bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of PET response to neoadjuvant therapy for patients with gastric and GEJ adenocarcinoma.
Authors: Hernandez Jonathan M. , Beylergil Volkan , Goldman Debora , Schöder Heiko , Gonen Mithat , Tang Laura H. , Downey Robert J. , Shah Manish A. , Strong Vivian E. , Coit Daniel G. 
Published: February 2017

114 Background: The implications of response to neoadjuvant treatment as measured by PET remain poorly defined for patients with gastric and gastro-esophageal junction (GEJ) adenocarcinoma. Our aims are to determine if changes in PET avidity correlate with histologic response, and to determine the best predictor(s) of disease-free survival (DFS) and overall survival (OS). Methods: We reviewed a prospective database to identify patients with gastric and GEJ adenocarcinoma who were evaluated with PET imaging prior to andfollowing neoadjuvant treatment. Spearman correlation and Cox proportional hazards were utilized. Results: Since 2002, 216 patients of median age 63 years met our criteria. At last follow-up (median 22 months, range: 0 - 119), 118 patients recurred or died. The median DFS and OS for expired patients were 7.5 months (range: 0-62) and 14 months (range: 0 - 69), respectively. Between baseline and follow-up PET imaging (median 63 days, range: 15 - 454), 170 patients were treated with chemotherapy and 46 patients with chemoradiotherapy. The median change in SUV was 43% (range: -300 - 100.0%) and the median histologic tumor response was 50% (range: 0 - 100%). No association was identified with the use of chemoradiation (as compared to chemotherapy alone) and change in SUV (p=0.8). We identified a significant relationship between change in SUV and histologic response (r=0.32, p<0.01). Furthermore, the change in SUV was related to both DFS and OS on univariate analysis, as was tumor response and pathologic stage (Table). On multivariate analysis only pathologic stage, and specifically the presence of lymph node metastases, was related to DFS (p<0.01) or OS (p<0.01). Conclusions: Following neoadjuvant therapy for gastric and GEJ adenocarcinoma, PET response is prognostic, although pathologic nodal status is the best predictor of outcome. [Table: see text]
Implications for the American Joint Committee on Cancer staging systems on esophageal squamous cell cancer patients receiving multimodality therapy.
Authors: Nomura Motoo , Abe Tetsuya , Komori Azusa , Narita Yukiya , Uegaki Shiori , Nitta Sohei , Yamaguchi Kazuhisa , Taniguchi Hiroya , Kawai Ryosuke , Uemura Norihisa , Kadowaki Shigenori , Takahari Daisuke , Ura Takashi , Andoh Masashi , Niwa Yasumasa , Shinoda Masayuki , Muro Kei 
Published: February 2017

123 Background: The 7th edition of the American Joint Committee on Cancer (AJCC) staging system is based on pathologic data from esophageal cancers treated by surgery alone. The objective of this study was to evaluate the prognostic impact of the pretreatment clinical stage (cTNM) and posttreatment pathologic stage (ypTNM) on esophageal cancer patients undergoing neoadjuvant chemotherapy followed by surgery (NAC-S). Methods: Information on 245 consecutive esophageal squamous cell carcinoma patients undergoing NAC-S was reviewed. Data collected included demographics, cTNM, ypTNM, and survival. Statistical methods included the Cox regression model, Akaike information criterion (AIC) within the Cox proportional hazard regression model, and Kaplan-Meier analyses. Results: The overall three-year survival rate was 67.6%. There were significant differences between stages II and III in cTNM and ypTNM stage, respectively (P < 0.01, respectively). There were no significant survival differences between stages I and II, between stages III and IV in each TNM stage. For all patients, cN stage (cN0 vs. cN1-3), ypT stage (ypT0-2 vs. ypT3-4), ypN stage (N0 vs. N1-3), and ypM stage were independent prognostic factors by multivariate analysis (P< 0.05). Compared with cTNM stage, ypTNM stage has a smaller AIC value, which described the optimum prognostic stratification. Conclusions: Our study indicates that the ypTNM stage of the 7th edition of AJCC staging system has better performance than the cTNM stage in patients undergoing NAC-S.
Impact of Hispanic ethnicity on the clinical presentation and survival of esophageal and gastric cancer in south Florida.
Authors: Palacio Sofia , Sussman Daniel A. , Ardalan Bach , Rocha Lima Caio Max S. , Hosein Peter Joel 
Published: February 2017

125 Background: Race and ethnicity are associated with differences in survival among patients with esophageal and gastric cancer (EGC); outcomes are better in Asian patients but worse for African-Americans compared to Caucasians and Asians. Limited data exist for Hispanics (Hisp) compared to non-Hispanic whites (NHW) or African-Americans (AA). Because of the large Hisp population in South Florida, we compared the clinical presentation and survival of patients with EGC by race and ethnicity. Methods: Using a cross-sectional study design, this IRB-approved analysis of the Florida Cancer Data System database identified all patients diagnosed at the University of Miami and Jackson Memorial Hospital between January 2000 and December 2012 with squamous cell carcinoma (SCC) or adenocarcinoma (AC) of the esophagus, and adenocarcinomas of the gastro-esophageal junction (GEJ) or stomach (STO). Demographic, treatment and survival data were extracted from the registry. Survival was analyzed using the Kaplan-Meier method and variables associated with survival were analyzed using a Cox proportional hazards model. Results: Data from 2,170 patients were available; 44% were Hisp, 19% AA and 38% NHW. Compared to NHW's and AA's, Hisp's were more likely to have the following features: male gender, advanced age at cancer diagnosis, esophageal site of malignancy, adenocarcinoma histology, earlier stage at presentation, history of smoking and alcohol use, private insurance, surgical resection and receipt of chemotherapy (p < 0.001 in each case). Hisp were less likely to have STO (p<0.001). In a multivariate model, race and ethnicity were not independently associated with survival but age, stage, surgical resection and chemotherapy administration were all independently associated with survival (p < 0.01 in each case). Country of birth did not influence results among Hispanic patients. Conclusions: Race and ethnicity were not independently associated with survival in this large registry study. However, significant differences in the tumor location, histology and stage of presentation exist, and further studies to elucidate the biological or environmental reasons for these disparities are warranted.
Freedom from recurrence after induction cisplatin/5-FU/RT versus carboplatin/paclitaxel/RT in patients with esophageal cancer.
Authors: Thomay Alan Adolph , Su Stacey , Friedant Adam J. , Ruth Karen J. , Astsaturov Igor A. , Burtness Barbara , Denlinger Crystal Shereen , Dotan Efrat , Hall Michael J. , Meyer Joshua E. , Shah Prashant C. , Cohen Steven J. , Scott Walter J. 
Published: February 2017

126 Background: The optimal neoadjuvant treatment regimen for esophageal cancer has yet to be defined. Methods: We analyzed a prospective database of esophageal cancer patients treated with cisplatin/5-FU/RT (A) or carboplatin/paclitaxel/RT (B) then esophagectomy. Endpoints were pathologic response (pCR), recurrence, and overall survival. Covariates (age, gender, clinical stage, Charlson comorbidity index (CCI), and ECOG PS) were adjusted via propensity score weighting from logistic regression. Differences in survival curves were compared using weighted Kaplan Meier methods and Wilcoxon tests. Landmark analysis compared differences in outcomes at least six months after surgery. Results: From January 2008 to June 2013, 71 patients received induction RT (50.4 Gy), with 38 and 33 patients in groups A and B, respectively. Patient demographics were similar (Table 1). Operative procedure, R0 resections, and operative complications did not differ (operative mortality 1/71, 1.4%; anastomotic leak rate 10% A vs. 9% B, p=1.0). Median follow-up was 18.2 and 9.1 months for groups A and B, respectively. There was no difference in overall survival (p=0.88) or total number of recurrences (11/38, 29% A vs. 10/33, 30% B). Landmark analysis revealed a difference in recurrence at least 6 months after surgery: time to recurrence was shorter in group B (median time to recurrence 31 mos A vs. 18 mos B, p=0.02). pCR was seen in 13/38 (34%) A and 9/33 (27%) B (p=0.53). In patients with pCR, there was a trend toward more recurrences in group B (2/13, 15% A v 4/9, 44% B, p=0.14). Conclusions: Six months after surgery patients receiving induction carboplatin/paclitaxel/RT had shorter time to recurrence compared to cisplatin/5-FU/RT. In those with pCR a trend towards increased distant recurrences was seen with carboplatin/paclitaxel/RT, which may have less systemic efficacy in esophageal cancer than cisplatin/5-FU/RT. This should be evaluated in larger series. [Table: see text]
Survival outcomes of schirrhus gastric cancer treated by multidisciplinary treatments: Putative impact on prognosis by DCS NAC.
Authors: Yamashita Keishi , Hosoda Kei , Katada Natsuya , Moriya Hiromitsu , Mieno Hiroaki , Kikuchi Shiro , Watanabe Masahiko 
Published: February 2017

128 Background: Among gastric cancer, schirrhus exhibited the poorest prognosis, and many patients die even after curative resection due to recurrence. Although progress of multidisciplinary treatments of advanced gastric cancer is outstanding, recent clinical outcome is obscure by such intensive treatments. Methods: Among the 5,664 gastric cancer patients who underwent gastrectomy between 1971 and 2013 in the Kitasato University Hospital, 287 of shirrhus gastric cancer were included (5%). We divided the total periods into early (1971-2004) and late period (2005-2013), and compared their prognosis. Multivariate proportional hazard model was applied to the significant univariate prognostic factors (p<0.05), and identified independent prognostic factors (IPFs). Finally we compared the IPFs in terms of periods, and discuss the most appropriate treatments. Results: (1) Five-year survival rate was 13% and 31% in the early and late periods, respectively (p=0.0010). Between the periods, there were significant differences of pT (p=0.013), CY (p<0.0001), and Margin status (p=0.041). (2) Univariate prognostic factors were age (p=0.032), pT (p=0.0009), pN (p<0.0001), P (p=0.0033), CY (p=0.0002), and Margin status (p<0.0001). Multivariate proportional hazard model elucidated IPFs of pN (pN0-2 vs pN3a-X, p<0.0001) and Margin status (positive vs negative, p=0.0003). If the 2 factors were combined, patients with pN0-2 plus margin negative showed much better survival (about 40% of 5-year OS) than otherwise cases (below 10%)(p<0.0001). (3) Comparison of the IPFs between early and late periods, margin positive cases were significantly less infrequent in the late period. This may be aggressive application of neoadjuvant chemotherapy of DCS (Docetaxel/CDDP/S1). Conclusions: Due to recent progress of multidisciplinary treatments of preoperative aggressive chemotherapy and surgery with curative intent for negative margin for schirrhus gastric cancer, its 5-year survival was dramatically improved. pN0-2 patients were promising for reasonable prognosis if negative margin is secured, so intraoperative diagnosis must be urgently developed.
Utility of the OSNA assay in sentinel node mapping for early gastric cancer.
Authors: Takeuchi Hiroya , Nishi Tomohiko , Nakamura Rieko , Takahashi Tsunehiro , Wada Norihito , Kawakubo Hirofumi , Saikawa Yoshiro , Omori Tai , Kitagawa Yuko 
Published: February 2017

13 Background: Recent studies on sentinel node (SN) mapping for early gastric cancer have shown acceptable results in terms of detection rate and accuracy to determine lymph node (LN) status. Accurate detection of nodal metastasis including micrometastasis during surgery is indispensable for clinical application of minimized gastrectomy based on SN mapping and biopsy. However, histopathological diagnosis of micrometastasis using frozen sections has to be considered as limitations for intraoperative pathology. We hypothesized that one-step nucleic acid amplification (OSNA) assay may allow the PCR-based intraoperative diagnosis to be applicable to SN mapping for early gastric cancer. Methods: A prospective study of SN mapping using the OSNA (One-step nucleic acid amplification) assay has been conducted for patients with cT1N0M0 gastric cancer at our institution. All SNs and randomly selected non-SNs were examined by routine histopathological diagnosis and the OSNA assay. Results: Histological examination was performed in in 1,732 LNs (286 SNs and 1,446 non-SNs) from 43 patients with cT1N0M0 gastric cancer. We also evaluated 439 LNs (286 SNs and 153 non-SNs) with histological examination and the OSNA assay from the 43 patients. Histological LN metastasis was revealed in 6 (14.0%) of 43 patients. All (100%) of the 6 patients with LN metastasis showed positive SNs by histological examination. The diagnostic accuracy to predict the LN status based on SN concept by histological examination was 100%. The concordance rate between the OSNA assay and the histological examination of paraffin specimens was 0.970 (95 % CI, 0.950–0.984). Discordant results were observed in 13 LNs (3.0 %). Sensitivity and specificity of the OSNA assay compared to the histological examination were 0.636 (95 % CI, 0.407–0.828) and 0.988 (95 % CI, 0.972–0.996), respectively. The OSNA assay to evaluate the SNs status was comparable with intraoperative pathological diagnosis of frozen sections of SNs in terms of concordance rate (0.981), sensitivity (0.800) and specificity (0.995). Conclusions: Our results suggest that the OSNA assay may be a useful tool for the intraoperative detection of metastasis in SNs for patients with early gastric cancer.
Survival impact of esophagectomy after chemoradiation for adenocarcinoma of the esophagus.
Authors: Shridhar Ravi , Freilich Jessica , Hoffe Sarah E. , Almhanna Khaldoun , Fulp William J. , Yue Binglin , Meredith Kenneth L. 
Published: February 2017

132 Background: To determine the impact of esophagectomy on survival in patients with adenocarcinoma (AC) of the esophagus cancer after chemoradiation (CRT). Methods: A database of esophageal cancer was queried for nonmetastatic patients with AC treated between 2000 and 2011 with CRT. Overall survival (OS) and recurrence-free survival (RFS) curves were calculated according to the Kaplan-Meier method and log-rank analysis. Multivariate analysis (MVA) was performed by the Cox proportional hazard model. Results: We identified 154 patients (60 without surgery; 94 with surgery) who were included in the analysis. The only differences between the 2 groups were more advanced stage and younger age in the surgery group. Patients undergoing surgery had significantly higher survival. Median and 5 year OS for surgical patients was 4.1 years and 43.6% versus 1.9 years and 35.6% for non surgical patients (p=0.007). MVA for OS and DFS revealed that factors associated with increased survival were surgical resection, tumor length <5 cm, male gender, and lower stage. Age, tumor location, radiation dose/technique, and induction chemotherapy were not prognostic. There was a trend towards improved survival on univariate analysis (p=0.10) and MVA (p=0.063) for surgery patients compared to non-surgical patients who were healthy enough for surgery pre-CRT (n=38), and no difference in OS in nonsurgical patients healthy enough for surgery post-CRT (n=22). Conclusions: Esophagectomy after CRT dramatically improves survival in patients with AC after CRT. Trimodality therapy should continue to remain the standard of care for esophageal AC. However, surgery should be performed at high volume centers.
Clinical response to neoadjuvant therapy to predict success of adjuvant chemotherapy for esophageal adenocarcinoma.
Authors: Tam Vernissia , Hooker Craig M. , Molena Daniela , Hulbert Alicia , Lee Beverly , Kleinberg Lawrence , Yang Stephen C. , Forastiere Arlene A. , Brock Malcolm 
Published: February 2017

137 Background: Evidence informing current guidelines advising postoperative chemotherapy following trimodality therapy for esophageal cancer are limited. Our objective was to identify patients with locally advanced esophageal adenocarcinoma treated with trimodality therapy who may benefit from adjuvant chemotherapy. Methods: A single institution retrospective study was performed in 308 patients with esophageal adenocarcinoma who underwent neoadjuvant chemoradiation followed by surgery between 1989-2012. Kaplan-Meier analysis compared postoperative survival by clinical response to trimodality therapy and the use of adjuvant chemotherapy. Cox proportional hazards regression models estimated the association of adjuvant chemotherapy with survival. Results: After trimodality treatment, 93 out of 308 patients(30%) received adjuvant chemotherapy. Partial response to trimodality treatment was observed in 150(48%) patients; 50 of whom received adjuvant therapy. The median survival for partial responders who received adjuvant therapy vs. those receiving trimodality therapy alone was 53.2 vs. 27.6 months, respectively (p=0.047). Patients with complete response or no response to trimodality therapy showed no difference in median survival with the addition of adjuvant chemotherapy. Univariate Cox regression revealed a 26% decrease in relative hazard for long-term survival amongst patients who received adjuvant chemotherapy compared to no adjuvant therapy (HR=0.74, 95% CI 0.55-0.98). This association remained stable after adjusting for clinical response to trimodality therapy, age, and ASA score (aHR=0.75, 95% CI 0.55-1.01). Conclusions: Adjuvant therapy for patients with locally advanced esophageal adenocarcinoma was associated with a 26% decrease in relative hazard for mortality compared to trimodality treatment alone. Long-term survival following adjuvant therapy was dependent on initial response to trimodality therapy. Partial responders may benefit most from adjuvant chemotherapy.
Risk factors that affect continuation of S-1 chemotherapy as an adjuvant setting after radical gastrectomy for gastric cancer.
Authors: Kobayashi Daisuke , Tanaka Chie , Iwata Naoki , Kanda Mitsuro , Yamada Suguru , Nakayama Goro , Fujii Tsutomu , Sugimoto Hiroyuki , Koike Masahiko , Nomoto Shuji , Fujiwara Michitaka , Kodera Yasuhiro 
Published: February 2017

151 Background: Based on the evidence from ACTS-GC trial, postoperative S-1 administration for 12 months is the current standard of care in Japan for patients with pathological Stage II/III gastric cancer treated with D2 gastrectomy. However, the proportion of patients who actually tolerated 12 months of treatment in the ACTS-GC trial was 65.8%. In the present study, we explored the risk factors that could affect the compliance of S-1 adjuvant therapy. Methods: This retrospective study selected 68 consecutive patients who underwent curative gastrectomy for gastric cancer and received S-1 chemotherapy at our institution between 2003 and 2012. Associations between S-1 compliance, adverse effects and clinical characteristics were analyzed. Results: 51 patients were male, and 17 were female. Patient age ranged between 20 and 80 years (median: 64.0). 47 patients (69%) completed the prescribed S-1 treatment for 1 year. In addition, 5 patients discontinued treatment due to recurrence within 1 year, and 3 patients due to reasons irrelevant to the S-1 toxicity. These 55 patients were designated as non-AE group. The remaining 13 patients (19%) were obliged to discontinue S-1 due to adverse effects within 1 year (AE group). The percentage of female was higher in the AE group (46% versus 20% in the non-AE group). The median age of patients was significantly higher in the AE group (72 versus 63 in the non-AE group, p=0.004). Although there was no difference in the serum creatinine level at the beginning of the treatment, creatinine clearance (CCr) of AE group was significantly lower at 65 mL/min (83 mL/min for the non-AE group, p=0.04). Median body weight loss during the first 3 postoperative months in the AE group (13% of the original weight) was significantly higher (10% in the non-AE group, p=0.04), although the median body weight before treatment didn’t differ between the two groups. Dose reduction was more diligently conducted among the population with CCr< 60 in the non-AE group (4/7) than in the AE group (1/5). Conclusions: Female, old age, low CCr and greater body weight loss affect compliance of the S-1 adjuvant chemotherapy. Meticulous dose modification is required for those with risk for discontinuation.
Phase I study of biweekly docetaxel, cisplatin, and S-1 combination neoadjuvant chemotherapy for stage III gastric cancer.
Authors: Kunisaki Chikara , Makino Hirochika , Kimura Jun , Oshima Takashi , Ota Mitsuyoshi , Takagawa Ryo , Kosaka Takashi , Akiyama Hirotoshi , Endo Itaru 
Published: February 2017

153 Background: It is unclear neoadjuvant chemotherapy for stage III gastric cancer can provide satisfactory outcomes. Therefore, we conducted a phase I study to clarify recommend dose (RD) of biweekly docetaxel, cisplatin, and S1 combination neoadjuvant chemotherapy for stage III gastric cancer. Methods: A dose escalation method was employed. S1 (80mg/m2/day; day1-7, 15-21) and docetaxel (20mg/m2/day; day1, 15) were fixed and cisplatin (day1, 15) was increased by 5mg/m2 from level I (20mg/m2/day). Each course was lasted for one month. Toxicity was examined by the CTCAE version 4.0 during two courses. Results: A total of 21 patients (male/female=14/7, mean age=63 years) was enrolled in this study. Of these, nine stage IIIA, nine stage IIIB, and three stage IIIC were included. In level I, There was no DLT case. In level II, we encountered perforation of gastric cancer in one case without any other DLT in the remaining five cases. In level III, IV, V, and VI, we did not encounter any cases with DLT. So, we decided that the RD of cisplatin was 50mg/m2/day (Level VI), which is regarded as maximum safety dose in the outpatient clinic. Response status was as follows: one PR case, 19 non CR/non-PD cases and one PD case. Total gastrectomy was performed in 14 cases, and distal gastrectomy in seven cases. Histologically, grade 1a was found in 13 cases, grade 1b in three cases, grade 2 in four cases, and grade 3 was one case. Five cases (23.8%) suffered from postoperative complications (two anastomotic leakage; one pneumonia; one pancreatic fistula; one chyloascites) although all cases recovered conservatively. Conclusions: RD of cisplatin was 50mg/m2/day in biweekly docetaxel, cisplatin, and S1 combination neoadjuvant chemotherapy for stage III gastric cancer. Phase II study is now going on to confirm the usefulness of this treatment.