bluuebunny/crossref_metadata_2025_split huggingface dataset:
TACE combined with apatinib for the treatment of BCLC stage C of hepatocellular carcinoma: A restrospective controlled study.
Authors: Kan Xuefeng , Xiong Bin , Wang Yong , Liang Bin , Zhou Guofeng , Zheng Chuansheng 
Published: January 2019

445 Background: To access the safety and effcacy of transarterial chemoembolization (TACE) combined with apatinib (TACE-apatinib) for the treatment of Barcelona Clinic Liver Cancer (BCLC) stage C of hepatocellular carcinoma (HCC). Methods: The medical records of 290 consecutive patients with BCLC stage C of HCC who underwent TACE-apatinib or TACE-alone from June 2015 to June 2017 were retrospectively reviewed. a-Fetoprotein (AFP) response at 4 weeks after treatment in the two groups were evaluated. Tumor response in the two groups were assessed according to modified Response Evaluation Criteria in Solid Tumors (m-RECIST) criteria. The time to tumor progression (TTP) and overall survival (OS) of patients in the two groups were evaluated respectively. Results: One hundred and ninety patients were included in the analysis; 95 patients underwent TACE-apatinib and 95 underwent TACE-alone. The baseline characteristics of patients between the two groups were comparable. The disease control rate (DCR) of tumor and AFP response in TACE-apatinib group was significantly greater than that of TACE-alone group ( P < 0.001). The median TTP was 14.0 months in the TACE-apatinib group and 3.0 months in the TACE-alone group, and the median OS was 17 months in the TACE-apatinib group and 6.0 months in the TACE-alone group. Apatinib-related adverse events of grade 3 occurred in 14 patients in TACE-apatinib group, and there was no occurrence of grade 4 adverse event. Conclusions: The adverse effects of apatinib were acceptable, and TACE-apatinib improved the outcomes for patients with BCLC stage C of HCC in comparison to TACE-alone.
Disparities in surgical resection for pancreatic cancer stratified by insurance coverage.
Authors: Hegde Sheetal , Kintada Jaswanth , Peña Miren , Rouhani Sammira , Seifi Ali , Kumar Pratap , Shah Dimpy 
Published: January 2019

451 Background: Roughly 50,000 Americans are diagnosed with pancreatic cancer yearly (Howlader, N, Noone, A, Krapcho, M. Cancer Stat Facts: Pancreas Cancer. http://seer.cancer.gov/statfacts/html/pancreas ). High mortality rates following pancreatic cancer make surgical resection the primary curative method for treatment. Literature suggests significantly higher mortality rates (12.3%) in patients classified as government payers vs those with private insurance (7.3%) (Glasgow, RE, Mulvihill, SJ (1996)). Hospital volume influences outcome in patients undergoing pancreatic resection for cancer. Western journal of medicine, 165(5),294). This study investigated disparities in use of resection as pancreatic cancer treatment, based on insurance status. Methods: A retrospective study was performed to evaluate use of pancreatic resection (ICD9: 52.51-52.53, 52.59, 52.6, 52.7) vs non-surgical options to treat patients with a principal diagnosis of pancreatic cancer (ICD9: 230.9, 157.1-157.4, 157.8, 157.9) from 2005-2014, using the Healthcare Cost and Utilization Project database. Rates of surgical resection were stratified based on insurance coverage status: private insurance, government insurance, or no insurance. Results: After adjusting for total discharges, we observed that percent pancreatic resections were highest for uninsured populations and lowest for Medicare. By 2014, the rate of surgical resections in uninsured patients decreased as a steady increase was observed for patients with Medicaid. Conclusions: Our preliminary findings suggest that the trends in rates of surgical resection as a treatment for pancreatic cancer vary by insurance status. Further research examining factors such as race, socioeconomic status, and comorbidities that increase the likelihood of uninsured patients receiving pancreatic resections vs other treatments are warranted. [Table: see text]
Thromboembolic events in advanced pancreatic cancer: A systematic review.
Authors: Muhsin Mann , Dabbous Omar , Morrison Blake , Vervaet Piet , Chondros Dimitrios 
Published: January 2019

461 Background: Pancreatic ductal adenocarcinoma (PDA) is highly associated with thromboembolic events (TEs). There is no consensus for prophylaxis of TEs across thromboprophylactic guidelines in ambulatory patient settings. Published ASCO (2014) and ESMO (2011) guidelines recommend use of primary thromboprophylaxis in pancreatic cancer outpatients at high risk of TEs. This systematic review investigated TE rates and prophylaxis among advanced PDA patients. Methods: A literature review identified clinical trials and observational studies reporting TE rates with and without thromboprophylaxis in PDA patients undergoing chemotherapy. A search was conducted using electronic databases including Medline, Medline In-Process, and Embase; limited to English language and publication between 1990 and April 2017. Retrieved articles were cross-referenced and scrutinized to identify additional publications. Results: Seven studies were identified; 2 randomized clinical trials (RCTs) and 5 observational/retrospective studies met the stated criteria. The TE rate in PDA in the 5 observational studies without prophylaxis ranged from 9.6% to 36.0%. Thromboprophylaxis was used in the 2 RCTs and was associated with lower TE rates. Conclusions: This comprehensive literature review shows that PDA patients face a substantial risk of TE after chemotherapy. The high rates of TEs in PDA, and the effectiveness of thromboprophylaxis in patients with PDA, highlight the importance of having consensus for prophylaxis of TEs across thromboprophylactic guidelines in ambulatory patient settings as a critical early preventive measure during the treatment of patients with advanced PDA. [Table: see text]
Deterioration of hepatic function after locoregional therapy (LRT) for hepatocellular carcinoma (HCC) measured by hepatic cholate clearance: A pilot study.
Authors: Hoteit Maarouf , Hsu Christine Cho-Shing , Levine Matthew H , Forde Kimberly A , Reiss Kim Anna , Nadolski Gregory , Soulen Michael C. , Kron Laura , Helmke Steve , Everson Gregory T , Ben-Josef Edgar 
Published: January 2019

468 Background: LRT is used in treating HCC, but is associated with a risk of hepatotoxicity, which is not accurately predicted by traditional measures of liver function. In this pilot study, we evaluated the change in liver function after LRT as measured by a test using dual, oral and IV, cholate clearances (HepQuantSHUNT). Our hypothesis is that LRT would impose a significant reduction in the disease severity index (DSI) measured in the HepQuant SHUNT test, as an indicator of reduced liver function. Methods: We conducted a prospective cohort study of 11 subjects undergoing LRT for HCC. HepQuantSHUNT was performed at baseline (T0) and 4-10 weeks after LRT (T1). Clinical assessment was performed at T0 and T1, and at 12-18 weeks after LRT (T2). Decompensation was defined as either a new complication of cirrhosis or an increase in Child-Pugh (CP) score by ≥2 points. Results: Median age was 61 years, 73% were men, 55% had hepatitis C. Median CP score was 7[5-8], including 36%CP A and 64%CP B. Subjects had a BCLC stage A(64%) or BCLC stage B(36%) HCC. LRT modalities were TACE (45%) or SBRT (55%). From T0 to T1, there was a reduction in oral cholate clearance(422[235-768] vs 339[208-362], p = 0.03) and in IV cholate clearance(210[150-300] vs 191[144-203],p = 0.04) as well as a trend towards a worsening disease severity index (DSI) (32.0[19.5-37.8] vs 33.0[29.7-38.0],p = 0.10); however, there was no significant change in MELD(12[9-13]vs 11[10-12],p = 0.72) or CP score(7[5-8] vs 7[6-8],p = 0.15). 89% of the subjects had a reduction in oral and IV cholate clearance, and 78% had a worsening DSI; while 44% subjects had increase in CP score, and 56% had an increase in MELD. Decompensation was observed in 43% of CP B patients and none of CP A patients; and in 60% patients with a DSI > 35, and none of the patients with DSI < 35. Conclusions: The dual cholate clearance assay HepQuant-SHUNT detects a deterioration in liver function after LRT for HCC more frequently than clinical measures of liver function. DSI 35 might be a cutoff for risk of clinical decompensation after LRT for HCC. Additional research is needed to evaluate the role of the HepQuant SHUNT test in improving the selection of Child B patients for LRT.
Implications of prolonged time to pancreaticoduodenectomy after neoadjuvant chemoradiation: Analysis of the National Cancer Database.
Authors: Teng Annabelle , Nguyen Trang , Bilchik Anton , O'Connor Victoria , Lee David Y 
Published: January 2019

473 Background: For patients with pancreatic adenocarcinoma (PA), the optimal time interval between neoadjuvant chemoradiation (CR) to surgical resection has not been well established. The National Cancer Database (NCDB) was used to evaluate the impact of radiation-surgery (RS) interval on outcomes. Methods: The NCDB from 2006-2014 was queried for patients ≥18 years old diagnosed with PA who received CR prior to surgery. Survival and short-term outcomes were compared between patients who had a Whipple procedure performed ≤12 weeks and > 12 weeks after completion of CR therapy. Results: 1610 patients met selection criteria. Average RS interval was 58.2 ± 39.5 days. 1419 patients had RS interval ≤12 weeks (mean 47.4 days) and 191 had RS interval > 12 weeks (mean 138.8 days). Age, race, gender, income, type of treatment facility, CA 19-9 levels, types of chemotherapy and radiation dosage administered were similar between the two groups. Mean tumor size was 32.2 mm in the ≤12 week group and 34.9 mm in the > 12 week group (p = 0.021). There was a higher proportion of patients with clinical stage III cancers in the > 12 weeks group than in the ≤12 weeks group (33.5% vs 14%). Short-term morbidity and mortality was not significantly different between the two groups in terms of length of stay, readmission within 30 days, 30-day and 90-day mortality. However, a long-term survival benefit was observed in the > 12 week group (median 25.8 months in ≤12 weeks vs 30.2 months in > 12 weeks, p = 0.049) that appears to persist. An interval > 12 weeks was associated with significantly prolonged survival on multivariate analysis (HR 0.80 (0.65-0.99 95% CI, p = 0.042)). Higher clinical stage and positive surgical margins were independently associated with worse survival. Conclusions: Surgical resection beyond 12 weeks after CR for PA did not worsen surgical outcomes. Waiting may contribute to better patient selection, especially those with larger tumors and higher clinical stage. In the absence of progressive disease, patients need to be continuously evaluated for surgical resection after CR.
A real world multicenter study of first (1L) and second (2L) line treatment patterns and outcomes in advanced pancreatic cancer (APC).
Authors: Cheung Winson Y. , Zhang Hanbo , Tang Patricia A. , Spratlin Jennifer L. , Lee-Ying Richard M. , Goodwin Rachel Anne , Meyers Brandon Matthew , Armstrong Dawn Elizabeth , Ramjeesingh Ravi , Vickers Michael M. , Kim Christina ,   On Behalf of the CHORD Consortium
Published: January 2019

476 Background: FOLFIRINOX (FFX), gemcitabine plus nab-paclitaxel (GN), and gemcitabine (gem) are 3 publicly funded and available treatment options for locally advanced (LAPC) and metastatic pancreatic cancer (MPC) in Canada since 2014. Without head-to-head trials that directly compare all 3 regimens, treatment selection and outcomes in 1L and 2L remain poorly characterized in routine clinical practice. Methods: Data from 4 tertiary, 8 regional, and 28 community hospitals in Canada were pooled. LAPC and MPC patients diagnosed from 2014 onwards and who received at least 1 line of systemic therapy were included. Analyses were conducted to identify predictors of treatment choice and to determine the relationship between treatment patterns and overall survival (OS) from APC diagnosis to death. Results: We identified 279 eligible patients. Median age was 64 (IQR 56-69) years, 55% were men, and 46% were ECOG ≥2. There were 27% LAPC and 73% MPC. In the 1L setting, FFX and GN were given in 44% and 41% of patients, respectively, and gem in 15%. GN was the preferred multi-agent therapy in worse ECOG patients (66% in ECOG 2+ vs 21% in ECOG 0, p = .001) and in more recently diagnosed cases (63% in 2016 vs 25% in 2014, p = .001). 1L treatment selection was not influenced by other baseline characteristics, such as age, sex, tumor location, or LAPC vs MPC status (all p > 0.05). A total of 91 patients proceeded to subsequent therapies, of whom 55 (60%), 27 (30%), and 9 (10%) had received 1L FFX, GN, and gem, respectively. In the 2L setting, GN after 1L FFX (41/55; 75%) and fluoropyrimidine (FP) after 1L GN (21/27; 78%) were the most common sequential approaches. Patients who underwent 2L therapy had better OS than those who did not (13 vs 7 months, p = .001). After adjusting for confounders, receipt of 1L FFX plus 2L GN or 1L GN plus 2L FP resulted in improved OS when compared to other treatment sequences (HR 0.43, 95%CI 0.28-0.67, p = 0.001 and HR 0.57, 95%CI 0.39-0.83, p = 0.004, respectively). Conclusions: One third of APC patients receive 2L therapy, highlighting the feasibility of 2L trials. Use of 1L multi-agent therapy followed by 2L non-cross-resistant regimens represents a reasonable treatment strategy for APC in the real world.
Palliative care and end-of-life health care utilization of pancreatic cancer patients at an urban safety-net hospital.
Authors: Bhulani Nizar , Paulk M. Elizabeth , Gupta Arjun , Donnell Kiauna , Harvey Valorie , Cox Joan , Cox John Vernon , Karri Sirisha , Verma Udit N. , Sanjeevaiah Aravind , Cheedella Naga Koteswari , Khosama Leticia , Arriaga Yull Edwin , Syed Samira K. , Kazmi Syed Mohammad Ali , Korenke Adam , Beg Muhammad Shaalan 
Published: January 2019

489 Background: There has been an increase in Palliative care utilization in cancer patients. We examined trends of palliative care and intensive care utilization in pancreatic cancer patients in an urban setting safety net hospital. Methods: This is a retrospective analysis of pancreatic cancer patients seen at the Parkland Health and Hospital System between January 1999 and September 2016. Cancer cases and receipt of palliative care were identified from prospectively maintained registries. Health care utilization including intensive care unit (ICU) was reviewed. All statistical analysis was done using IBM SPSS version 24. Results: We identified 455 new diagnoses of pancreatic cancer, mean age 61 years, 227 (50%) female and 228 (50%) white. Of these, 277 (61%) received palliative care ever. Patient who received palliative care were more likely to be younger (mean age, 59.3+-12 vs 62.8 +- 12 years) and have stage 4 disease vs stage 1-3 disease (p 0.006, and p 0.003 respectively). There was no statistically significant difference in palliative care utilization between gender and ethnicity groups. 140 patients had a DNR order and 29 required ICU admission at any point. A first contact with palliative care consult was obtained < = 7 days before death for 29 (10%) patients, < = 30 days before death for 86 (31%) patients, 30-60 days before death for 50 (18%) and more than 60 days before death for 141 (51%) patients. Patients receiving palliative care were more likely to have a DNR status (p < 0.001) but had no difference in ICU use within the last 30 days of life (p 0.285). Conclusions: The rate of palliative care in patients with pancreatic cancer in this cohort from a safety net hospital is higher than nationally reported studies. Most patients received palliative care > 30 days before death. While patients received early palliative care, it did not result in reduced ICU care. Factors influencing ICU care utilization near the end of life need further study.
The impact of lung and bone metastases on prognosis in advanced PDAC.
Authors: O'Kane Grainne M. , Fraser Adriana , Moignard Stephanie , Dodd Anna , Creighton Sean , Sim Hao-Wen , Aung Kyaw Lwin , Borgida Ayelet , Gallinger Steven , Knox Jennifer J. 
Published: January 2019

494 Background: Pancreatic ductal adenocarcinoma (PDAC) remains a highly fatal disease inherently resistant to cytotoxic treatment. Despite the prevalence of liver and peritoneal metastases, subsets of patients also develop lung and bone metastases highlighting phenotypic heterogeneity. We reviewed the prognostic implications of metastatic sites on survival. Methods: This retrospective cohort study included all patients with PDAC who received surgical or oncological treatment at the University Health Network from September 2012 until December 2016. Clinical and pathological variables were obtained from patient electronic records. Radiological images and pathology reports were reviewed to ascertain sites of metastatic disease. The Kaplan-Meier method for survival and multivariable cox regression analysis identified prognostic factors. Results: 1153 patients were reviewed and 985 were included. 55% were male and the median age at diagnosis was 67 years. 287 (29%) completed curative surgery and 698 (71%) had locally advanced or metastatic disease; the median survival was 22 months and 9 months respectively. Lung and bone metastases were present in 18% (N = 180) and 6% (N = 58) of patients. In multivariable analysis increasing age and stage at diagnosis correlated with inferior survival (p < 0.0001) and the presence of any lung (HR 0.77; 95% CI 0.63-0.94, p = 0.01) or bone metastases (HR 0.74; 95% CI 0.54-1.0, p = 0.05) resulted in improved outcomes. Liver and peritoneal disease were not prognostic. Sex and family history of PDAC did not associate with survival. There was no association between site of metastases and sex however patients with bone metastases were significantly younger at first diagnosis (median age 63yrs, p < 0.01). Conclusions: Patients with advanced PDAC and metastases to lung or bone may represent distinct biological subtypes of PDAC. Molecular profiling of available tissue is ongoing.
Clinical assessment of pancreatic cancer cases with thromboembolism complications.
Authors: Nagata Yusuke , Sawada Ryoichi , Kano Tomohiro , Ishimoto Utako , Nishimura Takashi , Noguchi Masaaki , Amano Katsushi , Kato Tomohiro , Saruta Masayuki 
Published: January 2019

495 Background: Cancer patients, particularly those with pancreatic cancer (PC), have an increased risk of developing thromboembolism, such as venous thromboembolism (VTE) and cerebral infarction (CI). Moreover, thromboembolisms in cancer are associated with poor prognosis. The purpose of this study was to investigate the clinical characteristics, clinical courses, and prognosis of PC patients (pts) with VTE and/or CI. Methods: We retrospectively reviewed the medical records of PC pts who were radiologically diagnosed with VTE and/or CI at our institution. We investigated the patients’ clinical information and evaluated overall survival (OS), which was defined as the date from diagnosis of VTE and/or CI to the date of death by any causes or censored. Results: Between January 2012 and December 2015, 100 pts were diagnosed with PC. A total of 14 pts developed VTE and/or CI at our institution. All 14 pts had unresectable advanced or metastatic PC, 10 pts (71%) were men, and the median age at the time of VTE and/or CI diagnosis was 68.8 (range, 29–84) years. Complications of VTE and CI developed in 6 (43%) and 8 pts (57%), respectively (3 pts with development of both VTE and CI were included as CI). The median OS in pts who developed VTE and CI was 7.59 and 1.48 months (p = 0.007), respectively. After the development of VTE and/or CI, 5 pts (36%) (3 with VTE and 2 with CI) received chemotherapy (CTx), while the remaining 9 pts (64%) received best supportive care (BSC). In pts with VTE, the median OS of those who received CTx and BSC was 7.59 and 3.15 months (p = 0.221), respectively. Meanwhile, in pts with CI, the median OS of those who received CTx and BSC was 3.84 and 1.48 months (p = 0.113), respectively. Conclusions: The prognosis of PC pts who developed CI as complications was significantly poorer than those who developed VTE. However, in both cases, treatment with CTx prolonged the OS of these patients.
Association of therapeutic management with a good prognosis in unresectable hepatocellular carcinoma patients undergoing sorafenib treatment: Dose adjustment and conversion therapy.
Authors: Oikawa Takayoshi , Kuroda Hidekatsu , Endo Kei , Sawara Kei , Takikawa Yasuhiro 
Published: January 2019

498 Background: When treating hepatocellular carcinoma (HCC) with sorafenib, it is important for the physician to evaluate the therapeutic effects because of the characteristic therapeutic response, the toxicity, and out of consideration for the liver function. We evaluated the relationship between changes in therapeutic management and the efficacy of sorafenib in the treatment of unresectable HCC. Methods: Out of a total of 118 patients who received sorafenib in our hospital between January 2010 and September 2017, 96 patients could be followed up and were included in the present study. We evaluated the profile of sorafenib treatment (etiology, cStage, initial dose, the percentage of cases in which the dose was changed), the clinical response by mRECIST, adverse events by CTCAE v.4.0, overall survival (OS), and the rate of patients continued sorafenib treatment or underwent conversion therapy after the development of progressive disease (PD) in two distinct periods of treatment: the former period (in which ordinary management was applied); and the latter period (in which management practices were strengthened in relation to the dose ). Results: Significant differences were observed in the rate (y/n) of change in the sorafenib dose and the rate of patients continued sorafenib treatment after the development of PD (the former/the latter, 13/42, 25/16, p = 0.005, 24/31,25/16, p = 0.045, respectively). A significant difference was observed in OS in the two periods (the former/ the latter, median OS 8.1/16.5 months, p = 0.019). In the latter period the percentage of dose escalation (400→800mg /day) was 60%. With regard to the clinical course after the development of PD, 15 patients (36.6%) in the latter received transarterial chemoembolization, and had a disease control rate of 60%. Conclusions: The prognosis of patients receiving sorafenib treatment for unresectable HCC can be extended when efforts are made to appropriately manage their medication based on their overall condition. After a sorafenib-treated patient develops PD, the continuation of sorafenib treatment or the addition of locoregional therapy may achieve a good response.