bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment strategy for obstructive colorectal cancer.
Authors: Iwagami Shiro , Miyanari Nobutomo , Kubota Tatsuo , Nakao Yousuke , Yamao Takanobu , Sugihara Hidetaka , Sawayama Hiroshi , Mizumoto Takao , Kitano Yuuki , Baba Hideo 
Published: February 2017

741 Background: The number of patients with colorectal cancer has been increasing in all over the world. Approximately 10 percent of CRC is complicated by obstructive symptoms at the time of their diagnosis. Obstructive colorectal cancer (OCRC) could be a fatal because of perforation peritonitis or sepsis, and it is necessary to immediate treatment. The aim of this study was to explore the treatment strategies for patients with OCRC. Methods: Between April 2008 and December 2014, six hundred seventy two patients underwent surgery in out institute. The numbers of OCRC were 82 cases (12.2%). We evaluated the feasibility and effectiveness of our treatments for OCRC. Results: Treatment strategies were adopted according to the location of CRC. For patients with right-sided OCRC, we performed one-stage surgery. They underwent primary tumor resection and anastomosis at the same time. For left-sided OCRC, patients were treated by two-stage surgery. At first, they were managed by decompression of their colon with colostomy or transanal ileus tube, and then, underwent colectomy. The cases of right-side OCRC were 23 cases, and all of them underwent one-stage surgery. We could find no cases of anastomotic leakage in these cases. The cases of left-side OCRC were 59 cases, and 50 patients (86%) of them were treated two-stage surgery. Stage IV OCRC patients tended to undergo colostomy only. Conclusions: One-stage surgery was feasible for patients with right-sided OCRC. For left-sided OCRC cases, two-stage surgery was effective to prevent perioperative complications.
Outcome comparison between bridge to surgery stenting and emergency surgery in stage II, III obstructive left colon cancer: A multicenter retrospective study.
Authors: Yoo Han-mo , Kang Won-Kyung 
Published: February 2017

747 Background: A SEMS (Self Expandable Metallic Stents) has been widely used for obstructive colorectal cancer as a bridge to surgery to avoid emergency surgery. However, it may increase the tumor spillage so that the long-term survival would be compromised. The aim of our study was to compare the short- and long-term outcome of surgery after stent insertion with those of emergency surgery alone for the left colon malignant obstruction patients. Methods: The medical records of patients who received curative resection due to obstructive primary left colon cancer and diagnosed to stage II or III from January 2004 to December 2010 in six hospitals affiliated to the Catholic Medical Center. Overall survival and disease free survival were compared between the SEMS (n = 158) and emergency surgery (n = 56) group. Short-term outcome was also compared. Factors affecting disease-free survival in the SEMS group were analyzed using the cox proportional hazards model. Results: Baseline characteristics were comparable between two groups by pathologic stage. Intra-operative complication (0.0% vs. 7.1%, p = 0.004), re-operation (1.3% vs. 7.1%, p = 0.042), post-operative hospital stay (11.2 ± 6.5 days vs. 14.6 ± 8.9 days, p = 0.010) and conversion rate (3.5% vs. 16.7%, p = 0.028) showed short-term advantages of the SEMS. 5-year DFS in stage II patients was 87.2% for the SMES group, 73.5% for the ES group (p = 0.117). Among stage III patients, 5-year DFS was 55.8% for the SEMS group and 72.0% for the ES group (p = 0.129). 5-year OS of the SEMS group was 90.2%, and of the ES group was 92.4% in stage II patients (p = 0.694). 5-year OS in the SEMS group was 82.8%, and the ES group 73.0% in stage III patients (p = 0.577). For the stage III SEMS patients, hospital of procedure (p = 0.041) and operation date (HR 0.400, 95% C.I 0.176-0.905, p = 0.028) were independent factors on disease free survival. Conclusions: If there’s an intervention team with sufficient experience for the SEMS and a sufficient preparation for emergency surgery, the SEMS is a good therapeutic option for malignant obstruction in left colon cancer.
Effect of first-line molecular targeted agents on the efficacy of second-line bevacizumab-containing regimen for metastatic colorectal cancer.
Authors: Hasegawa Hiroko , Taniguchi Hiroya , Mitani Seiichiro , Komori Azusa , Masuishi Toshiki , Narita Yukiya , Kadowaki Shigenori , Ura Takashi , Andoh Masashi , Muro Kei 
Published: February 2017

748 Background: Bevacizumab (BV)-containing regimen is a standard second-line chemotherapy(CTX) for patients (pts) with metastatic colorectal cancer (mCRC) regardless of the prior use of BV in the first-line CTX. However, little is known about the efficacy of the second-line BV-containing regimen after first-line CTX with anti-EGFR agents. Methods: We retrospectively evaluated the efficacy of a BV-containing regimen as the second-line CTX for mCRC. The eligibility criteria for the pts included in the study were as follows: ECOG PS 0–2, KRAS wild-type tumors, and refractory to first-line CTX with fluoropyrimidine and oxaliplatin or irinotecan from March 2007 to March 2015. The Kaplan–Meier method with a log-rank test and Cox regression analysis were performed to evaluate the progression-free survival (PFS) of the pts. Results: A total of 123 pts were eligible. The pts’ characteristics were as follows: males/females 73/50, median age 59 years, PS 0-1/2 118/5, LDH levels < 400IU/l / ≥ 400IU/l 91/32, second-line CTX regimen FOLFIRI+BV/FOLFOX+BV 111/12. The patients were categorized into the following 3 cohorts according to the prior use of molecular targeted agents: anti EGFR agents (cohort E, 35 pts), BV (cohort B, 58 pts), no molecular targeted agents (cohort C, 30 pts). There was hardly any difference in the baseline characteristics of the 3 cohorts; however, LDH levels in cohort E were higher than those in the other cohorts. Treatment efficacies were as follows (cohort E/B/C): response rate, 30%/10%/20%, with a significant difference between cohort E and B (OR = 1.50, p = 0.035) and median PFS, 8.6/5.9/6.9 months, with a significant difference between cohort E and B (p = 0.025). Multivariate analyses for PFS were adjusted for baseline characteristics such as histology, PS, chemotherapy regimen, presence of peritoneal metastasis, LDH levels, and duration of PFS in the first-line CTX. The PFS of cohort E was better than that of cohort B (HR = 2.180, p = 0.0025) and was not much different from that of cohort C (HR = 1.682, p = 0.64)in multivariate analyses. Conclusions: The second-line BV-containing regimen is effective regardless of the prior use of anti-EGFR agents.
Impact of relative dose intensity and G-CSF use in the adjuvant treatment of resected colon cancer.
Authors: Breadner Daniel Adam , Whiston Frances , Stitt Larry , Welch Stephen 
Published: February 2017

752 Background: The benefits of adjuvant chemotherapy in stage III colon cancer (CC) are well established. However, the consequences of dose delays and modifications are not well established. Relative dose intensity (RDI) and dose scheduling have been shown to have prognostic significance in a number of cancers. We examine the effect of RDI, dose intensity (DI) and dose delays on disease free survival (DFS) and overall survival (OS) in stage III CC. Furthermore, we investigate the role of G-CSF in CC and its role in preserving RDI, and its effect on outcomes. Methods: A retrospective review was conducted for patients with stage III CC seen at a Canadian academic cancer center between 2006 and 2011. Patients who received at least three cycles of FOLFOX or at least two cycles capecitabine were included in the analysis. The RDI and DI were calculated and examined for correlation with DFS and OS. The influence of G-CSF on RDI and DI was also investigated. Results: FOLFOX was used more commonly than capecitabine, 64% vs. 36%. Within the FOLFOX regimen median RDI for oxaliplatin was 76.3%, and 83.5% for 5-FU. Median capecitabine RDI was 73.8%. Median DI were similar at 75.4%, 86.5%, and 69.1%, respectively. 60% of patients receiving FOLFOX got over 80% of their intended dose, while only 29% of patients receiving capecitabine achieved this DI. 3-year DFS was higher when RDI or DI was > 80%, compared to ≤ 80%, for each chemotherapeutic, however the differences did not reach significance. 3-year OS trended towards being higher in patients with an RDI and DI > than 80%, however there were limited events in these groups. Over half of patients on FOLFOX experienced a dose delay, 56.9%, most of whom then received G-CSF, 64.9%. Patients who received G-CSF had a higher DI than those who did not, 74.9% and 87.4% versus 66.5% and 76.8%, for the oxaliplatin and 5-FU components, respectively. 3-year DFS and OS was higher in patients who received G-CSF versus those who did not, 78.3% and 97.5% vs. 69.8% and 91.5%, respectively. Conclusions: In patients with stage III colon cancer an RDI or DI is associated with improved 3-year DFS and OS, although the difference did not reach significance in our review. G-CSF as secondary prophylaxis improves RDI, DI, DFS and OS.
Effect of MiR-32 on gastric carcinoma tumorigenesis by targeting Kruppel-like factor 4.
Authors: Yan Chao , Yu Jianchun , Kang Weiming 
Published: February 2017

76 Background: Gastric cancer (GC) is a prevalent malignant cancer worldwide and is highly lethal because of its fast growth. Currently, the comprehensive treatment is the combination of surgery, chemotherapy and radiotherapy, which has made progress in the treatment of advanced GC. However, the accuracy of current diagnostic methods is not very satisfactory. To address these limitations and improve the survival rate and reduce mortality it is necessary to identify sensitive early diagnostic markers. MiR-32 has been reported as an oncogenic microRNA in many cancers, but its role in GC is unclear. Methods: We detected miR-32 expression in clinical gastric carcinoma tissue samples and adjacent normal tissue samples from the same patient. The expression of miR-32 was also detected in 40 gastric carcinoma patients’ plasma, as compared with the plasma of 40 healthy individuals. The proliferation ability of cells was monitored by the xCELLigence Real-Time Cell Analyzer (RTCA)-MP system. Transwell insert chambers with an 8 μm diameter porous membrane (Neuro Probe, MD, USA) were used for the migration/invasion assays. Also, the plasmid construction and luciferase reporter assay, western blotting analysis and immunofluorescence cell staining were performed. Data were analyzed with SPSS v.17.0 software. Results: We detected the expression level of miR-32 in two normal gastric tissue, the GES-1 cell line, and eight gastric carcinoma cell lines. The expression of miR-32 was significantly higher in tumor tissues as compared with normal tissues, p = 0.0016. The expression of miR-32 was significantly higher in 40 gastric carcinoma patients’ plasma, as compared with the plasma of 40 healthy individuals, p = 0.004.MiR-32 promotes the proliferation, migration and invasion of GC cells. The expression of KLF4 is negatively regulated by miR-32. Knockdown of KLF4 promotes cell proliferation, migration and invasion in GC cell-lines. Conclusions: In addition to identifying upregulated miR-32 as a diagnosis biomarker in clinical GC tissue and plasma, we have defined the biological functions of miR-32 as an oncogene in GC cells and explored the molecular mechanism of miR-32 in GC cells’ aggressive phenotype.
Relevance of CEA and LDH in relation to KRAS status in patients with unresectable colorectal liver metastases.
Authors: Connell Louise Catherine , Chou Joanne F. , Boucher Taryn Mary , Capanu Marinela , Kemeny Nancy E. 
Published: February 2017

762 Background: While the significance of CEA, LDH and KRAS status as individual prognostic factors for patients (pts) with metastatic colorectal cancer (mCRC) has been addressed, the relationship and interdependence between these prognostic factors on overall survival (OS) is limited. Methods: A retrospective review of pts with unresectable liver metastases and no extrahepatic disease and known KRAS status and baseline CEA and LDH treated with hepatic arterial infusion (HAI) plus systemic therapy from 2002 to 2013. Baseline values were taken from start of HAI. OS was estimated using Kaplan-Meyer. Relationship between OS and markers were evaluated using Cox regression method. Results: A total of 75 pts were included: 54 pts were KRAS wildtype (WT) and 21 pts were KRAS mutant (MUT). Median follow-up was 88 months (mos) and median OS was 45.7 mos [95% CI: 32.1-68.8]. 27 pts (36%) underwent hepatic resection at 1-year, with 3-year OS of 85% [95% CI: 64%-94%] versus 31% [95% CI: 18%-44%] for pts who did not get to resection (p<0.01). Univariate analysis of factors associated with OS are shown in Table 1. On multivariate analysis, pts with CEA >200 ng/mL [HR 2.6, 95% CI: 1.2-6.0, p=0.018], KRAS MUT [HR 2.2, 95% CI: 1.1-4.3, p=0.018] and prior chemotherapy [HR 2.3, 95% CI: 1.1-4.5, p=0.017] had significantly lower OS. Pts who achieved hepatic resection had significant increase in OS [HR 0.4, 95% CI: 0.2-0.8, p=0.009]. Conclusions: This analysis verifies that high CEA, KRAS MUT, prior chemotherapy, and hepatic resection affect OS in pts with unresectable mCRC. This data also suggests that CEA is an independent predictor of survival. Although further investigation is needed, CEA is clinically relevant and should be included in standard laboratory testing. [Table: see text]
REOX: Effectiveness evaluation of re-exposure to oxaliplatin in patients with metastatic colorectal cancer.
Authors: Costa Talita Gonzaga , Felismino Tiago Cordeiro , Boente Leonardo de Azevedo , Mello Celso Lopes 
Published: February 2017

764 Background: Colorectal cancer has high incidence and mortality rates. Treatment of metastatic colorectal adenocarcinoma has evolved since the approval of irinotecan, oxaliplatin and monoclonal antibodies with survival surpassing 30 months in contemporary trials. Nevertheless there is paucity of effective options after failure of these protocols. Thus re-exposure to previously used drugs became a treatment strategy. We aimed to evaluate the efficacy of retreatment with oxaliplatin in mCRC and its correlation with clinicopathological features. Methods: We retrospectively analyzed 83 patients with mCRC who underwent REOX treated at a single cancer center in Brazil. REOX was defined as a second trial of an oxaliplatin containing regimen after a previous failure. Primary endpoint was time to treatment failure (TTF) after REOX. Results: Median age of our cohort was 53.5y. Female/Male: 51.8%/48.2%. Primary colon was found in 67.5% while 32.5% had primary rectal adenocarcinoma. KRAS status was wild type in 57.8% and mutated in 39.8%. Exclusive hepatic metastasis was found in 19.3%. Median follow-up after REOX was 31m. Main chemotherapy regimen was mFOLFOX6 (84.3%). Bevacizumab and Cetuximab were used in 42.2% and 6% respectively. Most patients underwent REOX in third and fourth lines, 48.2% and 25.3% respectively. Median time to treatment failure (mTTF) after REOX was 6.04m. Overall survival was 10.04m. Disease control (CR + PR + SD) was observed in 56.6%, while 42.2% had progressive disease (PD). Reasons for interruption were as follows: PD (68.7%), toxicity (19.3%) and metastasectomy (2.4%). Patients who attained disease control had better OS (14.5m) compared with patients who had PD (14.5m versus 6.24m, p < 0.0001). Patients with exclusive hepatic metastasis had a trend to a better TTF compared to other metastasis sites (8.96m X 6.01m, p = 0.2). Regarding KRAS status, there was no difference in mTTF (wt 6.68m, mut 6.04m, p = 0.14). Conclusions: In the setting of pretreated mCRC patients where there are few options available, REOX remains an effective treatment, with mTTF of 6.04m in our cohort. This could be related to progression of cell clones sensitive to the drug after a time lapse since the previous exposure.
Intravenous weekly high-dose infusion of 5-fluorouracil and folinic acid in previously heavily pretreated patients with metastatic colorectal cancer.
Authors: Piringer Gudrun , Huber Verena , Burgstaller Sonja , Weninger Martin , Karrer Andreas , Mayrbaeurl Beate , Thaler Josef 
Published: February 2017

766 Background: Patients with metastatic colorectal cancer (CRC) usually receive multiple lines of treatment. Using a present day standard 1st line chemotherapy combination a progression free survival in the range of 8-12 months can be obtained. With consecutive treatment lines the median survival has now exceeded the 2-year landmark. In case of disease progression after two or more lines of treatment, the survival is about 4-6 months with best supportive care alone. However, some patients are still able and willing to receive further therapy. In the present retrospective analysis the efficacy of a weekly intravenous high-dose infusion of 5-Fluorouracil and folinic acid in heavily pretreated patients with metastatic CRC beyond the standard chemotherapy lines was evaluated. Methods: The Klinikum Wels-Grieskirchen collects data on all CRC patients since July 2006 in a clinical tumor registry. In this retrospective analysis pretreated CRC patients that were treated with the Ardalan-regimen (500mg/m2 folinic acid as 1 hour infusion followed by 2.600mg/m25-Fluorouracil as 24-hour infusion) have been evaluated. Results: A total of 23 evaluable patients with a median age of 66 years received the Ardalan-regimen as 2nd (4.4%), 3rd (13%), 4th (13%), 5th (52.2%), 6th (4.4%) or 7th (13%) line treatment. The median number of cycles received was 9 (range 2-18) and the Ardalan-regimen was started within 13-56 months (median 26 months) after the diagnosis of metastatic disease. Fourteen (60.9%) and nine (39.1%) out of these patients were women and men, respectively. 60.9% (14 patients) had a tumor located in the colon and 39.1% had rectal cancer. 17.4% of patients had stable disease and 65.2% of patients had progressive disease after 3 months of therapy. In 4 patients response according to RECIST criteria was not evaluable. Median overall survival since the start of the Ardalan-regimen was 6.7 months. Conclusions: Patients with advanced metastatic CRC can be candidates for multiple lines of therapy. In previously heavily pretreated patients, the Ardalan-regimen is able to control the disease in a limited proportion of patients.
Evaluation of state comprehensive cancer control plans for content related to stomach cancer.
Authors: Hillard James Randolph 
Published: February 2017

8 Background: Since 1998, each US state, as well as some US territories and tribal groups, has had a written Comprehensive Cancer Control Program (CCCP). These plans are charged by the National CCCP with emphasizing “primary prevention of cancer”, supporting “early detection and treatment activities”, and promoting “health equity as it relates to cancer control.” Since stomach cancer still causes over 10,000 deaths a year in the US, since it is in many cases preventable, since its prognosis is highly related to timeliness of diagnosis, and since minority populations are disproportionately affected, it would appear to be an appropriate target for state CCCPs. In 2014, the World Health Organization recommended increased prevention efforts, in an extensive monograph titled “Helicobacter pylori as a Strategy for Preventing Gastric Cancer.” Methods: We reviewed the cancer control plans available on the CDC website, http://www.cdc.gov/cancer/ncccp/ccc_plans.htm as of July 1, 2015. These included those of all 50 states, the District of Columbia, 7 US territories, and 7 Native American/Alaskan Native Tribes. These plans were searched for the words “stomach,” “gastric,” “helicobacter,” and “pylori.” Results: 38 of 65 (58%) of CCCs mentioned the words “stomach” or “gastric” in their text, but only 5 (0.8%) had goals or strategies related to stomach cancer. Of plans which did mention stomach cancer, 19 (32%) mentioned it in the contest of smoking, 16 (25%) in terms of health disparities, and 15 (23%) in terms of diet. Only 5 states (10%), and 5 (36%) territories or tribes mentioned the terms “helicobacter” or “pylori”. Some of the identified risk factors were idiosyncratic (e.g. relating HPV infection to stomach cancer) or inaccurate (e.g. “there is no evidence that” eradication of H. pylori changes the course of disease after cancer has developed, or “fecal occult blood test should not be used for cancer screening,” since 99% of positives are caused by gastritis due to H. pylori). Conclusions: Stomach cancer currently receives little attention in State CCCPs. H. pylori infection as a target for prevention efforts receives far less attention still. Important opportunities for control of this cancer are being neglected.
A phase II study of neoadjuvant chemotherapy with a modified FOLFOX6 regimen for locally advanced gastric cancer.
Authors: Wang Xiang , Zhao Lin , Liu Hongfeng , Bai Chunmei , Li Xiaoyi 
Published: February 2017

81 Background: The aim of this study was to evaluate the efficacy and safety of neoadjuvant chemotherapy with the mFOLFOX6 regimen in gastric cancer patients. Methods: This study was a single-arm phase II study. 73 patients with histologically confirmed locally advanced gastric cancer (T2-T4 or N+) were enrolled. The patients were administered the mFOLFOX6 regimen for 3 cycles. Surgery was scheduled 3-4 weeks after the completion of the chemotherapy. Postoperative chemotherapy began 4 weeks after surgery, and the program choice was based on the results of patients’ clinical/pathological evaluations. Perioperative efficacy, toxicity, effects of surgery, postoperative observation, and prognosis were studied. Survival analysis was performed to identify the relationship between the response and outcome and to identify factors predictive of OS. Results: 73 patients received the neoadjuvant chemotherapy, and 67 (91.8%) completed all of the preoperative cycles, with grade 3-4 toxicity arising in 33.0%. Surgery was performed in 71 (97.3%) patients, and radical resection was achieved in 67 (91.8%) patients. Postoperative chemotherapy started in 63 (88.7%) patients. The radiology response rate of chemotherapy was 45.8%. Among the patients who underwent radical surgery, pT downstaging was observed in 22 (32.8%) patients and pN downstaging was observed in 17 (25.4%) patients. All of the patients showed different levels of histological regression of the primary tumour, with a ≥ 50% regression rate of 49.2% and a pCR rate of 3.0%. Univariate analysis identified factors that were associated with OS, including local tumour infiltration, Lauren classification, pre-chemotherapy N stage, ypTNM stage, and pathologic regression rate (GHR)( ≥ 2/3/ < 2/3, ≥ 50%/ < 50%). Multivariate analysis identified both ypTNM stage and Lauren classification as independent predictors of survival. Conclusions: The mFOLFOX6 regimen was very effective and well-tolerated as a neoadjuvant chemotherapy for locally advanced gastric cancer. The ypTNM stage could serve as an independent predictor of survival. GHR ≥ 50% / < 50% could be used as a surrogate marker to guide the selection of a postoperative chemotherapy regimen. Clinical trial information: NCT02226380.