bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of perioperative transfusion on recurrence and survival after resection of distal cholangiocarcinoma: A 10-institution study from the U.S. Extrahepatic Biliary Malignancy Consortium.
Authors: Lopez-Aguiar Alexandra G , Ethun Cecilia , Pawlik Timothy M. , Poultsides George A. , Tran Thuy , Idrees Kamran , Isom Chelsea A , Fields Ryan C , Krasnick Bradley , Weber Sharon M. , Salem Ahmed , Martin Robert C. G. , Scoggins Charles Raben , Shen Perry , Mogal Harveshp , Schmidt Carl Richard , Beal Eliza W , Hatzaras Ioannis , Shenoy Rivfka , Maithel Shishir Kumar 
Published: March 2017

236 Background: Perioperative allogeneic blood transfusion is associated with poor oncologic outcomes in several malignancies. Its effect on recurrence and survival in distal cholangiocarcinoma (DCC) is unknown. Methods: All patients with DCC who underwent curative-intent pancreaticoduodenectomy at 10 institutions from 2000-2015 were included. 30-day mortalities were excluded. Primary outcomes were recurrence-free (RFS) and overall survival (OS). Results: Of 314 pts with DCC, 206 (66%) underwent curative-intent pancreaticoduodenectomy. Median age was 67yrs, and 53 pts (28%) received perioperative blood transfusions, with a median of 2 units.There were no differences in baseline demographics or operative data between transfusion and no-transfusion groups.Compared to no-transfusion, patients who received a transfusion were more likely to have (+)margins (28vs14%; p < 0.03) and major complications (46vs16%; p < 0.001). Receipt of neoadjuvant or adjuvant therapy was similar between groups. Transfusion was associated with lower median RFS (19vs32mos; p = 0.006) and OS (15vs29mos; p = 0.003), which persisted on multivariable (MV) analysis for both RFS (HR 1.8; 95%CI 1.1-3.1; p = 0.03)and OS (HR 1.9; 95%CI 1.1-3.2; p = 0.03), after controlling for portal vein resection, EBL, margin status, grade, LVI, LN status, and major complications. Similarly, transfusion of ≥ 2 pRBC units was associated with lower RFS (17vs32mos; p < 0.001) and OS (14vs29mos; p < 0.001), which again persisted on MV analysis for both RFS (HR 2.6; 95%CI 1.4-4.6; p = 0.002) and OS (HR 3.9; 95%CI 2.1-7.5; p < 0.001). The RFS and OS of patients transfused 1 unit was similar to those not transfused. Conclusions: Perioperative blood transfusion is associated with decreased RFS and OS after resection for distal cholangiocarcinoma, after accounting for known adverse pathologic factors. Volume of transfusion seems to exert an independent effect, as 1 unit is not associated with the same adverse effects as ≥ 2units. This supports the judicious use of perioperative transfusion; protocols should be developed and followed.
Comparison of the pathological features among HBV, HCV, and nonviral etiology-related hepatocellular carcinoma using explanted whole liver examinations.
Authors: Akashi Hayato , Hidaka Masaaki 
Published: March 2017

245 Background: The aim of this study is to compare the pathological features among HBV, HCV and non-viral etiology related hepatocellular carcinoma (HCC) in the explanted cirrhotic liver using whole liver examinations. Methods: Ninety patients (HBV 23, HCV 53, HBV+HCV 3, nonBnonC 16) out of 246 recipients of liver transplantation were analyzed. All specimens were sectioned serially at 5-7 mm intervals and then were examined by an experienced pathologist. The pathological characteristics of HCC among each group were retrospectively analyzed using whole liver thin sliced histological examinations. Results: The median number and maximum size of HCC were one nodule (range 0-3 nodules), 22 mm (range 7-50 mm) by pre-operative imaging, and two nodules (range 0-37 nodules), 20 mm (range 4-50 mm) based on histological examinations. Twenty-six patients (27.4%) had more than 3 nodules measuring less than 1 cm diameter based on histological examinations. Fifteen patients (15.8%) had HCC with micro vascular invasion. Twenty-seven patients (28.4%) demonstrated findings beyond the Milan Criteria based on pathological examinations. NonBnonC related HCC tended to be within the Milan Criteria based on pathological examinations in contrast to viral related HCC (nonBnonC 12.5%, HBV 34.8% and HCV 39.6%). There were significantly more undetectable HCCs in HCV related HCC than in detectable HCCs by imaging. Conclusions: The undetectable HCCs in HCV tended to be found in the explanted liver. HCCs exceeding the rate of the Milan Criteria were less frequently found in non-viral related HCC than in viral related HCC.
Heterogeneous growth rates of pancreatic adenocarcinoma by retrospective analysis of CT imaging data.
Authors: Mortenson Tanner , Bigeh Allison , Chen Yighua , Malek-Ahmadi Michael , Chen Kewei , Kundranda Maddapa , Chang John 
Published: March 2017

248 Background: Pancreatic ductal adenocarcinoma (PDAC) remains the fourth leading cause of cancer death in the United States. Despite its high mortality, there is no effective screening method or frequency. The purpose of this study is to retrospectively evaluate prediagnostic CT images in order to identify growth rate and determine a potential surveillance frequency for at risk patients. Methods: 188 PDAC patients were seen at Banner MD Anderson Cancer Center (BMDACC) from 1/1/2012 to 12/31/2015. 24 patients met the final inclusion and exclusion criteria. Tumor area on CT imaging was then evaluated for rate of change prior to diagnosis. Both absolute and relative areas were plotted against time prior to diagnosis at 3, 6, 9, 12, 24, 36, 48, 60, and 72 months. Results: With two exceptions, no evidence of malignancy was identifiable at two or more years prior to diagnosis. Growth rates per year varied significantly. Absolute area change ranged from 1.7 cm2/yr to 139.22 cm2/yr; relative area change ranged from 1.17 to 7.15. Assuming a spherical mass, these relative changes correspond to relative volume change (ratio) per year of 1.27 and 19.13; the equivalent linear tumor doubling times are 3.7 years and 20 days respectively. Student’s T-test yielded no significant difference for relative growth, absolute growth, PFS, or OS between male and female patients. Conclusions: The heterogeneity in growth rate has significant implications for potential screening of PDAC. Screening interval greater than 1 year is feasible with other slow growing tumors. However, annual screening is not feasible for rapidly growing PDAC. Based on our findings, screening may need to be as frequent as 3-month intervals which would incur significant economic cost. Further correlation of prediagnostic growth rate with molecular changes may be necessary to discover the driver of this heterogeneous growth pattern.
Can we expect long-term survival in patients with extrahepatic metastasis of hepatocellular carcinoma?
Authors: Kim Kangpyo , Seong Jinsil 
Published: March 2017

251 Background: Hepatocellular carcinoma presenting metastases has been considered detrimental situation. However, it is not infrequent observing long term survivors following active therapeutic intervention in selected patients. In this study, we investigated whether long term survival could be real as well as its common clinical features. Methods: From november 2005 to december 2014, among 1020 HCC patients with extrahepatic metastasis, 75 patients survived over 2 years. The patient and tumor characteristics were examined involving the site, number of metastatic lesions, liver function, and other factors. Treatment methods for liver and metastatic lesions were also reviewed with subgroup survival analysis according to the treatment strategies. Results: We observed survival over 2 years in 7.3 % with median survival of 41 months. The most common sites of extrahepatic metastasis were lung, bone, adrenal gland and lymph nodes in order of frequency. Of 75 survivors, 72 (96%) had single organ metastasis, and 46 (64%) had four or less countable metastatic lesions. Child-Pugh score was within 5 to 7 points for 71 patients when extrahepatic metastasis first occurred. More than two-thirds of patients (52 patients, 69.3%) received local treatments such as surgery or radiotherapy showing significantly higher survival than systemic treatment only (23 patients, 30.7 %) group; 3 year survival 65.7 % versus 21.7 % for the group with and without local treatment respectively (p = 0.001). For patients with a viable tumor in the liver, the application of local treatments such as transarterial treatment or radiotherapy showed a significant survival benefit (3-year survival 46.6 % versus 31.3%, p = 0.045). Conclusions: The long-term survivors presented limited number of extrahepatic metastasis (oligometastasis) and received local treatment for their metastatic lesions. Local treatments to metastatic lesions will increase the survival of advanced HCC patients who have proper liver function and a small number of metastases in a single organ. This study suggests the application of individually tailored therapeutic strategies for advanced HCC patients with extrahepatic metastasis.
A population-based analysis of urban-rural disparities in advanced pancreatic cancer (APC) management and outcomes.
Authors: Canale Thomas , Cheung Winson Y. 
Published: March 2017

254 Background: Given the significant morbidity burden associated with APC, its management is complex and frequently requires multidisciplinary care. Because of potential geographical barriers to healthcare access, we aimed to determine the effect of rurality on management and outcomes of APC patients. Methods: Patients diagnosed with APC (locally advanced or metastatic disease) from 2008 to 2015 and received gemcitabine (gem), gem plus nab-paclitaxel (gem/nab), or FOLFIRINOX at any 1 of 6 British Columbia cancer centers across the province were reviewed. Using postal codes, the Google Maps Distance Matrix determined the distance from each patient’s residence to the closest cancer center. Rural and urban status were defined as patients living >= 100 km and < 100 km from the closest treatment site, respectively. Univariate and Cox regression analyses were applied to examine whether rurality resulted in variations in management and outcomes. Results: In total, we identified 667 patients: median age 68 years, 54.3% men, and 45.7% metastatic disease. Among them, 19.5% lived rurally and 80.5% resided in urban areas. For treatment, 67.8%, 9.4%, and 22.8% received gem, gem/nab, and FOLFIRINOX, respectively. However, there were no differences in baseline clinical characteristics between rural and urban patients (all p > 0.05). Also, there were no significant variations in treatment patterns. For example, time from diagnosis to oncology appointment and time from appointment to treatment were 31.6 and 29.5 days for rural patients and 28.7 and 39.9 days for urban patients, respectively (all p > 0.05). Use of gem/nab (9.8 vs 9.4%) and FOLFIRINOX (20.5 vs 23.3%) were similar regardless of rurality. In multivariate Cox regression, risk of death was similar between rural and urban groups (HR 1.34, 95% CI 0.95-1.87, p = 0.09). Conclusions: Our findings suggest that there is no correlation between rurality and outcomes in APC. The strategic and geographic allocation of cancer care delivery across the province of British Columbia may serve as a model for other jurisdictions that experience disparities in the outcomes of cancers that often require complex multidisciplinary care.
Clinical impact of sarcopenia on prognosis in pancreatic ductal adenocarcinoma.
Authors: Ninomiya Go , Fujii Tsutomu , Yamada Suguru , Asano Tomonari , Takano Nao , Takami Hideki , Iwata Naoki , Kanda Mitsuro , Niwa Yukiko , Hayashi Masamichi , Kobayashi Daisuke , Tanaka Chie , Nakayama Goro , Sugimoto Hiroyuki , Fujiwara Michitaka , Koike Masahiko , Kodera Yasuhiro 
Published: March 2017

259 Background: In the past, various prognostic factors in pancreatic ductal carcinoma (PDAC) have been identified, and there found to be not only tumor-specific clinicopathological factors but also individual patient characteristics. In particular, weight loss, muscle wasting and cachexia are hallmarks of PDAC that may be associated with depletion of both skeletal muscle and adipose tissue. Most notably, sarcopenia is defined to be degenerative loss of skeletal muscle mass that is quantifiable using cross sectional imaging computed tomography (CT) by measurement of psoas area and the muscle’s density. Furthermore, visceral adipose tissue loss also has been reported to associate with a poor survival among patients with PDAC. Methods: A total of 265 patients who underwent curative surgery for PDAC were examined in this study. The total skeletal muscle and fat tissue areas were evaluated in a single image obtained at the third lumber vertebra during a preoperative computed tomography (CT) scan. The patients were assigned to either the sarcopenia or non-sarcopenia group based on their skeletal muscle index (SMI) and classified into high visceral fat area (H-VFA) or low VFA (L-VFA) groups. The association of clinicopathological features and prognosis with the body composition were statistically analyzed. Results: There were 170 patients (64.2%) with sarcopenia. The median survival time (MST) was 23.7 months for sarcopenia patients and 25.8 months for patients without sarcopenia. The MST was 24.4 months for H-VFA patients and 25.8 months for L-VFA patients. However, sarcopenia patients with BMI ≥ 22 exhibited significantly poorer survival than patients without sarcopenia (MST: 19.2 vs. 35.4 months, P = 0.025). There was a significant difference between patients with and without sarcopenia who did not receive chemotherapy (5-year survival rate: 0% vs. 68.3%, P = 0.003). The multivariate analysis revealed that tumor size, positive dissected peripancreatic tissue margin, and sarcopenia were independent prognostic factors. Conclusions: Sarcopenia is an independent prognostic factor in PDAC patients with a BMI ≥ 22. Therefore, evaluating skeletal muscle mass may be a simple and useful approach for predicting patient prognosis.
Clinical impact of visceral thrombosis (VT) in pancreatic ductal adenocarcinoma (PDAC).
Authors: Mier Hicks Angel , Raj Micheal , Do Richard Kinh Gian , Yu Kenneth H. , Lowery Maeve Aine , Varghese Anna M. , O'Reilly Eileen Mary 
Published: March 2017

260 Background: VT or splanchnic thrombosis is defined as thrombi within the hepato-portal venous system including; portal (PV), mesenteric (MV) and splenic vein (SV), as well as thrombi in renal or gonadal veins. Limited evidence has explored the prognostic significance, incidence and current clinical management of VT in patients with PDAC. Methods: We conducted an analysis of N = 95 patients treated at Memorial Sloan Kettering Cancer Center diagnosed between 1/1/13 and 12/31/15 with PDAC who developed a VT either at presentation or which developed during the disease course. Results: N = 134 VT events (VTe) occurred. Median age of PDAC diagnosis was 62.5 yrs. Overall survival (OS) was 10.5 months (m); seven patients were still alive in 7/ 16. Time to develop first VTe was 4.3m (SD6.71, 0-31) and time to death from VTe development was 6.1m (SD 5.7,0-24). Subsequently, N = 42 pts developed a second VTe and N = 13 pts a third VTe. At time of VT diagnosis, N = 37 (38%) pts were asymptomatic, and N = 58 (61%) pts had an incidental finding. N = 39 (39%) pts were treated with short-term anticoagulation (STAC) ( < 1m) (N = 35 pts, treated with Low Molecular Weight Heparin (LMWH)). N = 45(46%) pts were treated with long-term anticoagulation (LTAC) ( > 1m) (LMWH N = 32, N = 11 pts were transitioned to an oral anticoagulant (NOAC)). Only N = 12(12%) pts were treated with a NOAC. N = 8 (8%) pts developed a bleeding complication from LTAC. OS for pts receiving LTAC was 4m vs 3m with STAC. Conclusions: In patients with PDAC, VT can frequently present as an incidental finding on routine abdominal imaging. The most common location is PV followed by MV and SV. We observed that AC is under-utilized in this setting despite a low bleeding complication rate. LMWH appeared to be the preferred treatment with LTAC, followed by use of a NOAC. PV was associated with reduced OS. Use of therapeutic anticoagulation for treatment of VT is limited by lack of data. Future large prospective studies should explore the role of AC and value in this setting.[Table: see text]
Prospective evaluation of the clinical implications of the tumor metabolism and chemotherapy-related changes in advanced biliary tract cancer.
Authors: Jo Jaemin , Oh Do-Youn , Park Seongyeol , Kwon Hyun Woo , Cheon Gi Jeong , Bang Yung-Jue 
Published: March 2017

261 Background: Tumor metabolism measured by [18F] fluorodeoxy-D-glucose (18F-FDG) positron emission tomography (PET) has a diagnostic and prognostic role in several cancers. The clinical implication of tumor metabolism in biliary tract cancer (BTC) has not been studied well. Therefore, we prospectively evaluated the prognostic value of tumor metabolism and chemotherapy-related changes in advanced BTC patients. Methods: We prospectively enrolled advanced BTC patients before the initiation of palliative chemotherapy. Using 18F-FDG PET, we assessed the baseline maximum standardized uptake value (SUVmax) and monitored the changes of SUVmax during chemotherapy. We analyzed the associations between SUVmax, and clinicopathologic factors and clinical outcomes. Results: A total of 75 patients were enrolled. All patients received gemcitabine/cisplatin as first-line chemotherapy. Primary tumor site, histologic differentiation, molecular characteristics, laboratory findings, and disease extent were associated with the metabolic characteristics. The high metabolism group showed worse survival outcome [Hazard ratio (HR)=4.09, p=0.001 for progression-free survival (PFS); HR=2.61, p=0.019 for overall survival (OS)] than the low metabolism group. The lesser reduction of SUVmax during chemotherapy was also associated with worse outcome (HR=3.35, p=0.002 for PFS; HR=1.96, p=0.082 for OS). Considering both baseline tumor metabolic activity and chemotherapy-related changes in the tumor metabolism, patients with a low metabolism and a more reduction in metabolism obtained the best OS (20.7 months, p=0.013). Conclusions: Tumor metabolic activity and the chemotherapy-related changes in the metabolism were associated with prognosis in advanced BTC patients.
A study on thromboembolism of patients with pancreatic cancer.
Authors: LAM Kwan Yu , Lee Kirsty , Chong Charing , Chan Anthony WH , Mok Tony , Chan Stephen Lam 
Published: March 2017

262 Background: There have been studies on the association between thromboembolism (TE) and pancreatic cancer in Caucasian patients. This study aims to study the TE in Chinese patients with pancreatic cancer. Methods: This study retrospectively reviewed consecutive patients with confirmed diagnoses of pancreatic cancers from 2010-2015 in the Prince of Wales Hospital in Hong Kong. Patients with radiologically confirmed TE were identified. Corresponding information related to the type and site of TE were recorded. Predictive factors for the TE were studied by multivariate analysis. Results: Total 372 patients with pancreatic cancer were identified. In the cohort, the diagnoses of cancers were made by histology in 225 (60.5%) of them while others were made by radiology. The stage was as follows: 15 (4.1%) stage I; 113 (30.4%) stage II; 47 (12.7%) stage III and 196 (52.7%) stage IV. Total 55 (14.7%) patients had TE after diagnosis of pancreatic cancer. Of these 55 patients, 33 (60%) and 18 (32.7%) had venous and arterial events, respectively. For patients with TE, 27 (49.1%) were treated with anti-coagulants, and 13 (23.6%) had surgery within 2 years. The median time from surgery to the development of TE was 1.06 years. Patients with ECOG ≥2 and metastatic disease (HR 2.92, 95% CI 1.58-5.37; HR 6.90, 95% CI 3.63-13.14 respectively) had a higher risk of developing TE. Patients with venous, arterial, or both types of TE did not have significantly different overall survival. Poor prognostic factors for overall survival include ECOG ≥2 (HR 2.80, 95% CI 2.18-3.60) and tumour stage (stage II disease HR 1.36, 95% CI 0.70-2.62; stage III disease HR 1.85, 95% CI 0.92-3.70; stage IV disease HR 4.92, 95% CI 2.58-9.36). The presence of TE equated to a worse overall survival (median overall survival 148 vs. 228 days, HR 1.03, 95% CI 0.75-1.40, P=0.87), which was statistically insignificant. Conclusions: TE was similarly high in Chinese patients with pancreatic cancer. Patients with poorer performance status and metastatic disease had a greater risk of developing TE. Patients with TE had a worse overall survival (which was statistically insignificant) compared to patients without TE.
Evaluation of tumor marker cancer antigen 72-4 (CA 72-4) in the monitoring of metastatic or recurrent tumors of the gastrointestinal tract, lung, breast, and ovaries.
Authors: Mariampillai Anusiyanthan Isaac , Dela Cruz Josephine Pineda , Suh Jason , Sivapiragasam Abirami , Nevins Kyle , Hindenburg Alexander A. 
Published: March 2017

263 Background: In management of metastatic and recurrent cancers, measuring response is a constant challenge. CA72-4 is a tumor marker (TM) that has been found elevated in a variety of human adenocarcinomas, with reported sensitivities of up 50% and overall specificity of over 95%. Using the DRG TM-CA72-4 assay, we quantified the abnormality rate of TM CA72-4 compared with current FDA-approved TM in various cancers. Methods: We conducted a prospective, single center study by enrolling 96 patients between March 2013 and August 2016 with various de novo or previously diagnosed locally advanced, unresectable and/or metastatic cancers known to express CA72-4. Quantification of CA72-4 was performed according to manufacturer’s instructions using the DRG TM-CA72-4 ELISA kit, which was developed by DRG International (Germany) utilizing the CC-49 monoclonal mouse antibody directed against an epitope on the CA72-4 antigen. Positivity was calculated as greater than A) 0.8 U/mL or B) 4.0 U/mL based on systematic review of prior studies. Results: The positivity rates based on different cut-off points (0.8 U/mL vs 4 U/mL) and their corresponding FDA approved tumor markers are shown in the Table. Conclusions: Positivity rates of CA72-4 varied based on different assay cut-off levels with the highest positivity noted in the pancreatic, ovarian and colorectal carcinomas indicating a potential role for disease monitoring. [Table: see text]