bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of curative surgery in Borrmann type IV advanced gastric cancer.
Authors: Song Kyo Young , Kim Eun Young 
Published: February 2017

176 Background: The aims of the present study are to know the significance of curative surgery in Borrmann type IV and prove the causes related with poor prognosis by analyzing the recurrence patterns and unique diagnostic characteristics. Methods: We analyzed 168 patients with Borrmann type IV undergoing surgery at Seoul St. Mary Hospital from 1989 to 2010. We categorized the patients into curative (R0) and non-curative (R1, R2 and no-resection) group. Results: The numbers of curative and non-curative group were 91 and 77. The 3- and 5-yr OSRs of patients in curative group were significantly higher than those in non-curative group (curative: 52.4% and 33.0%, non-curative: 18.6% and 7.0%; p<0.001). In multivariate analysis, the curability was not a significant prognostic factor for survival (p=0.527). The most frequent recurrence site was peritoneum (64.7%). Most of recurrences were presented within early 2 years. The preoperative diagnostic rate of Borrmann type IV was only 50.5%. The reasons for non-curative surgery were unexpected peritoneal seeding (28.4%) and resection margin involvement (6.4%). Conclusions: The role of surgery for Borrmann type IV is quite limited. It has poor prognosis even after curative surgery, because it is very difficult to diagnose preoperatively and make curative surgery. [Table: see text]
FOLFIRINOX as first-line therapy in patients with metastatic gastroesophageal cancers (GEC).
Authors: Lockhart Albert C. , Krajewski Kenneth Anthony , Wang-Gillam Andrea , Amin Manik , Sorscher Steven , Lim Kian-Huat , Tan Benjamin R. , Picus Joel , Hecky Anne , Allen Kenisha , Peterson Jaclyn D , O'Day Emily , Marsh Robert de Wilton , Kozloff Mark , Polite Blase N. , Kindler Hedy Lee , Sharma Manish , Catenacci Daniel Virgil Thomas 
Published: February 2017

177 Background: Adenocarcinomas of the distal esophagus, gastroesophageal junction and stomach (GEC) remain challenging cancers to treat. Unfortunately, 80-90% of newly diagnosed patients (pts) present with advanced disease where the overall median survival (mOS) is less than 1 year. Discouragingly, various common first-line metastatic regimens have similar overall response rates (ORR) (30-40%; and 47% for HER2+ with trastuzumab). Given results within other GI tumors, FOLFIRINOX was administered to pts with newly diagnosed advanced GEC. Methods: A pooled analysis from two independent ongoing clinical trials was conducted from: 1) the University of Chicago UC (NCT01643499) where pts received modified ‘mFOLFIRINOX’ with irinotecan dosing based on UGT1A1*28 genotyping; and 2) Washington University (WU) (NCT01928290) where pts received standard ‘sFOLFIRINOX’ as previously described, and HER2+ pts also received trastuzumab (sFOLFIRINOX-T). Both studies administered therapy every 14 days. Trastuzumab was administered as 6 mg/kg loading dose then 4 mg/kg every 14 days. mFOLFIRINOX used UGT1A1 genotype *1/*1, *1/*28, and *28/*28 to assign initial irinotecan doses of 180, 135, and 90 mg/m2, respectively. The mFOLFIRINOX 5-FU dose was 2400 mg/m2 over 46 hours (no bolus) with leucovorin 400 mg/m2, and oxaliplatin 85 mg/m2. Outcomes included ORR, tolerability/safety, mPFS, and mOS for both trials. Results: In the pooled analysis, 18 pts with GEC were enrolled to date (11 at WU and 7 at UC), and 16 evaluable for response. ORR was 62.5% (10/16), (HER2- 58% (7/12), HER2+ 75% (3/4)). One HER2+ pt experienced a CR. mPFS was 8 months (range 1.5-18 months), however 10/16 pts have not progressed on first-line therapy to date. There were no unexpected toxicities for any of the regimens. Conclusions: ORR and PFS with first-line FOLFIRINOX were encouraging for metastatic GEC. sFOLFIRINOX was well tolerated in these patients, and sFOLFIRINOX-T was safely administered.mFOLFIRINOX consisting of genotype-directed irinotecan dose reductions and no 5FU bolus may limit toxicity yet retain similar benefit to sFOLFIRINOX. Continued investigation of this regimen is warranted given these encouraging preliminary results. Clinical trial information: 01928290.
Outcomes of recurrence after complete response to definitive chemoradiotherapy for stage II/III (non–T4) esophageal squamous cell carcinoma.
Authors: Kuwabara Hiroki , Kato Ken , Sasaki Yusuke , Takahashi Naoki , Shoji Hirokazu , Okita Natsuko T. , Takashima Atsuo , Honma Yoshitaka , Iwasa Satoru , Hamaguchi Tetsuya , Yamada Yasuhide , Boku Narikazu , Ito Yoshinori , Itami Jun 
Published: February 2017

179 Background: Recurrence after definitive chemoradiotherapy (dCRT) for locally advanced esophageal cancer is associated with poor outcome. We examined patterns of recurrence and clinical outcomes in patients with recurrence after complete response (CR) to dCRT. Methods: We retrospectively investigated 238 patients who had achieved initial CR after dCRT for locally advanced esophageal cancer between January 2000 and December 2010. From among these patients we selected 95 who had developed disease recurrence after CR. Overall survival was defined as survival time from recurrence to death and was calculated by using the Kaplan-Meier method. Univariate and multivariate analyses were performed with the Cox regression model to determine prognostic factors for survival. Results: The characteristics of the 95 patients were as follows: male: female = 84:11; median age = 64 years (range 46 to 80); clinical stage at diagnosis (UICC 6th edition) IIA/IIB/III = 20/31/44; and performance status at recurrence (0/1) = (51/44). Primary CRT consisted of 5-FU+cisplatin (n = 87), 5-FU+nedaplatin (n = 3), S-1+cisplatin (n = 3), 5-FU+cisplatin+ nimotuzumab (n = 1), or docetaxel (n = 1). The pattern of recurrence was locoregional failure (n = 53) or any distant failure (n = 42). Median time from the start of dCRT to recurrence was 13.0 months, and median survival time from recurrence to death was 19.6 months. Median survival time according to the pattern of failure was 34.7 months (locoregional failure) or 17.0 months (any distant failure). Application of the Cox regression model, including the additional prognostic variables of age, ECOG performance status, number of organs in which metastases were present, and LDH, revealed that any distant failure (hazard ratio [HR] 2.2; 95% confidence interval [CI] 1.2 to 4.1; P = 0.01) and recurrence before 13.0 months (HR 2.1; 95% CI 1.2 to 3.6; P = 0.01) were predictors of poor overall survival. Conclusions: Early recurrence and any distant failure were associated with poor prognosis after CR to dCRT for locally advanced esophageal cancer.
Acetaldehyde/ethanol breath test for identifying people at high risk of upper aerodigestive tract cancer.
Authors: Aoyama Ikuo , Tsurumaki Mihoko , Nakai Yukie , Ohashi Shinya , Muto Manabu 
Published: February 2017

18 Background: Alcohol drinking increases the risk of upper aerodigestive tract cancer, and acetaldehyde (a metabolite of alcohol) is a definite carcinogen for this type of cancer. Acetaldehyde is formed mainly by the oxidation of ethanol by alcohol dehydrogenase 1B (ADH1B) and is eliminated by aldehyde dehydrogenase 2 (ALDH2) in the liver. About 50% of Asian people have the ALDH2*2 variant allele, which encodes an inactive enzyme. Those with the ALDH2*2 allele and an alcohol drinking habit are at definite risk of esophageal and head and neck cancers. Genetic testing is the most reliable method for identifying the ALDH2 genotype, but it is not practical for mass screening because of the cost and time. Therefore, we have established a simple method to identify the ALDH2 genotype by analyzing breath samples. Methods: One hundred seven consecutive healthy Japanese volunteers participated in this study. After providing informed consent, participants drank 100 ml of 0.5% ethanol in a single gulp. Breath samples were collected with originally developed simple gasbags before the alcohol was consumed, and 1, 2, and 5 minutes later. The concentrations of acetaldehyde and ethanol in the bag were measured by high-sensitivity gas chromatography. The ALDH2 and ADH1B genotypes of all participants were confirmed using blood DNA. The relationships between acetaldehyde level and genotypes were determined. Results: The frequencies of ALDH2*1/*1, ALDH2*1/*2, and ALDH2*2/*2 were 46.7%, 43.9%, and 9.3%, respectively. The breath acetaldehyde levels at 1 minute after alcohol ingestion were 89.2 (18.1–399.0) ppb in those with ALDH2*1/*1, 346.3 (78.4–1218.4) ppb in those with ALDH2*1/*2, and 537.1 (213.2–1353.8) ppb in those with ALDH2*2/*2. The breath acetaldehyde level was significantly higher in the ALDH2*2 carrier group regardless of the ADH1B genotype (P<0.001). Setting the cutoff for the acetaldehyde/ethanol ratio at 22.3×10–3 to include ALDH2*2 carriers yielded an accuracy for the detection of ALDH2*2 carriers of 96.3% (95% CI: 91.5–96.9%), sensitivity of 100%, and specificity of 92%. Conclusions: Our breath test may be a convenient screening tool for identifying those at high risk of upper aerodigestive tract cancer.
Docetaxel plus FOLFOX4 compared with FOLFOX4 as adjuvant chemotherapy for gastric cancer.
Authors: Du Chun-Xia , Liu Xiao-Yan , Zhang Hong-Gang , Zhou Ai-Ping 
Published: February 2017

181 Background: To compare the efficacy of docetaxel plus FOLFOX4 to FOLFOX4 as adjuvant chemotherapy for gastric cancer patients. Methods: 320 patients with stage IB-IV (M0) gastric cancer were enrolled into the retrospective study. All patients received a total or subtotal gastrectomy with at least D1 lymph nodes dissection. 193 patients received FOLFOX4 as adjuvant chemotherapy. 127 patients received biweekly docetaxel plus FOLFOX4 (DOF regimen) as adjuvant chemotherapy. Docetaxel was administered at 40 mg/m2 on day 1, followed by FOLFOX4 regimen. Both of the regimens were repeated every 2 weeks for a maximum of 12 cycles. Results: In comparison with patients in FOLFOX4 group, patients in DOF group were relatively younger (p=.001), with more advanced disease in pN stage (p=.035) and pTNM stage (p=.031), received more cycles of adjuvant chemotherapy (p=.004), and had a higher percentage of adjuvant radiation (p =.002). After adjustment of unbalanced variables as mentioned above, no statistical difference was observed between DOF group and FOLFOX4 group in terms of 3-year disease-free survival (54% vs 69%, p = 0.100, HR 1.362, 95% CI (0.943-1.967)) and 3-year overall survival(70% vs 72%, p = 0.810, HR 1.049, 95% CI (0.711-1.548)). Stratified analysis according to clinicopathologic characters showed that there were almost no statistical differences of 3-year overall survival rates between two groups, except the primary site (middle 1/3) (p =.025) and pTNM stage (IIb stage) (p =.035) in favor of FOLFOX4 group. The incidences of grade 3/4 adverse events were obviously higher in DOF group than in FOLFOX4 group,including decreased appetite (18.1% V 10.4%, P = 0.046), diarrhea (4.7% V 0%, p=0.004 ), hypersensitivity reactions to oxaliplatin (3.1% V 0%, p=0.024) and neutropenia (47.3% V 31.6%, p=0.004). Conclusions: Compared to FOLFOX4 regimen, adjuvant docetaxel plus FOLFOX4 did not show significant survival advantages in gastric cancer patients. However, a more serious toxicity profile was observed in docetaxel plus FOLFOX4 arm. Further studies are needed to decide whether triplet regimen is appropriate as adjuvant chemotherapy of gastric cancer.
Second primary malignancies in gastric cancer: A U.S. population-based study.
Authors: Shah Binay Kumar , Khanal Amit 
Published: February 2017

191 Background: Risk of second primary malignancies (SPM) is not known in gastric cancer. In this population based study, we analyzed rates of SPM in gastric cancer. Methods: We selected adult (≥18 years) patients with gastric cancer as first primary malignancy diagnosed from January 1992 to December 2011 from Surveillance, Epidemiology and End Result 13 database. We used SEER*stat’s multiple primary standardized incidence ratio (MP-SIR) session to calculate the risk of SPM diagnosed 6 months after the diagnosis of index gastric cancer. Results: Among 31,818 patients with first primary gastric cancer, 1674 (5.26%) developed 1,839 SPM with observed/expected (O/E) ratio of 1.09 (95% CI = 1.05-1.15, p<0.0001) and excess risk of 16.15 per 10,000 population. The median time to first SPM from the time of diagnosis of stomach cancer was 49 months (range 6 months to 19.08 years). There was significantly increased risk of gastrointestinal malignancies [O/E ratio 1.65 (CI=1.53-1.79, p<0.001)], thyroid cancer [O/E ratio 1.98 (CI=1.32-2.84, p<0.01)] and myeloid leukemia [O/E ratio 1.47(CI=1-2.09, p<0.05)]. Interestingly, there was significantly decreased risk of melanoma, breast cancer and prostate cancer. Conclusions: Our study showed that patients with gastric cancer are at higher risk of gastrointestinal malignancies, thyroid cancer and myeloid leukemia. Similarly, risk of melanoma, breast cancer and prostate cancer in patients with gastric cancer is lower than general population.
The treatment for unresectable advanced gastric cancer with pyloric stenosis.
Authors: Watanabe Ryohei , Nakamura Yoichi , Nagaoka Yasushi , Asai Koji , Enomoto Toshiyuki , Watanabe Manabu , Saida Yoshihisa , Kusachi Shinya , Nagao Jiro 
Published: February 2017

194 Background: Inability of oral intake due to advanced gastric cancer with pyloric stenosis (AGCPS) should be avoided, because the key drug of chemotherapy for gastric cancer is S-1 in Japan. We have performed palliative gastrectomy (PG), gastrojejunostomy (GJ) or stent placement (SP) for unresectable AGCPS. We investigated therapeutic outcomes (gastric outlet obstruction scoring system: GOOSS, chemotherapy introduction rate: CIR and median survival time: MST) of each therapy retrospectively. Methods: Between April 1999 and April 2013, 42 patients with unresectable AGCPS were included in this study (PG/GJ/SP, 13/10/19). We compared therapeutic outcomes (GOOSS, CIR and MST) between the 3 groups. Results: The demographic characteristics of patients were similar across the three groups. We evaluated the Glasgow Prognostic Score (GPS) of all cases before treatment. GPS tended to be 1 in the PG group, 0 in the GJ group and 2 in the SP group. The proportion of GPS 2 in the SP group was higher than in PG or GJ group significantly (p=0.0056 for SP vs. PG, p=0.0191 for SP vs. GJ and p=0.007 for SP vs. Surgery). GOOSS scores of all patients were improved. GOOSS score 3 of PG/GJ/SP groups after treatment were 84.6 / 90 / 68.4% respectively. CIR, MST and post-operative complication rate of PG/GJ/SP groups were 53.8 / 90 / 42.1%, 222.5 / 435.5 / 74 days and 46.2 / 10 / 0%, respectively. The proportion of patients receiving chemotherapy was higher in the GJ group than in the PG group, and survival was longer in the GJ group than in the PG group. Post-operative complication rate was lower in GJ group than in PG group. Conclusions: GJ is well tolerated and offers improved survival compared with PG and SP in the patients with AGCPS. High CIR improved MST. Success of chemotherapy introduction might improve survival. Enabling oral intake is important for chemotherapy. However, it is very difficult to select a treatment method that suits the patient individually. GPS might be an important predictor in the selection of the treatment method for unresectable AGCPS.
Paclitaxel, carboplatin, and capecitabine (TCX) with and without radiation in locally advanced and metastatic distal esophageal and esophagogastric junction cancer: A single-center retrospective review.
Authors: Hosein Peter Joel , Ray Neha , Anthony Lowell Brian , Tzeng Ching-Wei David , Kudrimoti Mahesh R. , McGarry Ronald , Martin Jeremiah Thomas , Long Katie E , Overly Colleen , DeSimone Philip A. 
Published: February 2017

197 Background: Toxicities of the active triple-drug DCF regimen (docetaxel, cisplatin and 5-FU) in gastric cancer limit its broad use and general acceptance as first-line therapy. To improve the toxicity profile of triple-drug therapy, distal esophageal and esophagogastric junction (DE-EGJ) poorly differentiated and moderately differentiated adenocarcinoma patients were treated with TCX. This single-center retrospective review is reported for patients treated between 2005 and 2013. Methods: Patients with DE-EGJ adenocarcinoma were treated with capecitabine (850 mg/m2 5 out of 7 or 14 out of 21 days), carboplatin (AUC 5) and paclitaxel (175 mg/m2) every 3 weeks. Those with locally advanced disease received concomitant radiation therapy (50.4 Gy using 3D approach) during the first 2 cycles. Dose reductions (25-50%), delay of therapy and hospitalizations for disease and treatment-related Grades 3/4 toxicities were recorded. Growth factors were prescribed reactively. Kaplan-Meier statistics were used for survival analyses. The institutional tumor registry data provided the historical median survival. Results: Thirty-one males and 3 females (median age 56, range 37-82) with locally advanced (N=17) and metastatic (N=17) disease were included. Median overall survivals are shown below. Two patients were admitted for neutropenic fever and 7 total hospitalizations occurred. Conclusions: A triple-drug combination first-line regimen (TCX) with and without radiation in DE-EGJ cancer is active, and associated with a manageable toxicity profile. The median survival of 15.8 months in patients with metastatic disease treated with TCX compares favorably with the DCF regimen (9.2 mos), the EOX regimen (11.2 mos) as well as institutional historical controls. Our data suggests that future prospective trials evaluating triple-drug regimens in combination with targeted therapy may be feasible in patients with esophageal and gastric adenocarcinoma. [Table: see text]
Prognostic factors in advanced gastric cancer after second-line treatment.
Authors: LONGO FEDERICO , Pachon Vanessa , Guillen Carmen , Ferreiro Reyes , Rodriguez Garrote Mercedes , Puertas Pablo Reguera , Madariaga Ainhoa , Gion Maria , Lopez Hervas Pedro , Galindo Julio , Gonzalez Lizarbe Eva , Varona Constantino , Montans Jose , Earl Julie , Grande Enrique , Olmedo Garcia Maria Eugenia , Garrido Pilar , Lobo Eduardo , Palacios José , Carrato Alfredo 
Published: February 2017

201 Background: Advanced gastric cancer (AGC) is a highly lethal disease worldwide with a median overall survival (OS) of less than 12 months. Ramucirumab was the first targeted agent to show survival benefit in the second-line (2L) treatment of AGD. From the REGARD trial, women exhibited a trend towards a worse survival when compared to men. Methods: We retrospectively analyzed the outcome of a Spanish cohort of 55 AGC patients who had received at least two consecutive chemotherapy lines of treatment at our institution. We preselected some clinical parameters (age, gender, Lauren subtype, Her-2 status, grade of differentiation, primary tumor localization and resection, TNM stage, neoadjuvant/adjuvant administration, mono/polychemotherapy in 2L, irinotecan- or taxane-based 2L, Trastuzumab treatment, and administration of third-lines [3L]) to be tested as potential prognostic factors. We focused our analysis on the gender effect in OS after 2L treatment in AGC. The SPSS software package was used for all statistical analyses (Mann-Whitney U test, Chi Square, Kaplan-Meier, Cox regression). Results: Women, diffuse subtype, poorly differentiated tumors, sub-cardia location, single-agent 2L and 3L administration were the clinical characteristics with a significant shorter OS by the univariable analysis. Median OS of women (5 months, 95%CI 3.9-6.0) was significant lower than that in men (13 months, 95%CI 7.9-18.0) by both Log-Rank and Breslow tests (p 0.002). We found no significant differences in age, progression-free survival or time-on-treatment between men and women. Female gender was significantly associated with more taxane-based 2L and with less 3L treatment administration. When 3L treatment administration was excluded in the multivariable analysis, female gender was the only independent prognostic factor of all the clinical parameters included in our review (HR 0.33, 95%CI 0.15-0.75, p 0.008). Conclusions: Our retrospective study found that gender, Lauren subtype, grade of differentiation, primary tumor location, polychemotherapy and 3L administration may be potential prognostic factors in AGC after 2L treatment. Female gender was an independent prognostic factor in our Spanish cohort.
A retrospective analysis of 5-fluorouracil plus cisplatin as first-line chemotherapy in patients with metastatic or recurrent esophageal squamous cell carcinoma.
Authors: Hiramoto Shuji , Kato Ken , Shoji Hirokazu , Okita Natsuko T. , Takashima Atsuo , Honma Yoshitaka , Iwasa Satoru , Hamaguchi Tetsuya , Yamada Yasuhide , Shimada Yasuhiro 
Published: February 2017

204 Background: Patients with metastatic or recurrent esophageal squamous cell carcinoma (ESCC) have a poor prognosis. For decades, 5-fluorouracil /Cisplatin (FP) have been mostly used for these patients as first line chemotherapy. But there were few reports which reveal the reality containing the efficacy of FP regimen for ESCC. We conduct this retrospective study to reveal the efficacy and prognostic factors of the patients treated with FP as first line chemotherapy for ESCC. Methods: Patients with metastatic or recurrent ESCC after esophagectomy were enrolled. FP comprised of CDDP at a dose of 80mg/m2 on day1, and 5-FU at a dose of 800mg/m2given by continuous on days 1-5 every 4 weeks. Cox-proportional hazard model was used for multivariate analysis to evaluate prognostic factors. Results: Between April 2001 and March 2012 in the National Cancer Center Hospital, data of 187 patients were collected by medical records. Characteristics of 187 patients were as follows; the median age (range) 62 (34-84); (male/female) 163/24; (performance status: 0/1/2) 69/110/8; (metastatic/recurrent) 116/71; median number of metastasis 1(range1-4); median cycles of FP 2(range1-10). Overall response rate was 31.6% (95%CI: 25.0-38.7%). Median progression free and overall survival time was 4.9 month and 10.5 month, respectively. In multivariate analysis, serum CRP (≥2 vs <2 mg/dl) (HR=2.61, p<0.001), serum albumin (<3.5 vs >3.5 mg/dl) (HR=1.85, p=0.001) at the time of diagnosis and number of metastatic site (≥2 vs <2) (HR=1.563, p=0.01) were remaining independent prognostic factor for survival. Survival time of the patients who had no these poor prognostic factors was 17.9 month, while survival time who had all poor prognostic factors was only 4.0 month. Conclusions: Number of metastatic site, CRP, and serum albumin are independent prognostic factor on metastatic or recurrent ESCC patients treated with FP. Information from this analysis can be used to aid clinical decision-making and help individual patient risk stratification.