bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characterizing the specialty palliative care workforce in the United States: Results of a national survey.
Authors: Kamal Arif , Bull Janet , Rogers Ursula A. , Swetz Keith Mark , Kavalieratos Dio , Abernethy Amy Pickar 
Published: February 2017

90 Background: Increasingly, oncology teams and specialty palliative care (PC) clinicians are collaborating in the care of patients with serious or advanced cancer. Because of such partnerships, PC services have grown tremendously, with teams now available in most US cancer centers. Despite increased penetrance of services, little is known about the workforce that delivers this care, including their demographics, training, and future plans. Methods: Members of the American Academy of Hospice and Palliative Medicine (e.g. advanced practice provider (APP), registered nurses, chaplains) completed a workforce characteristics survey through electronic invitation in the second half of 2013; respondents were recruited via e-mail, blog and Facebook posts, and Twitter tweets. Descriptive statistics were calculated. Results: 1,241 clinicians responded, representing approximately a third of those who received the survey; 68% were physicians and 14% were APPs. Most (56%) were older than 50 years of age; 65% were female. Of physicians, 58% were board-certified through the experiential track, while 22% had completed fellowship training. Of clinical responsibilities, about half (48%) split time between consultative PC and hospice; 30% performed PC consultations only. Regarding organization size, 35% work with 1-3 other colleagues; 8% work alone. Regarding tenure, 34% have worked in PC for <5 years; 22% for >10 years. 82% reported they would become a PC clinician again, if asked to revisit their career choice. Of motivations for joining clinical PC, leading reasons were “opportunity for personal growth” and “influential experience during practicing another specialty”. About half (47%) intend to leave the field within 10 years. Of reasons to leave, 49% will retire; 24% may leave due to burnout; and 20% reported dissatisfaction with practice. Conclusions: The specialty PC workforce is diverse and faces sustainability challenges due to advancing physician age, impending retirements, evolving burnout, and dissatisfaction with the profession. If patients are going to have adequate access to services, research and approaches are needed to develop solutions that sustain and grow specialty PC.
Utility of the proximal margin frozen section for resection of gastric adenocarcinoma: A 7-institution study of the U.S. gastric cancer collaborative.
Authors: Squires Malcolm Hart , Kooby David A. , Pawlik Timothy M. , Weber Sharon M. , Poultsides George A. , Schmidt Carl Richard , Votanopoulos Konstantinos I. , Fields Ryan C. , Ejaz Aslam , Acher Alexandra W. , Worhunsky David J. , Saunders Neil , Swords Doug S. , Jin Linda X. , Cho Clifford Suhyun , Bloomston Mark , Winslow Emily , Cardona Kenneth , Staley Charles A. , Maithel Shishir K. 
Published: February 2017

103 Background: The proximal gastric margin dictates the extent of resection for gastric adenocarcinoma (GAC). The value of achieving negative margins by additional gastric resection after a positive proximal margin frozen section (FS) is unknown. Methods: The US Gastric Cancer Collaborative includes all patients who had resection of GAC at 7 institutions by oncologic surgeons from 2000-2012. Intraoperative proximal margin FS data were classified as R0 or R1 based on final permanent section (PS); positive distal margins were excluded. Primary aim was to evaluate the impact on local recurrence (LR) of converting a positive proximal margin FS to an R0 final margin by additional resection. Secondary endpoints were recurrence-free (RFS) and overall survival (OS). Results: Of 860 pts, 520 had a proximal margin FS; 67 were positive. Of these 67, 48 were converted to R0 on PS by additional resection. R0 proximal margin was achieved in 447 pts (86%), R1 in 25 (5%), and R1 converted to R0 in 48 (9%). Median FU was 44 mos. Although LR was decreased in the converted R1 to R0 group compared to the R1 group (10% vs 32%, p=0.01), when accounting for other pathologic variables on multivariate (MV) analysis, R1 to R0 conversion was not associated with decreased LR. Median RFS was similar between the R1 to R0 and R1 cohort (37 vs 31 mos; p=0.6) compared to 110 mos for the R0 group. Median OS was similar between the R1 to R0 conversion and R1 groups (36 vs 26 mos; p=0.14) compared to 50 mos for the R0 group. On MV analysis, increasing T-stage and positive lymph nodes were associated with worse OS; R1 to R0 conversion of the proximal margin was not associated with improved OS (p=0.5; Table). Conclusions: Conversion of a positive intraoperative proximal margin frozen section during gastric cancer resection does not decrease local recurrence or improve recurrence-free or overall survival. This may guide decisions regarding the extent of resection. [Table: see text]
Is primary surgery without preoperative chemotherapy the best treatment option for signet ring cell esophagogastric adenocarcinomas?
Authors: Ott Katja , Weichert Wilko , Blank Susanne , Jaeger Dirk , Heger Ulrike , Sisic Leila , Büchler Markus W. , Lordick Florian 
Published: February 2017

106 Background: Recent retrospective multicentric data favor a primary resection without neoadjuvant chemotherapy for signet ring cell (SRC) gastric cancer. Aim of this retrospective exploratory study is the comparison of primary resected with neoadjuvantly treated locally advanced SRC esophagogastric adenocarcinomas (EGA) in respect of outcome. Methods: From 2002-2012 200/646 resected EGA were classified as SRC by WHO classification (more than 50% signet ring cells) and staged cT3/4 Nany M0/x. Clinical response evaluation was based on endoscopy and CT-scan and histopathological regression was based on the Becker score (<10% residual tumor cells: responder). UICC 7th was used. Analysis was retrospectively from a prospective data base. Results: 103 were treated by preoperative chemotherapy (CTx), 97 were primary resected. 73 (37%) had AEG, 127 (63%) gastric cancer. Postoperative CTx was delivered in 62/103 (60%) of the patients with preoperative CTx and in 51/97 (53%) of the primary resected patients (p=0.28). In-hospital mortality was 4.5% (9/200). 20 (20%) were classified as clinical, 15 (8%) as histopathological responders. Preoperative CTx was significantly associated with worse pretherapeutic cT- (p=0.005) and cN- (p=0.008) categories, but subsequent lower (y)pN-category (p=0,001) and improved lymphnode ratio (p=0.001). Overall survival was significantly improved after preoperative CTx compared to primary resection (median survival 30.2 versus 17.6 months, p=0.001). Median survival of responding patients is not reached, median survival of nonresponder was 24.4 months (identical for clinical and histopathological responders) compared to 17.6 months in primary resected patients (p=0.002). The positive prognostic effect of preoperative CTx was significantly higher in AEG (p=0.004) compared to gastric cancer (p=0.067). In the 119 completely resected patients the survival was significantly improved by preoperative CTx (p=0.005), but it was no independent prognostic factor. Conclusions: A pre/periopative CTx seems also to be justified in SRC EGA. Relevant limitations are the retrospective and non-randomized design.
ALK, MET, and HER2 in esophageal adenocarcinoma with signet ring cell morphology.
Authors: Moore Catherine Elizabeth , Darbro Benjamin , Berg Daniel James , Clamon Gerald H. , Askeland Ryan W. , Abu Hejleh Taher 
Published: February 2017

138 Background: Signet cell morphology (SCM) is seen in various cancers. In Non-Small Cell Lung Cancer (NSCLC), SCM is associated with ALK gene rearrangements and MET amplification. Crizotinib is an ALK/MET inhibitor that showed dramatic responses in ALK rearranged NSCLC. In this study, we explored ALK rearrangements as well as MET and HER-2 amplification in esophageal carcinoma with SCM. Methods: We reviewed the medical records for 9 patients (pts) seen at the University of Iowa with a diagnosis of esophageal adenocarcinoma and SCM. Clinical characteristics were abstracted. The tumors were tested for ALK rearrangement by fluorescence in situ hybridization (FISH) using the ALK break-apart probe set (Abbott Vysis) and for MET amplification utilizing a MET/CEP7 FISH-probe combination. Both rearrangements and copy number of ALK were assessed as was amplification of MET relative to the centromere signal of chromosome 7. HER-2 was tested by immunohistochemistry (IHC) utilizing the FDA approved DAKO Hercept Test per the ToGA trial methods. Results: Average age at diagnosis was 60 years (43-82). Five pts were males. Neoadjuvant treatment was delivered in 5 of 9 pts. Esophagectomy was done in 7 of 9 pts. Median survival time was 5.8 months (range, 2.4 to 24 months). Histology was consistent with adenocarcinoma in all specimens. No ALK rearrangements were detected. One case had 4-15 extra copies of ALK in 58% of the nuclei. In that same case, there was a relative gain of MET compared to CEP7 (ratio MET/CEP7 = 1.88). Regarding HER-2, 7 of 9 pts were negative (<2+), 1 was equivocal (2+), and one was not done due to lack of tissue. The patient with high copy gain of ALK and a relative copy number increase of MET was treated with Crizotinib on compassionate use basis for 3 weeks after which the treatment was discontinued due to significant progression clinically and radiographically. Conclusions: SCM in esophageal adenocarcinoma was not associated with ALK rearrangements, or increased frequency of MET or HER-2 amplification. Overall, the results were most consistent with copy number variable status of ALK and MET as a result of chromosomal aneuploidy as opposed to locus specific rearrangement or amplification and did not result in significant response to Crizotinib.
Surgical treatment of gastric cancer: Oncologic outcome of neoadjuvant treatment in the German multicenter observational study II.
Authors: Stuebs Patrick , Garlipp Benjamin , Meyer Frank , Gastinger Ingo , Lippert Hans , Fahlke Joerg , Ridwelski Karsten 
Published: February 2017

139 Background: Neoadjuvant chemotherapy is broadly established in European centers when treating locally advanced gastric cancer. However, there still remain questions as to the benefit of this extended form of treatment in regards to tumor location and stage. Methods: Data obtained in the ongoing prospective, multicenter observational study (German Gastric Cancer Study II) on quality assurance in surgical therapy of gastric cancer containing a total of 2897 patients treated from 01/01/2007 through 31/12/2009 in 145 surgical departments to evaluate. Results: Overall, 506 patients (18.4%) received neoadjuvant treatment in regards to all tumor stages. Of the 530 patients with adenocarcinoma of the gastroesophageal junction (GEJ) 34.5% (n=183) received chemotherapy. In detail, 30.1% (n=873) of the patients were found to be in stage I. In regards to the mean time of survival for advanced stages (III/IV 6th editiion) a survival benefit for patients receiving neoadjuvant treatment (n=356) of 12.0 months was demonstrated versus 10.0 months (p=0.048) for patients not being treated neoadjuvantly. Improved survival through neoadjuvant treatment could not be demonstrated in GEJ tumors, both, comparing different types of GEJ and matching cancer of the GEJ and distal gastric cancer. Overall survival in GEJ tumors is significantly lower (25 months) compared to the overall survival in distal gastric cancers (38 months). In addition, 5-year survival rate of GEJ tumor patients (33.1 %) was distinctly lower than for patients with distal gastric cancer (41.4 %). Conclusions: The results reflect the difficulties of applying currently available study results to daily clinical practice. In order to achieve improved treatment results, requirements in diagnostics, oncological and surgical settings are paramount. Future data of this observational study can provide additional insight for this process.
Clinical significance of fibrinogen and albumin score for postoperative recurrence in esophageal cancer patients.
Authors: Matsuda Satoru , Takeuchi Hiroya , Fukuda Kazumasa , Nakamura Rieko , Takahashi Tsunehiro , Wada Norihito , Kawakubo Hirofumi , Saikawa Yoshiro , Omori Tai , Kitagawa Yuko 
Published: February 2017

14 Background: In order to predict the postoperative recurrence in esophageal cancer patients, we previously reported that esophageal cancer patients who had preoperative hyperfibrinogenemia (>350 mg/dl) showed high recurrence rate. Currently, combining the preoperative plasma fibrinogen level and serum albumin level, we established a new scoring system. In this study, we aim to clarify the validity of the fibrinogen and albumin score (FA score) in esophageal cancer patients. Methods: We retrospectively reviewed 215 patients who underwent curative transthoracic esophagectomy in our institution between January 2004 and August 2012. Preoperative plasma fibrinogen level and serum albumin level were confirmed in 204 patients. We investigated patient characteristics, clinicopathological factors, preoperative plasma fibrinogen level and plasma albumin level. Based on our previous reports, we defined a cutoff value of fibrinogen as 350 mg/dl. The cut off value of albumin was determined after the analysis of the albumin distribution in the present study. Prognostic score was constructed by assigning one point for hyperfibrinogenemia or hypoalbuminemia. Cumulative FA score was obtained by combining them. Results: Based on the result that preoperative serum albumin level was 4.1 ± 0.34 g/dl (mean ± SD), we defined a cutoff value of albumin as 4.0 g/dl. Approximately, 33% had hyperfibrinogenemia and 34% had hypoalbuminemia. The number of each FA score 0/1/2 was 98(48%)/75(37%)/31(15%) cases. The patients with advanced stage showed significantly high score. In survival univariate analysis, neoadjuvant treatment, depth of tumor invasion, lymph node metastasis, pretreatment stage, preoperative fibrinogen level and FA score were significantly correlated with postoperative disease free survival. In multivariate analysis, pretreatment stage and FA score were shown to predict postoperative DFS significantly. Conclusions: FA score was shown to predict postoperative recurrence in esophageal cancer patients. Both fibrinogen and albumin are popular indicators routinely measured in daily clinical practice, FA score may be highly validate and feasible.
Metastatic esophagogastric adenocarcinomas (EGA): Treatment, prognosis, and pretherapeutic selection options.
Authors: Ott Katja , Blank Susanne , Jaeger Dirk , Weichert Wilko , Sisic Leila , Grenacher Lars , Büchler Markus W. , Lordick Florian 
Published: February 2017

142 Background: Nowadays an increasing number of patients (pts.) with metastatic disease (MD) are discussed in interdisciplinary tumor boards. Preliminary results of the FLOT-3 study suggest a benefit for pts. with limited MD after resection compared to pts. with chemotherapy (CTx) only. Own published data suggest that a subgroup of pts. may benefit from surgery (ESJO, 2013). Primary objective of this retrospective explorative study was the outcome of pts. with resected metastatic EGA and the evaluation of our preoperative prognosis score (PPS) in a larger patients`series. Methods: From 2001-2012 123/800 EGA were classified as cM1 either confirmed intraoperatively as pM1 or confirmed by imaging during follow-up. Response evaluation was performed clinically by endoscopy and CT-scan, histopathologically by the Becker regression score. The PPS for pts. treated with CTx contains grading, clinical response and presumed R-category. Analysis was performed retrospectively from a prospective database. Results: M1 sites (70 AEG, 53 gastric cancer): 27 liver, 43 distant lymph nodes, 16 peritoneum, 10 lung, 6 others, 21 multiple. 11 (9%) were only explored, the rest resected. 49/112 (40%) had multivisceral resections. 63/112 (56%) were completely resected (R0). 72 had preoperative CTx, 51 primary resection. 26 (21%) were classified as clinical responder, 16 (13%) as histopathological responder, 30 (42%) as subgroup with improved prognosis by the PPS. The median survival was 20.0 months (m.). Survival was significantly increased by resection, a complete resection and a preoperative CTx (primary resection: 11m., after CTx: 30 m.)(all p=0.001), but not by multivisceral resection, number or type of metastases or localization of the primary tumor. In pts. who had preoperative CTx, clinical response and the PPS (21 m. versus 66 m., p=0.005) significantly influenced survival. In R0 pts. preoperative CTx (p=0.03), clinical response and the PPS remained prognostic (both p=0.001). Conclusions: A primary resection without preoperative CTx is not appropriate for metastatic EGA. Subgroups of pts. with limited metastatic spread may be selected for surgery using the PPS. Prospective randomized studies are required.
Correlation between standardized uptake value in pre- and post-neoadjuvant chemoradiotherapy and tumor regression grade in patients with locally advanced esophageal cancer.
Authors: Baksh Kathryn , Almhanna Khaldoun 
Published: February 2017

150 Background: A multimodality approach with neoadjuvant chemotherapy and radiation is the standard of care in the United States in the treatment of patients with locally advanced esophageal cancer. It is well established that neoadjuvant chemoradiotherapy (CRT) in these patients can facilitate downstaging, correlating with pathologic response, and improving overall survival. Our clinical practice involves the use of positron emission tomography (PET) to assist with staging in patients prior to undergoing neoadjuvant CRT and surgery. While there has been evidence showing correlation between tumor regression grade (TRG) and increased overall survival in these patients, the relationship between standardized uptake values on PET scans and TRG has not been discerned. The purpose of this study was to determine whether pre and post-chemoradiotherapy SUV on PET scans correlate with TRG in esophageal cancer patients receiving neoadjuvant chemoradiotherapy. Methods: A retrospective review of 56 patients with stage II-III esophageal cancer treated with neo-adjuvant CRT followed by surgery was performed. Pre- and post- treatment PET scans were reviewed. Maximum SUV at the site of the primary tumor was recorded. Upon completion of surgery, tumor regression grade was determined by a specialized pathologist. Spearman correlation was used to compare pre, post, and change in max SUV, to the 4 level TRG variables. Results: The median follow-up was 24 months. No significant correlation was found between pre-treatment or post treatment SUV and TRG with p value of 0.73 and 0.94 respectively. There was no significant correlation between decreased FDG uptake following CRT and TRG with p value of 0.82. Consistent with previous data, TRG predicted the therapeutic efficacy and prognosis for patients with locally advanced esophageal carcinoma treated by neoadjuvant chemotherapy. Conclusions: Our results are preliminary and retrospective in nature. A larger sample is needed to confirm these findings. Decreased FDG uptake in sequential PET scans strongly correlates with tumor response, but is not accurate enough to predict pathological response.
Quantification of MET expression using mass spectrometry (MS): Assay precision and stability in FFPE tumor tissue.
Authors: Hembrough Todd A. , Liao Wei-Li , Thyparambil Sheeno , Henderson Les , Rambo Brittany , Cecchi Fabiola , Bottaro Donald P. , Darfler Marlene , Xu Peng , Xiao Shu-Yuan , Zhao Lei , Veenstra Timothy D. , Burrows Jon , Catenacci Daniel Virgil Thomas 
Published: February 2017

16 Background: Overexpression of MET in gastroesophageal cancer (GEC) is associated with poor prognosis and potentially predictive of anti-MET therapeutic benefit. IHC has been the method chosen to quantify MET expression to date. However, IHC is semi-quantitative, suffers from cross-reactivity, and is low throughput. Moreover, MET IHC is hampered by antigenic instability in FFPE sections, limiting its utility to recently cut FFPE sections. Increasing recognition of the importance of other biomarkers in GEC suggests that ‘economic’ testing of scarce samples will be required. We sought to develop a MET quantitative assay within our ‘GEC-plex’ Liquid-Tissue-selected reaction monitoring (LT-SRM) MS test. Methods: We used trypsin digestion mapping of rMET to identify unique peptides for MS assay development. The assay was pre-clinically validated in 5 cell lines, where electrochemiluminescence (ECL) immunoassay measurement of MET was also performed. To assess the MET MS assay stability from archival FFPE sections, freshly cut FFPE tissue sections were immediately microdissected, processed and analyzed, while adjacent sections were processed and analyzed one year after cutting, to compare temporal quantification from the same FFPE samples (n=33). MET expression was assessed in GEC cases (n=121), and compared to IHC and FISH in select cases. Results: Tryptic digestion mapping of rMET showed that peptide TEFTTALQR was optimal for MET quantification. The LLOD for this peptide was 150 amol with CV<20%. Validation of the MET MS assay on 5 cell lines revealed concordance when compared to ECL (R2=0.99). The MET MS assay demonstrated temporal stability of serial sections cut from 33 samples analyzed one year apart: CVs<20%, R2=0.75. Analysis of 121 GEC FFPE tissues showed a broad range of MET expression levels (<150-4600 amol/ug), with 36/121 (29.7%) having detectable levels, similar to that observed using IHC. MS expression thresholds were determined that reliably identified MET gene amplification; sensitivity and specificity of these thresholds will be presented. Conclusions: ‘GEC-plex’ has a quantitative, sensitive, and specific MET MS assay that can be multiplexed along with other GEC biomarkers.