bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of palliative treatment modalities among patients with colon cancer: A review of NCDB Database.
Authors: Jafry Baqir , Buhaya Munir , Kazmi Syed Mohammad Ali 
Published: January 2024

220 Background: Among colon cancer patients some patients present with significant symptom burden needing upfront palliation-directed therapies, aimed to improve the quality of life of patients with severe illnesses. These include palliation-directed surgery, chemotherapy, radiation, pain management, or a combination of these. The extent to which these palliation-directed therapies are utilized in colon cancer remains under-explored. This study's purpose was to understand the trends in utilization and factors associated with palliation-directed treatment modalities among patients with colon cancer. Methods: From the National Cancer Database, we identified patients with colon cancer who received first-line palliation-directed therapies from 2004 to 2016 without an intent to give definitive therapy. We evaluated the use of these treatments over time and compared frequencies of categorical variables using Chi square tests. A multivariate logistic regression was also used to evaluate patient characteristics associated with the use of these treatments. Results: We identified a total of 21,516 patients receiving palliation-directed therapy among patients with colon cancer – 19,506 received single palliation-directed therapy, 908 received a combination of palliation-directed treatments without pain management and 1102 received a combination of palliation-directed treatments with pain management. Of the 21,516 patients who received single palliation-directed treatments, 50.6% and 49.4% were male and female, respectively. The mean age was 67 years. Most patients had no existing comorbidities (68.7%), lived in metropolitan areas (81.6%), had grade 2 (59.4%) and AJCC Clinical stage 4 colon cancer (32.6%). Overall, most patients received chemotherapy (50.7%) as a palliative treatment, followed by surgery (25.2%), pain management (14.4%) and radiation (9.7%). The utilization of chemotherapy (39.6% in 2004 to 63.1% in 2016) and pain management (9.7% in 2004 to 12.7% in 2016) increased over time while the utilization of surgery (37.1% in 2004 to 16.9% in 2016), and radiation (13.6% in 2004 to 7.3% in 2016) decreased over time. The type of facility, readmission rates, and proportion of individuals who were whites, elder (age>50), resided in metropolitan areas and had insurance were significantly different between groups. Male patients, patients without existing comorbidities, and patients with grade 2 tumors had higher odds of receiving surgery, radiation, or chemotherapy as palliative therapy compared to pain management. Conclusions: Utilization of first-line palliation-directed chemotherapy has increased significantly from 2004 to 2016 whereas surgery and radiation therapy use has decreased in that period. Notably, patient characteristics such as gender, absence of existing comorbidities and grade 2 tumors influence the choice of therapy.
Trends in utilization of MSI testing and reporting among patients with gastrointestinal cancers: A review of NCDB Database.
Authors: Jafry Baqir , Buhaya Munir , Huang Emina , Verma Nilesh , Kazmi Syed Mohammad Ali 
Published: January 2024

221 Background: MSI-H tumors have a different disease biology and clinical outcomes compared to MSS/MSI-low tumors. The frequency and pattern for MSI testing and reporting is unknown. The aim of this study was to characterize the trends of MSI testing and reporting among GI cancers. Methods: From the National Cancer Database, we identified all GI cancer patients from 2010 to 2016 to determine the number of patients where MSS/MSI low or MSI-H data were available. We describe the basic tumor and disease characteristics and treatment utilization for the two groups. Results: Between 2010-2016, MSI testing was done in 140,602 patients in colon, small intestine and rectal cancers among all GI cancers. MSI testing increased significantly during this study period (11,400 in 2010; 15,021 in 2011; 17,968 in 2012; 20,810 in 2013; 21,973 in 2014; 25,012 in 2015; 28,418 in 2016). We identified a total of 120,349 patients with MSI status reported, among these three tumor types, most commonly among colon followed by rectal and then small intestinal cancers. Overall 111,694 (92.8%) were MSS/MSI-low and 8,655 were MSI-H (7.2%). Among patients with reported MSI status, 52.1% were males and 47.9% were females. The mean age was 64.4 years. Most patients were whites (87.6%) and had insurance (96.8%), no existing comorbidities (70.4%), and grade 2 (70.8%) and AJCC Clinical Stage 4 (26.1%) GI cancer. A higher proportion of GI cancer patients with MSS/MSI-low utilized chemotherapy as first course compared to those with MSI high (48.2% vs 34.0%) whereas a lower proportion of GI cancer patients with MSS/MSI-low underwent a surgical procedure compared to those with MSI high (94.7% vs 97.1%). MSI status was reported most frequently in comprehensive community cancer program (40.3%) and academic center (34.8%), followed by integrated network cancer program (16.8%) and Community Cancer program (8.1%). Conclusions: The utilization of MSI testing has increased significantly between 2010 and 2016. Among all GI cancer patients, MSI status was most frequently reported in colon, rectum and small intestinal cancers. Comprehensive community cancer centers and academic centers reported MSI status more frequently than Integrated Network Cancer program and Community Cancer program.
Artificial intelligence-based model for recurrence prediction after local excision on whole slide images in T1 low rectal cancer.
Authors: Huang Chengzhi , Su Jiarui , Yao Xueqing 
Published: January 2024

24 Background: According to current guidelines, patients with resected specimens showing high-risk features are recommended for additional surgery after local excision of T1 colorectal cancer, despite the low incidence (~7%) of recurrence. However, surgical resection in patients with low rectal cancer (RC) is challenging and may compromise anal function, leading to a low quality of life. To reduce unnecessary surgical resection for these patients, we utilized artificial intelligence to develop and validate a prediction model for the risk of recurrence in T1 low rectal cancer patients. Methods: H&E-stained whole slide images (WSIs) were scanned for local excision (endoscopically or transanally minimally) specimens of 507 consecutive patients with T1 low rectal cancers that were locally resected at 4 hospitals between 2005 and 2015. The area under the receiver operating characteristic curve (AUROC), specificity and sensitivity were used to evaluate the performance of the model for the risk of recurrence, and an external validation cohort was to verify the applicability of the model. Results: We constructed a prediction model using convolutional neural networks (CNN) without incorporating clinical features. The model yielded good discrimination and calibration, achieving a 5-year recurrence-free survival AUROC of 0.90 (95% confidence interval [CI]: 0.86–0.93), sensitivity of 0.91 (95% CI: 0.84–0.96), and specificity of 0.82 (95% CI: 0.78–0.88) through fivefold cross-validation. Additionally, the AI avoided 25.7% of unnecessary additional surgery compared to the current guidelines. Conclusions: We proposed a novel prediction model for the risk of recurrence in T1 low RC patients to assist physicians in determining whether additional surgery is required after local excision of T1 low RC.
Pembrolizumab plus FLOT vs FLOT as neoadjuvant and adjuvant therapy in locally advanced gastric and gastroesophageal junction cancer: Interim analysis of the phase 3 KEYNOTE-585 study.
Authors: Al-Batran Salah-Eddin , Shitara Kohei , Folprecht Gunnar , Moehler Markus H. , Goekkurt Eray , Ben-Aharon Irit , Lonardi Sara , Stein Stacey , Hubert Ayala , Chau Ian , Mishaeli Moshe , Villanueva Luis , Kavan Petr , Fang Xiao , Shih Chie-Schin , Bhagia Pooja , Wyrwicz Lucjan S. 
Published: January 2024

247 Background: The phase 3 KEYNOTE-585 study (NCT03221426) evaluated neoadjuvant/adjuvant pembrolizumab (pembro) or placebo (pbo) + chemotherapy (chemo) followed by adjuvant pembro vs pbo in locally advanced, resectable gastric or gastroesophageal junction (G/GEJ) cancer. A separate cohort evaluated pembro + FLOT (FLOT cohort). We report results from safety and efficacy analyses of the FLOT cohort at third interim analysis. Methods: In the FLOT cohort, patients (pts) with untreated, locally advanced, resectable G/GEJ cancer were randomized 1:1 to neoadjuvant pembro 200 mg IV Q3W (pembro gp) or pbo (pbo gp) Q3W for 3 cycles + FLOT (docetaxel, oxaliplatin, leucovorin, and 5-FU) Q2W for 4 cycles. After surgery, pts received adjuvant pembro or pbo Q3W for 3 cycles + FLOT Q2W for 4 cycles, then adjuvant pembro or pbo Q3W for 11 cycles. Endpoints evaluated included safety, pathCR rate (BICR), EFS (RECIST 1.1, by investigator), and OS in the ITT. Data cut-off at third interim analysis was 09 Feb 2023. Results: A total of 203 pts were randomized (100 pembro + FLOT; 103 pbo + FLOT). Among these, 12 (6%) pts had cT1-T2, 161 (79%) had cT3, and 9 (4%) had cT4. 140 (69%) had N+ disease, and 79 (39%) had GEJ adenocarcinoma at baseline. Median follow-up was 31.6 months (mo) and 31.1 mo, respectively, at IA3. A total of 94 of 99 (95%) pts completed the neoadjuvant phase, 87 of 99 (87%) completed the surgery phase, and 45 of 77 (58%) completed adjuvant treatment. The R0-resection rate was 79% vs 80% in the pembro gp vs pbo gp, respectively. The pathCR rate was 17.0% (95% CI, 10.2-25.8) in the pembro gp and 6.8% (95% CI, 2.8-13.5) in the pbo gp, estimated difference (10.2% [95% CI, 1.3-19.7]). Median EFS was not reached (95% CI, 28.2-NR) in the pembro gp and 30.9 mo (22.8-NR) in the pbo gp (HR 0.79; 95% CI, 0.52-1.22). The 24-mo EFS rates were 66% and 57%, respectively. Median OS was not reached in either group (HR 1.04; 95% CI, 0.66-1.66). The 24-mo OS rates were 72% and 73%, respectively. Grade ≥ 3 drug-related AE rates in all phases combined were 76% and 63% in the pembro vs pbo gp, with serious drug-related AEs in 42% vs 20%, and surgery-related AEs in 20% vs 13%, respectively. A total of 3 (3%) vs 1 (1%) pt in the pembro vs pbo gp died due to a drug-related AE. Conclusions: Neoadjuvant/adjuvant pembro + FLOT was feasible with no new safety concerns. PathCR and EFS favored pembro + FLOT vs pbo + FLOT in pts with untreated, locally advanced resectable G/GEJ cancer. Clinical trial information: NCT03221426 .
Inpatient outcomes of metastatic epidural spinal cord compression in patients with gastric cancer compared to patients with other solid cancer.
Authors: Olafimihan Ayobami Gbenga , Turk Ekrem , Nieto Dominguez Alejandro , Pan Chun-Wei , Omaliko Chidiebele , Ibrahim Muhammad Bilal , Obomanu Elvis , Fawehinmi Praise , Batra Kunnal 
Published: January 2024

255 Background: Metastatic epidural spinal cord compression (MESCC) is an oncologic emergency which can be associated with poor outcomes for cancer patients. Our aim was to study the differences in outcomes of MESCC in patients with gastric cancer (GC-MESCC) compared to those with other solid malignancies. Methods: Healthcare Cost and Utilization Project-Nationwide Inpatient Sample database (2016-2020) was queried to identify all solid (breast, prostate, lung, gastrointestinal, renal and thyroid) cancer patients admitted with spinal cord compression. Multivariate logistic regression was used to evaluate differences in socio-demographics, medical comorbidities and outcomes between MESCC in gastric cancer patients and those with other solid cancers. The primary outcome included inpatient mortality, length of stay (LOS), and total hospital charges (THC). Results: 78,385 patients with the above solid cancers were admitted for spinal cord compression. Among them, 710 had gastric cancer. Patients with gastric cancer were younger (Mean age: 59.1 vs 66.3 years, p < 0.001). They had higher prevalence of anemia (56 vs 41%), protein energy malnutrition (28.9 vs 18.9%, p < 0.001), and lower prevalence of COPD (8.45 vs 18.5%, p =0.003), smoking (22.5 vs 33.6%, p =0.007) and CKD (9.4 vs 12.3%, p =0.03). On multivariate regression, those with GC-MESCC had two-fold higher odds of all-cause mortality (adjusted odds ratio (aOR): 2.0; 95% CI: 1.05-3.96, p = 0.034). On subgroup analysis, mortality was about four times higher for females with GC-MESCC relative to the other group (aOR = 3.8, 95% CI: 1.69-8.52, p = 0.001). There was a trend towards increased LOS (8.9 vs 7.8 days) and THC ($115, 805 vs $96, 074) but it was not statistically significant. Compared with the other cohort, GC-MESCC patients had higher rates of blood transfusion (16.2 vs 9%, p = 0.003). Conclusions: Metastatic epidural spinal cord compression is associated with increased odds of inpatient mortality in gastric cancer patients compared to those with other solid malignancies. Hence, these patients ought to have urgent intervention and close monitoring to prevent adverse outcomes. [Table: see text]
Differential burdens: A study of gastric cancer hospitalization and outcomes across race and ethnicities.
Authors: Pan Chun-Wei , Nieto Dominguez Alejandro , Olafimihan Ayobami Gbenga , Ibrahim Muhammad Bilal 
Published: January 2024

256 Background: Despite advances in H. pylori screening and eradication, gastric cancer remains a significant public health issue as the 4th most common cancer globally. Racial and ethnic disparities in disease presentation, surgical intervention, and healthcare burden in United States are not well understood. Methods: We retrospectively analyzed National Inpatient Sample data (2016-2020) for gastric cancer hospitalizations in patients ≥18 years. Primary outcome was in-hospital mortality. Secondary outcomes included disparities in gastrectomy, length of stay (LOS), and total hospital charges. Results: In our study, we analyzed 207,690 hospitalizations related to gastric cancer from 2016- 2019. Over this period, we observed a decrease in gastric cancer-related hospitalizations, from 42,865 to 39,855. However, among Hispanics, there was a significant increase in hospitalizations from 6,309 to 6,930 cases (annual percentage change [APC] of 1.89%, P<0.01). Notably, there was a significant higher in in-hospital mortality odds for African-American (AA) (aOR 1.15, 95CI: 1.03-1.29), Asian (aOR 1.23, 95CI: 1.06-1.42), and all other races (aOR 1.35, 95CI: 1.13-1.60). Surgical interventions differed among racial groups, with AA having lower odds of undergoing total gastrectomy (aOR 0.71, 95CI: 0.60-0.86), and Asians having higher odds of receiving partial gastrectomy (aOR 1.59, 95CI: 1.41-1.78). LOS also differs between ethnicities, AA had the highest LOS 7.9±0.1d days, followed by Native American/Other (NA) at 7.5±0.2 days. The financial impact of also differs, with Asians incurring the highest mean total charges at 101,436.8±3,253.5, followed by NA at 93,102.7±3,954.7. The total hospital charge burden of gastric cancer increased from 3,682.8 million to 3,880.0 million (APC 1.04%). The white population experienced the highest increase in this burden, from 1,879.2 million to 1,990.0 million (APC of 1.10%). Conclusions: Despite an overall decrease in gastric cancer hospitalizations, our study reveals notable disparities across racial and ethnic groups. Hospitalizations increased among Hispanics, and AA, Asians, and NA faced higher mortality odds. AA experienced the longest lengths of stay, while Asians bore the highest mean total charges. These findings highlight the need for targeted interventions to mitigate these disparities.[Table: see text]
Prognostic value of circulating tumor DNA following local therapy in colorectal cancer with liver metastases.
Authors: O'Donnell Conor , Storandt Michael H. , Mitchell Jessica L. , Jin Zhaohui 
Published: January 2024

26 Background: Local therapies have the potential to cure a portion of patients with colorectal cancer with liver-only metastatic disease (CRLM). Peri-operative chemotherapy has not been shown to improve overall survival when added to local therapy in CRLM. Circulating-tumor DNA (ct-DNA) may have potential to help guide management decisions following local therapy. Methods: We conducted a retrospective analysis of health records of CRLM patients who had tumor-informed ct-DNA (Signatera) measurement following curative-intent local therapy prior to August 30th, 2023. Disease-free survival (DFS) was defined as the time from ct-DNA test until radiographic evidence of disease. Descriptive characteristics of the cohort, ct-DNA results and their impact on adjuvant therapy decisions were recorded. Survival analysis was carried out using R software v4.3.1 with survival and survminer packages. The Kaplan–Meier method was used to estimate the survival distribution. Log-rank test was used for comparison. A multivariable Cox proportional hazards model was used to assess prognostic factors associated with DFS ( coxph). Results: 27 patients with CRLM underwent local therapy followed by ct-DNA collection. The median age was 61 years, 67% were male, and 85% were White. Molecular characteristics: KRAS 31%, NRAS/BRAF 0%, microsatellite instability 4%. The median time from initial diagnosis to treatment of liver disease was 21.0 months. 63% of patients received less than 6 months of systemic therapy prior to local therapy. ct-DNA was checked prior to definitive therapy in 12 cases and was positive in 5 cases (detection rate of 42%). Liver-directed therapy involved: resection (n=15), ablation (6), radiation (2) or a combination (4). The median follow-up time from liver-directed therapy was 13.2 months. Post-local therapy chemotherapy was initiated prior to recurrence in 59% of cases. ct-DNA results contributed to immediate post-management decisions in 15% of cases. There were 14 radiographic recurrences (11 to liver only, 3 to other sites). Positive ct-DNA on initial testing following local therapy was associated with poorer DFS in univariate analysis and was the only prognostic factor identified on multivariable analysis. Conclusions: ct-DNA positivity following local therapy for CRLM is associated with earlier recurrence. Baseline testing before local therapy may be important for interpretation of testing results post-local therapy, given frequent missed disease detection. Additional clinical trial data is needed to explore ct-DNA-guided treatment decisions in CRLM. [Table: see text]
Natural history of gastric leiomyoma.
Authors: Park Kwangbeom , Ahn Ji Yong , Na Hee Kyong , Jung Kee Wook , Lee Jeong Hoon , Kim Do Hoon , Choi Kee Don , Song Ho June , Lee Gin Hyug , Jung Hwoon-Yong 
Published: January 2024

262 Background: Most gastric leiomyomas are asymptomatic and benign subepithelial tumors (SETs); however, some may increase in size or become symptomatic. Understanding their natural history is therefore important to their management. We investigated the natural history of histologically proven gastric leiomyomas. Methods: We retrospectively reviewed histologically proven gastric leiomyoma cases at a tertiary center. The baseline characteristics of these cases were analyzed, and those with a follow-up period of at least 12 months without immediate resection were evaluated. The primary outcome was the frequency of size increase of more than 25% during the follow-up period, and the secondary outcome was the histopathologic results in cases that underwent resection. Results: Among the 231 patients with histologically proven gastric leiomyomas, the most frequent location was the cardia (77.1%), and the median size was 3 cm (IQR 2–4 cm). Eighty-four cases were followed up over a median period of 50.8 months (IQR 27.2–91.3 months). During the follow-up period, tumor size increased in two cases (2.4%). Surgical results showed that one case was leiomyoma, and the other was leiomyosarcoma. Among the remaining cases without change in size, 15 underwent surgical resection (n = 10) or endoscopic resection (n = 5), and all cases were confirmed as leiomyoma. Conclusions: Most gastric leiomyomas are benign SETs, and an increase in size is not frequent, even in large-sized cases. Close monitoring with routine follow-up without resection may be sufficient in cases of histologically proven gastric leiomyoma. However, in cases of ulceration or size increase, resection may be beneficial.
Prediction of lymph node status in stage T1 esophageal squamous cell carcinoma.
Authors: Chen Yongshun , Fan Xiangli , Chen Honglei 
Published: January 2024

263 Background: With the development of endoscopic therapy and the introduction of immunotherapies, it is more important for preserving the esophagus and uninvaded lymph nodes to avoid the damages involving the long-term quality of life and normal immune function caused by esophagectomy with radical lymphadenectomy. Methods: We collected patients with T1 ESCC who underwent endoscopic resection or esophagectomy from 2014 to 2021 in three cancer centers. The primary end point was presence of lymph node metastasis (LNM) in surgical resection specimens or detection of metastases during follow-up. Univariate and multivariate logistic regression were used to screen the clinicopathological features related to LNM. Using the function 'lrm' constructed the prediction model. The area under the curve (AUC) of receiver operating characteristic and calibration graphs were used to assess the performance of the model. An external validation was conducted to evaluate the generalization of the model. We then prospectively collected 28 surgically resected tissue samples of T1 ESCC to further supplement the model from the cellular and molecular level, and used 6 markers (CK, CD34, D2-40, CD4, CD8, FOXP3) and DAPI dye to process multiple immunofluorescence (mIF) staining. Afterwards, we analyzed the density, spatial distribution of microvessels, lymphatic capillaries and tumor-associated immune cells and the interaction between them and malignant cells in the tumor microenvironment of T1 ESCC to explore the relationship between tumor microenvironment and risk of LNM. Results: 1109 patients with T1 ESCC were included. 653 patients from two centers constituted the training cohort, and 456 patients from the third center served as the validation cohort. Multivariate logistic regression based on the training cohort showed that tumor invasion into the submucosa, poor histological grade, and lymphovascular invasion were risk factors for LNM in T1 ESCC. Subsequently, we constructed a model based on three variables to predict the risk of LNM in T1 ESCC. The model demonstrated good discriminative ability (AUC 0.858, 95%CI 0.826-0.890). After mIF staining of 28 prospectively collected T1 ESCC tissue samples, we observed that microvessels and lymphatic capillaries were abundant in the mucosa in lymph node-positive samples but not in lymph node-negative samples. In addition, the average density of FOXP3+ T cells in samples with and without metastasis was 253/mm2 and 26/mm2 (P < 0.001), and the average density of CD8+ T cells was 112/mm2 and 432/mm2 (P < 0.001) in quantitative analysis, respectively. Conclusions: This study (RENMIN-237) developed a well-performing LNM risk stratification model of T1 ESCC to reduce both overtreatment and undertreatment, and we found that FOXP3+ T cells in the tumor microenvironment are a risk factor for LNM, while CD8+ T cells can serve as a protective factor against LNM.