bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laboratory values and their relationship with short- and long-term outcome following transthoracic esophagectomy in patients with esophageal cancer.
Authors: Bosch Dirk , Nijsten Maarten , Plukker John Theodorus 
Published: February 2017

37 Background: Surgical resection in esophageal cancer patients remains the mainstay of therapy, but carries a considerable risk of post-operative complications. Deranged laboratory data in the early post-operative period could provide guidance in decision making for further treatment strategy. Therefore we related standard laboratory measurements on 90-day and 1-year mortality after esophagectomy. Methods: Esophagectomy with curative intent was performed in 226 consecutive patients with cancer of the esophagus between January 2000 and December 2009. Prognostic analyses for albumin, lactate dehydrogenase (LDH), ALAT, ASAT, gGT, urea, creatinine, C-reactive protein (CRP), white blood cell count (WBC) and platelet count were performed with a Mann-Whitney U-test (p<0.05) and ROC curve (area under the curve (AUC) >0.7) for postoperative day (POD) 1, 2, 3, 4, 5, 10 and 15. Extreme laboratory values (cutoff points) were calculated (5th or 95th percentile) in the case of significant outcomes. Results: Laboratory measurements between survivors and patients deceased within 90-days (n=16) were significantly different in the case of albumin on POD 1, 3, 5, 10 and 15 (5th percentile between 10-13.02, AUC: 0.761), CRP on POD 3, 4, 5, 10 and 15 (95th percentile between 228.8-324.7, AUC: 0.861) and LDH in the late postoperative period on POD 4, 10 and 15 (95th percentile between 387.1-512.2, AUC: 0.864). The other laboratory values showed no systematic differences. For one-year mortality (N=36), only albumin and CRP showed to have significant differences for non-survivors: albumin on POD 10 and 15 (5th percentile between13.2-13.75, AUC: < 0.7) and CRP on POD 3, 4 and 10 (95th percentile between 220.9-319.5, AUC: < 0.7). Conclusions: Albumin and CRP are the strongest prognostic measurements in predicting 90-day and one-year mortality after esophagectomy.
The effect of total lymph nodes removed and the lymph node ratio on overall survival in resected pancreatic cancer.
Authors: Wai Christina , Devarajan Karthik , Hoffman John Parker 
Published: February 2017

371 Background: Previous studies evaluating lymph node status in pancreatic cancer have demonstrated that the ratio of positive nodes to total numbers resected is an important prognostic factor for survival. In our study we sought to see if the total number of nodes removed and lymph node ratio (LNR) would influence overall survival. Methods: A retrospective chart review of 210 patients from July 1998 to July 2011 who underwent resection of pancreatic adenocarcinoma was done. Patients were evaluated for demographic information, neoadjuvant therapy status, surgical margins, pathological stage, total number of lymph nodes retrieved and the number of positive lymph nodes. The LNR was calculated by taking the number of positive lymph nodes to the total number of lymph nodes retrieved. The endpoint evaluated was overall survival (OS). Results: Of the 210 patients, 107 (51%) were male and 103 (49%) were female. The median age was 68. A total of 110 patients had 1 or more positive nodes. The median number of nodes evaluated for all patients was 15 (range 2-51) and the median number of positive lymph nodes was 1. In patients with positive lymph nodes, the median LNR was 0.15 or 15%. For the 210 patients, in univariate analysis, there was a statistically significant association between LNR and overall survival. When the LNR reached >11.2%, patient survival was worse (p=0.018). The total number of nodes removed was not significantly associated with OS for those with positive or negative nodes. However, with multivariable CART analysis, taking into account T stage and surgical margins, LNR had a significant impact on overall survival only for patients who had a R0 resection and T0-T2 disease. If there LNR was > 0, survival was better (p=0.043). Conclusions: In certain GI malignancies, complete evaluation of local lymph nodes is important and changes the survival of patients. In T0-T2 stage pancreatic cancer patients resected with negative margins, outcome is worse if there are positive nodes in these patients. Therefore based on our data, the LNR may be useful for determining the prognosis of early T stage cancer patients.
Gemcitabine chemotherapy until symptomatic disease progression in advanced pancreatic cancer: A retrospective analysis.
Authors: Ma Yuk Ting , Hussain Syed A. , Johnson Philip James , Palmer Daniel H. 
Published: February 2017

372 Background: Gemcitabine was established as the standard first-line therapy for patients with advanced pancreatic cancer in 1997 after a randomized phase III study showed a statistically significant improvement in clinical benefit response and a modest improvement in median survival time, compared to bolus 5FU chemotherapy. The natural history of advanced pancreatic cancer is characterised by the rapid and relentless progression of tumor-related symptoms, thus we have analysed the outcome of our patients with advanced pancreatic cancer who have been treated with gemcitabine until symptomatic disease progression, without the use of regular radiological assessment. Methods: A retrospective analysis was conducted on all patients with advanced pancreatic cancer who were treated with first-line gemcitabine chemotherapy between January 2008 – December 2009. Results: A total of 50 patients were identified (21 with locally advanced disease, 29 with metastatic disease). The overall median survival was 10.4 months (11.3 months for patients with locally advanced disease, 7.2 months for patients with metastatic disease). Conclusions: Our single centre experience suggests that clinical decision-making based on symptomatic disease progression in advanced pancreatic cancer, results in survival outcomes that are comparable to published trial data.
Treatment of cholangiocarcinoma: Retrospective analysis of a single-center experience.
Authors: Gaudig Ina , Schwoerer Harald , Ramadori Giuliano 
Published: February 2017

376 Background: Cholangiocarcinomas (CC) are relatively rare neoplasms, but they show a rising incidence worldwide. CC orginate from epithelial cells lining the intra- and extrahepatic biliary tract including the gallbladder. Methods: We retrospectively evaluated 105 patients with CC treated in our centre between 2000 and 2010. This collective consisted of 45 women (42,9 %) and 60 men (57,1 %). The median age was 64 years (33 – 87 years). 23 % of the patients were adipose, 22 % were diabetic and 23 % suffered from neoplasms different from CC. Symptoms of patients at initial diagnosis of CC were: 47 % weight loss, 39 % upper abdominal pain, 36 % jaundice. Imaging diagnostics consisted of ultrasonography, endosonography, computertomography and eRCP. Tumormarkers as CA19-9 and CEA were elevated in 76 % and 48 % of patients with CC, respectively. Localization of CC: 46 % hilus (Klatskintumor), 23 % distal choledochal truct, 20 % intrahepatic, 11 % gallbladder. Results: For 57 patients (54,3 %) primary curative surgery of the CC was considered. 13/57 showed at laparoscopy inoperability. 3/48 patients treated with palliative chemotherapy showed regression of CC, allowing surgery. Thus, 47/105 (45 %) underwent curative surgery of CC. Surgical results: 39/47 (83 %) R0-resection, 7/47 (15 %) R1-resection, 1/47 Rx-resection. Median recidive – free survival for patients with R0-resection was 14,4 months, for R1-resection 1,8 months. The mean survival time of CC patients undergone curative surgery was 22 months, that of patients with palliative chemotherapy 5 months. 1 – 3 and 5 year survival for curatively resected CC patients were 78 %, 39 % and 21 %, respectively. Palliative chemotherapeutic treatment caused 26 %, 2,5 % and 0 %, respectively. In the whole collective, median survival under chemotherapy (mainly gemcitabine) was 9 months, with best supportive care 2,5 months. Conclusions: Resection of CC is treatment of choice in localized neoplasms. In advanced CC chemotherapy mainly based on gemcitabine was superior to best supportive care.
Patient-reported outcomes (PROs) comparison of 5-FU and capecitabine (cape) with concurrent radiotherapy (RT) for neoadjuvant treatment of rectal cancer: Results of NSABP R-04.
Authors: Yothers Greg , Ganz Patricia A. , Lopa Samia H. , Ko Clifford Y. , Wickerham D. Lawrence , Wolmark Norman 
Published: February 2017

391 Background: Preliminary results of NSABP R-04 indicated that 5-FU and cape have similar pathologic complete response (pCR) outcomes and that the addition of oxaliplatin did not improve pCR. We present PROs comparing 5-FU and cape treatments on quality of life (QoL), convenience of care (CoC), and symptoms. Methods: Clinical stage II or III rectal cancer patients were randomized to receive 5-FU (225mg/m2 5 days/wk) or cape (825 mg/m2 5 days/wk) along with RT (4,500cGy in 25 fractions over 5 wk + boost of 540-1080cGy in 3-6 daily fractions). About half of these patients were also randomized to receive oxaliplatin (50 mg/m2 /wk). QoL was assessed by the functional assessment of cancer therapy–colorectal (FACT-C) trial outcome index (TOI) and symptoms were assessed by the fluoropyrimidine specific symptom checklist (SCL) collected at baseline, after chemoradiation before surgery (post therapy), and at 1 year. CoC was assessed by the modified ECOG CoC scale post therapy. Primary hypotheses were to compare 5-FU and cape on the endpoints of change in TOI and SCL baseline to post therapy and CoC at post therapy. P-values, means, and confidence intervals (CI) are adjusted for clinical stage, sex, and intent for sphincter-saving surgery. Results: 625 5-FU and 650 cape patients completed baseline and post therapy data forms. Patient characteristics were similar by treatment. Change in TOI was similar by treatment post therapy (p = .21). Change in SCL post therapy was greater for cape patients than for 5-FU patients (mean difference 1.02, 95% CI 0-2.04, p = .05). CoC was superior with cape compared to 5-FU post therapy (mean difference 3.07, 95% CI 1.31-6.01, p = .002). The change from baseline to post therapy for all FACT-C subscales was similar by treatment. Change in TOI, SCL, and all FACT-C subscales were similar by treatment at the 1-year assessment. Conclusions: PROs indicate that patients treated with 5-FU and cape have similar QoL. Cape provides significantly greater convenience of care but slightly increased symptoms compared to 5-FU. NCI PHS grants U10CA37377, U10CA69974, U10CA12027, and U10CA69651, support from sanofi-aventis and Hoffmann La-Roche.
Effect of Oncotype DX colon cancer test results on treatment recommendations in patients with stage II colon cancer: Preliminary results.
Authors: Cartwright Thomas H. , Chao Calvin , Lopatin Margarita , Bentley Tanya GK , Broder Michael Samuel , Chang Eunice 
Published: February 2017

398 Background: The Oncotype DX Colon Cancer Recurrence Score (RS) has been clinically validated as an independent predictor of individual recurrence risk in stage II colon cancer patients following surgery. As a result, physicians have been ordering the Oncotype DX assay for stage II colon cancer patients since January 2010, yet no data exist on the assay’s impact on adjuvant treatment planning in practice. We performed a survey to characterize the impact of the assay on adjuvant treatment recommendations in stage II colon cancer. Methods: U.S. medical oncologists (N=277) who ordered Oncotype DX for ≥3 patients with stage II colon cancer were contacted and asked to complete a web-based survey regarding the single most recent stage II colon cancer patient for whom the assay was ordered. The survey was developed through cognitive interviews with four medical oncologists, and the protocol was institutional review board approved. Results: As a planned preliminary analysis, we analyzed surveys from 92 eligible physicians. Physicians were more often in community (85%) than academic or other practices, and had a median of 14.5 years (range, 2-40) of practice experience. The median patient age was 62 years (range, 34–81). 84% of patients had T3 disease. Patients had ≤8, 9-11 and ≥12 nodes examined 2%, 14% and 84% of the time and 36% had comorbidities. Of the 60 patients tested for MMR/MSI, 9 (15%) were MMR-D or MSI-high and 37 (62%) were MMR-P or MSI-low; 14 (23%) unknown. Median RS was 20 (range, 1-77). Before obtaining the RS, chemotherapy was planned in 38 (41%) patients, observation in 35 (38%), and there was no recommendation in 19 (21%). For the 73 patients with pre-assay recommendations, recommended treatment changed after obtaining the RS for 23 patients (32%), including changes from chemotherapy to observation and vice-versa. Conclusions: These preliminary findings indicate that for stage II colon cancer patients, treatment recommendations were changed by RS results approximately one-third of the time. Final results will be reported to include accrual through December 2011.
Factors influencing the CEA positivity in patients with colon cancer including race.
Authors: Thota Ramya , Abu Hazeem Mahmoud , Kallam Avyakta , Silberstein Peter T. , Subbiah Shanmuga 
Published: February 2017

409 Background: Carcinoembryonic antigen (CEA) is a widely used tumor marker for surveillance in colon cancer. However, its accuracy is still debatable as its levels vary based on several factors. Hence we attempted to identify various clinicopathological factors influencing the CEA levels in patients with colon cancer. Methods: Retrospective analysis of 8910 colon cancer patients from 1995 to 2008 was done via the Veteran's Affairs Central Cancer Registry. Age at diagnosis, race, gender, stage, grade, CEA levels, depth of tumor invasion, nodal status, spread of tumor, smoking history, and family history data was studied. The influence of individual factors on CEA positivity was studied by using chi-square test for categorical variables and the unpaired t-test for continuous variables. Results: Out of 8919 patients identified, 3643 were CEA positive and 5276 were CEA negative. CEA levels varied significantly by race, stage, grade, nodal status, smoking history, and tumor size. African Americans have higher CEA levels (22% vs. 15.5%; P<0.0001). CEA positivity increased with increase in stage (stage 1- 20.3% vs. 54.3%; stage 2 – 15.8% vs.22.5%; stage 3 – 10% vs. 12%; stage 4 – 54% vs. 11.4%; P<0.0001). Increasing in T stage showed a proportionate increase in CEA positivity (T1 – 6.4% vs. 18%; T2 – 13.4% vs. 24%; T3 – 64.2% vs. 52%; T4 – 16% vs.7%; P<0.0001). Majority of CEA positive patients are node positive (N0 – 49.4% vs. 70.4%; N1- 28% vs. 20%; N2 – 22.3% vs. 10%; P<0.0001). CEA positive tumors had larger size of tumor compared to CEA negative tumors (54.2 mm vs. 45.6 mm; P<0.0001). CEA positive patients had more poorly differentiated tumors (17.5 % vs. 14.2 %; P<0.0001). Current smokers showed higher CEA levels (54% vs. 41.4%; P<0.0001). Age, gender, location of tumor and family history showed no significant difference among CEA positive and negative tumors. Conclusions: Significant clinicopathological differences noted in CEA positive and negative tumors. African Americans had high-CEA levels and these patients had larger tumor diameter, advanced T stage, more positive nodes, advanced stage and in current smokers. Moreover, a significant difference in histologic tumor grade was observed in CEA positive and negative patient groups.
Impact of tumor aneuploidy in pseudomyxoma peritonei.
Authors: Shetty Shreya Jagadish , Natarajan Bala , Loggie Brian W. 
Published: February 2017

414 Background: DNA aneuploidy is an indicator of poor prognosis in epithelial cancers arising from the colon, rectum, kidney and breast. To our knowledge, there is no data on the occurrence of DNA aneuploidy in Pseudomyxoma peritonei (PMP). The aim of this study is to investigate the frequency of DNA aneuploidy and analyze its relation to clinicopathological characteristics of the patients. Methods: One hundred and twenty patients with PMP were analyzed. Flow cytometry was used on paraffin embedded tissue samples and multiple tissue blocks and serial sections were analyzed for each tumor. The results of DNA analysis were correlated to clinicopathologic data. Chi- square test was used to analyze categorical variables and t-test was used for continuous variables. Kaplan-Meier analysis was used to study impact of aneuploidy on survival. Results: Of 120 patients analyzed, 41.7% (70/120) patients had disseminated peritoneal adenomucinosis (DPAM), 32.5% (39/120) patients had either peritoneal mucinous carcinomatosis- intermediate type (PMCAI) or peritoneal mucinous carcinomatosis (PMCA) and 25.8% (31/120) had signet cell carcinoma (SCC). DNA aneuploidy was detected in 13% (16/120) of the PMP patients. The incidence of aneuploidy was 2% (1/50) in patients with DPAM, 25.6% (10/39) in patients with PMCAI or PMCA and 16% (5/31) in patients with SCC (p=0.004). Nearly 56% (67/120) of patients were males and 44% (53/120) were females. Gender did not impact the incidence of aneuploidy. Mean age of patients with aneuploid tumors and diploid- near diploid tumors was 56.8 (±13.5) years and 49.6 (± 11.8) years respectively (p=0.027). Median survival in patients with aneuploidy was 54 months compared to 100 months in patients with diploid/ near-diploid status (p=0.021). Conclusions: Older age and high-grade PMP are associated with higher rates of aneuploidy. Aneuploidy was associated with worse survival in patients with PMP.
Early detection of colorectal cancer: A proteomic screening study for plasma biomarkers.
Authors: Thorsen Stine Buch , Lundberg Martin , Assarsson Erika , Gee Nick , Knowles Mick , Christensen Ib Jarle , Nielsen Hans J. , Ekstrom Bjorn , Andersson Claes , Gustafsson Mats , Brünner Nils , Stenvang Jan , Fredriksson Simon 
Published: February 2017

415 Background: Colorectal cancer (CRC) is the third most frequent cancer disease in the US. As the 5 year survival is closely associated to stage of disease at the time of diagnosis, patients with localized tumor limited to the colon or rectum have more than 90% chance of 5 year survival, while tumors spreading to regional lymph nodes or to distant organs, have a 5 year survival rate of 69% and 12%, respectively. Since late diagnosis is equal to a poor prognosis for the patients, biomarker guided early detection could make a difference for these patients. One strategy is blood based assays, where we hypothesis that a tumor and its microenvironment will lead to a deposition of specific proteins in the blood. However, due to the complexity of plasma, it is not only a biological but also a technical challenge to detect the proteins specific for CRC. Consequently, we combined the technical evaluation of multiplex proximity probing assays (PPA) with the search for relevant biomarkers for CRC. Each of the protein assays were based on thorough literature studies on the biology of CRC. Methods: Proteins were measured using multiplex PPA. Each assay was constructed from commercially available antibodies conjugated to two DNA oligonucleotides. When the antibodies from one assay bind the target protein simultaneously, it enables the DNA oligonucleotides to be either enzymatic ligated or extended to a PCR amplicon. This PCR amplicon reflects the identity of the proteins and can be quantified by real-time PCR. We evaluated the assays and searched for potential early markers using a collection of case-control plasma samples from a larger endoscopy study. In total we measure the levels of 150 different proteins in 296 human plasma samples from 74 CRC patients, 74 healthy individuals, 74 adenoma patients, and 74 patients with non-cancer diseases. Results: We have a successrate of 80%, the sensitivity is for most assays below 5 pM, and we find no cross-reactivity in chicken plasma for any of the assays. We previous reported that CEA, TIMP-1, CA242, and IL8 were upregulated in CRC plasma. These proteins were also identified in our extended study and the data will be presented. Conclusions: We find potential early markers, which we will validate in new sample material.
Bevacizumab in combination with FOLFIRI in metastatic colorectal cancer: A retrospective study of adverse events and their correlation with clinical outcome.
Authors: Lenehan John Gordon , MacKenzie Mary J. , Vincent Mark David , Welch Stephen 
Published: February 2017

426 Background: Bevacizumab is a monoclonal antibody against the VEGF ligand that disrupts vascularization of solid tumors and is part of first-line therapy for metastatic colorectal cancer (mCRC) in Ontario. The current study is intended to assess the rate of adverse events in general practice and to explore the relationship of adverse events to clinical outcomes in patients (pts) receiving bevacizumab. Methods: Patients with mCRC from one Ontario cancer centre who received FOLFIRI with bevacizumab (BEV-FOLFIRI) as first-line treatment were retrospectively reviewed. Data collected included demographics, adverse events, radiographic response, and survival times. Results: 57 patients were included in the study with a median age of 61 years, all with ECOG ≤1, and received a median of 5.5 cycles of BEV-FOLFIRI. Median follow-up was 5.8 months. Progression-free survival (PFS) was 9.8 months (95% CI 8.2-11.0) and overall survival (OS) was 13.1 months (95% CI 12.0-15.0). The most common bevacizumab-related adverse event was proteinuria with 11 (19.3%) pts developing any grade. Other adverse events included venous thromboembolism (VTE) in 9 (15.8%) pts, hypertension (NCI-CTCAE v3) in 7 (12.3%) pts, and GI perforation in 2 (3.5%) pts. 15 (26.3%) pts had a favorable radiographic response with 40% of pts who developed significant hypertension considered responders, compared with only 25% of those without hypertension. When using NCI-CTCAE v4.03, 19 (33.3%) pts developed grade ≥2 hypertension and had significantly longer PFS (13.5 vs 8.9 months, p=0.005) and OS (16.3 vs 11.0 months, p=0.015). Finally, developing a VTE was associated with increased PFS (14.8 vs 9.6 months, p=0.012), whereas proteinuria was associated with a significantly reduced OS (6.6 vs 14.0 months, p=0.001). Conclusions: Use of NCI-CTCAE v4.03 criteria for hypertension identifies more patients with significant hypertension. Patients with hypertension according to these criteria appear to have a better treatment response, suggesting hypertension may be a useful biomarker. Conversely, new or worse proteinuria related to therapy was associated with a poor treatment response.