bluuebunny/crossref_metadata_2025_split huggingface dataset:
183. NEOADJUVANT CAMRELIZUMAB PLUS CHEMOTHERAPY (NICE) VERSUS CROSS REGIMENS IN OESOPHAGEAL SQUAMOUS CELL CARCINOMA, A PROPENSITY-SCORE MATCHED ANALYSIS
Authors: Yang Yuxin , Zhu Kaiyuan , Liu Zhichao , Liu Jun , Yang Yang , Li Bin , Li Chunguang , Li Zhigang 
Published: August 2023

Abstract

Background
The CROSS regimen represents standard neoadjuvant management for oesophageal squamous cell carcinoma (ESCC) for the last decade, while the utility of Camrelizumab plus chemotherapy (NICE) is increasingly gaining attention. In the absence of published Randomized Controlled Trials, there remains a paucity of robust information on comparison of these two modalities. This study aims to compare the treatment response and short-term outcomes of NICE followed by oesophagectomy with that after CROSS-induced chemoradiotherapy, in treatment for ESCC.

Methods
A total of 234 patients staged as clinical II-IV, 117 in each arm, was enrolled in this study after propensity-score match. The primary outcomes were tumor response and survival. Secondary outcomes were toxicity and postoperative complications. Pathological response of tumor was evaluated by Chirieac tumor regression grade (TRG) and major pathological response (MPR) as well as responders were defined as TRG1–2 N0. Complications were defined as per the Esophageal Complications Consensus Group (ECCG) criteria and severity per Clavien-Dindo. Survival was evaluated by Kaplan–Meier method using Breslow test, and freedom from recurrence with the competing risk of death estimated per Fine-Gray method.

Results
After matching, R0 resection (93.2% vs 94.9%, P = 0.784), pCR (ypT0N0) (25.6% vs 30.8%, P = 0.468), MPR (46.2% vs 47.0%, P = 0.896) rates and TRG1/2 grades (P = 0.331) were comparable between CROSS and NICE regimens. However, NICE was associated with more lymph nodes yield (P &lt; 0.001) and higher risk of anastomotic leak (type2/3) (P = 0.030)(Fig. 1A-C). The 1-year overall survival was 86.6% and 93.5% for CROSS and NICE (P = 0.088) with comparable recurrence risk (21% vs 21%, P = 0.520) (Fig. 1D/E). Patients with pCR or responders showed similar K-M curves, but in nonresponder subgroup analysis, NICE regimen demonstrated superior survival benefit than CROSS (P = 0.035) (Fig. 1F-H).

Conclusion
In this matched study, NICE is safe and feasible for ESCC with comparable perioperative outcomes compared to CROSS. Moreover, NICE regimen shows superior survival benefit in nonresponder group than CROSS, suggesting its more powerful systemic treatment effects. However, Prospective RCT studies are needed to further verify these findings.
188. VITAMIN D RECEPTOR INDUCES OXIDATIVE STRESS TO PROMOTE ESOPHAGEAL SQUAMOUS CELL CARCINOMA PROLIFERATION VIA THE P53 SIGNALING PATHWAY
Authors: Shang Qi-Xin , Chen Long-Qi 
Published: August 2023

Abstract

Background
Esophageal squamous cell carcinoma (ESCC) is a common pathological esophageal cancer with poor prognosis. Vitamin D deficiency reportedly occurs in ESCC patients, and this is related to single nucleotide polymorphism of vitamin D receptor (VDR). We investigated the effect of VDR on ESCC proliferation, invasion, and metastasis and its potential mechanism.

Methods
ESCC and normal tissues were collected from 20 ESCC patients. The ESCC tissue microarray contained 116 pairs of ESCC and normal tissues and 73 single ESCC tissues. VDR expression and its clinicopathological role were determined by real-time quantitative polymerase chain reaction, western blot, and immunohistochemistry staining. sh-VDR and VDR overexpression were used to validate the effect of VDR on ESCC cell phenotype, and tandem mass tag-based quantitative proteomics and bioinformatics methods identified differential VDR-related proteins. The downstream pathway and regulatory effect were analyzed using ingenuity pathway analysis (IPA). Differentially expressed proteins were verified through parallel reaction monitoring and western blot. In vivo imaging visualized subcutaneous tumor growth following tail vein injection of VDR-deficient ESCC cells.

Results
High VDR expression was observed in ESCC tissues and cells. Gender, T stage, and TNM stage were related to VDR expression, which was the independent prognostic factor related to ESCC. VDR downregulation repressed ESCC cell proliferation, invasion, and migration in vitro and subcutaneous tumor growth and lung metastases in vivo. The cell phenotype changes were reversed upon VDR upregulation, and differential proteins were mainly enriched in the p53 signaling pathway. TP53 cooperated with ABCG2, APOE, FTH1, GCLM, GPX1, HMOX1, JUN, PRDX5, and SOD2 and may activate apoptosis and inhibit oxidative stress, cell metastasis, and proliferation. TP53 was upregulated after VDR knockdown, and TP53 downregulation reversed VDR knockdown-induced cell phenotype changes.

Conclusions
VDR may inhibit p53 signaling pathway activation and induce ESCC proliferation, invasion, and metastasis by activating oxidative stress.
195. OUTCOME OF A PATIENT CHOICE PROTOCOL OF SURGERY OR SURVEILLANCE FOR CLINICAL COMPLETE RESPONDERS TO NEOADJUVANT CHEMORADIOTHERAPY FOR ESOPHAGEAL CARCINOMA
Authors: Walsh Thomas 
Published: August 2023

Abstract

Background
Following neoadjuvant chemoradiotherapy (NCR) esophagectomy is mandated, regardless of response. But patients with pathological complete response (pCR) cannot benefit from resection but are exposed to its risks; and denying resection risks accusation of undertreatment of patients who succumb to recurrent disease. The majority cCR patients have a pCR. We hypothesized that offering patients a choice between surgery and surveillance would result in a non-inferior outcome. This cohort study examined the outcome of this policy.
Patients and Methods: Between 1998 and 2019, 205 patients were treated with curative intent, of whom 152 (74%) underwent NCR. They were re-staged with endoscopy, biopsy and computerized tomography (CT) six to ten weeks after completion of NCR. Of 152 so treated, 80 (52%) had a cCR. The decision to operate on cCR patients was based on patient preference. Survival time was analysed based on clinical response in all patients and with histopathological response in patients treated surgically.

Results
Of 80 (52%) patients that had a cCR 51 (64%) chose surgery and 29 (36%) chose surveillance. The mean ages of the surgery and surveillance cohorts were 59 and 70 years respectively (p &lt; 0.001). Of 51 cCR patients undergoing surgery 35 (69%) had a pCR. The mean survival of the surgery cohort was 76 months (median 50.0; SD 74.9; range 2.2 to 268 months) compared to 56 months (median 24.6; SD 62.7; range 6.1 to 206) for surveillance. When adjusted for age, Cox regression estimated an insignificant hazard ratio of 1.22 (95% CI 0.65 to 2.32; p = 0.53).

Conclusion
Survival of cCR patients who chose surveillance was not statically inferior to those choosing surgery. This was true for both adenocarcinoma (AC) and squamous cell carcinoma (SCC). A cCR was predictive of pCR in the majority of patients. Allowing patients to choose between surveillance and surgery is prudent, especially those patients at greatest operative risk and lowest risk for residual disease.
216. SHORT-TERM OUTCOMES OF 111 CASES OF MEDIASTINOSCOPIC ESOPHAGECTOMY FOR ALL ESOPHAGEAL CANCERS
Authors: Mitsui Takashi , Hakozaki Yuhei , Saito Kazuyuki , Okuyama Takashi , Yoshitomi Hideyuki 
Published: August 2023

Abstract

Background
Mediastinoscopic esophagectomy (ME) as a radical surgery for esophageal cancer is considered promising because of its low complication rate of pneumonia. In our hospital, ME with three-field lymphadenectomy is the first choice for radical esophagectomy and is indicated for all cases of esophageal cancer, including borderline resectable, locally invasive tumors, conversion surgery, and salvage surgery. However, there have been few reports of ME for highly advanced esophageal cancer, and its safety and feasibility are unknown.

Methods
From April 2018 to April 2023, we retrospectively investigated all cases of radical esophagectomy at our hospital. Patient characteristics and perioperative short-term outcomes were investigated.

Results
cStage 0/I/II/III/IV were 7/20/26/37/21 respectively. 70% of patients were treated with neoadjuvant chemotherapy. ME was performed in 111 cases, thoracoscopy and thoracotomy in 0 cases. The conversion rate from ME to thoracotomy was 0.9%. The mean operation time was 547 min and blood loss was 215 mL. Postoperative complications of classified as grade II in the CD classification occurred in 19.8%, and more than grade IIIa occurred in 13.5%. The mean postoperative hospital stay was 20 days. The number of dissected lymph nodes was 47. The completion rate of R0 surgery was 94%.

Conclusion
ME for all esophageal cancers, including borderline resectable tumors and locally invasive tumors, was safe and feasible. ME with three-field lymphadenectomy may be the first choice for radical esophagectomy.
224. A SUCCESSFUL CASE OF VACUUM-STENT TREATMENT FOR BOERHAAVE SYNDROME
Authors: Pattynama Lisanne , Eshuis Wietse J , Pouw Roos 
Published: August 2023

Abstract

Background
Boerhaave syndrome is a rare disease, associated with severe morbidity and mortality. Endoscopic vacuum therapy (EVT) has gained a greater role in the treatment of transmural defects in the upper gastrointestinal tract, including Boerhaave syndrome. Recently, a vacuum-stent was introduced as a new device to apply EVT. While allowing for oral intake of a soft diet, this device combines the benefits of negative pressure wound therapy and an intraluminal stent.

Methods
This video describes a patient with Boerhaave syndrome, successfully treated with a vacuum-stent, including the technical aspects of the technique. First, a guidewire was placed and the vacuum-stent was advanced over the guidewire and introduced into the esophagus. The vacuum-stent was placed over the defect and deployed using the distal release system. Lastly, the vacuum-stent was connected to a vacuum pump, which was set to a pressure of -125 mmHg on the day of placement and -75 mmHg from the second day on. Generally, a vacuum-stent was removed after 7 days. If the defect persisted, another vacuum-stent was placed.
Case/Results: A 36-year-old male presented with severe abdominal pain after emesis. CT-scan showed suspicion of a defect in the distal esophagus and an endoscopy was performed. Endoscopy showed a defect of 2 cm in length with moderate degree of debris. It was decided to initiate treatment with vacuum-stent. The vacuum stent was exchanged once per week and after a total of 31 days, the defect was closed, confirmed by CT-scan with oral contrast. During treatment, oral intake was extended to a soft diet. One day after removal, the patient resumed oral intake and was discharged.

Conclusions
The vacuum-stent seems to be a safe and possibly organ-saving treatment option for transmural defects in the upper gastrointestinal tract, including Boerhaave syndrome.
Link to video: https://we.tl/t-IA5oM70TX5
249. AUTOMATED PREDICTION SYSTEM USING COMPUTER VISION FOR ESOPHAGEAL STRICTURE AFTER ESOPHAGEAL ENDOSCOPIC RESECTION
Authors: Takeuchi Masashi , Kawakubo Hirofumi , Matsuda Satoru , Kitagawa Yuko 
Published: August 2023

Abstract

Background
Although endoscopic submucosal dissection (ESD) is a standard treatment for early esophageal cancer, post-treatment esophageal stricture (ES) is the most common complication, especially in patients with circumferential resection range greater than three-quarters. This study sought to establish an automated system for predicting ES after ESD from endoscopic video using computer vision. We believe that this automation can help endoscopists to perform appropriate decision-making, such as whether to perform steroid injection during ESD or preventative balloon dilatation after ESD.

Methods
This study assessed recorded endoscopic videos of 73 patients who underwent ESD for superficial esophageal cancer. A deep neural network-based classifier—DeepES—was developed to assess whether ES would occur. The model was trained and tested using k-4 folds cross-validation, and the area under the curve (AUC) values of DeepES were calculated to validate the model performance against several clinicopathological factors.

Results
For the 73 patients evaluated by k-4 folds cross-validation, overall accuracy for the DeepES was 0.712, meaning ES could be correctly predicted by AI for 52 patients.
The AUC value of DeepES was higher (AUC 0.709) compared with circumferential resection range (AUC 0.680) and pathological tumor depth (AUC 0.570).

Conclusion
DeepES has a higher accuracy for predicting ES during ESD than other factors, including circumferential resection range and pathological tumor depth. Use of DeepES enables optimal decision-making during ESD, such as whether to perform preventative strategies, including balloon dilatation. This report is the first to show the value of state-of-the-art technologies using computer vision for ESD to prevent ES.
253. ESOPHAGEAL REGENERATION FOLLOWING IMPLANTATION OF A TISSUE ENGINEERED ESOPHAGEAL IMPLANT: UNDERSTANDING THE REGENERATION TIME COURSE AND TRANSLATION TO THE CLINIC
Authors: Fodor William 
Published: August 2023

Abstract
Diseases of the esophagus, damage of the esophagus due to injury or congenital defects during fetal esophageal development, i.e., Esophageal Atresia (EA), typically require surgical intervention to restore esophageal continuity. The development of novel tissue engineered tubular structures would improve the treatment options for these conditions by providing an alternative that is organ sparing and can be manufactured to fit the exact dimensions of the defect. Biostage has developed an autologous tissue engineered Esophageal Implant, composed of an electrospun cellular scaffold seeded with autologous mesenchymal stromal cells, that can stimulate repair and regeneration of segmental defects in the esophagus following surgical implantation. Biostage has received approval from the FDA on an Investigational New Drg (IND) application for a clinical trial in adults requiring esophageal reconstruction. A discussion of the regeneration time course, in adults and in a pediatric model as well as the critical features of the IND, the Regulatory process for treating adults with the intention to treat Esophageal Atresia and the clinical study parameters highlight the novelty of this tissue engineered combination product.
270. PERIOPERATIVE CHEMOTHERAPY FOR OPERABLE GASTRO-ESOPHAGEAL JUNCTION OR GASTRIC CANCER: FLOT VERSUS ANTHRACYCLINE TRIPLETS
Authors: Geerts Julie F M , Zijden Charlène , Sluis Pieter C , Spaander Manon C W , Nieuwenhuijzen Grard A P , Rosman Camiel , Laarhoven Hanneke W M , Verhoeven Rob H A , Wijnhoven Bas P L , Lagarde Sjoerd L , Mostert Bianca 
Published: August 2023

Abstract

Background
Since the FLOT4-AIO study (2019) showed improved survival in patients treated with neoadjuvant fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) compared to those treated with neoadjuvant anthracycline triplets, FLOT became standard of care in the Netherlands and most Western countries. The aim of this study was to compare the overall survival (OS), pathological response and surgical outcomes of FLOT chemotherapy to anthracycline triplets in the Netherlands, using real-world population level data.

Methods
Patients diagnosed with resectable (cT2-4a/cTxN0–3/NxM0) gastro-esophageal junction and gastric carcinoma between 2015–2020 were selected from the Netherlands’ Cancer Registry. Patients were included if they received neoadjuvant FLOT or anthracycline triplets whether this was followed by resection or not. OS was calculated from start of neoadjuvant therapy, analyzed using cox regression analysis and adjusted for sex, age, comorbidities, performance status, cT-stage/cN-stage and tumor grade. Secondary outcomes included the pathological complete response (pCR), proportion of patients that fully completed neoadjuvant chemotherapy (100% of scheduled cycles permitting dose reductions), proportion of patients that underwent (radical) surgical resection and proportion receiving adjuvant therapy.

Results
778 included patients were treated with FLOT and 913 with anthracycline triplets. Patients treated with FLOT underwent more staging diagnostic laparoscopies (DLS) (73.5% vs. 44.1%, p &lt; 0.0001). Adjusted OS was better after neoadjuvant FLOT (HR = 0.84, 95% CI 0.72–0.98, p = 0.03). 3-year and 5-year OS were 56.4% and 46.6% after FLOT and 52.7% and 45.5% after anthracycline triplets, respectively. A higher proportion of patients treated with FLOT fully completed neoadjuvant chemotherapy (78.5% vs. 73.1%, p = 0.009) and had R0 resections (86.2% vs. 85.2%, p = 0.007). No statistically significant differences were seen in the proportions of patients that underwent resection, received adjuvant therapy, or had pCR.

Conclusion
Real-world population level data showed better OS of patients treated with FLOT chemotherapy compared to anthracycline triplets. No statistically significant difference was observed in pCR or resection rates. Thus, not every outcome as described in the FLOT4-AIO trial could be reproduced in a real-world population, despite improved staging with DLS in the FLOT group. Divergent baseline characteristics and less intensive neoadjuvant treatments in real-world patients compared to patients in clinical trials may contribute to this discrepancy.
290. RISK OF ESOPHAGEAL CANCER AFTER BARIATRIC SURGERY: COMPARISON BETWEEN SLEEVE GASTRECTOMY AND GASTRIC BYPASS AT 10 YEARS, A NATIONWIDE STUDY
Authors: Gronnier Caroline , Poghosyan Tigran , Lazzati Andrea 
Published: August 2023

Abstract

Backgroud
The risk of esophageal cancer after bariatric surgery is a matter of debate. Several studies have reported that bariatric surgery patients have a lower risk of cancer. However, esophageal cancer is associated with gastroesophageal reflux disease, which may increase after bariatric surgery and in particular after sleeve gastrectomy.

Objectives
The objective of this study is to evaluate the risk of esophageal cancer after two bariatric procedures: sleeve gastrectomy (SG) and gastric bypass (GBP).

Methods
Data from patients operated on for bariatric surgery between 2007 and 2020 in France were extracted from a national discharge database (PMSI). Adult patients operated on for SG or GBP were included and followed up until December 2020. Patients were divided into two groups according to the procedure initially performed. The endpoints were the occurrence of esophageal and cardia cancers. To assess the effect of the type of bariatric procedure on the development of cancer, a multivariate analysis was performed using a marginal Cox model after matching on propensity score (PS). In the sensitivity analysis, we used different models: standard Cox regression, Cox regression adjusted on propensity score, and Cox model with adjustment for inverse probability of treatment weighting.

Results
Of the 367,169 patients included, 68.7% were SGs and 31.3% were GBPs. The two groups differed at inclusion in terms of age, sex, BMI, and comorbidities. Median follow-up was 6.0 years (IQR 3.0–8.0 years) for the entire cohort, and approximately 35,000 patients were followed for at least 10 years. A total of 88 esophageal cancers were identified, including 64 after SG and 24 after GBP. In multivariate analysis, no significant difference was found between SG and GBP on cancer incidence (HR 1.6, 95%CI 0.9–2.7, p = 0.09 for OS versus GBP). No differences were found in sensitivity analyses.

Conclusion
In this large national cohort of bariatric surgery patients, no significant differences were found in the incidence of esophageal and cardia cancer between OS and GBP.
295. RELATIONSHIP BETWEEN ABDOMINAL FAT DISTRIBUTION AND PROGRESSION OF BARRETT’S ESOPHAGUS TO ADENOCARCINOMA
Authors: Towatari Shuichiro 
Published: August 2023

Abstract

Background
Obesity was known to be a risk factor of the incidence of Barrett’s esophagus (BE) and Barrett’s esophageal adenocarcinoma (BEA). Especially excessive visceral fat has recently reported to promote some cancers, including BEA. This study aimed to clarify the impact of abdominal fat distribution on the progression of BE to adenocarcinoma in long-segment BE (LSBE) and short-segment BE (SSBE).

Methods
Study 1: We retrospectively reviewed the 124 patients with pathologically defined superficial BEA who underwent endoscopic resection, including 4 endoscopic mucosal resection (EMR) and 85 endoscopic submucosal dissection (ESD), or surgical operation (35 esophagectomy) in our institution between January 2004 and December 2018. 124 BEA cases included 34 LSBE (length ≥ 3 cm) cases and 90 SSBE (length ≥ 1 and &lt; 3 cm) cases. Using computed tomography volumetry, we measured areas of visceral (VFA) and subcutaneous (SFA) fat at the level of the umbilicus, and calculated the VFA/SFA ratio in each patient, defining high-VFA/SFA ratio (≧1.0) and low-VFA/SFA ratio (&lt;1.0). VFA/SFA ratio were compared and analyzed between BEA with LSBE group and BEA with SSBE group.
Study2: We divided 62 patients who had LSBE into two groups based on prognosis of BEA; BEA with LSBE (34 patients) and non-BEA with LSBE group (18 patients). Abovementioned parameters were compared and analyzed between these two groups.
Study3: Abovementioned parameters were compared and analyzed between BEA with SSBE (90 cases) and non-BEA with SSBE group (100 controls).

Results
study1: High VS ratio were seen in 22 (64.7%) patients among BEA with LSBE group and 34 (37.8%) patients among BEA with SSBE group, which is statistically significant (p = 0.0072).
Study2: High VS ratio were seen in 6 (33.3%) patients among non-BEA with LSBE group. This result was statistically significant compared to BEA with LSBE group (0.038).
Study3: In non-BEA with SSBE, 32 patients (32.0%) had High VS ratio, showing no significant difference compared to BEA with SSBE.

Conclusion
High VFA/SFA ratio was significantly associated with progression of long-segment Barrett’s esophagus to esophageal adenocarcinoma.