bluuebunny/crossref_metadata_2025_split huggingface dataset:
Colorectal cancer patient outcomes in Nigeria: Results from the African Colorectal Cancer Group.
Authors: Alatise Olusegun Isaac , Komolafe Akinwunmi O. , Famurewa Olusola C , Katung Aba Ibrahim , Ariyibi Olufemi O , Egberoungbe Adedeji A , Olatoke Samuel Adegboyega , Agodirin Olayide S , Olaofe Olaejinrinde O , Kolawole Oladapo Adedayo , Eaton Anne , Kingham T. Peter ,   African Colorectal Cancer Group (ARGO)
Published: February 2017

729 Background: Colorectal cancer (CRC) is a growing problem in sub-Saharan Africa. There are, however, limited data describing the demographics, risk factors, presentation, treatments, and outcome of patients with CRC there. We established the African Colorectal Cancer Group (ARGO) to prospectively capture data and tissue from patients with CRC in Nigeria. This is vital to guide screening and treatment trials. Methods: The Consortium consists of 5 hospitals in Nigeria and MSKCC (USA). We have been prospectively collecting data since 2013. Tissue and blood samples were obtained. Ultrasounds and CT scans were provided by an NCI grant. Overall survival from date of diagnosis was estimated using Kaplan-Meier methods. Results: 152 patients have been accrued. The majority was male (56.8%), the median BMI was 22, the majority were non-smokers (89.1%) and non-drinkers (73.5%). Many patients had symptoms, as 65.8% of patients presented with obstruction or bleeding, 52.1% of patients had pellet like stool, and 88.4% had weight loss. 33.3% saw a traditional healer prior to presentation. The common locations of the primary tumor were rectum (52%) and right colon (23%). 8 patients (6.4%) had CEA > 30 ng/mL. The majority of patients presented with advanced disease. 43 (32.3%) patients had T3 tumors; 87 patients (66.9%) had T4 tumors. AJCC stage was II (n = 12, 9.3%), III (n = 34, 26.4%), and IV (n = 83, 64.3%). 97 patients (66%) had surgery. The most common operations were right hemicolectomy (23.1%) and diverting colostomy (22.4%). 110 patients (88.7%) had chemotherapy recommended; only 71 patients (61.2%) received chemotherapy. The reasons for not receiving chemotherapy included patient finances (n = 19) and mortality (n = 12). The commonly utilized chemotherapies were FOLFOX (n = 24) and XELOX (n = 15). 62 patients died with a median follow-up among survivors of 4.4 months. Overall 12-month survival from date of diagnosis (N = 138), was 48.4% (95% confidence interval 38.9-60.1). Conclusions: The majority of patients that present to hospitals in Nigeria with CRC are stage IV. The mortality rate is high. These data serve as a baseline to judge current screening trials. Identifying high-risk patients for screening is vital to improve outcomes.
Use and impact of selective internal radiation therapy (SIRT) in routine care patients with metastatic colorectal cancer (mCRC).
Authors: Lee Belinda , Wong Hui-Li , Field Kathryn Maree , Nott Louise M. , Shapiro Jeremy David , Wong Rachel , Power Jeremy David , Kosmider Suzanne , Lim Lionel , Gibbs Peter 
Published: February 2017

742 Background: The liver is the dominant site of metastasis in patients (pts) with mCRC. Radioembolisation is a potential option in the multidisciplinary management of these patients. Recently initial analysis of a randomised controlled trial (RCT) in the 1st line setting demonstrated no overall progression free survival (PFS) benefit from adding SIRT, but prolongation of liver PFS (HR 0.69, p=0.002) was seen. Methods: Consecutive pts with mCRC enrolled from January 2009 were identified from a prospective multi-site Australian registry. Characteristics and outcomes for pts selected for treatment with SIRT were analysed. Results: Of 1,694 pts with mCRC, 580 (34.2%) had liver only disease at diagnosis, 409/580 (70.5%) with synchronous vs 166/580 (28.6%) with metachronous disease. Of pts with liver only disease, 187 (32.2%) were considered resectable at diagnosis, 100 (17%) as potentially resectable and 293 (51%) were treated with palliative intent. Overall 47 pts received SIRT with 1stline chemotherapy (CT). SIRT treated pts were more likely to have a synchronous presentation (85% vs 68%, p=0.01), liver only disease (83.0% vs 27.3%, p=<0.01), to be ECOG 0 (51.1% vs 34.6%, p=0.01), to be younger (60.8 years vs. 65.9 years, p=0.008) and to be enrolled on a RCT (38.3% vs 7.3%, p=<0.01). In the liver only population treated with palliative intent, SIRT treated pts (n=30) vs CT only pts (n=188) had a median PFS of 10.6 months vs 9.9 months (HR 0.87, p = 0.18) and a median OS of 24.3 months vs 19.3 months (HR 0.73, p = 0.04). Conclusions: SIRT is rarely used in the 1st line treatment of mCRC in routine practice. The available data suggests that OS gains can be seen in the absence of differences in PFS. However, this observed differential effect on survival maybe due to selection biases. SIRT treated patients were significantly younger and fitter than the CT alone group. Future analyses will include a multivariate analysis and examine the impact of the recently presented SIRFLOX trial data on the use of SIRT in clinical practice.
An open-label, randomized, parallel-group study of the pharmacokinetics of trifluridine as a component of TAS-102 versus FTD alone.
Authors: Sun Weijing , Rosen Lee S. , Rasco Drew W. , Yoshida Kenichiro , Seraj Jabed , Shapiro Geoffrey , Cleary James M. 
Published: February 2017

751 Background: TAS-102 is a novel oral combination therapy of FTD plus tipiracil hydrochloride (TPI) with FTD:TPI molar and weight ratios of 1:0.5 and 1:0.471, respectively. FTD is a thymidine-based nucleoside analog that has shown antitumor effects in preclinical and clinical studies. TPI stabilizes orally administered FTD by inhibiting thymidine phosphorylase and TAS-102 has shown efficacy in refractory metastatic colorectal cancer. The objective of this study was to show that TPI, administered with FTD as TAS-102, increases exposure to FTD in patients with advanced solid tumors. Methods: This is a Phase 1, randomized, open-label, pharmacokinetic study of TAS-102 in patients with advanced solid tumors. On the morning of Day 1, one group received TAS-102 35 mg/m2 and the other group received FTD 35 mg/m2. Both groups received TAS-102 35 mg/m2 on the evening of Day 1, then twice daily on Days 2-5 and 8-12 in a 28-day cycle. Blood samples were collected to evaluate FTD AUC0-last and Cmax (primary endpoints). Results: Overall, 44 patients (50% male, mean age 57 years) were treated. After a single dose, the ratio of the geometric mean of FTD AUC0-last and Cmax were 38- and 22-fold higher, respectively (Table) following TAS-102 vs FTD alone. After multiple doses (Day 12 in Cycles 1, 2, or 3), FTD AUC and Cmax were ~3- and 2-fold higher, respectively, than after a single dose of TAS-102 (Day 1). For TPI, AUC and Cmax were similar after single and multiple doses of TAS-102. After Cycle 1, FTD did not accumulate with successive cycles of TAS-102 treatment. The most commonly reported treatment-related adverse events were nausea (47.7%), fatigue (31.8%), and anemia (27.3%), with Grade 3-4 events at 4.5%, 2.3%, and 18.2%, respectively. Grade ≥ 3 decreases in neutrophil counts were observed in 42.9% of the TAS-102 group. Conclusions: TPI, in combination with FTD, substantially increased exposure to FTD vs FTD alone. Clinical trial information: NCT01867866. [Table: see text]
Risk evaluation of postoperative complication in patients undergoing rectal cancer surgery.
Authors: Miyakita Hiroshi , Sadahiro Sotaro , Suzuki Toshiyuki , Tanaka Akira , Okada Kazutake , Saito Gota 
Published: February 2017

756 Background: Colorectal cancer patients with postoperative complications have poor long-term outcomes. Rectal cancer is associated with a higher incidence of complications than colon cancer. Reliable predictors of complications would facilitate determination of surgical procedures such as stoma creation. We examined the relations between five kinds of risk score and postoperative complications in patients(pts) with rectal cancer. Methods: The subjects were 261 pts with cStage II/III rectal cancer from 2003 to 2013. We categorized complications into all complications, leakage, infectious complications and intestinal obstruction. Estimation of physiologic ability and surgical stress comprehensive risk scores (E-PASS CRS), surgical Apgar scores (SAS), prognostic nutritional index (PNI), colorectal physiological and operative severity scores for the enumeration of mortality and morbidity (CR-POSSUM), and neutrophil-lymphocyte ratios (NLR) were assessed. Clavien-Dindo (CD) Grade 3a or higher requiring surgically invasive treatment were considered complications. For leakage, CD Grade 3b or higher were considered complications. Results: Complications occurred in 56 pts (21%), leakage (L) in 12 (14%), infectious complications (IC) in 19 (7%), and intestinal obstruction (IO) in 16 (6%). E-PASS CRS significantly correlated with all complications (OR 3.45; p < 0.001), IC (OR 0.26; p = 0.008), L (OR 4.94; p = 0.027), and IO (OR 3.92; p = 0.007). PNI correlated with all complications (OR 0.38; p = 0.002) and IO (OR 3.08; p = 0.024). NLR correlated with all complications (OR 0.40; p = 0.003), IC (OR 0.25; p = 0.004), L (OR 8.66; p < 0.001), and IO (OR 3.86; p = 0.007). SAS correlated with IC (OR 0.19; p = 0.004). CR-POSSUM correlated with all complications, (OR 2.26; p = 0.009), IC (OR 5.02; p < 0.001), and IO (OR 0.28; p = 0.014). Multivariate analysis revealed E-PASS CRS (OR 6.17 p = 0.020) and NLR (OR 7.11 p = 0.011) were independent risk factors for L. Conclusions: Five kinds of risk score were all useful for assessing the risk of complications in rectal cancer. NLR was the only risk factor for leakage that could be used before surgery. Our results suggest NLR might be an auxiliary means of evaluating the need for creation of diverting stoma.
Prediction of the long-term outcomes associated with body mass index and advanced gastric cancer.
Authors: Kim Jae Gyu , Kim Beom Jin , Chi Kyong-Choun , Park Jung Min , Kim Mi Kyoung , Hwang In Kyu 
Published: February 2017

82 Background: Radical gastrectomy followed by adjuvant chemotherapy for advanced gastric cancer brings about serious nutritional impairment. Recent studies have shown an association between body mass index (BMI) and perioperative outcomes of gastric cancer. However, little is known about the association between BMI and long-term outcomes of advanced gastric cancer. Our study evaluated the clinical impact of BMI on the long-term outcomes of gastric cancer staged at II and III, treated by radical gastrectomy followed by adjuvant chemotherapy. Methods: We analysed a total of 211 cases of advanced gastric cancer stage II and III between January 2005 and December 2010 at Chung-Ang University Hospital. The patients were divided into 4 groups according to BMI; underweight, normal, overweight, and obese. In addition, they were divided into two groups (BMI-High vs BMI-Low). We assessed age, sex, tumor location, lymph node involvement, operation method, initial cancer stage, recurrence, and survival (overall survival and disease free survival) between two groups. Results: We classified them into 4 groups according to BMI; underweight, normal, overweight, and obese. There was no difference in overall survival between normal, overweight, and obese group. However, there was significant difference between underweight group and the other groups. As for disease free survival, similar findings were observed. Among 211 patients, 154 patients (72.9%) were included in BMI-L (body mass index < 25), whereas 57 patients (27.1%) in BMI-H (body mass index ≥ 25). There was no difference in age, sex, tumor location, stage, lymph node involvement, operation method, recurrence, and cancer-related death between two groups. When classified into 4 groups as stage II in BMI-H, stage II in BMI-L, stage III in BMI-H, and stage III in BMI-L, overall survival showed significant difference in stage, however, no difference between BMI-H and BMI-L. Disease free survival showed no significant difference in stage and BMI, especially, no significant difference between stage II in BMI-L and stage III in BMI –H. Conclusions: Our findings suggest that preoperative BMI may predict the long term outcomes of advanced gastric cancer after radical surgery and chemotherapy.
Safety and efficacy of endoscopic spray cryotherapy for esophageal cancer.
Authors: Tsai Franklin C , Ghorbani Shireen , Greenwald Bruce D , Jang Sunguk , Dumot John A. , McKinley Matthew J , Shaheen Nicholas J. , Habr Fadlallah , Wolfsen Herbert C. , Abrams Julian A. , Lightdale Charles , Nishioka Norman S , Johnston Mark H. , Zfass Alvin , Coyle Walter 
Published: February 2017

83 Background: Although surgery is traditionally the standard of care for esophageal cancer, esophagectomy carries significant morbidity and mortality. Alternative endoscopic therapies are needed for patients who are not candidates for conventional treatment. The objective of this study was to assess the safety, efficacy, and tolerability of spray cryotherapy of esophageal cancer. Methods: This study includes patients enrolled retrospectively and prospectively in an open-label registry and patients in a retrospective cohort from twelve academic and community practices. Endoscopic spray cryotherapy was performed until local tumor eradication was confirmed by biopsy or until treatment was halted due to progression of disease, patient withdrawal or co-morbidities. Results: One-hundred and eight patients (median age 75.5, 79.6% male, 93.5% adenocarcinoma, mean length 5.2 cm) underwent 442 treatments (mean 4.2 per patient). Tumor stages included 40 with T1a, 27 with T1b, 10 with unspecified T1, 15 with T2, and 16 with no T stage reported. One-hundred and six patients completed treatment with complete response of intraluminal disease in 54.7%, including complete response in 74.4% for T1a, 50% for T1b, 65.3% for all T1, 6.7% for T2, and 50% for those with no T stage reported. Mean follow-up was 17.3 months. There were no deaths or perforations related to spray cryotherapy. Strictures developed in 11 of 108 patients (10.2%) but were present before spray cryotherapy in 3 of 11. Conclusions: This study suggests that endoscopic spray cryotherapy is safe, well tolerated and effective for early esophageal cancer in patients who are not candidates for conventional therapy.
Outcomes and toxicity in patients treated with bimodality or trimodality therapy for esophageal carcinoma with intensity modulated radiation therapy (IMRT).
Authors: Patel Ajay , Ko Stephen , James Sarah Elizabeth , Ashman Jonathan Ben , Rule William G. , Hobbs Corey James , Hallemeier Christopher Leigh , Brennan Emily R. , Heckman Michael , Tzou Katherine S. , Vallow Laura , Peterson Jennifer Layton , Miller Robert Clell , Buskirk Steven J. 
Published: February 2017

88 Background: There is not yet a consensus on the efficacy and safety of IMRT for the treatment of patients with esophageal carcinomas. We report on our experience with outcomes and toxicity with IMRT for these patients. Methods: Fifty-five patients with esophageal carcinoma were treated with IMRT at our institution from 12/2008 and 12/2014. Medical records were retrospectively reviewed. All patients received concurrent chemotherapy (majority 5-FU with oxaliplatin). Thirty-one (56%) patients underwent surgery. Fifty (91%) received 50.4 Gy in 28 fractions. Seventy-three percent of cases were adenocarcinoma. Regions include mid-thoracic (15%), lower thoracic (64%), and GE junction (22%). Clinical uT-stages were as follows: T1 (2%), T2 (20%), T3 (69%), and T4a (5%). Clinical N-stages were as follows: N0 (33%), N1 (53%), N2 (13%), and N3 (2%). Results: Median follow-up for all patients was 15 months (1.5 - 64.5) and 25.5 months (1.5 - 64.5) for patients who were alive at follow-up (n = 31). Fifty-one (93%) patients completed RT. Of the 31 patients who underwent surgery, 9 (29%) were found to have a complete pathologic response. Site of first recurrence was local (n = 2, 4%), regional (n = 3, 6%), and distant (n = 14, 26%). At 12 and 24 months, overall survival was 72% and 58%, freedom from recurrence was 78% and 65%, and freedom from distant recurrence was 78% and 68%. On univariate analysis, improved OS was noted with patients who underwent surgery (RR 0.29) or were cN0 (RR 0.27). Twenty eight patients (51%) experienced > / = CTCAE v.4grade 3 acute toxicity; notable were hematologic (n = 14, 25%), esophagitis (n = 6, 11%), acute coronary event (n = 1, 2%), and post-chemoRT pneumonia (n = 1, 2%). Fifteen patients (31%) experienced > grade 3 late toxicity; notable were esophageal stricture (n = 7, 14%), post-op pneumonia (n = 3, 6%), post-CRT pneumonia (n = 2, 4%), and COPD exacerbation (n = 1, 2%). Conclusions: Patient receiving IMRT with concurrent chemotherapy for esophageal carcinomas have good LC rates, with or without surgery. Majority of patients are able to finish treatment with acceptable rates of late toxicity. Patient who underwent surgery or were cN0 had better OS.
Changes of weight and body composition after gastrectomy in the elderly gastric cancer patients.
Authors: Segami Kenki , Aoyama Toru , Maezawa Yukio , Kano Kazuki , Sato Tsutomu , Ogata Takashi , Cho Haruhiko , Yoshikawa Takaki 
Published: February 2017

89 Background: Body weight, especially lean body mass, significantly reduces after gastrectomy for gastric cancer due to surgical invasion, reduced food intake, or decreased mobility, which could decrease quality of life and toxicity / compliance of adjuvant chemotherapy. These risks might be high especially in the elderly gastric cancer patients. However, it remains unclear whether changes of weight and body composition are different between the elderly and the non-elderly. Methods: This retrospective study examined patients who underwent curative surgery for gastric cancer between June 2010 and March 2014. Body weight and composition were evaluated by a bioelectrical impedance analyzer within 1 week before surgery (first measurement), at 1 week after surgery (second measurement), at 1 month after surgery (third measurement), and at 3 months after surgery (forth measurement). Patients were classified to the elderly (> 75 years) and the non-elderly ( < 75 years). Results: Four-hundred forty three patients (100 for the elderly and 343 for the non-elderly) were entered in the present study. Patients backgrounds, surgical factors, clinicopathological factors, surgical complications and adjuvant chemotherapy were not significantly different between the two groups. %Body weight loss until 1week, 1month, 3 months after surgery, defined as the proportion of the difference between 1st measurement and each measurement after surgery against 1st measurement, was 3.3%, 6.6%, and 9.7%, respectively in the elderly and 3.7%, 5.4%, and 8.2%, respectively in the non-elderly with significant difference (p = 0.05, 0.01, and 0.01, respectively). %Lean body mass loss until 1 week, 1 month, 3 months after surgery was 3.2%, 5.6%, and 6.1%, respectively in the elderly and 3.2%, 4.5%, and 4.2%, respectively in the non-elderly with p value of 0.36, 0.08, and 0.01, respectively. %Fat loss was not significantly different between the two groups at any time. Conclusions: Decreases in body weight and lean body mass after gastrectomy were more serious in the elderly patients as compared with the non-elderly. Surgical indication for the elderly must be carefully determined considering the risk and the benefit.
Alteration of recurrence patterns and prognostic factors by adjuvant S-1 monotherapy in patients with stage II/III gastric cancer.
Authors: Kanda Mitsuro , Kobayashi Daisuke , Tanaka Chie , Iwata Naoki , Yamada Suguru , Fujii Tsutomu , Nakayama Goro , Sugimoto Hiroyuki , Koike Masahiko , Fujiwara Michitaka , Kodera Yasuhiro 
Published: February 2017

90 Background: Survival benefit of adjuvant S-1 monotherapy among East Asian patients with stage II/III gastric cancer (GC) has been demonstrated by the ACTS-GC trial. Little is known about the changes in prognostic factors and recurrence patterns after it has become widespread as a standard of care. Methods: We enrolled 171 patients with stage II/III GC, 92 patients who underwent gastrectomy alone, and 79 patients treated with S-1 adjuvant. To balance more strictly the essential variables including stage of progression, we conducted propensity score analysis and 70 pairs of patients were generated from each group. Prognostic factors were compared between the groups and initial recurrence patterns were investigated to explore reasons for the change. Results: In concordance with the previous phase 3 trial, overall and recurrence-free survival were better for the S-1 adjuvant group. In the surgery alone group, carcinoembryonic antigen > 5 ng/mL, total gastrectomy, vessel invasion, pT4, and stage 3 were identified as significant prognostic factors. In striking contrast, macroscopic tumor size > 50 mm was the only significant prognostic factor for the S-1 adjuvant group. The lower overall recurrence rate of the S-1 adjuvant group was attributable mainly to a significant decrease of peritoneal recurrence. Conclusions: Prognostic factors changed substantially after implementation of S-1 adjuvant treatment. Macroscopic tumor size should be considered for patient stratification and selection of treatment options for patients with stage II/III GC.
Clinicopathological features of ruptured GIST in the ReGISTry study of high risk GIST patients after complete resection in Japan.
Authors: Nishida Toshirou , Kondo Masato , Ozaka Masato , Cho Haruhiko , Komatsu Yoshito , Doi Toshihiko , Baba Hideo , Kitagawa Yuko , Kurokawa Yukinori , Kanda Tetsuo , Sugiyama Toshiro , Sawaki Akira , Kakeji Yoshihiro , Hirai Toshihiro , Hato Shinji , Shirao Kuniaki , Ishioka Chikashi , Hirota Seiichi , Kagimura Tatsuo , Takagi Masakazu ,   STAR ReGISTry Gtoup
Published: February 2017

96 Background: Ruptured GIST, either preoperatively or intraoperatively, has ominous prognosis and is classified as high risk GIST in the modified Fletcher risk stratification. Although patients (pts) with these GISTs are recommended for 3-year imatinib adjuvant therapy, their clinicopathological features and compliance of guidelines are unknown. Methods: Between Dec. 2012 and Aug. 2015, 474 pts with high-risk GISTs locally diagnosed were prospectively registered. Among them, 453 pts with GISTs histologically confirmed by central review were analyzed. There were 243 males and 210 females with median age of 65 yrs. In the central review, H&E, immunohistochemistry, and genotyping were tested. Results: Disease was located in the stomach (n = 279), small intestine (n = 137), large intestine (n = 25), or others (n = 12). Median tumor size was 7.7 cm and median mitosis (local pathology) was 10/50HPF. Tumor rupture was seen in 54 pts (12%) who had preoperative rupture (28 pts) or intraoperative rupture (25 pts). After surgery, adjuvant therapy was administered for 342 pts (75%) and withheld for 89 pts (20%). Tumor rupture was frequently observed in small intestinal GIST (23.6%) other than the duodenum and in epithelioid and/or mixed features (24%). Mitosis of ruptured GIST (median = 5.0/50 HPF) was significantly lower than that of non-ruptured (11/50 HPF). Age, gender, tumor size and genotype are not related with rupture. There was no difference in postoperative complications and adhibition of adjuvant therapy in pts who have ruptures vs pts who don’t. Preoperative rupture was associated with small intestinal GIST and R1 surgery. Mitosis was significantly lower in GIST with preoperative rupture (5/50 HPF) than that without rupture (11/50 HPF). GIST with intraoperative rupture (11.8 cm) was larger than that without rupture (7.5 cm) although there was no difference in mitosis, location and genotype. Frequency of intraoperative rupture was not different between laparoscopic surgery (4.8%) and open one (6.3%). Conclusions: Tumor rupture was not infrequent in high risk GIST and half of rupture was occurred during surgery, which may be related to large tumor size but not with laparoscopic surgery. Clinical trial information: UMIN000009531.