bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic role of C-reactive protein levels in patients with hepatocellular carcinoma undergoing sorafenib therapy.
Authors: Lee Jean Kyung , Harding James J. , Chou Joanne F. , Capanu Marinela , Saltz Leonard , Abou-Alfa Ghassan K. 
Published: February 2017

340 Background: Markers of systemic inflammatory response including C-reactive protein (CRP) are associated with the prognosis of various malignancies including HCC. We investigated the significance of the serum CRP level as a prognostic factor in patients with advanced HCC on sorafenib therapy. Methods: The MSKCC institutional database was retrospectively queried for patients diagnosed with advanced HCC who received sorafenib therapy from 2002-2012 and had available serum CRP measurements. Patient demographics and outcomes were extracted under an IRB-approved waiver. Baseline CRP levels within 30 days of starting of sorafenib and while on sorafenib treatment were correlated with clinical outcomes. CRP levels after the initiation of sorafenib were analyzed as a time dependent covariate in a Cox regression model. Results: 51 patients had available CRP levels and received sorafenib: Median age 65 years (range 45-82); KPS 80 (70-90%); 9 females (17.6%); 32 AJCC stage IV disease (62.7%); 10 AJCC stage III (19.6%); 12 hepatitis C (23.5%), 10 hepatitis B (19.6%), 12 alcohol (23.5%), and 20 non-alcoholic steatohepatitis (39%); and 43 Child-Pugh A (84.3 %). The median time on sorafenib was 2.4 months (range 0.2-21.6). The median overall survival (OS) was 9.2 months [CI 5.8 – 13.6] and the median progression-free survival (PFS) was 2.1 months [CI 1.6 – 2.6]. 46 of 51 patients had baseline CRP levels available for analysis. Baseline CRP level was associated with OS [hazard ratio (HR) 1.2 (CI 0.996 – 1.4, p=0.056)] but not with PFS [HR 1.1 (CI 0.96-1.3, p=0.14)]. Time dependent covariate analysis demonstrated an association between CRP levels during sorafenib therapy and overall OS [HR 1.08 (CI 1.01-1.16, p=0.02)] as well as PFS [HR 1.09 (CI 1.02 – 1.16, p=0.009)]. Conclusions: Baseline CRP level prior to the start of sorafenib therapy showed a borderline significant association with OS but no association with PFS. Higher CRP levels showed a significant association with increased risk of disease progression and death for sorafenib treated HCC patients. Potential prognostic role of CRP in HCC patients undergoing sorafenib therapy is to be further studied prospectively.
Survival trends in chemorefractory unresectable intrahepatic cholangiocarcinoma (ICC) and the effect of yttrium-90 (Y90) radioembolization: SEER versus tertiary cancer center.
Authors: Xing Minzhi , Prajapati Hasmukh J. , Kokabi Nima , Camacho Juan C. , El-Rayes Bassel F. , Kim Hyun Sik 
Published: February 2017

342 Background: Survival in patients with chemorefractory unresectable ICC treated with Y90 radioembolization vs. best supportive care has not been investigated in large-scale population studies. Methods: Under IRB approval, our institute’s cancer registry was queried for Y90-treated patients with chemorefractory unresectable ICC diagnosed from Jan 2002 to Nov 2011. Eighteen registries of U.S. Surveillance, Epidemiology and End Results (SEER) database were queried for patients with advanced ICC not amenable to surgery/radiation diagnosed in the same period. Baseline characteristics, median overall survival (OS) from ICC diagnosis and median OS from first Y90 were stratified by national/state cohorts. Survival analysis and 95% confidence intervals (CI) were calculated using Kaplan-Meier estimation. Results: A total of 24 patients who received Y90 therapy for chemorefractory unresectable ICC (Group A) and 2757 patients with unresectable ICC who received neither radiation nor cancer-directed surgery (Group B) were included. Both groups were similar for mean age at diagnosis, gender, race, bilobar disease, portal vein thrombosis and mean largest tumor size (p>0.05). Median OS from ICC diagnosis was 20.8 months (Group A; 95% CI, 11.2-30.5) and 3.0 months (Group B; 95% CI, 2.7-3.3), p<0.001. Median OS from first Y90 was 11.5 months (Group A; 95% CI, 4.8-18.2). Interval survival rates from ICC diagnosis for Group A vs. B were: 100% vs. 77% (1 month), 100% vs. 63% (3 months), 92% vs. 30% (6 months), 67% vs. 17% (1 year), 42% vs. 6% (2 years), and 17% vs. 3% (3 years). Conclusions: Y90 radioembolization in patients with chemorefractory unresectable ICC demonstrated significantly greater median OS and favorable long-term survival rates compared to best supportive care. [Table: see text]
Adherence to the BCLC guidelines and impact on overall survival.
Authors: Mathew Jesna , Slipak Sasha , Kotru Anil , Blansfield Joseph , Woll Nicole , Shabahang Mohsen 
Published: February 2017

345 Background: Multiple studies exist that validate the prognostic value of the Barcelona Clinic Liver Cancer (BCLC) staging. However, none have established a survival benefit to the treatment recommendations. The aim of this study was to evaluate the adherence to the BCLC guidelines at a rural tertiary care center, and to determine the effect of following the treatment recommendations on overall survival. Methods: A retrospective chart review was conducted for 97 patients newly diagnosed with hepatocellular carcinoma (HCC) from 2000 to 2012. The treatment choice was compared with the BCLC guidelines and percentage adherence calculated. Overall survival was estimated using the Kaplan-Meier method and the log rank test was used to test the difference between the two groups. Cox regression tests were used to determine independent effects of stage, treatment aggressiveness, and guideline adherence on survival. A p-value <0.05 was considered statistically significant. Results: Of 97 patients, 75% (n=73) were male. Median overall survival was 12.9 months. In 59.8% (n=58) of the patients, treatment was adherent to stage specific guidelines proposed by the BCLC classification. There was no significant difference in overall survival between the adherent and non-adherent groups (11.2 vs 14.1 months, p<0.98). However on stage specific survival analysis, we noted a significant survival benefit for adherence to the guidelines for early stage HCC (27.9 vs 14.1 months, p<0.05), but a decrease in survival for adherence in the end stage (20 days vs 9.3 months, p<0.01). On univariate analysis, more aggressive treatment was associated with increased survival (hazard ratio [HR], 0.4; 95% confidence interval [CI], 0.22 to 0.87; p = 0.018). Multivariate analysis revealed that adherence did not independently affect survival when stage and aggressiveness of treatment were included in the model (HR, 1.3; 95% CI, 0.76 to 2.2, p = 0.34). Conclusions: Although the BCLC guidelines serve as a practical guide to the management of patients with HCC, they are not universally practiced. These results indicate that survival of patients with hepatocellular cancer is determined by stage and aggressiveness of treatment, not adherence to BCLC guidelines.
Phase I study of adjuvant chemotherapy with gemcitabine plus cisplatin in patients with biliary tract cancer undergoing curative resection without major hepatectomy (KHBO1004).
Authors: Toyoda Masanori , Ajiki Tetsuo , Fujiwara Yutaka , Nagano Hiroaki , Kobayashi Shogo , Sakai Daisuke , Hatano Etsuro , Kanai Masashi , Nakamori Shoji , Miyamoto Atsushi , Tsuji Akihito , Kaihara Satoshi , Ikoma Hisashi , Takemura Shigekazu , Toyokawa Hideyoshi , Terajima Hiroaki , Ioka Tatsuya ,   Kansai Hepatobiliary Oncology Group (KHBO)
Published: February 2017

347 Background: GC has become a standard chemotherapy for patients with locally advanced or metastatic BTC. The benefit of adjuvant therapy for BTC is unclear, however, it is used worldwide due to BTC’s dismal prognosis. We conducted a phase I study for adjuvant chemotherapy with GC in patients with BTC in order to determine the maximum-tolerated dose (MTD) and recommended dose (RD). Methods: Patients with BTC were eligible if they met the following criteria: Stage IB or higher; undergoing resection without major hepatectomy; over 20 years of age; ECOG PS 0-1; adequate organ functions. The starting dose (Level 1) of GC was the same as the standard dose of advanced disease and dose was planned to adjust, using a 3+3 design with cohorts of 3-6 patients and further cohort expansion took place. The Dose Limiting Toxicities (DLTs) were determined during the first six weeks and RD was determined through the entire treatment. Results: One DLT out of 6 patients, with grade 4 neutropenia, was observed at Level 1 and an expanded cohort was further examined. A total of eighteen patients were enrolled and one DLT was observed as described above. During the first six weeks, the most common grade 3 or 4 related adverse events were neutropenia (n=10: 56%) and leukopenia (n=6: 33%). Through the entire treatment, non-hematologic toxicities were manageable. Seven (39%) patients completed the protocol treatment, seven (39%) dropped off due to the need of second time dose reduction, two didn’t meet starting criteria of creatinin with grade 1 increase in CTCAE, one had rapid tumor progression died within 30 days after the last administration of GC and one withdrew after reporting dead case. Conclusions: A standard dose of GC might be feasible for adjuvant chemotherapy for BTC undergoing curative resection without major hepatectomy. We selected standard dose of GC as RD for a subsequent phase II study. Clinical trial information: NCT01297998.
The role of staging laparoscopy in type 4 gastric cancer.
Authors: Sugisawa Norihiko , Bando Etsuro , Miki Yuichiro , Makuuchi Rie , Goto Hironobu , Tokunaga Masanori , Tanizawa Yutaka , Kawamura Taiichi , Terashima Masanori 
Published: February 2017

35 Background: In type 4 gastric cancer, the incidence of peritoneal metastasis which was unexpectedly found during surgery was as high as 40 percent. It is very difficult to detect peritoneal metastasis in clinical imaging such as computed tomography or ultrasound before operation. Staging laparoscopy (SL) is considered to be an only minimal invasive procedure to detect peritoneal metastasis. However, the significance of SL had not yet been fully elucidated. The aim of this study is to assess the role of SL in type 4 gastric cancer. Methods: From September 2002 to March 2012, a total of 169 patients with type 4 gastric cancer who were diagnosed as not having distant metastasis in clinical imaging were enrolled in this study. SL was performed for 56 patients, and the other 113 patients underwent open laparotomy (OL) without SL. We retrospectively examined the incidence of peritoneal metastasis and positive peritoneal cytology and treatment courses in patients who underwent SL and OL. Results: In 56 patients undergoing SL, 23 (41%) had peritoneal metastasis and 40 (71%) had positive peritoneal cytology. Similarly, 54 (48%) had peritoneal metastasis and 86 (76%) had positive peritoneal cytology in 113 patients undergoing OL. There were no significant differences of the incidence of peritoneal metastasis and positive peritoneal cytology between the two groups. Subsequent treatments after SL or OL were diverse depends on patients condition and participating clinical trials, however, 17 (32%) in SL group and 13 (12%) in OL group were treated without surgical interventions. There was no morbidity and mortality in both SL group and OL group. In SL group, open surgery was performed soon afterword in 39 patients. Among them, 2 patients was failed to detect peritoneal metastasis by SL. Therefore the accuracy of detecting peritoneal metastasis in SL was 23/25 (92%). Conclusions: In type 4 gastric cancer, the incidence of peritoneal metastasis was around 40% and positive peritoneal lavage cytology was around 70% in both SL and OL. As SL is less invasive than OL, SL appears to be a useful way to detect peritoneal seeding and establish treatment strategy in patients with type 4 gastric cancer.
Comparison of concurrent chemoradiotherapy and chemotherapy alone for locally advanced pancreatic cancer.
Authors: Choi Younak , Kim Tae-Yong , Oh Do-Youn , Kim Kyubo , Chie Eui Kyu , Lee Kyung-Hun , Han Sae-Won , Im Seock-Ah , Kim Tae-You , Ha Sung W. , Bang Yung-Jue 
Published: February 2017

351 Background: The optimal treatment strategy for locally advanced pancreatic cancer (LAPC), especially the role of chemoradiotherapy (CCRT), is still in debate. We compared the clinical outcomes of CCRT and palliative chemotherapy alone (CA) in patients with LAPC. Methods: We consecutively enrolled LAPC patients treated between 2003 and 2010. AJCC 7th edition was followed for the diagnostic criteria of LAPC. We retrospectively evaluated the clinical outcomes according to treatment groups (CCRT vs CA). Results: A total of 86 patients were enrolled. Median age was 60 years. ECOG PS was 0-1 in 77 (89.5%) and 2 in 9 (10.5%). Forty five patients (52.3%) were treated with CCRT and 41 patients (47.7%) with CA. Baseline characteristics were not significantly different between CCRT and CA group. In the CCRT group, gemcitabine (n=7, 15.6%), 5-FU (n=10, 22.2%), and capecitabine (n=28, 62.2%) were concurrently used with radiation. Radiation was delivered with 55.8Gy/ 31fraction. All of the CA group patients were treated with gemcitabine-based chemotherapy. Median progression free survival (PFS) and overall survival (OS) of whole patients were 6.9 months [95%CI 4.8-9.0] and 12.7 months [95%CI 11.6-14.3]. PFS and OS of CCRT versus CA was 8.9 months [95%CI 6.8-11.0] vs 3.7 months [95%CI 2.9-4.5] (p<0.001) and 15.8 months [95%CI 13.5-18.1] vs 11.3 months [95%CI 9.3-13.3] (p=0.017). In multivariate analysis, tumor size (≥3cm), positive lymph node, elevated CA 19-9, decreased serum albumin and CCRT was significant for PFS and OS (adjusted hazard ratio of CCRT was 0.424 (p=0.002) in PFS and 0.472 (p=0.014) in OS). Grade 3-4 hematologic toxicity was less frequent during CCRT period (p=0.002). Conclusions: In LAPC, patients who received CCRT show better OS and PFS compared with patients who were treated with palliative chemotherapy alone. It’s worthy to further study the role of CCRT in LAPC.
Prognostic factors of pancreatic neck cancer.
Authors: Hirono Seiko , Tani Masaji , Kawai Manabu , Okada Ken-Ichi , Miyazawa Motoki , Shimizu Atsushi , Kitahata Yuji , Ueno Masaki , Hayami Shinya , Shigekawa Yoshiyasu , Yamaue Hiroki 
Published: February 2017

355 Background: Pancreatic neck cancer is surrounded by common hepatic artery (CHA), gastroduodenal artery (GDA) and portal vein (PV), and easily invades nerve plexus around main arteries, such as CHA, celiac trunk, and superior mesenteric artery (SMA). Therefore, the resectablity of pancreatic neck cancer is low, and the biological behaviors have been unclear. In this study, we reviewed 59 resected pancreatic neck cancer cases to identify the prognostic factors. Methods: From 2000 to 2012, 305 patients with pancreatic cancer underwent surgical resection, and in 59 patients (19%) among them with pancreatic neck cancer, 49 patients underwent pancreatoduodenectomy, 5 subtotal pancreatectomy, 4 distal pancreatectomy with en-bloc celiac axis, and 1 total pancreatectomy. We defined borderline resectable pancreatic cancer as tumor abutted CHA, celiac trunk, or SMA, and classified radiographic types of PV invasion into A (normal), B (unilateral), C (bilateral), or D (complete obstruction) by CT imaging. We analyzed retrospectively clinicopathological characteristics and prognostic factors for pancreatic neck cancer. Results: Pancreatic neck cancer was smaller than other located pancreatic cancer (21.1±7.0 vs. 32.0±13.5 mm, P<0.01), and the rate of pathological PV invasion was higher in pancreatic neck cancer (36 vs. 20%, P=0.01). In patients with pancreatic neck cancer, pathological PV invasion was observed in 0% of type A (0/9), 14% of type B (3/22), 48% of type C (10/21), and 86% of type D (6/7), and 37 patients (63%) had lymph node metastasis. In 32 patients with borderline resectable pancreatic neck cancer, neoadjuvant chemo(radiation)therapy (NAC) reduced the R1 rates (P=0.04) Pathological PV invasion, tub2/3 and lymph node ratio >0.1 were independent poor prognostic factors for pancreatic neck cancer (P<0.01, P=0.03, and P=0.03, odds ratio; 7.1, 2.8, and 3.1, respectively). Conclusions: Pancreatic neck cancer often had PV invasion even if CT imaging showed unilateral abutment, indicating that combined PV resection may be necessary for R0 resection of pancreatic neck cancer with radiological PV abutment. NAC may improve R0 resection rates and postoperative survival for pancreatic neck cancer.
The biomarkers of gemcitabine and erlotinib treatment in advanced pancreatic cancer.
Authors: Irie Kuniyasu , Ueno Makoto , Kobayashi Satoshi , Gouda Yoshihiro , Ohkawa Shinichi , Manabu Morimoto 
Published: February 2017

358 Background: A combination of gemcitabine+erlotinib is one of the standard chemotherapies in advanced pancreatic cancer (APC). Since APC patients often take antiulcer drugs to prevent gastritis (e.g., NSAIDs to reduce cancer pain), erlotinib concentration is generally decreased through the mechanism of CYP3A4. Furthermore, unlike lung cancer, the biomarkers for APC are not obvious except rash. Here, we examined biomarkers of gemcitabine+erlotinib treatment in APC patients including the presence of antiulcer drugs. Methods: The subjects were 59 advanced pancreatic cancer patients. They were treated with gemcitabine+erlotinib starting from Nov. 2011 to Apr. 2013. Gemcitabine was administered at 1000 mg/m2, on days 1, 8, and 15 for every 4 weeks, and erlotinib was taken 100 mg daily. The progression-free survival (PFS), UICC stage, sex, age, CRP concentration, performance status (PS), rash, and presence of antiulcer drugs were examined. The PFS curve was plotted according to the method of Kaplan and Meier. The difference in the PFS was calculated using the log-rank test, and a multivariate analysis was conducted using Cox hazard model. Results: UICC stages were as follows; i.e., stage II: 1, stage III: 8, and stage IV: 50. There were 36 males and 23 females, and their ages ranged from 41 to 82 years old (median: 65). The CRP concentrations ranged from 0.02 to 11.5 mg/dl (median: 0.57). 37 patients received antiulcer drugs, and 48 patients had rash. The univariate analysis revealed that the CRP concentration and rash were significant (p=0.009 and p=0.005, respectively). Low CRP (<0.57mg/dl) and presence of rash were related to good PFS. The multivariate analysis also revealed that the CRP concentration (HR, 0.34; 95%CI, 0.16-072; p=0.005) and rash (HR, 0.40; 95%CI, 0.16-0.96; p=0.04) were significant. The presence of antiulcer drugs on PFS was insignificant. Conclusions: The CRP concentration and rash were biomarkers of gemcitabine+erlotinib treatment in APC patients.
A retrospective, multicenter analysis of the clinicopathologic features of extra-gastrointestinal stromal tumor (EGIST).
Authors: Yi Jun Ho , Hwang In Gyu , Ahn Hee Kyung , Lim Sung Hee , Park Byeong-Bae , Won Young-Woong , Park Se Hoon 
Published: February 2017

36 Background: GIST is the most common mesenchymal tumor of the gastrointestinal tract although it constitutes only 1 percent of primary GI malignancy. Some GIST develops outside the alimentary canal such as omentum, mesentery, and retroperitoneum. These types are called extra-gastrointestinal stromal tumors (EGISTs). In this study, we retrospectively analyzed the clinicopathologic features of EGIST patients from 4 institutes in Korea Methods: From 2004 to 2012, a total of 43 patients with EGIST were identified. The clinicopathologic features including gender, age, location, tumor size, hisology, mitotic rate, IHC features, and genetic status were collected along with survival analysis. Results: The median age was 55 (range 29-80) and M:F ratio was 20:23. The most common sites were mesentery (11) and retroperitoneum (11) followed by omentum (7) and vagina (3). Other primary sites were liver (2), ovary (2), pancreas (2), perianal area (2), chest wall (1), pleura (1) and prostate (1). The median tumor size was 8.0 cm (range 2.6 – 30) and median mitotic rate was 5.0/50HPF (0 – 185) 4 cases were negative for c-Kit IHC, which were all confirmed by either IHC for DOG1 or mutational analysis. KIT analysis was performed in 10 cases with 6 wild-types and 4 exon 11 mutation were found. As for PDGFRα, 4 cases were analyzed which were all exon 18 mutation. Among 43 patients, 26 patients had undergone curative resection and 8 patients had unresectable disease and had taken palliative imatinib. Among 26 patients who had undergone curative resection, 12 patients had taken adjuvant imatinib and 14 patients had been observed without imatinib. The median tumor size of two groups were 11.0 (3.0 – 19.0) vs. 5.85 (2.6 – 18.9) and the median mitotic rate was 7.0 (2 – 18.5) vs. 1.0 (0 – 45). Regarding the 9 patients taken palliative imatinib, median tumor size was 20.9 (16.5 – 30.0), median mitotic rate was 15.0 (3 – 60) and median PFS was 22.7 months (95% CI 7.7 – 37.7). Conclusions: As the biologic behavior of GISTs is different by location, a more stratified strategy is needed for managing EGISTs including incorporation of molecular features. We are planning to perform further mutation analysis in this cohort.
Impact of adjuvant therapies on survival in patients with cholangiocarcinoma.
Authors: Dover Laura , Jacob Rojymon , Wang Thomas , Oster Robert , Dubay Derek 
Published: February 2017

360 Background: Surgical resection is the only curative option for Cholangiocarcinoma (CC) and currently there are no clear guidelines for adjuvant therapy following resection. Given the high incidence of local and distant recurrences following resection, we evaluated the impact of adjuvant chemotherapy or chemoradiation (CRT) on median survival (OS). Methods: A retrospective review was performed identifying all patients with CC who underwent curative surgical resection at our institution between 2002 and 2012. Patients who underwent aborted or palliative procedures were excluded. Survival estimates were quantified using Kaplan Meier curves, and differences between groups were compared with the log-rank test and Cox regression models. Results: During the study period, 103 patients underwent curative resection for CC at our institution. Tumor location was intrahepatic, perihilar and distal in 37% (n=38), 23% (n=24) and 40% (n=41) respectively. A total of 49 (48%) patients received adjuvant chemotherapy (n= 28) or CRT (n=21). Observation with no additional therapy was employed in the remaining 54 (52%) patients. No patient was treated using radiation alone. OS was 21.4 and 41.4 months (m) for those receiving adjuvant therapy versus observation (p=0.08). OS for adjuvant therapy versus observation were 28.4 m and 19.4 m respectively, if surgical margins were positive (p=0.036); and 79.1 m and 26.3 m respectively (p=0.4) with negative resection margins. OS was 41.4 m and 38.0 m with adjuvant chemo versus CRT respectively (p=0.1). Tumor stage was the only statistically significant pathologic indicator of outcome (p=0.019). Conclusions: A trend towards significant improvement in OS was observed with the use of adjuvant therapy among all patients following resection of CC. Adjuvant therapy significantly improved OS among CC patients with positive margins of resection. The small number of patients with negative margins of resection also benefitted, though not significantly. These data suggest that while adjuvant therapy should be considered for all patients irrespective of margin status; patients with positive margins are likely to benefit the most.