bluuebunny/crossref_metadata_2025_split huggingface dataset:
RA07.03: NON-ENDOSCOPIC SCREENING FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA: INTERIM ANALYSIS
Authors: Bhatt Maunil , Shah Parth , Gandhi Fenil , Patel Parth , Patel Dhwani , Patel Deep , Parmar Vipal , Mehta Bhavna , Rajput Sanjay , Godfrey Tony , Litle Virginia 
Published: September 2018

Abstract

Background
Esophageal Squamous Cell Carcinoma(ESCC) comprises 90% of esophageal cancer worldwide which typically presents at advanced stages and has extremely poor outcomes. Established risk factors for ESCC include tobacco, alcohol and betel nut use. We hypothesized that a screening program for high risk subjects could be established in a low- to middle-income country, using a low-cost, non-endoscopic, retrievable capsule sponge device called EsophaCap(EC).

Methods
The Institutional Review Board-approved study was conducted in western India from March 2017 through February 2018. Patients with high risk characteristics(smoking, tobacco, betel nut, alcohol, hot beverage consumption) were included. Patients with severe dysphagia, current upper aerodigestive tract cancer, metastatic cancer, esophageal varices, cirrhosis, and portal hypertension were excluded. Following EC specimen retrieval, endoscopic biopsies were collected at 20cm, 30cm and from any visible mucosal abnormalities. Cytology and biopsy specimens underwent H&E staining. An interim analysis was performed to make necessary changes given the lack of baseline data in this field.

Results
Of the 100 enrolled subjects(85% males, median age 50 years), 93% successfully swallowed the EC and 90% completed endoscopy. The median patient experience score on a 6-point visual analog scale was 5(‘minimal discomfort’). Six(7%) subjects had ESCC on their biopsy. In 2 ESCC patients with mild dysphagia, sponge cytology accurately detected atypical squamous cells(ASC) and dysplasia(100% Sensitivity & Specificity). The other 4 ESCC patients had moderate dysphagia with a near-complete obstruction. In 2 asymptomatic patients with no mucosal abnormalities on endoscopy or biopsies, sponge cytology detected ASC. Longitudinal follow-up of these patients is ongoing. On biopsies from twenty-one(23%) patients, leukoplakia was identified.

Conclusion
ESCC screening using the EC is feasible with good patient tolerance. Analysis of the cytology samples with H&E staining is potentially accurate for patients with non-obstructive lesions but has a high false negative rate in patients with advanced lesions, when the EC can’t traverse the obstruction. An unusually high rate of leukoplakia was detected in this population and will be evaluated as a potentially pre-malignant lesion with increased risk for development of ESCC. Future studies will include high-throughput sequencing to identify molecular changes that may correspond with leukoplakia or dysplastic cells retrieved with the EC.

Disclosure
All authors have declared no conflicts of interest.
RA08.01: WIDE-FIELD ENDOSCOPIC SUBMUCOSAL DISSECTION IN THE TREATMENT OF BARRETT’S ESOPHAGUS NEOPLASIA (WF-ESD)
Authors: Omae Masami , Konradsson Magnus , Wang Naning , Baldaque-Silva Francisco 
Published: September 2018

Abstract

Background
The role of ESD on Barrett's esophagus (BE) neoplasia has been studied in some small series with suboptimal results, mainly due to positive lateral margins (LM). We started ESD of neoplastic BE on 2011. Due to early suboptimal results because of positive lateral margins (LM), we decided to start performing wide-field ESD of Barrett's neoplasia from 2015. With the new approach resection is performed, as described for wide-field colorectal EMR with wider (5–10mm) free margins, after careful BE assessment. Our aim was to evaluate the feasibility, safety and efficacy of wide field ESD (WF-ESD) for resection of BE neoplasia comparing it to conventional ESD (c-ESD).

Methods
We asessed the patients and tumor characteristics and technical issue in all ESDs compared with c-ESD with WF-ESD. In order to reduce stricture risk, from 2015, oral steroids were used in patients with more than 3/4 resection of all circumferential lumen of the esophagus. The primary outcomes were the rates of en bloc, R0 and curative resection rates. The secondary outcomes were the rate of negative LM and adverse events rate such as bleeding, perforation and stricture rate. This study was approved by the Stockholm Regional Ethical Committee (2013–596-31).

Results
Total sixty-four consecutive ESD cases of early Barrett neoplasia were performed in 50 patients in our center between 2011–14 and 2015–17. The mean age was 67.1 ± 9.9 vs 67.2 ± 10.0, the male/female was 13/6 vs 25/6 in c-ESD and WF-ESD. In primary outcomes, en-block resection rate was 91.3 vs 100% (21/23 vs 41/41), R0 resection rate was 69.6 vs 85.4% (16/23 vs 35/41), curative resection rate was 56.5 vs 78.0% (13/23 vs 32/41) (P > 0.05). In the secondary outcomes, negative rate in LM was 26.1 vs 2.4% (6/23 vs 1/41), adverse event rate including perforation and bleeding was 4.3 vs 9.8%(1/23 vs 4/41) and stricture rate was 21.7 vs 2.4% (5/23 vs 1/41) with P < 0.01 for LM and P < 0.05 for stricture rate.

Conclusion
Wide field ESD is associated with improved efficacy and good safety profile in the treatment of neoplastic BE. More studies are necessary to confirm its role in the management of BE.

Disclosure
All authors have declared no conflicts of interest.
RA08.04: IMPORTANT ENDOSCOPIC AND HISTOPATHOLOGICAL CHARACTERISTICS FOR PREDICTING SUBMUCOSAL TUMOR INVASION IN SUPERFICIAL BARRETT ADENOCARCINOMA
Authors: Namikawa Ken , Nakano Kaoru , Akazawa Naoki , Ishiyama Akiyoshi , Fujisaki Jyunko 
Published: September 2018

Abstract

Background
Predicting the depth of invasion of superficial Barrett adenocarcinoma (s-BA) is important for choosing an appropriate treatment. This study aimed to evaluate the endoscopic and histopathological characteristics related to s-BA submucosal invasion.

Methods
We retrospectively reviewed 67 lesions in 63 cases with pathologically defined s-BA (SSBE, n = 56; LSBE, n = 7) that underwent endoscopic resection at our hospital from January 2004 to December 2017. Initial treatment included endoscopic mucosal resection (EMR) (n = 4), endoscopic submucosal dissection (ESD) (n = 99), and surgery (n = 33). We grouped 133 lesions into two groups based on depth of tumor invasion: group M comprised 87 intramucosal tumors and group SM comprised 49 submucosal tumors. We defined characteristic criteria for submucosal invasion as follows: tumor size ≥ 21 mm, complex macroscopic type; composed of > 2 macroscopic types, biopsy-por; biopsy specimens including poorly differentiated adenocarcinoma. Endoscopic ultrasound (EUS) was performed only in cases in which predicting the depth of tumor invasion was difficult.

Results
In group M, the median tumor diameter was 13 (range, 1–82) mm and included 68 SSBEs and 19 LSBEs. In group SM, the median tumor diameter was 23 (range, 4–55) mm and included 41 SSBEs and 8 LSBEs. Tumors larger than 21 mm were seen in 12 (13.8%) patients in group M and 25 (51.0%) in group SM. Complex macroscopic type tumors were present in 20 patients (23.0%) in group M and 30 (61.2%) in group SM. Biopsy-por was present in 2 (2.3%) in group M and 12 (24.5%) in group SM. Multivariate analysis indicated the above three characteristics as independent predictors of submucosal invasion; in particular, biopsy-por was highly significant (P < 0.001, odds ratio, 10.81). EUS was performed in 55 lesions including 28 tumors invading the submucosa. Sensitivity, specificity, positive predictive value, and negative predictive value of EUS for predicting submucosal invasion were 46.4%, 70.4%, 61.9%, and 57.5%, respectively.

Conclusion
Tumor size ≥ 21 mm, complex macroscopic type, and biopsy specimens including poorly differentiated adenocarcinoma were independent predictors of submucosal invasion. Specificity of EUS was relatively high for cases that were difficult to predict depth of tumor invasion.

Disclosure
All authors have declared no conflicts of interest.
RA08.05: ENDOSCOPIC THERAPY AND SURVEILLANCE VERSUS ESOPHAGECTOMY FOR EARLY ESOPHAGEAL ADENOCARCINOMA: A REVIEW OF EARLY OUTCOMES AND COST ANALYSIS
Authors: Boshier Piers , Wirsching Andrea , Krishnamoorthi Rajesh , Larsen Michael , Irani Shayan , Ross Andrew , Low Donald 
Published: September 2018

Abstract

Background
Endoscopic therapy is considered to be comparable to esophagectomy with respect to oncologic outcomes in early (clinical stage T1) esophageal adenocarcinoma (EC). The current study aims to compare early outcomes and financial costs, associated with endoscopic versus surgical therapy for early EC.

Methods
Retrospective review of patients undergoing either endoscopic or surgical therapy for cT1 EC between 2010 and 2015 at a single high-volume center. To ensure comparability between treatment groups only those patients who were deemed medically fit to undergo esophagectomy, regardless of ultimate management, were included. Cost analysis was performed for each patient group and was compared to procedural outcomes.

Results
Forty-three patients met the inclusion criteria for this study (endoscopic therapy n = 20; esophagectomy n = 23). All patients who underwent endoscopic therapy had clinical stage T1A, whilst 15 patients in the esophagectomy group had T1B disease (P < 0.001). Patient groups were well matched for all other baseline characteristics (P > 0.05). For patients undergoing endoscopic therapy a median of six interventions were performed per patient (range 2–18). Same day discharge was achieved after 98% of all endoscopic procedures with 72% of cases performed under general anesthesia. Endoscopic dilations due to stricture formation were required in five (25%) patients after endoscopic therapy. Esophagectomy was associated with a median hospital stay of 9 (8–13) days and greater procedure specific morbidity compared to endoscopic therapy. Median treatment costs for patients undergoing esophagectomy were significantly greater than that incurred for patients receiving endoscopic therapy only ($53,849, 95%-confidence interval: 50,541–88,784 vs. $22,640, 95%CI: 18,754–46,705, P < 0.001). The minimum cost associated with esophagectomy in the current study was approximately four times greater than for endoscopic therapy ($40,410 vs. $9236). In comparison the maximum cost incurred for surgical and endoscopic therapy were $247,808 and $127,508 respectively. Overall costs were significantly correlated to either number and severity or postoperative complications or number of endoscopic procedures performed (P < 0.002).

Conclusion
In patients with early EC endoscopic therapy was associated with lower rates of procedure specific morbidity compared to esophagectomy. Despite an increased number of interventions and longer duration of therapy, overall costs were significantly lower in patients undergoing endoscopic therapy when compared to esophagectomy.

Disclosure
All authors have declared no conflicts of interest.
RA08.06: ONGOING CHALLENGES IN CLINICAL ASSESSMENT OF NODAL STATUS IN T1 ESOPHAGEAL ADENOCARCINOMA
Authors: Nobel Tamar , Barbetta Arianna , Hsu Meier , See Tan Kay , Bains Manjit , Adusumilli Prasad , Bott Matthew , Isbell James , Sihag Smita , Jones David , Molena Daniela 
Published: September 2018

Abstract

Background
Endoscopic resection has emerged as an esophageal-preserving treatment for T1 esophageal adenocarcinoma (EAC); however, only patients with negligible risk of nodal metastasis should receive this option. Since preoperative reliable diagnostic tools are lacking, scoring systems have been developed to assess risk of lymph node metastasis (LNM). The purpose of this study was to provide external validation of two previously published scoring systems for clinical prediction of nodal status in patients with T1 EAC.

Methods
In adherence with patient selection criteria in the two previously published scoring systems (figure 1), we identified patients with T1 EAC (n = 230) who underwent esophagectomy without neoadjuvant treatment from a prospective database between 1995 and 2017. Clinicopathologic characteristics were compared between patients with LNM and without. Risk scores were tabulated in accordance with the two scoring systems. Predictive accuracy of the scores were evaluated by c-index and calibration plots, and compared using Venkatraman's test for paired receiver operating characteristics curves.

Results
Groups were similar in age, location and nodes harvested. There were 38 (17%) patients with positive LNM; 3/66 (5%) T1a and 35/164 (21%) T1b. LNM was associated with poor differentiation (25% vs 42; P = 0.001), positive LVI (16.1% vs 71.1; P < 0.001) and longer tumors (1.6 cm vs 2.2; P = 0.004). Median score A was 6.2 (IQR 4.2–7.6) for patients without LNM versus 12.5 (8–13.5) with LNM. Median score B was 2 for T1a and 3 for T1b patients without LNM versus 5 for T1a and T1b with LNM. AUCs of the two scoring systems were similar (score A 0.86, [95% CI 0.81–0.91] vs B 0.83 [0.77–0.89], P = 0.89). For patients with LNM (n = 38), all were high risk for LNM according to score A and 37 (97%) met criteria for esophagectomy according to B. In those without LNM (n = 192), 138 (72%) were high risk for LNM and 102 (53%) met criteria for esophagectomy.

Conclusion
Both scoring systems demonstrated good predictive accuracy for LNM; however, B may be simpler to implement. Most patients classified as high risk or for esophagectomy did not have nodal metastasis on pathology. Future scoring systems must better identify which patients are candidates for organ preservation on the basis of LNM.

Disclosure
All authors have declared no conflicts of interest.
RA08.07: NOMOGRAM PREDICTING LONG TIME SURVIVAL FOR M1 ESOPHAGEAL CANCER
Authors: Liu Mina 
Published: September 2018

Abstract

Background
Esophageal cancer is the sixth most common cause of cancer deaths globally, and causes the deaths of over 400,000 people worldwide annually. For the patients with M1 diseases, the population has been growing over the past 20 years. Chemotherapy is the standard treatment for them, however, the survival is not satisfactory, with 5-year relative survival less than 5%. Very limited patients were able to survive more than two years. Our study aimed to evaluate the clinicopathologic characteristics of the long-time survivals and construct a clinical nomogram using the Surveilance, Epidemiology, and End Results (SEER) database.

Methods
Information of patients diagnosed with M1 stage esophageal cancer from 2010–2014 was retrieved from SEER database. Patients with unknown TNM stage or unknown metastatic sites were not included. Demographic and clinicopathologic characteristics were compared between LTS (long time survivals: patients who have survived for no less than 2 years) and STS (shorter time survivals: patients who have survived for less than 2 years). Cox regression analysis was performed to evaluate prognostic factors. A nomogram comprising demographic and clinicopathologic factors was established to predict 1-year survival and 2-year survival for patients with M1 diseases.

Results
A total of 3133 patients from the SEER database were included for analysis. The demographic and clinicopathologic variables of the LTS and the STS groups were summarized and compared. Compared with the STS, married people and patients with Grade I-II differentiated diseases were significantly more likely to be LTS. Also, LTS were associated with less bone metastasis and more surgery. Seven point three percent married patients have survived more than two years, however, only 4.5% single or divoiced or widow patients were LTS. Among the 3313 patients, 123 patients recieved surgery, and as high as 28.5% patients were LTS. The OS nomogram (Figure 1) was based on the eleven variables: gender, age, marital status, T stage, histology, grade, bone metastasis, brain metastasis, liver metastasis, lung metastasis, and surgery. Figure 1 Nomogram predicting 1-year and 2-year OS for M1 stage esophageal cancer

Conclusion
We developed a nomogram predicting 1- and 2-year overall survival for M1 stage esophageal cancer. The prognostic model may improve clinicians’ abilities to predict individualized survival and to make treatment recommendations

Disclosure
All authors have declared no conflicts of interest.
RA09.02: LYMPH NODE RESPONSE AFTER NEOADJUVANT CHEMORADIATION THERAPY FOR ESOPHAGEAL ADENOCARCINOMA: TIME FOR AN APPROPRIATE YPN CLASSIFICATION
Authors: Depypere Lieven , De Hertogh Gert , Moons Johnny , Provoost An-Lies , Lerut Toni , Sagaert Xavier , Coosemans Willy , Van Veer Hans , Nafteux Philippe 
Published: September 2018

Abstract

Background
Response of the primary tumor and lymph node involvement are the most important prognosticators in resected patients with esophageal adenocarcinoma after neoadjuvant chemoradiation. Response on the primary tumor is well established using T(umor) R(egression) G(rading). However, little is known about the prognostic value of lymph node response in these patients.

Methods
Hematoxylin-eosin slides of 193 adenocarcinoma patients with clinical suspicion of lymph node involvement (cN+) and treated with neoadjuvant chemoradiation therapy between 2008 and 2015 were all reassessed by a senior pathologist. Lymph node response (LNR) was defined as a combination of central fibrosis and at least one other characteristic such as hemosiderin pigment, acellular mucin pools, foam cells, giant cells or calcifications. Lymph nodes were categorized in four categories: 1° as positive (ypN+) when viable tumor was found according to TNM 8th edition. 2° as negative (ypN0) in absence of any viable tumor. 3° as lymph nodes with signs of LNR (LNR+). 4° as lymph nodes without signs of LNR (LNR-). All patients were grouped according to lymph node positivity and lymph node regression. Multivariate and survival analysis were performed by Cox proportional hazard regression analysis.

Results
Thirty-four patients were ypN + /LNR + , 60 were ypN + /LNR-, 41 were ypN0/LNR + and 58 were ypN0/LNR-. Median overall survival was respectively 41.0 months, 18.5 months, 31.2 months and 62.9 months. Survival was significantly different between ypN0 groups (P = 0.045) but not between ypN + groups (P = 0.299). Multivariate analysis showed that LNR was an independent prognosticator (P = 0.011).

Conclusion
In cN + esophageal adenocarcinoma patients treated with neoadjuvant chemoradiation with final pathology being ypN0 after esophagectomy, median overall survival is doubled when no signs of LNR were found suggesting these patients were in fact true N0 and that ypN0/LNR + have a similar prognosis as ypN + /LNR + . Using these four categories of ypN allows for more precise evaluation of the impact of induction therapy.

Disclosure
All authors have declared no conflicts of interest.
RA09.03: PERINEURAL INVASION (PNI) IN ESOPHAGEAL CANCER: IMPROVING THE VALUE OF MODERN STAGING: A META-ANALYSIS
Authors: Leng Xue-Feng , Zhu Yi , Cheng Lei , Cheng Xin , Jin Jian , Yuan Yong 
Published: September 2018

Abstract

Background
Esophageal cancer treatment is largely determined by tumor stage. Despite improvements made in the treatment of different types of this malignant disease, staging has still in continuous renewal. The role of perineural invasion (PNI) in staging remains debated. We have assessed the relation of PNI with metastatic pattern to evaluate whether PNI might add significant new information to staging.

Methods
We performed a systematic literature search that was focused on the PNI in esophageal cancer published up to February 2018. Studies with neoadjuvant-treated patients were excluded. Data on T stage, N stage and other characteristics were extracted. Data were analyzed for the relevance of the presence of PNI, lymph node metastases, and the tumor invasion on the depth of esophageal structure and outcomes.

Results
A total of 9 cohorts were retrieved, covering 2207 patients. PNIs are invariably associated with poor outcome. Moreover, a total analysis of 2207 patients showed improved PNI in T3 + T4 (OR = 0.25, 95% CI: 0.15–0.44, and P < 0.00001), 674 of 2204 patients showed PNI more favored in N positive (OR = 0.61, 95% CI: 0.38–0.96, and P = 0.03), and 461 of 1788 patients showed improved PNI in G3 + G4 (OR = 0.70, 95% CI: 0.54–0.92, and P = 0.010) compared with T1 + T2, N − , and G1 + G2 patients, respectively.

Conclusion
PNI is an adverse prognostic factor in esophageal cancer. We have shown that PNIs have valuable prognostic information in advanced T, N stage and poor cell differentiation. Therefore, we propose that PNI may provide a vital clue to esophageal cancer staging in the future.

Disclosure
All authors have declared no conflicts of interest.
RA09.05: MDM2 AND ERCC1: NOVEL BIOMARKERS TO PREDICT THE RESPONSE TO NEOADJUVANT CHEMOTHERAPY FOR ESOPHAGEAL CANCER PATIENTS
Authors: Ito Ken , Konno Takuro , Onodera Yu , Ishida Hirotaka , Maruyama Shota , Okamoto Hiroshi , Sato Chiaki , Heishi Takahiro , Sakurai Tadashi , Taniyama Yusuke , Kamei Takashi 
Published: September 2018

Abstract

Background
Neoadjuvant chemotherapy (NAC) by 5-fluorouracil (5-FU) and cisplatin followed by esophagectomy has been established as a standard approach for the patients with clinical stage II/III esophageal squamous cell carcinoma (ESCC) in Japan. However, NAC is not always effective in all these patients, and it is important to identify biomarkers for predicting the response. Therefore, the present study aimed to identify markers for predicting the response to chemotherapy and the clinical outcomes.

Methods
This study included 62 ESCC patients who underwent esophagectomy following NAC. We performed immunohistochemical analyses for murine double minute 2 (MDM2), thymidine phosphorylase (TP), dihydropyrimidine dehydrogenase (DPD), and excision repair cross-complementing rodent repair deficiency-1 (ERCC1) in surgical specimens following NAC and assessed the associations of the findings with clinicopathological features in individual patients.

Results
The MDM2 status and ERCC1 status demonstrated significant inverse associations with the response to NAC (MDM2: P = 0.025, ERCC1: P = 0.021). In addition, a high TP status in the tumor was significantly associated with tumor differentiation (P = 0.008), depth of invasion (P < 0.001), lymphatic invasion (P = 0.003), venous invasion (P < 0.001) and tumor stage (P = 0.006). Moreover, a high DPD status was associated with tumor differentiation (P = 0.008), depth of invasion (P < 0.001), venous invasion (P = 0.003) and tumor stage (P = 0.007). The TP status also significantly predicted the eventual clinical outcome of patients following surgery.

Conclusion
Recently, overexpression of MDM2 has been reported for poor prognosis in patients with ESCC treated by chemoradiotherapy. 5-FU metabolic enzymes, such as TP andDPD, have been investigated for sensitivity to 5-FU. ERCC1, a key component of homologous recombination-based repair of interstrand DNA cross-links, has been reported to predict sensitivity to cisplatin. In our study, MDM2 and ERCC1 immunoreactivity predict chemosensitivity of NAC based on 5-FU and cisplatin. High intratumoral TP status and DPD status are associated with tumor progression and prognosis in ESCC patients receiving NAC.

Disclosure
All authors have declared no conflicts of interest.