bluuebunny/crossref_metadata_2025_split huggingface dataset:
Race, age, and sex differences on the influence of obesity on colorectal cancer (CRC) sidedness and mortality: A national cross-sectional study.
Authors: Ulanja Mark Bilinyi , Beutler Bryce D. , Antwi-Amoabeng Daniel , Rahman Ganiyu A. , Ulanja Reginald N. , Mabrouk Tariq , Alese Olatunji B. 
Published: June 2022

3527 Background: CRC sidedness has recently been recognized as a significant prognostic factor for survival; left-sided colorectal cancer (LCRC) is associated with superior outcomes as compared to right-sided colon cancer (rCC). Although obesity has long been recognized as a risk factor for CRC, the influence of obesity on CRC sidedness remains to be elucidated. To evaluate the effect of obesity on CRC sidedness and determine how race, age, and sex affect mortality among individuals with obesity and CRC. Methods: A survey-weighted analysis was conducted using data obtained from the National Inpatient Sample (NIS) between 2016 and 2019. Results: Of the 24,549 patient discharges included in the cohort with a diagnosis of CRC and a reported body mass index (BMI), 52.6% were LCRC and 47.5% were rCC. The race distribution was 67.7% White, 17.6% Black, 10.0% Hispanic, and 4.8% Other (American Indian, Asian, Pacific Islander, or Alaskan Native). Overweight and obese individuals were more likely to have rCC as compared to normal weight patient discharges [adjusted OR (aOR) = 1.28; 95% CI:1.17 – 1.39 and aOR = 1.45; 95% CI:1.37 –1.54, respectively). In addition, among the obese population, Blacks were more likely to have rCC as compared to Whites (aOR = 1.23; 95% CI: 1.09 – 1.38). Normal weight, overweight, and obese individuals in the “Other” race category had increased odds of death as compared to all other races (aOR=1.18; 95% CI:1.13-1.22; aOR=1.09 95% CI: 0.99-1.19; and aOR=1.19; 95% CI: 1.13-1.25, respectively). Overweight and obese patient discharges over the age of 65 years were more likely than their younger counterparts to present with rCC. As compared to males, females had a higher likelihood of presenting with rCC irrespective of weight, but lower mortality across all weight categories (Table). Conclusions: Obesity is associated with an increased risk of rCC. Racial disparities in CC sidedness and outcomes are particularly pronounced among the overweight and obese population. Investigation into causes of these disparities may help improve outcomes among all individuals with CRC. [Table: see text]
Trends in ethnic-specific colorectal cancer mortality in patients with and without diabetes in the United States: A CDC database population-based study 2011-2019.
Authors: Al Armashi Abdul Rahman , Al Zubaidi Anas , Hammad Faris , Elantably Dina , Patell Kanchi , Somoza-Cano Francisco , Krishna Chandar Apoorva , Ravakhah Keyvan , Alkrekshi Akram 
Published: June 2022

3545 Background: Colorectal cancer (CRC) is the third most frequent type of cancer and the second most lethal in both sexes combined. CRC is strongly associated with both environmental and genetic risk factors. Previous studies reported an increased mortality in CRC patients with diabetes mellitus, however, the interplay between ethnicity and diabetes mellitus was not explored. This study analyzes trends in mortality across ethnic groups and assess the impact of diabetes mellitus. Methods: We queried the Multiple Cause of Death database (International Classification of Diseases, 10th revision) between 2011 and 2019, we identified all patients (Hispanic and non-Hispanic origin) who died of a malignant neoplasm of the colon, rectosigmoid junction, and rectum {Codes C18.x to C20.x reported as the underlying cause of death (UCD)}. Then we identified the same group (UCD) among individuals with diabetes (Insulin-dependent diabetes mellitus and non-insulin-dependent diabetes mellitus) (Codes E10.x to E11.x reported as multiple causes of death). Age-adjusted mortality rates per million persons (PMP) were estimated, standardized to US census data from 2000, and stratified by Hispanic origin. Results: In the general population, a total of 464,058 deaths from CRC were identified, with an overall age- adjusted mortality rate of 137.9 PMP (Hispanic: 109.3, Non-Hispanic: 141.1). Overall, age-adjusted mortality declined by 13% among Hispanic, from 118.1 PMP in 2011 to 102.9 PMP in 2019, and by 8% among non-Hispanic, from 153.3 PMP in 2011 to 141.1 PMP in 2019. In the diabetic population, a total of 8679 CRC death were identified, with an overall age-adjusted mortality rate of 2.6 PMP (Hispanic: 3.6, Non-Hispanic: 2.5). Age-adjusted mortality increased by 32% in Hispanic from 3.1 PMP in 2011 to 4.1 PMP in 2019 and by 13% in non-Hispanic from 2.4 PMP in 2011 to 2.7 PMP in 2019. Conclusions: This study concludes that between 2011 and 2019, the CRC mortality was reduced in both Hispanic and non-Hispanic in the general population. Notably, this tendency was not observed in the diabetic population, where mortality increased, particularly among Hispanic. Additional studies are warranted to determine the causes of the rise among diabetics and strategies for minimizing the disparity between Hispanic and non-Hispanic. [Table: see text]
Effects of liver metastases on efficacy of immune checkpoint blockade in treatment refractory, metastatic colorectal cancer (CRC): CCTG CO.26.
Authors: Chen Eric Xueyu , Loree Jonathan M. , Tu Dongsheng , O'Callaghan Christopher J. , Kennecke Hagen Fritz , Jonker Derek J. , Chaudhary Ahmad , Colwell Bruce , Harb Mohammed , Aucoin Nathalie , Couture Felix , Samimi Setareh , Kavan Petr , Aubin Francine , Samson Benoit , Goffin John R. , Berry Scott , Abbas Tahir , Koski Sheryl L. , Wei Alice Chia-chi 
Published: June 2022

3600 Background: Immune checkpoint blockade has limited activity in microsatellite-stable (MSS) or mis-match repair proficient (pMMR) CRC. Recent findings suggest that immunotherapy efficacy may be modulated by the presence of liver metastases. We conducted a retrospective analysis of the Canadian Cancer Trials Group (CCTG) CO.26 study to investigate the relationship between the presence of liver metastases and activity of immune checkpoint blockade. Methods: The CCTG CO.26 study was a randomized phase II study (NCT02870920). Pts with treatment refractory CRC were randomized to durvalumab, tremelimumab and best supportive care (BSC) or BSC alone in a 2:1 fashion. Treatment consisted of durvalumab (1500 mg) q 28 days and tremelimumab (75 mg) q 28 days for the first 4 cycles. The primary endpoint was overall survival (OS) and a two-sided p-value <0.10 was considered significant. Results: Between 08/20106-06/2017, 180 pts were enrolled and 179 treated as randomized. Pt baseline characteristics were balanced between groups. With a median follow-up of 15.2 months, the median OS was 6.6 months for durvalumab and tremelimumab and 4.1 months for BSC (p = 0.07; Hazard ratio (HR): 0.72, 90% confidence interval (CI): 0.54 – 0.97). Progression free survival (PFS) was 1.8 months and 1.9 months respectively (HR 1.01, 90% CI: 0.76 – 1.34). Disease control rate (DCR) was 22.6% for durvalumab and tremelimumab and 6.6% for BSC (p = 0.006). At study entry, liver metastases were absent in 29.4% pts. Pts without liver metastases had improved OS compared to those with liver metastases, irrespective of treatments. PFS was significantly longer in those without liver metastases on durvalumab and tremelimumab (HR: 0.55, 90% CI: 0.31 – 0.97, p = 0.08, interaction p = 0.02). DCR was 49% in patients without liver metastases with durvalumab and tremelimumab, compared to 10% in those with liver metastases (Odds Ratio: 0.12, 90% CI: 0.05 – 0.26). Conclusions: Pts without liver metastases had improved OS and PFS, and higher DCR. Absence of liver metastases may be an indicator for improved efficacy of immune checkpoint blockade and should be investigated in future studies. [Table: see text]
Effect of adjuvant chemotherapy in patients with stage III colon cancer based on the Multi-Institutional Registry of Large Bowel Cancer in Japan.
Authors: Yamada Yasuhide , Kobayashi Hirotoshi , Nagashima Kengo , Sugihara Kenichi 
Published: June 2022

3610 Background: A fluoropyrimidine plus oxaliplatin is the standard of care for stage III colon cancer but a fluoropyrimidine alone is also recommended for stage III patients in Japanese and other practice guidelines. We assessed efficacy of adjuvant fluoropyrimidine with or without oxaliplatin across a population of stage III colon patients in the Multi-Institutional Registry of Large Bowel Cancer in Japan. Methods: 7,024 of stage III colorectal cancer patients in this registry were analyzed. Endpoints were relapse-free survival (RFS) and overall survival (OS). Results: All patients received adjuvant chemotherapy between 2008 and 2011.Patient characteristics except lymph node metastases were well balanced across groups. The RFS of fluoropyrimidine with or without oxaliplatin show comparable efficacy for stage III, even for stage IIIc patients, less than 70 years old, and T4 or N2b. Median follow-up was 74.9 months in oxaliplatin combined therapy and 74.7 months in fluoropyrimidine monotherapy. The additive efficacy of oxaliplatin was not shown for RFS and OS. Conclusions: Adjuvant fluoropyrimidine monotherapy and fluoropyrimidine plus oxaliplatin show comparable efficacy benefits for the treatment of stage III of Japanese colon cancer patients; supporting fluoropyrimidine alone as standard options for the adjuvant therapy of stage III in Japan. [Table: see text]
Total neoadjuvant chemoradiation combined with neoadjuvant PD-1 blockade for patients with pMMR, high-risk, and locally advanced middle to low rectal cancer.
Authors: WU Aiwen , Li Yingjie , Ji Dengbo , Zhang Li , Zhang Xiaoyan , Cai Yong , Zhang Yangzi , Yao Yunfeng , Wang Lin , Leng Jiahua , Zhan Tiancheng , Sun Ying-Shi , Li Zhongwu , Cui Xiaoli , Luo Haitao 
Published: June 2022

3611 Background: Total neoadjuvant therapy (TNT) with chemotherapy and chemoradiotherapy (CRT) is the standard treatment for locally advanced rectal cancer patients, especially for those with high risk factors. And the effects of immune checkpoint inhibitors (ICIs) on rectal cancer with defect mismatch repair (dMMR) have been demonstrated. However, the efficacy of TNT combined with PD-1 blockage for rectal cancer patients with proficient mismatch repair (pMMR) is unknown. The purpose of this study is to evaluate the clinical safety and efficacy of neoadjuvant PD-1 blockade combined with TNT in locally advanced rectal cancer with pMMR. Methods: We designed a prospective, single-arm, phase II study on stage II and III dMMR rectal cancer with high risk factors. Patients received neoadjuvant POC regimen (PD-1 inhibitor, camrelizumab, also called SHR01210, 200mg d1, Oxaliplatin 130mg/m2 d1 and Capecitabine 1250mg/m2 bid1-14, q3wks) for three cycles, then with long course chemoradiation (IMRT, 1.8Gy/f*25f). If there were no disease progression occurs, patients would be treated with another two cycles of CapeOx. The primary endpoint was pathological complete response rate (pCR rate), and the secondary outcome include adverse events and surgical complication. Biopsies and plasma pre-neoadjuvant therapy were collected and performed with whole-exome sequencing (WES), and ctDNA sequencing, respectively. Results: 27 patients were screened, of whom 25 patients were enrolled. All patients have completed the TNT. After neoadjuvant treatment, 21 patients underwent TME surgery. 7 (33.3%) patients were pCR, 3 (14.3%) achieved clinical complete or near complete response and 7 (33.3%) had a major pathological response. No progressive disease was found. WES and ctDNA sequencing analysis showed that tumor mutation burden (TMB) and level of ctDNA did not differ significantly between responders and non-responders. However, 3 responders with TMB high were found to be defective in other DNA damage repair pathways. Conclusions: Total neoadjuvant chemoradiation combined with neoadjuvant PD-1 blockade can achieve high pathological response rate, demonstrating its antitumor efficacy in pMMR locally advanced rectal cancer patients with high risk factors.
Adiposity in resectable colorectal cancer.
Authors: Hopkins Jessica , Bigam David , Baracos Vickie , Eurich Dean , Reif Rebecca , Sawyer Michael B. 
Published: June 2022

3614 Background: Sarcopenia and myosteatosis affect survival in colorectal cancer (CRC). The role of adiposity is not yet fully elucidated. This study explores visceral and subcutaneous adipose tissue (VAT/SAT) distributions, and how they affect overall (OS), disease-free (DFS) and cancer specific survival (CSS). Methods: This retrospective cohort study, included resected stage I-III CRC in Alberta from January 2007 to December 2009. We excluded recurrent/metastatic disease or no CT scan. This study was approved by the Health Research Ethics Board at the University of Alberta. Body composition parameters were measured from CT scans. Sarcopenia and myosteatosis were defined by cohort-specific cut-off values. Total and visceral fat areas were indexed by height, and cohort-specific cut-offs defined total and visceral obesity (VO). SAT (SC:TFR) and VAT (V:TFR) to total adipose ratios were compared by gender, as described by Fleming. SAT and VAT fat radiodensity (Hounsfield units, HU) was measured and divided into quartiles. Differences between groups were compared with student’s t-test and Fisher Exact test. Cox proportional hazard models were created, adjusting for important covariates, to assess adiposity effects on OS, DFS and CSS. Results: Our cohort included 968 patients with a median follow up of 63.5 months. The majority were stage II (38.6%) and III (51.0%). In total, 67.9% had total obesity and 51.0% had visceral obesity. In males, there was no difference in the incidence of myosteatosis or sarcopenia, regardless of V:TFR or SC:TFR. In women, those with a high V:TFR or SC:TFR had significantly higher incidence of myosteatosis, but not sarcopenia. Men and women with elevated V:TFR had significantly lower VAT and SAT HU (p<0.001, p=0.0113). Those with elevated SC:TFR had significantly higher VAT and SAT HU (p<0.001). VAT and SAT HU was lowest in those with myosteatosis alone (p<0.001; p=0.005). In survival analysis, VO and VAT HU quartiles predicted worse OS in uni-, but not multivariate analysis. SAT HU quartiles predicted worse survival in uni- and multivariate analysis, with the highest quartile of SAT HU predicting increased risk of death (HR 1.35, p=0.037). Adiposity was not predictive of CSS or DFS in uni- or multivariate analysis. Conclusions: This study demonstrated changes in VAT/SAT in relation to well described body composition parameters. SAT HU may have a more important role in OS than visceral adipose characteristics, despite known metabolic characteristics of VAT. True roles of adipose tissue in CRC outcomes remains unclear. VAT/SAT measurements using cross-sectional imaging allows for a detailed analysis and understanding of how adiposity may affect survival. [Table: see text]
Trend of sphincter-preserving surgeries for resectable low rectal cancer: A 20-year experience in China.
Authors: HU Qingqing , Zheng Kuo , Yao Yuting , Zhou Yuan , Meng Ronggui , Wang Hao , Hao Liqiang , Zhang Yongjing , Qiu Hong , Zhang Wei 
Published: June 2022

3615 Background: Over the last decades, patients with low rectal cancer have realized better functional, morbidity, and quality-of-life outcomes from improvements in surgical techniques in sphincter preservation. We aimed to quantify the trend in sphincter-preserving surgeries for low rectal cancer over 20 years in China. Methods: Between November 1999 and October 2021, a cohort of patients with pathologically confirmed primary malignant rectal tumor ≤5cm from the anal verge and who received selective surgery at Changhai Hospital, was identified. Demographic and clinical data were extracted from electronic medical records. Survival data were collected from outpatient medical records and follow-up phone interviews. A Joinpoint Regression Model was used to analyze trends in surgical procedures by average annual percentage change (AAPC). A Cox proportional hazards regression model adjusting for demographic and clinicopathological confounders was used to assess the overall survival for patients with sphincter-preserving surgery vs. abdominoperineal resection (APR). Results: Among 19,276 patients with colorectal cancer, 4,072 (21.1%) had a tumor in the low rectum during the study period; 3,025 (74.2%) underwent a sphincter-preserving surgery and 1,047 (25.7%) received APR. Sphincter-preserving surgery increased 3.6% per year (AAPC 3.6, p=.006). Anterior resection was the most performed procedure (86.3%) and maintained a steady trend (AAPC 0.13, p=.49), while intersphincteric resection (including conformal sphincter preservation operation) increased 49.4% annually (AAPC 49.4, p=.003). Laparoscopic techniques increased 15.1% per year (AAPC 15.1, p=.035). Sphincter-preserving surgery increased annually for tumors ≤2cm, 2-3cm and 3-4cm from the anal verge (AAPC 7.08, p=.001; 4.69, p=.001; 2.66, p=.001, respectively). A total of 2,854 patients had sufficient vital status data for inclusion in the survival analysis. The characteristics of those with and without a follow-up encounter were comparable. Patients with sphincter-preserving surgery had a lower risk of death compared to APR (adjusted HR 0.78, 95% CI, 0.65-0.93, p=.01). Conclusions: Utilization of sphincter-preserving surgeries increased significantly over the last 20 years. Patients with low rectal cancer who underwent sphincter preservation had better survival than similar patients who underwent APR.[Table: see text]
Total cost of care differences in National Comprehensive Cancer Center (NCCN) concordant and non-concordant patients with colon cancer.
Authors: Sapkota Ujwal , Cavers William , Reddy Shirisha , Avalos-Reyes Elisea , Johnson Kjel Andrew 
Published: June 2022

3624 Background: National Comprehensive Cancer Network (NCCN) colon cancer treatment guidelines have been developed to standardize and improve quality of care. While studies have shown that concordance to these guidelines improves survival, little information exists regarding the impact of concordance and total cost of care (TCOC). This study aimed to evaluate the economic impact of NCCN concordance in patients with colon cancer versus those receiving non-concordant therapies. Methods: This is a retrospective study of patients throughout the United States with colon cancer at a large national Medicaid, Medicare, and commercial insurer from January 1, 2019 - December 31, 2020. NCCN regimen concordance was identified from pharmacy and medical claims and defined as concordant if the entire prescribed treatment regimen matched an NCCN regimen (Level 1 and 2a); patients not receiving an NCCN recommended regimen were deemed to be non-concordant. TCOC and its cost components were contrasted on a matched population of concordant and non-concordant patients with a ratio of 2:1. To eliminate possible selection bias and differences in baseline characteristics that could affect cost, propensity scores were developed using logistic regression and used to match patients on age, comorbidity, socioeconomic status (SES) index and treatment type (chemotherapy and radiation). Results: A total of 937 patients with colon cancer were included (Medicare n = 588; commercial fully insured n = 149; commercial self-insured n = 200). Beginning with and including the first treatment and for up to 180 days after, the TCOC in the concordant group was significantly less among Medicare patients; a reduction of 33% (a difference of $2,986, p < 0.001) in TCOC per member per month (PMPM) was observed. This cost difference was driven primarily by medical chemotherapy spend as concordant patients spent 26% less (a difference of $1,160, p < 0.001). Concordant patients spent 29% less PMPM than non-concordant patients (a difference of $35, p < 0.001) on Evaluation and Management compared to non-concordant patients. There were no significant differences in Inpatient, Emergency Room and Radiation Oncology costs among all patients (p > 0.05). No significant differences were seen in TCOC among commercial fully insured (a difference of $69, p = 0.99) and commercial self-insured (a difference of $5,413, p = 0.07) patients, likely due to smaller sample sizes. Conclusions: In this study, Medicare patients who received NCCN concordant colon cancer regimens spent significantly less in TCOC than patients receiving non-concordant regimens. These savings highlight the importance of evidence-based guidelines in treatment determinations to optimize the value of cancer care. More extensive studies are needed to assess if these findings translate to commercially insured patients and the long-term economic impact of concordance.
A phase II study of stereotactic body radiotherapy (SBRT) combined with sintilimab in patients with recurrent or oligometastatic hepatocellular carcinoma (HCC).
Authors: Chen Yixing , Yang Ping , Du Shisuo , Zhou Jian , Huang Cheng , Zhu Wenchao , Hu Yong , Yu Yiyi , Liu Tianshu , Zeng Zhaochong 
Published: June 2022

4071 Background: SBRT is an emerging treatment option for oligometastatic cancer disease. Preclinical studies have shown the synergistic effects between the radiotherapy and immunotherapy. Early clinical data also suggested that immunotherapy might augment the local effects of radiotherapy and decrease metastatic recurrence. This study aimed to evaluate the efficacy and safety of SBRT combined with sintilimab (a PD-1 antibody) in patients with recurrent or oligometastatic HCC. Methods: In this single arm, phase II study (NCT03857815), eligibility criteria included Pts with recurrent or oligometastatic HCC (defined as ≤5 metastatic/recurrent lesions), Child-Pugh class A, ECOG PS ≤ 1. Pts received sintilimab 200 mg IV Q3W for up to 12 months, progressive disease, unacceptable toxicity, or withdrawal. SBRT to all lesions was started at cycle 1 day 1. Primary endpoint was progression free survival (PFS) per RECIST 1.1. Secondary endpoints included safety, objective response rate (ORR), disease control rate (DCR) and overall survival (OS). Results: At data cutoff (Dec 28th, 2021), 25 pts with 32 lesions were treated with SBRT + Sintilimab. SBRT was delivered at a median dose of 54 Gy (range 48-60) in 6 fractions (range 6-10) and the median follow-up time was 16.9 months (range 3.9-32.1). In those 25 evaluable pts, median age was 64 years (range 37-77), 24 (96%) were male, 24 (96%) were HBV+, 6 (24%) had extrahepatic metastasis, most pts had prior ≥2 local therapies. The confirmed ORR was 96% (24/25) according to RECIST 1.1 with 18pts CR and 6pts PR. 6-mo and 12-mo PFS rate was 100% and 70% (95%CI, 52.3%-93.6%), respectively.12-mo local control rate was 100%. Median PFS and OS was still not mature. Treatment-related adverse events (TRAEs) occurred in 14 pts (56%). Most common TRAEs were rash (16%), platelet count decreased (12%), myositis (8%). Grade 3 TRAEs (myositis) occurred in 1pt (4%). There were no grade 4-5 TRAEs. TRAEs led to discontinuation in 6 pts (24%). SAE were myocarditis (1pt Grade1), viral hepatitis (1pt Grade 3, treatment-independent) and upper gastrointestinal haemorrhage (1pt Grade 3, PD related). Conclusions: The combination of SBRT with Sintilimab was tolerable and showed an encouraging ORR of 96% in pts with recurrent or oligometastatic HCC. Longer follow up is required to further evaluate the efficacy and safety. Clinical trial information: NCT03857815.