bluuebunny/crossref_metadata_2025_split huggingface dataset:
The short-term and long-term prognostic risk stratification of patients with resectable gastric cancer.
Authors: Amada En , Kawakubo Hirofumi , Mayanagi Shuhei , Fukuda Kazumasa , Nakamura Rieko , Suda Koichi , Wada Norihito , Kitagawa Yuko 
Published: January 2019

23 Background: Some studies suggest anastomotic leakage (AL) may adversely affect long-term survival in patients undergoing radical gastrectomy (RG) for gastric cancer (GC). Therefore, we assume that common risk evaluation system for short-term and long-term prognosis can be devised in patients with GC that have undergone RG. Methods: Five hundred and twenty patients undergone RG against GC during May 2012 to March 2017 were enrolled. Patients’ characteristics, preoperative laboratory data, operative information and pathological factors were analyzed. Also AL with Clavien-Dindo classification Grade≥III (AL≥III), disease free survival (DFS) and disease specific survival (DSS) were examined. Results: By bringing patients under classification of “with or without relapse” and “with or without AL≥III”, we identified preoperative body weight (BW), serum C-reactive protein (CRP) and albumin (Alb) level were independent risk factors of both relapse and AL≥III. Stratifying patients with recurrence, we obtained crude hazard ratio (HR) of 1.04 (95% CI: 1.02-1.06) for 1kg-increase of BW, 1.51 (95% CI: 1.08-1.40) for 1mg/dl-increase of CRP and 1.23 (95% CI: 1.34-1.64) for 1g/dl-decrease of Alb. With these HR and median value of each parameters of none-relapse group, we defined ABC score (ABCs) is calculated by following formula; ABCs = (4.1-Alb)*51+(58.5-BW)*4+(CRP-0.05)*23. AL≥III were observed in 3.1% of the cases and ABCs of patients with AL≥III was significantly low (with AL≥III; -22.4, without AL≥III; 9.03, p = 0.045). We determine a cut off value of ABCs to -7 on the basis of the ROC curve. Patients with ABCs≤-7 had significantly high risk of AL≥III and we found ABCs≤-7 is an independent risk factor of AL≥III (HR 1.775, p = 0.003). Also, we stratified patients as Low group (L), Mid group (M), High group (H), by approximate tertile value of ABCs, -20 and 30. We found significant shortening of DFS and DSS in order of L, M and H (DFS; L vs M p = 0.006, Mid vs High p = 0.03, DSS; L vs M p = 0.002, L vs H p < 0.001). Moreover, HR for disease specific death for ABCs≥-20 was 4.2 (p = 0.003) in multivariate analysis. Conclusions: ABCs can be a risk evaluation system for short-term and long-term prognosis in patients with GC that have undergone RG.
Role of stereotactic body radiation therapy in patients with hepatocellular carcinoma extensively pretreated with transarterial chemoembolization or yttrium-90.
Authors: Tanimoto Kayo , Rusu Iris , Martin Brendan , Price Jennifer , Thomas Tarita 
Published: January 2019

233 Background: Hepatocellular carcinoma (HCC) is an aggressive disease with dismal outcomes. Patients who are not surgical candidates are routinely treated with local therapies such as TACE, Y90, or SRBT among others. The study aimed to assess treatment response and treatment related toxicity to SBRT in patients who received prior TACE or Y90 at our institution, some of whom subsequently underwent orthotopic liver transplantation. Methods: IRB approval was obtained to retrospectively review 26 medical records of patients who received SBRT at the Loyola University Medical Center from 9/9/14-12/28/16. GI toxicities were analyzed using the Common Terminology Criteria for Adverse Events (CTAE) version 4.0 following SBRT. Skin, pharyngeal/esophageal, thorax, lung, GU, and GI toxicities were included in toxicity analysis. Patients received radiation dose from 36 Gy - 50 Gy in 5 fractions using RTOG 1112 dose constraints for dosimetric plan evaluation. Fisher’s exact tests and Wilcoxon Rank Sum tests were used for statistical analysis. Results: Of the 26 patients, 21 patients had prior TACE (median 3 TACE procedures; ranging from 1-5). 6 patients had prior Y90 with or without prior TACE. Median follow up for the cohort was 51 weeks. No patient showed GI toxicities above grade 1 during SBRT, with fatigue and nausea being the most common. One patient who previously received Y90 developed fatal duodenal perforation. Pathology demonstrated this was related to tumor infiltration of the duodenum and was not related to post radiation necrosis. 6 patients went on to undergo OLT with all patients having treatment response on surgical pathology with 4 patients having complete treatment response. Conclusions: SBRT was shown to safely treat patients after prior therapies including Y90 and TACE. Furthermore, SBRT showed favorable outcomes in post-OLT patients. To our knowledge, this is the first study to assess the effects of SBRT following extensive local therapies for HCC including Y90. Prospective data is needed to evaluate these findings further with longer follow up.
A population-based study of morbidity after pancreatic cancer diagnosis.
Authors: Sarkar Reith , Fero Katherine Elaine , Panjwani Neil , Matsuno Rayna , Murphy James Don 
Published: January 2019

236 Background: Pancreatic cancer is characterized by early and relentless tumor spread. This leads healthcare providers to consider pancreatic cancer a “distant disease.” However, local tumor progression within the pancreas can lead to substantial morbidity. This study defines the long-term morbidity from local and non-local disease progression in a large population-based cohort. Methods: We identified 21,500 Medicare beneficiaries diagnosed with pancreatic cancer between 2000-2011 in the Survival, Epidemiology and End Results database. Hospitalizations identified from Medicare claims were attributed to complications either local (biliary, upper GI ulcer/bleed, pain, pancreatic, radiation toxicity) or non-local (thromboembolic events, any cytopenia, dehydration, nausea/vomiting/motility, malnutrition and cachexia, ascites, pathologic fracture, chemotherapy toxicity) in nature. Competing risk analyses were used to determine the cumulative incidence of complications from local, and non-local disease. Multivariable Fine-Gray models were used to identify the impact of chemotherapy or radiotherapy on the risk of hospitalization. Results: Of the total cohort 9,347 (43.5%) patients were hospitalized for a local complication, and 13,101 (52.4%) for a non-local complication. After adjusting for the competing risk of death, complication due to local disease at 24-months post-diagnosis was highest in non-metastatic non-resection (55.1%), followed by non-metastatic resection (44%) and metastatic (34.5%) patients. Non-local complications were highest in non-metastatic non-resection (60.6%), followed by metastatic (58.6%) and non-metastatic resection (52.5%) patients. Predictors of hospitalization for local and non-local complications included age, race-ethnicity, location, patient group, tumor size and diagnosis year. Radiation and chemotherapy had minimal impact on risk of hospitalization. Conclusions: Despite the widely-known predilection of distant disease spread in pancreatic cancer, local tumor progression also leads to substantial morbidity and hospitalization. Radiation and chemotherapy did not decrease the rates of hospitalization for local complications.
Implications of pancreatic cancer with diabetes mellitus on patient outcomes and care: A matched case-control study.
Authors: Karlin Nina J. , Amin Shailja , Buras Matthew , Kosiorek Heidi E. , Verona Patricia M. , Cook Curtiss B. 
Published: January 2019

239 Background: The aim of this case-control study was to determine the impact of DM on survival in pancreatic cancer patients, and to examine the impact of pancreatic cancer on glycemic control in DM. Methods: Ninety-two patients with newly diagnosed pancreatic cancer from 2007 to 2015 with DM were identified from the institutional Cancer Registry and matched to ninety-two pancreatic cancer patients without DM according to age, gender, and year of pancreatic cancer diagnosis. The file was linked to the electronic medical record to obtain information on DM and pancreatic cancer therapies, and laboratory results. Overall survival (OS) was estimated with the Kaplan-Meier method and compared by Cox regression analysis. Mixed models were used to compare hemoglobin A1c (HbA1c) and glucose over time. Results: Mean age of the entire pancreatic cancer cohort was 70 years, most (92%) were white, most common (88%) histology was adenocarcinoma, and majority (41%) were stage IV. No differences in age, race/ethnicity, histology, or tumor stage were detected between patients with and without DM, although DM patients had higher body mass index (P = 0.014). Mean ca 19-9 (U/ml) was 804 for diabetics, and 395 for non-diabetics. Among those with DM the mean HbA1c during the year following cancer diagnosis was 7.3%. Time (days since diagnosis) was significant in DM patients (p = 0.014) as HbA1c decreased over time. Mean glucose during the year following diagnosis among DM patients was significantly higher compared to non-DM patients [160.6 (SD = 38.0) versus 117.2 (SD = 19.0); p < 0.001]. Both groups had a decline in glucose over time (p = 0.008). In Kaplan-Meier survival analysis (median follow-up time of 11.9 months), 2 year overall survival was estimated at 15% [95% CI: 8-24%] for DM patients versus 26% [95% CI: 17-36%] in non-DM patients. Hazard ratio (for matched pairs) was 1.15 (95% CI: 0.75-1.77; p = 0.51). Conclusions: DM did not adversely impact survival in patients with pancreatic cancer. Pancreatic cancer did not affect glycemic control. Elevated ca 19-9 in diabetic patients may be an unreliable marker for gauging disease progression.
Prognostic impact of interval between diagnosis and surgery in patients with gastric cancer.
Authors: Kumazu Yuta , Hayashi Tsutomu , Hara Kentaro , Osakabe Hiroaki , Nagasawa Shinsuke , Nakazono Masato , Aoyama Toru , Yamada Takanobu , Sato Tsutomu , Rino Yasushi , Masuda Munetaka , Ogata Takashi , Yoshikawa Takaki 
Published: January 2019

24 Background: Patients with gastric cancer should receive treatment for the cure as soon as possible because cancer cells are considered to grow and metastasize quickly. However, patients sometimes have to wait for the treatment because of further examinations of comorbidity, social background, and limited medical resources. It remained unclear whether interval between diagnosis and surgery is a risk factor for the survival. Methods: This retrospective single-center study examined 801 patients who visited outpatient clinic for gastric cancer and underwent curative surgery from 2006 to 2012 at Kanagawa Cancer Center in Japan. The patients who received neoadjuvant chemotherapy were excluded. Interval was defined as the time from the date of the first visit to the date of surgery. Interval was divided by the median and was classified to the early (less than median) and the late (exceeding the median) groups. Survival was analyzed by separating clinical T1 and T2-4. Results: 461 patients had clinical T1 and 340 had clinical T2-4. Median interval was 55 days (15-269 days) in clinical T1 and 35 days (10-148 days) in clinical T2-4, respectively. In clinical T1, 5-year survival rate was 93.1% in the early group and 91.2% in the late group (p = 0.456). In clinical T2-4, 5-year survival rate was 77.8% in the early group and 78.9% in the late group (p = 0.864). In the multivariate analysis, significant independent risk factors were over 75 years of age and clinical T4, and clinical N+, over 75 years of age in clinical T1, and over 75 years of age and clinical T4 in clinical T2-4. Interval was not significant factor both in clinical T1 (HR: 1.242, 95%CI 0.641-2.407 p = 0.522) and in clinical T2-4 (HR: 1.078, 95%CI 0.672-1.729 p = 0.756). Conclusions: Interval between diagnosis and surgery did not have a negative impact on the prognosis in patients with gastric cancer. Necessary interval for the clinical practice would be acceptable.
Points to keep in mind when carrying out clinical trials in Japan on advanced pancreatic cancer cases without alternative treatments: Analysis of 367 cases.
Authors: Tsurita Giichiro , Yasui Hiroshi , Kurokawa Tomohiro , Yoshioka Yuichiro , Yazawa Kentaro 
Published: January 2019

243 Background: We commenced a physician-led clinical trial to examine the efficacy of a combined treatment of peptide vaccine therapy for advanced pancreatic cancer that has no effective treatment. During this trial, there were inquiries from 367 cases, of which 145 cases (40%) were examined at our outpatient clinic. The purpose of this study was to examine these cases in detail and to consider the points to be noted in executing clinical trials for poor prognosis cases. Methods: We examined the timing of inquiry, medical condition, the person(s) they inquired, and other relevant information regarding the 367 subjects who made inquiries. For the 145 cases visited the outpatient clinic of our hospital, we examined their medical condition, treatment and whether or not they have participated in a clinical trial. Results: 140 of the 367 cases (38%) of inquiry were concentrated within the first two months after the start. During these two months, there was a concentration of patients who had completed standard treatments and were a few months into BSC, but were unable to participate in the clinical trial due to deterioration of their general condition. Many of the inquiries were made by family members (spouse or child) of the patients, around twice the number of inquiries made by patients themselves. Even among the 145 subjects that were examined in the outpatient clinic of our hospital, severe cases, in particular, were seen several months after the start of the study. There were many cases that required urgent hospitalization during outpatient visits or patients whose general condition rapidly deteriorated during the screening tests. 23 cases (16%) underwent the clinical trial. Conclusions: In clinical trials such as this one, which handles cases with poor prognosis, many of the subjects are in poor general condition at the inquiry stage, and most of these inquiries are concentrated immediately after the start of the study. Therefore, it is very important to deal with inquiries and make judgments during the outpatient examination on whether or not clinical trial participation is possible.
Complications and seeding risk after percutaneous liver biopsy in an oncological setting.
Authors: De Paepe Katja , Bonne Lawrence , Fotiadis Nicos , Starling Naureen , Chau Ian , Gerlinger Marco , Rao Sheela , Watkins David J. , McCall James , Koh Dow-Mu , Brown Gina , Cunningham David 
Published: January 2019

246 Background: Percutaneous biopsy of suspected liver metastases is a common practice for diagnostic purposes. Particularly, in the setting of oncological clinical trials, it is a relatively non-invasive method to obtain sufficient tissue for molecular analyses at regular set time points. However, various complications may occur, including seeding of the tumour along the biopsy tract. Only few reports exist on the actual incidence of seeding, on a limited number of tumor types. The aim of this study was to evaluate the technique’s safety and risk of seeding. Methods: All patients with an ultrasound or CT-guided liver biopsy between 2012-2016 were included. Medical records were reviewed retrospectively for post-biopsy complications and all follow-up imaging was re-assessed for the presence of seeding, defined as tumoral deposits in the biopsy needle tract. Results: In total 782 biopsies were performed in 550 patients (282 women, 268 men; mean age of 61 years), 43.9% (343/782) for trials and 56.1% (439/782) for diagnostic/molecular purposes, 93.7% (733/782) were diagnostic, revealing malignancy in 96.9% (710/733). Number of biopsies per patient ranged between 1 (n=387) to 7 (n=1), a co-axial system was used in 70.6% (552/782) and multiple passes in 29.4% (230/782). Complications were reported in 8.8% (69/782), more often pain (4.7%) and hypotension/vasovagal (2.3%). Admission and/or re-intervention were needed for more severe complications as bleeding (1.0%), sepsis/fever (1.1%), pulmonary embolism (0.3%) and pneumothorax (0.4%). Seeding was seen in 1.1% (8/782) of cases (2/44 melanoma, 1/11 GIST, 1/39 cholangiocarcinoma, 1/247 colorectal, 1/14 oesophagus, 1/97 breast, 1/31 prostate). Mean time for seeding was 208 days (range 43-469 d); mean post-biopsy survival time was 495 days in the seeding and 349 days in the non-seeding group. Conclusions: Percutaneous liver biopsy is a highly effective and safe method for tissue collection, with only a minimal risk of seeding.
Clinical features of hemobilia in unresectable pancreatic cancer (uPC).
Authors: Kimura Gen , Ohno Izumi , Inamura Kensuke , Watanabe Kazuo , Umemoto Kumiko , Suzuki Yuko , Sasaki Mitsuhito , Takahashi Hideaki , Hashimoto Yusuke , Imaoka Hiroshi , Mitsunaga Shuichi , Kobayashi Tatsushi , Ikeda Masafumi 
Published: January 2019

247 Background: Hemobilia is a life-threatening, although rare event in uPC patient(pt)s. However, there are few reports about it. The purpose of this study was to identify it’s clinical features in uPC at our institute. Methods: Data of 2066 pts who received treatment for uPC between April 2008 and August 2017 were reviewed retrospectively from the electronic medical records. Hemobilia was determined when extravasation was detected from the biliary tree artery on contrast-enhanced computed tomography (CT) or angiography. Blood clot seen in the bile duct on endoscopy was also included. Pts whose bleeding was diagnosed due to tumor invasion of the stomach or duodenum by endoscopy were excluded. CT and angiography were reviewed by an experienced radiologist. Results: Eleven pts developed hemobilia; there were no pts before 2013. All of them received gemcitabine plus nab-paclitaxel (GnP) as first-line chemotherapy. Eight pts developed hemobilia during GnP, three had it after disease progression. Every pt had at least one symptom of Quinke’s triad; upper gastrointestinal hemorrhage (n = 8, 73%), biliary colic (n = 4, 36%), and jaundice (n = 6, 55%). The median time to hemobilia after the start of GnP was 198 days (range: 43-559 days). A covered self-expanding metal stent (cSEMS) was placed in the lower common bile duct in all pts. The median time to bleeding after cSEMS placement was 87 days (range: 30-467 days). Eight pts showed pseudoaneurysm(PA). In 7 of these pts, were diagnosed by CT, the remaining by interventional radiology(IR). IR was employed initially in 6 of the 8 pts, and hemostasis was successful in all. Two pts underwent cSEMS placement and was unsuccessful in both. Of these 2 pts, one underwent IR, with successful hemostasis. Of the remaining 3 pts, 2 pts had hemostasis without treatment, and one had cSEMS placement that was successful for hemostasis. Conclusions: In our study, hemobilia was only seen after 2014. Hemobilia developed after the start of GnP in all of the pts. Pts who showed PA, successful hemostasis was obtained in all cases that underwent IR. Hemobilia should be kept in mind as a cause of upper GI bleeding in uPC pts, especially those with a biliary stent and history of GnP. IR was effective for the management of hemobilia associated with PA.
Association of liquid biopsy and gastric cancer patients' prognosis: Comprehensive synopsis and a meta-analysis.
Authors: Chen Lin , Gao Yunhe , Xi Hongqing , Cui Jianxin , Cai Aizhen , Shen Weisong , Zhang Kecheng , Li Jiyang , Peng Zheng , Wei Bo 
Published: January 2019

25 Background: Liquid biopsy including circulating tumor cells (CTCs) and cell-free nucleic acids (cfNAs) has offered a minimally invasive approach for detection and measurement of gastric cancer (GC). Reports regarding associations between liquid biopsy and gastric cancer have been emerging rapidly in recent decades, yet their prognostic value still remains paradoxical. Methods: We searched Medline, Embase, Cochrane Central Register of Controlled Trials database for relevant studies that assessed the prognosis significance of CTCs and cfNAs in gastric cancer from peripheral blood(PB). Newcastle-Ottawa Scale (NOS) was used to assess the quality of evidence. Stata 12.0 was used for pooled analysis and subgroup analysis was performed to determine the association of CTCs or cfNAs’ presence and major clinical characteristics. Pooled results were displayed as hazard ratios (HRs) with their 95% confidence intervals (95% CI) with random effect models. Results: We identified 1258 studies, and then 43 were finally eligible for analysis. A total of 3792 patients were included for final evaluation. Pooled analysis showed that detection of certain CTCs, ctDNA or circulating miRNA was associated with poorer overall survival (OS) (CTCs, HR=2.05, 95%CI 1.65-2.55, p < 0.001; circulating miRNA HR=1.74, 95%CI 1.13-2.69, p=0.013; ctDNA, HR=1.77, 95%CI 1.28-2.44, p=0.001) and disease-free survival(DFS) (CTCs, HR=2.92, 95%CI 1.93-4.40, p < 0.001; circulating miRNA, HR=3.30, 95%CI 2.39-4.55, p < 0.001; ctDNA, HR=4.69, 95%CI 2.23-9.86, p < 0.001) of gastric cancer patients, regardless of the disease’s early or late stage. Conclusions: Several high-quality circulating biomarkers or detection methods for gastric cancer prognosis prediction were identified by subgroup analysis, including the Cellsearch system, cytokeratins, miR-20a, miR-200c, etc. Detection of these certain dysregulation circulating markers in patients’ PB indicates poor prognosis with advanced GC patients.
Method of diagnosis of pancreatic adenocarcinoma: A Nova Scotia experience.
Authors: Lees Caitlin , Hopman Wilma M , Younis Tallal , Lamond Nathan William Dana , Ramjeesingh Ravi 
Published: January 2019

252 Background: The gold standard for the diagnosis of pancreatic adenocarcinoma involves pathologic confirmation, as identified in consensus guidelines. Little is known about the care of patients with pancreatic cancer in Nova Scotia. This retrospective study intends to clarify the methods utilized in Nova Scotia to diagnose pancreatic adenocarcinoma and identify variables associated with pathologic confirmation of diagnosis. Methods: A provincial database, involving patients diagnosed with unresectable pancreatic adenocarcinoma between January 1, 2011 and December 31, 2014, was created as identified by the surveillance and epidemiology unit of the program of care for cancer. Pearson chi-square was used to determine significant differences between groups and logistic regression was used to identify those variables associated with a specific pathologic diagnosis. Results: Of the 264 patients identified, most were diagnosed by a combination of imaging and an elevated CA 19-9 level (n = 120, 45.5%) and 24.2% (n = 64) by imaging alone. Significant predictors of diagnosis by imaging alone included i) age 65 or more vs less than 65 (n = 55, 31.3% vs n = 9, 10.2%; p = 0.001), and ii) living in areas served by community hospitals (rather than a tertiary care centre) (n = 46, 28.6% vs n = 18, 17.5%; p = 0.014). A pathologic diagnosis was attempted (non-diagnostic or positive) in 40.2% of patients (n = 106), and a pathologic diagnosis was actually obtained in 30.3% of patients (n = 80). Patients were significantly less likely to have an attempted pathologic diagnosis if they were over 65 (OR = 1.95, 95% CI 1.13 – 3.38), female (OR = 1.78, 95% CI 1.05 – 3.01), or resided in a community with a tertiary care centre (OR = 2.02, 95% CI = 1.17 – 3.49). Conclusions: A significant majority of patients in Nova Scotia were diagnosed with pancreatic adenocarcinoma without pathological confirmation, and nearly a quarter of these patients were diagnosed on the basis of imaging alone. The lack of pathologic diagnosis does not conform to consensus guidelines of management of pancreatic cancer and suggests that more work needs to be done to improve care for these patients.