bluuebunny/crossref_metadata_2025_split huggingface dataset:
A systematic review of post first-line treatments for advanced gastrointestinal stromal tumor (GIST): Direct pairwise meta-analyses and indirect comparisons.
Authors: Shah Keya , Chan Kelvin K. , Ko Yoo-Joung 
Published: February 2017

195 Background: Treatment for metatastatic or unresectable GIST is with imatinib. The majority of patients eventually acquire imatinib resistance, prompting the development of a growing number of agents as post-first-line treatment. Currently no studies directly compare these treatments. Methods: A systematic review was performed through MEDLINE, EMBASE, CENTRAL, and ASCO meeting abstracts up to July 2014 to identify randomized controlled trials that included GIST patients who were previously treated with a first-line chemotherapy for advanced disease. Progression-free survival (PFS) and overall survival (OS) with 95% credible regions were extracted using the Parmar method. Direct pairwise meta-analyses and indirect comparisons using the Bucher method were performed. Results: Four studies were identified for the systematic review. 1 study (n=312) showed that sunitinib in the second-line setting (vs. placebo) improved PFS but not OS. 3 studies (n=528) examined the third-line setting (imatinib resumption vs. placebo; regorafenib vs. placebo; nilotinib vs. best supportive care with or without imatinib or sunitinib). Of the 3 third-line studies, there was significant heterogeneity between placebo-controlled trials and the non-placebo controlled trial (I2= 98%). Direct pairwise meta-analysis using random-effects of the 2 placebo-controlled studies showed that the PFS hazard ratio (HR) was 0.63 (0.22-0.61, p=0.0001), whereas the PFS HR for the non-placebo controlled study was 0.90 (0.65-1.26, p=0.56). These 2 HRs are different statistically (interaction: p=0.002). Indirect comparisons of imatinib resumption vs. regorafenib suggested that the PFS HR was 0.59 (0.31-1.11, p=0.10), trending in favor of regorafenib. OS HRs were not significant for direct or indirect comparison in the third-line setting. Conclusions: The number and size of completed phase III studies and the lack of a standard comparator arm limit the use of direct and indirect comparison methods to determine the best therapeutic option for patients who have progressed on imatinib. At this time, clinicians should interpret the available evidence at an individual level.
Impact of S-1 plus cisplatin neoadjuvant chemotherapy in scirrhous gastric cancer.
Authors: Kunisaki Chikara , Makino Hirochika , Kimura Jun , Takagawa Ryo , Kanazawa Amane , Oshima Takashi , Ota Mitsuyoshi , Kosaka Takashi , Ono Hidetaka , Akiyama Hirotoshi , Endo Itaru 
Published: February 2017

198 Background: This study aimed to address the therapeutic outcome for scirrhous gastric cancer patients by evaluating the effect of neoadjuvant chemotherapy prior to gastrectomy. Methods: Two cycles of a 3 week regime of the fluoropyrimidine, S-1 (40 mg/m2, orally, twice daily), with cisplatin (60 mg/m2, intravenously, day 8) were administered to patients, separated by a 2 week rest period. Surgery was performed 3 weeks later in the neoadjuvant group (n=27). We compared overall survival and prognostic factors in these patients with a non-neoadjuvant group (n=19). Results: For all patients, univariate analysis identified non-curative gastrectomy and positive lavage cytology as adverse prognostic factors; extended lymph node dissection was a positive prognostic factor. Multivariate analysis showed that non-curative resections independently influenced prognosis (hazard ratio=2.902, p=0.011). In the SP group, positive lavage cytology indicated significantly worse prognoses. In the 15 patients who also underwent curative gastrectomies after SP chemotherapy, the pathological response grade was a significant prognostic factor for 5-year survival. Additionally, lymph node metastasis tended to be an adverse prognostic factor. Conclusions: After SP neoadjuvant chemotherapy, a grade 2-3 pathological response may predict favorable outcomes in scirrhous gastric cancer patients receiving curative gastrectomy, but further studies are needed to confirm these results.
Association of complete pathologic response after neoadjuvant chemoradiotherapy and esophagectomy with overall survival that is independent of the timing of the surgery.
Authors: Singla Smit , Kukar Moshim , Alnaji Raed , Du William , Attwood Kristopher , Hochwald Steven N. 
Published: February 2017

200 Background: Esophagectomy after neoadjuvant chemoradiation (nCRT) is known to improve survival outcomes, however the timing of esophagectomy is not well defined. We sought to determine if delayed esophagectomy after nCRT would result in increased likelihood of complete pathological response (cPR) and improve outcomes. Methods: A single institution analysis of all patients treated with nCRT followed by esophagectomy between 2004 and 2014. Patients were divided into four groups based on the timing of surgery (<50 days & >50 days) and pathological response (complete and incomplete), and the data was analyzed for association with survival outcomes Results: Amongst 227 patients (M: 211, F: 16; median age, 61 years) included in our study, the most common site of tumor origin was distal esophagus (n=210, 92.5%), and the most common histologic subtype was adenocarcinoma (n=205, 90.7%). Barretts esophagus was seen in 119 (52.7%), while signet cells were identified in 52 patients (22.9%) on pathology. Most patients had performance status of ECOG 0 or 1 (n=213, 93.8%), and majority of esophagectomies were performed using an open technique (n=157, 69.2%). Most esophagectomies (77.1% vs 22.9%) were performed >50 days after completion of nCRT. These patients had higher proportional incidence of anastomotic leak (11.4% vs 5.8%, p=0.302), conduit necrosis (3% vs 0%, p=0.591), need for reoperation (16% vs 9.6%, p=0.369), and pulmonary (29.7% vs 21.2%, p=0.290) and cardiac complications (18.9% vs 13.5%, p=0.415), but these increases were not significant. There was no significant difference in overall survival (OS) between the groups (median, 48.9 vs 42.6 months in <50 days and >50 days, respectively; p=0.726); however when evaluated by PR, patients with tumors with a cPR were found to have better OS compared to non-cPR (NR vs 33 months, p<0.001). When survival outcomes were compared between the timing of surgery and PR, the difference was not significant (p=0.211). Conclusions: Patients with cPR after nCRT and esophagectomy have improved overall and progression free survival, however, this is independent of the timing of the surgery.
Content analysis of postings in a stomach cancer survivor and caregiver support group on Facebook.
Authors: Hillard James Randolph 
Published: February 2017

223 Background: Patients diagnosed with cancer are increasingly turning to patient created social media groups to connect with others suffering from similar conditions. These groups allow sharing of information and support between their members, without involving medical or mental health professionals. This study examines the content of communications within one of these groups in order to identify the needs these groups are addressing, and in order to explore implications for mental health. Methods: This study focuses on a single Facebook group for stomach cancer patients and caregivers which has grown from 239 members a year ago to 1,128 members now and which has been operating for about four years. Two thirds of members are cancer patients, and the rest are caregivers. About 75% of members are from the US. The age range is 40-79, with a mean of 54. Members are 55% women, and 80% are middle class. Most members have been in the group for six to twelve months. The site averages about five original posts and about 50 responses a day. 100 consecutive posts were assigned to one of 12 pre-selected content categories. Results: Primary purpose of each of 100 consecutive posts (1) Sharing updates on their condition: 14 (2) Questions about treatment side effects: 13 (3) General requests for information: 13 (4) Requests for support or prayers: 11 (5) Sharing good news: 11 (6) Welcoming new members: 11 (7) Giving general support: 9 (8) Announcing a death: 5 (9) Sharing information about new treatments: 5 (10) Sharing humor: 4 (11) Sharing bad news: 2 (12) Asking "How are you?": 2. Conclusions: This Facebook group served many of the same functions that are served by face to face support groups for cancer patients. Members routinely shared intimate details with each other, and they routinely asked questions about their illness that they could not get answers to anywhere else. Leaderless Facebook groups such as this one are an important, and little studied, psychological resource for patients suffering from cancer.
Molecular profiling of neuroendocrine tumors (NETs): The Fox Chase Cancer Center (FCCC) experience.
Authors: Vijayvergia Namrata , Boland Patrick McKay , Cohen Steven J. , Gustafson Karen S. , Cooper Harry S. , Astsaturov Igor A. , Engstrom Paul F. 
Published: February 2017

245 Background: The rarity of NETs can limit clinical trial accrual to develop new therapies. Given fewer approved treatments, a better understanding of underlying biology is critical to development of and assignment of patients (pts) to clinical trials. Methods: Pts with NETs (excluding small/large cell lung cancer) of all grades at FCCC were enrolled onto a prospective IRB approved protocol that utilized an NGS platform to detect somatic mutations (SM) in 50 cancer-related genes (Cancer Code) on archived tissue from primary or metastatic sites. Genes tested included ABL1, AKT1, ALK, APC, ATM, BRAF, CDH1, CDKN2A, CSF1R, CTNNB1, EGFR, ERBB2, ERBB4, EZH2, FBXW7, FGFR1, FGFR2, FGFR3, FLT3, GNA11, GNAQ, GNAS, HNF1A, HRAS, IDH1, IDH2, JAK2, JAK3, KDR, KIT, KRAS, MET, MLH1, MPL, NOTCH1, NPM1, NRAS, PDGFRA, PIK3CA, PTEN, PTPN11, RB1, RET, SMAD4, SMARCB1, SMO,SRC, STK11, TP53 and VHL. Review of pathology specimens for grade and Ki -67 was also performed. Results: Thirty-nine pts (median age 59 y, males 46%) were enrolled from October 2013 to July 2014. Gene profiling results are available on thirty-five pts. Ki-67 score was reviewed for 31/35 tumors. 6 (20%) pts had high grade (HG) tumors (Ki-67 > 20%) and 25 (80%) had low/intermediate grade (LIG) tumors (Ki-67 ≤20%). Thirteen (37%) pts were found to have SMs and 22 (63%) did not, with 4 (12%) pts’ tumors having >1 SMs (2 HG and 2 LIG tumors). Incidence of SM was 41% (12/29) in Caucasians, 16% (1/6) in other races, 46% (6/13) in smokers and 30% (6/20) in non-smokers. Incidence of SM was 24% (6/25) in LIG NETs and 84% (5/6) in the HG NETs. Among HG tumors, 66% (4/6) harbored TP53 gene mutation and 33% (2/6) were BRAF mutation positive. Conclusions: Tumor-specific mutations are seen in a minority of low grade NETs but are common in high grade tumors. Interestingly, no mutations were identified in pts with unknown primary. Analysis of clinical outcomes based on treatment received is ongoing to assess for possible prognostic/therapeutic implications of these mutations. [Table: see text]
Curative-intent surgery for pancreatic tumors: A review of 3,386 procedures from the Brazilian National Health System.
Authors: dos Santos Lucas Vieira , Lima Joao Paulo , Pontes Luciola De Barros , de Oliveira Cleyton Zanardo , Lopes Gilberto 
Published: February 2017

246 Background: In Brazil, a large country with major socioeconomic and health access disparities, resource limitations make the management of pancreatic tumors challenging. We aimed to evaluate curative-intent surgical procedures for pancreatic cancer (PC) in the public health care system. Methods: Based on Brazilian’s public health system database (DATASUS) and demographic database (IBGE), we collected data for curative-intent surgical procedures for pancreatic tumors. Information about number of procedures, costs, length of stay, number of perioperative deaths and PC deaths were analyzed for each State and Region and then correlated to State specific population, gross domestic product (GDP) per capita and number of procedures. Results: Between 2008 and 2012, 37,142 patients died due to PC in Brazil, with an increase of 6.3% in mortality annually. Mortality (per 100,000 persons-year) increases from North to South States. GPD per capita (rho=0.636, 2-tailed p<0.001) was associated to PC mortality. Between January 2008 and July 2014, 3,386 procedures were performed, the majority (51.2%) in the Southeast region (particularly in São Paulo State, 32.7%). Total cost was US$ 9,741,315.28, average cost per admission was US$ 2,876.94. The number of procedures per 100,000 residents was higher in Southeast and South Brazil. On multivariate analysis, average cost in each State was only correlated to the number of procedures (β=0.568, p=0.029). The mean length of hospital stay was 16.9 days, with no major differences across regions. The mean length of hospital stay was correlated to GDP per capita and number of procedures. However, no independent association was found on multivariate analysis. A total of 493 patients died, translating into an inpatient mortality rate of 14.55%, higher than observed in high-income countries. The Northern States have the highest mortality rates (mean 25%, and 33% for the State with highest mortality). Neither characteristic was associated to perioperative mortality. Conclusions: This is the first study to evaluate regional disparities in PC care and mortality in Brazil. These disparities calls for regionalized policies aiming the improvement of PC care.
The anatomic location of pancreatic cancer as a prognostic factor for inpatient complications.
Authors: Zhang Shuang Yin , Zhang Shuang Qin , Jiang Jimmy Jing , El-Rayes Bassel F. 
Published: February 2017

247 Background: Patients with cancer in the head of the pancreas (HP) have a higher frequency of biliary stents, which are associated with complications requiring hospitalization. We hypothesized that hospitalized patients with cancers of the HP have a higher incidence of morbidity and mortality as compared to patients with cancer in the body (B) or tail (T). The primary aim of this study was to investigate whether anatomic location of pancreatic primary lesions is associated with complications and mortality in hospitalized patients. Methods: The Nationwide Inpatient Sample (NIS) database was queried to identify all non-surgical hospital admissions for patients with a diagnosis of pancreatic cancer (PC) for 2011. Based on ICD-9 diagnosis codes, patients were divided into three groups: H, B, and T. Patient demographics, comorbidities, medical complications, and hospitalization outcomes were compared among these 3 groups by univariate analysis. Two sample independent t-tests were used to compare all linear variables, and Chi-squared tests were used to compare categorical data. Results: In total, 4,910 patient admissions were analyzed, of which 3,590 had H, 519 B, and 801 T. No difference was observed in the mean age for all three cohorts (67-68 years). Length of hospitalization for each cohort averaged 6 days. Patient with pancreatic cancer of tail had statistically significant higher incidence of pneumonia (H 4.7%, B 6.2%, T 9.1%, p<0.001), deep venous thrombosis (H 5.5%, B 10.6%, T 13.5%, p<0.001), pulmonary embolic (H 3.3%, B 6.9%, T 9.4%, p<0.001), cerebral vascular events (H 0.7%, B 1.5%, T 2.9%, p< 0.001), ileus (H 6.0%, B 8.1%, T 10%, p<0.001), encephalopathy (H 2.0%, B 1.7%, T 3.5%, p=0.02), acute renal failure (H 13%, B 9.1%, T 15%, p= 0.005), and in-hospital mortality (H 5.3%, B 6.9%, T 8.9%, p<0.001). Conclusions: In this study, pancreatic cancer of the tail correlates with higher incidences of in-hospital complications and mortality. This suggest that the impact of biliary stents on outcome of hospitalized patients with PC may be limited. Anatomic location of pancreatic malignancy may also be utilized as prognostic factor in management of inpatient PC patients.
Prognostic model for survival in patients with advanced pancreatic cancer receiving palliative chemotherapy.
Authors: Uneno Yu , Kou Tadayuki , Kanai Masashi , Yamamoto Michio , Xue Peng , Mori Yukiko , Kudo Yasushi , Kurita Akira , Uza Norimitsu , Kodama Yuzo , Asada Masanori , Masui Toshihiko , Yazumi Shujiro , Matsumoto Shigemi , Takaori Kyoichi , Morita Satoshi , Muto Manabu , Chiba Tsutomu 
Published: February 2017

248 Background: The prognosis of patients with advanced pancreatic cancer (APC) is extremely poor. Several clinical and laboratory factors have been known to be associated with prognosis of APC patients. However, there are few clinically available prognostic models predicting survival in APC patients receiving palliative chemotherapy. Methods: To construct a prognostic model to predict survival in APC patients receiving palliative chemotherapy, we analyzed the clinical data from 306 consecutive patients with pathologically confirmed APC who received palliative chemotherapy. We selected six independent prognostic factors which remained independent prognostic factors after multivariate analysis. Thereafter, we rounded the regression coefficient (β) for each independent prognostic factor derived from the Cox regression equation (HR = eβ) and developed a prognostic index (PI). Results: Developed prognostic index (PI) was as follows: PI = 2 (if performance status score 2–3) + 1 (if metastatic disease) + 1 (if initially unresectable disease) + 1 (if carcinoembryonic antigen level ≥5.0 ng/ml) + 1 (if carbohydrate antigen 19-9 level ≥1000 U/ml) + 2 (if neutrophil–lymphocyte ratio ≥5). The patients were classified into three prognostic groups: favorable (PI 0–1, n = 73), intermediate (PI 2–3, n = 145), and poor prognosis (PI 4–8, n = 88). The median overall survival for each prognostic group was 16.5, 12.3 and 6.2 months, respectively, and the 1-year survival rates were 67.3%, 51.3%, and 19.1%, respectively (P < 0.01). The c index of the model was 0.658. This model was well calibrated to predict 1-year survival, in which overestimation (2.4% and 0.2% in the favorable and poor prognosis groups, respectively) and underestimation (3.6% in the intermediate prognosis group) were observed. Conclusions: This prognostic model based on readily available clinical factors would help clinicians in estimating the overall survival in APC patients receiving palliative chemotherapy.
Discordances in HER2 status between primary gastric cancer and corresponding metastatic sites.
Authors: Gumusay Ozge , Benekli Mustafa , Ekinci Ozgur , Baykara Meltem , Ozet Ahmet , Coskun Ugur , Uner Aytug , Dursun Ayse , Atak Ecine Yesim , Buyukberber Suleyman 
Published: February 2017

25 Background: Determination of HER2 status in advanced gastric cancer (GC) is important in clinical decision making. In the ToGA trial, trastuzumab based therapy demonstrated a significant OS benefit in patients with HER2 positive advanced GC. HER2 discordance in GC primary and its metastases has been long debated. The aim of the study was to evaluate the rate of HER2 discordance and its effect on treatment decisions in advanced GC. Methods: A total of 74 patients with advanced GC were included in the study. Both immunohistochemical staining (IHC) and dual-color silver in situ hybridization (SISH) were performed in all patients to evaluate the HER2 status of the primary lesion and paired metastasis. Results: The assessment of HER2 status with the IHC staining method and SISH revealed a discordance rate of 9.5% and 16.2%, respectively. However, this discordance was clinically meaningful in only one patient leading to a change in treatment decision. While this patient had a HER2 negative status in primary tumor (IHC=0, SISH=negative), the HER2 status was positive for liver metastasis (IHC=2+, SISH=positive). Trastuzumab was added to the chemotherapy regimen. Conclusions: In this study, we found a higher rate of HER2 discordance between primary gastric tumor and metastatic lesions compared to the rates reported in previous studies. Detection of a HER2 positive metastasis with a HER2 negative primary tumor suggests that investigation of HER2 is also required for the metastatic lesion and that trastuzumab could be administered in case of a positive result.
Association between inflammatory markers and prognosis in resected pancreatic cancer (PC).
Authors: Riesco Martinez Maria Carmen , Pernaut Sanchez Cristina , Adeva Alfonso Jorge , Gomez-Martin Carlos , Lema Laura , Luis Robles Diaz , Parrilla Rubio Lucia , Blazquez Arroyo Maria , Merida Garcia Antonio , Lopez-Martin Jose A. 
Published: February 2017

250 Background: Inflammatory markers like the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) or fibrinogen (F) and nutritional markers like albumin (alb) have a prognostic value in different types of cancer. However, the paucity of data in pancreatic cancer (PC) keeps their role in this setting unclear. We aimed to determine whether NLR, PLR, F and alb may be prognostic factors in resectable PC. Methods: Demographic, histologic and serologic characteristics (pre and postoperative blood counts) of 77 consecutive PC patients (pts),who underwent curative surgery at our centre between January 2003 and December 2013,were retrospectively collected. We investigated the association of presurgical NLR, PLR, F and alb with overall survival (OS) and disease free survival (DFS) and analyzed the impact of their kinetics after surgery on the outcomes. Results: main pts characteristics are showed in Table. Median OS and DFS were 23 months (m), (95% CI 13.4-32.5) and 10 m (95% CI 7.4 - 12.6) respectively. Pts with NLR < 5 had a significant improvement in OS compared to those with NLR > 5 (29 m vs.16 m, log rank p <0.05 ). F values < 450 mg/dl were also associated with increased OS (30 vs. 16 m, log rank p=0.032). After adjusting by the Cox regression model, only NLR remained an independent prognostic factor for OS (HR, 1.6; p<0.05). PLR (grouped in 3 cutoffs: < 150, 150-300 and >300) and alb (<2, 2-3.5, >3.5 mg/dl) were not associated with significant differences in outcomes. Pre and postoperative values were compared. No association was found between a drop on NLR to <5 after surgery and OS or DFS. Conclusions: our results support that NLR could be a prognostic factor in PC pts undergoing surgery. Changes in NLR due to surgery do not seem to impact the outcome. PLR, F and alb did not correlate with prognosis. [Table: see text]