bluuebunny/crossref_metadata_2025_split huggingface dataset:
518. ARTIFICIAL INTELLIGENCE MODELS VS CLINICIAN PERSPECTIVES OF IMPORTANT FACTORS IN OESOPHAGEAL CANCER DECISION-MAKING
Authors: Webb Catherine , Thavanesan Nav , Dewar-Haggart Rachel Dewar-Haggart Rachel , Naiseh Mohammed , Underwood Timothy , Vigneswaran Ganesh 
Published: September 2024

Abstract

Background
Decision-making for oesophageal cancer (OC) management remains multifaceted and nuanced in the face of a traditionally complex patient demographic. The evolving movement of artificial intelligence (AI) offers the potential of an imminent paradigm shift in traditional multidisciplinary team (MDT) workflow with Machine Learning models proving capable of encapsulating much of that decision-making framework. Clinician buy-in however stems from trust that such models accurately represent the perceptions and considerations of the MDT in its current form.

Methods
A mixed methodology study combining a national survey of United Kingdom OC MDT clinicians (sent to the British Society of Gastroenterologists, Association of Upper Gastrointestinal Surgery and UK& Ireland Oesophagogastric Cancer group) was conducted and compared with a Machine Learning (ML) based Random Forests model of treatment-decisions from a leading UK tertiary referral centre. The factors influencing OC treatment decisions from a human perspective were contrasted with variable importance from the AI approach. Human perceptions of barriers and attractions of AI-driven support tools were also explored to understand how human-AI collaboration could be facilitated in future.

Results
The National Survey which generated 67 responses found age and gender to play a more significant role in the ML model than they did in the clinicians' conscious decision-making process. Additionally, thematic analysis identified a variety of important factors, including molecular tests, symptoms, social circumstances, and nutritional status. The prospect of utilising AI-based decision support in the future received generally positive feedback, although opinions varied widely. Challenges to its adoption include perceptions of clinician superiority, the uniqueness of patient cases, the need for transparency and safeguards in the model, the requirements for data input, and the demand for proven effectiveness.

Conclusions
Comparison with the model highlighted demographic factors which appear to heavily influence treatment but were consciously deemed less important by clinicians. While overall, the response was positive towards an ML tool, some respondents felt very unwilling to use one. This could limit its adoption by MDTs unless decision-tools are developed to address such concerns around the barriers identified.
522. MULTI-SLICE, VOLUMETRIC COMPUTED TOMOGRAPHY BODY COMPOSITION ANALYSIS IN PATIENTS WITH OESOPHAGOGASTRIC CANCER
Authors: Brown Leo , Soupashi Maria , Yule Michael , Laird Barry , Wigmore Stephen , Skipworth Richard 
Published: September 2024

Abstract

Background
Single-slice computed tomography (CT) body composition has been studied extensively for prognostication in patients with cancer. New software packages can also provide multi-slice volumetric measurements, but the clinical utility of these remains under explored. This study aimed to evaluate the concordance between single- and multi-slice body composition analyses in patients with oesophagogastric cancer, and to explore the association between these measures and overall survival.

Methods
Consecutive patients with newly diagnosed oesophagogastric cancer were identified through the prospectively maintained regional database of the South-East Scotland Cancer Network across a 2-year study period. CT body composition analyses were undertaken using scans collected during routine clinical care. Single-slice (cross-sectional area at mid L3) and multi-slice (volume between T12-L4) measurements were obtained for skeletal muscle (SKM), subcutaneous adipose (SAT), visceral adipose (VAT) and intermuscular adipose (IMAT). Agreement between sex-stratified z-scores was quantified using Pearson correlation coefficients and Bland–Altman analyses. Cox proportional hazard modelling was used to estimate the effect of these measures on overall survival.

Results
Overall, 504 patients (67.9% male, median 72 years) were newly diagnosed with oesophagogastric cancer during the study period. Treatment was commenced with curative intent for 131 patients (26.0%). Single-slice area and multi-slice measurements were highly correlated for SKM (R: 0.97, p&lt;0.001), SAT (R: 0.98, p&lt;0.001) and VAT (R: 0.97, p&lt;0.001), SKM radiodensity (R: 0.93, p&lt;0.001) and IMAT (R: 0.88, p&lt;0.001). Bias on Bland-Altman analysis was 0.00 for all tissue measurements. Limits of agreement (LoA) were narrowest for SAT (± 0.43), VAT (± 0.46) and SKM (± 0.48), but slightly wider for SKM radiodensity (± 0.73) and IMAT (± 0.96). Adipose tissue ‘outliers’ (those where agreement between single- and multi-slice z-scores was outside the LoA) had a higher median weight and body mass index (BMI), suggestive of poorer agreement in patients with obesity. Sensitivity analysis, excluding those with BMI &gt;30, narrowed the LoA for SKM, VAT, SAT and IMAT. Direction and magnitudes of observed effect sizes for overall survival were all highly comparable, with hazard ratios for each tissue type varying by ≤0.04 between single- and multi-slice adjusted estimates.

Conclusions
Single-slice and multi-slice assessments of CT body composition provide highly correlated measurements for skeletal muscle, subcutaneous fat, visceral fat, and intra-muscular fat amongst patients with OG cancer. However, agreement between measurements is poorer in patients with obesity. The associations between these tissues measurements and overall survival are comparable across both types of body composition analysis.
526. COMPARISON OF CANCER CACHEXIA DEFINITIONS AND THEIR ASSOCIATION WITH OVERALL SURVIVAL IN PATIENTS WITH INCURABLE OESOPHAGOGASTRIC CANCER
Authors: Brown Leo , Yule Michael , Soupashi Maria , Laird Barry , Wigmore Stephen , Skipworth Richard 
Published: September 2024

Abstract

Background
Cancer cachexia is highly prevalent in oesophagogastric cancer, particularly amongst patients with advanced stage disease. However, classifications for cachexia remain heterogenous within the existing literature. The aim of this study is to compare prognostication using the Fearon et al. consensus definition to the Global Leadership Initiative on Malnutrition (GLIM) criteria, in patients with incurable oesophagogastric cancer.

Methods
Consecutive patients with newly diagnosed incurable oesophagogastric cancer between 2019-2020 were identified from a prospectively maintained regional database. Data were collected regarding demographics, clinicopathological details, patient-reported involuntary weight loss and body mass index. CT body composition analysis was performed using staging scans and neutrophil-lymphocyte-ratio was retrieved as a marker of inflammation at the time of diagnosis. These data allowed comparison based on Fearon and GLIM classifications for cachexia. The primary outcome of interest was overall survival.

Results
Overall, 330 patients (66.9% male, median 74 years) were diagnosed with incurable oesophageal (70.6%) or gastric cancer (29.4%) during the study period. Of these 65.5% (n=216) met the Fearon definition of cachexia at diagnosis, while 64.8% (n=214) could be diagnosed based on the GLIM criteria. Both diagnostic criteria were met by 148 patients (47.9%). Clinicopathological characteristics were all broadly comparable between cachectic and non-cachectic groups based on both classifications. Worse overall survival was seen in cachectic patients using Fearon (median: 118 vs. 228 days) and GLIM (median: 114 vs. 245 days) diagnostic criteria (both p&lt;0.001). Following adjustment for known confounders, cachexia diagnosed based on the GLIM criteria (HR 1.60 (95%CI: 1.25-2.05), p&lt;0.001) was more strongly associated with adverse survival than that diagnosed using the Fearon criteria (HR: 1.44 (95%CI: 1.13-1.84), p=0.003)).

Conclusion
Cancer cachexia is strongly associated with worse survival in patients with incurable oesophagogastric cancer. Diagnosis based on the GLIM criteria appears to have the greatest prognostic effect.
536. TUMOR-INFORMED “LIQUID BIOPSY” FOR ESOPHAGEAL ADENOCARCINOMA FROM MATCHED CANCER ORGANOID CULTURE
Authors: Rispoli Thaiane , Shathasivam Premalatha , Aiyar Niharikaa , Allen Jonathan , Alisson Frances , Bach Yvonne , Dakpo Eugenia , Sundby Adam , Wilson Gavin , Yeung Jonathan 
Published: September 2024

Abstract

Background
The absence of recurrent mutations in esophageal adenocarcinoma (EAC) poses a challenge in detecting circulating tumor DNA (ctDNA) in plasma and may hinder the advancement of liquid biopsy methods. To address this, we cultured patient-derived EAC organoids (PDOs), speculating that they could serve as a guide for identifying ctDNA in the patient's blood samples. This approach aims to leverage organoids as a potential tool to overcome the complexity of identifying ctDNA in EAC, offering a promising avenue for refining liquid biopsy strategies in clinical practice.

Methods
PDOs were generated from EAC tumor tissue in Matrigel domes and expanded in suspension culture. To isolate mononucleosomes (147 bp), chromatin from PDOs was extracted and digested with micrococcal nuclease (MNase). Fragments larger than 147 bp were removed through size selection. MNase-sequencing was performed to generate a mutation map with preferential coverage of nucleosome-protected DNA for each sample. Matched whole genome sequencing of the tumor for each respective PDO sample was used as a control. Primers were designed for the identified mutations in nucleosome-protected DNA and used to amplify patient cfDNA for sequencing.

Results
DNA from five different PDOs were collected and MNase digested. MNase concentration and digestion time were optimized for each sample. MNase digestion produced mononucleosomes of approximately 147 bp for all samples. MNase-sequencing identified 24 mutations in peaks (mononucleosomes) in 24 genes, including known oncogenes. Among these were 16 missense, 2 frameshift, and 1 nonsense mutations, and 5 mutations in splice regions. To date, amplicons of expected size were detected by PCR for six genes using either total PDO DNA or normal cell-free DNA, confirming the detectability of these genes. PCR amplification using patient ctDNA and next-generation sequencing is ongoing.

Conclusion
These findings show that we are able to isolate and detect somatic mutations in nucleosomes from different PDOs, allowing us to generate a nucleosome SNV map for each sample. Preliminary data indicate these regions can be PCR amplified from normal cfDNA. Amplification and sequence verification of mutated regions from corresponding patient blood ctDNA is ongoing. The mapping of patient-specific variants will enable the development of targeted personalized PCR panels, aiding in recurrence prediction and enhancing drug screening accuracy. This advancement holds promise for early cancer detection and improving prognoses for individuals with EAC by addressing gaps in recurrence prediction.
537. ASSESSING THE EFFECT OF HIATAL HERNIA SIZE ON PERIOPERATIVE OUTCOMES AND HOSPITAL READMISSION RATES AFTER PRIMARY REPAIR
Authors: Latorre-Rodriguez Andres R , Rajan Ajay , Mittal Sumeet K 
Published: September 2024

Abstract

Background
Minimally invasive hiatal hernia (HH) repair remains the gold standard for correcting mechanical defects due to its safety and favorable clinical outcomes (i.e., relief of patient symptoms). However, several operative factors, including the HH size, may negatively impact the postoperative course. We aimed to determine if an increase in HH size was related to an increased risk of perioperative complications or hospital readmissions.

Methods
After IRB approval, we performed a retrospective analysis using a prospectively maintained database containing demographic, perioperative, and clinical data from all patients who underwent HH repair by a single experienced foregut surgeon between September 2016 and July 2023. Four groups were defined based on the proportion of stomach at the thoracic cavity determined during the surgery: A (small HH: &lt;25%), B (moderate HH: 25-49%), C (large HH: 50-74%), and D (intrathoracic stomach [ITS]: ≥75%). Non-parametric tests were used to assess differences between the groups, and logistic regressions were used to determine the relevant odds ratios (OR).

Results
A total of 391 patients who underwent primary HH repair met the inclusion criteria (73.7% women; mean age 64.4±12.5 years; mean BMI 28.9±4.9 kg/m2). The distribution of groups was: A (n=160, 40.9%), B (n=63, 16.1%), C (n=64, 16.4%), and D (n=104, 26.6%). Patients presenting with ITS (group D) were older, had longer operative duration, greater blood loss (p&lt;.001), and a significantly increased risk of presenting with early postoperative complications (OR 2.78 [CI95: 1.52-5.06]) and being admitted to the ICU (OR 12.35 [CI95: 3.41-44.71]).

Conclusion
The HH size, defined by the proportion of the stomach at the thoracic cavity, is associated with an increased risk of early postoperative complications and ICU admission; moreover, a trend toward higher 30- and 90-day hospital readmission rates was noted. This factor may be a consequence of the progressive nature of the disease; hence, it should be considered when choosing between continued medical observation and surgical treatment of patients presenting with asymptomatic HH. An early intervention may reduce the risk of postoperative comorbidity.
539. ASSOCIATION BETWEEN WAITING PERIOD FOR RADICAL SURGERY AND POSTOPERATIVE RELAPSE IN CLINICAL STAGE I ESOPHAGEAL CANCER
Authors: Miyawaki Yutaka , Sato Hiroshi , Lee Seigi , Kobayashi Ryota , Takabatake Kazuya , Toriumi Tetsuro , Ehara Gen , Hirano Yasumitsu , Okamoto Kojun , Koyama Isamu , Sakuramoto Shinichi 
Published: September 2024

Abstract

Background
Esophagectomy with locolegional lymphanedectomy based on potential lymph node metastatic risk is the current standard treatment for clinical Stage I thoracic esophageal cancer. Local excision by endoscopic submucosal dissection (ESD) is the standard treatment for clinical Stage 0, however surgery is considered as an additional treatment for pathological T1b cases due to potential metastatic risk. Cases of additional resection after ESD are those pathologically demonstrated to have a high risk of metastasis based on tumor depth and vascular invasion, etc. Compared to cases of surgery for clinical Stage I, many of these cases have a high risk of metastasis, and therefore a poor prognosis is generally expected. Addionally, the prolonged waiting time between initial diagnosis and radical surgery due to ESD may be a factor in poor prognosis, but there is currently no consensus on the risk. Therefore, we conducted a study to clarify the effect of waiting period before surgery (WP) on the risk of recurrence in clinical Stage I esophageal cancer surgery.

Methods
We retrospectively evaluated the association between WP and 3-year postoperative recurrence-free survival (3y-RFS) in 65 patients who underwent primary esophagectomy and gastric tube reconstruction for clinical Stage I esophageal cancer and 22 patients who underwent additional resection after ESD at our hospital.

Results
The WP of 87 patients was 2.12 ± 1.43 months (mean± SD), and 13 patients had postoperative recurrence (3y-RFS 85.1%). A 2-arm comparison of short or long WP with a cutoff value of 2.83 months (mean+0.5 SD) showed no clear association with 3y-RFS (100% vs 81.4%, p=0.071). A strong correlation was shown between WP and ESD (r=0.647, p&lt;0.01). WP was 1.69±1.20 months (mean± SD) in 65 patients who underwent surgery as initial treatment, and 12 patients had postoperative recurrence (3y-RFS 81.5%). A 2-arm comparison of short or long WP with a cutoff value of 2.29 months (mean+0.5 SD) suggested an association with 3y-RFS (85.7% vs 55.6%, p=0.018).

Conclusion
Although this is a single-center, retrospective study of a small number of cases and only a univariate study due to the small number of events, it suggests that a longer waiting period before surgery may be a risk factor for postoperative recurrence.
541. THE PHOENIX-HH SCORE: A TOOL TO PREDICT ADMISSION TO THE ICU AFTER HIATAL HERNIA REPAIR
Authors: Latorre-Rodriguez Andres R , Rajan Ajay , Bremner Ross M , Mittal Sumeet K 
Published: September 2024

Abstract

Background
Minimally invasive hiatal hernia (HH) repair is usually a safe procedure with low morbidity; however, a subset of patients may require intensive care unit (ICU) admission. To date, no specific and validated tool is available to predict the risk of ICU admission after HH repair. Although multiple tools to predict the risk of admission to the ICU after major surgical procedures have been reported, most of them are complex and require laboratory parameters. We propose a novel and quick intraoperative score that is useful for assessing unexpected ICU admission and tailoring patient management during HH repair.

Methods
A development cohort was established using a prospectively maintained database containing demographic, clinical, and surgical information of consecutive patients who underwent HH repair between September 2016 and July 2023. Clinical expertise and multiple logistic regressions were employed to select adequate demographic or surgical predictors to create an intuitive risk score (PHOENIX-HH). Further, a specific scoring system for each included variable was designated, and the total score (a scale from 0 to 9 points) was assessed for accuracy using the area under the receiver operating characteristic curve (AUC-ROC).

Results
The development cohort was formed by 391 patients who underwent primary HH repair (73.7% women; mean age 64.4±12.5 years; mean BMI 28.9±4.9 kg/m2). The mean AUC in the development cohort was 0.845 (95%CI: 0.756-0.934), and when defining a cut-off of ≥6 points, 12 of 15 patients who required ICU admission were identified using the proposed score (sensitivity, 80% [95%CI: 51.9-95.7%]; specificity, 80.1% [95%CI: 75.7-84%]; positive likelihood ratio, 4.0 [95%CI: 2.9-5.6]; negative predictive value, 99.0% [95%CI: 97.3-99.6%]).

Conclusion
The strongest predictor for unexpected ICU admission and postoperative complications following HH repair was the HH size (defined as the percentage of intrathoracic stomach); hence, the incorporation of this variable and other preoperative and intraoperative factors into a scoring system led to the development of the PHOENIX-HH score. This tool may allow early identification of patients who may require admission to the ICU after the surgery. Future validation using an external cohort is highly desirable.
549. CLINICAL IMPLICATIONS OF SELECTIVE RIGHT PARATRACHEAL LYMPH NODE DISSECTION IN PATIENTS WITH EARLY-STAGE ESOPHAGEAL CANCER: PROPENSITY-SCORE MATCHED ANAYLSIS
Authors: Kwon Yelee , Yun Jae Kwang , Kim Hyeong Ryul , Kim Yong-Hee , Jeong Jae Hwa 
Published: September 2024

Abstract

Background
The optimal extent of lymph node dissection in esophageal squamous cell carcinoma (Sqcc) still remains a topic of debate without specifying the lymph node stations. This study aimed to evaluate the clinical impact of selective right paratracheal lymph node (RtPTLN) dissection in patients with esophageal squamous cell carcinoma (SQCC).

Methods
We included the patients who underwent curative surgery for clinical stage I esophageal SQCC (cT1N0) at our institution between January 2010 and December 2021. Patients who underwent neoadjuvant therapy were excluded.
A total of 1,484 patients underwent surgery for esophageal cancer at our institution during the study period. Among these, 658 patients (mean age 63.1±7.7 years, 46 [7.0%] women) were identified, categorized into RtPTLN+ (dissection performed, n = 88) and RtPTLN- (no dissection, n = 570) groups. The RtPTLN+/- groups were matched in a 1:3 ratio using propensity scores.

Results
Median follow-up was 48.8 (24.2–85.2, interquartile) months. Five-year overall survival (OS, RtPTLN+ vs. RtPTLN-, 75.8% vs. 79.0%, P = 0.38) and recurrence-free survival (RFS, 70.0% vs. 72.5%, P = 0.55) rates showed no significant differences.
Propensity-score matching yielded 313 patients: RtPTLN+ (n = 83) and RtPTLN- (n = 230). OS and RFS rates did not significantly differ between RtPTLN+ and RtPTLN- groups (OS: 77.2% vs. 79.9%, P = 0.57; RFS: 72.1% vs. 74.7%, P = 0.79) after adjustment (Figure). Multivariate analysis confirmed that RtPTLN dissection was not a significant predictor for OS or RFS (Table).

Conclusion
In this propensity-score matched analysis, there was no significant difference in OS and RFS between patients with and without RtPTLN dissection. These findings discreetly suggest that the routine RtPTLN dissection may not be necessary, and selective dissection could be considered acceptable.
552. COMPARING ROBOTIC ESOPHAGECTOMY TO VIDEO-ASSISTED THORACOSCOPIC ESOPHAGECTOMY FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA: RESULTS FROM THE REVATE RANDOMIZED CLINICAL TRIAL
Authors: Chao Yin-Kai , Li Zhi-Gang , Jiang Hongjing , Chiu Chen-Hung , Li Bin , Shang Xiaobin 
Published: September 2024

Abstract

Background
The treatment of esophageal squamous cell carcinoma (ESCC) includes dissecting lymph nodes along the recurrent laryngeal nerve (RLN), which is oncologically important but is technical demanding. Vocal cord palsy as a result from RLN injury, carries significant morbidities. This randomized clinical trial (RCT) compared the efficacy and safety of robotic esophagectomy (RE) and video-assisted thoracoscopic esophagectomy (VATE) for performing RLN lymph node dissection (LND)

Methods
We conducted a multicenter RCT(NCT03713749) from November 2018 to March 2022, enrolling patients with ESCC who required McKeown esophagectomy. The primary endpoint was to determine the success rate of left RLN LND. Success was defined as the removal of lymph nodes confirmed by pathology, without causing permanent nerve palsy (duration &gt; 6 months). Secondary endpoints encompassed perioperative and oncological outcomes.

Results
The per-protocol analysis included data from 203 patients (RE group: n=103; VATE group: n=100). The primary endpoint was achieved in 88.3% of the RE group and 69% of the VATE group (p&lt;0.001). Additionally, the RE group had a higher mediastinal lymph node harvest (16 [12−22] versus 14 [10−20], p=0.04), shorter thoracic operating time (110 [89−137] min versus 124[103.5−154] min, p=0.004), and earlier drainage removal (4 [3−7] days versus 6 [4−9] days, p=0.007) compared to the VATE group. The two study arms exhibited comparable complication rates with no recorded in-hospital deaths in either group.

Conclusion
This multicenter trial demonstrates the effectiveness of RE in enhancing the feasibility and safety of RLN LND in ESCC. Additionally, RE leads to an improved mediastinal lymphadenectomy, shorter operating times, and earlier removal of drainage.