abnormal fragments to determine the areas under the curve (AUCs) for discriminating cases of PDAC from healthy controls. The best AUC was 0.81 (95% CI, 0.68-0.91). Conclusions: The urinary fragmentation ratios showed the ability to discriminate cases of resectable PDAC from a healthy control group; abnormal fragmentation ratios may be promising, noninvasively measurable biomarkers of early PDAC.
Clinical outcome of pancreatic cancer patients with indeterminate pulmonary nodules.
Authors: Kazarian Austin G , Mott Sarah L , Chan Carlos Hou Fai 
Published: January 2019

220 Background: Indeterminate pulmonary nodules (IPNs) are often found on staging CT scans for pancreatic cancer and pose a treatment conundrum since resection is contraindicated in metastatic setting. Here we aim to determine the clinical outcome of pancreatic cancer patients with IPNs undergoing curative resection. Methods: Retrospective analysis of 1,182 pancreatic cancer patients in the institutional Oncology Registry between 2007 and 2017 was conducted. Survival probabilities were estimated using the Kaplan-Meier method. Time was calculated from diagnosis to death for overall survival (OS), and from operation to recurrence for recurrence-free survival (RFS). Cox regression models were used to assess the effects of demographic, clinicopathologic, and treatment variables on OS and RFS. Results: IPNs were found in 50 patients undergoing surgery (43 pancreatoduodenectomy, 7 distal pancreatectomy). Negative margins were obtained in 82% of patients. Six and 44 patients had stage 0/I and stage II disease, respectively. Twelve and 35 patients received neoadjuvant and adjuvant therapy, respectively. Over a median follow-up of 20 months from the time of diagnosis, 37 patients (74%) developed local recurrence or distant metastasis in liver (38%), lung (32%), peritoneum (8%), or other sites (8%). Median RFS was 14 months and median OS was 23 months. Tumor size (HR 1.56, CI 1.23-1.98, p < 0.01) and elevated pre-operative CA19-9 (HR 2.51, 1.22 – 5.15, p = 0.01) were associated with lower RFS. Tumor size (HR 1.43, CI 1.10-1.86, p < 0.01) and diabetes (HR 2.05, CI 1.02-4.11, p = 0.04) were associated with lower OS. Patients with lung only recurrence tended to have superior OS relative to other single sites (HR 2.05, CI 0.66-6.33, p = 0.21) or multiple sites (HR 2.30, 0.75-7.50, p = 0.15). Patients with lung only recurrence had a median survival after recurrence of 17.9 months compared to 6.5 months for other single sites or 4.3 months for multiple sites. Conclusions: Only a portion of IPNs develop into true lung metastasis and that isolated lung metastatic recurrence may confer a better survival over metastasis of other sites. Ongoing efforts will identify serum biomarkers to predict recurrence in the hopes of guiding future clinical practice.
Role of nonalcoholic steatohepatitis as a risk factor for intrahepatic cholangiocarcinoma and its role in patients’ prognosis: A case-control study.
Authors: De Lorenzo Stefania , Tovoli Francesco , Vasuri Francesco , Malvi Deborah , D'Errico Antonietta , Brandi Giovanni 
Published: January 2019

224 Background: The prevalence of intrahepatic cholangiocarcinoma (ICC) is rising worldwide. The current epidemics of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) might be partly responsible for this trend. Methods: Case control study investigating the prevalence of histology-confirmed NASH in peritumoral liver of resected ICC patients and controls (pre-explant biopsies of liver donors). Controls were matched for age and sex in a 2:1 fashion. Correlates between NASH, tumor characteristics and overall survival (OS) were also explored in the ICC cohort. Results: Between 2006 and 2017, 84 ICCs were resected in our Institution. Sixty-two (74%) had no apparent risk factors for ICC. Amongst this group, the prevalence of NAFLD and NASH was 45.2% and 24.2%,respectively, compared to 44.3 and 8.9% in the 124 matched liver donors (p = 1.000 and p = 0.007, respectively). The 5-year OS rate was 20.0% in NASH and 57.4% in ICC without either NASH and other risk factors (p = 0.017). Main tumor size, sex and NASH (hazard ratio 2.618 , 95% confidence interval 1.140-6.013, p = 0.023) were independent predictors of the OS at the multivariate Cox regression. Conclusions: NASH (but not NAFLD) acts as a risk factor for ICC and may affect its long-term outcome. A collaborative multicenter approach could confirm and strengthen these data.