bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patterns of failure following tri-modality therapy for locally advanced esophageal cancer.
Authors: Shaikh Talha , Zaki Mark A. , Dominello Michael M. , Handorf Elizabeth , Konski Andre A. , Cohen Steven J. , Scott Walter Joseph , Meyer Joshua E. 
Published: February 2017

203 Background: Although tri-modality therapy is an acceptable standard of care in patients with locally advanced esophageal cancer, data regarding patterns of failure is lacking. We report bi-institutional patterns of failure experience treating patients using tri-modality therapy. Methods: Following IRB approval, we retrospectively reviewed all pts who underwent chemoradiation followed by esophagectomy at two NCI-designated cancer centers from 2000-2013. Patient and treatment factors were analyzed for failure patterns. First failure sites were categorized as local, regional nodal, or distant. Statistical analysis was performed using Fisher’s exact test and non-parametric Wilcoxon rank-sum test. Results: A total of 132 patients met the inclusion criteria with a median age of 62 (range 36-80) and median follow-up of 28 months (range 4-128). The majority of patients had T3 (82%), N1 (64%), or M0/M1a (92%) disease. At the time of last follow-up there were a total of 6 (4.5%) local, 13 (10%) regional nodal, and 32 (23.5%) distant failures. Local failure was correlated with fewer lymph nodes assessed (p=0.01) and close or positive margins (p<0.01). Regional nodal failure was correlated with fewer lymph nodes assessed (p<0.01) and smaller pre-treatment tumor size (p=0.04). Distant recurrence was correlated with post-treatment nodal stage (p<0.01), peri-neural invasion (p=0.03), negative margins (p=0.02), ulceration (p=0.02), incomplete response (p<0.01), post-treatment PET SUV (p=0.05), 3D-CRT (0.053), metastatic disease at diagnosis (p<0.01) and post-treatment metastatic disease (p<0.01). No other patient, tumor, or treatment factor was correlated with treatment failure. Conclusions: Per our bi-institutional experience, patient, tumor, and treatment factors may predict for failure in patients undergoing tri-modality therapy for locally advanced esophageal cancer. Further data is needed to identify patterns of failure in these patients.
Clinical features and the role of surgery in stage IV gastric cancer: A single center experience.
Authors: Perez-Florez Narjust , Gromko Larysa Jessica , Yoon Eric , Jennis Andrew , Bamboat Zubin M. , Gutierrez Martin 
Published: February 2017

212 Background: Gastric cancer is a prevalent global disease with significant mortality. Nearly 22,220 patients are diagnosed annually in the US, with approximately 50% of them presenting with disease that extends beyond loco-regional confines, and only a small percentage undergoing curative resection. We aim to study the clinical characteristics and survival benefit of surgery in stage IV gastric cancer. Methods: We reviewed the records of all patients diagnosed with gastric cancer in our cancer center from 1999 to 2013. A total of 272 stage IV cases were identified. Demographics, tumor characteristics, treatment modalities (surgical vs. non-surgical) and survival rate were analyzed. Kaplan-Meier was used for survival analysis and Cox regression for univariate and multivariate analysis. Results: Within the cohort 70 (26%) patients received surgery and 202 (74%) were treated with chemotherapy ± radiation. Mean age at diagnosis was 64 years in the surgical (S) patients and 66 years in the non-surgical (NS). Non-Hispanics whites were more likely to receive surgery vs. all other ethnic groups combined, representing 77% vs. 23% of the S subgroup (p<0.0001). Patients with proximal tumors were more likely to receive surgery when compared with distal tumors (37 (53%) vs. 14 (20%), p<0.0001). Total gastrectomy was the most common surgical procedure 33 (47%). There was a significant difference in disease specific survival between the two groups, being 17.3 months for S (95%CI: 11.1-23.4) and 5.3 months for NS (95%CI: 3.8-6.7) (p<0.0001). Age > 70 years (OR: 1.74, p<0.02), proximal tumor location (OR: 0.75, p<0.04), surgery (OR: 0.37, p<0.0001) and extended lymphadenectomy (D2) (OR: 0.26, p<0.02) were independent and significant predictors of survival by multivariate analysis. Conclusions: In our cohort, non-Hispanic whites and patients with proximal tumors were more likely to undergo surgery. A major survival benefit was observed for the surgical subgroup when compared to non-surgical treatment for stage IV gastric cancer. Future research should aim to further elucidate the specific role of surgery, as this could potentially impact management and transform the standard of care in stage IV gastric cancer.
Loss of lean body mass within one week as a major determinant for total weight loss at one month after gastrectomy for gastric cancer.
Authors: Aoyama Toru , Yoshikawa Takaki , Kawabe Taiichi , Fujikawa Hirohito , Hayashi Tsutomu , Yamada Takanobu , Sato Tsutomu , Oshima Takashi , Rino Yasushi , Ogata Takashi , Cho Haruhiko , Masuda Munetaka 
Published: February 2017

219 Background: Postoperative changes in body weight and composition during first 1 month after gastrectomy remained unclear. Methods: The patients who underwent gastrectomy for gastric cancer between May 2010 and October 2013 were examined. Body weight and composition were evaluated by bioelectrical impedance analyzer within 1 week before surgery (first measurement), at 1 week after surgery (second measurement), and at 1 month after surgery (third measurement). The changes of the early period were defined as the differences until the second measurement, while those of the late period as the differences from the second to the third measurement. Results: Two-hundred forty four patients were selected for this study. Total body weight loss (BWL) within 1 month was -3.4 kg and the rate of body weight at 1 month to the preoperative body weight was 94.1%. BWL was significantly greater in the early period rather than that of the late period (-2.1 kg vs -1.2 kg, p<0.001). In the early period, loss of lean body mass was significantly greater than loss of fat mass (-1.5 kg vs -0.6 kg, p<0.001). The same trend was observed regardless of type of gastrectomy and surgical approach. Conclusions: Loss of lean body mass within 1 week was a major determinant for total body weight loss at 1 month. To maintain lean body mass within 1 week and total body weight at 1 month, future trial should be focused on not the surgical approach but nutritional intervention within 1 week.
Interim analysis of hepatocellular carcinoma (HCC) screening and survival in 4,087 veterans diagnosed with HCC from 2008 to 2010.
Authors: Kaplan David Edward , Taddei Tamar H. , Aytaman Ayse , Hunt Kristel , Knott Astrid , Dieperink Eric , Baytarian Michelle , Fox Rena , Pedrosa Marcos , D'Addeo Kathryn , Dai Feng , Mehta Rajni , Duggal Mona , Pocha Christine , Skanderson Melissa , Valderrama Adriana ,   Veterans Outcomes and Cost Associated with Liver Disease (VOCAL) Study Group
Published: February 2017

243 Background: The Veterans Health Administration (VHA) is the largest provider of liver disease care in the US. From 2000-2007, there was a 5-fold increase in the incidence of hepatocellular carcinoma (HCC) among Veterans. The aim of the VOCAL group is to study outcomes and cost of Veterans diagnosed with cirrhosis and HCC from 2008-2010. Methods: The VA Corporate Data Warehouse was queried to identify all patients with ICD9 codes for HCC (155.0, 155.2) and cirrhosis (571.2, 571.5, 571.6). Chart abstraction was performed for each HCC patient to determine tumor characteristics, BCLC stage, and eligibility for transplantation. Results: This is an interim analysis of the first 4087 of 7,111 patients with HCC. HCC was confirmed in 3,207/4,087 (78%). Of these 3,207 patients, 778 (24%) were managed outside the VHA and 156 (6%) were diagnosed prior to 2008. Thus, 2,323 patients were analyzed. Median age was 60y (38-91). Males comprised 99% of the cohort; 61% were white, 24% were black, and 0.5% were Asian. Etiologies of cirrhosis were hepatitis C (HCV) (27%), alcohol-related (11%), HCV+alcohol (49%), hepatitis B (HBV) (9%), and other (metabolic, NASH) (2%). 63 (3%) were HIV-infected. Cirrhosis was coded in 83% (1918) prior to HCC diagnosis. Of cirrhotics, 11% (248) were optimally screened and 14% (335) were near-optimally screened; 75% of HCC were diagnosed incidentally or due to symptoms. AJCC stage was I/II/IIIA/IIIB/IIIC/IVA/IVB in 42/23/10/13/1/4/7%, respectively. 963 (41%) of patients were within Milan Criteria. BCLC staging was 0/A/B/C/D in 8/39/27/13/13%, respectively. Median OS was 400d and 1214/857/404/163/107d in BCLC 0/A/B/C/D, respectively. In multivariate survival model, age, the presence of ascites, serum albumin, serum bilirubin, serum sodium, CirCom score, Charlson-Deyo index, number of tumors, largest tumor size, and total tumor size were all statistically significantly predictive of survival. Conclusions: ICD9 codes for HCC have a PPV of ~80% for identifying true HCC cases in the CDW. Approximately 1/4 of patients received screening within AASLD 2010 guidelines. The majority of Veterans diagnosed with HCC present with intermediate to advanced disease with median survival 4.5-9.2 months.
Is proliferative index (Ki-67) useful to stratify patients (pts) with G2 gastroenteropancreatic neuroendocrine tumors (GEP-NETs)? Clinicopathologic correlation.
Authors: Angel Martin , O Connor Juan , Pesce Veronica , Mendez Guillermo Ariel , Bestani Claudia , Marmissolle Fabiana , Giacomi Nora , Belli Susana , Domenichini Enzo , Chacon Matias , Zamora Victor , Cabanne Ana Maria , Parma Patricia , Roca Enrique Luis ,   ARGENTUM Group
Published: February 2017

255 Background: Grade 2 (G2) Neuroendocrine tumors (NETs), of the digestive tract is a heterogeneous group of tumors. Several treatment options including chemotherapy and target therapy are available, but there is a lack of prospective trials assessing the role of pronostic factors in this population. Aim(s): to analyze prognostic factors and clinical characteristics in a population of patients with G2 GEP-NETs. To determine the role of ki 67 in the stratification of G2 population. Methods: Study population was obtained from our prospective database (Argentum Group). Survival was estimated using the Kaplan-Meier method and compared between Ki-67 quartiles using the log-rank test. Value of Ki-67 to discriminate mortality was assesed with a ROC curve analysis Results: 144 pts were evaluated. Mean age 54.9, 46.7% male. 102 (70.8%) with metastatic disease, mainly hepatic in 97 pts. (67.4%). 67.9 % underwent surgery. 34% received chemotherapy, and 10.9% target therapy. Median Ki-67 value was 6 (IQR 4-10), ROC curve=0.62 (95% CI 0.53 a 0.72 p=0.021. cut-off: 6.5 (sensitivity 62.2%, specificity 57.7%). Median survival was 97, 67, 51 and 27 months according stratification by quartile (p.001), 45 events (31.7%). Conclusions: Our results suggest that in the heterogenous G2 GEP-NETs there are significant differences in survival. This study was underpowered to detect differences between Ki-67 quartiles, we detected that chemotherapy was mostly used in the higher quartiles.
Prognostic value of gender in hospitalized pancreatic patients.
Authors: Zhang Shuang Yin , Zhang Shuang Qin , Jiang Jimmy Jing , El-Rayes Bassel F. 
Published: February 2017

256 Background: Women with pancreatic cancer (PC) are known to have a longer overall survival compared with men. However, no data address the association of gender with acute medical complications in the inpatient setting. We hypothesize that women with PC have fewer inpatient medical complications than men. Methods: The Nationwide Inpatient Sample (NIS) database was queried to identify all non-surgical hospital admissions for patients with a diagnosis of pancreatic cancer for 2011. We compared inpatient complications and mortality between females and males with PC using univariate and multivariate logistic regression model. Two sample independent t-tests were used to compare all linear variables, and Chi-squared tests were used to compare categorical data. Results: Of the 16,616 PC patients analyzed, there were 8,324 females (F) and 8,292 males (M). Mean age was 69 (F) and 67 (M). Length of stay for both averaged 6 days. After adjusting for gender, age, race, inpatient chemotherapy, and comorbidities (depression, alcoholism, arthritis, coagulopathies, drug use, diabetes, hypertension, hypothyroidism, liver disease [dz], metastatic dz, obesity, perivascular dz, renal failure), multivariate analysis showed that male gender in PC patients is independently associated with increased incidence of pneumonia (p<0.001, RR 0.77), pulmonary embolism (p=0.006, RR 0.80), ileus (p=0.001, RR 0.79), and acute renal failure (p<0.001, RR 0.76). Female patients experienced higher incidence of urinary tract infection (p<0.001, RR 1.9). Although incidence of mortality for male patients with PC was higher by univariate analysis (p= 0.005), it was not significantly higher by multivariate analysis (p= 0.087). Conclusions: In this study, men admitted with PC suffer higher incidences of inpatient complications compared to women. These findings may partly explain the higher overall survival rate of women compared to men with PC. It also implicates gender as prognostic tool in the management of hospitalized PC patients.
Exploration of rural disparities in pancreatic cancer staging and mortality to incidence ratio in Illinois.
Authors: Kistner Bridget , Zahnd Whitney , Ali Aman , Mellinger John D. , Ganai Sabha 
Published: February 2017

260 Background: Despite recent impetus towards regionalization of pancreatectomy to high-volume centers, rural disparities have not been explored for pancreas cancer outcomes. Analysis of the National Cancer Database showed less than one third of patients with resectable disease actually undergo surgery, suggesting opportunities for improvement in global systems related to pancreas cancer care, including appropriate referral for surgical resection. We intended to explore the impact of rurality and gastroenterologist (GI) density on staging and mortality for pancreas cancer. Methods: Age-adjusted pancreas cancer incidence and staging proportion were calculated for each county using 1991-2010 data from the Illinois State Cancer Registry. Age-adjusted mortality rates were calculated using SEER*STAT. Choropleth maps were created to illustrate Mortality-Incidence Ratios (MIRs) by Illinois county using ArcGIS. Mean GI density for each county was calculated from the US Area Health Resource File. USDA Economic Research Service rural-urban continuum codes (RUCC) and US census percent rurality data were used to designate county rurality and adjacency to metro counties. Chi-square, ANOVA, and Spearman’s rho calculations were performed. Results: A greater proportion of counties with high MIR were in Southern, more rural, Illinois. No GIs were located in 65 out of 102 Illinois counties (64%) during the time interval analyzed, with a mean density of 1.0 per 100,000. Counties without GIs were significantly more rural, poorer, and less educated than counties with GIs. Unstaged pancreas cancers were inversely correlated with GI density (Spearman’s rho=-0.20; p=0.04). MIR was positively correlated with percent rurality (Spearman’s rho=0.23; p=0.02). MIR was also predicted by RUCC category, and was significantly greater in rural regions not adjacent to metro counties (p=0.02). Conclusions: Higher rates of unstaged pancreas cancer and higher MIR were noted in rural regions, which may be influenced by the availability of gastroenterologists or other specialty services. Further exploration of the impact of distance from high-volume cancer centers on rural cancer outcomes is warranted.
T-cell redirected killing and cure of pancreatic and gastric cancer xenografts by targeting Trop-2.
Authors: Goldenberg David M. , Rossi Edmund A. , Rossi Diane L , Cardillo Thomas M. , Chang Chien-Hsing 
Published: February 2017

262 Background: Trop-2 [also called tumor-associated calcium signal transducer 2 (TACSTD2), EGP-1 (epithelial glycoprotein-1), GA733-1, or M1S1]is a 35 kDa transmembrane glycoprotein that is overexpressed relative to normal tissues in a variety of human cancers, including pancreatic and gastric carcinomas, where increased expression correlates with poor prognosis. Trop-2 appears to be more tumor-specific than the related molecule, EpCAM (Trop-1). MT110, the EpCAM antibody x CD3 bispecific T-cell engager (BiTE), is currently undergoing a Phase I study in various solid tumors, including lung, gastric, colorectal, breast, prostate, and ovarian cancers. We produced a similar T-cell redirecting bispecific tandem scFv, E1-3, using the variable domains of hRS7 (humanized anti-Trop-2 mAb) and Okt-3 (anti-CD3 mAb). Methods: T-cell activation, cytokine induction and cytotoxicity were evaluated ex vivo using PBMCs or purified T cells with human pancreatic (Capan-1 and BxPC3) and gastric (NCI-N87) cancer cell lines as target cells. In vivo activity was assayed with NCI-N87 xenografts that were inoculated s.c. in a mixture with twice the number of human PBMCs and matrigel. Results: In the presence of target cells and PBMCs, E1-3 potently induced T-cell activation, proliferation, and dose-dependent cytokine production of IL-2 (>2 ng/mL), IL-6 (>1 ng/mL), IL-10 (>7 ng/mL), TNF-α (>1 ng/mL) and IFN-γ (>50 ng/mL). In vitro, E1-3 mediated a highly potent T-cell lysis of BxPC3 [IC50=0.09(±0.04) pM], Capan-1 [IC50=1.2(±1.1) pM] and NCI-N87 [IC50=1.2(±1.2) pM] target cells. In vivo, two 50-µg doses of E1-3 given three days apart cured all of the mice (N=8) bearing NCI-N87 xenografts (P=0.0005; Log-Rank). Tumors in the control group (PBMCs only) reached the endpoint (TV>1 cm3) with a median of 39.5 days. All mice remained tumor-free in the E1-3 group at 78 days. Conclusions: Trop-2 is an attractive target for T-cell-mediated killing of pancreatic, gastric and other epithelial cancers.
S100P tumor-marker response to chemotherapy in patients with advanced pancreatic cancer.
Authors: Mitsunaga Shuichi , Umemoto Kumiko , Watanabe Kazuo , Okuyama Hiroyuki , Hashimoto Yusuke , Takahashi Hideaki , Ohno Izumi , Shimizu Satoshi , Ochiai Atsushi , Ikeda Masafumi 
Published: February 2017

265 Background: The serum tumor-marker in monitoring response to chemotherapy is not valid in advanced pancreatic cancer (PC). S100 calcium-binding protein P (S100P) has been reported as a predictive diagnostic index for PC and may serve as an early marker to activity of chemotherapy. The aim of this study was to analyze the correlation between the efficacies of chemotherapy and the kinetics of tumor-markers including serum S100P, carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) in prospective cohort of advanced PC. Methods: Patients who were treatment naïve for advanced PC with liver mets were eligible. Serum levels of S100P, CEA, and CA19-9 were measured at baseline and at one month later. The patients without monitoring of tumor-markers were excluded. A response of tumor-marker was defined as a decrease of at least 25%. Clinical data including radiological response according to the Response Evaluation Criteria In Solid Tumors ver. 1.1 were prospectively collected. S100P, CEA, and CA19-9 responses were tested in association with progression free survival (PFS) and overall survival (OS). Results: Fifty patients were analyzed in this study (male: 64%, median age: 67 years, Eastern Cooperative Oncology Group performance status [PS] 0: 60%). All of 50 patients received chemotherapy (gemcitabine [GEM]: 13 pts, GEM doublets: 34 pts, 5FU-based regimen: 3 pts). PFS and OS were 2.8 and 6.1 months. Responses of S100P, CEA, and CA19-9 were founded in 50%, 16%, and 32% of all, respectively. Multivariate analysis for PFS in Cox regression hazard model was performed using age, gender, PS, CEA, CA19-9, and S100P, and revealed that the independent predictors to longer PFS were responses of S100P (HR to progression: 0.47, P=0.02) and CEA (HR: 0.29, P=0.01). S100P or CEA responders showed better OS in univariate analysis using log-rank test, compared to non-responders of S100P (responder vs. non-responder: 8.4 vs. 3.7 months, P=0.04) or CEA (12.0 vs. 5.9 months, P=0.02), but not in multivariate analysis. Conclusions: Biochemical response of S100P might be useful for monitoring response to chemotherapy in advanced PC, which warranted further study in relationship between serum S100P response and treatment efficacies.
Cytology from endoscopic retrograde cholangiopancreatography in the evaluation of invasive pancreatic head intraductal papillary mucinous neoplasm: A necessity?
Authors: Roch Alexandra M , House Michael Garrett , Sharma Neil R , Cioffi Jessica L , DeWitt John M , Easler Jeffrey J , Ceppa Eugene P , Zyromski Nicholas J , Nakeeb Attila , Schmidt C. Max 
Published: February 2017

266 Background: Endoscopic retrograde cholangiopancreatography (ERCP) with brushing/fluid sampling has historically been the standard to establish invasive transformation of pancreatic head intraductal papillary mucinous neoplasm (IPMN). More recently, endoscopic ultrasound (EUS) with fine needle aspiration (FNA) has been employed for this purpose. We hypothesized that for patients with invasive IPMN, in the era of EUS FNA, there is no additional benefit of ERCP brushing/fluid sampling. Methods: A retrospective review of a prospectively maintained database of patients who underwent surgical resection for IPMN at a single academic center (1992-2014) was performed. Patients with invasive pancreatic head IPMN on surgical pathology were included. Cytopathology was considered positive if it showed adenocarcinoma or markedly atypical cells. Results: Of the 74 patients with invasive IPMN, 55 had a pancreatic head neoplasm. Preoperatively, 4 patients had neither EUS nor ERCP, 27 had only 1 endoscopic study (ERCP n=16, EUS n=11), and 24 had both EUS and ERCP. In 11 patients with EUS, 8 had positive FNA (73% sensitivity for cancer detection). In 16 patients with ERCP (brushing n=7, fluid n=9), 5 had positive cytology resulting in 31% sensitivity. Further analysis revealed 29% and 33% sensitivity for brushing and fluid sampling, respectively. When both procedures were performed (n=24; EUS+ERCP fluid n=10, EUS+ERCP brushing n=14), the sensitivity was 75%, but ERCP cytology changed the diagnosis in only 2 patients. EUS FNA was performed regardless of ERCP cytology results in 18 patients (after brushing n=6, after fluid sampling n=4, same day n=8; median interval=4 days). 6 patients had negative cytology from both EUS and ERCP. Conclusions: In patients with invasive pancreatic head IPMN, sensitivity of ERCP cytology for cancer detection was poor (31%), making an impact on diagnosis in only 2/55 patients. EUS FNA was performed in 75% patients regardless of ERCP cytology results. Aside from the therapeutic impact of ERCP (biliary endoprosthesis in jaundiced patients), its cytological role is limited, resulting in unnecessary and potentially avoidable cost.