bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of octreotide LAR (OCT) in patients (pts) with advanced neuroendocrine tumors (NET): A post hoc analysis of the placebo (PBO) arm of the phase III RADIANT-2 study with updated survival data.
Authors: Strosberg Jonathan R. , Yao James C. , Bajetta Emilio , Aout Mounir , Bakker Bert , Hainsworth John D. , Ruszniewski Philippe B. , Van Cutsem Eric , Oberg Kjell E. , Pavel Marianne E. 
Published: February 2017

265 Background: In pts with metastatic midgut NET, OCT showed antitumor activity and significantly extended time to tumor progression (TTP) vs PBO (PROMID trial, Rinke et al. 2009). We present a post hoc analysis assessing efficacy of OCT (30 mg q28d) in the PBO+ OCT arm of the phase III RADIANT-2 study. Methods: For this post hoc analysis, progression-free survival (PFS by central review, cutoff Apr 2, 2010) and overall survival (OS, cutoff Jun 13, 2013) in the PBO + OCT arm were estimated by prior somatostatin analogue (SSA) use and primary tumor location subgroups using the Kaplan-Meier (KM) method. Results: 213 pts were randomized to PBO + OCT (median age, 60 yrs; male, 58%; WHO PS: 0/1/2 in 66%/29%/5% pts; >80% had well-differentiated disease). Of these, 47 (22%) were SSA naïve (foregut, 32%; midgut, 51%; hindgut, 4%; not classified or missing, 13%) and 166 (78%) had received SSA (foregut, 10%; midgut, 72%; hindgut, 11%; not classified or missing, 7%) prior to study entry. Median PFS (95% CI) for pts who were SSA naïve vs who had received SSA was 13.6 (8.2-22.7) mos vs 11.1 (8.4-14.2) mos. By primary tumor location, median PFS (95% CI) in SSA naïve pts vs who received SSA was 5.7 (2.8-27.8) mos vs 8.7 (2.8-13.9) mos for foregut, 22.2 (8.3-29.5) mos vs 12.0 (8.4-17.7) mos for midgut, and not-reached (NR; 4.7-NR) vs 6.6 (3.0-13.0) mos for hindgut. OS analysis is in table. Conclusions: This post hoc analysis of the PBO + OCT arm of the RADIANT-2 study showed a PFS of 13.6 mos in SSA naïve pts treated with OCT. While the RADIANT-2 study PBO arm differs from PROMID in patient population and method of assessment of tumor progression, the data from this post hoc analysis provide additional evidence of the antiproliferative effect of OCT in NET. Clinical trial information: NCT00412061. [Table: see text]
Efficacy of prophylactic minocycline treatment for skin toxicities induced by erlotinib plus gemcitabine in advanced pancreatic cancer patients.
Authors: Shinohara Akira , Okuyama Hiroyuki , Kuwahara Akiko , Kobayashi Misaki , Takahashi Hideaki , Ohno Izumi , Shimizu Satoshi , Mitsunaga Shuichi , Saitoh Shinichiro , Ikeda Masafumi 
Published: February 2017

266 Background: Erlotinib has been reported to be associated with a high incidence of skin toxicities, such as acneiform rash, paronychia and xerosis. The aim of this study was to evaluate the efficacy of prophylactic minocycline treatment for the skin toxicities induced by erlotinib, as compared to deferred minocycline treatment. Methods: The study subjects were patients with advanced pancreatic cancer receiving treatment with erlotinib plus gemcitabine. In the prophylactic minocycline group, oral minocycline was administered at the dose of 200 mg/daily during the chemotherapy prior to the emergence of any skin toxicities, while in the deferred minocycline group, oral minocycline treatment at 200mg/daily was initiated after the emergence of grade 2-3 of skin toxicities. In both groups, heparinoids were administered during the chemotherapy and topical steroid therapy was initiated after the emergence of the skin toxicities. Results: A total of 96 patients were enrolled, of which 44 received prophylactic minocycline treatment and 52 received deferred minocycline treatment. The incidence rate of acneiform rash and xerosis of any grade during the first 6 weeks of chemotherapy was significantly reduced in the prophylactic minocycline treatment group as compared with that in the deferred minocycline treatment group (47.7% vs. 80.8%; p<0.001; 2.3% vs. 19.2%; p=0.01); on the other hand, no significant difference in the incidence rate of paronychia of any grade was observed between the two groups. Univariate and multivariate analyses identified prophylactic minocycline treatment and female gender as significant independent factors associated with the incidence of acneiform rash of any grade (odds ratio [OR], 0.20; 95%CI, 0.08 to 0.49; p<0.001; OR, 0.30; 95% CI, 0.11 to 0.87; p=0.03). Conclusions: Prophylactic minocycline treatment significantly reduced the incidence of acneiform rash and xerosis, but not that of paronychia, induced by erlotinib in advanced pancreatic cancer patients. Prophylactic minocycline treatment is recommended for the management of erlotinib-related acneiform rash and xerosis.
Cost-effectiveness of routine laparoscopic ultrasound for the assessment of resectability of gallbladder cancer.
Authors: Jayakrishnan Thejus T. , Nadeem Hasan , Groeschl Ryan Thomas , Zacharias Anthony J , Gamblin T. Clark , Turaga Kiran 
Published: February 2017

272 Background: In addition to a diagnostic laparoscopy (DL), aroutine laparoscopic ultrasound (LUS) has been proposed to identify undetected hepatic metastases and/or anatomically advanced disease in patients with T2 or higher gall bladder cancer (GBC) planned for surgical resection. It was hypothesized that a routine LUS is not a cost-effective strategy for these patients. Methods: Decision tree modeling was undertaken to compare DL-LUS vs. DL at the time of definitive resection of GBC (with no prior cholecystectomy). Costs in US dollars (payers’ perspective), quality-adjusted-life-weeks (QALWs) and incremental-cost-effectiveness-ratios (ICER) were calculated (horizon: 6 weeks, willingness-to-pay: $1,000/QALW or $50,000/ QALY). Results: DL-LUS was cost effective at the base case scenario (costs: $30,838 for DL vs. $30,791 for DL-LUS and effectiveness 3.81 QALWs DL vs. 3.82 QALW DL-LUS, resulting in a cost reduction of $9,220 per quality adjusted life week gained (or $479,469 per QALY). DL-LUS became less cost effective as the cost of ultrasound increased (threshold: $163.18) or the probability of exclusion from resection decreased (threshold 0.29) (Table represents the results of univariate analyses). Conclusions: Routine LUS with diagnostic laparoscopy for the assessment of resectability and exclusion of metastases is cost effective for patients with GBC. Until improvements in pre-operative imaging occur to decrease the probability of exclusion, this appears to be a feasible strategy. [Table: see text]
Association between preoperative neutrophil-lymphocyte ratio (NLR) and clinical outcomes in patients with gastric cancer.
Authors: Suzuki Akihiro , Takano Ryotaro , Takahashi Osamu , Taketa Takashi , Shimodaira Yuhsuke , Sudo Kazuki , Shiozaki Hironori , Ohigashi Seiji , Onodera Hisashi 
Published: February 2017

29 Background: The neutrophil-lymphocyte ratio (NLR) is related to inflammatory status of patients with some cancers. We hypothesize that preoperative NLR is associated with clinical outcomes in patients with gastric adenocarcinoma. Methods: We identified 458 gastric cancer patients who had curative gastrectomy at our institute between 2000 and 2009. All patients had baseline staging including blood test, CT scan and an endoscopic biopsy. Multiple statistical methods were used to analyze clinical outcomes. Results: Most patients were men and most had stage I. The median follow-up time was 74.8 months (95% C.I; 69.5-80.2). The estimated overall survival (OS) and recurrence-free survival (RFS) rate at 5 years were 76.1 +/- 2.1% and 78.6 +/- 2.2%, respectively. We divided 2 groups by NLR that cut off point was 4. In the stage I patients, the median OS and RFS of high and low NLR patients were not different (p=0.63, p=0.92, respectively). However, in stage II, III and IV patients, RFS of those were significantly different (p=0.027). In multivariate analyses, age (p<0.001) and baseline stage (p<0.001) was an independent prognosis factor for OS, and high NLR (p=0.005) and baseline stage (p<0.001) was an independent risk factor for RFS. High NLR had tendency to be associated with poor OS (p=0.069) in multivariate analysis. Conclusions: A high preoperative NLR may be a useful biomarker to predict a poor prognosis patient with gastric cancer before surgery.
Gastric cancer (GC) in California Cancer Registry (CCR): One disease, many faces.
Authors: Barzi Afsaneh , Stern Mariana C. , Zhang Juanjuan , Lenz Heinz-Josef , Iqbal Syma , Liu Lihua 
Published: February 2017

30 Background: In the US there are approximately 21,000 newly diagnosed GCs with California having the highest number of reported cases per year. Given the disparity in the incidence of the disease among Asians and Hispanics we conducted an analysis of GCs in the CCR to assess the differences in the presentation and outcome of the reported cases from 2000 to 2010. Methods: We identified 26,645 GCs inclusive of Asian, Hispanic, and non-Hispanic whites (NHW); 20% of our population is Asian and 30% of is Hispanic. We examined the tumor characteristics (demographics, stage, anatomical subsite), age adjusted incidence rates (AAIR), and survival among Asian and Hispanic patients as compared to NHW. Results: AAIR per 100,000 individuals is 5.87 (95% CI: 5.77-5.97) for NHW, 11.74 (95% CI: 11.46-12.02) for Hispanics and 13.31 (95% CI: 12.96-13.66) for Asians. Among Asians, Koreans have the highest rate and lowest median age of presentation (67ys). In the patients with known stage of the disease (82%) most patients present with stage IV (38%) with no differences in the stage of presentation among different racial/ethnic groups. The male/female (M/F) ratio is different among different racial/ethnic groups. M/F among NHWs is 2.2, followed by 1.8 in Hispanics, and 1.6 in Asians. Among NHW proximal GC (cardia and fundus) is the most common site of presentation (44%), whereas in Asians and Hispanics proximal GC are reported in 14% and 18% respectively. Hazard ratios from Cox regression models adjusted for age, gender, socioeconomic status, nativity, stage, anatomical subsite, and type of treatment received, showed that being of Mexican origin is associated with greater risk of cancer death compared to being NHW (HR = 1.3; 95% CI = 1.2-1.4; p<0.001). In contrast Koreans have better survival than NHW (HR = 0.9; 95% CI = 0.8-0.9; p=0.003). Prognostic factors for death from gastric cancer included age > 65 and immigration status, with immigrants doing better than US born. Conclusions: The observed disparity in the incidence, presentation, and outcome of GC in CCR suggests possible different etiologies that may have implications for the diagnosis and treatment of GC and deserve further exploration.
Benefit of chemotherapy (ctx) in elderly patients (pts) with advanced pancreatic adenocarcinoma (PC): A population-based analysis.
Authors: Teo MinYuen , Deady Sandra , Sharp Linda , McDermott Raymond S. 
Published: February 2017

310 Background: Benefit of ctx in elderly PC is unclear as they are under-represented in trials and most reports are retrospective series from academic centres. This population based study sought to examine the role of ctx in the elderly PC. Methods: Pts with diagnosis of PC between 1998 and 2010 inclusive who did not receive radical resection were identified from National Cancer Registry of Ireland database. Pts were divided into two age groups: ≥70 vs <70, and stratified based on metastatic status: M0 vs M1. Median overall survival (OS) was estimated with Kaplan-Meier method and hazard ratios (HR) with Cox regressional analysis. Results: A total of 4,509 pts were identified, of whom 2,875 (64%) were ≥70 yrs. For the entire group, 16% were staged M0, 42% were staged M1 and 42% didn't have documented staging (Mx). 16% received ctx, 5% chemoradiotherapy (crt) and 79% no cancer directed therapies. More pts ≥70 were Mx compared to <70 (48% vs 30%, p<.01); Mx pts were less likely to receive treatment than M0/M1 (88% vs 73% vs 73%, p<.01). Pts ≥70 were also less likely to receive any treatment (p<.01) (Table). Comparing the ≥70 and <70 groups, median OS (in months) for M0 who received ctx were 6.0 vs 7.3 (HR 1.28 [95% confidence interval 0.85-1.89], p=.24); received crt were 7.0 vs 9.7 (HR 0.95 [0.42-1.88] p=.89) and no treatment were 3.0 vs 3.5 (HR 1.03 [0.84-1.29] p=.75); median OS for M1 who received ctx were 2.4 vs 3.4 (HR 1.21 [0.97-1.49] p=.09), crt were 4.3 vs 6.0 (HR 1.69 [0.89-3.03] p = .11) and none were 1.2 vs 1.4 (HR 1.11 [1.00 – 1.24] p=.06). Regardless of age or M stage, cxt and crt conferred superior OS as compared to no treatment (Table). Conclusions: We observed a disparity in diagnostics and delivery of treatment to older pts with PC. Pts ≥70 who were treated benefited similarly to younger pts. Such therapeutic nihilism should be addressed in a systematic fashion. [Table: see text]
Stereotactic body radiation therapy following transarterial chemoembolization for Child-Pugh A and B hepatocellular carcinoma.
Authors: Baden Craig Joseph , Hinton Benjamin , Jacob Rojymon 
Published: February 2017

321 Background: Hepatocellular carcinoma (HCC) incidence continues to increase, but recent improvements in treatment of localized tumors have contributed to modest gains in survival rates. Though transarterial chemoembolization (TACE) and stereotactic body radiation therapy (SBRT) are increasingly used in the management of unresectable HCC, outcomes data regarding the combination of these treatments is limited. Here we report institutional outcomes for patients with Child-Pugh A (CPA) and B HCC treated with TACE followed by SBRT. Methods: We completed an institutional retrospective review of all patients treated with combination TACE and SBRT between 2009 and 2013. After compiling dosimetry, toxicity, and outcomes data for each patient we calculated descriptive statistics for the cohort and determined local control (LC), distant liver control (DLC), progression free survival (PFS), and overall survival (OS) utilizing the Kaplan-Meier method. We also compared these disease-related outcomes between CPA and CPB groups with the Mantel-Cox test for equality. Results: Thirty-one patients with HCC, median age 65, were treated with TACE and SBRT and followed for a median 16.6 months (range: 6.2-50.8). Twenty-two patients had CPA disease and 9 CPB at the time of initial treatment. Following TACE and a median interval of 10.5 days (range: 4.4-25.6) patients underwent SBRT, the majority (23) with 45 Gy in 3 fractions. All but 3 patients were treated with respiratory gating, and all had cone-beam CT for image guidance. One and 2 year disease-related outcomes were as follows: LC 92.0 and 82.8%, DLC 81.5 and 61.0%, PFS 73.6 and 61.8%, OS 96.8 and 64.2%. There were no statistically significant differences between CPA or CPB patients with respect to any of these disease-related outcome measures. Median survival times for class A and B patients were 34.2 months (95% CI 12.3-56.1) and 27.2 months (14.9-39.5) respectively. Conclusions: The combination of TACE and SBRT is generally well tolerated, and results in very good local control in both CPA and CPB patients. Distant liver failure remains a major problem in these patients and requires further study.
Use of staging and scoring systems in hepatocellular carcinoma (HCC): Lessons from U.S. regional analysis of the GIDEON registry.
Authors: Miksad Rebecca A. , Cohn Allen Lee , El-Khoueiry Anthony B. , Geschwind Jean-Francois , Gholam Pierre Michel , Goldenberg Alec , Mantry Parvez , Martin Robert C. G. , McGuire Brendan , Piperdi Bilal , Sanyal Arun J. , Imperial Joanne , Venook Alan Paul 
Published: February 2017

323 Background: Because HCC usually occurs in the presence of liver disease, patient (pt) evaluation and treatment are complex and require multidisciplinary care. Tumor staging and liver function scoring systems facilitate HCC research and treatment. However, specialists have varied training in these systems. We evaluated specialty-specific reporting of HCC-related staging/scoring data. Methods: GIDEON is a global, prospective, non-interventional study to evaluate sorafenib (SOR) in HCC under real-life practice conditions. Pts with unresectable HCC who were candidates for systemic therapy and for whom a decision was made to treat with SOR were eligible. Frequency of recorded Child-Pugh (CP); Barcelona Clinic Liver Cancer (BCLC); Cancer of the Liver Italian Program (CLIP); Tumor, Nodes, Metastasis (TNM); and calculated Model for End-stage Liver Disease (MELD) data were analyzed by physician specialty. Results are descriptive. Results: In the safety population (n=563), 299 pts (41%) were enrolled by medical oncology (MO), 228 (40%) by hepatology/gastroenterology (H/G), and 39 (5%) by other (23 by surgeons; 7 by interventional radiologists). 89% were treated by a multidisciplinary team. MO pts were twice as likely as H/G pts to be not evaluable (NE) for CP (table). Unknown international normalized ratio (INR) was the primary reason CP was NE. MO and H/G pts had similar % NE for BCLC stage. H/G pts were more likely to have ECOG performance status (PS) not recorded. MO pts were less likely to have CLIP or MELD data, while H/G pts were less likely to have TNM data. Portal vein thrombosis (PVT) and alpha-fetoprotein (AFP) were unknown in 17% overall. Conclusions: The elements of HCC staging systems represent factors that may influence patient management. Lack of complete data in up to 44% of pts, despite registry enrollment requiring data collection, suggests clinicians may be missing important information and the prevalence of clinicians using comprehensive HCC staging systems is variable. Clinical trial information: NCT00812175. [Table: see text]
Clinicopathologic features of gastric cancer in the elderly population.
Authors: Lim Joo Hyun , Lee Dong Ho , Shin Cheol Min , Kim Na Yung , Park Young Soo , Jung Hyun Chae , Song In Sung 
Published: February 2017

33 Background: Gastric cancer is one of the most common cancers, having great incidence among the elderly. However, little is known about gastric cancer in elderly patients. This study was designed to evaluate the specific features of gastric cancer in elderly patients. Methods: We reviewed medical records of 1107 patients who had undergone radical gastrectomy for gastric cancer between June 2005 and December 2009 retrospectively. They were divided into young age group (<65, n = 676), middle age group (65 ≤ age < 75, n = 332) and old age group (≥75, n = 99). To find out potential risk factors, these following factors were reviewed; symptoms, comorbidities, tumor marker levels, stages, H. pylori status, locations, Lauren type, differentiation, complications, microsatellite instability and p53 overexpression. Results: Elevated levels of CA 19-9 (5.6%, 13.4% and 14.6%, P = 0.001), advanced diseases (42.5%, 47.0% and 57.6, P = 0.014), and node metastasis (37.6%, 38.9% and 51.5%, P = 0.029) were more frequently detected in the middle and old age groups. However, no significant differences in H. pylori status (63.6%, 56.7% and 61.2%, P = 0.324) were observed among the three groups. Elderly patients had a tendency to show intestinal type in Lauren’s classification (40.7%, 58.7%, and 56.6%, P < 0.001). The rate of surgery-related complications did not differ among the three groups (5.3%, 5.1%, and 8.1%, P = 0.497). Microsatellite instability (P < 0.001) and p53 overexpression (P < 0.001) were more frequently found among the elderly patients. Conclusions: Gastric cancer in elderly patients was related to features known for favorable prognosis except p53 overexpression, despite the more advanced stage. Surgery in the elderly was as tolerable as in young patients. We recommend looking favorably upon surgery for elderly patients with operable gastric cancers.
Adjuvant chemoradiation to improve survival compared to adjuvant chemotherapy in selected patients with pancreatic cancer.
Authors: Kumar Aryavarta M. S. , Falk Gavin , Stephans Kevin L. , Walsh Matthew , Pelley Robert James , Abdel-Wahab May 
Published: February 2017

330 Background: While surgery remains the only potential curative option for resectable pancreatic cancer, adjuvant therapy improves outcomes over surgery alone; however, adjuvant recommendations of chemotherapy vs chemoradiation remain controversial. We present outcomes comparing the two adjuvant treatments. Methods: In our single institution review, 343 patients (2000-2012) had pancreatoduodenectomy for pancreatic cancer. Medical oncology made adjuvant recommendations. Chemotherapy was gemcitabine or 5-FU and radiotherapy prescription was 45-54 Gy. Locoregional recurrences (LRR) were operative bed or regional nodal failures. Results: Median follow up and median survival (MS) for all patients was 17.5 and 19.5 mo respectively. 130 patients had resection alone (A), 84 had adjuvant chemotherapy (B), and 129 had adjuvant chemoradiation (C). MS for groups A, B, and C were 13, 23 and 26 mo respectively. Locoregional recurrence (LRR) was 60%, 63%, and 38% and distant failure was 64%, 65%, and 66% for groups A, B, and C respectively. Group C had significantly lower LRR compared to group B (p=0.01) however, survival between groups B and C was not statistically significant (p=0.23). Angiolymphatic invasion (ALI) and perineural invasion were correlated with LRR (p<0.01). Multivariable analysis showed LRR, laparoscopy, ALI, and the interaction term of LRR with surgical margin were significant predictors of survival (p<0.05). MS of patients with lymph node ratio (LNR) > 0.2 and LNR ≤ 0.2 was 18 and 27 mo respectively. Subgroup analysis showed survival advantages to adjuvant chemoradiation compared with adjuvant chemotherapy. R1 resections in groups B and C were 37% and 39% (p=ns) with MS of 16 vs 27 mo respectively (p=0.01). For patients with ≥ 8 LN dissected and LNR ≤ 0.2, MS was 24 vs 32 mo for groups B and C respectively (p=0.04). Conclusions: Adjuvant chemoradiation significantly decreases LRR in resected pancreatic cancer patients. Compared to adjuvant chemotherapy alone, adjuvant chemoradiation improved survival for patients with a 1) positive surgical margin and/or 2) LNR ≤ 0.2 with ≥ 8 LNs dissected.