bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oncological outcomes in a Mexican cohort of patients with gallbladder cancer.
Authors: Meneses Medina MÃ³nica Isabel , Valenzuela Ana Karen , Nieto Zuleyma , Camargo Vanessa Rosas , Casanova Sánchez Iván Eliud , Gamboa Dominguez Armando , Contreras Saldívar Alan Gabriel , Huitzil Melendez Fidel David 
Published: January 2019

518 Background: gallbladder cancer is the most common malignancy of the biliary tract. Treatment modalities and outcomes for this disease in Mexican population have been infrequently reported. Methods: we retrospectively reviewed medical records from 61 patients with histologically confirmed gallbladder cancer treated at Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán from January 2005 to December 2015.Clinical and pathological information was recorded. Survival was estimated by Kaplan Meir method and compared by Log rank test. Results: we found 68.9% women and 31.1% men, with a median age of 68 years (32-93). Clinical stage was advanced in 65.6% (n=40), regional in 23% (n=14), localized in 4.9% (n=3) and in situ in 6.6% (n=4). For patients with localized disease (n=21), which included in situ, localized and regional disease, a potentially curative surgery was attempted in 100% of patients, achieving a R0 resection in 47.6% (n=10) of cases. The morbidity rate was 33.3% (n=7). There were 5 surgical deaths. For advanced disease (n=40), the initial treatment was: 42.5% (n=17) palliative surgery, 25% (n=10) palliative care and for 30% (n=12) systemic chemotherapy, more frequently gemcitabine plus cisplatin (n=7). At progression seven patients received second-line chemotherapy. Median overall survival (OS) in the global cohort was 5.6 months (IC 95, 2.4-8.77). According to clinical stage survival at 5 years was 100% for in situ and 67% for localized disease. Median survival was 6.3 months (IC 95, 2.3-10-3) for regional disease and 4.2 months (IC 95, 1.1-6.4) for advanced disease. For patients with localized disease not achieving R0 resection (p=0.03) and perineural invasion (p=0.025) were associated with decreased survival. For patients with advanced disease poor performance status (p=0.004) and absence of chemotherapy (p=0.002) were adverse prognostic factors. Conclusions: global poor outcomes may be explained by metastatic disease at presentation. Even for patients with apparent localized disease, a potentially curative resection could be offered to only half of the patients.
Treatment strategy and prognostic factors for Krukenberg tumors of gastric origin: Report of a 10-year single-center experience from China.
Authors: Pengfei Yu , Huang Ling , Du Yian 
Published: January 2019

52 Background: Gastric cancer patient with ovarian metastasis, i.e. Krukenberg tumor, is common in clinical practice, but it is still uncertain whether surgical resection of ovarian metastasis could improve the outcome. This study aimed to explore the survival benefit of metastasectomy plus chemotherapy over chemotherapy alone in the treatment of Krukenberg tumors arising from gastric cancer and to identify prognostic factors. Methods: All patients who were diagnosed with gastric cancer and ovarian metastases between January 2005 and December 2014 were included in the current study. Patients were subdivided according to treatment modality: the metastasectomy group (metastasectomy plus chemotherapy) and the non-metastasectomy group (chemotherapy alone). The clinicopathological features and the treatment records were reviewed in detail and their association with survival were analyzed. Results: A total of 152 patients were identified, including 93 patients with synchronous ovarian metastasis and 59 patients with metachronous ovarian metastasis. Overall survival (OS) was significantly better in metastasectomy group relative to the non-metastasectomy group for patients with synchronous ovarian metastasis (19.0 months vs. 11.8 months; P < 0.001) and those with metachronous ovarian metastasis (24.6 months vs. 14.3 months; P = 0.02), respectively. Metastasectomy (hazard ration [HR] 0.486; 95% confidence interval [CI] 0.323–0.729; P < 0.001), peritoneal carcinomatosis (HR 1.934; 95% CI 1.230–3.049; P = 0.004), and expression status of ER-β (HR 0.404; 95% CI 0.251–0.648; P < 0.001) and PR (HR 0.496; 95% CI 0.301–0.817; P < 0.001) were independent predictors of OS. Conclusions: Metastasectomy plus chemotherapy was associated with survival benefits in patients with Krukenberg tumors from gastric cancer. Metastasectomy, peritoneal carcinomatosis, and expression status of ER-β and PR were independent prognostic factors for survival.
Colorectal cancer screening: Why do some people never participate? Results from the EDIFICE surveys.
Authors: Viguier Jerome , Eisinger François , Touboul Chantal , Lhomel Christine , Morere Jean F. 
Published: January 2019

565 Background: The aim of EDIFICE surveys is to improve insight into the behavior of the French population with regard to cancer prevention and participation in screening programs. Via the colorectal cancer (CRC) screening program, all average-risk individuals in the 50-74-yr age group are invited every 2 years to do a guaiac-based or immunochemical fecal occult blood test. This analysis focuses on lay-population reasons for not undergoing the test. Methods: The 5th nationwide observational survey was conducted by phone interviews using the quota method. A representative sample of 1299 individuals with no history of cancer (age, 50-74 yrs) was interviewed between 22 November and 7 December 2016. Those who had never undertaken a screening test were asked for their reasons. Results: In total, 64% reported having undergone a screening test (colonoscopy, fecal occult blood test) at least once in their lifetime (coverage). There was a non-significant (NS) increase in coverage rates over the period 2014-2016. In 2016, the most frequently (36%) cited reason for not being screened was “individual negligence/not a priority”. This figure was significantly higher than in 2014 (24%, P < 0.05). Between one in four and one in five respondents answered “no risk factor” in both 2014 and 2016. Approximately one in ten respondents gave “pointlessness” as their reason for not being screened (12% in 2016 vs 8% in 2014, NS) while “fear of the examination or fear of the results”, “reasons related to the physician (he never suggested it” [3.8% in 2016] or “he recommended against screening” [2.5% in 2016]), or “refusal to participate”, all dropped significantly between 2014 and 2016. Conclusions: The issue of “individual negligence” requires further analysis so as to clearly define the categories of individuals who remain unreceptive to screening and identify how best to involve them. The significant mention of “no risk factors” reveals ignorance of the fact that the colorectal cancer screening program actually targets all individuals in a given age group, regardless of individual risk factors. The decrease in reasons involving “fear" or related to the physician may be a result of awareness campaigns and GP mobilization.
Compliance with NCCN screening and chemoprevention recommendations among carriers of deleterious mutations in the adenomatous polyposis coli gene.
Authors: Kazmi Syed Mohammad Ali , Mauer Caitlin , Pirzadeh-Miller Sara , Watson Elise , Beg Muhammad Shaalan , Ross Theodora S. 
Published: January 2019

571 Background: Deleterious mutations in adenomatous polyposis coli gene (APC) lead to familial adenomatous polyposis [FAP] and attenuated FAP (aFAP) syndromes associated with hereditary colorectal cancer (CRC) and extra-colonic neoplasms. Reports suggest only two-third of such patients (pts) comply with recommended screening guidelines. The objective of this study was to assess compliance of FAP/aFAP pts with NCCN recommended guidelines of screening endoscopies and chemoprevention in our population. Methods: Retrospective review of clinical charts of pts with APC mutations, identified through multi-gene panel or single-gene testing, and seen in our NCI designated Comprehensive Cancer Center between 01/2013 and 09/2017. Results: Out of 53 pts with deleterious APC gene mutations, 31 pts (58.5%) had mutations associated with an FAP (27 pts; mean-age 31 years) or aFAP (4 pts, mean-age 33 years) phenotype and were included in analyses. Ten of these 31 pts (32.3%) were diagnosed with FAP after diagnosis of CRC; the rest had family history of FAP/aFAP. Documentation of total-colectomy was found in 17 pts (54.8%), 4 pts (12.9%) did not undergo colectomy and this information was unknown in 10 pts (32.3%). Colonoscopy/EGD after diagnosis of FAP/aFAP was documented in 22 pts (71.1%) while subsequent annual EGD/colonoscopy was documented only in 14 pts (45.1%); records were missing in 13 pts (41.9%). Extra-colonic secondary neoplasms such as duodenal polyps were documented in 8 pts, gastric polyps in 7 pts, desmoid tumor in 2 pts and malignant cancer of ampulla of Vater in 1 pt. Other malignant neoplasms, unrelated with FAP/aFAP, were reported in 3 pts (9.6%, 1 breast, 1 kidney and 1 endometrial cancer). Chemoprevention with sulindac was used in 3 pts (9.7%), 3 pts (9.7%) declined such treatment, 17 pts (54.8%) records were without evidence of this being discussed. Conclusions: The rate of compliance in FAP/aFAP pts with NCCN recommended screening and chemoprevention guidelines in our cohort was low but similar to prior literature. A multidisciplinary approach and interventions to improve compliance among pts are necessary to improve annual screening and chemoprevention rates.
A real world analysis of recurrence risk factors for early colorectal cancer T1 treated with standard endoscopic resection.
Authors: Vila Clara Martinez , Pericay Carles , Oliveres Helena , Fernandez Paula Ribera , Alcala Maria Marin , Ruiz Juan Carlos Pardo , Joaquin Julia Giner , Romero Jose Manuel Cabrera , Serra Javier , Ballesteros Eva , Munte Antoni Malet , Casado Alejandro Casalots , Macias Ismael , Saigí Eugeni 
Published: January 2019

575 Background: Currently, endoscopic resection of early colorectal cancer (ECC) defined as carcinoma with invasion limited to the mucosa (Tis), and submucosa (T1) is possible due to advances in instrumentation. However, when tumor invades submucosal layer, lymph node dissemination is present in 16.2% of cases, requiring additional surgery and limfadenectomy. Risk factors for lymph node dissemination and independent for relapse have been previously described in literature. Methods: We performed a retrospective analysis of all patients with colorectal T1 tumors, treated at our center with endoscopic resection and some with additional surgery between 2006 and 2017. Stadistical analysis was perfomed with IBM SPSS Statistics 24.0. Results: 159 patients (p) were treated with endoscopic resection, 56.6% (90p) underwent additional surgery. Mean age was 68.74 years and 69.9% (111p) were male. Endoscopic resection: negative margins 87.6%, vascular 3.1%, lymphatic 2.5% and perineural invasion 3.8%, high degree of histological differentiation 1.3%. Surgical resection: negative margins 100%, lymph node spread 8.8%. In a mean follow-up of 23.36 months since endoscopic treatment, 13 patients had relapsed. Risk of relapse did not differ between patients who received additional surgery and those who only underwent endoscopic resection (p = 0.791). On the other hand, lymph node dissemination (p = 0.007) and a positive margin (p = 0.01) were independent risk factors for risk of relapse. Vascular, lymphatic and perineural invasion, nor degree of histological differentation were stadistically significant. However, there was a positive association between lymph node dissemination and lymphatic (p = 0.07), vascular (p = 0.007) and perineural (p = 0.001) invasion and also degree of histological differentiation (p = 0.000). Conclusions: In our study, relapse rate was under 10% in eleven years. The only independent risk factors for relapse were a positive margin and lymph node dissemination. Perineural, vascular and lymphatic invasion obtained from polypectomy sample, could infer the probability of positive lymph nodes and indirectly be an indicator for risk of relapse.
Clinicopathological characteristics and HER2 status in metastatic colorectal cancer patients: Results of a diagnostic model development study.
Authors: Sartore-Bianchi Andrea , Amatu Alessio , Porcu Luca , Ghezzi Silvia , Lonardi Sara , Bergamo Francesca , Bonazzina Erica Francesca , Mauri Gianluca , Cremolini Chiara , Ciardiello Fortunato , Valtorta Emanuele , Truini Mauro , Martino Cosimo , Marsoni Silvia , Di Nicolantonio Federica , Siravegna Giulia , Bardelli Alberto , Trusolino Livio , Torri Valter , Siena Salvatore 
Published: January 2019

581 Background: We have reported with the HERACLES Trial that HER2 amplification is a clinically relevant genetic alteration in metastatic colorectal cancer (mCRC). With present study, we aim to develop and internally validate a new diagnostic model for HER2 status in patients with mCRC based on clinicopathological characteristics to improve selection for HER2-targeted therapies and to refine negative selection for EGFR-targeted agents. Methods: Patients with KRAS exon 2 WT mCRC underwent molecular screening of HER2 according to HERACLES criteria (immunohistochemistry 3+ or 2+ in equal or more than 50% of cells, confirmed by FISH) for enrollment in HERACLES clinical trials with HER2-targeted therapies. All HER2-positive cases and a fraction of negative consecutive cases were annotated with clinical and pathological variables. A multivariable logistic regression model with a linear combination of all clinical and pathological characteristics as predictors was fitted to the complete set of data. A regression modeling strategy was applied to the full model to identify predictors explaining the bulk of HER2 amplification. Results: From August 2012 to June 2017, a total of 80 HER2-positive mCRC cases were detected out of 1355 screened patients. The large majority of HER2-positive primary tumors appeared to be left colon- or rectal-sided (88.0%). None of the relevant clinicopathological features explained the bulk of HER2 amplification, even though trends were observed for sidedness (left colon and rectal > proximal, OR 1.75, 95% CI 0.76-4.16), tumour grading (high > low, OR 2.21, 95% CI 0.19-26.38), and metastatic burden (high > low, OR 1.29, 95% IC 0.94-1.77). In a secondary analysis, patients with HER2-amplified mCRC who received treatment with anti-EGFR agents (n = 64) showed poorer outcome (objective response rate: 30% vs 55%, p = 0.044 and progression-free survival: 5.8 months vs 7 months, p = 0.056). Conclusions: Testing for HER2 should be offered to all patients with mCRC since it is unlikely to predict the occurrence of this biomarker based on main clinicopathological features. Patients with HER2-amplified mCRC are less likely to respond to anti-EGFR therapy.
Estimating 1- and 5-year relative survival trends in colorectal cancer (CRC) in the United States: 2004 to 2014.
Authors: Crooke Hannah , Kobayashi Monica , Mitchell Brian , Nwokeji Esmond , Laurie Melissa , Kamble Shital , McKenna Mike , Masood Ashiq , Korytowsky Beata 
Published: January 2019

587 Background: Patient survival is impacted by several factors, one of which is stage at diagnosis. From 1976 to 2014, CRC death rate in the United States (US) declined by 51%. This retrospective study was conducted using US Surveillance, Epidemiology and End Results (SEER) data to evaluate 1- and 5-year relative survival for patients with CRC by American Joint Committee on Cancer (AJCC) stage, age and sex at diagnosis. Methods: The study included adults (age ≥20 years) in the SEER-18 registry diagnosed with CRC in 2004-2014. One- and 5-year relative survival rates were stratified by AJCC stage, age group (20-64 vs. ≥65 years) and sex. Results: One- and 5-year survival was calculated by age and stage at diagnosis (Table), and by sex (data not shown). Overall, 5-year survival rates declined compared to 1-year rates, with the biggest decline observed in stage IV patients. Survival was higher in the younger cohort than in patients ≥65 years of age regardless of stage. Both men and women diagnosed with stage IIB CRC had lower 1- and 5-year survival compared to stage IIIA and IIIB groups, consistent with previous findings. Patients with stage IV had the lowest survival irrespective of age or sex. Conclusions: Overall trends in 1- and 5-year relative survival for CRC varied by AJCC stage, age and sex. Since survival is lowest among CRC patients diagnosed at stage IV, particularly in elderly patients, it reinforces the need for early diagnosis and availability of innovative late stage therapies in this population. [Table: see text]
Safety of administration of bevacizumab within a week from placement of a totally implantable central venous port system.
Authors: Muranaka Tetsuhito , Komatsu Yoshito , Yagisawa Masataka , Kawamoto Yasuyuki , Nakatsumi Hiroshi , Yuki Satoshi , Sakamoto Naoya 
Published: January 2019

589 Background: Totally implantable central venous port systems (TICVP) are easy to implant on an in- or outpatient basis and provide reliable, long-lasting central venous access for treatment of intravenous anti-cancer chemotherapy in patients with cancer but it is needed to cut 3cm of patients’ skin at the operation. Bevacizumab is one of the anti vascular endothelial growth factor (ant-VEGF) antibody which is known to improve overall survival in patients with colorectal cancer but have a side effect of delayed wound healing. There are few reports about the safety of administration of bevacizumab in a short period of time from the small surgery such as placement of TICVP. Methods: Patients who were placed TICVP in Department of Gastroenterology of Hokkaido University Hospital from July 2009 to December 2016. We planned to compare the rate of post-operative wound dehiscence (POWD) and surgical site infection (SSI) between patients who administered bevacizumab within a week from placement of TICVP (Group A) and the other patients (Group B). Patients who didn’t receive any chemotherapy after placement of TICVP were excluded. Results: We found 432 patients who implanted TICVP, and excluded 32 patients who didn’t receive any chemotherapy. 50 patients were assigned to Group A and 350 patients were assigned to Group B. Median age in both group were 67.5 in Group A and 65 in Group B. The averages of operation time were 38.7 (+/-19.3) minutes in Group A and 36.4 (+/-19.5) minutes in Group B. Prophylactic antibiotics were given to 27 patients (54%) in Group A and 146 patients (48.7%) in Group B. The rate of POWD was 0.0% (0/50) in Group A vs 1.1% (4/350) in Group B ( p = 0.45 ) , and the rate of SSI was 0.0%(0/50) in Group A vs 1.1% (4/350) in Group B ( p = 0.45 ) . The average of operation time of patients with and without POWD was 56.4 minutes and 36.7 minutes (p = 0.013). Conclusions: In our study, it was found that there is no significant increase of incidence by administration of bevacizumab within a short period from placement of TICVP. The long operation time tends to increase the rate of POWD.
First results of universal screening for Lynch syndrome in a Mexican cohort of colorectal cancer patients.
Authors: Nieto Zuleyma , Valenzuela Ana Karen , Huitzil Melendez Fidel David , Meneses Medina MÃ³nica Isabel , Gamboa Dominguez Armando , Camargo Vanessa Rosas , Arteaga Vazquez Jazmin , Pineda Mauricio Mora 
Published: January 2019

590 Background: universal screening has been proposed as an alternative to clinical criteria for detection of Lynch syndrome (LS). Results of such policy have not been evaluated in mexican population with low incidence of colo-rectal cancer (CCR). Objective: to determine the proportion of patients tested by immunohistochemistry (IHC) for mismatch repair-deficient (dMMR) and characterize subsequent molecular and clinical work up for abnormal results. Methods: we identified all consecutive cases of CCR during 2016 at Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico. We recorded clinical variables, IHC for mismatch repair (MMR) proteins and/or clinical genetics evaluation and molecular confirmation of LS if available. Results: universal screening policy was adopted by our institution in 2016. 209 CRC patients had an outpatient consultation. The median age at diagnosis was 59.8 years. 103 IHC for MMR proteins were done (49%) regardless of age at diagnosis and a family history of CRC. 36/103 (35%) IHC showed abnormal result meaning lack of expression of at least one of four MMR proteins: 26 MLH1, 7 MSH2, 10 MSH6 and 23 PMS2. 11/36 patients (30%) had a family history of CRC. 26/36 (72%) were evaluated by clinical genetics service. Of 26 MLH1 deficient patients, only one case was tested for BRAF mutation. 14/36 patients (39%) were tested by sequencing analysis: 7 MLH1, 5 MSH2, 1 MSH6, 1 PMS2. 2/14 patients were tested by MLPA assay given negative sequencing analysis. Germ-line mutations were identified in 7/36 patients (19%). All mutations were identified in patients with a clinical suspicion given strong family history of CRC. No identified mutations could be attributed to universal screening policy. Conclusions: during the first year of implementing universal screening for LS in CRC patients only half of the patients were screened by IHC. Despite MLH1/PMS2 deficiency was the most frequent abnormality, BRAF mutation analysis was not performed as recommended, given the lack of access to the test. A clinical suspicion of LS was a determinant driver for confirmatory molecular testing therefore limiting the usefulness of universal screening.
Systematic review and meta-analysis of the effect of pre-operative PET/PET-CT in the management of patients with potentially resectable colorectal cancer liver metastasis.
Authors: Serrano Aybar Pablo Emilio , Daza Julian Felipe , Solis Natalie , Parpia Sameer , Gallinger Steven , Moulton Carolanne 
Published: January 2019

591 Background: It has been proposed that PET with 18F-fluorodeoxyglucose alone or combined with CT improves detection of extra hepatic disease in the setting of colorectal cancer liver metastasis (CRLM). However, there remains conflicting evidence on the added benefit of PET/PET-CT prior to liver resection, and its effect on long-term survival. Thus, we set out to perform a systematic review of literature and meta-analysis. Methods: From 2000 to April 2017, MEDLINE, EMBASE, and CENTRAL were searched for studies (prospective and retrospective) investigating the preoperative use of PET/PET-CT in the management of patients with CRLM. We excluded studies in which neoadjuvant chemotherapy was given 2 weeks prior to PET/PET-CT. Screening, data abstraction, and quality assessment was performed in duplicate. Primary outcome was overall survival (OS). Secondary outcomes included disease-free survival (DFS), pre-operative change in surgical management, and open-close surgery. Random effect models were used to pool treatment effects. The protocol was published in PROSPERO. Results: Of 4034 articles reviewed, 37 met the inclusion criteria and were analyzed, and 8 compared PET/PET-CT to conventional imaging. All studies included PET (n=18), PET-CT (n=17), or both (n=2). OS for all patients was similar whether or not pre-operative staging included PET/PET-CT (HR 0.94, 95% CI 0.69-1.26). A similar effect was seen in the subgroup of patients who underwent surgery (HR 0.92, 95% CI 0.72-1.17). DFS in patients who underwent surgery was not different either (HR 0.93, 95% CI 0.81-1.08). PET/PET-CT reduced the odds of undergoing an open-close surgery (OR 0.52, 95% CI 0.35-0.76) and changed the surgical management of 23.4% patients (95% CI 19.33-27.47), however heterogeneity (I2=100%). Conclusions: Pre-operative PET/PET-CT may have a meaningful impact on surgical decision making in CRLM, however heterogeneity between studies is high, likely due to different study designs. It may also reduce the rate of open-close surgeries. The addition of PET/PET-CT to routine pre-operative imaging does not improve OS or DFS.