bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of colon cancer sidedness compared to tumor biology on stage-specific survival.
Authors: Dehal Ahmed , Vuong Brooke , Graff-Baker Amanda N , Lee Jihey , Bilchik Anton , Goldfarb Melanie R 
Published: March 2017

543 Background: Recent studies have reported a survival difference between right colon cancer (RCC) and left colon cancer (LCC) but were limited by lack of data on surgical therapy and underlying tumor biology including microsatellite instability (MSI) status. Our objective was to examine the influence of tumor sidedness on stage-specific survival after adjustment for those factors using a large national database. Methods: Adult patients with primary invasive colon cancer were identified from the National Cancer Data Base (NCDB) between 2009 and 2012. Cecum, ascending colon, hepatic flexure, and transverse colon were classified as “RCC” and sigmoid, descending colon, and splenic flexure were classified as “LCC”. Differences in 3-year overall survival (OS) between RCC versus LCC, stratified by stage, were obtained. Results: Of 24,092 patients, 9,095 (37.75%) presented with a LCC and 14,997 (62.25%) with a RCC. After adjustment for confounding factors, including demographics, MSI, KRAS, nodal retrieval and treatment, patients with RCC stage I, III, or IV had a 31-35% decreased OS compared to those with a LCC. However, in patients with stage II disease, RCC had a 15% improvement in OS compared to LCC (Table 1). MSI positivity was not significantly different in RCC versus LCC stage for stage nor did it contribute to decreased OS for either side. Conclusions: Colon cancer sidedness is an independent risk factor for decreased survival after adjusting for potential confounders including tumor biology and treatment characteristics. For patients with stage I, II, and IV disease, RCC portends a decreased survival compared to LCC, whereas the opposite is true for patients with stage II disease. Further research is needed to elucidate the exact the role of sidedness in risk-profiling and staging for colon cancer patients. [Table: see text]
Preoperative evaluation of heat shock protein 47 expression to identify patients with colorectal cancer with lymph node metastasis and poor prognosis.
Authors: Mori Koichiro , Toiyama Yuji , Okugawa Yoshinaga , Ichikawa Takashi , Nagano Yuka , Oki Satoshi , Imaoka Hiroki , Okigami Masato , Fujikawa Hiroyuki , Hiro Junichiro , Saigusa Susumu , Kobayashi Minako , Inoue Yasuhiro , Mohri Yasuhiko , Kusunoki Masato 
Published: March 2017

546 Background: Accumulating evidences reveal that overexpression of Heat shock protein 47 (HSP47) increase cancer progression, and that HSP47 expression in the tumor-associated stroma serve as diagnostic marker in various cancers. In addition, we recently performed immunohistochemistry to evaluate HSP47 expression in surgical colorectal cancer (CRC) specimens, and showed that the count of HSP47 positive spindle cell in cancer stroma was significantly associated with lymph node (LN) metastasis, early recurrence and poor prognosis in CRC patients. Thus, evaluating HSP47 expression in CRCs preoperatively may be valuable for planning the treatment of patients with CRC. In this study, we quantified the messenger RNA(mRNA) expression of HSP47 in CRCs by using preoperative biopsy samples, and analyzed the association between HSP47 mRNA expression and clinico-pathological factors including prognosis in patients with CRC. Methods: A total of 139 CRC samples, which were taken by biopsy before surgery at Mie University Hospital from 2000 to 2005, were enrolled. HSP47 gene expression was determined by quantitative real-time reverse transcription–PCR using Power SYBR Green PCR methods. Results: All CRC patients were classified according to the tumor-node-metastasis (TNM) classification system as follows: stage I (n = 33); stage II (n = 44); stage III (n = 33), and stage IV (n = 29). High HSP47 expression in CRC was significantly associated with higher T stage (p = 0.0163), LN metastasis (p = 0.0186), vessel invasion (p = 0.0328) and higher TNM staging (p = 0.0115). Kaplan-Meier analysis showed that patients with high HSP47 expression had significantly poorer overall survival (OS) than those with low (p = 0.0003). Furthermore, multivariate analyses revealed that HSP47 expression was an independent predictive marker for LN metastasis and poor OS in CRC patients, respectively (LN metastasis; OR; 2.3946, p = 0.0249, OS; HR; 2.7407, p = 0.00224). Conclusions: In conclusion, quantification of HSP47 expression using biopsy samples can identify the CRC patients who may suffer from LN metastasis and poor prognosis, preoperatively.
Prognostic value of the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in patients with colorectal cancer.
Authors: Kim Jae Hyun , Park Seun Ja 
Published: March 2017

551 Background: Inflammatory response plays an important role in the pathogenesis of cancer. Some evidence has suggested that elevations in the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are associated with decreased survival in various types of cancer. In this study, we aimed to evaluate the prognostic value of the NLR and PLR in patients with colorectal cancer (CRC). Methods: Between August 1995 and December 2010, medical records from a total of 2,004 patients with CRC were retrospectively reviewed. The values of simple inflammatory markers including NLR and PLR in predicting the long-term outcomes of these patients were evaluated using Kaplan-Meier curves and multivariate Cox regression models. Results: The median follow-up duration was 42 months (interquartile range, 19 – 69). The estimation of NLR and PLR was based on the time of diagnosis. In multivariate Cox regression analysis, high NLR ( ≥ 2.6) [hazard ratio (HR) 2.251, 95% confidence interval (CI) 1.570-3.228, p < 0.001] and high PLR ( ≥ 155) [HR 1.473, 95% CI 1.019 – 2.128, p = 0.039] were independent risk factors predicting poor overall survival (OS) in CRC patients. Combined high NLR and PLR was also an independent risk factor predicting poor OS in patients with CRC [HR 2.316, 95% CI 1.529 – 3.508, p < 0.001]. Conclusions: In this study, we identified that high NLR ( ≥ 2.6), high PLR ( ≥ 155), and combined high NLR and PLR are useful prognostic factors to predict OS in CRC patients.
Octogenarian patients with colorectal cancer: Characterizing an emerging clinical entity.
Authors: Goldvaser Hadar , Katz Shroitman Noa , Ben-Aharon Irit , Purim Ofer , Kundel Yulia , Shepshelovich Daniel , Shohat Tzippy , Brenner Baruch 
Published: March 2017

552 Background: Colorectal cancer (CRC) in Octogenarians is an emerging clinical entity. It is currently unclear whether these patients have unique features and whether their treatment should differ from younger patients with CRC. The aim of this study was to better characterize this patients population. Methods: A single-center, retrospective cohort study which included patients diagnosed with CRC at the age of ≥ 80 years between 2008-2013. A control group included consecutive patients younger than 80 years diagnosed with CRC during the same period. Clinicopathological characteristics, treatment and outcome were compared between the groups. Results: The study included 350 patients, followed for a median of 40.2 months (range 1.8-97.5). Several significant differences were noted. Elderly patients had a higher proportion of Ashkenazi ethnicity (p < 0.001), lower rates of family history of any cancer (p < 0.001) and family history of CRC (p = 0.006), and a higher rate of personal history of other malignancies (p = 0.035). CRC diagnosis by screening was less frequent in octogenarians (p < 0.001) and their performance status at presentation was worse. Octogenarians were more likely to have tumors located in the right colon (p = 0.029) and had a lower prevalence of well differentiated histology (p = 0.025). They received less treatment and treatment was less aggressive, both in patients with metastatic and non-metastatic disease, regardless of performance status. Their 5-year cancer specific survival was worse (63.4% vs.77.6%, p = 0.009), both for metastatic (p = 0.03) and for non-metastatic disease (p = 0.028). Conclusions: Elderly patients with CRC presented several differences in clinical and tumor characteristics compared to their younger counterparts. They were less likely to receive treatment and they had worse outcome. Further research is needed to better define this growing patient population and to establish their optimal treatment.
Impact of extra-nodal metastasis on survival in gastric cancer patients with lymph node involvement.
Authors: Nishiwaki Noriyuki , Tokunaga Masanori , Furukawa Kenichiro , Fujiya Keiichi , Omori Hayato , Takagi Wataru , Hirata Fumiko , Kaji Sanae , Hikage Makoto , Makuuchi Rie , Tanizawa Yutaka , Irino Tomoyuki , Bando Etsuro , Kawamura Taiichi , Kinugasa Yusuke , Sugiura Teiichi , Uesaka Katsuhiko , Terashima Masanori 
Published: March 2017

57 Background: Extra-nodal metastasis (ENM) is defined as a tumor nodule without lymph node structure, and distinguished from lymph node metastasis by histological findings. Despite the possible difference in metastatic mechanism, both are counted as metastasized lymph nodes according to the 3rd English edition of Japanese Classification of Gastric Carcinoma, and thus the prognostic value of ENM remains unclear. The aim of this study was to clarify the clinicopathogical characteristics and prognostic impact of ENM in gastric cancer patients with lymph node involvement. Methods: This study included 388 patients who underwent curative gastrectomy for primary gastric cancer between January 2009 and August 2013. A total of 2093 pathologically positive tumor nodules, including both metastatic lymph nodes and ENM, were examined. Clinicopathological characteristics and survival outcomes were compared between an ENM positive (ENMP) group (95 patients) and an ENM negative (ENMN) group (293 patients). In addition, multivariable analysis was performed to clarify the independent prognostic factors. Results: ENM was found in 269 of 2093 tumor nodules (12.9 percent). The incidence of ENM was significantly higher in patients with large tumor size, high pathological T stage (pT), high pathological N stage (pN) and in those with macroscopic infiltrative tumors, vascular and lymphatic invasion. Three-year relapse free survival was significantly worse in the ENMP group (56.5%) than in the ENMN group (82.4%, p < 0.001). Multivariable analysis revealed that ENM as well as age, pT and histological type was an independent prognostic factor. Conclusions: ENM is an independent prognostic factor in gastric cancer patients with lymph node involvement. A new N classification stratified by the presence of ENM might be considered.
Clinicopathological features and prognostic factors of colorectal neuroendocrine neoplasms.
Authors: Jiang Mengjie , Hu Hanguang , Yuan Ying 
Published: March 2017

572 Background: Limited research is available regarding colorectal neuroendocrine neoplasms (NENs), especially in China. The prognostic factors of colorectal NENs remain controversial. Methods: A total of 68 patients with colorectal NENs were studied retrospectively. Clinical characteristics and prognosis between colonic and rectal NENs were compared. The Kaplan-Meier method and Cox regression models were used to evaluate the capacity of various factors to predict the outcome. Results: Of the 68 colorectal NENs patients, 43 (63.2%) had rectal NENs, and 25 (36.8%) had colonic NENs. Compared with rectal NENs, colonic NENs more frequently exhibited larger tumor size ( P < 0.0001) and distant metastasis ( P < 0.0001). Colonic NENs had a worse prognosis ( P= 0.027), with 5-year overall survival rates of 66.7% vs. 88.1% compared with rectal NENs. Neuroendocrine tumors, neuroendocrine carcinomas and mixed adenoendocrine carcinomaswere noted in 61.8%, 23.5% and 14.7% of patients, respectively. According to the available data (n = 49), Ki-67 index values were ≤ 2% in 27 (39.7%) patients, ranged from 3 to 20% in 6 patients (8.8%) and were > 20% in 16 patients (23.5%). Multivariate analyses revealed that tumor location was not an independent prognostic factor ( P= 0.081), but tumor size ( P= 0.037) and pathological classification ( P= 0.012) were independent prognostic factors. Conclusions: Significant differences in clinicopathological feature and outcome exist between colonic and rectal NENs. Multivariate analysis indicated that tumor size and pathological classification were associated with the prognosis. However, tumor location was not an independent factor. The worse outcome of colonic NENs observed in clinical practice might be due not only to the biological differences, but also to larger tumor size in colonic NENs caused by the delayed diagnosis.
Systemic inflammation score (SIS) to predict the effect of the postoperative adjuvant chemotherapy for patients with stage III colorectal cancer.
Authors: Suzuki Yoshiyuki , Okabayashi Koji , Hasegawa Hirotoshi , Tsuruta Masashi , Ishida Takashi , Kitagawa Yuko 
Published: March 2017

575 Background: Postoperative adjuvant chemotherapy (CTx) is a standardized treatment for patients with Stage III colorectal cancer (CRC). Since previous studies reported that the benefit of adjuvant CTx is estimated up to only 15% in Stage III patients, it is necessary to establish an appropriate patient selection for adjuvant CTx. Recently, systemic inflammation is reported to play a critical role in the progression of cancer and several studies demonstrate the impact of inflammation-based score, such as mGPS and SIS. There however is a lack of evidence for the influence of inflammation on patient requiring adjuvant CTx. The aim of this study is to evaluate the impact of SIS on patient selection of adjuvant CTx for Stage III CRC. Methods: Between 2004 and 2012 a total of 295 patients with Stage III CRC who underwent curative resection were included. The SIS was developed based on serum albumin and lymphocyte-to-monocyte ratio (LMR) levels (SIS = 0; albumin > 4.0 g/dl and LMR > 4.44, SIS = 1; albumin < 4.0 g/dl or LMR < 4.44, SIS = 2; albumin < 4.0 g/dl and LMR < 4.44). Primary endpoint was defined as disease free survival (DFS). DFS rates were compared using Kaplan-Meier curves and Prognostic factors were assessed by Cox proportional hazard model. Results: The median follow-up period was 5.99 years. 75.9% of patients received adjuvant CTx. The distribution of SIS was SIS = 0; 32.6 %, SIS = 1; 43.3 %, and SIS = 2; 24.1 %. In multivariate analysis for overall patients, SIS was not a significant prognostic factor. Subgroup analysis according to each SIS score demonstrated that adjuvant CTx significantly prevented postoperative recurrence just only in patients with SIS = 0 (5-year DFS rate; adjuvant CTx (+) 85.5 % vs. CTx (-) 33.7 %, p < 0.001 ). In Cox proportional hazard model, protective effect of adjuvant CTx decreased in proportion to the increase of SIS (HR of adjuvant CTx (95 % CI): SIS = 0; 0.187 (0.089-0.393), SIS = 1; 0.601 (0.311–1.162), SIS = 2; 0.747 (0.319–1.752)). Conclusions: The SIS can provide an appropriate patient selection for patients with stage III CRC who can benefit from adjuvant CTx. The results from this study might enhance precision medicine for adjuvant CTx for Stage III CRC.
Relationship between tumor location and oncogenes mutations (RAS, BRAF, and PIK3CA) in colorectal cancer.
Authors: Inagaki Daisuke , Shiozawa Manabu , Satoyoshi Tetta , Atsumi Yousuke , Murakawa Masaaki , Kazama Keisuke , Aoyama Toru , Higuchi Akio , Morinaga Soichiro , Rino Yasushi , Masuda Munetaka , Miyagi Yohei 
Published: March 2017

580 Background: Several studies have reported that right-sided colon cancers (RCC) and left-sided colon cancers (LCC) differ in several factors including genetic features. We investigated the difference in clinicopathological characteristics and oncogenic mutation status between patients with RCC and LCC in all stages. Methods: This study was a prospective, observational study. Patients were recruited from December 2014 to February 2016. Formalin-fixed paraffin-embedded tissue blocks were collected and DNA wes extracted from tissue sections from 158 cases. Mutations in KRAS, NRAS, HRAS, BRAF and PIK3CAwere detected by next-generation DNA sequencer. Tumors from cecum to transverse colon were defined as RCC, and tumors from descending colon to rectsigmoid were defined as LCC. Results: RCC was 66 patients and LCC was 92 patients. Poorly differentiated adenocarcinoma or mutinous adenocarcinoma were significantly more frequent in RCC compared to LCC (P = 0.047). KRAS mutations were detected in 35 patients with RCC (53.0%) and in 32 patients with LCC (34.8%). NRAS mutations were detected in 2 patients with RCC (3.0%) and in 3 patients with LCC (3.3%). There was no HRAS mutation in all patients. BRAF mutations were detected in 7 patient with RCC (10.6%) and in 2 patients with LCC (2.2%). PIK3CA mutations were detected in 8 patients with RCC (12.1%) and in 10 patients with LCC (10.9%). KRAS and BRAF mutation in RCC were significantly more frequent than in LCC (P = 0.022 and P = 0.024, respectively). These mutations were not significantly different according to tumor stage. In this study, both KRAS and BRAFmutations were exclusive. Conclusions: KRAS and BRAF mutation were more frequent in the patients with RCC compared to those with LCC in all stages. This study suggested that it was important to evaluate BRAF mutation in addition to KRAS in order to select more effective treatments, especially in RCC.
CT and PET-CT for detection of synchronous lesion in patients with colorectal cancer obstruction.
Authors: Choi Hyun Ho , Kim Sang Woo , Kim Hyung-Keun , Kim Sung Soo , Chae Hiun-Suk 
Published: March 2017

581 Background: Full preoperative colonic evaluation is recommended to exclude synchronous lesions. In patients with occlusive colorectal cancers, preoperative colonoscopy may not be possible because of narrowing of the lumen. After colonic stent placement, colonoscopy to the proximal part of the obstruction is feasible. However, a complete preoperative colonoscopy was not possible in some cases. The aim of our study was to evaluate the efficacy of preoperative CT and PET-CT for detection of synchronous neoplasms compared with colonoscopy in colorectal cancer obstruction patients who underwent colonic stent. Methods: A retrospective chart review of 205 patients who performed endoscopic colon stent placement for acute malignant colorectal obstruction between January 2010 and October 2015. To find synchronous cancer and other precancerous lesion, we reviewed CT, PET-CT finding and colonoscopic image. The results of CT and PET-CT were compared with the finding of the colonoscopy, which was remains the most reliable method for the detection of synchronous neoplasm. Results: Of the 205 patients with colonic stent placement, 115 patients underwent CT, PET-CT and preoperative colonoscopy passing through the colonic stent. On preoperative colonoscopy, 3 of 115 patients (2.7%) had synchronous cancers and 11 of 115 patients (9.6%) had large polyps (tubulovillous adenoma with high grade dysplasia). On CT and PET-CT, all synchronous lesions were detected. But among the eleven polyps, nine polyps had not been seen at CT and PET-CT. Conclusions: Our study indicates that CT and PET-CT were feasible and useful method of evaluating the entire colon to exclude synchronous colonic lesions in patients with acute colon obstruction after an effective stent placement. But colonoscopy should be performed shortly to find out precancerous lesion especially adenoma with high grade dysplasia.
The impact of pulmnary emphysema evaluated by CT on lung metastasis in rectal cancer.
Authors: Toyota Naoyuki , Tsuruta Masashi , Hasegawa Hirotoshi , Okabayashi Koji , Ishida Takashi , Kondo Takayuki , Kitagawa Yuko 
Published: March 2017

582 Background: Our previous study suggested that smoking history could be a risk factor for pulmonary metastasis following rectal cancer surgery. Smoking causes emphysematous change in the lung, however, it remains unclear how much impact of pulmonary emphysema (PE) on the pathogenesis of pulmonary metastasis in rectal cancer. The objective of this study is to clarify the influence of PE on the pulmonary metastasis. Methods: Patients with rectal cancer who underwent curative resection from September 2005 to May 2014 in our institution were enrolled and their medical records were reviewed including the percentage volume of low attenuation area in the whole lung (LAA%), which were calculated from their preoperative chest CT by using AZE virtual place. PE was defined as more than 10% in LAA% and statistically evaluated the correlation with relapse free survival for pulmonary metastasis (RFSP). Results: A total of 286 patients, who consists of 7 in stage0,102 in StageⅠ, 75 in StageⅡ, and 102 in stageⅢ, were enrolled. The median LAA% was 3.16±3.78% and 14 patients (4.9%) were diagnosed PE by LAA%. Postoperative pulmonary metastasis was observed in 22 patients, including 3 patients in PE. Five-year RFSP rate in PE was significantly poorer than non-PE (25.4% vs 7.7%, p=0.02) by log-rank test. Multivariate survival analysis using Cox’s regression model revealed that PE was an independent risk factor for RFSP (Hazard Ratio = 19.14 [3.18 – 115.20], p < 0.001). Conclusions: Pulmonary emphysema may have a robust impact on pulmonary relapse after curative surgical resection of rectal cancer.
Long-chain omega-3 fatty acid and fish intake after colon cancer diagnosis and disease-free, recurrence-free, and overall survival in CALGB 89803 (Alliance).
Authors: Van Blarigan Erin , Fuchs Charles S. , Niedzwiecki Donna , Ye Xing , Zhang Sui , Song Mingyang , Saltz Leonard , Mayer Robert J. , Mowat Rex B. , Whittom Renaud , Hantel Alexander , Benson Al Bowen , Atienza Daniel M. , Messino Michael J. , Kindler Hedy L. , Venook Alan P. , Ogino Shuji , Willett Walter C. , Giovannucci Edward L. , Meyerhardt Jeffrey A. 
Published: March 2017

585 Background: Long-chain omega-3 fatty acids (LCN-3 FA) may prevent colon cancer (CC) progression, but data in humans are lacking. We hypothesized that LCN-3 FA and dark meat fish intake after CC diagnosis would be associated with longer disease-free survival (DFS), particularly among patients (pts) whose tumors expressed COX2. Methods: We conducted a prospective study among 1011 stage III CC pts enrolled in an adjuvant chemotherapy trial in 1999-2001. Intakes of dark meat fish; canned tuna; breaded fish; shrimp, lobster, scallops, clams; other fish; and fish oil supplements were assessed via food frequency questionnaire during and 6 months (mo) after therapy. Less than 5% of pts reported fish oil supplements. We estimated hazard ratios (HR) and 95% confidence intervals (CI) for disease-free, recurrence-free (RFS), and overall (OS) survival, adjusting for clinical, sociodemographic, and lifestyle factors. In a subset of 510 pts, we examined whether tumor COX2 expression modified the association between LCN-3 FA intake and DFS. Results: We observed 343 CC recurrences and 305 deaths (7 y median follow-up). Higher LCN-3 FA intake after CC diagnosis was associated with 28% improved DFS [HR highest (Q4) vs. lowest (Q1) quartile: 0.72 (0.54, 0.97); p: 0.03]. The association was driven by CC recurrence [RFS - HR Q4 vs. Q1: 0.68 (0.50, 0.94); p: 0.01; OS - HR Q4 vs. Q1: 0.79 (0.56, 1.13); p: 0.17]. Among pts with moderate/high COX2 expression tumors, LCN-3 FA intake was associated with 80% improved DFS [HR Q4 vs. Q1: 0.2 (0.06-0.76); p: 0.006]; there was no association among pts with absent/low COX2 expression ( p-interaction: 0.13). When we examined dietary sources of LCN-3 FA, pts who consumed dark meat fish ≥ 2 times/mo vs. none had longer DFS [HR: 0.64 (0.48, 0.86); p: 0.007), RFS [HR: 0.61 (0.44, 0.83); p: 0.005], and OS [HR: 0.68 (0.48, 0.97); p: 0.05]. No other fish or seafood after CC diagnosis was associated with DFS, RFS, or OS. Conclusions: LCN-3 FA and dark meat fish intake after CC diagnosis may be associated with improved DFS, especially among pts with high COX2 expression tumors. Support: K07CA197077, U10CA180821, U10CA180882. ClinicalTrials.gov: NCT00003835.