bluuebunny/crossref_metadata_2025_split huggingface dataset:
Primary small cell of esophageal carcinoma (SCEC): Experience of Beatson West of Scotland Cancer Center.
Authors: Alfayez Mohammad , McDonald Alexander , MacLaren Vivienne 
Published: February 2017

38 Background: Primary Small Cell of Esophageal Carcinoma (SCEC) is an aggressive tumor with no established treatment guidelines. A treatment strategy was adopted based on small cell carcinoma of the lung, as many clinicopathological features are shared. Methods: We retrospectively collected data from fourteen patients who were treated for small cell of esophageal carcinoma at Beatson West of Scotland Cancer Center between 2005 and 2012. All patients were required to have a histological diagnosis of small cell carcinoma. Data were collected retrospectively by case note review and electronic record on demographic details, performance status (PS), comorbidity, treatment, and response to treatment. Results: The data suggest the median age for SCEC diagnosis is 71 years old. Diagnoses in males predominate (64%). The tumors were mainly located in the lower third of the esophagus (71%). The majority of patients with SCEC were in the limited Disease (LD) at the time of diagnosis (71%). About 50% of the patients received chemotherapy alone and 28% received consolidation radiotherapy. Three patients (21%) only received concomitant chemoradiation. None of the patients have Primary Cranial Irradiation (PCI). The overall survival of patients with limited Disease (LD) vs. Extensive Disease (ES) was 22.2 vs. 4.6 months (P=0.013). None of the patients reviewed developed brain metastasis. Conclusions: There is trend in the data that the combination of radiotherapy and chemotherapy improves local control. Radiotherapy alone is probably inadequate if used alone. It should be combined with adjuvant or neoadjuvant platinum-based chemotherapy. Palliative chemotherapy for patients presenting with extensive disease prolonged survival. PCI should not be a standard treatment for these patients. The data presented are the second largest series from the western world. These data will help establish further guidelines for treatment of the small cell of esophageal carcinoma.
Prospective evaluation of a 12-gene assay on patient treatment decisions and physician confidence in mismatch repair-proficient (MMR-P) stage IIa colon cancer patients.
Authors: Alberts Steven R. , Renfro Lindsay A. , Lopatin Margarita , Tezcan Haluk , Sloan Jeff , Chao Calvin Y. , Lee Mark 
Published: February 2017

396 Background: The 12-gene Oncotype DXColon Cancer Assay is clinically validated as a predictor of recurrence risk in stage II colon cancer patients following surgery. We previously reported that the 12-gene assay led to 45% change in physician treatment (Tx) recommendations in a prospective study in MMR-P stage IIA colon cancer patients. Here, from the same prospective study, we report the influence of the 12-gene assay on patient Tx decisions, physician confidence, concordance in Tx choice between physicians and patients, and patient decisional conflict. Methods: Consecutive patients with resected stage IIA colon cancer who were candidates for adjuvant chemotherapy were enrolled by 105 physicians from 17 sites. Patient's tumor specimens were assessed by the 12-gene assay (RT-PCR) and MMR (IHC). Prior to and after receiving these results, patients completed surveys including (1) their Tx decisions (observation (Obs) vs. 5FU-monotherapy (5FU) vs. 5FU + oxaliplatin (Oxal)) and (2) indicators of decisional conflict. Results: 190 of 221 patients enrolled were evaluable including 139 who were MMR-P. Pre-assay: 46% of patients chose Obs, 3% 5FU, 7% Oxal, 2% other and 41% were undecided. Post-assay: 75% chose Obs, 12% 5FU, 11% Oxal, 3% other (undecided was not a possible response). Post-assay 129 (96%) of 135 definitive Tx decisions (Obs, 5FU, or Oxal) were concordant between patients and physicians compared to 49 (66%) of 74 definitive decisions pre-assay. In the majority of cases, patients (85%) and physicians (69%) reported that the assay influenced their Tx decisions. Assay results increased physician confidence in Tx recommendations in 126 (84%) and provided additional clinically relevant information to physicians in 129 (86%) of cases. Patient decisional conflict was significantly lower after assay results (p<0.001). Conclusions: In this prospective study, quantitative recurrence risk information provided by the 12-gene assay influenced Tx decisions for a majority of patients and physicians, increased physician confidence, improved concordance in Tx choice between patients and physicians and decreased patient decisional conflict.
Impact of preoperative sarcopenia on morbidity in gastric cancer surgery.
Authors: Sato Tsutomu , Aoyama Toru , Hayashi Tsutomu , Cho Haruhiko , Kawabe Taiichi , Fujikawa Hirohito , Ogata Takashi , Yamada Takanobu , Hasegawa Shinichi , Oshima Takashi , Rino Yasushi , Masuda Munetaka , Yoshikawa Takaki 
Published: February 2017

40 Background: Skeletal muscle depletion, known as sarcopenia, is characterized by decrease in muscle mass and function. Recent reports demonstrated that sarcopenia was a significant risk factor for complications in colorectal cancer surgery. This study aimed to evaluate impact of preoperative sarcopenia on morbidity in gastric cancer surgery. Methods: Between May 2011 and June 2013, 293 consecutive primary gastric cancer patients who underwent curative surgery were retrospectively examined. All patients received the same perioperative care of enhanced recovery after surgery program. Preoperative skeletal muscle mass was evaluated by bioelectrical impedance analysis and was expressed as skeletal muscle index or SMI (muscle mass/height2) by adjusting absolute muscle mass with height. Preoperative muscle function was measured by hand grip strength (HGS). Each cutoff value was determined as the gender-specific lowest 20% of the distribution of each measurement. Grade 2 or higher morbidity, evaluated by Clavien-Dindo classification, was picked-up from the patient record. Risk factor for morbidity was examined by uni- and multi-variate analyses. Results: Median age (range) was 68 years (37-85 years). Male to female ratio was 192:101. Operative procedure was 122 total, 169 distal, and 2 proximal gastrectomy. Lymphadenectomy was 162 D1+ and 131 D2 including 53 splenectomy. Pathological stage was I in 149, II in 39, III in 91, and IV in 14 patients. Morbidity included 7 pancreatic leakage, 12 anastomotic leakage, 4 intra-abdominal abscess, and others. In total, morbidity was observed in 39 patients (13.3%); 21 in grade 2, 16 in grade 3a, 1 in grade 3b, and 1 in grade 4. No mortality was observed. Univariate analysis showed that male, total gastrectomy, splenectomy, and low HGS were significant risk factor for morbidity. Low SMI was not a risk factor. By multi-variate analysis, low HGS(HR 2.457, p=0.029), male(HR 2.610, p=0.038)and total gastrectomy(HR 2.747, p=0.027)remained significant. Conclusions: Low hand grip strength was one of significant risk factor for morbidity in gastric cancer surgery. Hand grip strength as a surgical risk has a value to be examined in the future prospective studies.
Impact of colonoscopically missed cancers on patient outcomes.
Authors: Govindarajan Anand , Rabeneck Linda , Tinmouth Jill , Paszat Lawrence Frank , Baxter Nancy 
Published: February 2017

404 Background: There is increasing recognition of the potential for cancers to be missed on colonoscopy, but little is known about their outcomes. The objective of this study was to evaluate the outcomes of missed cancers relative to those detected by colonoscopy. Methods: We conducted a retrospective population-based cohort study, including all patients diagnosed with colorectal cancer (CRC) in Ontario, Canada from 2003-2009, who had undergone a colonoscopy within 36 months prior to diagnosis. Using previously defined time windows, we defined detected cancers as those diagnosed within 6 months of index colonoscopy and missed cancers as those diagnosed between 6 and 36 months after index colonoscopy. Patient and tumor factors were recorded as covariates. The primary outcome was overall survival, with secondary outcomes of resection rate, emergency presentation, and surgical complication rate. Logistic regression was used to analyze binary outcomes and Kaplan-Meier and Cox regression analyses were used for survival outcomes. Results: Overall, 30,475 patients were included in the study, with 2,804 being classified as having a missed cancer. Factors associated with missed cancers included colonic location (vs. rectum), older age, female sex, rural residence, and Charlson comorbidity score. Absolute 5-year overall survival was significantly lower in missed compared to detected cancers (60.8% vs. 68.3%, difference: 7.5%, p < 0.0001). In multivariable analysis, patients with missed cancers had a 22% higher hazard of death (HR: 1.22, 95% CI: 1.15 to 1.30, p < 0.0001). Patients with missed cancers were significantly more likely to present emergently with obstruction, bleeding or perforation (OR: 2.86, 95% CI: 2.56 to 3.13, p < 0.001) and were significantly less likely to have their tumors surgically resected (OR: 0.61, 95% CI: 0.55 to 0.67, p < 0.001). Conclusions: CRCs that are missed on initial colonoscopy are associated with markedly inferior patient outcomes, with a higher risk of emergent presentation, a lower likelihood of surgical resection, and most notably a significantly worse overall survival. These findings reinforce the critical importance of studying and improving quality measures of CRC screening to improve patient outcomes.
Predicting toxicities from adjuvant treatment in a population-based cohort of early colon cancer (CC) patients (pts): A strategy to improve use of curative chemotherapy.
Authors: Gresham Gillian , Sidhu Jasleen , Malhi Navraj , Cheung Winson Y. 
Published: February 2017

412 Background: CC pts treated with chemotherapy are at risk of experiencing a number of toxicities. The identification of pts who may be at a higher risk of developing toxicities allows clinicians to be more vigilant in preventing and managing side effects early, thus enabling more optimal delivery of chemotherapy. Our aim was to determine clinical factors associated with toxicities from adjuvant FOLFOX in early CC. Methods: Pts diagnosed with stage III CC from 2005 to 2008, seen at any 1 of 5 regional cancer centers of the British Columbia Cancer Agency, and treated with adjuvant FOLFOX chemotherapy were reviewed. We evaluated various toxicities, including gastrointestinal, hematologic, cardiovascular, and neurological side effects. Baseline and clinical factors were assessed in univariate and multivariate models to determine potential predictors for each of the different chemotherapy toxicities. Results: In total, 475 pts were included: median age was 62 years (range 26-89), 16.2% were aged >70 years, and 54.5% were men. In terms of function, the majority (90.1%) was ECOG 0/1. Time to adjuvant chemotherapy (TTAC) >8 weeks (OR 1.91, 95% CI 1.8-3.1, p=0.006) and renal dysfunction with a GFR <50 (OR 1.69, 95% CI 1.1-2.6, p=0.0038) were significantly associated with higher odds of any GI toxicity. Likewise, TTAC >8weeks (OR 2.8, 95% CI 1.5-5.2, p=0.002), ECOG PS >1 (OR 2.86, 95% CI 1.2-6.7, p=0.016), and low white blood cell count <6.4 (OR 2.32, 95% CI 1.3-4.0, p=0.0043) were correlated with a greater risk of significant neutropenia. Multiple toxicities were more prevalent among those who waited >8 weeks to initiate adjuvant FOLFOX (OR 1.69, 95%CI 1.1-2.7, p=0.03). Further, advanced age >70 years was an indepenent risk factor for worse nausea and diarrhea. Conclusions: Consideration of important baseline characteristics such as TTAC, advanced age, renal function, and specific laboratory parameters when recommending adjuvant FOLFOX can be useful in identifying patients with increased likelihood of toxicities. This group of patients may benefit from increased monitoring in order to enable optimal doses of curative chemotherapy to be delivered.
Hollow spheroids beyond the invasive front and malignant potential of colorectal cancer.
Authors: Yokoyama Shozo , Ieda Junji , Yamamoto Naoyuki , Mitani Yasuyuki , Mizumoto Yuki , Takifuji Katsunari , Hotta Tsukasa , Matsuda Kenji , Watanabe Takashi , Tani Masaji , Yamaue Hiroki 
Published: February 2017

418 Background: Hollow spheroid (HS) is a morophogenesis after budding at invasion front of colorectal cancer (CRC) tissue. HS formation of CRC cells has been shown to be induced by Carcinoembryonic Antigen-related Cell Adhesion Molecule 1 (CEACAM1) long cytoplasmic isoform dominance condition in three-dimensional (3D) in vitro culture. The aim of the current study is to address the existence and the clinical implication of HS in colorectal cancer. Methods: Immunohistochemical analyses were conducted with CEACAM1, CEACAM1-L, to address the existence of CEACAM1 expressing HS beyond the invasion front of CRC. The risk factors for metastases and survival were calculated using univariate and multivariate analyses on clinical samples from 164 patients with CRC. To investigate the role of HS for chemoresistance to 5-fluorouracil (5-FU), the risk factors for recurrence after adjuvant chemotherapy were calculated using univariate and multivariate analyses on clinical samples from 82 patients with Stage III CRC. Results: Immunohistochemical analyses showed that CEACAM1 expressing HS existed at the invasion front of colorectal cancer tissues. A multivariate analysis showed that the HS is an independent risk factor for lymph node metastasis (p = 0.004) and distant metastasis (p = 0.002). HS was also identified to be an independent prognostic factor by a Cox proportional hazards model (p = 0.020). The Kaplan-Meier evaluation for the overall survival analysis showed that HS was significantly associated with a shorter survival (p < 0.0001). Moreover, a multivariate analysis for recurrence after adjuvant chemotherapy showed that the HS is an independent risk factor (p = 0.0079). These results suggested that HS indicates malignant and chemoresistant phenotype. Conclusions: HS was significantly correlated with CRC metastasis, poor survival and chemoresistance to 5-FU. HS beyond the invasion front of CRC can be useful for diagnosis of malignant potential, and may be novel therapeutic target.
Nodal involvement and impact of adequate staging in older patients with resectable colon cancer: A population-based analysis.
Authors: Khan Hadi , Somasundar Ponnandai Sadasivan , Olszewski Adam J. 
Published: February 2017

424 Background: The variation in nodal involvement between age groups has not been thoroughly studied in colon cancer, but it may affect strategies for extent of resection in geriatric patients (pts). The objective of our study was to compare nodal involvement in resectable colon cancer pts, with a focus on surgical staging practices in the elderly. Methods: We extracted data from the Surveillance, Epidemiology, and End Results registry on 183,055 pts diagnosed with stage I-III colon adenocarcinoma between 2000 and 2010. Proportions of pts undergoing colon resection, pts with adequate staging with ≥12 lymph nodes examined (LNE, n=99,308), and with node-positive (N+) cancers were compared in age groups using chi-squared test. Relative risk (RR) of N+ cancer was compared in a multivariable log-linear model, and relative survival in a flexible parametric model, reporting excess hazard ratios (HR) with 95% confidence intervals (CI). Results: While the rates of colon resection were similar in all age groups, older pts were significantly less likely to have ≥12 LNE (P<0.0001; Table). When adequately staged, older pts had a significantly lower proportion of N+ cancers (P<0.0001), even after adjusting for multiple other variables. Survival was better in pts with ≥12 LNE, with no significant difference in the benefit between the age groups (P=0.25 for interaction). Conclusions: When adequately staged, older pts are less likely to have N+ colon cancer, which may help them avoid the recommendation for adjuvant chemotherapy. Since the survival benefit of ≥12 LNE is similar in every age group, the guidelines for extent of resection and pathological examination should be diligently adhered to in all pts undergoing curative surgery, regardless of age. [Table: see text]
Prognostic impact of tumor MET expression among patients with stage IV gastric cancer: A Danish cohort study.
Authors: Erichsen Rune , Oliner Kelly S. , Kelsh Michael A. , Nielsen Karsten B. , Frøslev Trine , Lænkholm Anne-Vibeke , Vyberg Mogens , Acquavella John F. , Sørensen Henrik Toft 
Published: February 2017

43 Background: Recent clinical trial data indicate poor prognosis for patients with late-stage gastric cancer and positive tumor mesenchymal epithelial transition factor (MET) protein expression. However, there is limited information about the real-world prevalence of MET-positive (-pos) cancers and the associated prognosis. Methods: Using medical registries, we identified a cohort of patients with stage IV gastric cancer in a single institution in Northern Denmark from 2003-2010. From these patients, we collected archived (paraffin-embedded) cancer specimens and analyzed MET protein expression by immunohistochemistry (MET-pos if ≥25% of tumor cells showed membrane staining). We calculated the prevalence of patients with MET-pos tumors. We estimated survival using the Kaplan-Meier method and computed mortality rate ratios comparing MET-pos to MET-negative (-neg) patients using Cox proportional hazards models adjusted for age, gender, and Charlson’s Comorbidity Index (score of 0, 1-2, and 3+). Results: 101 patients with stage IV gastric cancer were included in the study of which 55% had MET-pos tumors. The group of patients with MET-pos tumors were younger at diagnosis than patients with MET-neg tumors (median age 65 vs 68 years), included more men, showed higher comorbidity levels, included more poorly differentiated cancers, and were less likely to undergo surgery or chemotherapy. In patients with MET-pos tumors, one-year survival was 18% compared to 39% in patients with MET-neg tumors (mortality rate ratio=2.3, 95% CI: 1.4-3.9). Conclusions: A large proportion of patients with stage IV gastric cancer had tumors demonstrating MET protein expression, and these patients had poor survival compared with patients without tumor MET expression. [Table: see text]
Determinants of anemia in screen-detected colorectal cancer.
Authors: Mansouri David , McMillan Donald , Crighton Emilia M. , Horgan Paul G. 
Published: February 2017

430 Background: Anaemia is an important clinical feature in colorectal cancer, since it may result in blood transfusion that may in turn compromise long term survival. The aim of the present study was to examine the relationship between tumour and host features, and anaemia in patients undergoing surgery for screen detected colorectal cancer. Methods: A prospectively maintained database of patients with cancer detected through a population based faecal occult blood test (FOBt) screening programme was analysed. Preoperative anaemia was defined as Hb<115 g/l in females and Hb<130 g/l in males. The amount of blood in the stool was classified on the degree of positivity of the FOBt (strong/weak) and the SIR was measured by the preoperative neutrophil to lymphocyte ratio (NLR>5/NLR<5). Results: A total of 263 patients were included: 174 (66%) males, 49 (19%) rectal, 177 (67%) node negative. Preoperative anaemia was present in 61 (23%) patients. The presence of anaemia was associated with more advanced T-stage (5% T1 vs. 42% T4, p<0.001), advanced N-stage (18% N0 vs. 45% N2, p=0.001), and the presence of a right-sided tumour (44% vs. 14%, p<0.001). In addition, anaemia was more likely to be present in patients with a strongly positive FOBt (30% strong vs. 19% weak, p=0.034), and in patients with an elevated SIR (44% vs 22%, p=0.045). Right-sided tumours were more likely to be strongly positive on FOBt compared to left-sided tumours (43% vs. 34%, p=0.053). Furthermore, strong FOBt positivity was associated with advanced T-stage (p=0.015), however was not associated with the presence of an elevated SIR (p=0.604). When T-stage, FOBt positivity and the SIR were examined in binary logistic regression analysis, only advanced T-stage (O.R. 2.82, 95% C.I. 1.32 – 6.02, p=0.008) remained significant in predicting those more likely to be anaemic. Conclusions: In this predominantly early stage cohort of screen-detected colorectal cancer, anaemia was uncommon. Its presence was related to both a greater amount of enteric blood loss and an elevated SIR, however these appear to be driven by the stage of the tumour itself. Further work, exploring in more detail the mechanism by which anaemia develops in early stage colorectal cancer is required.
Targeted therapy in gastrointestinal stromal tumor (GIST): A nationwide database analysis from Taiwan.
Authors: Chiang I-Jen , Shau Wen-Yi , Fang Wei-Tse , Fang Chi-Hui , Chen Yen-Yang 
Published: February 2017

437 Background: Gastrointestinal stromal tumor (GIST) is a visceral sarcoma that arises from the gastrointestinal tract. Currently, imatinib (first-line) and sunitinib (second-line) are two reimbursed targeted therapies for GIST in Taiwan. This study aimed to evaluate the real world data of targeted therapies in GIST treatment among Taiwanese population. Methods: We conducted a nationwide retrospective cohort study based on data from the National Health Insurance Research Database (NHIRD) between January 2005 and December 2010. NHIRD is a comprehensive database of administrative and claim data which covers over 99% of entire population in Taiwan. Patients were selected with ICD codes and targeted therapy utilization, imatinib (IMA) or sunitinib (SUN). Time to treatment discontinuation (DC) due to any reasons (such as death, intolerance and disease progression) was estimated using Kaplan-Meier analysis. Results: From 2005 to 2010, the incidence rate of GIST in Taiwan was between 20 and 30 cases per million. A total of 3,436 GIST patients were identified; the mean age was 63.2 years and 57 % were male. Most patients (94.7%) received standard dose IMA (…400mg/day). Among these patients, 136 patients (4.0%) required IMA dose escalation and 44 (1.3%) patients switched to SUN after IMA. The probability of the 1st-line treatment DC was 20%, 30.7%, 38.9%, 43.2%, and 47.1% for years 1 to 5, respectively. The probability of a change in treatment pattern (defined as either IMA dose escalation or switch to SUN) was 4% 6.8%, 9.6%, 10.5% and 11.7% for years 1 to 5. Lastly, the probability of the 2nd-line treatment DC was 20.5%, 33.7%, 41.1%, 44.8%, 51.7% for years 1 to 5, respectively. Conclusions: First-line IMA plus other treatment modalities may provide additional benefits to progression-free survival. Taiwanese GIST patients who failed first-line treatment still gained benefit from either IMA dose escalation or a switch to SUN. Additional analysis is required for the detailed comparison in different treatment patterns.