bluuebunny/crossref_metadata_2025_split huggingface dataset:
Overall survival (OS) in gastrointestinal (GI) neuroendocrine tumors (NETs) based on primary site, stage, and surgery.
Authors: Laderian Bahar , Farha Nicole , Mundi Prabhjot Singh , Wei Wei , Khorana Alok A. , Kim Michelle Kang , Steele Scott , Gorgun Emre , Fojo Antonio Tito , Krishnamurthi Smitha S. 
Published: January 2023

643 Background: There are limited data on the impact of primary site and surgical intervention on long-term outcomes in GI-NETs. We hypothesized that primary site would be associated with differences in stage-specific OS. Methods: In the National Cancer DataBase, using histology codes, we identified 124,081 GI-NETs diagnosed between 2004-2019 in individuals 18 years or older. OS was estimated by the Kaplan-Meier method. Differences in survival based on primary site, stage, and surgical intervention were assessed using a Cox proportional hazards model, accounting for multiple comorbidities, e.g. Charlson-Deyo Comorbidity Index. Results: The most common primary site for GI-NETs was small intestine (33.6%), followed by colon, rectum, pancreas, and stomach comprising 19.8%, 17.5%, 15.5%, and 9.2%, respectively. Patients with stage I-III NETs undergoing surgery had significantly better median OS compared to those without surgery (mOS 197 vs 115 mo., p<0.0001 by log rank test). Patients with stage IV NETs undergoing primary resection also had improved mOS vs those with no surgery (125 vs 54 mo., p<0.0001). For stage I-III patients without surgery, 2-yr and 5-yr survival rates were highest in the rectum and lowest in small intestine ( p<0.0001). Among those with stage I-III with surgery, 2-yr and 5-yr survival rates were also highest in the rectum, and lowest in the biliary system at 89% and 82% ( p<0.0001). In contrast, for stage IV patients without primary resection, 2-yr and 5-yr survival rates were highest among small intestine and lowest in the rectum ( p<0.0001). Among those who had primary tumor resection, 2-yr and 5-yr survival rates were highest in pancreas and lowest in colon at 2 yrs and rectum at 5 yrs ( p<0.0001). Conclusions: Surgical intervention for GI-NETs is associated with improved OS in both localized and stage IV disease, with consistent trends across different primary sites. Primary tumor resection was associated with the largest increase in 5-yr survival for stage IV NETs arising from pancreas and stomach. Patient selection for surgery undoubtedly contributed to the improved OS, but resection of primary tumors in stage IV GI-NETs may have a disease modifying effect. Further study is warranted with more granular data to identify patients with stage IV GI-NETs who may benefit from primary tumor resection.[Table: see text]
Clinical outcomes in patients with microsatellite instability-high (MSI-H) metastatic colorectal cancer (mCRC) in the pre-immunotherapy era.
Authors: Zwart Koen , van der Baan Frederieke , Dixon Matthew , Frantz Bryan , Punt Cornelis J. A. , Koopman Miriam , Vink Geraldine R. , Roodhart Jeanine 
Published: January 2023

65 Background: Data on clinical treatment outcomes of systemic non-immunotherapy in patients with MSI-H mCRC are limited due to low incidence. Real world data can support the interpretation of immunotherapy studies. Our aim is to provide insight on clinical outcomes of patients with MSI-H mCRC treated with systemic non-immunotherapy. Methods: We describe an observational cohort study with real-world data from the Netherlands Cancer Registry during 2015-2018 (N=383) and trial-based data from three prospective phase III first-line clinical trials: CAIRO, CAIRO2 and CAIRO3 (N=54). We investigated progression free survival (PFS) and overall survival (OS), which were defined as time from the start of first-line (PFS1/OS1), second-line (PFS2/OS2) and third-line (PFS3/OS3) of systemic non-immunotherapy until disease progression or death, respectively. Furthermore, we investigated objective response rate (ORR), which was defined as the proportion of patients with a complete or partial response as best response after first-line (ORR1), second-line (ORR2) and third-line (ORR3). Results: A total of 437 patients with MSI-H mCRC were analyzed. The proportion of patients receiving at least one line of systemic non-immunotherapy was 63%, 21% received two lines, and 5% received three lines. Patients receiving one line of therapy (N=270) had a median age of 69, 50% were female, 49% had a WHO performance score of 0, 70% had a right-sided tumor, 72% had synchronous mCRC, and 64% of those with synchronous mCRC received primary tumor resection. When known, 52% of patients harbored a BRAF mutation and 21% a RAS mutation. The results of OS, PFS, and ORR are summarized. Conclusions: To our knowledge these results provide insight on clinical outcomes in the largest observational cohort of patients with MSI-H mCRC treated with systemic non-immunotherapy to date. We showed a median PFS1 of 5.9 months and an OS1 of 14.1 months, which are in distinct contrast with patients in MSI-H mCRC trials receiving mono-immunotherapy in which a median PFS1 of 16.5 months was reached and a median OS1 was not reached after median follow-up of 44.5 months. Only 21% of patients in our observational cohort reached second-line of systemic non-immunotherapy and 5% third-line. Our results underline the importance and early access to immunotherapy in the MSI-H mCRC population. [Table: see text]
Democratizing access to research for patients with pancreatic cancer across a diverse health system through natural language processing of radiology reports.
Authors: King Daniel , Valente Cristina , Barish Matthew , Carvino Anthony 
Published: January 2023

664 Background: Access to clinical trials and translational research studies is integral to improving cancer care for pancreatic cancer. The in-patient setting is a valuable opportunity to obtain research specimens and establish transition to out-patient oncology. However, samples coordinators rarely have sufficient lead time prior to biopsy to consent patients and be present for tissue collection. Meanwhile, histopathology of biopsied specimens may not be complete prior to discharge, hindering follow-up planning. Polyethnic-1000 is a research study enrolling African American patients with pancreatic cancer, is a priority study for our institution, and was the target study that motivated the below innovative strategy to better obtain research samples and ensure adequate follow-up. Methods: We observed recurrent suspicious abnormalities on abdominal radiology reports that foreshadow subsequent biopsy of the pancreas. To explore this further, we trained a natural language classifier to identify radiology reports as suspicious for pancreatic cancer. The pretrained model used is RadBERT, a custom-built language model based on Google’s BERT and further pretrained on several million radiology text reports. A gastrointestinal oncologist, clinical research coordinator, and radiologist informatician curated a dataset consisting of 1136 CT abdominal radiology reports, among which 696 were considered suspicious for pancreatic cancer. Among this curated database of reports, a training set consisting of 908 reports was used to fine-tune the RadBERT base model and produce our pancreatic cancer suspicion classifier. A validation and test dataset each consisting of 114 cases were reserved for model evaluation. We computed the final classifier performance metrics over the test dataset. Results: The model obtained an accuracy of 92%, and produced an F1 score of 0.936, a recall of 0.943, and a precision of 0.930. Conclusions: An early iteration model to classify CT abdominal radiology reports was highly accurate and has the potential to substantially increase identification of patients who may be suitable for clinical research studies and trials. We are now working to improve and expand our dataset in order to train classifiers with greater and more robust performance, while simultaneously developing an automated near real-time process that will leverage our models to identify reports suspicious for pancreatic cancer and then notify a coordinator and navigator.
Impact of COVID-19 pandemic on pancreatic cancer disparities and outcomes in Florida.
Authors: Lim Alexander , Telisnor Guettchina , Zhang Zhongyue , Lou XiangYang , Nassour Ibrahim , Salloum Ramzi , Rogers Sherise C. 
Published: January 2023

667 Background: Pancreatic cancer (PDAC) is the third-leading cause of cancer death in the United States. Florida had a high infection rate with several peaks throughout 2020 and 2021. The first aim of this study is to evaluate the impact of the COVID-19 pandemic on survival time, rate of surgical resection, and time to treatment of newly diagnosed pancreatic cancer in Florida. The second aim was to assess whether disparities with respect to race, age, income, and gender were exacerbated in newly diagnosed pancreatic cancer via stratified analysis of pandemic groups. Methods: This retrospective study included patients identified by OneFlorida+ Clinical Research Network, a statewide data trust, who were newly diagnosed with pancreatic adenocarcinoma via ICD 10 coding from January 1st, 2017 to October 31st, 2020. Patients were compared between 3 cohorts based on date of pancreatic cancer diagnosis: pre-pandemic (01/01/2017- 09/30/2019), transition (10/01/2019-02/28/2020), and pandemic (03/1/2020-10/31/2020). Patients with a diagnosis of neuroendocrine carcinoma were excluded. Results: 934 unique patients were identified for analysis, of whom 81.3% were in the pre-pandemic cohort, 8.2% in the transition cohort, and 10.5% in the pandemic cohort. The racial distribution was 19.4% African American, 70.2% Caucasian, 0.7% Asian, 8.2% of Other races, and 1.3% reported unknown race or refused to answer. The median age was 67 years (range, 27–89 years). Gender was even. The median income was $52,915 (range, $23,704–$124,821). The differences in overall survival were not significant for age and gender across the 3 groups. Patients with income <$53,000 had significantly lower survival time across all groups. African Americans had significantly lower survival time in the pre-pandemic and transition cohort (p< .005), but Caucasians had the lowest survival time for the pandemic group (p <.005). 60.2% of early-stage patients did not have surgery and the group distribution was 64.2% pre-pandemic, 48.5% transition, and 44.4% pandemic (p< 0.027). Time to treatment was not significant across all groups and demographics. Conclusions: This study found a decrease in diagnosis, survival rate for some groups, and surgical resection rates during the COVID-19 pandemic in Florida. Resource planning should target these disparities in income and race.[Table: see text]
Does distance traveled impact management and outcomes in patients with pancreatic adenocarcinoma who are candidates for curative resection?
Authors: Khan Mariam , Backer Grant , Alvarado Andrew , Wang Susanna , Devireddy Deepthi , Parker Jessica , Assifi M Mura , Chung Mathew , Wright G Paul , Chandana Sreenivasa R 
Published: January 2023

668 Background: We investigated the impact of distance traveled to a tertiary care center for treatment in the management and outcomes of patients with pancreatic adenocarcinoma (PDAC). Methods: Patients treated for operable PDAC at a single institution from 2010-2019 were retrospectively reviewed. Data was collected on demographics, tumor characteristics, social determinants of health, diagnostic/staging work-up, surgical details, and outcomes. Patients were divided into three groups based on distance from our institution: Group A, <10 miles, Group B, >11-50 miles, or Group C, > 50 miles. The primary outcome was two-year survival. Results: There were 314 patients included. The mean age was 67.6+10.5 years. Patients farther from the hospital were less likely to undergo CT with contrast (Group B 97.1% versus Group C 89.0%, p = 0.02) and more likely to get MRCP (Group A 17.0% versus Group C 36.3%, p = 0.01) for staging. Distance was also associated with increased time to first encounter with medical or surgical oncology (Group A 6 days versus Group C 9 days, p = 0.02) and treatment initiation (Group A 22 days versus Group C 28 days, p < 0.001). There were no differences in postoperative complications, length of stay, discharge disposition, or follow-up. Two-year survival was better in Group A than Group B (54.1% versus 35.5%, p = 0.04). There was no difference in five-year survival. In the multivariable model for two-year survival, no patient or tumor characteristics were significant. Conclusions: In this PDAC population, patients living farther from a tertiary cancer center had worse two-year postoperative survival. Prospective studies in this area are needed.
Tissue factor (TF) and factor VII/TF ratio (fVIIa:TF) as potential indicators of malignancy in pancreatic cystic lesions.
Authors: Haque Farzana , Featherby Sophie , Broughton Laura , Lykoudis Pavlos , Wedgwood Kevin , Dasgupta Dowmitra , Khulusi Sam , Ra Abdul , Buchanan Alexander , Huang Chao , Nikitenko Leonid , Ettelaie Camille , Maraveyas Anthony 
Published: January 2023

669 Background: Premalignant pancreatic cellular genotype may remain stable for many years, but compounding conditions can produce rapid malignant cellular transformation. This onset is rarely spontaneous and is often associated with the presence of inflammation. One inflammatory modulator is “tissue factor (TF),” which usually acts in complex with “coagulation factor VIIa (fVIIa)” to initiate coagulation. The role of TF in malignancy and its impact beyond thrombosis on cell proliferation, angiogenesis, and metastasis is well established. This suggests that TF may be a diagnostic marker in the inflammatory microenvironment of the precursor lesions of pancreatic cancer. Aim: To examine the potential of TF concentrations and the fVII:TF ratio within pancreatic cyst fluid as indicators of malignant cellular transformation from benign to malignant. Methods: Cyst fluid was prospectively collected from 31 patients with pancreatic cystic lesions (REC 18/LO/0736) and analysed in a blinded fashion. The level of TF and fVIIa proteins were measured by ELISA, and the fVIIa:TF ratios calculated. A cut-off value for TF concentration was determined using a ROC curve and compared to the conventional assessment parameters, including radiological features, carcinoembryonic antigen (CEA) and amylase. Results: Patients were categorised into four groups based on histology. Significant histological stage-dependent increases in TF level were observed, which corresponded to the progression of the normal ductal epithelium to invasive adenocarcinoma. The mean TF concentration was significantly higher ( p= 0.006) in the high-risk group (high-grade dysplasia & malignant; 1.17 ng/ml, 95% CI 0.68, 1.67) vs the low-risk group (benign & low-grade dysplasia; 0.27 ng/ml, 95% CI 0.1, 0.44). A strong positive correlation between TF concentration and the high-risk group was observed (correlation coefficient 0.746, p < 0.001, the cut-off value for TF 0.75 ng/ml, AUC 0.877, p= 0.002). In addition, the fVIIa:TF ratio, was marginally lower ( p= 0.274) in the high-risk group (mean = 84.82 [95% CI 0, 185.04]) vs the low-risk group (mean = 437.46 [95% CI 0, 901.02]). TF concentrations performed consistently better as an indicator of malignant transformation when compared to the conventional parameters and will be presented at the meeting. Conclusions: Cyst-associated TF levels appear to correlate with the cytological progression to the malignant phenotype, while the fVIIa:TF ratio indicates a breakdown in the ability of the body to contain the disease. Such indicators may allow better presurgical discrimination of malignant potential of tumours and offer a more nuanced tool for monitoring indeterminate cystic lesions. Further work is needed with a larger cohort to confirm these findings.
Clinical therapeutic effects of neoadjuvant chemotherapy in resectable pancreatic cancer.
Authors: Murakawa Masaaki , Takahashi Daishi , Kawahara Shinnosuke , Kamioka Yuto , Yamamoto Naoto , Tezuka Shun , Kobayashi Satoshi , Ueno Makoto , Morimoto Manabu , Oshima Takashi , Yukawa Norio , Rino Yasushi , Morinaga Soichiro 
Published: January 2023

677 Background: Results from the phase III Prep-02/JSAP-05 trial demonstrated the efficacy and safety of gemcitabine plus S-1 as neoadjuvant chemotherapy for resectable pancreatic cancer. However, consensus on neoadjuvant chemotherapy for pancreatic cancer has not yet been established, and the effects of neoadjuvant therapy on clinical features of the tumor and improvement in prognosis have not been fully investigated. We aimed to investigate the effect of neoadjuvant chemotherapy on resectable pancreatic cancer. Methods: Between 2013 and 2021, 291 patients who underwent curative resection for resectable pancreatic cancer at our hospital were enrolled. The patients were categorized into groups of those who received neoadjuvant chemotherapy (NAC group: n = 91) and those who received up-front surgery (US group: n = 200). Prognostic predictors were examined in (i) all patients, (ii) US group, and (iii) NAC group. Statistical significance was considered at p < 0.05. Results: The median follow-up periods were 20.7 and 33.2 months in the NAC and US groups, respectively. In the NAC group, 84 of the 91 patients (94.5%) received gemcitabine-based chemotherapy, and three (3.3%) received chemoradiotherapy. There was no difference in overall survival (OS) and recurrence free survival (RFS) between the two groups. In the background, the NAC group had lower preoperative CA19-9 levels, lower lymph node ratio (LNR), and smaller tumor size than in the US group. During multivariable analysis of OS, preoperative CA19-9 levels, LNR, modified Glasgow prognostic score (mGPS), resection margin, and tumor size were identified as possible prognostic predictors in all patients and in the US group, whereas LNR and mGPS were identified in the NAC group. Conclusions: The prognostic significance of preoperative CA19-9 level, tumor size, and LNR were counteracted in the NAC group. These findings may indicate the effect of neoadjuvant chemotherapy for resectable pancreatic cancer.
Analysis of survival outcomes in patients with pancreatic cancer who underwent upfront surgery.
Authors: Jung Jae Hyup , Park Jinkyeong , Ahn Jinwoo , Kim Bomi , Jung Kwangrok , Lee Jong-Chan , Hwang Jin-Hyeok , Kim Jaihwan 
Published: January 2023

679 Background: During the last decade, the survival outcomes of patients with pancreatic cancer (PC) have improved. We aimed to establish a model of which clinical factors contributed to improved survival in PC patients who underwent upfront surgery. Methods: Public data from the KOREA Health Insurance Review and Assessment (HIRA) database were collected. Medical records in a single tertiary center were also retrospectively reviewed between 2013 and 2018. Enrolled patients were those who underwent curative upfront surgery for PC. Results: A total of 12,146 patients in HIRA data and 267 patients in single-center data were collected. The overall survival (OS) rates have improved over the years in HIRA data and were reproduced in single-center data. Dividing the patients of single-center data into two periods (2013-2015 [119] vs. 2016-2018 [148]) based on the results of public data, the median OS was significantly different between the two periods (20.9 vs 32.1 months, p=0.003). According to multivariate regression analyses, young age (≤70 years), R0 resection, negative nodal involvement, adjuvant treatment, and palliative chemotherapy with FOLFIRINOX or gemcitabine plus nab-paclitaxel (GNP) were significantly associated with better OS. A survival prediction model was created using the beta-coefficients in cox regression analysis of the above five significant factors, and the c-index by bootstrap validation (resampling, 1500) was 0.7088. The weight scores were as follows: Age >70 years, 1; R1 resection, 1; pN1, 1; pN2 stage, 3; no adjuvant treatment, 2; palliative chemotherapy with FOLFIRINOX and/or GNP, 3; without FOLFIRINOX or GNP, 5; no palliative chemotherapy, 5. Conclusions: Regarding the survival trends in patients with resected PC, we presented the recent improvement in survival over the years and suggested several clinical factors that contributed to it by different weights. Further studies are necessary for validation.[Table: see text]
Impact of patient characteristics and treatment patterns on outcomes in potentially resectable pancreatic cancer (PC).
Authors: Steinmetz Andrew , Patel Sameer H. , Wilson Gregory C. , Sussman Jeffrey J. , Olowokure Olugbenga Olanrele , Kharofa Jordan , Ahmad Syed A. , Sohal Davendra 
Published: January 2023

681 Background: Treatment of PC remains a challenge, with surgery being the mainstay of potentially curative therapy. Even after surgical resection, however, many patients experience recurrence. There has been a shift toward treating PC as a systemic disease from diagnosis with neoadjuvant chemotherapy (nCT) or chemoradiation (nCRT). This study examines characteristics of real-world patients who were deemed to have resectable (R) or borderline resectable (BR) disease, and how they relate to overall survival (OS). Methods: This is a retrospective analysis of patients in an academic health system who presented for initiation of treatment for PC staged as R or BR. Descriptive data on patient characteristics, performance status (PS), laboratory values, neoadjuvant therapies, recurrence, and mortality were obtained. OS was evaluated using Kaplan-Meier analysis and log-rank tests. Two-sided p-values were calculated. Results: From electronic records at the University of Cincinnati, 129 patients were identified. Median age was 66 with baseline ECOG PS of mostly 0 (86, 67%) or 1 (40, 31%). Primary tumor site was most commonly head of pancreas (104, 81%). Of 129, 55 (43%) patients received surgery upfront; the rest received neoadjuvant therapy (39 nCRT, 35 nCT) with gemcitabine (68%) or 5-fluorouracil (32%) containing regimens. Of those receiving nCRT/nCT, 36 (49%) went on to resection; the rest experienced progression (27, 36%) or toxicities (11, 15%) including death. Of 129, 92 (71%) have died, with median OS of 20.1 months (95% CI 16.4 - 25.0) for the full cohort. On adjusted multivariable analysis, the following were associated with worse OS: failure to undergo resection (HR 5.65, 95% CI 3.17 - 10.09, p<0.0001); receiving <3 cycles nCT (HR 3.00, 95% CI 1.38 - 6.53, p=0.006); baseline CA 19-9 >100 (HR 2.73, 95% CI 1.52 - 4.90, p=0.001); BR disease (HR 2.20, 95% CI 1.27 – 3.81, p=0.005); not receiving RT (HR 1.91, 95% CI 1.04 - 3.53, p=0.038). Regimen choice was not associated with OS. Conclusions: In this real-world PC dataset, surgical resection remains the mainstay of curative therapy. Inadequate nCRT/nCT lead to suboptimal outcomes, likely reflecting patient physiology and disease biology effects. Future trials should focus on maximizing neoadjuvant therapy with the goal of resection.[Table: see text]