bluuebunny/crossref_metadata_2025_split huggingface dataset:
354. THE PARADIGM OF INACCURACIES IN STAGING EARLY OESOPHAGEAL ADENOCARCINOMA
Authors: Reyhani Arasteh , Gimson Eliza , Baker Cara , Kelly Mark , Maisey Nick , Meenan John , Subesinghe Manil , Hill Mark , Lagergren Jesper , Gossage James , Zeki Sebastian , Dunn Jason , Davies Andrew 
Published: September 2022

Abstract
The clinical value of multiple staging investigations for high-grade dysplasia (HGD) or early adenocarcinoma of the oesophagus (EOC) is unclear.
A single centre prospective cohort of patients treated for EOC between 2000 and 2019 was analysed. This coincided with a transition period from oesophagectomy to endoscopic mucosal resection (EMR) as the treatment of choice for early cancers. All patients were staged with computed tomography (CT), endoscopic ultrasound (EUS), and 2-deoxy-2-[18F]fluoro-d-glucose (FDG) positron emission tomography (PET)-CT. The aim of this study was to assess the accuracy of these investigations and impact on clinical management.
297 patients with HGD or EOC were included (EMRn = 184; oesophagectomy n = 113 [preceded by EMRn = 23]). Staging patterns for both groups were similar throughout staging modalities (CT, EUS, PET-CT), showing low overall accuracy. In the EMR group, over-staging that might have changed management occurred in 10 patients (3.6%)for T-staging (T2) and 14 patients (5.0%)for positive lymph node-staging (LNM). In the oesophagectomy alone group LNM identified following surgery was rare (8.9%) and staging sensitivity for these surgically treated patients was low (CT 12.5%, EUS 12.5%, PET-CT 0.0%). Overall, PET-CT and EUS changed decision-making in less than 1%of patients with a clear CT and low risk histology criteria on EMR specimen.
Staging accuracy is low in EOC and the addition of EUS and PET-CT does not change patient decision making significantly. Histology obtained from EMR specimens contain important predicting factors that do change patient management, proving to be an excellent staging tool rather than imaging techniques, hence, EUS and PET-CT should only be used selectively in patients being assessed for EOC.
361. EARLY RECURRENCE PATTERNS AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER IN PATIENTS UNDERGOING CROSS NEOADJUVANT THERAPY
Authors: Liu Zhonghe , Li Chunguang , Liu Zhichao , Liu Jun , Li Hongxuan , Li Bin , Hua Rong , Pan Jie , Shao Jincheng , Zhu Li , Li Zhigang 
Published: September 2022

Abstract
Chemoradiotherapy (CROSS regimen) has been regarded as standard preoperative treatment for patients with locally advanced esophageal cancer, but some patients still developed early recurrence after such intensive therapy. The present study aimed to determine the factors associated with early recurrence for patients with ESCC treated by CROSS therapy within 6 months.
Patients were identified from single institution from 2019 to 2021. All patients with locally advanced ESCC who underwent CROSS regimen NCRT and following R0 esophagectomy were reviewed.
Total 115 patients were included. 19 patients (16.52%) recurred within 6 months post-surgery. 8 patients (6.96%) had local-regional recurrence with most common location was cervical lymphnodes; 11 patients (9.56%) had distant recurrence and most often occured in lung. In univariate analysis: BMI before CROSS (p = 0.03), tumor size regression (p = 0.03), ypN≧1 (p = 0.002) and neck metastases (p = 0.01) were significantly associated with local-regional recurrence. In multivariate analysis: ypN≧1 (HR = 9.08, p = 0.05) was only independent covariate. For distant recurrence, tumor size regression (p = 0.02), ypN≧1 (p &lt; 0.0001) and TRG3/4 (p = 0.01) were risk factors in univariate analysis, ypN≧1 (HR = 15.60, p = 0.01) was also independent covariate in multivariate analysis.
For patients after CROSS neoadjuvant therapy, if there are still positive lymph nodes in clinical evaluation, M staging should be performed more carefully to avoid ineffective surgery with early postoperative distant recurrence.
366. SURGERY VERSUS NON-SURGICAL TREATMENT FOR THORACIC ESOPHAGEAL CANCER IN PATIENTS OLDER THAN 70 YEARS: A RETROSPECTIVE ANALYSIS OF 749 CASES
Authors: Li Kexun , Leng Xue Feng , Du Kunyi , Liu Kun , He Wenwu , Wang Qifeng , Luo Xi , Wang Chenghao , Wang Kangning , Liu Guangyuan , Wei Xing , Li Haojun , Zhou Qiang , Li Zhiyu , Jiang Longlin , Zheng Kai , Li Changding , Mao Tianqin , Du Kunyi , Fang Qiang , Xiao WenGuang , Han Yongtao , Peng Lin 
Published: September 2022

Abstract
The highest incidence of esophageal cancer is in East Asia, but as for advanced age people, there are also many non-tumor factors affecting overall survival (OS), such as cardiovascular and cerebrovascular diseases. Our purpose is to determine whether the older patients after esophagectomy had better OS than those treated with non-surgical treatment.
Data were obtained from the Sichuan Cancer Hospital & Institute Esophageal Cancer Case Management Database (SCH-ECCM Database) and Department of Radiation Oncology Database. We retrospective analyzed esophageal cancer patients older than 70 years who underwent esophagectomy or radiotherapy/chemotherapy from Jan. 2009 to Dec. 2017. The patients were divided into two groups: surgery group (S group), and non-surgery group (NS group). Outcome measures depend on OS.
After 60.6 months of median follow-up time, 749 patients were included. 532 of 749 patients (71.0%) underwent surgery, 217 of 749 patients (39.0%) underwent non-surgical treatment including radiotherapy and/or chemotherapy. In the S group, the median OS of was 39.7 months (95% CI 33.7–45.7), while the NS group was only 24.0 months (95% CI 19.6–28.4). The OS at 1, 3, and 5 years were 84%, 52%, and 39% in the S group, respectively. In the NS group, the OS rates at 1, 3, and 5 years were 72%, 32%, and 29%, respectively (HR 0.69, 95% CI 0.561–0.846, P&lt;0.0001).
Esophageal cancer patients older than 70 years who underwent esophagectomy had significantly better OS than those who underwent non-surgical treatment based on radiotherapy and/or chemotherapy.
368. EARLY DELAYED GASTRIC EMPTYING AFTER ESOPHAGECTOMY: VALIDATION OF THE INTERNATIONAL EXPERT CONSENSUS DEFINITION (MIE GROUP)
Authors: Abdelrahman Mohamed , Fu Kathryn , Tham Ji , Emslie Katy , Ariyarathenam Arun , Berrisford Richard , Humphreys Lee , Sanders Grant , Wheatley Tim , Chan David 
Published: September 2022

Abstract
Early delayed gastric emptying (DGE) affects up to 37% of patients after esophagectomy. An international expert consensus (IEC) agreed on a diagnostic criteria in 2020. The degree of adoption of this definition worldwide is unknown and how it compares to well established definitions locally with subtle yet significant differences. The aim of this study was to compare the IEC definition of early DGE to the definition at the University.
All patients who underwent esophagectomy for cancer at UHP between April 2019–August 2020 were analysed. The IEC definition was applied retrospectively and the rates of DGE were compared between the two criteria.
One hundred consecutive patients [74 Male (74%), median age (range) 68 (45–83 years)] were analysed. The rates of early DGE according to the IEC and UHP definitions were 20% and 28% respectively (p = 0.246). Eight patients had anastomotic leak, 6 of whom had DGE. Pneumonia was diagnosed in 28 patients (8 and 6 in the IEC and UHP groups respectively). Twenty-nine patients (29%) had pyloric balloon dilatation (PBD). Seventeen patients in the index admission and twelve at later date. Of the 17 patients 9 were in the IEC group and 11 in the UHP group.
The UHP definition does seem to match the MIE consensus definition and is not inferior. The dynamic process of DGE does support the policy our unit has to continue monitoring patients with chest radiographs. This not only identifies DGE early and modify management but also allows assessment of conduit after the patient starts eating.
Definition of Early Delayed Gastric Emptying post Esophagectomy.pdf (could not be inserted).
370. EXTERNAL VALIDATION OF A NOMOGRAM PREDICTING CONDITIONAL SURVIVAL AFTER CURATIVE TREATMENT OF ESOPHAGEAL CANCER
Authors: Schuring Nannet , Donlon NE , Hagens ERC , Donohoe CMD , van Berge Henegouwen MI , Reynolds JV , Gisbertz SS 
Published: September 2022

Abstract
To predict 5-year overall survival for esophageal cancer patients after neoadjuvant treatment followed by esophagectomy, recently a conditional survival nomogram was developed. This nomogram includes cN-stage, ypT-stage, ypN-stage, cardiac comorbidity, chyle leakage and pulmonary complications as independent predictors of survival. The aim of this study was to externally validate the conditional survival nomogram in a cohort of patients from another European high volume esophageal cancer center.
We included consecutive patients with a resectable (cT1-4a, N0–3, M0) adeno- or squamous cell esophageal carcinoma between January 2004 and January 2016 who received neoadjuvant treatment followed by an esophagectomy in a tertiary referral center for esophageal cancer. Standard prognostic factors and nomogram specific data were collected. The discriminative ability of the nomogram for the prediction of 5-year overall survival was quantified by Harrell’s C-statistics, directly after surgery and given survival for 1, 2, 3 and 4 years already survived. Calibration of the conditional survival nomogram was visualized by plotting actual 5 years survival against predicted probabilities.
296 patients were included. The median overall survival was 48.1 months (95%CI:37.5–58.7). The probability to achieve 5-year overall survival directly after surgery was 45% and increased to 57%, 68%, 78% and 89% for each additional year survived. Prediction of 5-year overall survival differed from the observed survival with a calibration slope of 0.54, 0.55, 0.59, 0.73 and 1.09, directly after surgery and given 1, 2, 3, and 4 years already survived, respectively. The discriminative ability of the nomogram for 5-year survival was moderate with a C-statistics of 0.65, compared to a value of 0.70 in the original study.
This study externally validated a model for conditional survival after neoadjuvant chemoradiotherapy and surgery for esophageal cancer. The proposed nomogram had a moderate predictive discrimination and accuracy for the derivation cohort, and therefore it should be updated for or used with caution in external cohorts for the prediction of conditional 5-year survival.
371. MAPPING OF LYMPH NODE METASTASIS IN ESOPHAGEAL SQUAMOUS CELL CARCINOMA AT ESOPHAGOGASTRIC JUNCTION: A RETROSPECTIVE SURGICAL STUDY COHORT
Authors: Jiang Chao , Liu Zhichao , Li Chunguang , Sun Yifeng , Guo Xufeng , Hua Rong , He Yi , Yang Yang , Zhang Jie , Wei Jinzhi , Li Zhigang 
Published: September 2022

Abstract
The aim of this study was to determine the optional extent of lymph node dissection of the squamous cell carcinoma (SCC) at the esophagogastric junction (EGJ) based on the incidence of metastasis in a retrospective single-center study.
Patients with SCC involving and within 5 cm of the esophagogastric junction (EGJ) who underwent McKeown esophagectomy without preoperative treatment were reviewed in a prospectively maintained database at a single institution from 2015 to 2021. Lymph nodes stations was based on the definitions from the Japan Esophageal Society, and lymph nodes were further classified according to the metastatic incidence rate, as follows: Category-1 (strongly recommended for dissection), rate of more than 10%; Category-2 (weakly recommended for dissection), rate of from 5% to 10%; and Category-3 (not recommended for dissection), rate of less than 5%.
Sixty-one patients were identified. T stage was pT1 (n = 9), pT2 (n = 11), pT3 (n = 40), and pT4 (n = 1). For all patients, category-1 nodes were predominantly abdominal stations (1, 2, 3, 7) and lower mediastinal stations (110); category-2 nodes were upper-middle mediastinal stations (105,106recR,107,108); station 106recL was category-3 with a metastasis rate of 4.92%. More nodal metastases were observed in cases with upper-margin exceeding EGJ &gt;3 cm, and station 106recL was upgraded to category-2. For pT1 SCC, category-1 was focused on station 111, with no nodal metastasis in upper-middle mediastinal. For pT2 and pT3 SCC, cervical, thoracic, and abdominal lymph node metastases were found.
Radical total mediastinal lymph node dissection is as important as abdominal dissection for SCC at EGJ, but lymph node dissection around the left recurrent laryngeal nerve appears to be exempt in T1 patients.
377. NEOADJUVANT CARBOPLATIN/PACLITAXEL VERSUS 5-FLUOROURACIL/CISPLATIN IN COMBINATION WITH RADIOTHERAPY FOR ESOPHAGEAL SQUAMOUS CELL CARCINOMA: A MULTICENTER COMPARATIVE STUDY
Authors: Gao Xing , Tsai PingChung , Chuang KaiHao , Pai ChuPin , Hsu PoKuei , Lee ShauHsuan , Lu HungI , van Lanschot Joseph Jan-Baptist , Chao YinKai 
Published: September 2022

Abstract
Treatment options for esophageal cancer (EC) have rapidly expanded from surgery alone to multimodal approaches comprising surgery, chemotherapy or radiotherapy. High-quality evidence from clinical trials indicated that both carboplatin/paclitaxel (CROSS) and cisplatin/5-fluorouracil (PF) regimens are significantly effective at improving survival. However, the most beneficial neoadjuvant chemoradiotherapy (nCRT) combination for esophageal squamous cell carcinoma (ESCC) in Asia still remains uncertain. In this study we compared neoadjuvant CROSS versus PF regimen in combination with 41.4-50.4Gy of radiotherapy.
Patients with ESCC were enrolled from three asian medical centers and stratified according to their nCRT regimen, i.e., CROSS+41.4-45Gy (CROSS) versus PF + 45Gy (PF4500) versus PF + 50.4Gy (PF5040). Propensity score analyses with stratification by inverse probability of treatment weighting (IPTW) was applied for nine baseline variables: gender, age, Charlson’s comorbidity index, clinical T and N stages, clinical stage, tumor length, tumor level and year of nCRT. Primary and secondary endpoints included overall survival (OS) and treatment-related complications. Compared to CROSS, patients who received PF regimens were expected to achieve comparable OS albeit more treatment-related complications.
Before IPTW, 334 patients were included (CROSS, n = 124 versus PF4500, n = 105 versus PF5040, n = 105). The lowest chemotherapy completion rate was observed in the PF5040 group (76.2% versus 89.4% in CROSS and 92% in the PF4500 group). Compared with CROSS, both PF groups showed more severe weight loss during nCRT and a higher frequency of post-esophagectomy anastomotic leaks. PF5040 had the significantly highest pCR rate (45.3%). CROSS conferred a significant OS benefit over PF4500 (hazard ratio [HR] =1.30, 95% CI = 1.05-1.62) and similar survival compared with PF5040 (HR = 1.17, 95% CI = 0.94-1.45). The same trends were found upon analysing recurrence free survival. (Figure).
Prior investigations reporting on the safety and efficacy of CROSS are mainly conducted in western populations, generally consisting adenocarcinoma, limiting the generalisability of these findings to Asian patients with ESCC. In our study, the CROSS regimen conferred a significant survival benefit over PF4500 and similar survival figures compared with PF5040. Considering the lower incidences of severe weight loss and post-esophagectomy anastomotic leaks, CROSS represents a safe and effective neoadjuvant treatment in Asian patients with ESCC.
379. ENLIGHTENMENT OF THE VENOUS ANATOMY OF THE ESOPHAGUS—AN ANOMALY CAPTURED UNDER MEDIASTINOSCOPY
Authors: Nakabayashi Rumi , Suzuki Akihiro , Yokoi Tadao , Miyachi Yosuke , Taketa Takashi , Matsubara Taketo , Shimada Gen , Kaido Toshimi 
Published: September 2022

Abstract
Distant organ metastasis often occurs early in the course of esophageal cancer development and is associated with a poor prognosis. The modes of metastasis include hematological and lymphatic routes. Although in the literature the venous outflow of the esophagus is described to occur through the esophageal vein into the azygous vein, which subsequently joins the superior vena cava, the detained anatomy of the venous and lymphatic systems of the esophagus remains to be further investigated.
We aimed to elucidate the regional anatomy of the venous system surrounding the esophagus via mediastinoscopic esophagectomy. Between January 2021 to January 2022, six patients with early esophageal cancer without apparent distant metastasis underwent minimally invasive esophagectomy and posterior mediastinal reconstruction with mediastinoscopy in our hospital. Detailed anatomy was captured and the spatial relationship between the esophageal vein and its draining vein was assessed intraoperatively and thoroughly reviewed postoperatively for any anomalies.
A venous anomaly was seen in one out of six patients where the esophageal vein drained into the left pulmonary vein rather than into the azygous vein. This anomaly was not detectable on the preoperative CT images. Hemostasis of the esophageal vein was achieved without major hemorrhage or injury to surrounding tissues. The esophageal specimen showed a localized ulcerative lesion in the midthoracic esophagus that was consistent with moderately differentiated squamous cell carcinoma, pT3N0M0 pStage IIB, with v1 and ly1 invasion. The patient will remain under surveillance for recurrence.
Direct venous drainage into the systemic circulation may attribute to its high rates of distant metastasis in esophageal cancer. This mechanism supports the higher prevalence of metastasis to the liver over the lung, and relatively high rates of bone and brain metastases. Close attention should be paid when performing esophagectomy as injuries to the esophageal vein and inadequate hemastasis may result in catastrophic bleeding when a direct connection with the systemic circulation is present.
380. UTILITY OF PET/CT FOR LYMPH NODE METASTASIS DETECTION IN PT1 EARLY ESOPHAGEAL SQUAMOUS CELL CARCINOMA
Authors: Xu Jia-qi , Lin Si-yun , Li Quan-Lin , Zhou Ping-Hong , Tan Li-Jie 
Published: September 2022

Abstract
Nodal staging for early esophageal squamous cell carcinoma (ESCC) was mandatory to decide therapy strategy. Utility of preoperative Positron Emission Tomography/Computed Tomography (PET/CT) for lymph node metastasis (LNM) detection in early ESCC was evaluated in the study.
186 consecutive patients with pathologically confirmed T1 tumors undergoing preoperative PET/CT at Zhongshan Hospital between 2015 August to 2020 December were retrospectively enrolled. Clinical characteristics and PET/CT results were collected and compared between patients with or without LNM. A PET integrated risk score model for prediction of LNM was established and validated. Survivals were compared between high risk group and low risk group by Log Rank test.
40 out of 186 patients were diagnosed with LNM on PET-CT. PET/CT alone for LNM detection was with a 53.3% sensitivity, 84.65% specificity, and 90.4% negative predictive value. Tumor size &gt;2.5 cm (P = 0.015), tumor depth (P = 0.012), LVI (P &lt; 0.001), differentiation (P = 0.066) and PET LN (+) (P &lt; 0.001) were included in the prediction model for LNM. The AUC of ROC in derivation cohort and validation cohort was 0.860 and 0.846 respectively. High risk group scoring &gt;3 points showed poorer 5-year recurrence free survival (62.6% VS. 74.7%, P = 0.046) and similar overall survival (87.6% VS. 86.9%, P = 0.942) as compared to low risk group.
PET/CT for LNM detection in early ESCC was of 53.3% sensitivity and 84.65% specificity. PET integrated risk score model for LNM was of fair property with 0.860 AUC and was predictive of recurrence.
382. PREDICTION OF ESOPHAGEAL SQUAMOUS CELL CARCINOMA (ESCC) RISK BY ASSESSING EPIGENETIC AND GENETIC FIELD DEFECTS
Authors: Kishino Takayoshi , Yakashita Satoshi , Lee Yi-Chia , Wu Ming-Shiang , Okano Keiichi , Ushijima Toshikazu 
Published: September 2022

Abstract
Field defects are important for human carcinogenesis. Such field defects are formed by accumulation of epigenetic and genetic alterations. Here, we aimed to predict cancer risk of ESCC by assessing epigenetic and genetic field defects.
First, we focused on epigenetic field defects. Genome-wide methylation analyses were performed using the esophageal mucosae, and methylation risk markers were isolated. Methylation levels of the isolated candidate genomic regions were measured by quantitative methylation-specific PCR (qMSP).
Second, we focused on genetic field defect. However, measurement of such point mutations has been very difficult in human DNA samples, because of their very low frequencies. We established a novel method to the such rare mutations at the 10–6 per bp level in non-cancerous mucosae: the 100-copy method.
Both epigenetic and genetic alterations were accumulated in a stepwise manner according to the risk level of the esophageal mucosae. The odds ratio to distinguish patients with ESCC (high-risk group) from healthy individuals exposed to risk factors, namely, alcohol drinking, betel quid chewing, and cigarette smoking (ABC) (intermediate-risk group), were 10.9 (AUC:0.787) by assessment of epigenetic alterations and 18.2 (AUC:0.791) by assessment of genetic alterations.
Integration of genetic and epigenetic markers could predict the ESCC risk more precisely [Yamashita, PNAS, 115:1328, 2018].
385. OUTCOME FOLLOWING MINIMAL INVASIVE VERSUS OPEN ESOPHAGECTOMY FOR ESOPHAGEAL CARCINOMA PATIENTS WITH LIVER CIRRHOSIS: A PROPENSITY SCORE-MATCHED ANALYSIS
Authors: Lin Yi-yu , Chiu Chien-Hung , Tsai Chun-Yi , Chao Yin-Kai 
Published: September 2022

Abstract
Although minimally invasive esophagectomy (MIE) has advanced into a safe and effective alternative to open esophagectomy (OE), its utility in cirrhotic esophageal cancer (EC) patients remained unknown. This study analyzed the perioperative outcomes of MIE for EC with LC compared with open esophagectomy (OE).
We retrospectively reviewed the clinical charts of patients treated with esophagectomy for EC who had a concomitant diagnosis of LC. Of the 74 patients identified from our records, 43 underwent MIE and 31 OE. The two treatment groups underwent propensity scores (PS) matching using a logistic model that included the following covariates: type of preoperative therapy, Charlson comorbidity index, Child-Pugh class, and elective versus emergency surgery.
Following PS matching, the MIE and OE groups consisted of 40 and 20 patients, respectively. Patients treated with MIE less frequently showed severe pneumonia (7.5% versus 30%, respectively, p = 0.049) and had a shorter length of stay (median: 16 versus 22 days, respectively, p = 0.009), albeit at the expense of a longer operating time (median: 465.5 versus 403 min, respectively, p = 0.015). Compared with OE, MIE was associated with a lower in-hospital mortality (25% versus 2.5%, respectively, p = 0.013). Moreover, MIE did not compromise the quality of resected specimens with similar R0 resection rate.
EC patients with LC showed more favorable mortality figures and lower rates of severe pneumonia after MIE compared with those who underwent OE. MIE may serve as a safe and feasible alternative for selected EC patients with LC.