bluuebunny/crossref_metadata_2025_split huggingface dataset:
Change of skeletal muscle index during the chemotherapy as a prognostic factor of survival in pancreatic cancer patients receiving palliative chemotherapy.
Authors: Choi Younak , Kim Tae Yong , Lee Kyung-Hun , Han Sae-Won , Oh Do-Youn , Im Seock-Ah , Kim Tae-You , Bang Yung-Jue 
Published: February 2017

363 Background: Body composition has emerged as a prognostic factor in cancer patients. We investigated whether sarcopenia at the diagnosis and progressive loss of skeletal muscle were associated with survival in pancreatic cancer (PC) patients receiving palliative chemotherapy. Methods: We retrospectively reviewed PC patients receiving palliative chemotherapy between 2003 and 2010. Skeletal muscle cross-sectional area at L3 was measured by computed tomography. Sarcopenia was defined using the previously published sex-specific cutoff points for Korean people. Loss of skeletal muscle was classified by sex-specific cutoffs from ROC curve. Results: Among 484 patients, 260 (53.7%) patients were more than sixty years old and 295 (61.0%) patients were male. Overall, 187 (38.6%) patients were sarcopenic at the diagnosis (male, <49.2cm2/m2; female, <31.1 cm2/m2). Decreased skeletal muscle index (SMI) during the chemotherapy, which was defined as a reduction by more than 0.21 for male and by more than 2.19 for female, was observed in 198 (77.3%) male patients and 61 (38.1%) female patients. Decreased body mass index (BMI) by more than 1 was observed in 149 patients (37.3%) without difference between genders. Median overall survival (OS) of whole patients was 8.4 months [95%CI 7.6-9.2]. In the multivariate analysis, sarcopenia (p=0.001), decreased SMI (p=0.003), and decreased BMI (p=0.001) was significantly poor prognostic factors for OS. When we analyzed four groups by SMI and BMI changes (maintained SMI and BMI, maintained SMI and decreased BMI, decreased SMI and maintained BMI, decreased SMI and BMI), the groups with maintained SMI had longer survival than the groups with decreased SMI regardless of BMI changes. Median OS was 11.5 months with maintained SMI and 8.1 months with decreased SMI (HR 0.534 and 1, p=0.004) in decreased BMI groups and 9.9 months with maintained SMI and 8.6 months with decreased SMI (HR 1 and 1.490, p=0.002) in maintained BMI groups, respectively. The analyses separately done by gender showed similar results. Conclusions: Decrease of SMI during chemotherapy was a significantly poor prognostic factor for survival regardless of BMI changes.
FOLFIRNOX for advanced pancreatic cancer (aPDAC) according to schedule and dose modifications: Clinical feasibility and impact of supportive care.
Authors: Vaccaro Vanja , Sperduti Isabella , Melisi Davide , Bria Emilio , Vasile Enrico , Santoni Matteo , Giordano Guido , Bertocchi Paola , Lucchini Eleonora , Pino Maria Simona , Russano Marco , Garufi Carlo , Santini Daniele , Zaniboni Alberto , Febbraro Antonio , Cascinu Stefano , Falcone Alfredo , Tortora Giampaolo , Cognetti Francesco , Milella Michele 
Published: February 2017

372 Background: Although FOLFIRINOX is considered one of the standards for aPDAC, concerns emerged with regard to the safety profile in clinical practice. Thus, we investigated the impact of dose/schedule modifications and additional supportive measures. Methods: The clinical charts of 292 aPDAC patients (pts) receiving classic (group 1) or modified (m)FOLFIRINOX (group 2) were retrieved at 8 Institutions. Results: Table summarizes pts’ characteristics;82/709 and 188/1127 pts/cycles were analyzed for groups 1 and 2, respectively. Overall toxicity was mild; significant differences in G2-4 toxicities between the two groups: asthenia (12.5% vs 6%, p<0.0001), anemia (6.1% vs 3.1%, p=0. 003), diarrhea (6.5% vs 4%, p=0.02), and thrombocytopenia (5.4% vs 0.5%, p<0.0001), favouring group 2, and neutropenia (4.7% vs 12.3%, p<0.0001), favouring group 1. G-CSF was used more frequently in group 1 (80% vs 36%, p<0.0001). Dose delays were comparable between the two groups; dose reductions were more common in group 2 (39% vs 28%, p<0.00001). No differences in the complete control of nausea/vomiting at cycle 1 (no N/V) with or without aprepitant were observed (50% vs 45%, respectively). The presence of a biliary stent did not appear to significantly worsen toxicity. Overall ORR and disease control rate (DCR: PR+SD) were 40% and 62%, respectively, without significant differences between the two groups. Median PFS was 7 mos for both groups. Median OS, however, was significantly longer in group 2 (12 vs 18 mos, respectively; p=0.01). Conclusions: Both schedulesare easily manageable and well tolerated and may be safely administered on an outpatient basis in pts carrying biliary stents as well. The minimal differences in toxicity and efficacy obtained with mFolfirinox require additional investigation. [Table: see text]
Intensity-modulated radiation therapy (IMRT) in patients with locally advanced pancreatic cancer (LAPC).
Authors: Hajj Carla , Huguet Florence , Wu Abraham Jing-Ching , O'Reilly Eileen Mary , Winston Corinne , Reidy Diane Lauren , Allen Peter J. , Goodman Karyn A. 
Published: February 2017

377 Background: To assess IMRT safety and evaluate local control and resectability among patients with LAPC treated with induction CT followed by IMRT. Methods: We reviewed records of 134 LAPC patients treated with CT (median duration 3.2 months) followed by IMRT (median dose 56 Gy) between 11/2006 and 11/2012. Patients had LAPC based on T4 disease or unreconstructable involvement of portal vein/hepatic artery on imaging (n=102) or were found to be unresectable after an attempted resection (n=32). Induction CT was gemcitabine-based (n=98) or FOLFIRINOX (n=32); concurrent CT was gemcitabine in 88 patients, continuous 5-FU or capecitabine in 37 patients. IMRT was given after induction CT in the absence of evidence of disease progression. After IMRT, 81 patients received maintenance CT. Results: Acute grade 3 GI and hematologic toxicity were seen in 4 (2.9%) and 33 (24.6%) patients, respectively. Acute grade 4 GI and hematologic toxicity were seen in 0 and 5 (3.7%) patients, respectively. Ten patients (7.4%) developed late grade 1 GI toxicity and 2 patients (0.7%) developed compression fractures. Twenty-six (19.4%) patients underwent resection 4.1 months (mean) after IMRT; 22 (84.6%) had negative margins, one of whom had a pathologic complete response and 4 had a microscopically positive margin. With 20.1 months median f-up, median local progression-free survival (LPFS) was 17.6 months. One- and 2-year LPFS were 90% and 55% respectively. Median distant metastasis free survival (DMFS) was 15.2 months. One- and 2-year DMFS were 69.5% and 30.7% respectively. Median OS was 19.7 months for the whole population (24.8 months for surgical patients and 19.7 months for the non-surgical patients). One- and 2-year OS for all patients were 85% and 47% respectively; one- and 2-year OS for the surgical patients were 96% and 72% respectively. Conclusions: In this large cohort of patients treated with IMRT for LAPC, acute and late toxicity was minimal. Patients with non-progressive LAPC after induction CT who received IMRT had high rates of local control which could translate into a better quality of life. In selected patients, induction CT followed by IMRT can downstage tumors allowing for R0 resections and improved overall survival.
Neutrophil-lymphocyte and platelet-lymphocyte ratio in patients after resection for hepato-pancreatico-biliary cancers.
Authors: Spolverato Gaya , Kim Yuhree , Margonis Georgios A , Makary Martin , Wolfgang Christopher Lee , Weiss Matthew J. , Hirose Kenzo , Cameron John L. , Pawlik Timothy M. 
Published: February 2017

378 Background: Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) may be indicative of the immune response around the time of surgery. We sought to determine whether NLR or PLR were associated with outcomes of patients undergoing surgery for a hepatopancreatico-biliary (HPB) malignancy. Methods: Between 2010-2011, 289 patients who underwent an HPB procedure for a malignant indication were identified. Clinicopathological characteristics, NLR and PLR, as well as short- and long-term outcomes were analyzed. High NLR and PLR were classified using a cut-off value of 3 and 150, respectively, based on ROC analysis. Results: Median patient age was 63 years and 52.3% were female. The majority of tumors were pancreatic in origin (67.2%), while a subset were primary (10.3%) or secondary (22.5%) liver tumors. Patients with low vs. high NLR and PLR had similar baseline characteristics with regard to performance status and tumor stage (all P>0.05). Operative interventions included pancreaticoduodenectomy (55.0%), ≤hemi-hepatectomy (29.1%), or extended hepatectomy (2.4%). Within 90-days of surgery, 143 patients experienced a complication for a morbidity of 49.5% (pancreas: 54.9% vs. liver: 40.0%). Patients with either an elevated NLR (OR=1.72) or PLR (OR=2.15) were at higher risk of a postoperative complication (both P<0.05). Among patients with a pancreatic, primary or secondary liver tumor, 3-year survival was 38.6%, 43.0%, and 65.0%, respectively. While elevated NLR was not associated with long-term outcome (HR=1.36)(P=0.14), patients with an elevated PLR had a higher risk of death (HR=2.14)(P=0.01). Conclusions: Patients with a high NLR or PLR had an increased risk of a perioperative complication. Elevated PLR was also a predictor of worse survival among patients with HPB malignancy undergoing resection.
Risk factors for severe weight loss after gastrectomy for gastric cancer.
Authors: Segami Kenki , Aoyama Toru , Kawabe Taiichi , Hayashi Shigeya , Makuuchi Yousuke , Sato Tsutomu , Yamada Takanobu , Hayashi Tsutomu , Fujikawa Hirohito , Rino Yasushi , Masuda Munetaka , Ogata Takashi , Cho Haruhiko , Yoshikawa Takaki 
Published: February 2017

38 Background: Body weight loss (BWL) is frequently observed in gastric cancer patients who underwent gastrectomy for gastric cancer. Recently, we reported that severe BWL after gastrectomy was a significant risk factor for continuation of S-1 adjuvant chemotherapy. However, risk factors of BWL after surgery remain unclear. Methods: The present study retrospectively examined the patients who electively underwent curative gastrectomy for gastric cancer between January of 2012 and June of 2014. All patients received peri-operative care of ERAS protocol. %BWL was calculated by percentile of body weight at one month after surgery to preoperative body weight. Severe BWL was defined as %BWL over 10%. Risk factors for severe BWL were determined by both univariate and multivariate logistic regression analyses. Results: Two-hundred seventy eight patients were examined. Median age (range) was 68 years (27-86). Median body mass index (range) was 22 (13.4-33.5). Thirty patients had received neoadjuvant chemotherapy. Operative procedure was total gastrectomy (TG) in 97 patients (Open in 61 and laparoscopic in 36) and distal gastrectomy (DG) in 181 patients (Open in 94 and laparoscopic in 87). Median operation time (range) was 268.5 minutes (95-554). Median blood loss (range) was 115 mL (0-1600). Morbidity of grade 2 or more defined by Clavien-Dindo classification was observed in 37 patients including pancreatic fistula in 8, anastomotic leakage in 5, and abdominal abscess in 3. No mortality was found. Completion of ERAS protocol without any variance was 95.3%. Median %BWL was 6% (-4.3% to 19.5%). Both univariate and multivariate logistic analyses demonstrated that morbidity (odds rate 3.56, p=0.001), blood loss over 300ml (odds rate 2.04, p=0.0356), and total gastrectomy (odds rate 2.1, p=0.0258) were significant risk factors for severe BWL. Conclusions: Nutritional intervention trial to inhibit BWL after gastrectomy should be focused on the patients who developed morbidity, showed blood loss over 300ml, or received total gastrectomy.
Association between equivalent uniform dose (EUD) and rates of local progression in liver tumors treated with stereotactic body radiation therapy (SBRT).
Authors: Lu Louis , Tao Yebin , Schipper Matthew J , Wahl Daniel , Stenmark Matthew H. , Lawrence Theodore Steven , Feng Mary Uan-Sian 
Published: February 2017

380 Background: When tumors are near organs at risk such as bowel or heart, this results in partial underdosing relative to prescribed dose. We hypothesized that equivalent uniform dose (EUD) may better capture the biologic effect than other dose metrics. Methods: In this IRB-approved retrospective study, 257 primary and metastatic liver tumors from 168 patients treated with SBRT at the University of Michigan Health System between 2005 and 2014 were identified. Univariate analysis and multivariate Cox regression models were used to correlate patient, tumor, and treatment characteristics with rates of LC. Results: 1 and 2 year LC were 93% and 75% for all. Of the 156 primary liver tumors, 1 and 2 year LC were 94% and 76%, compared to 83% and 61%, for patients with colorectal metastases (CRM). 22 tumors locally progressed in 17 patients of which 9 were CRM, 5 hepatocellular carcinomas (HCC), and 3 other. Tumors that locally progressed received a median prescribed dose of 50 Gy (24 - 60), GTV EUD (a=-10) 49 Gy (23 - 72), and PTV EUD 46 Gy (17 - 69). Median gross tumor volume (GTV) was 21 cc (1-103). Tumors that did not locally progress received a median prescribed dose of 50 Gy (19 - 60), GTV EUD (a=-10) 52 Gy (17 - 86), and PTV EUD 47 Gy (7 - 76). Median GTV was 10 cc (0.2 - 2092). On univariate analysis, CRM (p = 0.005) was correlated with higher progression, while high GTV and PTV EUD (a=-10) (p = 0.01, 0.05) were correlated with lower progression. HCC (p = 0.06) was borderline for low progression. Age, gender, primary or metastatic, prescribed dose, biologically equivalent dose (BED), minimum GTV or PTV dose and GTV did not predict for progression. In a multivariable model including age, gender, histology, prescribed dose, BED, GTV EUD and GTV size, only GTV EUD predicted for LC, HR = 0.947, 95% CI = 0.901 - 0.996, p = 0.036. Every 1 Gy increase in EUD decreased the risk of local failure by 5%. Conclusions: EUD was predictive of local progression even when accounting for histology, size, and dose as measured by prescribed dose and BED. GTV EUD (a=-10) over 47.64 Gy yielded a >95% local control. EUD may be the preferred dose metric in future tumor control studies.
Tumor reduction in pancreatic versus metastatic sites in a randomized phase III study (MPACT) of weekly nab-paclitaxel (nab-P) plus gemcitabine (Gem) versus Gem alone.
Authors: Kunzmann Volker , Ramanathan Ramesh K. , Goldstein David , Penenberg Darryl Neil , Ferrara Stefano , Lu Brian , Von Hoff Daniel D. 
Published: February 2017

382 Background: nab-P + Gem was superior to Gem alone in MPACT, a phase III metastatic pancreatic cancer (PC) trial, for all endpoints examined. An updated analysis verified the superior overall survival of nab-P + Gem vs Gem alone (median 8.7 vs 6.6 months; hazard ratio 0.72; P < 0.001). Whether antitumor agents may have differential activity on pancreatic vs metastatic lesions in PC has not been definitively addressed. This prespecified analysis examined the activity of nab-P + Gem vs Gem alone in reducing tumor size in pancreatic and metastatic lesions. Methods: Previously untreated metastatic PC pts (N = 861) were randomized 1:1 to receive nab-P 125 mg/m2 + Gem 1000 mg/m2 days 1, 8, and 15 every 4 weeks or Gem alone 1000 mg/m2weekly for 7 weeks followed by 1 week of rest (cycle 1) and then days 1, 8, and 15 every 4 weeks (cycles ≥ 2). Most pts (99%) underwent spiral CT imaging, allowing precise tumor measurement. Changes in the sum of target tumor diameter from baseline to postbaseline nadir were evaluated separately for pancreatic and metastatic lesions by independent radiological review. Results: Baseline sizes of pancreatic and metastatic tumors were comparable between treatment arms (Table). nab-P + Gem elicited an approximately 3-fold greater median percentage decrease vs Gem alone in pancreatic (−22.15% vs −7.02%) and metastatic (−24.27% vs −8.74%) tumor size, agreeing with the 3-fold higher overall response rate of target lesions by RECIST. Tumor shrinkage was similar between pancreatic and metastatic lesions. Conclusions: nab-P + Gem was associated with a greater reduction in tumor size of both primary and metastatic lesions compared with Gem alone. Clinical trial information: NCT00844649. [Table: see text]
Overall survival in intermediate-stage hepatocellular carcinoma (HCC) patients after first transarterial chemoembolization (TACE): Proposal of a new scoring system.
Authors: Sacco Rodolfo , Mismas Valeria , Romano Antonio , Ginanni Barbara , Marceglia Sara , Giacomelli Luca , Masi Gianluca , Falcone Alfredo , Bresci Giampaolo , Bartolozzi Carlo , Bargellini Irene 
Published: February 2017

386 Background: TACE is the standard treatment for patients with intermediate-stage HCC (BCLC-B according to the Barcelona Clinic Liver Cancer [BCLC] classification). However, prognostic factors for survival after the first TACE cycle are unclear. We correlated pre-treatment characteristics and response to therapy with overall survival (OS) and time to tumor progression (TTP), in order to propose a scoring system aimed at facilitating clinical decision after the first TACE. Methods: We retrospectively analyzed 149 patients (125 males; mean age 65.1±9.2 years) with BCLC-B HCC who received ≥1 cycle of TACE (Lipidol TACE, n=106; drug-eluting beads TACE, n=43). Univariate and multivariate analysis were used to correlate pre-treatment characteristics and response to TACE with OS and TTP. Identified predictive factors were used to define a score for each patient. Results: Median OS was 23 (95% Confidence interval [CI] 11.5-27) months, and median TTP was 11 months (CI 7-11). Complete response (CR) was reported in 63 patients (42.3%) and partial response (PR) in 71 (47.7%). Age >65 years (Hazard Ratio [HR] 1.77; 95% CI: 1.18-2.67), ascites (HR 2.44; 95% CI 1.32-4.29), total diameter of nodules >61 mm (HR: 1.96; 95% CI 1.28-3.08) and response at 1 month (HR 1.70; 95% CI 1.30-2.20) were predictors of survival and were used to build the scoring system (Table). Three groups of patients with different OS and TTP were then identified. Patients with score 0-1 had a longer OS (57.8 months) and TTP (12.7 months) than those with score 2-3 (21.1 and 8.2 months) or score 4-6 (8.0 and 6.3 months) (p<0.001 for both comparisons). Conclusions: This scoring system may allow the identification of three groups of patients with different prognosis after a first cycle of TACE and may therefore be useful in guiding clinical decisions, in particular whether continuing TACE therapy after a first cycle or moving to different therapies. Validation of this scoring system on a larger population is ongoing. [Table: see text]
A multicenter, phase II trial of preoperative gemcitabine and nab-paclitaxel for resectable pancreas cancer: The AGITG GAP study.
Authors: Barbour Andrew , O'Rourke Nicholas , Samra Jaswinder S. , Haghighi Koroush S , Kench James , Mitchell Jenna , Pavlakis Nick , Burge Matthew E. , Fawcett Jonathan , Gananadha Sivikumar , Harris Marion , Aghmesheh Morteza , Chua Yu Jo , Joubert Warren Lance , Chan Matthew MK , Chandrasegaram Manju Dashini , Yip Sonia , Simes John , Gebski Val , Goldstein David 
Published: February 2017

387 Background: Pancreatic cancer (PC) outcomes remain poor, recent series show approximately 37% of patients achieve R0 resection (all margins ≥ 1mm) for resectable disease. Recent data in metastatic disease shows that nab-paclitaxel (nab-PC) and gemcitabine (GEM) chemotherapy (CX) is an active regimen. We aimed to determine the feasibility and R0 resection rate with peri-operative nab-PC and GEM for resectable PC. Methods: A multicentre, single arm, phase 2 trial. Patients with operable PC received 2 cycles of neo-adjuvant GEM 1000mg/m2 and nab-PC 125mg/m2CX on days 1, 8 and 15 of a 28 day cycle followed by surgical resection and then 4 cycles of post-operative CX. The primary endpoint was R0 resection with the aim to assess if a rate of 85% could be achieved. Secondary endpoints included feasibility, toxicity, pathological response (College of American Pathologists Cancer Reporting Protocol for Exocrine Pancreatic Cancer, 2009), recurrence and survival. Results: Forty-one patients were enrolled from 2012-14. Median age was 65 (range 43-79), 41% male, 49% stage I and 51% stage II. Twenty nine (71%) patients underwent resection with evaluable cancer: 1 did not have proven cancer on central pathology review; 5 did not go to surgery (2 disease progression, 2 refused surgery, 1 due to cholangitis); and in 6 patients surgery was abandoned (unresectable disease). No deaths were surgery-related. Median tumor size was 27.5mm (IQR = 25-35). Pre-operative GEM and nab-PC produced an R0 rate of 52% (15/29) (95% CI 34-69%). 15/29 (52%) of resected tumors showed grade 0-2 tumor regression grade. Twenty-nine patients (71%) experienced >1 grade 3/4 toxicities (total 52 events) during pre-operative CX, neutropenia (46%) being most frequent with 8% febrile neutropenia. 39/41 (95%) patients received 2 cycles of pre-operative CX. Conclusions: Peri-operative GEM and nab-PC CX is feasible and well tolerated. The pre-operative regimen was associated with an R0 resection rate comparable or higher than surgical series without pre-operative therapy, although the primary endpoint of 85% could not be met. The value of this regimen will also depend on longer term outcomes related to recurrence and survival. Clinical trial information: 12611000848909.
The efficacy and risk of prophylactic entecavir for hepatitis B virus-related hepatocellular carcinonma receiving transcatheter arterial chemoembolization.
Authors: Li Xing , Zhong Xiang , Chen Zhan-Hong , Xing Yan-Fang , Ma Xiao-kun , Lin Zhi-Huan , Lin Qu , Wu Xiang-yuan 
Published: February 2017

388 Background: Hepatitis B virus (HBV) reactivation was reported to be induced by transcatheter arterial chemoembolization (TACE) in HBV-related hepatocellular carcinonma (HCC) patients with a high incidence. The effective strategy to reduce hepatitis flares due to HBV reactivation in this specific group of patients was limited to lamivudine. This retrospective study was aimed to investigate the efficacy of prophylactic entecavir in HCC patients receiving TACE. Methods: A consecutive series of 191 HBV-related HCC patients receiving TACE were analyzed including 44 patients received prophylactic entecavir. Virologic events, defined as an increase in serum HBV DNA level to more than 1 log10 copies/ml higher than nadir the level, and hepatitis flares due to HBV reactivation were the main endpoints. Results: Patients with or without prophylactic were similar in host factors and the majorities of characteristics regarding to tumor factors, HBV status, liver function and LMR. Notably, cycles of TACE were parallel between the groups. Ten (22.7%) patients receiving prophylactic entecavir reached virologic response. The patients receiving prophylactic entecavir presented significantly reduced virologic events (6.8% vs 54.4%, p=0.000) and hepatitis flares due to HBV reactivation (0.0% vs 11.6%, p=0.039) compared with patients without prophylaxis. Kaplan-Meier analysis illustrated that the patients in the entecavir group presented significantly improved virologic events free survival (p=0.000) and hepatitis flare free survival (p=0.017). Female and Eastern Cooperative Oncology Group (ECOG) performance status 2 was the only significant predictors for virological events in patients without prophylactic antiviral. Rescue antiviral therapy did not reduce the incidence of hepatitis flares due to HBV reactivation. Conclusions: Prophylactic entecavir presented promising efficacy in HBV-related cancer patients receiving TACE. Lower performance status and female gender might be the predictors for HBV reactivation in these patients.