bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS02.182: EFFECTIVENESS OF ANTI-PD-1 ANTIBODY MONOTHERAPY FOR THE PRIMARY MALIGNANT MELANOMA OF THE ESOPHAGUS: A CASE REPORT
Authors: Muroi Hiroto , Nakajima Masanobu 
Published: September 2018

Abstract

Background
Primary malignant melanoma of the esophagus (PMME) is extraordinarily rare with a high prevalence of malignancy and poor prognosis, and a standard therapy remains to be established. Since conventional therapeutic methods have been limited in their effects on treatment outcomes, innovative strategies for treating PMME are being explored, especially molecular targeting strategies. The programmed death 1 (PD-1) protein/programmed death ligand-1(PD-L1) inhibitor nivolumab is a promising agent for various cancers. To our knowledge, this is the first case report of PMME where a complete response was achieved using nivolumab.

Methods
We report an 80-year-old woman who was diagnosed with PMME with bone metastasis and lymph node metastases. Although dacarbazine combined chemotherapy was performed and continued for six cycles, the primary tumor deteriorated and liver metastases appeared. The patient then received nivolumab monotherapy (2 mg/kg, once every three weeks).

Results
After three cycles, nivolumab monotherapy for PMME resulted in a complete response as shown by positron emission tomography, computed tomography, and esophagogastroduodenoscopy.

Conclusion
In our case, nivolumab exerted a curative effect on PMME, thus suggesting that nivolumab can be effective in the treatment of this rare disease.

Disclosure
All authors have declared no conflicts of interest.
PS02.183: MORTALITY AFTER MULTIVITAMIN SUPPLEMENTATION: OVER 30 YEAR FOLLOW-UP OF THE RANDOMIZED LINXIAN DYSPLASIA NUTRITION INTERVENTION TRIAL
Authors: Fan Jin-Hu , Wang Bing , Wang Ming , Abnet Christian , Qiao Lin , Taylor Philip 
Published: September 2018

Abstract

Background
To evaluate the long-term effects of multivitamin supplementation on total and cause-specific mortality, overall and by gender and age groups.

Methods
The Linxian Dysplasia Nutrition Intervention Trial was a randomized, double-blind, placebo-controlled trial of multivitamins conducted in an under-nourished population of 3318 persons aged 40–69 years with esophageal squamous dysplasia in northern China for six years (1985–1991). Participants were followed for nearly 25 additional years after cessation of supplementation.

Results
For the combined over 30 year intervention and post-intervention observation period, multivitamin supplementation did not affect total mortality in all participants combined (2578 deaths, hazard ratio [HR] = 0.96, 95% confidence interval [CI] = 0.90–1.04), in men (1229 deaths, HR = 0.91, 0.81–1.02) or women (1349 deaths, HR = 1.02, 0.91–1.13), or in younger (1130 deaths, HR = 1.00, 0.89–1.12) or older participants (1448 deaths, HR = 0.93, 0.84–1.04). A borderline association was observed for total mortality among older men, especially for heart disease mortality. Multivitamin supplementation reduced esaphageal/cardia cancer mortality by 27% among younger men. No effects were observed for deaths from any cancer, heart and cerebrovascular disease in either all subjects or women subgroups.

Conclusion
Taking multivitamins did not reduce total mortality in this under-nourished population. Together with previous results from the well-nourished populations, there is no evidence for an effect of multivitamin supplementation on overall mortality in either under- or well-nourished populations.

Disclosure
All authors have declared no conflicts of interest.
PS02.184: PROFILING RETURN TO INTENDED ONCOLOGIC THERAPY (RIOT) IN LOCALLY ADVANCED ESOPHAGEAL CANCER PATIENTS RECEIVING ESOPHAGECTOMIES FOLLOWED BY POSTOPERATIVE CHEMOTHERAPY
Authors: Dai Wei , Shi Qiuling , Han Yongtao , Peng Lin 
Published: September 2018

Abstract

Background
As a novel metric to evaluate the quality of oncosurgical therapy, such as minimal invasive surgery, Return to Intended Oncologic Therapy (RIOT) has not been applied in patients with esophageal cancer (EC). This study aims to profile RIOT in locally advanced EC patients and to quantify its relationship with overall survival.

Methods
We conducted a retrospective study on consecutive locally advanced EC (T3–4 and/or N1–3) patients who received esophagectomies followed by postoperative chemotherapy (PC) from April 2015 to August 2017. RIOT included whether the patient did or did not undergo intended PC and the time between surgery and the start of PC. Overall survival at each RIOT group was compared via log-rank test. Cox regression models were used to estimate the prognostic value of RIOT.

Results
Among 658 locally advanced EC patients (547 males and 111 females) with complete PC data, 433 received minimal invasive esophagectomies (MIE) and 225 received open esophagectomies (OE). The RIOT rates were 58.0% for MIE and 54.2% for OE (P = 0.358). The 1-year overall survival rate of patients receiving PC was higher than that of patients not receiving PC (88.2% vs 76.4%; P = 0.005). After adjustment of age, gender, surgery type and postoperative length of stay, patients with PC showed significantly better OS than those without PC (HR 0.60, 95% CI 0.41–0.87; P = 0.007). Total 253 patients (MIE 168, OE 85) presented verified dates of starting PC. Median RIOT time was 42 days (min-max, 13–162) for MIE and 43 days (16–169) for OE (P = 0.855). Among those 253 patients, 179 (70.8%) started RIOT within 8 weeks. After 8 weeks, every one week delay of RIOT related to a 17% increase on the risk of death (P = 0.014).

Conclusion
Using a real world data, our study provided baseline profiles of RIOT in locally advanced EC patients who received esophagectomies and PC. Compared to OE, MIE did not show a significant advantage in RIOT rates and RIOT time. In spite of the short follow-up, successful RIOT is related to better OS. Prospective studies with longer follow-up are required for further application of RIOT in the evaluation of oncosurgical therapy.

Disclosure
All authors have declared no conflicts of interest.
PS02.191: CLINICAL SIGNIFICANCE OF JEJUNOSTOMY CATHETER FEEDING AFTER ESOPHAGECTOMY
Authors: Matsuyama Jin , Tamura Shigeyuki , Nagai Kenichi , Imamura Hiroki , Yagi Yuriko , Mokutani Yukako , Hashimoto Yasuji , Hirose Hajime , Ide Yoshihito , Kubota Masaru , Sasaki Yo , Ikenaga Masakazu , Yamada Terumasa 
Published: September 2018

Abstract

Background
Various attempts have been reported as nutritional therapy in the treatment of esophageal cancer, but there is not enough evidence. Preparing jejunostomy catheter during esophagectomy may allow early nutritional management after surgery, and may continue after leaving hospital. On the other hand, peri-operative chemotherapy or chemoradiotherapy are frequently performed in esophageal cancer treatment, and postoperative malnutrition may become a problem. Postoperative malnutrition affects treatment outcome, such as delaying recovery and difficulty of continuing treatment after surgery.

Methods
We considered that postoperative treatment can be continued while restoring and maintaining postoperative nutritional status by placing jejunostomy catheter during esophagectomy and we examined the safety and treatment outcome of the procedure.

Results
Out of 76 cases of thoracic esophageal cancer surgery from January 2008 to December 2017, 59 cases(77.6%) of jejunostomy catheter were prepared. The median age was 69 years old(50–82), cStageI/II/III/IV was 7/16/33/3 cases respectively, and 25 cases(42.4%) administered neoadjuvant chemotherapy. There was no complication of surgery related to preparing jejunostomy catheter, but 1 tube bending(1.7%), tube deviation in 3 cases(5.1%) and tube occlusion in 5 cases(8.5%) were confirmed during feeding period. The median day of start feeding was 2 days after surgery(1–12), the transition to home jejunostomy feeding was carried out in 45 cases(76.3%), the median period of feeding was 55 days(4- 521), and the median of caloric value was 400Kcal/day(200- 200). Postoperative chemotherapy and chemoradiotherapy were performed in 11 cases(14.5%), jejunostomy feeding was prepared in 10 cases(90.9%), nine cases(90%) continued feeding after leaving hospital. The median duration of jejunal catheter feeding was 71 days(21–101) and the median caloric value was 400Kcal/day(200 - 800).

Conclusion
Surgery for esophageal cancer is invasive, and in addition to malnutrition from preoperative state, adjuvant therapy is also frequent. Recovery of nutritional condition after surgery is not easy, and jejunal feeding is considered to help in perioperative period. Particularly in cases requiring postoperative treatment, the continuation rate of jejunal feeding is higher and the duration of jejunal feeding tends to be longer. Although jejunal catheter preparing surgery can be performed safely, countermeasures such as tube occlusion and deviation in tube management are necessary, and cooperation of medical staff is indispensable.

Disclosure
All authors have declared no conflicts of interest.
PS02.200: A COMPREHENSIVE SCREENING OF THE FRA-1 REGULATORY GENES IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Toyozumi Takeshi , Hoshino Isamu , Sakata Haruhito , Murakami Kentaro , Kano Masayuki , Takahashi Masahiko , Sekino Nobufumi , Yokoyama Masaya , Okada Koichiro , Shiraishi Tadashi , Matsubara Hisahiro 
Published: September 2018

Abstract

Background
The expression of Fos-related antigen 1 (Fra-1) affects tumor progression, migration and invasion. We previously reported that a high Fra-1 expression level is associated with lymph node metastasis and a poor prognosis in patients with esophageal squamous cell carcinoma (ESCC). In this study, we identified the genes regulated by Fra-1 in ESCC.

Methods
We constructed Fra-1 knockdown models via the transfection of small interfering RNA (siRNA) into ESCC cell lines (TE10, TE11). The expression levels of the genes in the knockdown models were analyzed using a microarray experiment and Biobase Upstream Analysis (Cytoline Solutions, Tokyo, Japan), and candidate genes regulated by Fra-1 in the ESCC cell lines were detected. The actual connection of Fra-1 to the promoter region was identified in a ChIP-PCR experiment. The expression levels of the candidate genes regulated by Fra-1 in the primary tumors of surgical specimens obtained from ESCC patients (n = 135) were compared to those observed in normal tissues using real-time PCR and immunohistochemical staining, and the clinicopathological features were analyzed.

Results
The results of the Biobase Upstream Analysis and ChIP-PCR showed high mobility group protein 1 (HMGA1) and hyaluronan mediated motility receptor (HMMR) to be significant genes regulated by Fra-1. The expression levels of both HMGA1 and HMMR were found to closely correlate with the Fra-1 expression in the clinical specimens. The patients with a positive HMGA1 expression had a poorer prognosis than those with a negative expression (P = 0.017) and the patients with positive HMMR expression also had a poorer prognosis (P = 0.018). Moreover, a multivariate analysis demonstrated a positive HMGA1 expression to be a significant independent prognostic factor in the ESCC patients.

Conclusion
HMGA1 and HMMR are regulated by Fra-1 in the setting of ESCC and the HMGA1 expression is significantly associated with a poor prognosis in ESCC patients. Downregulating the HMGA1 and HMMR expression may become a practical treatment strategy against ESCC in the future.

Disclosure
All authors have declared no conflicts of interest.
PS02.206: THE SYNERGISTIC ANTITUMOR EFFECT OF APATINIB COMBINED WITH CYTOTOXIC DRUGS ON ESOPHAGEAL CANCER
Authors: Wang Feng , Chi Yanyan , Meng Xiangrui , Fan Qingxia 
Published: September 2018

Abstract

Background
Esophageal cancer is one of the most common malignancies in the digestive system in the world. It is difficult to acquire satisfactory effect through chemotherapy which is an essential method to advanced esophageal cancer. Apatinib, a highly selective inhibitor of vascular endothelial growth factor receptor-2 (VEGFR-2), inhibits the angiogenesis of tumors.

Methods
The mRNA and protein expression of VEGFR-2 in esophageal cancer cell lines (Eca9706, Eca109, KYSE450, KYSE70) were detected by qRT-PCR and western blot assay. These cell lines were treated with apatinib combined with cytotoxic drugs: cisplatin, paclitaxel, or 5-Fu respectively. Cell proliferation was then measured using CCK-8; cell cycle distribution and apoptosis were analyzed by flow cytometry; cell migration and invasion were evaluated by wound healing and transwell assays. Esophageal cancer xenografts model was established and used to evaluate the the antitumor effects of combination of apatinib and cytotoxic drugs in vivo.

Results
The mRNA and protein expression of VEGFR-2 were higher in Eca109 and Eca9706 cell lines than those in KYSE70 and KYSE450. The proliferation, migration, and invasion ability of esophageal cancer cells treated with apatinib combined with cytotoxic drugs were lower than those untreated cells. Furthermore, the inhibition effects of apatinib with each cytotoxic drug on the proliferation, migration, and invasion of esophageal cancer cells were greater compared with those treated with either apatinib or cytotoxic drug (P < 0.05). The proportion of G0/G1 phase was increased and the effect of arresting cell cycle were enhanced in esophageal cancer cells treated with apatinib and cytotoxic drugs compared with those treated with either apatinib or cytotoxic drug (P < 0.05). The combination of apatinib with each cytotoxic drug demonstrate synergistic promotion effects on the apoptosis of esophageal cancer cells compared with those treated with either apatinib or cytotoxic drug (P < 0.05). The combination of apatinib with each cytotoxic drug displayed synergistic inhibition effects on the growth of esophageal cancer xenografts compared with those treated with either apatinib or cytotoxic drug (P < 0.05).

Conclusion
The combination of apatinib with cytotoxic drugs had the synergistic antitumor effects on esophageal cancer.

Disclosure
All authors have declared no conflicts of interest.
PS02.209: PROGNOSTIC VALUE OF CHEST-TUBE AMYLASE IN DETECTING EARLY ANASTOMOTIC LEAKAGE AFTER IVOR-LEWIS ESOPHAGECTOMY
Authors: Giulini Luca , Dubecz Attila , Solymosi Norbert , Stein Hubert 
Published: September 2018

Abstract

Background
Intrathoracic anastomotic leaks after esophagectomy are a significant cause of postoperative morbidity and death. Early detection and timely management is crucial but existing diagnostic methods are either invasive or have a low sensitivity. The aim of this study was to evaluate the effectiveness of daily drain amylase levels in detecting early anastomotic leaks after Ivor-Lewis esophagectomy compared with C-Reactive Protein (CRP) levels.

Methods
Between June 2015 and September 2017, 126 Ivor-Lewis esophagectomies for cancer were performed in our surgical department. In 80 of these patients, drain amylase levels were collected as long a right-sided chest-tube was in place. Chest-tubes were removed at a secretion volume < 300 ml/24 h. CRP levels were measured daily. If bile was detected in the chest-tube and/or after re-exploration of the chest, no further data were collected. Early anastomotic leaks were defined as occurring as long as the chest tubes were in site, in the mean the 5th postoperative day (POD). According to the collected data, drain amylase levels > 350 U/l, and CRP > 30 mg/dl were considered positive. Sensitivity and specificity in detecting anastomotic insufficiency for both drain amylase and CRP were calculated.

Results
A clinically significant anastomotic leak occurred in 7,1% (9/126) of all esophagectomy patients with 0,8% (1/126) postoperative 30-days mortality. An early anastomotic disruption occurred in 4 of the 80 analysed patients. Three of them had a positive chest-drain amylase level and none a positive CRP level on POD1. The same three patients had on POD 2 a positive CRP level or presented bile in the chest-tube. The fourth patient presented at POD 2 bile in the chest tubes. On POD 1 he presented neither positive amylase nor CRP. The sensitivity and specificity for drain amylase and CRP within the first 3 POD was 0,75 and 0,98 vs 0,75 and 0,85 respectively. The accuracy for both amylase and CRP were calculated at 0,97 vs 0,85.

Conclusion
Chest-tube amylase levels after Ivor-Lewis esophagectomy are more accurate for the detection of early esophageal anastomotic leaks than CRP. This could facilitate early detection of anastomotic leaks up to 24 hours earlier than elevated blood CRP levels.

Disclosure
All authors have declared no conflicts of interest.
PS02.220: ATTENUATION OF SATIETY GUT HORMONES INCREASES APPETITE AFTER CURATIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER
Authors: Elliott Jessie , Docherty Neil , Murphy Conor , Eckhardt Hans , Ravi Narayanasamy , Le Roux Carel , Reynolds John 
Published: September 2018

Abstract

Background
Reduced appetite and weight loss after esophagectomy (ES) occur in the context of an exaggerated postprandial satiety gut hormone response. Satiety gut hormones modulate central processing of food reward, resulting in reduced energy intake. The aim of this study was to investigate the effect of satiety gut hormone attenuation using the somatostatin analogue octreotide on appetitive behavior among patients after curative ES.

Methods
In this randomized, double-blind, placebo-controlled crossover study, disease-free patients at least one year after ES with gastric conduit reconstruction and matched controls received either 1mL 0.9% saline or 1mL (100μg) octreotide subcutaneously, before completing a progressive ratio task (PRT). A measure of appetitive behavior, the PRT requires subjects to undertake progressively increasing amounts of work to obtain a reinforcer—the final completed increment (breakpoint) representing reinforcer reward value in different states. Separate cohorts were studied in the fasted or 1-hour postprandial states. The institutional Research Ethics Committee approved the study (REC 2015/21/02), which was registered on ClinicalTrials.gov prior to recruitment of the first participant (NCT02381249).

Results
36 subjects (ES, n = 18, matched controls, n = 18) were studied. 2.5 ± 0.3 years postoperatively, ES patients demonstrated 14.6 ± 2.6% weight loss and an elevated postprandial GLP-1 (49.2 ± 13.4 versus controls with 20.2 ± 2.3 pM, P = 0.038). Octreotide did not alter appetite among ES or control subjects when tested fasting (breakpoint, ES: 980 ± 371 versus 1700 ± 583, P = 0.16; control: 1056 ± 274 versus 1124 ± 273, P = 0.80). When tested one hour postprandially, octreotide was associated with increased appetitive behavior versus placebo among ES subjects (breakpoint, 322 ± 143 versus 246 ± 149, P = 0.037), but not controls (248 ± 119 versus 247 ± 120, P = 0.98).

Conclusion
Attenuation of the exaggerated postprandial satiety gut hormone response is associated with increased appetitive behavior towards a sweet-fat stimulus among patients post ES. Suppression of satiety gut hormones may represent a novel target to increase appetite, food intake and body weight in patients after esophagectomy.

Disclosure
All authors have declared no conflicts of interest.
PS02.222: CLINICAL CHARACTERISTICS AND MANAGEMENT OF GASTRIC TUBE CANCER AFTER ESOPHAGECTOMY
Authors: Shirakawa Yasuhiro , Noma Kazuhiro , Maeda Naoaki , Ninomiya Takayuki , Ogawa Toshihiro , Sakurama Kazufumi , Tanabe Shunsuke , Fujiwara Toshiyoshi 
Published: September 2018

Abstract

Background
Gastric cancer is the second most common malignancy, overlapping with thoracic esophageal cancer (TEC). Among them, metachronous gastric tube cancers after TEC surgery have been increasing. The aims of this study were to examine the clinicopathological factors and treatment outcomes of gastric tube cancer (GTC) after TEC surgery.

Methods
Thirty-three GTCs in 30 cases after TEC treated between 1997 and 2016 were investigated retrospectively.

Results
Most cases were males. The median interval from TEC surgery to GTC occurrence was 68.1 months (6–190 months). Almost 2/3 lesions occurred in the lower third of the gastric tube (21/33); 29 lesions (in 26 cases) were superficial cancers, and 4 lesions were advanced cancers. Twenty-two lesions of superficial cancer were differentiated type, and the remaining seven lesions were undifferentiated type. Treatment for superficial cancer had previously been performed with partial gastric tube resection (10 lesions), and the number of cases undergoing endoscopic submucosal dissection (ESD) had increased recently (19 lesions). Most cases with superficial cancer survived without relapse. Four lesions of advanced cancer were found after a relatively long interval following TEC surgery. Most lesions of advanced cancer were scirrhous, undifferentiated type, and they died due to GTC.

Conclusion
GTCs may occur late in the postoperative course following TEC surgery. If they are discovered at an early stage, these lesions can be cured with ESD. Long-term periodic endoscopic examinations after TEC surgery are important.

Disclosure
All authors have declared no conflicts of interest.
PS02.229: ASSESSMENT OF VARYING QUALITY OF LIFE OUTCOMES BASED ON A STRATEGY OF ORGAN PRESERVATION VERSUS SURGERY FOR UPPER GASTROINTESTINAL MALIGNANCIES
Authors: O Connell Lauren , Coleman Mary , Kharyntiuk Natalia , Walsh Thomas 
Published: September 2018

Abstract

Background: Background
Neoadjuvant chemoradiotherapy (naCRT) for upper gastrointestinal malignancies induces a pathological complete response (pCR) in 25–85% of patients, depending on disease stage and regimen chosen. All patients with a pCR will have a clinical complete response (cCR). Avoidance of surgery is desirable where feasible, as operative intervention entails morbidity and mortality risks and a reduction in lifelong health related quality of life (HRQoL). Pursuant on a policy of permitting selected patients with a cCR to opt for surveillance, this study aims to compare the QoL of patients who chose surveillance over adjuvant surgery following a cCR to naCRT.

Methods: Methods
One hundred and fourteen patients participated in the study. These comprised 4 groups; Group 1 (n = 31) were healthy controls; Group 2 (n = 26) had chemoradiotherapy only; Group 3 (n = 31) had oesophagectomy post naCRT and Group 4(n = 26) had gastrectomy alone. A novel 33 point questionnaire assessing 5 functional domains was completed focusing on symptoms of antro-pyloric function, respiratory reflux and post-vagotomy symptoms, as well as a previously validated questionnaire instrument for purposes of comparison and external validation. The data was aggregated to produce a total score ranging from 20–93 with 20 representing the least symptomatic.

Results: Results
Mean(± sd) overall QoL scores were significantly better in patients avoiding resection (28.9 ± 4.5) vs oesophagectomy (32.3 ± 58. P = 0.042) and vs gastrectomy(33.19 ± 5.9, P = 0.004. Scores did not differ between patients undergoing oesophagectomy or gastrectomy (P = 0.889). Oesophagectomy was associated with a trend towards increased reflux-related respiratory symptoms (7.3 ± 2.2 vs 6.5 ± 1.9; P = 0.396) while gastrectomy patients reported more symptoms related to vagotomy (1.82 ± 0.9 vs 1.4 ± 0.6; P = 0.438) and early dumping (8.2 ± 1.4 vs 7.1 ± 1.7; P = 0.239). The mean score for the control group administered the novel questionnaire was 20.74, approaching the lowest possible score of 20. This was significantly lower than any of the scores recorded for the treatment groups (P = < 0.001).

Conclusion: Discussion
A strategy of active surveillance in complete responders to neoadjuvant chemoradiotherapy is rewarded with a superior quality of life than in those undergoing surgery.

Disclosure
All authors have declared no conflicts of interest.