bluuebunny/crossref_metadata_2025_split huggingface dataset:
C-reactive protein at 4 days after surgery as an early predictor of serious infectious complications following esophageal cancer surgery.
Authors: Kano Kazuki , Ogata Takashi , Maezawa Yukio , Segami Kenki , Nakajima Tetsushi , Ikeda Kousuke , Sato Tsutomu , Cho Haruhiko , Yoshikawa Takaki 
Published: February 2017

10 Background: Serious infectious complications (SICs), frequently observed morbidities, have been reported to be related not only with short-term mortality but also with poor long-term survival in various types of malignancies including esophageal cancer. SICs usually develop 7 to 10 days after esophagectomy and early diagnosis is believed to be difficult because systemic response by SICs is considered to be covered by surgical invasion. The aim of this study was to investigate whether serum C-reactive protein (CRP) on postoperative day (POD) 4 can be predictor of SICs after esophageal cancer surgery. Methods: The present study retrospectively examined 110 consecutive patients undergoing open thoracic esophagectomy after neoadjuvant chemotherapy for thoracic esophageal cancer between January 2011 and June 2015. All patients received perioperative care of enhanced recovery after surgery program with steroid therapy. SICs were defined as morbidity of grade III or more according to the Clavien-Dindo classification. Diagnostic accuracy was determined by measuring the area under the receiver operating characteristic curve (AUC). Clinical and laboratory parameters including CRP, all available before or within POD 4, were analyzed with univariate and multivariate logistic regression model to identify SICs. Results: Median age was 68 years. SICs were observed in 20 patients (18.2%). CRP on POD 4 had superior diagnostic accuracy for PICs (AUC 0.759; 95% confidence interval [CI], 0.652-0.866). Cut-off value for CRP was determined as 4.0 mg/dl which yielded a sensitivity of 70.0%, a specificity of 74.4% and a negative predictive value of 91.8% for the detection of SICs. Multivariate analysis identified CRP ≥ 4.0 mg/dl on POD 4 (odds ratio of 8.399 with 95% CI, 2.646–26.666) and three-field lymph node dissection (odds ratio of 4.658 with 95% CI, 1.306–16.619) as predictive factors for SICs after esophagectomy. Conclusions: CRP on POD 4 was an early indicator for serious infectious complications after esophageal cancer surgery, which could encourage imaging study to detect the focus or early intervention by antibiotics.
Subset of patients with unfavorable T1N2-3M0 gastric cancer for whom surgery alone is the standard treatment.
Authors: Maezawa Yukio , Sato Tsutomu , Aoyama Toru , Kano Kazuki , Segami Kenki , Nakajima Tetsushi , Ikeda Kousuke , Hayashi Tsutomu , Yamada Takanobu , Kunisaki Chikara , Oshima Takashi , Rino Yasushi , Masuda Munetaka , Ogata Takashi , Cho Haruhiko , Yoshikawa Takaki 
Published: February 2017

105 Background: ACTS-GC trial demonstrated that S-1 is effective as adjuvant chemotherapy for Japanese patients who have undergone curative D2 gastrectomy for gastric cancer and were diagnosed with pathological stage II disease. However, stages T1N2M0 and T1N3M0, which are classified as part of Stage II, were excluded from the ACTS-GC trial. The aim of the present study was to identify the unfavorable subset of patients with T1N2M0 and T1N3M0 gastric cancer for whom surgery alone is the standard treatment. Methods: The present study examined 59 patients who were diagnosed with T1N2M0 or T1N3M0 gastric cancer at Kanagawa Cancer Center and Yokohama City University Hospital between January 2000 and June 2010. Univariate and multivariate analyses were performed to identify risk factors for overall survival using a Cox proportional hazards model. Results: When overall survival was compared by the log-rank test, a significant difference was observed with regard to macroscopic tumor diameter. A macroscopic tumor diameter greater than 30mm was regarded as a critical point of classification considering the survival. Mulitivariate Cox’s proportional hazard analyses demonstrated that macroscopic tumor diameter was the only significant independent prognosticator. The five-year survival was 60.0% in patients with a macroscopic tumor diameter < 30mm, and 84.6% in those with a macroscopic tumor diameter > 30mm (P = 0.027). Conclusions: Among T1N2M0 and T1N3M0 gastric cancer patients for whom surgery alone is the standard treatment, having a small T1N2-3 tumor of less than 30 mm in diameter was the sole risk factor for gastric cancer survival. These tumors might be another target for adjuvant chemotherapy.
Survival benefit of additional surgery after non-curative endoscopic resection in patients with early gastric cancer.
Authors: Ryu Keun Won , Eom Bang Wool , Kim Young-Il , Kim Kwang Hee , Nam Byung-Ho , Yoon Hong Man , Cho Soo-Jeong , Lee Jong Yeul , Kim Chan Gyoo , Kook Myeong-Cherl , Kim Young Woo , Choi Il Ju 
Published: February 2017

106 Background: The aim of this study is to compare the long-term outcomes between patients who underwent endoscopic submucosal dissection (ESD) and those who underwent surgery for early gastric cancers (EGCs) turned out to be out-of-indication of ESD. Methods: We retrospectively reviewed database on gastric cancer patient cohort who underwent ESD or surgery from 2004 to 2014. Patients whose lesions revealed to be out-of-indication for endoscopic resection after ESD or surgery were included in the analysis after 1:1 propensity score matching for baseline clinicopathologic characteristics. Overall survival (OS) and gastric cancer recurrence rates were compared between the matched ESD and surgery groups. Results: After propensity score matching, a total of 193 pairs of patients were included, and 126 pairs were ESD with additional operation group and 67 pairs were ESD without additional operation group. OS (5-year OS rates, 89.5% vs. 89.9%; P=.105) and gastric cancer recurrence rates (5-year recurrence rates, 2.6% vs. 1.6%; P=.080) were not different between the ESD and the matched surgery group. In the matched subgroups, ESD with additional operation group had comparable OS and gastric cancer recurrence rates in comparison with matched surgery group. However, ESD without additional operation group had significantly shorter OS (5-year OS rates, 76.8% vs. 86.3%; P=.032) and higher gastric cancer recurrence rates (5-year recurrence rates, 11.9% vs. 0%; P=.002) than matched surgery group. ESD without additional operation was also significant risk factor for overall mortality and gastric cancer recurrence in multivariate analyses. Conclusions: Patients who did not undergo additional operation after ESD for EGCs turned out be the out-of-indication had worse long-term outcomes. Additional operation should be recommended, when EGC was identified to be the out-of-indication after ESD.
Efficacy and safety of endoscopic resection for gastric subepithelial tumors.
Authors: Jung Kyoungwon , Ahn Ji Yong , Kim Do Hoon , Gong Eun Jeong , Cho Charles J. , Na Hee Kyong , Lee Jeong Hoon , Jung Kee Wook , Choi Kee Don , Song Ho June , Lee Gin Hyug , Jung Hwoon-Yong , Kim Jin-Ho 
Published: February 2017

107 Background: Because small gastric subepithelial tumors (SETs) less than 2.0 cm might have malignant potential, ambiguous cases should be removed for optimal diagnosis and treatment. With the recent advances in endoscopic technique, endoscopic resection (ER) has been attempted for pathologic confirmation of gastric SETs. Herein, we aim to investigate the clinical usefulness and safety of ER of gastric SETs. Methods: A total of 115 subjects who underwent ER for gastric SETs from January 2005 to December 2014 were eligible for the study at the Asan Medical Center, Seoul, Korea. Patient’s demographic status, tumor related factors, procedure related factors, and clinical outcomes were retrospectively reviewed by using electronic medical record. Results: Among the 115 patients, 53 were male (46.1%) and the mean age was 51.59 ± 14.59 years. The mean size of all tumors was 18.58 ± 10.71 mm. Complete endoscopic resection was achieved in 108 of 115 tumors (93.9%). The final histopathologic diagnoses included 38 gastrointestinal stromal tumors (GISTs) (33.0%), 21 heterotopic pancreas (18.3%), 18 neuroendocrine tumors (15.7%), 11 leiomyoma (9.6%), 10 inflammatory fibroid polyp (8.7%), and others tumors (n = 17, 14.8%). Perforations occurred in 12 patients (10.4%) and they were successfully managed with endoscopic clipping. Severe bleeding during endoscopic resection occurred in 13 patients (11.3%) and they were treated by endoscopic management. Six patients underwent sequential wedge resection or gastrectomy of stomach because of non-curative resection and the pathologic evaluation revealed residual tumors in 3 patients. There was no recurrence or metastasis during mean follow-up of 44.96 ± 32.62 months (range 3-120.7 months). The rate for complete resection in relation to the final pathology was lower in GISTs (86.8%) than others (97.4%, p = 0.026). The rate of perforation was significantly higher for the fundus (66.7%) than for other locations (0% for the cardia, 16.7% for high body, 8.3% for mid body and 8.3% for antrum) (p < 0.001). Conclusions: ER of gastric SETs may be feasible and safe method for pathologic confirmation and further strategy.
Course and predictors of postoperative outcomes in older patients with localized gastric adenocarcinoma treated preoperatively.
Authors: Charalampakis Nikolaos , Xiao Lianchun , Elimova Elena , Shimodaira Yusuke , Shiozaki Hironori , Das Prajnan , Matamoros Aurelio , Sagebiel Tara L. , Blum Mariela A. , Lee Jeffrey H. , Bhutani Manoop S. , Weston Brian , Mansfield Paul F. , Minsky Bruce D. , Badgwell Brian D. , Ajani Jaffer A. 
Published: February 2017

132 Background: Older patients with localized gastric adenocarcinoma (LGAC) suffer from substantial postoperative morbidity and mortality; however, postoperative outcomes in older patients who have received preoperative chemotherapy and/or chemoradiation have not been reported. Our study examined the impact of age and other covariates on baseline, surgical and postoperative characteristics and explored potential predictors of postoperative outcomes. Methods: Patients with LGAC who were treated with chemotherapy (n = 36; 18%) and/or chemoradiation (n = 167; 82%) followed by surgery (n = 203) were grouped in 2 categories by age: 1) ≥ 65 years old (n = 70) and 2) < 65 years old (n = 133). The short-term outcomes included postoperative morbidity and mortality, and the long-term outcomes overall survival (OS) and progression-free survival (PFS). Potential predictors of 90-day postoperative outcomes were identified i) by age group and ii) by a number of other covariates. Descriptive statistics and survival analyses were utilized. Results: The 90-daypostoperative morbidity rate was similar in older and younger patients(61 vs 58%; p = 0.6549). The 90-day mortality rate did not differ statistically between the two groups (3 vs 0%; p = 0.1178). Although major Clavien grade III/IV complications after surgery were more common in older patients, this difference did not reach statistical significance (17 vs 12%; p = 0.3919). The long-term outcomes in terms of OS and PFS were also similar (p = 0.8629 and p = 0.558 respectively). The effect of patient age and ECOG PS on outcomes was not significant. Instead, other factors, such as Charlson comorbidity index (p = 0.0114), length of hospital stay (p = 0.0009), median operative time (p = 0.006) and presence of diabetes (p = 0.0282) were strong predictors of postoperative complications. Conclusions: Our data demonstrate that older patients with LGAC who received preoperative therapy had similar outcomes with younger patients but were more likely to demonstrate higher morbidity, although the differences were not statistically significant. Comorbidity indices provided more information than age in identifying postoperative short and long-term outcomes.
Survival analysis in gastric cancer patients of the Colombian coffee zone at the Oncologos del Occidente clinic during 2014.
Authors: Rojas Uribe Gustavo A. , Martinez Jose , Calvache Jaime 
Published: February 2017

148 Background: The risk of death for gastric cancer in Colombia is lightly higher for 2013 compared to 1998. Even though Risaralda has an irregular pattern for the risk of death, it was also higher compared to 1998, for these reasons the survival analysis was made with the information of gastric cancer patients treated in Oncólogos del Occidente clinic during 2014. Methods: A cohort study was made whose exposure is the treatment of gastric cancer. The time variable is the interval between the first medical appointment and the final control, interview or date of death, and the outcome makes reference to a death attributable to cancer gastric or surviving. The source of the cases were the clinical histories found in SAHICO data base, of the patients attended in the clinic Oncólogos del Occidente, to make univariate and bivariate analysis using Stata software. Results: There were 173 patients, from which 69.9% were male; the age group with highest incidence was 60 to 69 years old group (32.2%); 21.38% of the patients had family members with gastric cancer and 53.1% were diagnosed during advanced stages (III-IV). As far as the survival analysis, it was 207 days long, lessen if the patient only receives palliative treatment (122 days long) and increasing if surgery, chemotherapy and radiotherapy were done (252 days long). Conclusions: In a national and international level, the epidemiological data correlates with the findings in this study; with respect to the diagnosis, in Colombia, it is made during advanced stages, meanwhile in developed countries the diagnosis is made during earlier stages because of the screening tests. The oncological surgery increased the patient’s survival, also for the patients who underwent surgery when they received chemotherapy or radiotherapy.
Prognostic value of 18F-FDG PET/CT metabolic tumor volume for complete pathologic response and clinical outcomes after neoadjuvant chemoradiation therapy for locally advanced esophageal cancer.
Authors: Venkat Puja , Oliver Jasmine A , Jin Will , Dault Joshua , Frakes Jessica M. , Hoffe Sarah E. , Pimiento Jose Mario , Almhanna Khaldoun , Fontaine Jacques , Pena Luis , Latifi Kujtim 
Published: February 2017

150 Background: The prognostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) has not yet been defined in locally advanced esophageal cancer (LAEC). This study aims to elucidate the prognostic role of PET/CT for patients treated with neoadjuvant chemoradiation (CRT) followed by esophagectomy. Methods: We retrospectively evaluated patients with LAEC treated from 2006 to 2014 with neoadjuvant CRT followed by esophagectomy. 86 patients had pre-CRT and post CRT PET/CT scans performed at our institution. These scans were imported into an image analysis program. PET parameters maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), mean standardized uptake value (SUVmean), and peak standardized uptake value (SUVpeak) were recorded for both pre-CRT and post-CRT scans. MTV was defined using a previously described liver method. The correlation of these parameters with pathologic complete response (pCR) and clinical outcomes was analyzed using binomial logistic regression and cox regression. Results: Pre-CRT MTV < 33.6 (median value) was significantly predictive of pCR (p = 0.019, OR = 3.064). An ROC curve was produced to determine a binary cutoff of 35.8, yielding a higher specificity (62.3% vs. 59%) and the same sensitivity (72.7%), increasing the significance to p = 0.010, OR = 3.378. The ratio of postMTV/preMTV (MTVr) was calculated. MTVr > 0.2857 (median value) was significantly predictive of distant metastasis (DM) after esophagectomy (p = 0.018, OR = 3.680). An ROC curve was produced to determine a binary cutoff of 0.301, which increased specificity from 57.1% to 60.3%, and maintained the same sensitivity at 81.3%, increasing the significance to p = 0.014, OR = 3.815. SUVmax, mean and peak were not predictive. Conclusions: Pre CRT MTV was predictive of pCR and MTVr was predictive of DM. Our data suggests that MTV is superior to SUVmax, mean and peak in predicting for response to treatment in LAEC. Further study is needed to determine if Pre CRT MTV and change in MTV can help define which patients will most benefit from esophagectomy and/ or adjuvant chemotherapy.
Recurrence patterns and outcome of patients with stage IIIB-IV(M0) gastric cancer after gastrectomy and adjuvant chemotherapy: A retrospective analysis in one Chinese cancer center.
Authors: Du Chun-Xia , Zhou Hai-Tao , Zhong Yu-Xin , Pei Wei , Yu Yue , Zhou Ai-Ping 
Published: February 2017

160 Background: Gastric cancer is one of the leading causes of cancer-related death in China. Previous data showed 5-year OS rates varied from 10% to 20% in patients with stage IIIb and IV(M0) disease. This study aimedto explore recurrence patterns and outcome of stage IIIB-IV(M0) gastric cancer patients who underwent radical gastrectomy and adjuvant chemotherapy in the Cancer Hospital, Chinese Academy of Medical Center. Methods: Patients with stage IIIB-IV(M0) (AJCC V6) gastric adenocarcinoma were enrolled. All patients received a total or subtotal gastrectomy with at least D1 lymph node dissection. Adjuvant chemotherapy consisting of oxaliplatin, fluoropyrimidines with or without docetaxel was started within 1 month after surgery for maximum of 12 cycles. Results: From January 2006 to December 2011, a total of 137 patients were included (stage IIIB:85, stage IV(M0):52) in the study. The median age was 56 years (20-77) and 96 (70.1%) were male. With a median follow-up time of 40 months, 89 (65%) patients developed recurrence or a second primary malignancy. Peritoneal recurrence (28, 20.4%), locoregional lymph nodes (38, 27.7%) and hematogenous metastases (24, 17.5%) were the most common recurrence patterns. The 5-year DFS rates were 34% and 30% in patients with stage IIIB and stage IV(M0) diseases, respectively. The 5-year OS rates were 46% and 30%, respectively. No statistical difference was observed between stage IIIB and stage IV(M0) patients in terms of median DFS (27.0 m vs 17.4m, p = 0.35). The median OS was in favor of stage IIIB patients compared to stage IV (M0) patients (46.5 m vs 26.1 m, p = 0.02). Multivariate analysis revealed that male (p = 0.02), leather stomach or multiple original diseases (p = 0.02), T4 stage (p = 0.01) and higher lymph node ratio (p < 0.01) were independent negative prognostic factors. Conclusions: Patients with stage IIIB and IV (M0) gastric cancer achieved a better outcome than the historical data in our center. Further investigations are needed to focus on individual and multimodality adjuvant therapy for this group.
Analysis and follow-up of the patients diagnosed with metastatic gastric adenocarcinoma in the Parc Taulí Hospital, Sabadell, between 2010 and 2013.
Authors: Ferrer Marta , Pericay Carles , Macias Ismael , Dotor Emma , Pisa Aleydis , Saigí Eugeni 
Published: February 2017

169 Background: The primary endpoint of this study was to know the incidence and treatment of gastric carcinoma in our area. Other secondary endpoints were percentage of treated patients, overall survival (OS), survival in subgroups, and more frequent treatments. Methods: Since 2010 to 2013 all the patients diagnosed with metastatic gastric adenocarcinoma and treated at the hospital Parc Taulí from Sabadell were registered. The clinical information was compiled and analyzed. Survivals curves were determined with Kaplan-Meier functions Results: 168 patients were studied, with 79 metastatic (47%). 56% men and median age 67 years. Localizations were gastric body 52%, gastro-esophageal junction 20%, and antrum 25%. OS of the series was 5,05 months (95% CI, 2,99-7,10). 60% of the patients were treated with first line chemotherapy (CT). From them, 42% had a second line and 25% a third line. DFS were respectively 6,62 months (4,06-9,17), 4,29 months (2,28-6,30), and 2,88 months (1,12-4,64) for every line of treatment. OS of the patients that received chemotherapy was 9.7 months (6,40-13,00). CT more used in first line were triplets of fluropyrimidines, platinum and taxanes, in 45% (21 patients). Also just fluoropyrimidines and platinum without taxanes, in 38%. As a second line the predominant CT is also platinum and fluoropyrimidines (37%), and irinotecan (30%). In third line, 50% are combinations based on irinotecan. Conclusions: The OS of the patients who received CT is significantly prolonged respect the ones who didn’t. The data obtained matches the data already published in the literature, even the more frequent chemotherapy.
Prognostic significance of pre-treatment neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in locally advanced esophageal cancer.
Authors: Clara Joseph A. , Kim Dae Won , Venkat Puja , Frakes Jessica M. , Hoffe Sarah E. , Almhanna Khaldoun , Kothari Nishi , Pena Luis , Pimiento Jose Mario , Kim Richard D. 
Published: February 2017

172 Background: The prognosis for esophageal cancer remains poor despite advances in therapeutic modalities. Elevations of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been shown to be associated with poorer prognosis in several types of solid cancer. However, their prognostic value remains controversial in esophageal cancer. The aim of this study was to assess the prognostic value of NLR and PLR in esophageal and gastroesophageal junction (GEJ) cancer. Methods: We retrospectively reviewed the database of 77 patients who underwent neoadjuvant chemoradiation and potentially curative resection for esophageal cancer in our institute, between July 2006 and December 2011. NLR and PLR were calculated from laboratory data obtained prior to the start of chemoradiation. The predictive value of NLR and PLR was assessed using Kaplan-Meier curves and Cox regression models for an association with pathologic response to chemoradiation, relapse-free survival, and overall survival. Results: A total of 77 patients were identified with a median age at diagnosis of 62.5 years. In univariate analysis, neither NLR nor PLR were shown to be significantly associated with the pathologic response (p = 0.87, p = 0.89, respectively), relapse-free survival (p = 0.5, p = 0.4, respectively), or overall survival (p = 0.55, p = 0.44, respectively). Conclusions: The present study failed to confirm NLR and PLR as significant predictors of pathologic response to chemoradiation, relapse-free survival, and overall survival in patients with locally advanced esophageal and GEJ cancer undergoing neoadjuvant chemoradiation and surgical resection.