bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of comorbidity in the choice of curative treatment for esophageal cancer: A population-based study.
Authors: Faiz Zohra , Van Putten Margreet , Verhoeven Rob H.A. , van Sandick Johanna W. , Nieuwenhuijzen Grard A. P. , Lemmens Valery E. P. P. , Wijnhoven Bas P.L. , Plukker John Theodorus 
Published: February 2017

131 Background: Surgery after neoadjuvant chemoradiotherapy (nCRT) is the most common treatment with curative intent for esophageal cancer (EC) patients. Definitive chemoradiotherapy (dCRT) is an alternative for patients who are not eligible for resection because of comorbidity. The purpose of this retrospective study was to evaluate patient and tumor characteristics which are associated with the type of treatment. Methods: We selected all consecutive patients with a locally advanced EC (cT1 N + / T2-3N0-3M0-1a) who were treated with curative intent (nCRT, dCRT or surgery only) in the South East Netherlands between 1995 and 2013. For a proper assessment of the impact of co-morbidity, T4 tumors were excluded. The effect of co-morbidity on treatment decision and on survival was analyzed using a multivariable logistic regression and Kaplan-Meier method. Survival time was defined as time from 6 months after diagnosis until death or until January 1st 2015 for patients who were still alive. Results: Of the 1098 patients, surgery only was performed in 46%, nCRT in 28% and dCRT in 26%. Patients with ≥ 2 co-morbidities underwent more frequently dCRT (OR = 2.35; 95% CI: 1.45-3.86), or resection only (OR = 2.29; 95% CI: 1.41-3.69). Patients > 75 years (OR = 6.66; 95% CI: 3.48-12.77), patients with hypertension and diabetes (OR: 4.05;95% CI: 1.96-8.37-3.90) and patients with cardiovascular (mostly myocardial infarction) and pulmonary comorbidity (OR = 3:33; 95% CI: 1:51 to 7:34) underwent frequently more dCRT than nCRT. Patients with esophageal squamous cell carcinoma (ESCC) also had more frequently dCRT (OR = 2.27; 95% Cl: 1.38-3.73). Patients with an adenocarcinoma and ≥ 2 co-morbidities had favorable 3-year overall survival (OS) after nCRT compared with dCRT and surgery alone (p < 0.01). However, the 3-year OS after nCRT was similar after dCRT in ESCC patients with ≥ 2 co-morbidities (p = 0.75). Conclusions: The results of this study support the treatment with dCRT in patients with SCC of the esophagus, and with at least two co-morbidities, in particular, the combination of cardiovascular / pulmonary disorders and hypertension plus diabetes.
Evaluation of the effects of neoadjuvant therapy on stage specific outcome estimates in patients with completely resected gastric cancer.
Authors: Lowe Michael C. , Chou Joanne F. , Capanu Marinela , Coit Daniel G. 
Published: February 2017

139 Background: The current AJCC staging system for gastric cancer is based on pathologic staging and fails to take into consideration the effects of neoadjuvant therapy. We hypothesize that patients receiving neoadjuvant therapy have a worse outcome than patients with identical pathologic stage not receiving neoadjuvant therapy. Methods: We queried a prospectively maintained gastric cancer database for patients undergoing potentially curative resection for gastric adenocarcinoma between 1985 and 2012. Disease-specific survival (DSS) was estimated by Kaplan-Meier methods. The relationship between DSS and previously identified clinical risk factors was evaluated using Cox regression method. Results: A total of 2,752 patients were identified; of these 904 received neoadjuvant therapy and 1,848 received no neoadjuvant therapy. Patients receiving neoadjuvant therapy were younger (60.7 vs. 65.7 years) and more often male (72.9% vs. 62.4%). Their tumors were more often at the GE junction, but histology, differentiation, and rates of perineural and vascular invasion were similar. Of the 904 patients that received neoadjuvant treatment, 108 (11.9%) had a complete pathologic response. At a median follow up of 4.5 years, 5-year DSS is significantly worse for stage I patients (77% vs. 92%, p < 0.001) and stage III patients (18% vs. 28%, p = 0.025) receiving neoadjuvant therapy; there is a trend towards worse survival for stage II patients (60% vs. 67%, p = 0.059). Factors associated with inferior DSS include age, male sex, diffuse or mixed histology, tumor site, depth of invasion, tumor size, number of positive and negative lymph nodes, and neoadjuvant treatment. The effect of neoadjuvant treatment remains significantly associated with DSS (HR 1.30 [95%CI: 1.12-1.50], p = 0.0004) after adjusting for these other known risk factors. Conclusions: Patients receiving neoadjuvant therapy have a worse stage-specific survival compared to patients not receiving neoadjuvant treatment. The AJCC staging system should be updated to reflect this difference in survival in order to appropriately prognosticate based on pathologic staging.
Real world treatment patterns of previously treated advanced gastric and gastroesophageal junction adenocarcinoma (GC) in Mexico.
Authors: Jones Kyla , SILVA JUAN ALEJANDRO , Novick Diego , Botello Brenda S , Monroy Cruz Bárbara , Iglesias-Chiesa JM , Quintana Miguel 
Published: February 2017

143 Background: Little evidence is available on the management of patients (pts) with advanced GC after 1st-line treatment (tx). Until recently, no licensed therapies for 2nd-line tx were available. This study presents real-world data on pts characteristics, tx patterns, and resource utilization for these pts in Mexico. Methods: Data from medical charts was collected from 3 centers (tertiary-level). Eligible pts were ≥ 18 years old, diagnosed Jan 2007 - Jan 2015 with advanced or metastatic GC, had received 1st-line fluoropyrimidine+platinum, had ≥ 3 months of follow-up after 1st-line discontinuation, and had not participated in a clinical trial. Data were summarized using descriptive statistics. Results: Data from 180 charts was collected; the majority from the Mexican Institute of Social Security (IMSS) (167; 92.8%). Pts' mean age was 57.2 (±12.4) years and 56.7% were male. ECOG performance status (PS) during 1st-line tx was 78.3% PS = 1, 17.2% PS = 2, 0% PS = 0. A total of 16 unique 1st-line regimes were identified, of which EOX (32.2%), XELOX (23.3%), and ECF (14.4%) were the most frequent. The most common reasons for discontinuation were completion of planned regimen (27.2%), toxicity (27.2%) and disease progression (16.7%). A total of 151 (83.9%) pts received 2nd-line chemotherapy. Of these, 54.3% were PS = 1 and 33.1% PS = 2. A total of 19 regimes were identified; with the most frequent being capecitabine (34.4%), docetaxel (16.6%), and XELOX (13.9%). Among pts who received 2nd-line chemotherapy, 50 (33.1%) received 3rd-line chemotherapy. Resource use for patients receiving 2nd-line chemotherapy was: pain interventions (7.3%), nutritional support (1.3%), radiotherapy (13.9%), transfusions (10.6%), inpatient care (15.2%), emergency room visits (2.0%) and outpatient visits (other than scheduled follow-up) (3.3%). Conclusions: This study shows considerable variation in chemotherapy regime in both 1st- and 2nd-line therapy of pts with advanced GC. Understanding GC tx patterns in Mexico will help address unmet needs. Limitations: Pts who did not receive 2nd-line tx are likely underrepresented because these pts are typically managed at local clinics and not tertiary hospitals.
S-1 in combination with docetaxel and oxaliplatin (DOS) every 2 weeks (DOS2w) or every 3 weeks (DOS3w) in patients with advanced gastro-esophageal adenocarcinoma (aGEA): Final results of 2 parallel phase I studies.
Authors: Qvortrup Camilla , Bjerregaard Jon Kroll , Pfeiffer Per 
Published: February 2017

153 Background: S-1 in combination with cisplatin is one of several accepted doublets, but triplet combinations with docetaxel (D) increase efficacy and substitution with oxaliplatin (O) and oral fluoropyrimidines (S-1) ease the administration. Based on our recent phase I study, we wanted to establish a recommended dose (RD) for an every 3 week regimen (DOS3w) but inspired by promising data from the GATE study, we also sought for an every second week regimen (DOS2w). Therefore we designed this dose-finding study which present the first experience with the combination of D+O+S-1 (DOS) in Caucasian patients (Clinical trial ID: 2011-003471-11). Methods: All pts had chemo-naïve aGEA. We used a standard 3+3 phase I design. DOS2w (dose levels 1A-4A) was given with escalating doses of D (30 to 50 mg/m2 day 1) and S-1 (2x30 to 2x35 mg/m2/day - days 1-7) with a fixed dose of O (70 mg/m2day 1) every 2 weeks for a maximum of 9 cycles. DOS3w (dose levels 1B-3B) was given with escalating doses of D (40 to 60 mg/m2 day 1) and fixed doses of O (100 mg/m2 day 1) and S-1 (2x25 mg/m2/day - days 1-14 every 3 weeks) for a maximum of 6 cycles. After the planned number of DOS, S-1 maintenance therapy (2x30 mg/m2days 1-14 every 3 weeks) was administered until PD or toxicity. Toxicity was evaluated according to NCIC-CTC 4.0. Dose-limiting toxicity (DLT) was evaluated after the first course of DOS and defined as non-hematological toxicity grade ≥ 3 or febrile neutropenia. RD was defined as the highest level at which less than 2/6 of pts experienced a DLT. Once RD was established, this level was expanded to at least 6 pts. Results: From Oct. 2013 to Mar. 2015, 18 and 16 patients received DOS2w and DOS3w, respectively. Median age was 63 years (49-78). DLTs in both cohorts were febrile neutropenia. Response rates were 56% and 57% and OS were 13.8 and 11.6 months, respectively. Conclusions: We recommend DOS2w at dose level 3A (D 40 mg/m2 day 1; O 70 mg/m2 day 1 and S-1 2x35 mg/m2/day orally days 1-7 every 2 weeks) and DOS3w at dose level 2B (D 50 mg/m2 day 1; O 100 mg/m2 day 1 and S-1 2x25 mg/m2/day orally days 1-14 every 3 weeks). Both regimens are well-tolerated in an out-patient setting. Clinical trial information: 2011-003471-11.
Impact of anatomical location of positive lymph node on TNM classification in patients with node positive gastric cancer.
Authors: Tokunaga Masanori , Hikage Makoto , Makuuchi Rie , Tanizawa Yutaka , Bando Etsuro , Kawamura Taiichi , Terashima Masanori 
Published: February 2017

155 Background: In the 7th edition of TNM classification, node positive gastric cancer is subclassified into three categories (N1, 1-2 positive nodes; N2, 3-6 positive nodes; N3, 7 or more positive nodes) according to the number of positive lymph node (LN). However, anatomical location of positive LN is not taken into account in the TNM classification, although Japanese classification for gastric cancer had adopted anatomical location oriented nodal staging system and had shown relevance between location of positive LN and survival outcome. The aim of the present study is, therefore, to clarify the impact of anatomical location of positive LN on numerical number oriented, latest TNM nodal staging system. Methods: The present study included 1047 node positive gastric cancer patients who underwent curative gastrectomy at the Shizuoka Cancer Center between September 2002 and December 2014. Survival outcomes were compared between patients with positive extra-perigastric lymph node (PEPLN) and those with positive perigastric lymph node (PPLN) in each nodal stage according to the 7th edition of TNM classification. Results: The present study included 471 N1 patients, 309 N2 patients, and 267 N3 according to the 7th edition of TNM classification, and 5-year survival rates (5ysr) were 81.8%, 70.5%, and 51.9%, respectively. In the N1 group, 5ysr was 75.4% in patients with PEPLN, while it was 83.2% in those with PPLN, and the difference was not statistically significant (P = 0.105). It was also similar between patients with PEPLN (64.2%) and those with PPLN (73.8%, P = 0.343) in the N2 group. However, in the N3 group, survival outcome was significantly worse in patients with PEPLN (47.9%) than in those with PPLN (63.9%, P = 0.036). Conclusions: In the N1 and N2 group, involvement of extraperigastric LN did not have impact on survival outcome. On the contrary, in the N3 group, patients with PEPLN showed worse survival outcome than those with PPLN, and they could be potential candidates for intense postoperative adjuvant treatment.
Accuracy of clinical staging with EUS for early stage esophageal cancer: Are we denying patients beneficial neoadjuvant chemo-radiation?
Authors: Luu Carrie , Garcia-Henriquez Norbert , Klapman Jason , Harris Cynthia L. , Almhanna Khaldoun , Hoffe Sarah E. , Pimiento Jose Mario , Fontaine Jacques 
Published: February 2017

163 Background: Esophagectomy alone has been considered the standard of care for early stage esophageal cancer (EC) while neoadjuvant therapy is now standard for locally advanced disease. The choice of treatment therefore hinges on accurate locoregional staging by endoscopic ultrasound (EUS). Our objective is to evaluate the accuracy of EUS performed in a high-volume tertiary cancer center in clinical stage T1N0 (cT1N0) and T2N0 (cT2N0) esophageal cancer patients undergoing esophagectomy without neoadjuvant therapy. Methods: A retrospective review of the esophageal cancer database at a single institution was performed. Patients with cT1N0 and cT2N0 esophageal cancer based on EUS undergoing esophagectomy without neoadjuvant treatment were evaluated. Patient demographics, tumor characteristics, and treatment were reviewed. Surgical pathology was compared to EUS staging. Results: Between 2000 and 2015, 139 patients were identified. There were 25 (18%) female and 114 (82%) male patients. The tumor location included the middle 1/3 of the esophagus in 11 (8%) and lower 1/3 and gastroesophageal junction in 128 (92%) patients. Eighty-one percent of patients had adenocarcinoma, 9% had squamous cell carcinoma, 9% had Barrett’s dysplasia, and 1% had mixed histology. Clinical staging were as follows: 110 (79%) patients had cT1N0 and 29 (21%) patients had cT2N0 tumors. For the entire cohort, preoperative EUS matched the final surgical pathology in 76/139 patients for an accuracy rate of 53%. Twenty-nine patients (21%) were under-staged by EUS; of those, 19 (14%) had unrecognized nodal disease. This included 12/109 (11%) of cT1N0 and 7/29 (24%) of cT2N0 patients. Conclusions: The accuracy of preoperative EUS staging in early esophageal cancer remains sub-optimal. Interestingly, a significant proportion (24%) of cT2N0 EC patients were found to have positive lymph nodes on surgical pathology, and perhaps these patients could have benefitted from neoadjuvant therapy. In light of these findings, the current management of cT2N0 esophageal cancer should be reconsidered.
Outcomes of minimally invasive versus open esophagectomy for esophageal cancer: A single-center case-control study.
Authors: Santos Sousa Hugo Miguel Teixeira Ferraz Dos , Mesquita Márcio , Aral Marisa , Costa-Maia José 
Published: February 2017

171 Background: Esophagectomy is a major surgery associated with significant morbidity and mortality. There is growing evidence in literature that the minimally invasive approach in esophagectomy (MIE) may decrease morbidity. The aim of this study was the comparative analysis of the outcomes between MIE and open esophagectomy (OE) for esophageal cancer. Methods: Analysis (case-control study) of a prospective database with esophageal cancer cases submitted to curative intent surgery, between May 2006 and October 2014, in an Upper GI Surgery Unit. For this analysis, cases of non-resectional surgery were excluded. Results: From the initial population (n = 79), 65 cases (Group A: 24 MIE - 13 totally MIE and 11 hybrid MIE; Group B: 41 OE, including 5 cases of conversion from MIE) were included. Both groups were matched for gender, age, comorbidities, BMI, tumor location and histology, staging (cT and cN), neoadjuvant therapy and type of surgery. The presence of postoperative morbidity was 37,5% in MIE vs 61% in OE (p = 0,058), with a rate of respiratory complications of 16,7% and 22%, respectively (p = ns). Statistically significant differences were seen in Clavien classification of postoperative morbidity (p = 0,018) and in postoperative mortality (MIE 0% vs OE 22%, p = 0,021). Conclusions: The results of this case-control study provide further evidence for the feasibility and possible improvements in the postoperative morbidity and mortality of MIE, when performed in differentiated centers.
Accuracy of AASLD guidelines for pre-operative diagnosis of hepatocellular carcinoma in a surgical population.
Authors: Yang Edwin , Tiffany Hennedige Priyanti , Lim Miaoshan , Thng Choon Hua , Chow Pierce K. H. 
Published: February 2017

198 Background: The diagnosis of Hepatocellular Carcinoma (HCC) is mainly by dynamic imaging techniques based on guidelines such as that of the American Association for Study of Liver Disease (AASLD). No biopsy is required if criteria in the guidelines are met due to high pre-test probability of disease, risk of tumor seeding and patient morbidity that occurs with invasive liver biopsy. The 2005 AASLD guidelines mandates that there be liver cirrhosis before an imaging diagnosis of HCC can be made. However, updates to the guidelines in 2010 have been expanded to patients with either cirrhosis and/or chronic Hepatitis B carriers. AIM: To compare the sensitivity and positive predictive values of the 2005 and 2010 guidelines in a Hepatitis-B endemic region. Secondary aim: To evaluate proportion of patients who avoided unnecessary biopsies. Methods: A retrospective study of 176 patients from 2006-2010 from a joint cancer service in our centre who had undergone surgical resection for presumptive diagnoses of HCC, were analysed. Their hepatitis status and imaging findings were also examined. Multiphasic CT Liver images were re-examined by 2 oncologic radiologists and the diagnosis of HCC and cirrhosis was only made when there was concordance in opinion. Results: Of all cases, 89.6% of patients were histologically proven HCCs. Sensitivity of detecting cirrhosis on CT was 83.2% with an accuracy of 81.5%. Sensitivity of diagnosis based on the 2010 and 2005 guidelines were 58.1% and 57.4% respectively. When the sensitivities of the previous vs revised guidelines were compared using Mcnemar’s Test, the 2010 guidelines showed a 24.6% increase in sensitivity (p < 0.05). 4.65% more cases avoided unneeded biopsies when applying the 2010 criteria. Conclusions: Diagnosis of HCC under the 2005 AASLD guidelines were based on the pre-operative diagnosis of cirrhosis which in this centre, was of high sensitivity and accuracy. The increase in the sensitivity of diagnosing HCC in the 2010 criteria may reduce the need for invasive biopsy and likelihood for tumor seeding.
Resectability assessment of enhanced CT and contrast-enhanced endoscopic ultrasonography for the periampullary neoplasm.
Authors: Yu Pengfei 
Published: February 2017

199 Background: To evaluate the efficacy of enhanced CT and contrast-enhanced endoscopic ultrasonography (CE-EUS) for assessment of the resectability of periampullary neoplasm. Methods: a prospective analysis of 93 patients with periampullary neoplasm underwent CT and CE-EUS was conducted to compare the imaging data with the surgical and pathological findings, in order to evaluate their efficacies for the resectability assessment. Results: There was no significant difference in sensitivity and specificity between CT and CE-EUS in adjacent organ invasion, lymph node metastasis and liver metastasis (p > 0.05). For the diagnosis of periampullary neoplasm and assessment of vascular invasion, CE-EUS was better than CT (94.6% vs 84.1%,P = 0.023; 96.2% vs 85.9%, P = 0.041). Logistic regression showed that the accuracy of CE-EUS in determining adjacent organ invasion was correlated with the tumor size, and vascular invasion was correlated with the tumor location and size. Conclusions: CE-EUS has advantages in the assessment of the resectability of periampullary neoplasm, especially for the assessment of vascular invasion, and can be used as a supplementary Imaging technology to the enhanced CT.
The optimal time-interval to re-resection for incidentally discovered gallbladder cancer: A multi-institution analysis from the US Extrahepatic Biliary Malignancy Consortium.
Authors: Ethun Cecilia Grace , Postlewait Lauren McLendon , Pawlik Timothy M. , Buettner Stefan , Poultsides George A. , Tran Thuy , Idrees Kamran , Isom Chelsea A , Fields Ryan C. , Jin Linda , Weber Sharon M. , Salem Ahmed I. , Scoggins Charles Raben , Shen Perry , Mogal Harveshp , Schmidt Carl Richard , Beal Eliza W , Hatzaras Ioannis , Shenoy Rivfka , Maithel Shishir Kumar 
Published: February 2017

201 Background: Current recommendation is to perform re-resection for select patients with incidentally discovered gallbladder cancer. The interval time to re-resection that optimizes both patient selection and long-term survival is not known. Methods: All patients with incidentally discovered gallbladder cancer who underwent re-resection at 10 institutions from 01/2000-05/2015 were included. The interval time to re-resection was analyzed. Primary outcome was overall survival (OS). Results: Of 449pts with gallbladder cancer, 233 (52%) were discovered incidentally and underwent attempted re-resection at 3 different time-intervals from the date of original cholecystectomy: Group A: 0-4wks (49pts, 21%); B: 4-8wks (91pts, 39%); C: > 8wks (93pts, 40%). All 3 groups were similar with regards to T-stage, LN involvement, grade, and post-operative complications. Group A tended to have distant disease found less frequently at the time of re-resection (11% vs 20% vs 19%; p = 0.38) and was least likely to have residual disease on pathologic analysis (29% vs 47% vs 49%; p = 0.048). Despite these findings, patients who underwent attempted re-resection between 4-8 weeks had the longest median OS (Group B: 40.4mo) compared to those who underwent early (Group A: 18.1mo) or late (Group C: 23.6mo) re-exploration (p = 0.015). A 4-8 week time interval to re-resection, presence of residual disease, advanced T-stage, LN involvement, high grade, and positive margin were associated with decreased OS on UV Cox regression (all p < 0.05). Only a 4-8 week time interval to re-resection (HR 0.43, 95%CI 0.21-0.90; p = 0.02), advanced T-stage (HR 2.65, 95%CI 1.16-6.09; p = 0.02), and margin positivity (HR 2.46, 95%CI 1.16-5.22; p = 0.02) persisted on MV analysis. Conclusions: The optimal time-interval for attempted re-resection for incidentally discovered gallbladder cancer appears to be between 4-8 weeks after the date of the original cholecystectomy.