bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predicting early mortality in resectable pancreatic adenocarcinoma: A cohort study.
Authors: Sohal Davendra , Shrotriya Shiva , Glass Katherine , Pelley Robert James , McNamara Michael J. , Estfan Bassam N. , Shapiro Marc A. , Wey Jane , Chalikonda Sricharan , Morris-Stiff Gareth , Walsh Matthew , Khorana Alok A. 
Published: February 2017

414 Background: Overall survival after pancreatic cancer resection remains poor. A subgroup of patients die early (<6 months) and understanding factors associated with early mortality may help identify high-risk patients. The Khorana Score, including baseline hemoglobin, leukocyte and platelet counts, and body mass index [Khorana et al, Blood, 2008], has been shown to be associated with early mortality in solid tumors [Ay et al; Kuderer et al]. We evaluated the role of this score and other prognostic variables in predicting early mortality following resection. Methods: We conducted a cohort study of consecutive patients who underwent surgical resection for pancreatic cancer from January 2006 through June 2013 and were followed at the Cleveland Clinic. Baseline (diagnosis +/- 30 days) parameters were used to define patients as high-risk (Score >=3). Statistically significant univariable associations and a priori prognostic variables were tested in multivariable models; adjusted hazard ratios (HR) are presented. Results: The study population comprised 334 patients. Median age was 67 years; 50% were female; 86% were Caucasian. Pancreatic head was the primary site for 73%; 67% were T3 and 63% were N1 tumors. Median Khorana score was 2; 152 patients (47%) were high-risk. Adjunctive treatment included chemotherapy (70%) and radiation (40%). Post-operative (30-day) mortality was 0.9%. Six-month mortality for the entire cohort was 9.4%, with significantly higher rates for high-risk patients (13.4% vs. 5.6%, p=0.02). In univariable analyses, Khorana score, low hemoglobin, and elevated blood urea nitrogen (BUN) were associated with early mortality; T- and N-stage, as well as margin status (R0/R1), were not. In multivariable analyses (n=326), Khorana score (HR high-risk = 2.31, p=0.039) and elevated BUN (HR = 4.34, p<0.001) were associated with early mortality. Conclusions: Patients at high risk for early mortality after resection of pancreatic adenocarcinoma can be identified using simple baseline patient-related clinical and laboratory parameters rather than tumor characteristics. Future studies could evaluate the benefit of pre-operative interventions targeting patients at high risk for early mortality.
Surgical resectability after neo-adjuvant FOLFIRINOX for borderline or locally advanced pancreatic adenocarcinoma.
Authors: Alline Mathias , Colombo Pierre Emmanuel , Quenet François , Jarlier Marta , Portales Fabienne , Llacer Carmen , Fabre Jean Michel , Ychou Marc , Rouanet Philippe 
Published: February 2017

421 Background: FOLFIRINOX has already demonstrated its efficiency in metastatic pancreatic cancer (PC). This combination need to be assessed in a neoadjuvant situation for locally advanced non metastatic PC. Methods: From 2009 to 2013, 31 patients with borderline or locally advanced PC received a neoadjuvant treatment with FOLFIRINOX so as to get them to a resectable situation. According to the tumoral response, chemoradiotherapy with gemcitabine was done. The primary analysis endpoint was the resecability rate. Pathologic response, chemotherapy’s toxicity and surgical morbidity were also evaluated. Results: Among the 31 PC, 17 were borderline resectable and 14 locally advanced according to NCCN classification. 16 (52%) received complete chemotherapy with a median of 4 cycles. Toxicity lead to treatment modification or interruption for 9 patients (29%). Grade 3-4 toxicity occurred in 7 patients (24%). 22 patients (71%) underwent chemoradiotherapy after FOLFIRINOX chemotherapy. 13 patients (42%) had disease progression under treatment whereas 18 patients with objective radiologic response or at least stable disease were surgically explored with a resection completed in 13 cases (42%). Surgical morbidity was controlled with grade 1-2 complications for 9 patients (69%) and no mortality. 11 patients (35%) demonstrated a significant pathologic response. Resected patients had a global survival median of 36 months. Conclusions: FOLFIRINOX in a neoadjuvant setting seems feasible with limited morbidity in locally advanced PC with encouraging resecability and pathologic response rates. Resected patients’ survival is promising but need to be confirmed in larger series.
The oncologic impact of pancreatic fistula after pancreatectomy in patients with pancreatic cancer.
Authors: Kawai Manabu , Murakami Yoshiaki , Hirono Seiko , Okada Ken-Ichi , Motoi Fuyuhiko , Unno Michiaki , Sho Masayuki , Nakajima Yoshiyuki , Uemura Kenichiro , Satoi Sohei , Kwon A-Hon , Matsumoto Ippei , Asari Sadaki , Honda Goro , Kurata Masanao , Yamaue Hiroki 
Published: February 2017

426 Background: There is a few reports that evaluates the association between pancreatic and long-term survival after pancreatectomy in patients with pancreatic cancer. The aim of this study was to elucidate the oncological impact of pancreatic fistula (PF) on long-term survival after pancreatectomy in patients with pancreatic cancer by performing a survey of high volume centers for pancreatic resection in Japan. Methods: Between January 2001 and December 2012, 1,369 patients who underwent pancreatectomy for pancreatic cancer at 7 high-volume centers in Japan were retrospectively reviewed. Results: Pancreatic fistula(PF) occurred in 320 of 1,369 patients (23.5%), and these were classified based ISGPF as follows; grade A in 10.2%, grade B in 10.7%, and grade C in 2.6% of the patients. Median survival time (MST) in no fistula/grade A, grade B and grade C were 24.0, 26.3 and 11.0 months, respectively. MST in grade B PF was similar with that in no fistula/grade A. However, patients with grade C PF had a significantly poorer survival than those without (P<0.001). In the multivariate cox proportional hazard analysis, grade C PF was detected as an independent prognostic factor after pancreatectomy for pancreatic cancer (hazard ratio (HR) 2.15; 95% confidence interval (CI) 1.40-3.29; P< 0.001). Conclusions: Grade C PF adversely affects long-term survival of patients with pancreatic cancer undergoing pancreatectomy, although patients with grade B PF have similar prognosis with no fistula/grade A. Postoperative management to prevent grade C PF is important to improve prognosis in patients with pancreatic cancer undergoing pancreatectomy.
Efficacy trend of hepatic resection for hepatocellular carcinoma with large multinodular tumor or macrovascular invasion.
Authors: Zhong Jian-Hong , Li Le-Qun , Ye Xin-Ping , Ke Yang , Wang Lin , Wu Fei-Xiang , Xiang Bang-De , Ma Liang , You Xue-Mei , Chen Jie 
Published: February 2017

427 Background: Official guidelines and retrospective studies have different view on the role of hepatic resection (HR) for patients with large (≥5 cm) multinodular (≥2) hepatocellular carcinoma (HCC) and those involving macrovascular invasion (MVI). We aim to evaluate the efficacy and its variation trend and the safety of HR for these patients in three tertiary care settings. Methods: A consecutive sample of 1,824 patients with Child-Pugh A liver function and large/multinodular HCC or involving MVI and who underwent initial HR were divided into four groups: large/multinodular HCC of the previous (2000-2004, n = 496) and recent five years (2005-2010, n = 765), involving MVI of the previous (n = 242) and recent five years (n = 321). Results: Among our patient sample, the hospital mortality was less than 5% and had a downward trend. Moreover, patients in recent five years have statistically significant longer survival time. Among patients with large/multinodular HCC, patients in recent five years showed a significantly better overall survival than those in previous five years at 1-year (92% vs. 84%), 3-year (69% vs. 61%), and 5-year (45% vs. 40%) (P = 0.004). Moreover, among patients involving MVI, overall survival in recent five years was significantly higher at 1-year (83% vs. 78%), 3-year (50% vs. 41%), and 5-year (25% vs. 17%) (P= 0.033). However, the disease-free survival of recent five years was only slightly higher than that of the previous five years in the two subgroups. Conclusions: HR offers good overall survival for patients with resectable large/multinodular HCC or those involving MVI and with preserved liver function. Outcomes have tended to improve in recent decade.
Impact of margin status and lymphadenectomy on clinical outcomes in resected pancreatic cancer: Implications for adjuvant radiotherapy.
Authors: Osipov Arsen , Naziri Jason , Hendifar Andrew Eugene , Dhall Deepti , Rutgers Joanne K , Chopra Shefali , Li Quanlin , Annamalai Alagappan , Tighiouart Mourad , Nissen Nicholas N. , Tuli Richard 
Published: February 2017

429 Background: Adjuvant chemoradiotherapy (CRT) in the treatment of pancreatic ductal adenocarcinoma (PDA) is controversial. Minimal data exists regarding the clinical significance of margin clearance distance and lymph node (LN) parameters, such as extent of dissection and LN ratio. We assess the impact of these variables on clinical outcomes to identify the subset of patients who may benefit from adjuvant CRT. Methods: We identified 106 patients with resected stage 1-3 PDA from 2007-13. Resection margins were categorized as positive (tumor at ink), ≤ 1 mm, or > 1 mm. LN evaluation included total number examined (NE), number of positive nodes (NP), ratio of NP to NE (NR), and presence of periportal adenopathy. The impact of these variables was assessed on disease-free survival (DFS) and overall survival (OS) using multivariate cox proportional hazards modeling. Actuarial estimates for DFS and OS were calculated using Kaplan-Meier methods. Results: Margin status was highly correlated with NP (p=0.012). Margin status adjusted for NP was a significant predictor of DFS in patients receiving adjuvant chemotherapy (CT) alone with greater margin clearance leading to improved DFS for all 3 groups (p=0.0412, HR = 0.51). Range of NE was 4-37, with a mean of 19. NE was not associated with DFS or OS, yet absolute NP of 5 or more was associated with a significantly worse DFS (p=0.005). A median NR of 0.11 was associated with inferior DFS (p=0.0043; HR=4.04), but was not associated with OS. Whereas periportal lymphadenectomy did not result in improved DFS or OS, patients with positive periportal LN had worse clinical outcomes (DFS, p=0.0052; OS, p=0.023). The use of adjuvant CRT was associated with improved OS (p=0.049; HR=0.29). Conclusions: In patients receiving adjuvant CT alone, there was a clinically significant benefit in clearing the surgical margin beyond tumor at ink. Higher NR, having 5 or more NP and presence of periportal adenopathy clearly led to worse clinical outcomes. A more comprehensive evaluation of margins and LN parameters may identify an increasing number of patients at risk for locoregional failure who may benefit from adjuvant CRT.
Risks of severe adverse events of docetaxel, cisplatin, and 5-fluorouracil (DCF) combination chemotherapy of esophageal cancer.
Authors: Yuda Sayako , Kato Ken , Sasaki Yusuke , Takahashi Naoki , Shoji Hirokazu , Takashima Atsuo , Okita Natsuko T. , Honma Yoshitaka , Iwasa Satoru , Hamaguchi Tetsuya , Yamada Yasuhide , Nagashina Kengo , Boku Narikazu 
Published: February 2017

43 Background: Although adding docetaxel to cisplatin plus 5-fluorouracil (i.e. the DCF regimen) for esophageal cancer treatment may improve outcomes, this regimen has increased toxicity. However, the risk factors for severe non-hematological toxicities remain unknown. Methods: We analyzed data on esophageal cancer patients given at least one cycle of DCF between July 2009 and April 2014 at the National Cancer Center Hospital, Japan. DCF consisted of docetaxel 70 mg/m2/day (day 1), cisplatin 70 mg/m2/day (day 1), and continuous infusion of 5-fluorouracil 750 mg/m2/day (days 1–5), repeated every 3 weeks. Data on adverse events developing within three cycles were collected from medical records. Risk factors for severe adverse events were analyzed. Results: One hundred patients were enrolled, with a median age of 63 (range, 37 to 76); 81 male and 19 female; 96 squamous cell carcinomas and 4 adenocarcinomas; clinical situation neoadjuvant/induction/palliative: 69/23/8/1; clinical stage I/II/III/IV: 1/12/64/23; and performance status (PS) 0/1/2: 44/55/1. Forty patients (40%) developed grade 3 or more non-hematological adverse events, including anorexia (12%), mucositis (6%), and esophagitis (2%); 45 developed grade 4 hematological adverse events. Seventeen experienced febrile neutropenia (FN). There was one case of treatment-related death from serious infection. In multivariate analysis, age≥63 was at significantly increased risk of FN (P=0.013). Conclusions: DCF chemotherapy was safe in most patients and its toxicity was controllable. However, elderly patients may suffer from intense toxicity during DCF therapy.
A phase II study of 5-FU/l-LV/oxaliplatin (mFOLFOX6) in patients with metastatic or unresectable small bowel adenocarcinoma: A post hoc analysis.
Authors: Funakoshi Taro , Horimatsu Takahiro , Nakayama Norisuke , Moriwaki Toshikazu , Hirashima Yoshinori , Fujita Mikio , Asayama Masako , Moriyama Ichiro , Nakajima Koji , Baba Eishi , Kitamura Hiroshi , Tamura Takao , Hosokawa Ayumu , Muto Manabu 
Published: February 2017

430 Background: Small bowel adenocarcinoma (SBA) is a rare disease. Previous studies suggested several prognostic factors of unresectable SBA, including age, performance status (PS), primary site, resection of primary tumor, histology, and tumor marker (CEA and CA19–9) levels. However, prognostic factors of the patients treated with oxaliplatin–fluoropyrimidine combination therapy were unknown, while these drugs were reported as a promising chemotherapy regimen for SBA. Methods: Previously untreated SBA patients were treated with an mFOLFOX6 regimen, and a post hoc analyses for prognostic factors were performed. Results: Between April 2010 and November 2012, 24 patients were included in this study. The overall response rate was 45% (9/20). The median progression-free survival and overall survival (OS) were 5.4 months (95% CI, 4.8–6.0) and 17.3 months (95% CI, 11.7–19.0), respectively. Univariate analysis revealed that lower PS (HR= 0.27; 95% CI, 0.10–0.77; p= 0.014), primary disease of the jejunum (HR= 0.35; 95% CI, 0.11–1.12; p=0.077), and serum CEA in the normal range (HR= 0.40; 95% CI, 0.14–1.11; p= 0.079) were potential prognostic factors of longer OS (threshold, p< 0.10). Although resection of the primary tumor was not a predictive factor of survival in this study, 54% and 21% of the patients needed surgery (primary resection or bypass) because of stenosis before and during chemotherapy, respectively. It is considered that bowel obstruction should be addressed before and during treatment. Conclusions: PS, primary site, and serum CEA levels are potential prognostic factors of unresectable SBA. There is a higher incidence of bowel stenosis or obstruction caused by the primary tumor before and during the treatment of SBA.
Risk factors associated with overall survival (OS) in recurrent pancreatic adenocarcinoma (PAC) following curative resection (CR).
Authors: Ahn Daniel H. , Ahn Chul , Krishna Kavya , Krishna Somashekar , Muscarella Peter , Bloomston Mark , Bekaii-Saab Tanios S. 
Published: February 2017

437 Background: Patients (pts) with localized pancreas cancer (LPAC) undergo CR with curative intent. Despite improvements in adjuvant treatment (trmt) and surgical techniques, the majority of pts succumb to recurrent disease (dx). The purpose of this study is to identify risk factors associated with OS in pts with recurrent PAC. Methods: Pt clinical and dx data was obtained by a retrospective review of patients with LPAC who underwent CR from 2004-2012 and had recurrent dx. Pts were subdivided into two groups, time to recurrence less/equal or greater than 6 months. Univariate and multivariate Cox regression models were used to determine the association between pt characteristics and OS. Results: 93 pts were identified with recurrent PAC. Select pt characteristics are listed in the Table. In univariate Cox models, only lymph node (LN) status is significantly associated with OS (HR 01.67; p=0.043). OS was 25.6 months (95% CI, 19.4-25.6) for LN positive tumors and 10.6 months (95% CI, 10.6-20.1) for LN negative tumors. In a multivariate Cox model adjusted for pt characteristics, LN status remained significant for OS (HR=1.67; p=0.043). Pts with early recurrent PAC (≤6 month) seem to follow patterns of distant metastatic dx while pts with later recurrence that of locoregional dx. Conclusions: LN involvement is associated with patterns of early recurrence with predominantly metastatic disease and decreased OS in pts with recurrent PAC. LN status may act as a surrogate marker for pattern of recurrence and merit consideration in the selection, stratification and trmt of patients in clinical trials. After CR, LN involvement may influence choice trmt and warrant more aggressive therapy. [Table: see text]
The significance of ascites in patients with pancreatic cancer: A case-control study.
Authors: Pulluri Bhargavi , Kathait Anjaneya , Tsai Hua-Ling , Blackford Amanda L. , Herman Joseph M. , Laheru Daniel A. , Zheng Lei , Le Dung T. , Rasheed Zeshaan , De Jesus-Acosta Ana 
Published: February 2017

445 Background: Malignant ascites confers a poor prognosis in patients with metastatic pancreatic cancer (PC). It is unknown if radiographic ascites in patients with localized disease is a poor prognostic factor and if this finding should be sufficient to avoid upfront local therapies. We aimed to evaluate the survival outcomes of patients with PC and ascites. Methods: Retrospective case control study with overall survival as primary outcome. Eighty newly diagnosed PC patients with ascites (case group) and 80 similar controls without ascites were collected.Cases and controls were matched on age, gender, stage, ECOG performance, surgical treatment, lymph node status and margin status. Overall survival was compared between groups with Cox proportional hazards models by stages, and with a gamma frailty term to account for the correlation between matched pairs on entire cohort. Results: The 80 matched cases included 19 with resectable disease, 9 borderline resectable, 22 locally advanced and 31 with metastatic disease. 29 patients underwent pancreaticoduodenectomy. Table 1 summarizes the overall survival. Ascites patients had higher risk of death compared to patients without ascites (conditional hazard ratio = 1.58 (95% CI: 1.11-2.27), p=0.01). Conclusions: PC patients with ascites have poor overall survival compared to patients without ascites. Even in the setting of resectable disease, survival is similar to patients with advanced disease. This data suggest that all patients with ascites regardless of disease stage should be considered for systemic chemotherapy prior to attempting local treatments. [Table: see text]
Beneficial effects of perioperative chemotherapy for pancreatic cancer.
Authors: Kitago Minoru , Itano Osamu , Shinoda Masahiro , Yagi Hiroshi , Abe Yuta , Hibi Taizo , Kitagawa Yuko 
Published: February 2017

448 Background: We retrospectively assessed the benefits of 5-fluorouracil (5-FU)- and heparin-based portal infusion chemotherapy (PI) combined with systemic administration of mitomycin C (MMC) and cisplatin (CDDP) for 4 weeks following surgery (PI4W). The goal was to determine if this treatment prevented liver metastasis and improved survival for patients with potentially curative resection of pancreatic cancer. Methods: 263 patients who underwent pancreatectomy from January 1985 to December 2013 were treated. Of these cases, 50 patients received portal infusion with 5-FU (250 mg/day) for 2 weeks (PI2W) following surgery (1985 `2001 Group A), while 94 patients received PI4W therapy (250 mg/day of 5-FU with 2,000 IU/day of heparin for 4 weeks, 4 mg MMC on days 6, 13, 20, 27, and 10 mg CDDP on days 7, 14, 21, 28)(2001 `2013 Group B). The remaining 119 patients (Ct) without adjuvant therapy during the perioperative period divided Group A (n=58) and Group B (n=61). Results: The cumulative overall survival rate in the PI2W was significantly higher than those in Ct of Group A. The cumulative overall survival rate in the PI4W also was significantly higher than those in Ct of Group B. Furthermore, in the PI4W group, the rate of liver metastasis is lower than Ct. Conclusions: PI therapy after surgery, especially PI4W, could become a promising adjuvant therapy in patients with potentially curative resection of pancreatic cancer. Clinical trial information: 000002976.
Significance as a recurrence predictor of postoperative neutrophil-lymphocyte ratio in patients with stage II/III gastric cancer: A retrospective study.
Authors: Tanaka Hiroaki , Muguruma Kazuya , Sakurai Katsunobu , Toyokawa Takahiro , Kubo Naoshi , Ohira Masaichi , Hirakawa Kosei 
Published: February 2017

45 Background: Tumor markers such as carcinoembryonic antigen (CEA) and CA 19-9 are both widely used in the follow up of patients with gastric cancer. However, there are no definitive predictive markers for postopetrative recurrence. It has been reported that preoperative neutrophil lymphocyte ratio (NLR) was associated with prognosis of patients with gastrointestinal cancer. The aim of this study was to examine the impact of postoperative NLR on prediction for postoperative recurrence of gastric cancer. Methods: We retrospective reviewed data from 318 patients with Stage II/III gastric cancer who underwent curative surgical resection followed by adjuvant chemotherapy for between 2006 and 2013. Patients treated with preoperative chemotherapy or multiple cancers were excluded. Results: We found 118 recurrent diseases which mainly included 47 cases with peritoneal dissemination, 27 with distant lymph node metastasis and 24 with liver metastasis. Postoperative NLR was calculated every 6 months and the data at the time of recurrence or last survival were used for analysis. In univariate analysis, histological diffuse type, mascroscopical type 4 cancer, regional lymph node metastasis, lymphatic invasion in primary tumor, tumor diameter, elevated CEA or CA19-9, and elevated NLR were associated with poor prognosis. In multivariate analysis, we found that elevated CA19-9 and NLR were independent predictive markers. Increased NLR was associated with diffuse type, peritoneal dissemination, elevated CEA and preoperative NLR but not with adverse effect of adjuvant chemotherapy. Conclusions: The postoperative NLR might be one of the surrogate markers for recurrence after curative surgery for patients with Stage II/III gastric cancer.