bluuebunny/crossref_metadata_2025_split huggingface dataset:
Real-world impact of initial treatment modality on survival outcomes in patients with stage I-III pancreatic ductal adenocarcinoma.
Authors: Prakash Ajay , Schwanke Joschua , Le-Kumar Thuy-Hong , Patterson Brooke , Marmor Schelomo , Tignanelli Christopher , Jensen Eric Hans , Lou Emil 
Published: January 2023

684 Background: Management of non-metastatic pancreas cancer has been extensively studied in clinical trials over the past two decades, with a growing body of non-randomized data supporting the use of neoadjuvant chemotherapy in combination with surgery. Guidelines now recommend use of this treatment paradigm, but real-world follow-up is critical in understanding how these recommendations are translated into the clinic. Using real-world data, we aimed to evaluate the treatment modalities and subsequent survival outcomes for patients diagnosed with pancreatic adenocarcinoma within the MHealth/Fairview medical system. Methods: We identified 844 patients diagnosed with stage I-III pancreatic adenocarcinoma within the MHealth/Fairview system (Minneapolis, MN) from 2001-2021 with EHR data enriched by cancer registry abstracted data. Diagnoses were confirmed with ICD-10 coding and clinical staging. Patients were stratified by initial treatment with either surgery (N = 345) or neoadjuvant-intent chemotherapy (n = 499). Correlation between initial treatment modality, demographic identifiers, and time to treatment was calculated using both Pearson and Spearman method. Effect of initial treatment modality on overall survival was calculated using a Cox proportional Hazard (CPH) model controlling for age, sex, clinical stage, and time to treatment initiation (TTI). A sub-analysis with race was performed on samples where these data were available. Results: Relative to neoadjuvant chemotherapy, up-front surgery was associated with a significantly improved overall survival (Hazard Ratio (HR) 0.55 95% Confidence Interval (CI): 0.37 – 0.76; p < 0.001), when controlling for age, sex, clinical stage, and TTI. Surgical patients also had shorter mean TTI values (21 days; p < 0.001) relative to chemotherapy (28 days), and a slightly younger patient population (mean age 63, vs 66 for chemotherapy, p = < 0.001; rho = -0.14). We observed no significant correlation between age (p = 0.027) or TTI (p = 0.12) and survival within this population. We noted no significant correlation between race, sex, or clinical stage and initial treatment modality or overall survival. Conclusions: We observed that MHealth/Fairview system patients who received upfront surgery for stage I-III pancreas cancers demonstrated improved overall survival relative to other treatment modalities, even after controlling for the differences in age and TTI found between these patients and those who undergo initial chemotherapy. This is likely due to a multitude of factors not readily captured within this data set, including surgical patient selection and tumor biology. Further work is needed to understand why these findings diverge from study norms, and to optimize care for all patients with pancreatic adenocarcinoma.
Prospective characterization of oral and gut microbiome in a high-risk pancreatic cancer cohort.
Authors: Baydogan Seyda , Mohindroo Chirayu , Montiel Maria Fernanda , Petrosino Joseph , Maitra Anirban , Kim Michael Paul , Bhutani Manoop S. , White James R , McAllister Florencia 
Published: January 2023

691 Background: Pancreatic cancer (PC) is the third leading cause of cancer death in the United States. The high mortality associated with PC is attributed to multiple reasons: lack of effective therapies, aggressive biology and late diagnosis. Due to the absence of reliable early disease biomarkers, PC screening is largely dependent on imaging. Recent studies have highlighted the importance of the gut and tumor microbiome in PC. We present here the first report of oral and gut microbiome prospective analysis of PC high-risk individuals (PC-HRI) undergoing screening. Methods: We collected periodontal and stool samples at the University of Texas MD Anderson Cancer Center from 2017-2022. A total of 448 samples, consisting of 250 oral and 198 gut samples were obtained. Samples were collected from PC (n=73), PC-HRI (n=34), and healthy (n=143) individuals. 16s rRNA sequencing was used to characterize the oral and gut microbiome and statistical analysis and correlation with imaging and clinical characteristics were performed. Results: We identified three phyla, namely Proteobacteria, Actinobacteria, and Fusobacteria as significantly more abundant in the gut microbiome of PC patients. Conversely, Proteobacteria was decreased in the oral microbiome of PC patients. At the class level, Gammaproteobacteria (GP) oral/gut ratio was significantly decreased in PC patients compared with healthy individuals (p=0.02). Analysis of PC-HRI revealed also low GP oral/gut ratio in high-risk individuals who were diagnosed with worrisome pancreatic focal lesions. Interestingly, Gammaproteobacteria (GP) is one of the main classes of bacteria detected in pancreatic cancer tissue. GP shifts in oral and gut environments could be implicated in pancreatic early tumorigenesis and serve as biomarker of the disease. Additionally, gut bacteria with metabolic pathways related to lipid metabolism were more enriched in PC patients and PC-HRI with focal lesions compared to healthy controls. Conclusions: Gammaproteobacteria oral/gut ratio represents a potential novel biomarker which could predict presence of early high risk-pancreatic focal lesions in PC-HRI. Taken together, this report provides observational evidence about changes in oral and gut microbiome in patients with pancreatic cancer but even more importantly, the fact that those changes could be detected in PC-HRI with early high-risk lesions. Broader validation in other high-risk cohorts would be required. Detection of GP oral/gut ratio would represent an inexpensive, non-invasive method that could be useful for PC screening. Functional studies should be performed to determine how GP shifts can contribute with pancreatic tumorigenesis. Research supported by CPRIT (Grant Number: RP200173) and philanthropic funding through the MD Anderson Moonshot Program.
Analysis of the treatment outcome of ampulla of Vater carcinoma and the usefulness of postoperative adjuvant chemotherapy.
Authors: Ogawa Shinichiro , Adachi Tomohiko , Matsushima Hajime , Imamura Hajime , Kurotaki Koki , Fukumoto Masayuki , Yoshino Kyohei , Enjoji Takahiro , Tetsuo Hanako , Matsumoto Ryo , Hara Takanobu , Soyama Akihiko , Ito Shinichiro , Hidaka Masaaki , Kanetaka Kengo , Eguchi Susumu 
Published: January 2023

692 Background: Patients with ampulla of Vater carcinoma with lymph node metastasis reportedly have a poor prognosis and require postoperative adjuvant therapy. However, due to the small number of published cases, the efficacy of postoperative adjuvant therapy has not yet been established with a high level of evidence. Objective: The aim of this study was to describe the outcome of patients surgically treated for ampulla of Vater carcinoma in our department, evaluate the effectiveness of adjuvant chemotherapy (AC), and clarify which patient groups may benefit from AC. Methods: The study cohort comprised 46 patients who underwent surgery for ampulla of Vater carcinoma in our department from October 2005 to March 2022. We evaluated the clinicopathological background characteristics (tumor size, gross morphology, pancreatic/duodenal invasion, peripancreatic head lymph node metastasis), overall survival (OS), and relapse-free survival (RFS), and compared the OS and RFS in patients with versus without AC. We then analyzed the factors related to the long-term outcome of patients treated for ampulla of Vater carcinoma. Results: During a median observation period of 33.7 months, the 5-year OS and RFS were 63.1% and 61.7%, respectively. Recurrence was observed in 14 patients (30%), with recurrence occurring less than 1 year postoperatively in seven patients (15%). Fifteen patients received AC (chemotherapy regimen: S-1 in 11 patients, GEM in four). The 5-year OS rates with and without AC were 70.3% and 48.2%, respectively (p=0.093). The 5-year RFS rates with and without AC were 72.5% and 42.8%, respectively (p=0.058). Univariate analysis of the total patient cohort showed that the factors related to 5-year RFS were pancreatic invasion (p=0.01), duodenal invasion (p=0.03), and N+ (p=0.004). In multivariate analysis, the only factor related to 5-year RFS was N+ (HR 3.53; 95% CI, 0.99–12.6; p=0.03). The 5-year OS rates in patients with and without N+ were 77.1% and 42.7%, respectively (p=0.04). The 5-year RFS rates in patients with and without N+ were 80.4% and 32.1%, respectively (p=0.004). Conclusions: AC showed a tendency to be effective in preventing postoperative recurrence of ampulla of Vater carcinoma. AC may be particularly beneficial in N+ cases.
Effect of neoadjuvant therapy pathway (NATP) for pancreatic cancer on overall patient outcomes.
Authors: Cooper Dylan , Sidiqi Baho , Parakrama Ruwan , Demyan Lyudmyla , Pasha Shamsher , Pinto Danielle , Zavadsky Tiffany , Zou Xianghui , Patruni Sunita , Kapusta Adrianna , Standring Oliver , Nosrati Jason , Tchelebi Leila T , Weiss Matthew John , Herman Joseph M. , King Daniel 
Published: January 2023

695 Background: Significant variation exists in the management of potentially resectable pancreatic ductal adenocarcinoma (PDAC) across healthcare systems. We describe the results of a newly implemented neoadjuvant therapy pathway (NATP) in New York’s largest, most diverse health care system. Methods: The NATP was established in June 2019, consisting of a single-day pancreas multi-disciplinary clinic (PMDC) visit, followed by neoadjuvant therapy (NAT), imaging at specific intervals, and PMDC re-reviews at two and four months, prior to consideration of radiation and surgical resection. We conducted an IRB-approved retrospective analysis of patients enrolled in this pathway. Primary endpoints included completion of NATP and overall survival (OS). Results: The cohort consisted of 67 patients reviewed at PMDC and planned for NAT: 45% men, mean age 69.9 years, and 43% non-White between June 2019 and February 2022. Surgical stage at diagnosis was locally advanced (LAPC) 48%, borderline resectable (BRPC) 37% and resectable (RPC) 15%. Of 67 patients, 55 began the NATP (9 transferred care, and 3 declined NAT) and 28 (51%) completed NATP and underwent surgical exploration. Ten completed NATP and did not become surgical candidates, and 2 are still undergoing NAT. NATP was not completed in 15 patients due to 11 metastases (73.3%), 3 deaths (20%) and 1 local progression (6.7%) during NAT. NAT consisted of gemcitabine/nab-paclitaxel (GnP, 28%; 201 total cycles), FOLFIRINOX (45%; 251 total cycles), or a combination of both regimens (26%) with 31 (56%) patients receiving radiotherapy (97% SBRT). Of 28 patients who were explored, 86% underwent successful resection (62.5% R0, 16.7% R1 < 1mm and 20.8% R1). With median follow-up of 12.6 months, there were 17 deaths (31%) and median OS was reached at 20.9 mo (95% CI 10.5, 31.2); GnP vs. FOLFIRINOX median OS were 12.7 mo (95% CI 7.8, 17.6) vs. 26.1 mo (95% CI 9.3, 42.9) (p = 0.026). Median OS was not reached for the resected patients vs.16.3 months for non-resected (p = 0.006). Pathway adherence was seen in 28 (53%), with adherence improving median OS 20.9 mo vs. 16.3 mo (p = 0.039). NATP completion improved median OS 26.1 mo vs. 15.9 mo (p < 0.001). The percentage of patients that remained within the Northwell Health system for their post-NAT was higher among patients in the pathway, compared to prior (87% versus 44%). Conclusions: Implementation of NATP for pancreatic cancer within a single healthcare system increased the percentage of PDAC patients who underwent surgical resection and improved patient retention rate. Our data lay the foundation for further analysis of long-term outcomes of NAT in these patients.
The association of the CARE Frailty Index with survival among older adults with pancreatic cancer.
Authors: Kumar Vinod , Williams Grant Richard , Giri Smith , Outlaw Darryl Alan , Akce Mehmet , Dotan Efrat , El-Rayes Bassel F. , Harmon Christian , Tucker Abigail , Reddy Sushanth , Rose J. Bart , Dudeja Vikas , Hashmi Salila 
Published: January 2023

699 Background: Outcomes of older adults with pancreatic cancer are highly variable with increased susceptibility to chemotherapy toxicities and inferior survival compared to younger patients. Determining which older adults are at higher risk for adverse outcomes remains a clinical challenge. We evaluated the association of a novel patient-reported geriatric assessment (GA)-based frailty index with survival among older adults with pancreatic cancer. Methods: Older adults (≥60y) referred for initial consultation at the UAB GI oncology clinic were prospectively enrolled in the Cancer and Aging Resilience Evaluation (CARE) registry. All patients underwent a patient-reported GA capturing multiple aging-related domains of health. The 44-item CARE frailty index (CARE-FI) based on the principles of deficit accumulation was utilized to determine frailty. The primary outcome was overall survival (OS) from the time of GA. Kaplan Meier method was used to estimate OS and comparisons between groups were by log-rank. A multivariate Cox regression model adjusted for age, sex, race, and cancer stage. Results: A total 254 older adults with pancreatic cancer were included; median age 70y, 52.4% male, 77% non-Hispanic white and 43.4% with stage IV disease. Overall, 40.1% (n=102) were frail, 26.0% (n=66) pre-frail and 33.9% (n=86) robust. No significant clinico-demographic differences across the 3 frailty groups were found. Differences in OS over two-year period was observed across the three frailty groups by the KM method ( p=0.008). In multivariate cox regression, frail status was associated with an increased risk of mortality (HR 1.9 [95% CI 1.19 – 2.98]; p=0.01) compared to robust status after adjustment for aforementioned confounders. Conclusions: The CARE-FI is a novel frailty index built on the principles of deficit accumulation using a patient-reported GA and is independently associated with survival among older adults with pancreatic cancer.[Table: see text]
Calculator for detection of colorectal adenomas by using artificial intelligence models in patients with chronic hepatitis C.
Authors: Gogtay Maya , Singh Yuvaraj , Yekula Anuroop , Abraham George M. 
Published: January 2023

70 Background: Hepatitis C virus (HCV) is known for its oncogenic potential, especially in hepatocellular carcinoma and non-Hodgkin lymphoma. On review, several studies have indicated that patients with chronic hepatitis C (CHC) have an increased risk of developing colorectal cancer (CRC). We developed an artificial intelligence (AI) based tool using machine learning (ML) algorithms to help stratify these patients into a higher risk of CRC/adenomas. Methods: The study was approved by the institutional review board. We developed an AI automated calculator uploaded to a graphical user interface (GUI), and we applied ML to train models to predict the probability and the number of adenomas detected on colonoscopy. Data collected were age, smoking history, significant alcohol consumption, aspirin intake, ethnicity, HCV status, gender, body mass index (BMI), and colonoscopy findings. The models can operate either in the presence or absence of the above parameters. Data sets were split into 70:30 ratios for training and internal validation. Scikit-learn StandardScaler was used to scale values of continuous variables. We used the colonoscopy findings as the gold standard and applied a deep learning architecture to train six ML models for prediction. The ML models used were Support Vector Classifier, Random Forest, Bernoulli Naïve Bayes (BNB), Gradient Boosting Classifier (GBC), Logistic Regression, and Deep Neural Networks. Additional regression models were trained and tested to predict the number of polyps. A Flask (customizable python framework) application programming interface (API) was used to deploy the trained ML model with the highest accuracy as a web application. Finally, Heroku was used for the deployment of the web-based API to https://adenomadetection.herokuapp.com. Results: Data was collected for 415 patients, of which only 206 had colonoscopy results. On internal validation with the remaining patients, BNB predicted the probability of adenoma detection with the highest accuracy of 56%, precision of 55%, recall of 55%, and F1 measure of 54%. Support Vector Regressor (SVR) predicted the number of adenomas with the least mean absolute error (MAE) of 0.905. Conclusions: Our AI-based tool shows an association between CHC and colorectal adenomas. This tool can help providers stratify patients with CHC for early referral for screening colonoscopy. Along with giving a numerical percentage, the calculator can also comment on the number of adenomatous polyps a gastroenterologist can expect while doing a colonoscopy, thus prompting a higher adenoma detection rate.
Efficacy of the third-line chemotherapy in patients with advanced pancreatic cancer.
Authors: Kim Bomi , Ahn Jinwoo , Jung Jae Hyup , Jung Kwangrok , Lee Jong-Chan , Hwang Jin-Hyeok , Kim Jaihwan 
Published: January 2023

711 Background: First-line FOLFIRINOX or gemcitabine plus nab-paclitaxel (GNP) have improved the survival outcomes of patients with advanced pancreatic cancer (APC) and nano-liposomal irinotecan (nal-IRI) plus 5-FU/leucovorin is proven as the second-line agents. The current study aims to assess the efficacy of the third-line palliative chemotherapy in APC. Methods: Medical records were retrospectively reviewed in a single tertiary hospital between 2012 and 2020. The enrolled patients have APC who received the first and second-line chemotherapy. To fine the efficacy of the third-line chemotherapy, Kaplan Meier curve with cox-regression analysis was performed. Results: Of total 1,152 patients with pancreatic cancer, 362 patients were enrolled. Of these, 125 received the third-line chemotherapy and 238 received only supportive care after progression of the second-line chemotherapy. Median age at diagnosis was 60.3 years (range 36.0 – 86.0) and males were 52.0%. The first-line chemotherapy regimen was FOLFIRINOX (85, 68.0%), GNP (33, 26.4%), and others (7, 5.6%). The second-line chemotherapy regimen was GNP (55, 44.0%), FOLFIRINOX (34, 27.2%). As the third-line regimen, TS-1 and nal-IRI plus 5-FU/leucovorin were 73 (58.4%) and 20 (16.0%). The median overall survival (OS) from diagnosis was 18.0 months in all patients (95% CI, 14.6 – 21.4). The median OS after progression of the second-line therapy were 15.1 (95% CI, 12.8 – 17.5) and 8.5 weeks (95% CI, 7.7 – 9.4, p=0.007) between the patients with the third-line chemotherapy and supportive care only. Of the patients with the third-line chemotherapy, female showed the significant longer OS than male (12.4 (95% CI 10.2-14.6) vs. 6.6 weeks (95% CI 13.4-19.7), p=0.042). Conclusions: The current study suggested that proceeding with the third-line chemotherapy could be recommended in some patients. Females showed significantly more benefit than males. Further research on the selection for patient who will get the benefit from the third-line therapy is necessary.
Internet-based assessment tools for predicting colorectal cancer risk: How do they communicate individualized risk to the young adult?
Authors: Janak Allison , Peacock Oliver , White Michael , Guraieb-Trueba Montserrat , Nguyen Sa Thi , Alshenaifi Jumanah , Kopetz Scott , Johnson Benny , Smith Grace L. , Chang George J. , You Y. Nancy 
Published: January 2023

72 Background: Online prediction tools for cancer risk can inform individuals about their risk and potentially encourage adoption of risk-modifying health behavior. The Colorectal Cancer Risk Assessment Tool (CCRAT) is an interactive tool developed by the National Cancer Institute for estimating colorectal cancer (CRC) risk for individuals between the ages of 45 and 85 without high risk predisposing conditions. Given the rising incidence of CRC among young adults under age 50, we aimed to investigate the performance of CCRAT in estimating their CRC risk. Methods: An institutional protocol prospectively enrolled 563 patients newly diagnosed with non-hereditary CRC and administered a health behavior questionnaire at baseline. Self-reported demographics, diet and physical activity, medication use, and family history were extracted and entered into the CCRAT ( https://ccrisktool.cancer.gov/calculator.html ) to calculate their predicted 5-year and lifetime CRC risks. Health behaviors and the predicted CRC risks in reference to the population average were compared among three groups: youngest- (aged 18-44, N = 276, 49%), young- (aged 45-50, N = 178, 32%), and older-onset (aged > 50, N = 109; 19%). Results: The patient groups did not significantly differ in gender or in family history of CRC, but the youngest group had significantly more non-White patients (27, 22, vs. 19%; p = 0.008) and distal tumors (80, 76 and 65%; p = 0.05). The youngest and young groups had a higher prevalence of morbid obesity (18 and 15% vs. 12%; p = 0.002) and active smokers (6 and 8% vs. 3%; p = 0.005). There were no significant differences in vegetable intake, moderate exercise, NSAID use, or female hormone use. The 5-year CRC risk was correctly predicted as “higher than average population” for a significantly smaller proportion of the youngest (42%) and young (45%) patients, when compared to their older counterpart (71%; p < 0.001). Similarly, the tool communicated “higher than average” lifetime risk for CRC in only 56 and 60% of the youngest and young patients, but 72% of the older ones (p = 0.021). Conclusions: The existing risk prediction tool inadequately communicated CRC risk for adults younger than 50 years of age. Risk factors underlying young-onset CRC likely differ from and extend beyond those as currently assessed. New tools capturing age-specific risk factors are needed to accurately communicate individualized risk and potentially motivate risk-modifying lifestyles.