bluuebunny/crossref_metadata_2025_split huggingface dataset:
SCOT: Tumor sidedness and the influence of chemotherapy duration on DFS.
Authors: Saunders Mark P. , Paul James , Crosby Jana , Brown Gordon , Iveson Timothy , Kerr Rachel , Harkin Andrea , Allan Karen , McQueen John , Pearson Sarah R , Cassidy James , Medley Louise C. , Raouf Sherif , Harrison Mark , Brewster Alison , Rees Charlotte , Ellis Richard , Thomas Anne L. , Churn Mark , Maka Noori 
Published: January 2019

558 Background: Patients with R-sided tumours who develop metastatic disease have a worse prognosis compared to patients with L-sided tumours. The latter may also have a greater benefit from treatment with EGFR inhibitors. In general, registry studies and meta-analyses have shown that patients with loco-regional R-sided tumours have a worse overall survival (OS). This has recently been confirmed by the PETACC8 study but only after they had relapsed. There was not a significant difference in disease free survival (DFS). Methods: The SCOT study showed that 3-months of oxaliplatin-containing adjuvant chemotherapy (OxFp) was non-inferior to 6-months for patients with stage III and high-risk stage II colorectal cancer. Here we divide the population into left and right-sided tumours to see whether sidedness had an impact on DFS. We also evaluated whether sidedness impacted on the 3 vs. 6-months comparison in SCOT. Results: 6088 patients with Stage III/high risk Stage II cancers or the colon or rectum were randomised between March 27, 2008 and November 29, 2013 from 244 centres (164 UK, 32 Australia, 19 Spain, 14 Sweden, 10 Denmark and 5 New Zealand). In February 2017 (3-years FU) information on sidedness was available for 3219 patients (1207 R-sided, 2012 L-sided). Characteristics: Right: median age: 65, Male: 53%, T4 41%, Stage II: 17%; Left: median age: 65, Male: 66%, T4 24%, Stage II: 21%). Patients with R-sided tumours had a significantly worse DFS (3-year DFS right: 73% (se=1%), left: 80% (se=1%). HR 1.401 (95% CI 1.216-1.615; p=0.000004). Adjusting for T and N-stage reduced the HR to 1.215 (95% ci 1.051-1.404, p=0.009). The data did not suggest that sidedness affected the impact of chemotherapy duration on 3-year DFS (R: HR (3 month/6 month) 1.049 (0.849 -1.296) L: 0.910 (0.753-1.099). Test for homogeneity, p=0.327). Further sub-set analysis was limited due to cohort size. Conclusions: This is the first study to show that unselected patients with R-sided tumours had a worse DFS compared to L-sided tumours. This implies that prognosis is influenced primarily by greater recurrence rather than the contributing factors that influence OS. Tumour sidedness did not impact on the 3-months vs. 6-months comparison in SCOT. Clinical trial information: ISRCTN59757862.
Effect of PET-CT on disease recurrence and its management in patients with potentially resectable colorectal cancer liver metastases: The long-term results of a randomized control trial.
Authors: Serrano Aybar Pablo Emilio , Gu Chu-Shu , Husien Mohamed , Jalink Diederick , Martel Guillaume , Tsang Melanie E. , Hallet Julie I. , Gallinger Steven , Ritter Anne , McAlister Vivian , Sela Nathalie , Solomon Hannah , Beyfuss Kaitlyn , Li Christine , Lee Erika , Moulton Carolanne , Levine Mark Norman 
Published: January 2019

562 Background: The PETCAM randomized trial evaluated the effect of preoperative PET-CT (vs. no PET-CT) on surgical management in patients with colorectal cancer liver metastases. In this study, 8% of patients had a change in surgical management, including a higher proportion of major liver resections in the PET-CT arm. The current study compares the intervention groups for 5-year disease free (DFS) and overall survival (OS), and evaluated their long-term clinical course, i.e. sites of recurrence and management of disease recurrence. Methods: Recruitment to the trial occurred between 2005-2010, with last follow-up in 2013. Data on recurrence, management of recurrence and mortality from 2013-2017 was collected from patient’s charts. Recurrences according to site and management were described. Cox proportional Hazard Models were used to calculate the risk for recurrence and death. OS was calculated with Kaplan-Meir method and compared with log-rank test. Results: At 5 years, 157 of 404 (39%) patients were still alive and 19 patients were lost to follow-up. Median follow-up is 4.2 years. There were no differences in DFS (HR: 1.12, 95%CI: 0.88-1.42) or OS (HR: 0.97, 95%CI: 0.74-1.28) between groups. The median DFS for the 372 patients who had surgery was 17 months, 95%CI: 14.7-19.4. Risks factors for recurrence were: extrahepatic disease, liver tumour size, and nodal stage. The median OS for all patients was 50 months, 95%CI: 43.5-64.3. Risks factors for death also included age and prior use of chemotherapy. During the follow-up period, 287/404, 71% patients recurred (mostly liver and lung); 137 (48%) were treated solely with chemotherapy and 35% were treated with surgery with curative intent. Of these, the majority recurred (109/116, 94%). The median OS following first recurrence was 27.5 months, 95%CI: 23-30. Conclusions: PET-CT did not improve DFS or OS. Survival following liver resection is similar to previous reports, however most patients experience disease recurrence. A substantial proportion of patients who recur undergo surgery, however it is likely that they will recur again.
Utilization of imaging modalities in the staging of newly diagnosed rectal cancer: A survey of U.S. radiation oncologists.
Authors: Yahya Jehan , Farrell Matthew , Herzig Daniel , Degnin Catherine , Chen Yiyi , Holland John M. , Brown Simon , Jaboin Jerry Jeff , Thomas Charles R. , Mitin Timur 
Published: January 2019

564 Background: Accurate staging is crucial for management of patients (pts) with newly diagnosed rectal cancer. Endorectal ultrasound (EUS) has been a commonly used imaging modality for almost two decades, with magnetic resonance imaging (MRI) now preferred by national guidelines. Routine positron emission tomography (PET) is not recommended for initial staging. The current utilization of imaging modalities by radiation oncologists (ROs) in staging newly diagnosed rectal cancer pts in the United States is unknown. Methods: We conducted an anonymous IRB-approved online survey of practicing U.S. ROs. Respondent characteristics were tested for association with self-assessed utilization of imaging modalities using Chi-squared test. Staging 75% of more rectal cancer pts with a given modality was defined as high utilization. Results: We received 220 responses from practicing U.S. ROs. Among the responders, 85 are academically affiliated and the majority specialize in treating GI malignancies, with 98 seeing more than 10 rectal cancer pts annually. Most respondents utilize all three imaging modalities for rectal cancer staging - EUS, MRI and PET/CT. Fifty two percent and 38% of respondents are high utilizers of EUS and MRI, respectively. Nearly half (47%) of respondents are high PET utilizers. High utilization of PET was associated with practice in a private setting (p < 0.05) and being within 10 years from residency training completion (p < 0.05). Conclusions: Our analysis reveals a wide discordance between national guidelines and the practice patterns among U.S. ROs, with underutilization of MRI and overutilization of PET/CT. Substantial cost savings could be realized by following national guidelines recommendations to omit the routine use of PET/CT in the initial evaluation of pts with rectal cancer.
Does metabolic health status affect the optimal starting age for colorectal cancer screening? A Korean nationwide cross-sectional study.
Authors: Choi Yoon Jin , Lee Dong Ho 
Published: January 2019

573 Background: The association between metabolic syndrome and colorectal cancer (CRC) has been suggested as one of causes for the increasing incidence of CRC, particularly in younger age groups. The present study examined whether the current age threshold (50 years) for colorectal cancer (CRC) screening in Korea requires modification when considering metabolic syndrome. Methods: We examined data from the National Health Insurance Corporation database, which covers ~97% of the population in Korea. CRC risk was analyzed with stratification based on age and the presence/absence of relevant metabolic syndrome components (diabetes, dyslipidemia, and hypertension). The incidence of CRC was determined for four, 2-year time periods. Results: A total of 51,612,316 subjects enrolled during 2014-2015 were analyzed. Among them, 19.3% had diabetes, hypertension, dyslipidemia, or some combination thereof. This population had a higher incidence of CRC than did those without these conditions and this was more prominent in subjects < 40 years of age. The optimal cut-off age for detecting CRC, based on the highest Youden index, was 45 years among individuals without diabetes, dyslipidemia, and hypertension, and 62 years among individuals with at least one of these components of metabolic syndrome. Resetting the cut-off age from 50 years to 45 years achieved a 6% increment in sensitivity for CRC detection among the total population. Conclusions: An earlier start of CRC screening, namely at 45 rather than at 50 years of age, may improve secondary prevention of CRC in Korea.
Prognostic factors in patients who received surgery for colorectal cancer with peritoneal metastasis.
Authors: Furutani Akinobu , Yamaguchi Tomohiro , Kinugasa Yusuke , Shiomi Akio , Kagawa Hiroyasu , Yamakawa Yushi , Manabe Shoichi , Yamaoka Yusuke , Ogi Yusuke , Nagasawa Yoshinobu , Hino Hitoshi , Kato Shunichiro , Suzuki Takuya , Torii Kakeru , Koido Kohei 
Published: January 2019

574 Background: Peritoneal metastasis (PM) in patients diagnosed with colon cancer is associated with a poor prognosis. We aimed to analyze prognostic factors associated with PM in patients diagnosed with colorectal cancer (CRC). Methods: We evaluated 237 patients who underwent surgery between 2002 and 2016 for CRC with PM. The extent of PM was evaluated using the Peritoneal Cancer Index (PCI). Clinicopathological variables, PCI score, surgical curability, and the administration of postoperative chemotherapy were evaluated. Overall survival was analyzed using the Kaplan-Meier method. Multivariate analysis was performed to assess the prognostic value of these variables, using the Cox regression model. Results: Our patients included 119 men and 118 women with a median age of 64 (range: 21–90) years. The primary tumor sites were the right-sided colon (n = 103), left-sided colon (n = 84), and rectum (n = 50). The median PCI score was 4 (range: 1–30). Synchronous PM was detected at the time of diagnosis of the primary tumor in 165 patients (69.6%). Distant metastases except peritoneal metastases was detected in 137 patients (57.8%). R0 resection was performed in 62 patients (19.0%). Postoperative chemotherapy was performed in 165 patients (69.6%). The median survival time in all patients was 19.4 (range: 0–30) months, and the five-year overall survival rate was 16.3%. Multivariate analysis revealed that PCI ≤ 5 (hazard ratio [HR]: 2.56, 95% confidence interval [CI]: 1.56-4.32, P < 0.01); the absence of distant metastasis, except peritoneal metastasis (HR: 1.65, CI: 1.15-2.40, P < 0.01); R0 resection (HR: 4.21, CI: 2.44-7.50, P < 0.01) affected the survival rate. Conclusions: Our results show that a low PCI, the absence of distant metastasis except peritoneal metastasis, and R0 resection are prognostic factors in patients diagnosed with PM-CRC.
Evolving prevalence and incidence trends of SCC of the anal canal: A SEER study.
Authors: Zhang Shunqing , DiPetrillo Thomas A. , Leonard Kara Lynne 
Published: January 2019

583 Background: The incidence of squamous cell carcinoma of the anal canal (SCCA) has been rising in the last three decades. With changing patient demographics and behaviors, the trends in prevalence and incidence of the disease have changed in recent years. Methods: The Surveillance, Epidemiology, and End Results (SEER) data set from 2000 to 2014 was analyzed for trends in prevalence and incidence of SCCA and for associated demographic and tumor characteristics including stage (localized vs. regional vs. distant disease), age (20-34, 35-49, 50-64, > 65 years), and race/ethnicity (White, Black, American Indian/American Natives (AI/AN), American Pacific Islanders (API)). Results: 16,540 patients with SCCA were identified in the SEER database within the study period. The prevalence rate of SCCA was 0.01% (of 2000 standard U.S population), and the age-adjusted incidence rate of SCCA was 1.3/100,000. Prevalence and incidence was highest in patients age 50-64 and in the black population. Trend analysis of incidence demonstrated that while incidence rate continued to increase from 2000 to 2014, the average annual percentage change (APC) of incidence decreased from 4.80 before 2009 to 1.44 after. Patient population was divided into two groups: 2000-2008, with incidence of 1.6/100,000 and 2009-2014, with incidence of 2.1/100,000 (RR = 1.29, 95%CI = 1.25-1.33, p < 0.001). Incidence in the 2009-2014 group increased compared to the 2000-2008 group among all staged SCCA, patients 50 years of age and older (RR = 1.41, p < 0.001 and RR = 1.37, p < 0.001 for age groups 50-64 and > 65, respectively), and black (RR = 1.33, p < 0.001) and white (RR = 1.32, p < 0.001) race/ethnicity groups. APC in the 2009-2014 group decreased in all staged SCCA, increased in patients age 20-34, and decreased in all racial groups except AI/AN. Conclusions: There is a higher incidence and prevalence of SCCA in patients 50 years or older and in those of black ethnicity. Incidence of SCCA has increased in the US from 2000-2014, but the average APC in incidence has been decreasing except for in young patients and in those of AI/AN ethnicity. Awareness of disease prevalence and the pattern of change in incidence rate is important in the effort of disease prevention.
Can sidedness predict for survival in primary locoregional colon cancers?
Authors: Wang Weining , Seo Chin Jin , Tan Grace Hwei Ching , Chia Claramae Shulyn , Soo Khee Chee , Teo Melissa Ching Ching 
Published: January 2019

584 Background: Right and left-sided colon cancers are embryonically distinct and present differently. Recently, there has been growing belief that sidedness could be independently associated with survival outcomes. This has important clinical implications regarding the prognostication, management and surveillance of colon cancer patients. Hence, we aim to investigate the impact of sidedness on survival in our patient population in this study. Methods: Patients who had primary treatment naïve colon cancer who underwent curative surgical resection in our institution from September 2002 to December 2010 were included in this study. Demographic and clinicopathological data was collected from electronic records and clinical charts. Tumours arising from the cecum, ascending colon, hepatic flexure and transverse colon were considered right-sided, while those arising from splenic flexure and descending colon were considered left-sided. Cancers of the rectosigmoid junction and rectum were excluded. Kaplan-Meier curves and log-rank test were used to compare overall, locoregional recurrence-free and distant recurrence-free survivals (OS, LRFS, DRFS respectively) between both groups. Multivariate analysis was performed using Cox regression proportional hazards. Results: 389 patients were included in this study. 238 had left-sided tumours while the remaining 151 had right-sided tumours. In our cohort, right-sided tumours were associated with older age and mucinous histology. Kaplan-Meier curves plotted showed improved LRFS in left-sided tumours (p = 0.04, median survival not reached) but no significant difference in OS and DRFS. On multivariate analysis, sidedness was also found to be an independent prognostic factor for LRFS but not OS and DRFS despite factoring in age, size of tumour, pT, pN and histology. Conclusions: Our study suggests that left-sided tumours in primary colon cancer are independently prognostic for improved locoregional survival as compared to the right-sided tumours, even after taking into account other known factors such as age, staging and histology.
Baseline characteristics as predictors of adjuvant chemotherapy (AC) discontinuations and modifications in stage III colorectal cancer (CRC) patients.
Authors: Watanabe Akie , Yang Charlie , Cheung Winson Y. 
Published: January 2019

585 Background: Discontinuations and treatment modifications of AC can impact survival in CRC patients. Unfavorable baseline patient characteristics such as old age, poor ECOG performance status, and comorbidities may contribute to early treatment termination, but their precise associations with treatment interruptions are unclear. Methods: We reviewed a population-based cohort of CRC patients treated with adjuvant monotherapy (Capecitabine) or combination therapy (FOLFOX or CAPOX) within 12 weeks of curative resection in British Columbia, and determined the associations between baseline characteristics and treatment modifications (change in regimen and/or cessation of a single agent) or discontinuations. Results: Among 555 patients, median age was 66 years, 52% were men, and 16% were ECOG ≥2. In this cohort, 42% received monotherapy and 58% received combination therapy. 37% of patients had modifications to monotherapy and 31% discontinued it while 44% had modifications to combination therapy and 26% discontinued it. For monotherapy, univariate analyses showed significant associations between survival and treatment modifications ( P= 0.001) and discontinuations ( P< 0.001). Specifically, old age (≥70; P= 0.044) and pre-treatment anemia ( P= 0.016) were associated with permanent discontinuations. On multivariate analyses, non-mucinous adenocarcinoma histology predicted a higher chance of treatment modifications (OR 3.02, 95% CI 1.03-8.83, P= 0.044) while pre-treatment anemia was correlated with discontinuations (OR 2.27, 95% CI 1.14-4.50, P= 0.020). Univariate analyses of combination therapy showed a relationship between survival and discontinuations ( P= 0.005); however, only worse ECOG status (≥2) was predictive of discontinuations on multivariate analyses (OR 2.39, 95% CI 1.03-5.55, P= 0.042). Conclusions: Except for pre-treatment anemia and ECOG status, few baseline characteristics correlated with treatment modifications or discontinuations, underscoring the need for repeated clinical assessments throughout treatment. Baseline features may only be useful in deciding whether or not a patient should initiate chemotherapy.
Two-photon probes for pH: Detection of human colon cancer using two-photon microscopy.
Authors: Kim Woojung , Kim Eun Sun , Min Geeho , Kim Seung Han , Choi Seong ji , Lee Jung Min , Lee Jae Min , Choi Hyuk Soon , Keum Bora , Jeen Yoon Tae , Lee Hong Sik , Chun Hoon Jai , Kim Chang Duck , Hong Seung Taek , Heo Jung-Nyoung , Cho Bong Rae 
Published: January 2019

607 Background: In cancer cells, lysosomal pH decreases along with a concomitant increase in lysosomal volume and cathepsin expression levels. Lysosomes also play crucial roles in cancer progression following their release into the extracellular space. Since cancer cells invade a tissue by secreting degradative enzymes, the extracellular pH of tumor tissues becomes acidic. However, to date, there has been no report on the use of multi-photon microscopy (MPM) probes to image human colon cancer tissues. Methods: We have developed multi-photon (MP) pH-sensitive probes (BH-2 and BHEt-1) that exhibit absorption and emission maxima at 370 and 466 nm, and TP absorption cross-section values of 51 and 61 GM (1 GM = 10−50 cm4 s/photon), respectively, at 750 nm and pH 3.0 in a universal buffer (0.1 M citric acid, 0.1 M KH2PO4, 0.1 M Na2B4O7, 0.1 M Tris, 0.1 M KCl)/1,4-dioxane (7/ 3) solution. Results: The TPM images of CCD-18co (a normal colon cell line) and HCT116 cells (a colon cancer cell line) labeled with BH-2 were too dim to be distinguished. When the same cells were labeled with BHEt-1, however, the MPM image of the HCT116 cells was much brighter than that of CCD-18co cells, and the relative proportion of the acidic vesicles (Pacid) of the former was 5-fold larger than that of latter. BHEt-1 could also differentiate HepG2 cells (a human liver cancer cell line) from LX-2 cells (a human hepatic stellate cell line) with a 6-fold larger P acid value. Human colon cancer tissues labeled with BHEt-1 showed similar results, demonstrating much brighter MPM images and 6-fold larger Pacid values compared to normal tissue. Conclusions: These results suggest the potential utility of BHEt-1 for molecular image analysis of colon cancer tissues using MPM.
Self-monitoring and reminder text messages to increase physical activity after colorectal cancer (CRC): A pilot randomized controlled trial.
Authors: Van Blarigan Erin , Van Loon Katherine , Kenfield Stacey A. , Chan June M. , Mitchell Emily , Chan Hilary , Zhang Li , Paciorek Alan , Joseph Galen , Laffan Angela , Fukuoka Yoshimi , Miaskowski Christine , Meyerhardt Jeffrey A. , Venook Alan P. 
Published: January 2019

615 Background: Over 1.3 million people in the US are living with CRC. Physical activity is associated with lower risk of CRC mortality. Interventions are needed to increase physical activity after CRC diagnosis. Methods: We conducted a pilot RCT to determine the feasibility (adherence, attrition) and acceptability of a 12-wk intervention using a Fitbit Flex™ and daily text messages to increase physical activity after CRC. Eligible patients had to have colon or rectal cancer of any stage, be disease free or have stable disease, able to speak and read English, and access to Internet and a mobile phone. Individuals with contraindications to moderate-to-vigorous physical activity (MVPA) or exercising ≥30 min ≥5 d/wk were excluded. We explored the impact of the intervention (n = 20) vs. usual care (n = 21) on MVPA via ActiGraph GT3X+ accelerometers pre-/post-intervention. Results: The intervention was feasible and acceptable. On average, participants were 54 y, BMI 28 kg/m2 and enrolled 1.5 y after diagnosis; 59% were women, 73% were White, and 61% were stage III. The intervention arm wore their Fitbits a median of 74 d (89% of study days, IQR: 23-83 d) and responded to 74% (34) of the 46 text messages that asked for a reply (IQR: 28-82%). Older participants were more likely to wear the Fitbit ( r: 0.72; p < 0.001). Married participants were more likely to wear the Fitbit and respond to texts compared to unmarried (96% vs. 32% wear time, p: 0.02 and 85% vs. 46% response rate, p: 0.006). Most patients (88%) reported that the intervention motivated them to exercise and that they were satisfied with their experience. On average, the intervention arm increased MVPA by 14 min/d, while the control arm increased by only 1 min/d, but there was no statistically significant difference in change in MVPA between groups (mean difference comparing change in MVPA in the intervention vs. control: 13 min/d; 95% CI: -14, 40; p: 0.33). Conclusions: A 12-wk physical activity intervention with a Fitbit and text messages is feasible and acceptable among CRC patients after treatment. Larger studies are needed to determine whether the intervention increases physical activity. Clinical trial information: NCT02966054.