bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of effectiveness of FLOT perioperative chemotherapy in resectable locally advanced gastric or esophago-gastric junction cancer in a Kazakhstani population.
Authors: Kerimkulov Altay , Sarina Tomiris , Uskenbayev Talgat , Usipbekov Bayduysen , Umerzakova Bakhtzhan , Kovalchuk Dina , Sipenova Aigerim 
Published: July 2024

e16129 Background: Gastric cancer is the third most common malignancy in Kazakhstan and the second leading cause of cancer-related mortality. Docetaxel, oxaliplatin, leucovorin, and 5-fluorouracil (FLOT) perioperative chemotherapy is widely accepted treatment strategy of locally advanced gastric adenocarcinoma in Western countries. However, radical surgery is a preferable approach in Kazakhstan. The objective of this study was to assess the effectiveness and feasibility of FLOT perioperative chemotherapy in curable locally advanced gastric or esophago-gastric junction cancer. Methods: In this study, we reviewed the retrospective data of patients with locally advanced gastric or esophago-gastric junction cancer, who received FLOT perioperative chemotherapy between January 2020 and December 2022 in single center. To evaluate the effectiveness of treatment, histopathological regression, disease free survival (DFS) and 1- and 3-year overall survival outcomes were analyzed. Results: Total 136 patients with stage II and III with gastric or esophago-gastric junction cancer were treated. Fifty-six patients (41%) received FLOT preoperative chemotherapy. 9% (5) patients couldn’t complete all cycles of chemotherapy due to serious adverse events. Disease progression was observed in 10 (19%) patients after FLOT preoperative chemotherapy. Of the 46 radically operated patients, 5 (11%) had complete or near complete pathology response, 33 (72%) patients had partial response, and 8 (17%) patients had no response for preoperative chemotherapy (p = 0,405). 7 patients had not get adjuvant chemotherapy. Overall, 1- and 3-year survival were 78,6% and 34,9% respectively, disease free survival was 76,8% and 39% respectively. Conclusions: The FLOT perioperative chemotherapy was effective and feasible to administer and might be a standard treatment option among patients with locally advanced gastric or esophago-gastric junction cancer.
Potential impact of malnutrition on patients with hepatocellular carcinoma undergoing liver transplantation: A nationwide analysis.
Authors: Obeidat Adham , Mansour Nour , Mahfouz Ratib , Aldiabat Mohammad 
Published: July 2024

e16233 Background: Hepatocellular carcinoma (HCC) is the sixth most common cancer and the third leading cause of cancer mortality worldwide. Liver transplantation is the ideal treatment for HCC, and the Milan criteria, which has been the international gold standard, provided the opportunity for HCC patients to undergo liver transplantation with favorable outcomes. On the other hand, malnutrition is a prevalent condition, and carries a substantial burden on health and social-care systems. In this study, we aim to look at the potential impact of malnutrition on in-hospital mortality and other outcomes in HCC patients undergoing liver transplantation. Methods: The United States Nationwide Inpatient Sample (NIS) was used to extract hospitalization data of patients admitted between 2016 to 2018. Using ICD10 revision codes, we identified adults with a diagnosis of HCC, with or without cirrhosis, who underwent liver transplantation with concomitant malnutrition. The control group included HCC patients without malnutrition. The primary outcome was the in-hospital mortality. Secondary outcomes included length of stay (LOS), acute kidney injury (AKI) and hyponatremia. Multivariate logistic regression was used to adjust for relevant variables. Results: An estimated 33,321 patients were admitted with HCC during the study period. 503 of them underwent liver transplantation, and of those, 75 patients had the diagnosis of malnutrition. In this group of patients, the mean age was 60.3 years. 30% were females and 60% were Caucasians. When adjusted to other relevant variables, malnutrition was associated with increased in-hospital mortality (OR 2.42; P-value 0.033). It was also associated with increased chance of developing an AKI (OR 1.95; P-value 0.014). Moreover, it was associated with increased LOS (OR 1.18) and increased chance of liver transplant rejection (OR 1.47), however, these were not statistically significant. Other factors associated with increased in-hospital mortality in HCC patients undergoing liver transplantation are described in the table. Conclusions: Malnutrition is a potentially treatable condition, however, when untreated it may contribute to poor health and economic outcomes. In this study, HCC patients with malnutrition who underwent liver transplantation, have an increased chance of in-hospital mortality. Furthermore, they had an increased odds of developing an AKI which in turn can prolong the hospital length of stay and total charges. We recommend that clinicians pay more attention to identify patients with or at increased risk for malnutrition in order to treat and optimize them prior to liver transplantation, and therefore to prevent such complications. [Table: see text]
Treatment duration of adjuvant immune checkpoint inhibitor in hepatocellular carcinoma after curative resection: A prospective cohort study.
Authors: Pan Li-Xin , Su Jia-Yong , Li Le , Fan Xiao-Hui , Ma Liang , Zhong Jian-Hong 
Published: July 2024

e16266 Background: Adjuvant immune checkpoint inhibitors (ICIs) improve the recurrence-free survival for patients with hepatocellular carcinoma (HCC) after hepatic resection. However, the appropriateness of the treatment duration is unknown. This prospective cohort study aims to evaluate the effect of adjuvant ICIs duration in patients with HCC at high risk of recurrence after curative hepatic resection. Methods: Recurrence-free survival, overall survival, and adverse events were compared in patients receiving adjuvant ICIs therapy for more than 6 months or up to 6 months between March 2019 and March 2023. Patients who with HCC recurrence within 6 months after hepatic resection were excluded. Results: Of the 118 patients, 53 (44.9%) received longer than 6 months of adjuvant therapy, 65 (55.1%) received up to 6 months of adjuvant therapy. Recurrence-free and overall survivalwere significantly longer among patients who received longer than 6 months of adjuvant therapy than among those who received up to 6 months adjuvant therapy (HR 0.47, 95%CI 0.24–0.92, P = 0.021; HR 0.28, 95%CI 0.08–0.93, P = 0.045). However, patients who received more than 6 months of adjuvant therapy had a higher rate of adverse events than those who received up to 6 months of adjuvant therapy, especially grade 2 adverse events. Conclusions: Six months of adjuvant ICIs therapy may not be enough, but prolonged adjuvant therapy can significantly increase the incidence of adverse events. This study highlights the need to optimize the duration of adjuvant ICIs after curative resection for HCC in order to minimize risk of not only recurrence but also adverse events.
Neoadjuvant immune-checkpoint blockade therapy combined with TACE for resectable hepatocellular carcinoma with high recurrence risk: A phase II, single-arm clinical trial (MORNING).
Authors: Tan Li , Xu Lixia , Shen Shun-Li , Li Dongming , Hua Yunpeng , Li Shaoqiang , Liang Lijian , He Qiang , Zhou Qi , Xie Wenxuan , Chen Zebin , Wu Jian , Li Jiaping , Fan Wenzhe , Zhuang Wenquan , Chen Lili , Feng Shiting , Peng Sui , Wang Jiping , Kuang Ming 
Published: July 2024

e16267 Background: Prognoses of patients with hepatocellular carcinoma (HCC) remain unsatisfactory due to the high recurrence rate after curative hepatectomy. In this study, we investigated the safety and efficacy of neoadjuvant Cadonilimab (PD-1/CTLA-4, a bi-specific antibody) in combination with transarterial chemoembolization(TACE) for patients with high recurrence risk. Methods: For this phase II, single-centre, single-arm trial, resectable HCC (BCLC stage A/B) participants were enrolled, who should meet at least one of the following high-risk criteria: a) Multiple tumors or satellite lesions (≥2); b) tumor diameter>5cm (single tumor); c) AFP ≥ 400 ug/L; d) Predicted to be positive by the Microvascular invasion prediction model of our center according to preoperative imaging. All of the patients received two cycles of Cadonilimab(10mg/kg, Q3W) after TACE treatment. After resection, patients received additional 12 months of Cadonilimab(10mg/kg, Q3W) in the adjuvant setting. The primary end-point was the major pathologic response (MPR, defined as >90% necrosis of the resected tumour), the secondary endpoints are objective response rate (ORR), one-year recurrence rate and safety. Results: Between Apr 26th, 2023, and Jan 5th, 2024, 19 patients were enrolled, 84.2% of whom were male, with the mean age of 55. 9(47.4%) patients had more than one tumor and 13(68.4%) patients had tumors larger than 5cm. All patients received neoadjuvant TACE and at least one cycle of Cadonilimab. Of the 15 patients underwent successful resection, 7(46.7%) had MPR, while 12(80%) of them had 70% or greater tumour necrosis. 11 patients had partial response and the ORR was 73.3% per mRECIST. Additionally, only one patient received a partial response, while twelve patients maintained stable decease as assessed by RECIST1.1. 19(100%) patients had treatment-related adverse events of any grade during the neoadjuvant treatment period. The most common adverse events of any grade were ALT/AST increase (94.7%), abdominal pain (73.7%) and bilirubin increase (57.9%). 4 patients had grade 3 adverse events, including infusion reaction (2 patients), white blood cell decreased (2 patients) and fever (1 patients). The abdominal pain and fever were more relevant to TACE. No grade 4 or 5 events were observed. Conclusions: Cadonilimab combined with TACE as a neoadjuvant therapy seems to demonstrate safety and promising efficacy. Clinical trial information: NCT05578430 . [Table: see text]
TACE combined with tislelizumab and lenvatinib in the treatment of advanced liver cancer: A real world study.
Authors: Li Bo , Yang Xiaoli , Tang Hao , Qin Shu , Peng Fangyi , Su Song 
Published: July 2024

e16270 Background: The combination of transcatheter arterial chemoembolization (TACE) plus Lenvatinib prolonged progression-free survival (PFS) and overall survival (OS) than Lenvatinib or TACE monotherapy for patients with hepatocellular carcinoma (HCC). This study assessed the efficacy and safety of Lenvatinib plus monoclonal antibody against programmed cell death 1 (anti-PD1) and TACE for patients with advanced HCC. Methods: Pts with advanced HCC who treated with Lenvatinib plus anti-PD1 and TACE were enrolled. Objective response rate (ORR), PFS, disease control rate (DCR) and OS were calculated to assess the antitumor response and the treatment-related adverse events to the safety. Consecutive pts were identified from September 2021 to August 2023.The Patients were included based on the following chief eligibility criteria. After signing the informed consent form, patients received sequential treatment with TACE in combination with Lenvatinib and tislelizumab. The anti-PD1 were recommended to be used continually every 3 weeks until disease progression, or intolerable toxicity. Lenvatinib was recommended to be used continually every day until disease progression, or intolerable toxicity. Follow up TACE should be given according to the patient's condition, no more than 3 times. Results: Between Sep. 2021 to Aug. 2023, 45 were enrolled. All pts received at least one dose of study treatment. The median age was 56 years(range34,73), 4 of the pts are BCLC-B stage, 41 of the pts are BCLC-C stage.Progression occurred in 8 of 45 patients and 14 patients died. The median PFS was 13.4 months (95% CI: 10.9-15.8 months) and the median OS was 20 months (95% CI: 9.8-30.4months). Of the 45 patients, a total of 3 (6.7%) patients achieved complete response (CR), and these 3 patients were treated with surgical resection. Partial Response (PR) was achieved in 12 patients (20%), Stable Disease (SD) in 22 pts (33.3%), Progressive Disease (PD) in 8 pts (17.8%), and Objective Response Rate (ORR) in patients. The Objective Response Rate (ORR) was 33.3% and the Disease Control Rate (DCR) was 82.2%.Treatment-related adverse events included increased AST 44.4%(20/45), increased ALT 51.1%(23), increased total bilirubin 42.2%(19/45), rash 44.4%(20/45), pruritus 42.2%(19/45), gastrointestinal reaction 33.3%(15/45), abdominal pain 24.4%(11/45), sensory abnormality 20%(9/45), and arthralgias 4.4%(2/45), etc., and Grade 3 Adverse events were increased ALT 2.2%(1/45), increased AST 4.4%(2/45), increased total bilirubin 2.2%(1/45), rash 2.2%(1/45), and gastrointestinal reaction 2.2%(1/45).No grade 4 or above adverse events occurred. Conclusions: In this study, TACE plus anti-PD1 and targeted therapies showed favorable efficacy and manageability in patients with advanced HCC. Toxicity was manageable with a low incidence of grade 3-4 adverse events. There were no unexpected safety signals.
Laparoscopic versus open hepatectomy for hepatocellular carcinoma following conversion therapy: A systematic review and meta-analysis.
Authors: Lech Gabriele Eckerdt , Viana Patricia , Silva Raquel Oliveira de Sousa , Melão Bárbara , De Paiva Reis Camila Mariana de Paiva , Neto Edgar Paulo da Silva , Freitas João Luís Reis , Morriello Rafael 
Published: July 2024

e16272 Background: Conversion therapy for hepatocellular carcinoma (HCC) has emerged as a novel strategy allowing patients with previously unresectable HCC to transition to a resectable disease through a combination of therapies. Laparoscopic hepatectomy is associated with reduced blood loss and early recovery without compromising oncological results in cirrhotic patients. However, the specific benefits of laparoscopic hepatectomy in patients who have undergone conversion therapy are not clear. Methods: We searched PubMed, Embase, and Cochrane Central for any studies that compared laparoscopic versus open hepatectomy after the use of conversion therapy (transarterial chemoembolization, portal vein embolization, hepatic arterial infusion chemotherapy, or liver ablation) in patients with hepatocellular carcinoma. The outcomes of interest were length of hospital stay, blood loss, operative time, pedicle clamping, postoperative complications, and transfusion. Statistical analysis was performed using R statistical software 4.2.1. Heterogeneity was assessed with I². Results: We included 535 patients from 4 retrospective nonrandomized studies. The mean age in the laparoscopic group was 60.33, ranging from 29 to 83. Length of hospital stay was significantly reduced in the laparoscopic group (MD -5.01; 95% CI -9.76–-0.27; p = 0.04; I² = 92%), as well as the blood loss (MD -97.26; 95% CI -200.54–6.01; p = 0.06; I² = 76%). Postoperative complications also favored the laparoscopic group (OR 0.40; 95% CI 0.17–0.94; p = 0.035; I² = 0%). The endpoints of pedicle clamping (OR 0.7; 95% CI 0.11–4.36; p = 0.70; I² = 91%), transfusion (OR 0.69; 95% CI 0.36–1.33; p = 0.273; I² = 0%), and operative time (MD 34.21; 95% CI -36.68–105.10; p = 0.34; I² = 97%) did not favor any of the groups. Conclusions: In this meta-analysis, laparoscopic hepatectomy after conversion therapy was proven to be safe and feasible, without significant differences compared to open hepatectomy regarding pedicle clamping, transfusion, and operative time. Furthermore, the laparoscopic group presented less blood loss and a significantly reduced length of hospital stay. These findings suggest that laparoscopic resection could be safely used after conversion therapy and may improve surgical outcomes in these patients.
Longitudinal survival and complete tumor resection rates in Native American patients with hepatocellular carcinoma treated at academic institutions.
Authors: Becken Aidan John , Murugan Vikram , Bine Christopher Reese , Silberstein Peter T. 
Published: July 2024

e16281 Background: Hepatocellular carcinoma (HCC) is the prevailing type of primary liver cancer, exhibited at a higher frequency in individuals afflicted by chronic liver conditions, notably cirrhosis induced by hepatitis B or hepatitis C infection. Past literature has demonstrated the impact certain socioeconomic factors (eg. race, occupation, place of residence) have on the prognosis of HCC, however the analysis of facility types where treatment was received in relation to HCC has yet to be further examined. Historically, Native American patients have exhibited a higher incidence of advanced-stage cancers at the time of diagnosis compared to white counterparts and experience the lowest cancer survival rates among all racial and ethnic groups. Using the NCDB, this study analyzed the relationship between the facility type where care was received and survival in Native American patients with HCC. Methods: The National Cancer Database (NCDB) was used to identify Native American patients diagnosed with Hepatocellular Carcinoma from 2004 to 2019 using the histology code 8170 and race code 03 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA Chi-Square, and Cox Proportional Hazards tests were performed. Data was analyzed using SPSS version 27 and statistical significance was set at α = 0.05. Results: Of 1186 Native American patients included in the sample, 697 (45%) received treatment at an academic facility. Native American patients treated at academic facilities experienced greater survival as compared to those who were treated at nonacademic facilities (52 months vs 30 months, p < 0.05). When controlling for age, year of diagnosis, surgical status, income bracket and surgical margins, receiving care at an academic facility was associated with an independent decrease in hazard (HR = 0.403; p < 0.05). Native American patients who went to an academic facility were more likely present with Stage I and II tumors, receive surgery, have no residual tumor after surgery and have private insurance (p < 0.05). Nonacademic facility patients, on the other hand, were more likely to present with Stage III and IV tumors, poorly differentiated and undifferentiated tumors, and have bone, brain, liver and lung metastases (p < 0.05). No differences were seen in Charlson-Deyo score, adjuvant therapy type, or same hospital readmission within thirty days of hospital discharge. Conclusions: This study found that Native American patients with HCC who received treatment at academic facilities experienced improved overall survival. These results follow previous trends, wherein academic institutions may offer more specialized care or a greater spectrum of services that yield improved patient outcomes. Further research can explore other treatment differences that Native American HCC patients face and elucidate the cause of the disparity described here.
Predictors of malignancy and survival in patients with pheochromocytoma and paraganglioma.
Authors: Gonzalez-Sanchez Hector Raul , Aranda-Gutierrez Alejandro , Meraz-Brenez Andres , Verduzco-Aguirre Haydee Cristina , De la Peña-Lopez Roberto 
Published: July 2024

e16289 Background: Pheochromocytomas (PCC) and paragangliomas (PGL) are rare neuroendocrine tumors for which the definitive diagnosis of malignancy hinges on the detection of metastatic disease, rather than histological features, making prognostication particularly challenging. Consequently, identifying reliable clinical predictors for both malignancy and survival is of utmost importance. Methods: We retrospectively analyzed records of patients with biopsy-proven PCC or PGL treated at a single center in Mexico City from 2008 to 2022. Patients with follow-up > =12 months were eligible. Data was collected from electronic medical records. Independent-samples T-test and X2 and Fisher’s exact tests were used to evaluate associations between variables. We used the Kaplan-Meier method to calculate disease-free survival (DFS) and overall survival (OS) rates, and utilized the log-rank test to compare these outcomes across clinicopathological features. Cox regression analysis was used to determine survival hazard ratios (HR). Results: Among 60 patients, the mean age at diagnosis was 41 years, 37 (62%) had PCC, and 12 (20%) had malignant disease (6 distant recurrences and 6 de novo metastatic cases). Clinicopathological features according to disease type (i.e. benign or malignant) are shown in Table 1. Patients with malignant disease were more likely to have PGL (67% vs. 31%, p = 0.024) and have a body mass index of > =30 kg/m2 at diagnosis (67% vs. 8%, p < 0.01). With a median follow-up of 42 months (95% CI 35-49), 8 recurrences (2 local and 6 distant) and 6 deaths were recorded, yielding 3-year DFS and OS rates of 92% and 91%, respectively. In a multivariate analysis including factors associated with DFS and OS in univariate analyses (i.e. obesity status and hypertension at diagnosis), only obesity (HR 4.93, 95% CI 1.02 - 23.79; p = 0.047) remained associated with a worse DFS, with no influence on OS. Conclusions: This study highlights obesity as a significant predictor of malignancy and recurrence in patients with PCC and PGL, marking a novel finding in the literature on these tumors. Further research is warranted to explore the underlying mechanisms linking obesity with more aggressive disease in PCC and PGL. [Table: see text]
Impact of bowel ischemia on mortality in gastrointestinal malignancies: A nationwide analysis.
Authors: Polpichai Natchaya , Saowapa Sakditad , Wattanachayakul Phuuwadith , Jaroenlapnopparat Aunchalee , Abdalla Monzer , Lopimpisuth Chawin , Sirachainan Ekaphop 
Published: July 2024

e16370 Background: Bowel ischemia, characterized by reduced blood supply to the gastrointestinal (GI) tract, critically influences the pathogenesis and outcomes of GI malignancies through complex interactions involving vascular compromise, tumor biology, and systemic consequences. Despite this, the link between bowel ischemia and increased mortality in GI cancers remains unknown. This study aims to evaluate the impact of bowel ischemia on in-hospital mortality in GI cancer patients in the United States. Methods: This retrospective analysis utilized the 2016-2020 National Inpatient Survey (NIS) database. Adults aged 18 and above with esophageal, gastric, colon, cholangiocarcinoma, hepatocellular carcinoma, and pancreatic cancers were identified using the International Classification of Disease-10 (ICD-10) code. The cohort was stratified into patients with and without bowel ischemia. Hospital mortality was analyzed using STATA 18, adjusting for age, gender, race, insurance, Charlson’s index, baseline hospital characteristics, and comorbidities. Multivariate logistic regression analysis was performed, with all P values ≤ 0.05 considered statistically significant. Results: Among 2,133,465 adults with GI malignancies, 3,240 were hospitalized with bowel ischemia. Patients with bowel ischemia were older (mean age 68.10 vs. 67.07 years, P = 0.033), predominantly from the Southern region (33.49%, P = 0.019), and urban and teaching hospitals (76.83%; P = 0.006). Bowel ischemia was most associated with Pancreatic cancer (37.35%), Colon cancer (35.49%), and Hepatocellular carcinoma (11.57%). Within the cohort of patients with bowel ischemia, gastric cancer patients had the highest mortality rates of 45.83%. After adjusting for potential confounders, patients with gastric, esophageal, colon, and pancreatic cancers had significantly higher odds of in-hospital mortality of 11.90, 6.45, 4.14, 4.08, and 2.71, respectively. Conclusions: This study reveals an association between outcomes in hospitalized GI cancer patients and bowel ischemia, leading to increased mortality despite adjusting for potential confounders. Bowel ischemia significantly heightens the mortality risk in GI cancers through impaired nutrient and oxygen delivery, enhanced tumor aggressiveness, systemic inflammation, immune suppression, and compromised treatment efficacy. Understanding the intricate interplay between vascular compromise and cancer biology is crucial to improving patient care and outcomes in the face of these challenging malignancies.