bluuebunny/crossref_metadata_2025_split huggingface dataset:
PS02.067: PREDICTIVE VALUE OF 18F-FDG PET-CT METABOLIC PARAMETERS PRIOR TO TREATMENT ON SHORT-TERM CURATIVE EFFECTS OF ESOPHAGEAL CANCER
Authors: Li Jiancheng , Sun Weijie 
Published: September 2018

Abstract

Background
To investigate predictive value of pre-treatment maximal standardized uptake value (SUVmax) and metabolic tumor volume (MTV) on short-term curative effects in esophageal cancer patients.

Methods
Retrospective analysis was made for 98 cases of patients with esophageal cancer treated by radiotherapy or radiotherapy combined with chemotherapy in Fujian Cancer Hospital. Before treatment, 18F-FDG PET-CT scan was performed. PET/CT images prior to treatment were read by two doctors with a high-level professional title using double-blind method. SUVmax and MTV were determined and averaged. 1–3 months after treatment, an experienced deputy director of PET/CT center and a radiotherapist evaluated the curative effect of all patients according to the Response Evaluation Criteria in Solid Tumor (RECIST).

Results
There were no significant differences of SUVmax and MTV between two groups in age, gender, cancer site, and differential extent (P > 0.05). Factors related to SUVmax were lesion length, depth of invasion, lymph node metastasis and clinical stage, while differences were statistically significant (P < 0.05). SUVmax & MTV were positively correlated with lesion length, depth of invasion, lymph node metastasis and clinical stage. The effective rate was 67.3% (66/98). SUVmax (r = -0.283, P = 0.049) and MTV(r = -0.379, P = 0.007) were negatively correlated with short-term curative effects, but the curative effect of MTV was higher than that of SUVmax.

Conclusion
There were no significant effects of clinical factors e.g. age, gender, esophageal cancer site, and differential extent on SUVmax and MTV, but length of lesion, depth of invasion, lymph node metastasis and clinical stage had significant effect on SUVmax and MTV. SUVmax and MTV prior to treatment can predict short-term curative effects of radiotherapy or radiotherapy combined with chemotherapy for esophageal cancer patients, but MTV is more predictive than SUVmax.

Disclosure
All authors have declared no conflicts of interest.
PS02.078: FEASIBILITY OF PREOPERATIVE STAGING WITH USPIO ENHANCED MRI IN PATIENTS WITH RESECTABLE ESOPHAGEAL CARCINOMA (PRECIES STUDY)
Authors: De Gouw Didi , Klarenbeek Bastiaan , Van Der Post Chella , Hermans John , Maas Marnix , Slagt Cor , Rovers Maroeska , Scheenen Tom , Rosman Camiel 
Published: September 2018

Abstract

Background
In operable patients suffering from esophageal cancer, the percentage of patients without metastatic lymph nodes found after neoadjuvant chemoradiotherapy (nCRT) is 69%. Extensive lymph node dissections during esophagectomy may be omitted or minimized in these patients, reducing associated morbidity. Recently, MRI with ultrasmall superparamagnetic iron oxide nanoparticles (USPIO, ferumoxtran-10) has been reintroduced to detect metastatic lymph nodes in prostate cancer. The aim of this study is to assess the feasibility of USPIO-MRI to detect loco-regional lymph node metastases in patients with esophageal cancer.

Methods
USPIO-nanoparticles are intravenously infused 24 to 36 hours before MRI. USPIO-enhanced MRI is performed before and after nCRT. After nCRT, patients are scanned under general anesthesia immediately prior to surgery in the MR system of the hybrid MITeC operation room with controlled mechanical ventilation. During controlled prolonged apneu, a four-minute iron-sensitive MRI acquisition is used to visualize suspicious esophageal lymph nodes without motion artefacts. Resected specimens, still containing USPIO, are measured ex-vivo in a preclinical 7T MR system before histopathological examination. A radiological assessment of the presence of suspicious lymph nodes in-vivo is matched to the ex-vivo nodes on preclinical MRI, providing the ground truth for the presence of metastases.

Results
Currently, three patients were included in the study of which one patient has been examined before and after nCRT. MRI under anesthesia prior to surgery with controlled mechanical ventilation was possible resulting in a clinically relevant spatial resolution to visualize possible malignant lymph nodes. Suspicious nodes were identified and could be matched using corresponding anatomical landmarks to the ex-vivo MRI, which showed good visual agreement with esophageal specimen after resection.

Conclusion
A successful method was proposed to validate USPIO-enhanced MRI to detect metastatic lymph nodes in patients with esophageal cancer. Matching ex-vivo USPIO-MRI images with histopathology results provides direct information for validation of in vivo USPIO-MRI and characteristics of loco-regional lymph nodes. Final results on the feasibility of USPIO-MRI to detect metastatic lymph nodes after nCRT are still awaited. Feasibility and preliminary values of the accuracy of the technique are the starting point for a phase two study.

Disclosure
All authors have declared no conflicts of interest.
PS02.085: ASSESSMENT OF TUMOR REGRESSION OF ESOPHAGEAL SQUAMOUS CELL CARCINOMA AFTER NEOADJUVANT CHEMORADIOTHERAPY: COMPARISON OF 3 COMMONLY USED SCORING APPROACHES
Authors: Chao Yin-Kai , Fang Hsin-Yueh 
Published: September 2018

Abstract

Background
Tumor regression grade (TRG) is a measure of histopathological response of cancer to neoadjuvant chemoradiotherapy(nCRT) and is associated with outcomes. Several TRG system are used in esophageal cancer: Schneider 4 tier(0%,1∼10%,10∼50%, > 50% vital residual tumor cell[VRTC]), Chirieac 3 tier(0%,1∼50%, > 50% VRTC) and Japanese 4 tier(0%,1∼33%,33∼66%, > 66% VRTC). Although these methods are generally accepted, currently there is no common standard.

Methods
We compared the application of three major systems for assessment of tumor regression. Hematoxylin and eosin–stained slides from 370 resection specimens of esophageal squamous cell carcinoma following nCRT were independently reviewed by two pathologists. Primary endpoints included (1) interobserver agreement (2) prognostic discrimination

Results
Interobserver agreement was excellent for all three sutem while the Chirieac 3 tier system showed the best kappa value(0.93). All models had similar discriminatory and stratification power, and they predicted survival (P < 0.0001) on univariate analysis. While Chirieac system remained a significant predictor for overall survival independent of yp-stage and margin status in multivariate analysis.

Conclusion
A simple 3-tiered system with the estimation of VRTC(0%,1∼50%, > 50%) is most reproducible for the evaluation of histological response and together with yp-stage and margin status as independent predictors for survival.

Disclosure
All authors have declared no conflicts of interest.
PS02.088: COMPARATIVE STUDY OF CT AND PATHOLOGICAL DIAGNOSIS TOWARD MEDIASTINAL LYMPH NODE METASTASIS IN ESOPHAGEAL CARCINOMA
Authors: Li Jiancheng , Chen Shanshan 
Published: September 2018

Abstract

Background
To investigate the diagnostic criteria of mediastinal lymph node metastasis (MLNM) in special site, which were less than 1cm, in esophageal carcinoma (EC) by comparing the lymph node size measured by CT and obtained by postoperative pathological examination.

Methods
A total of 305 EC patients were selected, scanned the location, short diameter, and number of MLNs one week before surgery, and then compared with their pathological findings.

Results
the ROC curve analysis revealed that the best short diameters of MLNM in the thoracic cavity, supraclavicular fossa (located among the clavicle, sternocleidomastoid, and omohyoid muscle), tracheoesophageal groove that can be diagnosed by CT were 8mm, 5mm, and 6mm, respectively; compared with those with the short diameter as 10mm, the sensitivity was increased significantly, the specificity and accuracy were little changed, while the Youden's index was increased significantly.

Conclusion
It is reasonable to reduce the CT diagnostic criteria of the short diameter of positive lymph nodes in some special site such as supraclavicular fossa and tracheoesophageal groove.

Disclosure
All authors have declared no conflicts of interest.
PS02.091: ENDOSCOPIC FINDINGS OF SMALL ESOPHAGEAL SQUAMOUS CELL CARCINOMA DEPTH OF INVASION OF SM2
Authors: Nakano Kaoru , Ishiyama Akiyoshi , Namikawa Ken , Yamamoto Yasunori , Akazawa Naoki , Fujisaki Jyunko 
Published: September 2018

Abstract

Background
Among superficial esophageal squamous cell carcinomas (SESCCs), cases with invasion of deeper submucosal layer (clinical SM2) were not be indication for treatment with endoscopic resection (ER). We occasionally have selected ER for cSM2 SESCC in patients with small lesions or who are in poor general condition. The result of the report of clinical research (JCOG0508) proved non-inferiority of three year overall survival in stage pT1b cases with treated by of ER plus chemoradiotherapy compared to surgical resection. Accurate prediction of invasion depth of SM2 will be possible to resect by ER with negative vertical margins and to decrease radiation dose. In this study, we compared the efficacy of endoscopic modality for predicting SM2 invasion in patients with small SESCCs.

Methods
We enrolled 13 patients with SESCC, pathologically diagnosed SM2, and lesions smaller than 15mm who had undergone ESD with en-bloc resection at our hospital between April 2005 and March 2017. We compared accuracy rates of diagnosis before ESD for invasion depth in each modality. Especially with WLI, we defined several findings suspected to indicate SM2 invasion of tumor (hereinafter called ‘SM2 sign’). We evaluated whether ‘SM2 signs’ were present or absent for each lesion.

Results
The median size was 10mm. Macroscopic types elevated in three cases, flat in one and depressed in nine. The only flat type case was detected after iodine staining, and its predicted invasion depth was intra-mucosal layer. Among three elevated type lesions the accuracy of WLI and ME-NBI SM2 was 33% and 33%, respectively. EUS was underdiagnosed. ‘SMT-like elevation’, ‘elevate taller than 2mm’ and ‘intense redness’ were observed in two, one and one case, respectively. Among nine depressed type lesions, the accuracy of WLI, ME-NBI and EUS was 22%, 11%, and 25%, respectively. ‘Deep depression’ ‘uneven mucosa of depressed area’ and ‘marginal elevation’ were observed in zero, five and six cases, respectively. At least one finding of SM2 sign was observed in 77%.

Conclusion
We can increase in the accuracy rate of SM2 invasion for small SESCCs when focusing on SM2 sign with WLI before ER.

Disclosure
All authors have declared no conflicts of interest.
PS02.092: HER2 EXPRESSION AND GENE AMPLIFICATION CORRELATES WITH BETTER SURVIVAL IN ESOPHAGEAL ADENOCARCINOMA
Authors: Loeser Heike , Plum Patrick , Zander Thomas , Kraemer Max , Alakus Hakan , Buettner Reinhard , Bruns Christiane , Gebauer Florian , Quaas Alexander 
Published: September 2018

Abstract

Background
Targeting Her2 is highly established in cancers of the upper gastrointestinal tract, since clinical studies showed a survival benefit in Her2-positive gastric cancer. To date there is conflicting data concerning the impact of Her2 expression and gene amplification in esophageal adenocarcinoma (EAC), as most studies do not differ between cancers of the esophagus, gastroesophageal junction and stomach. The aim of this study was to analyze the expression and gene amplification of Her2 in EAC in correlation to clinical and pathological data to verify the prognostic impact.

Methods
We analyzed 506 patients with esophageal adenocarcinomas that underwent thoraco-abdominal esophagectomy between 1997 and 2013 using a tissue micro array (TMA) for the expression of Her2 by immunohistochemistry (IHC) according to the guidelines. Fluorescence-in-situ-hybridization (FISH) was performed for IHC score 2. The Her2-status was correlated with clinical and pathological data.

Results
Her2-positivity was found in 11.7% (n = 59) of all EAC (IHC score 3 + or IHC score 2 + with amplification) and demonstrated a significant better overall-survival (OS) in correlation to Her2-negative tumors (median OS 55.0 vs. 22.7 months, P < 0.0001) (Figure below). Overexpression of Her2 was associated with lower tumor stages (pT1/pT2, P = 0.038), absence of lymph node metastases (pN0/pN + , P = 0.030) and was significantly associated with tubular and/or papillary tumor growth pattern (P = 0.029).

Conclusion
We demonstrated a positive prognostic impact of Her2 expression and gene amplification in a large cohort of EAC, contrary to other solid malignancies including gastric cancer, but according to a large study of EAC from 2012. Her2-positive tumors significantly have a tubular and/or papillary tumor growth pattern, indicating a marker of differentiation in EAC.

Disclosure
All authors have declared no conflicts of interest.
PS02.097: PROGNOSTIC IMPACT OF LYMPH NODE METASTASIS STATIONS IN PN1 STAGE ESOPHAGEAL SQUAMOUS CARCINOMA PATIENTS
Authors: Tang Peng , Ma Zhao , Yu Zhentao 
Published: September 2018

Abstract

Background
Although numerically based lymph node staging system of UICC/AJCC of esophageal squamous cell carcinoma (ESCC) offers excellent prognostic performance, it doesn’t offer information on the anatomical extent of disease. The aim was to evaluate prognostic impact of lymph node metastasis (LNM) stations and regions in pN1 stage patients.

Methods
Among patients with ESCC undergone esophagectomy classified as R0 from January 2005 to December 2010, 185 patients diagnosed as pN1 were selected for analysis with univariate and multivariate Cox regression analysis.

Results
The most common metastasis areas in pN1 patients were middle and lower thoracic paraesophageal LN (28.6%), left gastric artery LN (27.6%) and paracardial LN (24.3%). Non- middle and lower paraesophageal LNM (P = 0.049), subcarinal LNM (P = 0.041) and multiple left gastric artery LNM (P = 0.010) were independent risk factors for worse survival. The median survival of the N1 (JES) group was significantly better than the N2 (JES) (40.1 months vs. 22.4 months, P = 0.012). However, no significant difference was found in median survival rate among intra-thoracic LNM, upper-abdominal LNM and both LNM.

Conclusion
Paraesophageal LNM, subcarinal LNM and left gastric artery LNM are predictive factors for survival and should be swept routinely in pN1 stage ESCC patients. On the basis of UICC/AJCC lymph node Classification system, anatomical lymphatic spread pattern analysis could further improve prognosis prediction.

Disclosure
All authors have declared no conflicts of interest.
PS02.099: EFFORTS IN PROPHYLAXIS OF FEBRILE NEUTROPENIA IN DCF THERAPY FOR ESOPHAGEAL CANCER
Authors: Okamoto Koichi , Ninomiya Itasu , Ohta Tetsuo , Fushida Sachio , Oyama Katsunobu , Kinoshita Jun 
Published: September 2018

Abstract

Background
DCF therapy (5-FU + CDDP + Docetaxel) for esophageal cancer is known to have strong anti-tumor effect but the incidence of bone marrow suppression (BMS) and febrile neutropenia (FN) after DCF therapy has been frequent and patients is often forced to reduce the dose of anti-cancer drug or discontinue of chemotherapy. We clarified the influence of prophylactic administration of a long-acting G-CSF, pegfilgrastim, in DCF therapy for esophageal cancer on the incidence of adverse events and anti-tumor effect.

Methods
From March, 2011 to July, 2017, 87 patients underwent DCF therapy (Docetaxel 60mg/m2 D1, CDDP 60mg/m2 D1, 5-FU 800mg/m2 D1–5) for esophageal squamous cell carcinoma above cStage II (33 patients administered pegfilgrastim, P group; 54 patients without pegfilgrastim, N group). We investigated the influence of pegfilgrastim on the incidence of adverse events in both groups according to CTCAE v4.0 grading system. And we investigated anti-tumor effects assessed by image examination in all patients and 47 surgically resected specimens.

Results
The incidence of leukocytopenia and neutropenia in P group were significantly lower than that in N group (15.2% vs 57.4%, P < 0.001; 21.2% vs 64.8%, P < 0.001, respectively). The incidence of FN in P group tended to be lower than that in N group (9.1% vs 20.4%, P = 0.233). Significantly more patients in N group suffered dose reduction or discontinuation of chemotherapy due to BMS or FN (30.3% vs 72.2%, P < 0.001). Relative dose intensity of 5-FU in P group was significantly higher than that in N group (95.6% vs 82.5%, P = < 0.001). In endoscopically evaluated response after 2 courses of DCF therapy, the reductive effects in the patients in P group significantly better than in those in N group (PR < ; 78.1% vs 44.0%, P = 0.002). The overall response rate was also significantly better in the patients in P group than in those in N group (PR < ; 60.6% vs 35.2%, P = 0.021). Histopathological responses in surgically resected tumor in P group tended to be better than N group (Grade 1b < ; 47.1% vs 33.3%, P = 0.352).

Conclusion
DCF chemotherapy with prophylactic administration of pegfilgrastim may be an option for safe and effective chemotherapy for advanced esophageal cancer.

Disclosure
All authors have declared no conflicts of interest.
PS02.103: THE PATTERN OF RESIDUAL TUMOR AFTER NEOADJUVANT CHEMOTHERAPY FOR ADVANCED ESOPHAGEAL CANCER AND ITS CLINICAL SIGNIFICANCE
Authors: Hashimoto Tadayoshi , Makino Tomoki , Yamasaki Makoto , Tanaka Koji , Miyazaki Yasuyuki , Takahashi Tsuyoshi , Kurokawa Yukinori , Nakajima Kiyokazu , Mori Masaki , Doki Yuichiro 
Published: September 2018

Abstract

Background
Although neoadjuvant chemotherapy (NAC) has recently became a standard treatment for locally-advanced esophageal squamous cell carcinoma (ESCC), residual pattern of cancer cells in resected specimen after NAC has not been clarified yet.

Methods
A total of 120 patients with cT3 or T4 ESCC who underwent curative esophagectomy after NAC and achieved grade2 as histological efficacy between 2000–2016 were analyzed. We classified the pattern of residual tumor into 4 categories; Type 1: Shallow remnant (between mucosa and submucosa), Type 2: Central remnant (between submucosa and muscularis propria), Type 3: Deep remnant (between muscularis propria and adventitia), and Type 4: diffuse remnant (between mucosa/submucosa and muscularis propria/adventitia) and examined its relationship with clinicopathological factors and prognosis.

Results
The tumor remnant type was categorized as follows; Type 1/Type 2/Type 3/Type 4: = 49/33/9/29 cases. Forty-five cases had no residual cancer cells in the mucosal layer. The positivity rate of lymphatic invasion was similar between 4 categories, while the positivity of venous invasion was significantly higher in Type 3 and 4 as compared to Type 1 or 2 (P = 0.04). Regarding the pattern of recurrence, lymph node recurrence was more common in Type 1 (69%) and Type 2 (83%) compared to Type 3 (50%) or Type 4 (38%) (P = 0.29). Notably, more patients with Type 3 or 4 developed pleural dissemination or distant metastasis as compared with those with Type 1 or 2 [pleural dissemination: Type 1/2/3/4: 0%/0%/50%/38% (P = 0.029), distant metastasis: Type 1/2/3/4: 31%/13%/50%/88%, (P = 0.11)]. No significant difference in 2-year recurrence-free survival rate was identified among 4 categories (Type 1/2/3/4: 65.9%/78.0%/74.1%/71.8%, P = 0.757).

Conclusion
The most common pattern of residual tumor after NAC for advanced ESCC was shallow remnant although approximately forty percent of cases inversely showed tumor disappearance at least in mucosal layer. Lymph node metastases was the predominant pattern of disease recurrence in patients with the shallow and middle remnant type while deep and diffuse remnant pattern were significantly associated with pleural dissemination and distant metastasis.

Disclosure
All authors have declared no conflicts of interest.
PS02.106: THE IMPACT OF HISTOPATHOLOGICAL LYMPH NODE METASTASES AFTER PREOPERATIVE CHEMO-RADIOTHERAPY ON THE PROGNOSIS IN ESOPHAGEAL CANCER PATIENTS
Authors: Murakami Kentaro 
Published: September 2018

Abstract

Background
Esophageal cancer does not have a good prognosis despite being resectable. A recent randomized controlled trial (the Dutch CROSS study) showed the superiority of preoperative chemo-radiotherapy over surgery alone with regard to the five-year survival. At present, this therapeutic approach is regarded as the standard care in the United States and Europe. However, the prognosis in cases where part of the tumor remains is poor, so additional adjuvant therapy is required. The impact of the histopathological lymph node metastases status after preoperative chemo-radiotherapy on the prognosis is unknown, and is which patients require additional adjuvant therapy to manage lymph node metastases.

Methods
Esophageal cancer patients with more than five lymph node metastases or lymph node metastases spreading into three fields have a poor prognosis, despite their tumor being resectable. We therefore performed neoadjuvant chemo-radiotherapy in these patients in 1998 (NACRT group). We also performed chemo-radiotherapy for initially unresectable locally advanced esophageal cancer invading adjacent organs and curative surgery for the above-mentioned patients in whom the invasion had disappeared after chemo-radiotherapy (conversion group). The chemo-radiotherapy regimen was the same for both groups and consisted of radiotherapy 40 Gy/20 fr and chemotherapy with 5-FU (500 mg/m2 days 0–4) and CDDP (15 mg/m2 days 1–5). We then examined the impact of the histopathological lymph node metastasis status after preoperative chemo-radiotherapy on the prognosis in our institute.

Results
Patients with three or more histopathological lymph node metastases had a significantly poorer prognosis than those with fewer metastases in both groups. In the NACRT group, the 5-year survival rate was 35.5% vs. 36.1% (number of lymph node metastases 0 vs. ≥ 1; P = 0.889), 34.0% vs. 36.7% (0–1 vs. ≥ 2; P = 0.678), and 47.1% vs. 0% (0–2 vs. ≥ 3; P = 0.003). In conversion group, it was 40.4% vs. 43.6% (number of lymph node metastases 0 vs. ≥ 1; P = 0.841), 45.6% vs. 33.6% (0–1 vs. ≥ 2; P = 0.106), and 49.5% vs. 20.0% (0–2 vs. ≥ 3; P = 0.025).

Conclusion
Patients with three or more histopathological lymph node metastases after preoperative chemo-radiotherapy had a significantly poorer prognosis than those with fewer metastases and required additional adjuvant therapy.

Disclosure
All authors have declared no conflicts of interest.