bluuebunny/crossref_metadata_2025_split huggingface dataset:
Navigation of sentinel node biopsy and selective axillary dissection using 3D-CT mammary lymphography with the arm lymph flow enhancement.
Authors: Yamashita K. , Shimizu K. , Haga S. 
Published: February 2017

98 Background: In early breast cancer, the presence of metastasis in axillary lymph nodes (AN) is an important factor in prognosis and further treatment. However, AN dissection causes many complications such as contracture of shoulder joint, lymph edema, and paralysis of upper extremities. Sentinel node (SN) biopsy provides us a valuable information about no need to dissect AN for node-negative patients. However, on node-positive patients, the conventional AN dissection has been performed. 3D-CT lymphography (LG) can show the precise individual lymphatic flow not only from the breast tumor to SN but also from SN to venous angle, which means breast lymphatic channel. We applied 3D-CT LG to distinguish them from the arm channel to avoid any arm complications. Methods: 3D-CT LG was performed before surgery to mark SN on the skin. Above the tumor and near the areola and the arm pit, 2 ml of iopamidol 300 was injected subcutaneously. Images of CT scan were taken at 1, 3, and 10 min after injection. They were reconstructed to produce a 3D image of lymph ducts and lymph nodes by the volume rendering software. The axillary node groups were classified to 5 groups as described before. The arm lymph channel was classified to 4 regions. SN biopsy and AN sampling were performed by dye-staining method using endoscopy. Results: We have performed 3D-CT LG on 200 patients and evaluated the arm lymph flow on 50 patients. The average age was 55.1 years old. The average tumor size was 2.4 cm. The average sampled number of SN was 2.3. The arm lymph channels were observed at 10 minutes after injection. They were divided into four directions: around and above the axillary vein (64%), the axilla (12%), the supraclavicule (8%), and the lateral chest (16%). The connection between the breast and the arm channel was observed in each five groups of axillary nodes shown by 3D-CT LG. We could detect their position on the axillary lymphatic mapping by 3D-CT LG during surgery. The selective axillary dissection can be performed by avoiding the arm lymph channel. Conclusions: The arm lymph channel can be observed by 3D-CT LG with the arm enhancement, which will help the selective axillary dissection to prevent the arm lymph edema.
The prognostic significance of apoptosis-related biological markers in Chinese gastric cancer patients.
Authors: Liu X. , Xu Y. , Long Z. , Zhu H. , Wang Y. 
Published: February 2017

108 Background: The prognosis varied among the patients with the same stage, therefore there was a need for new prognostic and predictive factors. The aim of this study was to evaluate the relationship of apoptosis-related biological markers such as P21, P27, P53, Bcl-2, Bax, and c-myc, and clinicopathological features and their prognostic value. Methods: From January 1996 to December 2007, 4,426 patients had undergone gastrectomy for gastric cancer at Fudan University Shanghai Cancer Center. Among 501 patients, the expression levels of P21, P27, P53, Bcl-2, Bax, and c-myc were examined by immunohistochemistry. The prognostic value of biological markers and the correlation between biological markers and other clinicopathological factors were investigated. Results: There were 339 males and 162 females (2.09:1) with a mean age of 57. The percentages of positive expression of P21, P27, P53, Bcl-2, Bax, and c-myc were 73%, 25%, 65%, 22%, 43%, and 58%, respectively. There was a strong correlation between P21, P53, Bax, and c-myc expression (p = 0.00). There was significant association between P27, Bcl-2, and Bax expression (p < 0.05). The P21 expression correlated with male (p = 0.00), histological grade (p = 0.00), Borrmann type (p = 0.02), tumor location (p = 0.01); the P53 expression with histological grade (p = 0.01); Bcl-2 expression with pathological stage (p = 0.01); Bax expression with male (p = 0.02), histological grade (p = 0.01), Borrmann type (p = 0.01), tumor location (p = 0.00), lymph node metastasis (p = 0.03), pathological stage (p = 0.01); c-myc expression with Borrmann type (p = 0.00). Bcl-2 expression was related with good survival in univariate analysis (p = 0.01). Multivariate analysis showed that Bcl-2 expression and pathological stage were defined as independent prognostic factors for gastric cancers. There was significant differences of overall 5-year survival rates according to Bcl-2 expression or not in stage III (p = 0.00). Conclusions: The expressionof Bcl-2 was an independent prognostic factor for Chinese patients with gastric cancer; it might be a candidate for the gastric cancer staging system. No significant financial relationships to disclose.
Conditional survival nomogram after an R0 resection for gastric cancer.
Authors: Dikken J. L. , Van De Velde C. J. , Verheij M. , Baser R. , Gonen M. , Kattan M. W. , Shah M. A. , Brennan M. F. , Coit D. G. 
Published: February 2017

11 Background: The risk of dying of cancer is highest in the first two years after a curative resection for gastric cancer. Therefore, the prognosis of patients who did not recur in the first two years is improved because they survived this critical period, a phenomenon called conditional survival. The US-derived gastric cancer nomogram predicts disease-specific survival (DSS) based on pathological variables. However, a disease-free interval after surgery, which improves the prognosis, is not captured by the nomogram. Therefore, it has only been used directly after surgery and not in the follow-up setting. The purposes of this study were to develop a conditional survival nomogram for 1, 2 and 3-year survivors (step 1) and to test if the introduction of follow-up variables would improve predictive accuracy of the nomogram in the follow-up setting (step 2). Methods: In a combined US-Dutch population of 1642 patients who underwent an R0 resection for gastric cancer and for whom the old nomogram variables were available, a conditional survival nomogram based on the original variables was developed for one (N=1147), two (N=879) and three (N=721) year survivors (step 1). To improve predictive accuracy in the follow-up setting, weight loss, performance status (PS), hemoglobin (HGB), and albumin (ALB) at one year after resection were retrospectively collected and added to the baseline variables in a new nomogram (step 2). Results: The conditional survival nomograms for 1, 2 and 3-year survivors (step 1) showed a high predictive accuracy in the calibration plots. Surviving one, two and three years shows a median improvement of 5-year DSS of 4%, 9% and 14% respectively. The introduction of weight loss, PS, HGB, and ALB at one year after surgery (step 2) did not improve this nomogram, but availability of these variables was limited. Conclusions: A strongly predictive conditional survival nomogram was developed, giving an improved prognosis for 1, 2 and 3-year survivors of gastric cancer. Introduction of variables available at one year after resection did not further improve this nomogram. This might be caused by the limited availability of follow-up data, as well as the strong predictive accuracy of the original variables. No significant financial relationships to disclose.
Outcomes and efficiency of National Cancer Screening Program for gastric cancer in Korea.
Authors: Kim B. , Cheon W. , Kim J. , Park J. , Kim S. 
Published: February 2017

13 Background: Gastric Cancer is a major cause of death and a substantial socioeconomic burden in Korea. The National Cancer Screening Program for Medicaid recipients was initiated in 1999 and has contributed to reduction of cancer-related mortality in Korea. Endoscopy may be cost-effective screening tool in Korea, where the cost of endoscopy and UGIS are similar and the gastric cancer incidence is high. Most of Japanese studies on the efficiency of mass screening for gastric cancer have dealt with photoflurography as a screening tool. Although biennial gastric cancer screening by endoscopy has been increasing in Korea as part of the National Cancer Screening Program, few studies have evaluated its efficiency. Therefore, we analyzed the outcomes and efficiency of the National Cancer Screening Program for gastric cancer using endoscopy in Korea. Methods: We reviewed results from the National Cancer Screening Program for gastric cancer at Chung-Ang University Yongsan Hospital in Korea from March 2003 to March 2008. The study population was comprised of Medicaid recipients ≥ 40 years of age who were taken from the National Health Insurance Corporation. Results: A total of 7,278 asymptomatic subjects underwent endoscopy for gastric cancer screening. The mean age of the screened subjects was 51.3 years for men and 48.9 years for women. The male to female ratio of the screened subjects was 1.2:1. Gastric cancer was diagnosed in 32 (0.44%) of 7,278 subjects (22 men and 10 women). Their mean age was 54.4 years. Of these, 21 subjects (0.29%) were diagnosed as early gastric cancer and 11 subjects (0.15%) were advanced gastric cancer. The proportion of EGCs among total gastric cancers was 65.6%. The compliance with this program was low (59% for men and 49% for women). Conclusions: Despite accomplishments of the National Cancer Screening Program for gastric cancer in Korea, its effectiveness remains an issue. Efficiency and cost-effectiveness analysis will be needed for successful progression. No significant financial relationships to disclose.
Locally advanced gastric cancer treated with neoadjuvant chemotherapy: Epirubicin, oxaliplatin, and capecitabine (EOX).
Authors: Pluschnig U. , Zacherl J. , Schoppmann S. , Raderer M. , Prager G. , Bartsch R. , Ba-Ssalamah A. , Lamm W. , Zielinski C. , Hejna M. 
Published: February 2017

136 Background: Gastric cancer is a worldwide common malignant disease with a high mortality rate. Adjuvant chemotherapy did not result in a survival advantage in Caucasian populations. Therapeutic chemotherapy options consist of either monotherapy or of polychemotherapy and have been applied as neoadjuvant chemotherapy with combinations of epirubicin, cyclophosphamide and 5-fluorouracil or capecitabine as well as cisplatin or oxaliplatin. The aim of this retrospective analysis was to investigate the use of the EOX regimen in the neoadjuvant setting which had shown activity in advanced gastric cancer. Methods: 23 patients (pts) (median age: 70, range 36-85, years; 16 pts >65 years) with locally advanced adenocarcinoma of the upper GI-tract received 3 courses of preoperative chemotherapy with epirubicin 50 mg/m2, day1, oxaliplatin 130 mg/m2, day 1, and capecitabine 2,000 mg/m2, days 1-14, of a 3-week cycle. Toxicity was assessed by CTC (Common Toxicity Criteria) after every cycle. Progression free survival (PFS) was defined as time from surgery to disease progression assessed by PET-CT which was performed at diagnosis and after 3 cycles chemotherapy. Results: 20 pts completed all three planned cycles of preoperative chemotherapy, 2 pts received only 1 cycle because of rapid tumor progression and 1 pt. is currently still on treatment. 16 pts. underwent surgery with curative resection with 2 pCRs on pathological review. 6 pts. remained inoperable despite chemotherapy and 1 pt is currently scheduled for surgery. After surgery, 2 pts. died after a median of 9 months (8-10). 4 pts. died without surgery due to disease progression. After a median follow-up of eight months (range 5-26), median PFS and overall survival was not reached yet. In 2 pts., grade 3-4 toxicities including nausea, diarrhea and hand-foot syndrome and one non-life-threatening pulmonary embolism occurred. Conclusions: In summary, EOX is a well tolerated, safe, and efficacious neoadjuvant treatment in also elderly patients with locally advanced adenocarcinoma of the upper GI-tract. However, more studies with a larger population are needed to corroborate the current results of this promising treatment schedule. [Table: see text]
Role of chemoradiotherapy alone in the management of unfit patients with nonmetastatic locally advanced squamous cell carcinoma of the esophagus.
Authors: Pisa A. , Moya I. , Pericay C. , Dotor E. , Alfaro J. , Alvarado A. , Navarro S. , Orellana R. , Pampols M. , Saigí E. 
Published: February 2017

138 Background: Surgery is considered the best treatment for patients (pts) with non-metastatic locally advanced squamous cell carcinoma of the esophagus who have responded to neoadjuvant chemoradiotherapy (CRT) in terms of locoregional control. However, in these pts PFS and OS have not been proved superior to those achieved by CRT alone. Besides, the addition of surgery to CRT increases treatment-related morbidity and mortality. Unfit pts are usually declined for surgical procedures and included in definitive CRT programs. The aim of this study was to define the role of non-surgical strategies (CRT, CT or RT) in unfit pts considered non-optimal for surgical procedures. Methods: We retrospectively reviewed 90 pts with squamous cell carcinoma of the esophagus who had been diagnosed and treated at our institution from January 2004 to December 2009. Fifty-one pts were non-metastatic among which 19 underwent surgery and 32 a non-surgical procedure (CRT, CT, RT or BSC). Our aim was to identify OS, PFS, RR, data on comorbidity and toxicity in these 32 pts. Results: Thirty out of the 32 pts were men with a median age of 62 years (range 41-90). Comorbidity was detected in 17 pts (53%) as means of respiratory disorders (21.9%), cardiopathy (12.5%), hepatopathy (21.9%), synchronic tumors (25%) and metachronic tumors (25%). Seventeen pts received CRT, 7 received CT, 1 received RT and 7 received BSC alone (53%, 22%, 3% and 22% respectively). Grade 3 and 4 toxicities were observed in 15 pts (46.9%) as means of mucositis (18.8%), oesophagitis (15.6%), diarrhoea (12.5%) and neutropaenia (12.5%). One patient in the CRT group died of toxicity. RR was 43.8% (70.6% for CRT, 14.3% for CT alone). Median follow-up was 17.2 months. Median PFS was 11.3 ± 6.12 months (17.9 for CRT, 5.1 for CT alone). Median OS was 15.6 ± 7.6 months (6.9 for CT alone). Conclusions: Our experience with CRT alone in unfit pts with locally advanced squamous cell carcinoma of the oesophagus supports its use with a median PFS of 17.9 months and controllable toxicity. Data on median OS are lacking due to pending long-term follow-up. No significant financial relationships to disclose.
Phase I study of biweekly intravenous paclitaxel plus intraperitoneal cisplatin and paclitaxel for gastric cancer with peritoneal metastasis.
Authors: Ishigami H. , Kitayama J. , Kaisaki S. , Yamaguchi H. , Yamashita H. , Emoto S. , Nagawa H. 
Published: February 2017

139 Background: Intraperitoneal (IP) chemotherapy is promising for the treatment of gastric cancer with peritoneal metastasis. We previously verified the safety and efficacy of IP paclitaxel (PTX) combined with S-1 and intravenous (IV) PTX in phase I and phase II studies (Oncology. 2009; Ann Oncol. 2010). Secondly, we developed a new IP-containing chemotherapy regimen, IV PTX plus IP cisplatin (CDDP) and PTX, for patients who have failed S-1-based chemotherapy. We performed a phase I study to determine the maximum-tolerated dose (MTD) and recommended dose (RD) in gastric cancer patients. Methods: A total of 9 gastric cancer patients were enrolled who had shown progression of peritoneal metastasis after S-1-based chemotherapy. PTX was administered intravenously at a dose of 100 mg/m2 and intraperitoneally over 1 hour with an initial dose of 20 mg/m2 (level 1), stepped up to 30 or 40 mg/m2 depending on observed toxicity. CDDP was subsequently administered intraperitoneally at a dose of 30 mg/m2 over 24 hours after PTX infusion. PTX and CDDP were administered on days 1 and 15 in 4-week cycles. Results: At dose level 1, dose-limiting toxicities (DLTs) were observed in 2 of 3 patients. One patient experienced grade 4 leukopenia, and the other grade 3 vomiting. Because of higher toxicities than anticipated, the initial dose-escalation schedule was abandoned, and the doses of IV PTX and IP CDDP were reduced to 80 mg/m2 and 25 mg/m2, respectively, while keeping the dose of IP PTX at 20 mg/m2 (level 0). At dose level 0, one of the first 3 patients experienced grade 3 nausea, and an additional 3 patients experienced no DLTs. Consequently, the MTD and RD were determined to be dose level 1 and dose level 0, respectively. No patients experienced complications related to the peritoneal access device or IP infusion. Conclusions: Combination chemotherapy of IV PTX plus IP CDDP and PTX was shown to be a safe regimen that should be further explored in clinical trials. No significant financial relationships to disclose.
Laparoscopic distal gastrectomy for gastric cancer: Institutional experience with 38 consecutive patients and oncologic outcomes.
Authors: Ho J. , Kachikwu E. L. , Nelson R. A. , Ellenhorn J. D. 
Published: February 2017

145 Background: The application of laparoscopy in the surgical treatment of gastric cancer has become more popular in recent years. Most of the published series are from Asia and few report on survival. Our objective was to elucidate the safety, efficacy, and oncologic outcomes of laparoscopic distal gastrectomy in patients with gastric cancer. Methods: The medical records of all patients who underwent laparoscopic distal gastrectomy at City of Hope National Medical Center between 6/2005 and 8/2010 were retrospectively reviewed. Relevant data analyzed included patient demographics, operative parameters, complications, recurrence, and survival. Results: A total of 38 consecutive patients were identified. Thirty-four of the 38 patients had a diagnosis of gastric adenocarcinoma. Median age was 70 years (35-96). Median operative time was 379 min (228-583). Median EBL was 200 ml (10-900). Seventeen of the 38 laparoscopic distal gastrectomy cases employed robotic assistance in lymph node dissection. The median number of lymph node retrieval was 23.5. Twenty-two cases included D2 lymph node dissections, 14 cases were D1 dissections, and 2 cases involved D0 dissections. All intended D2 dissections had greater than 15 nodes retrieved. Median hospital stay was 6 days (3-39). Morbidity and mortality rates were 11% and 0%, respectively. Of the 34 patients with gastric adenocarcinoma, histological staging revealed 1 patient had stage 0 disease, 25 had stage I, 7 had stage II, and 2 had stage III. Median follow-up was 12 months (0.5 to 58). Cancer recurrence occurred in 2 patients (6%). The 3 year overall survival is 69% and disease specific survival is 90%. The median survival has not been reached. Conclusions: Laparoscopic distal gastrectomy is feasible and safe and can be performed in patients with gastric cancer with excellent surgical and oncologic outcomes. No significant financial relationships to disclose.
Palliative resection for stage IV gastric cancer.
Authors: Muto O. , Kotanagi H. 
Published: February 2017

148 Background: Metastatic gastric adenocarcinoma is an incurable condition and little progress has been made in its treatment. The role of palliative surgical resection is still debatable. Methods: We retrospectively evaluated the efficacy of palliative gastrectomy for treating incurable gastric cancer. In our institution 51 cases were found to have incurable tumors at laparotomy and received palliative gastrectomy from 2003 through 2009. In the analysis, particular attention was paid to the prognostic factors of age, tissue type (diffuse type and intestinal type), metastatic site (liver, peritoneal and lymph node) and postoperative chemotherapy. Results: One-year survival rate of all patients was 58% and the median survival time was 23.5 months. The median survival time was significantly greater in patients undergoing chemotherapy group than in those not undergoing chemotherapy (24.0 versus 9.4 months; p=0.016). Conclusions: Long-term survival for patients with stage IV gastric cancer who are managed with surgical resection and chemotherapy is achievable. Further study with a larger number of patients is warranted. No significant financial relationships to disclose.
Effect of six months neoadjuvant imatinib on resectability potential of gastric stromal tumors in Egyptian patients.
Authors: Saied G. M. , Kensarah A. M. 
Published: February 2017

151 Background: Though recurrence is high, local excision is the preferred approach for dealing with gastric stromal tumors. Achieving negative margins is mandatory, sometimes requiring subtotal gastrectomy. Adjuvant imatinib is essential for advanced cases and prolonging survival; however, there is not enough data to recommend its use before surgery to increase resectability. The current study aims at investigating this concept in Egyptian patients. Methods: The study included 16 patients (13 males, 3 females, mean age 60 years) presenting with gastrointestinal stromal tumors (GISTs) who were candidates for emergency (n = 3) or elective (n = 13) surgery. Investigations included endoscopy (+ biopsy), sonography, and computed tomography (CT). Patients were enrolled in two groups: A (n = 6: projected to planned surgery) and B (n = 7: harboring c-kit+ tumors). Each B patient received imatinib (400 mg/day) for 6 months before surgery. Clinical and radiological evaluation was at day 100. The Chi-square test was used to check size changes, and p = <0.02535 was considered significant. Results: All patients had abdominal discomfort, while 62.5% had epigastric pain, and 12.5% had hematemesis. Tumor sizes ranged from 8.4 to 20 cm; 2/3 were located in the upper stomach. Five patients (31.3%) harbored lesions with low risk malignancy, eight (50%) with moderate risk and three (18.8%) with high risk. Wedge gastrectomy was the most common operation performed (81.25%) while partial gastrectomy was carried out in the rest, reporting no recurrence for 6 months. Not determined in group A patients, c-kit status was strongly positive in all members of group B; in two of them treatment was suspended due to poor response. Conclusions: Imatinib has an acceptable safety profile and can be considered as a neoadjuvant therapy in GISTs. Until clear guidelines have been developed, we report that a 6-month intake may noticeably increase their resectability potential and improve prognosis. No significant financial relationships to disclose.