bluuebunny/crossref_metadata_2025_split huggingface dataset:
A novel pathology-based preoperative risk score to predict distant and locoregional residual disease and survival for incidentally discovered gallbladder cancer: A 10-institution study from the US Extrahepatic Biliary Malignancy Consortium.
Authors: Ethun Cecilia Grace , Postlewait Lauren McLendon , Pawlik Timothy M. , Buettner Stefan , Poultsides George A. , Tran Thuy , Idrees Kamran , Isom Chelsea A , Fields Ryan C. , Jin Linda , Weber Sharon M. , Salem Ahmed I. , Scoggins Charles Raben , Shen Perry , Mogal Harveshp , Schmidt Carl Richard , Beal Eliza W , Hatzaras Ioannis , Shenoy Rivfka , Maithel Shishir Kumar 
Published: February 2017

202 Background: T-stage alone is currently used to guide treatment for incidentally discovered gallbladder cancer. We aimed to develop a more robust predictive model for discovering distant or locoregional residual disease at the time of re-resection. Methods: All patients with incidentally discovered gallbladder cancer who underwent re-resection at 10 institutions from 2000-2015 were included. We utilized routine pathology data from initial cholecystectomy to create a gallbladder cancer predictive risk score (GBRS) for finding distant or locoregional residual disease at re-resection and predicting overall survival (OS). Results: Of 449pts with gallbladder cancer, 262 (58%) were incidentally discovered and underwent attempted re-resection. Advanced T-stage, grade, and lymphovascular (LVI) and perineural (PNI) invasion were all associated with increased rates of distant and locoregional residual disease, and decreased OS. Each pathologic characteristic was assigned a value (T1a: 0, T1b: 1, T2: 2, T3/4: 3; well diff: 1, mod diff: 2, poor diff: 3; LVI neg: 1, LVI pos: 2; PNI neg: 1, PNI pos: 2), which were added for a total GBRS score ranging from 3-10. The scores were then separated into 3 risk groups (Low: 3-4; Intermediate: 5-7; High: 8-10). Each progressive GBRS group was associated with an increased risk of finding distant and isolated locoregional residual disease at the time of re-resection, and was associated with reduced median OS (Table). Conclusions: By accounting for pathologic variations within each T-stage, this novel predictive risk-score redistributes T1b, T2, and T3 disease across separate risk-groups and more accurately identifies patients with incidentally discovered gallbladder cancer at risk for distant and locoregional residual disease, and decreased long-term survival. This score may help to better optimize treatment strategy for patients with incidentally discovered gallbladder cancer. [Table: see text]
Molecular diagnosis with the 92-Gene Assay (92-GA) and decision-impact on treatment: Final results from a prospective, multi-disciplinary study.
Authors: Thomas Sachdev P. , Braiteh Fadi S. , Jacobson Lauren , Victorio Anthony R. , Cherkis Karen Ann , Operana Theresa N. , Blatner Nichole Renee , Schroeder Brock , Schnabel Catherine A. 
Published: February 2017

205 Background: Metastatic lesions with unknown or differential diagnoses pose significant challenges leading to suboptimal treatment and outcomes. Molecular diagnosis with the 92-GA has shown improved accuracy compared to IHC and improved survival in pts treated based on assay results. The following prospective, multi-institutional study assessed the utility and impact of the 92-GA in diagnosis and treatment decision-making in community clinical practice. Methods: Over 18 months, physicians (68 medical oncologists, 25 pathologists) completed standardized, discipline-specific questionnaires via a web-based data portal for 444 cases in which the 92-GA was ordered as part of routine clinical care for pts with unknown or differential diagnoses. Physician-reported utility and impact were characterized for oncologists and pathologists. Results: 92-GA molecular diagnoses included 22 different tumor types: pancreaticobiliary (21%), lung squamous (9%), lung adenocarcinoma (9%), and intestinal (9%) were most common. Factors contributing to ordering the 92-GA were interdisciplinary: for oncologists, no primary following clinical review and imaging (42%), pathology report of a differential diagnosis (21%) or unknown primary (20%), and differentiation between a new cancer or recurrence (16%) were most common; for pathologists, IHC inconclusive (50%; median 9 IHC stains) and oncology ordered due to unknown primary (30%) were most common. Oncologists reported that the diagnosis provided by the 92-GA resulted in changing the treatment option in 46% of cases. 75% of pts received therapy with a median time from biopsy to treatment of 25d. Following the 92-GA, predictive biomarkers (eg, EGFR, ALK) were ordered in 81% of cases diagnosed as lung and 67% diagnosed as colorectal cancer. Conclusions: This study demonstrated significant clinical utility of the 92-GA: changing treatment options in approximately half of pts. Clinical utility spanned a spectrum of diagnostic uncertainty for oncologists and pathologists, and helped narrow differential diagnosis. Additional biomarker testing was common after a diagnosis of lung or colorectal cancer was rendered by the 92-GA.
Identification of prognostic value of lymphocyte-to-monocyte ratio in patients with advanced HBV-associated hepatocellular carcinoma.
Authors: Chen Zhan-Hong , Hong Yingfen , Ma Xiao-kun , Li Xing , Wu Dong-hao , Lin Qu , Dong Min , Chen Jie , Wei Li , Wang Tian-tian , Ruan Dan-yun , Wen Jingyun , Wu Xiang-yuan 
Published: February 2017

206 Background: Inflammatory microenvironment plays an important role in the progression of HCC. Peripheral blood LMR, as a novel inflammatory biomarker combining an estimate of host immune homeostasis and tumor microenvironment, has been found to be a predictor for clinical outcomes in various malignancies. There have been no reports regarding the prognostic value of LMR in advanced HCC until now. We want to investigate the prognostic value of LMR in patients with advanced HBV-associated hepatocellular carcinoma. Methods: From September 2008 to June 2010, a total of 174 patients with HBV-associated advanced HCC without fever or signs of infections were analyzed. Clinicopathological parameters, including LMR, were evaluated to identify predictors of overall survival. Univariate and multivariate analyses were performed, using the Cox proportional hazards model. The best cutoff was determined with time-dependent receiver operating characteristic curve. Results: Univariate and multivariate analyses showed that LMR was an independent prognostic factor in overall survival in patients with advanced HCC(P < 0.01 ). The best cutoff point of LMR was 4.52. All patients were dichotomized into either a low LMR group( ≤ 4.52) or a high LMR group( > 4.52). Overall survival(OS) of high LMR group was significantly longer than that of low LMR group(P < 0.01 ). High LMR group patients had significantly higher 6-month OS rate(50% vs 23%, P < 0.01) than that of low LMR group patients. Higher LMR level was significantly correlated with the presence of metastasis and larger tumor size(P < 0.05). Conclusions: LMR is an independent prognostic factor of advanced HCC patients. Higher Baseline LMR levels indicates better prognosis.
Age barrier in clinical trials: Are we truly moving forward?
Authors: Ayodele Olubukola , Linkeviciute-Koneko Aiste , O'Connor Miriam , Calvert Paula , Horgan Anne M. 
Published: February 2017

208 Background: Older patients are underrepresented in clinical trials. This may in part be explained by the fact that, historically, there has often been an upper age limit for inclusion in studies. This is despite data that suggests that older patients are as likely as their younger counterparts to enroll in clinical trials if offered. Methods: All prospective, interventional phase III studies in GI malignancies registered with clinicaltrials.gov were identified. Currently opened and recruiting studies were included. Results: A total of 365 eligible trials were identified. One hundred and fifty (41%) were colorectal, 67 (18%) liver and 62 (16%) were pancreatic malignancies. Other malignancies were gastroesophageal, hepatobiliary and neuroendocrine tumours. A total of 172 (47%) studies had an upper age limit for inclusion. The most common tumor sites to have older age as an exclusion factor were - hepatobiliary (n = 10; 66%), liver (n = 39; 58%) and gastroesophageal (n = 31; 51%). The median age of exclusion was 75 years (range: 60-95). Chinese studies, which represented 30% (n = 111) of the total studies included, had the greatest proportion with an upper age limit (85%). The United States had the least, with only 3% of studies having an exclusion age. Conclusions: Significant progress had been made in recent years with many clinical trial protocols not having an upper age limit for inclusion. Study design and restrictive eligibity criteria need to be assessed and modified to ensure older patients are well represented in future clinical trials.
Does metabolic tumor volume predict tumor regression grade after neoadjuvant therapy for borderline resectable pancreatic cancer?
Authors: Jin Will , Mellon Eric Albert , Hoffe Sarah E. , Frakes Jessica M. , Springett Gregory M. , Hodul Pamela Joy , Centeno Barbara , Kim Richard D. , Mahipal Amit , Pimiento Jose Mario , Malafa Mokenge Peter , Latifi Kujtim 
Published: February 2017

214 Background: Metabolic tumor volume (MTV) based on FDG-PET has been shown to be prognostic for overall survival (OS) in patients with resectable, borderline resectable (BRPC) and locally advanced pancreatic cancer (LAPC). Tumor regression grade (TRG) following neoadjuvant therapy has also been shown to correlate with OS. No data currently exists evaluating whether metabolic response defined by MTV can predict pathologic response in BRPC. Methods: This IRB approved retrospective review evaluated 40 non-metastatic BRPC patients. All patients underwent staging imaging including FDG PET/CT. They then received induction multi-agent chemotherapy followed by five fraction stereotactic body radiation therapy (SBRT) with a median maximum dose of 35 Gy. Repeat pre-operative FDG PET/CT was performed for re-staging. Patients then underwent pancreatectomy. For this study, the diagnostic images were transferred to a software system that analyzed the pre-treatment, re-staging, and change in (differential) MTV values. We analyzed SUVmax and each of MTV2.5, MTV3.0, MTV4.0, and MTV5.0, as defined as the tumor volume with SUV above each threshold. At our center, each surgical specimen is assigned TRG using the College of American Pathology (CAP) criteria. The TRG scores regression from 0 – 3, with 0 indicating complete response and 3 indicating no response. Univariate ordinal logistic regression was used to correlate TRG with pre-, post-, absolute differential, and percent differential MTV 2.5-5.0 and SUVmax. Results: Of the sample population, TRG was as follows: TRG 0 n = 4, TRG 1 n = 17, TRG 2 n = 14, TRG 3 n = 5. TRG correlated with rradiologist reported re-staging SUVmax (p = 0.001) and percent differential SUVmax (p = 0.044). TRG did not correlate with pre-treatment SUVmax, absolute differential SUVmax, or any MTV measurements (all p > 0.05). Conclusions: We identified a correlation between SUVmax and percent change in SUVmax after neoadjuvant therapy with TRG (CAP scale). This analysis did not identify an association between any MTV threshold and TRG before or after neoadjuvant therapy. Future work seeks to identify alternate methods of neoadjuvant response assessment.
The accuracy of endoscopic ultrasonography for identifying stomach neoplasm before endoscopic submucosal dissection.
Authors: Song Pil Hun , Sung Hyun , Lee Jeonghun , Yoon Won Jae , Kim You Sun , Moon Jeong Seop , Ryu Soo Hyung , Lee Sang Woo , Jung Hyun chae 
Published: February 2017

22 Background: The treatment of stomach neoplasm was determined by the identification on of invasion extent and perigastric lymph node through endoscopic ultrasonography (EUS). In this study, we investigated diagnostic accuracy of EUS examination before endoscopic submucosal dissection (ESD). Methods: A retrospective study was conducted to both EUS and ESD for stomach neoplasms that were performed at Seoul Paik Hospital between January 2006 and July 2015. We compared the accuracy of EUS according to the location of lesion, tumor size and ulcer presence or absence on lesion. Results: 49 patients were enrolled in this study; their mean age was 64.14 ± 11.33 years. There were 40 male (81.6%) and 9 female (18.4%) patients. The cases of confined to the mucosa on pathology finding were 41 (83.6%) and involved to submucosal layer(sm) 1 were 3 (6.1%) and sm2 were 2 (4%) and sm3 were 1 (2%) and proper muscle layer were 2 (4%). The cases of lymphatic invasion were 2 (4%). The sensitivity and accuracy of antrum were 91.6 % (95% CI: 0.81-1.03) and 83.3 % (95% CI: 0.70-0.97), body of stomach were 92.3 % (CI: 0.78-1.07) and 83.3% (CI: 0.66-1.00), respectively. Whether lesions were no significant differences in any location. The tumor size was divided by smaller than 20 mm group, 20-30 mm group and more than 30 mm group. The smaller than 20 mm group, 20-30 mm group and more than 30 mm group were 36, 9, 2 patients. The remaining 2 patients were not described. The sensitivity and accuracy of smaller than 20 mm group were 96.6 % (95% CI: 0.90-1.03) and 83.3 % (CI: 0.71-0.95) and 2-30 mm group were 66.7 % (CI: 0.29-1.04) and 77.8 % (CI: 0.51-1.04), respectively. All patients were divided by ulcer presence or not. 27 patients were ulcer presence and 22 patients were not. The sensitivity and accuracy of ulcer presence group were 77.3 % (CI : 0.60-0.95) and 74 % (CI : 0.57-0.90), ulcer absence group were 95 % (CI : 0.85-1.04) and 91 % (CI : 0.79-1.02). Conclusions: The EUS for stomach neoplasm was reliable of lesion without ulcerous finding, smaller than 20 mm in diameter and irrespective of stomach neoplasm location.
Recurrence rates of resected appendix carcinoid tumors: A 20-year experience at Memorial Sloan Kettering Cancer Center.
Authors: Murphy Jennifer , Rosowicz Andrew , Saltz Leonard , Paty Philip , La Quaglia Michael P. , Reidy Diane Lauren 
Published: February 2017

221 Background: NETs of the appendix are rare neoplasms most often discovered during incidental appendectomy. Risk of nodal metastases based on single institution series has suggested that appendix carcinoid tumors > 2 cm should undergo a right colectomy. Unlike other tumors, lymph node involvement does not change management given the lack of adjuvant therapies. We sought to evaluate our experience of patients with resected appendix carcinoid, the risk of recurrence, and the benefit of surveillance following resection. Methods: A single institution database of all patients with diagnosis of neuroendocrine tumors was queried for all resected appendix carcinoid tumors. Excluded were patients with large and small cell neuroendocrine tumors, goblet carcinoid, and patients with inaccessible patient records. Results: 88 patients were included from August, 1994 through December, 2013. The mean age at diagnosis was 37.1(9.9-75.8). There were 19 (22%) children (less than 18 years of age) and 69 (78%) adults. Females represented 72% of all patients. All patients had well differentiated tumors. Median follow-up was 2.5 years (1-16.5 years, 45% of which had longer than 3-year follow-up). 43/88 (49%) patients underwent right hemicolectomy (average size 2 cm) and 45/88 (51%) simple appendectomy (average size 0.9 cm). Most patients were followed with CT scans and laboratory evaluations and frequency of surveillance was inconsistent. There were no recurrences (0/88). Ten-year survival was 100%. Conclusions: This is one of the largest series of resected appendix carcinoid reported and no patients recurred. Prognosis was excellent and in the absence of metastatic disease, excessive imaging and/or laboratory testing should be avoided. We question the use of routine right hemocolectomy in these patients.
Diagnostic potential of mucins in pancreatic juice for pancreatic cancer.
Authors: Patel Asish , Kaur Sukhwinder , Smith Lynette , Are Chandrakanth , Batra Surinder 
Published: February 2017

222 Background: Pancreatic juice remains an underutilized resource for diagnosing pancreatic cancer. Mucins are high molecular weight glycoproteins differentially upregulated in pancreatic cancer, and we hypothesize that their profile in pancreatic juice may have diagnostic potential. Methods: Pancreatic juice was obtained during endoscopy from non-healthy non-pancreatic control (NHPC, n = 57), chronic pancreatitis (CP, n = 23), and pancreatic cancer (PC, n = 23) patients. Sandwich ELISA was used to detect MUC1, MUC4, MUC5AC, CA125, and CA19-9. Kruskal-Wallis test and Wilcoxon rank sum test for group and pairwise comparison was done with p < 0.05 as significant. Logistic regression with ROC curve modeling of log transformed data was done for each biomarker individually and in combination to determine odds ratio (OR), sensitivity (SN), and specificity (SP) for PC. Results: PC vs NHPC: MUC5AC had the best individual performance for diagnosing PC with an OR = 2.78 (95% CI = 1.51-5.13), AUC = 0.81, and optimal SN/SP of 0.83 and 0.67, respectively. CA125 was increased in PC with an OR = 2.31 (95% CI = 1.4-4.0), AUC = 0.73, and optimal SN/SP of 0.88 and 0.67. CA19-9 was increased in PC with an OR = 1.5 (95% CI = 1.2-1.8), AUC = 0.76, and optimal SN/SP of 0.73 and 0.70. A combination of MUC1, MUC5AC, CA125, and CA19-9 outperformed all individual markers and had the largest AUC (0.89) with optimal SN/SP of 0.84 and 0.79. PC vs CP: MUC1 concentration in PC was significantly less than CP with an OR = 0.21 (95%CI = 0.088-0.49), AUC = 0.82, and optimal SN/SP of 0.87 and 0.78. PC vs NHPC+CP: MUC1 was decreased significantly in PC with an OR = 0.65 (95% CI = 0.44-0.96), AUC = 0.69, and optimal SN/SP of 0.87 and 0.63. CA125 was increased in PC with an OR = 1.64 (95%CI = 1.1-2.4), AUC = 0.66, and optimal SN/SP of 0.67 and 0.64. CA19-9 was increased in PC with an OR = 1.32 (95%CI = 1.1-1.6), AUC = 0.68, and optimal SN/SP of 0.63 and 0.67. A combination of MUC1, MUC5AC, CA125, and CA19-9 had an AUC = 0.86 with optimal SN/SP of 0.87 and 0.77 for PC. Conclusions: MUC1, MUC5AC, CA125, and CA19-9 combination provides a significantly improved diagnostic panel compared to any individual marker in pancreatic juice for detecting malignancy.
Lymph node metastases in the prognosis of gastroenteropancreatic neuroendocrine tumors.
Authors: Martin Jacob Andrew , Wisnivesky Juan P. , Kim Michelle Kang 
Published: February 2017

224 Background: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are a diverse group of malignancies affecting over 65,000 patients in the United States. GEP-NETs are currently classified as lymph node positive (N1) or negative (N0). The prognostic utility of the extent of lymph node involvement remains unknown. In this study, we used a population-based registry to investigate the relationship between lymph node ratio (LNR) and survival in patients with GEP-NETs. Methods: We used the Surveillance, Epidemiology, and End Results (SEER) data registry to identify patients with histologically confirmed, surgically resected NETs with lymph node involvement diagnosed between 1988 and 2011. Patients were divided into three groups based on the ratio of positive lymph nodes to total lymph nodes examined (LNR): ²0.20, >0.2-0.5, and >0.5. Kaplan-Meier, log-rank analysis, and Cox models were used to compare NET cancer-specific survival according to LNR category. Results: We identified 8,113 patients with GEP-NETs. Primary sites included small intestine (N=3,651), colon (N= 2,042), pancreas (N=1,070), appendix (N= 683), stomach (N=389), and rectum (N=278). Patients were 49% female, 76% white, and 12% black. Ten-year NET-specific survival rates were significantly different among patients in the three LNR groups and LN negative controls (p<.0001). Survival was worse in patients with LNRs of >0.2-0.5 (Hazard Ratio (HR) 1.338, p=.0002), and >0.5 (HR 1.692, p<.0001) compared to LN-negative controls. Higher LNR was correlated with worse survival. Conclusions: The degree of lymph node involvement is a prognostic factor across the most common primary sites of GEP-NETs. This information may be used clinically and in stratifying patients for clinical trials. Results across multiple sites may also be generalizable to GEP-NETs from rare primary locations that are difficult to study. [Table: see text]
Prevalence of radiologic evidence of metastatic pancreatic ductal adenocarcinoma (PDAC) at first post-operative restaging studies in patients (pts) undergoing pancreatic cancer surgery with curative intent.
Authors: Palacio Sofia , Hosein Peter Joel , Levi Joe U , Merchan Jaime R. , Monge Jorge , Portelance Lorraine , Reis Isildinha M. , Rocha Lima Caio Max S. 
Published: February 2017

225 Background: Surgical resection is the only potentially curative modality for PDAC. However, even after a successful surgical resection outcomes are poor due to both local and distant disease recurrence. Patients with early recurrence likely derive no benefit from surgery and could be considered for a non-surgical approach as initial therapy. Since the incidence of recurrent/metastatic disease at first post-operative staging scan is not well documented, our aim was to determine this incidence. Methods: This IRB-approved analysis identified all pts diagnosed with resectable PDAC that underwent surgery with intent to cure at the University of Miami/Sylvester Comprehensive Cancer Center between 2010 and 2012. Patients with imaging before and within 6 months after surgery were included. All post-operative CT scans performed within 3 months after surgery were reviewed for the presence of recurrent and/or metastatic disease. Progression-free survival (PFS) and overall survival (OS) were analyzed using the Kaplan-Meier method. Results: Data from105 pts were analyzed. Mean age was 61, 63% were male, 91% had adenocarcinoma, 84% had disease in the head of the pancreas. 11 out of 85 (13%) pts had recurrent/metastatic disease detected on first post-operative CT scan; 64% stage IIB and 73% had positive lymph nodes. 54 out of 105 (51%) had disease progression. 60% had local recurrence, 40% had distant metastasis. The mean time from preoperative CT scan to surgery was 35 days. Patients with early and late recurrence had similar OS from diagnosis (median 27.7 and 27.1 months, respectively) but worse than those with no disease recurrence (median not reached, OS rate 78% at 36 months). Conclusions: The relatively high incidence (13%) of early recurrence in this retrospective cohort suggests that further studies aimed at improving patient selection for surgery are warranted and provides a strong rationale for the use of neoadjuvant therapy to select patients with early disease progression who would not have benefitted from surgery.