bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence and trends of pancreatic cancer (PC) in Girona: A population-based study from the Girona Cancer Registry (1994-2015).
Authors: Garcia-Velasco Adelaida , Carmona Carmen , Bianca Antonia , Teixidor Helena , Valero Marc , Liñan Raquel , Carbajal Walter , Puigdemont Montserrat , Vilardell Loreto , Marcos Rafael 
Published: January 2019

225 Background: PC is the third leading-cause of cancer death in Spain. In this study we aim to investigate PC’s incidence and trends during 1994-2015 in Girona. Methods: Data were extracted from the population-based Girona Cancer Registry. Incident PC cases were classified using the ICD-O-3 Third Edition. Age-adjusted incidence rates (ASRE) to the European standard population and world standard population (ASRW) were obtained. Trends were assessed using the estimated annual percentage of change (EAPC) of the ASRE13. Results: We identified 1590 PC incident cases, 45.8% females and 54.2%. Patients > 64 years old represented a 72.6% of cases. According to histology, epithelial tumors stand for a 44% of cases and neuroendocrine neoplasms represented only the 3% of all cases, being most of PC tumors’ histology non-specified. Cases detected only by death certificates (DCO) were 7.7% in males and 7.4% in females. For the whole study population, crude rate (CR) cancer incidence was 11.26 cases per 100,000 inhabitants/year (12.17 men; 10.34 women). Regarding the ASR, results show an ASRE13 of 12.99 (95% CI 12.36;13.65) and ASRW of 5.58 (95% CI 5.8;13.655.91). Age-specific rates reflected a drastic increase with age, having the population over 85 years the highest rate (74.5 cases per 100,000 inhabitants/year). We also found a significant increase in incidence of PC cases over the study period, with an EAPC of 1.41% per year, present in both men (EAPC = 1.30%) and women (EAPC = 1.37%). Conclusions: Incidence rates of PC in Girona are within the European average, and likewise they have been increasing for the last two decades. There is an increase of incidence in the elderly population reflected in age-specific rates, reason whereby we believe there are a high proportion of unspecific histologies. These results can be used as baseline for further research.
Validity of hepatic cone-unit resection for hepatocellular carcinoma.
Authors: Imura Satoru , Yamada Shinichiro , Saito Yu , Iwahashi Shuichi , Ikemoto Tetsuya , Morine Yuji , Shimada Mitsuo 
Published: January 2019

228 Background: Anatomical liver resection (ALR) has been performed widely for hepatocellular carcinoma (HCC). However, there are difficult cases with typical ALR, due to tumor location or anatomical variation. The aim of this study is to review the cases of atypical ALR and to investigate the validity of small ALR for HCC. Methods: From 2007 to 2017, hepatic resection less than 2 segments was performed to 252 patients with HCC. (1) We reviewed cases with atypical ALR (eg. posterior segment + anterior dorsal area, S4 + S8 ventral area, etc.), and (2) Regarding the validity of cone-unite resection for single HCC, we compared the clinicopathological outcome with subsegmentectomy as a control. Results: (1) Atypical ALR was performed in 10% (17/169) of ALR less than 2 segments. There were 7 cases of extended anterior segmentectomy or extended S8 resection for patients having anterior or S8 portal branch that perfused to the right side of the right hepatic vein. Most of such atypical ALR tended to be indicated in right-side hepatectomy. (2) Liver function was well preserved in both groups, and it was better in subsegment group (ICGR15: 10.5 vs. 12.3%, ALB: 4.1 vs. 3.9g/dL). Regarding the tumor factor, the diameter was larger in the subsegment group than in the cone-unite group (2.8 vs. 2.1cm), and the proportion in which subsegmentectomy was performed in the case more than 3 cm was high (32 vs. 11%). There was no difference in OS and DFS between the two groups. Even when the tumor diameter was 3 cm or less, there was no difference in DFS between subsegment (n = 28) and cone-unite resection (n = 40). Conclusions: There are a number of cases that typical ALR is difficult, especially in the right-side hepatectomy. There was no difference in the prognosis depending on the range of resection, if HCC could be resected of subsegment or less. Therefore, depending on age and comorbidity, it is necessary to determine the type of hepatectomy without sticking to the subsegmentectomy.
Differences in presentation and management patterns in patients with hepatocellular carcinoma (HCC): Data from HCC registry in Asia.
Authors: Chow Pierce K. H. , Li Lequn , Li Jiangtao , Jia Fan , Wang Hee-Jee , Hasegawa Kiyoshi , Yang Jin-Mo , Tan Poh-Seng , Qin Shukui , Han Kwang-Hyub , Goh Brian , Han Ho Seong , Furuse Junji , Zhu Xu , Ling Joanna Zhi Jie , Gandhi Mihir 
Published: January 2019

229 Background: HCC is the 6th most common cancer worldwide with > 70% of cases in Asia. There is limited real-world data on the diagnosis, treatment modalities, outcomes and treatment costs in HCC. Methods: The HCC Registry in Asia (AHCC08) is a multi-country longitudinal cohort study of HCC patients diagnosed between 2013 and 2019. Target sample size is 2500 from 9 geographies: China, Singapore, South Korea, Japan, Taiwan, Australia, New Zealand, Hong Kong, and Thailand. We present initial data on diagnosis, etiology, stage at presentation, and treatment modalities of HCC from China [CN] (5 centers), Singapore [SG] (3 centers), South Korea [SK] (4 centers), and Japan [JP] (2 centers). Results: 657 patients (436 CN; 102 SG; 85 SK; 34 JP) were evaluated in August 2018. Patients from China were diagnosed at a younger age, while patients from Japan were diagnosed at an older age (mean age 51 years CN; 67 years SG; 58 years SK; 68 years JP). The highest proportion of regular alcohol drinkers were from Japan (16% CN; 21% SG; 24% SK; 50% JP) and occasional drinkers from China (20% CN; 17% SG; 12% SK; 15% JP). 77% had Hepatitis B across the 5 geographies, with the highest incidence in China (93%), followed by South Korea (68%). 27% were diagnosed using AASLD/APASL imaging criteria, with the highest utilization in Singapore (66% AASLD; 80% APASL) and South Korea (64% AASLD; 20% APASL). Later-stage patients (according to Barcelona Clinic Liver Cancer staging guidelines) were more predominant in Japan (Stage C: 28% CN, 16% SG, 8% SK, 41% JP; Stage D: 0.5% CN, 0% SG, 1% SK, 3% JP). Relatively few radiofrequency ablations were carried out as the first-line therapy across the 5 geographies (2% CN; 5% SG; 2% SK; 0% JP). In China, liver resection was preferred in first-line HCC treatment (65% CN vs 28% SG, SK, and JP aggregated), followed by loco-regional (27% CN vs 7% SG, SK, and JP aggregated) and systemic therapy (2% CN vs 10% SG, SK, and JP aggregated). Conclusions: There is considerable variation in presentation and management patterns between the 5 geographies. These data will benefit policymakers, companies and clinicians in improving policies and developing treatment strategies for HCC. (ClinicalTrials.gov: NCT03233360).
Utilizing cultural and ethnic variables in a survey to identify individuals at high risk for gastric cancer.
Authors: Solsky Ian , Parides Michael , Schechter Clyde , Rapkin Bruce D. , In Haejin 
Published: January 2019

23 Background: Absence of national US gastric cancer (GC) screening necessitates alternative methods like surveys to identify high-risk populations. Identification of high-risk persons may be enhanced by adding ethnic and cultural variables to more conventionally known risk factors for GC. Methods: Data from a prior case-control study of 40 GC cases and 100 controls were used. A "conventional" risk factor model (age, gender, family history of GC, body mass index, excessive salt intake, alcohol, smoking, blood type, H pylori) was compared to one incorporating ethnic and cultural variables (race, immigration, generation, cultural food at ages 15-18 years, acculturation and education) using model fit, sensitivity, specificity and expected positive predictive values (PPV). Stepwise regression was then used to create a model from this pool of variables. PPV was calculated using Bayes' Theorem applied to the baseline GC incidence in the US (7.2 per 100,000). Results: The "conventional" model required 14 questions and resulted in 25% sensitivity, 94% specificity, 28 per 100,000 PPV at the 70% probability cut-off, and AUC=0.871. The model incorporating ethnic and cultural variables required 38 questions and resulted in 48% sensitivity, 91% specificity, 38 per 100,000 PPV, and AUC =0.965. After eliminating items less predictive at p=0.2, age, gender, family history of GC, excessive salt intake, immigration, generation and race remained in the model. This model required 7 questions and resulted in 45% sensitivity, 96% specificity, 81 per 100,000 PPV and AUC=0.914. Conclusions: The model with the greatest ability to identify persons at risk of GC included ethnic and cultural variables. This model can be translated into a survey with few items that can serve as a highly scalable tool to identify high-risk individuals. Support: UG1CA189823 [Table: see text]
Immunotherapy response evaluation with MR elastography (MRE) in advanced HCC.
Authors: Qayyum Aliya , Avritscher Rony , Morani Ajaykumar , Sun Jia , Bhosale Priya , Hwang Ken-Pin , Stafford Jason , Abugabal Yehia I. , Ma Jingfei , Kaseb Ahmed Omar 
Published: January 2019

230 Background: To determine changes in MRE HCC stiffness as predictor of immunotherapy response in patients with advanced HCC. Methods: This was a prospective, Institutional Review Board approved study of 15 patients with biopsy proven advanced HCC (not amenable to curative therapy), who were to be treated with Pembrolizumab. Eligible patients were > 18 years old with radiographic disease progression/intolerance to sorafenib. All patients had liver MRI with MR Elastography (MRE) and liver biopsy at baseline and at 9 weeks of therapy. HCC stiffness (kilopascals, kPa) was measured on liver MRE elastograms (stiffness maps). Change in HCC stiffness on MRE was compared with overall survival, time to disease progression, and total number of lymphocytes on targeted liver biopsy. Data cutoff date was September 1st 2018. Analysis was performed using descriptive statistics including Spearman correlation ( R), Cox regression, Wilcoxon rank sum test and Fisher’s exact test. Results: Of the initial 15 patients, 4 withdrew from therapy, 1 patient did not undergo MRE scan, and 1 patient had MRE failure. The final 9 patients included 6 men. Median age was 70 years (range, 54-78). Etiology of liver disease was HCV (n = 4) and NASH (n = 5). HCC was moderately differentiated in 8 of 9 patients and well-differentiated in 1 patient. Median overall survival and time to progression were 52 weeks (range, 16-112) and 18 weeks (range, 9-48), respectively. Average non-tumorous liver stiffness was 3.2 kPa (range, 2.1-4.3). No significant change in non-tumor liver stiffness was seen at 9 weeks (p = 0.12). Median baseline tumor stiffness was 4.5 kPa (range, 2.4-7.5). Increase in HCC stiffness at 9 weeks was seen in 5 patients, decrease in 3 patients and no change in 1. Change in HCC stiffness at 9 weeks correlated significantly with overall survival ( R = 0.83), and time to progression ( R = 0.96), (p < 0.05). Nine patients had liver biopsy at baseline and 7 had biopsy at 9 weeks. HCC T lymphocytes on biopsy (n/mm2) significantly correlated with HCC stiffness ( R = 0.79), (p < 0.01). Conclusions: Our pilot data suggests early change in tumor stiffness may help predict better immunotherapy response in patients with advanced HCC.
Epidemiology and characteristics of patients (pts) with hepatocellular carcinoma (HCC) and care in the United States.
Authors: Doleh Yunes , Wang Huifen , Sun Ping , Yu Binbing , Herr Iksha 
Published: January 2019

231 Background: The incidence of liver and intrahepatic bile duct cancer, with HCC accounting for 72.7%, has doubled from 1992 to 2014 in the U.S. This study examined the latest epidemiology of HCC by analyzing 2 large U.S. databases. Methods: IBM MarketScan (IBM-MS) and Surveillance, Epidemiology, and End Results-National Program of Cancer Registries (SEER-NPCR) databases were analyzed separately. Pts (aged ≥ 18 years) with HCC as the primary cancer were identified from the IBM-MS database, who were covered by employer-provided commercial or Medicare Supplemental insurance. A new HCC diagnosis (Dx) was defined as the first HCC Dx using ICD-9/10 codes within the study period (Jan 2012-Sep 2017) and no other HCC Dx in the prior 12 months. Comorbidities, performance status, distribution of pts, and treatments received were described. In SEER-NPCR (Jan 2010-Dec 2014), a nationally representative patient sample was analyzed to describe the incidence and mortality of pts with HCC. Results: A total of 8,150 and 119,927 pts were identified in IBM-MS and SEER-NPCR, respectively. Pts were predominately male in both databases. The HCC incidence rates among the IBM-MS cohort were 5.9, 5.5, 4.9, and 4.7 per 100,000 person-years from 2013 to 2016, respectively. The downward trend in the HCC incidence rate post-2013 for this population coincided with the drop in HCC incidence rate from 2013 to 2014 in SEER-NPCR. Amongst the IBM-MS cohort, 6%, 36%, and 59% of pts had hepatitis B, hepatitis C, and cirrhosis at Dx, respectively. Most pts (88%) were considered having good performance status at Dx. Embolization and chemo/targeted therapies were the most common treatments received by pts irrespective of the disease stage (31% and 12%, respectively) and pts with de novo metastatic HCC (19% and 18%, respectively). About 44% of the HCC Dx occurred at hospital outpatient settings; 31% at inpatient settings and 23% at physician offices. Conclusions: This study identifies the recent epidemiologic changes in pts with HCC and characterizes their comorbidities in a commercially-insured and a U.S. representative population. These epidemiologic data may be important considerations for U.S. payers making coverage policies for pts with HCC.
Circulating tumor DNA may correlate with tumor size changes following therapy.
Authors: Chang John , Egert Daniel , Padniewski Jessica , Johnson Benjamin , Bay Curt , Dragovich Tomislav , Kundranda Madappa N. , Koo Phillip 
Published: January 2019

233 Background: Pancreatic cancer has significant mortality at five years, even in resectable disease. Recent effort has been dedicated to identify a more specific tumor marker for screening and assessing tumor response, in part because 10% of the population does not produce CA19-9. Detection and quantification of circulating tumor DNA (ctDNA) in the bloodstream is a novel concept for screening and treatment response assessment. This study examined possible correlations between ctDNA levels and various aspects of pancreatic cancer in a total of 17 patients receiving treatment at Banner MD Anderson Cancer Center. Methods: Present study is approved by our local IRB. Research was conducted according HIPPA regulation. Subjects on the present study were obtained from the list of patients participating in our ctDNA trial. A total of 17 subjects were identified from the list. Their ctDNA index levels were obtained from the sponsor (Chronyx) at baseline and following each cycle of the treatment. For each CT scan and each ctDNA study, they are considered the same time if they are obtained within 4 weeks of each other. The sizes of the primary tumor and the largest metastatic lesion were on a transverse image at the largest extent of the lesion. Data was analyzed with Spearman's correlation. Results: Baseline ctDNA levels did not correlate with patient demographic data (N = 17; gender, p = 0.63; age, p = 0.82), baseline size of primary mass on CT scan (N = 16; p = 0.85), baseline vessel involvement on CT Scan (N = 17; p = 0.58), presence of metastasis on CT scan (N = 17; p = 0.78), size of largest metastasis on CT scan (N = 17; p = 0.85), presence of peripancreatic lymph nodes on CT scan (N = 17; p = 0.45), or overall survival (N = 8; p = 0.6). However, there is a trend toward correlating the change in ctDNA and change in size on CT scan following treatment (N = 7; p = 0.12). Conclusions: ctDNA at baseline appears to be secreted independent of the primary tumor size, location, or presence of metastasis. However, changes in ctDNA does seem to correlate with changes in tumor size following treatment. Although our data was not statistically significant, this may be related to the low sample size. With larger sample size, it is expected that changes in ctDNA may prove to correlate with changes in tumor size.
The spectrum of activating EGFR mutations from cell-free DNA (cfDNA) in large pancreatic cancer cohort.
Authors: Price Kristin Sedgwick , Kiedrowski Lesli Ann , De Zarraga Fernando I. , Cusnir Mike , Lanman Richard B. , Nagy Rebecca J 
Published: January 2019

237 Background: Metastatic pancreatic cancer (mPC) is one of the deadliest cancers with a < 10% 5-year survival rate. Poor prognosis is well established with lack of response to or rapid progression on existing chemotherapy options. Targeted therapies, like EGFR-TKIs, have been shown to increase survival in other solid tumors like NSCLC with certain oncogenic drivers. Although treatment with the EGFR-TKI erlotinib, in combination with gemcitabine, is available for patients (pts) with mPC, the survival benefit is small in unselected patients. A better understanding of the spectrum of EGFR mutations in mPC may lead to improved therapy selection. Methods: We retrospectively reviewed genomic results from 2,938 consecutive mPC pt samples sent for ctDNA NGS analysis between 7/2014 - 9/2018 (Guardant Health, Inc.). All reported EGFR mutations were reviewed and activating mutations were determined based on literature review. Results: 19 EGFR activating mutations were identified in 16 unique pts (0.66% of total mPC pts with alterations detected). 3 mutations were identified in the extracellular domain and 16 mutations in the tyrosine kinase domain (3 in exon 18, 3 in exon 19, 6 in exon 20, 4 in exon 21). Alterations in exon 20 included 5 T790M mutations; two of these were reported at allelic frequencies suggestive of germline origin. Analysis of co-mutations revealed 7 pts with EGFR mutations that appeared subclonal relative to other potential drivers (4 KRAS, 2 ERBB2, 1 GNAS). The median number of alterations per sample was 4 (range 2-170) with the latter pt exhibiting a hypermutator phenotype. Multiple pts had more than one activating EGFR alteration including one who was found to have 4 EGFR sequence alterations (S768I, L861Q, T790M, p.Val769_Asp770insMet) plus EGFR amplification (plasma copy number 66.8). We will collect and report clinical details to characterize the treatment context for these pts. Conclusions: Activating EGFR mutations in mPC are rare but may present an opportunity for targeted therapy in this population. Further exploration is warranted to better understand the oncogenic activity of less common, subclonal, or co-occurring EGFR mutations and their sensitivity to EGFR-TKIs in mPC.
Impact of Ga-68 DOTATATE imaging on clinical management of neuroendocrine tumor patients: Post-FDA-approval analysis of first 200 clinical patients.
Authors: Chauhan Aman , Khouli Riham , Evers Mark , Oates Elizabeth , Anthony Lowell Brian 
Published: January 2019

238 Background: Gallium 68 dotatate (Ga-68 DOTA) provides physiologic imaging and assists in the localization of disease in somatostatin (SSA) receptor positive neuroendocrine tumor (NET) patients. Questions regarding the value of Ga-68 DOTA imaging in the FDA post-approval era for NET patients include: usefulness in disease monitoring, correlation of Ga-68 DOTA avidity to Ki-67 index and its impact on clinical decision making. We present our experience with 200 Ga-DOTATATE scans performed at University of Kentucky. Methods: A retrospective review of the first 200 patients who had undergone Ga-68 DOTA imaging at the Markey Cancer Center from Dec 2016 to Dec 2017 was conducted. Results: 59.5% were females and the median age was 62 (30-84 years). Primary tumor sites included: small bowel 37.5%, pancreas 18.5%, bronchial 14%, colon 3.5%, rectum 2%, appendix 1.5%, adrenal 0.5%, prostate 0.5%, others 3% and unknown primary 19%. Ga-68 DOTA scan influenced clinical decisions in 39% (n = 78) patients. Ga-68 DOTA imaging identified primary tumors in 17 of 38 patients who were classified as NET of unknown primary based on CT imaging. Subgroup analysis of mean standardized uptake value (SUV) for hepatic metastatic lesions revealed 37.3 for G1 (n = 20) as compared to 32.3 for G2 (n = 37) and 17.46 for G3 (n = 4). Mean hepatic SUV of the lesion with the greatest radiolabel uptake in 96 patients was similar irrespective of exposure to SSA LAR; 31.3 versus 27.8 for SSA versus the no SSA cohorts. Conclusions: Ga-68 DOTA imaging impacted clinical decision making in 39% of NET patients (n = 200) and identified the primary site in 17 of 38 patients with unknown primary. Systemic exposure to long acting SSA does not seem to impact quality of Ga-68 DOTA scan.
High-income is a stronger predictor than race in understanding disparate survival outcomes in PDAC.
Authors: Alvarez Marcus A , Deneve Jeremiah Lee , Behrman Stephen W , Dickson Paxton Vandiver , Shibata David , Glazer Evan Scott 
Published: January 2019

241 Background: Patients with pancreatic ductal adenocarcinoma (PDAC) from low income and minority racial groups have a lower reported long-term survival rates. It is unknown whether this is related to access to care, variations in genetic polymorphisms, or income status. We hypothesized that income status predicts survival better than race in PDAC. Methods: The pancreatic cancer data set of the National Cancer Database (NCDB) was studied for years 2011-15. Income groups were divided into top quartile (high income) or bottom three quartiles (non-high income) while racial groups were classified as Caucasian or non-Caucasian. Kaplan-Meier survival analysis and Cox proportional hazard models (CoxHR) were utilized. Analysis was controlled for established risk factors such as stage, grade, lymphovascular invasion, resection, and margin status. Results: Of the 164,631 patients meeting criteria, the average age was 68 ± 12 years, 51% were male, and 84% were Caucasian (the remaining patients were predominantly African American, 11%). Of patients with stage I or II PDAC who underwent resection, Caucasian patients had worse survival (CoxHR = 1.21, P<0.001) while high-income patients had better survival (CoxHR= 0.86, P<0.001). To investigate only differences due to income or race, a survival model of highly selected, low risk patients (stage I or II lymph node negative well-differentiated tumors without lymphovascular invasion and in patients who underwent margin negative resection who received chemotherapy) found that high-income predicted survival similar to race (CoxHR =0.89, P<0.001 vs. CoxHR = 1.12, P=0.005, respectively). On multivariable analysis, high-income was more impactful on survival (CoxHR = 0.83, P<0.001) than Caucasian race (CoxHR = 1.16, P <0.001). High-income, non-Caucasian patients had a median survival of 64 months while all other groups had a median survival of 40 months (P=0.005). Conclusions: Caucasian PDAC patients have worse survival compared to non-Caucasian patients after selecting for patients with favorable tumor biology who received adequate therapy. The data suggests that high-income is slightly more important than race in understanding disparate outcomes in PDAC.