bluuebunny/crossref_metadata_2025_split huggingface dataset:
Genomic landscape in small intestine cancer from real-world data (RWD) of clinical genomic testing.
Authors: Takeda Hiroyuki , Yamamoto Hiroyuki , Oikawa Ritsuko , Umemoto Kumiko , Doi Ayako , Horie Yoshiki , Mizukami Takuro , Ogura Takashi , Izawa Naoki , Moore Jay A. , Sokol Ethan , Sunakawa Yu 
Published: January 2022

642 Background: Panel-based comprehensive genomic profiling (CGP) is used in clinical practice worldwide, however, large aggregated RWD of patients with advanced small intestine cancer have not been characterized. In particular, there has been limited data regarding examining CGP in pediatric/ Adolescent and Young Adult (AYA) small intestine cancer. For patient subgroups, it is unclear what clinically relevant alterations co-occur. Here, we investigated the genomic landscape of small intestine cancer patients, stratified by sub-group to help refine and discover new targets for improved cancer therapies in advanced small intestine cancer. Methods: This is a collaborative biomarker study using RWD paired with CGP testing (Foundation Medicine, Inc.). Hybrid capture was carried out on up to 395 cancer-related genes and select introns from up to 31 genes frequently rearranged in cancer. One thousand three hundred sixty-four patients were available for analyses and were stratified by age (≥40/ < 40), MSI status, tumor mutational burden (TMB) status (High ≥10/Low < 10Muts/Mb), and select gene alterations. Using a chi-square test with Yate’s correction, frequencies of alterations were analyzed according to clinical or genomic background. Results: Genes with frequent alterations including mutation, amplification, and rearrangement/fusion were TP53 (59.8%), KRAS (54.8%), APC (27.7%), CDKN2A (22.4%), and SMAD4 (20.2%). Genomic profiling according to age, MSI, and TMB status is shown in the following table. In pediatric/AYA patients, frequency of APC alterations was significantly low ( P< 0.001). In KRAS mutated tumors, codon 12 most abundant mutations were G12D (31.1%) followed by G12V (22.3%), G12C (6.2%), and G12R (5.1%), while G13D (13.8%) was the predominant mutation in codon 13. In TMB-High tumors, which were detected in 12% of patients, the mutation rate of KRAS was modestly lower compared to TMB-Low tumors (42.3% vs. 53.3%). Frequent genes with amplification were MYC (6.7%), MDM2 (5.9%), GATA6 (5.5%), CCND1 (3.4%), FGF19 (3.3%), and ERBB2 (2.3%). The number of any gene amplification was lower in MSI-High compared to TMB-High population. Conclusions: RWD from clinical panel testing revealed the genomic landscape in small intestine cancer and differences in CGP according to clinical or genomic background. These findings would provide insight on the direction of the future development of the treatment in advanced small intestine cancer.[Table: see text]
Lower COVID-19 vaccination rates amongst Australians with gastrointestinal (GI) compared to other cancers.
Authors: Nguyen Mike , Bain Nathan , Grech Lisa , Hamad Nada , Chan Bryan Anthony , Blennerhassett Richard , Nott Louise M. , Harris Samuel J. , Chau Nguyen Minh Hieu , Underhill Craig , Williams Janne , Kwok Alastair , McCartney Amelia , Webber Kate , Day Daphne , Segelov Eva 
Published: January 2022

648 Background: People with cancer are at higher risk of serious illness and death from COVID-19 infection. We investigated the differences in COVID-19 vaccine uptake and attitudes in people with various solid organ and hematological malignancies. Methods: An online survey of adult patients with cancer attending eight health services across four states in Australia, was conducted from June to September 2021. Demographics, cancer history and vaccination status were recorded. Only completed surveys were analysed. Variables were compared with chi-squared and multivariable analysis using logistic regression. Vaccine hesitancy was assessed using the Oxford COVID-19 Vaccine Hesitancy Scale, the Oxford Vaccine Confidence and Complacency Scale, and the Monash Disease Vaccine Acceptance Scale. T-test analysis was used to examine relationships between the scales and groups. Results: There were 2997 evaluable responses; 53.2% female, 61.8% from metropolitan areas, 27.5% with metastatic solid organ disease and 50.6% on current anti-cancer treatment. Patients with GI cancers comprised 13.5% (n = 405), compared with hematological 28.4%, breast 24.6%, genitourinary 14.1% and other cancer types 19.4%. Vaccination rates were significantly lower for respondents with GI cancers compared to other cancer types (71.6% v 79.3%; p< 0.001). Significant differences in the GI cancer population compared to all others were: more males ( p < 0.001), lower level of education ( p= 0.001), fewer reporting English as first language ( p = 0.02) and shorter time since cancer diagnosis ( p < 0.001). These remained significant after logistic regression. Among GI cancer respondents, factors associated with being vaccinated compared to unvaccinated included: older age ( p < 0.001), higher education level ( p = 0.03) and English as first language ( p = 0.01). There was no significant difference in the scales measuring vaccine hesitancy, confidence and complacency, for the GI cancer population compared to other cancers. As expected, there were significant differences in all scales comparing vaccinated to unvaccinated respondents with GI cancers. Conclusions: In our large, contemporary survey, Australians with GI cancers report lower COVID-19 vaccine uptake compared with patients with other cancer types. We identified demographic and disease related characteristics that contribute to these differences. Interventions and targeted communication are required for people with GI cancers to maximise vaccination uptake in this medically vulnerable group.
HGCSG1902: Multicenter, prospective, observational study for patients with dysgeusia caused by chemotherapy for gastrointestinal cancer.
Authors: Ito Ken , Yuki Satoshi , Nakatsumi Hiroshi , Ando Takayuki , Sawada Kentaro , Yagisawa Masataka , Ishiguro Atsushi , Dazai Masayoshi , Iwanaga Ichiro , Hatanaka Kazuteru , Sato Atsushi , Matsumoto Ryusuke , Shindo Yoshiaki , Tateyama Miki , Muranaka Tetsuhito , Katagiri Masaki , Yokota Isao , Sakata Yuh , Sakamoto Naoya , Komatsu Yoshito 
Published: January 2022

649 Background: Dysgeusia is the one of important adverse events in patients treated with chemotherapy because it could reduce daily oral intake and worsen patient’s nutritional status. It is said that the lack of zinc is often observed in patients with chemotherapy because taste buds cells injured by chemotherapy require large amounts of zinc for their regeneration and cytotoxic agents have the possibility of working as a chelator for zinc. Some retrospective studies showed that zinc administration may improve dysgeusia in patients treated with chemotherapy, however, there is no prospective study. Therefore, we planned this study to clarify the effect of zinc therapy on dysgeusia in patients with gastrointestinal cancer. Methods: This was a multicenter, prospective observational study. From February 2020 to June 2021, patients with dysgeusia during chemotherapy for gastrointestinal cancer were enrolled from 17 institutes in Japan. The investigator selected one of the following treatment: no intervention (N), polaprezinc administration (P: contains 34.1mg of zinc par daily normal dose), or zinc acetate hydrate administration (Z: contains 50-100mg of zinc par daily normal dose). Serum zinc levels were measured at baseline, after 6 and 12 weeks, respectively. Dysgeusia was assessed by questionnaires according to four criteria, CTCAE v5.0, Subjective Total Taste Acuity (STTA), Visual Analogue Scale (VAS), and Chemotherapy-induced Taste Alteration Scale (CiTAS) at the time of enrollment and after 12 weeks. Results: A total of 180 patients, 60 in each group, were enrolled in the study. The mean serum zinc levels in each group at baseline were similar (67.3, 66.6, and 67.5μg/dl in N, P, Z group, respectively) and lower than lower limit of normal. The mean alterations of serum zinc level from baseline to after 12 weeks were -3.8, +14.3, and +46.6μg/dl in N, P, Z group, respectively. The STTA score was significantly improved in the P group compared to the N group at 12 weeks (p = 0.045), whereas it was not improved in the Z group (p = 0.945). The association between the alteration values of serum zinc level and improvement of dysgeusia was not observed. Conclusions: In this study, administration of polarezinc or zinc acetate hydrate increased serum zinc levels, but there was no significant correlation between the degree of serum zinc elevation and the improvement of dysgeusia. The STTA score was improved only in P group, thus our results suggest there are any factors for improvement of dysgeusia by polaprezinc administration other than serum zinc levels. Clinical trial information: UMIN000039653.
Making cancer care accessible: The practicality and value of a virtual gastrointestinal tumor board (VTB).
Authors: Agarwal Mohit Shiv , Ogden John R , Chiec Lauren , Shonkwiler Erin , Chaby Michael , Dempsey Naomi , Pishvaian Michael J. , Klempner Samuel J , Benson Al Bowen , Lieu Christopher Hanyoung , Jahanzeb Mohammad 
Published: January 2022

652 Background: Patients with cancer benefit from coordination with multiple subspecialties, often facilitated by discussion at a multidisciplinary tumor board. This enables collaboration on individualized patient plans and offers an opportunity for education. Regrettably, not all physicians have access to a multidisciplinary team, particularly those practicing outside of an academic setting or in underserved areas. Additionally, patients may want a second opinion but are limited by resources to travel to an academic center. A virtual tumor board could be a solution for these patients and physicians. Methods: Expert gastrointestinal (GI) oncology faculty in the US gathered via a virtual tumor board panel to discuss complex cases submitted by oncology providers and trainees. Panels consisted of a moderator and GI specialists from radiology, medical, surgical, and radiation oncology. The purposes of these panels were to test the feasibility of a virtual tumor board, provide expert opinions on complex cases, and create educational content. The panel’s recommendations were shared with the submitting providers within 48 hours and the recordings made available. Afterward, submitting physicians were surveyed to assess their satisfaction with the panel’s discussion and recommendations. Results: From March to June 2021, 4 GI virtual panels were conducted with 5 expert faculty discussing 44 patient scenarios from 14 providers; 12 providers (86%) submitted multiple cases. Surveys were sent to providers with a 50% response rate. Conclusions: Virtual tumor boards are feasible and lead to a high degree of satisfaction among the users. In this small cohort of responders, management of patients changed based on the panel’s recommendations, there was a perception that learning was improved, and the providers’ internal tumor boards’ recommendations were mostly included in the VTB discussion and expanded upon. Respondents felt that the service improved the care of patients and that they would submit future cases to this forum. Additional data from a larger cohort will be more helpful in understanding the impact of this endeavor.[Table: see text]
Validation of GIST nomogram performance from a statewide community cancer center.
Authors: Hitscherich Kyle Joseph , Garg Meera , Lozano Alicia J. , Hanlon Alexandra L. , Petrelli Nicholas J. , Bennett Joseph 
Published: January 2022

654 Background: Malignant behavior of Gastrointestinal Stromal Tumors (GISTs) can be predicted based on characteristics (size, location, etc.) which have been used to create risk calculators to anticipate recurrence. The most utilized nomogram (Gold et al 2009) was applied to a patient population from a statewide academic community-based cancer center to evaluate performance compared to that of Memorial Sloan Kettering (MSK), Mayo Clinic and National Spanish Registry (GEIS) populations. Methods: A retrospective review of all operative pathology reports for the past 14 years (January 2005 – May 2019) identified all patients diagnosed with GISTs. Patient demographics, pathology characteristics and recurrence free survival (RFS) was compiled. Those without recurrence or death were censored at the date of their last follow-up within hospital system. The nomogram prediction of RFS was estimated using methods described in the original text. Concordance probabilities for risk stratified quartiles were calculated based on nomogram scores to test performance of the nomogram against our Kaplan-Meier curve. Results: A total of 195 patients were treated for GISTs at our institution within the study timeline. The small majority were female (54%) with an average age of 64 years at presentation (21-90). Only one patient did not follow up within our system (n=194). The most prevalent tumor location was in the stomach (68%) and overall mitotic index was preferentially less than 5 mitosis per high power field (77%). Surgical margins negative of microscopic disease were obtained in 93% of resections. The average tumor size on final pathology was 3.4cm (0.2-29). Within our patient population, 16 (8%) developed recurrences with 1 patient deceased. Kaplan-Meier estimated RFS rates were 91% at 2 years and 88% at 5 years with a mean disease-free survival of 8.8 years (SE=0.2). Concordance probability of the nomogram with our data was found to be 0.82 (95% CI: 0.71-0.92), compared to concordance within the MSK (0.78), GEIS (0.76) and the Mayo Clinic (0.80) populations. Overall, the nomogram predicts a worse 2- and 5-year RFS particularly for the highest risk malignant GISTs (0.82 vs 0.38 and 0.76 vs. 0.21). Conclusions: The concordance of the predictive nomogram was similar in our population to other published series. However, the nomogram overpredicts recurrence rates for the highest risk quartile of GIST patients. Our patient population fared better than the nomogram predicted, in particular for the patients at highest risk of recurrence.[Table: see text]
Exploration of drug resistance in advanced gastrointestinal stromal tumor.
Authors: Xu Hao , Xu Zekuan , Xu Jianghao , Shao Yang 
Published: January 2022

662 Background: Gastrointestinal stromal tumors (GISTs) are prone to multi-drug resistance after drug treatment, but tissue samples from advanced patients with drug resistance are hard to obtain, impeding the study of the mechanism of drug resistance. In this study, plasma samples from TKI-resistant GIST patients were collected for next generation sequencing (NGS) to detect circulating tumor DNA (ctDNA), which were then used to generate mutation profiles leading to TKI resistance. Methods: A total of 82 GIST patients who acquired TKI resistance were enrolled from Apr. 2016 to Jun. 2021. Plasma ctDNA samples after drug resistance were collected for NGS analysis of 425 genes. Results: Among 82 patients, 54 received monotherapy with imatinib, 24 with 2 TKIs (21 with imatinib and subsequent sunitinib, 2 with imatinib subsequent regorafenib, and 1 with imatinib subsequent anlotinib), and 4 with 3 TKIs (imatinib subsequent sunitinib and regorafenib). Fifty patients (61%) were ctDNA-positive and their mutation profiles were further analyzed. Detection rate of ctDNA in imatinib-resistant patients was 57% (31/54). Among these 31 patients, 12 (39%) showed KIT gene mutation (8 with the known drug-resistant KIT mutations, 6 of these patients exhibited single-drug resistance while 2 showed multi-drug resistance due to KIT mutations mainly in Exon 13 V654A, Exons 17 Y823D, D820Y, N822Y, and N822K). The remaining 19/31 cases (61%) could be attributed to other gene mutations, with 47% due to cancer-associated mutations or other downstream signaling pathways (such as, cell cycle, TP53, RAS and PI3K). Among patients resistant to imatinib followed by other TKIs, ctDNA detection rate was 68% (19/28). Among these 19 patients, 10 (53%) showed KIT gene mutation (including 5 with the known drug-resistant KIT mutations, 4 of these patients exhibited single-drug resistance, while 1 showed multi-drug resistance due to mutations mainly in Exon 13 V654A, Exons 17 D820A, and D820G). The remaining 9/19 cases (47%) could be attributed to other gene mutations, with 44% due to cancer-associated mutations or other in downstream signaling pathways (such as Wnt, cell cycle, TP53, RAS and PI3K). Results indicated a growing trend of mutations leading to resistance among GIST patients treated with multiple TKIs (baseline vs. imatinib resistance vs. multiple TKIs resistance, 3.95% vs. 25.81% vs. 26.32%). Conclusions: Advanced GIST patients who received one or more TKI(s) may be resistant to single or multiple drugs due to complex mutations. NGS can be used to detect ctDNA without the need to obtain tumor tissue samples. This approach facilitates the monitoring of drug resistance in patients with advanced tumors, especially those with multiple metastases. NGS allows detection of mutations at multiple secondary sites and helps to overcome tumor heterogeneity, ctDNA-based NGS analysis will play an increasingly important role in assessment of drug resistance in GIST patients.
A feasibility study of leveraging the electronic health record to measure social determinants of health in patients with gastrointestinal cancer.
Authors: Hao Scarlett , Popowicz Patrycja , Iasiello Jack , Mejia Christopher , Wercholuk Ashley , Parikh Alexander A. , Snyder Rebecca A 
Published: January 2022

666 Background: Social determinants of health (SDOH) or circumstances influenced by a patient's neighborhood, social, political, and economic environment are not routinely assessed, and the prevalence and burden of individual SDOH needs among patients with cancer is not well-understood. The primary study aim was to evaluate feasibility of implementation of an electronic health record (EHR) instrument designed to measure SDOH into routine clinical practice. Methods: A prospective study was performed of all adult patients with gastrointestinal malignancy presenting to a regional cancer center for initial evaluation (11/2020-7/2021). An SDOH screening was administered by a nurse navigator or social worker or medical student using the EHR. Primary outcome measures included % eligible patients screened, median clinic visit time compared to historical control, and acceptability to the inter-professional care team. Secondary outcomes included the number of identified SDOH needs per patient and subsequent interventions. Results: Of 118 eligible patients, 113 (95.8%) were successfully screened for SDOH. Nearly half self-identified as Black (40.7%; n = 46) and the remainder White (58.4%; n = 66); 4.4% (n = 5) were uninsured and 17.7% (n = 20) Medicaid-insured. Median visit time was 97 minutes (95%CI 70-107) before implementation and 100 minutes after (95%CI 75-119; p = 0.95). Team members reported no significant clinic disruptions and were supportive of ongoing use. Most patients had 2-3 total needs with 1-2 moderate or 1-2 severe needs. In addition, 21 patients had 4 total needs and 13 patients had 5 or more needs. Most common severe needs included physical activity (n = 62), stress (n = 55), tobacco use (n = 23), and food insecurity (n = 9). Most common moderate needs included social connections (n = 76), tobacco use (n = 44), physical activity (n = 21), and financial strain (n = 12). Resources were offered to 20 patients (17.6%) to address SDOH needs. Conclusions: Routine collection of SDOH in an outpatient oncology setting using an EHR instrument is feasible and non-disruptive to workflow. Further investigation to determine if standardized SDOH assessment can improve cancer care delivery on an individual and population level is ongoing.
Evaluation of post-discharge deterioration following major gastrointestinal cancer surgery.
Authors: Joung Rachel H. , Li Ruojia D. , Chung Jeanette W. , Bentrem David J. , Yang Anthony D. , Bilimoria Karl Y. , Merkow Ryan P. 
Published: January 2022

667 Background: Clinical deterioration, defined as end-organ dysfunction following surgery, is a devastating, yet potentially preventable set of complications, usually occurring after an inciting event. The extent to which deterioration occurs post-discharge after major gastrointestinal cancer surgeries is unknown. Our objectives were to (1) evaluate the incidence of post-discharge deterioration (PDD), (2) characterize the events surrounding PDD, and (3) identify factors associated with PDD. Methods: Patients who underwent gastrointestinal resection for cancer were identified from the American College of Surgeons National Surgical Quality Improvement Program Participant Use Data File (2016-2019). Clinical deterioration was measured as a composite event consisting of respiratory failure, acute renal failure, cardiac arrest, or septic shock. Factors associated with PDD were evaluated using multivariable logistic regression. Results: Of 121,458 patients, 3,947 (3.3%) experienced clinical deterioration, with 19.1% occurring post-discharge. The median time to PDD from discharge was 8 days (IQR 4-13 days). Among patients who developed PDD, 58.9% had a previously diagnosed post-discharge complication, most commonly surgical site infection (38.2%), pneumonia (9.9%), and venous thromboembolism (5.4%). PDD was associated with older age, male sex, medical comorbidities, dependent functional status, longer operative time, transfusion, and discharge to a facility (all p < 0.05). Patients who underwent esophagectomy (OR 2.08 [95%CI, 1.39-3.10]) or pancreatectomy (OR 1.36 [95%CI, 1.07-1.74]) had significantly higher odds of developing PDD compared to patients who underwent colectomy. Conclusions: Post-discharge deterioration after major cancer surgeries commonly occurred after other potentially treatable post-discharge complications. Efforts should focus on improving post-discharge monitoring and timely and effective management of post-discharge complications to arrest their progression to post-discharge deterioration and mortality.