bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survival outcomes for de novo versus relapsed stage IV gastric and gastroesophageal junction (GEJ) adenocarcinoma.
Authors: Chan Bryan Anthony , Sim Hao-Wen , Natori Akina , Moignard Stephanie , Yokom Daniel , Lim Charles Henry , Jiang Di Maria , Chen Eric Xueyu , Knox Jennifer J. , Liu Geoffrey , Darling Gail Elizabeth , Swallow Carol Jane , Brar Savtaj Singh , Brierley James D. , Ringash Jolie , Wong Rebecca , Kim John , Hafezi-Bakhtiari Sara , Elimova Elena , Jang Raymond Woo-Jun 
Published: January 2019

148 Background: In gastric/GEJ cancer, 40% of patients (pts) are metastatic at diagnosis ( de novo stage IV) and up to 70% with locoregional disease recur (relapsed stage IV). We compared survival outcomes between de novo vs relapsed stage IV. Methods: A retrospective observational study of stage IV gastric/GEJ pts was conducted (2012-2015). Overall survival (OS) was from date of stage IV diagnosis. PFS1 defined the period from stage IV diagnosis to first progression. PFS2 was from first to second progression. For relapsed stage IV pts, disease-free interval (DFI) was the period from initial diagnosis to metastatic relapse. Cox proportional hazards models compared OS, PFS1 and PFS2 between de novo vs relapsed stage IV pts, stratified by DFI [ < 6, 6-12 and > 12 months (mo)] and controlled for baseline patient characteristics. Results: Of 198 pts, 62% were male and median age was 64 years (26-93), with 64% gastric and 36% GEJ adenocarcinomas. Primary therapy for locoregional pts included surgery (75%), perioperative chemotherapy (42%) and radiotherapy (42%). De novo and relapsed stage IV pts represented 68% and 32% of the cohort respectively. Median follow-up was 13 mo. Controlled for age, performance status and Charlson comorbidity index, there were no significant differences in OS (median OS 12.5 ( de novo) vs 12.2 mo (relapsed); HR 1.22, 95% CI 0.83-1.77, p = 0.31), PFS1 (6.8 vs 7.4 mo; HR 1.00, 95% CI 0.65-1.56, p = 0.98) or PFS2 (3.8 vs 3.0 mo; HR 1.03, 95% CI 0.44-2.41, p = 0.95). Median OS for relapsed stage IV patients were different by DFI groups (log-rank p = 0.02): 22.9 mo (for DFI > 12mo; n = 31), 11.2 mo (DFI 6-12; n = 19) and 7.5 mo (DFI < 6; n = 14). Additionally, OS was significantly better if the DFI was greater than 12 mo, compared with de novo stage IV (HR 0.50, 95% CI 0.28-0.88, p = 0.02). Conclusions: There was no observed difference in the natural history of de novo vs relapsed stage IV gastric/GEJ pts. DFI was strongly prognostic with median OS (from date of relapse) approaching 2 years for relapsed pts with DFI > 12 mo. In addition to implications for treatment strategy, tumor biology within subgroups should be examined to identify novel biomarkers and potential therapeutic targets.
Prognostic significance of nutritional risk index in patients with metastatic esophageal squamous cell cancer.
Authors: Shirasu Hiromichi , Tsushima Takahiro , Furuta Mitsuhiro , Kawahira Masahiro , Kawakami Takeshi , Yoshida Yukio , Kawai Sadayuki , Hamauchi Satoshi , Todaka Akiko , Machida Nozomu , Yokota Tomoya , Yamazaki Kentaro , Fukutomi Akira , Onozawa Yusuke , Yasui Hirofumi 
Published: January 2019

156 Background: It has been suggested that nutritional indicators predict the prognosis of esophageal cancer. Nutritional risk (NR) as prognostic factor evaluated by NR index (NRI) in metastatic esophageal squamous cell cancer (ESCC) has not been clarified. Methods: We retrospectively reviewed the data of consecutive patients (pts) with metastatic ESCC who received chemotherapy (CTx) as initial treatment at Shizuoka Cancer Center between April 2008 and December 2015. The selection criteria were as follows: histologically confirmed squamous cell carcinoma; no indication for curative resection or definitive chemoradiotherapy (dCRT); adequate organ function; no prior CTx, radiotherapy (RT) or chemoradiotherapy; no other advanced malignancies. NR was calculated by following formula: NRI = (1.489*serum albumin) + (41.7*present body weight [BW] / ideal BW). NR was classified into 4 groups according to NRI: major (NRI < 83.5), moderate (NRI = 83.5-97.5), mild (NRI = 97.5-100), none (NRI > 100). Multivariate analysis was carried out using cox proportional hazard to estimate the hazard ratio for overall survival (OS). Results: The patients’ characteristics of 138 pts who met the selection criteria were as follows: median age (range), 67 (33-86) years; male/female, 123/15; performance status (PS) 0/1/2, 62/68/8; number of metastatic sites 1/2/3/4, 55/56/23/4; smoking history -/+, 19/119; previous esophagectomy -/+, 118/20; median skeletal muscle index (range), 44.5 (27.8-63.2); median body mass index (range), 20.3 (14.3-27.4); NR major/moderate/mild/none 22/37/26/53; median serum C-reactive protein (CRP) level (range), 0.75 (0.01-20.48) mg/dL. The most common chemotherapy regimen used was fluoropyrimidine plus cisplatin (93%), and 70 patients (50%) received concomitant RT. Median OS was 4.6 months in pts with major NR and 11.8 months in others (p < 0.001). Multivariate analysis for OS identified PS 2, female sex, metastatic sites > 2, CRP ≥ 1mg/dL, and major NR independently associated with poor survival. Conclusions: Major NR calculated by NRI formula associated with poor survival in pts with metastatic ESCC.
Efficacy and safety of ramucirumab containing chemotherapy in patients with pretreated metastatic gastric neuroendocrine carcinoma.
Authors: Mishima Saori , Kawazoe Akihito , Matsumoto Hiroshi , Kuboki Yasutoshi , Bando Hideaki , Kojima Takashi , Doi Toshihiko , Ohtsu Atsushi , Yoshino Takayuki , Nonte Elizabeth M , Chintharlapalli Sudhakar , Nasir Aejaz , Kuwata Takeshi , Shitara Kohei 
Published: January 2019

157 Background: Gastric neuroendocrine carcinoma (G-NEC) is associated with poor prognosis. Most patients (pts) present with advanced disease and have short survival. Ramucirumab (RAM), a monoclonal antibody for VEGFR-2, has been effective for advanced gastric adenocarcinoma (AC). However, little is known about efficacy of RAM containing chemotherapy in G-NEC. Methods: We retrospectively analyzed and compared the efficacy and safety of RAM containing chemotherapy in pretreated G-NEC and AC pts in our hospital (March 2015- January 2017). G-NEC was defined by NEC features, regardless of the proportion, based on histology and neuroendocrine markers (synaptophysin, chromogranin A or CD56). VEGFR-2 expression in tumor vessels was evaluated in archival primary G-NEC tissues by immunohistochemistry using the same anti-VEGFR2 primary antibody and scoring scheme (vascular VEGFR2 H-score) as in REGARD trial (Fuchs CS, et al. BJC. 2016). Results: Seventeen G-NEC and 173 AC pts were analyzed. Therapy for G-NEC included RAM + paclitaxel (n = 13), RAM + irinotecan (n = 2), and RAM monotherapy (n = 2). The overall response rate was significantly better in pts with G-NEC than AC (59 vs. 22%, p = 0.001). Progression-free survival was significantly longer in pts with G-NEC than AC (median 6.8 vs. 3.2 months, HR 0.38 [95%CI 0.22-0.66]; p < 0.001). Overall survival was significantly longer in pts with G-NEC than AC (median 16.2 vs. 9.6 months, HR 0.4 [95%CI 0.19-0.86]; p = 0.014). No severe or unexpected adverse event occurred. Median vascular VEGFR2 H-score, based on available G-NEC tissues from 12 pts, was 220 (range 150-260) which was markedly higher than that reported on AC tissues from REGARD trial as historical control (median 35, range 0-240). Conclusions: Compared to AC patients, RAM containing chemotherapy showed a promising activity without severe or unexpected safety profile in G-NEC patients. This may in part be explained by higher vascular VEGFR-2 expression in G-NEC tissues. These data, though preliminary, support further clinical evaluation of RAM and biomarker investigation in this subset of gastric cancer.
Evaluation of the outcome of adjuvant treatment for gastric cancer in Brazil and Peru: A retrospective study in two cancer centers in Latin America.
Authors: Nunez Jose Eduardo , Felismino Tiago , Enriquez Daniel , Montenegro Paola Catherine , Coimbra Felipe , Costa Wilson L. , Begnami Maria D. , Taxa Luis , Casavilca Sandro , Fogaroli Ricardo , Alves Ana Caroline , Mello Celso Lopes 
Published: January 2019

160 Background: Gastric cancer (GC) is one of the most frequent malignancies in developing countries. In Peru, it is the fourth most incident cancer, and the sixth one in Brazil. Mortality is still high. The chance of relapse of patients with non-metastatic disease undergoing surgery is more than 50%. It is suspected that Latin American patients present worse evolution compared to those treated in Asia or in developed countries, therefore it is fundamental to study factors related to the prognosis and evolution of patients with GC in our continent. We aimed to evaluate the outcome of adjuvant treatment for GC in patients from two countries with different racial miscegenation and eating habits, and correlate this with clinicopathological features. Methods: We retrospectively analyzed 187 patients with GC who underwent curative surgery and received CRT at AC Camargo Cancer Center (ACCCC) in Brazil and Instituto Nacional de Enfermedades Neoplasicas (INEN) in Peru. CRT was defined as MacDonald protocol. Primary endpoint was overall survival (OS). Cox regression model was performed in order to calculate hazard ratio (HR) and 95% confidence intervals (95%CI). Results: Median follow up time was 51 and 20 months in Brazil and Peru, respectively. Median age of our cohort was 54 years-old. Male sex was predominant in both countries (Brazil: 54.7%; Peru: 56.9%). Diffuse subtype also was predominant (Brazil: 58.3%; Peru: 55.1%). Median OS was 103.9 and 45.2 months in Brazil and Peru respectively (p < 0.001). In the multiple analysis, we found that pathological stage (I/II vs. III; HR = 4.1, 95%CI 1.4-11.7; p = 0.009) was independent prognostic factor adjusted by country of treatment, histological subtype, localization, age and gender. Conclusions: Survival differences exist between Brazil and Peru. We observed that patients from Peru had more advanced pathological stage after surgery. This difference suggests a possible prognostic factor in OS. Ethnic/genetic factors, eating habits and other clinicopathological or molecular factors may also explain different prognosis. Future studies are warranted to determine these prognostic factors in Latin American gastric cancer patients.
Safety, effectiveness, and rapid adaptation of robotic gastrectomy for advanced gastric cancer.
Authors: Chen Lin , Li Jiyang , Xi Hongqing , Gao Yunhe , Cui Jianxin , Qiao Zhi , Zhang Kecheng , Xie Tianyu , Liang Wenquan , Wei Bo 
Published: January 2019

161 Background: As robotic surgery techniques advances, robotic gastrectomy has emerged as an alternative modality for advanced gastric cancer (AGC). However, there is a lack of supporting evidence regarding the safety, effectiveness and surgeon acceptance of robotic gastrectomy for AGC patients. Methods: An ambispective cohort study was conducted. We compared surgical and oncological outcomes between robotic and traditional laparoscopic gastrectomy for AGC patients. The Cumulative Sum (CUSUM) method was developed and used to analyze the learning curves of robotic gastrectomy for AGC by two surgeons who had different surgical experience. Results: From August 2011 to June 2017, a total of 134 AGC patients were performed robotic gastrectomy by surgeon A (n = 42) and surgeon B (n = 147). And there were 238 AGC patients received traditional laparoscopic gastrectomy which performed by the same two surgeons over the same period. There were no significant differences between the two operation methods regarding the clinicopathologic characteristics and long-term outcomes (p=0.737). However, robotic gastrectomy group had less operative blood loss (229 ml vs. 240 ml, p=0.031) and less Clavien-Dindo Grade II to IV complications (p=0.006) than laparoscopic group. Clinicopathologic characteristics, short-term and long-term outcomes of the patients treated by surgeon A and surgeon B are similarity. CUSUM analysis showed that operative time reached a stable state after around 12 cases in surgeon A who had more open gastrectomy experience than laparoscopic gastrectomy experience, and 21 cases in surgeon B who had more laparoscopic gastrectomy experience than open gastrectomy experience. The stable operation time was 242 min for surgeon A and 236 min for surgeon B. The number of lymph node dissections was 38 for surgeon A and 28 for surgeon B during their capacity-increasing phase. Conclusions: Robotic gastrectomy achieved superior short-term outcomes and comparable long-term outcomes compared with traditional laparoscopic gastrectomy for AGC patients. Surgeons with sufficient experience in either open or laparoscopic gastrectomy can rapidly overcome the learning curve and performed gastrectomy for AGC patients safely.
Regional variation in the costs of treating curative gastric cancer.
Authors: Jeong Yunni , Mahar Alyson L. , Zagorski Brandon , Coburn Natalie 
Published: January 2019

165 Background: Gastric cancer is a highly morbid and fatal disease. While the clinical challenge with gastric cancer is widely described, little is known about the economic burden of the disease. Many guidelines outline the curative treatment for gastric cancer and in a universal healthcare system, equal access and uniform healthcare delivery is predicted. Yet, regional variation in practice exists and may result in increased healthcare costs. We therefore aimed to investigate of the costs of treating curative gastric cancer, explore regional variation in costs, and to identify the factors which drive these costs. Methods: We conducted a patient-level cost analysis of curative-intent stage I-III gastric cancer diagnosed between 2005 and 2008 from the perspective of a universal healthcare system, using a 26-month time horizon. Clinical and stage data were abstracted from a provincial chart review. Costs associated with physician billings, same day surgery, hospitalization, drug benefits, emergency department visits, continuing care, and long-term care were derived using administrative healthcare databases and compared among healthcare regions. Costs were inflated to 2017 United States dollars (USD). We used a linear regression model to identify factors predictive of these treatment costs. Results: A total of 722 patients with Stage I-III gastric cancer were identified. Mean costs per region ranged from $55,650 to $92,852 (USD) across 14 health regions. The lowest contributing cost sector was long-term care and the highest contributing proportion of costs was from hospital admissions. A laparoscopic surgical approach was predictive of lower costs while age over 70 years and death at one year from diagnosis was predictive of higher costs. Conclusions: Regional variation exists in the treatment costs for patients with curative gastric cancer despite guidelines directing appropriate care and healthcare delivery in a universal healthcare system. Governmental intervention to ensure quality care delivery is necessary for improved and sustainable curative gastric cancer care across regions.
Short-term and long-term outcomes of laparoscopic pylorus-preserving gastrectomy.
Authors: Onoyama Haruna , Cho Haruhiko , Oohinata, Ryouki 
Published: January 2019

181 Background: Distal gastrectomy is still a standard surgical procedure for early gastric cancer locating in the middle third of the stomach. Laparoscopic pylorus-preserving gastrectomy (LPPG) is promising method which can achieve both minimally invasive and function-preserving outcomes; however, the advantage of PPG against laparoscopic distal gastrectomy (LDG) has not been clarified. Methods: This study examined the clinical outcomes of 71 patients who underwent LPPG for cT1 N0 GC located in the middle part of the stomach and 168 patients who underwent LDG with BillrothI reconstruction for cT1 N0 GC located in the middle or lower part of the stomach between September 2006 and December 2014. Surgical outcomes of LPPG were retrospectively compared with those of LDG. Results: The pathological T- and N-stage of the two groups were similar. There was no significant difference in the mean number of resected lymph nodes (37 in LPPG and 33 in LDG). Operation time was longer in LPPG than LDG (248min:LPPG, 228min:LDG) and blood loss were higher in LPPG than LDG (72ml:LPPG, 54ml:LDG). Postoperative hospital stay was longer in LPPG than LDG (13days:LPPG, 11days:LDG). There was no difference in the surgical complications (12.7%:LPPG, 9.5%:LDG) and no mortality occurred(no in-hospital deaths). Only one case of LDG was died of postoperative recurrence. The mean weight loss rate in 3 years after gastrectomy was lower in LPPG than in LDG (7.7% and 10.4%, respectively). Conclusions: LPPG is an acceptable and favorable operative method with possible prevention of weight loss for clinically diagnosed early stage GC.
Feasibility study of preoperative chemotherapy for patients with advanced esophageal cancer with or without naso-gastric ED tube for enteral feeding.
Authors: Ogata Takashi , Osakabe Hiroaki , Nagasawa Shinsuke , Nakazono Masato , Hara Kentaro , Kumazu Yuta , Hayashi Tsutomu , Yamada Takanobu , Yoshikawa Takaki 
Published: January 2019

184 Background: Advanced esophageal cancer patients sometimes have a difficulty to swallow food. On the other hand, standard treatment for resectable advanced esophageal cancer patients is surgery after 2 course preoperative chemotherapy of CDDP-5-FU (JCOG 9907). So we usually use naso-gastric ED tube for patients with difficulty of oral intake during preoperative chemotherapy to administrate adequate nutrition. But there is no report of the safety of this trial. Methods: The aim of this study is to clarify the safety of using ED tube during preoperative chemotherapy and compare the nutritional status between using ED tube or not. From Jan 2012 to June 2017, 122 patients were undergone esophagectomy with 2 course of preoperative chemotherapy, and 14 patients were treated with ED tube for nutrition(Group A) and 108 patients without ED tube(Group B). We evaluated the changes of nutritional status and postoperative complication as an indicator of safety. Results: Changes before and after preoperative chemotherapy(GroupA/B): average of body weight: 53.1→50.8/58.1→57.0, BMI: 20.0→19.2/22.0→21.6, TP: 6.7→6.9/7.3→6.9, alb: 3.5→3.8/4.3→4.2, pre-alb: 20.1→21.7/24.8→23.4, RBP: 2.77→3.33/3.15→3.23. Adverse events during chemotherapy: 1 case of Grade 3 hematologic toxicity and 1 case of Grade 2 non-hematologic toxicity were found at Group A(14.2%), and 11 cases of Grade 3 hematologic toxicity and 8 cases of Grade 2 non-hematologic toxicity were found at Group B(17.61%)(p = 0.758). Postoperative complications (clavien-dindo classification, Grade3 or more): 2 cases were observed at Group A(14.2%), and 21 cases were observed at Group B(19.4%)(p = 0.62). Conclusions: Preoperative chemotherapy with ED tube for nutrition was safe and effective to maintain the preoperative nutritional status.
Risk factors associated with outcomes following neoadjuvant chemoradiotherapy prior to esophagectomy in patients with adenocarcinoma of the esophagus.
Authors: Boussi Khalil , Thomas Tarita , Pappas Sam G. , Martin Brendan 
Published: January 2019

186 Background: The study was conducted to evaluate risk factors associated with treatment outcomes following concurrent chemoradiotherapy (CRT) and esophagectomy in patients diagnosed with resectable esophageal cancer. Methods: IRB approval was obtained to evaluate patients with esophageal cancer treated at our center from 2002 to 2017 with neoadjuvant CRT followed by esophagectomy. Patient characteristics pre and post-surgery including age, number of positive lymph nodes, length of time between neoadjuvant therapy and surgery were evaluated. Univariable and multivariable frailty survival analysis were used to evaluate the association between risk factors and treatment outcomes. Results: 74 patients met inclusion criteria of CRT and esophagectomy. Controlling for the number of days between the end of radiotherapy and surgery, the hazard of death for patients who developed metastatic cancer following completion of therapy was 2.08 (95 CI: 1.04 – 4.13) times higher compared to patients who did not develop metastasis (p = .04). Adjusting for metastatic cancer, for every five additional days between the end of radiotherapy and surgery, patients’ hazard of death increased 5% (HR = 1.05, 95 CI: 1.02 – 1.07, p < .001). Controlling for metastatic cancer and the number of positive nodes, for every one-year increase in age, patients’ hazard of recurrence decreased 5% (HR = 0.95, 95 CI: 0.91 – 0.99, p = .04). Adjusting for age and the number of positive nodes, the hazard of recurrence for patients who developed metastatic cancer was 28.57 (95 CI: 6.58-123.97) times higher compared to patients without metastasis (p < .0001). Conclusions: Longer duration between completion of CRT and surgery as well as developing metastatic disease are associated with a significantly higher hazard of death. Additionally, developing metastatic cancer, increase in age, and additional positive lymph nodes are all associated with a significantly higher hazard of recurrence. Optimal timing between neoadjuvant therapy and surgery needs to be evaluated further, as increasing hazard of death following therapy suggests that there may be a role for adjuvant chemotherapy in these patients.
Exosomal miRNA signature of pancreatic cyst: Liquid biopsies as indicators of pancreatic cancer.
Authors: Joshi Virendra , Guanzon Dominic , Molina Cris , Nuzhat Zarin , Rice Gregory , Gallo Carlos saloman 
Published: January 2019

225 Background: Pancreatic cysts are a group of lesions with malignant potential. Currently, there are no consistently reliable biomarkers or imaging modalities to accurately predict biologic behavior of these cysts. We tested the hypothesis that tumor-derived exosomes (better conserved than free miRNA) can be acquired endoscopically from pancreatic cyst fluid and may allow for improved distinction between benign, premalignant and malignant cysts. Methods: Exosomes were isolated and characterised by differential and buoyant centrifugation from pancreatic cyst fluid obtained from 30 patients with pseudocysts (PS), serous cystic (SC), mucinous cysts (MC), intraductal papillary mucinous neoplasms (IPMN), pancreatitis (PA), and pancreatic cancer (PC) , confirmed with imaging and histology. An Illumina TruSeq Small RNA kit was used to construct a small RNA library, and the libraries were sequenced using the Illumina NextSeq 500 platform. The resulting sequencing FASTQ files were analyzed using miRDeep2 to identify both known and novel miRNAs. Results: Four significant miRNAs which are shared between six of the analyses, specifically hsa-miR-199b-3p, hsa-miR-199a-2-3p, hsa-miR-199a-1-3p and hsa-let-7i-5p were identified. MiRNA hsa-miR-27a-3p was significant and shared between five of the analyses. A total of 15, 12 and 2 significant miRNAs were shared between four, three and two of the analyses, respectively. Importantly, there were a total of 10 significant miRNAs which were unique to each analysis, with the exception of IPMN vs Pseudocyst, and Pancreatic cancer vs Pancreatitis. Specifically these unique miRNAs for each analysis are: hsa-miR-92a-2-3p (Pancreatitis vs Pseudocyst); hsa-miR-92a-1-3p (Serous vs Pseudocyst); hsa-miR-30e-5p (Pancreatic cancer vs Serous), hsa-miR-30b-5p (IPMN vs Pancreatic cancer); and hsa-miR-23b-3p, hsa-miR-99b-5p, hsa-miR-222-3p, hsa-miR-31-5p, hsa-miR-151a-5p, hsa-miR-221-3p (Pancreatic cancer vs. Pseudocyst). Conclusions: Exosomal miRNAs in pancreatic fluid may be used as a biomarker to differentiate between various cyst types and pancreatic cancer. A larger cohort with miRNA quantification and is needed to further validate these findings .