bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identification of educational gaps among oncologists who treat patients with pancreatic cancer.
Authors: Barnes Justin A , Ellis Melissa L , Hwang Sharon , Musher Benjamin Leon , Emarine Joan , Merwin Patti A. , Salinas Gregory D 
Published: March 2017

431 Background: Pancreatic ductal adenocarcinoma (PDA) is the fourth-most common cause of cancer-related death in the United States, with only 7.7% of patients surviving beyond 5 years. Given the poor outcomes associated with PDA, it is imperative that patients with PDA receive optimal care. Continuing medical education (CME) offers an effective means to improve physician performance, and CME programs are most effective when they address areas of greatest need. This study was conducted to identify and quantify the educational gaps in PDA management that can potentially be addressed with CME. Methods: A case-vignette survey instrument was developed to assess physicians’ practices related to PDA. Case vignettes are a validated means of assessing healthcare provider practice patterns. The survey instrument included three patient cases: 1) A 50 year-old man with resectable PDA; 2) a 75 year-old man with locally advanced, unresectable PDA; and 3) a 55 year-old woman with metastatic PDA. Each case was followed by a series of questions designed to assess medical decision-making, physician/patient communication, and barriers to optimal practice. Results: Survey responses were collected from 150 US oncologists in July 2016 (19% at academic centers). Several key educational gaps were identified. For Case 1, 44% of oncologists did not select an evidence-based adjuvant chemotherapy regimen from a list of options. For Case 2, in which the patient had developed metastases and neuropathy after first-line therapy, 57% of respondents did not select an evidence-based second-line option, and 35% selected a regimen with oxaliplatin. For Case 3, only 18% of oncologists recommended an initial diagnostic evaluation that included a biopsy, chest imaging, and liver function tests. Finally, for all 3 cases, little emphasis was placed on enrolling patients in clinical trials. Conclusions: This study identified appreciable discrepancies between respondents’ recommendations and standard evidence-based guidelines for treating all stages of PDA. Well-designed CME programs may help bridge the educational gaps among practicing oncologists and ultimately improve adherence to national guidelines.
Establishment of disease-specific graded prognostic assessment for patients with hepatocellular carcinoma and spinal metastasis.
Authors: Rim Chai Hong , Choi Chiwhan , Choi Jinhyun , Seong Jinsil 
Published: March 2017

433 Background: Spinal metastasis (SM) of hepatocellular carcinoma (HCC) is a crucial clinical problem. It shows heterogenous length of survival suggesting a need for predicting prognosis. In this study, we aimed to develop and propose a graded prognostic assessment of SM of HCC (HCC-SM GPA). Methods: We previously reported the outcomes of 192 HCC patients with SM who received radiotherapy from April 1992 to February 2012. Prognostic factors with significant effects on survival in that study were used to establish the HCC-SM GPA. Validation was performed using an independent cohort of 63 patients recruited from September 2011 to March 2016. Results: We developed HCC-SM GPA using the following factors: Eastern Cooperative Oncology Group performance status ( < 2: 0, > 3: 1 point), controlled primary HCC (Yes: 0, No: 2 points), and extrahepatic metastases other than bone (No: 0, Yes: 1 points). Patients were stratified into low (GPA = 0), intermediate (GPA = 1–2), and high risk (GPA = 3–4). When applied to the validation cohort, the HCC-SM GPA determined median survival durations of 13.6, 4.8, and 2.6 months and 1-year overall survival rates of 58.3%, 8.9%, and 7.3% for the low-, intermediate-, and high-risk patient groups, respectively (p < 0.001). Conclusions: Our newly proposed HCC-SM GPA successfully predicted survival outcome. This index might be a useful tool for making treatment decision.
The effects of resident participation on patient morbidity and mortality in major gastrointestinal oncologic surgery.
Authors: Bellini Geoffrey , Teng Annabelle , Lee David Y , Rose Keith 
Published: March 2017

437 Background: While the effects of resident participation have been documented in various studies, there has yet to be a comprehensive study analyzing resident participation in overall gastrointestinal (GI) oncologic surgery. The aim of this study was to compare outcomes in major GI oncologic cases performed by an attending alone and those performed by an attending and resident. Methods: The ACS-NSQIP database from 2005-12 was utilized to study major (GI) operations (esophagectomy, gastrectomy, pancreatectomy, enterectomy, hepatectomy, and colectomy/proctectomy) in patients with an ICD-9 cancer diagnosis. Major complications and 30-day mortality were then compared in those patients who underwent surgery with an attending alone (AA) to those patients who underwent surgery with an attending and resident (AR). Results: A total of 64,637 patients met criteria for the study; AR n = 48,022 and AA n = 16,615. In 76.6% of AR cases, the resident assistance was classified as senior level PGY-4 or higher. On average, operative time was significantly increased in AR cases compared to AA cases (228 ± 130 vs 163 ± 104 min, p < 0.001). On multivariate analysis, AR cases were more likely to develop superficial incisional infection (OR 1.3, CI 95% 1.2-1.4, p < 0.001) and urinary tract infection (OR 1.2, CI 95%, 1.1-1.4, p < 0.001) compared to AA cases. However, on multivariate analysis, resident participation was associated with less likelihood of returning to the operating room (OR 0.9, 95% CI 0.8-0.9, p < 0.001) and lower mortality (OR 0.7, CI 95% 0.6-0.8, p < 0.001). Conclusions: The majority of major GI oncologic operations in the NSQIP database are performed by an attending with the assistance of a senior level resident. This may be due to the complex nature of GI oncologic operation. Potentially, operative time in cases with resident participation may be increased by teaching or by the complex nature of the operation due to the referral bias to teaching centers. However, even with potentially more complex operations, there was less mortality in cases performed by a resident and an attending.
Incidence and prognostic significance of extramural venous invasion in T3-4 esophageal cancer.
Authors: Faiz Zohra , Huijgen Lotte , Alqethami Hanadi , Kats-Ugurlu Gursah , Plukker John Theodorus 
Published: March 2017

44 Background: Extra mural venous invasion (EMVI) is known as an adverse prognostic indicator of survival and an important predictor of systemic recurrences in colorectal carcinoma. However, the incidence and significance of EMVI in esophageal cancer (EC) have not been studied well. Aim: To estimate the incidence and the prognostic significance of EMVI in pathological stage T3-4 EC resection specimens without neoadjuvant chemoradiotherapy (nCRT) Methods: From a prospective maintained database we retrospectively review the resected specimens of patients with an EC. For adequate EMVI assessment we only included patients without nCRT and excluded patients without previous malignancies and patients with cardia/gastroesophageal junction tumors. A total of 76 patients were included between 2000 and 2012. EMVI was assessed on haematoxylin and eosin slides and for confirmation additional Elastica van Gieson staining was performed. Disease free survival was analyzed using a multivariable logistic regression and Kaplan-Meier method. Results: Evidence of EMVI was found in 18 patients (23.7%). The incidence of EMVI was significantly higher in squamous cell carcinomas (p < 0.05) and among tumors located in the mid-esophagus (p < 0.05). In the univariate analysis, pathological N- stage (HR 3.6 95%Cl: 1.5-8.5; p = 0.004) and positive circumferential resection margin (CRM) (HR 2.3 95% Cl: 1.2-4.5 p = 0.015) were independent prognostic factors. By stepwise multivariate Cox regression analysis, pathological tumor length (HR 2.5 95%Cl: 1.0-6.5 p = 0.05), pathological N- stage (HR 2.7 95%Cl: 1.3-6.2 p = 0.008), positive CRM (HR 2.3 95% Cl: 1.2-4.5 p = 0.009) and EMVI (HR 2.2 95% Cl: 1.0-4.5 p = 0.04) were shown to be independent prognostic factors for disease free survival. Conclusions: A search for EMVI may provide additional prognostic information in esophageal cancer, especially in squamous cell carcinoma.
Should functional renal scans be obtained prior to upper abdominal radiation for pancreatic cancer?
Authors: Blitzer Grace , Tsai Susan , Aldakkak Mohammed , Hellman Robert , Evans Douglas B. , Christians Kathleen K. , George Ben , Ritch Paul S. , Hall William Adrian , Erickson Beth 
Published: March 2017

442 Background: Upper abdominal irradiation for pancreas cancer is given in close proximity to the radiation sensitive kidneys. While contemporary 3D and intensity modulated radiation therapy (IMRT) can decrease the total dose of radiation delivered to the kidneys; these plans may potentially exceed the established kidney dose constraints, especially if one kidney is providing most of the renal function. Less than 10% of the general population is estimated to have asymmetrical kidney function. Functional kidney scans using MAG3 clearance can give information about the contribution of each kidney to total renal function. We sought to determine if functional renal scans should be used to identify patients with occult renal dysfunction. Methods: Patients with resectable and borderline resectable pancreatic cancer who received abdominal irradiation therapy and had pre-radiation functional renal scans between 2009-2015 were studied. Asymmetrical kidney function was defined as a difference between the two kidneys that was ≥ 40%/60% on a functional renal scan. Serum studies (BUN, Cr, GFR) were routinely obtained pre-simulation. Restaging abdominal CT scans prior to radiation were screened for disparity in kidney size. Medical history that suggested decreased renal function was also collected. Results: Of the 205 patients examined, 24 (11.7%) had asymmetrical kidney function identified on pre-radiation functional renal scans. Of the patients with asymmetrical kidney function, 4 (2%) had a 75%/25% split or greater and 20 (9.7%) had kidney function between 60%/40% and 75%/25%. Elevated Cr or BUN, a GFR < 60, or a past medical history suggesting abnormal renal function were not significantly associated with asymmetrical kidney function. Only six (25%) of patients with asymmetrical kidney function scans had a notable difference in kidney size. Conclusions: In our series, approximately 12% of patients with pancreatic cancer have asymmetrical kidney function not identified by size, serum BUN, Cr, GFR, or a significant past medical history of renal compromise. These results provide important insight for cases when radiation plans may approach or exceed accepted dose constraints for the kidneys.
Ovarian metastasis from midgut neuroendocrine tumors: Incidence, clinical implications, and management options—An update.
Authors: Chauhan Aman , Anthony Lowell Brian , Beyer David T , Wang Yi-Zarn 
Published: March 2017

446 Background: Midgut neuroendocrine tumors (NETs) are rare malignancies that can produce carcinoid syndrome and/or carcinoid heart disease. The incidence of ovarian metastasis, their clinical implications, and the optimal management strategy for these metastasis have not been well studied. We hypothesized that patients with ovarian metastasis will have a high incidence of carcinoid syndrome and carcinoid heart disease. Methods: Charts of 431 female patients seen in our NET clinic between October 2006 and December 2014 with a diagnosis of midgut NET were reviewed. Patients who had a previous bilateral oophorectomy with or without total abdominal hysterectomy were excluded. The incidence of ovarian metastasis, carcinoid syndrome and carcinoid heart disease was calculated. Median survival and 5-year survival rates were determined via the Kaplan-Meier Method. Results: Forty-one (41/431, 10%) patients were found to have ovarian metastasis. Twenty-four (24/41, 59%) patients exhibited carcinoid syndrome and three (3/24, 13%) patients with carcinoid syndrome developed carcinoid-related heart disease. 5-year survival rates for the patients with and without ovarian metastasis were 92% and 87%, respectively. Conclusions: Ovarian metastasis was found in 10% patients with metastatic midgut NET. Fifty-nine percent of these patients exhibited carcinoid syndrome and thirteen percent of which developed carcinoid heart disease, in spite of aggressive somatostatin analog therapy. To improve quality of life, routine therapeutic or prophylactic oophorectomy is recommended for female patients undergoing cytoreductive surgery for their midgut NET, especially for those who are peri- or post-menopausal.
Efficacy of S-1 compared to modified FOLFIRINOX as second-line chemotherapy regimens after gemcitabine plus nab-paclitaxel for patients with metastatic pancreatic cancer.
Authors: Kimura Gen , Takahashi Hideaki , Umemoto Kumiko , Watanabe Kazuo , Sasaki Mitsuhito , Hashimoto Yusuke , Imaoka Hiroshi , Ohno Izumi , Mitsunaga Shuichi , Ikeda Masafumi 
Published: March 2017

449 Background: Recently, gemcitabine (GEM) plus nab-paclitaxel (nab-PTX) has been frequently used as a first-line chemotherapy regimen for the treatment of metastatic pancreatic cancer (mPC) in Japan. Nanoliposomal irinotecan combined with 5-fluorouracil and leucovorin (MM-398 plus 5FU/LV) has not yet been approved in Japan. Under these circumstances, a modified FOLFIRINOX (mFFX) regimen or S-1 is commonly used as a second-line chemotherapy regimen for patients with mPC after GEM plus nab-PTX has failed. Methods: Between December 2014 and March 2016, 45 patients with mPC received second-line chemotherapy after the failure of GEM plus nab-PTX (standard dose regimen) at the National Cancer Center Hospital East. Twenty-two patients received mFFX (irinotecan, 150 mg/m2; bolus of 5FU was eliminated), 19 received S-1 (80 mg/m2/d; d1-28, q6w or d1-14, q3w), and 4 received other chemotherapy regimens. The clinical records of the patients were reviewed retrospectively. Results: At baseline, S-1 group had a more severe disease status than the mFFX group (performance status of 0: 21% vs. 68%, P = 0.003; median CA19-9 level: 1832 vs. 577 U/mL, P = 0.30). No significant difference in the response rate (S-1, 5.3% vs. mFFX, 9.1%, P = 0.56) or the disease control rate (S-1, 42% vs. mFFX, 36%, P = 0.71) was seen between the two groups. The progression free survival (PFS) (median: S-1 vs. mFFX: 2.7 vs. 2.4 months (m), P = 0.77), the overall survival (OS) from the second-line treatment (median: 6.1 vs. 6.4m, P = 0.87) and the OS from the first-line treatment (median: 10.9 vs. 12.4m, P = 0.77) were not significantly different between the two groups. These results were similar to those observed for MM-398 plus 5FU/LV (PFS, 3.1m; OS, 6.1m) in a pivotal Phase III study (NAPOLI-1). The incidences of peripheral neuropathy (5.3% vs. 32%, P = 0.04), fatigue (11% vs. 50%, P = 0.007), and neutropenia (11% vs. 64%, P = 0.001) were significantly lower in the S-1 group. Conclusions: S-1 was less toxic than mFFX and exerted a similar anti-tumor effect in the present study. S-1 could be a treatment option for patients with mPC refractory to GEM plus nab-PTX.
Optimal indications for chemotherapy in elderly patients with unresectable pancreatic cancer.
Authors: Nakazuru Shoichi , Nakamori Shoji , Kato Seiya , Shoji Ayaka , Kiyota Ryosuke , Shinkai Kazuma , Tashiro Taku , Nakagawa Kentaro , Ishida Hisashi , Mita Eiji 
Published: March 2017

450 Background: Pancreatic cancer is seen predominantly in elderly patients. Since many patients with pancreatic cancer have locally advanced unresectable tumors or distant metastases at diagnosis, they require chemotherapy. However, it is difficult to appropriately select elderly patients who are likely to benefit from chemotherapy. This study aimed to identify prognostic factors for elderly patients with unresectable pancreatic cancer treated with chemotherapy. Methods: We retrospectively analyzed the data of 191 patients with pancreatic cancer, aged ≥ 70 years, who had been diagnosed at our hospital between January 2006 and August 2016. Their overall survival (OS) was calculated using Kaplan-Meyer analysis. Prognostic factors were evaluated using Cox regression analysis. Results: Of the 191 patients, 52 patients with unresectable pancreatic cancer were treated with chemotherapy. Their median age was 76.5 years (range, 70–85 years). Twenty-two patients (42%) were men, and 44 (85%) had metastatic disease. Forty-one (79%) and 11 (21%) patients had ECOG performance status (PS) 0–1 and 2–3, respectively. Thirty-eight (73%), 10 (19%), and 4 (8%) patients received gemcitabine, gemcitabine-based combination regimens, and S-1, respectively, as first-line chemotherapy. The median OS was 219 days (range, 7–920 days). On univariate analysis, ECOG PS ≥ 2 (hazard ratio [HR], 4.37; P = 0.0005), carcinoembryonic antigen ≥ 10 ng/mL (HR, 2.32; P = 0.0162), serum AST ≥ 30 U/L (HR, 2.02; P = 0.0263), serum albumin < 3.0 g/dL (HR, 2.38; P = 0.0247), serum C-reactive protein ≥ 0.5 mg/dL (HR, 2.21; P = 0.0140), neutrophil-to-lymphocyte ratio ≥ 5.0 (HR, 3.25; P = 0.0066), and presence of ascites on computed tomography (CT) scans (HR, 3.02; P = 0.0016) were significantly associated with shorter survival times. On multivariate analysis, ECOG PS ≥ 2 (HR, 5.49; 95% confidence interval [CI], 2.18–13.32; P = 0.0005) and presence of ascites on CT scans (HR, 2.53; 95% CI, 1.20–5.24; P = 0.0148) were associated with poor OS. Conclusions: Elderly patients with unresectable pancreatic cancer who have a good performance status and do not show ascites on CT scans are likely to benefit from chemotherapy.
Role of lymph node dissection for intrahepatic cholangiocarcinoma.
Authors: Hibi Taizo , Takemura Yusuke , Itano Osamu , Shinoda Masahiro , Kitago Minoru , Abe Yuta , Yagi Hiroshi , Kitagawa Yuko 
Published: March 2017

457 Background: The prognosis of intrahepatic cholangiocarcinoma (ICC) with lymph node metastases is dismal. Recent studies have highlighted the importance of lymph node retrieval from disease staging and therapeutic standpoints. To define the role of lymph node dissection for ICC, this study aimed to evaluate the patterns of lymph node metastases and their prognostic implication. Methods: A retrospective cohort analysis was conducted for 56 consecutive patients who underwent R0/R1 resection for ICC between 1990 and 2015. In principle, lymph nodes in the hepatic hilum and around the pancreas head were systematically removed. For left-sided tumors, lymph nodes in the lesser curvature of the stomach and the root of left gastric artery were also dissected. Clinicopathologic predictors of 3-year survival were identified by Cox multivariate analyses. Lymph node mapping was performed and positive nodes were classified into 3 compartments based on metastatic rates and prognoses. Results: Median tumor size, 4.5 (1.5–16.0) cm; Mass-forming and its dominant type, 42 (75%); R0 resection, 47 (84%). Nineteen (34%) patients had lymph node metastases. After excluding 4 in-hospital deaths, the overall and recurrence-free survival rates at 3 years were 66% and 33%, respectively (median follow-up, 36 months). Cox multivariate analysis revealed lymph node metastases [hazard ratio (HR) 6.3, 95% confidence interval (CI) 1.9-21.7, P = 0.003] and R1 resection (HR 7.8, 95% CI 1.6-38.3, P = 0.01) as independent negative predictors of overall survival. Patients with ≥ 4 positive nodes ( n = 7) had significantly decreased survival compared with those with 1–3 positive nodes ( n = 10, P= 0.005). Metastatic lymph nodes were classified into compartments I (metastatic rates ≥ 10% and longest survival ≥ 3 years), II (5%–10% and 1-year survival ≥ 50%), and III ( < 5% and 1-year survival < 50%). Lymph nodes in the suprapyloric area, celiac trunk, and paraaorta belonged to compartment III and appeared less important to be dissected. Conclusions: Systematic lymph node dissection for ICC based on tumor location provides accurate staging and may prolong survival in patients with limited number of positive nodes. Compartment classification is useful to determine the extent of dissection.
Characteristics and treatment patterns of elderly patients with biliary tract cancers.
Authors: Yang Ji Hyun , Kim In-Ho , Jeong Joon Won , Ro Sang Mi , Lee Myung Ah 
Published: March 2017

459 Background: Biliary tract cancers do not respond well to multipmodal treatment and generally show poor prognosis, and this may be a reason to make elderly patient consider best supportive care only. Methods: We reviewed 108 elderly patients of 80 years of age or older who diagnosed as biliary tract cancers from 2008 to 2014 at Seoul St. Mary's Hospital, Korea. Results: The mean age was 83.76 years ranging from 80 to 100. The patients included 24 intrahepatic(22.2%), 17 common bile duct(15.7%), 21 perihilar(19.4%), 37 gall bladder(34.3%), and 9 Ampulla of Vater(8.3%) cancers. 47 patients (43.5%) was initially resectable and 19(40.4%) of them underwent curative surgery, 17(36.2%) had percutaneous or endoscopic biliay drainage, and 11(23.4%) had best supportive care only. Mean survival was 29.8 months, 15.1 months, and 12 months, following the above treatment, respectively(p = 0.004). The mean hospitalized time for the curatively resected patients was 9.8 days. One died of traumatic SAH after surgery, 2 underwent adjuvant chemotherapy, and 10 experienced recurrence. Unresectable patients included 13 (12%) with locally advanced disease and 48 (44.4%) with distant metastasis. Among them, 4(6.6%) received palliative radiotherapy or chemotherapy, 30(49.2%) had biliary drainage, and 27(44.3%) had just best supportive care. Mean survival was 10.2 months, 7.3 months, and 3.6 months, respectively(p = 0.109). One with radiotherapy did not completed his treatment course due to intolerance. Three received chemotherapy with dose reduction from 75% to 70% considering their old age and poor performance status. Among those patients, 1 patient with stage IV intrahepatic cholangiocarcinoma showed partial response at 1st line of chemotherapy and had received totally 3 lines of chemotherapy. He survived 16.4 months. Conclusions: Elderly patients with early stage cancers who undewent curative resection and some selected advanced stage patients with palliative chemotherapy showed good response and survival improvement. There should be careful decision making for the management for geriatric biliary tract cancer patients and further investigations are needed to find more predictive factors.