bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic impact of postoperative morbidity after esophagectomy for esophageal cancer: Supplementary exploratory analysis of JCOG9907.
Authors: Takeuchi Hiroya , Mizusawa Junki , Kato Ken , Kataoka Kozo , Igaki Hiroyasu , Abe Tetsuya , Matsushita Hisayuki , Hayashi Kazuhiko , Nakagawa Satoru , Yoshikawa Takaki , Nozaki Isao , Iwaya Takeshi , Kosugi Shinichi , Hirao Motohiro , Udagawa Harushi , Ozawa Soji , Tsubosa Yasuhiro , Nakamura Kenichi , Ando Nobutoshi , Kitagawa Yuko 
Published: February 2017

155 Background: Although the impact of postoperative complications, especially infectious complications (IC), on long-term survival after transthoracic esophagectomy remains controversial to date, we hypothesized that postoperative IC may affect tumor recurrence and survival of the patients (pts) undergoing transthoracic esophagectomy. Methods: The data from JCOG9907 (Ando N; Ann Surg Oncol 2012) was used to estimate the influence of IC on the outcome of current standard preoperative chemotherapy followed by surgery for clinical stage II/III squamous cell carcinoma of the thoracic esophagus. IC were classified into three: pneumonia, anastomotic leakage, and the others. OS and PFS were estimated by landmark method at 6 months from randomization. Univariate and multivariate analyses using Cox proportional hazard model were performed to assess the impact of postoperative complications on the survival after right-transthoracic esophagectomy with extended lymphadenectomy. Results: Among the 152 analyzed pts, the incidence of overall IC was 36%, among which pneumonia and anastomotic leakage were observed both in 14%. OS of pts with any IC (n=54) was shorter than that of pts without IC (HR 1.66, 95%CI [1.02-2.71]) and PFS also tended to be shorter in pts with any IC (HR 1.44, [0.92-2.23]). OS of pts with pneumonia (n=22) was shorter than that of pts without pneumonia (HR 1.82, [1.01-3.29]), and PFS also tended to be shorter in pts with pneumonia (HR 1.50, [0.85-2.62]). OS of pts with anastomotic leakage (n=21) were nearly identical to that for pts without leakage (HR 1.06, [0.52-2.13]) and PFS was slightly shorter in pts with leakage (HR 1.28, [0.71-2.32]). Multivariate analysis revealed that pneumonia tended to compromise OS and PFS (HR 1.66, [0.87-3.17] and HR 1.37, [0.75-2.51]). Conclusions: This study reveals that postoperative morbidity, especially pneumonia may deteriorate the survival of pts undergoing esophagectomy after preoperative chemotherapy. Achieving esophagectomy without postoperative complications might prolong OS and PFS. Clinical trial information: NCT00190554.
The impact of neoadjuvant therapy for gastroesophageal adenocarcinoma on postoperative morbidity and mortality.
Authors: Fuentes Eva , Ahmad Rima , Hong Theodore S. , Clark Jeffrey W. , Kwak Eunice Lee , Rattner David W , Mullen John Thomas 
Published: February 2017

156 Background: The effects of neoadjuvant chemotherapy (CTX) or chemoradiotherapy (CTX-RT) on postoperative complications following surgical resection of adenocarcinomas of the stomach and gastroesophageal junction (GEJ) have not been well studied. Methods: We identified 308 patients undergoing a surgery-first approach and 145 patients undergoing neoadjuvant therapy (CTX, n = 73 and CTX-RT, n = 72) followed by curative-intent surgeryfor adenocarcinomas of the stomach and GEJ from 1995-2014. We compared the baseline characteristics and the postoperative outcomes between the two groups using univariate and multivariate analyses. Results: Patients receiving neoadjuvant therapy were significantly more likely to be of younger median age (63 y vs. 71 y), have tumors of the GEJ (37% vs. 17%), to undergo esophagogastrectomy (51% vs. 26%) and D2 lymphadenectomy (39% vs. 27%), and to have more advanced stage disease than patients undergoing surgery first. There were no differences in overall 30-day morbidity or mortality rates between the neoadjuvant therapy and surgery-first groups, respectively (Table). However, patients undergoing surgery first were significantly more likely to have higher-grade complications than those undergoing neoadjuvant therapy. Conclusions: Despite having more advanced disease and undergoing higher-risk surgical procedures, patients with adenocarcinomas of the stomach or GEJ who receive neoadjuvant therapy prior to surgery are less likely to have major post-operative complications than patients treated with a surgery-first approach. Concerns about higher rates of post-operative complications should not deter the use of neoadjuvant therapy for gastroesophageal cancer. [Table: see text]
Phase I study of s-1 plus fractional cisplatin as adjuvant chemotherapy for advanced gastric cancer in an outpatient setting (KOGC-03).
Authors: Ono Taiki , Takahashi Tsunehiro , Nakamura Rieko , Wada Norihito , Kawakubo Hirofumi , Takeuchi Hiroya , Saikawa Yoshiro , Omori Tai , Kitagawa Yuko 
Published: February 2017

157 Background: The aim of this phase I study is to confirm the dose of cisplatin as adjuvant combination chemotherapy with S-1 in gastric cancer patients in an outpatient setting. Methods: The first course was initiated with S-1 monotherapy on days 1-28. From the second to sixth course, S-1 was administered on days 1-28 and cisplatin was added on days 1, 15, and 29. Dose level of cisplatin was escalated as follows: 20 mg/m2 (level 1); 25 mg/m2 (level 2); 30 mg/m2 (level 3). Results: Between Sep. 2010 and Feb. 2014, 13 patients were entered into this study. The median age was 65 years. All patients had a performance status of 0. Final stages were: Stage IIIA, 4; Stage IIIB, 8; and Stage IIIC, 1. The first three patients enrolled at level 1 and none of the three patients experienced Dose-limiting toxicity (DLT). However, one patient at level 2 could not complete administration of cisplatin. Therefore, an additional three patients were entered into level 2. Since these patients did not experience any severe adverse events, level 2 was completed. The first patient enrolled at level 3 had experienced leukocytopenia and elevated bilirubin. These toxicities did not resolve to the level of the starting criteria for the next course within 21 days. In the next patient, the third course could not be started within 21 days because of fatigue and anorexia. Based on these results, the Maximum Tolerated Dose and Recommended Dose were confirmed as level 3 and level 2, respectively. The DLT was >21-day delay of starting the next course. Three patients at level 1 completed combination adjuvant chemotherapy between the second and sixth course based on the protocol. During these treatments, no grade >2 hematological or non-hematological toxicities were experienced. At level 2, two out of six patients completed 5 courses of combination chemotherapy without experiencing severe adverse events. Three out of six patients at level 2 had received 4 courses of combination chemotherapy. Conclusions: Although further clinical trials are recommended to evaluate efficacy, this combination S-1 plus cisplatin regimen is expected to become a standard adjuvant treatment for gastric cancer in the outpatient setting. Clinical trial information: 601995.
Postchemoradiotherapy (CRT) pathologic stage classified by American Joint Committee on Cancer (AJCC) staging system to predict prognosis of patients with locally advanced esophageal squamous cell carcinoma (ESCC).
Authors: Guo Jhe-Cyuan , Huang Ta-Chen , Lin Chia-Chi , Hsieh Min-Shu , Chang Chin-Hao , Lee Jang-Ming , Cheng Jason C. , Wang Hsiu-Po , Yeh Kun-Huei , Cheng Ann-Lii , Hsu Chih-Hung 
Published: February 2017

158 Background: Preoperative CRT followed by surgery is a curative treatment option for patients with locally advanced ESCC. Whether post-CRT pathologic staging can predict the outcomes of these patients is uncertain. Methods: Among 194 patients enrolled in three phase II clinical trials of preoperative CRT for patients with locally advanced ESCC (clinical T3N0-1M0 or T1-3N1M0 or M1a according to AJCC 6th edition), 140 patients were included. All patients received preoperative CRT comprised with twice weekly paclitaxel/cisplatin-based regimens and radiotherapy 40Gy given in 20 fractions, and esophagectomy. Post-CRT pathologic staging was classified according to AJCC 7thedition. Clinicopathologic factors were analyzed for their impacts on patients' overall survival (OS) and progression-free survival (PFS). Results: One hundred and thirty two men and 8 women were enrolled. The distribution of the post-CRT pathologic stages according to AJCC 7thedition and their median survival times were listed in Table 1. In univariate analysis, gender, performance status (PS), tumor location, pathologic N, pathologic stage, extranodal extension (ENE), and pathologic complete response (pCR) were statistically significant factors associated with PFS; PS, tumor location, pathologic N, pathologic stage, ENE, and pCR were statistically significant factors associated with OS. In multivariate analysis, PS (P < 0.001), tumor location (P = 0.016), and ENE (P = 0.024) were independent prognostic factors for PFS; PS (P < 0.001) and post-CRT pathologic stage (P = 0.027) were independent prognostic factors for OS. Conclusions: Post-CRT pathologic staging classified by AJCC 7thedition could predict the survivals of patients with locally advanced ESCC who underwent preoperative paclitaxel/cisplatin-based CRT followed by esophagectomy. (The work was supported by the Grant of MOST 103-2314-B-002-092.) [Table: see text]
The survival outcome after hepatic resection in patients with liver metastasis from gastric cancer.
Authors: Tatsubayashi Taichi , Miki Yuichiro , Takagi Wataru , Hirata Fumiko , Omori Hayato , Honda Shinsaku , Makuuchi Rie , Tokunaga Masanori , Tanizawa Yutaka , Bando Etsuro , Kawamura Taiichi , Terashima Masanori 
Published: February 2017

161 Background: Optimal treatment strategy for patients with liver metastasis from gastric cancer (LMGC) has not yet been established. Although systemic chemotherapy remains mainstay of treatment for LMGC, complete resection of primary tumor and LMGC may improve survival outcome. Thus, the aim of this study is to investigate survival outcome and prognostic factors of patients who underwent hepatic resection for LMGC. Methods: From September 2002 to February 2014, 30 patients underwent hepatic resection for LMGC in our hospital. Indications of hepatic resection were as follows; (1) hepatic lesion is not more than three, (2) without extrahepatic metastasis other than lymph node metastasis, (3) adequate liver function. We investigated the overall median survival time (MST) and 5-year survival rate of all eligible patients. Univariate and multivariate analyses were performed to assess the association between each clinicopathological features and overall survival time. Results: There were 25 males and 5 females with a median age of 72 (range, 39-86). There were 16 synchronous LMGCs and 14 metachronous LMGCs. With respect to the number of LMGC, 22 patients had 1 lesion, 7 patients had 2 lesions, and 1 patient had 3 lesions. Overall MST and 5 year survival rates after hepatic resection were 2.8 years and 31.0%, respectively. The significant prognostic factors were age (70 years or older, p=0.029) and blood transfusion (p=0.013). Multivariate analysis showed that lymph node metastasis was an only independent indicator of poor prognosis (HR=6.13, p=0.026). Conclusions: Hepatic resection for patients with LMGC might be a promising treatment strategy, with 5-year survival rate of 31.0%. Lymph node metastasis was an only independent prognostic factor. A multi-institutional confirmatory study will be required to evaluate the role of hepatic resection in patients with LMGC.
Long-term survival results of the patients who were enrolled to the feasibility study of laparoscopy-assisted distal gastrectomy for c-stage I gastric cancer.
Authors: Cho Haruhiko , Segami Kenki , Kawabe Taiichi , Hayashi Shigeya , Makuuchi Yousuke , Yamada Takanobu , Hasegawa Shinichi , Tsuchida Kazuhito , Murakami Hitoshi , Yoshida Tatsuya , Sato Tsutomu , Ogata Takashi , Yoshikawa Takaki 
Published: February 2017

166 Background: We introduced laparoscopy-assisted distal gastrectomy (LADG) as multi-institutional feasibility study, and already reported that the overall morbidity rate was 1.6% in the study (Gastric Cancer 2012). The aim of this study is to evaluate the long-term survival results of the patients who were enrolled to the study and finished 5-year follow-up. Methods: A total of 165 c-stage I gastric cancer patients who were registered from Kanagawa Cancer Center were included to the study. The Kaplan-Meier method was used to evaluate overall survival and recurrence-free survival. Results: Median follow-up period of the patients was 1901 days. The reconstruction methods were either B-I (n=150), R-Y (n=14), or B-II (n=1). The accuracy for preoperative diagnosis of stage I was 87.2% (144/165). Among 14 patients with p-stage II/III excluding T3N0/T1N2-3, eight patients received postoperative adjuvant chemotherapy. The recurrence rates by pathological stage were 0% (0/123) for stage IA, 4.7% (1/21) for stage IB, 6.2% (1/16) for stage II, and 60% (3/5) for stage III/IV, respectively. The organ of recurrence was mainly observed in liver (n=3), followed by bone, lymph node, peritoneum (n=1). The 5-year recurrence-free survival rates were 94.5% for all patients, 97.2%/92.3%/60% for pT1/pT2/pT3/4, 98.5%/82.4%/71.4%/66.7% for pN0/pN1/pN2/pN3, 97.9%/81.3%/40% for p-stage I/p-stage II/p-stage III/IV. Conclusions: LADG for c-stage I gastric cancer was feasible in long-term result, as well as in short-term outcome.
Weekly nanoparticle albumin-bound paclitaxel(nab-PTX) as second-or later-line treatment for unresectable or recurrent gastric cancer in practice.
Authors: Yagisawa Masataka , Sogabe Susumu , Iwanaga Ichiro , Oshino Tomohiro , Yamamura Takahiro , Hirata Hajime , Nakajima Masahito , Suzuki Kazuharu , Shimono Joji , Takasaka Takuma , Takahashi Kazuhiro , Kobayashi Yoshimitsu , Kudo Taiki , Okada Kohei , Dazai Masayoshi , Oda Hisashi , Miyagishima Takuto 
Published: February 2017

168 Background: Nanoparticle albumin-bound paclitaxel (nab-PTX) is a novel, solvent polyoxyethylated castor oil-free, biologically interactive form of paclitaxel (PTX). Nab-PTX allows shorter infusion schedules and needs no premedication for hypersensitivity reactions, so nab-PTX will be used as the alternative to PTX for more patients. In Japan, nab-PTX was approved as tri-weekly regimen (210mg/m2 every 3weeks) for gastric cancer. On the other hands, weekly PTX (80mg/m2 on day1, 8, and 15, every 4weeks) is mostly used as PTX regimen as 2nd or later line treatment for gastric cancer in Japan. So in practice, nab-PTX would be used by weekly regimen same as weekly PTX. However, the safety and efficacy of weekly nab-PTX for gastric cancer had not been reported yet. Methods: Unresectable or metastatic gastric cancer patients who began receiving weekly nab-PTX as 2nd or later line chemotherapy in our two facilities from February 2013 to August 2014 were retrospectively analyzed for the safety and efficacy. Written informed consent about the treatment of weekly nab-PTX was obtained from all patients before treatment. Results: A total of 32 patients were assessed, retrospectively. The dose and schedule of nab-PTX was 100mg/m2 on day1, 8, and 15, every 4weeks in all patients. Patients characteristics were as follows: median age 67.5(37-84); Male/female: 24/8; PS 0/1/2/3:15/8/7/2; treatment line 2/3/4/5: 12/14/5/1. The overall response rate was 9.3% (CR/PR/SD/PD/NE: 1/2/12/15/2). The median progression-free survival (mPFS) and median overall survival (mOS) were 2.99 months and 5.95 months, in all patients. In 23 patients whose PS were 0 or 1, mPFS and mOS were 4.14 months and 8.44 months. Most common grade 3/4 hematological toxicities were anemia (46.9%), neutropenia (40.6%), febrile neutropenia (15.6%). About the sensory neuropathy, grade 3 was 9.3%, grade2 was 21.9%, and grade1 was 3.1%. There were no treatment-related deaths. Conclusions: Weekly nab-PTX showed promising efficacy against previously treated unresectable or recurrent gastric cancer especially for good PS patients, The Common toxicities of weekly nab-PTX were well-tolerated.
Diagnostic accuracy of multi detector-row computed tomography (MDCT) and endoscopic ultrasound (EUS) for clinical N staging in early gastric cancer.
Authors: Jin Eun Hyo , Lee Dong Ho , Seo Ji Yeon , Yoon Hyuk , Shin Cheol Min , Kim Nayoung , Park Young Soo , Jung Hyun Chae 
Published: February 2017

17 Background: An accurate preoperative assessment of potential lymph node metastasis is useful in the decision for the treatment strategy of early gastric cancer. The aim of this study was to retrospectively evaluate the accuracy of preoperative assessment of lymph node status with multi detector-row computed tomography (MDCT) and endoscopic ultrasound (EUS). Methods: We had analyzed 1,104 patients with early gastric cancer who underwent gastrectomy with lymph-node dissection at Seoul National University Bundang Hospital from May 2003 to July 2011. Patients were underwent preoperative MDCT in 1,104 and EUS in 1,028. Lymph nodes were considered positive for metastasis if they were larger than 8mm in the short axis diameter of MDCT. The criteria of EUS for metastatic lymph nodes are rounded nodes larger than 8 mm diameter with hypoechogenicity. The clinical N staging of preoperative MDCT and EUS was compared to the postoperative pathological finding. Results: The overall diagnostic accuracy of MDCT and EUS for determining lymph node metastasis was 89.1% and 90.5%. In MDCT, the rate of overestimation of lymph node metastasis was 8.20% (91/1104) and underestimation was 8.7% (96/1104). Tumor size (>2cm) was significant related with overestimation (p=0.007). Underestimation of clinical N staging was related with female (p=0.025, OR 2.025), lymphovascular invasion (p<0.0001, OR 7.807), positive EGFR (p=0.015, OR 2.566) and tumor size (>2cm) (p=0.009, OR 3.221). In EUS, overestimated lymph node metastasis was 5.40% (56/1028) and underestimation was 9.6% (99/1028). No factor was significantly related with overestimation. Underestimation of lymph node metastasis was related with female (p=0.020, OR 2.049), lymphovascular invasion (p<0.0001, OR 11.716), positive EGFR (p=0.024, OR 2.489) and tumor size (>2cm) (p=0.020, OR 2.774). Conclusions: For preoperative assessment of lymph node metastasis in early gastric cancer, MDCT and EUS showed high diagnostic accuracy. Both MDCT and EUS, female, lymphovascular invasion, positive EGFR, large tumor size (>2cm) were related to underestimation of clinical N staging. We proposed that careful attention is required to choose treatment based on clinical N staging by MDCT and EUS.
Changes in neutrophil-to-lympocyte and platelet-to-lymphocyte ratios to predict survival and pathologic complete response in esophageal cancer patients who receive trimodality therapy.
Authors: Hyder Jalal , Boggs Drexell , Hanna Andrew , Suntharalingam Mohan , Chuong Michael David 
Published: February 2017

170 Background: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) predict for survival in cancer patients. In patients receiving multi-modality therapy, the effect of each specific therapy on the NLR and PLR is not well understood. We therefore evaluated changes in NLR and PLR among locally advanced esophageal cancer patients who received trimodality therapy. Methods: We performed a retrospective analysis of non-metastatic patients with esophageal cancer who received neoadjuvant chemoradiation (CRT) followed by esophagectomy at our institution between March 2000 and April 2012. NLR and PLR values were obtained the following time points (TP): 1) at diagnosis before CRT, 2) after CRT prior to surgery, and 3) after surgery. We also evaluated change in NLR and PLR using the difference and ratio between TPs. Overall survival (OS) was evaluated by Kaplan-Meier analysis. Univariate and multivariate Cox regression models were applied to evaluate the independent prognostic significance of NLR and PLR. Results: 83 patients with stage II-IV esophageal cancer and median age 60 years were included. Median follow up was 29.3 months. Median dose of 50.4 Gy (50.4-59.4) in 28 fractions (28-33) was used. Median NLR and PLR at the each TP: 1) 3.3 and 157.2, 2) 12 and 645, and 11.5 and 391.7, respectively. On multivariate analysis, inferior OS was associated with PLR ≥250 at TP 3 (p=.03), PLR decrease ≥609.2 from TP 2-3 (p=.02), and PLR ratio (TP 1/TP3) ≥1.08 (p=.03). Inferior progression free survival (PFS) was associated with NLR at TP 2 ≥36 (p=.0008), NLR increase ≥28.3 from TP 1-2 (p=.0005), PLR increase from TP 1-3 ≥19 (p=.01), and PLR ratio (TP 2/TP 3) ≥0.34 (p=0.1). Pathologic complete response (pCR) was less likely for adenocarcinoma histology (p=.03), NLR at TP 2 ≥10.6 (p=.04), and NLR increase from TP 1 to TP 2 ≥4.6 (p=.03). Conclusions: This is the first study to demonstrate that changes in NLR and PLR throughout trimodality therapy for esophageal cancer correlate with OS, PFS, and pCR. Further evaluation is warranted to better define which of the identified cut-off values are most clinically significant.
Efficacy and safety of regorafenib in Korean patients with advanced gastrointestinal stromal tumor after failure of imatinib and sunitinib: A multicenter study based on the management access program.
Authors: Son Myoung Kyun , Ryu Min-Hee , Park Joon Oh , Im Seock-Ah , Ryoo Baek-Yeol , Park Sook Ryun , Kang Yoon-Koo 
Published: February 2017

175 Background: GRID phase III trial showed that regorafenib improves progression free survival (PFS) in patients (pts) with advanced gastrointestinal stromal tumors (GIST) after failure of imatinib and sunitinib. This study aims to confirm the efficacy and safety of regorafenib for advanced GIST in Korean pts. Methods: Clinical records were reviewed from 57 Korean pts with advanced GIST who failed both imatinib and sunitinib and were treated with regorafenib under MAP between December 2012 and November 2013. Pts received regorafenib 160mg p.o. once daily in a 3 weeks on/1 week off schedule, every 4 weeks until intolerable toxicities or disease progression with no benefit by physician’s discretion. Results: Out of total 57 pts, none achieved a complete or a partial response whereas 25 pts (44%) showed stable disease for ≥ 12 weeks. With a median follow-up of 8.6 months (range, 0.2-15.3), median PFS and overall survival (OS) were 4.5 months (95% CI, 3.8-5.3) and 12.2 months (95% CI, 10.1-14.3), respectively. Interestingly, 15 patients (26%) experienced an exacerbation of cancer-related symptoms (abdominal pain in 8 and abdominal distension in 5) during the rest period of regorafenib, which were reduced with resumption of regorafenib. The most common grade 3 or 4 adverse events were hand-foot skin reaction (25%), hypertension (7%), and skin rash (7%). The dose of regorafenib was reduced in 44 patients (77%) because of toxicities, mainly due to hand-foot skin reaction (n=31). There was no treatment-related death. Conclusions: We could confirm the efficacy and safety ofregorafenib for advanced GIST after failure of imatinib and sunitinib reported in GRID trial in Korean pts. Considering exacerbation of cancer-related symptoms during rest periods, continuous dosing schedule of regorafenib needs to be explored in future clinical trials.