bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of neoadjuvant chemotherapy (NACT) on lymph node retrieval in gastroesophageal carcinoma: A comparison of two cohorts treated at a single institution.
Authors: Felismino Tiago Cordeiro , De Barros E. Silva Milton Jose , Fanelli Marcello Ferretti , Costa Wilson Luiz da , Coimbra Felipe José Fernandez , Mello Celso Lopes 
Published: February 2017

182 Background: Surgery for gastric cancer (GC) has evolved over time. D2-lymphademectomy with a minimum of 16 nodes is the current approach in many countries. In locally advanced GC, surgery alone has high rates of recurrence. Hence, adjuvant therapies are needed. Adjuvant chemoradiotherapy (CRT) and perioperative chemotherapy (PCT) are standard. The effect of PCT causing histological changes and tumor regression is clear. However it is unknown if PCT could change the number of dissected nodes due to tumor response and histological modification. Our aim is to evaluate patients treated with gastrectomy followed by CRT or PCT and surgery and define the impact of PCT in the number of nodes dissected. Methods: We retrospectively analyzed two historical cohorts treated at our institution. Cohort 1 (C1) underwent upfront gastrectomy and CRT. Cohort 2 (C2) underwent PCT and gastrectomy. Results: C1 had 51 patients. Median age was 54y. 60.8% male and 39.2% female. There were 88% primary gastric and 12% esophagastric junction (EGJ). Pathologic stages II or III were described in 92.2%. Median follow-up was 65 m. C2 had 66 patients. Median age was 58y. 70.1% male and 29.9% female. There were 71.6% primary gastric and 28.4% EGJ. cT3 was described in 82% and cN+ in 77.4%. Main chemotherapy regimens were DCF in 35.8%, EOX in 23.9% and CF in 13.4%. At surgery, 67.1% had stages II or III. Six patients had pathologic complete response. Three patients died due to toxicity. Median follow-up time was 34 m. Median number of dissected nodes was 35 in C1 and 31 in C2 (p=0.08). 90.2% in C1 and 91% in C2 had more then 16 nodes dissected. Median number of positive nodes was four in C1 and one in C2 (p=0.01). Regarding chemotherapy, DCF or a non-taxane regimen had the same median of 31 nodes dissected. 3-year recurrence free survival was 78.3% for C1 and 66% for C2 (p=0.21). 28.3% of patients recurred in C1 and 35% in C2, mainly in distant sites. Only two patients in each group had local failure. Conclusions: Although NACT induces histological changes, it does not reduce the number of retrieved lymph nodes at surgery. Moreover, PCT is associated with a lower median number of positive nodes, related to tumor downstaging.
Early tumor shrinkage (ETS) and deepness of response (DpR) in patients with metastatic esophageal cancer receiving a first-line treatment with DCF: Exploratory analysis of the JCOG0807.
Authors: Ura Takashi , Hironaka Shuichi , Tsubosa Yasuhiro , Mizusawa Junki , Kataoka Kozo , Kato Ken , Kitagawa Yuko , Kii Takayuki , Tomori Akihisa , Kiyota Naomi , Taniki Toshikatsu , Chin Keisho , Kojima Takashi , Doki Yuichiro 
Published: February 2017

183 Background: ETS and DpR have been recognized as favorable prognostic factors of metastatic colorectal cancer. However, the effect of tumor shrinkage on clinical outcomes has not yet been reported for metastatic esophageal cancer (mEC). The purpose of the present study is to determine the associations of ETS and DpR with progression-free survival (PFS), post-progression survival (PPS), and overall survival (OS) in patients (pts) with mEC. Methods: This exploratory analysis included 53 pts, who received triplet chemotherapy with docetaxel (D) plus CF (cisplatin plus 5-fluorouracil) (DCF) as a first-line treatment during the JCOG0807. ETS after 8 weeks was defined as a relative change of 20% in the sum of the longest diameters of target lesions compared with baseline. DpR was defined as a relative change in the sum of the longest diameters of target lesions at the nadir compared with baseline. The cutoff level of DpR was 30%. PPS was calculated as follows: PPS = OS - PFS. Univariate and multivariate analysis using Cox proportional hazard model was performed to identify a predictor of PFS and OS. Results: Thirty-five of the 53 pts achieved ETS ≥ 20% after 8 weeks. Thirty-seven of the 53 pts achieved DpR ≥ 30%. Pts with ETS ≥ 20% showed longer PFS (7.5 vs. 3.4 months (M), p < 0.001, HR: 0.26, 95% CI 0.14–0.49), longer OS (13.8 vs. 6.1 M, p < 0.001, HR 0.20, 95% CI 0.11–0.39), and longer PPS (6.4 vs. 2.8 M, p = 0.002, HR 0.38, 95% CI 0.20–0.72). Further, pts with DpR ≥ 30% showed longer PFS (7.5 vs. 2.9 M, p < 0.001, HR 0.17, 95% CI 0.08–0.34), longer OS (13.8 vs. 6.0 M, p < 0.001, HR 0.14, 95% CI 0.07–0.27), and longer PPS (6.8 vs. 2.8 M, p < 0.001, HR 0.30, 95% CI 0.15–0.57). Multivariate analysis, including the following additional prognostic variables: age, ECOG PS, the lactate dehydrogenase level, and the number of organs with metastases revealed that ETS ≥ 20% and DpR ≥ 30% were predictors of PFS and OS. Conclusions: ETS and DpR were associated with longer PFS, OS, and PPS. They were also strongly prognostic of PFS and OS in mEC pts treated with DCF. These findings support the treatment strategy involving the highly effective triplet chemotherapy as a first-line treatment of mEC. Clinical trial information: UMIN000001737.
Toxicity and efficacy of salvage paclitaxel chemotherapy in Royal Marsden (RM) oesophagogastric adenocarcinoma (OGA) patients (pts).
Authors: TARAZONA NOELIA , Smyth Elizabeth Catherine , Peckitt Clare , Chau Ian , Watkins David J. , Rao Sheela , Starling Naureen , Cunningham David 
Published: February 2017

188 Background: Paclitaxel is a standard global salvage therapy for pts with advanced refractory OGA. Western pts may differ from Asian pts with respect to chemotherapy metabolism and cancer behaviour, and the benefits associated with paclitaxel in this setting have not been assessed outside of Asia. We examined the efficacy and toxicity associated with salvage paclitaxel for advanced OGA at RM over a 3 year period. Methods: This was a retrospective observational study. We identified all pts with OGA treated with salvage weekly paclitaxel from 01/06/2011 to 21/02/2014 from the electronic pt record at RM. The following data was collected: demographics, metastatic sites, resection status, response/duration of response to prior chemotherapy, ECOG PS, haemoglobin, albumin, alkaline phosphatase (ALP), neutrophil/lymphocyte ratio, CEA, CA19.9, RM prognostic score, CT response and date of progression, death or last follow up. Toxicity was collected as per NCI Common Toxicity Criteria (v4.0). Overall and progression free survival (OS/PFS) were estimated using the Kaplan-Meier method. Multivariate Cox regression analysis examined the association between clinical and laboratory variables with survival. Results: 57 pts were identified. Pts were 74% male; median age 64y; 66% PS 0-1; 91% 2nd line. Median number cycles 3 (range 1-8). Median follow up 13.6m. Response rate was 18.4% in evaluable pts. OS and PFS were 5.8m (95% CI: 4.8 – 6.8m) and 2.6m (95% CI: 1.9 – 3.2m). 2y and 3y survival from start of 1st line treatment were 26% and 13%. In multivariate analyses PS ≥2 [HR 2.28, p = 0.018], and ALP ≥100 U/L, [HR=2.01, p= 0.033] were independent negative prognostic factors for OS. ≥ Grade 3 nausea, diarrhea and neuropathy were uncommon (<2% each), rate of ≥ grade 3 fatigue was 11%. Grade 3-4 neutropenia, leucopenia and thrombocytopenia occurred in 12%, 11% and 2% pts. Conclusions: Advanced OGA pts treated at RM with salvage paclitaxel have an OS equivalent to pts in clinical trials with less hematological toxicity than seen in Asian patients. This may be due to regional pharmacogenetic profiles. As a significant proportion of pts now survive 2-3y with limited toxicity, therapeutic nihilism is unwarranted.
Conversion chemotherapy combined with surgical treatment of unresectable advanced gastric cancer.
Authors: Du Yian , Yu Pengfei 
Published: February 2017

189 Background: Local advanced gastric cancer which could not receive R0 resection, or gastric cancer with single distant metastasis usually received palliative chemotherapy or entered into various clinical trials, and surgery usually roled as a symptomatic treatment. This study is to investigate the efficacy and safety of PCF chemotherapy combined with surgery in the treatment of these patients. Methods: From 2007.8 to 2012.8, 78 cases of local advanced gastric cancer which can not be treated with R0 resection(T4N2~3M0) or gastric cancer with single distant metastases(M1) were prospectively analysed. Patients were treated with 2~4 cycles of combined chemotherapy with paclitaxel (150mg/m2,d1), cisplatin(25mg/m2, d1~3) and 5-fluorouracil (750 mg/m2, d1~3) ( repeated every 3 weeks), and were then treated with cytoreductive surgery: mainly treated with radical resection of gastric tumor, combined with extended lymph node dissection, pancreaticoduodenal resection, colon resection, ovariectomy, liver resection and tumor radio frequency, followed by another 2~4 cycles of postoperative PCF chemotherapy.The treatment completion rate, patients’ tolerance and overall survival time were analyzed. Results: 56 patients (71.8%) accomplished chemotherapy and surgical resection as planned. 47 cases had R0 resection(60.3%). Grade 3/4 toxic effects included bone marrow suppression(24.4%) and gastrointestinal reaction(37.2%), the overall response rate (CR+PR) was 73.1%(CR 2 cases, PR 55 cases). Survival analysis: the median survival time was 23.4 months. 1-year and 3-year survival rate was 68.1% and 33.5%. The OS of patients with surgical resection was much longer than that of the non-surgery group.(36.1 VS 10.0 months, P<0.01). The OS of local advanced group was 38.6 months, and was significantly longer than 20.7 months of the distant metastasis group (P<0.01), however, it had no significant difference compared to 31.3 months of the distant metastasis group with R0 resection. Conclusions: PCF chemotherapy combined with surgical resection were safe and effective, and can make survival benefits for patients with local advanced gastric cancer or gastric cancer with single distant metastasis.
Risk factors for peritoneal recurrence in serosa-negative gastric cancer.
Authors: Omori Hayato , Miki Yuichiro , Takagi Wataru , Hirata Fumiko , Tatsubayashi Taichi , Honda Shinsaku , Makuuchi Rie , Tokunaga Masanori , Tanizawa Yutaka , Bando Etsuro , Kawamura Taiichi , Terashima Masanori 
Published: February 2017

19 Background: Peritoneal recurrence is often observed in gastric cancer patients without serosal invasion. It is difficult for pathologists to evaluate whether tumor cells penetrate serosa or not, because the subserosa layer is very thin. We evaluated the incidence and risk factors of peritoneal recurrence in serosa -negative gastric cancer patients to clarify the mechanism of peritoneal recurrence in these patients. Methods: A total of 1,745 gastric cancer patients underwent R0 resection from 2002 to 2009 were enrolled. The incidence of peritoneal recurrence according to tumor depth was analyzed. In serosa-nagative patients, the univariate and multivariate analysis were performed to identify the risk factors for peritoneal recurrence. Results: Peritoneal recurrence was observed in 64 (3.7 %) out of 1,745 patients. The incidence of peritoneal recurrence according to depth of tumor invasion was in 0 / 466 in T1a, 5 / 567 (0.88 %) in T1b, 4 / 187 (2.1 %) in T2, 31 / 360 (7.9 %) in T3, 20 / 108 (15.9 %) in T4a, and 4 / 12 (25 %) in T4b, respectively (p<0.001). As for the risk factor for peritoneal recurrence in T3 patients, histologically undifferentiated type, negative lymphatic invasion, scirrhous type, invasive infiltrating growth pattern were the significant factors identified by univariate analysis. Only the invasive infiltrating growth pattern (OR3.44 p0.038) was selected as significant independent risk factor for peritoneal recurrence by multivariate analysis. In T1b / T2 patients, massive lymph node metastasis (N3a, 3b), scirrhous type were the significant factor for peritoneal recurrence by univariate analysis. Only massive lymph node metastasis (OR25.1 p<0.001) was selected as the significant independent risk factor by multivariate analysis. Conclusions: The incidence of peritoneal recurrence increases in proportion to the tumor depth. Invasive infiltrating growth pattern was selected as an independent risk factor for peritoneal recurrence in T3 patients, while it was massive lymph node metastasis in T1b / T2 patients. The results suggest the possibility that microscopic serosal invasion in T3 tumor and lymphatic progression in T1b / T2 tumor may contribute to peritoneal recurrence in gastric cancer.
A retrospective review of treatment outcomes following definitive chemoradiotherapy or single modality radical radiotherapy among patients with locally advanced esophageal cancer.
Authors: Fulton Ben A , Gray Joanna , MacLaren Vivienne , McIntosh David , McDonald Alexander , Hennessy Aisling , Grose Derek B 
Published: February 2017

196 Background: Definitive chemoradiotherapy (CRT) has been advocated as an alternative to surgical resection for the treatment of locally advanced oesophageal cancer (OC). We have retrospectively reviewed 4 years experience of patients (pts) who underwent contemporary staging and were treated with concurrent chemoradiotherapy (CRT) or single modality radical radiotherapy (RT) with curative intent. Methods: Retrospective analysis permitted identification of consecutive pts who underwent contemporary staging prior to non-surgical treatment for oesophageal carcinoma. The primary outcomes were overall (OS) and disease-free survival (DFS), adjusted for baseline differences in age, tumour staging and histological cell type. All patients were treated with either definitive CRT or single modality RT within a single centre treated between 2009 and 2012. Results: We identified 135 pts in total (median age 69.8 yrs, male=130pts, female=105pts, Adenocarcinoma=85pts, Squamous=150pts). 190 pts received CRT and 45pts were treated with RT. All pts were staged with CT of chest, abdomen and pelvis, 226 pts underwent Endoscopic ultrasound (EUS) and 183 pts had PET-CT. Patients treated with CRT demonstrated longer OS (37 versus 25 months, p=0.02) and DFS (31 versus 16 months, p=0.01) compared to those treated with RT. More advanced tumour stage (stage 3 v stage 1-2) at presentation conferred poorer OS (32 versus 38.2 months) and DFS (11 versus 28 months, p=0.013). We demonstrated an acceptable toxicity profile with only 77 pts (32.8%) and 9 pts (4.2%) experiencing grade III or IV CTC toxicities respectively. Conclusions: This retrospective analysis is in keeping with current treatment paradigms emphasising the importance and safety of concurrent CRT in maximising curative potential for pts undergoing non-surgical treatment of oesophageal cancer. Although retrospective, in comparison to similar retrospective series from our centre, our data suggest improvements in OS and DFS, possibly due to improved patient selection through the use of more effective tumour staging.
Long-term follow-up of patients with Barrett esophagus: Progression to high-grade dysplasia and esophageal adenocarcinoma according to histology at presentation.
Authors: Kahn Allon , Kommineni Vishnu , Callaway Jonathan , Pannala Rahul , Fleischer David , Ashman Jonathan Ben , Ross Helen J. , Ramirez Francisco 
Published: February 2017

20 Background: Esophageal adenocarcinoma (EAC) incidence is rising and prognosis is uniformly poor, even with early stage disease. Barrett esophagus (BE) serves as a premalignant marker for EAC, with an estimated progression of 0.5% per year. Low-grade (LGD) and high-grade dysplasia (HGD) confer a higher risk of progression, providing an opportunity for intervention and surveillance. Aims: To evaluate a large cohort of patients undergoing endoscopic evaluation of BE and thereby better understand the natural history of BE and dysplasia. Methods: A retrospective review of endoscopic databases was conducted for all patients with the diagnosis of BE undergoing upper endoscopy at a tertiary academic medical center from 1991-2010. All endoscopy and accompanying pathology reports were reviewed. Only those patients with 2 biopsies documenting specialized intestinal metaplasia were analyzed. Results: 848 patients underwent upper endoscopy for evaluation of BE. Of these, 674 patients met inclusion criteria, at a mean follow up of 66.6 months. Table 1 depicts the distribution of patients according to their histology at presentation. 22 (3.2%) patients presented with established EAC, while EAC developed in 51 (7.6%). Of patients with HGD, LGD, or no dysplasia (ND) at presentation, EAC ultimately developed in 30.6%, 6.6%, and 2.7%, respectively. EAC developed in 4 patients despite RFA treatment for ND (2) or LGD (2). HGD developed in 6 such patients after treatment for ND (3) and LGD (3). Only 1 patient in each RFA-treated cohort required esophagectomy, while the others cleared dysplasia or EAC with continuous treatment. Conclusions: In this large cohort of patients with Barrett’s esophagus, higher grade of dysplasia at first endoscopy was associated with development of EAC. Continuous surveillance during and after endoscopic treatment is necessary and often results in clearance of dysplasia and EAC. [Table: see text]
Neoadjuvant or adjuvant chemoradiation therapy for stage II-III esophageal squamous cell carcinoma.
Authors: Chen Yongshun , Hao Daxuan , Wu Xiaoyuan , Yang Yuanyuan , He Chunyu , Wang Wen , Liu Jinsong , Wang Jianhua 
Published: February 2017

202 Background: Esophageal cancer is the eighth most common cancer worldwide, and especially in China is the fourth most common cause of death. Clinical trials have explored the value of neoadjuvant or adjuvant chemoradiation in potentially resectable esophageal squamous cell carcinoma (ESCC); however, these studies have produced conflicting results. This retrospective study was performed to investigate whether patients with resectable stage II/III ESCC should receive neoadjuvant or adjuvant therapy in addition to surgery. Methods: A review of stage II/III ESCC patients who underwent esophagectomy and either neoadjuvant or adjuvant chemoradiation was performed. Patients who underwent neoadjuvant therapy were treated with one cycle of chemotherapy consisted of cisplatin and fluorouracil concurrently with radiotherapy (40Gy/20f), adjuvant therapy consisted of two cycles of chemotherapy concurrently with radiotherapy (46-50Gy/23-25f, 5 days/week). Results: A total of 122 patients met inclusion criteria, of which 49 underwent neoadjuvant chemoradiation and 73 underwent adjuvant chemoradiation. Median follow up was 36.5 months. The median survival times and 3, 5-year OS rates for the neoadjuvant and adjuvant groups were 39.3 vs 31.5 months, and 53.0%, 45.7% vs 42.9%, 29.7% respectively (p = 0.091). For the patients with stage III ESCC, the median survival times and 5-year OS rates for the neoadjuvant and adjuvant group were 39.3 vs 21.2 months, and 43.4% vs 15.4% respectively (p = 0.005). Among lymph node-positive patients, the median survival times and 5-year OS rates for the neoadjuvant and adjuvant groups were 55.6 vs 23.7 months, and 43.0% vs 25.7% respectively (p = 0.085). The incidence of postoperative complications was 26.5% (13/49) in the neoadjuvant group and 20.5% (15/73) in the adjuvant group (p = 0.212). Conclusions: Neoadjuvant chemoradiation does not increase postoperative complications, and is associated with better OS when compared to adjuvant chemoradiation. OS in stage III patients is significantly improved with the use of neoadjuvant chemoradiation.
Effects of a planned preoperative exercise program on body composition in early gastric cancer patients with metabolic syndrome.
Authors: Kawabe Taiichi , Cho Haruhiko , Segami Kenki , Hayashi Shigeya , Makuuchi Yousuke , Sato Tsutomu , Aoyama Toru , Hayashi Tsutomu , Yamada Takanobu , Fujikawa Hirohito , Rino Yasushi , Masuda Munetaka , Ogata Takashi , Yoshikawa Takaki 
Published: February 2017

206 Background: Visceral fat obesity and skeletal muscle depletion were reported to be both risk factors for complications in abdominal cancers surgery. Preoperative exercise may reduce morbidity by modifying body composition. Methods: We conducted an exploratory study attached to a prospective study (AEGES) to examine the effects of a 4-weeks exercise in stage I gastric cancer patients with metabolic syndrome. The AEGES enrolled 50 patients between 2007 and 2013, of which 18 were assigned to the exercise arm. The exercise program consisted of aerobic training 3-7 days a week, resistance training once or twice a week, and stretching. The expected energy expenditure of exercise was set at 30 kcal/kg/week. The total energy expenditure was measured using a calorie counter. After completion of the exercise, the patients received CT and endoscopy for re-staging, then underwent curative gastrectomy. Total skeletal muscle cross-sectional area (cm2) was evaluated on the average of two adjacent axial images at L3. Muscle area was expressed as lumber skeletal muscle index (cm2/m2). Total visceral fat volume was evaluated at the level of umbilicus. The changes of parameters before and after the exercise were assessed by paired Wilcoxon sign test. Results: A total of 15 patients with evaluable CT image were examined. Body weight, body mass index, and abdominal circumference were significantly decreased (-1.5 kg, -0.52 kg/m2, and -3.3 cm, respectively). The median skeletal muscle index was 48.06 cm2/m2 before and 46.85 cm2/m2 after the exercise, which was not statistically significant (p=0.41), while the median visceral fat volume was 205.2 cm2 before and 169.0 cm2 after the exercise, which was statistically significant (p=0.001). There was a weak correlation between total energy expenditure and amount of skeletal muscle index change (r=0.22 by Spearman’s correlation and p=0.427). No patient demonstrated progression of clinical cancer stage during 4 weeks. Conclusions: Preoperative exercise for 4 weeks could significantly modify body composition without progression of gastric cancer. More intensive or personalized exercise would be required to increase skeletal muscle.